scholarly journals Distributional impact of the Malawian Essential Health Package

2020 ◽  
Vol 35 (6) ◽  
pp. 646-656
Author(s):  
Matthias Arnold ◽  
Dominic Nkhoma ◽  
Susan Griffin
Keyword(s):  
Population Health ◽  
Health Inequality ◽  
Census Data ◽  
Health Benefits ◽  
Health Gain ◽  
Health Coverage ◽  
Potential Health ◽  
Middle Income ◽  
The Impact ◽  
Benefits Package

Abstract In low- and middle-income countries (LMICs), making the best use of scarce resources is essential to achieving universal health coverage. The design of health benefits packages creates the opportunity to select interventions on the basis of explicit objectives. Distributional cost-effectiveness analysis (DCEA) provides a framework to evaluate interventions based on two objectives: increasing population health and reducing health inequality. We conduct aggregate DCEA of potential health benefits package interventions to demonstrate the feasibility of this approach in LMICs, using the case of the Malawian health benefits package. We use publicly available survey and census data common to LMICs and describe what challenges we encountered and how we addressed them. We estimate that diseases targeted by the health benefits package are most prevalent in the poorest population quintile and least prevalent in the richest quintile. The survey data we use indicate socioeconomic patterns in intervention uptake that diminish the population health gain and inequality reduction from the package. We find that a similar set of interventions would be prioritized when impact on health inequality is incorporated alongside impact on overall population health. However, conclusions about the impact of individual interventions on health inequalities are sensitive to assumptions regarding the health opportunity cost, the utilization of interventions, the distribution of diseases across population groups and the level of aversion to inequality. Our results suggest that efforts to improve access to the Essential Health Package could be targeted to specific interventions to improve the health of the poorest fastest but that identifying these interventions is uncertain. This exploratory work has shown the potential for applying the DCEA framework to inform health benefits package design within the LMIC setting and to provide insight into the equity impact of a health benefits package.

scholarly journals Evaluating medical education regulation changes in Brazil: workforce impact

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Alexandre Medeiros Figueiredo ◽  
Danette Waller McKinley ◽  
Adriano Massuda ◽  
George Dantas Azevedo
Keyword(s):  
Medical Education ◽  
Public Schools ◽  
Low Income ◽  
School Enrollment ◽  
Health Coverage ◽  
Continuous Assessment ◽  
Middle Income ◽  
Unified Health System ◽  
Medical Undergraduate ◽  
The Impact

Abstract Background Shortages and inequitable distribution of physicians is an obstacle to move towards Universal Health Coverage, especially in low-income and middle-income countries. In Brazil, expansion of medical school enrollment, curricula changes and recruitment programs were established to increase the number of physicians in underserved areas. This study seeks to analyze the impact of these measures in reduce inequities in access to medical education and physicians’ distribution. Methods This is an observational study that analyzes changes in the number of undergraduate medical places and number of physicians per inhabitants in different areas in Brazil between the years 2010 and 2018. Data regarding the number of undergraduate medical places, number and the practice location of physicians were obtained in public databases. Municipalities with less than 20,000 inhabitants were considered underserved areas. Data regarding access to antenatal visits were analyzed as a proxy for impact in access to healthcare. Results From 2010 to 2018, 19,519 new medical undergraduate places were created which represents an increase of 120.2%. The increase in the number of physicians engaged in the workforce throughout the period was 113,702 physicians, 74,771 of these physicians in the Unified Health System. The greatest increase in the physicians per 1000 inhabitants ratio in the municipalities with the smallest population, the lowest Gross Domestic Product per capita and in those located in the states with the lowest concentration of physicians occurred in the 2013–2015 period. Increase in physician supply improved access to antenatal care. Conclusions There was an expansion in the number of undergraduate medical places and medical workforce in all groups of municipalities assessed in Brazil. Medical undergraduate places expansion in the federal public schools was more efficient to reduce regional inequities in access to medical education than private sector expansion. The recruitment component of More Doctors for Brazil Program demonstrated effectiveness to increase the number of physicians in underserved areas. Our results indicate the importance of public policies to face inequities in access to medical education and physician shortages and the necessity of continuous assessment during the period of implementation, especially in the context of political and economic changes.

