scholarly journals Country differences in transmissibility, age distribution and case-fatality of SARS-CoV-2: a global ecological analysis

2021 ◽  
Author(s):  
Caroline Favas ◽  
Prudence Jarrett ◽  
Ruwan Ratnayake ◽  
Oliver J Watson ◽  
Francesco Checchi
Keyword(s):  
Low Income ◽  
Immune Modulation ◽  
Age Distribution ◽  
Case Fatality ◽  
Outcome Data ◽  
Low Income Countries ◽  
Parasitic Infections ◽  
Ecological Design ◽  
Country Level ◽  
Co Morbidity

AbstractIntroductionSARS-CoV-2 has spread rapidly across the world yet the first pandemic waves in many low-income countries appeared milder than initially forecasted through mathematical models. Hypotheses for this observed difference include under-ascertainment of cases and deaths, country population age structure, and immune modulation secondary to exposure to endemic parasitic infections. We conducted a country-level ecological study to describe patterns in key SARS-CoV-2 outcomes by country and region and to explore possible associations of the potential explanatory factors with these outcomes.MethodsWe collected publicly available data at country level and compared them using standardisation techniques. We then explored the association between exposures and outcomes using alternative approaches: random forest (RF) regression and linear (LM) regression. We adjusted for potential confounders and plausible effect modifications.ResultsAltogether, data on the mean time-varying reproduction number (mean Rt) were available for 153 countries, but standardised averages for the age of cases and deaths and for the case-fatality ratio (CFR) could only be computed for 61, 39 and 31 countries respectively. While mean Rt was highest in the WHO Europe and Americas regions, median age of death was lower in the Africa region even after standardisation, with broadly similar CFR. Population age was strongly associated with mean Rt and the age-standardised median age of observed cases and deaths in both RF and LM models. The models highlighted other plausible roles of population density, testing intensity and co-morbidity prevalence, but yielded uncertain results as regards exposure to common parasitic infections.ConclusionsThe average age of a population seems to be an important country-level factor explaining both transmissibility and the median age of observed cases and deaths, even after age-standardisation. Potential associations between endemic infections and COVID-19 are worthy of further exploration but seem unlikely, from this analysis, to be key drivers of the variation in observed COVID-19 epidemic trends. Our study was limited by the availability of outcome data and its causally uncertain ecological design, with the observed distribution of age amongst reported cases and deaths suggesting key differences in surveillance and testing strategy and capacity by country and the representativeness of case reporting of infection. Research at subnational and individual level is needed to explore hypotheses further.

scholarly journals Using Facebook Ad Data to Track the Global Digital Gender Gap

2018 ◽  
Author(s):  
Masoomali Fatehkia ◽  
Ridhi Kashyap ◽  
Ingmar Weber
Keyword(s):  
Mobile Phone ◽  
Gender Gap ◽  
Low Income ◽  
Low Income Countries ◽  
Gender Gaps ◽  
Mobile Access ◽  
Country Level ◽  
Highly Correlated ◽  
And Gender ◽  
Official Data

Gender equality in access to the internet and mobile phones has become increasingly recognised as a development goal. Monitoring progress towards this goal however is challenging due to the limited availability of gender-disaggregated data, particularly in low-income countries. In this data sparse context, we examine the potential of a source of digital trace `big data' -- Facebook's advertisement audience estimates -- that provides aggregate data on Facebook users by demographic characteristics covering the platform's over 2 billion users to measure and `nowcast' digital gender gaps. We generate a unique country-level dataset combining `online' indicators of Facebook users by gender, age and device type, `offline' indicators related to a country's overall development and gender gaps, and official data on gender gaps in internet and mobile access where available. Using this dataset, we predict internet and mobile phone gender gaps from official data using online indicators, as well as online and offline indicators. We find that the online Facebook gender gap indicators are highly correlated with official statistics on internet and mobile phone gender gaps. For internet gender gaps, models using Facebook data do better than those using offline indicators alone. Models combining online and offline variables however have the highest predictive power. Our approach demonstrates the feasibility of using Facebook data for real-time tracking of digital gender gaps. It enables us to improve geographical coverage for an important development indicator, with the biggest gains made for low-income countries for which existing data are most limited.

scholarly journals Intestinal Perforations Associated With a High Mortality and Frequent Complications During an Epidemic of Multidrug-resistant Typhoid Fever in Blantyre, Malawi

