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Sample records for income countries case

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

    Science.gov (United States)

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

    2009-01-01

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

  2. Developing national obesity policy in middle-income countries: a case study from North Africa.

    Science.gov (United States)

    Holdsworth, Michelle; El Ati, Jalila; Bour, Abdellatif; Kameli, Yves; Derouiche, Abdelfettah; Millstone, Erik; Delpeuch, Francis

    2013-12-01

    The prevalence of overweight and obesity is a rapidly growing threat to public health in both Morocco and Tunisia, where it is reaching similar proportions to high-income countries. Despite this, a national strategy for obesity does not exist in either country. The aim of this study was to explore the views of key stakeholders towards a range of policies to prevent obesity, and thus guide policy makers in their decision making on a national level. Using Multicriteria Mapping, data were gathered from 82 stakeholders (from 33 categories in Morocco and 36 in Tunisia) who appraised 12 obesity policy options by reference to criteria of their own choosing. The feasibility of policies in practical or political terms and their cost were perceived as more important than how effective they would be in reducing obesity. There was most consensus and preference for options targeting individuals through health education, compared with options that aimed at changing the environment, i.e. modifying food supply and demand (providing healthier menus/changing food composition/food sold in schools); controlling information (advertising controls/mandatory labelling) or improving access to physical activity. In Tunisia, there was almost universal consensus that at least some environmental-level options are required, but in Morocco, participants highlighted the need to raise awareness within the population and policy makers that obesity is a public health problem, accompanied by improving literacy before such measures would be accepted. Whilst there is broad interest in a range of policy options, those measures targeting behaviour change through education were most valued. The different socioeconomic, political and cultural contexts of countries need to be accounted for when prioritizing obesity policy. Obesity was not recognized as a major public health priority; therefore, convincing policy makers about the need to prioritize action to prevent obesity, particularly in Morocco, will be

  3. Developing national obesity policy in middle-income countries: a case study from North Africa

    Science.gov (United States)

    Holdsworth, Michelle; El Ati, Jalila; Bour, Abdellatif; Kameli, Yves; Derouiche, Abdelfettah; Millstone, Erik; Delpeuch, Francis

    2013-01-01

    Background The prevalence of overweight and obesity is a rapidly growing threat to public health in both Morocco and Tunisia, where it is reaching similar proportions to high-income countries. Despite this, a national strategy for obesity does not exist in either country. The aim of this study was to explore the views of key stakeholders towards a range of policies to prevent obesity, and thus guide policy makers in their decision making on a national level. Methods Using Multicriteria Mapping, data were gathered from 82 stakeholders (from 33 categories in Morocco and 36 in Tunisia) who appraised 12 obesity policy options by reference to criteria of their own choosing. Results The feasibility of policies in practical or political terms and their cost were perceived as more important than how effective they would be in reducing obesity. There was most consensus and preference for options targeting individuals through health education, compared with options that aimed at changing the environment, i.e. modifying food supply and demand (providing healthier menus/changing food composition/food sold in schools); controlling information (advertising controls/mandatory labelling) or improving access to physical activity. In Tunisia, there was almost universal consensus that at least some environmental-level options are required, but in Morocco, participants highlighted the need to raise awareness within the population and policy makers that obesity is a public health problem, accompanied by improving literacy before such measures would be accepted. Conclusion Whilst there is broad interest in a range of policy options, those measures targeting behaviour change through education were most valued. The different socioeconomic, political and cultural contexts of countries need to be accounted for when prioritizing obesity policy. Obesity was not recognized as a major public health priority; therefore, convincing policy makers about the need to prioritize action to prevent

  4. Should all suspected tuberculosis cases in high income countries be tested with GeneXpert?

    Science.gov (United States)

    Vella, Venanzio; Broda, Agnieszka; Drobniewski, Francis

    2018-05-01

    In countries with a low incidence of multidrug-resistant tuberculosis (MDR-TB), universal testing with GeneXpert might not be always cost-effective. This study provides hospital managers in low MDR-TB incidence countries with criteria on when decentralised universal GeneXpert testing would make sense. The alternatives taken into consideration include: universal microbiological culture and drug susceptibility testing (DST) only (comparator); as above but with concurrent centralized GeneXpert in a referral laboratory vs a decentralized GeneXpert system in every hospital to test smear-positive cases only; as above but testing all samples with GeneXpert regardless of smear status. The parameters were from the national TB statistics for England and from a systematic review. Decentralised GeneXpert to test any suspected TB case was the most cost-effective option when 6% or more TB patients belonged to the high-risk group, defined as previous TB diagnosis and or being born in countries with a high MDR-TB incidence. Hospital managers in England and other low MDR-TB incidence countries could use these findings to decide when to invest in GeneXpert or other molecular diagnostics with similar performance criteria for TB diagnostics. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. Bioaerosols in residential micro-environments in low income countries: A case study from Pakistan

    International Nuclear Information System (INIS)

    Nasir, Zaheer Ahmad; Colbeck, Ian; Sultan, Sikander; Ahmed, Shakil

    2012-01-01

    Our knowledge of the concentrations of bioaerosols in residential micro-environments in low income countries is scanty. The present investigation was conducted to assess the culturable concentration and size distribution of bacteria, gram negative bacteria and fungi in two rural and an urban site in Pakistan. The highest indoor culturable bacteria concentration was found at Rural Site II (14,650 CFU/m 3 ) while the outdoor maximum occurred at the urban site (16,416 CFU/m 3 ). With reference to fungi, both indoor and outdoor concentrations were considerably higher at Rural Site I than the other sites. The size distribution of culturable bacteria at all sites showed greater variability than that of culturable fungi. At all sites more than the half (55–93%) of the culturable bacterial and fungal counts were observed in the respirable fraction ( 3 in the indoor environment. ► Elevated levels outdoors due to proximity to cattle and poor sanitary conditions. ► More that 50% of the bacterial and fungal aerosols were respirable. ► Possible increased respiratory exposure of inhabitants. - Bioaerosol concentrations up to 14,650 CFU/m 3 were measured in the indoor environment reflecting the proximity to cattle and poor sanitary conditions. These elevated levels pose a significant health risk.

  6. Social costs of illicit financial flows in low- and middle-income countries: the case of infant vaccination coverage.

    Science.gov (United States)

    Ortega, Bienvenido; Sanjuán, Jesús; Casquero, Antonio

    2018-03-01

    The liberalization of capital flows is generally associated with prospects of higher growth. However, in developing countries, opening the capital account may also facilitate the flow of capital out of the country through illicit financial flows (IFFs). Given that IFFs drain the scarce public resources available to finance the provision of public goods and services, the extent of illicit capital flows from developing countries is serious cause for concern. In this context, as a first step in analysing the social costs of IFFs in developing countries, this article studied the relationship between IFFs and infant immunization coverage rates. Data for 56 low- and middle-income countries for the period 2002-13 were used in the empirical analysis. The main result was that the relative level of IFFs to total trade negatively impacted vaccination coverage but only in the case of countries with very high levels of perceived corruption. In this case, the total effect of an annual 1 p.p. increase in the ratio of IFFs to total trade was to reduce the level of vaccination coverage rates over the coming years by 0.19 p.p. Given that there was an annual average of 18 million infants in this cluster of 25 countries, this result suggests that at least 34 000 children may not receive this basic health care intervention in the future as a consequence of this increase in IFFs in any particular year. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  7. Income inequality and adolescent fertility in low-income countries

    Directory of Open Access Journals (Sweden)

    Ruben Castro

    2017-09-01

    Full Text Available Abstract: The well-known socioeconomic gradient in health does not imply that income inequality by itself has any effect on well-being. However, there is evidence of a positive association between income inequality and adolescent fertility across countries. Nevertheless, this key finding is not focused on low-income countries. This study applies a multilevel logistic regression of country-level adolescent fertility on country-level income inequality plus individual-level income and controls to the Demographic and Health Surveys data. A negative association between income inequality and adolescent fertility was found among low-income countries, controlling for income (OR = 0.981; 95%CI: 0.963-0.999. Different measures and different subsamples of countries show the same results. Therefore, the international association between income inequality and adolescent fertility seems more complex than previously thought.

  8. Income inequality and adolescent fertility in low-income countries.

    Science.gov (United States)

    Castro, Ruben; Fajnzylber, Eduardo

    2017-09-28

    : The well-known socioeconomic gradient in health does not imply that income inequality by itself has any effect on well-being. However, there is evidence of a positive association between income inequality and adolescent fertility across countries. Nevertheless, this key finding is not focused on low-income countries. This study applies a multilevel logistic regression of country-level adolescent fertility on country-level income inequality plus individual-level income and controls to the Demographic and Health Surveys data. A negative association between income inequality and adolescent fertility was found among low-income countries, controlling for income (OR = 0.981; 95%CI: 0.963-0.999). Different measures and different subsamples of countries show the same results. Therefore, the international association between income inequality and adolescent fertility seems more complex than previously thought.

  9. Public Health Responses to and Challenges for the Control of Dengue Transmission in High-Income Countries: Four Case Studies.

    Directory of Open Access Journals (Sweden)

    Elvina Viennet

    2016-09-01

    Full Text Available Dengue has a negative impact in low- and lower middle-income countries, but also affects upper middle- and high-income countries. Despite the efforts at controlling this disease, it is unclear why dengue remains an issue in affluent countries. A better understanding of dengue epidemiology and its burden, and those of chikungunya virus and Zika virus which share vectors with dengue, is required to prevent the emergence of these diseases in high-income countries in the future. The purpose of this review was to assess the relative burden of dengue in four high-income countries and to appraise the similarities and differences in dengue transmission. We searched PubMed, ISI Web of Science, and Google Scholar using specific keywords for articles published up to 05 May 2016. We found that outbreaks rarely occur where only Aedes albopictus is present. The main similarities between countries uncovered by our review are the proximity to dengue-endemic countries, the presence of a competent mosquito vector, a largely nonimmune population, and a lack of citizens' engagement in control of mosquito breeding. We identified important epidemiological and environmental issues including the increase of local transmission despite control efforts, population growth, difficulty locating larval sites, and increased human mobility from neighboring endemic countries. Budget cuts in health and lack of practical vaccines contribute to an increased risk. To be successful, dengue-control programs for high-income countries must consider the epidemiology of dengue in other countries and use this information to minimize virus importation, improve the control of the cryptic larval habitat, and engage the community in reducing vector breeding. Finally, the presence of a communicable disease center is critical for managing and reducing future disease risks.

  10. Public Health Responses to and Challenges for the Control of Dengue Transmission in High-Income Countries: Four Case Studies.

    Science.gov (United States)

    Viennet, Elvina; Ritchie, Scott A; Williams, Craig R; Faddy, Helen M; Harley, David

    2016-09-01

    Dengue has a negative impact in low- and lower middle-income countries, but also affects upper middle- and high-income countries. Despite the efforts at controlling this disease, it is unclear why dengue remains an issue in affluent countries. A better understanding of dengue epidemiology and its burden, and those of chikungunya virus and Zika virus which share vectors with dengue, is required to prevent the emergence of these diseases in high-income countries in the future. The purpose of this review was to assess the relative burden of dengue in four high-income countries and to appraise the similarities and differences in dengue transmission. We searched PubMed, ISI Web of Science, and Google Scholar using specific keywords for articles published up to 05 May 2016. We found that outbreaks rarely occur where only Aedes albopictus is present. The main similarities between countries uncovered by our review are the proximity to dengue-endemic countries, the presence of a competent mosquito vector, a largely nonimmune population, and a lack of citizens' engagement in control of mosquito breeding. We identified important epidemiological and environmental issues including the increase of local transmission despite control efforts, population growth, difficulty locating larval sites, and increased human mobility from neighboring endemic countries. Budget cuts in health and lack of practical vaccines contribute to an increased risk. To be successful, dengue-control programs for high-income countries must consider the epidemiology of dengue in other countries and use this information to minimize virus importation, improve the control of the cryptic larval habitat, and engage the community in reducing vector breeding. Finally, the presence of a communicable disease center is critical for managing and reducing future disease risks.

  11. Risk factors for falls with severe fracture in elderly people living in a middle-income country: a case control study

    OpenAIRE

    Coutinho, Evandro SF; Fletcher, Astrid; Bloch, Katia V; Rodrigues, Laura C

    2008-01-01

    Abstract Background Fracture after falling has been identified as an important problem in public health. Most studies of risk factors for fractures due to falls have been carried out in developed countries, although the size of the elderly population is increasing fast in middle income countries. The objective of this paper is to identify risk factors for fall related to severe fractures in those aged 60 or more in a middle-income country. Methods A case-control study was carried out in Rio d...

  12. Methodological variation in economic evaluations conducted in low- and middle-income countries: information for reference case development.

    Science.gov (United States)

    Santatiwongchai, Benjarin; Chantarastapornchit, Varit; Wilkinson, Thomas; Thiboonboon, Kittiphong; Rattanavipapong, Waranya; Walker, Damian G; Chalkidou, Kalipso; Teerawattananon, Yot

    2015-01-01

    Information generated from economic evaluation is increasingly being used to inform health resource allocation decisions globally, including in low- and middle- income countries. However, a crucial consideration for users of the information at a policy level, e.g. funding agencies, is whether the studies are comparable, provide sufficient detail to inform policy decision making, and incorporate inputs from data sources that are reliable and relevant to the context. This review was conducted to inform a methodological standardisation workstream at the Bill and Melinda Gates Foundation (BMGF) and assesses BMGF-funded cost-per-DALY economic evaluations in four programme areas (malaria, tuberculosis, HIV/AIDS and vaccines) in terms of variation in methodology, use of evidence, and quality of reporting. The findings suggest that there is room for improvement in the three areas of assessment, and support the case for the introduction of a standardised methodology or reference case by the BMGF. The findings are also instructive for all institutions that fund economic evaluations in LMICs and who have a desire to improve the ability of economic evaluations to inform resource allocation decisions.

  13. Methodological variation in economic evaluations conducted in low- and middle-income countries: information for reference case development.

    Directory of Open Access Journals (Sweden)

    Benjarin Santatiwongchai

    Full Text Available Information generated from economic evaluation is increasingly being used to inform health resource allocation decisions globally, including in low- and middle- income countries. However, a crucial consideration for users of the information at a policy level, e.g. funding agencies, is whether the studies are comparable, provide sufficient detail to inform policy decision making, and incorporate inputs from data sources that are reliable and relevant to the context. This review was conducted to inform a methodological standardisation workstream at the Bill and Melinda Gates Foundation (BMGF and assesses BMGF-funded cost-per-DALY economic evaluations in four programme areas (malaria, tuberculosis, HIV/AIDS and vaccines in terms of variation in methodology, use of evidence, and quality of reporting. The findings suggest that there is room for improvement in the three areas of assessment, and support the case for the introduction of a standardised methodology or reference case by the BMGF. The findings are also instructive for all institutions that fund economic evaluations in LMICs and who have a desire to improve the ability of economic evaluations to inform resource allocation decisions.

  14. The influence of actor capacities on EIA system performance in low and middle income countries -Cases from Georgia and Ghana

    NARCIS (Netherlands)

    Kolhoff, A.J.; Runhaar, H.A.C.; Gugushvili, Tamar; Sonderegger, Gabi; Leest, Van der Bart; Driessen, P.P.J.

    2016-01-01

    In this paper, we aim to better understand the factors that contribute to the substantive performance of EIA systems in low and middle income countries. Substantive performance is defined as the extent to which the EIA process contributes to the EIA objectives for the long term, namely

  15. The influence of actor capacities on EIA system performance in low and middle income countries -Cases from Georgia and Ghana

    NARCIS (Netherlands)

    Kolhoff, Arend J.; Runhaar, Hens A C; Gugushvili, Tamar; Sonderegger, Gabi; Van der Leest, Bart; Driessen, Peter

    2016-01-01

    In this paper, we aim to better understand the factors that contribute to the substantive performance of EIA systems in low and middle income countries. Substantive performance is defined as the extent to which the EIA process contributes to the EIA objectives for the long term, namely environmental

  16. Carbon emissions-income relationships with structural breaks: the case of the Middle Eastern and North African countries.

    Science.gov (United States)

    El Montasser, Ghassen; Ajmi, Ahdi Noomen; Nguyen, Duc Khuong

    2018-01-01

    This article revisits the carbon dioxide (CO 2 ) emissions-GDP causal relationships in the Middle Eastern and North African (MENA) countries by employing the Rossi (Economet Theor 21:962-990, 2005) instability-robust causality test. We show evidence of significant causality relationships for all considered countries within the instability context, whereas the standard Granger causality test fails to detect causal links in any direction, except for Egypt, Iran, and Morocco. An important policy implication resulting from this robust analysis is that the income is not affected by the cuts in the CO 2 emissions for only two MENA countries, the UAE and Syria.

  17. Impact of income inequality on life expectancy in a highly unequal developing country: the case of Brazil.

    Science.gov (United States)

    Rasella, Davide; Aquino, Rosana; Barreto, Mauricio Lima

    2013-08-01

    Few studies have analysed the effects of income inequality on health in developing countries, particularly during economic growth, reduction of social disparities and reinforcement of the welfare and healthcare system. We evaluated the association between income inequality and life expectancy in Brazil, including the effect of social and health interventions, in the period 2000-2009. A panel dataset was created for the 27 Brazilian states over the referred time period. Multivariable linear regressions were performed using fixed-effects estimation with heteroscedasticity and serial correlation robust SEs. Models were fitted for life expectancy as a dependent variable, using the Gini index or a percentile income dispersion ratio as the main independent variable, and for demographic, socioeconomic and healthcare-related determinants as covariates. The Gini index, as the other measure of income inequality, was negatively associated with life expectancy (pincome inequality, contributing-together with PHC-to decreasing death rates in the population. Reducing income inequality may represent an important step towards improving health and increasing life expectancy, particularly in developing countries where inequalities are high.

  18. Economic and social impact of diabetes mellitus in a low-income country: A case-control study in Sudan.

    Science.gov (United States)

    Elrayah-Eliadarous, Hind A; Östenson, Claes-Göran; Eltom, Mohamed; Johansson, Pia; Sparring, Vibeke; Wahlström, Rolf

    2017-12-01

    Diabetes mellitus accounts for 11% of total health expenditure worldwide, and most people with diabetes live in low- and middle-income countries. The present study examined the economic and social effects attributed to diabetes in Sudan by calculating out-of-pocket medical expenses and the health and social effects of the disease for people with diabetes (n = 375) and their families compared with a non-diabetic control group (n = 375), matched for age, sex, and residence area. Data were obtained in 2013 in four states within the Sudan, via structured interviews, using instruments from the International Diabetes Federation. Descriptive statistics were used to analyze differences between case and control participants. The median total annual medical expenditure was fourfold higher for people with than without diabetes (US$579 vs US$148, respectively). Annual mean expenditure was 85% higher for those with diabetes (US$1004 vs US$544). People with diabetes were also significantly more likely to suffer from serious comorbidities, such as cardiovascular disorders and foot ulcers, compared with control participants. Moreover, those with diabetes reported a higher proportion of personal adverse social effects, such as being prevented from doing paid work or participating in education, both for themselves and their families. The high economic burden and adverse social effects on people with diabetes and their families in Sudan call for the development of evidence-based policy and program strategies for the prevention and management of diabetes, with an emphasis on low-resource communities. © 2017 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.

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

    Science.gov (United States)

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

    2015-04-01

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

  20. An approach to mental health in low and middle income countries: a case example from urban India

    Science.gov (United States)

    Maitra, Shubhada; Brault, Marie A.; Schensul, Stephen L.; Schensul, Jean J.; Nastasi, Bonnie K.; Verma, Ravi K.; Burleson, Joseph A.

    2015-01-01

    Women in low and middle income countries (LMICs) facing poverty, challenging living conditions and gender inequality often express their emotional difficulties through physical health concerns and seek care at primary health facilities. However, primary care providers in LMICs only treat the physical health symptoms and lack appropriate services to address women's mental health problems. This paper, presents data from the counseling component of a multilevel, research and intervention project in a low income community in Mumbai, India whose objective was to improve sexual health and reduce HIV/STI risk among married women. Qualitative data from counselor notes shows that poor mental health, associated with negative and challenging life situations, is most often expressed by women as gynecological concerns through the culturally-based syndrome of tenshun. A path analysis was conducted on baseline quantitative data that confirmed the relationships between sources of tenshum, emotional status and symptoms of common mental disorders (CMDs). Based on these findings, the authors propose a need for culturally appropriate primary care services for LMICs that would integrate mental and physical health. This approach would reduce mental health morbidity among women through early intervention and prevention of the development of CMDs. PMID:26834278

  1. and high-income countries

    African Journals Online (AJOL)

    opperwjj

    sociodemographic, health risk behaviour and social-legal correlates among university students ... no national seatbelt law or a law that does not apply to all occupants, poor attitudes towards ..... inconsistently used seatbelts than female students, while in some other countries (China, ..... and Exercise, 35, 1381–1395. Cunill ...

  2. Needs for Professional Education to Optimize Cervical Cancer Screenings in Low-Income Countries: a Case Study from Tanzania.

    Science.gov (United States)

    Lavelle, Anne E; Su, Dejun; Kahesa, Crispin; Soliman, Amr S

    2017-09-11

    Cervical cancer is a significant health problem in many developing countries. Due to limited treatment facilities for cancer in Tanzania, a screening referral program was developed between two urban clinics and Ocean Road Cancer Institute (ORCI), the only cancer treatment center in Tanzania. This study aimed to evaluate the effectiveness of the program and to identify opportunities for professional education. The study included 139 patients who were referred to ORCI from the screening clinics of Magomeni and Temeke between January 2015 and May 2016. Abstracted data from the medical records included patient age, screening results, and treatment. Eight nurses performing screening at the three locations were interviewed about their screening experience. Over half of the referrals (51.9%) were false positives. False positive diagnosis was more common among younger patients (35.68 ± 8.6 years) (p education of nurses and improvement in the health systems. Continuous education of nurses may increase the effectiveness of cervical screening. Health system enhancement of screening facilities such as provision of Lugol's iodine, more space for screening, and consistency and completion of screening records are needed to increase the accuracy of cervical screening and referrals in Tanzania and other similar low-income countries.

  3. Stagnant neonatal mortality and persistent health inequality in middle-income countries: a case study of the Philippines.

    Directory of Open Access Journals (Sweden)

    Aleli D Kraft

    Full Text Available BACKGROUND: The probability of survival through childhood continues to be unequal in middle-income countries. This study uses data from the Philippines to assess trends in the prevalence and distribution of child mortality and to evaluate the country's socioeconomic-related child health inequality. METHODOLOGY: Using data from four Demographic and Health Surveys we estimated levels and trends of neonatal, infant, and under-five mortality from 1990 to 2007. Mortality estimates at national and subnational levels were produced using both direct and indirect methods. Concentration indices were computed to measure child health inequality by wealth status. Multivariate regression analyses were used to assess the contribution of interventions and socioeconomic factors to wealth-related inequality. FINDINGS: Despite substantial reductions in national under-five and infant mortality rates in the early 1990s, the rates of declines have slowed in recent years and neonatal mortality rates remain stubbornly high. Substantial variations across urban-rural, regional, and wealth equity-markers are evident, and suggest that the gaps between the best and worst performing sub-populations will either be maintained or widen in the future. Of the variables tested, recent wealth-related inequalities are found to be strongly associated with social factors (e.g. maternal education, regional location, and access to health services, such as facility-based delivery. CONCLUSION: The Philippines has achieved substantial progress towards Millennium Development Goal 4, but this success masks substantial inequalities and stagnating neonatal mortality trends. This analysis supports a focus on health interventions of high quality--that is, not just facility-based delivery, but delivery by trained staff at well-functioning facilities and supported by a strong referral system--to re-start the long term decline in neonatal mortality and to reduce persistent within-country

  4. Stagnant neonatal mortality and persistent health inequality in middle-income countries: a case study of the Philippines.

    Science.gov (United States)

    Kraft, Aleli D; Nguyen, Kim-Huong; Jimenez-Soto, Eliana; Hodge, Andrew

    2013-01-01

    The probability of survival through childhood continues to be unequal in middle-income countries. This study uses data from the Philippines to assess trends in the prevalence and distribution of child mortality and to evaluate the country's socioeconomic-related child health inequality. Using data from four Demographic and Health Surveys we estimated levels and trends of neonatal, infant, and under-five mortality from 1990 to 2007. Mortality estimates at national and subnational levels were produced using both direct and indirect methods. Concentration indices were computed to measure child health inequality by wealth status. Multivariate regression analyses were used to assess the contribution of interventions and socioeconomic factors to wealth-related inequality. Despite substantial reductions in national under-five and infant mortality rates in the early 1990s, the rates of declines have slowed in recent years and neonatal mortality rates remain stubbornly high. Substantial variations across urban-rural, regional, and wealth equity-markers are evident, and suggest that the gaps between the best and worst performing sub-populations will either be maintained or widen in the future. Of the variables tested, recent wealth-related inequalities are found to be strongly associated with social factors (e.g. maternal education), regional location, and access to health services, such as facility-based delivery. The Philippines has achieved substantial progress towards Millennium Development Goal 4, but this success masks substantial inequalities and stagnating neonatal mortality trends. This analysis supports a focus on health interventions of high quality--that is, not just facility-based delivery, but delivery by trained staff at well-functioning facilities and supported by a strong referral system--to re-start the long term decline in neonatal mortality and to reduce persistent within-country inequalities in child health.

  5. Estimating and explaining the effect of education and income on head and neck cancer risk: INHANCE consortium pooled analysis of 31 case-control studies from 27 countries.

    Science.gov (United States)

    Conway, David I; Brenner, Darren R; McMahon, Alex D; Macpherson, Lorna M D; Agudo, Antonio; Ahrens, Wolfgang; Bosetti, Cristina; Brenner, Hermann; Castellsague, Xavier; Chen, Chu; Curado, Maria Paula; Curioni, Otávio A; Dal Maso, Luigino; Daudt, Alexander W; de Gois Filho, José F; D'Souza, Gypsyamber; Edefonti, Valeria; Fabianova, Eleonora; Fernandez, Leticia; Franceschi, Silvia; Gillison, Maura; Hayes, Richard B; Healy, Claire M; Herrero, Rolando; Holcatova, Ivana; Jayaprakash, Vijayvel; Kelsey, Karl; Kjaerheim, Kristina; Koifman, Sergio; La Vecchia, Carlo; Lagiou, Pagona; Lazarus, Philip; Levi, Fabio; Lissowska, Jolanta; Luce, Daniele; Macfarlane, Tatiana V; Mates, Dana; Matos, Elena; McClean, Michael; Menezes, Ana M; Menvielle, Gwenn; Merletti, Franco; Morgenstern, Hal; Moysich, Kirsten; Müller, Heiko; Muscat, Joshua; Olshan, Andrew F; Purdue, Mark P; Ramroth, Heribert; Richiardi, Lorenzo; Rudnai, Peter; Schantz, Stimson; Schwartz, Stephen M; Shangina, Oxana; Simonato, Lorenzo; Smith, Elaine; Stucker, Isabelle; Sturgis, Erich M; Szeszenia-Dabrowska, Neonila; Talamini, Renato; Thomson, Peter; Vaughan, Thomas L; Wei, Qingyi; Winn, Deborah M; Wunsch-Filho, Victor; Yu, Guo-Pei; Zhang, Zuo-Feng; Zheng, Tongzhang; Znaor, Ariana; Boffetta, Paolo; Chuang, Shu-Chun; Ghodrat, Marianoosh; Amy Lee, Yuan-Chin; Hashibe, Mia; Brennan, Paul

    2015-03-01

    Low socioeconomic status has been reported to be associated with head and neck cancer risk. However, previous studies have been too small to examine the associations by cancer subsite, age, sex, global region and calendar time and to explain the association in terms of behavioral risk factors. Individual participant data of 23,964 cases with head and neck cancer and 31,954 controls from 31 studies in 27 countries pooled with random effects models. Overall, low education was associated with an increased risk of head and neck cancer (OR = 2.50; 95% CI = 2.02 - 3.09). Overall one-third of the increased risk was not explained by differences in the distribution of cigarette smoking and alcohol behaviors; and it remained elevated among never users of tobacco and nondrinkers (OR = 1.61; 95% CI = 1.13 - 2.31). More of the estimated education effect was not explained by cigarette smoking and alcohol behaviors: in women than in men, in older than younger groups, in the oropharynx than in other sites, in South/Central America than in Europe/North America and was strongest in countries with greater income inequality. Similar findings were observed for the estimated effect of low versus high household income. The lowest levels of income and educational attainment were associated with more than 2-fold increased risk of head and neck cancer, which is not entirely explained by differences in the distributions of behavioral risk factors for these cancers and which varies across cancer sites, sexes, countries and country income inequality levels. © 2014 UICC.

  6. Risk factors for falls with severe fracture in elderly people living in a middle-income country: a case control study

    Directory of Open Access Journals (Sweden)

    Bloch Katia V

    2008-08-01

    Full Text Available Abstract Background Fracture after falling has been identified as an important problem in public health. Most studies of risk factors for fractures due to falls have been carried out in developed countries, although the size of the elderly population is increasing fast in middle income countries. The objective of this paper is to identify risk factors for fall related to severe fractures in those aged 60 or more in a middle-income country. Methods A case-control study was carried out in Rio de Janeiro-Brazil based general hospitals between 2002–2003. Two hundred-fifty hospitalised cases of fracture were matched with 250 community controls by sex, age group and living area. Data were collected for socio-demographic variables, health status and drugs used before the fall. A conditional logistic regression model was fitted to identify variables associated with the risk of fall related severe fracture. Results Low body mass index, cognitive impairment, stroke and lack of urine control were associated with increased risk of severe fall related fractures. Benzodiazepines and muscle relaxants were also related to an increased risk of severe fractures while moderate use of alcohol was associated with reduced risk. Conclusion Although the association between benzodiazepines and fractures due to fall has been consistently demonstrated for old people, this has not been the case for muscle relaxant drugs. The decision to prescribe muscle relaxants for elderly people should take into account the risk of severe fracture associated with these drugs.

  7. Risk factors for falls with severe fracture in elderly people living in a middle-income country: a case control study.

    Science.gov (United States)

    Coutinho, Evandro S F; Fletcher, Astrid; Bloch, Katia V; Rodrigues, Laura C

    2008-08-26

    Fracture after falling has been identified as an important problem in public health. Most studies of risk factors for fractures due to falls have been carried out in developed countries, although the size of the elderly population is increasing fast in middle income countries. The objective of this paper is to identify risk factors for fall related to severe fractures in those aged 60 or more in a middle-income country. A case-control study was carried out in Rio de Janeiro-Brazil based general hospitals between 2002-2003. Two hundred-fifty hospitalised cases of fracture were matched with 250 community controls by sex, age group and living area. Data were collected for socio-demographic variables, health status and drugs used before the fall. A conditional logistic regression model was fitted to identify variables associated with the risk of fall related severe fracture. Low body mass index, cognitive impairment, stroke and lack of urine control were associated with increased risk of severe fall related fractures. Benzodiazepines and muscle relaxants were also related to an increased risk of severe fractures while moderate use of alcohol was associated with reduced risk. Although the association between benzodiazepines and fractures due to fall has been consistently demonstrated for old people, this has not been the case for muscle relaxant drugs. The decision to prescribe muscle relaxants for elderly people should take into account the risk of severe fracture associated with these drugs.

  8. The challenge of cancer in middle-income countries with an ageing population: Mexico as a case study

    Science.gov (United States)

    Aggarwal, Ajay; Unger-Saldaña, Karla; Lewison, Grant; Sullivan, Richard

    2015-01-01

    Mexico is undergoing rapid population ageing as a result of its epidemiological transition. This study explores the interface between this rapid population ageing and the burden of cancer. The number of new cancer cases is expected to increase by nearly 75% by 2030 (107,000 additional cases per annum), with 60% of cases in the elderly (aged ≥ 65). A review of the literature was supplemented by a bibliometric analysis of Mexico’s cancer research output. Cancer incidence projections for selected sites were estimated with Globocan software. Data were obtained from recent national census, surveys, and cancer death registrations. The elderly, especially women and those living in rural areas, face high levels of poverty, have low rates of educational attainment, and many are not covered by health insurance schemes. Out of pocket payments and private health care usage remain high, despite the implementation of Seguro Popular that was designed to achieve financial protection for the lowest income groups. A number of cancers that predominate in elderly persons are not covered by the scheme and individuals face catastrophic expenditure in seeking treatment. There is limited research output in those cancer sites that have a high burden in the elderly Mexican population, especially research that focuses on outcomes. The elderly population in Mexico is vulnerable to the effects of the rising cancer burden and faces challenges in accessing high quality cancer care. Based on our evidence, we recommend that geriatric oncology should be an urgent public policy priority for Mexico. PMID:26015805

  9. Stagnant Neonatal Mortality and Persistent Health Inequality in Middle-Income Countries: A Case Study of the Philippines

    Science.gov (United States)

    Kraft, Aleli D.; Nguyen, Kim-Huong; Jimenez-Soto, Eliana; Hodge, Andrew

    2013-01-01

    Background The probability of survival through childhood continues to be unequal in middle-income countries. This study uses data from the Philippines to assess trends in the prevalence and distribution of child mortality and to evaluate the country’s socioeconomic-related child health inequality. Methodology Using data from four Demographic and Health Surveys we estimated levels and trends of neonatal, infant, and under-five mortality from 1990 to 2007. Mortality estimates at national and subnational levels were produced using both direct and indirect methods. Concentration indices were computed to measure child health inequality by wealth status. Multivariate regression analyses were used to assess the contribution of interventions and socioeconomic factors to wealth-related inequality. Findings Despite substantial reductions in national under-five and infant mortality rates in the early 1990s, the rates of declines have slowed in recent years and neonatal mortality rates remain stubbornly high. Substantial variations across urban-rural, regional, and wealth equity-markers are evident, and suggest that the gaps between the best and worst performing sub-populations will either be maintained or widen in the future. Of the variables tested, recent wealth-related inequalities are found to be strongly associated with social factors (e.g. maternal education), regional location, and access to health services, such as facility-based delivery. Conclusion The Philippines has achieved substantial progress towards Millennium Development Goal 4, but this success masks substantial inequalities and stagnating neonatal mortality trends. This analysis supports a focus on health interventions of high quality – that is, not just facility-based delivery, but delivery by trained staff at well-functioning facilities and supported by a strong referral system – to re-start the long term decline in neonatal mortality and to reduce persistent within-country inequalities in child

  10. Income inequality and obesity prevalence among OECD countries.

    Science.gov (United States)

    Su, Dejun; Esqueda, Omar A; Li, Lifeng; Pagán, José A

    2012-07-01

    Using recent pooled data from the World Health Organization Global Infobase and the World Factbook compiled by the Central Intelligence Agency of the United States, this study assesses the relation between income inequality and obesity prevalence among 31 OECD countries through a series of bivariate and multivariate linear regressions. The United States and Mexico well lead OECD countries in both obesity prevalence and income inequality. A sensitivity analysis suggests that the inclusion or exclusion of these two extreme cases can fundamentally change the findings. When the two countries are included, the results reveal a positive correlation between income inequality and obesity prevalence. This correlation is more salient among females than among males. Income inequality alone is associated with 16% and 35% of the variations in male and female obesity rates, respectively, across OECD countries in 2010. Higher levels of income inequality in the 2005-2010 period were associated with a more rapid increase in obesity prevalence from 2002 to 2010. These associations, however, virtually disappear when the US and Mexico have been excluded from the analysis. Findings from this study underscore the importance of assessing the impact of extreme cases on the relation between income inequality and health outcomes. The potential pathways from income inequality to the alarmingly high rates of obesity in the cases of the US and Mexico warrant further research.

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

    Science.gov (United States)

    Li, David X; Guindon, G Emmanuel

    2013-04-01

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

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

    Science.gov (United States)

    Inotai, András; Kaló, Zoltán

    2012-01-01

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

  13. The Chinese Economy and Income Inequality among East Asian Countries

    OpenAIRE

    Sumie Sato; Mototsugu Fukushige

    2010-01-01

    Using the Atkinson inequality measure of income distribution, we analyze the impact of China as a single country and examine the effect of its domestic income inequality on total income inequality among East Asian countries. First, we find that China's domestic income inequality exacerbated income inequality among East Asian countries from the 1980s, and this effect became even more pronounced from 1990. Second, the growth of China's per capita GDP had an equalizing effect on income distribut...

  14. Childhood asthma in low income countries

    DEFF Research Database (Denmark)

    Østergaard, Marianne Stubbe; Nantanda, Rebecca; Tumwine, James K

    2012-01-01

    Bacterial pneumonia has hitherto been considered the key cause of the high respiratory morbidity and mortality in children under five years of age (under-5s) in low-income countries, while asthma has not been stated as a significant reason. This paper explores the definitions and concepts...... of pneumonia and asthma/wheezing/bronchiolitis and examines whether asthma in under-5s may be confused with pneumonia. Over-diagnosing of bacterial pneumonia can be suspected from the limited association between clinical pneumonia and confirmatory test results such as chest x-ray and microbiological findings...... and poor treatment results using antibiotics. Moreover, children diagnosed with recurrent pneumonia in infancy were often later diagnosed with asthma. Recent studies showed a 10-15% prevalence of preschool asthma in low-income countries, although under-5s with long-term cough and difficulty breathing...

  15. Health system functionality in a low-income country in the midst of conflict: the case of Yemen.

    Science.gov (United States)

    Qirbi, Naseeb; Ismail, Sharif A

    2017-07-01

     Although the literature on effects of armed conflict on population health is extensive, detailed assessments of effects on public health 'systems' are few. This article aims to help address this deficit through the medium of a case study on Yemen, describing health system and health outcome performance prior to the internationalisation of the conflict there in March 2015, before assessing the impact of war on health system functionality since that time. Review of peer- and non-peer reviewed literature from 2005 to 2016 from academic sources, multilateral organizations, donors and governmental and non-governmental organizations, augmented by secondary data analysis. Despite significant health system weaknesses and structural vulnerabilities pre-conflict, there were important improvements in selected health outcome measures in Yemen up to early 2015 (life expectancy, and infant and maternal mortality, e.g.), partly driven by a fragile health sector that was heavily reliant on out-of-pocket expenditure, and hampered by weak service penetration especially in rural areas. High intensity conflict has resulted in rising mortality and injury rates since March 2015, the first decline in life expectancy and increase in child and maternal mortality in Yemen for some years, and worsening levels of malnutrition. Service delivery has become increasingly challenging in the context of a funding crisis, destruction of health facilities, widespread shortages of essential medicines and equipment across the country, and governance fragmentation. Conflict in Yemen has resulted in humanitarian disaster on a wide scale in a short period of time, and crippled an already weak health system. Important areas of uncertainty remain, however, including the scale of health worker flight, and the extent to which alternative providers have stepped in to fill widening service gaps as the conflict has unfolded. Planning for longer-term health system reconstruction should begin as soon as possible

  16. Stillbirths : recall to action in high-income countries

    NARCIS (Netherlands)

    Flenady, Vicki; Wojcieszek, Aleena M.; Middleton, Philippa; Ellwood, David; Erwich, Jan Jaap; Coory, Michael; Khong, T. Yee; Silver, Robert M.; Smith, Gordon C. S.; Boyle, Frances M.; Lawn, Joy E.; Blencowe, Hannah; Leisher, Susannah Hopkins; Gross, Mechthild M.; Horey, Dell; Farrales, Lynn; Bloomfield, Frank; McCowan, Lesley; Brown, Stephanie J.; Joseph, K. S.; Zeitlin, Jennifer; Reinebrant, Hanna E.; Ravaldi, Claudia; Vannacci, Alfredo; Cassidy, Jillian; Cassidy, Paul; Farquhar, Cindy; Wallace, Euan; Siassakos, Dimitrios; Heazell, Alexander E. P.; Storey, Claire; Sadler, Lynn; Petersen, Scott; Froen, J. Frederik; Goldenberg, Robert L.

    2016-01-01

    Variation in stillbirth rates across high-income countries and large equity gaps within high-income countries persist. If all high-income countries achieved stillbirth rates equal to the best performing countries, 19 439 late gestation ( 28 weeks or more) stillbirths could have been avoided in 2015.

  17. Impact of health research capacity strengthening in low- and middle-income countries: the case of WHO/TDR programmes.

    Science.gov (United States)

    Minja, Happiness; Nsanzabana, Christian; Maure, Christine; Hoffmann, Axel; Rumisha, Susan; Ogundahunsi, Olumide; Zicker, Fabio; Tanner, Marcel; Launois, Pascal

    2011-10-01

    Measuring the impact of capacity strengthening support is a priority for the international development community. Several frameworks exist for monitoring and evaluating funding results and modalities. Based on its long history of support, we report on the impact of individual and institutional capacity strengthening programmes conducted by the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) and on the factors that influenced the outcome of its Research Capacity Strengthening (RCS) activities. A mix of qualitative and quantitative methods (questionnaires and in-depth interviews) was applied to a selected group of 128 individual and 20 institutional capacity development grant recipients that completed their training/projects between 2000 and 2008. A semi-structured interview was also conducted on site with scientists from four institutions. Most of the grantees, both individual and institutional, reported beneficial results from the grant. However, glaring inequities stemming from gender imbalances and a language bias towards English were identified. The study showed that skills improvement through training contributed to better formulation of research proposals, but not necessarily to improved project implementation or communication of results. Appreciation of the institutional grants' impact varied among recipient countries. The least developed countries saw the programmes as essential for supporting basic infrastructure and activities. Advanced developing countries perceived the research grants as complementary to available resources, and particularly suitable for junior researchers who were not yet able to compete for major international grants. The study highlights the need for a more equitable process to improve the effectiveness of health research capacity strengthening activities. Support should be tailored to the existing research capacity in disease endemic countries and should focus on strengthening

  18. Impact of health research capacity strengthening in low- and middle-income countries: the case of WHO/TDR programmes.

    Directory of Open Access Journals (Sweden)

    Happiness Minja

    2011-10-01

    Full Text Available BACKGROUND: Measuring the impact of capacity strengthening support is a priority for the international development community. Several frameworks exist for monitoring and evaluating funding results and modalities. Based on its long history of support, we report on the impact of individual and institutional capacity strengthening programmes conducted by the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR and on the factors that influenced the outcome of its Research Capacity Strengthening (RCS activities. METHODOLOGY AND PRINCIPAL FINDINGS: A mix of qualitative and quantitative methods (questionnaires and in-depth interviews was applied to a selected group of 128 individual and 20 institutional capacity development grant recipients that completed their training/projects between 2000 and 2008. A semi-structured interview was also conducted on site with scientists from four institutions. Most of the grantees, both individual and institutional, reported beneficial results from the grant. However, glaring inequities stemming from gender imbalances and a language bias towards English were identified. The study showed that skills improvement through training contributed to better formulation of research proposals, but not necessarily to improved project implementation or communication of results. Appreciation of the institutional grants' impact varied among recipient countries. The least developed countries saw the programmes as essential for supporting basic infrastructure and activities. Advanced developing countries perceived the research grants as complementary to available resources, and particularly suitable for junior researchers who were not yet able to compete for major international grants. CONCLUSION: The study highlights the need for a more equitable process to improve the effectiveness of health research capacity strengthening activities. Support should be tailored to the existing research

  19. The influence of actor capacities on EIA system performance in low and middle income countriesCases from Georgia and Ghana

    International Nuclear Information System (INIS)

    Kolhoff, Arend J.; Runhaar, Hens A.C.; Gugushvili, Tamar; Sonderegger, Gabi; Van der Leest, Bart; Driessen, Peter P.J.

    2016-01-01

    In this paper, we aim to better understand the factors that contribute to the substantive performance of EIA systems in low and middle income countries. Substantive performance is defined as the extent to which the EIA process contributes to the EIA objectives for the long term, namely environmental protection or, even more ambitious, sustainable development. We have therefore developed a conceptual model in which we focus on the key actors in the EIA system, the proponent and the EIA authority and their level of ownership as a key capacity to measure their performance, and we distinguish procedural performance and some contextual factors. This conceptual model is then verified and refined for the EIA phase and the EIA follow-up phase (permitting, monitoring and enforcement) by means of 12 case studies from Ghana (four cases) and Georgia (eight cases), both lower–middle income countries. We observe that in most cases the level of substantive performance increases during the EIA phase but drops during the EIA follow-up phase, and as a result only five out of 12 operational cases are in compliance with permit conditions or national environmental standards. We conclude, firstly that ownership of the proponent is the most important factor explaining the level of substantive performance; the higher the proponent's level of ownership the higher the level of substantive performance. The influence of the EIA authority on substantive performance is limited. Secondly, the influence of procedural performance on substantive performance seems less important than expected in the EIA phase but more important during the EIA follow-up phase. In order to improve substantive performance we learned two lessons. Firstly, increasing the proponent's level of ownership seems obvious, but direct change is probably difficult. However, where international finance institutes are involved they can increase ownership. Despite the limited influence of the EIA authority, a proactive strategy of

  20. The influence of actor capacities on EIA system performance in low and middle income countriesCases from Georgia and Ghana

    Energy Technology Data Exchange (ETDEWEB)

    Kolhoff, Arend J., E-mail: akolhoff@eia.nl [Netherlands Commission for Environmental Assessment, P.O. Box 2345, 3500 GH Utrecht (Netherlands); Runhaar, Hens A.C., E-mail: H.A.C.Runhaar@uu.nl [Environmental Studies and Policy, Copernicus Institute of Sustainable Development, Utrecht University, Utrecht (Netherlands); Forest and Nature Conservation Policy Group, Wageningen University and Research Centre, Wageningen (Netherlands); Gugushvili, Tamar, E-mail: gugushvili.tamuna@gmail.com [Netherlands Commission for Environmental Assessment, P.O. Box 2345, 3500 GH Utrecht (Netherlands); Sonderegger, Gabi, E-mail: gabi.sonderegger@gmail.com [Netherlands Commission for Environmental Assessment, P.O. Box 2345, 3500 GH Utrecht (Netherlands); Van der Leest, Bart, E-mail: bartvanderleest@hotmail.com [Netherlands Commission for Environmental Assessment, P.O. Box 2345, 3500 GH Utrecht (Netherlands); Driessen, Peter P.J., E-mail: p.driessen@uu.nl [Innovation and Environmental Sciences, Copernicus Institute of Sustainable Development, Utrecht University, Utrecht (Netherlands)

    2016-02-15

    In this paper, we aim to better understand the factors that contribute to the substantive performance of EIA systems in low and middle income countries. Substantive performance is defined as the extent to which the EIA process contributes to the EIA objectives for the long term, namely environmental protection or, even more ambitious, sustainable development. We have therefore developed a conceptual model in which we focus on the key actors in the EIA system, the proponent and the EIA authority and their level of ownership as a key capacity to measure their performance, and we distinguish procedural performance and some contextual factors. This conceptual model is then verified and refined for the EIA phase and the EIA follow-up phase (permitting, monitoring and enforcement) by means of 12 case studies from Ghana (four cases) and Georgia (eight cases), both lower–middle income countries. We observe that in most cases the level of substantive performance increases during the EIA phase but drops during the EIA follow-up phase, and as a result only five out of 12 operational cases are in compliance with permit conditions or national environmental standards. We conclude, firstly that ownership of the proponent is the most important factor explaining the level of substantive performance; the higher the proponent's level of ownership the higher the level of substantive performance. The influence of the EIA authority on substantive performance is limited. Secondly, the influence of procedural performance on substantive performance seems less important than expected in the EIA phase but more important during the EIA follow-up phase. In order to improve substantive performance we learned two lessons. Firstly, increasing the proponent's level of ownership seems obvious, but direct change is probably difficult. However, where international finance institutes are involved they can increase ownership. Despite the limited influence of the EIA authority, a proactive

  1. Guidelines in lower-middle income countries.

    Science.gov (United States)

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

    2017-06-01

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

  2. Growth faltering in low-income countries.

    Science.gov (United States)

    Prentice, Andrew M; Moore, Sophie E; Fulford, Anthony J

    2013-01-01

    Meta-analysis of growth data from over 50 low and low-middle income countries shows a consistent pattern of stunting and poor weight gain from about 3 months of age and persisting until at least 5 years. Children tend not to be wasted because their short stature offsets their underweight, leading to a rather adequately proportioned appearance. This frequently conceals the true levels of malnutrition in communities. At the macro-environmental level such growth faltering is due to the combined effects of poverty, food insecurity, low-dietary diversity, a highly infectious environment, poor washing facilities and poor understanding of the principles of nutrition and hygiene. These tend to be ameliorated as communities pass through the demographic transition with improved incomes and education. Because such changes will take generations to achieve, the global health community continues to search for effective interim solutions. Disappointingly, apart from intensive feeding programmes aimed at rehabilitating severely malnourished children, there are few examples of very successful nutrition interventions. This emphasizes the need for a better understanding of the etiology of growth failure. This paper uses anthropometric data collected over 6 decades in subsistence-farming communities from rural Gambia to illustrate the typical key features of growth faltering. Arising from this analysis, and from gaps in the published literature, the following issues are highlighted as still requiring a better resolution: (1) the pre-natal and inter-generational influences on growth failure; (2) the ontogeny of the infant immune system; (3) the exact nature of the precipitating insults that initiate gastroenteropathy; (4) the effects of both enteric and systemic infections on the hormonal regulation of growth; (5) interactions between macro- and micro-nutrient deficiencies and infections in causing growth failure, and (6) the role of the microbiome in modulating dietary influences on

  3. Facilitating health information exchange in low- and middle-income countries: conceptual considerations, stakeholders perspectives and deployment strategies illustrated through an in-depth case study of Pakistan

    OpenAIRE

    Akhlaq, Ather

    2016-01-01

    Background Health information exchange (HIE) may help healthcare professionals and policymakers make informed decisions to improve patient and population health outcomes. There is, however, limited uptake of HIE in many low- and middle-income countries (LMICs). While resource constraints are an obvious barrier to implementation of HIE, it is important to explore what other political, structural, technical, environmental, legal and cultural factors may be involved. In particu...

  4. Income inequality and income mobility in the Scandinavian countries compared to the United States

    OpenAIRE

    Aaberge, Rolf; Björklund, Anders; Jäntti, Markus; Palme, Mårten; Pedersen, Peder J.; Smith, Nina; Wennemo, Tom

    1996-01-01

    This paper compares income inequality and income mobility in the Scandinavian countries and the United States during the 1980's. The results demonstrate that inequality is greater in the United States than in the Scandinavian countries and that the ranking of countries with respect to inequality remains unchanged when the accounting period of income is extended from one to 11 years. The pattern of mobility turns out to be remarkably similar despite major differences in labor market and social...

  5. Pesticide Poisonings in Low- and Middle-Income Countries

    DEFF Research Database (Denmark)

    Jørs, Erik; Neupane, Dinesh; London, Leslie

    2018-01-01

    Aims and scope This editorial is an introduction to the papers making up the special issue on 'pesticide poisonings in low- and middle income countries'.......Aims and scope This editorial is an introduction to the papers making up the special issue on 'pesticide poisonings in low- and middle income countries'....

  6. Fluctuations, Uncertainty and Income Inequality in Developing Countries

    OpenAIRE

    Fadi Fawaz; Masha Rahnamamoghadam; Victor Valcarcel

    2012-01-01

    We analyze income inequality and high frequency movements in economic activity for low and high income developing countries (LIDC and HIDC). The impact of human capital, capital formation, and economic uncertainty on income inequality for LIDC and HIDC are also evaluated. We find strong evidence that business cycle fluctuations serve to exacerbate income inequality in HIDC while they help narrow the gap in LIDC. Importantly, volatility in output widens inequality across the board but to a con...

  7. Social Captial and Relative Income Concerns: Evidence from 26 Countries

    OpenAIRE

    Fischer, Justina A. V.; Torgler, Benno

    2007-01-01

    Research evidence on the impact of relative income position on individuals’ attitudes and behaviour is sorely lacking. Therefore, using the International Social Survey Programme 1998 data from 26 countries this paper investigates the impact of relative income on 14 measurements of social capital. We find support for a considerable deleterious positional concern effect of persons below the reference income. This effect is more sizeable by far than the beneficial impact of a relative income a...

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

    Directory of Open Access Journals (Sweden)

    Vincent Ahonkhai

    Full Text Available 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

  9. Factors influencing trainee doctor emigration in a high income country: a mixed methods study.

    OpenAIRE

    Clarke, Nicholas; Crowe, Sophie; Humphries, Niamh; Conroy, Ronan; O'Hare, Simon; Kavanagh, Paul; Brugha, Ruairi F

    2017-01-01

    BACKGROUND: The Global Code of Practice on the International Recruitment of Health Personnel focuses particularly on migration of doctors from low- and middle-income countries. Less is understood about migration from high-income countries. Recession has impacted several European countries in recent years, and in some cases emigration has reached unprecedented levels. This study measures and explores the predictors of trainee doctor emigration from Ireland. METHODS: Using a partially mixed ...

  10. Factors influencing trainee doctor emigration in a high income country: a mixed methods study.

    LENUS (Irish Health Repository)

    Clarke, Nicholas

    2017-09-25

    The Global Code of Practice on the International Recruitment of Health Personnel focuses particularly on migration of doctors from low- and middle-income countries. Less is understood about migration from high-income countries. Recession has impacted several European countries in recent years, and in some cases emigration has reached unprecedented levels. This study measures and explores the predictors of trainee doctor emigration from Ireland.

  11. Income inequality and population health in Islamic countries.

    Science.gov (United States)

    Esmaeili, A; Mansouri, S; Moshavash, M

    2011-09-01

    To undertake a fresh examination of the relationship between income inequality and population health for a group of Islamic countries using recent information derived from data resource sites from the World Bank and Islamic countries. Cross-sectional data on different measures of income distribution (prosperity, health care, women's role and environment) and indicators of population health were used to illuminate this issue. The relationship between income inequality and population health for a group of Islamic countries was tested using recent information derived from data resource sites from the World Bank and Islamic countries. After consideration of previous studies, seven dependent variables were determined and tested in six equation formats. According to the equations, the urban population percentage and gross domestic product are the most important significant variables that affect life expectancy and the infant mortality rate in Islamic countries. The income distribution coefficient, regardless of the type of measure, was almost insignificant in all equations. In selected Islamic countries, income level has a positive effect on population health, but the level of income distribution is not significant. Among the other dependent variables (e.g. different measures of income distribution, health care, role of women and environment), only environment and education had significant effects. Most of the Islamic countries studied are considered to be poorly developed. Copyright © 2011 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  12. Income inequality, trust and homicide in 33 countries.

    Science.gov (United States)

    Elgar, Frank J; Aitken, Nicole

    2011-04-01

    Theories of why income inequality correlates with violence suggest that inequality erodes social capital and trust, or inhibits investment into public services and infrastructure. Past research sensed the importance of these causal paths but few have examined them using tests of statistical mediation. We explored links between income inequality and rates of homicide in 33 countries and then tested whether this association is mediated by an indicator of social capital (interpersonal trust) or by public spending on health and education. Survey data on trust were collected from 48 641 adults and matched to country data on per capita income, income inequality, public expenditures on health and education and rate of homicides. Between countries, income inequality correlated with trust (r = -0.64) and homicide (r = 0.80) but not with public expenditures. Trust also correlated with homicides (r = -0.58) and partly mediated the association between income inequality and homicide, whilst public expenditures did not. Multilevel analysis showed that income inequality related to less trust after differences in per capita income and sample characteristics were taken into account. Results were consistent with psychosocial explanations of links between income inequality and homicide; however, the causal relationship between inequality, trust and homicide remains unclear given the cross-sectional design of this study. Societies with large income differences and low levels of trust may lack the social capacity to create safe communities.

  13. Differential pricing of new pharmaceuticals in lower income European countries.

    Science.gov (United States)

    Kaló, Zoltán; Annemans, Lieven; Garrison, Louis P

    2013-12-01

    Pharmaceutical companies adjust the pricing strategy of innovative medicines to the imperatives of their major markets. The ability of payers to influence the ex-factory price of new drugs depends on country population size and income per capita, among other factors. Differential pricing based on Ramsey principles is a 'second-best' solution to correct the imperfections of the global market for innovative pharmaceuticals, and it is also consistent with standard norms of equity. This analysis summarizes the boundaries of differential pharmaceutical pricing for policymakers, payers and other stakeholders in lower-income countries, with special focus on Central-Eastern Europe, and describes the feasibility and implications of potential solutions to ensure lower pharmaceutical prices as compared to higher-income countries. European stakeholders, especially in Central-Eastern Europe and at the EU level, should understand the implications of increased transparency of pricing and should develop solutions to prevent the limited accessibility of new medicines in lower-income countries.

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

    Science.gov (United States)

    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.