scholarly journals The Potential Therapeutic Value of Medicinal Plants in the Management of Metabolic Disorders

Molecules ◽  
2020 ◽  
Vol 25 (11) ◽  
pp. 2669 ◽  
Author(s):  
Trevor T. Nyakudya ◽  
Thulani Tshabalala ◽  
Rachael Dangarembizi ◽  
Kennedy H. Erlwanger ◽  
Ashwell R. Ndhlala
Keyword(s):  
Risk Factors ◽  
Medicinal Plants ◽  
South African ◽  
Health Benefits ◽  
Well Being ◽  
High Energy ◽  
Biologically Active ◽  
Potential Health ◽  
Increased Risk ◽  
The Impact

Metabolic syndrome (MetS) is a prevalent, multifactorial and complex disease that is associated with an increased risk of developing diabetes and other major cardiovascular complications. The rise in the global prevalence of MetS has been attributed to genetic, epigenetic, and environmental factors. The adoption of sedentary lifestyles that are characterized by low physical activity and the consumption of high-energy diets contributes to MetS development. Current management criteria for MetS risk factors involve changes in lifestyle and the use of pharmacological agents that target specific biochemical pathways involved in the metabolism of nutrients. Pharmaceutical drugs are usually expensive and are associated with several undesirable side effects. Alternative management strategies of MetS risk factors involve the use of medicinal plants that are considered to have multiple therapeutic targets and are easily accessible. Medicinal plants contain several different biologically active compounds that provide health benefits. The impact of phytochemicals present in local medicinal plants on sustainable health and well-being of individuals has been studied for many years and found to involve a plethora of complex biochemical, metabolic, and physiological mechanisms. While some of these phytochemicals are the basis of mainstream prescribed drugs (e.g., metformin, reserpine, quinine, and salicin), there is a need to identify more medicinal plants that can be used for the management of components of MetS and to describe their possible mechanisms of action. In this review, we assess the potential health benefits of South African ethnomedicinal plants in protecting against the development of health outcomes associated with MetS. We aim to provide the state of the current knowledge on the use of medicinal plants and their therapeutically important phytochemicals by discussing the current trends, with critical examples from recent primary references of how medicinal plants are being used in South African rural and urban communities.

scholarly journals Development and Characterization of a Pilot-Scale Model Cocoa Fermentation System Suitable for Studying the Impact of Fermentation on Putative Bioactive Compounds and Bioactivity of Cocoa

Foods ◽  
2019 ◽  
Vol 8 (3) ◽  
pp. 102 ◽  
Author(s):  
Kathryn Racine ◽  
Andrew Lee ◽  
Brian Wiersema ◽  
Haibo Huang ◽  
Joshua Lambert ◽  
...  
Keyword(s):  
Bioactive Compounds ◽  
Large Scale ◽  
Health Benefits ◽  
Pilot Scale ◽  
Model System ◽  
Scale Model ◽  
Cocoa Beans ◽  
Total Polyphenols ◽  
Potential Health ◽  
The Impact

Cocoa is a concentrated source of dietary flavanols—putative bioactive compounds associated with health benefits. It is known that fermentation and roasting reduce levels of native flavonoids in cocoa, and it is generally thought that this loss translates to reduced bioactivity. However, the mechanisms of these losses are poorly understood, and little data exist to support this paradigm that flavonoid loss results in reduced health benefits. To further facilitate large-scale studies of the impact of fermentation on cocoa flavanols, a controlled laboratory fermentation model system was increased in scale to a large (pilot) scale system. Raw cocoa beans (15 kg) were fermented in 16 L of a simulated pulp media in duplicate for 168 h. The temperature of the fermentation was increased from 25–55 °C at a rate of 5 °C/24 h. As expected, total polyphenols and flavanol levels decreased as fermentation progressed (a loss of 18.3% total polyphenols and 14.4% loss of total flavanols during fermentation) but some increases were observed in the final timepoints (120–168 h). Fermentation substrates, metabolites and putative cocoa bioactive compounds were monitored and found to follow typical trends for on-farm cocoa heap fermentations. For example, sucrose levels in pulp declined from >40 mg/mL to undetectable at 96 h. This model system provides a controlled environment for further investigation into the potential for optimizing fermentation parameters to enhance the flavanol composition and the potential health benefits of the resultant cocoa beans.

