Taxing sugar-sweetened beverages as a policy to reduce overweight and obesity in countries of different income classifications: a systematic review

Abstract Objective: To evaluate the potential impact of sugar-sweetened beverage (SSB) taxes on overweight and obesity prevalence in countries of different income classifications. Design: Systematic review following PRISMA guidelines (PROSPERO number CRD42020161612). Five databases (Cochrane Library, Embase, LILACS (via Virtual Health Library) and MEDLINE (via PubMed), and Web of Science were searched, from January 2009 up to December 2019. Articles that reported changes in purchases, sales, intake, body weight, BMI, overweight and/or obesity prevalence due to a tax on, or price change in SSBs were included. Setting: Studies conducted in countries of different income classifications. Participants: The search yielded 8,349 articles of which twenty-one met inclusion criteria. Results: Among the 16 studies selected, only 2 did not show that consumption, sales and purchase decreased as the price of SSBs increased. In 8 of the 13 studies selected, a positive effect of an SSB tax on decreasing overweight and obesity prevalence was expected. It is estimated that a 20% taxation on SSBs would result in a greater decrease in the prevalence of overweight and obesity compared to a 10% rate. Studies with no significant effect of taxing on sales, purchases, consumption and prevalence of obesity were from high-income countries, while significant effects of taxing on reducing purchase, consumption and/or obesity prevalence were found in studies from upper-middle and middle-income countries. Conclusion: A high SSB tax might be an effective fiscal policy to decrease purchase and consumption of SSBs and reduce overweight/obesity prevalence, especially if the tax were specific for beverage volume.

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Taxes on Sugar-Sweetened Beverages to Reduce Overweight and Obesity in Middle-Income Countries: A Systematic Review

PLoS ONE ◽

10.1371/journal.pone.0163358 ◽

2016 ◽

Vol 11 (9) ◽

pp. e0163358 ◽

Cited By ~ 46

Author(s):

Sharon S. Nakhimovsky ◽

Andrea B. Feigl ◽

Carlos Avila ◽

Gael O’Sullivan ◽

Elizabeth Macgregor-Skinner ◽

...

Keyword(s):

Systematic Review ◽

Overweight And Obesity ◽

Sugar Sweetened Beverages ◽

Middle Income ◽

Middle Income Countries ◽

Sweetened Beverages

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Global Trends in Child Obesity: Are Figures Converging?

10.20944/preprints202011.0638.v1 ◽

2020 ◽

Author(s):

María A. González-Álvarez ◽

Angelina Lázaro-Alquézar ◽

María Blanca Simón-Fernández

Keyword(s):

Adult Population ◽

International Comparisons ◽

Overweight And Obesity ◽

Industrialized Countries ◽

Obesity Prevalence ◽

Middle Income ◽

Global Trends ◽

Middle Income Countries ◽

Prevalence Of Obesity ◽

Economic Transitions

Infant obesity has become one of the most serious global health challenges of our time. The combined prevalence of overweight and obesity has rapidly increased worldwide during the last two decades, especially in some developing countries where obesity is reaching levels on a par with some industrialized countries, or even higher. This fast growth has occurred especially in countries in the midst of rapid social-economic transitions. Most international comparisons focus on the adult population while analyses focusing on the child population are more limited. Using the methodology developed by Phillips and Sul [1], this paper studies the worldwide evolution of infant body mass index (BMI), overweight and obesity prevalence for a large sample of countries during the period 1975-2016. Our results indicate that the figures for BMI or the prevalence of obesity in different countries do not converge, while the opposite is the case for overweight prevalence in children. Furthermore, there is a non-linear relationship between obesity and income or human capital, indicating that low and middle-income countries require a strong initiative for health policies targeting obesity prevention.

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Global Trends in Child Obesity: Are Figures Converging?

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17249252 ◽

2020 ◽

Vol 17 (24) ◽

pp. 9252

Author(s):

María A. González-Álvarez ◽

Angelina Lázaro-Alquézar ◽

María Blanca Simón-Fernández

Keyword(s):

Adult Population ◽

International Comparisons ◽

Overweight And Obesity ◽

Industrialized Countries ◽

Obesity Prevalence ◽

Middle Income ◽

Global Trends ◽

Middle Income Countries ◽

Prevalence Of Obesity ◽

Economic Transitions

Childhood obesity has become one of the most serious global health challenges of our time. The combined prevalence of overweight and obesity has rapidly increased worldwide during the last two decades, especially in some developing countries where obesity is reaching levels on a par with some industrialized countries, or even higher. This fast growth has occurred especially in countries in the midst of rapid social-economic transitions. Most international comparisons focus on the adult population while analyses focusing on the child population are more limited. Using the methodology developed by Phillips and Sul, this paper studies the worldwide evolution of children’s body mass index (BMI), overweight and obesity prevalence for a large sample of countries during the period 1975–2016. Our results indicate that the figures for BMI or the prevalence of obesity in different countries do not converge, while the opposite is the case for overweight prevalence in children. Furthermore, there is a non-linear relationship between obesity and income or human capital, indicating that low and middle-income countries require a strong initiative for health policies targeting obesity prevention.

