The Household Water InSecurity Experiences (HWISE) Scale: development and validation of a household water insecurity measure for low-income and middle-income countries

ObjectiveProgress towards equitable and sufficient water has primarily been measured by population-level data on water availability. However, higher-resolution measures of water accessibility, adequacy, reliability and safety (ie, water insecurity) are needed to understand how problems with water impact health and well-being. Therefore, we developed the Household Water InSecurity Experiences (HWISE) Scale to measure household water insecurity in an equivalent way across disparate cultural and ecological settings.MethodsCross-sectional surveys were implemented in 8127 households across 28 sites in 23 low-income and middle-income countries. Data collected included 34 items on water insecurity in the prior month; socio-demographics; water acquisition, use and storage; household food insecurity and perceived stress. We retained water insecurity items that were salient and applicable across all sites. We used classical test and item response theories to assess dimensionality, reliability and equivalence. Construct validity was assessed for both individual and pooled sites using random coefficient models.FindingsTwelve items about experiences of household water insecurity were retained. Items showed unidimensionality in factor analyses and were reliable (Cronbach’s alpha 0.84 to 0.93). The average non-invariance rate was 0.03% (threshold <25%), indicating equivalence of measurement and meaning across sites. Predictive, convergent and discriminant validity were also established.ConclusionsThe HWISE Scale measures universal experiences of household water insecurity across low-income and middle-income countries. Its development ushers in the ability to quantify the prevalence, causes and consequences of household water insecurity, and can contribute an evidence base for clinical, public health and policy recommendations regarding water.

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In pursuit of ‘safe’ water: the burden of personal injury from water fetching in 21 low-income and middle-income countries

BMJ Global Health ◽

10.1136/bmjgh-2020-003328 ◽

2020 ◽

Vol 5 (10) ◽

pp. e003328

Author(s):

Vidya Venkataramanan ◽

Jo-Anne L Geere ◽

Benjamin Thomae ◽

Justin Stoler ◽

Paul R Hunter ◽

...

Keyword(s):

Low Income ◽

Injury Risk ◽

Lower Limbs ◽

Water Access ◽

Water Insecurity ◽

Middle Income ◽

Middle Income Countries ◽

Physical Context ◽

Household Water ◽

Public Health Challenge

IntroductionWater fetching for household needs can cause injury, but documentation of the burden of harm globally has been limited. We described the frequency, characteristics and correlates of water-fetching injuries in 24 sites in 21 low-income and middle-income countries in Asia, Africa and Latin America and the Caribbean.MethodsIn a survey of 6291 randomly selected households, respondents reported whether and how they had experienced water-fetching injuries. Responses were coded for injury type, mechanism, bodily location and physical context. We then identified correlates of injury using a multilevel, mixed-effects logistic regression model.ResultsThirteen per cent of respondents reported at least one water-fetching injury. Of 879 injuries, fractures and dislocations were the most commonly specified type (29.2%), and falls were the most commonly specified mechanism (76.4%). Where specified, 61.1% of injuries occurred to the lower limbs, and dangerous terrain (69.4%) was the most frequently reported context. Significant correlates included being female (aOR=1.50, 95% CI 1.15 to 1.96); rural (aOR=4.80, 95% CI 2.83 to 8.15) or periurban residence (aOR=2.75, 95% CI 1.64 to 4.60); higher household water insecurity scores (aOR=1.09, 95% CI 1.07 to 1.10) and reliance on surface water (aOR=1.97, 95% CI 1.21 to 3.22) or off-premise water sources that required queueing (aOR=1.72, 95% CI 1.19 to 2.49).ConclusionThese data suggest that water-fetching injuries are an underappreciated and largely unmeasured public health challenge. We offer guidelines for comprehensive data collection on injuries to better capture the true burden of inadequate water access. Such data can guide the design of interventions to reduce injury risk and promote equitable water access solutions.

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Household Water Insecurity Will Complicate the Ongoing COVID-19 Response: Evidence from 29 Sites in 23 Low- and Middle-Income Countries

International Journal of Hygiene and Environmental Health ◽

10.1016/j.ijheh.2021.113715 ◽

2021 ◽

pp. 113715

Author(s):

Justin Stoler ◽

Joshua D. Miller ◽

Alexandra Brewis ◽

Matthew C. Freeman ◽

Leila M. Harris ◽

...

