scholarly journals Lower infant mortality and access to contraception reduce fertility in low- and middle-income nations

2021 ◽  
Author(s):  
Corey J. A. Bradshaw ◽  
Claire Perry ◽  
Chitra Maharani Saraswati ◽  
Melinda Judge ◽  
Jane Heyworth ◽  
...  
Keyword(s):  
Family Planning ◽  
Infant Mortality ◽  
Maternal Education ◽  
Explanatory Power ◽  
General Linear ◽  
Middle Income ◽  
Middle Income Countries ◽  
Access To Contraception ◽  
Low And Middle Income

Although average contraceptive use has increased globally in recent decades, an estimated 222 million (26%) of women of child-bearing age worldwide face an unmet need for family planning - defined as a discrepancy between fertility preferences and contraception practice, or failing to translate desires to avoid pregnancy into preventative behaviours and practices. While many studies have reported relationships between availability of contraception, infant mortality, and fertility, these relationships have not been evaluated quantitatively across a broad range of low- and middle-income countries. Using publicly available data from 46 low- and middle-income countries, we collated test and control variables in six themes: (i) availability of family planning, (ii) quality of family planning, (iii) maternal education, (iv) religion, (v) mortality, and (vi) socio-economic conditions. We predicted that higher nation-level availability/quality of family-planning services, maternal education, and wealth reduce average fertility, whereas higher infant mortality and religious adherence increase it. Given the sample size, we first constructed general linear models to test for relationships between fertility and the variables from each theme, from which we retained those with the highest explanatory power within a final general linear model set to determine the partial correlation of dominant test variables. We also applied boosted regression trees, generalised least-squares models, and a generalised linear mixed-effects models to account for non-linearity and spatial autocorrelation. On average among all countries, we found an association between all main variables and fertility, with reduced infant mortality having the strongest relationship with reduced fertility. Access to contraception was the next-highest correlate with reduced fertility, with female secondary education, home health visitations, and adherence to Catholicism having weak, if any, explanatory power. Our models suggest that decreasing infant mortality and increasing access to contraception will have the greatest effect on decreasing global fertility. We thus provide new evidence that progressing the United Nation's Sustainable Development Goals for reducing infant mortality can be accelerated by increasing access to any form of family planning.

scholarly journals Global AgeWatch Index and Insights

2020 ◽  
Author(s):  
Gibran Cruz-Martinez ◽  
Gokce Cerev
Keyword(s):  
Older People ◽  
Composite Index ◽  
Quality Data ◽  
Transformative Change ◽  
Middle Income ◽  
Middle Income Countries ◽  
Good Quality Data ◽  
Low And Middle Income

Global AgeWatch Index and Insights by HelpAge International aim to contribute to achievement of long-term transformative change in respect to ageing and the lives of older people by advocating for better production of timely and good quality data to inform policy and program response.The Global AgeWatch Index is a composite index that measures quality of life of older people, and ranks countries based on four domains – income security, health status, enabling environment and capability. The index was developed in partnership with Professor Asghar Zaidi. The index was published during 2013-2015.The Global AgeWatch Insights is a research-based advocacy tool that examines situation of older people in low- and middle-income countries, assesses availability of relevant data and evidence to support the analysis, and identification of policy actions. The Insights are produced in partnership with AARP. The reports were launched in 2018 are planned to be released every three years with a different thematic focus. The first report focuses on the inequities of the health systems in twelve low- and middle-income countries.

Pediatric Hospital Medicine and Global Health: A Fitting Niche for an Emerging Subspecialty

2021 ◽  
Author(s):  
Heather Haq ◽  
Amy R. L. Rule ◽  
Alexandra Coria ◽  
Lineo K. Thahane ◽  
Regina M. Duperval ◽  
...  
Keyword(s):  
Global Health ◽  
North American ◽  
Hospital Medicine ◽  
Essential Elements ◽  
Pediatric Hospital ◽  
Middle Income ◽  
Middle Income Countries ◽  
And Child Health ◽  
Low And Middle Income

