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Sample records for low-income countries lic

  1. Evidence for informing health policy development in Low-income Countries (LICs): perspectives of policy actors in Uganda.

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    Nabyonga-Orem, Juliet; Mijumbi, Rhona

    2015-03-08

    Although there is a general agreement on the benefits of evidence informed health policy development given resource constraints especially in Low-Income Countries (LICs), the definition of what evidence is, and what evidence is suitable to guide decision-making is still unclear. Our study is contributing to filling this knowledge gap. We aimed to explore health policy actors' views regarding what evidence they deemed appropriate to guide health policy development. Using exploratory qualitative methods, we conducted interviews with 51 key informants using an in-depth interview guide. We interviewed a diverse group of stakeholders in health policy development and knowledge translation in the Uganda health sector. Data were analyzed using inductive content analysis techniques. Different stakeholders lay emphasis on different kinds of evidence. While donors preferred international evidence and Ministry of Health (MoH) officials looked to local evidence, district health managers preferred local evidence, evidence from routine monitoring and evaluation, and reports from service providers. Service providers on the other hand preferred local evidence and routine monitoring and evaluation reports whilst researchers preferred systematic reviews and clinical trials. Stakeholders preferred evidence covering several aspects impacting on decision-making highlighting the fact that although policy actors look for factual information, they also require evidence on context and implementation feasibility of a policy decision. What LICs like Uganda categorize as evidence suitable for informing policy encompasses several types with no consensus on what is deemed as most appropriate. Evidence must be of high quality, applicable, acceptable to the users, and informing different aspects of decision-making. © 2015 by Kerman University of Medical Sciences.

  2. Evidence for Informing Health Policy Development in Low- Income Countries (LICS: Perspectives of Policy Actors in Uganda

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    Juliet Nabyonga-Orem

    2015-05-01

    Full Text Available Background Although there is a general agreement on the benefits of evidence informed health policy development given resource constraints especially in Low-Income Countries (LICs, the definition of what evidence is, and what evidence is suitable to guide decision-making is still unclear. Our study is contributing to filling this knowledge gap. We aimed to explore health policy actors’ views regarding what evidence they deemed appropriate to guide health policy development. Methods Using exploratory qualitative methods, we conducted interviews with 51 key informants using an indepth interview guide. We interviewed a diverse group of stakeholders in health policy development and knowledge translation in the Uganda health sector. Data were analyzed using inductive content analysis techniques. Results Different stakeholders lay emphasis on different kinds of evidence. While donors preferred international evidence and Ministry of Health (MoH officials looked to local evidence, district health managers preferred local evidence, evidence from routine monitoring and evaluation, and reports from service providers. Service providers on the other hand preferred local evidence and routine monitoring and evaluation reports whilst researchers preferred systematic reviews and clinical trials. Stakeholders preferred evidence covering several aspects impacting on decision-making highlighting the fact that although policy actors look for factual information, they also require evidence on context and implementation feasibility of a policy decision. Conclusion What LICslike Uganda categorize as evidence suitable for informing policy encompasses several types with no consensus on what is deemed as most appropriate. Evidence must be of high quality, applicable, acceptable to the users, and informing different aspects of decision-making.

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

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

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    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...

  5. 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...

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

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    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

  7. Treatment strategies and regimens of graduated intensity for childhood acute lymphoblastic leukemia in low-income countries: A proposal.

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    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.

  8. Scaling up Dietary Data for Decision-Making in Low-Income Countries: New Technological Frontiers.

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    Bell, Winnie; Colaiezzi, Brooke A; Prata, Cathleen S; Coates, Jennifer C

    2017-11-01

    Dietary surveys in low-income countries (LICs) are hindered by low investment in the necessary research infrastructure, including a lack of basic technology for data collection, links to food composition information, and data processing. The result has been a dearth of dietary data in many LICs because of the high cost and time burden associated with dietary surveys, which are typically carried out by interviewers using pencil and paper. This study reviewed innovative dietary assessment technologies and gauged their suitability to improve the quality and time required to collect dietary data in LICs. Predefined search terms were used to identify technologies from peer-reviewed and gray literature. A total of 78 technologies were identified and grouped into 6 categories: 1 ) computer- and tablet-based, 2 ) mobile-based, 3 ) camera-enabled, 4 ) scale-based, 5 ) wearable, and 6 ) handheld spectrometers. For each technology, information was extracted on a number of overarching factors, including the primary purpose, mode of administration, and data processing capabilities. Each technology was then assessed against predetermined criteria, including requirements for respondent literacy, battery life, requirements for connectivity, ability to measure macro- and micronutrients, and overall appropriateness for use in LICs. Few technologies reviewed met all the criteria, exhibiting both practical constraints and a lack of demonstrated feasibility for use in LICs, particularly for large-scale, population-based surveys. To increase collection of dietary data in LICs, development of a contextually adaptable, interviewer-administered dietary assessment platform is recommended. Additional investments in the research infrastructure are equally important to ensure time and cost savings for the user.

  9. Growth faltering in low-income countries.

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    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

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

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    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.

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

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    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.

  12. Domestic public debt in Low-Income Countries: Trends and structure

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    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.

  13. Overcoming Dietary Assessment Challenges in Low-Income Countries: Technological Solutions Proposed by the International Dietary Data Expansion (INDDEX) Project

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    Coates, Jennifer C.; Colaiezzi, Brooke A.; Bell, Winnie; Charrondiere, U. Ruth; Leclercq, Catherine

    2017-01-01

    An increasing number of low-income countries (LICs) exhibit high rates of malnutrition coincident with rising rates of overweight and obesity. Individual-level dietary data are needed to inform effective responses, yet dietary data from large-scale surveys conducted in LICs remain extremely limited. This discussion paper first seeks to highlight the barriers to collection and use of individual-level dietary data in LICs. Second, it introduces readers to new technological developments and research initiatives to remedy this situation, led by the International Dietary Data Expansion (INDDEX) Project. Constraints to conducting large-scale dietary assessments include significant costs, time burden, technical complexity, and limited investment in dietary research infrastructure, including the necessary tools and databases required to collect individual-level dietary data in large surveys. To address existing bottlenecks, the INDDEX Project is developing a dietary assessment platform for LICs, called INDDEX24, consisting of a mobile application integrated with a web database application, which is expected to facilitate seamless data collection and processing. These tools will be subject to rigorous testing including feasibility, validation, and cost studies. To scale up dietary data collection and use in LICs, the INDDEX Project will also invest in food composition databases, an individual-level dietary data dissemination platform, and capacity development activities. Although the INDDEX Project activities are expected to improve the ability of researchers and policymakers in low-income countries to collect, process, and use dietary data, the global nutrition community is urged to commit further significant investments in order to adequately address the range and scope of challenges described in this paper. PMID:28300759

  14. Surviving spinal cord injury in low income countries

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    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.

  15. Trends in health policy and systems research over the past decade: still too little capacity in low-income countries.

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    Adam, Taghreed; Ahmad, Saad; Bigdeli, Maryam; Ghaffar, Abdul; Røttingen, John-Arne

    2011-01-01

    The past decade has seen several high-level events and documents committing to strengthening the field of health policy and systems research (HPSR) as a critical input to strengthening health systems. Specifically, they called for increased production, capacity to undertake and funding for HPSR. The objective of this paper is to assess the extent to which progress has been achieved, an important feedback for stakeholders in this field. Two sources of data have been used. The first is a bibliometric analysis to assess growth in production of HPSR between 2003 and 2009. The six building blocks of the health system were used to define the scope of this search. The second is a survey of 96 research institutions undertaken in 2010 to assess the capacity and funding availability to undertake HPSR, compared with findings from the same survey undertaken in 2000 and 2008. Both analyses focus on HPSR relevant to low-income and middle-income countries (LMICs). Overall, we found an increasing trend of publications on HPSR in LMICs, although only 4% were led by authors from low-income countries (LICs). This is consistent with findings from the institutional survey, where despite improvements in infrastructure of research institutions, a minimal change has been seen in the level of experience of researchers within LIC institutions. Funding availability in LICs has increased notably to institutions in Sub-Saharan Africa; nonetheless, the overall increase has been modest in all regions. Although progress has been made in both the production and funding availability for HPSR, capacity to undertake the research locally has grown at a much slower pace, particularly in LICs where there is most need for this research. A firm commitment to dedicate a proportion of all future funding for research to building capacity may be the only solution to turn the tide.

  16. Trends in health policy and systems research over the past decade: still too little capacity in low-income countries.

    Directory of Open Access Journals (Sweden)

    Taghreed Adam

    Full Text Available BACKGROUND: The past decade has seen several high-level events and documents committing to strengthening the field of health policy and systems research (HPSR as a critical input to strengthening health systems. Specifically, they called for increased production, capacity to undertake and funding for HPSR. The objective of this paper is to assess the extent to which progress has been achieved, an important feedback for stakeholders in this field. METHODS AND FINDING: Two sources of data have been used. The first is a bibliometric analysis to assess growth in production of HPSR between 2003 and 2009. The six building blocks of the health system were used to define the scope of this search. The second is a survey of 96 research institutions undertaken in 2010 to assess the capacity and funding availability to undertake HPSR, compared with findings from the same survey undertaken in 2000 and 2008. Both analyses focus on HPSR relevant to low-income and middle-income countries (LMICs. Overall, we found an increasing trend of publications on HPSR in LMICs, although only 4% were led by authors from low-income countries (LICs. This is consistent with findings from the institutional survey, where despite improvements in infrastructure of research institutions, a minimal change has been seen in the level of experience of researchers within LIC institutions. Funding availability in LICs has increased notably to institutions in Sub-Saharan Africa; nonetheless, the overall increase has been modest in all regions. CONCLUSION: Although progress has been made in both the production and funding availability for HPSR, capacity to undertake the research locally has grown at a much slower pace, particularly in LICs where there is most need for this research. A firm commitment to dedicate a proportion of all future funding for research to building capacity may be the only solution to turn the tide.

  17. The influence of environmental and personal factors on participation of lower-limb prosthetic users in low-income countries: prosthetists' perspectives.

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    Kam, Season; Kent, Mallory; Khodaverdian, Alin; Daiter, Liane; Njelesani, Janet; Cameron, Debra; Andrysek, Jan

    2015-05-01

    To examine the environmental and personal factors in low-income countries (LICs) that influence prosthetic rehabilitation of adults with lower-limb (LL) amputations and their ability to participate in daily activities. In this qualitative descriptive study, 11 prosthetists participated in semi-structured interviews by telephone or Skype. Qualitative thematic analysis was guided by the International Classification of Function. Facilitating continuity of care, consideration of physical environments and usage, prosthetic quality including durability and socket fit, and minimizing the visibility of disability, were found to be important factors affecting the provision of prosthetic services in LICs. Environmental and personal factors must be considered when providing prosthetic rehabilitation for adults with LL amputations in LICs in order to optimize participation in activities. Results from this study provide new insights about some of the factors that influence the ability of individuals with LL amputations to rehabilitate to a level where they are able to participate in meaningful activities within their communities. There are unique environmental and personal components that can influence activity and participation of lower-limb (LL) prosthetic users in low-income countries (LICs). These components are often overlooked in the design of prosthetic devices and provision of prosthetic services. Continuity of care, condition of the post-surgical residuum, outdoor environments of common occupations, aesthetics and durability of prostheses, and user comfort should all be considered when providing prosthetic rehabilitation to adults with LL amputations in LICs to promote activity and participation. Results of our study can inform the practice of prosthetists in LICs by highlighting their contributions in enabling participation for LL prosthetic users. Our results can also inform the design of durable and comfortable prostheses and the provision of more appropriate

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

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    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

  19. Are the current recommendations for the use of aspirin in primary prevention of cardiovascular disease applicable in low-income countries?

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    Noubiap JJ

    2015-08-01

    Full Text Available Jean Jacques N Noubiap,1,2 Jobert Richie N Nansseu3,41Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa; 2Medical Diagnostic Center, Yaoundé, Cameroon; 3Sickle Cell Disease Unit, Mother and Child Centre, Chantal BIYA Foundation, Yaoundé, Cameroon; 4Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, CameroonAbstract: Although evidence has accumulated that long-term aspirin therapy is beneficial in secondary prevention of cardiovascular disease (CVD, a lot of controversies persist regarding the benefit of aspirin use in primary prevention of CVD. In low-income countries (LIC specifically, the decision to prescribe aspirin for primary CVD prevention is more problematic, as there is a dearth of evidence in this regard. Aspirin has been shown to have relative beneficial effects in preventing a first myocardial infarction, but not stroke. However, as stroke is the prevailing CVD in many LIC, especially in Africa, the benefit of aspirin in these settings is therefore questionable. Indeed, there is no published trial that has evaluated the benefits and risks of continuous aspirin therapy in populations of LIC. Furthermore, though cardiovascular risk assessment is crucial in decision-making for the use of aspirin in primary prevention of CVD, there are no risk assessment tools that have been validated in African populations. Studies are urgently warranted, to determine the usefulness of aspirin in primary prevention of CVD in low-income settings where the drug is highly available and affordable, as CVD is becoming the leading cause of deaths in LIC.Keywords: aspirin, cardiovascular disease, primary prevention, low-income countries

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

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    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.

  2. Lessons learned in shaping vaccine markets in low-income countries: a review of the vaccine market segment supported by the GAVI Alliance.

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    Gilchrist, Shawn A N; Nanni, Angeline

    2013-12-01

    The Global Alliance for Vaccines and Immunization (GAVI) anticipated that growing demand for new vaccines could sufficiently impact the vaccines market to allow low-income countries (LICs) to self-finance new vaccines. But the time required to lower vaccine prices was underestimated and the amount that prices would decline overestimated. To better understand how prices in the LIC vaccine market can be impacted, the vaccine market was retrospectively examined. GAVI archives and the published literature on the vaccine markets in LICs were reviewed for the purpose of identifying GAVI's early assumptions for the evolution of vaccine prices, and contrasting these retrospectively with actual outcomes. The prices in Phases I and II of GAVI-supported vaccines failed to decline to a desirable level within a projected 5-year timeframe. GAVI-eligible countries were unable to sustain newly introduced vaccines without prolonged donor support. Two key lessons can be applied to future vaccine market-shaping strategies: (1) accurate demand forecasting together with committed donor funding can increase supply to the LIC vaccines market, but even greater strides can be made to increase the certainty of purchase; and (2) the expected time to lower prices took much longer than 5 years; market competition is inherently linked to the development time for new vaccines--a minimum of 5-10 or more years. Other factors that can lower vaccine prices include: large-scale production or alternate financing mechanisms that can hasten vaccine price maturation. The impacts of competition on vaccine prices in the LIC new-vaccines market occurred after almost 10 years. The time for research and development, acquisition of technological know-how and to scale production must be accounted for to more accurately predict significant declines on vaccine prices. Alternate financing mechanisms and the use of purchase agreements should also be considered for lowering prices when planning new vaccine

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

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    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.

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

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    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.

  5. Vital Signs Directed Therapy: Improving Care in an Intensive Care Unit in a Low-Income Country.

    Directory of Open Access Journals (Sweden)

    Tim Baker

    Full Text Available Global Critical Care is attracting increasing attention. At several million deaths per year, the worldwide burden of critical illness is greater than generally appreciated. Low income countries (LICs have a disproportionally greater share of critical illness, and yet critical care facilities are scarce in such settings. Routines utilizing abnormal vital signs to identify critical illness and trigger medical interventions have become common in high-income countries but have not been investigated in LICs. The aim of the study was to assess whether the introduction of a vital signs directed therapy protocol improved acute care and reduced mortality in an Intensive Care Unit (ICU in Tanzania.Prospective, before-and-after interventional study in the ICU of a university hospital in Tanzania. A context-appropriate protocol that defined danger levels of severely abnormal vital signs and stipulated acute treatment responses was implemented in a four week period using sensitisation, training, job aids, supervision and feedback. Acute treatment of danger signs at admission and during care in the ICU and in-hospital mortality were compared pre and post-implementation using regression models. Danger signs from 447 patients were included: 269 pre-implementation and 178 post-implementation. Acute treatment of danger signs was higher post-implementation (at admission: 72.9% vs 23.1%, p<0.001; in ICU: 16.6% vs 2.9%, p<0.001. A danger sign was five times more likely to be treated post-implementation (Prevalence Ratio (PR 4.9 (2.9-8.3. Intravenous fluids were given in response to 35.0% of hypotensive episodes post-implementation, as compared to 4.1% pre-implementation (PR 6.4 (2.5-16.2. In patients admitted with hypotension, mortality was lower post-implementation (69.2% vs 92.3% p = 0.02 giving a numbers-needed-to-treat of 4.3. Overall in-hospital mortality rates were unchanged (49.4% vs 49.8%, p = 0.94.The introduction of a vital signs directed therapy protocol

  6. 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.

  7. 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.

  8. 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...

  9. 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...

  10. Reviewing the application of the balanced scorecard with implications for low-income health settings.

    Science.gov (United States)

    Rabbani, Fauziah; Jafri, S M Wasin; Abbas, Farhat; Pappas, Gregory; Brommels, Mats; Tomson, Goran

    2007-01-01

    High-income countries (HICs) are increasingly making use of the balanced scorecard (BSC) in healthcare. Evidence about BSC usage in low-income countries (LICs) is deficient. This study assessed feasibility of BSC use in LICs. Systematic review of electronic databases shows that the BSC improved patient, staff, clinical, and financial outcomes in HICs. To translate the experience of BSC use in HICs to their use in LICs, the applicability parameters of the National Committee for Quality Assurance were applied. Despite contextual challenges, pilot testing of BSC use can be undertaken in selected LICs. Committed leadership, cultural readiness, quality information systems, viable strategic plans, and optimum resources are required.

  11. 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

  12. 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

  13. 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

  14. 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.

  15. 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...

  16. 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.

  17. 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...

  18. 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.

  19. 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

  20. 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

  1. 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...

  2. 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...

  3. 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

  4. 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.

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

    Science.gov (United States)

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

    2018-01-01

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

  6. 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

  7. 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

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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

  15. 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.

  16. Are social franchises contributing to universal access to reproductive health services in low-income countries?

    Science.gov (United States)

    Sundari Ravindran, T K; Fonn, Sharon

    2011-11-01

    A social franchise in health is a network of for-profit private health practitioners linked through contracts to provide socially beneficial services under a common brand. The early 21st century has seen considerable donor enthusiasm for promoting social franchises for the provision of reproductive health services. Based on a compendium of descriptive information on 45 clinical social franchises, located in 27 countries of Africa, Asia and Latin America, this paper examines their contribution to universal access to comprehensive reproductive health services. It finds that these franchises have not widened the range of reproductive health services, but have mainly focused on contraceptive services, and to a lesser extent, maternal health care and abortion. In many instances, coverage had not been extended to new areas. Measures taken to ensure sustainability ran counter to the objective of access for low-income groups. In almost two-thirds of the franchises, the full cost of all services had to be paid out of pocket and was unaffordable for low-income women. While standards and protocols for quality assurance were in place in all franchises, evidence on adherence to these was limited. Informal interviews with patients indicated satisfaction with services. However, factors such as difficulties in recruiting franchisees and significant attrition, franchisees' inability to attend training programmes, use of lay health workers to deliver services without support or supervision, and logistical problems with applying quality assurance tools, all raise concerns. The contribution of social franchises to universal access to reproductive health services appears to be uncertain. Continued investment in them for the provision of reproductive health services does not appear to be justified until and unless further evidence of their value is forthcoming. Copyright © 2011 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

  17. 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

  18. Acute Care Referral Systems in Liberia: Transfer and Referral Capabilities in a Low-Income Country.

    Science.gov (United States)

    Kim, Jimin; Barreix, Maria; Babcock, Christine; Bills, Corey B

    2017-12-01

    referral exist and could serve as the basis for a more robust system. Well-integrated acute care referral systems in low-income countries, like Liberia, may help to mitigate future public health crises by augmenting a country's capacity for emergency preparedness. Kim J , Barreix M , Babcock C , Bills CB . Acute care referral systems in Liberia: transfer and referral capabilities in a low-income country. Prehosp Disaster Med. 2017;32(6):642-650.

  19. 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

  20. 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.

  1. 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.

  2. 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.

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

    Science.gov (United States)

    Herrera, Cristian A; Lewin, Simon; Paulsen, Elizabeth; Ciapponi, Agustín; Opiyo, Newton; Pantoja, Tomas; Rada, Gabriel; Wiysonge, Charles S; Bastías, Gabriel; Garcia Marti, Sebastian; Okwundu, Charles I; Peñaloza, Blanca; Oxman, Andrew D

    2017-09-12

    Governance arrangements include changes in rules or processes that determine authority and accountability for health policies, organisations, commercial products and health professionals, as well as the involvement of stakeholders in decision-making. Changes in governance arrangements can affect health and related goals in numerous ways, generally through changes in authority, accountability, openness, participation and coherence. A broad overview of the findings of systematic reviews can help policymakers, their technical support staff and other stakeholders to identify strategies for addressing problems and improving the governance of their health systems. To provide an overview of the available evidence from up-to-date systematic reviews about the effects of governance arrangements for health systems in low-income countries. Secondary objectives include identifying needs and priorities for future evaluations and systematic reviews on governance arrangements and informing refinements of the framework for governance arrangements outlined 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 governance arrangements on patient outcomes (health and health behaviours), the quality or utilisation of healthcare services, resource use (health expenditures, healthcare provider costs, out-of-pocket payments, cost-effectiveness), healthcare provider outcomes (such as sick leave), or social outcomes (such as poverty, employment) and that were published after April 2005. We excluded reviews with limitations that were important enough to compromise the reliability of the findings of the review. Two overview authors independently screened reviews, extracted data and assessed the certainty of evidence using GRADE. We prepared

  4. 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

    2017-01-01

    Background 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. Objectives 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. Methods 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. Main results We identified 7272 systematic reviews and included 39 of

  5. 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.

  6. 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

    Delivery arrangements include changes in who receives care and when, who provides care, the working conditions of those who provide care, coordination of care amongst different providers, where care is provided, the use of information and communication technology to deliver care, and quality and safety systems. How services are delivered can have impacts on the effectiveness, efficiency and equity of health systems. This broad overview of the findings of systematic reviews can help policymakers and other stakeholders identify strategies for addressing problems and improve the delivery of services. To provide an overview of the available evidence from up-to-date systematic reviews about the effects of delivery arrangements for health systems in low-income countries. Secondary objectives include identifying needs and priorities for future evaluations and systematic reviews on delivery arrangements and informing refinements of the framework for delivery arrangements outlined in the review. 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 delivery 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 or employment) 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

  7. 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.

  8. Uterotonic use at home births in low-income countries: a literature review.

    Science.gov (United States)

    Flandermeyer, Dawn; Stanton, Cynthia; Armbruster, Deborah

    2010-03-01

    This literature review compiles data on rates of use, indications, types of provider, mode of administration, and dose of uterotonics used for home births in low-income countries, and identifies gaps meriting further research. Published and unpublished English language articles from 1995 through 2008 pertaining to home use of uterotonics were identified via electronic searches of medical and social science databases. In addition, bibliographies of articles were examined for eligible studies. Data were abstracted and analyzed by the objectives outlined for this review. Twenty-three articles met the inclusion/exclusion criteria. Use rates of uterotonics at home births ranged widely from 1% to 69%, with the large majority of observations from South Asia. Descriptive studies suggest that home use of uterotonics before delivery of the baby are predominantly administered by nonprofessionals to accelerate labor, and are not perceived as unsafe. To achieve maximum benefit and minimal harm, programs that increase access to uterotonics for postpartum hemorrhage prevention must take into account existing practices among pregnant women. Further research regarding access to uterotonics and intervention studies for provider behavior change regarding uterotonic use is warranted.

  9. Public health measures to control tuberculosis in low-income countries: ethics and human rights considerations.

    Science.gov (United States)

    Kraemer, J D; Cabrera, O A; Singh, J A; Depp, T B; Gostin, L O

    2011-06-01

    In low-income countries, tuberculosis (TB) control measures should be guided by ethical concerns and human rights obligations. Control programs should consider the principles of necessity, reasonableness and effectiveness of means, proportionality, distributive justice, and transparency. Certain measures-detention, infection control, and treatment to prevent transmission-raise particular concerns. While isolation is appropriate under certain circumstances, quarantine is never an acceptable control measure for TB, and any detention must be limited by necessity and conducted humanely. States have a duty to implement hospital infection control to the extent of their available resources and to provide treatment to health care workers (HCWs) infected on the job. HCWs, in turn, have an obligation to provide care unless conditions are unreasonably and unforeseeably unsafe. Finally, states have an obligation to provide adequate access to treatment, as a means of preventing transmission, as broadly as possible and in a non-discriminatory fashion. Along with treatment, states should provide support to increase treatment adherence and retention with respect for patient privacy and autonomy. Compulsory treatment is almost never acceptable. Governments should take care to respect human rights and ethical obligations as they execute TB control programs.

  10. 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.

  11. Barriers to obstetric fistula treatment in low-income countries: a systematic review.

    Science.gov (United States)

    Baker, Zoë; Bellows, Ben; Bach, Rachel; Warren, Charlotte

    2017-08-01

    To identify the barriers faced by women living with obstetric fistula in low-income countries that prevent them from seeking care, reaching medical centres and receiving appropriate care. Bibliographic databases, grey literature, journals, and network and organisation websites were searched in English and French from June to July 2014 and again from August to November 2016 using key search terms and specific inclusion and exclusion criteria for discussion of barriers to fistula treatment. Experts provided recommendations for additional sources. Of 5829 articles screened, 139 were included in the review. Nine groups of barriers to treatment were identified: psychosocial, cultural, awareness, social, financial, transportation, facility shortages, quality of care and political leadership. Interventions to address barriers primarily focused on awareness, facility shortages, transportation, financial and social barriers. At present, outcome data, though promising, are sparse and the success of interventions in providing long-term alleviation of barriers is unclear. Results from the review indicate that there are many barriers to fistula treatment, which operate at the individual, community and national levels. The successful treatment of obstetric fistula may thus require targeting several barriers, including depression, stigma and shame, lack of community-based referral mechanisms, financial cost of the procedure, transportation difficulties, gender power imbalances, the availability of facilities that offer fistula repair, community reintegration and the competing priorities of political leadership. © 2017 John Wiley & Sons Ltd.

  12. Integrating mental health in primary healthcare in low-income countries

    DEFF Research Database (Denmark)

    Sørensen, Carina Winkler; Bæk, Ole; Kallestrup, Per

    2017-01-01

    . AIMS: This paper seeks to explore the rationale behind the WHO recommendations for improving mental health services in LICs. At the core of these recommendations is an integration of mental health services into existing primary healthcare. This article presents available research supporting...... from LICs that investigate mental health interventions is scarce. The evidence that does exist favours integration into primary healthcare. There is evidence that collaborative- and stepped-care interventions can provide viable treatment options for patients. CONCLUSION: Integration of mental health...... services into primary healthcare seems like a viable solution to ensure that treatment becomes more available, even though the evidence is limited. Locally conducted research is needed to guide the development of sustainable evidence-based mental health treatment, involving relevant healthcare providers...

  13. 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

    Background Delivery arrangements include changes in who receives care and when, who provides care, the working conditions of those who provide care, coordination of care amongst different providers, where care is provided, the use of information and communication technology to deliver care, and quality and safety systems. How services are delivered can have impacts on the effectiveness, efficiency and equity of health systems. This broad overview of the findings of systematic reviews can help policymakers and other stakeholders identify strategies for addressing problems and improve the delivery of services. Objectives To provide an overview of the available evidence from up-to-date systematic reviews about the effects of delivery arrangements for health systems in low-income countries. Secondary objectives include identifying needs and priorities for future evaluations and systematic reviews on delivery arrangements and informing refinements of the framework for delivery arrangements outlined in the review. 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 delivery 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 or employment) 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

  14. Nutritional status of children from low-income countries arriving in Spain.

    Science.gov (United States)

    Belhassen-García, Moncef; Velasco-Tirado, Virginia; Lopez-Bernus, Amparo; Muñoz Bellido, Juan Luis; Muro, Antonio; Cordero, Miguel; Pardo-Lledias, Javier

    2017-09-01

    Nutritional problems, anaemia and infectious diseases are the main causes of morbidity and mortality in children and adolescents in tropical and subtropical areas. The main objective of this study was to determine the nutritional status in children from low-income countries who migrated to Spain and the value of the usual biochemistry markers of nutrition in these children, as well as to evaluate the nutritional status associated with imported infectious diseases. Moreover, we evaluated the association between anaemia and nutrition problems. We prospectively evaluated immigrants younger than 18 years of age, from tropical or subtropical areas, who were referred on suspicion of or screening for imported diseases. Detailed medical records and physical and oral examinations were obtained. Blood count and biochemical measures of micronutrients and nutritional biomarkers were performed. We included microbiological methods for diagnosing imported infectious diseases according to the region of origin and clinical setting. 373 minors were evaluated, including 250 (67.0%) from sub-Saharan Africa, 67 (18.0%) from North Africa and 56 (15.0%) from Latin America. The mean BMI of the subjects was 19.8±0.2. BMI increased by 0.02 for each month of stay in Spain. Nineteen patients (6.8%) had a nutritional risk of growth problems, and 50 (17.8%) were overweight. The time since arrival was longer in patients who were overweight (pnutritional issue. A low level of ferritin is the most frequently detected nutritional problem and the main cause of anaemia. © The Author 2017. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  15. 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.

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

    Science.gov (United States)

    Herrera, Cristian A; Lewin, Simon; Paulsen, Elizabeth; Ciapponi, Agustín; Opiyo, Newton; Pantoja, Tomas; Rada, Gabriel; Wiysonge, Charles S; Bastías, Gabriel; Garcia Marti, Sebastian; Okwundu, Charles I; Peñaloza, Blanca; Oxman, Andrew D

    2017-01-01

    Background Governance arrangements include changes in rules or processes that determine authority and accountability for health policies, organisations, commercial products and health professionals, as well as the involvement of stakeholders in decision-making. Changes in governance arrangements can affect health and related goals in numerous ways, generally through changes in authority, accountability, openness, participation and coherence. A broad overview of the findings of systematic reviews can help policymakers, their technical support staff and other stakeholders to identify strategies for addressing problems and improving the governance of their health systems. Objectives To provide an overview of the available evidence from up-to-date systematic reviews about the effects of governance arrangements for health systems in low-income countries. Secondary objectives include identifying needs and priorities for future evaluations and systematic reviews on governance arrangements and informing refinements of the framework for governance arrangements outlined 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 governance arrangements on patient outcomes (health and health behaviours), the quality or utilisation of healthcare services, resource use (health expenditures, healthcare provider costs, out-of-pocket payments, cost-effectiveness), healthcare provider outcomes (such as sick leave), or social outcomes (such as poverty, employment) and that were published after April 2005. We excluded reviews with limitations that were important enough to compromise the reliability of the findings of the review. Two overview authors independently screened reviews, extracted data and assessed the certainty of evidence

  17. Health workforce skill mix and task shifting in low income countries: a review of recent evidence

    Directory of Open Access Journals (Sweden)

    Auh Erica

    2011-01-01

    Full Text Available Abstract Background Health workforce needs-based shortages and skill mix imbalances are significant health workforce challenges. Task shifting, defined as delegating tasks to existing or new cadres with either less training or narrowly tailored training, is a potential strategy to address these challenges. This study uses an economics perspective to review the skill mix literature to determine its strength of the evidence, identify gaps in the evidence, and to propose a research agenda. Methods Studies primarily from low-income countries published between 2006 and September 2010 were found using Google Scholar and PubMed. Keywords included terms such as skill mix, task shifting, assistant medical officer, assistant clinical officer, assistant nurse, assistant pharmacist, and community health worker. Thirty-one studies were selected to analyze, based on the strength of evidence. Results First, the studies provide substantial evidence that task shifting is an important policy option to help alleviate workforce shortages and skill mix imbalances. For example, in Mozambique, surgically trained assistant medical officers, who were the key providers in district hospitals, produced similar patient outcomes at a significantly lower cost as compared to physician obstetricians and gynaecologists. Second, although task shifting is promising, it can present its own challenges. For example, a study analyzing task shifting in HIV/AIDS in sub-Saharan Africa noted quality and safety concerns, professional and institutional resistance, and the need to sustain motivation and performance. Third, most task shifting studies compare the results of the new cadre with the traditional cadre. Studies also need to compare the new cadre's results to the results from the care that would have been provided--if any care at all--had task shifting not occurred. Conclusions Task shifting is a promising policy option to increase the productive efficiency of the delivery of health

  18. 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.

  19. 'Tweaking' the model for understanding and preventing maternal and neonatal morbidity and mortality in Low Income Countries: "inserting new ideas into a timeless wine skin".

    Science.gov (United States)

    Mwaniki, Michael K; Baya, Evaline J; Mwangi-Powell, Faith; Sidebotham, Peter

    2016-01-25

    Maternal and neonatal morbidity and mortality in Low Income Countries, especially in sub-Saharan Africa involves numerous interrelated causes. The three-delay model/framework was advanced to better understand the causes and associated Contextual factors. It continues to inform many aspects of programming and research on combating maternal and child morbidity and mortality in the said countries. Although this model addresses some of the core areas that can be targeted to drastically reduce maternal and neonatal morbidity and mortality, it potentially omits other critical facets especially around primary prevention, and pre- and post-hospitalization continuum of care. The final causes of Maternal and Neonatal mortality and morbidity maybe limited to a few themes largely centering on infections, preterm births, and pregnancy and childbirth related complications. However, to effectively tackle these causes of morbidity and mortality, a broad based approach is required. Some of the core issues that need to be addressed include:-i) prevention of vertically transmitted infections, intra-partum related adverse events and broad primary prevention strategies, ii) overall health care seeking behavior and delays therein, iii) quality of care at point of service delivery, and iv) post-insult treatment follow up and rehabilitation. In this article we propose a five-pronged framework that takes all the above into consideration. This frameworks further builds on the three-delay model and offers a more comprehensive approach to understanding and preventing maternal and neonatal morbidity and mortality in Low Income Countries In shaping the post 2015 agenda, the scope of engagement in maternal and newborn health need to be widened if further gains are to be realized and sustained. Our proposed five pronged approach incorporates the need for continued investment in tackling the recognized three delays, but broadens this to also address earlier aspects of primary prevention, and the

  20. Simulation in Pre-departure Training for Residents Planning Clinical Work in a Low-Income Country

    Directory of Open Access Journals (Sweden)

    Kevin R. Schwartz

    2015-12-01

    Full Text Available Introduction: Increasingly, pediatric and emergency medicine (EM residents are pursuing clinical rotations in low-income countries. Optimal pre-departure preparation for such rotations has not yet been established. High-fidelity simulation represents a potentially effective modality for such preparation. This study was designed to assess whether a pre-departure high-fidelity medical simulation curriculum is effective in helping to prepare residents for clinical rotations in a low-income country. Methods: 43 pediatric and EM residents planning clinical rotations in Liberia, West Africa, participated in a simulation-based curriculum focused on severe pediatric malaria and malnutrition and were then assessed by survey at three time points: pre-simulation, post-simulation, and after returning from work abroad. Results: Prior to simulation, 1/43 (2% participants reported they were comfortable with the diagnosis and management of severe malnutrition; this increased to 30/42 (71% after simulation and 24/31 (77% after working abroad. Prior to simulation, 1/43 (2% of residents reported comfort with the diagnosis and management of severe malaria; this increased to 26/42 (62% after simulation and 28/31 (90% after working abroad; 36/42 (86% of residents agreed that a simulation-based global health curriculum is more useful than a didactic curriculum alone, and 41/42 (98% felt a simulator-based curriculum should be offered to all residents planning a clinical trip to a low-income country. Conclusion: High-fidelity simulation is effective in increasing residents’ self-rated comfort in management of pediatric malaria and malnutrition and a majority of participating residents feel it should be included as a component of pre-departure training for all residents rotating clinically to low-income countries.

  1. 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.

  2. 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.

  3. Excess mortality in women of reproductive age from low-income countries: a Swedish national register study.

    Science.gov (United States)

    Esscher, Annika; Haglund, Bengt; Högberg, Ulf; Essén, Birgitta

    2013-04-01

    Cause-of-death statistics is widely used to monitor the health of a population. African immigrants have, in several European studies, shown to be at an increased risk of maternal death, but few studies have investigated cause-specific mortality rates in female immigrants. In this national study, based on the Swedish Cause of Death Register, we studied 27,957 women of reproductive age (aged 15-49 years) who died between 1988 and 2007. Age-standardized mortality rates per 100,000 person years and relative risks for death and underlying causes of death, grouped according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, were calculated and compared between women born in Sweden and in low-, middle- and high-income countries. The total age-standardized mortality rate per 100,000 person years was significantly higher for women born in low-income (84.4) and high-income countries (83.7), but lower for women born in middle-income countries (57.5), as compared with Swedish-born women (68.1). The relative risk of dying from infectious disease was 15.0 (95% confidence interval 10.8-20.7) and diseases related to pregnancy was 6.6 (95% confidence interval 2.6-16.5) for women born in low-income countries, as compared to Swedish-born women. Women born in low-income countries are at the highest risk of dying during reproductive age in Sweden, with the largest discrepancy in mortality rates seen for infectious diseases and diseases related to pregnancy, a cause of death pattern similar to the one in their countries of birth. The World Bank classification of economies may be a useful tool in migration research.

  4. Causality between trade openness and energy consumption: What causes what in high, middle and low income countries

    International Nuclear Information System (INIS)

    Shahbaz, Muhammad; Nasreen, Samia; Ling, Chong Hui; Sbia, Rashid

    2014-01-01

    This paper explores the relationship between trade openness and energy consumption using data of 91 high, middle and low income countries. The study covers the period of 1980–2010. We have applied panel cointegration to examine long run relationship between the variables. The direction of causal relationship between trade openness is investigated by applying Homogenous non-causality, Homogenous causality and Heterogeneous causality tests. Our variables are integrated at I(1) confirmed by time series and panel unit root tests and cointegration is found between trade openness and energy consumption. The relationship between trade openness and energy consumption is inverted U-shaped in high income countries but U-shaped in middle and low income countries. The homogenous and non-homogenous causality analysis reveals the bidirectional causality between trade openness and energy consumption. This paper opens up new insights for policy makers to design a comprehensive economic, trade and policies for sustainable economic growth in long run following heterogeneous causality findings. - Highlights: • Trade openness and energy consumption are cointegrated for long run. • The feedback effect exists between trade openness and energy consumption. • The inverted U-shaped relationship is found between both variables in high income countries

  5. Forecasting and Monetary Policy Analysis in Low-Income Countries; Food and non-Food Inflation in Kenya

    OpenAIRE

    Michal Andrle; Andrew Berg; R. Armando Morales; Rafael Portillo; Jan Vlcek

    2013-01-01

    We develop a semi-structural new-Keynesian open-economy model, with separate food and non-food inflation dynamics, for forecasting and monetary policy analysis in low-income countries and apply it to Kenya. We use the model to run several policy-relevant exercises. First, we filter international and Kenyan data (on output, inflation and its components, exchange rates and interest rates) to recover a model-based decomposition of most variables into trends (or potential values) and temporary mo...

  6. The health professions and the performance of future health systems in low-income countries: support or obstacle?

    Science.gov (United States)

    Dussault, Gilles

    2008-05-01

    This paper discusses the present and future role of the health professions in health services delivery systems in low-income countries. Unlike richer countries, most low-income countries do not have a tradition of labour market regulation and the capacity of the professions themselves to regulate the provision of health services by their members tends to be weak. The paper looks at the impact of professional monopolies on the performance of health services delivery systems, e.g. equity of access, effectiveness of services, efficiency in the use of scarce resources, responsiveness to users' needs, including protection against the financial impact of utilising health services. It identifies issues which policy-makers face in relation to opening the health labour market while guaranteeing the safety and security of services provided by professionals. The suggestion is made that a "social contract", granting privileges of practice in exchange of a commitment to actively maintain and enhance the quality of their services, may be a viable course of action. This would require that the actors in the policy process collaborate in strengthening the capacity of regulatory agencies to perform their role.

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

    Directory of Open Access Journals (Sweden)

    Dieleman Marjolein

    2008-01-01

    Full Text Available Abstract 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 most damaging effects of severely weakened and under-resourced health systems is the difficulty they face in producing, recruiting, and retaining health professionals, particularly in remote areas. Low wages, poor working conditions, lack of supervision, lack of equipment and infrastructure as well as HIV and AIDS, all contribute to the flight of health care personnel from remote areas. In this global context of accelerating inequities health service policy makers and managers are searching for ways to improve the attraction and retention of staff in remote areas. But the development of appropriate strategies first requires an understanding of the factors which influence decisions to accept and/or stay in a remote post, particularly in the context of mid and low income countries (MLICS, and which strategies to improve attraction and retention are therefore likely to be successful. It is the aim of this review article to explore the links between attraction and retention factors and strategies, with a particular focus on the organisational diversity and location of decision-making. Methods This is a narrative literature review which took an iterative approach to finding relevant literature. It focused on English-language material published between 1997 and 2007. The authors conducted Pubmed searches using a range of different search terms relating to attraction and retention of staff in remote areas. Furthermore, a number of relevant journals as well as unpublished literature were systematically searched. While the initial search included articles from high- middle- and low-income countries, the review focuses on middle- and low-income

  8. HPV Testing from Dried Urine Spots as a Tool for Cervical Cancer Screening in Low-Income Countries.

    Science.gov (United States)

    Frati, Elena Rosanna; Martinelli, Marianna; Fasoli, Ester; Colzani, Daniela; Bianchi, Silvia; Binda, Sandro; Olivani, Pierfranco; Tanzi, Elisabetta

    2015-01-01

    Nowadays, several screening strategies are available to prevent cervical cancer, but inadequate resources, sociocultural barriers, and sampling issues impede their success in low-income countries. To overcome these issues, this study aimed to evaluate the performance of human papillomavirus (HPV) testing from dried urine spots (DUS). Eighty-eight urine samples (including 56 HPV DNA positive specimens) were spotted on filter paper, dried, and stored in paper-bags. HPV DNA was detected from the DUS after 1 week and 4 weeks of storage using a polymerase chain reaction (PCR) assay. The sensitivity, specificity, and concordance of the DUS-based HPV test were evaluated by comparing the results with those of HPV testing on fresh urine samples as the gold standard. The sensitivity of the test was 98.21% (95% CI: 90.56-99.68) for DUS stored for 1 week and 96.42% (95% CI: 87.88-99.01) for DUS stored for 4 weeks. The specificity was 100% (95% CI: 89.28-100) at both time points. The concordance between DUS and fresh urine HPV testing was "almost perfect" using the κ statistic. These preliminary data suggest that a DUS-based assay could bypass sociocultural barriers and sampling issues and therefore could be a suitable, effective tool for epidemiological surveillance and screening programs, especially in low-income countries.

  9. HPV Testing from Dried Urine Spots as a Tool for Cervical Cancer Screening in Low-Income Countries

    Directory of Open Access Journals (Sweden)

    Elena Rosanna Frati

    2015-01-01

    Full Text Available Nowadays, several screening strategies are available to prevent cervical cancer, but inadequate resources, sociocultural barriers, and sampling issues impede their success in low-income countries. To overcome these issues, this study aimed to evaluate the performance of human papillomavirus (HPV testing from dried urine spots (DUS. Eighty-eight urine samples (including 56 HPV DNA positive specimens were spotted on filter paper, dried, and stored in paper-bags. HPV DNA was detected from the DUS after 1 week and 4 weeks of storage using a polymerase chain reaction (PCR assay. The sensitivity, specificity, and concordance of the DUS-based HPV test were evaluated by comparing the results with those of HPV testing on fresh urine samples as the gold standard. The sensitivity of the test was 98.21% (95% CI: 90.56–99.68 for DUS stored for 1 week and 96.42% (95% CI: 87.88–99.01 for DUS stored for 4 weeks. The specificity was 100% (95% CI: 89.28–100 at both time points. The concordance between DUS and fresh urine HPV testing was “almost perfect” using the κ statistic. These preliminary data suggest that a DUS-based assay could bypass sociocultural barriers and sampling issues and therefore could be a suitable, effective tool for epidemiological surveillance and screening programs, especially in low-income countries.

  10. HPV Testing from Dried Urine Spots as a Tool for Cervical Cancer Screening in Low-Income Countries

    Science.gov (United States)

    Olivani, Pierfranco

    2015-01-01

    Nowadays, several screening strategies are available to prevent cervical cancer, but inadequate resources, sociocultural barriers, and sampling issues impede their success in low-income countries. To overcome these issues, this study aimed to evaluate the performance of human papillomavirus (HPV) testing from dried urine spots (DUS). Eighty-eight urine samples (including 56 HPV DNA positive specimens) were spotted on filter paper, dried, and stored in paper-bags. HPV DNA was detected from the DUS after 1 week and 4 weeks of storage using a polymerase chain reaction (PCR) assay. The sensitivity, specificity, and concordance of the DUS-based HPV test were evaluated by comparing the results with those of HPV testing on fresh urine samples as the gold standard. The sensitivity of the test was 98.21% (95% CI: 90.56–99.68) for DUS stored for 1 week and 96.42% (95% CI: 87.88–99.01) for DUS stored for 4 weeks. The specificity was 100% (95% CI: 89.28–100) at both time points. The concordance between DUS and fresh urine HPV testing was “almost perfect” using the κ statistic. These preliminary data suggest that a DUS-based assay could bypass sociocultural barriers and sampling issues and therefore could be a suitable, effective tool for epidemiological surveillance and screening programs, especially in low-income countries. PMID:26180790

  11. 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.

  12. What research tells us about knowledge transfer strategies to improve public health in low-income countries: a scoping review.

    Science.gov (United States)

    Siron, Stéphanie; Dagenais, Christian; Ridde, Valéry

    2015-11-01

    This study describes the current state of research on knowledge transfer strategies to improve public health in low-income countries, to identify the knowledge gaps on this topic. In this scoping review, a descriptive and systematic process was used to analyse, for each article retained, descriptions of research context and methods, types of knowledge transfer activities and results reported. 28 articles were analysed. They dealt with the evaluation of transfer strategies that employed multiple activities, mostly targeting health professionals and women with very young children. Most often these studies used quantitative designs and measurements of instrumental use with some methodological shortcomings. Results were positive and suggested recommendations for improving professional practices, knowledge and health-related behaviours. The review highlights the great diversity of transfer strategies used, strategies and many conditions for knowledge use. The review provides specific elements for understanding the transfer processes in low-income countries and highlights the need for systematic evaluation of the conditions for research results utilization.

  13. 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.

  14. The Desire for (Danish) Quality in High and Low Income Countries

    DEFF Research Database (Denmark)

    Nguyen, Daniel Xuyen

    with sales. These correlations are significantly different across destination countries within product categories, but across years for a given product-destination pair. While some existing theories perform better than others at predicting these patterns, none can reconcile the variation across countries......We estimate the correlation between firm prices and sales within a CN8 product-country-year market. We do this for every market to which at least 16 different Danish firms exported between 1999 and 2006. Approximately 60% of Danish exports are to markets in which the price is negatively correlated....... To fully explain the patterns, We introduce a model in which the price-sales correlation can be interpreted as the market's desire for high quality goods over low cost substitutes. We discover an inverted U shaped relation between a country's desire for quality and its per capita GDP, which we term...

  15. The association between ownership of common household devices and obesity and diabetes in high, middle and low income countries.

