Contraceptive prevalence, reproductive health and our common future. The C. Donald Christian Memorial Lecture.

PubMed

Diczfalusy, E

1993-05-01

Worldwide, female sterilization is the most common contraceptive method, followed by IUDs and oral contraceptives. As unwanted pregnancy for women in developing countries can mean life or death, which may explain why modern contraceptive methods with low failure rates (e.g., sterilization, IUDs. and hormonal methods) predominate in developing countries. Conventional methods with relatively high failure rates (e.g., natural family planning, barrier methods, and withdrawal) predominate in developed countries. Developing-country governments first supported family planning programs for demographic reasons. They now embrace them because they save the lives of women and children. The four fundamental pillars of reproductive health policy are family planning, maternal care, infant and child care, and control of sexually transmitted diseases (STDs). Indicators of reproductive health include, rates of maternal mortality and morbidity; induced abortion; infertility; perinatal, infant, and child mortality; and STDs (including AIDS). Governments in the poorest countries invest only US$5 per capita for health, compared to US$400 per capita for developed countries. If the poorest countries increased that $5 figure by just $2 per capita, they could immunize all children, eradicate polio, and provide the drugs to cure the most common diseases. Further, if humans were to use resources more reasonably, we could greatly decrease the number of people living in poverty. Three UN population projections show that the population will continue to grow well within the next century. With strong commitment from governments and individuals, we can increase contraceptive use and reduce total fertility rates. Barriers to achieving those goals are few funds allocated to family planning methods and services; politicians; religious and community leaders; culture; low women's status; limited accessibility to information, methods, and quality services; and limited contraceptive choice.

Meeting Basic Needs Is Not beyond Our Reach.

ERIC Educational Resources Information Center

Haq, Mahbub ul

1978-01-01

Reviews the status of the continuing debate on the concept of "basic needs" in development policy for the world's poorest countries, reprinted from a World Bank report. Discusses "core" basic needs (food and nutrition, drinking water, basic health, shelter, and basic education) and possible operational policies. (MF)

A SUSTAINABLE METHOD OF WATER EXTRACTION FOR SCHOOL-COMMUNITY GARDENS IN NIGER, WEST AFRICA

EPA Science Inventory

The challenge of this project is significant in the developing world, specifically in the Air Massif region of Niger, the poorest country in the world. A sustainable water extraction system is needed to irrigate community gardens. These gardens produce a basic need, food, for ...

Global population trends and policy options.

PubMed

Ezeh, Alex C; Bongaarts, John; Mberu, Blessing

2012-07-14

Rapid population growth is a threat to wellbeing in the poorest countries, whereas very low fertility increasingly threatens the future welfare of many developed countries. The mapping of global trends in population growth from 2005-10 shows four distinct patterns. Most of the poorest countries, especially in sub-Saharan Africa, are characterised by rapid growth of more than 2% per year. Moderate annual growth of 1-2% is concentrated in large countries, such as India and Indonesia, and across north Africa and western Latin America. Whereas most advanced-economy countries and large middle-income countries, such as China and Brazil, are characterised by low or no growth (0-1% per year), most of eastern Europe, Japan, and a few western European countries are characterised by population decline. Countries with rapid growth face adverse social, economic, and environmental pressures, whereas those with low or negative growth face rapid population ageing, unsustainable burdens on public pensions and health-care systems, and slow economic growth. Countries with rapid growth should consider the implementation of voluntary family planning programmes as their main policy option to reduce the high unmet need for contraception, unwanted pregnancies, and probirth reproductive norms. In countries with low or negative growth, policies to address ageing and very low fertility are still evolving. Further research into the potential effect of demographic policies on other social systems, social groups, and fertility decisions and trends is therefore recommended. Copyright © 2012 Elsevier Ltd. All rights reserved.

Assessing levels and trends of child health inequality in 88 developing countries: from 2000 to 2014

PubMed Central

Li, Zhihui; Li, Mingqiang; Subramanian, S. V.; Lu, Chunling

2017-01-01

ABSTRACT Background: Reducing child mortality was one of the Millennium Development Goals. In the current Sustainable Development Goals era, achieving equity is prioritized as a major aim. Objective: This study aims to provide a comprehensive and updated picture of inequalities in child health intervention coverage and child health outcomes by wealth status, as well as their trends between 2000 and 2014. Methods: Using data from Demographic Health Surveys and Multiple Indicator Cluster Surveys, we adopted three measures of inequality, including one absolute inequality indicator and two relative inequality indicators, to estimate the level and trends of inequalities in three child health outcome variables and 17 intervention coverages in 88 developing countries. Results: While improvements in child health outcomes and coverage of interventions have been observed between 2000 and 2014, large inequalities remain. There was a high level of variation between countries’ progress toward reducing child health inequalities, with some countries significantly improving, some deteriorating, and some remaining statistically unchanged. Among child health interventions, the least equitable one was access to improved sanitation (The absolute difference in coverages between the richest quintile and the poorest quintile reached 49.5% [42.7, 56.2]), followed by access to improved water (34.1% [29.5, 38.6]), and skilled birth attendant (SBA) (34.1% [28.8, 39.4]). The most equitable intervention coverage was insecticide-treated bed net for children (1.0% [−3.9, 5.9]), followed by oral rehydration therapy for diarrhea ((8.0% [5.2, 10.8]), and vitamin A supplement (8.4% [5.1, 11.7]). These findings were robust to various inequality measurements. Conclusions: Although child health outcomes and coverage of interventions have improved largely over the study period for almost all wealth quintiles, insufficient progress was made in reducing child health inequalities between the poorest and richest wealth quintiles. Future efforts should focus on reaching the poorest children by increasing investments toward expanding the coverage of interventions in resource-limited settings. PMID:29228888

Gender-Sensitive Education for a Better World. Background Document.

ERIC Educational Resources Information Center

Aksornkool, Namtip

Economic restructuring has severely affected the education of girls, particularly in the poorest and least developed countries where poverty is the major obstacle to education. Girls still constitute the majority of children not enrolled in school, and illiteracy among women remains one of the biggest challenges for the 21st century. Deep-rooted…

Bridging the Digital Divide in the Schools of Developing Countries

ERIC Educational Resources Information Center

Tiene, Drew

2004-01-01

The so-called "digital divide" problem, significant disparities in access to technology between the affluent and impoverished, is a global phenomenon that is most serious in the poorest parts of the world. The millions who struggle daily for enough food, clothing, housing, and transportation, are unable to afford the hardware, software and service…

Neglected tropical diseases: progress towards addressing the chronic pandemic.

PubMed

Molyneux, David H; Savioli, Lorenzo; Engels, Dirk

2017-01-21

The concept of neglected tropical diseases (NTDs) emerged more than a decade ago and has been recognised as a valid way to categorise diseases that affect the poorest individuals. Substantial progress in control and elimination has been achieved and policy momentum has been generated through continued bilateral, philanthropic, and non-governmental development organisation (NGDO) support, and donations of drugs from pharmaceutical companies. WHO has defined a Roadmap to reach 2020 targets, which was endorsed by member states in a World Health Assembly Resolution in 2013. NTDs have been included within the Sustainable Development Goal targets and are a crucial component of universal health coverage, conceptualised as "leaving no one behind". WHO reported that more than 1 billion people in 88 countries have benefited from preventive chemotherapy in 2014. The research agenda has defined the need for affordable products (diagnostics, drugs and insecticides). However challenges such as insecurity and weak health systems continue to prevail in the poorest countries, inhibiting progress in scaling up and also in achieving Roadmap goals. Copyright © 2017 Elsevier Ltd. All rights reserved.

Energy resources of the developing countries and some priority markets for the use of solar energy

NASA Technical Reports Server (NTRS)

Siddiqi, T. A.; Hein, G. F.

1977-01-01

Energy consumption for the developed and non-developed world is expressed as a function of GNP. An almost straight-line graph results when energy consumption statistics are treated in this manner. The richest countries consume the most energy, and the poorest countries the least. It therefore follows that greater energy production in the developing countries (leading to greater energy consumption) will contribute to their economic growth. Energy resources in the developing countries are compared, including: solid fossil fuels, crude oil, natural gas, oil shale, and uranium. Mention is also made of the potential of renewable energy resources, such as solar, wind, and hydroelectric power, in the underdeveloped world; and it is these resources which offer the greatest possibilities for economic improvement if the money is forthcoming, i.e., from the world bank, to fund the necessary technology.

New Vaccines for the World's Poorest People.

PubMed

Hotez, Peter J; Bottazzi, Maria Elena; Strych, Ulrich

2016-01-01

The 2000 Millennium Development Goals helped stimulate the development of life-saving childhood vaccines for pneumococcal and rotavirus infections while greatly expanding coverage of existing vaccines. However, there remains an urgent need to develop new vaccines for HIV/AIDS, malaria, and tuberculosis, as well as for respiratory syncytial virus and those chronic and debilitating (mostly parasitic) infections known as neglected tropical diseases (NTDs). The NTDs represent the most common diseases of people living in extreme poverty and are the subject of this review. The development of NTD vaccines, including those for hookworm infection, schistosomiasis, leishmaniasis, and Chagas disease, is being led by nonprofit product development partnerships (PDPs) working in consortia of academic and industrial partners, including vaccine manufacturers in developing countries. NTD vaccines face unique challenges with respect to their product development and manufacture, as well as their preclinical and clinical testing. We emphasize global efforts to accelerate the development of NTD vaccines and some of the hurdles to ensuring their availability to the world's poorest people.

Twenty Years of Progress on Maternal and Child Health in the Philippines: An Equity Lens.

PubMed

Bredenkamp, Caryn; Buisman, Leander R

2017-07-01

This article assesses trends and inequalities in maternal and child health in the Philippines between 1993 and 2013, using 6 national household surveys, and also compares the Philippines' performance to 15 other Asia-Pacific countries. Thirteen indicators of child health outcomes and maternal and child health interventions are examined. Two measures of inequality are used: the absolute difference between the poorest and wealthiest quintile, and the concentration index. Coverage of all indicators has improved, both on average and among the poorest quintile; however, increases are very small for child health interventions (especially immunization coverage). By the first measure of inequality, all indicators show narrowing inequalities. By the second measure, inequality has fallen only for maternal health interventions. Compared with other 15 other developing Asia-Pacific countries, the Philippines performs among the best on the child health outcomes examined and above average on maternal health interventions (except family planning), but only at or below average on child health interventions.

Policy directions in urban health in developing countries--the slum improvement approach.

PubMed

Harpham, T; Stephens, C

1992-07-01

The urban development, or housing, sector has a longer experience of addressing the problems of the urban poor in developing countries than the health sector. In recent years the policy of 'slum improvement', which involves both sectors, has attracted the support of international donors. This article documents the development of the slum improvement approach and addresses key issues of the approach which have implications for health planning: covering the poorest dwellers; relocation; land tenure; gentrification; debt burdens and the impact on women. Questions about the approach which still need answering are defined and a summary of the constraints in slum improvement and potential solutions is presented.

Economic growth and decline in mortality in developing countries: an analysis of the World Bank development datasets.

PubMed

Renton, A; Wall, M; Lintott, J

2012-07-01

The 1999 World Bank report claimed that growth in gross domestic product (GDP) between 1960 and 1990 only accounted for 15% of concomitant growth in life expectancy in developing countries. These findings were used repeatedly by the World Health Organization (WHO) to support a policy shift away from promoting social and economic development, towards vertical technology-driven programmes. This paper updates the 1999 World Bank report using the World Bank's 2005 dataset, providing a new assessment of the relative contribution of economic growth. Time-series analysis. Cross-sectional time-series regression analysis using a random effect model of associations between GDP, education and technical progress and improved health outcomes. The proportion of improvement in health indicators between 1970 and 2000 associated with changes in GDP, education and technical progress was estimated. In 1970, a 1% difference in GDP between countries was associated with 6% difference in female (LEBF) and 5% male (LEBM) life expectancy at birth. By 2000, these values had increased to 14% and 12%, explaining most of the observed health gain. Excluding Europe and Central Asia, the proportion of the increase in LEBF and LEBM attributable to increased GDP was 31% and 33% in the present analysis, vs. 17% and 14%, respectively, estimated by the World Bank. In the poorest countries, higher GDPs were required in 2000 than in 1970 to achieve the same health outcomes. In the poorest countries, socio-economic change is likely to be a more important source of health improvement than technical progress. Technical progress, operating by increasing the size of the effect of a unit of GDP on health, is likely to benefit richer countries more than poorer countries, thereby increasing global health inequalities. Copyright © 2012 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Honduran-U.S. Relations

DTIC Science & Technology

2010-11-30

legislature should help the government secure approval of its policy agenda, the political crisis left the new President with daunting challenges...The Lobo government faces significant challenges in fostering economic development in one of the hemisphere’s poorest countries; securing...indicators. The government has little room to address these issues as the country’s fiscal balance has deteriorated in recent years despite benefiting

A landscape analysis of universal health coverage for mothers and children in South Asia.

PubMed

Scammell, Katy; Noble, Douglas J; Rasanathan, Kumanan; O'Connell, Thomas; Ahmed, Aishath Shahula; Begkoyian, Genevieve; Goldner, Tania; Jayatissa, Renuka; Kuppens, Lianne; Raaijmakers, Hendrikus; Simbeye, Isabel Vashti; Varkey, Sherin; Chopra, Mickey

2016-01-01

The United Nations made universal health coverage (UHC) a key health goal in 2012 and it is one of the Sustainable Development Goals' targets. This analysis focuses on UHC for mothers and children in the 8 countries of South Asia. A high level overview of coverage of selected maternal, newborn and child health services, equity, quality of care and financial risk protection is presented. Common barriers countries face in achieving UHC are discussed and solutions explored. In countries of South Asia, except Bhutan and Maldives, between 42% and 67% of spending on health comes from out-of-pocket expenditure (OOPE) and government expenditure does not align with political aspirations. Even where reported coverage of services is good, quality of care is often low and the poorest fare worst. There are strong examples of ongoing successes in countries such as Bhutan, the Maldives and Sri Lanka. Related to this success are factors such as lower OOPE and higher spending on health. To make progress in achieving UHC, financial and non-financial barriers to accessing and receiving high-quality healthcare need to be reduced, the amount of investment in essential health services needs to be increased and allocation of resources must disproportionately benefit the poorest.

A landscape analysis of universal health coverage for mothers and children in South Asia

PubMed Central

Scammell, Katy; Noble, Douglas J; Rasanathan, Kumanan; O'Connell, Thomas; Ahmed, Aishath Shahula; Begkoyian, Genevieve; Goldner, Tania; Jayatissa, Renuka; Kuppens, Lianne; Raaijmakers, Hendrikus; Simbeye, Isabel Vashti; Varkey, Sherin; Chopra, Mickey

2016-01-01

The United Nations made universal health coverage (UHC) a key health goal in 2012 and it is one of the Sustainable Development Goals' targets. This analysis focuses on UHC for mothers and children in the 8 countries of South Asia. A high level overview of coverage of selected maternal, newborn and child health services, equity, quality of care and financial risk protection is presented. Common barriers countries face in achieving UHC are discussed and solutions explored. In countries of South Asia, except Bhutan and Maldives, between 42% and 67% of spending on health comes from out-of-pocket expenditure (OOPE) and government expenditure does not align with political aspirations. Even where reported coverage of services is good, quality of care is often low and the poorest fare worst. There are strong examples of ongoing successes in countries such as Bhutan, the Maldives and Sri Lanka. Related to this success are factors such as lower OOPE and higher spending on health. To make progress in achieving UHC, financial and non-financial barriers to accessing and receiving high-quality healthcare need to be reduced, the amount of investment in essential health services needs to be increased and allocation of resources must disproportionately benefit the poorest. PMID:28588912

Bridging the global health divides.

PubMed

2007-10-01

The information gap between rich and poor countries is widening, and the digital divide is more dramatic than any inequity in health or income.[1] Of 3.47 million articles in 4,091 health-related publications reviewed from 1991 to 2002, 90% were contributed by authors in the 20 most developed nations; writers from the 63 poorest countries accounted for under 2%. Representation from sub-Saharan Africa actually declined over the period, and 96% of the articles were in English. A 2003 survey found only two of 111 editorial board members in a selection of leading medical journals came from low-income countries.[2,3,4].

Bridging the global health divides.

PubMed

2008-10-01

The information gap between rich and poor countries is widening, and the digital divide is more dramatic than any inequity in health or income.[1] Of 3.47 million articles in 4,091 health-related publications reviewed from 1991 to 2002, 90% were contributed by authors in the 20 most developed nations; writers from the 63 poorest countries accounted for under 2%. Representation from sub-Saharan Africa actually declined over the period, and 96% of the articles were in English. A 2003 survey found only two of 111 editorial board members in a selection of leading medical journals came from low-income countries.[2,3,4].

Innovation in Primary School Construction: Community Participation in Seti Zone, Nepal. Educational Building Report 20. A Case Study.

ERIC Educational Resources Information Center

Tamang, H. D.; Dharam, K. C.

Nepal is one of the poorest countries in the world. In 1981 the Education for Rural Development in Seti Zone Project--more commonly known as the "Seti Project"--was part of the Nepalese government's effort to develop a system of basic education in that far western region of Nepal. The early success of the project provided the impetus for…

The health, financial and distributional consequences of increases in the tobacco excise tax among smokers in Lebanon.

PubMed

Salti, Nisreen; Brouwer, Elizabeth; Verguet, Stéphane

2016-12-01

Tobacco use is a significant risk factor for the leading causes of death worldwide, including cancer, heart disease and stroke. Most of these deaths occur in low- and middle-income countries, where tobacco-related deaths are also rising rapidly. Taxation is one of the most effective tobacco control measures, yet evidence on the distributional impact of tobacco taxation in low- and middle-income countries remains scant. This paper considers the financial and health effects, by socio-economic class, of increasing tobacco taxes in Lebanon, a middle-income country. An Almost Ideal Demand System is used to estimate price elasticities of demand for tobacco products. Extended cost-effectiveness analysis (ECEA) methods are applied to quantify, across quintiles of socio-economic status, the health benefits gained, the additional tax revenues raised, and the net financial consequences for households from a 50% increase in the price of tobacco through excise taxes. We find that demand for tobacco is price inelastic with elasticities ranging from -0.32 for the poorest quintile to -0.22 for the richest quintile. The increase in tobacco tax is estimated to result in 65,000 (95% CI: 37,000-93,000) premature deaths averted, 25% of them in the poorest quintile, $300M ($256-340M) of additional tax revenues, 12% borne by the poorest quintile, $23M ($13-33M) of out-of-pocket spending on healthcare averted, 36% of which accrue to the poorest quintile, 9% to the richest. These savings would be associated with 23,000 (13,000-33,000) poverty cases averted (63% in the poorest quintile). Increasing tobacco taxes would lead to large financial and health benefits, and would be pro-poor in health gains, savings on healthcare, and poverty reduction. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Improving Care of Critically Unwell Patients through Development of a Simulation Programme in a Malawian Hospital

ERIC Educational Resources Information Center

Barnes, Jonathan; Paterson-Brown, Lucy

2017-01-01

Introduction: Malawi is one of the world's poorest countries with very limited healthcare spending and a lack of post-graduate training for healthcare workers, including in critical illness management. Critical illness simulation courses have been shown to be an effective training tool and form a key part of training for healthcare professionals…

Population increase, economic growth, educational inequality, and income distribution: some recent evidence.

PubMed

Ram, R

1984-04-01

The relationship between population increase, economic growth, education and income inequality was examined in a cross-section study based on data from 26 developing and 2 developed countries. As other studies have noted, high population growth is associated with a less equal income distribution. A 1 percentage point reduction in the rate of population growth tends to raise the income share of the poorest 80% in the less developed world by almost 5 percentage points and is associated with a 1.7 percentage point increase in the income share of the poorest 40%. The relationship between short-run income growth and equality, on the other hand, is strong and positive. Estimates suggest that a 1 percentage point increase in the short-run rate of growth of the gross domestic product (GDP) increases the income share of the bottom 80% by about 2 percentage points and that of the poorest 40% by almost 1 percentage point. Although higher mean schooling appears to be a mild equalizer, educational inequality does not appear to have an adverse effect on income distribution. Overall, these results challenge the widely held belief that there must be a growth-equity trade-off. Moreover, they suggest that the impact of educational inequality on income distribution may be different from that observed in earlier studies, implying a need for caution in using these earlier results as a basis for educational policy development.

Financing children's vaccines.

PubMed

Nelson, E Anthony S; Sack, David; Wolfson, Lara; Walker, Damian G; Seng, Lim Fong; Steele, Duncan

2009-11-20

A 2006 Commonwealth Association of Paediatric Gastroenterology and Nutrition workshop on financing children's vaccines highlighted the potential for vaccines to control diarrhoea and other diseases as well as spur economic development through better health. Clear communication of vaccination value to decision-makers is required, together with sustainable funding mechanisms. GAVI and partners have made great progress providing funding for vaccines for children in the poorest countries but other solutions may be required to achieve the same gains in middle- and high-income countries. World Health Organization has a wealth of freely available country-level data on immunisation that academics and advocates can use to communicate the economic and health benefits of vaccines to decision-makers.

Comparing private sector family planning services to government and NGO services in Ethiopia and Pakistan: how do social franchises compare across quality, equity and cost?

PubMed Central

Shah, Nirali M; Wang, Wenjuan; Bishai, David M

2011-01-01

Policy makers in developing countries need to assess how public health programmes function across both public and private sectors. We propose an evaluation framework to assist in simultaneously tracking performance on efficiency, quality and access by the poor in family planning services. We apply this framework to field data from family planning programmes in Ethiopia and Pakistan, comparing (1) independent private sector providers; (2) social franchises of private providers; (3) non-government organization (NGO) providers; and (4) government providers on these three factors. Franchised private clinics have higher quality than non-franchised private clinics in both countries. In Pakistan, the costs per client and the proportion of poorest clients showed no differences between franchised and non-franchised private clinics, whereas in Ethiopia, franchised clinics had higher costs and fewer clients from the poorest quintile. Our results highlight that there are trade-offs between access, cost and quality of care that must be balanced as competing priorities. The relative programme performance of various service arrangements on each metric will be context specific. PMID:21729919

Comparing private sector family planning services to government and NGO services in Ethiopia and Pakistan: how do social franchises compare across quality, equity and cost?

PubMed

Shah, Nirali M; Wang, Wenjuan; Bishai, David M

2011-07-01

Policy makers in developing countries need to assess how public health programmes function across both public and private sectors. We propose an evaluation framework to assist in simultaneously tracking performance on efficiency, quality and access by the poor in family planning services. We apply this framework to field data from family planning programmes in Ethiopia and Pakistan, comparing (1) independent private sector providers; (2) social franchises of private providers; (3) non-government organization (NGO) providers; and (4) government providers on these three factors. Franchised private clinics have higher quality than non-franchised private clinics in both countries. In Pakistan, the costs per client and the proportion of poorest clients showed no differences between franchised and non-franchised private clinics, whereas in Ethiopia, franchised clinics had higher costs and fewer clients from the poorest quintile. Our results highlight that there are trade-offs between access, cost and quality of care that must be balanced as competing priorities. The relative programme performance of various service arrangements on each metric will be context specific.

Delivering Reading Intervention to the Poorest Children: The Case of Liberia and EGRA-Plus, a Primary Grade Reading Assessment and Intervention

ERIC Educational Resources Information Center

Davidson, Marcia; Hobbs, Jenny

2013-01-01

As governments, donors and implementation organisations re-focus Education for All Goals in terms of quality of education, increasing concerns have been raised over low literacy levels in developing countries. This paper provides key learning from the application of an early reading intervention applied in post-conflict Liberia, which included a…

"Farming Miners" or "Mining Farmers"?: Diamond Mining and Rural Development in Post-Conflict Sierra Leone

ERIC Educational Resources Information Center

Maconachie, Roy; Binns, Tony

2007-01-01

Sierra Leone is currently emerging from a brutal civil war that lasted most of the 1990s, and now has the dubious distinction of being ranked among the world's poorest countries. As thousands of displaced people move back to their villages, a large proportion of the predominantly farm-based rural population are growing food crops for the first…

Poverty and cancer.

PubMed

Tomatis, L

1997-01-01

Despite the attraction of certain utopias and the convincing strength of some of the social and philosophical theories underlying attempts to change the social structure and to achieve a more egalitarian society, social inequalities have not disappeared and seem even to be increasing worldwide. Inequalities in health are part of the social inequalities present in our society and one of their most convincing indices. Sanitary conditions are worse, mortality higher, survival rates of cancer patients lower, and life expectancy shorter in developing countries than in industrialized countries. Similar if not identical differences can be seen within industrialized countries between socioeconomically less and more favoured population groups. In many areas of the industrialized countries social and environmental conditions comparable with those existing in the poorest countries last century have been recreated. Occupational risks are becoming a serious problem in developing countries, largely as a consequence of the transfer of hazardous industries from industrialized countries where certain industries are judged to be unacceptable. A similar double standard is applied to tobacco advertising and sales in the industrialized and developing countries. The projections of the total number of cancer cases in the next decades indicate a generalized increase, proportionally greater in developing than in industrialized countries.

Who is being served least by family planning providers? A study of modern contraceptive use in Ghana, Tanzania And Zimbabwe.

PubMed

Clements, Steve; Madise, Nyovani

2004-08-01

This study was conducted to identify the poorest and other vulnerable sub-groups being served least by family planning providers. The study was set in three countries in sub-Saharan Africa, namely, Ghana, Tanzania and Zimbabwe. This region generally has a low but increasing uptake of modern contraceptive methods. As the use of family planning providers increases, there is a need to understand who is not being served and why. Logistic regression analyses of demographic and health survey data were conducted to identify the characteristics and geographical areas of women who are not using modern contraceptive methods. The results show some similarities among the countries in those using modern methods the least. However, a number of groups were country specific. Identifying the poorest women with the lowest use of modern methods is best done by assessing their household amenities or their partner's status rather than theirs.

How Pronounced Is Income Inequality around the World--and How Can Education Help Reduce It? Education Indicators in Focus. No. 4

ERIC Educational Resources Information Center

OECD Publishing (NJ1), 2012

2012-01-01

How pronounced is income inequality around the world--and how can education help reduce it? This paper reports the following: (1) Across OECD (Organisation for Economic Cooperation and Development) countries, the average income of the richest 10% of the population was about nine times that of the poorest 10% before the onset of the global economic…

Beyond the Millennium Development Goals: public health challenges in water and sanitation.

PubMed

Rheingans, R; Dreibelbis, R; Freeman, M C

2006-01-01

Over 1 billion people lack access to improved water sources and 2.6 billion lack access to appropriate sanitation, greatly contributing to the global burden of disease. The international community has committed to reducing by half the proportion of the world's population lacking access to water and sanitation as a part of the Millennium Development Goals (MDGs). However, the disease burden due to poor access, is borne primarily by the poorest countries and the poorest people within them. Simply reducing the proportion of people without adequate access will not automatically result in proportional reductions in the related disease burden. The public health challenge inherent in meeting the MDG targets is ensuring that improvements result in access to water and sanitation for the critical at-risk populations. Innovative approaches are required to ensure the availability of low-cost, simple, and locally acceptable water and sanitation interventions and integrating these approaches into existing social institutions, such as schools, markets, and health facilities.

IMPROVED COOK STOVES FOR HAITI USING THERMOELECTRICS TO REDUCE DEFORESTATION AND IMPROVE QUALITY OF LIFE

EPA Science Inventory

Haiti, the poorest country in the Western Hemisphere, is plagued with continual problems due to severe deforestation throughout the country. Haiti was once nearly completely covered by lush forest, but now less than three percent of Haiti is forested. This environmental cala...

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.

[Spanish international cooperation in health].

PubMed

Mazarrasa-Alvear, Lucía; Montero-Corominas, María José

2004-05-01

In this chapter, there is a view of the relationships between the Spanish policy for international cooperation aid and the main health problems of the developing world, with a gender perspective. The population health is a result of the development inequity between rich and poor countries. The international institutions have established the frame and priorities of the cooperation aid, being poverty eradication the main priority. The compromise of the Millennium Conference was to reduce in 2/3 child mortality and 3/4 maternal mortality before year 2015, to stop and reduce HIV-AIDS, malaria and others serious diseases as tuberculosis and to facilitate developing countries the access to drugs. Although the resources allocated, the total amount for cooperation has been reduced 30% during the last years. The Spanish AOD in health is difficult to account because it is considered among social basic services and it is not addressed to solve the main health problems in the poorest countries.

Simplified and lower cost methods for culinary-medicinal mushrooms cultivation.

PubMed

Cleaver, Phillip D; Bailey, Cody; Holliday, John C

2012-01-01

The importance and prospect of growing mushrooms through utilization of low-cost, technologically simple methods for developing Third World countries has recently been outlined. Three different species from genus Pleurotus (P. djamor, P. pulmonarius, and P. sajor-caju) and one from genus Hypsizygus (H. ulmarius) were studied. Whole stalk wheat straw, shredded wheat straw, and ground maize cob (Zea mays) were used as the substrates. Wheat straw is the post-harvest stalk of Triticum aestivum. Biological efficiency (BE), growth dynamics, and photographs are provided for each cultivated strain, on different substrates, and substrate treatment comparisons are made. From several experiments conducted with various technologically simple methods of cultivation, it was found that all above mentioned species can be successfully cultivated at the village level in any country, be it highly developed or the poorest country on earth.

Effective interventions for unintentional injuries: a systematic review and mortality impact assessment among the poorest billion.

PubMed

Vecino-Ortiz, Andres I; Jafri, Aisha; Hyder, Adnan A

2018-05-01

Between 1990 and 2015, the global injury mortality declined, but in countries where the poorest billion live, injuries are becoming an increasingly prevalent cause of death. The vulnerability of this population requires immediate attention from policy makers to implement effective interventions that lessen the burden of injuries in these countries. Our aim was two-fold; first, to review all the evidence on effective interventions for the five main types of unintentional injury; and second, to estimate the potential number of lives saved by effective injury interventions among the poorest billion. For our systematic review we used references in the Disability Control Priorities third edition, and searched PubMed and the Cochrane database for papers published until Sept 10, 2016, using a comprehensive search strategy to find interventions for the five major causes of unintentional injuries: road traffic crashes, falls, drowning, burns, and poisoning. Studies were included if they presented evidence with significant effects sizes for any outcome; no inclusions or exclusions made on the basis of where the study was carried out (ie, low-income, middle-income, or high-income country). Then we used data from the Global Burden of Disease 2015 study and a Monte Carlo simulation technique to estimate the potential annual attributable number of lives saved among the poorest billion by these evidence-based injury interventions. We estimated results for 84 countries where the poorest billion live. From the 513 papers identified, 47 were eligible for inclusion. We identified 11 interventions that had an effect on injury mortality. For road traffic deaths, the most successful interventions in preventing deaths are speed enforcement (>80 000 lives saved per year) and drink-driving enforcement (>60 000 lives saved per year). Interventions potentially most effective in preventing deaths from drowning are formal swimming lessons for children younger than 14 years (>25 000 lives saved per year) and the use of crèches to supervise younger children (younger than 5 years; >10 000 lives saved per year). We did not find sufficient evidence on interventions for other causes of unintentional injuries (poisoning, burns, and falls) to run similar simulations. Based on the little available evidence, key interventions have been identified to prevent lives lost from unintentional injuries among the poorest billion. This Article provides guidance to national authorities on evidence-based priority interventions that can reduce the burden of injuries among the most vulnerable members of the population. We also identify an important gap in knowledge on the effectiveness and the mortality impacts of injury interventions. Partly supported by the Fogarty International Center of the US National Institutes of Health (Chronic Consequences of Trauma, Injuries, Disability Across the Lifespan: Uganda; #D43TW009284). Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Financial accessibility and user fee reforms for maternal healthcare in five sub-Saharan countries: a quasi-experimental analysis.

PubMed

Leone, Tiziana; Cetorelli, Valeria; Neal, Sarah; Matthews, Zoë

2016-01-28

Evidence on whether removing fees benefits the poorest is patchy and weak. The aim of this paper is to measure the impact of user fee reforms on the probability of giving birth in an institution or undergoing a caesarean section (CS) in Ghana, Burkina Faso, Zambia, Cameroon and Nigeria for the poorest strata of the population. Women's experience of user fees in 5 African countries. Using quasi-experimental regression analysis we tested the impact of user fee reforms on facilities' births and CS differentiated by wealth, education and residence in Burkina Faso and Ghana. Mapping of the literature followed by key informant interviews are used to verify details of reform implementation and to confirm and support our countries' choice. We analysed data from consecutive surveys in 5 countries: 2 case countries that experienced reforms (Ghana and Burkina Faso) by contrast with 3 that did not experience reforms (Zambia, Cameroon, Nigeria). User fee reforms are associated with a significant percentage of the increase in access to facility births (27 percentage points) and to a much lesser extent to CS (0.7 percentage points). Poor (but not the poorest), and non-educated women, and those in rural areas benefitted the most from the reforms. User fees reforms have had a higher impact in Burkina Faso compared with Ghana. Findings show a clear positive impact on access when user fees are removed, but limited evidence for improved availability of CS for those most in need. More women from rural areas and from lower socioeconomic backgrounds give birth in health facilities after fee reform. Speed and quality of implementation might be the key reason behind the differences between the 2 case countries. This calls for more research into the impact of reforms on quality of care. 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/

Two Languages Are Better than One

ERIC Educational Resources Information Center

Brion, Corinne

2014-01-01

A program of helping students learn French by integrating students' native tongue into their school instruction, along with French--the country's national language--promises to improve education outcomes in one of the world's poorest nations.

Effects of "Sesame Street": A Meta-Analysis of Children's Learning in 15 Countries

ERIC Educational Resources Information Center

Mares, Marie-Louise; Pan, Zhongdang

2013-01-01

"Sesame Street" is broadcast to millions of children globally, including in some of the world's poorest regions. This meta-analysis examines the effects of children's exposure to international co-productions of "Sesame Street", synthesizing the results of 24 studies, conducted with over 10,000 children in 15 countries. The results indicated…

Gavi's Transition Policy: Moving From Development Assistance To Domestic Financing Of Immunization Programs.

PubMed

Kallenberg, Judith; Mok, Wilson; Newman, Robert; Nguyen, Aurélia; Ryckman, Theresa; Saxenian, Helen; Wilson, Paul

2016-02-01

Gavi, the Vaccine Alliance, was created in 2000 to accelerate the introduction of new and underused vaccines in lower-income countries. The period 2000-15 was marked by the rapid uptake of new vaccines in more than seventy countries eligible for Gavi support. To stay focused on the poorest countries, Gavi's support phases out after countries' gross national income per capita surpasses a set threshold, which requires governments to assume responsibility for the continued financing of vaccines introduced with Gavi support. Gavi's funding will end in the period 2016-20 for nineteen countries that have exceeded the eligibility threshold. To avoid disrupting lifesaving immunization programs and to ensure the long-term sustainable impact of Gavi's investments, it is vital that governments succeed in transitioning from development assistance to domestic financing of immunization programs. This article discusses some of the challenges facing countries currently transitioning out of Gavi support, how Gavi's policies have evolved to help manage the risks involved in this process, and the lessons learned from this experience. Project HOPE—The People-to-People Health Foundation, Inc.

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.

Financial accessibility and user fee reforms for maternal healthcare in five sub-Saharan countries: a quasi-experimental analysis

PubMed Central

Leone, Tiziana; Cetorelli, Valeria; Neal, Sarah; Matthews, Zoë

2016-01-01

Objectives Evidence on whether removing fees benefits the poorest is patchy and weak. The aim of this paper is to measure the impact of user fee reforms on the probability of giving birth in an institution or undergoing a caesarean section (CS) in Ghana, Burkina Faso, Zambia, Cameroon and Nigeria for the poorest strata of the population. Setting Women's experience of user fees in 5 African countries. Primary and secondary outcome measures Using quasi-experimental regression analysis we tested the impact of user fee reforms on facilities’ births and CS differentiated by wealth, education and residence in Burkina Faso and Ghana. Mapping of the literature followed by key informant interviews are used to verify details of reform implementation and to confirm and support our countries’ choice. Participants We analysed data from consecutive surveys in 5 countries: 2 case countries that experienced reforms (Ghana and Burkina Faso) by contrast with 3 that did not experience reforms (Zambia, Cameroon, Nigeria). Results User fee reforms are associated with a significant percentage of the increase in access to facility births (27 percentage points) and to a much lesser extent to CS (0.7 percentage points). Poor (but not the poorest), and non-educated women, and those in rural areas benefitted the most from the reforms. User fees reforms have had a higher impact in Burkina Faso compared with Ghana. Conclusions Findings show a clear positive impact on access when user fees are removed, but limited evidence for improved availability of CS for those most in need. More women from rural areas and from lower socioeconomic backgrounds give birth in health facilities after fee reform. Speed and quality of implementation might be the key reason behind the differences between the 2 case countries. This calls for more research into the impact of reforms on quality of care. PMID:26823178

Uganda: The Challenge of Growth and Poverty Reduction. A World Bank Country Study.

ERIC Educational Resources Information Center

World Bank, Washington, DC.

This report examines the outcomes of economic reform in Uganda and defines issues that Uganda must address in medium- and long-term strategies for poverty reduction. With a per capita income of approximately $220, Uganda is one of the poorest countries in the world. Its economy and social indicators bear the marks of nearly 15 years of political…

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.

Exploring the impact of targeted distribution of free bed nets on households bed net ownership, socio-economic disparities and childhood malaria infection rates: analysis of national malaria survey data from three sub-Saharan Africa countries

PubMed Central

2013-01-01

Background The last decade has witnessed increased funding for malaria control. Malaria experts have used the opportunity to advocate for rollout of such interventions as free bed nets. A free bed net distribution strategy is seen as the quickest way to improve coverage of effective malaria control tools especially among poorest communities. Evidence to support this claim is however, sparse. This study explored the effectiveness of targeted free bed net distribution strategy in achieving equity in terms of ownership and use of bed nets and also reduction of malaria prevalence among children under-five years of age. Methods National malaria indicator survey (MIS) data from Angola, Tanzania and Uganda was used in the analysis. Hierarchical multilevel logistic regression models were used to analyse the relationship between variables of interest. Outcome variables were defined as: childhood test-confirmed malaria infections, household ownership of any mosquito net and children’s use of any mosquito nets. Marginal effects of having free bed net distribution on households with different wealth status were calculated. Results Angolan children from wealthier households were 6.4 percentage points less likely to be parasitaemic than those in poorest households, whereas those from Tanzania and Uganda were less likely to test malaria positive by 7 and 11.6 percentage points respectively (p < 0.001). The study estimates and present results on the marginal effects based on the impact of free bed net distribution on children's malaria status given their socio-economic background. Poorest households were less likely to own a net by 21.4% in Tanzania, and 2.8% in Uganda, whereas both poorer and wealthier Angolan households almost achieved parity in bed net ownership (p < 0.001). Wealthier households had a higher margin of using nets than poorest people in both Tanzania and Uganda by 11.4% and 3.9% respectively. However, the poorest household in Angola had a 6.1% net use advantage over children in wealthier households (p < 0.001). Conclusion This is the first study to use nationally representative data to explore inequalities in bed net ownership and related consequences on childhood malaria infection rates across different countries. While targeted distribution of free bed nets improved overall bed net ownership, it did not overcome ownership inequalities as measured by household socioeconomic status. Use of bed nets was disproportionately lower among poorest children, except for Angola where bed net use was higher among poorest households when compared to children in wealthier households. The study highlights the need for malaria control world governing bodies and policy makers to continue working on finding appropriate strategies to improve access to effective malaria control tools especially by the poorest who often times bears the brunt of malaria burden than their wealthier counterparts. PMID:23855893

Lesson and Impressions of the Ghanaian Capital Markets

DTIC Science & Technology

2011-07-31

with natural resources, Ghana has roughly twice the per capita output of the poorest countries in West Africa. Gold and cocoa production are major...sources of foreign exchange. Interestingly, the country’s largest source of foreign exchange is remittances from workers abroad. Oil production has...prominent industries include textiles, apparel, steel, tires, flour milling, cocoa processing, beverages, tobacco, simple consumer goods, and car, truck

The poorest first: WHO's activities to help the people in greatest need.

PubMed

Jancloes, M

1998-01-01

Through its Division of Intensified Cooperation with Countries and Peoples in Greatest Need, WHO is giving special attention to the relationship between poverty and ill-health. The work of the Division is outlined in the present article.

Effects of food price inflation on infant and child mortality in developing countries.

PubMed

Lee, Hyun-Hoon; Lee, Suejin A; Lim, Jae-Young; Park, Cyn-Young

2016-06-01

After a historic low level in the early 2000s, global food prices surged upwards to bring about the global food crisis of 2008. High and increasing food prices can generate an immediate threat to the security of a household's food supply, thereby undermining population health. This paper aims to assess the precise effects of food price inflation on child health in developing countries. This paper employs a panel dataset covering 95 developing countries for the period 2001-2011 to make a comprehensive assessment of the effects of food price inflation on child health as measured in terms of infant mortality rate and child mortality rate. Focusing on any departure of health indicators from their respective trends, we find that rising food prices have a significant detrimental effect on nourishment and consequently lead to higher levels of both infant and child mortality in developing countries, and especially in least developed countries (LDCs). High food price inflation rates are also found to cause an increase in undernourishment only in LDCs and thus leading to an increase in infant and child mortality in these poorest countries. This result is consistent with the observation that, in lower-income countries, food has a higher share in household expenditures and LDCs are likely to be net food importing countries. Hence, there should be increased efforts by both LDC governments and the international community to alleviate the detrimental link between food price inflation and undernourishment and also the link between undernourishment and infant mortality.

[Quality of medicines in least developed countries].

PubMed

Videau, J Y

2006-12-01

Due to worsening economic conditions and poor enforcement of existing pharmaceutical and customs regulations, third world countries are faced with a growing threat from counterfeit and substandard medicines. With the expansion of illicit markets in urban areas, the sales of medicines of uncertain quality and origin are increasing. Most victims of this illicit trade are among the world's poorest populations that cannot afford to buy quality drugs through private-sector distribution channels. National pharmaceutical programs promoting universal access to essential generic medicines at reasonable cost are the key to curbing this problem. A system based on strict, rational pharmaceutical purchasing and distribution policies with quality assurance at every level of the supply chain is needed to guarantee that patients receive safe effective high quality healthcare products.

The Role of Non-Governmental Organisations and Faith-Based Organisations in Achieving Education for All: The Case of Sierra Leone

ERIC Educational Resources Information Center

Nishimuko, Mikako

2009-01-01

Sierra Leone, one of the world's poorest countries, experienced a civil war from 1991 to 2002. The government's capacity to provide educational services remains weak, and still over 30% of children in the country are hard to reach and do not have access to primary education. This paper discusses the role of non-governmental organisations (NGOs)…

The Promise of E-Platform Technology in Medical Education.

PubMed

Dawd, Siraj

2016-03-01

Increasing the number as well as improving the capacity and quality of medical professionals to achieve an equitable health care for all is a global priority and a global challenge. In developing countries, which are facing the largest burden of disease, to achieve the above stated objective, there is a big need for more well-trained, competent and dedicated health care providers. Currently, there is a well-documented shortage of trained health workers globally, with the poorest countries having the greatest shortfalls. The time tested, traditional approach of training health care force by importing professionals from overseas is not only prohibitively expensive but also not sufficient to achieve the scale and pace of the required human capacity building. Considering this fact, distance learning programs, which include m-Health as well as other information technology (IT) platforms and tools, can provide unique, timely, cost-effective, easily scalable and valuable opportunities to expand access to training health care manpower in developing countries where the shortage is critical.

The relationship between parity and overweight varies with household wealth and national development.

PubMed

Kim, Sonia A; Yount, Kathryn M; Ramakrishnan, Usha; Martorell, Reynaldo

2007-02-01

Recent studies support a positive relationship between parity and overweight among women of developing countries; however, it is unclear whether these effects vary by household wealth and national development. Our objective was to determine whether the association between parity and overweight [body mass index (BMI) > or =25 kg/m(2)] in women living in developing countries varies with levels of national human development and/or household wealth. We used data from 28 nationally representative, cross-sectional surveys conducted between 1996 and 2003 (n = 275 704 women, 15-49 years). The relationship between parity and overweight was modelled using logistic regression, controlling for several biological and sociodemographic factors and national development, as reflected by the United Nations' Human Development Index. We also modelled the interaction between parity and national development, and the three-way interaction between parity, household wealth and national development. Parity had a weak, positive association with overweight, which varied by household wealth and national development. Among the poorest women and women in the second tertile of household wealth, parity was positively related to overweight only in the most developed countries. Among the wealthiest women, parity was positively related to overweight regardless of the level of national development. As development increases, the burden of parity-related overweight shifts to include poor as well as wealthy women. In the least-developed countries, programmes to prevent parity-related overweight should target wealthy women, whereas such programmes should be provided to all women in more developed countries.

Equity and immunization supply chain in Madagascar.

PubMed

van den Ent, Maya M V X; Yameogo, Andre; Ribaira, Eric; Hanson, Celina M; Ratoto, Ramiandrasoa; Rasolomanana, Saholy; Foncha, Chrysanthus; Gasse, François

2017-04-19

Vaccination rates have improved in many countries, yet immunization inequities persist within countries and the poorest communities often bear the largest burden of vaccine preventable disease. Madagascar has one of the world's largest equity gaps in immunization rates. Barriers to immunization include immunization supply chain, human resources, and service delivery to reflect the health system building blocks, which affect poor rural communities more than affluent communities. The Reaching Every District (RED) approach was revised to address barriers and bottlenecks. This approach focuses on the provision of regular services, including making cold chain functional. This report describes Madagascar's inequities in immunization, its programmatic causes and the country's plans to address barriers to immunization in the poorest regions in the country. Two cross-sectional health facility surveys conducted in November and December 2013 and in March 2015 were performed in four regions of Madagascar to quantify immunization system barriers. Of the four regions studied, 26-33% of the population live beyond 5km (km) of a health center. By 2015, acceptable (fridges stopped working for less than 6days) cold chains were found in 52-80% of health facilities. Only 10-57% of health centers had at least two qualified health workers. Between 65% and 95% of planned fixed vaccination sessions were conducted and 50-88% of planned outreach sessions were conducted. The proportion of planned outreach sessions that were conducted increased between the two surveys. Madagascar's immunization program faces serious challenges and those affected most are the poorest populations. Major inequities in immunization were found at the subnational level and were mainly geographic in nature. Approaches to improve immunization systems need to be equitable. This may include the replacement of supply chain equipment with those powered by sustainable energy sources, monitoring its functionality at health facility level and vaccination services in all communities. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Tools and approaches to ensure quality of vaccines throughout the cold chain.

PubMed

Kartoglu, Umit; Milstien, Julie

2014-07-01

The Expanded Program on Immunization was designed 40 years ago for two types of vaccines: those that are heat stable but freeze sensitive and those that are stable to freezing but heat labile. A cold chain was developed for transport and storage of such vaccines and established in all countries, despite limited access to resources and electricity in the poorest areas. However, cold chain problems occur in all countries. Recent changes to vaccines and vaccine handling include development and introduction of new vaccines with a wide range of characteristics, improvement of heat stability of several basic vaccines, observation of vaccine freezing as a real threat, development of regulatory pathways for both vaccine development and the supply chain, and emergence of new temperature monitoring devices that can pinpoint and avoid problems. With such tools, public health groups have now encouraged development of vaccines labeled for use in flexible cold chains and these tools should be considered for future systems.

Tools and approaches to ensure quality of vaccines throughout the cold chain

PubMed Central

Kartoglu, Umit; Milstien, Julie

2014-01-01

The Expanded Program on Immunization was designed 40 years ago for two types of vaccines: those that are heat stable but freeze sensitive and those that are stable to freezing but heat labile. A cold chain was developed for transport and storage of such vaccines and established in all countries, despite limited access to resources and electricity in the poorest areas. However, cold chain problems occur in all countries. Recent changes to vaccines and vaccine handling include development and introduction of new vaccines with a wide range of characteristics, improvement of heat stability of several basic vaccines, observation of vaccine freezing as a real threat, development of regulatory pathways for both vaccine development and the supply chain, and emergence of new temperature monitoring devices that can pinpoint and avoid problems. With such tools, public health groups have now encouraged development of vaccines labeled for use in flexible cold chains and these tools should be considered for future systems. PMID:24865112

Child Health and Survival in a Changing World.

PubMed

Denno, Donna M; Paul, Shadae L

2017-08-01

Ninety-nine percent of the 5.9 million annual child deaths occur in low and middle-income countries. Undernutrition underlies 45% of deaths. Determinants include access to care, maternal education, and absolute and relative poverty. Socio-political-economic factors and policies tremendously influence health and their determinants. Most deaths can be prevented with interventions that are currently available and recommended for widespread implementation. Millennium Development Goal 4 was not achieved. Sustainable Development Goal 3.2 presents an even more ambitious target and opportunity to save millions of lives; and requires attention to scaling up interventions, especially among the poorest and most vulnerable children. Copyright © 2017 Elsevier Inc. All rights reserved.

Sociopolitical and economic elements to explain the environmental performance of countries.

PubMed

Almeida, Thiago Alexandre das Neves; García-Sánchez, Isabel-María

2017-01-01

The present research explains environmental performance using an ecological composite index as the dependent variable and focusing on two national dimensions: sociopolitical characteristics and economics. Environmental performance is measured using the Composite Index of Environmental Performance (CIEP) indicator proposed by García-Sánchez et al. (2015). The first model performs a factor analysis to aggregate the variables according to each analyzed dimension. In the second model, the estimation is run using only single variables. Both models are estimated using generalized least square estimation (GLS) using panel data from 152 countries and 6 years. The results show that sociopolitical factors and international trade have a positive effect on environmental performance. When the variables are separately analyzed, democracy and social policy have a positive effect on environmental performance while transport, infrastructure, consumption of goods, and tourism have a negative effect. Further observation is that the trade-off between importing and exporting countries overshadows the pollution caused by production. It was also observed that infrastructure has a negative coefficient for developing countries and positive for developed countries. The best performances are in the democratic and richer countries that are located in Europe, while the worst environmental performance is by the nondemocratic and the poorest countries, which are on the African continent.

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.

Technology innovation for infectious diseases in the developing world.

PubMed

So, Anthony D; Ruiz-Esparza, Quentin

2012-10-25

Enabling innovation and access to health technologies remains a key strategy in combating infectious diseases in low- and middle-income countries (LMICs). However, a gulf between paying markets and the endemicity of such diseases has contributed to the dearth of R&D in meeting these public health needs. While the pharmaceutical industry views emerging economies as potential new markets, most of the world's poorest bottom billion now reside in middle-income countries--a fact that has complicated tiered access arrangements. However, product development partnerships--particularly those involving academic institutions and small firms--find commercial opportunities in pursuing even neglected diseases; and a growing pharmaceutical sector in BRICS countries offers hope for an indigenous base of innovation. Such innovation will be shaped by 1) access to building blocks of knowledge; 2) strategic use of intellectual property and innovative financing to meet public health goals; 3) collaborative norms of open innovation; and 4) alternative business models, some with a double bottom line. Facing such resource constraints, LMICs are poised to develop a new, more resource-effective model of innovation that holds exciting promise in meeting the needs of global health.

The Feminization of Poverty for Midlife and Older Women and Its Effects on Their Health.

ERIC Educational Resources Information Center

Porcino, Jane

There are 16.4 million women over age 65 in this country, compared to 11 million men. The 41 percent of this population who live alone are the poorest of the poor in this country, with an annual median income of just over $3,000 for white women and little more than $2,000 for black women. This abject poverty affects the ability of these women to…

Health and economic outcomes of HPV 16,18 vaccination in 72 GAVI-eligible countries.

PubMed

Goldie, Sue J; O'Shea, Meredith; Campos, Nicole Gastineau; Diaz, Mireia; Sweet, Steven; Kim, Sun-Young

2008-07-29

The risk of dying from cervical cancer is disproportionately borne by women in developing countries. Two new vaccines are highly effective in preventing HPV 16,18 infection, responsible for approximately 70% of cervical cancer, in girls not previously infected. The GAVI Alliance (GAVI) provides technical assistance and financial support for immunization in the world's poorest countries. Using population-based and epidemiologic data for 72 GAVI-eligible countries we estimate averted cervical cancer cases and deaths, disability-adjusted years of life (DALYs) averted and incremental cost-effectiveness ratios (I$/DALY averted) associated with HPV 16,18 vaccination of young adolescent girls. In addition to vaccine coverage and efficacy, relative and absolute cancer reduction depended on underlying incidence, proportion attributable to HPV types 16 and 18, population age-structure and competing mortality. With 70% coverage, mean reduction in the lifetime risk of cancer is below 40% in some countries (e.g., Nigeria, Ghana) and above 50% in others (e.g., India, Uganda, Kenya). At I$10 per vaccinated girl (approximately $2.00 per dose assuming three doses, plus wastage, administration, program support) vaccination was cost-effective in all countries using a per capita GDP threshold; for 49 of 72 countries, the cost per DALY averted was less than I$100 and for 59 countries, it was less than I$200. Taking into account country-specific assumptions (per capita GNI, DPT3 coverage, percentage of girls who are enrolled in fifth grade) for the year of introduction, percent coverage achieved in the first year, and years to maximum coverage, a 10-year modeled scenario prevented the future deaths of approximately 2 million women vaccinated as adolescents. Despite favorable cost-effectiveness, assessment of financial costs raised concerns about affordability; as the cost per vaccinated girl was increased from I$10 to I$25 (approximately $2 to $5 per dose), the financial costs for the 10-year scenario increased from >US$ 900 million to US$ 2.25 billion. Provided high coverage of young adolescent girls is feasible, and vaccine costs are lowered, HPV 16,18 vaccination could be very cost-effective even in the poorest countries, and provide comparable value for resources to other new vaccines such as rotavirus.

In Haiti, a Rare Leg Up

ERIC Educational Resources Information Center

Campbell, Monica

2007-01-01

This article features Haitian Education & Leadership Program, Haiti's largest university-scholarship program, which provides merit scholarships to students in the top 10 percent of their high-school classes in the country's poorest areas. On average, the scholarships pay students $4,100, which covers tuition, textbooks, and school supplies,…

Financial challenges of immunization: a look at GAVI.

PubMed Central

Kaddar, Miloud; Lydon, Patrick; Levine, Ruth

2004-01-01

Securing reliable and adequate public funding for prevention services, even those that are considered highly cost effective, often presents a challenge. This has certainly been the case with childhood immunizations in developing countries. Although the traditional childhood vaccines cost relatively little, funding in poor countries is often at risk and subject to the political whims of donors and national governments. With the introduction of newer and more costly vaccines made possible under the Global Alliance for Vaccines and Immunization (GAVI), the future financial challenges have become even greater. Experience so far suggests that choosing to introduce new combination vaccines can significantly increase the costs of national immunization programmes. With this experience comes a growing concern about their affordability in the medium term and long term and a realization that, for many countries, shared financial responsibility between national governments and international donors may initially be required. This article focuses on how GAVI is addressing the challenge of sustaining adequate and reliable funding for immunizations in the poorest countries. PMID:15628208

NOW AND THEN: The Global Nutrition Transition: The Pandemic of Obesity in Developing Countries

PubMed Central

Popkin, Barry M.; Adair, Linda S.; Ng, Shu Wen

2011-01-01

Decades ago discussion of an impending global pandemic of obesity was thought of as heresy. Diets in the 1970’s began to shift toward increased reliance upon processed foods, increased away from home intake and greater use of edible oils and sugar-sweetened beverages. Reduced physical activity and increased sedentary time was seen also. These changes began in the early 1990-‘s in the low and middle income world but did not become clearly recognized until diabetes, hypertension and obesity began to dominate the globe. Urban and rural areas from sub-Saharan Africa and South Asia’s poorest countries to the higher income ones are shown to have experienced rapid increases in overweight and obesity status. Concurrent rapid shifts in diet and activity are documented. An array of large-scale programmatic and policy shifts are being explored in a few countries; however despite the major health challenges faced, few countries are serious in addressing prevention of the dietary challenges faced. PMID:22221213

The population slide.

PubMed

Mukerjee, M

1998-12-01

The level of total fertility in Bangladesh has fallen from 7 in 1975 to 3 today, the sharpest fertility transition in South Asia. Fertility decline in Bangladesh and Nepal follows such transition occurring first in Sri Lanka, then in India. While in Western countries, levels of fertility began to fall once an advanced stage of development had been reached, these new declines in South Asia are not directly correlated with indicators of development such as increased literacy or the alleviation of poverty. Bangladesh has experienced major fertility decline despite being one of the world's 20 poorest countries. Fertility decline in Bangladesh may be attributed to a combination of an effective government family planning program, a general desire among Bangladesh's population to bear fewer children, reductions in mortality, the availability of microcredit, changes in women's status, and the provision of health and family planning information over the radio 6 hours per day.

Supporting Early Childhood Teachers in Guinea-Bissau

ERIC Educational Resources Information Center

Portugal, Maria Gabriela; Aveleira, Ana Paula

2009-01-01

This article presents a reflective report on a project aiming to strengthen educators and improve early childhood education in Guinea-Bissau--one of the poorest countries on the African continent, where preschool teachers have no training and have to face several ongoing difficulties. Helping these Guinea-Bissau teachers to focus on curriculum…

Using Radio To Promote Family Planning in Sub-Saharan Africa.

ERIC Educational Resources Information Center

Henry, Kathleen

Family planning programs in sub-Saharan Africa (42 countries and 450 million population), the fastest growing and poorest region in the world, need effective communications campaigns to educate people about the benefits of contraception, help change attitudes about fertility control and family size, and provide information about available…

Individual and community level socioeconomic inequalities in contraceptive use in 10 Newly Independent States: a multilevel cross-sectional analysis

PubMed Central

2012-01-01

Introduction Little is known regarding the association between socioeconomic factors and contraceptive use in the Newly Independent States (NIS), countries that have experienced profound changes in reproductive health services during the transition from socialism to a market economy. Methods Using 2005–2006 data from Demographic Health Surveys (Armenia, Azerbaijan, and Moldova) and Multiple Indicator Cluster Surveys (Belarus, Georgia, Kazakhstan, Kyrgyzstan, Tajikistan, Ukraine, and Uzbekistan), we examined associations between individual and community socioeconomic status with current modern contraceptive use (MCU) among N = 55,204 women aged 15–49 married or in a union. Individual socioeconomic status was measured using quintiles of wealth index and education level (higher than secondary school, secondary school or less). Community socioeconomic status was measured as the percentage of households in the poorest quintile of the nationals household wealth index (0%, 0–25%, or greater than 25%). We used multilevel logistic regression to estimate associations adjusted for age, number of children, urban/rural, and socioeconomic variables. Results MCU varied by country from 14% (in Azerbaijan) to 62% (in Belarus). Overall, women living in the poorest communities were less likely than those in the richest to use modern contraceptives (adjusted odds ratio (aOR) = 0.82, 95% Confidence Interval = 0.76, 0.89). Similarly, there was an increasing odds of MCU with increasing individual-level wealth. Women with a lower level of education also had lower odds of MCU than those with a higher level of education (aOR = .75, 95%CI = 0.71, 0.79). In country-specific analyses, community-level socioeconomic inequalities were apparent in 4 of 10 countries; in contrast, inequalities by individual-level wealth were apparent in 7 countries and by education in 8 countries. All countries in which community-level socioeconomic status was associated with MCU were in Central Asia, whereas at the individual-level inequalities of the largest magnitude were found in the Caucasus. There were no distinct patterns found in Eastern European countries. Conclusions Community-level socioeconomic inequalities in MCU were most pronounced in Central Asian countries, whereas individual-level socioeconomic inequalities in MCU were most pronounced in the Caucasus. It is important to consider multilevel contextual determinants of modern contraceptive use in the development of reproductive health and family planning programs. PMID:23158261

Reframing noncommunicable diseases and injuries for the poorest Malawians: the Malawi National NCDI Poverty Commission.

PubMed

Cundale, Katie; Wroe, Emily; Matanje-Mwagomba, Beatrice L; Muula, Adamson S; Gupta, Neil; Berman, Josh; Kasomekera, Noel; Masiye, Jones

2017-06-01

Noncommunicable diseases and injuries (NCDIs) account for nearly 70% of deaths worldwide, with an estimated 75% of these deaths occurring in low- and middle-income countries. Globally, the burden of disease from noncommunicable diseases (NCDs) is most often caused by the "big 4," namely: diabetes, cardiovascular diseases, cancer, and chronic lung diseases. However, in Malawi, these 4 conditions account for only 29% of the NCDI disease burden. The Malawi National NCDI Poverty Commission was launched in November 2016 and will describe and evaluate the current NCDI situation in Malawi, with a focus on the poorest populations. The National Commission will investigate which NCDIs cause the biggest burden, which are more present in the young, and which interventions are available to avert death and disability from NCDIs in Malawi, particularly among the poorest segments of the population. The evidence gained through the work of this Commission will help inform research, policy, and programme interventions, all through an advocacy lens, as we strive to address the impact of NCDIs among all populations in Malawi.

Improved Reproductive Health Equity Between the Poor and the Rich: An Analysis of Trends in 46 Low- and Middle-Income Countries.

PubMed

Ross, John

2015-09-07

While several indicators for reproductive health have improved for entire populations, few analyses are available for trends over time in the gaps between the poor and the rich. This paper tracks improvements in the equitable distribution of reproductive health indicators according to wealth quintiles, especially for contraceptive use, in 46 low- and middle-income countries based on national population-based surveys conducted between 1990 and 2013. It focuses on the gaps between the poorest and richest quintiles in the earliest and latest survey rounds across a number of reproductive health indicators related to family planning, fertility desires, antenatal care, and infant and child mortality, as well as on improvements in the absolute levels of contraceptive use by the poorest quintile. Gap changes were decomposed to show how the gaps can either diminish or grow due to either the bottom or top quintile, or both. In addition, bivariate correlation analysis was conducted to examine the relationship of the gaps, and of contraceptive use by the poor, to national family planning program efforts. Overall, the gaps between the poorest and richest have narrowed, due primarily to faster improvements among the poor than the rich. For example, the gap between the richest and poorest in the modern contraceptive prevalence rate has declined by 25%, from a 20.4 percentage point difference to a 15.4 point difference. And the gap has decreased more where family planning programs have been stronger. Across most of 18 other reproductive health indicators, the gaps have also been narrowing. For instance, the poor-rich gap for antenatal care decreased by over a third, from a difference of 30.7 percentage points to 19.6 percentage points. Gaps in infant and child mortality also have declined by about one-third. The pattern for contraceptive use in sub-Saharan Africa, however, has been mixed, with the gap actually increasing in some countries with strong programs. This disparity may largely reflect that family planning in the region is generally at an earlier stage in its history, and so programs may initially be reaching better-off clients, especially in urban areas. To promote additional equity, programs should emphasize efforts to increase access to voluntary family planning services to the least well-off, including those in rural and peri-urban areas. © Ross.

Improved Reproductive Health Equity Between the Poor and the Rich: An Analysis of Trends in 46 Low- and Middle-Income Countries

PubMed Central

2015-01-01

While several indicators for reproductive health have improved for entire populations, few analyses are available for trends over time in the gaps between the poor and the rich. This paper tracks improvements in the equitable distribution of reproductive health indicators according to wealth quintiles, especially for contraceptive use, in 46 low- and middle-income countries based on national population-based surveys conducted between 1990 and 2013. It focuses on the gaps between the poorest and richest quintiles in the earliest and latest survey rounds across a number of reproductive health indicators related to family planning, fertility desires, antenatal care, and infant and child mortality, as well as on improvements in the absolute levels of contraceptive use by the poorest quintile. Gap changes were decomposed to show how the gaps can either diminish or grow due to either the bottom or top quintile, or both. In addition, bivariate correlation analysis was conducted to examine the relationship of the gaps, and of contraceptive use by the poor, to national family planning program efforts. Overall, the gaps between the poorest and richest have narrowed, due primarily to faster improvements among the poor than the rich. For example, the gap between the richest and poorest in the modern contraceptive prevalence rate has declined by 25%, from a 20.4 percentage point difference to a 15.4 point difference. And the gap has decreased more where family planning programs have been stronger. Across most of 18 other reproductive health indicators, the gaps have also been narrowing. For instance, the poor-rich gap for antenatal care decreased by over a third, from a difference of 30.7 percentage points to 19.6 percentage points. Gaps in infant and child mortality also have declined by about one-third. The pattern for contraceptive use in sub-Saharan Africa, however, has been mixed, with the gap actually increasing in some countries with strong programs. This disparity may largely reflect that family planning in the region is generally at an earlier stage in its history, and so programs may initially be reaching better-off clients, especially in urban areas. To promote additional equity, programs should emphasize efforts to increase access to voluntary family planning services to the least well-off, including those in rural and peri-urban areas. PMID:26374803

Climate change and developing-country cities: implications for environmental health and equity.

PubMed

Campbell-Lendrum, Diarmid; Corvalán, Carlos

2007-05-01

Climate change is an emerging threat to global public health. It is also highly inequitable, as the greatest risks are to the poorest populations, who have contributed least to greenhouse gas (GHG) emissions. The rapid economic development and the concurrent urbanization of poorer countries mean that developing-country cities will be both vulnerable to health hazards from climate change and, simultaneously, an increasing contributor to the problem. We review the specific health vulnerabilities of urban populations in developing countries and highlight the range of large direct health effects of energy policies that are concentrated in urban areas. Common vulnerability factors include coastal location, exposure to the urban heat-island effect, high levels of outdoor and indoor air pollution, high population density, and poor sanitation. There are clear opportunities for simultaneously improving health and cutting GHG emissions most obviously through policies related to transport systems, urban planning, building regulations and household energy supply. These influence some of the largest current global health burdens, including approximately 800,000 annual deaths from ambient urban air pollution, 1.2 million from road-traffic accidents, 1.9 million from physical inactivity, and 1.5 million per year from indoor air pollution. GHG emissions and health protection in developing-country cities are likely to become increasingly prominent in policy development. There is a need for a more active input from the health sector to ensure that development and health policies contribute to a preventive approach to local and global environmental sustainability, urban population health, and health equity.

The Inequality of Climate Change From 1.5 to 2°C of Global Warming

NASA Astrophysics Data System (ADS)

King, Andrew D.; Harrington, Luke J.

2018-05-01

The Paris Agreement aims to keep global warming well below 2°C above preindustrial levels with a preferred ambitious 1.5°C target. Developing countries, especially small island nations, pressed for the 1.5°C target to be adopted, but who will suffer the largest changes in climate if we miss this target? Here we show that exceeding the 1.5°C global warming target would lead to the poorest experiencing the greatest local climate changes. Under these circumstances greater support for climate adaptation to prevent poverty growth would be required.

Socioeconomic Status and Stroke Prevalence in Morocco: Results from the Rabat-Casablanca Study

PubMed Central

Engels, Thomas; Baglione, Quentin; Audibert, Martine; Viallefont, Anne; Mourji, Fouzi; El Alaoui Faris, Mustapha

2014-01-01

Background Stroke is a growing public health concern in low- and middle- income countries. Improved knowledge about the association between socioeconomic status and stroke in these countries would enable the development of effective stroke prevention and management strategies. This study presents the association between socioeconomic status and the prevalence of stroke in Morocco, a lower middle-income country. Methods Data on the prevalence of stroke and stroke-related risk factors were collected during a large population-based survey. The diagnosis of stroke in surviving patients was confirmed by neurologists while health, demographic, and socioeconomic characteristics of households were collected using structured questionnaires. We used Multiple Correspondence Analysis to develop a wealth index based on characteristics of the household dwelling as well as ownership of selected assets. We used logistic regressions controlling for multiple variables to assess the statistical association between socioeconomic status and stroke. Findings Our results showed a significant association between household socioeconomic status and the prevalence of stroke. This relationship was non-linear, with individuals from both the poorest (mainly rural) and richest (mainly urban) households having a lower prevalence of stroke as compared to individuals with medium wealth level. The latter belonged mainly to urban households with a lower socioeconomic status. When taking into account the urban population only, we observed that a third of poorest households experienced a significantly higher prevalence of stroke compared to the richest third (OR = 2.06; CI 95%: 1.09; 3.89). Conclusion We conclude that individuals from the most deprived urban households bear a higher risk of stroke than the rest of the population in Morocco. This result can be explained to a certain extent by the higher presence of behavioral risk factors in this specific category of the population, which leads in turn to metabolic and physiological risk factors of stroke, such as obesity, diabetes, and hypertension. PMID:24586649

Air quality in developing world disaster and conflict zones--the case of post-earthquake Haiti.

PubMed

Davis, Mary E; Rappaport, Ann

2014-10-15

Data on air quality are remarkably limited in the poorest of the world's countries. This is especially true for post-conflict and disaster zones, where international relief efforts focus largely on more salient public health challenges such as water and sanitation, infectious diseases, and housing. Using post-earthquake Haiti as the example case, this commentary explores air quality challenges in the developing world, highlighting concerns related to infrastructure damage from post-conflict and disaster settings. We contend that there is a growing and presently unmet need for further research and attention from the global health community to address these issues. Copyright © 2014 Elsevier B.V. All rights reserved.

Systematic reviews and knowledge translation.

PubMed Central

Tugwell, Peter; Robinson, Vivian; Grimshaw, Jeremy; Santesso, Nancy

2006-01-01

Proven effective interventions exist that would enable all countries to meet the Millennium Development Goals. However, uptake and use of these interventions in the poorest populations is at least 50% less than in the richest populations within each country. Also, we have recently shown that community effectiveness of interventions is lower for the poorest populations due to a "staircase" effect of lower coverage/access, worse diagnostic accuracy, less provider compliance and less consumer adherence. We propose an evidence-based framework for equity-oriented knowledge translation to enhance community effectiveness and health equity. This framework is represented as a cascade of steps to assess and prioritize barriers and thus choose effective knowledge translation interventions that are tailored for relevant audiences (public, patient, practitioner, policy-maker, press and private sector), as well as the evaluation, monitoring and sharing of these strategies. We have used two examples of effective interventions (insecticide-treated bednets to prevent malaria and childhood immunization) to illustrate how this framework can provide a systematic method for decision-makers to ensure the application of evidence-based knowledge in disadvantaged populations. Future work to empirically validate and evaluate the usefulness of this framework is needed. We invite researchers and implementers to use the cascade for equity-oriented knowledge translation as a guide when planning implementation strategies for proven effective interventions. We also encourage policy-makers and health-care managers to use this framework when deciding how effective interventions can be implemented in their own settings. PMID:16917652

Systematic reviews and knowledge translation.

PubMed

Tugwell, Peter; Robinson, Vivian; Grimshaw, Jeremy; Santesso, Nancy

2006-08-01

Proven effective interventions exist that would enable all countries to meet the Millennium Development Goals. However, uptake and use of these interventions in the poorest populations is at least 50% less than in the richest populations within each country. Also, we have recently shown that community effectiveness of interventions is lower for the poorest populations due to a "staircase" effect of lower coverage/access, worse diagnostic accuracy, less provider compliance and less consumer adherence. We propose an evidence-based framework for equity-oriented knowledge translation to enhance community effectiveness and health equity. This framework is represented as a cascade of steps to assess and prioritize barriers and thus choose effective knowledge translation interventions that are tailored for relevant audiences (public, patient, practitioner, policy-maker, press and private sector), as well as the evaluation, monitoring and sharing of these strategies. We have used two examples of effective interventions (insecticide-treated bednets to prevent malaria and childhood immunization) to illustrate how this framework can provide a systematic method for decision-makers to ensure the application of evidence-based knowledge in disadvantaged populations. Future work to empirically validate and evaluate the usefulness of this framework is needed. We invite researchers and implementers to use the cascade for equity-oriented knowledge translation as a guide when planning implementation strategies for proven effective interventions. We also encourage policy-makers and health-care managers to use this framework when deciding how effective interventions can be implemented in their own settings.

Anaesthesia and hospital links: strengthening healthcare through South-North hospital partnerships.

PubMed

Parry, E H O; Percy, D B

2007-12-01

Health services can respond to the needs of the poorest people in developing countries if those who work in the front line of health care are supported and motivated and if development needs in services and training programmes can be filled. This can be achieved when a Health Link between a southern hospital and/or training school and its northern counterpart is designed to build a disciplined and long-term programme of staff development including the needs of anaesthetic services, which meets the needs identified by the southern partner. Development of anaesthetic practice is best carried out in the context of an institution-wide Health Link where not only the staff and systems involved in anaesthesia but all the essential 'back office' or support services are also supported and developed.

Vaccines against enteric infections for the developing world.

PubMed

Czerkinsky, Cecil; Holmgren, Jan

2015-06-19

Since the first licensure of the Sabin oral polio vaccine more than 50 years ago, only eight enteric vaccines have been licensed for four disease indications, and all are given orally. While mucosal vaccines offer programmatically attractive tools for facilitating vaccine deployment, their development remains hampered by several factors: -limited knowledge regarding the properties of the gut immune system during early life; -lack of mucosal adjuvants, limiting mucosal vaccine development to live-attenuated or killed whole virus and bacterial vaccines; -lack of correlates/surrogates of mucosal immune protection; and -limited knowledge of the factors contributing to oral vaccine underperformance in children from developing countries. There are now reasons to believe that the development of safe and effective mucosal adjuvants and of programmatically sound intervention strategies could enhance the efficacy of current and next-generation enteric vaccines, especially in lesser developed countries which are often co-endemic for enteric infections and malnutrition. These vaccines must be safe and affordable for the world's poorest, confer long-term protection and herd immunity, and must be able to contain epidemics. © 2015 The Author(s) Published by the Royal Society. All rights reserved.

Vaccines against enteric infections for the developing world

PubMed Central

Czerkinsky, Cecil; Holmgren, Jan

2015-01-01

Since the first licensure of the Sabin oral polio vaccine more than 50 years ago, only eight enteric vaccines have been licensed for four disease indications, and all are given orally. While mucosal vaccines offer programmatically attractive tools for facilitating vaccine deployment, their development remains hampered by several factors: —limited knowledge regarding the properties of the gut immune system during early life;—lack of mucosal adjuvants, limiting mucosal vaccine development to live-attenuated or killed whole virus and bacterial vaccines;—lack of correlates/surrogates of mucosal immune protection; and—limited knowledge of the factors contributing to oral vaccine underperformance in children from developing countries.There are now reasons to believe that the development of safe and effective mucosal adjuvants and of programmatically sound intervention strategies could enhance the efficacy of current and next-generation enteric vaccines, especially in lesser developed countries which are often co-endemic for enteric infections and malnutrition. These vaccines must be safe and affordable for the world's poorest, confer long-term protection and herd immunity, and must be able to contain epidemics. PMID:25964464

Illiteracy and Poverty. Literacy Lessons.

ERIC Educational Resources Information Center

Adiseshiah, Malcolm S.

There is a close connection between illiteracy and poverty at all levels--global, national, and subnational; the countries with the lowest levels of literacy are also the poorest economically. Poverty breeds illiteracy by forcing children to drop out of school to work, and these illiterate people are forced to stay on the lowest levels of the work…

A resolution supporting the role of the United States in ensuring children in the world's poorest countries have access to vaccines and immunization through Gavi, the Vaccine Alliance.

