Global access to infertility care in developing countries: a case of human rights, equity and social justice.

PubMed

Ombelet, W

2011-01-01

According to WHO data more than 180 million couples in developing countries suffer from primary or secondary infertility. The social stigma of childlessness still leads to isolation and abandonment in many developing countries. Differences between the developed and developing world are emerging because of the different availability in infertility care and different socio-cultural value surrounding procreation and childlessness. Although reproductive health education and prevention of infertility are number one priorities, the need for accessible diagnostic procedures and new reproductive technologies (ART) is very high. The success and sustainability of ART in resource-poor settings will depend to a large extend on our ability to optimise these techniques in terms of availability, affordability and effectiveness. Accessible infertility treatment can only be successfully introduced in developing countries if socio-cultural and economic prerequisites are fulfilled and governments can be persuaded to support their introduction. We have to liaise with the relevant authorities to discuss the strengthening of infertility services, at the core of which lies the integration of infertility, contraceptive and maternal health services within public health care structures. After a fascinating period of more than 30 years of IVF, only a small part of the world population benefits from these new technologies. Time has come to give equitable access to effective and safe infertility care in resource-poor countries as well.

[The year 2000: one billion couples of child-bearing age].

PubMed

Lintong, L J

1988-04-01

Out of 1 billion couples there are only 124 million who use modern and effective contraceptives. World abortions number 33 million/year. 250 million sexually active women of child-bearing age in developing countries outside China do not use modern and effective contraceptives. Fertility control costs on the average US$2.5 billion a year in each developing country, 20% of which is assistance from developed countries. Expanding the family planning service to the 250 million sexually active child-bearing aged women costs an additional U.S. $5 billion yearly. A family planning accessibility survey was conducted by the Population Crisis Committee. PCC divided the countries into 2 categories: Developed and developing countries. The 110 countries (15 developed and 95 developing) covered 96% of the world population. The survey placed the countries in 5 classes according to accessibility levels: Excellent, good, fair, poor, very poor. The developed countries were analyzed according to effective contraceptive methods, service to the poor and minorities, sex education in the schools, and family planning information and advertisement. The developing countries were analyzed according to effective contraceptive methods, performance of service and distribution, public information and education, private sector participation, government finance and policies. Of the 15 developed countries, 43% were excellent, 22% good, 24% fair, and 2% poor. Of the 95 developing countries, 5 were excellent, 10 good, 16 fair, and 64 either poor or very poor countries in respect to family planning accessibility. In the face of a population explosion in the year 2000, many countries lack of government support for family planning programs. After 30 years of world effort in population control, half of the world population still has no effective family planning services.

Health-financing reforms in southeast Asia: challenges in achieving universal coverage.

PubMed

Tangcharoensathien, Viroj; Patcharanarumol, Walaiporn; Ir, Por; Aljunid, Syed Mohamed; Mukti, Ali Ghufron; Akkhavong, Kongsap; Banzon, Eduardo; Huong, Dang Boi; Thabrany, Hasbullah; Mills, Anne

2011-03-05

In this sixth paper of the Series, we review health-financing reforms in seven countries in southeast Asia that have sought to reduce dependence on out-of-pocket payments, increase pooled health finance, and expand service use as steps towards universal coverage. Laos and Cambodia, both resource-poor countries, have mostly relied on donor-supported health equity funds to reach the poor, and reliable funding and appropriate identification of the eligible poor are two major challenges for nationwide expansion. For Thailand, the Philippines, Indonesia, and Vietnam, social health insurance financed by payroll tax is commonly used for formal sector employees (excluding Malaysia), with varying outcomes in terms of financial protection. Alternative payment methods have different implications for provider behaviour and financial protection. Two alternative approaches for financial protection of the non-poor outside the formal sector have emerged-contributory arrangements and tax-financed schemes-with different abilities to achieve high population coverage rapidly. Fiscal space and mobilisation of payroll contributions are both important in accelerating financial protection. Expanding coverage of good-quality services and ensuring adequate human resources are also important to achieve universal coverage. As health-financing reform is complex, institutional capacity to generate evidence and inform policy is essential and should be strengthened. Copyright © 2011 Elsevier Ltd. All rights reserved.

Designing Targeted Educational Voucher Schemes for the Poor in Developing Countries

ERIC Educational Resources Information Center

Shafiq, M. Najeeb

2010-01-01

A targeted educational voucher scheme (TEVS) is often proposed for the poor in developing countries. Essentially, TEVS involves issuing vouchers to poor households, thus enabling them to pay tuition and fees for their children's schooling at participating non-public schools. However, little is known about TEVS' design in developing countries. This…

Rich Donors, Poor Countries

ERIC Educational Resources Information Center

Thomas, M. A.

2012-01-01

The shifting ideological winds of foreign aid donors have driven their policy towards governments in poor countries. Donors supported state-led development policies in poor countries from the 1940s to the 1970s; market and private-sector driven reforms during the 1980s and 1990s; and returned their attention to the state with an emphasis on…

Is globalization good for your health?

PubMed Central

Dollar, D.

2001-01-01

Four points are made about globalization and health. First, economic integration is a powerful force for raising the incomes of poor countries. In the past 20 years several large developing countries have opened up to trade and investment, and they are growing well--faster than the rich countries. Second, there is no tendency for income inequality to increase in countries that open up. The higher growth that accompanies globalization in developing countries generally benefits poor people. Since there is a large literature linking income of the poor to health status, we can be reasonably confident that globalization has indirect positive effects on nutrition, infant mortality and other health issues related to income. Third, economic integration can obviously have adverse health effects as well: the transmission of AIDS through migration and travel is a dramatic recent example. However, both relatively closed and relatively open developing countries have severe AIDS problems. The practical solution lies in health policies, not in policies on economic integration. Likewise, free trade in tobacco will lead to increased smoking unless health-motivated disincentives are put in place. Global integration requires supporting institutions and policies. Fourth, the international architecture can be improved so that it is more beneficial to poor countries. For example, with regard to intellectual property rights, it may be practical for pharmaceutical innovators to choose to have intellectual property rights in either rich country markets or poor country ones, but not both. In this way incentives could be strong for research on diseases in both rich and poor countries. PMID:11584730

Is globalization good for your health?

PubMed

Dollar, D

2001-01-01

Four points are made about globalization and health. First, economic integration is a powerful force for raising the incomes of poor countries. In the past 20 years several large developing countries have opened up to trade and investment, and they are growing well--faster than the rich countries. Second, there is no tendency for income inequality to increase in countries that open up. The higher growth that accompanies globalization in developing countries generally benefits poor people. Since there is a large literature linking income of the poor to health status, we can be reasonably confident that globalization has indirect positive effects on nutrition, infant mortality and other health issues related to income. Third, economic integration can obviously have adverse health effects as well: the transmission of AIDS through migration and travel is a dramatic recent example. However, both relatively closed and relatively open developing countries have severe AIDS problems. The practical solution lies in health policies, not in policies on economic integration. Likewise, free trade in tobacco will lead to increased smoking unless health-motivated disincentives are put in place. Global integration requires supporting institutions and policies. Fourth, the international architecture can be improved so that it is more beneficial to poor countries. For example, with regard to intellectual property rights, it may be practical for pharmaceutical innovators to choose to have intellectual property rights in either rich country markets or poor country ones, but not both. In this way incentives could be strong for research on diseases in both rich and poor countries.

The evolution of child health programmes in developing countries: from targeting diseases to targeting people.

PubMed Central

Claeson, M.; Waldman, R. J.

2000-01-01

Mortality rates among children and the absolute number of children dying annually in developing countries have declined considerably over the past few decades. However, the gains made have not been distributed evenly: childhood mortality remains higher among poorer people and the gap between rich and poor has grown. Several poor countries, and some poorer regions within countries, have experienced a levelling off of or even an increase in childhood mortality over the past few years. Until now, two types of programmes--short-term, disease-specific initiatives and more general programmes of primary health care--have contributed to the decline in mortality. Both types of programme can contribute substantially to the strengthening of health systems and in enabling households and communities to improve their health care. In order for them to do so, and in order to complete the unfinished agenda of improving child health globally, new strategies are needed. On the one hand, greater emphasis should be placed on promoting those household behaviours that are not dependent on the performance of health systems. On the other hand, more attention should be paid to interventions that affect health at other stages of the life cycle while efforts that have been made to develop interventions that can be used during childhood continue. PMID:11100618

Why health advocates must get involved in development economics: the case of the International Monetary Fund.

PubMed

Rowden, Rick

2010-01-01

International health advocates have traditionally focused on calling for external strategies for achieving health goals in developing countries, such as more foreign aid, foreign direct investment, loans, and debt cancellation, as opposed to internal approaches, such as building domestic productive capacity and accumulating capital. They have largely neglected questions of development economics, particularly the effectiveness, or lack thereof, of the currently dominant neoliberal development model promoted by the rich countries and aid agencies for poor countries. While critics have been correct to blame the International Monetary Fund for its policies curtailing public health spending in developing countries, their analysis generally neglects the underlying issue of why developing countries are seemingly unable to build their domestic tax base on which health budgets depend. International health advocates should engage with such macroeconomic questions and challenge the failures of the dominant neoliberal economic model that blocks countries from industrializing and building their own productive capacities with which to generate their own resources for financing their health budgets over time.

Combining employment and family in Europe: the role of family policies in health.

PubMed

Artazcoz, Lucía; Cortès, Imma; Puig-Barrachina, Vanessa; Benavides, Fernando G; Escribà-Agüir, Vicenta; Borrell, Carme

2014-08-01

The objectives of this study were: (i) to analyse the relationship between health status and paid working hours and household composition in the EU-27, and (ii) to examine whether patterns of association differ as a function of family policy typologies and gender. Cross-sectional study based on data from the 5th European Working Conditions Survey of 2010. The sample included married or cohabiting employees aged 25-64 years from the EU-27 (10,482 men and 8,882 women). The dependent variables were self-perceived health status and psychological well-being. Irrespective of differences in family policy typologies between countries, working long hours was more common among men, and part-time work was more common among women. In Continental and Southern European countries, employment and family demands were associated with poor health status in both sexes, but more consistently among women. In Anglo-Saxon countries, the association was mainly limited to men. Finally, in Nordic and Eastern European countries, employment and family demands were largely unassociated with poor health outcomes in both sexes. The combination of employment and family demands is largely unassociated with health status in countries with dual-earner family policy models, but is associated with poorer health outcomes in countries with market-oriented models, mainly among men. This association is more consistent among women in countries with traditional models, where males are the breadwinners and females are responsible for domestic and care work. © The Author 2013. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Physiotherapy beyond Our Borders: Investigating Ideal Competencies for Canadian Physiotherapists Working in Resource-Poor Countries

PubMed Central

Cassady, Christina; Meru, Rehana; Chan, Nga Man Carmen; Engelhardt, Julie; Fraser, Michelle

2014-01-01

ABSTRACT Purpose: To explore the perspectives of Canadian physiotherapists with global health experience on the ideal competencies for Canadian physiotherapists working in resource-poor countries. Method: A qualitative interpretive methodology was used, and the Essential Competency Profile for Physiotherapists in Canada, 2009 (ECP), was employed as a starting point for investigation and analysis. Semi-structured one-on-one interviews (60–90 minutes) were conducted with 17 Canadian physiotherapists who have worked in resource-poor countries. Descriptive and thematic analyses were conducted collaboratively. Results: The seven ECP roles—Expert, Communicator, Collaborator, Manager, Advocate, Scholarly Practitioner, and Professional—were all viewed as important for Canadian physiotherapists working in resource-poor countries. Two roles, Communicator and Manager, have additional competencies that participants felt were important. Three novel roles—Global Health Learner, Critical Thinker, and Respectful Guest—were created to describe other competencies related to global health deemed crucial by participants. Conclusions: This is the first study to examine competencies required by Canadian physiotherapists working in resource-poor countries. In addition to the ECP roles, supplementary competencies are recommended for engagement in resource-poor countries. These findings align with ideas in current global health and international development literature. Future research should examine the relevance of these findings to resource-poor settings within Canada. PMID:24719503

Explaining the Role of Proximate Determinants on Fertility Decline among Poor and Non-Poor in Asian Countries

PubMed Central

Majumder, Nabanita; Ram, Faujdar

2015-01-01

Objectives We examined the overall contributions of the poor and non-poor in fertility decline across the Asian countries. Further, we analyzed the direct and indirect factors that determine the reproductive behaviour of two distinct population sub-groups. Design Data from several new rounds of DHS surveys are available over the past few years. The DHS provides cross-nationally comparable and useful data on fertility, family planning, maternal and child health along with the other information. Six selected Asian countries namely: Bangladesh, India, Indonesia, Nepal, Philippines, and Vietnam are considered for the purpose of the study. Three rounds of DHS surveys for each country (except Vietnam) are considered in the present study. Methods Economic status is measured by computing a “wealth index”, i.e. a composite indicator constructed by aggregating data on asset ownership and housing characteristics using principal components analysis (PCA). Computed household wealth index has been broken into three equal parts (33.3 percent each) and the lowest and the highest 33.3 percent is considered as poor and non-poor respectively. The Bongaarts model was employed to quantify the contribution of each of the proximate determinants of fertility among poor and non-poor women. Results Fertility reduction across all population subgroups is now an established fact despite the diversity in the level of socio-economic development in Asian countries. It is clear from the analysis that fertility has declined irrespective of economic status at varying degrees within and across the countries which can be attributed to the increasing level of contraceptive use especially among poor women. Over the period of time changing marriage pattern and induced abortion are playing an important role in reducing fertility among poor women. Conclusions Fertility decline among majority of the poor women across the Asian countries is accompanied by high prevalence of contraceptive use followed by changing marriage pattern and induced abortion. PMID:25689843

Health, Well-Being and Energy Poverty in Europe: A Comparative Study of 32 European Countries.

PubMed

Thomson, Harriet; Snell, Carolyn; Bouzarovski, Stefan

2017-05-31

Despite growing pan-European interest in and awareness of the wide-ranging health and well-being impacts of energy poverty-which is characterised by an inability to secure adequate levels of energy services in the home-the knowledge base is largely British-centric and dominated by single-country studies. In response, this paper investigates the relationship between energy poverty, health and well-being across 32 European countries, using 2012 data from the European Quality of Life Survey. We find an uneven concentration of energy poverty, poor health, and poor well-being across Europe, with Eastern and Central Europe worst affected. At the intersection of energy poverty and health, there is a higher incidence of poor health (both physical and mental) amongst the energy poor populations of most countries, compared to non-energy poor households. Interestingly, we find the largest disparities in health and well-being levels between energy poor and non-energy poor households occur within relatively equal societies, such as Sweden and Slovenia. As well as the unique challenges brought about by rapidly changing energy landscapes in these countries, we also suggest the relative deprivation theory and processes of social comparison hold some value in explaining these findings.

An intervention to stop smoking among patients suspected of TB - evaluation of an integrated approach

PubMed Central

2010-01-01

Background In many low- and middle-income countries, where tobacco use is common, tuberculosis is also a major problem. Tobacco use increases the risk of developing tuberculosis, secondary mortality, poor treatment compliance and relapses. In countries with TB epidemic, even a modest relative risk leads to a significant attributable risk. Treating tobacco dependence, therefore, is likely to have benefits for controlling tuberculosis in addition to reducing the non-communicable disease burden associated with smoking. In poorly resourced health systems which face a dual burden of disease secondary to tuberculosis and tobacco, an integrated approach to tackle tobacco dependence in TB control could be economically desirable. During TB screening, health professionals come across large numbers of patients with respiratory symptoms, a significant proportion of which are likely to be tobacco users. These clinical encounters, considered to be "teachable moments", provide a window of opportunity to offer treatment for tobacco dependence. Methods/Design We aim to develop and trial a complex intervention to reduce tobacco dependence among TB suspects based on the WHO 'five steps to quit' model. This model relies on assessing personal motivation to quit tobacco use and uses it as the basis for assessing suitability for the different therapeutic options for tobacco dependence. We will use the Medical Research Council framework approach for evaluating complex interventions to: (a) design an evidence-based treatment package (likely to consist of training materials for health professionals and education tools for patients); (b) pilot the package to determine the delivery modalities in TB programme (c) assess the incremental cost-effectiveness of the package compared to usual care using a cluster RCT design; (d) to determine barriers and drivers to the provision of treatment of tobacco dependence within TB programmes; and (e) support long term implementation. The main outcomes to assess the effectiveness would be point abstinence at 4 weeks and continuous abstinence up to 6 months. Discussion This work will be carried out in Pakistan and is expected to have relevance for other low and middle income countries with high tobacco use and TB incidence. This will enhance our knowledge of the cost-effectiveness of treating tobacco dependence in patients suspected of TB. Trial Registration Trial Registration Number: ISRCTN08829879 PMID:20338041

Urbanization and health in developing countries.

PubMed

Harpham, T; Stephens, C

1991-01-01

In developing countries the level of urbanization is expected to increase to 39.5% by the end of this century and to 56.9% by 2025. The number of people living in slums and shanty towns represent about one-third of the people living in cities in developing countries. This article focuses upon these poor urban populations and comments upon their lifestyle and their exposure to hazardous environmental conditions which are associated with particular patterns of morbidity and mortality. The concept of marginality has been used to describe the lifestyle of the urban poor in developing countries. This concept is critically examined and it is argued that any concept of the urban poor in developing countries being socially, economically or politically marginal is a myth. However, it can certainly be claimed that in health terms the urban poor are marginal as demonstrated by some of the studies reviewed in this article. Most studies of the health of the urban poor in developing countries concentrate on the environmental conditions in which they live. The environmental conditions of the urban poor are one of the main hazards of the lifestyle of poor urban residents. However, other aspects of their way of life, or lifestyle, have implications for their health. Issues such as smoking, diet, alcohol and drug abuse, and exposure to occupational hazards, have received much less attention in the literature and there is an urgent need for more research in these areas.

Desperately seeking targets: the ethics of routine HIV testing in low-income countries.

PubMed Central

Rennie, Stuart; Behets, Frieda

2006-01-01

The human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) pandemic, and responses to it, have exposed clear political, social and economic inequities between and within nations. The most striking manifestations of this inequity is access to AIDS treatment. In affluent nations, antiretroviral treatment is becoming the standard of care for those with AIDS, while the same treatment is currently only available for a privileged few in most resource-poor countries. Patients without sufficient financial and social capital -- i.e., most people with AIDS -- die each day by the thousands. Recent AIDS treatment initiatives such as the UNAIDS and WHO "3 by 5" programme aim to rectify this symptom of global injustice. However, the success of these initiatives depends on the identification of people in need of treatment through a rapid and massive scale-up of HIV testing. In this paper, we briefly explore key ethical challenges raised by the acceleration of HIV testing in resource-poor countries, focusing on the 2004 policy of routine ("opt-out") HIV testing recommended by UNAIDS and WHO. We suggest that in settings marked by poverty, weak health-care and civil society infrastructures, gender inequalities, and persistent stigmatization of people with HIV/AIDS, opt-out HIV-testing policies may become disconnected from the human rights ideals that first motivated calls for universal access to AIDS treatment. We leave open the ethical question of whether opt-out policies should be implemented, but we recommend that whenever routine HIV-testing policies are introduced in resource-poor countries, that their effect on individuals and communities should be the subject of empirical research, human-rights monitoring and ethical scrutiny. PMID:16501715

Country of birth, parental background and self-rated health among adolescents: a population-based study.

PubMed

Lindström, Martin; Modén, Birgit; Rosvall, Maria

2014-12-01

The aim of this study was to investigate differences according to country of birth and parental country of birth, in relation to poor self-rated health (SRH), in Swedish adolescents. The Scania public health survey among children and adolescents, conducted in 2012, is a cross-sectional study including most pupils in grade 9 (15 years old), including in 32 of 33 municipalities. The participation rate was 83% (9,791 of 11,735). We performed logistic regressions to investigate the association between the students' country of birth, parental country of birth and poor SRH. Boys born outside Europe had an odds ratio (OR) 2.1 (1.6-2.8) of poor SRH in the unadjusted model, which was reduced to 0.7 (0.4-1.3) in the multiple model, as compared to boys born in Sweden with both or one parent born in Sweden. Boys born in Europe had an OR 0.4 (0.2-0.9) of poor SRH, after multiple adjustments. Girls born in Sweden with both parents born abroad, and girls born outside of Europe had significantly lower ORs of poor SRH in the multiple model. In particular, adjustment for socio-demographic and psychosocial factors reduced the ORs of poor SRH among boys, but did so to a lesser extent among girls. Differences in socio-demographic and psychosocial factors explained the higher odds of poor SRH among boys born outside of Europe. Girls born in Sweden with both parents born abroad, and girls born outside Europe, had significantly lower ORs of poor SRH. Our results indicate that there are gender differences in the factors behind poor self-rated health, according to the country-related background of adolescents in Sweden. © 2014 the Nordic Societies of Public Health.

Measuring the bias against low-income country research: an Implicit Association Test.

PubMed

Harris, Matthew; Macinko, James; Jimenez, Geronimo; Mullachery, Pricila

2017-11-06

With an increasing array of innovations and research emerging from low-income countries there is a growing recognition that even high-income countries could learn from these contexts. It is well known that the source of a product influences perception of that product, but little research has examined whether this applies also in evidence-based medicine and decision-making. In order to examine likely barriers to learning from low-income countries, this study uses established methods in cognitive psychology to explore whether healthcare professionals and researchers implicitly associate good research with rich countries more so than with poor countries. Computer-based Implicit Association Test (IAT) distributed to healthcare professionals and researchers. Stimuli representing Rich Countries were chosen from OECD members in the top ten (>$36,000 per capita) World Bank rankings and Poor Countries were chosen from the bottom thirty (<$1000 per capita) countries by GDP per capita, in both cases giving attention to regional representation. Stimuli representing Research were descriptors of the motivation (objective/biased), value (useful/worthless), clarity (precise/vague), process (transparent/dishonest), and trustworthiness (credible/unreliable) of research. IAT results are presented as a Cohen's d statistic. Quantile regression was used to assess the contribution of covariates (e.g. age, sex, country of origin) to different values of IAT responses that correspond to different levels of implicit bias. Poisson regression was used to model dichotomized responses to the explicit bias item. Three hundred twenty one tests were completed in a four-week period between March and April 2015. The mean Implicit Association Test result (a standardized mean relative latency between congruent and non-congruent categories) for the sample was 0.57 (95% CI 0.52 to 0.61) indicating that on average our sample exhibited moderately strong implicit associations between Rich Countries and Good Research. People over 40 years of age were less likely to exhibit pro-poor implicit associations, and being a peer reviewer contributes to a more pro-poor association. The majority of our participants associate Good Research with Rich Countries, compared to Poor Countries. Implicit associations such as these might disfavor research from poor countries in research evaluation, evidence-based medicine and diffusion of innovations.

Poverty and access to health care in developing countries.

PubMed

Peters, David H; Garg, Anu; Bloom, Gerry; Walker, Damian G; Brieger, William R; Rahman, M Hafizur

2008-01-01

People in poor countries tend to have less access to health services than those in better-off countries, and within countries, the poor have less access to health services. This article documents disparities in access to health services in low- and middle-income countries (LMICs), using a framework incorporating quality, geographic accessibility, availability, financial accessibility, and acceptability of services. Whereas the poor in LMICs are consistently at a disadvantage in each of the dimensions of access and their determinants, this need not be the case. Many different approaches are shown to improve access to the poor, using targeted or universal approaches, engaging government, nongovernmental, or commercial organizations, and pursuing a wide variety of strategies to finance and organize services. Key ingredients of success include concerted efforts to reach the poor, engaging communities and disadvantaged people, encouraging local adaptation, and careful monitoring of effects on the poor. Yet governments in LMICs rarely focus on the poor in their policies or the implementation or monitoring of health service strategies. There are also new innovations in financing, delivery, and regulation of health services that hold promise for improving access to the poor, such as the use of health equity funds, conditional cash transfers, and coproduction and regulation of health services. The challenge remains to find ways to ensure that vulnerable populations have a say in how strategies are developed, implemented, and accounted for in ways that demonstrate improvements in access by the poor.

Health, Well-Being and Energy Poverty in Europe: A Comparative Study of 32 European Countries

PubMed Central

Thomson, Harriet; Snell, Carolyn; Bouzarovski, Stefan

2017-01-01

Despite growing pan-European interest in and awareness of the wide-ranging health and well-being impacts of energy poverty—which is characterised by an inability to secure adequate levels of energy services in the home—the knowledge base is largely British-centric and dominated by single-country studies. In response, this paper investigates the relationship between energy poverty, health and well-being across 32 European countries, using 2012 data from the European Quality of Life Survey. We find an uneven concentration of energy poverty, poor health, and poor well-being across Europe, with Eastern and Central Europe worst affected. At the intersection of energy poverty and health, there is a higher incidence of poor health (both physical and mental) amongst the energy poor populations of most countries, compared to non-energy poor households. Interestingly, we find the largest disparities in health and well-being levels between energy poor and non-energy poor households occur within relatively equal societies, such as Sweden and Slovenia. As well as the unique challenges brought about by rapidly changing energy landscapes in these countries, we also suggest the relative deprivation theory and processes of social comparison hold some value in explaining these findings. PMID:28561767

The Primary Care Physician Workforce: Ethical and Policy Implications

PubMed Central

Starfield, Barbara; Fryer, George E.

2007-01-01

PURPOSE We undertook a study to examine the characteristics of countries exporting physicians to the United States according to their relative contribution to the primary care supply in the United States. METHODS We used data from the World Health Organization and from the American Medical Association Physician Masterfile to gather sociodemographic, health system, and health characteristics of countries and the number of international medical graduates (IMGs) for the countries, according to the specialty of their practice in the United States. RESULTS Countries whose medical school graduates added a relatively greater percentage of the primary care physicians than the overall percentage of primary care physicians in the United States (31%) were poor countries with relatively extreme physician shortages, high infant mortality rates, lower life expectancies, and lower immunization rates than countries contributing relatively more specialists to the US physician workforce. CONCLUSION The United States disproportionately uses graduates of foreign medical schools from the poorest and most deprived countries to maintain its primary care physician supply. The ethical aspects of depending on foreign medical graduates is an important issue, especially when it deprives disadvantaged countries of their graduates to buttress a declining US primary care physician supply. PMID:18025485

The Case for Research in Pure Physics in Developing Countries

NASA Astrophysics Data System (ADS)

Mweene, H. V.

Science and technology are the keys to modern economic development. But, it has often been argued that poor countries cannot really afford to support research, or that they should at most devote their efforts to applied science only. The scientific knowledge necessary for development would then be partly or wholly obtained from other countries. In this paper, the case will be argued that developing countries cannot afford to leave research, both pure and applied, to the developed countries and that the only way the developing world is going to solve its problems is through development driven by their own research activities. With reference to physics, the importance of research by researchers in poor countries is explained. Lastly, it is outlined how the logistics of doing research under the difficult conditions prevailing in poor countries can be managed.

Poverty and health sector inequalities.

PubMed Central

Wagstaff, Adam

2002-01-01

Poverty and ill-health are intertwined. Poor countries tend to have worse health outcomes than better-off countries. Within countries, poor people have worse health outcomes than better-off people. This association reflects causality running in both directions: poverty breeds ill-health, and ill-health keeps poor people poor. The evidence on inequalities in health between the poor and non-poor and on the consequences for impoverishment and income inequality associated with health care expenses is discussed in this article. An outline is given of what is known about the causes of inequalities and about the effectiveness of policies intended to combat them. It is argued that too little is known about the impacts of such policies, notwithstanding a wealth of measurement techniques and considerable evidence on the extent and causes of inequalities. PMID:11953787

Regulatory environment and claims - limits and opportunities.

PubMed

Martin, Ambroise

2010-01-01

During the past decade, the use of claims became more and more important in many countries in relation to the increased awareness of consumer about the link between foods and health, offering to industry a valuable opportunity to differentiate and valorize their products and to promote innovation. However, more and more stringent regulations are developed, all based on the general principles adopted by the Codex Alimentarius Commission. In addition to the different regulatory processes and administrative requirements according to the country, the high level (and cost) of scientific substantiation of claims, the constraints introduced by nutrient profiles and the poor knowledge of the impact on consumer depending on the cultural contexts may limit these opportunities or, at least complicate their use. All these issues are briefly analyzed, highlighting some striking convergences and differences between countries. Copyright © 2010 S. Karger AG, Basel.

Poverty Alleviation: Insights and Strategies.

ERIC Educational Resources Information Center

Sharma, Motilal

The development theory for progress in the countries of the Third World must be based on the aspirations of the common people; the majority poor. The poor cannot simply be provided with resources; they must also be psychologically, socially, and economically empowered. The most important conflict in poor countries is between urban and rural…

A balancing act? Work-life balance, health and well-being in European welfare states.

PubMed

Lunau, Thorsten; Bambra, Clare; Eikemo, Terje A; van der Wel, Kjetil A; Dragano, Nico

2014-06-01

Recent analyses have shown that adverse psychosocial working conditions, such as job strain and effort-reward imbalance, vary by country and welfare state regimes. Another work-related factor with potential impact on health is a poor work-life balance. The aims of this study are to determine the association between a poor work-life balance and poor health across a variety of European countries and to explore the variation of work-life balance between European countries. Data from the 2010 European Working Conditions Survey were used with 24,096 employees in 27 European countries. Work-life balance is measured with a question on the fit between working hours and family or social commitments. The WHO-5 well-being index and self-rated general health are used as health indicators. Logistic multilevel models were calculated to assess the association between work-life balance and health indicators and to explore the between-country variation of a poor work-life balance. Employees reporting a poor work-life balance reported more health problems (Poor well-being: OR = 2.06, 95% CI = 1.83-2.31; Poor self-rated health: OR = 2.00, 95% CI = 1.84-2.17). The associations were very similar for men and women. A considerable part of the between-country variation of work-life balance is explained by working hours, working time regulations and welfare state regimes. The best overall work-life balance is reported by Scandinavian men and women. This study provides some evidence on the public health impact of a poor work-life balance and that working time regulations and welfare state characteristics can influence the work-life balance of employees. © The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Transmission of Hepatitis E Virus in Developing Countries

PubMed Central

Khuroo, Mohammad S.; Khuroo, Mehnaaz S.; Khuroo, Naira S.

2016-01-01

Hepatitis E virus (HEV), an RNA virus of the Hepeviridae family, has marked heterogeneity. While all five HEV genotypes can cause human infections, genotypes HEV-1 and -2 infect humans alone, genotypes HEV-3 and -4 primarily infect pigs, boars and deer, and genotype HEV-7 primarily infects dromedaries. The global distribution of HEV has distinct epidemiological patterns based on ecology and socioeconomic factors. In resource-poor countries, disease presents as large-scale waterborne epidemics, and few epidemics have spread through person-to-person contact; however, endemic diseases within these countries can potentially spread through person-to-person contact or fecally contaminated water and foods. Vertical transmission of HEV from infected mother to fetus causes high fetal and perinatal mortality. Other means of transmission, such as zoonotic transmission, can fluctuate depending upon the region and strain of the virus. For instance, zoonotic transmission can sometimes play an insignificant role in human infections, such as in India, where human and pig HEV infections are unrelated. However, recently China and Southeast Asia have experienced a zoonotic spread of HEV-4 from pigs to humans and this has become the dominant mode of transmission of hepatitis E in eastern China. Zoonotic HEV infections in humans occur by eating undercooked pig flesh, raw liver, and sausages; through vocational contact; or via pig slurry, which leads to environmental contamination of agricultural products and seafood. Lastly, blood transfusion-associated HEV infections occur in many countries and screening of donors for HEV RNA is currently under serious consideration. To summarize, HEV genotypes 1 and 2 cause epidemic and endemic diseases in resource poor countries, primarily spreading through contaminated drinking water. HEV genotypes 3 and 4 on the other hand, cause autochthonous infections in developed, and many developing countries, by means of a unique zoonotic food-borne transmission. PMID:27657112

JPRS Report, Near East & South Asia, Pakistan

DTIC Science & Technology

1991-09-18

Press delegation last week, India earlier this year by an important Major-General of could not take care of the poor at the bottom of society. the PLA...developing coun- want China to sell missiles in particular or other military tries." He said: "All countries, big or small, rich or poor ,equipment, to...country. country will suffer endlessly for no fault of its poor masses. It is a fact, nevertheless, that as a people we have been Politicians Focused on

Recruiting medical students into psychiatry in lower income countries.

PubMed

Nortje, Gareth; Seedat, Soraya

2013-08-01

There is a serious shortage of psychiatrists and poor recruitment of new psychiatry trainees worldwide. Low and middle income countries suffer disproportionately on many accounts. A negative attitude towards psychiatry is thought to contribute to poor recruitment of psychiatry trainees. Previous reviews have focused on the attitudes of medical students in high income countries, but factors relevant to attitude and recruitment may be different in lower income countries. Here we review studies of medical students' attitudes towards psychiatry from low and lower-middle income countries, summarize key themes which negatively influence attitudes, and suggest strategies for overcoming them. Major themes include stigma, perceived status of psychiatry, lack of psychiatric trainers, local cultural beliefs, poor working conditions, and quality of patient care.

Assessing dementia in resource-poor regions.

PubMed

Maestre, Gladys E

2012-10-01

The numbers and proportions of elderly are increasing rapidly in developing countries, where prevalence of dementia is often high. Providing cost-effective services for dementia sufferers and their caregivers in these resource-poor regions poses numerous challenges; developing resources for diagnosis must be the first step. Capacity building for diagnosis involves training and education of healthcare providers, as well as the general public, development of infrastructure, and resolution of economic and ethical issues. Recent progress in some low-to-middle-income countries (LMICs) provides evidence that partnerships between wealthy and resource-poor countries, and between developing countries, can improve diagnostic capabilities. Without the involvement of the mental health community of developed countries in such capacity-building programs, dementia in the developing world is a disaster waiting to happen.

Why restrictions on the immigration of health workers are unjust.

PubMed

Hidalgo, Javier

2014-12-01

Some bioethicists and political philosophers argue that rich states should restrict the immigration of health workers from poor countries in order to prevent harm to people in these countries. In this essay, I argue that restrictions on the immigration of health workers are unjust, even if this immigration results in bad health outcomes for people in poor countries. I contend that negative duties to refrain from interfering with the occupational liberties of health workers outweighs rich states' positive duties to prevent harm to people in sending countries. Furthermore, I defend this claim against the objection that health workers in poor countries acquire special duties to their compatriots that render them liable to coercive interference. © 2012 John Wiley & Sons Ltd.

Rickets–vitamin D deficiency and dependency

PubMed Central

Sahay, Manisha; Sahay, Rakesh

2012-01-01

Rickets is an important problem even in countries with adequate sun exposure. The causes of rickets/osteomalacia are varied and include nutritional deficiency, especially poor dietary intake of vitamin D and calcium. Non-nutritional causes include hypophosphatemic rickets primarily due to renal phosphate losses and rickets due to renal tubular acidosis. In addition, some varieties are due to inherited defects in vitamin D metabolism and are called vitamin D dependent rickets. This chapter highlights rickets/osteomalacia related to vitamin D deficiency or to inherited defects in vitamin D metabolism. Hypophosphatemic rickets and rickets due to renal tubular acidosis are discussed in other sections of the journal. PMID:22470851

Barriers to rural households' participation in low-skilled off-farm labor markets: theory and empirical results from northern Ethiopia.

PubMed

Bhatta, Bharat P; Arethun, Torbjørn

2013-12-01

Promotion of low-skilled off-farm rural labor market participation can be an important strategy to improve livelihoods and food security of the poor in developing countries. This paper investigates rural farm households' participation in low-skilled off-farm labor markets with disaggregate data from a survey of 400 households in Tigray, the northern highlands of Ethiopia. Adopting Heckman's two stage approach, we examined households' decisions to participate or not in markets by probit model in the first stage and level of participation by ordinary least squares procedures in the second stage. The results show that households' decision to enter into a labor market significantly depends on the characteristics of the households such as sex, age of the household heads and labor endowments in the households. Similarly, the level of participation in labor markets measured by the amount of off-farm wage income depends on labor endowments in the households and the place where the households are located. Since cash constrained rural households do not find themselves advantageous to participate in off-farm labor markets, the reduction of cash constraint is the major policy implication of the paper. This holds true in general for all cash constrained rural households in developing countries. Similarly, the empirical results in the paper suggest removal of locational barriers to access labor markets. This helps them to earn off-farm income. It is necessary to eliminate (or at least reduce) obstacles for rural households to enter into a market of off-farm wage earning activities. This holds true in general for all rural households in developing countries. This paper is therefore expected to contribute to frame appropriate policy that promotes participation in low-skilled off-farm rural labor markets in developing countries where many rural households are not only poor but also low-skilled.

Treatment Nonadherence in Inflammatory Bowel Disease: Identification, Scope, and Management Strategies.

PubMed

Herman, Margot L; Kane, Sunanda V

2015-12-01

Treatment adherence is of critical importance in the management of patients with IBD. Poor adherence can lead to increased disease activity, loss of response to therapy, and increased costs of care. It has been well established that adherence to long-term therapy for chronic illnesses is extremely poor, averaging around 50% in developed countries. Measured rates of nonadherence in IBD are similar, but vary depending on the type of therapy and the population being observed. This article reviews the scientific data on treatment nonadherence in IBD. The methods commonly used to evaluate treatment adherence investigation are reviewed. The consequences and scope of treatment nonadherence are summarized. Finally, the scientific data on management strategies to address the problem of treatment nonadherence are explored.

How Effective Have Thirty Years of Internationally Driven Conservation and Development Efforts Been in Madagascar?

PubMed

Waeber, Patrick O; Wilmé, Lucienne; Mercier, Jean-Roger; Camara, Christian; Lowry, Porter P

2016-01-01

Conservation and development are intricately linked. The international donor community has long provided aid to tropical countries in an effort to alleviate poverty and conserve biodiversity. While hundreds of millions of $ have been invested in over 500 environmental-based projects in Madagascar during the period covered by a series of National Environmental Action Plans (1993-2008) and the protected areas network has expanded threefold, deforestation remains unchecked and none of the eight Millennium Development Goals (MDGs) established for 2000-2015 were likely be met. Efforts to achieve sustainable development had failed to reduce poverty or deliver progress toward any of the MDGs. Cross-sectorial policy adjustments are needed that (i) enable and catalyze Madagascar's capacities rather than deepening dependency on external actors such as the World Bank, the International Monetary Fund and donor countries, and that (ii) deliver improvements to the livelihoods and wellbeing of the country's rural poor.

Health and the 2008 Economic Recession: Evidence from the United Kingdom

PubMed Central

Astell-Burt, Thomas; Feng, Xiaoqi

2013-01-01

Introduction The economic recession which began in 2008 has resulted in a substantial increase in unemployment across many countries, including the United Kingdom. Strong association between unemployment and poor health status among individuals is widely recognised. We investigated whether the prevalence of poor health at a population level increased concurrent to the rise in unemployment during the economic recession, and whether the impact on health varied by geographical and socioeconomic circumstances. Method Health, demographic and socioeconomic measures on 1.36 million survey responses aged 16–64 were extracted from the Quarterly Labour Force Survey of the United Kingdom, collected every three months, from January 2006 to December 2010. The likelihood of self-reporting poor health status and specific types of health problems (depression, mental illness, cardiovascular and respiratory) across time were estimated separately using logistic regression. Explanatory variables included economic status (International Labour Organization definition), occupational class, age, gender, country of birth, ethnicity, educational qualifications, couple status, household tenure, number of dependents, and geographical region. Results Unemployment (age-gender adjusted) rose from 4.5% in January 2008 to 7.1% by September 2009. The reporting of poor health status increased from 25.7% in July 2009 to 29.5% by December 2010. Similar increases were found for cardiovascular and respiratory health problems; not depression or mental illness. The prevalence of poor health status among the unemployed decreased from 28.8% in July 2008, to 24.9% by March 2009; but this was followed by an increase in poor health experienced across all regions and by all socioeconomic groups, including those who remained employed, regardless of their occupational class. Interpretation Although our study found no exacerbation of pre-recession health inequalities, the rise in poor health status not only for the unemployed, but also among people who remained employed, regardless of their occupational class, justifies concern voiced among many public health commentators. PMID:23437208

Safer Muslim motherhood: Social conditions and maternal mortality in the Muslim world.

PubMed

Liese, Kylea Laina; Maeder, Angela B

2018-05-01

The greatest variation in maternal mortality is among poor countries and wealthy countries that rely on emergency obstetric technology to save a woman's life during childbirth. However, substantial variation in maternal mortality ratios (MMRs) exists within and among poor countries with uneven access to advanced obstetric services. This article examines MMRs across the Muslim world and compares the impact of national wealth, female education, and skilled birth attendants on maternal mortality. Understanding how poor countries have lowered MMRs without access to expensive obstetric technologies suggests that certain social variables may act protectively to reduce the maternal risk for life-threatening obstetric complications that would require emergency obstetric care.

Renal rickets-practical approach

PubMed Central

Sahay, Manisha; Sahay, Rakesh

2013-01-01

Rickets/osteomalacia is an important problem in a tropical country. Many cases are due to poor vitamin D intake or calcium deficient diets and can be corrected by administration of calcium and vitamin D. However, some cases are refractory to vitamin D therapy and are related to renal defects. These include rickets of renal tubular acidosis (RTA), hypophosphatemic rickets, and vitamin D dependent rickets (VDDR). The latter is due to impaired action of 1α-hydroxylase in renal tubule. These varieties need proper diagnosis and specific treatment. PMID:24251212

The metrics and correlates of physician migration from Africa.

PubMed

Arah, Onyebuchi A

2007-05-17

Physician migration from poor to rich countries is considered an important contributor to the growing health workforce crisis in the developing world. This is particularly true for Africa. The perceived magnitude of such migration for each source country might, however, depend on the choice of metrics used in the analysis. This study examined the influence of choice of migration metrics on the rankings of African countries that suffered the most physician migration, and investigated the correlates of physician migration. Ranking and correlational analyses were conducted on African physician migration data adjusted for bilateral net flows, and supplemented with developmental, economic and health system data. The setting was the 53 African birth countries of African-born physicians working in nine wealthier destination countries. Three metrics of physician migration were used: total number of physician émigrés; emigration fraction defined as the proportion of the potential physician pool working in destination countries; and physician migration density defined as the number of physician émigrés per 1000 population of the African source country. Rankings based on any of the migration metrics differed substantially from those based on the other two metrics. Although the emigration fraction and physician migration density metrics gave proportionality to the migration crisis, only the latter was consistently associated with source countries' workforce capacity, health, health spending, economic and development characteristics. As such, higher physician migration density was seen among African countries with relatively higher health workforce capacity (0.401 < or = r < or = 0.694, p < or = 0.011), health status, health spending, and development. The perceived magnitude of physician migration is sensitive to the choice of metrics. Complementing the emigration fraction, the physician migration density is a metric which gives a different but proportionate picture of which African countries stand to lose relatively more of its physicians with unchecked migration. The nature of health policies geared at health-worker migration can be expected to depend on the choice of migration metrics.

What Is the Role of Informal Healthcare Providers in Developing Countries? A Systematic Review

PubMed Central

Sudhinaraset, May; Ingram, Matthew; Lofthouse, Heather Kinlaw; Montagu, Dominic

2013-01-01

Informal health care providers (IPs) comprise a significant component of health systems in developing nations. Yet little is known about the most basic characteristics of performance, cost, quality, utilization, and size of this sector. To address this gap we conducted a comprehensive literature review on the informal health care sector in developing countries. We searched for studies published since 2000 through electronic databases PubMed, Google Scholar, and relevant grey literature from The New York Academy of Medicine, The World Bank, The Center for Global Development, USAID, SHOPS (formerly PSP-One), The World Health Organization, DFID, Human Resources for Health Global Resource Center. In total, 334 articles were retrieved, and 122 met inclusion criteria and chosen for data abstraction. Results indicate that IPs make up a significant portion of the healthcare sector globally, with almost half of studies (48%) from Sub-Saharan Africa. Utilization estimates from 24 studies in the literature of IP for healthcare services ranged from 9% to 90% of all healthcare interactions, depending on the country, the disease in question, and methods of measurement. IPs operate in a variety of health areas, although baseline information on quality is notably incomplete and poor quality of care is generally assumed. There was a wide variation in how quality of care is measured. The review found that IPs reported inadequate drug provision, poor adherence to clinical national guidelines, and that there were gaps in knowledge and provider practice; however, studies also found that the formal sector also reported poor provider practices. Reasons for using IPs included convenience, affordability, and social and cultural effects. Recommendations from the literature amount to a call for more engagement with the IP sector. IPs are a large component of nearly all developing country health systems. Research and policies of engagement are needed. PMID:23405101

Perceived Discrimination and Health among Immigrants in Europe According to National Integration Policies.

PubMed

Borrell, Carme; Palència, Laia; Bartoll, Xavier; Ikram, Umar; Malmusi, Davide

2015-08-31

Discrimination harms immigrants' health. The objective of this study was to analyze the association between perceived discrimination and health outcomes among first and second generation immigrants from low-income countries living in Europe, while accounting for sex and the national policy on immigration. Cross-sectional study including immigrants from low-income countries aged ≥15 years in 18 European countries (European Social Survey, 2012) (sample of 1271 men and 1335 women). The dependent variables were self-reported health, symptoms of depression, and limitation of activity. The independent variables were perceived group discrimination, immigrant background and national immigrant integration policy. We tested for association between perceived group discrimination and health outcomes by fitting robust Poisson regression models. We only observed significant associations between perceived group discrimination and health outcomes in first generation immigrants. For example, depression was associated with discrimination among both men and women (Prevalence Ratio-, 1.55 (95% CI: 1.16-2.07) and 1.47 (95% CI: 1.15-1.89) in the multivariate model, respectively), and mainly in countries with assimilationist immigrant integration policies. Perceived group discrimination is associated with poor health outcomes in first generation immigrants from low-income countries who live in European countries, but not among their descendants. These associations are more important in assimilationist countries.

Poverty and progress: choices for the developing world.

PubMed

Chenery, H B

1980-06-01

Some development strategists equate progress with economic growth and others consider increased equity in income distribution or a reduction in poverty as indicators of progress. This report examined the empirical relationship between economic growth and income distribution using data derived from a number of recent comparative studies. Various studies supported the Kuznets hypothesis, which states that during the early phases of development income distribution worsens and improves during the later phases. These studies demonstrated that as per capita income increases in poor countries, income distribution worsens until the per capita income reaches the $800 level. After that level is reached, income distribution generally improves. In a study of 11 countries, the relationship, in recent years, between income growth for the rich and for the poor, and income growth for the country as a whole was examined. Of the 11 countries, Taiwan, Yugoslavia, Sri Lanka, Korea, and Costa Rica were ranked as good performers, since more than 30% of the increment in national income was allocated to the poorest 60% of the population. The countries of India, Philippines, Turkey, and Colombia were ranked as intermediate performers since 20-30% of the increment in national income went to the poorest 60%. Poor performance countries were Brazil, Mexico, and Peru. In these countries less than 20% of the income increment was allocated to the poorest 60%. A table provided comparative national income and income distribution data for the 11 countries. These findings did not permit an assessment of different development strategies; however, they did indicate that: 1) some countries, such as Taiwan, Yugoslavia, and Korea, achieved both rapid growth and greater income distribution equity; and that 2) although some countires, such as Sri Lanka, which stressed equity, grew less rapidly than other countries, such as Mexico, which stressed economic growth, the poor fared much better in the former countries than in the latter countries. The conclusion was reached that proverty must be reduced by: 1) improving income distribution; 2) promoting economic growth; and 3) reducing population growth. Efforts must be directed toward preventing the poor from falling behind the rich as development proceeds.

Food provisioning experiences of ultra poor female heads of household living in Bangladesh.

PubMed

McIntyre, Lynn; Rondeau, Krista; Kirkpatrick, Sharon; Hatfield, Jennifer; Islam, Khaled Shamsul; Huda, Syed Nazmul

2011-03-01

Ultra poor women in Bangladesh are especially vulnerable to poverty and food insecurity, and they have generally been excluded from recent improvements in hunger and poverty rates in the country. An examination of the food provisioning narratives of 43 ultra poor female heads of household in Bangladesh was conducted in order to deepen understanding of this obstacle to the country's achievement of the First Millennium Development Goal. All participants were the household's sole income provider, had dependent children, and earned less than $1 USD per day. Women were purposively selected based on occupational group, context, and personal characteristics. Ethnographic interviews were conducted in January and February, 2008. Analysis of women's accounts of their daily food routine revealed chronic and pervasive food insecurity punctuated by acute episodes of absolute food deprivation that resulted from seasonal fluctuations in earnings, rising food prices, illness disrupting work, and healthcare costs. Women's accounts of their daily food provisioning experiences suggested compromises in, and trade-offs between, multiple basic needs as a result of inadequate income. Women were further constrained by social norms and gender roles that influenced their ability to work outside the home. Our method of inquiry led us to construct an organizing framework that extends knowledge of ultra poor women in Bangladesh's complex and multi-sphered experience of poverty and food insecurity. Based on these findings, we propose a strategy called whole person development (WPD), which seeks small adjustments to services, programs, and policies based on leverage points identified through in-depth narratives. Copyright © 2011 Elsevier Ltd. All rights reserved.

Is Cheap Labor a Magnet for Capital?

ERIC Educational Resources Information Center

Hanson, John R., II

1995-01-01

Contends that it is widely believed that cheap labor in poor countries attracts foreign investors. Asserts that historical evidence indicates that past patterns of direct foreign investment in poor countries are inconsistent with the cheap-labor argument. Includes two figures and one table. (CFR)

[Poor, propertyless and pregnant: classification of women's status by country].

PubMed

1988-12-01

A new study called "Poor, propertyless, and pregnant" that classified the condition of women in 99 countries found women in Sweden, Finland, and the US to enjoy the best legal and social conditions and the greatest degree of equality with men. The worst discrimination against women occurred in Bangladesh, Mali, Afghanistan, North Yemen, Pakistan, Nigeria, and Saudi Arabia. Women do not have complete equality with men in any country. But over 60% of the world's female population lives in countries where extensive poverty and sexual discrimination have created conditions of deprivation. One of the principal mechanisms that negatively influences the condition of women is early procreation; early and frequent childbirth obliterates women's chances for education and paid employment. Feminization of poverty is becoming universal, largely because a growing proportion of households are headed by women with dependent children. In developed and developing countries alike, working women with families work a double day. Although the struggle for legal and social equality for women takes different forms in different countries, certain basic measures can be applied by all governments. Reforms are needed to give women access to more remunerative jobs, equal property rights, and access to credit. Greater investments are needed in reproductive health and in education and training for women. Governments, employers, and husbands should recognize the social value of childbirth and child rearing. The study is divided into 5 sections, each of which has 4 series of data, so that each country is evaluated on 20 variables. The 5 sections are health, nuptiality and children, education, economic participation, and social equality. In most developed countries women live an average of 7 years longer than men, but in developing countries the difference is only 2 years. Complications of pregnancy and childbirth cause the deaths of over 500,000 women each year and affect another 5 million, mostly in developing countries. The condition and welfare of women are tightly linked to 3 factors: age at marriage, beginning of procreation, and capacity to regulate and space pregnancies. Women's status is also influenced by whether they are married and their rights to divorce. In developing countries about 45% of women are illiterate, compared to 25% of men. The salaries of women do not equal those of men in any country. Only Finland and Sweden have been unreservedly committed to providing equal political rights and legal protection against sexual discrimination.

Are area-level and individual-level socioeconomic factors associated with self-rated health in adult urban citizens? Evidence from Slovak and Dutch cities.

PubMed

Behanova, Martina; Reijneveld, Sijmen A; Nagyova, Iveta; Katreniakova, Zuzana; van Ameijden, Erik J C; Dijkshoorn, Henriëtte; van Dijk, Jitse P

2017-05-01

Evidence shows that living in disadvantaged areas is associated with poor health. This may be due to the socioeconomic (SE) characteristics of both these residents and the areas where they live. Evidence regarding this on Central European (CE) countries is scarce. Our aim was to assess whether the prevalence of poor self-rated health (SRH) was higher in deprived urban areas, whether this can be explained by individual SE status (SES) and whether this differed between Slovakia and the Netherlands per age group. We examined the association of urban-level data and individual-level SE factors from different urban areas in different countries (Slovakia, the Netherlands) using comparable urban health indicators and area indicators. We also obtained unique data from the EU-FP7 EURO-URHIS 2 project. Multilevel logistic regression showed that poor SRH was associated with area deprivation in both countries. Regarding age by country, poor SRH occurred more frequently in the more deprived areas for the younger age group (≤64) in the Netherlands but for the older age group (≥65 years) in Slovakia. Moreover, Slovak citizens reported poor SRH significantly more often than Dutch residents. Individual SES was significantly associated with poor SRH in both age groups and both countries for most area-level SE measures. Individual SES is associated with SRH more strongly than area deprivation. Therefore, it is important to account for relative deprivation at an individual level when considering health-enhancing activities. Moreover, the effect of urban-area deprivation seems to differ between CE and WE countries. © The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

[Maternal mortality: the demographic aspects].

PubMed

Sanogo, D

1989-10-01

The World Health Organization (WHO) has defined maternal mortality (MM) as a death following a delivery or during the 42 day period following a prolonged or complicated delivery. This definition is ambiguous because it does not take into account the institutional causes (deficiencies) that lead to MM in Sub-Saharan Africa (SSA) nor does it reflect all the reasons leading to MM because of the lack of nationwide health information systems and the lack of accurate statistics. While developed countries can depend on the state to provide accurate statistics, developing countries depend on hospitals, health training centers and special surveys to provide such data which often leads to 25-50% gross underestimations of MM. The most recent WHO data (1989) shows that SSA has the highest MM rates worldwide, ranging from 500- 700/100,000 as compared to Asia with 55-650; Latin America with 110-210 and the developed countries with 10-48. The data for SSA doesn't reflect the true situation in the rural areas where MM rates are over 1000/1000,000. MM is a symptom of poor countries where women contribute to their own deaths through repeated pregnancies, causing significant socioeconomic losses to society. UNICEF (1988) has categorized the demographic factors as high risk for women based on: 1) the age of the mother, and 2) the number of pregnancies. Family planning (FP) reduces MM by preventing illegal abortions; it reduces the number of unwanted pregnancies and increases the earnings of a community by reducing the number of pregnant women. The experience of developed countries demonstrates how women have avoided high-risk and unwanted pregnancies.

Energy, affluence, and poverty. [United Arab Emirates

DOE Office of Scientific and Technical Information (OSTI.GOV)

Al-Otaiba, M.S.

The United Arab Emirates realizes that its newly found wealth imposes upon it certain humanistic obligations towards the less-fortunate nations. Accordingly, it allocated 30 percent of its 1975 national income or $1.24 billion for aid to the developing countries. Two points discussed for bridging the gap between the rich and the poor countries involve two commitments: (1) developed or developing, wealthy countries should allocate a reasonable percentage of their GNP to aid poor nations; and (2) the industrial countries, in addition, must provide the technical expertise necessary for the construction of such projects as are appropriate to the particular conditionsmore » in each underdeveloped country. (MCW)« less

Resource allocation in Pakistan's health sector: a critical appraisal and a path toward the Millennium Development Goals.

PubMed

Shaikh, Babar Tasneem; Ejaz, Irum; Mazhar, Arslan; Hafeez, Assad

2013-01-01

Pakistan is trying hard to sustain its progress toward the Millennium Development Goals. However, because of a lack of political commitment to innovative solutions to improve its financing mechanism, the health system is unable to provide even essential and basic services to the people. The country, with more than 70% of the population living on less than two US dollars a day, largely depends on direct taxes for its revenue. Because of inadequate financing, the quality of government services is inexcusably poor; therefore, a majority of people seek healthcare in the private sector. This has led to a horde of issues pertaining to equity, accessibility and fairness. High out-of-pocket expenses on health jeopardize a family's livelihood, pushing it into a vicious circle of poverty. In the wake of recent devolution, this paper presents options for future health financing that enables the provinces to exert their autonomy to safeguard the health of the most vulnerable in the country. Our recommendations follow the vision of the World Health Organization and the Commission on Macroeconomics and Health, to achieve universal health coverage and social protection for the poor. Copyright © 2013 Longwoods Publishing.

Saving maternal lives in resource-poor settings: facing reality.

PubMed

Prata, Ndola; Sreenivas, Amita; Vahidnia, Farnaz; Potts, Malcolm

2009-02-01

Evaluate safe-motherhood interventions suitable for resource-poor settings that can be implemented with current resources. Literature review to identify interventions that require minimal treatment/infrastructure and are not dependent on skilled providers. Simulations were run to assess the potential number of maternal lives that could be saved through intervention implementation according to potential program impact. Regional and country level estimates are provided as examples of settings that would most benefit from proposed interventions. Three interventions were identified: (i) improve access to contraception; (ii) increase efforts to reduce deaths from unsafe abortion; and (iii) increase access to misoprostol to control postpartum hemorrhage (including for home births). The combined effect of postpartum hemorrhage and unsafe abortion prevention would result in the greatest gains in maternal deaths averted. Bold new initiatives are needed to achieve the Millennium Development Goal of reducing maternal mortality by three-quarters. Ninety-nine percent of maternal deaths occur in developing countries and the majority of these women deliver alone, or with a traditional birth attendant. It is time for maternal health program planners to reprioritize interventions in the face of human and financial resource constraints. The three proposed interventions address the largest part of the maternal health burden.

Considering the case for vitamin B12 fortification of flour

USDA-ARS?s Scientific Manuscript database

Reasons to fortify flour with vitamin B12 are considered, which include the high prevalence of depletion and deficiency of this vitamin that occurs in persons of all ages in resource-poor countries and in elderly in wealthier countries, as well as the adverse functional consequences of poor vitamin ...

Designing Targeted Educational Voucher Schemes for the Poor in Developing Countries

ERIC Educational Resources Information Center

Shafiq, M. Najeeb

2009-01-01

Targeted educational voucher schemes [TEVS] are often proposed for poor children in developing countries. This article explores the design of an effective TEVS using three policy instruments: regulation, support services, and finance. The regulation design addresses the rules that must be adhered to by participating households, children, and…

Wealth, justice and freedom: Objective and subjective measures predicting poor mental health in a study across eight countries.

PubMed

Scholten, Saskia; Velten, Julia; Neher, Torsten; Margraf, Jürgen

2017-12-01

Macro-level factors (MF) such as wealth, justice and freedom measured with objective country-level indicators (objective MF), for instance the Gross Domestic Product (GDP), have been investigated in relation to health and well-being, but rarely in connection with depression, anxiety and stress subsumed as poor mental health. Also, a combination of different objective MF and of how individuals perceive those MF (subjective MF) has not been taken into consideration. In the present study, we combined subjective and objective measures of wealth, justice and freedom and examined their relationship with poor mental health. Population-based interviews were conducted in France, Germany, Poland, Russia, Spain, Sweden, U.K. and U.S.A. (n ≈ 1000 per country). GDP, GINI coefficient, Justice Index and Freedom Index were used as objective MF, whereas subjective MF were perceived wealth, justice and freedom measured at the individual level. Poor mental health was assessed as a combination of symptoms of depression, anxiety and stress. In a random-intercept-model, GINI coefficient and Freedom Index were significant positive country-level, and perceived wealth, justice, and freedom significant negative individual-level predictors of symptoms of poor mental health. Multiple subjective and objective MF should be combined to assess the macrosystem's relationship with poor mental health more precisely. The relationship between MF and poor mental health indicates that the macrosystem should be taken into account as relevant context for mental health problems, too.

Palliative care, public health and justice: setting priorities in resource poor countries.

PubMed

Blinderman, Craig

2009-12-01

Many countries have not considered palliative care a public health problem. With limited resources, disease-oriented therapies and prevention measures take priority. In this paper, I intend to describe the moral framework for considering palliative care as a public health priority in resource-poor countries. A distributive theory of justice for health care should consider integrative palliative care as morally required as it contributes to improving normal functioning and preserving opportunities for the individual. For patients requiring terminal care, we are guided less by principles of justice and more by the duty to relieve suffering and society's commitment to protecting the professional's obligation to uphold principles of beneficence, compassion and non-abandonment. A fair deliberation process is necessary to allow these strong moral commitments to serve as reasons when setting priorities in resource poor countries.

Developmental potential in the first 5 years for children in developing countries

PubMed Central

Grantham-McGregor, Sally; Cheung, Yin Bun; Cueto, Santiago; Glewwe, Paul; Richter, Linda; Strupp, Barbara

2007-01-01

Summary Many children younger than 5 years in developing countries are exposed to multiple risks, including poverty, malnutrition, poor health, and unstimulating home environments, which detrimentally affect their cognitive, motor, and social-emotional development. There are few national statistics on the development of young children in developing countries. We therefore identified two factors with available worldwide data—the prevalence of early childhood stunting and the number of people living in absolute poverty—to use as indicators of poor development. We show that both indicators are closely associated with poor cognitive and educational performance in children and use them to estimate that over 200 million children under 5 years are not fulfilling their developmental potential. Most of these children live in south Asia and sub-Saharan Africa. These disadvantaged children are likely to do poorly in school and subsequently have low incomes, high fertility, and provide poor care for their children, thus contributing to the intergenerational transmission of poverty. PMID:17208643

The food, fuel, and financial crises affect the urban and rural poor disproportionately: a review of the evidence.

PubMed

Ruel, Marie T; Garrett, James L; Hawkes, Corinna; Cohen, Marc J

2010-01-01

The vulnerability of the urban poor to the recent food and fuel price crisis has been widely acknowledged. The unfolding global financial crisis, which brings higher unemployment and underemployment, is likely to further intensify this vulnerability. This paper reviews the evidence concerning the disproportionate vulnerability of the urban compared with the rural poor to these types of shocks. It reviews some of the unique characteristics of urban life that could make the urban poor particularly susceptible to price and financial shocks and summarizes the evidence regarding the disproportionate vulnerability of the urban poor. The focus is on impacts on poverty, food insecurity, and malnutrition. The review shows that although the urban poor are clearly one of the population groups most affected by the current (and previous) crises, the rural poor, landless, and net buyers are in no better position to confront the crisis without significant suffering. The poorest of the poor are the ones who will be most affected, irrespective of the continent, country, or urban or rural area where they live. The magnitude and severity of their suffering depends on their ability to adapt and on the specific nature, extent, and duration of the coping strategies they adopt. A better understanding of how these coping strategies are used and staggered is critical to help design triggers for action that can prevent households from moving to more desperate measures. Using these early coping strategies as early warning indicators could help prevent dramatic losses in welfare.

Livelihood Vulnerability Approach to Assess Climate Change Impacts to Mixed Agro-Livestock Smallholders Around the Gandaki River Basin of Nepal

NASA Astrophysics Data System (ADS)

Panthi, J., Sr.

2014-12-01

Climate change vulnerability depends upon various factors and differs between places, sectors and communities. People in developing countries whose subsistence livelihood depends upon agriculture and livestock are identified as particularly vulnerable. Nepal, where the majority of people are in a mixed agro-livestock system, is identified as the world's fourth most vulnerable country to climate change. However, there are few studies on how vulnerable mixed agro-livestock smallholders are and how their vulnerability differs across different ecological regions. This study aims to test two vulnerability assessment indices, livelihood vulnerability index (LVI) and IPCC vulnerability index (VI-IPCC), around the Gandaki river basin of Nepal. A total of 543 households practicing mixed agro-livestock were surveyed from three districts (Dhading, Syangja and Kapilvastu) representing the mountain, mid-hill and lowland altitudinal belts respectively. Data on socio-demographics, livelihoods, social networks, health, food and water security, natural disasters and climate variability were collected. Both indices differed across the three districts, with mixed agro-livestock smallholders of Dhading district found to be the most vulnerable and that of Syangja least vulnerable. This vulnerability index approach may be used to monitor rural vulnerability and/or evaluate potential program/policy effectiveness in poor countries like Nepal. The present findings are intended to help in designing intervention strategies to reduce vulnerability of mixed agro-livestock smallholders and other rural people in developing countries to climate change.

Perceived Discrimination and Health among Immigrants in Europe According to National Integration Policies

PubMed Central

Borrell, Carme; Palència, Laia; Bartoll, Xavier; Ikram, Umar; Malmusi, Davide

2015-01-01

Background: Discrimination harms immigrants’ health. The objective of this study was to analyze the association between perceived discrimination and health outcomes among first and second generation immigrants from low-income countries living in Europe, while accounting for sex and the national policy on immigration. Methods: Cross-sectional study including immigrants from low-income countries aged ≥15 years in 18 European countries (European Social Survey, 2012) (sample of 1271 men and 1335 women). The dependent variables were self-reported health, symptoms of depression, and limitation of activity. The independent variables were perceived group discrimination, immigrant background and national immigrant integration policy. We tested for association between perceived group discrimination and health outcomes by fitting robust Poisson regression models. Results: We only observed significant associations between perceived group discrimination and health outcomes in first generation immigrants. For example, depression was associated with discrimination among both men and women (Prevalence Ratio-, 1.55 (95% CI: 1.16–2.07) and 1.47 (95% CI: 1.15–1.89) in the multivariate model, respectively), and mainly in countries with assimilationist immigrant integration policies. Conclusion: Perceived group discrimination is associated with poor health outcomes in first generation immigrants from low-income countries who live in European countries, but not among their descendants. These associations are more important in assimilationist countries. PMID:26334284

The Cost-Effectiveness of Education Interventions in Poor Countries. Policy Insight, Volume 2, Issue 4

ERIC Educational Resources Information Center

Evans, David K.; Ghosh, Arkadipta

2008-01-01

Poor countries need development programs that are both effective and cost-effective. To assess effectiveness, researchers are increasingly using randomized trials (or quasi-experimental methods that imitate randomized trials), which provide a clear picture of which outcomes are attributable to the program being evaluated. This "Policy Insight"…

Open Educational Resources (OER): Opportunities and Challenges for Indian Higher Education

ERIC Educational Resources Information Center

Dutta, Indrajeet

2016-01-01

Creation of knowledge workers holds key for success of a country. Unfortunately, many of the countries though having chain of human resources yet are unable to transform human resources to their advantage as they face multiple challenges like poverty, poor economy, poor infrastructure, limited access to education and inadequate technological…

Plagiarism, Cheating and Research Integrity: Case Studies from a Masters Program in Peru.

PubMed

Carnero, Andres M; Mayta-Tristan, Percy; Konda, Kelika A; Mezones-Holguin, Edward; Bernabe-Ortiz, Antonio; Alvarado, German F; Canelo-Aybar, Carlos; Maguiña, Jorge L; Segura, Eddy R; Quispe, Antonio M; Smith, Edward S; Bayer, Angela M; Lescano, Andres G

2017-08-01

Plagiarism is a serious, yet widespread type of research misconduct, and is often neglected in developing countries. Despite its far-reaching implications, plagiarism is poorly acknowledged and discussed in the academic setting, and insufficient evidence exists in Latin America and developing countries to inform the development of preventive strategies. In this context, we present a longitudinal case study of seven instances of plagiarism and cheating arising in four consecutive classes (2011-2014) of an Epidemiology Masters program in Lima, Peru, and describes the implementation and outcomes of a multifaceted, "zero-tolerance" policy aimed at introducing research integrity. Two cases involved cheating in graded assignments, and five cases correspond to plagiarism in the thesis protocol. Cases revealed poor awareness of high tolerance to plagiarism, poor academic performance, and widespread writing deficiencies, compensated with patchwriting and copy-pasting. Depending on the events' severity, penalties included course failure (6/7) and separation from the program (3/7). Students at fault did not engage in further plagiarism. Between 2011 and 2013, the Masters program sequentially introduced a preventive policy consisting of: (i) intensified research integrity and scientific writing education, (ii) a stepwise, cumulative writing process; (iii) honor codes; (iv) active search for plagiarism in all academic products; and (v) a "zero-tolerance" policy in response to documented cases. No cases were detected in 2014. In conclusion, plagiarism seems to be widespread in resource-limited settings and a greater response with educational and zero-tolerance components is needed to prevent it.

Health disparities in Europe's ageing population: the role of social network.

PubMed

Olofsson, Jenny; Padyab, Mojgan; Malmberg, Gunnar

2018-01-01

Previous research suggests that the social network may play very different roles in relation to health in countries with differing welfare regimes. The study aimed to assess the interplay between social network, socioeconomic position, and self-rated health (SRH) in European countries. The study used cross-sectional data on individuals aged 50+ from the fourth wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) and includes data from 16 countries. The outcome is poor SRH. All analyses are adjusted for age and stratified by gender. Low satisfaction with the social network was associated with poor SRH among women in all country groups, but predicted poor SRH among males in West/Central and Eastern Europe only. The results from the multivariable analysis showed an increased likelihood of poor SRH among those with relatively lower education, as well as among those with low satisfaction with the social network (women from all country groups and men from Western/Central and Eastern Europe). However, the results from interaction analysis show that poor SRH for those with lower relative position in educational level was greater among those with higher satisfaction with the social network among male and female participants from Northern Europe. The health of individuals who are highly satisfied with their social network is more associated with socioeconomic status in Northern Europe. This study highlights the significance of social network and socioeconomic gradients in health among the elderly in Europe.

