scholarly journals Investigating equalisation of health inequalities during adolescence in four low-income and middle-income countries: an analysis of the Young Lives cohort study

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e022114 ◽  
Author(s):  
Joseph L Ward ◽  
Russell M Viner
Keyword(s):  
Health Inequalities ◽  
Low Income ◽  
Health Indicators ◽  
Wealth Index ◽  
Middle Income ◽  
Socioeconomic Gradients ◽  
Middle Income Countries ◽  
Multiple Health ◽  
Young Lives

ObjectiveTo investigate if socioeconomic gradients in health reduce during adolescence (the equalisation hypothesis) in four low-income and middle-income countries (LMIC).SettingAnalysis of the Young Lives Study cohorts in Ethiopia, Peru, Vietnam and India.ParticipantsA total of 3395 participants (across the four cohorts) aged 6–10 years at enrolment and followed up for 11 years.Outcomes measuredChange in income-related health inequalities from mid-childhood to late adolescence. Socioeconomic status was determined by wealth index quartile. The health indicators included were self-reported health, injuries in the previous 4 years, presence of long-term health problems, low mood, alcohol use, overweight/obesity, thinness and stunting. The relative risk of each adverse health outcome between highest and lowest wealth index quartile were compared across four waves of the study within each country.ResultsWe found steep socioeconomic gradients across multiple health indicators in all four countries. Socioeconomic gradients remained similar across all waves of the study, with no significant decrease during adolescence.ConclusionWe found no consistent evidence of equalisation for income-related health inequalities in youth in these LMIC. Socioeconomic gradients for health in these cohorts appear to persist and be equally damaging across the early life course and during adolescence.

scholarly journals Coping with healthcare costs for chronic illness in low-income and middle-income countries: a systematic literature review

2019 ◽  
Vol 4 (4) ◽  
pp. e001475 ◽  
Author(s):  
Adrianna Murphy ◽  
Catherine McGowan ◽  
Martin McKee ◽  
Marc Suhrcke ◽  
Kara Hanson
Keyword(s):  
Chronic Illness ◽  
Coping Strategies ◽  
Low Income ◽  
Financial Risk ◽  
Long Term Effects ◽  
Financial Risk Protection ◽  
Middle Income ◽  
Middle Income Countries ◽  
Risk Protection

BackgroundExperiencing illness in low-income and middle-income countries (LMICs) can incur very high out-of-pocket (OOP) payments for healthcare and, while the existing literature typically focuses on levels of expenditure, it rarely examines what happens when households do not have the necessary money. Some will adopt one or more ‘coping strategies’, such as borrowing money, perhaps at exorbitant interest rates, or selling assets, some necessary for their future income, with detrimental long-term effects. This is particularly relevant for chronic illnesses that require consistent, long-term OOP payments. We systematically review the literature on strategies for financing OOP costs of chronic illnesses in LMICs, their correlates and their impacts on households.MethodsWe searched MEDLINE, EconLit, EMBASE, Global Health and Scopus on 22 October 2018 for literature published on or after 1 January 2000. We included qualitative or quantitative studies describing at least one coping strategy for chronic illness OOP payments in a LMIC context. Our narrative review follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines.ResultsForty-seven papers were included. Studies identified coping strategies for chronic illness costs that are not traditionally addressed in financial risk protection research (eg, taking children out of school, sending them to work, reducing expenditure on food or education, quitting work to give care). Twenty studies reported socioeconomic or other correlates of coping strategies, with poorer households and those with more advanced disease more vulnerable to detrimental strategies. Only six studies (three cross-sectional and three qualitative) included evidence of impacts of coping strategies on households, including increased labour to repay debts and discontinuing treatment.ConclusionsMonitoring of financial risk protection provides an incomplete picture if it fails to capture the effect of coping strategies. This will require qualitative and longitudinal research to understand the long-term effects, especially those associated with chronic illness in LMICs.

scholarly journals 40 years after Alma-Ata, is building new hospitals in low-income and lower-middle-income countries beneficial?