THOMAS, 113th Congress

Sen. Menendez, Robert [D-NJ

2014-11-13

Senate - 12/04/2014 Placed on Senate Legislative Calendar under General Orders. Calendar No. 614. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

Age- and sex-specific analysis of homicide mortality as a function of economic development: a cross-national comparison.

PubMed

Moniruzzaman, Syed; Andersson, Ragnar

2005-01-01

This study examined the association between homicide rates and GNP per capita (as a measure of economic development) among all age- and sex-specific groups in 53 countries. Cross-sectional data on homicide rates by age- and sex- specific groups were obtained for 53 countries from World Health Statistics Annual 1996. The association between homicide rates and economic development was studied by using two methods: (1) with regression analysis and (2) by categorizing the data into four income-based country groups and then comparing the differences in their mean values. Results indicate that there was a negative correlation between homicide rates and economic development. The association between homicide rates and country GNP per capita became stronger with increasing age. Pearson's product moment correlation coefficient was strongest among older age groups (65+year) in both sexes (male, r = -0.77 and female, r = -0.71). The correlation was weakest and positive among 1- to 4-year-old children (males, r = 0.17 and females, r = 0.07). The homicide rate among females was highest for <1-year-old children in low income countries (LICs) (12.8 per 100,000). Lower middle-income countries are in the stage of high priority where both homicide rates and homicide as percentage of total death are high, and its impact was greatest for young males. However, infanticide as a public health problem seems highly concentrated in the poorest countries, while homicide among small children, 1-4 years old, appears to be a universal phenomenon across all nations.

Technology innovation for infectious diseases in the developing world

PubMed Central

2012-01-01

Enabling innovation and access to health technologies remains a key strategy in combating infectious diseases in low- and middle-income countries (LMICs). However, a gulf between paying markets and the endemicity of such diseases has contributed to the dearth of R&D in meeting these public health needs. While the pharmaceutical industry views emerging economies as potential new markets, most of the world’s poorest bottom billion now reside in middle-income countries--a fact that has complicated tiered access arrangements. However, product development partnerships--particularly those involving academic institutions and small firms--find commercial opportunities in pursuing even neglected diseases; and a growing pharmaceutical sector in BRICS countries offers hope for an indigenous base of innovation. Such innovation will be shaped by 1) access to building blocks of knowledge; 2) strategic use of intellectual property and innovative financing to meet public health goals; 3) collaborative norms of open innovation; and 4) alternative business models, some with a double bottom line. Facing such resource constraints, LMICs are poised to develop a new, more resource-effective model of innovation that holds exciting promise in meeting the needs of global health. PMID:23849080

The tragedy of Haiti: A reason for major cultural change.

PubMed

Brown, Geraldine

2010-01-01

With the recent earthquake in Haiti, it is most befitting to discuss my travel to this poor country more than a decade ago. The travel was a mission that examined the health status and the education of residents in the capital city of Port- au-Prince. After close observation, it seems that the health and educational status then, today and since the tragedy, is basically the same with less, if any, possible improvement. This article examines the present state of health and education of the Haitian people, in the wake of its recent tragedy. Although, the people were very poor in economics, they were rich in culture and exhibited polite mannerisms that made me feel overly welcomed in their homes and to the few resources they had to offer It appears that in past years, this country was and still is noted as the poorest country in the Americas, however, it is not the poorest country in the Western Hemisphere. On many occasions, it has been publicly and widely reported that Haiti experienced political violence throughout its history. The government of Haiti is known for corruption. It also appears that an earthquake the magnitude of 7.0 would not have easily destroyed so many of its infrastructure and people, if in the past, the surrounding countries, including the United States, would have assisted in providing this country with safer and stronger foundations for buildings and especially shelter for the residents and the many visitors who were the true victims. Despite the repressive regime, Haiti's location, history and culture were very attractive to tourists in the 1960s and 1970s. Visitors returned home with memorable artifacts that included cave paintings, wood statues (figurines) and hand made jewelry.

Height of nations: a socioeconomic analysis of cohort differences and patterns among women in 54 low- to middle-income countries.

PubMed

Subramanian, S V; Özaltin, Emre; Finlay, Jocelyn E

2011-04-20

Adult height is a useful biological measure of long term population health and well being. We examined the cohort differences and socioeconomic patterning in adult height in low- to middle-income countries. We analyzed cross-sectional, representative samples of 364,538 women aged 25-49 years drawn from 54 Demographic and Health Surveys (DHS) conducted between 1994 and 2008. Linear multilevel regression models included year of birth, household wealth, education, and area of residence, and accounted for clustering by primary sampling units and countries. Attained height was measured using an adjustable measuring board. A yearly change in birth cohorts starting with those born in 1945 was associated with a 0.0138 cm (95% CI 0.0107, 0.0169) increase in height. Increases in heights in more recent birth year cohorts were largely concentrated in women from the richer wealth quintiles. 35 of the 54 countries experienced a decline (14) or stagnation (21) in height. The decline in heights was largely concentrated among the poorest wealth quintiles. There was a strong positive association between height and household wealth; those in two richest quintiles of household wealth were 1.988 cm (95% CI 1.886, 2.090) and 1.018 cm (95% CI 0.916, 1.120) taller, compared to those in the poorest wealth quintile. The strength of the association between wealth and height was positive (0.05 to 1.16) in 96% (52/54) countries. Socioeconomic inequalities in height remain persistent. Height has stagnated or declined over the last decades in low- to middle-income countries, particularly in Africa, suggesting worsening nutritional and environmental circumstances during childhood.

LONGEVITY IN NORTH KOREA AND SOUTH KOREA: PREVALENCE OF CENTENARIANS IN ONE THE POOREST AND ONE OF THE RICHEST NATIONS.

PubMed

Schwekendiek, Daniel

2018-03-01

Over recent decades, economic living conditions have dramatically improved in South Korea, which now represents one of the most developed nations. At the same time, its twin in the North remains one of the poorest countries on earth. Thus, the Korean peninsula represents a unique historical experiment that allows for study of the effects of environment on human development under a variety of ceteris paribus cultural, genetic and climatic conditions. Previous studies comparing the biosocial performances of the two Koreas have focused on indicators such as weight, height, mid-upper arm circumference and age at menarche. The purpose of the present study was to investigate longevity based on the number of centenarians living in the two Koreas by drawing on censuses implemented around 1925 and 2010. The study found that North Korea had some 0.7 centenarians per one million persons in 1925, and this rate moderately improved to 2.7 around 2010. Conversely, rates skyrocketed in South Korea from 2.7 in 1925 to 38.2 around 2010. This suggests that the rate of centenarians in North Korea around 2010 corresponds to that of South Korea in 1925, suggesting a chronological lag in delayed human development of some 85 years. The prevalence of centenarians is fourteen times higher in contemporary South Korea compared with the North - broadly confirming previous biosocial studies on the two Koreas and two Germanies reporting improved human development in market-oriented systems compared with socialist ones.

Climate Change and Developing-Country Cities: Implications For Environmental Health and Equity

PubMed Central

Corvalán, Carlos

2007-01-01

Climate change is an emerging threat to global public health. It is also highly inequitable, as the greatest risks are to the poorest populations, who have contributed least to greenhouse gas (GHG) emissions. The rapid economic development and the concurrent urbanization of poorer countries mean that developing-country cities will be both vulnerable to health hazards from climate change and, simultaneously, an increasing contributor to the problem. We review the specific health vulnerabilities of urban populations in developing countries and highlight the range of large direct health effects of energy policies that are concentrated in urban areas. Common vulnerability factors include coastal location, exposure to the urban heat-island effect, high levels of outdoor and indoor air pollution, high population density, and poor sanitation. There are clear opportunities for simultaneously improving health and cutting GHG emissions most obviously through policies related to transport systems, urban planning, building regulations and household energy supply. These influence some of the largest current global health burdens, including approximately 800,000 annual deaths from ambient urban air pollution, 1.2 million from road-traffic accidents, 1.9 million from physical inactivity, and 1.5 million per year from indoor air pollution. GHG emissions and health protection in developing-country cities are likely to become increasingly prominent in policy development. There is a need for a more active input from the health sector to ensure that development and health policies contribute to a preventive approach to local and global environmental sustainability, urban population health, and health equity. PMID:17393341

Prevalence and Sociodemographic Correlates of Lifetime Substance Use among a Rural and Diverse Sample of Adolescents

ERIC Educational Resources Information Center

McDermott, Michael J.; Drescher, Christopher F.; Smitherman, Todd A.; Tull, Matthew T.; Heiden, Laurie; Damon, John D.; Hight, Terry L.; Young, John

2013-01-01

Background: Data are limited regarding the prevalence of substance use among adolescents in rural and ethnically diverse communities. This study examined rates and sociodemographic correlates of lifetime substance use among adolescents in Mississippi, a rural state that is the poorest in the country (21.3% poverty rate) and has the largest…

San Ysidro High School: An Invincible Sense of Promise

ERIC Educational Resources Information Center

Principal Leadership, 2013

2013-01-01

Commitment to one another, determination to prove stereotypes wrong, and a strong belief in the power of education are the core values at San Ysidro High School in San Diego, California. The school serves 2,364 students in one of the poorest communities in the country. The community celebrates its predominately Mexican-American heritage and…

Right along the Border: Mexican-American Students Write Themselves into The(ir) World

ERIC Educational Resources Information Center

Zwerling, Philip

2009-01-01

Hidalgo County, Texas, is one of the poorest in the country. The population in the Lower Rio Grande Valley is 85% Mexican-American. Underprepared for college and juggling full time jobs, their own children, and sometimes dysfunctional extended families, students often do not expect to succeed. I recently taught a Creative Writing course which…

Five Propositions That Explain Why Schools Struggle to Improve Social Mobility

ERIC Educational Resources Information Center

Barker, Bernard; Hoskins, Kate

2016-01-01

Government plans to increase social mobility in the United Kingdom place a strong emphasis on improving education to ensure more equal life chances for everyone. As Secretary of State for Education between 2010 and 2014, Michael Gove declared that he was "determined to do everything I can to help the poorest children in our country"…

A new index to assess nitrogen dynamics in potato (Solanum tuberosum L.) production systems of Bolivia

USDA-ARS?s Scientific Manuscript database

Bolivia is the poorest country in South America with over 80% of the rural population under the poverty line. Agricultural productivity is closely correlated with poverty levels across rural Bolivia. Potato (Solanum tuberosum L.) is one of the most important crops for food security in Bolivia and th...

Warfare and children.

PubMed

Shann, Frank

2010-05-01

In 2007, 136 million children were born in the world, and 9.2 million died before they were 5 years old; 99.8% of these deaths were in developing countries, and 8.2 million were unnecessary. This is 23 000 unnecessary deaths every day. Approximately 0.2 million children die from the direct effects of war every year, and at least twice as many die from the indirect effects. However, most child deaths are caused by common childhood infections in communities that are not affected by war. In 2007, overseas development aid totalled only $104 billion, and world military expenditure totalled US$1339 billion. The 49 poorest countries in the world have a population of 1.3 billion; they spent only $27 per person on health in 2006, but the world spent $201 per person on military activity. The five permanent members of the United Nations Security Council account for 90% of weapons sales to developing countries, yet they are the very countries that have accepted responsibility for ensuring world security. Unfortunately, many governments in both rich and poor countries do not want to limit military spending - the vested interests that support military activity are too powerful. War is immensely harmful, but not primarily because of the horrible injuries, nor the large number of deaths it causes indirectly from infection, malnutrition, and social and political disruption. By far, the greatest harm comes from the diversion of huge amounts of money that could be used for beneficial development into harmful and destructive military activity.

Impact of reproductive health on socio-economic development: a case study of Nigeria.

PubMed

Adinma, J I B; Adinma, E D

2011-03-01

The link between reproductive health, sexual and reproductive right, and development was highlighted at the International Conference on Population and Development held in Egypt. Developmental disparities are related to socio-economic differences which have led to the identification of distinct socio-economic classifications of nations. Human development represents the socioeconomic standing of any nation, in addition to literacy status and life expectancy. Africa accounts for 25% of the world's landmass but remains the world's poorest continent. Nigeria, the most populous country in Africa, has policies and programmes geared towards the improvement of its socio-economic standing and overal development, with little positive result. Reproductive health is a panacea towards reversing the stalled socio-economic growth of Nigeria as evident from the linkage between reproductive health and development, highlighted in Millennium Development Goals 3, 4, 5 and 6. Fast tracking Nigeria's development requires implementation of reproductive health policies and programmes targeted on women and children.

Levels, Trends and Disparities in Public-Health-Related Indicators among Reproductive-Age Women in Bangladesh by Urban-Rural and Richest-Poorest Groups, 1993-2011

PubMed Central

Khan, Md. Mobarak Hossain; Zanuzdana, Arina; Kraemer, Alexander

2013-01-01

Background And Objectives Although Bangladesh has already achieved noticeable progress in the field of development and health, disparities in public health indicators for several markers are still reported. To assess public health development in Bangladesh during the last two decades, firstly, we analysed levels, trends and disparities in public-health-related indicators by rural versus urban as well as by the richest versus poorest group of women who have ever been married. Secondly, using the most recent data set we performed multiple analyses to check whether urban-rural and richest-poorest disparities were still significant. Methods The analysis was based on six nationally representative data sets from the Bangladesh Demographic and Health Surveys (BDHS) conducted in 1993-94 (n=9,640), 1996-1997 (n=9,127), 1999-2000 (n=10,544), 2004 (n=11,440), 2007 (n=10,996) and 2011 (n=17,749). The outcome variables were six selected public-health-related indicators. We performed various types of analyses, including multiple logistic regressions. Results The trend of all indicators except being overweight (1993-2011) displayed gradual improvements for both markers. However, the urban and richest groups revealed a better situation than their counterparts in both simple and multiple analyses. Disparities between richest-poorest groups were more pronounced than urban-rural disparities. For instance, the prevalence of delivery at any healthcare facility in 2011 was 20.4% in rural areas and 46.5% in urban areas, whereas it was 9.1% in the poorest group and 57.6% in the richest group. Conclusion The public health sector in Bangladesh has achieved some successes over the last two decades. However, urban-rural and richest-poorest disparities are still considerable and therefore more public health strategies and efforts are clearly needed for the rural and poorest groups of women in order to reduce these gaps further. PMID:24086485

Examining the relationship between socioeconomic status and the double burden of maternal over and child under-nutrition in Bangladesh.

PubMed

Hauqe, Syed Emdadul; Sakisaka, Kayako; Rahman, Mosiur

2018-04-25

There is little research on the association between socioeconomic status (SES) and the familial co-existence of maternal over and child under-nutrition (MOCU). Most of these studies conducted in the Latin American countries. Therefore, we intended to further this important area of query by exploring the relationship between SES and the dual burden of MOCU in Bangladesh. We used data from the 2014 Bangladesh Demographic Health Survey (BDHS). The analyses were based on the responses of 5687 mother-child pairs. We focused standard of living (hereafter referred to as wealth) as a measure of SES. We determined MOCU if there were an undernourished child and an overweight mother in the same household. Maternal overweight and MOCU prevalence is higher among the wealthier segment whereas prevalence of child under-nutrition is higher among the poorest segment of the households. The relative risk of a household having MOCU increased by the factors of 2.84 (confidence interval (CI) = 1.58-5.12) among households with richest bands of wealth compared to the poorest category. Household from the medium (Relative risk ratio (RRR) = 1.87, 95% CI = 1.07-3.28) and richer SES groups (RRR = 2.56, 95% CI = 1.39-4.69) had increased chance for MOCU as compared to the household from poorest SES group. As opposed to findings from other Latin American countries, the prevalence of MOCU in Bangladesh is higher in the wealthiest households. Findings of our study therefore suggest that overweight prevention programs in wealthier households of Bangladesh need to think out the possibility that their focus households may also include underweight persons.

Why are the poor less covered in Ghana's national health insurance? A critical analysis of policy and practice.

PubMed

Kotoh, Agnes Millicent; Van der Geest, Sjaak

2016-02-25

The National Health Insurance Scheme (NHIS) was introduced in Ghana to ensure equity in healthcare access. Presently, some low and middle income countries including Ghana are using social health insurance schemes to reduce inequity in access to healthcare. In Ghana, the NHIS was introduced to address the problem of inequity in healthcare access in a period that was characterised by user-fee regimes. The premium is heavily subsidised and exemption provided for the poorest, yet studies reveal that they are least enrolled in the scheme. We used a multi-level perspective as conceptual and methodological tool to examine why the NHIS is not reaching the poor as envisaged. Fifteen communities in the Central and Eastern Regions of Ghana were surveyed after implementing a 20 months intervention programme aimed at ensuring that community members have adequate knowledge of the NHIS' principles and benefits and improve enrollment and retention rates. Observation and in-depth interviews were used to gather information about the effects of the intervention in seven selected communities, health facilities and District Health Insurance Schemes in the Central Region. The results showed a distinct rise in the NHIS' enrollment among the general population but the poor were less covered. Of the 6790 individuals covered in the survey, less than half (40.3 %) of the population were currently insured in the NHIS and 22.4 % were previously insured. The poorest had the lowest enrollment rate: poorest 17.6 %, poor 31.3 %, rich 46.4 % and richest 44.4 % (p = 0.000). Previous enrollment rates were: poorest (15.4 %) and richest (23.8 %), (p = 0.000). Ironically, the poor's low enrollment was widely attributed to their poverty. The underlying structural cause, however, was policy makers' and implementers' lack of commitment to pursue NHIS' equity goal. Inequity in healthcare access persists because of the social and institutional environment in which the NHIS operates. There is a need to effectively engage stakeholders to develop interventions to ensure that the poor are included in the NHIS.

Inequality, poverty and development.

PubMed

Ahluwalia, M S

1976-12-01

Dicussion explores the nature of the relationship between the distribution of income and the process of development on the basis of cross country data on income inequality. The results presented are based on a sample of 60 countries, including 40 developing countries, 14 developed countries, and 6 socialist countries. The approach adopted is essentially exploratory. Multivariate regression analysis was used to estimate cross country relationships between the income shares of different percentile groups and selected variables reflecting aspects of the development process which are likely to influence income inequality. The estimated equations are then used as a basis for broad generalizations about the relationship between income distribution and development. There was strong support for the proposition that relative inequaltiy increases substantially in the early stages of development, with a reversal of this tendency in the later stages. The propositions held whether the sample was restricted to developing countries or expanded to include developed and socialist countries. The process was most prolonged for the poorest group. There were a number of processes occurring "pari passu" with development which were correlated with income inequality and which can plausibly be interpreted as causal. These were intersectoral shifts in the structure of production, expansion in education attainment and skill level of the labor force; and reduction in the growth of population. The operation of these processes appeared to explain some of the improvement in income distribution observed in the later stages of development, but they did not serve to explain the marked deterioration observed in the earlier stages. The cross section results failed to support the stronger hypothesis that the deterioration in relative inequality reflected a prolonged absolute impoverishment of large sections of the population in the course of development. The cross country pattern showed average absolute incomes of the lower percentile groups rising as per capita gross national product rises, although slower than for upper income groups. The cross section results failed to support the view that a faster rate of growth is systematically associated with higher inequality than can be expected given the state of development realized. An appendix identifies data sources and problems.

Basic Needs and Wealth as Independent Determinants of Happiness: An Illustration from Thailand

ERIC Educational Resources Information Center

Guillen-Royo, Monica; Velazco, Jackeline; Camfield, Laura

2013-01-01

Thailand has been a global economic success story, transforming from one of the poorest countries in Southeast Asia in the 1960s, to a modern and dynamic nation, and all within the lifetime of the current generation. However, growth has been accompanied by marked increases in economic inequality both at the regional and individual levels. In this…

Transforming Lives. EDC Annual Report, 2006

ERIC Educational Resources Information Center

Davis-Kay, Jennifer, Ed.

2007-01-01

Highlights of the 2006 Annual Report include: (1) Program outreach to more than half a million teachers in all 50 states and 50 countries outside of the U.S. via distance-learning tools to provide teachers in some of the poorest and most remote regions of the world with up-to-date materials and training; (2) Advisors to the board of the National…

Investing in Low-Wage Workers: Lessons from Family Child Care in Rhode Island

ERIC Educational Resources Information Center

Roder, Anne; Seavey, Dorie

2006-01-01

While child care is one of the fastest growing occupations in the country, most employment in this field is precarious and low-wage. Investing in Low-Wage Workers profiles the Day Care Justice Co-op, a group of largely Latina and African American women living and working in some of Rhode Island's poorest communities. Determined to improve family…

Care arrangements for people with dementia in developing countries.

PubMed

Prince, Martin

2004-02-01

Rapid demographic ageing will soon lead to large increases in the numbers of persons with dementia in developing countries. This study is the first comprehensive assessment of care arrangements for people with dementia in those regions. A descriptive and comparative study of dementia care; caregiver characteristics, the nature of care provided, and the practical, psychological (Zarit Burden Interview, General Health Questionnaire) and economic impact upon the caregiver in 24 centres in India, China and South East Asia, Latin America and the Caribbean and Africa. We interviewed 706 persons with dementia, and their caregivers. Most caregivers were women, living with the person with dementia in extended family households. One-quarter to one-half of households included a child. Larger households were associated with lower caregiver strain, where the caregiver was co-resident. However, despite the traditional apparatus of family care, levels of caregiver strain were at least as high as in the developed world. Many had cutback on work to care and faced the additional expense of paid carers and health services. Families from the poorest countries were particularly likely to have used expensive private medical services, and to be spending more than 10% of the per capita GNP on health care. Older people in developing countries are indivisible from their younger family members. The high levels of family strain identified in this study feed into the cycle of disadvantage and should thus be a concern for policymakers in the developing world. Copyright 2004 John Wiley & Sons, Ltd.

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

PubMed Central

2018-01-01

Abstract Objective To examine the impact of a 50% increase in market prices of cigarettes on health, poverty, and financial protection. Design Compartmental model study. Setting 13 middle income countries, totalling two billion men. Participants 500 million male smokers. Main outcome measures Life years gained, averted treatment costs, number of men avoiding catastrophic healthcare expenditures and poverty, and additional tax revenue by income group. Results A 50% increase in cigarette prices would lead to about 450 million years of life gained across the 13 countries from smoking cessation, with half of these in China. Across all countries, men in the bottom income group (poorest 20% of the population) would gain 6.7 times more life years than men in the top income group (richest 20% of the population; 155 v 23 million). The average life years gained from cessation for each smoker in the bottom income group was 5.1 times that of the top group (1.46 v 0.23 years). Of the $157bn (£113bn; €127bn) in averted treatment costs, the bottom income group would avert 4.6 times more costs than the top income group ($46bn v $10bn). About 15.5 million men would avoid catastrophic health expenditures in a subset of seven countries without universal health coverage. As result, 8.8 million men, half of them in the bottom income group, would avoid falling below the World Bank definition of extreme poverty. These 8.8 million men constitute 2.4% of people living in extreme poverty in these countries. In contrast, the top income group would pay twice as much as the bottom income group of the $122bn additional tax collected. Overall, the bottom income group would get 31% of the life years saved and 29% each of the averted disease costs and averted catastrophic health expenditures, while paying only 10% of the additional taxes. Conclusions Higher prices of cigarettes provide more health and financial gains to the poorest 20% than to the richest 20% of the population. Higher excise taxes support the targets of the sustainable development goals on non-communicable diseases and poverty, and provides financial protection against illness. PMID:29643096

Nature's role in sustaining economic development

PubMed Central

Dasgupta, Partha

2010-01-01

In this paper, I formalize the idea of sustainable development in terms of intergenerational well-being. I then sketch an argument that has recently been put forward formally to demonstrate that intergenerational well-being increases over time if and only if a comprehensive measure of wealth per capita increases. The measure of wealth includes not only manufactured capital, knowledge and human capital (education and health), but also natural capital (e.g. ecosystems). I show that a country's comprehensive wealth per capita can decline even while gross domestic product (GDP) per capita increases and the UN Human Development Index records an improvement. I then use some rough and ready data from the world's poorest countries and regions to show that during the period 1970–2000 wealth per capita declined in South Asia and sub-Saharan Africa, even though the Human Development Index (HDI) showed an improvement everywhere and GDP per capita increased in all places (except in sub-Saharan Africa, where there was a slight decline). I conclude that, as none of the development indicators currently in use is able to reveal whether development has been, or is expected to be, sustainable, national statistical offices and international organizations should now routinely estimate the (comprehensive) wealth of nations. PMID:20008380

Nature's role in sustaining economic development.

PubMed

Dasgupta, Partha

2010-01-12

In this paper, I formalize the idea of sustainable development in terms of intergenerational well-being. I then sketch an argument that has recently been put forward formally to demonstrate that intergenerational well-being increases over time if and only if a comprehensive measure of wealth per capita increases. The measure of wealth includes not only manufactured capital, knowledge and human capital (education and health), but also natural capital (e.g. ecosystems). I show that a country's comprehensive wealth per capita can decline even while gross domestic product (GDP) per capita increases and the UN Human Development Index records an improvement. I then use some rough and ready data from the world's poorest countries and regions to show that during the period 1970-2000 wealth per capita declined in South Asia and sub-Saharan Africa, even though the Human Development Index (HDI) showed an improvement everywhere and GDP per capita increased in all places (except in sub-Saharan Africa, where there was a slight decline). I conclude that, as none of the development indicators currently in use is able to reveal whether development has been, or is expected to be, sustainable, national statistical offices and international organizations should now routinely estimate the (comprehensive) wealth of nations.

Patents and access to drugs in developing countries: an ethical analysis.

PubMed

Sterckx, Sigrid

2004-05-01

More than a third of the world's population has no access to essential drugs. More than half of this group of people live in the poorest regions of Africa and Asia. Several factors determine the accessibility of drugs in developing countries. Hardly any medicines for tropical diseases are being developed, but even existing drugs are often not available to the patients who need them. One of the important determinants of access to drugs is the working of the patent system. This paper first maps out some facts about the global patent regime that has emerged as a consequence of the conclusion of the WTO-TRIPs Agreement in 1994. Attempts to construct a moral justification of the patent system have been based on three grounds: natural rights, distributive justice, and utilitarian arguments. This paper examines to what extent and on which grounds drug patents can be justified. The final section looks at the so-called 'Doha Declaration on the TRIPs Agreement and Public Health', which was adopted by the WTO Ministerial Conference two years ago, recognising the primacy of public health over the interests of patent proprietors.

The Cairo crunch.

PubMed

Myers, N

1994-01-01

The emphasis on excessive population growth in developing countries has diverted attention from the equally significant issue of excessive consumption in developed countries. For example, the rich nations, which contain only 22% of the world's population, cause 74-87% of major pollutants and consume 76-92% of global natural resources each year. While the world's wealthiest 1 billion people have doubled their consumption of meat, energy, steel, copper, and timber since 1950, there has been no increase among the poorest 1 billion. The worldwide value of luxury goods is equivalent to two-thirds of the gross national products of all Third World countries. Although the mass media's introduction into the Third World has raised the aspirations of the world's poor, stores of nonrenewable raw materials would be depleted within a decade if the standard of living were to be equalized. Even if per capita consumption worldwide declines to 2% per year from its current level of 3%, the sustainable capacity of the Earth is in jeopardy. The threat to the continued ability of the planet to sustain life and to the dignity of the have-nots could be ameliorated by a combination of measures, including zero population growth in developed countries, increased foreign aid to population programs in the Third World, production of goods that require fewer raw materials and generate less pollution, and reduced consumption in the North.

Engaging Patients through Mobile Phones: Demonstrator Services, Success Factors, and Future Opportunities in Low and Middle-income Countries

PubMed Central

Hartzler, A.

2014-01-01

Summary Objectives Evolving technology and infrastructure can benefit patients even in the poorest countries through mobile health (mHealth). Yet, what makes mobile-phone-based services succeed in low and middle-income countries (LMIC) and what opportunities does the future hold that still need to be studied. We showcase demonstrator services that leverage mobile phones in the hands of patients to promote health and facilitate health care. Methods We surveyed the recent biomedical literature for demonstrator services that illustrate well-considered examples of mobile phone interventions for consumer health. We draw upon those examples to discuss enabling factors, scalability, reach, and potential of mHealth as well as obstacles in LMIC. Results Among the 227 articles returned by a PubMed search, we identified 55 articles that describe services targeting health consumers equipped with mobile phones. From those articles, we showcase 19 as demonstrator services across clinical care, prevention, infectious diseases, and population health. Services range from education, reminders, reporting, and peer support, to epidemiologic reporting, and care management with phone communication and messages. Key achievements include timely adherence to treatment and appointments, clinical effectiveness of treatment reminders, increased vaccination coverage and uptake of screening, and capacity for efficient disease surveillance. We discuss methodologies of delivery and evaluation of mobile-phone-based mHealth in LMIC, including service design, social context, and environmental factors to success. Conclusions Demonstrated promises using mobile phones in the poorest countries encourage a future in which IMIA takes a lead role in leveraging mHealth for citizen empowerment through Consumer Health Informatics. PMID:25123741

Engaging Patients through Mobile Phones: Demonstrator Services, Success Factors, and Future Opportunities in Low and Middle-income Countries.

PubMed

Hartzler, A; Wetter, T

2014-08-15

Evolving technology and infrastructure can benefit patients even in the poorest countries through mobile health (mHealth). Yet, what makes mobile-phone-based services succeed in low and middle-income countries (LMIC) and what opportunities does the future hold that still need to be studied. We showcase demonstrator services that leverage mobile phones in the hands of patients to promote health and facilitate health care. We surveyed the recent biomedical literature for demonstrator services that illustrate well-considered examples of mobile phone interventions for consumer health. We draw upon those examples to discuss enabling factors, scalability, reach, and potential of mHealth as well as obstacles in LMIC. Among the 227 articles returned by a PubMed search, we identified 55 articles that describe services targeting health consumers equipped with mobile phones. From those articles, we showcase 19 as demonstrator services across clinical care, prevention, infectious diseases, and population health. Services range from education, reminders, reporting, and peer support, to epidemiologic reporting, and care management with phone communication and messages. Key achievements include timely adherence to treatment and appointments, clinical effectiveness of treatment reminders, increased vaccination coverage and uptake of screening, and capacity for efficient disease surveillance. We discuss methodologies of delivery and evaluation of mobile-phone-based mHealth in LMIC, including service design, social context, and environmental factors to success. Demonstrated promises using mobile phones in the poorest countries encourage a future in which IMIA takes a lead role in leveraging mHealth for citizen empowerment through Consumer Health Informatics.

The potential impact of plant biotechnology on the Millennium Development Goals.

PubMed

Yuan, Dawei; Bassie, Ludovic; Sabalza, Maite; Miralpeix, Bruna; Dashevskaya, Svetlana; Farre, Gemma; Rivera, Sol M; Banakar, Raviraj; Bai, Chao; Sanahuja, Georgina; Arjó, Gemma; Avilla, Eva; Zorrilla-López, Uxue; Ugidos-Damboriena, Nerea; López, Alberto; Almacellas, David; Zhu, Changfu; Capell, Teresa; Hahne, Gunther; Twyman, Richard M; Christou, Paul

2011-03-01

The eight Millennium Development Goals (MDGs) are international development targets for the year 2015 that aim to achieve relative improvements in the standards of health, socioeconomic status and education in the world's poorest countries. Many of the challenges addressed by the MDGs reflect the direct or indirect consequences of subsistence agriculture in the developing world, and hence, plant biotechnology has an important role to play in helping to achieve MDG targets. In this opinion article, we discuss each of the MDGs in turn, provide examples to show how plant biotechnology may be able to accelerate progress towards the stated MDG objectives, and offer our opinion on the likelihood of such technology being implemented. In combination with other strategies, plant biotechnology can make a contribution towards sustainable development in the future although the extent to which progress can be made in today's political climate depends on how we deal with current barriers to adoption.

Informal care motivations and intergenerational transfers in European countries.

PubMed

Jiménez-Martín, Sergi; Vilaplana Prieto, Cristina

2015-03-01

This work sets out to analyze the motivations adult children may have to provide informal care, considering the monetary transfers they receive from their parents. Traditional motivations, such as altruism and exchange, are matched against more recent social bond theories. Our findings indicate that informal caregivers receive less frequent and less generous transfers than non-caregivers; that is, caregivers are more prone to suppress their self-interested motivations in order to prioritize the well being of another person. Additionally, long-term public care benefits increase both the probability of receiving a transfer and its amount, with this effect being more intense for both the poorest and richest households. Our findings suggest that if long-term care benefits are intended to increase the recipients' welfare and represent a higher fraction of total income for the poorest households, the effectiveness of these long-term care policies may be diluted. Copyright © 2015 John Wiley & Sons, Ltd.

Towards achieving Abuja targets: identifying and addressing barriers to access and use of insecticides treated nets among the poorest populations in Kenya.

PubMed

Chuma, Jane; Okungu, Vincent; Ntwiga, Janet; Molyneux, Catherine

2010-03-16

Ensuring that the poor and vulnerable population benefit from malaria control interventions remains a challenge for malaria endemic countries. Until recently, ownership and use of insecticides treated nets (ITNs) in most countries was low and inequitable, although coverage has increased in countries where free ITN distribution is integrated into mass vaccination campaigns. In Kenya, free ITNs were distributed to children aged below five years in 2006 through two mass campaigns. High and equitable coverage were reported after the campaigns in some districts, although national level coverage remained low, suggesting that understanding barriers to access remains important. This study was conducted to explore barriers to ownership and use of ITNs among the poorest populations before and after the mass campaigns, to identify strategies for improving coverage, and to make recommendations on how increased coverage levels can be sustained. The study was conducted in the poorest areas of four malaria endemic districts in Kenya. Multiple data collection methods were applied including: cross-sectional surveys (n = 708 households), 24 focus group discussions and semi-structured interviews with 70 ITN suppliers. Affordability was reported as a major barrier to access but non-financial barriers were also shown to be important determinants. On the demand side key barriers to access included: mismatch between the types of ITNs supplied through interventions and community preferences; perceptions and beliefs on illness causes; physical location of suppliers and; distrust in free delivery and in the distribution agencies. Key barriers on the supply side included: distance from manufacturers; limited acceptability of ITNs provided through interventions; crowding out of the commercial sector and the price. Infrastructure, information and communication played a central role in promoting or hindering access. Significant resources have been directed towards addressing affordability barriers through providing free ITNs to vulnerable groups, but the success of these interventions depends largely on the degree to which other barriers to access are addressed. Only if additional efforts are directed towards addressing non-financial barriers to access, will high coverage levels be achieved and sustained.

ACE, Place, Race, and Poverty: Building Hope for Children.

PubMed

Bruner, Charles

Adverse childhood experiences research has focused attention on the importance of family safety, stability, and nurturing in ensuring healthy development. This safety, stability, and nurturing can be compromised by family poverty, discrimination and marginalization, and geographic location. Drawing upon census data, this report shows that place, race, and poverty are intertwined concepts with particular implications for young children. Examining census tracts according to their levels of poverty shows that the poorest census tracts also: 1) are the "richest" in the proportion of young children, 2) have the least realized social, physical, and educational, as well as economic capital, and 3) are highly racially segregated and separated from many sources of economic opportunity. The implications are that the country's poorest neighborhoods require substantially more supports for young children but currently have many fewer. This includes individual services to young children and their families but also publicly available services and voluntary supports, such as parks, playgrounds, and libraries. These data suggest that improving child health trajectories and reducing health disparities according to race and socioeconomic status therefore will require concerted individual service as well as community-building efforts directed to poor and usually racially segregated neighborhoods and communities. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

State of emergency medicine in Rwanda 2015: an innovative trainee and trainer model.

PubMed

Mbanjumucyo, Gabin; DeVos, Elizabeth; Pulfrey, Simon; Epino, Henry M

2015-01-01

The 1994 Rwandan war and genocide left more than 1 million people dead; millions displaced; and the country's economic, social, and health infrastructure destroyed. Despite remaining one of the poorest countries in the world, Rwanda has made remarkable gains in health, social, and economic development over the last 20 years, but modern emergency care has been slow to progress. Rwanda has recently established the Human Resources for Health program to rapidly build capacity in multiple sectors of its healthcare delivery system, including emergency medicine. This project involves multiple medical and surgical residencies, nursing programs, allied health professional trainings, and hospital administrative support. A real strength of the program is that trainers work with international faculty at Rwanda's referral hospital, but also as emergency medicine specialty trainers when returning to their respective district hospitals. Rwanda's first emergency medicine trainees are playing a unique and important role in the implementation of emergency care systems and education in the country's district hospitals. While there has been early vital progress in building emergency medicine's foundations in Rwanda, there remains much work to be done. This will be accomplished with careful planning and strong commitment from the country's healthcare and emergency medicine leaders.

Medical tourism's impact on health care equity and access in low- and middle-income countries: making the case for regulation.

PubMed

Chen, Y Y Brandon; Flood, Colleen M

2013-01-01

There is currently an evidentiary gap in the scholarship concerning medical tourism's impact on low- and middle-income destination countries (LMICs). This article reviews relevant evidence that exists and concludes that there are signs of correlation between medical tourism and the expansion of private, technology- intensive health care in LMICs, which has largely remained out of reach for the majority of the local patients. In light of this health care inequity between local residents and medical tourists in LMICs, we argue that the presumption should not be in favor of medical tourism and that governments have a legitimate interest in seeking to regulate this industry to ensure that the net effects for their citizens is positive. Moreover, sending countries, particularly those in the developed world, have the responsibility to adopt public policies to diminish demand on the part of their citizens for medical tourism and to work with LMICs to ensure that the growth of medical tourism does not occur at the expense of the poorest of the poor. © 2013 American Society of Law, Medicine & Ethics, Inc.

Interventional bioethics: epistemology for peripheral countries.

PubMed

Garrafa, Volnei; Porto, Dora

2008-01-01

Principlism, which originated in the United States based on four supposedly universal principles, brought international visibility to the field of bioethics over the final years of the twentieth century. Nevertheless, from 1990 onwards, criticism regarding the universal applicability of these principles emerged, especially concerning their limitations in dealing with collective macroproblems--social, sanitary and environmental--that are seen in poor developing countries every day. In this respect, the idea of Intervention Bioethics was presented at the University of Brasília, Brazil, in 1998, and was subsequently expanded to encompass other Latin American countries. From the outset, this epistemological proposal of third-world construction and perspective advocated politicisation of the international bioethics agenda, and this aim was achieved through the content of UNESCO's Universal Declaration on Bioethics and Human Rights, which was adopted in 2005. Grounded in a utilitarian and consequentialistic approach, Intervention Bioethics gives priority, ahead of vulnerabilities relating to gender, sexual orientation, ethnicity and similar considerations, to the fields of social and sanitary justice in order to defend the poorest and most disempowered populations in the asymmetrical contemporary world.

Drug companies cut HIV drug prices in the developing world.

PubMed

Yamey, G

2000-05-20

The UN has reported that five multinational pharmaceutical companies would cut down HIV drug prices in the developing world. One of these drug companies is GlaxoWellcome, which has promised to reduce the price of zidovudine and lamivudine to US$2 in the poorest nations, a fifth of its price in the US. Although Peter Piot, director of the UN Program on HIV/AIDS, welcomed the companies' promises, he warned that price cuts alone will not curb the epidemic. He stated that this initiative is only one critical factor in what must become a much broader and more urgent effort to help people living with HIV/AIDS. Moreover, health and development agencies expressed concern that AIDS drugs will still be unaffordable for the vast majority of those in need in developing countries. In addition, poor countries lack the infrastructure to deliver these drugs safely and effectively. During the time of the UN announcement, US President Bill Clinton also signed an executive order allowing sub-Saharan Africa to adopt legal measures to obtain cheap HIV drugs. Meanwhile, South Africa's reaction to the offer to cut antiretroviral drug prices has been lukewarm.

Laos: development against all the odds.

PubMed

1979-10-01

Laos, with a $90 per capita income, is one of the world's poorest 15 countries. In Asia, only Bhutan is poorer. The French, when they departed, left no infrastructure for development, and the Americans, during the Vietnam war, desolated most of the area known as the Plain of Jars by bombing. At present, 750,000 persons out of a total population of 3.3 million are officially termed "displaced." Nevertheless, the Pathet Lao government, with financial aid from the World Bank and from Sweden, has initiated development policies which are beginning to have some effect. Rice production is the first priority because last year the government had to buy 120,000 tons on the open market with precious foreign currency. Irrigation schemes are being vigorously promoted, and one of them is maintained by the American Friends Service. Literacy is another priority; Lao is the official language. The absence of good roads, however, continues to hamper communications, there is a shortage of transport, no railways, and large areas of arable land still remain unusable. The country is rich in mineral resources and forest products, especially teak, but much of the present development is confined to the area immediately around the capital, Vientiane.

The economic dimensions of malnutrition in young children.

PubMed

Reutlinger, S; Selowsky, M

1979-06-01

1 billion people - 1/3 of them children under the age of 10 - live on diets that are deficient in essential calories. Focus in this discussion is on the magnitude of the problem. The economic implications of specific intervention programs designed to solve the problem are reviewed. Caloric intake is closely associated with per capita income, and malnutrition characterizes the poorest segments of the population. Since the lowest-income groups have larger families, the incidence of malnutrition among children is certain to be higher than the incidence among adults. 3 factors will determine whether, on the basis of current trends, caloric malnutrition can be expected to be eliminated among the poorest segments of the population of the development countries: 1) the future income growth of the malnourished groups; 2) their propensity to use additional income to increase their caloric consumption; and 3) the future changes in the relative price of the main staples, basically cereals. The problem of malnutrition cannot be resolved quickly enough without explicit measures to raise the level of caloric consumption. Governments can initiate a wide range of programs and policies in an effort to augment the caloric consumption of children in the target population - transfer of cash to target households, target group oriented food programs, and food stamps for certain groups. In order for a food program to have more of an effect on consumption than would an equivalent transfer of income, 2 conditions need to be met: 1) the food must be made available at lower prices and in larger quantities than that previously consumed; and 2) reselling of the food must be precluded. In sum, the only effective solution for dealing with the problem of malnutrition among children of developing countries is either a more equitable distribution of income or supplying the food to the target population at a price far below its normally supply price.

The equity impacts of community financing activities in three African countries.

PubMed

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

2000-01-01

Although the Bamako Initiative from its very beginning was caught up in wider debates about the potential equity impact of any form of user financing, to date there has been little empirical investigation of this impact. This three-country study, undertaken in Benin, Kenya and Zambia in 1994/95, was initiated to add to the body of relevant evidence. It sought to understand not only what had been the equity impacts of community financing activities in these countries but also how they had been brought about. As a result, it investigated equity primarily through consideration of the design of these financing activities and through the perceptions of different actors, within a limited number of purposively selected geographical areas in each country, about their strengths and weaknesses. Additional data on utilization were either collected during the course of the study (Kenya) or drawn from other available studies (Benin and Zambia). Key issues considered in the studies' assessment of equity were the extent to which both relative and absolute affordability gains were achieved, as well as as an influence over both the distributional and procedural justice of the financing activities, the pattern of decision-making. Across countries there was evidence of relative affordability gains in Benin and Kenya, but Kenyan gains were not sustained over time and no such gains were identified in Zambia. In addition, no country had given attention either to the issue of absolute affordability, through the implementation of effective exemption mechanisms to protect the poorest from the burden of payment, or to the establishment of community decision-making bodies that effectively represented the interests of all groups including the poorest. Overall, therefore, although the Benin Bamako Initiative programme might be judged as successful in terms of what appear to be its own equity objectives, the other two countries' schemes had clear equity problems even in these terms. The experience across countries also highlights the unresolved question of whether equity is concerned with the greatest good for the greatest number or with promoting the interests of the most disadvantaged.

Comparative study of the silica and cation geothermometry of the Malawi hot springs: Potential alternative energy source

NASA Astrophysics Data System (ADS)

Dulanya, Zuze; Morales-Simfors, Nury; Sivertun, Åke

2010-06-01

Malawi is one of the poorest countries in the world and one of the most densely populated in south-eastern Africa. Its major power source is hydro-electricity. During the past few years, the power generation capacity has been reduced, which has impacted negatively on the socio-economic development of the country. The country holds an enormous potential to generate geothermal energy due to the country's position within the Great African Rift valley. This could contribute to economic growth, poverty reduction and technological development in Malawi. The paper presents findings of research on comparisons between silica (quartz and chalcedony) and cation geothermometers (Na-K, Na-K-Ca and K-Mg) of hot springs in the Malawi Rift, in order to deduce the temperature at depth of selected hot springs. The saturation indices of most springs have a bearing on the geology of the areas where these hot springs are found. The Na-K geothermometers are, in general, higher than the Na-K-Ca geothermometer and the K-Mg geothermometer shows temperatures that are too low to be considered. The difference in the results between the different geothermometers may indicate shallow conditions of mixing with groundwater. Results also indicate that some hot springs have sufficient heat-generating capabilities and warrant further exploration work to assess their suitability for energy generation.

Developing and implementing mental health policy in Zanzibar, a low income country off the coast of East Africa

PubMed Central

2011-01-01

Background The Zanzibar Ministry of Health and Social Welfare, concerned about mental health in the country, requested technical assistance from WHO in 1997. Aims This article describes the facilitation over many years by a WHO Collaborating Centre, of sustainable mental health developments in Zanzibar, one of the poorest countries in the world, using systematic approaches to policy design and implementation. Methods Based on intensive prior situation appraisal and consultation, a multi-faceted set of interventions combining situation appraisal to inform planning; sustained policy dialogue at Union and state levels; development of policy and legislation, development of strategic action plans, establishment of intersectoral national mental health implementation committee, establishment of national mental health coordination system, integration of mental health into primary care, strengthening of primary-secondary care liaison, rationalisation and strengthening of secondary care system, ensuring adequate supply of medicines, use of good practice guidelines and health information systems, development of services for people with intellectual disability, establishment of formal mechanism for close liaison between the mental health services and other governmental, non-governmental and traditional sectors, mental health promotion, suicide prevention, and research and development. Results The policy and legislation introduced in 1999 have resulted in enhanced mental health activities over the ensuing decade, within a setting of extreme low resource. However, advances ebb and flow and continued efforts are required to maintain progress and continue mental health developments. Lessons learnt have informed the development of mental health policies in neighbouring countries. Conclusions A multi-faceted and comprehensive programme can be effective in achieving considerable strengthening of mental health programmes and services even in extremely low resource settings, but requires sustained input and advocacy if gains are to be maintained and enhanced. PMID:21320308

The Twin Challenges of Mediocrity and Inequality: Literacy in the U.S. from an International Perspective.

ERIC Educational Resources Information Center

Sum, Andrew; Kirsch, Irwin; Taggart, Robert

This monograph focuses on the literacy performance of U.S. adults in comparison to adults in other high-income countries, underscoring the fact that the overall U.S. performance is mediocre at best and that the U.S. is a world leader in the degree of inequality between the best and poorest performers. The monograph describes the National and the…

Wildland fire risk and social vulnerability in the Southeastern United States: An exploratory spatial data analysis approach

Treesearch

Cassandra Johnson Gaither; N.C. Poudyal; S. Goodrick; J.M. Bowker; S. Malone; J. Gan

2011-01-01

The southeastern U.S. is one of the more wildland fire prone areas of the country and also contains some of the poorest or most socially vulnerable rural communities. Our project addresses wildland fire risk in this part of the U.S and its intersection with social vulnerability. We examine spatial association between high wildland fire prone areas which also rank high...

Does health insurance mitigate inequities in non-communicable disease treatment? Evidence from 48 low- and middle-income countries.

PubMed

El-Sayed, Abdulrahman M; Palma, Anton; Freedman, Lynn P; Kruk, Margaret E

2015-09-01

Non-communicable diseases (NCDs) are the greatest contributor to morbidity and mortality in low- and middle-income countries (LMICs). However, NCD care is limited in LMICs, particularly among the disadvantaged and rural. We explored the role of insurance in mitigating socioeconomic and urban-rural disparities in NCD treatment across 48 LMICs included in the 2002-2004 World Health Survey (WHS). We analyzed data about ever having received treatment for diagnosed high-burden NCDs (any diagnosis, angina, asthma, depression, arthritis, schizophrenia, or diabetes) or having sold or borrowed to pay for healthcare. We fit multivariable regression models of each outcome by the interaction between insurance coverage and household wealth (richest 20% vs. poorest 50%) and urbanicity, respectively. We found that insurance was associated with higher treatment likelihood for NCDs in LMICs, and helped mitigate socioeconomic and regional disparities in treatment likelihood. These influences were particularly strong among women. Insurance also predicted lower likelihood of borrowing or selling to pay for health services among the poorest women. Taken together, insurance coverage may serve as an important policy tool in promoting NCD treatment and in reducing inequities in NCD treatment by household wealth, urbanicity, and sex in LMICs. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Why has the Universal Coverage Scheme in Thailand achieved a pro-poor public subsidy for health care?

PubMed Central

2012-01-01

Background Thailand has achieved universal health coverage since 2002 through the implementation of the Universal Coverage Scheme (UCS) for 47 million of the population who were neither private sector employees nor government employees. A well performing UCS should achieve health equity goals in terms of health service use and distribution of government subsidy on health. With these goals in mind, this paper assesses the magnitude and trend of government health budget benefiting the poor as compared to the rich UCS members. Method Benefit incidence analysis was conducted using the nationally representative household surveys, Health and Welfare Surveys, between 2003 and 2009. UCS members are grouped into five different socio-economic status using asset indexes and wealth quintiles. Findings The total government subsidy, net of direct household payment, for combined outpatient (OP) and inpatient (IP) services to public hospitals and health facilities provided to UCS members, had increased from 30 billion Baht (US$ 1 billion) in 2003 to 40-46 billion Baht in 2004-2009. In 2003 for 23% and 12% of the UCS members who belonged to the poorest and richest quintiles of the whole-country populations respectively, the share of public subsidies for OP service was 28% and 7% for the poorest and the richest quintiles, whereby for IP services the share was 27% and 6% for the poorest and richest quintiles respectively. This reflects a pro-poor outcome of public subsidies to healthcare. The OP and IP public subsidies remained consistently pro-poor in subsequent years. The pro-poor benefit incidence is determined by higher utilization by the poorest than the richest quintiles, especially at health centres and district hospitals. Thus the probability and the amount of household direct health payment for public facilities by the poorest UCS members were less than their richest counterparts. Conclusions Higher utilization and better financial risk protection benefiting the poor UCS members are the results of extensive geographical coverage of health service infrastructure especially at district level, adequate finance and functioning primary healthcare, comprehensive benefit package and zero copayment at points of services. PMID:22992431

Effects of economic downturns on child mortality: a global economic analysis, 1981-2010.

PubMed

Maruthappu, Mahiben; Watson, Robert A; Watkins, Johnathan; Zeltner, Thomas; Raine, Rosalind; Atun, Rifat

2017-01-01

To analyse how economic downturns affect child mortality both globally and among subgroups of countries of variable income levels. Retrospective observational study using economic data from the World Bank's Development Indicators and Global Development Finance (2013 edition). Child mortality data were sourced from the Institute for Health Metrics and Evaluation. Global. 204 countries between 1981 and 2010. Child mortality, controlling for country-specific differences in political, healthcare, cultural, structural, educational and economic factors. 197 countries experienced at least 1 economic downturn between 1981 and 2010, with a mean of 7.97 downturns per country (range 0-21; SD 0.45). At the global level, downturns were associated with significant (p<0.0001) deteriorations in each child mortality measure, in comparison with non-downturn years: neonatal (coefficient: 1.11, 95% CI 0.855 to 1.37), postneonatal (2.00, 95% CI 1.61 to 2.38), child (2.93, 95% CI 2.26 to 3.60) and under 5 years of age (5.44, 95% CI 4.31 to 6.58) mortality rates. Stronger (larger falls in the growth rate of gross domestic product/capita) and longer (lasting 2 years rather than 1) downturns were associated with larger significant deteriorations (p<0.001). During economic downturns, countries in the poorest quartile experienced ∼1½ times greater deterioration in neonatal mortality, compared with their own baseline; a 3-fold deterioration in postneonatal mortality; a 9-fold deterioration in child mortality and a 3-fold deterioration in under-5 mortality, than countries in the wealthiest quartile (p<0.0005). For 1-5 years after downturns ended, each mortality measure continued to display significant deteriorations (p<0.0001). Economic downturns occur frequently and are associated with significant deteriorations in child mortality, with worse declines in lower income countries.

Sexual and reproductive health: Progress and outstanding needs

PubMed Central

Snow, Rachel C.; Laski, Laura; Mutumba, Massy

2015-01-01

We examine progress towards the 1994 International Conference on Population and Development (ICPD) commitment to provide universal access to sexual and reproductive health (SRH) services by 2014, with an emphasis on changes for those living in poor and emerging economies. Accomplishments include a 45% decline in the maternal mortality ratio (MMR) between 1990 and 2013; 11.5% decline in global unmet need for modern contraception; ~21% increase in skilled birth attendance; and declines in both the case fatality rate and rate of abortion. Yet aggregate gains mask stark inequalities, with low coverage of services for the poorest women. Demographic and Health Surveys and Multiple Indicator Cluster Surveys from 80 developing countries highlight persistent disparities in skilled birth attendance by household wealth: in 70 of 80 countries (88%), ≥80% of women in the highest quintile were attended by a skilled provider at last birth; in only 23 of the same countries (29%) was this the case for women in the lowest wealth quintile. While there have been notable declines in HIV incidence and prevalence, women affected by HIV are too often bereft of other SRH services, including family planning. Achieving universal access to SRH will require substantially greater investment in comprehensive and integrated services that reach the poor. PMID:25555027

Cyclone shelters and their locational suitability: an empirical analysis from coastal Bangladesh.

PubMed

Mallick, Bishawjit

2014-07-01

Bangladesh is one of the poorest and the most disaster-prone countries in Asia; it is important, therefore, to know how its disaster reduction strategies are organised and planned. Cyclone shelters comprise a widely acceptable form of infrastructural support for disaster management in Bangladesh. This paper attempts to analyse empirically their use during cyclones in a sample study area along the southwest coastal belt of the country. It shows how the location of a cyclone shelter can determine the social power structure in coastal Bangladesh. The results reveal that the establishment of cyclone shelters in the studied communities is determined by neither a right-based nor a demand-based planning approach; rather, their creation is dependent on the socio-political affluence of local-level decision-makers. The paper goes on to demonstrate that socially vulnerable households (defined, for example, by income or housing conditions) are afforded disproportionately less access to cyclone shelters as compared to less socially vulnerable households. © 2014 The Author(s). Disasters © Overseas Development Institute, 2014.

Does User Fee Removal Policy Provide Financial Protection from Catastrophic Health Care Payments? Evidence from Zambia

PubMed Central

Masiye, Felix; Kaonga, Oliver; Kirigia, Joses M

2016-01-01

Background Out-of-pocket payments in health care have been shown to impose significant burden on households in Sub-Saharan Africa, leading to constrained access to health care and impoverishment. In an effort to reduce the financial burden imposed on households by user fees, some countries in Sub-Saharan Africa have abolished user fees in the health sector. Zambia is one of few countries in Sub-Saharan Africa to abolish user fees in primary health care facilities with a view to alleviating financial burden of out-of-pocket payments among the poor. The main aim of this paper was to examine the extent and patterns of financial protection from fees following the decision to abolish user fees in public primary health facilities. Methods Our analysis is based on a nationally representative health expenditure and utilization survey conducted in 2014. We calculated the incidence and intensity of catastrophic health expenditure based on households’ out-of-pocket payments during a visit as a percentage of total household consumption expenditure. We further show the intensity of the problem of catastrophic health expenditure (CHE) experienced by households. Results Our analysis show that following the removal of user fees, a majority of patients who visited public health facilities benefitted from free care at the point of use. Further, seeking care at public primary health facilities is associated with a reduced likelihood of incurring CHE after controlling for economic wellbeing and other covariates. However, 10% of households are shown to suffer financial catastrophe as a result of out-of-pocket payments. Further, there is considerable inequality in the incidence of CHE whereby the poorest expenditure quintile experienced a much higher incidence. Conclusion Despite the removal of user fees at primary health care level, CHE is high among the poorest sections of the population. This study also shows that cost of transportation is mainly responsible for limiting the protective effectiveness of user fee removal on CHE among particularly poorest households. PMID:26795620

Does User Fee Removal Policy Provide Financial Protection from Catastrophic Health Care Payments? Evidence from Zambia.

PubMed

Masiye, Felix; Kaonga, Oliver; Kirigia, Joses M

2016-01-01

Out-of-pocket payments in health care have been shown to impose significant burden on households in Sub-Saharan Africa, leading to constrained access to health care and impoverishment. In an effort to reduce the financial burden imposed on households by user fees, some countries in Sub-Saharan Africa have abolished user fees in the health sector. Zambia is one of few countries in Sub-Saharan Africa to abolish user fees in primary health care facilities with a view to alleviating financial burden of out-of-pocket payments among the poor. The main aim of this paper was to examine the extent and patterns of financial protection from fees following the decision to abolish user fees in public primary health facilities. Our analysis is based on a nationally representative health expenditure and utilization survey conducted in 2014. We calculated the incidence and intensity of catastrophic health expenditure based on households' out-of-pocket payments during a visit as a percentage of total household consumption expenditure. We further show the intensity of the problem of catastrophic health expenditure (CHE) experienced by households. Our analysis show that following the removal of user fees, a majority of patients who visited public health facilities benefitted from free care at the point of use. Further, seeking care at public primary health facilities is associated with a reduced likelihood of incurring CHE after controlling for economic wellbeing and other covariates. However, 10% of households are shown to suffer financial catastrophe as a result of out-of-pocket payments. Further, there is considerable inequality in the incidence of CHE whereby the poorest expenditure quintile experienced a much higher incidence. Despite the removal of user fees at primary health care level, CHE is high among the poorest sections of the population. This study also shows that cost of transportation is mainly responsible for limiting the protective effectiveness of user fee removal on CHE among particularly poorest households.

Bangladesh.

PubMed

1987-04-01

The population of Bangladesh was 104 million in 1986, with an annual growth rate of 2.6%. The country's infant mortality rate is 12.1%, and life expectancy stands at 54 years. The literacy rate is 29%. The work force of 34.1 million is distributed among agriculture (74%), industry (11%), and services (15%). The gross domestic product (GDP) is US$15.3 billion, with a real annual growth rate of 3.6% and a per capita GDP of $151. As one of the world's poorest and most densely populated countries, Bangladesh must struggle to produce domestically and import enough food to feed its rapidly increasing population. The country's transportation, communications, and power infrastructure is relatively poorly developed. Since 1971, an emphasis has been placed on developing new industrial capacity and rehabilitating the economy. The statist economic model, including nationalization of the key jute industry, had resulted in inefficiency and economic stagnation. At present, rapid population growth, inefficiency in the public sector, and restricted natural resources and capital continue to impede economic development. On the other hand, economic policies aimed at encouraging private enterprise and investment, denationalizing public industries, reinstating budgetary discipline, and mobilizing domestic resources are beginning to have an impact. Underemployment remains a serious problem, and there are growing concerns regarding the ability of the agricultural sector to absorb additional manpower. To reach the goal of 10% annual industrial growth for the 1986-89 period, the government is aggressively seeking foreign investment.

Mitigating land pollution through pesticide packages - The case of a collection scheme in Rural China.

PubMed

Jin, Shuqin; Bluemling, Bettina; Mol, Arthur P J

2018-05-01

Pesticide packages that are discarded on agricultural land can contaminate water bodies and pose a threat to the environment and human health. Little is known about how developing countries deal with this kind of land pollution. While in developed countries, packages are collected by professional organizations, the smallholder context in developing countries makes the collection of this waste much more difficult. This paper introduces and analyses a successful Pesticide Package Collection Scheme in one of the poorest regions in China, i.e. Guangxi Province. The purpose of the paper is to analyze and discuss how such a scheme can be established by multiple actors. The paper finds that the underlying success factors for establishing such a scheme are 1.) that a scheme piggy-bags on existing economic structures that reach out to farmers (e.g. associations); 2.) that the scheme itself facilitates actors' exchange of resources to establish a temporary resource equilibrium; 3.) that all stakeholders obtain returns on their investment, even if the quality and time scale of these returns may differ. The initiation of the scheme by a pesticide company however increased both its political and market influence. Caution hence has to be paid to whether the short-term improvement in land pollution happens at the expense of a dependency on and increased use of certain kinds of pesticides. Copyright © 2017 Elsevier B.V. All rights reserved.

[Population and development].

PubMed

Castanon Romo, R; Sandoval Navarrete, J

1996-01-01

This broad survey of the debate concerning the relationship between population growth and economic development discusses the history and current status of world population growth, summarizes several influential theoretical positions on the topic, and proposes that redefinition of women's social role is indispensable if worldwide control of population growth is to be achieved. The introductory section discusses the acceleration of population growth in the second half of the 20th century and the increasing concentration of growth in the poor and developing countries. The positions of those who see in population control a means of promoting economic development and political stability are contrasted to the positions of those who believe that a large and growing population is the key to achieving economic and political progress. The international community, facing great uncertainty about the size, distribution, and well-being of the future world population, is increasingly concerned about the effect of growing numbers on the environment and natural resources. The second section summarizes the works of Malthus, Julian Simon, and the Club of Rome, and analyzes the propositions of demographic transition theory. The conclusion notes that despite uncertainty about the future of world population, development, and health, most of the poorest countries have become aware of the desirability of slowing population growth. A broad redefinition of the social role of women will inevitably accompany the worldwide demographic transition.

Socioeconomic gradients in early childhood health: evidence from Bangladesh and Nepal.

PubMed

Devkota, Satis; Panda, Bibhudutta

2016-05-16

A large literature has developed researching the origins of socioeconomic gradients in child health in developed countries. Particularly, this research examines the age at which these gradient effects emerge and how they change across different stages of childhood. However, similar research on developing countries is limited. This paper examines the socioeconomic gradients in early childhood health in two developing countries, Bangladesh and Nepal using the 2011 Demographic and Health Surveys. The paper separately studies two measures of household socioeconomic status: household wealth and maternal educational attainment. Two anthropometric measures of early childhood health, height-for-age and weight-for-age Z scores for 0-59 months of children, are used for our empirical exercise. The paper uses both non-parametric and multivariate ordinary least squares approaches to examine at what age socioeconomic disparities in health emerge, and investigates if these disparities increase with age in early childhood. The paper provides significant evidence of age-specific socioeconomic gradients in early childhood health in both countries. Health disparities in household wealth exist in both countries. This disparity emerges in the first 11 months of life, and is particularly severe for children from the poorest quintile. On the other hand, while the emergence of maternal education gradients during the first 11 months is sensitive to the choice of childhood health measure, the study finds the children of mothers with higher education to enjoy significantly higher health outcomes in comparison to those with lower education. However, controlling for father's education weakens the effects of maternal education on child health in both countries. Further, the paper does not find statistically significant evidence where socioeconomic gradients in health increase with age in early childhood. Our study concludes that socioeconomic disparities in health outcomes exist even in very early childhood in Bangladesh and Nepal. This has important implications for targeted policy interventions in the form of food security and nutrition supplement programs, free provision of health care, and maternal education in both countries.

Constructs of Childhood: Enduring or Open to Change? Early Years Students' Reflections on First Hand Experiences of Childhood and Early Years Education in a Different Country and Culture

ERIC Educational Resources Information Center

McGillivray, Gill

2009-01-01

It can be argued that globalisation brings change for children and their families in the guise of increased poverty and inequality; for example, for the world's poorest populations and communities. Students undertaking Early Childhood Studies degrees in the United Kingdom are likely to encounter modules with a focus on childhood in a variety of…

How changes in coverage affect equity in maternal and child health interventions in 35 Countdown to 2015 countries: an analysis of national surveys.

PubMed

Victora, Cesar G; Barros, Aluisio J D; Axelson, Henrik; Bhutta, Zulfiqar A; Chopra, Mickey; França, Giovanny V A; Kerber, Kate; Kirkwood, Betty R; Newby, Holly; Ronsmans, Carine; Boerma, J Ties

2012-09-29

Achievement of global health goals will require assessment of progress not only nationally but also for population subgroups. We aimed to assess how the magnitude of socioeconomic inequalities in health changes in relation to different rates of national progress in coverage of interventions for the health of mothers and children. We assessed coverage in low-income and middle-income countries for which two Demographic Health Surveys or Multiple Indicator Cluster Surveys were available. We calculated changes in overall coverage of skilled birth attendants, measles vaccination, and a composite coverage index, and examined coverage of a newly introduced intervention, use of insecticide-treated bednets by children. We stratified coverage data according to asset-based wealth quintiles, and calculated relative and absolute indices of inequality. We adjusted correlation analyses for time between surveys and baseline coverage levels. We included 35 countries with surveys done an average of 9·1 years apart. Pro-rich inequalities were very prevalent. We noted increased coverage of skilled birth attendants, measles vaccination, and the composite index in most countries from the first to the second survey, while inequalities were reduced. Rapid changes in overall coverage were associated with improved equity. These findings were not due to a capping effect associated with limited scope for improvement in rich households. For use of insecticide-treated bednets, coverage was high for the richest households, but countries making rapid progress did almost as well in reaching the poorest groups. National increases in coverage were primarily driven by how rapidly coverage increased in the poorest quintiles. Equity should be accounted for when planning the scaling up of interventions and assessing national progress. Bill & Melinda Gates Foundation; World Bank; Governments of Australia, Brazil, Canada, Norway, Sweden, and UK. Copyright © 2012 Elsevier Ltd. All rights reserved.

A profile of women at the highest risk of maternal death in Pakistan.

PubMed

Agha, Sohail

2015-09-01

Traditionally, health interventions implemented in Pakistan have been designed to increase the supply of maternal health services, but have not focused on reaching the poorest women or on providing high-quality services. Demand-side barriers to the utilization of health services are substantial in Pakistan, as are supply-side constraints to the provision of quality health care. This study uses data from the Pakistan Demographic and Health Survey 2006-07 to develop a profile of the poorest women in Pakistan in order to understand demand-side barriers to accessing maternal health care. The study shows stark differences in human capital, material and demographic resources between the poorest women and other women. It illustrates how these differences translate into low levels of service utilization among the poorest women. The purpose of the study is to stimulate a discussion of both the difficulty and the importance of reaching the poorest women with high-quality maternal health interventions. The findings from several pilot projects in Pakistan suggest that the poorest women can be reached at disproportionately higher rates than non-poor women through targeted, community-based, interventions. There is little demonstrable evidence, however, that high-quality care has been provided through these interventions. Evidence-based approaches, which have the potential to overcome financial and sociocultural barriers to service utilization, should be scaled up as soon as possible. However, measures should be taken to ensure that the quality of care provided through these interventions is adequate and able to lead to significant reductions in mortality. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

[Financing healthcare in low-income countries: recurring questions, new challenges].

PubMed

Audibert, M; Mathonnat, J; de Roodenbeke, E

2004-01-01

Healthcare financing policies in low-income countries have gone through three successive phases. In the first phase the dominant approach was based on free access to healthcare and focused first on development of vertical programs and then on the necessity of providing primary care to all. While maintaining the emphasis on accessibility to primary care, the second policy phase introduced user fees and attempted to integrate healthcare programs into district-based healthcare structures. The third phase has been strongly influenced by the relationship between healthcare and development and the Millenium Objectives and places strong emphasis on necessity of developing insurance schemes. Recent studies on the relationship between healthcare spending and health status indicate that the efficiency and effectiveness of healthcare spending plays a more determinant role than the amount. At the same time an effort is being made to develop synergy between the different players in the health care systems and to clarify the role of each player by hinging financing decisions on operating criteria such as "public welfare", externalities, catastrophic costs, and equity. Although many countries have made significant progress, there are still several lagging areas, i.e., coverage for the poorest segment of the population (despite the rhetoric), follow-up of financing, and governance. Increasing external aid already initiated by several states may have a non-negligible impact on the macroeconomic balance. Since these changes could lead to adverse effects on health, there is a need to implement careful non-dogmatic policies.

Countdown to 2015 and beyond: fulfilling the health agenda for women and children.

PubMed

Requejo, Jennifer Harris; Bryce, Jennifer; Barros, Aluisio J D; Berman, Peter; Bhutta, Zulfiqar; Chopra, Mickey; Daelmans, Bernadette; de Francisco, Andres; Lawn, Joy; Maliqi, Blerta; Mason, Elizabeth; Newby, Holly; Presern, Carole; Starrs, Ann; Victora, Cesar G

2015-01-31

The end of 2015 will signal the end of the Millennium Development Goal era, when the world can take stock of what has been achieved. The Countdown to 2015 for Maternal, Newborn, and Child Survival (Countdown) has focused its 2014 report on how much has been achieved in intervention coverage in these groups, and on how best to sustain, focus, and intensify efforts to progress for this and future generations. Our 2014 results show unfinished business in achievement of high, sustained, and equitable coverage of essential interventions. Progress has accelerated in the past decade in most Countdown countries, suggesting that further gains are possible with intensified actions. Some of the greatest coverage gaps are in family planning, interventions addressing newborn mortality, and case management of childhood diseases. Although inequities are pervasive, country successes in reaching of the poorest populations provide lessons for other countries to follow. As we transition to the next set of global goals, we must remember the centrality of data to accountability, and the importance of support of country capacity to collect and use high-quality data on intervention coverage and inequities for decision making. To fulfill the health agenda for women and children both now and beyond 2015 requires continued monitoring of country and global progress; Countdown is committed to playing its part in this effort. Copyright © 2015 Elsevier Ltd. All rights reserved.

Cross-cultural differences in health-related quality of life of people with epilepsy: findings from a European study.

PubMed

Buck, D; Jacoby, A; Baker, G A; Ley, H; Steen, N

1999-12-01

To examine between-country differences in health-related quality of life (HRQOL) of adults with epilepsy across a large number of European countries. Self-completion postal questionnaire sent to large sample of adults with epilepsy, recruited from epilepsy support groups or epilepsy outpatient clinics. The questionnaire was developed in English and translated. Back-translations from each language were checked for accuracy. The questionnaire sought information on clinical and socio-demographic details, and contained a number of previously validated scales of psychosocial well-being (the SF-36, the perceived impact of epilepsy scale, and a feelings of stigma scale). Controlling for socio-demographic and clinical characteristics, significant between-country differences were found in scores on the perceived impact of epilepsy scale, on seven of the eight SF-36 domains, and on the feelings of stigma scale. Respondents in Spain and the Netherlands fared consistently better, whilst those in France fared poorest, compared to those in other countries in terms of the various HRQOL measures used. Several possible reasons for the cross-cultural differences in HRQOL are proposed. Clearly, there is no single explanation and there may also be reasons which we have overlooked. This study emphasises the need for further comprehensive research in order that the position of people with epilepsy in different countries be more thoroughly understood in the social context.

Transgenic multivitamin corn through biofortification of endosperm with three vitamins representing three distinct metabolic pathways

PubMed Central

Naqvi, Shaista; Zhu, Changfu; Farre, Gemma; Ramessar, Koreen; Bassie, Ludovic; Breitenbach, Jürgen; Perez Conesa, Dario; Ros, Gaspar; Sandmann, Gerhard; Capell, Teresa; Christou, Paul

2009-01-01

Vitamin deficiency affects up to 50% of the world's population, disproportionately impacting on developing countries where populations endure monotonous, cereal-rich diets. Transgenic plants offer an effective way to increase the vitamin content of staple crops, but thus far it has only been possible to enhance individual vitamins. We created elite inbred South African transgenic corn plants in which the levels of 3 vitamins were increased specifically in the endosperm through the simultaneous modification of 3 separate metabolic pathways. The transgenic kernels contained 169-fold the normal amount of β-carotene, 6-fold the normal amount of ascorbate, and double the normal amount of folate. Levels of engineered vitamins remained stable at least through to the T3 homozygous generation. This achievement, which vastly exceeds any realized thus far by conventional breeding alone, opens the way for the development of nutritionally complete cereals to benefit the world's poorest people. PMID:19416835

Achievements and challenges for the use of killed oral cholera vaccines in the global stockpile era.

PubMed

Desai, Sachin N; Pezzoli, Lorenzo; Alberti, Kathryn P; Martin, Stephen; Costa, Alejandro; Perea, William; Legros, Dominique

2017-03-04

Cholera remains an important but neglected public health threat, affecting the health of the poorest populations and imposing substantial costs on public health systems. Cholera can be eliminated where access to clean water, sanitation, and satisfactory hygiene practices are sustained, but major improvements in infrastructure continue to be a distant goal. New developments and trends of cholera disease burden, the creation of affordable oral cholera vaccines (OCVs) for use in developing countries, as well as recent evidence of vaccination impact has created an increased demand for cholera vaccines. The global OCV stockpile was established in 2013 and with support from Gavi, has assisted in achieving rapid access to vaccine in emergencies. Recent WHO prequalification of a second affordable OCV supports the stockpile goals of increased availability and distribution to affected populations. It serves as an essential step toward an integrated cholera control and prevention strategy in emergency and endemic settings.

Direct foreign investment: a migration push-factor?

PubMed

Sassen-koob, S

1984-01-01

Policymakers and analysts now recognize that US military activities abroad contribute to the creation of refugee flows into the US. Previously, immigration into the US was viewed as a result of inept and failed domestic policies in the countries of origin. Results show that recent immigrants to the US come from countries with neither the poorest nor the largest population growth rate in the less developed world. However, the sending countries received US direct foreign investment (DFI) in the 1970s, particularly labor intensive investment in export manufacturing. Significant levels and concentrations of DFI promote emigration through: 1) the incorporation of new segments of the population into wage labor and the associated disruption of traditional work structures, 2) the feminization of the new industrial work force and its impact on the work opportunities of men, and 3) the consolidation of objective and ideological links with the highly industrialized countries where most foreign capital originates. The data suggest an examination of the causes of emigration on a much more specific level than that of underdevelopment, poverty, and population growth. These facts carry immediate policy implications for US immigration organizations: 1) if US firms in export processing zones recruited workers from the pool of unemployed--mostly prime-age males--rather than expanding the labor supply by recruiting young women, thereby disrupting unwaged work structures, and 2) if these firms would desist from having high turnover rates among workers, then the migration impact of this type of development would be minimized.

Global considerations for implementation of telemedicine

NASA Technical Reports Server (NTRS)

Lechat, M. F.

1991-01-01

In Dec. 1989, the United Nations proclaimed the Decade 1990-1999 as the International Decade for Natural Disasters Reduction (IDNDR). The Decade identified a number of research programs. IDNDR, provides a unique opportunity to explore the potential offered by the emerging technologies, and to promote, develop, and support those technologies deemed adequate to make the next century a safer one, especially in the poorest countries of the world. But all this improvement cannot be accomplished in a vacuum. We must begin now to eliminate pitfalls and illusions. A new attitude must emerge. In the scope of reducing human damages resulting from disasters, we must reconsider the cross-cultural understanding, and reach a real awareness which combines humility with a sense of relativeness. Promoting the right context is essential to the mandate of the Decade.

Malaria and tuberculosis: our concerns.

