scholarly journals The long term effect of pulmonary tuberculosis on income and employment in a low income, urban setting

Thorax ◽  
2020 ◽  
pp. thoraxjnl-2020-215338
Author(s):  
Jamilah Meghji ◽  
Stefanie Gregorius ◽  
Jason Madan ◽  
Fatima Chitimbe ◽  
Rachael Thomson ◽  
...  
Keyword(s):  
Low Income ◽  
Disease Onset ◽  
Treatment Completion ◽  
Well Being ◽  
Urban Setting ◽  
Financial Strain ◽  
First Episode ◽  
Health Seeking ◽  
Tb Treatment

BackgroundMitigating the socioeconomic impact of tuberculosis (TB) is key to the WHO End TB Strategy. However, little known about socioeconomic well-being beyond TB-treatment completion. In this mixed-methods study, we describe socioeconomic outcomes after TB-disease in urban Blantyre, Malawi, and explore pathways and barriers to financial recovery.MethodsAdults ≥15 years successfully completing treatment for a first episode of pulmonary TB under the National TB Control Programme were prospectively followed up for 12 months. Socioeconomic, income, occupation, health seeking and cost data were collected. Determinants and impacts of ongoing financial hardship were explored through illness narrative interviews with purposively selected participants.Results405 participants were recruited from February 2016 to April 2017. Median age was 35 years (IQR: 28–41), 67.9% (275/405) were male, and 60.6% (244/405) were HIV-positive. Employment and incomes were lowest at TB-treatment completion, with limited recovery in the following year: fewer people were in paid work (63.0% (232/368) vs 72.4% (293/405), p=0.006), median incomes were lower (US$44.13 (IQR: US$0–US$106.15) vs US$72.20 (IQR: US$26.71–US$173.29), p<0.001), and more patients were living in poverty (earning <US$1.90/day: 57.7% (211/366) vs 41.6% (166/399), p<0.001) 1 year after TB-treatment completion compared with before TB-disease onset. Half of the participants (50.5%, 184/368) reported ongoing dissaving (use of savings, selling assets, borrowing money) and 9.5% (35/368) reported school interruptions in the year after TB-treatment completion. Twenty-one participants completed in-depth interviews. Reported barriers to economic recovery included financial insecurity, challenges rebuilding business relationships, residual physical morbidity and stigma.ConclusionsTB-affected households remain economically vulnerable even after TB-treatment completion, with limited recovery in income and employment, persistent financial strain requiring dissaving, and ongoing school interruptions. Measures of the economic impact of TB disease should include the post-TB period. Interventions to protect the long-term health and livelihoods of TB survivors must be explored.

scholarly journals Lessons from a Health Policy and Systems Research programme exploring the quality and coverage of newborn care in Kenya

2020 ◽  
Vol 5 (1) ◽  
pp. e001937
Author(s):  
Mike English ◽  
David Gathara ◽  
Jacinta Nzinga ◽  
Pratap Kumar ◽  
Fred Were ◽  
...  
Keyword(s):  
Health System ◽  
Low Income ◽  
Health Workers ◽  
Newborn Care ◽  
Well Being ◽  
Public Hospitals ◽  
Urban Setting ◽  
Health System Strengthening ◽  
Research Approach ◽  
Systems Research

There are global calls for research to support health system strengthening in low-income and middle-income countries (LMICs). To examine the nature and magnitude of gaps in access and quality of inpatient neonatal care provided to a largely poor urban population, we combined multiple epidemiological and health services methodologies. Conducting this work and generating findings was made possible through extensive formal and informal stakeholder engagement linked to flexibility in the research approach while keeping overall goals in mind. We learnt that 45% of sick newborns requiring hospital care in Nairobi probably do not access a suitable facility and that public hospitals provide 70% of care accessed with private sector care either poor quality or very expensive. Direct observations of care and ethnographic work show that critical nursing workforce shortages prevent delivery of high-quality care in high volume, low-cost facilities and likely threaten patient safety and nurses’ well-being. In these challenging settings, routines and norms have evolved as collective coping strategies so health professionals maintain some sense of achievement in the face of impossible demands. Thus, the health system sustains a functional veneer that belies the stresses undermining quality, compassionate care. No one intervention will dramatically reduce neonatal mortality in this urban setting. In the short term, a substantial increase in the number of health workers, especially nurses, is required. This must be combined with longer term investment to address coverage gaps through redesign of services around functional tiers with improved information systems that support effective governance of public, private and not-for-profit sectors.