As North American hospitals serve increasingly diverse patient populations, including recent immigrants, refugees, and returned travelers, all pediatric hospitalists (PHs) require foundational competency in global health, and a subset of PHs are carving out niches focused in global health. Pediatric hospitalists are uniquely positioned to collaborate with low- and middle-income country clinicians and child health advocates to improve the health of hospitalized children worldwide. Using the 2018 WHO standards for improving the quality of care for children and adolescents worldwide, we describe how PHs’ skills align closely with what the WHO and others have identified as essential elements to bring high-quality, sustainable care to children in low- and middle-income countries. Furthermore, North American global health hospitalists bring home expertise that reciprocally benefits their home institutions.

scholarly journals Psychological interventions for bipolar disorder in low- and middle-income countries: systematic review

BJPsych Open ◽  
2018 ◽  
Vol 4 (5) ◽  
pp. 375-384 ◽  
Author(s):  
Mekdes Demissie ◽  
Charlotte Hanlon ◽  
Rahel Birhane ◽  
Lauren Ng ◽  
Girmay Medhin ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Bipolar Disorder ◽  
Low Income ◽  
Hospital Admissions ◽  
Psychological Interventions ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

BackgroundAdjunctive psychological interventions for bipolar disorder have demonstrated better efficacy in preventing or delaying relapse and improving outcomes compared with pharmacotherapy alone.AimsTo evaluate the efficacy of psychological interventions for bipolar disorder in low- and middle-income countries.MethodA systematic review was conducted using PubMed, PsycINFO, Medline, EMBASE, Cochrane database for systematic review, Cochrane central register of controlled trials, Latin America and Caribbean Center on Health Science Literature and African Journals Online databases with no restriction of language or year of publication. Methodological heterogeneity of studies precluded meta-analysis.ResultsA total of 18 adjunctive studies were identified: psychoeducation (n = 14), family intervention (n = 1), group cognitive–behavioural therapy (CBT) (n = 2) and group mindfulness-based cognitive therapy (MBCT) (n = 1). In total, 16 of the 18 studies were from upper-middle-income countries and none from low-income countries. All used mental health specialists or experienced therapists to deliver the intervention. Most of the studies have moderately high risk of bias. Psychoeducation improved treatment adherence, knowledge of and attitudes towards bipolar disorder and quality of life, and led to decreased relapse rates and hospital admissions. Family psychoeducation prevented relapse, decreased hospital admissions and improved medication adherence. CBT reduced both depressive and manic symptoms. MBCT reduced emotional dysregulation.ConclusionsAdjunctive psychological interventions alongside pharmacotherapy appear to improve the clinical outcome and quality of life of people with bipolar disorder in middle-income countries. Further studies are required to investigate contextual adaptation and the role of non-specialists in the provision of psychological interventions to ensure scalability and the efficacy of these interventions in low-income country settings.Declaration of interestNone.

scholarly journals Reforming medical education admission and training in low- and middle-income countries: who gets admitted and why it matters

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Katherine Tumlinson ◽  
Dilshad Jaff ◽  
Barbara Stilwell ◽  
Dickens Otieno Onyango ◽  
Kenneth L. Leonard
Keyword(s):  
Medical Education ◽  
Intrinsic Motivation ◽  
Healthcare Providers ◽  
Extrinsic Factors ◽  
Middle Income ◽  
Negative Behaviors ◽  
Middle Income Countries ◽  
And Training ◽  
Low And Middle Income

AbstractRecent studies reveal public-sector healthcare providers in low- and middle-income countries (LMICs) are frequently absent from work, solicit informal payments for service delivery, and engage in disrespectful or abusive treatment of patients. While extrinsic factors may foster and facilitate these negative practices, it is not often feasible to alter the external environment in low-resource settings. In contrast, healthcare professionals with strong intrinsic motivation and a desire to serve the needs of their community are less likely to engage in these negative behaviors and may draw upon internal incentives to deliver a high quality of care. Reforming medical education admission and training practices in LMICs is one promising strategy for increasing the prevalence of medical professionals with strong intrinsic motivation.

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