The underlying factors of excess mortality in 2020: a cross-country analysis of pre-pandemic healthcare conditions and strategies to cope with Covid-19

Abstract Background Government responses to the pandemic varied in terms of timing, duration, and stringency, seeking to protect healthcare systems, whose pre-pandemic state varied significantly. Therefore, the severity of Covid-19 and, thus, excess mortality have been unequal across counties. This paper explores the geography of excess mortality and its underlying factors in 2020, highlighting the effects of health policies pre-pandemic and strategies devised by governments to cope with Covid-19. Methods Excess mortality is estimated for 79 high, medium and low-income countries. The factors of excess mortality are examined employing median quantile regression analysis. Results Health privatization, healthcare underfunding, and late implementation of containment and mitigation strategies were powerful drivers of excess mortality. By contrast, the results suggest a negative association of excess mortality with health expenditure, number of doctors and hospital beds, share of population covered by health insurance and test and trace capacity. Conclusions The evidence highlights the importance of sufficiently funded healthcare systems with universal access and strong primary healthcare in the battle against the pandemic. An early response to Covid-19, including borders’ controls and a strong test and trace capacity, could improve epidemiological surveillance and minimize excess mortality, with stringent and lengthy lockdowns not providing a significant benefit.

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Fe0/H2O Filtration Systems for Decentralized Safe Drinking Water: Where to from Here?

Water ◽

10.3390/w11030429 ◽

2019 ◽

Vol 11 (3) ◽

pp. 429 ◽

Cited By ~ 14

Author(s):

Charles Nanseu-Njiki ◽

Willis Gwenzi ◽

Martin Pengou ◽

Mohammad Rahman ◽

Chicgoua Noubactep

Keyword(s):

Drinking Water ◽

Low Income ◽

Universal Access ◽

Low Cost ◽

Low Income Countries ◽

Future Research ◽

Systematic Research ◽

Safe Drinking Water ◽

Iron Corrosion ◽

Small Communities

Inadequate access to safe drinking water is one of the most pervasive problems currently afflicting the developing world. Scientists and engineers are called to present affordable but efficient solutions, particularly applicable to small communities. Filtration systems based on metallic iron (Fe0) are discussed in the literature as one such viable solution, whether as a stand-alone system or as a complement to slow sand filters (SSFs). Fe0 filters can also be improved by incorporating biochar to form Fe0-biochar filtration systems with potentially higher contaminant removal efficiencies than those based on Fe0 or biochar alone. These three low-cost and chemical-free systems (Fe0, biochar, SSFs) have the potential to provide universal access to safe drinking water. However, a well-structured systematic research is needed to design robust and efficient water treatment systems based on these affordable filter materials. This communication highlights the technology being developed to use Fe0-based systems for decentralized safe drinking water provision. Future research directions for the design of the next generation Fe0-based systems are highlighted. It is shown that Fe0 enhances the efficiency of SSFs, while biochar has the potential to alleviate the loss of porosity and uncertainties arising from the non-linear kinetics of iron corrosion. Fe0-based systems are an affordable and applicable technology for small communities in low-income countries, which could contribute to attaining self-reliance in clean water supply and universal public health.

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COVID-19 control in low-income settings and displaced populations: what can realistically be done?

Conflict and Health ◽

10.1186/s13031-020-00296-8 ◽

2020 ◽

Vol 14 (1) ◽

Cited By ~ 12

Author(s):

Maysoon Dahab ◽

Kevin van Zandvoort ◽

Stefan Flasche ◽

Abdihamid Warsame ◽

Ruwan Ratnayake ◽

...

Keyword(s):

Low Income ◽

Treatment Options ◽

Extended Period ◽

Mitigation Strategies ◽

Low Income Countries ◽

Behavioural Science ◽

Displaced Populations ◽

Resource Limited ◽

Wide Scale ◽

Modelling Assumptions

Abstract COVID-19 prevention strategies in resource limited settings, modelled on the earlier response in high income countries, have thus far focused on draconian containment strategies, which impose movement restrictions on a wide scale. These restrictions are unlikely to prevent cases from surging well beyond existing hospitalisation capacity; not withstanding their likely severe social and economic costs in the long term. We suggest that in low-income countries, time limited movement restrictions should be considered primarily as an opportunity to develop sustainable and resource appropriate mitigation strategies. These mitigation strategies, if focused on reducing COVID-19 transmission through a triad of prevention activities, have the potential to mitigate bed demand and mortality by a considerable extent. This triade is based on a combination of high-uptake of community led shielding of high-risk individuals, self-isolation of mild to moderately symptomatic cases, and moderate physical distancing in the community. We outline a set of principles for communities to consider how to support the protection of the most vulnerable, by shielding them from infection within and outside their homes. We further suggest three potential shielding options, with their likely applicability to different settings, for communities to consider and that would enable them to provide access to transmission-shielded arrangements for the highest risk community members. Importantly, any shielding strategy would need to be predicated on sound, locally informed behavioural science and monitored for effectiveness and evaluating its potential under realistic modelling assumptions. Perhaps, most importantly, it is essential that these strategies not be perceived as oppressive measures and be community led in their design and implementation. This is in order that they can be sustained for an extended period of time, until COVID-19 can be controlled or vaccine and treatment options become available.