PubMed

Shiva, M

1997-01-01

In 1978 the concept of primary health care was adopted by 116 countries at Alma Ata, yet the negative impact of structural readjustment programs in Africa and South America could be felt due to the cuts in expenditures on health, education, and social matters. The result is a resurgence of communicable diseases such as malaria and tuberculosis. Another factor in this resurgence is extreme poverty. In 1994 over 1000 people died in Rajasthan, India, of a malaria epidemic, and during the same time in Delhi over 300 deaths were attributed to hemorrhagic dengue fever. Malariogenic and tuberculous conditions continue to flourish owing to distorted development patterns and commercialization of medical care as public health and community health services are being replaced by profit-oriented curative care, 80% of which is in private hands. This has resulted in spiraling medical care costs and rural indebtedness. Socioeconomic deprivation in developing countries threatens TB control. Factors contributing to the spread of TB were established in 1899 and are still valid in India and other developing countries: TB contamination of air, inadequate food, overcrowded dwelling, and low state of physical health. Even in developed countries TB is on the rise: there were 172 cases in 1991 in England vs. 305 cases in 1993, half of them among immigrants. The increase occurred in the poorest 30% of the population. The World Bank is providing loans for a revised TB and malaria strategy, and the Disability Adjusted Life Year has been used to identify the greatest burden of diseases. On the other hand, the Indian National Health Policy has not been revised since 1983. Priority must be given to those living in extreme poverty to curb the resurgence of once controlled diseases.

What are the emerging features of community health insurance schemes in East Africa?

PubMed Central

Basaza, Robert; Pariyo, George; Criel, Bart

2009-01-01

Background The three East African countries of Uganda, Tanzania, and Kenya are characterized by high poverty levels, population growth rates, prevalence of HIV/AIDS, under-funding of the health sector, poor access to quality health care, and small health insurance coverage. Tanzania and Kenya have user-fees whereas Uganda abolished user-fees in public-owned health units. Objective To provide comparative description of community health insurance (CHI) schemes in three East African countries of Uganda, Tanzania, and Kenya and thereafter provide a basis for future policy research for development of CHI schemes. Methods An analytical grid of 10 distinctive items pertaining to the nature of CHI schemes was developed so as to have a uniform lens of comparing country situations of CHI. Results and conclusions The majority of the schemes have been in existence for a relatively short time of less than 10 years and their number remains small. There is need for further research to identify what is the mix and weight of factors that cause people to refrain from joining schemes. Specific issues that could also be addressed in subsequent studies are whether the current schemes provide financial protection, increase access to quality of care and impact on the equity of health services financing and delivery. On the basis of this knowledge, rational policy decisions can be taken. The governments thereafter could consider an option of playing more roles in advocacy, paying for the poorest, and developing an enabling policy and legal framework. PMID:22312207

Paediatric emergency and acute care in resource poor settings.

PubMed

Duke, Trevor; Cheema, Baljit

2016-02-01

Acute care of seriously ill children is a global public health issue, and there is much scope for improving quality of care in hospitals at all levels in many developing countries. We describe the current state of paediatric emergency and acute care in the least developed regions of low and middle income countries and identify gaps and requirements for improving quality. Approaches are needed which span the continuum of care: from triage and emergency treatment, the diagnostic process, identification of co-morbidities, treatment, monitoring and supportive care, discharge planning and follow-up. Improvements require support and training for health workers and quality processes. Effective training is that which is ongoing, combining good technical training in under-graduate courses and continuing professional development. Quality processes combine evidence-based guidelines, essential medicines, appropriate technology, appropriate financing of services, standards and assessment tools and training resources. While initial emergency treatment is based on common clinical syndromes, early differentiation is required for specific treatment, and this can usually be carried out clinically without expensive tests. While global strategies are important, it is what happens locally that makes a difference and is too often neglected. In rural areas in the poorest countries in the world, public doctors and nurses who provide emergency and acute care for children are revered by their communities and demonstrate daily that much can be carried out with little. © 2016 The Authors. Journal of Paediatrics and Child Health © 2016 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

The Human Hookworm Vaccine

PubMed Central

Hotez, Peter J.; Diemert, David; Bacon, Kristina M.; Beaumier, Coreen; Bethony, Jeffrey M.; Bottazzi, Maria Elena; Brooker, Simon; Couto, Artur Roberto; da Silva Freire, Marcos; Homma, Akira; Lee, Bruce Y.; Loukas, Alex; Loblack, Marva; Morel, Carlos Medicis; Oliveira, Rodrigo Correa; Russell, Philip K.

2013-01-01

Hookworm infection is one of the world's most common neglected tropical diseases and a leading cause of iron deficiency anemia in low- and middle-income countries. A Human Hookworm Vaccine is currently being developed by the Sabin Vaccine Institute and is in phase 1 clinical testing. The candidate vaccine is comprised of two recombinant antigens known as Na-GST-1 and Na-APR-1, each of which is an important parasite enzyme required for hookworms to successfully utilize host blood as a source of energy. The recombinant proteins are formulated on Alhydrogel® and are being tested in combination with a synthetic Toll-like receptor 4 agonist. The aim of the vaccine is to induce anti-enzyme antibodies that will reduce both host blood loss and the number of hookworms attached to the gut. Transfer of the manufacturing technology to the Oswaldo Cruz Foundation (FIOCRUZ)/Bio-Manguinhos (a Brazilian public sector developing country vaccine manufacturer) is planned, with a clinical development plan that could lead to registration of the vaccine in Brazil. The vaccine would also need to be introduced in the poorest regions of Africa and Asia, where hookworm infection is highly endemic. Ultimately, the vaccine could become an essential tool for achieving hookworm control and elimination, a key target in the 2012 London Declaration on Neglected Tropical Diseases. PMID:23598487

Initiating malaria control programs in the third world: directives for short- and long-term solutions.

PubMed

Basu, Sanjay

2002-01-01

Although malaria is a growing problem affecting several hundred million people each year, many malarial countries lack successful disease control programs. Worldwide malaria incidence rates are dramatically increasing, generating fear among many people who are witnessing malaria control initiatives fail. In this paper, we explore two options for malaria control in poor countries: (1) the production and distribution of a malaria vaccine and (2) the control of mosquitoes that harbor the malaria parasite. We first demonstrate that the development of a malaria vaccine is indeed likely, although it will take several years to produce because of both biological obstacles and insufficient research support. The distribution of such a vaccine, as suggested by some economists, will require that wealthy states promise a market to pharmaceutical companies who have traditionally failed to investigate diseases affecting the poorest of nations. But prior to the development of a malaria vaccine, we recommend the implementation of vector control pro- grams, such as those using Bti toxin, in regions with low vector capacity. Our analysis indicates that both endogenous programs in malarial regions and molecular approaches to parasite control will provide pragmatic solutions to the malaria problem. But the successful control of malaria will require sustained support from wealthy nations, without whom vaccine development and vector control programs will likely fail.

Perceived Stress and Its Relationship With Chronic Medical Conditions and Multimorbidity Among 229,293 Community-Dwelling Adults in 44 Low- and Middle-Income Countries.

PubMed

Vancampfort, Davy; Koyanagi, A; Ward, Philip B; Veronese, Nicola; Carvalho, André F; Solmi, Marco; Mugisha, James; Rosenbaum, Simon; De Hert, Marc; Stubbs, Brendon

2017-10-15

In this study, we assessed the association of chronic medical conditions and multimorbidity with perceived stress among community-dwelling adults in 44 low- and middle-income countries. Data from the World Health Survey (2002-2004), including 229,293 adults, were analyzed. A perceived stress score (range, 0 (lowest stress)-100 (highest stress)) was computed on the basis of 2 questions from the Perceived Stress Scale. Eleven chronic conditions were assessed. Multivariable linear regression analyses were conducted to explore the associations. All chronic conditions were associated with significantly higher mean perceived stress scores, with the exception of edentulism. The associations were particularly strong for depression (β = 14.71, 95% confidence interval (CI): 13.68, 15.74), visual impairment (β = 10.66, 95% CI: 8.09, 13.23), and schizophrenia (β = 9.98, 95% CI: 7.71, 12.24). Compared with no chronic conditions, the β coefficients for perceived stress with the presence of 1, 2, 3, and ≥4 chronic conditions were 5.58 (95% CI: 4.94, 6.23), 9.58 (95% CI: 8.67, 10.49), 14.15 (95% CI: 12.63, 15.67), and 20.17 (95% CI: 18.29, 22.05), respectively. The associations with perceived stress were significantly stronger among the poorest individuals for arthritis, asthma, diabetes, edentulism, and ≥4 chronic conditions. Our data suggest that a range of chronic conditions and multimorbidity are associated with greatly increased perceived stress among people in low- and middle-income countries, and that the poorest persons may be a particularly vulnerable group. © The Author(s) 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The comparative cost-effectiveness of an equity-focused approach to child survival, health, and nutrition: a modelling approach.

PubMed

Carrera, Carlos; Azrack, Adeline; Begkoyian, Genevieve; Pfaffmann, Jerome; Ribaira, Eric; O'Connell, Thomas; Doughty, Patricia; Aung, Kyaw Myint; Prieto, Lorena; Rasanathan, Kumanan; Sharkey, Alyssa; Chopra, Mickey; Knippenberg, Rudolf

2012-10-13

Progress on child mortality and undernutrition has seen widening inequities and a concentration of child deaths and undernutrition in the most deprived communities, threatening the achievement of the Millennium Development Goals. Conversely, a series of recent process and technological innovations have provided effective and efficient options to reach the most deprived populations. These trends raise the possibility that the perceived trade-off between equity and efficiency no longer applies for child health--that prioritising services for the poorest and most marginalised is now more effective and cost effective than mainstream approaches. We tested this hypothesis with a mathematical-modelling approach by comparing the cost-effectiveness in terms of child deaths and stunting events averted between two approaches (from 2011-15 in 14 countries and one province): an equity-focused approach that prioritises the most deprived communities, and a mainstream approach that is representative of current strategies. We combined some existing models, notably the Marginal Budgeting for Bottlenecks Toolkit and the Lives Saved Tool, to do our analysis. We showed that, with the same level of investment, disproportionately higher effects are possible by prioritising the poorest and most marginalised populations, for averting both child mortality and stunting. Our results suggest that an equity-focused approach could result in sharper decreases in child mortality and stunting and higher cost-effectiveness than mainstream approaches, while reducing inequities in effective intervention coverage, health outcomes, and out-of-pocket spending between the most and least deprived groups and geographic areas within countries. Our findings should be interpreted with caution due to uncertainties around some of the model parameters and baseline data. Further research is needed to address some of these gaps in the evidence base. Strategies for improving child nutrition and survival, however, should account for an increasing prioritisation of the most deprived communities and the increased use of community-based interventions. Copyright © 2012 Elsevier Ltd. All rights reserved.

Private enrollments and expenditure on education: Some macro trends

NASA Astrophysics Data System (ADS)

Tan, Jee-Peng

1985-12-01

Many less-developed countries (LDCs) are today facing difficulties in the financing of education. On the one hand, state budgetary allocations to the sector are already very high, and appear likely to grow only slowly, if at all. At the same time, however, the demand for education is rising, not least because of demographic pressures. Without changes in the system, both to reduce unit costs through improving efficiency and to mobilize additional resources for the sector, the level of educational development, particularly in the poorest LDCs, is likely to remain low. Coupled with the stagnation in public spending on education, the data suggest that total national spending in the sector has tended to decline as GDP grew. This trend should perhaps be discouraged since education contributes significantly to economic development. One way of doing so is to increase the share of private participation in total spending in the sector, for example, by increasing the role of private education, especially where it is weak and declining over time.

Innovation for the 'bottom 100 million': eliminating neglected tropical diseases in the Americas.

PubMed

Hotez, Peter J; Dumonteil, Eric; Heffernan, Michael J; Bottazzi, Maria E

2013-01-01

An estimated 100 million people in the Latin American and Caribbean (LAC) region live on less than US$2 per day, while another 46 million people in the US live below that nation's poverty line. Almost all of the 'bottom 100 million' people suffer from at least one neglected tropical disease (NTD), including one-half of the poorest people in the region infected with hookworms, 10% with Chagas disease, and up to 1-2% with dengue, schistosomiasis, and/or leishmaniasis. In the US, NTDs such as Chagas disease, cysticercosis, toxocariasis, and trichomoniasis are also common among poor populations. These NTDs trap the poorest people in the region in poverty, because of their impact on maternal and child health, and occupational productivity. Through mass drug administration (MDA), several NTDs are on the verge of elimination in the Americas, including lymphatic filariasis, onchocerciasis, trachoma, and possibly leprosy. In addition, schistosomiasis may soon be eliminated in the Caribbean. However, for other NTDs including hookworm infection, Chagas disease, dengue, schistosomiasis, and leishmaniasis, a new generation of 'anti-poverty vaccines' will be required. Several vaccines for dengue are under development by multinational pharmaceutical companies, whereas others are being pursued through non-profit product development partnerships (PDPs), in collaboration with developing country manufacturers in Brazil and Mexico. The Sabin Vaccine Institute PDP is developing a primarily preventive bivalent recombinant human hookworm vaccine, which is about to enter phase 1 clinical testing in Brazil, as well as a new therapeutic Chagas disease vaccine in collaboration with several Mexican institutions. The Chagas disease vaccine would be administered to seropositive patients to delay or prevent the onset of Chagasic cardiomyopathy (secondary prevention). Together, MDA and the development of new anti-poverty vaccines afford an opportunity to implement effective control and elimination strategies for the major NTDs in the Americas.

The global impact of income inequality on health by age: an observational study.

PubMed

Dorling, Danny; Mitchell, Richard; Pearce, Jamie

2007-10-27

To explore whether the apparent impact of income inequality on health, which has been shown for wealthier nations, is replicated worldwide, and whether the impact varies by age. Observational study. 126 countries of the world for which complete data on income inequality and mortality by age and sex were available around the year 2002 (including 94.4% of world human population). Data on mortality were from the World Health Organization and income data were taken from the annual reports of the United Nations Development Programme. Mortality in 5-year age bands for each sex by income inequality and income level. At ages 15-29 and 25-39 variations in income inequality seem more closely correlated with mortality worldwide than do variations in material wealth. This relation is especially strong among the poorest countries in Africa. Mortality is higher for a given level of overall income in more unequal nations. Income inequality seems to have an influence worldwide, especially for younger adults. Social inequality seems to have a universal negative impact on health.

Effects of economic downturns on child mortality: a global economic analysis, 1981–2010

PubMed Central

Maruthappu, Mahiben; Watson, Robert A; Watkins, Johnathan; Zeltner, Thomas; Raine, Rosalind; Atun, Rifat

2017-01-01

Objectives To analyse how economic downturns affect child mortality both globally and among subgroups of countries of variable income levels. Design Retrospective observational study using economic data from the World Bank's Development Indicators and Global Development Finance (2013 edition). Child mortality data were sourced from the Institute for Health Metrics and Evaluation. Setting Global. Participants 204 countries between 1981 and 2010. Main outcome measures Child mortality, controlling for country-specific differences in political, healthcare, cultural, structural, educational and economic factors. Results 197 countries experienced at least 1 economic downturn between 1981 and 2010, with a mean of 7.97 downturns per country (range 0–21; SD 0.45). At the global level, downturns were associated with significant (p<0.0001) deteriorations in each child mortality measure, in comparison with non-downturn years: neonatal (coefficient: 1.11, 95% CI 0.855 to 1.37), postneonatal (2.00, 95% CI 1.61 to 2.38), child (2.93, 95% CI 2.26 to 3.60) and under 5 years of age (5.44, 95% CI 4.31 to 6.58) mortality rates. Stronger (larger falls in the growth rate of gross domestic product/capita) and longer (lasting 2 years rather than 1) downturns were associated with larger significant deteriorations (p<0.001). During economic downturns, countries in the poorest quartile experienced ∼1½ times greater deterioration in neonatal mortality, compared with their own baseline; a 3-fold deterioration in postneonatal mortality; a 9-fold deterioration in child mortality and a 3-fold deterioration in under-5 mortality, than countries in the wealthiest quartile (p<0.0005). For 1–5 years after downturns ended, each mortality measure continued to display significant deteriorations (p<0.0001). Conclusions Economic downturns occur frequently and are associated with significant deteriorations in child mortality, with worse declines in lower income countries. PMID:28589010

Family Planning in the Context of Latin America's Universal Health Coverage Agenda.

PubMed

Fagan, Thomas; Dutta, Arin; Rosen, James; Olivetti, Agathe; Klein, Kate

2017-09-27

Countries in Latin America and the Caribbean (LAC) have substantially improved access to family planning over the past 50 years. Many have also recently adopted explicit declarations of universal rights to health and universal health coverage (UHC) and have begun implementing UHC-oriented health financing schemes. These schemes will have important implications for the sustainability and further growth of family planning programs throughout the region. We examined the status of contraceptive methods in major health delivery and financing schemes in 9 LAC countries. Using a set of 37 indicators on family planning coverage, family planning financing, health financing, and family planning inclusion in UHC-oriented schemes, we conducted a desk review of secondary sources, including population surveys, health financing assessments, insurance enrollment reports, and unit cost estimates, and interviewed in-country experts. Findings: Although the modern contraceptive prevalence rate (mCPR) has continued to increase in the majority of LAC countries, substantial disparities in access for marginalized groups remain. On average, mCPR is 20% lower among indigenous women than the general population, 5% lower among uninsured women than insured, and 7% lower among the poorest women than the wealthiest. Among the poorest quintile of women, insured women had an mCPR 16.5 percentage points higher than that of uninsured women, suggesting that expansion of insurance coverage is associated with increased family planning access and use. In the high- and upper-middle-income countries we reviewed, all modern contraceptive methods are typically available through the social health insurance schemes that cover a majority of the population. However, in low- and lower-middle-income countries, despite free provision of most family planning services in public health facilities, stock-outs and implicit rationing present substantial barriers that prevent clients from accessing their preferred method or force them to pay out of pocket. Leveraging UHC-oriented schemes to sustain and further increase family planning progress will require that governments take deliberate steps to (1) target poor and informal sector populations, (2) include family planning in benefits packages, (3) ensure sufficient financing for family planning, and (4) reduce nonfinancial barriers to access. Through these steps, countries can increase financial protection for family planning and better ensure the right to health of poor and marginalized populations. © Fagan et al.

Family Planning in the Context of Latin America's Universal Health Coverage Agenda

PubMed Central

Fagan, Thomas; Dutta, Arin; Rosen, James; Olivetti, Agathe; Klein, Kate

2017-01-01

ABSTRACT Background: Countries in Latin America and the Caribbean (LAC) have substantially improved access to family planning over the past 50 years. Many have also recently adopted explicit declarations of universal rights to health and universal health coverage (UHC) and have begun implementing UHC-oriented health financing schemes. These schemes will have important implications for the sustainability and further growth of family planning programs throughout the region. Methods: We examined the status of contraceptive methods in major health delivery and financing schemes in 9 LAC countries. Using a set of 37 indicators on family planning coverage, family planning financing, health financing, and family planning inclusion in UHC-oriented schemes, we conducted a desk review of secondary sources, including population surveys, health financing assessments, insurance enrollment reports, and unit cost estimates, and interviewed in-country experts. Findings: Although the modern contraceptive prevalence rate (mCPR) has continued to increase in the majority of LAC countries, substantial disparities in access for marginalized groups remain. On average, mCPR is 20% lower among indigenous women than the general population, 5% lower among uninsured women than insured, and 7% lower among the poorest women than the wealthiest. Among the poorest quintile of women, insured women had an mCPR 16.5 percentage points higher than that of uninsured women, suggesting that expansion of insurance coverage is associated with increased family planning access and use. In the high- and upper-middle-income countries we reviewed, all modern contraceptive methods are typically available through the social health insurance schemes that cover a majority of the population. However, in low- and lower-middle-income countries, despite free provision of most family planning services in public health facilities, stock-outs and implicit rationing present substantial barriers that prevent clients from accessing their preferred method or force them to pay out of pocket. Conclusion: Leveraging UHC-oriented schemes to sustain and further increase family planning progress will require that governments take deliberate steps to (1) target poor and informal sector populations, (2) include family planning in benefits packages, (3) ensure sufficient financing for family planning, and (4) reduce nonfinancial barriers to access. Through these steps, countries can increase financial protection for family planning and better ensure the right to health of poor and marginalized populations. PMID:28765156

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

Per-capita GDP and nonequilibrium wealth-concentration in a model for trade

NASA Astrophysics Data System (ADS)

Moukarzel, Cristian F.

2013-12-01

Data describing the per-capita Gross Domestic Product of around two hundred countries in years 1960 to 2008 are analyzed and found to decay approximately exponentially with rank. We discuss this experimental fact in the context of a wealth exchange model called Yard-Sale exchange, in which pairs of agents (i.e. nations) 'bet' for a fraction f of the wealth of the poorest of them. If the chances for this poorest agent to win the bet are not large enough, this model presents a 'wealth condensation' phase, in which one lucky agent gets to own the whole wealth in the end. In a recent study of this model [1], it was found that, in the condensed phase, the typical wealth of an agent with rank R decays exponentially with R. By establishing a parallel between wealth of a nation and its per-capita GDP, these observations suggest that international trade rules are such that strong wealth concentration is favored. Possible extensions of this work, that also consider endogenous factors affecting the evolution of GDP, are also discussed.

Utilization and management of maternal and child health funds in rural Nepal.

PubMed

Morrison, Joanna; Thapa, Rita; Sen, Aman; Neupane, Rishi; Borghi, Jo; Tumbahangphe, Kirti Man; Osrin, David; Manandhar, Dharma; Costello, Anthony

2010-01-01

Maternal and neonatal mortality rates are highest in the poorest countries, and financial barriers impede access to health care. Community loan funds can increase access to cash in rural areas, thereby reducing delays in care seeking. As part of a participatory intervention in rural Nepal, community women's groups initiated and managed local funds. We explore the factors affecting utilization and management of these funds and the role of the funds in the success of the women's group intervention. We conducted a qualitative study using focus group discussions, group interviews and unstructured observations. Funds may increase access to care for members of trusted 'insider' families adjudged as able to repay loans. Sustainability and sufficiency of funds was a concern but funds increased women's independence and enabled timely care seeking. Conversely, the perceived necessity to contribute may have deterred poorer women. While funds were integral to group success and increased women's autonomy, they may not be the most effective way of supporting the poorest, as the risk pool is too small to allow for repayment default.

National economic development and disparities in body mass index: a cross-sectional study of data from 38 countries.

PubMed

Neuman, Melissa; Kawachi, Ichiro; Gortmaker, Steven; Subramanian, Sv

2014-01-01

Increases in body mass index (BMI) and the prevalence of overweight in low- and middle income countries (LMICs) are often ascribed to changes in global trade patterns or increases in national income. These changes are likely to affect populations within LMICs differently based on their place of residence or socioeconomic status (SES). Using nationally representative survey data from 38 countries and national economic indicators from the World Bank and other international organizations, we estimated ecological and multilevel models to assess the association between national levels of gross domestic product (GDP), foreign direct investment (FDI), and mean tariffs and BMI. We used linear regression to estimate the ecological association between average annual change in economic indicators and BMI, and multilevel linear or ordered multinomial models to estimate associations between national economic indicators and individual BMI or over- and underweight. We also included cross-level interaction terms to highlight differences in the association of BMI with national economic indicators by type of residence or socioeconomic status (SES). There was a positive but non-significant association of GDP and mean BMI. This positive association of GDP and BMI was greater among rural residents and the poor. There were no significant ecological associations between measures of trade openness and mean BMI, but FDI was positively associated with BMI among the poorest respondents and in rural areas and tariff levels were negatively associated with BMI among poor and rural respondents. Measures of national income and trade openness have different associations with the BMI across populations within developing countries. These divergent findings underscore the complexity of the effects of development on health and the importance of considering how the health effects of "globalizing" economic and cultural trends are modified by individual-level wealth and residence.

The impact of democracy and media freedom on under-5 mortality, 1961-2011.

PubMed

Wigley, Simon; Akkoyunlu-Wigley, Arzu

2017-10-01

Do democracies produce better health outcomes for children than autocracies? We argue that (1) democratic governments have an incentive to reduce child mortality among low-income families and (2) that media freedom enhances their ability to deliver mortality-reducing resources to the poorest. A panel of 167 countries for the years 1961-2011 is used to test those two theoretical claims. We find that level of democracy is negatively associated with under-5 mortality, and that that negative association is greater in the presence of media freedom. These results are robust to the inclusion of country and year fixed effects, time-varying control variables, and the multiple imputation of missing values. Copyright © 2017 Elsevier Ltd. All rights reserved.

[Malnutrition and poverty in Colombia].

PubMed

Rico Velasco, J; Acciarri, G; Fajardo, L F

1982-01-01

A history of colonial exploitation and a development model that concentrates wealth and excludes a large proportion of the population from the development process are the principal determinants of income distribution in Colombia. This work analyzes the extent of malnutrition among the poorest 30% of the Colombian population. The National Plan for Feeding and Nutrition (PAN), an important component of the national development plan, strives to improve the nutritional status of the most vulnerable population groups living in rural areas and marginal urban neighborhoods, with particular emphasis on mothers and children. The program initially was focussed on 11 priority regions where 5 types of interventions were developed: primary health care, environmental sanitation, food production, food distribution, and nutrition education. Because of the good results initially obtained, PAN now covers the entire national territory. A 1977 survey stratified by socioeconomic levels indicated that among the poorest 30% of the population, 67% of the children examined had low weight for age caused by a combination of chronic and acute malnutrition. 12% were considered to have severe and 23% moderate malnutrition. 8% had severe and 17% had moderate problems of height for age. 26% had deficient weight for height. Comparison of the data to normal values published by the World Health Organization clearly demonstrates the pattern of overall malnutrition indicated by weight for age figures. It can be concluded at 33% of children in the poorest 30% of the population are normal, 31% have mild malnutrition, 23% moderate malnutrition, and 12% severe malnutrition. Data on height for age indicated that 43% were normal, 32% had mild chronic malnutrition, 17% had moderate chronic malnutrition, and 8% had severe chronic malnutrition. The prevalence of acute malnutrition in the poor population measured by the ratio of weight to height was less than that of chronic or overall malnutrition. 21% were considered to show mild, 4% moderate, and 1% severe acute malnutrition. Nutritional status was greatly influenced by age, with the lowest rates of malnutrition occurring in children under 1. Mortality among children aged 1-2 years probably was responsible for a decline in malnutrition rates in children over 2. Patterns of malnutrition in children of the poorest 30% of the Colombian population were quite similar in the 11 departments included in the 1977 survey. Comparison with earlier data indicates that the nutritional status of children in the poorest population sector has not improved since the 1960s.

The millennium development goals and road traffic injuries: exploring the linkages in South Asia.

PubMed

Hyder, Adnan A; Ghaffar, Abdul

2004-12-01

In a major summit of the members of the United Nations (UN) in 2000, a Millennium Declaration was adopted which called for making the elimination of poverty and promotion of sustainable development a global priority. A road map was agreed upon to operationalize the declaration, and the Millennium Development Goals (MDG) were integrated within the document. The MDGs are now increasingly being used to assess the performance of countries, institutions and the global community. WHO declares that the MDGs provide "a set of outcomes that are relevant to the development of national health policy frameworks". It also states that although MDGs do not cover all the components of public health, when broadly interpreted "the goals provide an opportunity to address important cross-cutting issues and key constraints to health". Consistent with WHO's call for a broad interpretation of the MDGs, and building on the health linkages identified by WHO, this paper explores the linkages between the MDGs and the impact of road traffic injuries (RTI). This is done in the context of South Asia, one of the poorest and populated regions of the developing world.

[How practical guidelines can be applied in poor countries? Example of the introduction of a bronchoscopy unit in Cambodia].

PubMed

Couraud, S; Chan, S; Avrillon, V; Horn, K; Try, S; Gérinière, L; Perrot, É; Guichon, C; Souquet, P-J; Ny, C

2013-10-01

According to UN, Cambodia is one of the poorest countries in the World. Respiratory diseases are current public health priorities. In this context, a new bronchoscopy unit (BSU) was created in the respiratory medicine department of Preah Kossamak hospital (PKH) thanks to a tight cooperation between a French and a Cambodian team. Aim of this study was to describe conditions of introduction of this equipment. Two guidelines for practice are available. They are respectively edited by the French and British societies of pulmonology. These guidelines were reviewed and compared to the conditions in which BS was introduced in PKH. Each item from guidelines was combined to a categorical value: "applied", "adapted" or "not applied". In 2009, 54 bronchoscopies were performed in PKH, mainly for suspicion of infectious or tumour disease. In total, 52% and 46% of the French and British guideline items respectively were followed in this Cambodian unit. Patient safety items are those highly followed. By contrast "staff safety" items were those weakly applied. Implementation of EBS in developing countries seems feasible in good conditions of quality and safety for patients. However, some recommendations cannot be applied due to local conditions. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

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.

Military westernization and state repression in the post-Cold War era.

PubMed

Swed, Ori; Weinreb, Alexander

2015-09-01

The waves of unrest that have shaken the Arab world since December 2010 have highlighted significant differences in the readiness of the military to intervene in political unrest by forcefully suppressing dissent. We suggest that in the post-Cold War period, this readiness is inversely associated with the level of military westernization, which is a product of the acquisition of arms from western countries. We identify two mechanisms linking the acquisition of arms from western countries to less repressive responses: dependence and conditionality; and a longer-term diffusion of ideologies regarding the proper form of civil-military relations. Empirical support for our hypothesis is found in an analysis of 2523 cases of government response to political unrest in 138 countries in the 1996-2005 period. We find that military westernization mitigates state repression in general, with more pronounced effects in the poorest countries. However, we also identify substantial differences between the pre- and post-9/11 periods. Copyright © 2015 Elsevier Inc. All rights reserved.

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

An alternative mechanism for international health aid: evaluating a Global Social Protection Fund.

PubMed

Basu, Sanjay; Stuckler, David; McKee, Martin

2014-01-01

Several public health groups have called for the creation of a global fund for 'social protection'-a fund that produces the international equivalent of domestic tax collection and safety net systems to finance care for the ill and disabled and related health costs. All participating countries would pay into a global fund based on a metric of their ability to pay and withdraw from the common pool based on a metric of their need for funds. We assessed how alternative strategies and metrics by which to operate such a fund would affect its size and impact on health system financing. Using a mathematical model, we found that common targets for health funding in low-income countries require higher levels of aid expenditures than presently distributed. Some mechanisms exist that may incentivize reduction of domestic health inequalities, and direct most funds towards the poorest populations. Payments from high-income countries are also likely to decrease over time as middle-income countries' economies grow.

Analysis of changes in the association of income and the utilization of curative health services in Mexico between 2000 and 2006

PubMed Central

2011-01-01

Background A common characteristic of health systems in most developing countries is unequal access to health services. As a result, members of the poorest population groups often do not receive formal attention for health services, because they cannot afford it. In 2001 in Mexico, to address income-related differences in the use of health services, the government launched a major healthcare reform, which includes a health insurance program called Seguro Popular, aimed at improving healthcare access among poor, uninsured residents. This paper analyzes the before and after changes in the demand for curative ambulatory health services focusing on the association of income-related characteristics and the utilization of formal healthcare providers vs. no healthcare service utilization. Methods By using two nationally representative health surveys (ENSA-2000 and ENSANUT-2006), we modeled an individual's decision when experiencing an illness to use services provided by the (1) Ministry of Health (MoH), (2) social security, (3) private entities, or (4) to not use formal services (no healthcare service utilization). Results Poorer individuals were more likely in 2006 than in 2000 to respond to an illness by using formal healthcare providers. Trends in provider selection differed, however. The probability of using public services from the MoH increased among the poorest population, while the findings indicated an increase in utilization of private health services among members of low- and middle-income groups. No significant change was seen among formal workers -covered by social security services-, regardless of socioeconomic status. Conclusions Overall, for 2006 the Mexican population appears less differentiated in using healthcare across economic groups than in 2000. This may be related, in part, to the implementation of Seguro Popular, which seems to be stimulating healthcare demand among the poorest and previously uninsured segment of the population. Still, public health authorities need to address the remaining income-related healthcare utilization differences, the differences in quality between public and private health services, and the general perception that MoH facilities offer inferior services. PMID:21978183

Analysis of changes in the association of income and the utilization of curative health services in Mexico between 2000 and 2006.

PubMed

Danese-Dlsantos, Laura G; Sosa-Rubí, Sandra G; Valencia-Mendoza, Atanacio

2011-10-07

A common characteristic of health systems in most developing countries is unequal access to health services. As a result, members of the poorest population groups often do not receive formal attention for health services, because they cannot afford it. In 2001 in Mexico, to address income-related differences in the use of health services, the government launched a major healthcare reform, which includes a health insurance program called Seguro Popular, aimed at improving healthcare access among poor, uninsured residents. This paper analyzes the before and after changes in the demand for curative ambulatory health services focusing on the association of income-related characteristics and the utilization of formal healthcare providers vs. no healthcare service utilization. By using two nationally representative health surveys (ENSA-2000 and ENSANUT-2006), we modeled an individual's decision when experiencing an illness to use services provided by the (1) Ministry of Health (MoH), (2) social security, (3) private entities, or (4) to not use formal services (no healthcare service utilization). Poorer individuals were more likely in 2006 than in 2000 to respond to an illness by using formal healthcare providers. Trends in provider selection differed, however. The probability of using public services from the MoH increased among the poorest population, while the findings indicated an increase in utilization of private health services among members of low- and middle-income groups. No significant change was seen among formal workers -covered by social security services-, regardless of socioeconomic status. Overall, for 2006 the Mexican population appears less differentiated in using healthcare across economic groups than in 2000. This may be related, in part, to the implementation of Seguro Popular, which seems to be stimulating healthcare demand among the poorest and previously uninsured segment of the population. Still, public health authorities need to address the remaining income-related healthcare utilization differences, the differences in quality between public and private health services, and the general perception that MoH facilities offer inferior services.

Predictors of Antenatal Care, Skilled Birth Attendance, and Postnatal Care Utilization among the Remote and Poorest Rural Communities of Zambia: A Multilevel Analysis.

PubMed

Jacobs, Choolwe; Moshabela, Mosa; Maswenyeho, Sitali; Lambo, Nildah; Michelo, Charles

2017-01-01

Optimal utilization of maternal health-care services is associated with reduction of mortality and morbidity for both mothers and their neonates. However, deficiencies and disparity in the use of key maternal health services within most developing countries still persist. We examined patterns and predictors associated with the utilization of specific indicators for maternal health services among mothers living in the poorest and remote district populations of Zambia. A cross-sectional baseline household survey was conducted in May 2012. A total of 551 mothers with children between the ages 0 and 5 months were sampled from 29 catchment areas in four rural and remote districts of Zambia using the lot quality assurance sampling method. Using multilevel modeling, we accounted for individual- and community-level factors associated with utilization of maternal health-care services, with a focus on antenatal care (ANC), skilled birth attendance (SBA), and postnatal care (PNC). Utilization rates of focused ANC, SBA, and PNC within 48 h were 30, 37, and 28%, respectively. The mother's ability to take an HIV test and receiving test results and uptake of intermittent preventive treatment for malaria were positive predictors of focused ANC. Receiving ANC at least once from skilled personnel was a significant predictor of SBA and PNC within 48 h after delivery. Women who live in centralized rural areas were more likely to use SBA than those living in remote rural areas. Utilization of maternal health services by mothers living among the remote and poor marginalized populations of Zambia is much lower than the national averages. Finding that women that receive ANC once from a skilled attendant among the remote and poorest populations are more likely to have a SBA and PNC, suggests the importance of contact with a skilled health worker even if it is just once, in influencing use of services. Therefore, it appears that in order for women in these marginalized communities to benefit from SBA and PNC, it is important for them to have at least one ANC provided by a skilled personnel, rather than non-skilled health-care providers.

Debt relief and public health spending in heavily indebted poor countries.

PubMed Central

Gupta, Sanjeev; Clements, Benedict; Guin-Siu, Maria Teresa; Leruth, Luc

2002-01-01

The Heavily Indebted Poor Countries (HIPC) Initiative, which was launched in 1996, is the first comprehensive effort by the international community to reduce the external debt of the world's poorest countries. The Initiative will generate substantial savings relative to current and past public spending on health and education in these countries. Although there is ample scope for raising public health spending in heavily indebted poor countries, it may not be advisable to spend all the savings resulting from HIPC resources for this purpose. Any comprehensive strategy for tackling poverty should also focus on improving the efficiency of public health outlays and on reallocating funds to programmes that are most beneficial to the poor. In order to ensure that debt relief increases poverty-reducing spending and benefits the poor, all such spending, not just that financed by HIPC resources, should be tracked. This requires that countries improve all aspects of their public expenditure management. In the short run, heavily indebted poor countries can take some pragmatic tracking measures based on existing public expenditure management systems, but in the longer run they should adopt a more comprehensive approach so as to strengthen their budget formulation, execution, and reporting systems. PMID:11953794

Chemical composition and sources of particle pollution in affluent and poor neighborhoods of Accra, Ghana

NASA Astrophysics Data System (ADS)

Zhou, Zheng; Dionisio, Kathie L.; Verissimo, Thiago G.; Kerr, Americo S.; Coull, Brent; Arku, Raphael E.; Koutrakis, Petros; Spengler, John D.; Hughes, Allison F.; Vallarino, Jose; Agyei-Mensah, Samuel; Ezzati, Majid

2013-12-01

The highest levels of air pollution in the world now occur in developing country cities, where air pollution sources differ from high-income countries. We analyzed particulate matter (PM) chemical composition and estimated the contributions of various sources to particle pollution in poor and affluent neighborhoods of Accra, Ghana. Elements from earth’s crust were most abundant during the seasonal Harmattan period between late December and late January when Saharan dust is carried to coastal West Africa. During Harmattan, crustal particles accounted for 55 μg m-3 (37%) of fine particle (PM2.5) mass and 128 μg m-3 (42%) of PM10 mass. Outside Harmattan, biomass combustion, which was associated with higher black carbon, potassium, and sulfur, accounted for between 10.6 and 21.3 μg m-3 of fine particle mass in different neighborhoods, with its contribution largest in the poorest neighborhood. Other sources were sea salt, vehicle emissions, tire and brake wear, road dust, and solid waste burning. Reducing air pollution in African cities requires policies related to energy, transportation and urban planning, and forestry and agriculture, with explicit attention to impacts of each strategy in poor communities. Such cross-sectoral integration requires emphasis on urban environment and urban poverty in the post-2015 Development Agenda.

Rice fortification: its potential for improving micronutrient intake and steps required for implementation at scale.

PubMed

Piccoli, Nina Beretta; Grede, Nils; de Pee, Saskia; Singhkumarwong, Anusara; Roks, Eveline; Moench-Pfanner, Regina; Bloem, Martin W

2012-12-01

Micronutrient deficiencies affect over 2 billion people worldwide, with profound implications for health, cognitive development, education, economic development, and productivity. Fortification of staple foods is a cost-effective strategy to increase vitamin and mineral intake among the general population. Rice is consumed by billions of people (> 440 million MT/year) but is as yet rarely fortified. To discuss the untapped opportunity of rice fortification. Review literature and experience with rice fortification and compare to fortification of other staple foods. Most technologies used to fortify rice first produce the fortified kernels and then blend them with regular, polished rice. Technologies differ with regard to how nutrients are added to the rice kernels, required investment, production cost, and degree of resemblance to unfortified rice. There are, so far, limited success stories for rice fortification. Some of the main roadblocks appear to be high initial investment and associated cost; lack of government leadership; and consumer hesitation to accept variations in the characteristics of rice, or a higher price, without good understanding of the benefits. In countries with a large centralized rice milling industry, starting rice fortification is easier than in countries with many small mills. Countries with large safety nets that supply rice to the poorest, for free or subsidized, have a good channel to reach those most in need. Furthermore, key players from the public and private sectors should establish a coalition to support the use of fortified rice and address some of the barriers to its implementation.

Resilience in the global food system

NASA Astrophysics Data System (ADS)

Seekell, David; Carr, Joel; Dell'Angelo, Jampel; D'Odorico, Paolo; Fader, Marianela; Gephart, Jessica; Kummu, Matti; Magliocca, Nicholas; Porkka, Miina; Puma, Michael; Ratajczak, Zak; Rulli, Maria Cristina; Suweis, Samir; Tavoni, Alessandro

2017-02-01

Ensuring food security requires food production and distribution systems function throughout disruptions. Understanding the factors that contribute to the global food system’s ability to respond and adapt to such disruptions (i.e. resilience) is critical for understanding the long-term sustainability of human populations. Variable impacts of production shocks on food supply between countries indicate a need for national-scale resilience indicators that can provide global comparisons. However, methods for tracking changes in resilience have had limited application to food systems. We developed an indicator-based analysis of food systems resilience for the years 1992-2011. Our approach is based on three dimensions of resilience: socio-economic access to food in terms of income of the poorest quintile relative to food prices, biophysical capacity to intensify or extensify food production, and the magnitude and diversity of current domestic food production. The socio-economic indicator has a large variability, but with low values concentrated in Africa and Asia. The biophysical capacity indicator is highest in Africa and Eastern Europe, in part because of a high potential for extensification of cropland and for yield gap closure in cultivated areas. However, the biophysical capacity indicator has declined globally in recent years. The production diversity indicator has increased slightly, with a relatively even geographic distribution. Few countries had exclusively high or low values for all indicators. Collectively, these results are the basis for global comparisons of resilience between countries, and provide necessary context for developing generalizations about resilience in the global food system.

Monitoring What Governments “Give for” and “Spend on” Vaccine Procurement: Vaccine Procurement Assistance and Vaccine Procurement Baseline

PubMed Central

Nelson, E. A. S.; Bloom, David E.; Mahoney, Richard T.

2014-01-01

Background The Global Vaccine Action Plan will require, inter alia, the mobilization of financial resources from donors and national governments – both rich and poor. Vaccine Procurement Assistance (VPA) and Vaccine Procurement Baseline (VPB) are two metrics that could measure government performance and track resources in this arena. VPA is proposed as a new subcategory of Official Development Assistance (ODA) given for the procurement of vaccines and VPB is a previously suggested measure of the share of Gross Domestic Product (GDP) that governments spend on their own vaccine procurement. Objective To determine realistic targets for VPA and VPB. Methods Organization for Economic Co-Operation and Development (OECD) and World Bank data for 2009 were analyzed to determine the proportions of bilateral ODA from the 23 Development Assistance Committee (DAC) countries disbursed (as % of GDP in current US$) for infectious disease control. DAC country contributions to the GAVI Alliance for 2009 were assessed as a measure of multilateral donor support for vaccines and immunization programs. Findings In 2009, total DAC bilateral ODA was 0.16% of global GDP and 0.25% of DAC GDP. As a percentage of GDP, Norway (0.013%) and United Kingdom (0.0085%) disbursed the greatest proportion of bilateral ODA for infectious disease control, and Norway (0.024%) and Canada (0.008%) made the greatest contributions to the GAVI Alliance. In 2009 0.02% of DAC GDP was US$7.61 billion and 0.02% of the GDP of the poorest 117 countries was US$2.88 billion. Conclusions Adopting 0.02% GDP as minimum targets for both VPA and VPB is based on realistic estimates of what both developed and developing countries should spend, and can afford to spend, to jointly ensure procurement of vaccines recommended by national and global bodies. New OECD purpose codes are needed to specifically track ODA disbursed for a) vaccine procurement; and b) immunization programs. PMID:24586899

Monitoring what governments "give for" and "spend on" vaccine procurement: Vaccine Procurement Assistance and Vaccine Procurement Baseline.

PubMed

Nelson, E A S; Bloom, David E; Mahoney, Richard T

2014-01-01

The Global Vaccine Action Plan will require, inter alia, the mobilization of financial resources from donors and national governments - both rich and poor. Vaccine Procurement Assistance (VPA) and Vaccine Procurement Baseline (VPB) are two metrics that could measure government performance and track resources in this arena. VPA is proposed as a new subcategory of Official Development Assistance (ODA) given for the procurement of vaccines and VPB is a previously suggested measure of the share of Gross Domestic Product (GDP) that governments spend on their own vaccine procurement. To determine realistic targets for VPA and VPB. Organization for Economic Co-Operation and Development (OECD) and World Bank data for 2009 were analyzed to determine the proportions of bilateral ODA from the 23 Development Assistance Committee (DAC) countries disbursed (as % of GDP in current US$) for infectious disease control. DAC country contributions to the GAVI Alliance for 2009 were assessed as a measure of multilateral donor support for vaccines and immunization programs. In 2009, total DAC bilateral ODA was 0.16% of global GDP and 0.25% of DAC GDP. As a percentage of GDP, Norway (0.013%) and United Kingdom (0.0085%) disbursed the greatest proportion of bilateral ODA for infectious disease control, and Norway (0.024%) and Canada (0.008%) made the greatest contributions to the GAVI Alliance. In 2009 0.02% of DAC GDP was US$7.61 billion and 0.02% of the GDP of the poorest 117 countries was US$2.88 billion. Adopting 0.02% GDP as minimum targets for both VPA and VPB is based on realistic estimates of what both developed and developing countries should spend, and can afford to spend, to jointly ensure procurement of vaccines recommended by national and global bodies. New OECD purpose codes are needed to specifically track ODA disbursed for a) vaccine procurement; and b) immunization programs.

Achievements and challenges for the use of killed oral cholera vaccines in the global stockpile era

PubMed Central

Desai, Sachin N.; Pezzoli, Lorenzo; Alberti, Kathryn P.; Martin, Stephen; Costa, Alejandro; Perea, William; Legros, Dominique

2017-01-01

ABSTRACT Cholera remains an important but neglected public health threat, affecting the health of the poorest populations and imposing substantial costs on public health systems. Cholera can be eliminated where access to clean water, sanitation, and satisfactory hygiene practices are sustained, but major improvements in infrastructure continue to be a distant goal. New developments and trends of cholera disease burden, the creation of affordable oral cholera vaccines (OCVs) for use in developing countries, as well as recent evidence of vaccination impact has created an increased demand for cholera vaccines. The global OCV stockpile was established in 2013 and with support from Gavi, has assisted in achieving rapid access to vaccine in emergencies. Recent WHO prequalification of a second affordable OCV supports the stockpile goals of increased availability and distribution to affected populations. It serves as an essential step toward an integrated cholera control and prevention strategy in emergency and endemic settings. PMID:27813703

Compounds from African Medicinal Plants with Activities Against Selected Parasitic Diseases: Schistosomiasis, Trypanosomiasis and Leishmaniasis.

PubMed

Simoben, Conrad V; Ntie-Kang, Fidele; Akone, Sergi H; Sippl, Wolfgang

2018-05-09

Parasitic diseases continue to represent a threat on a global scale, particularly among the poorest countries in the world. This is particularly because of the absence of vaccines, and in some cases, resistance against available drugs, currently being used for their treatment. In this review emphasis is laid on natural products and scaffolds from African medicinal plants (AMPs) for lead drug discovery and possible further development of drugs for the treatment of parasitic diseases. In the discussion, emphasis has been laid on alkaloids, terpenoids, quinones, flavonoids and narrower compound classes of compounds with micromolar range activities against Schistosoma, Trypanosoma and Leishmania species. In each subparagraph, emphasis is laid on the compound subclasses with most promising in vitro and/or in vivo activities of plant extracts and isolated compounds. Suggestions for future drug development from African medicinal plants have also been provided. This review covering 167 references, including 82 compounds, provides information published within two decades (1997-2017).

Crowd-Sourcing Management Activity Data to Drive GHG Emission Inventories in the Land Use Sector

NASA Astrophysics Data System (ADS)

Paustian, K.; Herrick, J.

2015-12-01

Greenhouse gas (GHG) emissions from the land use sector constitute the largest source category for many countries in Africa. Enhancing C sequestration and reducing GHG emissions on managed lands in Africa has to potential to attract C financing to support adoption of more sustainable land management practices that, in addition to GHG mitigation, can provide co-benefits of more productive and climate-resilient agroecosystems. However, robust systems to measure and monitor C sequestration/GHG reductions are currently a significant barrier to attracting more C financing to land use-related mitigation efforts.Anthropogenic GHG emissions are driven by a variety of environmental factors, including climate and soil attributes, as well as human-activities in the form of land use and management practices. GHG emission inventories typically use empirical or process-based models of emission rates that are driven by environmental and management variables. While a lack of field-based flux and C stock measurements are a limiting factor for GHG estimation, we argue that an even greater limitation may be availabiity of data on the management activities that influence flux rates, particularly in developing countries in Africa. In most developed countries there is a well-developed infrastructure of agricultural statistics and practice surveys that can be used to drive model-based GHG emission estimations. However, this infrastructure is largely lacking in developing countries in Africa. While some activity data (e.g. land cover change) can be derived from remote sensing, many key data (e.g., N fertilizer practices, residue management, manuring) require input from the farmers themselves. The explosive growth in cellular technology, even in many of the poorest parts of Africa, suggests the potential for a new crowd-sourcing approach and direct engagement with farmers to 'leap-frog' the land resource information model of developed countries. Among the many benefits of this approach would be high resolution management data to support GHG inventories at multiple scales. We present an overall conceptual model for this approach and examples from on-going projects in Africa employing direct farmer engagement, cellular technology and apps to develop this information resource.

Evaluating performance of local case-mix system by international comparison: a case study in Beijing, China.

PubMed

Jian, Wei-Yan; Lu, Ming; Cui, Tao; Hu, Mu

2011-01-01

Case-mix is an important tool for health planning and management in many countries. As a major developing country, China is considering the introduction of the case-mix system in the health reform. Beijing, the capital of China, developed a local case-mix version whose performance needs to be evaluated before utilization. The objective of this study was to evaluate the performance of the case-mix system developed in Beijing by comparing it with those used in Australia and the U.S.A. A total of 1.3 million inpatient records from 154 hospitals in Beijing in 2008 were grouped respectively using three case-mix systems: (i) Beijing Diagnosis Related Groups (BJ-DRGs); (ii) US-based All Patient DRGs; and (iii) Australian Refined DRGs. Coefficient of variation (CV) and reduction in variance (RIV) were used to measure the performance of DRGs system. The BJ-DRGs produced the best CV and RIV results for expenditure. However, at the level of Major Diagnostic Category (MDC), three MDCs of BJ-DRGs gave the poorest RIVs for both expenditure and length of stay. Although the performance of BJ-DRGs was acceptable, further revision and improvement is needed. Comparisons with other mature DRGs versions can assist in identifying the improvement priorities of the local version. Copyright © 2011 John Wiley & Sons, Ltd.

The Human Hookworm Vaccine.

PubMed

Hotez, Peter J; Diemert, David; Bacon, Kristina M; Beaumier, Coreen; Bethony, Jeffrey M; Bottazzi, Maria Elena; Brooker, Simon; Couto, Artur Roberto; Freire, Marcos da Silva; Homma, Akira; Lee, Bruce Y; Loukas, Alex; Loblack, Marva; Morel, Carlos Medicis; Oliveira, Rodrigo Correa; Russell, Philip K

2013-04-18

Hookworm infection is one of the world's most common neglected tropical diseases and a leading cause of iron deficiency anemia in low- and middle-income countries. A Human Hookworm Vaccine is currently being developed by the Sabin Vaccine Institute and is in phase 1 clinical testing. The candidate vaccine is comprised of two recombinant antigens known as Na-GST-1 and Na-APR-1, each of which is an important parasite enzyme required for hookworms to successfully utilize host blood as a source of energy. The recombinant proteins are formulated on Alhydrogel(®) and are being tested in combination with a synthetic Toll-like receptor 4 agonist. The aim of the vaccine is to induce anti-enzyme antibodies that will reduce both host blood loss and the number of hookworms attached to the gut. Transfer of the manufacturing technology to the Oswaldo Cruz Foundation (FIOCRUZ)/Bio-Manguinhos (a Brazilian public sector developing country vaccine manufacturer) is planned, with a clinical development plan that could lead to registration of the vaccine in Brazil. The vaccine would also need to be introduced in the poorest regions of Africa and Asia, where hookworm infection is highly endemic. Ultimately, the vaccine could become an essential tool for achieving hookworm control and elimination, a key target in the 2012 London Declaration on Neglected Tropical Diseases. Copyright © 2012 Elsevier Ltd. All rights reserved.

A meta-analysis of telemedicine success in Africa

PubMed Central

Wamala, Dan S.; Augustine, Kaddu

2013-01-01

The use of information and communication technologies (ICT) tools to improve the efficiency of professionalism at work is increasing every time under the dynamic digital environment. Tools such as telemedicine, tele-education, and health informatics have of late been incorporated in the health sector to enable easy access to essential services, for example, in medical areas from referral centers by the patients on one hand and enabling the doctor to doctor consultations for the benefit of patients. Unfortunately, observations indicate dearth efforts and commitment to optimize use of the tools in the majority of the countries south of the Sahara. Sub-Saharan Africa has been left almost behind the rest of the world in terms of development going through decades of economic exploitation by especially the west through its natural and human resources. These factors, ethnic conflicts and endless wars have continued to ruin sub-Saharan Africa’s socio-economic development. Information was obtained through a network of telemedicine practitioners in different African countries using internet communication, through E-mail and reviewing existing literature of their activities. This information was compiled from representative countries in each African region and the previous authors’experiences as telemedicine practioners. Most of these countries have inadequate ICT infrastructure, which yet creates sub-optimal application. Sub-Saharan Africa, made up of 33 of the 48 global poorest countries has to extend its ICT diffusion and policy to match the ever developing global economy. In some countries such as Ethiopia and South Africa there is significant progress in Telemedicine while in countries such as Burkina Faso and Nigeria the progress is slow because of lack of political support. Almost all reference to Africa is made in due respect to sub-Saharan Africa, one with big social, economic, and political problems with resultant high morbidity and mortality rates. This also highlights the under-representation of African researchers in the global whelm of information system research. Telemedicine in Africa though has not attracted enough political support is potentially a very useful conduit of health-care given the fact that the continent is resource limited and still enduring the effects of scarce human resource especially in health. PMID:23858382

A comparative study of campus experiences of college students with mental illnesses versus a general college sample.

PubMed

Salzer, Mark S

2012-01-01

Examine campus experiences and relationships of college students with mental illnesses compared to general student norms using the College Student Experiences Questionnaire to understand potential sources of distress and retention issues. Responses were obtained from 449 former and current students with mental illnesses from more than 300 colleges and universities around the country. Participants completed an online survey available from July 2005 to July 2006. Multivariate analysis of variance and t test results indicate that college students with mental illnesses report less engagement on campus and poorer relationships, and that these factors were associated with lower graduation rates. Students reporting they were treated differently "most of the time" because of a mental illness had the lowest levels of engagement and poorest relationships. More attention is needed to developing interventions that enhance social functioning and engagement and address stigma on campus in order to reduce distress and enhance retention.

Temperature Effects on Labor in Latin America

NASA Astrophysics Data System (ADS)

Foreman, T.

2016-12-01

It has long been known that environmental conditions can affect humans' performance of various tasks, both physical and mental. In light of projected climate change, heat's impact on performance is of particular concern. While there is evidence that performance suffers, from an economic standpoint, how this performance effect changes a worker's ability or willingness to work is of particular concern. Workers' decisions to supply less labor may be a key channel for economic losses due to climate change, especially in developing countries that experience high temperatures and humidity. In a study of worker behavior in Guatemala, Mexico, and Nicaragua, increasing temperatures by 1°C was found to reduce labor supplied by up to an hour per day for each worker on average in the poorest and hottest places. This result holds across different levels of risk exposure to heat, indicating little evidence of potential adaptation measures.

Diabetes Cultural Beliefs and Traditional Medicine Use Among Health Center Patients in Oaxaca, Mexico.

PubMed

Espinoza Giacinto, Rebeca; Castañeda, Sheila F; Perez, Ramona L; Nodora, Jesse N; Gonzalez, Patricia; Lopez, Emma Julián; Talavera, Gregory A

2016-12-01

Type II diabetes mellitus is currently the leading cause of death in Mexico. Oaxaca is one of the poorest states in Mexico with the largest concentration of indigenous people in the country. Despite the alarming increase of diabetes rates in this region, little is known about the indigenous populations' cultural understandings and related practices for this chronic disease. This study examined diabetes cultural beliefs and traditional medicine use among a sample of 158 adults with and without diabetes in Oaxaca, Mexico. Individuals with and without diabetes did not differ in their traditional culture beliefs regarding diabetes in this study. Younger age (OR = 1.04) and stronger beliefs in punitive and mystical retribution (OR = 5.42) regarding diabetes causality increased the likelihood of using traditional medicine (p < .05). Findings may aid in the development of culturally tailored programs to address diabetes prevention and management efforts in the region.

Sources of indoor air pollution and respiratory health in preschool children.

PubMed

Fuentes-Leonarte, Virginia; Ballester, Ferran; Tenías, José Maria

2009-01-01

We carried out bibliographic searches in PubMed and Embase.com for the period from 1996 to 2008 with the aim of reviewing the scientific literature on the relationship between various sources of indoor air pollution and the respiratory health of children under the age of five. Those studies that included adjusted correlation measurements for the most important confounding variables and which had an adequate population size were considered to be more relevant. The results concerning the relationship between gas energy sources and children's respiratory health were heterogeneous. Indoor air pollution from biomass combustion in the poorest countries was found to be an important risk factor for lower respiratory tract infections. Solvents involved in redecorating, DYI work, painting, and so forth, were found to be related to an increased risk for general respiratory problems. The distribution of papers depending on the pollution source showed a clear relationship with life-style and the level of development.

The Hyperspectral Infrared Imager (HyspIRI) Public Health and Air Quality Applications

NASA Technical Reports Server (NTRS)

Luvall, Jeffrey C.; Hook, Simon J.

2014-01-01

The neglected tropical diseases (NTDs), a group of chronic, debilitating, and poverty-promoting parasitic, bacterial, and some viral and fungal infections, are among the most common causes of illness of the poorest people living in developing countries. Abiotic environmental factors are important in determining the distribution of disease-causing vectors and their life-cycles. HyspIRI observations can be merged through a Land Data Assimilation System (LDAS) be used to drive spatially-explicit ecological models of NTD vectors distribution and life cycles. Assimilations will be driven by observational data LDAS and satellite-derived meteorological forcing data, parameter datasets, and assimilation observations. HyspIRI hyperspectral measurements would provide global measurements of surface mineralogy and biotic crusts important in accessing the impact of dust in human health. HyspIRI surface thermal measurements would also help identify the variability of dust sources due to surface moisture conditions and map mineralogy.

The Hyperspectral Infrared Imager (HyspIRI) Public Health and Air Quality Applications

NASA Technical Reports Server (NTRS)

Luvall, Jeffrey C.; Hook, Simon J.

2013-01-01

The neglected tropical diseases (NTDs), a group of chronic, debilitating, and poverty-promoting parasitic, bacterial, and some viral and fungal infections, are among the most common causes of illness of the poorest people living in developing countries. Abiotic environmental factors are important in determining the distribution of disease-causing vectors and their life-cycles. HyspIRI observations can be merged through a Land Data Assimilation System (LDAS) be used to drive spatially-explicit ecological models of NTD vectors distribution & life cycles. Assimilations will be driven by observational data LDAS and satellite-derived meteorological forcing data, parameter datasets, and assimilation observations. HyspIRI hyperspectral measurements would provide global measurements of surface mineralogy and biotic crusts important in accessing the impact of dust in human health. HyspIRI surface thermal measurements would also help identify the variability of dust sources due to surface moisture conditions and map mineralogy.

The Hyperspectral Infrared Imager (HyspIRI) Public Health & Air Quality Applications

NASA Technical Reports Server (NTRS)

Luvall, Jeffrey C.; Hook, Simon J.

2013-01-01

The neglected tropical diseases (NTDs), a group of chronic, debilitating, and poverty-promoting parasitic, bacterial, and some viral and fungal infections, are among the most common causes of illness of the poorest people living in developing countries. Abiotic environmental factors are important in determining the distribution of disease-causing vectors and their life-cycles. HyspIRI observations can be merged through a Land Data Assimilation System (LDAS) be used to drive spatially-explicit ecological models of NTD vectors distribution & life cycles. Assimilations will be driven by observational data LDAS and satellite-derived meteorological forcing data, parameter datasets, and assimilation observations. HyspIRI hyperspectral measurements would provide global measurements of surface mineralogy and biotic crusts important in accessing the impact of dust in human health. HyspIRI surface thermal measurements would also help identify the variability of dust sources due to surface moisture conditions and map mineralogy.

The pediatrician's role in the twenty-first century.

PubMed

Gracey, M

1998-10-01

The world's children comprise: (i) those in wealthy, industrialized countries; (ii) those from rapidly industrializing countries; (iii) minority groups including recently arrived immigrants in otherwise affluent and healthy societies; (iv) previously traditional people in rapid transition to urbanized, Western lifestyles; and (v) many millions living in grinding poverty in overcrowded, unhygienic conditions where child mortality is high and often due to malnutrition and infections. Industrialization, affluence, better housing, hygiene and nutrition, better clinical care and disease prevention have helped enhance child health in many countries over the past century. However, this is being offset by obesity, smoking, alcohol and drug abuse and social disruption, mental disease and high rates of violence including homicide and suicide. These 'new morbidities' are worse among minorities and in populations undergoing rapid social change. Social pressures including unemployment, depression and family dysfunction are important. Pediatricians must become active in decisions about the use of public resources in disease prevention, health education and more rational and equitable use of high technology. They should also be active advocates for children and their rights and advise governments about all issues that affect child health, protection and well-being. This is particularly so in the poorest and developing countries. There is a need for better international collaboration, training and exchange programs involving the International Pediatric Association, United Nations International Children's Emergency Fund, World Health Organization and other local, national and regional organizations to help overcome these problems as the next century draws near.

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.

Socioeconomic status and children's health: evidence from a low-income country.

PubMed

Sepehri, Ardeshir; Guliani, Harminder

2015-04-01

There has been a growing empirical literature on the relationship between household socioeconomic status (SES) and children's health, and in particular, whether this SES gradient is constant or varies in strength across different life stages. Much of this literature focuses on the developed countries and less evidence has been presented for developing countries. Using Vietnam's rich National Health Survey (2001-02) and appropriate multilevel modeling this study empirically assesses the SES gradient in health and whether it varies in strength across different life stages of children aged 15 and younger (N = 45,448). The results for the interaction terms between the natural logarithm of household consumption and age groups indicate no evidence of a steeper health gradient for older children. However, health-consumption gradients are found to be sensitive to the functional form of the regression model as well as the model specification. The results for the interaction terms between consumption expenditure quintiles and age groups indicate that gradients vary in strength across ages. Not only are children from the poorest households worse off, compared to those from the richest households, but this relative disadvantage is greater among the 0-3 year olds. The inclusion of parental health status in the regression model weakens the gradients for all age groups as does the inclusion of household sources of drinking water. However, poorer children are still relatively worse off, specially the 0-3 year olds. This suggests that absolute deprivation may help explain the relative health disadvantage of younger children. Better measures of poverty alleviation are hence needed to improve children's health in a low-income country such as Vietnam. Copyright © 2015 Elsevier Ltd. All rights reserved.

Prevalence of thoracic surgical care need in a developing country: results of a cluster-randomized, cross-sectional nationwide survey.

PubMed

Zogg, Cheryl K; Kamara, Thaim B; Groen, Reinou S; Mungo, Benedetto; Kushner, Adam L; Molena, Daniela

2015-01-01

Developing countries without established surgical capacity face heightened morbidity and mortality from poorly understood, untreated thoracic surgical impairments. This study sought to estimate the prevalence of thoracic surgical need in a low-income country and consider contributing factors involved. Cluster-randomized, cross-sectional nationwide survey using the Surgeons OverSeas Assessment of Surgical Need tool in Sierra Leone from January 9-February 3, 2012. Data were collected and analyzed from 3645 respondents (response rate 98.3%). 273 (7.5%) reported ≥1 chest (including heart, lungs, and mediastinum) or breast surgical problem during their lifetime; 268 (7.4%) reported ≥1 back complaint. Multiple problems could be reported, resulting in a total of 277 chest/breast and 268 back complaints. The majority (184/545) were related to acquired deformities. Most occurred ≥12 months ago (364/545) and continued to impact the participant at the time of the interview (339/545). 322/545 sought care; however, 40% (130/322) did not receive care, predominately due to an inability to pay. Adjusted logistic regression found that chest/breast problems were more common among farm workers, older participants, and individuals with minimal education, while back problems were more common in the same groups and males. The study provides data on the prevalence of thoracic surgical conditions and factors affecting prevalence in one of the world's poorest countries. The results speak to the need for further work to enhance health systems strengthening while offering the opportunity for future training and research in resource-limited settings--an area of thoracic surgery that is not well understood. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

Cost-effectiveness of pneumococcal conjugate vaccination in the prevention of child mortality: an international economic analysis.

PubMed

Sinha, Anushua; Levine, Orin; Knoll, Maria D; Muhib, Farzana; Lieu, Tracy A

2007-02-03

Routine vaccination of infants against Streptococcus pneumoniae (pneumococcus) needs substantial investment by governments and charitable organisations. Policymakers need information about the projected health benefits, costs, and cost-effectiveness of vaccination when considering these investments. Our aim was to incorporate these data into an economic analysis of pneumococcal vaccination of infants in countries eligible for financial support from the Global Alliance for Vaccines & Immunization (GAVI). We constructed a decision analysis model to compare pneumococcal vaccination of infants aged 6, 10, and 14 weeks with no vaccination in the 72 countries that were eligible as of 2005. We used published and unpublished data to estimate child mortality, effectiveness of pneumococcal conjugate vaccine, and immunisation rates. Pneumococcal vaccination at the rate of diptheria-tetanus-pertussis vaccine coverage was projected to prevent 262,000 deaths per year (7%) in children aged 3-29 months in the 72 developing countries studied, thus averting 8.34 million disability-adjusted life years (DALYs) yearly. If every child could be reached, up to 407,000 deaths per year would be prevented. At a vaccine cost of International 5 dollars per dose, vaccination would have a net cost of 838 million dollars, a cost of 100 dollars per DALY averted. Vaccination at this price was projected to be highly cost-effective in 68 of 72 countries when each country's per head gross domestic product per DALY averted was used as a benchmark. At a vaccine cost of between 1 dollar and 5 dollars per dose, purchase and accelerated uptake of pneumococcal vaccine in the world's poorest countries is projected to substantially reduce childhood mortality and to be highly cost-effective.

Health sector employment: a tracer indicator for universal health coverage in national Social Protection Floors.

PubMed

Scheil-Adlung, Xenia; Behrendt, Thorsten; Wong, Lorraine

2015-08-31

Health sector employment is a prerequisite for availability, accessibility, acceptability and quality (AAAQ) of health services. Thus, in this article health worker shortages are used as a tracer indicator estimating the proportion of the population lacking access to such services: The SAD (ILO Staff Access Deficit Indicator) estimates gaps towards UHC in the context of Social Protection Floors (SPFs). Further, it highlights the impact of investments in health sector employment equity and sustainable development. The SAD is used to estimate the share of the population lacking access to health services due to gaps in the number of skilled health workers. It is based on the difference of the density of the skilled health workforce per population in a given country and a threshold indicating UHC staffing requirements. It identifies deficits, differences and developments in access at global, regional and national levels and between rural and urban areas. In 2014, the global UHC deficit in numbers of health workers is estimated at 10.3 million, with most important gaps in Asia (7.1 million) and Africa (2.8 million). Globally, 97 countries are understaffed with significantly higher gaps in rural than in urban areas. Most affected are low-income countries, where 84 per cent of the population remains excluded from access due to the lack of skilled health workers. A positive correlation of health worker employment and population health outcomes could be identified. Legislation is found to be a prerequisite for closing access as gaps. Health worker shortages hamper the achievement of UHC and aggravate weaknesses of health systems. They have major impacts on socio-economic development, particularly in the world's poorest countries where they act as drivers of health inequities. Closing the gaps by establishing inclusive multi-sectoral policy approaches based on the right to health would significantly increase equity, reduce poverty due to ill health and ultimately contribute to sustainable development and social justice.

Feasibility of developing a pediatric telehealth network in Honduras with international consultation support.

PubMed

Brooks, Mary; Holden, Kenton R; Durón, Reyna M; McElligott, James T; Summer, Andrea

2017-01-01

Honduras is the second poorest country in Central America, and roughly 50% of the population lives in rural areas. A telehealth network linking these areas to larger health centers may improve patient access to care, and physician access to educational opportunities. This pilot study assessed the feasibility of establishing a pediatric telehealth network between underserved clinics in Honduras and the Medical University of South Carolina (MUSC). Two underserved Honduran clinics were identified and invited to participate in the telehealth network. Providers from these clinics connected remotely to educational conferences at MUSC, and received teleconsults from MUSC physicians and physicians from the other Honduran site. Honduran providers completed five-point Likert scale satisfaction surveys following participation in the conferences and teleconsults. Survey feedback was positive, with 100% of respondents stating they would utilize telemedicine in the future. Dissatisfaction was expressed subjectively in the survey comments with regards to poor Internet connectivity and unreliable electrical power. The establishment of a telehealth network between Honduras and MUSC is feasible, and rural providers were receptive to the clinical and educational opportunities this network provides. Future projects will expand telehealth capabilities to other Honduran sites and focus on intra-country collaboration to ensure sustainability.

Zika puzzle in Brazil: peculiar conditions of viral introduction and dissemination - A Review

PubMed Central

Possas, Cristina; Brasil, Patricia; Marzochi, Mauro CA; Tanuri, Amilcar; Martins, Reinaldo M; Marques, Ernesto TA; Bonaldo, Myrna C; Ferreira, Antonio GP; Lourenço-de-Oliveira, Ricardo; Nogueira, Rita Maria R; Sequeira, Patricia C; Marzochi, Keyla BF; Homma, Akira

2017-01-01

This article discusses the peculiar conditions that favoured the unexpected introduction of Zika virus into the poorest northeastern region of Brazil in 2015, its speed of transmission to other Brazilian states, other Latin American countries and other regions, and the severity of related neurological disorders in newborns and adults. Contrasting with evidence that Zika had so far caused only mild cases in humans in the last six decades, the epidemiological scenario of this outbreak in Brazil indicates dramatic health effects: in 2015, an increase of 20-fold in notified cases of microcephaly and/or central nervous system (CNS) alterations suggestive of Zika congenital infection, followed by an exponential increase in 2016, with 2366 cumulative cases confirmed in the country by the end of December 2016. A significant increase in Guillain-Barré syndrome in adults has also been reported. Factors involved in viral dissemination, neural pathogenesis and routes of transmission in Brazil are examined, such as the role of social and environmental factors and the controversies involved in the hypothesis of antibody-dependent enhancement, to explain the incidence of congenital Zika syndrome in Brazil. Responses to the Zika outbreak and the development of new products are also discussed. PMID:28443985

[Experience in establishing ophthalmology at the Hôpital Albert Schweitzer (HAS) in Deschapelles, Haiti].

PubMed

Eisenmann, D; Bracher, H R

2007-04-01

Haiti is regarded as the poorest country of the Western hemisphere. The Hôpital Albert Schweitzer (HAS), founded in 1956 by Larimer Melon, is providing medical care to the Artibonite valley, an area in the centre of Haiti with over 400 000 inhabitants. Until 2001, a three-fold population was without eye care in central Haiti. In 2001, Hans Rudolf Bracher, a retired ophthalmologist from Bern, initiated the eye department at HAS and organised an eye examination unit, a microscope and further surgical equipment. Since then, eye care to the population was provided by short-term visits of ophthalmologists, nurses and orthoptists, mainly from switzerland. Additionally, teaching and surgical training was performed at university hospital in Port-au-Price, the only education centre for ophthalmologists in the country. The actual political and security situation complicates visits of western doctors. A development association for the HAS eye department was founded and with its help, an Haitian ophthalmologist is employed in a full-time position. Furthermore, logistic support is provided with drugs and surgical equipment. Today, under difficult circumstances, the eye department is well established as an effective and cost-covering institution at HAS.

Bolivia.

PubMed

1986-10-01

Background notes by the U.S. States Department on the landlocked country of Bolivia, in the center of South America are presented. Bolivia has 6.25 million persons, about 1/3 each of Aymara indians, Quechua indians and mixed races. The growth rate is 2.6%, despite high death rates: infant mortality is 123/1000 and life expectancy is 49 years. There are fertile tropical lowland climate, hills and valleys, high plateaus and very high, dry cold mountain regions. Bolivia is the least developed, poorest nation in South America (per capita income is $536). There are remarkable cultural resources in archaeology, art, music, folklore and crafts, however. The country is plagued with military coups, social unrest, debt, poverty, and the disruption of international traffic in illegal drugs. One of the major resources, tin, has been lost as income due to collapse in tin prices in 1985. Other resources include natural gas, zinc, silver, tungsten, coffee, and undeveloped lithium, potassium and borax. Bolivia has had difficulties with border disputes with Chile, and since 1980, with many former friendly nations, including the U.S. due to a repressive military dictatorship. Recently, a more moderate government came into power, and relations and economic aid have resumed.

Private investment in AIDS vaccine development: obstacles and solutions.

PubMed

Batson, A; Ainsworth, M

2001-01-01

The development of vaccines for the prevention of AIDS, malaria, tuberculosis, and other diseases requires both public and private investment. Private investment, however, has been far lower than might have been hoped, given the massive human toll of these diseases, particularly in the poorest countries. With a view to understanding this situation and exploring potential solutions, the World Bank AIDS Vaccine Task Force commissioned a study on the perspectives of the biotechnology, vaccine, and pharmaceutical industries regarding investment in research and development work on an AIDS vaccine. It was found that different obstacles to the development of an AIDS vaccine arose during the product development cycle. During the earlier phases, before obtaining proof of product, the principal barriers were scientific. The lack of consensus on which approach was likely to be effective increased uncertainty and the risks associated with investing in expensive clinical trials. The later phases, which involved adapting, testing, and scaling up production for different populations, were most influenced by market considerations. In order to raise the levels of private research and development in an AIDS vaccine there will probably have to be a combination of push strategies, which reduce the cost and scientific risk of investment, and pull strategies, which guarantee a market.

Water flowing north of the border: export agriculture and water politics in a rural community in Baja California.

PubMed

Zlolniski, Christian

2011-01-01

Favored by neoliberal agrarian policies, the production of fresh crops for international markets has become a common strategy for economic development in Mexico and other Latin American countries. But as some scholars have argued, the global fresh produce industry in developing countries in which fresh crops are produced for consumer markets in affluent nations implies “virtual water flows,” the transfer of high volumes of water embedded in these crops across international borders. This article examines the local effects of the production of fresh produce in the San Quintín Valley in northwestern Mexico for markets in the United States. Although export agriculture has fostered economic growth and employment opportunities for indigenous farm laborers, it has also led to the overexploitation of underground finite water resources, and an alarming decline of the quantity and quality of water available for residents’ domestic use. I discuss how neoliberal water policies have further contributed to water inequalities along class and ethnic lines, the hardships settlers endure to secure access to water for their basic needs, and the political protests and social tensions water scarcity has triggered in the region. Although the production of fresh crops for international markets is promoted by organizations such as the World Bank and Inter-American Development Bank as a model for economic development, I argue that it often produces water insecurity for the poorest, threatening the UN goal of ensuring access to clean water as a universal human right.