  15. Breast Cancer in Low- and Middle-Income Countries: An Emerging and Challenging Epidemic

    Directory of Open Access Journals (Sweden)

    Arafat Tfayli

    2010-01-01

    Full Text Available Breast cancer is a major health care problem that affects more than one million women yearly. While it is traditionally thought of as a disease of the industrialized world, around 45% of breast cancer cases and 55% of breast cancer deaths occur in low and middle income countries. Managing breast cancer in low income countries poses a different set of challenges including access to screening, stage at presentation, adequacy of management and availability of therapeutic interventions. In this paper, we will review the challenges faced in the management of breast cancer in low and middle income countries.

  16. International Comparisons of Income Inequality: Tests for Lorenz Dominance across Nine Countries

    OpenAIRE

    Bishop, John; Smith, W. James; Formby, John

    1989-01-01

    This paper examines income inequality across nine countries using the Luxembourg Income Study data set. New statistical tests and comparability of data provide an exceptionally clear picture of relative income inequality. Only 4 comparisons out of a possible 108 cannot be ranked. In most cases, differences in the definition of the recipient unit make little difference in the rankings. Irrespective of recipient units, Sweden, Norway, and Germany come out at the top of the ordinal Lorenz rankin...

  17. Convergence in Food Demand and Delivery: Do Middle-Income Countries Follow High-Income Trends?

    OpenAIRE

    Regmi, Anita; Takeshima, Hiroyuki; Unnevehr, Laurian J.

    2008-01-01

    This study uses food expenditures and food-sales data from 1990 to 2004 to examine whether food-consumption patterns and food-delivery-mechanism trends are converging across 47 high- and middle-income countries. Results point to a high degree of convergence in global food systems. Middle-income countries appear to be following trends in high-income countries. Convergence is apparent in most important food-expenditure categories and in indicators of food-system modernization such as supermarke...

  18. Financing the response to HIV in low-income and middle-income countries.

    Science.gov (United States)

    Izazola-Licea, José Antonio; Wiegelmann, Jan; Arán, Christian; Guthrie, Teresa; De Lay, Paul; Avila-Figueroa, Carlos

    2009-12-01

    To describe levels of national HIV spending and examine programmatic allocations according to the type of epidemic and country income. Cross-sectional analysis of HIV expenditures from 50 low-income and middle-income countries. Sources of information included country reports of domestic spending by programmatic activity and HIV services. These HIV spending categories were cross tabulated by source of financing, stratified by type of HIV epidemic and income level of the country and reported in international dollars (I$). Fifty low-income and middle-income countries spent US $ 2.6 billion (I$ 5.8 billion) on HIV in 2006; 87% of the funding among the 17 low-income countries came from international donors. Average per capita spending was I$ 2.1 and positively correlated with Gross National Income. Per capita spending was I$ 1.5 in 9 countries with low-level HIV epidemics, I$ 1.6 in 27 countries with concentrated HIV epidemics and I$ 9.5 in 14 countries with generalized HIV epidemics. On average, spending on care and treatment represented 50% of AIDS spending across all countries. The treatment-to-prevention spending ratio was 1.5:1, 3:1, and 2:1 in countries with low-level, concentrated and generalized epidemics, respectively. Spending on prevention represented 21% of total AIDS spending. However, expenditures addressing most-at-risk populations represented less than 1% in countries with generalized epidemics and 7% in those with low-level or concentrated epidemics. The most striking finding is the mismatch between the types of HIV epidemics and the allocation of resources. The current global economic recession will force countries to rethink national strategies, especially in low-income countries with high aid dependency. Mapping HIV expenditures provides crucial guidance for reallocation of resources and supports evidence-based decisions. Now more than ever, countries need to know and act on their epidemics and give priority to the most effective programmatic

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

    Science.gov (United States)

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

  20. Income inequality, trust, and population health in 33 countries.

    Science.gov (United States)

    Elgar, Frank J

    2010-11-01

    I examined the association between income inequality and population health and tested whether this association was mediated by interpersonal trust or public expenditures on health. Individual data on trust were collected from 48 641 adults in 33 countries. These data were linked to country data on income inequality, public health expenditures, healthy life expectancy, and adult mortality. Regression analyses tested for statistical mediation of the association between income inequality and population health outcomes by country differences in trust and health expenditures. Income inequality correlated with country differences in trust (r = -0.51), health expenditures (r = -0.45), life expectancy (r = -0.74), and mortality (r = 0.55). Trust correlated with life expectancy (r = 0.48) and mortality (r = -0.47) and partly mediated their relations to income inequality. Health expenditures did not correlate with life expectancy and mortality, and health expenditures did not mediate links between inequality and health. Income inequality might contribute to short life expectancy and adult mortality in part because of societal differences in trust. Societies with low levels of trust may lack the capacity to create the kind of social supports and connections that promote health and successful aging.

  1. The importance of continued engagement during the implementation phase of tobacco control policies in a middle-income country: the case of Costa Rica

    Science.gov (United States)

    Crosbie, Eric; Sosa, Patricia; Glantz, Stanton A

    2016-01-01

    Objective To analyse the process of implementing and enforcing smoke-free environments, tobacco advertising, tobacco taxes and health warning labels from Costa Rica's 2012 tobacco control law. Method Review of tobacco control legislation, newspaper articles and interviewing key informants. Results Despite overcoming decades of tobacco industry dominance to win enactment of a strong tobacco control law in March 2012 consistent with WHO's Framework Convention on Tobacco Control, the tobacco industry and their allies lobbied executive branch authorities for exemptions in smoke-free environments to create public confusion, and continued to report in the media that increasing cigarette taxes led to a rise in illicit trade. In response, tobacco control advocates, with technical support from international health groups, helped strengthen tobacco advertising regulations by prohibiting advertising at the point-of-sale (POS) and banning corporate social responsibility campaigns. The Health Ministry used increased tobacco taxes earmarked for tobacco control to help effectively promote and enforce the law, resulting in high compliance for smoke-free environments, advertising restrictions and health warning label (HWL) regulations. Despite this success, government trade concerns allowed, as of December 2015, POS tobacco advertising, and delayed the release of HWL regulations for 15 months. Conclusions The implementation phase continues to be a site of intensive tobacco industry political activity in low and middle-income countries. International support and earmarked tobacco taxes provide important technical and financial assistance to implement tobacco control policies, but more legal expertise is needed to overcome government trade concerns and avoid unnecessary delays in implementation. PMID:26856614

  2. The importance of continued engagement during the implementation phase of tobacco control policies in a middle-income country: the case of Costa Rica.

    Science.gov (United States)

    Crosbie, Eric; Sosa, Patricia; Glantz, Stanton A

    2017-01-01

    To analyse the process of implementing and enforcing smoke-free environments, tobacco advertising, tobacco taxes and health warning labels from Costa Rica's 2012 tobacco control law. Review of tobacco control legislation, newspaper articles and interviewing key informants. Despite overcoming decades of tobacco industry dominance to win enactment of a strong tobacco control law in March 2012 consistent with WHO's Framework Convention on Tobacco Control, the tobacco industry and their allies lobbied executive branch authorities for exemptions in smoke-free environments to create public confusion, and continued to report in the media that increasing cigarette taxes led to a rise in illicit trade. In response, tobacco control advocates, with technical support from international health groups, helped strengthen tobacco advertising regulations by prohibiting advertising at the point-of-sale (POS) and banning corporate social responsibility campaigns. The Health Ministry used increased tobacco taxes earmarked for tobacco control to help effectively promote and enforce the law, resulting in high compliance for smoke-free environments, advertising restrictions and health warning label (HWL) regulations. Despite this success, government trade concerns allowed, as of December 2015, POS tobacco advertising, and delayed the release of HWL regulations for 15 months. The implementation phase continues to be a site of intensive tobacco industry political activity in low and middle-income countries. International support and earmarked tobacco taxes provide important technical and financial assistance to implement tobacco control policies, but more legal expertise is needed to overcome government trade concerns and avoid unnecessary delays in implementation. 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/.

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

    Science.gov (United States)

    Alvarez, Francisco N; El-Sayed, Abdulrahman M

    2017-05-01

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

  4. Institutional quality and income inequality in the advanced countries

    Directory of Open Access Journals (Sweden)

    Josifidis Kosta

    2017-01-01

    Full Text Available The purpose of this paper is to shed more light on the effects of changes in quality of economic, legal and political institutions on income inequality in the advanced countries over the last two decades. Using the robust panel model on a sample of 21 OECD countries, it is found that the impact of elitization of society is more pronounced than the impact of unionization on income redistribution, but both effects are less expressed in comparison to the influence of institutional changes on redistribution. In a globalized economy, insufficient redistribution and high inequality might be interpreted as the consequence of institutional inertia to disruptive technological and business changes.

  5. Height-income association in developing countries: Evidence from 14 countries.

    Science.gov (United States)

    Patel, Pankaj C; Devaraj, Srikant

    2017-12-28

    The purpose of this study was to assess whether the height-income association is positive in developing countries, and whether income differences between shorter and taller individuals in developing countries are explained by differences in endowment (ie, taller individuals have a higher income than shorter individuals because of characteristics such as better social skills) or due to discrimination (ie, shorter individuals have a lower income despite having comparable characteristics). Instrumental variable regression, Oaxaca-Blinder decomposition, quantile regression, and quantile decomposition analyses were applied to a sample of 45 108 respondents from 14 developing countries represented in the Research on Early Life and Aging Trends and Effects (RELATE) study. For a one-centimeter increase in country- and sex-adjusted median height, real income adjusted for purchasing power parity increased by 1.37%. The income differential between shorter and taller individuals was explained by discrimination and not by differences in endowments; however, the effect of discrimination decreased at higher values of country- and sex-adjusted height. Taller individuals in developing countries may realize higher income despite having characteristics similar to those of shorter individuals. © 2017 Wiley Periodicals, Inc.

  6. Influenza vaccines in low and middle income countries

    Science.gov (United States)

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

    2013-01-01

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

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

    Science.gov (United States)

    Newton, Charles R.

    2012-01-01

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

  8. Reflections on Health Promotion and Disability in Low and Middle-Income Countries: Case Study of Parent-Support Programmes for Children with Congenital Zika Syndrome

    Directory of Open Access Journals (Sweden)

    Hannah Kuper

    2018-03-01

    Full Text Available Universal health coverage (UHC has been adopted by many countries as a national target for 2030. People with disabilities need to be included within efforts towards UHC, as they are a large group making up 15% of the world’s population and are more vulnerable to poor health. UHC focuses both on covering the whole population as well as providing all the services needed and must include an emphasis on health promotion, as well as disease treatment and cure. Health promotion often focusses on tackling individual behaviours, such as encouraging exercise or good nutrition. However, these activities are insufficient to improve health without additional efforts to address poverty and inequality, which are the underlying drivers of poor health. In this article, we identify common challenges, opportunities and examples for health promotion for people with disabilities, looking at both individual behaviour change as well as addressing the drivers of poor health. We present a case study of a carer support programme for parents of children with Congenital Zika Syndrome in Brazil as an example of a holistic programme for health promotion. This programme operates both through improving skills of caregivers to address the health needs of their child and tackling poverty and exclusion.

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

    Science.gov (United States)

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

    2015-01-01

    Abstract We aimed to obtain overall and regional estimates of hypertension prevalence, and to examine the pattern of this disease condition across different socio-demographic characteristics in low-and middle-income countries. We searched electronic databases from inception to August 2015. We included population-based studies that reported hypertension prevalence using the current definition of blood pressure ≥140/90 mm Hg or self-reported use of antihypertensive medication. We used random-effects meta-analyses to pool prevalence estimates of hypertension, overall, by World Bank region and country income group. Meta-regression analyses were performed to explore sources of heterogeneity across the included studies. A total of 242 studies, comprising data on 1,494,609 adults from 45 countries, met our inclusion criteria. The overall prevalence of hypertension was 32.3% (95% confidence interval [CI] 29.4–35.3), with the Latin America and Caribbean region reporting the highest estimates (39.1%, 95% CI 33.1–45.2). Pooled prevalence estimate was also highest across upper middle income countries (37.8%, 95% CI 35.0–40.6) and lowest across low-income countries (23.1%, 95% CI 20.1–26.2). Prevalence estimates were significantly higher in the elderly (≥65 years) compared with younger adults (hypertension prevalence (31.9% vs 30.8%, P = 0.6). Persons without formal education (49.0% vs 24.9%, P hypertensive, compared with those who were educated, normal weight, and rural settlers respectively. This study provides contemporary and up-to-date estimates that reflect the significant burden of hypertension in low- and middle-income countries, as well as evidence that hypertension remains a major public health issue across the various socio-demographic subgroups. On average, about 1 in 3 adults in the developing world is hypertensive. The findings of this study will be useful for the design of hypertension screening and treatment programmes in low- and middle-income

  10. Deriving pragmatic factors behind geo-spatial variation of public sanitation relating to health: A case from a mega-city in lower-middle income developing country

    Science.gov (United States)

    Biswas, R.; Arya, K.; Deshpande, S. C.

    2017-12-01

    Sanitation is the daily water-human interaction, but Billions of people are still far away from access to improved public sanitation - mostly in developing countries. This challenges Millennium Development Goals across the globe. Economic growth with provision of basic services is unable to assure improvements in sanitation & health. Policymakers & researchers often focus on building infrastructural-capacity without considering empirical factors behind poor sanitation. What are these driving factors? Is there a nexus between sanitation & health? How it is spatially distributed? We have conducted geo-spatial assessment and exploratory regression to interpret spatial-distribution data and deriving influential pragmatic factors in the process. Mumbai is our test-bed, where we have accumulated and applied a total of 40 ward-wise-attributes related to socio-demographic, spatial, services, diseases and infrastructural data. The results indicate that: higher population per toilet-seat, numerous toilet-issues, low toilet density and poor/moderate toilet-condition may be the reason behind the spread of Diarrhoea. On the other hand, illiteracy, per capita waste generation, excreta overflow to open gutter/nallah from toilets and poor/moderate toilet-condition may be the reasons for the spread of Malaria. Strong correlation or associations observed, as in our Malaria-model has an adjusted R2 of 0.65 and the Diarrhoea-model has 0.76. The identified variables are significant enough, since the p-value is public sanitation & excessive waste generation along with Malaria & Diarrhoea disease-cases. This study and its methods contribute to the advancement of scientific method as a tool that may be useful for researchers, stakeholders and policymakers to conduct further scientific studies in analogous cities. This also permits us to model them to explore policy amendments to mitigate poor sanitation practices that affect public health in contemporary societies.

  11. Zipf rank approach and cross-country convergence of incomes

    Science.gov (United States)

    Shao, Jia; Ivanov, Plamen Ch.; Urošević, Branko; Stanley, H. Eugene; Podobnik, Boris

    2011-05-01

    We employ a concept popular in physics —the Zipf rank approach— in order to estimate the number of years that EU members would need in order to achieve "convergence" of their per capita incomes. Assuming that trends in the past twenty years continue to hold in the future, we find that after t≈30 years both developing and developed EU countries indexed by i will have comparable values of their per capita gross domestic product {\\cal G}_{i,t} . Besides the traditional Zipf rank approach we also propose a weighted Zipf rank method. In contrast to the EU block, on the world level the Zipf rank approach shows that, between 1960 and 2009, cross-country income differences increased over time. For a brief period during the 2007-2008 global economic crisis, at world level the {\\cal G}_{i,t} of richer countries declined more rapidly than the {\\cal G}_{i,t} of poorer countries, in contrast to EU where the {\\cal G}_{i,t} of developing EU countries declined faster than the {\\cal G}_{i,t} of developed EU countries, indicating that the recession interrupted the convergence between EU members. We propose a simple model of GDP evolution that accounts for the scaling we observe in the data.

  12. 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.

    Science.gov (United States)

    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.

  13. Income inequality and schizophrenia: increased schizophrenia incidence in countries with high levels of income inequality.

    Science.gov (United States)

    Burns, Jonathan K; Tomita, Andrew; Kapadia, Amy S

    2014-03-01

    Income inequality is associated with numerous negative health outcomes. There is evidence that ecological-level socio-environmental factors may increase risk for schizophrenia. The aim was to investigate whether measures of income inequality are associated with incidence of schizophrenia at the country level. We conducted a systematic review of incidence rates for schizophrenia, reported between 1975 and 2011. For each country, national measures of income inequality (Gini coefficient) along with covariate risk factors for schizophrenia were obtained. Multi-level mixed-effects Poisson regression was performed to investigate the relationship between Gini coefficients and incidence rates of schizophrenia controlling for covariates. One hundred and seven incidence rates (from 26 countries) were included. Mean incidence of schizophrenia was 18.50 per 100,000 (SD = 11.9; range = 1.7-67). There was a significant positive relationship between incidence rate of schizophrenia and Gini coefficient (β = 1.02; Z = 2.28; p = .02; 95% CI = 1.00, 1.03). Countries characterized by a large rich-poor gap may be at increased risk of schizophrenia. We suggest that income inequality impacts negatively on social cohesion, eroding social capital, and that chronic stress associated with living in highly disparate societies places individuals at risk of schizophrenia.

  14. Injury patterns in road traffic victims comparing road user categories: Analysis of 811 consecutive cases in the emergency department of a level I institution in a low-income country

    Directory of Open Access Journals (Sweden)

    A. Chichom-Mefire

    Full Text Available Background: More than a million people die every day on world's roads and according to current estimates traffic related injuries will become the 5th highest killer in the world by 2030. Low and middle-income countries carry over 90% of this burden with substantial socio-economic consequences. Policies to reduce this burden are currently centered on preventive measures and the care of the injured is still neglected. This study aims at describing the crash characteristics and pattern of injuries in an urban area of a middle-income country with particular emphasis on the differential analysis of various road user categories. Methods: in this prospective cohort analysis conducted over a period of 5 months in the casualty department of the largest hospital in the city of Douala in Cameroon, all patients admitted after sustaining a traffic related injury were analyzed for crash characteristics, pattern and severity of injury and final outcome after a maximum follow-up period of 1 week. The analysis compared various user categories for different variables. Results: a total of 811 cases could be analyzed. These included 586 (72.2% males for a sex-ratio of 2.6/1. Motorized two-wheelers and pedestrians represented overall over 80% of all victims and the most frequent collision involved a motorcycle and a tourist car. Over 95% of victims did not use a protective device. Most patients sustained external soft tissue lesions frequently involving the limbs and face. A total of 280 patients (34.52% sustained a limb fracture. The most frequently fractured bones were the tibia, fibula and femur. Most injury cases were minor or moderate and collision between a motorcycle and a truck resulted in a significantly more severe injury. Motorized two-wheelers and pedestrian were significantly more exposed to external injuries while car occupants were more exposed to chest and spine injuries. Conclusion: crash characteristics in Douala are greatly influenced by the

  15. Globalization and the income distribution between the countries

    OpenAIRE

    Georgieva Svrtinov, Vesna; Gorgieva-Trajkovska, Olivera; Temjanovski, Riste

    2014-01-01

    Globalization is contested concept. In general, it is considered to be beneficial for the growth of economy. But, there are also many adverse effects of globalization on growth in many developing countries. It increases poverty and worsens the income distribution. Globalization has raised powerful debate between optimists and pessimists. There are pro and against globalization debates, with strong arguments in both sides. The objective of this paper is to analyze the relationship betwe...

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

    Science.gov (United States)

    Smith, Elise; Hunt, Matthew; Master, Zubin

    2014-05-28

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

  17. Marginal Effects of a Gross Income Increase for a Single Parent Family in Six European Countries

    DEFF Research Database (Denmark)

    Willumsen, Marie

    the contributions to the combined marginal rate, the marginal effective tax rate, METR, using the OECD term, from taxation, payment for childcare, tapering of housing benefits and sometimes child benefits, when the income varies from a low level to a high level for a single parent family. Six countries are included......High marginal tax rates constitute an issue in several countries because they are supposed to create barriers for increased labour supply. It is, however, often the case that relatively low income families with children face substantially higher combined marginal rates than even the highest...

  18. Improving Outcomes from Breast Cancer in a Low-Income Country: Lessons from Bangladesh

    Directory of Open Access Journals (Sweden)

    H. L. Story

    2012-01-01

    Full Text Available Women in low- and middle-income countries (LMICs have yet to benefit from recent advances in breast cancer diagnosis and treatment now experienced in high-income countries. Their unique sociocultural and health system circumstances warrant a different approach to breast cancer management than that applied to women in high-income countries. Here, we present experience from the last five years working in rural Bangladesh. Case and consecutive series data, focus group and individual interviews, and clinical care experience provide the basis for this paper. These data illustrate a complex web of sociocultural, economic, and health system conditions which affect womens’ choices to seek and accept care and successful treatment. We conclude that health system, human rights, and governance issues underlie high mortality from this relatively rare disease in Bangladesh.

  19. Improving outcomes from breast cancer in a low-income country: lessons from bangladesh.

    Science.gov (United States)

    Story, H L; Love, R R; Salim, R; Roberto, A J; Krieger, J L; Ginsburg, O M

    2012-01-01

    Women in low- and middle-income countries (LMICs) have yet to benefit from recent advances in breast cancer diagnosis and treatment now experienced in high-income countries. Their unique sociocultural and health system circumstances warrant a different approach to breast cancer management than that applied to women in high-income countries. Here, we present experience from the last five years working in rural Bangladesh. Case and consecutive series data, focus group and individual interviews, and clinical care experience provide the basis for this paper. These data illustrate a complex web of sociocultural, economic, and health system conditions which affect womens' choices to seek and accept care and successful treatment. We conclude that health system, human rights, and governance issues underlie high mortality from this relatively rare disease in Bangladesh.

  20. Improving Outcomes from Breast Cancer in a Low-Income Country: Lessons from Bangladesh

    International Nuclear Information System (INIS)

    Story, H.L.; Love, R.R.; Ginsburg, O.M.; Story, H.L.; Salim, R.; Roberto, A.J.; Krieger, J.L.; Ginsburg, O.M.

    2012-01-01

    Women in low- and middle-income countries (LMICs) have yet to benefit from recent advances in breast cancer diagnosis and treatment now experienced in high-income countries. Their unique socio cultural and health system circumstances warrant a different approach to breast cancer management than that applied to women in high-income countries. Here, we present experience from the last five years working in rural Bangladesh. Case and consecutive series data, focus group and individual interviews, and clinical care experience provide the basis for this paper. These data illustrate a complex web of socio cultural, economic, and health system conditions which affect women's choices to seek and accept care and successful treatment. We conclude that health system, human rights, and governance issues underlie high mortality from this relatively rare disease in Bangladesh

  1. Surviving spinal cord injury in low income countries

    Directory of Open Access Journals (Sweden)

    Tone Øderud

    2014-08-01

    Objectives: The aims of this study were to explore life expectancy (life expectancy is the average remaining years of life of an individual and the situation of persons living with SCI in low income settings. Method: Literature studies and qualitative methods were used. Qualitative data was collected through semi-structured interviews with 23 informants from four study sites in Zimbabwe representing persons with SCI, their relatives and rehabilitation professionals. Results: There are few publications available about life expectancy and the daily life of persons with SCI in low income countries. Those few publications identified and the study findings confirm that individuals with SCI are experiencing a high occurrence of pressure sores and urinary tract infections leading to unnecessary suffering, often causing premature death. Pain and depression are frequently reported and stigma and negative attitudes are experienced in society. Lack of appropriate wheelchairs and services, limited knowledge about SCI amongst health care staff, limited access to health care and rehabilitation services, loss of employment and lack of financial resources worsen the daily challenges. Conclusion: The study indicates that life expectancy for individuals with SCI in low income settings is shorter than for the average population and also with respect to individuals with SCI in high income countries. Poverty worsened the situation for individuals with SCI, creating barriers that increase the risk of contracting harmful pressure sores and infections leading to premature death. Further explorations on mortality and how individuals with SCI and their families in low income settings are coping in their daily life are required to provide comprehensive evidences.

  2. Is income inequality related to childhood dental caries in rich countries?

    Science.gov (United States)

    Bernabé, Eduardo; Hobdell, Martin H

    2010-02-01

    The aim of this study was to assess the correlates of income and income inequality with dental caries in a sample of all countries, as well as in rich countries alone. In this ecological study, the authors analyzed national data on income, income inequality and dental caries from 48 countries. Of them, 22 were rich countries (according to World Bank criteria). The authors determined income by gross national income (GNI) per capita (formerly known as gross national product) and income inequality by the Gini coefficient (a measure of income inequality on a scale between 0 and 1). They assessed dental caries according to the decayed, missing, filled teeth (dmft) index in 5- to 6-year-old children. The authors used Pearson and partial correlation coefficients to examine the linear associations of income and income inequality with dental caries. GNI per capita, but not the Gini coefficient, was inversely correlated with the dmft index in the 48 countries. However, the results showed an opposite pattern when analyses were restricted to rich countries (that is, the dmft index was significantly correlated with the Gini coefficient but not with GNI per capita). These findings support the income inequality hypothesis that beyond a certain level of national income, the relationship between income and the population's health is weak. Income inequality was correlated more strongly with dental caries than was income in rich countries. Among rich countries, income inequality is a stronger determinant of childhood dental caries than is absolute income.

  3. Labor Share in National Income: Implications in the Baltic Countries

    Directory of Open Access Journals (Sweden)

    Razgūnė Aušra

    2017-06-01

    Full Text Available Despite the fact that stability of labor share in national income is a key foundation in macroeconomic models, scientists acknowledge, that in the last three decades it has been declining around the world. The Baltic countries are not an exception; they follow similar patters to large economies, thus the research aims at determining economic factors at play. With the help of error correction model and time series data covering the past twenty years, we determine factors which contribute to the decline of labor share in the Baltic countries. We find significant long-term relationships between labor share and government spending, trade openness, and emigration. Government spending exhibits the highest contribution to variance of labor share in Lithuania, which also explains a large part of Latvia’s labor share variations. We find many similarities between the analyzed countries, however some differences are also visible.

  4. Bank concentration, country income and financial development in ...

    African Journals Online (AJOL)

    kirstam

    between bank concentration and financial development in the SADC region. ... 5The study findings suggest that bank assets in SADC are concentrated in ... a country's cities/administrative regions, or across countries within a regional ... sector emphasises the importance of local embeddedness, networks, ...... The Case of.

  5. Essential Medicines in a High Income Country: Essential to Whom?

    Science.gov (United States)

    Duong, Mai; Moles, Rebekah J; Chaar, Betty; Chen, Timothy F

    2015-01-01

    To explore the perspectives of a diverse group of stakeholders engaged in medicines decision making around what constitutes an "essential" medicine, and how the Essential Medicines List (EML) concept functions in a high income country context. In-depth qualitative semi-structured interviews were conducted with 32 Australian stakeholders, recognised as decision makers, leaders or advisors in the area of medicines reimbursement or supply chain management. Participants were recruited from government, pharmaceutical industry, pharmaceutical wholesale/distribution companies, medicines non-profit organisations, academic health disciplines, hospitals, and consumer groups. Perspectives on the definition and application of the EML concept in a high income country context were thematically analysed using grounded theory approach. Stakeholders found it challenging to describe the EML concept in the Australian context because many perceived it was generally used in resource scarce settings. Stakeholders were unable to distinguish whether nationally reimbursed medicines were essential medicines in Australia. Despite frequent generic drug shortages and high prices paid by consumers, many struggled to describe how the EML concept applied to Australia. Instead, broad inclusion of consumer needs, such as rare and high cost medicines, and consumer involvement in the decision making process, has led to expansive lists of nationally subsidised medicines. Therefore, improved communication and coordination is needed around shared interests between stakeholders regarding how medicines are prioritised and guaranteed in the supply chain. This study showed that decision-making in Australia around reimbursement of medicines has strayed from the fundamental utilitarian concept of essential medicines. Many stakeholders involved in medicine reimbursement decisions and management of the supply chain did not consider the EML concept in their approach. The wide range of views of what stakeholders

  6. Essential Medicines in a High Income Country: Essential to Whom?

    Directory of Open Access Journals (Sweden)

    Mai Duong

    Full Text Available To explore the perspectives of a diverse group of stakeholders engaged in medicines decision making around what constitutes an "essential" medicine, and how the Essential Medicines List (EML concept functions in a high income country context.In-depth qualitative semi-structured interviews were conducted with 32 Australian stakeholders, recognised as decision makers, leaders or advisors in the area of medicines reimbursement or supply chain management. Participants were recruited from government, pharmaceutical industry, pharmaceutical wholesale/distribution companies, medicines non-profit organisations, academic health disciplines, hospitals, and consumer groups. Perspectives on the definition and application of the EML concept in a high income country context were thematically analysed using grounded theory approach.Stakeholders found it challenging to describe the EML concept in the Australian context because many perceived it was generally used in resource scarce settings. Stakeholders were unable to distinguish whether nationally reimbursed medicines were essential medicines in Australia. Despite frequent generic drug shortages and high prices paid by consumers, many struggled to describe how the EML concept applied to Australia. Instead, broad inclusion of consumer needs, such as rare and high cost medicines, and consumer involvement in the decision making process, has led to expansive lists of nationally subsidised medicines. Therefore, improved communication and coordination is needed around shared interests between stakeholders regarding how medicines are prioritised and guaranteed in the supply chain.This study showed that decision-making in Australia around reimbursement of medicines has strayed from the fundamental utilitarian concept of essential medicines. Many stakeholders involved in medicine reimbursement decisions and management of the supply chain did not consider the EML concept in their approach. The wide range of views of

  7. Global Surgery 2030: a roadmap for high income country actors

    Science.gov (United States)

    Greenberg, Sarah L M; Abdullah, Fizan; Amado, Vanda; Anderson, Geoffrey A; Cossa, Matchecane; Costas-Chavarri, Ainhoa; Davies, Justine; Debas, Haile T; Dyer, George S M; Erdene, Sarnai; Farmer, Paul E; Gaumnitz, Amber; Hagander, Lars; Haider, Adil; Leather, Andrew J M; Lin, Yihan; Marten, Robert; Marvin, Jeffrey T; McClain, Craig D; Meara, John G; Meheš, Mira; Mock, Charles; Mukhopadhyay, Swagoto; Orgoi, Sergelen; Prestero, Timothy; Price, Raymond R; Raykar, Nakul P; Riesel, Johanna N; Riviello, Robert; Rudy, Stephen M; Saluja, Saurabh; Sullivan, Richard; Tarpley, John L; Taylor, Robert H; Telemaque, Louis-Franck; Toma, Gabriel; Varghese, Asha; Walker, Melanie; Yamey, Gavin; Shrime, Mark G

    2016-01-01

    The Millennium Development Goals have ended and the Sustainable Development Goals have begun, marking a shift in the global health landscape. The frame of reference has changed from a focus on 8 development priorities to an expansive set of 17 interrelated goals intended to improve the well-being of all people. In this time of change, several groups, including the Lancet Commission on Global Surgery, have brought a critical problem to the fore: 5 billion people lack access to safe, affordable surgical and anaesthesia care when needed. The magnitude of this problem and the world's new focus on strengthening health systems mandate reimagined roles for and renewed commitments from high income country actors in global surgery. To discuss the way forward, on 6 May 2015, the Commission held its North American launch event in Boston, Massachusetts. Panels of experts outlined the current state of knowledge and agreed on the roles of surgical colleges and academic medical centres; trainees and training programmes; academia; global health funders; the biomedical devices industry, and news media and advocacy organisations in building sustainable, resilient surgical systems. This paper summarises these discussions and serves as a consensus statement providing practical advice to these groups. It traces a common policy agenda between major actors and provides a roadmap for maximising benefit to surgical patients worldwide. To close the access gap by 2030, individuals and organisations must work collectively, interprofessionally and globally. High income country actors must abandon colonial narratives and work alongside low and middle income country partners to build the surgical systems of the future. PMID:28588908

  8. Information systems for mental health in six low and middle income countries : Cross country situation analysis

    NARCIS (Netherlands)

    Upadhaya, Nawaraj; Jordans, Mark J D; Abdulmalik, Jibril; Ahuja, Shalini; Alem, Atalay; Hanlon, Charlotte; Kigozi, Fred; Kizza, Dorothy; Lund, Crick; Semrau, Maya; Shidhaye, Rahul; Thornicroft, Graham; Komproe, Ivan H.; Gureje, Oye

    2016-01-01

    Background: Research on information systems for mental health in low and middle income countries (LMICs) is scarce. As a result, there is a lack of reliable information on mental health service needs, treatment coverage and the quality of services provided. Methods: With the aim of informing the

  9. Using participatory methods to design an mHealth intervention for a low income country, a case study in Chikwawa, Malawi.

    Science.gov (United States)

    Laidlaw, Rebecca; Dixon, Diane; Morse, Tracy; Beattie, Tara K; Kumwenda, Save; Mpemberera, Grant

    2017-07-05

    mHealth holds the potential to educate rural communities in developing countries such as Malawi, on issues which over-burdened and under staffed health centres do not have the facilities to address. Previous research provides support that mHealth could be used as a vehicle for health education campaigns at a community level; however the limited involvement of potential service users in the research process endangers both user engagement and intervention effectiveness. This two stage qualitative study used participatory action research to inform the design and development of an mHealth education intervention. First, secondary analysis of 108 focus groups (representing men, women, leadership, elderly and male and female youth) identified four topics where there was a perceived health education need. Second, 10 subsequent focus groups explored details of this perceived need and the acceptability and feasibility of mHealth implementation in Chikwawa, Malawi. Stage 1 and Stage 2 informed the design of the intervention in terms of target population, intervention content, intervention delivery and the frequency and timing of the intervention. This has led to the design of an SMS intervention targeting adolescents with contraceptive education which they will receive three times per week at 4 pm and will be piloted in the next phase of this research. This study has used participatory methods to identify a need for contraception education in adolescents and inform intervention design. The focus group discussions informed practical considerations for intervention delivery, which has been significantly influenced by the high proportion of users who share mobile devices and the intervention has been designed to allow for message sharing as much as possible.

  10. How Are New Vaccines Prioritized in Low-Income Countries? A Case Study of Human Papilloma Virus Vaccine and Pneumococcal Conjugate Vaccine in Uganda.

    Science.gov (United States)

    Wallace, Lauren; Kapirir, Lydia

    2017-04-08

    To date, research on priority-setting for new vaccines has not adequately explored the influence of the global, national and sub-national levels of decision-making or contextual issues such as political pressure and stakeholder influence and power. Using Kapiriri and Martin's conceptual framework, this paper evaluates priority setting for new vaccines in Uganda at national and sub-national levels, and considers how global priorities can influence country priorities. This study focuses on 2 specific vaccines, the human papilloma virus (HPV) vaccine and the pneumococcal conjugate vaccine (PCV). This was a qualitative study that involved reviewing relevant Ugandan policy documents and media reports, as well as 54 key informant interviews at the global level and national and sub-national levels in Uganda. Kapiriri and Martin's conceptual framework was used to evaluate the prioritization process. Priority setting for PCV and HPV was conducted by the Ministry of Health (MoH), which is considered to be a legitimate institution. While respondents described the priority setting process for PCV process as transparent, participatory, and guided by explicit relevant criteria and evidence, the prioritization of HPV was thought to have been less transparent and less participatory. Respondents reported that neither process was based on an explicit priority setting framework nor did it involve adequate representation from the districts (program implementers) or publicity. The priority setting process for both PCV and HPV was negatively affected by the larger political and economic context, which contributed to weak institutional capacity as well as power imbalances between development assistance partners and the MoH. Priority setting in Uganda would be improved by strengthening institutional capacity and leadership and ensuring a transparent and participatory processes in which key stakeholders such as program implementers (the districts) and beneficiaries (the public) are

  11. Income Inequality and Use of Dental Services in 66 Countries.

    Science.gov (United States)

    Bhandari, B; Newton, J T; Bernabé, E

    2015-08-01

    This study explored the association between income inequality and use of dental services and the role that investment in health care plays in explaining that association. We pooled individual-level data from 223,299 adults, 18 years or older, in 66 countries, who participated in the World Health Organization (WHO) World Health Surveys with country-level data from different international sources. Income inequality was measured at the national level using the Gini coefficient, and use of dental services was defined as having received treatment to address problems with mouth and/or teeth in the past year. The association between the Gini coefficient and use of dental services was examined in multilevel models controlling for a standard set of individual- and country-level confounders. The individual and joint contributions of 4 indicators of investment in health care were evaluated in sequential modeling. The Gini coefficient and use of dental services were inversely associated after adjustment for confounders. Every 10% increase in the Gini coefficient corresponded with a 15% lower odds of using dental services (odds ratio: 0.85; 95% confidence interval: 0.70-0.99). The association between the Gini coefficient and use of dental services was attenuated and became nonsignificant after individual adjustment for total health expenditure, public expenditure on health, health system responsiveness, or type of dental health system. The 4 indicators together explained 80% of the association between the Gini coefficient and use of dental services. This study suggests that more equal countries have greater use of dental services. It also supports the mediating role of investment in health care in explaining that association. © International & American Associations for Dental Research 2015.

  12. Nonlinearity and cross-country dependence of income inequality

    OpenAIRE

    Leena Kalliovirta; Tuomas Malinen

    2015-01-01

    We use top income data and the newly developed regime switching Gaussian mixture vector autoregressive model to explain the dynamics of income inequality in developed economies within the last 100 years. Our results indicate that the process of income inequality consists of two equilibriums identifiable by high inequality, high income fluctuations and low inequality, low income fluctuations. Our results also show that income inequality in the U.S. is the driver of income inequality in other d...

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

    Science.gov (United States)

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

    2014-10-01

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

  14. Acquired heart disease in low-income and middle-income countries.

    Science.gov (United States)

    Curry, Chris; Zuhlke, Liesl; Mocumbi, Ana; Kennedy, Neil

    2018-01-01

    The burden of illness associated with acquired cardiac disease in children in low-income and middle-income countries (LMIC) is significant and may be equivalent to that of congenital heart disease. Rheumatic heart disease, endomyocardial fibrosis, cardiomyopathy (including HIV cardiomyopathy) and tuberculosis are the most important causes. All are associated with poverty with the neediest children having the least access to care. The associated mortality and morbidity is high. There is an urgent need to improve cardiac care in LMIC, particularly in sub-Saharan Africa and parts of Southeast Asia where the burden is highest. © 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.

  15. Evidence to modify guidelines for routine retinopathy of prematurity screening to avoid childhood blindness in middle-income countries

    Directory of Open Access Journals (Sweden)

    Miroslava Paolah Meraz-Gutiérrez

    2016-07-01

    Conclusions: These findings show that the valid guidelines at the time of the screening were based on a different population and were not sufficient to detect all ROP cases in a middle-income country. With the update of the Mexican guidelines established in July 2015, the patients from this study would have been screened. Therefore, review and modification of the current screening guidelines in other middle-income countries should be considered to include all babies at risk for ROP.

  16. Mental health in low- and middle-income countries.

    Science.gov (United States)

    Patel, Vikram

    2007-01-01

    Mental disorders in low- and middle-income countries (LAMIC) do not attract global health policy attention. This article is based on a selective review of research on mental disorders in adults in LAMIC since 2001 and recent analyses of disease burden in developing countries. Mental disorders account for 11.1% of the total burden of disease in LAMIC. Unipolar depressive disorder is the single leading neuropsychiatric cause of disease burden. Alcohol use disorders account for nearly 4% of the attributable disease burden in LAMIC. Mental disorders are closely associated with other public health concerns such as maternal and child health and HIV/AIDS. Poverty, low education, social exclusion, gender disadvantage, conflict and disasters are the major social determinants of mental disorders. Clinical trials demonstrate that locally available, affordable interventions in community and primary care settings are effective for the management of mental disorders. Mental health resources are very scarce and investment in mental health is < 1% of the health budget in many countries. The majority of people with mental disorders do not receive evidence-based care, leading to chronicity, suffering and increased costs of care. Strengthening care and services for people with mental disorders is a priority; this will need additional investment in human resources and piggy backing on existing public health programmes. Campaigns to increase mental health literacy are needed at all levels of the health system.

  17. Financing pediatric surgery in low-, and middle-income countries.

    Science.gov (United States)

    Hsiung, Grace; Abdullah, Fizan

    2016-02-01

    Congenital anomalies once considered fatal, are now surgically correctable conditions that now allow children to live a normal life. Pediatric surgery, traditionally thought of as a privilege of the rich, as being too expensive and impractical, and which has previously been overlooked and excluded in resource-poor settings, is now being reexamined as a cost-effective strategy to reduce the global burden of disease-particularly in low, and middle-income countries (LMICs). However, to date, global pediatric surgical financing suffers from an alarming paucity of data. To leverage valuable resources and prioritize pediatric surgical services, timely, accurate and detailed global health spending and financing for pediatric surgical care is needed to inform policy making, strategic health-sector budgeting and resource allocation. This discussions aims to characterize and highlight the evidence gaps that currently exist in global financing and funding flow for pediatric surgical care in LMICs. Copyright © 2016. Published by Elsevier Inc.

  18. Global Pediatric Oncology: Lessons From Partnerships Between High-Income Countries and Low- to Mid-Income Countries

    Science.gov (United States)

    Antillon, Federico; Pedrosa, Francisco; Pui, Ching-Hon

    2016-01-01

    Partnerships between medical institutions in high-income countries (HICs) and low- to mid-income countries (LMICs) have succeeded in initiating and expanding pediatric cancer control efforts. The long-term goal is consistently a sustainable national pediatric cancer program. Here, we review the elements required for successful implementation, development, and long-term sustainability of pediatric cancer programs in LMICs that first arise as partnerships with institutions in HICs. Although plans must be adapted to each country's resources, certain components are unfailingly necessary. First, an essential step is provision of treatment regardless of ability to pay. Second, financial support for program development and long-term sustainability must be sought from sources both international and local, public and private. A local leader, typically a well-trained pediatric oncologist who devotes full-time effort to the project, should direct medical care and collaborate with hospital, governmental, and community leadership and international agencies. Third, nurses must be trained in pediatric cancer care and allowed to practice this specialty full-time. It is also essential to develop a grassroots organization, such as a foundation, dedicated solely to pediatric oncology. Its members must be trained and educated to provide pediatric cancer advocacy, fundraising, and (in concert with government) program sustainability. Finally, a project mentor in the HIC is crucial and should explore the possibility of collaborative research in the LMIC, which may offer significant opportunities. Relationships between the partnership's leaders and influential individuals in the community, hospital, grassroots foundation, and government will lay the foundation for productive collaboration and a sustainable pediatric oncology program. PMID:26578620

  19. 26 CFR 1.863-6 - Income from sources within a foreign country.

    Science.gov (United States)

    2010-04-01

    ...) INCOME TAX (CONTINUED) INCOME TAXES Regulations Applicable to Taxable Years Prior to December 30, 1996 § 1.863-6 Income from sources within a foreign country. The principles applied in sections 861 through 863 and section 865 and the regulations thereunder for determining the gross and the taxable income...

  20. Within country inequalities in caesarean section rates: observational study of 72 low and middle income countries.

    Science.gov (United States)

    Boatin, Adeline Adwoa; Schlotheuber, Anne; Betran, Ana Pilar; Moller, Ann-Beth; Barros, Aluisio J D; Boerma, Ties; Torloni, Maria Regina; Victora, Cesar G; Hosseinpoor, Ahmad Reza

    2018-01-24

    To provide an update on economic related inequalities in caesarean section rates within countries. Secondary analysis of demographic and health surveys and multiple indicator cluster surveys. 72 low and middle income countries with a survey conducted between 2010 and 2014 for analysis of the latest situation of inequality, and 28 countries with a survey also conducted between 2000 and 2004 for analysis of the change in inequality over time. Women aged 15-49 years with a live birth during the two or three years preceding the survey. Data on caesarean section were disaggregated by asset based household wealth status and presented separately for five subgroups, ranging from the poorest to the richest fifth. Absolute and relative inequalities were measured using difference and ratio measures. The pace of change in the poorest and richest fifths was compared using a measure of excess change. National caesarean section rates ranged from 0.6% in South Sudan to 58.9% in the Dominican Republic. Within countries, caesarean section rates were lowest in the poorest fifth (median 3.7%) and highest in the richest fifth (median 18.4%). 18 out of 72 study countries reported a difference of 20 percentage points or higher between the richest and poorest fifth. The highest caesarean section rates and greatest levels of absolute inequality were observed in countries from the region of the Americas, whereas countries from the African region had low levels of caesarean use and comparatively lower levels of absolute inequality, although relative inequality was quite high in some countries. 26 out of 28 countries reported increases in caesarean section rates over time. Rates tended to increase faster in the richest fifth (median 0.9 percentage points per year) compared with the poorest fifth (median 0.2 percentage points per year), indicating an increase in inequality over time in most of these countries. Substantial within country economic inequalities in caesarean deliveries remain

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

    Science.gov (United States)

    Vargas Bustamante, Arturo; V Shimoga, Sandhya

    2017-07-19

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

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

    Science.gov (United States)

    Vargas Bustamante, Arturo; Shimoga, Sandhya V.

    2018-01-01

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

  3. Should low-income countries invest in breast cancer screening?

    Science.gov (United States)

    Gyawali, Bishal; Shimokata, Tomoya; Honda, Kazunori; Tsukuura, Hiroaki; Ando, Yuichi

    2016-11-01

    With the increase in incidence and mortality of breast cancer in low-income countries (LICs), the question of whether LICs should promote breast cancer screening for early detection has gained tremendous importance. Because LICs have limited financial resources, the value of screening must be carefully considered before integrating screening programs into national healthcare system. Mammography-the most commonly used screening tool in developed countries-reduces breast cancer-specific mortality among women of age group 50-69, but the evidence is not so clear for younger women. Further, it does not reduce the overall mortality. Because the women in LICs tend to get breast cancer at younger age and are faced with various competing causes of mortality, LICs need to seriously evaluate whether mammographic screening presents a good value for the investment. Instead, we suggest a special module of clinical breast examination that could provide similar benefits at a very low cost. Nevertheless, we believe that LICs would obtain a much greater value for their investment if they promote primary prevention by tobacco cessation, healthier food and healthier lifestyle campaigns instead.

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

    Directory of Open Access Journals (Sweden)

    Jean-Pierre Unger

    2006-09-01

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

  5. Income inequality and population health: a panel data analysis on 21 developed countries

    OpenAIRE

    Roberta Torre; Mikko Myrskylä

    2011-01-01

    The relative income-health hypothesis postulates that income distribution is one of the key determinants of population health. The discussion on the age and gender patterns of this association is still open. We test the relative income-health hypothesis using a panel data covering 21 developed countries for over 30 years. We find that net of trends in GDP per head and unobserved period and country factors, income inequality, measured by the Gini index, is strongly and positively associated wi...

  6. Tailoring science education graduate programs to the needs of science educators in low-income countries

    Science.gov (United States)

    Lunetta, Vincent N.; van den Berg, Euwe

    Science education graduate programs in high-income countries frequently enroll students from low-income countries. Upon admission these students have profiles of knowledge, skills, and experiences which can be quite different from those of students from the host high-income countries. Upon graduation, they will normally return to work in education systems with conditions which differ greatly from those in high-income countries. This article attempts to clarify some of the differences and similarities between such students. It offers suggestions for making graduate programs more responsive to the special needs of students from low-income countries and to the opportunities they offer for enhancing cross-cultural sensitivity. Many of the suggestions can be incorporated within existing programs through choices of elective courses and topics for papers, projects, and research. Many references are provided to relevant literature on cultural issues and on science education in low-income countries.

  7. The income elasticity of health care spending in developing and developed countries.

    Science.gov (United States)

    Farag, Marwa; NandaKumar, A K; Wallack, Stanley; Hodgkin, Dominic; Gaumer, Gary; Erbil, Can

    2012-06-01

    To date, international analyses on the strength of the relationship between country-level per capita income and per capita health expenditures have predominantly used developed countries' data. This study expands this work using a panel data set for 173 countries for the 1995-2006 period. We found that health care has an income elasticity that qualifies it as a necessity good, which is consistent with results of the most recent studies. Furthermore, we found that health care spending is least responsive to changes in income in low-income countries and most responsive to in middle-income countries with high-income countries falling in the middle. Finally, we found that 'Voice and Accountability' as an indicator of good governance seems to play a role in mobilizing more funds for health.

  8. Cardiovascular Risk and Events in 17 Low-, Middle-, and High-Income Countries.

    OpenAIRE

    Yusuf, S; Rangarajan, S; Teo, K; Islam, S; Li, W; Liu, L; Bo, J; Lou, Q; Lu, F; Liu, T; Yu, L; Zhang, S; Mony, P; Swaminathan, S; Mohan, V

    2014-01-01

    : More than 80% of deaths from cardiovascular disease are estimated to occur in low-income and middle-income countries, but the reasons are unknown. : We enrolled 156,424 persons from 628 urban and rural communities in 17 countries (3 high-income, 10 middle-income, and 4 low-income countries) and assessed their cardiovascular risk using the INTERHEART Risk Score, a validated score for quantifying risk-factor burden without the use of laboratory testing (with higher scores indicating greater r...

  9. Exposing and addressing tobacco industry conduct in low-income and middle-income countries.

    Science.gov (United States)

    Gilmore, Anna B; Fooks, Gary; Drope, Jeffrey; Bialous, Stella Aguinaga; Jackson, Rachel Rose

    2015-03-14

    The tobacco industry's future depends on increasing tobacco use in low-income and middle-income countries (LMICs), which face a growing burden of tobacco-related disease, yet have potential to prevent full-scale escalation of this epidemic. To drive up sales the industry markets its products heavily, deliberately targeting non-smokers and keeps prices low until smoking and local economies are sufficiently established to drive prices and profits up. The industry systematically flaunts existing tobacco control legislation and works aggressively to prevent future policies using its resource advantage to present highly misleading economic arguments, rebrand political activities as corporate social responsibility, and establish and use third parties to make its arguments more palatable. Increasingly it is using domestic litigation and international arbitration to bully LMICs from implementing effective policies and hijacking the problem of tobacco smuggling for policy gain, attempting to put itself in control of an illegal trade in which there is overwhelming historical evidence of its complicity. Progress will not be realised until tobacco industry interference is actively addressed as outlined in Article 5.3 of the Framework Convention on Tobacco Control. Exemplar LMICs show this action can be achieved and indicate that exposing tobacco industry misconduct is an essential first step. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. Information systems for mental health in six low and middle income countries: cross country situation analysis.

    Science.gov (United States)

    Upadhaya, Nawaraj; Jordans, Mark J D; Abdulmalik, Jibril; Ahuja, Shalini; Alem, Atalay; Hanlon, Charlotte; Kigozi, Fred; Kizza, Dorothy; Lund, Crick; Semrau, Maya; Shidhaye, Rahul; Thornicroft, Graham; Komproe, Ivan H; Gureje, Oye

    2016-01-01

    Research on information systems for mental health in low and middle income countries (LMICs) is scarce. As a result, there is a lack of reliable information on mental health service needs, treatment coverage and the quality of services provided. With the aim of informing the development and implementation of a mental health information sub-system that includes reliable and measurable indicators on mental health within the Health Management Information Systems (HMIS), a cross-country situation analysis of HMIS was conducted in six LMICs (Ethiopia, India, Nepal, Nigeria, South Africa and Uganda), participating in the 'Emerging mental health systems in low and middle income countries' (Emerald) research programme. A situation analysis tool was developed to obtain and chart information from documents in the public domain. In circumstances when information was inadequate, key government officials were contacted to verify the data collected. In this paper we compare the baseline policy context, human resources situation as well as the processes and mechanisms of collecting, verifying, reporting and disseminating mental health related HMIS data. The findings suggest that countries face substantial policy, human resource and health governance challenges for mental health HMIS, many of which are common across sites. In particular, the specific policies and plans for the governance and implementation of mental health data collection, reporting and dissemination are absent. Across sites there is inadequate infrastructure, few HMIS experts, and inadequate technical support and supervision to junior staff, particularly in the area of mental health. Nonetheless there are also strengths in existing HMIS where a few mental health morbidity, mortality, and system level indicators are collected and reported. Our study indicates the need for greater technical and resources input to strengthen routine HMIS and develop standardized HMIS indicators for mental health, focusing in

  11. Three models of community mental health services In low-income countries

    Directory of Open Access Journals (Sweden)

    De Silva Mary

    2011-01-01

    Full Text Available Abstract Objective To compare and contrast three models of community mental health services in low-income settings. Data Sources/Study Setting Primary and secondary data collected before, during, and after site visits to mental health programs in Nigeria, the Philippines, and India. Study Design Qualitative case study methodology. Data Collection Data were collected through interviews and observations during site visits to the programs, as well as from reviews of documentary evidence. Principal Findings A set of narrative topics and program indicators were used to compare and contrast three community mental health programs in low-income countries. This allowed us to identify a diversity of service delivery models, common challenges, and the strengths and weaknesses of each program. More definitive evaluations will require the establishment of data collection methods and information systems that provide data about the clinical and social outcomes of clients, as well as their use of services. Conclusions Community mental health programs in low-income countries face a number of challenges. Using a case study methodology developed for this purpose, it is possible to compare programs and begin to assess the effectiveness of diverse service delivery models.

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

    Science.gov (United States)

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

    2013-08-03

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

  13. Postnatal depression and its effects on child development: a review of evidence from low- and middle-income countries.

    Science.gov (United States)

    Parsons, Christine E; Young, Katherine S; Rochat, Tamsen J; Kringelbach, Morten L; Stein, Alan

    2012-01-01

    It is well established that postnatal depression (PND) is prevalent in high-income countries and is associated with negative personal, family and child developmental outcomes. Here, studies on the prevalence of maternal PND in low- and middle-income countries are reviewed and a geographical prevalence map is presented. The impact of PND upon child outcomes is also reviewed. The available evidence suggests that rates of PND are substantial, and in many regions, are higher than those reported for high-income countries. An association between PND and adverse child developmental outcomes was identified in many of the countries examined. Significant heterogeneity in prevalence rates and impact on child outcomes across studies means that the true extent of the disease burden is still unclear. Nonetheless, there is a compelling case for the implementation of interventions to reduce the impact of PND on the quality of the mother-infant relationship and improve child outcomes.

  14. Income inequality and periodontal diseases in rich countries: an ecological cross-sectional study.

    Science.gov (United States)

    Sabbah, Wael; Sheiham, Aubrey; Bernabé, Eduardo

    2010-10-01

    There are adverse effects of income inequality on morbidity and mortality. This relationship has not been adequately examined in relation to oral health. To examine the relationship between income inequality and periodontal disease in rich countries. Adults aged 35-44 years in 17 rich countries with populations of more than 2 million. National level data on periodontal disease, income inequality and absolute national income were collected from 17 rich countries with populations of more than 2m. Pearson and partial correlations were used to examine the relationship between income inequality and percentage of 35-44-year-old adults with periodontal pockets > or = 4 mm and > or = 6 mm deep, adjusting for absolute national income. Higher levels of income inequality were significantly associated with higher levels of periodontal disease, independently of absolute national income. Absolute income was not associated with levels of periodontal disease in these 17 rich countries. Income inequality appears to be an important contextual determinant of periodontal disease. The results emphasise the importance of relative income rather than absoluteincome in relation to periodontal disease in rich countries.

  15. Inequality in CO2 emissions across countries and its relationship with income inequality : a distributive approach

    OpenAIRE

    Padilla, Emilio

    2006-01-01

    This paper analyses the inequality in CO2 emissions across countries (and groups of countries) and the relationship of this inequality with income inequality across countries for the period (1971-1999). The research employs the tools that are usually applied in income distribution analysis. The methodology used here gives qualitative and quantitative information on some of the features of the inequalities across countries that are considered most relevant for the design and discussion of poli...

  16. Inequality in CO2 emissions across countries and its relationship with income inequality: a distributive approach

    OpenAIRE

    Emilio Padilla; Alfredo Serrano

    2005-01-01

    This paper analyses the inequality in CO2 emissions across countries (and groups of countries) and the relationship of this inequality with income inequality across countries for the period (1971-1999). The research employs the tools that are usually applied in income distribution analysis. The methodology used here gives qualitative and quantitative information on some of the features of the inequalities across countries that are considered most relevant for the design and discussion of poli...