2019 ◽  
Vol 3 (Suppl 3) ◽  
pp. e001293 ◽  
Author(s):  
Fanny Chabrol ◽  
Lucien Albert ◽  
Valéry Ridde
Keyword(s):  
Low Income ◽  
Environmental Sustainability ◽  
Public Hospitals ◽  
Decision Makers ◽  
Middle Income ◽  
Middle Income Countries ◽  
Geographical Inequalities ◽  
Urban Rural ◽  
Hospital Construction

Public hospitals in low-income and lower-middle-income countries face acute material and financial constraints, and there is a trend towards building new hospitals to contend with growing population health needs. Three cases of new hospital construction are used to explore issues in relation to their funding, maintenance and sustainability. While hospitals are recognised as a key component of healthcare systems, their role, organisation, funding and other aspects have been largely neglected in health policies and debates since the Alma Ata Declaration. Building new hospitals is politically more attractive for both national decision-makers and donors because they symbolise progress, better services and nation-building. To avoid the ‘white elephant’ syndrome, the deepening of within-country socioeconomic and geographical inequalities (especially urban–rural), and the exacerbation of hospital-centrism, there is an urgent need to investigate in greater depth how these hospitals are integrated into health systems and to discuss their long-term economic, social and environmental sustainability.

Tenofovir resistance in early and long-term treated patients on first-line antiretroviral therapy in eight low-income and middle-income countries

AIDS ◽  
2020 ◽  
Vol 34 (13) ◽  
pp. 1965-1969
Author(s):  
Seth C. Inzaule ◽  
Michael R. Jordan ◽  
Amandine Cournil ◽  
Amalia Girón-Callejas ◽  
Santiango Avila-Rios ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Low Income ◽  
First Line ◽  
Middle Income ◽  
Middle Income Countries

P4567Factors associated with poor adherence to medication among hypertensive patients in twelve low and middle income sub-Saharan countries

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K E Kramoh ◽  
D Macquart De Terline ◽  
J M F Damourou ◽  
C Kouam Kouam ◽  
I Ali Toure ◽  
...  
Keyword(s):  
Low Income ◽  
Wealth Index ◽  
Poor Adherence ◽  
Low Income Countries ◽  
Middle Income ◽  
Hypertensive Patients ◽  
Factors Associated ◽  
Middle Income Countries ◽  
Adherence To Medication ◽  
Sub Saharan

Abstract Background Over the past few decades, the prevalence of hypertension has dramatically increased in Sub-Saharan Africa. Poor adherence has been identified as a major cause of failure to control hypertension. Scarce data are available in Africa. Purpose We assessed adherence to medication and identified socioeconomics, clinical and treatment factors associated with low adherence among hypertensive patients in 12 sub-Saharan African countries. Methods We conducted a cross-sectional survey in urban clinics of both low and middle income countries. Data were collected by physicians on demographics, treatment and clinical data among hypertensive patients attending the clinics. Adherence was assessed by questionnaires completed by the patients. Factors associated with low adherence were investigated using logistic regression with a random effect on countries. Results There were 2198 individuals from 12 countries enrolled in the study. Overall, 678 (30.8%), 738 (33.6%), 782 (35.6%) participants had respectively low, medium and high adherence to antihypertensive medication. Multivariate analysis showed that the use of traditional medicine (OR: 2.28, 95% CI [1.79–2.90]) and individual wealth index (low vs. high wealth: OR: 1.86, 95% CI [1.35–2.56] and middle vs. high wealth: OR: 1.42, 95% CI [1.11–1.81]) were significantly and independently associated with poor adherence to medication. In stratified analysis, these differences in adherence to medication according to individual wealth index were observed in low-income countries (p<0.001) but not in middle-income countries (p=0.17). In addition, 26.5% of the patients admitted having stopped their treatment due to financial reasons and this proportion was 4 fold higher in the lowest than highest wealth group (47.8% vs 11.4%) (p<0.001). Conclusion This study revealed the high frequency of poor adherence in African patients and the associated factors. These findings should be useful for tailoring future programs to tackle hypertension in low income countries that are better adapted to patients, with a potential associated enhancement of their effectiveness. Figure 1. Percentage of patients according to their adherence level by patient wealth index stratified by country-level income.