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Country Level Sales of Ultra-Processed Foods and Sugar-Sweetened Beverages Predict Higher BMI and Increased Prevalence of Overweight in Adult and Youth Populations

Current Developments in Nutrition ◽

10.1093/cdn/nzaa053_030 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 825-825 ◽

Cited By ~ 1

Author(s):

Jacob Eaton

Keyword(s):

Overweight And Obesity ◽

High Income ◽

Processed Foods ◽

Obesity Prevalence ◽

Middle Income ◽

Middle Income Countries ◽

Funding Sources ◽

Sweetened Beverages ◽

Country Level ◽

Bmi Trajectories

Abstract Objectives Ultra-processed foods (UPF) and sugar-sweetened beverages (SSB) comprise over 50% of energy intake in most upper-middle and high-income contexts. Higher intake of UPF and SSB is associated with an increased prevalence of overweight and obesity at the individual level, but few studies have examined the association between UPF, SSB, and BMI at the country level. The objective of this study was to evaluate global trends in UPF and SSB sales and associations with trajectories of change in BMI and prevalence of overweight, and obesity. Methods Data on UPF and SSB sales was collected from EuroMonitor International; BMI, overweight, and obesity prevalence from the NCD Risk Factor Collaboration; and potential confounders from the World Health Organization Global Health Observatory. Longitudinal multi-level models were used to estimate the relationship between country-level UPF/SSB sales and weight trajectories for adults and children and adolescents less than 19 years, for both general population and sex disaggregated. Results UPF sales grew 2.7% between 2005 and 2018. Sales were highest in high income contexts of North America (139.3 kg/person/year) and Europe (117.3 kg/p/y) but grew most rapidly in low and lower-middle income countries, particularly South Asia and Sub-Saharan Africa. SSB sales grew 1.9% but ranged from −22.4% in North America (120.3 liters/person/year in 2018) to 144.7% in South Asia (7.3 liters/p/year). Both UPF and SSB were significant and positive predictors of BMI; 1 SD increases in sales predicted mean population BMI increases between 0.2 kg/m² and 0.5 kg/m². Neither UPF nor SSB predicted obesity, but both were significantly associated with overweight prevalence trajectories for the adult general population and for males. Associations remained controlling for both country calorie supply and physical inactivity prevalence. In children and adolescents (5–19 years), SSBs significantly predicted BMI levels and obesity prevalence, while only UPF was associated with overweight. Conclusions UPF and SSB sales have a significant impact on country-level BMI trajectories. At current rates, upper-middle income countries will soon equal high-income contexts in UPF/SSB consumption and BMI trajectories. Findings suggest the need for global level action to limit UPF and SSB consumption. Funding Sources No funding sources declared.

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Seroprevalence of SARS CoV-2 infection in Low and Middle-Income Countries and risk classification in the context of rolling out vaccine candidate across these countries : Protocol for a systematic review and meta-analysis

10.21203/rs.3.rs-578481/v1 ◽

2021 ◽

Author(s):

Martin Ackah ◽

Louise Ameyaw ◽

Kwadwo Owusu Akuffo ◽

Cynthia Osei Yeboah ◽

Nana Esi Wood ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Vaccine Candidate ◽