2020 ◽  
Vol 71 (Supplement_2) ◽  
pp. S96-S101
Author(s):  
Franziska Olgemoeller ◽  
Jonathan J Waluza ◽  
Dalitso Zeka ◽  
Jillian S Gauld ◽  
Peter J Diggle ◽  
...  
Keyword(s):  
Typhoid Fever ◽  
Low Income ◽  
Intestinal Perforation ◽  
Bowel Perforation ◽  
Temporal Trends ◽  
Case Fatality ◽  
Salmonella Typhi ◽  
Outcome Data ◽  
Morbidity And Mortality ◽  
Abdominal Viscus

Abstract Background Typhoid fever remains a major source of morbidity and mortality in low-income settings. Its most feared complication is intestinal perforation. However, due to the paucity of diagnostic facilities in typhoid-endemic settings, including microbiology, histopathology, and radiology, the etiology of intestinal perforation is frequently assumed but rarely confirmed. This poses a challenge for accurately estimating burden of disease. Methods We recruited a prospective cohort of patients with confirmed intestinal perforation in 2016 and performed enhanced microbiological investigations (blood and tissue culture, plus tissue polymerase chain reaction [PCR] for Salmonella Typhi). In addition, we used a Poisson generalized linear model to estimate excess perforations attributed to the typhoid epidemic, using temporal trends in S. Typhi bloodstream infection and perforated abdominal viscus at Queen Elizabeth Central Hospital from 2008–2017. Results We recruited 23 patients with intraoperative findings consistent with intestinal perforation. 50% (11/22) of patients recruited were culture or PCR positive for S. Typhi. Case fatality rate from typhoid-associated intestinal perforation was substantial at 18% (2/11). Our statistical model estimates that culture-confirmed cases of typhoid fever lead to an excess of 0.046 perforations per clinical typhoid fever case (95% CI, .03–.06). We therefore estimate that typhoid fever accounts for 43% of all bowel perforation during the period of enhanced surveillance. Conclusions The morbidity and mortality associated with typhoid abdominal perforations are high. By placing clinical outcome data from a cohort in the context of longitudinal surgical registers and bacteremia data, we describe a valuable approach to adjusting estimates of the burden of typhoid fever.

The World Bank and Educational Assistance

2017 ◽  
Author(s):  
D. Brent Edwards ◽  
Inga Storen
Keyword(s):  
Education Reform ◽  
World Bank ◽  
Low Income ◽  
Technical Assistance ◽  
International Political Economy ◽  
Low Income Countries ◽  
Educational Assistance ◽  
Country Level ◽  
The World Bank ◽  
The World

Since the 1950s, the World Bank’s involvement and influence in educational assistance has increased greatly. The World Bank has not only been a key player, but, at times, has been the dominant international organization working with low-income countries to reform their education systems. Given the contributions that education makes to country development, the World Bank works in the realm of education as part of its broad mission to reduce poverty and to increase prosperity. This work takes the form of financing, technical assistance and knowledge production (among others) and occurs at multiple levels, as the World Bank seeks to contribute to country development and to shape the global conversation around the purposes and preferred models of education reform, in addition to engaging in international processes and politics with other multi- and bilateral organizations. The present article examines the work of the World Bank in historical perspective in addition to discussing how the role of this institution has been theorized and research by scholars. Specifically, the first section provides an overview of this institution’s history with a focus on how the leadership, preferred policies, organizational structure, lending, and larger politics to which it responds have changed over time, since the 1940s. Second, the article addresses the ways that the World Bank is conceptualized and approached by scholars of World Culture Theory, international political economy, and international relations. The third section contains a review of research on (a) how the World Bank is involved in educational policy making at the country level, (b) the ways the World Bank engages with civil society and encourages its general participation in educational assistance, (c) what is known about the World Bank in relation to policy implementation, and (d) the production of research in and on the Bank.

scholarly journals Access to Controlled Medicines in Low-Income Countries: Listening to Stakeholders in the Field

2020 ◽  
pp. 002073142090674
Author(s):  
Agnes Vitry ◽  
Gilles Forte ◽  
Jason White
Keyword(s):  
Low Income ◽  
Low Income Countries ◽  
Structured Interviews ◽  
African Countries ◽  
Country Level ◽  
Written Information ◽  
Health Authorities ◽  
Psychotropic Medicines ◽  
Republic Of The Congo ◽  
International Conventions