Health disparities in Europe’s ageing population: the role of social network

PubMed Central

Olofsson, Jenny; Malmberg, Gunnar

2018-01-01

ABSTRACT Background: Previous research suggests that the social network may play very different roles in relation to health in countries with differing welfare regimes. Objective: The study aimed to assess the interplay between social network, socioeconomic position, and self-rated health (SRH) in European countries. Methods: The study used cross-sectional data on individuals aged 50+ from the fourth wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) and includes data from 16 countries. The outcome is poor SRH. All analyses are adjusted for age and stratified by gender. Results: Low satisfaction with the social network was associated with poor SRH among women in all country groups, but predicted poor SRH among males in West/Central and Eastern Europe only. The results from the multivariable analysis showed an increased likelihood of poor SRH among those with relatively lower education, as well as among those with low satisfaction with the social network (women from all country groups and men from Western/Central and Eastern Europe). However, the results from interaction analysis show that poor SRH for those with lower relative position in educational level was greater among those with higher satisfaction with the social network among male and female participants from Northern Europe. The health of individuals who are highly satisfied with their social network is more associated with socioeconomic status in Northern Europe. Conclusions: This study highlights the significance of social network and socioeconomic gradients in health among the elderly in Europe. PMID:29553305

Societal characteristics and health in the former communist countries of Central and Eastern Europe and the former Soviet Union: a multilevel analysis.

PubMed

Bobak, Martin; Murphy, Mike; Rose, Richard; Marmot, Michael

2007-11-01

To examine whether, in former communist countries that have undergone profound social and economic transformation, health status is associated with income inequality and other societal characteristics, and whether this represents something more than the association of health status with individual socioeconomic circumstances. Multilevel analysis of cross-sectional data. 13 Countries from Central and Eastern Europe and the former Soviet Union. Population samples aged 18+ years (a total of 15 331 respondents). Poor self-rated health. There were marked differences among participating countries in rates of poor health (a greater than twofold difference between the countries with the highest and lowest rates of poor health), gross domestic product per capita adjusted for purchasing power parity (a greater than threefold difference), the Gini coefficient of income inequality (twofold difference), corruption index (twofold difference) and homicide rates (20-fold difference). Ecologically, the age- and sex-standardised prevalence of poor self-rated health correlated strongly with life expectancy at age 15 (r = -0.73). In multilevel analyses, societal (country-level) measures of income inequality were not associated with poor health. Corruption and gross domestic product per capita were associated with poor health after controlling for individuals' socioeconomic circumstances (education, household income, marital status and ownership of household items); the odds ratios were 1.15 (95% confidence interval 1.03 to 1.29) per 1 unit (on a 10-point scale) increase in the corruption index and 0.79 (95% confidence interval 0.68 to 0.93) per $5000 increase in gross domestic product per capita. The effects of gross domestic product and corruption were virtually identical in people whose household income was below and above the median. Societal measures of prosperity and corruption, but not income inequalities, were associated with health independently of individual-level socioeconomic characteristics. The finding that these effects were similar in persons with lower and higher income suggests that these factors do not operate exclusively through poverty.

India changes patent law to meet WTO treaty, making new medicines less available to most citizens, other countries.

PubMed

James, John S

2004-01-01

India changed its pharmaceutical patent law to conform to the U.S.-European system, just ahead of a Jan. 1 World Trade Organization deadline--meaning that most new medicines (patentable in 1995 or later) will be priced out of reach of the great majority of people in India--and in Africa and other poor regions as well. "The real issue for the multinational corporations is not the poor-country markets, which are financially small and unattractive, but the poor-country examples. How would thousands of people in rich countries, especially the U.S., be persuaded to accept death from cancer and other diseases because they cannot pay tens of thousands of dollars a year for a new generation of treatments that could save their lives--if companies in India could manufacture and sell the same treatments for a small fraction of the price?"

Efficiency, equity and feasibility of strategies to identify the poor: an application to premium exemptions under National Health Insurance in Ghana.

PubMed

Jehu-Appiah, Caroline; Aryeetey, Genevieve; Spaan, Ernst; Agyepong, Irene; Baltussen, Rob

2010-05-01

This paper outlines the potential strategies to identify the poor, and assesses their feasibility, efficiency and equity. Analyses are illustrated for the case of premium exemptions under National Health Insurance (NHI) in Ghana. A literature search in Medline search was performed to identify strategies to identify the poor. Models were developed including information on demography and poverty, and costs and errors of in- and exclusion of these strategies in two regions in Ghana. Proxy means testing (PMT), participatory welfare ranking (PWR), and geographic targeting (GT) are potentially useful strategies to identify the poor, and vary in terms of their efficiency, equity and feasibility. Costs to exempt one poor individual range between US$11.63 and US$66.67, and strategies may exclude up to 25% of the poor. Feasibility of strategies is dependent on their aptness in rural/urban settings, and administrative capacity to implement. A decision framework summarizes the above information to guide policy making. We recommend PMT as an optimal strategy in relative low poverty incidence urbanized settings, PWR as an optimal strategy in relative low poverty incidence rural settings, and GT as an optimal strategy in high incidence poverty settings. This paper holds important lessons not only for NHI in Ghana but also for other countries implementing exemption policies. Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.

Developing child mental health services in resource-poor countries.

PubMed

Omigbodun, Olayinka

2008-06-01

Despite significant gains in tackling the major causes of child mortality and evidence of an urgent need for child mental health services, resource-poor countries continue to lag behind in child and adolescent mental health service development. This paper analyses possible barriers to the development of child mental health services in resource-poor countries and attempts to proffer solutions. Obstacles identified are the magnitude of child mental health problems that remain invisible to policy makers, an absence of child mental policies to guide the process of service development, and overburdened child mental health professionals. The belief systems about mental illness also prompt help seeking in alternative health systems, thereby reducing the evidence for the burden associated with health seeking. Solutions that may support child mental health service development are the provision of adequate advocacy tools to reveal the burden, poverty alleviation, health awareness programmes, enforcing legislation, training centred within the region, and partnerships with professionals in developed countries. These solutions require simultaneous approaches to encourage service development and utilization. Reductions in child mortality in resource-poor countries will be even more dramatic in the years to come and preparations need to be made to take care of the mental health needs of the children who will survive.

Quality: what do poor women want?

PubMed

Verma, A

1994-01-01

Although all individuals and couples want high quality services, many dimensions of such services are impractical or even unfeasible in poor settings. The author considers the situation in the majority of South Asian countries where 75-80% of the population lives in rural areas or urban slums on the periphery of large metropolitan cities. Typically poorly trained community health workers live and work in cramped, unhygienic, poorly equipped service delivery centers often with neither electricity nor safe drinking water. Supplies of essential drugs, contraceptives, and equipment are extremely limited. When the workers do not live in the small facilities, they often commute by bus from a neighboring village or walk 5-6 kilometers to work. The number of males or females available and willing to be trained for services is often insufficient. The author explains that good quality is all relative. Such impoverished contexts demand that standards be situation-specific, dependent upon resource availability, and fitted to local circumstances and the social milieu. Moreover, efforts must be made to focus upon the needs of women and undertake low-cost improvements where possible. The Mini Welfare Center Scheme of the Indian Ministry of Health and Family Welfare to help voluntary organizations promote health and family welfare activities is described.

Changes in Child Mortality Over Time Across the Wealth Gradient in Less-Developed Countries

PubMed Central

2014-01-01

BACKGROUND: It is unknown whether inequalities in under-5 mortality by wealth in low- and middle-income countries (LMICs) are growing or declining. METHODS: All Demographic and Health Surveys conducted between 2002 and 2012 were used to measure under-5 mortality trends in 3 wealth tertiles. Two approaches were used to estimate changes in under-5 mortality: within-survey changes from all 54 countries, and between-survey changes for 29 countries with repeated survey waves. The principal outcome measures include annual decline in mortality, and the ratio of mortality between the poorest and least-poor wealth tertiles. RESULTS: Mortality information in 85 surveys from 929 224 households and 1 267 167 women living in 54 countries was used. In the subset of 29 countries with repeat surveys, mortality declined annually by 4.36, 3.36, and 2.06 deaths per 1000 live births among the poorest, middle, and least-poor tertiles, respectively (P = .031 for difference). The mortality ratio declined from 1.68 to 1.48 during the study period (P = .006 for trend). In the complete set of 85 surveys, the mortality ratio declined in 64 surveys (from 2.11 to 1.55), and increased in 21 surveys (from 1.58 to 1.88). Multivariate analyses suggest that convergence was associated with good governance (P ≤ .03 for 4 governance indicators: government effectiveness, rule of law, regulatory quality, and control of corruption). CONCLUSIONS: Overall, under-5 mortality in low- and middle-income countries has decreased faster among the poorest compared with the least poor between 1995 and 2012, but progress in some countries has lagged, especially with poor governance. PMID:25384496

A multi-scalar investigation of development and health in Ethiopia: household electrification in a agriculturally dependent and climate sensitive country

NASA Astrophysics Data System (ADS)

Grace, K.; Brown, M. E.; Bakhtsiyarava, M.

2017-12-01

In poor countries, household electricity status is often used as a measure of household resources. Often, the primary use of the variable is to sort the poorest households - those without electricity - from the better-off households - those with electricity. Expanding electrification is also part of a suite of goals developed by health and development and reflected in the Millennium Development Goals (MDG) and now the UN's Sustainable Development Goals. Therefore, this measure is also used in a macro-level description of a country to describe a country's process of urbanization or development. As countries, electrify and expand access to electrification to the poorest households and communities, understanding the role and impact of electrification on the health and development of these communities is necessary. In other words, moving beyond the binomial categorization of a household as electrified or not electrified and instead investigating the ways that electrification impacts communities, households and individuals is a necessary component of understanding contemporary patterns of health and development in the world's poorest countries. The goal of this research is to examine the linkages between health and development using multi-scalar, remotely-sensed measures of electrification in Ethiopia, one of the poorest countries in the world. For this study we use spatially referenced Demographic and Health Survey (DHS) data for Ethiopia from 2000 and 2005. In addition to measures of electrification gathered from the DHS, we also use time-varying satellite based measure of electrification collected by the US Department of Defense. Also, because many rural Ethiopians are dependent on small-scale, rainfed agriculture and therefore highly vulnerable to climate shocks and food insecurity, any investigation of health and development must also consider the local food production context. To support the analysis and provide information on broader measures of food insecurity and wellbeing, we also use livelihood zone data from the Famine Early Warning Systems (FEWS NET), as well as remotely sensed based estimates of rainfall and temperature.

Occupational asthma in the developing and industrialised world: a review.

PubMed

Jeebhay, M F; Quirce, S

2007-02-01

Occupational asthma is the most common occupational lung disease in industrialised countries, and the second most common occupational lung disease reported after pneumoconioses in developing countries. The median proportion of adult cases of asthma attributable to occupational exposure is between 10% and 15%. The population attributable fraction appears to be similar in industrialised and developing countries characterised by rapid industrialisation (13-15%), but lower in less industrialised developing countries (6%). The high-risk occupations and industries associated with the development of occupational asthma vary depending on the dominant industrial sectors in a particular country. High-risk exposure to cleaning agents and pesticide exposure in developing countries appear to be as important as exposure to isocyanates, cereal flour/grain dust, welding fumes, wood dust and, more recently, hairdressing chemicals, commonly reported in industrialised countries. The reported mean annual incidence of occupational asthma in developing countries is less than 2 per 100 000 population, compared to very high rates of up to 18/100 000 in Scandinavian countries. While occupational asthma remains under-recognised, especially in developing countries, it remains poorly diagnosed and managed and inadequately compensated worldwide. Primary and secondary preventive strategies should be directed at controlling workplace exposures, accompanied by intense educational and managerial improvements. Appropriate treatment remains early removal from exposure to ensure that the worker has no further exposure to the causal agent, with preservation of income. However, up to one third of workers with occupational asthma continue to remain exposed to the causative agent or suffer prolonged work disruption, discrimination and risk of unemployment.

From Many Lands. Voices of the Poor.

ERIC Educational Resources Information Center

Narayan, Deepa, Ed.; Petesch, Patti, Ed.

This book, the last volume in a three-part series, draws on a large-scale worldwide poverty study to present the views, experiences, and aspirations of poor people in 14 selected countries. In each country, interviews and discussion groups were held in 8-15 rural and urban communities that reflected the most prevalent poverty groups and the…

Poverty in the Developing Countries--1985.

ERIC Educational Resources Information Center

Clausen, A. W.

Although the number of people in developing nations who are too poor to provide themselves with an adequate diet is rising, this is not reason to assume that such poverty is inevitable. Strategies that foster economic growth and include poor people in the growth process can be found in countries with such diverse political and economic systems as…

Overcoming phase 1 delays: the critical component of obstetric fistula prevention programs in resource-poor countries

PubMed Central

2012-01-01

Background An obstetric fistula is a traumatic childbirth injury that occurs when labor is obstructed and delivery is delayed. Prolonged obstructed labor leads to the destruction of the tissues that normally separate the bladder from the vagina and creates a passageway (fistula) through which urine leaks continuously. Women with a fistula become social outcasts. Universal high-quality maternity care has eliminated the obstetric fistula in wealthy countries, but millions of women in resource-poor nations still experience prolonged labor and tens of thousands of new fistula sufferers are added to the millions of pre-existing cases each year. This article discusses fistula prevention in developing countries, focusing on the factors which delay treatment of prolonged labor. Discussion Obstetric fistulas can be prevented through contraception, avoiding obstructed labor, or improving outcomes for women who develop obstructed labor. Contraception is of little use to women who are already pregnant and there is no reliable screening test to predict obstruction in advance of labor. Improving the outcome of obstructed labor depends on prompt diagnosis and timely intervention (usually by cesarean section). Because obstetric fistulas are caused by tissue compression, the time interval from obstruction to delivery is critical. This time interval is often extended by delays in deciding to seek care, delays in arriving at a hospital, and delays in accessing treatment after arrival. Communities can reasonably demand that governments and healthcare institutions improve the second (transportation) and third (treatment) phases of delay. Initial delays in seeking hospital care are caused by failure to recognize that labor is prolonged, confusion concerning what should be done (often the result of competing therapeutic pathways), lack of women’s agency, unfamiliarity with and fear of hospitals and the treatments they offer (especially surgery), and economic constraints on access to care. Summary Women in resource-poor countries will use institutional obstetric care when the services provided are valued more than the competing choices offered by a pluralistic medical system. The key to obstetric fistula prevention is competent obstetrical care delivered respectfully, promptly, and at affordable cost. The utilization of these services is driven largely by trust. PMID:22809234

The contribution of poor and rural populations to national trends in reproductive, maternal, newborn, and child health coverage: analyses of cross-sectional surveys from 64 countries.

PubMed

Victora, Cesar G; Barros, Aluisio J D; França, Giovanny V A; da Silva, Inácio C M; Carvajal-Velez, Liliana; Amouzou, Agbessi

2017-04-01

Coverage levels for essential interventions aimed at reducing deaths of mothers and children are increasing steadily in most low-income and middle-income countries. We assessed how much poor and rural populations in these countries are benefiting from national-level progress. We analysed trends in a composite coverage indicator (CCI) based on eight reproductive, maternal, newborn, and child health interventions in 209 national surveys in 64 countries, from Jan 1, 1994, to Dec 31, 2014. Trends by wealth quintile and urban or rural residence were fitted with multilevel modelling. We used an approach akin to the calculation of population attributable risk to quantify the contribution of poor and rural populations to national trends. From 1994 to 2014, the CCI increased by 0·82 percent points a year across all countries; households in the two poorest quintiles had an increase of 0·99 percent points a year, which was faster than that for the three wealthiest quintiles (0·68 percent points). Gains among poor populations were faster in lower-middle-income and upper-middle-income countries than in low-income countries. Globally, national level increases in CCI were 17·5% faster than they would have been without the contribution of the two poorest quintiles. Coverage increased more rapidly annually in rural (0·93 percent points) than urban (0·52 percent points) areas. National coverage gains were accelerated by important increases among poor and rural mothers and children. Despite progress, important inequalities persist, and need to be addressed to achieve the Sustainable Development Goals. UNICEF, Wellcome Trust. Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license. Published by Elsevier Ltd.. All rights reserved.

Review: Sustainability of crossbreeding in developing countries; definitely not like crossing a meadow….

PubMed

Leroy, G; Baumung, R; Boettcher, P; Scherf, B; Hoffmann, I

2016-02-01

Crossbreeding, considering either terminal or rotational crossing, synthetic breed creation or breed replacement, is often promoted as an efficient strategy to increase farmers' income through the improvement of productivity of local livestock in developing countries. Sustainability of crossbreeding is however frequently challenged by constraints such as poor adaptation to the local environment or lack of logistic support. In this review, we investigate factors that may influence the long-term success or the failure of crossbreeding programs, based on the scientific literature and country reports submitted for The Second Report on the State of the World's Animal Genetic Resources for Food and Agriculture. Crossbreeding activities vary widely across species and countries. Its sustainability is dependent on different prerequisites such as continual access to adequate breeding stock (especially after the end of externally funded crossbreeding projects), the opportunity of improved livestock to express their genetic potential (e.g. through providing proper inputs) and integration within a reliable market chain. As formal crossbreeding programs are often associated with adoption of other technologies, they can be a catalyst for innovation and development for smallholders. Given the increasing global demand for animal products, as well as the potential environmental consequences of climate change, there is a need for practical research to improve the implementation of long-term crossbreeding programs in developing countries.

Nurse Migration from a Source Country Perspective: Philippine Country Case Study

PubMed Central

Lorenzo, Fely Marilyn E; Galvez-Tan, Jaime; Icamina, Kriselle; Javier, Lara

2007-01-01

Objectives To describe nurse migration patterns in the Philippines and their benefits and costs. Principal Findings The Philippines is a job-scarce environment and, even for those with jobs in the health care sector, poor working conditions often motivate nurses to seek employment overseas. The country has also become dependent on labor migration to ease the tight domestic labor market. National opinion has generally focused on the improved quality of life for individual migrants and their families, and on the benefits of remittances to the nation. However, a shortage of highly skilled nurses and the massive retraining of physicians to become nurses elsewhere has created severe problems for the Filipino health system, including the closure of many hospitals. As a result, policy makers are debating the need for new policies to manage migration such that benefits are also returned to the educational institutions and hospitals that are producing the emigrant nurses. Conclusions and Recommendations There is new interest in the Philippines in identifying ways to mitigate the costs to the health system of nurse emigration. Many of the policy options being debated involve collaboration with those countries recruiting Filipino nurses. Bilateral agreements are essential for managing migration in such a way that both sending and receiving countries derive benefit from the exchange. PMID:17489922

Nurse migration from a source country perspective: Philippine country case study.

PubMed

Lorenzo, Fely Marilyn E; Galvez-Tan, Jaime; Icamina, Kriselle; Javier, Lara

2007-06-01

To describe nurse migration patterns in the Philippines and their benefits and costs. The Philippines is a job-scarce environment and, even for those with jobs in the health care sector, poor working conditions often motivate nurses to seek employment overseas. The country has also become dependent on labor migration to ease the tight domestic labor market. National opinion has generally focused on the improved quality of life for individual migrants and their families, and on the benefits of remittances to the nation. However, a shortage of highly skilled nurses and the massive retraining of physicians to become nurses elsewhere has created severe problems for the Filipino health system, including the closure of many hospitals. As a result, policy makers are debating the need for new policies to manage migration such that benefits are also returned to the educational institutions and hospitals that are producing the emigrant nurses. There is new interest in the Philippines in identifying ways to mitigate the costs to the health system of nurse emigration. Many of the policy options being debated involve collaboration with those countries recruiting Filipino nurses. Bilateral agreements are essential for managing migration in such a way that both sending and receiving countries derive benefit from the exchange.

Trends and inequities in where women delivered their babies in 25 low-income countries: evidence from Demographic and Health Surveys.

PubMed

Limwattananon, Supon; Tangcharoensathien, Viroj; Sirilak, Supakit

2011-05-01

In low-income countries, the coverage of institutional births is low. Using data from the two most recent Demographic and Health Surveys (1995-2001 and 2001-2006) for 25 low-income countries, this study examined trends in where women delivered their babies--public or private facilities or non-institutional settings. More than half of deliveries were in institutional settings in ten countries, mostly public facilities. In the other 15 countries, the majority of births were in women's homes, which was often their only option. Between the two survey periods, all five Asian countries studied (except Bangladesh) had an increase of 10-20 percentage points in institutional coverage, whereas none of the 19 sub-Saharan African countries saw an increase of more than 10 percentage points. More urban women and more in the richest (least poor) quintile gave birth in public or private facilities than rural and poorest quintile women. The rich-poor gap of institutional births was wider than the urban-rural gap. Inadequate public investment in health system infrastructure in rural areas and lack of skilled health professionals are major obstacles in reducing maternal mortality. Governments in low-income countries must invest more, especially in rural maternity services. Strengthening private, for-profit providers is not a policy choice for poor, rural communities. Copyright © 2011 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

Factors affecting sustainable adoption of e-health technology in developing countries: an exploratory survey of Nigerian hospitals from the perspective of healthcare professionals

PubMed Central

Toycan, Mehmet

2018-01-01

Background E-health technology applications are essential tools of modern information technology that improve quality of healthcare delivery in hospitals of both developed and developing countries. However, despite its positive benefits, studies indicate that the rate of the e-health adoption in some developing countries is either low or underutilized. This is due in part, to barriers such as resistance from healthcare professionals, poor infrastructure, and low technical expertise among others. Objective The aim of this study is to investigate, identify and analyze the underlying factors that affect healthcare professionals decision to adopt and use e-health technology applications in developing countries, with particular reference to hospitals in Nigeria. Methods The study used a cross sectional approach in the form of a close-ended questionnaire to collect quantitative data from a sample of 465 healthcare professionals randomly selected from 15 hospitals in Nigeria. We used the modified Technology Acceptance Model (TAM) as the dependent variable and external factors as independent variables. The collected data was then analyzed using SPSS statistical analysis such as frequency test, reliability analysis, and correlation coefficient analysis. Results The results obtained, which correspond with findings from other researches published, indicate that perceived usefulness, belief, willingness, as well as attitude of healthcare professionals have significant influence on their intention to adopt and use the e-health technology applications. Other strategic factors identified include low literacy level and experience in using the e-health technology applications, lack of motivation, poor organizational and management policies. Conclusion The study contributes to the literature by pinpointing significant areas where findings can positively affect, or be found useful by, healthcare policy decision makers in Nigeria and other developing countries. This can help them understand their areas of priorities and weaknesses when planning for e-health technology adoption and implementation. PMID:29507830

Factors affecting sustainable adoption of e-health technology in developing countries: an exploratory survey of Nigerian hospitals from the perspective of healthcare professionals.

PubMed

Zayyad, Musa Ahmed; Toycan, Mehmet

2018-01-01

E-health technology applications are essential tools of modern information technology that improve quality of healthcare delivery in hospitals of both developed and developing countries. However, despite its positive benefits, studies indicate that the rate of the e-health adoption in some developing countries is either low or underutilized. This is due in part, to barriers such as resistance from healthcare professionals, poor infrastructure, and low technical expertise among others. The aim of this study is to investigate, identify and analyze the underlying factors that affect healthcare professionals decision to adopt and use e-health technology applications in developing countries, with particular reference to hospitals in Nigeria. The study used a cross sectional approach in the form of a close-ended questionnaire to collect quantitative data from a sample of 465 healthcare professionals randomly selected from 15 hospitals in Nigeria. We used the modified Technology Acceptance Model (TAM) as the dependent variable and external factors as independent variables. The collected data was then analyzed using SPSS statistical analysis such as frequency test, reliability analysis, and correlation coefficient analysis. The results obtained, which correspond with findings from other researches published, indicate that perceived usefulness, belief, willingness, as well as attitude of healthcare professionals have significant influence on their intention to adopt and use the e-health technology applications. Other strategic factors identified include low literacy level and experience in using the e-health technology applications, lack of motivation, poor organizational and management policies. The study contributes to the literature by pinpointing significant areas where findings can positively affect, or be found useful by, healthcare policy decision makers in Nigeria and other developing countries. This can help them understand their areas of priorities and weaknesses when planning for e-health technology adoption and implementation.

Determinants of self-rated health in elderly populations in urban areas in Slovenia, Lithuania and UK: findings of the EURO-URHIS 2 survey.

PubMed

Stanojevic Jerkovic, Olivera; Sauliune, Skirmante; Šumskas, Linas; Birt, Christopher A; Kersnik, Janko

2017-05-01

Ageing imposes extra financial burdens on social and health services in developed countries. Self-rated health (SRH) is considered to be both a reliable measurement of overall health status including morbidity and mortality and an important predictor of hospitalization, functional impairment and greater demand for health-care services in the elderly. Our aim was to identify factors associated with poor SRH in elderly populations and investigate possible differences between urban areas in Slovenia, Lithuania and UK. Data were obtained from population-based surveys from the European Urban Health Indicator System Part 2 project. The stratified representative sample (41% men and 59% women) consisted of a total of 2547 respondents aged ≥65 from the urban areas in the three countries. The prevalence of poor SRH was highest in Lithuanian urban areas. The strongest factors associated with poor SRH were low education [OR (odds ratio) 4.3, 95% CI (confidence interval) 2.5-7.3, P < 0.001], restriction of activities attributable to a chronic disease (OR 2.6, 95% CI 2.2-3.0, P < 0.001), inadequate physical activity (OR 1.7, 95% CI 1.2-2.5, P = 0.007) and poor mental health (OR 1.1, 95% CI 1.1-1.2, P < 0.001). The main factors associated with poor SRH by country included the following: living alone (Slovenia) (OR 2.0, 95% CI 1.1-3.7, P = 0,023), female sex (Lithuania) (OR 2.0, 95% CI 1.0-4.2, P = 0.058) and inadequate physical activity (UK) (OR 2.2, 95% CI 1.3-3.6, P = 0,003). Despite different levels of poor SRH, the factors associated with poor SRH were similar for the urban areas of the three countries. Factors associated with poor SRH in the urban areas could also reflect either cultural differences or specific situations for elderly in that country, which need further research. © The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Identifying the Community Structure of the Food-Trade International Multi-Network

NASA Technical Reports Server (NTRS)

Torreggiani, S.; Mangioni, G.

2018-01-01

Achieving international food security requires improved understanding of how international trade networks connect countries around the world through the import-export flows of food commodities. The properties of international food trade networks are still poorly documented, especially from a multi-network perspective. In particular, nothing is known about the multi-network's community structure. Here we find that the individual crop-specific layers of the multi-network have densely connected trading groups, a consistent characteristic over the period 2001-2011. Further, the multi-network is characterized by low variability over this period but with substantial heterogeneity across layers in each year. In particular, the layers are mostly assortative: more-intensively connected countries tend to import from and export to countries that are themselves more connected. We also fit econometric models to identify social, economic and geographic factors explaining the probability that any two countries are co-present in the same community. Our estimates indicate that the probability of country pairs belonging to the same food trade community depends more on geopolitical and economic factors-such as geographical proximity and trade-agreement co-membership-than on country economic size and/or income. These community-structure findings of the multi-network are especially valuable for efforts to understand past and emerging dynamics in the global food system, especially those that examine potential 'shocks' to global food trade.

Identifying the community structure of the food-trade international multi-network

NASA Astrophysics Data System (ADS)

Torreggiani, S.; Mangioni, G.; Puma, M. J.; Fagiolo, G.

2018-05-01

Achieving international food security requires improved understanding of how international trade networks connect countries around the world through the import-export flows of food commodities. The properties of international food trade networks are still poorly documented, especially from a multi-network perspective. In particular, nothing is known about the multi-network’s community structure. Here we find that the individual crop-specific layers of the multi-network have densely connected trading groups, a consistent characteristic over the period 2001–2011. Further, the multi-network is characterized by low variability over this period but with substantial heterogeneity across layers in each year. In particular, the layers are mostly assortative: more-intensively connected countries tend to import from and export to countries that are themselves more connected. We also fit econometric models to identify social, economic and geographic factors explaining the probability that any two countries are co-present in the same community. Our estimates indicate that the probability of country pairs belonging to the same food trade community depends more on geopolitical and economic factors—such as geographical proximity and trade-agreement co-membership—than on country economic size and/or income. These community-structure findings of the multi-network are especially valuable for efforts to understand past and emerging dynamics in the global food system, especially those that examine potential ‘shocks’ to global food trade.

Healthy public policy in poor countries: tackling macro-economic policies.

PubMed

Mohindra, K S

2007-06-01

Large segments of the population in poor countries continue to suffer from a high level of unmet health needs, requiring macro-level, broad-based interventions. Healthy public policy, a key health promotion strategy, aims to put health on the agenda of policy makers across sectors and levels of government. Macro-economic policy in developing countries has thus far not adequately captured the attention of health promotion researchers. This paper argues that healthy public policy should not only be an objective in rich countries, but also in poor countries. This paper takes up this issue by reviewing the main macro-economic aid programs offered by international financial institutions as a response to economic crises and unmanageable debt burdens. Although health promotion researchers were largely absent during a key debate on structural adjustment programs and health during the 1980s and 1990s, the international macro-economic policy tool currently in play offers a new opportunity to participate in assessing these policies, ensuring new forms of macro-economic policy interventions do not simply reproduce patterns of (neoliberal) economics-dominated development policy.

Educational inequalities in obesity and gross domestic product: evidence from 70 countries.

PubMed

Kinge, Jonas Minet; Strand, Bjørn Heine; Vollset, Stein Emil; Skirbekk, Vegard

2015-12-01

We test the reversal hypothesis, which suggests that the relationship between obesity and education depends on the economic development in the country; in poor countries, obesity is more prevalent in the higher educated groups, while in rich countries the association is reversed-higher prevalence in the lower educated. We assembled a data set on obesity and education including 412,921 individuals from 70 countries in the period 2002-2013. Gross domestic product (GDP) per capita was used as a measure of economic development. We assessed the association between obesity and GDP by education using a two-stage mixed effects model. Country-specific educational inequalities in obesity were investigated using regression-based inequality indices. The reversal hypothesis was supported by our results in men and women. Obesity was positively associated with country GDP only among individuals with lower levels of education, while this association was absent or reduced in those with higher levels of education. This pattern was more pronounced in women than in men. Furthermore, educational inequalities in obesity were reversed with GDP; in low-income countries, obesity was more prevalent in individuals with higher education, in medium-income and high-income countries, obesity shifts to be more prevalent among those with lower levels of education. Obesity and economic development were positively associated. Our findings suggest that education might mitigate this effect. Global and national action aimed at the obesity epidemic should take this into account. 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/

[Causes of iron deficiency in children].

PubMed

Olives, J-P

2017-05-01

Iron deficiency and iron deficiency anemia are common conditions worldwide affecting especially children. In developing countries, iron deficiency is caused by poor iron intake and parasitic infection. Poor iron intake linked to inadequate diets, low iron intestinal absorption, chronic blood losses and increased requirements are common causes in high-income countries. © 2017 Elsevier Masson SAS. Tous droits réservés.

Use of modern contraception by the poor is falling behind.

PubMed

Gakidou, Emmanuela; Vayena, Effy

2007-02-01

The widespread increase in the use of contraception, due to multiple factors including improved access to modern contraception, is one of the most dramatic social transformations of the past fifty years. This study explores whether the global progress in the use of modern contraceptives has also benefited the poorest. Demographic and Health Surveys from 55 developing countries were analyzed using wealth indices that allow the identification of the absolute poor within each country. This article explores the macro level determinants of the differences in the use of modern contraceptives between the poor and the national averages of several countries. Despite increases in national averages, use of modern contraception by the absolute poor remains low. South and Southeast Asia have relatively high rates of modern contraception in the absolute poor, on average 17% higher than in Latin America. Over time the gaps in use persist and are increasing. Latin America exhibits significantly larger gaps in use between the poor and the averages, while gaps in sub-Saharan Africa are on average smaller by 15.8% and in Southeast Asia by 11.6%. The secular trend of increasing rates of modern contraceptive use has not resulted in a decrease of the gap in use for those living in absolute poverty. Countries with large economic inequalities also exhibit large inequalities in modern contraceptive use. In addition to macro level factors that influence contraceptive use, such as economic development and provision of reproductive health services, there are strong regional variations, with sub-Saharan Africa exhibiting the lowest national rates of use, South and Southeast Asia the highest use among the poor, and Latin America the largest inequalities in use.

Coming to terms: toward a North-South bargain for the environment.

PubMed

Speth, J G

1989-06-01

To attack the major environmental problems, global warming, natural resource losses, and loss of biological diversity, an understanding between the industrialized and developing countries must occur. Weather patterns and sea levels are being affected by global warming which is caused by the use of fossil fuels and deforestation. The industrialized countries must cut back on the use of fossil fuels, and developing countries need to slow the process of deforestation. The loss of genetic resources and the extinction of species is happening rapidly, and most of it is in the tropical forests of developing countries. The developing countries are more dependent on their natural resources, forests, minerals, soils, and fisheries than industrialized countries. They are being depleted more rapidly with the population growth, social inequalities, and poor policies. Industrial countries are partly to blame also since they make investment and development decisions without concerns for the environment. The 4 major actions that can be initiated by industrialized countries are as follows. The initiation of national and international movements to reduce gas emissions that cause the greenhouse effect. The increased distribution of new technology and financing for population programs, sustainable development and environmental protection. The reduction of the external dept of developing countries, and the creation of programs to give technical assistance, scientific and other training for environmental problems of developing countries. Financial assistance can be linked to population programs and to environmental issues of the developing countries. Carbon dioxide taxes could be used to finance forest management and ecological zoning. The exchange of forest conservation for debt relief is a possible solution. Any dept restructuring plan should include strong environmental conservation provisions and policy reform requirements.

The Social and Productive Impacts of Zambia's Child Grant.

PubMed

Handa, Sudhanshu; Seidenfeld, David; Davis, Benjamin; Tembo, Gelson

2016-01-01

Accumulated evidence from dozens of cash transfer programs across the world suggest that there are few interventions that can match the range of impacts and cost-effectiveness of a small, predictable monetary transfer to poor families in developing countries. However, individual published impact assessments typically focus on only one program and one outcome. This article presents two-year impacts of the Zambian Government's Child Grant, an unconditional cash transfer to families with children under age five, across a wide range of domains including consumption, productive activity and women and children's outcomes, making this one of the first studies to assess both protective and productive impacts of a national unconditional cash transfer program. We show strong impacts on consumption, food security, savings and productive activity. However, impacts in areas such as child nutritional status and schooling depend on initial conditions of the household, suggesting that cash alone is not enough to solve all constraints faced by these poor, rural households. Nevertheless, the apparent transformative effects of this program suggest that unconditional transfers in very poor settings can contribute to both protection and development outcomes.

Working Hours Mismatch, Macroeconomic Changes, and Mental Well-being in Europe.

PubMed

De Moortel, Deborah; Thévenon, Olivier; De Witte, Hans; Vanroelen, Christophe

2017-06-01

This study explores the association between involuntarily working less or more than the standard workweek and poor mental well-being, and whether this relationship is dependent upon (changing) national-level unemployment and gross domestic product growth rates. Data from the European Social Survey Round 2 (2004-2005) and Round 5 (2010) were analyzed. The sample included 16,224 male and 16,184 female employees. Mental well-being was assessed by the World Health Organization Well-being Index. Three-level linear multilevel modeling was used to account for clustering of employees within research years and countries. Working involuntary long hours was positively associated with poor mental well-being for men. For women, working voluntary long, involuntary long, and involuntary short hours were positively associated with poor mental well-being. The mental well-being of women working voluntary and involuntary long hours was negatively influenced by deteriorating economic conditions. This study suggests women are more vulnerable to the effects of long working hours and working hours mismatch on mental well-being, especially during difficult economic periods.

Optimizing the ‘demographic dividend’ in young developing countries: The role of contractual savings and insurance for financing education

PubMed Central

Ssewamala, Fred M.

2014-01-01

Many developing regions are facing a youth bulge, meaning that young people comprise the highest proportion of the population. These regions are at risk of losing what could be a tremendous opportunity for economic growth and development if they do not capitalize on this young and economically productive population - also referred to as the “demographic dividend,” defined as the increase in economic growth that tends to follow increases in the ratio of the working-age population - essentially the labor force - to dependents. Nations undergoing this population transition have the opportunity to capitalize on the demographic dividend if the right social, economic, and human capital policies are in place. In particular, sub-Saharan Africa, the Middle East, and North Africa are at risk of losing the demographic dividend. These regions face high youth unemployment, low primary school completion, and low secondary school enrollment. This results in an undereducated and unskilled segment of the population. The prohibitive costs of education prevent young people from finishing school, thereby entering the labor market unprepared. This article presents a case for youth-focused financial inclusion programs as one of the antidotes to the masses of poor, undereducated, and low-skilled young people swelling the labor markets of poor developing countries. PMID:26273211

The resource curse and child mortality, 1961-2011.

PubMed

Wigley, Simon

2017-03-01

There is now an extensive literature on the adverse effect of petroleum wealth on the political, economic and social well-being of a country. In this study we examine whether the so-called resource curse extends to the health of children, as measured by under-five mortality. We argue that the type of revenue available to governments in petroleum-rich countries reduces their incentive to improve child health. Whereas the type of revenue available to governments in petroleum-poor countries encourages policies designed to improve child health. In order to test that line of argument we employ a panel of 167 countries (all countries with populations above 250,000) for the years 1961-2011. We find robust evidence that petroleum-poor countries outperform petroleum-rich countries when it comes to reducing under-five mortality. This suggests that governments in oil abundant countries often fail to effectively use the resource windfall at their disposal to improve child health. Copyright © 2017 Elsevier Ltd. All rights reserved.

Socioeconomic differential in self-assessment of health and happiness in 5 African countries: Finding from World Value Survey.

PubMed

Adesanya A, Oluwafunmilade; Rojas, Bomar Mendez; Darboe, Amadou; Beogo, Idrissa

2017-01-01

Factors that contribute to wealth related inequalities in self-rated health (SRH) and happiness remains unclear most especially in sub-Saharan countries (SSA). This study aims to explore and compare socioeconomic differentials in SRH and happiness in five SSA countries. Using the 2010/2014 World Values Survey (WVS), we obtained a sample of 9,869 participants of age 16 and above from five SSA countries (Nigeria, Ghana, South Africa, Rwanda and Zimbabwe). Socioeconomic inequalities were quantified using the concentration index. The contribution of each predictor to concentration index's magnitude was obtained by means of regression based decomposition analysis. Poor SRH ranges from approximately 9% in Nigeria to 20% in Zimbabwe, whereas unhappiness was lower in Rwanda (9.5%) and higher in South Africa (23.3%). Concentration index was negative for both outcomes in all countries, which implies that poor SRH and unhappiness are excessively concentrated among the poorest socioeconomic strata. Although magnitudes differ across countries, however, the major contributor to wealth-related inequality in poor SRH is satisfaction with financial situation whereas for unhappiness the major contributors are level of income and satisfaction with financial situation. This study underscores an association between wealth related inequalities and poor SRH and unhappiness in the context of SSA. Improving equity in health, as suggested by the commission of social determinants of health may be useful in fighting against the unfair distribution of resources. Thus, knowledge about the self-rating of health and happiness can serve as proxy estimates for understanding the distribution of health care access and economic resources needed for well-being in resident countries.

The effectiveness of international development assistance from American organizations to deaf communities in Jamaica.

PubMed

Wilson, Amy T

American organizations bringing assistance to deaf people in developing countries unintentionally create relationships of dependency or oppression rather than relationships of support. Using qualitative methods, the author examined the effectiveness of development assistance provided to the Jamaican Deaf community by two American churches, one American nongovernmental organization, and one U.S. federal agency. Documents were reviewed and observations were made. Interviews were conducted with more than 60 deaf and hearing people involved with the American organizations, the Jamaican organizations, and deaf Jamaican beneficiaries. The author concludes that the Jamaican Deaf community was often excluded in planning, designing, or evaluating programs, and was unsatisfied with the American assistance it received. Results also indicate that the American organizations were poorly prepared to work with the Deaf community. Suggestions for American organizations wishing to strengthen and empower deaf people through development assistance in developing countries are proposed.

The effects of ill health on entering and maintaining paid employment: evidence in European countries.

PubMed

Schuring, Merel; Burdorf, Lex; Kunst, Anton; Mackenbach, Johan

2007-07-01

To examine the effects of ill health on selection into paid employment in European countries. Five annual waves (1994-8) of the European Community Household Panel were used to select two populations: (1) 4446 subjects unemployed for at least 2 years, of which 1590 (36%) subjects found employment in the next year, and (2) 57 436 subjects employed for at least 2 years, of which 6191 (11%) subjects left the workforce in the next year because of unemployment, (early) retirement or having to take care of household. The influence of a perceived poor health and a chronic health problem on employment transitions was studied using logistic regression analysis. An interaction between health and sex was observed, with women in poor health (odds ratio (OR) 0.4), men in poor health (OR 0.6) and women (OR 0.6) having less chance to enter paid employment than men in good health. Subjects with a poor health and low/intermediate education had the highest risks of unemployment or (early) retirement. Taking care of the household was only influenced by health among unmarried women. In most European countries, a poor health or a chronic health problem predicted staying or becoming unemployed and the effects of health were stronger with a lower national unemployment level. In most European countries, socioeconomic inequalities in ill health were an important determinant for entering and maintaining paid employment. In public health measures for health equity, it is of paramount importance to include people with poor health in the labour market.

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.

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.

Changing the food environment: the effect of trained volunteers on mealtime care for older people in hospital.

PubMed

Roberts, Helen C

2018-05-01

This review will describe the evidence for changing the hospital environment to improve nutrition of older people, with particular emphasis on the role of additional mealtime assistance. Poor nutrition among older people in hospital is well recognised in many countries and is associated with poor outcomes of hospital care including increased mortality and longer lengths of stay. Factors recognised to contribute to poor dietary intake include acute illness, co-morbidities, cognitive impairment, low mood and medication. The hospital environment has also been scrutinised with reports from many countries of food being placed out of reach or going cold because time-pressured ward and catering staff often struggle to help an increasingly dependent group of patients at mealtimes. Routine screening in hospital for people at risk of under nutrition is recommended. Coloured trays and protected mealtimes are widespread although there is relatively little evidence for their impact on dietary intake. Volunteers can be trained to sfely give additional mealtime assistance including feeding to older patients on acute medical wards. They can improve the quality of mealtime care for patients and nursing staff although the evidence for improved dietary intake is mixed. In conclusion, improving the nutrition of older patients in hospital is challenging. Initiatives such as routine screening, the use of coloured trays, protected mealtimes and additional mealtime assistance can work together synergistically. Volunteers are likely to be increasingly important in an era when healthcare systems are generally limited in both financial resources and the ability to recruit sufficient nursing staff.

Plagiarism, Cheating and Research Integrity: Case Studies from a Masters Program in Peru

PubMed Central

Carnero, Andres M.; Mayta-Tristan, Percy; Konda, Kelika A.; Mezones-Holguin, Edward; Bernabe-Ortiz, Antonio; Alvarado, German F.; Canelo-Aybar, Carlos; Maguiña, Jorge L.; Segura, Eddy R.; Quispe, Antonio M.; Smith, Edward S.; Bayer, Angela M.; Lescano, Andres G.

2017-01-01

Plagiarism is a serious, yet widespread type of research misconduct, and is often neglected in developing countries. Despite its far-reaching implications, plagiarism is poorly acknowledged and discussed in the academic setting, and insufficient evidence exists in Latin America and developing countries to inform the development of preventive strategies. In this context, we present a longitudinal case study of seven instances of plagiarism and cheating arising in four consecutive classes (2011–2014) of an Epidemiology Masters program in Lima, Peru, and describes the implementation and outcomes of a multifaceted, “zero-tolerance” policy aimed at introducing research integrity. Two cases involved cheating in graded assignments, and five cases correspond to plagiarism in the thesis protocol. Cases revealed poor awareness of high tolerance to plagiarism, poor academic performance, and widespread writing deficiencies, compensated with patchwriting and copy-pasting. Depending on the events’ severity, penalties included course failure (6/7) and separation from the program (3/7). Students at fault did not engage in further plagiarism. Between 2011 and 2013, the Masters program sequentially introduced a preventive policy consisting of: (i) intensified research integrity and scientific writing education, (ii) a stepwise, cumulative writing process; (iii) honor codes; (iv) active search for plagiarism in all academic products; and (v) a “zero-tolerance” policy in response to documented cases. No cases were detected in 2014. In conclusion, plagiarism seems to be widespread in resource-limited settings and a greater response with educational and zero-tolerance components is needed to prevent it. PMID:27848191

Inequalities in health and health risk factors in the Southern African Development Community: evidence from World Health Surveys.

PubMed

Umuhoza, Stella M; Ataguba, John E

2018-04-27

Socioeconomic inequalities in health have been documented in many countries including those in the Southern African Development Community (SADC). However, a comprehensive assessment of health inequalities and inequalities in the distribution of health risk factors is scarce. This study specifically investigates inequalities both in poor self-assessed health (SAH) and in the distribution of selected risk factors of ill-health among the adult populations in six SADC countries. Data come from the 2002/04 World Health Survey (WHS) using six SADC countries (Malawi, Mauritius, South Africa, Swaziland, Zambia and Zimbabwe) where the WHS was conducted. Poor SAH is reporting bad or very bad health status. Risk factors such as smoking, heavy drinking, low fruit and vegetable consumption and physical inactivity were considered. Other environmental factors were also considered. Socioeconomic status was assessed using household expenditures. Standardised and normalised concentration indices (CIs) were used to assess socioeconomic inequalities. A positive (negative) concentration index means a pro-rich (pro-poor) distribution where the variable is reported more among the rich (poor). Generally, a pro-poor socioeconomic inequality exists in poor SAH in the six countries. However, this is only significant for South Africa (CI = - 0.0573; p < 0.05), and marginally significant for Zambia (CI = - 0.0341; P < 0.1) and Zimbabwe (CI = - 0.0357; p < 0.1). Smoking and inadequate fruit and vegetable consumption were significantly concentrated among the poor. Similarly, the use of biomass energy, unimproved water and sanitation were significantly concentrated among the poor. However, inequalities in heavy drinking and physical inactivity are mixed. Overall, a positive relationship exists between inequalities in ill-health and inequalities in risk factors of ill-health. There is a need for concerted efforts to tackle the significant socioeconomic inequalities in ill-health and health risk factors in the region. Because some of the determinants of ill-health lie outside the health sector, inter-sectoral action is required.

Addressing poverty through disease control programmes: examples from Tuberculosis control in India.

PubMed

Kamineni, Vishnu Vardhan; Wilson, Nevin; Das, Anand; Satyanarayana, Srinath; Chadha, Sarabjit; Sachdeva, Kuldeep Singh; Chauhan, Lakbir Singh

2012-03-26

Tuberculosis remains a major public health problem in India with the country accounting for one-fifth or 21% of all tuberculosis cases reported globally. The purpose of the study was to obtain an understanding on pro-poor initiatives within the framework of tuberculosis control programme in India and to identify mechanisms to improve the uptake and access to TB services among the poor. A national level workshop was held with participation from all relevant stakeholder groups. This study conducted during the stakeholder workshop adopted participatory research methods. The data was elicited through consultative and collegiate processes. The research study also factored information from primary and secondary sources that included literature review examining poverty headcount ratios and below poverty line population in the country; and quasi-profiling assessments to identify poor, backward and tribal districts as defined by the TB programme in India. Results revealed that current pro-poor initiatives in TB control included collaboration with private providers and engaging community to improve access among the poor to TB diagnostic and treatment services. The participants identified gaps in existing pro-poor strategies that related to implementation of advocacy, communication and social mobilisation; decentralisation of DOT; and incentives for the poor through the available schemes for public-private partnerships and provided key recommendations for action. Synergies between TB control programme and centrally sponsored social welfare schemes and state specific social welfare programmes aimed at benefitting the poor were unclear. Further in-depth analysis and systems/policy/operations research exploring pro-poor initiatives, in particular examining service delivery synergies between existing poverty alleviation schemes and TB control programme is essential. The understanding, reflection and knowledge of the key stakeholders during this participatory workshop provides recommendations for action, further planning and research on pro-poor TB centric interventions in the country.

Cross-cultural comparison of maternal sleep.

PubMed

Mindell, Jodi A; Sadeh, Avi; Kwon, Robert; Goh, Daniel Y T

2013-11-01

To characterize cross-cultural sleep patterns and sleep problems in a large sample of mothers of children (ages birth to 6 years) in multiple predominantly Asian and predominantly Caucasian countries. Mothers of 10,085 young children (predominantly Asian countries/regions: China, Hong Kong, India, Korea, Japan, Malaysia, Philippines, Singapore, Thailand; predominantly Caucasian countries: Australia, Canada, New Zealand, United Kingdom, United States) completed an internet-based expanded version of the Pittsburgh Sleep Quality Index. Mothers in predominantly Asian countries/regions had later bedtimes, decreased number and duration of night wakings, more nighttime sleep, and more total sleep than mothers from predominantly Caucasian countries, P < 0.001. More than half (54.7%) of mothers reported having poor sleep, ranging from 50.9% of mothers in Malaysia to 77.8% of mothers in Japan. Sleep disturbance symptoms were quite common, especially symptoms related to insomnia, and were more likely to be reported by mothers in predominantly Caucasian countries. However, psychosocial factors, including having children of a younger age, being unemployed, and having a lower education level were the best predictors of poor sleep, whereas culture was not a significant predictor. Overall, mothers in predominantly Asian countries/regions reported later bedtimes but sleeping better and longer than mothers from predominantly Caucasian countries, which is dissimilar to cross-cultural findings of young children. Psychosocial factors were found to be the best predictors of poor sleep, irrespective of culture. Further studies are needed to understand the impact of these findings.

American health improvement depends upon addressing class disparities.

PubMed

Schroeder, Steven A

2016-11-01

The gap in health status between the United States and other (OECD) developed countries not only persists but has widened over the past decade. This has occurred despite major declines in smoking prevalence. But as with other health problems, such as obesity, gun violence, and teenage pregnancy, progress against smoking has disproportionately benefitted the better off segments of the American population. Thus smoking, as well as other problems, is now concentrated among the vulnerable members of our society: the poor and less educated, as well as disadvantaged groups such as those with mental illness and substance use disorders, the homeless, those who are incarcerated, and the LGBT community. Although this is a national issue, these problems, as well as overall poverty, are especially concentrated in the Southeastern part of the country. Compared with the other OECD countries, the U.S. has much greater inequality of income and wealth. Furthermore, we are unique in leaving substantial portions of our population not covered by health insurance, again most prominently in the southeastern region. This national health disparity is not simply a factor of the multicultural nature of American society, because it persists when the health of the whites only is compared with the more racially homogeneous OECD nations. The complexity of our poor health performance rules out a single intervention. But it is clear that without focusing on the less fortunate members of our society, especially those in the Southeast, our performance will continue to lag, and possibly deteriorate further. Copyright © 2016 Elsevier Inc. All rights reserved.

Inequality in Human Development: An Empirical Assessment of 32 Countries

PubMed Central

Harttgen, Kenneth; Klasen, Stephan; Misselhorn, Mark; Munzi, Teresa; Smeeding, Timothy

2009-01-01

One of the most frequent critiques of the HDI is that is does not take into account inequality within countries in its three dimensions. In this paper, we apply a simply approach to compute the three components and the overall HDI for quintiles of the income distribution. This allows a comparison of the level in human development of the poor with the level of the non-poor within countries, but also across countries. This is an application of the method presented in Grimm et al. (World Development 36(12):2527–2546, 2008) to a sample of 21 low and middle income countries and 11 industrialized countries. In particular the inclusion of the industrialized countries, which were not included in the previous work, implies to deal with a number of additional challenges, which we outline in this paper. Our results show that inequality in human development within countries is high, both in developed and industrialized countries. In fact, the HDI of the lowest quintiles in industrialized countries is often below the HDI of the richest quintile in many middle income countries. We also find, however, a strong overall negative correlation between the level of human development and inequality in human development. PMID:20461123

Risk Protection, Service Use, and Health Outcomes under Colombia’s Health Insurance Program for the Poor

PubMed Central

Miller, Grant; Pinto, Diana

2013-01-01

Unexpected medical care spending imposes considerable financial risk on developing country households. Based on managed care models of health insurance in wealthy countries, Colombia’s Régimen Subsidiado is a publicly financed insurance program targeted to the poor, aiming both to provide risk protection and to promote allocative efficiency in the use of medical care. Using a “fuzzy” regression discontinuity design, we find that the program has shielded the poor from some financial risk while increasing the use of traditionally under-utilized preventive services – with measurable health gains. PMID:25346799

Identification of poor households for premium exemptions in Ghana's National Health Insurance Scheme: empirical analysis of three strategies.

PubMed

Aryeetey, Genevieve Cecilia; Jehu-Appiah, Caroline; Spaan, Ernst; D'Exelle, Ben; Agyepong, Irene; Baltussen, Rob

2010-12-01

To evaluate the effectiveness of three alternative strategies to identify poor households: means testing (MT), proxy means testing (PMT) and participatory wealth ranking (PWR) in urban, rural and semi-urban settings in Ghana. The primary motivation was to inform implementation of the National Health Insurance policy of premium exemptions for the poorest households. Survey of 145-147 households per setting to collect data on consumption expenditure to estimate MT measures and of household assets to estimate PMT measures. We organized focus group discussions to derive PWR measures. We compared errors of inclusion and exclusion of PMT and PWR relative to MT, the latter being considered the gold standard measure to identify poor households. Compared to MT, the errors of exclusion and inclusion of PMT ranged between 0.46-0.63 and 0.21-0.36, respectively, and of PWR between 0.03-0.73 and 0.17-0.60, respectively, depending on the setting. Proxy means testing and PWR have considerable errors of exclusion and inclusion in comparison with MT. PWR is a subjective measure of poverty and has appeal because it reflects community's perceptions on poverty. However, as its definition of the poor varies across settings, its acceptability as a uniform strategy to identify the poor in Ghana may be questionable. PMT and MT are potential strategies to identify the poor, and their relative societal attractiveness should be judged in a broader economic analysis. This study also holds relevance to other programmes that require identification of the poor in low-income countries. © 2010 Blackwell Publishing Ltd.

The impact of Gonoshasthaya Kendra's Micro Health Insurance plan on antenatal care among poor women in rural Bangladesh.

PubMed

Islam, Mohammad Touhidul; Igarashi, Isao; Kawabuchi, Koichi

2012-08-01

Low utilization of antenatal care (ANC) by pregnant women, particularly in rural areas, is an obstacle to ensuring safe motherhood in Bangladesh. Currently, Micro Health Insurance (MHI) is being considered in many developing countries as a potential method for assuring greater access to health care, especially for the poor. So far, there is only limited evidence evaluating MHI schemes. This study assesses the impact of MHI administered by Gonoshasthaya Kendra (GK) on ANC utilization by poor women in rural Bangladesh. We conducted a questionnaire survey and collected 321 valid responses from women enrolled in GK's MHI scheme and 271 from women not enrolled in any health insurance plan. We used a two-part model in which dependent variables were whether or not women utilized ANC and the number of times ANC was used. The model consisted of logistic regression analysis and ordinary least squares regression analysis. The main independent variables were dummies for socioeconomic classes according to GK, each of which represented the premiums and co-payments charged by class. The results showed that destitute, ultra-poor, and poor women enrolled in MHI used ANC significantly more than women not enrolled in health insurance. Women enrolled in MHI, except for those who were destitute or ultra-poor, utilized ANC significantly more times than women not enrolled in health insurance. We assume that GK's sliding premium and co-payment scales are key to ANC utilization by women. Expanding the MHI scheme may enhance ANC utilization among poor women in rural Bangladesh.

Designing Targeted Educational Voucher Schemes for the Poor in Developing Countries

NASA Astrophysics Data System (ADS)

Shafiq, M. Najeeb

2010-02-01

A targeted educational voucher scheme (TEVS) is often proposed for the poor in developing countries. Essentially, TEVS involves issuing vouchers to poor households, thus enabling them to pay tuition and fees for their children's schooling at participating non-public schools. However, little is known about TEVS' design in developing countries. This article provides the foundation for constructing a TEVS and conducting subsequent scientific evaluations to support, modify or oppose such a system. Specifically, this article uses three policy instruments to design a TEVS: regulation, support services and finance. Regulation here refers to the rules that must be adhered to by participating households, children and schools. Support services refer to services facilitating the participation of children, households, schools, and financial and political supporters. Finance refers to the value of each voucher, total TEVS costs and sources of finance.

U.S. Efforts to Educate and Train the Poor in Developing Countries. Report to the Congress of the United States by the Comptroller General.

ERIC Educational Resources Information Center

Comptroller General of the U.S., Washington, DC.

Agency for International Development (AID) education and training assistance to developing countries is herein reviewed by the General Accounting Office (GAO), with particular attention paid to the changes in emphasis since the 1973 New Directions Mandate by Congress and to the nature of recurring problems in improving education of the poor. One…

Poverty, health & intellectual property rights with special reference to India.

PubMed

Satyanarayana, K; Srivastava, S

2007-10-01

This paper examines the nexus between poverty and global health with specific focus on IPR protection and attempts to highlight the current global endeavours to overcome barriers to access to medicines for diseases of the poor. The number of very poor people in the world has increased by 10.4 per cent between 1987 and 2001 to 2735 million. India is now home to the largest number of millionaires in the developing countries. But over 800 million Indians who still survive on Rs 20.0 (US$0.5) a day, and rural poverty is on the rise. The link between poverty and health is well established with the underprivileged are more vulnerable to major health risks due to poor nutrition, inadequate access to clean drinking water, sanitation, exposure to indoor smoke, etc. all of which contribute to the huge and growing burden of disease in the poor countries. The global disease burden is not just huge but growing: over 10 million children die of preventable conditions including vaccine-preventable diseases, about 14 million are killed by infectious diseases every year, 90-95 per cent in poor countries. An estimated third of global population has limited or no access to essential medicines. While the number of poor and unhealthy is growing, Government expenditure on health is dwindling. Many of the diseases of the poor require new medicines and none are forthcoming as there is little R&D for these infections. There are several barriers to access to existing and the newly discovered drugs. One major reason is the general lack of interest by the pharma industry to discover new medicines for diseases of the poor due to very limited market in developing countries. In addition, global intellectual property rights (IPR) protection regimes like the Trade Related Intellectual Property Rights (TRIPS) are considered a major obstacle for the poor access to medicines. There have been some global initiatives on the need to improve affordability and accessibility of medicines. Some strategies to promote R&D on diseases of the poor such as Prize Fund Model, the Medical R&D Treaty and steps to invoke flexibilities in TRIPS read with Doha Declaration are discussed. Health of the poor is a global problem that requires global solutions with global participation and commitment.

SEPARABLE FACTOR ANALYSIS WITH APPLICATIONS TO MORTALITY DATA

PubMed Central

Fosdick, Bailey K.; Hoff, Peter D.

2014-01-01

Human mortality data sets can be expressed as multiway data arrays, the dimensions of which correspond to categories by which mortality rates are reported, such as age, sex, country and year. Regression models for such data typically assume an independent error distribution or an error model that allows for dependence along at most one or two dimensions of the data array. However, failing to account for other dependencies can lead to inefficient estimates of regression parameters, inaccurate standard errors and poor predictions. An alternative to assuming independent errors is to allow for dependence along each dimension of the array using a separable covariance model. However, the number of parameters in this model increases rapidly with the dimensions of the array and, for many arrays, maximum likelihood estimates of the covariance parameters do not exist. In this paper, we propose a submodel of the separable covariance model that estimates the covariance matrix for each dimension as having factor analytic structure. This model can be viewed as an extension of factor analysis to array-valued data, as it uses a factor model to estimate the covariance along each dimension of the array. We discuss properties of this model as they relate to ordinary factor analysis, describe maximum likelihood and Bayesian estimation methods, and provide a likelihood ratio testing procedure for selecting the factor model ranks. We apply this methodology to the analysis of data from the Human Mortality Database, and show in a cross-validation experiment how it outperforms simpler methods. Additionally, we use this model to impute mortality rates for countries that have no mortality data for several years. Unlike other approaches, our methodology is able to estimate similarities between the mortality rates of countries, time periods and sexes, and use this information to assist with the imputations. PMID:25489353

Mother-child health research (IRN-MCH): achievements and prospects of an international network.

PubMed

de Thé, Guy; Zetterström, Rolf

2005-07-01

The Inter-Academy Panel (IAP) is critical about the scarce support to mother-child health (MCH) research in developing countries. At the request of the IAP, a group of members of the French and Swedish Academies of Science have arrived at the conclusion that an efficient network between scientists in resource-poor and industrialized countries will facilitate MCH research in developing countries. The priorities for such a network have been listed as follows: The present organization for the MCH website at the Pasteur Institute in Paris should be adapted to better promote collaboration between scientists from industrialized and developing countries. To provide short-term courses for young scientists from developing countries in the design of research protocols, and in the writing of scientific reports and manuscripts. To organize workshops on various topics of relevance for MCH in developing countries in order to create new research networks for scientific collaboration between industrialized and resource-poor countries. To establish collaboration between non-governmental organizations (NGOs) that support MCH research in developing countries. Topics for such collaborative studies and the way in which they may be performed are summarized.

Challenges to implementation of the WHO Global Code of Practice on International Recruitment of Health Personnel: the case of Sudan.

PubMed

Abuagla, Ayat; Badr, Elsheikh

2016-06-30

The WHO Global Code of Practice on the International Recruitment of Health Personnel (hereafter the WHO Code) was adopted by the World Health Assembly in 2010 as a voluntary instrument to address challenges of health worker migration worldwide. To ascertain its relevance and effectiveness, the implementation of the WHO Code needs to be assessed based on country experience; hence, this case study on Sudan. This qualitative study depended mainly on documentary sources in addition to key informant interviews. Experiences of the authors has informed the analysis. Migration of Sudanese health workers represents a major health system challenge. Over half of Sudanese physicians practice abroad and new trends are showing involvement of other professions and increased feminization. Traditional destinations include Gulf States, especially Saudi Arabia and Libya, as well as the United Kingdom and the Republic of Ireland. Low salaries, poor work environment, and a lack of adequate professional development are the leading push factors. Massive emigration of skilled health workers has jeopardized coverage and quality of healthcare and health professional education. Poor evidence, lack of a national policy, and active recruitment in addition to labour market problems were barriers for effective migration management in Sudan. Response of destination countries in relation to cooperative arrangements with Sudan as a source country has always been suboptimal, demonstrating less attention to solidarity and ethical dimensions. The WHO Code boosted Sudan's efforts to address health worker migration and health workforce development in general. Improving migration evidence, fostering a national dialogue, and promoting bilateral agreements in addition to catalysing health worker retention strategies are some of the benefits accrued. There are, however, limitations in publicity of the WHO Code and its incorporation into national laws and regulatory frameworks for ethical recruitment. The outlook is bleak for Sudan unless the country designs and implements a robust national policy for migration management and unless prospects for source-destination country collaboration improve within a more sound version of the WHO Code. The WHO Code catalysed some vital steps in managing migration and strengthening the national health workforce in Sudan. Nevertheless, the country has not utilized the full potential of this instrument. Revisions of the WHO Code would benefit much from lessons of its application in the context of developing countries such as Sudan.

Monitoring equity in vaccination coverage: A systematic analysis of demographic and health surveys from 45 Gavi-supported countries.

PubMed

Arsenault, Catherine; Harper, Sam; Nandi, Arijit; Mendoza Rodríguez, José M; Hansen, Peter M; Johri, Mira

2017-02-07

(1) To conduct a systematic analysis of inequalities in childhood vaccination coverage in Gavi-supported countries; (2) to comparatively assess alternative measurement approaches and how they may affect cross-country comparisons of the level of inequalities. Using the most recent Demographic and Health Surveys (2005-2014) in 45 Gavi-supported countries, we measured inequalities in vaccination coverage across seven dimensions of social stratification and of vulnerability to poor health outcomes. We quantified inequalities using pairwise comparisons (risk differences and ratios) and whole spectrum measures (slope and relative indices of inequality). To contrast measurement approaches, we pooled the estimates using random-effects meta-analyses, ranked countries by the magnitude of inequality and compared agreement in country ranks. At the aggregate level, maternal education, multidimensional poverty, and wealth index poverty were the dimensions associated with the largest inequalities. In 36 out of 45 countries, inequalities were substantial, with a difference in coverage of 10 percentage points or more between the top and bottom of at least one of these social dimensions. Important inequalities by child sex, child malnutrition and urban/rural residence were also found in a smaller set of countries. The magnitude of inequality and ranking of countries differed across dimension and depending on the measure used. Pairwise comparisons could not be estimated in certain countries. The slope and relative indices of inequality were estimated in all countries and produced more stable country rankings, and should thus facilitate more reliable international comparisons. Inequalities in vaccination coverage persist in a large majority of Gavi-supported countries. Inequalities should be monitored across multiple dimensions of vulnerability. Using whole spectrum measures to quantify inequality across multiple ordered social groups has important advantages. We illustrate these findings using an equity dashboard designed to support decision-making in the Sustainable Development Goals period. Copyright © 2017 Elsevier Ltd. All rights reserved.

State of inequality in malaria intervention coverage in sub-Saharan African countries.

PubMed

Galactionova, Katya; Smith, Thomas A; de Savigny, Don; Penny, Melissa A

2017-10-18

Scale-up of malaria interventions over the last decade have yielded a significant reduction in malaria transmission and disease burden in sub-Saharan Africa. We estimated economic gradients in the distribution of these efforts and of their impacts within and across endemic countries. Using Demographic and Health Surveys we computed equity metrics to characterize the distribution of malaria interventions in 30 endemic countries proxying economic position with an asset-wealth index. Gradients were summarized in a concentration index, tabulated against level of coverage, and compared among interventions, across countries, and against respective trends over the period 2005-2015. There remain broad differences in coverage of malaria interventions and their distribution by wealth within and across countries. In most, economic gradients are lacking or favor the poorest for vector control; malaria services delivered through the formal healthcare sector are much less equitable. Scale-up of interventions in many countries improved access across the wealth continuum; in some, these efforts consistently prioritized the poorest. Expansions in control programs generally narrowed coverage gaps between economic strata; gradients persist in countries where growth was slower in the poorest quintile or where baseline inequality was large. Despite progress, malaria is consistently concentrated in the poorest, with the degree of inequality in burden far surpassing that expected given gradients in the distribution of interventions. Economic gradients in the distribution of interventions persist over time, limiting progress toward equity in malaria control. We found that, in countries with large baseline inequality in the distribution of interventions, even a small bias in expansion favoring the least poor yielded large gradients in intervention coverage while pro-poor growth failed to close the gap between the poorest and least poor. We demonstrated that dimensions of disadvantage compound for the poor; a lack of economic gradients in the distribution of malaria services does not translate to equity in coverage nor can it be interpreted to imply equity in distribution of risk or disease burden. Our analysis testifies to the progress made by countries in narrowing economic gradients in malaria interventions and highlights the scope for continued monitoring of programs with respect to equity.

The next target of bioterrorism: your food.

PubMed Central

Pellerin, C

2000-01-01

One of the many forms that biological warfare may take is the targeting of major food crops. In a poor country where millions of citizens depend on staple crops such as rice, an act of bioterrorism that destroys the crop would create a famine, resulting not only in malnutrition and starvation but also in reduced immune resistance to a range of common illnesses. To reduce the potential of deliberate introductions of crop pathogens as acts of terrorism, researchers must be able to "fingerprint" pathogens at the molecular level and discriminate between naturally occurring and deliberately introduced outbreaks. Several domestic and international surveillance, tracking, and reporting efforts are under way. PMID:10706540

[Extravasation of Cytostatic Drugs - Prevention and Best Practices].

PubMed

Maňásek, V

2016-01-01

Extravasation is the leakage of a drug (intended primarily for intravenous administration) into tissues surrounding the vascular system. The damage to surrounding varies depending on the nature and volume of extravasation. Cytostatic extravasation is associated with poor outcomes for patients. This paper summarizes the types of risk associated with cytostatic extravasation, and the preventative measures that can be used when such an event occurs. We also provide information on potential treatments. However, justification for their use has only been substantiated in papers with different levels of significance and these papers are not available in all countries. We summarize current international recommendations for actions to be taken in the event of extravasation.