An equity dashboard to monitor vaccination coverage.

PubMed

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

2017-02-01

Equity monitoring is a priority for Gavi, the Vaccine Alliance, and for those implementing The 2030 agenda for sustainable development . For its new phase of operations, Gavi reassessed its approach to monitoring equity in vaccination coverage. To help inform this effort, we made a systematic analysis of inequalities in vaccination coverage across 45 Gavi-supported countries and compared results from different measurement approaches. Based on our findings, we formulated recommendations for Gavi's equity monitoring approach. The approach involved defining the vulnerable populations, choosing appropriate measures to quantify inequalities, and defining equity benchmarks that reflect the ambitions of the sustainable development agenda. In this article, we explain the rationale for the recommendations and for the development of an improved equity monitoring tool. Gavi's previous approach to measuring equity was the difference in vaccination coverage between a country's richest and poorest wealth quintiles. In addition to the wealth index, we recommend monitoring other dimensions of vulnerability (maternal education, place of residence, child sex and the multidimensional poverty index). For dimensions with multiple subgroups, measures of inequality that consider information on all subgroups should be used. We also recommend that both absolute and relative measures of inequality be tracked over time. Finally, we propose that equity benchmarks target complete elimination of inequalities. To facilitate equity monitoring, we recommend the use of a data display tool - the equity dashboard - to support decision-making in the sustainable development period. We highlight its key advantages using data from Côte d'Ivoire and Haiti.

Economic and other determinants of infant and child mortality in small developing countries: the case of Central America and the Caribbean.

PubMed

Hojman, D E

1996-03-01

This analysis involves empirically testing a theoretical model among 22 Central American and Caribbean countries during the 1990s that explains differences in infant and child mortality. Explanatory measures capture demographic, economic, health care, and educational characteristics. The model is expected to allow for an assessment of the potential impact of structural adjustment and external debt. It is pointed out that birth rates and child mortality rates followed similar patterns over time and between countries. In this study's regression analyses all variables in the three models that explain infant mortality are exogenous: low birth weight, immunization, gross domestic product per capita, years of schooling for women, population/nurse, and debt as a proportion of gross national product. As nations became richer, infant mortality declined. Infant mortality was lower in countries with high external debt. In models for explaining the birth rate and the child mortality rate, the best fit included variables for debt, real public expenditure on health care, water supply, and malnutrition. Analysis in a simultaneous model for 10 countries revealed that the birth rate and the child mortality rate were more responsive to shocks in exogenous variables in Barbados than in the Dominican Republic, and more responsive in the Dominican Republic than in Guatemala. The impact of each exogenous variable varied by country. In Barbados education was four times more effective in explaining the birth rate than water. In Guatemala, the most effective exogenous variable was malnutrition. Child mortality rates were affected more by multiplier effects. In richer countries, the most important impact on child survival was improved access to safe water, and the most important impact on the birth rate was increased real public expenditure on education per capita. For the poorest countries, findings suggest first improvement in malnutrition and then improvement in safe water supplies. Structural adjustment variables were found to have small impacts on the birth rate or limited impacts on child survival in poorer countries.

The impacts of rapid demographic transition on family structure and income inequality in Brazil, 1981-2011.

PubMed

Maia, Alexandre Gori; Sakamoto, Camila Strobl

2016-11-01

This study analysed the impact of changing family structure on income distribution. Specifically, it analysed how changes in the proportions of different categories of family in the population contributed to increases in the income of the richest and poorest social strata in Brazil, and the consequent impacts on income inequality. Rural and urban families were compared in order to understand how these dynamics had different impacts on more developed (urban) and less developed (rural) areas. The results emphasize how changes observed in family structure are more pronounced among the richest families, contributing to an increase in (i) the income of the richest families and (ii) income inequality between the richest and poorest families, as well as between urban and rural areas.

Nicaragua: an example of commitments and strengths despite problems of poverty.

PubMed

Ross, Carl A

2007-01-01

Nicaragua is located in the middle of the Central American isthmus between the countries of Honduras and Costa Rica. It is the largest Central American country and is equivalent in size to the state of Georgia. Nicaragua is cited by Pan American Health Organization as one of the poorest third-world countries. One factor that continues to contribute to Nicaragua's chronic poverty state is the demographics of the country. Nearly half of all Nicaraguans are under 15 years of age, and more than a quarter are between the ages of 15 and 29 years. Only a quarter of the population is over 30 years of age. Beyond the hardship and poverty, there is a country rich in beauty. Nicaragua has a beautiful countryside with lush green mountains, black sand beaches of the Pacific Ocean, and the natural wonder of active volcanoes. It is easy to become engulfed by the tranquility of these surroundings and to steer away from the harsh conditions of the country. It is, however, a temporary escape from reality, for it was the hardships and unfavorable circumstances of this country that are never forgotten and which persist until today. This article focuses on a variety of interventions used to assist Nicaragua with their health care and state of well-being.

Relational and Purpose Development in Youth Offenders

ERIC Educational Resources Information Center

Coll, Kenneth M.; Thobro, Patti; Haas, Robin

2004-01-01

This study explored which risk factors are associated with degrees of relational and purpose development in youth offenders. Results indicate that those with the poorest development particularly struggled with substance abuse, lack of family support, and risky behaviors to self. Several treatment recommendations and clinical strategies are…

Free-trade agreements: challenges for global health

PubMed Central

Ribeiro, Helena

2015-01-01

In this study new free-trade agreements are discussed, which are based on the breaking down of tariff and technical barriers and normally exclude most of the poorest countries in the world. Considering the current context of economic globalization and its health impacts, seven controversial points of these treaties and their possible implications for global public health are presented, mainly regarding health equity and other health determinants. Finally, this research proposes a greater social and health professionals participation in the formulation and discussion of these treaties, and a deeper insertion of Brazil in this important international agenda. PMID:26270018

Study design of a cluster-randomized controlled trial to evaluate a large-scale distribution of cook stoves and water filters in Western Province, Rwanda.

PubMed

Nagel, Corey L; Kirby, Miles A; Zambrano, Laura D; Rosa, Ghislane; Barstow, Christina K; Thomas, Evan A; Clasen, Thomas F

2016-12-15

In Rwanda, pneumonia and diarrhea are the first and second leading causes of death, respectively, among children under five. Household air pollution (HAP) resultant from cooking indoors with biomass fuels on traditional stoves is a significant risk factor for pneumonia, while consumption of contaminated drinking water is a primary cause of diarrheal disease. To date, there have been no large-scale effectiveness trials of programmatic efforts to provide either improved cookstoves or household water filters at scale in a low-income country. In this paper we describe the design of a cluster-randomized trial to evaluate the impact of a national-level program to distribute and promote the use of improved cookstoves and advanced water filters to the poorest quarter of households in Rwanda. We randomly allocated 72 sectors (administratively defined units) in Western Province to the intervention, with the remaining 24 sectors in the province serving as controls. In the intervention sectors, roughly 100,000 households received improved cookstoves and household water filters through a government-sponsored program targeting the poorest quarter of households nationally. The primary outcome measures are the incidence of acute respiratory infection (ARI) and diarrhea among children under five years of age. Over a one-year surveillance period, all cases of acute respiratory infection (ARI) and diarrhea identified by health workers in the study area will be extracted from records maintained at health facilities and by community health workers (CHW). In addition, we are conducting intensive, longitudinal data collection among a random sample of households in the study area for in-depth assessment of coverage, use, environmental exposures, and additional health measures. Although previous research has examined the impact of providing household water treatment and improved cookstoves on child health, there have been no studies of national-level programs to deliver these interventions at scale in a developing country. The results of this study, the first RCT of a large-scale programmatic cookstove or household water filter intervention, will inform global efforts to reduce childhood morbidity and mortality from diarrheal disease and pneumonia. This trial is registered at Clinicaltrials.gov (NCT02239250).

Socioeconomic Inequality in Disability Among Adults: A Multicountry Study Using the World Health Survey

PubMed Central

Hosseinpoor, Ahmad R.; Stewart Williams, Jennifer A.; Gautam, Jeny; Posarac, Aleksandra; Officer, Alana; Verdes, Emese; Kostanjsek, Nenad

2013-01-01

Objectives. We compared national prevalence and wealth-related inequality in disability across a large number of countries from all income groups. Methods. Data on 218 737 respondents participating in the World Health Survey 2002–2004 were analyzed. A composite disability score (0–100) identified respondents who experienced significant disability in physical, mental, and social functioning irrespective of their underlying health condition. Disabled persons had disability composite scores above 40. Wealth was evaluated using an index of economic status in households based on ownership of selected assets. Socioeconomic inequalities were measured using the slope index of inequality and the relative index of inequality. Results. Median age-standardized disability prevalence was higher in the low- and lower middle-income countries. In all the study countries, disability was more prevalent in the poorest than in the richest wealth quintiles. Pro-rich inequality was statistically significant in 43 of 49 countries, with disability prevalence higher among populations with lower wealth. Median relative inequality was higher in the high- and upper middle-income countries. Conclusions. Integrating equity components into the monitoring of disability trends would help ensure that interventions reach and benefit populations with greatest need. PMID:23678901

Socioeconomic inequality in disability among adults: a multicountry study using the World Health Survey.

PubMed

Hosseinpoor, Ahmad R; Stewart Williams, Jennifer A; Gautam, Jeny; Posarac, Aleksandra; Officer, Alana; Verdes, Emese; Kostanjsek, Nenad; Chatterji, Somnath

2013-07-01

We compared national prevalence and wealth-related inequality in disability across a large number of countries from all income groups. Data on 218,737 respondents participating in the World Health Survey 2002-2004 were analyzed. A composite disability score (0-100) identified respondents who experienced significant disability in physical, mental, and social functioning irrespective of their underlying health condition. Disabled persons had disability composite scores above 40. Wealth was evaluated using an index of economic status in households based on ownership of selected assets. Socioeconomic inequalities were measured using the slope index of inequality and the relative index of inequality. Median age-standardized disability prevalence was higher in the low- and lower middle-income countries. In all the study countries, disability was more prevalent in the poorest than in the richest wealth quintiles. Pro-rich inequality was statistically significant in 43 of 49 countries, with disability prevalence higher among populations with lower wealth. Median relative inequality was higher in the high- and upper middle-income countries. Integrating equity components into the monitoring of disability trends would help ensure that interventions reach and benefit populations with greatest need.

The development of cardiac surgery in West Africa-the case of Ghana

PubMed Central

Edwin, Frank; Tettey, Mark; Aniteye, Ernest; Tamatey, Martin; Sereboe, Lawrence; Entsua-Mensah, Kow; Kotei, David; Baffoe-Gyan, Kofi

2011-01-01

West Africa is one of the poorest regions of the world. The sixteen nations listed by the United Nations in this sub-region have some of the lowest gross domestic products in the world. Health care infrastructure is deficient in most of these countries. Cardiac surgery, with its heavy financial outlay is unavailable in many West African countries. These facts notwithstanding, some West African countries have a proud history of open heart surgery not very well known even in African health care circles. Many African health care givers are under the erroneous impression that the cardiovascular surgical landscape of West Africa is blank. However, documented reports of open-heart surgery in Ghana dates as far back as 1964 when surface cooling was used by Ghanaian surgeons to close atrial septal defects. Ghana's National Cardiothoracic Center is still very active and is accredited by the West African College of Surgeons for the training of cardiothoracic surgeons. Reports from Nigeria indicate open-heart surgery taking place from 1974. Cote D'Ivoire had reported on its first 300 open-heart cases by 1983. Senegal reported open-heart surgery from 1995 and still runs an active center. Cameroon started out in 2009 with work done by an Italian group that ultimately aims to train indigenous surgeons to run the program. This review traces the development and current state of cardiothoracic surgery in West Africa with Ghana's National Cardiothoracic Center as the reference. It aims to dispel the notion that there are no major active cardiothoracic centers in the West African sub-region. PMID:22355425

Managing intellectual property to develop medicines for the world's poorest.

PubMed

Fonteilles-Drabek, Sylvie; Reddy, David; Wells, Timothy N C

2017-04-01

It has been argued that patents impede the development and access of medicines for tropical diseases such as malaria. However, we believe that intellectual property can be a key tool to enable timely progression of drug development projects involving multiple partners and to ensure equitable access to successful products.

Knowledge of commercial bus drivers about road safety measures in Lagos, Nigeria.

PubMed

Okafor Ifeoma, P; Odeyemi Kofoworola, A; Dolapo Duro, C

2013-01-01

Road traffic injuries have persisted as a serious public health problem and much of the health burden is in developing countries. Over-speeding, poor enforcement of traffic regulations and commuter buses have been highly implicated in road traffic injuries in developing countries. The aim of this study was to determine drivers' knowledge of selected road safety measures, i.e. the pre-requisites for driver's license, road signs and speed limits. This was a cross-sectional study carried out in Lagos, Nigeria. Simple random sampling was used to select the two motor parks used for the study and all the consenting commercial minibus drivers operating within the parks (407) were included in the study. Data was collected with a pre-tested, structured, interviewer-administered questionnaire and analyzed with epi-info statistical software. Two hundred and sixty-one (64.1%) of them knew that Visual Acuity test should be done before obtaining driver's license and 53.8% knew the correct minimum age for obtaining driver's license. Only 1% of the drivers had correct knowledge of the driver's license authorities in Nigeria. The drivers had poor knowledge of road signs (59.0%) and poor knowledge of maximum speed limits (100%). The oldest, least educated and least experienced drivers had the poorest level of knowledge. The drivers demonstrated poor knowledge of road safety measures. There is need for driver education to improve their knowledge.

Socioeconomic status and the incidence of child injuries in China.

PubMed

Fang, Xiangming; Jing, Ruiwei; Zeng, Guang; Linnan, Huan Wan; Zhu, Xu; Linnan, Michael

2014-02-01

Injuries are the major cause of morbidity among children and one of the leading causes of death for children ages 1-17 years in developing countries. Of particular importance is whether child injuries are equally distributed across all socioeconomic groups and the implications of this question for child injury prevention, but there is a lack of research on the relationship between socioeconomic status and risk of child injuries in developing countries, including China. This study used a provincially-representative, population-based sample of 98,385 Chinese children under age 18 to investigate the relationships between socioeconomic status (SES) and child injuries. Despite the lack of a SES gradient in the overall incidence of nonhospitalized injuries, evidence of SES disparity was found for the overall incidence of H/PD injuries (injuries resulting in hospitalization or permanent disability) and fatal injuries. The odds of getting injured in the poorest wealth quintile were about 1.3 and 3.5 times greater than the odds found in the richest wealth quintile for H/PD and fatal injuries respectively. Further analyses showed that the associations between SES and injuries varied by type and severity of injury, and across different life stages. The findings have important implications for identifying at-risk populations and the optimal times for interventions to reduce different types and severity levels of child injuries. Copyright © 2013. Published by Elsevier Ltd.

Climate and mortality changes due to reductions in household cooking emissions

NASA Astrophysics Data System (ADS)

Bergman, Tommi; Mielonen, Tero; Arola, Antti; Kokkola, Harri

2016-04-01

Household cooking is a significant cause for health and environmental problems in the developing countries. There are more than 3 billion people who use biomass for fuel in cooking stoves in their daily life. These cooking stoves use inadequate ventilation and expose especially women and children to indoor smoke. To reduce problems of the biomass burning, India launched an initiative to provide affordable and clean energy solutions for the poorest households by providing clean next-generation cooking stoves. The improved cooking stoves are expected to improve outdoor air quality and to reduce the climate-active pollutants, thus simultaneously slowing the climate change. Previous research has shown that the emissions of black carbon can be decreased substantially, as much as 90 % by applying better technology in cooking stoves. We have implemented reasonable (50% decrease) and best case (90% decrease) scenarios of the reductions in black and organic carbon due to improved cooking stoves in India into ECHAM-HAMMOZ aerosol-climate model. The global simulations of the scenarios will be used to study how the reductions of emissions in India affect the pollutant concentrations and radiation. The simulated reductions in particulate concentrations will also be used to estimate the decrease in mortality rates. Furthermore, we will study how the emission reductions would affect the global climate and mortality if a similar initiative would be applied in other developing countries.

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.

National Economic Development and Disparities in Body Mass Index: A Cross-Sectional Study of Data from 38 Countries

PubMed Central

Neuman, Melissa; Kawachi, Ichiro; Gortmaker, Steven; Subramanian, SV.

2014-01-01

Background Increases in body mass index (BMI) and the prevalence of overweight in low- and middle income countries (LMICs) are often ascribed to changes in global trade patterns or increases in national income. These changes are likely to affect populations within LMICs differently based on their place of residence or socioeconomic status (SES). Objective Using nationally representative survey data from 38 countries and national economic indicators from the World Bank and other international organizations, we estimated ecological and multilevel models to assess the association between national levels of gross domestic product (GDP), foreign direct investment (FDI), and mean tariffs and BMI. Design We used linear regression to estimate the ecological association between average annual change in economic indicators and BMI, and multilevel linear or ordered multinomial models to estimate associations between national economic indicators and individual BMI or over- and underweight. We also included cross-level interaction terms to highlight differences in the association of BMI with national economic indicators by type of residence or socioeconomic status (SES). Results There was a positive but non-significant association of GDP and mean BMI. This positive association of GDP and BMI was greater among rural residents and the poor. There were no significant ecological associations between measures of trade openness and mean BMI, but FDI was positively associated with BMI among the poorest respondents and in rural areas and tariff levels were negatively associated with BMI among poor and rural respondents. Conclusion Measures of national income and trade openness have different associations with the BMI across populations within developing countries. These divergent findings underscore the complexity of the effects of development on health and the importance of considering how the health effects of “globalizing” economic and cultural trends are modified by individual-level wealth and residence. PMID:24919199

An economic perspective on Malawi's medical "brain drain".

PubMed

Record, Richard; Mohiddin, Abdu

2006-12-18

The medical "brain drain" has been described as rich countries "looting" doctors and nurses from developing countries undermining their health systems and public health. However this "brain-drain" might also be seen as a success in the training and "export" of health professionals and the benefits this provides. This paper illustrates the arguments and possible policy options by focusing on the situation in one of the poorest countries in the world, Malawi. Many see this "brain drain" of medical staff as wrong with developed countries exploiting poorer ones. The effects are considerable with Malawi facing high vacancy rates in its public health system, and with migration threatening to outstrip training despite efforts to improve pay and conditions. This shortage of staff has made it more challenging for Malawi to deliver on its Essential Health Package and to absorb new international health funding.Yet, without any policy effort Malawi has been able to demonstrate its global competitiveness in the training ("production") of skilled health professionals. Remittances from migration are a large and growing source of foreign exchange for poor countries and tend to go directly to households. Whilst the data for Malawi is limited, studies from other poor countries demonstrate the power of remittances in significantly reducing poverty. Malawi can benefit from the export of health professionals provided there is a resolution of the situation whereby the state pays for training and the benefits are gained by the individual professional working abroad. Solutions include migrating staff paying back training costs, or rich host governments remitting part of a tax (e.g. income or national insurance) to the Malawi government. These schemes would allow Malawi to scale up training of health professionals for local needs and to work abroad. There is concern about the negative impacts of the medical "brain-drain". However a closer look at the evidence for and against the medical "brain-drain" in Malawi suggests that there are potential gains in managing medical migration to produce outcomes that are beneficial to individuals, households and the country. Finally we present several policy options.

An economic perspective on Malawi's medical "brain drain"

PubMed Central

Record, Richard; Mohiddin, Abdu

2006-01-01

Background The medical "brain drain" has been described as rich countries "looting" doctors and nurses from developing countries undermining their health systems and public health. However this "brain-drain" might also be seen as a success in the training and "export" of health professionals and the benefits this provides. This paper illustrates the arguments and possible policy options by focusing on the situation in one of the poorest countries in the world, Malawi. Discussion Many see this "brain drain" of medical staff as wrong with developed countries exploiting poorer ones. The effects are considerable with Malawi facing high vacancy rates in its public health system, and with migration threatening to outstrip training despite efforts to improve pay and conditions. This shortage of staff has made it more challenging for Malawi to deliver on its Essential Health Package and to absorb new international health funding. Yet, without any policy effort Malawi has been able to demonstrate its global competitiveness in the training ("production") of skilled health professionals. Remittances from migration are a large and growing source of foreign exchange for poor countries and tend to go directly to households. Whilst the data for Malawi is limited, studies from other poor countries demonstrate the power of remittances in significantly reducing poverty. Malawi can benefit from the export of health professionals provided there is a resolution of the situation whereby the state pays for training and the benefits are gained by the individual professional working abroad. Solutions include migrating staff paying back training costs, or rich host governments remitting part of a tax (e.g. income or national insurance) to the Malawi government. These schemes would allow Malawi to scale up training of health professionals for local needs and to work abroad. Summary There is concern about the negative impacts of the medical "brain-drain". However a closer look at the evidence for and against the medical "brain-drain" in Malawi suggests that there are potential gains in managing medical migration to produce outcomes that are beneficial to individuals, households and the country. Finally we present several policy options. PMID:17176457

Defining and refining international donor support for combating the AIDS pandemic.

PubMed

Attaran, A; Sachs, J

2001-01-06

The international aid effort against AIDS is greatly incommensurate with the severity of the epidemic. Drawing on the data that international aid donors self-reported to the Organization for Economic Cooperation and Development (OECD), we find that, between 1996 and 1998, finance from all rich countries to sub-Saharan Africa for projects designated as AIDS control averaged US $69 million annually, and, assuming a safe margin for under-reporting and misreporting, we estimate that total donor spending on HIV/AIDS control was perhaps twice that at most. Since the late 1980s, aid levels have dropped relative to the prevalence of HIV infection, and stood recently at about $3 per HIV-infected person. Lack of finance is now the primary constraint on progress against AIDS, notwithstanding the widespread belief that a lack of interest from the goveements of poor countries is limiting. We argue that to produce a meaningful response to the pandemic, international assistance must be based on grants, not loans, for the poorest countries; be increased within the next 3 years to a minimum of $7.5 billion or more; be directed toward funding projects which are proposed and desired by the affected countries themselves, and which are judged as having epidemiological merit against the pandemic by a panel of independent scientific experts; and fund concurrent needs, including prevention, drug treatment (such as highly active antiretroviral therapy), and blocking mother-to-child HIV transmission. An effort of this scope and scale will both radically alter the prospects for intervention against AIDS in poor countries, and together with comparable efforts to control other infectious diseases, is easily afforded by the OECD donor economies, whose aggregate national income recently surpassed $21 trillion annually.

Addressing Inequities in Urban Health: Do Decision-Makers Have the Data They Need? Report from the Urban Health Data Special Session at International Conference on Urban Health Dhaka 2015.

PubMed

Elsey, H; Thomson, D R; Lin, R Y; Maharjan, U; Agarwal, S; Newell, J

2016-06-01

Rapid and uncontrolled urbanisation across low and middle-income countries is leading to ever expanding numbers of urban poor, defined here as slum dwellers and the homeless. It is estimated that 828 million people are currently living in slum conditions. If governments, donors and NGOs are to respond to these growing inequities they need data that adequately represents the needs of the urban poorest as well as others across the socio-economic spectrum.We report on the findings of a special session held at the International Conference on Urban Health, Dhaka 2015. We present an overview of the need for data on urban health for planning and allocating resources to address urban inequities. Such data needs to provide information on differences between urban and rural areas nationally, between and within urban communities. We discuss the limitations of data most commonly available to national and municipality level government, donor and NGO staff. In particular we assess, with reference to the WHO's Urban HEART tool, the challenges in the design of household surveys in understanding urban health inequities.We then present two novel approaches aimed at improving the information on the health of the urban poorest. The first uses gridded population sampling techniques within the design and implementation of household surveys and the second adapts Urban HEART into a participatory approach which enables slum residents to assess indicators whilst simultaneously planning the response. We argue that if progress is to be made towards inclusive, safe, resilient and sustainable cities, as articulated in Sustainable Development Goal 11, then understanding urban health inequities is a vital pre-requisite to an effective response by governments, donors, NGOs and communities.

Analysis of changes in crop farming in the Dudh Koshi (Nepal) driven by climate changes

NASA Astrophysics Data System (ADS)

Gianinetto, Marco; Polinelli, Francesco; Frassy, Federico; Aiello, Martina; Rota Nodari, Francesco; Soncini, Andrea; Bocchiola, Daniele

2017-10-01

Nepal is one of the poorest nations of the world and the Koshi Basin includes some of the poorest regions of this country. It's farming system is subsistence agriculture, mainly rainfed, with crop productivity among the lowest in South Asia. Nepal is also severely impacted by climate changes, such as retreat of glaciers, rise in temperature, erratic rainfalls and increase in frequency of extreme weather. This paper describes the spatio-temporal evolution of cultivated land in Dudh Koshi during the last four decades (1970s-2010s), by mapping the farming of its four main cereals in the districts of Solukhumbu, Okhaldunga and Kothang from space. The analysis of satellite time series showed a 10% of increment in farmland from 1970s to 1990s, and about 60% in the following twenty years. With a shift of cropping to higher altitudes. Data belonging to of the second twenty years are strongly correlated with the population growth observed in the same period (0.97

Municipal solid waste management in rural areas and small counties: an economic analysis using contingent valuation to estimate willingness to pay for Yunnan, China.

PubMed

Wang, Hua; He, Jie; Kim, Yoonhee; Kamata, Takuya

2014-08-01

Municipal solid waste management (SWM) is a major challenge for local governments in rural China. One key issue is the low priority assigned by the local government which is faced with limited financing capacity. We conducted an economic analysis in Eryuan, a poor county in Yunnan, China, where the willingness- to- pay (WTP) for an improved solid waste collection and disposal service was valuated and compared with project cost. Similar to most previous studies in developing countries, this study found that the mean WTP is approximately 1% of the household income. The economic internal rate of return of the project is about 5%, which signifies the estimated social benefit to be already higher than the project cost. Moreover, we believe our estimation of social benefit to be a conservative one since our study only focuses on the local people who will be directly served by the project; wider positive externality of the project, such as CO2 emission reduction and groundwater pollution alleviation, etc., whose impact most probably surpass the frontier of Eryuan county, are not considered explicitly in our survey. The analysis also reveals that the poorest households are not only willing to pay more than the rich households in terms of percentage income but are also willing to pay no less than the rich in terms of absolute value in locations where solid waste services are unavailable. This result reveals the fact that the poorest households have stronger demands for public SWM services, whereas the rich may have the ability to employ private solutions. © The Author(s) 2014.

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.

Differential effect of wealth quintile on modern contraceptive use and fertility: evidence from Malawian women

PubMed Central

2014-01-01

Background High fertility and wide inequality in wealth distribution are phenomenal problems in sub-Saharan Africa. Modern Contraceptives (MC) are useful for limiting fertility, but are not always easily accessible in Malawi. This study examines the gap in MC use and fertility between women in the richest and poorest Wealth Quintile (WQ). Methods The study was cross-sectional in design and utilized Malawi DHS dataset, 2010. It focused on women of reproductive age. The dependent variables are ever and current use of MC. Chi-square and multinomial logistic regression were used for the analysis. Results Mean children ever born by women in the poorest and richest WQs were 3.94 ± 2.7 and 2.82 ± 2.3 respectively (p < 0.001). The adjusted total fertility rate (Adj.TFR) was higher among women in the poorest (Adj.TFR = 7.60) WQ than the richest (Adj.TFR = 4.45). The prevalence of ever use of MC was higher among women in the richest WQ (82.4%) than the poorest (66.8%) (p < 0.001). Similar pattern exists for current use of MC; 58.5% and 45.9% for women in the richest and poorest WQs respectively (p < 0.001). Women in the richest WQ were more likely to ever use (OR = 2.36; C.I = 2.07-2.69, p < 0.001) and currently using (OR = 1.66; C.I = 1.40-1.97, p < 0.001) MC than their counterparts in the poorest WQ. Slight reduction in odd-ratio of MC use among women in richest WQ resulted when socio-demographic variables were used as control. Conclusion Fertility was higher and the use of MC was lower among women in the poorest than their counterparts in the richest WQ. Ensuring availability of MC at little or no cost may bridge the gap in contraceptive use between women in the poorest and richest WQ in Malawi. PMID:24602452

Control of human parasitic diseases: Context and overview.

PubMed

Molyneux, David H

2006-01-01

The control of parasitic diseases of humans has been undertaken since the aetiology and natural history of the infections was recognized and the deleterious effects on human health and well-being appreciated by policy makers, medical practitioners and public health specialists. However, while some parasitic infections such as malaria have proved difficult to control, as defined by a sustained reduction in incidence, others, particularly helminth infections can be effectively controlled. The different approaches to control from diagnosis, to treatment and cure of the clinically sick patient, to control the transmission within the community by preventative chemotherapy and vector control are outlined. The concepts of eradication, elimination and control are defined and examples of success summarized. Overviews of the health policy and financing environment in which programmes to control or eliminate parasitic diseases are positioned and the development of public-private partnerships as vehicles for product development or access to drugs for parasite disease control are discussed. Failure to sustain control of parasites may be due to development of drug resistance or the failure to implement proven strategies as a result of decreased resources within the health system, decentralization of health management through health-sector reform and the lack of financial and human resources in settings where per capita government expenditure on health may be less than $US 5 per year. However, success has been achieved in several large-scale programmes through sustained national government investment and/or committed donor support. It is also widely accepted that the level of investment in drug development for the parasitic diseases of poor populations is an unattractive option for pharmaceutical companies. The development of partnerships to specifically address this need provides some hope that the intractable problems of the treatment regimens for the trypanosomiases and leishmaniases can be solved in the not too distant future. However, it will be difficult to implement and sustain such interventions in fragile health services often in settings where resources are limited but also in unstable, conflict-affected or post-conflict countries. Emphasis is placed on the importance of co-endemicity and polyparasitism and the opportunity to control parasites susceptible to cost-effective and proven chemotherapeutic interventions for a package of diseases which can be implemented at low cost and which would benefit the poorest and most marginalized groups. The ecology of parasitic diseases is discussed in the context of changing ecology, environment, sociopolitical developments and climate change. These drivers of global change will affect the epidemiology of parasites over the coming decades, while in many of the most endemic and impoverished countries parasitic infections will be accorded lower priority as resourced stressed health systems cope with the burden of the higher-profile killing diseases viz., HIV/AIDS, TB and malaria. There is a need for more holistic thinking about the interactions between parasites and other infections. It is clear that as the prevalence and awareness of HIV has increased, there is a growing recognition of a host of complex interactions that determine disease outcome in individual patients. The competition for resources in the health as well as other social sectors will be a continuing challenge; effective parasite control will be dependent on how such resources are accessed and deployed to effectively address well-defined problems some of which are readily amenable to successful interventions with proven methods. In the health sector, the problems of the HIV/AIDS and TB pandemics and the problem of the emerging burden of chronic non-communicable diseases will be significant competitors for these limited resources as parasitic infections aside from malaria tend to be chronic disabling problems of the poorest who have limited access to scarce health services and are representative of the poorest quintile. Prioritization and advocacy for parasite control in the national and international political environments is the challenge.

The child health implications of privatizing Africa's urban water supply.

PubMed

Kosec, Katrina

2014-05-01

Can private sector participation (PSP) in the piped water sector improve child health? I use child-level data from 39 African countries during 1986-2010 to show that PSP decreases diarrhea among urban-dwelling, under-five children by 2.6 percentage points, or 16% of its mean prevalence. Children from the poorest households benefit most. PSP is also associated with a 7.8 percentage point increase in school attendance of 7-17 year olds. Importantly, PSP increases usage of piped water by 9.7 percentage points, suggesting a possible causal channel explaining health improvements. To attribute causality, I exploit time-variation in the private water market share controlled by African countries' former colonizers. A placebo analysis reveals that PSP does not affect respiratory illness, nor does it affect a control group of rural children. Copyright © 2014 Elsevier B.V. All rights reserved.

Future and potential spending on health 2015-40: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries.

PubMed

2017-05-20

The amount of resources, particularly prepaid resources, available for health can affect access to health care and health outcomes. Although health spending tends to increase with economic development, tremendous variation exists among health financing systems. Estimates of future spending can be beneficial for policy makers and planners, and can identify financing gaps. In this study, we estimate future gross domestic product (GDP), all-sector government spending, and health spending disaggregated by source, and we compare expected future spending to potential future spending. We extracted GDP, government spending in 184 countries from 1980-2015, and health spend data from 1995-2014. We used a series of ensemble models to estimate future GDP, all-sector government spending, development assistance for health, and government, out-of-pocket, and prepaid private health spending through 2040. We used frontier analyses to identify patterns exhibited by the countries that dedicate the most funding to health, and used these frontiers to estimate potential health spending for each low-income or middle-income country. All estimates are inflation and purchasing power adjusted. We estimated that global spending on health will increase from US$9·21 trillion in 2014 to $24·24 trillion (uncertainty interval [UI] 20·47-29·72) in 2040. We expect per capita health spending to increase fastest in upper-middle-income countries, at 5·3% (UI 4·1-6·8) per year. This growth is driven by continued growth in GDP, government spending, and government health spending. Lower-middle income countries are expected to grow at 4·2% (3·8-4·9). High-income countries are expected to grow at 2·1% (UI 1·8-2·4) and low-income countries are expected to grow at 1·8% (1·0-2·8). Despite this growth, health spending per capita in low-income countries is expected to remain low, at $154 (UI 133-181) per capita in 2030 and $195 (157-258) per capita in 2040. Increases in national health spending to reach the level of the countries who spend the most on health, relative to their level of economic development, would mean $321 (157-258) per capita was available for health in 2040 in low-income countries. Health spending is associated with economic development but past trends and relationships suggest that spending will remain variable, and low in some low-resource settings. Policy change could lead to increased health spending, although for the poorest countries external support might remain essential. Bill & Melinda Gates Foundation. Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Blindness and poverty in India: the way forward.

PubMed

Khanna, Rohit; Raman, Usha; Rao, Gullapalli N

2007-11-01

A few recent studies have shown that poverty is an exacerbating and often determining factor in the incidence of disabling conditions, including visual impairment. Recent estimates from the World Health Organization indicate that 90 per cent of all those affected by visual impairment live in the poorest countries of the world. India is home to one-fifth of the world's visually impaired people and therefore, any strategies to combat avoidable blindness must take into account the socio-economic conditions within which people live. This paper looks at the relationship between poverty and blindness in India and suggests strategies to address blindness prevention in a comprehensive manner.

Private investment in AIDS vaccine development: obstacles and solutions.

PubMed Central

Batson, A.; Ainsworth, M.

2001-01-01

The development of vaccines for the prevention of AIDS, malaria, tuberculosis, and other diseases requires both public and private investment. Private investment, however, has been far lower than might have been hoped, given the massive human toll of these diseases, particularly in the poorest countries. With a view to understanding this situation and exploring potential solutions, the World Bank AIDS Vaccine Task Force commissioned a study on the perspectives of the biotechnology, vaccine, and pharmaceutical industries regarding investment in research and development work on an AIDS vaccine. It was found that different obstacles to the development of an AIDS vaccine arose during the product development cycle. During the earlier phases, before obtaining proof of product, the principal barriers were scientific. The lack of consensus on which approach was likely to be effective increased uncertainty and the risks associated with investing in expensive clinical trials. The later phases, which involved adapting, testing, and scaling up production for different populations, were most influenced by market considerations. In order to raise the levels of private research and development in an AIDS vaccine there will probably have to be a combination of push strategies, which reduce the cost and scientific risk of investment, and pull strategies, which guarantee a market. PMID:11545328

Traumatic injuries in developing countries: report from a nationwide cross-sectional survey of Sierra Leone.

PubMed

Stewart, Kerry-Ann A; Groen, Reinou S; Kamara, Thaim B; Farahzad, Mina M; Samai, Mohamed; Cassidy, Laura D; Kushner, Adam L; Wren, Sherry M

2013-05-01

To use a nationwide household survey tool to provide an estimate of injury prevalence, mechanisms of traumatic injuries, and number of injury-related deaths in a low-income country. A randomized, cross-sectional nationwide survey using the Surgeons OverSeas Assessment of Surgical Need tool was conducted in 2012. Sierra Leone, Africa. Three thousand seven hundred fifty randomly selected participants throughout Sierra Leone. Mechanisms of injury based on age, sex, anatomic location, cause, and sociodemographic factors as well as mechanisms of injury-related deaths in the previous year were the primary outcome measures. Data were collected and analyzed from 1843 households and 3645 respondents (98% response rate). Four hundred fifty-two respondents (12%) reported at least 1 traumatic injury in the preceding year. Falls were the most common cause of nonfatal injuries (40%). The extremities were the most common injury site regardless of age or sex. Traffic injuries were the leading cause of injury-related deaths (32% of fatal injuries). This study provides baseline data on the mechanisms of traumatic injuries as well as the sociodemographic factors affecting injury prevalence in one of the world's poorest nations. It is anticipated that these data will provide an impetus for further studies to determine injury severity, associated disability, and barriers to accessing care in these resource-poor areas.

Surgery, public health, and Pakistan.

PubMed

Zafar, Syed Nabeel; McQueen, K A Kelly

2011-12-01

Surgical healthcare is rapidly gaining recognition as a major public health issue. Surgical disparities are large, with poorest populations receiving the least amount of emergency and essential surgical care. In light of recent evidence, developing countries, such as Pakistan, must acknowledge surgical disease as a major public health issue and prioritize research and intervention accordingly. We review information from various sources and describe the current situation of surgical health care in Pakistan and highlight areas of neglect. Pakistan suffers an annual deficit of 17 million surgeries. Surgical disease kills more people than infectious diseases inclusive of tuberculosis, HIV/AIDS, diarrheal disease, and childhood infections. The incidence of trauma and maternal mortality ratio are staggeringly high. There is a severe dearth of surgical and anesthesia-related epidemiological data. Important information that would help to drive policy and planning is not available. Corruption and neglect have led to a dilapidated health care infrastructure. Surgical care is largely inaccessible to the poor, especially those living in rural areas. The country faces a dearth of healthcare professionals, especially paramedics, anesthetists, and surgeons. Unsafe surgery and anesthesia poses a significant risk to patients. There is no national policy on surgical illness and the preventive aspects of surgery are nonexistent. Consistent with other underdeveloped countries, surgical care in Pakistan is dismal. Neglecting surgery and safe anesthesia has led to countless deaths and disability. Physicians, researchers, policy makers, and the government health care system must engage and commit to provide access to emergency, essential, and safe surgical care.

Determinant factors of tobacco use among ever-married men in Bangladesh

PubMed Central

Rahman, Md Shafiur; Mondal, Md Nazrul Islam; Islam, Md Rafiqul; Rahman, Md Mizanur; Hoque, M Nazrul; Alam, Md Shamsher

2015-01-01

Background The burden of tobacco use is shifting from developed to developing countries. This study aimed to explore the different types of tobacco use, and to identify the determinant factors associated with the tobacco use among ever-married men in Bangladesh. Data and methods Data of 3,771 ever-married men, 15–54 years of age were extracted from the Bangladesh Demographic and Health Survey 2007. Prevalence rate, chi-square (χ2) test, and binary logistic regression analysis were used as the statistical tools to analyze the data. Results Tobacco use through smoking (58.68%) was found to be higher than that of chewing (21.63%) among men, which was significantly more prevalent among the poorest, less educated, and businessmen. In bivariate analysis, all the socioeconomic factors were found significantly associated with tobacco use; while in multivariate analysis, age, education, wealth index, and occupation were identified as the significant predictors. Conclusion Tobacco use was found to be remarkably common among males in Bangladesh. The high prevalence of tobacco use suggests that there is an urgent need for developing intervention plans to address this major public health problem in Bangladesh. PMID:25999762

Sources of Indoor Air Pollution and Respiratory Health in Preschool Children

PubMed Central

Fuentes-Leonarte, Virginia; Ballester, Ferran; Tenías, José Maria

2009-01-01

We carried out bibliographic searches in PubMed and Embase.com for the period from 1996 to 2008 with the aim of reviewing the scientific literature on the relationship between various sources of indoor air pollution and the respiratory health of children under the age of five. Those studies that included adjusted correlation measurements for the most important confounding variables and which had an adequate population size were considered to be more relevant. The results concerning the relationship between gas energy sources and children's respiratory health were heterogeneous. Indoor air pollution from biomass combustion in the poorest countries was found to be an important risk factor for lower respiratory tract infections. Solvents involved in redecorating, DYI work, painting, and so forth, were found to be related to an increased risk for general respiratory problems. The distribution of papers depending on the pollution source showed a clear relationship with life-style and the level of development. PMID:20168984

Discourse on malaria elimination: where do forcibly displaced persons fit in these discussions?

PubMed Central

2013-01-01

Background Individuals forcibly displaced are some of the poorest people in the world, living in areas where infrastructure and services are at a bare minimum. Out of a total of 10,549,686 refugees protected and assisted by the United Nations High Commissioner for Refugees globally, 6,917,496 (65.6%) live in areas where malaria is transmitted. Historically, national malaria control programmes have excluded displaced populations. Results The current discourse on malaria elimination rarely includes discussion of forcibly displaced persons who reside within malaria-eliminating countries. Of the 100 malaria-endemic countries, 64 are controlling malaria and 36 are in some stage of elimination. Of these, 30 malaria-controlling countries and 13 countries in some phase of elimination host displaced populations of ≥50,000, even though 13 of the 36 (36.1%) malaria-elimination countries host displaced populations of ≥50,000 people. Discussion Now is the time for the malaria community to incorporate forcibly displaced populations residing within malarious areas into malaria control activities. Beneficiaries, whether they are internally displaced persons or refugees, should be viewed as partners in the delivery of malaria interventions and not simply as recipients. Conclusion Until equitable and sustainable malaria control includes everyone residing in an endemic area, the goal of malaria elimination will not be met. PMID:23575209

World Health Organization perspectives on the contribution of the Global Alliance for Vaccines and Immunization on reducing child mortality.

PubMed

Bustreo, F; Okwo-Bele, J-M; Kamara, L

2015-02-01

Child mortality has decreased substantially globally-from 12.6 million in 1990 to 6.3 million in 2013-due, in large part to of governments' and organisations' work, to prevent pneumonia, diarrhoea and malaria, the main causes of death in the postneonatal period. In 2012, the World Health Assembly adopted the Decade of Vaccines Global Vaccine Action Plan 2011-2020 as the current framework aimed at preventing millions of deaths through more equitable access to existing vaccines for people in all communities. The Global Alliance for Vaccines and Immunization (GAVI) plays a critical role in this effort by financing and facilitating delivery platforms for vaccines, with focused support for the achievements of improved vaccination coverage and acceleration of the uptake of WHO-recommended lifesaving new vaccines in 73 low-income countries. The GAVI Alliance has contributed substantially towards the progress of Millennium Development Goal 4 and to improving women's lives. By 2013, the GAVI Alliance had immunised 440 million additional children and averted six million future deaths from vaccine-preventable diseases in the world's poorest countries. The GAVI Alliance is on track to reducing child mortality to 68 per 1000 live births by 2015 in supported countries. This paper discusses the GAVI Alliance achievements related to Millennium Development Goal 4 and its broader contribution to improving women's lives and health systems, as well as challenges and obstacles it has faced. Additionally, it looks at challenges for the future and how it will continue its work related to reducing child mortality and improving women's health. 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.

Gaps in policy-relevant information on burden of disease in children: a systematic review.

PubMed

Rudan, Igor; Lawn, Joy; Cousens, Simon; Rowe, Alexander K; Boschi-Pinto, Cynthia; Tomasković, Lana; Mendoza, Walter; Lanata, Claudio F; Roca-Feltrer, Arantxa; Carneiro, Ilona; Schellenberg, Joanna A; Polasek, Ozren; Weber, Martin; Bryce, Jennifer; Morris, Saul S; Black, Robert E; Campbell, Harry

Valid information about cause-specific child mortality and morbidity is an essential foundation for national and international health policy. We undertook a systematic review to investigate the geographical dispersion of and time trends in publication for policy-relevant information about children's health and to assess associations between the availability of reliable data and poverty. We identified data available on Jan 1, 2001, and published since 1980, for the major causes of morbidity and mortality in young children. Studies with relevant data were assessed against a set of inclusion criteria to identify those likely to provide unbiased estimates of the burden of childhood disease in the community. Only 308 information units from more than 17,000 papers identified were regarded as possible unbiased sources for estimates of childhood disease burden. The geographical distribution of these information units revealed a pattern of small well-researched populations surrounded by large areas with little available information. No reliable population-based data were identified from many of the world's poorest countries, which account for about a third of all deaths of children worldwide. The number of new studies diminished over the last 10 years investigated. The number of population-based studies yielding estimates of burden of childhood disease from less developed countries was low. The decreasing trend over time suggests reductions in research investment in this sphere. Data are especially sparse from the world's least developed countries with the highest child mortality. Guidelines are needed for the conduct of burden-of-disease studies together with an international research policy that gives increased emphasis to global equity and coverage so that knowledge can be generated from all regions of the world.

Association between chronic undernutrition and hypertension.

PubMed

Sawaya, Ana L; Sesso, Ricardo; Florêncio, Telma M de Menezes Toledo; Fernandes, Maria T B; Martins, Paula A

2005-07-01

In developing countries nutritional deficit during prenatal and continuing in post-natal life is very common. This condition leads to stunting and important metabolic changes. Over 30% of children in the world are stunted. The metabolic resultants of nutritional deficit during growth are classically known to aim at energy conservation. This review summarizes data from Brazil, a developing country undergoing the double burden of obesity and undernutrition, especially among the poor, and suggests that stunting or chronic undernutrition increases the risk of obesity and hypertension later in life. Around 60 million people are under the poverty line in Brazil. In São Paulo, the richest city of the country, 20% of the population live in slums and in Maceió, the capital of one of the poorest states, this percentage reaches 50%. Undernutrition in this population is around 20% among children, with high frequency of infections, anemia, and parasitic infestations, associated with poor sanitation. Among stunted adolescents, we found a high prevalence of hypertension (21%) that is a considerably higher estimate compared to non-stunted adolescents (less than 10%). The prevalence of hypertension in undernourished pre-school children, or in those who recovered from undernutrition, was higher than that in controls (29%, 20% and 2%, respectively, P < 0.001). Among stunted adults eating no more than 66% of the requirements (adjusted for stature), overweight/obesity was 35% in women and 25% in men. The prevalence of hypertension was 44% among stunted women and 18% among stunted men. Fifty per cent of stunted and obese women had hypertension. These data reinforce the important association between undernutrition and hypertension from childhood through adulthood. Health policies for preventing and combating childhood undernutrition should have an impact on the morbidity and mortality related to hypertension during adulthood.

Vaccines to combat the neglected tropical diseases.

PubMed

Bethony, Jeffrey M; Cole, Rhea N; Guo, Xiaoti; Kamhawi, Shaden; Lightowlers, Marshall W; Loukas, Alex; Petri, William; Reed, Steven; Valenzuela, Jesus G; Hotez, Peter J

2011-01-01

The neglected tropical diseases (NTDs) represent a group of parasitic and related infectious diseases such as amebiasis, Chagas disease, cysticercosis, echinococcosis, hookworm, leishmaniasis, and schistosomiasis. Together, these conditions are considered the most common infections in low- and middle-income countries, where they produce a level of global disability and human suffering equivalent to better known conditions such as human immunodeficiency virus/acquired immunodeficiency syndrome and malaria. Despite their global public health importance, progress on developing vaccines for NTD pathogens has lagged because of some key technical hurdles and the fact that these infections occur almost exclusively in the world's poorest people living below the World Bank poverty line. In the absence of financial incentives for new products, the multinational pharmaceutical companies have not embarked on substantive research and development programs for the neglected tropical disease vaccines. Here, we review the current status of scientific and technical progress in the development of new neglected tropical disease vaccines, highlighting the successes that have been achieved (cysticercosis and echinococcosis) and identifying the challenges and opportunities for development of new vaccines for NTDs. Also highlighted are the contributions being made by non-profit product development partnerships that are working to overcome some of the economic challenges in vaccine manufacture, clinical testing, and global access. © 2010 John Wiley & Sons A/S.

Vaccines to combat the neglected tropical diseases

PubMed Central

Bethony, Jeffrey M.; Cole, Rhea N.; Guo, Xiaoti; Kamhawi, Shaden; Lightowlers, Marshall W.; Loukas, Alex; Petri, William; Reed, Steven; Valenzuela, Jesus G.; Hotez, Peter J.

2012-01-01

Summary The neglected tropical diseases (NTDs) represent a group of parasitic and related infectious diseases such as amebiasis, Chagas disease, cysticercosis, echinococcosis, hookworm, leishmaniasis, and schistosomiasis. Together, these conditions are considered the most common infections in low- and middle-income countries, where they produce a level of global disability and human suffering equivalent to better known conditions such as human immunodeficiency virus/acquired immunodeficiency syndrome and malaria. Despite their global public health importance, progress on developing vaccines for NTD pathogens has lagged because of some key technical hurdles and the fact that these infections occur almost exclusively in the world’s poorest people living below the World Bank poverty line. In the absence of financial incentives for new products, the multinational pharmaceutical companies have not embarked on substantive research and development programs for the neglected tropical disease vaccines. Here, we review the current status of scientific and technical progress in the development of new neglected tropical disease vaccines, highlighting the successes that have been achieved (cysticercosis and echinococcosis) and identifying the challenges and opportunities for development of new vaccines for NTDs. Also highlighted are the contributions being made by non-profit product development partnerships that are working to overcome some of the economic challenges in vaccine manufacture, clinical testing, and global access. PMID:21198676

Measuring Socioeconomic Inequalities With Predicted Absolute Incomes Rather Than Wealth Quintiles: A Comparative Assessment Using Child Stunting Data From National Surveys.

PubMed

Fink, Günther; Victora, Cesar G; Harttgen, Kenneth; Vollmer, Sebastian; Vidaletti, Luís Paulo; Barros, Aluisio J D

2017-04-01

To compare the predictive power of synthetic absolute income measures with that of asset-based wealth quintiles in low- and middle-income countries (LMICs) using child stunting as an outcome. We pooled data from 239 nationally representative household surveys from LMICs and computed absolute incomes in US dollars based on households' asset rank as well as data on national consumption and inequality levels. We used multivariable regression models to compare the predictive power of the created income measure with the predictive power of existing asset indicator measures. In cross-country analysis, log absolute income predicted 54.5% of stunting variation observed, compared with 20% of variation explained by wealth quintiles. For within-survey analysis, we also found absolute income gaps to be predictive of the gaps between stunting in the wealthiest and poorest households (P < .001). Our results suggest that absolute income levels can greatly improve the prediction of stunting levels across and within countries over time, compared with models that rely solely on relative wealth quintiles.

GAVI and hepatitis B immunisation in India.

PubMed

Kolås, A

2011-01-01

In cooperation with Indian health authorities, the GAVI Alliance (GAVI) is introducing Hepatitis B (HepB) vaccination into the immunisation programmes of 11 'better-performing' Indian states. This article describes the concerns and interests of major stakeholders in the programme, including GAVI partners and the Indian government, and summarises Indian debates that have emerged in response to the project, especially on the issue of selective vs. universal immunisation. The article suggests that programme planning should be based on a good knowledge of disease prevalence and the relative importance of perinatal HepB transmission, which would require a comprehensive cross-country study of the epidemiology of HepB among different populations, the relative importance of different transmission routes and the degree of geographical variation in India. Based on this research, further studies could address the feasibility and cost-effectiveness of routine birth-dose administration and selective birth-dose immunisation of infants born to mothers who are chronic HepB virus carriers. The GAVI 'formula' could be strengthened by supporting the basic epidemiological research that is essential to effective programme planning in recipient countries, which are by definition among the world's poorest countries.

Impact of High Seas Closure on Food Security in Low Income Fish Dependent Countries

PubMed Central

Teh, Louise S. L.; Lam, Vicky W. Y.; Cheung, William W. L.; Miller, Dana; Teh, Lydia C. L.; Sumaila, U. Rashid

2016-01-01

We investigate how high seas closure will affect the availability of commonly consumed food fish in 46 fish reliant, and/or low income countries. Domestic consumption of straddling fish species (fish that would be affected by high seas closure) occurred in 54% of the assessed countries. The majority (70%) of countries were projected to experience net catch gains following high seas closure. However, countries with projected catch gains and that also consumed the straddling fish species domestically made up only 37% of the assessed countries. In contrast, much fewer countries (25%) were projected to incur net losses from high seas closure, and of these, straddling species were used domestically in less than half (45%) of the countries. Our findings suggest that, given the current consumption patterns of straddling species, high seas closure may only directly benefit the supply of domestically consumed food fish in a small number of fish reliant and/or low income countries. In particular, it may not have a substantial impact on improving domestic fish supply in countries with the greatest need for improved access to affordable fish, as only one third of this group used straddling fish species domestically. Also, food security in countries with projected net catch gains but where straddling fish species are not consumed domestically may still benefit indirectly via economic activities arising from the increased availability of non-domestically consumed straddling fish species following high seas closure. Consequently, this study suggests that high seas closure can potentially improve marine resource sustainability as well as contribute to human well-being in some of the poorest and most fish dependent countries worldwide. However, caution is required because high seas closure may also negatively affect fish availability in countries that are already impoverished and fish insecure. PMID:28033359

Impact of High Seas Closure on Food Security in Low Income Fish Dependent Countries.

PubMed

Teh, Louise S L; Lam, Vicky W Y; Cheung, William W L; Miller, Dana; Teh, Lydia C L; Sumaila, U Rashid

2016-01-01

We investigate how high seas closure will affect the availability of commonly consumed food fish in 46 fish reliant, and/or low income countries. Domestic consumption of straddling fish species (fish that would be affected by high seas closure) occurred in 54% of the assessed countries. The majority (70%) of countries were projected to experience net catch gains following high seas closure. However, countries with projected catch gains and that also consumed the straddling fish species domestically made up only 37% of the assessed countries. In contrast, much fewer countries (25%) were projected to incur net losses from high seas closure, and of these, straddling species were used domestically in less than half (45%) of the countries. Our findings suggest that, given the current consumption patterns of straddling species, high seas closure may only directly benefit the supply of domestically consumed food fish in a small number of fish reliant and/or low income countries. In particular, it may not have a substantial impact on improving domestic fish supply in countries with the greatest need for improved access to affordable fish, as only one third of this group used straddling fish species domestically. Also, food security in countries with projected net catch gains but where straddling fish species are not consumed domestically may still benefit indirectly via economic activities arising from the increased availability of non-domestically consumed straddling fish species following high seas closure. Consequently, this study suggests that high seas closure can potentially improve marine resource sustainability as well as contribute to human well-being in some of the poorest and most fish dependent countries worldwide. However, caution is required because high seas closure may also negatively affect fish availability in countries that are already impoverished and fish insecure.

Family planning, antenatal and delivery care: cross-sectional survey evidence on levels of coverage and inequalities by public and private sector in 57 low- and middle-income countries.

PubMed

Campbell, Oona M R; Benova, Lenka; MacLeod, David; Baggaley, Rebecca F; Rodrigues, Laura C; Hanson, Kara; Powell-Jackson, Timothy; Penn-Kekana, Loveday; Polonsky, Reen; Footman, Katharine; Vahanian, Alice; Pereira, Shreya K; Santos, Andreia Costa; Filippi, Veronique G A; Lynch, Caroline A; Goodman, Catherine

2016-04-01

The objective of this study was to assess the role of the private sector in low- and middle-income countries (LMICs). We used Demographic and Health Surveys for 57 countries (2000-2013) to evaluate the private sector's share in providing three reproductive and maternal/newborn health services (family planning, antenatal and delivery care), in total and by socio-economic position. We used data from 865 547 women aged 15-49, representing a total of 3 billion people. We defined 'met and unmet need for services' and 'use of appropriate service types' clearly and developed explicit classifications of source and sector of provision. Across the four regions (sub-Saharan Africa, Middle East/Europe, Asia and Latin America), unmet need ranged from 28% to 61% for family planning, 8% to 22% for ANC and 21% to 51% for delivery care. The private-sector share among users of family planning services was 37-39% across regions (overall mean: 37%; median across countries: 41%). The private-sector market share among users of ANC was 13-61% across regions (overall mean: 44%; median across countries: 15%). The private-sector share among appropriate deliveries was 9-56% across regions (overall mean: 40%; median across countries: 14%). For all three healthcare services, women in the richest wealth quintile used private services more than the poorest. Wealth gaps in met need for services were smallest for family planning and largest for delivery care. The private sector serves substantial numbers of women in LMICs, particularly the richest. To achieve universal health coverage, including adequate quality care, it is imperative to understand this sector, starting with improved data collection on healthcare provision. © 2016 The Authors. Tropical Medicine & International Health published by John Wiley & Sons Ltd.

Economic status, education and empowerment: implications for maternal health service utilization in developing countries.

PubMed

Ahmed, Saifuddin; Creanga, Andreea A; Gillespie, Duff G; Tsui, Amy O

2010-06-23

Relative to the attention given to improving the quality of and access to maternal health services, the influence of women's socio-economic situation on maternal health care use has received scant attention. The objective of this paper is to examine the relationship between women's economic, educational and empowerment status, introduced as the 3Es, and maternal health service utilization in developing countries. The analysis uses data from the most recent Demographic and Health Surveys conducted in 31 countries for which data on all the 3Es are available. Separate logistic regression models are fitted for modern contraceptive use, antenatal care and skilled birth attendance in relation to the three covariates of interest: economic, education and empowerment status, additionally controlling for women's age and residence. We use meta-analysis techniques to combine and summarize results from multiple countries. The 3Es are significantly associated with utilization of maternal health services. The odds of having a skilled attendant at delivery for women in the poorest wealth quintile are 94% lower than that for women in the highest wealth quintile and almost 5 times higher for women with complete primary education relative to those less educated. The likelihood of using modern contraception and attending four or more antenatal care visits are 2.01 and 2.89 times, respectively, higher for women with complete primary education than for those less educated. Women with the highest empowerment score are between 1.31 and 1.82 times more likely than those with a null empowerment score to use modern contraception, attend four or more antenatal care visits and have a skilled attendant at birth. Efforts to expand maternal health service utilization can be accelerated by parallel investments in programs aimed at poverty eradication (MDG 1), universal primary education (MDG 2), and women's empowerment (MDG 3).

Poverty, development, and women: why should we care?

PubMed

Thompson, Joyce E Beebe

2007-01-01

Healthy, prosperous nations require healthy women and newborns. Young girls and women in resource-poor nations suffer the greatest ill-health consequences from low status, denial of basic human rights, and poverty. Poverty and poor health result in poor economic development. The Millennium Development Goals call for immediate efforts to reduce poverty, improve health, especially of girls and women, and foster development in the world's poorest nations.

The impacts of climate change on poverty in 2030, and the potential from rapid, inclusive and climate-informed development

NASA Astrophysics Data System (ADS)

Rozenberg, J.; Hallegatte, S.

2016-12-01

There is a consensus on the fact that poor people are more vulnerable to climate change than the rest of the population, but, until recently, few quantified estimates had been proposed and few frameworks existed to design policies for addressing the issue. In this paper, we analyze the impacts of climate change on poverty using micro-simulation approaches. We start from household surveys that describe the current distribution of income and occupations, we project these households into the future and we look at the impacts of climate change on people's income. To project households into the future, we explore a large range of assumptions on future demographic changes (including on education), technological changes, and socio-economic trends (including redistribution policies). This approach allows us to identify the main combination of factors that lead to fast poverty reduction, and the ones that lead to high climate change impacts on the poor. Identifying these factors is critical for designing efficient policies to protect the poorest from climate change impacts and making economic growth more inclusive. Conclusions are twofold. First, by 2030 climate change can have a large impact on poverty, with between 3 and 122 million more people in poverty, but climate change remains a secondary driver of poverty trends within this time horizon. Climate change impacts do not only affect the poorest: in 2030, the bottom 40 percent lose more than 4 percent of income in many countries. The regional hotspots are Sub-Saharan Africa and - to a lesser extent - India and the rest of South Asia. The most important channel through which climate change increases poverty is through agricultural income and food prices. Second, by 2030 and in the absence of surprises on climate impacts, inclusive climate-informed development can prevent most of (but not all) the impacts on poverty. In a scenario with rapid, inclusive and climate-proof development, climate change impact on poverty is between 3 and 16 million, vs. between 35 and 122 million if development is delayed and less inclusive. Development and inclusive policies appears to reduce the impact of climate change on poverty much more than it reduces aggregated losses expressed in percentage of GDP.

Tackling Health Inequities in Chile: Maternal, Newborn, Infant, and Child Mortality Between 1990 and 2004

PubMed Central

Requejo, Jennifer Harris; Nien, Jyh Kae; Merialdi, Mario; Bustreo, Flavia; Betran, Ana Pilar

2009-01-01

Objectives. We analyzed trends in maternal, newborn, and child mortality in Chile between 1990 and 2004, after the introduction of national interventions and reforms, and examined associations between trends and interventions. Methods. Data were provided by the Chilean Ministry of Health on all pregnancies between 1990 and 2004 (approximately 4 000 000). We calculated yearly maternal mortality ratios, stillbirth rates, and mortality rates for neonates, infants (aged > 28 days and < 1 year), and children aged 1 to 4 years. We also calculated these statistics by 5-year intervals for Chile's poorest to richest district quintiles. Results. During the study period, the maternal mortality ratio decreased from 42.1 to 18.5 per 100 000 live births. The mortality rate for neonates decreased from 9.0 to 5.7 per 1000 births, for infants from 7.8 to 3.1 per 1000 births, and for young children from 3.1 to 1.7 per 1000 live births. The stillbirth rate declined from 6.0 to 5.0 per 1000 births. Disparities in these mortality statistics between the poorest and richest district quintiles also decreased, with the largest mortality reductions in the poorest quintile. Conclusions. During a period of socioeconomic development and health sector reforms, Chile experienced significant mortality and inequity reductions. PMID:19443831

Environment matters

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

NONE

2005-07-01

This year's annual review is devoted to the theme of environmental health. It contains: an overview by the Director of the World Bank's Environment Department, J. Warren Evans; viewpoints on health risks of environmental pollution, integrating health concerns into carbon planning, sanitation in the world's poorest countries and impacts of indoor air pollution on health; and reviews on the World Bank's efforts to adapt safeguards to demanding priorities and on the Banks' 2005 environmental portfolio. Feature articles include a review of the Bank's Clean Air Initiative (now active in Africa, South and East Asia and Latin America). Reviews of workmore » in the Bank's six regions focus on efforts to address the linkages among poverty, environmental pollution and human health.« less

The Sustainable Development Goal for Urban Sanitation: Africa's Statistical Tragedy Continues?

PubMed

Buckley, Robert M; Kallergis, Achilles

2018-06-01

Sanitation delivery in the urban areas of sub-Saharan African countries has been a chronic issue, particularly difficult to tackle. Under the Millennium Development Goals, the sanitation target in urban sub-Saharan Africa was missed by a wide margin and witnessed almost no improvement. After 2 years of review, the WHO/UNICEF Joint Monitoring Programme published a new measure of access to sanitation as a baseline for the Sustainable Development Goals. There are a number of improvements in the new measure. However, despite the improvements, the new measure continues to be characterized by an important flaw: it continues to disregard how shared toilet facilities contribute towards the SDG sanitation target. As a result, the new measure does not indicate whether progress is being made in low-income urban areas where a large number of households rely on shared sanitation; nor does it provide a goal that can be achieved in cities of the poorest countries over the measurement period. But, its most egregious failing is that it directs resources towards investments which will often fail cost/benefit tests. In sum, it is not a surprise that a Working Group recommended that the measure should be changed to include some shared facilities. Following the Working Group's recommendation would have avoided the adverse consequences of continued reliance on a key component of the methodology used for monitoring sanitation improvements under the Millennium Development Goals. The paper discusses the limitations of this methodology in the context of urban sub-Saharan Africa, where current sanitation conditions are seriously lacking, and the significant future urban population growth will add more pressure for the delivery of vital sanitation services.

Speeding Access to Vaccines and Medicines in Low- and Middle-Income Countries: A Case for Change and a Framework for Optimized Product Market Authorization

PubMed Central

Ahonkhai, Vincent; Portet, Alexandre; Hartman, Dan

2016-01-01

Background The United Nations Millennium Development Goals galvanized global efforts to alleviate suffering of the world’s poorest people through unprecedented public-private partnerships. Donor aid agencies have demonstrably saved millions of lives that might otherwise have been lost to disease through increased access to quality-assured vaccines and medicines. Yet, the introduction of these health interventions in low- and middle-income countries (LMICs) continues to face a time lag due to factors which remain poorly understood. Methods and Findings A recurring theme from our partnership engagements was that an optimized regulatory process would contribute to improved access to quality health products. Therefore, we investigated the current system for medicine and vaccine registration in LMICs as part of our comprehensive regulatory strategy. Here, we report a fact base of the registration timelines for vaccines and drugs used to treat certain communicable diseases in LMICs. We worked with a broad set of stakeholders, including the World Health Organization’s prequalification team, national regulatory authorities, manufacturers, procurers, and other experts, and collected data on the timelines between first submission and last approval of applications for product registration sub-Saharan Africa. We focused on countries with the highest burden of communicable disease and the greatest need for the products studied. The data showed a typical lag of 4 to 7 years between the first regulatory submission which was usually to a regulatory agency in a high-income country, and the final approval in Sub-Saharan Africa. Two of the three typical registration steps which products undergo before delivery in the countries involve lengthy timelines. Failure to leverage or rely on the findings from reviews already performed by competent regulatory authorities, disparate requirements for product approval by the countries, and lengthy timelines by manufacturers to respond to regulatory queries were key underlying factors for the delays. Conclusions We propose a series of measures which we developed in close collaboration with key stakeholders that could be taken to reduce registration time and to make safe, effective medicines more quickly available in countries where they are most needed. Many of these recommendations are being implemented by the responsible stakeholders, including the WHO prequalification team and the national regulatory authorities in Sub-Saharan Africa. Those efforts will be the focus of subsequent publications by the pertinent groups. PMID:27851831

Speeding Access to Vaccines and Medicines in Low- and Middle-Income Countries: A Case for Change and a Framework for Optimized Product Market Authorization.

PubMed

Ahonkhai, Vincent; Martins, Samuel F; Portet, Alexandre; Lumpkin, Murray; Hartman, Dan

2016-01-01

The United Nations Millennium Development Goals galvanized global efforts to alleviate suffering of the world's poorest people through unprecedented public-private partnerships. Donor aid agencies have demonstrably saved millions of lives that might otherwise have been lost to disease through increased access to quality-assured vaccines and medicines. Yet, the introduction of these health interventions in low- and middle-income countries (LMICs) continues to face a time lag due to factors which remain poorly understood. A recurring theme from our partnership engagements was that an optimized regulatory process would contribute to improved access to quality health products. Therefore, we investigated the current system for medicine and vaccine registration in LMICs as part of our comprehensive regulatory strategy. Here, we report a fact base of the registration timelines for vaccines and drugs used to treat certain communicable diseases in LMICs. We worked with a broad set of stakeholders, including the World Health Organization's prequalification team, national regulatory authorities, manufacturers, procurers, and other experts, and collected data on the timelines between first submission and last approval of applications for product registration sub-Saharan Africa. We focused on countries with the highest burden of communicable disease and the greatest need for the products studied. The data showed a typical lag of 4 to 7 years between the first regulatory submission which was usually to a regulatory agency in a high-income country, and the final approval in Sub-Saharan Africa. Two of the three typical registration steps which products undergo before delivery in the countries involve lengthy timelines. Failure to leverage or rely on the findings from reviews already performed by competent regulatory authorities, disparate requirements for product approval by the countries, and lengthy timelines by manufacturers to respond to regulatory queries were key underlying factors for the delays. We propose a series of measures which we developed in close collaboration with key stakeholders that could be taken to reduce registration time and to make safe, effective medicines more quickly available in countries where they are most needed. Many of these recommendations are being implemented by the responsible stakeholders, including the WHO prequalification team and the national regulatory authorities in Sub-Saharan Africa. Those efforts will be the focus of subsequent publications by the pertinent groups.

Socioeconomic inequalities in childhood exposure to secondhand smoke before and after smoke-free legislation in three UK countries

PubMed Central

Moore, Graham F.; Currie, Dorothy; Gilmore, Gillian; Holliday, Jo C.; Moore, Laurence

2012-01-01

Background Secondhand smoke (SHS) exposure is higher among lower socioeconomic status (SES) children. Legislation restricting smoking in public places has been associated with reduced childhood SHS exposure and increased smoke-free homes. This paper examines socioeconomic patterning in these changes. Methods Repeated cross-sectional survey of 10 867 schoolchildren in 304 primary schools in Scotland, Wales and Northern Ireland. Children provided saliva for cotinine assay, completing questionnaires before and 12 months after legislation. Results SHS exposure was highest, and private smoking restrictions least frequently reported, among lower SES children. Proportions of saliva samples containing <0.1 ng/ml (i.e. undetectable) cotinine increased from 31.0 to 41.0%. Although across the whole SES spectrum, there was no evidence of displacement of smoking into the home or increased SHS exposure, socioeconomic inequality in the likelihood of samples containing detectable levels of cotinine increased. Among children from the poorest families, 96.9% of post-legislation samples contained detectable cotinine, compared with 38.2% among the most affluent. Socioeconomic gradients at higher exposure levels remained unchanged. Among children from the poorest families, one in three samples contained >3 ng/ml cotinine. Smoking restrictions in homes and cars increased, although socioeconomic patterning remained. Conclusions Urgent action is needed to reduce inequalities in SHS exposure. Such action should include emphasis on reducing smoking in cars and homes. PMID:22448041

Increased educational attainment and its effect on child mortality in 175 countries between 1970 and 2009: a systematic analysis.

PubMed

Gakidou, Emmanuela; Cowling, Krycia; Lozano, Rafael; Murray, Christopher J L

2010-09-18

In addition to the inherent importance of education and its essential role in economic growth, education and health are strongly related. We updated previous systematic assessments of educational attainment, and estimated the contribution of improvements in women's education to reductions in child mortality in the past 40 years. We compiled 915 censuses and nationally representative surveys, and estimated mean number of years of education by age and sex. By use of a first-differences model, we investigated the association between child mortality and women's educational attainment, controlling for income per person and HIV seroprevalence. We then computed counterfactual estimates of child mortality for every country year between 1970 and 2009. The global mean number of years of education increased from 4·7 years (95% uncertainty interval 4·4-5·1) to 8·3 years (8·0-8·6) for men (aged ≥25 years) and from 3·5 years (3·2-3·9) to 7·1 years (6·7 -7·5) for women (aged ≥25 years). For women of reproductive age (15-44 years) in developing countries, the years of schooling increased from 2·2 years (2·0-2·4) to 7·2 years (6·8-7·6). By 2009, in 87 countries, women (aged 25-34 years) had higher educational attainment than had men (aged 25-34 years). Of 8·2 million fewer deaths in children younger than 5 years between 1970 and 2009, we estimated that 4·2 million (51·2%) could be attributed to increased educational attainment in women of reproductive age. The substantial increase in education, especially of women, and the reversal of the gender gap have important implications not only for health but also for the status and roles of women in society. The continued increase in educational attainment even in some of the poorest countries suggests that rapid progress in terms of Millennium Development Goal 4 might be possible. Bill & Melinda Gates Foundation. Copyright © 2010 Elsevier Ltd. All rights reserved.

Equity and adequacy of international donor assistance for global malaria control: an analysis of populations at risk and external funding commitments.

PubMed

Snow, Robert W; Okiro, Emelda A; Gething, Peter W; Atun, Rifat; Hay, Simon I

2010-10-23

Financing for malaria control has increased as part of international commitments to achieve the Millennium Development Goals (MDGs). We aimed to identify the unmet financial needs that would be biologically and economically equitable and would increase the chances of reaching worldwide malaria-control ambitions. Populations at risk of stable Plasmodium falciparum or Plasmodium vivax transmission were calculated for 2007 and 2009 for 93 malaria-endemic countries to measure biological need. National per-person gross domestic product (GDP) was used to define economic need. An analysis of external donor assistance for malaria control was done for the period 2002-09 to compute overall and annualised per-person at-risk-funding commitments. Annualised malaria donor assistance was compared with independent predictions of funding needed to reach international targets of 80% coverage of best practices in case-management and effective disease prevention. Countries were ranked in relation to biological, economic, and unmet needs to examine equity and adequacy of support by 2010. International financing for malaria control has increased by 166% (from $0·73 billion to $1·94 billion) since 2007 and is broadly consistent with biological needs. African countries have become major recipients of external assistance; however, countries where P vivax continues to pose threats to control ambitions are not as well funded. 21 countries have reached adequate assistance to provide a comprehensive suite of interventions by 2009, including 12 countries in Africa. However, this assistance was inadequate for 50 countries representing 61% of the worldwide population at risk of malaria-including ten countries in Africa and five in Asia that coincidentally are some of the poorest countries. Approval of donor funding for malaria control does not correlate with GDP. Funding for malaria control worldwide is 60% lower than the US$4·9 billion needed for comprehensive control in 2010; this includes funding shortfalls for a wide range of countries with different numbers of people at risk and different levels of domestic income. More efficient targeting of financial resources against biological need and national income should create a more equitable investment portfolio that with increased commitments will guarantee sustained financing of control in countries most at risk and least able to support themselves. Wellcome Trust. Copyright © 2010 Elsevier Ltd. All rights reserved.

Equity and adequacy of international donor assistance for global malaria control: an analysis of populations at risk and external funding commitments

PubMed Central

Snow, Robert W; Okiro, Emelda A; Gething, Peter W; Atun, Rifat; Hay, Simon I

2010-01-01

Summary Background Financing for malaria control has increased as part of international commitments to achieve the Millennium Development Goals (MDGs). We aimed to identify the unmet financial needs that would be biologically and economically equitable and would increase the chances of reaching worldwide malaria-control ambitions. Methods Populations at risk of stable Plasmodium falciparum or Plasmodium vivax transmission were calculated for 2007 and 2009 for 93 malaria-endemic countries to measure biological need. National per-person gross domestic product (GDP) was used to define economic need. An analysis of external donor assistance for malaria control was done for the period 2002–09 to compute overall and annualised per-person at-risk-funding commitments. Annualised malaria donor assistance was compared with independent predictions of funding needed to reach international targets of 80% coverage of best practices in case-management and effective disease prevention. Countries were ranked in relation to biological, economic, and unmet needs to examine equity and adequacy of support by 2010. Findings International financing for malaria control has increased by 166% (from $0·73 billion to $1·94 billion) since 2007 and is broadly consistent with biological needs. African countries have become major recipients of external assistance; however, countries where P vivax continues to pose threats to control ambitions are not as well funded. 21 countries have reached adequate assistance to provide a comprehensive suite of interventions by 2009, including 12 countries in Africa. However, this assistance was inadequate for 50 countries representing 61% of the worldwide population at risk of malaria—including ten countries in Africa and five in Asia that coincidentally are some of the poorest countries. Approval of donor funding for malaria control does not correlate with GDP. Interpretation Funding for malaria control worldwide is 60% lower than the US$4·9 billion needed for comprehensive control in 2010; this includes funding shortfalls for a wide range of countries with different numbers of people at risk and different levels of domestic income. More efficient targeting of financial resources against biological need and national income should create a more equitable investment portfolio that with increased commitments will guarantee sustained financing of control in countries most at risk and least able to support themselves. Funding Wellcome Trust. PMID:20889199

Veterinary Public Health in Italy: From Healthy Animals to Healthy Food, Contribution to Improve Economy in Developing Countries.

