Strategies used to establish palliative care in rural low- and middle-income countries: an integrative review

2020 ◽  
Vol 35 (8) ◽  
pp. 1110-1129
Author(s):  
Atsede Aregay ◽  
Margaret O’Connor ◽  
Jill Stow ◽  
Nicola Ayers ◽  
Susan Lee
Keyword(s):  
Palliative Care ◽  
Low Income ◽  
Rural Areas ◽  
Urban Areas ◽  
Care Home ◽  
Sub Saharan Africa ◽  
Integrative Review ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Abstract Globally, 40 million people need palliative care; about 69% are people over 60 years of age. The highest proportion (78%) of adults are from low- and middle-income countries (LMICs), where palliative care still developing and is primarily limited to urban areas. This integrative review describes strategies used by LMICs to establish palliative care in rural areas. A rigorous integrative review methodology was utilized using four electronic databases (Ovid MEDLINE, Ovid Emcare, Embase classic+Embase and CINAHL). The search terms were: ‘palliative care’, ‘hospice care’, ‘end of life care’, ‘home-based care’, ‘volunteer’, ‘rural’, ‘regional’, ‘remote’ and ‘developing countries’ identified by the United Nations (UN) as ‘Africa’, ‘Sub-Saharan Africa’, ‘low-income’ and ‘middle- income countries’. Thirty papers published in English from 1990 to 2019 were included. Papers were appraised for quality and extracted data subjected to analysis using a public health model (policy, drug availability, education and implementation) as a framework to describe strategies for establishing palliative care in rural areas. The methodological quality of the reviewed papers was low, with 7 of the 30 being simple programme descriptions. Despite the inclusion of palliative care in national health policy in some countries, implementation in the community was often reliant on advocacy and financial support from non-government organizations. Networking to coordinate care and medication availability near-patient homes were essential features of implementation. Training, role play, education and mentorship were strategies used to support health providers and volunteers. Home- and community-based palliative care services for rural LMICs communities may best be delivered using a networked service among health professionals, community volunteers, religious leaders and technology.

scholarly journals Does connectivity reduce gender gaps in off-farm employment? Evidence from 12 low- and middle-income countries

2021 ◽  
Author(s):  
Eva-Maria Egger ◽  
Aslihan Arslan ◽  
Emanuele Zucchini
Keyword(s):  
Young Women ◽  
Gender Gap ◽  
Rural Areas ◽  
Urban Areas ◽  
Sub Saharan Africa ◽  
Gender Gaps ◽  
Middle Income ◽  
Middle Income Countries ◽  
Entry Points ◽  
Low And Middle Income

Gender gaps in labour force participation in developing countries persist despite income growth or structural change. We assess this persistence across economic geographies within countries, focusing on youth employment in off-farm wage jobs. We combine household survey data from 12 low- and middle-income countries in Asia, Latin America, and sub-Saharan Africa with geospatial data on population density, and estimate simultaneous probit models of different activity choices across the rural-urban gradient. The gender gap increases with connectivity from rural to peri-urban areas, and disappears in high-density urban areas. In non-rural areas, child dependency does not constrain young women, and secondary education improves their access to off-farm employment. The gender gap persists for married young women independent of connectivity improvements, indicating social norm constraints. Marital status and child dependency are associated positively with male participation, and negatively with female participation; other factors such as education are show a positive association for both sexes. These results indicate entry points for policy.

scholarly journals Expanding the use of community health workers in urban settings: a potential strategy for progress towards universal health coverage

2019 ◽  
Author(s):  
Brian Wahl ◽  
Susanna Lehtimaki ◽  
Stefan Germann ◽  
Nina Schwalbe
Keyword(s):  
Health Services ◽  
Community Health ◽  
Low Income ◽  
Urban Areas ◽  
Access To Health Services ◽  
Middle Income ◽  
Urban Settings ◽  
Middle Income Countries ◽  
Access To Health ◽  
Low And Middle Income

Abstract Community health worker (CHW) programmes have been used for decades to improve access to health services in rural settings in low- and middle-income countries. With more than half of the world’s population currently living in urban areas and this population expected to grow, equitable access to health services in urban areas is critically important. To understand the extent to which CHW programmes have been successfully deployed in low-income urban settings, we conducted a review of the literature between 2000 and 2018 to identify studies evaluating and describing CHW programmes implemented fully or partially in urban or peri-urban settings. We identified 32 peer-reviewed articles that met our inclusion criteria. Benefits have been documented in several urban settings in low- and middle-income countries including those to address TB/HIV, child health, maternal health and non-communicable diseases through a variety of study designs.

scholarly journals COVID-19 preparedness—a survey among neonatal care providers in low- and middle-income countries