Cross-Cultural Comparison of Maternal Sleep

PubMed Central

Mindell, Jodi A.; Sadeh, Avi; Kwon, Robert; Goh, Daniel Y. T.

2013-01-01

Background: To characterize cross-cultural sleep patterns and sleep problems in a large sample of mothers of children (ages birth to 6 years) in multiple predominantly Asian and predominantly Caucasian countries. Methods: Mothers of 10,085 young children (predominantly Asian countries/regions: China, Hong Kong, India, Korea, Japan, Malaysia, Philippines, Singapore, Thailand; predominantly Caucasian countries: Australia, Canada, New Zealand, United Kingdom, United States) completed an internet-based expanded version of the Pittsburgh Sleep Quality Index. Results: Mothers in predominantly Asian countries/regions had later bedtimes, decreased number and duration of night wakings, more nighttime sleep, and more total sleep than mothers from predominantly Caucasian countries, P < 0.001. More than half (54.7%) of mothers reported having poor sleep, ranging from 50.9% of mothers in Malaysia to 77.8% of mothers in Japan. Sleep disturbance symptoms were quite common, especially symptoms related to insomnia, and were more likely to be reported by mothers in predominantly Caucasian countries. However, psychosocial factors, including having children of a younger age, being unemployed, and having a lower education level were the best predictors of poor sleep, whereas culture was not a significant predictor. Conclusions: Overall, mothers in predominantly Asian countries/regions reported later bedtimes but sleeping better and longer than mothers from predominantly Caucasian countries, which is dissimilar to cross-cultural findings of young children. Psychosocial factors were found to be the best predictors of poor sleep, irrespective of culture. Further studies are needed to understand the impact of these findings. Citation: Mindell JA; Sadeh A; Kwon R; Goh DYT. Cross-cultural comparison of maternal sleep. SLEEP 2013;36(11):1699-1706. PMID:24179304

Integration of International Migrants into Western Society

DTIC Science & Technology

2017-05-01

analysis for nominal data and Kendall’s tau-b for ordinal data. Differences within cross-tabulated results were determined to be significant when the...years. Retirees were significantly more likely to have spent over 20 years in-country and less likely to have recently arrived. Sex was not... sex (Kendall’s tau-b 0.144, p=0.07). Notably, women comprised 75% and 90% of the very poor and poor categories, respectively. Country of birth was

Demographics of the European Apicultural Industry

PubMed Central

Chauzat, Marie-Pierre; Cauquil, Laura; Roy, Lise; Franco, Stéphanie; Hendrikx, Pascal; Ribière-Chabert, Magali

2013-01-01

Over the last few years, many European and North American countries have reported a high rate of disorders (mortality, dwindling and disappearance) affecting honeybee colonies (Apis mellifera). Although beekeeping has become an increasingly professional activity in recent years, the beekeeping industry remains poorly documented in Europe. The European Union Reference Laboratory for Honeybee Health sent a detailed questionnaire to each Member State, in addition to Kosovo and Norway, to determine the demographics and state of their beekeeping industries. Based on data supplied by the National Reference Laboratory for honeybee diseases in each European country, a European database was created to describe the beekeeping industry including the number and types of beekeepers, operation size, industry production, and health (notifiable diseases, mortalities). The total number of beekeepers in Europe was estimated at 620 000. European honey production was evaluated at around 220 000 tons in 2010. The price of honey varied from 1.5 to 40 €/kg depending on the country and on the distribution network. The estimated colony winter mortality varied from 7 to 28% depending on the country and the origin of the data (institutional survey or beekeeping associations). This survey documents the high heterogeneity of the apicultural industry within the European Union. The high proportion of non-professional beekeepers and the small mean number of colonies per beekeeper were the only common characteristics at European level. The tremendous variation in European apicultural industries has implication for any comprehensive epidemiological or economic analysis of the industry. This variability needs to be taken into account for such analysis as well as for future policy development. The industry would be served if beekeeping registration was uniformly implemented across member states. Better information on the package bee and queen production would help in understanding the ability of the industry to replace lost honey bee stocks. PMID:24236084

Demographics of the European apicultural industry.

PubMed

Chauzat, Marie-Pierre; Cauquil, Laura; Roy, Lise; Franco, Stéphanie; Hendrikx, Pascal; Ribière-Chabert, Magali

2013-01-01

Over the last few years, many European and North American countries have reported a high rate of disorders (mortality, dwindling and disappearance) affecting honeybee colonies (Apis mellifera). Although beekeeping has become an increasingly professional activity in recent years, the beekeeping industry remains poorly documented in Europe. The European Union Reference Laboratory for Honeybee Health sent a detailed questionnaire to each Member State, in addition to Kosovo and Norway, to determine the demographics and state of their beekeeping industries. Based on data supplied by the National Reference Laboratory for honeybee diseases in each European country, a European database was created to describe the beekeeping industry including the number and types of beekeepers, operation size, industry production, and health (notifiable diseases, mortalities). The total number of beekeepers in Europe was estimated at 620,000. European honey production was evaluated at around 220,000 tons in 2010. The price of honey varied from 1.5 to 40 €/kg depending on the country and on the distribution network. The estimated colony winter mortality varied from 7 to 28% depending on the country and the origin of the data (institutional survey or beekeeping associations). This survey documents the high heterogeneity of the apicultural industry within the European Union. The high proportion of non-professional beekeepers and the small mean number of colonies per beekeeper were the only common characteristics at European level. The tremendous variation in European apicultural industries has implication for any comprehensive epidemiological or economic analysis of the industry. This variability needs to be taken into account for such analysis as well as for future policy development. The industry would be served if beekeeping registration was uniformly implemented across member states. Better information on the package bee and queen production would help in understanding the ability of the industry to replace lost honey bee stocks.

Exploring models for the roles of health systems’ responsiveness and social determinants in explaining universal health coverage and health outcomes

PubMed Central

Bonsel, Gouke J.

2016-01-01

Background Intersectoral perspectives of health are present in the rhetoric of the sustainable development goals. Yet its descriptions of systematic approaches for an intersectoral monitoring vision, joining determinants of health, and barriers or facilitators to accessing healthcare services are lacking. Objective To explore models of associations between health outcomes and health service coverage, and health determinants and health systems responsiveness, and thereby to contribute to monitoring, analysis, and assessment approaches informed by an intersectoral vision of health. Design The study is designed as a series of ecological, cross-country regression analyses, covering between 23 and 57 countries with dependent health variables concentrated on the years 2002–2003. Countries cover a range of development contexts. Health outcome and health service coverage dependent variables were derived from World Health Organization (WHO) information sources. Predictor variables representing determinants are derived from the WHO and World Bank databases; variables used for health systems’ responsiveness are derived from the WHO World Health Survey. Responsiveness is a measure of acceptability of health services to the population, complementing financial health protection. Results Health determinants’ indicators – access to improved drinking sources, accountability, and average years of schooling – were statistically significant in particular health outcome regressions. Statistically significant coefficients were more common for mortality rate regressions than for coverage rate regressions. Responsiveness was systematically associated with poorer health and health service coverage. With respect to levels of inequality in health, the indicator of responsiveness problems experienced by the unhealthy poor groups in the population was statistically significant for regressions on measles vaccination inequalities between rich and poor. For the broader determinants, the Gini mattered most for inequalities in child mortality; education mattered more for inequalities in births attended by skilled personnel. Conclusions This paper adds to the literature on comparative health systems research. National and international health monitoring frameworks need to incorporate indicators on trends in and impacts of other policy sectors on health. This will empower the health sector to carry out public health practices that promote health and health equity. PMID:26942516

Exploring models for the roles of health systems' responsiveness and social determinants in explaining universal health coverage and health outcomes.

PubMed

Valentine, Nicole Britt; Bonsel, Gouke J

2016-01-01

Intersectoral perspectives of health are present in the rhetoric of the sustainable development goals. Yet its descriptions of systematic approaches for an intersectoral monitoring vision, joining determinants of health, and barriers or facilitators to accessing healthcare services are lacking. To explore models of associations between health outcomes and health service coverage, and health determinants and health systems responsiveness, and thereby to contribute to monitoring, analysis, and assessment approaches informed by an intersectoral vision of health. The study is designed as a series of ecological, cross-country regression analyses, covering between 23 and 57 countries with dependent health variables concentrated on the years 2002-2003. Countries cover a range of development contexts. Health outcome and health service coverage dependent variables were derived from World Health Organization (WHO) information sources. Predictor variables representing determinants are derived from the WHO and World Bank databases; variables used for health systems' responsiveness are derived from the WHO World Health Survey. Responsiveness is a measure of acceptability of health services to the population, complementing financial health protection. Health determinants' indicators - access to improved drinking sources, accountability, and average years of schooling - were statistically significant in particular health outcome regressions. Statistically significant coefficients were more common for mortality rate regressions than for coverage rate regressions. Responsiveness was systematically associated with poorer health and health service coverage. With respect to levels of inequality in health, the indicator of responsiveness problems experienced by the unhealthy poor groups in the population was statistically significant for regressions on measles vaccination inequalities between rich and poor. For the broader determinants, the Gini mattered most for inequalities in child mortality; education mattered more for inequalities in births attended by skilled personnel. This paper adds to the literature on comparative health systems research. National and international health monitoring frameworks need to incorporate indicators on trends in and impacts of other policy sectors on health. This will empower the health sector to carry out public health practices that promote health and health equity.

A historical and socioeconomic analysis of occupational safety and health in India.

PubMed

Vilanilam, J V

1980-01-01

Workers in poor countries of the so-called Third World are more likely to be affected by the dangers of high technology than their counterparts in wealthier countries. Owing to their lack of education, most workers in the "developing" world are unaware of the hazards of their occupations. Moreover, their general backwardness in sanitation and nutrition and climatic proneness of their geographic region to epidemics cause diseases contracted from the work environment to be aggravated. occupational diseases are often misconstrued as diseases resulting from the general environment. Since unemployment in underdeveloped countries is of a very high order, workers are prepared to accept any job, irrespective of the dangers involved. Labor is cheap and easily replaceable, so employers see no need for improving occupational safety and health. Labor unions are mostly controlled by full-time politicians who consider health a political issue, especially when their party controls the country's government. The seriousness of all these factors is heightened by the existing socioeconomic order in poor countries, in which national medievalism and multinational modernism play a crucial role. In order to understand the prevailing socioeconomic order, one has to analyze the social structures of poor countries in the context of today's world economic structure. India is taken as an example of a "developing" country where all the above-mentioned factors and many others are in operation: backwardness of the worker; poor nutrition; lack of concern for public health; proneness to epidemics; and indifference on the part of employers, politicians, and unions toward occupational health; high unemployment, control of the local economy by multinational corporations; and control of the mass media by feudalistic vested interests. This article attempts to analyze the occupational health and safety issue in India from a historical perspective, and stresses the vital need of structural changes in various fields so that workers can have a safe and healthy working environment.

The Old-Age Healthy Dependency Ratio in Europe.

PubMed

Muszyńska, Magdalena M; Rau, Roland

2012-09-01

The aim of this study is to answer the question of whether improvements in the health of the elderly in European countries could compensate for population ageing on the supply side of the labour market. We propose a state-of-health-specific (additive) decomposition of the old-age dependency ratio into an old-age healthy dependency ratio and an old-age unhealthy dependency ratio in order to participate in a discussion of the significance of changes in population health to compensate for the ageing of the labour force. Applying the proposed indicators to the Eurostat's population projection for the years 2010-2050, and assuming there will be equal improvements in life expectancy and healthy life expectancy at birth, we discuss various scenarios concerning future of the European labour force. While improvements in population health are anticipated during the years 2010-2050, the growth in the number of elderly people in Europe may be expected to lead to a rise in both healthy and unhealthy dependency ratios. The healthy dependency ratio is, however, projected to make up the greater part of the old-age dependency ratio. In the European countries in 2006, the value of the old-age dependency ratio was 25. But in the year 2050, with a positive migration balance over the years 2010-2050, there would be 18 elderly people in poor health plus 34 in good health per 100 people in the current working age range of 15-64. In the scenarios developed in this study, we demonstrate that improvements in health and progress in preventing disability will not, by themselves, compensate for the ageing of the workforce. However, coupled with a positive migration balance, at the level and with the age structure assumed in the Eurostat's population projections, these developments could ease the effect of population ageing on the supply side of the European labour market.

In New Survey Of Eleven Countries, US Adults Still Struggle With Access To And Affordability Of Health Care.

PubMed

Osborn, Robin; Squires, David; Doty, Michelle M; Sarnak, Dana O; Schneider, Eric C

2016-12-01

Surveys of patients' experiences with health care services can reveal how well a country's health system is meeting the needs of its population. Using data from a 2016 survey conducted in eleven countries-Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States-we found that US adults reported poor health and well-being and were the most likely to experience material hardship. The United States trailed other countries in making health care affordable and ranked poorly on providing timely access to medical care (except specialist care). In all countries, shortfalls in patient engagement and chronic care management were reported, and at least one in five adults experienced a care coordination problem. Problems were often particularly acute for low-income adults. Overall, the Netherlands performed at the top of the eleven-country range on most measures of access, engagement, and coordination. Project HOPE—The People-to-People Health Foundation, Inc.

Addressing the social and environmental determinants of urban health equity: evidence for action and a research agenda.

PubMed

Friel, Sharon; Akerman, Marco; Hancock, Trevor; Kumaresan, Jacob; Marmot, Michael; Melin, Thomas; Vlahov, David

2011-10-01

Urban living is the new reality for the majority of the world's population. Urban change is taking place in a context of other global challenges--economic globalization, climate change, financial crises, energy and food insecurity, old and emerging armed conflicts, as well as the changing patterns of communicable and noncommunicable diseases. These health and social problems, in countries with different levels of infrastructure and health system preparedness, pose significant development challenges in the 21st century. In all countries, rich and poor, the move to urban living has been both good and bad for population health, and has contributed to the unequal distribution of health both within countries (the urban-rural divide) and within cities (the rich-poor divide). In this series of papers, we demonstrate that urban planning and design and urban social conditions can be good or bad for human health and health equity depending on how they are set up. We argue that climate change mitigation and adaptation need to go hand-in-hand with efforts to achieve health equity through action in the social determinants. And we highlight how different forms of governance can shape agendas, policies, and programs in ways that are inclusive and health-promoting or perpetuate social exclusion, inequitable distribution of resources, and the inequities in health associated with that. While today we can describe many of the features of a healthy and sustainable city, and the governance and planning processes needed to achieve these ends, there is still much to learn, especially with respect to tailoring these concepts and applying them in the cities of lower- and middle-income countries. By outlining an integrated research agenda, we aim to assist researchers, policy makers, service providers, and funding bodies/donors to better support, coordinate, and undertake research that is organized around a conceptual framework that positions health, equity, and sustainability as central policy goals for urban management.

Population growth and development in the Third World: the neocolonial context.

PubMed

Patterson, J G; Shrestha, N R

1988-01-01

Less developed countries (LDCs) that were colonies of other nations continued operating under the same social and political structures set up by the former ruling nations. The small minority of elites in the LDCs held on to the power acquired during colonial times. In order to preserve their political and financial status after independence, they maintained their close linkages to the capitalist nations and their multinational corporations (MNCs). The elites did not generally have popular support, however. These capitalist nations and their commercial interests continue to dictate most LDCs development process which supports the financial interests of the MNCs and the local elites and not those of the majority, the poor. The poor realize that they are trapped and unable to break away from the economic and political structures, therefore, to assure some form of security, they have many children which exacerbates their poverty. Yet population control policies based on Malthusian theory and those that rely on such undimensional, technical approaches as family planning alone cannot cure the multidimensional social problems of high population growth and poverty. Neither the Malthusian nor Marxist theories totally explain the situation in the LDCs or even provide workable solutions. Research on population and development in LDCs needs to address both the Malthusian concern for the problems posed by high growth rates and the Marxist critique of class struggle in development trends. To eliminate the trap of poverty and dependent economies, each country must design its own remedies based on its history, culture, and geography and alter the prevailing social, economic, and political power structures in favor of the poor. 6 propositions that must be modified to each nation's particular problems and needs are presented to guide LDCs in formulating or reformulating policies to alleviate the problems of population and poverty.

Poor Children in Rich Countries.

ERIC Educational Resources Information Center

Smeeding, Timothy M.; Torrey, Barbara Boyld

1988-01-01

Reports on a comparison of the poverty rates of families with children in six industrial countries. Discusses income and poverty, poverty among children, family poverty rates before and after taxes and income transfers, and conclusions. States that the poverty of children may affect long-term competitiveness with other countries. (RT)

More for less: best patient outcomes in a time of financial restraint.

PubMed

Merry, Alan F; Hamblin, Richard

2012-12-01

In many countries, expenditure on health care has increased dramatically over recent years. There have been parallel improvements in many indicators of population health, but too many patients continue to be harmed by health care or receive care that is supply-sensitive, ineffective, or poorly aligned with their needs and values. In addition to human costs, this translates into substantial waste of resource. The world has recently faced economic challenges unseen since the great depression of the 1930s. The financial situation of a country can, like a business, be expressed in three sets of accounts: statements of financial position, financial performance, and cash flow. A key test of solvency is the ability to pay debts as they become due (whether from current account or further borrowing). In general, this is a function of public debt, which for many countries has become very high. However, private debt and net financial position are also relevant to a country's financial prospects. Ultimately, borrowing is not sustainable indefinitely and given limited prospects for growth in income in the coming years, most countries will likely need to reduce or at least constrain expenditure on health care. This implies obtaining better value from the resources that are available, and we suggest that the key to this lies in improving the quality of care and, in particular, reducing variation in health care. In the United States, new legislation promoting accountable care organizations may help to do this. Cardiac surgery can be particularly effective in extending patients' lives and in improving the quality of their lives. Our ability to continue to provide cardiac surgery in the face of constrained economic times will depend on engaging more actively in ensuring that what we do is the right thing: that our operations are effective and that they truly meet the needs and values of our patients. It will also depend on doing these operations right the first time.

Addressing poverty through disease control programmes: examples from Tuberculosis control in India

PubMed Central

2012-01-01

Introduction Tuberculosis remains a major public health problem in India with the country accounting for one-fifth or 21% of all tuberculosis cases reported globally. The purpose of the study was to obtain an understanding on pro-poor initiatives within the framework of tuberculosis control programme in India and to identify mechanisms to improve the uptake and access to TB services among the poor. Methodology A national level workshop was held with participation from all relevant stakeholder groups. This study conducted during the stakeholder workshop adopted participatory research methods. The data was elicited through consultative and collegiate processes. The research study also factored information from primary and secondary sources that included literature review examining poverty headcount ratios and below poverty line population in the country; and quasi-profiling assessments to identify poor, backward and tribal districts as defined by the TB programme in India. Results Results revealed that current pro-poor initiatives in TB control included collaboration with private providers and engaging community to improve access among the poor to TB diagnostic and treatment services. The participants identified gaps in existing pro-poor strategies that related to implementation of advocacy, communication and social mobilisation; decentralisation of DOT; and incentives for the poor through the available schemes for public-private partnerships and provided key recommendations for action. Synergies between TB control programme and centrally sponsored social welfare schemes and state specific social welfare programmes aimed at benefitting the poor were unclear. Conclusion Further in-depth analysis and systems/policy/operations research exploring pro-poor initiatives, in particular examining service delivery synergies between existing poverty alleviation schemes and TB control programme is essential. The understanding, reflection and knowledge of the key stakeholders during this participatory workshop provides recommendations for action, further planning and research on pro-poor TB centric interventions in the country. PMID:22449205

An eye for inequality: how trachoma relates to poverty in Tanzania and Vietnam.

PubMed

Jansen, Evertjan; Baltussen, Rob M P M; van Doorslaer, Eddy; Ngirwamungu, Edith; Nguyen, Mai P; Kilima, Peter M

2007-01-01

An important challenge for trachoma control strategies is to break the circle of poverty, poor hygiene and poor health by bringing its benefits to the poor. This article aims to assess to what extent trachoma is a disease of the poor, and trachoma services reach the poor in Tanzania and Vietnam. Individual level data on trachoma prevalence (active trachoma and trichiasis) and utilization of trachoma-related services were collected in both countries in 2004. Prevalence data were also available for Vietnam in 2001. We used household level data to construct an asset index as our living standards measure. Next, we related trachoma prevalence and service use to living standards, and used concentration indices to summarize and test the degree of inequality. Trachoma prevalence was higher among the poorest groups in Tanzania. No such relation could be established in Vietnam where prevalence declined over the period 2001-2004 and particularly so among the least poor. Antibiotics were used more by the poorest in Tanzania and by the less poor in Vietnam. In both countries, there was no unequivocal pattern for the relation between living standards and the use of trachoma services. Trachoma is found to be a disease of the poorest in Tanzania, but not in Vietnam. In the latter country there are indications that district characteristics have an important impact on trachoma prevalence. The higher use of antibiotics among the better-off in Vietnam may have contributed to their larger decline in active trachoma prevalence between 2001 and 2004 compared to the poorer segments.

Global health and local poverty: rich countries' responses to vulnerable populations.

PubMed

Simms, Chris D; Persaud, D David

2009-01-01

Poverty is an important determinant of ill health, mortality and suffering across the globe. This commentary asks what we can learn about poverty by looking at the way rich countries respond to the needs of vulnerable populations both within their own societies and those of low-income countries. Taking advantage of recent efforts to redefine child poverty in a way that is consistent with the World Health Organization's Commission on Social Determinants of Health, three sets of data are reviewed: levels of child well-being within 23 Organization of Economic Community Development countries; the amount of official development assistance these countries disburse to poor countries; and, government social transfers targeted at families as a percentage of GDP. Analysis shows that countries in Northern Europe tend to have lower levels of child poverty, and are the most generous with social transfers and providing development assistance to poor countries; in contrast, the non-European countries like Australia, Canada, Japan, and the United States, and generally, the G7 countries, are the least generous towards the vulnerable at home and abroad and tend to have the highest levels of child poverty. The findings suggest that nations' responses tend to be ideologically based rather than evidence or needs based and that poverty is neither inevitable nor intractable.

The Walking Egg Project: Universal access to infertility care – from dream to reality

PubMed Central

Ombelet, W.

2013-01-01

Childlessness and infertility care are neglected aspects of family planning in resource-poor countries, although the consequences of involuntary childlessness are much more dramatic and can create more wide ranging societal problems compared to Western societies, particularly for women. Because many families in developing countries completely depend on children for economic survival, childlessness has to be regarded as a social and public health issue and not only as an individual medical problem. In the Walking Egg Project we strive to raise awareness surrounding childlessness in resource-poor countries and to make infertility care in all its aspects, including assisted reproductive technologies, available and accessible for a much larger part of the world population. We hope to achieve this goal through innovation and research, advocacy and networking, training and capacity building and service delivery. The Walking Egg non-profit organization has chosen a holistic approach of reproductive health and therefore strengthening infertility care should go together with strengthening other aspects of family planning and mother care. Right from the start The Walking Project has approached the problem of infertility in a multidisciplinary and global manner. It gathers medical, social, ethical, epidemiological, juridical and economical scientists and experts along with artists and philosophers to discuss and work together towards its goal. We recently developed a simplified tWE lab IVF culture system with excellent results. According to our first cost calculation, the price of a single IVF cycle using the methodologies and protocols we described, seems to be less than 200 Euros. We realize that universal access to infertility care can only be achieved when good quality but affordable infertility care is linked to effective family planning and safe motherhood programmes. Only a global project with respect to sociocultural, ethical, economical and political differences can be successful. PMID:24753941

The future is urban.

PubMed

1992-05-01

Urban centers are growing due to natural increase and the movement of people from rural areas. Urban areas are the traditional centers of trade, science, and culture, but growth over a threshold results in crime, congestion, and pollution. Sustainability is threatened in modern towns that are dependent on other sources for food, fuel, or water. Housing, water, food supplies, and sanitation, communication, and transportation services are threatened in rapidly growing cities. In 1990 45/100 people lived in towns or cities. Hyper-cities have grown in number to 20, of which 14 are in developing countries. 83% of world population increase is expected to occur in cities. In 48 countries with faster population growth cities had growth rates averaging about 6.1% per year, and the urban share of total population averaged 2.8%. In 49 countries with slower population growth, urban growth rates averaged only 3.6% per year, and the urban share of total population averaged about 1.8%. Squatter settlements are endemic to urban areas that are congested and without basic services, limited housing particularly for the poor, and few job opportunities. The number of street children in urban areas has risen. This child population is subjected to low wages, overwork, auto accidents, poor health, and lack of social services. Malnutrition is a more serious issue in urban areas. In the Philippines malnutrition is 3% nationally and 9% in Metro Manila. Rural land reform in the Philippines is no longer a viable solution. In Metro Manila squatters are expected to increase in number to 4 million people by the year 2000, which would be almost 50% of total population. The squatter areas are areas of neglect, decay, and poverty. Cities are viewed as development's "blind alleys."

Societal characteristics and health in the former communist countries of Central and Eastern Europe and the former Soviet Union: a multilevel analysis

PubMed Central

Bobak, Martin; Murphy, Mike; Rose, Richard; Marmot, Michael

2007-01-01

Objectives To examine whether, in former communist countries that have undergone profound social and economic transformation, health status is associated with income inequality and other societal characteristics, and whether this represents something more than the association of health status with individual socioeconomic circumstances. Design Multilevel analysis of cross‐sectional data. Setting 13 Countries from Central and Eastern Europe and the former Soviet Union. Participants Population samples aged 18+ years (a total of 15 331 respondents). Mean outcome measures Poor self‐rated health. Results There were marked differences among participating countries in rates of poor health (a greater than twofold difference between the countries with the highest and lowest rates of poor health), gross domestic product per capita adjusted for purchasing power parity (a greater than threefold difference), the Gini coefficient of income inequality (twofold difference), corruption index (twofold difference) and homicide rates (20‐fold difference). Ecologically, the age‐ and sex‐standardised prevalence of poor self‐rated health correlated strongly with life expectancy at age 15 (r = −0.73). In multilevel analyses, societal (country‐level) measures of income inequality were not associated with poor health. Corruption and gross domestic product per capita were associated with poor health after controlling for individuals' socioeconomic circumstances (education, household income, marital status and ownership of household items); the odds ratios were 1.15 (95% confidence interval 1.03 to 1.29) per 1 unit (on a 10‐point scale) increase in the corruption index and 0.79 (95% confidence interval 0.68 to 0.93) per $5000 increase in gross domestic product per capita. The effects of gross domestic product and corruption were virtually identical in people whose household income was below and above the median. Conclusion Societal measures of prosperity and corruption, but not income inequalities, were associated with health independently of individual‐level socioeconomic characteristics. The finding that these effects were similar in persons with lower and higher income suggests that these factors do not operate exclusively through poverty. PMID:17933958

The economic impacts of foot and mouth disease – What are they, how big are they and where do they occur?

PubMed Central

Knight-Jones, T.J.D.; Rushton, J.

2013-01-01

Although a disease of low mortality, the global impact of foot and mouth disease (FMD) is colossal due to the huge numbers of animals affected. This impact can be separated into two components: (1) direct losses due to reduced production and changes in herd structure; and (2) indirect losses caused by costs of FMD control, poor access to markets and limited use of improved production technologies. This paper estimates that annual impact of FMD in terms of visible production losses and vaccination in endemic regions alone amount to between US$6.5 and 21 billion. In addition, outbreaks in FMD free countries and zones cause losses of >US$1.5 billion a year. FMD impacts are not the same throughout the world:1.FMD production losses have a big impact on the world's poorest where more people are directly dependent on livestock. FMD reduces herd fertility leading to less efficient herd structures and discourages the use of FMD susceptible, high productivity breeds. Overall the direct losses limit livestock productivity affecting food security.2.In countries with ongoing control programmes, FMD control and management creates large costs. These control programmes are often difficult to discontinue due to risks of new FMD incursion.3.The presence, or even threat, of FMD prevents access to lucrative international markets.4.In FMD free countries outbreaks occur periodically and the costs involved in regaining free status have been enormous. FMD is highly contagious and the actions of one farmer affect the risk of FMD occurring on other holdings; thus sizeable externalities are generated. Control therefore requires coordination within and between countries. These externalities imply that FMD control produces a significant amount of public goods, justifying the need for national and international public investment. Equipping poor countries with the tools needed to control FMD will involve the long term development of state veterinary services that in turn will deliver wider benefits to a nation including the control of other livestock diseases. PMID:23958457

Protein Kinase Cα Modulates Estrogen-Receptor-Dependent Transcription and Proliferation in Endometrial Cancer Cells

PubMed Central

Thorne, Alicia M.; Jackson, Twila A.; Willis, Van C.; Bradford, Andrew P.

2013-01-01

Endometrial cancer is the most common invasive gynecologic malignancy in developed countries. The most prevalent endometrioid tumors are linked to excessive estrogen exposure and hyperplasia. However, molecular mechanisms and signaling pathways underlying their etiology and pathophysiology remain poorly understood. We have shown that protein kinase Cα (PKCα) is aberrantly expressed in endometrioid tumors and is an important mediator of endometrial cancer cell survival, proliferation, and invasion. In this study, we demonstrate that expression of active, myristoylated PKCα conferred ligand-independent activation of estrogen-receptor- (ER-) dependent promoters and enhanced responses to estrogen. Conversely, knockdown of PKCα reduced ER-dependent gene expression and inhibited estrogen-induced proliferation of endometrial cancer cells. The ability of PKCα to potentiate estrogen activation of ER-dependent transcription was attenuated by inhibitors of phosphoinositide 3-kinase (PI3K) and Akt. Evidence suggests that PKCα and estrogen signal transduction pathways functionally interact, to modulate ER-dependent growth and transcription. Thus, PKCα signaling, via PI3K/Akt, may be a critical element of the hyperestrogenic environment and activation of ER that is thought to underlie the development of estrogen-dependent endometrial hyperplasia and malignancy. PKCα-dependent pathways may provide much needed prognostic markers of aggressive disease and novel therapeutic targets in ER positive tumors. PMID:23843797

Home Health Care (HHC) Managers Perceptions About Challenges and Obstacles that Hinder HHC Services in Jordan

PubMed Central

Ajlouni, Musa T.; Dawani, Hania; Diab, Salah M.

2015-01-01

Home care aims at supporting people with various degrees of dependency to remain at home rather than use residential, long-term, or institutional-based nursing care. Demographic, epidemiological, social, and cultural trends in Jordan as in other countries are changing the traditional patterns of care with growing emphasis on home care. The purpose of this study is to highlight the most common challenges related to home health care (HHC) services in Jordan as perceived by the managers of HHC agencies. Methods: a descriptive qualitative design that depends on focus group discussions has been used to collect data from a sample of 18 managers who met the selection criteria and who are willing to participate, the study found that, the main challenges of HHC services as perceived by managers were: shortage of female staff, lack of governance and regulation, poor management, unethical practices, lack of referral systems, and low accessibility of the poor and less privileged as HHC services are not included in health insurance schemes, it concludes also that the home health care industry in Jordan is facing many challenges and problems that may have negative effects on the effectiveness, efficiency, equity and quality of services and should be addressed by health policy makers. PMID:25946949

Maternal care receptivity and its relation to perinatal and neonatal mortality. A rural study.

PubMed

Bhardwaj, N; Hasan, S B; Zaheer, M

1995-04-01

A longitudinal study was conducted on 212 pregnant women from May 1987 to April 1988. Maternal Care Receptivity (MCR) "an innovative approach" was adopted for the assessment of maternal care services provided to pregnant mothers at their door steps. During follow-up, scores were allotted to each of the services rendered and antenatal status of pregnant women. Depending on the score--MCR was classified as high (11 to 8), moderate (7 to 4) or poor (3 to 0). Perinatal and neonatal deaths were recorded and an inverse relationship between MCR and perinatal and mortalities was observed (z = 5.46, p < 0.0001). Significantly, no perinatal or neonatal deaths occurred in women with high MCR. One of the most important cause of high PNMR and neonatal mortality rate in developing countries is poor MCR, i.e., under utilization of even the existing maternal health services. The main reasons for this under utilization appear to be poverty, illiteracy, ignorance and lack of faith in modern medicine.

A validity assessment of the Progress out of Poverty Index (PPI)™.

PubMed

Desiere, Sam; Vellema, Wytse; D'Haese, Marijke

2015-04-01

Development organisations need easy-to-use and quick-to-implement indicators to quantify poverty when requested to measure program impact. In this paper we assess the validity of the Progress out of Poverty Index (PPI)™, a country-specific indicator based on ten closed questions on directly observable household characteristics, by its compliance to the SMART criteria. Each response receives a pre-determined score, such that the sum of these scores can be converted into the likelihood the household is living below the poverty line. We focus on the PPI scorecard for Rwanda, which was validated using two national household surveys conducted in 2005/06 and 2010/11. The PPI is Specific, Measurable, Available cost effectively, and Timely available. Yet, its Relevance depends on the way it is used. Although it accurately distinguishes poor from non-poor households, making it a useful reporting tool, its limited sensitivity to changes in poverty status restricts its usefulness for evaluating the impact of development projects. Copyright © 2014 Elsevier Ltd. All rights reserved.

The Diffusion of IT in the Historical Context of Innovations from Developed Countries

ERIC Educational Resources Information Center

James, Jeffrey

2013-01-01

The well-known s-shaped diffusion of technology curve generally works well in developed countries. But how does it perform in the very different context of developing countries? Across a wide range of new technologies imported from the developed countries it works poorly. In most cases the penetration rate fails to reach 25% of the population. The…

Living with systemic lupus erythematosus in the developing world.

PubMed

Phuti, A; Schneider, M; Tikly, M; Hodkinson, B

2018-03-26

Most of our understanding of SLE and its negative impact originates from developed countries. This review aims to collate existing literature on Health-Related Quality of Life (HRQoL) in SLE patients living in developing countries to identify the gaps for the focus of future research. A narrative literature review was compiled using selected MeSH terms to search EBSCOHOST for articles published between January 1975 and February 2018 pertaining to HRQoL in SLE patients in developing countries. 31 studies from 11 countries were included for analysis. Only one longitudinal, one randomized controlled trial (RCT), one qualitative study, and two intervention studies were found. High disease activity and organ damage were associated with poor functional ability, mental health and low socio-economic status (SES). Poor SES is a recurring theme in developing countries, and worsens all SLE outcomes by reducing access to healthcare, mental, social and emotional support systems. In developing countries, SLE has a globally negative impact on patients' HRQoL, similar to that seen in developed countries. There is an urgent need for more HRQoL studies, and in particular, longitudinal, qualitative and interventional studies in these countries to investigate unmet needs, and to explore novel strategies to improve patient outcomes.

Cross-National Differences in Psychosocial Factors of Perinatal Depression: A Systematic Review of India and Japan.

PubMed

Takegata, Mizuki; Ohashi, Yukiko; Lazarus, Anisha; Kitamura, Toshinori

2017-12-04

Perinatal depression is prevalent worldwide. However, there are few available studies that discuss the different cultural factors affecting perinatal depression within Asian countries. This study aims to compare the literature regarding related factors relating to perinatal depression in India and Japan, and to synthesize the evidence common to both countries in addition to the country-specific evidence. We conducted a systematic review using several databases (CINAHL, MEDLINE, Pubmed, Ovid, SCOPUS, IndMED, and ICHUSI). Keywords were "antenatal depression" or "postpartum depression", and "India" or "Japan". Both Japanese and English language papers were reviewed. The identified evidence was compared between the two countries, as well as with non-Asian countries based on previous reports. In total, 15 articles on India and 35 on Japan were reviewed. Although several factors were shared between the two countries as well as with other non-Asian countries (vulnerable personality, being abused, age, marital conflict, and lower socio-demographic status), some differing factors were identified between India and Japan and non-Asian countries; India: poor socioeconomic status, living only with the husband, pregnancy not welcomed by the husband, a female baby, and poor relationship with in-laws; Japan: infertility treatment, conflict with work-life balance, poor relationships with biological mother or in-laws, and concerns about social relations with the other mother's friends. To conclude, involving the family and community may be important for implementing both global standardized and culture-specific interventions. In India, treatment involving the in-laws may be effective because large family structure is a significant predictor of perinatal depression. In Japan, a family/community approach involving not only the mother's family of origin but also the working environment is essential.

The Social Development Summit and the developing countries.

PubMed

Barnabas, A P; Kulkarni, P D; Nanavatty, M C; Singh, R R

1996-01-01

This article discusses some concerns of the 1996 UN Summit on Social Development. Conference organizers identified the three key conference issues as poverty alleviation, social integration of the marginalized and disadvantaged, and expansion of productive employment. The goal of a "society for all" means dealing with the increasing differences between rich and poor countries, the survival of weaker economies in a competitive market system, wide variations in consumption patterns between countries, attainment of political stability while respecting ethnic identity, the rise in social problems among countries with a high human development index, and increasing joblessness. The Human Development Report for 1994 emphasizes human security. Social development is not the equivalent of human resource development nor a side issue of economic growth. The integration of ethnic groups poses social and political problems. There remains a question about what political system and culture would be best for social integration. Developed countries define poverty as the inability of people and government to provide resources and necessary services for people's productive activity. Poverty in developing countries is blamed on colonialism. Globally, developed countries control 71% of world trade. Sharing resources to meet basic needs throughout the world is not an operational ideal. The highest 20% of income earners receive 83% of the world income. The culture of poverty is the strategy used by the poor to survive. Welfare is not an end in itself but does enable the poor to improve their conditions. Development that focuses on productive employment is uncertain. Developed and developing countries do not share similar perceptions of human rights. There is a question as to who should set the priorities for social development. Sustainable social development is related to preservation of natural resources, control of population growth, and promotion of social security.

Cross-National Differences in Psychosocial Factors of Perinatal Depression: A Systematic Review of India and Japan

PubMed Central

Ohashi, Yukiko; Lazarus, Anisha; Kitamura, Toshinori

2017-01-01

Perinatal depression is prevalent worldwide. However, there are few available studies that discuss the different cultural factors affecting perinatal depression within Asian countries. This study aims to compare the literature regarding related factors relating to perinatal depression in India and Japan, and to synthesize the evidence common to both countries in addition to the country-specific evidence. We conducted a systematic review using several databases (CINAHL, MEDLINE, Pubmed, Ovid, SCOPUS, IndMED, and ICHUSI). Keywords were “antenatal depression” or “postpartum depression”, and “India” or “Japan”. Both Japanese and English language papers were reviewed. The identified evidence was compared between the two countries, as well as with non-Asian countries based on previous reports. In total, 15 articles on India and 35 on Japan were reviewed. Although several factors were shared between the two countries as well as with other non-Asian countries (vulnerable personality, being abused, age, marital conflict, and lower socio-demographic status), some differing factors were identified between India and Japan and non-Asian countries; India: poor socioeconomic status, living only with the husband, pregnancy not welcomed by the husband, a female baby, and poor relationship with in-laws; Japan: infertility treatment, conflict with work–life balance, poor relationships with biological mother or in-laws, and concerns about social relations with the other mother’s friends. To conclude, involving the family and community may be important for implementing both global standardized and culture-specific interventions. In India, treatment involving the in-laws may be effective because large family structure is a significant predictor of perinatal depression. In Japan, a family/community approach involving not only the mother’s family of origin but also the working environment is essential. PMID:29207561

[The report of the Commission on Macroeconomics and Health: its relevance to the countries of Latin America and the Caribbean].

PubMed

2002-09-01

The Commission on Macroeconomics and Health (CMH) was established by the Director-General of the World Health Organization (WHO) to evaluate the role of health in economic development. On 20 December 2001 the CMH submitted its report to the WHO Director-General. Entitled Macroeconomics and Health: Investing in Health for Economic Development, the CMH report affirms that in order to reduce poverty; and achieve economic development, it is essential to improve the health of the poor; to accomplish this, it is necessary to expand the access that the poor have to essential health services. The Commission believes that more financial resources are needed, that the health expenditures of less-developed and low-income countries are insufficient for the challenges that these countries face, and that high-income countries must increase their financial assistance in order to help solve the main health problems of less-developed and low-income countries. This piece summarizes a report that was prepared by the Program on Public Policy and Health of the Division of Health and Human Development of the Pan American Health Organization (PAHO). The PAHO document analyzes the importance of the CMH report for the countries of Latin America and the Caribbean, focusing on some of the central arguments put forth in the CMH report as they relate to achieving better health conditions in the Americas. These arguments have been organized around three major themes in the CMH report: a) the relationships between health and economic growth, b) the principal health problems that affect the poor in low-income and low-middle-income#10; countries, and c) the gap between the funding needed to address the principal problems that affect these countries and the actual spending levels. #10;

University Access for Disadvantaged Children: A Comparison across Countries

ERIC Educational Resources Information Center

Jerrim, John; Vignoles, Anna

2015-01-01

In this paper, we consider whether certain countries are particularly adept (or particularly poor) at getting children from disadvantaged homes to study for a bachelor's degree. A series of university access models are estimated for four English-speaking countries (England, Canada, Australia and the USA), which include controls for comparable…

Impact of clinical osteoarthritis of the hip, knee and hand on self-rated health in six European countries: the European Project on OSteoArthritis.

PubMed

van Schoor, N M; Zambon, S; Castell, M V; Cooper, C; Denkinger, M; Dennison, E M; Edwards, M H; Herbolsheimer, F; Maggi, S; Sánchez-Martinez, M; Pedersen, N L; Peter, R; Schaap, L A; Rijnhart, J J M; van der Pas, S; Deeg, D J H

2016-06-01

Osteoarthritis (OA) has been shown to be associated with decreased physical function, which may impact upon a person's self-rated health (SRH). Only a few studies have examined the association between OA and SRH in the general population, but to date none have used a clinical definition of OA. The objectives are: (1) To examine the cross-sectional association between clinical OA and fair-to-poor SRH in the general population; (2) To examine whether this association differs between countries; (3) To examine whether physical function is a mediator in the association between clinical OA and SRH. Baseline data of the European Project on OSteoArthritis (EPOSA) were used, which includes pre-harmonized data from six European cohort studies (n = 2709). Clinical OA was defined according to the American College of Rheumatology criteria. SRH was assessed using one question: How is your health in general? Physical function was assessed using the Western Ontario and McMaster Universities OA Index and Australian/Canadian OA Hand Index. The prevalence of fair-to-poor SRH ranged from 19.8 % in the United Kingdom to 63.5 % in Italy. Although country differences in the strength of the associations were observed, clinical OA of the hip, knee and hand were significantly associated with fair-to-poor SRH in five out of six European countries. In most countries and at most sites, the association between clinical OA and fair-to-poor SRH was partly or fully mediated by physical function. Clinical OA at different sites was related to fair-to-poor SRH in the general population. Most associations were (partly) mediated by physical functioning, indicating that deteriorating physical function in patients with OA should be a point of attention in patient care.

EPIC Studies: Governments Finance, On Average, More Than 50 Percent Of Immunization Expenses, 2010-11.

PubMed

Brenzel, Logan; Schütte, Carl; Goguadze, Keti; Valdez, Werner; Le Gargasson, Jean-Bernard; Guthrie, Teresa

2016-02-01

Governments in resource-poor settings have traditionally relied on external donor support for immunization. Under the Global Vaccine Action Plan, adopted in 2014, countries have committed to mobilizing additional domestic resources for immunization. Data gaps make it difficult to map how well countries have done in spending government resources on immunization to demonstrate greater ownership of programs. This article presents findings of an innovative approach for financial mapping of routine immunization applied in Benin, Ghana, Honduras, Moldova, Uganda, and Zambia. This approach uses modified System of Health Accounts coding to evaluate data collected from national and subnational levels and from donor agencies. We found that government sources accounted for 27-95 percent of routine immunization financing in 2011, with countries that have higher gross national product per capita better able to finance requirements. Most financing is channeled through government agencies and used at the primary care level. Sustainable immunization programs will depend upon whether governments have the fiscal space to allocate additional resources. Ongoing robust analysis of routine immunization should be instituted within the context of total health expenditure tracking. Project HOPE—The People-to-People Health Foundation, Inc.

Editorial comment on Malkin and Keane (2010).

PubMed

Voigt, Herbert F; Krishnan, Shankar M

2010-07-01

Malkin and Keane (Med Biol Eng Comput, 2010) take an innovative approach to determine if unused, broken medical and laboratory equipment could be repaired by volunteers with limited resources. Their positive results led them to suggest that resource-poor countries might benefit from an on-the-job educational program for local high school graduates. The program would train biomedical technician assistants (BTAs) who would repair medical devices and instrumentation and return them to service. This is a program worth pursuing in resource-poor countries.

How Effective Have Thirty Years of Internationally Driven Conservation and Development Efforts Been in Madagascar?

PubMed Central

Wilmé, Lucienne; Mercier, Jean-Roger; Camara, Christian; Lowry, Porter P.

2016-01-01

Conservation and development are intricately linked. The international donor community has long provided aid to tropical countries in an effort to alleviate poverty and conserve biodiversity. While hundreds of millions of $ have been invested in over 500 environmental-based projects in Madagascar during the period covered by a series of National Environmental Action Plans (1993–2008) and the protected areas network has expanded threefold, deforestation remains unchecked and none of the eight Millennium Development Goals (MDGs) established for 2000–2015 were likely be met. Efforts to achieve sustainable development had failed to reduce poverty or deliver progress toward any of the MDGs. Cross-sectorial policy adjustments are needed that (i) enable and catalyze Madagascar’s capacities rather than deepening dependency on external actors such as the World Bank, the International Monetary Fund and donor countries, and that (ii) deliver improvements to the livelihoods and wellbeing of the country’s rural poor. PMID:27532499

Long working hours and health in Europe: Gender and welfare state differences in a context of economic crisis.

PubMed

Artazcoz, Lucía; Cortès, Imma; Benavides, Fernando G; Escribà-Agüir, Vicenta; Bartoll, Xavier; Vargas, Hernán; Borrell, Carme

2016-07-01

This article examines the relationship between moderately long working hours and health status in Europe. A cross-sectional study based on data from the 2010 European Working Conditions Survey (13,518 men and 9381 women) was performed. Working moderately long hours was consistently associated with poor health status and poor psychological wellbeing in countries with traditional family models, in both sexes in Liberal countries and primarily among women in Continental and Southern European countries. A combination of economic vulnerability, increasing labour market deregulation and work overload related to the combination of job and domestic work could explain these findings. Copyright © 2016 Elsevier Ltd. All rights reserved.

Unintended consequences of Helicobacter pylori infection in children in developing countries

PubMed Central

Queiroz, Dulciene MM; Rocha, Andreia MC; Crabtree, Jean E

2013-01-01

Helicobacter pylori infection is predominantly acquired early in life. The prevalence of the infection in childhood is low in developed countries, whereas in developing countries most children are infected by 10 y of age. In poor resource settings, where malnutrition, parasitic/enteropathogen and H. pylori infection co-exist in young children, H. pylori might have potentially more diverse clinical outcomes. This paper reviews the impact of childhood H. pylori infection in developing countries that should now be the urgent focus of future research. The extra-gastric manifestations in early H. pylori infection in infants in poor resource settings might be a consequence of the infection associated initial hypochlorhydria. The potential role of H. pylori infection on iron deficiency, growth impairment, diarrheal disease, malabsorption and cognitive function is discussed in this review. PMID:23988829

Street vending and waste picking in developing countries: a long-standing hazardous occupational activity of the urban poor

PubMed Central

2016-01-01

Uncontrolled urbanization in developing countries has led to widespread urban poverty and increased susceptibility to environmental exposures owing to the hazardous occupational activities of the urban poor. Street vending and waste picking are the dominant works undertaken by the urban poor, and besides the physical hazards, it also exposes them to several pathogens and high levels of air pollutants present in the outdoor environment. The situation has severe consequences for the health of the workers. Eliminating these occupational activities from the urban landscape of developing countries should therefore receive urgent attention from the global health community and governments. In this article, we provide evidence to support this policy recommendation by documenting exposure experiences of the workers, the associated adverse health effects, whilst also outlining measures for addressing the problem sustainably. We conclude that with the adoption of the sustainable development goals (SDG), governments now have a commitment to address poverty and the associated occupational health hazards experienced by the poor through their choices to help achieve the health-related SDG target (3.9) of substantially reducing the number of deaths and illnesses from hazardous chemicals and air, water, and soil pollution and contamination by 2030. PMID:27467691

Street vending and waste picking in developing countries: a long-standing hazardous occupational activity of the urban poor.

PubMed

Amegah, Adeladza Kofi; Jaakkola, Jouni J K

2016-07-01

Uncontrolled urbanization in developing countries has led to widespread urban poverty and increased susceptibility to environmental exposures owing to the hazardous occupational activities of the urban poor. Street vending and waste picking are the dominant works undertaken by the urban poor, and besides the physical hazards, it also exposes them to several pathogens and high levels of air pollutants present in the outdoor environment. The situation has severe consequences for the health of the workers. Eliminating these occupational activities from the urban landscape of developing countries should therefore receive urgent attention from the global health community and governments. In this article, we provide evidence to support this policy recommendation by documenting exposure experiences of the workers, the associated adverse health effects, whilst also outlining measures for addressing the problem sustainably. We conclude that with the adoption of the sustainable development goals (SDG), governments now have a commitment to address poverty and the associated occupational health hazards experienced by the poor through their choices to help achieve the health-related SDG target (3.9) of substantially reducing the number of deaths and illnesses from hazardous chemicals and air, water, and soil pollution and contamination by 2030.

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.

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

The paradox of nutrition-related diseases in the Arab countries: the need for action.

PubMed

Musaiger, Abdulrahman O; Hassan, Abdelmonem S; Obeid, Omar

2011-09-01

The aim of this review was to highlight the current situation of nutrition-related diseases in the Arab countries, and factors associated with prevalence of these diseases. PubMed and Google Scholar were searched for data relating to such nutrition-related diseases published between January 1990 and May 2011. The picture of nutritional status in the Arab countries has changed drastically over the past 30 years as a result of changes in the social and economic situation. Two contrasting nutrition-related diseases exist, those associated with inadequate intake of nutrients and unhealthy dietary habits such as growth retardation among young children and micronutrient deficiencies; and those associated with changes in lifestyle such as cardiovascular disease, cancer, osteoporosis, diabetes and obesity (diet-related non-communicable diseases). Factors contributing to nutritional problems vary from country to country, depending on socio-economic status. In general, unsound dietary habits, poor sanitation, poverty, ignorance and lack of access to safe water and health services are mainly responsible for under-nutrition. Changes in lifestyle and dietary habits as well as inactivity are associated with the occurrence of diet-related non-communicable diseases. Programs to prevent and control nutrition-related diseases are insufficient and ineffective, due mainly to a focus on curative care at the expense of preventive health care services, lack of epidemiological studies, lack of nutritional surveillance, inadequate nutrition information and lack of assessment of the cost-effectiveness of nutrition intervention programs.

Global approach to reducing lead exposure and poisoning.

PubMed

Meyer, Pamela A; Brown, Mary Jean; Falk, Henry

2008-01-01

Lead poisoning is an important environmental disease that can have life-long adverse health effects. Most susceptible are children, and most commonly exposed are those who are poor and live in developing countries. Studies of children's blood-lead levels (BLLs) are showing cognitive impairment at increasingly lower BLLs. Lead is dangerous at all levels in children. The sources of lead exposure vary among and within countries depending on past and current uses. Sources of lead may be from historic contamination, recycling old lead products, or from manufacturing new products. In all countries that have banned leaded gasoline, average population BLLs have declined rapidly. In many developing countries where leaded gasoline is no longer used, many children and workers are exposed to fugitive emissions and mining wastes. Unexpected lead threats, such as improper disposal of electronics and children's toys contaminated with lead, continue to emerge. The only medical treatment available is chelation, which can save lives of persons with very high BLLs. However, chelating drugs are not always available in developing countries and have limited value in reducing the sequelae of chronic low dose lead exposure. Therefore, the best approach is to prevent exposure to lead. Because a key strategy for preventing lead poisoning is to identify and control or eliminate lead sources, this article highlights several major sources of lead poisoning worldwide. In addition, we recommend three primary prevention strategies for lead poisoning: identify sources, eliminate or control sources, and monitor environmental exposures and hazards.

The Paradox of Nutrition-Related Diseases in the Arab Countries: The Need for Action

PubMed Central

Musaiger, Abdulrahman O.; Hassan, Abdelmonem S.; Obeid, Omar

2011-01-01

The aim of this review was to highlight the current situation of nutrition-related diseases in the Arab countries, and factors associated with prevalence of these diseases. PubMed and Google Scholar were searched for data relating to such nutrition-related diseases published between January 1990 and May 2011. The picture of nutritional status in the Arab countries has changed drastically over the past 30 years as a result of changes in the social and economic situation. Two contrasting nutrition-related diseases exist, those associated with inadequate intake of nutrients and unhealthy dietary habits such as growth retardation among young children and micronutrient deficiencies; and those associated with changes in lifestyle such as cardiovascular disease, cancer, osteoporosis, diabetes and obesity (diet-related non-communicable diseases). Factors contributing to nutritional problems vary from country to country, depending on socio-economic status. In general, unsound dietary habits, poor sanitation, poverty, ignorance and lack of access to safe water and health services are mainly responsible for under-nutrition. Changes in lifestyle and dietary habits as well as inactivity are associated with the occurrence of diet-related non-communicable diseases. Programs to prevent and control nutrition-related diseases are insufficient and ineffective, due mainly to a focus on curative care at the expense of preventive health care services, lack of epidemiological studies, lack of nutritional surveillance, inadequate nutrition information and lack of assessment of the cost-effectiveness of nutrition intervention programs. PMID:22016708

Psychosocial work characteristics and self rated health in four post-communist countries.

PubMed

Pikhart, H; Bobak, M; Siegrist, J; Pajak, A; Rywik, S; Kyshegyi, J; Gostautas, A; Skodova, Z; Marmot, M

2001-09-01

To examine whether psychosocial factors at work are related to self rated health in post-communist countries. Random samples of men and women in five communities in four countries were sent a postal questionnaire (Poland, Czech Republic and Lithuania) or were invited to an interview (Hungary). Working subjects (n=3941) reported their self rated health in the past 12 months (5 point scale), their socioeconomic circumstances, perceived control over life, and the following aspects of the psychosocial work environment: job control, job demand, job variety, social support, and effort and reward at work (to calculate a ratio of effort/reward imbalance). As the results did not differ by country, pooled analyses were performed. Odds ratios of poor or very poor health ("poor health") were estimated for a 1 SD increase in the scores of work related factors. The overall prevalence of poor health was 6% in men and 7% in women. After controlling for age, sex and community, all work related factors were associated with poor health (p<0.05). After further adjustment for perceived control, only two work related factors remained associated with poor health; the odds ratios (95% confidence intervals) for 1 SD increase in the effort/reward ratio (log transformed) and job variety were 1.51 (1.29, 1.78) and 0.82 (0.73, 1.00), respectively. Further adjustment for all work related factors did not change these estimates. There were no interactions between individual work related factors, but the effects of job control and social support at work differed by marital status, and the odds ratio of job demand increased with increasing education. The continuous measure of effort/reward imbalance at work was a powerful determinant of self rated health in these post-communist populations. Although the cross sectional design does not allow firm conclusions as to causality, this study suggests that the effect of the psychosocial work environment is not confined to Western populations.

Disaster Risk Transfer for Developing Countries

NASA Astrophysics Data System (ADS)

Linneroothbayer, J.; Mechler, R.; Pflug, G.; Hochrainer, S.

2005-12-01

Financing disaster recovery often diverts resources from development, which can have long-term effects on economic growth and the poor in developing countries. Moreover, post-disaster assistance, while important for humanitarian reasons, has failed to meet the needs of developing countries in reducing their exposure to disaster risks and assuring sufficient funds to governments and individuals for financing the recovery process. The authors argue that part of disaster aid should be refocused from post-disaster to pre-disaster assistance including financial disaster risk management. Such assistance is now possible with new modeling techniques for estimating and pricing risks of natural disasters coupled with the advent of novel insurance instruments for transferring catastrophe risk to the global financial markets. The authors illustrate the potential for risk transfer in developing countries using the IIASA CATSIM model, which shows the potential impacts of disasters on economic growth in selected developing countries and the pros and cons of financial risk management to reduce those adverse impacts. The authors conclude by summarizing the advantages of investing in risk-transfer instruments (coupled with preventive measures) as an alternative to traditional post-disaster donor assistance. Donor-supported risk-transfer programs would not only leverage limited disaster aid budgets, but would also free recipient countries from depending on the vagaries of post-disaster assistance. Both the donors and the recipients stand to gain, especially since the instruments can be designed to encourage preventive measures. Precedents already exist for imaginative risk-transfer programs in highly exposed developing countries, including national insurance systems, micro-insurance schemes like weather derivatives and novel instruments (e.g., catastrophe bonds) to provide insurance cover for public sector risks.

Estimation of the global burden of mesothelioma deaths from incomplete national mortality data.

PubMed

Odgerel, Chimed-Ochir; Takahashi, Ken; Sorahan, Tom; Driscoll, Tim; Fitzmaurice, Christina; Yoko-O, Makoto; Sawanyawisuth, Kittisak; Furuya, Sugio; Tanaka, Fumihiro; Horie, Seichi; Zandwijk, Nico van; Takala, Jukka

2017-12-01

Mesothelioma is increasingly recognised as a global health issue and the assessment of its global burden is warranted. To descriptively analyse national mortality data and to use reported and estimated data to calculate the global burden of mesothelioma deaths. For the study period of 1994 to 2014, we grouped 230 countries into 59 countries with quality mesothelioma mortality data suitable to be used for reference rates, 45 countries with poor quality data and 126 countries with no data, based on the availability of data in the WHO Mortality Database. To estimate global deaths, we extrapolated the gender-specific and age-specific mortality rates of the countries with quality data to all other countries. The global numbers and rates of mesothelioma deaths have increased over time. The 59 countries with quality data recorded 15 011 mesothelioma deaths per year over the 3 most recent years with available data (equivalent to 9.9 deaths per million per year). From these reference data, we extrapolated the global mesothelioma deaths to be 38 400 per year, based on extrapolations for asbestos use. Although the validity of our extrapolation method depends on the adequate identification of quality mesothelioma data and appropriate adjustment for other variables, our estimates can be updated, refined and verified because they are based on commonly accessible data and are derived using a straightforward algorithm. Our estimates are within the range of previously reported values but higher than the most recently reported values. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Work stress and health in Western European and post-communist countries: an East-West comparison study.

PubMed

Salavecz, G; Chandola, T; Pikhart, H; Dragano, N; Siegrist, J; Jöckel, K-H; Erbel, R; Pajak, A; Malyutina, S; Kubinova, R; Marmot, M; Bobak, M; Kopp, M

2010-01-01

There is evidence that psychosocial factors at work influence the risk of poor health in Western societies, but little is known about the effect of work stress in the former communist countries. The aim of this paper is to compare the association of work stress with self-rated health in Western European and post-communist countries. Data from four epidemiological studies were used: the HAPIEE study (Poland, Russia and the Czech Republic), the Hungarian Epidemiological Panel (Hungary), the Heinz Nixdorf Recall study (Germany) and the Whitehall II study (UK). The overall sample consisted of 18 494 male and female workers aged 35-65 years. High effort-reward imbalance at work was associated with poor self-rated health. The adjusted odds ratios for the highest versus lowest quartile of the effort-reward ratio were 3.8 (95% CI 1.9 to 7.7) in Hungary, 3.6 (95% CI 2.3 to 5.7) in the Czech Republic, 2.5 (95% CI 1.5 to 4.1) in the UK, 2.3 (95% CI 1.6 to 3.5) in Germany, 1.5 (95% CI 1.0 to 2.1) in Poland and 1.4 (95% CI 1.1 to 1.8) in Russia. The differences in odds ratios between countries were statistically significant (p<0.05). A similar pattern was observed for the effect of overcommitment on poor health. The association of effort-reward imbalance at work and of a high degree of work-related overcommitment with poor self-rated health was seen in all countries, but the size of the effects differed considerably. It does not appear that the effects in Eastern Europe are systematically stronger than in the West.

Work stress and health in Western European and post-communist countries: an East–West comparison study

PubMed Central

Salavecz, G; Chandola, T; Pikhart, H; Dragano, N; Siegrist, J; Jöckel, K-H; Erbel, R; Pajak, A; Malyutina, S; Kubinova, R; Marmot, M; Bobak, M; Kopp, M

2014-01-01

Background There is evidence that psychosocial factors at work influence the risk of poor health in Western societies, but little is known about the effect of work stress in the former communist countries. The aim of this paper is to compare the association of work stress with self-rated health in Western European and post-communist countries. Methods Data from four epidemiological studies were used: the HAPIEE study (Poland, Russia and the Czech Republic), the Hungarian Epidemiological Panel (Hungary), the Heinz Nixdorf Recall study (Germany) and the Whitehall II study (UK). The overall sample consisted of 18 494 male and female workers aged 35–65 years. Results High effort-reward imbalance at work was associated with poor self-rated health. The adjusted odds ratios for the highest versus lowest quartile of the effort-reward ratio were 3.8 (95% CI 1.9 to 7.7) in Hungary, 3.6 (95% CI 2.3 to 5.7) in the Czech Republic, 2.5 (95% CI 1.5 to 4.1) in the UK, 2.3 (95% CI 1.6 to 3.5) in Germany, 1.5 (95% CI 1.0 to 2.1) in Poland and 1.4 (95% CI 1.1 to 1.8) in Russia. The differences in odds ratios between countries were statistically significant (p<0.05). A similar pattern was observed for the effect of overcommitment on poor health. Conclusion The association of effort-reward imbalance at work and of a high degree of work-related overcommitment with poor self-rated health was seen in all countries, but the size of the effects differed considerably. It does not appear that the effects in Eastern Europe are systematically stronger than in the West. PMID:19692735

A global study on lone mothers: exploring the associations of self-assessed general health with motherhood types and gender inequality in 32 countries.

PubMed

Witvliet, Margot I; Arah, Onyebuchi A; Stronks, Karien; Kunst, Anton E

2014-01-01

In a study of 32 mostly non-affluent countries, we aimed to i) compare lone mother's general health to the health of other women and ii) assess whether the association of health with gender inequality was stronger among lone mothers than among other women. World Health Survey data were analyzed on 57,182 women aged 18 to 50 in 32 countries. The main outcome was self-assessed general poor health. The Global Gender Gap Index (GGGI) was used to measure the magnitude of gender inequality within countries. Logistic multilevel regression was used to compare the health of different groups of women, and to study the possible influence of gender inequality. Compared with all other women, lone mothers had the highest odds of poor health odds ratio (OR, 1.15; 95% confidence interval [CI], 1.09-1.22), also at 35 years or older with an OR of 1.18 (95% CI, 1.10-1.27). Lone mothers in Ethiopia and Tunisia had the highest odds of reporting poor health (OR, 1.65 [95% CI, 1.21-2.26] and OR, 1.57 [95% CI, 0.92-2.68], respectively). The degree of gender inequality was weakly related to cross-national variations in health of women. These associations were about similar for all women. For example, the OR for the GGGI was 1.03 for all women except coupled mothers. As within North America, lone mothers in non-affluent countries tend to have higher rates of poor health. The degree of gender inequality is not related to the relative health of lone mothers, suggesting that other characteristics of nations might be more influential. Copyright © 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Estimated Under-Five Deaths Associated with Poor-Quality Antimalarials in Sub-Saharan Africa

PubMed Central

Renschler, John P.; Walters, Kelsey M.; Newton, Paul N.; Laxminarayan, Ramanan

2015-01-01

Many antimalarials sold in sub-Saharan Africa are poor-quality (falsified, substandard, or degraded), and the burden of disease caused by this problem is inadequately quantified. In this article, we estimate the number of under-five deaths caused by ineffective treatment of malaria associated with consumption of poor-quality antimalarials in 39 sub-Saharan countries. Using Latin hypercube sampling our estimates were calculated as the product of the number of private sector antimalarials consumed by malaria-positive children in 2013; the proportion of private sector antimalarials consumed that were of poor-quality; and the case fatality rate (CFR) of under-five malaria-positive children who did not receive appropriate treatment. An estimated 122,350 (interquartile range [IQR]: 91,577–154,736) under-five malaria deaths were associated with consumption of poor-quality antimalarials, representing 3.75% (IQR: 2.81–4.75%) of all under-five deaths in our sample of 39 countries. There is considerable uncertainty surrounding our results because of gaps in data on case fatality rates and prevalence of poor-quality antimalarials. Our analysis highlights the need for further investigation into the distribution of poor-quality antimalarials and the need for stronger surveillance and regulatory efforts to prevent the sale of poor-quality antimalarials. PMID:25897068

Contextual Determinants of School Teaching Intensity in the Teaching of Adult Immigrant Students

ERIC Educational Resources Information Center

Christophersen, Knut-Andreas; Elstad, Eyvind; Turmo, Are

2011-01-01

The integration policies in some Northern European countries display relatively poor outcomes of passed exam rates for immigrant language training, and several groups of immigrants have very low employment rates. These measures, in many countries, are strong incentives for host-country language acquisition in addition to the obligation to document…

Education for Agriculture and Rural Development in Low-Income Countries: Implications of the Digital Divide.

ERIC Educational Resources Information Center

Gasperini, Lavinia; Mclean, Scott

The "digital divide" refers to inequitable access to information and communication technologies (ICTs) between wealthy and poor countries and between privileged and underprivileged social groups within all countries. This presentation outlines global parameters of the digital divide, discusses the use of ICTs in education in…

Current obstacles to organ transplant in Middle Eastern countries.

PubMed

Shaheen, Faissal A M; Souqiyyeh, Muhammad Ziad

2015-04-01

The Middle Eastern map includes all the Arab countries, Iran, Turkey, Pakistan, and countries of Central Asia. There are common features of organ transplant in these countries such as inadequate preventive medicine, uneven health infrastructure, poor awareness of the medical community and public about the importance of organ donation and transplant, high level of ethnicity, poor government support of organ transplant, and political unrest. In addition, there is inadequate team spirit among transplant physicians, lack of planning for organ procurement and transplant centers, and lack of effective health insurance. Living-donor organ transplant is the most widely practiced type of transplant in the Middle East. Deceased-donor organ donation is not used properly because of continued debate in the medical community about the concept of death according to neurologic criteria (brain death) and inadequate awareness of the public about the importance of organ donation and transplant in many countries in this region. Continuous work is needed to provide solutions to overcome the current obstacles.

Trends in coal use - global, EU and Poland

NASA Astrophysics Data System (ADS)

Suwała, Wojciech; Wyrwa, Artur; Olkuski, Tadeusz

2017-11-01

That aim of this paper is to compare trends in global, European use of coal with tendencies in Poland, one of heavy coal dependent countries. Polish power generation is unique among OECD countries, the share of both hard coal and lignite in power generation reaches 81% [1]. Climate policy of European Union is to phase out intensive greenhouse gases sectors, thus to transform Polish power generation into less carbon intensive. Although such policy is generally accepted in Poland, the paste and practically proposed regulation that excludes coal generation from capacity mechanisms, is considered as threat to energy security. Coal is the base for generation for one simple reason, abundant in European scale hard coal reserves and significant capacities in lignite. Natural gas reserves allow to supply about 1/3 of consumption, but prices and supplies dependent hitherto on contracts with GAZPROM did not allow to develop significant generation capacities. Renewable resources are limited, there is not much possibilities for hydro, wind and solar. Poland is also one of the countries of poor air quality, traditional coal based space heating systems plus obsolete car fleet generate vast emissions, especially during the winter. Only recently this became top priority of environmental authorities. This situation is subject to transformation, government, managers are aware that the role of coal needs to be decreased, but there are two main questions, the paste of transformation and the future energy mix. The paper attempts to answer the question whether the expected changes in Polish energy mix are comparable or differ from the global and European tendencies.

Quality of work, well-being, and intended early retirement of older employees: baseline results from the SHARE Study.

PubMed

Siegrist, Johannes; Wahrendorf, Morten; von dem Knesebeck, Olaf; Jürges, Hendrik; Börsch-Supan, Axel

2007-02-01

Given the challenge of a high proportion of older employees who retire early from work we analyse associations of indicators of a poor psychosocial quality of work with intended premature departure from work in a large sample of older male and female employees in 10 European countries. Baseline data from the 'Survey of Health, Ageing and Retirement in Europe' (SHARE) were obtained from 3523 men and 3318 women in 10 European countries. Data on intended early retirement, four measures of well-being (self-rated health, depressive symptoms, general symptom load, and quality of life), and quality of work (effort-reward imbalance; low control at work) were obtained from structured interviews and questionnaires. Country-specific and total samples are analysed, using logistic regression analysis. Poor quality of work is significantly associated with intended early retirement. After adjustment for well-being odds ratios (OR) of effort-reward imbalance [OR 1.72 (1.43-2.08)] and low control at work [OR 1.51 (1.27-1.80)] on intended early retirement are observed. Poor quality of work and reduced well-being are independently associated with the intention to retire from work. The consistent association of a poor psychosocial quality of work with intended early retirement among older employees across all European countries under study calls for improved investments into better quality of work, in particular increased control and an appropriate balance between efforts spent and rewards received at work.