Meta Analysis ◽

Cochrane Library ◽

Research Database ◽

Middle Income ◽

Middle Income Countries ◽

Low Middle Income Countries ◽

Low And Middle Income

Abstract Background Seroprevalence of SARS Cov-2 provides a good indication of the extent of exposure and spread in the population, as well as those likely to benefit from a vaccine candidate. To date, there is no published or ongoing systematic review on the seroprevalence of COVID-19 in Low- and Middle-Income Countries (LMICs). This systematic review and meta-analysis will estimate SARS Cov-2 seroprevalence and the risk factors for SARS Cov-2 infection in LMICs.Methods We will search PubMed, EMBASE, WHO COVID-19 Global research database, Google Scholar, the African Journals Online, LILAC, HINARI, medRxiv, bioRxiv and Cochrane Library for potentially useful studies on seroprevalence of COVID-19 in LMICs from December 2019 to December 2020 without language restriction. Two authors will independently screen all the articles, select studies based on pre-specified eligibility criteria and extract data using a pre-tested data extraction form. Any disagreements will be resolved through discussion between the authors. The pooled seroprevalence of SARS CoV-2 for people from LMICs will be calculated. Random effects model will be used in case of substantial heterogeneity in the included studies, otherwise fixed-effect model will be used. A planned subgroup, sensitivity and meta-regression analyses will be performed. For comparative studies, the analyses will be performed using Review Manager v 5.4; otherwise, STATA 16 will be used. All effect estimates will be presented with their confidence intervals.Discussion The study will explore and systematically review empirical evidence on SARS Cov-2 seroprevalence in LMICs, and to assess the risk factors for SARS Cov-2 infection in Low Middle Income Countries in the context of rolling out vaccines in these countries. Finally, explore risk classifications to help with the rolling out of vaccines in LMICs.Systematic review registration: The protocol for this review has been registered in PROSPERO (CRD422020221548).

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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

BMJ Open ◽

10.1136/bmjopen-2017-018193 ◽

2018 ◽

Vol 8 (2) ◽

pp. e018193 ◽

Cited By ~ 2

Author(s):

Grace Kathryn Ryan ◽

Andreas Bauer ◽

Judith K Bass ◽

Julian Eaton

Keyword(s):

Mental Health ◽

Systematic Review ◽

Low Income ◽

Tertiary Education ◽

Grey Literature ◽

Theory Of Change ◽

Cochrane Library ◽

Middle Income ◽

Middle Income Countries ◽

Humanitarian Crises

IntroductionThere 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 analysisQualitative, 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 disseminationFindings 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 numberCRD42017058287.

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Efficacy of zinc as adjunctive pneumonia treatment in children aged 2 to 60 months in low-income and middle-income countries: a systematic review and meta-analysis

BMJ Paediatrics Open ◽

10.1136/bmjpo-2020-000662 ◽

2020 ◽

Vol 4 (1) ◽

pp. e000662 ◽

Cited By ~ 1

Author(s):

Nick Brown ◽

Antti Juhani Kukka ◽

Andreas Mårtensson

Keyword(s):

Systematic Review ◽

Treatment Failure ◽

Low Income ◽

Meta Analysis ◽

Severe Pneumonia ◽

Risk Of Bias ◽

Sensitivity Analyses ◽

Cochrane Library ◽

Middle Income ◽

Middle Income Countries

BackgroundDespite advances in vaccination and case management, pneumonia remains the single largest contributor to early child mortality worldwide. Zinc has immune-enhancing properties, but its role in adjunctive treatment of pneumonia in low-income and middle-income countries (LMICs) is controversial and research still active.MethodsSystematic review and meta-analysis of randomised controlled trials of zinc and placebo in pneumonia in children aged 2 to 60 months in LMICs. Databases included MEDLINE, the Cochrane Library, EMBASE, LILACS, SciELO, the WHO portal, Scopus, Google Scholar and ClinicalTrials.gov. Inclusion criteria included accepted signs of pneumonia and clear measure of outcome. Risk of bias was independently assessed by two authors. ORs with 95% CI were used for calculating the pooled estimate of dichotomous outcomes including treatment failure and mortality. Time to recovery was expressed as HRs. Sensitivity analyses considering risk of bias and subgroup analyses for pneumonia severity were performed.ResultsWe identified 11 trials published between 2004 and 2019 fulfilling the a priori defined criteria, 7 from South Asia and 3 from Africa and 1 from South America. Proportional treatment failure was comparable in both zinc and placebo groups when analysed for all patients (OR 0.95 (95% CI 0.80 to 1.14)) and only for those with severe pneumonia (OR 0.93 (95% CI 0.75 to 1.14)). No difference was seen in mortality between zinc and placebo groups (OR 0.64 (95% CI 0.31 to 1.31)). Time to recovery from severe pneumonia did not differ between the treatment and control groups for patients with severe pneumonia (HR 1.01 (95% CI 0.89 to 1.14)). Removal of four studies with high risk of bias made no difference to the conclusions.ConclusionThere is no evidence that adjunctive zinc treatment improves recovery from pneumonia in children in LMICs.Trial registration numberCRD42019141602.

