scholarly journals The effect of COVID-19 on maternal newborn and child health (MNCH) services in Bangladesh, Nigeria and South Africa: call for a contextualised pandemic response in LMICs

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Tanvir Ahmed ◽  
Ahmed Ehsanur Rahman ◽  
Taiwo Gboluwaga Amole ◽  
Hadiza Galadanci ◽  
Mushi Matjila ◽  
...  
Keyword(s):  
South Africa ◽  
Resource Constraints ◽  
Childhood Mortality ◽  
Health Priorities ◽  
Local Context ◽  
Middle Income ◽  
Mortality And Morbidity ◽  
Middle Income Countries ◽  
Care Family ◽  
Development Goals

AbstractGlobal response to COVID-19 pandemic has inadvertently undermined the achievement of existing public health priorities and laregely overlooked local context. Recent evidence suggests that this will cause additional maternal and childhood mortality and morbidity especially in low- and middle-income countries (LMICs). Here we have explored the contextual factors influencing maternal, neonatal and children health (MNCH) care in Bangladesh, Nigeria and South Africa amidst the pandemic. Our findings suggest that between March and May 2020, there was a reduction in utilisation of basic essential MNCH services such as antenatal care, family planning and immunization due to: a) the implementation of lockdown which triggered fear of contracting the COVID-19 and deterred people from accessing basic MNCH care, and b) a shift of focus towards pandemic, causing the detriment to other health services, and c) resource constraints. Taken together these issues have resulted in compromised provision of basic general healthcare. Given the likelihood of recurrent waves of the pandemic globally, COVID-19 mitigation plans therefore should be integrated with standard care provision to enhance system resilience to cope with all health needs. This commentary suggests a four-point contextualised mitigation plan to safeguard MNCH care during the pandemic using the observed countries as exemplars for LMIC health system adaptations to maintain the trajectory of progress regarding sustainable development goals (SDGs).

scholarly journals How local context influences access to neuropsychological rehabilitation after acquired brain injury in South Africa

2019 ◽  
Vol 4 (Suppl 10) ◽  
pp. e001353
Author(s):  
Noorjehan Joosub
Keyword(s):  
South Africa ◽  
Brain Injury ◽  
Low Income ◽  
Resource Constraints ◽  
Acquired Brain Injury ◽  
Local Context ◽  
Contextual Influences ◽  
Healthcare Resources ◽  
Middle Income ◽  
Neuropsychological Rehabilitation

The numbers of acquired brain injury (ABI) survivors in South Africa are increasing; however, facilities to provide neuropsychological rehabilitation are limited due to a lack of healthcare resources. The updated International Classification of Health, Functioning, and Disability (ICF) from the WHO emphasises how the context of an impairment influences the patient’s activity limitations and participation restrictions. This analysis examined South African contextual influences on the accessibility, quality and efficiency of neuropsychological rehabilitation interventions after ABI in South Africa. Three main contextual influences were identified, namely, socioeconomic disparities, sociocultural influences and discharge to underprepared communities. Systems thinking and inclusive models of healthcare are needed in low-income and middle-income countries, such as South Africa, where resource constraints necessitate creative and ecological forms of rehabilitation interventions after ABI. Contextual influences are vital to consider when designing neuropsychological rehabilitation interventions in order to improve the accessibility and relevance of these interventions and to ensure the effective utilisation of scarce healthcare resources.

scholarly journals Clinical outcomes and cost-effectiveness of COVID-19 vaccination in South Africa

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Krishna P. Reddy ◽  
Kieran P. Fitzmaurice ◽  
Justine A. Scott ◽  
Guy Harling ◽  
Richard J. Lessells ◽  
...  
Keyword(s):  
South Africa ◽  
Cost Effectiveness ◽  
Clinical Outcomes ◽  
Program Implementation ◽  
Resource Constraints ◽  
Vaccination Program ◽  
Middle Income ◽  
Epidemic Dynamics ◽  
Middle Income Countries ◽  
Wide Range

AbstractLow- and middle-income countries are implementing COVID-19 vaccination strategies in light of varying vaccine efficacies and costs, supply shortages, and resource constraints. Here, we use a microsimulation model to evaluate clinical outcomes and cost-effectiveness of a COVID-19 vaccination program in South Africa. We varied vaccination coverage, pace, acceptance, effectiveness, and cost as well as epidemic dynamics. Providing vaccines to at least 40% of the population and prioritizing vaccine rollout prevented >9 million infections and >73,000 deaths and reduced costs due to fewer hospitalizations. Model results were most sensitive to assumptions about epidemic growth and prevalence of prior immunity to SARS-CoV-2, though the vaccination program still provided high value and decreased both deaths and health care costs across a wide range of assumptions. Vaccination program implementation factors, including prompt procurement, distribution, and rollout, are likely more influential than characteristics of the vaccine itself in maximizing public health benefits and economic efficiency.