    Science.gov (United States)

    Lear, Scott A; Teo, Koon; Gasevic, Danijela; Zhang, Xiaohe; Poirier, Paul P; Rangarajan, Sumathy; Seron, Pamela; Kelishadi, Roya; Tamil, Azmi Mohd; Kruger, Annamarie; Iqbal, Romaina; Swidan, Hani; Gómez-Arbeláez, Diego; Yusuf, Rita; Chifamba, Jephat; Kutty, V Raman; Karsıdag, Kubilay; Kumar, Rajesh; Li, Wei; Szuba, Andrzej; Avezum, Alvaro; Diaz, Rafael; Anand, Sonia S; Rosengren, Annika; Yusuf, Salim

    2014-03-04

    Household devices (e.g., television, car, computer) are common in high income countries, and their use has been linked to obesity and type 2 diabetes mellitus. We hypothesized that device ownership is associated with obesity and diabetes and that these effects are explained through reduced physical activity, increased sitting time and increased energy intake. We performed a cross-sectional analysis using data from the Prospective Urban Rural Epidemiology study involving 153,996 adults from high, upper-middle, lower-middle and low income countries. We used multilevel regression models to account for clustering at the community and country levels. Ownership of a household device increased from low to high income countries (4% to 83% for all 3 devices) and was associated with decreased physical activity and increased sitting, dietary energy intake, body mass index and waist circumference. There was an increased odds of obesity and diabetes with the ownership of any 1 household device compared to no device ownership (obesity: odds ratio [OR] 1.43, 95% confidence interval [CI] 1.32-1.55; diabetes: OR 1.38, 95% CI 1.28-1.50). Ownership of a second device increased the odds further but ownership of a third device did not. Subsequent adjustment for lifestyle factors modestly attenuated these associations. Of the 3 devices, ownership of a television had the strongest association with obesity (OR 1.39, 95% CI 1.29-1.49) and diabetes (OR 1.33, 95% CI 1.23-1.44). When stratified by country income level, the odds of obesity and diabetes when owning all 3 devices was greatest in low income countries (obesity: OR 3.15, 95% CI 2.33-4.25; diabetes: OR 1.97, 95% CI 1.53-2.53) and decreased through country income levels such that we did not detect an association in high income countries. The ownership of household devices increased the likelihood of obesity and diabetes, and this was mediated in part by effects on physical activity, sitting time and dietary energy intake. With

  16. 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.

  17. 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.

  18. 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.

  19. 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

  20. 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.

  1. Safety and benefits of antenatal oral iron supplementation in low-income countries

    NARCIS (Netherlands)

    Mwangi, Martin N.; Prentice, Andrew M.; Verhoef, Hans

    2017-01-01

    The World Health Organization recommends universal iron supplementation of 30-60 mg/day in pregnancy but coverage is low in most countries. Its efficacy is uncertain, however, and there has been a vigorous debate in the last decade about its safety, particularly in areas with a high burden of

  2. 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.

  3. 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

  4. 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.

  5. Improving the Estimation of Local Welfare Costs of Conservation in Low-Income Countries Using Choice Experiments

    DEFF Research Database (Denmark)

    Rakotonarivo, Onjamirindra Sarobidy

    and comprises a systematic review and three field tests of DCE in a new REDD+ (Reducing Emissions from Deforestation and forest Degradation) project and national park in eastern Madagascar. I first conducted a systematic review of empirical evidence on the reliability and validity of DCEs when valuing non-market...... the validity of DCE in estimating the costs of conservation restrictions ex-ante. I found that experience of forest protection matters; households who have been exposed to forest protection for a comparatively longer period had significantly higher welfare costs for restricting forest clearance than those who...... techniques. It also has major implications for how forest conservation policy may be devised in low-income countries, including devolution of secure forestland tenure to local people and genuinely negotiating conservation with forest users....

  6. Short of transformation: American ADN students' thoughts, feelings, and experiences of studying abroad in a low-income country.

    Science.gov (United States)

    Foronda, Cynthia L; Belknap, Ruth Ann

    2012-06-03

    ADN students are a large yet distinct subgroup of nursing students who require research and understanding. The purpose of this study was to describe the thoughts, feelings, and experiences of American associate degree nursing (ADN) students who participated in a short study abroad course in a low-income country. A qualitative, narrative method was used. Three categories emerged from the analysis. Participants revealed thoughts of "constant comparisons", feelings of an "emotional journey", and they experienced "learning". Participants did not demonstrate perspective transformation as defined by Mezirow as participants signified no intent for social action. Several potential blocks to perspective transformation were identified: egocentrism/emotional disconnect, perceived powerlessness/being overwhelmed, and a vacation mindset. The findings provide insight into the student experience of studying abroad. Transformative learning is not a guaranteed result. Nurse educators must consider strategies to foster transformation including discussing global systemic oppressors, international relations, coping, connecting, and social action.

  7. 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.

  8. High-Amplitude Atlantic Hurricanes Produce Disparate Mortality in Small, Low-Income Countries.

    Science.gov (United States)

    Dresser, Caleb; Allison, Jeroan; Broach, John; Smith, Mary-Elise; Milsten, Andrew

    2016-12-01

    Hurricanes cause substantial mortality, especially in developing nations, and climate science predicts that powerful hurricanes will increase in frequency during the coming decades. This study examined the association of wind speed and national economic conditions with mortality in a large sample of hurricane events in small countries. Economic, meteorological, and fatality data for 149 hurricane events in 16 nations between 1958 and 2011 were analyzed. Mortality rate was modeled with negative binomial regression implemented by generalized estimating equations to account for variable population exposure, sequence of storm events, exposure of multiple islands to the same storm, and nonlinear associations. Low-amplitude storms caused little mortality regardless of economic status. Among high-amplitude storms (Saffir-Simpson category 4 or 5), expected mortality rate was 0.72 deaths per 100,000 people (95% confidence interval [CI]: 0.16-1.28) for nations in the highest tertile of per capita gross domestic product (GDP) compared with 25.93 deaths per 100,000 people (95% CI: 13.30-38.55) for nations with low per capita GDP. Lower per capita GDP and higher wind speeds were associated with greater mortality rates in small countries. Excessive fatalities occurred when powerful storms struck resource-poor nations. Predictions of increasing storm amplitude over time suggest increasing disparity between death rates unless steps are taken to modify the risk profiles of poor nations. (Disaster Med Public Health Preparedness. 2016;10:832-837).

  9. 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.

  10. Prevention programs for chronic kidney disease in low-income countries.

    Science.gov (United States)

    Perico, Norberto; Remuzzi, Giuseppe

    2016-04-01

    Chronic kidney disease (CKD) is an important determinant of the poor health outcome for major noncommunicable diseases that are the leading cause of death worldwide. Early recognition with screening programs of CKD and co-morbid conditions, like hypertension, diabetes, or toxic environments, can potentially slow progression to renal failure, improve quality of life and reduce healthcare cost. Effective multimodal tools are available to prevent CKD by managing its risk factors, and to slow or even halt disease progression to end-stage renal failure (ESRF). They can be adapted even to poor-resource settings of low- and middle-income countries for individual at high risk of CKD. CKD is also linked to acute kidney injury (AKI), that in poorest part of Africa, Asia and Latin America is preventable, treatable and often reversible, if managed adequately and in timely manner as proposed by the program "AKI 0by25" launched by the international Society of Nephrology in 2013. In addition to saving lives, prevention programs will create major heath gains, eventually reducing the current health inequity that arises from unaffordable or unobtainable renal replacement therapies in many part of the developing world if ESRF is not prevented.

  11. Adapting enzyme-based microbial water quality analysis to remote areas in low-income countries.

    Science.gov (United States)

    Abramson, Adam; Benami, Maya; Weisbrod, Noam

    2013-09-17

    Enzyme-substrate microbial water tests, originally developed for efficiency gains in laboratory settings, are potentially useful for on-site analysis in remote settings. This is especially relevant in developing countries where water quality is a pressing concern and qualified laboratories are rare. We investigated one such method, Colisure, first for sensitivity to incubation temperatures in order to explore alternative incubation techniques appropriate for remote areas, and then in a remote community of Zambia for detection of total coliforms and Escherichia coli in drinking-water samples. We sampled and analyzed 352 water samples from source, transport containers and point-of-use from 164 random households. Both internal validity (96-100%) and laboratory trials (zero false negatives or positives at incubation between 30 and 40 °C) established reliability under field conditions. We therefore recommend the use of this and other enzyme-based methods for remote applications. We also found that most water samples from wells accessing groundwater were free of E. coli whereas most samples from surface sources were fecally contaminated. We further found very low awareness among the population of the high levels of recontamination in household storage containers, suggesting the need for monitoring and treatment beyond the water source itself.

  12. 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/.

  13. mHealth Interventions in Low-Income Countries to Address Maternal Health: A Systematic Review.

    Science.gov (United States)

    Colaci, Daniela; Chaudhri, Simran; Vasan, Ashwin

    The wide availability and relative simplicity of mobile phones make them a promising instrument for delivering a variety of health-related interventions. Mobile health (mHealth) interventions have been tested in a variety of health delivery areas, but research has been restricted to pilot and small studies with limited generalizability. The aim of this review was to explore the current evidence on the use of mHealth for maternal health interventions in low- and low middle-income countries. Peer-reviewed papers were identified from Medline/PubMed, Web of Science, and Cochrane Library via a combination of search terms. Quantitative or mixed-methods papers published in the English language between January 2000 and July 2015 were included. Three hundred and seventy papers were found in the literature search. We assessed the full text of 57 studies, and included 19 in the review. Study designs included were 5 randomized controlled trials, 9 before and after comparisons, 1 study with endline assessment only, 3 postintervention assessments, and 1 cohort study. Quality assessment elucidated 9 low-quality, 5 moderate, and 5 high studies. Five studies supported the use of mobile phones for data collection, 3 for appointment reminders, and 4 for both appointment reminders and health promotion. Six studies supported the use of mHealth for provider-to-provider communication and 1 for clinical management. Studies demonstrated promise for the use of mHealth in maternal health; however, much of the evidence came from low- and moderate-quality studies. Pilot and small programs require more rigorous testing before allocating resources to scaling up this technology. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  14. The impact of implementing a demand forecasting system into a low-income country's supply chain.

    Science.gov (United States)

    Mueller, Leslie E; Haidari, Leila A; Wateska, Angela R; Phillips, Roslyn J; Schmitz, Michelle M; Connor, Diana L; Norman, Bryan A; Brown, Shawn T; Welling, Joel S; Lee, Bruce Y

    2016-07-12

    To evaluate the potential impact and value of applications (e.g. adjusting ordering levels, storage capacity, transportation capacity, distribution frequency) of data from demand forecasting systems implemented in a lower-income country's vaccine supply chain with different levels of population change to urban areas. Using our software, HERMES, we generated a detailed discrete event simulation model of Niger's entire vaccine supply chain, including every refrigerator, freezer, transport, personnel, vaccine, cost, and location. We represented the introduction of a demand forecasting system to adjust vaccine ordering that could be implemented with increasing delivery frequencies and/or additions of cold chain equipment (storage and/or transportation) across the supply chain during varying degrees of population movement. Implementing demand forecasting system with increased storage and transport frequency increased the number of successfully administered vaccine doses and lowered the logistics cost per dose up to 34%. Implementing demand forecasting system without storage/transport increases actually decreased vaccine availability in certain circumstances. The potential maximum gains of a demand forecasting system may only be realized if the system is implemented to both augment the supply chain cold storage and transportation. Implementation may have some impact but, in certain circumstances, may hurt delivery. Therefore, implementation of demand forecasting systems with additional storage and transport may be the better approach. Significant decreases in the logistics cost per dose with more administered vaccines support investment in these forecasting systems. Demand forecasting systems have the potential to greatly improve vaccine demand fulfilment, and decrease logistics cost/dose when implemented with storage and transportation increases. Simulation modeling can demonstrate the potential health and economic benefits of supply chain improvements. Copyright

  15. [Leadership and vision in the improvement of universal health care coverage in low-income countries].

    Science.gov (United States)

    Meda, Ziemlé Clément; Konate, Lassina; Ouedraogo, Hyacinthe; Sanou, Moussa; Hercot, David; Sombie, Issiaka

    2011-01-01

    In Burkina Faso, as in most developing countries, the operational level of the health system is made up of Health Districts (HDs), the activities of which are typically coordinated by the District Team (DT). Assessing the the core functions of DTs, as described by WHO, shows two important weaknesses. Firstly, instructions from "above" are often implemented rather passively: DTs tend not to display much leadership. Secondly, the current organisation, based on input financing and centralised planning, does not sufficiently promote either the vision or research functions of DTs. In this article, we report our experience in the Orodora HD in Burkina Faso, where the DT's leadership and vision proved to be essential ingredients for effective health action in the district. Our description of six interventions implemented between 2004 and 2008 shows how DT leadership and vision have improved outputs at the HD level. Until 2004, the district applied static health planning. The health system was insufficiently financed and performed poorly. Faced with this situation, the DT decided to set up several priority interventions based on health care access criteria and patient concerns, while respecting and contextualizing national norms and objectives. Six interventions were then implemented. The first was ensure that quality blood (meeting transfusion security norms) was available at the District Hospital (DH), by picking blood up from the regional blood transfusion center weekly. This speeded up care at the DH, reduced the number of cases referred to the regional hospital for transfusion, and reduced neonatal and maternal mortality. The second intervention sought to improve the skills of health workers in managing emergency cases and to improve relationships with the referral hospital through the reintroduction of counter-referral procedures. This led to a decrease in unnecessary referrals and also reduced the mortality rates of serious cases. The third intervention, by

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

    Science.gov (United States)

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

    2013-11-01

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

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

    Directory of Open Access Journals (Sweden)

    E. Benjamín Puertas

    2013-11-01

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

  18. 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.

  19. 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.

  20. The niche reduction approach: an opportunity for optimal control of infectious diseases in low-income countries?

    Science.gov (United States)

    Roche, Benjamin; Broutin, Hélène; Choisy, Marc; Godreuil, Sylvain; de Magny, Guillaume Constantin; Chevaleyre, Yann; Zucker, Jean-Daniel; Breban, Romulus; Cazelles, Bernard; Simard, Frédéric

    2014-07-25

    During the last century, WHO led public health interventions that resulted in spectacular achievements such as the worldwide eradication of smallpox and the elimination of malaria from the Western world. However, besides major successes achieved worldwide in infectious diseases control, most elimination/control programs remain frustrating in many tropical countries where specific biological and socio-economical features prevented implementation of disease control over broad spatial and temporal scales. Emblematic examples include malaria, yellow fever, measles and HIV. There is consequently an urgent need to develop affordable and sustainable disease control strategies that can target the core of infectious diseases transmission in highly endemic areas. Meanwhile, although most pathogens appear so difficult to eradicate, it is surprising to realize that human activities are major drivers of the current high rate of extinction among upper organisms through alteration of their ecology and evolution, i.e., their "niche". During the last decades, the accumulation of ecological and evolutionary studies focused on infectious diseases has shown that the niche of a pathogen holds more dimensions than just the immune system targeted by vaccination and treatment. Indeed, it is situated at various intra- and inter- host levels involved on very different spatial and temporal scales. After developing a precise definition of the niche of a pathogen, we detail how major advances in the field of ecology and evolutionary biology of infectious diseases can enlighten the planning and implementation of infectious diseases control in tropical countries with challenging economic constraints. We develop how the approach could translate into applied cases, explore its expected benefits and constraints, and we conclude on the necessity of such approach for pathogen control in low-income countries.

  1. To what extent do potential conservation donors value community-aspects of conservation projects in low income countries?

    Science.gov (United States)

    Young, Richard P.; Gibbons, James M.; Jones, Julia P. G.

    2018-01-01

    There is a major gap in funding required for conservation, especially in low income countries. Given the significant contribution of taxpayers in industrialized countries to funding conservation overseas, and donations from membership organisation, understanding the preferences of ordinary people in a high income country for different attributes of conservation projects is valuable for future marketing of conservation. We conducted a discrete choice experiment with visitors to a UK zoo, while simultaneously conducting a revealed preference study through a real donation campaign on the same sample. Respondents showed the highest willingness to pay for projects that have local community involvement in management (95% confidence interval £9.82 to £15.83), and for improvement in threatened species populations (£2.97 - £13.87). Both of these were significantly larger than the willingness to pay for projects involving provision of alternative livelihoods, or improving the condition of conservation sites. Results of the simultaneous donation campaign showed that respondents were very willing to donate the suggested £1 or above donation (88% made a donation, n = 1798); there was no effect of which of the two campaigns they were exposed to (threatened species management or community involvement in management). The small number of people who did not make a donation had a higher stated willingness to pay within the choice experiment, which may suggest hypothetical bias. Conservationists increasingly argue that conservation should include local communities in management (for both pragmatic and moral reasons). It is heartening that potential conservation donors seem to agree. PMID:29451923

  2. Combining evidence and values in priority setting: testing the balance sheet method in a low-income country.

    Science.gov (United States)

    Makundi, Emmanuel; Kapiriri, Lydia; Norheim, Ole Frithjof

    2007-09-24

    Procedures for priority setting need to incorporate both scientific evidence and public values. The aim of this study was to test out a model for priority setting which incorporates both scientific evidence and public values, and to explore use of evidence by a selection of stakeholders and to study reasons for the relative ranking of health care interventions in a setting of extreme resource scarcity. Systematic search for and assessment of relevant evidence for priority setting in a low-income country. Development of a balance sheet according to Eddy's explicit method. Eight group interviews (n-85), using a modified nominal group technique for eliciting individual and group rankings of a given set of health interventions. The study procedure made it possible to compare the groups' ranking before and after all the evidence was provided to participants. A rank deviation is significant if the rank order of the same intervention differed by two or more points on the ordinal scale. A comparison between the initial rank and the final rank (before deliberation) showed a rank deviation of 67%. The difference between the initial rank and the final rank after discussion and voting gave a rank deviation of 78%. Evidence-based and deliberative decision-making does change priorities significantly in an experimental setting. Our use of the balance sheet method was meant as a demonstration project, but could if properly developed be feasible for health planners, experts and health workers, although more work is needed before it can be used for laypersons.

  3. Judgment under uncertainty; a probabilistic evaluation framework for decision-making about sanitation systems in low-income countries.

    Science.gov (United States)

    Malekpour, Shirin; Langeveld, Jeroen; Letema, Sammy; Clemens, François; van Lier, Jules B

    2013-03-30

    This paper introduces the probabilistic evaluation framework, to enable transparent and objective decision-making in technology selection for sanitation solutions in low-income countries. The probabilistic framework recognizes the often poor quality of the available data for evaluations. Within this framework, the evaluations will be done based on the probabilities that the expected outcomes occur in practice, considering the uncertainties in evaluation parameters. Consequently, the outcome of evaluations will not be single point estimates; but there exists a range of possible outcomes. A first trial application of this framework for evaluation of sanitation options in the Nyalenda settlement in Kisumu, Kenya, showed how the range of values that an evaluation parameter may obtain in practice would influence the evaluation outcomes. In addition, as the probabilistic evaluation requires various site-specific data, sensitivity analysis was performed to determine the influence of each data set quality on the evaluation outcomes. Based on that, data collection activities could be (re)directed, in a trade-off between the required investments in those activities and the resolution of the decisions that are to be made. Copyright © 2013 Elsevier Ltd. All rights reserved.

  4. Infant CPAP for low-income countries: An experimental comparison of standard bubble CPAP and the Pumani system.

    Science.gov (United States)

    Falk, Markus; Donaldsson, Snorri; Drevhammar, Thomas

    2018-01-01

    Access to inexpensive respiratory support to newborn infants improves survival in low-income countries. Standard bubble continuous positive airway pressure (CPAP) has been extensively used worldwide for more than 30 years. One project aimed at providing affordable CPAP is the Pumani system developed by Rice 360°. Compared to standard bubble CPAP the system has an unconventional design. The aim was to compare the Pumani system with two traditional bubble CPAP systems, focusing on in-vitro performance and safety. The Pumani system was compared to traditional bubble CPAP from Fisher & Paykel (Auckland, New Zealand) and Diamedica (Devon, United Kingdom). The systems were tested using static flow resistance and simulated breathing for a range of fresh gas flows and submersion levels. There were large differences between the Pumani CPAP and the conventional bubble CPAP systems. The Pumani system was not pressure stable, had high resistance and high imposed work of breathing. It was not possible to use submersion depth to adjust CPAP without accounting for fresh gas flow. The Pumani design is novel and not similar to any previously described CPAP system. The main mechanism for CPAP generation was resistance, not submersion depth. The system should therefore not be referred to as bubble CPAP. The clinical consequences of its pressure instability and high imposed work of breathing are not known and trials on outcome and safety are needed.

  5. Measuring self-reported health in low-income countries: piloting three instruments in semi-rural Burkina Faso

    Directory of Open Access Journals (Sweden)

    Yulia Blomstedt

    2012-07-01

    Full Text Available Background: National surveys in low-income countries increasingly rely on self-reported measures of health. The ease, speed, and economy of collecting self-reports of health make such collection attractive for rapid appraisals. However, the interpretation of these measures is complicated since different cultures understand and respond to the same question in different ways. Objective: The aim of this pilot study was to develop a culturally sensitive tool to study the self-reported health (SRH of the local adult population in Burkina Faso. Design: The study was carried out in the 2009 rainy season. The sample included 27 men and 25 women aged 18 or older who live in semi-urban Nouna, Burkina Faso. Three culturally adapted instruments were tested: a SRH question, a wooden visual analogue scale (VAS, and a drawn VAS. Respondents were asked to explain their answers to each instrument. The narratives were analyzed with the content analysis technique, and the prevalence of poor SRH was estimated from the quantitative data by stratification for respondent background variables (sex, age, literacy, education, marital status, ethnicity, chronic diseases. The correlation between the instruments was tested with Spearman's correlation test. Results: The SRH question showed a 38.5% prevalence of poor SRH and 44.2% prevalence with both VAS. The correlation between the VAS was 0.89, whereas the correlation between the VAS and the SRH question was 0.60–0.64. Nevertheless, the question used as the basis of each instrument was culturally sensitive and clear to all respondents. Analysis of the narratives shows that respondents clearly differentiated between the various health statuses. Conclusion: In this pilot, we developed and tested a new version of the SRH question that may be more culturally sensitive than its non-adapted equivalents. Additional insight into this population's understanding and reporting of health was also obtained. A larger sample is needed

  6. 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.

  7. Unreported births and deaths, a severe obstacle for improved neonatal survival in low-income countries; a population based study

    Directory of Open Access Journals (Sweden)

    Wallin Lars

    2008-03-01

    Full Text Available Abstract Background In order to improve child survival there is a need to target neonatal mortality. In this pursuit, valid local and national statistics on child health are essential. We analyze to what extent births and neonatal deaths are unreported in a low-income country and discuss the consequences at local and international levels for efforts to save newborn lives. Methods Information on all births and neonatal deaths in Quang Ninh province in Northern Vietnam in 2005 was ascertained by systematic inventory through group interviews with key informants, questionnaires and examination of health facility records. Health care staff at 187 Community Health Centers (CHC and 18 hospitals, in addition to 1372 Village Health Workers (VHW, were included in the study. Results were compared with the official reports of the Provincial Health Bureau. Results The neonatal mortality rate (NMR was 16/1000 (284 neonatal deaths/17 519 births, as compared to the official rate of 4.2/1000. The NMR varied between 44/1000 and 10/1000 in the different districts of the province. The under-reporting was mainly attributable to a dysfunctional reporting system and the fact that families, not the health system, were made responsible to register births and deaths. This under-reporting has severe consequences at local, national and international levels. At a local level, it results in a lack of awareness of the magnitude and differentials in NMR, leading to an indifference towards the problem. At a national and international level the perceived low mortality rate is manifested in a lack of investments in perinatal health programs. Conclusion This example of a faulty health information system is reportedly not unique in low and middle income countries where needs for neonatal health reforms are greatest. Improving reporting systems on births and neonatal deaths is a matter of human rights and a prerequisite for reducing neonatal mortality in order to reach the fourth

  8. Social autopsy: a potential health-promotion tool for preventing maternal mortality in low-income countries.

    Science.gov (United States)

    Mahato, Preeti K; Waithaka, Elizabeth; van Teijlingen, Edwin; Pant, Puspa Raj; Biswas, Animesh

    2018-04-01

    Despite significant global improvements, maternal mortality in low-income countries remains unacceptably high. Increasing attention in recent years has focused on how social factors, such as family and peer influences, the community context, health services, legal and policy environments, and cultural and social values, can shape and influence maternal outcomes. Whereas verbal autopsy is used to attribute a clinical cause to a maternal death, the aim of social autopsy is to determine the non-clinical contributing factors. A social autopsy of a maternal death is a group interaction with the family of the deceased woman and her wider local community, where facilitators explore the social causes of the death and identify improvements needed. Although still relatively new, the process has proved useful to capture data for policy-makers on the social determinants of maternal deaths. This article highlights a second aspect of social autopsy - its potential role in health promotion. A social autopsy facilitates "community self-diagnosis" and identification of modifiable social and cultural factors that are attributable to the death. Social autopsy therefore has the potential not only for increasing awareness among community members, but also for promoting behavioural change at the individual and community level. There has been little formal assessment of social autopsy as a tool for health promotion. Rigorous research is now needed to assess the effectiveness and cost effectiveness of social autopsy as a preventive community-based intervention, especially with respect to effects on social determinants. There is also a need to document how communities can take ownership of such activities and achieve a sustainable impact on preventable maternal deaths.

  9. Psychosocial factors and obesity in 17 high-, middle- and low-income countries: the Prospective Urban Rural Epidemiologic study.

    Science.gov (United States)

    Rosengren, A; Teo, K; Rangarajan, S; Kabali, C; Khumalo, I; Kutty, V R; Gupta, R; Yusuf, R; Iqbal, R; Ismail, N; Altuntas, Y; Kelishadi, R; Diaz, R; Avezum, A; Chifamba, J; Zatonska, K; Wei, L; Liao, X; Lopez-Jaramillo, P; Yusufali, A; Seron, P; Lear, S A; Yusuf, S

    2015-08-01

    Psychosocial stress has been proposed to contribute to obesity, particularly abdominal, or central obesity, through chronic activation of the neuroendocrine systems. However, these putative relationships are complex and dependent on country and cultural context. We investigated the association between psychosocial factors and general and abdominal obesity in the Prospective Urban Rural Epidemiologic study. This observational, cross-sectional study enrolled 151 966 individuals aged 35-70 years from 628 urban and rural communities in 17 high-, middle- and low-income countries. Data were collected for 125 290 individuals regarding education, anthropometrics, hypertension/diabetes, tobacco/alcohol use, diet and psychosocial factors (self-perceived stress and depression). After standardization for age, sex, country income and urban/rural location, the proportion with obesity (body mass index ≥30 kg m(-)(2)) increased from 15.7% in 40 831 individuals with no stress to 20.5% in 7720 individuals with permanent stress, with corresponding proportions for ethnicity- and sex-specific central obesity of 48.6% and 53.5%, respectively (P<0.0001 for both). Associations between stress and hypertension/diabetes tended to be inverse. Estimating the total effect of permanent stress with age, sex, physical activity, education and region as confounders, no relationship between stress and obesity persisted (adjusted prevalence ratio (PR) for obesity 1.04 (95% confidence interval: 0.99-1.10)). There was no relationship between ethnicity- and sex-specific central obesity (adjusted PR 1.00 (0.97-1.02)). Stratification by region yielded inconsistent associations. Depression was weakly but independently linked to obesity (PR 1.08 (1.04-1.12)), and very marginally to abdominal obesity (PR 1.01 (1.00-1.03)). Although individuals with permanent stress tended to be slightly more obese, there was no overall independent effect and no evidence that abdominal obesity or its consequences

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

    Science.gov (United States)

    Limwattananon, Supon; Tangcharoensathien, Viroj; Sirilak, Supakit

    2011-05-01

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

  11. 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

  12. Positive postpartum depression screening practices and subsequent mental health treatment for low-income women in Western countries: a systematic literature review.

    Science.gov (United States)

    Hansotte, Elinor; Payne, Shirley I; Babich, Suzanne M

    2017-01-01

    Left undiagnosed and/or untreated, the short-and long-term sequelae of postpartum depression may negatively impact both mother and child. In Western countries, access to mental health care is influenced by socioeconomic factors. The objective of this systematic literature review is to compile factors that hinder and improve access to postpartum depression treatment in low-income women after a positive screen for postpartum depression. The key question of focus is: what are the characteristics associated with access to mental health treatment for low-income women with a positive postpartum depression screen in Western countries? A PRISMA-based systematic literature review was conducted of studies published in English before February 2016 that looked at treatment for postpartum depression in low-income women who had been identified with the condition. PubMed and EBSCO databases were searched using MESH and key terms and found 100 articles that met the selection criteria. After review by two independent researchers, 18 studies with 17 unique populations were included in the literature review. Two independent abstractors searched the included articles for themes surrounding impediments and advantages for low-income women identified with postpartum depression in obtaining mental health treatment. Characteristics of successful mental health treatment included studies that employed the use of a home visitor and those that separated outcomes for women with previous mental health treatment. Themes that emerged as treatment obstacles included cultural barriers, physical barriers, systemic health care barriers, and social barriers. This review will help to better inform screening and treatment priorities for those in the medical field who may encounter women experiencing postpartum depression and are not aware of the various barriers to care specific to low-income women. This review will also help policymakers identify specific obstacles that are not addressed in postpartum

  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. Validation of a simple stool diary used by caregivers to document diarrhea among young children in a low-income country

    DEFF Research Database (Denmark)

    Grenov, Benedikte; Namusoke, Hanifa; Nabukeera-Barungi, Nicolette

    2017-01-01

    OBJECTIVES: Development and validation of a simple stool diary for caretakers collecting data on stool frequency and consistency among young children in a low-income country. METHODS: Focus group studies evaluated how diarrhea was understood by caregivers (content validity). The sensitivity......, reliability, and correlations between dehydration and diary scores (construct validity) were tested in a clinical trial. RESULTS: Caregivers recognized and understood the concept and severity of diarrhea. Stool frequency and liquid consistency decreased in children admitted with diarrhea (p 

  15. 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.

  16. Why is patient safety so hard in low-income countries? A qualitative study of healthcare workers' views in two African hospitals.

    Science.gov (United States)

    Aveling, Emma-Louise; Kayonga, Yvette; Nega, Ansha; Dixon-Woods, Mary

    2015-02-25

    The views of practitioners at the sharp end of health care provision are now recognised as a valuable source of intelligence that can inform efforts to improve patient safety in high-income countries. Yet despite growing policy emphasis on patient safety in low-income countries, little research examines the views of practitioners in these settings. We aimed to give voice to how healthcare workers in two East African hospitals identify and explain the major obstacles to ensuring the safety of patients in their care. We conducted in-depth, face to face interviews with healthcare workers in two East African hospitals. Our sample included a total of 57 hospital staff, including nurses, physicians, technicians, clinical services staff, administrative staff and hospital managers. Hospital staff in low-income settings offered broadly encompassing and aspirational definitions of patient safety. They identified obstacles to patient safety across three major themes: material context, staffing issues and inter-professional working relationships. Participants distinguished between the proximal influences on patient safety that posed an immediate threat to patient care, and the distal influences that generated the contexts for such hazards. These included contexts of severe material deprivation, but also the impact of relational factors such as teamwork and professional hierarchies. Structures of authority, governance and control that were not optimally aligned with achieving patient safety were widely reported. As in high-income countries, the accounts of healthcare workers in low-income countries provide sophisticated and valuable insights into the challenges of patient safety. Though the impact of resource constraints and weak governance structures are particularly marked in low-income countries, the congruence between accounts of health workers in diverse settings suggest that the origins and solutions to patient safety problems are likely to be similar everywhere and are

  17. 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.

  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. Re-envisioning global agricultural trade: time for a paradigm shift to ensure food security and population health in low-income countries.

    Science.gov (United States)

    Pirkle, Catherine M; Poliquin, Hélène; Sia, Drissa; Kouakou, Kouassi Joseph; Sagna, Tani

    2015-03-01

    In this commentary, we use examples from West Africa to highlight how the liberalization of global agricultural trade exacerbates population health inequalities by threatening the livelihoods and food security of communities in low-income settings. We highlight the exploitative nature of trade agreements with West African countries demonstrating how these agreements disincentivize local agricultural investment and take jobs away from small-scale farmers. Further, we link agricultural trade liberalization to increased food insecurity, malnutrition, and exposure to environmental contaminants. Finally, we propose a paradigm shift that advocates for food sovereignty and the right to food. © The Author(s) 2014.

  20. 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

  1. A review of phytate, iron, zinc, and calcium concentrations in plant-based complementary foods used in low-income countries and implications for bioavailability.

    Science.gov (United States)

    Gibson, Rosalind S; Bailey, Karl B; Gibbs, Michelle; Ferguson, Elaine L

    2010-06-01

    Plant-based complementary foods often contain high levels of phytate, a potent inhibitor of iron, zinc, and calcium absorption. This review summarizes the concentrations of phytate (as hexa- and penta-inositol phosphate), iron, zinc, and calcium and the corresponding phytate:mineral molar ratios in 26 indigenous and 27 commercially processed plant-based complementary foods sold in low-income countries. Phytate concentrations were highest in complementary foods based on unrefined cereals and legumes (approximately 600 mg/100 g dry weight), followed by refined cereals (approximately 100 mg/100 g dry weight) and then starchy roots and tubers (source foods and/or fortification with minerals. Dephytinization, either in the household or commercially, can potentially enhance mineral absorption in high-phytate complementary foods, although probably not enough to overcome the shortfalls in iron, zinc, and calcium content of plant-based complementary foods used in low-income countries. Instead, to ensure the World Health Organization estimated needs for these minerals from plant-based complementary foods for breastfed infants are met, dephytinization must be combined with enrichment with animal-source foods and/or fortification with appropriate levels and forms of mineral fortificants.

  2. Options for Low Income Countries Effective and Efficient Use of Tax Incentives for Investment : A Report to the G-20 Development Working Group by the IMF, OECD, UN and World Bank

    OpenAIRE

    International Monetary Fund; OECD; United Nations; World Bank

    2015-01-01

    Experience shows that there is often ample room for more effective and efficient use of investment tax incentives in low-income countries. Tax incentives generally rank low in investment climate surveys in low-income countries, and there are many examples in which they are reported to be redundant, that is, investment will have been undertaken even without them. And their fiscal cost can b...

  3. Using international human rights law to improve child health in low-income countries: a framework for healthcare professionals.

    Science.gov (United States)

    O'Hare, Bernadette Ann-Marie; Devakumar, Delan; Allen, Stephen

    2016-03-30

    The Committee on Economic, Social and Cultural Rights states that the right to health is closely related to, and dependent upon, the realization of other human rights, including the right to food, water, education and shelter which are important determinants of health. Children's healthcare workers in low income settings may spend the majority of their professional lives trying to mitigate deficiencies of these rights but have little influence over them. In order to advocate successfully at a local level, we should be aware of the proportion of children living in our catchment population who do not have access to their basic rights. In order to carry out a rights audit, a framework within which healthcare workers could play their part is required, as is an agreed minimum core of rights, a timeframe and a set of indicators. A framework to assess how well states and their developmental partners are adhering to human rights principles is discussed, including the role that a healthcare worker might optimally play. A minimum core of economic and social rights seeks to establish a legal minimum set of protections, which should be available with immediate effect and applicable to all nations despite very different resources. Minimum core rights and the impact that progressive realisation may have had on the right to health is discussed, including what they should include from the perspective of children's health. A set of absolute rights are suggested, based on physiological needs and aligned with the corresponding articles of the United Nations Convention on the Rights of the Child. The development indicators which are likely to be used to monitor progress towards the Sustainable Development Goals is suggested as a way to monitor rights. We consider the ways in which the healthcare worker could use a rights audit to advocate with, and for their community. These audits could achieve several objectives. They may legitimise healthcare workers' interests in the determinants

  4. Strategies and methods to promote occupational health in low-income countries : industrial counselling in tanneries in India

    NARCIS (Netherlands)

    F.G. Öry

    1997-01-01

    textabstractConcern for occupational health and safety has a long tradition in Westem countries. In these countries, well-established disciplines are able to recognize and control inherent risks of industrial processes. The occupational health care system is well-developed and occupational health

  5. 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

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

    Science.gov (United States)

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

    2016-11-01

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

  7. Service- and population-based exemptions: are these the way forward for equity and efficiency in health financing in low-income countries?

    Science.gov (United States)

    Witter, Sophie

    2009-01-01

    The first wave of experiences of exemptions policies suggested that poverty-based exemptions, using individual targeting, were not effective, for practical and political economic reasons. In response, many countries have changed their approach in recent years--while maintaining user fees as a necessary source of revenue for facilities, they have been switching to categorical targeting, offering exemptions based on high-priority services or population groups. This chapter aims to examine the impact and conditions for effectiveness of this recent health finance modality. The chapter is based on a literature review and on data from two complex evaluations of national fee exemption policies for delivery care in West Africa (Ghana and Senegal). A conceptual framework for analysing the impact of exemption policies is developed and used. Although the analysis focuses on exemption for deliveries, the framework and findings are likely to be generalisable to other service- or population-based exemptions. The chapter presents background information on the nature of delivery exemptions, the drivers for their use, their scale and common modalities in low-income countries. It then looks at evidence of their impact, on utilisation, quality of care and equity and investigates their cost-effectiveness. The final section presents lessons on implementation and implications for policy-makers, including the acceptability and sustainability of exemptions and how they compare to other possible mechanisms. The chapter concludes that funded service- or group-based exemptions offer a simple, potentially effective route to mitigating inequity and inefficiency in the health systems of low-income countries. However, there are a number of key constraints. One is the fungibility of resources at health facility level. The second is the difficulty of sustaining a separate funding stream over the medium to long term. The third is the arbitrary basis for selecting high-priority services for

  8. 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

  9. Migration and mental health: a study of low-income Ethiopian women working in Middle Eastern countries.

    Science.gov (United States)

    Anbesse, Birke; Hanlon, Charlotte; Alem, Atalay; Packer, Samuel; Whitley, Rob

    2009-11-01

    Few studies have explored influences on mental health of migrants moving between non-Western countries. Focus group discussions were used to explore the experiences of Ethiopian female domestic migrants to Middle Eastern countries, comparing those who developed severe mental illness with those remaining mentally well. Prominent self-identified threats to mental health included exploitative treatment, enforced cultural isolation, undermining of cultural identity and disappointment in not achieving expectations. Participants countered these risks by affirming their cultural identity and establishing socio-cultural supports. Mental health of migrant domestic workers may be jeopardized by stressors, leading to experience of social defeat.

  10. Incorporating Demand and Supply Constraints into Economic Evaluations in Low-Income and Middle-Income Countries

    NARCIS (Netherlands)

    Vassall, Anna; Mangham-Jefferies, Lindsay; Gomez, Gabriela B.; Pitt, Catherine; Foster, Nicola

    2016-01-01

    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

  11. Influences on Academic Achievement Across High and Low Income Countries: A Re-Analysis of IEA Data.

    Science.gov (United States)

    Heyneman, S.; Loxley, W.

    Previous international studies of science achievement put the data through a process of winnowing to decide which variables to keep in the final regressions. Variables were allowed to enter the final regressions if they met a minimum beta coefficient criterion of 0.05 averaged across rich and poor countries alike. The criterion was an average…

  12. Human papillomavirus vaccine introduction in low-income and middle-income countries: guidance on the use of cost-effectiveness models

    Directory of Open Access Journals (Sweden)

    Praditsitthikorn Naiyana

    2011-05-01

    Full Text Available Abstract Background The World Health Organization (WHO recommends that the cost effectiveness of introducing human papillomavirus (HPV vaccination is considered before such a strategy is implemented. However, developing countries often lack the technical capacity to perform and interpret results of economic appraisals of vaccines. To provide information about the feasibility of using such models in a developing country setting, we evaluated models of HPV vaccination in terms of their capacity, requirements, limitations and comparability. Methods A literature review identified six HPV vaccination models suitable for low-income and middle-income country use and representative of the literature in terms of provenance and model structure. Each model was adapted by its developers using standardised data sets representative of two hypothetical developing countries (a low-income country with no screening and a middle-income country with limited screening. Model predictions before and after vaccination of adolescent girls were compared in terms of HPV prevalence and cervical cancer incidence, as was the incremental cost-effectiveness ratio of vaccination under different scenarios. Results None of the models perfectly reproduced the standardised data set provided to the model developers. However, they agreed that large decreases in type 16/18 HPV prevalence and cervical cancer incidence are likely to occur following vaccination. Apart from the Thai model (in which vaccine and non-vaccine HPV types were combined, vaccine-type HPV prevalence dropped by 75% to 100%, and vaccine-type cervical cancer incidence dropped by 80% to 100% across the models (averaging over age groups. The most influential factors affecting cost effectiveness were the discount rate, duration of vaccine protection, vaccine price and HPV prevalence. Demographic change, access to treatment and data resolution were found to be key issues to consider for models in developing countries

  13. Human papillomavirus vaccine introduction in low-income and middle-income countries: guidance on the use of cost-effectiveness models.

    Science.gov (United States)

    Jit, Mark; Demarteau, Nadia; Elbasha, Elamin; Ginsberg, Gary; Kim, Jane; Praditsitthikorn, Naiyana; Sinanovic, Edina; Hutubessy, Raymond

    2011-05-12

    The World Health Organization (WHO) recommends that the cost effectiveness of introducing human papillomavirus (HPV) vaccination is considered before such a strategy is implemented. However, developing countries often lack the technical capacity to perform and interpret results of economic appraisals of vaccines. To provide information about the feasibility of using such models in a developing country setting, we evaluated models of HPV vaccination in terms of their capacity, requirements, limitations and comparability. A literature review identified six HPV vaccination models suitable for low-income and middle-income country use and representative of the literature in terms of provenance and model structure. Each model was adapted by its developers using standardised data sets representative of two hypothetical developing countries (a low-income country with no screening and a middle-income country with limited screening). Model predictions before and after vaccination of adolescent girls were compared in terms of HPV prevalence and cervical cancer incidence, as was the incremental cost-effectiveness ratio of vaccination under different scenarios. None of the models perfectly reproduced the standardised data set provided to the model developers. However, they agreed that large decreases in type 16/18 HPV prevalence and cervical cancer incidence are likely to occur following vaccination. Apart from the Thai model (in which vaccine and non-vaccine HPV types were combined), vaccine-type HPV prevalence dropped by 75% to 100%, and vaccine-type cervical cancer incidence dropped by 80% to 100% across the models (averaging over age groups). The most influential factors affecting cost effectiveness were the discount rate, duration of vaccine protection, vaccine price and HPV prevalence. Demographic change, access to treatment and data resolution were found to be key issues to consider for models in developing countries. The results indicated the usefulness of considering

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

    Science.gov (United States)

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

    2017-09-01

    The ambitious development agenda of the Sustainable Development Goals (SDGs) requires substantial investments across several sectors, including for SDG 3 (healthy lives and wellbeing). No estimates of the additional resources needed to strengthen comprehensive health service delivery towards the attainment of SDG 3 and universal health coverage in low-income and middle-income countries have been published. We developed a framework for health systems strengthening, within which population-level and individual-level health service coverage is gradually scaled up over time. We developed projections for 67 low-income and middle-income countries from 2016 to 2030, representing 95% of the total population in low-income and middle-income countries. We considered four service delivery platforms, and modelled two scenarios with differing levels of ambition: a progress scenario, in which countries' advancement towards global targets is constrained by their health system's assumed absorptive capacity, and an ambitious scenario, in which most countries attain the global targets. We estimated the associated costs and health effects, including reduced prevalence of illness, lives saved, and increases in life expectancy. We projected available funding by country and year, taking into account economic growth and anticipated allocation towards the health sector, to allow for an analysis of affordability and financial sustainability. We estimate that an additional $274 billion spending on health is needed per year by 2030 to make progress towards the SDG 3 targets (progress scenario), whereas US$371 billion would be needed to reach health system targets in the ambitious scenario-the equivalent of an additional $41 (range 15-102) or $58 (22-167) per person, respectively, by the final years of scale-up. In the ambitious scenario, total health-care spending would increase to a population-weighted mean of $271 per person (range 74-984) across country contexts, and the share of gross

  15. Public-private partnerships to build human capacity in low income countries: findings from the Pfizer program

    Directory of Open Access Journals (Sweden)

    Connelly Patrick

    2007-03-01

    Full Text Available Abstract Background The ability of health organizations in developing countries to expand access to quality services depends in large part on organizational and human capacity. Capacity building includes professional development of staff, as well as efforts to create working environments conducive to high levels of performance. The current study evaluated an approach to public-private partnership where corporate volunteers give technical assistance to improve organizational and staff performance. From 2003 to 2005, the Pfizer Global Health Fellows program sent 72 employees to work with organizations in 19 countries. This evaluation was designed to assess program impact. Methods The researchers administered a survey to 60 Fellows and 48 Pfizer Supervisors. In addition, the team conducted over 100 interviews with partner organization staff and other key informants during site visits in Uganda, Kenya, Ghana, South Africa and India, the five countries where 60% of Fellows were placed. Results Over three-quarters of Fellowships appear to have imparted skills or enhanced operations of NGOs in HIV/AIDS and other health programs. Overall, 79% of Fellows reported meeting all or most technical assistance goals. Partner organization staff reported that the Fellows provided training to clinical and research personnel; strengthened laboratory, pharmacy, financial control, and human resource management systems; and helped expand Partner organization networks. Local staff also reported the Program changed their work habits and attitudes. The evaluation identified problems in defining goals of Fellowships and matching Organizations with Fellows. Capacity building success also appears related to size and sophistication of partner organization. Conclusion Public expectations have grown regarding the role corporations should play in improving health systems in developing countries. Corporate philanthropy programs based on "donations" of personnel can help build

  16. Public-private partnerships to build human capacity in low income countries: findings from the Pfizer program.

    Science.gov (United States)

    Vian, Taryn; Richards, Sarah C; McCoy, Kelly; Connelly, Patrick; Feeley, Frank

    2007-03-02

    The ability of health organizations in developing countries to expand access to quality services depends in large part on organizational and human capacity. Capacity building includes professional development of staff, as well as efforts to create working environments conducive to high levels of performance. The current study evaluated an approach to public-private partnership where corporate volunteers give technical assistance to improve organizational and staff performance. From 2003 to 2005, the Pfizer Global Health Fellows program sent 72 employees to work with organizations in 19 countries. This evaluation was designed to assess program impact. The researchers administered a survey to 60 Fellows and 48 Pfizer Supervisors. In addition, the team conducted over 100 interviews with partner organization staff and other key informants during site visits in Uganda, Kenya, Ghana, South Africa and India, the five countries where 60% of Fellows were placed. Over three-quarters of Fellowships appear to have imparted skills or enhanced operations of NGOs in HIV/AIDS and other health programs. Overall, 79% of Fellows reported meeting all or most technical assistance goals. Partner organization staff reported that the Fellows provided training to clinical and research personnel; strengthened laboratory, pharmacy, financial control, and human resource management systems; and helped expand Partner organization networks. Local staff also reported the Program changed their work habits and attitudes. The evaluation identified problems in defining goals of Fellowships and matching Organizations with Fellows. Capacity building success also appears related to size and sophistication of partner organization. Public expectations have grown regarding the role corporations should play in improving health systems in developing countries. Corporate philanthropy programs based on "donations" of personnel can help build the organizational and human capacity of frontline agencies

  17. Not just a number: examining coverage and content of antenatal care in low-income and middle-income countries.

    Science.gov (United States)

    Benova, Lenka; Tunçalp, Özge; Moran, Allisyn C; Campbell, Oona Maeve Renee

    2018-01-01

    Antenatal care (ANC) provides a critical opportunity for women and babies to benefit from good-quality maternal care. Using 10 countries as an illustrative analysis, we described ANC coverage (number of visits and timing of first visit) and operationalised indicators for content of care as available in population surveys, and examined how these two approaches are related. We used the most recent Demographic and Health Survey to analyse ANC related to women's most recent live birth up to 3 years preceding the survey. Content of care was assessed using six components routinely measured across all countries, and a further one to eight additional country-specific components. We estimated the percentage of women in need of ANC, and using ANC, who received each component, the six routine components and all components. In all 10 countries, the majority of women in need of ANC reported 1+ ANC visits and over two-fifths reported 4+ visits. Receipt of the six routine components varied widely; blood pressure measurement was the most commonly reported component, and urine test and information on complications the least. Among the subset of women starting ANC in the first trimester and receiving 4+ visits, the percentage receiving all six routinely measured ANC components was low, ranging from 10% (Jordan) to around 50% in Nigeria, Nepal, Colombia and Haiti. Our findings suggest that even among women with patterns of care that complied with global recommendations, the content of care was poor. Efficient and effective action to improve care quality relies on development of suitable content of care indicators.