scholarly journals COVID-19 and the ‘ethics of disruption’: Current dilemmas facing longitudinal research in low- and middle-income countries

2021 ◽  
Vol 14 (1) ◽  
pp. 205979912199422
Author(s):  
Gina Crivello ◽  
Marta Favara
Keyword(s):  
Cohort Studies ◽  
Longitudinal Research ◽  
Middle Income ◽  
Longitudinal Cohort ◽  
Middle Income Countries ◽  
Phone Survey ◽  
Observational Study Design ◽  
Low And Middle Income ◽  
Young Lives

In this piece, we draw on recent experiences from the Young Lives study to discuss some of the ethical and practical challenges facing longitudinal cohort studies in low- and middle-income countries in the time of coronavirus. We argue that COVID-19 has instigated an ‘ethics of disruption’ for social researchers across the world, and for longitudinal cohort studies like Young Lives, this requires navigating three core considerations: first, managing research relationships and reciprocity within an observational study design; second, maintaining methodological continuity and consistency across time; and third, balancing an immediate short-term response to COVID-19 against the long-term perspective. We refer to the study’s plan to implement a new COVID-19 phone survey to illustrate how the team are navigating this altered ethical terrain.

scholarly journals Integrated care for people with long-term mental and physical health conditions in low-income and middle-income countries

2019 ◽  
Vol 6 (2) ◽  
pp. 174-186 ◽  
Author(s):  
Graham Thornicroft ◽  
Shalini Ahuja ◽  
Sarah Barber ◽  
Daniel Chisholm ◽  
Pamela Y Collins ◽  
...  
Keyword(s):  
Physical Health ◽  
Integrated Care ◽  
Low Income ◽  
Health Conditions ◽  
Middle Income ◽  
Middle Income Countries ◽  
Mental And Physical Health

scholarly journals Performance-based financing in low-income and middle-income countries: isn’t it time for a rethink?

2018 ◽  
Vol 3 (1) ◽  
pp. e000664 ◽  
Author(s):  
Elisabeth Paul ◽  
Lucien Albert ◽  
Badibanga N’Sambuka Bisala ◽  
Oriane Bodson ◽  
Emmanuel Bonnet ◽  
...  
Keyword(s):  
Low Income ◽  
Health Sector ◽  
Policy Dialogue ◽  
Open Approach ◽  
Long Term Effects ◽  
Middle Income ◽  
Middle Income Countries ◽  
Performance Based Financing ◽  
Entry Points

This paper questions the view that performance-based financing (PBF) in the health sector is an effective, efficient and equitable approach to improving the performance of health systems in low-income and middle-income countries (LMICs). PBF was conceived as an open approach adapted to specific country needs, having the potential to foster system-wide reforms. However, as with many strategies and tools, there is a gap between what was planned and what is actually implemented. This paper argues that PBF as it is currently implemented in many contexts does not satisfy the promises. First, since the start of PBF implementation in LMICs, concerns have been raised on the basis of empirical evidence from different settings and disciplines that indicated the risks, cost and perverse effects. However, PBF implementation was rushed despite insufficient evidence of its effectiveness. Second, there is a lack of domestic ownership of PBF. Considering the amounts of time and money it now absorbs, and the lack of evidence of effectiveness and efficiency, PBF can be characterised as a donor fad. Third, by presenting itself as a comprehensive approach that makes it possible to address all aspects of the health system in any context, PBF monopolises attention and focuses policy dialogue on the short-term results of PBF programmes while diverting attention and resources from broader processes of change and necessary reforms. Too little care is given to system-wide and long-term effects, so that PBF can actually damage health services and systems. This paper ends by proposing entry points for alternative approaches.