  17. Micronutrients in Pregnancy in Low- and Middle-Income Countries

    Directory of Open Access Journals (Sweden)

    Ian Darnton-Hill

    2015-03-01

    Full Text Available Pregnancy is one of the more important periods in life when increased micronutrients, and macronutrients are most needed by the body; both for the health and well-being of the mother and for the growing foetus and newborn child. This brief review aims to identify the micronutrients (vitamins and minerals likely to be deficient in women of reproductive age in Low- and Middle-Income Countries (LMIC, especially during pregnancy, and the impact of such deficiencies. A global prevalence of some two billion people at risk of micronutrient deficiencies, and multiple micronutrient deficiencies of many pregnant women in LMIC underline the urgency to establishing the optimal recommendations, including for delivery. It has long been recognized that adequate iron is important for best reproductive outcomes, including gestational cognitive development. Similarly, iodine and calcium have been recognized for their roles in development of the foetus/neonate. Less clear effects of deficiencies of zinc, copper, magnesium and selenium have been reported. Folate sufficiency periconceptionally is recognized both by the practice of providing folic acid in antenatal iron/folic acid supplementation and by increasing numbers of countries fortifying flours with folic acid. Other vitamins likely to be important include vitamins B12, D and A with the water-soluble vitamins generally less likely to be a problem. Epigenetic influences and the likely influence of micronutrient deficiencies on foetal origins of adult chronic diseases are currently being clarified. Micronutrients may have other more subtle, unrecognized effects. The necessity for improved diets and health and sanitation are consistently recommended, although these are not always available to many of the world’s pregnant women. Consequently, supplementation programmes, fortification of staples and condiments, and nutrition and health support need to be scaled-up, supported by social and cultural measures

  18. Economic freedom, income inequality and life satisfaction in OECD countries

    NARCIS (Netherlands)

    Graafland, Johan; Lous, Bjorn

    2017-01-01

    Since Piketty’s Capital in the 21st Century in 2014, scientific interest into the impact of income inequality on society has been on the rise. However, little is known about the mediating role of income inequality in the relationship between market institutions and subjective well-being. Using panel

  19. Income and beyond: Multidimensional Poverty in Six Latin American Countries

    Science.gov (United States)

    Battiston, Diego; Cruces, Guillermo; Lopez-Calva, Luis Felipe; Lugo, Maria Ana; Santos, Maria Emma

    2013-01-01

    This paper studies multidimensional poverty for Argentina, Brazil, Chile, El Salvador, Mexico and Uruguay for the period 1992-2006. The approach overcomes the limitations of the two traditional methods of poverty analysis in Latin America (income-based and unmet basic needs) by combining income with five other dimensions: school attendance for…

  20. Stillbirths 5. Stillbirths : the way forward in high-income countries

    NARCIS (Netherlands)

    Flenady, Vicki; Middleton, Philippa; Smith, Gordon C.; Duke, Wes; Erwich, Jan Jaap; Khong, T. Yee; Neilson, Jim; Ezzati, Majid; Koopmans, Laura; Ellwood, David; Fretts, Ruth; Froen, J. Frederik

    2011-01-01

    Stillbirth rates in high-income countries declined dramatically from about 1940, but this decline has slowed or stalled over recent times. The present variation in stillbirth rates across and within high-income countries indicates that further reduction in stillbirth is possible. Large disparities

  1. Growing apart : the comparative political economy of income inequality and social policy development in affluent countries

    NARCIS (Netherlands)

    Thewissen, Stefan Hubert

    2015-01-01

    Over the past few decades, most OECD countries witnessed a widening of the income distribution. This doctoral thesis collects five studies that provide insight into determinants and political and economic consequences of income inequality and social policy development in affluent countries. The

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

    Science.gov (United States)

    Nieto, Sandra; Ramos, Raúl

    2015-01-01

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

  3. The global cancer divide: Relationships between national healthcare resources and cancer outcomes in high-income vs. middle- and low-income countries

    Directory of Open Access Journals (Sweden)

    Ali Batouli

    2014-06-01

    Conclusions: The analysis of this study suggested that cancer MIR is greater in middle/low-income countries. Furthermore, the WHO healthcare score was associated with improved cancer outcomes in middle/low-income countries while absolute levels of financial resources and infrastructure played a more important role in high-income countries.

  4. In Search for a Smoking Gun: What Makes Income Inequality Vary Over Time in Different Countries?

    OpenAIRE

    Gustafsson, Björn A.; Johansson, Mats

    1997-01-01

    Forces affecting the development of the distribution of income in OECD-countries are investigated by analyzing an unbalanced panel with information covering 16 countries from 1966 to 1994. Income inequality is measured with the Gini-coefficient of equivalent disposable income. The results suggest that many factors affect the development of inequality. Factors are strictly economic or outside a strictly defined market-sphere as well as being demographic. However, a relation between the unemplo...

  5. Estimating the economic effects of cystic echinococcosis: Uruguay, a developing country with upper-middle income.

    Science.gov (United States)

    Torgerson, P R; Carmona, C; Bonifacino, R

    2000-10-01

    Cost-benefit analyses, run before the commencement of a programme to control a parasitic disease, should include estimates of the economic losses attributable to the disease. Uruguay, a middle-income, developing country, has a recent history of persistent problems with cystic echinococcosis, in both its human population and livestock. The economic effects in Uruguay of this disease, caused by the larval stage of the canine tapeworm Echinococcus granulosus, have now been evaluated. Data on the incidence of the disease, in humans and livestock, were used to construct cost estimates. The estimated minimum cost (U.S.$2.9 million/year) was based on the condemnation costs of infected offal together with the actual costs of the hospital treatment of the human cases. The estimate of the maximum cost (U.S.$22.1 million/year) also included the production losses resulting from lower livestock efficiency and the reduced income of individuals with morbidity attributable to the disease.

  6. Inequality reducing properties of progressive income tax schedules: The case of endogenous income

    OpenAIRE

    Carbonell-Nicolau, Oriol; Llavador, Humberto

    2016-01-01

    The case for progressive income taxation is often based on the classic result of Jakobsson (1976) and Fellman (1976), according to which progressive and only progressive income taxes - in the sense of increasing average tax rates on income - ensure a reduction in income inequality. This result has been criticized on the ground that it ignores the possible disincentive effect of taxation on work effort, and the resolution of this critique has been a long-standing problem in public finance. Thi...

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

    Science.gov (United States)

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

    2016-02-01

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

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

    Science.gov (United States)

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

    2016-10-01

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

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

    Science.gov (United States)

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

    2012-01-01

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

  10. Impact of Globalization on Income Inequality in Selected Asian Countries

    OpenAIRE

    Bukhari, Mahnoor; Munir, Kashif

    2016-01-01

    The primary objective of this study is to investigate the relationship between globalization and income inequality in selected Asian economies i.e. Bangladesh, China, India, Indonesia, Malaysia, Pakistan, Philippines, Sri Lanka, Singapore, South Korea and Thailand. The specific objectives of this study are to analyze the relationship between trade globalization, financial globalization and technological globalization on income inequality. For attaining these objectives this study used panel d...

  11. Sustaining innovation and improvement in the treatment of childhood cancer: lessons from high-income countries.

    Science.gov (United States)

    Pritchard-Jones, Kathy; Pieters, Rob; Reaman, Gregory H; Hjorth, Lars; Downie, Peter; Calaminus, Gabriele; Naafs-Wilstra, Marianne C; Steliarova-Foucher, Eva

    2013-03-01

    Cancer in children and adolescents is rare and biologically very different from cancer in adults. It accounts for 1·4% of all cancers worldwide, although this proportion ranges from 0·5% in Europe to 4·8% in Africa, largely because of differences in age composition and life expectancy. In high-income countries, survival from childhood cancer has reached 80% through a continuous focus on the integration of clinical research into front-line care for nearly all children affected by malignant disease. However, further improvement must entail new biology-driven approaches, since optimisation of conventional treatments has in many cases reached its limits. In many instances, such approaches can only be achieved through international collaborative research, since rare cancers are being subdivided into increasingly smaller subgroups on the basis of their molecular characteristics. The long-term effect of anticancer treatment on quality of life must also be taken into account because more than one in 1000 adults in high-income countries are thought to be survivors of cancer in childhood or adolescence. The introduction of drugs that are less toxic and more targeted than those currently used necessitates a partnership between clinical and translational researchers, the pharmaceutical industry, drug regulators, and patients and their families. This therapeutic alliance will ensure that efforts are focused on the unmet clinical needs of young people with cancer. Most children with cancer live in low-income and middle-income countries, and these countries account for 94% of all deaths from cancer in people aged 0-14 years. The immediate priority for these children is to improve access to an affordable, best standard of care in each country. Every country should have a national cancer plan that recognises the unique demographic characteristics and care needs of young people with cancer. Centralisation of the complex components of treatment of these rare diseases is essential

  12. Decentralising HIV treatment in lower- and middle-income countries

    Directory of Open Access Journals (Sweden)

    Tamara Kredo

    Full Text Available BACKGROUND: Policy makers, health staff and communities recognise that health services in lower- and middle-income countries need to improve people's access to HIV treatment and retention to treatment programmes. One strategy is to move antiretroviral delivery from hospitals to more peripheral health facilities or even beyond health facilities. This could increase the number of people with access to care, improve health outcomes, and enhance retention in treatment programmes. On the other hand, providing care at less sophisticated levels in the health service or at community-level may decrease quality of care and result in worse health outcomes. To address these uncertainties, we summarised the research studies examining the risks and benefits of decentralising antiretroviral therapy service delivery.OBJECTIVES: To assess the effects of various models that decentralised HIV treatment and care to more basic levels in the health system for initiating and maintaining antiretroviral therapy.METHODS:Search methods: We conducted a comprehensive search to identify all relevant studies regardless of language or publication status (published, unpublished, in press, and in progress from 1 January 1996 to 31 March 2013, and contacted relevant organisations and researchers. The search terms included "decentralisation", "down referral", "delivery of health care", and "health services accessibility". Selection criteria: Our inclusion criteria were controlled trials (randomised and non-randomised, controlled-before and after studies, and cohorts (prospective and retrospective in which HIV-infected people were either initiated on antiretroviral therapy or maintained on therapy in a decentralised setting in lower- and middle-income countries. We define decentralisation as providing treatment at a more basic level in the health system to the comparator. Data collection and analysis: Two authors applied the inclusion criteria and extracted data independently. We

  13. Comprehensive taxonomy and worldwide trends in pharmaceutical policies in relation to country income status.

    Science.gov (United States)

    Maniadakis, N; Kourlaba, G; Shen, J; Holtorf, A

    2017-05-25

    Rapidly evolving socioeconomic and technological trends make it challenging to improve access, effectiveness and efficiency in the use of pharmaceuticals. This paper identifies and systematically classifies the prevailing pharmaceutical policies worldwide in relation to a country's income status. A literature search was undertaken to identify and taxonomize prevailing policies worldwide. Countries that apply those policies and those that do not were then grouped by income status. Pharmaceutical policies are linked to a country's socioeconomics. Developed countries have universal coverage and control pharmaceuticals with external and internal price referencing systems, and indirect price-cost controls; they carry out health technology assessments and demand utilization controls. Price-volume and risk-sharing agreements are also evolving. Developing countries are underperforming in terms of coverage and they rely mostly on restrictive state controls to regulate prices and expenditure. There are significant disparities worldwide in the access to pharmaceuticals, their use, and the reimbursement of costs. The challenge in high-income countries is to maintain access to care whilst dealing with trends in technology and aging. Essential drugs should be available to all; however, many low- and middle-income countries still provide most of their population with only poor access to medicines. As economies grow, there should be greater investment in pharmaceutical care, looking to the policies of high-income countries to increase efficiency. Pharmaceutical companies could also develop special access schemes with low prices to facilitate coverage in low-income countries.

  14. Household expenditure for dental care in low and middle income countries.

    Directory of Open Access Journals (Sweden)

    Mohd Masood

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

  15. Inequality in CO2 emissions across countries and its relationship with income inequality: A distributive approach

    International Nuclear Information System (INIS)

    Padilla, Emilio; Serrano, Alfredo

    2006-01-01

    This paper analyzes the inequality in CO 2 emissions across countries (and groups of countries) and the relationship of this inequality with income inequality across countries for the period (1971-1999). The research employs the tools that are usually applied in income distribution analysis. The methodology used here gives qualitative and quantitative information on some of the features of the inequalities across countries that are considered most relevant for the design and discussion of policies aimed at mitigating climate change. The paper studies the relationship between CO 2 emissions and GDP and shows that income inequality across countries has been followed by an important inequality in the distribution of emissions. This inequality has diminished mildly, although the inequality in emissions across countries ordered in the increasing value of income (inequality between rich and poor countries) has diminished less than the 'simple' inequality in emissions. Lastly, the paper shows that the inequality in CO 2 emissions is mostly explained by the inequality between groups with different per capita income level. The importance of the inequality within groups of similar per capita income is much lower and has diminished during the period, especially in the low middle income group

  16. Potential market size and impact of hepatitis C treatment in low- and middle-income countries.

    Science.gov (United States)

    Woode, M E; Abu-Zaineh, M; Perriëns, J; Renaud, F; Wiktor, S; Moatti, J-P

    2016-07-01

    The introduction of direct-acting antiviral agents (DAAs) has made hepatitis C infection curable in the vast majority of cases and the elimination of the infection possible. Although initially too costly for large-scale use, recent reductions in DAA prices in some low- and middle-income countries (LaMICs) has improved the prospect of many people having access to these drugs/medications in the future. This article assesses the pricing and financing conditions under which the uptake of DAAs can increase to the point where the elimination of the disease in LaMICs is feasible. A Markov simulation model is used to study the dynamics of the infection with the introduction of treatment over a 10-year period. The impact on HCV-related mortality and HCV incidence is assessed under different financing scenarios assuming that the cost of the drugs is completely paid for out-of-pocket or reduced through either subsidy or drug price decreases. It is also assessed under different diagnostic and service delivery capacity scenarios separately for low-income (LIC), lower-middle-income (LMIC) and upper-middle-income countries (UMIC). Monte Carlo simulations are used for sensitivity analyses. At a price of US$ 1680 per 12-week treatment duration (based on negotiated Egyptian prices for an all oral two-DAA regimen), most of the people infected in LICs and LMICs would have limited access to treatment without subsidy or significant drug price decreases. However, people in UMICs would be able to access it even in the absence of a subsidy. For HCV treatment to have a significant impact on mortality and incidence, a significant scaling-up of diagnostic and service delivery capacity for HCV infection is needed. © 2016 The Authors. The Journal of Viral Hepatitis Published by John Wiley & Sons Ltd.

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

    Science.gov (United States)

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

    2011-08-01

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

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

    Science.gov (United States)

    Fesenfeld, Michaela; Hutubessy, Raymond; Jit, Mark

    2013-08-20

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

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

    Science.gov (United States)

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

    2017-11-06

    With an increasing array of innovations and research emerging from low-income countries there is a growing recognition that even high-income countries could learn from these contexts. It is well known that the source of a product influences perception of that product, but little research has examined whether this applies also in evidence-based medicine and decision-making. In order to examine likely barriers to learning from low-income countries, this study uses established methods in cognitive psychology to explore whether healthcare professionals and researchers implicitly associate good research with rich countries more so than with poor countries. Computer-based Implicit Association Test (IAT) distributed to healthcare professionals and researchers. Stimuli representing Rich Countries were chosen from OECD members in the top ten (>$36,000 per capita) World Bank rankings and Poor Countries were chosen from the bottom thirty (based medicine and diffusion of innovations.

  20. Electronic Payment Adoption in the Banking Sector of Low-Income Countries

    OpenAIRE

    Teshome Alemu; Tridib Bandyopadhyay; Solomon Negash

    2015-01-01

    Banks in low-income countries are launching e-banking services such as Internet banking, SMS banking, ATM banking, card banking, point of sales (PoS) and mobile banking. Among these planned services, ATM is the most matured service in many private and state owned banks in Ethiopia. ATM is a recent phenomenon in low-income countries (; ), and is still being introduced in financial sectors in low-income countries (Angeli, 2008; ) making investigation of factors of ICT technology adoption in low...

  1. Exploring Variation in Glycemic Control Across and Within Eight High-Income Countries

    DEFF Research Database (Denmark)

    Charalampopoulos, Dimitrios; Hermann, Julia M; Svensson, Jannet

    2018-01-01

    OBJECTIVE: International studies on childhood type 1 diabetes (T1D) have focused on whole-country mean HbA1c levels, thereby concealing potential variations within countries. We aimed to explore the variations in HbA1c across and within eight high-income countries to best inform international ben...

  2. Energy consumption and economic growth relationship: Evidence from panel data for low and middle income countries

    International Nuclear Information System (INIS)

    Ozturk, Ilhan; Aslan, Alper; Kalyoncu, Huseyin

    2010-01-01

    This paper uses the panel data of energy consumption (EC) and economic growth (GDP) for 51 countries from 1971 to 2005. These countries are divided into three groups: low income group, lower middle income group and upper middle income group countries. Firstly, a relationship between energy consumption and economic growth is investigated by employing panel cointegration method. Secondly, panel causality test is applied to investigate the way of causality between the energy consumption and economic growth. Finally, we test whether there is a strong or weak relationship between these variables by using method. The empirical results of this study are as follows: i) Energy consumption and GDP are cointegrated for all three income group countries. ii) The panel causality test results reveal that there is long-run Granger causality running from GDP to EC for low income countries and there is bidirectional causality between EC and GDP for middle income countries. iii) The estimated cointegration factor, β, is not close to 1. In other words, no strong relation is found between energy consumption and economic growth for all income groups considered in this study. The findings of this study have important policy implications and it shows that this issue still deserves further attention in future research.

  3. Cigarette Design Features in Low-, Middle-, and High-Income Countries

    Directory of Open Access Journals (Sweden)

    Rosalie V. Caruso

    2012-01-01

    Full Text Available Previous studies have shown that country income grouping is correlated with cigarette engineering. Cigarettes (=111 brands were purchased during 2008–2010 from 11 low-, middle-, and high-income countries to assess physical dimensions and an array of cigarette design features. Mean ventilation varied significantly across low- (7.5%, middle- (15.3%, and high-income (26.2% countries (≤0.001. Differences across income groups were also seen in cigarette length (=0.001, length of the tipping paper (=0.01, filter weight (=0.017, number of vent rows (=0.003, per-cigarette tobacco weight (=0.04, and paper porosity (=0.008. Stepwise linear regression showed ventilation and tobacco length as major predictors of ISO tar yields in low-income countries (=0.909, 0.047, while tipping paper (<0.001, filter length (<0.001, number of vent rows (=0.014, and per-cigarette weight (=0.015 were predictors of tar yields in middle-income countries. Ventilation (<0.001, number of vent rows (=0.009, per-cigarette weight (<0.001, and filter diameter (=0.004 predicted tar yields in high-income countries. Health officials must be cognizant of cigarette design issues to provide effective regulation of tobacco products.

  4. Is the UN Convention on the Rights of Persons with Disabilities Impacting Mental Health Laws and Policies in High-Income Countries? A Case Study of Implementation in Canada.

    Science.gov (United States)

    Hoffman, Steven J; Sritharan, Lathika; Tejpar, Ali

    2016-11-11

    Persons with psychosocial disabilities face disparate access to healthcare and social services worldwide, along with systemic discrimination, structural inequalities, and widespread human rights abuses. Accordingly, many people have looked to international human rights law to help address mental health challenges. On December 13, 2006, the United Nations formally adopted the Convention on the Rights of Persons with Disabilities (CRPD) - the first human rights treaty of the 21st century and the fastest ever negotiated. This study assesses the CRPD's potential impact on mental health systems and presents a legal and public policy analysis of its implementation in one high-income country: Canada. As part of this analysis, a critical review was undertaken of the CRPD's implementation in Canadian legislation, public policy, and jurisprudence related to mental health. While the Convention is clearly an important step forward, there remains a divide, even in Canada, between the Convention's goals and the experiences of Canadians with disabilities. Its implementation is perhaps hindered most by Canada's reservations to Article 12 of the CRPD on legal capacity for persons with psychosocial disabilities. The overseeing CRPD Committee has stated that Article 12 only permits "supported decision-making" regimes, yet most Canadian jurisdictions maintain their "substitute decision-making" regimes. This means that many Canadians with mental health challenges continue to be denied legal capacity to make decisions related to their healthcare, housing, and finances. But changes are afoot: new legislation has been introduced in different jurisdictions across the country, and recent court decisions have started to push policymakers in this direction. Despite the lack of explicit implementation, the CRPD has helped to facilitate a larger shift in social and cultural paradigms of mental health and disability in Canada. But ratification and passive implementation are not enough. Further

  5. Income development of General Practitioners in eight European countries from 1975 to 2005

    Directory of Open Access Journals (Sweden)

    Van der Zee Jouke

    2009-02-01

    Full Text Available Abstract Background This study aims to gain insight into the international development of GP incomes over time through a comparative approach. The study is an extension of an earlier work (1975–1990, conducted in five yearly intervals. The research questions to be addressed in this paper are: 1 How can the remuneration system of GPs in a country be characterized? 2 How has the annual GP income developed over time in selected European countries? 3 What are the differences in GP incomes when differences in workload are taken into account? And 4 to what extent do remuneration systems, supply of GPs and gate-keeping contribute to the income position of GPs? Methods Data were collected for Belgium, Denmark, Germany, Finland, France, the Netherlands, Sweden and the United Kingdom. Written sources, websites and country experts were consulted. The data for the years 1995 and 2000 were collected in 2004–2005. The data for 2005 were collected in 2006–2007. Results During the period 1975–1990, the income of GPs, corrected for inflation, declined in all the countries under review. During the period 1995–2005, the situation changed significantly: The income of UK GPs rose to the very top position. Besides this, the gap between the top end (UK and bottom end (Belgium widened considerably. Practice costs form about 50% of total revenues, regardless of the absolute level of revenues. Analysis based on income per patient leads to a different ranking of countries compared to the ranking based on annual income. In countries with a relatively large supply of GPs, income per hour is lower. The type of remuneration appeared to have no effect on the financial position of the GPs in the countries in this study. In countries with a gate-keeping system the average GP income was systematically higher compared to countries with a direct-access system. Conclusion There are substantial differences in the income of GPs among the countries included in this study. The

  6. Income development of General Practitioners in eight European countries from 1975 to 2005.

    Science.gov (United States)

    Kroneman, Madelon W; Van der Zee, Jouke; Groot, Wim

    2009-02-09

    This study aims to gain insight into the international development of GP incomes over time through a comparative approach. The study is an extension of an earlier work (1975-1990, conducted in five yearly intervals). The research questions to be addressed in this paper are: 1) How can the remuneration system of GPs in a country be characterized? 2) How has the annual GP income developed over time in selected European countries? 3) What are the differences in GP incomes when differences in workload are taken into account? And 4) to what extent do remuneration systems, supply of GPs and gate-keeping contribute to the income position of GPs? Data were collected for Belgium, Denmark, Germany, Finland, France, the Netherlands, Sweden and the United Kingdom. Written sources, websites and country experts were consulted. The data for the years 1995 and 2000 were collected in 2004-2005. The data for 2005 were collected in 2006-2007. During the period 1975-1990, the income of GPs, corrected for inflation, declined in all the countries under review. During the period 1995-2005, the situation changed significantly: The income of UK GPs rose to the very top position. Besides this, the gap between the top end (UK) and bottom end (Belgium) widened considerably. Practice costs form about 50% of total revenues, regardless of the absolute level of revenues. Analysis based on income per patient leads to a different ranking of countries compared to the ranking based on annual income. In countries with a relatively large supply of GPs, income per hour is lower. The type of remuneration appeared to have no effect on the financial position of the GPs in the countries in this study. In countries with a gate-keeping system the average GP income was systematically higher compared to countries with a direct-access system. There are substantial differences in the income of GPs among the countries included in this study. The discrepancy between countries has increased over time. The income of

  7. THE EFFECTIVE LEVEL OF CORPORATE INCOME TAX IN THEEUROPEAN COUNTRIES

    Directory of Open Access Journals (Sweden)

    Adam Adamczyk

    2012-01-01

    Full Text Available Despite of the factthat European Union economy is the subject to integrationprocess, there has been no harmonization of corporate income taxation. Nocompulsion to adapt to common tax law requirements makes that many,especially new member states of EU, tends to use corporate income tax to attractcapital flows. The tax competition often takes a form of so called “race to thebottom” and consists in reducing tax rates. At the same time fiscal authoritiesusually broaden their tax bases in favor to increase the neutrality of the corporateincome tax.The main goal of this article is to measure the combined effect ofreducing statutory tax rates and broadening of tax bases in selected MemberStates.

  8. Selective Teacher Attention in Lower-Income Countries: A Phenomenon Linked to Dropout and Illiteracy?

    Science.gov (United States)

    Abadzi, Helen; Llambiri, Stavri

    2011-01-01

    In lower-income countries students face an important challenge that has not been well documented: selective teacher attention. In classes with many low-income students, teachers may concentrate on those few who can perform and neglect those who require more help. The latter may fail to learn, attend school less often, and eventually drop out.…

  9. Architectural frameworks for developing national health information systems in low and middle income countries

    CSIR Research Space (South Africa)

    Mudaly, T

    2013-11-01

    Full Text Available Consolidating currently fragmented health information systems in low and middle-income countries (LMIC) into a coherent national information system will increase operational efficiencies, improve decision-making and will lead to better health...

  10. Bucking the trend? Health care expenditures in low-income countries 1990-1995.

    Science.gov (United States)

    Jowett, M

    1999-01-01

    Health care expenditures in low-income countries are analysed for the years 1990 and 1995 using four key indicators. Key findings include a substantial reduction in public spending per capita across low-income countries between 1990-95; a significant shift towards private expenditures, which appears increasingly to be substituting rather than supplementing public expenditures; a fall in total and public health spending in many countries despite growth in national income, contradicting the relationship found in other studies. Two possible explanations are put forward. First that the patterns found are a direct result of the structural adjustment policies adopted by many low-income countries, which aim to control and often cut public financing, whilst promoting private health expenditures. Secondly, that following the wave of privatization of state industries, many governments are finding problems adapting to their new role as a tax collector, and are thus not benefiting from economic growth to the extent that might be expected.

  11. Income inequality in post-communist Central and Eastern European countries

    Directory of Open Access Journals (Sweden)

    Sara ROSE

    2014-06-01

    Full Text Available Income inequality has become an important issue in Central and Eastern European countries during their transition process. This study constructs a model incorporating different categories of factors that impact inequality and tests whether the wealth of a country makes a difference in these relationships. This article shows that different income categories of Central and Eastern European transition countries do experience different relationships between income inequality and its contributing factors: economic, demographic, political, and cultural and environmental. The resulting Random Effects models of the best fit incorporate economic and political factors and show differences in magnitude, direction, and in their significance. These findings add to the literature by taking a cross-country and cross-income view on the impact of various factors.

  12. Explicit Bias Toward High-Income-Country Research: A Randomized, Blinded, Crossover Experiment Of English Clinicians.

    Science.gov (United States)

    Harris, Matthew; Marti, Joachim; Watt, Hillary; Bhatti, Yasser; Macinko, James; Darzi, Ara W

    2017-11-01

    Unconscious bias may interfere with the interpretation of research from some settings, particularly from lower-income countries. Most studies of this phenomenon have relied on indirect outcomes such as article citation counts and publication rates; few have addressed or proven the effect of unconscious bias in evidence interpretation. In this randomized, blinded crossover experiment in a sample of 347 English clinicians, we demonstrate that changing the source of a research abstract from a low- to a high-income country significantly improves how it is viewed, all else being equal. Using fixed-effects models, we measured differences in ratings for strength of evidence, relevance, and likelihood of referral to a peer. Having a high-income-country source had a significant overall impact on respondents' ratings of relevance and recommendation to a peer. Unconscious bias can have far-reaching implications for the diffusion of knowledge and innovations from low-income countries.

  13. Scoping response system management of alcohol’s harm to others in lower middle income countries

    Directory of Open Access Journals (Sweden)

    Laslett Anne-Marie

    2016-12-01

    Full Text Available AIMS - As part of the WHO Harm from others’ drinking project, Thailand, Sri Lanka, India, Chile, Nigeria and Vietnam undertook scoping studies to examine: which service agencies in low and middle income countries responded to people affected by others’ drinking; how commonly key informants from these agencies indicated alcohol was part of the problems they managed; and whether any routine reporting systems collected information on alcohol’s harm to others (AHTO and the types and examples of harms experienced across the six countries. METHODS - Researchers synthetised within country peer-review literature, reports, news and agency website information. Additionally, researchers interviewed key informants to investigate current structures, functions and practices of service agencies, and in particular their recording practices surrounding cases involving others’ drinking. RESULTS - 111 key informants agreed to participate from 91 purposively selected agencies from health, social protection, justice and police, and ‘other’ sectors. National and provincial level data, as well as state-run and civil society agency data were collected. Diverse service response systems managed AHTO in the different countries. A large range in the percentage of all cases attributed to AHTO was identified. Case story examples from each country illustrate the different responses to, and the nature of, many severe problems experienced because of others’ drinking. CONCLUSIONS - AHTO was a major issue for service systems in LMIC, and significantly contributed to their workload, yet, very few recording systems routinely collected AHTO data. Recommendations are outlined to improve AHTO data collection across multiple sectors and enable LMIC to better identify and respond to AHTO.

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

    Science.gov (United States)

    Ward, Joseph L; Viner, Russell M

    2017-05-11

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

  15. Assessment of eight HPV vaccination programs implemented in lowest income countries

    OpenAIRE

    Ladner, Joël; Besson, Marie-Hélène; Hampshire, Rachel; Tapert, Lisa; Chirenje, Mike; Saba, Joseph

    2012-01-01

    Abstract Background Cervix cancer, preventable, continues to be the third most common cancer in women worldwide, especially in lowest income countries. Prophylactic HPV vaccination should help to reduce the morbidity and mortality associated with cervical cancer. The purpose of the study was to describe the results of and key concerns in eight HPV vaccination programs conducted in seven lowest income countries through the Gardasil Access Program (GAP). Methods The GAP provides free HPV vaccin...

  16. Satisfaction with job and income among older individuals across European countries

    OpenAIRE

    Bonsang, E.D.M.; van Soest, A.

    2010-01-01

    Using data on individuals of age 50 and older from 11 European countries, we analyze two economic aspects of subjective well-being of older Europeans: satisfaction with household income, and job satisfaction. Both have been shown to contribute substantially to overall well-being (satisfaction with life or happiness). We use anchoring vignettes to correct for potential differences in response scales across countries. The results highlight a large variation in self-reported income satisfaction,...

  17. Incidence of neonatal necrotising enterocolitis in high-income countries: a systematic review.

    Science.gov (United States)

    Battersby, Cheryl; Santhalingam, Tharsika; Costeloe, Kate; Modi, Neena

    2018-03-01

    To conduct a systematic review of neonatal necrotising enterocolitis (NEC) rates in high-income countries published in peer-reviewed journals. We searched MEDLINE, Embase and PubMed databases for observational studies published in peer-reviewed journals. We selected studies reporting national, regional or multicentre rates of NEC in 34 Organisation for Economic Co-operation and Development countries. Two investigators independently screened studies against predetermined criteria. For included studies, we extracted country, year of publication in peer-reviewed journal, study time period, study population inclusion and exclusion criteria, case definition, gestation or birth weight-specific NEC and mortality rates. Of the 1888 references identified, 120 full manuscripts were reviewed, 33 studies met inclusion criteria, 14 studies with the most recent data from 12 countries were included in the final analysis. We identified an almost fourfold difference, from 2% to 7%, in the rate of NEC among babies born REVIEWS REGISTRATION NUMBER: CRD42015030046. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  18. ENERGY CONSUMPTION AND ECONOMIC GROWTH: EVIDENCE FROM LOW-INCOME COUNTRIES IN SUB-SAHARAN AFRICA

    Directory of Open Access Journals (Sweden)

    Eyup Dogan

    2014-04-01

    Full Text Available The main purpose of this paper is to investigate the causality relationship between energy consumption and economic growth in four low-income countries in Sub-Saharan Africa using the econometrics in time-series methods. Along the estimation process, I use the annual data on energy consumption and real GDP per capita over the years of 1971 and 2011. The results of the ADF unit root test show that the time series are not stationary for all countries at levels, but log of economic growth in Benin and Congo become stationary after taking the differences of the data, and log of energy consumption become stationary for all countries and LGR in Kenya and Zimbabwe are found to be stationary after taking the second differences of the time-series. The findings of the Johansen co-integration test demonstrate that the variables LEC and LGR are not co-integrated for the cases of Kenya and Zimbabwe, so no long-run relationship between the variables arises in any country. The Granger causality test indicates that there is a unidirectional causality running from energy use to economic growth in Kenya and no causality linkage between EC and GR in Benin, Congo and Zimbabwe.

  19. The employment and income benefits of airport operation on the country in transition

    Directory of Open Access Journals (Sweden)

    Sonia Huderek-Glapska

    2013-03-01

    Full Text Available Background: The air transport market in Poland is undergoing significant changes, which take place both on the demand and supply side. Polish airports have experienced the unprecedented growth of air traffic. However, the increase in the number of airline connections - which benefits airports, passengers, aircraft industry and, indirectly, the whole society - at the same time results in the growth of social costs reflected by the intensification of noise and environmental pollution. The benefits of airport operation are reflected in the generation of employment and income. Existing literature reveals a gap in the knowledge in respect of impact of aviation in countries in transition. Material and methods: This paper investigates the applicability of socio-economic impact of air transport model to country in transition. In particular, it presents the employment and income benefits of airport operation. The input-output model is employed to measure the economic benefits of airport operation. The largest airport in Poland, Warsaw Chopin Airport is used as a case study. Results: The estimation results for the income and employment effects are found to be significant.  The operations of Warsaw Chopin Airport contributed to the generation of 527.8m EUR in current prices in 2011. Altogether, 19,349 jobs have been generated as the result of the direct, indirect and induced impact of Warsaw Chopin Airport.  Conclusion:  The size of production in the airport expressed in the number of aircraft operations and the number of passengers and goods serviced is positively correlated with the level of economic impact. The restriction on the development of the airport reflected by the inability to meet transport needs expressed by the society may generate opportunity costs.  

  20. Childhood obesity in low- and middle-income countries.

    Science.gov (United States)

    Poskitt, E M E

    2014-11-01

    Overweight and obesity in childhood is an increasing problem for the less affluent countries of the world. The prevalence of overweight/obesity varies, not only between countries but across countries, depending on the environments in which children live. Changes in physical activity and diet are having adverse effects on children's nutrition. Greater affluence and urbanisation with more technology such as television in homes are associated with overweight. Affluence also brings the ability to purchase commercial, prepared 'fast-food' items, leading too often to disadvantageous effects on children's diets. The solutions to this rising tide of overweight/obesity seem to lie with broad-based programmes initiated at central government level or at more local community level but which are designed to reach across and throughout societies to enable families and communities to modify the unhealthy lifestyle which too often accompanies increasing affluence and development.

  1. Income levels and income growth : some new cross-country evidence and some interpretative puzzles

    NARCIS (Netherlands)

    Castaldi, C.; Dosi, G.

    2004-01-01

    This work brings together two distinct ensembles of evidence concerning, at macro level, international distributions of incomes and their dynamics, and, at micro level, the size distributions of firms and the properties of their growth rates. Together, we also consider an intermediate level of

  2. Causality between income and emission. A country group-specific econometric analysis

    International Nuclear Information System (INIS)

    Coondoo, Dipankor; Dinda, Soumyananda

    2002-01-01

    Empirical studies of the Environmental Kuznets Curve (EKC) examine the presence or otherwise of an inverted U-shaped relationship between the level of pollution and the level of income. Customarily, in the diagram of EKC the level of income is shown on the horizontal axis and that of pollution on the vertical axis. Thus, it is presumed that the relationship between income and pollution is one of unidirectional causality with income causing environmental changes and not vice versa. The validity of this presumption is now being questioned. It is being asserted that the nature and direction of causality may vary from one country to the other. In this paper, we present the results of a study of income-CO 2 emission causality based on a Granger causality test to cross-country panel data on per capita income and the corresponding per capita CO 2 emission data. Briefly, our results indicate three different types of causality relationship holding for different country groups. For the developed country groups of North America and Western Europe (and also for Eastern Europe) the causality is found to run from emission to income. For the country groups of Central and South America, Oceania and Japan causality from income to emission is obtained. Finally, for the country groups of Asia and Africa the causality is found to be bi-directional. The regression equations estimated as part of the Granger causality test further suggest that for the country groups of North America and Western Europe the growth rate of emission has become stationary around a zero mean, and a shock in the growth rate of emission tends to generate a corresponding shock in the growth rate of income. In contrast, for the country groups of Central and South America, Oceania and Japan a shock in the income growth rate is likely to result in a corresponding shock in the growth rate of emission. Finally, causality being bi-directional for the country groups of Asia and Africa, the income and the emission growth

  3. Causality between income and emission. A country group-specific econometric analysis

    Energy Technology Data Exchange (ETDEWEB)

    Coondoo, Dipankor [Economic Research Unit, Indian Statistical Institute, 203 B.T. Road, 35 Kolkata (India); Dinda, Soumyananda [S.R. Fatepuria College, Beldanga, West Bengal, Murshidabad (India)

    2002-03-01

    Empirical studies of the Environmental Kuznets Curve (EKC) examine the presence or otherwise of an inverted U-shaped relationship between the level of pollution and the level of income. Customarily, in the diagram of EKC the level of income is shown on the horizontal axis and that of pollution on the vertical axis. Thus, it is presumed that the relationship between income and pollution is one of unidirectional causality with income causing environmental changes and not vice versa. The validity of this presumption is now being questioned. It is being asserted that the nature and direction of causality may vary from one country to the other. In this paper, we present the results of a study of income-CO{sub 2} emission causality based on a Granger causality test to cross-country panel data on per capita income and the corresponding per capita CO{sub 2} emission data. Briefly, our results indicate three different types of causality relationship holding for different country groups. For the developed country groups of North America and Western Europe (and also for Eastern Europe) the causality is found to run from emission to income. For the country groups of Central and South America, Oceania and Japan causality from income to emission is obtained. Finally, for the country groups of Asia and Africa the causality is found to be bi-directional. The regression equations estimated as part of the Granger causality test further suggest that for the country groups of North America and Western Europe the growth rate of emission has become stationary around a zero mean, and a shock in the growth rate of emission tends to generate a corresponding shock in the growth rate of income. In contrast, for the country groups of Central and South America, Oceania and Japan a shock in the income growth rate is likely to result in a corresponding shock in the growth rate of emission. Finally, causality being bi-directional for the country groups of Asia and Africa, the income and the

  4. Radiotherapy services in countries in transition: gross national income per capita as a significant factor

    International Nuclear Information System (INIS)

    Levin, Victor; Tatsuzaki, Hideo

    2002-01-01

    Background and purpose: The acquisition of radiotherapy by countries in transition (CITs) is an evolutionary process from having no resources whatsoever, to meeting the standards adopted by well-developed countries. The influence of the economic ability of a country to acquire and sustain this technology has intuitively been accepted as a major factor but has not before been subjected to analysis for a large group of countries. This information has been analysed to provide guidance to countries commencing and expanding radiotherapy services. Material and methods: The number of linear accelerators and 60 Co megavoltage teletherapy machines in 72 CITs, those with gross national income per capita (GNI/cap) $12000 pa were expressed as machines per million population (MEV/mil) and used as an index of the ability of the country to provide a service. This figure was related to GNI/cap. The average populations of 24 further countries without radiotherapy were compared with 21 countries with radiotherapy facilities having the same range of GNI/cap. Results: The relationship log 10 MEV/mil=-2.90+0.85 log 10 GNI/cap was identified between the machines and income. Also verified was that small low income countries were less likely to have the technology than those with large populations. Conclusions: The increase in the number of teletherapy machines is closely linked to the GNI/cap of a country. Our sample of well developed countries failed to demonstrate a levelling off of equipment acquisition with income. In the lower income group, smaller countries were less likely to have radiotherapy services than those with large populations

  5. A realist synthesis of cross-border patient movement from low and middle income countries to similar or higher income countries.

    Science.gov (United States)

    Durham, Jo; Blondell, Sarah J

    2017-08-29

    Patient travel across borders to access healthcare is becoming increasingly common and widespread. Patients moving from high income to middle income countries for healthcare is well documented, with patients seeking treatments that are cheaper or more readily available than at home. Less well understood is when patients move from one low income country to another or from a low income country to a higher income country. In this paper, a realist review was undertaken to explore why, in what contexts and how patients from lower income countries travel to countries with the same, or more advanced, economies for planned healthcare. Based on an initial scoping of the literature and discussions with key informants, we generated an initial theory and set of propositions about why, how, who and in what contexts people cross international borders for planned healthcare. We then systematically located and synthesized (1) peer-reviewed studies from the Scopus, Embase, Web of Science and Econlit databases; (2) non-indexed reports using key informants and Google; and (3) papers from the reference lists of included documents, to glean supportive or contradictory evidence for our initial propositions. As we reviewed the literature and extracted our data, we drew on the work of Pierre Bourdieu to understand the interplay between material and non-material capital and cognitive processes in decisions to cross borders for healthcare. Patient travel was largely undertaken due to a lack of services in the home country and/or unacceptability of local services, with decisions on when, and where, to travel, usually made within the patient's social networks. They were able to travel via use of multiple resources, including social networks, economic and cultural capital, and habitus. Those patients with greater volumes of the aforementioned factors had greater healthcare options; however, even those with limited resources engaged in patient travel. Patient movement challenges traditional

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

    Science.gov (United States)

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

    2018-01-01

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

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

    Science.gov (United States)

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

    2011-10-08

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

  8. Assessing urban recycling in low- and middle-income countries: Building on modernised mixtures

    NARCIS (Netherlands)

    Scheinberg, A.; Spies, S.; Simpson, M.H.; Mol, A.P.J.

    2011-01-01

    Recycling and valorisation of waste in urban centres in low- and middle-income countries is often misunderstood. Recycling in these countries represents neither the service of removal, nor an activity of “greening” related to ecological modernisation. Recycling is first of all an economic activity

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

    Science.gov (United States)

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

    2011-01-01

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

  10. Balancing safety, efficacy and cost: Improving rotavirus vaccine adoption in low- and middle-income countries

    Directory of Open Access Journals (Sweden)

    Anant Bhan

    2011-12-01

    Full Text Available Diarrheal disease caused by rotavirus claims approximately 500 000 lives each year, mostly in low-income countries. Many of these deaths are preventable through the use of available rotavirus vaccines. Yet, in spite of a WHO recommendation that these vaccines be adopted into all national immunization programs, only a few countries have done so.

  11. The growth of income and energy consumption in six developing countries

    International Nuclear Information System (INIS)

    Sari, Ramazan; Soytas, Ugur

    2007-01-01

    This paper reexamines the inter-temporal link between energy consumption and income in six developing countries with diverse economic backgrounds and energy statistics, in a production function framework. We employ the generalized variance decompositions and generalized impulse response techniques to see if the growth of income and energy consumption contains considerable information to predict each other. In all countries, energy appears as an essential factor of production. Results indicate that energy may be a relatively more important input than labor and/or capital in some countries. Hence, neutrality of energy does not seem to hold

  12. Migration to middle-income countries and tuberculosis-global policies for global economies.

    Science.gov (United States)

    Pescarini, Julia Moreira; Rodrigues, Laura Cunha; Gomes, M Gabriela M; Waldman, Eliseu Alves

    2017-03-15

    International migration to middle-income countries is increasing and its health consequences, in particular increasing transmission rates of tuberculosis (TB), deserve consideration. Migration and TB are a matter of concern in high-income countries and targeted screening of migrants for active and latent TB infection is a main strategy to manage risk and minimize transmission. In this paper, we discuss some aspects of TB control and migration in the context of middle-income countries, together with the prospect of responding with equitable and comprehensive policies. TB rates in middle-income countries remain disproportionally high among the poorest and most vulnerable groups in large cities where most migrant populations are concentrated. Policies that tackle migrant TB in high-income countries may be inadequate for middle-income countries because of their different socio-economic and cultural scenarios. Strategies to control TB in these settings must take into account the characteristics of middle-income countries and the complexity of TB as a disease of poverty. Intersectoral policies of social protection such as cash-transfer programs help reducing poverty and improving health in vulnerable populations. We address the development of new approaches to improve well-established strategies including contact tracing and active and latent TB screening as an 'add on' to the existing health care guidelines of conditional cash transfer programs. In addition, we discuss how it might improve health and welfare among both poor migrants and locally-born populations. Authorities from middle-income countries should recognise that migrants are a vulnerable social group and promote cooperation efforts between sending and receiving countries for mitigation of poverty and prevention of disease in this group. Middle-income countries have long sent migrants overseas. However, the influx of large migrant populations into their societies is relatively new and a growing phenomenon and

  13. Material wealth in 3D: Mapping multiple paths to prosperity in low- and middle- income countries.

    Science.gov (United States)

    Hruschka, Daniel J; Hadley, Craig; Hackman, Joseph

    2017-01-01

    Material wealth is a key factor shaping human development and well-being. Every year, hundreds of studies in social science and policy fields assess material wealth in low- and middle-income countries assuming that there is a single dimension by which households can move from poverty to prosperity. However, a one-dimensional model may miss important kinds of prosperity, particularly in countries where traditional subsistence-based livelihoods coexist with modern cash economies. Using multiple correspondence analysis to analyze representative household data from six countries-Nepal, Bangladesh, Ethiopia, Kenya, Tanzania and Guatemala-across three world regions, we identify a number of independent dimension of wealth, each with a clear link to locally relevant pathways to success in cash and agricultural economies. In all cases, the first dimension identified by this approach replicates standard one-dimensional estimates and captures success in cash economies. The novel dimensions we identify reflect success in different agricultural sectors and are independently associated with key benchmarks of food security and human growth, such as adult body mass index and child height. The multidimensional models of wealth we describe here provide new opportunities for examining the causes and consequences of wealth inequality that go beyond success in cash economies, for tracing the emergence of hybrid pathways to prosperity, and for assessing how these different pathways to economic success carry different health risks and social opportunities.

  14. Material wealth in 3D: Mapping multiple paths to prosperity in low- and middle- income countries.

    Directory of Open Access Journals (Sweden)

    Daniel J Hruschka

    Full Text Available Material wealth is a key factor shaping human development and well-being. Every year, hundreds of studies in social science and policy fields assess material wealth in low- and middle-income countries assuming that there is a single dimension by which households can move from poverty to prosperity. However, a one-dimensional model may miss important kinds of prosperity, particularly in countries where traditional subsistence-based livelihoods coexist with modern cash economies. Using multiple correspondence analysis to analyze representative household data from six countries-Nepal, Bangladesh, Ethiopia, Kenya, Tanzania and Guatemala-across three world regions, we identify a number of independent dimension of wealth, each with a clear link to locally relevant pathways to success in cash and agricultural economies. In all cases, the first dimension identified by this approach replicates standard one-dimensional estimates and captures success in cash economies. The novel dimensions we identify reflect success in different agricultural sectors and are independently associated with key benchmarks of food security and human growth, such as adult body mass index and child height. The multidimensional models of wealth we describe here provide new opportunities for examining the causes and consequences of wealth inequality that go beyond success in cash economies, for tracing the emergence of hybrid pathways to prosperity, and for assessing how these different pathways to economic success carry different health risks and social opportunities.

  15. Therapeutic research on children in low–income countries

    DEFF Research Database (Denmark)

    Whyte, Susan Reynolds

    2015-01-01

    -established institutions in Africa show that parents eagerly have their children ‘join’ such projects. They assess benefits and risks less in research terms and more through overall trust in care provided previously by such institutions in the community. Bioethics should go beyond concern with protecting individual......Social scientists undertaking studies in developing countries focus on ‘trial communities’: networks of funders, institutions, researchers, clinical staff, fieldworkers, and study participants. Whereas bioethicists consider universal ethical requirements, social scientists examine ethical practices...... subjects from research risks and should view clinical care and research functions as indistinguishable for many who seek sustained support for the children’s health....

  16. Ethical issues in research in low-income countries.

    Science.gov (United States)

    Benatar, S R; Fleischer, T E

    2007-06-01

    During the twentieth century, spectacular developments in science, technology and medical practice coupled with economic growth have transformed health care and improved the lives of many people. Despite such progress, the world today is more inequitable than it was 50 years ago: disparities in wealth and health are widening inexorably, and infectious diseases are again becoming a major scourge and pose a threat to the lives of all. Hundreds of millions of people live in degrading poverty, with little, if any, access to health care. Recognition of this context in which much research takes place should sharpen our focus on the ethical requirements for research that could improve the health of a greater proportion of the world's population--one of the most pressing moral problems of our time. The intense debate on ethical dilemmas associated with an expanding programme of clinical research in developing countries has revealed much common ground, but has also left a residuum of controversy. We suggest that contested issues could be resolved by paying greater attention to different world views on the relationship between research and clinical care and by defining policies that both progressively improve the standard of care in research and link research to improved delivery of health care in developing countries.

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

    Science.gov (United States)

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

    2018-01-01

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

  18. Obligations of low income countries in ensuring equity in global health financing.

    Science.gov (United States)

    Barugahare, John; Lie, Reidar K

    2015-09-08

    Despite common recognition of joint responsibility for global health by all countries particularly to ensure justice in global health, current discussions of countries' obligations for global health largely ignore obligations of developing countries. This is especially the case with regards to obligations relating to health financing. Bearing in mind that it is not possible to achieve justice in global health without achieving equity in health financing at both domestic and global levels, our aim is to show how fulfilling the obligation we propose will make it easy to achieve equity in health financing at both domestic and international levels. Achieving equity in global health financing is a crucial step towards achieving justice in global health. Our general view is that current discussions on global health equity largely ignore obligations of Low Income Country (LIC) governments and we recommend that these obligations should be mainstreamed in current discussions. While we recognise that various obligations need to be fulfilled in order to ultimately achieve justice in global health, for lack of space we prioritise obligations for health financing. Basing on the evidence that in most LICs health is not given priority in annual budget allocations, we propose that LIC governments should bear an obligation to allocate a certain minimum percent of their annual domestic budget resources to health, while they await external resources to supplement domestic ones. We recommend and demonstrate a mechanism for coordinating this obligation so that if the resulting obligations are fulfilled by both LIC and HIC governments it will be easy to achieve equity in global health financing. Although achieving justice in global health will depend on fulfillment of different categories of obligations, ensuring inter- and intra-country equity in health financing is pivotal. This can be achieved by requiring all LIC governments to allocate a certain optimal per cent of their domestic

  19. Utilization and expenditure at public and private facilities in 39 low-income countries.

    Science.gov (United States)

    Saksena, Priyanka; Xu, Ke; Elovainio, Riku; Perrot, Jean

    2012-01-01

    To document the patterns of health service utilization and health payments at public and private facilities across countries. We used data from the World Health Surveys from 39 low- and low-middle income countries to examine differences between public and private sectors. Utilization of outpatient and inpatient services, out-of-pocket payments (OOP) at public and private facilities, and transportation costs were compared. Utilization and payments to public and private sectors differ widely. Public facilities dominated in most countries for both outpatient and inpatient services. But, whereas use of private facilities is more common among the rich, poor people also use them, to a considerable extent and in almost all the countries in the study. The majority of OOP were incurred at public providers for inpatient services. On average, this was not the case for outpatient services. Medicines accounted for the largest share of OOP for all services except inpatient services at private facilities, where consultation fees did. Transportation costs were considerable. Price competition is certainly not the only factor that guides choice of provider. The results support continued efforts by the governments to engage strategically with the private sector. However, they also highlight the importance of not generalizing conditions across countries. Governments may need to reconsider simplistic user-fee abolition strategies at public providers if they simply focus on consultation fees. Policies to make health services more accessible need to consider a comprehensive benefit package that includes a wider scope of costs related to care such as expenditures on medicines and transportation. © 2011 Blackwell Publishing Ltd.

  20. Public health oncology: a framework for progress in low- and middle-income countries.

    Science.gov (United States)

    Love, R R; Ginsburg, O M; Coleman, C N

    2012-12-01

    The problems of cancer are increasing in low- and middle-income countries (LMCs), which now have significant majorities of the global case and mortality burdens. The professional oncology community is being increasingly called upon to define pragmatic and realistic approaches to these problems. Focusing on mortality and case burden outcomes defines public health oncology or population-affecting cancer medicine. We use this focus to consider practical approaches. The greatest cancer burdens are in Asia. A public health oncology perspective mandates: first, addressing the major and social challenges of cancer medicine for populations: human rights, health systems, corruption, and our limited knowledge base for value-conscious interventions. Second, adoption of evolving concepts and models for sustainable development in LMCs. Third, clear and realistic statements of action and inaction affecting populations, grounded in our best cancer science, and attention to these. Finally, framing the goals and challenges for population-affecting cancer medicine requires a change in paradigm from historical top-down models of technology transfer, to one which is community-grounded and local-evidence based. Public health oncology perspectives define clear focus for much needed research on country-specific practical approaches to cancer control.

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

    Science.gov (United States)

    Hajizadeh, Mohammad; Nandi, Arijit

    2016-12-01

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

  2. Franchising of health services in low-income countries.

    Science.gov (United States)

    Montagu, Dominic

    2002-06-01

    Grouping existing providers under a franchised brand, supported by training, advertising and supplies, is a potentially important way of improving access to and assuring quality of some types of clinical medical services. While franchising has great potential to increase service delivery points and method acceptability, a number of challenges are inherent to the delivery model: controlling the quality of services provided by independent practitioners is difficult, positioning branded services to compete on either price or quality requires trade-offs between social goals and provider satisfaction, and understanding the motivations of clients may lead to organizational choices which do not maximize quality or minimize costs. This paper describes the structure and operation of existing franchises and presents a model of social franchise activities that will afford a context for analyzing choices in the design and implementation of health-related social franchises in developing countries.

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

    Science.gov (United States)

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

    2018-05-12

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

  4. Delivering affordable cancer care in high-income countries.

    Science.gov (United States)

    Sullivan, Richard; Peppercorn, Jeffrey; Sikora, Karol; Zalcberg, John; Meropol, Neal J; Amir, Eitan; Khayat, David; Boyle, Peter; Autier, Philippe; Tannock, Ian F; Fojo, Tito; Siderov, Jim; Williamson, Steve; Camporesi, Silvia; McVie, J Gordon; Purushotham, Arnie D; Naredi, Peter; Eggermont, Alexander; Brennan, Murray F; Steinberg, Michael L; De Ridder, Mark; McCloskey, Susan A; Verellen, Dirk; Roberts, Terence; Storme, Guy; Hicks, Rodney J; Ell, Peter J; Hirsch, Bradford R; Carbone, David P; Schulman, Kevin A; Catchpole, Paul; Taylor, David; Geissler, Jan; Brinker, Nancy G; Meltzer, David; Kerr, David; Aapro, Matti

    2011-09-01

    The burden of cancer is growing, and the disease is becoming a major economic expenditure for all developed countries. In 2008, the worldwide cost of cancer due to premature death and disability (not including direct medical costs) was estimated to be US$895 billion. This is not simply due to an increase in absolute numbers, but also the rate of increase of expenditure on cancer. What are the drivers and solutions to the so-called cancer-cost curve in developed countries? How are we going to afford to deliver high quality and equitable care? Here, expert opinion from health-care professionals, policy makers, and cancer survivors has been gathered to address the barriers and solutions to delivering affordable cancer care. Although many of the drivers and themes are specific to a particular field-eg, the huge development costs for cancer medicines-there is strong concordance running through each contribution. Several drivers of cost, such as over-use, rapid expansion, and shortening life cycles of cancer technologies (such as medicines and imaging modalities), and the lack of suitable clinical research and integrated health economic studies, have converged with more defensive medical practice, a less informed regulatory system, a lack of evidence-based sociopolitical debate, and a declining degree of fairness for all patients with cancer. Urgent solutions range from re-engineering of the macroeconomic basis of cancer costs (eg, value-based approaches to bend the cost curve and allow cost-saving technologies), greater education of policy makers, and an informed and transparent regulatory system. A radical shift in cancer policy is also required. Political toleration of unfairness in access to affordable cancer treatment is unacceptable. The cancer profession and industry should take responsibility and not accept a substandard evidence base and an ethos of very small benefit at whatever cost; rather, we need delivery of fair prices and real value from new technologies

  5. Investigating DRG cost weights for hospitals in middle income countries.

    Science.gov (United States)

    Ghaffari, Shahram; Doran, Christopher; Wilson, Andrew; Aisbett, Chris; Jackson, Terri

    2009-01-01

    Identifying the cost of hospital outputs, particularly acute inpatients measured by Diagnosis Related Groups (DRGs), is an important component of casemix implementation. Measuring the relative costliness of specific DRGs is useful for a wide range of policy and planning applications. Estimating the relative use of resources per DRG can be done through different costing approaches depending on availability of information and time and budget. This study aims to guide costing efforts in Iran and other countries in the region that are pursuing casemix funding, through identifying the main issues facing cost finding approaches and introducing the costing models compatible with their hospitals accounting and management structures. The results show that inadequate financial and utilisation information at the patient's level, poorly computerized 'feeder systems'; and low quality data make it impossible to estimate reliable DRGs costs through clinical costing. A cost modelling approach estimates the average cost of 2.723 million Rials (Iranian Currency) per DRG. Using standard linear regression, a coefficient of 0.14 (CI = 0.12-0.16) suggests that the average cost weight increases by 14% for every one-day increase in average length of stay (LOS).We concluded that calculation of DRG cost weights (CWs) using Australian service weights provides a sensible starting place for DRG-based hospital management; but restructuring hospital accounting systems, designing computerized feeder systems, using appropriate software, and development of national service weights that reflect local practice patterns will enhance the accuracy of DRG CWs.