  18. Design and implementation of a voluntary collective earthquake insurance policy to cover low-income homeowners in a developing country

    OpenAIRE

    Marulanda, M.; Cardona, O.; Mora, Miguel; Barbat, Alex

    2018-01-01

    Understanding and evaluating disaster risk due to natural hazard events such as earthquakes creates powerful incentives for countries to develop planning options and tools to reduce potential damages. The use of models for earthquake risk evaluation allows obtaining outputs such as the loss exceedance curve, the expected annual loss and the probable maximum loss, which are probabilistic metrics useful for risk analyses, for designing strategies for risk reduction and mitigation, for emergency...

  19. Supporting the delivery of cost-effective interventions in primary health-care systems in low-income and middle-income countries: an overview of systematic reviews.

    Science.gov (United States)

    Lewin, Simon; Lavis, John N; Oxman, Andrew D; Bastías, Gabriel; Chopra, Mickey; Ciapponi, Agustín; Flottorp, Signe; Martí, Sebastian García; Pantoja, Tomas; Rada, Gabriel; Souza, Nathan; Treweek, Shaun; Wiysonge, Charles S; Haines, Andy

    2008-09-13

    Strengthening health systems is a key challenge to improving the delivery of cost-effective interventions in primary health care and achieving the vision of the Alma-Ata Declaration. Effective governance, financial and delivery arrangements within health systems, and effective implementation strategies are needed urgently in low-income and middle-income countries. This overview summarises the evidence from systematic reviews of health systems arrangements and implementation strategies, with a particular focus on evidence relevant to primary health care in such settings. Although evidence is sparse, there are several promising health systems arrangements and implementation strategies for strengthening primary health care. However, their introduction must be accompanied by rigorous evaluations. The evidence base needs urgently to be strengthened, synthesised, and taken into account in policy and practice, particularly for the benefit of those who have been excluded from the health care advances of recent decades.

  20. 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

  1. Determinants of prenatal care use: evidence from 32 low-income countries across Asia, Sub-Saharan Africa and Latin America.

    Science.gov (United States)

    Guliani, Harminder; Sepehri, Ardeshir; Serieux, John

    2014-08-01

    While much has been written on the determinants of prenatal care attendance in low-income countries, comparatively little is known about the determinants of the frequency of prenatal visits in general and whether there are separate processes generating the decisions to use prenatal care and the frequency of use. Using the Demographic and Health Surveys data for 32 low-income countries (across Asia, Sub-Saharan Africa and Latin America) and appropriate two-part and multilevel models, this article empirically assesses the influence of a wide array of observed individual-, household- and community-level characteristics on a woman's decision to use prenatal care and the frequency of that use, while controlling for unobserved community level factors. The results suggest that, though both the decision to use care and the number of prenatal visits are influenced by a range of observed individual-, household- and community-level characteristics, the influence of these determinants vary in magnitude for prenatal care attendance and the frequency of prenatal visits. Despite remarkable consistency among regions in the association of individual, household and community indicators with prenatal care utilization, the estimated coefficients of the risk factors vary greatly across the three world regions. The strong influence of household wealth, education and regional poverty on the use of prenatal care suggests that safe motherhood programmes should be linked with the objectives of social development programmes such as poverty reduction, enhancing the status of women and increasing primary and secondary school enrolment rate among girls. Finally, the finding that teenage mothers and unmarried women and those with unintended pregnancies are less likely to use prenatal care and have fewer visits suggests that safe mother programmes need to pay particular attention to the disadvantaged and vulnerable subgroups of population whose reproductive health issues are often fraught with

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

    Directory of Open Access Journals (Sweden)

    Suleiman Said

    2011-02-01

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

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

    Science.gov (United States)

    Jenkins, Rachel; Mussa, Mahmoud; Haji, Suleiman A; Haji, Mohammed S; Salim, Ahmed; Suleiman, Said; Riyami, Alya S; Wakil, Abdul; Mbatia, Joseph

    2011-02-14

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

  4. The complications of treating chronic obstructive pulmonary disease in low income countries of sub-Saharan Africa.

    Science.gov (United States)

    van Gemert, Frederik A; Kirenga, Bruce J; Gebremariam, Tewodros Haile; Nyale, George; de Jong, Corina; van der Molen, Thys

    2018-03-01

    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 and public health planning. Programs for the management of COPD are poorly developed, and the quality of care is often of a low standard. Inhaled medication is often not available or not affordable. Tobacco smoking is the most common encountered risk factor for COPD. However, in sub-Saharan Africa, household air pollution is another major risk factor for the development of COPD. Communities are also exposed to a variety of other risk factors, such as low birth weight, malnutrition, severe childhood respiratory infections, occupational exposures, outdoor pollution, human-immunodeficiency virus and tuberculosis. All these factors contribute to the high burden of poor respiratory health in sub-Saharan Africa. Expert commentary: A silent growing epidemic of COPD seems to be unravelling. Therefore, prevention and intervention programs must involve all the stakeholders and start as early as possible. More research is needed to describe, define and inform treatment approaches, and natural history of biomass-related COPD.

  5. What is the private sector? Understanding private provision in the health systems of low-income and middle-income countries.

    Science.gov (United States)

    Mackintosh, Maureen; Channon, Amos; Karan, Anup; Selvaraj, Sakthivel; Cavagnero, Eleonora; Zhao, Hongwen

    2016-08-06

    Private health care in low-income and middle-income countries is very extensive and very heterogeneous, ranging from itinerant medicine sellers, through millions of independent practitioners-both unlicensed and licensed-to corporate hospital chains and large private insurers. Policies for universal health coverage (UHC) must address this complex private sector. However, no agreed measures exist to assess the scale and scope of the private health sector in these countries, and policy makers tasked with managing and regulating mixed health systems struggle to identify the key features of their private sectors. In this report, we propose a set of metrics, drawn from existing data that can form a starting point for policy makers to identify the structure and dynamics of private provision in their particular mixed health systems; that is, to identify the consequences of specific structures, the drivers of change, and levers available to improve efficiency and outcomes. The central message is that private sectors cannot be understood except within their context of mixed health systems since private and public sectors interact. We develop an illustrative and partial country typology, using the metrics and other country information, to illustrate how the scale and operation of the public sector can shape the private sector's structure and behaviour, and vice versa. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. 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/

  7. Criteria to assess potential reverse innovations: opportunities for shared learning between high- and low-income countries.

    Science.gov (United States)

    Bhattacharyya, Onil; Wu, Diane; Mossman, Kathryn; Hayden, Leigh; Gill, Pavan; Cheng, Yu-Ling; Daar, Abdallah; Soman, Dilip; Synowiec, Christina; Taylor, Andrea; Wong, Joseph; von Zedtwitz, Max; Zlotkin, Stanley; Mitchell, William; McGahan, Anita

    2017-01-25

    Low- and middle-income countries (LMICs) are developing novel approaches to healthcare that may be relevant to high-income countries (HICs). These include products, services, organizational processes, or policies that improve access, cost, or efficiency of healthcare. However, given the challenge of replication, it is difficult to identify innovations that could be successfully adapted to high-income settings. We present a set of criteria for evaluating the potential impact of LMIC innovations in HIC settings. An initial framework was drafted based on a literature review, and revised iteratively by applying it to LMIC examples from the Center for Health Market Innovations (CHMI) program database. The resulting criteria were then reviewed using a modified Delphi process by the Reverse Innovation Working Group, consisting of 31 experts in medicine, engineering, management and political science, as well as representatives from industry and government, all with an expressed interest in reverse innovation. The resulting 8 criteria are divided into two steps with a simple scoring system. First, innovations are assessed according to their success within the LMIC context according to metrics of improving accessibility, cost-effectiveness, scalability, and overall effectiveness. Next, they are scored for their potential for spread to HICs, according to their ability to address an HIC healthcare challenge, compatibility with infrastructure and regulatory requirements, degree of novelty, and degree of current collaboration with HICs. We use examples to illustrate where programs which appear initially promising may be unlikely to succeed in a HIC setting due to feasibility concerns. This study presents a framework for identifying reverse innovations that may be useful to policymakers and funding agencies interested in identifying novel approaches to addressing cost and access to care in HICs. We solicited expert feedback and consensus on an empirically-derived set of criteria

  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. How consistent are associations between maternal and paternal education and child growth and development outcomes across 39 low-income and middle-income countries?

    Science.gov (United States)

    Jeong, Joshua; Kim, Rockli; Subramanian, S V

    2018-05-01

    Maternal and paternal education are associated with improved early child outcomes. However, less is known about how these relative associations compare for preschool children's growth versus development outcomes; and across country contexts. We analysed data from 89 663 children aged 36 to 59 months in 39 low-income and middle-income countries (LMICs). We used linear regression models with country fixed effects to estimate the joint associations between maternal and paternal education and children's growth and development outcomes. Additionally, we examined the variability in these relationships by each country and within subgroups of countries. In the pooled sample, maternal and paternal education were independently associated with 0.37 (95% CI 0.33 to 0.41) and 0.20 (95% CI 0.16 to 0.24) higher height-for-age z-scores, and 0.31 (95% CI 0.29 to 0.34) and 0.16 (95% CI 0.14 to 0.18) higher Early Childhood Development Index z-scores, respectively (comparing secondary or higher to no education). Associations were stronger for maternal education than paternal education but comparable between child outcomes. In country-specific regressions, we found the most heterogeneity in the associations between maternal education and children's growth; and between paternal education and children's development. Subgroup analyses suggested that these associations may be systematically patterned by country-level adult illiteracy, infant mortality and food insecurity. Our findings highlight variability in the statistical significance and magnitude of the associations between caregivers' education and children's outcomes. Further research is needed to understand the sources of variation that may promote or constrain the benefits of caregivers' education for children's early health and development in LMICs. © 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

  10. 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.

  11. Vaccine Induced Herd Immunity for Control of Respiratory Syncytial Virus Disease in a Low-Income Country Setting.

    Directory of Open Access Journals (Sweden)

    Timothy M Kinyanjui

    Full Text Available Respiratory syncytial virus (RSV is globally ubiquitous, and infection during the first six months of life is a major risk for severe disease and hospital admission; consequently RSV is the most important viral cause of respiratory morbidity and mortality in young children. Development of vaccines for young infants is complicated by the presence of maternal antibodies and immunological immaturity, but vaccines targeted at older children avoid these problems. Vaccine development for young infants has been unsuccessful, but this is not the case for older children (> 6 m. Would vaccinating older children have a significant public health impact? We developed a mathematical model to explore the benefits of a vaccine against RSV.We have used a deterministic age structured model capturing the key epidemiological characteristics of RSV and performed a statistical maximum-likelihood fit to age-specific hospitalization data from a developing country setting. To explore the effects of vaccination under different mixing assumptions, we included two versions of contact matrices: one from a social contact diary study, and the second a synthesised construction based on demographic data. Vaccination is assumed to elicit an immune response equivalent to primary infection. Our results show that immunisation of young children (5-10 m is likely to be a highly effective method of protection of infants (<6 m against hospitalisation. The majority benefit is derived from indirect protection (herd immunity. A full sensitivity and uncertainty analysis using Latin Hypercube Sampling of the parameter space shows that our results are robust to model structure and model parameters.This result suggests that vaccinating older infants and children against RSV can have a major public health benefit.

  12. Financing universal health coverage—effects of alternative tax structures on public health systems: cross-national modelling in 89 low-income and middle-income countries

    Science.gov (United States)

    Reeves, Aaron; Gourtsoyannis, Yannis; Basu, Sanjay; McCoy, David; McKee, Martin; Stuckler, David

    2015-01-01

    Summary Background How to finance progress towards universal health coverage in low-income and middle-income countries is a subject of intense debate. We investigated how alternative tax systems affect the breadth, depth, and height of health system coverage. Methods We used cross-national longitudinal fixed effects models to assess the relationships between total and different types of tax revenue, health system coverage, and associated child and maternal health outcomes in 89 low-income and middle-income countries from 1995–2011. Findings Tax revenue was a major statistical determinant of progress towards universal health coverage. Each US$100 per capita per year of additional tax revenues corresponded to a yearly increase in government health spending of $9·86 (95% CI 3·92–15·8), adjusted for GDP per capita. This association was strong for taxes on capital gains, profits, and income ($16·7, 9·16 to 24·3), but not for consumption taxes on goods and services (−$4·37, −12·9 to 4·11). In countries with low tax revenues (tax revenue per year substantially increased the proportion of births with a skilled attendant present by 6·74 percentage points (95% CI 0·87–12·6) and the extent of financial coverage by 11·4 percentage points (5·51–17·2). Consumption taxes, a more regressive form of taxation that might reduce the ability of the poor to afford essential goods, were associated with increased rates of post-neonatal mortality, infant mortality, and under-5 mortality rates. We did not detect these adverse associations with taxes on capital gains, profits, and income, which tend to be more progressive. Interpretation Increasing domestic tax revenues is integral to achieving universal health coverage, particularly in countries with low tax bases. Pro-poor taxes on profits and capital gains seem to support expanding health coverage without the adverse associations with health outcomes observed for higher consumption taxes. Progressive tax

  13. Financing universal health coverage--effects of alternative tax structures on public health systems: cross-national modelling in 89 low-income and middle-income countries.

    Science.gov (United States)

    Reeves, Aaron; Gourtsoyannis, Yannis; Basu, Sanjay; McCoy, David; McKee, Martin; Stuckler, David

    2015-07-18

    How to finance progress towards universal health coverage in low-income and middle-income countries is a subject of intense debate. We investigated how alternative tax systems affect the breadth, depth, and height of health system coverage. We used cross-national longitudinal fixed effects models to assess the relationships between total and different types of tax revenue, health system coverage, and associated child and maternal health outcomes in 89 low-income and middle-income countries from 1995-2011. Tax revenue was a major statistical determinant of progress towards universal health coverage. Each US$100 per capita per year of additional tax revenues corresponded to a yearly increase in government health spending of $9.86 (95% CI 3.92-15.8), adjusted for GDP per capita. This association was strong for taxes on capital gains, profits, and income ($16.7, 9.16 to 24.3), but not for consumption taxes on goods and services (-$4.37, -12.9 to 4.11). In countries with low tax revenues (tax revenue per year substantially increased the proportion of births with a skilled attendant present by 6.74 percentage points (95% CI 0.87-12.6) and the extent of financial coverage by 11.4 percentage points (5.51-17.2). Consumption taxes, a more regressive form of taxation that might reduce the ability of the poor to afford essential goods, were associated with increased rates of post-neonatal mortality, infant mortality, and under-5 mortality rates. We did not detect these adverse associations with taxes on capital gains, profits, and income, which tend to be more progressive. Increasing domestic tax revenues is integral to achieving universal health coverage, particularly in countries with low tax bases. Pro-poor taxes on profits and capital gains seem to support expanding health coverage without the adverse associations with health outcomes observed for higher consumption taxes. Progressive tax policies within a pro-poor framework might accelerate progress toward achieving major

  14. 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

  15. The complexity of 'harm reduction' with smokeless tobacco as an approach to tobacco control in low-income and middle-income countries.

    Science.gov (United States)

    Ayo-Yusuf, Olalekan A; Burns, David M

    2012-03-01

    To review the implications of recommending smokeless tobacco (ST) use as a harm reduction approach for low-income and middle-income countries (LMICs). Narrative review of published papers and other data sources (including conference abstracts and internet-based information) on the health risks posed by the use of ST products for individual smokers and for the population with a focus on their implications for LMICs. Swedish snus has a relatively lower toxicity profile than ST products available in other markets, including older products used in the US and products used in Africa and Asia. The experience with snus in Sweden provides information on the effects of snus use in a population where cigarette smoking was already culturally ingrained. However, population effects are likely to be different in those LMICs where smoking is not yet the dominant culturally accepted form of tobacco use. The total effect may be negative in countries where locally-popular ST products have substantially higher disease risks than Swedish snus and where there is limited regulatory and tobacco use surveillance capacity. Issues relating to how populations in LMICs respond to marketing efforts, the risks of the dual use of ST and smoking, and the capacity to regulate ST products need to be considered in making decisions about harm reduction strategies in LMICs. The public health effects of supporting ST as a harm reduction strategy may vary substantively in countries with different pre-existing tobacco use patterns.

  16. Critical care of tropical disease in low income countries: Report from the Task Force on Tropical Diseases by the World Federation of Societies of Intensive and Critical Care Medicine.

    Science.gov (United States)

    Baker, Tim; Khalid, Karima; Acicbe, Ozlem; McGloughlin, Steve; Amin, Pravin

    2017-12-01

    Tropical disease results in a great burden of critical illness. The same life-saving and supportive therapies to maintain vital organ functions that comprise critical care are required by these patients as for all other diseases. In low income countries, the little available data points towards high mortality rates and big challenges in the provision of critical care. Improving critical care in low income countries requires a focus on hospital design, training, triage, monitoring & treatment modifications, the basic principles of critical care, hygiene and the involvement of multi-disciplinary teams. As a large proportion of critical illness from tropical disease is in low income countries, the impact and reductions in mortality rates of improved critical care in such settings could be substantial. Copyright © 2017. Published by Elsevier Inc.

  17. 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

  18. Population-based cancer screening programmes in low-income and middle-income countries: regional consultation of the International Cancer Screening Network in India.

    Science.gov (United States)

    Sivaram, Sudha; Majumdar, Gautam; Perin, Douglas; Nessa, Ashrafun; Broeders, Mireille; Lynge, Elsebeth; Saraiya, Mona; Segnan, Nereo; Sankaranarayanan, Rengaswamy; Rajaraman, Preetha; Trimble, Edward; Taplin, Stephen; Rath, G K; Mehrotra, Ravi

    2018-02-01

    The reductions in cancer morbidity and mortality afforded by population-based cancer screening programmes have led many low-income and middle-income countries to consider the implementation of national screening programmes in the public sector. Screening at the population level, when planned and organised, can greatly benefit the population, whilst disorganised screening can increase costs and reduce benefits. The International Cancer Screening Network (ICSN) was created to share lessons, experience, and evidence regarding cancer screening in countries with organised screening programmes. Organised screening programmes provide screening to an identifiable target population and use multidisciplinary delivery teams, coordinated clinical oversight committees, and regular review by a multidisciplinary evaluation board to maximise benefit to the target population. In this Series paper, we report outcomes of the first regional consultation of the ICSN held in Agartala, India (Sept 5-7, 2016), which included discussions from cancer screening programmes from Denmark, the Netherlands, USA, and Bangladesh. We outline six essential elements of population-based cancer screening programmes, and share recommendations from the meeting that policy makers might want to consider before implementation. Copyright © 2018 Elsevier Ltd. All rights reserved.

  19. Does task shifting yield cost savings and improve efficiency for health systems? A systematic review of evidence from low-income and middle-income countries.

    Science.gov (United States)

    Seidman, Gabriel; Atun, Rifat

    2017-04-13

    Task shifting has become an increasingly popular way to increase access to health services, especially in low-resource settings. Research has demonstrated that task shifting, including the use of community health workers (CHWs) to deliver care, can improve population health. This systematic review investigates whether task shifting in low-income and middle-income countries (LMICs) results in efficiency improvements by achieving cost savings. Using the PRISMA guidelines for systematic reviews, we searched PubMed, Embase, CINAHL, and the Health Economic Evaluation Database on March 22, 2016. We included any original peer-review articles that demonstrated cost impact of a task shifting program in an LMIC. We identified 794 articles, of which 34 were included in our study. We found that substantial evidence exists for achieving cost savings and efficiency improvements from task shifting activities related to tuberculosis and HIV/AIDS, and additional evidence exists for the potential to achieve cost savings from activities related to malaria, NCDs, NTDs, childhood illness, and other disease areas, especially at the primary health care and community levels. Task shifting presents a viable option for health system cost savings in LMICs. Going forward, program planners should carefully consider whether task shifting can improve population health and health systems efficiency in their countries, and researchers should investigate whether task shifting can also achieve cost savings for activities related to emerging global health priorities and health systems strengthening activities such as supply chain management or monitoring and evaluation.

  20. Cigarettes point of purchase patterns in 19 low-income and middle-income countries: Global Adult Tobacco Survey, 2008-2012.

    Science.gov (United States)

    Mbulo, Lazarous; Kruger, Judy; Hsia, Jason; Yin, Shaoman; Salandy, Simone; Orlan, Elizabeth N; Agaku, Israel; Ribisl, Kurt M

    2018-04-05

    There is little information on cigarette-purchasing behaviour among smokers globally. Understanding cigarette purchase and point-of-sale patterns can help guide the development and implementation of tobacco-control strategies in retail environments. The purpose of this study was to identify where adults in 19 countries last purchased cigarettes. Data were from 19 low-income and middle-income countries that conducted the Global Adult Tobacco Survey (GATS) during 2008-2012. GATS is a nationally representative household survey of adults aged 15 years or older using a standardised protocol to measure tobacco-related behaviours. Data were weighted to yield nationally representative estimates within each country and summarised by using descriptive statistics. Overall prevalence of current cigarette smoking ranged from 3.7% in Nigeria to 38.5% in the Russian Federation. Among current cigarette smokers, locations of last purchase were as follows: stores, from 14.6% in Argentina to 98.7% in Bangladesh (median=66.8%); street vendors, from 0% in Thailand to 35.7% in Vietnam (median=3.0%); kiosks, from 0.1% in Thailand to 77.3% in Argentina (median=16.1%); other locations, from 0.3% in China and Egypt to 57.5% in Brazil (median=2.6%). Cigarettes are purchased at various retail locations globally. However, stores and kiosks were the main cigarette purchase locations in 18 of the 19 countries assessed. Knowledge of where cigarette purchases occur could help guide interventions to reduce cigarette accessibility and use. © 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.

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

    Science.gov (United States)

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

    2014-04-01

    Economic growth is widely regarded as a necessary, and often sufficient, condition for the improvement of population health. We aimed to assess whether macroeconomic growth was associated with reductions in early childhood undernutrition in low-income and middle-income countries. We analysed data from 121 Demographic and Health Surveys from 36 countries done between Jan 1, 1990, and Dec 31, 2011. The sample consisted of nationally representative cross-sectional surveys of children aged 0-35 months, and the outcome variables were stunting, underweight, and wasting. The main independent variable was per-head gross domestic product (GDP) in constant prices and adjusted for purchasing power parity. We used logistic regression models to estimate the association between changes in per-head GDP and changes in child undernutrition outcomes. Models were adjusted for country fixed effects, survey-year fixed effects, clustering, and demographic and socioeconomic covariates for the child, mother, and household. Sample sizes were 462,854 for stunting, 485,152 for underweight, and 459,538 for wasting. Overall, 35·6% (95% CI 35·4-35·9) of young children were stunted (ranging from 8·7% [7·6-9·7] in Jordan to 51·1% [49·1-53·1] in Niger), 22·7% (22·5-22·9) were underweight (ranging from 1·8% [1·3-2·3] in Jordan to 41·7% [41·1-42·3] in India), and 12·8% (12·6-12·9) were wasted (ranging from 1·2% [0·6-1·8] in Peru to 28·8% [27·5-30·0] in Burkina Faso). At the country level, no association was seen between average changes in the prevalence of child undernutrition outcomes and average growth of per-head GDP. In models adjusted only for country and survey-year fixed effects, a 5% increase in per-head GDP was associated with an odds ratio (OR) of 0·993 (95% CI 0·989-0·995) for stunting, 0·986 (0·982-0·990) for underweight, and 0·984 (0·981-0·986) for wasting. ORs after adjustment for the full set of covariates were 0·996 (0·993-1·000) for stunting, 0

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

    Science.gov (United States)

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

    2017-07-27

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

  3. Using Economic Evidence to Set Healthcare Priorities in Low-Income and Lower-Middle-Income Countries: A Systematic Review of Methodological Frameworks.

    Science.gov (United States)

    Wiseman, Virginia; Mitton, Craig; Doyle-Waters, Mary M; Drake, Tom; Conteh, Lesong; Newall, Anthony T; Onwujekwe, Obinna; Jan, Stephen

    2016-02-01

    Policy makers in low-income and lower-middle-income countries (LMICs) are increasingly looking to develop 'evidence-based' frameworks for identifying priority health interventions. This paper synthesises and appraises the literature on methodological frameworks--which incorporate economic evaluation evidence--for the purpose of setting healthcare priorities in LMICs. A systematic search of Embase, MEDLINE, Econlit and PubMed identified 3968 articles with a further 21 articles identified through manual searching. A total of 36 papers were eligible for inclusion. These covered a wide range of health interventions with only two studies including health systems strengthening interventions related to financing, governance and human resources. A little under half of the studies (39%) included multiple criteria for priority setting, most commonly equity, feasibility and disease severity. Most studies (91%) specified a measure of 'efficiency' defined as cost per disability-adjusted life year averted. Ranking of health interventions using multi-criteria decision analysis and generalised cost-effectiveness were the most common frameworks for identifying priority health interventions. Approximately a third of studies discussed the affordability of priority interventions. Only one study identified priority areas for the release or redeployment of resources. The paper concludes by highlighting the need for local capacity to conduct evaluations (including economic analysis) and empowerment of local decision-makers to act on this evidence. © 2016 The Authors. Health Economics published by John Wiley & Sons Ltd.

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

    Science.gov (United States)

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

    2015-05-01

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

  5. Tenecteplase versus Alteplase for the Management of Acute Ischemic Stroke in a Low-income Country-Nepal: Cost, Efficacy, and Safety.

    Science.gov (United States)

    Nepal, Gaurav; Kharel, Ghanshyam; Ahamad, Shaik Tanveer; Basnet, Babin

    2018-02-09

    Intravenous alteplase is the only approved treatment for acute ischemic stroke. Tenecteplase, a genetically engineered, mutant tissue plasminogen activator, is an alternative thrombolytic agent. The economic feasibility of stroke treatment has been a matter of huge debate and discussion thus far. The use of thrombolytics for the management of ischemic stroke has recently begun in Nepal. In low-income countries like Nepal, where the per capita income falls at just $691.7 and 25.2% of the population are under the poverty line, stroke patients cannot meet treatment expenses. Tenecteplase is easily available (for the management of acute coronary syndrome) in tertiary-level hospitals of Nepal and the price quote of tenecteplase ($450) is half the price of alteplase ($1000). In emergency cases, sometimes, the cost of alteplase can be greater than the patient can afford and they can't undergo thrombolysis even after arriving on time. However, evidence exists that supports the use of other alternatives (tenecteplase), which are also effective in the management of acute ischemic stroke. In this article, we examined current evidence for the efficacy and safety of tenecteplase when compared to alteplase. This review will make neurologists in Nepal familiar with the efficacy and safety of tenecteplase in comparison with alteplase since it is common for patients to not be able to afford the expensive alteplase, which makes guideline-based practice impossible some times.

  6. Absenteeism amongst health workers – developing a typology to support empiric work in low-income countries and characterizing reported associations

    Science.gov (United States)

    2013-01-01

    The contribution of inadequate health worker numbers and emigration have been highlighted in the international literature, but relatively little attention has been paid to absenteeism as a factor that undermines health-care delivery in low income countries. We therefore aimed to review the literature on absenteeism from a health system manager’s perspective to inform needed work on this topic. Specifically, we aimed to develop a typology of definitions that might be useful to classify different forms of absenteeism and identify factors associated with absenteeism. Sixty-nine studies were reviewed, only four were from sub-Saharan Africa where the human resources for health crisis is most acute. Forms of absenteeism studied and methods used vary widely. No previous attempt to develop an overarching approach to classifying forms of absenteeism was identified. A typology based on key characteristics is proposed to fill this gap and considers absenteeism as defined by two key attributes, whether it is: planned/unplanned, and voluntary/involuntary. Factors reported to influence rates of absenteeism may be broadly classified into three thematic categories: workplace and content, personal and organizational and cultural factors. The literature presents an inconsistent picture of the effects of specific factors within these themes perhaps related to true contextual differences or inconsistent definitions of absenteeism. PMID:23866770

  7. Stigma, explanatory models and unmet needs of caregivers of children with developmental disorders in a low-income African country: a cross-sectional facility-based survey.

    Science.gov (United States)

    Tilahun, Dejene; Hanlon, Charlotte; Fekadu, Abebaw; Tekola, Bethlehem; Baheretibeb, Yonas; Hoekstra, Rosa A

    2016-04-27

    Understanding the perspectives of caregivers of children with developmental disorders living in low-income countries is important to inform intervention programmes. The purpose of this study was to examine the stigma experiences, explanatory models, unmet needs, preferred interventions and coping mechanisms of caregivers of children with developmental disorders in Ethiopia. Participants comprised caregivers (n = 102) of children with developmental disorders attending two child mental health clinics in Addis Ababa. The majority (66.7%; n = 68) had a diagnosis of intellectual disability (ID); 34 children (33.3%) had autism spectrum disorder (ASD) as their primary diagnosis. All caregivers were administered a structured questionnaire via a face-to-face interview, which included an adaptation of the Family Interview Schedule, closed questions about socio-demographic characteristics, explanatory models of illness, type of interventions used or desired and coping strategies, and an open ended question regarding the family's unmet needs. Most caregivers reported experience of stigma: 43.1% worried about being treated differently, 45.1% felt ashamed about their child's condition and 26.7% made an effort to keep their child's condition secret. Stigma did not depend on the type of developmental disorder, the child's age or gender, or on the age or level of education of the caregiver (all p > 0.05). Reported stigma was significantly higher in caregivers who had sought traditional help (p child's condition (p = .02) and in caregivers of Orthodox Christian faith (p = .03). Caregivers gave a mixture of biomedical explanations (e.g. head injury (30.4%) or birth complications (25.5%)) and supernatural explanations (e.g. spirit possession (40.2%) or sinful act (27.5%)) for their child's condition. The biggest reported unmet need was educational provision for their child (74.5%), followed by treatment by a health professional (47.1%), financial support (30.4%) and expert help to

  8. Priorities for action on the social determinants of health: Empirical evidence on the strongest associations with life expectancy in 54 low-income countries, 1990-2012.

    Science.gov (United States)

    Hauck, K; Martin, S; Smith, P C

    2016-10-01

    The WHO Commission on the Social Determinants of Health set out an impressive collection of policy proposals on the social determinants of health. However, a serious weakness for securing implementation is the difficulty for policymakers in identifying priorities for action. The objective of this study is to determine a small set of the most influential determinants using existing data and an empirical approach. 45 Indicators from the World Bank's World Development Indicators are selected to measure attainment for the determinants proposed by the Commission. Panel data models of life expectancy at birth for 54 low-income countries over the years 1990-2012 (1188 country-years) are estimated. Each determinant is subjected to a robustness test using Extreme Bound Analysis, to determine the stability of its estimated impact on life expectancy. For 20 robust and significant determinants the magnitude of association with life expectancy is determined. The largest average increases in life expectancy at 14.5 months per capita is associated with a one standard deviation reduction in HIV prevalence among children, followed by advances in gender equality at 9.4 months. Improvements in life expectancy between 6 and 9 months are associated with agricultural production, political stability, access to clean water and sanitation, good governance, and primary school enrolment. Improvements below 6 months are associated with increases in private health expenditure and overseas development assistance, and control of armed conflict and HIV prevalence among men. There is no evidence that national income, public spending on healthcare and education, secondary schooling, terms of international trade, employment, debt service and relief, out-of-pocket expenditures, agricultural ex- or imports, lifestock production, foreign investment, urbanization or environmental degradation are robustly associated with population health. Results provide support for the relevance of some proposed

  9. Interventions for the prevention of cardiovascular diseases: a protocol for a systematic review of economic evaluations in low-income and middle-income countries.

    Science.gov (United States)

    Aminde, Leopold Ndemnge; Veerman, Lennert

    2016-12-21

    Low-income and middle-income countries (LMICs) are experiencing a growing disease burden due to cardiovascular and other chronic non-communicable diseases. Interventions for the control of these diseases are paramount; however, these countries are faced with competing health and financial needs. There is an urgent need for quality evidence on cost-effective strategies to address these chronic diseases. We aim to synthesise the current literature on economic evaluations of interventions for primary and secondary cardiovascular disease prevention in LMICs. A systematic review of studies (published and unpublished) in LMICs up to 30 October 2016 will be conducted. The following databases will be searched: PubMed/MEDLINE, EMBASE, SCOPUS, CINAHL, Web of Science, EconLit, NHS Economic Evaluations Database (NHS EED). Data sources specific to African literature, such as the WHO AFROLIB, Africa Index Medicus and African Journals online (AJOL) as well as grey literature, will also be searched. 2 reviewers shall independently screen potential articles for inclusion and disagreements shall be resolved by consensus. Quality appraisal of studies shall be done using Drummond's checklist for economic evaluation of studies. A descriptive synthesis of the evidence obtained is planned. The primary outcomes will be costs per life years gained or unit of clinical outcome, cost per quality-adjusted life years or disability-adjusted life years. This systematic review protocol has been prepared according to the Preferred Reporting Items for Systematic reviews and Meta-analyses for Protocols (PRISMA-P) 2015 statement. Ethics approval is not required considering that this is a protocol for a systematic review of published studies. Results from this review will be disseminated via conference presentations and peer-reviewed journal publications. CRD42016043510. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  10. State of inequality in diphtheria-tetanus-pertussis immunisation coverage in low-income and middle-income countries: a multicountry study of household health surveys.

    Science.gov (United States)

    Hosseinpoor, Ahmad Reza; Bergen, Nicole; Schlotheuber, Anne; Gacic-Dobo, Marta; Hansen, Peter M; Senouci, Kamel; Boerma, Ties; Barros, Aluisio J D

    2016-09-01

    Immunisation programmes have made substantial contributions to lowering the burden of disease in children, but there is a growing need to ensure that programmes are equity-oriented. We aimed to provide a detailed update about the state of between-country inequality and within-country economic-related inequality in the delivery of three doses of the combined diphtheria, tetanus toxoid, and pertussis-containing vaccine (DTP3), with a special focus on inequalities in high-priority countries. We used data from the latest available Demographic and Health Surveys and Multiple Indicator Cluster Surveys done in 51 low-income and middle-income countries. Data for DTP3 coverage were disaggregated by wealth quintile, and inequality was calculated as difference and ratio measures based on coverage in richest (quintile 5) and poorest (quintile 1) household wealth quintiles. Excess change was calculated for 21 countries with data available at two timepoints spanning a 10 year period. Further analyses were done for six high-priority countries-ie, those with low national immunisation coverage and/or high absolute numbers of unvaccinated children. Significance was determined using 95% CIs. National DTP3 immunisation coverage across the 51 study countries ranged from 32% in Central African Republic to 98% in Jordan. Within countries, the gap in DTP3 immunisation coverage suggested pro-rich inequality, with a difference of 20 percentage points or more between quintiles 1 and 5 for 20 of 51 countries. In Nigeria, Pakistan, Laos, Cameroon, and Central African Republic, the difference between quintiles 1 and 5 exceeded 40 percentage points. In 15 of 21 study countries, an increase over time in national coverage of DTP3 immunisation was realised alongside faster improvements in the poorest quintile than the richest. For example, in Burkina Faso, Cambodia, Gabon, Mali, and Nepal, the absolute increase in coverage was at least 2·0 percentage points per year, with faster improvement in the

  11. HIV-1 drug resistance before initiation or re-initiation of first-line antiretroviral therapy in low-income and middle-income countries: a systematic review and meta-regression analysis

    NARCIS (Netherlands)

    Gupta, Ravindra K.; Gregson, John; Parkin, Neil; Haile-Selassie, Hiwot; Tanuri, Amilcar; Andrade Forero, Liliana; Kaleebu, Pontiano; Watera, Christine; Aghokeng, Avelin; Mutenda, Nicholus; Dzangare, Janet; Hone, San; Hang, Zaw Zaw; Garcia, Judith; Garcia, Zully; Marchorro, Paola; Beteta, Enrique; Giron, Amalia; Hamers, Raph; Inzaule, Seth; Frenkel, Lisa M.; Chung, Michael H.; de Oliveira, Tulio; Pillay, Deenan; Naidoo, Kogie; Kharsany, Ayesha; Kugathasan, Ruthiran; Cutino, Teresa; Hunt, Gillian; Avila Rios, Santiago; Doherty, Meg; Jordan, Michael R.; Bertagnolio, Silvia

    2018-01-01

    Pretreatment drug resistance in people initiating or re-initiating antiretroviral therapy (ART) containing non-nucleoside reverse transcriptase inhibitors (NNRTIs) might compromise HIV control in low-income and middle-income countries (LMICs). We aimed to assess the scale of this problem and whether

  12. 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.

  13. A systematic review of factors that affect uptake of community-based health insurance in low-income and middle-income countries.

    Science.gov (United States)

    Adebayo, Esther F; Uthman, Olalekan A; Wiysonge, Charles S; Stern, Erin A; Lamont, Kim T; Ataguba, John E

    2015-12-08

    Low-income and middle-income countries (LMICs) have difficulties achieving universal financial protection, which is primordial for universal health coverage. A promising avenue to provide universal financial protection for the informal sector and the rural populace is community-based health insurance (CBHI). We systematically assessed and synthesised factors associated with CBHI enrolment in LMICs. We searched PubMed, Scopus, ERIC, PsychInfo, Africa-Wide Information, Academic Search Premier, Business Source Premier, WHOLIS, CINAHL, Cochrane Library, conference proceedings, and reference lists for eligible studies available by 31 October 2013; regardless of publication status. We included both quantitative and qualitative studies in the review. Both quantitative and qualitative studies demonstrated low levels of income and lack of financial resources as major factors affecting enrolment. Also, poor healthcare quality (including stock-outs of drugs and medical supplies, poor healthcare worker attitudes, and long waiting times) was found to be associated with low CBHI coverage. Trust in both the CBHI scheme and healthcare providers were also found to affect enrolment. Educational attainment (less educated are willing to pay less than highly educated), sex (men are willing to pay more than women), age (younger are willing to pay more than older individuals), and household size (larger households are willing to pay more than households with fewer members) also influenced CBHI enrolment. In LMICs, while CBHI schemes may be helpful in the short term to address the issue of improving the rural population and informal workers' access to health services, they still face challenges. Lack of funds, poor quality of care, and lack of trust are major reasons for low CBHI coverage in LMICs. If CBHI schemes are to serve as a means to providing access to health services, at least in the short term, then attention should be paid to the issues that militate against their success.

  14. Simulating the impact of excise taxation for disease prevention in low-income and middle-income countries: an application to South Africa.

    Science.gov (United States)

    Stacey, Nicholas; Summan, Amit; Tugendhaft, Aviva; Laxminarayan, Ramanan; Hofman, Karen

    2018-01-01

    Excise taxes are policy tools that have been applied internationally with some success to reduce consumption of products adversely impacting population health including tobacco, alcohol and increasingly junk foods and sugary beverages. As in other low-income and middle-income countries, South Africa faces a growing burden of lifestyle diseases; accordingly we simulate the impact of multiple excise tax interventions in this setting. We construct a mathematical model to simulate the health and revenue effects of increased excise taxes, which is adaptable to a variety of settings given its limited data requirements. Applying the model to South Africa, we simulate the impact of increased tax rates on tobacco and beer and of the introduction of a tax on sugar-sweetened beverages (SSB). Drawing on surveys of product usage and risk factor prevalence, the model uses a potential impact fraction to simulate the health effects of tax interventions. Adopting an excise rate of 60% on tobacco would result in a gain of 858 923 life-years (95% uncertainty interval (UI) 480 188 to 1 310 329), while adopting an excise rate of 25% on beer would result in a gain of 568 063 life-years (95% UI 412 110 to 775 560) and the adoption of a 20% tax on SSBs would result in a gain of 688 719 life-years (95% UI 321 788 to 1 079 653). More aggressive excise tax policies on tobacco, beer and SSBs in South Africa could result in meaningful improvements in population health and raised revenue.

  15. Is overseas volunteering beneficial to the NHS? The analysis of volunteers' responses to a feedback questionnaire following experiences in low-income and middle-income countries.

    Science.gov (United States)

    Yeomans, Daniel; Le, Grace; Pandit, Hemant; Lavy, Chris

    2017-10-16

    Locally requested and planned overseas volunteering in low-income and middle-income countries by National Health Service (NHS) staff can have benefits for the host or receiving nation, but its impact on the professional development of NHS staff is not proven. The Knowledge and Skills Framework (KSF) and Leadership Framework (LF) are two tools used by employers as a measure of individuals' development. We have used dimensions from both tools as a method of evaluating the benefit to NHS doctors who volunteer overseas. 88 NHS volunteers participating with local colleagues in Primary Trauma Care and orthopaedic surgical training courses in sub-Saharan Africa were asked to complete an online self-assessment questionnaire 6 months following their return to the UK. The survey consisted of questions based on qualities outlined in both the KSF and LF. 85 completed responses to the questionnaire were received. In every KSF domain assessed, the majority of volunteers agreed that their overseas volunteering experience improved their practice within the NHS. Self-assessed pre-course and post-course scores evaluating the LF also saw a universal increase, notably in the 'working with others' domain. There is a growing body of literature outlining the positive impact of overseas volunteering on NHS staff. Despite increasing evidence that such experiences can develop volunteers' essential skills, individuals often find it difficult to gain support of their employers. Our study, in line with the current literature, shows that overseas volunteering by NHS staff can provide an opportunity to enhance professional and personal development. Skills gained from volunteering within international links match many of the qualities outlined in both KSF and LF, directly contributing to volunteers' continued professional development. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless

  16. Is overseas volunteering beneficial to the NHS? The analysis of volunteers’ responses to a feedback questionnaire following experiences in low-income and middle-income countries

    Science.gov (United States)

    Yeomans, Daniel; Le, Grace; Pandit, Hemant; Lavy, Chris

    2017-01-01

    Introduction Locally requested and planned overseas volunteering in low-income and middle-income countries by National Health Service (NHS) staff can have benefits for the host or receiving nation, but its impact on the professional development of NHS staff is not proven. The Knowledge and Skills Framework (KSF) and Leadership Framework (LF) are two tools used by employers as a measure of individuals' development. We have used dimensions from both tools as a method of evaluating the benefit to NHS doctors who volunteer overseas. Methods 88 NHS volunteers participating with local colleagues in Primary Trauma Care and orthopaedic surgical training courses in sub-Saharan Africa were asked to complete an online self-assessment questionnaire 6 months following their return to the UK. The survey consisted of questions based on qualities outlined in both the KSF and LF. Results 85 completed responses to the questionnaire were received. In every KSF domain assessed, the majority of volunteers agreed that their overseas volunteering experience improved their practice within the NHS. Self-assessed pre-course and post-course scores evaluating the LF also saw a universal increase, notably in the ‘working with others’ domain. Discussion There is a growing body of literature outlining the positive impact of overseas volunteering on NHS staff. Despite increasing evidence that such experiences can develop volunteers’ essential skills, individuals often find it difficult to gain support of their employers. Our study, in line with the current literature, shows that overseas volunteering by NHS staff can provide an opportunity to enhance professional and personal development. Skills gained from volunteering within international links match many of the qualities outlined in both KSF and LF, directly contributing to volunteers’ continued professional development. PMID:29042388

  17. Exploring the potential of antimicrobial hand hygiene products in reducing the infectious burden in low-income countries: An integrative review.

    Science.gov (United States)

    de Witt Huberts, Jessie; Greenland, Katie; Schmidt, Wolf-Peter; Curtis, Val

    2016-07-01

    The purpose of this review was to understand whether adding antimicrobial agents to hand hygiene products could increase the health benefits of handwashing with plain soap (HWWS) in low-income settings. A review of experimental studies comparing the effects of HWWS with antimicrobial soap and waterless hand sanitizer on health and hand contamination in naturalistic conditions was conducted. In addition, an analysis was completed of the evidence from laboratory studies examining the factors that may affect the impact of antimicrobial soap, taking into account the conditions in low-income settings. The review found no evidence for a superior effect of antimicrobial products compared with HWWS on disease incidence and limited evidence for an effect on hand contamination under naturalistic conditions. An analysis of the effectiveness of antimicrobial soap in laboratory settings suggested that it was only more effective than HWWS when handwashing frequency, duration, and product concentrations were above levels that could be expected in low-income settings. The limited available evidence suggests that under naturalistic conditions, antimicrobial products are no more effective than HWWS in removing pathogens from hands. Without significant improvement in efficacy, antimicrobial products are unlikely to produce greater health gains than HWWS in low-income settings. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  18. Low income product innovation

    Directory of Open Access Journals (Sweden)

    Maria Cecília Sobral

    2008-10-01

    Full Text Available At affluent markets, the literature on product development management tells us to aggregate value and technology, to differentiate products and to launch fast. And at the low-income markets? This exploratory research defines a popular product, characterizes and measures their markets in Brazil, and identifies innovation strategies for them. The results suggest that the effective strategic orientation differs from affluent markets. It includes: to enhance the auto service component; to identify and service the key functionalities to the targeted public; to standardize products and increase the production scale; to extend the product life cycle; to use convenient distribution and marketing channels; to build product images that have appeal in the popular market; to offer longer financing horizons with befittingly lower installments. Data came from market researches and general demographic census. General media published stories were used to identify companies and their strategies. And a few case studies allowed the authors a deeper exploration of the relevant themes.

  19. Genetic improvement of under-utilized and neglected crops in low income food deficit countries through irradiation and related techniques. Proceedings of a final research coordination meeting

    International Nuclear Information System (INIS)

    2004-11-01

    The majority of the world's food is produced from only a few crops, and yet many neglected and under-utilized crops are extremely important for food production in low income food deficit countries (LIFDCs). As the human population grows at an alarming rate in LIFDCs, food availability has declined and is also affected due to environmental factors, lack of improvement of local crop species, erosion of genetic diversity and dependence on a few crop species for food supply. Neglected crops are traditionally grown by farmers in their centres of origin or centres of diversity, where they are still important for the subsistence of local communities, and maintained by socio-cultural preferences and traditional uses. These crops remain inadequately characterised and, until very recently, have been largely ignored by research and conservation. Farmers are losing these crops because they are less competitive with improved major crop species. Radiation-induced mutation techniques have successfully been used that benefited the most genetic improvement of 'major crops' and their know-how have a great potential for enhancing the use of under-utilized and neglected species and speeding up their domestication and crop improvement. The FAO/IAEA efforts on genetic improvement of under-utilized and neglected species play a strategic role in complementing the work that is being carried out worldwide in their promotion. This CRP entitled Genetic Improvement of Under-utilized and Neglected Crops in LIFDCs through Irradiation and Related Techniques was initiated in 1998 with an overall objective to improve food security, enhance nutritional balance, and promote sustainable agriculture in LIFDCs. Specific objectives addressed major constraints to productivity of neglected and under-utilized crops by genetic improvement with radiation-induced mutations and biotechnology in order to enhance economic viability and sustain crop species diversity, and in future to benefit small farmers. This

  20. Factors that affect the uptake of community-based health insurance in low-income and middle-income countries: a systematic protocol.