2021 ◽  
Author(s):  
Claus Klingenberg ◽  
◽  
Sahil K. Tembulkar ◽  
Anna Lavizzari ◽  
Charles C. Roehr ◽  
...  
Keyword(s):  
Low Income ◽  
Care Delivery ◽  
Neonatal Care ◽  
Sub Saharan Africa ◽  
World Health ◽  
Care Providers ◽  
Clinical Practices ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Abstract Objective To evaluate COVID-19 pandemic preparedness, available resources, and guidelines for neonatal care delivery among neonatal health care providers in low- and middle-income countries (LMICs) across all continents. Study design Cross-sectional, web-based survey administered between May and June, 2020. Results Of 189 invited participants in 69 LMICs, we received 145 (77%) responses from 58 (84%) countries. The pandemic provides significant challenges to neonatal care, particularly in low-income countries. Respondents noted exacerbations of preexisting shortages in staffing, equipment, and isolation capabilities. In Sub-Saharan Africa, 9/35 (26%) respondents noted increased mortality in non-COVID-19-infected infants. Clinical practices on cord clamping, isolation, and breastfeeding varied widely, often not in line with World Health Organization guidelines. Most respondents noted family access restrictions, and limited shared decision-making. Conclusions Many LMICs face an exacerbation of preexisting resource challenges for neonatal care during the pandemic. Variable approaches to care delivery and deviations from guidelines provide opportunities for international collaborative improvement.

scholarly journals Socioeconomic Factors Affecting Water Access in Rural Areas of Low and Middle Income Countries

Water ◽  
2019 ◽  
Vol 11 (2) ◽  
pp. 202 ◽  
Author(s):  
Mabel Gomez ◽  
Jordi Perdiguero ◽  
Alex Sanz
Keyword(s):  
Socioeconomic Factors ◽  
Low Income ◽  
Rural Areas ◽  
National Income ◽  
Political Stability ◽  
Water Access ◽  
Middle Income ◽  
Middle Income Countries ◽  
Development Goals ◽  
Low And Middle Income

Worldwide, 844 million people still lack access to basic drinking water, especially in the rural areas of low and middle income countries. However, considerable progress has been made in recent years due to work on the Millennium Development Goals and Sustainable Development Goals. Nevertheless, countries’ national characteristics have often impacted on this progress. This paper analyzes whether specific socioeconomic factors affect access to improved water sources in the rural areas of developing countries. In particular, we analyze access to ‘total improved’, piped on premises, as well as other improved sources of access in rural areas for low income, low-middle income, and high-middle income countries. Our results suggest that gross national income (GNI); female primary completion rate; agriculture; growth of rural population; and governance indicators, such as political stability, control of corruption, or regulatory quality are variables related to water access, although specific associations depend on the source of water and income group examined. Understanding these interrelations could be of great importance for decision makers in the water sector as well as for future research on this topic.

scholarly journals Weak surveillance and policy attention to cancer in global health: the example of Mozambique

2018 ◽  
Vol 3 (2) ◽  
pp. e000654 ◽  
Author(s):  
Cesaltina Lorenzoni ◽  
Laura Oliveras ◽  
Alba Vilajeliu ◽  
Carla Carrilho ◽  
Mamudo R Ismail ◽  
...  
Keyword(s):  
Low Income ◽  
Urban Areas ◽  
Public Health Problem ◽  
Cancer Surveillance ◽  
Sub Saharan Africa ◽  
High Morbidity ◽  
Middle Income ◽  
Cancer Burden ◽  
Middle Income Countries ◽  
Policy Attention

Cancer is an emerging public health problem in sub-Saharan Africa due to population growth, ageing and westernisation of lifestyles. The increasing burden of cancer calls for urgent policy attention to develop cancer prevention and control programmes. Cancer surveillance is an essential prerequisite. Only one in five low-income and middle-income countries have the necessary data to drive policy and reduce the cancer burden. In this piece, we use data from Mozambique over a 50-year period to illustrate cancer epidemiological trends in low-income and middle-income countries to hypothesise potential circumstances and factors that could explain changes in cancer burden and to discuss surveillance weaknesses and potential improvements. Like many low-income and middle-income countries, Mozambique faces the dual challenge of a still high morbidity and mortality due to infectious diseases in rural areas and increased incidence of cancers associated with westernisation of lifestyles in urban areas, as well as a rise of cancers related to the HIV epidemic. An increase in cancer burden and changes in the cancer profile should be expected in coming years. The Mozambican healthcare and health-information systems, like in many other low-income and middle-income countries, are not prepared to face this epidemiological transition, which deserves increasing policy attention.

scholarly journals Prevalence of COVID-19 In Rural Versus Urban Areas in a Low-Income Country: Findings from a State-Wide Study in Karnataka, India

2020 ◽  
Author(s):  
Manoj Mohanan ◽  
Anup Malani ◽  
Kaushik Krishnan ◽  
Anu Acharya
Keyword(s):  
Low Income ◽  
Rural Areas ◽  
Urban Areas ◽  
Agricultural Activity ◽  
Middle Income ◽  
Low Income Country ◽  
Rural And Urban Areas ◽  
Middle Income Countries ◽  
Rural And Urban ◽  
Order Of Magnitude