Little is known on current practices and challenges associated with the legal trade of medicines controlled under international conventions in low-income countries. This qualitative survey involved semi-structured interviews of stakeholders engaged in the trade of controlled medicines at a global level or at a country level in 3 African countries (Uganda, Kenya, Democratic Republic of the Congo). Nine interviews were conducted, including 3 international wholesalers, 2 relief organizations, 2 procurement officers, and 2 regulatory officers. Additionally, 4 other participants provided written information. All participants consistently reported that the current process of procuring controlled medicines in compliance with international conventions was long and complex given the number of administrative steps required for obtaining export and import authorizations, which are mandatory for both narcotic and psychotropic medicines. It may be difficult or impossible to obtain import authorizations from some health authorities in low-income countries because of long delays, mistakes in forms, absence or shortage of staff, or when annual national estimates are exceeded. The complexities of the trade of controlled medicines directly contribute to the lack of access to essential controlled medicines, both narcotics and psychotropics, in low-income countries.

scholarly journals Prevalence of Intestinal Parasitic Infections and Associated Risk Factors among the First-Cycle Primary Schoolchildren in Sasiga District, Southwest Ethiopia

2020 ◽  
Vol 2020 ◽  
pp. 1-13
Author(s):  
Baye Sitotaw ◽  
Wakgari Shiferaw
Keyword(s):  
Risk Factors ◽  
Low Income ◽  
Family Income ◽  
Low Income Countries ◽  
Personal Hygiene ◽  
Parasitic Infections ◽  
Intestinal Parasitic Infections ◽  
Southwest Ethiopia ◽  
Primary Schoolchildren ◽  
Associated Risk Factors

Intestinal parasitic infections (IPIs) have been major public health burdens in low-income countries like Ethiopia. Studies in different areas of Ethiopia have shown a high prevalence of IPIs in poor families. A similar study has not been conducted in Sasiga District given that the area is possibly at high-risk of IPIs due to the prevailing risk factors. This study is aimed at assessing the prevalence of IPIs and associated risk factors among schoolchildren in Sasiga District, southwest Ethiopia. A school-based cross-sectional study was conducted from December 2018 to March 2019 to estimate the prevalence of IPIs and associated risk factors among the study participants. A total of 383 children were selected using resident-type and grade-level stratified systematic random sampling technique. Stool samples were examined microscopically using direct wet mount and formal-ether concentration techniques. A structured questionnaire was used to get information on the associated risk factors. Data were analyzed using SPSS version 20 and p value of ≤0.05 was taken as statistically significant. The overall prevalence of IPIs among the children was 62.4% (239/383). Single, double, and triple infections were 49.9%, 10.7%, and 1.83%, respectively. Residence, family income, place of defecation, source of drinking water, shoe-wearing habit, handwashing habit after toilet use, ways of waste disposal, and cleanliness of fingernail were the most important predictors of IPIs (p<0.05). Ascaris lumbricoides (22.7% (87/383)) and hookworms (20.6% (79/383)) were the most prevalent parasites, followed by Entamoeba histolytica (8.1%), Trichuris trichiura (7.6%), Giardia intestinalis (6.5%), Hymenolepis nana (5.7%), and Schistosoma mansoni (4.4%), in that order. Sasiga District primary schoolchildren are likely at a high burden of IPIs. Intensive health education on personal hygiene and environmental sanitation is needed.

scholarly journals Acute respiratory distress syndrome

2017 ◽  
Vol 26 (144) ◽  
pp. 160116 ◽  
Author(s):  
Marco Confalonieri ◽  
Francesco Salton ◽  
Francesco Fabiano
Keyword(s):  
Risk Factors ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Low Income ◽  
Distress Syndrome ◽  
Plasma Concentrations ◽  
Outcome Data ◽  
Low Income Countries ◽  
Resource Setting

Since its first description, the acute respiratory distress syndrome (ARDS) has been acknowledged to be a major clinical problem in respiratory medicine. From July 2015 to July 2016 almost 300 indexed articles were published on ARDS. This review summarises only eight of them as an arbitrary overview of clinical relevance: definition and epidemiology, risk factors, prevention and treatment. A strict application of definition criteria is crucial, but the diverse resource-setting scenarios foster geographic variability and contrasting outcome data. A large international multicentre prospective cohort study including 50 countries across five continents reported that ARDS is underdiagnosed, and there is potential for improvement in its management. Furthermore, epidemiological data from low-income countries suggest that a revision of the current definition of ARDS is needed in order to improve its recognition and global clinical outcome. In addition to the well-known risk-factors for ARDS, exposure to high ozone levels and low vitamin D plasma concentrations were found to be predisposing circumstances. Drug-based preventive strategies remain a major challenge, since two recent trials on aspirin and statins failed to reduce the incidence in at-risk patients. A new disease-modifying therapy is awaited: some recent studies promised to improve the prognosis of ARDS, but mortality and disabling complications are still high in survivors in intensive care.