    Science.gov (United States)

    Adebayo, Esther F; Ataguba, John E; Uthman, Olalekan A; Okwundu, Charles I; Lamont, Kim T; Wiysonge, Charles S

    2014-02-14

    Many people residing in low-income and middle-income countries (LMICs) are regularly exposed to catastrophic healthcare expenditure. It is therefore pertinent that LMICs should finance their health systems in ways that ensure that their citizens can use needed healthcare services and are protected from potential impoverishment arising from having to pay for services. Ways of financing health systems include government funding, health insurance schemes and out-of-pocket payment. A health insurance scheme refers to pooling of prepaid funds in a way that allows for risks to be shared. The health insurance scheme particularly suitable for the rural poor and the informal sector in LMICs is community-based health insurance (CBHI), that is, insurance schemes operated by organisations other than governments or private for-profit companies. We plan to search for and summarise currently available evidence on factors associated with the uptake of CBHI, as we are not aware of previous systematic reviews that have looked at this important topic. This is a protocol for a systematic review of the literature. We will include both quantitative and qualitative studies in this review. Eligible quantitative studies include intervention and observational studies. Qualitative studies to be included are focus group discussions, direct observations, interviews, case studies and ethnography. We will search EMBASE, PubMed, Scopus, ERIC, PsycInfo, Africa-Wide Information, Academic Search Premier, Business Source Premier, WHOLIS, CINAHL and the Cochrane Library for eligible studies available by 31 October 2013, regardless of publication status or language of publication. We will also check reference lists of included studies and proceedings of relevant conferences and contact researchers for eligible studies. Two authors will independently screen the search output, select studies and extract data, resolving discrepancies by consensus and discussion. Qualitative data will be extracted using

  1. Effectiveness of community health worker training programmes for cardiovascular disease management in low-income and middle-income countries: a systematic review.

    Science.gov (United States)

    Abdel-All, Marwa; Putica, Barbara; Praveen, Deversetty; Abimbola, Seye; Joshi, Rohina

    2017-11-03

    Community health workers (CHWs) are increasingly being tasked to prevent and manage cardiovascular disease (CVD) and its risk factors in underserved populations in low-income and middle-income countries (LMICs); however, little is known about the required training necessary for them to accomplish their role. This review aimed to evaluate the training of CHWs for the prevention and management of CVD and its risk factors in LMICs. A search strategy was developed in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and five electronic databases (Medline, Global Health, ERIC, EMBASE and CINAHL) were searched to identify peer-reviewed studies published until December 2016 on the training of CHWs for prevention or control of CVD and its risk factors in LMICs. Study characteristics were extracted using a Microsoft Excel spreadsheet and quality assessed using Effective Public Health Practice Project's Quality Assessment Tool. The search, data extraction and quality assessment were performed independently by two researchers. The search generated 928 articles of which 8 were included in the review. One study was a randomised controlled trial, while the remaining were before-after intervention studies. The training methods included classroom lectures, interactive lessons, e-learning and online support and group discussions or a mix of two or more. All the studies showed improved knowledge level post-training, and two studies demonstrated knowledge retention 6 months after the intervention. The results of the eight included studies suggest that CHWs can be trained effectively for CVD prevention and management. However, the effectiveness of CHW trainings would likely vary depending on context given the differences between studies (eg, CHW demographics, settings and training programmes) and the weak quality of six of the eight studies. Well-conducted mixed-methods studies are needed to provide reliable evidence about the effectiveness and

  2. Exploring the potential of antimicrobial hand hygiene products in reducing the infectious burden in low-income countries: An integrative review.

    OpenAIRE

    de Witt Huberts, J; Greenland, K; Schmidt, WP; Curtis, V

    2016-01-01

    The purpose of this review was to understand whether adding antimicrobial agents to hand hygiene products could increase the health benefits of handwashing with plain soap (HWWS) in low-income settings. A review of experimental studies comparing the effects of HWWS with antimicrobial soap and waterless hand sanitizer on health and hand contamination in naturalistic conditions was conducted. In addition, an analysis was completed of the evidence from laboratory studies examining the factors th...

  3. Socioeconomic status and non-communicable disease behavioural risk factors in low-income and lower-middle-income countries: a systematic review.

    Science.gov (United States)

    Allen, Luke; Williams, Julianne; Townsend, Nick; Mikkelsen, Bente; Roberts, Nia; Foster, Charlie; Wickramasinghe, Kremlin

    2017-03-01

    Non-communicable diseases are the leading global cause of death and disproportionately afflict those living in low-income and lower-middle-income countries (LLMICs). The association between socioeconomic status and non-communicable disease behavioural risk factors is well established in high-income countries, but it is not clear how behavioural risk factors are distributed within LLMICs. We aimed to systematically review evidence on the association between socioeconomic status and harmful use of alcohol, tobacco use, unhealthy diets, and physical inactivity within LLMICs. We searched 13 electronic databases, including Embase and MEDLINE, grey literature, and reference lists for primary research published between Jan 1, 1990, and June 30, 2015. We included studies from LLMICs presenting data on multiple measures of socioeconomic status and tobacco use, alcohol use, diet, and physical activity. No age or language restrictions were applied. We excluded studies that did not allow comparison between more or less advantaged groups. We used a piloted version of the Cochrane Effective Practice and Organisation of Care Group data collection checklist to extract relevant data at the household and individual level from the included full text studies including study type, methods, outcomes, and results. Due to high heterogeneity, we used a narrative approach for data synthesis. We used descriptive statistics to assess whether the prevalence of each risk factor varied significantly between members of different socioeconomic groups. The study protocol is registered with PROSPERO, number CRD42015026604. After reviewing 4242 records, 75 studies met our inclusion criteria, representing 2 135 314 individuals older than 10 years from 39 LLMICs. Low socioeconomic groups were found to have a significantly higher prevalence of tobacco and alcohol use than did high socioeconomic groups. These groups also consumed less fruit, vegetables, fish, and fibre than those of high

  4. Carrying water may be a major contributor to disability from musculoskeletal disorders in low income countries: a cross-sectional survey in South Africa, Ghana and Vietnam

    Science.gov (United States)

    Geere, Jo-Anne; Bartram, Jamie; Bates, Laura; Danquah, Leslie; Evans, Barbara; Fisher, Michael B; Groce, Nora; Majuru, Batsirai; Mokoena, Michael M; Mukhola, Murembiwa S; Nguyen-Viet, Hung; Duc, Phuc Pham; Williams, Ashley Rhoderick; Schmidt, Wolf-Peter; Hunter, Paul R

    2018-01-01

    . The factor ‘axial compression’ was more strongly associated with carrying water containers on the head. Conclusions Participants who reported a history of current or past water carrying more frequently reported pain in locations most likely to be associated with sustained spinal axial compression in the cervical region. Given the fact that cervical spinal conditions are globally one of the more common causes of disability, our findings suggest that water carrying, especially by head loading is a major contributing factor in musculoskeletal disease burden in low income countries. Our findings support the proposed indicator for monitoring SDG6.1: “Percentage of population using safely managed drinking water services at home.” PMID:29497503

  5. Carrying water may be a major contributor to disability from musculoskeletal disorders in low income countries: a cross-sectional survey in South Africa, Ghana and Vietnam.

    Science.gov (United States)

    Geere, Jo-Anne; Bartram, Jamie; Bates, Laura; Danquah, Leslie; Evans, Barbara; Fisher, Michael B; Groce, Nora; Majuru, Batsirai; Mokoena, Michael M; Mukhola, Murembiwa S; Nguyen-Viet, Hung; Duc, Phuc Pham; Williams, Ashley Rhoderick; Schmidt, Wolf-Peter; Hunter, Paul R

    2018-06-01

    more strongly associated with carrying water containers on the head. Participants who reported a history of current or past water carrying more frequently reported pain in locations most likely to be associated with sustained spinal axial compression in the cervical region. Given the fact that cervical spinal conditions are globally one of the more common causes of disability, our findings suggest that water carrying, especially by head loading is a major contributing factor in musculoskeletal disease burden in low income countries. Our findings support the proposed indicator for monitoring SDG6.1: "Percentage of population using safely managed drinking water services at home."

  6. Food sources and intake of n-6 and n-3 fatty acids in low-income countries with emphasis on infants, young children (6-24 months), and pregnant and lactating women.

    Science.gov (United States)

    Michaelsen, Kim F; Dewey, Kathryn G; Perez-Exposito, Ana B; Nurhasan, Mulia; Lauritzen, Lotte; Roos, Nanna

    2011-04-01

    With increasing interest in the potential effects of n-6 and n-3 fatty acids in early life, there is a need for data on the dietary intake of polyunsaturated fatty acids (PUFA) in low-income countries. This review compiles information on the content in breast milk and in foods that are important in the diets of low-income countries from the few studies available. We also estimate the availability of fat and fatty acids in 13 low-income and middle-income countries based on national food balance sheets from the United Nations' Food and Agriculture Organization Statistical Database (FOASTAT). Breast milk docosahexaenoic acid content is very low in populations living mainly on a plant-based diet, but higher in fish-eating countries. Per capita supply of fat and n-3 fatty acids increases markedly with increasing gross domestic product (GDP). In most of the 13 countries, 70-80% of the supply of PUFA comes from cereals and vegetable oils, some of which have very low α-linolenic acid (ALA) content. The total n-3 fatty acid supply is below or close to the lower end of the recommended intake range [0.4%E (percentage of energy supply)] for infants and young children, and below the minimum recommended level (0.5%E) for pregnant and lactating women in the nine countries with the lowest GDP. Fish is important as a source of long-chain n-3 fatty acids, but intake is low in many countries. The supply of n-3 fatty acids can be increased by using vegetable oils with higher ALA content (e.g. soybean or rapeseed oil) and by increasing fish production (e.g. through fish farming). © 2011 Blackwell Publishing Ltd.

  7. National and regional under-5 mortality rate by economic status for low-income and middle-income countries: a systematic assessment.

    Science.gov (United States)

    Chao, Fengqing; You, Danzhen; Pedersen, Jon; Hug, Lucia; Alkema, Leontine

    2018-05-01

    The progress to achieve the fourth Millennium Development Goal in reducing mortality rate in children younger than 5 years since 1990 has been remarkable. However, work remains to be done in the Sustainable Development Goal era. Estimates of under-5 mortality rates at the national level can hide disparities within countries. We assessed disparities in under-5 mortality rates by household economic status in low-income and middle-income countries (LMICs). We estimated country-year-specific under-5 mortality rates by wealth quintile on the basis of household wealth indices for 137 LMICs from 1990 to 2016, using a Bayesian statistical model. We estimated the association between quintile-specific and national-level under-5 mortality rates. We assessed the levels and trends of absolute and relative disparity in under-5 mortality rate between the poorest and richest quintiles, and among all quintiles. In 2016, for all LMICs (excluding China), the aggregated under-5 mortality rate was 64·6 (90% uncertainty interval [UI] 61·1-70·1) deaths per 1000 livebirths in the poorest households (first quintile), 31·3 (29·5-34·2) deaths per 1000 livebirths in the richest households (fifth quintile), and in between those outcomes for the middle quintiles. Between 1990 and 2016, the largest absolute decline in under-5 mortality rate occurred in the two poorest quintiles: 77·6 (90% UI 71·2-82·6) deaths per 1000 livebirths in the poorest quintile and 77·9 (72·0-82·2) deaths per 1000 livebirths in the second poorest quintile. The difference in under-5 mortality rate between the poorest and richest quintiles decreased significantly by 38·8 (90% UI 32·9-43·8) deaths per 1000 livebirths between 1990 and 2016. The poorest to richest under-5 mortality rate ratio, however, remained similar (2·03 [90% UI 1·94-2·11] in 1990, 1·99 [1·91-2·08] in 2000, and 2·06 [1·92-2·20] in 2016). During 1990-2016, around half of the total under-5 deaths occurred in the poorest two quintiles

  8. Motives Underlying Food Choice for Children and Perception of Nutritional Information Among Low-Income Mothers in a Latin American Country.

    Science.gov (United States)

    Machín, Leandro; Giménez, Ana; Curutchet, María Rosa; Martínez, Joseline; Ares, Gastón

    2016-01-01

    The aim of the present study was to investigate the influence of nutritional information on how low-income mothers select food for their children. Five focus groups, each consisting of 5-10 participants, were conducted. Women, older than 18 years, mothers of young children who were beneficiaries of one of the national food stamps programs in Uruguay. Focus group discussions were held around motives underlying food choices for children and perception of labeling systems. Transcripts of the focus group discussions were analyzed using inductive coding. Forty-two women, aged between 18 and 40 years, participated in 5 focus groups. Results showed that low-income mothers do not consider nutritional information when selecting food their children. Traditional nutritional labeling was perceived as complex, difficult to find, and difficult to understand. Participants stressed that they relied on the nutrition claims included on labels for assessing the healthfulness of food products. Semi-directive and directive front-of-pack labels were positively evaluated in terms of ease of interpretation. Participants preferred the traffic light system over other alternatives. Results suggest the need to implement simplified nutritional labeling and to regulate the use of nutrition claims on products targeted at children. Copyright © 2016 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

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

    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

  10. 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

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

    Science.gov (United States)

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

    2014-01-01

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

  12. Education modifies the association of wealth with obesity in women in middle-income but not low-income countries: an interaction study using seven national datasets, 2005-2010.

    Science.gov (United States)

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

    2014-01-01

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

  13. 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

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

    Science.gov (United States)

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

    2016-04-01

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

  15. 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...

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

    Science.gov (United States)

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

    2018-01-01

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

  17. Global Poverty and the New Bottom Billion: Three-Quarters of the World?s Poor Live in Middle-Income Countries

    OpenAIRE

    Andy Sumner

    2011-01-01

    In 1990, 93 per cent of the world?s poor people lived in poor countries?that is, low-income countries (LICs). For 2007?2008, our estimates suggest three things. First, three-quarters of the world?s poor, or almost 1 billion poor people, now live in middle-income countries (MICs). Second, just a quarter of the world?s poor live in 39 LICs. Third, in contrast to earlier estimates that a third of the poor live in fragile states, our estimate is about 23 per cent if one takes the broadest definit...

  18. Transportability of an Evidence-Based Early Childhood Intervention in a Low-Income African Country: Results of a Cluster Randomized Controlled Study.

    Science.gov (United States)

    Huang, Keng-Yen; Nakigudde, Janet; Rhule, Dana; Gumikiriza-Onoria, Joy Louise; Abura, Gloria; Kolawole, Bukky; Ndyanabangi, Sheila; Kim, Sharon; Seidman, Edward; Ogedegbe, Gbenga; Brotman, Laurie Miller

    2017-11-01

    Children in Sub-Saharan Africa (SSA) are burdened by significant unmet mental health needs. Despite the successes of numerous school-based interventions for promoting child mental health, most evidence-based interventions (EBIs) are not available in SSA. This study investigated the implementation quality and effectiveness of one component of an EBI from a developed country (USA) in a SSA country (Uganda). The EBI component, Professional Development, was provided by trained Ugandan mental health professionals to Ugandan primary school teachers. It included large-group experiential training and small-group coaching to introduce and support a range of evidence-based practices (EBPs) to create nurturing and predictable classroom experiences. The study was guided by the Consolidated Framework for Implementation Research, the Teacher Training Implementation Model, and the RE-AIM evaluation framework. Effectiveness outcomes were studied using a cluster randomized design, in which 10 schools were randomized to intervention and wait-list control conditions. A total of 79 early childhood teachers participated. Teacher knowledge and the use of EBPs were assessed at baseline and immediately post-intervention (4-5 months later). A sample of 154 parents was randomly selected to report on child behavior at baseline and post-intervention. Linear mixed effect modeling was applied to examine effectiveness outcomes. Findings support the feasibility of training Ugandan mental health professionals to provide Professional Development for Ugandan teachers. Professional Development was delivered with high levels of fidelity and resulted in improved teacher EBP knowledge and the use of EBPs in the classroom, and child social competence.

  19. Education modifies the association of wealth with obesity in women in middle-income but not low-income countries: an interaction study using seven national datasets, 2005-2010.

    Directory of Open Access Journals (Sweden)

    Amina Aitsi-Selmi

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

  20. Do existing research summaries on health systems match immunisation managers' needs in middle- and low-income countries? Analysis of GAVI health systems strengthening support

    Directory of Open Access Journals (Sweden)

    Kelly Marion

    2011-06-01

    Full Text Available Abstract Background The GAVI Alliance was created in 2000 to increase access to vaccines. More recently, GAVI has supported evidence-based health systems strengthening to overcome barriers to vaccination. Our objectives were: to explore countries' priorities for health systems strengthening; to describe published research summaries for each priority area in relation to their number, quality and relevance; and to describe the use of national data from surveys in identifying barriers to immunisation. Methods From 44 health systems strengthening proposals submitted to GAVI in 2007 and 2008, we analysed the topics identified, the coverage of these topics by existing systematic reviews and the use of nation-wide surveys with vaccination data to justify the needs identified in the proposals. Results Thirty topics were identified and grouped into three thematic areas: health workforce (10 topics; organisation and management (14; and supply, distribution and maintenance (6. We found 51 potentially relevant systematic reviews, although for the topic that appeared most frequently in the proposals ('Health information systems' no review was identified. Thematic and geographic relevance were generally categorised as "high" in 33 (65% and 25 (49% reviews, respectively, but few reviews were categorised as "highly relevant for policy" (7 reviews, 14%. With regard to methodological quality, 14 reviews (27% were categorised as "high". The number of topics that were addressed by at least one high quality systematic review was: seven of the 10 topics in the 'health workforce' thematic area; six of the 14 topics in the area of 'organisation and management'; and none of the topics in the thematic area of 'supply, distribution and maintenance'. Only twelve of the 39 countries with available national surveys referred to them in their proposals. Conclusion Relevant, high quality research summaries were found for few of the topics identified by managers. Few proposals

  1. Does autonomization of public hospitals and exposure to market pressure complement or debilitate social health insurance systems? Evidence from a low-income country.

    Science.gov (United States)

    Sepehri, Ardeshir

    2014-01-01

    Granting public hospitals greater autonomy and creating organizational arrangements that mimic the private sector and encourage competition is often promoted as a way to increase efficiency and public accountability and to improve quality of care at these facilities. The existence of good-quality health infrastructure, in turn, encourages the population to join and support the social health insurance system and achieve universal coverage. This article provides a critical review of hospital autonomization, using Vietnam's experience to assess the influence of hospital autonomy on the sustainability of Vietnam's social health insurance. The evidence suggests that a reform process based on greater autonomy of resource mobilization and on the retention and use of own-source revenues can create perverse incentives among managers and health care providers, leading to the development of a two-tiered provision of clinical care, provider-induced supply of an inefficient service mix, a high degree of duplication, wasteful investment, and cost escalation. Rather than complementing social health insurance and helping the country to achieve universal coverage, granting public hospitals greater autonomy that mimics the private sector may indeed undermine the legitimacy and sustainability of social health insurance as health care costs escalate and higher quality of care remains elusive.

  2. Remote tele-mentored ultrasound for non-physician learners using FaceTime: A feasibility study in a low-income country.

    Science.gov (United States)

    Robertson, Thomas E; Levine, Andrea R; Verceles, Avelino C; Buchner, Jessica A; Lantry, James H; Papali, Alfred; Zubrow, Marc T; Colas, L Nathalie; Augustin, Marc E; McCurdy, Michael T

    2017-08-01

    Ultrasound (US) is a burgeoning diagnostic tool and is often the only available imaging modality in low- and middle-income countries (LMICs). However, bedside providers often lack training to acquire or interpret US images. We conducted a study to determine if a remote tele-intensivist could mentor geographically removed LMIC providers to obtain quality and clinically useful US images. Nine Haitian non-physician health care workers received a 20-minute training on basic US techniques. A volunteer was connected to an intensivist located in the USA via FaceTime. The intensivist remotely instructed the non-physicians to ultrasound five anatomic sites. The tele-intensivist evaluated the image quality and clinical utility of performing tele-ultrasound in a LMIC. The intensivist agreed (defined as "agree" or "strongly agree" on a five-point Likert scale) that 90% (57/63) of the FaceTime images were high quality. The intensivist felt comfortable making clinical decisions using FaceTime images 89% (56/63) of the time. Non-physicians can feasibly obtain high-quality and clinically relevant US images using video chat software in LMICs. Commercially available software can connect providers in institutions in LMICs to geographically removed intensivists at a relatively low cost and without the need for extensive training of local providers. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Worldwide burden of COPD in high- and low-income countries. Part II. Burden of chronic obstructive lung disease in Latin America: the PLATINO study

    Energy Technology Data Exchange (ETDEWEB)

    Menezes, A.M.B.; Perez-Padilla, R.; Hallal, P.C.; Jardim, J.R.; Muino, A.; Lopez, M.V.; Valdivia, G.; Pertuze, J.; de Oca, M.M.; Talamo, C. [Universidade Federal de Pelotas, Pelotas (Brazil)

    2008-07-15

    The objective of the paper is to describe the burden of chronic obstructive pulmonary disease (COPD) in Latin America. Five Latin American cities were investigated, namely, Sao Paulo, Brazil; Mexico City, Mexico; Montevideo, Uruguay; Santiago, Chile; Caracas, Venezuela. This is a multi Centre study. Post-bronchodilator spirometry was used and the main outcome measure was FEV1/FVC < 0.7 (fixed ratio criterion). Global Obstructive Lung Disease (GOLD) stages were also analysed. The combined population aged {>=} 40 years in the five countries included in the study was approximately 85.3 million. Of these, it was estimated that 12.2 million have airflow obstruction, which corresponds to our prevalence estimate of 14.3%. The proportion of subjects in Stages II-IV of the GOLD classification was 5.6%. Risk factors presenting the highest actiological fractions for COPD were age, current smoking, indoor exposure to coal and exposure to dust in the workplace. Smoking, the modifiable factor with the strongest aetiological fraction for COPD, affects 29.2% of adults aged {>=} 40 years in these cities, corresponding to approximately 25 million smokers in this age group. Prevention of smoking and exposure to pollutants, such as coal and dust, are the interventions most likely to succeed against COPD in Latin America.

  4. What is the impact of water sanitation and hygiene in healthcare facilities on care seeking behaviour and patient satisfaction? A systematic review of the evidence from low-income and middle-income countries

    Science.gov (United States)

    Cumming, Oliver; Hunter, Paul R

    2018-01-01

    Patient satisfaction with healthcare has clear implications on service use and health outcomes. Barriers to care seeking are complex and multiple and delays in seeking care are associated with significant morbidity and mortality. We sought to assess the relationship between water, sanitation and hygiene (WASH) provision in healthcare facilities (HCF) and patient satisfaction/care seeking behaviour in low-income and middle-income countries. Pubmed and Medline Ovid were searched using a combination of search terms. 984 papers were retrieved and only 21 had a WASH component warranting inclusion. WASH was not identified as a driver of patient satisfaction but poor WASH provision was associated with significant patient dissatisfaction with infrastructure and quality of care. However, this dissatisfaction was not sufficient to stop patients from seeking care in these poorly served facilities. With specific regard to maternal health services, poor WASH provision was the reason for women choosing home delivery, although providers’ attitudes and interpersonal behaviours were the main drivers of patient dissatisfaction with maternal health services. Patient satisfaction was mainly assessed via questionnaires and studies reported a high risk of courtesy bias, potentially leading to an overestimation of patient satisfaction. Patient satisfaction was also found to be significantly affected by expectation, which was strongly influenced by patients’ socioeconomic status and education. This systematic review also highlighted a paucity of research to describe and evaluate interventions to improve WASH conditions in HCF in low-income setting with a high burden of healthcare-associated infections. Our review suggests that improving WASH conditions will decrease patience dissatisfaction, which may increase care seeking behaviour and improve health outcomes but that more rigorous research is needed. PMID:29765776

  5. 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.

  6. 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

  7. What stage are low-income and middle-income countries (LMICs) at with patient safety curriculum implementation and what are the barriers to implementation? A two-stage cross-sectional study

    Science.gov (United States)

    Ginsburg, Liane R; Dhingra-Kumar, Neelam; Donaldson, Liam J

    2017-01-01

    Objectives The improvement of safety in healthcare worldwide depends in part on the knowledge, skills and attitudes of staff providing care. Greater patient safety content in health professional education and training programmes has been advocated internationally. While WHO Patient Safety Curriculum Guides (for Medical Schools and Multi-Professional Curricula) have been widely disseminated in low-income and middle-income countries (LMICs) over the last several years, little is known about patient safety curriculum implementation beyond high-income countries. The present study examines patient safety curriculum implementation in LMICs. Methods Two cross-sectional surveys were carried out. First, 88 technical officers in Ministries of Health and WHO country offices were surveyed to identify the pattern of patient safety curricula at country level. A second survey followed that gathered information from 71 people in a position to provide institution-level perspectives on patient safety curriculum implementation. Results The majority, 69% (30/44), of the countries were either considering whether to implement a patient safety curriculum or actively planning, rather than actually implementing, or embedding one. Most organisations recognised the need for patient safety education and training and felt a safety curriculum was compatible with the values of their organisation; however, important faculty-level barriers to patient safety curriculum implementation were identified. Key structural markers, such as dedicated financial resources and relevant assessment tools to evaluate trainees’ patient safety knowledge and skills, were in place in fewer than half of organisations studied. Conclusions Greater attention to patient safety curriculum implementation is needed. The barriers to patient safety curriculum implementation we identified in LMICs are not unique to these regions. We propose a framework to act as a global standard for patient safety curriculum implementation

  8. Patient safety in low-income countries

    Directory of Open Access Journals (Sweden)

    Robert Lindfield

    2015-09-01

    Full Text Available The concept of ‘first do no harm’ is taught to every medical and nursing student. This phrase means that, as professionals, our first duty is to make sure that patients are not harmed as a result of their care.

  9. Do changes to supply chains and procurement processes yield cost savings and improve availability of pharmaceuticals, vaccines or health products? A systematic review of evidence from low-income and middle-income countries.

    Science.gov (United States)

    Seidman, Gabriel; Atun, Rifat

    2017-01-01

    Improving health systems performance, especially in low-resource settings facing complex disease burdens, can improve population health. Specifically, the efficiency and effectiveness of supply chains and procurement processes for pharmaceuticals, vaccines and other health products has important implications for health system performance. Pharmaceuticals, vaccines and other health products make up a large share of total health expenditure in low-income and middle-income countries (LMICs), and they are critical for delivering health services. Therefore, programmes which achieve cost savings on these expenditures may help improve a health system's efficiency, whereas programmes that increase availability of health products may improve a health system's effectiveness. This systematic review investigates whether changes to supply chains and procurement processes can achieve cost savings and/or improve the availability of drugs in LMICs. Using the PRISMA guidelines for systematic reviews, we searched PubMed, Embase, CINAHL and the Health Economic Evaluation Database to identify. We identified 1264 articles, of which 38 were included in our study. We found evidence that centralised procurement and tendering can achieve direct cost savings, while supply chain management programmes can reduce drug stock outs and increase drug availability for populations. This research identifies a broad set of programmes which can improve the ways that health systems purchase and delivery health products. On the basis of this evidence, policymakers and programme managers should examine the root causes of inefficiencies in pharmaceutical supply chain and procurement processes in order to determine how best to improve health systems performance in their specific contexts.

  10. Theory of change for the delivery of talking therapies by lay workers to survivors of humanitarian crises in low-income and middle-income countries: protocol of a systematic review

    Science.gov (United States)

    Ryan, Grace Kathryn; Bass, Judith K; Eaton, Julian

    2018-01-01

    Introduction There is a severe shortage of specialist mental healthcare providers in low-income and middle-income countries (LMICs) affected by humanitarian crises. In these settings, talking therapies may be delivered by non-specialists, including lay workers with no tertiary education or formal certification in mental health. This systematic review will synthesise the literature on the implementation and effectiveness of talking therapies delivered by lay workers in LMICs affected by humanitarian crises, in order to develop a Theory of Change (ToC). Methods and analysis Qualitative, quantitative and mixed-methods studies assessing the implementation or effectiveness of lay-delivered talking therapies for common mental disorders provided to adult survivors of humanitarian crises in LMICs will be eligible for inclusion. Studies set in high-income countries will be excluded. No restrictions will be applied to language or year of publication. Unpublished studies will be excluded. Seven electronic databases will be searched: MEDLINE, Embase, PsycINFO, PsycEXTRA, Global Health, Cochrane Library and ClinicalTrials.gov. Contents pages of three peer-reviewed journals will be hand-searched. Sources of grey literature will include resource directories of two online mental health networks (MHPSS.net and MHInnovation.net) and expert consultation. Forward and backward citation searches of included studies will be performed. Two reviewers will independently screen studies for inclusion, extract data and assess study quality. A narrative synthesis will be conducted, following established guidelines. A ToC map will be amended iteratively to take into account the review results and guide the synthesis. Ethics and dissemination Findings will be presented in a manuscript for publication in a peer-reviewed journal and disseminated through a coordinated communications strategy targeting knowledge generators, enablers and users. PROSPERO registration number CRD42017058287. PMID

  11. Theory of change for the delivery of talking therapies by lay workers to survivors of humanitarian crises in low-income and middle-income countries: protocol of a systematic review.

    Science.gov (United States)

    Ryan, Grace Kathryn; Bauer, Andreas; Bass, Judith K; Eaton, Julian

    2018-02-17

    There is a severe shortage of specialist mental healthcare providers in low-income and middle-income countries (LMICs) affected by humanitarian crises. In these settings, talking therapies may be delivered by non-specialists, including lay workers with no tertiary education or formal certification in mental health. This systematic review will synthesise the literature on the implementation and effectiveness of talking therapies delivered by lay workers in LMICs affected by humanitarian crises, in order to develop a Theory of Change (ToC). Qualitative, quantitative and mixed-methods studies assessing the implementation or effectiveness of lay-delivered talking therapies for common mental disorders provided to adult survivors of humanitarian crises in LMICs will be eligible for inclusion. Studies set in high-income countries will be excluded. No restrictions will be applied to language or year of publication. Unpublished studies will be excluded. Seven electronic databases will be searched: MEDLINE, Embase, PsycINFO, PsycEXTRA, Global Health, Cochrane Library and ClinicalTrials.gov. Contents pages of three peer-reviewed journals will be hand-searched. Sources of grey literature will include resource directories of two online mental health networks (MHPSS.net and MHInnovation.net) and expert consultation. Forward and backward citation searches of included studies will be performed. Two reviewers will independently screen studies for inclusion, extract data and assess study quality. A narrative synthesis will be conducted, following established guidelines. A ToC map will be amended iteratively to take into account the review results and guide the synthesis. Findings will be presented in a manuscript for publication in a peer-reviewed journal and disseminated through a coordinated communications strategy targeting knowledge generators, enablers and users. CRD42017058287. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018

  12. What stage are low-income and middle-income countries (LMICs) at with patient safety curriculum implementation and what are the barriers to implementation? A two-stage cross-sectional study.

    Science.gov (United States)

    Ginsburg, Liane R; Dhingra-Kumar, Neelam; Donaldson, Liam J

    2017-06-15

    The improvement of safety in healthcare worldwide depends in part on the knowledge, skills and attitudes of staff providing care. Greater patient safety content in health professional education and training programmes has been advocated internationally. While WHO Patient Safety Curriculum Guides (for Medical Schools and Multi-Professional Curricula) have been widely disseminated in low-income and middle-income countries (LMICs) over the last several years, little is known about patient safety curriculum implementation beyond high-income countries. The present study examines patient safety curriculum implementation in LMICs. Two cross-sectional surveys were carried out. First, 88 technical officers in Ministries of Health and WHO country offices were surveyed to identify the pattern of patient safety curricula at country level. A second survey followed that gathered information from 71 people in a position to provide institution-level perspectives on patient safety curriculum implementation. The majority, 69% (30/44), of the countries were either considering whether to implement a patient safety curriculum or actively planning, rather than actually implementing, or embedding one. Most organisations recognised the need for patient safety education and training and felt a safety curriculum was compatible with the values of their organisation; however, important faculty-level barriers to patient safety curriculum implementation were identified. Key structural markers, such as dedicated financial resources and relevant assessment tools to evaluate trainees' patient safety knowledge and skills, were in place in fewer than half of organisations studied. Greater attention to patient safety curriculum implementation is needed. The barriers to patient safety curriculum implementation we identified in LMICs are not unique to these regions. We propose a framework to act as a global standard for patient safety curriculum implementation. Educating leaders through the system in

  13. 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

    popularization of motorized two-wheelers who are exposed to collision with tourist cars. Victims mostly tend to develop external lesions resulting in minor injuries. However, there is need to emphasize on the need to associate to current preventive measures an appropriate policy of management of the injured. Keywords: Road traffic victims, Pattern of injury, Emergency department, Laquintinie hospital, Road user category, Low-income country, Outcome

  14. Cancer Outcomes in Low-Income Elders

    Data.gov (United States)

    U.S. Department of Health & Human Services — Cancer Outcomes in Low-Income Elders, Is There An Advantage to Being on Medicaid Because of reduced financial barriers, dual Medicare-Medicaid enrollment of...

  15. Association between maternal age at childbirth and child and adult outcomes in the offspring: a prospective study in five low-income and middle-income countries (COHORTS collaboration).

    Science.gov (United States)

    Fall, Caroline H D; Sachdev, Harshpal Singh; Osmond, Clive; Restrepo-Mendez, Maria Clara; Victora, Cesar; Martorell, Reynaldo; Stein, Aryeh D; Sinha, Shikha; Tandon, Nikhil; Adair, Linda; Bas, Isabelita; Norris, Shane; Richter, Linda M

    2015-07-01

    Both young and advanced maternal age is associated with adverse birth and child outcomes. Few studies have examined these associations in low-income and middle-income countries (LMICs) and none have studied adult outcomes in the offspring. We aimed to examine both child and adult outcomes in five LMICs. In this prospective study, we pooled data from COHORTS (Consortium for Health Orientated Research in Transitioning Societies)-a collaboration of five birth cohorts from LMICs (Brazil, Guatemala, India, the Philippines, and South Africa), in which mothers were recruited before or during pregnancy, and the children followed up to adulthood. We examined associations between maternal age and offspring birthweight, gestational age at birth, height-for-age and weight-for-height Z scores in childhood, attained schooling, and adult height, body composition (body-mass index, waist circumference, fat, and lean mass), and cardiometabolic risk factors (blood pressure and fasting plasma glucose concentration), along with binary variables derived from these. Analyses were unadjusted and adjusted for maternal socioeconomic status, height and parity, and breastfeeding duration. We obtained data for 22 188 mothers from the five cohorts, enrolment into which took place at various times between 1969 and 1989. Data for maternal age and at least one outcome were available for 19 403 offspring (87%). In unadjusted analyses, younger (≤19 years) and older (≥35 years) maternal age were associated with lower birthweight, gestational age, child nutritional status, and schooling. After adjustment, associations with younger maternal age remained for low birthweight (odds ratio [OR] 1·18 (95% CI 1·02-1·36)], preterm birth (1·26 [1·03-1·53]), 2-year stunting (1·46 [1·25-1·70]), and failure to complete secondary schooling (1·38 [1·18-1·62]) compared with mothers aged 20-24 years. After adjustment, older maternal age remained associated with increased risk of preterm birth (OR 1

  16. Researching Entrepreneurship in Low-income Settlements

    DEFF Research Database (Denmark)

    Gough, Katherine V.; Langevang, Thilde; Namatovu, Rebecca

    2014-01-01

    of entrepreneurship conducted in a low-income settlement, which combined participatory quantitative and qualitative approaches, highlighting the strengths and challenges of using participatory methods. The paper demonstrates how drawing on a range of participatory methods can contribute to creating more engaging...

  17. Coping with low incomes and cold homes

    International Nuclear Information System (INIS)

    Anderson, Will; White, Vicki; Finney, Andrea

    2012-01-01

    This paper presents findings from a study of low-income households in Great Britain which explored households’ strategies for coping both with limited financial resources in the winter months, when demand for domestic energy increases, and, in some cases, with cold homes. The study combined a national survey of 699 households with an income below 60 per cent of national median income with in-depth interviews with a subsample of 50 households. The primary strategy adopted by low-income households to cope with financial constraint was to reduce spending, including spending on essentials such as food and fuel, and thereby keep up with core financial commitments. While spending on food was usually reduced by cutting the range and quality of food purchased, spending on energy was usually reduced by cutting consumption. Sixty-three per cent of low-income households had cut their energy consumption in the previous winter and 47 per cent had experienced cold homes. Improvements to the thermal performance of homes reduced but did not eliminate the risk of going cold as any heating cost could be a burden to households on the lowest incomes. Householders’ attitudes were central to their coping strategies, with most expressing a determination to ‘get by’ come what may.

  18. The LiC detector toy program

    International Nuclear Information System (INIS)

    Regler, Meinhard; Valentan, Manfred; Fruehwirth, Rudolf

    2007-01-01

    This note describes the 'LiC Detector Toy' ('LiC' for Linear Collider) software tool which has been developed for detector design studies, aiming at investigating the resolution of reconstructed track parameters for the purpose of comparing and optimizing various detector setups. It consists of a simplified simulation of the detector measurements, taking into account multiple scattering, followed by full single track reconstruction using the Kalman filter. The tool is written in MATLAB and may be installed on a laptop. It can easily be used as a black-box tool by non-experts, but also adapted to individual needs

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

    OpenAIRE

    Attaei, MW; Khatib, R; McKee, M; Lear, S; Dagenais, G; Igumbor, EU; AlHabib, KF; Kaur, M; Kruger, L; Teo, K; Lanas, F; Yusoff, K; Oguz, A; Gupta, R; Yusufali, AM

    2017-01-01

    Hypertension is considered the most important risk factor for cardiovascular diseases, but its control is poor worldwide. We aimed to assess the availability and affordability of blood pressure-lowering medicines, and the association with use of these medicines and blood pressure control in countries at varying levels of economic development. We analysed the availability, costs, and affordability of blood pressure-lowering medicines with data recorded from 626 communities in 20 countries part...

  20. Parenting perceptions of low-income mothers.

    Science.gov (United States)

    Webb, Jenny; Morris, Melanie Hall; Thomas, Sandra P; Combs-Orme, Terri

    2015-01-01

    The purpose of this descriptive qualitative study was to gain understanding of perceptions of low-income pregnant women and mothers about parenting. Participants were 65 low-income, primarily African American, women in their 20s and 30s who were recruited from a faith-based social service center in Memphis, Tennessee. Interviews were conducted by nursing, social work, and psychology students. The existential phenomenological method was used to analyze verbatim responses of participants to vignettes depicting parenting behaviors of hypothetical mothers. Five global themes were identified: (a) Focus on baby's development: "Because I'm the Mother, I'm the First Teacher"; (b) Focus on baby's safety/security: "The Baby Could Be Hurt"; (c) Focus on conveying love: "She Just Wants the Baby to Feel Her Love"; (d) Focus on learning the rules of good childcare: "It's Important to Know the Do's and Don'ts"; and (e) Focus on doing it differently (better) than parents did: "When You Know Better, You Do Better." Findings suggest that these mothers care deeply about providing a better life for their children than the life they have had. They desire to learn about being the best parents they can be. As nurses, we can help to provide educational opportunities for mothers through a variety of evidence-based interventions delivered across the childbearing years.

  1. Wealth and cardiovascular health: a cross-sectional study of wealth-related inequalities in the awareness, treatment and control of hypertension in high-, middle- and low-income countries.

    Science.gov (United States)

    Palafox, Benjamin; McKee, Martin; Balabanova, Dina; AlHabib, Khalid F; Avezum, Alvaro Jr; Bahonar, Ahmad; Ismail, Noorhassim; Chifamba, Jephat; Chow, Clara K; Corsi, Daniel J; Dagenais, Gilles R; Diaz, Rafael; Gupta, Rajeev; Iqbal, Romaina; Kaur, Manmeet; Khatib, Rasha; Kruger, Annamarie; Kruger, Iolanthe Marike; Lanas, Fernando; Lopez-Jaramillo, Patricio; Minfan, Fu; Mohan, Viswanathan; Mony, Prem K; Oguz, Aytekin; Palileo-Villanueva, Lia M; Perel, Pablo; Poirier, Paul; Rangarajan, Sumathy; Rensheng, Lei; Rosengren, Annika; Soman, Biju; Stuckler, David; Subramanian, S V; Teo, Koon; Tsolekile, Lungiswa P; Wielgosz, Andreas; Yaguang, Peng; Yeates, Karen; Yongzhen, Mo; Yusoff, Khalid; Yusuf, Rita; Yusufali, Afzalhussein; Zatońska, Katarzyna; Yusuf, Salim

    2016-12-08

    Effective policies to control hypertension require an understanding of its distribution in the population and the barriers people face along the pathway from detection through to treatment and control. One key factor is household wealth, which may enable or limit a household's ability to access health care services and adequately control such a chronic condition. This study aims to describe the scale and patterns of wealth-related inequalities in the awareness, treatment and control of hypertension in 21 countries using baseline data from the Prospective Urban and Rural Epidemiology study. A cross-section of 163,397 adults aged 35 to 70 years were recruited from 661 urban and rural communities in selected low-, middle- and high-income countries (complete data for this analysis from 151,619 participants). Using blood pressure measurements, self-reported health and household data, concentration indices adjusted for age, sex and urban-rural location, we estimate the magnitude of wealth-related inequalities in the levels of hypertension awareness, treatment, and control in each of the 21 country samples. Overall, the magnitude of wealth-related inequalities in hypertension awareness, treatment, and control was observed to be higher in poorer than in richer countries. In poorer countries, levels of hypertension awareness and treatment tended to be higher among wealthier households; while a similar pro-rich distribution was observed for hypertension control in countries at all levels of economic development. In some countries, hypertension awareness was greater among the poor (Sweden, Argentina, Poland), as was treatment (Sweden, Poland) and control (Sweden). Inequality in hypertension management outcomes decreased as countries became richer, but the considerable variation in patterns of wealth-related inequality - even among countries at similar levels of economic development - underscores the importance of health systems in improving hypertension management for all

  2. Effects of low income on infant health.

    Science.gov (United States)

    Séguin, Louise; Xu, Qian; Potvin, Louise; Zunzunegui, Maria-Victoria; Frohlich, Katherine L

    2003-06-10

    Few population-based studies have analyzed the link between poverty and infant morbidity. In this study, we wanted to determine whether inadequate income itself has an impact on infant health. We interviewed 2223 mothers of 5-month-old children participating in the 1998 phase of the Quebec Longitudinal Study of Child Development to determine their infant's health and the sociodemographic characteristics of the household (including household income, breast-feeding and the smoking habits of the mother). Data on the health of the infants at birth were taken from medical records. We examined the effects of household income using Statistics Canada definitions of sufficient (above the low-income threshold), moderately inadequate (between 60% and 99% of the low-income threshold) and inadequate (below 60% of the low-income threshold) income on the mother's assessment of her child's overall health, her report of her infant's chronic health problems and her report of the number of times, if any, her child had been admitted to hospital since birth. In the analysis, we controlled for factors known to affect infant health: infant characteristics and neonatal health problems, the mother's level of education, the presence or absence of a partner, the duration of breast-feeding and the mother's smoking status. Compared with infants in households with sufficient incomes, those in households with lower incomes were more likely to be judged by their mothers to be in less than excellent health (moderately inadequate incomes: adjusted odds ratio [OR] 1.5, 95% confidence interval [CI] 1.1-2.1; very inadequate incomes: adjusted OR 1.8, 95% CI 1.3-2.6). Infants in households with moderately inadequate incomes were more likely to have been admitted to hospital (adjusted OR 1.8, 95% CI 1.2-2.6) than those in households with sufficient incomes, but the same was not true of infants in households with very inadequate incomes (adjusted OR 0.7, 95% CI 0.4-1.2). Household income did not

  3. A framework for Controlled Human Infection Model (CHIM studies in Malawi: Report of a Wellcome Trust workshop on CHIM in Low Income Countries held in Blantyre, Malawi [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Stephen B Gordon

    2017-08-01

    Full Text Available Controlled human infection model (CHIM studies have pivotal importance in vaccine development, being useful for proof of concept, pathogenesis, down-selection and immunogenicity studies.  To date, however, they have seldom been carried out in low and middle income countries (LMIC, which is where the greatest burden of vaccine preventable illness is found.  This workshop discussed the benefits and barriers to CHIM studies in Malawi.  Benefits include improved vaccine effectiveness and host country capacity development in clinical, laboratory and governance domains.  Barriers include acceptability, safety and regulatory issues. The report suggests a framework by which ethical, laboratory, scientific and governance issues may be addressed by investigators considering or planning CHIM in LMIC.

  4. 77 FR 65139 - Designation of Low-Income Status; Acceptance of Secondary Capital Accounts by Low-Income...

    Science.gov (United States)

    2012-10-25

    ...-Income Status; Acceptance of Secondary Capital Accounts by Low-Income Designated Credit Unions AGENCY... amend its low-income credit unions regulation by extending the time credit unions have to accept a low- income designation. Under the current rule, an FCU that has received notification from NCUA that it...

  5. 78 FR 4030 - Designation of Low-Income Status; Acceptance of Secondary Capital Accounts by Low-Income...

    Science.gov (United States)

    2013-01-18

    ...-Income Status; Acceptance of Secondary Capital Accounts by Low-Income Designated Credit Unions AGENCY... amending its low-income credit unions regulation by extending the time period in which a federal credit union (FCU) may accept a low-income designation. Under the current rule, an FCU that receives notice...

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

    Directory of Open Access Journals (Sweden)

    Marjan W Attaei, MA

    2017-09-01

    Funding: Population Health Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, Canadian Institutes of Health Research Strategy for Patient Oriented Research through the Ontario SPOR Support Unit, the Ontario Ministry of Health and Long-Term Care, pharmaceutical companies (with major contributions from AstraZeneca [Canada], Sanofi Aventis [France and Canada], Boehringer Ingelheim [Germany amd Canada], Servier, and GlaxoSmithKline, Novartis and King Pharma, and national or local organisations in participating countries.

  7. Supporting and including children from low income families

    OpenAIRE

    Benoist, FD

    2017-01-01

    This chapter explores: • What we mean by low income and poverty and how poverty is defined • The families living on low income in the UK today and the impact of low income and poverty on children’s well-being, development and learning • Supporting children from low income families • The attainment gap between children from low income backgrounds and their peers • The pupil premium and how schools have used the extra funding to raise attainment • Key aspects of good practice and what schools c...

  8. High burden of mental illness and low utilization of care among school-going youth in Central Haiti: A window into the youth mental health treatment gap in a low-income country.

    Science.gov (United States)

    Eustache, Eddy; Gerbasi, Margaret E; Smith Fawzi, Mary C; Fils-Aimé, J Reginald; Severe, Jennifer; Raviola, Giuseppe J; Legha, Rupinder; Darghouth, Sarah; Grelotti, David J; Thérosmé, Tatiana; Pierre, Ermaze L; Affricot, Emmeline; Alcindor, Yoldie; Becker, Anne E

    2017-05-01

    The mental health treatment gap for youth in low- and middle-income countries (LMICs) is substantial; strategies for redress are urgently needed to mitigate the serious health and social consequences of untreated mental illness in youth. To estimate the burden of major depressive episode (MDE) and posttraumatic stress disorder (PTSD) as well as utilization of care among Haitian youth in order to describe the mental health treatment gap in a LMIC setting. We estimated the point prevalence of MDE, PTSD, and subthreshold variants in a school-based sample of youth ( n = 120, ages 18-22 years) using a modified Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID)-based interview and examined treatment utilization among those receiving one of these diagnoses. We assessed additional psychopathology with self-report measures to examine validity of study diagnostic assignments. The combined prevalence of full-syndrome or subthreshold MDE or PTSD was high (36.7%). A large majority of affected individuals (88.6%) had accessed no mental health services in the health sector, and 36.4% had accessed no care of any kind in either the health or folk sectors in the past year. Findings demonstrate a high mental health burden among Haiti's youth and that many youth with MDE and PTSD are not accessing mental health care.