PubMed

Cacaci, Margherita; Lelli, Rossella Colomba

2018-01-01

The role of the veterinarian as a public health officer is intrinsic to the history and the culture of veterinary organization in Italy. The Veterinary service being part of the Health administration since the birth of the Italian State in the XIX Century. In the second half of the last century the birth of the Italian National Health Service confirmed that the function of the Italian veterinary service was to analyze and reduce the risks for the human population connected to the relationship man-animal-environment, animal health, food safety and security. The Italian Veterinary Medicine School curricula, reflected this "model" of veterinarian as well. In the majority of countries in the world, Veterinary Services are organized within the Agriculture Administration with the main function to assure animal health and wellbeing. After the so-called "Mad-cow crisis" the awareness of the direct and essential role of veterinary services in the prevention of human illness has been officially recognized and in the third millennium the old concept of "one health" and "human-animal interface" has gained popularity worldwide.The concept of Veterinary Public Health, has evolved at International level and has incorporated the more than a century old vision of the Italian Veterinary medicine and it is defined as "the sum of the contributions to the physical, mental and social development of people through the knowledge and application of veterinary science" (WHO, Future trends in veterinary public health. Gruppo di lavoro OMS: TE, Italy, 1999, Available from: http://www.who.int/zoonoses/vph/en/ . Last visited 16 Feb 2016, 1999).On the subject of Cooperation, Sustainability and Public Health, the EXPO 2015 event and the activities of international organizations WHO, FAO and World Organization for Animal Health are refocusing at present their worldwide mandate to protect human health and the economy of both the poorest Countries and the developed countries, according to the "new" concept of Veterinary Public Health.Focus of Italian Veterinary Services activity is connected to research, diagnosis and epidemiological analysis of infectious diseases, including zoonosis, food safety as well as food security.

Design optimization and performance characteristics of a photovoltaic microirrigation system for use in developing countries

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

Matlin, R. W.

1979-07-10

Tens of millions of the world's poorest farmers currently subsist on small farms below two hectares in size. The increasing cost of animal irrigation coupled with decreasing farm size and the lack of a utility grid or acceptable alternate power sources is causing interest in the use of solar photovoltaics for these very small (subkilowatt) water pumping systems. The attractive combinations of system components (array, pump, motor, storage and controls) have been identified and their interactions characterized in order to optimize overall system efficiency. Computer simulations as well as component tests were made of systems utilizing flat-plate and low-concentration arrays,more » direct-coupled and electronic-impedance-matching controls, fixed and incremental (once or twice a day) tracking, dc and ac motors, and positive-displacement, centrifugal and vertical turbine pumps. The results of these analyses and tests are presented, including water volume pumped as a function of time of day and year, for the locations of Orissa, India and Cairo, Egypt. Finally, a description and operational data are given for a prototype unit that was developed as a result of the previous analyses and tests.« less

Climate-related disaster opens a window of opportunity for rural poor in northeastern Honduras

PubMed Central

McSweeney, Kendra; Coomes, Oliver T.

2011-01-01

Two distinct views are evident in research on how rural communities in developing countries cope with extreme weather events brought by climate change: (i) that the resource-reliant poor are acutely vulnerable and need external assistance to prepare for such events, and (ii) that climate-related shocks can offer windows of opportunity in which latent local adaptive capacities are triggered, leading to systemic improvement. Results from a longitudinal study in a Tawahka community in Honduras before and after Hurricane Mitch (1994–2002) indicate that residents were highly vulnerable to the hurricane—due in part to previous development assistance—and that the poorest households were the hardest hit. Surprisingly, however, the disaster enabled the poor to initiate an institutional change that led to more equitable land distribution, slowed primary forest conversion, and positioned the community well to cope with comparable flooding occurring 10 y later. The study provides compelling evidence that communities can seize on the window of opportunity created by climate-induced shocks to generate sustained social-ecological improvement, and suggests that future interventions should foster local capacities for endogenous institutional change to enhance community resilience to climate shocks. PMID:21402909

Schistosomiasis and soil-transmitted helminthiasis control in Cameroon and Côte d'Ivoire: implementing control on a limited budget.

PubMed

Tchuenté, L A Tchuem; N'goran, E K

2009-11-01

Schistosomiasis and soil-transmitted helminthiasis occur throughout the developing world and remain a major public health problem in the poorest communities with enormous consequences for development. The extent of the problem has long been neglected because these diseases rarely kill at a young age and also because of their insidious nature. Today there exists a momentum and an unprecedented opportunity for a cost-effective control of these neglected tropical diseases. The control of these diseases has become a priority on the agenda of many governments, donors and international agencies. This paper highlights the progress made and future control activities in Cameroon and Côte d'Ivoire, where schistosomiasis and soil-transmitted helminthiasis control measures have been implemented over the past decade with limited budgets. In Cameroon, deworming activities were increased to encompass all ten regions in 2007 as a result of a co-ordinated effort of the Ministry of Health and the Ministry of Education with national and international partners. In Côte d'Ivoire, focal control activities were achieved with support from various partners. Prospects, opportunities and challenges for the control of neglected tropical diseases in these two countries are discussed.

Design and development of decentralized water and wastewater technologies: a combination of safe wastewater disposal and fertilizer production.

PubMed

Fach, S; Fuchs, S

2010-01-01

Modern wastewater treatment plants are often inappropriate for communities in developing countries. Such communities lack the funding, resources and skilled labour required to implement, operate, and maintain these plants. This research was conducted to investigate and establish an appropriate wastewater treatment system for the district of Gunung Kidul, Indonesia. Due to its lack of water during the dry season, this district is considered one of the poorest areas in the nation. First, wastewater was stored in septic tank units for a retention time of 26 days. Anaerobic conditions occurred, resulting in an 80% reduction of initial COD. The retained sludge was well stabilized with great potential, if dewatered, for reuse as fertilizer. Consequently, supernatant was separated for experiments consisting of lab scale aerobic sand filtering unit. Through filtration, further removals of COD (about 30%) and pathogens were achieved. Rich in nitrogen, the resulting effluent could be used for irrigation and soil conditioning. With faecal sludge and also a mixture of septic sludge and food waste, the hydrolysis stage of anaerobic digestion was examined. This paper discusses the laboratory findings in Karlsruhe and the design and implementation of a treatment system in Glompong, Indonesia.

Maternal dietary diversity and odds of low birth weight: empirical findings from India.

PubMed

Rammohan, Anu; Goli, Srinivas; Singh, Deepti; Ganguly, Dibyasree; Singh, Uma

2018-06-19

India has the highest proportion of low birth weight (LBW) babies born in the developing world. Poor maternal nutrition during pregnancy is associated with adverse infant health outcomes. The main objective of this paper was to assess the socioeconomic factors associated with dietary diversity among pregnant women and to investigate the association between maternal dietary diversity and LBW among their babies. The data for these analyses were derived from a survey conducted in November and December, 2014 among 230 women who had newly delivered in hospitals in Uttar Pradesh, the largest Indian state which has the poorest maternal outcomes in the country. The results from multivariate binary logistic regression model indicated that low maternal education and economic status was significantly associated with poor dietary diversity among participants. Also, women with low maternal dietary diversity had a significantly higher proportion of LBW babies compared to those in the medium to high dietary diversity categories. From a policy perspective, these findings suggest that continuous tracking of pregnant women's nutritional needs through existing monitoring systems, e.g., the Nutrition Resource Platform and Health Management Information System, and necessary interventions through Integrated Child Development Services may yield better results, thereby, addressing maternal under-nutrition and LBW.

Gates, GAVI, the glorious global funds and more: all you ever wanted to know.

PubMed

Nossal, Gustav J V

2003-02-01

Global immunization programmes have achieved some remarkable successes. In 1977, Frank Fenner's Commission declared smallpox to have been eradicated by an 11-year-long intensive campaign. The Expanded Programme on Immunization encompassed six important childhood vaccines and reached over three-quarters of the world's children. Polio eradication has gone remarkably well, with only 10 out of 200 countries reporting residual cases. But amidst all the good news, there is also bad news. Coverage is variable; infrastructure is crumbling; and newer vaccines are not being incorporated in many country programmes. The Bill and Melinda Gates Foundation has introduced a new dynamic here. From their initial gift of $100 million in December 1998, their commitment to date is US$1.5 billion - and rising. At the centre is a Global Children's Vaccine Fund which permitted the launch, in January 2000, of the Global Alliance for Vaccines and Immunization. This is targeted to the 74 poorest countries of the world and is designed to improve vaccination infrastructure, to purchase newer vaccines and to support research and development. Even before we know how successful this programme will be, it has had its imitators. The Global Fund to Fight AIDS, TB and Malaria borrowed many concepts from GAVI. The Global Alliance for Improved Nutrition announced in May 2002 does so as well, and is heavily supported by Gates. Highly effective parasite control programmes antedate all this but will be much strengthened. However, we still face a sizeable budgetary gap both for research and for bringing the best advances to all people who need them.

Quality of care: measuring a neglected driver of improved health

PubMed Central

Kruk, Margaret E

2017-01-01

Abstract The quality of care provided by health systems contributes towards efforts to reach sustainable development goal 3 on health and well-being. There is growing evidence that the impact of health interventions is undermined by poor quality of care in lower-income countries. Quality of care will also be crucial to the success of universal health coverage initiatives; citizens unhappy with the quality and scope of covered services are unlikely to support public financing of health care. Moreover, an ethical impetus exists to ensure that all people, including the poorest, obtain a minimum quality standard of care that is effective for improving health. However, the measurement of quality today in low- and middle-income countries is inadequate to the task. Health information systems provide incomplete and often unreliable data, and facility surveys collect too many indicators of uncertain utility, focus on a limited number of services and are quickly out of date. Existing measures poorly capture the process of care and the patient experience. Patient outcomes that are sensitive to health-care practices, a mainstay of quality assessment in high-income countries, are rarely collected. We propose six policy recommendations to improve quality-of-care measurement and amplify its policy impact: (i) redouble efforts to improve and institutionalize civil registration and vital statistics systems; (ii) reform facility surveys and strengthen routine information systems; (iii) innovate new quality measures for low-resource contexts; (iv) get the patient perspective on quality; (v) invest in national quality data; and (vi) translate quality evidence for policy impact. PMID:28603313

[Children's conditions. Peace should be used for the children's advantage].

PubMed

Neertoft, S

1990-02-28

It is estimated that about half of the budgets of underdeveloped countries are spent on armaments and repayments of debt. These two essentially unproductive activities cost an average of $500/family in underdeveloped countries each year. At the same time about 8000 children die each day for lack of vaccination. About 7000 children die each day from dehydration as a result of diarrhea and about 6000 children die each day from lung inflammation. The solutions to these health problems are well known and would cost only about what the USSR spends on vodka or what tobacco companies in the US spend on cigarette advertising. It would amount to 10% of the European Economic Community's support to agriculture and about 2% of what developing countries altogether spend on armaments. UNICEF, the UN children's organization, in its 1990 report on the state of the world's children estimates that about 40,000 children die each day worldwide from preventable causes and that many more live undernourished in poor health, physically and mentally unable to sustain the level of capability that they were born with. With military expenditures falling, there is hope that the peace dividend can be diverted to improve the world level of health care. If the debt crisis could be solved, a cut of only 5-10% in military expenditures would produce about $50 billion which could be used in the poorest parts of the world during the next 10 years to cover the most fundamental needs for food, pure drinking water, health care and education.

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.

Inequities in maternal and child health outcomes and interventions in Ghana.

PubMed

Zere, Eyob; Kirigia, Joses M; Duale, Sambe; Akazili, James

2012-03-31

With the date for achieving the targets of the Millennium Development Goals (MDGs) approaching fast, there is a heightened concern about equity, as inequities hamper progress towards the MDGs. Equity-focused approaches have the potential to accelerate the progress towards achieving the health-related MDGs faster than the current pace in a more cost-effective and sustainable manner. Ghana's rate of progress towards MDGs 4 and 5 related to reducing child and maternal mortality respectively is less than what is required to achieve the targets. The objective of this paper is to examine the equity dimension of child and maternal health outcomes and interventions using Ghana as a case study. Data from Ghana Demographic and Health Survey 2008 report is analyzed for inequities in selected maternal and child health outcomes and interventions using population-weighted, regression-based measures: slope index of inequality and relative index of inequality. No statistically significant inequities are observed in infant and under-five mortality, perinatal mortality, wasting and acute respiratory infection in children. However, stunting, underweight in under-five children, anaemia in children and women, childhood diarrhoea and underweight in women (BMI < 18.5) show inequities that are to the disadvantage of the poorest. The rates significantly decrease among the wealthiest quintile as compared to the poorest. In contrast, overweight (BMI 25-29.9) and obesity (BMI ≥ 30) among women reveals a different trend - there are inequities in favour of the poorest. In other words, in Ghana overweight and obesity increase significantly among women in the wealthiest quintile compared to the poorest. With respect to interventions: treatment of diarrhoea in children, receiving all basic vaccines among children and sleeping under ITN (children and pregnant women) have no wealth-related gradient. Skilled care at birth, deliveries in a health facility (both public and private), caesarean section, use of modern contraceptives and intermittent preventive treatment for malaria during pregnancy all indicate gradients that are in favour of the wealthiest. The poorest use less of these interventions. Not unexpectedly, there is more use of home delivery among women of the poorest quintile. Significant Inequities are observed in many of the selected child and maternal health outcomes and interventions. Failure to address these inequities vigorously is likely to lead to non-achievement of the MDG targets related to improving child and maternal health (MDGs 4 and 5). The government should therefore give due attention to tackling inequities in health outcomes and use of interventions by implementing equity-enhancing measure both within and outside the health sector in line with the principles of Primary Health Care and the recommendations of the WHO Commission on Social Determinants of Health.

Socioeconomic health inequality in malaria indicators in rural western Kenya: evidence from a household malaria survey on burden and care-seeking behaviour.

PubMed

Were, Vincent; Buff, Ann M; Desai, Meghna; Kariuki, Simon; Samuels, Aaron; Ter Kuile, Feiko O; Phillips-Howard, Penelope A; Patrick Kachur, S; Niessen, Louis

2018-04-16

Health inequality is a recognized barrier to achieving health-related development goals. Health-equality data are essential for evidence-based planning and assessing the effectiveness of initiatives to promote equity. Such data have been captured but have not always been analysed or used to manage programming. Health data were examined for microeconomic differences in malaria indices and associated malaria control initiatives in western Kenya. Data was analysed from a malaria cross-sectional survey conducted in July 2012 among 2719 people in 1063 households in Siaya County, Kenya. Demographic factors, history of fever, malaria parasitaemia, malaria medication usage, insecticide-treated net (ITN) use and expenditure on malaria medications were collected. A composite socioeconomic status score was created using multiple correspondence analyses (MCA) of household assets; households were classified into wealth quintiles and dichotomized into poorest (lowest 3 quintiles; 60%) or less-poor (highest 2 quintiles; 40%). Prevalence rates were calculated using generalized linear modelling. Overall prevalence of malaria infection was 34.1%, with significantly higher prevalence in the poorest compared to less-poor households (37.5% versus 29.2%, adjusted prevalence ratio [aPR] 1.23; 95% CI = 1.08-1.41, p = 0.002). Care seeking (aPR = 0.95; 95% CI 0.87-1.04, p = 0.229), medication use (aPR = 0.94; 95% CI 0.87-1.00, p = 0.087) and ITN use (aPR = 0.96; 95% CI = 0.87-1.05, p = 0.397) were similar between households. Among all persons surveyed, 36.4% reported taking malaria medicines in the prior 2 weeks; 92% took artemether-lumefantrine, the recommended first-line malaria medication. In the poorest households, 4.9% used non-recommended medicines compared to 3.5% in less-poor (p = 0.332). Mean and standard deviation [SD] for expenditure on all malaria medications per person was US$0.38 [US$0.50]; the mean was US$0.35 [US$0.52] amongst the poorest households and US$0.40 [US$0.55] in less-poor households (p = 0.076). Expenditure on non-recommended malaria medicine was significantly higher in the poorest (mean US$1.36 [US$0.91]) compared to less-poor households (mean US$0.98 [US$0.80]; p = 0.039). Inequalities in malaria infection and expenditures on potentially ineffective malaria medication between the poorest and less-poor households were evident in rural western Kenya. Findings highlight the benefits of using MCA to assess and monitor the health-equity impact of malaria prevention and control efforts at the microeconomic level.

Neoliberal policy, rural livelihoods, and urban food security in West Africa: A comparative study of The Gambia, Côte d'Ivoire, and Mali

PubMed Central

Moseley, William G.; Carney, Judith; Becker, Laurence

2010-01-01

This study examines the impact of two decades of neoliberal policy reform on food production and household livelihood security in three West African countries. The rice sectors in The Gambia, Côte d’Ivoire, and Mali are scrutinized as well as cotton and its relationship to sorghum production in Mali. Although market reforms were intended to improve food production, the net result was an increasing reliance on imported rice. The vulnerability of the urban populations in The Gambia and Côte d’Ivoire became especially clear during the 2007–2008 global food crisis when world prices for rice spiked. Urban Mali was spared the worst of this crisis because the country produces more of its own rice and the poorest consumers shifted from rice to sorghum, a grain whose production increased steeply as cotton production collapsed. The findings are based on household and market surveys as well as on an analysis of national level production data. PMID:20339079

During the 'decade of vaccines,' the lives of 6.4 million children valued at $231 billion could be saved.

PubMed

Ozawa, Sachiko; Stack, Meghan L; Bishai, David M; Mirelman, Andrew; Friberg, Ingrid K; Niessen, Louis; Walker, Damian G; Levine, Orin S

2011-06-01

Governments constantly face the challenge of determining how much they should spend to prevent premature deaths and suffering in their populations. In this article we explore the benefits of expanding the delivery of life-saving vaccines in seventy-two low- and middle-income countries, which we estimate would prevent the deaths of 6.4 million children between 2011 and 2020. We present the economic benefits of vaccines by using a "value of statistical life" approach, which is based on individuals' perceptions regarding the trade-off between income and increased risk of mortality. Our analysis shows that the vaccine expansion described above corresponds to $231 billion (uncertainty range: $116-$614 billion) in the value of statistical lives saved. This analysis complements results from analyses based on other techniques and is the first of its kind for immunizations in the world's poorest countries. It highlights the major economic benefits made possible by improving vaccine coverage.

Neoliberal policy, rural livelihoods, and urban food security in West Africa: a comparative study of The Gambia, Cote d'Ivoire, and Mali.

PubMed

Moseley, William G; Carney, Judith; Becker, Laurence

2010-03-30

This study examines the impact of two decades of neoliberal policy reform on food production and household livelihood security in three West African countries. The rice sectors in The Gambia, Côte d'Ivoire, and Mali are scrutinized as well as cotton and its relationship to sorghum production in Mali. Although market reforms were intended to improve food production, the net result was an increasing reliance on imported rice. The vulnerability of the urban populations in The Gambia and Côte d'Ivoire became especially clear during the 2007-2008 global food crisis when world prices for rice spiked. Urban Mali was spared the worst of this crisis because the country produces more of its own rice and the poorest consumers shifted from rice to sorghum, a grain whose production increased steeply as cotton production collapsed. The findings are based on household and market surveys as well as on an analysis of national level production data.

British American Tobacco and the "insidious impact of illicit trade" in cigarettes across Africa.

PubMed

Legresley, E; Lee, K; Muggli, M E; Patel, P; Collin, J; Hurt, R D

2008-10-01

To provide an overview of the complicity of British American Tobacco (BAT) in the illicit trade of cigarettes across the African continent in terms of rationale, supply routes and scale. Analysis of internal BAT documents and industry publications. BAT has relied on illegal channels to supply markets across Africa since the 1980s. Available documents suggest smuggling has been an important component of BAT's market entry strategy in order to gain leverage in negotiating with governments for tax concessions, compete with other transnational tobacco companies, circumvent local import restrictions and unstable political and economic conditions and gain a market presence. BAT worked through distributors and local agents to exploit weak government capacity to gain substantial market share in major countries. Documents demonstrate that the complicity of BAT in cigarette smuggling extends to Africa, which includes many of the poorest countries in the world. This is in direct conflict with offers by the company to contribute to stronger international cooperation to tackle the illicit tobacco trade.

The great exterminator of children.

PubMed

Logie, D

1992-05-30

Time is running out. Major contributors to declines in the health of Brazilian children, particularly street children, are the international debt crisis, the reverse flow of capital from the South to the North, and economic adjustment policies. There are medical consequences and an ecological debt. There is a question about the merits of having the poor pay for the folly of bad, past government decisions. All the major charities campaigned against repayment of debt. Banks are only exposed to 3% of their total assets in Third World debt, and are receiving tax relief for non repayment. Austerity programs have meant cuts in health and education, and diversion of food, wages, and welfare to producing exports in order to repay the debt. The message is earn more and spend less. The poor are hit the hardest, particularly by rising food prices. Diseases which were though to be eradicated are coming back. After decades of economic advances, countries are slipping back into mass poverty. Cuts in food subsidies or health care and family planning affect women and overpopulation. Land is being usurped from peasant farmers and tropical forests destroyed; urbanization has led to abandonment of 8 million children on the streets. The 1989 Brady plan suggests trading commercial debt for lower priced bonds which could be purchased by big business or even by the country itself. The deals tend to be complex. So far only 6 countries have benefited. Another proposal is English Prime Minister John Major's Trinidad Terms of September 1990, which is directed to low income country debtors. In December 1991 the UK cancelled 50% of the debt to the poorest countries over the next 3 years. The US and Australia have set up rescheduling agreements. World Bank debt is still in question. Commercial banks should also make an offer of relief. It is suggested that doctors unite in an organization called Physicians Against International Debt-PAID to lobby banks, governments, and the international community to make human development a priority and reduce debt.

[Trends in environmental risks in the context of the economic crisis. SESPAS report 2014].

PubMed

Ballester, Ferran; Llop, Sabrina; Querol, Xavier; Esplugues, Ana

2014-06-01

This article aims to analyze the impact of the economic and financial crisis on environmental determinants of health. The World Health Organization estimates that between 13% and 27% of the disease burden in countries could be prevented by improving the environment. These effects are larger in vulnerable populations, especially among the poorest. In the last decade, outdoor air pollution (the most significant environmental health risk in most European countries) has declined, mostly due to the European policy of reducing emissions and to the decrease in activity following the economic crisis. During the last few years, this improvement in air quality has occurred simultaneously with a reduction in investment in environmental protection and could therefore be offset in the medium-term. The economic crisis has not reduced the trend for higher temperatures in Spain and Europe because climate change is a global phenomenon that is not directly related to local emissions. To reduce the risk of an increase in the health impact of environmental factors, certain key aspects should be considered, such as the need to maintain or develop adequate monitoring and control systems and the opportunity to implement policies that help improve the quality of the environment and reduce the vulnerability of different population groups in a cross-disciplinary framework of transparency and citizen participation. Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.

Widespread inequalities in smoking & smokeless tobacco consumption across wealth quintiles in States of India: Need for targeted interventions.

PubMed

Thakur, J S; Prinja, Shankar; Bhatnagar, Nidhi; Rana, Saroj Kumar; Sinha, Dhirendra Narain; Singh, Poonam Khetarpal

2015-06-01

India is a large country with each State having distinct social, cultural and economic characteristics. Tobacco epidemic is not uniform across the country. There are wide variations in tobacco consumption across age, sex, regions and socio-economic classes. This study was conducted to understand the wide inequalities in patterns of smoking and smokeless tobacco consumption across various States of India. Analysis was conducted on Global Adult Tobacco Survey, India (2009-2010) data. Prevalence of both forms of tobacco use and its association with socio-economic determinants was assessed across States and Union Territories of India. Wealth indices were calculated using socio-economic data of the survey. Concentration index of inequality and one way ANOVA assessed economic inequality in tobacco consumption and variation of tobacco consumption across quintiles. Multiple logistic regression was done for tobacco consumption and wealth index adjusting for age, sex, area, education and occupation. Overall prevalence of smoking and smokeless tobacco consumption was 13.9 per cent (14.6, 13.3) and 25.8 per cent (26.6, 25.0), respectively. Prevalence of current smoking varied from 1.6 per cent (richest quintile in Odisha) to 42.2 per cent (poorest quintile in Meghalaya). Prevalence of current smokeless tobacco consumption varied from 1.7 per cent (richest quintile in Jammu and Kashmir) to 59.4 per cent (poorest quintile in Mizoram). Decreasing odds of tobacco consumption with increasing wealth was observed in most of the States. Reverse trend of tobacco consumption was observed in Nagaland. Significant difference in odds of smoking and smokeless tobacco consumption with wealth quintiles was observed. Concentration index of inequality was significant for smoking tobacco -0.7 (-0.62 to-0.78) and not significant for smokeless tobacco consumption -0.15 (0.01 to-0.33) INTERPRETATION & CONCLUSIONS: The findings of our analysis indicate that tobacco control policy and public health interventions need to consider widespread socio-economic inequities in tobacco consumption across the States in India.

Does an expansion in private sector contraceptive supply increase inequality in modern contraceptive use?

PubMed

Agha, Sohail; Do, Mai

2008-11-01

To determine whether an expansion in private sector contraceptive supply is associated with increased socio-economic inequality in the modern contraceptive prevalence rate (MCPR inequality). Multiple rounds of Demographic and Health Surveys data were analysed for five countries that experienced an increase in the private sector supply of contraceptives: Morocco, Indonesia, Kenya, Ghana and Bangladesh. Information on household assets and amenities was used to construct wealth quintiles. A concentration index, which calculates the degree of inequality in contraceptive use by wealth, was calculated for each survey round. Socio-economic inequality in the MCPR (MCPR inequality) declined in Morocco and Indonesia, where substantial expansion in private sector contraceptive supply occurred. In both countries, poor women continued to rely heavily on contraceptives supplied by the public sector even as they increased use of contraceptives obtained from the private sector. A marginally significant decline in MCPR inequality occurred in Bangladesh, where the increase in private sector supply was modest. There was no significant overall change in MCPR inequality in Kenya or Ghana. In Kenya, this lack of significant overall change disguised trends moving in opposite directions in urban and rural areas. In urban Kenya, MCPR inequality declined as low-income urban women increased use of contraceptives obtained primarily from the public sector. In rural Kenya, MCPR inequality increased. This increase was associated with a decline in the supply of contraceptives by the public sector and non-governmental organizations to the poorest, rural, women. The study found no support for the hypothesis that an increase in private sector contraceptive supply leads to higher MCPR inequality. The findings suggest that continued public sector supply of contraceptives to the poorest women protects against increased MCPR inequality. The study highlights the role of the public sector in building contraceptive markets for the private sector to exploit.

An equity analysis of performance-based financing in Rwanda: are services reaching the poorest women?

PubMed

Priedeman Skiles, Martha; Curtis, Siân L; Basinga, Paulin; Angeles, Gustavo

2013-12-01

Maternal health services continue to favour the wealthiest in lower and middle income countries. Debate about the potential of performance-based financing (PBF) to address these disparities continues. As PBF is adopted by countries, it is critical to understand the equity effects for maternal services. The aim of this study is to examine the effects of PBF on equity in maternal health service use when no specific provisions target the poorest in the population. In Rwanda, PBF was designed to increase health service use, which was universally low. Paired districts were randomly assigned to intervention and control for PBF implementation. Using Rwanda's Demographic Health Survey data from 2005 (pre-intervention) and 2007-8 (post-intervention), a cluster-level panel dataset of 7899 women 15-49 years of age from intervention (4477) and control districts (3422) was created. The impact of PBF on reported use of facility deliveries, antenatal care (ANC) and modern contraceptive use was estimated using a difference-in-differences model with community fixed effects. Interaction terms between wealth quintiles and PBF were estimated to identify the differential effect of PBF among poorer women. The probability of a facility delivery increased by 10 percentage points in the intervention when compared with the control districts (P = 0.014), while no significant effects were noted for ANC visits or modern contraceptive use. Service use increased for intervention and control populations and across all wealth quintiles from 2005 to 2007, with no evidence that PBF was a pro-poor or a pro-rich strategy. Insurance remained a positive predictor of service use. This research suggests that if service use is uniformly low then a PBF programme that incentivizes select services, such as facility deliveries, may improve service use overall. However, if the equity gap is extreme, then a PBF programme without equity targets will do little to alleviate disparities.

Unequal Funding: Leveling the Playing Field for Families in the Poorest School Districts. Family Review.

ERIC Educational Resources Information Center

Lindjord, Denise

2002-01-01

Argues that recent federal education legislation will not eliminate unequal funding, school performance inequities, and student achievement gaps that have persisted in the poorest school districts. Asserts that adequate, equitable, and targeted human and financial resources and standards are necessary, and that the slight increases in federal…

Microenterprise program gives hope to the world's poor.

PubMed

Anderson, J B

2000-01-01

When the Point Four Program was launched by US President Harry Truman in 1949, helping the world's poorest people help themselves became the primary aim of US development assistance. While much of the US Agency for International Development's (USAID) economic development work has concentrated on policy reforms, privatization and other measures aimed at strengthening overall economies, the very poor often are unable to share in the resulting economic growth. Although starting small businesses is an important way for people to work their way out of poverty, the poorest people usually lack the resources to get started and have no access to traditional loans. However, microenterprise financing is changing that by granting poor people loans to enable them to establish and expand microenterprises. It is noted that since 1990 USAID has provided well over US$1 billion to support more than 1000 institutions around the world that provide the very poor with small loans and secure, interest-bearing savings accounts as well as services to help them develop businesses. In turn, it is recorded that USAID-supported institutions have helped more than 10 million microentrepreneurs in Asia, Africa, Latin America, and Eastern and Central Europe build better lives for their families.

Are community midwives addressing the inequities in access to skilled birth attendance in Punjab, Pakistan? Gender, class and social exclusion.

PubMed

Mumtaz, Zubia; O'Brien, Beverley; Bhatti, Afshan; Jhangri, Gian S

2012-09-19

Pakistan is one of the six countries estimated to contribute to over half of all maternal deaths worldwide. To address its high maternal mortality rate, in particular the inequities in access to maternal health care services, the government of Pakistan created a new cadre of community-based midwives (CMW). A key expectation is that the CMWs will improve access to skilled antenatal and intra-partum care for the poor and disadvantaged women. A critical gap in our knowledge is whether this cadre of workers, operating in the private health care context, will meet the expectation to provide care to the poorest and most marginalized women. There is an inherent paradox between the notions of fee-for-service and increasing access to health care for the poorest who, by definition, are unable to pay. Data will be collected in three interlinked modules. Module 1 will consist of a population-based survey in the catchment areas of the CMW's in districts Jhelum and Layyah in Punjab. Proportions of socially excluded women who are served by CMWs and their satisfaction levels with their maternity care provider will be assessed. Module 2 will explore, using an institutional ethnographic approach, the challenges (organizational, social, financial) that CMWs face in providing care to the poor and socially marginalized women. Module 3 will identify the social, financial, geographical and other barriers to uncover the hidden forces and power relations that shape the choices and opportunities of poor and marginalized women in accessing CMW services. An extensive knowledge dissemination plan will facilitate uptake of research findings to inform positive developments in maternal health policy, service design and care delivery in Pakistan. The findings of this study will enhance understanding of the power dynamics of gender and class that may underlie poor women's marginalization from health care systems, including community midwifery care. One key outcome will be an increased sensitization of the special needs of socially excluded women, an otherwise invisible group. Another expectation is that the poor, socially excluded women will be targeted for provision of maternity care. The research will support the achievement of the 5th Millennium Development Goal in Pakistan.

Wealth inequality and utilization of reproductive health services in the Republic of Vanuatu: insights from the multiple indicator cluster survey, 2007

PubMed Central

2011-01-01

Background Although the Republic of Vanuatu has improved maternal indicators, more needs to be done to improve equity among the poorest in the use of reproductive health services to expedite the progress towards the Millennium Development Goal 5(MDG 5) target. While large developing country studies provide evidence of a rich-poor gap in reproductive health services utilization, not much is written in terms of Pacific Islands. Thus, this study aims to examine the degree of inequality in utilization of reproductive health services in a nationally representative sample of Vanuatu households. Methods This paper used data from the 2007 Vanuatu Multiple Indicator Cluster Survey (MICS). The analyses were based on responses from 615 ever married women, living with at least one child below two years of age. Outcomes included antenatal care (ANC) and use of birth attendants at delivery, place of delivery, and counseling and testing for HIV/AIDS. Descriptive statistics and multivariate logistic regression methods were employed in the analysis. Results Findings revealed that the economic well-being status of the household to which women belong, played a crucial role in explaining the variation in service utilization. Inequality in utilization was found to be more pronounced between the poorest and richest groups within the wealth quintiles. In adjusted models, mothers in the richest bands of wealth were 5.50 (95% confidence interval [CI]: 1.34-22.47), 2.12 (95% CI: 1.02-3.42), 4.0 (95% CI 1.58-10.10), and 2.0 (95% CI 1.02-5.88) times more likely to have assisted delivery from medically trained personnel, have institutional deliveries, and have counseling and testing for HIV/AIDS. Conclusions Association between household wealth inequality and utilization of ANC and delivery assistance from medically trained personnel, institutional delivery, and counseling and testing for HIV/AIDS suggest that higher utilization of reproductive health care services in Vanuatu poor-rich inequalities need to be addressed. Reducing poverty and making services more available and accessible to the poor may be essential for improving overall reproductive health care utilization rate in Vanuatu. PMID:22132828

Using a community-based definition of poverty for targeting poor households for premium subsidies in the context of a community health insurance in Burkina Faso.

PubMed

Savadogo, Germain; Souarès, Aurelia; Sié, Ali; Parmar, Divya; Bibeau, Gilles; Sauerborn, Rainer

2015-02-06

One of the biggest challenges in subsidizing premiums of poor households for community health insurance is the identification and selection of these households. Generally, poverty assessments in developing countries are based on monetary terms. The household is regarded as poor if its income or consumption is lower than a predefined poverty cut-off. These measures fail to recognize the multi-dimensional character of poverty, ignoring community members' perception and understanding of poverty, leaving them voiceless and powerless in the identification process. Realizing this, the steering committee of Nouna's health insurance devised a method to involve community members to better define 'perceived' poverty, using this as a key element for the poor selection. The community-identified poor were then used to effectively target premium subsidies for the insurance scheme. The study was conducted in the Nouna's Health District located in northwest Burkina Faso. Participants in each village were selected to take part in focus-group discussions (FGD) organized in 41 villages and 7 sectors of Nouna's town to discuss criteria and perceptions of poverty. The discussions were audio recorded, transcribed and analyzed in French using the software NVivo 9. From the FGD on poverty and the subjective definitions and perceptions of the community members, we found that poverty was mainly seen as scarcity of basic needs, vulnerability, deprivation of capacities, powerlessness, voicelessness, indecent living conditions, and absence of social capital and community networks for support in times of need. Criteria and poverty groups as described by community members can be used to identify poor who can then be targeted for subsidies. Policies targeting the poorest require the establishment of effective selection strategies. These policies are well-conditioned by proper identification of the poor people. Community perceptions and criteria of poverty are grounded in reality, to better appreciate the issue. It is crucial to take these perceptions into account in undertaking community development actions which target the poor. For most community-based health insurance schemes with limited financial resources, using a community-based definition of poverty in the targeting of the poorest might be a less costly alternative.

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

PubMed Central

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

2016-01-01

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

Effect of the Global Alliance for Vaccines and Immunisation on diphtheria, tetanus, and pertussis vaccine coverage: an independent assessment.

PubMed

Lu, Chunling; Michaud, Catherine M; Gakidou, Emmanuela; Khan, Kashif; Murray, Christopher J L

2006-09-23

The Global Alliance for Vaccines and Immunisation (GAVI) was created in 1999 to enable even the poorest countries to provide vaccines to all children. We aimed to assess the effect of GAVI on combined diphtheria, tetanus, and pertussis vaccine (DTP3) coverage. We examined the relation between DTP3 coverage for GAVI recipient countries from 1995 to 2004 and immunisation services support (ISS) and non-ISS expenditure per surviving child, controlling for income per head and local political governance variables. We analysed DTP3 coverage reported by governments and estimated by WHO/UNICEF. We also investigated the effect of GAVI on country reporting behaviour. In countries with DTP3 coverage of 65% or less at baseline, ISS spending per surviving child had a significant positive effect on DTP3 coverage (p=0.0005). This effect was not present in countries with DTP3 coverage of 65-80% or 80% or more at baseline. If ISS expenditure only is assessed, the estimated cost per additional child immunised in countries with baseline coverage of 65% or less is US$14 and if ISS and non-ISS expenditures are included the cost per child is almost $20. The success of ISS funding in countries with baseline DTP3 coverage of 65% or less provides evidence that a public-private partnership can work to reverse a negative trend in global health and that performance-related disbursement can work in some settings. Because ISS funding seems to have no effect in countries with baseline coverage greater than 65%, GAVI should consider redistributing its resources to countries with the lowest coverage.

Lowell Revitalization: One Student Conflict Manager at a Time

ERIC Educational Resources Information Center

Lane-Garon, Pamela S.

2011-01-01

This article summarizes the initial, collaborative implementation efforts of a school-based conflict resolution program. Lowell elementary School is predominately Hispanic and located in one of the poorest areas of Fresno. The University's Kremen School of Education and Human Development partners with local educators to train children in grades…

Museum-University Partnerships Transform Teenagers' Futures

ERIC Educational Resources Information Center

Rose, Sarah W.

2016-01-01

The New Bedford Whaling Museum's High School Apprenticeship Program assists economically disadvantaged New Bedford-area high school students to achieve success in high school and post-secondary education. The museum developed the program as a direct response to low high school graduation rates in New Bedford, one of Massachusetts' poorest cities.…

Study of a thermoelectric system equipped with a maximum power point tracker for stand-alone electric generation.

NASA Astrophysics Data System (ADS)

Favarel, C.; Champier, D.; Bédécarrats, J. P.; Kousksou, T.; Strub, F.

2012-06-01

According to the International Energy Agency, 1.4 billion people are without electricity in the poorest countries and 2.5 billion people rely on biomass to meet their energy needs for cooking in developing countries. The use of cooking stoves equipped with small thermoelectric generator to provide electricity for basic needs (LED, cell phone and radio charging device) is probably a solution for houses far from the power grid. The cost of connecting every house with a landline is a lot higher than dropping thermoelectric generator in each house. Thermoelectric generators have very low efficiency but for isolated houses, they might become really competitive. Our laboratory works in collaboration with plane`te-bois (a non governmental organization) which has developed energy-efficient multifunction (cooking and hot water) stoves based on traditional stoves designs. A prototype of a thermoelectric generator (Bismuth Telluride) has been designed to convert a small part of the energy heating the sanitary water into electricity. This generator can produce up to 10 watts on an adapted load. Storing this energy in a battery is necessary as the cooking stove only works a few hours each day. As the working point of the stove varies a lot during the use it is also necessary to regulate the electrical power. An electric DC DC converter has been developed with a maximum power point tracker (MPPT) in order to have a good efficiency of the electronic part of the thermoelectric generator. The theoretical efficiency of the MMPT converter is discussed. First results obtained with a hot gas generator simulating the exhaust of the combustion chamber of a cooking stove are presented in the paper.

Key strategies to further reduce stunting in Southeast Asia: lessons from the ASEAN countries workshop.

PubMed

Bloem, Martin W; de Pee, Saskia; Hop, Le Thi; Khan, Nguyen Cong; Laillou, Arnaud; Minarto; Moench-Pfanner, Regina; Soekarjo, Damayanti; Soekirman; Solon, J Antonio; Theary, Chan; Wasantwisut, Emorn

2013-06-01

To further reduce stunting in Southeast Asia, a rapidly changing region, its main causes need to be identified. Assess the relationship between different causes of stunting and stunting prevalence over time in Southeast Asia. Review trends in mortality, stunting, economic development, and access to nutritious foods over time and among different subgroups in Southeast Asian countries. Between 1990-2011, mortality among under-five children declined from 69/1,000 to 29/1,000 live births. Although disease reduction, one of two direct causes of stunting, has played an important role which should be maintained, improvement in meeting nutrient requirements, the other direct cause, is necessary to reduce stunting further. This requires dietary diversity, which is affected by rapidly changing factors: economic development; urbanization, giving greater access to larger variety of foods, including processed and fortified foods; parental education; and modernizing food systems, with increased distance between food producers and consumers. Wealthier consumers are increasingly able to access a more nutritious diet, while poorer consumers need support to improve access, and may also still need better hygiene and sanitation. In order to accelerate stunting reduction in Southeast Asia, availability and access to nutritious foods should be increased by collaboration between private and public sectors, and the Association of Southeast Asian Nations (ASEAN) can play a facilitating role. The private sector can produce and market nutritious foods, while the public sector sets standards, promotes healthy food choices, and ensures access to nutritious foods for the poorest, e.g, through social safety net programs.

Projecting Poverty at the Household Scale to Assess the Impact of Climate Change on Poor People

NASA Astrophysics Data System (ADS)

Hallegatte, S.; Rozenberg, J.

2015-12-01

This paper quantifies the potential impacts of climate change on poverty in 2030 and 2050, in 92 countries covering 90% of the developing world population. It accounts for the deep uncertainties that characterize future socio-economic evolutions and the lack of data regarding the condition and livelihood of poor people. It also considers many impacts of climate change, another source of uncertainty. We use a micro-simulation model based on household surveys and explore a wide range of uncertainties on future structural change, productivity growth or demographic changes. This results, for each country, in the creation of several hundred scenarios for future income growth and income distribution. We then explore the resulting space of possible futures and use scenario discovery techniques to identify the main drivers of inequalities and poverty reduction. We find that redistribution and structural change are powerful drivers of poverty and inequality reduction, except in low-income countries. In the poorest countries in Africa, reducing poverty cannot rely on redistribution but requires low population growth and productivity growth in agriculture. Once we have explored the space of possible outcomes for poverty and inequalities, we choose two representative scenarios of the best and worst cases and model the impacts of climate change in each of these two scenarios. Climate change impacts are modeled through 4 channels. First, climate change has an impact on labor productivity growth for people who work outside because of higher temperatures. Second, climate change has an impact on human capital because of more severe stunting in some places. Third, climate change has an impact on physical capital via more frequent natural disasters. Fourth, climate change has an impact on consumption because of changes in food prices. Impacts are very heterogeneous across countries and are mostly concentrated in African and South-East Asian countries. For high radiative forcing (RCP8.5), the impact of climate change on poverty is 6 times larger in the pessimistic scenario than in the optimistic scenario, illustrating how development and poverty reduction are powerful adaptation tools. Our results stress the urgency of achieving poverty eradication by 2030 in order to limit the negative impacts of climate change on the poor.

A multiple criteria analysis for household solid waste management in the urban community of Dakar.

PubMed

Kapepula, Ka-Mbayu; Colson, Gerard; Sabri, Karim; Thonart, Philippe

2007-01-01

Household solid waste management is a severe problem in big cities of developing countries. Mismanaged solid waste dumpsites produce bad sanitary, ecological and economic consequences for the whole population, especially for the poorest urban inhabitants. Dealing with this problem, this paper utilizes field data collected in the urban community of Dakar, in view of ranking nine areas of the city with respect to multiple criteria of nuisance. Nine criteria are built and organized in three families that represent three classical viewpoints: the production of wastes, their collection and their treatment. Thanks to the method PROMETHEE and the software ARGOS, we do a pair-wise comparison of the nine areas, which allows their multiple criteria rankings according to each viewpoint and then globally. Finding the worst and best areas in terms of nuisance for a better waste management in the city is our final purpose, fitting as well as possible the needs of the urban community. Based on field knowledge and on the literature, we suggest applying general and area-specific remedies to the household solid waste problems.

The Health Impact of Rabies in Haiti and Recent Developments on the Path Toward Elimination, 2010–2015

PubMed Central

Wallace, Ryan; Etheart, Melissa; Ludder, Fleurinord; Augustin, Pierre; Fenelon, Natael; Franka, Richard; Crowdis, Kelly; Dely, Patrick; Adrien, Paul; Pierre-Louis, J.; Osinubi, Modupe; Orciari, Lillian; Vigilato, Marco; Blanton, Jesse; Patel, Roopal; Lowrance, David; Liverdieu, Andrecy; Coetzer, Andre; Boone, John; Lindenmayer, Joanne; Millien, M.

2017-01-01

Abstract. Haiti, a Caribbean country of 10.5 million people, is estimated to have the highest burden of canine-mediated human rabies deaths in the Western Hemisphere, and one of the highest rates of human rabies deaths in the world. Haiti is also the poorest country in the Western Hemisphere and has numerous economic and health priorities that compete for rabies-control resources. As a result, primary rabies-control actions, including canine vaccination programs, surveillance systems for human and animal rabies, and appropriate postbite treatment, have not been fully implemented at a national scale. After the 2010 earthquake that further hindered the development of public health program infrastructure and services, the U.S. Centers for Disease Control and Prevention worked with the Ministry of Public Health and Population and key health development partners (including the Pan-American Health Organization) to provide technical expertise and funding for general disease surveillance systems, laboratory capacity, and selected disease control programs; including rabies. In 2011, a cross-ministerial rabies consortium was convened with participation from multiple international rabies experts to develop a strategy for successful rabies control in Haiti. The consortium focused on seven pillars: 1) enhancement of laboratory diagnostic capacity, 2) development of comprehensive animal surveillance system, 3) development of comprehensive human rabies surveillance system, 4) educational outreach, 5) sustainable human rabies biologics supply, 6) achievement of sustained canine vaccination rates of ≥ 70%, and 7) finalization of a national rabies control strategy. From 2010 until 2015, Haiti has seen improvements in the program infrastructure for canine rabies control. The greatest improvements were seen in the area of animal rabies surveillance, in support of which an internationally recognized rabies laboratory was developed thereby leading to an 18-fold increase in the detection of rabid animals. Canine rabies vaccination practices also improved, from a 2010 level of approximately 12% to a 2015 dog population coverage level estimated to be 45%. Rabies vaccine coverage is still below the goal of 70%, however, the positive trend is encouraging. Gaps exist in the capacity to conduct national surveillance for human rabies cases and access to human rabies vaccine is lacking in many parts of the country. However, control has improved over the past 5 years as a result of the efforts of Haiti’s health and agriculture sectors with assistance from multiple international organizations. Haiti is well situated to eliminate canine-mediated human rabies deaths in the near future and should serve as a great example to many developing countries struggling with similar barriers and limitations. PMID:29064363

The Health Impact of Rabies in Haiti and Recent Developments on the Path Toward Elimination, 2010-2015.

PubMed

Wallace, Ryan; Etheart, Melissa; Ludder, Fleurinord; Augustin, Pierre; Fenelon, Natael; Franka, Richard; Crowdis, Kelly; Dely, Patrick; Adrien, Paul; Pierre-Louis, J; Osinubi, Modupe; Orciari, Lillian; Vigilato, Marco; Blanton, Jesse; Patel, Roopal; Lowrance, David; Liverdieu, Andrecy; Coetzer, Andre; Boone, John; Lindenmayer, Joanne; Millien, M

2017-10-01

Haiti, a Caribbean country of 10.5 million people, is estimated to have the highest burden of canine-mediated human rabies deaths in the Western Hemisphere, and one of the highest rates of human rabies deaths in the world. Haiti is also the poorest country in the Western Hemisphere and has numerous economic and health priorities that compete for rabies-control resources. As a result, primary rabies-control actions, including canine vaccination programs, surveillance systems for human and animal rabies, and appropriate postbite treatment, have not been fully implemented at a national scale. After the 2010 earthquake that further hindered the development of public health program infrastructure and services, the U.S. Centers for Disease Control and Prevention worked with the Ministry of Public Health and Population and key health development partners (including the Pan-American Health Organization) to provide technical expertise and funding for general disease surveillance systems, laboratory capacity, and selected disease control programs; including rabies. In 2011, a cross-ministerial rabies consortium was convened with participation from multiple international rabies experts to develop a strategy for successful rabies control in Haiti. The consortium focused on seven pillars: 1) enhancement of laboratory diagnostic capacity, 2) development of comprehensive animal surveillance system, 3) development of comprehensive human rabies surveillance system, 4) educational outreach, 5) sustainable human rabies biologics supply, 6) achievement of sustained canine vaccination rates of ≥ 70%, and 7) finalization of a national rabies control strategy. From 2010 until 2015, Haiti has seen improvements in the program infrastructure for canine rabies control. The greatest improvements were seen in the area of animal rabies surveillance, in support of which an internationally recognized rabies laboratory was developed thereby leading to an 18-fold increase in the detection of rabid animals. Canine rabies vaccination practices also improved, from a 2010 level of approximately 12% to a 2015 dog population coverage level estimated to be 45%. Rabies vaccine coverage is still below the goal of 70%, however, the positive trend is encouraging. Gaps exist in the capacity to conduct national surveillance for human rabies cases and access to human rabies vaccine is lacking in many parts of the country. However, control has improved over the past 5 years as a result of the efforts of Haiti's health and agriculture sectors with assistance from multiple international organizations. Haiti is well situated to eliminate canine-mediated human rabies deaths in the near future and should serve as a great example to many developing countries struggling with similar barriers and limitations.

An impact evaluation of medical insurance for poor in Georgia: preliminary results and policy implications.

PubMed

Gotsadze, George; Zoidze, Akaki; Rukhadze, Natia; Shengelia, Natia; Chkhaidze, Nino

2015-03-01

The objective of this article is to assess the impact of the new health financing reform in Georgia-'medical insurance for the poor (MIP)'-which uses private insurance companies and delivers state-subsidized health benefits to the poorest groups of the Georgian population. To evaluate the reform we looked at access to health care services and financial protection against health care costs, which are two key dimensions proposed for the universal coverage plans. The data from two nationally representative Health Utilization and Expenditure Surveys (2007 and 2010) were used, and a difference-in-difference method of evaluation was applied. The MIP was not found to have a significant impact on service utilization growth nationwide, but in the capital city the MIP insured were 12% more likely to use formal health services and 7.6% more likely to use hospitals as compared with other areas of the country. The MIP impact on out-of-pocket health expenditures was greater in reducing costs of accessing services. The cost reductions were sizable and more pronounced among the poorest. Finally, the MIP significantly increased the odds of obtaining free benefits by insured individuals as compared with the control group. Such an increase was most noticeable for the poorest third of the population. Marginal changes in access to services and the geographically diverse impact of the MIP on service utilization points to other factors affecting health-seeking behaviour of the insured. These other factors include private insurer behaviour that may have used strategies for reducing claims and managing utilization. Equity impact of the MIP and improved financial protection, especially for the poor, are benefits to be retained by government policies when universal health coverage is rolled out nationwide and all citizens will be covered. The role of private insurance companies as financial intermediaries of the publicly funded programme needs further evaluation before moving forward. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2015; all rights reserved.

The efficacy of economic-development programs in forest-dependent communities

Treesearch

Rory Fraser

1997-01-01

West Virginia is one of the poorest states in the nation and its rural communities are more hard pressed than their urban counterparts. At the same time, West Virginia is one of the most densely forested states in the USA. The combination of poverty amidst a wealth of forest suggest that economic development based on the forest resource could provide solutions for poor...

Why are some vulnerable children healthy and others stunted? A case study of vulnerability and resilience among very young children in West Africa

NASA Astrophysics Data System (ADS)

Grace, K.; Nagle, N.

2014-12-01

Stunting, when children are shorter than average for their age, poses serious problems for short- and long-term development of individuals, families and communities. Stunting is linked to increase risk or illness or death, reduced educational attainment, reduced earnings and increases the likelihood (for girls) that the next generation of children will be stunted. Stunting occurs as a result of a culmination of inadequate food/calories, experiences with frequent illness, poor care and low weight at birth. Because almost 40% of children under 5 in the developing world suffer from stunting, understanding the community, household and individual components that lead to stunting are vital as these countries aim to improve children's health and development. We focus this research on childhood stunting in the neighboring countries of Mali and Burkina Faso, two of the poorest and least developed countries in the world. The populations of both countries are heavily reliant on subsistence farming and the share of children under 5 who are stunted hovers around 30%. In this research we aim to explore child stunting with attention to biology, behavior and environment. Specifically we aim to determine why children in some food insecure communities are stunted while others in the same community are healthy and, as an extension, why some low birth weight babies grow into healthy children and others are stunted. Because of the significance of food and nutrition on stunting outcomes, and because no micro-level estimates of food production exist, we use high resolution remotely sensed imagery (~1m) combined with coarser resolution landscape data (rainfall, slope, Normalized Difference Vegetation Index) to estimate community level food production for each year of the child's life. We construct a multi-level analysis through the linking of food production data to other community features gathered from Demographic and Health Survey and smaller scale community surveys gathered by USAID's WA-WASH. We will include type of water source, distance to a road, presence of a health facility, share of educated individuals, as well as maternal height/weight, parental socio-economic characteristics, household size/assets. Finally, we will evaluate the impact of specific characteristics of the child - age, sex, health history, birth order.

Perceptions of Global Warming Among the Poorest Counties in the Southeastern United States.

PubMed

Kearney, Gregory D; Bell, Ronny A

2018-03-07

The geographic position and high level of poverty in the southeastern United States are significant risk factors that contribute to the region's high vulnerability to climate change. The goal of this study was to evaluate beliefs and perceptions of global warming among those living in poverty in the poorest counties in the southeastern United States. Results from this project may be used to support public health efforts to increase climate-related messaging to vulnerable and underserved communities. This was an ecological study that analyzed public opinion poll estimates from previously gathered national level survey data (2016). Responses to 5 questions related to beliefs, attitudes, and perceptions of global warming were evaluated. Counties below the national average poverty level (13.5%) were identified among 11 southeastern US states (Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Michigan, North Carolina, South Carolina, Tennessee, Virginia). Student t tests were used to compare public perceptions of global warming among the poorest urban and rural counties with national-level public opinion estimates. Overall, counties below the national poverty level in the southeastern US were significantly less likely to believe that global warming was happening compared with national-level estimates. The poorest rural counties were less likely to believe that global warming was happening than the poorest urban counties. Health care providers and public health leaders at regional and local levels are in ideal positions to raise awareness and advocate the health implications of climate change to decision makers for the benefit of helping underserved communities mitigate and adequately adapt to climate-related threats.

Index-based Crop Insurance for Climate Adaptation in the Developing World

NASA Astrophysics Data System (ADS)

Brown, M. E.; Osgood, D. E.; Carriquiry, M. A.

2011-12-01

Weather has always presented a challenge to small-scale farmers, particularly in regions where poverty and lack of infrastructure has restricted the development of financial instruments to limit risk. New 'index' insurance innovations in agriculture are beginning to enable even the poorest farmers to unlock major productivity gains (e.g. insuring loans for improved seeds). Although index insurance has the potential to greatly improve productivity in developing country agriculture, the principal technical challenge to up-scaling this product is "data poverty," the absence of weather data in low-income areas needed to design robust and affordable insurance products. Earth science, particularly remote sensing, has the potential to ameliorate data poverty. However, raw use of earth science model output leads to non-optimal indexes and many obstacles remain to transform earth science products into insurance solutions. Estimation uncertainty, limited availability of consistent time series, and difficulties of predicting loses based on remote observations are reviewed in this article. The importance of multidisciplinary approaches addressing the needs of stakeholders in simple to understand indexes is highlighted. The successful use of Earth science data to support the index insurance industry in currently poor and isolated communities in the developing world would transform the ability of small farmers to increase yields, household incomes and regional economies, if the growing gap between earth science and index insurance can be closed.

Global Equity and Justice Issues for Young People During the First Three Decades of Life.

PubMed

Petersen, Anne; Koller, Silvia H; Motti-Stefanidi, Frosso; Verma, Suman

This chapter takes a global perspective on equity and justice during development from childhood into adulthood. Globally, the population of young people is booming with the most rapid growth among young people in the poorest countries. While already faced with significant issues related to development and thriving, this population boom also exacerbates equity and justice for these children. Given this urgent situation, this chapter builds from the large body of minority world research, as well as the emergent majority world research, to argue that in order to turn the youth bulge into a demographic dividend, researchers must utilize a positive development framing rather than the more dominant problem-focused framing in studying these issues. The structural challenges confronting young people growing up in contexts marked by poverty; weak systems and institutions, especially those serving education, health, and justice; weak political and governance systems; and continual conflict must also be addressed by global and national governmental bodies. This chapter will emphasize the strengths and opportunities of the majority world, highlighting some of the strong, emergent examples of programs that support and develop the strengths of young people. We conclude with a discussion of appropriate support required from the minority and majority worlds that would further strengthen young people globally and enable them to become leaders of a more just, equitable world. © 2016 Elsevier Inc. All rights reserved.

Incentives to Exclude: The Political Economy Constraining School Fee Abolition in South Africa

ERIC Educational Resources Information Center

Nordstrum, Lee E.

2012-01-01

In 2009, the South African Department of Education extended tuition fee abolition to schools serving the poorest 60% of students, increased from 40% in 2007. This policy intends to increase access to and longevity in school for the poorest households by removing fees as a barrier and replacing private revenue with increased state funds. Despite…

Social Justice and School Improvement: Improving the Quality of Schooling in the Poorest Neighbourhoods

ERIC Educational Resources Information Center

Lupton, Ruth

2005-01-01

Social justice in education demands, at the very least, that all students should have access to the same quality of educational processes, even if their outcomes turn out to be unequal. Yet schools in the poorest neighbourhoods are consistently adjudged to provide a lower quality of education than those in more advantaged areas. Based on a…

U.S. private voluntary organizations in development: an assessment.

PubMed

Schwartz, E

1980-10-01

The strengths and weaknesses of U.S. private voluntary organizations were compared to other types of organizations. Private voluntary organizations (PVOs), in general, are organizations that are private, non-profit, and tax-exempt. Voluntary is a reference more to the nature of the contributions individuals may make to these organizations than to their volunteer-sending programs. Cooperative organizations are included within the definition, but universities, colleges, and various research or scientific institutions are not. The primary issue in this evaluation was to determine the effectiveness of the PVOs in carrying out development assistance efforts. Current consensus would rate the PVOs as excellent practitioners of the basic human needs development strategy at the grassroots level. They have been leaders and innovators of this approach, and it is in this area that they have a comparative advantage. The work of PVOs has also been expanding in areas identified as most useful by development specialists. The 7 criteria that may be used in assessing the effectiveness of PVOs in meeting development assistance goals are reviewed: 1) fostering self-help initiative among the poorest of the poor; 2) mobilizing U.S. private financial and human resources; 3) stimulating innovative projects which can be replicated elsewhere; 4) strengthening people-to-people contact; 5) encouraging the establishment of indigenous participatory institutions; 6) creating conditions for self-sustaining development efforts; and 7) increasing the capacity of less developed countries to absorb outside capital by increasing the level of local skills and resources.

Community Support for Basic Education in Sub-Saharan Africa. Africa Region Human Development Working Paper Series.

ERIC Educational Resources Information Center

Watt, Patrick

Currently, Africa stands out as the world's poorest and most educationally deprived region. Where communities are empowered to identify their own needs and priorities, participate in decisions about resource allocation, and hold education providers accountable for ensuring that children receive a minimum acceptable standard of education, schooling…

The Cornell Urban Scholars Program: Cultivating New York City's Next Generation of Civic Leaders

ERIC Educational Resources Information Center

Reardon, Kenneth M.

2005-01-01

This article describes the origins, evolution, and development of a comprehensive civic engagement program designed to encourage Ivy League students to pursue public service careers with nonprofits and municipal government organizations serving New York City's poorest children, families, and neighborhoods. The article offers a detailed description…

Education, Poverty and Development--Mapping Their Interconnections

ERIC Educational Resources Information Center

Colclough, Christopher

2012-01-01

Human capital and functionalist paradigms underpin the stance taken by most governments to education policy. These models have also had a profound effect upon the determination of education priorities in the poorest states and, indeed, upon aid policy. This paper argues, on the basis of evidence from the papers in this volume and from the wider…

How a clogged canal affects ecological and human health in a tropical urban wetland ecosystem

EPA Science Inventory

The coastal city of San Juan, Puerto Rico is a tropical urban ecosystem woven among a series of interconnected bays, lagoons, drains, canals, and mangroves. As the city has expanded, infilling and urban development by the region’s poorest residents has choked an important c...

Utilizing NASA Earth Observations to Monitor Land Management Practices and the Development of Marshlands to Rice Fields in Rwanda

NASA Astrophysics Data System (ADS)

Dusabimana, M. R.; Blach, D.; Mwiza, F.; Muzungu, E.; Swaminathan, R.; Tate, Z.

2014-12-01

Rwanda, a small country with the highest population density in Sub-Saharan Africa, is one of the world's poorest countries. Although agriculture is the backbone of Rwandan economy, agricultural productivity is extremely low. Over 90 % of the population is engaged in subsistence farming and only 52 % of the total land surface area is arable. Of this land, approximately 165,000 hectares are marshlands, of which only 57 % has been cultivated. Rwandan government has invested in the advancement of agriculture with activities such as irrigation, marshland reclamation, and crop regionalization. In 2001, Ministry of Agriculture and Animal Resources (MINAGRI) released the Rural Sector Support Program (RSSP), which aimed at converting marshlands into rice fields at various development sites across the country. The focus of this project was to monitor rice fields in Rwanda utilizing NASA Earth observations such as Landsat 5 Thematic Mapper and Landsat 8 Operational Land Imager. Modified Normalized Difference Water Index (MNDWI) was used to depict the progress of marshland to rice field conversion as it highlights the presence of irrigated rice fields from the surrounding area. Additionally, Decision Support System for Agrotechnology Transfer (DSSAT) was used to estimate rice yield at RSSP sites. Various simulations were run to find perfect conditions for cultivating the highest yield for a given farm. Furthermore, soil erosion susceptibility masks were created by combining factors derived from ASTER, MERRA, and ground truth data using Revised Universal Soil Loss Equation (RUSLE). The end results, maps, and tutorials were delivered to the partners and policy makers in Rwanda to help make informed decisions. It can be clearly seen that Earth observations can be successfully used to monitor agricultural and land management practices as a cost effective method that will enable farmers to improve crop yield production and food security.

Holistic care of complicated tuberculosis in healthcare settings with limited resources.

PubMed

Duke, Trevor; Kasa Tom, Sharon; Poka, Harry; Welch, Henry

2017-12-01

In recent years, most of the focus on improving the quality of paediatric care in low-income countries has been on improving primary care using the Integrated Management of Childhood Illness, and improving triage and emergency treatment in hospitals aimed at reducing deaths in the first 24 hours. There has been little attention paid to improving the quality of care for children with chronic or complex diseases. Children with complicated forms of tuberculosis (TB), including central nervous system and chronic pulmonary TB, provide examples of acute and chronic multisystem paediatric illnesses that commonly present to district-level and second-level referral hospitals in low-income countries. The care of these children requires a holistic clinical and continuous quality improvement approach. This includes timely decisions on the commencement of treatment often when diagnoses are not certain, identification and management of acute respiratory, neurological and nutritional complications, identification and treatment of comorbidities, supportive care, systematic monitoring of treatment and progress, rehabilitation, psychological support, ensuring adherence, and safe transition to community care. New diagnostics and imaging can assist this, but meticulous attention to clinical detail at the bedside and having a clear plan for all aspects of care that is communicated well to staff and families are essential for good outcomes. The care is multidimensional: biomedical, rehabilitative, social and economic, and multidisciplinary: medical, nursing and allied health. In the era of the Sustainable Development Goals, approaches to these dimensions of healthcare are needed within the reach of the poorest people who access district hospitals in low-income countries. © 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.

Financing transformative health systems towards achievement of the health Sustainable Development Goals: a model for projected resource needs in 67 low-income and middle-income countries.

PubMed

Stenberg, Karin; Hanssen, Odd; Edejer, Tessa Tan-Torres; Bertram, Melanie; Brindley, Callum; Meshreky, Andreia; Rosen, James E; Stover, John; Verboom, Paul; Sanders, Rachel; Soucat, Agnès

2017-09-01

The ambitious development agenda of the Sustainable Development Goals (SDGs) requires substantial investments across several sectors, including for SDG 3 (healthy lives and wellbeing). No estimates of the additional resources needed to strengthen comprehensive health service delivery towards the attainment of SDG 3 and universal health coverage in low-income and middle-income countries have been published. We developed a framework for health systems strengthening, within which population-level and individual-level health service coverage is gradually scaled up over time. We developed projections for 67 low-income and middle-income countries from 2016 to 2030, representing 95% of the total population in low-income and middle-income countries. We considered four service delivery platforms, and modelled two scenarios with differing levels of ambition: a progress scenario, in which countries' advancement towards global targets is constrained by their health system's assumed absorptive capacity, and an ambitious scenario, in which most countries attain the global targets. We estimated the associated costs and health effects, including reduced prevalence of illness, lives saved, and increases in life expectancy. We projected available funding by country and year, taking into account economic growth and anticipated allocation towards the health sector, to allow for an analysis of affordability and financial sustainability. We estimate that an additional $274 billion spending on health is needed per year by 2030 to make progress towards the SDG 3 targets (progress scenario), whereas US$371 billion would be needed to reach health system targets in the ambitious scenario-the equivalent of an additional $41 (range 15-102) or $58 (22-167) per person, respectively, by the final years of scale-up. In the ambitious scenario, total health-care spending would increase to a population-weighted mean of $271 per person (range 74-984) across country contexts, and the share of gross domestic product spent on health would increase to a mean of 7·5% (2·1-20·5). Around 75% of costs are for health systems, with health workforce and infrastructure (including medical equipment) as the main cost drivers. Despite projected increases in health spending, a financing gap of $20-54 billion per year is projected. Should funds be made available and used as planned, the ambitious scenario would save 97 million lives and significantly increase life expectancy by 3·1-8·4 years, depending on the country profile. All countries will need to strengthen investments in health systems to expand service provision in order to reach SDG 3 health targets, but even the poorest can reach some level of universality. In view of anticipated resource constraints, each country will need to prioritise equitably, plan strategically, and cost realistically its own path towards SDG 3 and universal health coverage. WHO. Copyright © 2017 World Health Organization; licensee Elsevier. This is an Open Access article published under the CC BY 3.0 IGO license which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any use of this article, there should be no suggestion that WHO endorses any specific organisation, products or services. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.

Growth and development of ponderosa pine on sites of contrasting productivities: relative importance of stand density and shrub competition effects

Treesearch

Jianwei Zhang; William W. Oliver; Matt D. Busse

2006-01-01

Effects of stand density and shrub competition on growth and development were compared across a gradient of study sites. Challenge, the most productive site, is located in the foothills of the Sierra Nevada, northern California. Pringle Falls is of intermediate productivity in the rain shadow of the central Oregon Cascades. Trough Springs Ridge is the poorest site...

Suicide rates and income in São Paulo and Brazil: a temporal and spatial epidemiologic analysis from 1996 to 2008

PubMed Central

2012-01-01

Background In a classical study, Durkheim noted a direct relation between suicide rates and wealth in the XIX century France. Since that time, several studies have verified this relationship. It is known that suicide rates are associated with income, although the direction of this association varies worldwide. Brazil presents a heterogeneous distribution of income and suicide across its territory; however, evaluation for an association between these variables has shown mixed results. We aimed to evaluate the relationship between suicide rates and income in Brazil, State of São Paulo (SP), and City of SP, considering geographical area and temporal trends. Methods Data were extracted from the National and State official statistics departments. Three socioeconomic areas were considered according to income, from the wealthiest (area 1) to the poorest (area 3). We also considered three regions: country-wide (27 Brazilian States and 558 Brazilian micro-regions), state-wide (645 counties of SP State), and city-wide (96 districts of SP city). Relative risks (RR) were calculated among areas 1, 2, and 3 for all regions, in a cross-sectional approach. Then, we used Joinpoint analysis to explore the temporal trends of suicide rates and SaTScan to investigate geographical clusters of high/low suicide rates across the territory. Results Suicide rates in Brazil, the State of SP, and the city of SP were 6.2, 6.6, and 5.4 per 100,000, respectively. Taking suicide rates of the poorest area (3) as reference, the RR for the wealthiest area was 1.64, 0.88, and 1.65 for Brazil, State of SP, and city of SP, respectively (p for trend <0.05 for all analyses). Spatial cluster of high suicide rates were identified at Brazilian southern (RR = 2.37), state of SP western (RR = 1.32), and city of SP central (RR = 1.65) regions. A direct association between income and suicide were found for Brazil (OR = 2.59) and the city of SP (OR = 1.07), and an inverse association for the state of SP (OR = 0.49). Conclusions Temporospatial analyses revealed higher suicide rates in wealthier areas in Brazil and the city of SP and in poorer areas in the State of SP. We further discuss the role of socioeconomic characteristics for explaining these discrepancies and the importance of our findings in public health policies. Similar studies in other Brazilian States and developing countries are warranted. PMID:22928689

Suicide rates and income in São Paulo and Brazil: a temporal and spatial epidemiologic analysis from 1996 to 2008.

PubMed

Bando, Daniel H; Brunoni, Andre R; Benseñor, Isabela M; Lotufo, Paulo A

2012-08-28

In a classical study, Durkheim noted a direct relation between suicide rates and wealth in the XIX century France. Since that time, several studies have verified this relationship. It is known that suicide rates are associated with income, although the direction of this association varies worldwide. Brazil presents a heterogeneous distribution of income and suicide across its territory; however, evaluation for an association between these variables has shown mixed results. We aimed to evaluate the relationship between suicide rates and income in Brazil, State of São Paulo (SP), and City of SP, considering geographical area and temporal trends. Data were extracted from the National and State official statistics departments. Three socioeconomic areas were considered according to income, from the wealthiest (area 1) to the poorest (area 3). We also considered three regions: country-wide (27 Brazilian States and 558 Brazilian micro-regions), state-wide (645 counties of SP State), and city-wide (96 districts of SP city). Relative risks (RR) were calculated among areas 1, 2, and 3 for all regions, in a cross-sectional approach. Then, we used Joinpoint analysis to explore the temporal trends of suicide rates and SaTScan to investigate geographical clusters of high/low suicide rates across the territory. Suicide rates in Brazil, the State of SP, and the city of SP were 6.2, 6.6, and 5.4 per 100,000, respectively. Taking suicide rates of the poorest area (3) as reference, the RR for the wealthiest area was 1.64, 0.88, and 1.65 for Brazil, State of SP, and city of SP, respectively (p for trend <0.05 for all analyses). Spatial cluster of high suicide rates were identified at Brazilian southern (RR = 2.37), state of SP western (RR = 1.32), and city of SP central (RR = 1.65) regions. A direct association between income and suicide were found for Brazil (OR = 2.59) and the city of SP (OR = 1.07), and an inverse association for the state of SP (OR = 0.49). Temporospatial analyses revealed higher suicide rates in wealthier areas in Brazil and the city of SP and in poorer areas in the State of SP. We further discuss the role of socioeconomic characteristics for explaining these discrepancies and the importance of our findings in public health policies. Similar studies in other Brazilian States and developing countries are warranted.

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 poor stay thinner: stable socioeconomic gradients in BMI among women in lower- and middle-income countries123

PubMed Central

Neuman, Melissa; Finlay, Jocelyn E; Davey Smith, George

2011-01-01

Background: Recent studies have shown a strong positive association between individual BMI (in kg/m2) or overweight prevalence and socioeconomic status (SES) in low- and middle-income countries (LMICs). However, it is not clear whether this association is weakening or reversing over time. Objective: With the use of nationally representative data collected at 2 time points in 37 LMICs, we compared the associations of SES with BMI and of SES with overweight between the earlier surveys and the later surveys. Design: We conducted a cross-sectional analysis of nationally representative samples of 547,056 ever-married nonpregnant women aged 15–49 y: 208,570 women in the earlier round of surveys conducted between 1991 and 2003 and 338,486 women in the later round conducted between 1998 and 2008. We used linear and modified Poisson analyses with a country fixed effect to obtain a pooled estimate and a country-stratified analysis for country-specific estimates. Results: In adjusted models, BMI was 2.32 units higher (95% CI: 2.23, 2.41 units) among women in the wealthiest quintile compared with women in the poorest quintile in the earlier surveys and was 3.00 units higher (95% CI: 2.92, 3.07 units) in the later surveys. The association between BMI and wealth was positive in 37 countries in the earlier round of surveys and in 36 countries in the later round. Patterns were similar for overweight prevalence. Conclusion: The association between SES and BMI or overweight is positive in most LMICs and has not weakened over time. It appears that the burden of overweight is consistently greater among wealthier populations within LMICs. PMID:21993437

Housing ownership and affordability among low-income society in the poorest sub-district of Semarang, Central Java, Indonesia

NASA Astrophysics Data System (ADS)

Indrianingrum, Lulut

2017-03-01

The Government has intervened to deal with various affordable public housing programs, as well as financing programs for Low Income society in Indonesia. The characteristics of this society in each region are so diverse, that made the housing programs for this social segment uneasy in reaching the right target. Regulation of Housing and Settlement No. 2/2001 has mandated that the State are obliged to implement a habitable public housing for people, especially for the low income society. The purpose of this study is exploring the low-income residents' preferences and affordability of home ownership for their families in the poorest sub-district of Semarang. Aspects of studies include family conditions, financing, location, housing type and price. The research used a descriptive method to analyze a set of questionnaire data, distributed to low income residents in Sub district Tanjungmas, which isthe poorest sub district in Semarang. The results showed that the respondents developed a vision of home ownership by saving their money for the allocated housing budget and taking a bank installment. They tended to plan to get a house in their current neighborhood or nearby or anywhere else with the same price range. They really understood that, in order to get a better home and neighborhood they have to pay for higher prices. Therefore, their housing criteria or standards were set based on the quality of life in their current residential area, and should be located in a township (kampung).

Relevance of the EU Structural Funds’ Allocation to the Needs of Combating Air Pollution in Poland. Analysis of the Operational Programmes of Regions Threatened With Critical Air Pollution from Distributed Energy Sources

NASA Astrophysics Data System (ADS)

Włodarski, Marcin; Martyniuk-Pęczek, Justyna

2017-10-01

Recent years, the European Environmental Agency, has been reporting air quality parameters in Poland, as the poorest among all the EU countries. Despite of adoption of the EU legislation on energy efficiency and energy performance of buildings, existing legal solutions occur insufficient in reducing air pollution in Polish regions. Lack of an effective schemes supporting complex thermal renovation of buildings, exchange of inefficient boilers, developing district heating based on clean and renewable fuels results in severe health problems and 40 000 of premature deaths related to air pollution. Availability of the EU structural funds may become a tremendous opportunity, especially for the residential sector, to conduct a massive scale modernization. Nevertheless, lack of a coordinated action involving all levels of governance may put the opportunity at risk. The article aims to answer the question on the readiness of the regional governments to effectively implement energy efficiency measures mitigating the problem of air pollution. Second objective is to analyse whether the Regional Operational Programmes allocating the ERDF funds to support specific development needs of the regions, have been constructed in a way that properly addresses the problems related to energy performance of residential buildings.