Keyword(s):

Water Insecurity ◽

Middle Income ◽

Middle Income Countries ◽

Household Water ◽

Low And Middle Income

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Efficacy of deep learning methods for predicting under-five mortality in 34 low-income and middle-income countries

BMJ Open ◽

10.1136/bmjopen-2019-034524 ◽

2020 ◽

Vol 10 (8) ◽

pp. e034524

Author(s):

Adeyinka Emmanuel Adegbosin ◽

Bela Stantic ◽

Jing Sun

Keyword(s):

Neural Network ◽

Deep Learning ◽

Low Income ◽

Maternal Education ◽

Household Wealth ◽

Secondary Outcome ◽

Cross Sectional ◽

Middle Income ◽

Under Five ◽

Middle Income Countries

ObjectivesTo explore the efficacy of machine learning (ML) techniques in predicting under-five mortality (U5M) in low-income and middle-income countries (LMICs) and to identify significant predictors of U5M.DesignThis is a cross-sectional, proof-of-concept study.Settings and participantsWe analysed data from the Demographic and Health Survey. The data were drawn from 34 LMICs, comprising a total of n=1 520 018 children drawn from 956 995 unique households.Primary and secondary outcome measuresThe primary outcome measure was U5M; secondary outcome was comparing the efficacy of deep learning algorithms: deep neural network (DNN); convolution neural network (CNN); hybrid CNN-DNN with logistic regression (LR) for the prediction of child’s survival.ResultsWe found that duration of breast feeding, number of antenatal visits, household wealth index, postnatal care and the level of maternal education are some of the most important predictors of U5M. We found that deep learning techniques are superior to LR for the classification of child survival: LR sensitivity=0.47, specificity=0.53; DNN sensitivity=0.69, specificity=0.83; CNN sensitivity=0.68, specificity=0.83; CNN-DNN sensitivity=0.71, specificity=0.83.ConclusionOur findings provide an understanding of determinants of U5M in LMICs. It also demonstrates that deep learning models are more efficacious than traditional analytical approach.

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Job morale of physicians in low-income and middle-income countries: a systematic literature review of qualitative studies

BMJ Open ◽

10.1136/bmjopen-2018-028657 ◽

2019 ◽

Vol 9 (12) ◽

pp. e028657 ◽

Cited By ~ 1

Author(s):

Alina Sabitova ◽

Sana Zehra Sajun ◽

Sandra Nicholson ◽

Franziska Mosler ◽

Stefan Priebe

Keyword(s):

Low Income ◽

Grey Literature ◽

Well Being ◽

Analytical Framework ◽

Working Environment ◽

Reference List ◽

Middle Income ◽

Staff Shortage ◽

Middle Income Countries ◽

Context Specific

ObjectivesTo systematically review the available literature on physicians’ and dentists’ experiences influencing job motivation, job satisfaction, burnout, well-being and symptoms of depression as indicators of job morale in low-income and middle-income countries.DesignThe review was reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for studies evaluating outcomes of interest using qualitative methods. The framework method was used to analyse and integrate review findings.Data sourcesA primary search of electronic databases was performed by using a combination of search terms related to the following areas of interest: ‘morale’, ‘physicians and dentists’ and ‘low-income and middle-income countries’. A secondary search of the grey literature was conducted in addition to checking the reference list of included studies and review papers.ResultsTen papers representing 10 different studies and involving 581 participants across seven low-income and middle-income countries met the inclusion criteria for the review. However, none of the studies focused on dentists’ experiences was included. An analytical framework including four main categories was developed: work environment (physical and social), rewards (financial, non-financial and social respect), work content (workload, nature of work, job security/stability and safety), managerial context (staffing levels, protocols and guidelines consistency and political interference). The job morale of physicians working in low-income and middle-income countries was mainly influenced by negative experiences. Increasing salaries, offering opportunities for career and professional development, improving the physical and social working environment, implementing clear professional guidelines and protocols and tackling healthcare staff shortage may influence physicians’ job morale positively.ConclusionsThere were a limited number of studies and a great degree of heterogeneity of evidence. Further research is recommended to assist in scrutinising context-specific issues and ways of addressing them to maximise their utility.PROSPERO registration numberCRD42017082579.