  9. Methods of nutrition surveillance in low-income countries

    Directory of Open Access Journals (Sweden)

    Veronica Tuffrey

    2016-03-01

    Full Text Available Abstract Background In 1974 a joint FAO/UNICEF/WHO Expert Committee met to develop methods for nutrition surveillance. There has been much interest and activity in this topic since then, however there is a lack of guidance for practitioners and confusion exists around the terminology of nutrition surveillance. In this paper we propose a classification of data collection activities, consider the technical issues for each category, and examine the potential applications and challenges related to information and communication technology. Analysis There are three major approaches used to collect primary data for nutrition surveillance: repeated cross-sectional surveys; community-based sentinel monitoring; and the collection of data in schools. There are three major sources of secondary data for surveillance: from feeding centres, health facilities, and community-based data collection, including mass screening for malnutrition in children. Surveillance systems involving repeated surveys are suitable for monitoring and comparing national trends and for planning and policy development. To plan at a local level, surveys at district level or in programme implementation areas are ideal, but given the usually high cost of primary data collection, data obtained from health systems are more appropriate provided they are interpreted with caution and with contextual information. For early warning, data from health systems and sentinel site assessments may be valuable, if consistent in their methods of collection and any systematic bias is deemed to be steady. For evaluation purposes, surveillance systems can only give plausible evidence of whether a programme is effective. However the implementation of programmes can be monitored as long as data are collected on process indicators such as access to, and use of, services. Surveillance systems also have an important role to provide information that can be used for advocacy and for promoting accountability for actions or lack of actions, including service delivery. Conclusion This paper identifies issues that affect the collection of nutrition surveillance data, and proposes definitions of terms to differentiate between diverse sources of data of variable accuracy and validity. Increased interest in nutrition globally has resulted in high level commitments to reduce and prevent undernutrition. This review helps to address the need for accurate and regular data to convert these commitments into practice.

  10. Brucellosis in low-income and middle-income countries

    Science.gov (United States)

    Rubach, Matthew P.; Halliday, Jo E.B.; Cleaveland, Sarah; Crump, John A.

    2014-01-01

    Purpose of review Human brucellosis is a neglected, underrecognized infection of widespread geographic distribution. It causes acute febrile illness and a potentially debilitating chronic infection in humans, and livestock infection has substantial socioeconomic impact. This review describes new information regarding the epidemiology of brucellosis in the developing world and advances in diagnosis and treatment. Recent findings The highest recorded incidence of human brucellosis occurs in the Middle East and Central Asia. Fever etiology studies demonstrate brucellosis as a cause of undifferentiated febrile illness in the developing world. Brucellosis is a rare cause of fever among returning travelers, but is more common among travelers returning from the Middle East and North Africa. Sensitive and specific rapid diagnostic tests appropriate for resource-limited settings have been validated. Randomized controlled trials demonstrate that optimal treatment for human brucellosis consists of doxycycline and an aminoglycoside. Decreasing the burden of human brucellosis requires control of animal brucellosis, but evidence to inform the design of control programs in the developing world is needed. Summary Brucellosis causes substantial morbidity in human and animal populations. While improvements in diagnostic options for resource-limited settings and stronger evidence for optimal therapy should enhance identification and treatment of human brucellosis, prevention of human disease through control in animals remains paramount. PMID:23963260

  11. Prenatal and postnatal depression among low income Brazilian women

    Directory of Open Access Journals (Sweden)

    V.A. Da-Silva

    1998-06-01

    Full Text Available Postnatal depression is a significant problem affecting 10-15% of mothers in many countries and has been the subject of an increasing number of publications. Prenatal depression has been studied less. The aims of the present investigation were: 1 to obtain information on the prevalence of prenatal and postnatal depression in low income Brazilian women by using an instrument already employed in several countries, i.e., the Edinburgh Postnatal Depression Scale (EPDS; 2 to evaluate the risk factors involved in prenatal and postnatal depression in Brazil. The study groups included 33 pregnant women interviewed at home during the second and third trimesters of pregnancy, and once a month during the first six months after delivery. Questions on life events and the mother's relationship with the baby were posed during each visit. Depressed pregnant women received less support from their partners than non-depressed pregnant women (36.4 vs 72.2%, P<0.05; Fisher exact test. Black women predominated among pre- and postnatally depressed subjects. Postnatal depression was associated with lower parity (0.4 ± 0.5 vs 1.1 ± 1.0, P<0.05; Student t-test. Thus, the period of pregnancy may be susceptible to socio-environmental factors that induce depression, such as the lack of affective support from the partner. The prevalence rate of 12% observed for depression in the third month postpartum is comparable to that of studies from other countries.

  12. Travel patterns and characteristics of low-income subpopulation in New York state

    Energy Technology Data Exchange (ETDEWEB)

    Reuscher, Tim [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Hwang, Ho-Ling [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Lim, Hyeonsup [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

    2017-10-01

    Studies have shown that people residing in poverty face more mobility challenges in their daily travels as compared to those living in higher income households. In many cities, the lack of a public transportation systems and investments in low-income areas are making it difficult for those living in poverty to access jobs, goods, and services (schools, groceries, health cares, etc. In this study, Oak Ridge National Laboratory was tasked by the New York State (NYS) Department of Transportation to conduct a detailed examination of the travel behaviors and identify patterns and trends of the low-income residents within NYS. The 2009 National Household Travel Survey data was used as the primary information source to analyze subjects associated with poverty and mobility, as well as to address questions such as are there differences in traveler demographics between the low-income population and those of others who live in various NYS regions (e.g., New York City, other urban areas of NYS)? How do they compare with the population at large (e.g., rest of the country) or with findings from previous years (i.e., trend)? Are there any regional differences (e.g., urban versus rural)? Do any unique travel characteristics or patterns exist within the low-income group? Through this study, various key findings on low-income population sizes, household characteristics, travel patterns, and mobility limitations were identified and summarized in this report.

  13. Siblings, Language, and False Belief in Low-Income Children

    Science.gov (United States)

    Tompkins, Virginia; Farrar, M. Jeffrey; Guo, Ying

    2013-01-01

    The authors examined the relationship between number of siblings and false belief understanding (FBU) in 94 low-income 4-5-year-olds. Previous research with middle-income children has shown a positive association between number of siblings and FBU. However, it is unclear whether having multiple siblings in low-income families is related to better…

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

    Science.gov (United States)

    Lynch, Elizabeth B.; Holmes, Shane

    2011-01-01

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

  15. 75 FR 8392 - Low Income Housing Tax Credit Tenant Database

    Science.gov (United States)

    2010-02-24

    ... DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT [Docket No. FR-5376-N-11] Low Income Housing Tax Credit Tenant Database AGENCY: Office of the Chief Information Officer, HUD. ACTION: Notice. SUMMARY: The... Lists the Following Information Title Of Proposal: Low Income Housing Tax Credit Tenant Database. Omb...

  16. Improving Strategies for Low-Income Family Children's Information Literacy

    Science.gov (United States)

    Zhang, Haiyan; Washington, Rodney; Yin, Jianjun

    2014-01-01

    This article discussed the significance of improving low-income family children's information literacy, which could improve educational quality, enhance children's self-esteem, adapt children to the future competitive world market, as well as the problems in improving low-income family children's information literacy, such as no home computer and…

  17. 42 CFR 457.310 - Targeted low-income child.

    Science.gov (United States)

    2010-10-01

    ... family income at or below 200 percent of the Federal poverty line for a family of the size involved; (ii... 42 Public Health 4 2010-10-01 2010-10-01 false Targeted low-income child. 457.310 Section 457.310... Requirements: Eligibility, Screening, Applications, and Enrollment § 457.310 Targeted low-income child. (a...

  18. Poject Managment Approach to Public Low Income Housing. | Ogbu ...

    African Journals Online (AJOL)

    This research assesses the impacts of project management (PM) variables on the socio-economic formation of public low-income housing (LIH) users in Abia and ... socio-economic impact of public low income housing (LIH) and the PM variables: project scope control (PS), project planning (PPC), project cost control (PC), ...

  19. The Effectiveness Of Rental Housing Finance For Low-Income Households In Sombo Rental Flats Surabaya

    Directory of Open Access Journals (Sweden)

    Annisa Nur Ramadhani

    2017-07-01

    Full Text Available Fullfilment for the needs of housing is a priority that cannot be suspended especially in urban areas of developing country whose population continues to increase because of the rapid urbanization. Indonesia as the developing country still has a fairly high backlog approximately at 7.6 millions unit house in 2014 most of them are low income people. The Government has several plan in striving for the scarcity of housing. One of them is the development of rental flats which have goals for the social housing fulfillment for low income people and increase their housing affordability by lowering the rental rates. The intention is to assist the low income people save their money to buy their own homes. But in facts there are several constraints related to this rental flats finance such as late payment by the residents uncontroled right transfer and the tariff adjusted to the ability of the inhabitants can not cover the cost of the physical building management and maintanance. This study aims to evaluate Sombo rental flat finance for for low income people in which the data are collected through in depth interview observation and documentation. The results of several qualitatively descriptive analysis show that the effectiveness of rental flat financing in the aspect of the purpose and goal to facilitating low income community needs of housing is quiet accomplished. Beside that the organization is also well structured and have the efficient human resources. But Sombo rental flats effectivenes is relatively low in the aspect of profit ability rental financing program and in the enforcement of rules and regulation. The main problem is in the arrears of residents rental payment and the deficiency for maintanance cost so it has to depend on the city government subsidies. The rental finance constraint are caused by several factors which are historic factors residents factors and the vision and commitment of the city government to facilitate housing for low

  20. Designing Low-Income Housing Using Local Architectural Concepts

    Science.gov (United States)

    Trumansyahjaya, K.; Tatura, L. S.

    2018-02-01

    The provision of houses for low-income people who do not have a home worthy of being one of the major problems in the city of Gorontalo, because the community in establishing the house only pay attention to their wants and needs in creating a healthy environment, the beauty of the city and the planning of the home environment in accordance with the culture of the people of Gorontalo. In relation to the condition, the focus of this research is the design of housing based on local architecture as residential house so that it can be reached by a group of low income people with house and environment form determined based on family development, social and economic development of society and environment which take into account the local culture. Stages of this research includes five (5) stages, including the identification phase characteristics Gorontalo people of low income, the characteristics of the identification phase house inhabited by low-income people, the stage of identification preference low-income households, the phase formation house prototype and the environment, as well as the stage of formation model home for low-income people. Analysis of the model homes for low-income people using descriptive analysis, Hierarchical Cluster Analysis, and discrimination analysis to produce a prototype of the house and its surroundings. The prototype is then reanalyzed to obtain the model home for low-income people in the city of Gorontalo. The shape of a model home can be used as a reference for developers of housing intended for low-income people so that housing is provided to achieve the goals and the desired target group.

  1. Energy Efficiency and Renewable Energy in Low-Income Communities

    Science.gov (United States)

    State and local governments can provide benefits to low-income communities by investing in energy efficiency. Use the Program Finder table to identify those programs that reach the sectors and audiences of interest in your organization.

  2. Resource handbook for low-income residential retrofits

    Energy Technology Data Exchange (ETDEWEB)

    Callaway, J.W.; Brenchley, D.L.; Davis, L.J.; Ivey, D.L.; Smith, S.A.; Westergard, E.J.

    1987-04-01

    The purpose of the handbook is to provide technical assistance to state grantees participating in the Partnerships in Low-Income Residential Retrofit (PILIRR) Program. PILIRR is a demonstration program aimed at identifying innovative, successful approaches to developing public and private support for weatherization of low-income households. The program reflects the basic concept that responsibility for financial support for conservation activities such as low-income residential retrofitting is likely to gradually shift from the DOE to the states and the private sector. In preparing the handbook, PNL staff surveyed over 50 programs that provide assistance to low-income residents. The survey provided information on factors that contribute to successful programs. PNL also studied the winning PILIRR proposals (from the states of Florida, Iowa, Kentucky, Oklahoma and Washington) and identified the approaches proposed and the type of information that would be most helpful in implementing these approaches.

  3. achieving improved financing for low-income producers

    African Journals Online (AJOL)

    KEY WORDS: Approaches, Improved Access, Finance, Low-income, Producers. INTRODUCTION .... either by setting up a dual-purpose financial institution, or by making ..... management information systems (Braverman and. Huppi, 1991).

  4. A Portrait of Low-Income Migrants in Contemporary Qatar

    OpenAIRE

    GARDNER, ANDREW; GARDNER, ANDREW; PESSOA, SILVIA; DIOP, ABDOULAYE; AL-GHANIM, KALTHAM; LE TRUNG, KIEN; HARKNESS, LAURA

    2013-01-01

    Though transnational labor migration in the Gulf States has increasingly been of scholarly interest, that scholarship has to date relied largely on qualitative ethnographic methodologies or small non-representative sampling strategies. This paper presents the findings of a large representative sample of low-income migrant laborers in Qatar. The data describe the basic characteristics of the low-income migrant population in Qatar, the process by which migrants obtain employment, the frequency ...

  5. Promoting food security of low income women in central Uganda

    DEFF Research Database (Denmark)

    Midtvåge, Runa; Hiranandani, Vanmala Sunder; Nambuanyi, Lekunze Ransom

    • Midtvåge, R., Hiranandani, V. S., & Lekunze, R. (2014). Promoting food security of low income women in central Uganda. Poster presentation, Sustainability Science Congress, University of Copenhagen, Denmark, October 22-24, 2014.......• Midtvåge, R., Hiranandani, V. S., & Lekunze, R. (2014). Promoting food security of low income women in central Uganda. Poster presentation, Sustainability Science Congress, University of Copenhagen, Denmark, October 22-24, 2014....

  6. Effectiveness and cost-effectiveness of telephone-based support versus usual care for treatment of pressure ulcers in people with spinal cord injury in low-income and middle-income countries: study protocol for a 12-week randomised controlled trial.

    Science.gov (United States)

    Arora, Mohit; Harvey, Lisa Anne; Hayes, Alison Joy; Chhabra, Harvinder Singh; Glinsky, Joanne Valentina; Cameron, Ian Douglas; Lavrencic, Lucija; Arumugam, Narkeesh; Hossain, Sohrab; Bedi, Parneet Kaur

    2015-07-28

    Pressure ulcers are a common and severe complication of spinal cord injury, particularly in low-income and middle-income countries where people often need to manage pressure ulcers alone and at home. Telephone-based support may help people in these situations to manage their pressure ulcers. The aim of this study is to determine the effectiveness and cost-effectiveness of telephone-based support to help people with spinal cord injury manage pressure ulcers at home in India and Bangladesh. A multicentre (3 sites), prospective, assessor-blinded, parallel, randomised controlled trial will be undertaken. 120 participants with pressure ulcers on the sacrum, ischial tuberosity or greater trochanter of the femur secondary to spinal cord injury will be randomly assigned to a Control or Intervention group. Participants in the Control group will receive usual community care. That is, they will manage their pressure ulcers on their own at home but will be free to access whatever healthcare support they can. Participants in the Intervention group will also manage their pressure ulcers at home and will also be free to access whatever healthcare support they can, but in addition they will receive weekly telephone-based support and advice for 12 weeks (15-25 min/week). The primary outcome is the size of the pressure ulcer at 12 weeks. 13 secondary outcomes will be measured reflecting other aspects of pressure ulcer resolution, depression, quality of life, participation and satisfaction with healthcare provision. An economic evaluation will be run in parallel and will include a cost-effectiveness and a cost-utility analysis. Ethical approval was obtained from the Institutional Ethics Committee at each site. The results of this study will be disseminated through publications and presented at national and international conferences. ACTRN12613001225707. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  7. 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

  8. CROWDING AND SHOPPING VALUE IN LOW-INCOME RETAIL CENTERS

    Directory of Open Access Journals (Sweden)

    Izabelle Quezado

    2014-07-01

    Full Text Available Considering the great potential of low-income consumption, this research is based on the scales developed by Babin, Darden and Griffin (1994 and by Machleit, Kellaris and Eroglu (1994, aiming to investigate hedonic and utilitarian consumer behavior and its relation with low-income perception of crowding. A research was performed with 404 consumers in real store environment and the results showed that consumers revealed being prone to utilitarian behavior in both centers. About crowding phenomenon, the consumers felt more uncomfortable by crowding at the commercial center with less infrastructure. There were indices that this discomfort was less intense in hedonic consumers.

  9. BARRIERS AND OPPORTUNITIES IN DEVELOPING 'DO-IT-YOURSELF' (DIY PRODUCTS FOR LOW-INCOME HOUSING

    Directory of Open Access Journals (Sweden)

    Priscilla Lepre

    2010-06-01

    Full Text Available Direct involvement of the user in the assembling process of his/her own products or even entire house is a reality among low-income populations in developing countries. Nevertheless, there are a limited number of products that have actually been designed from a do-it-yourself (DIY perspective, which results in several problems, such as poor user safety while the product is being assembled or inadequate results from an improvised assembling. Hence, the main goal of this paper is to analyse barriers to and opportunities for developing DIY products for low-income housing in developing countries. The research method utilises a case study of a DIY product consisting of a hybrid solution that acted as both a partition wall and a wardrobe. The identified opportunities included more systematic use of existing craft competencies among low-income families and the possibility of cost reduction through DIY concepts. Major barriers included the perception of the DIY product as inferior and the difficulty of communicating the DIY assembly process to users who quite often are illiterate.

  10. Empowering low-income community in Kampong settlement by exploring people's activities in surrounding environment

    Science.gov (United States)

    Bawole, Paulus; Sutanto, Haryati B.

    2017-11-01

    Urban Kampong is a spontaneous settlement growing in several big cities within developing countries including Indonesia. This settlement is developed by low-income people without any plan. Therefore there is no specific housing pattern in the settlement. The characteristics of the settlements is dominated by Javanese traditional roof typology and narrow path with minimal public open spaces. People's creativity in building their houses often uses second hand building materials that make their houses look specific. Besides, infrastructure facilities within Kampong Settlement are very poor. Because the poor living in Urban Kampong have to adjust their live with minimum infrastructure facilities available, they have to be creative in using all facilities available. Through the creativities of low-income people living in Urban Kampong the research will show how the inhabitants can be empowered by exploring inhabitant's creativities and consequently the environmental quality within Urban Kampong can be improved as well.

  11. Institutional Variation in Enrollment of Low-Income Students

    Science.gov (United States)

    Monks, James

    2018-01-01

    Socioeconomic diversity in tertiary education has come under heightened scrutiny in the past few years. This paper estimates the relationship between prices (both sticker price and net price), financial aid policies, and selectivity on the variation of low-income students across postsecondary institutions. All three factors are significant in…

  12. Concept of innovation in low-income market

    Directory of Open Access Journals (Sweden)

    Vitor Koki da Costa Nogami

    2018-01-01

    Full Text Available Purpose – Investigate the concept and the adoption of innovation in the low-income market. Design/methodology/approach – Four different studies were conducted. First, a Delphi study with 126 Marketing and Innovation professors from graduate programs. Second, interviews with 13 professionals, technical assistance professionals and retail managers. Third, two focus groups with low-income consumers. Fourth, survey with 390 respondents. Findings – The results indicate that innovations in the low-income markets are mainly characterized by adaptations and adjustments in products, with emphasis on incremental innovations, not radical. In addition, the adoption of innovation in this context is characterized as late, not initial. Originality/value – In terms of theoretical contributions, the present study reveals how the concept of innovation is built in the low-income market. From a perspective collectively constructed with information from different market agents (industry, retail and consumers, research findings become robust to understanding a phenomenon. Moreover, in addition to different market agents, different methods of data collection and analysis were also used, further enriching the results. This collective contribution, based theoretically on a literature of social construction, interviewing different market agents and using different methodological approaches, synergistically potentiated the development of this paper

  13. Using Banks: Teaching Banking Skills to Low-Income Consumers.

    Science.gov (United States)

    Shurtz, Mary Ann; LeFlore, Ann Becker

    This module, one of six on teaching consumer matters to low-income adults, discusses banking skills. Topics include banking services (savings accounts, safety deposit boxes, Christmas clubs, loans, etc.), checking accounts (deposits, checkwriting, check registers, opening an account), how to use the check register (cancelled checks, deposits),…

  14. Bringing Bike Share to a Low-Income Community

    Centers for Disease Control (CDC) Podcasts

    This podcast is an interview with Sarah Kretman Stewart, MPH, MEd, Healthy Living Minneapolis Project Specialist at the Minneapolis Health Department. In this program, Sarah talks about the impact a bike share program had on the low-income town of Near North, Minnesota.

  15. Positive Reading Attitudes of Low-Income Bilingual Latinos

    Science.gov (United States)

    Bussert-webb, Kathy M.; Zhang, Zhidong

    2018-01-01

    Many assume low-income, emergent bilingual Latinos have poor reading attitudes. To investigate this issue, we surveyed 1,503 Texas public high school students through stratified cluster sampling to determine their reading attitudes. Most represented Latinos and mixed-race Latinos/Whites who heard Spanish at home and whose mother tongue was…

  16. Financial Arrangements and Relationship Quality in Low-Income Couples

    Science.gov (United States)

    Addo, Fenaba R.; Sassler, Sharon

    2010-01-01

    This study explored the association between household financial arrangements and relationship quality using a representative sample of low-income couples with children. We detailed the banking arrangements couples utilize, assessed which factors relate to holding a joint account versus joint and separate, only separate, or no account, and analyzed…

  17. Harsh, Firm, and Permissive Parenting in Low-Income Families.

    Science.gov (United States)

    Shumow, Lee; Vandell, Deborah Lowe; Posner, Jill K.

    1998-01-01

    Parents' reports of their child-rearing expectations and intentions were measured for 184 low-income urban families when children were in the third and fifth grades. Parenting strategies were stable over time. Parenting strategies were related to measures of adjustment at school, behavior problems in the home, academic achievement, and…

  18. Learning from Low Income Market-driven Innovations and Social ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Learning from Low Income Market-driven Innovations and Social Entrepreneurship in India. A social enterprise is one that uses innovation, finance and business acumen in a business setting to produce social outcomes such as poverty alleviation, health benefits or social inclusion. Social enterprises generate products and ...

  19. Successful schools and risky behaviors among low-income adolescents.

    Science.gov (United States)

    Wong, Mitchell D; Coller, Karen M; Dudovitz, Rebecca N; Kennedy, David P; Buddin, Richard; Shapiro, Martin F; Kataoka, Sheryl H; Brown, Arleen F; Tseng, Chi-Hong; Bergman, Peter; Chung, Paul J

    2014-08-01

    We examined whether exposure to high-performing schools reduces the rates of risky health behaviors among low-income minority adolescents and whether this is due to better academic performance, peer influence, or other factors. By using a natural experimental study design, we used the random admissions lottery into high-performing public charter high schools in low-income Los Angeles neighborhoods to determine whether exposure to successful school environments leads to fewer risky (eg, alcohol, tobacco, drug use, unprotected sex) and very risky health behaviors (e.g., binge drinking, substance use at school, risky sex, gang participation). We surveyed 521 ninth- through twelfth-grade students who were offered admission through a random lottery (intervention group) and 409 students who were not offered admission (control group) about their health behaviors and obtained their state-standardized test scores. The intervention and control groups had similar demographic characteristics and eighth-grade test scores. Being offered admission to a high-performing school (intervention effect) led to improved math (P performance of public schools in low-income communities may be a powerful mechanism to decrease very risky health behaviors among low-income adolescents and to decrease health disparities across the life span. Copyright © 2014 by the American Academy of Pediatrics.

  20. How Low-Income Children Use the Internet at Home

    Science.gov (United States)

    Jackson, Linda A.; von Eye, Alexander; Biocca, Frank; Barbatsis, Gretchen; Zhao, Yong; Fitzgerald, Hiram E.

    2005-01-01

    HomeNetToo is a longitudinal field study designed to examine home Internet use by low-income families in the United States. Participants were 140 children, mostly African American, whose Internet use was continuously and automatically recorded for one year. This article focuses on relationships between children's main computer activities, academic…

  1. Camouflage: The Experiences of Low-Income Business College Students

    Science.gov (United States)

    Ponton de Dutton, Scarlett

    2011-01-01

    This qualitative study shares the complex stories of two low-income business students who attend a flagship, public university as out-of-state students with the purpose of understanding, describing, giving voice to, and discovering insight from their experiences. Throughout U.S. Higher Education history, there is a pattern of limited participation…

  2. Alienation: A Concept for Understanding Low-Income, Urban Clients

    Science.gov (United States)

    Holcomb-McCoy, Cheryl

    2004-01-01

    The author examines the concept of alienation and how it can be used to understand low-income, urban clients. A description is presented of 4 dimensions of alienation: powerlessness, meaninglessness, normlessness, and social isolation. Case illustrations are provided, and recommendations are made for counseling alienated clients. This article…

  3. Low Income Consumer Utility Issues: A National Perspective; TOPICAL

    International Nuclear Information System (INIS)

    Eisenberg, J

    2001-01-01

    This report provides a survey of assistance programs that public utility commissions have approved in most states to assist the low-income customers of utilities within their states. Surveys find that there is no single model of low-income assistance; rather, each state has adopted a program that meets its particular circumstances. However, while the details of programs vary considerably, they all fall within four broad categories: (1) Affordability programs, which provide direct assistance in paying energy bills; (2) Consumer protections, such as collection practices and installment billing requirements, which make it easier to pay energy bills on time; (3) Education programs, which teach consumers about prudent energy use and counsel them about budgeting; and (4) Efficiency and weatherization programs, which make investments to help consumers control their energy bills by reducing their need for energy. Programs usually include more than one of these components. All programs also include outreach and evaluation components. This report describes these options, the advantages and disadvantages of each, and the economic and other benefits of utility assistance programs for low-income customers. Low-income programs help participants by lowering the fraction of their incomes devoted to energy bills (the energy burden) from a very high level. In the United States, the median household devotes only 3.8 percent of its income to electricity while a family depending on a minimum-wage earner must devote 12.1 percent to energy while facing housing cost increases all over the nation. Low-income families unable to keep up with these pressures find themselves forced to go without power at times, to move, or to forgo other necessities such as food or medicine in order to pay their electricity bills

  4. Gender Differences in Caregiver Emotion Socialization of Low-Income Toddlers

    Science.gov (United States)

    Chaplin, Tara M.; Casey, James; Sinha, Rajita; Mayes, Linda C.

    2010-01-01

    Low-income children are at elevated risk for emotion-related problems; however, little research has examined gender and emotion socialization in low-income families. The authors describe the ways in which emotion socialization may differ for low-income versus middle-income families. They also present empirical data on low-income caregivers'…

  5. Low Income, Mexican Mothers' Perception of Their Infants' Weight Status and Beliefs about Their Foods and Physical Activity

    Science.gov (United States)

    Jimenez-Cruz, Arturo; Bacardi-Gascon, Montserrat; Castillo-Ruiz, Octelina; Mandujano-Trujillo, Zally; Pichardo-Osuna, Alexandra

    2010-01-01

    Childhood obesity is being considered a global health epidemic, and one of the countries mostly affected by it is Mexico. The aim of this study was to assess the perceptions of low-income mothers with regard to their child's weight status and physical activity and their beliefs about healthy and high-density foods. A total of 813 mothers attending…

  6. Impact of Pneumococcal Conjugate Vaccines on Pneumonia Hospitalizations in High- and Low-Income Subpopulations in Brazil

    DEFF Research Database (Denmark)

    Warren, Joshua L.; Shioda, Kayoko; Kürüm, Esra

    2017-01-01

    Background: Pneumococcal conjugate vaccines (PCVs) are being used worldwide. A key question is whether the impact of PCVs on pneumonia is similar in low- and high-income populations. However, most low-income countries, where the burden of disease is greatest, lack reliable data that can be used t...

  7. Energy-microfinance intervention for low income households in India

    Science.gov (United States)

    Rao, P. Sharath Chandra

    In India, limited energy access and energy inequity hamper the lives of low income households. Traditional fuels such as firewood and dung cake account for 84 percent and 32 percent of the rural and urban household cooking energy (NSSO, 2007). With 412 million people without access to electricity in 2005, India hosts the world's largest such population (IEA, 2007). But, low income households still spend 9 - 11.7 percent1 of their incomes on inefficient forms of energy while wealthy households spend less than 5 percent on better energy products (Saghir, 2005). Renewable energy technologies coupled with innovative financial products can address the energy access problem facing the low income households in India (MacLean & Siegel, 2007; REEEP, 2009). Nevertheless, the low income households continue to face low access to mainstream finance for purchasing renewable energy technology at terms that meet their monthly energy related expenditure (ESMAP, 2004a; SEEP, 2008a) and low or no access to energy services (Ailawadi & Bhattacharyya, 2006; Modi et. al., 2006). The lack of energy-finance options has left the marginalized population with little means to break the dependence on traditional fuels. This dissertation proposes an energy microfinance intervention to address the present situation. It designed a loan product dedicated to the purchase of renewable energy technologies while taking into account the low and irregular cash flows of the low income households. The arguments presented in this dissertation are based on a six-month pilot project using this product designed and developed by the author in conjunction with a microfinance institution and its low income clients and Energy Service Companies in the state of Karnataka. Finding the right stakeholders and establishing a joint agreement, obtaining grant money for conducting the technology dissemination workshops and forming a clear procedure for commissioning the project, are the key lessons learnt from this study

  8. Financial barriers and pricing strategies related to participation in sports activities: the perceptions of people of low income.

    Science.gov (United States)

    Steenhuis, Ingrid H M; Nooy, Steffie B C; Moes, Machiel J G; Schuit, Albertine J

    2009-11-01

    Physical activity levels in most affluent countries are low and many people do not meet the current recommendations. Particularly for people with a low income, economic strategies seem promising to stimulate taking part in sports activities. This study investigated the importance of economic restraints for taking part in sports activities as well as perceptions of low-income people toward different pricing interventions. A qualitative study was conducted, using semistructured, individual interviews with 27 low-income men and women. The framework approach was used to analyze the transcripts of the interviews. The respondents considered finances to be an important barrier for participating in sports activities, together with some individual barriers. Promising pricing strategies are a discount on the subscription to the fitness or sports club, a 1 month free trial, and free entrance to the swimming pool once a week. Pricing strategies may be a promising intervention to increase physical activity levels of low-income people. However, this study indicates that this should be coupled with an intervention directed at individual barriers. Some pricing strategies will be used and appreciated more by low-income people than other pricing strategies. In addition, pricing strategies should be tailored to individual needs and preferences.

  9. Comparison the effects of poor health and low income on early retirement: a systematic review and meta-analysis.

    Science.gov (United States)

    Homaie Rad, Enayatollah; Rashidian, Arash; Arab, Mohamad; Souri, Ali

    2017-08-08

    The main aim of this study was to estimate the effects of poor health and low income on early retirement. For this purpose systematic review and meta-analysis were conducted. Web of Science, PUBMED and Scopus databases were searched systematically. Finally 17 surveys were added in meta-analysis. These studies were conducted in 13 countries. At the end a Meta regression was done to show the effects of welfare system type on effect sizes of poor health and low income. The results of this study showed that poor health had effect on the risk of early retirement. (Poor health pooled effect sizes: 1.279 CI: (1.15 1.41), low income pooled effect sizes: 1.042 CI: (0.92 1.17), (poor health pooled marginal effects: 0.046 CI: (-0.03 0.12), low income pooled marginal effects: -0.002 CI: (-0.003 0.000). The results of this study showed that association between poor health and early retirement was stronger in comparison with low income and early retirement.

  10. Occupational Engagement in Low-Income Latina Breast Cancer Survivors.

    Science.gov (United States)

    Sleight, Alix G

    This qualitative study examined the experience of occupational engagement in low-income Latina breast cancer survivors and suggests the potential for occupational therapy practitioners to improve health outcomes in this vulnerable and underserved population. Semistructured interviews were conducted with 9 participants. Inductive analysis was used to code for themes and patterns related to occupational engagement and quality of life (QOL). Lack of occupational engagement negatively affected QOL, but participation in occupations such as religious activity and caregiving promoted well-being. Financial concerns and communication barriers decreased QOL. Breast cancer can have a negative impact on occupational engagement in low-income Latina breast cancer survivors; however, some occupations may increase QOL. Socioeconomic status and cultural values influence occupational engagement and QOL. Occupational therapy practitioners can improve health outcomes in this population through awareness of relevant sociocultural factors and attention to appropriate patient communication. Copyright © 2017 by the American Occupational Therapy Association, Inc.

  11. Estimating the Impact of Low-Income Universal Service Programs

    OpenAIRE

    Daniel A. Ackerberg; David R. DeRemer; Michael H. Riordan; Gregory L. Rosston; Bradley S. Wimmer

    2013-01-01

    This policy study uses U.S. Census microdata to evaluate how subsidies for universal telephone service vary in their impact across low-income racial groups, gender, age, and home ownership. Our demand specification includes both the subsidized monthly price (Lifeline program) and the subsidized initial connection price (Linkup program) for local telephone service. Our quasi-maximum likelihood estimation controls for location differences and instruments for price endogeneity. The microdata all...

  12. Interconnected microbiomes and resistomes in low-income human habitats

    OpenAIRE

    Pehrsson, Erica C.; Tsukayama, Pablo; Patel, Sanket; Mej?a-Bautista, Melissa; Sosa-Soto, Giordano; Navarrete, Karla M.; Calderon, Maritza; Cabrera, Lilia; Hoyos-Arango, William; Bertoli, M. Teresita; Berg, Douglas E.; Gilman, Robert H.; Dantas, Gautam

    2016-01-01

    Summary Antibiotic-resistant infections annually claim hundreds of thousands of lives worldwide. This problem is exacerbated by resistance gene exchange between pathogens and benign microbes from diverse habitats. Mapping resistance gene dissemination between humans and their environment is a public health priority. We characterized the bacterial community structure and resistance exchange networks of hundreds of interconnected human fecal and environmental samples from two low-income Latin A...

  13. Empowering low-income black families of handicapped children.

    Science.gov (United States)

    Kalyanpur, M; Rao, S S

    1991-10-01

    A qualitative study of four black, low-income, single mothers used in-depth interviews and participant observation to evaluate their interactions with outreach agency professionals. Three perceived aspects (disrespect, focus on deficits, and discounting parenting style differences) were associated with exclusionary (unempowering) relationships. A reciprocal and supportive approach was associated with collaborative (empowering) relationships. Implications of these findings for professionals serving minority families are discussed.

  14. Low Income Consumer Utility Issues: A National Perspective

    Energy Technology Data Exchange (ETDEWEB)

    Eisenberg, J

    2001-03-26

    This report has been prepared to provide low-income advocates and other stakeholders information on the energy burden faced by low-income customers and programs designed to alleviate that burden in various states. The report describes programs designed to lower payments, manage arrearages, weatherize and provide other energy efficiency measures, educate consumers, increase outreach to the target It discusses the costs and benefits of the population, and evaluate the programs. various options--to the degree this information is available--and describes attempts to quantify benefits that have heretofore not been quantified. The purpose of this report is to enable the low-income advocates and others to assess the options and design program most suitable for the citizens of their states or jurisdictions. It is not the authors' intent to recommend a particular course of action but, based on our broad experience in the field, to provide the information necessary for others to do so. We would be happy to answer any questions or provide further documentation on any of the material presented herein. The original edition of this report was prepared for the Utah Committee on Consumer Services, pursuant to a contract with the National Consumer Law Center (NCLC), to provide information to the Utah Low-Income Task Force established by the Utah Public Service, Commission. Attachment 1 is drawn from NCLC's 1998 Supplement to its Access to Utility Services; NCLC plans to update this list in 2001, and it will be available then from NCLC. This report has been updated by the authors for this edition.

  15. Bringing Bike Share to a Low-Income Community

    Centers for Disease Control (CDC) Podcasts

    2013-08-14

    This podcast is an interview with Sarah Kretman Stewart, MPH, MEd, Healthy Living Minneapolis Project Specialist at the Minneapolis Health Department. In this program, Sarah talks about the impact a bike share program had on the low-income town of Near North, Minnesota.  Created: 8/14/2013 by Preventing Chronic Disease (PCD), National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 8/14/2013.

  16. Adverse childhood experiences of low-income urban youth.

    Science.gov (United States)

    Wade, Roy; Shea, Judy A; Rubin, David; Wood, Joanne

    2014-07-01

    Current assessments of adverse childhood experiences (ACEs) may not adequately encompass the breadth of adversity to which low-income urban children are exposed. The purpose of this study was to identify and characterize the range of adverse childhood experiences faced by young adults who grew up in a low-income urban area. Focus groups were conducted with young adults who grew up in low-income Philadelphia neighborhoods. Using the nominal group technique, participants generated a list of adverse childhood experiences and then identified the 5 most stressful experiences on the group list. The most stressful experiences identified by participants were grouped into a ranked list of domains and subdomains. Participants identified a range of experiences, grouped into 10 domains: family relationships, community stressors, personal victimization, economic hardship, peer relationships, discrimination, school, health, child welfare/juvenile justice, and media/technology. Included in these domains were many but not all of the experiences from the initial ACEs studies; parental divorce/separation and mental illness were absent. Additional experiences not included in the initial ACEs but endorsed by our participants included single-parent homes; exposure to violence, adult themes, and criminal behavior; personal victimization; bullying; economic hardship; and discrimination. Gathering youth perspectives on childhood adversity broadens our understanding of the experience of stress and trauma in childhood. Future work is needed to determine the significance of this broader set of adverse experiences in predisposing children to poor health outcomes as adults. Copyright © 2014 by the American Academy of Pediatrics.

  17. Usage of Library and Information Centers (LICs) by students in ...

    African Journals Online (AJOL)

    Poor lending policy; problems associated with network in the cyber cafe; the opening and closing hours of the library were some of the problems associated with their use of the library and information centres (LICs) Recommendations were proffered to include: the review and amendment of the lending policy of the library, ...

  18. Impact of Pneumococcal Conjugate Vaccines on Pneumonia Hospitalizations in High- and Low-Income Subpopulations in Brazil

    DEFF Research Database (Denmark)

    Warren, Joshua L.; Shioda, Kayoko; Kürüm, Esra

    2017-01-01

    Background Pneumococcal conjugate vaccines (PCVs) are being used worldwide. A key question is whether the impact of PCVs on pneumonia is similar in low- and high-income populations. However, most low-income countries, where the burden of disease is greatest, lack reliable data that can be used...... to evaluate the impact. Data from middle-income countries that have both low- and high-income subpopulations can provide a proxy measure for the impact of the vaccine in low-income countries. Methods We evaluated the impact of PCV10 on hospitalizations for all-cause pneumonia in Brazil, a middle......-income country with localities that span a broad range of human development index (HDI) levels. We used complementary time series and spatiotemporal methods (synthetic controls and hierarchical Bayesian spatial regression) to test whether the decline in pneumonia hospitalizations associated with vaccine...

  19. Financial management of low-income urban families

    Energy Technology Data Exchange (ETDEWEB)

    Schnittgrund, K.P. (Univ. of California, Riverside); Baker, G.

    1983-09-01

    The major focus of this research was the difference in financial-management practices used by low-income urban white, black, and Mexican-American families. A random sample of 199 interviews was completed during the spring of 1980 in Phoenix, Arizona, USA. The sample consisted of 69 white, 70 black, and 60 Mexican-American families. Differences in financial behavior did occur for each race. In addition, they were optimistic regarding their own ability to handle money and resolve financial problems but generally negative toward the ability of other families to manage money, use credit, and plan purchases. 20 references, 3 tables.

  20. Improved Methods for Fire Risk Assessment in Low-Income and Informal Settlements

    Directory of Open Access Journals (Sweden)

    John Twigg

    2017-02-01

    Full Text Available Fires cause over 300,000 deaths annually worldwide and leave millions more with permanent injuries: some 95% of these deaths are in low- and middle-income countries. Burn injury risk is strongly associated with low-income and informal (or slum settlements, which are growing rapidly in an urbanising world. Fire policy and mitigation strategies in poorer countries are constrained by inadequate data on incidence, impacts, and causes, which is mainly due to a lack of capacity and resources for data collection, analysis, and modelling. As a first step towards overcoming such challenges, this project reviewed the literature on the subject to assess the potential of a range of methods and tools for identifying, assessing, and addressing fire risk in low-income and informal settlements; the process was supported by an expert workshop at University College London in May 2016. We suggest that community-based risk and vulnerability assessment methods, which are widely used in disaster risk reduction, could be adapted to urban fire risk assessment, and could be enhanced by advances in crowdsourcing and citizen science for geospatial data creation and collection. To assist urban planners, emergency managers, and community organisations who are working in resource-constrained settings to identify and assess relevant fire risk factors, we also suggest an improved analytical framework based on the Haddon Matrix.

  1. Phenotypes of asthma in low-income children and adolescents: cluster analysis

    Directory of Open Access Journals (Sweden)

    Anna Lucia Barros Cabral

    Full Text Available ABSTRACT Objective: Studies characterizing asthma phenotypes have predominantly included adults or have involved children and adolescents in developed countries. Therefore, their applicability in other populations, such as those of developing countries, remains indeterminate. Our objective was to determine how low-income children and adolescents with asthma in Brazil are distributed across a cluster analysis. Methods: We included 306 children and adolescents (6-18 years of age with a clinical diagnosis of asthma and under medical treatment for at least one year of follow-up. At enrollment, all the patients were clinically stable. For the cluster analysis, we selected 20 variables commonly measured in clinical practice and considered important in defining asthma phenotypes. Variables with high multicollinearity were excluded. A cluster analysis was applied using a twostep agglomerative test and log-likelihood distance measure. Results: Three clusters were defined for our population. Cluster 1 (n = 94 included subjects with normal pulmonary function, mild eosinophil inflammation, few exacerbations, later age at asthma onset, and mild atopy. Cluster 2 (n = 87 included those with normal pulmonary function, a moderate number of exacerbations, early age at asthma onset, more severe eosinophil inflammation, and moderate atopy. Cluster 3 (n = 108 included those with poor pulmonary function, frequent exacerbations, severe eosinophil inflammation, and severe atopy. Conclusions: Asthma was characterized by the presence of atopy, number of exacerbations, and lung function in low-income children and adolescents in Brazil. The many similarities with previous cluster analyses of phenotypes indicate that this approach shows good generalizability.

  2. Improved Methods for Fire Risk Assessment in Low-Income and Informal Settlements.

    Science.gov (United States)

    Twigg, John; Christie, Nicola; Haworth, James; Osuteye, Emmanuel; Skarlatidou, Artemis

    2017-02-01

    Fires cause over 300,000 deaths annually worldwide and leave millions more with permanent injuries: some 95% of these deaths are in low- and middle-income countries. Burn injury risk is strongly associated with low-income and informal (or slum) settlements, which are growing rapidly in an urbanising world. Fire policy and mitigation strategies in poorer countries are constrained by inadequate data on incidence, impacts, and causes, which is mainly due to a lack of capacity and resources for data collection, analysis, and modelling. As a first step towards overcoming such challenges, this project reviewed the literature on the subject to assess the potential of a range of methods and tools for identifying, assessing, and addressing fire risk in low-income and informal settlements; the process was supported by an expert workshop at University College London in May 2016. We suggest that community-based risk and vulnerability assessment methods, which are widely used in disaster risk reduction, could be adapted to urban fire risk assessment, and could be enhanced by advances in crowdsourcing and citizen science for geospatial data creation and collection. To assist urban planners, emergency managers, and community organisations who are working in resource-constrained settings to identify and assess relevant fire risk factors, we also suggest an improved analytical framework based on the Haddon Matrix.

  3. High Resolution Population Maps for Low Income Nations: Combining Land Cover and Census in East Africa

    Science.gov (United States)

    Tatem, Andrew J.; Noor, Abdisalan M.; von Hagen, Craig; Di Gregorio, Antonio; Hay, Simon I.

    2007-01-01

    Background Between 2005 and 2050, the human population is forecast to grow by 2.7 billion, with the vast majority of this growth occurring in low income countries. This growth is likely to have significant social, economic and environmental impacts, and make the achievement of international development goals more difficult. The measurement, monitoring and potential mitigation of these impacts require high resolution, contemporary data on human population distributions. In low income countries, however, where the changes will be concentrated, the least information on the distribution of population exists. In this paper we investigate whether satellite imagery in combination with land cover information and census data can be used to create inexpensive, high resolution and easily-updatable settlement and population distribution maps over large areas. Methodology/Principal Findings We examine various approaches for the production of maps of the East African region (Kenya, Uganda, Burundi, Rwanda and Tanzania) and where fine resolution census data exists, test the accuracies of map production approaches and existing population distribution products. The results show that combining high resolution census, settlement and land cover information is important in producing accurate population distribution maps. Conclusions We find that this semi-automated population distribution mapping at unprecedented spatial resolution produces more accurate results than existing products and can be undertaken for as little as $0.01 per km2. The resulting population maps are a product of the Malaria Atlas Project (MAP: http://www.map.ox.ac.uk) and are freely available. PMID:18074022

  4. High resolution population maps for low income nations: combining land cover and census in East Africa.

    Directory of Open Access Journals (Sweden)

    Andrew J Tatem

    2007-12-01

    Full Text Available Between 2005 and 2050, the human population is forecast to grow by 2.7 billion, with the vast majority of this growth occurring in low income countries. This growth is likely to have significant social, economic and environmental impacts, and make the achievement of international development goals more difficult. The measurement, monitoring and potential mitigation of these impacts require high resolution, contemporary data on human population distributions. In low income countries, however, where the changes will be concentrated, the least information on the distribution of population exists. In this paper we investigate whether satellite imagery in combination with land cover information and census data can be used to create inexpensive, high resolution and easily-updatable settlement and population distribution maps over large areas.We examine various approaches for the production of maps of the East African region (Kenya, Uganda, Burundi, Rwanda and Tanzania and where fine resolution census data exists, test the accuracies of map production approaches and existing population distribution products. The results show that combining high resolution census, settlement and land cover information is important in producing accurate population distribution maps.We find that this semi-automated population distribution mapping at unprecedented spatial resolution produces more accurate results than existing products and can be undertaken for as little as $0.01 per km(2. The resulting population maps are a product of the Malaria Atlas Project (MAP: http://www.map.ox.ac.uk and are freely available.

  5. Preconception Health Behaviors of Low-Income Women.

    Science.gov (United States)

    Ayoola, Adejoke B; Sneller, Krista; Ebeye, Tega D; Dykstra, Megan Jongekrijg; Ellens, Victoria L; Lee, HaEun Grace; Zandee, Gail L

    2016-01-01

    Preconception behaviors have a significant impact on birth outcomes, particularly among low-income minority groups, and women with unplanned pregnancies. This study examined women's perceived health status and behaviors such as drinking, smoking, exercise, and use of multivitamins and folic acid. This was a descriptive study based on a convenience sample of women living in urban underserved neighborhoods. Univariate and bivariate analyses were conducted using STATA 13. The sample consisted of 123 women ages 18 to 51 years (mean = 30.57); 51.22% were Hispanic, 36.59% African American, and 12.2% Caucasian. Over 70% had a household income of less than $20,000, 57.72% had no health insurance in the last year, and 58.54% were not married. These women were below the Healthy People 2020 goals for drinking, smoking, and multivitamin use, especially those who were planning to get pregnant in the next 6 months or not sure of their pregnancy planning status. There were no significant differences on any of the preconception health behavior variables based on pregnancy intention. Nurses and healthcare providers should emphasize importance of practicing healthy behaviors during the preconception period among low-income ethnic minority women specifically those living in urban medically underserved areas who are unsure of their pregnancy planning status or are at risk of unintended pregnancy.