Multidimensional poverty and catastrophic health spending in the mountainous regions of Myanmar, Nepal and India.

PubMed

Mohanty, Sanjay K; Agrawal, Nand Kishor; Mahapatra, Bidhubhusan; Choudhury, Dhrupad; Tuladhar, Sabarnee; Holmgren, E Valdemar

2017-01-18

Economic burden to households due to out-of-pocket expenditure (OOPE) is large in many Asian countries. Though studies suggest increasing household poverty due to high OOPE in developing countries, studies on association of multidimensional poverty and household health spending is limited. This paper tests the hypothesis that the multidimensionally poor are more likely to incur catastrophic health spending cutting across countries. Data from the Poverty and Vulnerability Assessment (PVA) Survey carried out by the International Center for Integrated Mountain Development (ICIMOD) has been used in the analyses. The PVA survey was a comprehensive household survey that covered the mountainous regions of India, Nepal and Myanmar. A total of 2647 households from India, 2310 households in Nepal and 4290 households in Myanmar covered under the PVA survey. Poverty is measured in a multidimensional framework by including the dimensions of education, income and energy, water and sanitation using the Alkire and Foster method. Health shock is measured using the frequency of illness, family sickness and death of any family member in a reference period of one year. Catastrophic health expenditure is defined as 40% above the household's capacity to pay. Results suggest that about three-fifths of the population in Myanmar, two-fifths of the population in Nepal and one-third of the population in India are multidimensionally poor. About 47% of the multidimensionally poor in India had incurred catastrophic health spending compared to 35% of the multidimensionally non-poor and the pattern was similar in both Nepal and Myanmar. The odds of incurring catastrophic health spending was 56% more among the multidimensionally poor than among the multidimensionally non-poor [95% CI: 1.35-1.76]. While health shocks to households are consistently significant predictors of catastrophic health spending cutting across country of residence, the educational attainment of the head of the household is not significant. The multidimensionally poor in the poorer regions are more likely to face health shocks and are less likely to afford professional health services. Increasing government spending on health and increasing households' access to health insurance can reduce catastrophic health spending and multidimensional poverty.

Ecology of Freedom: Competitive Tests of the Role of Pathogens, Climate, and Natural Disasters in the Development of Socio-Political Freedom

PubMed Central

Kusano, Kodai; Kemmelmeier, Markus

2018-01-01

Many countries around the world embrace freedom and democracy as part of their political culture. However, culture is at least in part a human response to the ecological challenges that a society faces; hence, it should not be surprising that the degree to which societies regulate the level of individual freedom is related to environmental circumstances. Previous research suggests that levels of societal freedom across countries are systematically related to three types of ecological threats: prevalence of pathogens, climate challenges, and natural disaster threat. Though their incidence overlaps, the literature has not yet provided a competitive test. Drawing upon the ecocultural framework, we tested five rival hypotheses, alternately focused on the above ecological factors and their interactions with economic wealth in explaining country variations in socio-political freedom. Focusing on data from 150 countries, we performed a series of linear mixed-effects regressions predicting freedom in the domains of politics, media, and economy. We found that countries with higher pathogen prevalence were more likely to suppress democracy and media freedom. Economic wealth, however, moderated the effect of pathogen prevalence on economic freedom, with the main effect being only found among wealthy countries, but not among poor countries. In contrast, natural disaster threat predicted political freedom and press freedom only among poor countries, consistent with the idea that disaster threat accompanied by poor resources promote socio-political freedom as a means of increasing collective survival. Throughout our analyses, we found no support for hypotheses based on climatic challenges. In addition, our multilevel approach revealed that country scores for socio-political freedom were highly clustered within world regions, accounting for substantial portions of variance. Overall, the present research offers a nuanced view of the interplay between ecology and wealth in the emergence of socio-political freedom. We discuss new directions in future research considering methodological and theoretical contributions of the present findings.

The disproportionate high risk of HIV infection among the urban poor in sub-Saharan Africa.

PubMed

Magadi, Monica A

2013-06-01

The link between HIV infection and poverty in sub-Saharan Africa (SSA) is rather complex and findings from previous studies remain inconsistent. While some argue that poverty increases vulnerability, existing empirical evidence largely support the view that wealthier men and women have higher prevalence of HIV. In this paper, we examine the association between HIV infection and urban poverty in SSA, paying particular attention to differences in risk factors of HIV infection between the urban poor and non-poor. The study is based on secondary analysis of data from the Demographic and Health Surveys from 20 countries in SSA, conducted during 2003-2008. We apply multilevel logistic regression models, allowing the urban poverty risk factor to vary across countries to establish the extent to which the observed patterns are generalizable across countries in the SSA region. The results reveal that the urban poor in SSA have significantly higher odds of HIV infection than their urban non-poor counterparts, despite poverty being associated with a significantly lower risk among rural residents. Furthermore, the gender disparity in HIV infection (i.e. the disproportionate higher risk among women) is amplified among the urban poor. The paper confirms that the public health consequence of urban poverty that has been well documented in previous studies with respect to maternal and child health outcomes does apply to the risk of HIV infection. The positive association between household wealth and HIV prevalence observed in previous studies largely reflects the situation in the rural areas where the majority of the SSA populations reside.

Comparison of two cash transfer strategies to prevent catastrophic costs for poor tuberculosis-affected households in low- and middle-income countries: An economic modelling study.

PubMed

Rudgard, William E; Evans, Carlton A; Sweeney, Sedona; Wingfield, Tom; Lönnroth, Knut; Barreira, Draurio; Boccia, Delia

2017-11-01

Illness-related costs for patients with tuberculosis (TB) ≥20% of pre-illness annual household income predict adverse treatment outcomes and have been termed "catastrophic." Social protection initiatives, including cash transfers, are endorsed to help prevent catastrophic costs. With this aim, cash transfers may either be provided to defray TB-related costs of households with a confirmed TB diagnosis (termed a "TB-specific" approach); or to increase income of households with high TB risk to strengthen their economic resilience (termed a "TB-sensitive" approach). The impact of cash transfers provided with each of these approaches might vary. We undertook an economic modelling study from the patient perspective to compare the potential of these 2 cash transfer approaches to prevent catastrophic costs. Model inputs for 7 low- and middle-income countries (Brazil, Colombia, Ecuador, Ghana, Mexico, Tanzania, and Yemen) were retrieved by literature review and included countries' mean patient TB-related costs, mean household income, mean cash transfers, and estimated TB-specific and TB-sensitive target populations. Analyses were completed for drug-susceptible (DS) TB-related costs in all 7 out of 7 countries, and additionally for drug-resistant (DR) TB-related costs in 1 of the 7 countries with available data. All cost data were reported in 2013 international dollars ($). The target population for TB-specific cash transfers was poor households with a confirmed TB diagnosis, and for TB-sensitive cash transfers was poor households already targeted by countries' established poverty-reduction cash transfer programme. Cash transfers offered in countries, unrelated to TB, ranged from $217 to $1,091/year/household. Before cash transfers, DS TB-related costs were catastrophic in 6 out of 7 countries. If cash transfers were provided with a TB-specific approach, alone they would be insufficient to prevent DS TB catastrophic costs in 4 out of 6 countries, and when increased enough to prevent DS TB catastrophic costs would require a budget between $3.8 million (95% CI: $3.8 million-$3.8 million) and $75 million (95% CI: $50 million-$100 million) per country. If instead cash transfers were provided with a TB-sensitive approach, alone they would be insufficient to prevent DS TB-related catastrophic costs in any of the 6 countries, and when increased enough to prevent DS TB catastrophic costs would require a budget between $298 million (95% CI: $219 million-$378 million) and $165,367 million (95% CI: $134,085 million-$196,425 million) per country. DR TB-related costs were catastrophic before and after TB-specific or TB-sensitive cash transfers in 1 out of 1 countries. Sensitivity analyses showed our findings to be robust to imputation of missing TB-related cost components, and use of 10% or 30% instead of 20% as the threshold for measuring catastrophic costs. Key limitations were using national average data and not considering other health and social benefits of cash transfers. A TB-sensitive cash transfer approach to increase all poor households' income may have broad benefits by reducing poverty, but is unlikely to be as effective or affordable for preventing TB catastrophic costs as a TB-specific cash transfer approach to defray TB-related costs only in poor households with a confirmed TB diagnosis. Preventing DR TB-related catastrophic costs will require considerable additional investment whether a TB-sensitive or a TB-specific cash transfer approach is used.

Changing Patterns of Access to Education in Anglophone and Francophone Countries in Sub Saharan Africa: Is Education for All Pro-Poor? CREATE Pathways to Access. Research Monograph No. 52

ERIC Educational Resources Information Center

Lewin, Keith M.; Sabates, Ricardo

2011-01-01

This paper explores patterns of growth in participation in six Anglophone and seven Francophone countries in SSA. The countries are Kenya, Malawi, Nigeria, Tanzania, Uganda, Zambia, Benin, Burkina Faso, Cameroon, Madagascar, Mali, Niger and Senegal. These countries all have large scale Universal Primary Education programmes and all have…

Nursing shortages and international nurse migration.

PubMed

Ross, S J; Polsky, D; Sochalski, J

2005-12-01

The United Kingdom and the United States are among several developed countries currently experiencing nursing shortages. While the USA has not yet implemented policies to encourage nurse immigration, nursing shortages will likely result in the growth of foreign nurse immigration to the USA. Understanding the factors that drive the migration of nurses is critical as the USA exerts more pull on the foreign nurse workforce. To predict the international migration of nurses to the UK using widely available data on country characteristics. The Nursing and Midwifery Council serves as the source of data on foreign nurse registrations in the UK between 1998 and 2002. We develop and test a regression model that predicts the number of foreign nurse registrants in the UK based on source country characteristics. We collect country-level data from sources such as the World Bank and the World Health Organization. The shortage of nurses in the UK has been accompanied by massive and disproportionate growth in the number of foreign nurses from poor countries. Low-income, English-speaking countries that engage in high levels of bilateral trade experience greater losses of nurses to the UK. Poor countries seeking economic growth through international trade expose themselves to the emigration of skilled labour. This tendency is currently exacerbated by nursing shortages in developed countries. Countries at risk for nurse emigration should adjust health sector planning to account for expected losses in personnel. Moreover, policy makers in host countries should address the impact of recruitment on source country health service delivery.

Opportunities for a forest energy industry in a developing country: an example from Moldova

Treesearch

Vitalie Gulca; Robert Deal

2010-01-01

Developing sustainable energy from forest biomass presents both opportunities and challenges for the future generations of Moldova. Located in the southeastern part of Europe between Ukraine and Romania, Moldova is a relatively poor country with limited natural resources compared with other developing European countries such as Albania or Bosnia. This lack of fossil...

Caught between Internationalisation and Immigration: The Case of Nepalese Students in Denmark

ERIC Educational Resources Information Center

Valentin, Karen

2012-01-01

An explicit marketisation and national profiling of Denmark as an attractive country for foreign students has resulted in an increasing number of students from poor countries in the global South, including Nepal, being admitted to Danish colleges and universities. The influx of students from these countries has led to several accusations against…

Dire need of changes in the methods for assessing university faculty productivity in developing countries.

PubMed

Sheikh, Ali Sibtain Farooq; Mohamed, Mona Adel

2015-01-01

Publishing has become a necessity for promotion of faculty in academia. The faculties in developing countries face considerable difficulties publishing due to their prime focus on clinical approaches and resources for proper research. This often leaves no room for the pressured clinicians but to pursue poor quality publications just for the sake of promotion when the time for their promotion comes. The authors suggest establishing separate promotion tracks besides research in these underprivileged areas in order to avoid infestation of original research with poor ones.

Impact of savings groups on the lives of the poor

PubMed Central

Karlan, Dean; Savonitto, Beniamino; Thuysbaert, Bram; Udry, Christopher

2017-01-01

Savings-led microfinance programs operate in poor rural communities in developing countries to establish groups that save and then lend out the accumulated savings to each other. Nonprofit organizations train villagers to create and lead these groups. In a clustered randomized evaluation spanning three African countries (Ghana, Malawi, and Uganda), we find that the promotion of these community-based microfinance groups leads to an improvement in household business outcomes and women’s empowerment. However, we do not find evidence of impacts on average consumption or other livelihoods. PMID:28270615

Path Dependence and Universal Health Coverage: The Case of Egypt

PubMed Central

Fouda, Ayman; Paolucci, Francesco

2017-01-01

Universal health coverage (UHC) is the big objective in health policy which several countries are seeking to achieve. Egypt is no different and its endeavors to attain UHC have been going on since the 1960s. This article discusses the status of UHC in Egypt using theories of political science and economics by analyzing the historical transformations in the Egyptian health system and its institutional settings. This article then specifically examines the path dependence theory against the sociopolitical background of Egypt and assesses any pattern between the theory and the current UHC status in Egypt. The important finding of this analysis is that the health policies and reforms in Egypt have been significantly influenced and limited by its historical institutional structure and development. Both the health policies and the institutional settings adopted a dependent path that limited Egypt’s endeavors to achieve the universal coverage. This dependent path also yielded many of the present-day challenges as in the weaknesses of the healthcare financing system and the inability to extend health coverage to the poor and the informal sector. These challenges subsequently had a negative impact on the accessibility of the healthcare services. PMID:29276704

Surveillance guidelines for disease elimination: A case study of canine rabies

PubMed Central

Townsend, Sunny E.; Lembo, Tiziana; Cleaveland, Sarah; Meslin, François X.; Miranda, Mary Elizabeth; Putra, Anak Agung Gde; Haydon, Daniel T.; Hampson, Katie

2013-01-01

Surveillance is a critical component of disease control programmes but is often poorly resourced, particularly in developing countries lacking good infrastructure and especially for zoonoses which require combined veterinary and medical capacity and collaboration. Here we examine how successful control, and ultimately disease elimination, depends on effective surveillance. We estimated that detection probabilities of <0.1 are broadly typical of rabies surveillance in endemic countries and areas without a history of rabies. Using outbreak simulation techniques we investigated how the probability of detection affects outbreak spread, and outcomes of response strategies such as time to control an outbreak, probability of elimination, and the certainty of declaring freedom from disease. Assuming realistically poor surveillance (probability of detection <0.1), we show that proactive mass dog vaccination is much more effective at controlling rabies and no more costly than campaigns that vaccinate in response to case detection. Control through proactive vaccination followed by 2 years of continuous monitoring and vaccination should be sufficient to guarantee elimination from an isolated area not subject to repeat introductions. We recommend that rabies control programmes ought to be able to maintain surveillance levels that detect at least 5% (and ideally 10%) of all cases to improve their prospects of eliminating rabies, and this can be achieved through greater intersectoral collaboration. Our approach illustrates how surveillance is critical for the control and elimination of diseases such as canine rabies and can provide minimum surveillance requirements and technical guidance for elimination programmes under a broad-range of circumstances. PMID:23260376

Socioeconomic inequality in domains of health: results from the World Health Surveys

PubMed Central

2012-01-01

Background In all countries people of lower socioeconomic status evaluate their health more poorly. Yet in reporting overall health, individuals consider multiple domains that comprise their perceived health state. Considered alone, overall measures of self-reported health mask differences in the domains of health. The aim of this study is to compare and assess socioeconomic inequalities in each of the individual health domains and in a separate measure of overall health. Methods Data on 247,037 adults aged 18 or older were analyzed from 57 countries, drawn from all national income groups, participating in the World Health Survey 2002-2004. The analysis was repeated for lower- and higher-income countries. Prevalence estimates of poor self-rated health (SRH) were calculated for each domain and for overall health according to wealth quintiles and education levels. Relative socioeconomic inequalities in SRH were measured for each of the eight health domains and for overall health, according to wealth quintiles and education levels, using the relative index of inequality (RII). A RII value greater than one indicated greater prevalence of self-reported poor health among populations of lower socioeconomic status, called pro-rich inequality. Results There was a descending gradient in the prevalence of poor health, moving from the poorest wealth quintile to the richest, and moving from the lowest to the highest educated groups. Inequalities which favor groups who are advantaged either with respect to wealth or education, were consistently statistically significant in each of the individual domains of health, and in health overall. However the size of these inequalities differed between health domains. The prevalence of reporting poor health was higher in the lower-income country group. Relative socioeconomic inequalities in the health domains and overall health were higher in the higher-income country group than the lower-income country group. Conclusions Using a common measurement approach, inequalities in health, favoring the rich and the educated, were evident in overall health as well as in every health domain. Existent differences in averages and inequalities in health domains suggest that monitoring should not be limited only to overall health. This study carries important messages for policy-making in regard to tackling inequalities in specific domains of health. Targeting interventions towards individual domains of health such as mobility, self-care and vision, ought to be considered besides improving overall health. PMID:22429978

Pharmacological strategies for the management of cancer pain in developing countries

PubMed Central

Omoti, Afekhide E.; Omoti, Caroline E.

Pain associated with cancer is often under treated especially in the developing countries where there are problems of poor economy, poor purchasing power of the citizens, absence of effective national health insurance schemes, poor manpower, fake adulterated and expired drugs, poor drug storage conditions; adverse temperature conditions combined with poor power supply which may affect drug efficacy. There is also poor understanding of the physiopharmacology of cancer pain management by health care providers. Assessment of the severity of the pain by location, oncological type, as well as psychosocial, emotional and environmental factors are necessary. The pain often occurs from malignancy, from procedures done to diagnose, stage and treat the malignancy, and from the toxicities of therapy used in treating the cancer. The first priority of treatment is to control pain rapidly and completely, as judged by the patient. The second priority is to prevent recurrence of pain. Analgesic drugs are given ‘by the ladder,’ ‘by the clock’ and ‘by the appropriate route’ using the analgesic ladder guideline proposed by the World Health Organization (WHO). The pharmacological aspects of various drugs used in the management of cancer pain are discussed. PMID:25247009

Are we doing enough to prevent poor-quality antimalarial medicines in the developing world?

PubMed

Walker, Erin J; Peterson, Gregory M; Grech, James; Paragalli, Evie; Thomas, Jackson

2018-05-15

Malaria is a deadly parasitic disease that affects more than 3 billion people worldwide, in predominantly resource-poor countries. Despite malaria being preventable and treatable, a large number of adults and children, mostly in Africa, die from this disease each year. One contributor to needless morbidity and mortality is the production and distribution of poor-quality antimalarial medicines; indeed, it is estimated that over 122,000 deaths of children under 5 years of age in sub-Saharan countries were caused by poor-quality antimalarial medicines, in 2013 alone. Poor-quality medicines include those that are deliberately falsified for monetary gain and may contain incorrect amounts or even no active ingredients at all, as well as products that are inadequate due to poor compliance to conventional quality standards and medicines that have degraded over time. Across a number of studies it has been reported that 4-92% of antimalarials tested are poor quality. This represents a massive risk to the population subjected to the use of these medicines, in the form of more severe and prolonged illness, additional costs to individuals who already have very little money, and lack of confidence in treatments. The continuing circulation of poor-quality medicines results from a number of factors, including insufficient regulatory capacity in susceptible countries, inadequate funding to perform regulatory functions, poor coordination between regulatory authorities, and inefficient import/export control systems. To combat the distribution of poor-quality medicines a number of organisations have developed guidelines for the procurement of antimalarials, and programs to educate consumers about the risks of poor-quality medicines and incentivise retailers to identify and report falsified medicines. The development of new technologies to quickly identify poor-quality medicines in the field is also essential, and some significant advances have been made. There has been considerable improvement in the delivery of high-quality antimalarials to those who need them; however, there is still an urgent need for a collective response by the international community, political leaders, regulatory bodies, and pharmaceutical companies. This should include political commitment for enhanced research and development funding, such as for new innovative track-and-trace field devices, and international efforts to strengthen and harmonise drug regulation practices.

The self-reported health of legal and illegal/irregular immigrants in the Czech Republic.

PubMed

Pikhart, Hynek; Drbohlav, Dusan; Dzurova, Dagmar

2010-10-01

To test whether immigrants with illegal/irregular status have higher odds of poor self-rated health (SRH) than immigrants with legal status, and whether different demographic, socioeconomic and psychosocial factors affect SRH among legal and illegal/irregular immigrants. Analysis is based on data from two questionnaire surveys of 285 Post-Soviet and Vietnamese immigrants (126 legal and 159 illegal/irregular) living and working in the Czech Republic, which were conducted between 2003 and 2006. The risk of poor SRH was estimated by ordered polytomous regression, the dependent variable was SRH, and selected demographic, socioeconomic and psychosocial characteristics entered the analysis as explanatory variables. Odds of poor SRH among illegal immigrants were not statistically significantly higher than among legal migrants in fully adjusted analysis. Females and older immigrants had poorer SRH. Satisfaction with work, and, partly, with housing were found to have a significant role. Educational level and 'social communication' variables did not have an important role in predicting SRH. Inequalities in SRH among legal and illegal immigrants were largely explained by socioeconomic and psychosocial factors in this study. These results should stimulate further research activities that might improve health policy and planning related to immigrants' health in this and other countries in Europe.

Comorbidities, polypharmacy, functionality and nutritional status in Turkish community-dwelling female elderly.

PubMed

Bahat, Gulistan; Tufan, Fatih; Bahat, Zumrut; Tufan, Asli; Aydin, Yucel; Akpinar, Timur Selcuk; Nadir, Sevilay; Erten, Nilgun; Karan, Mehmet Akif

2014-06-01

Most elderly persons live in developing countries where current geriatric epidemiological data are scarce. We aimed to study major comorbidities, polypharmacy, functional and nutritional status in a Turkish community-dwelling female elderly clinic population. Female geriatrics outpatient clinic patients were assessed cross-sectionally. Patients underwent comprehensive geriatric cassessment, including identification of chronic diseases, drugs, functionality, and nutrition. Comorbidities and drugs were defined by the review of patients' self-reports and current medications. Geriatric depression and cognition were assessed by 30-item geriatric depression scale and Folstein mini-mental-state-examination. Functional status was assessed by the evaluation of activities of daily living (ADL) and instrumental activities of daily living (IADL) scales. Nutritional assessment was performed by mini-nutritional-assessment-short form. Five-hundred and fifteen patients were included in this study over an 8-year period. Mean age was 73.4 ± 6.9 years. Mean number of chronic diseases was 2.8. 61.1 % had >3 chronic diseases. Most common 3 diagnoses were hypertension (75.3 %), depression (45.5 %) and dementia (39.4 %). Mean number of drugs was 4.8. Polypharmacy was noted as 63.2 and 47.6 % by definitions as >4 or >5 chronic drug use, respectively. Subjects with at least one dependency of ADL and IADL were 23.4 and 64.0 %. Prevalence of poor nutrition was 39.1 %. In patients with at least one ADL or IADL dependency, undernutrition (p < 0.001), dementia (p < 0.001), cerebrovascular accident, Parkinson's disease, diabetes were more prevalent (p < 0.05) and were taking higher number of drugs (p < 0.01). Polypharmacy and functional dependency seem to be prevalent among female elders in our country. Nutritional status was worse than the other reported urban area of Turkey and also than among males of same region but better than among Iranian counterparts. This study illustrates geographical differences in and between the individual countries and supports the continued need for comprehensive geriatric assessment worldwide.

The influence of gender equality policies on gender inequalities in health in Europe.

PubMed

Palència, Laia; Malmusi, Davide; De Moortel, Deborah; Artazcoz, Lucía; Backhans, Mona; Vanroelen, Christophe; Borrell, Carme

2014-09-01

Few studies have addressed the effect of gender policies on women's health and gender inequalities in health. This study aims to analyse the relationship between the orientation of public gender equality policies and gender inequalities in health in European countries, and whether this relationship is mediated by gender equality at country level or by other individual social determinants of health. A multilevel cross-sectional study was performed using individual-level data extracted from the European Social Survey 2010. The study sample consisted of 23,782 men and 28,655 women from 26 European countries. The dependent variable was self-perceived health. Individual independent variables were gender, age, immigrant status, educational level, partner status and employment status. The main contextual independent variable was a modification of Korpi's typology of family policy models (Dual-earner, Traditional-Central, Traditional-Southern, Market-oriented and Contradictory). Other contextual variables were the Gender Empowerment Measure (GEM), to measure country-level gender equality, and the Gross Domestic Product (GDP). For each country and country typology the prevalence of fair/poor health by gender was calculated and prevalence ratios (PR, women compared to men) and 95% confidence intervals (CI) were computed. Multilevel robust Poisson regression models were fitted. Women had poorer self-perceived health than men in countries with traditional family policies (PR = 1.13, 95%CI: 1.07-1.21 in Traditional-Central and PR = 1.27, 95%CI: 1.19-1.35 in Traditional-Southern) and in Contradictory countries (PR = 1.08, 95%CI: 1.05-1.11). In multilevel models, only gender inequalities in Traditional-Southern countries were significantly higher than those in Dual-earner countries. Gender inequalities in self-perceived health were higher, women reporting worse self-perceived health than men, in countries with family policies that were less oriented to gender equality (especially in the Traditional-Southern country-group). This was partially explained by gender inequalities in the individual social determinants of health but not by GEM or GDP. Copyright © 2014 Elsevier Ltd. All rights reserved.

Are Married Men Healthier than Single Women? A Gender Comparison of the Health Effects of Marriage and Marital Satisfaction in East Asia

PubMed Central

Chung, Woojin; Kim, Roeul

2015-01-01

Background Although Asian societies are remarkably different from Western societies in terms of sociocultural characteristics, little is known about the gender differences in the health effects of marriage and marital satisfaction in Asian countries. Methodology/Principal Findings Using a randomly sampled dataset from the 2006 East Asian Social Survey comprising 8528 individuals from China, Japan, Taiwan, and South Korea, this study performs analyses using a multivariate logistic regression model to predict the probability for a man or a woman to report poor health. Our results differ quite significantly from those of most studies focusing on Western countries. Considering marital satisfaction, there may be no health benefits from marriage for a specific gender in a given country, because the health loss associated with a dissatisfied marriage usually supersedes the health benefits from marriage. Moreover, women may reap greater health benefits from marriage than men. Additionally, those most likely to report poor health are found to be married and dissatisfied men or women, rather than never-married individuals. Conclusion/Significance The present study argues the need to design and carry out a gender- and country-specific social health policy approach to target individuals suffering from poor health, thereby reducing the gender differences in health status. PMID:26230841

Catastrophic payments for health care in Asia.

PubMed

van Doorslaer, Eddy; O'Donnell, Owen; Rannan-Eliya, Ravindra P; Somanathan, Aparnaa; Adhikari, Shiva Raj; Garg, Charu C; Harbianto, Deni; Herrin, Alejandro N; Huq, Mohammed Nazmul; Ibragimova, Shamsia; Karan, Anup; Lee, Tae-Jin; Leung, Gabriel M; Lu, Jui-Fen Rachel; Ng, Chiu Wan; Pande, Badri Raj; Racelis, Rachel; Tao, Sihai; Tin, Keith; Tisayaticom, Kanjana; Trisnantoro, Laksono; Vasavid, Chitpranee; Zhao, Yuxin

2007-11-01

Out-of-pocket (OOP) payments are the principal means of financing health care throughout much of Asia. We estimate the magnitude and distribution of OOP payments for health care in fourteen countries and territories accounting for 81% of the Asian population. We focus on payments that are catastrophic, in the sense of severely disrupting household living standards, and approximate such payments by those absorbing a large fraction of household resources. Bangladesh, China, India, Nepal and Vietnam rely most heavily on OOP financing and have the highest incidence of catastrophic payments. Sri Lanka, Thailand and Malaysia stand out as low to middle income countries that have constrained both the OOP share of health financing and the catastrophic impact of direct payments. In most low/middle-income countries, the better-off are more likely to spend a large fraction of total household resources on health care. This may reflect the inability of the poorest of the poor to divert resources from other basic needs and possibly the protection of the poor from user charges offered in some countries. But in China, Kyrgyz and Vietnam, where there are no exemptions of the poor from charges, they are as, or even more, likely to incur catastrophic payments. (c) 2007 John Wiley & Sons, Ltd.

Are Married Men Healthier than Single Women? A Gender Comparison of the Health Effects of Marriage and Marital Satisfaction in East Asia.

PubMed

Chung, Woojin; Kim, Roeul

2015-01-01

Although Asian societies are remarkably different from Western societies in terms of sociocultural characteristics, little is known about the gender differences in the health effects of marriage and marital satisfaction in Asian countries. Using a randomly sampled dataset from the 2006 East Asian Social Survey comprising 8528 individuals from China, Japan, Taiwan, and South Korea, this study performs analyses using a multivariate logistic regression model to predict the probability for a man or a woman to report poor health. Our results differ quite significantly from those of most studies focusing on Western countries. Considering marital satisfaction, there may be no health benefits from marriage for a specific gender in a given country, because the health loss associated with a dissatisfied marriage usually supersedes the health benefits from marriage. Moreover, women may reap greater health benefits from marriage than men. Additionally, those most likely to report poor health are found to be married and dissatisfied men or women, rather than never-married individuals. The present study argues the need to design and carry out a gender- and country-specific social health policy approach to target individuals suffering from poor health, thereby reducing the gender differences in health status.

Comparison of two cash transfer strategies to prevent catastrophic costs for poor tuberculosis-affected households in low- and middle-income countries: An economic modelling study

PubMed Central

Lönnroth, Knut; Boccia, Delia

2017-01-01

Background Illness-related costs for patients with tuberculosis (TB) ≥20% of pre-illness annual household income predict adverse treatment outcomes and have been termed “catastrophic.” Social protection initiatives, including cash transfers, are endorsed to help prevent catastrophic costs. With this aim, cash transfers may either be provided to defray TB-related costs of households with a confirmed TB diagnosis (termed a “TB-specific” approach); or to increase income of households with high TB risk to strengthen their economic resilience (termed a “TB-sensitive” approach). The impact of cash transfers provided with each of these approaches might vary. We undertook an economic modelling study from the patient perspective to compare the potential of these 2 cash transfer approaches to prevent catastrophic costs. Methods and findings Model inputs for 7 low- and middle-income countries (Brazil, Colombia, Ecuador, Ghana, Mexico, Tanzania, and Yemen) were retrieved by literature review and included countries' mean patient TB-related costs, mean household income, mean cash transfers, and estimated TB-specific and TB-sensitive target populations. Analyses were completed for drug-susceptible (DS) TB-related costs in all 7 out of 7 countries, and additionally for drug-resistant (DR) TB-related costs in 1 of the 7 countries with available data. All cost data were reported in 2013 international dollars ($). The target population for TB-specific cash transfers was poor households with a confirmed TB diagnosis, and for TB-sensitive cash transfers was poor households already targeted by countries’ established poverty-reduction cash transfer programme. Cash transfers offered in countries, unrelated to TB, ranged from $217 to $1,091/year/household. Before cash transfers, DS TB-related costs were catastrophic in 6 out of 7 countries. If cash transfers were provided with a TB-specific approach, alone they would be insufficient to prevent DS TB catastrophic costs in 4 out of 6 countries, and when increased enough to prevent DS TB catastrophic costs would require a budget between $3.8 million (95% CI: $3.8 million–$3.8 million) and $75 million (95% CI: $50 million–$100 million) per country. If instead cash transfers were provided with a TB-sensitive approach, alone they would be insufficient to prevent DS TB-related catastrophic costs in any of the 6 countries, and when increased enough to prevent DS TB catastrophic costs would require a budget between $298 million (95% CI: $219 million–$378 million) and $165,367 million (95% CI: $134,085 million–$196,425 million) per country. DR TB-related costs were catastrophic before and after TB-specific or TB-sensitive cash transfers in 1 out of 1 countries. Sensitivity analyses showed our findings to be robust to imputation of missing TB-related cost components, and use of 10% or 30% instead of 20% as the threshold for measuring catastrophic costs. Key limitations were using national average data and not considering other health and social benefits of cash transfers. Conclusions A TB-sensitive cash transfer approach to increase all poor households’ income may have broad benefits by reducing poverty, but is unlikely to be as effective or affordable for preventing TB catastrophic costs as a TB-specific cash transfer approach to defray TB-related costs only in poor households with a confirmed TB diagnosis. Preventing DR TB-related catastrophic costs will require considerable additional investment whether a TB-sensitive or a TB-specific cash transfer approach is used. PMID:29112693

The effect of women's role on health: the paradox.

PubMed

Kabira, W M; Gachukia, E W; Matiangi, F O

1997-07-01

Most societies in Africa are patriarchal in nature. Traditional Africa has allocated the role of nurturing, and ensuring the health of the family and the community as a whole to women. From the age of six, girls begin to work with their mothers, cleaning, sweeping, nursing and caring for the younger children, the aged and the sick. Therefore, the female child is customarily socialized as the custodian of family health. Because women are traditionally responsible for health in African countries and their status in society is low, the status of the health sector has received less attention than other sectors. The paradox of entrusting the woman with the responsibility of health and at the same time denying her the opportunities to influence policies remains a major obstacle. Factors that influence women's health in Africa most commonly include poverty, poor education and poor nutrition. Access to education for African women is a major problem. The impact of a poorly educated mother is passed on to the daughter. In some parts of Africa, female circumcision contributes to the high school dropout rates. Once the girls are withdrawn from school to participate in the ceremonies, they do not return to school. They are encouraged and socialized towards marriage. Africa has the highest fertility rate, the lowest life expectancy (49 years for males and 52 for females, the highest infant mortality rate (114 deaths per 1000 live births); the highest maternal mortality rate and the highest dependency ratio (47% under 15 years and only 3% over 65). The foregoing factors call for urgent attention to health issues, especially those which affect women who are the traditional health providers. There is an unacceptably high rate of unsafe abortion which accounts for up to 30% of maternal mortality in some African countries, and there is growing concern over teenage pregnancies in some African countries. Nearly two-thirds of the cases of septic abortions are in the 15-19-year age group and yet African governments and the legal systems would rather not deal with abortion. The gap between mortality and fertility is widening; it doubled between 1972 and 1994 and is expected to double in 2017. In many African countries, children are the only 'goods' that women are expected to produce. Unless this attitude changes, fertility rates will continue to rise as women continue to search for their place in society and justify their place within marriages and relationships through child bearing.

Coverage and timing of antenatal care among poor women in 6 Mesoamerican countries.

PubMed

Dansereau, Emily; McNellan, Claire R; Gagnier, Marielle C; Desai, Sima S; Haakenstad, Annie; Johanns, Casey K; Palmisano, Erin B; Ríos-Zertuche, Diego; Schaefer, Alexandra; Zúñiga-Brenes, Paola; Hernandez, Bernardo; Iriarte, Emma; Mokdad, Ali H

2016-08-19

Poor women in the developing world have a heightened need for antenatal care (ANC) but are often the least likely to attend it. This study examines factors associated with the number and timing of ANC visits for poor women in Guatemala, Honduras, Mexico, Nicaragua, Panama, and El Salvador. We surveyed 8366 women regarding the ANC they attended for their most recent birth in the past two years. We conducted logistic regressions to examine demographic, household, and health characteristics associated with attending at least one skilled ANC visit, four skilled visits, and a skilled visit in the first trimester. Across countries, 78 % of women attended at least one skilled ANC visit, 62 % attended at least four skilled visits, and 56 % attended a skilled visit in the first trimester. The proportion of women attending four skilled visits was highest in Nicaragua (81 %) and lowest in Guatemala (18 %) and Panama (38 %). In multiple countries, women who were unmarried, less-educated, adolescent, indigenous, had not wanted to conceive, and lacked media exposure were less likely to meet international ANC guidelines. In countries with health insurance programs, coverage was associated with attending skilled ANC, but not the timeliness. Despite significant policy reforms and initiatives targeting the poor, many women living in the poorest regions of Mesoamérica are not meeting ANC guidelines. Both supply and demand interventions are needed to prioritize vulnerable groups, reduce unplanned pregnancies, and reach populations not exposed to common forms of media. Top performing municipalities can inform effective practices across the region.

The global burden of oral diseases and risks to oral health.

PubMed Central

Petersen, Poul Erik; Bourgeois, Denis; Ogawa, Hiroshi; Estupinan-Day, Saskia; Ndiaye, Charlotte

2005-01-01

This paper outlines the burden of oral diseases worldwide and describes the influence of major sociobehavioural risk factors in oral health. Despite great improvements in the oral health of populations in several countries, global problems still persist. The burden of oral disease is particularly high for the disadvantaged and poor population groups in both developing and developed countries. Oral diseases such as dental caries, periodontal disease, tooth loss, oral mucosal lesions and oropharyngeal cancers, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)-related oral disease and orodental trauma are major public health problems worldwide and poor oral health has a profound effect on general health and quality of life. The diversity in oral disease patterns and development trends across countries and regions reflects distinct risk profiles and the establishment of preventive oral health care programmes. The important role of sociobehavioural and environmental factors in oral health and disease has been shown in a large number of socioepidemiological surveys. In addition to poor living conditions, the major risk factors relate to unhealthy lifestyles (i.e. poor diet, nutrition and oral hygiene and use of tobacco and alcohol), and limited availability and accessibility of oral health services. Several oral diseases are linked to noncommunicable chronic diseases primarily because of common risk factors. Moreover, general diseases often have oral manifestations (e.g. diabetes or HIV/AIDS). Worldwide strengthening of public health programmes through the implementation of effective measures for the prevention of oral disease and promotion of oral health is urgently needed. The challenges of improving oral health are particularly great in developing countries. PMID:16211157

Poor self-reported health and sleeping difficulties among Kurdish immigrant men in Sweden.

PubMed

Taloyan, Marina; Johansson, Leena Maria; Johansson, Sven-Erik; Sundquist, Jan; Koctürk, Tahire O

2006-09-01

This study explores the association between ethnicity and poor self-reported health and psychological distress, sleeping difficulties, and use of psychotropic drugs among immigrant Kurdish men and native Swedish men, based on data from the first Swedish National Survey of Immigrants and the Swedish Level-of-Living Surveys collected in 1996 by Statistics Sweden. The age-adjusted odds of poor self-reported health and sleeping difficulties among Kurdish men was about 3.5 times higher than among Swedish men. The odds ratio decreased to 2.1 and 2.7 respectively in a model adjusted for age and the other explanatory variables. Yearning for the home country, perceived discrimination and unemployment in the host country seem to be possible explanations for the higher levels of distress among Kurdish immigrants to Sweden.

Effect of immigration background and country-of-origin contextual factors on adolescent substance use in Spain.

PubMed

Sarasa-Renedo, Ana; Sordo, Luis; Pulido, José; Guitart, Anna; González-González, Rocío; Hoyos, Juan; Bravo, María J; Barrio, Gregorio

2015-08-01

The effects of adolescent- and parental-birthplace and country-of-origin contextual factors on substance use among adolescents with recent immigrant background (ARIBs) are poorly understood. We aimed to assess these effects and identify the main mediating factors in Spain. Participants were 12,432 ARIBs (≥1 foreign-born parent) and 75,511 autochthonous adolescents from pooled 2006-2010 school surveys. Outcomes were prevalence of use of alcohol, tobacco, cannabis, stimulants and sedative-hypnotics. ARIBs were classified by adolescent birthplace (Spain/abroad), whether they had mixed-parents (one Spanish-born and one foreign-born), and country-of-origin characteristics. Adjusted prevalence ratios (aPRs) and percent change expressing disparities in risk were estimated using Poisson regression with robust variance. Compared to autochthonous adolescents, foreign-born ARIBs without mixed-parents showed significant aPRs <1 for all substances, which generally approached 1 in Spanish-born ARIBs with mixed-parents. The main factors mediating ARIBs' lower risk were less frequent socialization in leisure environments and less association with peers who use such substances. ARIBs' lower risk depended more on country-of-origin characteristics and not having mixed-parents than being foreign-born. Tobacco, cannabis and stimulant use in ARIBs increased with increasing population use of these substances in the country-of-origin. ARIBs from the non-Muslim-regions had a lower risk of using alcohol and higher risk of using sedative-hypnotics than those from the Muslim-region. Among ARIBs in Spain, parental transmission of norms and values could influence substance use as much as or more than exposure to the Spanish context. Future research should better assess effects of adolescent- and parental-birthplace and country-of-origin contextual factors on substance use. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Private health insurance: implications for developing countries.

PubMed Central

Sekhri, Neelam; Savedoff, William

2005-01-01

Private health insurance is playing an increasing role in both high- and low-income countries, yet is poorly understood by researchers and policy-makers. This paper shows that the distinction between private and public health insurance is often exaggerated since well regulated private insurance markets share many features with public insurance systems. It notes that private health insurance preceded many modern social insurance systems in western Europe, allowing these countries to develop the mechanisms, institutions and capacities that subsequently made it possible to provide universal access to health care. We also review international experiences with private insurance, demonstrating that its role is not restricted to any particular region or level of national income. The seven countries that finance more than 20% of their health care via private health insurance are Brazil, Chile, Namibia, South Africa, the United States, Uruguay and Zimbabwe. In each case, private health insurance provides primary financial protection for workers and their families while public health-care funds are targeted to programmes covering poor and vulnerable populations. We make recommendations for policy in developing countries, arguing that private health insurance cannot be ignored. Instead, it can be harnessed to serve the public interest if governments implement effective regulations and focus public funds on programmes for those who are poor and vulnerable. It can also be used as a transitional form of health insurance to develop experience with insurance institutions while the public sector increases its own capacity to manage and finance health-care coverage. PMID:15744405

Private health insurance: implications for developing countries.

PubMed

Sekhri, Neelam; Savedoff, William

2005-02-01

Private health insurance is playing an increasing role in both high- and low-income countries, yet is poorly understood by researchers and policy-makers. This paper shows that the distinction between private and public health insurance is often exaggerated since well regulated private insurance markets share many features with public insurance systems. It notes that private health insurance preceded many modern social insurance systems in western Europe, allowing these countries to develop the mechanisms, institutions and capacities that subsequently made it possible to provide universal access to health care. We also review international experiences with private insurance, demonstrating that its role is not restricted to any particular region or level of national income. The seven countries that finance more than 20% of their health care via private health insurance are Brazil, Chile, Namibia, South Africa, the United States, Uruguay and Zimbabwe. In each case, private health insurance provides primary financial protection for workers and their families while public health-care funds are targeted to programmes covering poor and vulnerable populations. We make recommendations for policy in developing countries, arguing that private health insurance cannot be ignored. Instead, it can be harnessed to serve the public interest if governments implement effective regulations and focus public funds on programmes for those who are poor and vulnerable. It can also be used as a transitional form of health insurance to develop experience with insurance institutions while the public sector increases its own capacity to manage and finance health-care coverage.

Survival and Associated Risk Factors for Mortality Among Infants with Critical Congenital Heart Disease in a Developing Country.

PubMed

Mat Bah, Mohd Nizam; Sapian, Mohd Hanafi; Jamil, Mohammad Tamim; Alias, Amelia; Zahari, Norazah

2018-05-14

Critical congenital heart disease (CCHD) is associated with significant morbidity and mortality. However, data on survival of CCHD and the risk factors associated with its mortality are limited. This study examined CCHD survival and the risk factors for CCHD mortality. Using a retrospective cohort study of infants born with CCHD from 2006 to 2015, survival over 10 years was estimated using Kaplan-Meier analysis, and the risk factors for mortality were analyzed using multivariate Cox proportional hazards regression. A total of 491 CCHD cases were included in the study, with an overall mortality rate of 34.8% (95% confidence interval [CI] 30.6-39.2). The intervention/surgical mortality rate was 9.8% ≤ 30 days and 11.5% > 30 days after surgery, and 17% died before surgery or intervention. The median age at death was 2.7 months [first quartile: 1 month, third quartile: 7.3 months]. The CCHD survival rate was 90.4% (95% CI 89-91.8%) at 1 month, 69.3% (95% CI 67.2-71.4%) at 1 year, 63.4% (95% CI 61.1-65.7%) at 5 years, and 61.4% (95% CI 58.9-63.9%) at 10 years. Weight of < 2 kg at diagnosis, associated syndromes, poor pre-operative condition, and non-duct-dependent CCHD were independent risk factors for poor survival, with hazard ratios of 2.61, 2.10, 2.22, and 1.70, respectively. CCHD is associated with a high mortality rate. Low weight, poor pre-operative condition, associated syndromes, and non-duct-dependent CCHD are significant risk factors affecting the survival of infants with CCHD.

Towards Sustainable Research Capacity Development and Research Ownership for Academic Institutes in Developing Countries: The Malawian Research Support Centre Model

ERIC Educational Resources Information Center

Gomo, Exnevia; Kalilani, Linda; Mwapasa, Victor; Trigu, Chifundo; Phiri, Kamija; Schmidt, Joann; van Hensbroek, Michael Boele

2011-01-01

In lesser-developed African countries, the lack of institutionalised support for research, combined with limited career opportunities and poor remuneration, have contributed to weak research infrastructure and capacity, and a continuing brain drain to developed countries. Malawi's Research Support Centre (RSC) model is novel in that it provides a…

Poverty and mental health in Indonesia.

PubMed

Tampubolon, Gindo; Hanandita, Wulung

2014-04-01

Community and facility studies in developing countries have generally demonstrated an inverse relationship between poverty and mental health. However, recent population-based studies contradict this. In India and Indonesia the poor and non-poor show no difference in mental health. We revisit the relationship between poverty and mental health using a validated measure of depressive symptoms (CES-D) and a new national sample from Indonesia - a country where widespread poverty and deep inequality meet with a neglected mental health service sector. Results from three-level overdispersed Poisson models show that a 1% decrease in per capita household expenditure was associated with a 0.05% increase in CES-D score (depressive symptoms), while using a different indicator (living on less than $2 a day) it was estimated that the poor had a 5% higher CES-D score than the better off. Individual social capital and religiosity were found to be positively associated with mental health while adverse events were negatively associated. These findings provide support for the established view regarding the deleterious association between poverty and mental health in developed and developing countries. Copyright © 2014 Elsevier Ltd. All rights reserved.

Clinical research, prophylaxis, therapy, and care for HIV disease in Africa.

PubMed Central

De Cock, K M; Lucas, S B; Lucas, S; Agness, J; Kadio, A; Gayle, H D

1993-01-01

By the end of the century, citizens of resource-poor countries will constitute 90% of the world's human immunodeficiency virus (HIV)-infected people. Clinical management of such persons in developing countries has been neglected; most AIDS research has concentrated on epidemiology, and donor agencies have generally invested in the prevention of HIV infection. The heavy burden of HIV disease in Africa requires that care for AIDS be addressed, and prevention and care should be seen as interrelated. Prevention and treatment of tuberculosis, the commonest severe infection in persons with AIDS in Africa, illustrate this interrelationship. We outline priorities for applied research on the management of HIV disease in a resource-poor environment, and discuss prophylaxis, therapy for opportunistic diseases, terminal care, and use of antiretroviral therapy. Research should define the standard of care that can realistically be demanded for HIV disease in a resource-poor environment. Research and public health programs for AIDS in developing countries must address AIDS care and attempt to reduce the widening gap between interventions available for HIV-infected persons in different parts of the world. PMID:8214225

Snakebite in bedroom kills a physician in Cameroon: a case report.

PubMed

Nkwescheu, Armand; Mbasso, Leopold Cyriaque Donfack; Pouth, Franky Baonga Ba; Dzudie, Anastase; Billong, Serge Clotaire; Ngouakam, Hermann; Diffo, Joseph Le Doux; Eyongorock, Hanny; Mbacham, Wilfred

2016-01-01

The World Health Organization (WHO) classifies snake bites as neglected public health problem affecting mostly tropical and subtropical countries. In Africa there are an estimated 1 million snake bites annually with about half needing a specific treatment. Women, children and farmers in poor rural communities in developing countries are the most affected. Case management of snake bites are not adequate in many health facilities in developing countries where personnel are not always abreast with the new developments in snake bite management and in addition, quite often the anti-venom serum is lacking. We report the case of a medical doctor bitten by a cobra in the rural area of Poli, Cameroon while asleep in his bedroom. Lack of facilities coupled with poor case management resulted in a fatal outcome.

A fundamental shift in the approach to international health by WHO, UNICEF, and the World Bank: instances of the practice of "intellectual fascism" and totalitarianism in some Asian countries.

PubMed

Banerji, D

1999-01-01

Navarro has used the term "intellectual fascism" to depict the intellectual situation in the McCarthy era. Intellectual fascism is now more malignant in the poor countries of the world. The Indian Subcontinent, China, and some other Asian countries provide the context. The struggles of the working class culminated in the Alma-Ata Declaration of self-reliance in health by the peoples of the world. To protect their commercial and political interests, retribution from the rich countries was sharp and swift, they "invented" Selective Primary Health Care and used WHO, UNICEF, the World Bank, and other agencies to let loose on poor countries a barrage of "international initiatives" as global programs on immunization, AIDS, and tuberculosis. These programs were astonishingly defective in concept, design, and implementation. The agencies refused to take note of such criticisms when they were published by others. They have been fascistic, ahistorical, grossly unscientific, and Goebbelsian propagandists. The conscience keepers of public health have mostly kept quiet.

A multi-dimensional environment-health risk analysis system for the English regions

NASA Astrophysics Data System (ADS)

Vitolo, Claudia; Scutari, Marco; Ghalaieny, Mohamed; Tucker, Allan; Russell, Andrew

2017-04-01

There is an overwhelming body of evidence that environmental pollution, and air pollution in particular, is a significant threat to health worldwide. While in developed countries the introduction of environmental legislation and sustainable technologies aims to mitigate adverse effects, developing countries are at higher risk. Within the scope of the British Council funded KEHRA project, work is on-going to develop a reproducible and reliable system to assess health risks due to exposure to pollution under climate change and across countries. Our approach is based on the use of Bayesian Networks. We used these graphical models to explore and model the statistical dependence structure of the intricate environment-health nexus. We developed a robust modelling workflow in the R programming language to facilitate reproducibility and tested it on the English regions in the United Kingdom. Preliminary results are encouraging, showing that the model tests generally well in sample (training data spans the period 1981-2005) and has good predictive power when tested out of sample (testing data spans the period 2006-2014). We plan to show the results of this preliminary analysis as well as test the model under future climate change scenarios. Future work will also investigate the transferability of the model from a data-rich (England) to a data-poor environment (Kazakhstan).

Reducing maternal mortality: can we derive policy guidance from developing country experiences?

PubMed

Liljestrand, Jerker; Pathmanathan, Indra

2004-01-01

Developing countries are floundering in their efforts to meet the Millennium Development Goal of reducing maternal mortality by 75% by 2015. Two issues are being debated. Is it doable within this time frame? And is it affordable? Malaysia and Sri Lanka have in the past 50 years repeatedly halved their maternal mortality ratio (MMR) every 7-10 years to reduce MMR from over 500 to below 50. Experience from four other developing countries--Bolivia, Yunan in China, Egypt, and Jamaica-confirms that each was able to halve MMR in less than 10 years beginning from levels of 200-300. Malaysia and Sri Lanka, invested modestly (but wisely)--less than 0.4% of GDP--on maternal health throughout the period of decline, although the large majority of women depended on publicly funded maternal health care. Analysis of their experience suggests that provision of access to and removal of barriers for the use of skilled birth attendance has been the key. This included professionalization of midwifery and phasing out of traditional birth attendants; monitoring births and maternal deaths and use of such information for high profile advocacy on the importance of reducing maternal death; and addressing critical gaps in the health system; and reducing disparities between different groups through special attention to the poor and disadvantaged populations.

The value of virtual conferencing for ecology and conservation.

PubMed

Fraser, Hannah; Soanes, Kylie; Jones, Stuart A; Jones, Chris S; Malishev, Matthew

2017-06-01

The objectives of conservation science and dissemination of its research create a paradox: Conservation is about preserving the environment, yet scientists spread this message at conferences with heavy carbon footprints. Ecology and conservation science depend on global knowledge exchange-getting the best science to the places it is most needed. However, conference attendance from developed countries typically outweighs that from developing countries that are biodiversity and conservation hotspots. If any branch of science should be trying to maximize participation while minimizing carbon emissions, it is conservation. Virtual conferencing is common in other disciplines, such as education and humanities, but it is surprisingly underused in ecology and conservation. Adopting virtual conferencing entails a number of challenges, including logistics and unified acceptance, which we argue can be overcome through planning and technology. We examined 4 conference models: a pure-virtual model and 3 hybrid hub-and-node models, where hubs stream content to local nodes. These models collectively aim to mitigate the logistical and administrative challenges of global knowledge transfer. Embracing virtual conferencing addresses 2 essential prerequisites of modern conferences: lowering carbon emissions and increasing accessibility for remote, time- and resource-poor researchers, particularly those from developing countries. © 2017 The Authors. Conservation Biology published by Wiley Periodicals, Inc. on behalf of Society for Conservation Biology.

Perceived discrimination and self-rated health in the immigrant population of the Basque Country, Spain.

PubMed

Rodríguez-Álvarez, Elena; González-Rábago, Yolanda; Borrell, Luisa N; Lanborena, Nerea

To examine the effect of perceived discrimination and self-rated health among the immigrant population in the Basque Country, Spain, and determine whether this effect varies according to region of origin, age, sex and education. Descriptive cross-sectional study. The study population included immigrants aged 18 and older residing in the Basque Country. Data from the 2014 Foreign Immigrant Population Survey (n=3,456) were used. Log-binomial regression was used to quantify the association between perceived discrimination and self-rated health before and after checking for the selected characteristics. Almost 1 in 10 immigrant adults reports perceiving discrimination. In adjusted analyses, the immigrants perceiving discrimination were almost were 1.92 more likely to rate their health as poor (prevalence ratio: 1.92; 95% CI: 1.44-2.56) than those who did not report discrimination. This association did not vary according to region of origin, age, sex or educational level. Perceived discrimination shows a consistent relationship with perceived health. Moreover, this association did not depend on the region of origin, age, sex or educational level of immigrants. These results show the need for implementing inclusive policies to eliminate individual and institutional discrimination and reduce health inequalities between the immigrant and native populations. Copyright © 2017. Publicado por Elsevier España, S.L.U.

Generating carbon finance through avoided deforestation and its potential to create climatic, conservation and human development benefits.

PubMed

Ebeling, Johannes; Yasué, Maï

2008-05-27

Recent proposals to compensate developing countries for reducing emissions from deforestation (RED) under forthcoming climate change mitigation regimes are receiving increasing attention. Here we demonstrate that if RED credits were traded on international carbon markets, even moderate decreases in deforestation rates could generate billions of Euros annually for tropical forest conservation. We also discuss the main challenges for a RED mechanism that delivers real climatic benefits. These include providing sufficient incentives while only rewarding deforestation reductions beyond business-as-usual scenarios, addressing risks arising from forest degradation and international leakage, and ensuring permanence of emission reductions. Governance may become a formidable challenge for RED because some countries with the highest RED potentials score poorly on governance indices. In addition to climate mitigation, RED funds could help achieve substantial co-benefits for biodiversity conservation and human development. However, this will probably require targeted additional support because the highest biodiversity threats and human development needs may exist in countries that have limited income potentials from RED. In conclusion, how successfully a market-based RED mechanism can contribute to climate change mitigation, conservation and development will strongly depend on accompanying measures and carefully designed incentive structures involving governments, business, as well as the conservation and development communities.

More for Less: Best Patient Outcomes in a Time of Financial Restraint

PubMed Central

Merry, Alan F.; Hamblin, Richard

2012-01-01

Abstract: In many countries, expenditure on health care has increased dramatically over recent years. There have been parallel improvements in many indicators of population health, but too many patients continue to be harmed by health care or receive care that is supply-sensitive, ineffective, or poorly aligned with their needs and values. In addition to human costs, this translates into substantial waste of resource. The world has recently faced economic challenges unseen since the great depression of the 1930s. The financial situation of a country can, like a business, be expressed in three sets of accounts: statements of financial position, financial performance, and cash flow. A key test of solvency is the ability to pay debts as they become due (whether from current account or further borrowing). In general, this is a function of public debt, which for many countries has become very high. However, private debt and net financial position are also relevant to a country’s financial prospects. Ultimately, borrowing is not sustainable indefinitely and given limited prospects for growth in income in the coming years, most countries will likely need to reduce or at least constrain expenditure on health care. This implies obtaining better value from the resources that are available, and we suggest that the key to this lies in improving the quality of care and, in particular, reducing variation in health care. In the United States, new legislation promoting accountable care organizations may help to do this. Cardiac surgery can be particularly effective in extending patients’ lives and in improving the quality of their lives. Our ability to continue to provide cardiac surgery in the face of constrained economic times will depend on engaging more actively in ensuring that what we do is the right thing: that our operations are effective and that they truly meet the needs and values of our patients. It will also depend on doing these operations right the first time. PMID:23441557

Introducing white pine into poor-site hardwood stands in West Virginia

Treesearch

Harry W. Yawney

1961-01-01

Poor hardwood land presents a problem that is only too well known: what to do with areas in hardwood country that support only stunted, slow-growing trees? This is a question that vexes foresters and landowners in many parts of West Virginia and neighboring mountainous areas of Maryland and Virginia. On these poor sites, it is doubtful whether the hardwoods can pay the...

Venture Capital Investment in the Life Sciences in Switzerland.

PubMed

Hosang, Markus

2014-12-01

Innovation is one of the main driving factors for continuous and healthy economic growth and welfare. Switzerland as a resource-poor country is particularly dependent on innovation, and the life sciences, which comprise biotechnologies, (bio)pharmaceuticals, medical technologies and diagnostics, are one of the key areas of innovative strength of Switzerland. Venture capital financing and venture capitalists (frequently called 'VCs') and investors in public equities have played and still play a pivotal role in financing the Swiss biotechnology industry. In the following some general features of venture capital investment in life sciences as well as some opportunities and challenges which venture capital investors in Switzerland are facing are highlighted. In addition certain means to counteract these challenges including the 'Zukunftsfonds Schweiz' are discussed.

Sub-national mapping of population pyramids and dependency ratios in Africa and Asia

NASA Astrophysics Data System (ADS)

Pezzulo, Carla; Hornby, Graeme M.; Sorichetta, Alessandro; Gaughan, Andrea E.; Linard, Catherine; Bird, Tomas J.; Kerr, David; Lloyd, Christopher T.; Tatem, Andrew J.

2017-07-01

The age group composition of populations varies substantially across continents and within countries, and is linked to levels of development, health status and poverty. The subnational variability in the shape of the population pyramid as well as the respective dependency ratio are reflective of the different levels of development of a country and are drivers for a country's economic prospects and health burdens. Whether measured as the ratio between those of working age and those young and old who are dependent upon them, or through separate young and old-age metrics, dependency ratios are often highly heterogeneous between and within countries. Assessments of subnational dependency ratio and age structure patterns have been undertaken for specific countries and across high income regions, but to a lesser extent across the low income regions. In the framework of the WorldPop Project, through the assembly of over 100 million records across 6,389 subnational administrative units, subnational dependency ratio and high resolution gridded age/sex group datasets were produced for 87 countries in Africa and Asia.

Type 1 Diabetes in a Resource-Poor Setting: Malnutrition Related, Malnutrition Modified, or Just Diabetes?

PubMed

Balcha, Shitaye Alemu; Phillips, David I W; Trimble, Elisabeth R

2018-06-14

Very little is known about the occurrence of type 1 diabetes (T1DM) in resource-poor countries and particularly in their rural hinterlands. Studies of the epidemiology of T1DM in Ethiopia and similar countries in sub-Saharan Africa show that the pattern of presenting disease differs substantially from that in the West. Typically, the peak age of onset of the disease is more than a decade later with a male excess and a low prevalence of indicators of islet-cell autoimmunity. It is also associated with markers of undernutrition. These findings raise the question as to whether the principal form of T1DM seen in these resource-poor communities has a different pathogenesis. Whether the disease is a direct result of malnutrition or whether malnutrition may modify the expression of islet-cell autoimmunity is unclear. However, the poor prognosis in these settings underlines the urgent need for detailed clinical and epidemiological studies.

Socioeconomic inequalities in informal payments for health care: An assessment of the 'Robin Hood' hypothesis in 33 African countries.

PubMed

Kankeu, Hyacinthe Tchewonpi; Ventelou, Bruno

2016-02-01

In almost all African countries, informal payments are frequently made when accessing health care. Some literature suggests that the informal payment system could lead to quasi-redistribution among patients, with physicians playing a 'Robin Hood' role, subsidizing the poor at the expense of the rich. We empirically tested this assumption with data from the rounds 3 and 5 of the Afrobarometer surveys conducted in 18 and 33 African countries respectively, from 2005 to 2006 for round 3 and from 2011 to 2013 for round 5. In these surveys, nationally representative samples of people aged 18 years or more were randomly selected in each country, with sizes varying between 1048 and 2400 for round 3 and between 1190 and 2407 for round 5. We used the 'normalized' concentration index, the poor/rich gap and the odds ratio to assess the level of inequality in the payment of bribes to access care at the local public health facility and implemented two decomposition techniques to identify the contributors to the observed inequalities. We obtained that: i) the socioeconomic gradient in informal payments is in favor of the rich in almost all countries, indicating a rather regressive system; ii) this is mainly due to the socioeconomic disadvantage itself, to poor/rich differences in supply side factors like lack of medicines, absence of doctors and long waiting times, as well as regional disparities. Although essentially empirical, the paper highlights the need for African health systems to undergo substantial country-specific reforms in order to better protect the worse-off from financial risk when they seek care. Copyright © 2016 Elsevier Ltd. All rights reserved.

Migrant integration policies and health inequalities in Europe.

PubMed

Giannoni, Margherita; Franzini, Luisa; Masiero, Giuliano

2016-06-01

Research on socio-economic determinants of migrant health inequalities has produced a large body of evidence. There is lack of evidence on the influence of structural factors on lives of fragile groups, frequently exposed to health inequalities. The role of poor socio-economic status and country level structural factors, such as migrant integration policies, in explaining migrant health inequalities is unclear. The objective of this paper is to examine the role of migrant socio-economic status and the impact of migrant integration policies on health inequalities during the recent economic crisis in Europe. Using the 2012 wave of Eurostat EU-SILC data for a set of 23 European countries, we estimate multilevel mixed-effects ordered logit models for self-assessed poor health (SAH) and self-reported limiting long-standing illnesses (LLS), and multilevel mixed-effects logit models for self-reported chronic illness (SC). We estimate two-level models with individuals nested within countries, allowing for both individual socio-economic determinants of health and country-level characteristics (healthy life years expectancy, proportion of health care expenditure over the GDP, and problems in migrant integration policies, derived from the Migrant Integration Policy Index (MIPEX). Being a non-European citizen or born outside Europe does not increase the odds of reporting poor health conditions, in accordance with the "healthy migrant effect". However, the country context in terms of problems in migrant integration policies influences negatively all of the three measures of health (self-reported health status, limiting long-standing illnesses, and self-reported chronic illness) in foreign people living in European countries, and partially offsets the "healthy migrant effect". Policies for migrant integration can reduce migrant health disparities.

Towards a global flood detection system using social media

NASA Astrophysics Data System (ADS)

de Bruijn, Jens; de Moel, Hans; Jongman, Brenden; Aerts, Jeroen

2017-04-01

It is widely recognized that an early warning is critical in improving international disaster response. Analysis of social media in real-time can provide valuable information about an event or help to detect unexpected events. For successful and reliable detection systems that work globally, it is important that sufficient data is available and that the algorithm works both in data-rich and data-poor environments. In this study, both a new geotagging system and multi-level event detection system for flood hazards was developed using Twitter data. Geotagging algorithms that regard one tweet as a single document are well-studied. However, no algorithms exist that combine several sequential tweets mentioning keywords regarding a specific event type. Within the time frame of an event, multiple users use event related keywords that refer to the same place name. This notion allows us to treat several sequential tweets posted in the last 24 hours as one document. For all these tweets, we collect a series of spatial indicators given in the tweet metadata and extract additional topological indicators from the text. Using these indicators, we can reduce ambiguity and thus better estimate what locations are tweeted about. Using these localized tweets, Bayesian change-point analysis is used to find significant increases of tweets mentioning countries, provinces or towns. In data-poor environments detection of events on a country level is possible, while in other, data-rich, environments detection on a city level is achieved. Additionally, on a city-level we analyse the spatial dependence of mentioned places. If multiple places within a limited spatial extent are mentioned, detection confidence increases. We run the algorithm using 2 years of Twitter data with flood related keywords in 13 major languages and validate against a flood event database. We find that the geotagging algorithm yields significantly more data than previously developed algorithms and successfully deals with ambiguous place names. In addition, we show that our detection system can both quickly and reliably detect floods, even in countries where data is scarce, while achieving high detail in countries where more data is available.

Global pediatric environmental health.

PubMed

Guidotti, Tee L; Gitterman, Benjamin A

2007-04-01

Children are uniquely vulnerable to environmental health problems. Developed countries report as the most common problems ambient (outdoor) air pollution and lead. Developing countries have a wider range of common problems, including childhood injuries, indoor air pollution, infectious disease, and poor sanitation with unsafe water. Globally, the agencies of the United Nations act to protect children and perform essential reporting and standards-setting functions. Conditions vary greatly among countries and are not always better in developing countries. Protecting the health of children requires strengthening the public health and medical systems in every country, rather than a single global agenda.

Virtual water trade of agri-food products: Evidence from italian-chinese relations.

PubMed

Lamastra, Lucrezia; Miglietta, Pier Paolo; Toma, Pierluigi; De Leo, Federica; Massari, Stefania

2017-12-01

At global scale, the majority of world water withdrawal is for the agricultural sector, with differences among countries depending on the relevance of agri-food sector in the economy. Virtual water and water footprint could be useful to express the impact on the water resources of each production process and good with the objective to lead to a sustainable use of water at a global level. International trade could be connected to the virtual water flows, in fact through commodities importation, water poor countries can save their own water resources. The present paper focuses on the bilateral virtual water flows connected to the top ten agri-food products traded between Italy and China. Comparing the virtual water flow related to the top 10 agri-food products, the virtual water flow from Italy to China is bigger than the water flow in the opposite direction. Moreover, the composition of virtual water flows is different; Italy imports significant amounts of grey water from China, depending on the different environmental strategies adopted by the two selected countries. This difference could be also related to the fact that traded commodities are very different; the 91% of virtual water imported by Italy is connected to crops products, while the 95% of virtual water imported by China is related to the animal products. Considering national water saving and global water saving, appears that Italy imports virtual water from China while China exerts pressure on its water resources to supply the exports to Italy. This result at global scale implies a global water loss of 129.29millionm3 because, in general, the agri-food products are traded from the area with lower water productivity to the area with the higher water productivity. Copyright © 2017 Elsevier B.V. All rights reserved.

Prevalence and Correlates of Functional Status in an Older Community-Representative Sample in Brazil

PubMed Central

Blay, Sergio L; Andreoli, Sergio B; Gastal, Fábio L

2013-01-01

Objective Information on dependency level of elderly in rapidly aging developing countries is limited, but is needed to ascertain extent of need for help with activities of daily living (ADLs). Methods In-person information was obtained in 1995 from a statewide survey of representative community residents ≥60 years of age in the state of Rio Grande do Sul, Brazil (N=7040), on demographic characteristics, health conditions, social ties, health behaviors, and ADL performance. Results Nearly 40% needed help with one or more ADLs. In controlled analyses, need for help approximately doubled with each succeeding decade. Increased education and income and regular physical activity reduced risk. Selected health conditions (stroke, depression, poor self-rated health) were consistently associated with need for help, Discussion A large proportion of noninstitutionalized elderly have ADL problems. In addition to health care, interventions promoting equity of access to education and economic opportunity could reduce ADL dependency in coming generations. PMID:20147651

If you had less than a year to live, would you want to know? A seven-country European population survey of public preferences for disclosure of poor prognosis.