  6. A comparison of the poverty impact of transfers, taxes and market income across five OECD countries.

    Science.gov (United States)

    Bibi, Sami; Duclos, Jean-Yves

    2010-01-01

    This paper compares the poverty reduction impact of income sources, taxes and transfers across five OECD countries. Since the estimation of that impact can depend on the order in which the various income sources are introduced into the analysis, it is done by using the Shapley value. Estimates of the poverty reduction impact are presented in a normalized and unnormalized fashion, in order to take into account the total as well as the per dollar impacts. The methodology is applied to data from the Luxembourg Income Study database.

  7. Multivitamin use and adverse birth outcomes in high-income countries

    DEFF Research Database (Denmark)

    Wolf, Hanne T.; Hegaard, Hanne K.; Huusom, Lene D.

    2017-01-01

    of the studies compared the use of folic acid and iron vs the use of multivitamins. The use of multivitamin did not change the risk of the primary outcome, preterm birth (relative risk, 0.84 [95% confidence interval, 0.69–1.03]). However, the risk of small for gestational age (relative risk, 0.77 [95% confidence......Background In high-income countries, a healthy diet is widely accessible. However, a change toward a poor-quality diet with a low nutritional value in high-income countries has led to an inadequate vitamin intake during pregnancy. Objective We conducted a systematic review and meta......). Study Design We searched electronic databases (MEDLINE, Embase, Cochrane, Scopus, and CINAHL) from inception to June 17, 2016, using synonyms of pregnancy, study/trial type, and multivitamins. Eligible studies were all studies in high-income countries investigating the association between multivitamin...

  8. How many low birthweight babies in low- and middle-income countries are preterm?

    Directory of Open Access Journals (Sweden)

    Fernando C Barros

    2011-06-01

    Full Text Available OBJECTIVE: To assess the prevalence of preterm birth among low birthweight babies in low and middle-income countries. METHODS: Major databases (PubMed, LILACS, Google Scholar were searched for studies on the prevalence of term and preterm LBW babies with field work carried out after 1990 in low- and middle-income countries. Regression methods were used to model this proportion according to LBW prevalence levels. RESULTS: According to 47 studies from 27 low- and middle-income countries, approximately half of all LBW babies are preterm rather than one in three as assumed in studies previous to the 1990s. CONCLUSIONS: The estimate of a substantially higher number of LBW preterm babies has important policy implications in view of special health care needs of these infants. As for earlier projections, our findings are limited by the relative lack of population-based studies.

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

    Science.gov (United States)

    Oortwijn, Wija; Mathijssen, Judith; Banta, David

    2010-05-01

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

  10. Determinants and Consequences of Non-Interest Income Diversification of Commercial Banks in OECD Countries

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    Joon-Ho Hahm

    2008-06-01

    Full Text Available This paper studies determinants and consequences of theThis paper studies determinants and consequences of the changing income structure of commercial banks in the era of financial conglomeration. Utilizing a dataset of 662 relatively large commercial banks in 29 OECD countries from 1992 to 2006, we find that banks with relatively large asset sizes, low net interest margins, high impaired loan ratios, and high cost-income ratios tend to exhibit higher non-interest income shares. As for macroeconomic factors, banks in countries with slow economic growth, a stable inflation environment, and well- developed stock markets tend to show higher non-interest income shares. Second, we investigate the consequences of non-interest income expansion on bank profitability and risks. While the positive effects on profit and capital adequacy seem to become weaker under the consideration of macroeconomic factors and endogeneity problems, the adverse impact on profit variability remains robust. Overall, these findings suggest that expanding toward non-interest income may not produce desired income diversification effects, and it does not necessarily imply a shift toward superior return-risk frontiers.

  11. Child development assessment tools in low-income and middle-income countries: how can we use them more appropriately?

    Science.gov (United States)

    Sabanathan, Saraswathy; Wills, Bridget; Gladstone, Melissa

    2015-05-01

    Global emphasis has shifted beyond reducing child survival rates to improving health and developmental trajectories in childhood. Optimum early childhood experience is believed to allow children to benefit fully from educational opportunities resulting in improved human capital. Investment in early childhood initiatives in low-income and middle-income countries (LMICs) is increasing. These initiatives use early childhood developmental assessment tools (CDATs) as outcome measures. CDATs are also key measures in the evaluation of programmatic health initiatives in LMICs, influencing public health policy. Interpretation of CDAT outcomes requires understanding of their structure and psychometric properties. This article reviews the structure and main methods of CDAT development with specific considerations when applied in LMICs. 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.

  12. Are women deciding against home births in low and middle income countries?

    Science.gov (United States)

    Amoako Johnson, Fiifi; Padmadas, Sabu S; Matthews, Zoë

    2013-01-01

    Although there is evidence to tracking progress towards facility births within the UN Millennium Development Goals framework, we do not know whether women are deciding against home birth over their reproductive lives. Using Demographic and Health Surveys (DHS) data from 44 countries, this study aims to investigate the patterns and shifts in childbirth locations and to determine whether these shifts are in favour of home or health settings. The analyses considered 108,777 women who had at least two births in the five years preceding the most recent DHS over the period 2000-2010. The vast majority of women opted for the same place of childbirth for their successive births. However, about 14% did switch their place and not all these decisions favoured health facility over home setting. In 24 of the 44 countries analysed, a higher proportion of women switched from a health facility to home. Multilevel regression analyses show significantly higher odds of switching from home to a facility for high parity women, those with frequent antenatal visits and more wealth. However, in countries with high infant mortality rates, low parity women had an increased probability of switching from home to a health facility. There is clear evidence that women do change their childbirth locations over successive births in low and middle income countries. After two decades of efforts to improve maternal health, it might be expected that a higher proportion of women will be deciding against home births in favour of facility births. The results from this analysis show that is not the case.

  13. Are women deciding against home births in low and middle income countries?

    Directory of Open Access Journals (Sweden)

    Fiifi Amoako Johnson

    Full Text Available Although there is evidence to tracking progress towards facility births within the UN Millennium Development Goals framework, we do not know whether women are deciding against home birth over their reproductive lives. Using Demographic and Health Surveys (DHS data from 44 countries, this study aims to investigate the patterns and shifts in childbirth locations and to determine whether these shifts are in favour of home or health settings.The analyses considered 108,777 women who had at least two births in the five years preceding the most recent DHS over the period 2000-2010. The vast majority of women opted for the same place of childbirth for their successive births. However, about 14% did switch their place and not all these decisions favoured health facility over home setting. In 24 of the 44 countries analysed, a higher proportion of women switched from a health facility to home. Multilevel regression analyses show significantly higher odds of switching from home to a facility for high parity women, those with frequent antenatal visits and more wealth. However, in countries with high infant mortality rates, low parity women had an increased probability of switching from home to a health facility.There is clear evidence that women do change their childbirth locations over successive births in low and middle income countries. After two decades of efforts to improve maternal health, it might be expected that a higher proportion of women will be deciding against home births in favour of facility births. The results from this analysis show that is not the case.

  14. A systematic review of radiotherapy capacity in low and middle income countries

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    Surbhi eGrover

    2015-01-01

    Full Text Available Objectives: The cancer burden in Low and Middle Income Countries (LMIC is substantial. The purpose of this study was to identify and describe country and region-specific patterns of radiotherapy (RT facilities in LMIC. Methods: A systematic review of the literature was undertaken. A search strategy was developed to include articles on radiation capacity in LMIC from the following databases: PubMed, Embase, CINAHL Plus, Global Health and the Latin-American and Caribbean System on Health Sciences Information. Searches included all literature up to April 2013. Results: A total of 49 articles were included in the review. Studies reviewed were divided into one of four regions: Africa, Asia, Eastern Europe, and South America. The African continent has the least amount of resources for RT. Furthermore, a wide disparity exists, as 60% of all machines on the continent are concentrated in Egypt and South Africa while 29 countries in Africa are still lacking any RT resource. A significant heterogeneity also exists across Southeast Asia despite a three-fold increase in megavoltage teletherapy machines from 1976 to 1999, which corresponds with a rise in economic status. In LMIC of the Americas, only Uruguay met the International Atomic Energy Agency (IAEA recommendations of 4 MV/million population, whereas Bolivia and Venezuela had the most radiation oncologists (>1 per 1000 new cancer cases. The main concern with the review of RT resources in Eastern Europe was the lack of data.Conclusions: There is a dearth of publications on RT therapy infrastructure in LMIC. However, based on limited published data, availability of RT resources reflects the economic status of the countries. The challenges to delivering radiation in the discussed regions are multidimensional and include: lack of physical resources, lack of human personnel, and lack of data. Furthermore, access to existing radiotherapy and affordability of care remains a large problem.

  15. Socioeconomic determinants of dietary patterns in low- and middle-income countries: a systematic review.

    Science.gov (United States)

    Mayén, Ana-Lucia; Marques-Vidal, Pedro; Paccaud, Fred; Bovet, Pascal; Stringhini, Silvia

    2014-12-01

    In high-income countries, high socioeconomic status (SES) is generally associated with a healthier diet, but whether social differences in dietary intake are also present in low- and middle-income countries (LMICs) remains to be established. We performed a systematic review of studies that assessed the relation between SES and dietary intake in LMICs. We carried out a systematic review of cohort and cross-sectional studies in adults in LMICs and published between 1996 and 2013. We assessed associations between markers of SES or urban and rural settings and dietary intake. A total of 33 studies from 17 LMICs were included (5 low-income countries and 12 middle-income countries; 31 cross-sectional and 2 longitudinal studies). A majority of studies were conducted in Brazil (8), China (6), and Iran (4). High SES or living in urban areas was associated with higher intakes of calories; protein; total fat; cholesterol; polyunsaturated, saturated, and monounsaturated fatty acids; iron; and vitamins A and C and with lower intakes of carbohydrates and fiber. High SES was also associated with higher fruit and/or vegetable consumption, diet quality, and diversity. Although very few studies were performed in low-income countries, similar patterns were generally observed in both LMICs except for fruit intake, which was lower in urban than in rural areas in low-income countries. In LMICs, high SES or living in urban areas is associated with overall healthier dietary patterns. However, it is also related to higher energy, cholesterol, and saturated fat intakes. Social inequalities in dietary intake should be considered in the prevention and control of noncommunicable diseases in LMICs. © 2014 American Society for Nutrition.

  16. The global burden of visual difficulty in low, middle, and high income countries.

    Directory of Open Access Journals (Sweden)

    Ellen E Freeman

    Full Text Available Using a world-wide, population-based dataset of adults, we sought to determine the frequency of far visual difficulty and its associated risk factors.The World Health Survey (WHS was conducted in 70 countries throughout the world in 2003 using a random, multi-stage, stratified, cluster sampling design of adults ages 18 years and older. Far vision was assessed by asking "In the last 30 days, how much difficulty did you have in seeing and recognizing a person you know across the road (i.e. from a distance of about 20 meters?". Responses included none, mild, moderate, severe, or extreme/unable. The income status of countries was estimated using gross national income per capita data from 2003 from the World Bank. Prevalence and regression estimates were adjusted to account for the complex sample design.21% of adults reported any visual difficulty. The rate varied by the income status of the country with the percentage who had any visual difficulty being 24%, 23%, and 13% in low, middle, and high income countries, respectively. Five percent of people reported severe or extreme visual difficulty with rates in low, middle, and high income countries of 6%, 5%, and 2% respectively. Risk factors for visual difficulty included older age, female sex, poorer socioeconomic status, little to no formal education, and diabetes (P<0.05.One out of five adults in the WHS reported some degree of far visual difficulty. Given the importance of vision to living an independent life, better access to quality eye care services and life course factors affecting vision health (e.g. repeated eye infections, diet lacking vitamin A must receive adequate attention and resources, especially in low and middle income countries.

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

    Science.gov (United States)

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

    2012-03-01

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

  18. Should pharmacogenetics be incorporated in major depression treatment? Economic evaluation in high- and middle-income European countries.

    Science.gov (United States)

    Olgiati, Paolo; Bajo, Emanuele; Bigelli, Marco; De Ronchi, Diana; Serretti, Alessandro

    2012-01-10

    The serotonin transporter 5-HTTLPR polymorphism moderates response to SSRIs and side-effect burden. The aim of this study is to quantify the cost-utility of incorporating 5-HTTLPR genotyping in drug treatment of major depressive disorder (MDD). We previously reported a theoretical model to simulate antidepressant treatment with citalopram or bupropion for 12 weeks. The drugs were alternatively selected according to an 'as usual' algorithm or based on response and tolerability predicted by 5-HTTLPR profile. Here we apply this model to conduct a cost-utility analysis in three European regions with high GDP (Euro A), middle GDP (Euro B) and middle-high GDP (Euro C). In addition we test a verification scenario in which citalopram+bupropion augmentation is administered to individuals with the least favorable 5-HTTLPR genotype. Treatment outcomes are remission and Quality Adjusted-Life Weeks (QALW). Cost data (international $, year 2009) are retrieved from the World Health Organization (WHO) and national official sources. In base-case scenario incremental cost-effectiveness ratio (ICER) values are $1147 (Euro A), $1185 (Euro B) and $1178 (Euro C). From cost-effectiveness acceptability curve (CEAC), the probability of having an ICER value below WHO recommended cost-utility threshold (3 GDP per capita=$1926) is >90% in high-income countries (Euro A). In middle- income regions, these probabilities are <30% (Euro B) and <55% (Euro C) respectively. All estimates are robust against variations in treatment parameters, but if genetic test cost decreases to $100, pharmacogenetic approach becomes cost-effective in middle-income countries (Euro B). This simulation using data from 27 European states suggests that choosing antidepressant treatment from the results of 5-HTTLPR might be a cost-effective solution in high income countries. Its feasibility in middle income countries needs further research. Copyright © 2011 Elsevier Inc. All rights reserved.

  19. Income Inequalities, Productive Structure and Macroeconomic Dynamics. A Regional Approach to the Russian Case

    Directory of Open Access Journals (Sweden)

    Julien Vercueil

    2016-07-01

    Full Text Available During the past decades, sustained economic growth in emerging countries (and among them, BRICS countries has attracted much attention in the western world. Multinational companies have been lured by the growing purchasing power of a significant part of the population, often presented as the “promised land” of consumer spending in durable goods, high tech services and fashion products. Of course, increasing incomes imply also significant socio-economic changes within these countries as well. A growing number of studies have been carried in order to track the evolution of income distribution in BRICS countries, and the formation and composition of a social group usually called “middle class” in western countries (Kharas (2010, SIEMS (2010, Levada (2012, Ernst and Young (2013, Kochhar R., Oates R. (2015. In this paper we try to assess the impact of recent macroeconomic fluctuations on Russian households income levels. We analyse the Russian trajectory in three different ways. First, we compare the evolution of the “middle class” in Russia with other (BRIC and western countries, using the wealthbased definition of this group proposed in the Global Wealth Report (Crédit Suisse Research Institute, 2015. Second, we go deeper into the Russian case in order to show how regional disparities regarding incomes distribution can be interpreted, considering the country’s recent macroeconomic trajectory. For this purpose, we build a productive typology of the Russian regions and study the link between each type and the level of income inequalities, using the varying structures in sources of household’s incomes as a possible explanation of regional variations. We conclude by an assessment of the remaining challenges for incomes policy in Russia

  20. Outstanding challenges for rotavirus vaccine introduction in low-income countries

    DEFF Research Database (Denmark)

    Ustrup, Marte; Madsen, Lizell B; Bygbjerg, Ib C

    2011-01-01

    Rotavirus infections are the most common cause of severe diarrhoea in children worldwide. Two internationally licensed rotavirus vaccines have proven to be efficacious in middle and high-income countries and they could potentially be valuable tools for the prevention of rotavirus....... There is also a need for political commitment to prevent rotavirus infections as well as a need for an overall strengthening of the health systems in low-income countries. If these challenges were met, rotavirus vaccination could substantially improve child health and survival from rotavirus...

  1. Epidemiological and Economic Impact of Monovalent and Pentavalent Rotavirus Vaccines in Low and Middle Income Countries: A Cost-effectiveness Modeling Analysis.

    Science.gov (United States)

    Paternina-Caicedo, Angel; De la Hoz-Restrepo, Fernando; Alvis-Guzmán, Nelson

    2015-07-01

    The competing choices of vaccination with either RV1 or RV5, the potential budget impact of vaccines on the EPI with different prices and new evidence make important an updated analysis for health decision makers in each country. The objective of this study is to assess cost-effectiveness of the monovalent and pentavalent rotavirus vaccines and impact on children deaths, inpatient and outpatient visits in 116 low and middle income countries that represent approximately 99% of rotavirus mortality. A decision tree model followed hypothetical cohorts of children from birth up to 5 years of age for each country in 2010. Inputs were gathered from international databases and previous research on incidence and effectiveness of monovalent and pentavalent vaccines. Costs were expressed in 2010 international dollars. Outcomes were reported in terms of cost per disability-adjusted life-year averted, comparing no vaccination with either monovalent or pentavalent mass introduction. Vaccine price was assumed fixed for all world low-income and middle-income countries. Around 292,000 deaths, 3.34 million inpatient cases and 23.09 million outpatient cases would occur with no vaccination. In the base-case scenario, monovalent vaccination would prevent 54.7% of inpatient cases and 45.4% of deaths. Pentavalent vaccination would prevent 51.4% of inpatient cases and 41.1% of deaths. The vaccine was cost-effective in all world countries in the base-case scenario for both vaccines. Cost per disability-adjusted life-year averted in all selected countries was I$372 for monovalent, and I$453 for pentavalent vaccination. Rotavirus vaccine is cost-effective in most analyzed countries. Despite cost-effectiveness analysis is a useful tool for decision making in middle-income countries, for low-income countries health decision makers should also assess the impact of introducing either vaccine on local resources and budget impact analysis of vaccination.

  2. International outsourcing of medical research by high-income countries: changes from 1995 to 2005.

    Science.gov (United States)

    Belforti, Raquel K; Wall, Michal Sarah; Lindenauer, Peter K; Pekow, Penelope S; Rothberg, Michael B

    2010-02-01

    Medical research outsourcing provides a financial benefit to those conducting research and financial incentives to the developing countries hosting the research. Little is known about how frequently outsourcing occurs or the type of research that is outsourced. To document changes in medical research outsourcing over a 10-year period, we conducted a cross-sectional comparison of 3 medical journals: Lancet, The New England Journal of Medicine, and JAMA: The Journal of the American Medical Association in the last 6 months of 1995 and 2005. The main outcome measure was the 10-year change in proportion of studies including patients from low-income countries. We reviewed 598 articles. During the 10-year period, the proportion of first authors from low-income countries increased from 3% to 6% (P = 0.21), whereas studies with participants from low-income countries increased from 8% to 22% (P = Outsourcing of medical research seems to be increasing. Additional studies are required to know if subjects from low-income countries are being adequately protected.

  3. Reciprocity in Labor Market Relationships: Evidence from an Experiment across High-Income OECD Countries

    Directory of Open Access Journals (Sweden)

    Israel Waichman

    2015-10-01

    Full Text Available We study differences in behavior across countries in a labor market context. To this end, we conducted a bilateral gift-exchange experiment comparing the behavior of subjects from five high-income OECD countries: Germany, Spain, Israel, Japan and the USA. We observe that in all countries, effort levels are increasing while rejection rates are decreasing in wage offers. However, we also find considerable differences in behavior across countries in both one-shot and repeated relationships, the most striking between Germany and Spain. We also discuss the influence of socio-economic indicators and the implications of our findings.

  4. Staffing remote rural areas in middle- and low-income countries : a literature review of attraction and retention

    NARCIS (Netherlands)

    Lehmann, Uta; Dieleman, Marjolein; Martineau, Tim

    2008-01-01

    BACKGROUND: Many countries in middle- and low-income countries today suffer from severe staff shortages and/or maldistribution of health personnel which has been aggravated more recently by the disintegration of health systems in low-income countries and by the global policy environment. One of the

  5. High coverage needle/syringe programs for people who inject drugs in low and middle income countries: a systematic review

    Directory of Open Access Journals (Sweden)

    Des Jarlais Don C

    2013-01-01

    Full Text Available Abstract Background Persons who inject drugs (PWID are at an elevated risk for human immunodeficiency virus (HIV and hepatitis C virus (HCV infection. In many high-income countries, needle and syringe exchange programs (NSP have been associated with reductions in blood-borne infections. However, we do not have a good understanding of the effectiveness of NSP in low/middle-income and transitional-economy countries. Methods A systematic literature review based on PRISMA guidelines was utilized to collect primary study data on coverage of NSP programs and changes in HIV and HCV infection over time among PWID in low-and middle-income and transitional countries (LMICs. Included studies reported laboratory measures of either HIV or HCV and at least 50% coverage of the local injecting population (through direct use or through secondary exchange. We also included national reports on newly reported HIV cases for countries that had national level data for PWID in conjunction with NSP scale-up and implementation. Results Studies of 11 NSPs with high-coverage from Bangladesh, Brazil, China, Estonia, Iran, Lithuania, Taiwan, Thailand and Vietnam were included in the review. In five studies HIV prevalence decreased (range −3% to −15% and in three studies HCV prevalence decreased (range −4.2% to −10.2%. In two studies HIV prevalence increased (range +5.6% to +14.8%. HCV incidence remained stable in one study. Of the four national reports of newly reported HIV cases, three reported decreases during NSP expansion, ranging from −30% to −93.3%, while one national report documented an increase in cases (+37.6%. Estimated incidence among new injectors decreased in three studies, with reductions ranging from −11/100 person years at risk to −16/100 person years at risk. Conclusions While not fully consistent, the data generally support the effectiveness of NSP in reducing HIV and HCV infection in low/middle-income and transitional-economy countries. If

  6. Income-environment relationship in Sub-Saharan African countries: Further evidence with trade openness.

    Science.gov (United States)

    Zerbo, Eléazar

    2017-07-01

    This paper examines the dynamic relationship between energy consumption, income growth, carbon emissions and trade openness in fourteen Sub-Saharan African (SSA) countries. The autoregressive distributed lag (ARDL) approach to cointegration and the Toda-Yamamoto causality test were used to investigate the long-run and short-run properties, respectively. The long-run estimations give evidence against the environmental Kuznets curve (EKC) hypothesis in SSA countries. In contrast, the results highlight the significant and monotonically contribution of income growth and energy consumption in explaining carbon emissions in the long-run and short-run in several countries. Furthermore, the results show that trade openness enhances economic growth and is not linked to causing carbon emissions in these countries. Hence, a trade incentive policy may be implemented without harmful effect on the quality of the environment.

  7. What works for human papillomavirus vaccine introduction in low and middle-income countries?

    Directory of Open Access Journals (Sweden)

    Natasha Howard

    2017-12-01

    Full Text Available Since 2007, low and middle-income countries (LMICs have gained experience delivering HPV vaccines through HPV vaccination pilots, demonstration projects and national programmes. This commentary summarises lessons from HPV vaccination experiences in 45 LMICs and what works for HPV vaccination introduction. Methods included a systematic literature review, unpublished document review, and key informant interviews. Data were extracted from 61 peer-reviewed articles, 11 conference abstracts, 188 technical reports, and 56 interviews, with quantitative data analysed descriptively and qualitative data analysed thematically. Key lessons are described under five themes of preparation, communications, delivery, coverage achievements, and sustainability. Lessons learnt were generally consistent across countries and projects and sufficient lessons have been learnt for countries to deliver HPV vaccine through phased national rollout rather than demonstration projects. However, challenges remain in securing the political will and financial resources necessary to implement successful national programmes. Keywords: Cervical cancer prevention, Human papillomavirus, Vaccination, Low and middle-income countries, Demonstration projects

  8. PRUNE BELLY SYNDROME: CASE REPORT OF A FAILED MANAGEMENT IN A LOWINCOME COUNTRY.

    Directory of Open Access Journals (Sweden)

    Marcella Schiavone

    2016-04-01

    Full Text Available Prune Belly Syndrome (PBS is a rare congenital syndrome characterized by three main features: abdominal wall flaccidity, bilateral intra-abdominal cryptorchidism, and urologic abnormalities. In this study we describe the case of a 2,600 gr baby, born at the Central Hospital of Beira, Mozambique. Our study confirms that in a low-income country only conservative management can be delivered, and therefore prognosis is worse and less effective than high-income countries.

  9. Human Capital Versus Income Variations: Are They Linked in OECD Countries?

    Directory of Open Access Journals (Sweden)

    Jakub Bartak

    2016-03-01

    Full Text Available Purpose: The theory of endogenous growth suggests a number of relations between income inequality and human capital. However, empirical evidence in this field is scarce. Therefore, in this paper we aim to demonstrate the existence of interdependencies between income inequality and human capital across OECD countries.Methodology: We present findings of the endogenous growth theory on the mechanisms linking inequality with human capital. Subsequently, we attempt to verify these links empirically using the regression function estimated by means of the generalized method of moments (GMM. The empirical analysis is based on panel data from 1995–2010.Findings: The results of the study reveal the existence of a negative relationship between income inequality and health indicators (infant mortality and maternal mortality. However, we did not reach an authoritative conclusion about the relationship between income inequality and quantitative indicators of educational achievement.Research limitations: Research is limited to the sample of OECD countries. Interdependencies between income inequality and human capital could be captured more clearly using a broader sample.Originality: This paper presents one of few studies testing the relation between human capital and income inequality. The use of high-quality empirical data on inequality (SWIID data and the generalized method of moments made it possible to contribute new arguments to the discussion of empirical analyses of these economic categories.

  10. Social inequalities in adult oral health in 40 low- and middle-income countries.

    Science.gov (United States)

    Bhandari, Bishal; Newton, Jonathon T; Bernabé, Eduardo

    2016-10-01

    This study evaluated social inequalities in adult oral health across several low- and middle-income countries. We used data from 40 countries that participated in the World Health Surveys. Participants' socio-economic position was assessed using the wealth index. Oral health was assessed using two perceived measures, namely total tooth loss and whether they had any problems with their mouth and/or teeth during the last 12 months (perceived needs). Absolute and relative wealth inequalities in oral health were measured using the slope index of inequality (SII) and the relative index of inequality (RII), respectively, after adjusting for participants' sex, age and education. There were wealth inequalities in total tooth loss and perceived needs in most countries. However, significant monotonic gradients were found in 21 countries for total tooth loss and in 18 countries for perceived needs. Two distinctive patterns of social inequality in oral health were found across countries using the RII and the SII. For total tooth loss, pro-rich inequality was found in 25 countries (significant RII/SII in eight countries) and pro-poor inequality was found in 15 (significant RII/SII in three countries). For perceived needs, pro-poor inequality was found in 26 countries (significant RII/SII in six countries) and pro-rich inequality was found in 14 (significant RII/SII in five countries). The well-documented social gradient in adult oral health favouring the rich was not present in all low- and middle-income countries. Pro-poor inequalities in total tooth loss, and particularly in perceived dental-treatment needs, were observed in some countries. © 2016 FDI World Dental Federation.

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

    Science.gov (United States)

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

    2014-03-01

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

  12. Terms of trade effects on PPP and incomes of primary-commodity exporting countries

    OpenAIRE

    Koya, Sharmistha N.

    1994-01-01

    This dissertation investigates the commodity currency argument of primary and secondary effects of the terms of trade on exchange rates and real income, respectively. The Johansen procedure of cointegration testing is applied to dynamic models for a set of four developed countries (New Zealand, Australia, Norway and Iceland) and five less developed countries (Colombia, India, Malaysia, Thailand and Venezuela) each against it's major trading partner and the United States. The ...

  13. Financial Intermediation Costs in Low-Income Countries; The Role of Regulatory, Institutional, and Macroeconomic Factors

    OpenAIRE

    Tigran Poghosyan

    2012-01-01

    We analyze factors driving persistently higher financial intermediation costs in low-income countries (LICs) relative to emerging market (EMs) country comparators. Using the net interest margin as a proxy for financial intermediation costs at the bank level, we find that within LICs a substantial part of the variation in interest margins can be explained by bank-specific factors: margins tend to increase with higher riskiness of credit portfolio, lower bank capitalization, and smaller bank si...

  14. Estimating costs of care for meningitis infections in low- and middle-income countries.

    Science.gov (United States)

    Portnoy, Allison; Jit, Mark; Lauer, Jeremy; Blommaert, Adriaan; Ozawa, Sachiko; Stack, Meghan; Murray, Jillian; Hutubessy, Raymond

    2015-05-07

    Meningitis infections are often associated with high mortality and risk of sequelae. The costs of treatment and care for meningitis are a great burden on health care systems, particularly in resource-limited settings. The objective of this study is to review data on the costs of care for meningitis in low- and middle-income countries, as well as to show how results could be extrapolated to countries without sound data. We conducted a systematic review of the literature from six databases to identify studies examining the cost of care in low- and middle-income countries for all age groups with suspected, probable, or confirmed meningitis. We extracted data on treatment costs and sequelae by infectious agent and/or pathogen, where possible. Using multiple regression analysis, a relationship between hospital costs and associated determinants was investigated in order to predict costs in countries with missing data. This relationship was used to predict treatment costs for all 144 low- and middle-income countries. The methodology of conducting a systematic review, extrapolating, and setting up a standard database can be used as a tool to inform cost-effectiveness analyses in situations where cost of care data are poor. Both acute and long-term costs of meningitis could be extrapolated to countries without reliable data. Although only bacterial causes of meningitis can be vaccine-preventable, a better understanding of the treatment costs for meningitis is crucial for low- and middle-income countries to assess the cost-effectiveness of proposed interventions in their country. This cost information will be important as inputs in future cost-effectiveness studies, particularly for vaccines. Copyright © 2014 Elsevier Ltd. All rights reserved.

  15. Human development, occupational structure and physical inactivity among 47 low and middle income countries

    OpenAIRE

    Atkinson, Kaitlin; Lowe, Samantha; Moore, Spencer

    2016-01-01

    This study aimed to (a) assess the relationship between a person's occupational category and their physical inactivity, and (b) analyze the association among country-level variables and physical inactivity. The World Health Survey (WHS) was administered in 2002?2003 among 47 low- and middle-income countries (n?=?196,742). The International Physical Activity Questionnaire (IPAQ) was used to collect verbal reports of physical activity and convert responses into measures of physical inactivity. ...

  16. Babies, soft drinks and snacks: a concern in low- and middle-income countries?

    OpenAIRE

    Huffman, Sandra L; Piwoz, Ellen G; Vosti, Stephen A; Dewey, Kathryn G

    2014-01-01

    Undernutrition in infants and young children is a global health priority while overweight is an emerging issue. Small-scale studies in low- and middle-income countries have demonstrated consumption of sugary and savoury snack foods and soft drinks by young children. We assessed the proportion of children 6?23 months of age consuming sugary snack foods in 18 countries in Asia and Africa using data from selected Demographic and Health Surveys and household expenditures on soft drinks and biscui...

  17. Socioeconomic inequities in the health and nutrition of children in low/middle income countries

    OpenAIRE

    Barros, Fernando C; Victora, Cesar G; Scherpbier, Robert; Gwatkin, Davidson

    2010-01-01

    OBJECTIVE: To describe the effects of social inequities on the health and nutrition of children in low and middle income countries. METHODS: We reviewed existing data on socioeconomic disparities within-countries relative to the use of services, nutritional status, morbidity, and mortality. A conceptual framework including five major hierarchical categories affecting inequities was adopted: socioeconomic context and position, differential exposure, differential vulnerability, differential hea...

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

    Science.gov (United States)

    Mills, Anne

    2014-08-22

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

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

    Science.gov (United States)

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

    2016-12-01

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

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

    Science.gov (United States)

    Abdalla, Marwah

    2017-02-01

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

  1. Pensions at a glance 2011 retirement-income systems in OECD and G20 countries

    CERN Document Server

    Organisation for Economic Cooperation and Development. Paris

    2011-01-01

    The theme of this fourth edition of Pensions at a Glance is pensions, retirement and life expectancy. Many countries have increased pension ages in the face of population ageing and longer lives. Some have introduced an automatic link between pensions and life expectancy. Improvements to the incentives to work rather than retire are also a common part of recent pension-reform packages. However, ensuring that there are enough jobs for older workers remains a challenge. An in-depth look at these important policy issues is provided by five special chapters on: pension ages, retirement behaviour, pension incentives to retire, the demand for older workers and linking pensions to life expectancy. This edition updates information on the key features of pension provision in OECD countries and provides projections of retirement income for today’s workers. It offers an expanded range of 34 indicators, covering the design of national retirement-income provision, pension entitlements, incomes of older people, the finan...

  2. Science for Agriculture and Rural Development in Low-Income Countries

    Science.gov (United States)

    Barros, Vicente

    2008-09-01

    During recent months, another sign of the global fragility to sustain the increasing human demand for resources has appeared with merciless cruelty. Increasing food prices, paradoxically driven to a large extent by the rapid economic growth of vast regions of the emerging world, are affecting hundreds of millions of the poorest people in Africa, Asia, and Latin America. As described in Science for Agriculture and Rural Development in Low-Income Countries, most of the poorest people in these low-income countries live in rural areas and are engaged in agriculture or related activities. Because many people in these areas are engaged in subsistence agriculture, they do not share in the added income derived from higher market prices for food.

  3. Integrated care: a fresh perspective for international health policies in low and middle-income countries

    Directory of Open Access Journals (Sweden)

    Jean-Pierre Unger

    2006-09-01

    Full Text Available Purpose: To propose a social-and-democrat health policy alternative to the current neoliberal one. Context of case: The general failure of neoliberal health policies in low and middle-income countries justifies the design of an alternative to bring disease control and health care back in step with ethical principles and desired outcomes. Data sources: National policies, international programmes and pilot experiments—including those led by the authors—are examined in both scientific and grey literature. Case description: We call for the promotion of a publicly-oriented health sector as a cornerstone of such alternative policy. We define ‘publicly-oriented’ as opposed to ‘private-for-profit’ in terms of objectives and commitment, not of ownership. We classify development strategies for such a sector according to an organisation-based typology of health systems defined by Mintzberg. As such, strategies are adapted to three types of health systems: machine bureaucracies, professional bureaucracies and divisionalized forms. We describe avenues for family and community health and for hospital care. We stress social control at the peripheral level to increase accountability and responsiveness. Community-based, national and international sources are required to provide viable financing. Conclusions and discussion: Our proposed social-and-democrat health policy calls for networking, lobbying and training as a joint effort in which committed health professionals can lead the way.

  4. The promotion of intrauterine contraception in low- and middle-income countries: a narrative review.

    Science.gov (United States)

    Cleland, John; Ali, Moazzam; Benova, Lenka; Daniele, Marina

    2017-06-01

    The contribution of copper-bearing intrauterine devices (IUDs) to overall contraceptive protection has declined in many countries, despite their well-known advantages. In response, initiatives to promote this method have been undertaken. To review and interpret the experience of interventions to promote use of IUDs in low- and middle-income countries in order to provide strategic guidance for policies and programs. We conducted a systematic search of Medline, Popline, Embase and Global Health electronic databases for relevant journal papers, reports and gray literature since 2010. Telephone interviews were held with two donors and six international family planning organizations. We identified a total of 31 publications. Four reported the results of randomized control trials and three were derived from quasi-experiments. The majority were based on service statistics. Eight publications concerned interventions for HIV-positive women or couples, nine for postpartum or postabortion cases and 14 for general populations. Intervention approaches included vouchers, franchising of private practitioners, mobile outreach services, placement of dedicated staff in high-volume facilities and demand creation. Most publications adduced evidence of a positive impact and some reported impressively large numbers of IUD insertions. Results to date on the uptake of IUDs in postpartum interventions are modest. There is also almost no evidence of effects on IUD use at national levels. Implant uptake generally exceeded IUD uptake when both were offered. The evidence base is weak and offers few lessons on what strategies are most effective. The overall impression is that IUD use can be increased in a variety of ways but that progress is hampered by persistent adverse perceptions by both providers and potential clients. Provider enthusiasm is a key to success. The lack of a population impact stems in part from the fact that nearly all interventions are initiated by international

  5. Factors influencing trainee doctor emigration in a high income country: a mixed methods study.

    Science.gov (United States)

    Clarke, Nicholas; Crowe, Sophie; Humphries, Niamh; Conroy, Ronan; O'Hare, Simon; Kavanagh, Paul; Brugha, Ruairi

    2017-09-25

    The Global Code of Practice on the International Recruitment of Health Personnel focuses particularly on migration of doctors from low- and middle-income countries. Less is understood about migration from high-income countries. Recession has impacted several European countries in recent years, and in some cases emigration has reached unprecedented levels. This study measures and explores the predictors of trainee doctor emigration from Ireland. Using a partially mixed sequential dominant (quantitative) study design, a nationally representative sample of 893 trainee doctors was invited to complete an online survey. Of the 523 who responded (58.6% response rate), 423 were still in Ireland and responded to questions on factors influencing intention to practice medicine abroad and are the subjects of this study. Explanatory factors for intention to practice medicine in Ireland in the foreseeable future, the primary outcome, included demographic variables and experiences of working within the Irish health system. Associations were examined using univariable and multivariable logistic regression to estimate odds ratios for factors influencing the primary outcome. Qualitative interviews were conducted with 50 trainee doctors and analysed thematically, exploring issues associated with intention to practice medicine abroad. There were high levels of dissatisfaction among trainee doctors around working conditions, training and career progression opportunities in Ireland. However, most factors did not discriminate between intention to leave or stay. Factors that did predict intention to leave included dissatisfaction with one's work-life balance (odds ratio (OR) 2.51; 95% confidence interval (CI) 1.53-4.10; P < 0.001); feeling that the quality of training in Ireland was poor (OR 1.82; 95% CI 1.09-3.05; P = 0.002) and leaving for family or personal reasons (OR 1.85; 95% CI 1.08-3.17; P = 0.027). Qualitative findings illustrated the stress of doing postgraduate

  6. Economic Evaluation of Family Planning Interventions in Low and Middle Income Countries : A Systematic Review

    NARCIS (Netherlands)

    Zakiyah, Neily; van Asselt, Antoinette D. I.; Roijmans, Frank; Postma, Maarten J.

    2016-01-01

    Background A significant number of women in low and middle income countries (L-MICs) who need any family planning, experience a lack in access to modern effective methods. This study was conducted to review potential cost effectiveness of scaling up family planning interventions in these regions

  7. Ethics of Ancillary Care in Clinical Trials in Low Income Countries: A ...

    African Journals Online (AJOL)

    AJRH Managing Editor

    income countries where HIV incidence is high, but the benefits of research are ... provision of ancillary care – medical care provided to clinical trial participants during a ... to or use of quality delivery services is an issue of ... with drastically reduced costs, questions arise over .... The 'partial entrustment' model differentiates.

  8. Systematic review of willingness to pay for health insurance in low and middle income countries

    NARCIS (Netherlands)

    Nosratnejad, S. (Shirin); Rashidian, A. (Arash); D.M. Dror (David)

    2016-01-01

    textabstractObjective Access to healthcare is mostly contingent on out-of-pocket spending (OOPS) by health seekers, particularly in low- and middle-income countries (LMICs). This would require many LMICs to raise enough funds to achieve universal health insurance coverage. But, are individuals or

  9. Earnings disparities and income inequality in CEE countries: an analysis of development and relationships

    Czech Academy of Sciences Publication Activity Database

    Večerník, Jiří

    2012-01-01

    Roč. 50, č. 3 (2012), s. 27-48 ISSN 0012-8775 R&D Projects: GA ČR(CZ) GAP404/11/1521 Institutional support: RVO:68378025 Keywords : earnings disparities * income inequality * CEE countries Subject RIV: AH - Economics Impact factor: 0.211, year: 2012

  10. Childhood immunization, vaccine hesitancy, and provaccination policy in high-income countries

    DEFF Research Database (Denmark)

    Thomsen, Frej Klem

    2017-01-01

    Increasing vaccine hesitancy among parents in high-income countries and the resulting drop in early childhood immunization constitute an important public health problem, and raise the issue of what policies might be taken to promote higher rates of vaccination. This article first outlines the bac...

  11. Education, Income, and Support for Suicide Bombings: Evidence from Six Muslim Countries

    Science.gov (United States)

    Shafiq, M. Najeeb; Sinno, Abdulkader H.

    2010-01-01

    The authors examine the effect of educational attainment and income on support for suicide bombing among Muslim publics in six predominantly Muslim countries that have experienced suicide bombings: Indonesia, Jordan, Lebanon, Morocco, Pakistan, and Turkey. The authors make two contributions. First, they present a conceptual model, which has been…

  12. Reducing the Incidence of Low Birth Weight in Low-Income Countries Has Substantial Economic Benefits

    OpenAIRE

    Alderman, Harold; Behrman, Jere R.

    2006-01-01

    Reducing the incidence of low birth weight not only lowers infant mortality rates but also has multiple benefits over the life cycle. This study estimates the economic benefits of reducing the incidence of low birth weight in low-income countries, both through lower mortality rates and medical costs and through increased learning and productivity. The estimated economic benefits, under pla...

  13. A systematic review of online interventions for mental health in low and middle income countries

    NARCIS (Netherlands)

    Arjadi, R.; Nauta, M.H.; Chowdhary, N.; Bockting, C.L.H.

    2015-01-01

    Background. Low and middle income countries (LMICs) are facing an increase of the impact of mental health problems while confronted with limited resources and limited access to mental health care, known as the ?mental health gap?. One strategy to reduce the mental health gap would be to utilize the

  14. Content, participants and outcomes of three diabetes care programmes in three low and middle income countries.

    NARCIS (Netherlands)

    Olmen, J. van; Ku, G.M.; Darras, C.; Kalobu, J.C.; Bewa, E.; Pelt, M. van; Hen, H.; Acker, K. van; Eggermont, N.; Schellevis, F.; Kegels, G.

    2015-01-01

    Aims: To improve access and quality of diabetes care for people in low-income countries, it is important to understand which elements of diabetes care are effective. This paper analyses three diabetes care programmes in the DR Congo, Cambodia and the Philippines. Methods: Three programmes offering

  15. Content, participants and outcomes of three diabetes care programmes in three low and middle income countries

    NARCIS (Netherlands)

    van Olmen, J.; Marie, K.G.; Christian, D.; Clovis, K.J.; Emery, B.; Maurits, V.P.; Heang, H.; Kristien, V.A.; Natalie, E.; Francois, S.; Guy, K.

    2015-01-01

    Aims To improve access and quality of diabetes care for people in low-income countries, it is important to understand which elements of diabetes care are effective. This paper analyses three diabetes care programmes in the DR Congo, Cambodia and the Philippines. Methods Three programmes offering

  16. Postgraduate Education in Radiation Oncology in Low- and Middle-income Countries

    DEFF Research Database (Denmark)

    Eriksen, J. G.

    2017-01-01

    Radiation therapy is one of the most cost-effective ways to treat cancer patients on both a curative and palliative basis in low- and middle-income countries (LMICs). Despite this, the gap in radiation oncology capacity is enormous and is even increasing due to a rapid rise in the incidence...

  17. Satisfaction with Job and Income among Older Individuals across European Countries

    Science.gov (United States)

    Bonsang, Eric; van Soest, Arthur

    2012-01-01

    Using data on individuals of age 50 and older from 11 European countries, we analyze two economic aspects of subjective well-being of older Europeans: satisfaction with household income, and job satisfaction. Both have been shown to contribute substantially to overall well-being (satisfaction with life or happiness). We use anchoring vignettes to…

  18. Satisfaction with job and income among older individuals across European countries

    NARCIS (Netherlands)

    Bonsang, E.; van Soest, A.H.O.

    2012-01-01

    Using data on individuals of age 50 and older from 11 European countries, we analyze two economic aspects of subjective well-being of older Europeans: satisfaction with household income, and job satisfaction. Both have been shown to contribute substantially to overall well-being (satisfaction with

  19. Socioeconomic Inequalities in Overweight and Obesity in Low- and Middle-Income Countries

    NARCIS (Netherlands)

    S.L. López Arana (Sandra Liliana)

    2016-01-01

    markdownabstractMany low- and middle-income countries are experiencing a rapid increase of overweight and obesity rates. Nonetheless, there are some concerns not only about the pace of the increase in overweight and obesity, but also about inequalities in their distribution across social groups. The

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

    Science.gov (United States)

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

    2014-01-01

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

  1. Correlation between national income, HIV/AIDS and political status and mortalities in African countries.

    Science.gov (United States)

    Andoh, S Y; Umezaki, M; Nakamura, K; Kizuki, M; Takano, T

    2006-07-01

    To investigate associations between mortalities in African countries and problems that emerged in Africa in the 1990s (reduction of national income, HIV/AIDS and political instability) by adjusting for the influences of development, sanitation and education. We compiled country-level indicators of mortalities, national net income (the reduction of national income by the debt), infection rate of HIV/AIDS, political instability, demography, education, sanitation and infrastructure, from 1990 to 2000 of all African countries (n=53). To extract major factors from indicators of the latter four categories, we carried out principal component analysis. We used multiple regression analysis to examine the associations between mortality indicators and national net income per capita, infection rate of HIV/AIDS, and political instability by adjusting the influence of other possible mortality determinants. Mean of infant mortality per 1000 live births (IMR); maternal mortality per 100,000 live birth (MMR); adult female mortality per 1000 population (AMRF); adult male mortality per 1000 population (AMRM); and life expectancy at birth (LE) in 2000 were 83, 733, 381, 435, and 51, respectively. Three factors were identified as major influences on development: education, sanitation and infrastructure. National net income per capita showed independent negative associations with MMR and AMRF, and a positive association with LE. Infection rate of HIV/AIDS was independently positively associated with AMRM and AMRF, and negatively associated with LE in 2000. Political instability score was independently positively associated with MMR. National net income per capita, HIV/AIDS and political status were predictors of mortality indicators in African countries. This study provided evidence for supporting health policies that take economic and political stability into account.

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

    Science.gov (United States)

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

    2017-01-01

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

  3. Dietary management of childhood diarrhea in low- and middle-income countries: a systematic review

    Science.gov (United States)

    2013-01-01

    analyses to studies where both intervention and control diets were lactose-free, weight gain in children with acute diarrhea was shown to be greater among those fed with a home-available diet. Conclusions Among children in low- and middle-income countries, where the dual burden of diarrhea and malnutrition is greatest and where access to proprietary formulas and specialized ingredients is limited, the use of locally available age-appropriate foods should be promoted for the majority of acute diarrhea cases. Lactose intolerance is an important complication in some cases, but even among those children for whom lactose avoidance may be necessary, nutritionally complete diets comprised of locally available ingredients can be used at least as effectively as commercial preparations or specialized ingredients. These same conclusions may also apply to the dietary management of children with persistent diarrhea, but the evidence remains limited. PMID:24564685

  4. Global occurrence of anti-infectives in contaminated surface waters: Impact of income inequality between countries.

    Science.gov (United States)

    Segura, Pedro A; Takada, Hideshige; Correa, José A; El Saadi, Karim; Koike, Tatsuya; Onwona-Agyeman, Siaw; Ofosu-Anim, John; Sabi, Edward Benjamin; Wasonga, Oliver V; Mghalu, Joseph M; dos Santos Junior, Antonio Manuel; Newman, Brent; Weerts, Steven; Yargeau, Viviane

    2015-07-01

    The presence anti-infectives in environmental waters is of interest because of their potential role in the dissemination of anti-infective resistance in bacteria and other harmful effects on non-target species such as algae and shellfish. Since no information on global trends regarding the contamination caused by these bioactive substances is yet available, we decided to investigate the impact of income inequality between countries on the occurrence of anti-infectives in surface waters. In order to perform such study, we gathered concentration values reported in the peer-reviewed literature between 1998 and 2014 and built a database. To fill the gap of knowledge on occurrence of anti-infectives in African countries, we also collected 61 surface water samples from Ghana, Kenya, Mozambique and South Africa, and measured concentrations of 19 anti-infectives. A mixed one-way analysis of covariance (ANCOVA) model, followed by Turkey-Kramer post hoc tests was used to identify potential differences in anti-infective occurrence between countries grouped by income level (high, upper-middle and lower-middle and low income) according to the classification by the World Bank. Comparison of occurrence of anti-infectives according to income level revealed that concentrations of these substances in contaminated surface waters were significantly higher in low and lower-middle income countries (p=0.0001) but not in upper-middle income countries (p=0.0515) compared to high-income countries. We explained these results as the consequence of the absence of or limited sewage treatment performed in lower income countries. Furthermore, comparison of concentrations of low cost anti-infectives (sulfonamides and trimethoprim) and the more expensive macrolides between income groups suggest that the cost of these substances may have an impact on their environmental occurrence in lower income countries. Since wastewaters are the most important source of contamination of anti-infectives and other

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

    Science.gov (United States)

    2004-07-01

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

  6. Strategies for Better Hypertension Control in India and Other Lower Middle Income Countries.

    Science.gov (United States)

    Gupta, Rajeev; Khedar, Raghuvir Singh; Panwar, Raja Babu

    2016-09-01

    Hypertension is the most important cause of global burden of disease. It is highly prevalent in India and other low and lower-middle income countries. Prevalence of uncontrolled hypertension varies from 70-90% and is significantly greater in rural vs urban locations. Guidelines based treatment strategy has improved blood pressure (BP) control in high income countries but no context-specific guidelines exist in low and lower-middle income countries such as India. There are numerous barriers to proper BP control in these countries and include political apathy, bureaucratic inertia, weak health systems, overburdened healthcare providers and unempowered patients. Hypertension control can be improved in these countries by better political focus on social determinants of health such as education, development of health systems, proper healthcare financing, free or low-cost BP medicines, healthcare provider education for hypertension management, free primary care, task sharing with trained community health workers, patient empowerment and use of technological innovations. © Journal of the Association of Physicians of India 2011.

  7. Pensions at a glance 2009 retirement-income systems in OECD countries

    CERN Document Server

    Organisation for Economic Cooperation and Development. Paris

    2009-01-01

    Pension and retirement policies have changed dramatically in recent years, as governments have tried to balance the goals of adequate retirement incomes and the long-term financial sustainability of pension systems in the face of population ageing. Pensions at a Glance 2009 provides a consistent framework for comparing pension policies between countries along with reliable data. This third edition updates information on key features of pension provision in OECD countries and provides projections of retirement income for todays workers. It offers an expanded range of indicators, including measures of assets, investment performance, coverage of private pensions, public pension spending, and the demographic context and outlook. Four special chapters provide an in-depth look at important issues in pension policy today. The first examines the implications of the present financial and economic crisis on pension systems. Which countries and which individuals are most affected? What can governments do to help and whi...

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

    Science.gov (United States)

    Taylor, Alison

    2017-05-01

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

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

    Science.gov (United States)

    Pengpid, Supa; Peltzer, Karl

    2015-01-01

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

  10. Mortuary based injury surveillance for low-mid income countries: process evaluation of pilot studies.

    Science.gov (United States)

    Kipsaina, Chebiwot; Ozanne-Smith, Joan; Bartolomeos, Kidist; Routley, Virginia

    2015-08-01

    Globally, injury is the fourth major cause of death and the third leading contributor to Disability Adjusted Life Years lost due to health conditions, with the greatest burden borne by low-middle income countries (LMICs) where injury data is scarce. In the absence of effective vital registration systems, mortuaries have been shown to provide an alternative source of cause of death information for practitioners and policy makers to establish strategic injury prevention policies and programs. This evaluation sought to assess the feasibility of implementing a standardised fatal injury data collection process to systematically collect relevant fatal injury data from mortuaries. The process evaluation is described. A manual including a one page data collection form, coding guide, data dictionary, data entry and analysis program was developed through World Health Organization and Monash University Australia collaboration, with technical advice from an International Advisory Group. The data collection component was piloted in multiple mortuaries, in five LMICs (Egypt, India, Sri-Lanka, Tanzania and Zambia). Process evaluation was based on a questionnaire completed by each country's Principal Investigator. Questionnaires were completed for data collections in urban and rural mortuaries between September 2010 and February 2011. Of the 1795 reported fatal injury cases registered in the participating mortuaries, road traffic injury accounted for the highest proportion of cases, ranging from 22% to 87%. Other causes included burns, poisoning, drowning and falls. Positive system attributes were feasibility, acceptability, usefulness, timeliness, and simplicity and data field completeness. Some limitations included short duration of the pilot studies, limited injury data collector training and apparent underreporting of cases to the medico-legal system or mortuaries. The mortuary has been shown to be a potential data source for identifying injury deaths and their circumstances

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

    Science.gov (United States)

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

    2018-04-11

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

  12. THE INFLUENCE OF PRICES AND INCOME ON CONSUMER BEHAVIOUR OF THE POPULATION. THE CASE OF ROMANIA

    Directory of Open Access Journals (Sweden)

    Anghelina Andrei

    2012-12-01

    Full Text Available The recession influenced the consummers in their biggest concern – their income. In the same time the recession changed some important trends in consume. In this paperwork the authors intend to determine how strong the influence of prices and incomes of the population is on the consumer behavior, especially in Romania. Also the author want to present the case study of Romania concerning the recession of economy and some new aspects of consumer behavior. There is a strong conexion between the income and consume and the time of recession show it in the best way. In this way the author did some research on the market and by some analyses in a statistical editor we conclude that there is a strong determination in the consumer behavior by the income of the population especially in Romania, a country with a developing economy.

  13. Human development, occupational structure and physical inactivity among 47 low and middle income countries.

    Science.gov (United States)

    Atkinson, Kaitlin; Lowe, Samantha; Moore, Spencer

    2016-06-01

    This study aimed to (a) assess the relationship between a person's occupational category and their physical inactivity, and (b) analyze the association among country-level variables and physical inactivity. The World Health Survey (WHS) was administered in 2002-2003 among 47 low- and middle-income countries (n = 196,742). The International Physical Activity Questionnaire (IPAQ) was used to collect verbal reports of physical activity and convert responses into measures of physical inactivity. Economic development (GDP/c), degree of urbanization, and the Human Development Index (HDI) were used to measure country-level variables and physical inactivity. Multilevel logistic regression analysis was used to examine the association among country-level factors, individual occupational status, and physical inactivity. Overall, the worldwide prevalence of physical inactivity in 2002-2003 was 23.7%. Individuals working in the white-collar industry compared to agriculture were 84% more likely to be physically inactive (OR: 1.84, CI: 1.73-1.95). Among low- and middle-income countries increased HDI values were associated with decreased levels of physical inactivity (OR: 0.98, CI: 0.97-0.99). This study is one of the first to adjust for within-country differences, specifically occupation while analyzing physical inactivity. As countries experience economic development, changes are also seen in their occupational structure, which result in increased countrywide physical inactivity levels.

  14. Income Inequality or Performance Gap? A Multilevel Study of School Violence in 52 Countries.

    Science.gov (United States)

    Contreras, Dante; Elacqua, Gregory; Martinez, Matias; Miranda, Álvaro

    2015-11-01

    The purpose of the study was to examine the association between income inequality and school violence and between the performance inequality and school violence in two international samples. The study used data from Trends in International Mathematics and Science Study 2011 and from the Central Intelligence Agency of United States which combined information about academic performance and students' victimization (physical and social) for 269,456 fourth-grade students and 261,747 eighth-grade students, with gross domestic product and income inequality data in 52 countries. Ecological correlations tested associations between income inequality and victimization and between school performance inequality and victimization among countries. Multilevel ordinal regression and multilevel regression analyses tested the strength of these associations when controlling for socioeconomic and academic performance inequality at school level and family socioeconomic status and academic achievement at student level. Income inequality was associated with victimization rates in both fourth and eighth grade (r ≈ .60). Performance inequality shows stronger association with victimization among eighth graders (r ≈ .46) compared with fourth graders (r ≈ .30). Multilevel analyses indicate that both an increase in the income inequality in the country and school corresponds with more frequent physical and social victimization. On the other hand, an increase in the performance inequality at the system level shows no consistent association to victimization. However, school performance inequality seems related to an increase in both types of victimizations. Our results contribute to the finding that income inequality is a determinant of school violence. This result holds regardless of the national performance inequality between students. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  15. National income inequality and self-rated health : The differing impact of individual social trust across 89 countries

    NARCIS (Netherlands)

    Rözer, J.; Kraaykamp, G.; Huijts, T.

    2016-01-01

    The well-known Income Inequality Hypothesis suggests that income disparities in a country are detrimental for people's health. Empirical studies testing this hypothesis so far have found mixed results. In this study, we argue that a reason for these mixed findings may be that high national income

  16. National income inequality and self-rated health: The differing impact of individual social trust across 89 countries

    NARCIS (Netherlands)

    Rözer, J.; Kraaykamp, G.L.M.; Huijts, T.H.M.