  6. Nation's Capital to cover low-income women's abortions.

    Science.gov (United States)

    1994-04-15

    Sharon Pratt Kelly, the mayor of the District of Columbia, has announced that, effective May 1, 1994, the city will use its Medical Charities Fund to pay for "medically appropriate" abortions for women with annual incomes of US$13,200 who do not have health insurance that covers abortions. This income level represents 185% of the federal poverty level for single women. The determination as to whether an abortion is "appropriate" will be made by the woman's physician. From 1989-93, there was a ban on the use of District of Columbia tax monies to cover abortions for local women. In 1988, however, approximately 4000 District women received funding for their abortions. The US$1 million Medical Charities Fund was originally set up to cover emergency room bills for low-income District residents who did not qualify for Medicaid. $650,000 is expected to be added to the fund; in addition, the District's 1995 budget will allocate funding earmarked for abortion coverage for low-income women.

  7. Assets among low-income families in the Great Recession

    Science.gov (United States)

    Garfinkel, Irwin

    2018-01-01

    This paper examines the association between the Great Recession and real assets among families with young children. Real assets such as homes and cars are key indicators of economic well-being that may be especially valuable to low-income families. Using longitudinal data from the Fragile Families and Child Wellbeing Study (N = 4,898), we investigate the association between the city unemployment rate and home and car ownership and how the relationship varies by family structure (married, cohabiting, and single parents) and by race/ethnicity (White, Black, and Hispanic mothers). Using mother fixed-effects models, we find that a one percentage point increase in the unemployment rate is associated with a -0.5 percentage point decline in the probability of home ownership and a -0.7 percentage point decline in the probability of car ownership. We also find that the recession was associated with lower levels of home ownership for cohabiting families and for Hispanic families, as well as lower car ownership among single mothers and among Black mothers, whereas no change was observed among married families or White households. Considering that homes and cars are the most important assets among middle and low-income households in the U.S., these results suggest that the rise in the unemployment rate during the Great Recession may have increased household asset inequality across family structures and race/ethnicities, limiting economic mobility, and exacerbating the cycle of poverty. PMID:29401482

  8. Assets among low-income families in the Great Recession.

    Directory of Open Access Journals (Sweden)

    Valentina Duque

    Full Text Available This paper examines the association between the Great Recession and real assets among families with young children. Real assets such as homes and cars are key indicators of economic well-being that may be especially valuable to low-income families. Using longitudinal data from the Fragile Families and Child Wellbeing Study (N = 4,898, we investigate the association between the city unemployment rate and home and car ownership and how the relationship varies by family structure (married, cohabiting, and single parents and by race/ethnicity (White, Black, and Hispanic mothers. Using mother fixed-effects models, we find that a one percentage point increase in the unemployment rate is associated with a -0.5 percentage point decline in the probability of home ownership and a -0.7 percentage point decline in the probability of car ownership. We also find that the recession was associated with lower levels of home ownership for cohabiting families and for Hispanic families, as well as lower car ownership among single mothers and among Black mothers, whereas no change was observed among married families or White households. Considering that homes and cars are the most important assets among middle and low-income households in the U.S., these results suggest that the rise in the unemployment rate during the Great Recession may have increased household asset inequality across family structures and race/ethnicities, limiting economic mobility, and exacerbating the cycle of poverty.

  9. Assets among low-income families in the Great Recession.

    Science.gov (United States)

    Duque, Valentina; Pilkauskas, Natasha V; Garfinkel, Irwin

    2018-01-01

    This paper examines the association between the Great Recession and real assets among families with young children. Real assets such as homes and cars are key indicators of economic well-being that may be especially valuable to low-income families. Using longitudinal data from the Fragile Families and Child Wellbeing Study (N = 4,898), we investigate the association between the city unemployment rate and home and car ownership and how the relationship varies by family structure (married, cohabiting, and single parents) and by race/ethnicity (White, Black, and Hispanic mothers). Using mother fixed-effects models, we find that a one percentage point increase in the unemployment rate is associated with a -0.5 percentage point decline in the probability of home ownership and a -0.7 percentage point decline in the probability of car ownership. We also find that the recession was associated with lower levels of home ownership for cohabiting families and for Hispanic families, as well as lower car ownership among single mothers and among Black mothers, whereas no change was observed among married families or White households. Considering that homes and cars are the most important assets among middle and low-income households in the U.S., these results suggest that the rise in the unemployment rate during the Great Recession may have increased household asset inequality across family structures and race/ethnicities, limiting economic mobility, and exacerbating the cycle of poverty.

  10. Social marketing nutrition education for low-income population.

    Science.gov (United States)

    Hagues, Rachel; Stotz, Sarah; Childers, Austin; Phua, Joe; Hibbs, Judy; Murray, Deborah; Lee, Jung Sun

    2018-01-01

    As access to healthy food (or lack thereof) could be considered a social justice issue, social workers should be concerned about this issue and willing to collaborate with colleagues of various disciplines to address it. This study was a formative evaluation conducted to understand best practices, recommendations, and feasibility of a social-marketing-based nutrition education program tailored to the needs of adults with limited income. The authors report findings from focus groups conducted with Cooperative Extension Agents (CEAs) and region coordinators (n = 45) and Supplemental Nutrition Assistance Program Education (SNAP-Ed) (n = 69) eligible participants to inform the development of a social marketing nutrition intervention for SNAP-Ed in Georgia. Barriers to healthy eating included cultural preferences, costs of healthy food, lack of time, and lack of availability. Social marketing has a potential to deliver effective and efficient SNAP-Ed targeted to large, limited-resource Georgians. Segmenting the low-income population based on geographical location as well as best methods for outreach can allow tailored messages to meet identified needs, lifestyles, and other variables that make these individuals most likely to respond to the program. Food security and nutrition education are topics of concern for all health care professionals interested in addressing complex health issues of many low-income adults.

  11. Outpatient case management in low-income epilepsy patients.

    Science.gov (United States)

    Tatum, William O; Al-Saadi, Sam; Orth, Thomas L

    2008-12-01

    Case management (CM) has been shown to improve the medical care of patients in several paradigms of general medicine. This study was undertaken to assess the impact of CM on low-income patients with epilepsy. From 2002 to 2003, 737 epilepsy patients had CM provided by a non-profit, state-supported, epilepsy service subserving a four county region in southeastern Florida. Standardized survey forms distributed by the Florida Department of Health were completed by 159 consecutive patients at program admission. Follow-up information regarding seizure frequency, antiepileptic drugs, and quality of life self-rating was performed after 1 year of CM. The patients evaluated were composed of 58.5% men, with a mean age of 41.0 years. After CM, an increase in self-reported seizure control was seen in 40.2% of patients (preduction of ED visits per patient from 1.83 per patient per year before CM to 0.14 per patient per year after CM (p<0.0001, Wilcoxon matched-pairs test). Following CM, fewer patients reported difficulty with friends, employers, problems socializing, and feelings of anger (p<0.05, Fisher's exact test). CM of low-income patients with epilepsy resulted in self-reported improvement in seizure control, QoL, and significantly reduced ED visitation. CM in epilepsy is feasible and represents a cost-effective improvement in outpatient epilepsy management.

  12. 42 CFR 435.229 - Optional targeted low-income children.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Optional targeted low-income children. 435.229... Coverage of Families and Children § 435.229 Optional targeted low-income children. The agency may provide Medicaid to— (a) All individuals under age 19 who are optional targeted low-income children as defined in...

  13. 77 FR 25787 - Low Income Taxpayer Clinic Grant Program; Availability of 2013 Grant Application Package

    Science.gov (United States)

    2012-05-01

    ... DEPARTMENT OF THE TREASURY Internal Revenue Service Low Income Taxpayer Clinic Grant Program... Package and Guidelines (Publication 3319) for organizations interested in applying for a Low Income... nominal fee to low income taxpayers involved in tax controversies with the IRS, or inform individuals for...

  14. Low-Income Urban High School Students' Use of the Internet to Access Financial Aid

    Science.gov (United States)

    Venegas, Kristan M.

    2006-01-01

    This article focuses on the Web-based resources available to low-income students as they build their perceptions, make their decisions, and engage in financial aid activities. Data are gathered from the results of six focus groups with low-income high school students attending urban high schools. Findings suggest that low-income students do have…

  15. Shopping Behaviors of Low-income Families during a 1-Month Period of Time

    Science.gov (United States)

    Darko, Janice; Eggett, Dennis L.; Richards, Rickelle

    2013-01-01

    Objective: To explore food shopping behaviors among low-income families over the course of the month. Design: Two researchers conducted 13 90-minute focus groups. Setting: Two community organizations serving low-income populations and a university campus. Participants: Low-income adults (n = 72) who were the primary household food shoppers and who…

  16. Review of the indoor environmental quality and energy consumption studies for low income households in Europe.

    Science.gov (United States)

    Kolokotsa, D; Santamouris, M

    2015-12-01

    The term energy poverty is used to describe a situation of a household not able to satisfy socially and materially the required levels of its energy services. Energy and fuel poverty is an increasing problem in the European Union. Although the specific conditions vary from country to country the drivers defining fuel and energy poverty are similar in all Europe. This paper aims to present the state of the art regarding the energy demand and indoor environmental quality of low income households in Europe. The characteristics of this specific population group are presented including details on the specific energy consumption, the indoor comfort and finally the impact of the specific living conditions on the occupants' health. Copyright © 2015 Elsevier B.V. All rights reserved.

  17. Sustainable performance of microinsurance in low-income markets

    Directory of Open Access Journals (Sweden)

    Last Mazambani

    2018-06-01

    Full Text Available Sustainable performance in microinsurance offering in low-income markets is important to ensure that the service simultaneously achieves corporate profitability and poverty alleviation. Sustainable performance requires a balanced integration of supply and demand factors in the offering of the service. Microinsurance is still supply driven thereby creating a lopsided mismatch between demand and supply that leads to oversupply and low uptake. On the basis of extant literature, the paper aims to propose and discuss factors critical to demand and supply of microinsurance. A conceptual framework for sustainable microinsurance is presented with individual metrics that can be addressed as managerial tools for driving and controlling sustained superior performance. While this is a theoretical paper, microinsurance practitioners may benefit from the application of the presented theory

  18. Determinants of disciplinary practices in low-income black mothers.

    Science.gov (United States)

    Kelly, M L; Power, T G; Wimbush, D D

    1992-06-01

    Disciplinary attitudes and practices of low-income black mothers were examined. Mothers were interviewed about their parenting attitudes and control practices, and their responses were coded in terms of the degree to which they took a parent-versus a child-oriented approach to discipline. Mothers in the sample varied widely in their attitudes toward physical punishment, and mothers who used power-assertive techniques were as likely to take the child's perspective and give input into the socialization process as those who did not. Factors associated with maternal disciplinary styles included: maternal education, father absence, maternal age, and self-reported religious beliefs. Findings are discussed in terms of the variability in disciplinary practices in this population, as well as the factors contributing to these individual differences.

  19. How motivation influences breastfeeding duration among low-income women.

    Science.gov (United States)

    Racine, Elizabeth F; Frick, Kevin D; Strobino, Donna; Carpenter, Laura M; Milligan, Renee; Pugh, Linda C

    2009-05-01

    In-depth interviews were conducted with 44 low-income breastfeeding women to explore the incentives and disincentives to breastfeeding experienced within 6 months postpartum. Using an individual net benefit maximization (INBM) framework based on economic theory, we assessed women's motivations, incentives, and disincentives for breastfeeding. Based on the framework and their experience breastfeeding, women fell into 3 groups: intrinsically motivated, extrinsically motivated, and successfully experienced with both intrinsic and extrinsic motivation. Successfully experienced women were most likely to breastfeed to 6 months. Intrinsically motivated women valued breastfeeding but often required information and instruction to reach breastfeeding goals. Extrinsically motivated women were least likely to continue breastfeeding even with support and instruction. Providers can screen women to determine their experience and motivation then tailor interventions accordingly. Intrinsically motivated women may need support and instruction, extrinsically motivated women may benefit from motivational interviewing, and successfully experienced women may need only minimal breastfeeding counseling.

  20. Recruiting and retaining low-income Latinos in psychotherapy research.

    Science.gov (United States)

    Miranda, J; Azocar, F; Organista, K C; Muñoz, R F; Lieberman, A

    1996-10-01

    This article offers suggestions for recruiting and retaining low-income Latinos in treatment studies. Because Latinos underuse traditional mental health services, places such as medical centers or churches with large Latino constituents are suggested as useful alternative sources. To keep Latinos in research protocols, providing culturally sensitive treatments are necessary. Culturally sensitive treatments should incorporate families as part of recruitment efforts, particularly older men in the family. In addition, showing respect is an important aspect of traditional Latino culture that includes using formal titles and taking time to listen carefully. Finally, traditional Latinos tend to like interactions with others that are more warm and personal than is generally part of a research atmosphere.

  1. Climacteric complaints among very low-income women from a tropical region of Brazil

    Directory of Open Access Journals (Sweden)

    Sebastião Freitas de Medeiros

    Full Text Available CONTEXT AND OBJECTIVE: Climacteric symptoms may vary between different countries and cultures. Socioeconomic factors and climate may be implicated. The aim of this study was to identify climacteric symptomatology among very low-income Brazilian women, living in a hot and humid region. DESIGN AND SETTING: This cross-sectional population-based study was conducted in Cuiabá, at Júlio Müller University Hospital, a tertiary institution. METHODS: The study enrolled 354 climacteric women. The variables analyzed were social class, symptomatology and abnormal concurrent conditions. The study was approved by the hospital's research ethics committee. RESULTS: Sixty-five percent of the participants (232/354 were very poor and had had little schooling. The number of symptoms per woman was 8.0 ± 5.7. Hot flushes, nervousness, forgetfulness and fatigue were each found in nearly 60.0%. Tearfulness, depression, melancholy and insomnia were also frequent. Sexual problems were reported by 25%. The most relevant concurrent abnormal conditions reported were hypertension (33.9%, obesity (26.5%, arthritis/arthrosis (15.0% and diabetes mellitus (9.6%. Hot flushes were associated with tearfulness, nervousness and forgetfulness. CONCLUSION: Brazilian climacteric women of low income and low schooling present multiple symptoms. Vasomotor and psychosexual symptoms were the most prevalent disorders. Hot flushes were associated with nervousness, forgetfulness and tearfulness.

  2. Environmental Impacts and Embodied Energy of Construction Methods and Materials in Low-Income Tropical Housing

    Directory of Open Access Journals (Sweden)

    Arman Hashemi

    2015-06-01

    Full Text Available This paper evaluates the current conditions of Ugandan low-income tropical housing with a focus on construction methods and materials in order to identify the key areas for improvement. Literature review, site visits and photographic surveys are carried out to collect relevant information on prevailing construction methods/materials and on their environmental impacts in rural areas. Low quality, high waste, and energy intensive production methods, as well as excessive soil extraction and deforestation, are identified as the main environmental damage of the current construction methods and materials. The embodied energy is highlighted as the key area which should be addressed to reduce the CO2 emissions of low-income tropical housing. The results indicate that the embodied energy of fired bricks in Uganda is up to 5.7 times more than general clay bricks. Concrete walling is identified as a much more environmentally friendly construction method compared to brick walling in East African countries. Improving fuel efficiency and moulding systems, increasing access to renewable energy sources, raising public awareness, educating local manufacturers and artisans, and gradual long-term introduction of innovative construction methods and materials which are adapted to local needs and conditions are some of the recommended actions to improve the current conditions.

  3. Stress, social relationships and health outcomes in low-income Francistown, Botswana.

    Science.gov (United States)

    Modie-Moroka, Tirelo

    2014-08-01

    Studies assessing the impact of stress on health outcomes are lacking in developing countries such as Botswana, in Southern Africa. This study examines the relationships between individual life stressors (stressful life events and chronic life stressors), social relationships and quality of life (QoL), for low-income urban residents in Francistown, Botswana. Although there are many studies of social support and quality of life, no studies have so far explored the relationship among the three variables. Selected concepts from stress theory are used as a conceptual framework. Using a cross-sectional quantitative design (both descriptive and explanatory), this study examined the associations among life stress (stressful life events and chronic life stressors), social relationships, and four indicators of health and QoL among a sample of 388 low-income urban dwellers in Francistown, Botswana. Using multiple regression models, the results of this study show that the availability of social relationships was associated with better physical and psychological health and level of independence. Controlling for the physical domain of QoL, social relationships buffered the effects of chronic life stressors on QoL and level of independence. Social relationships buffer the effects of stressful life events on quality, not on psychological well-being. Social relationships had no moderating effect on physical health, level of independence and on quality of life.

  4. Staying report of Lic. Mirtha Gamba from (Cnea - Argentina) energetic minerals department

    International Nuclear Information System (INIS)

    Lara Vigil, P.

    1988-01-01

    The visit of the Lic.Gamba to our country, it was oriented to realise a completion of the geochemical sampling by uranium and other elements of interest to clear in lands of the Crystalline basament and the training of the taking of alluvium samples. The tasks were developed so much in cabinet as in field. Besides it were made visits to the laboratories where take place the preparation of samples, chemical analyses and petrography. Also were visited the laboratories of physical analyses in the D.N.T.N (Direction National of Nuclear technology) that it is mounted in DI.NA.MI.GE. And the exit of field was realised to visit two zones worked by the uranium program during years 1985-1987, Valle Chico (Photo-plan Alferez) and Puntas del Mataojo

  5. Health financing to promote access in low income settings-how much do we know?

    Science.gov (United States)

    Palmer, Natasha; Mueller, Dirk H; Gilson, Lucy; Mills, Anne; Haines, Andy

    In this article we outline research since 1995 on the impact of various financing strategies on access to health services or health outcomes in low income countries. The limited evidence available suggests, in general, that user fees deterred utilisation. Prepayment or insurance schemes offered potential for improving access, but are very limited in scope. Conditional cash payments showed promise for improving uptake of interventions, but could also create a perverse incentive. The largely African origin of the reports of user fees, and the evidence from Latin America on conditional cash transfers, demonstrate the importance of the context in which studies are done. There is a need for improved quality of research in this area. Larger scale, upfront funding for evaluation of health financing initiatives is necessary to ensure an evidence base that corresponds to the importance of this issue for achieving development goals.

  6. Assessing demand for improved sustainable sanitation in low-income informal settlements of urban areas: a critical review.

    Science.gov (United States)

    Okurut, Kenan; Kulabako, Robinah Nakawunde; Chenoweth, Jonathan; Charles, Katrina

    2015-01-01

    Sanitation improvement is crucial in saving lives that are lost due to water contamination. Progress towards achieving full sanitation coverage is still slow in low-income informal settlements in most developing countries. Furthermore, resources are being wasted on installing facilities that are later misused or never used because they do not meet the local demand. Understanding demand for improved sanitation in the local context is critical if facilities are to be continually used. Various approaches that attempt to change peoples' behaviours or create demand have been reviewed to identify what they are designed to address. A multi-disciplinary research team using mixed methods is re-emphasised as a comprehensive approach for assessing demand for improved sanitation in low-income informal settlements, where the sanitation situation is more challenging than in other areas. Further research involving a multi-disciplinary research team and use of mixed methods to assess sanitation demand in informal settlements is needed.

  7. The moderating role of brands for low income luxury consumers

    Directory of Open Access Journals (Sweden)

    Flavio Santino Bizarrias

    2017-09-01

    Full Text Available The value of luxury is a multidimensional construct that assesses how consumers consider the various dimensions of luxury in their consumption relations. The consumption of luxury is not a trivial activity for most people, but brings a certain fascination and is part of the imaginary of the lower classes in emerging markets. The social identity of these consumers is changing because they aspire a new social position. But luxury consumption hurts the standards of this consumer profile. At the same time the self esteem is observed as an important element of people self-confirmation. For consumers, specifically, self-esteem is an important antecedent of consumption decisions. A sample of low income students was analyzed in this study to describe their relationship with luxury, and its influence on self-esteem when moderated by brand expressiveness. Through structural equation modeling this study found that the expression of the brand moderates the relationship of the value of luxury with self-esteem, allowing consumers of lower classes to observe a significant role of luxury in their lives.

  8. CFD Simulations to Improve Ventilation in Low-Income Housing

    Science.gov (United States)

    Ho, Rosemond; Gorle, Catherine

    2017-11-01

    Quality of housing plays an important role in public health. In Dhaka, Bangladesh, the leading causes of death include tuberculosis, lower respiratory infections, and chronic obstructive pulmonary disease, so improving home ventilation could potentially mitigate these negative health effects. The goal of this project is to use computational fluid dynamics (CFD) to predict the relative effectiveness of different ventilation strategies for Dhaka homes. A Reynolds-averaged Navier-Stokes CFD model of a standard Dhaka home with apertures of different sizes and locations was developed to predict air exchange rates. Our initial focus is on simulating ventilation driven by buoyancy-alone conditions, which is often considered the limiting case in natural ventilation design. We explore the relationship between ventilation rate and aperture area to determine the most promising configurations for optimal ventilation solutions. Future research will include the modeling of wind-driven conditions, and extensive uncertainty quantification studies to investigate the effect of variability in the layout of homes and neighborhoods, and in local wind and temperature conditions. The ultimate objective is to formulate robust design recommendations that can reduce risks of respiratory illness in low-income housing.

  9. Xerostomia Among Older Adults With Low Income: Nuisance or Warning?

    Science.gov (United States)

    Lee, Young-Shin; Kim, Hee-Gerl; Moreno, Kim

    2016-01-01

    The purpose of this study was to identify the prevalence of xerostomia and related factors among low-income older adults in South Korea. A cross-sectional, population-based study. Using data from the Home Healthcare Service Project, a population-based interview survey with home healthcare service, a total of 9,840 adults 65 years of age and older were assessed for the presence of xerostomia in association with aspects of health lifestyles, chronic disease, oral conditions, and oral function. Overall, 40% of participants reported experiencing xerostomia. Multivariate regression analysis indicated xerostomia was more likely to be reported by women having symptoms of gingival bleeding/pain, having difficulty swallowing liquid or chewing solid food, and having multiple chronic diseases. Interestingly, older adults who live alone and drink alcohol (two or more times per week) reported fewer problems with xerostomia. Increased focus on the detrimental health consequences of xerostomia would make treatment a higher priority. Improved assessment of at-risk populations, particularly among the elderly, could lead to earlier preventative interventions, lessening the negative impact on quality of life. Health professionals along with the general public need increased knowledge about the detrimental effects of xerostomia on overall health. There is a need for earlier assessment and treatment to facilitate optimal health promotion and disease prevention. © 2015 Sigma Theta Tau International.

  10. Maternal concerns about children overeating among low-income children.

    Science.gov (United States)

    Pesch, Megan H; Rizk, Monika; Appugliese, Danielle P; Rosenblum, Katherine L; Miller, Alison; Lumeng, Julie C

    2016-04-01

    Addressing overeating is essential to obesity treatment and prevention. The objectives of this study were to investigate maternal concern for child overeating, to identify associated participant characteristics and to determine if concern for child overeating is associated with maternal feeding practices. Low-income mothers (N=289) of children (mean age 70.8months) participated in a semi-structured interview. Themes of maternal concern for child overeating were identified and a coding scheme was reliably applied. Maternal feeding practices were measured by questionnaire and videotaped eating interactions. Logistic regressions were used to test the associations of participant characteristics with the presence of each theme, and bivariate analyses were used to test the associations of the presence of each theme with feeding practices. Three themes were identified: 1) mothers worry that their child does overeat, 2) mothers acknowledge that their child may overeat but indicate that it is not problematic because they manage their child's eating behavior, and 3) mothers acknowledge that their child may overeat but indicate that it is not problematic because of characteristics inherent to the child. Child obesity predicted the themes; mothers of obese and overweight children are more likely to be concerned about overeating. Themes were associated with lower levels of observed pressure to eat. Only Theme 2 was associated with greater restrictive feeding practices. Interventions that provide parents' practical, healthy ways to prevent child overeating may be helpful. Copyright © 2016. Published by Elsevier Ltd.

  11. AFFORDABILITY OF LOW INCOME HOUSING IN PUMWANI, NAIROBI, KENYA

    Directory of Open Access Journals (Sweden)

    Crispino C. Ochieng

    2007-07-01

    Full Text Available Since 1987, in Kenya, through the National Housing Corporation (NHC, an arm of the central government that delivers affordable houses, the local government embarked on the redevelopment of Pumwani the oldest surviving affordable low income housing in Nairobi. Pumwani was started in 1923 and it targeted early African immigrants to Nairobi. Currently, the old Pumwani is home to some of the city’s poorest dwellers majorities who depend on the informal sector for an income. Redevelopment was targeted at housing all the genuine dwellers. Instead delivery ended up with house types that were at first rejected by the beneficiaries. Although the new housing was slightly of an improved physical and spatial quality it was unaffordable. Beneficiaries were required to pay an average monthly rent of US$157 for up to eighteen years towards purchase of the new house. In the beginning, some of them had declined to take position of the newly built houses. To raise the basic rent majorities of those who have since moved in have opted to rent out some of the space. To date there is still standoff with some of the houses still unoccupied. Except during the period of social survey when the beneficiaries were brought in to supply the necessary information, the entire construction process was undertaken by NHC under a turnkey project. Among other factors the construction process was at fault for it raised the costs. Also, some of the basic housing needs were not effectively looked into. There was a housing mismatch.

  12. Low-Income Community Solar: Utility Return Considerations for Electric Cooperatives

    Energy Technology Data Exchange (ETDEWEB)

    Aznar, Alexandra Y [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Gagne, Douglas A [National Renewable Energy Laboratory (NREL), Golden, CO (United States)

    2018-04-05

    The objective of this short report is to identify project structures that make low-income community solar projects more cost-effective, replicable, and scalable, for electric cooperative and municipal utilities. This report explores the tradeoffs between providing energy bill savings for low-income subscribers and utility project returns, as well as some of the key lessons learned from existing successful low-income community solar pilot projects.

  13. Food Stress in Adelaide: The Relationship between Low Income and the Affordability of Healthy Food

    OpenAIRE

    Paul R. Ward; Fiona Verity; Patricia Carter; George Tsourtos; John Coveney; Kwan Chui Wong

    2013-01-01

    Healthy food is becoming increasingly expensive, and families on low incomes face a difficult financial struggle to afford healthy food. When food costs are considered, families on low incomes often face circumstances of poverty. Housing, utilities, health care, and transport are somewhat fixed in cost; however food is more flexible in cost and therefore is often compromised with less healthy, cheaper food, presenting an opportunity for families on low incomes to cut costs. Using a “Healthy ...

  14. Feeding practices of low-income mothers: how do they compare to current recommendations?

    OpenAIRE

    Power, Thomas G; Hughes, Sheryl O; Goodell, L Suzanne; Johnson, Susan L; Duran, J Andrea Jaramillo; Williams, Kimberly; Beck, Ashley D; Frankel, Leslie A

    2015-01-01

    Background Despite a growing consensus on the feeding practices associated with healthy eating patterns, few observational studies of maternal feeding practices with young children have been conducted, especially in low-income populations. The aim of this study was to provide such data on a low income sample to determine the degree to which observed maternal feeding practices compare with current recommendations. Methods Eighty low-income mothers and their preschool children were videotaped a...

  15. 24 CFR 1000.142 - What is the “useful life” during which low-income rental housing and low-income homebuyer housing...

    Science.gov (United States)

    2010-04-01

    ... Activities § 1000.142 What is the “useful life” during which low-income rental housing and low-income... recipient shall describe in its IHP its determination of the useful life of each assisted housing unit in... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false What is the âuseful lifeâ during...

  16. Food Choices of Minority and Low-Income Employees

    Science.gov (United States)

    Levy, Douglas E.; Riis, Jason; Sonnenberg, Lillian M.; Barraclough, Susan J.; Thorndike, Anne N.

    2012-01-01

    Background Effective strategies are needed to address obesity, particularly among minority and low-income individuals. Purpose To test whether a two-phase point-of-purchase intervention improved food choices across racial, socioeconomic (job type) groups. Design A 9-month longitudinal study from 2009 to 2010 assessing person-level changes in purchases of healthy and unhealthy foods following sequentially introduced interventions. Data were analyzed in 2011. Setting/participants Participants were 4642 employees of a large hospital in Boston MA who were regular cafeteria patrons. Interventions The first intervention was a traffic light–style color-coded labeling system encouraging patrons to purchase healthy items (labeled green) and avoid unhealthy items (labeled red). The second intervention manipulated “choice architecture” by physically rearranging certain cafeteria items, making green-labeled items more accessible, red-labeled items less accessible. Main outcome measures Proportion of green- (or red-) labeled items purchased by an employee. Subanalyses tracked beverage purchases, including calories and price per beverage. Results Employees self-identified as white (73%), black (10%), Latino (7%), and Asian (10%). Compared to white employees, Latino and black employees purchased a higher proportion of red items at baseline (18%, 28%, and 33%, respectively, p0.05 for interaction between race or job type and intervention). Mean calories per beverage decreased similarly over the study period for all racial groups and job types, with no increase in per-beverage spending. Conclusions Despite baseline differences in healthy food purchases, a simple color-coded labeling and choice architecture intervention improved food and beverage choices among employees from all racial and socioeconomic backgrounds. PMID:22898116

  17. Faculty as Institutional Agents for Low-Income Latino Students in Science, Technology, Engineering, and Mathematics Fields at a Hispanic-Serving Institution

    Science.gov (United States)

    Santiago, Cecilia

    2012-01-01

    Despite the exponential growth of Latinos during the past decade and an increase in higher education participation, there continues to be a gap in degree attainment compared to other ethnic and racial groups in this country. This gap is even greater for low-income Latino students seeking a degree in STEM fields. A proposed solution for this gap…

  18. The Economic Payoff for Closing College-Readiness and Completion Gaps: Why States Should Invest in Accelerating Low-Income Youth to and through Postsecondary Credentials

    Science.gov (United States)

    Vargas, Joel

    2013-01-01

    The low rates at which U.S. college students complete a degree and the amount time they spend in remedial coursework are national problems. The situation is particularly acute for low-income and other underserved youth, including populations such as Hispanic students that are growing the fastest in the country and that have some of the lowest…

  19. Child Disinhibition, Parent Restriction, and Child Body Mass Index in Low-Income Preschool Families

    Science.gov (United States)

    Sparks, Martha A.; Radnitz, Cynthia L.

    2013-01-01

    Objective: To examine both unique and interactive effects of parent restrictive feeding and child disinhibited eating behavior on child body mass index (BMI) in low-income Latino and African American preschoolers. Methods: The sample included 229 parent-child pairs, the majority of whom were low-income and Latino (57%) or African American (25%).…

  20. Building and Using a Social Network: Nurture for Low-Income Chinese American Adolescents' Learning

    Science.gov (United States)

    Li, Jin; Holloway, Susan D.; Bempechat, Janine; Loh, Elaine

    2008-01-01

    Little research has examined how low-income Asian American children are supported to achieve well in school. The authors used the notion of social capital to study higher versus lower achieving Chinese adolescents from low-income backgrounds. They found that families of higher-achieving adolescents built and used more effectively three kinds of…

  1. The role of urban agriculture for food security in low income areas in Nairobi

    NARCIS (Netherlands)

    Mwangi, A.M.

    1995-01-01

    This paper, which is based on research carried out among 210 households in Nairobi (Kenya) in 1994, examines the role of urban agriculture in household food security among low-income urban households. It determines the different strategies the low-income population of Nairobi deploys in order to

  2. Improving Readability of an Evaluation Tool for Low-Income Clients Using Visual Information Processing Theories

    Science.gov (United States)

    Townsend, Marilyn S.; Sylva, Kathryn; Martin, Anna; Metz, Diane; Wooten-Swanson, Patti

    2008-01-01

    Literacy is an issue for many low-income audiences. Using visual information processing theories, the goal was improving readability of a food behavior checklist and ultimately improving its ability to accurately capture existing changes in dietary behaviors. Using group interviews, low-income clients (n = 18) evaluated 4 visual styles. The text…

  3. A New Majority: Low Income Students Now a Majority in the Nation's Public Schools. Research Bulletin

    Science.gov (United States)

    Southern Education Foundation, 2015

    2015-01-01

    For the first time in recent history, a majority of the schoolchildren attending the nation's public schools come from low income families. The latest data collected from the states by the National Center for Education Statistics (NCES), evidence that 51 percent of the students across the nation's public schools were low income in 2013. The…

  4. 42 CFR 436.229 - Optional targeted low-income children.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Optional targeted low-income children. 436.229... Options for Coverage as Categorically Needy Options for Coverage of Families and Children and Aged, Blind, and Disabled Individuals, Including Pregnant Women § 436.229 Optional targeted low-income children...

  5. 76 FR 36976 - Sample Income Data To Meet the Low-Income Definition

    Science.gov (United States)

    2011-06-24

    ... NATIONAL CREDIT UNION ADMINISTRATION 12 CFR Part 701 RIN 3133-AD76 Sample Income Data To Meet the Low-Income Definition AGENCY: National Credit Union Administration (NCUA). ACTION: Final rule. SUMMARY... low-income designation using the geo-coding software the agency has developed for that purpose to...

  6. 75 FR 80364 - Sample Income Data To Meet the Low-Income Definition

    Science.gov (United States)

    2010-12-22

    ... 701 RIN 3133-AD76 Sample Income Data To Meet the Low-Income Definition AGENCY: National Credit Union... (FCUs) that do not qualify for a low-income designation using the geo-coding software the NCUA has developed for that purpose to submit an analysis of a statistically valid sample of their member income data...

  7. Critical Components of a Summer Enrichment Program for Urban Low-Income Gifted Students

    Science.gov (United States)

    Kaul, Corina R.; Johnsen, Susan K.; Witte, Mary M.; Saxon, Terrill F.

    2015-01-01

    Effective program models are needed for low-income youth. This article describes one successful summer enrichment program, University for Young People's Project Promise, and outlines three key components of a Partnership for Promoting Potential in Low-Income Gifted Students (Partnership Model), which is based on Lee, Olszewski-Kubilius, and…

  8. Arts Enrichment and Preschool Emotions for Low-Income Children at Risk

    Science.gov (United States)

    Brown, Eleanor D.; Sax, Kacey L.

    2013-01-01

    No studies to date examine the impact of arts-integrated preschool programming on the emotional functioning of low-income children at risk for school problems. The present study examines observed emotion expression and teacher-rated emotion regulation for low-income children attending Settlement Music School's Kaleidoscope Preschool Arts…

  9. 13 CFR 108.710 - Requirement to finance Low-Income Enterprises.

    Science.gov (United States)

    2010-01-01

    ... VENTURE CAPITAL (âNMVCâ) PROGRAM Financing of Small Businesses by NMVC Companies Determining the... of your Portfolio Concerns must be Low-Income Enterprises in which you have an Equity Capital... total dollars) in Equity Capital Investments in Low-Income Enterprises. (b) Non-compliance with this...

  10. Contemporary Work and Family Issues Affecting Marriage and Cohabitation among Low-Income Single Mothers

    Science.gov (United States)

    Joshi, Pamela; Quane, James M.; Cherlin, Andrew J.

    2009-01-01

    In this paper, we advance and test an integrative model of the effects of employment status, nonstandard work schedules, male employment, and women's perceptions of economic instability on union formation among low-income single mothers. On the basis of the longitudinal data from 1,299 low-income mothers from the Three-City Welfare Study, results…

  11. Assessment of Low-Income Adults' Access to Technology: Implications for Nutrition Education

    Science.gov (United States)

    Neuenschwander, Lauren M.; Abbott, Angela; Mobley, Amy R.

    2012-01-01

    Objective: The main objective of this study was to investigate access and use of technologies such as the Internet among Indiana's low-income population. The secondary objective was to determine whether access and use of computers significantly differed by age, race, and/or education level. Methods: Data were collected from low-income adult…

  12. 78 FR 33154 - Low Income Taxpayer Clinic Grant Program; Availability of 2014 Grant Application Package

    Science.gov (United States)

    2013-06-03

    ... Package and Guidelines (Publication 3319) for organizations interested in applying for a Low Income... nominal fee to low income taxpayers involved in tax disputes with the IRS, or educate individuals for whom... Grant Application Package and Guidelines, IRS Publication 3319 (Rev. 5-2013), can be downloaded from the...

  13. 76 FR 34297 - Low Income Taxpayer Clinic Grant Program; Availability of 2012 Grant Application Package

    Science.gov (United States)

    2011-06-13

    ... guidelines (Publication 3319) for organizations interested in applying for a Low Income Taxpayer Clinic (LITC... representation for free or for a nominal fee to low income taxpayers involved in tax controversies with the IRS..., IRS Publication 3319 (Rev. 5-2011), can be downloaded from the IRS Internet site at http://www.irs.gov...

  14. Developmental Trends in Self-Regulation among Low-Income Toddlers

    Science.gov (United States)

    Raikes, H. Abigail; Robinson, JoAnn L.; Bradley, Robert H.; Raikes, Helen H.; Ayoub, Catherine C.

    2007-01-01

    The attainment of self-regulatory skills during the toddler years is an understudied issue, especially among low-income children. The present study used growth modeling to examine the change over time and the final status in children's abilities to self-regulate, in a sample of 2,441 low-income children aged 14 to 36 months. Positive growth in…

  15. Federally Funded Education and Job Training Programs for Low-Income Youth

    Science.gov (United States)

    Dworsky, Amy

    2011-01-01

    With the growing demand for highly skilled workers and declining wages for those who are less skilled, low-income youth with limited education and no work experience have few opportunities for gainful employment. Since the Great Depression, the federal government has been funding programs that provide low-income, out-of-school, and unemployed…

  16. The Experience of Low-Income College Students at a Selective University: An Interpretative Phenomenological Analysis

    Science.gov (United States)

    Dias, Paula Ribeiro

    2017-01-01

    Low-income students at selective institutions report feeling a sense of isolation, alienation, and marginalization. However, it is essential that the voices of low-income students that have successfully navigated the college experience be part of the conversation. Rather than approach the study from a deficit perspective, this Interpretative…

  17. Aflatoxin exposure among young children in urban low-income ...

    African Journals Online (AJOL)

    Populations in tropical and subtropical developing countries are exposed to largely uncontrolled levels of aflatoxins through food. These countries (especially in Africa and Asia) also present a high prevalence of stunting. Studies have reported an association between aflatoxin exposure and growth impairment in children ...

  18. Cost-effectiveness of maternal GBS immunization in low-income sub-Saharan Africa.

    Science.gov (United States)

    Russell, Louise B; Kim, Sun-Young; Cosgriff, Ben; Pentakota, Sri Ram; Schrag, Stephanie J; Sobanjo-Ter Meulen, Ajoke; Verani, Jennifer R; Sinha, Anushua

    2017-12-14

    A maternal group B streptococcal (GBS) vaccine could prevent neonatal sepsis and meningitis. Its cost-effectiveness in low-income sub-Saharan Africa, a high burden region, is unknown. We used a decision tree model, with Markov nodes to project infants' lifetimes, to compare maternal immunization delivered through routine antenatal care with no immunization. 37 countries were clustered on the basis of economic and health resources and past public health performance. Vaccine efficacy for covered serotypes was ranged from 50% to 90%. The model projected EOGBS (early-onset) and LOGBS (late-onset) cases and deaths, disability-adjusted life years (DALYs), healthcare costs (2014 US$), and cost-effectiveness for a representative country in each of the four clusters: Guinea-Bissau, Uganda, Nigeria, and Ghana. Maximum vaccination costs/dose were estimated to meet two cost-effectiveness benchmarks, 0.5 GDP and GDP per capita/DALY, for ranges of disease incidence (reported and adjusted for under-reporting) and vaccine efficacy. At coverage equal to the proportion of pregnant women with≥4 antenatal visits (ANC4) and serotype-specific vaccine efficacy of 70%, maternal GBS immunization would prevent one-third of GBS cases and deaths in Uganda and Nigeria, where ANC4 is 50%, 42-43% in Guinea-Bissau (ANC4=65%), and 55-57% in Ghana (ANC4=87%). At a vaccination cost of $7/dose, maternal immunization would cost $320-$350/DALY averted in Guinea-Bissau, Nigeria, and Ghana, less than half these countries' GDP per capita. In Uganda, which has the lowest case fatality ratios, the cost would be $573/DALY. If the vaccine prevents a small proportion of stillbirths, it would be even more cost-effective. Vaccination cost/dose, disease incidence, and case fatality were key drivers of cost/DALY in sensitivity analyses. Maternal GBS immunization could be a cost-effective intervention in low-income sub-Saharan Africa, with cost-effectiveness ratios similar to other recently introduced vaccines

  19. Closing the mental health gap in low-income settings by building research capacity: perspectives from Mozambique.

    Science.gov (United States)

    Sweetland, Annika C; Oquendo, Maria A; Sidat, Mohsin; Santos, Palmira F; Vermund, Sten H; Duarte, Cristiane S; Arbuckle, Melissa; Wainberg, Milton L

    2014-01-01

    Neuropsychiatric disorders are the leading cause of disability worldwide, accounting for 22.7% of all years lived with disability. Despite this global burden, fewer than 25% of affected individuals ever access mental health treatment; in low-income settings, access is much lower, although nonallopathic interventions through traditional healers are common in many venues. Three main barriers to reducing the gap between individuals who need mental health treatment and those who have access to it include stigma and lack of awareness, limited material and human resources, and insufficient research capacity. We argue that investment in dissemination and implementation research is critical to face these barriers. Dissemination and implementation research can improve mental health care in low-income settings by facilitating the adaptation of effective treatment interventions to new settings, particularly when adapting specialist-led interventions developed in high-resource countries to settings with few, if any, mental health professionals. Emerging evidence from other low-income settings suggests that lay providers can be trained to detect mental disorders and deliver basic psychotherapeutic and psychopharmacological interventions when supervised by an expert. We describe a new North-South and South-South research partnership between Universidade Eduardo Mondlane (Mozambique), Columbia University (United States), Vanderbilt University (United States), and Universidade Federal de São Paulo (Brazil), to build research capacity in Mozambique and other Portuguese-speaking African countries. Mozambique has both the political commitment and available resources for mental health, but inadequate research capacity and workforce limits the country's ability to assess local needs, adapt and test interventions, and identify implementation strategies that can be used to effectively bring evidence-based mental health interventions to scale within the public sector. Global training and

  20. Implementing new health interventions in developing countries: why do we lose a decade or more?

    Directory of Open Access Journals (Sweden)

    Brooks Alan

    2012-08-01

    Full Text Available Abstract Background It is unclear how long it takes for health interventions to transition from research and development (R&D to being used against diseases prevalent in resource-poor countries. We undertook an analysis of the time required to begin implementation of four vaccines and three malaria interventions. We evaluated five milestones for each intervention, and assessed if the milestones were associated with beginning implementation. Methods The authors screened World Health Organization (WHO databases to determine the number of years between first regulatory approval of interventions, and countries beginning implementation. Descriptive analyses of temporal patterns and statistical analyses using logistic regression and Cox proportional hazard models were used to evaluate associations between five milestones and the beginning of implementation for each intervention. The milestones were: (A presence of a coordinating group focused on the intervention; (B availability of an intervention tailored to developing country health systems; (C international financing commitment, and; (D initial and (E comprehensive WHO recommendations. Countries were categorized by World Bank income criteria. Results Five years after regulatory approval, no low-income countries (LICs had begun implementing any of the vaccines, increasing to an average of only 4% of LICs after 10 years. Each malaria intervention was used by an average of 7% of LICs after five years and 37% after 10 years. Four of the interventions had similar implementation rates to hepatitis B vaccine (HepB, while one was slower and one was faster than HepB. A financing commitment and initial WHO recommendation appeared to be temporally associated with the beginning of implementation. The initial recommendation from WHO was the only milestone associated in all statistical analyses with countries beginning implementation (relative rate = 1.97, P  Conclusions Although possible that four

  1. Wilms Tumor Treatment Outcomes: Perspectives From a Low-Income Setting.

    Science.gov (United States)

    Njuguna, Festus; Martijn, Hugo A; Kuremu, Robert Tenge; Saula, Peter; Kirtika, Patel; Olbara, Gilbert; Langat, Sandra; Martin, Steve; Skiles, Jodi; Vik, Terry; Kaspers, Gertjan J L; Mostert, Saskia

    2017-10-01

    Wilms tumor is the commonest renal malignancy in childhood. Survival in high-income countries is approximately 90%, whereas in low-income countries, it is less than 50%. This study assessed treatment outcomes of patients with Wilms tumor at a Kenyan academic hospital. We conducted a retrospective medical record review of all children diagnosed with Wilms tumor between 2010 and 2012. Data on treatment outcomes and various sociodemographic and clinical characteristics were collected. Of the 39 patients with Wilms tumor, 41% had event-free survival, 31% abandoned treatment, 23% died, and 5% had progressive or relapsed disease. Most patients presented at an advanced stage: stage I (0%), II (7%), III (43%), IV (40%), or V (10%). The most likely treatment outcome in patients with low-stage (I to III) disease was event-free survival (67%), whereas in those with high-stage (IV to V) disease, it was death (40%). No deaths or instances of progressive or relapsed disease were recorded among patients with low-stage disease; their only reason for treatment failure was abandonment of treatment. Stage of disease significantly affected treatment outcomes ( P = .014) and event-free survival estimates ( P abandonment is the most common cause of treatment failure. Stage of disease at diagnosis statistically significantly affects treatment outcomes and survival.

  2. An approach to the study of financial consumption in the low-income sectors of Buenos Aires, Argentina

    Directory of Open Access Journals (Sweden)

    Iara Nadina Hadad

    2017-09-01

    Full Text Available An approach is proposed on the study of financial consumption in the low-income sectors of Argentina. As mentioned in multiple research studies conducted in different Latin American countries, the study of this recent and widespread phenomenon demands to highlight some of the common places that have caused the characterization of the economic life of the popular sectors. We propose some theoretical guidelines to reconsider such consumption and analyze the results of our still ongoing investigation regarding consumption and indebtedness in the lower sectors of the metropolitan area of Buenos Aires.

  3. Using social media to communicate child health information to low-income parents.

    Science.gov (United States)

    Stroever, Stephanie J; Mackert, Michael S; McAlister, Alfred L; Hoelscher, Deanna M

    2011-11-01

    The objective of this study was to determine the value of using social media to communicate child health information to low-income parents. We evaluated qualitative data obtained through focus groups with low-income, predominantly Hispanic parents. Results were mixed; lack of time and credibility were the primary objections parents cited in using social media to obtain information about their children's health. Social media has value as part of an overall communication strategy, but more work is needed to determine the most effective way to use this channel in low-income populations.

  4. The Best of All Worlds: Full Spectrum Conflict, LIC, and the Transformation of the Army

    National Research Council Canada - National Science Library

    Slate, Nathan

    2001-01-01

    The findings of the paper's research indicate that the U.S. Army has undertaken a sweeping transformation that promises to create a force that will be prepared for a broad range of low intensity conflict (LIC...

  5. Wilms Tumor Treatment Outcomes: Perspectives From a Low-Income Setting

    Directory of Open Access Journals (Sweden)

    Festus Njuguna

    2017-10-01

    Full Text Available Purpose: Wilms tumor is the commonest renal malignancy in childhood. Survival in high-income countries is approximately 90%, whereas in low-income countries, it is less than 50%. This study assessed treatment outcomes of patients with Wilms tumor at a Kenyan academic hospital. Patients and Methods: We conducted a retrospective medical record review of all children diagnosed with Wilms tumor between 2010 and 2012. Data on treatment outcomes and various sociodemographic and clinical characteristics were collected. Results: Of the 39 patients with Wilms tumor, 41% had event-free survival, 31% abandoned treatment, 23% died, and 5% had progressive or relapsed disease. Most patients presented at an advanced stage: stage I (0%, II (7%, III (43%, IV (40%, or V (10%. The most likely treatment outcome in patients with low-stage (I to III disease was event-free survival (67%, whereas in those with high-stage (IV to V disease, it was death (40%. No deaths or instances of progressive or relapsed disease were recorded among patients with low-stage disease; their only reason for treatment failure was abandonment of treatment. Stage of disease significantly affected treatment outcomes (P = .014 and event-free survival estimates (P < .001. Age at diagnosis, sex, duration of symptoms, distance to hospital, and health insurance status did not statistically significantly influence treatment outcomes or event-free survival estimates. Conclusion: Survival of patients with Wilms tumor in Kenya is lower compared with that in high-income countries. Treatment abandonment is the most common cause of treatment failure. Stage of disease at diagnosis statistically significantly affects treatment outcomes and survival.