A Researcher–Practitioner Collaboration to Enable Replication of an Evidence-Based Financial Education and Coaching Program That Improves Health in Low-Income Single Mothers

2021 ◽  
pp. 152483992110654
Author(s):  
Danielle Galvin ◽  
Julie Kalkowski
Keyword(s):  
Low Income ◽  
Controlled Trial ◽  
Financial Education ◽  
Well Being ◽  
Social Determinant ◽  
Theory Of Change ◽  
Financial Strain ◽  
Structured Interviews ◽  
Health Related ◽  
Core Components

Financial strain is a social determinant of health (SDOH). Although public financial education helps individuals improve financial well-being, specifics are lacking on how and why effective programs work, potentially limiting their successful replication in other practice settings. In this study, researchers and practitioners cocreated the core components and theory of change of a novel financial education and coaching program, which a randomized controlled trial found was effective in significantly improving participants’ financial and health-related behaviors. A Cocreating Knowledge Translation Framework within a case study design was used at a university-affiliated nonprofit in Omaha, Nebraska, from August to December 2020. Twelve practitioner and alumni participants were purposefully sampled. An administrative records review, semi-structured interviews (n =3), survey (n = 10), and facilitated backward mapping session (n = 5) were conducted. Transcripts were coded to identify themes. Thirty-one core components were identified within program principles, design, tools, activities, and expectations of participants and coaches. Ten theory of change outcomes described participants’ pathway to change. Interventions occurred at individual, relationship, and community levels from initial engagement, through behavioral changes, to improved health-related quality of life. Activities and indicators were mapped to each outcome. The program’s intersecting and reinforcing design was key to enabling participants’ outcomes. Its theory of change described how and why the model improved financial and health behaviors. Findings suggest that other SDOH-focused organizations may benefit from researcher–practitioner collaboration to investigate their interventions’ core components and theories of change. This may enable replication, promoting downstream health benefits in new community settings.

scholarly journals Neighborhood Effects on the Long-Term Well-Being of Low-Income Adults

Science ◽  
2012 ◽  
Vol 337 (6101) ◽  
pp. 1505-1510 ◽  
Author(s):  
J. Ludwig ◽  
G. J. Duncan ◽  
L. A. Gennetian ◽  
L. F. Katz ◽  
R. C. Kessler ◽  
...  
Keyword(s):  
Low Income ◽  
Neighborhood Effects ◽  
Well Being

scholarly journals A model for sustainable, partnership-based telehealth services in rural India: An early process evaluation from Tuver village, Gujarat

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0261907
Author(s):  
Shoba Ramanadhan ◽  
Krishnan Ganapathy ◽  
Lovakanth Nukala ◽  
Subramaniya Rajagopalan ◽  
John C. Camillus
Keyword(s):  
Rural Communities ◽  
Process Evaluation ◽  
Low Income ◽  
Local Development ◽  
Well Being ◽  
Power Sharing ◽  
Strategic Decision ◽  
Quality Healthcare ◽  
Local Staff

Background Telehealth can improve access to high-quality healthcare for rural populations in India. However, rural communities often have other needs, such as sanitation or employment, to benefit fully from telehealth offerings, highlighting a need for systems-level solutions. A Business of Humanity approach argues that innovative solutions to wicked problems like these require strategic decision-making that attends to a) humaneness, e.g., equity and safety and b) humankind, or the needs and potential of large and growing markets comprised of marginalized and low-income individuals. The approach is expected to improve economic performance and long-term value creation for partners, thus supporting sustainability. Methods A demonstration project was conducted in Tuver, a rural and tribal village in Gujarat, India. The project included seven components: a partnership that emphasized power-sharing and complementary contributions; telehealth services; health promotion; digital services; power infrastructure; water and sanitation; and agribusiness. Core partners included the academic partner, local village leadership, a local development foundation, a telehealth provider, and a design-build contractor. This early process evaluation relies on administrative data, field notes, and project documentation and was analyzed using a case study approach. Results Findings highlight the importance of taking a systems perspective and engaging inter-sectoral partners through alignment of values and goals. Additionally, the creation of a synergistic, health-promoting ecosystem offers potential to support telehealth services in the long-term. At the same time, engaging rural, tribal communities in the use of technological advances posed a challenge, though local staff and intermediaries were effective in bridging disconnects. Conclusion Overall, this early process evaluation highlights the promise and challenges of using a Business of Humanity approach for coordinated, sustainable community-level action to improve the health and well-being of marginalized communities.