PubMed

Harding, R; Simms, V; Calanzani, N; Higginson, I J; Hall, S; Gysels, M; Meñaca, A; Bausewein, C; Deliens, L; Ferreira, P; Toscani, F; Daveson, B A; Ceulemans, L; Gomes, B

2013-10-01

With increasing European cancer deaths, clinicians must manage information regarding poor prognosis. This study aimed to determine European citizens' preferences, within a scenario of serious illness such as cancer with less than a year to live, for information disclosure regarding poor prognosis, the likely symptoms and problems, and the care options available, to measure variations between countries and to identify factors associated with preferences. A population-based cross-national telephone survey using random digit dialling in seven countries was conducted. Among 9344 respondents, data revealed an international preference (73.9%) to always be informed in the scenario of having a serious illness such as cancer with less than a year to live. This varied from 67.6% in Italy to 80.7% in Flanders. A minority (21.1%) did not want such information unless they ask, or at all. People younger than 70 years (OR 0.72, 95% CI 0.62-0.83, p < 0.001), men (OR 1.23, 95% CI 1.10-1.37, p < 0.001), those with experience of illness (OR = 1.20. 95% CI 1.01-1.43, p < 0.05) and with more education (OR = 1.20, 95% CI 1.09-1.32, p < 0.001) were more likely to want to know of limited time left. The models confirmed the influence of four factors in more than one country (age, gender, education and most concerning problem) and added 11 country-specific factors to which national policies and clinical practice should respond. These findings confirm a majority public preference to be informed in a scenario of poor prognosis. Policy clinical practice should facilitate elucidation and delivery of preferences. Evidence for effective communication skills-building interventions for clinicians is required. Copyright © 2013 John Wiley & Sons, Ltd.

[Zika virus: Another emerging arbovirus in Venezuela?].

PubMed

Valero Nereida

2015-09-01

Current health conditions of Venezuela, together with the tropical proliferation of different types of Aedes (aegypti and albopictus), suggest the arrival to this country of ZIKA virus (ZIKV). The Pan American Health Organization urges Latin American countries to take measures to prevent the ZIKV entry and advises that these measures must be designed to detect the introduction of ZIKV in an area, track its spread and actively monitor the disease. In Venezuela and other Latin-American countries, where endemicity is high for other arboviruses such as dengue arid chikungunya, health authorities should strengthen their surveillance systems to detect early and timely introduction of ZIKV ap.d refine diagnostic methods to confirm the infection rate; however, the high incidence of cases due those viral agents reflects weakened and poorly timed insensitive monitoring systems, as well as, poor vector control measures, arising the questions: will this arbovirus pop in our country, will it set as the other as edemicepidemic and lead to alter their clinical behavior and severity of the disease?

Globalization and occupational health: a perspective from southern Africa.

PubMed Central

Loewenson, R.

2001-01-01

Increased world trade has generally benefited industrialized or strong economies and marginalized those that are weak. This paper examines the impact of globalization on employment trends and occupational health, drawing on examples from southern Africa. While the share of world trade to the world's poorest countries has decreased, workers in these countries increasingly find themselves in insecure, poor-quality jobs, sometimes involving technologies which are obsolete or banned in industrialized countries. The occupational illness which results is generally less visible and not adequately recognized as a problem in low-income countries. Those outside the workplace can also be affected through, for example, work-related environmental pollution and poor living conditions. In order to reduce the adverse effects of global trade reforms on occupational health, stronger social protection measures must be built into production and trade activities, including improved recognition, prevention, and management of work-related ill-health. Furthermore, the success of production and trade systems should be judged on how well they satisfy both economic growth and population health. PMID:11584735

Prevention and control of avian influenza: the need for a paradigm shift in pandemic influenza preparedness.

PubMed

Martinot, A; Thomas, J; Thiermann, A; Dasgupta, N

2007-03-10

Avian influenza presents both challenges and opportunities to leaders around the world engaged in pandemic influenza preparedness planning. Most resource-poor countries will be unable to stockpile antivirals or have access to eventual human vaccines for pandemic flu. Preparedness plans, directed at controlling avian influenza at the source, enable countries simultaneously to promote national and global health, animal welfare and international development. Improving the veterinary infrastructure and capacity of resource-poor countries is one way to prevent potential pandemic flu deaths in resource-rich countries. In this article, Amanda Martinot, James Thomas, Alejandro Thiermann and Nabarun Dasgupta argue that national health leaders need to consider more comprehensive strategies that incorporate veterinary surveillance and improvements in veterinary infrastructure for the control of avian influenza epizootics as part of national pandemic preparedness planning. This, they argue, will require a shift in attitude, from thinking in terms of preparation for an inevitable pandemic to pre-emption of the potential pandemic through prevention measures in the animal population.

Association between Facebook dependence and poor sleep quality: a study in a sample of undergraduate students in Peru.

PubMed

Wolniczak, Isabella; Cáceres-DelAguila, José Alonso; Palma-Ardiles, Gabriela; Arroyo, Karen J; Solís-Visscher, Rodrigo; Paredes-Yauri, Stephania; Mego-Aquije, Karina; Bernabe-Ortiz, Antonio

2013-01-01

Internet can accelerate information exchange. Social networks are the most accessed especially Facebook. This kind of networks might create dependency with several negative consequences in people's life. The aim of this study was to assess potential association between Facebook dependence and poor sleep quality. A cross sectional study was performed enrolling undergraduate students of the Universidad Peruana de Ciencias Aplicadas, Lima, Peru. The Internet Addiction Questionnaire, adapted to the Facebook case, and the Pittsburgh Sleep Quality Index, were used. A global score of 6 or greater was defined as the cutoff to determine poor sleep quality. Generalized linear model were used to determine prevalence ratios (PR) and 95% confidence intervals (95%CI). A total of 418 students were analyzed; of them, 322 (77.0%) were women, with a mean age of 20.1 (SD: 2.5) years. Facebook dependence was found in 8.6% (95% CI: 5.9%-11.3%), whereas poor sleep quality was present in 55.0% (95% CI: 50.2%-59.8%). A significant association between Facebook dependence and poor sleep quality mainly explained by daytime dysfunction was found (PR = 1.31; IC95%: 1.04-1.67) after adjusting for age, sex and years in the faculty. There is a relationship between Facebook dependence and poor quality of sleep. More than half of students reported poor sleep quality. Strategies to moderate the use of this social network and to improve sleep quality in this population are needed.

Patent controversies and court cases

PubMed Central

Fialho, Arsenio M.; Chakrabarty, Ananda M.

2012-01-01

Patents are issued essentially by all countries on inventions that are deemed novel, non-obvious, clearly described and of significant utility or industrial application. The only exceptions to patenting an invention are abstract ideas, laws of nature and natural phenomena, although the exceptions vary depending on countries where moral, public order or human rights considerations are also taken into account. Although patent laws are updated over decades, the rapid progress of science creates situations that the patent laws on the book cannot address, leading to contentious legal issues. This is often true for life saving drugs, particularly drugs for cancers or HIV/AIDS, which are expensive and beyond the reach of poor people because of the proprietary positions of these patented drugs. Another contentious issue is the patent eligibility of human genes and mutations that are often thought of nature's contribution to human health and propagation and should be beyond the reach of patentability. In this review, we address some of these current legal issues and their implications for the development of diagnostic methods, therapeutic interventions and even prevention for cancer, a scourge of mankind. PMID:22954683

Vouchers for family planning and sexual and reproductive health services: a review of voucher programs involving Marie Stopes International among 11 Asian and African countries.

PubMed

Eva, Gillian; Quinn, Andrew; Ngo, Thoai D

2015-08-01

To evaluate provision of vouchers for family planning and sexual and reproductive health (SRH) services. A review was conducted to assess the effects of 24 voucher programs in Marie Stopes International programs across 11 countries in Asia and Africa between 2005 and the present. The outcome measures were uptake of services; service use among specific subgroups; user satisfaction with service quality; and efficiency of service delivery. Twelve of the 24 programs covered family planning only, whereas the other 12 programs covered family planning and/or SRH. Service uptake increased following implementation, although voucher redemption rates varied by program (44.1%-92.4%). Most programs were successful in reaching subgroups, such as the poor and young (under 25years), although this outcome depended on the targeting approach. Most programs recorded high user satisfaction; however, the evidence regarding efficiency was mixed. Vouchers increased uptake of services and, in some cases, improved service quality and reach to specific groups. Nevertheless, robust evaluation designs are required to measure efficiency. Copyright © 2015. Published by Elsevier Ireland Ltd.

76 FR 54928 - Export Administration Regulations: Netherlands Antilles, Curaçao, Sint Maarten and Timor-Leste

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-06

... Chart. The territories and dependencies of a country are treated as the parent country under the EAR..., these dependencies are treated like the Netherlands and will not be listed on the Commerce Country Chart... adding in its place ``territory, possession, dependency or department'' in two places. The Commerce...

A University for the Rural Poor in the Third World.

ERIC Educational Resources Information Center

Gow, Kathryn M.

One possible way of educating residents of developing countries is through a "university for the poor" based on shared village Internet posts and village technology learning centers. Western colleges and universities could donate their courses, and multinational organizations could subsidize the program's administration. Academics could…

Loneliness: Its Correlates and Association with Health Behaviours and Outcomes in Nine Countries of the Former Soviet Union

PubMed Central

Stickley, Andrew; Koyanagi, Ai; Roberts, Bayard; Richardson, Erica; Abbott, Pamela; Tumanov, Sergei; McKee, Martin

2013-01-01

Background Research suggests that the prevalence of loneliness varies between countries and that feeling lonely may be associated with poorer health behaviours and outcomes. The aim of the current study was to examine the factors associated with loneliness, and the relationship between feeling lonely and health behaviours and outcomes in the countries of the former Soviet Union (FSU) – a region where loneliness has been little studied to date. Methods Using data from 18,000 respondents collected during a cross-sectional survey undertaken in nine FSU countries – Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia and Ukraine – in 2010/11, country-wise logistic regression analysis was conducted to determine: the factors associated with feeling lonely; the association between feeling lonely and alcohol consumption, hazardous drinking and smoking; and whether feeling lonely was linked to poorer health (i.e. poor self-rated health and psychological distress). Results The prevalence of loneliness varied widely among the countries. Being divorced/widowed and low social support were associated with loneliness in all of the countries, while other factors (e.g. living alone, low locus of control) were linked to loneliness in some of the countries. Feeling lonely was connected with hazardous drinking in Armenia, Kyrgyzstan and Russia but with smoking only in Kyrgyzstan. Loneliness was associated with psychological distress in all of the countries and poor self-rated health in every country except Kazakhstan and Moldova. Conclusions Loneliness is associated with worse health behaviours and poorer health in the countries of the FSU. More individual country-level research is now needed to formulate effective interventions to mitigate the negative effects of loneliness on population well-being in the FSU. PMID:23861843

[Population pressure: a factor of political destabilization].

PubMed

Tallon, F

1993-04-01

Political stability throughout the world appears to be greater in countries with slowly growing populations than in those with rapid growth. Population is not the only influence on political stability, however. The relationship between political stability and development is strong. The rich countries with the slowest growth are the most stable, while poor developing countries with rapid growth suffer from chronic instability. Demographic pressure and density are not the same thing and must be distinguished. A fragile environment like that of the Sahel will experience demographic pressure despite low density. Japan has a greater population density than Rwanda and little cultivable land, but the population has a high standard of living. demographic pressure is not comparable in Japan and Rwanda because Japan has slow population growth and stable democratic political institutions. The rate of growth seems to be a more important element in destabilization than density. Rapid growth creates enormous political tensions especially when profound ethnic divisions exist, and it complicates problems of government by encouraging rapid urbanization. The unbalanced age structures resulting from rapid growth hinder the satisfaction of employment, educational, and health care needs for the ever-increasing masses of young people. 49% of Rwanda's population is under 15 and 66% is under 25. Rwanda is already densely populated, with around 300 inhabitants/sq km, and its population is projected to double in 20 years. 95% of the population is dependent on agriculture, but by 1988 the average landholding per family was only 1.25 hectares and 58% of families did not grown sufficient food for household needs. Further reduction in the size of holdings or a growing landless population will have multiple consequences. Urban migration will inevitably increase, bringing with it all the problems so evident in other poor countries where the process is more advanced than in Rwanda. Chaotic urbanization is in itself a destabilizing force. The phenomenon of potential political destabilization due to demographic pressure had been analyzed according to different criteria. Unconstitutional sudden changes of government, incomplete civil and political liberties, violent conflicts between ethnic and other subgroups, and the frustrated aspirations of large numbers of young persons are among possible indicators of political instability. A report by the Population Crisis committee which evaluated these indicators in different countries placed Rwanda 39th among 120 countries for potential destabilization. But the period of observation avoided the 1973 disturbances and the 1990 war in Rwanda. The results would undoubtedly be considerably less favorable if the period of observation extended to the present.

Methadone maintenance therapy as evidence based drug abuse planning in developed countries: can developing countries afford and learn from this experience?

PubMed

Nsimba, Stephen E D

2010-03-01

Use of illicit substances of abuse is a major public health problem in developed countries like the US. However, this problem of illicit substance use has spread like a tumor to include currently developing countries where most of its youths and adolescents are actively engaged in this illegal practice. This problem is even more worse in poor resource countries, as use of these substances is accompanied with a lot of HIV- risk behaviours, and for cocaine and heroin drug injectors often share injecting equipments hence increasing the chances of contracting and spreading HIV infection. Apart from HIV infection, other infections include hepatitis B, C, abscesses and other ill-health problems such as drug dependence manifested with complex set of behaviours related to mental illnesses. For non-drug injectors, the chances of contracting and spreading HIV through their unsafe/unprotected sexual behaviours especially those having multiple partners is there. Use of these illicit substances have other consequences like compromising the dosing schedule or adherence / poor compliance to ARTs/ARVs among those enrolled. Furthermore, use of illicit substances may be accompanied with domestic sexual violence which is done without using any protective (condoms) measures) leading to HIV/AIDS and unplanned pregnancies. However, various studies and preventive approaches have been tried in the US on drug abusers in order to prevent the associated adverse health outcomes. There are many reasons why people use drugs. In many situations, drugs are being used as artificial problem-solvers such as frustrations, stress or tiredness. Drugs can often make a problem disappear for a short time but not usually the answer for solving the problem. They just help to remove it temporarily. Other people choose to use drugs to enjoy the feelings or for recreational purposes which many drugs produce. For example, many people, especially young people, experiment with using drugs to find out more about the sensations they produce. Drug use is a problem to users when it begins to cause some damage to their physical health, mental health and social well-being. These include mental illness, diseases caused by or related to use of drugs e.g. practice of sharing needles or syringes among drug injectors and also non-drug injectors may acquire HIV/AIDS and Hepatitis, crimes and violence. However, the number of harm associated with the use of drugs is increasing in Tanzania and other developing countries in Sub-Saharan Africa and globally in developed nations like the US and many others.

Psychological interventions for post-traumatic stress disorder in people living with HIV in Resource poor settings: a systematic review.

PubMed

Verhey, Ruth; Chibanda, Dixon; Brakarsh, Jonathan; Seedat, Soraya

2016-10-01

Post-traumatic stress disorder is pervasive in low- and middle-income countries. There is evidence to suggest that post-traumatic stress disorder is more common among people living with HIV than non-infected matched controls. We carried out a systematic review of interventions for adult post-traumatic stress disorder from resource poor settings with a focus on people living with HIV. We included all studies that investigated interventions for adult post-traumatic stress disorder from resource poor settings with a focus on interventions that were either randomised controlled trials or observational cohort studies carried out from 1980 to May 2015. Of the 25 articles that were identified for full review, two independent reviewers identified seven studies that met our study inclusion criteria. All randomised controlled trials (RCT) (n = 6) used cognitive behavioural therapy-based interventions and focused on people living with HIV in resource poor settings. There was only one study focusing on the use of lay counsellors to address post-traumatic stress disorder but core competencies were not described. There were no intervention studies from Africa, only an observational cohort study from Rwanda. Rigorously evaluated interventions for adult post-traumatic stress disorder in people living with HIV are rare. Most were undertaken in resource poor settings located in high-income countries. There is a need for research on the development and implementation of appropriate interventions for post-traumatic stress disorder in people living with HIV in low- and middle-income countries. © 2016 John Wiley & Sons Ltd.

Wealth and under-nourishment among married women in two impoverished nations: evidence from Burkina Faso and Congo Democratic Republic.

PubMed

Adebowale, Ayo Stephen; Palamuleni, Martin Enoch; Odimegwu, Clifford Obby

2015-02-08

Burkina Faso (BF) and Congo Democratic Republic (CDR) are among the top-ten poverty and hunger stricken countries globally. The influence of poverty and hunger on health is enormous. The objectives of the study are to; examine the association between poverty and nutritional status, it also identified socio-demographic and health related mediating factors that contribute to the relationship between poverty and poor nutritional status. The study focused on married or cohabiting women aged 15-49 years and utilized 2010 and 2007 DHS dataset from BF and CDR respectively. Mean age of the women in BF and CDR were 34.4 ± 9.3 and 34.7 ± 9.0 years respectively. About 19.4% and 18.4% of the poor were malnourished as against 7.7% and 9.7% of the rich women in BF and CDR respectively. Obesity and overweight were more prominent among the rich than the poor. Higher prevalence of under-nourish women was found among the older than the younger women in BF. In the countries, the prevalence of malnutrition was significantly higher among women; in the rural areas, with no formal education, anaemic and those who are not working. Multivariate analysis revealed that in the countries, the risk of under-nourishment was significantly higher among poor and middle class than the rich women despite controlling for confounding variables. Undernourished women were more common among the poor and those with no formal education. Programs that target nutrition of women of reproductive age should be strengthened in BF and CDR.

Infertility in resource-constrained settings: moving towards amelioration.

PubMed

Hammarberg, Karin; Kirkman, Maggie

2013-02-01

It is often presumed that infertility is not a problem in resource-poor areas where fertility rates are high. This is challenged by consistent evidence that the consequences of childlessness are very severe in low-income countries, particularly for women. In these settings, childless women are frequently stigmatized, isolated, ostracized, disinherited and neglected by the family and local community. This may result in physical and psychological abuse, polygamy and even suicide. Attitudes among people in high-income countries towards provision of infertility care in low-income countries have mostly been either dismissive or indifferent as it is argued that scarce healthcare resources should be directed towards reducing fertility and restricting population growth. However, recognition of the plight of infertile couples in low-income settings is growing. One of the United Nation's Millennium Development Goals was for universal access to reproductive health care by 2015, and WHO has recommended that infertility be considered a global health problem and stated the need for adaptation of assisted reproductive technology in low-resource countries. This paper challenges the construct that infertility is not a serious problem in resource-constrained settings and argues that there is a need for infertility care, including affordable assisted reproduction treatment, in these settings. It is often presumed that infertility is not a problem in densely populated, resource-poor areas where fertility rates are high. This presumption is challenged by consistent evidence that the consequences of childlessness are very severe in low-income countries, particularly for women. In these settings, childless women are frequently stigmatized, isolated, ostracized, disinherited and neglected by the family and local community. This may result in physical and psychological abuse, polygamy and even suicide. Because many families in low-income countries depend on children for economic survival, childlessness and having fewer children than the number identified as appropriate are social and public health matters, not only medical problems. Attitudes among people in high-income countries towards provision of infertility care in low-income countries have mostly been either dismissive or indifferent as it is argued that scarce healthcare resources and family planning activities should be directed towards reducing fertility and restricting population growth. However, recognition of the plight of infertile couples in low-income settings is growing. One of the United Nation's Millennium Development Goals was for universal access to reproductive health care by 2015, and WHO has recommended that infertility be considered a global health problem and stated the need for adaptation of assisted reproduction technology in low-resource countries. In this paper, we challenge the construct that infertility is not a serious problem in resource-constrained settings and argue that there is a need for infertility care, including affordable assisted reproduction treatment, in these settings. Copyright © 2012 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

76 FR 70337 - Exports and Reexports to the Principality of Liechtenstein

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-14

..., possession, dependency or department of a country included on the Country Chart, the EAR accords your destination the same licensing treatment as the country of which it is a territory, possession, dependency or...

Maternal and child health project in Nigeria.

PubMed

Okafor, Chinyelu B

2003-12-01

Maternal deaths in developing countries are rooted in womens powerlessness and their unequal access to employment, finance, education, basic health care, and other resources. Nigeria is Africa's most populous country, and it is an oil producing country, but Nigeria has one of the worst maternal mortality rates in Africa. These deaths were linked to deficiencies in access to health care including poor quality of health services, socio-cultural factors, and access issues related to the poor status of women. To address these problems, a participatory approach was used to bring Christian women from various denominations in Eastern Nigeria together. With technical assistance from a research unit in a university in Eastern Nigeria, the women were able to implement a Safe Motherhood project starting from needs assessment to program evaluation. Lessons learned from this program approach are discussed.

Nurses' shift length and overtime working in 12 European countries: the association with perceived quality of care and patient safety.

PubMed

Griffiths, Peter; Dall'Ora, Chiara; Simon, Michael; Ball, Jane; Lindqvist, Rikard; Rafferty, Anne-Marie; Schoonhoven, Lisette; Tishelman, Carol; Aiken, Linda H

2014-11-01

Despite concerns as to whether nurses can perform reliably and effectively when working longer shifts, a pattern of two 12- to 13-hour shifts per day is becoming common in many hospitals to reduce shift to shift handovers, staffing overlap, and hence costs. To describe shift patterns of European nurses and investigate whether shift length and working beyond contracted hours (overtime) is associated with nurse-reported care quality, safety, and care left undone. Cross-sectional survey of 31,627 registered nurses in general medical/surgical units within 488 hospitals across 12 European countries. A total of 50% of nurses worked shifts of ≤ 8 hours, but 15% worked ≥ 12 hours. Typical shift length varied between countries and within some countries. Nurses working for ≥ 12 hours were more likely to report poor or failing patient safety [odds ratio (OR)=1.41; 95% confidence interval (CI), 1.13-1.76], poor/fair quality of care (OR=1.30; 95% CI, 1.10-1.53), and more care activities left undone (RR=1.13; 95% CI, 1.09-1.16). Working overtime was also associated with reports of poor or failing patient safety (OR=1.67; 95% CI, 1.51-1.86), poor/fair quality of care (OR=1.32; 95% CI, 1.23-1.42), and more care left undone (RR=1.29; 95% CI, 1.27-1.31). European registered nurses working shifts of ≥ 12 hours and those working overtime report lower quality and safety and more care left undone. Policies to adopt a 12-hour nursing shift pattern should proceed with caution. Use of overtime working to mitigate staffing shortages or increase flexibility may also incur additional risk to quality.

Early sexual debut and associated factors among in-school adolescents in eight African countries.

PubMed

Peltzer, Karl

2010-08-01

This report examines early sexual debut (

Nurses’ Shift Length and Overtime Working in 12 European Countries

PubMed Central

Dall’Ora, Chiara; Simon, Michael; Ball, Jane; Lindqvist, Rikard; Rafferty, Anne-Marie; Schoonhoven, Lisette; Tishelman, Carol; Aiken, Linda H.

2014-01-01

Background: Despite concerns as to whether nurses can perform reliably and effectively when working longer shifts, a pattern of two 12- to 13-hour shifts per day is becoming common in many hospitals to reduce shift to shift handovers, staffing overlap, and hence costs. Objectives: To describe shift patterns of European nurses and investigate whether shift length and working beyond contracted hours (overtime) is associated with nurse-reported care quality, safety, and care left undone. Methods: Cross-sectional survey of 31,627 registered nurses in general medical/surgical units within 488 hospitals across 12 European countries. Results: A total of 50% of nurses worked shifts of ≤8 hours, but 15% worked ≥12 hours. Typical shift length varied between countries and within some countries. Nurses working for ≥12 hours were more likely to report poor or failing patient safety [odds ratio (OR)=1.41; 95% confidence interval (CI), 1.13–1.76], poor/fair quality of care (OR=1.30; 95% CI, 1.10–1.53), and more care activities left undone (RR=1.13; 95% CI, 1.09–1.16). Working overtime was also associated with reports of poor or failing patient safety (OR=1.67; 95% CI, 1.51–1.86), poor/fair quality of care (OR=1.32; 95% CI, 1.23–1.42), and more care left undone (RR=1.29; 95% CI, 1.27–1.31). Conclusions: European registered nurses working shifts of ≥12 hours and those working overtime report lower quality and safety and more care left undone. Policies to adopt a 12-hour nursing shift pattern should proceed with caution. Use of overtime working to mitigate staffing shortages or increase flexibility may also incur additional risk to quality. PMID:25226543

Communication imperialism and dependency: a conceptual clarification.

PubMed

Lee, P S

1988-01-01

Communications imperialism has to do with the domination of a country's media activities by another. The ownership, structure, distribution or content of the media in 1 country are affected by pressures from media interests of another country or group out of proportion with those of that country. To determine if this is happening we should consider the country's policies, the private sector;s efforts to export communications elements, and actions of the dominant country against the dominated. The 4 aspects of international media in this situation are television program exportation, foreign ownership and control of media distribution, the infringement of capital opinions on other societies, and the transfer of commercialism and broadcasting norms. In addition to the software and hardware and the other forms of communication such as satellites, computers, and transportation of the mass media, there are the cultural effects on the developing countries. In the case of involuntary of voluntary dependency of the recipient country, the effect of the unbalanced international communication can be harmful or beneficial. Communication dependency may not be harmful to the culture of the recipient country. In determining the theory of unbalanced international communications 3 factors should be considered. There are: the role of the interacting countries, the nature of the dependency of the recipient country, and the beneficial or harmful effect of unbalanced communication pattern on that country.

Country Immunization Information System Assessments - Kenya, 2015 and Ghana, 2016.

PubMed

Scott, Colleen; Clarke, Kristie E N; Grevendonk, Jan; Dolan, Samantha B; Ahmed, Hussein Osman; Kamau, Peter; Ademba, Peter Aswani; Osadebe, Lynda; Bonsu, George; Opare, Joseph; Diamenu, Stanley; Amenuvegbe, Gregory; Quaye, Pamela; Osei-Sarpong, Fred; Abotsi, Francis; Ankrah, Joseph Dwomor; MacNeil, Adam

2017-11-10

The collection, analysis, and use of data to measure and improve immunization program performance are priorities for the World Health Organization (WHO), global partners, and national immunization programs (NIPs). High quality data are essential for evidence-based decision-making to support successful NIPs. Consistent recording and reporting practices, optimal access to and use of health information systems, and rigorous interpretation and use of data for decision-making are characteristics of high-quality immunization information systems. In 2015 and 2016, immunization information system assessments (IISAs) were conducted in Kenya and Ghana using a new WHO and CDC assessment methodology designed to identify root causes of immunization data quality problems and facilitate development of plans for improvement. Data quality challenges common to both countries included low confidence in facility-level target population data (Kenya = 50%, Ghana = 53%) and poor data concordance between child registers and facility tally sheets (Kenya = 0%, Ghana = 3%). In Kenya, systemic challenges included limited supportive supervision and lack of resources to access electronic reporting systems; in Ghana, challenges included a poorly defined subdistrict administrative level. Data quality improvement plans (DQIPs) based on assessment findings are being implemented in both countries. IISAs can help countries identify and address root causes of poor immunization data to provide a stronger evidence base for future investments in immunization programs.

Towards a sustainable livestock production in developing countries and the importance of animal health strategy therein.

PubMed

Kaasschieter, G A; de Jong, R; Schiere, J B; Zwart, D

1992-04-01

Livestock and animal health development projects have not always led to substantial increases in animal productivity or in farmers' welfare. Some have even resulted in unsustainable systems, when they were not based on an understanding of (livestock) production systems. The multipurpose functions of livestock and complex relationships between the biological, technical and social components require a systems approach, whereby nutrition, animal health, breeding, biotechnology knowhow, inputs and technologies are used to optimise resource use. The challenge for developed and developing countries is to reverse the current degradation of the environment, and arrive at sustainable increases in crop and livestock production to secure present and future food supplies. For rural development, governments should show long term commitment and political will to support the rural population in development programmes, because smallholders (including women and landless livestock keepers) represent a large labour force in developing countries. Different systems need different approaches. Pastoral systems must focus on effective management of grazing pressure of the rangelands. Communal rangelands management involves not only the development and application of technologies (e.g. feedlots, vaccination campaigns), but also land tenure policies, institutional development, economic return and a reduction in the number of people depending upon livestock. Smallholder mixed farms must aim at intensification of the total production system, in which external inputs are indispensable, but with the emphasis on optimum input-output relationships by reducing resource losses due to poor management. Resource-poor farming systems must aim at the improved management of the various livestock species in backyards and very small farms, and proper packages for cattle, buffaloes, sheep, goats, rabbits and poultry should be developed. Specialised commercial livestock farming systems (poultry, pigs, dairy or meat) can only be sustainable with adequate marketing, supply of quality feed, veterinary services, labour, management and control of pollution. Animal health programmes play a keyrole in the proposed system approach.

Care for Child Development: an intervention in support of responsive caregiving and early child development.

PubMed

Lucas, J E; Richter, L M; Daelmans, B

2018-01-01

An estimated 43% of children younger than 5 years of age are at elevated risk of failing to achieve their human potential. In response, the World Health Organization and UNICEF developed Care for Child Development (CCD), based on the science of child development, to improve sensitive and responsive caregiving and promote the psychosocial development of young children. In 2015, the World Health Organization and UNICEF identified sites where CCD has been implemented and sustained. The sites were surveyed, and responses were followed up by phone interviews. Project reports provided information on additional sites, and a review of published studies was undertaken to document the effectiveness of CCD for improving child and family outcomes, as well as its feasibility for implementation in resource-constrained communities. The inventory found that CCD had been integrated into existing services in diverse sectors in 19 countries and 23 sites, including child survival, health, nutrition, infant day care, early education, family and child protection and services for children with disabilities. Published and unpublished evaluations have found that CCD interventions can improve child development, growth and health, as well as responsive caregiving. It has also been reported to reduce maternal depression, a known risk factor for poor pregnancy outcomes and poor child health, growth and development. Although CCD has expanded beyond initial implementation sites, only three countries reported having national policy support for integrating CCD into health or other services. Strong interest exists in many countries to move beyond child survival to protect and support optimal child development. The United Nations Sustainable Development Goals depend on children realizing their potential to build healthy and emotionally, cognitively and socially competent future generations. More studies are needed to guide the integration of the CCD approach under different conditions. Nevertheless, the time is right to provide for the scale-up of CCD as part of services for families and children. © 2017 The Authors. Child: Care, Health and Development Published by John Wiley & Sons Ltd.

A global predictive model of carbon in mangrove soils

NASA Astrophysics Data System (ADS)

Jardine, Sunny L.; Siikamäki, Juha V.

2014-10-01

Mangroves are among the most threatened and rapidly vanishing natural environments worldwide. They provide a wide range of ecosystem services and have recently become known for their exceptional capacity to store carbon. Research shows that mangrove conservation may be a low-cost means of reducing CO2 emissions. Accordingly, there is growing interest in developing market mechanisms to credit mangrove conservation projects for associated CO2 emissions reductions. These efforts depend on robust and readily applicable, but currently unavailable, localized estimates of soil carbon. Here, we use over 900 soil carbon measurements, collected in 28 countries by 61 independent studies, to develop a global predictive model for mangrove soil carbon. Using climatological and locational data as predictors, we explore several predictive modeling alternatives, including machine-learning methods. With our predictive model, we construct a global dataset of estimated soil carbon concentrations and stocks on a high-resolution grid (5 arc min). We estimate that the global mangrove soil carbon stock is 5.00 ± 0.94 Pg C (assuming a 1 meter soil depth) and find this stock is highly variable over space. The amount of carbon per hectare in the world’s most carbon-rich mangroves (approximately 703 ± 38 Mg C ha-1) is roughly a 2.6 ± 0.14 times the amount of carbon per hectare in the world’s most carbon-poor mangroves (approximately 272 ± 49 Mg C ha-1). Considerable within country variation in mangrove soil carbon also exists. In Indonesia, the country with the largest mangrove soil carbon stock, we estimate that the most carbon-rich mangroves contain 1.5 ± 0.12 times as much carbon per hectare as the most carbon-poor mangroves. Our results can aid in evaluating benefits from mangrove conservation and designing mangrove conservation policy. Additionally, the results can be used to project changes in mangrove soil carbon stocks based on changing climatological predictors, e.g. to assess the impacts of climate change on mangrove soil carbon stocks.

Psychosocial working conditions and psychological well-being among employees in 34 European countries.

PubMed

Schütte, Stefanie; Chastang, Jean-François; Malard, Lucile; Parent-Thirion, Agnès; Vermeylen, Greet; Niedhammer, Isabelle

2014-11-01

The aim of this study was to explore the associations between psychosocial working conditions and psychological well-being among employees in 34 European countries. Another objective was to examine whether these associations varied according to occupation and country. The study was based on data from the European Working Conditions Survey 2010 including 33,443 employees, 16,512 men and 16,931 women, from 34 European countries. Well-being was measured by the WHO-5 well-being index. Twenty-five psychosocial work factors were constructed including job demands, role stressors, work hours, job influence and freedom, job promotion, job insecurity, social support, quality of leadership, discrimination and violence at work, and work-life imbalance. The associations between these factors and well-being were examined using multilevel logistic regression analyses. Different models were performed including interaction tests. When all 25 psychosocial work factors were studied simultaneously in the same model with adjustment variables, 13 showed a significant association with poor well-being among both genders: quantitative demands, demands for hiding emotions, low possibilities for development, low meaning of work, low role conflict, low quality of leadership, low social support, low sense of community, job insecurity, low job promotion, work-life imbalance, discrimination, and bullying. The association with low sense of community on poor well-being was particularly strong. A large number of psychosocial work factors were associated with poor well-being. Almost no country and occupational differences were found in these associations. This study gave a first European overview and could be useful to inform cross-national policy debate.

Annual Research Review: Improved Nutrition--A Pathway to Resilience

ERIC Educational Resources Information Center

Yousafzai, Aisha K.; Rasheed, Muneera A.; Bhutta, Zulfiqar A.

2013-01-01

Background: Early child nutritional deficiencies are prevalent in low- and middle-countries with consequences linked not only to poor survival and growth, but also to poor development outcomes. Children in disadvantaged communities face multiple risks for nutritional deficiencies, yet some children may be less susceptible or may recover more…

Increased dependence of humans on ecosystem services and biodiversity.

PubMed

Guo, Zhongwei; Zhang, Lin; Li, Yiming

2010-10-01

Humans have altered ecosystems more rapidly and extensively than ever, largely to meet rapidly growing demands for resources along with economic development. These demands have been considered important drivers of ecosystem degradation and biodiversity loss. Are humans becoming less dependent on ecosystem services and biodiversity following economic development? Here, we used roundwood production, hydroelectricity generation and tourism investment in 92 biodiversity hotspot and 60 non-hotspot countries as cases to seek the answer. In 1980-2005, annual growth rates of roundwood production, hydroelectricity generation and tourism investment were higher in hotspot countries (5.2, 9.1 and 7.5%) than in non-hotspot countries (3.4, 5.9 and 5.6%), when GDP grew more rapidly in hotspot countries than non-hotspot countries. Annual growth rates of per capita hydropower and per capita tourism investment were higher in hotspot countries (5.3% and 6.1%) than in non-hotspot countries (3.5% and 4.3%); however, the annual growth rate of per capita roundwood production in hotspot countries (1%) was lower than in non-hotspot countries (1.4%). The dependence of humans on cultural services has increased more rapidly than on regulating services, while the dependence on provisioning services has reduced. This pattern is projected to continue during 2005-2020. Our preliminary results show that economic growth has actually made humans more dependent upon ecosystem services and biodiversity. As a consequence, the policies and implementations of both economic development and ecosystems/biodiversity conservation should be formulated and carried out in the context of the increased dependence of humans on ecosystem services along with economic development.

Poverty's threat.

PubMed

1988-03-01

In the debate on the Report of the World Commission on Environment and Development, chaired by Mrs. Gro Harlem Brundtland, Prime Minister of Norway, delegates to the UN General Assembly asserted that problems generated by the impact of poverty on the environment could not be solved by restricting aid to developing countries unless those countries promised to cease damaging their environment. Rather, most delegates agreed, aid should include the resources which would enable those countries to achieve "sustainable development," i.e., development that does not destroy the environment and deplete natural resources. The United States countered with the opinion that what is needed is not a UN organized "sustainable development program," but rather a grassroots "sustainable development movement" in all countries. Several delegates pointed out that it was the affluent countries which played a large part in the destruction of the environment. The Present of the Maldives, Maumoon Abdul Gayoom, pointed out, for example, that the greenhouse effect, generated by the burning of fossil fuels, would raise the sea level 2 meters, virtually submerging his country. Mrs. Brundtland pointed out that it was not morally acceptable to suggest that the poor remain poor to protect the environment. Governments at all levels, she said, must include environmental concerns in their decision making in all sectors of governmental functioning, e.g., finance, industry, energy, and agriculture.

[Problems of demographic data collecting in Arab countries of the Middle East].

PubMed

Chasteland, J C

1970-06-01

12 Middle Eastern Arab countries can be divided into 5 northern countries with demographic data from census or survey and 7 southern countries primarily in the Arabian peninsula (Bahrien excepted) with no data. Obstacles include lack of information on tribes, migrations, and even nomadic status, large areas with sparse population, low socioeconom ic and literacy levels, and cumbersome registration systems. The author computed the index of regularity of age and sex, age distribution by sex, and crude birth-, death, and infant mortality rates to estimate the validity of existing data in each country. These estimates showed that for birthrates registration was about 100% complete for Kuwait and Jordan, 80% for Libya, 60% for Syria, 40% for Iraq. For mortality the registration was so poor that it is only about 30%-40% complete, even in Kuwait and Libya. Data on infant mortality are also poor and have apparently worsened in the 1960s compared with the 1950s. Bias probably exists in birth place, marital status, education, and profession. The author suggested that in southern countries a census should proceed over several years in steps: 1) lists of towns and tribes, 2) simple head count, and 3) complete census. valid vital statistics are urgently needed for national economic planning.

Obesity and poverty paradox in developed countries.

PubMed

Żukiewicz-Sobczak, Wioletta; Wróblewska, Paula; Zwoliński, Jacek; Chmielewska-Badora, Jolanta; Adamczuk, Piotr; Krasowska, Ewelina; Zagórski, Jerzy; Oniszczuk, Anna; Piątek, Jacek; Silny, Wojciech

2014-01-01

Obesity is a civilization disease and the proportion of people suffering from it continues to grow, especially in the developed countries. Number of obese people in Europe has increased threefold over the last 20 years. The paradox of obesity and poverty relationship is observed especially in the developed and developing countries. In developing countries, along with economic development and income growth, the number of people with overweight and obesity is increasing. This paradox has a relationship with both the easy availability and low cost of highly processed foods containing 'empty calories' and no nutritional value. To date, this paradox has been described in the United States and the United Kingdom, although many European countries are also experiencing high percentages of obese people. Among the reasons for the growing obesity in the population of poor people are: higher unemployment, lower education level, and irregular meals. Another cause of obesity is low physical activity, which among the poor is associated with a lack of money for sports equipment. Due to the large rate of deaths caused by diseases directly linked to obesity, the governments of many countries implement prevention programmes of overweight and obesity. These programmes are based primarily on educating the public about a healthy lifestyle based on healthy eating, daily physical activity and avoiding alcohol and cigarettes.

Assessment of the Baby Friendly Hospital Initiative Implementation in the Eastern Mediterranean Region.

PubMed

Al-Jawaldeh, Ayoub; Abul-Fadl, Azza

2018-03-11

The Baby-Friendly Hospital Initiative (BFHI) is a global program for promoting support and protection for breastfeeding. However, its impact on malnutrition, especially in countries of the Eastern Mediterranean region (EMR) that are facing the turmoil of conflict and emergencies, deserves further investigation. Having said that, this paper aims to discuss the status and challenges to BFHI implementation in the EMR countries. Data on BFHI implementation, breastfeeding practices, and nutritional status were collected from countries through structured questionnaires, personal interviews, and databases. The 22 countries of the EMR were categorized as follows: 8 countries in advanced nutrition transition stage (group I), 5 countries in early nutrition transition stage (group II), 4 countries with significant undernutrition (group III), and 5 countries in complex emergency (group IV). The challenges to BFHI implementation were discussed in relation to malnutrition. BFHI was not implemented in 22.7% of EMR countries. Designated Baby-Friendly hospitals totaled 829 (group I: 78.4%, group II: 9.05%; group III: 7.36%; group: IV5.19%). Countries with advanced nutrition transition had the highest implementation of BFHI but the lowest breastfeeding continuity rates. On the other hand, poor nutritional status and emergency states were linked with low BFHI implementation and low exclusive breastfeeding rates but high continuity rates. Early initiation and longer duration of breastfeeding correlated negatively with overweight and obesity ( p < 0.001). In countries with emergency states, breastfeeding continues to be the main source of nourishment. However, suboptimal breastfeeding practices prevail because of poor BFHI implementation which consequently leads to malnutrition. Political willpower and community-based initiatives are needed to promote breastfeeding and strengthen BFHI in the region.

Country level economic disparities in child injury mortality.

PubMed

Khan, Uzma Rahim; Sengoelge, Mathilde; Zia, Nukhba; Razzak, Junaid Abdul; Hasselberg, Marie; Laflamme, Lucie

2015-02-01

Injuries are a neglected cause of child mortality globally and the burden is unequally distributed in resource poor settings. The aim of this study is to explore the share and distribution of child injury mortality across country economic levels and the correlation between country economic level and injuries. All-cause and injury mortality rates per 100,000 were extracted for 187 countries for the 1-4 age group and under 5s from the Global Burden of Disease Study 2010. Countries were grouped into four economic levels. Gross domestic product (GDP) per capita was used to determine correlation with injury mortality. For all regions and country economic levels, the share of injuries in all-cause mortality was greater when considering the 1-4 age group than under 5s, ranging from 36.6% in Organization for Economic Cooperation and Development countries to 10.6% in Sub-Saharan Africa. Except for Sub-Saharan Africa, there is a graded association between country economic level and 1-4 injury mortality across regions, with all low-income countries having the highest rates. Except for the two regions with the highest overall injury mortality rates, there is a significant negative correlation between GDP and injury mortality in Latin America and the Caribbean, Eastern Europe/Central Asia, Asia East/South-East and Pacific and North Africa/ Middle East. Child injury mortality is unevenly distributed across regions and country economic level to the detriment of poorer countries. A significant negative correlation exists between GDP and injury in all regions, exception for the most resource poor where the burden of injuries is highest. 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.

Surveillance guidelines for disease elimination: a case study of canine rabies.

PubMed

Townsend, Sunny E; Lembo, Tiziana; Cleaveland, Sarah; Meslin, François X; Miranda, Mary Elizabeth; Putra, Anak Agung Gde; Haydon, Daniel T; Hampson, Katie

2013-05-01

Surveillance is a critical component of disease control programmes but is often poorly resourced, particularly in developing countries lacking good infrastructure and especially for zoonoses which require combined veterinary and medical capacity and collaboration. Here we examine how successful control, and ultimately disease elimination, depends on effective surveillance. We estimated that detection probabilities of <0.1 are broadly typical of rabies surveillance in endemic countries and areas without a history of rabies. Using outbreak simulation techniques we investigated how the probability of detection affects outbreak spread, and outcomes of response strategies such as time to control an outbreak, probability of elimination, and the certainty of declaring freedom from disease. Assuming realistically poor surveillance (probability of detection <0.1), we show that proactive mass dog vaccination is much more effective at controlling rabies and no more costly than campaigns that vaccinate in response to case detection. Control through proactive vaccination followed by 2 years of continuous monitoring and vaccination should be sufficient to guarantee elimination from an isolated area not subject to repeat introductions. We recommend that rabies control programmes ought to be able to maintain surveillance levels that detect at least 5% (and ideally 10%) of all cases to improve their prospects of eliminating rabies, and this can be achieved through greater intersectoral collaboration. Our approach illustrates how surveillance is critical for the control and elimination of diseases such as canine rabies and can provide minimum surveillance requirements and technical guidance for elimination programmes under a broad-range of circumstances. Copyright © 2012 Elsevier Ltd. All rights reserved.

Rising consumption of meat and milk in developing countries has created a new food revolution.

PubMed

Delgado, Christopher L

2003-11-01

People in developing countries currently consume on average one-third the meat and one-quarter of the milk products per capita compared to the richer North, but this is changing rapidly. The amount of meat consumed in developing countries over the past has grown three times as much as it did in the developed countries. The Livestock Revolution is primarily driven by demand. Poor people everywhere are eating more animal products as their incomes rise above poverty level and as they become urbanized. By 2020, the share of developing countries in total world meat consumption will expand from 52% currently to 63%. By 2020, developing countries will consume 107 million metric tons (mmt) more meat and 177 mmt more milk than they did in 1996/1998, dwarfing developed-country increases of 19 mmt for meat and 32 mmt for milk. The projected increase in livestock production will require annual feed consumption of cereals to rise by nearly 300 mmt by 2020. Nonetheless, the inflation-adjusted prices of livestock and feed commodities are expected to fall marginally by 2020, compared to precipitous declines in the past 20 y. Structural change in the diets of billions of people is a primal force not easily reversed by governments. The incomes and nutrition of millions of rural poor in developing countries are improving. Yet in many cases these dietary changes also create serious environmental and health problems that require active policy involvement to prevent irreversible consequences.

Access to emergency and surgical care in sub-Saharan Africa: the infrastructure gap.

PubMed

Hsia, Renee Y; Mbembati, Naboth A; Macfarlane, Sarah; Kruk, Margaret E

2012-05-01

The effort to increase access to emergency and surgical care in low-income countries has received global attention. While most of the literature on this issue focuses on workforce challenges, it is critical to recognize infrastructure gaps that hinder the ability of health systems to make emergency and surgical care a reality. This study reviews key barriers to the provision of emergency and surgical care in sub-Saharan Africa using aggregate data from the Service Provision Assessments and Demographic and Health Surveys of five countries: Ghana, Kenya, Rwanda, Tanzania and Uganda. For hospitals and health centres, competency was assessed in six areas: basic infrastructure, equipment, medicine storage, infection control, education and quality control. Percentage of compliant facilities in each country was calculated for each of the six areas to facilitate comparison of hospitals and health centres across the five countries. The percentage of hospitals with dependable running water and electricity ranged from 22% to 46%. In countries analysed, only 19-50% of hospitals had the ability to provide 24-hour emergency care. For storage of medication, only 18% to 41% of facilities had unexpired drugs and current inventories. Availability of supplies to control infection and safely dispose of hazardous waste was generally poor (less than 50%) across all facilities. As few as 14% of hospitals (and as high as 76%) among those surveyed had training and supervision in place. No surveyed hospital had enough infrastructure to follow minimum standards and practices that the World Health Organization has deemed essential for the provision of emergency and surgical care. The countries where these hospitals are located may be representative of other low-income countries in sub-Saharan Africa. Thus, the results suggest that increased attention to building up the infrastructure within struggling health systems is necessary for improvements in global access to medical care.

Education and Poverty in Affluent Countries. Routledge Research in Education

ERIC Educational Resources Information Center

Raffo, Carlo, Ed.; Dyson, Alan, Ed.; Gunter, Helen, Ed.; Hall, Dave, Ed.; Jones, Lisa, Ed.; Kalambouka, Afroditi, Ed.

2011-01-01

For the first time, researchers, policymakers and practitioners across the world will have access to a comprehensive mapping of research evidence and policy strategies about education and poverty in affluent countries. Although there is widespread agreement that poverty and poor educational outcomes are related, there are competing explanations as…

Association between Facebook Dependence and Poor Sleep Quality: A Study in a Sample of Undergraduate Students in Peru

PubMed Central

Wolniczak, Isabella; Cáceres-DelAguila, José Alonso; Palma-Ardiles, Gabriela; Arroyo, Karen J.; Solís-Visscher, Rodrigo; Paredes-Yauri, Stephania; Mego-Aquije, Karina; Bernabe-Ortiz, Antonio

2013-01-01

Objectives Internet can accelerate information exchange. Social networks are the most accessed especially Facebook. This kind of networks might create dependency with several negative consequences in people’s life. The aim of this study was to assess potential association between Facebook dependence and poor sleep quality. Methodology/Principal Findings A cross sectional study was performed enrolling undergraduate students of the Universidad Peruana de Ciencias Aplicadas, Lima, Peru. The Internet Addiction Questionnaire, adapted to the Facebook case, and the Pittsburgh Sleep Quality Index, were used. A global score of 6 or greater was defined as the cutoff to determine poor sleep quality. Generalized linear model were used to determine prevalence ratios (PR) and 95% confidence intervals (95%CI). A total of 418 students were analyzed; of them, 322 (77.0%) were women, with a mean age of 20.1 (SD: 2.5) years. Facebook dependence was found in 8.6% (95% CI: 5.9%–11.3%), whereas poor sleep quality was present in 55.0% (95% CI: 50.2%–59.8%). A significant association between Facebook dependence and poor sleep quality mainly explained by daytime dysfunction was found (PR = 1.31; IC95%: 1.04–1.67) after adjusting for age, sex and years in the faculty. Conclusions There is a relationship between Facebook dependence and poor quality of sleep. More than half of students reported poor sleep quality. Strategies to moderate the use of this social network and to improve sleep quality in this population are needed. PMID:23554978

Tobacco use and secondhand smoke exposure during pregnancy in low- and middle-income countries: the need for social and cultural research.

PubMed

Nichter, Mimi; Greaves, Lorraine; Bloch, Michele; Paglia, Michael; Scarinci, Isabel; Tolosa, Jorge E; Novotny, Thomas E

2010-01-01

Tobacco use is a leading cause of death and of poor pregnancy outcome in many countries. While tobacco use is decreasing in many high-income countries, it is increasing in many low- and middle-income countries (LMICs), where by the year 2030, 80% of deaths caused by tobacco use are expected to occur. In many LMICs, few women smoke tobacco, but strong evidence indicates this is changing; increased tobacco smoking by pregnant women will worsen pregnancy outcomes, especially in resource-poor settings, and threatens to undermine or reverse hard-won gains in maternal and child health. To date, little research has focused on preventing pregnant women's tobacco use and secondhand smoke (SHS) exposure in LMICs. Research on social and cultural influences on pregnant women's tobacco use will greatly facilitate the design and implementation of effective prevention programs and policies, including the adaptation of successful strategies used in high-income countries. This paper describes pregnant women's tobacco use and SHS exposure and the social and cultural influences on pregnant women's tobacco exposure; it also presents a research agenda put forward by an international workgroup convened to make recommendations in this area.

Current drivers and future directions of global livestock disease dynamics

PubMed Central

Perry, Brian D.; Grace, Delia; Sones, Keith

2013-01-01

We review the global dynamics of livestock disease over the last two decades. Our imperfect ability to detect and report disease hinders assessment of trends, but we suggest that, although endemic diseases continue their historic decline in wealthy countries, poor countries experience static or deteriorating animal health and epidemic diseases show both regression and expansion. At a mesolevel, disease is changing in terms of space and host, which is illustrated by bluetongue, Lyme disease, and West Nile virus, and it is also emerging, as illustrated by highly pathogenic avian influenza and others. Major proximate drivers of change in disease dynamics include ecosystem change, ecosystem incursion, and movements of people and animals; underlying these are demographic change and an increasing demand for livestock products. We identify three trajectories of global disease dynamics: (i) the worried well in developed countries (demanding less risk while broadening the circle of moral concern), (ii) the intensifying and market-orientated systems of many developing countries, where highly complex disease patterns create hot spots for disease shifts, and (iii) the neglected cold spots in poor countries, where rapid change in disease dynamics is less likely but smallholders and pastoralists continue to struggle with largely preventable and curable livestock diseases. PMID:21576468

Dying of corruption.

PubMed

Holmberg, Sören; Rothstein, Bo

2011-10-01

In many poor countries, over 80% of the population have experienced corrupt practices in the health sector. In rich countries, corruption takes other forms such as overbilling. The causal link between low levels of the quality of government (QoG) and population health can be either direct or indirect. Using cross-sectional data from more than 120 countries, our findings are that more of a QoG variable is positively associated with higher levels of life expectancy, lower levels of mortality rates for children and mothers, higher levels of healthy life expectancies and higher levels of subjective health feelings. In contrast to the strong relationships between the QoG variables and the health indicators, the relationship between the health-spending measures and population health are rather weak most of the time and occasionally non-existent. Moreover, for private health spending as well as for private share of total health spending, the relation to good health is close to zero or slightly negative. The policy recommendation coming out of our study to improve health levels around the world, in rich countries as well as in poor countries, is to improve the QoG and to finance health care with public, not private, money.

Beyond Bellagio: addressing the challenge of sustainable child health in developing countries.

PubMed

Bhutta, Z A

2004-05-01

Despite the hype and ostensible investments in child survival strategies, the state of child health in much of the developing world is alarming. Not only are global investments and support programmes for child health by the development agencies declining, but commensurate support for maternal and child health by poor countries themselves is poor. In order to make a meaningful contribution to maternal and child health and survival, a multi-pronged approach is needed which not only focuses on the proximal determinants of child health but also some of the underlying factors governing the status of women in society and expenditures on health and development.

How community physical, structural, and social stressors relate to mental health in the urban slums of Accra, Ghana.

PubMed

Greif, Meredith J; Nii-Amoo Dodoo, F

2015-05-01

Urban health in developing counties is a major public health challenge. It has become increasingly evident that the dialog must expand to include mental health outcomes, and to shift focus to the facets of the urban environment that shape them. Population-based research is necessary, as empirical findings linking the urban environment and mental health have primarily derived from developed countries, and may not be generalizable to developing countries. Thus, the current study assesses the prevalence of mental health problems (i.e., depression, perceived powerlessness), as well as their community-based predictors (i.e., crime, disorder, poverty, poor sanitation, local social capital and cohesion), among a sample of 690 residents in three poor urban communities in Accra, Ghana. It uncovers that residents in poor urban communities in developing countries suffer from mental health problems as a result of local stressors, which include not only physical and structural factors but social ones. Social capital and social cohesion show complex, often unhealthy, relationships with mental health, suggesting considerable drawbacks in making social capital a key focus among policymakers. Copyright © 2015. Published by Elsevier Ltd.

Child health inequities in developing countries: differences across urban and rural areas

PubMed Central

Fotso, Jean-Christophe

2006-01-01

Objectives To document and compare the magnitude of inequities in child malnutrition across urban and rural areas, and to investigate the extent to which within-urban disparities in child malnutrition are accounted for by the characteristics of communities, households and individuals. Methods The most recent data sets available from the Demographic and Health Surveys (DHS) of 15 countries in sub-Saharan Africa (SSA) are used. The selection criteria were set to ensure that the number of countries, their geographical spread across Western/Central and Eastern/Southern Africa, and their socioeconomic diversities, constitute a good yardstick for the region and allow us to draw some generalizations. A household wealth index is constructed in each country and area (urban, rural), and the odds ratio between its uppermost and lowermost category, derived from multilevel logistic models, is used as a measure of socioeconomic inequalities. Control variables include mother's and father's education, community socioeconomic status (SES) designed to represent the broad socio-economic ecology of the neighborhoods in which families live, and relevant mother- and child-level covariates. Results Across countries in SSA, though socioeconomic inequalities in stunting do exist in both urban and rural areas, they are significantly larger in urban areas. Intra-urban differences in child malnutrition are larger than overall urban-rural differentials in child malnutrition, and there seem to be no visible relationships between within-urban inequities in child health on the one hand, and urban population growth, urban malnutrition, or overall rural-urban differentials in malnutrition, on the other. Finally, maternal and father's education, community SES and other measurable covariates at the mother and child levels only explain a slight part of the within-urban differences in child malnutrition. Conclusion The urban advantage in health masks enormous disparities between the poor and the non-poor in urban areas of SSA. Specific policies geared at preferentially improving the health and nutrition of the urban poor should be implemented, so that while targeting the best attainable average level of health, reducing gaps between population groups is also on target. To successfully monitor the gaps between urban poor and non-poor, existing data collection programs such as the DHS and other nationally representative surveys should be re-designed to capture the changing patterns of the spatial distribution of population. PMID:16831231

Child health inequities in developing countries: differences across urban and rural areas.

PubMed

Fotso, Jean-Christophe

2006-07-11

To document and compare the magnitude of inequities in child malnutrition across urban and rural areas, and to investigate the extent to which within-urban disparities in child malnutrition are accounted for by the characteristics of communities, households and individuals. The most recent data sets available from the Demographic and Health Surveys (DHS) of 15 countries in sub-Saharan Africa (SSA) are used. The selection criteria were set to ensure that the number of countries, their geographical spread across Western/Central and Eastern/Southern Africa, and their socioeconomic diversities, constitute a good yardstick for the region and allow us to draw some generalizations. A household wealth index is constructed in each country and area (urban, rural), and the odds ratio between its uppermost and lowermost category, derived from multilevel logistic models, is used as a measure of socioeconomic inequalities. Control variables include mother's and father's education, community socioeconomic status (SES) designed to represent the broad socio-economic ecology of the neighborhoods in which families live, and relevant mother- and child-level covariates. Across countries in SSA, though socioeconomic inequalities in stunting do exist in both urban and rural areas, they are significantly larger in urban areas. Intra-urban differences in child malnutrition are larger than overall urban-rural differentials in child malnutrition, and there seem to be no visible relationships between within-urban inequities in child health on the one hand, and urban population growth, urban malnutrition, or overall rural-urban differentials in malnutrition, on the other. Finally, maternal and father's education, community SES and other measurable covariates at the mother and child levels only explain a slight part of the within-urban differences in child malnutrition. The urban advantage in health masks enormous disparities between the poor and the non-poor in urban areas of SSA. Specific policies geared at preferentially improving the health and nutrition of the urban poor should be implemented, so that while targeting the best attainable average level of health, reducing gaps between population groups is also on target. To successfully monitor the gaps between urban poor and non-poor, existing data collection programs such as the DHS and other nationally representative surveys should be re-designed to capture the changing patterns of the spatial distribution of population.

Current Scenario of Spurious and Substandard Medicines in India: A Systematic Review

PubMed Central

Khan, A. N.; Khar, R. K.

2015-01-01

Globally, every country is the victim of substandard or spurious drugs, which result in life threatening issues, financial loss of consumer and manufacturer and loss in trust on health system. The aim of this enumerative review was to probe the extent on poor quality drugs with their consequences on public health and the preventive measures taken by the Indian pharmaceutical regulatory system. Government and non-government studies, literature and news were gathered from journals and authentic websites. All data from 2000 to 2013 were compiled and interpreted to reveal the real story of poor quality drugs in India. For minimizing spurious/falsely-labelled/falsified/counterfeit drugs or not of standard quality drugs, there is urgent requirement of more stringent regulation and legal action against the problem. However, India has taken some preventive steps in the country to fight against the poor quality drugs for protecting and promoting the public health. PMID:25767312

Laboratory challenges in the scaling up of HIV, TB, and malaria programs: The interaction of health and laboratory systems, clinical research, and service delivery.

PubMed

Birx, Deborah; de Souza, Mark; Nkengasong, John N

2009-06-01

Strengthening national health laboratory systems in resource-poor countries is critical to meeting the United Nations Millennium Development Goals. Despite strong commitment from the international community to fight major infectious diseases, weak laboratory infrastructure remains a huge rate-limiting step. Some major challenges facing laboratory systems in resource-poor settings include dilapidated infrastructure; lack of human capacity, laboratory policies, and strategic plans; and limited synergies between clinical and research laboratories. Together, these factors compromise the quality of test results and impact patient management. With increased funding, the target of laboratory strengthening efforts in resource-poor countries should be the integrating of laboratory services across major diseases to leverage resources with respect to physical infrastructure; types of assays; supply chain management of reagents and equipment; and maintenance of equipment.

Understanding and Addressing the Global Need for Orthopaedic Trauma Care.

PubMed

Agarwal-Harding, Kiran J; von Keudell, Arvind; Zirkle, Lewis G; Meara, John G; Dyer, George S M

2016-11-02

➤The burden of musculoskeletal trauma is high worldwide, disproportionately affecting the poor, who have the least access to quality orthopaedic trauma care.➤Orthopaedic trauma care is essential, and must be a priority in the horizontal development of global health systems.➤The education of surgeons, nonphysician clinicians, and ancillary staff in low and middle income countries is central to improving access to and quality of care.➤Volunteer surgical missions from rich countries can sustainably expand and strengthen orthopaedic trauma care only when they serve a local need and build local capacity.➤Innovative business models may help to pay for care of the poor. Examples include reducing costs through process improvements and cross-subsidizing from profitable high-volume activities.➤Resource-poor settings may foster innovations in devices or systems with universal applicability in orthopaedics. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

Quality of life among treatment seeking methamphetamine-dependent individuals.

PubMed

Gonzales, Rachel; Ang, Alfonso; Glik, Deborah C; Rawson, Richard A; Lee, Stella; Iguchi, Martin Y

2011-01-01

As the number of men and women entering treatment for substance use disorders continues to increase across the country, it becomes vitally important to understand their quality of life (QOL) or perceived health status, in order to inform treatment efforts for improving such outcomes. To date, QOL assessments among methamphetamine (MA) dependent users are limited. This paper examines QOL health status among a sample of 838 treatment seeking MA users at admission. Using regression analysis, predictors of QOL are examined among MA users. Predictors of poor QOL among MA users at treatment admission included being female, white, high school educated or more, married, experiencing psychosocial dysfunction (lifetime trauma, suicide, social conflict), reporting a high frequency of both MA and polydrugs for 15 days or more in the past month, chronicity of MA and polydrug use, injection use, and having co-morbid medical and psychiatric impairment. Employment status was the only factor related to better health status perceptions. This study expands the scope of scholarly examination of MA-dependent users entering treatment, as there has not been a development of coherent profiles of QOL among representative samples of clinical MA-abusing populations to date. © American Academy of Addiction Psychiatry.

[The Third World before the Third World, 1770-1870].

PubMed

Batou, J

1992-01-01

The advent of the development gap between the industrialized countries and the underdeveloped countries is explored through an examination of early attempts to industrialize in Latin America and the Middle East in the years 1770-1870. The beginning of the development gap can be dated to 1830-60, with the diffusion of the industrial revolution in Western Europe and the US. The periphery remained poorly defined and still enjoyed a significant degree of economic autonomy through 1870, but lowered cost of international freight, the increasing cost and technological complexity of machinery,and other factors after that date combined to assure increasing economic integration of nations. Latin America and the Middle East were selected for study because they were the only present-day developing regions to have developed modern industry before 1850-60 except for Bengal, which was already colonized by the British. The industrial revolution was a decisive development in the history of human societies, marked by a drastic acceleration of the rate of economic growth as much as by an unprecedented increase in inequality of development between countries. Societies bypassed by technological innovations thus seemed doomed sooner or later to depend on societies at the center of development. Third world contemporaries of the early industrial revolution appear to have been aware of this, and some peripheral states made serious efforts to avoid the worst forms of external dependence and to resist the deindustrialization, pauperization, and direct colonization of underdevelopment. 3 types of attempts at industrialization in Latin America and the Middle East before 1860-80 are distinguished and described, including partial and unsuccessful public efforts in several countries, isolated private initiatives going against prevailing trends in Mexico and Brazil, and industrial development directed step by step by the state in Egypt and Paraguay. It is argued that the model of industrialization in Egypt and Paraguay anticipated the Japanese experience in certain respects and would have had a good chance of success hand not devastating warfare destroyed the economics of both countries. The author explores 5 questions to assess the relevance of the Paraguayan and Egyptian model: 1) whether the natural environment of the 2 countries offered favorable conditions for modern factories, 2) whether peripheral states had the resources for financing a true industrialization policy, 3) whether the sociocultural context of the 2 countries would have permitted them to develop an industrial culture, 4) whether the West would have tolerated the competition implied by their economic development and industrialization, and 5) whether this model of industrialization was adjusted to the specific conditions of the periphery.

Mechanical erosion of xenoliths by magmatic shear flow

NASA Astrophysics Data System (ADS)

Del Gaudio, Piero; Ventura, Guido

2008-05-01

We focus on the role of mechanical erosion by magmatic shear flow in the formation of xenoliths occurring in lava flows. The process is analyzed by combining the physics of fragmentation and erosion to the concept of rock mass. The conditions for the country rock fragmentation are analyzed as a function of the magma viscosity, strain rate and tensile strength of the rock mass. In reservoirs, mechanical processes play a subordinate role and thermal erosion processes prevail. In conduits, intermediate and silicic magmas may erode and, eventually, fragment good to poor quality country rock masses. Basalts may erode poor quality country rocks. A crystal-rich magma has more chance to break up the conduit walls with respect to a vesiculated melt. The variety of xenoliths of a lava reflects a set of wall-rocks with similar mechanical properties and may not mirror the stratigraphy of the substratum of a volcanic area.

Sustainable development in an N-rich/n-poor world.

PubMed

Perrings, Charles; Kinzig, Ann; Halkos, George

2014-11-01

Sustainable development requires that per capita inclusive wealth-produced, human, and natural capital-does not decline over time. We investigate the impact of changes in nitrogen on inclusive wealth. There are two sides to the nitrogen problem. Excess use of nitrogen in some places gives rise to N-pollution, which can cause environmental damage. Insufficient replacement of nitrogen in other places gives rise to N-depletion, or loss of nutrient stocks. Neither is explicitly accounted for in current wealth measures, but both affect wealth. We calculate an index of net N-replacement, and investigate its relationship to wealth. In countries with low levels of relative N-loss, we find that the uncompensated loss of soil nitrogen in poorer countries is associated with declining rates of growth of inclusive per capita wealth. What is less intuitive is that increasing fertilizer application in both rich and poor countries can increase per capita inclusive wealth.

From life insurance to safer sex--reflections of a marketing man.

PubMed

Mackay, Bruce

2008-05-01

Much of the writing on health in developing countries focuses on the public sector rather than the private market, and on providers rather than on consumers. A more consumer-oriented perspective would regard the transactions by which most people in most poor countries buy healthcare as the norm, just one among many purchases of a personal service which all of us, as consumers, have to make. This paper contends that asymmetric information is not confined to health and medicine, but is a common problem for consumers whatever the GDP of the country they live in, and however rich and poor they may be. Understanding how consumers overcome these problems yields insights into the ways in which providers have to market their services, and into what, if anything, governments and donors can do to extend, improve or regulate the private healthcare market.

Principlism, medical individualism, and health promotion in resource-poor countries: can autonomy-based bioethics promote social justice and population health?

PubMed Central

2010-01-01

Through its adoption of the biomedical model of disease which promotes medical individualism and its reliance on the individual-based anthropology, mainstream bioethics has predominantly focused on respect for autonomy in the clinical setting and respect for person in the research site, emphasizing self-determination and freedom of choice. However, the emphasis on the individual has often led to moral vacuum, exaggeration of human agency, and a thin (liberal?) conception of justice. Applied to resource-poor countries and communities within developed countries, autonomy-based bioethics fails to address the root causes of diseases and public health crises with which individuals or communities are confronted. A sociological explanation of disease causation is needed to broaden principles of biomedical ethics and provides a renewed understanding of disease, freedom, medical practice, patient-physician relationship, risk and benefit of research and treatment, research priorities, and health policy. PMID:20082703

Principlism, medical individualism, and health promotion in resource-poor countries: can autonomy-based bioethics promote social justice and population health?

PubMed

Azétsop, Jacquineau; Rennie, Stuart

2010-01-18

Through its adoption of the biomedical model of disease which promotes medical individualism and its reliance on the individual-based anthropology, mainstream bioethics has predominantly focused on respect for autonomy in the clinical setting and respect for person in the research site, emphasizing self-determination and freedom of choice. However, the emphasis on the individual has often led to moral vacuum, exaggeration of human agency, and a thin (liberal?) conception of justice. Applied to resource-poor countries and communities within developed countries, autonomy-based bioethics fails to address the root causes of diseases and public health crises with which individuals or communities are confronted. A sociological explanation of disease causation is needed to broaden principles of biomedical ethics and provides a renewed understanding of disease, freedom, medical practice, patient-physician relationship, risk and benefit of research and treatment, research priorities, and health policy.

The Cost of Uncertain Life Span*

PubMed Central

Edwards, Ryan D.

2012-01-01

A considerable amount of uncertainty surrounds the length of human life. The standard deviation in adult life span is about 15 years in the U.S., and theory and evidence suggest it is costly. I calibrate a utility-theoretic model of preferences over length of life and show that one fewer year in standard deviation is worth about half a mean life year. Differences in the standard deviation exacerbate cross-sectional differences in life expectancy between the U.S. and other industrialized countries, between rich and poor countries, and among poor countries. Accounting for the cost of life-span variance also appears to amplify recently discovered patterns of convergence in world average human well-being. This is partly for methodological reasons and partly because unconditional variance in human length of life, primarily the component due to infant mortality, has exhibited even more convergence than life expectancy. PMID:22368324

Extending the Progressive Tradition to Poor Countries: The Role of Universities and Colleges

ERIC Educational Resources Information Center

Gathuo, Shiko

2016-01-01

American universities and colleges have always been a bastion of liberalism and progressive thought. Historically, the academic community has supported social justice issues, given a voice to the poor, minorities and the disadvantaged, and brought to light subjects that are considered taboo elsewhere. Indeed, many social movements have either…

Socioeconomic and Behavioral Factors Leading to Acquired Bacterial Resistance to Antibiotics in Developing Countries

PubMed Central

Okeke, Iruka N.; Lamikanra, Adebayo

1999-01-01

In developing countries, acquired bacterial resistance to antimicrobial agents is common in isolates from healthy persons and from persons with community-acquired infections. Complex socioeconomic and behavioral factors associated with antibiotic resistance, particularly regarding diarrheal and respiratory pathogens, in developing tropical countries, include misuse of antibiotics by health professionals, unskilled practitioners, and laypersons; poor drug quality; unhygienic conditions accounting for spread of resistant bacteria; and inadequate surveillance. PMID:10081668

Evaluating the relative environmental impact of countries.