    2016-01-01

    The well-known Income Inequality Hypothesis suggests that income disparities in a country are detrimental for people's health. Empirical studies testing this hypothesis so far have found mixed results. In this study, we argue that a reason for these mixed findings may be that high national income

  17. Midline versus transverse incision for cesarean delivery in low-income countries

    DEFF Research Database (Denmark)

    Maaløe, Nanna; Aabakke, Anna J M; Secher, Niels J

    2014-01-01

    While transverse incision is the recommended entry technique for cesarean delivery in high-income countries, it is our experience that midline incision is still used routinely in many low-income settings. Accordingly, international guidelines lack uniformity on this matter. Although evidence...... is limited, the literature suggests important advantages of the transverse incision, with lower risk of long-term disabilities such as wound disruption and hernia. Also, potential extra time spent on this incision appears not to impact neonatal outcome. Therefore, we suggest that it is time for a change...

  18. Material Deprivation in Selected EU Countries According to EU-SILC Income Statistics

    Directory of Open Access Journals (Sweden)

    Stávková Jana

    2012-06-01

    Full Text Available The article deals with issues of households at risk of poverty in relative conception. Income poverty means a situation when the threshold of 0.6 of median income is not achieved. The analysis of a broader definition of poverty is based on identification and assessment of material deprivation factors, including: financial stress, housing conditions, availability of consumer durables and basic needs. Data sources are based EU-SILC dataset. Presented analysis is focused on selected EU countries, namely Czech Republic, Finland, France, Spain and United Kingdom. The result identifies the problem areas that cause deprivation symptoms.

  19. Cervical Precancer Treatment in Low- and Middle-Income Countries: A Technology Overview

    Directory of Open Access Journals (Sweden)

    Mauricio Maza

    2017-08-01

    Full Text Available Cervical cancer is the fourth leading cause of cancer-related death in women worldwide, with 90% of cases occurring in low- and middle-income countries (LMICs. There has been a global effort to increase access to affordable screening in these settings; however, a corresponding increase in availability of effective and inexpensive treatment modalities for ablating or excising precancerous lesions is also needed to decrease mortality. This article reviews the current landscape of available and developing technologies for treatment of cervical precancer in LMICs. At present, the standard treatment of most precancerous lesions in LMICs is gas-based cryotherapy. This low-cost, effective technology is an expedient treatment in many areas; however, obtaining and transporting gas is often difficult, and unwieldy gas tanks are not conducive to mobile health campaigns. There are several promising ablative technologies in development that are gasless or require less gas than conventional cryotherapy. Although further evaluation of the efficacy and cost-effectiveness is needed, several of these technologies are safe and can now be implemented in LMICs. Nonsurgical therapies, such as therapeutic vaccines, antivirals, and topical applications, are also promising, but most remain in early-stage trials. The establishment of evidence-based standardized protocols for available treatments and the development and introduction of novel technologies are necessary steps in overcoming barriers to treatment in LMICs and decreasing the global burden of cervical cancer. Guidance from WHO on emerging treatment technologies is also needed.

  20. Methodology to Forecast Volume and Cost of Cancer Drugs in Low- and Middle-Income Countries

    Directory of Open Access Journals (Sweden)

    Yehoda M. Martei

    2018-02-01

    Full Text Available Purpose: In low- and middle-income countries (LMICs, frequent outages of the stock of cancer drugs undermine cancer care delivery and are potentially fatal for patients with cancer. The aim of this study is to describe a methodologic approach to forecast chemotherapy volume and estimate cost that can be readily updated and applied in most LMICs. Methods: Prerequisite data for forecasting are population-based incidence data and cost estimates per unit of drug to be ordered. We used the supplementary guidelines from the WHO list of essential medicines for cancer to predict treatment plans and ordering patterns. We used de-identified aggregate data from the Botswana National Cancer Registry to estimate incident cases. The WHO Management Sciences for Health International Price Indicator was used to estimate unit costs per drug. Results: Chemotherapy volume required for incident cancer cases was estimated as the product of the standardized dose required to complete a full treatment regimen per patient, with a given cancer diagnosis and stage, multiplied by the total number of incident cancer cases with the respective diagnosis. The estimated chemotherapy costs to treat the 10 most common cancers in the public health care sector of Botswana is approximately 2.3 million US dollars. An estimated 66% of the budget is allocated to costs of rituximab and trastuzumab alone, which are used by approximately 10% of the cancer population. Conclusion: This method provides a reproducible approach to forecast chemotherapy volume and cost in LMICs. The chemotherapy volume and cost outputs of this methodology provide key stakeholders with valuable information that can guide budget estimation, resource allocation, and drug-price negotiations for cancer treatment. Ultimately, this will minimize drug shortages or outages and reduce potential loss of lives that result from an erratic drug supply.

  1. Policy options for pharmaceutical pricing and purchasing: issues for low- and middle-income countries.

    Science.gov (United States)

    Nguyen, Tuan Anh; Knight, Rosemary; Roughead, Elizabeth Ellen; Brooks, Geoffrey; Mant, Andrea

    2015-03-01

    Pharmaceutical expenditure is rising globally. Most high-income countries have exercised pricing or purchasing strategies to address this pressure. Low- and middle-income countries (LMICs), however, usually have less regulated pharmaceutical markets and often lack feasible pricing or purchasing strategies, notwithstanding their wish to effectively manage medicine budgets. In high-income countries, most medicines payments are made by the state or health insurance institutions. In LMICs, most pharmaceutical expenditure is out-of-pocket which creates a different dynamic for policy enforcement. The paucity of rigorous studies on the effectiveness of pharmaceutical pricing and purchasing strategies makes it especially difficult for policy makers in LMICs to decide on a course of action. This article reviews published articles on pharmaceutical pricing and purchasing policies. Many policy options for medicine pricing and purchasing have been found to work but they also have attendant risks. No one option is decisively preferred; rather a mix of options may be required based on country-specific context. Empirical studies in LMICs are lacking. However, risks from any one policy option can reasonably be argued to be greater in LMICs which often lack strong legal systems, purchasing and state institutions to underpin the healthcare system. Key factors are identified to assist LMICs improve their medicine pricing and purchasing systems. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

  2. Role of income in intergenerational co-residence: Evidence from selected African and Asian countries.

    Science.gov (United States)

    Aziz, Nusrate; Hossain, Belayet; Emran, Masum

    2018-06-01

    The study investigates the macroeconomic determinants of co-residing arrangement between generations in selected developing countries with a focus on examining the effect of changing income level of the working generation. A reduced form model is specified for co-residence between the older generation and altruistic working generation. The fixed- and random-effects models are applied in two waves of data for 22 countries. Estimated results indicate that the income of the altruistic working generation has a negative effect on co-residence, suggesting that if the income of the working generation increases, co-residence decreases. This decrease is greater for older men compared with their female counterparts. Life expectancy, literacy and culture also have significant influences on co-residence. Co-residence is expected to fall in developing countries with economic growth over time. Consequently, a higher proportion of older citizens will be vulnerable in the future. Hence, governments of developing countries will face increasing pressure from their older people to provide appropriate planning and strategy to face this challenge. © 2018 AJA Inc.

  3. Classification of EU Countries in the Context of Corporate Income Tax

    Directory of Open Access Journals (Sweden)

    Alena Andrejovská

    2016-01-01

    Full Text Available Taxes are an integral part of human society, regardless of the economic, cultural and political disparities between the countries. Income taxes of legal entities represent significant part of the budget, what is the reason for their timeliness and public discussion. The aim of the paper is a classification of the EU countries into economic groups and an assessment of the grouping these EU member states based on common characteristics in the area of corporate income taxes. Common features are determined by the structure of selected macroeconomic indicators: public debt, government budget balance, the overall tax burden, economic performance, nominal and effective tax rate. The analysis compares a range of methodological approaches of hierarchical (Ward linkage and median linkage, and non‑hierarchical clustering (k-means clustering and fuzzy cluster analysis. The results of cluster analysis grouped the monitored countries into five clusters based on common characteristics as the corporate income tax rate, economics performance and the level of public debt. The result of the analysis shows that despite of ongoing there are still differences present, which are present in the ratios of countries’ development as well as in the economic policies of the particular countries.

  4. Decomposing income-related inequality in cervical screening in 67 countries.

    Science.gov (United States)

    McKinnon, Brittany; Harper, Sam; Moore, Spencer

    2011-04-01

    The development of successful policies to reduce income-related inequalities in cervical cancer screening rates requires an understanding of the reasons why low-income women are less likely to be screened. We sought to identify important determinants contributing to inequality in cervical screening rates. We analyzed data from 92,541 women aged 25-64 years, who participated in the World Health Survey in 2002-2003. Income-related inequality in Pap screening was measured using the concentration index (CI). Using a decomposition method for the CI, we quantified the contribution to inequality of age, education level, marital status, urbanicity and recent health-care need. There was substantial heterogeneity in the contributions of different determinants to inequality among countries. Education generally made the largest contribution (median = 15%, interquartile range [IQR] = 23%), although this varied widely even within regions (e.g., 5% in Austria, 28% in Hungary). The contribution of rural residence was greatest in African countries (median = 10%, IQR = 13%); however, there was again substantial within-region variation (e.g., 26% in Zambia, 2% in Kenya). Considerable heterogeneity in the contributions of screening determinants among countries suggests interventions to reduce screening inequalities may require country-specific approaches.

  5. Medicines coverage and community-based health insurance in low-income countries

    Directory of Open Access Journals (Sweden)

    Wagner Anita K

    2008-10-01

    Full Text Available Abstract Objectives The 2004 International Conference on Improving Use of Medicines recommended that emerging and expanding health insurances in low-income countries focus on improving access to and use of medicines. In recent years, Community-based Health Insurance (CHI schemes have multiplied, with mounting evidence of their positive effects on financial protection and resource mobilization for healthcare in poor settings. Using literature review and qualitative interviews, this paper investigates whether and how CHI expands access to medicines in low-income countries. Methods We used three complementary data collection approaches: (1 analysis of WHO National Health Accounts (NHA and available results from the World Health Survey (WHS; (2 review of peer-reviewed articles published since 2002 and documents posted online by national insurance programs and international organizations; (3 structured interviews of CHI managers about key issues related to medicines benefit packages in Lao PDR and Rwanda. Results In low-income countries, only two percent of WHS respondents with voluntary insurance belong to the lowest income quintile, suggesting very low CHI penetration among the poor. Yet according to the WHS, medicines are the largest reported component of out-of-pocket payments for healthcare in these countries (median 41.7% and this proportion is inversely associated with income quintile. Publications have mentioned over a thousand CHI schemes in 19 low-income countries, usually without in-depth description of the type, extent, or adequacy of medicines coverage. Evidence from the literature is scarce about how coverage affects medicines utilization or how schemes use cost-containment tools like co-payments and formularies. On the other hand, interviews found that medicines may represent up to 80% of CHI expenditures. Conclusion This paper highlights the paucity of evidence about medicines coverage in CHI. Given the policy commitment to expand CHI

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

    Science.gov (United States)

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

    2017-01-01

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

  7. Pediatric clinical drug trials in low-income countries: key ethical issues.

    Science.gov (United States)

    MacLeod, S M; Knoppert, D C; Stanton-Jean, M; Avard, D

    2015-02-01

    Potential child participants in clinical research trials in low-income countries are often vulnerable because of poverty, high morbidity and mortality, inadequate education, and varied local cultural norms. However, vulnerability by itself must not be accepted as an obstacle blocking children from the health benefits that may accrue as an outcome of sound clinical research. As greater emphasis is placed on evidence-based treatment of children, it should be anticipated that there will be a growing call for agreement on principles to guide clinical investigations in low-income countries. There is now general acceptance of the view that children must be protected from non-evidence-based interventions and from substandard treatments. The questions remaining relate to how best to stimulate clinical research activity that will serve the needs of infants, children, and youth in developing countries and how best to assign priority to ethically sound research that will meet their clinical requirements. In low-income countries, 39 % of citizens are 13 years of age or younger, and consequently it is certain that clinical investigations of some new therapeutic products will be conducted there more frequently. This review offers some suggestions for approaches that will help to achieve more effective ethical consideration, including (1) improving the quality of research ethics boards; (2) fostering collaborative partnerships among important stakeholders; (3) making concerted efforts to build capacity; (4) improving the quality of the consent and waiver process; and (5) developing improved governance for harmonized ethics platforms. Continuing support by international organizations is required to sustain the establishment and maintenance of stronger research ethics boards to protect children enrolled in clinical trials. This review underscores the importance of developing a culture of solidarity and true partnership between developed and low-income country organizations, which

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

    Science.gov (United States)

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

    2017-03-01

    Reducing unwanted adolescent childbearing is a global priority. Little is known about how national-level economic and human development indicators relate to early adolescent childbearing. This ecological study evaluates associations of Gross Domestic Product (GDP), GINI index, Human Development Index (HDI) and Gender-related Development Index (GDI; i.e. the HDI adjusted for gender disparities) with early adolescent childbearing in 27 low- and middle-income countries (LMICs) across three time periods. Among women ages 18–24, prevalence estimates for early birth (development adjusted for gender disparities in educational and economic prospects, was more consistently related to early adolescent childbearing than the absolute development prospects as given by the HDI. While creating gender equality is an important goal in and of itself, the findings emphasize the potential for improved national-level gender equitable development as a means to improve adolescents’ sexual and reproductive health.

  9. Changes in Income at Macro Level Predict Sex Ratio at Birth in OECD Countries.

    Science.gov (United States)

    Kanninen, Ohto; Karhula, Aleksi

    2016-01-01

    The human sex ratio at birth (SRB) is approximately 107 boys for every 100 girls. SRB was rising until the World War II and has been declining slightly after the 1950s in several industrial countries. Recent studies have shown that SRB varies according to exposure to disasters and socioeconomic conditions. However, it remains unknown whether changes in SRB can be explained by observable macro-level socioeconomic variables across multiple years and countries. Here we show that changes in disposable income at the macro level positively predict SRB in OECD countries. A one standard deviation increase in the change of disposable income is associated with an increase of 1.03 male births per 1000 female births. The relationship is possibly nonlinear and driven by extreme changes. The association varies from country to country being particular strong in Estonia. This is the first evidence to show that economic and social conditions are connected to SRB across countries at the macro level. This calls for further research on the effects of societal conditions on general characteristics at birth.

  10. Stochastic properties of the consumption-income ratios in central and eastern European countries

    Directory of Open Access Journals (Sweden)

    Giray Gozgor

    2013-12-01

    Full Text Available This paper aims to investigate stochastic properties of the consumption-income ratios in eleven central and eastern European (CEE countries: Bulgaria, Croatia, the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania, Slovakia, and Slovenia. The heterogeneous panel unit root tests are used to account for cross-sectional dependence and the Modified Augmented Dickey-Fuller unit root test over the period March 1997-September 2012. The half-lives are also calculated as to find the strong mean-reversion in the consumption income ratio for nine of eleven CEE economies; and the exceptions are Croatia and Slovenia. In other words, empirical findings provide significant support for the existence of hypothesis that the consumption-income ratio is a mean reversion. Accordingly, the policy implications have permanent effects on the consumption of households only in Croatia and Slovenia.

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

    Science.gov (United States)

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

    2017-01-01

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

  12. The Analysis of Income per Capita Convergence on ASEAN Plus Three (APT Countries

    Directory of Open Access Journals (Sweden)

    Any Fatiwetunusa

    2017-09-01

    Full Text Available The main objective of this study is to test the convergence of income per capita in APT countries through three models: absolute convergence, conditional convergence and sigma convergence. Regression analysis of panel data from 13 APT countries during the period of 2001-2014 is used to analysed to study problem. In absolute convergence model, the growth of real GDP per capita and initial real GDP are used as the variables, meanwhile, 8 variables such as the growth of real GPD per capita, initial real GDP per capita, labor force ratio, value added in agricultural sector, value added in industrial sector, terms of trade, foreign direct investment and internet users ratio are analyzed in conditional convergence model. According to the Solow model, the economies of the countries will converge in which the growth of income per capita of developing countries will be higher than those of developed countries. The economies will be convergent if the countries tend to move to a similar steady state resulting in smaller gap between the countries. Based on the results of absolute convergence and conditional convergence models, APT countries is converging with the rate of 2% and 2.2%. This is consistent with the results of sigma convergence model that shows a declining trend in the dispersion of real GDP per capita in APT regions. The growth of real GDP per capita is influenced by initial GDP per capita, labor force ratio, value added in agricultural sector, value added in industrial sector, terms of trade, foreign direct investment and internet users ratio. Developed countries such as Singapore, Brunei Darussalam and South Korea experience the impact of high real GDP per capita growth. On the contrary, Indonesia, Laos, Vietnam and The Phillipines undergo the impact of low GDP per capita growth.

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

    Science.gov (United States)

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

    2013-03-28

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

  14. Is skewed income distribution good for environmental quality? A comparative analysis among selected BRICS countries.

    Science.gov (United States)

    Mahalik, Mantu Kumar; Mallick, Hrushikesh; Padhan, Hemachandra; Sahoo, Bhagaban

    2018-06-03

    A large number of studies have examined the linkage between income inequality and environmental quality at the individual country levels. This study attempts to examine the linkage between the two factors for the individual BRICS economies from a comparative perspective, which is scarce in the literature. It examines the selected countries (Brazil, India, China and South Africa) by endogenising the patterns of primary energy consumption (coal use and petroleum use), total primary energy consumption, economic growth, and urbanisation as key determining factors in CO 2 emission function. The long-run results based on ARDL bounds testing revealed that income inequality leads to increase in CO 2 emissions for Brazil, India and China, while the same factor leads to reduction in CO 2 emissions for South Africa. However, it observes that while coal use increases CO 2 emissions for India, China and South Africa, it has no effect for Brazil. In contrast, the use of petroleum products contributes to CO 2 emissions in Brazil, while the use of the same surprisingly results in reduction of carbon emissions in South Africa, India and China. The findings suggest that given the significance of income inequality in environmental pollution, the policy makers in these emerging economies have to take into consideration the role of income inequality, while designing the energy policy to achieve environmental sustainability.

  15. Delivery arrangements for health systems in low-income countries: an overview of systematic reviews.

    Science.gov (United States)

    Ciapponi, Agustín; Lewin, Simon; Herrera, Cristian A; Opiyo, Newton; Pantoja, Tomas; Paulsen, Elizabeth; Rada, Gabriel; Wiysonge, Charles S; Bastías, Gabriel; Dudley, Lilian; Flottorp, Signe; Gagnon, Marie-Pierre; Garcia Marti, Sebastian; Glenton, Claire; Okwundu, Charles I; Peñaloza, Blanca; Suleman, Fatima; Oxman, Andrew D

    2017-09-13

    findings to low-income countries. We identified 7272 systematic reviews and included 51 of them in this overview. We judged 6 of the 51 reviews to have important methodological limitations and the other 45 to have only minor limitations. We grouped delivery arrangements into eight categories. Some reviews provided more than one comparison and were in more than one category. Across these categories, the following intervention were effective; that is, they have desirable effects on at least one outcome with moderate- or high-certainty evidence and no moderate- or high-certainty evidence of undesirable effects. Who receives care and when: queuing strategies and antenatal care to groups of mothers. Who provides care: lay health workers for caring for people with hypertension, lay health workers to deliver care for mothers and children or infectious diseases, lay health workers to deliver community-based neonatal care packages, midlevel health professionals for abortion care, social support to pregnant women at risk, midwife-led care for childbearing women, non-specialist providers in mental health and neurology, and physician-nurse substitution. Coordination of care: hospital clinical pathways, case management for people living with HIV and AIDS, interactive communication between primary care doctors and specialists, hospital discharge planning, adding a service to an existing service and integrating delivery models, referral from primary to secondary care, physician-led versus nurse-led triage in emergency departments, and team midwifery. Where care is provided: high-volume institutions, home-based care (with or without multidisciplinary team) for people living with HIV and AIDS, home-based management of malaria, home care for children with acute physical conditions, community-based interventions for childhood diarrhoea and pneumonia, out-of-facility HIV and reproductive health services for youth, and decentralised HIV care. Information and communication technology: mobile

  16. Financial arrangements for health systems in low-income countries: an overview of systematic reviews

    OpenAIRE

    Wiysonge, Charles S; Paulsen, Elizabeth; Lewin, Simon; Ciapponi, Agustín; Herrera, Cristian A; Opiyo, Newton; Pantoja, Tomas; Rada, Gabriel; Oxman, Andrew D

    2017-01-01

    Background One target of the Sustainable Development Goals is to achieve "universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all". A fundamental concern of governments in striving for this goal is how to finance such a health system. This concern is very relevant for low-income countries. Objectives To provide an overview of the evidence from...

  17. Public reporting on quality, waiting times and patient experience in 11 high-income countries

    OpenAIRE

    Rechel, Bernd; McKee, Martin; Haas, Marion; Marchildon, Gregory P; Bousquet, Frederic; Blümel, Miriam; Geissler, Alexander; van Ginneken, Ewout; Ashton, Toni; Saunes, Ingrid Sperre; Anell, Anders; Quentin, Wilm; Saltman, Richard; Culler, Steven; Barnes, Andrew

    2016-01-01

    : This article maps current approaches to public reporting on waiting times, patient experience and aggregate measures of quality and safety in 11 high-income countries (Australia, Canada, England, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland and the United States). Using a questionnaire-based survey of key national informants, we found that the data most commonly made available to the public are on waiting times for hospital treatment, being reported for major hospi...

  18. Immediate postpartum use of long-acting reversible contraceptives in low- and middle-income countries

    OpenAIRE

    Harrison, Margo S.; Goldenberg, Robert L.

    2017-01-01

    Globally, data show that many women of reproductive age desire to use modern family planning methods. Many of these women do not have access to modern contraceptives, which is termed their ‘unmet need’ for contraception. In low- and middle-income countries where total fertility rates can be high and many women have undesired fertility, or wish to increase their inter-pregnancy intervals, access to modern contraceptives is often inadequate. The puerperium is a unique time for interventions to ...

  19. Managing menstruation in the workplace: an overlooked issue in low- and middle-income countries.

    OpenAIRE

    Sommer, Marni; Chandraratna, Sahani; Cavill, Sue; Mahon, Therese; Phillips-Howard, Penelope

    2016-01-01

    The potential menstrual hygiene management barriers faced by adolescent girls and women in workplace environments in low- and middle-income countries has been under addressed in research, programming and policy. Despite global efforts to reduce poverty among women in such contexts, there has been insufficient attention to the water and sanitation related barriers, specifically in relation to managing monthly menstruation, that may hinder girls? and women?s contributions to the workplace, and ...

  20. Fiscal Consequences of Armed Conflict and Terrorism in Low- and Middle-Income Countries

    OpenAIRE

    Benedict J. Clements; Sanjeev Gupta; Shamit Chakravarti; Rina Bhattacharya

    2002-01-01

    This paper analyses the fiscal effects of armed conflict and terrorism on low- and middle-income countries. An analysis of 22 conflict episodes shows that armed conflict is associated with lower growth and higher inflation, and has adverse effects on tax revenues and investment. It also leads to higher government spending on defense, but this tends to be at the expense of macroeconomic stability rather than at the cost of lower spending on education and health. Our econometric estimates are c...

  1. Prevention of Drowning by Community-Based Intervention: Implications for Low- and Middle- Income Countries

    OpenAIRE

    Davoudi-Kiakalayeh, Ali; Mohammadi, Reza; Yousefzadeh-Chabok, Shahrokh

    2012-01-01

    Background Drowning is a serious but neglected health problem in low-and middle-income countries. Objectives To describe the effectiveness of drowning prevention program on the reduction of drowning mortality rates in rural settings at the north of Iran, and guide its replication elsewhere. Patients and Methods This interventional design included pre- and post-intervention observations in the rural area of the Caspian Sea coastline without a comparison community. Cross-sectional data were col...

  2. Menstrual hygiene management among adolescent schoolgirls in low- and middle-income countries: research priorities

    OpenAIRE

    Phillips-Howard, Penelope; Caruso, Bethany; Torondel, Belen; Zulaika, Garazi; Sahin, Murat; Sommer, Marni

    2016-01-01

    Background: A lack of adequate guidance on menstrual management; water, disposal, and private changing facilities; and sanitary hygiene materials in low- and middle-income countries leaves schoolgirls with limited options for healthy personal hygiene during monthly menses. While a plethora of observational studies have described how menstrual hygiene management (MHM) barriers in school impact girls’ dignity, well-being, and engagement in school activities, studies have yet to confirm if inade...

  3. The Analysis of Income Per Capita Convergence on ASEAN Plus Three (APT) Countries

    OpenAIRE

    Fatiwetunusa, Any; Syamsurijal, Syamsurijal; Yuliana, Sa’adah

    2017-01-01

    The main objective of this study is to test the convergence of income per capita in APT countries through three models: absolute convergence, conditional convergence and sigma convergence. Regression analysis of panel data from 13 APT countries during the period of 2001-2014 is used to analysed to study problem. In absolute convergence model, the growth of real GDP per capita and initial real GDP are used as the variables, meanwhile, 8 variables such as the growth of real GPD per capita, init...

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

    Science.gov (United States)

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

    2016-11-01

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

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

    Science.gov (United States)

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

    2014-02-01

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

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

    Science.gov (United States)

    Pengpid, Supa; Peltzer, Karl

    2015-01-01

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

  7. Acculturation and obesity among migrant populations in high income countries – a systematic review

    Science.gov (United States)

    2013-01-01

    Background There is evidence to suggest that immigrant populations from low or medium-income countries to high income countries show a significant change in obesogenic behaviors in the host society, and that these changes are associated with acculturation. However, the results of studies vary depending on how acculturation is measured. The objective of this study is to systematically review the evidence on the relationship between acculturation - as measured with a standardized acculturation scale - and overweight/obesity among adult migrants from low/middle countries to high income countries. Methods A systematic review of relevant studies was undertaken using six EBSCOhost databases and following the Centre for Reviews and Dissemination’s Guidance for Undertaking Reviews in Health Care. Results The initial search identified 1135 potentially relevant publications, of which only nine studies met the selection criteria. All of the studies were from the US with migrant populations from eight different countries. Six studies employed bi-directional acculturation scales and three used uni-directional scales. Six studies indicated positive general associations between higher acculturation and body mass index (BMI), and three studies reported that higher acculturation was associated with lower BMI, as mainly among women. Conclusion Despite the small number of studies, a number of potential explanatory hypotheses were developed for these emerging patterns. The ‘Healthy Migrant Effect’ may diminish with greater acculturation as the host culture potentially promotes more unhealthy weight gain than heritage cultures. This appears particularly so for men and a rapid form of nutrition transition represents a likely contributor. The inconsistent results observed for women may be due to the interplay of cultural influences on body image, food choices and physical activity. That is, the Western ideal of a slim female body and higher values placed on physical activity and

  8. Income inequality, life expectancy and cause-specific mortality in 43 European countries, 1987-2008: a fixed effects study.

    Science.gov (United States)

    Hu, Yannan; van Lenthe, Frank J; Mackenbach, Johan P

    2015-08-01

    Whether income inequality is related to population health is still open to debate. We aimed to critically assess the relationship between income inequality and mortality in 43 European countries using comparable data between 1987 and 2008, controlling for time-invariant and time-variant country-level confounding factors. Annual data on income inequality, expressed as Gini index based on net household income, were extracted from the Standardizing the World Income Inequality Database. Data on life expectancy at birth and age-standardized mortality by cause of death were obtained from the Human Lifetable Database and the World Health Organization European Health for All Database. Data on infant mortality were obtained from the United Nations World Population Prospects Database. The relationships between income inequality and mortality indicators were studied using country fixed effects models, adjusted for time trends and country characteristics. Significant associations between income inequality and many mortality indicators were found in pooled cross-sectional regressions, indicating higher mortality in countries with larger income inequalities. Once the country fixed effects were added, all associations between income inequality and mortality indicators became insignificant, except for mortality from external causes and homicide among men, and cancers among women. The significant results for homicide and cancers disappeared after further adjustment for indicators of democracy, education, transition to national independence, armed conflicts, and economic freedom. Cross-sectional associations between income inequality and mortality seem to reflect the confounding effects of other country characteristics. In a European context, national levels of income inequality do not have an independent effect on mortality.

  9. Are current cost-effectiveness thresholds for low- and middle-income countries useful? Examples from the world of vaccines.

    Science.gov (United States)

    Newall, A T; Jit, M; Hutubessy, R

    2014-06-01

    The World Health Organization's CHOosing Interventions that are Cost Effective (WHO-CHOICE) thresholds for averting a disability-adjusted life-year of one to three times per capita income have been widely cited and used as a measure of cost effectiveness in evaluations of vaccination for low- and middle-income countries (LMICs). These thresholds were based upon criteria set out by the WHO Commission on Macroeconomics and Health, which reflected the potential economic returns of interventions. The CHOICE project sought to evaluate a variety of health interventions at a subregional level and classify them into broad categories to help assist decision makers, but the utility of the thresholds for within-country decision making for individual interventions (given budgetary constraints) has not been adequately explored. To examine whether the 'WHO-CHOICE thresholds' reflect funding decisions, we examined the results of two recent reviews of cost-effectiveness analyses of human papillomavirus and rotavirus vaccination in LMICs, and we assessed whether the results of these studies were reflected in funding decisions for these vaccination programmes. We found that in many cases, programmes that were deemed cost effective were not subsequently implemented in the country. We consider the implications of this finding, the advantages and disadvantages of alternative methods to estimate thresholds, and how cost perspectives and the funders of healthcare may impact on these choices.

  10. A standardised equine-based welfare assessment tool used for six years in low and middle income countries.

    Science.gov (United States)

    Sommerville, Rebecca; Brown, Ashleigh F; Upjohn, Melissa

    2018-01-01

    The majority of horses, donkeys and mules (equids) are in low- and middle-income countries, where they remain a key source of labour in the construction, agriculture and tourism industries, as well as supporting households daily through transporting people and staple goods. Globally, approximately 600 million people depend on working equids for their livelihood. Safeguarding the welfare of these animals is essential for them to work, as well as for the intrinsic value of the animal's quality of life. In order to manage animal welfare, it must be measured. Over the past decade, welfare assessment methodologies have emerged for different species, more recently for equids. We present the Standardised Equine-Based Welfare Assessment Tool (SEBWAT) for working equids. The tool is unique, in that it has been applied in practice by a non-governmental organisation (NGO) for six years across Low-Middle-Income Countries (LMICs). We describe the revision of the tool from an original to a second version, the tool methodology and user training process and how data collection and analysis have been conducted. We describe its application at scale, where it has been used more than 71,000 times in 11 countries. Case study examples are given from the tool being used for a needs assessment in Guatemala and monitoring welfare change in Jordan. We conclude by describing the main benefits and limitations for how the tool could be applied by others on working equids in LMICs and how it may develop in the future.

  11. A standardised equine-based welfare assessment tool used for six years in low and middle income countries.

    Directory of Open Access Journals (Sweden)

    Rebecca Sommerville

    Full Text Available The majority of horses, donkeys and mules (equids are in low- and middle-income countries, where they remain a key source of labour in the construction, agriculture and tourism industries, as well as supporting households daily through transporting people and staple goods. Globally, approximately 600 million people depend on working equids for their livelihood. Safeguarding the welfare of these animals is essential for them to work, as well as for the intrinsic value of the animal's quality of life. In order to manage animal welfare, it must be measured. Over the past decade, welfare assessment methodologies have emerged for different species, more recently for equids. We present the Standardised Equine-Based Welfare Assessment Tool (SEBWAT for working equids. The tool is unique, in that it has been applied in practice by a non-governmental organisation (NGO for six years across Low-Middle-Income Countries (LMICs. We describe the revision of the tool from an original to a second version, the tool methodology and user training process and how data collection and analysis have been conducted. We describe its application at scale, where it has been used more than 71,000 times in 11 countries. Case study examples are given from the tool being used for a needs assessment in Guatemala and monitoring welfare change in Jordan. We conclude by describing the main benefits and limitations for how the tool could be applied by others on working equids in LMICs and how it may develop in the future.

  12. A standardised equine-based welfare assessment tool used for six years in low and middle income countries

    Science.gov (United States)

    Brown, Ashleigh F.; Upjohn, Melissa

    2018-01-01

    The majority of horses, donkeys and mules (equids) are in low- and middle-income countries, where they remain a key source of labour in the construction, agriculture and tourism industries, as well as supporting households daily through transporting people and staple goods. Globally, approximately 600 million people depend on working equids for their livelihood. Safeguarding the welfare of these animals is essential for them to work, as well as for the intrinsic value of the animal’s quality of life. In order to manage animal welfare, it must be measured. Over the past decade, welfare assessment methodologies have emerged for different species, more recently for equids. We present the Standardised Equine-Based Welfare Assessment Tool (SEBWAT) for working equids. The tool is unique, in that it has been applied in practice by a non-governmental organisation (NGO) for six years across Low-Middle-Income Countries (LMICs). We describe the revision of the tool from an original to a second version, the tool methodology and user training process and how data collection and analysis have been conducted. We describe its application at scale, where it has been used more than 71,000 times in 11 countries. Case study examples are given from the tool being used for a needs assessment in Guatemala and monitoring welfare change in Jordan. We conclude by describing the main benefits and limitations for how the tool could be applied by others on working equids in LMICs and how it may develop in the future. PMID:29466391

  13. Increasing fruit and vegetable consumption among schoolchildren: efforts in middle-income countries.

    Science.gov (United States)

    Wijesinha-Bettoni, Ramani; Orito, Aya; Löwik, Marianne; Mclean, Catherine; Muehlhoff, Ellen

    2013-03-01

    To reverse the trend of rising child obesity rates in many middle-income countries, recommendations include increasing fruit and vegetable consumption. Schools can positively impact children's eating behavior, and multicomponent interventions that include the curriculum, school food environments, and parental involvement are most effective. To find out how fruits and vegetables feature in the dietary guidelines provided to schools, what specific schemes are available for providing these foods, the extent to which nutrition education is included in the curriculum, and how vegetables and fruits are procured in primary schools. In 2008, a survey questionnaire previously validated and revised was sent electronically to national program managers and focal points for school feeding programs in 58 middle-income countries. The rationale was to obtain information relevant to the entire country from these key informants. The survey response rate was 46%. The information provided by 22 respondents in 18 countries was included in the current study. On average, respondents answered 88% of the questions analyzed in this paper. Of the respondents, 73% worked for the national authority responsible for school food programs, with 45% at the program coordinator or director level. Few countries have any special fruit and vegetable schemes; implementation constraints include cost and lack of storage facilities. Although 11 of 18 countries have both nutrient-based guidelines and school food guidelines for meals, fruits and vegetables are often not adequately specified. In some countries, nutrition education, special activities, school gardens, and parental participation are used to promote fruits and vegetables. Specific schemes are needed in some, together with school food guidelines that include fruits and vegetables.

  14. Systematic Review of Willingness to Pay for Health Insurance in Low and Middle Income Countries.

    Science.gov (United States)

    Nosratnejad, Shirin; Rashidian, Arash; Dror, David Mark

    2016-01-01

    Access to healthcare is mostly contingent on out-of-pocket spending (OOPS) by health seekers, particularly in low- and middle-income countries (LMICs). This would require many LMICs to raise enough funds to achieve universal health insurance coverage. But, are individuals or households willing to pay for health insurance, and how much? What factors positively affect WTP for health insurance? We wanted to examine the evidence for this, through a review of the literature. We systematically searched databases up to February 2016 and included studies of individual or household WTP for health insurance. Two authors appraised the identified studies. We estimated the WTP as a percentage of GDP per capita, and adjusted net national income per capita of each country. We used meta-analysis to calculate WTP means and confidence intervals, and vote-counting to identify the variables that more often affected WTP. 16 studies (21 articles) from ten countries met the inclusion criteria. The mean WTP of individuals was 1.18% of GDP per capita and 1.39% of adjusted net national income per capita. The corresponding figures for households were 1.82% and 2.16%, respectively. Increases in family size, education level and income were consistently correlated with higher WTP for insurance, and increases in age were correlated with reduced WTP. The WTP for healthcare insurance among rural households in LMICs was just below 2% of the GPD per capita. The findings demonstrate that in moving towards universal health coverage in LMICs, governments should not rely on households' premiums as a major financing source and should increase their fiscal capacity for an equitable health care system using other sources.

  15. Systematic Review of Willingness to Pay for Health Insurance in Low and Middle Income Countries.

    Directory of Open Access Journals (Sweden)

    Shirin Nosratnejad

    Full Text Available Access to healthcare is mostly contingent on out-of-pocket spending (OOPS by health seekers, particularly in low- and middle-income countries (LMICs. This would require many LMICs to raise enough funds to achieve universal health insurance coverage. But, are individuals or households willing to pay for health insurance, and how much? What factors positively affect WTP for health insurance? We wanted to examine the evidence for this, through a review of the literature.We systematically searched databases up to February 2016 and included studies of individual or household WTP for health insurance. Two authors appraised the identified studies. We estimated the WTP as a percentage of GDP per capita, and adjusted net national income per capita of each country. We used meta-analysis to calculate WTP means and confidence intervals, and vote-counting to identify the variables that more often affected WTP.16 studies (21 articles from ten countries met the inclusion criteria. The mean WTP of individuals was 1.18% of GDP per capita and 1.39% of adjusted net national income per capita. The corresponding figures for households were 1.82% and 2.16%, respectively. Increases in family size, education level and income were consistently correlated with higher WTP for insurance, and increases in age were correlated with reduced WTP.The WTP for healthcare insurance among rural households in LMICs was just below 2% of the GPD per capita. The findings demonstrate that in moving towards universal health coverage in LMICs, governments should not rely on households' premiums as a major financing source and should increase their fiscal capacity for an equitable health care system using other sources.

  16. Environment and air pollution like gun and bullet for low-income countries: war for better health and wealth.

    Science.gov (United States)

    Zou, Xiang; Azam, Muhammad; Islam, Talat; Zaman, Khalid

    2016-02-01

    The objective of the study is to examine the impact of environmental indicators and air pollution on "health" and "wealth" for the low-income countries. The study used a number of promising variables including arable land, fossil fuel energy consumption, population density, and carbon dioxide emissions that simultaneously affect the health (i.e., health expenditures per capita) and wealth (i.e., GDP per capita) of the low-income countries. The general representation for low-income countries has shown by aggregate data that consist of 39 observations from the period of 1975-2013. The study decomposes the data set from different econometric tests for managing robust inferences. The study uses temporal forecasting for the health and wealth model by a vector error correction model (VECM) and an innovation accounting technique. The results show that environment and air pollution is the menace for low-income countries' health and wealth. Among environmental indicators, arable land has the largest variance to affect health and wealth for the next 10-year period, while air pollution exerts the least contribution to change health and wealth of low-income countries. These results indicate the prevalence of war situation, where environment and air pollution become visible like "gun" and "bullet" for low-income countries. There are required sound and effective macroeconomic policies to combat with the environmental evils that affect the health and wealth of the low-income countries.

  17. The global burden of child burn injuries in light of country level economic development and income inequality.

    Science.gov (United States)

    Sengoelge, Mathilde; El-Khatib, Ziad; Laflamme, Lucie

    2017-06-01

    Child burn mortality differs widely between regions and is closely related to material deprivation, but reports on their global distribution are few. Investigating their country level distribution in light of economic level and income inequality will help assess the potential for macro-level improvements. We extracted data for child burn mortality from the Global Burden of Disease study 2013 and combined data into 1-14 years to calculate rates at country, region and income levels. We also compiled potential lives saved. Then we examined the relationship between country level gross domestic product per capita from the World Bank and income inequality (Gini Index) from the Standardized World Income Inequality Database and child burn mortality using Spearman coefficient correlations. Worldwide, the burden of child burn deaths is 2.5 per 100,000 across 103 countries with the largest burden in Sub-Saharan Africa (4.5 per 100,000). Thirty-four thousand lives could be saved yearly if all countries in the world had the same rates as the best performing group of high-income countries; the majority in low-income countries. There was a negative graded association between economic level and child burns for all countries aggregated and at regional level, but no consistent pattern existed for income inequality at regional level. The burden of child burn mortality varies by region and income level with prevention efforts needed most urgently in middle-income countries and Sub-Saharan Africa. Investment in safe living conditions and access to medical care are paramount to achieving further reductions in the global burden of preventable child burn deaths.

  18. The global burden of child burn injuries in light of country level economic development and income inequality

    Directory of Open Access Journals (Sweden)

    Mathilde Sengoelge

    2017-06-01

    Full Text Available Child burn mortality differs widely between regions and is closely related to material deprivation, but reports on their global distribution are few. Investigating their country level distribution in light of economic level and income inequality will help assess the potential for macro-level improvements. We extracted data for child burn mortality from the Global Burden of Disease study 2013 and combined data into 1–14 years to calculate rates at country, region and income levels. We also compiled potential lives saved. Then we examined the relationship between country level gross domestic product per capita from the World Bank and income inequality (Gini Index from the Standardized World Income Inequality Database and child burn mortality using Spearman coefficient correlations. Worldwide, the burden of child burn deaths is 2.5 per 100,000 across 103 countries with the largest burden in Sub-Saharan Africa (4.5 per 100,000. Thirty-four thousand lives could be saved yearly if all countries in the world had the same rates as the best performing group of high-income countries; the majority in low-income countries. There was a negative graded association between economic level and child burns for all countries aggregated and at regional level, but no consistent pattern existed for income inequality at regional level. The burden of child burn mortality varies by region and income level with prevention efforts needed most urgently in middle-income countries and Sub-Saharan Africa. Investment in safe living conditions and access to medical care are paramount to achieving further reductions in the global burden of preventable child burn deaths.

  19. Burden of typhoid fever in low-income and middle-income countries: a systematic, literature-based update with risk-factor adjustment.

    Science.gov (United States)

    Mogasale, Vittal; Maskery, Brian; Ochiai, R Leon; Lee, Jung Seok; Mogasale, Vijayalaxmi V; Ramani, Enusa; Kim, Young Eun; Park, Jin Kyung; Wierzba, Thomas F

    2014-10-01

    No access to safe water is an important risk factor for typhoid fever, yet risk-level heterogeneity is unaccounted for in previous global burden estimates. Since WHO has recommended risk-based use of typhoid polysaccharide vaccine, we revisited the burden of typhoid fever in low-income and middle-income countries (LMICs) after adjusting for water-related risk. We estimated the typhoid disease burden from studies done in LMICs based on blood-culture-confirmed incidence rates applied to the 2010 population, after correcting for operational issues related to surveillance, limitations of diagnostic tests, and water-related risk. We derived incidence estimates, correction factors, and mortality estimates from systematic literature reviews. We did scenario analyses for risk factors, diagnostic sensitivity, and case fatality rates, accounting for the uncertainty in these estimates and we compared them with previous disease burden estimates. The estimated number of typhoid fever cases in LMICs in 2010 after adjusting for water-related risk was 11·9 million (95% CI 9·9-14·7) cases with 129 000 (75 000-208 000) deaths. By comparison, the estimated risk-unadjusted burden was 20·6 million (17·5-24·2) cases and 223 000 (131 000-344 000) deaths. Scenario analyses indicated that the risk-factor adjustment and updated diagnostic test correction factor derived from systematic literature reviews were the drivers of differences between the current estimate and past estimates. The risk-adjusted typhoid fever burden estimate was more conservative than previous estimates. However, by distinguishing the risk differences, it will allow assessment of the effect at the population level and will facilitate cost-effectiveness calculations for risk-based vaccination strategies for future typhoid conjugate vaccine. Copyright © 2014 Mogasale et al. Open Access article distributed under the terms of CC BY-NC-SA. Published by .. All rights reserved.

  20. Health Care Spending in the United States and Other High-Income Countries.

    Science.gov (United States)

    Papanicolas, Irene; Woskie, Liana R; Jha, Ashish K

    2018-03-13

    Health care spending in the United States is a major concern and is higher than in other high-income countries, but there is little evidence that efforts to reform US health care delivery have had a meaningful influence on controlling health care spending and costs. To compare potential drivers of spending, such as structural capacity and utilization, in the United States with those of 10 of the highest-income countries (United Kingdom, Canada, Germany, Australia, Japan, Sweden, France, the Netherlands, Switzerland, and Denmark) to gain insight into what the United States can learn from these nations. Analysis of data primarily from 2013-2016 from key international organizations including the Organisation for Economic Co-operation and Development (OECD), comparing underlying differences in structural features, types of health care and social spending, and performance between the United States and 10 high-income countries. When data were not available for a given country or more accurate country-level estimates were available from sources other than the OECD, country-specific data sources were used. In 2016, the US spent 17.8% of its gross domestic product on health care, and spending in the other countries ranged from 9.6% (Australia) to 12.4% (Switzerland). The proportion of the population with health insurance was 90% in the US, lower than the other countries (range, 99%-100%), and the US had the highest proportion of private health insurance (55.3%). For some determinants of health such as smoking, the US ranked second lowest of the countries (11.4% of the US population ≥15 years smokes daily; mean of all 11 countries, 16.6%), but the US had the highest percentage of adults who were overweight or obese at 70.1% (range for other countries, 23.8%-63.4%; mean of all 11 countries, 55.6%). Life expectancy in the US was the lowest of the 11 countries at 78.8 years (range for other countries, 80.7-83.9 years; mean of all 11 countries, 81.7 years), and infant

  1. HIV/AIDS health care challenges for cross- country migrants in low- and middle-income countries: a scoping review

    Directory of Open Access Journals (Sweden)

    Suphanchaimat R

    2014-02-01

    Full Text Available Rapeepong Suphanchaimat,1,2 Angkana Sommanustweechai,1 Chiraporn Khitdee,1 Chompoonut Thaichinda,1 Kanang Kantamaturapoj,3 Pattara Leelahavarong,4 Pensom Jumriangrit,1 Thitikorn Topothai,1 Thunthita Wisaijohn,1 Weerasak Putthasri1 1International Health Policy Program (IHPP, Ministry of Public Health, Nonthaburi, Thailand; 2Banphai Hospital, Khon Kaen, Thailand; 3Department of Social Sciences, Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, Thailand; 4Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand Introduction: HIV/AIDS has been one of the world's most important health challenges in recent history. The global solidarity in responding to HIV/AIDS through the provision of antiretroviral therapy (ART and encouraging early screening has been proved successful in saving lives of infected populations in past decades. However, there remain several challenges, one of which is how HIV/AIDS policies keep pace with the growing speed and diversity of migration flows. This study therefore aimed to examine the nature and the extent of HIV/AIDS health services, barriers to care, and epidemic burdens among cross-country migrants in low- and middle-income countries. Methods: A scoping review was undertaken by gathering evidence from electronic databases and gray literature from the websites of relevant international initiatives. The articles were reviewed according to the defined themes: epidemic burdens of HIV/AIDS, barriers to health services and HIV/AIDS risks, and the operational management of the current health systems for HIV/AIDS. Results: Of the 437 articles selected for an initial screening, 35 were read in full and mapped with the defined research questions. A high HIV/AIDS infection rate was a major concern among cross-country migrants in many regions, in particular sub-Saharan Africa. Despite a large number of studies reported in Africa, fewer studies were found in

  2. Delivery arrangements for health systems in low-income countries: an overview of systematic reviews

    Science.gov (United States)

    Ciapponi, Agustín; Lewin, Simon; Herrera, Cristian A; Opiyo, Newton; Pantoja, Tomas; Paulsen, Elizabeth; Rada, Gabriel; Wiysonge, Charles S; Bastías, Gabriel; Dudley, Lilian; Flottorp, Signe; Gagnon, Marie-Pierre; Garcia Marti, Sebastian; Glenton, Claire; Okwundu, Charles I; Peñaloza, Blanca; Suleman, Fatima; Oxman, Andrew D

    2017-01-01

    assessments of the relevance of findings to low-income countries. Main results We identified 7272 systematic reviews and included 51 of them in this overview. We judged 6 of the 51 reviews to have important methodological limitations and the other 45 to have only minor limitations. We grouped delivery arrangements into eight categories. Some reviews provided more than one comparison and were in more than one category. Across these categories, the following intervention were effective; that is, they have desirable effects on at least one outcome with moderate- or high-certainty evidence and no moderate- or high-certainty evidence of undesirable effects. Who receives care and when: queuing strategies and antenatal care to groups of mothers. Who provides care: lay health workers for caring for people with hypertension, lay health workers to deliver care for mothers and children or infectious diseases, lay health workers to deliver community-based neonatal care packages, midlevel health professionals for abortion care, social support to pregnant women at risk, midwife-led care for childbearing women, non-specialist providers in mental health and neurology, and physician-nurse substitution. Coordination of care: hospital clinical pathways, case management for people living with HIV and AIDS, interactive communication between primary care doctors and specialists, hospital discharge planning, adding a service to an existing service and integrating delivery models, referral from primary to secondary care, physician-led versus nurse-led triage in emergency departments, and team midwifery. Where care is provided: high-volume institutions, home-based care (with or without multidisciplinary team) for people living with HIV and AIDS, home-based management of malaria, home care for children with acute physical conditions, community-based interventions for childhood diarrhoea and pneumonia, out-of-facility HIV and reproductive health services for youth, and decentralised HIV care

  3. Is Child Labor a Barrier to School Enrollment in Low- and Middle-Income Countries?

    Science.gov (United States)

    Putnick, Diane L.; Bornstein, Marc H.

    2015-01-01

    Achieving universal primary education is one of the Millennium Development Goals. In low- and middle-income developing countries (LMIC), child labor may be a barrier. Few multi-country, controlled studies of the relations between different kinds of child labor and schooling are available. This study employs 186,795 families with 7- to 14-year-old children in 30 LMIC to explore relations of children’s work outside the home, family work, and household chores with school enrollment. Significant negative relations emerged between each form of child labor and school enrollment, but relations were more consistent for family work and household chores than work outside the home. All relations were moderated by country and sometimes by gender. These differentiated findings have nuanced policy implications. PMID:26034342

  4. Perception of vulnerability among mothers of healthy infants in a middle-income country.

    Science.gov (United States)

    Dogan, D G; Ertem, I O; Karaaslan, T; Forsyth, B W

    2009-11-01

    Although four decades have passed since the concept of 'vulnerable children' has been introduced into paediatric literature, research on vulnerability is limited to high-income, Western countries. To adapt and adopt practices that have been advised for paediatricians to prevent 'the vulnerable child syndrome', information is needed also on the prevalence and correlates of perceived vulnerability in children in low- and middle-income (LAMI) countries. To determine the rate and correlates of the perception of vulnerability among healthy young children in a healthy population of children in Ankara, Turkey. In this cross-sectional observational study, participants comprised of a 'prescriptive sample' of healthy, thriving children with no known health risk for vulnerability. Maternal perception of child vulnerability was assessed using the Child Vulnerability Scale (CVS). Potential risks factors for vulnerability including history of threatened abortion during pregnancy, child gender, birth order, maternal and paternal age and education were collected using a structured questionnaire. A total of 519 children - 264 boys (50.9%) and 255 girls (49.1%) - comprised the sample. The internal consistency of the CVS was 0.71. Item-total scale correlations were 0.30 or above for all of the eight items. The median CVS score of the sample was 2.0 and 30 mothers (5.8%) were found to perceive their children as vulnerable. None of the socio-demographic variables that were investigated were found to be associated with high vulnerability scores. This study is the first to examine maternal perceived vulnerability of healthy children in a middle-income country. The findings imply that a high proportion of healthy children are perceived as vulnerable by their mothers and that previously studied socio-demographic factors do not explain perceived vulnerability. The results of this study may provide a comparison point for studies on childhood vulnerability in LAMI countries.

  5. Financial costs for families of children with Type 1 diabetes in lower-income countries.

    Science.gov (United States)

    Ogle, G D; Kim, H; Middlehurst, A C; Silink, M; Jenkins, A J

    2016-06-01

    To assess the direct costs of necessary consumables for minimal care of a child with Type 1 diabetes in countries where the public health system does not regularly provide such care. Supply costs were collected between January 2013 and February 2015 from questionnaires submitted by centres requesting International Diabetes Federation Life for a Child Program support. All 20 centres in 15 countries agreed to the use of their responses. Annual costs for minimal care were estimated for: 18 × 10 ml 100 IU/ml insulin, 1/3 cost of a blood glucose meter, two blood glucose test strips/day, two syringes/week, and four HbA1c tests/year. Costs were expressed in US dollars, and as % of gross national income (purchasing power parity) per capita. The ranges (median) for the minimum supply costs through the private system were: insulin 10 ml 100 IU/ml equivalent vial: $5.10-$25 ($8.00); blood glucose meter: $15-$121 ($33.33); test strip: $0.15-$1.20 ($0.50); syringe: $0.10-$0.56 ($0.20); and HbA1c : $4.90-$20 ($9.75). Annual costs ranged from $255 (Pakistan) to $1,185 (Burkina Faso), with a median of $553. Annual % gross national income costs were 12-370% (median 56%). For the lowest 20% income earners the annual cost ranged 20-1535% (median 153%). St Lucia and Mongolia were the only countries whose governments consistently provided insulin. No government provided meters and strips, which were the most expensive supplies (62% of total cost). In less-resourced countries, even minimal care is beyond many families' means. In addition, families face additional costs such as consultations, travel and indirect costs. Action to prevent diabetes-related death and morbidity is needed. © 2015 Diabetes UK.

  6. Eye care utilization by older adults in low, middle, and high income countries

    Directory of Open Access Journals (Sweden)

    Vela Claudia

    2012-04-01

    Full Text Available Abstract Background The risk of visual impairment increases dramatically with age and therefore older adults should have their eyes examined at least every 1 to 2 years. Using a world-wide, population-based dataset, we sought to determine the frequency that older people had their eyes examined. We also examined factors associated with having a recent eye exam. Methods The World Health Surveys were conducted in 70 countries throughout the world in 2002-2003 using a random, multi-stage, stratified, cluster sampling design. Participants 60 years and older from 52 countries (n = 35,839 were asked "When was the last time you had your eyes examined by a medical professional?". The income status of countries was estimated using gross national income per capita data from 2003 from the World Bank website. Prevalence estimates were adjusted to account for the complex sample design. Results Overall, only 18% (95% CI 17, 19 of older adults had an eye exam in the last year. The rate of an eye exam in the last year in low, lower middle, upper middle, and high income countries was 10%, 24%, 22%, and 37% respectively. Factors associated with having an eye exam in the last year included older age, female gender, more education, urban residence, greater wealth, worse self-reported health, having diabetes, and wearing glasses or contact lenses (p Conclusions Given that older adults often suffer from age-related but treatable conditions, they should be seen on a regular basis to prevent visual impairment and its disabling consequences.

  7. Relationships between cancer pattern, country income and geographical region in Asia.

    Science.gov (United States)

    Ng, Chirk Jenn; Teo, Chin Hai; Abdullah, Nurdiana; Tan, Wei Phin; Tan, Hui Meng

    2015-09-03

    Cancer incidence and mortality varies across region, sex and country's economic status. While most studies focused on global trends, this study aimed to describe and analyse cancer incidence and mortality in Asia, focusing on cancer site, sex, region and income status. Age-standardised incidence and mortality rates of cancer were extracted from the GLOBOCAN 2012 database. Cancer mortality to incidence ratios (MIRs) were calculated to represent cancer survival. The data were analysed based on the four regions in Asia and income. Cancer incidence rate is lower in Asia compared to the West but for MIR, it is the reverse. In Asia, the most common cancers in men are lung, stomach, liver, colorectal and oesophageal cancers while the most common cancers in women are breast, lung, cervical, colorectal and stomach cancers. The MIRs are the highest in lung, liver and stomach cancers and the lowest in colorectal, breast and prostate cancers. Eastern and Western Asia have a higher incidence of cancer compared to South-Eastern and South-Central Asia but this pattern is the reverse for MIR. Cancer incidence rate increases with country income particularly in colorectal and breast cancers but the pattern is the opposite for MIR. This study confirms that there is a wide variation in cancer incidence and mortality across Asia. This study is the first step towards documenting and explaining the changing cancer pattern in Asia in comparison to the rest of the world.

  8. The Analysis of Corporate Tax and Personal Income Tax in European Countries

    Directory of Open Access Journals (Sweden)

    Telnova Hanna V.

    2017-06-01

    Full Text Available The aim of the article is to reveal the relationship between the rates of corporate tax and personal income tax and the pace of economic development. The existence of the open financial market under conditions of globalization leaves its imprint on forming the vectors of development of the tax systems in the countries. Thus, the optimal corporate taxation creates a competitive and investment-attractive climate, facilitates encouraging foreign investments and locating economic activities. The study made it possible to establish the absence of a direct link between the tax rates and economic growth. At the same time, a linear relationship between the tax rates and the tax burden is revealed. On the basis of the presented mathematical expression, it can be concluded that an increase in the personal income tax causes an increase in the tax burden, and an increase in the corporate tax — its reduction. The cluster analysis of the corporate tax and the personal income tax in European countries allowed to justify the determinants of successful economic development presenting the formation of the vector of the tax policy in the aspect of moderate taxation of individuals and the need for low taxation of corporate profits.