POVERTY AND INEQUALITY IN LATIN AMERICA

2021 ◽  
Vol 4 (5) ◽  
pp. 152-164
Author(s):  
A. R. KELEKHSAEVA ◽  
Keyword(s):  
Latin America ◽  
Latin American ◽  
Low Income ◽  
Poverty Reduction ◽  
Well Being ◽  
Social Policies ◽  
Poverty And Inequality ◽  
The Caribbean ◽  
The Impact

The article examines poverty and inequality as serious long-term and widespread problems in society. Research on poverty has been mainly conducted from the perspective of economics, now the focus has shifted to psychological aspects with an emphasis on the causes and consequences of poverty. The overall economic disaster that COVID-19 will leave in Latin America and the Caribbean remains to be seen, but its impact on social well-being portends a bleak future. After seven years of slow growth, the region's GDP fell 5,3%, the largest drop in a century. According to a joint report submitted by the Economic Commission for Latin America and the Caribbean (ECLAC) and the Food and Agriculture Organization of the United Nations (FAO), the impact of the pandemic could plunge an additional 16 million people into extreme poverty in 2020, resulting in 83,4 million Hispanics will live in complete poverty. These organizations warn that hunger will be the biggest problem facing the region, where 53,7 million people are already surviving severely food insecure. The purpose of this study is to examine the relationship between poverty and inequality as economic categories in the context of their impact on the countries of Latin America. To do this, the authors examined the key factors affecting poverty and inequality, analyzed trends in poverty and inequality in Latin America and the Latin Basin. The article is based on research on poverty and inequality in macroeconomic theory. In particular, the works of Y. Amiel, F. Cowell, T. Buhard, P. Wizard, the study of socio-economic inequality and the fight against poverty – G. Babeuf, I. Bentham, J. M. Keynes, V. Paret, G. Spencer, L. Erhard, K. Arrow, D. Rocardo, A. Pigou and many others are devoted to the problem of inequality. Significant results of studies of poverty and welfare are given in the works of prominent foreign researchers: P. Townsend, A. Sen, D. Sachs, M. Orshan-sky, T. Marshall, F. Hayek, thanks to which the system of ideas about poverty was formed. The importance of poverty and its impact on government discourses, policies and programs has fueled much research on a Latin American scale. Publications on this topic have been rolled out over the past three decades and have created a veritable battlefield. Poverty reduction is a key development challenge facing Latin America and the Caribbean. Inequality is one of the historical problems in Latin America, one of the factors that most paralyzes the eco-nomic and social aspirations of most countries in the region. Poverty reduction can be understood in both a limited and a broad sense. The first involves a focus on programs and projects that target the poor – vocational training programs for low-income people, food stamps, productivity projects in the informal sector, and care for mothers and children in communities that do not have access to this service, etc. These programs are usually funded from so-called emergency funds and social investments, although they may also be specialized activities of the minis-tries or secretariats that make up the “social sector”. On the other hand, the broader definition of poverty reduction includes economic policies and traditional social policies (especially education and health). One of the main ways to solve this problem in the medium and long term obliges countries to move towards a universal basic income, giving priority to families with children and adolescents, and to maintain universal, comprehensive and sustainable social protection systems, increase their coverage as a central component of the new welfare state. A broad and lasting consensus and political commitment are required to make significant improvements in education, health and well-being. Unfortunately, some Latin American coun-tries have serious governance problems that hinder the effective functioning of democratic systems due to fragmentation and lack of policy consensus. For this reason, stability and continuity of economic and social policies are an indispensable element for the development of nations and the progress of peoples.

scholarly journals LONG-TERM COSTS OF GRANDPARENT CAREGIVING: RESULTS FROM THREE WAVES OF THE MIDLIFE IN THE UNITED STATES STUDY (MIDUS)

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S797-S798
Author(s):  
Elizabeth Rickenbach ◽  
Elizabeth H Rickenbach ◽  
Chih-Chien Huang ◽  
Jessica Y Allen ◽  
Kelly E Cichy
Keyword(s):  
United States ◽  
Older Adults ◽  
Low Income ◽  
Longitudinal Research ◽  
Well Being ◽  
The United States ◽  
Lower Income ◽  
Cross Sectional ◽  
Grandparent Caregiving