scholarly journals Prevalence of Soil-Transmitted Helminthiases and Schistosomiasis in Preschool Age Children in Mwea Division, Kirinyaga South District, Kirinyaga County, and Their Potential Effect on Physical Growth

2017 ◽  
Vol 2017 ◽  
pp. 1-12 ◽  
Author(s):  
Stephen Sifuna Wefwafwa Sakari ◽  
Amos K. Mbugua ◽  
Gerald M. Mkoji
Keyword(s):  
Low Income ◽  
Intestinal Parasites ◽  
Preschool Age ◽  
Physical Growth ◽  
Low Income Countries ◽  
Intestinal Helminth ◽  
Parasitic Infections ◽  
Anthropometric Indices ◽  
Intestinal Parasitic Infections ◽  
Preschool Age Children

Intestinal parasitic infections can significantly contribute to the burden of disease, may cause nutritional and energetic stress, and negatively impact the quality of life in low income countries of the world. This cross-sectional study done in Mwea irrigation scheme, in Kirinyaga, central Kenya, assessed the public health significance of soil-transmitted helminthiases (STH), schistosomiasis, and other intestinal parasitic infections, among 361 preschool age children (PSAC) through fecal examination, by measuring anthropometric indices, and through their parents/guardians, by obtaining sociodemographic information. Both intestinal helminth and protozoan infections were detected, and, among the soil-transmitted helminth parasites, there were Ascaris lumbricoides (prevalence, 3%), Ancylostoma duodenale (<1%), and Trichuris trichiura (<1%). Other intestinal helminths were Hymenolepis nana (prevalence, 3.6%) and Enterobius vermicularis (<1%). Schistosoma mansoni occurred at a prevalence of 5.5%. Interestingly, the protozoan, Giardia lamblia (prevalence, 14.7%), was the most common among the PSAC. Other protozoans were Entamoeba coli (3.9%) and Entamoeba histolytica (<1). Anthropometric indices showed evidence of malnutrition. Intestinal parasites were associated with hand washing behavior, family size, water purification, and home location. These findings suggest that G. lamblia infection and malnutrition may be significant causes of ill health among the PSAC in Mwea, and, therefore, an intervention plan is needed.

scholarly journals COVID-19, Australia: Epidemiology Report 15: Reporting week to 2359 AEST 10 May 2020

2020 ◽  
Vol 44 ◽  
Author(s):  
Keyword(s):  
Public Health ◽  
Low Income ◽  
Case Fatality Rate ◽  
Case Fatality ◽  
International Travel ◽  
Low Income Countries ◽  
Fatality Rate ◽  
Public Health Action ◽  
The Past ◽  
Global Rate

Confirmed cases in Australia notified up to 10 May 2020: notifications = 6,971; deaths = 98. The incidence of new cases of COVID-19 has reduced dramatically since a peak in mid-march. The reduction in international travel, social distancing measures and public health action have likely been effective in slowing the spread of the disease, in the Australian community. Cases of COVID-19 continue to be notified by jurisdictions, albeit at a slowed rate. Testing rates over the past week have increased markedly, with a very low proportion of people testing positive. These low rates of detection are indicative of low levels of COVID-19 transmission. It is important that testing rates and community adherence to public health measures remain high to support the continued suppression of the virus, particularly in vulnerable high-risk groups and settings. In the past reporting week new cases in Australia are mostly considered to be locally acquired, consistent with the drop in international travel. Most locally-acquired cases can be linked back to a known case or cluster. Although the proportion of locally-acquired cases has increased, the overall rate of cases, regardless of place of acquisition, continues to decrease. The crude case fatality rate in Australia remains low (1.4%), compared with the WHO reported global rate (6.9%). The low case fatality rate is likely reflective of high case detection and high quality of health care services in Australia. Deaths from COVID-19 in Australia have occurred predominantly among the elderly and those with comorbidities, with no deaths occurring in those under 40 years. The highest rate of COVID-19 continues to be among people aged 60-79 years, with a third of these cases associated with several outbreaks linked to cruise ships. The lowest rate of disease is in young children, a pattern reflected in international reports. Internationally, cases continue to increase, with some areas such as Brazil and India showing a dramatic rise in reported cases. Although some low-income countries have currently reported few cases, it is possible that this is due to limited diagnostic and public health capacity, and may not be reflective of disease occurrence.