  9. Redistribution and transmission mechanisms of income inequality - panel analysis of the affluent OECD countries

    Directory of Open Access Journals (Sweden)

    Josifidis Kosta

    2016-01-01

    Full Text Available The aim of this paper is to point out the limitations of conventional approaches, articulated via political processes, in reducing income inequality. Using the panel data methods, on the sample of 21 affluent OECD countries in the period from 1980 to 2011, it is observed that the increase in labour productivity as well as preferences of voters to parties that advocate greater redistribution, contrary to common perception, not necessarily lead to reduction in income inequality. Increasing dominance of big capital in the field of technological progress changes the conventions about contribution of workers to labour productivity. The result is a weakening of workers’ bargaining power in relation to employers as well as increase in gap between labour productivity growth and real wage growth, which both lead to increase in income inequality. In comparison with the other political parties, it seems that the right-wing parties are more efficient in using voters’ support to implement their concept of the welfare state, which contributes to maintaining the high market-generated income inequality. Such situation could be explained that de jure power of the government depends on election results, whereas de facto power depends on the support of so-called globally-oriented super elites. [Projekat Ministarstva nauke Republike Srbije, br. 47010

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

    Science.gov (United States)

    2018-04-05

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

  11. Health disparities from economic burden of diabetes in middle-income countries: evidence from México.

    Directory of Open Access Journals (Sweden)

    Armando Arredondo

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

  12. Prevalence of frailty and prefrailty among community-dwelling older adults in low-income and middle-income countries: a systematic review and meta-analysis.

    Science.gov (United States)

    Siriwardhana, Dhammika D; Hardoon, Sarah; Rait, Greta; Weerasinghe, Manuj C; Walters, Kate R

    2018-03-01

    To systematically review the research conducted on prevalence of frailty and prefrailty among community-dwelling older adults in low-income and middle-income countries (LMICs) and to estimate the pooled prevalence of frailty and prefrailty in community-dwelling older adults in LMICs. Systematic review and meta-analysis. PROSPERO registration number is CRD42016036083. MEDLINE, EMBASE, AMED, Web of Science, CINAHL and WHO Global Health Library were searched from their inception to 12 September 2017. Low-income and middle-income countries. Community-dwelling older adults aged ≥60 years. We screened 7057 citations and 56 studies were included. Forty-seven and 42 studies were included in the frailty and prefrailty meta-analysis, respectively. The majority of studies were from upper middle-income countries. One study was available from low-income countries. The prevalence of frailty varied from 3.9% (China) to 51.4% (Cuba) and prevalence of prefrailty ranged from 13.4% (Tanzania) to 71.6% (Brazil). The pooled prevalence of frailty was 17.4% (95% CI 14.4% to 20.7%, I 2 =99.2%) and prefrailty was 49.3% (95% CI 46.4% to 52.2%, I 2 =97.5%). The wide variation in prevalence rates across studies was largely explained by differences in frailty assessment method and the geographic region. These findings are for the studies with a minimum recruitment age 60, 65 and 70 years. The prevalence of frailty and prefrailty appears higher in community-dwelling older adults in upper middle-income countries compared with high-income countries, which has important implications for healthcare planning. There is limited evidence on frailty prevalence in lower middle-income and low-income countries. CRD42016036083. © 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.

  13. National and regional estimates of term and preterm babies born small for gestational age in 138 low-income and middle-income countries in 2010

    DEFF Research Database (Denmark)

    Lee, Anne C C; Katz, Joanne; Blencowe, Hannah

    2013-01-01

    million low-birthweight babies, 59% were term-SGA and 41% were preterm-SGA. Two-thirds of small-for-gestational-age infants were born in Asia (17·4 million in south Asia). Preterm-SGA babies totalled 2·8 million births in low-income and middle-income countries. Most small-for-gestational-age infants were......BACKGROUND: National estimates for the numbers of babies born small for gestational age and the comorbidity with preterm birth are unavailable. We aimed to estimate the prevalence of term and preterm babies born small for gestational age (term-SGA and preterm-SGA), and the relation to low...... birthweight (age was defined as lower than the 10th centile for fetal growth from the 1991 US national reference population. Data from 22 birth cohort studies (14 low-income and middle-income countries) and from...

  14. Income inequality and population health: an analysis of panel data for 21 developed countries, 1975-2006.

    Science.gov (United States)

    Torre, Roberta; Myrskylä, Mikko

    2014-03-01

    The relative income-health hypothesis postulates that income distribution is an important determinant of population health, but the age and sex patterns of this association are not well known. We tested the relative income-health hypothesis using panel data collected for 21 developed countries over 30 years. Net of trends in gross domestic product per head and unobserved period and country factors, income inequality measured by the Gini index is positively associated with the mortality of males and females at ages 1-14 and 15-49, and with the mortality of females at ages 65-89 albeit less strongly than for the younger age groups. These findings suggest that policies to decrease income inequality may improve health, especially that of children and young-to-middle-aged men and women. The mechanisms behind the income inequality-mortality association remain unknown and should be the focus of future research.

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

    Science.gov (United States)

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

    2014-09-01

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

  16. Migration and Social Replacement Incomes: How to Protect Low-IncomeWorkers in the Industrialized Countries against the Forces of Globalizationand Market Integration

    OpenAIRE

    Sinn, Hans-Werner

    2005-01-01

    This paper discusses how an industrialized country could defend the wages and social benefits of its unskilled workers against wage competition from immigrants. It shows that fixing social standards harms the workers and that fixing social replacement incomes implies migration into unemployment. Defending wages with replacement incomes brings about first-order efficiency losses that outweigh the budget cost to the government. By contrast, wage subsidies involve much smaller welfare losses. Wh...

  17. Relationship between gross domestic product and duration of untreated psychosis in low- and middle-income countries.

    Science.gov (United States)

    Large, Matthew; Farooq, Saeed; Nielssen, Olav; Slade, Tim

    2008-10-01

    The duration of untreated psychosis (DUP), the period between the first onset of psychotic symptoms and treatment, has an important influence on the outcome of schizophrenia. To compare the published studies of DUP in low- and middle-income (LAMI) countries with the DUP of high-income countries, and examine a possible association between DUP and per capita income. We used six search strategies to locate studies of the DUP from LAMI countries published between January 1975 and January 2008. We then examined the relationship between DUP and measures of economic activity, which was assessed using the LAMI classification of countries and gross domestic product (GDP) purchasing power parity. The average mean DUP in studies from LAMI countries was 125.0 weeks compared with 63.4 weeks in studies from high-income countries (P=0.012). Within the studies from LAMI countries, mean DUP fell by 6 weeks for every $1000 of GDP purchasing power parity. There appears to be an inverse relationship between income and DUP in LAMI countries. The cost of treatment is an impediment to care and subsidised antipsychotic medication would improve the access to treatment and the outcome of psychotic illness in LAMI countries.

  18. Health systems research in a low income country - easier said than done

    Science.gov (United States)

    English, Mike; Irimu, Grace; Wamae, Annah; Were, Fred; Wasunna, Aggrey; Fegan, Greg; Peshu, Norbert

    2009-01-01

    Summary Small hospitals sit at the apex of the pyramid of primary care in many low-income country health systems. If the Millennium Development Goal for child survival is to be achieved hospital care for severely ill, referred children will need to be improved considerably in parallel with primary care in many countries. Yet we know little about how to achieve this. We describe the evolution and final design of an intervention study attempting to improve hospital care for children in Kenyan district hospitals. We believe our experience illustrates many of the difficulties involved in reconciling epidemiological rigour and feasibility in studies at a health system rather than an individual level and the importance of the depth and breadth of analysis when trying to provide a plausible answer to the question - does it work? While there are increasing calls for more health systems research in low-income countries the importance of strong, broadly-based local partnerships and long term commitment even to initiate projects are not always appreciated. PMID:18495913

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

    Science.gov (United States)

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

    2016-01-01

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

  20. Composite measures of women's empowerment and their association with maternal mortality in low-income countries.

    Science.gov (United States)

    Lan, Chiao-Wen; Tavrow, Paula

    2017-11-08

    Maternal mortality has declined significantly since 1990. While better access to emergency obstetrical care is partially responsible, women's empowerment might also be a contributing factor. Gender equality composite measures generally include various dimensions of women's advancement, including educational parity, formal employment, and political participation. In this paper, we compare several composite measures to assess which, if any, are associated with maternal mortality ratios (MMRs) in low-income countries, after controlling for other macro-level and direct determinants. Using data from 44 low-income countries (half in Africa), we assessed the correlation of three composite measures - the Gender Gap Index, the Gender Equity Index (GEI), and the Social Institutions and Gender Index (SIGI) - with MMRs. We also examined two recognized contributors to reduce maternal mortality (skilled birth attendance (SBA) and total fertility rate (TFR)) as well as several economic and political variables (such as the Corruption Index) to see which tracked most closely with MMRs. We examined the countries altogether, and disaggregated by region. We then performed multivariate analysis to determine which measures were predictive. Two gender measures (GEI and SIGI) and GDP per capita were significantly correlated with MMRs for all countries. For African countries, the SIGI, TFR, and Corruption Index were significant, whereas the GEI, SBA, and TFR were significant in non-African countries. After controlling for all measures, SBA emerged as a predictor of log MMR for non-African countries (β = -0.04, P = 0.01). However, for African countries, only the Corruption Index was a predictor (β = -0.04, P = 0.04). No gender measure was significant. In African countries, corruption is undermining the quality of maternal care, the availability of critical drugs and equipment, and pregnant women's motivation to deliver in a hospital setting. Improving gender equality and

  1. The CO{sub 2} emissions-income nexus: Evidence from rich countries

    Energy Technology Data Exchange (ETDEWEB)

    Jaunky, Vishal Chandr, E-mail: vishaljaunky@intnet.m [Faculty of Social Studies and Humanities, Department of Economics and Statistics, University of Mauritius, Reduit (Mauritius)

    2011-03-15

    The paper attempts to test the Environment Kuznets Curve (EKC) hypothesis for 36 high-income countries for the period 1980-2005. The test is based on the suggestion of . Various panel data unit root and co-integration tests are applied. Carbon dioxide (CO{sub 2}) emissions and GDP series are integrated of order one and co-integrated, especially after controlling for cross-sectional dependence. Additionally, the Blundell-Bond system generalised methods of moments (GMM) is employed to conduct a panel causality test in a vector error-correction mechanism (VECM) setting. Unidirectional causality running from real per capita GDP to per capita CO{sub 2} emissions is uncovered in both the short-run and the long-run. The empirical analysis based on individual countries provides evidence of an EKC for Greece, Malta, Oman, Portugal and the United Kingdom. However, it can be observed that for the whole panel, a 1% increase in GDP generates an increase of 0.68% in CO{sub 2} emissions in the short-run and 0.22% in the long-run. The lower long-run income elasticity does not provide evidence of an EKC, but does indicate that, over time, CO{sub 2} emissions are stabilising in the rich countries. - Research highlights: {yields} The Environment Kuznets Curve hypothesis for 36 rich countries is studied over the period 1980-2005. {yields} approach is used and extended by including a causality analysis. {yields} Carbon dioxide (CO{sub 2}) emissions are found to be stabilizing in the rich countries.

  2. The CO2 emissions-income nexus: Evidence from rich countries

    International Nuclear Information System (INIS)

    Jaunky, Vishal Chandr

    2011-01-01

    The paper attempts to test the Environment Kuznets Curve (EKC) hypothesis for 36 high-income countries for the period 1980-2005. The test is based on the suggestion of . Various panel data unit root and co-integration tests are applied. Carbon dioxide (CO 2 ) emissions and GDP series are integrated of order one and co-integrated, especially after controlling for cross-sectional dependence. Additionally, the Blundell-Bond system generalised methods of moments (GMM) is employed to conduct a panel causality test in a vector error-correction mechanism (VECM) setting. Unidirectional causality running from real per capita GDP to per capita CO 2 emissions is uncovered in both the short-run and the long-run. The empirical analysis based on individual countries provides evidence of an EKC for Greece, Malta, Oman, Portugal and the United Kingdom. However, it can be observed that for the whole panel, a 1% increase in GDP generates an increase of 0.68% in CO 2 emissions in the short-run and 0.22% in the long-run. The lower long-run income elasticity does not provide evidence of an EKC, but does indicate that, over time, CO 2 emissions are stabilising in the rich countries. - Research highlights: → The Environment Kuznets Curve hypothesis for 36 rich countries is studied over the period 1980-2005. → approach is used and extended by including a causality analysis. → Carbon dioxide (CO 2 ) emissions are found to be stabilizing in the rich countries.

  3. Prenatal care and child growth and schooling in four low- and medium-income countries.

    Science.gov (United States)

    Liu, Xiaoying; Behrman, Jere R; Stein, Aryeh D; Adair, Linda S; Bhargava, Santosh K; Borja, Judith B; da Silveira, Mariangela Freitas; Horta, Bernardo L; Martorell, Reynaldo; Norris, Shane A; Richter, Linda M; Sachdev, Harshpal S

    2017-01-01

    The effectiveness of prenatal care for improving birth and subsequent child outcomes in low-income countries remains controversial, with much of the evidence to date coming from high-income countries and focused on early-life outcomes. We examined associations between prenatal care visits and birth weight, height-for-age at 24 months and attained schooling in four low- and middle-income countries. We pooled data from prospective birth-cohort studies from Brazil, Guatemala, Philippines and South Africa. We created a prenatal care utilization index based on the number and timing of prenatal visits. Associations were examined between this index and birth weight, height-for-age at 24 months, and highest attained schooling grade until adulthood. Among 7203 individuals in the analysis, 68.9% (Philippines) to 96.7% (South Africa) had at least one prenatal care visit, with most having at least four visits. Over 40% of Brazilians and Guatemalans had their first prenatal visit in the first trimester, but fewer Filipinos (13.9%) and South Africans (19.8%) did so. Prenatal care utilization was not significantly associated with birth weight (p>0.05 in pooled data). Each unit increase in the prenatal care utilization index was associated with 0.09 (95% CI 0.04 to 0.15) higher height-for-age z-score at 24 months and with 0.26 (95% CI 0.17 to 0.35) higher schooling grades attained. Although there was some heterogeneity and greater imprecision across sites, the results were qualitatively similar among the four different populations. While not related to birth weight, prenatal care utilization was associated with important outcomes later in life, specifically higher height-for-age at 24 months and higher attained school grades. These results suggest the relevance of prenatal care visits for human capital outcomes important over the lifecycle.

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

    Science.gov (United States)

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

    2015-01-01

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

  5. Infant feeding and school attainment in five cohorts from low- and middle-income countries.

    Science.gov (United States)

    Horta, Bernardo L; Bas, Abet; Bhargava, Santosh K; Fall, Caroline H D; Feranil, Alan; de Kadt, Julia; Martorell, Reynaldo; Richter, Linda M; Stein, Aryeh D; Victora, Cesar G

    2013-01-01

    Performance in intelligence tests tends to be higher among individuals breastfed as infants, but little is known about the association between breastfeeding and achieved schooling. We assessed the association of infant feeding with school achievement in five cohorts from low- and middle-income countries. Unlike high-income country settings where most previous studies come from, breastfeeding is not positively associated with socioeconomic position in our cohorts, thus reducing the likelihood of a spurious positive association. Participants included 10,082 young adults from five birth cohorts (Brazil, India, Guatemala, the Philippines, and South Africa). The exposures variables were whether the subject was ever breastfed, total duration of breastfeeding, and age at introduction of complementary foods. We adjusted the estimates for age at follow up, sex, maternal age, smoking during pregnancy, birthweight and socioeconomic position at birth. The key outcome was the highest grade achieved at school. In unadjusted analyses, the association between ever breastfeeding and schooling was positive in Brazil, inverse in the Philippines, and null in South Africa; in adjusted analyses, these associations were attenuated. In Brazil, schooling was highest among individuals breastfed for 3-12 months whereas in the Philippines duration of breastfeeding was inversely associated with schooling; and null associations were observed in South Africa and Guatemala. These associations were attenuated in adjusted models. Late introduction of solid foods was associated with lower schooling achievement in Brazil and South Africa. Measures of breastfeeding are not consistently related to schooling achievement in contemporary cohorts of young adults in lower and middle-income countries.

  6. Infant feeding and school attainment in five cohorts from low- and middle-income countries.

    Directory of Open Access Journals (Sweden)

    Bernardo L Horta

    Full Text Available Performance in intelligence tests tends to be higher among individuals breastfed as infants, but little is known about the association between breastfeeding and achieved schooling. We assessed the association of infant feeding with school achievement in five cohorts from low- and middle-income countries. Unlike high-income country settings where most previous studies come from, breastfeeding is not positively associated with socioeconomic position in our cohorts, thus reducing the likelihood of a spurious positive association.Participants included 10,082 young adults from five birth cohorts (Brazil, India, Guatemala, the Philippines, and South Africa. The exposures variables were whether the subject was ever breastfed, total duration of breastfeeding, and age at introduction of complementary foods. We adjusted the estimates for age at follow up, sex, maternal age, smoking during pregnancy, birthweight and socioeconomic position at birth. The key outcome was the highest grade achieved at school. In unadjusted analyses, the association between ever breastfeeding and schooling was positive in Brazil, inverse in the Philippines, and null in South Africa; in adjusted analyses, these associations were attenuated. In Brazil, schooling was highest among individuals breastfed for 3-12 months whereas in the Philippines duration of breastfeeding was inversely associated with schooling; and null associations were observed in South Africa and Guatemala. These associations were attenuated in adjusted models. Late introduction of solid foods was associated with lower schooling achievement in Brazil and South Africa.Measures of breastfeeding are not consistently related to schooling achievement in contemporary cohorts of young adults in lower and middle-income countries.

  7. Income inequality, life expectancy and cause-specific mortality in 43 European countries, 1987–2008: a fixed effects study

    NARCIS (Netherlands)

    Y. Hu (Yannan); F.J. van Lenthe (Frank); J.P. Mackenbach (Johan)

    2015-01-01

    textabstractWhether income inequality is related to population health is still open to debate. We aimed to critically assess the relationship between income inequality and mortality in 43 European countries using comparable data between 1987 and 2008, controlling for time-invariant and time-variant

  8. Exploring health systems research and its influence on policy processes in low income countries

    Directory of Open Access Journals (Sweden)

    Syed Shamsuzzoha B

    2007-10-01

    Full Text Available Abstract Background The interface between research and policymaking in low-income countries is highly complex. The ability of health systems research to influence policy processes in such settings face numerous challenges. Successful analysis of the research-policy interface in these settings requires understanding of contextual factors as well as key influences on the interface. Future Health Systems (FHS: Innovations for Equity is a consortium conducting research in six countries in Asia and Africa. One of the three cross-country research themes of the consortium is analysis of the relationship between research (evidence and policy making, especially their impact on the poor; insights gained in the initial conceptual phase of FHS activities can inform the global knowledge pool on this subject. Discussion This paper provides a review of the research-policy interface in low-income countries and proposes a conceptual framework, followed by directions for empirical approaches. First, four developmental perspectives are considered: social institutional factors; virtual versus grassroots realities; science-society relationships; and construction of social arrangements. Building on these developmental perspectives three research-policy interface entry points are identified: 1. Recognizing policy as complex processes; 2. Engaging key stakeholders: decision-makers, providers, scientists, and communities; and 3. Enhancing accountability. A conceptual framework with three entry points to the research-policy interface – policy processes; stakeholder interests, values, and power; and accountability – within a context provided by four developmental perspectives is proposed. Potential empirical approaches to the research-policy interface are then reviewed. Finally, the value of such innovative empirical analysis is considered. Conclusion The purpose of this paper is to provide the background, conceptual framework, and key research directions for

  9. Ethics issues in social media-based HIV prevention in low- and middle-income countries.

    Science.gov (United States)

    Chiu, Chingche J; Menacho, Luis; Fisher, Celia; Young, Sean D

    2015-07-01

    Questions have been raised regarding participants' safety and comfort when participating in e-health education programs. Although researchers have begun to explore this issue in the United States, little research has been conducted in low- and middle-income countries, where Internet and social media use is rapidly growing. This article reports on a quantitative study with Peruvian men who have sex with men who had previously participated in the Harnessing Online Peer Education (HOPE) program, a Facebook-based HIV education program. The survey assessed participants' ethics-relevant perspectives during recruitment, consent, intervention, and follow-up.

  10. Financail Disaster Risk Mangement Solutions for Life Systems Infrastructure in Low and Middle Income Countries

    Science.gov (United States)

    Skees, J. R.

    2016-12-01

    Growing populations and increased frequency of extreme climate events as a result of anthropogenic climate change will make poor populations more vulnerable in the future. Seismic events (earthquakes and tsunamis) also create extreme hazards for the poor and vulnerable living in cities in low and middle income countries. Vulnerability of life-systems infrastructure (e.g., water treatment facilities, hospitals, protective sea walls, etc.) to extreme climate and seismic events compound problems for the poor and vulnerable. By using risk hazard modelling with engineering design, it is possible to blend improved engineering in concert with financial disaster risk management (including insurance) solutions to improve the resiliency of life-systems infrastructure.

  11. Open access for operational research publications from low- and middle-income countries: who pays?

    Science.gov (United States)

    Zachariah, R; Kumar, A M V; Reid, A J; Van den Bergh, R; Isaakidis, P; Draguez, B; Delaunois, P; Nagaraja, S B; Ramsay, A; Reeder, J C; Denisiuk, O; Ali, E; Khogali, M; Hinderaker, S G; Kosgei, R J; van Griensven, J; Quaglio, G L; Maher, D; Billo, N E; Terry, R F; Harries, A D

    2014-09-21

    Open-access journal publications aim to ensure that new knowledge is widely disseminated and made freely accessible in a timely manner so that it can be used to improve people's health, particularly those in low- and middle-income countries. In this paper, we briefly explain the differences between closed- and open-access journals, including the evolving idea of the 'open-access spectrum'. We highlight the potential benefits of supporting open access for operational research, and discuss the conundrum and ways forward as regards who pays for open access.

  12. Integration of antenatal care services with health programmes in low– and middle– income countries: systematic review

    Directory of Open Access Journals (Sweden)

    Thyra E de Jongh

    2016-06-01

    Full Text Available Antenatal care (ANC presents a potentially valuable platform for integrated delivery of additional health services for pregnant women–services that are vital to reduce the persistently high rates of maternal and neonatal mortality in low– and middle–income countries (LMICs. However, there is limited evidence on the impact of integrating health services with ANC to guide policy. This review assesses the impact of integration of postnatal and other health services with ANC on health services uptake and utilisation, health outcomes and user experience of care in LMICs.

  13. Is operational research delivering the goods? The journey to success in low-income countries

    OpenAIRE

    Zachariah, R; Ford, N; Maher, D; Bissell, K; Van den Bergh, R; van den Boogaard, W; Reid, T; Castro, K G; Draguez, B; von Schreeb, J; Chakaya, J; Atun, R; Lienhardt, C; Enarson, D A; Harries, A D

    2012-01-01

    Operational research in low-income countries has a key role in filling the gap between what we know from research and what we do with that knowledge-the so-called know-do gap, or implementation gap. Planned research that does not tangibly affect policies and practices is ineffective and wasteful, especially in settings where resources are scarce and disease burden is high. Clear parameters are urgently needed to measure and judge the success of operational research. We define operational rese...

  14. Psychological and psychosocial interventions for refugee children resettled in high-income countries.

    Science.gov (United States)

    Fazel, M

    2018-04-01

    Large numbers of refugee children are arriving in high-income countries. The evidence to date suggests that they have mental health needs that are higher than for the general population and that these are exacerbated by the numbers of traumatic events they have experienced and the post-migration stressors they continue to be exposed to. The importance of a thorough and thoughtful assessment is discussed. Treatments of note are described for post-traumatic stress disorder, family functioning, general mental health problems and school environments. Future opportunities to operationalise outcome measures, develop multimodal interventions and utilise implementation science methodology are considered.

  15. Contribution of Maternal Immunity to Decreased Rotavirus Vaccine Performance in Low- and Middle-Income Countries

    Science.gov (United States)

    Mwila, Katayi; Simuyandi, Michelo; Permar, Sallie R.

    2016-01-01

    ABSTRACT The role of maternal immunity, received by infants either transplacentally or orally from breast milk, in rotavirus vaccine (RV) performance is evaluated here. Breastfeeding withholding has no effect on vaccine responses, but higher levels of transplacental rotavirus-specific IgG antibody contribute to reduced vaccine seroconversion. The gaps in knowledge on the factors associated with low RV efficacy in low- and middle-income countries (LMIC) remain, and further research is needed to shed more light on these issues. PMID:27847365

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

    Science.gov (United States)

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

    2013-08-01

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

  17. Is youth smoking responsive to cigarette prices? Evidence from low- and middle-income countries.

    Science.gov (United States)

    Kostova, Deliana; Ross, Hana; Blecher, Evan; Markowitz, Sara

    2011-11-01

    To estimate the price elasticity of cigarette demand among youth in low- and middle-income countries (LMIC). The Global Youth Tobacco Survey was used to obtain data on the smoking behaviour of 315,353 adolescents from 17 LMIC. Two-part model of cigarette demand with country fixed effects. The first part estimates the impact of prices on smoking participation while the second part estimates the impact of prices on the number of cigarettes smoked among current smokers. Besides controlling for individual characteristics such as Age, Gender, Parental Smoking and availability of Pocket Money, the authors control for confounding environmental factors such as anti-smoking sentiment, the prevalence of cigarette advertising and anti-tobacco media messAges, and ease of purchasing cigarettes. All countries in this study are represented with at least two observations over time, which allows us to control for unobserved country characteristics and/or policies that may influence smoking patterns within countries. Cigarette price is an important determinant of smoking. The estimated price elasticity of smoking participation is -0.74, and the estimated price elasticity of conditional cigarette demand is approximately -1.37. The total price elasticity of cigarette demand is -2.11, implying that an increase in price of 10% would reduce youth cigarette consumption by 21.1% at the mean.

  18. Oral hygiene practices among middle-school students in 44 low- and middle-income countries.

    Science.gov (United States)

    McKittrick, Terence R; Jacobsen, Kathryn H

    2014-06-01

    To examine the frequency of toothbrushing or cleaning among middle school students from 44 low- and middle-income countries. Secondary analysis of nationally representative data from 146,462 middle school students who participated in the Global School-based Student Health Survey (GSHS) between 2003 and 2010. In 39 of the 44 countries, more than 80% of students reported brushing or cleaning their teeth at least once each day. In 23 countries, more than 5% of participants reported brushing their teeth less than once a day or never. In 37 countries, boys reported a significantly lower frequency of toothbrushing or cleaning than did girls. Countries where miswak (chewing stick) use is common reported lower toothbrushing or cleaning frequency, perhaps because the questionnaire item did not clarify that this counts as a form of tooth cleaning. School-based dental health education programmes that target early adolescents may help students to develop habits that improve their immediate and long-term health. © 2014 FDI World Dental Federation.

  19. Treatment strategies and regimens of graduated intensity for childhood acute lymphoblastic leukemia in low-income countries: A proposal.

    Science.gov (United States)

    Hunger, Stephen P; Sung, Lillian; Howard, Scott C

    2009-05-01

    Cure rates for children with acute lymphoblastic leukemia (ALL) are 80-85% in high-income countries (HICs) in North America and Western Europe. However, cure rates are much lower in many low-income countries (LICs), where most cases of ALL occur. Over the past several decades partnerships ("twinning") between HIC and LIC pediatric oncology programs have led to major improvements in outcome for children with ALL in some LICs, often by developing time and resource intensive relationships that allow LIC centers to treat children with regimens similar or identical to those used in HICs. However, the resources are not available in most LICs to allow immediate introduction of intensive ALL treatment regimens similar to those used in HICs. With these thoughts in mind, we present a proposal for a systematic and graduated approach to ALL diagnosis, risk classification, and treatment in LICs. We have based the strategy and the proposed regimens on those developed by the Children's Cancer Group (CCG) and Children's Oncology Group (COG) over the past several decades, beginning with a first level regimen similar to CCG therapy of the early 1980s and then layering on successive treatment intensifications proven effective in randomized clinical trials. Simple monitoring rules are included to help centers decide when they are ready to add new treatment components. This proposal provides a framework that LIC centers can use to provide effective ALL therapy, particularly in regions of the world where few children are currently being cured. (c) 2009 Wiley-Liss, Inc.

  20. A public health approach to preventing child abuse in low- and middle-income countries: a call for action.

    Science.gov (United States)

    Skeen, Sarah; Tomlinson, Mark

    2013-01-01

    Violence against children is prevalent across all countries and cultures, with the burden of child injury and violence heaviest in low- and middle-income (LAMI) settings. There are several types of program to prevent child abuse, with family-based approaches to prevention being the most comprehensively researched and successful interventions in high-income settings. In LAMI countries, however, there is very little research evidence for the prevention of child abuse. We conducted a systematic search of relevant databases for studies published between 1995 and 2011 and the search revealed only one relevant study. There is thus a need for research into child maltreatment prevention in LAMI settings, taking account of local resources and contexts. In the light of the lack of evidence, we focus on two case studies that document the use of home visiting by community health workers perinatally to improve maternal and child outcomes. We propose four areas for action moving forward, including increased investment in early intervention and prevention programs, development of a research agenda that prioritizes prevention research, integration of implementation research into efforts to scale up interventions, and improving systematically collected information on child maltreatment.

  1. Cancer genetics education in a low- to middle-income country: evaluation of an interactive workshop for clinicians in Kenya.

    Directory of Open Access Journals (Sweden)

    Jessica A Hill

    Full Text Available Clinical genetic testing is becoming an integral part of medical care for inherited disorders. While genetic testing and counseling are readily available in high-income countries, in low- and middle-income countries like Kenya genetic testing is limited and genetic counseling is virtually non-existent. Genetic testing is likely to become widespread in Kenya within the next decade, yet there has not been a concomitant increase in genetic counseling resources. To address this gap, we designed an interactive workshop for clinicians in Kenya focused on the genetics of the childhood eye cancer retinoblastoma. The objectives were to increase retinoblastoma genetics knowledge, build genetic counseling skills and increase confidence in those skills.The workshop was conducted at the 2013 Kenyan National Retinoblastoma Strategy meeting. It included a retinoblastoma genetics presentation, small group discussion of case studies and genetic counseling role-play. Knowledge was assessed by standardized test, and genetic counseling skills and confidence by questionnaire.Knowledge increased significantly post-workshop, driven by increased knowledge of retinoblastoma causative genetics. One-year post-workshop, participant knowledge had returned to baseline, indicating that knowledge retention requires more frequent reinforcement. Participants reported feeling more confident discussing genetics with patients, and had integrated more genetic counseling into patient interactions.A comprehensive retinoblastoma genetics workshop can increase the knowledge and skills necessary for effective retinoblastoma genetic counseling.

  2. Cancer genetics education in a low- to middle-income country: evaluation of an interactive workshop for clinicians in Kenya.

    Science.gov (United States)

    Hill, Jessica A; Lee, Su Yeon; Njambi, Lucy; Corson, Timothy W; Dimaras, Helen

    2015-01-01

    Clinical genetic testing is becoming an integral part of medical care for inherited disorders. While genetic testing and counseling are readily available in high-income countries, in low- and middle-income countries like Kenya genetic testing is limited and genetic counseling is virtually non-existent. Genetic testing is likely to become widespread in Kenya within the next decade, yet there has not been a concomitant increase in genetic counseling resources. To address this gap, we designed an interactive workshop for clinicians in Kenya focused on the genetics of the childhood eye cancer retinoblastoma. The objectives were to increase retinoblastoma genetics knowledge, build genetic counseling skills and increase confidence in those skills. The workshop was conducted at the 2013 Kenyan National Retinoblastoma Strategy meeting. It included a retinoblastoma genetics presentation, small group discussion of case studies and genetic counseling role-play. Knowledge was assessed by standardized test, and genetic counseling skills and confidence by questionnaire. Knowledge increased significantly post-workshop, driven by increased knowledge of retinoblastoma causative genetics. One-year post-workshop, participant knowledge had returned to baseline, indicating that knowledge retention requires more frequent reinforcement. Participants reported feeling more confident discussing genetics with patients, and had integrated more genetic counseling into patient interactions. A comprehensive retinoblastoma genetics workshop can increase the knowledge and skills necessary for effective retinoblastoma genetic counseling.

  3. Costs of vaccine programs across 94 low- and middle-income countries.

    Science.gov (United States)

    Portnoy, Allison; Ozawa, Sachiko; Grewal, Simrun; Norman, Bryan A; Rajgopal, Jayant; Gorham, Katrin M; Haidari, Leila A; Brown, Shawn T; Lee, Bruce Y

    2015-05-07

    While new mechanisms such as advance market commitments and co-financing policies of the GAVI Alliance are allowing low- and middle-income countries to gain access to vaccines faster than ever, understanding the full scope of vaccine program costs is essential to ensure adequate resource mobilization. This costing analysis examines the vaccine costs, supply chain costs, and service delivery costs of immunization programs for routine immunization and for supplemental immunization activities (SIAs) for vaccines related to 18 antigens in 94 countries across the decade, 2011-2020. Vaccine costs were calculated using GAVI price forecasts for GAVI-eligible countries, and assumptions from the PAHO Revolving Fund and UNICEF for middle-income countries not supported by the GAVI Alliance. Vaccine introductions and coverage levels were projected primarily based on GAVI's Adjusted Demand Forecast. Supply chain costs including costs of transportation, storage, and labor were estimated by developing a mechanistic model using data generated by the HERMES discrete event simulation models. Service delivery costs were abstracted from comprehensive multi-year plans for the majority of GAVI-eligible countries and regression analysis was conducted to extrapolate costs to additional countries. The analysis shows that the delivery of the full vaccination program across 94 countries would cost a total of $62 billion (95% uncertainty range: $43-$87 billion) over the decade, including $51 billion ($34-$73 billion) for routine immunization and $11 billion ($7-$17 billion) for SIAs. More than half of these costs stem from service delivery at $34 billion ($21-$51 billion)-with an additional $24 billion ($13-$41 billion) in vaccine costs and $4 billion ($3-$5 billion) in supply chain costs. The findings present the global costs to attain the goals envisioned during the Decade of Vaccines to prevent millions of deaths by 2020 through more equitable access to existing vaccines for people in all

  4. Umbilical cord-care practices in low- and middle-income countries: a systematic review

    Directory of Open Access Journals (Sweden)

    Patricia S. Coffey

    2017-02-01

    Full Text Available Abstract Background Neonatal sepsis is the third leading cause of deaths for infants in their first month of life. The newly cut umbilical cord can be a pathway for bacteria that can cause newborn sepsis and death. Optimal umbilical cord care practices for newborns and during the first week of life, especially in settings with poor hygiene, has the potential to avoid these preventable neonatal deaths. The purpose of this review of cord care practices is to assist in the development of behavior-change strategies to support introduction of novel cord-care regimens, particularly 7.1% chlorhexidine digluconate for umbilical cord care. Methods We searched domestic and international databases for articles that were published in English between January 1, 2000, and August 24, 2016. We found 321 articles and reviewed 65 full-text articles using standardized inclusion criteria. The primary criteria for inclusion was a description of substances applied to the umbilical cord stump in the days following birth. Results We included 46 articles in this review of umbilical cord-care practices. Articles included data from 15 low- and middle-income countries in sub-Saharan Africa (8 countries, Asia (5 countries, North Africa (1 country, and Latin America and the Caribbean (1 country. Findings from this review suggest that documentation of cord-care practices is not consistent throughout low- and middle-income countries, yet existing literature depicts a firm tradition of umbilical cord care in every culture. Cord-care practices vary by country and by regions or cultural groups within a country and employ a wide range of substances. The desire to promote healing and hasten cord separation are the underlying beliefs related to application of substances to the umbilical cord. The frequency of application of the substance (either the number of days or the number of times per day the substance was applied, and source and cost of products used is not well

  5. The health and economic impact of scaling cervical cancer prevention in 50 low- and lower-middle-income countries.

    Science.gov (United States)

    Campos, Nicole G; Sharma, Monisha; Clark, Andrew; Lee, Kyueun; Geng, Fangli; Regan, Catherine; Kim, Jane; Resch, Stephen

    2017-07-01

    To estimate the health impact, financial costs, and cost-effectiveness of scaling-up coverage of human papillomavirus (HPV) vaccination (young girls) and cervical cancer screening (women of screening age) for women in countries that will likely need donor assistance. We used a model-based approach to synthesize population, demographic, and epidemiological data from 50 low- and lower-middle-income countries. Models were used to project the costs (US $), lifetime health impact (cervical cancer cases, deaths averted), and cost-effectiveness (US $ per disability adjusted life year [DALY] averted) of: (1) two-dose HPV-16/18 vaccination of girls aged 10 years; (2) once-in-a-lifetime screening, with treatment when needed, of women aged 35 years with either HPV DNA testing or visual inspection with acetic acid (VIA); and (3) cervical cancer treatment over a 10-year roll-out. We estimated that both HPV vaccination and screening would be very cost-effective, and a comprehensive program could avert 5.2 million cases, 3.7 million deaths, and 22.0 million DALYs over the lifetimes of the intervention cohorts for a total 10-year program cost of US $3.2 billion. Investment in HPV vaccination of young girls and cervical cancer screen-and-treat programs in low- and lower-middle-income countries could avert a substantial burden of disease while providing good value for public health dollars. © 2017 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.

  6. Science, technology and poverty. Five ways to mobilize development in low-income countries

    International Nuclear Information System (INIS)

    Sachs, J.

    2002-01-01

    The problems of underdevelopment, particularly the problems of the lowest income countries in the world, extend far beyond the issues of economic strategy alone. What we find in many parts of the world is that there is a dearth of the needed science and technology to address critical problems of health, food supply, nutrition, environmental management, climate change, that impose enormous barriers to economic development. This article emphasises the role of international research organizations such as CGIAR (the Council to the Group for International Agricultural Research) in conducting research and development and United Nations agencies such as the IAEA, FAO, the WMO, UNEP and the WHO in the transfer of technology to developing countries

  7. Domestic public debt in Low-Income Countries: Trends and structure

    Directory of Open Access Journals (Sweden)

    Giovanna Bua

    2014-01-01

    Full Text Available This paper introduces a new dataset on the stock and structure of domestic debt in 36 Low-Income Countries over the period 1971–2011. We characterize the recent trends regarding LICs domestic public debt and explore the relevance of different arguments put forward on the benefits and costs of government borrowing in local public debt markets. The main stylized fact emerging from the data is the increase in domestic government debt since 1996. We also observe that poor countries have been able to increase the share of long-term instruments over time and that the maturity lengthening went together with a decrease in borrowing costs. However, the concentration of the investor base, mainly dominated by commercial banks and the Central Bank, may crowd out lending to the private sector.

  8. Biomarker Testing for Personalized Therapy in Lung Cancer in Low- and Middle-Income Countries.

    Science.gov (United States)

    Hirsch, Fred R; Zaric, Bojan; Rabea, Ahmed; Thongprasert, Sumitra; Lertprasertsuke, Nirush; Dalurzo, Mercedes Liliana; Varella-Garcia, Marileila

    2017-01-01

    There have been many important advances in personalized therapy for patients with lung cancer, particularly for those with advanced disease. Molecular testing is crucial for implementation of personalized therapy. Although the United States and many Western countries have come far in the implementation of personalized therapy for lung cancer, there are substantial challenges for low- and middle-income countries (LMICs). Globally, the LMICs display great heterogeneity in the pattern of implementation of molecular testing and targeted therapy. The current review presents an attempt to identify the challenges and obstacles for the implementation of molecular testing and the use of targeted therapies in these areas. Lack of infrastructure, lack of technical expertise, economic factors, and lack of access to new drugs are among the substantial barriers.

  9. Capacity for conducting systematic reviews in low- and middle-income countries: a rapid appraisal.

    Science.gov (United States)

    Oliver, Sandy; Bangpan, Mukdarut; Stansfield, Claire; Stewart, Ruth

    2015-04-26

    Systematic reviews of research are increasingly recognised as important for informing decisions across policy sectors and for setting priorities for research. Although reviews draw on international research, the host institutions and countries can focus attention on their own priorities. The uneven capacity for conducting research around the world raises questions about the capacity for conducting systematic reviews. A rapid appraisal was conducted of current capacity and capacity strengthening activities for conducting systematic reviews in low- and middle-income countries (LMICs). A systems approach to analysis considered the capacity of individuals nested within the larger units of research teams, institutions that fund, support, and/or conduct systematic reviews, and systems that support systematic reviewing internationally. International systematic review networks, and their support organisations, are dominated by members from high-income countries. The largest network comprising a skilled workforce and established centres is the Cochrane Collaboration. Other networks, although smaller, provide support for systematic reviews addressing questions beyond effective clinical practice which require a broader range of methods. Capacity constraints were apparent at the levels of individuals, review teams, organisations, and system wide. Constraints at each level limited the capacity at levels nested within them. Skills training for individuals had limited utility if not allied to opportunities for review teams to practice the skills. Skills development was further constrained by language barriers, lack of support from academic organisations, and the limitations of wider systems for communication and knowledge management. All networks hosted some activities for strengthening the capacities of individuals and teams, although these were usually independent of core academic programmes and traditional career progression. Even rarer were efforts to increase demand for

  10. Assessment of eight HPV vaccination programs implemented in lowest income countries.

    Science.gov (United States)

    Ladner, Joël; Besson, Marie-Hélène; Hampshire, Rachel; Tapert, Lisa; Chirenje, Mike; Saba, Joseph

    2012-05-23

    Cervix cancer, preventable, continues to be the third most common cancer in women worldwide, especially in lowest income countries. Prophylactic HPV vaccination should help to reduce the morbidity and mortality associated with cervical cancer. The purpose of the study was to describe the results of and key concerns in eight HPV vaccination programs conducted in seven lowest income countries through the Gardasil Access Program (GAP). The GAP provides free HPV vaccine to organizations and institutions in lowest income countries. The HPV vaccination programs were entirely developed, implemented and managed by local institutions. Institutions submitted application forms with institution characteristics, target population, communication delivery strategies. After completion of the vaccination campaign (3 doses), institutions provided a final project report with data on doses administered and vaccination models. Two indicators were calculated, the program vaccination coverage and adherence. Qualitative data were also collected in the following areas: government and community involvement; communication, and sensitization; training and logistics resources, and challenges. A total of eight programs were implemented in seven countries. The eight programs initially targeted a total of 87,580 girls, of which 76,983 received the full 3-dose vaccine course, with mean program vaccination coverage of 87.8%; the mean adherence between the first and third doses of vaccine was 90.9%. Three programs used school-based delivery models, 2 used health facility-based models, and 3 used mixed models that included schools and health facilities. Models that included school-based vaccination were most effective at reaching girls aged 9-13 years. Mixed models comprising school and health facility-based vaccination had better overall performance compared with models using just one of the methods. Increased rates of program coverage and adherence were positively correlated with the number of

  11. Assessment of eight HPV vaccination programs implemented in lowest income countries

    Directory of Open Access Journals (Sweden)

    Ladner Joël

    2012-05-01

    Full Text Available Abstract Background Cervix cancer, preventable, continues to be the third most common cancer in women worldwide, especially in lowest income countries. Prophylactic HPV vaccination should help to reduce the morbidity and mortality associated with cervical cancer. The purpose of the study was to describe the results of and key concerns in eight HPV vaccination programs conducted in seven lowest income countries through the Gardasil Access Program (GAP. Methods The GAP provides free HPV vaccine to organizations and institutions in lowest income countries. The HPV vaccination programs were entirely developed, implemented and managed by local institutions. Institutions submitted application forms with institution characteristics, target population, communication delivery strategies. After completion of the vaccination campaign (3 doses, institutions provided a final project report with data on doses administered and vaccination models. Two indicators were calculated, the program vaccination coverage and adherence. Qualitative data were also collected in the following areas: government and community involvement; communication, and sensitization; training and logistics resources, and challenges. Results A total of eight programs were implemented in seven countries. The eight programs initially targeted a total of 87,580 girls, of which 76,983 received the full 3-dose vaccine course, with mean program vaccination coverage of 87.8%; the mean adherence between the first and third doses of vaccine was 90.9%. Three programs used school-based delivery models, 2 used health facility-based models, and 3 used mixed models that included schools and health facilities. Models that included school-based vaccination were most effective at reaching girls aged 9-13 years. Mixed models comprising school and health facility-based vaccination had better overall performance compared with models using just one of the methods. Increased rates of program coverage and

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

    Science.gov (United States)

    Gray, Andrew Lofts; Suleman, Fatima

    2015-10-01

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

  13. Medicine prices, availability, and affordability in 36 developing and middle-income countries: a secondary analysis.

    Science.gov (United States)

    Cameron, A; Ewen, M; Ross-Degnan, D; Ball, D; Laing, R

    2009-01-17

    WHO and Health Action International (HAI) have developed a standardised method for surveying medicine prices, availability, affordability, and price components in low-income and middle-income countries. Here, we present a secondary analysis of medicine availability in 45 national and subnational surveys done using the WHO/HAI methodology. Data from 45 WHO/HAI surveys in 36 countries were adjusted for inflation or deflation and purchasing power parity. International reference prices from open international procurements for generic products were used as comparators. Results are presented for 15 medicines included in at least 80% of surveys and four individual medicines. Average public sector availability of generic medicines ranged from 29.4% to 54.4% across WHO regions. Median government procurement prices for 15 generic medicines were 1.11 times corresponding international reference prices, although purchasing efficiency ranged from 0.09 to 5.37 times international reference prices. Low procurement prices did not always translate into low patient prices. Private sector patients paid 9-25 times international reference prices for lowest-priced generic products and over 20 times international reference prices for originator products across WHO regions. Treatments for acute and chronic illness were largely unaffordable in many countries. In the private sector, wholesale mark-ups ranged from 2% to 380%, whereas retail mark-ups ranged from 10% to 552%. In countries where value added tax was applied to medicines, the amount charged varied from 4% to 15%. Overall, public and private sector prices for originator and generic medicines were substantially higher than would be expected if purchasing and distribution were efficient and mark-ups were reasonable. Policy options such as promoting generic medicines and alternative financing mechanisms are needed to increase availability, reduce prices, and improve affordability.

  14. The impact of increasing income inequalities on educational inequalities in mortality - An analysis of six European countries.

    Science.gov (United States)

    Hoffmann, Rasmus; Hu, Yannan; de Gelder, Rianne; Menvielle, Gwenn; Bopp, Matthias; Mackenbach, Johan P

    2016-07-08

    Over the past decades, both health inequalities and income inequalities have been increasing in many European countries, but it is unknown whether and how these trends are related. We test the hypothesis that trends in health inequalities and trends in income inequalities are related, i.e. that countries with a stronger increase in income inequalities have also experienced a stronger increase in health inequalities. We collected trend data on all-cause and cause-specific mortality, as well as on the household income of people aged 35-79, for Belgium, Denmark, England & Wales, France, Slovenia, and Switzerland. We calculated absolute and relative differences in mortality and income between low- and high-educated people for several time points in the 1990s and 2000s. We used fixed-effects panel regression models to see if changes in income inequality predicted changes in mortality inequality. The general trend in income inequality between high- and low-educated people in the six countries is increasing, while the mortality differences between educational groups show diverse trends, with absolute differences mostly decreasing and relative differences increasing in some countries but not in others. We found no association between trends in income inequalities and trends in inequalities in all-cause mortality, and trends in mortality inequalities did not improve when adjusted for rising income inequalities. This result held for absolute as well as for relative inequalities. A cause-specific analysis revealed some association between income inequality and mortality inequality for deaths from external causes, and to some extent also from cardiovascular diseases, but without statistical significance. We find no support for the hypothesis that increasing income inequality explains increasing health inequalities. Possible explanations are that other factors are more important mediators of the effect of education on health, or more simply that income is not an important

  15. Financial arrangements for health systems in low-income countries: an overview of systematic reviews.

    Science.gov (United States)

    Wiysonge, Charles S; Paulsen, Elizabeth; Lewin, Simon; Ciapponi, Agustín; Herrera, Cristian A; Opiyo, Newton; Pantoja, Tomas; Rada, Gabriel; Oxman, Andrew D

    2017-09-11

    One target of the Sustainable Development Goals is to achieve "universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all". A fundamental concern of governments in striving for this goal is how to finance such a health system. This concern is very relevant for low-income countries. To provide an overview of the evidence from up-to-date systematic reviews about the effects of financial arrangements for health systems in low-income countries. Secondary objectives include identifying needs and priorities for future evaluations and systematic reviews on financial arrangements, and informing refinements in the framework for financial arrangements presented in the overview. We searched Health Systems Evidence in November 2010 and PDQ-Evidence up to 17 December 2016 for systematic reviews. We did not apply any date, language, or publication status limitations in the searches. We included well-conducted systematic reviews of studies that assessed the effects of financial arrangements on patient outcomes (health and health behaviours), the quality or utilisation of healthcare services, resource use, healthcare provider outcomes (such as sick leave), or social outcomes (such as poverty, employment, or financial burden of patients, e.g. out-of-pocket payment, catastrophic disease expenditure) and that were published after April 2005. We excluded reviews with limitations important enough to compromise the reliability of the findings. Two overview authors independently screened reviews, extracted data, and assessed the certainty of evidence using GRADE. We prepared SUPPORT Summaries for eligible reviews, including key messages, 'Summary of findings' tables (using GRADE to assess the certainty of the evidence), and assessments of the relevance of findings to low-income countries. We identified 7272 reviews and included 15 in this

  16. Evidence review of hydroxyurea for the prevention of sickle cell complications in low-income countries.

    Science.gov (United States)

    Mulaku, Mercy; Opiyo, Newton; Karumbi, Jamlick; Kitonyi, Grace; Thoithi, Grace; English, Mike

    2013-11-01

    Hydroxyurea is widely used in high-income countries for the management of sickle cell disease (SCD) in children. In Kenyan clinical guidelines, hydroxyurea is only recommended for adults with SCD. Yet many deaths from SCD occur in early childhood, deaths that might be prevented by an effective, disease modifying intervention. The aim of this review was to summarise the available evidence on the efficacy, effectiveness and safety of hydroxyurea in the management of SCD in children below 5 years of age to support guideline development in Kenya. We undertook a systematic review and used the Grading of Recommendations Assessment, Development and Evaluation system to appraise the quality of identified evidence. Overall, available evidence from 1 systematic review (n=26 studies), 2 randomised controlled trials (n=354 children), 14 observational studies and 2 National Institute of Health reports suggest that hydroxyurea may be associated with improved fetal haemoglobin levels, reduced rates of hospitalisation, reduced episodes of acute chest syndrome and decreased frequency of pain events in children with SCD. However, it is associated with adverse events (eg, neutropenia) when high to maximum tolerated doses are used. Evidence is lacking on whether hydroxyurea improves survival if given to young children. Majority of the included studies were of low quality and mainly from high-income countries. Overall, available limited evidence suggests that hydroxyurea may improve morbidity and haematological outcomes in SCD in children aged below 5 years and appears safe in settings able to provide consistent haematological monitoring.

  17. The dynamic implications of debt relief for low-income countries

    Directory of Open Access Journals (Sweden)

    Alma Lucía Romero-Barrutieta

    2015-06-01

    Full Text Available Debt relief provides low-income countries with an incentive to accumulate debt, boost consumption, and reduce investment over time. We quantify this incentive effect employing a dynamic stochastic general equilibrium model, calibrated to 1982–2006 Ugandan data, and find that long-run debt and consumption-to-GDP ratios are about twice as high with debt relief than without it, while the investment-to-GDP ratio is sixty percent lower. Our simulations show that debt-relief episodes are likely to have only a temporary impact on debt levels but may have a lasting effect over the size of the economy, lowering GDP growth up to twenty percent over time. These results fill a gap in the debt relief literature since, to the best of our knowledge, the quantification of incentive effects is rather scarce. The paper further contributes to the literature by constructing a tractable structural model that is able to replicate the data well and captures key features of low-income countries facing the possibility of debt relief.

  18. Capacity-building in clinical skills of rehabilitation workforce in low- and middle-income countries

    Directory of Open Access Journals (Sweden)

    Fary Khan

    2018-02-01

    Full Text Available Objective: Despite the prevalence of disability in low-and middle-income countries, the clinical skills of the rehabilitation workforce are not well described. We report health professionals’ perspectives on clinical skills in austere settings and identify context-specific gaps in workforce capacity. Methods: A cross-sectional pilot survey (Pakistan, Morocco, Nigeria, Malaysia of health professionals’ working in rehabilitation in hospital and community settings. A situational-analysis survey captured assessment of clinical skills required in various rehabilitation settings. Responses were coded in a line-by-line process, and linked to categories in domains of the International Classification of Functioning, Disability and Health (ICF. Results: Respondents (n = 532 from Pakistan 248, Nigeria 159, Morocco 93 and Malaysia 32 included the following: physiotherapists (52.8%, nurses (8.8%, speech (5.3% and occupational therapists (8.5%, rehabilitation physicians (3.8%, other doctors (5.5% and prosthetist/orthotists (1.5%. The 10 commonly used clinical skills reported were prescription of: physical activity, medications, transfer-techniques, daily-living activities, patient/carer education, diagnosis/screening, behaviour/cognitive interventions, comprehensive patient-care, referrals, assessments and collaboration. There was significant overlap in skills listed irrespective of profession. Most responses linked with ICF categories in activities/participation and personal factors. Conclusion: The core skills identified reflect general rehabilitation practice and a task-shifting approach, to address shortages of health workers in low-and middle-income countries.

  19. Technology transfer of hearing aids to low and middle income countries: policy and market factors.

    Science.gov (United States)

    Seelman, Katherine D; Werner, Roye

    2014-09-01

    The competitive market advantages of industry and the balancing force of international governmental organizations (IGOs) are examined to identify market and policy in support of sustainable technology transfer of hearing aids to low and middle income countries. A second purpose is to examine the usefulness of findings for other assistive technologies (AT). Searches of electronic databases, IGO documents, industry reports and journals were supplemented by informal discussions with industry and IGO staff and audiologists. The value chain is used to examine the competitive advantage of industry and the balancing tools of certain IGOs. Both industry and IGOs engage in intellectual property (IP) and competition activities and are active in each segment of the hearing aid value chain. Their market and policy objectives and strategies are different. IGOs serve as balancing forces for the competitive advantages of industry. The hearing aid market configuration and hearing aid fitting process are not representative of other AT products but IP, trade and competition policy tools used by IGOs and governments are relevant to other AT. The value chain is a useful tool to identify the location of price mark-ups and the influence of actors. Market factors and reimbursement and subsidization policies drive hearing aid innovation. UN-related international government organization activities are responsive to the needs of disability populations who cannot afford assistive technology. Policy tools used by international governmental organizations are applicable across assistive technology. A partnership model is important to distribution of hearing aids to low and middle income countries.

  20. Financial development, income inequality, and CO2 emissions in Asian countries using STIRPAT model.

    Science.gov (United States)

    Khan, Abdul Qayyum; Saleem, Naima; Fatima, Syeda Tamkeen

    2018-03-01

    The main purpose of this paper is to find the effects of financial development, income inequality, energy usage, and per capita GDP on carbon dioxide (CO 2 ) emissions as well the environmental Kuznets curve (EKC) for the three developing Asian countries-Bangladesh, India, and Pakistan. Panel data during the period 1980-2014 and the Stochastic Impacts by Regression on Population, Affluence, and Technology model with fully modified ordinary least squares (FMOLS) are employed for empirical investigation. The results show that financial development has a significant negative relationship with CO 2 emission in the three selected Asian countries with the exception of India. The results further reveal that income inequality in Pakistan and India reduce CO 2 emission, while the result for Bangladesh is opposite. Likewise, energy usage has a significant positive effect on CO 2 emission in Bangladesh, Pakistan, and India. Our empirical analysis based on long-run and short-run elasticity appraisal suggests the validation of the EKC in Pakistan and India. The study findings recommend an important policy insinuation. The study suggests introducing a motivational campaign for the inhabitant towards utilization of high-efficiency electrical appliances, constructing mutual cooperation for economic development rather involve in winning development race, and introducing effective pollution absorption measures along with big projects.