  6. 26 CFR 1.42-1T - Limitation on low-income housing credit allowed with respect to qualified low-income buildings...

    Science.gov (United States)

    2010-04-01

    ... credit agencies for exclusive use in making housing credit allocations to buildings that are part of... housing credit allocations in excess of an agency's aggregate housing credit dollar amount. In the event... not perform an independent investigation of the qualified low-income building in order to certify on...

  7. Estimating the Cost of Neurosurgical Procedures in a Low-Income Setting: An Observational Economic Analysis.

    Science.gov (United States)

    Abdelgadir, Jihad; Tran, Tu; Muhindo, Alex; Obiga, Doomwin; Mukasa, John; Ssenyonjo, Hussein; Muhumza, Michael; Kiryabwire, Joel; Haglund, Michael M; Sloan, Frank A

    2017-05-01

    There are no data on cost of neurosurgery in low-income and middle-income countries. The objective of this study was to estimate the cost of neurosurgical procedures in a low-resource setting to better inform resource allocation and health sector planning. In this observational economic analysis, microcosting was used to estimate the direct and indirect costs of neurosurgical procedures at Mulago National Referral Hospital (Kampala, Uganda). During the study period, October 2014 to September 2015, 1440 charts were reviewed. Of these patients, 434 had surgery, whereas the other 1006 were treated nonsurgically. Thirteen types of procedures were performed at the hospital. The estimated mean cost of a neurosurgical procedure was $542.14 (standard deviation [SD], $253.62). The mean cost of different procedures ranged from $291 (SD, $101) for burr hole evacuations to $1,221 (SD, $473) for excision of brain tumors. For most surgeries, overhead costs represented the largest proportion of the total cost (29%-41%). This is the first study using primary data to determine the cost of neurosurgery in a low-resource setting. Operating theater capacity is likely the binding constraint on operative volume, and thus, investing in operating theaters should achieve a higher level of efficiency. Findings from this study could be used by stakeholders and policy makers for resource allocation and to perform economic analyses to establish the value of neurosurgery in achieving global health goals. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Diabetes and obesity prevention: changing the food environment in low-income settings.

    Science.gov (United States)

    Gittelsohn, Joel; Trude, Angela

    2017-01-01

    Innovative approaches are needed to impact obesity and other diet-related chronic diseases, including interventions at the environmental and policy levels. Such interventions are promising due to their wide reach. This article reports on 10 multilevel community trials that the present authors either led (n = 8) or played a substantial role in developing (n = 2) in low-income minority settings in the United States and other countries that test interventions to improve the food environment, support policy, and reduce the risk for developing obesity and other diet-related chronic diseases. All studies examined change from pre- to postintervention and included a comparison group. The results show the trials had consistent positive effects on consumer psychosocial factors, food purchasing, food preparation, and diet, and, in some instances, obesity. Recently, a multilevel, multicomponent intervention was implemented in the city of Baltimore that promises to impact obesity in children, and, potentially, diabetes and related chronic diseases among adults. Based on the results of these trials, this article offers a series of recommendations to contribute to the prevention of chronic disease in Mexico. Further work is needed to disseminate, expand, and sustain these initiatives at the city, state, and federal levels. © The Author(s) 2016. Published by Oxford University Press on behalf of the International Life Sciences Institute. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  9. Child feeding practices and household food insecurity among low-income mothers in Buenos Aires, Argentina.

    Science.gov (United States)

    Lindsay, Ana Cristina; Ferarro, Mabel; Franchello, Alejandra; Barrera, Raul de La; Machado, Marcia Maria Tavares; Pfeiffer, Martha Erin; Peterson, Karen Eileen

    2012-03-01

    This qualitative study of low-income mothers in Buenos Aires, Argentina, examines the influence of socio-economic conditions, organizational structures, family relationships, and food insecurity on child feeding practices and weight status. Thirty-eight mothers of preschool children living in urban Buenos Aires participated in four focus group discussions. The results indicated that many mothers were aware that obesity may be detrimental to the child's health, but most of them are unclear about the specific consequences. Maternal employment, family pressures, food insecurity and financial worries seem to influence child feeding practices. These findings have important implications for developing strategies for nutritional assistance that could benefit the health of children and provide opportunities for educational programs that are directed to nutritional awareness in Buenos Aires, Argentina. The right to eat regularly and properly is an obligation of the State and must be implemented taking into account the notion of food sovereignty and respecting the importance of preserving the culture and eating habits of a country and its diverse population groups.

  10. Incidence and determinants of hysterectomy in a low-income setting in Gujarat, India.

    Science.gov (United States)

    Desai, Sapna; Campbell, Oona Mr; Sinha, Tara; Mahal, Ajay; Cousens, Simon

    2017-02-01

    Hysterectomy is a leading reason for use of health insurance amongst low-income women in India, but there are limited population-level data available to inform policy. This paper reports on the findings of a mixed-methods study to estimate incidence and identify predictors of hysterectomy in a low-income setting in Gujarat, India. The estimated incidence of hysterectomy, 20.7/1000 woman- years (95% CI: 14.0, 30.8), was considerably higher than reported from other countries, at a relatively low mean age of 36 years. There was strong evidence that among women of reproductive age, those with lower income and at least two children underwent hysterectomy at higher rates. Nearly two-thirds of women undergoing hysterectomy utilized private hospitals, while the remainder used government or other non-profit facilities. Qualitative research suggested that weak sexual and reproductive health services, a widespread perception that the post-reproductive uterus is dispensable and lack of knowledge of side effects have resulted in the normalization of hysterectomy. Hysterectomy appears to be promoted as a first or second-line treatment for menstrual and gynaecological disorders that are actually amenable to less invasive procedures. Most women sought at least two medical opinions prior to hysterectomy, but both public and private providers lacked equipment, skills and motivation to offer alternatives. Profit and training benefits also appeared to play a role in some providers' behaviour. Although women with insecure employment underwent the procedure knowing the financial and physical implications of undergoing a major surgery, the future health and work security afforded by hysterectomy appeared to them to outweigh risks. Findings suggest that sterilization may be associated with an increased risk of hysterectomy, potentially through biological or attitudinal links. Health policy interventions require improved access to sexual and reproductive health services and health

  11. "I'm Happy with My Mommy": Low-Income Preschoolers' Causal Attributions for Emotions.

    Science.gov (United States)

    Curenton, Stephanie M.; Wilson, Melvin N.

    2003-01-01

    This study examined low-income African American and European American preschoolers' socioemotional causal attributions. Results indicate that younger preschoolers, particularly young African Americans, may need help articulating emotions. Adults can support children's emotional reasoning through scaffolding. (Author)

  12. Assisted Housing - Low Income Housing Tax Credit Properties - National Geospatial Data Asset (NGDA)

    Data.gov (United States)

    Department of Housing and Urban Development — The Low-Income Housing Tax Credit (LIHTC) is the primary Federal program for creating affordable housing in the United States. The LIHTC database, created by HUD and...

  13. The conceptual mismatch: transportation stressors and experiences for low-income adults.

    Science.gov (United States)

    2015-10-01

    Physical access to jobs has long been identified as a barrier to employment and earnings, with prior : research identifying the spatial mismatch between suburban entry-level jobs and low-income workers. : However, existing transportation resear...

  14. The Effects of Low Income Housing Tax Credit Developments on Neighborhoods.

    Science.gov (United States)

    Baum-Snow, Nathaniel; Marion, Justin

    2009-06-01

    This paper evaluates the impacts of new housing developments funded with the Low Income Housing Tax Credit (LIHTC), the largest federal project based housing program in the U.S., on the neighborhoods in which they are built. A discontinuity in the formula determining the magnitude of tax credits as a function of neighborhood characteristics generates pseudo-random assignment in the number of low income housing units built in similar sets of census tracts. Tracts where projects are awarded 30 percent higher tax credits receive approximately six more low income housing units on a base of seven units per tract. These additional new low income developments cause homeowner turnover to rise, raise property values in declining areas and reduce incomes in gentrifying areas in neighborhoods near the 30th percentile of the income distribution. LIHTC units significantly crowd out nearby new rental construction in gentrifying areas but do not displace new construction in stable or declining areas.

  15. Low-Income Housing Tax Credit (LIHTC) Qualified Census Tract (QCT)

    Data.gov (United States)

    Department of Housing and Urban Development — It allows to generate tables for Low-Income Housing Tax Credit (LIHTC) Qualified Census Tracts (QCT) and for Difficult Development Areas (DDA). LIHTC Qualified...

  16. Low-Income Demand for Local Telephone Service: Effects of Lifeline and Linkup

    OpenAIRE

    Daniel Ackerberg; Michael Riordan; Gregory Rosston; Bradley Wimmer

    2008-01-01

    A comprehensive data set on local telephone service prices is used to evaluate the effect of Lifeline and Linkup programs on the telephone penetration rates of low-income households in the United States. Lifeline and Linkup programs respectively subsidize the monthly subscription and initial installation charges of eligible low-income households. Telephone penetration rates are explained by an estimated nonlinear function of local service characteristics (including subsidized prices) and the ...

  17. Associations between family food behaviors, maternal depression, and child weight among low-income children

    OpenAIRE

    McCurdy, Karen; Gorman, Kathleen S.; Kisler, Tiffani; Metallinos-Katsaras, Metallinos-Katsaras

    2014-01-01

    Although low-income children are at greater risk for overweight and obesity than their higher income counterparts, the majority of poor children are not overweight. The current study examined why such variation exists among diverse young children in poor families. Cross-sectional data were collected on 164 low-income, preschool aged children and their mothers living in two Rhode Island cities. Over half of the sample was Hispanic (55%). Mothers completed measures of family food behaviors and ...

  18. Legislated changes to federal pension income in Canada will adversely affect low income seniors' health.

    Science.gov (United States)

    Emery, J C Herbert; Fleisch, Valerie C; McIntyre, Lynn

    2013-12-01

    This study uses a population health intervention modeling approach to project the impact of recent legislated increases in age eligibility for Canadian federally-funded pension benefits on low income seniors' health, using food insecurity as a health indicator. Food insecurity prevalence and income source were assessed for unattached low income (seniors aged 65-69 years (population weighted n=151,485) using public use data from the Canadian Community Health Survey Cycle 4.1 (2007-2008). Seniors' benefits through federal public pension plans constituted the main source of income for the majority (79.4%) of low income seniors aged 65-69 years, in contrast to low income seniors aged 60-64 years who reported their main income from employment, employment insurance, Workers' Compensation, or welfare. The increase in income provided by federal pension benefits for low income Canadians 65 and over coincided with a pronounced (50%) decrease in food insecurity prevalence (11.6% for seniors ≥65 years versus 22.8% for seniors seniors' benefits in Canada from 65 to 67 years will negatively impact low income seniors' health, relegating those who are food insecure to continued hardship. © 2013.

  19. Does a low-income urban population practise healthy dietary habits?

    Science.gov (United States)

    Azizan, Nurul Ain; Thangiah, Nithiah; Su, Tin Tin; Majid, Hazreen Abdul

    2018-03-01

    The purpose of this study was to identify the unhealthy dietary habits and practices in a low-income community in an urban area and determine the associated factors. A cross-sectional survey was conducted in a low-income housing area in Kuala Lumpur, Malaysia. Data were collected using a questionnaire via face-to-face interviews by trained enumerators in order to obtain details on sociodemographic characteristics and dietary practices. Descriptive statistics showed that 86.7% of the respondents in the low-income community consumed fruit and vegetables less than five times per day, 11.7% consumed carbonated and sweetened drinks more than twice per day and about 25% consumed fast food more than four times per month. In total, 65.2% (n=945) did not have healthy dietary practices. Binary logistic regression showed that age, education and ethnicity were significant predictors of unhealthy dietary practices among the low-income community. Those in the 30-59 years age group had higher odds (odds ratio 1.65, p=0.04) of practising an unhealthy diet as compared with those older than 60 years of age. Unhealthy dietary practices were found to be common among the low-income group living in an urban area. Healthy lifestyle intervention should be highlighted so that it can be adopted in the low-income group.

  20. Differences in perceptions and fast food eating behaviours between Indians living in high- and low-income neighbourhoods of Chandigarh, India.

    Science.gov (United States)

    Aloia, Christopher Robert; Gasevic, Danijela; Yusuf, Salim; Teo, Koon; Chockalingam, Arun; Patro, Binod Kumar; Kumar, Rajesh; Lear, Scott Alexander

    2013-01-07

    Increased density of fast food restaurants is associated with increased prevalence of obesity in developed countries. However, less is known about this relationship in developing countries undergoing rapid urbanization and how differences in neighbourhood income affect the patronage of fast food outlets. The purpose of the study is to explore the differences in fast food preferences, perceptions, and patronage between Indians living in high- and low-income neighbourhoods. This cross-sectional study recruited 204 men and women (35 to 65 years in age) from high- and low-income neighbourhoods who completed a questionnaire on fast food consumption. The questionnaire asked participants to define fast food and to provide reasons for and frequency of visits to fast food restaurants. The differences were analyzed using Chi square and t-tests for categorical and continuous variables, respectively. Participants from a high-income neighbourhood were more likely to perceive Western -style fast food as fast food, while people from the low-income neighbourhood were more likely to identify food sold by street vendors as fast food (p food from street vendors while less likely to dine out at both fast food and non-fast food restaurants (pfood restaurants than their low-income neighbourhood counterparts, there were no significant differences in the reasons for visiting fast food restaurants (convenience, price, social enjoyment, and quality of meals) between the two groups. Both groups preferred home cooked over restaurant meals, and they recognized that home cooked food was healthier. Overall, consumption of fast food was low. People from a high-income neighbourhood dined out more frequently and were more likely to perceive Western-style food as fast food compared to their counterparts from the low-income neighbourhood.

  1. Correlates of complete childhood vaccination in East African countries.

    Directory of Open Access Journals (Sweden)

    Maureen E Canavan

    Full Text Available BACKGROUND: Despite the benefits of childhood vaccinations, vaccination rates in low-income countries (LICs vary widely. Increasing coverage of vaccines to 90% in the poorest countries over the next 10 years has been estimated to prevent 426 million cases of illness and avert nearly 6.4 million childhood deaths worldwide. Consequently, we sought to provide a comprehensive examination of contemporary vaccination patterns in East Africa and to identify common and country-specific barriers to complete childhood vaccination. METHODS: Using data from the Demographic and Health Surveys (DHS for Burundi, Ethiopia, Kenya, Rwanda, Tanzania, and Uganda, we looked at the prevalence of complete vaccination for polio, measles, Bacillus Calmette-Guérin (BCG and DTwPHibHep (DTP as recommended by the WHO among children ages 12 to 23 months. We conducted multivariable logistic regression within each country to estimate associations between complete vaccination status and health care access and sociodemographic variables using backwards stepwise regression. RESULTS: Vaccination varied significantly by country. In all countries, the majority of children received at least one dose of a WHO recommended vaccine; however, in Ethiopia, Tanzania, and Uganda less than 50% of children received a complete schedule of recommended vaccines. Being delivered in a public or private institution compared with being delivered at home was associated with increased odds of complete vaccination status. Sociodemographic covariates were not consistently associated with complete vaccination status across countries. CONCLUSIONS: Although no consistent set of predictors accounted for complete vaccination status, we observed differences based on region and the location of delivery. These differences point to the need to examine the historical, political, and economic context of each country in order to maximize vaccination coverage. Vaccination against these childhood diseases is a

  2. Development of a brief instrument for assessing healthcare employee satisfaction in a low-income setting.

    Science.gov (United States)

    Alpern, Rachelle; Canavan, Maureen E; Thompson, Jennifer T; McNatt, Zahirah; Tatek, Dawit; Lindfield, Tessa; Bradley, Elizabeth H

    2013-01-01

    Ethiopia is one of 57 countries identified by the World Health Report 2006 as having a severely limited number of health care professionals. In recognition of this shortage, the Ethiopian Federal Ministry of Health, through the Ethiopian Hospital Management Initiative, prioritized the need to improve retention of health care workers. Accordingly, we sought to develop the Satisfaction of Employees in Health Care (SEHC) survey for use in hospitals and health centers throughout Ethiopia. Literature reviews and cognitive interviews were used to generate a staff satisfaction survey for use in the Ethiopian healthcare setting. We pretested the survey in each of the six hospitals and four health centers across Ethiopia (98% response rate). We assessed content validity and convergent validity using factor analysis and examined reliability using the Cronbach alpha coefficients to assess internal consistency. The final survey was comprised of 18 questions about specific aspects of an individual's work and two overall staff satisfaction questions. We found support for content validity, as data from the 18 responses factored into three factors, which we characterized as 1) relationship with management and supervisors, 2) job content, and 3) relationships with coworkers. Summary scores for two factors (relationship with management and supervisors and job content) were significantly associated (P-value, satisfaction items. Cronbach's alpha coefficients showed good to excellent internal consistency (Cronbach alpha coefficients >0.70) for the items in the three summary scores. The introduction of consistent and reliable measures of staff satisfaction is crucial to understand and improve employee retention rates, which threaten the successful achievement of the Millennium Development Goals in low-income countries. The use of the SEHC survey in Ethiopian healthcare facilities has ample leadership support, which is essential for addressing problems that reduce staff satisfaction and

  3. The Poverty Penalty in France: How the Market Makes Low-Income Populations Poorer

    Directory of Open Access Journals (Sweden)

    Frédéric Dalsace

    2012-06-01

    Full Text Available What has come to be known as the poverty penalty – the additional cost paid for goods and services by the poor relative to the more affluent – is a familiar mechanism in emerging countries. For profoundly different reasons, however, poor people in developed countries also suffer from the poverty penalty. Quite naturally, without any particular ill will on the part of the actors in the commercial sector, the market sometimes penalizes the poor by making them pay more than other households, per unit of consumption, for the same goods and services. Drawing on a study by the Boston Consulting Group conducted at the request of the action tank “Entreprises et Pauvreté”, this paper sets out to quantify a part of the poverty penalty. The economic impact is far from incidental, as it represents, at the very least, a “double jeopardy” of an extra 2.5% of the total budget for low-income households, or some €500 –more than a month’s worth of “discretionary” spending. The paper sheds light on the various underlying mechanisms that contribute to the creation of the poverty penalty. These “undesirable side-effects” of the market are of five types:• An unfavorable cost structure• An unfavorable price structure• The law of supply and demand• A lack of equipment or an unfavorable risk profile• Insufficient objectivity to deal with scarce, imperfect or missing information.The ultimate aim is to favor the development of compensation or annulment solutions through “positive discrimination” actions implemented by businesses; experiments currently under way offer some hope in the fight against the poverty penalty.

  4. Development of a brief instrument for assessing healthcare employee satisfaction in a low-income setting.

    Directory of Open Access Journals (Sweden)

    Rachelle Alpern

    Full Text Available Ethiopia is one of 57 countries identified by the World Health Report 2006 as having a severely limited number of health care professionals. In recognition of this shortage, the Ethiopian Federal Ministry of Health, through the Ethiopian Hospital Management Initiative, prioritized the need to improve retention of health care workers. Accordingly, we sought to develop the Satisfaction of Employees in Health Care (SEHC survey for use in hospitals and health centers throughout Ethiopia.Literature reviews and cognitive interviews were used to generate a staff satisfaction survey for use in the Ethiopian healthcare setting. We pretested the survey in each of the six hospitals and four health centers across Ethiopia (98% response rate. We assessed content validity and convergent validity using factor analysis and examined reliability using the Cronbach alpha coefficients to assess internal consistency. The final survey was comprised of 18 questions about specific aspects of an individual's work and two overall staff satisfaction questions.We found support for content validity, as data from the 18 responses factored into three factors, which we characterized as 1 relationship with management and supervisors, 2 job content, and 3 relationships with coworkers. Summary scores for two factors (relationship with management and supervisors and job content were significantly associated (P-value, 0.70 for the items in the three summary scores.The introduction of consistent and reliable measures of staff satisfaction is crucial to understand and improve employee retention rates, which threaten the successful achievement of the Millennium Development Goals in low-income countries. The use of the SEHC survey in Ethiopian healthcare facilities has ample leadership support, which is essential for addressing problems that reduce staff satisfaction and exacerbate excessive workforce shortages.

  5. Silicon Savanna? Local Competence Building and International Venture Capital in Low Income Countries

    DEFF Research Database (Denmark)

    Hain, Daniel; Jurowetzki, Roman

    2015-01-01

    , or business models which are potentially fit for international or even global markets. In this paper we investigate the pattern of current technology investments in Kenya – one of sub-Saharan Africa’s buzzing ICT centers. In many cases these financial investments are accompanied by intensive technical...

  6. Making Growth Work for Women in Low-income Countries (GrOW ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    This project is part of the Growth and Economic Opportunities for Women (GrOW) program. GrOW is a five-year, multi-funder partnership with the UK's Department for International Development (DFID), The William ... In addition to 10 projects addressing the barriers to women's economic ... Careers · Contact Us · Site map.

  7. Communicating with Low-Income and Low Education Farmers in a Developing Country.

    Science.gov (United States)

    Fett, John H.

    Selected findings from a number of communication research projects conducted by, or in collaboration with, the Economic Studies and Research Institute (IEPE), Federal University of Rio Grande do Sul, Brazil, are reported. Communication research in IEPE during the past 4 years has concentrated on mass media performance and use, because extension…

  8. Symptom Endorsement and Sociodemographic Correlates of Postnatal Distress in Three Low Income Countries

    Directory of Open Access Journals (Sweden)

    Amanda J. Nguyen

    2016-01-01

    Full Text Available Background. Maternal mental illness has been implicated in adverse child development outcomes. Factors such as context and culture may influence experiences of maternal distress and explain differences in outcomes across settings. Methods. We analyzed baseline data from 5,647 mothers in Ethiopia, India (Andhra Pradesh, and Vietnam participating in an ongoing cohort study (Young Lives to compare symptom endorsement and sociodemographic correlates of distress. Maternal distress was assessed using the Self-Reporting Questionnaire-20 Items (cutoff: ≥8. Logistic regressions were stratified by sample to identify correlates of distress. Results. Symptom endorsement was similar among distressed women, particularly with regard to feeling unhappy (76%, 80%, and 79%. Notable differences were observed in three items assessing Depressive Thoughts, which were most highly endorsed in Ethiopia (49%–56%. Having a child experiencing a life-threatening event was correlated with distress in all three samples. A variety of correlates were unique to only one sample. Conclusions. There were multiple similarities but also notable differences across sites in the expression and correlates of maternal distress. Feeling unhappy appears to be a hallmark feature of distress. Correlates highlight the relationship between distress and indicators of poverty, child wellbeing, and economic shocks. Differences demonstrate the value of further exploration of cross-cultural differences.

  9. The operational setup of intensive care units in a low income country ...

    African Journals Online (AJOL)

    East African Medical Journal. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 92, No 2 (2015) >. Log in or Register to get access to full text downloads.

  10. Acute bacterial infections of the lower respiratory tract in children from low-income countries

    NARCIS (Netherlands)

    Fleer, A; Wolf, B.H.M.

    Acute bacterial infection of the lower respiratory tract is a major cause of morbidity and mortality in children and is responsible for 4 million childhood deaths each year. Most of these deaths are caused by pneumonia and occur in the youngest children in the poorest parts of the world. Severe

  11. Local Competence Building and International Venture Capital in Low Income Countries

    DEFF Research Database (Denmark)

    Hain, Daniel; Jurowetzki, Roman

    2017-01-01

    Purpose: In this paper, we explore the new phenomenon of international high-tech investments into entrepreneurial ventures at the case of Kenya. Classifying investors and start-ups, and mapping the interaction structure between them, we aim at identifying investment patterns that can contribute...

  12. Adoption of Falsified Medical Products in a Low-Income Country : Empirical Evidence for Suriname

    NARCIS (Netherlands)

    Ph.H.B.F. Franses (Philip Hans); M.M. Lede (Madesta)

    2017-01-01

    markdownabstractBased on detailed shipping figures for Suriname’s main harbour in Paramaribo, we estimate the total shipments (in kilograms) of original and falsified medical products for 1996–2008 across five product categories. Using various time series techniques and diffusion models, we document

  13. Air Quality, Energy Budget, and Offset Policy in South Africa's Low-Income Settlements

    Science.gov (United States)

    Hersey, S. P.; Piketh, S.; Burger, R.

    2014-12-01

    Urban and exurban residential populations in South Africa reside primarily in low-income settlements, including many townships remaining from Apartheid. Over 3 million free government homes have been built in the last 20 years, but the number of people living in informal settlements is the same as at the end of Apartheid in 1994 - a consequence of rapid urbanization. Despite availability of electricity to the vast majority of South Africans, ~80% of electrified homes in low-income areas also burn coal and/or wood as supplementary fuels for cooking and heating. These domestic burning activities represent 70-85% of total PM10mass during winter in South Africa's low-income settlements. Here we analyze data from observations of human-atmosphere systems in: 1) 19 ground monitoring sites in Gauteng Province (Johannesburg and Pretoria), and 2) an intensive sampling campaign in a township in Mpumalanga Province (Industrial Highveld). From ground monitoring, we quantitatively describe seasonal and diurnal trends in PM10 and PM2.5 typical in low-income settlements as compared with industrial and developed suburban areas, and demonstrate the impact of low-income settlements on regional air quality. We also explore the implications of economic development in townships (increased household income, expanded commercialization and widespread electricity usage) on local and regional air quality. Data from the intensive township sampling study provides a seasonal energy budget for domestic burning in low-income settlements and suggests that indoor and ambient air quality are independent systems requiring unique interventions. We conclude with a preview of innovative strategies being developed by industry, government, and academic stakeholders for a not-like-for-like emissions offset policy in South Africa, focused on investments directly into low-income settlements that are aimed at reducing PM exposure.

  14. Effects of simplifying outreach materials for energy conservation programs that target low-income consumers

    International Nuclear Information System (INIS)

    Wong-Parodi, Gabrielle; Bruine de Bruin, Wändi; Canfield, Casey

    2013-01-01

    Critics have speculated that the limited success of energy conservation programs among low-income consumers may partly be due to recipients having insufficient literacy to understand the outreach materials. Indeed, we found outreach materials for low-income consumers to require relatively high levels of reading comprehension. We therefore improved the Flesch–Kincaid readability statistics for two outreach brochures, by using shorter words and shorter sentences to describe their content. We examined the effect of that simplification on low-income consumers′ responses. Participants from low-income communities in the greater Pittsburgh area, who varied in literacy, were randomly assigned to either original communications about energy conservation programs or our simplified versions. Our findings suggest that lowering readability statistics successfully simplified only the more straightforward brochure in our set of two, likely because its content lent itself better to simplification. Findings for this brochure showed that simplification improved understanding of its content among both low-literacy and high-literacy recipients, without adversely affecting their evaluation of the materials, or their intention to enroll in the advertised programs. We discuss strategies for improving communication materials that aim to reach out to low-income populations. - Highlights: • Brochures about energy programs for low-income consumers can be too hard to read. • We made brochures easier to read by using shorter words and shorter sentences. • Simplifying a straightforward brochure improved the understanding of all recipients. • However, simplifying a complex brochure had no effect on understanding. • We suggest strategies for improving outreach to low-income consumers

  15. 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.

  16. Correlates of protection against human rotavirus disease and the factors influencing protection in low-income settings.

    Science.gov (United States)

    Clarke, E; Desselberger, U

    2015-01-01

    Rotaviruses (RV) are the leading cause of gastroenteritis in infants and children worldwide and are associated with high mortality predominately in low-income settings. The virus is classified into G and P serotypes and further into P genotypes based on differences in the surface-exposed proteins VP7 and VP4, respectively. Infection results in a variable level of protection from subsequent reinfection and disease. This protection is predominantly homotypic in some settings, whereas broader heterotypic protection is reported in other cohorts. Two antigenically distinct oral RV vaccines are licensed and are being rolled out widely, including in resource-poor setting, with funding provided by the GAVI alliance. First is a monovalent vaccine derived from a live-attenuated human RV strain, whereas the second is a pentavalent bovine-human reassortment vaccine. Both vaccines are highly efficacious in high-income settings, but greatly reduced levels of protection are reported in low-income countries. Here, the current challenges facing mucosal immunologists and vaccinologists aiming to define immunological correlates and to understand the variable levels of protection conferred by these vaccines in humans is considered. Such understanding is critical to maximize the public health impact of the current vaccines and also to the development of the next generation of RV vaccines, which are needed.

  17. Association of Household Food Insecurity with the Mental and Physical Health of Low-Income Urban Ecuadorian Women with Children

    Directory of Open Access Journals (Sweden)

    M. Margaret Weigel

    2016-01-01

    Full Text Available Chronic physical and mental health conditions account for a rising proportion of morbidity, mortality, and disability in the Americas region. Household food insecurity (HFI has been linked to chronic disease in US and Canadian women but it is uncertain if the same is true for low- and middle-income Latin American countries in epidemiologic transition. We conducted a survey to investigate the association of HFI with the physical and mental health of 794 women with children living in low-income Quito, Ecuador, neighborhoods. Data were collected on HFI and health indicators including self-reported health (SF-1, mental health (MHI-5, blood pressure, and self-reported mental and physical health complaints. Fasting blood glucose and lipids were measured in a subsample. The multivariate analyses revealed that HFI was associated with poorer self-rated health, low MHI-5 scores, and mental health complaints including stress, depression, and ethnospecific illnesses. It was also associated with chest tightness/discomfort/pain, dental disease, and gastrointestinal illness but not other conditions. The findings suggest that improving food security in low-income households may help reduce the burden of mental distress in women with children. The hypothesized link with diabetes and hypertension may become more apparent as Ecuador moves further along in the epidemiologic transition.

  18. Population density, distance to public transportation, and health of women in low-income neighborhoods.

    Science.gov (United States)

    DeGuzman, Pamela B; Merwin, Elizabeth I; Bourguignon, Cheryl

    2013-01-01

    The purpose of this research was to determine the impact of two neighborhood walkability (the extent to which the built environment is pedestrian friendly) metrics on health outcomes of women living in low-income urban neighborhoods, both before and after accounting for individual and neighborhood factors. A cross-sectional, retrospective design was used. The sample of 1800 low-income women was drawn from Welfare, Children and Families: A Three-City Study (a study of low-income women from three U.S. cities). Using multilevel modeling and geographic information systems, the study sought to determine the effect of distance to public transportation and residential density on health status, mental health symptoms, and health-related limitations. No significant relationship was found between the two walkability metrics and health outcomes. Instead, neighborhood problems that affect crime and safety impacted health status and mental health symptoms. As cities make changes to the built environment with the hope of affecting residents' health outcomes, public health nurses need to be aware that changing walkability characteristics in a neighborhood may not affect the health of residents of high crime, low-income neighborhoods. Without first addressing neighborhood crime, efforts to improve walkability in low-income neighborhoods may fail. © 2013 Wiley Periodicals, Inc.

  19. An optimization algorithm for simulation-based planning of low-income housing projects

    Directory of Open Access Journals (Sweden)

    Mohamed M. Marzouk

    2010-10-01

    Full Text Available Construction of low-income housing projects is a replicated process and is associated with uncertainties that arise from the unavailability of resources. Government agencies and/or contractors have to select a construction system that meets low-income housing projects constraints including project conditions, technical, financial and time constraints. This research presents a framework, using computer simulation, which aids government authorities and contractors in the planning of low-income housing projects. The proposed framework estimates the time and cost required for the construction of low-income housing using pre-cast hollow core with hollow blocks bearing walls. Five main components constitute the proposed framework: a network builder module, a construction alternative selection module, a simulation module, an optimization module and a reporting module. An optimization module utilizing a genetic algorithm enables the defining of different options and ranges of parameters associated with low-income housing projects that influence the duration and total cost of the pre-cast hollow core with hollow blocks bearing walls method. A computer prototype, named LIHouse_Sim, was developed in MS Visual Basic 6.0 as proof of concept for the proposed framework. A numerical example is presented to demonstrate the use of the developed framework and to illustrate its essential features.

  20. How Medicaid Expansion Affected Out-of-Pocket Health Care Spending for Low-Income Families.

    Science.gov (United States)

    Glied, Sherry; Chakraborty, Ougni; Russo, Therese

    2017-08-01

    ISSUE. Prior research shows that low-income residents of states that expanded Medicaid under the Affordable Care Act are less likely to experience financial barriers to health care access, but the impact on out-of-pocket spending has not yet been measured. GOAL. Assess how the Medicaid expansion affected out-of-pocket health care spending for low-income families compared to those in states that did not expand and consider whether effects differed in states that expanded under conventional Medicaid rules vs. waiver programs. METHODS. Analysis of the Consumer Expenditure Survey 2010–2015. KEY FINDINGS AND CONCLUSIONS. Compared to families in nonexpansion states, low-income families in states that did expand Medicaid saved an average of $382 in annual spending on health care. In these states, low-income families were less like to report any out-of-pocket spending on insurance premiums or medical care than were similar families in nonexpansion states. For families that did have some out-of-pocket spending, spending levels were lower in states that expanded Medicaid. Low-income families in Medicaid expansion states were also much less likely to have catastrophically high spending levels. The form of coverage expansion — conventional Medicaid or waiver rules — did not have a statistically significant effect on these outcomes.

  1. How children with special health care needs affect the employment decisions of low-income parents.

    Science.gov (United States)

    Loprest, Pamela; Davidoff, Amy

    2004-09-01

    To better understand the impact of having a child with special health care needs (CSHCN), on low-income parents' employment decisions. Using data from the 1999 and 2000 National Health Interview Survey (NHIS), we estimate multivariate statistical regressions (logit and tobit models) to estimate the relationship between having a CSHCN and the likelihood of employment and hours of employment for a sample-of low-income single parents. Controlling for differences in demographic and family characteristics, we find no significant association between having a CSHCN and the probability of work or the number of hours worked among low-income single-parent families. Separate analysis of different dimensions of special health care needs shows that parents of children with activity limitations are significantly less likely to work and work fewer hours. This result does not hold true for the group of children defined based on elevated or special service use, or for the group of children with specific chronic conditions. These results indicate that only a specific subset of children with special needs present difficulties for low-income parents' work. This suggests that policies to help low-income single parents of children with disabilities move into work should target this specific subset of children with special health care needs.

  2. Food Stress in Adelaide: The Relationship between Low Income and the Affordability of Healthy Food

    Directory of Open Access Journals (Sweden)

    Paul R. Ward

    2013-01-01

    Full Text Available Healthy food is becoming increasingly expensive, and families on low incomes face a difficult financial struggle to afford healthy food. When food costs are considered, families on low incomes often face circumstances of poverty. Housing, utilities, health care, and transport are somewhat fixed in cost; however food is more flexible in cost and therefore is often compromised with less healthy, cheaper food, presenting an opportunity for families on low incomes to cut costs. Using a “Healthy Food Basket” methodology, this study costed a week’s supply of healthy food for a range of family types. It found that low-income families would have to spend approximately 30% of household income on eating healthily, whereas high-income households needed to spend about 10%. The differential is explained by the cost of the food basket relative to household income (i.e., affordability. It is argued that families that spend more than 30% of household income on food could be experiencing “food stress.” Moreover the high cost of healthy foods leaves low-income households vulnerable to diet-related health problems because they often have to rely on cheaper foods which are high in fat, sugar, and salt.

  3. Perceptions of New Zealand nutrition labels by Māori, Pacific and low-income shoppers.

    Science.gov (United States)

    Signal, Louise; Lanumata, Tolotea; Robinson, Jo-Ani; Tavila, Aliitasi; Wilton, Jenny; Ni Mhurchu, Cliona

    2008-07-01

    In New Zealand the burden of nutrition-related disease is greatest among Māori, Pacific and low-income peoples. Nutrition labels have the potential to promote healthy food choices and eating behaviours. To date, there has been a noticeable lack of research among indigenous peoples, ethnic minorities and low-income populations regarding their perceptions, use and understanding of nutrition labels. Our aim was to evaluate perceptions of New Zealand nutrition labels by Māori, Pacific and low-income peoples and to explore improvements or alternatives to current labelling systems. Māori, Samoan and Tongan researchers recruited participants who were regular food shoppers. Six focus groups were conducted which involved 158 people in total: one Māori group, one Samoan, one Tongan, and three low-income groups. Māori, Pacific and low-income New Zealanders rarely use nutrition labels to assist them with their food purchases for a number of reasons, including lack of time to read labels, lack of understanding, shopping habits and relative absence of simple nutrition labels on the low-cost foods they purchase. Current New Zealand nutrition labels are not meeting the needs of those who need them most. Possible improvements include targeted social marketing and education campaigns, increasing the number of low-cost foods with voluntary nutrition labels, a reduction in the price of 'healthy' food, and consideration of an alternative mandatory nutrition labelling system that uses simple imagery like traffic lights.

  4. Opportunities for Prevention: Assessing Where Low-Income Patients Seek Care for Preventable Coronary Artery Disease.

    Science.gov (United States)

    Klaiman, Tamar A; Valdmanis, Vivian G; Bernet, Patrick; Moises, James

    2015-10-01

    The Affordable Care Act has many aspects that are aimed at improving health care for all Americans, including mandated insurance coverage for individuals, as well as required community health needs assessments (CHNAs), and reporting of investments in community benefit by nonprofit hospitals in order to maintain tax exemptions. Although millions of Americans have gained access to health insurance, many--often the most vulnerable--remain uninsured, and will continue to depend on hospital community benefits for care. Understanding where patients go for care can assist hospitals and communities to develop their CHNA and implementation plans in order to focus resources where the need for prevention is greatest. This study evaluated patient care-seeking behavior among patients with coronary artery disease (CAD) in Florida in 2008--analyzed in 2013--to assess whether low-income patients accessed specific safety net hospitals for treatment or received care from hospitals that were geographically closer to their residence. This study found evidence that low-income patients went to hospitals that treated more low-income patients, regardless of where they lived. The findings demonstrate that hospitals-especially public safety net hospitals with a tradition of treating low-income patients suffering from CAD-should focus prevention activities where low-income patients reside.

  5. Wanting better: a qualitative study of low-income parents about their children's oral health.

    Science.gov (United States)

    Lewis, Charlotte W; Linsenmayer, Kristi A; Williams, Alexis

    2010-01-01

    Using qualitative methods, the purpose of this study was to understand low-income parents' experiences and how these influenced their oral health-related behavior toward their children. Twenty-eight parents were recruited from 7 sites that serve low-income families. Interviews, which were audiotaped and transcribed, were comprised of mostly open-ended questions. Transcripts were analyzed for common themes. Parents' experiences influenced their oral health-related beliefs, intentions, and behaviors. Finding dentists who accept Medicaid was the greatest barrier to realizing intended preventive dental care. Physicians appeared to have relatively little impact on these families' oral health care, even though parents believed that oral health is part of overall health care. WIC (the Supplemental Nutrition Program for Women, Infants and Children) played an important role in facilitating oral health knowledge and access to dental care. Most low-income parents had received little attention to their own oral health, yet wanted better for their children. This motivated the high value placed on their children's preventive oral health. Parents faced challenges finding dental care for their children. Difficulty finding a regular source of dental care for low-income adults, however, was nearly universal. The authors identified strategies, which emerged from their interviews, to improve the oral health knowledge and dental care access for these low-income families.

  6. Food stress in Adelaide: the relationship between low income and the affordability of healthy food.

    Science.gov (United States)

    Ward, Paul R; Verity, Fiona; Carter, Patricia; Tsourtos, George; Coveney, John; Wong, Kwan Chui

    2013-01-01

    Healthy food is becoming increasingly expensive, and families on low incomes face a difficult financial struggle to afford healthy food. When food costs are considered, families on low incomes often face circumstances of poverty. Housing, utilities, health care, and transport are somewhat fixed in cost; however food is more flexible in cost and therefore is often compromised with less healthy, cheaper food, presenting an opportunity for families on low incomes to cut costs. Using a "Healthy Food Basket" methodology, this study costed a week's supply of healthy food for a range of family types. It found that low-income families would have to spend approximately 30% of household income on eating healthily, whereas high-income households needed to spend about 10%. The differential is explained by the cost of the food basket relative to household income (i.e., affordability). It is argued that families that spend more than 30% of household income on food could be experiencing "food stress." Moreover the high cost of healthy foods leaves low-income households vulnerable to diet-related health problems because they often have to rely on cheaper foods which are high in fat, sugar, and salt.

  7. Cigarette smoking and food insecurity among low-income families in the United States, 2001.

    Science.gov (United States)

    Armour, Brian S; Pitts, M Melinda; Lee, Chung-Won

    2008-01-01

    To quantify the association between food insecurity and smoking among low-income families. A retrospective study using data from the 2001 Panel Study of Income Dynamics (PSID), a longitudinal study of a representative sample of U.S. men, women, and children and the family units in which they reside. Low-income families. Family income was linked with U.S. poverty thresholds to identify 2099 families living near or below 200% of the federal poverty level. Food insecurity (i.e., having insufficient funds to purchase enough food to maintain an active and healthy lifestyle) was calculated from the 18-core-item food security module of the U.S. Department of Agriculture. Current smoking status was determined. Smoking prevalence was higher among low-income families who were food insecure compared with low-income families who were food secure (43.6% vs. 31.9%; p < .01). Multivariate analysis revealed that smoking was associated with an increase in food insecurity of approximately six percentage points (p < .01). Given our finding that families near the federal poverty level spend a large share of their income on cigarettes, perhaps it would be prudent for food-assistance and tobacco-control programs to work together to help low-income people quit smoking.

  8. Conceptual design studies for the liquid metal target META:LIC

    International Nuclear Information System (INIS)

    Class, A.G.; Fazio, C.; Fetzer, J.R.; Gordeev, S.

    2014-01-01

    When the construction of ESS (European Spallation Source) in Sweden was initiated, the target station concept selection group decided to reevaluate a variety of target designs to respect new developments in their selection process. The META:LIC (MEgawatt TArget:Lead bIsmuth Cooled) target concept was developed following an extensive analysis of existing and new proposed designs and reached the level of proof of principle within only 2 years. ESS selected META:LIC as comparative target option for licensing purposes during the design update phase of ESS. The present work describes the design motivation of META:LIC referring to properties and design features of other targets. Therefore, META:LIC design is an evolutionary target which incorporates the extensive experience of liquid metal targets. The modular LBE (Lead Bismuth Eutectic) target concept with focus on the target module is introduced. Both, a window target option for the start of operation and a windowless option with extended lifetime are foreseen. Thermohydraulic simulations show that adequate window cooling can be realized. The stability of the free surface in the windowless option has been shown. Robust target module instrumentation based on free surface levels and the MEGAPIE experience is proposed for target control. Since the META:LIC concept foresees a horizontal extraction for both moderators and target from the monolith a safety concept based on the SNS and JSNS experience is proposed

  9. Early Math Trajectories: Low-Income Children's Mathematics Knowledge From Ages 4 to 11.

    Science.gov (United States)

    Rittle-Johnson, Bethany; Fyfe, Emily R; Hofer, Kerry G; Farran, Dale C

    2017-09-01

    Early mathematics knowledge is a strong predictor of later academic achievement, but children from low-income families enter school with weak mathematics knowledge. An early math trajectories model is proposed and evaluated within a longitudinal study of 517 low-income American children from ages 4 to 11. This model includes a broad range of math topics, as well as potential pathways from preschool to middle grades mathematics achievement. In preschool, nonsymbolic quantity, counting, and patterning knowledge predicted fifth-grade mathematics achievement. By the end of first grade, symbolic mapping, calculation, and patterning knowledge were the important predictors. Furthermore, the first-grade predictors mediated the relation between preschool math knowledge and fifth-grade mathematics achievement. Findings support the early math trajectories model among low-income children. © 2016 The Authors. Child Development © 2016 Society for Research in Child Development, Inc.

  10. Social Policy Trends- Housing Affordability for Families with Low Incomes Across Canada

    Directory of Open Access Journals (Sweden)

    Margarita (Gres Wilkins

    2017-06-01

    Full Text Available HOUSING AFFORDABILITY FOR FAMILIES WITH LOW INCOMES ACROSS CANADA Percentage of income devoted to paying lowest-priced rent in a city, by low-income family type, select years, 1990-2015 Much public attention has been directed towards the issue of a Canada-wide housing crisis. The focus has typically been on the cost of housing for an average income Canadian family. Less attention has been paid to families with incomes much lower than those of the average Canadian household, for which the housing crisis is far more severe. Households and individuals with particularly low incomes are at the highest risk of experiencing the worst effects of a lack of housing affordability, including homelessness.

  11. The Role of Educational Aspirations and Expectations in the Discontinuity of Intergenerational Low-Income Status

    Science.gov (United States)

    Lee, Jungeun Olivia; Hill,, Karl G.; Hawkins, J. David

    2012-01-01

    This study investigated one potential mechanism mediating continuity and discontinuity in low-income status across generations: children's educational aspirations and expectations. Data were drawn from a community sample of 808 participants who were followed from age 10 to 30. Four trajectory groups of children's educational aspirations and expectations were identified from ages 10 to 18 (grades five through 12): “stable-high” group, “stable-low” group, “increaser” group, and “decreaser” group. Among participants from low-income families, those in the stable-high group and the increaser group were equally likely to graduate from high school. High school graduation was positively associated with level of total household income at age 30. Findings suggest that social work efforts that support the development of high educational aspirations and expectations in children might serve to reduce the intergenerational continuity of low-income status. PMID:24385713

  12. Economics, Marketing and Low Income Individuals: interest after a history of indifference

    Directory of Open Access Journals (Sweden)

    Marcus Wilcox Hemais

    2014-08-01

    Full Text Available During the early years of marketing, researchers used theories and concepts from economics as base for the development of their own theories and concepts. This similarity can be seen in the way marketing viewed the low income individual and his relationship with consumption, in the first studies of the subject. Like the economists, researchers in marketing described these individuals as dependents of society and governments to better their lives. This view changes when Prahalad defends a new perspective, through which individuals in this context are seen as consumers, with desires to consume products of diverse nature. The objective of this article, therefore, is to analyze the paths trailed by economics and two moments in marketing about the low income individual. Initially, the view economics has on low income individuals is discussed, so that, afterwards, two perspectives of marketing about this segment can be presented.

  13. Access to and use of paid sick leave among low-income families with children.

    Science.gov (United States)

    Clemans-Cope, Lisa; Perry, Cynthia D; Kenney, Genevieve M; Pelletier, Jennifer E; Pantell, Matthew S

    2008-08-01

    The ability of employed parents to meet the health needs of their children may depend on their access to sick leave, especially for low-income workers, who may be afforded less flexibility in their work schedules to accommodate these needs yet also more likely to have children in poor health. Our goal was to provide rates of access to paid sick leave and paid vacation leave among low-income families with children and to assess whether access to these benefits is associated with parents' leave taking to care for themselves or others. We used a sample of low-income families (paid leave and characteristics of children, families, and parents' employer. Access to paid leave was lower among children in low-income families than among those in families with higher income. Within low-income families, children without >or=1 full-time worker in the household were especially likely to lack access to this benefit, as were children whose parents work for small employers. Among children whose parents had access to paid sick leave, parents were more likely to take time away from work to care for themselves or others. This relationship is even more pronounced among families with the highest need, such as children in fair or poor health and children with all parents in full-time employment. Legislation mandating paid sick leave could dramatically increase access to this benefit among low-income families. It would likely diminish gaps in parents' leave taking to care for others between families with and without the benefit. However, until the health-related consequences are better understood, the full impact of such legislation remains unknown.