The Economic Cost of Violence Against Women and Girls in Low- and Middle-Income Countries: A Systematic Review of the Evidence

2021 ◽  
pp. 152483802110160
Author(s):  
Seema Vyas ◽  
Melissa Meinhart ◽  
Katrina Troy ◽  
Hannah Brumbaum ◽  
Catherine Poulton ◽  
...  
Keyword(s):  
South Africa ◽  
Systematic Review ◽  
Violence Against Women ◽  
Economic Burden ◽  
Data Availability ◽  
Female Genital Cutting ◽  
Middle Income ◽  
Middle Income Countries ◽  
Women And Girls ◽  
Low And Middle Income

Evidence demonstrating the economic burden of violence against women and girls can support policy and advocacy efforts for investment in violence prevention and response programming. We undertook a systematic review of evidence on the costs of violence against women and girls in low- and middle-income countries published since 2005. In addition to understanding costs, we examined the consistency of methodological approaches applied and identified and assessed common methodological issues. Thirteen articles were identified, eight of which were from sub-Saharan Africa. Eight studies estimated costs associated with domestic or intimate partner violence, others estimated the costs of interpersonal violence, female genital cutting, and sexual assaults. Methodologies applied to estimate costs were typically based on accounting approaches. Our review found that out-of-pocket expenditures to individuals for seeking health care after an episode of violence ranged from US$29.72 (South Africa) to US$156.11 (Romania) and that lost productivity averaged from US$73.84 to US$2,151.48 (South Africa) per facility visit. Most studies that estimated provider costs of service delivery presented total programmatic costs, and there was variation in interventions, scale, and resource inputs measured which hampered comparability. Variations in methodological assumptions and data availability also made comparisons across countries and settings challenging. The limited scope of studies in measuring the multifaceted impacts of violence highlights the challenges in identifying cost metrics that extend beyond specific violence episodes. Despite the limited evidence base, our assessment leads us to conclude that the estimated costs of violence against women and girls are a fraction of its true economic burden.

scholarly journals Affordability and Availability of Child Restraints in an Under-Served Population in South Africa

2020 ◽  
Vol 17 (6) ◽  
pp. 1979 ◽  
Author(s):  
Prasanthi Puvanachandra ◽  
Aliasgher Janmohammed ◽  
Pumla Mtambeka ◽  
Megan Prinsloo ◽  
Sebastian Van As ◽  
...  
Keyword(s):  
South Africa ◽  
Road Traffic ◽  
Public Health Problem ◽  
Global Public Health ◽  
Injury Death ◽  
Middle Income ◽  
Suitable Alternative ◽  
Middle Income Countries ◽  
Restraint Use ◽  
Child Restraint

Background: Child road traffic injuries are a major global public health problem and the issue is particularly burdensome in middle-income countries such as South Africa where injury death rates are 41 per 100,000 for under 5′s and 24.5 per 100,000 for 5–14-year-old. Despite their known effectiveness in reducing injuries amongst children, the rates of use of child restraint systems (CRS) remains low in South Africa. Little is known about barriers to child restraint use especially in low- and middle-income countries. Methods: We carried out observation studies and parent/carer surveys in 7 suburbs of Cape Town over a three month period to assess usage rates and explore the knowledge and perceptions of parents towards child restraint legislation, ownership and cost; Results: Only 7.8% of child passengers were observed to be properly restrained in a CRS with driver seatbelt use and single child occupancy being associated with higher child restraint use. 92% of survey respondents claimed to have knowledge of current child restraint legislation, however, only 32% of those parents/carers were able to correctly identify the age requirements and penalty. Reasons given for not owning a child seat included high cost and the belief that seatbelts were a suitable alternative. Conclusions: These findings indicate the need for a tighter legislation with an increased fine paired with enhanced enforcement of both adult seatbelt and child restraint use. The provision of low-cost/subsidised CRS or borrowing schemes and targeted social marketing through online fora, well baby clinics, early learning centres would be beneficial in increasing ownership and use of CRS.