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Clostridium Tetani and Tetanus

10.33442/vt202129 ◽

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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Current status of HIV treatment in Asia and the Pacific region

Sexual Health ◽

10.1071/sh13045 ◽

2014 ◽

Vol 11 (2) ◽

pp. 119 ◽

Cited By ~ 5

Author(s):

Angsana Phuphuakrat ◽

Sasisopin Kiertiburanakul ◽

Somnuek Sungkanuparph

Keyword(s):

Low Income ◽

Universal Access ◽

Scale Up ◽

Hiv Treatment ◽

High Income ◽

Low Income Countries ◽

Current Status ◽

People Living With Hiv ◽

The Pacific ◽

Living With Hiv

Asia and the Pacific represent a diverse group of nations facing HIV epidemic profiles of differing severity. Compared to other parts of the world, the burden of HIV disease is high in this region because of its large populations. At the end of 2011, 5 million people were living with HIV in Asia and the Pacific. This accounted for 15% of people living with HIV worldwide. The prevalence of people living with HIV, as well as access to HIV treatment and care, varies widely between countries. Differences between high-income economies and the rest of the continent are remarkable. Many high-income countries provide antiretroviral therapy (ART) to their citizens. Middle- and low-income countries have rapid ART scale-up and are dependent on international funding. This may compromise the sustainability of ART availability. In addition, lack of access to second- and third-line therapy remains a problem in many countries. The global goal of achieving universal access to ART by 2015 requires mainly low- and middle-income countries to be targeted. Regional policy should be developed in order to identify new infections in key populations, to start earlier treatment, to retain patients in care and to maintain funding.

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Temporal Trends in Generic and Brand Prices of Antiretroviral Medicines Procured with Donor Funds in Developing Countries

Journal of Generic Medicines The Business Journal for the Generic Medicines Sector ◽

10.1057/jgm.2010.6 ◽

2010 ◽

Vol 7 (2) ◽

pp. 159-175 ◽

Cited By ~ 8

Author(s):

Brenda Waning ◽

Warren Kaplan ◽

Matthew P Fox ◽

Mariah Boyd-Boffa ◽

Alexis C King ◽

...

Keyword(s):

Low Income ◽

Price Competition ◽

Public Procurement ◽

Universal Access ◽

Temporal Trends ◽

World Health ◽

Low Income Countries ◽

Careful Examination ◽

Price Variation ◽

Middle Income

Pharmaceutical markets in low resource settings are imperfect. Suppliers provide information on ‘suggested’ medicine prices, but actual purchase prices vary substantially across purchasers and these prices paid are typically unavailable. Public procurement databases now, however, provide timely market intelligence on prices for antiretroviral (ARV) medicines purchased with donor funds, allowing for careful examination of market trends. We used data posted by the World Health Organization to create a longitudinal database of 15 111 ARV procurements from 2002–2008. We noted dramatic price reductions for ARVs over this 6-year time period. Most generic ARVs were cheaper than branded counterparts, with the exception of protease inhibitors (PIs) in which some generic versions were more expensive than branded counterparts. Less price variation was noted for ARVs in low-income countries than middle-income countries where price variations of threefold or greater were noted in five of 28 (18 per cent) generic and 15 of 25 (60 per cent) brand dosage forms. In order to meet global goals of universal access to HIV/AIDS treatment, further price reductions are needed for abacavir, tenofovir and PIs. New approaches are needed to create incentives for generic manufacturers of these ARVs to enter the market and create price competition with these medicines.

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SARS-CoV-2 variants of concern exhibit reduced sensitivity to live-virus neutralization in sera from CoronaVac vaccinees and naturally infected COVID-19 patients

10.1101/2021.07.10.21260232 ◽

2021 ◽

Author(s):

Vimvara Vacharathit ◽

Pakorn Aiewsakun ◽

Suwimon Manopwisedjaroen ◽

Chanya Srisaowakarn ◽

Thanida Laopanupong ◽

...