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Older People, Mobility and Transport in Low- and Middle-Income Countries: A Review of the Research

Sustainability ◽

10.3390/su11216157 ◽

2019 ◽

Vol 11 (21) ◽

pp. 6157 ◽

Cited By ~ 4

Author(s):

Mark Gorman ◽

Sion Jones ◽

Jeffrey Turner

Keyword(s):

Older People ◽

Low Income ◽

Well Being ◽

The State ◽

Small Scale ◽

Knowledge Gaps ◽

Middle Income ◽

Middle Income Countries ◽

The Impact ◽

Low And Middle Income

Older populations are rising globally, which in high-income countries has helped to generate a growing literature on the impact of ageing on travel requirements and transport policy. This article aims to provide an initial assessment of the state of knowledge on the impact on transportation policy and usage of the increasing numbers of older people in low- and middle-income countries (LAMICs), through a review of the literature relating to older people and transportation. As both the academic and policy/practice-related literature specifically addressing ageing and transport in LAMICs is limited, the study looks beyond transportation to assess the state of knowledge regarding the ways in which older people’s mobility is affected by issues, such as health, well-being, social (dis)engagement and gender. We find significant knowledge gaps, resulting in an evidence base to support the implementation of policy is lacking. Most research in low-income countries (LICs) is either broad quantitative analysis based on national survey data or small-scale qualitative studies. We conclude that, although study of the differing contexts of ageing in LAMICs as they relate to older people’s mobilities and transport use has barely begun, institutions which both make and influence policymaking recognise the existence of significant knowledge gaps. This should provide the context in which research agendas can be established.

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Reporting of inequalities in blindness in low income and middle income countries: a review of cross sectional surveys

Clinical and Experimental Ophthalmology ◽

10.1111/ceo.13001 ◽

2017 ◽

Vol 46 (1) ◽

pp. 99-100 ◽

Cited By ~ 1

Author(s):

Jacqueline Ramke ◽

Anna Palagyi ◽

Jennifer Petkovic ◽

Clare E Gilbert

Keyword(s):

Low Income ◽

Cross Sectional ◽

Middle Income ◽

Middle Income Countries

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Universal health coverage for elderly people with non-communicable diseases in low-income and middle-income countries: a cross-sectional analysis

The Lancet ◽

10.1016/s0140-6736(14)61869-9 ◽

2014 ◽

Vol 384 ◽

pp. S6 ◽

Cited By ~ 3

Author(s):

Christine Goeppel ◽

Patricia Frenz ◽

Peter Tinnemann ◽

Linus Grabenhenrich

Keyword(s):

Elderly People ◽

Universal Health Coverage ◽

Low Income ◽

Health Coverage ◽

Cross Sectional ◽

Middle Income ◽

Non Communicable Diseases ◽

Middle Income Countries ◽

Sectional Analysis ◽

Universal Health

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Effects of integrated economic and health interventions with women’s groups on health-related knowledge, behaviours and outcomes in low-income and middle-income countries: a systematic review protocol

BMJ Open ◽

10.1136/bmjopen-2020-046856 ◽

2021 ◽

Vol 11 (7) ◽

pp. e046856

Author(s):

Sapna Desai ◽

Kala M Mehta ◽

Roopal Jyoti Singh ◽

Allie K Westley ◽

Osasuyi Dirisu ◽

...

Keyword(s):

Systematic Review ◽

Low Income ◽

Public Health Intervention ◽

Well Being ◽

Health Interventions ◽

Women's Groups ◽

Middle Income ◽

Middle Income Countries ◽

Women’S Groups ◽

Health Related

IntroductionEconomic groups, such as microfinance or self-help groups are widely implemented in low-income and middle-income countries (LMICs). Women’s groups are voluntary groups, which aim to improve the well-being of members through activities, such as joint savings, credit, livelihoods development and/or health activities. Health interventions are increasingly added on to existing women’s economic groups as a public health intervention for women and their families. Here, we present the protocol for a mixed-methods systematic review we will conduct of the evidence on integrated economic and health interventions on women’s groups to assess whether and how they improve health-related knowledge, behaviour and outcomes in LMICs.Methods and analysisWe will search seven electronic databases for published literature, along with manual searches and consultation. The review will include (1) randomised trials and non-randomised quasiexperimental studies of intervention effects of integrated economic and health interventions delivered through women’s groups in LMICs, and (2) sibling studies that examine factors related to intervention content, context, implementation processes and costs. We will appraise risk of bias and study quality using standard tools. High and moderate quality studies will be grouped by health domain and synthesised without meta-analysis. Qualitative evidence will be thematically synthesised and integrated into the quantitative synthesis using a matrix approach.Ethics and disseminationThis protocol was reviewed and deemed exempt by the institutional review board at the American Institutes for Research. Findings will be shared through peer-reviewed publication and disseminated with programme implementers and policymakers engaged with women’s groups.PROSPERO registration numberCRD42020199998.

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