Global health funding and economic development.

PubMed

Martin, Greg; Grant, Alexandra; D'Agostino, Mark

2012-04-10

The impact of increased national wealth, as measured by Gross Domestic Product (GDP), on public health is widely understood, however an equally important but less well-acclaimed relationship exists between improvements in health and the growth of an economy. Communicable diseases such as HIV, TB, Malaria and the Neglected Tropical Diseases (NTDs) are impacting many of the world's poorest and most vulnerable populations, and depressing economic development. Sickness and disease has decreased the size and capabilities of the workforce through impeding access to education and suppressing foreign direct investment (FDI). There is clear evidence that by investing in health improvements a significant increase in GDP per capita can be attained in four ways: Firstly, healthier populations are more economically productive; secondly, proactive healthcare leads to decrease in many of the additive healthcare costs associated with lack of care (treating opportunistic infections in the case of HIV for example); thirdly, improved health represents a real economic and developmental outcome in-and-of itself and finally, healthcare spending capitalises on the Keynesian 'economic multiplier' effect. Continued under-investment in health and health systems represent an important threat to our future global prosperity. This editorial calls for a recognition of health as a major engine of economic growth and for commensurate investment in public health, particularly in poor countries.

Global health funding and economic development

PubMed Central

2012-01-01

The impact of increased national wealth, as measured by Gross Domestic Product (GDP), on public health is widely understood, however an equally important but less well-acclaimed relationship exists between improvements in health and the growth of an economy. Communicable diseases such as HIV, TB, Malaria and the Neglected Tropical Diseases (NTDs) are impacting many of the world's poorest and most vulnerable populations, and depressing economic development. Sickness and disease has decreased the size and capabilities of the workforce through impeding access to education and suppressing foreign direct investment (FDI). There is clear evidence that by investing in health improvements a significant increase in GDP per capita can be attained in four ways: Firstly, healthier populations are more economically productive; secondly, proactive healthcare leads to decrease in many of the additive healthcare costs associated with lack of care (treating opportunistic infections in the case of HIV for example); thirdly, improved health represents a real economic and developmental outcome in-and-of itself and finally, healthcare spending capitalises on the Keynesian 'economic multiplier' effect. Continued under-investment in health and health systems represent an important threat to our future global prosperity. This editorial calls for a recognition of health as a major engine of economic growth and for commensurate investment in public health, particularly in poor countries. PMID:22490207

eC3--a modern telecommunications matrix for cervical cancer prevention in Zambia.

PubMed

Parham, Groesbeck P; Mwanahamuntu, Mulindi H; Pfaendler, Krista S; Sahasrabuddhe, Vikrant V; Myung, Daniel; Mkumba, Gracilia; Kapambwe, Sharon; Mwanza, Bianca; Chibwesha, Carla; Hicks, Michael L; Stringer, Jeffrey S A

2010-07-01

Low physician density, undercapacitated laboratory infrastructures, and limited resources are major limitations to the development and implementation of widely accessible cervical cancer prevention programs in sub-Saharan Africa. We developed a system operated by nonphysician health providers that used widely available and affordable communication technology to create locally adaptable and sustainable public sector cervical cancer prevention program in Zambia, one of the world's poorest countries. Nurses were trained to perform visual inspection with acetic acid aided by digital cervicography using predefined criteria. Electronic digital images (cervigrams) were reviewed with patients, and distance consultation was sought as necessary. Same-visit cryotherapy or referral for further evaluation by a gynecologist was offered. The Zambian system of "electronic cervical cancer control" bypasses many of the historic barriers to the delivery of preventive health care to women in low-resource environments while facilitating monitoring, evaluation, and continued education of primary health care providers, patient education, and medical records documentation. The electronic cervical cancer control system uses appropriate technology to bridge the gap between screening and diagnosis, thereby facilitating the conduct of "screen-and-treat" programs. The inherent flexibility of the system lends itself to the integration with future infrastructures using rapid molecular human papillomavirus-based screening approaches and wireless telemedicine communications.

Impact of conditional cash transfers on maternal and newborn health.

PubMed

Glassman, Amanda; Duran, Denizhan; Fleisher, Lisa; Singer, Daniel; Sturke, Rachel; Angeles, Gustavo; Charles, Jodi; Emrey, Bob; Gleason, Joanne; Mwebsa, Winnie; Saldana, Kelly; Yarrow, Kristina; Koblinsky, Marge

2013-12-01

Maternal and newborn health (MNH) is a high priority for global health and is included among the Millennium Development Goals (MDGs). However, the slow decline in maternal and newborn mortality jeopardizes achievements of the targets of MDGs. According to UNICEF, 60 million women give birth outside of health facilities, and family planning needs are satisfied for only 50%. Further, skilled birth attendance and the use of antenatal care are most inequitably distributed in maternal and newborn health interventions in low- and middle-income countries. Conditional cash transfer (CCT) programmes have been shown to increase health service utilization among the poorest but little is written on the effects of such programmes on maternal and newborn health. We carried out a systematic review of studies on CCT that report maternal and newborn health outcomes, including studies from 8 countries. The CCT programmes have increased antenatal visits, skilled attendance at birth, delivery at a health facility, and tetanus toxoid vaccination for mothers and reduced the incidence of low birthweight. The programmes have not had a significant impact on fertility while the impact on maternal and newborn mortality has not been well-documented thus far. Given these positive effects, we make the case for further investment in CCT programmes for maternal and newborn health, noting gaps in knowledge and providing recommendations for better design and evaluation of such programmes. We recommend more rigorous impact evaluations that document impact pathways and take factors, such as cost-effectiveness, into account.

Barriers to the implementation of the SAFE strategy to combat hyperendemic trachoma in Australia.

PubMed

Wright, Heathcote R; Keeffe, Jill E; Taylor, Hugh R

2010-12-01

Australia is the only developed country in the world that still has endemic levels of blinding trachoma. The SAFE (Surgery, Antibiotics, Facial cleanliness, Environmental improvement) strategy is an effective public health intervention that has been successfully used to eliminate blinding trachoma in some of the poorest countries of the world. Yet the SAFE strategy has not been systematically implemented in Australia. We undertook semi-structured interviews to identify some of barriers to the implementation of the SAFE strategy within remote indigenous communities of Australia. Health care professionals who were responsible for delivering trachoma control programs throughout the Northern Territory were asked to participate in a semi-structured interview. Quantitative analysis was performed using an existing strategic management framework. Fourteen individuals were interviewed. Responses were grouped into 19 categories; 12 from the existing strategic management framework and 7 additional categories that were created for ideas unique to the trachoma control program in Australia. A number of key themes emerged from the interview and are presented in a literary style. From these key themes critical success factors for the implementation of a sustainable trachoma control program were identified. With the election of the Rudd government there has been a renewed interest in "closing the gap" between the health of indigenous and non-indigenous Australians. A federal government funding package of $58 million over four years has just been announced to tackle trachoma. It is hoped that the findings of this research can assist in making sure that money achieves its goal.

Potential long-term consequences of fad diets on health, cancer, and longevity: lessons learned from model organism studies.

PubMed

Ruden, Douglas M; Rasouli, Parsa; Lu, Xiangyi

2007-06-01

While much of the third world starves, many in the first world are undergoing an obesity epidemic, and the related epidemics of type II diabetes, heart disease, and other diseases associated with obesity. The amount of economic wealth being directly related to a decline in health by obesity is ironic because rich countries contribute billions of dollars to improve the health of their citizens. Nevertheless, nutritional experiments in model organisms such as yeast, C. elegans, Drosophila, and mice confirm that "caloric restriction" (CR), which is defined generally as a 30-40% decrease in caloric intake, a famine-like condition for humans seen only in the poorest of countries, promotes good health and increases longevity in model organisms. Because caloric restriction, and dieting in general, requires a great deal of will power to deal with the feelings of deprivation, many fad diets, such as the Atkins, South Beach, and Protein Power, have been developed which allow people to lose weight purportedly without the severe feelings of deprivation. However, the long-term effects of such fad diets are not known and few experiments have been performed in the laboratory to investigate possible side affects and adverse consequences. In this paper, we review studies with fad-like dietary conditions in humans and model organisms, and we propose a "Dietary Ames Test" to rapidly screen fad diets, dietary supplements, and drugs for potential long-term health consequences in model organisms.

Examining land use change and cooking fuel-use in Uganda: implications and potential win-win scenarios for policy and carbon financing

NASA Astrophysics Data System (ADS)

Brunner, Nicole; Semmens, Darius; Hawbaker, Todd

2016-04-01

Uganda is one of the world's most biodiverse countries, yet also one of the poorest. Human dependence on natural resources, especially from forests, is most pronounced in developing countries such as Uganda, where many people live in poverty and rely on fuel wood for cooking. These demands often compete with conservation efforts aimed at protecting forests and biodiversity. An understanding of trends in forest condition and local community use of forests is necessary to explore the implications of changing environmental conditions on the sustainability of Uganda's forests and forest-related socioeconomic activities. A human-environment framework is applied to this research by comparing environmental layers derived from remotely sensed imagery with socioeconomic data acquired from household surveys. Statistical modeling was used to explain the relationship between household characteristics (e.g., fuel use) and environmental characteristics (e.g., land cover change) and to quantify the role of spatial arrangement or pattern in understanding human-environment relationships (e.g., access and distance). The findings show that distance from protected forests is related to changes in household fuel type. For example, increases in charcoal as the primary cooking fuel is observed in households a closer distance to protected forests. This change is likely due to access to forest resources. The results of this study could inform policies aimed at protecting forests as well as protecting the interests of people in proximity to protected forests.

Country watch: Nicaragua.

PubMed

Pauw, J

1999-01-01

The Association of Workers for Education, Health and Social Integration (TESIS) works with commercial sex workers to control HIV and sexually transmitted diseases in Nicaragua through free condom distribution and education. Education includes group work, individual counseling, and demonstrations of correct condom use. Condoms are also distributed to the motels frequented by commercial sex workers. When the Condom Social Marketing (CSM) project in Central America started, it sold condoms of the same quality as the ones offered by TESIS; thus the condom donors reduced their donations, and in turn, TESIS lost its normal quota for free condom distribution. Because of this situation, TESIS dealt with a condom promotion scheme at a lower cost for the poorest women. Condom quality did not deteriorate as products only came with simpler packaging. TESIS fills the gap which CSM missed.

British American Tobacco and the “insidious impact of illicit trade” in cigarettes across Africa

PubMed Central

LeGresley, E; Lee, K; Muggli, M E; Patel, P; Collin, J; Hurt, R D

2008-01-01

Objectives: To provide an overview of the complicity of British American Tobacco (BAT) in the illicit trade of cigarettes across the African continent in terms of rationale, supply routes and scale. Methods: Analysis of internal BAT documents and industry publications. Results: BAT has relied on illegal channels to supply markets across Africa since the 1980s. Available documents suggest smuggling has been an important component of BAT’s market entry strategy in order to gain leverage in negotiating with governments for tax concessions, compete with other transnational tobacco companies, circumvent local import restrictions and unstable political and economic conditions and gain a market presence. BAT worked through distributors and local agents to exploit weak government capacity to gain substantial market share in major countries. Conclusions: Documents demonstrate that the complicity of BAT in cigarette smuggling extends to Africa, which includes many of the poorest countries in the world. This is in direct conflict with offers by the company to contribute to stronger international cooperation to tackle the illicit tobacco trade. PMID:18617598

[Food insecurity in the Northeast and South of Brazil: magnitude, associated factors, and per capita income patterns for reducing inequities].

PubMed

Facchini, Luiz Augusto; Nunes, Bruno Pereira; Motta, Janaína Vieira dos Santos; Tomasi, Elaine; Silva, Suele Manjourany; Thumé, Elaine; Silveira, Denise Silva da; Siqueira, Fernando Vinholes; Dilélio, Alitéia Santiago; Saes, Mirelle de Oliveira; Miranda, Vanessa Iribarrem Avena; Volz, Pâmela Moraes; Osório, Alessander; Fassa, Anaclaudia Gastal

2014-01-01

This article addresses food insecurity among urban Brazilian families with children under seven years. A cross-sectional study in areas covered by primary health care centers identified 5,419 families in the Northeast and 5,081 in the South of the country. Food insecurity was assessed by the Brazilian Food Insecurity Scale. Prevalence of moderate or severe food insecurity was 22.9% in the Northeast and 7.5% in the South. According to the adjusted analysis, increased likelihood of moderate or severe food insecurity was associated with families headed by women, black or brown maternal skin color, low maternal education, low family income, and enrollment in the Bolsa Família program (conditional income transfer). Moderate or severe food insecurity would be reduced by 59.5% in the Northeast and 45.4% in the South with a per capita income of at least BRL 175.00 per month. Increased family income for the poorest families and better targeting of Bolsa Família are essential for reducing food insecurity in the country.

Head and neck cancer in South Asia: Macroeconomic consequences and the role of the head and neck surgeon.

PubMed

Alkire, Blake C; Bergmark, Regan W; Chambers, Kyle; Lin, Derrick T; Deschler, Daniel G; Cheney, Mack L; Meara, John G

2016-08-01

Head and neck cancer constitutes a substantial portion of the burden of disease in South Asia, and there is an undersupply of surgical capacity in this region. The purpose of this study was to estimate the economic welfare losses due to head and neck cancer in India, Pakistan, and Bangladesh in 2010. We used publicly available estimates of head and neck cancer morbidity and mortality along with a concept termed the value of a statistical life to estimate economic welfare losses in the aforementioned countries in 2010. Economic losses because of head and neck cancer in India, Pakistan, and Bangladesh totaled $16.9 billion (2010 US dollars [USD]), equivalent to 0.26% of the region's economic output. Bangladesh, the poorest country, experienced the greatest proportional losses. The economic consequences of head and neck cancer in South Asia are significant, and building surgical capacity is essential to begin to address this burden. © 2016 Wiley Periodicals, Inc. Head Neck 38:1242-1247, 2016. © 2016 Wiley Periodicals, Inc.

Learning and Skills for Neighbourhood Renewal: Summary Report on Research for the Neighbourhood Renewal Unit. Research Report.

ERIC Educational Resources Information Center

Taylor, Sue

A study examined how further education (FE) colleges and Local Education Authority adult education services contribute to neighborhood renewal (NR) in deprived areas and how their strategic role might develop. The National Strategy for Neighborhood Renewal was tackling deprivation in 88 of England's poorest communities by promoting the development…

McGovern-Dole International Food for Education and Child Nutrition Program. Fact Sheet

ERIC Educational Resources Information Center

US Department of Agriculture, 2009

2009-01-01

The McGovern-Dole International Food for Education and Child Nutrition Program (McGovern-Dole program) helps support education, child development, and food security for some of the world's poorest children. It provides for donations of U.S. agricultural products, as well as financial and technical assistance, for school feeding and maternal and…

Issues in Cross Cultural Training: Educating the Imagination with Cross Cultural Approaches to Literacy Development.

ERIC Educational Resources Information Center

Mikkelsen, Nina

An instructor's teaching practices have been influenced by Edward T. Hall's theory in "Beyond Culture," which begins with the notion that "what is known least well and is therefore in the poorest position to be studied is what is closest to oneself," the "unconscious patterns that control us." This wisdom has been…

Entrepreneurship Education at Tertiary Education Level: Implication to Historical Studies

ERIC Educational Resources Information Center

Lawal, Salahu Mohammed

2013-01-01

Nigeria is richly endowed with both human and material resources that when well utilized can make her one of the richest and developed nation in the world. But poor utilization of the resources, corruption and dwindling fortune in her education system made her among the first twenty five poorest nations in the world. Similarly, report shows that…

Safely Managed Sanitation for All Means Fecal Sludge Management for At Least 1.8 Billion People in Low and Middle Income Countries.

PubMed

Berendes, David M; Sumner, Trent A; Brown, Joe M

2017-03-07

Although global access to sanitation is increasing, safe management of fecal waste is a rapidly growing challenge in low- and middle-income countries (LMICs). The goal of this study was to evaluate the current need for fecal sludge management (FSM) in LMICs by region, urban/rural status, and wealth. Recent Demographic and Health Survey data from 58 countries (847 685 surveys) were used to classify households by sanitation facility (facilities needing FSM, sewered facilities, ecological sanitation/other, or no facilities). Onsite piped water infrastructure was quantified to approximate need for wastewater management and downstream treatment. Over all surveyed nations, 63% of households used facilities requiring FSM, totaling approximately 1.8 billion people. Rural areas had similar proportions of toilets requiring FSM as urban areas. FSM needs scaled inversely with wealth: in the poorest quintile, households' sanitation facilities were almost 170 times more likely to require FSM (vs sewerage) than in the richest quintile. About one out of five households needing FSM had onsite piped water infrastructure, indicating domestic or reticulated wastewater infrastructure may be required if lacking for safe management of aqueous waste streams. FSM strategies must be included in future sanitation investment to achieve safe management of fecal wastes and protect public health.

Neglected tropical diseases: now more than just 'other diseases'--the post-2015 agenda.

PubMed

Molyneux, David H

2014-09-01

Neglected tropical diseases (NTDs) have become recognised as important health problems facing at least a billion people in the low-income countries and the poorest communities in middle-income countries. WHO plays a leading role in developing strategies to address these diseases, pharmaceutical companies provide drug donations to treat or control the NTDs and many partners from different constituencies have become increasingly committed to their control or elimination. This review looks to the post-2015 agenda and emphasises that despite the progress made over recent years, if the targets established are to be achieved, then not only will additional financial resources be required to up-scale treatments and increase access, but increased applied and operational research will be necessary to address problems and human capacity in NTD skills will need to be strengthened. Continuing advocacy for the relevance of control or elimination of NTDs must be placed in the context of universal health coverage and access to donated essential medicines for the poor as a right. The evidence that investment in NTD interventions are cost-effective and impact not only on health, but also to enhance socio-economic development, must be refined and promulgated. The global burden of disease attributable to NTDs requires reassessment to appropriately define the true burden, while the potential for unexpected events, political, climatic, environmental as well as biological, have the potential to reduce future progress towards the agreed post-2015 targets. NTD progress towards the WHO Roadmap targets and the fulfilment of the World Health Assembly Resolution 66.12 of 2013 demand continued commitment from all partner constituencies when challenges emerge. © The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Where Do the Poorest Go to Seek Outpatient Care in Bangladesh: Hospitals Run by Government or Microfinance Institutions?

PubMed Central

Tseng, Yu-hwei; Khan, Mujibul Alam

2015-01-01

Introduction Health programs implemented by microfinance institutions (MFIs) aim to benefit the poor, but whether these services reach the poorest remains uncertain. This study intended to investigate the socioeconomic distribution of patients in hospitals operated by microfinance institutions (i.e. MFI hospitals) in Bangladesh and compare the differences with public hospitals to determine if the programs were consistent with their pro-poor mandate. Methods In this cross-sectional study, we used the convenience sampling method to conduct an interviewer-assisted questionnaire survey among 347 female outpatients, with 170 in public hospitals and 177 in MFI hospitals. Independent variables were patient characteristics categorized into predisposing factors (age, education, marital status, family size), enabling factors (microcredit membership, household income) and need factors (self-rated health, perceived needs for care). We employed Generalized Estimating Equations (GEE) to evaluate how these factors contributed to MFI hospital use. Results Use of MFI hospitals was associated with microcredit membership over 5 years (OR=2.9, p<.01), moderately poor household (OR=4.09, p<.001), non-poor household (OR=7.34, p<.01) and need for preventive care (OR=3.4, p<.01), compared with public hospitals. Combining membership and income, we found microcredit members had a higher tendency towards utilization but membership effect pertained to the non- and moderately-poor. Compared with the group who were non-members and the poorest, microcredit members who were non-poor had the highest likelihood (OR=7.46, p<.001) to visit MFI hospitals, followed by members with moderate income (OR=6.91, p<.001) and then non-members in non-poor households (OR=4.48, p<.01). Those who were members but the poorest had a negative association (OR=0.42), though not significant. Despite a higher utilization of preventive services in MFI hospitals, expenditure there was significantly higher. Conclusion Inequity was more pronounced in MFI hospitals than public ones. MFI hospitals appeared to miss their target population. We suggest that MFIs reorganize health programs toward primary health care to make care equitable and universally accessible. This study holds practical implications for governments, development agencies and microfinance practitioners working at the grassroots level. PMID:25807500

Where do the poorest go to seek outpatient care in Bangladesh: hospitals run by government or microfinance institutions?

PubMed

Tseng, Yu-hwei; Khan, Mujibul Alam

2015-01-01

Health programs implemented by microfinance institutions (MFIs) aim to benefit the poor, but whether these services reach the poorest remains uncertain. This study intended to investigate the socioeconomic distribution of patients in hospitals operated by microfinance institutions (i.e. MFI hospitals) in Bangladesh and compare the differences with public hospitals to determine if the programs were consistent with their pro-poor mandate. In this cross-sectional study, we used the convenience sampling method to conduct an interviewer-assisted questionnaire survey among 347 female outpatients, with 170 in public hospitals and 177 in MFI hospitals. Independent variables were patient characteristics categorized into predisposing factors (age, education, marital status, family size), enabling factors (microcredit membership, household income) and need factors (self-rated health, perceived needs for care). We employed Generalized Estimating Equations (GEE) to evaluate how these factors contributed to MFI hospital use. Use of MFI hospitals was associated with microcredit membership over 5 years (OR=2.9, p<.01), moderately poor household (OR=4.09, p<.001), non-poor household (OR=7.34, p<.01) and need for preventive care (OR=3.4, p<.01), compared with public hospitals. Combining membership and income, we found microcredit members had a higher tendency towards utilization but membership effect pertained to the non- and moderately-poor. Compared with the group who were non-members and the poorest, microcredit members who were non-poor had the highest likelihood (OR=7.46, p<.001) to visit MFI hospitals, followed by members with moderate income (OR=6.91, p<.001) and then non-members in non-poor households (OR=4.48, p<.01). Those who were members but the poorest had a negative association (OR=0.42), though not significant. Despite a higher utilization of preventive services in MFI hospitals, expenditure there was significantly higher. Inequity was more pronounced in MFI hospitals than public ones. MFI hospitals appeared to miss their target population. We suggest that MFIs reorganize health programs toward primary health care to make care equitable and universally accessible. This study holds practical implications for governments, development agencies and microfinance practitioners working at the grassroots level.

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

Achieving polio eradication: a review of health communication evidence and lessons learned in India and Pakistan

PubMed Central

Chitnis, Ketan; Morry, Chris; Feek, Warren; Bates, Jeffrey; Galway, Michael; Ogden, Ellyn

2009-01-01

Abstract Since 1988, the world has come very close to eradicating polio through the Global Polio Eradication Initiative, in which communication interventions have played a consistently central role. Mass media and information dissemination approaches used in immunization efforts worldwide have contributed to this success. However, reaching the hardest-to-reach, the poorest, the most marginalized and those without access to health services has been challenging. In the last push to eradicate polio, Polio Eradication Initiative communication strategies have become increasingly research-driven and innovative, particularly through the introduction of sustained interpersonal communication and social mobilization approaches to reach unreached populations. This review examines polio communication efforts in India and Pakistan between the years 2000 and 2007. It shows how epidemiological, social and behavioural data guide communication strategies that have contributed to increased levels of polio immunity, particularly among underserved and hard-to-reach populations. It illustrates how evidence-based and planned communication strategies – such as sustained media campaigns, intensive community and social mobilization, interpersonal communication and political and national advocacy combined – have contributed to reducing polio incidence in these countries. Findings show that communication strategies have contributed on several levels by: mobilizing social networks and leaders; creating political will; increasing knowledge; ensuring individual and community-level demand; overcoming gender barriers and resistance to vaccination; and reaching out to the poorest and marginalized populations. The review concludes with observations about the added value of communication strategies in polio eradication efforts and implications for global and local public health communication interventions. PMID:19705014

Restavèk children in context: Wellbeing compared to other Haitian children.

PubMed

Haydocy, Kelci E; Yotebieng, Marcel; Norris, Alison

2015-12-01

In Haiti, large numbers of vulnerable children and the country's particular historical context has led to a unique phenomenon known as the "restavèk" system. An estimated 300,000 Haitian children are restavèks, living as unpaid domestic servants. Child-welfare advocates describe the restavèk system as modern slavery, but researchers and advocates lack information about restavèk children's circumstances, particularly vis-à-vis other children in Haiti. In a cross-sectional analysis of a nationally representative sample, we evaluated differences in well-being (school attendance, work responsibilities, physical abuse, and hunger) between restavèk children and: (a) all non-restavèk children; and (b) the poorest quintile of non-restavèk children. As compared to all Haitian children and the poorest Haitian children, restavèk children have statistically significantly lower school attendance rates and more labor responsibilities. However, restavèk children experience statistically significantly less physical abuse and less hunger than non-restavèk Haitian children. The restavèk system remains active in Haiti because poor families lack basic resources to support their children, and restavèk children are at risk for mistreatment due to their vulnerable social status. The surprising finding that restavèk children are better off in some respects than their non-restavèk peers highlights the desperate poverty in Haiti and suggests that structural changes for poverty reduction will be required before the restavèk system will end. Copyright © 2015 Elsevier Ltd. All rights reserved.

The noncommunicable disease outcomes of primary healthcare screening in two rural subdistricts of the Eastern Cape Province, South Africa

PubMed Central

2017-01-01

Background Middle and lower income countries are challenged with a double burden of disease: while still coping with the onslaught of Human Immunodeficiency Virus (HIV) and increasing levels of tuberculosis (TB), there is a considerable increase in the level of noncommunicable diseases (NCDs). The poor are especially disadvantaged and are at an increased risk for NCDs. Adequate healthcare resources for this environment can only be allocated once the extent and exact nature of the problem is determined. Aim and setting The aim of this study was to collect demographic and NCD-related data in the poorest community of the poorest province of South Africa in order to determine the extent of the problem and advise on allocation of resources accordingly. Methods Data were collected via a household primary health screening process, which included taking anthropometric measurements, blood pressure and blood glucose and referring to clinics for further testing and treatment where necessary. Results It was found that the population screened was generally older, consisted of women, and had a high incidence of obesity and hypertension. Of note was the fact that in those without known hypertension, close to 40% of individuals had possible newly diagnosed hypertension. This increased with increase in age and body mass index (BMI). The total prevalence of diabetes was close to 5%, but possible new diabetes was considerably lower at approximately 1%. Conclusion In this rural area of the Eastern Cape, South Africa, undiagnosed hypertension is a major concern and renewed efforts at detection and control are warranted. PMID:29113445

Achieving polio eradication: a review of health communication evidence and lessons learned in India and Pakistan.

PubMed

Obregón, Rafael; Chitnis, Ketan; Morry, Chris; Feek, Warren; Bates, Jeffrey; Galway, Michael; Ogden, Ellyn

2009-08-01

Since 1988, the world has come very close to eradicating polio through the Global Polio Eradication Initiative, in which communication interventions have played a consistently central role. Mass media and information dissemination approaches used in immunization efforts worldwide have contributed to this success. However, reaching the hardest-to-reach, the poorest, the most marginalized and those without access to health services has been challenging. In the last push to eradicate polio, Polio Eradication Initiative communication strategies have become increasingly research-driven and innovative, particularly through the introduction of sustained interpersonal communication and social mobilization approaches to reach unreached populations. This review examines polio communication efforts in India and Pakistan between the years 2000 and 2007. It shows how epidemiological, social and behavioural data guide communication strategies that have contributed to increased levels of polio immunity, particularly among underserved and hard-to-reach populations. It illustrates how evidence-based and planned communication strategies - such as sustained media campaigns, intensive community and social mobilization, interpersonal communication and political and national advocacy combined - have contributed to reducing polio incidence in these countries. Findings show that communication strategies have contributed on several levels by: mobilizing social networks and leaders; creating political will; increasing knowledge; ensuring individual and community-level demand; overcoming gender barriers and resistance to vaccination; and reaching out to the poorest and marginalized populations. The review concludes with observations about the added value of communication strategies in polio eradication efforts and implications for global and local public health communication interventions.

Housing index, urbanisation level and lifetime prevalence of depressive and anxiety disorders: a cross-sectional analysis of the Colombian national mental health survey

PubMed Central

Rincon, Carlos Javier; Tamayo Martínez, Nathalie; Rodriguez, Nelcy; Tiemeier, Henning; Mackenbach, Johan P; Gómez-Restrepo, Carlos; Guarnizo-Herreño, Carol C

2018-01-01

Objectives To study socioeconomic inequalities in mental health in rural and urban Colombia, a country with a history of internal conflict and large socioeconomic inequalities. Recent survey data are available to study this understudied topic in a middle-income country. Methods Using data from 9656 respondents from the 2015 Colombian Mental Health survey, we investigated the association between lifetime prevalence of depressive and anxiety disorders and quality of dwellings and access to public services housing score (HS). We calculated the relative index of inequality (RII) and slope index of inequality (SII) for HS in urban and rural areas, adjusting for potential confounders and mediating factors. Outcomes The lifetime prevalence of anxiety and depression (combined) was 9.6% in urban versus 6.9% in rural areas (p<0.001). HS was not associated with prevalence of anxiety and depression in urban settings, whereas a higher HS (poorer housing quality) was associated with fewer mental disorders in rural areas in both univariate and multivariate models (multivariate RIIurban0.96 (95% CI 0.51 to 1.81); RIIrural0.11 (95% CI 0.04 to 0.32)). In rural areas, the prevalence of mental health problems was 12% points lower in persons living in the poorest quality dwellings than in those living in high-quality dwellings (SII −0.12 (95% CI −0.18 to −0.06)). Interestingly, within rural areas, persons living in ‘populated centres’ (small towns, villages) had a higher lifetime prevalence of any mental health disorder (9.8% (95% CI 6.9 to 13.6)) compared with those living in more isolated, dispersed areas (6.0% (95% CI 4.6 to 7.7)). Interpretation In rural Colombia, those living in the poorest houses and in dispersed areas had a lower prevalence of mental health problems. Further understanding of this phenomenon of a seemingly inverse association of prevalence of mental disorders with poverty and/or urbanisation in rural areas is needed. Particularly, considering the progressive urbanisation process in Colombia, it is important to monitor mental health in populations migrating to the cities. PMID:29880561

Widespread inequalities in smoking & smokeless tobacco consumption across wealth quintiles in States of India: Need for targeted interventions

PubMed Central

Thakur, J.S.; Prinja, Shankar; Bhatnagar, Nidhi; Rana, Saroj Kumar; Sinha, Dhirendra Narain; Singh, Poonam Khetarpal

2015-01-01

Background & objectives: India is a large country with each State having distinct social, cultural and economic characteristics. Tobacco epidemic is not uniform across the country. There are wide variations in tobacco consumption across age, sex, regions and socio-economic classes. This study was conducted to understand the wide inequalities in patterns of smoking and smokeless tobacco consumption across various States of India. Methods: Analysis was conducted on Global Adult Tobacco Survey, India (2009-2010) data. Prevalence of both forms of tobacco use and its association with socio-economic determinants was assessed across States and Union Territories of India. Wealth indices were calculated using socio-economic data of the survey. Concentration index of inequality and one way ANOVA assessed economic inequality in tobacco consumption and variation of tobacco consumption across quintiles. Multiple logistic regression was done for tobacco consumption and wealth index adjusting for age, sex, area, education and occupation. Results: Overall prevalence of smoking and smokeless tobacco consumption was 13.9 per cent (14.6, 13.3) and 25.8 per cent (26.6, 25.0), respectively. Prevalence of current smoking varied from 1.6 per cent (richest quintile in Odisha) to 42.2 per cent (poorest quintile in Meghalaya). Prevalence of current smokeless tobacco consumption varied from 1.7 per cent (richest quintile in Jammu and Kashmir) to 59.4 per cent (poorest quintile in Mizoram). Decreasing odds of tobacco consumption with increasing wealth was observed in most of the States. Reverse trend of tobacco consumption was observed in Nagaland. Significant difference in odds of smoking and smokeless tobacco consumption with wealth quintiles was observed. Concentration index of inequality was significant for smoking tobacco -0.7 (-0.62 to-0.78) and not significant for smokeless tobacco consumption -0.15 (0.01to-0.33) Interpretation & conclusions: The findings of our analysis indicate that tobacco control policy and public health interventions need to consider widespread socio-economic inequities in tobacco consumption across the States in India. PMID:26205022

Negative impact on calorie intake associated with the 2006-08 food price crisis in Latin America.

PubMed

Iannotti, Lora; Robles, Miguel

2011-06-01

From 2006 to 2008, there were sharp increases in the prices of major food commodities globally, including maize, rice, and wheat. Few studies have contributed empirical evidence of the nutritional impacts of this food price crisis. To assess changes in energy intake in response to food price shocks and in relation to calorie adequacy levels in seven Latin American countries. Data were drawn from nationally representative household budget surveys. The quadratic almost ideal demand system (QUAIDS) model characterized change patterns in consumption for six food groups and one nonfood group under two scenarios: actual change in food prices by country, and standardized 10% increase in prices across all countries. Energy intakes before and after the crisis were determined once calories were assigned to food items from the ProPAN and US Department of Agriculture food composition databases. Energy intakes were reduced by 8.0% (range, 0.95% to 15.1%) from precrisis levels across all countries. Ecuador and Panama were the worst affected, followed by Haiti and Nicaragua. There was a consistent, direct relationship between wealth quintile and change in energy intake. Rural areas were affected to the same extent as or a greater extent than urban areas. High positive increases in calorie consumption were found in the richest wealth quintile, exceeding 10% of previous levels in five countries. Policies and programs targeting the poorest households in both rural and urban areas may be needed to offset the energy deficits associated with food price increases. More research is needed on the effect of food prices and micronutrient nutrition.

Education and Development in Poor Rural Communities: An Interdisciplinary Research Agenda. ERIC Digest.

ERIC Educational Resources Information Center

Carter, Carolyn S.

More than 30 years after the Great Society initiatives, poverty continues to put large numbers of students at risk of school failure. The challenges to education and life success are most severe for children in the nation's poorest rural counties, the 535 rural persistent poverty (RPP) counties. This digest provides background on RPP counties and…

American Indians and Federal Aid. Brookings Studies in Social Economics.

ERIC Educational Resources Information Center

Sorkin, Alan L.

"American Indians are the poorest of any nonwhite minority in the United States. Life on the reservation offers them few opportunities: if they move to the city, they face problems of adjustment that can prove insurmountable. What is being done--what more could be done--to help Indians satisfy their needs in a largely alien society? To develop the…

Competent Governance for Sustainable Development in Africa: A Philosophical Reflection

ERIC Educational Resources Information Center

Kadenyi, Misia; George, Kegode; Marcella, Mwaka; Kyalo, Wambua B.

2013-01-01

Africa has been known to be the bedrock of numerous natural resources. However, it seems to be the home of the poorest of the poor in the world. Much of the situation is pathetically characterized by hunger, extreme poverty, corruption, and insecurity. All of these offer the greatest compromise to any hope of change. Aware of this scenario,…

Dialectic of control and emancipation in organizing for social change: a multitheoretic study of the Grameen Bank in Bangladesh.

PubMed

Papa, M J; Auwal, M A; Singhal, A

1995-08-01

Dedicated to helping the poorest of the poor obtain the financial means to become productively self-employed, the Grameen Bank in Bangladesh is founded upon the belief that credit is a fundamental human right and that development should be measured according to the per capita income of the bottom 50% of the population. The bank provides collateral-free loans and social services for the poor, charging 20% interest on capital, all the while maintaining a 99% loan recovery rate. The bank has 1.9 million members, 94% of whom are women, and has successfully organized grassroots microenterprises for productive self-employment and social change. The authors use the coorientation, concertive control, and critical feminist theories to analyze the bank's programs in an effort to explain the dialectic between control and emancipation in organizing for social change. Examining the bank's organizational processes from multiple theoretical perspectives allows insights to be drawn about theory and praxis in organizing for social change. The Grameen Bank has effectively demonstrated that development is an organized process of education, environmentally sound productivity, and improvement in the quality of life for the poorest of the poor.

Health system reform and safe abortion: a case study of Mongolia.

PubMed

Beck, Christina; Berry, Nicole S; Choijil, Semjidmaa

2013-01-01

Unsafe abortion serves as a marker of global inequity as it is concentrated in the developing world where the poorest and most vulnerable women live. While liberalisation of abortion law is essential to the reduction of unsafe abortion, a number of challenges exist beyond this important step. This paper investigates how popular health system reforms consonant with neoliberal agendas can challenge access to safe abortion. We use Mongolia, a country that has liberalised abortion law, yet, limited access to safe abortion, as a case study. Mongolia embraced market reforms in 1990 and subsequently reformed its health system. We document how common reforms in the areas of finance and regulation can compromise the safety of abortions as they foster challenges that include inconsistencies in service delivery that further foment health inequities, adoption of reproductive health programmes that are incompatible with the local sociocultural context, unregulated growth of the private sector and poor enforcement of standards and technical guidelines for safe abortion. We then discuss how this case study suggests the conversations that reproductive health policy-makers must have with those engineering health sector reform to ensure access to safe abortion in a liberalised environment.

Spatial access to inpatient health care in northern rural India.

PubMed

Ranga, Vikram; Panda, Pradeep

2014-05-01

Access to health care in rural areas is a major concern for local populations as well as for policy makers in developing countries. This paper examines spatial access to in-patient health care in northern rural India. In order to measure spatial access, impedance-based competition using the Three-Step floating Catchment Area (3SFCA) method, a modification of the simple gravity model, was used. 3SFCA was chosen for the study of the districts of Pratapgarh and Kanpur Dehat in the Uttar Pradesh state and Vaishali in the Bihar state, two of India's poorest states. This approach is based on discrete distance decay and also considers more parameters than other available methods, hence is believed to be a robust methodology. It was found that Vaishali district has the highest spatial access to in-patient health care followed by Pratapgarh and Kanpur Dehat. There is serious lack of health care, in Pratapgarh and Kanpur Dehat with 40% and 90% of the villages having shortage of in-patient care facilities in these respective districts. The most important factor affecting spatial access was found to be the distance to the nearest major urban agglomeration.

Association between economic growth and early childhood undernutrition: evidence from 121 Demographic and Health Surveys from 36 low-income and middle-income countries.

PubMed

Vollmer, Sebastian; Harttgen, Kenneth; Subramanyam, Malavika A; Finlay, Jocelyn; Klasen, Stephan; Subramanian, S V

2014-04-01

Economic growth is widely regarded as a necessary, and often sufficient, condition for the improvement of population health. We aimed to assess whether macroeconomic growth was associated with reductions in early childhood undernutrition in low-income and middle-income countries. We analysed data from 121 Demographic and Health Surveys from 36 countries done between Jan 1, 1990, and Dec 31, 2011. The sample consisted of nationally representative cross-sectional surveys of children aged 0-35 months, and the outcome variables were stunting, underweight, and wasting. The main independent variable was per-head gross domestic product (GDP) in constant prices and adjusted for purchasing power parity. We used logistic regression models to estimate the association between changes in per-head GDP and changes in child undernutrition outcomes. Models were adjusted for country fixed effects, survey-year fixed effects, clustering, and demographic and socioeconomic covariates for the child, mother, and household. Sample sizes were 462,854 for stunting, 485,152 for underweight, and 459,538 for wasting. Overall, 35·6% (95% CI 35·4-35·9) of young children were stunted (ranging from 8·7% [7·6-9·7] in Jordan to 51·1% [49·1-53·1] in Niger), 22·7% (22·5-22·9) were underweight (ranging from 1·8% [1·3-2·3] in Jordan to 41·7% [41·1-42·3] in India), and 12·8% (12·6-12·9) were wasted (ranging from 1·2% [0·6-1·8] in Peru to 28·8% [27·5-30·0] in Burkina Faso). At the country level, no association was seen between average changes in the prevalence of child undernutrition outcomes and average growth of per-head GDP. In models adjusted only for country and survey-year fixed effects, a 5% increase in per-head GDP was associated with an odds ratio (OR) of 0·993 (95% CI 0·989-0·995) for stunting, 0·986 (0·982-0·990) for underweight, and 0·984 (0·981-0·986) for wasting. ORs after adjustment for the full set of covariates were 0·996 (0·993-1·000) for stunting, 0·989 (0·985-0·992) for underweight, and 0·983 (0·979-0·986) for wasting. These findings were consistent across various subsamples and for alternative variable specifications. Notably, no association was seen between per-head GDP and undernutrition in young children from the poorest household wealth quintile. ORs for the poorest wealth quintile were 0·997 (0·990-1·004) for stunting, 0·999 (0·991-1·008) for underweight, and 0·991 (0·978-1·004) for wasting. A quantitatively very small to null association was seen between increases in per-head GDP and reductions in early childhood undernutrition, emphasising the need for direct health investments to improve the nutritional status of children in low-income and middle-income countries. None. Copyright © 2014 Vollmer et al. Open Access article distributed under the terms of CC BY. Published by .. All rights reserved.

Are community midwives addressing the inequities in access to skilled birth attendance in Punjab, Pakistan? Gender, class and social exclusion

PubMed Central

2012-01-01

Background Pakistan is one of the six countries estimated to contribute to over half of all maternal deaths worldwide. To address its high maternal mortality rate, in particular the inequities in access to maternal health care services, the government of Pakistan created a new cadre of community-based midwives (CMW). A key expectation is that the CMWs will improve access to skilled antenatal and intra-partum care for the poor and disadvantaged women. A critical gap in our knowledge is whether this cadre of workers, operating in the private health care context, will meet the expectation to provide care to the poorest and most marginalized women. There is an inherent paradox between the notions of fee-for-service and increasing access to health care for the poorest who, by definition, are unable to pay. Methods/Design Data will be collected in three interlinked modules. Module 1 will consist of a population-based survey in the catchment areas of the CMW’s in districts Jhelum and Layyah in Punjab. Proportions of socially excluded women who are served by CMWs and their satisfaction levels with their maternity care provider will be assessed. Module 2 will explore, using an institutional ethnographic approach, the challenges (organizational, social, financial) that CMWs face in providing care to the poor and socially marginalized women. Module 3 will identify the social, financial, geographical and other barriers to uncover the hidden forces and power relations that shape the choices and opportunities of poor and marginalized women in accessing CMW services. An extensive knowledge dissemination plan will facilitate uptake of research findings to inform positive developments in maternal health policy, service design and care delivery in Pakistan. Discussion The findings of this study will enhance understanding of the power dynamics of gender and class that may underlie poor women’s marginalization from health care systems, including community midwifery care. One key outcome will be an increased sensitization of the special needs of socially excluded women, an otherwise invisible group. Another expectation is that the poor, socially excluded women will be targeted for provision of maternity care. The research will support the achievement of the 5th Millennium Development Goal in Pakistan. PMID:22992347

An equity dashboard to monitor vaccination coverage

PubMed Central

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

2017-01-01

Abstract Equity monitoring is a priority for Gavi, the Vaccine Alliance, and for those implementing The 2030 agenda for sustainable development. For its new phase of operations, Gavi reassessed its approach to monitoring equity in vaccination coverage. To help inform this effort, we made a systematic analysis of inequalities in vaccination coverage across 45 Gavi-supported countries and compared results from different measurement approaches. Based on our findings, we formulated recommendations for Gavi’s equity monitoring approach. The approach involved defining the vulnerable populations, choosing appropriate measures to quantify inequalities, and defining equity benchmarks that reflect the ambitions of the sustainable development agenda. In this article, we explain the rationale for the recommendations and for the development of an improved equity monitoring tool. Gavi’s previous approach to measuring equity was the difference in vaccination coverage between a country’s richest and poorest wealth quintiles. In addition to the wealth index, we recommend monitoring other dimensions of vulnerability (maternal education, place of residence, child sex and the multidimensional poverty index). For dimensions with multiple subgroups, measures of inequality that consider information on all subgroups should be used. We also recommend that both absolute and relative measures of inequality be tracked over time. Finally, we propose that equity benchmarks target complete elimination of inequalities. To facilitate equity monitoring, we recommend the use of a data display tool – the equity dashboard – to support decision-making in the sustainable development period. We highlight its key advantages using data from Côte d’Ivoire and Haiti. PMID:28250513

Globalization and local response to epidemiological overlap in 21st century Ecuador

PubMed Central

Waters, William F

2006-01-01

Background Third World countries are confronted by a complex overlay of two sets of health problems. Traditional maladies, including communicable diseases, malnutrition, and environmental health hazards coexist with emerging health challenges, including cardiovascular disease, cancer, and increasing levels of obesity. Using Ecuador as an example, this paper proposes a conceptual framework for linking epidemiologic overlap to emerging social structures and processes at the national and global levels. Discussion Epidemiologic trends can be seen as part of broader processes related to globalization, but this does not imply that globalization is a monolithic force that inevitably and uniformly affects nations, communities, and households in the same manner. Rather, characteristics and forms of social organization at the subnational level can shape the way that globalization takes place. Thus, globalization has affected Ecuador in specific ways and is, at the same time, intimately related to the form in which the epidemiologic transition has transpired in that country. Summary Ecuador is among neither the poorest nor the wealthiest countries and its situation may illuminate trends in other parts of the world. As in other countries, insertion into the global economy has not taken place in a vacuum; rather, Ecuador has experienced unprecedented social and demographic change in the past several decades, producing profound transformation in its social structure. Examples of local represent alternatives to centralized health systems that do not effectively address the complex overlay of traditional and emerging health problems. PMID:16712722

Does equity in healthcare spending exist among Indian states? Explaining regional variations from national sample survey data.

PubMed

Dwivedi, Rinshu; Pradhan, Jalandhar

2017-01-14

Equity and justice in healthcare payment form an integral part of health policy and planning. In the majority of low and middle-income countries (LMICs), healthcare inequalities are further aggravated by Out of Pocket Expenditure (OOPE). This paper examines the pattern of health equity and regional disparities in healthcare spending among Indian states by applying Andersen's behavioural model of healthcare utilization. The present study uses data from the 66 th quinquennial round of Consumer Expenditure Survey, of the National Sample Survey Organization (NSSO), conducted in 2009-10 by Ministry of Statistics and Programme Implementation (MoSPI), Government of India (GoI). To measure equity and regional disparities in healthcare expenditure, states have been categorized under three heads on the basis of monthly OOPE i.e., Category A (OOPE > =INR 100); Category B (OOPE between INR 50 to 99) and Category C (OOPE < INR 50). Multiple Generalised Linear Regression Model (GLRM) has been employed to explore the effect of various socio-economic covariates on the level of OOPE. The gap in the ratio of average healthcare spending between the poorest and richest households was maximum in Category A states (richest/poorest = 14.60), followed by Category B (richest/poorest 11.70) and Category C (richest/poorest 11.40). Results also indicate geographical concentration of lower level healthcare spending among Indian states (e.g., Odisha, Chhattisgarh and all the north-eastern states). Results from the multivariate analysis suggest that people residing in urban areas, having higher economic status, belonging to non-Muslim communities, non-Scheduled Tribes (STs), and non-poor households spend more on healthcare than their counterparts. In spite of various efforts by the government to reduce the burden of healthcare spending, widespread inequalities in healthcare expenditure are prevalent. Households with high healthcare needs (SCs/STs, and the poor) are in a more disadvantaged position in terms of spending on health care. It has also been observed that spending on healthcare was comparatively lower among backward or isolated states. No doubt, the overall social security measures should be enhanced, but at the same time, looking at the regional differences, more priority should be assigned to the disadvantaged states to reduce the burden of OOPE. It is proposed that there is need to increase government spending, especially for the disadvantaged states and population, to minimise the burden of OOPE.

Determinants of community health fund membership in Tanzania: a mixed methods analysis.

PubMed

Macha, Jane; Kuwawenaruwa, August; Makawia, Suzan; Mtei, Gemini; Borghi, Josephine

2014-11-20

In many developing countries, initiatives are underway to strengthen voluntary community based health insurance as a means of expanding access to affordable care among the informal sector. However, increasing coverage with voluntary health insurance in low income settings can prove challenging. There are limited studies on determinants of enrolling in these schemes using mixed methods. This study aims to shed light on the characteristics of those joining a community health fund, a type of community based health insurance, in Tanzania and the reasons for their membership and subsequent drop out using mixed methods. A cross sectional survey of households in four rural districts was conducted in 2008, covering a total of 1,225 (524 members of CHF and 701 non-insured) households and 7,959 individuals. In addition, 12 focus group discussions were carried out with CHF members, non-scheme members and members of health facility governing committees in two rural districts. Logistic regression was used to assess the determinants of CHF membership while thematic analysis was done to analyse qualitative data. The quantitative analysis revealed that the three middle income quintiles were more likely to enrol in the CHF than the poorest and the richest. CHF member households were more likely to be large, and headed by a male than uninsured households from the same areas. The qualitative data supported the finding that the poor rather than the poorest were more likely to join as were large families and of greater risk of illness, with disabilities or persons with chronic diseases. Households with elderly members or children under-five years were also more likely to enrol. Poor understanding of risk pooling deterred people from joining the scheme and was the main reason for not renewing membership. On the supply side, poor quality of public care services, the limited benefit package and a lack of provider choice were the main factors for low enrolment. Determinants of CHF membership are diverse and improving the quality of health services and expanding the benefit package should be prioritised to expand voluntary health insurance coverage.

A global health partnership's use of time-limited support to catalyze health practice change: the case of GAVI's Injection Safety Support.

PubMed

Levin, Ann; Fang, Arnold; Hansen, Peter M; Pyle, David; Dia, Ousmane; Schwalbe, Nina

2010-09-27

This paper presents the findings of a study to assess the effectiveness and sustainability of a GAVI (Global Alliance of Vaccines and Immunization) sponsored, time-limited Injection Safety (INS) support. The support came in two forms: 1) in-kind, in the form of AD syringes and safety boxes, and 2) in cash, for those countries that already had a secure, multi-year source of AD syringes and safety boxes, but proposed to use INS support to strengthen their injection safety activities. In total, GAVI gave INS support for a three-year period to 58 countries: 46 with commodities and 12 with cash support. To identify variables that might be associated with financial sustainability, frequencies and cross-tabulations were run against various programmatic and socio-economic variables in the 58 countries. All but two of the 46 commodity-recipient countries were able to replace and sustain the use of AD syringes and safety boxes after the end of their GAVI INS support despite the fact that standard disposable syringes are less costly than ADs (10-15 percent differential). In addition, all 12 cash-recipient countries continued to use AD syringes and safety boxes in their immunization programs in the years following GAVI INS assistance. At the same time, countries were often not prepared for the increased waste management requirements associated with the use of the syringes, suggesting the importance of anticipating challenges with the introduction of new technologies. The sustained use of AD syringes in countries receiving injection safety support from GAVI, in a majority of cases through government financing, following the completion of three years of time-limited support, represents an early indication of how GHPs can contribute to improved health outcomes in immunization safety in the world's poorest countries in a sustainable way.

An Update on the United Nations Millennium Development Goals.

PubMed

Campbell, Della Anne

The United Nations Millennium Development Goals initiative, designed to meet the needs of the world's poorest, ended in 2015. The purpose of this article is to describe the progress made through the Millennium Development Goals and the additional work needed to address vulnerable populations worldwide, especially women and children. A description of the subsequent Sustainable Development Goals, enacted to address the root causes of poverty and the universal need for development for all people, is provided. Copyright © 2017 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

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

Van Aalst, M.

Climate change is already taking place, and further changes are inevitable. Developing countries, and particularly the poorest people in these countries, are most at risk. The impacts result not only from gradual changes in temperature and sea level but also, in particular, from increased climate variability and extremes, including more intense floods, droughts, and storms. These changes are already having major impacts on the economic performance of developing countries and on the lives and livelihoods of millions of poor people around the world. Climate change thus directly affects the World Bank Group's mission of eradicating poverty. It also puts atmore » risk many projects in a wide range of sectors, including infrastructure, agriculture, human health, water resources, and environment. The risks include physical threats to the investments, potential underperformance, and the possibility that projects will indirectly contribute to rising vulnerability by, for example, triggering investment and settlement in high-risk areas. The way to address these concerns is not to separate climate change adaptation from other priorities but to integrate comprehensive climate risk management into development planning, programs, and projects. While there is a great need to heighten awareness of climate risk in Bank work, a large body of experience on climate risk management is already available, in analytical work, in country dialogues, and in a growing number of investment projects. This operational experience highlights the general ingredients for successful integration of climate risk management into the mainstream development agenda: getting the right sectoral departments and senior policy makers involved; incorporating risk management into economic planning; engaging a wide range of nongovernmental actors (businesses, nongovernmental organizations, communities, and so on); giving attention to regulatory issues; and choosing strategies that will pay off immediately under current climate conditions. There are several ways in which the World Bank Group can continue helping its clients better manage climate risks to poverty reduction and sustainable development: Integrating climate risk management into the project cycle, by adopting early risk identification (for instance by applying a quick and simple risk-screening tool) and following up throughout the design process if necessary. Integrating climate risk management into country and sector dialogues, especially in countries and sectors that are particularly vulnerable. Enhancing internal support for and coordination of climate risk management by, for example, expanding analytical work and capacity for cross-support by the Global Climate Change Team and the Hazard Management Unit of the World Bank and by actively developing climate risk management activities within regional departments. Supporting the establishment of proper financing mechanisms for adaptation, using, for example, the Investment Framework for Clean Energy and Development. New funding mechanisms created under the United Nations Framework Convention on Climate Change (UNFCCC) and being made operational by the Global Environment Facility (GEF), as well as the Kyoto Protocol, should be used to leverage maximum adaptation results within the Bank's broad range of development activities and investments. By enhancing climate risk management, the World Bank Group will be able to address the growing risks from climate change and, at the same time, make current development investments more resilient to climate variability and extreme weather events. In that way, climate risk management will not only guard the Bank's investments in a changing climate but will also improve the impact of development efforts right now.« less

A new face for private providers in developing countries: what implications for public health?

PubMed

Palmer, Natasha; Mills, Anne; Wadee, Haroon; Gilson, Lucy; Schneider, Helen

2003-01-01

The use of private health care providers in low- and middle-income countries (LMICs) is widespread and is the subject of considerable debate. We review here a new model of private primary care provision emerging in South Africa, in which commercial companies provide standardized primary care services at relatively low cost. The structure and operation of one such company is described, and features of service delivery are compared with the most probable alternatives: a private general practitioner or a public sector clinic. In a case study of cost and quality of services, the clinics were popular with service users and run at a cost per visit comparable to public sector primary care clinics. However, their current role in tackling important public health problems was limited. The implications for public health policy of the emergence of this new model of private provider are discussed. It is argued that encouraging the use of such clinics by those who can afford to pay for them might not help to improve care available for the poorest population groups, which are an important priority for the government. Encouraging such providers to compete for government funding could, however, be desirable if the range of services presently offered, and those able to access them, could be broadened. However, the constraints to implementing such a system successfully are notable, and these are acknowledged. Even without such contractual arrangements, these companies provide an important lesson to the public sector that acceptability of services to users and low-cost service delivery are not incompatible objectives.

A new face for private providers in developing countries: what implications for public health?

PubMed Central

Palmer, Natasha; Mills, Anne; Wadee, Haroon; Gilson, Lucy; Schneider, Helen

2003-01-01

The use of private health care providers in low- and middle-income countries (LMICs) is widespread and is the subject of considerable debate. We review here a new model of private primary care provision emerging in South Africa, in which commercial companies provide standardized primary care services at relatively low cost. The structure and operation of one such company is described, and features of service delivery are compared with the most probable alternatives: a private general practitioner or a public sector clinic. In a case study of cost and quality of services, the clinics were popular with service users and run at a cost per visit comparable to public sector primary care clinics. However, their current role in tackling important public health problems was limited. The implications for public health policy of the emergence of this new model of private provider are discussed. It is argued that encouraging the use of such clinics by those who can afford to pay for them might not help to improve care available for the poorest population groups, which are an important priority for the government. Encouraging such providers to compete for government funding could, however, be desirable if the range of services presently offered, and those able to access them, could be broadened. However, the constraints to implementing such a system successfully are notable, and these are acknowledged. Even without such contractual arrangements, these companies provide an important lesson to the public sector that acceptability of services to users and low-cost service delivery are not incompatible objectives. PMID:12764496

Optimizing community case management strategies to achieve equitable reduction of childhood pneumonia mortality: An application of Equitable Impact Sensitive Tool (EQUIST) in five low- and middle-income countries.

PubMed

Waters, Donald; Theodoratou, Evropi; Campbell, Harry; Rudan, Igor; Chopra, Mickey

2012-12-01

The aim of this study was to populate the Equitable Impact Sensitive Tool (EQUIST) framework with all necessary data and conduct the first implementation of EQUIST in studying cost-effectiveness of community case management of childhood pneumonia in 5 low- and middle-income countries with relation to equity impact. Wealth quintile-specific data were gathered or modelled for all contributory determinants of the EQUIST framework, namely: under-five mortality rate, cost of intervention, intervention effectiveness, current coverage of intervention and relative disease distribution. These were then combined statistically to calculate the final outcome of the EQUIST model for community case management of childhood pneumonia: US$ per life saved, in several different approaches to scaling-up. The current 'mainstream' approach to scaling-up of interventions is never the most cost-effective. Community-case management appears to strongly support an 'equity-promoting' approach to scaling-up, displaying the highest levels of cost-effectiveness in interventions targeted at the poorest quintile of each study country, although absolute cost differences vary by context. The relationship between cost-effectiveness and equity impact is complex, with many determinants to consider. One important way to increase intervention cost-effectiveness in poorer quintiles is to improve the efficiency and quality of delivery. More data are needed in all areas to increase the accuracy of EQUIST-based estimates.

The association of minimum wage change on child nutritional status in LMICs: A quasi-experimental multi-country study.

PubMed

Ponce, Ninez; Shimkhada, Riti; Raub, Amy; Daoud, Adel; Nandi, Arijit; Richter, Linda; Heymann, Jody

2017-08-02

There is recognition that social protection policies such as raising the minimum wage can favourably impact health, but little evidence links minimum wage increases to child health outcomes. We used multi-year data (2003-2012) on national minimum wages linked to individual-level data from the Demographic and Health Surveys (DHS) from 23 low- and middle-income countries (LMICs) that had least two DHS surveys to establish pre- and post-observation periods. Over a pre- and post-interval ranging from 4 to 8 years, we examined minimum wage growth and four nutritional status outcomes among children under 5 years: stunting, wasting, underweight, and anthropometric failure. Using a differences-in-differences framework with country and time-fixed effects, a 10% increase in minimum wage growth over time was associated with a 0.5 percentage point decline in stunting (-0.054, 95% CI (-0.084,-0.025)), and a 0.3 percentage point decline in failure (-0.031, 95% CI (-0.057,-0.005)). We did not observe statistically significant associations between minimum wage growth and underweight or wasting. We found similar results for the poorest households working in non-agricultural and non-professional jobs, where minimum wage growth may have the most leverage. Modest increases in minimum wage over a 4- to 8-year period might be effective in reducing child undernutrition in LMICs.

Assessing long-term water demand of constantine province in Kébir-Rhumel Mediterranean catchment

NASA Astrophysics Data System (ADS)

Kiniouar, H.; Hani, A.; Younsi, A.

2017-02-01

By mid-century, in the southern Mediterranean countries, levies probably reach the limit level of renewable water resources. Algeria is one of the poorest countries in renewable water resources, with an annual storage capacity of 14.6 million m3 in the Mediterranean coastal watersheds, representing 7% of the land area and accounts for 90 % of total surface runoff of the country. In this paper, we assess water demand to meet the needs of water users in Constantine province. The latter is located in the Kébir-Rhumel Mediterranean basin under semi-arid climate with relatively high growth rate of population, agricultural and industrial activities. Using Water Evaluation And Planning system (WEAP), we built a model for managing water demand of Constantine province. A business as usual and five scenarii of «water demand " were calculated by WEAP model to simulate the uncertainties over the period of 20 years (2008-2027) : (1) Population growth, (2) increase in irrigated crop lands, (3) decrease in basic drinking water consumption, (4) decrease in basic irrigation water consumption and (5) increase in basic industrial water consumption. The results showed that scenario 3 is the best alternative scenario and the most efficient by reducing drinking water demand for about 12 Mm3 in 20 years, and thus preserve reaching the limits of water resources potentialities.

eC3—A Modern Telecommunications Matrix for Cervical Cancer Prevention in Zambia

PubMed Central

Parham, Groesbeck P.; Mwanahamuntu, Mulindi H.; Pfaendler, Krista S.; Sahasrabuddhe, Vikrant V.; Myung, Daniel; Mkumba, Gracilia; Kapambwe, Sharon; Mwanza, Bianca; Chibwesha, Carla; Hicks, Michael L.; Stringer, Jeffrey S.A.

2013-01-01

Objectives Low physician density, undercapacitated laboratory infrastructures, and limited resources are major limitations to the development and implementation of widely accessible cervical cancer prevention programs in sub-Saharan Africa. Materials and Methods We developed a system operated by nonphysician health providers that used widely available and affordable communication technology to create locally adaptable and sustainable public sector cervical cancer prevention program in Zambia, one of the world’s poorest countries. Results Nurses were trained to perform visual inspection with acetic acid aided by digital cervicography using predefined criteria. Electronic digital images (cervigrams) were reviewed with patients, and distance consultation was sought as necessary. Same-visit cryotherapy or referral for further evaluation by a gynecologist was offered. The Zambian system of “electronic cervical cancer control” bypasses many of the historic barriers to the delivery of preventive health care to women in low-resource environments while facilitating monitoring, evaluation, and continued education of primary health care providers, patient education, and medical records documentation. Conclusions The electronic cervical cancer control system uses appropriate technology to bridge the gap between screening and diagnosis, thereby facilitating the conduct of “screen-and-treat” programs. The inherent flexibility of the system lends itself to the integration with future infrastructures using rapid molecular human papillomavirus–based screening approaches and wireless telemedicine communications. PMID:20592550

Socioeconomic inequality in preterm birth in four Brazilian birth cohort studies.

PubMed

Sadovsky, Ana Daniela Izoton de; Matijasevich, Alicia; Santos, Iná S; Barros, Fernando C; Miranda, Angelica Espinosa; Silveira, Mariangela Freitas

To analyze economic inequality (absolute and relative) due to family income in relation to the occurrence of preterm births in Southern Brazil. Four birth cohort studies were conducted in the years 1982, 1993, 2004, and 2011. The main exposure was monthly family income and the primary outcome was preterm birth. The inequalities were calculated using the slope index of inequality and the relative index of inequality, adjusted for maternal skin color, education, age, and marital status. The prevalence of preterm births increased from 5.8% to approximately 14% (p-trend<0.001). Late preterm births comprised the highest proportion among the preterm births in all studies, although their rates decreased over the years. The analysis on the slope index of inequality demonstrated that income inequality arose in the 1993, 2004, and 2011 studies. After adjustment, only the 2004 study maintained the difference between the poorest and the richest subjects, which was 6.3 percentage points. The relative index of inequality showed that, in all studies, the poorest mothers were more likely to have preterm newborns than the richest. After adjustment for confounding factors, it was observed that the poorest mothers only had a greater chance of this outcome in 2004. In a final model, economic inequalities resulting from income were found in relation to preterm births only in 2004, although a higher prevalence of prematurity continued to be observed in the poorest population, in all the studies. Copyright © 2017 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

Mozambique's Debt and the International Monetary Fund's Influence on Poverty, Education, and Health.

PubMed

Beste, Jason; Pfeiffer, James

2016-01-01

For nearly 30 years, Mozambique has been facing austerity measures regulated by the IMF. These austerity measures, grounded in macroeconomic policies, were supposed to lift Mozambique out of poverty, and improve its healthcare and education systems. By taking an in-depth look at the major etiologies of Mozambique's debt and the conditions which forced the country to accept austerity measures-despite their protests-prior to receiving IMF funding, this paper examines how IMF policies over the past 30 years have affected poverty, health, and the education system. The results of these policies have contributed to Mozambique's enduring classification as one of the poorest countries in the world. Aside from economic outcomes, Mozambique also has abysmal health and education systems, with one of the lowest life expectancies in Sub-Saharan Africa. It is time to re-evaluate how the current IMF macroeconomic policies negatively affect, health, education and the socioeconomic status of those who live in abject poverty. As short term macroeconomic policies of PARPA have been ineffective at reducing poverty, promoting education and improving health, the IMF should consider using longer term macroeconomic policies which invest in-rather than limit-public services such as health and education. © The Author(s) 2016.

Cutaneous leishmaniasis in Syria: clinical features, current status and the effects of war.

PubMed

Hayani, Kinan; Dandashli, Anwar; Weisshaar, Elke

2015-01-01

Cutaneous leishmaniasis (CL) is a worldwide disease caused by an infection with the protozoan parasite Leishmania transmitted via sand flies. It is endemic in many of the poorest countries of all continents. "Aleppo boil" is one of the recognised names given to this disease in the medical literature. Although CL used to be well-controlled and well-documented in Syria, its incidence has dramatically increased since the beginning of the war; however, there is lack of documentation. Here, we present the past and current epidemiological situation of the disease in Syria. We also draw attention to gross and highly unusual clinical variants of CL presented to the Department of Dermatology in Aleppo covering the important differential clinical diagnoses, since this disease is already known to mimic other conditions. Diagnostic procedures and treatment as well as prevention are summarised. Due to the increased ability to travel, and especially the flight of Syrians to neighbouring countries, as well as to Europe, CL may become a new threat in formerly unaffected regions. Through this account, we hope to give weight to the aspiration that CL does not remain a neglected and often clinically overlooked tropical dermatosis.

Struggle against injustice.

PubMed

Martin, J

1992-09-01

For more than a decade, striving to implement equitable health systems has been fundamental to improving the health of populations, yet in the poorer countries of the world, things age getting worse in terms of people's health and access to health care. An estimated 1600 women die every day from complications of pregnancy or childbirth, since less than 20% of deliveries take place under the supervision of trained personnel compared to 99% in industrialized countries. In africa south of the Sahara, 100 million clinical cases of malaria are reported every year resulting in close to 1 million deaths. The problem is worse than it was 10 years ago. The resources, money, and political will to tackle prevention and control are lacking. For the first time this century, a cholera epidemic broke out in Peru with almost 250,000 cases in the first 6 months of 1991. 12 African countries also suffered serious outbreaks with case-fatality rates of 10-12%. In almost all countries of the world, the gap between the rich and the very poor continues to grow. In the USA, it is estimated that 1/4 of the population does not have proper access to health care owing to the rising costs of health insurance. The false impression that health is the exclusive concern of medical workers has been encouraged by the health professions for decades. Most countries do not recognize the needs of the poorest groups in their societies. It is necessary to encourage and teach people to prevent disease by promoting good health practices, to care for the sick and dying, and to exert pressure to win commitment and action on behalf of those in need.

Accomplishing reform: successful case studies drawn from the health systems of 60 countries.

PubMed

Braithwaite, Jeffrey; Mannion, Russell; Matsuyama, Yukihiro; Shekelle, Paul; Whittaker, Stuart; Al-Adawi, Samir; Ludlow, Kristiana; James, Wendy; Ting, Hsuen P; Herkes, Jessica; Ellis, Louise A; Churruca, Kate; Nicklin, Wendy; Hughes, Clifford

2017-10-01

Healthcare reform typically involves orchestrating a policy change, mediated through some form of operational, systems, financial, process or practice intervention. The aim is to improve the ways in which care is delivered to patients. In our book 'Health Systems Improvement Across the Globe: Success Stories from 60 Countries', we gathered case-study accomplishments from 60 countries. A unique feature of the collection is the diversity of included countries, from the wealthiest and most politically stable such as Japan, Qatar and Canada, to some of the poorest, most densely populated or politically challenged, including Afghanistan, Guinea and Nigeria. Despite constraints faced by health reformers everywhere, every country was able to share a story of accomplishment-defining how their case example was managed, what services were affected and ultimately how patients, staff, or the system overall, benefited. The reform themes ranged from those relating to policy, care coverage and governance; to quality, standards, accreditation and regulation; to the organization of care; to safety, workforce and resources; to technology and IT; through to practical ways in which stakeholders forged collaborations and partnerships to achieve mutual aims. Common factors linked to success included the 'acorn-to-oak tree' principle (a small scale initiative can lead to system-wide reforms); the 'data-to-information-to-intelligence' principle (the role of IT and data are becoming more critical for delivering efficient and appropriate care, but must be converted into useful intelligence); the 'many-hands' principle (concerted action between stakeholders is key); and the 'patient-as-the-pre-eminent-player' principle (placing patients at the centre of reform designs is critical for success). © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care.

Prevalence and risk factors for metabolic syndrome in Asian Indians: A community study from urban Eastern India.

PubMed

Prasad, D S; Kabir, Z; Dash, A K; Das, B C

2012-07-01

To determine the prevalence of metabolic syndrome and to identify predictors for the same, specific to an underdeveloped urban locale of Eastern India. Population-based cross-sectional study, with multistage random sampling technique. Urban city-dwellers in Orissa one of the poorest states of Eastern India bordering a prosperous state of Andhra Pradesh of Southern India. 1178 adults of age 20-80 years randomly selected from 37 electoral wards of the urban city. Definition of Metabolic Syndrome: We followed a unified definition of the metabolic syndrome by joint interim statement of five major scientific organizations - the International Diabetes Federation, the National Heart, Lung, and Blood Institute, the American Heart Association, the World Heart Federation, the International Atherosclerosis Society, and the International Association of the Study of Obesity. Individuals who meet at least three of five clinical criteria of abdominal obesity, hypertriglyceredimia, low HDL, hypertension, and hyperglycemia are diagnosed as having the condition; presence of none of these criteria is mandatory. Explicit cut points are defined for all criteria, except elevated waist circumference, which must rely on population and country-specific definitions. Prevalence and significant predictors of metabolic syndrome. Both descriptive and multivariable logistic regression analyses. Age-standardized prevalence rates of metabolic syndrome were 33.5% overall, 24.9 % in males and 42.3% in females. Older age, female gender, general obesity, inadequate fruit intake, hypercholesterolemia, and middle-to-high socioeconomic status significantly contributed to increased risk of metabolic syndrome. Metabolic syndrome is a significant public health problem even in one of the poorest states of India that needs to be tackled with proven strategies.

Poverty and Blindness in Nigeria: Results from the National Survey of Blindness and Visual Impairment.

PubMed

Tafida, A; Kyari, F; Abdull, M M; Sivasubramaniam, S; Murthy, G V S; Kana, I; Gilbert, Clare E

2015-01-01

Poverty can be a cause and consequence of blindness. Some causes only affect the poorest communities (e.g. trachoma), and poor individuals are less likely to access services. In low income countries, cataract blind adults have been shown to be less economically active, indicating that blindness can exacerbate poverty. This study aims to explore associations between poverty and blindness using national survey data from Nigeria. Participants ≥40 years were examined in 305 clusters (2005-2007). Sociodemographic information, including literacy and occupation, was obtained by interview. Presenting visual acuity (PVA) was assessed using a reduced tumbling E LogMAR chart. Full ocular examination was undertaken by experienced ophthalmologists on all with PVA <6/12 in either eye. Causes of vision loss were determined using World Health Organization guidelines. Households were categorized into three levels of poverty based on literacy and occupation at household level. A total of 569/13,591 participants were blind (PVA <3/60, better eye; prevalence 4.2%, 95% confidence interval [CI] 3.8-4.6%). Prevalences of blindness were 8.5% (95% CI 7.7-9.5%), 2.5% (95% CI 2.0-3.1%), and 1.5% (95% CI 1.2-2.0%) in poorest, medium and affluent households, respectively (p = 0.001). Cause-specific prevalences of blindness from cataract, glaucoma, uncorrected aphakia and corneal opacities were significantly higher in poorer households. Cataract surgical coverage was low (37.2%), being lowest in females in poor households (25.3%). Spectacle coverage was 3 times lower in poor than affluent households (2.4% vs. 7.5%). In Nigeria, blindness is associated with poverty, in part reflecting lower access to services. Reducing avoidable causes will not be achieved unless access to services improves, particularly for the poor and women.

An extended cost-effectiveness analysis of schizophrenia treatment in India under universal public finance.

PubMed

Raykar, Neha; Nigam, Aditi; Chisholm, Dan

2016-01-01

Schizophrenia remains a priority condition in mental health policy and service development because of its early onset, severity and consequences for affected individuals and households. This paper reports on an 'extended' cost-effectiveness analysis (ECEA) for schizophrenia treatment in India, which seeks to evaluate through a modeling approach not only the costs and health effects of intervention but also the consequences of a policy of universal public finance (UPF) on health and financial outcomes across income quintiles. Using plausible values for input parameters, we conclude that health gains from UPF are concentrated among the poorest, whereas the non-health gains in the form of out-of-pocket private expenditures averted due to UPF are concentrated among the richest income quintiles. Value of insurance is the highest for the poorest quintile and declines with income. Universal public finance can play a crucial role in ameliorating the adverse economic and social consequences of schizophrenia and its treatment in resource-constrained settings where health insurance coverage is generally poor. This paper shows the potential distributional and financial risk protection effects of treating schizophrenia.

Politics and health in eight European countries: a comparative study of mortality decline under social democracies and right-wing governments.

PubMed

Granados, José A Tapia

2010-09-01

Recent publications have argued that the welfare state is an important determinant of population health, and that social democracy in office and higher levels of health expenditure promote health progress. In the period 1950-2000, Greece, Portugal, and Spain were the poorest market economies in Europe, with a fragmented system of welfare provision, and many years of military or authoritarian right-wing regimes. In contrast, the five Nordic countries were the richest market economies in Europe, governed mostly by center or center-left coalitions often including the social democratic parties, and having a generous and universal welfare state. In spite of the socioeconomic and political differences, and a large gap between the five Nordic and the three southern nations in levels of health in 1950, population health indicators converged among these eight countries. Mean decadal gains in longevity of Portugal and Spain between 1950 and 2000 were almost three times greater than gains in Denmark, and about twice as great as those in Iceland, Norway and Sweden during the same period. All this raises serious doubts regarding the hypothesis that the political regime, the political party in office, the level of health care spending, and the type of welfare state exert major influences on population health. Either these factors are not major determinants of mortality decline, or their impact on population health in Nordic countries was more than offset by other health-promoting factors present in Southern Europe. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

Estimated economic impact of vaccinations in 73 low- and middle-income countries, 2001-2020.

