scholarly journals Unmet need for hypercholesterolemia care in 35 low- and middle-income countries: A cross-sectional study of nationally representative surveys

PLoS Medicine ◽  
2021 ◽  
Vol 18 (10) ◽  
pp. e1003841
Author(s):  
Maja E. Marcus ◽  
Cara Ebert ◽  
Pascal Geldsetzer ◽  
Michaela Theilmann ◽  
Brice Wilfried Bicaba ◽  
...  
Keyword(s):  
Unmet Need ◽  
Medication Use ◽  
Older Age ◽  
Lipid Lowering ◽  
Middle Income ◽  
High Tc ◽  
Middle Income Countries ◽  
Comorbid Diagnosis ◽  
Nationally Representative ◽  
Diagnosis Of Hypertension

Background As the prevalence of hypercholesterolemia is increasing in low- and middle-income countries (LMICs), detailed evidence is urgently needed to guide the response of health systems to this epidemic. This study sought to quantify unmet need for hypercholesterolemia care among adults in 35 LMICs. Methods and findings We pooled individual-level data from 129,040 respondents aged 15 years and older from 35 nationally representative surveys conducted between 2009 and 2018. Hypercholesterolemia care was quantified using cascade of care analyses in the pooled sample and by region, country income group, and country. Hypercholesterolemia was defined as (i) total cholesterol (TC) ≥240 mg/dL or self-reported lipid-lowering medication use and, alternatively, as (ii) low-density lipoprotein cholesterol (LDL-C) ≥160 mg/dL or self-reported lipid-lowering medication use. Stages of the care cascade for hypercholesterolemia were defined as follows: screened (prior to the survey), aware of diagnosis, treated (lifestyle advice and/or medication), and controlled (TC <200 mg/dL or LDL-C <130 mg/dL). We further estimated how age, sex, education, body mass index (BMI), current smoking, having diabetes, and having hypertension are associated with cascade progression using modified Poisson regression models with survey fixed effects. High TC prevalence was 7.1% (95% CI: 6.8% to 7.4%), and high LDL-C prevalence was 7.5% (95% CI: 7.1% to 7.9%). The cascade analysis showed that 43% (95% CI: 40% to 45%) of study participants with high TC and 47% (95% CI: 44% to 50%) with high LDL-C ever had their cholesterol measured prior to the survey. About 31% (95% CI: 29% to 33%) and 36% (95% CI: 33% to 38%) were aware of their diagnosis; 29% (95% CI: 28% to 31%) and 33% (95% CI: 31% to 36%) were treated; 7% (95% CI: 6% to 9%) and 19% (95% CI: 18% to 21%) were controlled. We found substantial heterogeneity in cascade performance across countries and higher performances in upper-middle-income countries and the Eastern Mediterranean, Europe, and Americas. Lipid screening was significantly associated with older age, female sex, higher education, higher BMI, comorbid diagnosis of diabetes, and comorbid diagnosis of hypertension. Awareness of diagnosis was significantly associated with older age, higher BMI, comorbid diagnosis of diabetes, and comorbid diagnosis of hypertension. Lastly, treatment of hypercholesterolemia was significantly associated with comorbid hypertension and diabetes, and control of lipid measures with comorbid diabetes. The main limitations of this study are a potential recall bias in self-reported information on received health services as well as diminished comparability due to varying survey years and varying lipid guideline application across country and clinical settings. Conclusions Cascade performance was poor across all stages, indicating large unmet need for hypercholesterolemia care in this sample of LMICs—calling for greater policy and research attention toward this cardiovascular disease (CVD) risk factor and highlighting opportunities for improved prevention of CVD.

scholarly journals Cardiovascular disease risk profile and management practices in 45 low-income and middle-income countries: A cross-sectional study of nationally representative individual-level survey data

PLoS Medicine ◽  
2021 ◽  
Vol 18 (3) ◽  
pp. e1003485
Author(s):  
David Peiris ◽  
Arpita Ghosh ◽  
Jennifer Manne-Goehler ◽  
Lindsay M. Jaacks ◽  
Michaela Theilmann ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Low Income ◽  
Medication Use ◽  
Demographic Characteristics ◽  
Cvd Risk ◽  
Cross Sectional ◽  
Middle Income ◽  
Middle Income Countries ◽  
Nationally Representative ◽  
Country Specific

Background Global cardiovascular disease (CVD) burden is high and rising, especially in low-income and middle-income countries (LMICs). Focussing on 45 LMICs, we aimed to determine (1) the adult population’s median 10-year predicted CVD risk, including its variation within countries by socio-demographic characteristics, and (2) the prevalence of self-reported blood pressure (BP) medication use among those with and without an indication for such medication as per World Health Organization (WHO) guidelines. Methods and findings We conducted a cross-sectional analysis of nationally representative household surveys from 45 LMICs carried out between 2005 and 2017, with 32 surveys being WHO Stepwise Approach to Surveillance (STEPS) surveys. Country-specific median 10-year CVD risk was calculated using the 2019 WHO CVD Risk Chart Working Group non-laboratory-based equations. BP medication indications were based on the WHO Package of Essential Noncommunicable Disease Interventions guidelines. Regression models examined associations between CVD risk, BP medication use, and socio-demographic characteristics. Our complete case analysis included 600,484 adults from 45 countries. Median 10-year CVD risk (interquartile range [IQR]) for males and females was 2.7% (2.3%–4.2%) and 1.6% (1.3%–2.1%), respectively, with estimates indicating the lowest risk in sub-Saharan Africa and highest in Europe and the Eastern Mediterranean. Higher educational attainment and current employment were associated with lower CVD risk in most countries. Of those indicated for BP medication, the median (IQR) percentage taking medication was 24.2% (15.4%–37.2%) for males and 41.6% (23.9%–53.8%) for females. Conversely, a median (IQR) 47.1% (36.1%–58.6%) of all people taking a BP medication were not indicated for such based on CVD risk status. There was no association between BP medication use and socio-demographic characteristics in most of the 45 study countries. Study limitations include variation in country survey methods, most notably the sample age range and year of data collection, insufficient data to use the laboratory-based CVD risk equations, and an inability to determine past history of a CVD diagnosis. Conclusions This study found underuse of guideline-indicated BP medication in people with elevated CVD risk and overuse by people with lower CVD risk. Country-specific targeted policies are needed to help improve the identification and management of those at highest CVD risk.