scholarly journals Levels of domain-specific physical activity at work, in the household, for travel and for leisure among 327 789 adults from 104 countries

2020 ◽  
Vol 54 (24) ◽  
pp. 1488-1497 ◽  
Author(s):  
Tessa Strain ◽  
Katrien Wijndaele ◽  
Leandro Garcia ◽  
Melanie Cowan ◽  
Regina Guthold ◽  
...  
Keyword(s):  
Physical Activity ◽  
Low Income ◽  
Vigorous Physical Activity ◽  
Age Groups ◽  
World Health ◽  
Low Income Countries ◽  
Domain Specific ◽  
Country Level ◽  
Household Travel ◽  
Health Organization

ObjectiveTo compare the country-level absolute and relative contributions of physical activity at work and in the household, for travel, and during leisure-time to total moderate-to-vigorous physical activity (MVPA).MethodsWe used data collected between 2002 and 2019 from 327 789 participants across 104 countries and territories (n=24 low, n=34 lower-middle, n=30 upper-middle, n=16 high-income) from all six World Health Organization (WHO) regions. We calculated mean min/week of work/household, travel and leisure MVPA and compared their relative contributions to total MVPA using Global Physical Activity Questionnaire data. We compared patterns by country, sex and age group (25–44 and 45–64 years).ResultsMean MVPA in work/household, travel and leisure domains across the 104 countries was 950 (IQR 618–1198), 327 (190–405) and 104 (51–131) min/week, respectively. Corresponding relative contributions to total MVPA were 52% (IQR 44%–63%), 36% (25%–45%) and 12% (4%–15%), respectively. Work/household was the highest contributor in 80 countries; travel in 23; leisure in just one. In both absolute and relative terms, low-income countries tended to show higher work/household (1233 min/week, 57%) and lower leisure MVPA levels (72 min/week, 4%). Travel MVPA duration was higher in low-income countries but there was no obvious pattern in the relative contributions. Women tended to have relatively less work/household and more travel MVPA; age groups were generally similar.ConclusionIn the largest domain-specific physical activity study to date, we found considerable country-level variation in how MVPA is accumulated. Such information is essential to inform national and global policy and future investments to provide opportunities to be active, accounting for country context.

Clostridium Tetani and Tetanus

2021 ◽  
Author(s):  
Collins Ankunda
Keyword(s):  
Low Income ◽  
Universal Access ◽  
Case Fatality ◽  
High Income ◽  
Neonatal Tetanus ◽  
Low Income Countries ◽  
Immunization Programs ◽  
African Countries ◽  
Clostridium Tetani ◽  
Animal Excreta

Tetanus is acquired through exposure to the environmental spore-forming Gram-positive bacillus Clostridium tetani, which may infect human wounds and cause disease by production of an exotoxin (tetanospasmin). There is no human-to-human transmission. The disease occurs worldwide and it is sporadic in high-income countries with universal access to well-accepted immunization programs. It is more common in agricultural regions and in low-income countries where contact with animal excreta is more likely and immunization programs are inadequate. Neonatal tetanus (NNT) following unclean deliveries and poor postnatal hygiene is still responsible for the majority of tetanus cases and deaths; the majority of NNT occurs in poor Asian and African countries, whereas in high-income countries the disease is extremely rare. Three forms of clinical disease can be distinguished: the most common form is generalized tetanus, whereas local tetanus and cephalic tetanus are rare. Neonatal tetanus (NNT) is a form of generalized tetanus in newborns. The case fatality rate of tetanus is high, 3%–95% depending on age, immune- and immunization-status, form of disease, and availability of proper medical care. The efficacy of tetanus toxoid vaccines was never formally studied, but cases in adequately vaccinated subjects are extremely rare and impact data (e.g. for NNT) convincingly show high vaccine effectiveness. WHO estimates that in 2018, 25,000 newborns died from NNT, an 88% reduction from the situation in 2000.

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