scholarly journals 'Health Benefits Package': a centerpiece of Universal Health Coverage

2018 ◽  
Vol 24 (4) ◽  
pp. 405-406
Author(s):  
Zafar Mirza ◽  
◽  
Awad Mataria ◽  
Hassan Salah ◽  
Gulin Gedik ◽  
...  
Keyword(s):  
Universal Health Coverage ◽  
Health Benefits ◽  
Health Coverage ◽  
Universal Health ◽  
Benefits Package

scholarly journals Geographic barriers to establishing a successful hospital referral system in rural Madagascar

2021 ◽  
Vol 6 (12) ◽  
pp. e007145
Author(s):  
Felana Angella Ihantamalala ◽  
Matthew H Bonds ◽  
Mauricianot Randriamihaja ◽  
Luc Rakotonirina ◽  
Vincent Herbreteau ◽  
...  
Keyword(s):  
Underserved Populations ◽  
Travel Speed ◽  
Climatic Conditions ◽  
Health System Strengthening ◽  
Health Coverage ◽  
Remotely Sensed Data ◽  
Middle Income ◽  
Hospital Referral ◽  
Prehospital Time ◽  
The Impact

BackgroundThe provision of emergency and hospital care has become an integral part of the global vision for universal health coverage. To strengthen secondary care systems, we need to accurately understand the time necessary for populations to reach a hospital. The goal of this study was to develop methods that accurately estimate referral and prehospital time for rural districts in low and middle-income countries. We used these estimates to assess how local geography can limit the impact of a strengthened referral programme in a rural district of Madagascar.MethodsWe developed a database containing: travel speed by foot and motorised vehicles in Ifanadiana district; a full mapping of all roads, footpaths and households; and remotely sensed data on terrain, land cover and climatic characteristics. We used this information to calibrate estimates of referral and prehospital time based on the shortest route algorithms and statistical models of local travel speed. We predict the impact on referral numbers of strategies aimed at reducing referral time for underserved populations via generalised linear mixed models.ResultsAbout 10% of the population lived less than 2 hours from the hospital, and more than half lived over 4 hours away, with variable access depending on climatic conditions. Only the four health centres located near the paved road had referral times to the hospital within 1 hour. Referral time remained the main barrier limiting the number of referrals despite health system strengthening efforts. The addition of two new referral centres is estimated to triple the population living within 2 hours from a centre with better emergency care capacity and nearly double the number of expected referrals.ConclusionThis study demonstrates how adapting geographic accessibility modelling methods to local scales can occur through improving the precision of travel time estimates and pairing them with data on health facility use.

Revealing new leads for the impact of galacto-oligosaccharides on gut commensals and gut health benefits through text mining

2020 ◽  
Vol 11 (3) ◽  
pp. 283-302
Author(s):  
A.M. Sijbers ◽  
R.J.W. Schoemaker ◽  
A. Nauta ◽  
W. Alkema
Keyword(s):  
Text Mining ◽  
Health Effects ◽  
Health Benefits ◽  
Large Set ◽  
Gut Health ◽  
Potential Health ◽  
Beneficial Effects ◽  
Bifidobacterium Species ◽  
The Impact ◽  
Insight Into