PubMed

Ozawa, Sachiko; Clark, Samantha; Portnoy, Allison; Grewal, Simrun; Stack, Meghan L; Sinha, Anushua; Mirelman, Andrew; Franklin, Heather; Friberg, Ingrid K; Tam, Yvonne; Walker, Neff; Clark, Andrew; Ferrari, Matthew; Suraratdecha, Chutima; Sweet, Steven; Goldie, Sue J; Garske, Tini; Li, Michelle; Hansen, Peter M; Johnson, Hope L; Walker, Damian

2017-09-01

To estimate the economic impact likely to be achieved by efforts to vaccinate against 10 vaccine-preventable diseases between 2001 and 2020 in 73 low- and middle-income countries largely supported by Gavi, the Vaccine Alliance. We used health impact models to estimate the economic impact of achieving forecasted coverages for vaccination against Haemophilus influenzae type b, hepatitis B, human papillomavirus, Japanese encephalitis, measles, Neisseria meningitidis serogroup A, rotavirus, rubella, Streptococcus pneumoniae and yellow fever. In comparison with no vaccination, we modelled the costs - expressed in 2010 United States dollars (US$) - of averted treatment, transportation costs, productivity losses of caregivers and productivity losses due to disability and death. We used the value-of-a-life-year method to estimate the broader economic and social value of living longer, in better health, as a result of immunization. We estimated that, in the 73 countries, vaccinations given between 2001 and 2020 will avert over 20 million deaths and save US$ 350 billion in cost of illness. The deaths and disability prevented by vaccinations given during the two decades will result in estimated lifelong productivity gains totalling US$ 330 billion and US$ 9 billion, respectively. Over the lifetimes of the vaccinated cohorts, the same vaccinations will save an estimated US$ 5 billion in treatment costs. The broader economic and social value of these vaccinations is estimated at US$ 820 billion. By preventing significant costs and potentially increasing economic productivity among some of the world's poorest countries, the impact of immunization goes well beyond health.

Low use of contraception among poor women in Africa: an equity issue

PubMed Central

Gillespie, Duff; Karklins, Sabrina; Tsui, Amy O

2011-01-01

Abstract Objective To examine the use of contraception in 13 countries in sub-Saharan Africa; to assess changes in met need for contraception associated with wealth-related inequity; and to describe the relationship between the use of long-term versus short-term contraceptive methods and a woman’s fertility intentions and household wealth. Methods The analysis was conducted with Demographic and Health Survey data from 13 sub-Saharan African countries. Wealth-related inequities in the use of contraception were calculated using household wealth and concentration indices. Logistic regression models were fitted for the likelihood of using a long-term contraceptive method, with adjustments for: wealth index quintile, fertility intentions (to space births versus to stop childbearing), residence (urban/rural), education, number of living children, marital status and survey year. Findings The use of contraception has increased substantially between surveys in Ethiopia, Madagascar, Mozambique, Namibia and Zambia but has declined slightly in Kenya, Senegal and Uganda. Wealth-related inequalities in the met need for contraception have decreased in most countries and especially so in Mozambique, but they have increased in Kenya, Uganda and Zambia with regard to spacing births, and in Malawi, Senegal, Uganda, the United Republic of Tanzania and Zambia with regard to limiting childbearing. After adjustment for fertility intention, women in the richest wealth quintile were more likely than those in the poorest quintile to practice long-term contraception. Conclusion Family planning programmes in sub-Saharan Africa show varying success in reaching all social segments, but inequities persist in all countries. PMID:21479090

Availability, prices and affordability of essential medicines in Haiti

PubMed Central

Chahal, Harinder Singh; St. Fort, Nazaire; Bero, Lisa

2013-01-01

Background Haiti is the poorest country in the Western Hemisphere and faces numerous challenges, including inadequate medication access for its residents. The objective of this study was to determine the availability, prices, and affordability of essential medicines in Haiti and compare these findings to other countries. Methods We conducted a cross–sectional nationwide survey in 2011 of availability and consumer prices of 60 essential medicines in Haiti using a standardized methodology developed by the World Health Organization and Health Action International. The survey was conducted in 163 medicine outlets in four health care sectors (public, retail, nonprofit and mixed sectors). Medicine prices were expressed as ratios relative to the International Reference Price. Affordability was calculated by comparing the costs of treatment for common conditions with the salary of the lowest paid government worker and was compared to available data from four Latin American countries. Results For generic medicines, the availability in public, retail, nonprofit and mixed sectors was 20%, 37%, 24% and 23% of medications, respectively. Most of the available medicines were priced higher than the International Reference Price. The lowest paid government worker would need 2.5 days’ wages to treat an adult respiratory infection with generic medicines from the public sector. For treatment of common conditions with originator brands (OB) purchased from a retail pharmacy, costs were between 1.4 (anaerobic bacterial infection) and 13.7 (hyperlipidemia) days’ wages, respectively. Treatment of pediatric bacterial infections with the OB of ceftriaxone from a retail pharmacy would cost 24.6 days’ wages. Prices in Bolivia, Colombia, Mexico and Nicaragua were frequently lower for comparable medications. Conclusions The availability of essential medicines was low and prices varied widely across all four sectors. Over 75% of Haitians live on less than US$ 2.00 /day; therefore, most medication regimens are largely unaffordable. Inclusion of essential medications on the national formulary and working with organizations responsible for importing medications into Haiti, particularly drug donation agencies, are important first steps to increasing medication access. PMID:24363923

Globalization and Health: Exploring the opportunities and constraints for health arising from globalization

PubMed Central

Yach, Derek

2005-01-01

The tremendous benefits which have been conferred to almost 5 billion people through improved technologies and knowledge highlights the concomitant challenge of bringing these changes to the 1 billion people living mostly in sub-Saharan Africa and South Asia who are yet to benefit. There is a growing awareness of the need to reduce human suffering and of the necessary participation of governments, non-government organizations and industry within this process. This awareness has recently translated into new funding mechanisms to address HIV/Aids and vaccines, a global push for debt relief and better trade opportunities for the poorest countries, and recognition of how global norms that address food safety, infectious diseases and tobacco benefit all. 'Globalization and Health' will encourage an exchange of views on how the global architecture for health governance needs to changes in the light of global threats and opportunities. PMID:15847700

Why prioritize when there isn't enough money?

PubMed

Wikler, Daniel

2003-02-26

In an informal address to the 4th International Conference on Priorities in Health (Oslo, 23 September 2002), Professor Jeffrey Sachs - Chairperson of the WHO Commission on Macroeconomics and Health - maintained that the real causes of the inability of the world's poorest people to receive help for the lethal diseases that burden them did not include the "usual suspects" (corruption, mismanagement, and wrong priorities). Rather, the root cause was argued to be an inherent lack of money, indicating that the burden of disease would be lifted only if rich countries gave more money to poor ones.Without taking exception to anything that Sachs said in his address, there nevertheless remain a number of justifications for efforts to improve priority setting in the face of severely shortages of resources, including the following three defenses: prioritization is needed if we are to know that prioritization is insufficient; prioritization is most important when there is little money; prioritization can itself increase resources.

The role of fine needle aspiration cytology in medical-surgical missions.

PubMed

Reyes, Cesar V; Reyes, Elisa A

2009-01-01

To relate a 6-year, short-term experience of utilizing fine needle aspiration cytology (FNAC) during medical-surgical missions in the impoverished areas of the Philippines. FNAC is a simple, accurate, fast and economical procedure and requires the simplest devices to implement. During medical-surgical missions to the poorest areas in the Third World countries, where there is almost complete lack of tissue processing and frozen section evaluation, and scarcity of laboratory testing, FNAC becomes a practical technique to use. FNAC in these situations plays an important role as an alternative diagnostic modality to surgery. Our week-long mission experience for 6 different years of successful application of FNAC is described. While the mission volunteers have gained extremely rewarding experience in these limited mission works, FNAC has proven to be a very useful adjunct in the delivery of short-term health care during medical-surgical treatment even in a less-than-ideal setting.

Health inequalities after austerity in Greece.

PubMed

Karanikolos, Marina; Kentikelenis, Alexander

2016-05-31

Since the beginning of economic crisis, Greece has been experiencing unprecedented levels of unemployment and profound cuts to public budgets. Health and welfare sectors were subject to severe austerity measures, which have endangered provision of as well as access to services, potentially widening health inequality gap. European Union Statistics on Income and Living Conditions data show that the proportion of individuals on low incomes reporting unmet medical need due to cost doubled from 7 % in 2008 to 13.9 % in 2013, while the relative gap in access to care between the richest and poorest population groups increased almost ten-fold. In addition, austerity cuts have affected other vulnerable groups, such as undocumented migrants and injecting drug users. Steps have been taken in attempt to mitigate the impact of the austerity, however addressing the growing health inequality gap will require persistent effort of the country's leadership for years to come.

Swaziland: perspectives in school health.

PubMed

Myeni, A D; McGrath, E

1990-09-01

Following major quantitative expansions of the educational system in Swaziland during the two decades since independence, the focus has shifted to improving efficiency. Efficiency of any educational system depends mainly on the characteristics of children entering school. Although Swaziland is not among the poorest countries, infant child mortality rates still reflect less than optimum living conditions and parental knowledge of child nutrition and disease prevention and management. Although access to primary schooling is universal, there is substantial waste during the early years of school through dropout and repetition, both associated with low socioeconomic status. School performance can be increased at little extra cost through increasing the nutrition and health status of students before school entry and through the early school years. In Swaziland, many activities are carried out to provide physical and mental health care to students. Coordinating these efforts and formulating clear policy on school health through cooperation among key ministries and nongovernmental organizations remains to be done.

Poor recovery of households from out-of-pocket payment for assisted reproductive technology.

PubMed

Dyer, Silke J; Vinoos, Latiefa; Ataguba, John E

2017-12-01

How do households recover financially from direct out-of-pocket payment for government subsidized ART? After a mean of 3.8 years, there was poor recovery from initiated financial coping strategies with the poorest households being disproportionatley affected. Out-of-pocket payment for health services can create financial burdens for households and inequities in access to care. A previous study conducted at a public-academic institution in South Africa documented that patient co-payment for one cycle of ART resulted in catastrophic expenditure for one in five households, and more frequently among the poorest, requiring diverse financial coping strategies to offset costs. An observational follow-up study was conducted ~4 years later to assess financial recovery among the 135 couples who had participated in this previous study. Data were collected over 12 months from 73 informants. The study was conducted at a level three referral hospital in the public-academic health sector of South Africa. At this institution ART is subsidized but requires patient co-payments. A purpose-built questionnaire capturing socio-economic information and recovery from financial coping strategies which had been activated was administered to all informants. Financial recovery was defined as the resolution of strategies initiated for the specific purpose of covering the original ART cycle. Results were analysed by strategy and household with the latter including analysis by tertiles based on socio-economic status at the time of the original expenditure. In addition to descriptive statistics, the Pearson Chi squared test was used to determine differences between socioeconomic tertiles and associations between recovery and other variables. The participation rate in this follow-up study was 54.1% with equal representation from the three socio-economic tertiles. The average duration of follow-up was 46.1 months (±9.78 SD) and respondents' mean age was 42 years (range 31-52). The recovery rate was below 50% for four of five strategies evaluated: 23.1% of households had re-purchased a sold asset; 23.5% had normalized a previous reduction in household spending, 33.8% had regained their savings, and 48.7% were no longer bolstering income through additional work. Two-thirds of households (60.0%) had repaid all loans and debts. The poorest households showed lower rates of recovery when compared to households in the richest tertile. Complete recovery from all strategies initiated was reported by only 10 households (13.7%): 1 of 19 in the lowest tertile, 3 of 30 in the middle and by 6 of 24 households in the richest tertile (P > 0.05). No association was found between the degree of financial recovery and additional cost burdens incurred, including related to babies born; or between the degree of recovery and ongoing pursuit of ART. The sample size was limited. The participation rate was just over 50%. Results were dependent on participants' narrative and recall. The willingness of patients to pay for ART does not necessarily imply the ability to pay. As a result, the lack of comprehensive third-party funding for ART can create immediate and long-term financial hardship which is more pronounced among poorer households. While more data on the impact of out-of-pocket payment for ART are needed to illustrate the problem in other low resource settings, the results from South Africa provide useful information for similar developing countries. The current absence of more extensive data should therefore not be a barrier to the promotion of financial risk protection for infertile couples, especially the poorest, in need of ART. The study was supported by a Masters Student Grant from the Faculty of Health Sciences, University of Cape Town. The authors had no competing interests. Not applicable. © The Author 2017. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com

Injury assessment in three low-resource settings: a reference for worldwide estimates.

PubMed

Gupta, Shailvi; Wren, Sherry M; Kamara, Thaim B; Shrestha, Sunil; Kyamanywa, Patrick; Wong, Evan G; Groen, Reinou S; Nwomeh, Benedict C; Kushner, Adam L; Price, Raymond R

2015-04-27

Trauma has become a worldwide pandemic. Without dedicated public health interventions, fatal injuries will rise 40% and become the 4th leading cause of death by 2030, with the burden highest in low-income and middle-income countries (LMICs). The aim of this study was to estimate the prevalence of traumatic injuries and injury-related deaths in low-resource countries worldwide, using population-based data from the Surgeons OverSeas Assessment of Surgical Need (SOSAS), a validated survey tool. Using data from three resource-poor countries (Nepal, Rwanda, and Sierra Leone), a weighted average of injury prevalence and deaths due to injury was calculated and extrapolated to low-resource countries worldwide. Injuries were defined as wounds from road traffic injuries (bus, car, truck, pedestrian, and bicycle), gunshot or stab or slash wounds, falls, work or home incidents, and burns. The Nepal study included a visual physical examination that confirmed the validity of the self-reported data. Population and annual health expenditure per capita data were obtained from the World Bank. Low-resource countries were defined as those with an annual per capita health expenditure of US$100 or less. The overall prevalence of lifetime injury for these three countries was 18·03% (95% CI 18·02-18·04); 11·64% (95% CI 11·53-11·75) of deaths annually were due to injury. An estimated prevalence of lifetime injuries for the total population in 48 low-resource countries is 465·7 million people; about 2·6 million fatal injuries occur in these countries annually. The limitations of this observational study with self-reported data include possible recall and desirability bias. About 466 million people at a community level (18%) sustain at least one injury during their lifetime and 2·6 million people die annually from trauma in the world's poorest countries. Trauma care capacity should be considered a global health priority; the importance of integrating a coordinated trauma system into any health system should not be underestimated. None. Copyright © 2015 Elsevier Ltd. All rights reserved.

Socioeconomic disparities in colorectal cancer mortality in the United States, 1990-2007.

PubMed

Enewold, Lindsey; Horner, Marie-Josèphe; Shriver, Craig D; Zhu, Kangmin

2014-08-01

United States colorectal cancer mortality rates have declined; however, disparities by socioeconomic status and race/ethnicity persist. The objective of this study was to describe the temporal association between colorectal cancer mortality and socioeconomic status by sex and race/ethnicity. Cancer mortality rates in the United States from 1990 to 2007, which were generated by the National Center for Health Statistics, and county-level socioeconomic status, which was estimated as the proportion of county residents living below the national poverty line based on 1990 US Census Bureau data, were obtained from the Surveillance, Epidemiology, and End Results program. The Kunst-Mackenbach relative index of inequality, which considers data across all poverty levels when comparing risks in the poorest (≥ 20%) and richest counties (<10%), was calculated as the measure of association. The study found that colorectal cancer mortality rates were significantly lower in the poorest counties than the richest counties during 1990-1992 among non-Hispanic whites, non-Hispanic black women and non-Hispanic API men. Over time though the tendency was for the poorest counties to have higher mortality rates. By 2003-2007 colorectal cancer mortality rates were significantly higher in the poorest than the richest counties among all sex-race/ethnicity groups. This disparity was most noticeable and appeared to be increasing most among Hispanic men. This suggests that socioeconomic disparities in colorectal cancer mortality were apparent after stratifying by sex and race/ethnicity and reversed over time. Further studies into the causes of these disparities would provide a basis for targeted cancer control interventions and allocation of public health resources.

[International financing for cooperation to develop health in Latin America and the Caribbean].

PubMed

De Los Ríos, Rebecca; Arósquipa, Carlos; Vigil-Oliver, William

2011-08-01

The purpose of this study is (a) to examine the ways in which Latin America and the Caribbean (LAC) have benefited from increases in international development assistance for health (DAH) at the global level and whether the trend observed after the Millennium Summit has also applied to the Region; (b) to determine whether there are differences in the distribution of this assistance, based on the gross per capita income of each country; (c) to identify the possible effects of the 2008 international financial crisis on official bilateral assistance; and (d) to compare trends in public health expenditure in relation to DAH before and after the Millennium Summit. The study has found that DAH in LAC follows a very different pattern than in other regions of the world. The period from 1997 to 2008 was one of fluctuating stagnation, with average annual disbursements of US$ 1 200 million. Multilateral financial institutions accounted for 79% of the average disbursements in the upper-middle income countries between 2002 and 2008, while official bilateral assistance held the greatest share (61%) in the low- and lower-middle income countries. Bilateral assistance grew at an annual rate of 13% during this period, but in the year after the crisis, disbursements fell to US$ 20 million. Sixty-four percent of bilateral assistance came from the United States, Spain, and Canada, with 29% of it being directed to HIV/AIDS and sexually transmitted diseases. After the Millennium Summit DAH channeled to governments decreased 30% in the period 2001-2006, and its share of public health expenditure in the region was 0.3% for the same period, with an equally marginal proportion in relation to total health expenditure for 2008 (0.37%; US$ 2 per capita). The study concludes that after the Millennium Summit, DAH in LAC did not grow nor did it equal the trends prior to 2000, and public health expenditure followed its historical growth trend, without further increases in relation to the regional gross domestic product. Given these realities and the fact that LAC is the world's most unequal region, but not its poorest, it is imperative to reconsider the concepts, management, and delivery of cooperation in the development of health, using innovative approaches and alternative financing mechanisms that respond more effectively to the realities of the region.

Serving the world's poor, profitably.

PubMed

Prahalad, C K; Hammond, Allen

2002-09-01

By stimulating commerce and development at the bottom of the economic pyramid, multi-nationals could radically improve the lives of billions of people and help create a more stable, less dangerous world. Achieving this goal does not require MNCs to spearhead global social-development initiatives for charitable purposes. They need only act in their own self-interest. How? The authors lay out the business case for entering the world's poorest markets. Fully 65% of the world's population earns less than $2,000 per year--that's 4 billion people. But despite the vastness of this market, it remains largely untapped. The reluctance to invest is easy to understand, but it is, by and large, based on outdated assumptions of the developing world. While individual incomes may be low, the aggregate buying power of poor communities is actually quite large, representing a substantial market in many countries for what some might consider luxury goods like satellite television and phone services. Prices, and margins, are often much higher in poor neighborhoods than in their middle-class counterparts. And new technologies are already steadily reducing the effects of corruption, illiteracy, inadequate infrastructure, and other such barriers. Because these markets are in the earliest stages of economic development, revenue growth for multi-nationals entering them can be extremely rapid. MNCs can also lower costs, not only through low-cost labor but by transferring operating efficiencies and innovations developed to serve their existing operations. Certainly, succeeding in such markets requires MNCs to think creatively. The biggest change, though, has to come from executives: Unless business leaders confront their own preconceptions--particularly about the value of high-volume, low-margin businesses--companies are unlikely to master the challenges or reap the rewards of these developing markets.

Neighborhood Social Inequalities in Road Traffic Injuries: The Influence of Traffic Volume and Road Design

PubMed Central

Gauvin, Lise; Plante, Céline; Fournier, Michel; Morency, Catherine

2012-01-01

Objectives. We examined the extent to which differential traffic volume and road geometry can explain social inequalities in pedestrian, cyclist, and motor vehicle occupant injuries across wealthy and poor urban areas. Methods. We performed a multilevel observational study of all road users injured over 5 years (n = 19 568) at intersections (n = 17 498) in a large urban area (Island of Montreal, Canada). We considered intersection-level (traffic estimates, major roads, number of legs) and area-level (population density, commuting travel modes, household income) characteristics in multilevel Poisson regressions that nested intersections in 506 census tracts. Results. There were significantly more injured pedestrians, cyclists, and motor vehicle occupants at intersections in the poorest than in the richest areas. Controlling for traffic volume, intersection geometry, and pedestrian and cyclist volumes greatly attenuated the event rate ratios between intersections in the poorest and richest areas for injured pedestrians (−70%), cyclists (−44%), and motor vehicle occupants (−44%). Conclusions. Roadway environment can explain a substantial portion of the excess rate of road traffic injuries in the poorest urban areas. PMID:22515869

Achieving effective learning effects in the blended course: a combined approach of online self-regulated learning and collaborative learning with initiation.

PubMed

Tsai, Chia-Wen

2011-09-01

In many countries, undergraduates are required to take at least one introductory computer course to enhance their computer literacy and computing skills. However, the application software education in Taiwan can hardly be deemed as effective in developing students' practical computing skills. The author applied online self-regulated learning (SRL) and collaborative learning (CL) with initiation in a blended computing course and examined the effects of different combinations on enhancing students' computing skills. Four classes, comprising 221 students, participated in this study. The online SRL and CL with initiation (G1, n = 53), online CL with initiation (G2, n = 68), and online CL without initiation (G3, n = 68) were experimental groups, and the last class, receiving traditional lecture (G4, n = 32), was the control group. The results of this study show that students who received the intervention of online SRL and CL with initiation attained significantly best grades for practical computing skills, whereas those that received the traditional lectures had statistically poorest grades among the four classes. The implications for schools and educators who plan to provide online or blended learning for their students, particularly in computing courses, are also provided in this study.

Threats from emerging and re-emerging neglected tropical diseases (NTDs).

PubMed

Mackey, Tim K; Liang, Bryan A

2012-01-01

Neglected tropical diseases impact over 1 billion of the world's poorest populations and require special attention. However, within the NTDs recognized by the World Health Organization, some are also dually categorized as emerging and re-emerging infectious diseases requiring more detailed examination on potential global health risks. We reviewed the 17 NTDs classified by the WHO to determine if those NTDs were also categorized by the US Centers for Disease Control and Prevention as emerging and re-emerging infectious diseases (''EReNTDs''). We then identified common characteristics and risks associated with EReNTDs. Identified EReNTDs of dengue, rabies, Chagas Disease, and cysticercosis disproportionately impact resource-poor settings with poor social determinants of health, spread through globalization, are impacted by vector control, lack available treatments, and threaten global health security. This traditionally neglected subset of diseases requires urgent attention and unique incentive structures to encourage investment in innovation and coordination. Multi-sectorial efforts and targeted public-private partnerships would spur needed R&D for effective and accessible EReNTD treatments, improvement of social determinants of health, crucial low-income country development, and health system strengthening efforts. Utilization of One Health principles is essential for enhancing knowledge to efficaciously address public health aspects of these EReNTDs globally.

A conversation with the leaders of the Gates Foundation's Global Health Program: Gordon Perkin and William Foege.

PubMed

Perkin, G; Foege, W

2000-07-08

Over the past 3 years, the Bill & Melinda Gates Foundation has committed more than $1.7 billion to help prevent and eradicate diseases that afflict people living in the world's poorest nations. The gifts have revitalized a number of major global health initiatives that in recent years had lost momentum and helped to refocus the world's attention on the health crises facing many developing nations.

A Study in Child Care (Case Study from Volume II-A): "Life is Good, Right? Right!" Day Care Programs Reprint Series.

ERIC Educational Resources Information Center

O'Farrell, Brigid

Housed in structures formerly used by a church, the 5th City Preschool is located in one of Chicago's poorest black ghettos. The 228 infant-to-kindergarten-age children (78% Black, 22% White) are all from families living in the 5th City area. The program emphasizes the development of the total child and concentrates on helping children to build a…

Housing index, urbanisation level and lifetime prevalence of depressive and anxiety disorders: a cross-sectional analysis of the Colombian national mental health survey.

PubMed

de Vries, Esther; Rincon, Carlos Javier; Tamayo Martínez, Nathalie; Rodriguez, Nelcy; Tiemeier, Henning; Mackenbach, Johan P; Gómez-Restrepo, Carlos; Guarnizo-Herreño, Carol C

2018-06-07

To study socioeconomic inequalities in mental health in rural and urban Colombia, a country with a history of internal conflict and large socioeconomic inequalities. Recent survey data are available to study this understudied topic in a middle-income country. Using data from 9656 respondents from the 2015 Colombian Mental Health survey, we investigated the association between lifetime prevalence of depressive and anxiety disorders and quality of dwellings and access to public services housing score (HS). We calculated the relative index of inequality (RII) and slope index of inequality (SII) for HS in urban and rural areas, adjusting for potential confounders and mediating factors. The lifetime prevalence of anxiety and depression (combined) was 9.6% in urban versus 6.9% in rural areas (p<0.001). HS was not associated with prevalence of anxiety and depression in urban settings, whereas a higher HS (poorer housing quality) was associated with fewer mental disorders in rural areas in both univariate and multivariate models (multivariate RII urban 0.96 (95% CI 0.51 to 1.81); RII rural 0.11 (95% CI 0.04 to 0.32)). In rural areas, the prevalence of mental health problems was 12% points lower in persons living in the poorest quality dwellings than in those living in high-quality dwellings (SII -0.12 (95% CI -0.18 to -0.06)). Interestingly, within rural areas, persons living in 'populated centres' (small towns, villages) had a higher lifetime prevalence of any mental health disorder (9.8% (95% CI 6.9 to 13.6)) compared with those living in more isolated, dispersed areas (6.0% (95% CI 4.6 to 7.7)). In rural Colombia, those living in the poorest houses and in dispersed areas had a lower prevalence of mental health problems. Further understanding of this phenomenon of a seemingly inverse association of prevalence of mental disorders with poverty and/or urbanisation in rural areas is needed. Particularly, considering the progressive urbanisation process in Colombia, it is important to monitor mental health in populations migrating to the cities. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Geography and gender.

PubMed

Bondi, L

1989-05-01

Most people in Britain today work in jobs dominated very markedly by either women or men. Sex-typing occurs in many other activities. For example, child care and domestic work, whether paid or unpaid, are generally considered to be tasks for women. However, with the exception of domestic work and child care, the allocation of activities to women or men varies between societies. For example, in much of sub-Saharan Africa, women work in fields, growing basic subsistence crops for their families, whereas in much of Latin America, women's agricultural work is confined to tending animals and food processing. Inequality arises because the role of women is generally associated with inferior status, socially, politically and/or economically. When mapping the geography of gender, an example shows that female life expectancy at birth is highest in the developed countries and lowest in the poorest countries of the Third World. Regarding the relationship between gender divisions and various aspects of spatial organization within societies most attention has focused on differences in ethnic group, social class, and stage in the life cycle. In mid-19th century Britain large-scale factory production precipitated a spatial separation between home and work and created the possibility of separate spheres of life for women and men. A particular social form, namely a nuclear family with a dependent wife, can operate as a factor contributing to changes in the spatial organization of urban areas in the form of suburban growth. After decades of outward movement by affluent social groups, a return to small pockets within inner-urban areas is now evident. This process is known as gentrification. An additional factor of significance in connection with gentrification is the increasing success of middle-class women in obtaining well-paid career jobs.

Science education for empowerment and social change: a case study of a teacher educator in urban Pakistan

NASA Astrophysics Data System (ADS)

Zahur, Rubina; Calabrese Barton, Angela; Upadhyay, Bhaskar Raj

2002-09-01

In this manuscript we focus on the question, 'What should be the purpose of science education for children of the very poor class in caste-oriented developing countries such as Pakistan?' In other words, in a country where the literacy rate hovers around 10 per cent for the poorest segment of society and where there is no expectation that children will complete primary school, of what importance is primary science education and to what end should it be offered in schools? We begin a conversation around this question by presenting, in this manuscript, a case study of one teacher educator whose beliefs and practices sharply deviate from the norm - she believes science education ought to be about empowering students to make physical and political changes in their community. In particular, using the rich, contextual interview and observational data generated through case study, we show how Haleema's (pseudonym) orientation to science teacher education are buttressed by three fundamental beliefs: that low levels of literacy and school achievement among poor children have as much to do with poor families' lack of power/influence on the purposes and processes of schooling as it has to do with opportunities and resources; that school science can begin to address inequalities in power by fostering a kind of scientific literacy among children that leads to individual and community empowerment around health and environmental issues, the very science-related issues that divide quality of life and opportunity for poor families; and that teacher education programmes can play a role in transforming a society's views about how science and scientific practices might play a role in bringing communities together to effect change for the better.

Rural-urban differentials of premature mortality burden in south-west China.

PubMed

Cai, Le; Chongsuvivatwong, Virasakdi

2006-10-14

Yunnan province is located in south western China and is one of the poorest provinces of the country. This study examines the premature mortality burden from common causes of deaths among an urban region, suburban region and rural region of Kunming, the capital of Yunnan. Years of life lost (YLL) rate per 1,000 and mortality rate per 100,000 were calculated from medical death certificates in 2003 and broken down by cause of death, age and gender among urban, suburban and rural regions. YLL was calculated without age-weighting and discounting rate. Rates were age-adjusted to the combined population of three regions. However, 3% discounting rate and a standard age-weighting function were included in the sensitivity analysis. Non-communicable diseases contributed the most YLL in all three regions. The rural region had about 50% higher premature mortality burden compared to the other two regions. YLL from infectious diseases and perinatal problems was still a major problem in the rural region. Among non-communicable diseases, YLL from stroke was the highest in the urban/suburban regions; COPD followed as the second and was the highest in the rural region. Mortality burden from injuries was however higher in the rural region than the other two regions, especially for men. Self-inflicted injuries were between 2-8 times more serious among women. The use of either mortality rate or YLL gives a similar conclusion regarding the order of priority. Reanalysis with age-weighting and 3% discounting rate gave similar results. Urban south western China has already engaged in epidemiological pattern of developed countries. The rural region is additionally burdened by diseases of poverty and injury on top of the non-communicable diseases.

"Cairo must address the equity issue." Interview: Sandra Postel.

PubMed

1994-01-01

Sandra Postel, of the Worldwatch Institute, believes that inequalities in consumption and income foster environmental degradation. The richest 20% are getting richer and consuming excessively. The bottom 20%, comprising about 1 billion people, are getting poorer and are degrading their environment in order to survive. Per capita availability of resources is continually being reduced. If there is a desire to improve the quality of life for the poorest segment of the world population, then the richest must forfeit something. Environmental taxation could reduce excessive consumption in general; this strategy would be the most efficient and useful. Taxes would be placed on pollution and resources in danger of depletion; income taxes could be reduced to balance the impact of increased taxes on the economy. Wealthy countries must make a renewed commitment to poverty alleviation and to realistic sustainable development. Aid budgets should no longer reflect military priorities or strategic objectives. Trade is clearly related to the environment and poverty, and these connections must be made publicly known. National and international trade policies must deal with poverty issues and not contribute to further environmental destruction. Eliminating debt problems is another problem in need of change. The World Bank and structural adjustment policies have not proved to be environmentally sound and have not benefitted the poor. Evaluation of programs is needed, and lending policies should reflect the growing awareness of the problems of the poor and environmental consequences. Consumption of energy, wood, paper, and water are all higher among industrialized wealthy countries. Technology needs to be applied to maximize resource use, and policies must reflect this commitment. Israel has set a good example with water consumption reduction through advanced technology.

[Chikungunya, La Réunion and Mayotte, 2005-2006: an epidemic without a story?].

PubMed

Flahault, Antoine; Aumont, Gilles; Boisson, Véronique; de Lamballerile, Xavier; Favier, François; Fontenille, Didier; Gaüzère, Bernard-Alex; Journeaux, Sophie; Lotteau, Vincent; Paupy, Christophe; Sanquer, Marie-Anne; Setbon, Michel

2007-01-01

Many triggering factors for onset of emerging infectious diseases are now recognised, such as: globalisation, demographic increase, population movements, international trade, urbanisation, forest destruction, climate changes, loss in biodiversity, and extreme life conditions such as poverty, famine and war. Epidemic burden is often leading to disasters, in terms of human losses, as well as economic, political or social consequences. These outbreaks may jeopardize within a few weeks or months, industry, trade, or tourism. While dengue and its most severe forms (hemorrhagic and shock syndrome) is spreading all over the tropical world, another arbovirosis, chikungunya disease dramatically spread in Indian Ocean islands where 30 to 75% of population were infected in 2005 and 2006, and then extended its progression towards India, Sri Lanka, Indonesia, Malaysia, Maldives islands with more than a million people infected with the East-African strain, replacing the former Asian strain which was known to prevail more than 30 years ago in India. Patients experience sequelae with disability, work loss, and rarely severe outcome recently identified in La Réunion and Mayotte (French overseas territories). No country, no part of the world may consider itself as protected against such events. However, consequences of emerging or re-emerging diseases are more and more unacceptable when they impact the poorest countries of the world. Viruses, bacteria, as well as wild animals, birds, or arthropods are not stopped by borders. It is time now to promote barriers against infectious diseases, including prevention, anticipation, disease surveillance and research. This is not only for humanitarian reasons, but also for contributing to a sustainable development with equity for worldwide population. This report presents comprehensive actions taken in 2006 for tracing the epidemic and mobilise research, as requested to the task force set up by the Prime Minister by March 20, 2006.

Benin.

PubMed

1984-11-01

Focus in this discussion of Benin is on the following: the people; geography; history; government and political conditions; economy; defense; foreign relations; and relations between the US and Benin. The population totaled 3.8 million in 1983 with an annual growth rate of 2.6%. The infant mortality rate is 45/1000 and life expectancy 46.9 years. The population comprises about 20 sociocultural groups. 4 groups -- the Fon, Aja, Bariba, and Yoruba -- account for more than half of the population. The name was changed from Dahomey to the People's Republic of Benin in 1975. 2 years after the military coup d'etat in 1972, Marxism-Leninism was declared the guiding philosophy of the new government. Marxism-Leninism remains the official doctrine, but the government has moved to take account of popular resistance to a radical social transformation, as well as problems encountered in attempting to establish a centrally directed economy. Benin is ranked as 1 of the world's 35 poorest countries. The commercial, industrial, and agricultural sectors are all experiencing severe problems. The government's newest 5 year plan for 1983-88 places a stronger emphasis on developing agriculture. In so doing, the government hopes to assure its own domestic needs and to become a supplier of basic foodstuffs to the region. Benin's Armed Forces number about 3000 personnel. Benin is a member of the Non-Aligned Movement and the Organization of African Unity. Relations with France are important because of historical, cultural, economic, and aid links. After 1972, relations between the US and Benin became strained as Benin moved to strengthen its ties with the Soviet Union and other socialist countries and mounted harsh propaganda attacks on the US.

The decisive decade. What we can do about population.

PubMed

Hinrichsen, D

1990-01-01

In a speech given by former West German Chancellor Willy Brandt to the International Forum on Population in the 21st Century, the suggested mandate for international and regional organizations was to create the equivalent of a security council on global environment and population concerns. Nafis Sadik, Executive Director of the US Population Fund, stated that the present decisions will affect the future of humanity and life on Earth. Effective decision-making in the next 10 years in crucial. There must be integrated planning on a national and international level. A global population increase of 250,000 persons/day or 90 million/year adds to the sharing of the earth and its resources. 75% of Latin America, 42% of Africa, and 37% of Asia will become urbanized. Urban air pollution in developing countries is very high. Expectations of growth, even with fertility decline, are another 3 billion by 2025 and 14 billion by 2100. Growth is occurring in countries where governments are unable to deal with the resource and environmental consequences. Growth rates are uneven, with developed countries increasing 5.2% while developing countries increase 25%. The global underclass of poverty is expected to reach 1 billion by 2000. Environmental destruction occurs due to 1) the bottom billion poorest people overexploiting the environment for food and a livelihood and 2) the top billion richest people indirectly causing distraction through consumer preferences. 15 million acres of prime agricultural land are lost every year. Decertification threatens 33% of the land surface. 25 million acres/year of rain forest are being destroyed. Several million species will be extinct. The highest growth rates are in Africa and the Middle East, where children (6-8/woman) are seen as assets, not liabilities. Lack of access to family planning (FP) and health services is a critical issue for women with unmet needs and a desire for fewer children. FP will be brought to the attention of policymakers and national planners at international meetings. Ambitious goals to keep population at 6.2 billion in 2000 and 10.5 billion by 2100 are to increase contraception users to 535 million from 326 million, to increase spending to 9 billion US dollars from 3.5 billion, to improve the status of women, to guarantee the right to decide freely and responsibly the number and spacing of children, to increase national population programs, to promote community participation and youth involvement, to ensure the UN development strategy and the 1992 Conference on the Environment and the 1994 UN Population Meeting includes the results of this meeting, and to adopt integrated population, environment, and natural resource management policies.

Inequalities in Health Status from EQ-5D Findings: A Cross-Sectional Study in Low-Income Communities of Bangladesh

PubMed Central

Sultana, Marufa; Sarker, Abdur Razzaque; Mahumud, Rashidul Alam; Ahmed, Sayem; Ahmed, Wahid; Chakrovorty, Sanchita; Rahman, Hafizur; Islam, Ziaul; Khan, Jahangir A. M.

2016-01-01

Background: Measuring health status by using standardized and validated instrument has become a growing concern over the past few decades throughout the developed and developing countries. The aim of the study was to investigate the overall self-reported health status along with potential inequalities by using EuroQol 5 dimensions (EQ-5D) instrument among low-income people of Bangladesh. Methods: A cross-sectional household survey was conducted in Chandpur district of Bangladesh. Bangla version of the EQ-5D questionnaire was employed along with socio-demographic information. EQ-5D questionnaire composed of 2-part measurements: EQ-5D descriptive system and the visual analogue scale (VAS). For measuring health status, UK-based preference weights were applied while higher score indicated better health status. For facilitating the consistency with EQ-5D score, VASs were converted to a scale with scores ranging from 0 to 1. Multiple logistic regression models were also employed to examine differences among EQ-5D dimensions. Results: A total of 1433 respondents participated in the study. The mean EQ-5D and VAS score was 0.76 and 0.77, respectively. The females were more likely to report any problem than the males (P < 0.001). Compared to the younger, elderly were more than 2-3 times likely to report any health problem in all EQ-5D dimensions (OR [odds ratio] = 3.17 for mobility, OR = 3.24 for self-care). However, the respondents of the poorest income group were significantly suffered more from every EQ-5D dimension than the richest income quintile. Conclusion: Socio-economic and demographic inequalities in health status was observed in the study. Study suggests to do further investigation with country representative sample to measure the inequalities of overall health status. It would be helpful for policy-maker to find a new way aiming to reduce such inequalities. PMID:27239879

Non-communicable diseases in Mozambique: risk factors, burden, response and outcomes to date

PubMed Central

2012-01-01

Mozambique is located on the East Coast of Africa bordering South Africa, Zimbabwe, Zambia, Malawi and Tanzania and is one of the poorest countries in the world. Currently NCDs account for 28% of deaths in Mozambique. Risk factors such as tobacco and alcohol use and poor diet are present in both urban and rural settings. Diseases such as hypertension and diabetes affect large proportions of the population, but people are often unaware of their condition or poorly managed. Data from studies on diabetes highlight the financial burden for NCD management in Mozambique for both the individual and health system. The National Strategic Plan for the prevention and control of NCDs in Mozambique has as its aim to create a positive environment to minimise or eliminate the exposure to risk factors and guarantee access to care. The plan has as its overall objective to reduce exposure to risk factors and morbidity and mortality due to NCDs and has 4 areas of intervention: 1) Prevention and health education with regards to NCDs; 2) Access to quality care, treatment and follow-up; 3) Prevention of disability and premature mortality and 4) Surveillance, research, monitoring and evaluation and advocacy for NCDs. The Ministry of Health developed projects for diabetes and hypertension and used these as key lessons that could then be applied to other NCDs. Mozambique, through political commitment from the Ministry of Health and the dedication of local champions, has been able to garner international support to improve care for people with diabetes and then use this to develop its National Plan for NCDs. Despite this increase in attention resources available do not match the challenge of NCDs in Mozambique. Mozambique’s experience provides a practical example of actions that can be undertaken in a resource poor country to tackle the emerging burden of NCDs. PMID:23171496

Traumatic Injuries in Developing Countries: Report from a Nationwide Cross-Sectional Survey of Sierra Leone

PubMed Central

Stewart, Kerry-Ann; Groen, Reinou S.; Kamara, Thaim B.; Farahzard, Mina; Samai, Mohamed; Yambasu, Sahr E.; Cassidy, Laura D.; Kushner, Adam L.; Wren, Sherry M.

2014-01-01

Objective Despite the tremendous disability and mortality caused by traumatic injuries worldwide, there is a relative dearth of information on the burden of injuries in developing countries. In an effort to document the surgical burden of disease in Sierra Leone, a nationwide survey was conducted utilizing the Surgeons OverSeas Assessment of Surgical Need (SOSAS) tool. Here, we report the injury data from this study with the aim to (1) provide an estimate of injury prevalence, (2) determine the mechanisms of injury, and (3) evaluate the degree of injury related deaths. Methods A population-based household survey was conducted in Sierra Leone in 2012. Participants were selected using a two-stage random sampling method, which generated a target population of 3750 participants across the 14 districts of Sierra Leone. Frequency distributions of mechanisms of injury based on age, sex, and urban versus rural residence were computed, and bivariate logistic regression models used to determine associations between sociodemographic factors and injury patterns. Results Data was analyzed from 1,843 households and 3,645 respondents, representing a response rate of 98.3%. Four hundred and fifty-two respondents (12.4%) reported at least one traumatic injury in the preceding year. Falls were the most common cause of non-fatal injuries, accounting for over 40% of injuries. The extremities were most commonly injured (55% of injuries) regardless of age or sex. Although motor vehicle related injuries were the 4th most common cause of injury overall, they were the leading cause of injury related deaths, accounting for almost 6% of fatal injuries. Conclusion This study provides baseline data on the burden of traumatic injuries in one of the world's poorest nations. In addition to injury prevention measures, immediate strategies to address current healthcare deficits are urgently needed in these resource poor areas. This report is an Original Article with Level I evidence. PMID:23325317

Prevalence and risk factors for stunting and severe stunting among under-fives in North Maluku province of Indonesia.

PubMed

Ramli; Agho, Kingsley E; Inder, Kerry J; Bowe, Steven J; Jacobs, Jennifer; Dibley, Michael J

2009-10-06

Adequate nutrition is needed to ensure optimum growth and development of infants and young children. Understanding of the risk factors for stunting and severe stunting among children aged less than five years in North Maluku province is important to guide Indonesian government public health planners to develop nutrition programs and interventions in a post conflict area. The purpose of the current study was to assess the prevalence of and the risk factors associated with stunting and severe stunting among children aged less than five years in North Maluku province of Indonesia. The health and nutritional status of children aged less than five years was assessed in North Maluku province of Indonesia in 2004 using a cross-sectional multi-stage survey conducted on 750 households from each of the four island groups in North Maluku province. A total of 2168 children aged 0-59 months were used in the analysis. Prevalence of stunting and severe stunting were 29% (95%CI: 26.0-32.2) and 14.1% (95%CI: 11.7-17.0) for children aged 0-23 months and 38.4% (95%CI: 35.9-41.0) and 18.4% (95%CI: 16.1-20.9) for children aged 0-59 months, respectively. After controlling for potential confounders, multivariate analysis revealed that the risk factors for stunted children were child's age in months, male sex and number of family meals per day (

Optimizing community case management strategies to achieve equitable reduction of childhood pneumonia mortality: An application of Equitable Impact Sensitive Tool (EQUIST) in five low– and middle–income countries

PubMed Central

Waters, Donald; Theodoratou, Evropi; Campbell, Harry; Rudan, Igor; Chopra, Mickey

2012-01-01

Background The aim of this study was to populate the Equitable Impact Sensitive Tool (EQUIST) framework with all necessary data and conduct the first implementation of EQUIST in studying cost–effectiveness of community case management of childhood pneumonia in 5 low– and middle–income countries with relation to equity impact. Methods Wealth quintile–specific data were gathered or modelled for all contributory determinants of the EQUIST framework, namely: under–five mortality rate, cost of intervention, intervention effectiveness, current coverage of intervention and relative disease distribution. These were then combined statistically to calculate the final outcome of the EQUIST model for community case management of childhood pneumonia: US$ per life saved, in several different approaches to scaling–up. Results The current ‘mainstream’ approach to scaling–up of interventions is never the most cost–effective. Community–case management appears to strongly support an ‘equity–promoting’ approach to scaling–up, displaying the highest levels of cost–effectiveness in interventions targeted at the poorest quintile of each study country, although absolute cost differences vary by context. Conclusions The relationship between cost–effectiveness and equity impact is complex, with many determinants to consider. One important way to increase intervention cost–effectiveness in poorer quintiles is to improve the efficiency and quality of delivery. More data are needed in all areas to increase the accuracy of EQUIST–based estimates. PMID:23289077

Paving the way for universal family planning coverage in Ethiopia: an analysis of wealth related inequality.

PubMed

Yigzaw, Muluneh; Zakus, David; Tadesse, Yehualashet; Desalegn, Muluked; Fantahun, Mesganaw

2015-09-14

Family planning plays a significant role in reducing maternal and child mortality and ultimately in achieving national and international development goals. It also has an important role in reducing new pediatric HIV infections by preventing unwanted pregnancies among HIV positive women. Investing in family planning is one of the smart investments for development as population dynamics have a fundamental influence on the pillars of sustainable development, including that of a sustainable environment. To identify and quantify wealth related differences in family planning use between poor and rich Ethiopian women based on the Demographic and Health Survey asset based wealth quintiles. The proportion of women who used contraceptives during implementation of the 2011 and 2005 Ethiopia Demographic and Health Surveys was calculated across wealth quintiles. Data were stratified for place of residence to analyze and determine inequalities in family planning use separately for rural and urban women. Socioeconomic inequalities according to wealth were measured using the slope index of inequality and the relative index of inequality. The absolute difference of contraceptive prevalence between poorest and richest women was over 25.3 percentage points (95% CI = 18.9-31.7) in 2011. Contraceptive use was more than twice (RII: 2.6, 95% CI = 2.0 - 3.3) as prevalent among the richest compared with the poorest. Despite efforts to provide contraceptives for free at all public health facilities, wealth based inequalities still prevail in Ethiopia. People at lower socioeconomic strata should be empowered more to avoid the root causes of inequality and to achieve national Health Sector Development Program Goals.

Perceptions of and barriers to family planning services in the poorest regions of Chiapas, Mexico: a qualitative study of men, women, and adolescents.

PubMed

Dansereau, Emily; Schaefer, Alexandra; Hernández, Bernardo; Nelson, Jennifer; Palmisano, Erin; Ríos-Zertuche, Diego; Woldeab, Alex; Zúñiga, Maria Paola; Iriarte, Emma Margarita; Mokdad, Ali H; El Bcheraoui, Charbel

2017-10-17

In the poorest regions of Chiapas, Mexico, 50.2% of women in need of contraceptives do not use any modern method. A qualitative study was needed to design effective and culturally appropriate interventions. We used purposive maximum-variation sampling to select eight municipalities with a high proportion of residents in the poorest wealth quintile, including urban, rural, indigenous, and non-indigenous communities. We conducted 44 focus group discussions with 292 women, adolescent women, and men using semi-structured topic guides. We analyzed the data through recursive abstraction. There were intergenerational and cultural gaps in the acceptability of family planning, and in some communities family planning use was greatly limited by gender roles and religious objections to contraception. Men strongly influenced family planning choices in many households, but were largely unreached by outreach and education programs due to their work hours. Respondents were aware of many modern methods but often lacked deeper knowledge and held misconceptions about long-term fertility risks posed by some hormonal methods. Acute physical side effects also dissuaded use. The implant was a new and highly acceptable method due to ease of use, low upkeep, and minimal side effects; however, it was perceived as subject to stock-outs. Adolescent women reported being refused services at health facilities and requested more reproductive health information from their parents and schools. Mass and social media are growing sources of reproductive health information. Our study identifies a number of barriers to family planning that have yet to be adequately addressed by existing programs in Chiapas' poorest regions, and calls for reinvigorated efforts to provide effective, acceptable, and culturally appropriate interventions for these communities.

The nexus of oil, conflict, and climate change vulnerability of pastoral communities in northwest Kenya

NASA Astrophysics Data System (ADS)

Schilling, J.; Locham, R.; Weinzierl, T.; Vivekananda, J.; Scheffran, J.

2015-11-01

Turkana, in northwest Kenya, is the country's poorest and least developed county. Pastoralism in Turkana is well adapted to the harsh climatic conditions, but an increase in drought frequency associated with global climate change and intensifying violent conflicts between pastoral groups poses significant challenges for local communities. The conflicts are especially violent in the border region between the Turkana and the Pokot communities. In this very region significant oil reserves have recently been found. The first aim of this paper is to analyse how the oil exploration affects the communities' vulnerability to climate change. Secondly, the paper explores the risk of the oil explorations creating new conflicts or aggravating existing ones. The primary method of the study is qualitative field research supplemented with a geo-spatial analysis of conflict data. The field research was conducted in October 2013 and April 2014 in three villages with different levels of engagement with the oil exploration. At the time of the research, oil exploration was expected close to Lokwamosing, while it had recently started in the vicinity of Lopii and had been ongoing for a longer time close to Nakukulas. The findings suggest that the oil exploration increases the community's vulnerability to climate change. Further, unmet community expectations for water, employment and development pose a significant risk for violent conflict between local communities and the operating oil company. Intercommunal conflict over water and land could increase as well.

Improving water quality in China: Environmental investment pays dividends.

PubMed

Zhou, Yongqiang; Ma, Jianrong; Zhang, Yunlin; Qin, Boqiang; Jeppesen, Erik; Shi, Kun; Brookes, Justin D; Spencer, Robert G M; Zhu, Guangwei; Gao, Guang

2017-07-01

This study highlights how Chinese economic development detrimentally impacted water quality in recent decades and how this has been improved by enormous investment in environmental remediation funded by the Chinese government. To our knowledge, this study is the first to describe the variability of surface water quality in inland waters in China, the affecting drivers behind the changes, and how the government-financed conservation actions have impacted water quality. Water quality was found to be poorest in the North and the Northeast China Plain where there is greater coverage of developed land (cities + cropland), a higher gross domestic product (GDP), and higher population density. There are significant positive relationships between the concentration of the annual mean chemical oxygen demand (COD) and the percentage of developed land use (cities + cropland), GDP, and population density in the individual watersheds (p < 0.001). During the past decade, following Chinese government-financed investments in environmental restoration and reforestation, the water quality of Chinese inland waters has improved markedly, which is particularly evident from the significant and exponentially decreasing GDP-normalized COD and ammonium (NH 4 + -N) concentrations. It is evident that the increasing GDP in China over the past decade did not occur at the continued expense of its inland water ecosystems. This offers hope for the future, also for other industrializing countries, that with appropriate environmental investments a high GDP can be reached and maintained, while simultaneously preserving inland aquatic ecosystems, particularly through management of sewage discharge. Copyright © 2017 Elsevier Ltd. All rights reserved.

The importance of creating a social business to produce low-cost hearing aids.

PubMed

Caccamo, Samantha; Voloshchenko, Anastasia; Dankyi, Nana Yaa

2014-09-01

The World Health Organization (WHO) estimates that about 280 million people worldwide have a bilateral hearing loss, mostly living in poor countries. Hearing loss causes heavy social burdens on individuals, families, communities and countries. However, due to the lack of accessibility and affordability, the vast majority of people in the world who need hearing aids do not have access to them. Low-income countries are thus pulled into a disability/poverty spiral. From this standpoint, the production of available, accessible and affordable hearing aids for the poorest populations of our planet should be one of the main issues in global hearing healthcare. Designing and producing a brand new low-cost hearing aid is the most effective option. Involving a large producer of hearing aids in the creation of a social business to solve the problem of access to affordable hearing aids is an essential step to reduce hearing disability on a large scale globally. Today's technology allows for the creation of a "minimal design" product that does not exceed $100-$150, that can be further lowered when purchased in large quantities and dispensed with alternative models. It is conceivable that by making a sustainable social business, the low cost product could be sold with a cross-subsidy model in order to recover the overhead costs. Social business is an economic model that has the potential to produce and distribute affordable hearing aids in low- and middle-income countries. Rehabilitation of hearing impaired children will be carried out in partnership with Sahic (Society of Assistance to Hearing Impaired Children) in Dhaka, Bangladesh and the ENT Department of Ospedale Burlo di Trieste, Dr. Eva Orzan.

Estimated economic impact of vaccinations in 73 low- and middle-income countries, 2001–2020

PubMed Central

Clark, Samantha; Portnoy, Allison; Grewal, Simrun; Stack, Meghan L; Sinha, Anushua; Mirelman, Andrew; Franklin, Heather; Friberg, Ingrid K; Tam, Yvonne; Walker, Neff; Clark, Andrew; Ferrari, Matthew; Suraratdecha, Chutima; Sweet, Steven; Goldie, Sue J; Garske, Tini; Li, Michelle; Hansen, Peter M; Johnson, Hope L; Walker, Damian

2017-01-01

Abstract Objective To estimate the economic impact likely to be achieved by efforts to vaccinate against 10 vaccine-preventable diseases between 2001 and 2020 in 73 low- and middle-income countries largely supported by Gavi, the Vaccine Alliance. Methods We used health impact models to estimate the economic impact of achieving forecasted coverages for vaccination against Haemophilus influenzae type b, hepatitis B, human papillomavirus, Japanese encephalitis, measles, Neisseria meningitidis serogroup A, rotavirus, rubella, Streptococcus pneumoniae and yellow fever. In comparison with no vaccination, we modelled the costs – expressed in 2010 United States dollars (US$) – of averted treatment, transportation costs, productivity losses of caregivers and productivity losses due to disability and death. We used the value-of-a-life-year method to estimate the broader economic and social value of living longer, in better health, as a result of immunization. Findings We estimated that, in the 73 countries, vaccinations given between 2001 and 2020 will avert over 20 million deaths and save US$ 350 billion in cost of illness. The deaths and disability prevented by vaccinations given during the two decades will result in estimated lifelong productivity gains totalling US$ 330 billion and US$ 9 billion, respectively. Over the lifetimes of the vaccinated cohorts, the same vaccinations will save an estimated US$ 5 billion in treatment costs. The broader economic and social value of these vaccinations is estimated at US$ 820 billion. Conclusion By preventing significant costs and potentially increasing economic productivity among some of the world’s poorest countries, the impact of immunization goes well beyond health. PMID:28867843

Gender violence, poverty and HIV infection risk among persons engaged in the sex industry: cross-national analysis of the political economy of sex markets in 30 European and Central Asian countries.

PubMed

Reeves, A; Steele, S; Stuckler, D; McKee, M; Amato-Gauci, A; Semenza, J C

2017-11-01

Persons engaged in the sex industry are at greater risk of HIV and other sexually transmitted infections than the general population. One major factor is exposure to higher levels of risky sexual activity. Expanding condom use is a critical prevention strategy, but this requires negotiation with those buying sex, which takes place in the context of cultural and economic constraints. Impoverished individuals who fear violence are more likely to forego condoms. Here we tested the hypotheses that poverty and fear of violence are two structural drivers of HIV infection risk in the sex industry. Using data from the European Centre for Disease Prevention and Control and the World Bank for 30 countries, we evaluated poverty, measured using the average income per day per person in the bottom 40% of the income distribution, and gender violence, measured using homicide rates in women and the proportion of women exposed to violence in the last 12 months and/or since age 16 years. We found that HIV prevalence among those in the sex industry was higher in countries where there were greater female homicide rates (β = 0.86; P = 0.018) and there was some evidence that self-reported exposure to violence was also associated with higher HIV prevalence (β = 1.37; P = 0.043). Conversely, HIV prevalence was lower in countries where average incomes among the poorest were greater (β = -1.05; P = 0.046). Our results are consistent with the theory that reducing poverty and exposure to violence may help reduce HIV infection risk among persons engaged in the sex industry. © 2017 British HIV Association.

Global health inequalities and the need for solidarity: a view from the Global South.

PubMed

Tosam, Mbih J; Chi, Primus Che; Munung, Nchangwi Syntia; Oukem-Boyer, Odile Ouwe Missi; Tangwa, Godfrey B

2017-12-20

Although the world has experienced remarkable progress in health care since the last half of the 20th century, global health inequalities still persist. In some poor countries life expectancy is between 37-40 years lower than in rich countries; furthermore, maternal and infant mortality is high and there is lack of access to basic preventive and life-saving medicines, as well a high prevalence of neglected diseases, HIV/AIDS, tuberculosis, and malaria. Moreover, globalization has made the world more connected than before such that health challenges today are no longer limited within national or regional boundaries, making all persons equally vulnerable. Because of this, diseases in the most affluent countries are closely connected with diseases in the poorest countries. In this paper, we argue that, because of global health inequalities, in a situation of equal vulnerability, there is need for global solidarity not only as a means of reducing health inequalities, but also as a way of putting up a united force against global health challenges. We argue for an African approach to solidarity in which the humanity of a person is not determined by his/her being human or rational capacity, but by his/her capacity to live a virtuous life. According to this view of solidarity, because no one is self-sufficient, no individual can survive alone. If we are to collectively flourish in a world where no individual, nation or region has all the health resources or protection needed for survival, we must engage in solidarity where we remain compassionate and available to one another at all times. © 2017 John Wiley & Sons Ltd.

Accomplishing reform: successful case studies drawn from the health systems of 60 countries

PubMed Central

Braithwaite, Jeffrey; Mannion, Russell; Matsuyama, Yukihiro; Shekelle, Paul; Whittaker, Stuart; Al-Adawi, Samir; Ludlow, Kristiana; James, Wendy; Ting, Hsuen P; Herkes, Jessica; Ellis, Louise A; Churruca, Kate; Nicklin, Wendy; Hughes, Clifford

2017-01-01

Abstract Healthcare reform typically involves orchestrating a policy change, mediated through some form of operational, systems, financial, process or practice intervention. The aim is to improve the ways in which care is delivered to patients. In our book ‘Health Systems Improvement Across the Globe: Success Stories from 60 Countries’, we gathered case-study accomplishments from 60 countries. A unique feature of the collection is the diversity of included countries, from the wealthiest and most politically stable such as Japan, Qatar and Canada, to some of the poorest, most densely populated or politically challenged, including Afghanistan, Guinea and Nigeria. Despite constraints faced by health reformers everywhere, every country was able to share a story of accomplishment—defining how their case example was managed, what services were affected and ultimately how patients, staff, or the system overall, benefited. The reform themes ranged from those relating to policy, care coverage and governance; to quality, standards, accreditation and regulation; to the organization of care; to safety, workforce and resources; to technology and IT; through to practical ways in which stakeholders forged collaborations and partnerships to achieve mutual aims. Common factors linked to success included the ‘acorn-to-oak tree’ principle (a small scale initiative can lead to system-wide reforms); the ‘data-to-information-to-intelligence’ principle (the role of IT and data are becoming more critical for delivering efficient and appropriate care, but must be converted into useful intelligence); the ‘many-hands’ principle (concerted action between stakeholders is key); and the ‘patient-as-the-pre-eminent-player’ principle (placing patients at the centre of reform designs is critical for success). PMID:29036604

Becoming successful entrepreneurs. Bangladesh. ADB supports pioneering family-based approach to provide micro-credit and skills training.

PubMed

Molitor, C

1996-01-01

The Thana Resource Development and Employment Project (TRDEP), built upon the successful experience of the Grameen Bank and other nongovernmental organizations, is a comprehensive poverty alleviation scheme implemented by the government of Bangladesh and targeted to the poorest segment of Bangladeshi society. The project provides soft loans to landless poor for income-generating activities involving non-crop livelihoods and trades. The loans are granted at an 18% interest rate including a 2% charge which goes into a risk fund. The poorest of poor are eligible to receive loans as long as each borrowing unit is a self-help group comprised of five members of one family and each member of the group assumes the responsibility of paying each other member's loan. Each member of a borrowing group may receive loans in the amount of Taka 3000-5000 (US$75-125). The loans are then repayable in 50 equal installments over the course of 1 year. One member's default disqualifies all other group members from receiving future credit until the default is cleared. TRDEP borrowers have started small, successful entrepreneurial activities with their loans as capital.

Leave taking and overtime behavior as related to demographic, health, and job variables

NASA Technical Reports Server (NTRS)

Arnoldi, L. B.; Townsend, J. C.

1969-01-01

An intra-installation model is formulated that correlates demographic, health and job related variables to the various types and amounts of leave and overtime taking behavior of employees. Statistical comparison of composite health ratings assigned to subjects based upon clinical criteria and bio-statistical data show that those employees who take the most annual leave as well as sick leave are the ones that have the poorest health ratings; employees who put in the most overtime have also the poorest health records. Stress effects of peak activity periods increase use of sick leave immediately after peak activity but not the use of annual leave.

An international comparison of occupational health guidelines for the management of mental disorders and stress-related psychological symptoms.

PubMed

Joosen, Margot C W; Brouwers, Evelien P M; van Beurden, Karlijn M; Terluin, Berend; Ruotsalainen, Jani H; Woo, Jong-Min; Choi, Kyeong-Sook; Eguchi, Hisashi; Moriguchi, Jiro; van der Klink, Jac J L; van Weeghel, Jaap

2015-05-01

We compared available guidelines on the management of mental disorders and stress-related psychological symptoms in an occupational healthcare setting and determined their development and reporting quality. To identify eligible guidelines, we systematically searched National Guideline Clearinghouse, Guidelines International Network Library and PubMed. Members of the International Commission on Occupational Health (ICOH), were also consulted. Guidelines recommendations were compared and reporting quality was assessed using the AGREE II instrument. Of 2126 titles retrieved, 14 guidelines were included: 1 Japanese, 2 Finnish, 2 Korean, 2 British and 7 Dutch. Four guidelines were of high-reporting quality. Best described was the Scope and Purpose, and the poorest described were competing interests (Editorial independence) and barriers and facilitators for implementation (Applicability). Key recommendations were often difficult to identify. Most guidelines recommend employing an inventory of symptoms, diagnostic classification, performance problems and workplace factors. All guidelines recommend specific return-to-work interventions, and most agreed on psychological treatment and communication between involved stakeholders. Practice guidelines to address work disability due to mental disorders and stress-related symptoms are available in various countries around the world, however, these guidelines are difficult to find. To promote sharing, national guidelines should be accessible via established international databases. The quality of the guideline's developmental process varied considerably. To increase quality and applicability, guideline developers should adopt a common structure for the development and reporting of their guidelines, for example Appraisal of Guidelines for Research and Evaluation (AGREE) criteria. Owing to differences in social systems, developers can learn from each other through reviews of this kind. 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.

Is governance, gross domestic product, inequality, population size or country surface area associated with coverage and equity of health interventions? Ecological analyses of cross-sectional surveys from 80 countries.

PubMed

Wehrmeister, Fernando C; da Silva, Inácio Crochemore M; Barros, Aluisio J D; Victora, Cesar G

2017-01-01

To assess associations between national characteristics, including governance indicators, with a proxy for universal health coverage in reproductive, maternal, newborn and child health (RMNCH). Ecological analysis based on data from national standardised cross-sectional surveys. Low-income and middle-income countries with a Demographic and Health Survey or a Multiple Indicator Cluster Survey since 2005. 1 246 710 mothers and 2 129 212 children from 80 national surveys. Gross domestic product (GDP), country surface area, population, Gini index and six governance indicators (control of corruption, political stability and absence of violence, government effectiveness, regulatory quality, rule of law, and voice and accountability). Levels and inequality in the composite coverage index (CCI), a weighted average of eight RMNCH interventions. Relative and absolute inequalities were measured through the concentration index (CIX) and slope index of inequality (SII) for CCI, respectively. The average values of CCI (70.5% (SD=13.3)), CIX (5.3 (SD=5.1)) and mean slope index (19.8 (SD=14.7)) were calculated. In the unadjusted analysis, all governance variables and GDP were positively associated with the CCI and negatively with inequalities. Country surface showed inverse associations with both inequality indices. After adjustment, among the governance indicators, only political stability and absence of violence was directly related to CCI (β=6.3; 95% CI 3.6 to 9.1; p<0.001) and inversely associated with relative (CIX; β=-1.4; 95% CI -2.4 to -0.4; p=0.007) and absolute (SII; β=-5.3; 95% CI -8.9 to -1.7; p=0.005) inequalities. The strongest associations with governance indicators were found in the poorest wealth quintile. Similar patterns were observed for GDP. Country surface area was inversely related to inequalities on CCI. Levels and equity in RMNCH interventions are positively associated with political stability and absence of violence, and with GDP, and inversely associated with country surface area.

Who Delivers without Water? A Multi Country Analysis of Water and Sanitation in the Childbirth Environment.

PubMed

Gon, Giorgia; Restrepo-Méndez, María Clara; Campbell, Oona M R; Barros, Aluísio J D; Woodd, Susannah; Benova, Lenka; Graham, Wendy J

2016-01-01

Hygiene during childbirth is essential to the health of mothers and newborns, irrespective of where birth takes place. This paper investigates the status of water and sanitation in both the home and facility childbirth environments, and for whom and where this is a more significant problem. We used three datasets: a global dataset, with information on the home environment from 58 countries, and two datasets for each of four countries in Eastern Africa: a healthcare facility dataset, and a dataset that incorporated information on facilities and the home environment to create a comprehensive description of birth environments in those countries. We constructed indices of improved water, and improved water and sanitation combined (WATSAN), for the home and healthcare facilities. The Joint Monitoring Program was used to construct indices for household; we tailored them to the facility context-household and facility indices include different components. We described what proportion of women delivered in an environment with improved WATSAN. For those women who delivered at home, we calculated what proportion had improved WATSAN by socio-economic status, education and rural-urban status. Among women delivering at home (58 countries), coverage of improved WATSAN by region varied from 9% to 53%. Fewer than 15% of women who delivered at home in Sub-Saharan Africa, had access to water and sanitation infrastructure (range 0.1% to 37%). This was worse among the poorest, the less educated and those living in rural areas. In Eastern Africa, where we looked at both the home and facility childbirth environment, a third of women delivered in an environment with improved water in Uganda and Rwanda; whereas, 18% of women in Kenya and 7% in Tanzania delivered with improved water and sanitation. Across the four countries, less than half of the facility deliveries had improved water, or improved water and sanitation in the childbirth environment. Access to water and sanitation during childbirth is poor across low and middle-income countries. Even when women travel to health facilities for childbirth, they are not guaranteed access to basic WATSAN infrastructure. These indicators should be measured routinely in order to inform improvements.

Is governance, gross domestic product, inequality, population size or country surface area associated with coverage and equity of health interventions? Ecological analyses of cross-sectional surveys from 80 countries

PubMed Central

Wehrmeister, Fernando C; da Silva, Inácio Crochemore M; Barros, Aluisio J D; Victora, Cesar G

2017-01-01

Objective To assess associations between national characteristics, including governance indicators, with a proxy for universal health coverage in reproductive, maternal, newborn and child health (RMNCH). Design Ecological analysis based on data from national standardised cross-sectional surveys. Setting Low-income and middle-income countries with a Demographic and Health Survey or a Multiple Indicator Cluster Survey since 2005. Participants 1 246 710 mothers and 2 129 212 children from 80 national surveys. Exposures of interest Gross domestic product (GDP), country surface area, population, Gini index and six governance indicators (control of corruption, political stability and absence of violence, government effectiveness, regulatory quality, rule of law, and voice and accountability). Main outcomes Levels and inequality in the composite coverage index (CCI), a weighted average of eight RMNCH interventions. Relative and absolute inequalities were measured through the concentration index (CIX) and slope index of inequality (SII) for CCI, respectively. Results The average values of CCI (70.5% (SD=13.3)), CIX (5.3 (SD=5.1)) and mean slope index (19.8 (SD=14.7)) were calculated. In the unadjusted analysis, all governance variables and GDP were positively associated with the CCI and negatively with inequalities. Country surface showed inverse associations with both inequality indices. After adjustment, among the governance indicators, only political stability and absence of violence was directly related to CCI (β=6.3; 95% CI 3.6 to 9.1; p<0.001) and inversely associated with relative (CIX; β=−1.4; 95% CI −2.4 to −0.4; p=0.007) and absolute (SII; β=−5.3; 95% CI –8.9 to −1.7; p=0.005) inequalities. The strongest associations with governance indicators were found in the poorest wealth quintile. Similar patterns were observed for GDP. Country surface area was inversely related to inequalities on CCI. Conclusions Levels and equity in RMNCH interventions are positively associated with political stability and absence of violence, and with GDP, and inversely associated with country surface area. PMID:29225951

No effect of user fee exemption on perceived quality of delivery care in Burkina Faso: a case-control study.

PubMed

Philibert, Aline; Ridde, Valéry; Bado, Aristide; Fournier, Pierre

2014-03-11

Although many developing countries have developed user fee exemption policies to move towards universal health coverage as a priority, very few studies have attempted to measure the quality of care. The present paper aims at assessing whether women's satisfaction with delivery care is maintained with a total fee exemption in Burkina Faso. A quasi-experimental design with both intervention and control groups was carried out. Six health centres were selected in rural health districts with limited resources. In the intervention group, delivery care is free of charge at health centres while in the control district women have to pay 900 West African CFA francs (U$2). A total of 870 women who delivered at the health centre were interviewed at home after their visit over a 60-day range. A series of principal component analyses (PCA) were carried out to identify the dimension of patients' satisfaction. Women's satisfaction loaded satisfactorily on a three-dimension principal component analysis (PCA): 1-provider-patient interaction; 2-nursing care services; 3-environment. Women in both the intervention and control groups were satisfied or very satisfied in 90% of cases (in 31 of 34 items). For each dimension, average satisfaction was similar between the two groups, even after controlling for socio-demographic factors (p = 0.436, p = 0.506, p = 0.310, respectively). The effects of total fee exemption on satisfaction were similar for any women without reinforcing inequalities between very poor and wealthy women (p ≥ 0.05). Although the wealthiest women were more dissatisfied with the delivery environment (p = 0.017), the poorest were more highly satisfied with nursing care services (p = 0.009). Contrary to our expectations, total fee exemption at the point of service did not seem to have a negative impact on quality of care, and women's perceptions remained very positive. This paper shows that the policy of completely abolishing user fees with organized implementation is certainly a way for developing countries to engage in universal coverage while maintaining the quality of care.

Growing pains: status of emergency medicine in Nicaragua.

PubMed

Gaitan, M; Mendez, W; Sirker, N E; Green, G B

1998-03-01

Nicaragua is one of the poorest nations in the Western Hemisphere. The health of the population suffers as a result of poor nutrition, epidemic diseases, natural and manmade disasters, sporadic violence, urban industrial growth, and inadequate government funding for even basic medical equipment and supplies. Within this environment, emergency services development has been recognized as an important and cost-effective public health intervention. In recent years, government and nongovernmental agencies working together have had a dramatic positive impact on the quality of emergency care provided.

Antiparasitic Therapy

PubMed Central

Kappagoda, Shanthi; Singh, Upinder; Blackburn, Brian G.

2011-01-01

Parasitic diseases affect more than 2 billion people globally and cause substantial morbidity and mortality, particularly among the world's poorest people. This overview focuses on the treatment of the major protozoan and helminth infections in humans. Recent developments in antiparasitic therapy include the expansion of artemisinin-based therapies for malaria, new drugs for soil-transmitted helminths and intestinal protozoa, expansion of the indications for antiparasitic drug treatment in patients with Chagas disease, and the use of combination therapy for leishmaniasis and human African trypanosomiasis. PMID:21628620

Combining deep learning and satellite data to inform sustainable development

NASA Astrophysics Data System (ADS)

Lobell, D. B.

2017-12-01

Methods in machine learning, and in particular deep learning, are quickly advancing, in parallel with dramatic increases in the availability of fine resolution satellite data. The combination of both offers the possibility to improve understanding of some of the poorest regions of the world, where traditional data sources are limited. This talk will cover recent applications to track poverty at the village level in Africa, spot the onset of disease outbreaks in agriculture, and identify land use patterns and crop productivity.

Care seeking behaviour for children with suspected pneumonia in countries in sub-Saharan Africa with high pneumonia mortality.

PubMed

Noordam, Aaltje Camielle; Carvajal-Velez, Liliana; Sharkey, Alyssa B; Young, Mark; Cals, Jochen W L

2015-01-01

Pneumonia is the leading cause of childhood mortality in sub-Saharan Africa (SSA). Because effective antibiotic treatment exists, timely recognition of pneumonia and subsequent care seeking for treatment can prevent deaths. For six high pneumonia mortality countries in SSA we examined if children with suspected pneumonia were taken for care, and if so, from which type of care providers, using national survey data of 76530 children. We also assessed factors independently associated with care seeking from health providers, also known as 'appropriate' providers. We report important differences in care seeking patterns across these countries. In Tanzania 85% of children with suspected pneumonia were taken for care, whereas this was only 30% in Ethiopia. Most of the children living in these six countries were taken to a primary health care facility; 86, 68 and 59% in Ethiopia, Tanzania and Burkina Faso respectively. In Uganda, hospital care was sought for 60% of children. 16-18% of children were taken to a private pharmacy in Democratic Republic of Congo (DRC), Tanzania and Nigeria. In Tanzania, children from the richest households were 9.5 times (CI 2.3-39.3) more likely to be brought for care than children from the poorest households, after controlling for the child's age, sex, caregiver's education and urban-rural residence. The influence of the age of a child, when controlling for sex, urban-rural residence, education and wealth, shows that the youngest children (<2 years) were more likely to be brought to a care provider in Nigeria, Ethiopia and DRC. Urban-rural residence was not significantly associated with care seeking, after controlling for the age and sex of the child, caregivers education and wealth. The study suggests that it is crucial to understand country-specific care seeking patterns for children with suspected pneumonia and related determinants using available data prior to planning programmatic responses.

Social media in public health: an analysis of national health authorities and leading causes of death in Spanish-speaking Latin American and Caribbean countries.

PubMed

Novillo-Ortiz, David; Hernández-Pérez, Tony

2017-02-03

Information and communications technologies, like social media, have the potential to reduce some barriers in disease prevention and control in the Americas. National health authorities can use these technologies to provide access to reliable and quality health information. A study was conducted to analyze availability of information about the leading causes of death on social media channels of national health authorities in 18 Spanish-speaking Latin American and Caribbean countries. We gathered data of national health authorities's institutional presence in social media. Exploratory-descriptive research was useful for analysis and interpretation of the data collected. An analysis was carried out for 6 months, from April 1 to September 30, 2015. Sixteen of the 18 countries studied have institutional presences on social media. National health authorities have a presence in an average of almost three platforms (2.8%). An average of 1% of the populations with Internet access across the 18 countries in this study follows national health authorities on social media (approximately, an average of 0.3% of the total population of the countries under study). On average, information on 3.2 of the 10 leading causes of death was posted on the national health authorities' Facebook pages, and information on 2.9 of the 10 leading causes of death was posted on their Twitter profiles. Additionally, regarding public health expenditures and the possibility of retrieving information on the leading causes of death, an apparent negative correlation exists in the case of Facebook, r(13) = -.54, P = .03 and a weak negative correlation in the case of Twitter, r(14) = -.26, P = .31, for the countries with presences in those networks. National health authorities can improve their role in participating in conversations on social media regarding the leading causes of death affecting their countries. Taking into account Internet accessibility levels in the countries under study and the high rates of people using social networks in even the poorest countries, further research is needed to provide evidence that more dedication to health promotion interventions through social media could significantly improve the impact and reach of public health messages and initiatives.