  14. Developing Community-Based Rehabilitation Programs for Musculoskeletal Diseases in Low-Income Areas of Mexico: The Community-Based Rehabilitation for Low-Income Communities Living With Rheumatic Diseases (CONCORD) Protocol

    Science.gov (United States)

    2014-01-01

    Background The negative impact of musculoskeletal diseases on the physical function and quality of life of people living in developing countries is considerable. This disabling effect is even more marked in low-socioeconomic communities within developing countries. In Mexico, there is a need to create community-based rehabilitation programs for people living with musculoskeletal diseases in low-socioeconomic areas. These programs should be directed to prevent and decrease disability, accommodating the specific local culture of communities. Objective The objective of this paper is to describe a research protocol designed to develop, implement, and evaluate culturally sensitive community-based rehabilitation programs aiming to decrease disability of people living with musculoskeletal diseases in two low-income Mexican communities. Methods A community-based participatory research approach is proposed, including multi and transdisciplinary efforts among the community, medical anthropology, and the health sciences. The project is structured in 4 main stages: (1) situation analysis, (2) program development, (3) program implementation, and (4) program evaluation. Each stage includes the use of quantitative and qualitative methods (mixed method program). Results So far, we obtained resources from a Mexican federal agency and completed stage one of the project at Chankom, Yucatán. We are currently receiving funding from an international agency to complete stage two at this same location. We expect that the project at Chankom will be concluded by December of 2017. On the other hand, we just started the execution of stage one at Nuevo León with funding from a Mexican federal agency. We expect to conclude the project at this site by September of 2018. Conclusions Using a community-based participatory research approach and a mixed method program could result in the creation of culturally sensitive community-based rehabilitation programs that promote community development and

  15. Approaches to Electric Utility Energy Efficiency for Low Income Customers in a Changing Regulatory Environment

    Energy Technology Data Exchange (ETDEWEB)

    Brockway, N.

    2001-05-21

    As the electric industry goes through a transformation to a more market-driven model, traditional grounds for utility energy efficiency have come under fire, undermining the existing mechanisms to fund and deliver such services. The challenge, then, is to understand why the electric industry should sustain investments in helping low-income Americans use electricity efficiently, how such investments should be made, and how these policies can become part of the new electric industry structure. This report analyzes the opportunities and barriers to leveraging electric utility energy efficiency assistance to low-income customers during the transition of the electric industry to greater competition.

  16. "Broken windows": Relationship between neighborhood conditions and behavioral health among low-income African American adolescents.

    Science.gov (United States)

    Voisin, Dexter R; Kim, Dong Ha

    2018-03-01

    This study explored the association between neighborhood conditions and behavioral health among African American youth. Cross-sectional data were collected from 683 African American youth from low-income communities. Measures for demographics, neighborhood conditions (i.e. broken windows index), mental health, delinquency, substance use, and sexual risk behaviors were assessed. Major findings indicated that participants who reported poorer neighborhood conditions compared to those who lived in better living conditions were more likely to report higher rates of mental health problems, delinquency, substance use, and unsafe sexual behaviors. Environmental factors need to be considered when addressing the behavioral health of low-income African American youth.

  17. Recycling attitudes and behavior among a clinic-based sample of low-income Hispanic women in southeast Texas.

    Science.gov (United States)

    Pearson, Heidi C; Dawson, Lauren N; Radecki Breitkopf, Carmen

    2012-01-01

    We examined attitudes and behavior surrounding voluntary recycling in a population of low-income Hispanic women. Participants (N = 1,512) 18-55 years of age completed a self-report survey and responded to questions regarding household recycling behavior, recycling knowledge, recycling beliefs, potential barriers to recycling (transportation mode, time), acculturation, demographic characteristics (age, income, employment, marital status, education, number of children, birth country), and social desirability. Forty-six percent of participants (n = 810) indicated that they or someone else in their household recycled. In a logistic regression model controlling for social desirability, recycling behavior was related to increased age (Precycle (Precycling saves landfill space (Precycling takes too much time (Precycling knowledge and recycling behavior (Precycling behavior among Hispanic women and highlight the need for educational outreach and intervention strategies to increase recycling behavior within this understudied population.

  18. Recycling Attitudes and Behavior among a Clinic-Based Sample of Low-Income Hispanic Women in Southeast Texas

    Science.gov (United States)

    Pearson, Heidi C.; Dawson, Lauren N.; Radecki Breitkopf, Carmen

    2012-01-01

    We examined attitudes and behavior surrounding voluntary recycling in a population of low-income Hispanic women. Participants (N = 1,512) 18–55 years of age completed a self-report survey and responded to questions regarding household recycling behavior, recycling knowledge, recycling beliefs, potential barriers to recycling (transportation mode, time), acculturation, demographic characteristics (age, income, employment, marital status, education, number of children, birth country), and social desirability. Forty-six percent of participants (n = 810) indicated that they or someone else in their household recycled. In a logistic regression model controlling for social desirability, recycling behavior was related to increased age (Precycle (Precycling saves landfill space (Precycling takes too much time (Precycling knowledge and recycling behavior (Precycling behavior among Hispanic women and highlight the need for educational outreach and intervention strategies to increase recycling behavior within this understudied population. PMID:22493693

  19. Predictive mutagenesis of ligation-independent cloning (LIC) vectors for protein expression and site-specific chemical conjugation

    DEFF Research Database (Denmark)

    Vernet, Erik; Sauer, Jørgen; Andersen, Peter Andreas

    2011-01-01

    Ligation-independent cloning (LIC) allows for cloning of DNA constructs independent of insert restriction sites and ligases. However, any required mutations are typically introduced by additional, time-consuming steps. We present a rapid, inexpensive method for mutagenesis in the 5' LIC site...

  20. Healthy Mothers, Healthy Babies: A Compendium of Program Ideas for Serving Low-Income Women.

    Science.gov (United States)

    Healthy Mothers, Healthy Babies Coalition, Washington, DC.

    The Healthy Mothers, Healthy Babies survey conducted in spring 1985 drew responses from over 1,500 programs active in maternal and child health efforts directed toward low-income women and their families. The executive summary of this report identifies the major goals, common strategies, and needs of program respondents. Chapter 1 summarizes a…

  1. A Mixed Methods Study on Developing Low-Income Kindergarten Students' Intrinsic Reading Motivation

    Science.gov (United States)

    Brady, Kara J.

    2017-01-01

    The purpose of this mixed methods study was to determine how the effects of kindergarten teachers' evidence-based literacy instructional practices impact the development of low-income kindergarten students' intrinsic reading motivation. The research questions are: (a) What are kindergarten teachers' perceptions of students' intrinsic reading…

  2. Discrepancies in Parent and Teacher Ratings of Low-Income Preschooler's Social Skills

    Science.gov (United States)

    Heyman, Miriam; Poulakos, Anthoula; Upshur, Carole; Wenz-Gross, Melodie

    2016-01-01

    Parent-teacher rating discrepancies in rating of children's social skills were examined in a low-income, ethnically diverse preschool sample, using the Social Skills Improvement System-Rating Scales [Gresham, F. J. & Elliott, S. N. (2008). "Social Skills Improvement System-Rating Scales." Minneapolis, MN: Pearson Assessments].…

  3. Understanding Barriers and Solutions Affecting Preschool Attendance in Low-Income Families

    Science.gov (United States)

    Susman-Stillman, Amy; Englund, Michelle M.; Storm, Karen J.; Bailey, Ann E.

    2018-01-01

    Preschool attendance problems negatively impact children's school readiness skills and future school attendance. Parents are critical to preschoolers' attendance. This study explored parental barriers and solutions to preschool attendance in low-income families. School-district administrative data from a racially/ethnically diverse sample of…

  4. Playing Linear Numerical Board Games Promotes Low-Income Children's Numerical Development

    Science.gov (United States)

    Siegler, Robert S.; Ramani, Geetha B.

    2008-01-01

    The numerical knowledge of children from low-income backgrounds trails behind that of peers from middle-income backgrounds even before the children enter school. This gap may reflect differing prior experience with informal numerical activities, such as numerical board games. Experiment 1 indicated that the numerical magnitude knowledge of…

  5. Facebook Is an Effective Strategy to Recruit Low-Income Women to Online Nutrition Education

    Science.gov (United States)

    Lohse, Barbara

    2013-01-01

    Objective: Nutrition education research recruitment expense and effort are substantial; sample selection is crucial for intervention assessment. Effectiveness and cost of Facebook to recruit low-income women to an online nutrition program were examined, including biopsychosocial characteristics of Facebook responders. Methods: An ad appeared on…

  6. Family and Cultural Influences on Low-Income Latino Children's Adjustment

    Science.gov (United States)

    Santiago, Catherine DeCarlo; Wadsworth, Martha E.

    2011-01-01

    This study examined family and cultural influences on adjustment among 90 low-income Latino middle school children (46% girls; average age = 11.38, SD = 0.66) and their primary caregivers (93% female; average age = 36.12, SD = 6.13). All participants identified as Hispanic/Latino, with 75% of families identifying as Mexican-origin Latino, and 77%…

  7. Children's Effects on Parenting Stress in a Low Income, Minority Population.

    Science.gov (United States)

    Bendell, R. Debra; And Others

    1989-01-01

    Relationships between parenting stress and other maternal and child characteristics were investigated with 66 low income mothers and their five- to eight-year-old children at risk for educational disabilities. Child characteristics (self esteem, behavior conduct, and spelling achievement) and maternal characteristics (self esteem and crowding…

  8. Healthy and comfortable dwellings for the low-income settlements in Surakarta

    NARCIS (Netherlands)

    Arsandrie, Y.; Bokel, R.M.J.; Van der Linden, A.C.; Kurvers, S.R.; Cauberg, J.J.M.

    2012-01-01

    Technology for the low-income group of people should be as simple as their daily life. Giving recommendations for simple dwelling design and changing people’s behaviour for a better living are the concerns of this research. A field-survey was conducted in November-December 2010 involving 426

  9. Smoking Attitudes and Practices among Low-Income African Americans: Qualitative Assessment of Contributing Factors.

    Science.gov (United States)

    Beech, Bettina M.; Scarinci, Isabel C.

    2003-01-01

    Qualitatively examined sociocultural factors associated with smoking attitudes and practices among low-income, African American young adults smokers and nonsmokers. Focus group data indicated that specific contextual and familial factors contributed to smoking initiation, maintenance, and cessation (e.g., strong parental discipline, limited…

  10. Prenatal Care Initiation in Low-Income Hispanic Women: Risk and Protective Factors

    Science.gov (United States)

    Luecken, Linda J.; Purdom, Catherine L.; Howe, Rose

    2009-01-01

    Objectives: To examine the psychosocial risk (distress, stress, unintended pregnancy) and protective factors (social support, mastery, familism) associated with entry into prenatal care among low-income Hispanic women. Methods: Between April and September 2005, 483 postpartum Medicaid-eligible Hispanic women completed a survey at the hospital.…

  11. Prospera Digital Phase II: Financial inclusion for low-income women ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Prospera Digital Phase II: Financial inclusion for low-income women in Mexico ... a research network in Latin America, to identify barriers and opportunities to scale up ... Call for new OWSD Fellowships for Early Career Women Scientists now open ... conference of McGill's Institute for the Study of International Development.

  12. Employment and the Risk of Domestic Abuse among Low-Income Women

    Science.gov (United States)

    Gibson-Davis, Christina M.; Magnuson, Katherine; Gennetian, Lisa A.; Duncan, Greg J.

    2005-01-01

    This paper uses data from 2 randomized evaluations of welfare-to-work programs--the Minnesota Family Investment Program and the National Evaluation of Welfare-to-Work Strategies--to estimate the effect of employment on domestic abuse among low-income single mothers. Unique to our analysis is the application of a 2-stage least squares method, in…

  13. Talking about Corporal Punishment: Nine Low-Income African American Mothers' Perspectives

    Science.gov (United States)

    Ispa, J.M.; Halgunseth, L.C.

    2004-01-01

    Qualitative interviews conducted over the course of 5 years with nine young low-income African American mothers were analyzed in order to gain understanding of their perspectives on corporal punishment. All used corporal punishment with their children. Results pertain to the vocabulary mothers used to describe corporal punishment (pop, tap, whup,…

  14. Gender Distrust and Intimate Unions among Low-Income Hispanic and African American Women

    Science.gov (United States)

    Estacion, Angela; Cherlin, Andrew

    2010-01-01

    This article investigates levels of generalized distrust of men among low-income non-Hispanic African American, Mexican, Puerto Rican, Dominican and non-Hispanic White women in a three-city survey. The results reveal substantial variation. Hispanics' overall levels of distrust are found to be higher than levels for either African Americans or…

  15. Process Evaluation of a Parenting Program for Low-Income Families in South Africa

    Science.gov (United States)

    Lachman, Jamie M.; Kelly, Jane; Cluver, Lucie; Ward, Catherine L.; Hutchings, Judy; Gardner, Frances

    2018-01-01

    Objective: This mixed-methods process evaluation examined the feasibility of a parenting program delivered by community facilitators to reduce the risk of child maltreatment in low-income families with children aged 3-8 years in Cape Town, South Africa (N = 68). Method: Quantitative measures included attendance registers, fidelity checklists,…

  16. School Readiness among Low-Income Black Children: Family Characteristics, Parenting, and Social Support

    Science.gov (United States)

    Bono, Katherine E.; Sy, Susan R.; Kopp, Claire B.

    2016-01-01

    This study focuses on the associations between family variables and academic and social school readiness in low-income Black children. Analyses drew from the National Institute for Child Development (NICHD) Study of Early Child Care and Youth Development dataset. The participants included 122 children and their mothers. Data collection occurred…

  17. Multidisciplinary Perspectives towards the Education of Young Low-Income Immigrant Children

    Science.gov (United States)

    Isik-Ercan, Zeynep; Demir-Dagdas, Tuba; Cakmakci, Huzeyfe; Cava-Tadik, Yasemin; Intepe-Tingir, Seyma

    2017-01-01

    This paper examines the issues surrounding low-income immigrants in the U.S. and the ways they shape the educational experiences of their young children. Using a multidisciplinary lens including sociology, family studies, education, and mental health, the authors analyse multiple perspectives towards the educational experiences of children in…

  18. After-School Multifamily Groups: A Randomized Controlled Trial Involving Low-Income, Urban, Latino Children

    Science.gov (United States)

    McDonald, Lynn; Moberg, D. Paul; Brown, Roger; Rodriguez-Espiricueta, Ismael; Flores, Nydia I.; Burke, Melissa P.; Coover, Gail

    2006-01-01

    This randomized controlled trial evaluated a culturally representative parent engagement strategy with Latino parents of elementary school children. Ten urban schools serving low-income children from mixed cultural backgrounds participated in a large study. Classrooms were randomly assigned either either to an after-school, multifamily support…

  19. Sexual Activity and Contraceptive Use among Low-Income Urban Black Adolescent Females.

    Science.gov (United States)

    Keith, Judith B.; And Others

    1991-01-01

    Examined sexual activity and contraception among urban, low-income African-American adolescent female clients who were not sexually active (n=50), sexually active/noncontracepting (n=20), or sexually active/contracepting (n=72). Not sexually active group was younger, more career motivated, had father at home, was more influenced by family values,…

  20. 76 FR 64882 - Inquiry Into Disbursement Process for the Universal Service Fund Low Income Program

    Science.gov (United States)

    2011-10-19

    ...] Inquiry Into Disbursement Process for the Universal Service Fund Low Income Program AGENCY: Federal... payments would replace the current administrative process, under which the Universal Service Administrative... Wireline Competition Bureau (WCB) seeks comment on a proposal for disbursing Universal Service Fund low...

  1. Maternal Characteristics Associated with Television Viewing Habits of Low-Income Preschool Children

    Science.gov (United States)

    Conners, Nicola A.; Tripathi, Shanti P.; Clubb, Richard; Bradley, Robert H.

    2007-01-01

    Few studies have examined maternal characteristics associated with heavy or inappropriate television viewing on the part of their children. We investigated the relationship between children's television viewing habits and maternal depressive symptoms and parenting beliefs. The participants were 175 low income children (mean age = 62.1 months) and…

  2. Does Maternal Employment Following Childbirth Support or Inhibit Low-Income Children's Long-Term Development?

    Science.gov (United States)

    Coley, Rebekah Levine; Lombardi, Caitlin McPherran

    2013-01-01

    This study assessed whether previous findings linking early maternal employment to lower cognitive and behavioral skills among middle-class and White children generalized to other groups. Using a representative sample of urban, low-income, predominantly African American and Hispanic families ("n" = 444), ordinary least squares regression…

  3. Assessing the Productive Vocabulary of Spanish-English Bilingual Toddlers from Low-Income Families

    Science.gov (United States)

    Mancilla-Martinez, Jeannette; Pan, Barbara Alexander; Vagh, Shaher Banu

    2011-01-01

    This study investigates the utility and validity of the MacArthur-Bates Communicative Development Inventory (CDI) for use with low-income parents and their 24- to 36-month-old Spanish-English bilingual children (n = 79). Issues in the interpretation of the integrated CDI/Inventarios del Desarrollo de Habilidades Comunicativas (IDHC) score to index…

  4. Experiential Cooking Programs for Low-Income Adults: Strategies for Success

    Science.gov (United States)

    Franck, Karen; Vineyard, Michelle; Olson, Ann; Peterson, Ashley

    2012-01-01

    Experiential cooking classes for low-income adults can help improve healthy nutrition behaviors. However, nutrition educators and Extension professionals can face challenges in successful implementation of these programs such as difficulties recruiting and retaining participants. Drawing upon lessons learned from a cooking intervention with…

  5. Preschool Interactive Peer Play Mediates Problem Behavior and Learning for Low-Income Children

    Science.gov (United States)

    Bulotsky-Shearer, Rebecca J.; Bell, Elizabeth R.; Romero, Sandy L.; Carter, Tracy M.

    2012-01-01

    The study employed a developmental, ecological, and resiliency framework to examine whether interactive peer play competencies mediated associations between teacher reported problem behavior and learning outcomes for a representative sample of urban low-income children (N = 507 across 46 Head Start classrooms). Structural equation models provided…

  6. Elaboration and Autonomy Support in Low-Income Mothers' Reminiscing: Links to Children's Autobiographical Narratives

    Science.gov (United States)

    Leyva, Diana; Reese, Elaine; Grolnick, Wendy; Price, Carrie

    2008-01-01

    Maternal elaboration and autonomy support during reminiscing facilitate middle-class children's autobiographical narrative skills. In this study, low-income Hispanic, White, and Black mothers' elaboration and autonomy support in reminiscing were examined in relation to children's joint and independent autobiographical narratives and engagement.…

  7. Parental Mathematics Homework Involvement of Low-Income Families with Middle School Students

    Science.gov (United States)

    O'Sullivan, Robyn Hackford; Chen, Yung-Chi; Fish, Marian C.

    2014-01-01

    This study explores the relationships between methods of parental assistance (i.e., provision of structure, direct assistance, and autonomy support) with mathematics homework for high-achieving and low-achieving students and children's achievement in mathematics in low-income families and examines the impact of parental efficacy on these…

  8. Acceptability of the integral solar water heater by householders in the low income urban community

    CSIR Research Space (South Africa)

    Basson, FA

    1984-01-01

    Full Text Available A research and demonstration project on the use and performance of low cost integral solar water heaters in urban low-income dwellings was carried out in 1982/83. The project involved technical and socio-economic components. This report summarises...

  9. Understanding the Gender Gap in School Performance among Low-Income Children: A Developmental Trajectory Analysis

    Science.gov (United States)

    Kingdon, Danielle; Serbin, Lisa A.; Stack, Dale M.

    2017-01-01

    Internationally, girls outperform boys in overall school performance. The gender gap is particularly large among those in at-risk groups, such as children from families at economic disadvantage. This study modeled the academic trajectories of a low-income sample of boys and girls from the Concordia Longitudinal Risk Project across the full course…

  10. The feasibility of a Paleolithic diet for low-income consumers

    NARCIS (Netherlands)

    Metzgar, Matthew; Rideout, Todd C.; Fontes-Villalba, Maelan; Kuipers, Remko S.

    Many low-income consumers face a limited budget for food purchases. The United States Department of Agriculture developed the Thrifty Food Plan to address this problem of consuming a healthy diet given a budget constraint. This dietary optimization program uses common food choices to build a

  11. Factors Influencing the General Well-Being of Low-Income Korean Immigrant Elders

    Science.gov (United States)

    Lee, Kyoung Hag; Yoon, Dong Pil

    2011-01-01

    This study explores factors that influence the general well-being (anxiety, depression, positive well-being, self-control, vitality, and general health) of low-income Korean immigrant elders by interviewing 206 older adults living in Los Angeles County and Orange County, California. Ordinary least squares regression results reveal that lack of…

  12. Evaluation of DOE's Partnership in Low-Income Residential Retrofit (PILIRR) Program

    Energy Technology Data Exchange (ETDEWEB)

    Callaway, J.W.; Lee, A.D.

    1989-05-01

    In July 1986, the US Department of Energy (DOE) awarded competitive grants to five states to conduct pilot projects to establish partnerships and use resource leveraging to stimulate support for low-income residential energy retrofits. The projects were conducted under DOE's Partnerships in Low-Income Residential Retrofit (PILIRR) Program. These projects have been monitored and analyzed through a concurrent process evaluation conducted by the Pacific Northwest Laboratory (PNL). This study reports the findings of that evaluation. The overriding goal of the PILIRR Program was to determine whether the states could stimulate support for low-income residential energy improvements from non-federal sources. The goal for the process evaluation was to conduct an assessment of the processes used by the states and the extent to which they successfully established partnerships and leveraged resources. Five states were selected to participate in the program: Florida, Iowa, Kentucky, Oklahoma and Washington. Each state proposed a different approach to promote non-federal support for low-income residential weatherization. Three of the five states--Florida, Iowa, and Washington--established partnerships that led to retrofits during the monitoring period (October 1986--October 1988). Kentucky established its partnership during the monitoring period, but did not accomplish its retrofits until after monitoring was complete. Oklahoma completed development of its marketing program and had begun marketing efforts by the end of the monitoring period. 16 refs., 7 figs., 1 tab.

  13. Social Competence among Low-Income Preschoolers: Emotion Socialization Practices and Social Cognitive Correlates.

    Science.gov (United States)

    Garner, Pamela W.; And Others

    1994-01-01

    Two studies investigated the relationship between emotion socialization variables, social cognitive knowledge, and children's social competence in preschoolers from low-income families. Found that mothers' self-reported emotion socialization practices were related to children's emotional knowledge and sibling caregiving behavior. (MDM)

  14. Low-Income Parental Profiles of Coping, Resource Adequacy, and Public Assistance Receipt: Links to Parenting

    Science.gov (United States)

    Maupin, Angela N.; Brophy-Herb, Holly E.; Schiffman, Rachel F.; Bocknek, Erika L.

    2010-01-01

    Variation in perceptions of resources and in coping strategies among low-income parents likely influences parenting. The purposes of this study were to identify differences in parental profiles, as indicated by receipt of public assistance, perceptions of adequacy of resources, and coping strategies, and to examine these profiles relative to…

  15. Low-Income Mothers' Food Practices with Young Children: A Qualitative Longitudinal Study

    Science.gov (United States)

    Harden, Jeni; Dickson, Adele

    2015-01-01

    Objective: Young children living in socioeconomically deprived areas of Scotland have an increased risk of becoming overweight or obese. To enhance understanding of the wider contexts within which family food practices are developed, this study examined the experiences of low-income mothers with young children. Design: Qualitative longitudinal…

  16. Low-Income Children, Their Families and the Great Recession: What Next in Policy?

    Science.gov (United States)

    Aber, Lawrence; Chaudry, Ajay

    2010-01-01

    Children and youth vary in their developmental health due to differences in family economic security and exposure to toxic stress. The economic downturn has increased the challenges facing low-income children. The American Recovery and Reinvestment Act of 2009 (ARRA) and the President's first budget made significant down-payments on investments in…

  17. Educator Perceptions of Low-Income Elementary Students and Their Effects on Reading

    Science.gov (United States)

    Fenske, Mark S.

    2013-01-01

    The correlation between income level and achievement has led some educators to believe that low-income students cannot learn at the same level as can middle-class and affluent peers. This problem is significant because as more families become impoverished, more students may be at risk for failure. Many studies have identified challenges facing…

  18. Associations of Low-Income Working Mothers' Daily Interactions with Supervisors and Mother-Child Interactions

    Science.gov (United States)

    Gassman-Pines, Anna

    2011-01-01

    This study investigated associations of low-income working mothers' daily interactions with supervisors and their interactions with children. Sixty-one mothers of preschool-aged children were asked to report on their interactions with their supervisors at work and their interactions with children for 2 weeks (N = 520 workdays). Results show…

  19. Dimensions of Family Functioning: Perspectives of Low-Income African American Single Parent Families

    Science.gov (United States)

    Mccreary, Linda L.; Dancy, Barbara L.

    2004-01-01

    Family functioning is influenced by socio-economic status, culture, family structure, and developmental stage, and is assessed primarily using instruments developed for middle-income European American two-parent families. These instruments may not validly assess low-income African American single-parent families. This qualitative study was…

  20. Life After Welfare Reform: Low-Income Single Parent Families, Pre- and Post-TANF.

    Science.gov (United States)

    Peterson, Janice; Song, Xue; Jones-DeWeever, Avis

    This study used data from the first and last waves of the 1996 U.S. Census Bureau's Survey of Income and Program Participation to compare the characteristics and wellbeing of low-income, single parent families before and after passage of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), noting the characteristics and…

  1. Student Success for All: Support for Low-Income Students at an Urban Public University

    Science.gov (United States)

    Potter, Mark

    2017-01-01

    Although federal financial aid has increased in recent years, the costs of college tuition and living expenses have increased even more, leaving larger numbers of students with unmet need. Restructuring of financial aid, however, is insufficient to address the problem of diverging attainment gaps between low-income students and their more…

  2. Low-Income, African American Adolescent Mothers and Their Toddlers Exhibit Similar Dietary Variety Patterns

    Science.gov (United States)

    Papas, Mia A.; Hurley, Kristen M.; Quigg, Anna M.; Oberlander, Sarah E.; Black, Maureen M.

    2009-01-01

    Objective: To examine the relationship between maternal and toddler dietary variety. Design: Longitudinal; maternal and toddler dietary data were collected at 13 months; anthropometry was collected at 13 and 24 months. Setting: Data were collected in homes. Participants: 109 primiparous, low-income, African American adolescent mothers and…

  3. Suppressor Effects in Coping Research with African American Adolescents from Low-Income Communities

    Science.gov (United States)

    Gaylord-Harden, Noni K.; Cunningham, Jamila A.; Holmbeck, Grayson N.; Grant, Kathryn E.

    2010-01-01

    Objective: The purpose of the current study was to demonstrate the replicable nature of statistical suppressor effects in coping research through 2 examples with African American adolescents from low-income communities. Method: Participants in the 1st example included 497 African American adolescents (mean age = 12.61 years, SD = 0.99; 57% female)…

  4. The Impact of GEAR UP on College Readiness for Students in Low Income Schools

    Science.gov (United States)

    Bausmith, Jennifer Merriman; France, Megan

    2012-01-01

    The purpose of this study was to evaluate the impact of the Gaining Early Awareness and Readiness for Undergraduate Program (GEAR UP) on college readiness outcomes using a quasi-experimental design. GEAR UP is designed to increase the number of low-income students who are prepared to enter and succeed in postsecondary education by providing 6-year…

  5. A Phenomenological Study to Discover Low-Income Adults' Perceptions and Expectations Regarding Financial Literacy

    Science.gov (United States)

    Schaffer, Brigid Ann

    2013-01-01

    This phenomenological study explored the perceptions and expectations of low income adults regarding financial literacy to discover ways to increase attendance in financial literacy programs designs for this cohort. The study utilized interviews with closed-ended questions to establish the participants' backgrounds, then opened-ended questions to…

  6. Feminist Relational Advocacy: Processes and Outcomes from the Perspective of Low-Income Women with Depression

    Science.gov (United States)

    Goodman, Lisa A.; Glenn, Catherine; Bohlig, Amanda; Banyard, Victoria; Borges, Angela

    2009-01-01

    This article describes a qualitative study of how low-income women who are struggling with symptoms of depression experience feminist relational advocacy, a new model that is informed by feminist, multicultural, and community psychology theories. Using qualitative content analysis of participant interviews, the authors describe the processes and…

  7. Occupational and Educational Goals of Low Income Children in Kentucky, 1969 and 1975. RS-49.

    Science.gov (United States)

    Gabbard, Anne V.; Coleman, A. Lee

    Changes in the occupational and educational aspirations and expectations of fifth and sixth grade children over a 6-year period were studied. In 1969, a questionnaire was administered to 355 students from 4 rural mountain schools and 3 urban schools in low-income areas in 3 Kentucky counties. In 1975, 199 students from the same rural mountain…

  8. Family Investments in Low-Income Children's Achievement and Socioemotional Functioning

    Science.gov (United States)

    Longo, Francesca; McPherran Lombardi, Caitlin; Dearing, Eric

    2017-01-01

    Family processes and parenting practices help explain developmental differences between children in low- versus higher-income households. There are, however, few studies addressing the question of: what are the key family processes and parenting practices for promoting low-income children's growth? We address this question in the present study,…

  9. Childbirth attendance strategies and their impact on maternal mortality and morbidity in low-income settings

    DEFF Research Database (Denmark)

    Pyone, Thidar; Sorensen, Bjarke Lund; Tellier, Siri

    2012-01-01

    Objective. To review quantitative evidence of the effect on maternal health of different childbirth attendance strategies in low-income settings. Design. Systematic review. Methods. Studies using quantitative methods, referring to the period 1987-2011, written in English and reporting the impact ...

  10. Depression in Low-Income Elementary School Children in South Korea: Gender Differences

    Science.gov (United States)

    Lee, Gyungjoo; McCreary, Linda; Kim, Mi Ja; Park, Chang Gi; Jun, Won Hee; Yang, Soo

    2013-01-01

    This study examined depression in low-income elementary school children and identified gender differences in factors that influence depression from an ecological perspective. Participants were 262 first- to sixth-grade children recruited from six Korean community centers. Personal factors were anxiety and self-concept. Environmental factors…

  11. Personal Empowerment in the Study of Home Internet Use by Low-Income Families.

    Science.gov (United States)

    Bier, Melinda; Gallo, Michael; Nucklos, Eddy; Sherblom, Stephen; Pennick, Michael

    1997-01-01

    Describes a United States Department of Commerce (National Telecommunications and Information Administrations, NTIA, 1995) study of home Internet use by Low-income families. The study investigated the barriers, benefits (empowerment), and perceived worth of the Internet and concluded that home Internet access enabled powerful emotional and…

  12. Variations in Classroom Language Environments of Preschool Children Who Are Low Income and Linguistically Diverse

    Science.gov (United States)

    Sawyer, Brook; Atkins-Burnett, Sally; Sandilos, Lia; Scheffner Hammer, Carol; Lopez, Lisa; Blair, Clancy

    2018-01-01

    Research Findings: This study aimed to (a) provide an in-depth description of the frequency and type of language interactions that children who are low income and/or dual language learners (DLLs) experience in their classrooms and (b) examine whether differences exist in children's language experiences based on children's DLL status and level of…

  13. Widening Income Inequalities: Higher Education's Role in Serving Low Income Students

    Science.gov (United States)

    Dalton, Jon C.; Crosby, Pamela C.

    2015-01-01

    Many scholars argue that America is becoming a dangerously divided nation because of increasing inequality, especially in income distribution. This article examines the problem of widening income inequality with particular focus on the role that colleges and universities and their student affairs organizations play in serving low income students…

  14. Social Support and Low-Income, Urban Mothers: Longitudinal Associations with Adolescent Delinquency

    Science.gov (United States)

    Ghazarian, Sharon R.; Roche, Kathleen M.

    2010-01-01

    The current study examined the role of engaged parenting in explaining longitudinal associations between maternal perceptions of social network support and whether youth engage in delinquent behaviors during the transition into adolescence. The sample included 432 low-income, African American and Latino youth (49% female) and their mothers…

  15. Parenting and Preschool Child Development: Examination of Three Low-Income U.S. Cultural Groups

    Science.gov (United States)

    Whiteside-Mansell, Leanne; Bradley, Robert H.; McKelvey, Lorraine

    2009-01-01

    We examined the impact of parenting behaviors on preschool children's social development in low-income families from three cultural groups: European American (n = 286), African American (n = 399), and Hispanic American (n = 164) using Spanish as the primary language in the home. Observed parenting behaviors of stimulation, responsivity, and…

  16. Is the Feeling Mutual? Examining Parent-Teacher Relationships in Low-Income, Predominantly Latino Schools

    Science.gov (United States)

    Miller, Hannah; Robinson, Michelle; Valentine, Jessa Lewis; Fish, Rachel

    2016-01-01

    Strong parent-teacher relationships are critical to students' academic success. Mismatches in parents' and teachers' perceptions of each other may negatively affect children's outcomes. Using survey data collected from parents and teachers in 52 low-income, predominantly Latino schools, we explore subgroup variation in parents' and teachers'…

  17. Characterizing Air Pollution in Two Low-Income Neighborhoods in Accra, Ghana

    Science.gov (United States)

    Sub-Saharan Africa has the highest rate of urban population growth in the world, with a large number of urban residents living in low-income “slum” neighborhoods. We conducted a study for an initial assessment of the levels and spatial and/or temporal patterns of multiple polluta...

  18. Fruit and vegetable attitudes, norms, and intake in low-income youth

    Science.gov (United States)

    Fruit and vegetable (FV) attitudes and norms have been shown to influence intake in youth; yet research with low-income youth and studies supplementing self-report with objective measures of intake are lacking. Cross-sectional survey data on self-rated FV intake, FV attitudes, and FV norms were coll...

  19. Housing Dependence and Intimate Relationships in the Lives of Low-Income Puerto Rican Mothers

    Science.gov (United States)

    Clark, Sherri Lawson; Burton, Linda M.; Flippen, Chenoa A.

    2011-01-01

    Using longitudinal ethnographic data from the Three-City Study, the authors examined the relationship between 16 low-income Puerto Rican mothers' housing dependencies and their intimate partner relations. This study traced mothers' dependent housing arrangements and entree to marital or cohabiting relationships from their teens through their…

  20. Prediction of cardiovascular disease risk among low-income urban dwellers in metropolitan Kuala Lumpur, Malaysia.

    Science.gov (United States)

    Su, Tin Tin; Amiri, Mohammadreza; Mohd Hairi, Farizah; Thangiah, Nithiah; Bulgiba, Awang; Majid, Hazreen Abdul

    2015-01-01

    We aimed to predict the ten-year cardiovascular disease (CVD) risk among low-income urban dwellers of metropolitan Malaysia. Participants were selected from a cross-sectional survey conducted in Kuala Lumpur. To assess the 10-year CVD risk, we employed the Framingham risk scoring (FRS) models. Significant determinants of the ten-year CVD risk were identified using General Linear Model (GLM). Altogether 882 adults (≥30 years old with no CVD history) were randomly selected. The classic FRS model (figures in parentheses are from the modified model) revealed that 20.5% (21.8%) and 38.46% (38.9%) of respondents were at high and moderate risk of CVD. The GLM models identified the importance of education, occupation, and marital status in predicting the future CVD risk. Our study indicated that one out of five low-income urban dwellers has high chance of having CVD within ten years. Health care expenditure, other illness related costs and loss of productivity due to CVD would worsen the current situation of low-income urban population. As such, the public health professionals and policy makers should establish substantial effort to formulate the public health policy and community-based intervention to minimize the upcoming possible high mortality and morbidity due to CVD among the low-income urban dwellers.

  1. Prediction of Cardiovascular Disease Risk among Low-Income Urban Dwellers in Metropolitan Kuala Lumpur, Malaysia

    Directory of Open Access Journals (Sweden)

    Tin Tin Su

    2015-01-01

    Full Text Available We aimed to predict the ten-year cardiovascular disease (CVD risk among low-income urban dwellers of metropolitan Malaysia. Participants were selected from a cross-sectional survey conducted in Kuala Lumpur. To assess the 10-year CVD risk, we employed the Framingham risk scoring (FRS models. Significant determinants of the ten-year CVD risk were identified using General Linear Model (GLM. Altogether 882 adults (≥30 years old with no CVD history were randomly selected. The classic FRS model (figures in parentheses are from the modified model revealed that 20.5% (21.8% and 38.46% (38.9% of respondents were at high and moderate risk of CVD. The GLM models identified the importance of education, occupation, and marital status in predicting the future CVD risk. Our study indicated that one out of five low-income urban dwellers has high chance of having CVD within ten years. Health care expenditure, other illness related costs and loss of productivity due to CVD would worsen the current situation of low-income urban population. As such, the public health professionals and policy makers should establish substantial effort to formulate the public health policy and community-based intervention to minimize the upcoming possible high mortality and morbidity due to CVD among the low-income urban dwellers.

  2. Fostering Community and Civic Engagement in Low-Income Multicultural Schools through Transformative Leadership

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    Bader, Barbara; Horman, Judith; Lapointe, Claire

    2010-01-01

    In this study, we examine how transformative leadership enables students from a low-income and multicultural neighbourhood to learn about democracy, responsible citizenship, and community engagement at school. As part of a graduate seminar on critical pedagogy and cultural studies in education, in-depth group interviews were conducted with…

  3. Promoting health and advancing development through improved housing in low-income settings

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    Haines, A.; Bruce, N.; Cairncross, S.; Davies, M.; Greenland, K.; Hiscox, A.F.; Lindsay, S.; Lindsay, T.; Satterthwaite, D.; Wilkinson, P.

    2013-01-01

    There is major untapped potential to improve health in low-income communities through improved housing design, fittings, materials and construction. Adverse effects on health from inadequate housing can occur through a range of mechanisms, both direct and indirect, including as a result of extreme

  4. Household Food Security and Fruit and Vegetable Intake among Low-Income Fourth-Graders

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    Grutzmacher, Stephanie; Gross, Susan

    2011-01-01

    Objective: To examine the relationship between household food security and children's and parents' fruit, vegetable, and breakfast consumption and fruit and vegetable availability. Design: Cross-sectional study using matched parent-child surveys. Setting: Title I elementary schools in Maryland. Participants: Ninety-two low-income parent-child…

  5. Recognizing Social Class in the Psychotherapy Relationship: A Grounded Theory Exploration of Low-Income Clients

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    Thompson, Mindi N.; Cole, Odessa D.; Nitzarim, Rachel S.

    2012-01-01

    The process of psychotherapy among 16 low-income clients was explored using grounded theory (Charmaz, 2006; Glaser & Strauss, 1967) in order to understand and identify their unique experiences and needs. Semistructured interviews were conducted with 12 women and 4 men who had attended at least 6 sessions of psychotherapy within 6 months of the…

  6. Poverty Levels and Debt Indicators among Low-Income Households before and after the Great Recession

    Science.gov (United States)

    Kim, Kyoung Tae; Wilmarth, Melissa J.; Henager, Robin

    2017-01-01

    This study analyzed the debt profile of low-income households before and after the Great Recession using the 2007, 2010, and 2013 Survey of Consumer Finances (SCF). We used Heckman selection models to investigate three debt characteristics: (a) the amount of debt, (b) debt-to-income ratio, and (c) debt delinquency. Before and after the Great…

  7. Health-related quality-of-life in low-income, uninsured men with prostate cancer.

    Science.gov (United States)

    Krupski, Tracey L; Fink, Arlene; Kwan, Lorna; Maliski, Sally; Connor, Sarah E; Clerkin, Barbara; Litwin, Mark S

    2005-05-01

    The objective was to describe health-related quality-of-life (HRQOL) in low-income men with prostate cancer. Subjects were drawn from a statewide public assistance prostate cancer program. Telephone and mail surveys included the RAND 12-item Health Survey and UCLA Prostate Cancer Index Short Form and were compared with normative age-matched men without cancer from the general population reported on in the literature. Of 286 eligible men, 233 (81%) agreed to participate and completed the necessary items. The sample consisted of 51% Hispanics, 23% non-Hispanic whites, and 17% African Americans. The low-income men had worse scores in every domain of prostate-specific and general HRQOL than had the age-matched general population controls. The degree of disparity indicated substantial clinical differences in almost every domain of physical and emotional functioning between the sample group and the control group. Linear regression modeling determined that among the low-income men, Hispanic race, and income level were predictive of worse physical functioning, whereas only comorbidities predicted mental health. Low-income patients with prostate cancer appear to have quality-of-life profiles that are meaningfully worse than age-matched men from the general population without cancer reported on in the literature.

  8. A Talent for Tinkering: Developing Talents in Children from Low-Income Households through Engineering Curriculum

    Science.gov (United States)

    Robinson, Ann; Adelson, Jill L.; Kidd, Kristy A.; Cunningham, Christine M.

    2018-01-01

    Guided by the theoretical framework of curriculum as a platform for talent development, this quasi-experimental field study investigated an intervention focused on engineering curriculum and curriculum based on a biography of a scientist through a comparative design implemented in low-income schools. Student outcome measures included science…

  9. Modeling exposures to organophosphates and pyrethroids for children living in an urban low-income environment

    Science.gov (United States)

    Pesticide exposure in urban low-income residential environments may be elevated as a result of persistent application due to severe pest infestation. Children living in this environment may be a sensitive subpopulation for these non-dietary exposures, due to their physiological a...

  10. Fresh Fruit and Vegetable Purchases in an Urban Supermarket by Low-Income Households

    Science.gov (United States)

    Phipps, Etienne J.; Stites, Shana D.; Wallace, Samantha L.; Braitman, Leonard E.

    2013-01-01

    Objective: To investigate the predictors of fresh fruit and vegetable purchases in a low-income population and identify subgroups in which interventions to increase such purchases might prove useful. Methods: Retrospective analysis of 209 shopping transactions from 30 households. Individual and household characteristics obtained from primary…

  11. Millennial Learners and Net-Savvy Teens? Examining Internet Use among Low-Income Students

    Science.gov (United States)

    Greenhow, Christine; Walker, J. D.; Kim, Seongdok

    2010-01-01

    This paper discusses access and use of information and communication technologies among urban high school students from low-income families, a topic of great interest to teacher educators, educational policymakers, and others concerned with digital literacy instruction. Recent reports from national digital learning initiatives have portrayed…

  12. Does Home Internet Use Influence the Academic Performance of Low-Income Children?

    Science.gov (United States)

    Jackson, Linda A.; von Eye, Alexander; Biocca, Frank A.; Barbatsis, Gretchen; Zhao, Yong; Fitzgerald, Hiram E.

    2006-01-01

    HomeNetToo is a longitudinal field study designed to examine the antecedents and consequences of home Internet use in low-income families http://www.HomeNetToo.org). The study was done between December 2000 and June 2002. Among the consequences considered was children's academic performance. Participants were 140 children, mostly African…

  13. Influence of a Supervised Mentoring Program on the Achievement of Low-Income South Korean Students

    Science.gov (United States)

    Choi, Sumi; Lemberger, Matthew E.

    2010-01-01

    This study examined the effectiveness of a supervised mentoring program designed to improve the academic achievement of 834 low-income elementary and secondary school students in Seoul, South Korea. When compared to the control group, both elementary and middle school students exposed to the mentoring program improved in mathematic and reading…

  14. Growth in Means-Tested Programs and Tax Credits for Low-Income Households

    Science.gov (United States)

    Carrington, William; Dahl, Molly; Falk, Justin

    2013-01-01

    The federal government devotes roughly one-sixth of its spending to 10 major means-tested programs and tax credits, which provide cash payments or assistance in obtaining health care, food, housing, or education to people with relatively low income or few assets. Those programs and credits consist of the following: (1) Medicaid; (2) the low-income…

  15. ENRICHMENT PROGRAM FOR ACADEMICALLY TALENTED JUNIOR HIGH SCHOOL STUDENTS FROM LOW INCOME FAMILIES.

    Science.gov (United States)

    PRESSMAN, HARVEY

    A PROPOSAL FOR AN ENRICHMENT PROGRAM FOR ACADEMICALLY TALENTED JUNIOR HIGH SCHOOL STUDENTS FROM LOW-INCOME FAMILIES IN CERTAIN AREAS OF BOSTON IS PRESENTED. BASIC ASSUMPTIONS ARE THAT THERE IS AND OBVIOUS AND PRESSING NEED TO GIVE EXTRA HELP TO THE ABLE STUDENT FROM A DISADVANTAGED BACKGROUND, AND THAT A RELATIVELY BRIEF ENRICHMENT EXPERIENCE FOR…

  16. Contraceptive use among low-income urban married women in India.

    Science.gov (United States)

    Kumar, Manisha; Meena, Jyoti; Sharma, Sumedha; Poddar, Anju; Dhalliwal, Vikas; Modi-Satish Chander Modi, S C; Singh, Kamlesh

    2011-02-01

    The reports of a rise in contraceptive practices have not been matched by a similar decrease in population, so there is a need to look into the causes of this discrepancy. To obtain information from low-income urban married women regarding their contraceptive knowledge, practices, and utilization of the services. Percentage of low-income urban married women using contraception, different types of contraception used, influence of education on choice of contraception. All nonpregnant married women between the ages of 18 and 45 years, belonging to low-income groups were selected for study. Statistical analysis was done using EPI Info ver-5.0. Chi square test was used to test the significance of data. Contraceptive use among these women was 52%; the most common method was tubal ligation. Educated women used spacing methods more often than uneducated women. Women had adequate awareness regarding type of contraceptives available but had no idea about the timing of starting contraception after delivery and about emergency contraception. The low-income urban population is aware of the importance of limiting the family size and has family planning facilities yet has less contraceptive usage because of low level of education, increased rate of discontinuation, and lack of proper knowledge of the use of contraception. © 2010 International Society for Sexual Medicine.

  17. 78 FR 63993 - ``Low-Income Levels'' Used for Various Health Professions and Nursing Programs

    Science.gov (United States)

    2013-10-25

    ... changes in the Consumer Price Index. The Secretary annually adjusts the low-income levels based on the... applicable programs. The income figures below have been updated to reflect increases in the Consumer Price... recognition of same-sex spouses and same-sex marriages, was unconstitutional. In light of this decision...

  18. Maternal Correlates of Growth in Toddler Vocabulary Production in Low-Income Families

    Science.gov (United States)

    Pan, Barbara Alexander; Rowe, Meredith L.; Singer, Judith D.; Snow, Catherine E.

    2005-01-01

    This study investigated predictors of growth in toddlers' vocabulary production between the ages of 1 and 3 years by analyzing mother-child communication in 108 low-income families. Individual growth modeling was used to describe patterns of growth in children's observed vocabulary production and predictors of initial status and between-person…

  19. Voluntary, Randomized, Student Drug-Testing: Impact in a Rural, Low-Income, Community

    Science.gov (United States)

    Barrington, Kyle D.

    2008-01-01

    Illegal drug use and abuse by the nation's secondary school students is a continuing public health issue and this is especially true for students living in rural, low-income areas where access to intervention and treatment services is often limited. To address this issue, some school districts have implemented voluntary, randomized, student …

  20. A Postsecondary Transition Model for Low-Income, Minority Youth in Philadelphia

    Science.gov (United States)

    Brown, Alexis Tolbert

    2016-01-01

    School administrators are in the best position, but often lack the knowledge, to help low-income, minority youth transition to college. Consequently, some youth are not meeting their full potential and there are long-term, deleterious consequences on local economies as wage earning potential stagnates. Using Aslanargun's, Farmer-Hinton's, and…