scholarly journals Which public health interventions are effective in reducing morbidity, mortality and health inequalities from infectious diseases amongst children in low-income and middle-income countries (LMICs): protocol for an umbrella review

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e032981
Author(s):  
Elodie Besnier ◽  
Katie Thomson ◽  
Donata Stonkute ◽  
Talal Mohammad ◽  
Nasima Akhter ◽  
...  
Keyword(s):  
Public Health ◽  
Global Health ◽  
Infectious Diseases ◽  
Health Inequalities ◽  
Low Income ◽  
Health Interventions ◽  
Umbrella Review ◽  
Public Health Interventions ◽  
Middle Income ◽  
Middle Income Countries

IntroductionDespite significant progress in the last few decades, infectious diseases remain a significant threat to children’s health in low-income and middle-income countries. Effective means of prevention and control for these diseases exist, making any differences in the burden of these diseases between population groups or countries inequitable. Yet, gaps remain in our knowledge of the effect these public health interventions have on health inequalities in children, especially in low-income and middle-income countries. This umbrella review aims to address some of these gaps by exploring which public health interventions are effective in reducing morbidity, mortality and health inequalities from infectious diseases among children in low-income and middle-income countries.Methods and analysisAn umbrella review will be conducted to identify systematic reviews or evidence synthesis of public health interventions that reduce morbidity, mortality and/or health inequalities due to infectious diseases among children (aged under 5 years) in low-income and middle-income countries. The interventions of interest are public health interventions targeting infectious diseases or associated risk factors in children. We will search for reviews reporting health and health inequalities outcomes in and between populations. The literature search will be undertaken using the Cochrane Library, Medline, EMBASE, the CAB Global Health database, Health Evidence, the Campbell Collaboration Library of Systematic Reviews, International Initiative for Impact Evaluation Systematic review repository, Scopus, the Social Sciences Citation Index and PROSPERO. Additionally, a manual search will be performed in Google Scholar and three international organisations websites (UNICEF Office of Research—Innocenti, UNICEF, WHO) to capture grey literature. Data from the records meeting our inclusion/exclusion criteria will be collated using a narrative synthesis approach.Ethics and disseminationThis review will exclusively work with anonymous group-level information available from published reviews. No ethical approval was required.The results of the review will be submitted for publication in academic journals and presented at international public health conferences. Additionally, key findings will be summarised for dissemination to a wider policy and general public audience as part of the Centre for Global Health Inequalities Research’s policy work.PROSPERO registration numberCRD42019141673

scholarly journals Tax Composition and Growth: A Broad Cross-country Perspective

2019 ◽  
Vol 20 (4) ◽  
pp. e70-e106
Author(s):  
Santiago Acosta-Ormaechea ◽  
Sergio Sola ◽  
Jiae Yoo
Keyword(s):  
Low Income ◽  
Income Taxes ◽  
Low Income Countries ◽  
Property Taxes ◽  
Middle Income ◽  
Middle Income Countries ◽  
Long Run ◽  
Development Levels ◽  
Broad Cross Section

Abstract We investigate how changes in the composition of tax revenue affect long-run growth in a broad cross-section of countries. To do this, we construct a new dataset that covers 70 countries (23 high-, 23 middle- and 24 low-income countries), with at least 20 years of observations during the period 1970-2009. In the context of revenue-neutral reallocations, we find that increasing consumption and property taxes while reducing income taxes boosts long-term growth. Among income taxes, we find that social security contributions and personal income taxes tend to have a stronger negative association with growth relative to corporate income taxes. Results, however, depend on countries’ development levels, suggesting nonlinearities in the relation between taxes and growth even after controlling for convergence effects. Although results are robust for high- and middle-income countries, these are generally not significant for low-income countries.

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