PubMed

Bradshaw, Corey J A; Giam, Xingli; Sodhi, Navjot S

2010-05-03

Environmental protection is critical to maintain ecosystem services essential for human well-being. It is important to be able to rank countries by their environmental impact so that poor performers as well as policy 'models' can be identified. We provide novel metrics of country-specific environmental impact ranks - one proportional to total resource availability per country and an absolute (total) measure of impact - that explicitly avoid incorporating confounding human health or economic indicators. Our rankings are based on natural forest loss, habitat conversion, marine captures, fertilizer use, water pollution, carbon emissions and species threat, although many other variables were excluded due to a lack of country-specific data. Of 228 countries considered, 179 (proportional) and 171 (absolute) had sufficient data for correlations. The proportional index ranked Singapore, Korea, Qatar, Kuwait, Japan, Thailand, Bahrain, Malaysia, Philippines and Netherlands as having the highest proportional environmental impact, whereas Brazil, USA, China, Indonesia, Japan, Mexico, India, Russia, Australia and Peru had the highest absolute impact (i.e., total resource use, emissions and species threatened). Proportional and absolute environmental impact ranks were correlated, with mainly Asian countries having both high proportional and absolute impact. Despite weak concordance among the drivers of environmental impact, countries often perform poorly for different reasons. We found no evidence to support the environmental Kuznets curve hypothesis of a non-linear relationship between impact and per capita wealth, although there was a weak reduction in environmental impact as per capita wealth increases. Using structural equation models to account for cross-correlation, we found that increasing wealth was the most important driver of environmental impact. Our results show that the global community not only has to encourage better environmental performance in less-developed countries, especially those in Asia, there is also a requirement to focus on the development of environmentally friendly practices in wealthier countries.

The Gradual Shift of Overweight, Obesity, and Abdominal Obesity Towards the Poor in a Multi-ethnic Developing Country: Findings From the Malaysian National Health and Morbidity Surveys

PubMed Central

Mariapun, Jeevitha; Ng, Chiu-Wan; Hairi, Noran N.

2018-01-01

Background Economic development is known to shift the distribution of obesity from the socioeconomically more advantaged to the less advantaged. We assessed the socioeconomic trends in overweight, obesity, and abdominal obesity across a period of significant economic growth. Methods We used the Malaysian National Health and Morbidity Survey data sets for the years 1996, 2006, and 2011 to analyze the trends among adults aged 30 years and above. The World Health Organization’s Asian body mass index cut-off points of ≥23.0 kg/m2 and ≥27.5 kg/m2 were used to define overweight and obesity, respectively. Abdominal obesity was defined as having a waist circumference of ≥90 cm for men and ≥80 cm for women. Household per-capita income was used as a measure of socioeconomic position. As a summary measure of inequality, we computed the concentration index. Results Women in Peninsular Malaysia demonstrated patterns that were similar to that of developed countries in which the distributions for overweight, obesity, and abdominal obesity became concentrated among the poor. For women in East Malaysia, distributions became neither concentrated among the rich nor poor, while distributions for men were still concentrated among the rich. Chinese women, particularly from the richest quintile, had the lowest rates and lowest increase in overweight and obesity. All distributions of Chinese women were concentrated among the poor. The distributions of Malay men were still concentrated among the rich, while distributions for Chinese and Indian men and Malay and Indian women were neither concentrated among the rich nor poor. Conclusion As the country continues to progress, increasing risks of overweight and obesity among the socioeconomically less advantaged is expected. PMID:29657257

The Gradual Shift of Overweight, Obesity, and Abdominal Obesity Towards the Poor in a Multi-ethnic Developing Country: Findings From the Malaysian National Health and Morbidity Surveys.

PubMed

Mariapun, Jeevitha; Ng, Chiu-Wan; Hairi, Noran N

2018-06-05

Economic development is known to shift the distribution of obesity from the socioeconomically more advantaged to the less advantaged. We assessed the socioeconomic trends in overweight, obesity, and abdominal obesity across a period of significant economic growth. We used the Malaysian National Health and Morbidity Survey data sets for the years 1996, 2006, and 2011 to analyze the trends among adults aged 30 years and above. The World Health Organization's Asian body mass index cut-off points of ≥23.0 kg/m 2 and ≥27.5 kg/m 2 were used to define overweight and obesity, respectively. Abdominal obesity was defined as having a waist circumference of ≥90 cm for men and ≥80 cm for women. Household per-capita income was used as a measure of socioeconomic position. As a summary measure of inequality, we computed the concentration index. Women in Peninsular Malaysia demonstrated patterns that were similar to that of developed countries in which the distributions for overweight, obesity, and abdominal obesity became concentrated among the poor. For women in East Malaysia, distributions became neither concentrated among the rich nor poor, while distributions for men were still concentrated among the rich. Chinese women, particularly from the richest quintile, had the lowest rates and lowest increase in overweight and obesity. All distributions of Chinese women were concentrated among the poor. The distributions of Malay men were still concentrated among the rich, while distributions for Chinese and Indian men and Malay and Indian women were neither concentrated among the rich nor poor. As the country continues to progress, increasing risks of overweight and obesity among the socioeconomically less advantaged is expected.

Brain drain adds to AIDS crisis in developing world.

PubMed

Green, Stanley

2006-01-01

Thousands of desperately needed doctors and other medical professionals leave poor countries because no one there can pay them, or provide safe and effective working conditions. Many go to English-speaking countries that do not train enough medical professionals themselves--such as the U.S., where a quarter of the doctors are foreign trained.

Learning Style Preferences and Mathematics Achievement of Secondary School Learners

ERIC Educational Resources Information Center

Bosman, Anne; Schulze, Salome

2018-01-01

Mathematics is a key subject necessary to the promotion of economic development, particularly in developing countries; however, South African learners perform poorly in Mathematics when benchmarked against their counterparts in other countries. One way to address this issue is by taking cognisance of the learners' learning styles when teaching.…

Marketing Sports Facilities: Perspectives from Botswana

ERIC Educational Resources Information Center

Bohutsana, Basuti; Akpata, Dele

2013-01-01

The provision of sports facilities contributes immensely to the growth of sports and leisure activities in the countries where they are provided. In some countries, as was the case in Botswana, the government had to spend millions of dollars to provide new Integrated Sports Facilities (ISF's) as a panacea for the continued poor performance of its…

Curriculum-Guided Crowd Sourcing of Assessments in a Developing Country

ERIC Educational Resources Information Center

Zualkernan, Imran A.; Raza, Anjana; Karim, Asad

2012-01-01

Success of Wikipedia has opened a number of possibilities for crowd sourcing learning resources. However, not all crowd sourcing initiatives are successful. For developing countries, adoption factors like lack of infrastructure and poor teacher training can have an impact on success of such systems. This paper presents an exploratory study to…

Energy access and living standards: some observations on recent trends

NASA Astrophysics Data System (ADS)

Rao, Narasimha D.; Pachauri, Shonali

2017-02-01

A subset of Sustainable Development Goals pertains to improving people’s living standards at home. These include the provision of access to electricity, clean cooking energy, improved water and sanitation. We examine historical progress in energy access in relation to other living standards. We assess regional patterns in the pace of progress and relative priority accorded to these different services. Countries in sub-Saharan Africa would have to undergo unprecedented rates of improvement in energy access in order to achieve the goal of universal electrification by 2030. World over, access to clean cooking fuels and sanitation facilities consistently lag improved water and electricity access by a large margin. These two deprivations are more concentrated among poor countries, and poor people in middle income countries. They are also correlated to health risks faced disproportionately by women. However, some Asian countries have been able to achieve faster progress in electrification at lower income levels compared to industrialized countries’ earlier efforts. These examples offer hope that future efforts need not be constrained by historical rates of progress.

Initial assessment of strategic plans for improving the performance of veterinary services in developing countries: a review of OIE PVS gap analysis reports.

PubMed

Weaver, J; Leon, E; Edan, M; D'Alessio, F

2012-08-01

The World Organisation for Animal Health (OIE) carries out Gap Analysis missions (if a country so wishes) as part of its programme to assess and improve the Performance of Veterinary Services (the 'PVS Pathway') in Member Countries. These Gap Analysis missions have found that many national Veterinary Services comply to only a limited extent with the international standards established by the OIE and that their competence is compromised by poor governance. This failure threatens animal and public health not only nationally but also internationally. The OIE PVS Gap Analysis reports reviewed found that all the Veterinary Services have a strong vision and commitmentto improvement but are held back by a weak chain of command, inadequate and outdated legislation, insufficient funding, weak technical competencies, compromised technical independence, poor communications and limited joint programmes. There are weaknesses across all the core technical areas of trade, animal health, veterinary public health and veterinary laboratories and also in the overall management of the Veterinary Services. The OIE PVS Gap Analysis missions recommend significant increases in budget in all countries.

Road Maintenance in Africa: Approaches and Perspectives

NASA Astrophysics Data System (ADS)

M, Mostafa Hassan

2018-06-01

In Africa, roads are the dominant mode of passenger and freight transport, for which the need is growing rapidly. It is noticeable that most of the African countries do not do enough to ensure the sustainability of road infrastructure as it has been widely reported that roads are affected, to varying degrees, by premature deterioration. Most of the African countries have adopted institutional reforms, notably entailing the creation of road funds and road agencies, and made significant progress on road maintenance. However, many challenges remain to be addressed in all of them to ensure appropriate maintenance. Although spending on road maintenance has increased over time in all African countries it remains insufficient to cover the needs. Poorly maintained roads constrain mobility, significantly raise vehicle operating costs, increase accident rates and their associated human and property costs, and aggravate isolation, poverty, poor health, and illiteracy in rural communities. This paper focuses, in particular, on road maintenance in some African countries considering types of road maintenance and the different approaches aiming at a comparison to reflect on similarities and differences.

HIV antiretroviral medication stock-outs in Ghana: contributors and consequences.

PubMed

Poku, Rebecca A; Owusu, Adobea Yaa; Mullen, Patricia Dolan; Markham, Christine; McCurdy, Sheryl A

2017-09-01

Drug stock-outs are an unfortunate yet common reality for patients living in low and middle income countries, particularly in sub-Saharan Africa where trouble with consistent stock of antiretroviral medications (ARVs) continues. Our study takes a snapshot of this problem in Ghana. Although the country launched its antiretroviral therapy (ART) programme in 2003, progress toward realising the full benefit of ART for treated individuals has been limited, in part, because of stock-outs. In Ghana's Greater Accra region, we conducted semi-structured interviews with 40 women living with HIV (WLHIV) and 15 individuals with a history of HIV-related work in government or non-governmental organisations, or healthcare facilities. We used repeated review with coding and mapping techniques to analyse the transcripts and identify common themes. Stock-outs of ARVs result in inconsistent administration of therapy, increased indirect medical costs for WLHIV, and negative labelling of patients. Inefficiencies in drug supply, poor coordination with port authorities, inadequate government funding and dependence on international aid contribute to the stock-outs experienced in Ghana. Although using ARVs produced in-country could reduce supply problems, the domestically-manufactured product currently does not meet World Health Organization (WHO) standards. We recommend focused efforts to produce WHO standard ARVs in Ghana, and a review of current supply chain management to identify and mend pitfalls in the system.

Obstetric fistula in low and middle income countries.

PubMed

Capes, Tracy; Ascher-Walsh, Charles; Abdoulaye, Idrissa; Brodman, Michael

2011-01-01

Vesicovaginal fistula secondary to obstructed labor continues to be an all-too-common occurrence in underdeveloped nations throughout Africa and Asia. Vesicovaginal fistula remains largely an overlooked problem in developing nations as it affects the most marginalized members of society: young, poor, illiterate women who live in remote areas. The formation of obstetric fistula is a result of complex interactions of social, biologic, and economic influences. The key underlying causes of fistula are the combination of a lack of functional emergency obstetric care, poverty, illiteracy, and low status of women. In order to prevent fistula, some strategies include creation of governmental policy aimed toward reducing maternal mortality/morbidity and increasing availability of skilled obstetric care, as well as attempts to increase awareness about its prevention and treatment among policymakers, service providers, and communities. Whereas prevention will require the widespread development of infrastructure within these developing countries, treatment of fistula is an act which can be done "in the now." Treatment and subsequent reintegration of fistula patients requires a team of specialists including surgeons, nurses, midwives, and social workers, which is largely unavailable in developing countries. However, there is increasing support for training of fistula surgeons through standardized programs as well as establishment of rehabilitation centers in many nations. The eradication of fistula is dependent upon building programs that target both prevention and treatment. © 2011 Mount Sinai School of Medicine.

Prevalence of Vitamin A Deficiency in South Asia: Causes, Outcomes, and Possible Remedies

PubMed Central

Ahmed, Anwaar; Randhawa, Muhammad Atif; Atukorala, Sunethra; Arlappa, Nimmathota; Ismail, Tariq; Ali, Zulfiqar

2013-01-01

Vitamin A deficiency (VAD) has been recognized as a public-health issue in developing countries. Economic constraints, sociocultural limitations, insufficient dietary intake, and poor absorption leading to depleted vitamin A stores in the body have been regarded as potential determinants of the prevalence of VAD in South Asian developing countries. VAD is exacerbated by lack of education, poor sanitation, absence of new legislation and enforcement of existing food laws, and week monitoring and surveillance system. Several recent estimates confirmed higher morbidly and mortality rate among children and pregnant and non-pregnant women of childbearing age. Xerophthalmia is the leading cause of preventable childhood blindness with its earliest manifestations as night blindness and Bitot's spots, followed by blinding keratomalacia, all of which are the ocular manifestations of VAD. Children need additional vitamin A because they do not consume enough in their normal diet. There are three general ways for improving vitamin A status: supplementation, fortification, and dietary diversification. These approaches have not solved the problem in South Asian countries to the desired extent because of poor governmental support and supervision of vitamin A supplementation twice a year. An extensive review of the extant literature was carried out, and the data under various sections were identified by using a computerized bibliographic search via PubMed, Web of Science, and Google Scholar. All abstracts and full-text articles were examined, and the most relevant articles were selected for screening and inclusion in this review. Conclusively, high prevalence of VAD in South Asian developing countries leads to increased morbidity and mortality among infants, children, and pregnant women. Therefore, stern efforts are needed to address this issue of public-health significance at local and international level in lower- and middle-income countries of South Asia. PMID:24592582

Feeding humanity through global food trade

NASA Astrophysics Data System (ADS)

D'Odorico, Paolo; Carr, Joel A.; Laio, Francesco; Ridolfi, Luca; Vandoni, Stefano

2014-09-01

The recent intensification of international trade has led to a globalization of food commodities and to an increased disconnection between human populations and the land and water resources that support them through crop and livestock production. Several countries are not self-sufficient and depend on imports from other regions. Despite the recognized importance of the role of trade in global and regional food security, the societal reliance on domestic production and international trade remains poorly quantified. Here we investigate the global patterns of food trade and evaluate the dependency of food security on imports. We investigate the relationship existing between the trade of food calories and the virtual transfer of water used for their production. We show how the amount of food calories traded in the international market has more than doubled between 1986 and 2009, while the number of links in the trade network has increased by more than 50%. Likewise, global food production has increased by more than 50% in the same period, providing an amount of food that is overall sufficient to support the global population at a rate of 2700-3000 kcal per person per day. About 23% of the food produced for human consumption is traded internationally. The water use efficiency of food trade (i.e., food calories produced per unit volume of water used) has declined in the last few decades. The water use efficiency of food production overall increases with the countries' affluence; this trend is likely due to the use of more advanced technology.

Job insecurity and health: A study of 16 European countries

PubMed Central

László, Krisztina D.; Pikhart, Hynek; Kopp, Mária S.; Bobak, Martin; Pajak, Andrzej; Malyutina, Sofia; Salavecz, Gyöngyvér; Marmot, Michael

2010-01-01

Although the number of insecure jobs has increased considerably over the recent decades, relatively little is known about the health consequences of job insecurity, their international pattern, and factors that may modify them. In this paper, we investigated the association between job insecurity and self-rated health, and whether the relationship differs by country or individual-level characteristics. Cross-sectional data from 3 population-based studies on job insecurity, self-rated health, demographic, socioeconomic, work-related and behavioural factors and lifetime chronic diseases in 23,245 working subjects aged 45–70 years from 16 European countries were analysed using logistic regression and meta-analysis. In fully adjusted models, job insecurity was significantly associated with an increased risk of poor health in the Czech Republic, Denmark, Germany, Greece, Hungary, Israel, the Netherlands, Poland and Russia, with odds ratios ranging between 1.3 and 2.0. Similar, but not significant, associations were observed in Austria, France, Italy, Spain and Switzerland. We found no effect of job insecurity in Belgium and Sweden. In the pooled data, the odds ratio of poor health by job insecurity was 1.39. The association between job insecurity and health did not differ significantly by age, sex, education, and marital status. Persons with insecure jobs were at an increased risk of poor health in most of the countries included in the analysis. Given these results and trends towards increasing frequency of insecure jobs, attention needs to be paid to the public health consequences of job insecurity. PMID:20060634

General health and well-being among primary care patients aged 75+ years: Associations with living conditions, oral health and dependency.

PubMed

Brennan, David S; Keuskamp, Dominic; Balasubramanian, Madhan; Amarasena, Najith

2018-03-01

Our aim was to examine the associations between general health and well-being with living conditions, oral health and degree of dependency. We surveyed people from a primary care service and collected data on sociodemographic characteristics, general health, health utility, well-being, activities, living conditions and oral health impact. Overall, 459 participated (78% response rate). Poor general health was associated with decreased instrumental activities of daily living scores (18% of those with poor general health were independent vs 60% with good general health). Greater oral health impact was also related to poor general health. Health utility was lower for some dependency, for renting and oral health impact. Well-being was also lower for some dependency, for renting, not speaking English and oral health impact. In addition to the well-known association of poor general health with dependency, our results also illustrate the potential importance of living conditions and oral health. © 2017 AJA Inc.

Peer victimization and subjective health among students reporting disability or chronic illness in 11 Western countries.

PubMed

Sentenac, Mariane; Gavin, Aoife; Gabhainn, Saoirse Nic; Molcho, Michal; Due, Pernille; Ravens-Sieberer, Ulrike; Matos, Margarida Gaspar de; Malkowska-Szkutnik, Agnieszka; Gobina, Inese; Vollebergh, Wilma; Arnaud, Catherine; Godeau, Emmanuelle

2013-06-01

To compare the strength of the association between peer victimization at school and subjective health according to the disability or chronic illness (D/CI) status of students across countries. This study used data from 55 030 students aged 11, 13 and 15 years from 11 countries participating in the 2005-06 Health Behaviour in School-aged Children survey. Self-completed questionnaires were administered in classrooms. Multivariate models of logistic regression (controlled for confounding factors and countries) were used to investigate differences in the association between peer victimization and poor subjective health according to the D/CI status. Overall, 13.5% of the students reported having been bullied at least two or three times a month. The percentage of victims was significantly higher among those reporting D/CI than among others in all countries studied. Victims of bullying were more likely to report poor self-rated health, low life satisfaction and multiple health complaints. However, there were no differences in the associations between peer victimization and subjective health indicators according to the D/CI status. In all countries studied, students reporting D/CI were more likely to report being victims of bullying. Victims of bullying reported more negative subjective health outcomes regardless of their D/CI status. Although inclusive education is currently a major topic of educational policies in most countries, additional efforts should be made to improve the quality of the integration of students with D/CI.

Public spending on health care in Africa: do the poor benefit?

PubMed Central

Castro-Leal, F.; Dayton, J.; Demery, L.; Mehra, K.

2000-01-01

Health care is a basic service essential in any effort to combat poverty, and is often subsidized with public funds to help achieve that aim. This paper examines public spending on curative health care in several African countries and finds that this spending favours mostly the better-off rather than the poor. It concludes that this targeting problem cannot be solved simply by adjusting the subsidy allocations. The constraints that prevent the poor from taking advantage of these services must also be addressed if the public subsidies are to be effective in reaching the poor. PMID:10686734

Migration of scientists and the International Centre for Theoretical Physics -- a Personal and Professional Perspective

NASA Astrophysics Data System (ADS)

Sreenivasan, Katepalli R.

2011-03-01

Scientists migrate for a variety of reasons: political problems with their governments, lack of professional opportunities in their countries, the lure of better lives, financial security for them and their families, better education for their off-springs, and so forth. Migration usually occurs from poor and oppressed countries--the two categories are not one and the same--to the rich and the open. It has created, over time, a dilemma for the poor countries: in the midst of all their other problems, how to justify spending on higher education and research when that investment often results in the most enterprising of its citizens to leave their countries behind? (When migration has reversed direction occasionally, it is because of certain necessities of the scientists to be back in their countries or for opportunities that some individuals see for wielding greater scientific power.) The ideal of keeping the best scientists in their own countries, still ensuring that they remain scientifically productive and inspiring to the youth, is what provided the motivation for the creation of the International Centre for Theoretical Physics in Trieste, Italy, where I served as Director for some seven years. In this talk, I will present the story behind the formation of the Centre in 1964, explain its rationale, and analyze its evolution over time to accommodate the changing scene in world; I will discuss how some things have remained the same even as more of them have changed over time. Finally, I will remark on the broad needs of developing countries even though such needs are often very specific to a country.

Indoor air pollution in developing countries: a major environmental and public health challenge.

PubMed Central

Bruce, N.; Perez-Padilla, R.; Albalak, R.

2000-01-01

Around 50% of people, almost all in developing countries, rely on coal and biomass in the form of wood, dung and crop residues for domestic energy. These materials are typically burnt in simple stoves with very incomplete combustion. Consequently, women and young children are exposed to high levels of indoor air pollution every day. There is consistent evidence that indoor air pollution increases the risk of chronic obstructive pulmonary disease and of acute respiratory infections in childhood, the most important cause of death among children under 5 years of age in developing countries. Evidence also exists of associations with low birth weight, increased infant and perinatal mortality, pulmonary tuberculosis, nasopharyngeal and laryngeal cancer, cataract, and, specifically in respect of the use of coal, with lung cancer. Conflicting evidence exists with regard to asthma. All studies are observational and very few have measured exposure directly, while a substantial proportion have not dealt with confounding. As a result, risk estimates are poorly quantified and may be biased. Exposure to indoor air pollution may be responsible for nearly 2 million excess deaths in developing countries and for some 4% of the global burden of disease. Indoor air pollution is a major global public health threat requiring greatly increased efforts in the areas of research and policy-making. Research on its health effects should be strengthened, particularly in relation to tuberculosis and acute lower respiratory infections. A more systematic approach to the development and evaluation of interventions is desirable, with clearer recognition of the interrelationships between poverty and dependence on polluting fuels. PMID:11019457

[Alternatives for the financing of health care in Latin America and the Caribbean].

PubMed

Campino, A C

1995-06-01

Latin America and the Caribbean (LAC) countries are experiencing both an economic crisis and a crisis in the public sector. As a result it is impossible to increase the amount of resources available to the health sector, unless there is a drastic restructuring of the way in which financing occurs. The measures so far referred to in the economic debate - user fees, cost recovery, privatization - at best represent partial solutions. Given the magnitude of health problem in LAC countries, they are unable to generate the amount of money needed to cover the deficit of financial resources for medical treatment. The central idea behind this article is that in order to cover the deficit of resources for medical it is necessary to utilize fiscal resources. It is shown that it is possible to increase the amount of financial resources available for medical treatment either through increases in taxes and/or through an increase in the proportion of the government budget dedicated to medical treatment. Increases in taxes collected provide a feasible alternative. In some of the poor countries of Latin America and the Caribbean, the proportion of the Gross National Product that goes for the payment of taxes is well below the figure for that proportion found in developed countries. To increase the proportion of the government budget dedicated to medical treatment is a political decision that depends solely upon the discretion of the governments concerned. The potential of Social Emergency Funds and debt swaps to finance innovations in the production of medical treatment services, thus maintaining the current level to activity in the sector, is discussed.

Patient-Related Determinants of Glycaemic Control in People with Type 2 Diabetes in the Gulf Cooperation Council Countries: A Systematic Review.

PubMed

Alramadan, Mohammed J; Afroz, Afsana; Hussain, Sultana Monira; Batais, Mohammed Ali; Almigbal, Turky H; Al-Humrani, Hassan Ahmad; Albaloshi, Ahmed; Romero, Lorena; Magliano, Dianna J; Billah, Baki

2018-01-01

The aim of this systematic review is to assess patient-related factors affecting glycaemic control among people with type 2 diabetes in the Arabian Gulf Council countries. MEDLINE, Embase, PsycINFO, CINAHL, and Cochrane CENTRAL databases were searched from their date of inception to May 2016. Two researchers independently identified eligible studies and assessed the risk of bias. A total of 13 studies met the inclusion criteria. One study was population based, six recruited participants from multiple centres, and the remaining were single centred. The majority of the studies were of low to moderate quality. Factors associated with poor glycaemic control include longer duration of diabetes, low level of education, poor compliance to diet and medication, poor attitude towards the disease, poor self-management behaviour, anxiety, depression, renal impairment, hypertension, and dyslipidaemia. Healthcare providers should be aware of these factors and provide appropriate education and care especially for those who have poor glycaemic control. Innovative educational programs should be implemented in the healthcare systems to improve patient compliance and practices. A variation in the results of the included studies was observed, and some potentially important risk factors such as dietary habits, physical activity, family support, and cognitive function were not adequately addressed. Further research is needed in this area.

Menstrual Hygiene Management in Resource-Poor Countries

PubMed Central

Kuhlmann, Anne Sebert; Henry, Kaysha; Wall, L. Lewis

2017-01-01

Importance Adequate management of menstrual hygiene is taken for granted in affluent countries; however, inadequate menstrual hygiene is a major problem for girls and women in resource-poor countries, which adversely affects the health and development of adolescent girls. Objective The aim of this article is to review the current evidence concerning menstrual hygiene management in these settings. Evidence Acquisition A PubMed search using MeSH terms was conducted in English, supplemented by hand searching for additional references. Retrieved articles were reviewed, synthesized, and summarized. Results Most research to date has described menstrual hygiene knowledge, attitudes, and practices, mainly in sub-Saharan Africa and South Asia. Many school-based studies indicate poorer menstrual hygiene among girls in rural areas and those attending public schools. The few studies that have tried to improve or change menstrual hygiene practices provide moderate to strong evidence that targeted interventions do improve menstrual hygiene knowledge and awareness. Conclusion and Relevance Challenges to improving menstrual hygiene management include lack of support from teachers (who are frequently male); teasing by peers when accidental menstrual soiling of clothes occurs; poor familial support; lack of cultural acceptance of alternative menstrual products; limited economic resources to purchase supplies; inadequate water and sanitation facilities at school; menstrual cramps, pain, and discomfort; and lengthy travel to and from school, which increases the likelihood of leaks/stains. Areas for future research include the relationship between menarche and school dropout, the relationship between menstrual hygiene management and other health outcomes, and how to increase awareness of menstrual hygiene management among household decision makers including husbands/fathers and in-laws. Target Audience Obstetricians and gynecologists, family physicians. Learning Objectives After completion of this educational activity, the obstetrician/gynecologist should be able to define what is meant by “adequate menstrual hygiene management,” identify the challenges to adequate menstrual hygiene management that exist in resource-poor countries, and describe some of the intervention strategies that have been proposed to improve menstrual hygiene management for girls and women in those countries. PMID:28661550

Contracting but not without caution: experience with outsourcing of health services in countries of the Eastern Mediterranean Region.

PubMed Central

Siddiqi, Sameen; Masud, Tayyeb Imran; Sabri, Belgacem

2006-01-01

The public sector in developing countries is increasingly contracting with the non-state sector to improve access, efficiency and quality of health services. We conducted a multicountry study to assess the range of health services contracted out, the process of contracting and its influencing factors in ten countries of the Eastern Mediterranean Region: Afghanistan, Bahrain, Egypt, Islamic Republic of Iran, Jordan, Lebanon, Morocco, Pakistan, the Syrian Arab Republic and Tunisia. Our results showed that Afghanistan, Egypt, Islamic Republic of Iran and Pakistan had experience with outsourcing of primary care services; Jordan, Lebanon and Tunisia extensively contracted out hospital and ambulatory care services; while Bahrain, Morocco and the Syrian Arab Republic outsourced mainly non-clinical services. The interest of the non-state sector in contracting was to secure a regular source of revenue and gain enhanced recognition and credibility. While most countries promoted contracting with the private sector, the legal and bureaucratic support in countries varied with the duration of experience with contracting. The inherent risks evident in the contracting process were reliance on donor funds, limited number of providers in rural areas, parties with vested interests gaining control over the contracting process, as well as poor monitoring and evaluation mechanisms. Contracting provides the opportunity to have greater control over private providers in countries with poor regulatory capacity, and if used judiciously can improve health system performance. PMID:17143460

Contracting but not without caution: experience with outsourcing of health services in countries of the Eastern Mediterranean Region.

PubMed

Siddiqi, Sameen; Masud, Tayyeb Imran; Sabri, Belgacem

2006-11-01

The public sector in developing countries is increasingly contracting with the non-state sector to improve access, efficiency and quality of health services. We conducted a multicountry study to assess the range of health services contracted out, the process of contracting and its influencing factors in ten countries of the Eastern Mediterranean Region: Afghanistan, Bahrain, Egypt, Islamic Republic of Iran, Jordan, Lebanon, Morocco, Pakistan, the Syrian Arab Republic and Tunisia. Our results showed that Afghanistan, Egypt, Islamic Republic of Iran and Pakistan had experience with outsourcing of primary care services; Jordan, Lebanon and Tunisia extensively contracted out hospital and ambulatory care services; while Bahrain, Morocco and the Syrian Arab Republic outsourced mainly non-clinical services. The interest of the non-state sector in contracting was to secure a regular source of revenue and gain enhanced recognition and credibility. While most countries promoted contracting with the private sector, the legal and bureaucratic support in countries varied with the duration of experience with contracting. The inherent risks evident in the contracting process were reliance on donor funds, limited number of providers in rural areas, parties with vested interests gaining control over the contracting process, as well as poor monitoring and evaluation mechanisms. Contracting provides the opportunity to have greater control over private providers in countries with poor regulatory capacity, and if used judiciously can improve health system performance.

Poverty & health: criticality of public financing.

PubMed

Duggal, Ravi

2007-10-01

Countries with universal or near universal access to healthcare have health financing mechanisms which are single-payer systems in which either a single autonomous public agency or a few coordinated agencies pool resources to finance healthcare. This contributes to both equity in healthcare as well as to low levels of poverty in these countries. It is only in countries like India and a number of developing countries, which still rely mostly on out-of-pocket payments, where universal access to healthcare is elusive. In such countries those who have the capacity to buy healthcare from the market most often get healthcare without having to pay for it directly because they are either covered by social insurance or buy private insurance. In contrast, a large majority of the population, who suffers a hand-to-mouth existence, is forced to make direct payments, often with a heavy burden of debt, to access healthcare from the market because public provision is grossly inadequate or non existent. Thus, the absence of adequate public health investment not only results in poor health outcomes but it also leads to escalation of poverty. This article critically reviews the linkages of poverty with healthcare financing using evidence from national surveys and concludes that public financing is critical to good access to healthcare for the poor and its inadequacy is closely associated with poverty levels in the country.

An analysis of perceived access to health care in Europe: How universal is universal coverage?

PubMed

Cylus, Jonathan; Papanicolas, Irene

2015-09-01

The objective of this paper is to examine variations in perceptions of access to health care across and within 29 European countries. Using data from the 2008 round of the European Social Survey, we investigate the likelihood of an individual perceiving that they will experience difficulties accessing health care in the next 12 months, should they need it (N=51,835). We find that despite most European countries having mandates for universal health coverage, individuals who are low income, in poor health, lack citizenship in the country where they reside, 20-30 years old, unemployed and/or female have systematically greater odds of feeling unable to access care. Focusing on the role of income, we find that while there is a strong association between low income and perceived access barriers across countries, within many countries, perceptions of difficulties accessing care are not concentrated uniquely among low-income groups. This implies that factors that affect all income groups, such as poor quality care and long waiting times may serve as important barriers to access in these countries. Despite commitments to move towards universal health coverage in Europe, our results suggest that there is still significant heterogeneity among individuals' perceptions of access and important barriers to accessing health care. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Persistence, Privilege, and Parenting: The Comparative Study of Intergenerational Mobility

ERIC Educational Resources Information Center

Smeeding, Timothy M., Ed.; Erikson, Robert, Ed.; Jantti, Markus, Ed.

2011-01-01

Americans like to believe that theirs is the land of opportunity, but the hard facts are that children born into poor families in the United States tend to stay poor and children born into wealthy families generally stay rich. Other countries have shown more success at lessening the effects of inequality on mobility--possibly by making public…

Contextual Factors Related to Math Anxiety in Second-Grade Children

ERIC Educational Resources Information Center

Jameson, Molly M.

2014-01-01

As the United States falls farther behind other countries in standardized math assessments, the author seeks to understand why U.S. students perform so poorly. One of the possible explanations to U.S. students' poor math performance may be math anxiety. However, math anxiety in elementary school children is a neglected area in the research. The…

The Global Economic Crisis, Poverty and Education: A Perspective from India

ERIC Educational Resources Information Center

Nambissan, Geetha B.

2010-01-01

Debates on the global economic recession have failed to draw adequate attention to the meaning of the crisis for the poor and their education, especially in later developing societies. In this paper, I focus on the education of children of the poor in India--a country that has experienced economic slowdown rather than recession. Available research…

Productivity Indicators for the Rural Poor in Developing Countries

ERIC Educational Resources Information Center

James, Jeffrey

2007-01-01

Meeting the Millennium Development Goals will necessarily require a heavy focus on rural areas, where most of the world's poor are to be found. More specifically, policy will need to raise the productivity of this group, which includes farmers, wage labourers and those suffering from disease and malnutrition. Yet, at present, no index exists which…

Moving toward New Horizons for Marketing Education: Designing a Marketing Training for the Poor in Developing and Emerging Markets

ERIC Educational Resources Information Center

Teklehaimanot, Mebrahtu L.; Ingenbleek, Paul T. M.; Tessema, Workneh K.; van Trijp, Hans C. M.

2017-01-01

In recent years, marketing education has broadened to poor people in developing and emerging countries. In this article, the authors use four empirical studies that apply well-established training design procedures to design a marketing training program for Ethiopian pastoralists. Because pastoralists operate in extremely remote, traditional, and…

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.

Attention to Local Health Burden and the Global Disparity of Health Research

PubMed Central

Evans, James A.; Shim, Jae-Mahn; Ioannidis, John P. A.

2014-01-01

Most studies on global health inequality consider unequal health care and socio-economic conditions but neglect inequality in the production of health knowledge relevant to addressing disease burden. We demonstrate this inequality and identify likely causes. Using disability-adjusted life years (DALYs) for 111 prominent medical conditions, assessed globally and nationally by the World Health Organization, we linked DALYs with MEDLINE articles for each condition to assess the influence of DALY-based global disease burden, compared to the global market for treatment, on the production of relevant MEDLINE articles, systematic reviews, clinical trials and research using animal models vs. humans. We then explored how DALYs, wealth, and the production of research within countries correlate with this global pattern. We show that global DALYs for each condition had a small, significant negative relationship with the production of each type of MEDLINE articles for that condition. Local processes of health research appear to be behind this. Clinical trials and animal studies but not systematic reviews produced within countries were strongly guided by local DALYs. More and less developed countries had very different disease profiles and rich countries publish much more than poor countries. Accordingly, conditions common to developed countries garnered more clinical research than those common to less developed countries. Many of the health needs in less developed countries do not attract attention among developed country researchers who produce the vast majority of global health knowledge—including clinical trials—in response to their own local needs. This raises concern about the amount of knowledge relevant to poor populations deficient in their own research infrastructure. We recommend measures to address this critical dimension of global health inequality. PMID:24691431

Attention to local health burden and the global disparity of health research.

PubMed

Evans, James A; Shim, Jae-Mahn; Ioannidis, John P A

2014-01-01

Most studies on global health inequality consider unequal health care and socio-economic conditions but neglect inequality in the production of health knowledge relevant to addressing disease burden. We demonstrate this inequality and identify likely causes. Using disability-adjusted life years (DALYs) for 111 prominent medical conditions, assessed globally and nationally by the World Health Organization, we linked DALYs with MEDLINE articles for each condition to assess the influence of DALY-based global disease burden, compared to the global market for treatment, on the production of relevant MEDLINE articles, systematic reviews, clinical trials and research using animal models vs. humans. We then explored how DALYs, wealth, and the production of research within countries correlate with this global pattern. We show that global DALYs for each condition had a small, significant negative relationship with the production of each type of MEDLINE articles for that condition. Local processes of health research appear to be behind this. Clinical trials and animal studies but not systematic reviews produced within countries were strongly guided by local DALYs. More and less developed countries had very different disease profiles and rich countries publish much more than poor countries. Accordingly, conditions common to developed countries garnered more clinical research than those common to less developed countries. Many of the health needs in less developed countries do not attract attention among developed country researchers who produce the vast majority of global health knowledge--including clinical trials--in response to their own local needs. This raises concern about the amount of knowledge relevant to poor populations deficient in their own research infrastructure. We recommend measures to address this critical dimension of global health inequality.

The Joint Commission calls for comprehensive action on poor health literacy.

PubMed

2007-03-01

A new call to action on poor health literacy. Maintaining that the problem is costing the country dearly in dollars as well as quality of life, The Joint Commission has put out a new policy white paper calling on all key players to take steps to deal with the problem of poor health literacy. Although changes at the top are sorely needed, policy makers maintain that there is much that individual providers can do to alleviate the problem.

What motivates medical students to select medical studies: a systematic literature review.

PubMed

Goel, Sonu; Angeli, Federica; Dhirar, Nonita; Singla, Neetu; Ruwaard, Dirk

2018-01-17

There is a significant shortage of health workers across and within countries. It is of utmost importance to determine the factors that motivate students to opt for medical studies. The objective of this study is to group and review all the studies that investigated the motivational factors that underpin students' selection of medical study in recent years. The literature search was carried out by two researchers independently in PubMed, Google Scholar, Wiley and IndMED databases for articles published from year 2006 till 2016. A total of 38 combinations of MeSH words were used for search purpose. Studies related to medical students and interns have been included. The application of inclusion and exclusion criteria and PRISMA guidelines for reporting systematic review led to the final selection of 24 articles. The majority of the studies (n = 16; 66.6%) were from high-income countries followed by an equal number from upper-middle and lower-middle income countries (n = 4,16.7%). None of the studies were from low-income countries. All of the studies were cross-sectional in nature. The main motivating factors that emerged were scientific (interest in science / medicine, social interest and academia, flexible work hours and work independence), societal (prestige, job security, financial security) and humanitarian (serving the poor and under priviledged) in high-, upper-middle and lower-middle income countries, respectively. The findings were comparable to Maslow's hierarchy of needs theory of motivation. This systematic review identifies the motivational factors influencing students to join medical studies in different parts of the globe. These factors vary per country depending on the level of income. This study offers cues to policy makers and educators to formulate policy in order to tackle the shortage of health workers, i.e. medical doctors. However, more research is needed to translate health policy into concrete and effective measures.

What is the quality of the maternal near-miss case reviews in WHO European Region? Cross-sectional study in Armenia, Georgia, Latvia, Republic of Moldova and Uzbekistan

PubMed Central

Bacci, Alberta; Hodorogea, Stelian; Khachatryan, Henrik; Babojonova, Shohida; Irsa, Signe; Jansone, Maira; Dondiuc, Iurie; Matarazde, George; Lazdane, Gunta; Lazzerini, Marzia

2018-01-01

Objectives The maternal near-miss case review (NMCR) cycle is a type of clinical audit aiming at improving quality of maternal healthcare by discussing near-miss cases. In several countries this approach has been introduced and supported by WHO and partners since 2004, but information on the quality of its implementation is missing. This study aimed at evaluating the quality of the NMCR implementation in selected countries within WHO European Region. Design Cross-sectional study. Settings Twenty-three maternity units in Armenia, Georgia, Latvia, Moldova and Uzbekistan. Assessment tools A predefined checklist including 50 items, according to WHO methodology. Quality in the NMCR implementation was defined by summary scores ranging from 0 (totally inappropriate) to 3 (appropriate). Results Quality of the NMCR implementation was heterogeneous among different countries, and within the same country. Overall, the first part of the audit cycle (from case identification to case analysis) was fairly well performed (mean score 2.00, 95% CI 1.94 to 2.06), with the exception of the ‘inclusion of users’ views’ (mean score 0.66, 95% CI 0.11 to 1.22), while the second part (developing recommendations, implementing them and ensuring quality) was poorly performed (mean score 0.66, 95% CI 0.11 to 1.22). Each country had at least one champion facility, where quality of the NMCR cycle was acceptable. Quality of the implementation was not associated with its duration. Gaps in implementation were of technical, organisational and attitudinal nature. Conclusions Ensuring quality in the NMCR may be difficult but achievable. The high heterogeneity in results within the same country suggests that quality of the NMCR implementation depends, to a large extent, from hospital factors, including staff’s commitment, managerial support and local coordination. Efforts should be put in preventing and mitigating common barriers that hamper successful NMCR implementation. PMID:29654004

Social capital and health in the least developed countries: A critical review of the literature and implications for a future research agenda

PubMed Central

Story, William T.

2015-01-01

Research on the linkage between social capital and health has grown in recent years; however, there is a dearth of evidence from resource-poor countries. This review examines the association between social capital and physical health (including health behaviours) in the least developed countries (LDCs). Citations were searched using three databases from 1990 to 2011 using the keyword ‘social capital’ combined with the name of each of the 48 LDCs. Of the 14 studies reviewed, 12 took place in Africa and two in South Asia. All used cross-sectional study designs, including five qualitative and nine quantitative studies. The literature reviewed suggests that social capital is an important factor for improving health in resource-poor settings; however, more research is needed in order to determine the best measures for social capital and elucidate the mechanisms through which social capital affects health in the developing world. Future research on social capital and health in the developing world should focus on applying appropriate theoretical conceptualizations of social capital to the developing country context, adapting and validating instruments for measuring social capital, and examining multilevel models of social capital and health in developing countries. PMID:24172027

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

Ethical issues related to epilepsy care in the developing world.

PubMed

Tan, Chong-Tin; Avanzini, Giuliano

2009-05-01

There are three major issues of ethical concern related to epilepsy care in the developing world. First, is it ethical for a developing country to channel its limited resources from direct epilepsy care to research? The main considerations in addressing this question are the particular research questions to be addressed and whether such research will bring direct benefits to the local community. Second, in a country with limited resources, when does ignoring the high treatment gap become an ethical issue? This question is of particular concern when the community has enough resources to afford treatment for its poor, yet is not providing such care because of gross wastage and misallocation of the national resources. Third, do countries with plentiful resources have an ethical responsibility to help relieve the high epilepsy treatment gap of poor countries? Indeed, we believe that reasonable health care is a basic human right, and that human rights transcend national boundaries. Although health care is usually the responsibility of the nation-state, many modern states in the developing world are arbitrary creations of colonization. There is often a long process from the establishment of a political-legal state to a mature functional nation. During the long process of nation building, help from neighboring countries is often required.

Poverty Reduction in Zambia: A Conceptual Analysis of the Zambian Poverty Reduction Strategy Paper

ERIC Educational Resources Information Center

Imboela, Bruce Lubinda

2005-01-01

Poverty reduction strategy papers (PRSPs) present a recipient country's program of intent for the utilization of World Bank loans and grants to alleviate debt under the bank's programs of action for poverty reduction in highly indebted poor countries (HIPCs). This article argues that structural transformation is a prerequisite for poverty…

Short Message Service (SMS) as an Educational Tool during Pregnancy: A Literature Review

ERIC Educational Resources Information Center

Lamont, Kim; Sliwa, Karen; Stewart, Simon; Carrington, Melinda; Pretorius, Sandra; Libhaber, Elena; Wiysonge, Charles S.; Adebayo, Esther F.; Klipstein-Grobusch, Kerstin

2016-01-01

Background: In many low- and middle-income countries, access to health information during pregnancy is poor. The rapid adoption of mobile phones in these countries has created new opportunities for disseminating such information. Objective: This paper reviews existing information on the use of short message services (SMSs) as a feasible tool to…

A Record of Experience. Catalogue of FFHC/Action for Development Documents, 1971-1976.

ERIC Educational Resources Information Center

Freedom from Hunger Campaign, Rome (Italy).

The FFHC/AD (Freedom From Hunger Campaign/Action for Development) is the Food and Agriculture Organization's (FAO) link with peoples' organizations in the world's poor and rich countries. During its 18 years of activities, FFHC/AD has channelled additional funds collected by private financing agencies in the industrialized countries to rural…

"Ayiti Cheri": Cultural Orientation of Early Adolescents in Rural Haiti

ERIC Educational Resources Information Center

Ferguson, Gail M.; Desir, Charlene; Bornstein, Marc H.

2014-01-01

Adolescents are an emerging population in Haiti, particularly after the deadly 2010 earthquake. The steady penetration of U.S. culture into this poor, disaster-prone country begs the question, Do today's adolescents possess a similar fondness for their home country, culture, and traditional family values as did Haitians of old? Or are they more…

Mobile Phones in Africa: How Much Do We Really Know?

ERIC Educational Resources Information Center

James, Jeffrey; Versteeg, Mila

2007-01-01

Mobile phones are a crucial mode of communication and welfare enhancement in poor countries, especially those lacking an infrastructure of fixed lines. In recent years much has been written about how mobile telephony in Africa is rapidly reducing the digital divide with developed countries. Yet, when one examines the evidence it is not at all…

Family Inequality, School Inequalities, and Mathematics Achievement in 65 Countries: Microeconomic Mechanisms of Rent Seeking and Diminishing Marginal Returns

ERIC Educational Resources Information Center

Chiu, Ming Ming

2015-01-01

Background/Context: While many studies show that greater economic inequality widens the achievement gap between rich and poor students, recent studies indicate that countries with greater economic inequality have lower overall student achievement. Purpose/Objective/Research Question/Focus of Study: This study explores whether family inequalities…

When Things Fall Apart: Qualitative Studies of Poverty in the Former Soviet Union.

ERIC Educational Resources Information Center

Dudwick, Nora, Ed.; Gomart, Elizabeth, Ed.; Marc, Alexandre, Ed.; Kuehnast, Kathleen, Ed.

Using qualitative methods, the studies in this volume highlight certain aspects of the dynamics of poverty in eight countries of the former Soviet Union and the interactions of poverty with gender, age, and ethnicity. They deepen understanding of how poor people in these countries experience and cope with the shock of sudden poverty, worsening…

Climate change impacts on rural poverty in low-elevation coastal zones

NASA Astrophysics Data System (ADS)

Barbier, Edward B.

2015-11-01

This paper identifies the low-elevation coastal zone (LECZ) populations and developing regions most vulnerable to sea-level rise and other coastal hazards, such as storm surges, coastal erosion and salt-water intrusion. The focus is on the rural poor in the LECZ, as their economic livelihoods are especially endangered both directly by coastal hazards and indirectly through the impacts of climate change on key coastal and near-shore ecosystems. Using geo-spatially referenced malnutrition and infant mortality data for 2000 as a proxy for poverty, this study finds that just 15 developing countries contain over 90% of the world's LECZ rural poor. Low-income countries as a group have the highest incidence of poverty, which declines somewhat for lower middle-income countries, and then is much lower for upper middle-income economies. South Asia, East Asia and the Pacific and Sub-Saharan Africa account for most of the world's LECZ rural poor, and have a high incidence of poverty among their rural LECZ populations. Although fostering growth, especially in coastal areas, may reduce rural poverty in the LECZ, additional policy actions will be required to protect vulnerable communities from disasters, to conserve and restore key coastal and near-shore ecosystems, and to promote key infrastructure investments and coastal community response capability.

Use of a novel epidermal harvesting system in resource-poor countries.

PubMed

Serena, Thomas; Francius, Adler; Taylor, Cristin; MacDonald, John

2015-03-01

The 2010 earthquake in Port-au-Prince, Haiti, highlighted the need for wound care in resource-poor countries. Subsequently, the University of Miami in Florida established one of the first interprofessional wound care centers located at Bernard Mevs Hospital in the central portion of Port-au-Prince, caring for patients with acute and chronic wounds. In 2012, the authors used a novel epidermal harvesting system (CelluTome Epidermal Harvesting System; Kinetic Concepts Inc, San Antonio, Texas) to harvest epithelium to be grafted on 7 patients at the Mevs Hospital with longstanding wounds. Epidermal microblisters were obtained from each patient's thigh using the CelluTome Epidermal Harvesting System. After 35 minutes, microblisters were raised using the device harvester, and an adhesive dressing was inserted into the harvester for transfer to the wound site. In patients with lower-extremity wounds, a 2-layer compression dressing was placed over epidermal grafts. Six of the 7 wounds improved or achieved complete closure in 4 weeks. One of the patients with a 2-year-old thigh wound failed to demonstrate improvement; this may have been secondary to an inability to adequately secure the graft. All donor sites healed without any visible scarring. The authors were able to conclude that epidermal grafting may represent a viable reconstructive option for patients in resource-poor countries.

Poor nutrition is a serious problem in children with cerebral palsy in Palawan, the Philippines.

PubMed

Socrates, C; Grantham-McGregor, S M; Harknett, S G; Seal, A J

2000-09-01

Children with cerebral palsy (CP) in developed countries have poor nutritional status; however there is little data from developing countries. In Palawan, in the Philippines, the nutritional status of 31 children with CP was compared to that of their siblings (n = 20) and a control group of neighbourhood children (n = 64), matched for age and sex. The children's weights, heights and armspans were measured. The heights of children with CP could not be measured and were estimated from their armspans using an equation relating height to armspan in siblings and controls. Haemoglobin levels of the study cases and siblings were measured. Siblings and controls had similar nutritional status. The children with CP had extremely poor nutritional status, and had significantly smaller weights for height, heights for age and weights for age than siblings or controls. Haemoglobin levels were not significantly different between the children with CP and their siblings. The nutritional status of children with quadriplegic CP was much poorer than that of similar children in the USA. The severity of malnutrition in children with CP is likely to be detrimental to their development, and a nutritional component should be incorporated into rehabilitation programmes. Also, there is a need to examine the nutritional status of children with CP in other developing countries.

Can innovative health financing policies increase access to MDG-related services? Evidence from Rwanda.

PubMed

Sekabaraga, Claude; Diop, Francois; Soucat, Agnes

2011-11-01

Ensuring financial access to health services is a critical challenge for poor countries if they are to reach the health Millennium Development Goals (MDGs). This article examines the case of Rwanda, a country which has championed innovative health care financing policies. Between 2000 and 2007, Rwanda has improved financial access for the poor, increased utilization of health services and reduced out-of-pocket payments for health care. Poor groups' utilization has increased for all health services, sometimes dramatically. Use of assisted deliveries, for example, increased from 12.1% to 42.7% among the poorest quintile; payments at the point of delivery have also been reduced; and catastrophic expenditures have declined. Part of these achievements is likely linked to innovative health financing policies, particularly the expansion of micro-insurance ('mutuelles') and performance-based financing. The paper concludes that the Rwanda experience provides a useful example of effective implementation of policies that reduce the financial barrier to health services, hereby contributing to the health MDGs. Today's main challenge is to build the sustainability of this system. Finally, the paper proposes a simple set of rigorous metrics to assess the impact of health financing policies and calls for implementing rigorous impact evaluation of health care financing policies in low-income countries.

Worldwide burden of COPD in high- and low-income countries. Part III. Asia-Pacific studies.

PubMed

Ko, F W S; Hui, D S C; Lai, C K W

2008-07-01

Chronic obstructive pulmonary disease (COPD) is a global health problem that poses a heavy burden on most countries in the Asia-Pacific region. When compared to industrialised Western countries, the COPD burden in the Asia-Pacific region is higher in terms of the number of deaths, years spent living with disability and years of life lost. Given the high prevalence of tobacco smoking, poor indoor and outdoor air quality and the aging population in many Asian countries, urgent actions need to be taken to reduce the development, morbidity and mortality of this disease.

A fuzzy MICMAC analysis for improving supply chain performance of basic vaccines in developing countries.

PubMed

Chandra, Dheeraj; Kumar, Dinesh

2018-03-01

In recent years, demand to improve child immunization coverage globally, and the development of the latest vaccines and technology has made the vaccine market very complex. The rise in such complexities often gives birth to numerous issues in the vaccine supply chain, which are the primary cause of its poor performance. Figuring out the cause of the performance problem can help you decide how to address it. The goal of the present study is to identify and analyze important issues in the supply chain of basic vaccines required for child immunization in the developing countries. Twenty-five key issues as various factors of the vaccine supply chain have been presented in this paper. Fuzzy MICMAC analysis has been carried out to classify the factors based on their driving and dependence power and to develop a hierarchy based model. Further, the findings have been discussed with the field experts to identify the critical factors. Three factors: better demand forecast, communication between the supply chain members, and proper planning and scheduling have been identified as the critical factors of vaccine supply chain. These factors should be given special care to improve vaccine supply chain performance.

A right to live: girl workers in the Bangladeshi garment industry.

PubMed

Wahra, G N; Rahman, F

1995-06-01

According to a survey conducted in 1989, there are 772 approved and registered garment factories in Bangladesh. These factories employ approximately 300,000 individuals, 90% of whom are women. A more recent estimate in a Bangladeshi newspaper, however, posits that up to five million people are directly or indirectly dependent upon the garment industry. Many of the women who work in Bangladesh's garment factories are under age 15 years. In some countries, such as the US, the employment of such young individuals constitutes a violation of child labor laws. Therefore, under the Harkin Bill, the US will no longer import garments produced by children younger than age 15 years. Many garment workers under age 15 years have already been put out of work or will soon be terminated. The authors explain that while the intent of the Harkin Bill may be to protect children, it is difficult to adopt the moral high ground in a poor country like Bangladesh. Regardless of one's age in Bangladesh, having a job may be the only way to survive. No job often means no food or shelter. The authors discuss women in the garment industry, one girl's case, alternative employment opportunities, and the future.

The Hepatitis E virus intraviral interactome.

PubMed

Osterman, Andreas; Stellberger, Thorsten; Gebhardt, Anna; Kurz, Marisa; Friedel, Caroline C; Uetz, Peter; Nitschko, Hans; Baiker, Armin; Vizoso-Pinto, Maria G

2015-10-14

Hepatitis E virus (HEV) is an emerging virus causing epidemic acute hepatitis in developing countries as well as sporadic cases in industrialized countries. The life cycle of HEV is still poorly understood and the lack of efficient cell culture systems and animal models are the principal limitations for a detailed study of the viral replication cycle. Here we exhaustively examine all possible intraviral protein-protein interactions (PPIs) of HEV by systematic Yeast two-hybrid (Y2H) and LuMPIS screens, providing a basis for studying the function of these proteins in the viral replication cycle. Key PPIs correlate with the already published HEV 3D structure. Furthermore, we report 20 novel PPIs including the homodimerization of the RNA dependent RNA polymerase (RdRp), the self-interaction of the papain like protease, and ORF3 interactions with the papain-like protease and putative replicase components: RdRp, methylase and helicase. Furthermore, we determined the dissociation constant (Kd) of ORF3 interactions with the viral helicase, papain-like protease and methylase, which suggest a regulatory function for ORF3 in orchestrating the formation of the replicase complex. These interactions may represent new targets for antiviral drugs.

Can education change the world? Education amplifies differences in liberalization values and innovation between developed and developing countries.

PubMed

Van Hiel, Alain; Van Assche, Jasper; De Cremer, David; Onraet, Emma; Bostyn, Dries; Haesevoets, Tessa; Roets, Arne

2018-01-01

The present study investigated the relationship between level of education and liberalization values in large, representative samples administered in 96 countries around the world (total N = 139,991). These countries show meaningful variation in terms of the Human Development Index (HDI), ranging from very poor, developing countries to prosperous, developed countries. We found evidence of cross-level interactions, consistently showing that individuals' level of education was associated with an increase in their liberalization values in higher HDI societies, whereas this relationship was curbed in lower HDI countries. This enhanced liberalization mindset of individuals in high HDI countries, in turn, was related to better scores on national indices of innovation. We conclude that this 'education amplification effect' widens the gap between lower and higher HDI countries in terms of liberalized mentality and economic growth potential. Policy implications for how low HDI countries can counter this gap are discussed.

Cultural humility and working with marginalized populations in developing countries.

PubMed

Kools, Susan; Chimwaza, Angela; Macha, Swebby

2015-03-01

Population health needs in developing countries are great and countries are scaling up health professional education to meet these needs. Marginalized populations, in particular, are vulnerable to poor health and health care. This paper presents a culturally appropriate diversity training program delivered to Global Health Fellows who are educators and leaders in health professions in Malawi and Zambia. The purpose of this interprofessional education experience was to promote culturally competent and humble care for marginalized populations. © The Author(s) 2014.

Evidence-based healthcare in developing countries.

PubMed

Pearson, Alan; Jordan, Zoe

2010-06-01

Developing countries have limited resources, so it is particularly important to invest in healthcare that works. The case for evidence-based practice has long been made in the West. However, poor access to information makes this endeavour near impossible for health professionals working with vulnerable communities in low-income economies. This paper provides a call to action to create an evidence base for health professionals in developing countries and identify appropriate strategies for the dissemination of this information in realistic and meaningful ways.

STATISTICS AND INTELLIGENCE IN DEVELOPING COUNTRIES: A NOTE.

PubMed

Kodila-Tedika, Oasis; Asongu, Simplice A; Azia-Dimbu, Florentin

2017-05-01

The purpose of this study is to assess the relationship between intelligence (or human capital) and the statistical capacity of developing countries. The line of inquiry is motivated essentially by the scarce literature on poor statistics in developing countries and an evolving stream of literature on the knowledge economy. A positive association is established between intelligence quotient (IQ) and statistical capacity. The relationship is robust to alternative specifications with varying conditioning information sets and control for outliers. Policy implications are discussed.

Is Private Health Care the Answer to the Health Problems of the World's Poor?

PubMed Central

Hanson, Kara; Gilson, Lucy; Goodman, Catherine; Mills, Anne; Smith, Richard; Feachem, Richard; Feachem, Neelam Sekhri; Koehlmoos, Tracey Perez; Kinlaw, Heather

2008-01-01

Background to the debate: The global burden of disease falls disproportionately upon the world's low-income countries, which are often struggling with weak health systems. Both the public and private sector deliver health care in these countries, but the appropriate role for each of these sectors in health system strengthening remains controversial. This debate examines whether the private sector should step up its involvement in the health systems of low-income countries. PMID:19067483

Presence of arsenic in agricultural products from arsenic-endemic areas and strategies to reduce arsenic intake in rural villages.

PubMed

Carbonell-Barrachina, Angel A; Signes-Pastor, Antonio J; Vázquez-Araújo, Laura; Burló, Francisco; Sengupta, Bhaskar

2009-05-01

About 100 million rural people in Asia are exposed to arsenic (As)-polluted drinking water and agricultural products. Total and inorganic arsenic (t-As and i-As) intake mainly depend on the quality of drinking and cooking waters, and amounts of seafood and rice consumed. The main problems occur in countries with poor water quality where the population depends on rice for their diet, and their t-As and i-As intake is high as a result of growing and cooking rice in contaminated water. Workable solutions to remove As from water and breeding rice cultivars with low As accumulation are being sought. In the meantime, simple recommendations for processing and cooking foods will help to reduce As intake. For instance, cooking using high volumes of As-free water may be a cheap way of reducing As exposure in rural populations. It is necessary to consider the effects of cooking and processing on t-As and i-As to obtain a realistic view of the risks associated with intake of As in As-endemic areas.

Sick regimes and sick people: a multilevel investigation of the population health consequences of perceived national corruption.

PubMed

Witvliet, Margot I; Kunst, Anton E; Arah, Onyebuchi A; Stronks, Karien

2013-10-01

There is a paucity of empirical work on the potential population health impact of living under a regime marred by corruption. African countries differ in the extent of national corruption, and we explore whether perceived national corruption is associated with population health across all rungs of society. World Health Survey data were analysed on 72 524 adults from 20 African countries. The main outcome was self-reported poor general health. Multilevel logistic regression was used to assess the association between poor health and perceived corruption, while jointly accounting for individual- and country-level human development factors. In this research, we use Transparency International's corruption perception index (CPI), which measures 'both administrative and political corruption' on a 0-10 scale. A higher score pertains to a higher rate of perceived corruption within society. We also examined effect modification by gender, age and socio-economic status. Higher national corruption perception was consistently associated with an increase in poor health prevalence, also after multivariable adjustments, with odds ratio (OR) of 1.62 (95% CI: 1.01-2.60). Stratified analyses by age and gender suggested this same pattern in all subgroups. Positive associations between poor health and perceived corruption were evident in all socio-economic groups, with the association being somewhat more positive among less educated people (OR = 1.61, 95% CI: 1.01-2.58) than among more educated people (OR = 1.40, 95% CI: 0.83-2.37). This study is a cautious first step in empirically testing the general health consequences of corruption. Our results suggest that higher perceived national corruption is associated with general health of both men and women within all socio-economic groups across the lifespan. Further research is needed using more countries to assess the magnitude of the health consequences of corruption. © 2013 John Wiley & Sons Ltd.

The availability, pricing and affordability of three essential asthma medicines in 52 low- and middle-income countries.

PubMed

Babar, Zaheer-Ud-Din; Lessing, Charon; Mace, Cécile; Bissell, Karen

2013-11-01

Almost 300 million people suffer from asthma, yet many in low- and middle-income countries have difficulty accessing essential asthma medicines. Availability, price and affordability of medicines are likely to affect access. Very few studies have included asthma medicines, particularly inhaled corticosteroids, in these countries. Reflections about international reference prices (IRPs) are generally absent from pricing studies, yet some IRPs may be masking the extent of access problems. Our objective was to determine the availability, pricing and affordability of beclometasone, budesonide and salbutamol, the three asthma medicines on the World Health Organization's Model List of Essential Medicines (EML) in selected low- and middle-income countries and to reflect on the appropriateness of using IRPs. A cross-sectional pricing survey was conducted in 52 countries. Data were collected on country demographics including national currency, $US exchange rate and daily wage of the lowest-paid unskilled government worker. Pricing and availability data were collected for salbutamol, beclometasone and budesonide in two private retail pharmacies, the national procurement centre and a main public hospital. Availability was particularly poor for corticosteroids, and worse in national procurement centres and main hospitals. The surveyed strength of beclometasone was only on the EML of ten countries. Considerable variability was found in pricing and affordability across countries. Procurement systems appeared largely inefficient when Asthma Drug Facility prices were applied as references. Some countries appear to be subsidising asthma medicines, making them free or less expensive for patients, while other countries are applying very high margins, which can significantly increase the price for patients unless a reimbursement system exists. Findings raise important policy concerns. Availability of inhaled corticosteroids is poor; many EMLs are not updated; IRPs can be misleading; health systems and patients are paying more than necessary for asthma medicines, which are unaffordable for many patients in many countries.

Long-acting nifedipine for hypertensive patients in the Middle East and Morocco: observations on efficacy and tolerability of monotherapy or combination therapy

PubMed Central

Ghoneim, Raafat AL; Omar, Abdalla Kamal; Sebastian, VJ; Kassab, Roland; Akijian, George; Hafiz, Meryem; Schmidt, Birgit

2013-01-01

Background The Middle Eastern and North African region of developing countries is associated with poor rates of blood pressure (BP) control and antihypertensive prescribing patterns. This post hoc analysis of data from an international observational study aimed to investigate the efficacy and tolerability of long-acting nifedipine (30 mg or 60 mg; monotherapy or in combination) in the Middle Eastern and Moroccan populations defined as having high cardiovascular risk. Methods This was a prospective, noninterventional, multicenter observational study. Observations from patients (aged ≥ 18 years) with treated or untreated hypertension from the Middle East (Jordan, Saudi Arabia, Kuwait, Lebanon, Qatar, United Arab Emirates, and Yemen) and Morocco are presented. Hypertension grade and cardiovascular risk were defined at baseline, and systolic/diastolic BP change was defined at post-baseline visits (≤3). Adverse events and ratings of therapy efficacy and patient/physician satisfaction were recorded. Results The study included 1466 patients from the Middle East and 524 from Morocco. Characteristics of the populations differed, with a more severe hypertension profile in Moroccan patients. Despite these differences, nifedipine reduced BP to a similar extent in each group, with efficacy dependent on cardiovascular risk factors such as hypertension grade and age. Few adverse drug reactions occurred and nifedipine was well-tolerated in both populations. Efficacy and satisfaction with therapy were rated highly. Conclusion Good rates of BP control were observed with nifedipine in patients with moderate-to-severe hypertension and high added risk. Published data in these countries suggest poor antihypertensive prescribing patterns and BP control; these data confirm this trend and suggest that suboptimal dosing may be prevalent. PMID:23807860

An Open Data Platform For Africa

NASA Astrophysics Data System (ADS)

Boulton, G. S.; Hodson, S.

2016-12-01

The International Council for Science's Committee on Data for Science and Technology (CODATA) is collaborating with the South African Department of Science and Technology and other African regional players to create an African Open Data Platform, to be launched in December 2016. Its purpose is to coordinate and support moves in Africa to develop national science systems capacities (political, institutional, individual) that will enable them to exploit the opportunities of the digital revolution for scientific discovery, in reducing costs and increasing efficiency in business and public administration, and in new and powerful ways of addressing issues such as agricultural productivity, disease tracking and control, the production of bio-fuels, and in addressing many global problems where global solutions will only be achieved if there is global participation. Success in avoiding yet another "knowledge divide" between rich and poor depends fundamentally on the extent to which national systems of scientific priority setting, funding and institutional research management respond in a concerted way to the challenge. Although many countries are now addressing these opportunities, it is essential that developing and least developed countries, which have much to gain from the data revolution but which typically have poorly resourced national research systems, do not fail to respond to this imperative, which is also vital for the attainment of the UN Sustainable Development Goals. The Platform will be a basis for political commitment and innovative policy developmen, including shared investment in infrastructure. It will harvest and circulate good ideas, spread and support good practice and develop the capacities of individuals and institutions. It will promote key applications of relevance to African economies and societies, but also act as a conduit for links with international open data programmes and standards that will be vital if it is to flourish.