  1. Psychological Treatments for the World: Lessons from Low- and Middle-Income Countries.

    Science.gov (United States)

    Singla, Daisy R; Kohrt, Brandon A; Murray, Laura K; Anand, Arpita; Chorpita, Bruce F; Patel, Vikram

    2017-05-08

    Common mental disorders, including depression, anxiety, and posttraumatic stress, are leading causes of disability worldwide. Treatment for these disorders is limited in low- and middle-income countries. This systematic review synthesizes the implementation processes and examines the effectiveness of psychological treatments for common mental disorders in adults delivered by nonspecialist providers in low- and middle-income countries. In total, 27 trials met the eligibility criteria; most treatments targeted depression or posttraumatic stress. Treatments were commonly delivered by community health workers or peers in primary care or community settings; they usually were delivered with fewer than 10 sessions over 2-3 months in an individual, face-to-face format. Treatments included common elements, such as nonspecific engagement and specific domains of behavioral, interpersonal, emotional, and cognitive elements. The pooled effect size was 0.49 (95% confidence interval = 0.36-0.62), favoring intervention conditions. Our review demonstrates that psychological treatments-comprising a parsimonious set of common elements and delivered by a low-cost, widely available human resource-have moderate to strong effects in reducing the burden of common mental disorders.

  2. Changes in Hypertension Prevalence, Awareness, Treatment, and Control in High-, Middle-, and Low-Income Countries: An Update.

    Science.gov (United States)

    Cifkova, Renata; Fodor, George; Wohlfahrt, Peter

    2016-08-01

    The aim of this paper was to critically evaluate recent publications on hypertension treatment and control in regions by income. Prevalence of hypertension is increasing worldwide, most prominently in low-income countries. Awareness, treatment, and control are most successful in North America while remaining a challenge in middle- and low-income countries. Easy access to medical care and aggressive use of pharmacotherapy are the key strategies which have proved to be successful in reducing the burden of hypertension on the population level.

  3. Determinants of Small Enterprises’ Performance in Developing Countries: A Bangladesh Case

    OpenAIRE

    Khondoker, Abdul Mottaleb; Sonobe, Tetsushi

    2011-01-01

    Family-based traditional microenterprises are abundant in developing countries, and in many cases they are a major source of income and employment for both urban and rural poor. With a few exceptions, however, most these family-based traditional microenterprises in the rural areas of developing countries seldom grow in terms of enterprises’ size and product quality. Thus, they tend to perform poorly relative to their growth potentials. The development of these family-based microenterprises wo...

  4. Maternal employment and childhood overweight in low- and middle-income countries.

    Science.gov (United States)

    Oddo, Vanessa M; Mueller, Noel T; Pollack, Keshia M; Surkan, Pamela J; Bleich, Sara N; Jones-Smith, Jessica C

    2017-10-01

    To investigate the association between maternal employment and childhood overweight in low- and middle-income countries (LMIC). Design/Setting We utilized cross-sectional data from forty-five Demographic and Health Surveys from 2010 to 2016 (n 268 763). Mothers were categorized as formally employed, informally employed or non-employed. We used country-specific logistic regression models to investigate the association between maternal employment and childhood overweight (BMI Z-score>2) and assessed heterogeneity in the association by maternal education with the inclusion of an interaction term. We used meta-analysis to pool the associations across countries. Sensitivity analyses included modelling BMI Z-score and normal weight (weight-for-age Z-score≥-2 to employment was associated with childhood overweight. However, children of employed mothers, compared with children of non-employed mothers, had higher BMI Z-score and higher odds of normal weight. In countries where the association varied by education, children of formally employed women with high education, compared with children of non-employed women with high education, had higher odds of overweight (pooled OR=1·2; 95 % CI 1·0, 1·4). We find no clear association between employment and child overweight. However, maternal employment is associated with a modestly higher BMI Z-score and normal weight, suggesting that employment is currently associated with beneficial effects on children's weight status in most LMIC.

  5. Public reporting on quality, waiting times and patient experience in 11 high-income countries.

    Science.gov (United States)

    Rechel, Bernd; McKee, Martin; Haas, Marion; Marchildon, Gregory P; Bousquet, Frederic; Blümel, Miriam; Geissler, Alexander; van Ginneken, Ewout; Ashton, Toni; Saunes, Ingrid Sperre; Anell, Anders; Quentin, Wilm; Saltman, Richard; Culler, Steven; Barnes, Andrew; Palm, Willy; Nolte, Ellen

    2016-04-01

    This article maps current approaches to public reporting on waiting times, patient experience and aggregate measures of quality and safety in 11 high-income countries (Australia, Canada, England, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland and the United States). Using a questionnaire-based survey of key national informants, we found that the data most commonly made available to the public are on waiting times for hospital treatment, being reported for major hospitals in seven countries. Information on patient experience at hospital level is also made available in many countries, but it is not generally available in respect of primary care services. Only one of the 11 countries (England) publishes composite measures of overall quality and safety of care that allow the ranking of providers of hospital care. Similarly, the publication of information on outcomes of individual physicians remains rare. We conclude that public reporting of aggregate measures of quality and safety, as well as of outcomes of individual physicians, remain relatively uncommon. This is likely to be due to both unresolved methodological and ethical problems and concerns that public reporting may lead to unintended consequences. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  6. Digital technology for health sector governance in low and middle income countries: a scoping review.

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    Holeman, Isaac; Cookson, Tara Patricia; Pagliari, Claudia

    2016-12-01

    Poor governance impedes the provision of equitable and cost-effective health care in many low- and middle-income countries (LMICs). Although systemic problems such as corruption and inefficiency have been characterized as intractable, "good governance" interventions that promote transparency, accountability and public participation have yielded encouraging results. Mobile phones and other Information and Communication Technologies (ICTs) are beginning to play a role in these interventions, but little is known about their use and effects in the context of LMIC health care. Multi-stage scoping review: Research questions and scope were refined through a landscape scan of relevant implementation activities and by analyzing related concepts in the literature. Relevant studies were identified through iterative Internet searches (Google, Google Scholar), a systematic search of academic databases (PubMed, Web of Science), social media crowdsourcing (targeted LinkedIn and Twitter appeals) and reading reference lists and websites of relevant organizations. Parallel expert interviews helped to verify concepts and emerging findings and identified additional studies for inclusion. Results were charted, analyzed thematically and summarized. We identified 34 articles from a wide range of disciplines and sectors, including 17 published research articles and 17 grey literature reports. Analysis of these articles revealed 15 distinct ways of using ICTs for good governance activities in LMIC health care. These use cases clustered into four conceptual categories: 1) gathering and verifying information on services to improve transparency and auditability 2) aggregating and visualizing data to aid communication and decision making 3) mobilizing citizens in reporting poor practices to improve accountability and quality and 4) automating and auditing processes to prevent fraud. Despite a considerable amount of implementation activity, we identified little formal evaluative research

  7. Digital technology for health sector governance in low and middle income countries: a scoping review

    Science.gov (United States)

    Holeman, Isaac; Cookson, Tara Patricia; Pagliari, Claudia

    2016-01-01

    Background Poor governance impedes the provision of equitable and cost–effective health care in many low– and middle–income countries (LMICs). Although systemic problems such as corruption and inefficiency have been characterized as intractable, “good governance” interventions that promote transparency, accountability and public participation have yielded encouraging results. Mobile phones and other Information and Communication Technologies (ICTs) are beginning to play a role in these interventions, but little is known about their use and effects in the context of LMIC health care. Methods Multi–stage scoping review: Research questions and scope were refined through a landscape scan of relevant implementation activities and by analyzing related concepts in the literature. Relevant studies were identified through iterative Internet searches (Google, Google Scholar), a systematic search of academic databases (PubMed, Web of Science), social media crowdsourcing (targeted LinkedIn and Twitter appeals) and reading reference lists and websites of relevant organizations. Parallel expert interviews helped to verify concepts and emerging findings and identified additional studies for inclusion. Results were charted, analyzed thematically and summarized. Results We identified 34 articles from a wide range of disciplines and sectors, including 17 published research articles and 17 grey literature reports. Analysis of these articles revealed 15 distinct ways of using ICTs for good governance activities in LMIC health care. These use cases clustered into four conceptual categories: 1) gathering and verifying information on services to improve transparency and auditability 2) aggregating and visualizing data to aid communication and decision making 3) mobilizing citizens in reporting poor practices to improve accountability and quality and 4) automating and auditing processes to prevent fraud. Despite a considerable amount of implementation activity, we identified

  8. Incorporating Demand and Supply Constraints into Economic Evaluations in Low-Income and Middle-Income Countries.

    Science.gov (United States)

    Vassall, Anna; Mangham-Jefferies, Lindsay; Gomez, Gabriela B; Pitt, Catherine; Foster, Nicola

    2016-02-01

    Global guidelines for new technologies are based on cost and efficacy data from a limited number of trial locations. Country-level decision makers need to consider whether cost-effectiveness analysis used to inform global guidelines are sufficient for their situation or whether to use models that adjust cost-effectiveness results taking into account setting-specific epidemiological and cost heterogeneity. However, demand and supply constraints will also impact cost-effectiveness by influencing the standard of care and the use and implementation of any new technology. These constraints may also vary substantially by setting. We present two case studies of economic evaluations of the introduction of new diagnostics for malaria and tuberculosis control. These case studies are used to analyse how the scope of economic evaluations of each technology expanded to account for and then address demand and supply constraints over time. We use these case studies to inform a conceptual framework that can be used to explore the characteristics of intervention complexity and the influence of demand and supply constraints. Finally, we describe a number of feasible steps that researchers who wish to apply our framework in cost-effectiveness analyses. © 2016 The Authors. Health Economics published by John Wiley & Sons Ltd.

  9. The variation of acute treatment costs of trauma in high-income countries

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    Willenberg Lynsey

    2012-08-01

    Full Text Available Abstract Background In order to assist health service planning, understanding factors that influence higher trauma treatment costs is essential. The majority of trauma costing research reports the cost of trauma from the perspective of the receiving hospital. There has been no comprehensive synthesis and little assessment of the drivers of cost variation, such as country, trauma, subgroups and methods. The aim of this review is to provide a synthesis of research reporting the trauma treatment costs and factors associated with higher treatment costs in high income countries. Methods A systematic search for articles relating to the cost of acute trauma care was performed and included studies reporting injury severity scores (ISS, per patient cost/charge estimates; and costing methods. Cost and charge values were indexed to 2011 cost equivalents and converted to US dollars using purchasing power parities. Results A total of twenty-seven studies were reviewed. Eighty-one percent of these studies were conducted in high income countries including USA, Australia, Europe and UK. Studies either reported a cost (74.1% or charge estimate (25.9% for the acute treatment of trauma. Across studies, the median per patient cost of acute trauma treatment was $22,448 (IQR: $11,819-$33,701. However, there was variability in costing methods used with 18% of studies providing comprehensive cost methods. Sixty-three percent of studies reported cost or charge items incorporated in their cost analysis and 52% reported items excluded in their analysis. In all publications reviewed, predictors of cost included Injury Severity Score (ISS, surgical intervention, hospital and intensive care, length of stay, polytrauma and age. Conclusion The acute treatment cost of trauma is higher than other disease groups. Research has been largely conducted in high income countries and variability exists in reporting costing methods as well as the actual costs. Patient populations studied

  10. The variation of acute treatment costs of trauma in high-income countries.

    Science.gov (United States)

    Willenberg, Lynsey; Curtis, Kate; Taylor, Colman; Jan, Stephen; Glass, Parisa; Myburgh, John

    2012-08-21

    In order to assist health service planning, understanding factors that influence higher trauma treatment costs is essential. The majority of trauma costing research reports the cost of trauma from the perspective of the receiving hospital. There has been no comprehensive synthesis and little assessment of the drivers of cost variation, such as country, trauma, subgroups and methods. The aim of this review is to provide a synthesis of research reporting the trauma treatment costs and factors associated with higher treatment costs in high income countries. A systematic search for articles relating to the cost of acute trauma care was performed and included studies reporting injury severity scores (ISS), per patient cost/charge estimates; and costing methods. Cost and charge values were indexed to 2011 cost equivalents and converted to US dollars using purchasing power parities. A total of twenty-seven studies were reviewed. Eighty-one percent of these studies were conducted in high income countries including USA, Australia, Europe and UK. Studies either reported a cost (74.1%) or charge estimate (25.9%) for the acute treatment of trauma. Across studies, the median per patient cost of acute trauma treatment was $22,448 (IQR: $11,819-$33,701). However, there was variability in costing methods used with 18% of studies providing comprehensive cost methods. Sixty-three percent of studies reported cost or charge items incorporated in their cost analysis and 52% reported items excluded in their analysis. In all publications reviewed, predictors of cost included Injury Severity Score (ISS), surgical intervention, hospital and intensive care, length of stay, polytrauma and age. The acute treatment cost of trauma is higher than other disease groups. Research has been largely conducted in high income countries and variability exists in reporting costing methods as well as the actual costs. Patient populations studied and the cost methods employed are the primary drivers for the

  11. The burden of typhoid fever in low- and middle-income countries: A meta-regression approach.

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    Marina Antillón

    2017-02-01

    Full Text Available Upcoming vaccination efforts against typhoid fever require an assessment of the baseline burden of disease in countries at risk. There are no typhoid incidence data from most low- and middle-income countries (LMICs, so model-based estimates offer insights for decision-makers in the absence of readily available data.We developed a mixed-effects model fit to data from 32 population-based studies of typhoid incidence in 22 locations in 14 countries. We tested the contribution of economic and environmental indices for predicting typhoid incidence using a stochastic search variable selection algorithm. We performed out-of-sample validation to assess the predictive performance of the model.We estimated that 17.8 million cases of typhoid fever occur each year in LMICs (95% credible interval: 6.9-48.4 million. Central Africa was predicted to experience the highest incidence of typhoid, followed by select countries in Central, South, and Southeast Asia. Incidence typically peaked in the 2-4 year old age group. Models incorporating widely available economic and environmental indicators were found to describe incidence better than null models.Recent estimates of typhoid burden may under-estimate the number of cases and magnitude of uncertainty in typhoid incidence. Our analysis permits prediction of overall as well as age-specific incidence of typhoid fever in LMICs, and incorporates uncertainty around the model structure and estimates of the predictors. Future studies are needed to further validate and refine model predictions and better understand year-to-year variation in cases.

  12. The burden of typhoid fever in low- and middle-income countries: A meta-regression approach.

    Science.gov (United States)

    Antillón, Marina; Warren, Joshua L; Crawford, Forrest W; Weinberger, Daniel M; Kürüm, Esra; Pak, Gi Deok; Marks, Florian; Pitzer, Virginia E

    2017-02-01

    Upcoming vaccination efforts against typhoid fever require an assessment of the baseline burden of disease in countries at risk. There are no typhoid incidence data from most low- and middle-income countries (LMICs), so model-based estimates offer insights for decision-makers in the absence of readily available data. We developed a mixed-effects model fit to data from 32 population-based studies of typhoid incidence in 22 locations in 14 countries. We tested the contribution of economic and environmental indices for predicting typhoid incidence using a stochastic search variable selection algorithm. We performed out-of-sample validation to assess the predictive performance of the model. We estimated that 17.8 million cases of typhoid fever occur each year in LMICs (95% credible interval: 6.9-48.4 million). Central Africa was predicted to experience the highest incidence of typhoid, followed by select countries in Central, South, and Southeast Asia. Incidence typically peaked in the 2-4 year old age group. Models incorporating widely available economic and environmental indicators were found to describe incidence better than null models. Recent estimates of typhoid burden may under-estimate the number of cases and magnitude of uncertainty in typhoid incidence. Our analysis permits prediction of overall as well as age-specific incidence of typhoid fever in LMICs, and incorporates uncertainty around the model structure and estimates of the predictors. Future studies are needed to further validate and refine model predictions and better understand year-to-year variation in cases.

  13. Is inequality at the heart of it? Cross-country associations of income inequality with cardiovascular diseases and risk factors.

    Science.gov (United States)

    Kim, Daniel; Kawachi, Ichiro; Hoorn, Stephen Vander; Ezzati, Majid

    2008-04-01

    Despite a number of cross-national studies that have examined the associations between income inequality and broad health outcomes such as life expectancy and all-cause mortality, investigations of the cross-country relations between income inequality and cardiovascular disease (CVD) morbidity, mortality, and risk factors are sparse. We analyzed the cross-national relations between income inequality and age-standardized mean body mass index (BMI), serum total cholesterol, systolic blood pressure (SBP), obesity prevalence, smoking impact ratio (SIR), and age-standardized and age-specific disability-adjusted life-years (DALYs) and mortality rates from coronary heart disease (CHD) and stroke, controlling for multiple country-level factors and specifying 5- to 10-year lag periods. In multivariable analyses primarily limited to industrialized countries, countries in the middle and highest (vs. lowest) tertiles of income inequality had higher absolute age-standardized obesity prevalences in both sexes. Higher income inequality was also related to higher mean SBP in both sexes, and higher SIR in women. In analyses of larger sets of countries with available data, positive associations were observed between higher income inequality and mean BMI, obesity prevalence, and CHD DALYs and mortality rates. Associations with stroke outcomes were inverse, yet became positive with the inclusion of eastern bloc and other countries in recent economic/political transition. China was also identified to be an influential data point, with the positive associations with stroke mortality rates becoming attenuated with its inclusion. Overall, our findings are compatible with harmful effects of income inequality at the national scale on CVD morbidity, mortality, and selected risk factors, particularly BMI/obesity. Future studies should consider income inequality as an independent contributor to variations in CVD burden globally.

  14. Economic Evaluation of Family Planning Interventions in Low and Middle Income Countries; A Systematic Review.

    Directory of Open Access Journals (Sweden)

    Neily Zakiyah

    Full Text Available A significant number of women in low and middle income countries (L-MICs who need any family planning, experience a lack in access to modern effective methods. This study was conducted to review potential cost effectiveness of scaling up family planning interventions in these regions from the published literatures and assess their implication for policy and future research.A systematic review was performed in several electronic databases i.e Medline (Pubmed, Embase, Popline, The National Bureau of Economic Research (NBER, EBSCOHost, and The Cochrane Library. Articles reporting full economic evaluations of strategies to improve family planning interventions in one or more L-MICs, published between 1995 until 2015 were eligible for inclusion. Data was synthesized and analyzed using a narrative approach and the reporting quality of the included studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS statement.From 920 references screened, 9 studies were eligible for inclusion. Six references assessed cost effectiveness of improving family planning interventions in one or more L-MICs, while the rest assessed costs and consequences of integrating family planning and HIV services, concerning sub-Saharan Africa. Assembled evidence suggested that improving family planning interventions is cost effective in a variety of L-MICs as measured against accepted international cost effectiveness benchmarks. In areas with high HIV prevalence, integrating family planning and HIV services can be efficient and cost effective; however the evidence is only supported by a very limited number of studies. The major drivers of cost effectiveness were cost of increasing coverage, effectiveness of the interventions and country-specific factors.Improving family planning interventions in low and middle income countries appears to be cost-effective. Additional economic evaluation studies with improved reporting quality are necessary

  15. Pathogens associated with persistent diarrhoea in children in low and middle income countries: systematic review

    Directory of Open Access Journals (Sweden)

    Hart C Anthony

    2009-06-01

    Full Text Available Abstract Background Persistent diarrhoea in children is a common problem in low and middle income countries. To help target appropriate treatment for specific pathogens in the absence of diagnostic tests, we systematically reviewed pathogens most commonly associated with persistent diarrhoea in children. Methods We sought all descriptive studies of pathogens in the stool of children with diarrhoea of over 14 days duration in low and middle income countries with a comprehensive search of the MEDLINE, EMBASE, LILACS and WEB OF SCIENCE databases. We described the study designs and populations, assessed the quality of the laboratory tests, and extracted and summarised data on pathogens. For Escherichia coli, we calculated high and low prevalence estimates of all enteropathic types combined. Results across studies were compared for geographical patterns. Results Nineteen studies were included. Some used episodes of diarrhoea as the unit of analysis, others used children. The quality of reporting of laboratory procedures varied, and pathogens (particularly E. coli types were classified in different ways. As there were no apparent regional differences in pathogen prevalence, we aggregated data between studies to give a guide to overall prevalence. Enteropathic E. coli types were commonly found in children with persistent diarrhoea (up to 63%. Various other organisms, including viruses, bacteria and parasites, were detected but across all studies their prevalence was under 10%. However, these pathogens were also found in similar frequencies in children without diarrhoea. Conclusion A number of pathogens are commonly associated with persistent diarrhoea in children, but in children without diarrhoea the pathogens are found with similar frequencies. New research with carefully selected controls and standardised laboratory investigations across countries will help map causes and help explore effective options for presumptive treatment.

  16. The economic consequences of neurosurgical disease in low- and middle-income countries.

    Science.gov (United States)

    Rudolfson, Niclas; Dewan, Michael C; Park, Kee B; Shrime, Mark G; Meara, John G; Alkire, Blake C

    2018-05-18

    OBJECTIVE The objective of this study was to estimate the economic consequences of neurosurgical disease in low- and middle-income countries (LMICs). METHODS The authors estimated gross domestic product (GDP) losses and the broader welfare losses attributable to 5 neurosurgical disease categories in LMICs using two distinct economic models. The value of lost output (VLO) model projects annual GDP losses due to neurosurgical disease during 2015-2030, and is based on the WHO's "Projecting the Economic Cost of Ill-health" tool. The value of lost economic welfare (VLW) model estimates total welfare losses, which is based on the value of a statistical life and includes nonmarket losses such as the inherent value placed on good health, resulting from neurosurgical disease in 2015 alone. RESULTS The VLO model estimates the selected neurosurgical diseases will result in $4.4 trillion (2013 US dollars, purchasing power parity) in GDP losses during 2015-2030 in the 90 included LMICs. Economic losses are projected to disproportionately affect low- and lower-middle-income countries, risking up to a 0.6% and 0.54% loss of GDP, respectively, in 2030. The VLW model evaluated 127 LMICs, and estimates that these countries experienced $3 trillion (2013 US dollars, purchasing power parity) in economic welfare losses in 2015. Regardless of the model used, the majority of the losses can be attributed to stroke and traumatic brain injury. CONCLUSIONS The economic impact of neurosurgical diseases in LMICs is significant. The magnitude of economic losses due to neurosurgical diseases in LMICs provides further motivation beyond already compelling humanitarian reasons for action.

  17. Economic Evaluation of Family Planning Interventions in Low and Middle Income Countries; A Systematic Review.

    Science.gov (United States)

    Zakiyah, Neily; van Asselt, Antoinette D I; Roijmans, Frank; Postma, Maarten J

    2016-01-01

    A significant number of women in low and middle income countries (L-MICs) who need any family planning, experience a lack in access to modern effective methods. This study was conducted to review potential cost effectiveness of scaling up family planning interventions in these regions from the published literatures and assess their implication for policy and future research. A systematic review was performed in several electronic databases i.e Medline (Pubmed), Embase, Popline, The National Bureau of Economic Research (NBER), EBSCOHost, and The Cochrane Library. Articles reporting full economic evaluations of strategies to improve family planning interventions in one or more L-MICs, published between 1995 until 2015 were eligible for inclusion. Data was synthesized and analyzed using a narrative approach and the reporting quality of the included studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. From 920 references screened, 9 studies were eligible for inclusion. Six references assessed cost effectiveness of improving family planning interventions in one or more L-MICs, while the rest assessed costs and consequences of integrating family planning and HIV services, concerning sub-Saharan Africa. Assembled evidence suggested that improving family planning interventions is cost effective in a variety of L-MICs as measured against accepted international cost effectiveness benchmarks. In areas with high HIV prevalence, integrating family planning and HIV services can be efficient and cost effective; however the evidence is only supported by a very limited number of studies. The major drivers of cost effectiveness were cost of increasing coverage, effectiveness of the interventions and country-specific factors. Improving family planning interventions in low and middle income countries appears to be cost-effective. Additional economic evaluation studies with improved reporting quality are necessary to generate

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

    Science.gov (United States)

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

    2016-09-01

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

  19. Raw and real: an innovative communication approach to smokeless tobacco control messaging in low and middle-income countries.

    Science.gov (United States)

    Turk, Tahir; Chaturvedi, Pankaj; Murukutla, Nandita; Mallik, Vaishakhi; Sinha, Praveen; Mullin, Sandra

    2017-07-01

    The evidence on the efficacy of tobacco control messages in low and middle-income country (LMIC) settings is limited but growing. Low message salience and disengagement, in the face of tobacco control messages, are possible barriers to self-efficacy and cessation-related behaviours of tobacco users. Although adaptations of existing pretested graphic and emotional appeals have been found to impact on behaviours, more personalised, culturally relevant and compelling appeals may more fully engage message receivers to elicit optimal behavioural responses. The objective of these case studies is to use lessons learnt from high-income country tobacco control communication programmes, and adapt practical approaches to provide cost-effective, culturally nuanced, graphic and personalised messages from tobacco victims to achieve the optimal behavioural impact for population-level communication campaigns in the resource-constrained settings of LMICs. The 'raw and real' messaging approach, which emanated from message pretesting in India, outlines creative and production processes for the production of tobacco victim testimonials, given the need to source patients, facing life-threatening conditions. This cost-efficient approach uses real tobacco victims, doctors and family members in a cinéma vérité style approach to achieve more personalised and culturally resonant messages. The methodological approach, used for the development of a number of patient testimonial messages initially in India, and later adapted for tobacco cessation, smoke-free and graphic health warning communication campaigns in other countries, is outlined. Findings from campaigns evaluated to date are encouraging as a result of the simple fact that true stories of local people's suffering are simply too difficult to ignore. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  20. Prices of second-line antiretroviral treatment for middle-income countries inside versus outside sub-Saharan Africa.

    Science.gov (United States)

    Simmons, Bryony; Hill, Andrew; Ford, Nathan; Ruxrungtham, Kiat; Ananworanich, Jintanat

    2014-01-01

    Antiretrovirals are available at low prices in sub-Saharan Africa, but these prices may not be consistently available for middle-income countries in other regions with large HIV epidemics. Over 30% of HIV infected people live in countries outside sub-Saharan Africa. Several key antiretrovirals are still on patent, with generic production restricted. We assessed price variations for key antiretroviral drugs inside versus outside sub-Saharan Africa. HIV drug prices used in national programmes (2010-2014) were extracted from the WHO Global Price Reporting Mechanism database for all reporting middle-income countries as classified by the World Bank. Treatment costs (branded and generic) were compared for countries inside sub-Saharan Africa versus those outside. Five key second-line antiretrovirals were analysed: abacavir, atazanavir, darunavir, lopinavir/ritonavir, raltegravir. Prices of branded antiretrovirals were significantly higher outside sub-Saharan Africa (psub-Saharan Africa versus $4689 (IQR $4075-5717) in non-African middle-income countries, an increase of 541%. However, when supplied by generic companies, most antiretrovirals were similarly priced between countries in sub-Saharan Africa and other regions. Pharmaceutical companies are selling antiretrovirals to non-African middle-income countries at prices 74-541% higher than African countries with similar gross national incomes. However, generic companies are selling most of these drugs at similar prices across regions. Mechanisms to ensure fair pricing for patented antiretrovirals across both African and non-African middle-income countries need to be improved, to ensure sustainable treatment access.

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

    Science.gov (United States)

    Levin, Ann; Kaddar, Miloud

    2011-07-01

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

  2. Comparative performance of private and public healthcare systems in low- and middle-income countries: a systematic review.

    Directory of Open Access Journals (Sweden)

    Sanjay Basu

    Full Text Available INTRODUCTION: Private sector healthcare delivery in low- and middle-income countries is sometimes argued to be more efficient, accountable, and sustainable than public sector delivery. Conversely, the public sector is often regarded as providing more equitable and evidence-based care. We performed a systematic review of research studies investigating the performance of private and public sector delivery in low- and middle-income countries. METHODS AND FINDINGS: Peer-reviewed studies including case studies, meta-analyses, reviews, and case-control analyses, as well as reports published by non-governmental organizations and international agencies, were systematically collected through large database searches, filtered through methodological inclusion criteria, and organized into six World Health Organization health system themes: accessibility and responsiveness; quality; outcomes; accountability, transparency, and regulation; fairness and equity; and efficiency. Of 1,178 potentially relevant unique citations, data were obtained from 102 articles describing studies conducted in low- and middle-income countries. Comparative cohort and cross-sectional studies suggested that providers in the private sector more frequently violated medical standards of practice and had poorer patient outcomes, but had greater reported timeliness and hospitality to patients. Reported efficiency tended to be lower in the private than in the public sector, resulting in part from perverse incentives for unnecessary testing and treatment. Public sector services experienced more limited availability of equipment, medications, and trained healthcare workers. When the definition of "private sector" included unlicensed and uncertified providers such as drug shop owners, most patients appeared to access care in the private sector; however, when unlicensed healthcare providers were excluded from the analysis, the majority of people accessed public sector care. "Competitive

  3. Comparative Performance of Private and Public Healthcare Systems in Low- and Middle-Income Countries: A Systematic Review

    Science.gov (United States)

    Basu, Sanjay; Andrews, Jason; Kishore, Sandeep; Panjabi, Rajesh; Stuckler, David

    2012-01-01

    Introduction Private sector healthcare delivery in low- and middle-income countries is sometimes argued to be more efficient, accountable, and sustainable than public sector delivery. Conversely, the public sector is often regarded as providing more equitable and evidence-based care. We performed a systematic review of research studies investigating the performance of private and public sector delivery in low- and middle-income countries. Methods and Findings Peer-reviewed studies including case studies, meta-analyses, reviews, and case-control analyses, as well as reports published by non-governmental organizations and international agencies, were systematically collected through large database searches, filtered through methodological inclusion criteria, and organized into six World Health Organization health system themes: accessibility and responsiveness; quality; outcomes; accountability, transparency, and regulation; fairness and equity; and efficiency. Of 1,178 potentially relevant unique citations, data were obtained from 102 articles describing studies conducted in low- and middle-income countries. Comparative cohort and cross-sectional studies suggested that providers in the private sector more frequently violated medical standards of practice and had poorer patient outcomes, but had greater reported timeliness and hospitality to patients. Reported efficiency tended to be lower in the private than in the public sector, resulting in part from perverse incentives for unnecessary testing and treatment. Public sector services experienced more limited availability of equipment, medications, and trained healthcare workers. When the definition of “private sector” included unlicensed and uncertified providers such as drug shop owners, most patients appeared to access care in the private sector; however, when unlicensed healthcare providers were excluded from the analysis, the majority of people accessed public sector care. “Competitive dynamics” for

  4. Comparative performance of private and public healthcare systems in low- and middle-income countries: a systematic review.

    Science.gov (United States)

    Basu, Sanjay; Andrews, Jason; Kishore, Sandeep; Panjabi, Rajesh; Stuckler, David

    2012-01-01

    Private sector healthcare delivery in low- and middle-income countries is sometimes argued to be more efficient, accountable, and sustainable than public sector delivery. Conversely, the public sector is often regarded as providing more equitable and evidence-based care. We performed a systematic review of research studies investigating the performance of private and public sector delivery in low- and middle-income countries. Peer-reviewed studies including case studies, meta-analyses, reviews, and case-control analyses, as well as reports published by non-governmental organizations and international agencies, were systematically collected through large database searches, filtered through methodological inclusion criteria, and organized into six World Health Organization health system themes: accessibility and responsiveness; quality; outcomes; accountability, transparency, and regulation; fairness and equity; and efficiency. Of 1,178 potentially relevant unique citations, data were obtained from 102 articles describing studies conducted in low- and middle-income countries. Comparative cohort and cross-sectional studies suggested that providers in the private sector more frequently violated medical standards of practice and had poorer patient outcomes, but had greater reported timeliness and hospitality to patients. Reported efficiency tended to be lower in the private than in the public sector, resulting in part from perverse incentives for unnecessary testing and treatment. Public sector services experienced more limited availability of equipment, medications, and trained healthcare workers. When the definition of "private sector" included unlicensed and uncertified providers such as drug shop owners, most patients appeared to access care in the private sector; however, when unlicensed healthcare providers were excluded from the analysis, the majority of people accessed public sector care. "Competitive dynamics" for funding appeared between the two sectors, such

  5. Foreign direct investment and technology spillovers in low and middle-income countries : a comparative cross-sectoral analysis

    NARCIS (Netherlands)

    Jacob, J.; Sasso, S.

    2015-01-01

    In this paper we analyse the trends in Foreign Direct Investment (FDI) flows worldwide across sectors and across value-chain activities, with a particular focus on low- and middle-income countries in comparison with advanced countries. We begin by discussing the growing fragmentation of global

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

    Science.gov (United States)

    Othman, Mariam; Muijs, Daniel

    2013-01-01

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

  7. The complications of treating chronic obstructive pulmonary disease in low income countries of sub-Saharan Africa

    NARCIS (Netherlands)

    van Gemert, Frederik A; Kirenga, Bruce J; Gebremariam, Tewodros Haile; Nyale, George; de Jong, Corina; van der Molen, Thys

    2018-01-01

    INTRODUCTION: In most low and middle-income countries, chronic obstructive pulmonary disease (COPD) is on the rise. Areas covered: Unfortunately, COPD is a neglected disease in these countries. Taking sub-Saharan Africa as an example, in rural areas, COPD is even unknown regarding public awareness

  8. Higher Education R&D and Productivity Growth: An Empirical Study on High-Income OECD Countries

    Science.gov (United States)

    Eid, Ashraf

    2012-01-01

    This paper is a macro study on higher education R&D and its impact on productivity growth. I measure the social rate of return on higher education R&D in 17 high-income OECD countries using country level data on the percentage of gross expenditure on R&D performed by higher education, business, and government sectors over the period…

  9. Barriers and Facilitators for implementing programmes and services to address hyperglycaemia in pregnancy in low and middle income countries

    DEFF Research Database (Denmark)

    Nielsen, Karoline Kragelund; Damm, Peter; Bygbjerg, Ib C

    2018-01-01

    AIMS: An estimated 87.6% of hyperglycaemia in pregnancy cases is in low and middle income countries (LMICs). The aim of this study is to review the evidence on barriers and facilitators to programmes and services addressing hyperglycaemia in pregnancy in LMICs. METHODS: A systematic review...... they relate to capacity in terms of human and material resources; availability of feasible and appropriate guidelines; organizational management and referral pathways. Individual level barriers and facilitators include knowledge; risk perception; illness beliefs; financial condition; work obligations......; concerns for the baby and hardship associated with services. At the social and societal level, perceptions and norms related to women's roles, mobility and health; the knowledge and support of the women's social network; and structural aspects are important influencing factors. CONCLUSIONS: Numerous...

  10. Overweight and obesity among children at risk of intellectual disability in 20 low and middle income countries.

    Science.gov (United States)

    Savage, A; Emerson, E

    2016-11-01

    Children with intellectual disability (ID) in high income countries are at significantly greater risk of obesity than their non-disabled peers. We aimed to estimate the prevalence of overweight and obesity in 3 to 4-year-old children who are/are not at risk of ID in low and middle income countries. Secondary analysis of Round 4 and 5 UNICEF Multiple Indicator Cluster Surveys (MICS) from 20 low and middle income countries that included a total of 83 597 3 to 4-year-old children. Few differences in risk of overweight or obesity were apparent between 3 and 4-year-old children identified as being at risk/not at risk of ID in 20 low and middle income countries. In the two countries where statistically significant differences were observed, prevalence of overweight/obesity was lower among children at risk of ID. These results stand in stark contrast to evidence from high income countries which suggest that children with ID are at significantly increased risk of obesity when compared to their non-intellectually disabled peers. © 2016 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

  11. Income inequality and cardiovascular disease risk factors in a highly unequal country: a fixed-effects analysis from South Africa.

    Science.gov (United States)

    Adjaye-Gbewonyo, Kafui; Kawachi, Ichiro; Subramanian, S V; Avendano, Mauricio

    2018-03-06

    Chronic stress associated with high income inequality has been hypothesized to increase CVD risk and other adverse health outcomes. However, most evidence comes from high-income countries, and there is limited evidence on the link between income inequality and biomarkers of chronic stress and risk for CVD. This study examines how changes in income inequality over recent years relate to changes in CVD risk factors in South Africa, home to some of the highest levels of income inequality globally. We linked longitudinal data from 9356 individuals interviewed in the 2008 and 2012 National Income Dynamics Study to district-level Gini coefficients estimated from census and survey data. We investigated whether subnational district income inequality was associated with several modifiable risk factors for cardiovascular disease (CVD) in South Africa, including body mass index (BMI), waist circumference, blood pressure, physical inactivity, smoking, and high alcohol consumption. We ran individual fixed-effects models to examine the association between changes in income inequality and changes in CVD risk factors over time. Linear models were used for continuous metabolic outcomes while conditional Poisson models were used to estimate risk ratios for dichotomous behavioral outcomes. Both income inequality and prevalence of most CVD risk factors increased over the period of study. In longitudinal fixed-effects models, changes in district Gini coefficients were not significantly associated with changes in CVD risk factors. Our findings do not support the hypothesis that subnational district income inequality is associated with CVD risk factors within the high-inequality setting of South Africa.

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

    Science.gov (United States)

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

    2017-12-01

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

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

    Science.gov (United States)

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

    2015-10-01

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

  14. Childhood disability and socio-economic circumstances in low and middle income countries: systematic review

    Directory of Open Access Journals (Sweden)

    Simkiss Douglas E

    2011-12-01

    Full Text Available Abstract Background The majority of children with disability live in low and middle income (LAMI countries. Although a number of important reviews of childhood disability in LAMI countries have been published, these have not, to our knowledge, addressed the association between childhood disability and the home socio-economic circumstances (SEC. The objective of this study is to establish the current state of knowledge on the SECs of children with disability and their households in LAMI countries through a systematic review and quality assessment of existing research. Methods Electronic databases (MEDLINE; EMBASE; PUBMED; Web of Knowledge; PsycInfo; ASSIA; Virtual Health Library; POPLINE; Google scholar were searched using terms specific to childhood disability and SECs in LAMI countries. Publications from organisations including the World Bank, UNICEF, International Monetary Fund were searched for. Primary studies and reviews from 1990 onwards were included. Studies were assessed for inclusion, categorisation and quality by 2 researchers. Results 24 primary studies and 13 reviews were identified. Evidence from the available literature on the association between childhood disability and SECs was inconsistent and inconclusive. Potential mechanisms by which poverty and low household SEC may be both a cause and consequence of disability are outlined in the reviews and the qualitative studies. The association of poor SECs with learning disability and behaviour problems was the most consistent finding and these studies had low/medium risk of bias. Where overall disability was the outcome of interest, findings were divergent and many studies had a high/medium risk of bias. Qualitative studies were methodologically weak. Conclusions This review indicates that, despite socially and biologically plausible mechanisms underlying the association of low household SEC with childhood disability in LAMI countries, the empirical evidence from quantitative studies

  15. Social inequality in infant mortality: what explains variation across low and middle income countries?

    Science.gov (United States)

    Hajizadeh, Mohammad; Nandi, Arijit; Heymann, Jody

    2014-01-01

    Growing work demonstrates social gradients in infant mortality within countries. However, few studies have compared the magnitude of these inequalities cross-nationally. Even fewer have assessed the determinants of social inequalities in infant mortality across countries. This study provides a comprehensive and comparative analysis of social inequalities in infant mortality in 53 low-and-middle-income countries (LMICs). We used the most recent nationally representative household samples (n = 874,207) collected through the Demographic Health Surveys (DHS) to calculate rates of infant mortality. The relative and absolute concentration indices were used to quantify social inequalities in infant mortality. Additionally, we used meta-regression analyses to examine whether levels of inequality in proximate determinants of infant mortality were associated with social inequalities in infant mortality across countries. Estimates of both the relative and the absolute concentration indices showed a substantial variation in social inequalities in infant mortality among LMICs. Meta-regression analyses showed that, across countries, the relative concentration of teenage pregnancy among poorer households was positively associated with the relative concentration of infant mortality among these groups (beta = 0.333, 95% CI = 0.115 0.551). Our results demonstrate that the concentration of infant deaths among socioeconomically disadvantaged households in the majority of LMICs remains an important health and social policy concern. The findings suggest that policies designed to reduce the concentration of teenage pregnancy among mothers in lower socioeconomic groups may mitigate social inequalities in infant mortality. Copyright © 2013 Elsevier Ltd. All rights reserved.

  16. Financial arrangements for health systems in low-income countries: an overview of systematic reviews

    Science.gov (United States)

    Wiysonge, Charles S; Paulsen, Elizabeth; Lewin, Simon; Ciapponi, Agustín; Herrera, Cristian A; Opiyo, Newton; Pantoja, Tomas; Rada, Gabriel; Oxman, Andrew D

    2017-01-01

    Background One target of the Sustainable Development Goals is to achieve "universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all". A fundamental concern of governments in striving for this goal is how to finance such a health system. This concern is very relevant for low-income countries. Objectives To provide an overview of the evidence from up-to-date systematic reviews about the effects of financial arrangements for health systems in low-income countries. Secondary objectives include identifying needs and priorities for future evaluations and systematic reviews on financial arrangements, and informing refinements in the framework for financial arrangements presented in the overview. Methods We searched Health Systems Evidence in November 2010 and PDQ-Evidence up to 17 December 2016 for systematic reviews. We did not apply any date, language, or publication status limitations in the searches. We included well-conducted systematic reviews of studies that assessed the effects of financial arrangements on patient outcomes (health and health behaviours), the quality or utilisation of healthcare services, resource use, healthcare provider outcomes (such as sick leave), or social outcomes (such as poverty, employment, or financial burden of patients, e.g. out-of-pocket payment, catastrophic disease expenditure) and that were published after April 2005. We excluded reviews with limitations important enough to compromise the reliability of the findings. Two overview authors independently screened reviews, extracted data, and assessed the certainty of evidence using GRADE. We prepared SUPPORT Summaries for eligible reviews, including key messages, 'Summary of findings' tables (using GRADE to assess the certainty of the evidence), and assessments of the relevance of findings to low-income countries. Main results We

  17. Prevalence of rheumatoid arthritis in low– and middle–income countries: A systematic review and analysis

    Directory of Open Access Journals (Sweden)

    Igor Rudan

    2015-06-01

    Full Text Available Background: Rheumatoid arthritis (RA is an autoimmune disorder that affects the small joints of the body. It is one of the leading causes of chronic morbidity in high–income countries, but little is known about the burden of this disease in low– and middle–income countries (LMIC. Methods: The aim of this study was to estimate the prevalence of RA in six of the World Health Organization's (WHO regions that harbour LMIC by identifying all relevant studies in those regions. To accomplish this aim various bibliographic databases were searched: PubMed, EMBASE, Global Health, LILACS and the Chinese databases CNKI and WanFang. Studies were selected based on pre–defined inclusion criteria, including a definition of RA based on the 1987 revision of the American College of Rheumatology (ACR definition. Results: Meta–estimates of regional RA prevalence rates for countries of low or middle income were 0.40% (95% CI: 0.23–0.57% for Southeast Asian, 0.37% (95% CI: 0.23–0.51% for Eastern Mediterranean, 0.62% (95% CI: 0.47–0.77% for European, 1.25% (95% CI: 0.64–1.86% for American and 0.42% (95% CI: 0.30–0.53% for Western Pacific regions. A formal meta–analysis could not be performed for the sub–Saharan African region due to limited data. Male prevalence of RA in LMIC was 0.16% (95% CI: 0.11–0.20% while the prevalence in women reached 0.75% (95% CI: 0.60–0.90%. This difference between males and females was statistically signifcant (P<0.0001. The prevalence of RA did not differ significantly between urban and rural settings (P=0.353. These prevalence estimates represent 2.60 (95% CI: 1.85–3.34% million male sufferers and 12.21 (95% CI: 9.78–14.67% million female sufferers in LMIC in the year 2000, and 3.16 (95% CI: 2.25–4.05% million affected males and 14.87 (95% CI: 11.91–17.86% million affected females in LMIC in the year 2010. Conclusion: Given that majority of the world’s population resides in LMIC, the number of

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

    Science.gov (United States)

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

    2017-12-27

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

  19. Methods for conducting systematic reviews of risk factors in low- and middle-income countries

    Directory of Open Access Journals (Sweden)

    Yulia Shenderovich

    2016-03-01

    Full Text Available Abstract Background Rates of youth violence are disproportionately high in many low- and middle-income countries [LMICs] but existing reviews of risk factors focus almost exclusively on high-income countries. Different search strategies, including non-English language searches, might be required to identify relevant evidence in LMICs. This paper discusses methodological issues in systematic reviews aiming to include evidence from LMICs, using the example of a recent review of risk factors for child conduct problems and youth violence in LMICs. Methods We searched the main international databases, such as PsycINFO, Medline and EMBASE in English, as well as 12 regional databases in Arabic, Chinese, English, French, Spanish, Portuguese and Russian. In addition, we used internet search engines and Google Scholar, and contacted over 200 researchers and organizations to identify potentially eligible studies in LMICs. Results The majority of relevant studies were identified in the mainstream databases, but additional studies were also found through regional databases, such as CNKI, Wangfang, LILACS and SciELO. Overall, 85 % of eligible studies were in English, and 15 % were reported in Chinese, Spanish, Portuguese, Russian or French. Among eligible studies in languages other than English, two-thirds were identified only by regional databases and one-third was also indexed in the main international databases. Conclusions There are many studies on child conduct problems and youth violence in LMICs which have not been included in prior reviews. Most research on these subjects in LMICs has been produced in the last two-three decades and mostly in middle-income countries, such as China, Brazil, Turkey, South Africa and Russia. Based on our findings, it appears that many studies of child conduct problems and youth violence in LMICs are reported in English, Chinese, Spanish and Portuguese, but few such studies are published in French, Arabic or Russian. If

  20. Early neonatal mortality in twin pregnancy: Findings from 60 low- and middle-income countries.

    Science.gov (United States)

    Bellizzi, Saverio; Sobel, Howard; Betran, Ana Pilar; Temmerman, Marleen

    2018-06-01

    with vaginal birth in health facility (aOR = 1.7; 95% CI = 1.4-2.0). Institutional deliveries and increased access of caesarian sections may be considered for twin pregnancies in low- and middle- income countries to decrease early adverse neonatal outcomes.

  1. Framework for laboratory harmonization of folate measurements in low- and middle-income countries and regions.

    Science.gov (United States)

    Pfeiffer, Christine M; Zhang, Mindy; Jabbar, Shameem

    2018-02-01

    The measurement of serum and red blood cell folate, two commonly used biomarkers of folate status in populations, is complicated by analytical and data interpretation challenges. Folate results show poor comparability across laboratories, even using the same analytical technique. The folate microbiologic assay produces accurate results and requires simple instrumentation. Thus, it could be set up and maintained in low- and middle-income country laboratories. However, the assay has to be harmonized through the use of common critical reagents (e.g., microorganism and folate calibrator) in order to produce comparable results across laboratories and over time, so that the same cutoff values can be applied across surveys. There is a limited need for blood folate measurements in a country owing to the periodic nature of surveys. Having a network of regional resource laboratories proficient in conducting the folate microbiologic assay and willing and able to perform service work for other countries will be the most efficient way to create an infrastructure wherein qualified laboratories produce reliable blood folate data. Continuous participation of these laboratories in a certification program can verify and document their proficiency. If the resource laboratories conduct the work on a fee-for-service basis, they could become self-sustaining in the long run. © 2018 This article is a U.S. Government work and is in the public domain in the USA.

  2. Dynamics in the Fitness-Income plane: Brazilian states vs World countries.

    Science.gov (United States)

    Operti, Felipe G; Pugliese, Emanuele; Andrade, José S; Pietronero, Luciano; Gabrielli, Andrea

    2018-01-01

    In this paper we introduce a novel algorithm, called Exogenous Fitness, to calculate the Fitness of subnational entities and we apply it to the states of Brazil. In the last decade, several indices were introduced to measure the competitiveness of countries by looking at the complexity of their export basket. Tacchella et al (2012) developed a non-monetary metric called Fitness. In this paper, after an overview about Brazil as a whole and the comparison with the other BRIC countries, we introduce a new methodology based on the Fitness algorithm, called Exogenous Fitness. Combining the results with the Gross Domestic Product per capita (GDPp), we look at the dynamics of the Brazilian states in the Fitness-Income plane. Two regimes are distinguishable: one with high predictability and the other with low predictability, showing a deep analogy with the heterogeneous dynamics of the World countries. Furthermore, we compare the ranking of the Brazilian states according to the Exogenous Fitness with the ranking obtained through two other techniques, namely Endogenous Fitness and Economic Complexity Index.

  3. Welfare state regimes, gender, and depression: a multilevel analysis of middle and high income countries.

    Science.gov (United States)

    Chung, Haejoo; Ng, Edwin; Ibrahim, Selahadin; Karlsson, Björn; Benach, Joan; Espelt, Albert; Muntaner, Carles

    2013-03-28

    Using the 2002 World Health Survey, we examine the association between welfare state regimes, gender and mental health among 26 countries classified into seven distinct regimes: Conservative, Southeast Asian, Eastern European, Latin American, Liberal, Southern/Ex-dictatorship, and Social Democratic. A two-level hierarchical model found that the odds of experiencing a brief depressive episode in the last 12 months was significantly higher for Southern/Ex- dictatorship countries than for Southeast Asian (odds ratio (OR) = 0.12, 95% confidence interval (CI) 0.05-0.27) and Eastern European (OR = 0.36, 95% CI 0.22-0.58) regimes after controlling for gender, age, education, marital status, and economic development. In adjusted interaction models, compared to Southern/Ex-dictatorship males (reference category), the odds ratios of depression were significantly lower among Southeast Asian males (OR = 0.16, 95% CI 0.08-0.34) and females (OR = 0.23, 95% CI 0.10-0.53) and Eastern European males (OR = 0.41, 95% CI 0.26-0.63) and significantly higher among females in Liberal (OR = 2.00, 95% CI 1.14-3.49) and Southern (OR = 2.42, 95% CI 1.86-3.15) regimes. Our results highlight the importance of incorporating middle-income countries into comparative welfare regime research and testing for interactions between welfare regimes and gender on mental health.

  4. Child work and labour among orphaned and abandoned children in five low and middle income countries

    Directory of Open Access Journals (Sweden)

    Pence Brian

    2011-01-01

    Full Text Available Abstract Background The care and protection of the estimated 143,000,000 orphaned and abandoned children (OAC worldwide is of great importance to global policy makers and child service providers in low and middle income countries (LMICs, yet little is known about rates of child labour among OAC, what child and caregiver characteristics predict child engagement in work and labour, or when such work infers with schooling. This study examines rates and correlates of child labour among OAC and associations of child labour with schooling in a cohort of OAC in 5 LMICs. Methods The Positive Outcomes for Orphans (POFO study employed a two-stage random sampling survey methodology to identify 1480 single and double orphans and children abandoned by both parents ages 6-12 living in family settings in five LMICs: Cambodia, Ethiopia, India, Kenya, and Tanzania. Regression models examined child and caregiver associations with: any work versus no work; and with working Results The majority of OAC (60.7% engaged in work during the past week, and of those who worked, 17.8% (10.5% of the total sample worked 28 or more hours. More than one-fifth (21.9%; 13% of the total sample met UNICEF's child labour definition. Female OAC and those in good health had increased odds of working. OAC living in rural areas, lower household wealth and caregivers not earning an income were associated with increased child labour. Child labour, but not working fewer than 28 hours per week, was associated with decreased school attendance. Conclusions One in seven OAC in this study were reported to be engaged in child labour. Policy makers and social service providers need to pay close attention to the demands being placed on female OAC, particularly in rural areas and poor households with limited income sources. Programs to promote OAC school attendance may need to focus on the needs of families as well as the OAC.

  5. Review of quality assessment tools for family planning programmes in low- and middle-income countries.

    Science.gov (United States)

    Sprockett, Andrea

    2017-03-01

    Measuring and tracking the quality of healthcare is a critical part of improving service delivery, clinic efficiency and health outcomes. However, no standardized or widely accepted tool exists to assess the quality of clinic-based family planning services in low- and middle-income countries. The objective of this literature review was to identify widely used public domain quality assessment tools with existing or potential application in clinic-based family planning programmes. Using PubMed, PopLine, Google Scholar and Google, key terms such as ‘quality assessment tool’, ‘quality assessment method’, ‘quality measurement’, ‘LMIC’, ‘developing country’, ‘family planning’ and ‘reproductive health’ were searched for articles, identifying 20 relevant tools. Tools were assessed to determine the type of quality components assessed, divided into structure and process components, level of application (national or facility), health service domain that can be assessed by the tool, cost and current use of the tool. Tools were also assessed for shortcomings based on application in a low- and middle-income clinic-based family planning programme, including personnel required, re-assessment frequency, assessment of structure, process and outcome quality, comparability of data over time and across facilities and ability to benchmark clinic results to a national benchmark. No tools met all criteria, indicating a critical gap in quality assessment for low- and middle-income family planning programmes. To achieve Universal Health Coverage, agreed on in the Sustainable Development Goals and to improve system-wide healthcare quality, we must develop and widely adopt a standardized quality assessment tool.

  6. Oral Health Behaviour and Social and Health Factors in University Students from 26 Low, Middle and High Income Countries

    OpenAIRE

    Peltzer, Karl; Pengpid, Supa

    2014-01-01

    Poor oral health is still a major burden for populations throughout the world, particularly in developing countries. The aim of this study was investigate oral health behaviour (tooth brushing and dental attendance) and associated factors in low, middle and high income countries. Using anonymous questionnaires, data were collected from 19,560 undergraduate university students (mean age 20.8, SD = 2.8) from 27 universities in 26 countries across Asia, Africa and the Americas. Results indicate...

  7. Tackling socioeconomic inequalities and non-communicable diseases in low-income and middle-income countries under the Sustainable Development agenda.

    Science.gov (United States)

    Niessen, Louis W; Mohan, Diwakar; Akuoku, Jonathan K; Mirelman, Andrew J; Ahmed, Sayem; Koehlmoos, Tracey P; Trujillo, Antonio; Khan, Jahangir; Peters, David H

    2018-05-19

    Five Sustainable Development Goals (SDGs) set targets that relate to the reduction of health inequalities nationally and worldwide. These targets are poverty reduction, health and wellbeing for all, equitable education, gender equality, and reduction of inequalities within and between countries. The interaction between inequalities and health is complex: better economic and educational outcomes for households enhance health, low socioeconomic status leads to chronic ill health, and non-communicable diseases (NCDs) reduce income status of households. NCDs account for most causes of early death and disability worldwide, so it is alarming that strong scientific evidence suggests an increase in the clustering of non-communicable conditions with low socioeconomic status in low-income and middle-income countries since 2000, as previously seen in high-income settings. These conditions include tobacco use, obesity, hypertension, cancer, and diabetes. Strong evidence from 283 studies overwhelmingly supports a positive association between low-income, low socioeconomic status, or low educational status and NCDs. The associations have been differentiated by sex in only four studies. Health is a key driver in the SDGs, and reduction of health inequalities and NCDs should become key in the promotion of the overall SDG agenda. A sustained reduction of general inequalities in income status, education, and gender within and between countries would enhance worldwide equality in health. To end poverty through elimination of its causes, NCD programmes should be included in the development agenda. National programmes should mitigate social and health shocks to protect the poor from events that worsen their frail socioeconomic condition and health status. Programmes related to universal health coverage of NCDs should specifically target susceptible populations, such as elderly people, who are most at risk. Growing inequalities in access to resources for prevention and treatment need to

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

    Science.gov (United States)

    Hosseinpoor, Ahmad Reza; Bergen, Nicole; Kunst, Anton; Harper, Sam; Guthold, Regina; Rekve, Dag; d'Espaignet, Edouard Tursan; Naidoo, Nirmala; Chatterji, Somnath

    2012-10-28

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

  9. Choice of first-line antiretroviral therapy regimen and treatment outcomes for HIV in a middle income compared to a high income country: a cohort study.

    Science.gov (United States)

    Dragovic, Gordana; Smith, Colette J; Jevtovic, Djordje; Dimitrijevic, Bozana; Kusic, Jovana; Youle, Mike; Johnson, Margaret A

    2016-03-03

    The range of combination antiretroviral therapy (cART) regimens available in many middle-income countries differs from those suggested in international HIV treatment guidelines. We compared first-line cART regimens, timing of initiation and treatment outcomes in a middle income setting (HIV Centre, Belgrade, Serbia - HCB) with a high-income country (Royal Free London Hospital, UK - RFH). All antiretroviral-naïve HIV-positive individuals from HCB and RFH starting cART between 2003 and 2012 were included. 12-month viral load and CD4 count responses were compared, considering the first available measurement 12-24 months post-cART. The percentage that had made an antiretroviral switch for any reason, or for toxicity and the percentage that had died by 36 months (the latest time at which sufficient numbers remained under follow-up) were investigated using standard survival methods. 361/597 (61 %) of individuals initiating cART at HCB had a prior AIDS diagnosis, compared to 337/1763 (19 %) at RFH. Median pre-ART CD4 counts were 177 and 238 cells/mm(3) respectively (p HIV disease, resulting in higher mortality rates than in high income countries, supporting improved testing campaigns for early detection of HIV infection and early introduction of newer cART regimens.