AbstractAlthough the vast majority of confirmed cases of COVID-19 are in low- and middle-income countries, there are relatively few published studies on the epidemiology of SARS-CoV-2 in these countries. The few there are focus on disease prevalence in urban areas. We conducted state-wide surveillance for COVID-19, in both rural and urban areas of Karnataka between June 15-August 29, 2020. We tested for both viral RNA and antibodies targeting the receptor binding domain (RBD). Adjusted seroprevalence across Karnataka was 46.7% (95% CI: 43.3-50.0), including 44.1% (95% CI: 40.0-48.2) in rural and 53.8% (95% CI: 48.4-59.2) in urban areas. The proportion of those testing positive on RT-PCR, ranged from 1.5 to 7.7% in rural areas and 4.0 to 10.5% in urban areas, suggesting a rapidly growing epidemic. The relatively high prevalence in rural areas is consistent with the higher level of mobility measured in rural areas, perhaps because of agricultural activity. Overall seroprevalence in the state implies that by August at least 31.5 million residents had been infected by August, nearly an order of magnitude larger than confirmed cases.

scholarly journals Poverty and suicide research in low- and middle-income countries: systematic mapping of literature published in English and a proposed research agenda

2016 ◽  
Vol 3 ◽  
Author(s):  
J. Bantjes ◽  
V. Iemmi ◽  
E. Coast ◽  
K. Channer ◽  
T. Leone ◽  
...  
Keyword(s):  
Low Income ◽  
Suicidal Behaviour ◽  
English Literature ◽  
Sub Saharan Africa ◽  
Low Income Countries ◽  
Systematic Mapping ◽  
Middle Income ◽  
Middle Income Countries ◽  
The Relationship ◽  
Low And Middle Income

Approximately 75% of suicides occur in low- and middle-income countries (LMICs) where rates of poverty are high. Evidence suggests a relationship between economic variables and suicidal behaviour. To plan effective suicide prevention interventions in LMICs we need to understand the relationship between poverty and suicidal behaviour and how contextual factors may mediate this relationship. We conducted a systematic mapping of the English literature on poverty and suicidal behaviour in LMICs, to provide an overview of what is known about this topic, highlight gaps in literature, and consider the implications of current knowledge for research and policy. Eleven databases were searched using a combination of key words for suicidal ideation and behaviours, poverty and LMICs to identify articles published in English between January 2004 and April 2014. Narrative analysis was performed for the 84 studies meeting inclusion criteria. Most English studies in this area come from South Asia and Middle, East and North Africa, with a relative dearth of studies from countries in Sub-Saharan Africa. Most of the available evidence comes from upper middle-income countries; only 6% of studies come from low-income countries. Most studies focused on poverty measures such as unemployment and economic status, while neglecting dimensions such as debt, relative and absolute poverty, and support from welfare systems. Most studies are conducted within a risk-factor paradigm and employ descriptive statistics thus providing little insight into the nature of the relationship. More robust evidence is needed in this area, with theory-driven studies focussing on a wider range of poverty dimensions, and employing more sophisticated statistical methods.

scholarly journals Reasons for nonuse of contraceptive methods by women with demand for contraception not satisfied: an assessment of low and middle-income countries using demographic and health surveys

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Laísa Rodrigues Moreira ◽  
Fernanda Ewerling ◽  
Aluisio J. D. Barros ◽  
Mariangela Freitas Silveira
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Reproductive Age ◽  
Demographic And Health Surveys ◽  
Contraceptive Methods ◽  
Middle Income ◽  
Health Concerns ◽  
Middle Income Countries ◽  
Low And Middle Income ◽  
Lack Of Knowledge

Abstract Background Nonuse of contraceptive methods by women in need of contraception may impact their sexual and reproductive health. The aim of this study was to describe the reasons for nonuse of contraception among women with demand for contraception not satisfied in low and middle-income countries (considering both overall countries and various subgroups of women). Methods We used the latest Demographic and Health Survey data from 47 countries. A descriptive analysis of the reasons for nonuse of contraceptive methods was performed among sexually active women with demand for contraception not satisfied. The prevalence of each reported reason was also evaluated according to marital status, woman’s age and schooling, area of residence, wealth index, and parity. Wealth-related absolute inequality for each reason was also evaluated using the Slope Index of Inequality. A pro-rich inequality pattern means that the reason is more prevalent among the richest women while a pro-poor means the reason is more common among the poorest ones. Results On average, 40.9% of women in need of contraception were not using any contraceptive methods to avoid pregnancy. Overall, the most prevalent reasons for nonuse of contraceptives were “health concerns” and “infrequent sex,” but the prevalence of each reason varied substantially across countries. Nonuse due to “opposition from others” was higher among married than unmarried women; in turn, the prevalence of nonuse due to “lack of access” or “lack of knowledge” was about two times higher in rural areas than in urban areas. Women with less schooling more often reported nonuse due to “lack of access.” Pro-rich inequality was detected for reasons “health concerns,” “infrequent sex,” and “method-related”, while the reasons “other opposed,” “fatalistic,” “lack of access,” and “lack of knowledge” were linked to patterns of pro-poor inequality. Conclusions Family planning promotion policies must take into account the different reasons for the nonuse of contraceptive methods identified in each country as well as the contextual differences regarding women of reproductive age (such as social norms and barriers that prevent women from accessing and using contraceptives).

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