Material, psychosocial and sociodemographic determinants are associated with positive mental health in Europe: a cross-sectional study

PubMed Central

Dreger, Stefanie; Buck, Christoph; Bolte, Gabriele

2014-01-01

Objectives To investigate the association between psychosocial, sociodemographic and material determinants of positive mental health in Europe. Design Cross-sectional analysis of survey data. Setting 34 European countries. Participants Representative Europe-wide sample consisting of 21 066 men and 22 569 women aged 18 years and over, from 34 European countries participating in the third wave of the European Quality of Life Survey (2011–2012). Outcome Positive mental health as measured by the WHO-5—Mental Well-being Index, while the lowest 25% centile indicated poor positive mental health. Results The prevalence of poor positive mental health was 30% in women and 24% in men. Material, as well as psychosocial, and sociodemographic factors were independently associated with poor positive mental health in a Europe-wide sample from 34 European countries. When studying all factors together, the highest OR for poor positive mental health was reported for social exclusion (men: OR=1.73, 95% CI 1.59 to 1.90; women: OR=1.69, 95% CI 1.57 to 1.81) among the psychosocial factors. Among the material factors, material deprivation had the highest impact (men: OR=1.96, 95% CI 1.78 to 2.15; women: OR=1.93, 95% CI 1.79 to 2.08). Conclusions This study gives the first overview on determinants of positive mental health at a European level and could be used as the basis for preventive policies in the field of positive mental health in Europe. PMID:24871540

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

Strategic Implications of Global Health

DTIC Science & Technology

2008-12-01

National Intelligence Officer for Economic Issues, with the active collaboration of CIA, DIA/National Center for Medical Intelligence, and the...participating in other forms of economic activity . • A degraded health sector, shortages of medical personnel, and infections stemming from deficient...country, and poor health undercuts efforts to diversify economic activity away from oil into more skill-intensive and value-added sectors. Poor health of

Educational Equity in Poor Urban Contexts--Exploring Issues of Place/Space and Young People's Identity and Agency

ERIC Educational Resources Information Center

Raffo, Carlo

2011-01-01

An enduring concern for educational policy in many affluent countries is the endemic nature of educational inequalities that are predominately located in poor urban contexts. Given the inabilities of school reform "per se" to deal with these inequalities, the paper focuses on issues of scarcity and spatial processes that are implicated…

Second Chance Education Matters! Income Trajectories of Poorly Educated Non-Nordics in Sweden

ERIC Educational Resources Information Center

Nordlund, Madelene; Bonfanti, Sara; Strandh, Mattias

2015-01-01

In this study we examine the long-term impact of second chance education (SCE) on incomes of poorly educated individuals who live in Sweden but were not born in a Nordic country, using data on income changes from 1992 to 2003 compiled by Statistics Sweden. Ordinary Least Squares regression analyses show that participation in SCE increased the work…

Demand-Side Financing in Education: a Critical Examination of a Girls' Scholarship Program in Malawi--(Case Study)

ERIC Educational Resources Information Center

Sineta, Abraham

2012-01-01

Despite the push for universal education, many disadvantaged and poor children in developing countries still do not have access to basic education. This among other reasons is due to poverty where poor families cannot afford the cost of basic education even when it is "free" of tuition (McDonald, 2007). Demand-side financing…

Estimating the impact on health of poor reliability of drinking water interventions in developing countries.

PubMed

Hunter, Paul R; Zmirou-Navier, Denis; Hartemann, Philippe

2009-04-01

Recent evidence suggests that many improved drinking water supplies suffer from poor reliability. This study investigates what impact poor reliability may have on achieving health improvement targets. A Quantitative Microbiological Risk Assessment was conducted of the impact of interruptions in water supplies that forced people to revert to drinking raw water. Data from the literature were used to construct models on three waterborne pathogens common in Africa: Rotavirus, Cryptosporidium and Enterotoxigenic E. coli. Risk of infection by the target pathogens is substantially greater on days that people revert to raw water consumption. Over the course of a few days raw water consumption, the annual health benefits attributed to consumption of water from an improved supply will be almost all lost. Furthermore, risk of illness on days drinking raw water will fall substantially on very young children who have the highest risk of death following infection. Agencies responsible for implementing improved drinking water provision will not make meaningful contributions to public health targets if those systems are subject to poor reliability. Funders of water quality interventions in developing countries should put more effort into auditing whether interventions are sustainable and whether the health benefits are being achieved.

Growing vegetables in developing countries for local urban populations and export markets: problems confronting small-scale producers.

PubMed

Dinham, Barbara

2003-05-01

Vegetables attract high applications of pesticides, and farmers in developing countries use many acutely toxic insecticides to control pests on these crops. With the liberalisation of agricultural markets in developing countries, the number of small-scale farmers growing vegetables for both domestic and export markets is increasing. Demand for supplies of year-round and exotic fruit and vegetables has grown in industrialised countries, but with rising quality standards and traceability requirements it is difficult for small-scale farmers to benefit from this lucrative non-traditional agricultural export trade. The demand is high for vegetables in the expanding cities in developing countries, and farmers in peri-urban areas, or rural areas with good access to the cities, are in a position to find a growing market for their produce. Poor storage facilities will often mean that farmers are forced to sell at peak times when prices are low. Farmers rarely have access to training in pesticide use, and have only limited or no access to advice on the complicated management of pesticides. The Food and Agriculture Organisation of the UN is concerned about high levels of poor quality and adulterated pesticides on sale in developing countries. Surveys repeatedly show that without training, farmers are unable to make good crop decisions: recognition of pests and their predators is generally low, leading to decisions to spray to kill any insect; knowledge of product selection, application rates and timing is poor; different products are often combined in the belief that the effect will be greater; re-entry periods after spraying and essential harvest intervals are not known; and without knowledge of alternatives, farmers will often assume that the only solution to pest problems is to spray more frequently. From a consumer's point of view, few developing countries are able to monitor pesticide residues, particularly for produce grown for home consumption: most countries do not have laboratories for even simple residue testing. Changes in European Maximum Residue Limits means that export crops will be rejected if they contain residues at the Limit of Detection of pesticides not registered in Europe. Season-long field level training in Integrated Pest Management can help farmers to become better decision-makers, and to greatly reduce pesticide use while reducing risks to their own health and environment, producing safer products for consumers, maintaining yields, and increasing incomes.

The French method (of representing noise annoyance)

NASA Technical Reports Server (NTRS)

Collet, F.; Delol, J.

1980-01-01

The psophic index used in France for noise exposure from aircraft globally represents the annoyance with the following hypotheses: (1) the global annoyance is a function of the number of aircraft overflights of each type but does not depend on the overflight time; (2) an aircraft flying at night is considered to be just as annoying as 10 aircraft of the same type passing overhead during the day; and (3) and annoyance is only a function of the peak noise levels. Overall, the psophic index appears statistically as good a representation of the average annoyance as methods used in other countries; however, it does seem to reflect poorly the annoyance caused by light aircraft. Noise maps produced for Orly, Roissy, and the area around Paris are described. The range of applications and limitations of the psophic index are discussed.

Globalization, poverty and women's health: mapping the connections.

PubMed

Sicchia, Suzanne R; Maclean, Heather

2006-01-01

Poverty and other forms of inequity undermine individual and population health and retard development. Although absolute poverty has reportedly declined in recent years, research suggests that relative poverty or the gap between the rich and poor within and between countries has been exacerbated over this same period. There is growing concern about the feminization of poverty, and the impact globalization is having on this important social problem. Gender inequality persists in all regions, and women and girls continue to be over-represented among the world's poor. This suggests that women are not consistently benefitting from the economic, political and social gains globalization can offer. Instead, it appears that poor women and girls, particularly those living in developing countries, are disproportionately burdened by the costs of these swift changes to the detriment of their personal health and well-being. Immediate action is needed to correct these disparities and ensure that globalization supports both national and international commitments to poverty reduction, and the, promotion of women's health and human rights.

Water and sanitation service delivery, pricing, and the poor: An empirical estimate of subsidy incidence in Nairobi, Kenya

NASA Astrophysics Data System (ADS)

Fuente, David; Gakii Gatua, Josephine; Ikiara, Moses; Kabubo-Mariara, Jane; Mwaura, Mbutu; Whittington, Dale

2016-06-01

The increasing block tariff (IBT) is among the most widely used tariffs by water utilities, particularly in developing countries. This is due in part to the perception that the IBT can effectively target subsidies to low-income households. Combining data on households' socioeconomic status and metered water use, this paper examines the distributional incidence of subsidies delivered through the IBT in Nairobi, Kenya. Contrary to conventional wisdom, we find that high-income residential and nonresidential customers receive a disproportionate share of subsidies and that subsidy targeting is poor even among households with a private metered connection. We also find that stated expenditure on water, a commonly used means of estimating water use, is a poor proxy for metered use and that previous studies on subsidy incidence underestimate the magnitude of the subsidy delivered through water tariffs. These findings have implications for both the design and evaluation of water tariffs in developing countries.

Strategies for promoting equity: experience with community financing in three African countries.

PubMed

Gilson, L; Kalyalya, D; Kuchler, F; Lake, S; Oranga, H; Ouendo, M

2001-10-01

Although the need for a pro-poor health reform agenda in low and middle income countries is increasingly clear, implementing such policy change is always difficult. This paper seeks to contribute to thinking about how to take forward such an agenda by reflection on the community financing activities of the UNICEF/WHO Bamako Initiative. It presents findings from a three-country study, undertaken in Benin, Kenya and Zambia in 1994/95, which was initiated in order to better understand the nature of the equity impact of community financing activities as well as the factors underlying this impact. The sustained relative affordability gains achieved in Benin emphasise the importance of ensuring that financing change is used as a policy lever for strengthening health service management in support of quality of care improvements. All countries, however, failed in protecting the most poor from the burden of payment, benefiting this group preferentially and ensuring that their views were heard in decision-making. Tackling these problems requires, amongst other things, an appropriate balance between central and local-level decision-making as well as the creation of local decision-making structures which have representation from civil society groups that can voice the needs of the most poor. Leadership, strategy and tactics are also always important in securing any kind of equity gain-such as establishing equity goals to drive implementation. In the experiences examined, the dominance of the goal of financial sustainability contributed to their equity failures. Further research is required to understand what equity goals communities themselves would prefer to guide financing policy.

The inverse primary care law in sub-Saharan Africa: a qualitative study of the views of migrant health workers

PubMed Central

Moosa, Shabir; Wojczewski, Silvia; Hoffmann, Kathryn; Poppe, Annelien; Nkomazana, Oathokwa; Peersman, Wim; Willcox, Merlin; Derese, Anselme; Mant, David

2014-01-01

Background Many low-income and middle-income countries globally are now pursuing ambitious plans for universal primary care, but are failing to deliver adequate care quality because of intractable human resource problems. Aim To understand why migrant nurses and doctors from sub-Saharan Africa did not wish to take up available posts in primary and first-contact care in their home countries. Design and setting Qualitative study of migrant health workers to Europe (UK, Belgium, and Austria) or southern Africa (Botswana and South Africa) from sub-Saharan Africa. Method Semi-structured interviews with 66 health workers (24 nurses and 42 doctors) from 18 countries between July 2011 and April 2012. Transcripts were analysed thematically using a framework approach. Results The reasons given for choosing not to work in primary care were grouped into three main analytic streams: poor working environment, difficult living experiences, and poor career path. Responders described a lack of basic medicines and equipment, an unmanageable workload, and lack of professional support. Many had concerns about personal security, living conditions (such as education for children), and poor income. Primary care was seen as lower status than hospital medicine, with lack of specialist training opportunities and more exposure to corruption. Conclusions Clinicians are reluctant to work in the conditions they currently experience in primary care in sub-Saharan Africa and these conditions tend to get worse as poverty and need for primary care increases. This inverse primary care law undermines achievement of universal health coverage. Policy experience from countries outside Africa shows that it is not immutable. PMID:24868069

The inverse primary care law in sub-Saharan Africa: a qualitative study of the views of migrant health workers.

PubMed

Moosa, Shabir; Wojczewski, Silvia; Hoffmann, Kathryn; Poppe, Annelien; Nkomazana, Oathokwa; Peersman, Wim; Willcox, Merlin; Derese, Anselme; Mant, David

2014-06-01

Many low-income and middle-income countries globally are now pursuing ambitious plans for universal primary care, but are failing to deliver adequate care quality because of intractable human resource problems. To understand why migrant nurses and doctors from sub-Saharan Africa did not wish to take up available posts in primary and first-contact care in their home countries. Qualitative study of migrant health workers to Europe (UK, Belgium, and Austria) or southern Africa (Botswana and South Africa) from sub-Saharan Africa. Semi-structured interviews with 66 health workers (24 nurses and 42 doctors) from 18 countries between July 2011 and April 2012. Transcripts were analysed thematically using a framework approach. The reasons given for choosing not to work in primary care were grouped into three main analytic streams: poor working environment, difficult living experiences, and poor career path. Responders described a lack of basic medicines and equipment, an unmanageable workload, and lack of professional support. Many had concerns about personal security, living conditions (such as education for children), and poor income. Primary care was seen as lower status than hospital medicine, with lack of specialist training opportunities and more exposure to corruption. Clinicians are reluctant to work in the conditions they currently experience in primary care in sub-Saharan Africa and these conditions tend to get worse as poverty and need for primary care increases. This inverse primary care law undermines achievement of universal health coverage. Policy experience from countries outside Africa shows that it is not immutable. © British Journal of General Practice 2014.

Welfare effects of natural disasters in developing countries: an examination using multi-dimensional socio-economic indicators

NASA Astrophysics Data System (ADS)

Mutter, J. C.; Deraniyagala, S.; Mara, V.; Marinova, S.

2011-12-01

The study of the socio-economic impacts of natural disasters is still in its infancy. Social scientists have historically regarded natural disasters as exogenous or essentially random perturbations. More recent scholarship treats disaster shocks as endogenous, with pre-existing social, economic and political conditions determining the form and magnitude of disaster impacts. One apparently robust conclusion is that direct economic losses from natural disasters, similar to human losses, are larger (in relative terms) the poorer a country is, yet cross-country regressions show that disasters may accrue economic benefits due to new investments in productive infrastructure, especially if the investment is funded by externally provided capital (Work Bank assistance, private donations, etc) and do not deplete national savings or acquire a debt burden. Some econometric studies also show that the quality of a country's institutions can mitigate the mortality effects of a disaster. The effects on income inequality are such that the poor suffer greater 'asset shocks' and may never recover from a disaster leading to a widening of existing disparities. Natural disasters affect women more adversely than men in terms of life expectancy at birth. On average they kill more women than men or kill women at a younger age than men, and the more so the stronger the disaster. The extent to which women are more likely to die than men or to die at a younger age from the immediate disaster impact or from post-disaster events depends not only on disaster strength itself but also on the socioeconomic status of women in the affected country. Existing research on the economic effects of disasters focus almost exclusively on the impact on economic growth - the growth rate of GDP. GDP however is only a partial indicator of welfare, especially for countries that are in the lower ranks of development status. Very poor communities are typically involved in subsistence level activities or in the informal economy and will not register disaster set backs in GDP accounts. The alterations to their lives can include loss of livelihood, loss of key assets such as livestock, loss of property and loss of savings, reduced life expectancy among survivors, increased poverty rates, increased inequality, greater subsequent maternal and child mortality (due to destruction of health care facilities), reduced education attainment (lack of school buildings), increased gender-based violence and psychological ailments. Our study enhances this literature in two ways. Firstly, it examines the effects of disasters on human development and poverty using cross-country econometric analysis with indicators of welfare that go beyond GDP. We aim to search the impact of disasters on human development and absolute poverty. Secondly we use Peak Ground Acceleration for earthquakes, a modified Palmer Drought Severity and Hurricane Energy rather than disaster event occurrence to account for the severity of the disaster.

Sociocultural and psychological determinants in migrants for noncompliance with occlusion therapy for amblyopia.

PubMed

Tjiam, Angela M; Akcan, Hilal; Ziylan, Fatma; Vukovic, Elizabet; Loudon, Sjoukje E; Looman, Caspar W N; Passchier, Jan; Simonsz, Huibert J

2011-12-01

Compliance with occlusion therapy for amblyopia in children is low when their parents have a low level of education, speak Dutch poorly, or originate from another country. We determined how sociocultural and psychological determinants affect compliance. Included were amblyopic children between the ages of 3 and 6, living in low socio-economic status (SES) areas. Compliance with occlusion therapy was measured electronically. Their parents completed an oral questionnaire, based on the "Social Position & Use of Social Services by Migrants and Natives" questionnaire that included demographics and questions on issues like education, employment, religion and social contacts. Parental fluency in Dutch was rated on a five-point scale. Regression analysis was used to describe the relationship between the level of compliance and sociocultural and psychological determinants. Data from 45 children and their parents were analyzed. Mean electronically measured compliance was 56 ± 44 percent. Children whose parents had close contact with their neighbors or who were highly dependent on their family demonstrated low levels of compliance. Children of parents who were members of a club and who had positive conceptualizations of Dutch society showed high levels of compliance. Poor compliance was also associated with low income, depression, and when patching interfered with the child's outdoor activity. Religion was not associated with compliance. Poor compliance with occlusion therapy seems correlated with indicators of social cohesion. High social cohesion at micro level, i.e., family, neighbors and friends, and low social cohesion on macro level, i.e., Dutch society, are associated with noncompliance. However, such parents tend to speak Dutch poorly, so it is difficult to determine its actual cause.

Food beliefs and practices in urban poor communities in Accra: implications for health interventions.

PubMed

Boatemaa, Sandra; Badasu, Delali Margaret; de-Graft Aikins, Ama

2018-04-02

Poor communities in low and middle income countries are reported to experience a higher burden of chronic non-communicable diseases (NCDs) and nutrition-related NCDs. Interventions that build on lay perspectives of risk are recommended. The objective of this study was to examine lay understanding of healthy and unhealthy food practices, factors that influence food choices and the implications for developing population health interventions in three urban poor communities in Accra, Ghana. Thirty lay adults were recruited and interviewed in two poor urban communities in Accra. The interviews were audio-taped, transcribed and analysed thematically. The analysis was guided by the socio-ecological model which focuses on the intrapersonal, interpersonal, community, structural and policy levels of social organisation. Food was perceived as an edible natural resource, and healthy in its raw state. A food item retained its natural, healthy properties or became unhealthy depending on how it was prepared (e.g. frying vs boiling) and consumed (e.g. early or late in the day). These food beliefs reflected broader social food norms in the community and incorporated ideas aligned with standard expert dietary guidelines. Healthy cooking was perceived as the ability to select good ingredients, use appropriate cooking methods, and maintain food hygiene. Healthy eating was defined in three ways: 1) eating the right meals; 2) eating the right quantity; and 3) eating at the right time. Factors that influenced food choice included finances, physical and psychological state, significant others and community resources. The findings suggest that beliefs about healthy and unhealthy food practices are rooted in multi-level factors, including individual experience, family dynamics and community factors. The factors influencing food choices are also multilevel. The implications of the findings for the design and content of dietary and health interventions are discussed.

Antimicrobial Resistance in Asia: Current Epidemiology and Clinical Implications

PubMed Central

Kang, Cheol-In

2013-01-01

Antimicrobial resistance has become one of the most serious public health concerns worldwide. Although circumstances may vary by region or country, it is clear that some Asian countries are epicenters of resistance, having seen rapid increases in the prevalence of antimicrobial resistance of major bacterial pathogens. In these locations, however, the public health infrastructure to combat this problem is very poor. The prevalence rates of methicillin-resistant Staphylococcus aureus (MRSA), macrolide-resistant Streptococcus pneumoniae, and multidrug-resistant enteric pathogens are very high due to the recent emergence of extremely drug-resistant gram-negative bacilli in Asia. Because antimicrobial options for these pathogens are extremely limited, infections caused by antimicrobial-resistant bacteria are often associated with inappropriate antimicrobial therapy and poor clinical outcomes. Physicians should be aware of the current epidemiological status of resistance and understand the appropriate use of antimicrobial agents in clinical practice. This review focuses on describing the epidemiology and clinical implications of antimicrobial-resistant bacterial infections in Asian countries. PMID:24265947

Detection of Bartonella quintana in African Body and Head Lice

PubMed Central

Sangaré, Abdoul Karim; Boutellis, Amina; Drali, Rezak; Socolovschi, Cristina; Barker, Stephen C.; Diatta, Georges; Rogier, Christophe; Olive, Marie-Marie; Doumbo, Ogobara K.; Raoult, Didier

2014-01-01

Currently, the body louse is the only recognized vector of Bartonella quintana, an organism that causes trench fever. In this work, we investigated the prevalence of this bacterium in human lice in different African countries. We tested 616 head lice and 424 body lice from nine African countries using real-time polymerase chain reaction targeting intergenic spacer region 2 and specific B. quintana genes. Overall, B. quintana DNA was found in 54% and 2% of body and head lice, respectively. Our results also show that there are more body lice positive for B. quintana in poor countries, which was determined by the gross domestic product, than in wealthy areas (228/403 versus 0/21, P < 0.001). A similar finding was obtained for head lice (8/226 versus 2/390, P = 0.007). Our findings suggest that head lice in Africa may be infected by B. quintana when patients live in poor economic conditions and are also exposed to body lice. PMID:24935950

Critical role of developing national strategic plans as a guide to strengthen laboratory health systems in resource-poor settings.

PubMed

Nkengasong, John N; Mesele, Tsehaynesh; Orloff, Sherry; Kebede, Yenew; Fonjungo, Peter N; Timperi, Ralph; Birx, Deborah

2009-06-01

Medical laboratory services are an essential, yet often neglected, component of health systems in developing countries. Their central role in public health, disease control and surveillance, and patient management is often poorly recognized by governments and donors. However, medical laboratory services in developing countries can be strengthened by leveraging funding from other sources of HIV/AIDS prevention, care, surveillance, and treatment programs. Strengthening these services will require coordinated efforts by national governments and partners and can be achieved by establishing and implementing national laboratory strategic plans and policies that integrate laboratory systems to combat major infectious diseases. These plans should take into account policy, legal, and regulatory frameworks; the administrative and technical management structure of the laboratories; human resources and retention strategies; laboratory quality management systems; monitoring and evaluation systems; procurement and maintenance of equipment; and laboratory infrastructure enhancement. Several countries have developed or are in the process of developing their laboratory plans, and others, such as Ethiopia, have implemented and evaluated their plan.

Drug policy and administration affecting quality of life of the poor in Thailand.

PubMed

Prutipinyo, Chardsumon; Sirichotiratana, Nithat

2011-09-01

This study aims to analyze drug policy and administration affecting quality of life of the poor in Thailand. Review of official reports and related documents, for the past 10 years (from 2000-2010). By imposing compulsory licensing, the Thai government maintains negotiating power over the price of pharmaceutical products with the patent holders of the original drugs. This gives an opportunity for relevant government agencies to produce or import patented drugs. At present, there are many problems and obstacles. The findings show that developing countries need to strengthen their negotiating power so that the pharmaceutical manufacturers cannot take advantage through mechanisms provided for such as compulsory licensing and provisions for flexibility in Trade-Related Intellectual Property Rights (TRIPS) agreement. Furthermore, these countries must support and empower the local pharmaceutical manufacturers to produce generic drugs. Developing countries should ensure that their populations have confidence in universal coverage service and medical systems regarding the quality of generic drugs.

Towards safety, hygiene and environmental (SHE) management in African small and medium companies.

PubMed

Meité, Vaflahi; Baeyens, Jan; Dewil, Raf

2009-03-01

Although Safety, Health and Environment (SHE) principles are adhered to in companies of developed countries, the application in developing countries is at its infant stage, as shown by the present article where the authors surveyed SHE Practice in 242 companies of 8 West-African countries. The survey demonstrated that (i) the overall performances are poor, although significant improvement can be achieved with a minimum of goodwill and management support; (ii) despite financial difficulties faced by small and medium enterprises (SME), SHE management is a must and should start with a pollution prevention program that will vary with individual needs but some conscious planning effort is always necessary; (iii) it is necessary to prepare for appropriate actions for pollution abatement, adapted to the existing and future production facilities. Although the recorded results are rather poor, there are obviously many possibilities of improvement, with a little goodwill of the SME managers and supervisors. Reaching a standard level of the environmental management is a long but an important process.

A dubious success: The NGO campaign against GMOs

PubMed Central

Paarlberg, Robert

2014-01-01

Genetically engineered agricultural crops are widely grown for animal feed (yellow corn, soybean meal) and for industrial purposes (such as cotton for fabric, or yellow corn for ethanol), but almost nobody grows GMO food staple crops. The only GMO food staple crop planted anywhere is white maize, and only in one country – the Republic of South Africa. It has been two decades now since GMO crops were first planted commercially, yet it is still not legal anywhere to plant GMO wheat or GMO rice. When it comes to GMO food crops, anti-GMO campaigners have thus won a remarkable yet dubious victory. They have not prevented rich countries from using GMO animal feed or GMO cotton, yet farmers and consumers in poor countries need increased productivity for food crops, not animal feed or industrial crops. Today's de facto global ban on GMO food crops therefore looks suspiciously like an outcome designed by the rich and for the rich, with little regard for the interests of the poor. PMID:25437241

A dubious success: the NGO campaign against GMOs.

PubMed

Paarlberg, Robert

2014-07-03

Genetically engineered agricultural crops are widely grown for animal feed (yellow corn, soybean meal) and for industrial purposes (such as cotton for fabric, or yellow corn for ethanol), but almost nobody grows GMO food staple crops. The only GMO food staple crop planted anywhere is white maize, and only in one country--the Republic of South Africa. It has been two decades now since GMO crops were first planted commercially, yet it is still not legal anywhere to plant GMO wheat or GMO rice. When it comes to GMO food crops, anti-GMO campaigners have thus won a remarkable yet dubious victory. They have not prevented rich countries from using GMO animal feed or GMO cotton, yet farmers and consumers in poor countries need increased productivity for food crops, not animal feed or industrial crops. Today's de facto global ban on GMO food crops therefore looks suspiciously like an outcome designed by the rich and for the rich, with little regard for the interests of the poor.

Detection of Bartonella quintana in African body and head lice.

PubMed

Sangaré, Abdoul Karim; Boutellis, Amina; Drali, Rezak; Socolovschi, Cristina; Barker, Stephen C; Diatta, Georges; Rogier, Christophe; Olive, Marie-Marie; Doumbo, Ogobara K; Raoult, Didier

2014-08-01

Currently, the body louse is the only recognized vector of Bartonella quintana, an organism that causes trench fever. In this work, we investigated the prevalence of this bacterium in human lice in different African countries. We tested 616 head lice and 424 body lice from nine African countries using real-time polymerase chain reaction targeting intergenic spacer region 2 and specific B. quintana genes. Overall, B. quintana DNA was found in 54% and 2% of body and head lice, respectively. Our results also show that there are more body lice positive for B. quintana in poor countries, which was determined by the gross domestic product, than in wealthy areas (228/403 versus 0/21, P < 0.001). A similar finding was obtained for head lice (8/226 versus 2/390, P = 0.007). Our findings suggest that head lice in Africa may be infected by B. quintana when patients live in poor economic conditions and are also exposed to body lice. © The American Society of Tropical Medicine and Hygiene.

Bringing cancer care to the poor: experiences from Rwanda.

PubMed

Shulman, Lawrence N; Mpunga, Tharcisse; Tapela, Neo; Wagner, Claire M; Fadelu, Temidayo; Binagwaho, Agnes

2014-12-01

The knowledge and tools to cure many cancer patients exist in developed countries but are unavailable to many who live in the developing world, resulting in unnecessary loss of life. Bringing cancer care to the poor, particularly to low-income countries, is a great challenge, but it is one that we believe can be met through partnerships, careful planning and a set of guiding principles. Alongside vaccinations, screening and other cancer-prevention efforts, treatment must be a central component of any cancer programme from the start. It is also critical that these programmes include implementation research to determine programmatic efficacy, where gaps in care still exist and where improvements can be made. This article discusses these issues using the example of Rwanda's expanding national cancer programme.

Soil erosion in developing countries: A politicoeconomic explanation

NASA Astrophysics Data System (ADS)

Thapa, Gopal B.; Weber, Karl E.

1991-07-01

Soil erosion is accelerating in developing countries of Asia, Africa, and Latin America. It has threatened the livelihood of millions of peasants, for agriculture is their economic mainstay. A probe into the forces causing erosion reveals that the elite’s resolve to accumulate ever more wealth and to maintain, consolidate, or expand their sociopolitical power and the necessity of the poor to fulfill their requirements of food, fuelwood, and fodder are the two major factors accelerating soil erosion. Unless the vast masses of poor people are integrated into the national mainstream through the implementation of equitable and redistributive development policies, it is impossible to control the accelerating rate of soil erosion and thus to achieve the objective of sustainable development.

Child Health: Reaching the Poor

PubMed Central

Wagstaff, Adam; Bustreo, Flavia; Bryce, Jennifer; Claeson, Mariam

2004-01-01

In most countries, rates of mortality and malnutrition among children continue to decline, but large inequalities between poor and better-off children exist, both between and within countries. These inequalities, which appear to be widening, call into question the strategies for child mortality reduction relied upon to date. We review (1) what is known about the causes of socioeconomic inequalities in child health and where programs aimed at reducing inequalities may be most effectively focused and (2) what is known about the success of actual programs in narrowing these inequalities. We end with lessons learned: the need for better evidence, but most of all for a new approach to improving the health of all children that is evidence based, broad, and multifaceted. PMID:15117689

The High Return to Private Schooling in a Low-Income Country. Africa Growth Initiative. Working Paper 5

ERIC Educational Resources Information Center

Bold, Tessa; Kimenyi, Mwangi; Mwabu, Germano; Sandefur, Justin

2013-01-01

Existing studies from the United States, Latin America and Asia provide scant evidence that private schools dramatically improve academic performance relative to public schools. Using data from Kenya--a poor country with weak public institutions--we find a large effect of private schooling on test scores, equivalent to one full standard deviation.…

Poverty and Ethnicity: A Cross-Country Study of Roma Poverty in Central Europe. World Bank Technical Paper.

ERIC Educational Resources Information Center

Revenga, Ana; Ringold, Dena; Tracy, William Martin

Roma, or "gypsies," are the main poverty risk group in many countries of central and eastern Europe. Living standards for the Roma have deteriorated more severely during the region's transition to a market economy than they have for other population groups, and Roma have been poorly positioned to take advantage of emerging economic and…

Eastern Bolivia: The White Promised Land. IWGIA Document 31.

ERIC Educational Resources Information Center

Lewis, Norman

The Indians of Bolivia, already exploited by a military dictatorship, will have to take up more of the white man's burden if South Africans and Rhodesians accept an invitation to colonize the country. White South Africans, accustomed to the excesses of their own police, will find much that is familiar in Bolivia. Bolivia is a poor country, its per…

Language Policy and Science: Could Some African Countries Learn from Some Asian Countries?

ERIC Educational Resources Information Center

Brock-Utne, Birgit

2012-01-01

This article deals with the fact that most children in Africa are taught in a language neither they nor their teachers master, resulting in poor education outcomes. While there are also donor interests and donor competition involved in retaining ex-colonial languages, as well as an African elite that may profit from this system, one of the main…

Selecting Teaching Practice Schools across Social Contexts: Conceptual and Policy Challenges from South Africa

ERIC Educational Resources Information Center

Robinson, Maureen

2014-01-01

In a country like South Africa, as in many other countries around the world, there is an imperative to prepare student teachers for a wide variety of social contexts, as part of breaking the cycle of disadvantage for poor learners. This article explores the challenge of placing student teachers for their field experience in schools that differ…

Influences on Academic Achievement Across High and Low Income Countries: A Re-Analysis of IEA Data.

ERIC Educational Resources Information Center

Heyneman, S.; Loxley, W.

Previous international studies of science achievement put the data through a process of winnowing to decide which variables to keep in the final regressions. Variables were allowed to enter the final regressions if they met a minimum beta coefficient criterion of 0.05 averaged across rich and poor countries alike. The criterion was an average…

Self-Rated Health and Mortality: Does the Relationship Extend to a Low Income Setting?

ERIC Educational Resources Information Center

Frankenberg, Elizabeth; Jones, Nathan R.

2004-01-01

Although a relationship between poor self-reported health status and excess mortality risk has been well-established for industrialized countries, almost no research considers developing countries. We use data from Indonesia to show that in a low-income setting, as in more advantaged parts of the world, individuals who perceive their health to be…

Inequality in Human Development: An Empirical Assessment of 32 Countries

ERIC Educational Resources Information Center

Grimm, Michael; Harttgen, Kenneth; Klasen, Stephan; Misselhorn, Mark; Munzi, Teresa; Smeeding, Timothy

2010-01-01

One of the most frequent critiques of the HDI is that is does not take into account inequality within countries in its three dimensions. In this paper, we apply a simply approach to compute the three components and the overall HDI for quintiles of the income distribution. This allows a comparison of the level in human development of the poor with…

Imbalances in the knowledge about infant mental health in rich and poor countries: too little progress in bridging the gap.

PubMed

Tomlinson, Mark; Bornstein, Marc H; Marlow, Marguerite; Swartz, Leslie

2014-01-01

The vast majority of infants are born in poor countries, but most of our knowledge about infants and children has emerged from high-income countries. In 2003, M. Tomlinson and L. Swartz conducted a survey of articles on infancy between 1996 and 2001 from major international journals, reporting that a meager 5% of articles emanated from parts of the world other than North America, Europe, or Australasia. In this article, we conducted a similar review of articles on infancy published between 2002 and 2012 to assess whether the status of cross-national research has changed in the subsequent decade. Results indicate that despite slight improvements in research output from the rest of world, only 2.3% of articles published in 11 years included data from low- and middle-income countries--where 90% of the world's infants live. These discrepancies are indicative of the progress still needed to bridge the so-called 10/90 gap (S. Saxena, G. Paraje, P. Sharan, G. Karam, & R. Sadana,) in infant mental health research. Cross-national collaboration is urgently required to ensure expansion of research production in low-resource settings. © 2014 Michigan Association for Infant Mental Health.

Country material distribution and adolescents' perceived health: multilevel study of adolescents in 27 countries

PubMed Central

Torsheim, Torbjorn; Currie, Candace; Boyce, Will; Samdal, Oddrun

2006-01-01

Objective To assess the impact of country material distribution on adolescents' perceptions of health. Design Cross sectional multilevel study. Setting Data were collected from the school based health behaviour in school aged children: WHO cross national study 1997/98, which includes students from 27 European and North American countries. Participants 12 0381 students in year 6, 8, and 10 who were attending school classes on the day of data collection. Main result Adolescents in countries with a high dispersion of family affluence were more likely to have self rated poor health even after controlling for individual family level of affluence and family social resources. Conclusion There are substantial inequalities in subjective health across European and North American countries related to the distribution of family material resources in these countries. PMID:16415267

Birds of passage are also women.

PubMed

Morokvasic, M

1984-01-01

Migrant women from poor countries represent a labor supply which is, at once, the most vulnerable, flexible and, at least in the beginning, the least demanding. They are incorporated into sexually segregated labor markets at the lowest stratum in high-tech industries or at the cheapest sectors in labor intensive industries. They bear the brunt of the ideology of racism and an insecure political and legal status as all migrants do, which along with gender discrimination and class exploitation, contribute to their vulnerability. For instance, after the 1974 halt on further labor immigration, the Western European receiving countries imposed either a complete ban or waiting periods for entry into the labor market for the spouces who joined migrants already in these countries. This regulation concerned non-EEC citizens, mostly women. In the absence of legitimate employment opportunities, these women turned to illegal employment. For employers, there are obvious advantages in hiring illegal labor--tax violation, flexibility, and non-application of labor legislation. Legally, these women are defined as dependents,' in keeping with the Western ideology where man is the breadwinner, whether this dependency is real or not. Thus, there stay is linked to the legal status of their migrant husbands. The work of native and migrant women do not always conform to the prevailing definition of 'work,' and therefore, not often recognized as an economic activity in data collection. In the process of migration and incorporation into waged employment, women may experience either increased exploitation, or, may gain greater independence and an awareness that their situation can be changed. The changes in women's position are a function of the socioeconomic and cultural context in which they take place, and are related to their role in production, social status in the place of origin, employment opportunities in the receiving areas for men as well as women, and finally, migration patterns and reasons for migration. Migration tends to be treated as a phenomenon involving young males seeking economic betterment. There is need for better understanding of migration of women.

Evaluating the Relative Environmental Impact of Countries

PubMed Central

Bradshaw, Corey J. A.; Giam, Xingli; Sodhi, Navjot S.

2010-01-01

Environmental protection is critical to maintain ecosystem services essential for human well-being. It is important to be able to rank countries by their environmental impact so that poor performers as well as policy ‘models’ can be identified. We provide novel metrics of country-specific environmental impact ranks – one proportional to total resource availability per country and an absolute (total) measure of impact – that explicitly avoid incorporating confounding human health or economic indicators. Our rankings are based on natural forest loss, habitat conversion, marine captures, fertilizer use, water pollution, carbon emissions and species threat, although many other variables were excluded due to a lack of country-specific data. Of 228 countries considered, 179 (proportional) and 171 (absolute) had sufficient data for correlations. The proportional index ranked Singapore, Korea, Qatar, Kuwait, Japan, Thailand, Bahrain, Malaysia, Philippines and Netherlands as having the highest proportional environmental impact, whereas Brazil, USA, China, Indonesia, Japan, Mexico, India, Russia, Australia and Peru had the highest absolute impact (i.e., total resource use, emissions and species threatened). Proportional and absolute environmental impact ranks were correlated, with mainly Asian countries having both high proportional and absolute impact. Despite weak concordance among the drivers of environmental impact, countries often perform poorly for different reasons. We found no evidence to support the environmental Kuznets curve hypothesis of a non-linear relationship between impact and per capita wealth, although there was a weak reduction in environmental impact as per capita wealth increases. Using structural equation models to account for cross-correlation, we found that increasing wealth was the most important driver of environmental impact. Our results show that the global community not only has to encourage better environmental performance in less-developed countries, especially those in Asia, there is also a requirement to focus on the development of environmentally friendly practices in wealthier countries. PMID:20454670

Between-Country Inequalities in the Neglected Tropical Disease Burden in 1990 and 2010, with Projections for 2020.

PubMed

Stolk, Wilma A; Kulik, Margarete C; le Rutte, Epke A; Jacobson, Julie; Richardus, Jan Hendrik; de Vlas, Sake J; Houweling, Tanja A J

2016-05-01

The World Health Organization (WHO) has set ambitious time-bound targets for the control and elimination of neglected tropical diseases (NTDs). Investing in NTDs is not only seen as good value for money, but is also advocated as a pro-poor policy since it would improve population health in the poorest populations. We studied the extent to which the disease burden from nine NTDs (lymphatic filariasis, onchocerciasis, schistosomiasis, soil-transmitted helminths, trachoma, Chagas disease, human African trypanosomiasis, leprosy, visceral leishmaniasis) was concentrated in the poorest countries in 1990 and 2010, and how this would change by 2020 in case the WHO targets are met. Our analysis was based on 1990 and 2010 data from the Global Burden of Disease (GBD) 2010 study and on projections of the 2020 burden. Low and lower-middle income countries together accounted for 69% and 81% of the global burden in 1990 and 2010 respectively. Only the soil-transmitted helminths and Chagas disease caused a considerable burden in upper-middle income countries. The global burden from these NTDs declined by 27% between 1990 and 2010, but reduction largely came to the benefit of upper-middle income countries. Achieving the WHO targets would lead to a further 55% reduction in the global burden between 2010 and 2020 in each country income group, and 81% of the global reduction would occur in low and lower-middle income countries. The GBD 2010 data show the burden of the nine selected NTDs in DALYs is strongly concentrated in low and lower-middle income countries, which implies that the beneficial impact of NTD control eventually also largely comes to the benefit of these same countries. While the nine NTDs became increasingly concentrated in developing countries in the 1990-2010 period, this trend would be rectified if the WHO targets were met, supporting the pro-poor designation.

Does the distribution of healthcare utilization match needs in Africa?

PubMed

Bonfrer, Igna; van de Poel, Ellen; Grimm, Michael; Van Doorslaer, Eddy

2014-10-01

An equitable distribution of healthcare use, distributed according to people's needs instead of ability to pay, is an important goal featuring on many health policy agendas worldwide. However, relatively little is known about the extent to which this principle is violated across socio-economic groups in Sub-Saharan Africa (SSA). We examine cross-country comparative micro-data from 18 SSA countries and find that considerable inequalities in healthcare use exist and vary across countries. For almost all countries studied, healthcare utilization is considerably higher among the rich. When decomposing these inequalities we find that wealth is the single most important driver. In 12 of the 18 countries wealth is responsible for more than half of total inequality in the use of care, and in 8 countries wealth even explains more of the inequality than need, education, employment, marital status and urbanicity together. For the richer countries, notably Mauritius, Namibia, South Africa and Swaziland, the contribution of wealth is typically less important. As the bulk of inequality is not related to need for care and poor people use less care because they do not have the ability to pay, healthcare utilization in these countries is to a large extent unfairly distributed. The weak average relationship between need for and use of health care and the potential reporting heterogeneity in self-reported health across socio-economic groups imply that our findings are likely to even underestimate actual inequities in health care. At a macro level, we find that a better match of needs and use is realized in those countries with better governance and more physicians. Given the absence of social health insurance in most of these countries, policies that aim to reduce inequities in access to and use of health care must include an enhanced capacity of the poor to generate income. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.

The contribution of health to the economy in the European Union.

PubMed

Suhrcke, Marc; McKee, Martin; Stuckler, David; Sauto Arce, Regina; Tsolova, Svetla; Mortensen, Jørgen

2006-11-01

Despite increasing recognition of the link between health and economic development in low-income countries, the relationship has to date received scant attention in rich countries. We argue that this lack of attention is not justifiable. While the economic argument for investing in health in rich countries may differ in detail from that in low-income countries, there is considerable and convincing evidence that significant economic benefits can be achieved by improving health not only in poor, but also in rich countries. Better health increases labour supply and productivity and historically, health has been a major contributor to economic growth. In spite of remaining evidence gaps economic policy-makers also in developed countries should consider investing in health as one (of few) ways by which to achieve their economic objectives.

Developing Capacity or a Culture of Dependency: Are Humanitarian Assistance Projects Initiated by the Provincial Reconstruction Teams Reinforcing Dependency or True Capacity in the Paktia-Khost Provinces of Afghanistan?

DTIC Science & Technology

2013-05-22

47 Prebisch found that developing countries were mainly primary producers, whereas developed countries were industrial producers. Primary producers...can do nothing to add value to the corn, potatoes, copper, lumber etc. that they produce, whereas industrial countries can add value (and increase...the price) of cars, planes, machines, engines, etc. So industrial countries grow faster than primary producers, and in essence, exploit them

Vocational Education and Training as a Tool To Ensure Social and Economic Cohesion. National Observatory Country Report. Lithuania, 1999.

ERIC Educational Resources Information Center

Dienys, Vincentas; Beleckiene, Giedre; Zimina, Natalija

The poor state of the Lithuanian economy has led to a diminishing number of jobs and growing number of unemployed. Statistical data make it evident that the poor standard of education is one cause of unemployment. Stages of vocational education and training (VET) are initial, secondary, and postsecondary. The state oversees operation of education…

Why Are There Proportionately More Poor Pupils Enrolled in Non-State Schools in Urban Kenya in Spite of FPE Policy?

ERIC Educational Resources Information Center

Oketch, Moses; Mutisya, Maurice; Ngware, Moses; Ezeh, Alex C.

2010-01-01

One of the conundrums of free primary education (FPE) policy in several countries in Sub-Saharan Africa is the "mushrooming" of fee-paying private schools. Several researchers have become interested in studying this phenomenon and have raised the question--does free primary education meet the needs of the poor? Emerging voices among this…

Is There a Private Schooling Market in Poor Neighbourhoods in Maputo, Mozambique? Exploring the Role of the Non-State Education Sector

ERIC Educational Resources Information Center

Härmä, Joanna

2016-01-01

In some low-income countries, low-fee private schools targeting relatively poor communities have sprung up in considerable numbers meeting growing demand. This is often the case where government is not providing enough school places, but also where parents could access government schools for their children but choose not to, due to perceived low…

Can Information and Counseling Help Students from Poor Rural Areas Go to High School? Evidence from China

ERIC Educational Resources Information Center

Loyalka, Prashant; Liu, Chengfang; Song, Yingquan; Yi, Hongmei; Huang, Xiaoting; Wei, Jianguo; Zhang, Linxiu; Shi, Yaojiang; Chu, James; Rozelle, Scott

2013-01-01

To sustain its economic growth in the coming years, China will have to increase the country's supply of skilled labor by enabling its workforce to attain to higher levels of formal education. Unfortunately, when children in poor, rural areas today grow up, they may not be able to enjoy China's future economic prosperity because of their low levels…

Spousal violence in sub-Saharan Africa: does household poverty-wealth matter?

PubMed Central

2014-01-01

Introduction Despite the threat of violence to the health and rights of women yet, for many years, there has been a dearth of nationally comparable data on domestic violence in sub-Saharan Africa. This paper examines whether women from poor households are more likely to experience violence from husband/partner than other women who are from middle or rich households. Method Data for the study are derived from most recent DHS surveys of ever-married women age 15-49 in Cameroun(3,691), Kenya(4,336), Mozambique(5610), Nigeria (16,763), Zambia(3,010) and Zimbabwe(5,016) who participated in the questions on Domestic Violence Module. Bivariate analysis and Binary Logistic Regression Analysis are used to explore the linkage between household poverty-wealth and spousal violence while simultaneously controlling for confounding variables. Results The overall prevalence of any form of violence (physical, sexual or emotional) ranges from 30.5% in Nigeria to 43.4% in Zimbabwe; 45.3% in Kenya; 45.5% in Mozambique; 53.9% in Zambia and 57.6% in Cameroun. Both bivariate and multivariate analyses show that in two of the six countries –Zambia and Mozambique, experience of violence is significantly higher among women from non-poor (rich) households than those from other households (poor and middle). For Zimbabwe and Kenya, women from poor households are more likely to have ever experienced spousal violence than those from non-poor households. In the remaining two countries- Nigeria and Cameroun, women from the middle class are more likely to have ever suffered abuse from husband/partner than those from the poor and rich households. Conclusion Our results thus show that similar measurements of household poverty-wealth have produced varying relationships with respect to experience of spousal violence in six sub-Saharan African countries. In other words, experience of violence cuts across all household poverty-wealth statuses and therefore may not provide enough explanations on whether household-poverty necessarily serves to facilitate the ending of violence. These results suggest that eliminating violence against women in sub-Sahara Africa requires a comprehensive approach rather than addressing household poverty-wealth alone. PMID:24935486

Integration of HIV care into maternal health services: a crucial change required in improving quality of obstetric care in countries with high HIV prevalence.

PubMed

Madzimbamuto, Farai D; Ray, Sunanda; Mogobe, Keitshokile D

2013-06-10

The failure to reduce preventable maternal deaths represents a violation of women's right to life, health, non-discrimination and equality. Maternal deaths result from weaknesses in health systems: inadequate financing of services, poor information systems, inefficient logistics management and most important, the lack of investment in the most valuable resource, the human resource of health workers. Inadequate senior leadership, poor communication and low staff morale are cited repeatedly in explaining low quality of healthcare. Vertical programmes undermine other service areas by creating competition for scarce skilled staff, separate reporting systems and duplication of training and tasks. Confidential enquiries and other quality-improvement activities have identified underlying causes of maternal deaths, but depend on the health system to respond with remedies. Instead of separate vertical programmes for management of HIV, tuberculosis, and reproductive health, integration of care and joint management of pregnancy and HIV would be more effective. Addressing health system failures that lead to each woman's death would have a wider impact on improving the quality of care provided in the health service as a whole. More could be achieved if existing resources were used more effectively. The challenge for African countries is how to get into practice interventions known from research to be effective in improving quality of care. Advocacy and commitment to saving women's lives are crucial elements for campaigns to influence governments and policy -makers to act on the findings of these enquiries. Health professional training curricula should be updated to include perspectives on patients' rights, communication skills, and integrated approaches, while using adult learning methods and problem-solving techniques. In countries with high rates of Human Immunodeficiency Virus (HIV), indirect causes of maternal deaths from HIV-associated infections now exceed direct causes of hemorrhage, hypertension and sepsis. Advocacy for all pregnant HIV-positive women to be on anti-retroviral therapy must extend to improvements in the quality of service offered, better organised obstetric services and integration of clinical HIV care into maternity services. Improved communication and specialist support to peripheral facilities can be facilitated through advances in technology such as mobile phones.

Senegal.

PubMed

1991-07-01

Background notes and statistics on Senegal are provided in the document. 196,840 sq. km. of diversified terrain are encompassed by the country, with a 1990 population of 7 million growing at the annual rate of 3%. The work force totals 3 million. Senegal claims a population comprised of 5 ethnic groups and various others, 3 religious beliefs, and speaking 5 languages. No period of education is listed as compulsory, with the country overall experiencing 28% literacy. The infant mortality rate is 78/1,000, while life expectancy is 48 years. 1989 GDP was $5 billion, and was growing at the rate of 6%. 1988 per capita GDP was $630, with a 1989 inflation rate of 2%. Agriculture accounts for 22% of GDP, industry for 24%; 1990 international trade deficit totalled $209 million. Additional data are provided on Senegal's people, government, economy, international affiliations, defense, history, political conditions, principal government officials, foreign relations, and bilateral relations with the United States. Senegal suffers from a resource-poor economy vulnerable to environmental and international commodity price fluctuations. The country depends heavily on international donor assistance. 70% of the labor force is engaged in farming, with peanuts accounting for 1/2 of agricultural output. Agroindustry investment is planned to bring Senegal further along toward food self-sufficiency. Fishing, phosphate production, and tourism are all areas for economic growth. Economic reforms along with favorable weather in recent years have resulted in real GDP growth. Foreign investment is welcomed in Senegal, as demonstrated by revised terms set forth in the investment code of 1987.

Economic constraints on production and consumption of animal source foods for nutrition in developing countries.

PubMed

Steinfeld, Henning

2003-11-01

Livestock ownership currently supports and sustains the livelihoods of an estimated 675 million rural poor, who depend partially or fully on livestock for their income and/or subsistence. Human population growth, increasing urbanization and rising incomes are predicted to double the demand for, and production of, livestock and livestock products in the developing countries over the next 20 y. Land availability limits the expansion of livestock numbers in extensive production systems in most regions, and the bulk of the increase in livestock production will come from increased productivity through intensification and a wider adoption of existing and new production and marketing technologies. The significant changes in the global consumption and demand for animal source foods, along with increasing pressures on resources, are having some important implications for the principal production systems. Production at the smallholder level is constrained by a number of barriers, lack of competitiveness and risk factors. The future holds both opportunities as well as serious pitfalls for animal production in developing countries. There is a danger that livestock production and processing will become dominated by integrated large-scale commercial operations, displacing small-scale livestock farmers and thus exacerbating rural poverty and malnutrition. Conversely, correctly managed, a dynamic livestock sector could prove to be a catalyst for stimulating rural economies. However, the livestock sector will not take on this role on its own, but requires proactive policies on behalf of the private and public sectors.

Food system consequences of a fungal disease epidemic in a major crop.

PubMed

Godfray, H Charles J; Mason-D'Croz, Daniel; Robinson, Sherman

2016-12-05

Fungal diseases are major threats to the most important crops upon which humanity depends. Were there to be a major epidemic that severely reduced yields, its effects would spread throughout the globalized food system. To explore these ramifications, we use a partial equilibrium economic model of the global food system (IMPACT) to study a hypothetical severe but short-lived epidemic that reduces rice yields in the countries affected by 80%. We modelled a succession of epidemic scenarios of increasing severity, starting with the disease in a single country in southeast Asia and ending with the pathogen present in most of eastern Asia. The epidemic and subsequent crop losses led to substantially increased global rice prices. However, as long as global commodity trade was unrestricted and able to respond fast enough, the effects on individual calorie consumption were, to a large part, mitigated. Some of the worse effects were projected to be experienced by poor net-rice importing countries in sub-Saharan Africa, which were not affected directly by the disease but suffered because of higher rice prices. We critique the assumptions of our models and explore political economic pressures to restrict trade at times of crisis. We finish by arguing for the importance of 'stress-testing' the resilience of the global food system to crop disease and other shocks.This article is part of the themed issue 'Tackling emerging fungal threats to animal health, food security and ecosystem resilience'. © 2016 The Author(s).

Correlates of poor health among orphans and abandoned children in less wealthy countries: the importance of caregiver health.

PubMed

Thielman, Nathan; Ostermann, Jan; Whetten, Kathryn; Whetten, Rachel; O'Donnell, Karen

2012-01-01

More than 153 million children worldwide have been orphaned by the loss of one or both parents, and millions more have been abandoned. We investigated relationships between the health of orphaned and abandoned children (OAC) and child, caregiver, and household characteristics among randomly selected OAC in five countries. Using a two-stage random sampling strategy in 6 study areas in Cambodia, Ethiopia, India, Kenya, and Tanzania, the Positive Outcomes for Orphans (POFO) study identified 1,480 community-living OAC ages 6 to 12. Detailed interviews were conducted with 1,305 primary caregivers at baseline and after 6 and 12 months. Multivariable logistic regression models describe associations between the characteristics of children, caregivers, and households and child health outcomes: fair or poor child health; fever, cough, or diarrhea within the past two weeks; illness in the past 6 months; and fair or poor health on at least two assessments. Across the six study areas, 23% of OAC were reported to be in fair or poor health; 19%, 18%, and 2% had fever, cough, or diarrhea, respectively, within the past two weeks; 55% had illnesses within the past 6 months; and 23% were in fair or poor health on at least two assessments. Female gender, suspected HIV infection, experiences of potentially traumatic events, including the loss of both parents, urban residence, eating fewer than 3 meals per day, and low caregiver involvement were associated with poorer child health outcomes. Particularly strong associations were observed between child health measures and the health of their primary caregivers. Poor caregiver health is a strong signal for poor health of OAC. Strategies to support OAC should target the caregiver-child dyad. Steps to ensure food security, foster gender equality, and prevent and treat traumatic events are needed.

Antenatal corticosteroids for management of preterm birth: a multi-country analysis of health system bottlenecks and potential solutions

PubMed Central

2015-01-01

Background Preterm birth complications are the leading cause of deaths for children under five years. Antenatal corticosteroids (ACS) are effective at reducing mortality and serious morbidity amongst infants born at <34 weeks gestation. WHO guidelines strongly recommend use of ACS for women at risk of imminent preterm birth where gestational age, imminent preterm birth, and risk of maternal infection can be assessed, and appropriate maternal/newborn care provided. However, coverage remains low in high-burden countries for reasons not previously systematically investigated. Methods The bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the Every Newborn Action Plan process. Country workshops involved technical experts to complete the survey tool, which is designed to synthesise and grade health system "bottlenecks", factors that hinder the scale up, of maternal-newborn intervention packages. We used quantitative and qualitative methods to analyse the bottleneck data, combined with literature review, to present priority bottlenecks and actions relevant to different health system building blocks for ACS. Results Eleven out of twelve countries provided data in response to the ACS questionnaire. Health system building blocks most frequently reported as having significant or very major bottlenecks were health information systems (11 countries), essential medical products and technologies (9 out of 11 countries) and health service delivery (9 out of 11 countries). Bottlenecks included absence of coverage data, poor gestational age metrics, lack of national essential medicines listing, discrepancies between prescribing authority and provider cadres managing care, delays due to referral, and lack of supervision, mentoring and quality improvement systems. Conclusions Analysis centred on health system building blocks in which 9 or more countries (>75%) reported very major or significant bottlenecks. Health information systems should include improved gestational age assessment and track ACS coverage, use and outcomes. Better health service delivery requires clarified policy assigning roles by level of care and cadre of provider, dependent on capability to assess gestational age and risk of preterm birth, and the implementation of guidelines with adequate supervision, mentoring and quality improvement systems, including audit and feedback. National essential medicines lists should include dexamethasone for antenatal use, and dexamethasone should be integrated into supply logistics. PMID:26390927

Knowledge, Attitude, and Experience of Cervical Cancer and Screening among Sub-saharan African Female Students in a UK University

PubMed Central

Ogbonna, Faith Sopuruchukwu

2017-01-01

Background: Cervical cancer is one of the major diseases that affect women of child bearing age. Its main cause is the human papilloma virus; although, other associated factors have been evidenced to increase its risk. Pap-smear screening and vaccination which has been shown to be successful in reducing the incidence and prevalence of the disease in developed countries, has been neglected in developing countries due to lack of knowledge, misconceptions, and cultural beliefs. Materials and Methods: A cross-sectional study involving only female Sub-Saharan Africa (SSA) students in a UK university setting. Results: One hundred and eighty-six (42%) African female students were recruited from the 442 SSA students attending one of the major Universities in the UK. Seventy-one (38.2%) of the students were aware of cervical screening, but only 20 (10.8%) reported having knowledge of cervical cancer. A small percentage of about 26.9% (50 Students) were already part of this screening program; although, 81 (43.5%) showed willingness to participate in future screening programs. More so, it was evident that student's perception was dependent on their experience of the disease (P = 000) just as their participation in screening program was dependent on their awareness level (P ≤ 0.01). Conclusion: Female African students from the SSA region have poor knowledge of the disease which influenced their attitude toward screening. More needs to be carried out to increase awareness and uptake of screening within the school environment as university setting provides a viable platform to promote healthy behavior. PMID:28300047

Communication and Third World development: a dead end?

PubMed

Sonaike, S A

1988-01-01

The debate over the effects of communication on the development of the Third World goes back over 30 years. The mass media was supposed to teach the masses basic productive skills, complement formal education, and promote basic adult literacy. The theory was proposed that if you increase urbanization, literacy, and media participation in underdeveloped areas political and economic improvements would follow. In quantitative measures, much progress has been made in urbanization, literacy, and health care. However, the quality of life of the people in underdeveloped countries has not improved greatly. The mass media has often promoted capitalist ideals and values, and raised hopes beyond what the state could supply. Large transnational corporations advertising in these countries have introduced different ethical values and changed customer demand. This is seen as a threat by those countries to their cultural identity. Modernization has disrupted the traditional values and ways of life in many of these countries and increased the gap between the rich and poor. The dependency theory stated that development and underdevelopment were interrelated processes and effected all aspects of life, including political and economic aspects. In recent times, a new theory on the role of communication in development promotes an integration of traditional and modern methods to enhance the development messages. The culturalists believe the failure of the mass media in the past was the elitism of the modern media. The current theory is based on 2 concepts, 1 of intermediate technology and another appropriate technology. Intermediate technology is production by the masses, using the best knowledge and experience to serve the person, rather than making him the slave of machines. Appropriate technology aims at improving the quality of life of the people. communication must teach and promote the skills that will help people solve their problems in this new model.

The population problem: conceptions and misconceptions.

PubMed

Berelson, B

1971-01-01

Only 1 in about 110 sex acts results in a conception and 1 in 270 in a live birth. Of all conceptions, 40% result in live births, 5% in stillbirths, and 55% never develop. 1/3 of all known conceptions ends in abortion, spontaneous or induced. It appears that the population problem depends on a small fraction of the potential. Misconceptions of the problem are corrected, and it is emphasized that while no social problem facing the U.S. would be easier with a larger population, demographic factors do not cause all of the other problems. Increasing numbers are not as important as the rate of increase (2% annually worldwide). Today's population problem has been caused by a decreased death rate, not an increased birthrate. There are 2 kinds of countries in the world today: those with a high standard of living and low fertility and those with a low standard of living and high fertility. Most of the uninformed women of the world would not choose to have large numbers of children if they had a choice. Population density is not a problem in itself. Experts disagree, but it is improbable that large numbers of people will die of starvation in the next few decades. Environmental deterioration is more the result of modern economic and technological practices than of demographic factors. Efforts at fertility control are not aimed at minorities in this country and elsewhere. The poor are discriminated against in access to family planning services and abortion. Moslems of developing countries have higher fertility rates than Roman Catholics in developed countries. There would be many social costs if the U.S. were to achieve zero population growth in the near future. The population problem has implications for the future quality of life.

Regional Water System Vulnerabilities and Strengths for Unavoidable Climate Adaptation

NASA Astrophysics Data System (ADS)

Gleick, P. H.; Palaniappan, M.; Christian-Smith, J.; Cooley, H.

2011-12-01

A wide range of options are available to help water systems prepare and adapt for unavoidable climate impacts, but these options vary depending on region, climatic conditions, economic status, and technical infrastructure in place. Drawing on case studies from the United States, India, and elsewhere, and from both urban and agricultural water systems, risks to water supply and quality are evaluated and summarized and categories of responses to help improve the effectiveness of adaptation policies are reviewed. Among the issues to be discussed are characteristics unique to developing country cities, such as the predominance of informal actors in the water sector. The formal, or government sector, which often exclusively manages water access and distribution in developed country cities, is only one among many players in the water sector in developing country cities. Informal access to water includes direct access by individuals through private groundwater systems, private water markets using vendors or sales of bottled water, and rainwater harvesting systems on individual homes. In this environment, with already existing pressures on water availability and use, the impacts of climate change on water will be strongly felt. This complicates planning for water supply and demand and risks increasing already prevalent water insecurity, especially for urban poor. In wealthier countries, any planning for water-related climate impacts tends to take the form of "business as usual" responses, such as efforts to expand supply with new infrastructure, manage demand through conservation programs, or simply put off addressing the problem to the next generation of managers and users. These approaches can be effective, but also risk missing unusual, non-linear, or threshold impacts. Examples of more informed and innovative efforts to substantively address climate change risks will be presented.

Women's relationship with the environment.

PubMed

Davidson, J

1993-02-01

In developing countries, all development activities as well as reclamation of degraded areas, pollution reduction, and preservation of biodiversity affect women's environment, especially in rural areas. Women produce most subsistence foods and cash crops, but control only about 1% of the world's land. Lack of land tenure and of access to it keep women from obtaining credit, training, and other supports, thereby preventing them from using their traditional, longterm conservation practices. In many developing countries, commercial producers force women off the most productive lands and onto marginal lands where they grow subsistence crops. They tend to overuse the marginal land and to allow little time for soil recovery. Soil degradation is exacerbated when women need to travel greater distances to collect fuelwood, water, fodder, and food. Almost complete desertification awaits Rajasthan, India, where such events and intensive cash cropping occur. Heavy pesticide use on large commercial farms increases pest resistance, thereby boosting infestation and reducing species diversity. Women are testing sustainable agricultural techniques, for instance, interplanting and crop rotation. Even though women supply water needs, they tend to be excluded from planning, implementing, and maintaining water supplies. Women depend on forests to provide food, fodder, fuel, building materials, medicines, and many materials for income-earning efforts. Commercial logging, migration and resettlement, agricultural development, and cutting for firewood and charcoal destroy these forests. Reforestation schemes do not consider women's needs. Deforestation and desertification increase women's work burdens. Poor women who have migrated to urban areas also experience environmental degradation, deteriorating health, and resource depletion; most live in squatter settlements. Deteriorating economic circumstances in developing countries, reduced flows of official development assistance to developing countries, rapid population growth, lack of women's support mechanisms, and civil conflict are underlying factors for environmental degradation.

The care dependency scale for measuring basic human needs: an international comparison.

PubMed

Dijkstra, Ate; Yönt, Gülendam Hakverdioğlu; Korhan, Esra Akin; Muszalik, Marta; Kędziora-Kornatowska, Kornelia; Suzuki, Mizue

2012-10-01

To report a study conducted to compare the utility of the care dependency scale across four countries. The care dependency scale provides a framework for assessing the needs of institutionalized patients for nursing care. Henderson's components of nursing care have been used to specify the variable aspects of the concept of care dependency and to develop the care dependency scale items. The study used a cross-cultural survey design. Patients were recruited from four different countries: Japan, The Netherlands, Poland and Turkey. In each of the participating countries, basic human needs were assessed by nurses using a translated version of the original Dutch care dependency scale. Psychometric properties in terms of reliability and validity of the care dependency scale have been assessed using Cronbach's alpha, Guttman's lambda-2, inter-item correlation and principal components analysis. Data were collected in 2008 and 2009. High internal consistency values were demonstrated. Principal component analysis confirmed the one-factor model reported in earlier studies. Outcomes confirm Henderson's idea that human needs are fundamental appearing in every patient-nurse relationship, independent of the patient's age, the type of care setting and/or cultural background. The psychometric characteristics of the care dependency scale make this instrument very useful for comparative research across countries. © 2012 Blackwell Publishing Ltd.

Donor issues in Indonesia: A developing country in South East Asia.

PubMed

Soedarmono, Yuyun S M

2010-01-01

In most developing countries in South East Asia blood services have not been treated properly as an important service to support health program. Indonesia as a large archipelago country in South East Asia has specific obstacles in managing a blood service. To position the country blood service profile especially in term of donor issues, we compared our blood service with that in other South East Asia countries. Indonesia has 17 thousand islands with 220 million inhabitants. Blood services have been mostly run by the Indonesian Red Cross as a government assignment since 1950. Donor recruitment programs have been directed toward 100% of Voluntary Non Remunerated Blood Donor (VNRD), which now have reached 81.3%. Dissemination of information on VNRD, donor recruiter's training and VNRD appreciation programs are strategies to increase and maintain the VNRD. Limited female donors and insufficient blood supply during the fasting month and holidays constitute major challenges. Low hemoglobin level, low body weight and fear are reasons for low number of female donors. Poor management of blood stock during fasting month, long holidays and also poor networking of blood supply are reasons for insufficient blood supply during the year. Considering the great size of Indonesia with different ethnic groups and cultures, worsened by lack of infrastructure, decisive and effective strategies in donor recruitment and retention programs are needed. Copyright 2010 The International Association for Biologicals. Published by Elsevier Ltd. All rights reserved.

Inequitable Access to Health Care by the Poor in Community-Based Health Insurance Programs: A Review of Studies From Low- and Middle-Income Countries

PubMed Central

Umeh, Chukwuemeka A; Feeley, Frank G

2017-01-01

Background: Out-of-pocket payments for health care services lead to decreased use of health services and catastrophic health expenditures. To reduce out-of-pocket payments and improve access to health care services, some countries have introduced community-based health insurance (CBHI) schemes, especially for those in rural communities or who work in the informal sector. However, there has been little focus on equity in access to health care services in CBHI schemes. Methods: We searched PubMed, Web of Science, African Journals OnLine, and Africa-Wide Information for studies published in English between 2000 and August 2014 that examined the effect of socioeconomic status on willingness to join and pay for CBHI, actual enrollment, use of health care services, and drop-out from CBHI. Our search yielded 755 articles. After excluding duplicates and articles that did not meet our inclusion criteria (conducted in low- and middle-income countries and involved analysis based on socioeconomic status), 49 articles remained that were included in this review. Data were extracted by one author, and the second author reviewed the extracted data. Disagreements were mutually resolved between the 2 authors. The findings of the studies were analyzed to identify their similarities and differences and to identify any methodological differences that could account for contradictory findings. Results: Generally, the rich were more willing to pay for CBHI than the poor and actual enrollment in CBHI was directly associated with socioeconomic status. Enrollment in CBHI was price-elastic—as premiums decreased, enrollment increased. There were mixed results on the effect of socioeconomic status on use of health care services among those enrolled in CBHI. We found a high drop-out rate from CBHI schemes that was not related to socioeconomic status, although the most common reason for dropping out of CBHI was lack of money to pay the premium. Conclusion: The effectiveness of CBHI schemes in achieving universal health coverage in low- and middle-income countries is questionable. A flexible payment plan where the poor can pay in installments, subsidized premiums for the poor, and removal of co-pays are measures that can increase enrollment and use of CBHI by the poor. PMID:28655804

Human louse-transmitted infectious diseases.

PubMed

Badiaga, S; Brouqui, P

2012-04-01

Several of the infectious diseases associated with human lice are life-threatening, including epidemic typhus, relapsing fever, and trench fever, which are caused by Rickettsia prowazekii, Borrelia recurrentis, and Bartonella quintana, respectively. Although these diseases have been known for several centuries, they remain a major public health concern in populations living in poor-hygiene conditions because of war, social disruption, severe poverty, or gaps in public health management. Poor-hygiene conditions favour a higher prevalence of body lice, which are the main vectors for these diseases. Trench fever has been reported in both developing and developed countries in populations living in poor conditions, such as homeless individuals. In contrast, outbreaks of epidemic typhus and epidemic relapsing fever have occurred in jails and refugee camps in developing countries. However, reports of a significantly high seroprevalence for epidemic typhus and epidemic relapsing fever in the homeless populations of developed countries suggest that these populations remain at high risk for outbreaks of these diseases. Additionally, experimental laboratory studies have demonstrated that the body louse can transmit other emerging or re-emerging pathogens, such as Acinetobacter baumannii and Yersinia pestis. Therefore, a strict survey of louse-borne diseases and the implementation of efficient delousing strategies in these populations should be public health priorities. © 2012 The Authors. Clinical Microbiology and Infection © 2012 European Society of Clinical Microbiology and Infectious Diseases.

Velocity distribution of women's 30-km cross-country skiing during Olympic Games from 2002-2014.

PubMed

Erdmann, Wlodzimierz S; Dancewicz-Nosko, Dorota; Giovanis, Vasilios

2017-12-01

Within several investigated endurance sport disciplines the distribution of load of the best competitors has a manner of evenly or slightly rising velocity values. Unfortunately many other competitors have usually diminishing values or when they are very poor they have evenly values. The aim of this study was to investigate distribution of velocity within 30-km cross-country female skiers. Cross-country skiing runs were investigated of Olympic Games 2002-2014 (Salt Lake City, Turin, Vancouver, Sochi). At every race two 15 km or three 10 km loops of the same vertical profile were taken into account. The competitors were divided onto: A - winners, B - medallists, C - competitors who obtained places 4 to 10 at the finish line (medium runners), D - competitors who obtained places 11 to 30 at the finish line (poor runners). Velocity data presented on the web pages of several institutions were utilized. The competitors had their velocity distributed in a manner with usually diminishing values. While comparing velocity of sequential loops with the mean velocity the difference for the poor runners reached the value of almost 6 %, which was too high. There was significant (usually negative) correlation coefficient between values of velocity deviation for the first and second loops and the mean value of velocity for the entire distance for the better runners and mixed, i.e. positive and negative values for the poorer runners. It was postulated investigations of velocity distribution should be introduced in coaching in order to inform competitors about their running. This advise is especially important for the poorer runners. Up to now cross country skiers run for themselves. It should be discussed whether the tactics used by road and track runners, i.e. running with pace makers, can be introduced in cross country skiing. Also the use of a drone during training can be used in order to maintain proper pace.