scholarly journals Spiritual care practices in hospices in the Western cape, South Africa: the challenge of diversity

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Ronita Mahilall ◽  
Leslie Swartz
Keyword(s):  
South Africa ◽  
Spiritual Care ◽  
Resource Constraints ◽  
Care Service ◽  
Western Cape ◽  
Group Discussions ◽  
Middle Income ◽  
Care Services ◽  
African Context ◽  
Care Practices

Abstract Background South Africa is a very diverse middle-income country, still deeply divided by the legacy of its colonial and apartheid past. As part of a larger study, this article explored the experiences and views of representatives of hospices in the Western Cape province of South Africa on the provision of appropriate spiritual care, given local issues and constraints. Methods Two sets of focus group discussions, with 23 hospice participants, were conducted with 11 of the 12 Hospice Palliative Care Association registered hospices in the Western Cape, South Africa, to understand what spiritual care practices existed in their hospices against the backdrop of multifaceted diversities. The discussions were analysed using thematic analysis. Results Two prominent themes emerged: the challenges of providing relevant spiritual care services in a religiously, culturally, linguistically and racially diverse setting, and the organisational context impacting such a spiritual care service. Participants agreed that spiritual care is an important service and that it plays a significant role within the inter-disciplinary team. Participants recognised the need for spiritual care training and skills development, alongside the financial costs of employing dedicated spiritual care workers. In spite of the diversities and resource constraints, the approach of individual hospices to providing spiritual care remained robust. Discussion Given the diversities that are largely unique to South Africa, shaped essentially by past injustices, the hospices have to navigate considerable hurdles such as cultural differences, religious diversity, and language barriers to provide spiritual care services, within significant resource constraints. Conclusions While each of the hospices have established spiritual care services to varying degrees, there was an expressed need for training in spiritual care to develop a baseline guide that was bespoke to the complexities of the South African context. Part of this training needs to focus on the complexity of providing culturally appropriate services.

The Oxford Handbook of the South African Economy

2021 ◽  
Keyword(s):  
South Africa ◽  
South African ◽  
Economic History ◽  
Economic Policies ◽  
The South ◽  
Economic Sectors ◽  
Middle Income ◽  
Strategic Issues ◽  
Middle Income Countries ◽  
Depth Analysis

While South Africa shares some characteristics with other middle-income countries, it has a unique economic history with distinctive characteristics. South Africa is an economic powerhouse with a significant role not only at the southern African regional and continental levels, but also as a member of BRICS. However, the country faces profound developmental challenges, including the ‘triple challenges’ of poverty, inequality and unemployment. There has been a lack of structural transformation and weak economic growth. Ongoing debates around economic policies to address these challenges need to be based on rigorous and robust empirical evidence and in-depth analysis of South African economic issues. This necessitates wide-ranging research, such as that brought together in this handbook. This volume intends to provide original, comprehensive, detailed, state-of-the-art analytical perspectives, that contribute to knowledge while also contributing to well-informed and productive discourse on the South African economy. While concentrating on the more recent economic challenges facing the country, the handbook also provides historical and political context, an in-depth examination of strategic issues in the various critical economic sectors, and assembles diverse analytical perspectives and arguments that have implications for policymaking.

scholarly journals Toward Model-Generated Household Listing in Low- and Middle-Income Countries Using Deep Learning

2018 ◽  
Vol 7 (11) ◽  
pp. 448 ◽  
Author(s):  
Robert Chew ◽  
Kasey Jones ◽  
Jennifer Unangst ◽  
James Cajka ◽  
Justine Allpress ◽  
...  
Keyword(s):  
Sustainable Development ◽  
Object Detection ◽  
Household Surveys ◽  
Building Structures ◽  
Middle Income ◽  
The Sustainable Development ◽  
Detection Model ◽  
Middle Income Countries ◽  
Development Goals ◽  
Low And Middle Income