Galacto-oligosaccharides (GOS) are linked to various health benefits, such as the relief of symptoms of constipation. Part of the beneficial effects of GOS are thought to be the consequence of their bifidogenic effect, stimulating the growth of several Bifidobacterium species in vivo. However, GOS may exert additional effects by directly stimulating other bacterial species or by effects that bifidobacteria may have on other commensals in the gut. To get a better insight into the potential health effects induced by GOS, a good understanding of the gut ecosystem, the role of GOS and bifidobacteria is important. An increasing number of 16S DNA profiling and metagenomics studies have led to an expanding inventory of genera, species and strains that can be found in the human gut. To investigate the potential connection of these commensals with GOS and bifidobacteria, we have undertaken a text-mining study to chart the literature landscape around these commensals. To this end, we created controlled vocabularies describing GOS, a large set of gut commensals and a number of terms related to gut health, which were used to mine the entire MEDLINE database. Co-occurrence text-mining revealed that a large number of commensals found in the gut have a connection with Bifidobacterium species and with gut health effects. Word frequency analysis provided more insight into the functional nature of these relationships. Combined co-occurrence search results pointed to putative novel health benefits indirectly linked to bifidobacteria and GOS. The potential beneficial effects of GOS on the protection of epithelial function and epithelial barrier impairment and appendicitis are interesting novel leads. The text-mining approach reported here revealed a number of novel leads through which GOS could exert health effects and that could be investigated in dedicated studies.

Public health priorities in countries undergoing economic transition

2021 ◽  
pp. 47-62
Author(s):  
Stephen Tollman ◽  
Jessica Price
Keyword(s):  
Economic Transition ◽  
Health Priorities ◽  
Intersectoral Collaboration ◽  
Health Coverage ◽  
Middle Income ◽  
Demographic Transitions ◽  
Middle Income Countries ◽  
Impact Of Urbanization ◽  
The Life Course ◽  
The Impact

This chapter starts by reviewing the relationship between the economy and health, looking at changes in health outcome as income increases, demographic transitions related to economic growth, and the impact of urbanization on health outcomes. It then reviews major health challenges facing middle-income countries (MICs), including the triple burden of disease, multimorbidity, mental health across the life course, and the impacts of migration, climate change, and antimicrobial resistance. Finally, it discusses health system challenges and the importance of building resilient and ‘learning’ health systems with the agility to adapt to meet MICs’ evolving health needs. We discuss strategies to achieve universal health coverage in MICs and the importance of intersectoral collaboration in promoting health.

scholarly journals Exploring the relationship between exposure to technological and gastrointestinal stress and probiotic functional properties of lactobacilli and bifidobacteria

2016 ◽  
Vol 62 (9) ◽  
pp. 715-725 ◽  
Author(s):  
O.D. Amund
Keyword(s):  
Functional Properties ◽  
Health Benefits ◽  
Stress Conditions ◽  
Probiotic Properties ◽  
Negative Effects ◽  
Potential Health ◽  
Colonization Potential ◽  
Protective Strategies ◽  
Processing And Storage ◽  
The Impact

Strains of Lactobacillus and Bifidobacterium are considered probiotic because of their associated potential health benefits. Probiotics are commonly administered orally via incorporation into food products. Microorganisms for use as probiotics encounter stress conditions, which include acid, bile, osmotic, oxidative, heat and cold stresses. These can occur during processing and storage and during passage through the gastrointestinal tract, and can affect viability. Probiotic bacteria have to remain viable to confer any health benefits. Therefore, the ability to withstand technological and gastrointestinal stresses is crucial probiotic selection criteria. While the stress tolerance mechanisms of lactobacilli and bifidobacteria are largely understood, the impact of exposure to stressful conditions on the functional properties of surviving probiotic microorganisms is not clear. This review explores the potentially positive and negative relationships between exposure to stress conditions and probiotic functional properties, such as resistance to gastric acid and bile, adhesion and colonization potential, and tolerance to antibiotics. Protective strategies can be employed to combat negative effects of stress on functional properties. However, further research is needed to ascertain synergistic relationships between exposure to stress and probiotic properties.

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