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Evidence Based Dentistry among Dentists in Low and Middle Income Countries: A Systematic Review

East African Health Research Journal ◽

10.24248/eahrj.v5i2.662 ◽

2021 ◽

Vol 5 (2) ◽

pp. 129-136

Author(s):

Irene Kida Minja ◽

Edda Tandi Lwoga

Keyword(s):

Systematic Review ◽

Scientific Evidence ◽

Grey Literature ◽

Cochrane Library ◽

Evidence Based ◽

Middle Income ◽

Hand Search ◽

Middle Income Countries ◽

Evidence Based Dentistry ◽

Low And Middle Income

Purpose of this systematic review was to bring together studies of evidence-based practice among dentists in low- and middle-income countries, where its use has been reported to be limited. The protocol was registered in PROSPERO. Methodology: We searched the evidence (in English only) from medical databases including PubMed, EBSCO, The Cochrane Library, CINAHL, ScienceDirect, HINARI summon, and SCOPUS and Web of Science via Research4Life, grey literature, hand search from relevant articles, and augmented results on Google scholar.Published reports were retrieved from relevant websites and organizations. Studies included those that looked at key factors that facilitate or hinder Evidence Based Dentistry (EBD), as well as outcomes in terms of: knowledge, attitudes and skills of EB practice among dentists; and the methodology used and their relevance in future EBD strategies.Main focus was on dentists, as practitioners and faculty members. Studies on students and non-dental personnel were excluded.Findings:A total of 4568 records were retrieved and five potentially relevant articles were selected after title/abstract screening. Two articles were excluded after full text screening, and therefore Three papers were included in this review. The studies report limited knowledge,unsatisfactory attitude towards EBD and lowpractice of EBD and use of scientific evidence databases. None of the studies reported implementation of EBD nor evaluation thereof. The main barriers that constrained application of EBD ranged from lack of interest to infrastructural limitations. Originality: The current review showed that there is a need to strategised implementation of EBD in this region.

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Investigating the use of ultrasonography for the antenatal diagnosis of structural congenital anomalies in low-income and middle-income countries: systematic review protocol

BMJ Paediatrics Open ◽

10.1136/bmjpo-2019-000538 ◽

2019 ◽

Vol 3 (1) ◽

pp. e000538 ◽

Cited By ~ 1

Author(s):

Stephanie Michele Goley ◽

Sidonie Sakula-Barry ◽

Ann Kelly ◽

Naomi Wright

Keyword(s):

Systematic Review ◽

Health Outcomes ◽

Low Income ◽

Congenital Anomalies ◽

Antenatal Diagnosis ◽

Risk Of Bias ◽

Cochrane Library ◽

Middle Income ◽

Antenatal Ultrasound ◽

Middle Income Countries

IntroductionCongenital anomalies are the fifth leading cause of mortality in children under 5 years globally. The greatest burden is faced by those in developing countries, where over 95% of deaths occur. Many of these deaths may have been preventable through antenatal diagnosis and early intervention. This study aims to conduct a systematic review that investigates the use of antenatal ultrasound to diagnose congenital anomalies and improve the health outcomes of infants in low-income and middle-income countries (LMICs).Methods and analysisA systematic literature review will be conducted using three search strings: (1) structural congenital anomalies, (2) LMICs and (3) antenatal diagnosis. Four electronic databases will be searched: MEDLINE, Embase, PubMed and the Cochrane Library. Title, abstract and full-text screening will be undertaken in duplicate by two reviewers independently using Covidence. Consensus will be sought from the wider authorship for discrepancies. Data extraction will be undertaken by the principal investigator. The primary analysis will focus on the availability and effectiveness of antenatal ultrasound for structural congenital anomalies. Secondary outcomes will include neonatal morbidity and mortality, termination rates and referral rates for further antenatal care. Descriptive statistics and a narrative synthesis will be included in the final report. The methodological quality of the included studies will be evaluated using the Cochrane-approved Risk of Bias for Non-Randomised Studies of Intervention and Risk of Bias in Randomised Trials V.2.0 tools.Ethics and disseminationEthical approval is not required for conducting the systematic review as there will be no direct collection of data from individuals. The results will be submitted for publication in a scientific journal and presented internationally.ConclusionThis is the first study, to our knowledge, to systematically review current literature on the use of antenatal ultrasound for the detection of congenital anomalies in LMICs. This is vital to define current practice, highlight global disparities and evaluate effects on health outcomes for infants in low-resource settings.PROSPERO registration numberCRD42019105620.

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