While governments, researchers, and NGOs are exploring ways to leverage big data sources for sustainable development, household surveys are still a critical source of information for dozens of the 232 indicators for the Sustainable Development Goals (SDGs) in low- and middle-income countries (LMICs). Though some countries’ statistical agencies maintain databases of persons or households for sampling, conducting household surveys in LMICs is complicated due to incomplete, outdated, or inaccurate sampling frames. As a means to develop or update household listings in LMICs, this paper explores the use of machine learning models to detect and enumerate building structures directly from satellite imagery in the Kaduna state of Nigeria. Specifically, an object detection model was used to identify and locate buildings in satellite images. In the test set, the model attained a mean average precision (mAP) of 0.48 for detecting structures, with relatively higher values in areas with lower building density (mAP = 0.65). Furthermore, when model predictions were compared against recent household listings from fieldwork in Nigeria, the predictions showed high correlation with household coverage (Pearson = 0.70; Spearman = 0.81). With the need to produce comparable, scalable SDG indicators, this case study explores the feasibility and challenges of using object detection models to help develop timely enumerated household lists in LMICs.

scholarly journals Generating Evidence From Contextual Clinical Research in Low- to Middle Income Countries: A Roadmap Based on Theory of Change

2021 ◽  
Vol 9 ◽  
Author(s):  
Babar S. Hasan ◽  
Muneera A. Rasheed ◽  
Asra Wahid ◽  
Raman Krishna Kumar ◽  
Liesl Zuhlke
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Theory Of Change ◽  
Health Priorities ◽  
Global Health Research ◽  
Local Health ◽  
Care Providers ◽  
Middle Income ◽  
Middle Income Countries ◽  
Health Ministries

Along with inadequate access to high-quality care, competing health priorities, fragile health systems, and conflicts, there is an associated delay in evidence generation and research from LMICs. Lack of basic epidemiologic understanding of the disease burden in these regions poses a significant knowledge gap as solutions can only be developed and sustained if the scope of the problem is accurately defined. Congenital heart disease (CHD), for example, is the most common birth defect in children. The prevalence of CHD from 1990 to 2017 has progressively increased by 18.7% and more than 90% of children with CHD are born in Low and Middle-Income Countries (LMICs). If diagnosed and managed in a timely manner, as in high-income countries (HICs), most children lead a healthy life and achieve adulthood. However, children with CHD in LMICs have limited care available with subsequent impact on survival. The large disparity in global health research focus on this complex disease makes it a solid paradigm to shape the debate. Despite many challenges, an essential aspect of improving research in LMICs is the realization and ownership of the problem around paucity of local evidence by patients, health care providers, academic centers, and governments in these countries. We have created a theory of change model to address these challenges at a micro- (individual patient or physician or institutions delivering health care) and a macro- (government and health ministries) level, presenting suggested solutions for these complex problems. All stakeholders in the society, from government bodies, health ministries, and systems, to frontline healthcare workers and patients, need to be invested in addressing the local health problems and significantly increase data to define and improve the gaps in care in LMICs. Moreover, interventions can be designed for a more collaborative and effective HIC-LMIC and LMIC-LMIC partnership to increase resources, capacity building, and representation for long-term productivity.

scholarly journals Risk Factors That Cause Stunting in Indonesia

2017 ◽  
Vol 1 (1) ◽  
pp. 46-48
Author(s):  
Arief Andriyanto ◽  
Faisal Ibnu ◽  
Rina Nur Hidayati
Keyword(s):  
Sustainable Development Goals ◽  
Complementary Feeding ◽  
Family Factors ◽  
Poor Child ◽  
Middle Income ◽  
The Sustainable Development ◽  
Global Challenge ◽  
Middle Income Countries ◽  
Breastfeeding Practices ◽  
Development Goals

The Sustainable Development Goals emphasizing an intervention to prioritize solutions to the global challenge of poor child development in low and middle income countries (LMICs). In 2015, about 25% of children under five years of age in low were stunted (Kim & Subramanian, 2017; Perkins et al., 2017; UNICEF, 2015) The WHO conceptual framework for stunting (2013) identified household and family factors, complementary feeding, breastfeeding practices and infections as the most plausible causes of stunting(Stewart, Iannotti, Dewey, Michaelsen, & Onyango, 2013)

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