Social solidarity and willingness to tolerate risk- and income-related cross-subsidies within health insurance: experiences from Ghana, Tanzania and South Africa.

PubMed

Goudge, Jane; Akazili, James; Ataguba, John; Kuwawenaruwa, August; Borghi, Josephine; Harris, Bronwyn; Mills, Anne

2012-03-01

The importance of ill-health in perpetuating poverty is well recognized. In order to prevent the damaging downward spiral of poverty and illness, there is a need for a greater level of social protection, with greater cross-subsidization between the poor and wealthy, and the healthy and those with ill-health. The aim of this paper is to examine individual preferences for willingness to pre-pay for health care and willingness to cross-subsidize the sick and the poor in Ghana, South Africa and Tanzania. Household surveys in the three countries elicited views on cross-subsidization within health care financing. The paper examines how these preferences varied by socio-economic status, other respondent characteristics, and the extent and type of experience of health insurance in the light of country context. In South Africa and Ghana, 62% and 55% of total respondents, respectively, were in favour of a progressive financing system in which richer groups would pay a higher proportion of income than poorer groups, rather than a system where individuals pay the same proportion of income irrespective of their wealth (proportional). In Tanzania, 45% of the total sample were willing to pay for the health care of the poor. However, in all three countries, a progressive system was favoured by a smaller proportion of the most well off than of less well off groups. Solidarity has been considered to be a collective property of a specific socio-political culture, based on shared expectations and developed as part of a communal, historical learning process. The three countries had different experiences of health insurance and this may have contributed to the above differences in expressed willingness to pay between countries. Building and 'living with' institutions that provide affordable universal coverage is likely to be an essential part of the learning process which supports the development of social solidarity.

Smoking dependence in 18 European countries: Hard to maintain the hardening hypothesis.

PubMed

Fernández, Esteve; Lugo, Alessandra; Clancy, Luke; Matsuo, Keitaro; La Vecchia, Carlo; Gallus, Silvano

2015-12-01

When the prevalence of smoking decreases in a population, there is a hypothesis-the so-called "hardening hypothesis"-that the remaining smokers form a subgroup of "hardcore smokers." Our aims were to test the hardening hypothesis and to analyze the determinants of high dependence taking into account both individual and country-level characteristics. Within the Pricing Policies and Control of Tobacco in Europe (PPACTE) project, we conducted a face-to-face survey on smoking between January and July 2010 in 18 European countries, including 2882 male and 2254 female smokers with complete information on smoking dependence. The Heaviness of Smoking Index (HSI) was used as a measure of tobacco dependence. We correlated smoking prevalence and dependence using the country as unit of analysis. Moreover, we fitted multilevel logistic regression models. Country-specific prevalence of smoking was positively, although not significantly, correlated with the proportion of highly tobacco-dependent smokers (overall rsp=0.203, p=0.419), both in men (rsp=0.235, p=0.347) and women (rsp=0.455, p=0.058). Using individual-level analysis, high dependence was positively related to age, and, although not significantly, to smoking prevalence, and inversely related to level of education. The lack of a smoking ban at home was positively related to smoking dependence. Using both ecological and individual-level analyses, the relations between smoking prevalence and HSI were not significant, but in the opposite direction as compared to that assumed by the "hardening hypothesis." Therefore, our data provide empirical evidence against this theory, thus supporting the feasibility of an endgame strategy. Copyright © 2015. Published by Elsevier Inc.

Country Rankings of the Status of Women: Poor, Powerless, and Pregnant. Population Briefing Paper No. 20.

ERIC Educational Resources Information Center

Population Crisis Committee, Washington, DC.

In this study of 99 countries, representing 2.3 billion women (92 percent of the world's female population), 20 indicators measure women's well-being in the following sectors: (1) health; (2) marriage and children; (3) education; (4) employment; and (5) social equality. Original data for each of the 20 indicators were converted mathematically to 5…

Education and Training in Madagascar: Toward a Policy Agenda for Economic Growth and Poverty Reduction. A World Bank Country Study.

ERIC Educational Resources Information Center

World Bank, Washington, DC.

Madagascar is a poor, primarily rural country in which three-quarters of the population has subsisted below the poverty line for at least two decades. In view of the important role of education in the government's poverty reduction agenda, this report documents the current status of educational development in Madagascar and the key constraints on…

Tobacco

MedlinePlus

... raise the cost of health care and hinder economic development. In some countries, children from poor households ... illicit trade in tobacco products poses major health, economic and security concerns around the world. It is ...

Where Do Poor Women in Developing Countries Give Birth? A Multi-Country Analysis of Demographic and Health Survey Data

PubMed Central

Montagu, Dominic; Yamey, Gavin; Visconti, Adam; Harding, April; Yoong, Joanne

2011-01-01

Background In 2008, over 300,000 women died during pregnancy or childbirth, mostly in poor countries. While there are proven interventions to make childbirth safer, there is uncertainty about the best way to deliver these at large scale. In particular, there is currently a debate about whether maternal deaths are more likely to be prevented by delivering effective interventions through scaled up facilities or via community-based services. To inform this debate, we examined delivery location and attendance and the reasons women report for giving birth at home. Methodology/Principal Findings We conducted a secondary analysis of maternal delivery data from Demographic and Health Surveys in 48 developing countries from 2003 to the present. We stratified reported delivery locations by wealth quintile for each country and created weighted regional summaries. For sub-Saharan Africa (SSA), where death rates are highest, we conducted a subsample analysis of motivations for giving birth at home. In SSA, South Asia, and Southeast Asia, more than 70% of all births in the lowest two wealth quintiles occurred at home. In SSA, 54.1% of the richest women reported using public facilities compared with only 17.7% of the poorest women. Among home births in SSA, 56% in the poorest quintile were unattended while 41% were attended by a traditional birth attendant (TBA); 40% in the wealthiest quintile were unattended, while 33% were attended by a TBA. Seven per cent of the poorest women reported cost as a reason for not delivering in a facility, while 27% reported lack of access as a reason. The most common reason given by both the poorest and richest women for not delivering in a facility was that it was deemed “not necessary” by a household decision maker. Among the poorest women, “not necessary” was given as a reason by 68% of women whose births were unattended and by 66% of women whose births were attended. Conclusions In developing countries, most poor women deliver at home. This suggests that, at least in the near term, efforts to reduce maternal deaths should prioritize community-based interventions aimed at making home births safer. PMID:21386886

Where do poor women in developing countries give birth? A multi-country analysis of demographic and health survey data.

PubMed

Montagu, Dominic; Yamey, Gavin; Visconti, Adam; Harding, April; Yoong, Joanne

2011-02-28

In 2008, over 300,000 women died during pregnancy or childbirth, mostly in poor countries. While there are proven interventions to make childbirth safer, there is uncertainty about the best way to deliver these at large scale. In particular, there is currently a debate about whether maternal deaths are more likely to be prevented by delivering effective interventions through scaled up facilities or via community-based services. To inform this debate, we examined delivery location and attendance and the reasons women report for giving birth at home. We conducted a secondary analysis of maternal delivery data from Demographic and Health Surveys in 48 developing countries from 2003 to the present. We stratified reported delivery locations by wealth quintile for each country and created weighted regional summaries. For sub-Saharan Africa (SSA), where death rates are highest, we conducted a subsample analysis of motivations for giving birth at home. In SSA, South Asia, and Southeast Asia, more than 70% of all births in the lowest two wealth quintiles occurred at home. In SSA, 54.1% of the richest women reported using public facilities compared with only 17.7% of the poorest women. Among home births in SSA, 56% in the poorest quintile were unattended while 41% were attended by a traditional birth attendant (TBA); 40% in the wealthiest quintile were unattended, while 33% were attended by a TBA. Seven per cent of the poorest women reported cost as a reason for not delivering in a facility, while 27% reported lack of access as a reason. The most common reason given by both the poorest and richest women for not delivering in a facility was that it was deemed "not necessary" by a household decision maker. Among the poorest women, "not necessary" was given as a reason by 68% of women whose births were unattended and by 66% of women whose births were attended. In developing countries, most poor women deliver at home. This suggests that, at least in the near term, efforts to reduce maternal deaths should prioritize community-based interventions aimed at making home births safer.

Impaired decision-making under risk in individuals with alcohol dependence

PubMed Central

Brevers, Damien; Bechara, Antoine; Cleeremans, Axel; Kornreich, Charles; Verbanck, Paul; Noël, Xavier

2014-01-01

Background Alcohol dependence is associated with poor decision-making under ambiguity, that is, when decisions are to be made in the absence of known probabilities of reward and loss. However, little is known regarding decisions made by individuals with alcohol dependence in the context of known probabilities (decision under risk). In this study, we investigated the relative contribution of these distinct aspects of decision making to alcohol dependence. Methods Thirty recently detoxified and sober asymptomatic alcohol-dependent individuals, and thirty healthy control participants were tested for decision-making under ambiguity (using the Iowa Gambling Task), and decision-making under-risk (using the Cups Task and Coin Flipping Task). We also tested their capacities for working memory storage (Digit-span Forward), and dual-tasking (Operation-span Task). Results Compared to healthy control participants, alcohol-dependent individuals made disadvantageous decisions on the Iowa Gambling Task, reflecting poor decisions under ambiguity. They also made more risky choices on the Cups and Coin Flipping Tasks reflecting poor decision-making under risk. In addition, alcohol-dependent participants showed some working memory impairments, as measured by the dual tasking, and the degree of this impairment correlated with high-risk decision-making, thus suggesting a relationship between processes sub-serving working memory and risky decisions. Conclusion These results suggest that alcohol dependent individuals are impaired in their ability to decide optimally in multiple facets of uncertainty (i.e., both risk and ambiguity), and that at least some aspects of these deficits are linked to poor working memory processes. PMID:24948198

Strengthening institutional and organizational capacity for social health protection of the informal sector in lesser-developed countries: a study of policy barriers and opportunities in Cambodia.

PubMed

Annear, Peter Leslie; Ahmed, Shakil; Ros, Chhun Eang; Ir, Por

2013-11-01

Reaching out to the poor and the informal sector is a major challenge for achieving universal coverage in lesser-developed countries. In Cambodia, extensive coverage by health equity funds for the poor has created the opportunity to consolidate various non-government health financing schemes under the government's proposed social health protection structure. This paper identifies the main policy and operational challenges to strengthening existing arrangements for the poor and the informal sector, and considers policy options to address these barriers. Conducted in conjunction with the Cambodian Ministry of Health in 2011-12, the study reviewed policy documents and collected qualitative data through 18 semi-structured key informant interviews with government, non-government and donor officials. Data were analysed using the Organizational Assessment for Improving and Strengthening Health Financing conceptual framework. We found that a significant shortfall related to institutional, organisational and health financing issues resulted in fragmentation and constrained the implementation of social health protection schemes, including health equity funds, community-based health insurance, vouchers and others. Key documents proposed the establishment of a national structure for the unification of the informal-sector schemes but left unresolved issues related to structure, institutional capacity and the third-party status of the national agency. This study adds to the evidence base on appropriate and effective institutional and organizational arrangements for social health protection in the informal sector in developing countries. Among the key lessons are: the need to expand the fiscal space for health care; a commitment to equity; specific measures to protect the poor; building national capacity for administration of universal coverage; and working within the specific national context. Copyright © 2013 Elsevier Ltd. All rights reserved.

Productivity in physical and chemical science predicts the future economic growth of developing countries better than other popular indices.

PubMed

Jaffe, Klaus; Caicedo, Mario; Manzanares, Marcos; Gil, Mario; Rios, Alfredo; Florez, Astrid; Montoreano, Claudia; Davila, Vicente

2013-01-01

Scientific productivity of middle income countries correlates stronger with present and future wealth than indices reflecting its financial, social, economic or technological sophistication. We identify the contribution of the relative productivity of different scientific disciplines in predicting the future economic growth of a nation. Results show that rich and poor countries differ in the relative proportion of their scientific output in the different disciplines: countries with higher relative productivity in basic sciences such as physics and chemistry had the highest economic growth in the following five years compared to countries with a higher relative productivity in applied sciences such as medicine and pharmacy. Results suggest that the economies of middle income countries that focus their academic efforts in selected areas of applied knowledge grow slower than countries which invest in general basic sciences.

The politics of environmental concern: A cross-national analysis*

PubMed Central

Nawrotzki, Raphael J.

2016-01-01

Prior research in the U.S. has found that liberals are generally more environmentally concerned than conservatives. The present study explores whether conservatives’ opposition to environmental protection is solely a U.S. or a universal phenomenon and whether this association is contingent on country-level characteristics such as development, environmental conditions, and communist history. Employing data for 19 countries from the ISSP module “Environment II,” this paper explores inter-country variations in the relationship between individual conservatism and environmental concern using multilevel modeling with cross-level interactions. The models reveal a number of intriguing associations. Most important, conservatives’ support for environmental protection varies by country. This variation is a function of country-level characteristics. The strongest opposition of conservatives’ toward environmental protection was observed in developed, capitalist nations, with superior environmental conditions. On the other hand, in less developed countries, and countries characterized by poor environmental quality, conservatives are more environmentally concerned than liberals. PMID:27616877

Assessment of universal health coverage for adults aged 50 years or older with chronic illness in six middle-income countries

PubMed Central

Frenz, Patricia; Grabenhenrich, Linus; Keil, Thomas; Tinnemann, Peter

2016-01-01

Abstract Objective To assess universal health coverage for adults aged 50 years or older with chronic illness in China, Ghana, India, Mexico, the Russian Federation and South Africa. Methods We obtained data on 16 631 participants aged 50 years or older who had at least one diagnosed chronic condition from the World Health Organization Study on Global Ageing and Adult Health. Access to basic chronic care and financial hardship were assessed and the influence of health insurance and rural or urban residence was determined by logistic regression analysis. Findings The weighted proportion of participants with access to basic chronic care ranged from 20.6% in Mexico to 47.6% in South Africa. Access rates were unequally distributed and disadvantaged poor people, except in South Africa where primary health care is free to all. Rural residence did not affect access. The proportion with catastrophic out-of-pocket expenditure for the last outpatient visit ranged from 14.5% in China to 54.8% in Ghana. Financial hardship was more common among the poor in most countries but affected all income groups. Health insurance generally increased access to care but gave insufficient protection against financial hardship. Conclusion No country provided access to basic chronic care for more than half of the participants with chronic illness. The poor were less likely to receive care and more likely to face financial hardship in most countries. However, inequity of access was not fully determined by the level of economic development or insurance coverage. Future health reforms should aim to improve service quality and increase democratic oversight of health care. PMID:27034521

Knowledge about, attitude toward, and practice of skin lightening products use and its social correlates among university students in five Association of Southeast Asian Nations (ASEAN) countries.

PubMed

Peltzer, Karl; Pengpid, Supa

2017-03-01

The aim of this study was to investigate the knowledge about, attitude toward, and use of skin lightening products (SLP) and its social and psychological correlates among university students from five Association of Southeast Asian Nations (ASEAN) countries. In a cross sectional survey, 3259 undergraduate university students (Mean age = 20.5 years, SD = 1.6) from five ASEAN countries responded to an anonymous questionnaire. Multivariate logistic regression analysis was used to identify associations between sociodemographic characteristics, knowledge, attitude, poor mental health, and SLP use. Overall, 79.1% of the students were aware that the use of SLP can harm the skin, and 30.1% knew the active ingredients of SLP. Most students had a positive perception of having a lighter skin tone and SLP. Overall, the prevalence of SLP use over the past 12 months was 30.7%, 16.7% of male, and 30.0% of female students, ranging from 13.4% in Myanmar to 69.4% in Thailand. In multivariate logistic regression analysis, among women, older age, coming from a poorer family, residing in an upper middle income country, awareness of active skin lightening ingredients, and poor mental health were associated with SLP, while among men, not aware of the negative effects of SLP and awareness of active skin lightening ingredients and poor mental health were associated with SLP use. A high prevalence of SLP use was found in a large sample of ASEAN university students, and several social and mental health-related risk factors were found that may help in guiding interventions. © 2017 The International Society of Dermatology.

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.

Trends in inequalities in child stunting in South Asia.

PubMed

Krishna, Aditi; Mejía-Guevara, Iván; McGovern, Mark; Aguayo, Victor; Subramanian, S V

2017-10-19

We analysed socio-economic inequalities in stunting in South Asia and investigated disparities associated with factors at the individual, caregiver, and household levels (poor dietary diversity, low maternal education, and household poverty). We used time-series analysis of data from 55,459 children ages 6-23 months from Demographic and Health Surveys in Bangladesh, India, Nepal, and Pakistan (1991-2014). Logistic regression models, adjusted for age, sex, birth order, and place of residency, examined associations between stunting and multiple types of socio-economic disadvantage. All countries had high stunting rates. Bangladesh and Nepal recorded the largest reductions-2.9 and 4.1 percentage points per year, respectively-compared to 1.3 and 0.6 percentage points in India and Pakistan, respectively. Socio-economic adversity was associated with increased risk of stunting, regardless of disadvantage type. Poor children with inadequate diets and with poorly educated mothers experienced greater risk of stunting. Although stunting rates declined in the most deprived groups, socio-economic differences were largely preserved over time and in some cases worsened, namely, between wealth quintiles. The disproportionate burden of stunting experienced by the most disadvantaged children and the worsening inequalities between socio-economic groups are of concern in countries with substantial stunting burdens. Closing the gap between best and worst performing countries, and between most and least disadvantaged groups within countries, would yield substantial improvements in stunting rates in South Asia. To do so, greater attention needs to be paid to addressing the social, economic, and political drivers of stunting with targeted efforts towards the populations experiencing the greatest disadvantage and child growth faltering. © 2017 John Wiley & Sons Ltd.

The associations between unhealthy behaviours, mental stress, and low socio-economic status in an international comparison of representative samples from Thailand and England

PubMed Central

2014-01-01

Background Socioeconomic status is a recognised determinant of health status, and the association may be mediated by unhealthy behaviours and psychosocial adversities, which, in developed countries, both aggregate in low socioeconomic sectors of the population. We explored the hypothesis that unhealthy behavioural choices and psychological distress do not both aggregate in low socioeconomic status groups in developing countries. Methods Our study is based on a cross-sectional comparison between national population samples of adults in England and Thailand. Psychological distress was assessed using the General Health Questionnaire (GHQ-12) or three anxiety-oriented items from the Kessler scale (K6). Socioeconomic status was assessed on the basis of occupational status. We computed a health-behaviour score using information about smoking, alcohol consumption, fruit and vegetable consumption, and physical activity. Results The final sample comprised 40,679 participants. In both countries and in both genders separately, there was a positive association between poor health-behaviour and high psychological distress, and between high psychological distress and low socioeconomic status. In contrast, the association between low socioeconomic status and poor health-behaviour was positive in both English men and women, flat in Thai men, and was negative in Thai women (likelihood ratio test P <0.001). Conclusion The associations between socioeconomic status, behavioural choices, and psychological distress are different at the international level. Psychological distress may be consistently associated with low socioeconomic status, whereas poor health-behaviour is not. Future analyses will test whether psychological distress is a more consistent determinant of socioeconomic differences in health across countries. PMID:24555674

An update on the management of breast cancer in Africa.

PubMed

Vanderpuye, V; Grover, S; Hammad, N; PoojaPrabhakar; Simonds, H; Olopade, F; Stefan, D C

2017-01-01

There is limited information about the challenges of cancer management and attempts at improving outcomes in Africa. Even though South and North Africa are better resourceds to tackle the burden of breast cancer, similar poor prognostic factors are common to all countries. The five-year overall Survival rate for breast cancer patients does not exceed 60% for any low and middle-income country (LMIC) in Africa. In spite of the gains achieved over the past decade, certain characteristics remain the same such as limited availability of breast conservation therapies, inadequate access to drugs, few oncology specialists and adherence to harmful socio-cultural practices. This review on managing breast cancer in Africa is authored by African oncologists who practice or collaborate in Africa and with hands-on experience with the realities. A search was performed via electronic databases from 1999 to 2016. (PubMed/Medline, African Journals Online) for all literature in English or translated into English, covering the terms "breast cancer in Africa and developing countries". One hundred ninety were deemed appropriate. Breast tumors are diagnosed at earlier ages and later stages than in highincome countries. There is a higher prevalence of triple-negative cancers. The limitations of poor nursing care and surgery, inadequate access to radiotherapy, poor availability of basic and modern systemic therapies translate into lower survival rate. Positive strides in breast cancer management in Africa include increased adaptation of treatment guidelines, improved pathology services including immuno-histochemistry, expansion and upgrading of radiotherapy equipment across the continent in addition to more research opportunities. This review is an update of the management of breast cancer in Africa, taking a look at the epidemiology, pathology, management resources, outcomes, research and limitations in Africa from the perspective of oncologists with local experience.

Association between attendance at religious services and self-reported health in 22 European countries.

PubMed

Nicholson, Amanda; Rose, Richard; Bobak, Martin

2009-08-01

There are consistent reports of protective associations between attendance at religious services and better self-rated health but existing data rarely consider the social or individual context of religious behaviour. This paper investigates whether attendance at religious services is associated with better self-rated health in diverse countries across Europe. It also explores whether the association varies with either individual-level (gender, educational, social contact) or country-level characteristics (overall level of religious practice, corruption, GDP). Cross-sectional data from round 2 of the European Social Survey were used and 18,328 men and 21,373 women from 22 European countries were included in multilevel analyses, with country as higher level. Compared to men who attended religious services at least once a week, men who never attended were almost twice as likely to describe their health as poor, with an age and education adjusted odds ratio of 1.83 [95% CI, 1.49-2.26]. A similar but weaker effect was seen in women, with an age and education adjusted odds ratio of 1.38 [1.19-1.61]. The associations were reduced only marginally in men by controlling for health status, social contact and country-level variables, but weakened in women. The relationships were stronger in people with longstanding illness, less than university education and in more affluent countries with lower levels of corruption and higher levels of religious belief. These analyses confirm that an association between less frequent attendance at religious services and poor health exists across Europe, but emphasise the importance of taking individual and contextual factors into account. It remains unclear to what extent the observed associations reflect reverse causality or are due to differing perceptions of health.

Personal review and justice analysis of nursing experiences in Haiti.

PubMed

Emmott, Helen

2008-08-01

Health care providers frequently struggle to develop wise applications of theoretical knowledge. As a nurse studying traditional approaches in ethics while simultaneously volunteering in Haiti, I wrestled with the notion of justice in the midst of radical material inequities. Paul Farmer, physician and anthropologist, provides an analytic perspective for health care providers who work in poor and underserved countries by expanding the liberation theology of the 1970s to include social applications. Analyzing my past experiences in Haiti using Farmer's methodology provided insight into my successes and failures and prompted me to search for personal and professional reasons to provide care for the poor in the future. This type of reflection is essential for health care providers who work with the underserved, regardless of their religion or the country in which they work.

Environmental Enteric Dysfunction in Children.

PubMed

Syed, Sana; Ali, Asad; Duggan, Christopher

2016-07-01

Diarrheal diseases are a major cause of childhood death in resource-poor countries, killing approximately 760,000 children younger than 5 years each year. Although deaths due to diarrhea have declined dramatically, high rates of stunting and malnutrition have persisted. Environmental enteric dysfunction (EED) is a subclinical condition caused by constant fecal-oral contamination with resultant intestinal inflammation and villous blunting. These histological changes were first described in the 1960s, but the clinical effect of EED is only just being recognized in the context of failure of nutritional interventions and oral vaccines in resource-poor countries. We review the existing literature regarding the underlying causes of and potential interventions for EED in children, highlighting the epidemiology, clinical and histologic classification of the entity, and discussing novel biomarkers and possible therapies. Future research priorities are also discussed.

Rotational rural surgery for the poor in developing countries.

PubMed

Aderounmu, A O A; Afolayan, S A; Nasiru, T A; Olaore, J A; Adeoti, M L; Adelasoye, M

2008-07-01

Radio and television announcements advised patients with surgical problems in the rural areas of Osun State, Nigeria, to report at any of the nine zonal headquarters of the state which were closest to their homes in order to receive free treatment. Over 1000 patients reported and 801 received operations on a rotational basis within nine weeks. We studied 719 of these patients, ages between 4 months and 87 years, who had detailed follow-up records. There were 14 different procedures ranging from a hernia repair to the separation of syndactyly. Complications included postoperative pain, haematoma and late superficial wound infection. We concluded that rotational free surgery can help the poor in the third-world countries to receive treatment that they would otherwise not be able to afford.

Costing the scaling-up of human resources for health: lessons from Mozambique and Guinea Bissau

PubMed Central

2010-01-01

Introduction In the context of the current human resources for health (HRH) crisis, the need for comprehensive Human Resources Development Plans (HRDP) is acute, especially in resource-scarce sub-Saharan African countries. However, the financial implications of such plans rarely receive due consideration, despite the availability of much advice and examples in the literature on how to conduct HRDP costing. Global initiatives have also been launched recently to standardise costing methodologies and respective tools. Methods This paper reports on two separate experiences of HRDP costing in Mozambique and Guinea Bissau, with the objective to provide an insight into the practice of costing exercises in information-poor settings, as well as to contribute to the existing debate on HRH costing methodologies. The study adopts a case-study approach to analyse the methodologies developed in the two countries, their contexts, policy processes and actors involved. Results From the analysis of the two cases, it emerged that the costing exercises represented an important driver of the HRDP elaboration, which lent credibility to the process, and provided a financial framework within which HRH policies could be discussed. In both cases, bottom-up and country-specific methods were designed to overcome the countries' lack of cost and financing data, as well as to interpret their financial systems. Such an approach also allowed the costing exercises to feed directly into the national planning and budgeting process. Conclusions The authors conclude that bottom-up and country-specific costing methodologies have the potential to serve adequately the multi-faceted purpose of the exercise. It is recognised that standardised tools and methodologies may help reduce local governments' dependency on foreign expertise to conduct the HRDP costing and facilitate regional and international comparisons. However, adopting pre-defined and insufficiently flexible tools may undermine the credibility of the costing exercise, and reduce the space for policy negotiation opportunities within the HRDP elaboration process. PMID:20579341

Costing the scaling-up of human resources for health: lessons from Mozambique and Guinea Bissau.

PubMed

Tyrrell, Amanda K; Russo, Giuliano; Dussault, Gilles; Ferrinho, Paulo

2010-06-25

In the context of the current human resources for health (HRH) crisis, the need for comprehensive Human Resources Development Plans (HRDP) is acute, especially in resource-scarce sub-Saharan African countries. However, the financial implications of such plans rarely receive due consideration, despite the availability of much advice and examples in the literature on how to conduct HRDP costing. Global initiatives have also been launched recently to standardise costing methodologies and respective tools. This paper reports on two separate experiences of HRDP costing in Mozambique and Guinea Bissau, with the objective to provide an insight into the practice of costing exercises in information-poor settings, as well as to contribute to the existing debate on HRH costing methodologies. The study adopts a case-study approach to analyse the methodologies developed in the two countries, their contexts, policy processes and actors involved. From the analysis of the two cases, it emerged that the costing exercises represented an important driver of the HRDP elaboration, which lent credibility to the process, and provided a financial framework within which HRH policies could be discussed. In both cases, bottom-up and country-specific methods were designed to overcome the countries' lack of cost and financing data, as well as to interpret their financial systems. Such an approach also allowed the costing exercises to feed directly into the national planning and budgeting process. The authors conclude that bottom-up and country-specific costing methodologies have the potential to serve adequately the multi-faceted purpose of the exercise. It is recognised that standardised tools and methodologies may help reduce local governments' dependency on foreign expertise to conduct the HRDP costing and facilitate regional and international comparisons. However, adopting pre-defined and insufficiently flexible tools may undermine the credibility of the costing exercise, and reduce the space for policy negotiation opportunities within the HRDP elaboration process.

Food Self-Provisioning in Czechia: Beyond Coping Strategy of the Poor--A Response to Alber and Kohler's "Informal Food Production in the Enlarged European Union" (2008)

ERIC Educational Resources Information Center

Jehlicka, Petr; Kostelecky, Tomas; Smith, Joe

2013-01-01

Food systems are of increasing interest in both research and policy communities. Surveys of post-socialist countries of Central and Eastern Europe (CEE) show high rates of food self-provisioning. These practices have been explained in terms of being "coping strategies of the poor". Alber and Kohler's "Informal Food Production in the…

The Testimony of Neoliberal Contradiction in Education Choice and Privatisation in a Poor Country: The Case of a Private, Undocumented Rural Primary School in Uganda

ERIC Educational Resources Information Center

Mayengo, Nathaniel; Namusoke, Jane; Dennis, Barbara

2015-01-01

With international momentum to achieve "Education for All" by 2015, global attention is being paid to those parts of the world where mass formal primary schooling is relatively new. Uganda is such a place. In the context of ethnographic fieldwork at a poor, undocumented, private primary school in rural Uganda, parents were interviewed in…

Confronting Crisis. A Comparative Study of Household Responses to Poverty and Vulnerability in Four Poor Urban Communities. Environmentally Sustainable Development Studies and Monographs Series No. 8.

ERIC Educational Resources Information Center

Moser, Caroline O. N.

This volume presents the main findings of a comparative study of four poor urban communities in countries experiencing economic difficulties during the late 1980s: Chawama (Zambia), Cisne Dos (Ecuador), Commonwealth (the Philippines), and Angyalfold (Hungary). The study extended a longitudinal community panel study begun in Ecuador by using a…

Regulated compensated donation in Pakistan and Iran.

PubMed

Rizvi, Adibul Hasan S; Naqvi, Anwar S A; Zafar, Naqi M; Ahmed, Ejaz

2009-04-01

Paid living unrelated kidney donor transplantation has flourished in Pakistan and Iran. This review discusses the dynamics and consequences of organ trade in Pakistan and of a regulated paid donor model in Iran on transplant activities in these countries. In 2007, over 2500 renal transplants were performed in Pakistan, where more than 70% were from socioeconomic disadvantaged kidney vendors. More than half of recipients were foreigners who paid US$20,000-30,000. Recipients of vendor kidneys had poor outcome and high infectious complications. Regulated paid donor kidney transplant in Iran number around 1500 per year and constitute 70% of the total transplants. Graft survival rates are similar to those for living related donors. The donors are paid US$1200 and additional monies are negotiated between the recipient-donor pair. This model claims to have abolished waiting lists, although many poor patients wait for deceased donors. In both countries, recipients are relatively rich and vendors are the poor of the society who sell kidneys for quick money or to repay debts. Paid donation, regulated or commercial, leads to coercion and exploitation of the poor and benefits the rich. This situation has forestalled deceased donor program and hence other solid-organ transplants. The way forward is to promote deceased donors by making transplant available to all who need it.

Poor-quality antimalarial drugs in southeast Asia and sub-Saharan Africa.

PubMed

Nayyar, Gaurvika M L; Breman, Joel G; Newton, Paul N; Herrington, James

2012-06-01

Poor-quality antimalarial drugs lead to drug resistance and inadequate treatment, which pose an urgent threat to vulnerable populations and jeopardise progress and investments in combating malaria. Emergence of artemisinin resistance or tolerance in Plasmodium falciparum on the Thailand-Cambodia border makes protection of the effectiveness of the drug supply imperative. We reviewed published and unpublished studies reporting chemical analyses and assessments of packaging of antimalarial drugs. Of 1437 samples of drugs in five classes from seven countries in southeast Asia, 497 (35%) failed chemical analysis, 423 (46%) of 919 failed packaging analysis, and 450 (36%) of 1260 were classified as falsified. In 21 surveys of drugs from six classes from 21 countries in sub-Saharan Africa, 796 (35%) of 2297 failed chemical analysis, 28 (36%) of 77 failed packaging analysis, and 79 (20%) of 389 were classified as falsified. Data were insufficient to identify the frequency of substandard (products resulting from poor manufacturing) antimalarial drugs, and packaging analysis data were scarce. Concurrent interventions and a multifaceted approach are needed to define and eliminate criminal production, distribution, and poor manufacturing of antimalarial drugs. Empowering of national medicine regulatory authorities to protect the global drug supply is more important than ever. Copyright © 2012 Elsevier Ltd. All rights reserved.

Can a poverty-reducing and progressive tax and transfer system hurt the poor?

PubMed

Higgins, Sean; Lustig, Nora

2016-09-01

To analyze anti-poverty policies in tandem with the taxes used to pay for them, comparisons of poverty before and after taxes and transfers are often used. We show that these comparisons, as well as measures of horizontal equity and progressivity, can fail to capture an important aspect: that a substantial proportion of the poor are made poorer (or non-poor made poor) by the tax and transfer system. We illustrate with data from seventeen developing countries: in fifteen, the fiscal system is poverty-reducing and progressive, but in ten of these at least one-quarter of the poor pay more in taxes than they receive in transfers. We call this fiscal impoverishment, and axiomatically derive a measure of its extent. An analogous measure of fiscal gains of the poor is also derived, and we show that changes in the poverty gap can be decomposed into our axiomatic measures of fiscal impoverishment and gains.

The Politics of School Choice in Two Countries with Large Private-Dependent Sectors (Spain and Chile): Family Strategies, Collective Action and Lobbying

ERIC Educational Resources Information Center

Rambla, Xavier; Valiente, Oscar; Frias, Carla

2011-01-01

In many countries choice of school is an increasing concern for families and governments. In Spain and Chile, it is also associated with a long-standing political cleavage on the regulation of large sectors of private-dependent schools. This article analyses both the micro- and the macro-politics of choice in these two countries, where low-status…

Disasters and development in agricultural input markets: bean seed markets in Honduras after Hurricane Mitch.

PubMed

Mainville, Denise Y

2003-06-01

The bulk of developing countries' populations and poor depend on agriculture for food and income. While rural economies and people are generally the most severely affected by natural disasters, little is known about how disasters and subsequent relief activities affect agricultural markets with differing levels of development. The article addresses this gap, drawing evidence from bean seed markets in Honduras after Hurricane Mitch. Case studies are used to address hypotheses about a disaster's effects on supply and demand in seed markets, farmers' responses and the performance of relief interventions in markets showing differing levels of development. The results show the importance of tailoring relief interventions to the markets that they will affect and to the specific effects of a disaster; the potential to use local and emerging seed distribution channels in a relief intervention; and opportunities for relief activities to strengthen community seed systems.

Draught animals and welfare.

PubMed

Ramaswamy, N S

1994-03-01

In fifty developing countries, which contain half of the total human population of the world, there is a heavy dependence on draught animals as an energy source. These animals are used for agriculture operations in 52% of cultivated areas of the world, as well as for hauling 25 million carts. This situation is likely to continue for at least another fifty years. The work performed annually by these draught animals would require 20 million tons of petroleum, valued at US$6 billion, if it were performed by motorized vehicles. The poor working conditions of these animals often adversely affect their productivity. The application of improved technology and better management (i.e. through better feed and health services, and improved design of agricultural implements and carts) could considerably improve the welfare of these animals. Improved systems would generate sufficient benefits for the economy to justify the required investment. High priority should therefore be given to draught animal power in the economic development agenda.

Attachment style and adjustment to divorce.

PubMed

Yárnoz-Yaben, Sagrario

2010-05-01

Divorce is becoming increasingly widespread in Europe. In this study, I present an analysis of the role played by attachment style (secure, dismissing, preoccupied and fearful, plus the dimensions of anxiety and avoidance) in the adaptation to divorce. Participants comprised divorced parents (N = 40) from a medium-sized city in the Basque Country. The results reveal a lower proportion of people with secure attachment in the sample group of divorcees. Attachment style and dependence (emotional and instrumental) are closely related. I have also found associations between measures that showed a poor adjustment to divorce and the preoccupied and fearful attachment styles. Adjustment is related to a dismissing attachment style and to the avoidance dimension. Multiple regression analysis confirmed that secure attachment and the avoidance dimension predict adjustment to divorce and positive affectivity while preoccupied attachment and the anxiety dimension predicted negative affectivity. Implications for research and interventions with divorcees are discussed.

Cost-effectiveness of Different Diabetic Retinopathy Screening Modalities

PubMed Central

Pasquel, Francisco J.; Hendrick, Andrew M.; Ryan, Martha; Cason, Emily; Ali, Mohammed K.; Narayan, K. M. Venkat

2015-01-01

Current screening strategies aimed at detection of diabetic retinopathy (DR) historically have poor compliance, but advancements in technology can enable improved access to care. Nearly 80% of all persons with diabetes live in low- and middle-income countries (LMICs), highlighting the importance of a cost effective screening program. Establishing mechanisms to reach populations with geographic and financial barriers to access is essential to prevent visual disability. Teleretinal programs leverage technology to improve access and reduce cost. The quality of currently employed screening modalities depends on many variables including the instrument used, use of pupillary mydriasis, number of photographic fields, and the qualifications of the photographer and image interpreter. Recent telemedicine and newer technological approaches have been introduced, but data for these technologies is yet limited. We present results of a systematic review of studies evaluating cost-effectiveness of DR screening, and discuss potential relevance for LMICs. PMID:26719134

Rheumatic fever

MedlinePlus

... common in countries that have a lot of poverty and poor health systems. It does not often ... by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is ...

Leptospirosis in the Asia Pacific region

PubMed Central

2009-01-01

Background Leptospirosis is a worldwide zoonotic infection that has been recognized for decades, but the problem of the disease has not been fully addressed, particularly in resource-poor, developing countries, where the major burden of the disease occurs. This paper presents an overview of the current situation of leptospirosis in the region. It describes the current trends in the epidemiology of leptospirosis, the existing surveillance systems, and presents the existing prevention and control programs in the Asia Pacific region. Methods Data on leptospirosis in each member country were sought from official national organizations, international public health organizations, online articles and the scientific literature. Papers were reviewed and relevant data were extracted. Results Leptospirosis is highly prevalent in the Asia Pacific region. Infections in developed countries arise mainly from occupational exposure, travel to endemic areas, recreational activities, or importation of domestic and wild animals, whereas outbreaks in developing countries are most frequently related to normal daily activities, over-crowding, poor sanitation and climatic conditions. Conclusion In the Asia Pacific region, predominantly in developing countries, leptospirosis is largely a water-borne disease. Unless interventions to minimize exposure are aggressively implemented, the current global climate change will further aggravate the extent of the disease problem. Although trends indicate successful control of leptospirosis in some areas, there is no clear evidence that the disease has decreased in the last decade. The efficiency of surveillance systems and data collection varies significantly among the countries and areas within the region, leading to incomplete information in some instances. Thus, an accurate reflection of the true burden of the disease remains unknown. PMID:19732423

Understanding the causes and consequences of injuries to adolescents growing up in poverty in Ethiopia, Andhra Pradesh (India), Vietnam and Peru: a mixed method study.

PubMed

Morrow, Virginia; Barnett, Inka; Vujcich, Daniel

2014-01-01

The World Health Organization estimates that almost half of all premature deaths among 15- to 19-year olds can be attributed to injuries with most (95%) fatal injuries occurring in low- and middle-income countries. Yet the evidence base for adolescent injuries in low-income countries is poor. This article uses a mixed method approach to gain an understanding of patterns, causes and consequences of unintentional injuries among adolescents aged between 14 and 16 years in four low-income country settings. Survey data collected in 2009 in Ethiopia, India (Andhra Pradesh), Peru and Vietnam (from ~900 adolescents in each country) were integrated with qualitative research (conducted between 2007 and 2011) with a nested sample of older cohort children in Ethiopia (n = 25) and India (n = 25) using an iterative process. Logistic regression models were fitted to examine potential risk factors for injuries. Injuries were a concern for adolescents in all countries and occurred during work, recreation and sports or transportation. Being male was associated with an increased risk for all types of injuries, whereas being poor was only significantly associated with work injuries. Area of residence (urban vs rural) made a difference in some countries and for some kinds of injuries as did perceived health status. Qualitative findings highlight the consequences of injuries not only for the adolescents but also for the social and economic status of the entire household. Injury prevention programmes need to be specific to cultural and environmental settings, expectations of adolescent's responsibilities and responsive to the context of poverty.

Country characteristics and acute diarrhea in children from developing nations: a multilevel study.

PubMed

Pinzón-Rondón, Ángela María; Zárate-Ardila, Carol; Hoyos-Martínez, Alfonso; Ruiz-Sternberg, Ángela María; Vélez-van-Meerbeke, Alberto

2015-08-21

Each year 2.5 billion cases of diarrheal disease are reported in children under five years, and over 1,000 die. Country characteristics could play a role on this situation. We explored associations between country characteristics and diarrheal disease in children under 5 years of age, adjusting by child, mother and household attributes in developing countries. This study included 348,706 children from 40 nations. We conducted a multilevel analysis of data from the Demographic and Health Surveys and the World Bank. The prevalence of acute diarrhea was 14 %. Country inequalities (OR = 1.335; 95 % CI 1.117-1.663) and country's low income (OR = 1.488; 95 % CI 1.024-2.163) were associated with diarrhea, and these country characteristics changed the associations of well-known determinants of diarrhea. Specifically, living in poor countries strengthens the association of poor household wealth and mother's lack of education with the disease. Other factors associated with diarrhea were female sex of the child (OR = 0.922; 95 % CI 0.900-0.944), age of the child (OR = 0.978; 95 % CI 0.978-0.979), immunization status (OR = 0.821; 95 % CI 0.799-0.843), normal birthweight (OR = 0.879; 95 % CI 0.834-0.926), maternal age (OR = 0.987; 95 % CI 0.985-0.989), lack of maternal education (OR = 1.416; 95 % CI 1.283-1.564), working status of the mother (OR = 1.136; 95 % CI 1.106-1.167), planned pregnancy (OR = 0.774; 95 % CI 0.753-0.795), a nuclear family structure (OR = 0.949; 95 % CI 0.923-0.975), and household wealth (OR = 0.948; 95 % CI 0.921-0.977). Inequalities and lack of resources at the country level in developing countries -but not health expenditure- were associated with acute diarrhea, independently of child, family and household features. The broad environment considerably modifies well-known social determinants of acute diarrhea and public health campaigns designed to target diarrhea should consider macro characteristics of the country.

Ensuring the Health, Safety and Preparedness of U.S. Medical Students Participating in Global Health Electives Overseas.

PubMed

Imperato, Pascal James; Bruno, Denise M; Monica Sweeney, M

2016-04-01

Global health electives based in resource-poor countries have become extremely popular with medical students from resource rich ones. As the number of such programs and participants increase, so too do the absolute health and safety risks. It is clear from a number of published reports that many institutions provide little or no meaningful preparedness for students and do little to ensure their health and safety. These deficiencies together can affect students, their foreign hosts, and sponsoring institutions. The School of Public Health at the State University of New York, Downstate Medical Center, and its predecessor, the Department of Preventive Medicine and Community Health, have sponsored a 6-8 week global health elective for fourth year medical students since 1980. The purposes of this elective are to provide students with an opportunity to observe the health care and public health systems in resource-poor countries, provide medical service, and have a cross-cultural experience. Over the course of the past 35 years, 386 students have participated in this global health elective in more than 41 resource-poor countries. Recent annual applications for this elective have been as high as 44 out of a class of 200 students. Over the past 10 years, annual acceptance rates have varied, ranging from a low of 32 % in 2007-2008 to a high of 74 % in 2010-2011 and 2013-2014. Careful screening, including a written application, review of academic records and personal interviews, has resulted in the selection of highly mature, adaptable, and dedicated students who have performed well at overseas sites. Appropriately preparing students for an overseas global health experience in resource-poor countries requires the investment of much professional and staff time and effort. At the SUNY Downstate School of Public Health, these resources have underpinned our Global Health in Developing Countries elective for many years. As a result, the elective is characterized by meticulous organization, extensive preparedness measures for students, and continuous monitoring of site and country safety. The health of students is ensured by one-on-one assessment of immunization needs, anti-malarials, and the provision of a five-day supply of post-exposure HIV prophylaxis. Students sign agreements regarding the legal issues, immunizations, and anti-malarials recommended as well as HIV post-exposure prophylaxis. They are also required to obtain medical evacuation insurance provided by the university, and medical care insurance valid overseas. Student travel plans are also approved as is in-country lodging. The focus of our 6-8 week global health elective is not clinical medicine. Rather, it is to enable students to learn about the health care and public health systems in a resource-poor country. Through that focus, they also come to understand the causes of health and health care disparities that exist in the country to which they are assigned. Our students are greatly advantaged with regard to cross-cultural understanding since our school is located in New York City's Borough of Brooklyn, where 40 % of the population was born outside of the U.S. Our comprehensive effort at risk management for this global health elective includes a thorough debriefing for each student upon his/her return. Special attention is given to ascertaining illness or injury while overseas, and, when necessary, immediate referral is made to an appropriate university clinical department where a student can be appropriately case managed. Meticulous oversight, careful selection of safe overseas sites, and attention to preparing students have resulted in significant risk reduction and successful experiences for the majority of our 386 students. This article describes the model we have developed for ensuring the health, safety, and preparedness of students participating in our global health elective.

Reading Does Not Depend on Writing, Even in Chinese

ERIC Educational Resources Information Center

Bi, Yanchao; Han, Zaizhu; Zhang, Yumei

2009-01-01

A recent hypothesis proposes that reading depends on writing in a logographic language--Chinese. We present a Chinese individual (HLD) with brain damage whose profile challenges this hypothesis. HLD was severely impaired in the whole process of writing. He could not access orthographic knowledge, had poor orthographic awareness, and was poor at…

Policy and technology for clean air - the federal government must make a strong commitment to applying state-of-art technologies to the challenge of clearing the air.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Streets, D. G.; Decision and Information Sciences

1999-01-01

The federal government must make a strong commitment to applying state-of-the-art technologies to the challenge of clearing the air. Environmental hazards in one form or another surround us. While essentially all of them threaten our health and well-being, our ability to respond to them varies. We can move away from toxic waste sites; we can sanitize our water before we drink it; we can shield ourselves from harmful radiation. But we cannot escape the air. As a fluid medium, the air accepts all the contaminants we inject into it, mixes them together, and delivers the resulting concoction directly into ourmore » lungs. Though our exposure to air pollutants varies by time and place, and the effect depends on our individual susceptibilities, one truth remains: if we live, we breathe. Today, in many parts of the United States and in many other countries around the world, poor air quality threatens human health and the environment. But our expectations for clean air are higher today than they have ever been, and the damage caused by poor air quality is better understood than ever.« less

The Rise of Syria’s Urban Poor: Why the War for Syria’s Future Will Be Fought Over the Country’s New Urban Villages

DTIC Science & Technology

2014-01-01

those urban poor living in the slums sprouting up around Syria’s cities. This “village-izing” of Syria’s ancient cit- ies has changed the complexion...1986 to 20.8 million in 2010.6 This population rose predominantly in the slums surrounding Syria’s cities. From 2000 to 2010, Syria grew by 4.92...opposition activity. Baba Amr, a slum of Homs adjacent to the orchards that once fed the city, is synonymous with the THE RISE OF SYRIA’S POOR

Access to essential drugs in poor countries: a lost battle?

PubMed

Pécoul, B; Chirac, P; Trouiller, P; Pinel, J

1999-01-27

Drugs offer a simple, cost-effective solution to many health problems, provided they are available, affordable, and properly used. However, effective treatment is lacking in poor countries for many diseases, including African trypanosomiasis, Shigella dysentery, leishmaniasis, tuberculosis, and bacterial meningitis. Treatment may be precluded because no effective drug exists, it is too expensive, or it has been withdrawn from the market. Moreover, research and development in tropical diseases have come to a near standstill. This article focuses on the problems of access to quality drugs for the treatment of diseases that predominantly affect the developing world: (1) poor-quality and counterfeit drugs; (2) lack of availability of essential drugs due to fluctuating production or prohibitive cost; (3) need to develop field-based drug research to determine optimum utilization and remotivate research and development for new drugs for the developing world; and (4) potential consequences of recent World Trade Organization agreements on the availability of old and new drugs. These problems are not independent and unrelated but are a result of the fundamental nature of the pharmaceutical market and the way it is regulated.

The ethics of developed nations recruiting nurses from developing countries: the case of Malawi.

PubMed

Muula, Adamson S; Mfutso-Bengo, Joseph M; Makoza, Joan; Chatipwa, Elita

2003-07-01

There is currently a global shortage of nurses. Developing countries such as Malawiare among those hardest hit by this shortage. The demands on available nurses have increased and at the same time there is a lack of interest in becoming a nurse owing to the poor working conditions among those still employed in the service. It is questionable if developed nations should recruit nurses from countries such as Malawi, where severe human resource constraints are being experienced. We argue in this article that the current phenomenon of nurses leaving developing nations for western countries is complex. Human rights issues of individual autonomy and public interest are at stake.

The product space conditions the development of nations.

PubMed

Hidalgo, C A; Klinger, B; Barabási, A-L; Hausmann, R

2007-07-27

Economies grow by upgrading the products they produce and export. The technology, capital, institutions, and skills needed to make newer products are more easily adapted from some products than from others. Here, we study this network of relatedness between products, or "product space," finding that more-sophisticated products are located in a densely connected core whereas less-sophisticated products occupy a less-connected periphery. Empirically, countries move through the product space by developing goods close to those they currently produce. Most countries can reach the core only by traversing empirically infrequent distances, which may help explain why poor countries have trouble developing more competitive exports and fail to converge to the income levels of rich countries.

Water resources management. World Bank policy study; Ordenacion de los recursos hidricos

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

1994-12-31

This study examines new World Bank policies that deal with scarce water resources in developing countries. The study describes key policy goals that each country program should adopt. Practical ways to modernize irrigation techniques and hydropower systems, to protect ecosystems, minimize resettlement, and maintain biodiversity are outlined. Low-cost methods of providing drinking water for the rural poor and water for industry and agriculture are recommended.

United States Airline Transport Pilot International Flight Language Experiences, Report 2: Word Meaning and Pronunciation

DTIC Science & Technology

2010-04-01

different countries are understood; (4) Poor radios and transmission quality contribute to the unintelligibility of some controller transmissions; (5...going into a foreign country; (7) Differences associated with U.S. and ICAO phraseology need to be resolved and procedural ambiguities eliminated...affect you most related to differences in the word(s) used to describe a clearance, instruction, advisory, or request? Please list some examples

JPRS Report, Near East & South Asia.

DTIC Science & Technology

1992-03-20

that human rural development further leads to rapid urbanisation beings’ basis of sustenance is not only economical but and that urbanisation is...pursued by the ’ urbanisation , traditionally seen as an evil, is responsible capitalist countries if the Plan has a genuine concern for for economic growth...plan that urbanisation can be cially in poor countries. There are no major gains with checked through various policies of the government. It is the

Ensuring uninterrupted supplies of antiretroviral drugs in resource-poor settings: an example from Malawi.

PubMed

Harries, Anthony D; Schouten, Erik J; Makombe, Simon D; Libamba, Edwin; Neufville, Henry N; Some, Eliab; Kadewere, Godfrey; Lungu, Douglas

2007-02-01

Drug procurement and distribution practices are weak in many resource-poor countries, and are a major reason for lack of access to medicines. With many countries scaling up antiretroviral therapy (ART), it is vital to avoid interrupted drug supplies, which would lead to drug resistance and treatment failure. Malawi has adapted a model, based on that adopted by the country's Tuberculosis Control Programme, to allow rational ART drug forecasting. The model includes a focus on one standardized first-line ART regimen; a "push system" and "ceilings" for first-line ART drugs for facilities; use of starter pack and continuation pack kits; quarterly monitoring of patient outcomes and ART drug stocks at facility level; provision of a three-month buffer stock of ART drugs at facility level; and use of a procurement and distribution system outside central medical stores. The focus on a single first-line regimen, "ceilings" for first-line ART drugs and quarterly data collections to calculate drug needs (for new and follow-up patients, respectively), as well as the use of an independent procurement facility, allow drug orders to be made 6-9 months ahead. These measures have so far ensured that there have been no ART drug stock-outs in the country.

A responsive evaluation of mental health treatment in Cambodia: Intentionally addressing poverty to increase cultural responsiveness in therapy.

PubMed

Seponski, Desiree M; Lewis, Denise C; Megginson, Maegan C

2014-01-01

Mental health issues are significant contributors to the global burden of disease with the highest incidence in resource poor countries; 90% of those in need of mental health treatment reside in low resource countries but receive only 10% of the world's resources. Cambodia, the eighth least developed country in the world, serves as one example of the need to address mental health concerns in low-income, resource poor countries. The current study utilises responsive evaluation methodology to explore how poverty-stricken Cambodian clients, therapists and supervisors experience Western models of therapy as culturally responsive to their unique needs. Quantitative and qualitative data were triangulated across multiple stakeholders using numerous methods including a focus group, interviews, surveys, case illustrations and live supervision observation and analysed using constant comparative analysis. Emerging findings suggest that poverty, material needs, therapy location and financial situations greatly impact the daily lives and mental health conditions of Cambodians and hinder clients' therapeutic progress. The local community needs and context of poverty greatly hinder clients' therapeutic progress in therapy treatment and when therapy does not directly address the culture of poverty, clients did not experience therapy as valuable despite some temporary decreases in mental health symptoms.

Drivers for the renaissance of coal

PubMed Central

Steckel, Jan Christoph; Edenhofer, Ottmar; Jakob, Michael

2015-01-01

Coal was central to the industrial revolution, but in the 20th century it increasingly was superseded by oil and gas. However, in recent years coal again has become the predominant source of global carbon emissions. We show that this trend of rapidly increasing coal-based emissions is not restricted to a few individual countries such as China. Rather, we are witnessing a global renaissance of coal majorly driven by poor, fast-growing countries that increasingly rely on coal to satisfy their growing energy demand. The low price of coal relative to gas and oil has played an important role in accelerating coal consumption since the end of the 1990s. In this article, we show that in the increasingly integrated global coal market the availability of a domestic coal resource does not have a statistically significant impact on the use of coal and related emissions. These findings have important implications for climate change mitigation: If future economic growth of poor countries is fueled mainly by coal, ambitious mitigation targets very likely will become infeasible. Building new coal power plant capacities will lead to lock-in effects for the next few decades. If that lock-in is to be avoided, international climate policy must find ways to offer viable alternatives to coal for developing countries. PMID:26150491

Giardia Prevention and Control: General Public

MedlinePlus

... uncooked foods when traveling in countries with poor food and water treatment. For more information, see Preventing Illness While Traveling. Prevent contact and contamination with feces (poop) during sex. Use a barrier ...

Understanding the futility of countries' obligations for health rights: realising justice for the global poor.

PubMed

Barugahare, John; Lie, Reidar K

2016-06-03

Although health is a right of all individuals without any distinction, the realisation of this right has remained very difficult for the marginalised populations of poor countries. Inequitable distribution of health opportunities globally is a major factor in explaining why this is the case. Whereas the Protection, Promotion and Fulfilment of the health rights of poor country citizens are a joint responsibility of both domestic and external governments, most governments flout their obligations. So far disproportionate effort has been dedicated to reaffirming and interpreting these obligations as opposed to investigating the fundamental question regarding why these obligations have nevertheless remained largely unfulfilled. Further the normative question regarding what ought to be done about the shortcomings of current obligations has been largely ignored. We conduct a critical content analysis of existing literature on efforts towards the realisation of the health rights of marginalised populations in our attempt to ascertain their capacity to guarantee basic health opportunities to marginalised populations. In our analysis we treat issues of 'health rights' and 'justice in global health' as having unity of purpose - guaranteeing basic health opportunities to the marginalised populations. We identify two sets of reasons for the failure of present obligations for global distributive justice in general: a set of 'superficial reasons' and a set of 'fundamental reasons' which account for the superficial reasons. In order to overcome these reasons we propose a strategy which consists in specifying a number of minimum and less-demanding obligations for both external and domestic governments to guarantee to all individuals a certain threshold of health goods and services. We argue that these minimum obligations can be freely accepted and fully complied with or enforced with "a thin system of enforcement" without significant threat to national sovereignty and autonomy. The futility of countries' obligations for the health rights of the global poor as is the case with global distributive injustice is because of lack of political will to specify and enforce such obligations. Minimum obligations should be specified and enforced with a "thin system" which is consistent with principles of national sovereignty and autonomy.

Income inequality in the developing world.

PubMed

Ravallion, Martin

2014-05-23

Should income inequality be of concern in developing countries? New data reveal less income inequality in the developing world than 30 years ago. However, this is due to falling inequality between countries. Average inequality within developing countries has been slowly rising, though staying fairly flat since 2000. As a rule, higher rates of growth in average incomes have not put upward pressure on inequality within countries. Growth has generally helped reduce the incidence of absolute poverty, but less so in more unequal countries. High inequality also threatens to stall future progress against poverty by attenuating growth prospects. Perceptions of rising absolute gaps in living standards between the rich and the poor in growing economies are also consistent with the evidence. Copyright © 2014, American Association for the Advancement of Science.

Urban-rural differentials in child malnutrition: trends and socioeconomic correlates in sub-Saharan Africa.

PubMed

Fotso, Jean-Christophe

2007-03-01

This paper examines levels and trends of urban-rural differentials in child malnutrition, and investigates whether residual differences exist between urban and rural areas, given comparable measures of socioeconomic status (SES) of households and communities. Using data from Demographic and Health Surveys of 15 sub-Saharan African countries, and multilevel modelling, it shows that urban-rural differentials are considerable in all countries, that they have narrowed in most countries due primarily to an increase in urban malnutrition, and have widened in few countries as a result of sharp decline in urban malnutrition. These urban-rural gaps are abolished in almost all countries when SES is controlled. These results suggest that policies and programs contributing to the attainment of the MDGs should pay particular attention to the urban poor.

Climate volatility deepens poverty vulnerability in developing countries

NASA Astrophysics Data System (ADS)

Ahmed, Syud A.; Diffenbaugh, Noah S.; Hertel, Thomas W.

2009-07-01

Extreme climate events could influence poverty by affecting agricultural productivity and raising prices of staple foods that are important to poor households in developing countries. With the frequency and intensity of extreme climate events predicted to change in the future, informed policy design and analysis requires an understanding of which countries and groups are going to be most vulnerable to increasing poverty. Using a novel economic-climate analysis framework, we assess the poverty impacts of climate volatility for seven socio-economic groups in 16 developing countries. We find that extremes under present climate volatility increase poverty across our developing country sample—particularly in Bangladesh, Mexico, Indonesia, and Africa—with urban wage earners the most vulnerable group. We also find that global warming exacerbates poverty vulnerability in many nations.

Dental public health capacity worldwide: Results of a global survey.

PubMed

Lomazzi, Marta; Wordley, Valerie; Bedi, Raman

2016-12-01

The World Federation of Public Health Associations' Oral Health Working Group (WFPHA OHWG) carried out a survey to establish the extent of global dental public health (DPH) capacity. Senior stakeholders in DPH completed 124 surveys, covering 73 countries and all WHO regions. The survey evaluated DPH workforce within the country, funding, education, current services, and integration between public health and DPH in countries across the world. In 62 per cent of countries, DPH is only partially integrated in the public health system, while in 25 per cent of countries it has not yet been formally integrated. DPH programs at Masters level are available in 44 per cent of countries. Over half of countries have 0 to 10 trained DPH professionals. Because both poor oral and general health share several common risk factors, DPH must be integrated into national health systems and budgets, with an emphasis on having trained DPH specialists available in every country to collaborate in healthcare policy and provision.

Economic policy uncertainty, equity premium and dependence between their quantiles: Evidence from quantile-on-quantile approach

NASA Astrophysics Data System (ADS)

Raza, Syed Ali; Zaighum, Isma; Shah, Nida

2018-02-01

This paper examines the relationship between economic policy uncertainty and equity premium in G7 countries over a period of the monthly data from January 1989 to December 2015 using a novel technique namely QQ regression proposed by Sim and Zhou (2015). Based on QQ approach, we estimate how the quantiles of the economic policy uncertainty affect the quantiles of the equity premium. Thus, it provides a comprehensive insight into the overall dependence structure between the equity premium and economic policy uncertainty as compared to traditional techniques like OLS or quantile regression. Overall, our empirical evidence suggests the existence of a negative association between equity premium and EPU predominately in all G7 countries, especially in the extreme low and extreme high tails. However, differences exist among countries and across different quantiles of EPU and the equity premium within each country. The existence of this heterogeneity among countries is due to the differences in terms of dependency on economic policy, other stock markets, and the linkages with other country's equity market.

Restructuring brain drain: strengthening governance and financing for health worker migration.

PubMed

Mackey, Tim K; Liang, Bryan A

2013-01-15

Health worker migration from resource-poor countries to developed countries, also known as ''brain drain'', represents a serious global health crisis and a significant barrier to achieving global health equity. Resource-poor countries are unable to recruit and retain health workers for domestic health systems, resulting in inadequate health infrastructure and millions of dollars in healthcare investment losses. Using acceptable methods of policy analysis, we first assess current strategies aimed at alleviating brain drain and then propose our own global health policy based solution to address current policy limitations. Although governments and private organizations have tried to address this policy challenge, brain drain continues to destabilise public health systems and their populations globally. Most importantly, lack of adequate financing and binding governance solutions continue to fail to prevent health worker brain drain. In response to these challenges, the establishment of a Global Health Resource Fund in conjunction with an international framework for health worker migration could create global governance for stable funding mechanisms encourage equitable migration pathways, and provide data collection that is desperately needed.

Initiating and developing clinical services, training and research in a low resource setting: the Malawi ENT experience.

PubMed

Mulwafu, Wakisa; Nyirenda, Thomas Elliot; Fagan, Johannes J; Bem, Chris; Mlumbe, Kumvana; Chitule, Jean

2014-07-01

Sub-Saharan Africa countries like Malawi have a paucity of ear, nose and throat (ENT) data, services and training opportunities. To reflect on new Malawian ENT experience and to propose guidelines to poorly resourced countries. Analysis of data predating and following establishment of ENT services in Malawi. In 2008 the first and only Malawian ENT specialist established ENT services with external funding. Fifteen clinical officers have been trained and a nurse placed at each outreach hospital. In 2012, 15,284 consultations were recorded: 543 (3.6%) from outreach clinics. Forty-nine percent needed medical treatment, while 45% needed medical advice. Surgery was performed on 2.7% of patients; 21% for foreign bodies in the nose and throat and 18% for foreign bodies and biopsies of ears. To establish accessible and sustainable specialist ENT services in a poor country requires building on an established local health delivery system, careful planning and investment in personnel, infrastructure, training and data collection. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

The prices people pay for medicines in Zimbabwe.

PubMed

Gavaza, P; Simoyi, T; Makunike, B; Maponga, C C

2009-01-01

To collect, analyse and compare prices of medicines in different sectors and parts of the country and to compare them with the medicine prices in other countries. A prospective cross sectional study. Pharmacy outlets in Zimbabwe comprising 27 retail pharmacies, 23 dispensing doctors, eight public hospital pharmacies and seven municipal clinics. Median price ratios, 25th percentiles and 75th percentiles. Innovator brands in the private sector were priced 10 times the International References Prices (IRP) and more than three times the price of generic medicines. Dispensing doctors were charging the highest prices for medicines and the public sector had the least prices. The national procurement agency, NatPharm, procured medicines at prices slightly below the Management Sciences for Health (MSH) prices. Prices of medicines in the public sector were higher than average prices for medicines from seven other African countries. Medicine prices in Zimbabwe are high, a scenario that may compromise affordability and accessibility to medicines especially by the poor. Urgent steps are needed to reduce the level and effect of the high prices on the population, especially the poor.

Socioeconomic Determinants of Adult Mortality in Namibia Using an Event History Analysis.

PubMed

Kandjimbi, Alina; Nickanor, Ndeyapo; Kazembe, Lawrence N

2014-01-01

Adult mortality remains a neglected public health issue in sub-Saharan Africa, with most policy instruments concentrated on child and maternal health. In developed countries, adult mortality is negatively associated with socioeconomic factors. A similar pattern is expected in developing countries, but has not been extensively demonstrated, because of dearth of data. Understanding the hazard and factors associated with adult mortality is crucial for informing policies and for implementation of interventions aimed at improving adult survival. This paper applied a geo-additive survival model to elucidate effects of socioeconomic factors on adult mortality in Namibia, controlling for spatial frailties. Results show a clear disadvantage for adults in rural areas, for those not married and from poor households or in female-headed households. The hazard of adult mortality was highly variable with a 1.5-fold difference between areas, with highest hazard recorded in north eastern, central west and southern west parts of the country. The analysis emphasizes that, for Namibia to achieve its national development goals, targeted interventions should be aimed at poor-resourced adults, particularly in high-risk areas.

Restructuring brain drain: strengthening governance and financing for health worker migration

PubMed Central

Mackey, Tim K.; Liang, Bryan A.

2013-01-01

Background Health worker migration from resource-poor countries to developed countries, also known as ‘‘brain drain’’, represents a serious global health crisis and a significant barrier to achieving global health equity. Resource-poor countries are unable to recruit and retain health workers for domestic health systems, resulting in inadequate health infrastructure and millions of dollars in healthcare investment losses. Methods Using acceptable methods of policy analysis, we first assess current strategies aimed at alleviating brain drain and then propose our own global health policy based solution to address current policy limitations. Results Although governments and private organizations have tried to address this policy challenge, brain drain continues to destabilise public health systems and their populations globally. Most importantly, lack of adequate financing and binding governance solutions continue to fail to prevent health worker brain drain. Conclusions In response to these challenges, the establishment of a Global Health Resource Fund in conjunction with an international framework for health worker migration could create global governance for stable funding mechanisms encourage equitable migration pathways, and provide data collection that is desperately needed. PMID:23336617

A note of caution

NASA Astrophysics Data System (ADS)

Petherick, Anna

2012-03-01

Big money will soon flow from rich countries to poor ones that are particularly susceptible to the effects of climate change. Safeguarding this cash against corruption will be an exceptionally tough job, argues Anna Petherick.

Better kitchens and toilets: both needed for better health.

PubMed

Ravindra, Khaiwal; Smith, Kirk R

2018-05-01

Both poor water, sanitation, hygiene (WaSH) and household air pollution (HAP) adversely affect the health of millions of people each year around the globe and specifically in developing countries. The objective of current work is to highlight the importance of HAP in parallel to WaSH for decision making to achieve better health specially in developing countries. There are examples, where developing countries are strengthening efforts to tackle the issue of poor water and sanitation such as 'Clean India Mission' was recently launched by the Government of India. However, there is lack of actions to address the issue related to HAP-to extend the coverage of clean fuel, efficient stoves and ventilated kitchens to the deprived population under the 'Clean India Mission'. Most of the rural household and urban slums in developing countries have only a single room, where people cook and sleep. This leads them to exposure to toxic HAP, which can be minimized by developing country specific indoor air quality guidelines and action framework. Hence, there should be policies to provide them not only the subsidy for clean fuel but also to build properly ventilated kitchens along with the promotion of clean toilets and water supplies. There is a need to strengthen global efforts, to jointly address the challenges associated with the risks related to WaSH and HAP in order to efficiently reduce the global burden of disease. Further, this will also help to timely attain the sustainable development goals for better health and environment.

Social inequalities in obesity and overweight in 11 OECD countries.

PubMed

Devaux, Marion; Sassi, Franco

2013-06-01

Evidence of inequalities in obesity and overweight is available mostly from national studies. This article provides a broad international comparison of inequalities by education level and socio-economic status, in men and women and over time. Data from national health surveys of 11 OECD countries were used. The size of inequalities was assessed on the basis of absolute and relative inequality indexes. A regression-analysis approach was used to assess differences between social groups in trends over time. Of the countries examined, USA and England had the highest rates of obesity and overweight. Large social inequalities were consistently detected in all countries, especially in women. Absolute inequalities were largest in Hungary and Spain with a difference of 11.6 and 10% in obesity rates in men, and 18.3 and 18.9% in women, respectively, across the education spectrum. Relative inequalities were largest in France and Sweden with poorly educated men 3.2 and 2.8 times as likely to be obese as men with the highest education (18 and 17 times for women in Spain and Korea, respectively). Pro-poor inequalities in overweight were observed for men in USA, Canada, Korea, Hungary, Australia and England. Inequalities remained virtually stable during the last 15 years, with only small variations in England, Korea, Italy and France. Large and persistent social inequalities in obesity and overweight by education level and socio-economic status exist in OECD countries. These are consistently larger in women than in men.