Keyword(s):

Low Income ◽

Neutralizing Antibodies ◽

Healthcare Workers ◽

Mitigation Strategies ◽

Low Income Countries ◽

Live Virus ◽

Neutralizing Capacity ◽

Need To Evaluate ◽

Beijing China ◽

Spike Sequence

Recent surges in SARS-CoV-2 variants of concern (VOCs) call for the need to evaluate levels of vaccine- and infection- induced SARS-CoV-2 neutralizing antibodies (NAbs). CoronaVac (Sinovac Biotech, Beijing, China) is currently being used for mass vaccination in Thailand as well as other low-income countries. Three VOCs currently circulating within Thailand include the B.1.1.7 (Alpha), B.1.351 (Beta), and B.1.617.2 (Delta) strains. We assessed NAb potency against the prototypic strain containing the original spike sequence (WT) compared to that against the 3 VOCs using sera derived from a cohort of healthcare workers who received a full 2-dose regimen of CoronaVac. Sera from two other cohorts consisting of COVID-19 patients who had been hospitalized in 2020 and 2021 were evaluated for comparison. We found that, despite equally robust production of S1-RBD-binding IgG and 100% seropositivity, sera from both CoronaVac vaccinees and naturally infected individuals had significantly reduced neutralizing capacity against all 3 VOCs compared to WT. Strikingly, NAb titers against Alpha and Beta were comparable, but Delta appears to be significantly more refractory to NAbs in all groups. Our results may help inform on CoronaVac NAb-inducing capacity, which is a proxy for vaccine efficacy, in the context of the WT strain and 3 VOCs. Our results also have critical implications for public health decisionmakers who may need to maintain efficient mitigation strategies amid a potentially high risk for infection with VOCs even in those who have been previously infected.

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An affordable anti-SARS-COV-2 spike protein ELISA test for early detection of IgG seroconversion suited for large-scale surveillance studies in low-income countries

10.1101/2020.07.13.20152884 ◽

2020 ◽

Cited By ~ 1

Author(s):

Renata G. F. Alvim ◽

Tulio M. Lima ◽

Danielle A. S. Rodrigues ◽

Federico F. Marsili ◽

Vicente B. T. Bozza ◽

...

Keyword(s):

Low Income ◽

Large Scale ◽

Low Cost ◽

Venous Blood ◽

Hek293 Cells ◽

Epidemiological Surveillance ◽

Low Income Countries ◽

Serological Tests ◽

S Protein ◽

Surveillance Studies

AbstractBackgroundAccurate serological tests are essential tools to allow adequate monitoring and control of COVID-19 spread. Production of a low-cost and high-quality recombinant viral antigen can enable the development of reliable and affordable serological assays, which are urgently needed to facilitate epidemiological surveillance studies in low-income economies.MethodsTrimeric SARS-COV-2 spike (S) protein was produced in serum-free, suspension-adapted HEK293 cells. Highly purified S protein was used to develop an ELISA, named S-UFRJ test. It was standardized to work with different types of samples: (i) plasma or serum from venous blood samples; (ii) eluates from dried blood spots (DBS) obtained by collecting blood drops from finger prick.FindingsWe developed a cost-effective, scalable technology to produce S protein based on its stable expression in HEK293 cells. Using this recombinant antigen we presented a workflow for test development in the setting of a pandemic, starting from limited amounts of samples up to reaching final validation with hundreds of samples. Test specificity was determined to be 98.6%, whereas sensitivity was 95% for samples collected 11 or more days after symptoms onset. A ROC analysis allowed optimizing the cut-off and confirming the high accuracy of the test. Endpoint titers were shown to correlate with virus neutralization assessed as PRNT90. There was excellent agreement between plasma and DBS samples, significantly simplifying sample collection, storing and shipping. An overall cost estimate revealed that final retail price could be in the range of one US dollar.InterpretationThe S-UFRJ assay developed herein meets the quality requirements of high sensitivity and specificity. The low cost and the use of mailable DBS samples allow for serological surveillance of populations regardless of geographical and socio-economic aspects, with special relevance for public health policy actions in low-income countries.FundingCTG, Senai DN/CETIQT, FAPERJ, CNPq, CAPES and Instituto Serrapilheira.

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Globalization and the Burden of Disease

10.1093/oso/9780190946265.003.0009 ◽

2021 ◽

pp. 143-154

Author(s):

Charles Weiss

Keyword(s):

Health Services ◽

Low Income ◽

Universal Access ◽

World Health ◽

Low Income Countries ◽

Access To Health Services ◽

Global Epidemic ◽

Downward Spiral ◽

Health Organization ◽

Epidemic Response

More equitable and need-oriented funding of health services and research would safeguard everyone’s health. Worldwide health expenditures on health disproportionately address problems of the well-off, while research on diseases like malaria affecting hundreds of millions of mostly low-income people are underfunded. Nor are sufficient resources devoted to mental illness, traffic injuries, and natural disasters. As people in low-income countries live longer, chronic, non-communicable, and lifestyle diseases add to long-standing burdens of infectious and parasitic disease, and maternal and child health. This epidemiological transition calls for universal access to health services, which will also improve these countries’ ability to detect and respond to infectious diseases like the COVID-19 pandemic. The World Health Organization, coordinator of global epidemic response, needs to be freed from its downward spiral of decreased effectiveness, frozen funding, and increased politicization. Statistics on global causes of death and disability elevate the importance of social determinants of health.

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