Geo hazard studies and their policy implications in Nicaragua

NASA Astrophysics Data System (ADS)

Strauch, W.

2007-05-01

Nicaragua, situated at the Central American Subduction zone and placed in the trajectory of tropical storms and hurricanes, is a frequent showplace of natural disasters which have multiplied the negative effects of a long term socioeconomic crisis leaving Nicaragua currently as the second poorest country of the Americas. In the last years, multiple efforts were undertaken to prevent or mitigate the affectation of the natural phenomena to the country. National and local authorities have become more involved in disaster prevention policy and international cooperation boosted funding for disaster prevention and mitigation measures in the country. The National Geosciences Institution (INETER) in cooperation with foreign partners developed a national monitoring and early warning system on geological and hydro-meteorological phenomena. Geological and risk mapping projects were conducted by INETER and international partners. Universities, NGO´s, International Technical Assistance, and foreign scientific groups cooperated to capacitate Nicaraguan geoscientists and to improve higher education on disaster prevention up to the master degree. Funded by a World Bank loan, coordinated by the National System for Disaster Prevention, Mitigation and Attention (SINAPRED) and scientifically supervised by INETER, multidisciplinary hazard and vulnerability studies were carried out between 2003 and 2005 with emphasis on seismic hazard. These GIS based works provided proposals for land use policies on a local level in 30 municipalities and seismic vulnerability and risk information for each single building in Managua, Capital of Nicaragua. Another large multidisciplinary project produced high resolution air photos, elaborated 1:50,000 vectorized topographic maps, and a digital elevation model for Western Nicaragua. These data, integrated in GIS, were used to assess: 1) Seismic Hazard for Metropolitan Managua; 2) Tsunami hazard for the Pacific coast; 3) Volcano hazard for Telica-Cerro Negro and El Hoyo volcanoes; and 4) Flood hazard map of Maravilla river. This study was realized between 2004 and 2006, through technical cooperation of Japan International Cooperation Agency with INETER, upon the request of the Government of Nicaragua. The results of the mapping and investigations are fed in a National GIS on Geohazards maintained by INETER and developed in the frame of a regional cooperation project with BGR, Germany, and other international institutions. Many maps, project reports and GIS coverage are made available on INETER´s Website to the general public. (www.ineter.gob.ni/geofisica/geofisica.html ).

Albania.

PubMed

1986-11-01

Background notes on Albania, by the U.S. State Department, are brief because of scarce information from this tightly controlled communist nation. Albania is on the Adriatic coast between Greece and Yugoslavia. Albania has about 3 million people. Literacy is reported to be 75%; life expectancy 72 years. Per capita income is $900, the poorest and most agricultural of all Europe, but nevertheless, they are not self-sufficient in food. There are 2 ethnic groups, and 70% were formerly Muslim, although religious practice is banned. Albania has been under the domination of some other power for virtually all of its history, notably the Turks for centuries, and its own puppet communist regime since 1941. The communist government was aligned with Yugoslavia until 1948, then with Russia until 1961, then with China until 1978, and now is on its own. Albania has no relations or aid from any major power, and attempts to export goods to Western European countries in exchange for imported needs, largely machinery and equipment. Exports include electric power, metal ores, copper, petroleum, coal, tobacco, and textiles.

Income elasticity of health expenditures in Iran.

PubMed

Zare, Hossein; Trujillo, Antonio J; Leidman, Eva; Buttorff, Christine

2013-09-01

Because of its policy implications, the income elasticity of health care expenditures is a subject of much debate. Governments may have an interest in subsidizing the care of those with low income. Using more than two decades of data from the Iran Household Expenditure and Income Survey, this article investigates the relationship between income and health care expenditure in urban and rural areas in Iran, a resource rich, upper-middle-income country. We implemented spline and quantile regression techniques to obtain a more robust description of the relationship of interest. This study finds non-uniform effects of income on health expenditures. Although the results show that health care is a necessity for all income brackets, spline regression estimates indicate that the income elasticity is lowest for the poorest Iranians in urban and rural areas. This suggests that they will show low flexibility in medical expenses as income fluctuates. Further, a quantile regression model assessing the effect of income at different level of medical expenditure suggests that households with lower medical expenses are less elastic.

International involvement and national health governance: the basic benefit package in Tajikistan.

PubMed

Rechel, Bernd; Khodjamurodov, Ghafur

2010-06-01

Tajikistan, a Central Asian state of 7.4 million inhabitants, is facing particular health policy challenges: not only is the country the poorest of the former Soviet republics, but its capacity to deal with post-communist transition and economic crisis has been further undermined through civil war and large-scale migration. This paper, examining the introduction of the basic benefit package and formal co-payments, elucidates how international involvement in Tajikistan's health sector has impacted on national health governance. Based on documentary sources and information provided by key informants, we find that external agencies have both strengthened and weakened national health governance. Although they have played a major part in supporting Tajikistan's health sector, these efforts have often been fragmented, as donor coordination was at times less than optimal. A key challenge for national health governance is the limited technical and institutional capacity of the Ministry of Health and further efforts are needed to build national capacity. Copyright 2010 Elsevier Ltd. All rights reserved.

The educational approach within Colombia's nutrition plan (PAN)

NASA Astrophysics Data System (ADS)

de Pizano, Julia Mejia

1980-03-01

With the knowledge that malnutrition affects the quality of life of an individual, the Colombian Government set up in 1976 a unique multi-sectorial plan (PAN), to combat the country's serious malnutrition. Government agencies and private industries in the sectors of production, distribution, health, sanitation, and education have coordinated their previously independent efforts. Among the interesting aspects are the coordination of sectors through work at various levels and through control of the budget, the limitation of bureaucracy, and the decentralization of decision-making. The ongoing attempts to overcome the difficulties encountered include making decisions in the face of inconclusive knowledge on what constitutes a well-balanced diet; combating the lack of knowledge of professionals about the environment of the poorest percentage of the population; and revising the traditional teaching method to make it more successful through a multi-media approach to assure wider coverage and more impact for the least cost, using materials such as games, puppets, posters and radio.

A community practitioner abroad: listening to women in Dailekh, Nepal.

PubMed

Nixon, Catherine

2015-07-01

Nepal is one of the poorest countries in the world, and has a strongly patriarchal culture. This study reports on methods used to explore women's opportunities in decision-making roles in Dailekh, Nepal. Action-based research was used to support women to identify barriers and to enable them to find solutions which could increase meaningful, practical and genuine representation. Participants were women in nominal positions of leadership in the community and subsequently also men in leadership roles. Focus groups and interviews enabled data to be collected and analysed using participatory and 'rich picture' tools. A five-stage framework approach was used to analyse data. A major theme of 'power' emerged comprised of supporting themes; 'place in society 'formal power,' informal power and 'voice'. These outcomes formed the basis for identifying viable action plans generated by the participants of both genders to promote meaningful involvement of women in community decision making. Women were clear that involving men and women in the actions was key to increasing success.

Deployment of ACT antimalarials for treatment of malaria: challenges and opportunities

PubMed Central

Whitty, Christopher JM; Chandler, Clare; Ansah, Evelyn; Leslie, Toby; Staedke, Sarah G

2008-01-01

Following a long period when the effectiveness of existing mono-therapies for antimalarials was steadily declining with no clear alternative, most malaria-endemic countries in Africa and Asia have adopted artemisinin combination therapy (ACT) as antimalarial drug policy. Several ACT drugs exist and others are in the pipeline. If properly targeted, they have the potential to reduce mortality from malaria substantially. The major challenge now is to get the drugs to the right people. Current evidence suggests that most of those who need the drugs do not get them. Simultaneously, a high proportion of those who are given antimalarials do not in fact have malaria. Financial and other barriers mean that, in many settings, the majority of those with malaria, particularly the poorest, do not access formal healthcare, so the provision of free antimalarials via this route has only limited impact. The higher cost of ACT creates a market for fake drugs. Addressing these problems is now a priority. This review outlines current evidence, possible solutions and research priorities. PMID:19091041

Vector-borne diseases in Haiti: a review.

PubMed

Ben-Chetrit, Eli; Schwartz, Eli

2015-01-01

Haiti lies on the western third of the island of Hispaniola in the Caribbean, and is one of the poorest nations in the Western hemisphere. Haiti attracts a lot of medical attention and support due to severe natural disasters followed by disastrous health consequences. Vector-borne infections are still prevalent there with some unique aspects comparing it to Latin American countries and other Caribbean islands. Although vector-borne viral diseases such as dengue and recently chikungunya can be found in many of the Caribbean islands, including Haiti, there is an apparent distinction of the vector-borne parasitic diseases. Contrary to neighboring Carribbean islands, Haiti is highly endemic for malaria, lymphatic filariasis and mansonellosis. Affected by repeat natural disasters, poverty and lack of adequate infrastructure, control of transmission within Haiti and prevention of dissemination of vector-borne pathogens to other regions is challenging. In this review we summarize some aspects concerning diseases caused by vector-borne pathogens in Haiti. Copyright © 2015 Elsevier Ltd. All rights reserved.

Why prioritize when there isn't enough money?

PubMed Central

Wikler, Daniel

2003-01-01

In an informal address to the 4th International Conference on Priorities in Health (Oslo, 23 September 2002), Professor Jeffrey Sachs – Chairperson of the WHO Commission on Macroeconomics and Health – maintained that the real causes of the inability of the world's poorest people to receive help for the lethal diseases that burden them did not include the "usual suspects" (corruption, mismanagement, and wrong priorities). Rather, the root cause was argued to be an inherent lack of money, indicating that the burden of disease would be lifted only if rich countries gave more money to poor ones. Without taking exception to anything that Sachs said in his address, there nevertheless remain a number of justifications for efforts to improve priority setting in the face of severely shortages of resources, including the following three defenses: prioritization is needed if we are to know that prioritization is insufficient; prioritization is most important when there is little money; prioritization can itself increase resources. PMID:12773216

How equitable is social franchising? Case studies of three maternal healthcare franchises in Uganda and India

PubMed Central

Haemmerli, Manon; Santos, Andreia; Penn-Kekana, Loveday; Lange, Isabelle; Matovu, Fred; Benova, Lenka; Wong, Kerry LM

2018-01-01

Abstract Substantial investments have been made in clinical social franchising to improve quality of care of private facilities in low- and middle-income countries but concerns have emerged that the benefits fail to reach poorer groups. We assessed the distribution of franchise utilization and content of care by socio-economic status (SES) in three maternal healthcare social franchises in Uganda and India (Uttar Pradesh and Rajasthan). We surveyed 2179 women who had received antenatal care (ANC) and/or delivery services at franchise clinics (in Uttar Pradesh only ANC services were offered). Women were allocated to national (Uganda) or state (India) SES quintiles. Franchise users were concentrated in the higher SES quintiles in all settings. The percent in the top two quintiles was highest in Uganda (over 98% for both ANC and delivery), followed by Rajasthan (62.8% for ANC, 72.1% for delivery) and Uttar Pradesh (48.5% for ANC). The percent of clients in the lowest two quintiles was zero in Uganda, 7.1 and 3.1% for ANC and delivery, respectively, in Rajasthan and 16.3% in Uttar Pradesh. Differences in SES distribution across the programmes may reflect variation in user fees, the average SES of the national/state populations and the range of services covered. We found little variation in content of care by SES. Key factors limiting the ability of such maternal health social franchises to reach poorer groups may include the lack of suitable facilities in the poorest areas, the inability of the poorest women to afford any private sector fees and competition with free or even incentivized public sector services. Moreover, there are tensions between targeting poorer groups, and franchise objectives of improving quality and business performance and enhancing financial sustainability, meaning that middle income and poorer groups are unlikely to be reached in large numbers in the absence of additional subsidies. PMID:29373681

How equitable is social franchising? Case studies of three maternal healthcare franchises in Uganda and India.

PubMed

Haemmerli, Manon; Santos, Andreia; Penn-Kekana, Loveday; Lange, Isabelle; Matovu, Fred; Benova, Lenka; Wong, Kerry L M; Goodman, Catherine

2018-04-01

Substantial investments have been made in clinical social franchising to improve quality of care of private facilities in low- and middle-income countries but concerns have emerged that the benefits fail to reach poorer groups. We assessed the distribution of franchise utilization and content of care by socio-economic status (SES) in three maternal healthcare social franchises in Uganda and India (Uttar Pradesh and Rajasthan). We surveyed 2179 women who had received antenatal care (ANC) and/or delivery services at franchise clinics (in Uttar Pradesh only ANC services were offered). Women were allocated to national (Uganda) or state (India) SES quintiles. Franchise users were concentrated in the higher SES quintiles in all settings. The percent in the top two quintiles was highest in Uganda (over 98% for both ANC and delivery), followed by Rajasthan (62.8% for ANC, 72.1% for delivery) and Uttar Pradesh (48.5% for ANC). The percent of clients in the lowest two quintiles was zero in Uganda, 7.1 and 3.1% for ANC and delivery, respectively, in Rajasthan and 16.3% in Uttar Pradesh. Differences in SES distribution across the programmes may reflect variation in user fees, the average SES of the national/state populations and the range of services covered. We found little variation in content of care by SES. Key factors limiting the ability of such maternal health social franchises to reach poorer groups may include the lack of suitable facilities in the poorest areas, the inability of the poorest women to afford any private sector fees and competition with free or even incentivized public sector services. Moreover, there are tensions between targeting poorer groups, and franchise objectives of improving quality and business performance and enhancing financial sustainability, meaning that middle income and poorer groups are unlikely to be reached in large numbers in the absence of additional subsidies.

Universal health coverage in Turkey: enhancement of equity.

PubMed

Atun, Rifat; Aydın, Sabahattin; Chakraborty, Sarbani; Sümer, Safir; Aran, Meltem; Gürol, Ipek; Nazlıoğlu, Serpil; Ozgülcü, Senay; Aydoğan, Ulger; Ayar, Banu; Dilmen, Uğur; Akdağ, Recep

2013-07-06

Turkey has successfully introduced health system changes and provided its citizens with the right to health to achieve universal health coverage, which helped to address inequities in financing, health service access, and health outcomes. We trace the trajectory of health system reforms in Turkey, with a particular emphasis on 2003-13, which coincides with the Health Transformation Program (HTP). The HTP rapidly expanded health insurance coverage and access to health-care services for all citizens, especially the poorest population groups, to achieve universal health coverage. We analyse the contextual drivers that shaped the transformations in the health system, explore the design and implementation of the HTP, identify the factors that enabled its success, and investigate its effects. Our findings suggest that the HTP was instrumental in achieving universal health coverage to enhance equity substantially, and led to quantifiable and beneficial effects on all health system goals, with an improved level and distribution of health, greater fairness in financing with better financial protection, and notably increased user satisfaction. After the HTP, five health insurance schemes were consolidated to create a unified General Health Insurance scheme with harmonised and expanded benefits. Insurance coverage for the poorest population groups in Turkey increased from 2·4 million people in 2003, to 10·2 million in 2011. Health service access increased across the country-in particular, access and use of key maternal and child health services improved to help to greatly reduce the maternal mortality ratio, and under-5, infant, and neonatal mortality, especially in socioeconomically disadvantaged groups. Several factors helped to achieve universal health coverage and improve outcomes. These factors include economic growth, political stability, a comprehensive transformation strategy led by a transformation team, rapid policy translation, flexible implementation with continuous learning, and simultaneous improvements in the health system, on both the demand side (increased health insurance coverage, expanded benefits, and reduced cost-sharing) and the supply side (expansion of infrastructure, health human resources, and health services). Copyright © 2013 Elsevier Ltd. All rights reserved.

Socioeconomic Segregation in Large Cities in France and the United States.

PubMed

Quillian, Lincoln; Lagrange, Hugues

2016-08-01

Past cross-national comparisons of socioeconomic segregation have been undercut by lack of comparability in measures, data, and concepts. Using IRIS data from the French Census of 2008 and the French Ministry of Finance as well as tract data from the American Community Survey (2006-2010) and the U.S. Department of Housing and Urban Development Picture of Subsidized Households, and constructing measures to be as similar as possible, we compare socioeconomic segregation in metropolitan areas with a population of more than 1 million in France and the United States. We find much higher socioeconomic segregation in large metropolitan areas in the United States than in France. We also find (1) a strong pattern of low-income neighborhoods in central cities and high-income neighborhoods in suburbs in the United States, but varying patterns across metropolitan areas in France; (2) that high-income persons are the most segregated group in both countries; (3) that the shares of neighborhood income differences that can be explained by neighborhood racial/ethnic composition are similar in France and the United States; and (4) that government-assisted housing is disproportionately located in the poorest neighborhoods in the United States but is spread across many neighborhood income levels in France. We conclude that differences in government provision of housing assistance and levels of income inequality are likely important contributing factors to the Franco-U.S. difference in socioeconomic segregation.

Waste disposal and households' heterogeneity. Identifying factors shaping attitudes towards source-separated recycling in Bogotá, Colombia.

PubMed

J Padilla, Alcides; Trujillo, Juan C

2018-04-01

Solid waste management in many cities of developing countries is not environmentally sustainable. People traditionally dispose of their solid waste in unsuitable urban areas like sidewalks and satellite dumpsites. This situation nowadays has become a serious public health problem in big Latin American conurbations. Among these densely-populated urban spaces, the Colombia's capital and main city stands out as a special case. In this study, we aim to identify the factors that shape the attitudes towards source-separated recycling among households in Bogotá. Using data from the Colombian Department of Statistics and Bogotá's multi-purpose survey, we estimated a multivariate Probit model. In general, our results show that the higher the household's socioeconomic class, the greater its effort for separating solid wastes. Likewise, our findings also allowed us to characterize household profiles regarding solid waste separation and considering each socioeconomic class. Among these profiles, we found that at lower socioeconomic classes, the attitudes towards solid waste separation are influenced by the use of Internet, the membership to an environmentalist organization, the level of education of the head of household and the homeownership. Hence, increasing the education levels within the poorest segment of the population, promoting affordable housing policies and facilitating Internet access for the vulnerable population could reinforce households' attitudes towards a greater source-separated recycling effort. Copyright © 2017 Elsevier Ltd. All rights reserved.

Finance is good for the poor but it depends where you live

PubMed Central

Rewilak, Johan

2013-01-01

I examine whether or not the incomes of the poor systematically grow with average incomes, and whether financial development enhances the incomes of the poorest quintile. Following the methodology of Dollar and Kraay (2002), I find, once extending Dollar and Kraay’s data, their findings are robust to the Lucas critique and economic growth is important for poverty reduction universally. However, in comparison to other authors’ work I show financial development aids the incomes of the poor in certain regions, whilst it may be detrimental in others. This proposes evidence against a “one size fits all” model adding a further contribution to the literature on financial development and poverty. PMID:23805027

Early-life family income and subjective well-being in adolescents.

PubMed

Gariepy, Genevieve; Elgar, Frank J; Sentenac, Mariane; Barrington-Leigh, Christopher

2017-01-01

Subjective well-being (SWB) in youths positively relates to family income, however its association with income during childhood is unclear. Using longitudinal data from the US Panel Study of Income Dynamics (n = 2234 adolescents, age 12-19 years), we examined whether the timing and duration of low family income in childhood was associated with adolescent SWB. We categorized family income during childhood into state-specific quintiles. Adolescent SWB was assessed using a 12-item questionnaire (score range 3-18). We used marginal structural modelling to test for sensitive periods of exposure to low income and tested cumulative effects of income by modelling the number of years spent in the poorest income quintiles. A period in early childhood (age 0-2 years) was particularly sensitive to low family income. Adolescent SWB was 1.65 (95% CI 0.40, 2.91) points lower in those who grew up in the poorest income quintiles during early childhood compared with the top quintile. Further, each childhood year spent in the poorest income quintiles was associated with a 0.10 point (95% CI 0.04, 0.16) lower SWB score in adolescence. The timing and duration of low family income in childhood both predict individual differences in adolescent SWB. Further studies are needed to clarify the mechanisms of these models and inform public policies.

Alcohol abuse and other factors associated with risky sexual behaviors among adolescent students from the poorest areas in Costa Rica.

PubMed

Rios-Zertuche, Diego; Cuchilla, Jose; Zúñiga-Brenes, Paola; Hernández, Bernardo; Jara, Patricia; Mokdad, Ali H; Iriarte, Emma

2017-03-01

We applied the Integrative Model of Behavioral Prediction to analyze factors associated with risky sexual behaviors for adolescent students living in the poorest segments in Costa Rica. We used data from a school-based knowledge, attitudes, and behaviors survey from the poorest districts of Costa Rica, collected for Salud Mesoamerica Initiative. We analyzed responses of 919 male and female students (12-19 years old) to determine factors associated with sexual intercourse and condom use. One of every four students reported being sexually active. Students that reported being sexually active were more likely to consume excessive alcohol (OR 3.04 [95 % CI 1.94-4.79]). While 88.0 % [95 % CI 73.5-95.1] of sexually active adolescents said they would use a condom the next time they have sex, only 53.1 % [95 % CI 39.3-66.5] reported condom use the last time. Non-condom-users felt purchasing condoms was uncomfortable (OR 0.34 [95 % CI 0.12-0.93]). Poor adolescents in Costa Rica begin sexual activities early and undertake behaviors that increase their risk for unwanted pregnancies and sexually transmitted infections. We found the urgent need to address alcohol abuse, and recognize gender differences in youth health programs.

The Fate of the World is in your hands: computer gaming for multi-faceted climate change education

NASA Astrophysics Data System (ADS)

Bedford, D. P.

2015-12-01

Climate change is a multi-faceted (or 'wicked') problem. True climate literacy therefore requires understanding not only the workings of the climate system, but also the current and potential future impacts of climate change and sea level rise on individuals, communities and countries around the world, as noted in the US Global Change Research Program's (2009) Climate Literacy: The Essential Principles of Climate Sciences. The asymmetric nature of climate change impacts, whereby the world's poorest countries have done the least to cause the problem but will suffer disproportionate consequences, has also been widely noted. Education in climate literacy therefore requires an element of ethics in addition to physical and social sciences. As if addressing these multiple aspects of climate change were not challenging enough, polling data has repeatedly shown that many members of the public tend to see climate change as a far away problem affecting people remote from them at a point in the future, but not themselves. This perspective is likely shared by many students. Computer gaming provides a possible solution to the combined problems of, on the one hand, addressing the multi-faceted nature of climate change, and, on the other hand, making the issue real to students. Fate of the World, a game produced by the company Red Redemption, has been used on several occasions in a small (20-30 students) introductory level general education course on global warming at Weber State University. Players are required to balance difficult decisions about energy investment while managing regional political disputes and attempting to maintain minimum levels of development in the world's poorer countries. By providing a realistic "total immersion" experience, the game has the potential to make climate change issues more immediate to players, and presents them with the ethical dilemmas inherent in climate change. This presentation reports on the use of Fate of the World in an educational setting, highlighting student experiences and lessons learned from two attempts to use the game as a tool for teaching the multi-faceted nature of climate change.

Price elasticity of tobacco products among economic classes in India, 2011–2012

PubMed Central

Selvaraj, Sakthivel; Srivastava, Swati; Karan, Anup

2015-01-01

Objectives The objectives of this study are to: (1) examine the pattern of price elasticity of three major tobacco products (bidi, cigarette and leaf tobacco) by economic groups of population based on household monthly per capita consumption expenditure in India and (2) assess the effect of tax increases on tobacco consumption and revenue across expenditure groups. Setting Data from the 2011–2012 nationally representative Consumer Expenditure Survey from 101 662 Indian households were used. Participants Households which consumed any tobacco or alcohol product were retained in final models. Primary outcome measures The study draws theoretical frameworks from a model using the augmented utility function of consumer behaviour, with a two-stage two-equation system of unit values and budget shares. Primary outcome measures were price elasticity of demand for different tobacco products for three hierarchical economic groups of population and change in tax revenue due to changes in tax structure. We finally estimated price elasticity of demand for bidi, cigarette and leaf tobacco and effects of changes in their tax rates on demand for these tobacco products and tax revenue. Results Own price elasticities for bidi were highest in the poorest group (−0.4328) and lowest in the richest group (−0.0815). Cigarette own price elasticities were −0.832 in the poorest group and −0.2645 in the richest group. Leaf tobacco elasticities were highest in the poorest (−0.557) and middle (−0.4537) groups. Conclusions Poorer group elasticities were the highest, indicating that poorer consumers are more price responsive. Elasticity estimates show positive distributional effects of uniform bidi and cigarette taxation on the poorest consumers, as their consumption is affected the most due to increases in taxation. Leaf tobacco also displayed moderate elasticities in poor and middle tertiles, suggesting that tax increases may result in a trade-off between consumption decline and revenue generation. A broad spectrum rise in tax rates across all products is critical for tobacco control. PMID:26656009

Association of 6-Minute Walk Performance and Physical Activity With Incident Ischemic Heart Disease Events and Stroke in Peripheral Artery Disease

PubMed Central

McDermott, Mary M; Greenland, Philip; Tian, Lu; Kibbe, Melina R; Green, David; Zhao, Lihui; Criqui, Michael H; Guralnik, Jack M; Ferrucci, Luigi; Liu, Kiang; Wilkins, John T; Huffman, Mark D; Shah, Sanjiv J; Liao, Yihua; Lloyd-Jones, Donald M

2015-01-01

Background We determined whether poorer 6-minute walk performance and lower physical activity levels are associated with higher rates of ischemic heart disease (IHD) events in people with lower extremity peripheral artery disease (PAD). Methods and Results Five hundred ten PAD participants were identified from Chicago-area medical centers and followed prospectively for 19.0±9.5 months. At baseline, participants completed the 6-minute walk and reported number of blocks walked during the past week (physical activity). IHD events were systematically adjudicated and consisted of new myocardial infarction, unstable angina, and cardiac death. For 6-minute walk, IHD event rates were 25/170 (14.7%) for the third (poorest) tertile, 10/171 (5.8%%) for the second tertile, and 6/169 (3.5%) for the first (best) tertile (P=0.003). For physical activity, IHD event rates were 21/154 (13.6%) for the third (poorest) tertile, 15/174 (8.6%) for the second tertile, and 5/182 (2.7%) for the first (best) tertile (P=0.001). Adjusting for age, sex, race, smoking, body mass index, comorbidities, and physical activity, participants in the poorest 6-minute walk tertile had a 3.28-fold (95% CI 1.17 to 9.17, P=0.024) higher hazard for IHD events, compared with those in the best tertile. Adjusting for confounders including 6-minute walk, participants in the poorest physical activity tertile had a 3.72-fold (95% CI 1.24 to 11.19, P=0.019) higher hazard for IHD events, compared with the highest tertile. Conclusions Six-minute walk and physical activity predict IHD event rates in PAD. Further study is needed to determine whether interventions that improve 6-minute walk, physical activity, or both can reduce IHD events in PAD. PMID:26219563

Coverage and inequalities in maternal and child health interventions in Afghanistan.

PubMed

Akseer, Nadia; Bhatti, Zaid; Rizvi, Arjumand; Salehi, Ahmad S; Mashal, Taufiq; Bhutta, Zulfiqar A

2016-09-12

Afghanistan has made considerable gains in improving maternal and child health and survival since 2001. However, socioeconomic and regional inequities may pose a threat to reaching universal coverage of health interventions and further health progress. We explored coverage and socioeconomic inequalities in key life-saving reproductive, maternal, newborn and child health (RMNCH) interventions at the national level and by region in Afghanistan. We also assessed gains in child survival through scaling up effective community-based interventions across wealth groups. Using data from the Afghanistan Multiple Indicator Cluster Survey (MICS) 2010/11, we explored 11 interventions that spanned all stages of the continuum of care, including indicators of composite coverage. Asset-based wealth quintiles were constructed using standardised methods, and absolute inequalities were explored using wealth quintile (Q) gaps (Q5-Q1) and the slope index of inequality (SII), while relative inequalities were assessed with ratios (Q5/Q1) and the concentration index (CIX). The lives saved tool (LiST) modeling used to estimate neonatal and post-neonatal deaths averted from scaling up essential community-based interventions by 90 % coverage by 2025. Analyses considered the survey design characteristics and were conducted via STATA version 12.0 and SAS version 9.4. Our results underscore significant pro-rich socioeconomic absolute and relative inequalities, and mass population deprivation across most all RMNCH interventions studied. The most inequitable are antenatal care with a skilled attendant (ANCS), skilled birth attendance (SBA), and 4 or more antenatal care visits (ANC4) where the richest have between 3.0 and 5.6 times higher coverage relative to the poor, and Q5-Q1 gaps range from 32 % - 65 %. Treatment of sick children and breastfeeding interventions are the most equitably distributed. Across regions, inequalities were highest in the more urbanised East, West and Central regions of the country, while they were lowest in the South and Southeast. About 7700 newborns and 26,000 post-neonates could be saved by scaling up coverage of community outreach interventions to 90 %, with the most gains in the poorest quintiles. Afghanistan is a pervasively poor and conflict-prone nation that has only recently experienced a decade of relative stability. Though donor investments during this period have been plentiful and have contributed to rebuilding of health infrastructure in the country, glaring inequities remain. A resolution to scaling up health coverage in insecure and isolated regions, and improving accessibility for the poorest and marginalised populations, should be at the forefront of national policy and programming efforts.

Factors associated with postnatal care utilisation in Rwanda: A secondary analysis of 2010 Demographic and Health Survey data.

PubMed

Rwabufigiri, Bernard N; Mukamurigo, Judith; Thomson, Dana R; Hedt-Gautier, Bethany L; Semasaka, Jean Paul S

2016-05-31

Postnatal care (PNC) in the first seven days is important for preventing morbidity and mortality in mothers and new-borns. Sub-Saharan African countries, which account for 62 % of maternal deaths globally, have made major efforts to increase PNC utilisation, but utilisation rates remains low even in countries like Rwanda where PNC services are universally available for free. This study identifies key socio-economic and demographic factors associated with PNC utilisation in Rwanda to inform improved PNC policies and programs. This is a secondary analysis of the 2010 Demographic and Health Survey, a national multi-stage, cross-sectional survey. In bivariate analysis, we used chi-square tests to identify demographic and socio-economic factors associated with PNC utilisation at α = 0.1. Pearson's R statistic (r > 0.5) was used to identify collinear covariates, and to choose which covariate was more strongly associated with PNC utilisation. Manual backward stepwise logistic regression was performed on the remaining covariates to identify key factors associated with PNC utilisation at α = 0.05. All analyses were performed in Stata 13 adjusting for sampling weights, clustering, and stratification. Of the 2,748 women with a live birth in the last two years who answered question about PNC utilisation, 353 (12.8 %) returned for PNC services within seven days after birth. Three factors were positively associated with PNC use: delivering at a health facility (OR: 2.97; 95 % CI: 2.28-3.87), being married but not involved with one's own health care decision-making (OR: 1.69; 95 % CI: 1.17, 2.44) compared to being married and involved; and being in the second (OR: 1.46; 95 % CI: 1.01-2.09) or richest wealth quintile (OR: 2.04; 95 % CI: 1.27-3.29) compared to the poorest. Mother's older age at delivery was negatively associated with PNC use (20-29 - OR: 0.51, 95 % CI: 0.29-0.87; 30-39 - OR: 0.47, 95 % CI: 0.27-0.83; 40-49 - OR: 0.32, 95 % CI: 0.16-0.64). Low PNC utilisation in Rwanda appears to be a universal problem though older age and poverty are further barriers to PNC utilisation. A recent change in the provision of BCG vaccination to new-borns might promote widespread PNC utilisation. We further recommend targeted campaigns to older mothers and poorest mothers, focusing on perceptions of health system quality, cultural beliefs, and pregnancy risks.

The Prevention and Control of HIV/AIDS, TB and Vector-borne Diseases in Informal Settlements: Challenges, Opportunities and Insights

PubMed Central

Mercado, Susan P.; Becker, Daniel; Edmundo, Katia; Mugisha, Frederick

2007-01-01

Today’s urban settings are redefining the field of public health. The complex dynamics of cities, with their concentration of the poorest and most vulnerable (even within the developed world) pose an urgent challenge to the health community. While retaining fidelity to the core principles of disease prevention and control, major adjustments are needed in the systems and approaches to effectively reach those with the greatest health risks (and the least resilience) within today’s urban environment. This is particularly relevant to infectious disease prevention and control. Controlling and preventing HIV/AIDS, tuberculosis and vector-borne diseases like malaria are among the key global health priorities, particularly in poor urban settings. The challenge in slums and informal settlements is not in identifying which interventions work, but rather in ensuring that informal settlers: (1) are captured in health statistics that define disease epidemiology and (2) are provided opportunities equal to the rest of the population to access proven interventions. Growing international attention to the plight of slum dwellers and informal settlers, embodied by Goal 7 Target 11 of the Millennium Development Goals, and the considerable resources being mobilized by the Global Fund to fight AIDS, TB and malaria, among others, provide an unprecedented potential opportunity for countries to seriously address the structural and intermediate determinants of poor health in these settings. Viewed within the framework of the “social determinants of disease” model, preventing and controlling HIV/AIDS, TB and vector-borne diseases requires broad and integrated interventions that address the underlying causes of inequity that result in poorer health and worse health outcomes for the urban poor. We examine insights into effective approaches to disease control and prevention within poor urban settings under a comprehensive social development agenda. PMID:17431796

Karst Geomophology and Hazards in Bijie, Guizhou

NASA Astrophysics Data System (ADS)

Zhang, Dachang

2010-05-01

The largest intensively karstified area in China is in the Southwest China, including Guangxi, Guizhou, and Yunnan provinces. Bijie Prefecture lies in the fragile karst ecological high mountains of Guizhou, and is one of the country's poorest regions, characterized with serious soil erosion and rock desertification, companied with thin-poor soil, aridlands, waterlog, mud-rock flow, landslide, ground cracks, ground subsidence, difficulty in the rural water supply, slope degraded ecosystem, etc. To lift the people especially the farmers out of poverty and backwardness, Bijie Prefecture is set up as the national "Developing Anti-poverty, Ecological Construction" theme pilot area, providing the necessary experience of the coexist in harmony and sustainable development between man and nature. The main task is to control rock-desertification. However, most, if not all efforts, have encountered difficulties. (1) The karst water system characterized by groundriver and rapid conduit flow cannot provide a stable, adequate source of drinking water, not to mention the irrigation water. (2) Plants on the arid slopes, owing to the lack of water and fertilizer, grow slowly and unhealth and cannot help much to improve land carrying capacity in a very long period of time. (3) The current ecological rehabilitation or reconstruction measures cannot stop the continuing expansion of the land rocky desertification, and elimination of frequent droughts alternating flood disaster in many depressions. (4) The harmony is still not reached between economic development and ecosystem rehabilitation or reconstruction, and as a result, the farmers are still in poverty. It is a goal of historic significance to actively exploring the innovation and breakthrough in the scientific theory, method and technology to promote the pilot area changing from the rocky desertification to a beautiful ecological environment, endeavour to achieve economic and social growth by leaps and bounds.

Private sector participation and health system performance in sub-saharan Africa.

PubMed

Yoong, Joanne; Burger, Nicholas; Spreng, Connor; Sood, Neeraj

2010-10-07

The role of the private health sector in developing countries remains a much-debated and contentious issue. Critics argue that the high prices charged in the private sector limits the use of health care among the poorest, consequently reducing access and equity in the use of health care. Supporters argue that increased private sector participation might improve access and equity by bringing in much needed resources for health care and by allowing governments to increase focus on underserved populations. However, little empirical exists for or against either side of this debate. We examine the association between private sector participation and self-reported measures of utilization and equity in deliveries and treatment of childhood respiratory disease using regression analysis, across a sample of nationally-representative Demographic and Health Surveys from 34 SSA economies. We also examine the correlation between private sector participation and key background factors (socioeconomic development, business environment and governance) and use multivariate regression to control for potential confounders. Private sector participation is positively associated with greater overall access and reduced disparities between rich and poor as well as urban and rural populations. The positive association between private sector participation and improved health system performance is robust to controlling for confounders including per capita income and maternal education. Private sector participation is positively correlated with measures of socio-economic development and favorable business environment. Greater participation is associated with favorable intermediate outcomes in terms of access and equity. While these results do not establish a causal link between private sector participation and health system performance, they suggest that there is no deleterious link between private sector participation and health system performance in SSA.

The poorest of the poor: a poverty appraisal of households affected by visceral leishmaniasis in Bihar, India.

PubMed

Boelaert, M; Meheus, F; Sanchez, A; Singh, S P; Vanlerberghe, V; Picado, A; Meessen, B; Sundar, S

2009-06-01

To provide data about wealth distribution in visceral leishmaniasis (VL)-affected communities compared to that of the general population of Bihar State, India. After extensive disease risk mapping, 16 clusters with high VL transmission were selected in Bihar. An exhaustive census of all households in the clusters was conducted and socio-economic household characteristics were documented by questionnaire. Data on the general Bihar population taken from the National Family Health Survey of India were used for comparison. An asset index was developed based on Principal Components Analysis and the distribution of this asset index for the VL communities was compared with that of the general population of Bihar. 83% of households in communities with high VL attack rates belonged to the two lowest quintiles of the Bihar wealth distribution. All socio-economic indicators showed significantly lower wealth for those households. Visceral leishmaniasis clearly affects the poorest of the poor in India. They are most vulnerable, as this vector-born disease is linked to poor housing and unhealthy habitats. The disease leads the affected households to more destitution because of its impact on household income and wealth. Support for the present VL elimination initiative is important in the fight against poverty.

Tobacco use & social status in Kerala.

PubMed

Thankappan, K R; Thresia, C U

2007-10-01

Health indicators of Kerala State such as infant mortality rate (14/ 1000 live births) and life expectancy at birth (71 yr for men and 76 yr for women) are far ahead of the Indian averages (IMR 58, life expectancy men 62 and women 63) and closer to the developed countries. However, tobacco use prevalence is similar to the national average. Smoking is the commonest form of tobacco usage among men in the State whereas chewing tobacco is more common among women and children. Tobacco chewing among men is increasing in Kerala probably due to the smoking ban and industry strategy to focus on smokeless tobacco. Tobacco use is significantly more among the low socio-economic (SE) groups compared to the high SE group. Mortality and morbidity attributed to tobacco is higher among the poorest people in the State. Age adjusted cancer rate of oral cavity and lung cancer has been increasing in the State in recent years. Heart diseases among the young people are increasing in the State. Cancer and heart diseases are chronic illnesses which may pull the individual and the entire family below the poverty line. Tobacco control therefore should be a top priority not only as a health issue but as a poverty reduction issue. Poverty alleviation is one of the major goals of developing economies. No poverty alleviation programme can ignore the potential impoverishment associated with tobacco use. Kerala with a very strong decentralized government has a very good opportunity to address tobacco control as a priority at the grass root level and reduce the impoverishment due to tobacco use.

Drinking water sources, availability, quality, access and utilization for goats in the Karak Governorate, Jordan.

PubMed

Al-Khaza'leh, Ja'far Mansur; Reiber, Christoph; Al Baqain, Raid; Valle Zárate, Anne

2015-01-01

Goat production is an important agricultural activity in Jordan. The country is one of the poorest countries in the world in terms of water scarcity. Provision of sufficient quantity of good quality drinking water is important for goats to maintain feed intake and production. This study aimed to evaluate the seasonal availability and quality of goats' drinking water sources, accessibility, and utilization in different zones in the Karak Governorate in southern Jordan. Data collection methods comprised interviews with purposively selected farmers and quality assessment of water sources. The provision of drinking water was considered as one of the major constraints for goat production, particularly during the dry season (DS). Long travel distances to the water sources, waiting time at watering points, and high fuel and labor costs were the key reasons associated with the problem. All the values of water quality (WQ) parameters were within acceptable limits of the guidelines for livestock drinking WQ with exception of iron, which showed slightly elevated concentration in one borehole source in the DS. These findings show that water shortage is an important problem leading to consequences for goat keepers. To alleviate the water shortage constraint and in view of the depleted groundwater sources, alternative water sources at reasonable distance have to be tapped and monitored for water quality and more efficient use of rainwater harvesting systems in the study area is recommended.

Leaving no one behind: a neglected tropical disease indicator and tracers for the Sustainable Development Goals

PubMed Central

Fitzpatrick, Christopher; Engels, Dirk

2016-01-01

The Sustainable Development Goals (SDGs) have emerged as a global pledge to ‘leave no one behind’. Under SDG 3, ‘Ensure healthy lives and promote wellbeing for all’, target 3.3 extends the Millennium Development Goals (MDGs) beyond HIV, TB and malaria to ‘end the epidemic’ of neglected tropical diseases (NTDs) by 2030. Other targets are also relevant to NTDs, especially 3.8 (Universal Health Coverage), 6.1 (water) and 6.2 (sanitation). This commentary summarises the proposed NTD indicator (3.3) and tracers (3.8 and 6.1/6.2). These will help ensure that the world's poorest and most marginalized people are prioritized at every step on the path towards SDG targets. PMID:26940304

Early-life family income and subjective well-being in adolescents

PubMed Central

Elgar, Frank J.; Sentenac, Mariane; Barrington-Leigh, Christopher

2017-01-01

Purpose Subjective well-being (SWB) in youths positively relates to family income, however its association with income during childhood is unclear. Using longitudinal data from the US Panel Study of Income Dynamics (n = 2234 adolescents, age 12–19 years), we examined whether the timing and duration of low family income in childhood was associated with adolescent SWB. Methods We categorized family income during childhood into state-specific quintiles. Adolescent SWB was assessed using a 12-item questionnaire (score range 3–18). We used marginal structural modelling to test for sensitive periods of exposure to low income and tested cumulative effects of income by modelling the number of years spent in the poorest income quintiles. Results A period in early childhood (age 0–2 years) was particularly sensitive to low family income. Adolescent SWB was 1.65 (95% CI 0.40, 2.91) points lower in those who grew up in the poorest income quintiles during early childhood compared with the top quintile. Further, each childhood year spent in the poorest income quintiles was associated with a 0.10 point (95% CI 0.04, 0.16) lower SWB score in adolescence. Conclusions The timing and duration of low family income in childhood both predict individual differences in adolescent SWB. Further studies are needed to clarify the mechanisms of these models and inform public policies. PMID:28715418

Developing a European urban health indicator system: results of EURO-URHIS 1.

PubMed

Patterson, Lesley; Heller, Richard; Robinson, Jude; Birt, Christopher A; van Ameijden, Erik; Bocsan, Ioan; White, Chris; Skalkidis, Yannis; Bothra, Vinay; Onyia, Ifeoma; Hellmeier, Wolfgang; Lyshol, Heidi; Gemmell, Isla; Spencer, Angela; Klumbiene, Jurate; Krampac, Igor; Rajnicova, Iveta; Macherianakis, Alexis; Bourke, Michael; Harrison, Annie; Verma, Arpana

2017-05-01

More than half of the world's population now live in cities, including over 70% in Europe. Cities bring opportunities but can be unhealthy places to live. The poorest urban dwellers live in the worst environments and are at the greatest risk of poor health outcomes. EURO-URHIS 1 set out to compile a cross-EU inventory of member states use of measures of urban health in order to support policymakers and improve public health policy. Following a literature review to define terms and find an appropriate model to guide urban health research, EURO-URHIS Urban Areas in all EU member states except Luxembourg, as well as Croatia, Turkey, Macedonia, Iceland and Norway, were defined and selected in collaboration with project partners. Following piloting of the survey tool, a the EURO-URHIS 45 data collection tool was sent out to contacts in all countries with identified EUA's, asking for data on 45 Urban Health Indicators (UHI) and 10 other indicators. 60 questionnaires were received from 30 countries, giving information on local health indicator availability, definitions and sources. Telephone interviews were also conducted with 14 respondents about their knowledge of sources of urban health data and barriers or problems experienced when collecting the data. Most participants had little problem identifying the sources of data, though some found that data was not always routinely recorded and was held by diverse sources or not at local level. Some participants found the data collection instrument to not be user-friendly and with UHI definitions that were sometimes unclear. However, the work has demonstrated that urban health and its measurement is of major relevance and importance for Public Health across Europe. The current study has constructed an initial system of European UHIs to meet the objectives of the project, but has also clearly demonstrated that further development work is required. The importance and value of examining UHIs has been confirmed, and the scene has been set for further studies on this topic. © The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Modern contraceptive use, unmet need, and demand satisfied among women of reproductive age who are married or in a union in the focus countries of the Family Planning 2020 initiative: a systematic analysis using the Family Planning Estimation Tool.

PubMed

Cahill, Niamh; Sonneveldt, Emily; Stover, John; Weinberger, Michelle; Williamson, Jessica; Wei, Chuchu; Brown, Win; Alkema, Leontine

2018-03-03

The London Summit on Family Planning in 2012 inspired the Family Planning 2020 (FP2020) initiative and the 120×20 goal of having an additional 120 million women and adolescent girls become users of modern contraceptives in 69 of the world's poorest countries by the year 2020. Working towards achieving 120 × 20 is crucial for ultimately achieving the Sustainable Development Goals of universal access and satisfying demand for reproductive health. Thus, a performance assessment is required to determine countries' progress. An updated version of the Family Planning Estimation Tool (FPET) was used to construct estimates and projections of the modern contraceptive prevalence rate (mCPR), unmet need for, and demand satisfied with modern methods of contraception among women of reproductive age who are married or in a union in the focus countries of the FP2020 initiative. We assessed current levels of family planning indicators and changes between 2012 and 2017. A counterfactual analysis was used to assess if recent levels of mCPR exceeded pre-FP2020 expectations. In 2017, the mCPR among women of reproductive age who are married or in a union in the FP2020 focus countries was 45·7% (95% uncertainty interval [UI] 42·4-49·1), unmet need for modern methods was 21·6% (19·7-23·9), and the demand satisfied with modern methods was 67·9% (64·4-71·1). Between 2012 and 2017 the number of women of reproductive age who are married or in a union who use modern methods increased by 28·8 million (95% UI 5·8-52·5). At the regional level, Asia has seen the mCPR among women of reproductive age who are married or in a union grow from 51·0% (95% UI 48·5-53·4) to 51·8% (47·3-56·5) between 2012 and 2017, which is slow growth, particularly when compared with a change from 23·9% (22·9-25·0) to 28·5% (26·8-30·2) across Africa. At the country level, based on a counterfactual analysis, we found that 61% of the countries that have made a commitment to FP2020 exceeded pre-FP2020 expectations for modern contraceptive use. Country success stories include rapid increases in Kenya, Mozambique, Malawi, Lesotho, Sierra Leone, Liberia, and Chad relative to what was expected in 2012. Whereas the estimate of additional users up to 2017 for women of reproductive age who are married or in a union would suggest that the 120 × 20 goal for all women is overly ambitious, the aggregate outcomes mask the diversity in progress at the country level. We identified countries with accelerated progress, that provide inspiration and guidance on how to increase the use of family planning and inform future efforts, especially in countries where progress has been poor. The Bill & Melinda Gates Foundation, through grant support to the University of Massachusetts Amherst and Avenir Health. Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

A Global Assessment of Access to and Use of Medical Information: The State of Evidence-Based Surgery.

PubMed

LaGrone, Lacey N; Fuhs, Amy K; Egoavil, Eduardo Huaman; Langdale, Lorrie A; Fuangworawong, Phupit; Hamasaki, Jose Luis; Gyedu, Adam; Mock, Charles N

2018-02-01

We aimed to assess surgeons' access to and use of medical information, as well as their training and perceptions about evidence-based medicine (EBM), in order to identify priority areas for improvement. An anonymous survey conducted among surgeons from the USA, Ghana, Peru, and Thailand examined access to, and use and perception of, medical literature. Of 307 participants, 98% reported access to "OK" or "good" internet. Fifty-one percent reported that language was a barrier to accessing needed medical information; most frequently in Peru (73%) and Thailand (64%). Access to priced full-text journals was poorest in Peru, where 54% lacked access, followed by Ghana (42%) and Thailand (32%). US respondents scored highest on the EBM knowledge test (1.4, SD 0.8), followed by Thailand (1.3, SD 0.9), Ghana (1.1, SD 0.8), and Peru (0.9, SD 0.8) (p < 0.001). Adjusted analysis revealed Ghanaians and Peruvians spent 5% and 1% more on medical information, respectively, relative to country income, than persons from other countries (p < 0.01). After adjustment, employment in a large and/or urban hospital and history of EBM training were associated with better EBM test scores, while middle-income origin and public hospital employment were associated with worse scores (p < 0.05). Language, access to priced full-text journals, and training are significant barriers to surgeons' practice of EBM globally. The way forward involves collaboration among surgical societies, publishers, hospital employers, and international policymakers in providing surgeons from all country income levels with the access and training necessary to interpret and apply medical information.

Carbon dioxide (CO2) levels this century will alter the protein, micronutrients, and vitamin content of rice grains with potential health consequences for the poorest rice-dependent countries

PubMed Central

Zhu, Jianguo; Jiang, Qian; Xu, Xi; Liu, Gang; Ebi, Kristie L.; Drewnowski, Adam

2018-01-01

Declines of protein and minerals essential for humans, including iron and zinc, have been reported for crops in response to rising atmospheric carbon dioxide concentration, [CO2]. For the current century, estimates of the potential human health impact of these declines range from 138 million to 1.4 billion, depending on the nutrient. However, changes in plant-based vitamin content in response to [CO2] have not been elucidated. Inclusion of vitamin information would substantially improve estimates of health risks. Among crop species, rice is the primary food source for more than 2 billion people. We used multiyear, multilocation in situ FACE (free-air CO2 enrichment) experiments for 18 genetically diverse rice lines, including Japonica, Indica, and hybrids currently grown throughout Asia. We report for the first time the integrated nutritional impact of those changes (protein, micronutrients, and vitamins) for the 10 countries that consume the most rice as part of their daily caloric supply. Whereas our results confirm the declines in protein, iron, and zinc, we also find consistent declines in vitamins B1, B2, B5, and B9 and, conversely, an increase in vitamin E. A strong correlation between the impacts of elevated [CO2] on vitamin content based on the molecular fraction of nitrogen within the vitamin was observed. Finally, potential health risks associated with anticipated CO2-induced deficits of protein, minerals, and vitamins in rice were correlated to the lowest overall gross domestic product per capita for the highest rice-consuming countries, suggesting potential consequences for a global population of approximately 600 million. PMID:29806023

Carbon dioxide (CO2) levels this century will alter the protein, micronutrients, and vitamin content of rice grains with potential health consequences for the poorest rice-dependent countries.

PubMed

Zhu, Chunwu; Kobayashi, Kazuhiko; Loladze, Irakli; Zhu, Jianguo; Jiang, Qian; Xu, Xi; Liu, Gang; Seneweera, Saman; Ebi, Kristie L; Drewnowski, Adam; Fukagawa, Naomi K; Ziska, Lewis H

2018-05-01

Declines of protein and minerals essential for humans, including iron and zinc, have been reported for crops in response to rising atmospheric carbon dioxide concentration, [CO 2 ]. For the current century, estimates of the potential human health impact of these declines range from 138 million to 1.4 billion, depending on the nutrient. However, changes in plant-based vitamin content in response to [CO 2 ] have not been elucidated. Inclusion of vitamin information would substantially improve estimates of health risks. Among crop species, rice is the primary food source for more than 2 billion people. We used multiyear, multilocation in situ FACE (free-air CO 2 enrichment) experiments for 18 genetically diverse rice lines, including Japonica, Indica, and hybrids currently grown throughout Asia. We report for the first time the integrated nutritional impact of those changes (protein, micronutrients, and vitamins) for the 10 countries that consume the most rice as part of their daily caloric supply. Whereas our results confirm the declines in protein, iron, and zinc, we also find consistent declines in vitamins B1, B2, B5, and B9 and, conversely, an increase in vitamin E. A strong correlation between the impacts of elevated [CO 2 ] on vitamin content based on the molecular fraction of nitrogen within the vitamin was observed. Finally, potential health risks associated with anticipated CO 2 -induced deficits of protein, minerals, and vitamins in rice were correlated to the lowest overall gross domestic product per capita for the highest rice-consuming countries, suggesting potential consequences for a global population of approximately 600 million.

Estimating the Global Burden of Endemic Canine Rabies

PubMed Central

Hampson, Katie; Coudeville, Laurent; Lembo, Tiziana; Sambo, Maganga; Kieffer, Alexia; Attlan, Michaël; Barrat, Jacques; Blanton, Jesse D.; Briggs, Deborah J.; Cleaveland, Sarah; Costa, Peter; Freuling, Conrad M.; Hiby, Elly; Knopf, Lea; Leanes, Fernando; Meslin, François-Xavier; Metlin, Artem; Miranda, Mary Elizabeth; Müller, Thomas; Nel, Louis H.; Recuenco, Sergio; Rupprecht, Charles E.; Schumacher, Carolin; Taylor, Louise; Vigilato, Marco Antonio Natal; Zinsstag, Jakob; Dushoff, Jonathan

2015-01-01

Background Rabies is a notoriously underreported and neglected disease of low-income countries. This study aims to estimate the public health and economic burden of rabies circulating in domestic dog populations, globally and on a country-by-country basis, allowing an objective assessment of how much this preventable disease costs endemic countries. Methodology/Principal Findings We established relationships between rabies mortality and rabies prevention and control measures, which we incorporated into a model framework. We used data derived from extensive literature searches and questionnaires on disease incidence, control interventions and preventative measures within this framework to estimate the disease burden. The burden of rabies impacts on public health sector budgets, local communities and livestock economies, with the highest risk of rabies in the poorest regions of the world. This study estimates that globally canine rabies causes approximately 59,000 (95% Confidence Intervals: 25-159,000) human deaths, over 3.7 million (95% CIs: 1.6-10.4 million) disability-adjusted life years (DALYs) and 8.6 billion USD (95% CIs: 2.9-21.5 billion) economic losses annually. The largest component of the economic burden is due to premature death (55%), followed by direct costs of post-exposure prophylaxis (PEP, 20%) and lost income whilst seeking PEP (15.5%), with only limited costs to the veterinary sector due to dog vaccination (1.5%), and additional costs to communities from livestock losses (6%). Conclusions/Significance This study demonstrates that investment in dog vaccination, the single most effective way of reducing the disease burden, has been inadequate and that the availability and affordability of PEP needs improving. Collaborative investments by medical and veterinary sectors could dramatically reduce the current large, and unnecessary, burden of rabies on affected communities. Improved surveillance is needed to reduce uncertainty in burden estimates and to monitor the impacts of control efforts. PMID:25881058

The Financial Burden of Non-Communicable Chronic Diseases in Rural Nigeria: Wealth and Gender Heterogeneity in Health Care Utilization and Health Expenditures.

PubMed

Janssens, Wendy; Goedecke, Jann; de Bree, Godelieve J; Aderibigbe, Sunday A; Akande, Tanimola M; Mesnard, Alice

2016-01-01

Better insights into health care utilization and out-of-pocket expenditures for non-communicable chronic diseases (NCCD) are needed to develop accessible health care and limit the increasing financial burden of NCCDs in Sub-Saharan Africa. A household survey was conducted in rural Kwara State, Nigeria, among 5,761 individuals. Data were obtained using biomedical and socio-economic questionnaires. Health care utilization, NCCD-related health expenditures and distances to health care providers were compared by sex and by wealth quintile, and a Heckman regression model was used to estimate health expenditures taking selection bias in health care utilization into account. The prevalence of NCCDs in our sample was 6.2%. NCCD-affected individuals from the wealthiest quintile utilized formal health care nearly twice as often as those from the lowest quintile (87.8% vs 46.2%, p = 0.002). Women reported foregone formal care more often than men (43.5% vs. 27.0%, p = 0.058). Health expenditures relative to annual consumption of the poorest quintile exceeded those of the highest quintile 2.2-fold, and the poorest quintile exhibited a higher rate of catastrophic health spending (10.8% among NCCD-affected households) than the three upper quintiles (4.2% to 6.7%). Long travel distances to the nearest provider, highest for the poorest quintile, were a significant deterrent to seeking care. Using distance to the nearest facility as instrument to account for selection into health care utilization, we estimated out-of-pocket health care expenditures for NCCDs to be significantly higher in the lowest wealth quintile compared to the three upper quintiles. Facing potentially high health care costs and poor accessibility of health care facilities, many individuals suffering from NCCDs-particularly women and the poor-forego formal care, thereby increasing the risk of more severe illness in the future. When seeking care, the poor spend less on treatment than the rich, suggestive of lower quality care, while their expenditures represent a higher share of their annual household consumption. This calls for targeted interventions that enhance health care accessibility and provide financial protection from the consequences of NCCDs, especially for vulnerable populations.

Distributional cost-effectiveness analysis in low- and middle-income countries: illustrative example of rotavirus vaccination in Ethiopia.

PubMed

Dawkins, Bryony R; Mirelman, Andrew J; Asaria, Miqdad; Johansson, Kjell Arne; Cookson, Richard A

2018-04-01

Reducing health inequality is a major policy concern for low- and middle-income countries (LMICs) on the path to universal health coverage. However, health inequality impacts are rarely quantified in cost-effectiveness analyses of health programmes. Distributional cost-effectiveness analysis (DCEA) is a method developed to analyse the expected social distributions of costs and health benefits, and the potential trade-offs that may exist between maximising total health and reducing health inequality. This is the first paper to show how DCEA can be applied in LMICs. Using the introduction of rotavirus vaccination in Ethiopia as an illustrative example, we analyse a hypothetical re-designed vaccination programme, which invests additional resources into vaccine delivery in rural areas, and compare this with the standard programme currently implemented in Ethiopia. We show that the re-designed programme has an incremental cost-effectiveness ratio of US$69 per health-adjusted life year (HALY) compared with the standard programme. This is potentially cost-ineffective when compared with current estimates of health opportunity cost in Ethiopia. However, rural populations are typically less wealthy than urban populations and experience poorer lifetime health. Prioritising such populations can thus be seen as being equitable. We analyse the trade-off between cost-effectiveness and equity using the Atkinson inequality aversion parameter, ε, representing the decision maker's strength of concern for reducing health inequality. We find that the more equitable programme would be considered worthwhile by a decision maker whose inequality concern is greater than ε = 5.66, which at current levels of health inequality in Ethiopia implies that health gains are weighted at least 3.86 times more highly in the poorest compared with the richest wealth quintile group. We explore the sensitivity of this conclusion to a range of assumptions and cost-per-HALY threshold values, to illustrate how DCEA can inform the thinking of decision makers and stakeholders about health equity trade-offs.

Economic costs of hospitalized diarrheal disease in Bangladesh: a societal perspective.

PubMed

Sarker, Abdur Razzaque; Sultana, Marufa; Mahumud, Rashidul Alam; Ali, Nausad; Huda, Tanvir M; Salim Uzzaman, M; Haider, Sabbir; Rahman, Hafizur; Islam, Ziaul; Khan, Jahangir A M; Van Der Meer, Robert; Morton, Alec

2018-01-01

Diarrheal diseases are a major threat to human health and still represent a leading cause of morbidity and mortality worldwide. Although the burden of the diarrheal diseases is much lower in developed countries, it is a significant public health problem in low and middle-income countries like Bangladesh. Though diarrhea is preventable and managed with low-cost interventions, it is still the leading cause of morbidity according to the patient who sought care from public hospitals in Bangladesh indicating that significant resources are consumed in treating those patients. The aim of the study is to capture the inpatients and outpatient treatment cost of diarrheal disease and to measure the cost burden and coping mechanisms associated with diarrheal illness. This study was conducted in six randomly selected district hospitals from six divisions (larger administrative units) in Bangladesh. The study was performed from the societal perspective which means all types of costs were identified, measured and valued no matter who incurred them. Cost analysis was estimated using the guideline proposed by the World Health Organization for estimating the economic burden of diarrheal diseases. The study adopted quantitative techniques to collect the household and hospital level data including structured and semi-structured questionnaires, observation checklists, analysis of hospital database, telephone interviews and compilation of service statistics. The average total societal cost of illness per episode was BDT 5274.02 (US $ 67.18) whereas the average inpatient and outpatient costs were BDT 8675.09 (US $ 110.51) and BDT 1853.96 (US $ 23.62) respectively. The cost burden was significantly highest for poorest households, 21.45% of household income, compared to 4.21% of the richest quintile. Diarrheal diseases continue to be an overwhelming problem in Bangladesh. The economic impact of any public health interventions (either preventive or promotive) that can reduce the prevalence of diarrheal diseases can be estimated from the data generated from this study.

Variation in Drug Prices at Pharmacies: Are Prices Higher in Poorer Areas?

PubMed Central

Gellad, Walid F; Choudhry, Niteesh K; Friedberg, Mark W; Brookhart, M Alan; Haas, Jennifer S; Shrank, William H

2009-01-01

Objective To determine whether retail prices for prescription drugs are higher in poorer areas. Data Sources The MyFloridarx.com website, which provides retail prescription prices at Florida pharmacies, and median ZIP code income from the 2000 Census. Study Design We compared mean pharmacy prices for each of the four study drugs across ZIP code income groups. Pharmacies were classified as either chain pharmacies or independent pharmacies. Data Collection Prices were downloaded in November 2006. Principal Findings Across the four study drugs, mean prices were highest in the poorest ZIP codes: 9 percent above the statewide average. Independent pharmacies in the poorest ZIP codes charged the highest mean prices. Conclusions Retail prescription prices appear to be higher in poorer ZIP codes of Florida. PMID:19178584

[Stunting in Mexico in the last quarter century: analysis of four national surveys].

PubMed

Rivera-Dommarco, Juan Ángel; Cuevas-Nasu, Lucía; González de Cosío, Teresita; Shamah-Levy, Teresa; García-Feregrino, Raquel

2013-01-01

To describe the magnitude, distribution, and trends of undernutrition and overweight from 1988 to 2006, and provide recommendations for their erradication. Antrhopometric indicators of nutritional status in children <5 y from four surveys were analyzed. Despite its significant reduction in the study period, stunting remains as a public health problem, with the highest prevalences in indigenous population, the rural south and the lowest living conditions quintile. Several policies and programs have demonstrated effectiveness, but implementation challenges persist among the poorest population, particularly in indigenous households. Measures for improving the effectiveness of the nutrition policies and programs, particularly among the indigenous and poorest population, are provided, which include adjusting current programs according to the results of evaluations, and the implementation of policies that address the social determinants of undernutrition.

Price elasticity of tobacco products among economic classes in India, 2011-2012.

PubMed

Selvaraj, Sakthivel; Srivastava, Swati; Karan, Anup

2015-12-09

The objectives of this study are to: (1) examine the pattern of price elasticity of three major tobacco products (bidi, cigarette and leaf tobacco) by economic groups of population based on household monthly per capita consumption expenditure in India and (2) assess the effect of tax increases on tobacco consumption and revenue across expenditure groups. Data from the 2011-2012 nationally representative Consumer Expenditure Survey from 101,662 Indian households were used. Households which consumed any tobacco or alcohol product were retained in final models. The study draws theoretical frameworks from a model using the augmented utility function of consumer behaviour, with a two-stage two-equation system of unit values and budget shares. Primary outcome measures were price elasticity of demand for different tobacco products for three hierarchical economic groups of population and change in tax revenue due to changes in tax structure. We finally estimated price elasticity of demand for bidi, cigarette and leaf tobacco and effects of changes in their tax rates on demand for these tobacco products and tax revenue. Own price elasticities for bidi were highest in the poorest group (-0.4328) and lowest in the richest group (-0.0815). Cigarette own price elasticities were -0.832 in the poorest group and -0.2645 in the richest group. Leaf tobacco elasticities were highest in the poorest (-0.557) and middle (-0.4537) groups. Poorer group elasticities were the highest, indicating that poorer consumers are more price responsive. Elasticity estimates show positive distributional effects of uniform bidi and cigarette taxation on the poorest consumers, as their consumption is affected the most due to increases in taxation. Leaf tobacco also displayed moderate elasticities in poor and middle tertiles, suggesting that tax increases may result in a trade-off between consumption decline and revenue generation. A broad spectrum rise in tax rates across all products is critical for tobacco control. 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/

Potential Barriers to Healthcare in Malawi for Under-five Children with Cough and Fever: A National Household Survey

PubMed Central

Ngwira, Bagrey; Stockman, Lauren J.; Deming, Michael; Nyasulu, Peter; Bowie, Cameron; Msyamboza, Kelias; Meyrowitsch, Dan W.; Cunliffe, Nigel A.; Bresee, Joseph; Fischer, Thea K.

2014-01-01

Failure to access healthcare is an important contributor to child mortality in many developing countries. In a national household survey in Malawi, we explored demographic and socioeconomic barriers to healthcare for childhood illnesses and assessed the direct and indirect costs of seeking care. Using a cluster-sample design, we selected 2,697 households and interviewed 1,669 caretakers. The main reason for households not being surveyed was the absence of a primary caretaker in the household. Among 2,077 children aged less than five years, 504 episodes of cough and fever during the previous two weeks were reported. A trained healthcare provider was visited for 48.0% of illness episodes. A multivariate regression model showed that children from the poorest households (p=0.02) and children aged >12 months (p=0.02) were less likely to seek care when ill compared to those living in wealthier households and children of higher age-group respectively. Families from rural households spent more time travelling compared to urban households (68.9 vs 14.1 minutes; p<0.001). In addition, visiting a trained healthcare provider was associated with longer travel time (p<0.001) and higher direct costs (p<0.001) compared to visiting an untrained provider. Thus, several barriers to accessing healthcare in Malawi for childhood illnesses exist. Continued efforts to reduce these barriers are needed to narrow the gap in the health and healthcare equity in Malawi. PMID:24847595

Rio Soliette (haiti): AN International Initiative for Flood-Hazard Assessment and Mitigation

NASA Astrophysics Data System (ADS)

Gandolfi, S.; Castellarin, A.; Barbarella, M.; Brath, A.; Domeneghetti, A.; Brandimarte, L.; Di Baldassarre, G.

2013-01-01

Natural catastrophic events are one of most critical aspects for health and economy all around the world. However, the impact in a poor region can impact more dramatically than in others countries. Isla Hispaniola (Haiti and the Dominican Republic), one of the poorest regions of the planet, has repeatedly been hit by catastrophic natural disasters that caused incalculable human and economic losses. After the catastrophic flood event occurred in the basin of River Soliette on May 24th, 2004, the General Direction for Development and Cooperation of the Italian Department of Foreign Affairs funded an international cooperation initiative (ICI) coordinated by the University of Bologna, that involved Haitian and Dominican institutions.Main purpose of the ICI was hydrological and hydraulic analysis of the May 2004 flood event aimed at formulating a suitable and affordable flood risk mitigation plan, consisting of structural and non-structural measures. In this contest, a topographic survey was necessary to realize the hydrological model and to improve the knowledge in some areas candidates to be site for mitigation measures.To overcome the difficulties arising from the narrowness of funds, surveyors and limited time available for the survey, only GPS technique have been used, both for framing aspects (using PPP approach), and for geometrical survey of the river by means of river cross-sections and detailed surveys in two areas (RTK technique). This allowed us to reconstruct both the river geometry and the DTM's of two expansion areas (useful for design hydraulic solutions for mitigate flood-hazard risk).

Long-term evaluation of the performance of four point-of-use water filters.

PubMed

Pérez-Vidal, Andrea; Diaz-Gómez, Jaime; Castellanos-Rozo, Jose; Usaquen-Perilla, Olga Lucía

2016-07-01

Despite technological advances water supply quality and poor access to safe water remain a major problem in developing countries, especially in rural areas. Point-of-use (POU) water treatment has been shown to be a viable option to produce safe drinking water quality. The aim of this study was to evaluate, under laboratory conditions over 14 months, the performance of four household filtration systems: membrane filter (MF), one-candle ceramic filter (1CCF), two-candle ceramic filter (2CCF) and pot ceramic filter (PCF). The evaluation was made using spiked water having the required concentrations of turbidity, Escherichia coli and Total Dissolved Solids (TDS). The results show that all systems have high removal efficiencies for turbidity (98-99%), and E. coli 4-5 Log Reduction Value (LRV). The poorest efficiency was for TDS (9-18%). The MF and the CCF displayed no significant difference in efficiencies for these parameters. The PCF had less significant differences for turbidity removal than the other systems. The average filtration rate for all systems decreased during the operation time. The CPF showed the major potential to be used in rural communities mainly for its low operational level and maintenance requirements as well as its local craftsmanship. It was observed that the efficiency of the systems is highly sensitive to cleaning and maintenance activities and therefore, the system sustainability will depend considerably on the training and education of the potential users. Copyright © 2016 Elsevier Ltd. All rights reserved.

An Overture for eCAM: Science, Technology and Innovation Initiation for Prosperous, Healthy Nepal.

PubMed

Kaphle, Krishna; Bhuju, Dinesh Raj; Jha, Pramod Kr; Bhattarai, Hom Nath

2011-01-01

Nepal the "Shangri-La" in the lap of the Himalayas is gearing up for modern times as it starts rebuilding after a decade of senseless violence and destruction. The nation one of the poorest in the global development index is rich in natural resources and biodiversity. Reports of medicinal plants far exceeding those recorded and reported so far are encouraging and at the same time concerns for medicinal plants under threat as a result of overexploitation are emerging from Nepal. The harsh mountain terrains, lack of industrialization and harnessing potentiality of its areas of strength; water; natural resources and tourism make it poor in per capita income which averages ~ 300 US$, with half the population living under >1$ a day. Nepal is beginning to realize that the way ahead is only possible through the path of Science and Technology (ST). Nepal Academy of Science and Technology formerly known as Royal Academy of Science and Technology organized the fifth national conference held every 4 years that took place in the capital Kathmandu during November 10-12, 2008. The ST initiation event saw the participation of ~ 1400 people representing over 150 organizations from the country and experts from abroad. The theme for the fifth national meet was "Science, Technology and Innovation for Prosperous Nepal". Complementary and Alternative Medicine (CAM) was an important theme in the event as the realization for the need of ST research focused in CAM for harnessing the chemo diversity potential was univocally approved.

A telephone survey of patient satisfaction with realtime telemedicine in a rural community in Colombia.

PubMed

López, Catalina; Valenzuela, José Ignacio; Calderón, Jorge Enrique; Velasco, Andrés Fabián; Fajardo, Roosevelt

2011-01-01

We conducted a telephone survey of all patients referred to a realtime telemedicine consultation at the Centre for Telehealth in Bogotá. Over a six-month period, 281 teleconsultations were conducted, and we were able to retrieve telephone numbers for 156 patients. Of these, 121 patients (78%) agreed to answer the questionnaire. Eighty percent of the respondents were satisfied or very satisfied with the teleconsultation and 63% would use telemedicine again. Sixty-five percent thought that telemedicine improved their medical care. More than 50% believed that telemedicine had a positive effect in terms of medical care improvement, time- and cost-savings. Twenty-seven percent felt that teleconsultation was not as good as a traditional face-to-face consultation. Lack of familiarity with ICT did not appear to act as a major barrier to telemedicine, and cognitive factors may be more important in acceptability to patients and their satisfaction. The results of the present study may also be relevant to the poorest countries of the world, where two-thirds of the population live in rural areas.

Cohort Profile: The Malawi Longitudinal Study of Families and Health (MLSFH).

PubMed

Kohler, Hans-Peter; Watkins, Susan C; Behrman, Jere R; Anglewicz, Philip; Kohler, Iliana V; Thornton, Rebecca L; Mkandawire, James; Honde, Hastings; Hawara, Augustine; Chilima, Ben; Bandawe, Chiwoza; Mwapasa, Victor; Fleming, Peter; Kalilani-Phiri, Linda

2015-04-01

The Malawi Longitudinal Study of Families and Health (MLSFH) is one of very few long-standing, publicly available longitudinal cohort studies in a sub-Saharan African (SSA) context. It provides a rare record of more than a decade of demographic, socioeconomic and health conditions in one of the world's poorest countries. The MLSFH was initially established in 1998 to study social network influences on fertility behaviours and HIV risk perceptions, and over time the focus of the study expanded to include health, sexual behaviours, intergenerational relations and family/household dynamics. The currently available data include MLSFH rounds collected in 1998, 2001, 2004, 2006, 2008, 2010 and 2012 for up to 4000 individuals, providing information about socioeconomic and demographic characteristics, sexual behaviours, marriage, household/family structure, risk perceptions, social networks and social capital, intergenerational relations, HIV/AIDS and other dimensions of health. The MLSFH public use data can be requested on the project website: http://www.malawi.pop.upenn.edu/. © The Author 2014; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.

The performance of health workers in Ethiopia: results from qualitative research.

PubMed

Lindelow, Magnus; Serneels, Pieter

2006-05-01

Insufficient attention has been paid to understanding what determines the performance of health workers. This paper reports on findings from focus group discussions with both health workers and users of health services in Ethiopia, a country with some of the poorest health outcomes in the world. We describe performance problems identified by both health users and health workers participating in the focus group discussions, including absenteeism and shirking, pilfering drugs and materials, informal health care provision and illicit charging, and corruption. In the second part of the paper we present four structural reasons why these problems arise: (i) the ongoing transition from health sector dominated by the public sector, towards a more mixed model; (ii) the failure of government policies to keep pace with the transition towards a mixed model of service delivery; (iii) weak accountability mechanisms and the erosion of professional norms in the health sector; and (iv) the impact of HIV/AIDS. The discussions underline the need to base policies on a micro-analysis of how health workers make constrained choices, both in their career and in their day to day professional activities.

The Association of Socioeconomic Status and Dental Caries Experience in Children in Dili, Timor-Leste.

PubMed

Babo Soares, Lucio Frederico; Allen, Penny; Bettiol, Silvana; Crocombe, Leonard

2016-10-01

Timor-Leste is one of the poorest countries in the world. The aim of this article was to investigate the association between socioeconomic status (SES) and dental caries experience in children living in Dili. Four out of 6 Dili subdistricts and 40 schools were randomly selected. Equal numbers of school children from 4 age groups (6-8, 9-11, 12-14, 15-17 years) were invited to participate. Data were gathered via a questionnaire and an oral examination by dental practitioners. In bivariate analysis, decayed, missing, and filled teeth index for deciduous + permanent teeth (dmft) was higher in children from mid- to high-SES than low-SES schools (1.1, 2.2, P = .001). With age, having had a toothache and dental visiting in the past 12 months in the multivariable model, higher dmft was found in children from mid- to high- to low-SES schools ( P < .001). The primary dental caries experience was greater among children from mid- to high- than low-SES schools, which may be explained by high sugar consumption.

Progressive universalism? The impact of targeted coverage on health care access and expenditures in Peru.

PubMed

Neelsen, Sven; O'Donnell, Owen

2017-12-01

Like other countries seeking a progressive path to universalism, Peru has attempted to reduce inequalities in access to health care by granting the poor entitlement to tax-financed basic care without charge. We identify the impact of this policy by comparing the target population's change in health care utilization with that of poor adults already covered through employment-based insurance. There are positive effects on receipt of ambulatory care and medication that are largest among the elderly and the poorest. The probability of getting formal health care when sick is increased by almost two fifths, but the likelihood of being unable to afford treatment is reduced by more than a quarter. Consistent with the shallow coverage offered, there is no impact on use of inpatient care. Neither is there any effect on average out-of-pocket health care expenditure, but medical spending is reduced by up to 25% in the top quarter of the distribution. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.