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

    Directory of Open Access Journals (Sweden)

    S. Pollett

    2016-01-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

  12. Socioeconomic status and response to antiretroviral therapy in high-income countries: a literature review.

    Science.gov (United States)

    Burch, Lisa S; Smith, Colette J; Phillips, Andrew N; Johnson, Margaret A; Lampe, Fiona C

    2016-05-15

    It has been shown that socioeconomic factors are associated with the prognosis of several chronic diseases; however, there is no recent systematic review of their effect on HIV treatment outcomes. We aimed to review the evidence regarding the existence of an association of socioeconomic status with virological and immunological response to antiretroviral therapy (ART). We systematically searched the current literature using the database PubMed. We identified and summarized original research studies in high-income countries that assessed the association between socioeconomic factors (education, employment, income/financial status, housing, health insurance, and neighbourhood-level socioeconomic factors) and virological response, immunological response, and ART nonadherence among people with HIV-prescribed ART. A total of 48 studies met the inclusion criteria (26 from the United States, six Canadian, 13 European, and one Australian), of which 14, six, and 35 analysed virological, immunological, and ART nonadherence outcomes, respectively. Ten (71%), four (67%), and 23 (66%) of these studies found a significant association between lower socioeconomic status and poorer response, and none found a significant association with improved response. Several studies showed that adjustment for nonadherence attenuated the association between socioeconomic status and ART response. Our review provides strong support that socioeconomic disadvantage is associated with poorer response to ART. However, most studies have been conducted in settings such as the United States without universal free healthcare access. Further study in settings with free access to ART could help assess the impact of socioeconomic status on ART outcomes and the mechanisms by which it operates.

  13. Challenges associated with informed consent in low- and low-middle-income countries

    Directory of Open Access Journals (Sweden)

    Melissa Upjohn

    2016-10-01

    Full Text Available Frontiers in Veterinary Medicine endorse the Helsinki declaration and guidelines of the International Committee of Medical and Journal Editors, including the requirement to obtain informed consent from all research participants. Whilst the concept of informed consent is well understood in western research environments, its components require further consideration when reviewing studies involving humans and owned animals in low- and middle-income countries (LMICs in order to take account of different social, educational and research norms. This piece identifies some of the challenges that need to be considered and how they might affect the process of obtaining informed consent. It explains the approach taken by an animal welfare non-governmental organization working in LMICs to addressing these challenges. It also identifies questions that reviewers might consider when asked to comment on work originating in this context.

  14. Asylum seekers, violence and health: a systematic review of research in high-income host countries.

    Science.gov (United States)

    Kalt, Anne; Hossain, Mazeda; Kiss, Ligia; Zimmerman, Cathy

    2013-03-01

    We performed a systematic review of literature on violence and related health concerns among asylum seekers in high-income host countries. We extracted data from 23 peer-reviewed studies. Prevalence of torture, variably defined, was above 30% across all studies. Torture history in clinic populations correlated with hunger and posttraumatic stress disorder, although in small, nonrepresentative samples. One study observed that previous exposure to interpersonal violence interacted with longer immigration detention periods, resulting in higher depression scores. Limited evidence suggests that asylum seekers frequently experience violence and health problems, but large-scale studies are needed to inform policies and services for this vulnerable group often at the center of political debate.

  15. Improving access to medicines in low and middle income countries: corporate responsibilities in context.

    Science.gov (United States)

    Leisinger, Klaus Michael; Garabedian, Laura Faden; Wagner, Anita Katharina

    2012-12-01

    More than two billion people in low- and middle-income countries (LMIC) lack adequate access to essential medicines. In this paper, we make strong public health, human rights and economic arguments for improving access to medicines in LMIC and discuss the different roles and responsibilities of key stakeholders, including national governments, the international community, and non-governmental organizations (NGOs). We then establish a framework of pharmaceutical firms' corporate responsibilities - the "must," the "ought to," and the "can" dimensions - and make recommendations for actionable business strategies for improving access to medicines. We discuss controversial topics, such as pharmaceutical profits and patents, with the goal of building consensus around facts and working towards a solution. We conclude that partnerships and collaboration among multiple stakeholders are urgently needed to improve equitable access to medicines in LMIC.

  16. Managing menstruation in the workplace: an overlooked issue in low- and middle-income countries.

    Science.gov (United States)

    Sommer, Marni; Chandraratna, Sahani; Cavill, Sue; Mahon, Therese; Phillips-Howard, Penelope

    2016-06-06

    The potential menstrual hygiene management barriers faced by adolescent girls and women in workplace environments in low- and middle-income countries has been under addressed in research, programming and policy. Despite global efforts to reduce poverty among women in such contexts, there has been insufficient attention to the water and sanitation related barriers, specifically in relation to managing monthly menstruation, that may hinder girls' and women's contributions to the workplace, and their health and wellbeing. There is an urgent need to document the specific social and environmental barriers they may be facing in relation to menstrual management, to conduct a costing of the implications of inadequate supportive workplace environments for menstrual hygiene management, and to understand the implications for girls' and women's health and wellbeing. This will provide essential evidence for guiding national policy makers, the private sector, donors and activists focused on advancing girls' and women's rights.

  17. Clinical Trials Infrastructure as a Quality Improvement Intervention in Low- and Middle-Income Countries.

    Science.gov (United States)

    Denburg, Avram; Rodriguez-Galindo, Carlos; Joffe, Steven

    2016-06-01

    Mounting evidence suggests that participation in clinical trials confers neither advantage nor disadvantage on those enrolled. Narrow focus on the question of a "trial effect," however, distracts from a broader mechanism by which patients may benefit from ongoing clinical research. We hypothesize that the existence of clinical trials infrastructure-the organizational culture, systems, and expertise that develop as a product of sustained participation in cooperative clinical trials research-may function as a quality improvement lever, improving the quality of care and outcomes of all patients within an institution or region independent of their individual participation in trials. We further contend that this "infrastructure effect" can yield particular benefits for patients in low- and middle-income countries (LMICs). The hypothesis of an infrastructure effect as a quality improvement intervention, if correct, justifies enhanced research capacity in LMIC as a pillar of health system development.

  18. Early life opportunities for prevention of diabetes in low and middle income countries

    Directory of Open Access Journals (Sweden)

    Hanson Mark A

    2012-11-01

    Full Text Available Abstract Background The global burden of diabetes and other non-communicable diseases is rising dramatically worldwide and is causing a double poor health burden in low- and middle-income countries. Early life influences play an important part in this scenario because maternal lifestyle and conditions such as gestational diabetes and obesity affect the risk of diabetes in the next generation. This indicates important periods during the lifecourse when interventions could have powerful affects in reducing incidence of non-communicable diseases. However, interventions to promote diet and lifestyle in prospective parents before conception have not received sufficient attention, especially in low- and middle-income countries undergoing socio-economic transition. Discussion Interventions to produce weight loss in adults or to reduce weight gain in pregnancy have had limited success and might be too late to produce the largest effects on the health of the child and his/her later risk of non-communicable diseases. A very important factor in the prevention of the developmental component of diabetes risk is the physiological state in which the parents enter pregnancy. We argue that the most promising strategy to improve prospective parents’ body composition and lifestyle is the promotion of health literacy in adolescents. Multiple but integrated forms of community-based interventions that focus on nutrition, physical activity, family planning, breastfeeding and infant feeding practices are needed. They need to address the wider social economic context in which adolescents live and to be linked with existing public health programmes in sexual and reproductive health and maternal and child health initiatives. Summary Interventions aimed at ensuring a healthy body composition, diet and lifestyle before pregnancy offer a most effective solution in many settings, especially in low- and middle-income countries undergoing socio-economic transition. Preparing

  19. Strategies to Improve Stroke Care Services in Low- and Middle-Income Countries

    DEFF Research Database (Denmark)

    Pandian, Jeyaraj Durai; William, Akanksha G; Kate, Mahesh P

    2017-01-01

    subsidies. Adherence to secondary preventive drugs is affected by limited availability and affordability, emphasizing the importance of primary prevention. Training of paramedics, care-givers and nurses in post-stroke care is feasible. CONCLUSION: In this systematic review, we found several reports...... on evidence-based implementable stroke services in LMICs. Some strategies are economic, feasible and reproducible but remain untested. Data on their outcomes and sustainability is limited. Further research on implementation of locally and regionally adapted stroke-services and cost-effective secondary......BACKGROUND: The burden of stroke in low- and middle-income countries (LMICs) is large and increasing, challenging the already stretched health-care services. AIMS AND OBJECTIVES: To determine the quality of existing stroke-care services in LMICs and to highlight indigenous, inexpensive, evidence...

  20. Socio-hydrogeology and low-income countries: taking science to rural society

    Science.gov (United States)

    Limaye, Shrikant Daji

    2017-11-01

    Rural societies in low-income, high-population countries often faces scarcity of water of suitable quality for domestic use and agriculture. Hydrogeologists should therefore orientate their research work towards solving practical problems and impart basic knowledge about the hydrogeology of local watersheds to the village councils and communities so as to ensure their participation in better management of groundwater resources. Such cooperation between the hydrogeologists and villagers is the foundation of socio-hydrogeology, which aims at broader dissemination of information and discussions with hydrogeologists at village meetings regarding watershed management such as recharge augmentation, groundwater quality issues and prudent use of groundwater. Socio-hydrogeology implies improved accessibility of rural society to hydrogeological experts and better communication through the use of more appropriate and understandable language.

  1. Acute Kidney Injury Recognition in Low- and Middle-Income Countries

    Directory of Open Access Journals (Sweden)

    Jorge Cerdá

    2017-07-01

    Full Text Available Acute kidney injury (AKI is increasingly common around the world. Because of the low availability of effective therapies and resource limitations, early preventive and therapeutic measures are essential to decrease morbidity, mortality, and cost. Timely recognition and diagnosis of AKI requires a heightened degree of suspicion in the appropriate clinical and environmental context. In low- and middle-income countries (LMICs, early detection is impaired by limited resources and low awareness. In this article, we report the consensus recommendations of the 18th Acute Dialysis Quality Initiative meeting in Hyderabad, India, on how to improve recognition of AKI. We expect these recommendations will lead to an earlier and more accurate diagnosis of AKI, and improved research to promote a better understanding of the epidemiology, etiology, and histopathology of AKI in LMICs.

  2. Is operational research delivering the goods? The journey to success in low-income countries.

    Science.gov (United States)

    Zachariah, Rony; Ford, Nathan; Maher, Dermot; Bissell, Karen; Van den Bergh, Rafael; van den Boogaard, Wilma; Reid, Tony; Castro, Kenneth G; Draguez, Bertrand; von Schreeb, Johan; Chakaya, Jeremiah; Atun, Rifat; Lienhardt, Christian; Enarson, Don A; Harries, Anthony D

    2012-05-01

    Operational research in low-income countries has a key role in filling the gap between what we know from research and what we do with that knowledge-the so-called know-do gap, or implementation gap. Planned research that does not tangibly affect policies and practices is ineffective and wasteful, especially in settings where resources are scarce and disease burden is high. Clear parameters are urgently needed to measure and judge the success of operational research. We define operational research and its relation with policy and practice, identify why operational research might fail to affect policy and practice, and offer possible solutions to address these shortcomings. We also propose measures of success for operational research. Adoption and use of these measures could help to ensure that operational research better changes policy and practice and improves health-care delivery and disease programmes. Copyright © 2012 Elsevier Ltd. All rights reserved.

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

    Science.gov (United States)

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

    2014-01-01

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

  4. Failing to retain a new generation of doctors: qualitative insights from a high-income country.

    Science.gov (United States)

    Humphries, Niamh; Crowe, Sophie; Brugha, Ruairí

    2018-02-27

    The failure of high-income countries, such as Ireland, to achieve a self-sufficient medical workforce has global implications, particularly for low-income, source countries. In the past decade, Ireland has doubled the number of doctors it trains annually, but because of its failure to retain doctors, it remains heavily reliant on internationally trained doctors to staff its health system. To halve its dependence on internationally trained doctors by 2030, in line with World Health Organisation (WHO) recommendations, Ireland must become more adept at retaining doctors. This paper presents findings from in-depth interviews conducted with 50 early career doctors between May and July 2015. The paper explores the generational component of Ireland's failure to retain doctors and makes recommendations for retention policy and practice. Interviews revealed that a new generation of doctors differ from previous generations in several distinct ways. Their early experiences of training and practice have been in an over-stretched, under-staffed health system and this shapes their decision to remain in Ireland, or to leave. Perhaps as a result of the distinct challenges they have faced in an austerity-constrained health system and their awareness of the working conditions available globally, they challenge the traditional view of medicine as a vocation that should be prioritised before family and other commitments. A new generation of doctors have career options that are also strongly shaped by globalisation and by the opportunities presented by emigration. Understanding the medical workforce from a generational perspective requires that the health system address the issues of concern to a new generation of doctors, in terms of working conditions and training structures and also in terms of their desire for a more acceptable balance between work and life. This will be an important step towards future-proofing the medical workforce and is essential to achieving medical workforce

  5. Experiences of ICU survivors in a low middle income country- a multicenter study.

    Science.gov (United States)

    Pieris, Lalitha; Sigera, Ponsuge Chathurani; De Silva, Ambepitiyawaduge Pubudu; Munasinghe, Sithum; Rashan, Aasiyah; Athapattu, Priyantha Lakmini; Jayasinghe, Kosala Saroj Amarasiri; Samarasinghe, Kerstein; Beane, Abi; Dondorp, Arjen M; Haniffa, Rashan

    2018-03-21

    Stressful patient experiences during the intensive care unit (ICU) stay is associated with reduced satisfaction in High Income Countries (HICs) but has not been explored in Lower and Middle Income Countries (LMICs). This study describes the recalled experiences, stress and satisfaction as perceived by survivors of ICUs in a LMIC. This follow-up study was carried out in 32 state ICUs in Sri Lanka between July and December 2015.ICU survivors' experiences, stress factors encountered and level of satisfaction were collected 30 days after ICU discharge by a telephone questionnaire adapted from Granja and Wright. Of 1665 eligible ICU survivors, 23.3% died after ICU discharge, 49.1% were uncontactable and 438 (26.3%) patients were included in the study. Whilst 78.1% (n = 349) of patients remembered their admission to the hospital, only 42.3% (n = 189) could recall their admission to the ICU. The most frequently reported stressful experiences were: being bedridden (34.2%), pain (34.0%), general discomfort (31.7%), daily needle punctures (32.9%), family worries (33.6%), fear of dying and uncertainty in the future (25.8%). The majority of patients (376, 84.12%) found the atmosphere of the ICU to be friendly and calm. Overall, the patients found the level of health care received in the ICU to be "very satisfactory" (93.8%, n = 411) with none of the survivors stating they were either "dissatisfied" or "very dissatisfied". In common with HIC, survivors were very satisfied with their ICU care. In contrast to HIC settings, specific ICU experiences were frequently not recalled, but those remembered were reported as relatively stress-free. Stressful experiences, in common with HIC, were most frequently related to uncertainty about the future, dependency, family, and economic concerns.

  6. Alcohol taxation policy in Thailand: implications for other low- to middle-income countries.

    Science.gov (United States)

    Sornpaisarn, Bundit; Shield, Kevin D; Rehm, Jürgen

    2012-08-01

      Prevention of drinking initiation is a significant challenge in low- and middle-income countries that have a high prevalence of abstainers, including life-time abstainers. This paper aims to encourage a debate on an alternative alcohol taxation approach used currently in Thailand, which aims specifically to prevent drinking initiation in addition to reduce alcohol-attributable harms.   Theoretical evaluation, simulation and empirical analysis.   The taxation method of Thailand, 'Two-Chosen-One' (2C1) combines specific taxation (as a function of the alcohol content) and ad valorem taxation (as a function of the price), resulting in an effective tax rate that puts a higher tax both on beverages which are preferred by heavy drinkers and on beverages which are preferred by potential alcohol consumption neophytes, compared to either taxation system alone. As a result of these unique properties of the 2C1 taxation system, our simulations indicate that 2C1 taxation leads to a lower overall consumption than ad valorem or specific taxation alone. In addition, it puts a relatively high tax on beverages attractive to young people, the majority of whom are currently abstaining. Currently, the abstention rates in Thailand are higher than expected based on its economic wealth, which could be taken as an indication that the taxation strategy is successful.   'Two-chosen-one' (2C1) taxation has the potential to simultaneously reduce alcohol consumption and prevent drinking initiation among youth; however, additional empirical evidence is needed to assess its effectiveness in terms of the public health impact in low- and middle-income countries. © 2012 The Authors, Addiction © 2012 Society for the Study of Addiction.

  7. Model for Service Delivery for Developmental Disorders in Low-Income Countries.

    Science.gov (United States)

    Hamdani, Syed Usman; Minhas, Fareed Aslam; Iqbal, Zafar; Rahman, Atif

    2015-12-01

    As in many low-income countries, the treatment gap for developmental disorders in rural Pakistan is near 100%. We integrated social, technological, and business innovations to develop and pilot a potentially sustainable service for children with developmental disorders in 1 rural area. Families with developmental disorders were identified through a mobile phone-based interactive voice response system, and organized into "Family Networks." "Champion" family volunteers were trained in evidence-based interventions. An Avatar-assisted Cascade Training and information system was developed to assist with training, implementation, monitoring, and supervision. In a population of ∼30,000, we successfully established 1 self-sustaining Family Network consisting of 10 trained champion family volunteers working under supervision of specialists, providing intervention to 70 families of children with developmental disorders. Each champion was responsible for training and providing ongoing support to 5 to 7 families from his or her village, and the families supported each other in management of their children. A pre-post evaluation of the program indicated that there was significant improvement in disability and socioemotional difficulties in the child, reduction in stigmatizing experiences, and greater family empowerment to seek services and community resources for the child. There was no change in caregivers' well-being. To replicate this service more widely, a social franchise model has been developed whereby the integrated intervention will be "boxed" up and passed on to others to replicate with appropriate support. Such integrated social, technological, and business innovations have the potential to be applied to other areas of health in low-income countries. Copyright © 2015 by the American Academy of Pediatrics.

  8. Financing of health systems to achieve the health Millennium Development Goals in low-income countries.

    Science.gov (United States)

    Fryatt, Robert; Mills, Anne; Nordstrom, Anders

    2010-01-30

    Concern that underfunded and weak health systems are impeding the achievement of the health Millennium Development Goals in low-income countries led to the creation of a High Level Taskforce on Innovative International Financing for Health Systems in September, 2008. This report summarises the key challenges faced by the Taskforce and its Working Groups. Working Group 1 examined the constraints to scaling up and costs. Challenges included: difficulty in generalisation because of scarce and context-specific health-systems knowledge; no consensus for optimum service-delivery approaches, leading to wide cost differences; no consensus for health benefits; difficulty in quantification of likely efficiency gains; and challenges in quantification of the financing gap owing to uncertainties about financial commitments for health. Working Group 2 reviewed the different innovative mechanisms for raising and channelling funds. Challenges included: variable definitions of innovative finance; small evidence base for many innovative finance mechanisms; insufficient experience in harmonisation of global health initiatives; and inadequate experience in use of international investments to improve maternal, newborn, and child health. The various mechanisms reviewed and finally recommended all had different characteristics, some focusing on specific problems and some on raising resources generally. Contentious issues included the potential role of the private sector, the rights-based approach to health, and the move to results-based aid. The challenges and disagreements that arose during the work of the Taskforce draw attention to the many issues facing decision makers in low-income countries. International donors and recipient governments should work together to improve the evidence base for strengthening health systems, increase long-term commitments, and improve accountability through transparent and inclusive national approaches. Copyright 2010 Elsevier Ltd. All rights reserved.

  9. Pediatric Central Nervous System Tumors in Nepal: Retrospective Analysis and Literature Review of Low- and Middle-Income Countries.

    Science.gov (United States)

    Azad, Tej D; Shrestha, Ram Kumar; Vaca, Silvia; Niyaf, Ali; Pradhananga, Amit; Sedain, Gopal; Sharma, Mohan R; Shilpakar, Sushil K; Grant, Gerald A

    2015-12-01

    Central nervous system (CNS) tumors are the most common cause of cancer-related death in children. Little is known about the demographics and treatment of pediatric brain tumors in low- and middle-income countries (LMICs). We performed a retrospective chart review of all pediatric patients who presented to the neurosurgical service at Tribhuvan University Teaching Hospital in Kathmandu, Nepal from 2009-2014 and collected information on patients tumor. We analyzed age, gender, clinical presentation, extent of surgical resection, histopathology, and length of hospital stay. We also conducted a literature review using specific terminology to capture studies of pediatric neuro-oncologic epidemiology conducted in LMICs. Study location, length of study, sample size, study type, and occurrence of 4 common pediatric brain tumors were extracted. We identified 39 cases of pediatric CNS tumors, with 62.5% observed in male children. We found that male children (median = 13 years) presented later than female children (median = 8 years). The most frequently observed pediatric brain tumor type was ependymoma (17.5%), followed by astrocytoma (15%) and medulloblastoma (15%). Surgical resection was performed for 80% of cases, and gross total resection reported in 62.9% of all surgeries. More than half (54.1%) of patients had symptoms for more than 28 days before seeking treatment. Symptomatic hydrocephalus was noted in 57.1% of children who presented with CNS tumors. The literature review yielded studies from 18 countries. Study length ranged from 2-20 years, and sample sizes varied from 35-1948. Overall, we found more pronounced variation in the relative frequencies of the most common pediatric brain tumors, compared with high-income countries. We present the first operative series of childhood CNS tumors in Nepal. Children often had delayed diagnosis and treatment of a tumor, despite symptoms. More comprehensive data are required to develop improved treatment and management

  10. Estimating the Prevalence of Toxic Waste Sites in Low- and Middle-Income Countries.

    Science.gov (United States)

    Dowling, Russell; Caravanos, Jack; Grigsby, Patrick; Rivera, Anthony; Ericson, Bret; Amoyaw-Osei, Yaw; Akuffo, Bennett; Fuller, Richard

    Exposure to heavy metals at contaminated industrial and mining sites, known also as hot spots, is a significant source of toxic exposure and adverse health outcomes in countries around the world. The Toxic Sites Identification Program (TSIP) developed by Pure Earth, a New York-based nongovernmental organization, is the only systematic effort to catalogue contaminated sites globally. To date, TSIP has identified and catalogued 3282 sites in low- and middle-income countries. The TSIP methodology is not designed to survey all contaminated sites in a country. Rather sites are prioritized based on their perceived impact on human health, and only a limited number of the most highly hazardous sites are surveyed. The total number of contaminated sites globally and the fraction of contaminated sites captured by TSIP is not known. To determine the TSIP site capture rate, the fraction of contaminated sites in a country catalogued by TSIP. Ghana was selected for this analysis because it is a rapidly industrializing lower middle income country with a heterogeneous industrial base, a highly urban population (51%), and good public records systems. To develop an estimate of the fraction of sites in Ghana captured by TSIP, assessors targeted randomly selected geographic quadrats for comprehensive assessment using area and population statistics from the Ghana Statistical Service. Investigators physically walked all accessible streets in each quadrat to visually identify all sites. Visual identification was supplemented by field-based confirmation with portable x-ray fluorescence instruments to test soils for metals. To extrapolate from survey findings to develop a range of estimates for the entire country, the investigators used 2 methodologies: a "bottom-up" approach that first estimated the number of waste sites in each region and then summed these regional subtotals to develop a total national estimate; and a "top-down" method that estimated the total number of sites in Ghana and

  11. The weight of work: the association between maternal employment and overweight in low- and middle-income countries.

    Science.gov (United States)

    Oddo, Vanessa M; Bleich, Sara N; Pollack, Keshia M; Surkan, Pamela J; Mueller, Noel T; Jones-Smith, Jessica C

    2017-10-18

    Maternal employment has increased in low-and middle-income countries (LMIC) and is a hypothesized risk factor for maternal overweight due to increased income and behavioral changes related to time allocation. However, few studies have investigated this relationship in LMIC. Using cross-sectional samples from Demographic and Health Surveys, we investigated the association between maternal employment and overweight (body mass index [BMI] ≥ 25 kg/m 2 ) among women in 38 LMIC (N = 162,768). We categorized mothers as formally employed, informally employed, or non-employed based on 4 indicators: employment status in the last 12 months; aggregate occupation category (skilled, unskilled); type of earnings (cash only, cash and in-kind, in-kind only, unpaid); and seasonality of employment (all year, seasonal/occasional employment). Formally employed women were largely employed year-round in skilled occupations and earned a wage (e.g. professional), whereas informally employed women were often irregularly employed in unskilled occupations and in some cases, were paid in-kind (e.g. domestic work). For within-country analyses, we used adjusted logistic regression models and included an interaction term to assess heterogeneity in the association by maternal education level. We then used meta-analysis and meta-regression to explore differences in the associations pooled across countries. Compared to non-employed mothers, formally employed mothers had higher odds of overweight (pooled odds ratio [POR] = 1.3; 95% Confidence Interval [CI] 1.2, 1.4) whereas informally employed mothers, compared to non-employed mothers, had lower odds of overweight (POR = 0.72; 95% CI: 0.64, 0.81). In 14 LMIC, the association varied by education. In these countries, the magnitude of the formal employment-overweight association was larger for women with low education (POR = 1.5; 95% CI: 1.1, 1.9) compared to those with high education (POR = 1.2; 95% CI: 1.0, 1.3). Formally employed

  12. Implementation strategies for health systems in low-income countries: an overview of systematic reviews.

    Science.gov (United States)

    Pantoja, Tomas; Opiyo, Newton; Lewin, Simon; Paulsen, Elizabeth; Ciapponi, Agustín; Wiysonge, Charles S; Herrera, Cristian A; Rada, Gabriel; Peñaloza, Blanca; Dudley, Lilian; Gagnon, Marie-Pierre; Garcia Marti, Sebastian; Oxman, Andrew D

    2017-09-12

    A key function of health systems is implementing interventions to improve health, but coverage of essential health interventions remains low in low-income countries. Implementing interventions can be challenging, particularly if it entails complex changes in clinical routines; in collaborative patterns among different healthcare providers and disciplines; in the behaviour of providers, patients or other stakeholders; or in the organisation of care. Decision-makers may use a range of strategies to implement health interventions, and these choices should be based on evidence of the strategies' effectiveness. To provide an overview of the available evidence from up-to-date systematic reviews about the effects of implementation strategies for health systems in low-income countries. Secondary objectives include identifying needs and priorities for future evaluations and systematic reviews on alternative implementation strategies and informing refinements of the framework for implementation strategies presented in the overview. We searched Health Systems Evidence in November 2010 and PDQ-Evidence up to December 2016 for systematic reviews. We did not apply any date, language or publication status limitations in the searches. We included well-conducted systematic reviews of studies that assessed the effects of implementation strategies on professional practice and patient outcomes and that were published after April 2005. We excluded reviews with limitations important enough to compromise the reliability of the review findings. Two overview authors independently screened reviews, extracted data and assessed the certainty of evidence using GRADE. We prepared SUPPORT Summaries for eligible reviews, including key messages, 'Summary of findings' tables (using GRADE to assess the certainty of the evidence) and assessments of the relevance of findings to low-income countries. We identified 7272 systematic reviews and included 39 of them in this overview. An additional four

  13. Performance of critical care prognostic scoring systems in low and middle-income countries: a systematic review.

    Science.gov (United States)

    Haniffa, Rashan; Isaam, Ilhaam; De Silva, A Pubudu; Dondorp, Arjen M; De Keizer, Nicolette F

    2018-01-26

    Prognostic models-used in critical care medicine for mortality predictions, for benchmarking and for illness stratification in clinical trials-have been validated predominantly in high-income countries. These results may not be reproducible in low or middle-income countries (LMICs), not only because of different case-mix characteristics but also because of missing predictor variables. The study objective was to systematically review literature on the use of critical care prognostic models in LMICs and assess their ability to discriminate between survivors and non-survivors at hospital discharge of those admitted to intensive care units (ICUs), their calibration, their accuracy, and the manner in which missing values were handled. The PubMed database was searched in March 2017 to identify research articles reporting the use and performance of prognostic models in the evaluation of mortality in ICUs in LMICs. Studies carried out in ICUs in high-income countries or paediatric ICUs and studies that evaluated disease-specific scoring systems, were limited to a specific disease or single prognostic factor, were published only as abstracts, editorials, letters and systematic and narrative reviews or were not in English were excluded. Of the 2233 studies retrieved, 473 were searched and 50 articles reporting 119 models were included. Five articles described the development and evaluation of new models, whereas 114 articles externally validated Acute Physiology and Chronic Health Evaluation, the Simplified Acute Physiology Score and Mortality Probability Models or versions thereof. Missing values were only described in 34% of studies; exclusion and or imputation by normal values were used. Discrimination, calibration and accuracy were reported in 94.0%, 72.4% and 25% respectively. Good discrimination and calibration were reported in 88.9% and 58.3% respectively. However, only 10 evaluations that reported excellent discrimination also reported good calibration

  14. Lessons learnt from human papillomavirus (HPV) vaccination in 45 low- and middle-income countries

    Science.gov (United States)

    Howard, Natasha; Kabakama, Severin; Mounier-Jack, Sandra; Griffiths, Ulla K.; Feletto, Marta; Burchett, Helen E. D.; LaMontagne, D. Scott; Watson-Jones, Deborah

    2017-01-01

    Objective To synthesise lessons learnt and determinants of success from human papillomavirus (HPV) vaccine demonstration projects and national programmes in low- and middle-income countries (LAMICs). Methods Interviews were conducted with 56 key informants. A systematic literature review identified 2936 abstracts from five databases; after screening 61 full texts were included. Unpublished literature, including evaluation reports, was solicited from country representatives; 188 documents were received. A data extraction tool and interview topic guide outlining key areas of inquiry were informed by World Health Organization guidelines for new vaccine introduction. Results were synthesised thematically. Results Data were analysed from 12 national programmes and 66 demonstration projects in 46 countries. Among demonstration projects, 30 were supported by the GARDASIL® Access Program, 20 by Gavi, four by PATH and 12 by other means. School-based vaccine delivery supplemented with health facility-based delivery for out-of-school girls attained high coverage. There were limited data on facility-only strategies and little evaluation of strategies to reach out-of-school girls. Early engagement of teachers as partners in social mobilisation, consent, vaccination day coordination, follow-up of non-completers and adverse events was considered invaluable. Micro-planning using school/ facility registers most effectively enumerated target populations; other estimates proved inaccurate, leading to vaccine under- or over-estimation. Refresher training on adverse events and safe injection procedures was usually necessary. Conclusion Considerable experience in HPV vaccine delivery in LAMICs is available. Lessons are generally consistent across countries and dissemination of these could improve HPV vaccine introduction. PMID:28575074

  15. Weight of nations: a socioeconomic analysis of women in low- to middle-income countries.

    Science.gov (United States)

    Subramanian, S V; Perkins, Jessica M; Özaltin, Emre; Davey Smith, George

    2011-02-01

    The increasing trend in body mass index (BMI) and overweight in rapidly developing economies is well recognized. We assessed the association between socioeconomic status and BMI and overweight in low- to middle-income countries. We conducted a cross-sectional analysis of nationally representative samples of 538,140 women aged 15-49 y drawn from 54 Demographic and Health Surveys conducted between 1994 and 2008. BMI, calculated as weight in kilograms divided by height squared in meters, was specified as the outcome, and a BMI (in kg/m(2)) of ≥25 was additionally specified to model the likelihood of being overweight. Household wealth and education were included as markers of individual socioeconomic status, and per capita Gross Domestic Product (pcGDP) was included as a marker of country-level economic development. Globally, a one-quartile increase in wealth was associated with a 0.54 increase in BMI (95% CI: 0.50, 0.64) and a 33% increase in overweight (95% CI: 26%, 41%) in adjusted models. Although the strength of this association varied across countries, the association between wealth and BMI and overweight was positive in 96% (52 of 54) of the countries. Similar patterns were observed in urban and rural areas, although SES gradients tended to be greater in urban areas. There was a positive association between pcGDP and BMI or overweight, with only weak evidence of an interaction between pcGDP and wealth. Higher BMI and overweight remain concentrated in higher socioeconomic groups, even though increasing BMI and overweight prevalence are important global public concerns.

  16. Socioeconomic inequalities in smoking in low and mid income countries: positive gradients among women?

    Science.gov (United States)

    Bosdriesz, Jizzo R; Mehmedovic, Selma; Witvliet, Margot I; Kunst, Anton E

    2014-02-06

    In Southern Europe, smoking among older women was more prevalent among the high educated than the lower educated, we call this a positive gradient. This is dominant in the early stages of the smoking epidemic model, later replaced by a negative gradient. The aim of this study is to assess if a positive gradient in smoking can also be observed in low and middle income countries in other regions of the world. We used data of the World Health Survey from 49 countries and a total of 233,917 respondents. Multilevel logistic regression was used to model associations between individual level smoking and both individual level and country level determinants. We stratified results by education, occupation, sex and generation (younger vs. older than 45). Countries were grouped based on GDP and region. In Eastern Europe and the Eastern Mediterranean, we observed a positive gradient in smoking among older women and a negative gradient among younger women. In Sub-Saharan Africa and Latin America no clear gradient was observed: inequalities were relatively small. In South-East Asia and East Asia a strong negative gradient was observed. Among men, no positive gradients were observed, and like women the strongest negative gradients were seen in South-East Asia and East Asia. A positive socio-economic gradient in smoking was found among older women in two regions, but not among younger women. But contrary to predictions derived from the smoking epidemic model, from a worldwide perspective the positive gradients are the exception rather than the rule.

  17. Human papillomavirus (HPV) vaccine coverage achievements in low and middle-income countries 2007-2016.

    Science.gov (United States)

    Gallagher, Katherine E; Howard, Natasha; Kabakama, Severin; Mounier-Jack, Sandra; Burchett, Helen E D; LaMontagne, D Scott; Watson-Jones, Deborah

    2017-12-01

    Since 2007, HPV vaccine has been available to low and middle income countries (LAMIC) for small-scale 'demonstration projects', or national programmes. We analysed coverage achieved in HPV vaccine demonstration projects and national programmes that had completed at least 6 months of implementation between January 2007-2016. A mapping exercise identified 45 LAMICs with HPV vaccine delivery experience. Estimates of coverage and factors influencing coverage were obtained from 56 key informant interviews, a systematic published literature search of 5 databases that identified 61 relevant full texts and 188 solicited unpublished documents, including coverage surveys. Coverage achievements were analysed descriptively against country or project/programme characteristics. Heterogeneity in data, funder requirements, and project/programme design precluded multivariate analysis. Estimates of uptake, schedule completion rates and/or final dose coverage were available from 41 of 45 LAMICs included in the study. Only 17 estimates from 13 countries were from coverage surveys, most were administrative data. Final dose coverage estimates were all over 50% with most between 70% and 90%, and showed no trend over time. The majority of delivery strategies included schools as a vaccination venue. In countries with school enrolment rates below 90%, inclusion of strategies to reach out-of-school girls contributed to obtaining high coverage compared to school-only strategies. There was no correlation between final dose coverage and estimated recurrent financial costs of delivery from cost analyses. Coverage achieved during joint delivery of HPV vaccine combined with another intervention was variable with little/no evaluation of the correlates of success. This is the most comprehensive descriptive analysis of HPV vaccine coverage in LAMICs to date. It is possible to deliver HPV vaccine with excellent coverage in LAMICs. Further good quality data are needed from health facility based

  18. Babies, soft drinks and snacks: a concern in low- and middle-income countries?

    Science.gov (United States)

    Huffman, Sandra L; Piwoz, Ellen G; Vosti, Stephen A; Dewey, Kathryn G

    2014-10-01

    Undernutrition in infants and young children is a global health priority while overweight is an emerging issue. Small-scale studies in low- and middle-income countries have demonstrated consumption of sugary and savoury snack foods and soft drinks by young children. We assessed the proportion of children 6-23 months of age consuming sugary snack foods in 18 countries in Asia and Africa using data from selected Demographic and Health Surveys and household expenditures on soft drinks and biscuits using data from four Living Standards Measurement Studies (LSMS). Consumption of sugary snack foods increased with the child's age and household wealth, and was generally higher in urban vs. rural areas. In one-third of countries, >20% of infants 6-8 months consumed sugary snacks. Up to 75% of Asian children and 46% of African children consumed these foods in the second year of life. The proportion of children consuming sugary snack foods was generally higher than the proportion consuming fortified infant cereals, eggs or fruit. Household per capita daily expenditures on soft drinks ranged from $0.03 to $0.11 in three countries for which LSMS data were available, and from $0.01 to $0.04 on biscuits in two LSMS. Future surveys should include quantitative data on the purchase and consumption of snack foods by infants and young children, using consistent definitions and methods for identifying and categorising snack foods across surveys. Researchers should assess associations between snack food consumption and stunting and overweight, and characterise household, maternal and child characteristics associated with snack food consumption. © 2014 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.

  19. Funding AIDS programmes in the era of shared responsibility: an analysis of domestic spending in 12 low-income and middle-income countries.

    Science.gov (United States)

    Resch, Stephen; Ryckman, Theresa; Hecht, Robert

    2015-01-01

    As the incomes of many AIDS-burdened countries grow and donors' budgets for helping to fight the disease tighten, national governments and external funding partners increasingly face the following question: what is the capacity of countries that are highly affected by AIDS to finance their responses from domestic sources, and how might this affect the level of donor support? In this study, we attempt to answer this question. We propose metrics to estimate domestic AIDS financing, using methods related to national prioritisation of health spending, disease burden, and economic growth. We apply these metrics to 12 countries in sub-Saharan Africa with a high prevalence of HIV/AIDS, generating scenarios of possible future domestic expenditure. We compare the results with total AIDS financing requirements to calculate the size of the resulting funding gaps and implications for donors. Nearly all 12 countries studied fall short of the proposed expenditure benchmarks. If they met these benchmarks fully, domestic spending on AIDS would increase by 2·5 times, from US$2·1 billion to $5·1 billion annually, covering 64% of estimated future funding requirements and leaving a gap of around a third of the total $7·9 billion needed. Although upper-middle-income countries, such as Botswana, Namibia, and South Africa, would become financially self-reliant, lower-income countries, such as Mozambique and Ethiopia, would remain heavily dependent on donor funds. The proposed metrics could be useful to stimulate further analysis and discussion around domestic spending on AIDS and corresponding donor contributions, and to structure financial agreements between recipient country governments and donors. Coupled with improved resource tracking, such metrics could enhance transparency and accountability for efficient use of money and maximise the effect of available funding to prevent HIV infections and save lives. US Centers for Disease Control and Prevention. Copyright © 2015 Hecht et

  20. Is wealthier always healthier in poor countries? The health implications of income, inequality, poverty, and literacy in India.

    Science.gov (United States)

    Rajan, Keertichandra; Kennedy, Jonathan; King, Lawrence

    2013-07-01

    Standard policy prescriptions for improving public health in less developed countries (LDCs) prioritise raising average income levels over redistributive policies since it is widely accepted that 'wealthier is healthier'. It is argued that income inequality becomes a significant predictor of public health only after the 'epidemiological transition'. This paper tests this theory in India, where rising income levels have not been matched by improvements in public health. We use state-, district-, and individual-level data to investigate the relationship between infant and under-five mortality, and average income, poverty, income inequality, and literacy. Our analysis shows that at both state- and district-level public health is negatively associated with average income and positively associated with poverty. But, at both levels, controlling for poverty and literacy renders average income statistically insignificant. At state-level, only literacy remains a significant and negative predictor. At the less aggregated district-level, both poverty and literacy predict public health but literacy has a stronger effect than poverty. Inequality does not predict public health at state- or district-levels. At the individual-level, however, it is a strong predictor of self-reported ailment, even after we control for district average income, individual income, and individual education. Our analysis suggests that wealthier is indeed healthier in India - but only to the extent that high average incomes reflect low poverty and high literacy. Furthermore, inequality has a strong effect on self-reported health. Standard policy prescriptions, then, need revision: first, alleviating poverty may be more effective than raising average income levels; second, non-income goods like literacy may make an important contribution to public health; and third, policy should be based on a broader understanding of societal well-being and the factors that promote it. Copyright © 2013 Elsevier Ltd. All

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

    Science.gov (United States)

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

    2015-01-01

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

  2. The Life Course Implications of Ready to Use Therapeutic Food for Children in Low-Income Countries.

    Science.gov (United States)

    Bazzano, Alessandra N; Potts, Kaitlin S; Bazzano, Lydia A; Mason, John B

    2017-04-11

    The development of ready-to-use therapeutic food (RUTF) for the treatment of uncomplicated cases of severe acute malnutrition in young children from 6 months to 5 years old has greatly improved survival through the ability to treat large numbers of malnourished children in the community setting rather than at health facilities during emergencies. This success has led to a surge in demand for RUTF in low income countries that are frequently food insecure due to environmental factors such as cyclical drought. Worldwide production capacity for the supply of RUTF has increased dramatically through the expansion and development of new manufacturing facilities in both low and high income countries, and new business ventures dedicated to ready-to-use foods have emerged not only for emergencies, but increasingly, for supplementing caloric intake of pregnant women and young children not experiencing acute undernutrition. Due to the lack of evidence on the long term health impact these products may have, in the midst of global nutrition transitions toward obesity and metabolic dysfunction, the increased use of manufactured, commercial products for treatment and prevention of undernutrition is of great concern. Using a framework built on the life course health development perspective, the current research presents several drawbacks and limitations of RUTF for nutrition of mothers and young children, especially in non-emergency situations. Recommendations follow for potential strategies to limit the use of these products to the treatment of acute undernutrition only, study the longer term health impacts of RUTF, prevent conflict of interests arising for social enterprises, and where possible, ensure that whole foods are supported for life-long health and nutrition, as well as environmental sustainability.

  3. Impacts of urbanization on national transport and road energy use: Evidence from low, middle and high income countries

    International Nuclear Information System (INIS)

    Poumanyvong, Phetkeo; Kaneko, Shinji; Dhakal, Shobhakar

    2012-01-01

    Few attempts have been made to investigate quantitatively and systematically the impact of urbanization on transport energy use for countries of different stages of economic development. This paper examines the influence of urbanization on national transport and road energy use for low, middle and high income countries during 1975–2005, using the Stochastic Impacts by Regression on Population, Affluence and Technology (STIRPAT) model. After controlling for population size, income per capita and the share of services in the economy, the main results suggest that urbanization influences national transport and road energy use positively. However, the magnitude of its influence varies among the three income groups. Changes in urbanization appear to have a greater impact on transport and road energy use in the high income group than in the other groups. Surprisingly, the urbanization elasticities of transport and road energy use in the middle income group are smaller than those of the low income group. This study not only sheds further light on the existing literature, but also provides policy makers with insightful information on the link between urbanization and transport energy use at the three different stages of development. - Highlights: ► Overall, urbanization increases national transport and road energy use. ► Urbanization elasticities of transport energy use differ across development stages. ► Urbanization elasticities in high-income group are higher than in other groups.

  4. Community Hospitals in Selected High Income Countries: A Scoping Review of Approaches and Models

    Directory of Open Access Journals (Sweden)

    Eleanor M Winpenny

    2016-11-01

    Full Text Available Background: There is no single definition of a community hospital in the UK, despite its long history. We sought to understand the nature and scope of service provision in community hospitals, within the UK and other high-income countries. Methods: We undertook a scoping review of literature on community hospitals published from 2005 to 2014. Data were extracted on features of the hospital model and the services provided, with results presented as a narrative synthesis. Results: 75 studies were included from ten countries. Community hospitals provide a wide range of services, with wide diversity of provision appearing to reflect local needs. Community hospitals are staffed by a mixture of general practitioners (GPs, nurses, allied health professionals and healthcare assistants. We found many examples of collaborative working arrangements between community hospitals and other health care organisations, including colocation of services, shared workforce with primary care and close collaboration with acute specialists. Conclusions: Community hospitals are able to provide a diverse range of services, responding to geographical and health system contexts. Their collaborative nature may be particularly important in the design of future models of care delivery, where emphasis is placed on integration of care with a key focus on patient-centred care.

  5. Home birth attendants in low income countries: who are they and what do they do?

    Science.gov (United States)

    2012-01-01

    Background Nearly half the world’s babies are born at home. We sought to evaluate the training, knowledge, skills, and access to medical equipment and testing for home birth attendants across 7 international sites. Methods Face-to-face interviews were done by trained interviewers to assess level of training, knowledge and practices regarding care during the antenatal, intrapartum and postpartum periods. The survey was administered to a sample of birth attendants conducting home or out-of-facility deliveries in 7 sites in 6 countries (India, Pakistan, Guatemala, Democratic Republic of the Congo, Kenya and Zambia). Results A total of 1226 home birth attendants were surveyed. Less than half the birth attendants were literate. Eighty percent had one month or less of formal training. Most home birth attendants did not have basic equipment (e.g., blood pressure apparatus, stethoscope, infant bag and mask manual resuscitator). Reporting of births and maternal and neonatal deaths to government agencies was low. Indian auxilliary nurse midwives, who perform some home but mainly clinic births, were far better trained and differed in many characteristics from the birth attendants who only performed deliveries at home. Conclusions Home birth attendants in low-income countries were often illiterate, could not read numbers and had little formal training. Most had few of the skills or access to tests, medications and equipment that are necessary to reduce maternal, fetal or neonatal mortality. PMID:22583622

  6. Home birth attendants in low income countries: who are they and what do they do?

    Directory of Open Access Journals (Sweden)

    Garces Ana

    2012-05-01

    Full Text Available Abstract Background Nearly half the world’s babies are born at home. We sought to evaluate the training, knowledge, skills, and access to medical equipment and testing for home birth attendants across 7 international sites. Methods Face-to-face interviews were done by trained interviewers to assess level of training, knowledge and practices regarding care during the antenatal, intrapartum and postpartum periods. The survey was administered to a sample of birth attendants conducting home or out-of-facility deliveries in 7 sites in 6 countries (India, Pakistan, Guatemala, Democratic Republic of the Congo, Kenya and Zambia. Results A total of 1226 home birth attendants were surveyed. Less than half the birth attendants were literate. Eighty percent had one month or less of formal training. Most home birth attendants did not have basic equipment (e.g., blood pressure apparatus, stethoscope, infant bag and mask manual resuscitator. Reporting of births and maternal and neonatal deaths to government agencies was low. Indian auxilliary nurse midwives, who perform some home but mainly clinic births, were far better trained and differed in many characteristics from the birth attendants who only performed deliveries at home. Conclusions Home birth attendants in low-income countries were often illiterate, could not read numbers and had little formal training. Most had few of the skills or access to tests, medications and equipment that are necessary to reduce maternal, fetal or neonatal mortality.

  7. Psychological and social consequences among mothers suffering from perinatal loss: perspective from a low income country

    Directory of Open Access Journals (Sweden)

    Ali Mohammed

    2011-06-01

    Full Text Available Abstract Background In developed countries, perinatal death is known to cause major emotional and social effects on mothers. However, little is known about these effects in low income countries which bear the brunt of perinatal mortality burden. This paper reports the impact of perinatal death on psychological status and social consequences among mothers in a rural area of Bangladesh. Methods A total of 476 women including 122 women with perinatal deaths were assessed with the Edinburgh Postnatal Depression Scale (EPDS-B at 6 weeks and 6 months postpartum, and followed up for negative social consequences at 6 months postpartum. Trained female interviewers carried out structured interviews at women's home. Results Overall 43% (95% CI: 33.7-51.8% of women with a perinatal loss at 6 weeks postpartum were depressed compared to 17% (95% CI: 13.7-21.9% with healthy babies (p = Conclusions This study highlights the greatly increased vulnerability of women with perinatal death to experience negative psychological and social consequences. There is an urgent need to develop appropriate mental health care services for mothers with perinatal deaths in Bangladesh, including interventions to develop positive family support.

  8. Psychological and social consequences among mothers suffering from perinatal loss: perspective from a low income country.

    Science.gov (United States)

    Gausia, Kaniz; Moran, Allisyn C; Ali, Mohammed; Ryder, David; Fisher, Colleen; Koblinsky, Marge

    2011-06-09

    In developed countries, perinatal death is known to cause major emotional and social effects on mothers. However, little is known about these effects in low income countries which bear the brunt of perinatal mortality burden. This paper reports the impact of perinatal death on psychological status and social consequences among mothers in a rural area of Bangladesh. A total of 476 women including 122 women with perinatal deaths were assessed with the Edinburgh Postnatal Depression Scale (EPDS-B) at 6 weeks and 6 months postpartum, and followed up for negative social consequences at 6 months postpartum. Trained female interviewers carried out structured interviews at women's home. Overall 43% (95% CI: 33.7-51.8%) of women with a perinatal loss at 6 weeks postpartum were depressed compared to 17% (95% CI: 13.7-21.9%) with healthy babies (p = death to experience negative psychological and social consequences. There is an urgent need to develop appropriate mental health care services for mothers with perinatal deaths in Bangladesh, including interventions to develop positive family support.

  9. Social cost of heavy drinking and alcohol dependence in high-income countries.

    Science.gov (United States)

    Mohapatra, Satya; Patra, Jayadeep; Popova, Svetlana; Duhig, Amy; Rehm, Jürgen

    2010-06-01

    A comprehensive review of cost drivers associated with alcohol abuse, heavy drinking, and alcohol dependence for high-income countries was conducted. The data from 14 identified cost studies were tabulated according to the potential direct and indirect cost drivers. The costs associated with alcohol abuse, alcohol dependence, and heavy drinking were calculated. The weighted average of the total societal cost due to alcohol abuse as percent gross domestic product (GDP)--purchasing power parity (PPP)--was 1.58%. The cost due to heavy drinking and/or alcohol dependence as percent GDP (PPP) was estimated to be 0.96%. On average, the alcohol-attributable indirect cost due to loss of productivity is more than the alcohol-attributable direct cost. Most of the countries seem to incur 1% or more of their GDP (PPP) as alcohol-attributable costs, which is a high toll for a single factor and an enormous burden on public health. The majority of alcohol-attributable costs incurred as a consequence of heavy drinking and/or alcohol dependence. Effective prevention and treatment measures should be implemented to reduce these costs.

  10. Hidden concerns of sharing research data by low/middle-income country scientists.

    Science.gov (United States)

    Bezuidenhout, Louise; Chakauya, Ereck

    2018-01-01

    There has considerable interest in bringing low/middle-income countries (LMIC) scientists into discussions on Open Data - both as contributors and users. The establishment of in situ data sharing practices within LMIC research institutions is vital for the development of an Open Data landscape in the Global South. Nonetheless, many LMICs have significant challenges - resource provision, research support and extra-laboratory infrastructures. These low-resourced environments shape data sharing activities, but are rarely examined within Open Data discourse. In particular, little attention is given to how these research environments shape scientists' perceptions of data sharing (dis)incentives. This paper expands on these issues of incentivizing data sharing, using data from a quantitative survey disseminated to life scientists in 13 countries in sub-Saharan Africa. This interrogated not only perceptions of data sharing amongst LMIC scientists, but also how these are connected to the research environments and daily challenges experienced by them. The paper offers a series of analysis around commonly cited (dis)incentives such as data sharing as a means of improving research visibility; sharing and funding; and online connectivity. It identifies key areas that the Open Data community need to consider if true openness in research is to be established in the Global South.

  11. Religiosity and Health Risk Behaviour Among University Students in 26 Low, Middle and High Income Countries.

    Science.gov (United States)

    Peltzer, Karl; Pengpid, Supa; Amuleru-Marshall, Omowale; Mufune, Pempelani; Zeid, Alaa Abou

    2016-12-01

    The aim of this study was to assess religiosity and health risk behaviours among university students from 26 low, middle and high income countries. Using anonymous questionnaires, data were collected from 20,222 undergraduate university students (mean age 20.8, SD = 2. 8) from 27 universities in 26 countries across Asia, Africa and the Americas. Among all students, 41.1 % engaged at least once a week in organized religious activity, 35.8 % practised a non-organized religious activity daily or more than once daily, and more or less two-thirds of the students agreed to the three different statements on intrinsic of subjective religiosity. In multivariate logistic regression analysis, higher reported involvement in organized religious activity was associated with addictive, injury, sexual and oral health risk behaviour, while lower reported involvement in organized religious activity was associated with physical inactivity and oral health risk behaviour. Lower reported involvement in non-organized religious activity was associated with addictive, nutrition risk, injury, sexual and oral health risk behaviour, while higher reported involvement in non-organized religious activity was associated with physical inactivity. Finally, lower reported intrinsic religiosity was associated with addictive and sexual risk behaviour, while higher reported intrinsic religiosity was associated with nutrition risk behaviour, physical inactivity and oral health risk behaviour.

  12. Impact of rotavirus vaccines in low and middle-income countries.

    Science.gov (United States)

    Sindhu, Kulandaipalayam Natarajan Chella; Babji, Sudhir; Ganesan, Santhosh Kumar

    2017-10-01

    Rotavirus vaccines are playing a pivotal role in improving lives of infants and young children in low and middle-income countries (LMICs). Many of these countries have adopted the vaccine into their routine immunization, whereas others are considering introduction. This article provides an update on the impact of rotavirus vaccines in LMICs on morbidity and mortality in children aged less than 5 years, and their cost-effectiveness. The WHO, in 2013, updated its recommendation to prioritize introduction of rotavirus vaccines in the routine immunization schedule, without age restrictions. Despite the decreased efficacy of the vaccines in LMICs, data from Sub-Saharan Africa have demonstrated a decrease in rotavirus-related morbidity, with some sites reporting an indirect protective effect on children age ineligible to receive the vaccine. Even with improvements in sanitation, nutritional status in children, and other health-related indices in LMICs, the use of rotavirus vaccines will play an important role in preventing rotavirus-related gastroenteritis. Economic models predict a reduction in economic burden because of rotavirus-related health costs, making vaccine introduction cost-effective in resource-constrained settings. Increasing evidence from impact studies shows the significant impact of rotavirus vaccination on hospitalizations and economic burden because of rotavirus gastroenteritis in LMICs. Universal rotavirus vaccination is recommended, and introductions should be monitored by robust surveillance systems to measure effectiveness and impact.

  13. Civic engagement among orphans and non-orphans in five low- and middle-income countries.

    Science.gov (United States)

    Gray, Christine L; Pence, Brian W; Messer, Lynne C; Ostermann, Jan; Whetten, Rachel A; Thielman, Nathan M; O'Donnell, Karen; Whetten, Kathryn

    2016-10-11

    Communities and nations seeking to foster social responsibility in their youth are interested in understanding factors that predict and promote youth involvement in public activities. Orphans and separated children (OSC) are a vulnerable population whose numbers are increasing, particularly in resource-poor settings. Understanding whether and how OSC are engaged in civic activities is important for community and world leaders who need to provide care for OSC and ensure their involvement in sustainable development. The Positive Outcomes for Orphans study (POFO) is a multi-country, longitudinal cohort study of OSC randomly sampled from institution-based care and from family-based care, and of non-OSC sampled from the same study regions. Participants represent six sites in five low-and middle-income countries. We examined civic engagement activities and government trust among subjects > =16 years old at 90-month follow-up (approximately 7.5 years after baseline). We calculated prevalences and estimated the association between key demographic variables and prevalence of regular volunteer work using multivariable Poisson regression, with sampling weights to accounting for the complex sampling design. Among the 1,281 POFO participants > =16 who were assessed at 90-month follow-up, 45 % participated in regular community service or volunteer work; two-thirds of those volunteers did so on a strictly voluntary basis. While government trust was fairly high, at approximately 70 % for each level of government, participation in voting was only 15 % among those who were > =18 years old. We did not observe significant associations between demographic characteristics and regular volunteer work, with the exception of large variation by study site. As the world's leaders grapple with the many competing demands of global health, economic security, and governmental stability, the participation of today's youth in community and governance is essential for

  14. A systematic review of hepatitis B screening economic evaluations in low- and middle-income countries.

    Science.gov (United States)

    Wright, Cameron M; Boudarène, Lydia; Ha, Ninh Thi; Wu, Olivia; Hawkins, Neil

    2018-03-20

    Chronic hepatitis B infection is a significant cause of morbidity and mortality worldwide; low- and middle-income countries (LMICs) are disproportionately affected. Economic evaluations are a useful decision tool to assess costs versus benefits of hepatitis B virus (HBV) screening. No published study reviewing economic evaluations of HBV screening in LMICs has been undertaken to date. The following databases were searched from inception to 21 April 2017: MEDLINE, PubMed, EMBASE, CINAHL Plus, the Cochrane Library, Global Health and the Cost-effectiveness Analysis Registry. English-language studies were included if they assessed the costs against the benefits of HBV screening in LMICs. PROSPERO registration: CRD42015024391, 20 July 2015. Nine studies fulfilled the eligibility criteria. One study from Thailand indicated that adding hepatitis B immunoglobulin (HBIG) to HBV vaccination for newborns following screening of pregnant women might be cost-effective for some LMICs, though inadequate total funding and health infrast