Abstract Cross-sectional studies reveal the health burden of grandparent caregiving. Still, longitudinal, research is needed to understand how grandparent caregiving compromises grandparents’ long-term health. Using three waves of data from the Midlife in the United States Study (MIDUS), we examined sociodemographic factors, health and well-being outcomes between caregiving (CG) and non-caregiving (NCG) grandparents. By wave 3, 12.8% (n = 234) were CG. CG were younger, more likely female, and had lower income and education. MANCOVA adjusted for age, gender, education, and number of children revealed CG reported poorer physical and emotional well-being (e.g. higher depression, anxiety, lower life satisfaction, greater morbidity); CG were consistently less healthy than NCG across all three waves. Lower income and less healthy older adults are more likely to become grandparents, and they remain less healthy over time. Policies and resources to assist grandparents, particularly low-income and vulnerable older adults who are caring for grandchildren, are needed.

scholarly journals Long-Term Neighborhood Effects on Low-Income Families: Evidence from Moving to Opportunity

2013 ◽  
Vol 103 (3) ◽  
pp. 226-231 ◽  
Author(s):  
Jens Ludwig ◽  
Greg J Duncan ◽  
Lisa A Gennetian ◽  
Lawrence F Katz ◽  
Ronald C Kessler ◽  
...  
Keyword(s):  
Low Income ◽  
Neighborhood Effects ◽  
Well Being ◽  
Detectable Effect ◽  
Subjective Well Being ◽  
Physical And Mental Health ◽  
Youth Outcomes ◽  
Moving To Opportunity ◽  
Low Income Families

We examine long-term neighborhood effects on low-income families using data from the Moving to Opportunity (MTO) randomized housing-mobility experiment. This experiment offered to some public-housing families but not to others the chance to move to less-disadvantaged neighborhoods. We show that ten to 15 years after baseline, MTO: (i) improves adult physical and mental health; (ii) has no detectable effect on economic outcomes or youth schooling or physical health; and (iii) has mixed results by gender on other youth outcomes, with girls doing better on some measures and boys doing worse. Despite the somewhat mixed pattern of impacts on traditional behavioral outcomes, MTO moves substantially improve adult subjective well-being.

Long-term and late effects (LLEs), anxiety, and depression among long-term survivors of pediatric, adolescent, and young adult (P-AYA) cancer.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 143-143
Author(s):  
Linda A. Jacobs ◽  
Abigail N. Blauch ◽  
Donna A. Pucci ◽  
Steven C Palmer
Keyword(s):  
Body Image ◽  
Low Income ◽  
Depression Scale ◽  
Psychosocial Outcomes ◽  
Well Being ◽  
Anxiety And Depression ◽  
Psychological Well Being ◽  
Income Status ◽  
Body Image Concerns

143 Background: Adult P-AYA cancer survivors report numerous LLEs, as well as potential decrements in psychological well-being. The relationship between LLEs and psychological well-being, however, has not been well described in this population. We examined this relationship and predictors of LLEs and well-being in a sample of adult survivors of P-AYA cancer. Methods: Survivors of P-AYA cancer > 2 years from end of treatment completed the Hospital Anxiety and Depression Scale (HADS) and a measure of presence and severity of 11 common LLEs following a survivorship visit. LLEs included fatigue, pain, insomnia, numbness, joint or muscle pain, difficulties with concentration or memory, body image concerns, decreased sexual interest, and weight. Results: Participants (N = 237) were predominately white (89%), college educated (76%), single (63%), and had an annual income of > $60,000 (69%). A plurality had diagnoses of leukemia (30%) or Hodgkin's lymphoma (29%) treated 17 years previously. Treatment included surgery (35%), chemotherapy (91%), XRT (59%), and BMT (17%). Anxiety (M = 6.02; SD = 3.07) and depression (M = 2.54; SD = 2.85) scores were generally low and below the cutpoint of 8 (all t < -7.8; all p < .001 ), although 21% and 9% screened positively for anxiety or depression, respectively. 91% of participants reported at least 1 LLE (M = 4.8, SD = 3.1), most commonly fatigue (73%), concentration (57%) and memory difficulties (53%), and body image problems (48%). Total number LLEs was associated with elevations in both anxiety and depression, as was severity for each individual LLE (all p < 0.001). Only one LLE, difficulty with body image, produced large effects for both anxiety and depression. Low income status were associated with both LLEs and elevations in anxiety and depression (all p < 0.01). Conclusions: Most P-AYA survivors report LLEs. Although anxiety and depression are modest, elevations occur in a substantial number of survivors. Presence of LLEs is associated with worse psychosocial outcomes, particularly difficulties with body image. Lower income individuals and those with body image concerns may be at particular risk of poorer psychosocial outcomes.

Sign in / Sign up

Export Citation Format

Share Document