scholarly journals Gestational weight gain in low-income and middle-income countries: a modelling analysis using nationally representative data

2020 ◽  
Vol 5 (11) ◽  
pp. e003423
Author(s):  
Dongqing Wang ◽  
Molin Wang ◽  
Anne Marie Darling ◽  
Nandita Perumal ◽  
Enju Liu ◽  
...  
Keyword(s):  
Weight Gain ◽  
North Africa ◽  
Low Income ◽  
Sub Saharan Africa ◽  
Middle Income ◽  
Middle Income Countries ◽  
Gestational Weight ◽  
Latin America And Caribbean ◽  
Nationally Representative ◽  
Sub Saharan

IntroductionGestational weight gain (GWG) has important implications for maternal and child health and is an ideal modifiable factor for preconceptional and antenatal care. However, the average levels of GWG across all low-income and middle-income countries of the world have not been characterised using nationally representative data.MethodsGWG estimates across time were computed using data from the Demographic and Health Surveys Program. A hierarchical model was developed to estimate the mean total GWG in the year 2015 for all countries to facilitate cross-country comparison. Year and country-level covariates were used as predictors, and variable selection was guided by the model fit. The final model included year (restricted cubic splines), geographical super-region (as defined by the Global Burden of Disease Study), mean adult female body mass index, gross domestic product per capita and total fertility rate. Uncertainty ranges (URs) were generated using non-parametric bootstrapping and a multiple imputation approach. Estimates were also computed for each super-region and region.ResultsLatin America and Caribbean (11.80 kg (95% UR: 6.18, 17.41)) and Central Europe, Eastern Europe and Central Asia (11.19 kg (95% UR: 6.16, 16.21)) were the super-regions with the highest GWG estimates in 2015. Sub-Saharan Africa (6.64 kg (95% UR: 3.39, 9.88)) and North Africa and Middle East (6.80 kg (95% UR: 3.17, 10.43)) were the super-regions with the lowest estimates in 2015. With the exception of Latin America and Caribbean, all super-regions were below the minimum GWG recommendation for normal-weight women, with Sub-Saharan Africa and North Africa and Middle East estimated to meet less than 60% of the minimum recommendation.ConclusionThe levels of GWG are inadequate in most low-income and middle-income countries and regions. Longitudinal monitoring systems and population-based interventions are crucial to combat inadequate GWG in low-income and middle-income countries.

scholarly journals Suitability of Measurement Tools for Assessing the Prevalence of Child Domestic Work: A Rapid Systematic Review

2021 ◽  
Vol 18 (5) ◽  
pp. 2357
Author(s):  
Nicola S. Pocock ◽  
Clara W. Chan ◽  
Cathy Zimmerman
Keyword(s):  
Systematic Review ◽  
Domestic Work ◽  
Quality Measurement ◽  
Measurement Tool ◽  
Current Standard ◽  
Middle Income ◽  
Middle Income Countries ◽  
Measurement Tools ◽  
Survey Instruments ◽  
Nationally Representative

Child domestic work (CDW) is a hidden form of child labour. Globally, there were an estimated 17.2 million CDWs aged 5–17 in 2012, but there has been little critical analysis of methods and survey instruments used to capture prevalence of CDW. This rapid systematic review identified and critically reviewed the measurement tools used to estimate CDWs in Low- and Middle-Income Countries, following PRISMA guidelines (PROSPERO registration: CRD42019148702). Fourteen studies were included. In nationally representative surveys, CDW prevalence ranged from 17% among 13–24-year-old females in Haiti to 2% of children aged 10–17 in Brazil. Two good quality studies and one good quality measurement tool were identified. CDW prevalence was assessed using occupation-based methods (n = 9/14), household roster (n = 7) and industry methods (n = 4). Six studies combined approaches. Four studies included task-based questions; one study used this method to formally calculate prevalence. The task-based study estimated 30,000 more CDWs compared to other methods. CDWs are probably being undercounted, based on current standard measurement approaches. We recommend use of more sensitive, task-based methods for inclusion in household surveys. The cognitive and pilot testing of newly developed task-based questions is essential to ensure comprehension. In analyses, researchers should consider CDWs who may be disguised as distant or non-relatives.

scholarly journals Socioeconomic Inequalities in Health among Armenian Adolescents

2020 ◽  
Vol 17 (11) ◽  
pp. 4055
Author(s):  
Armen A. Torchyan ◽  
Hans Bosma
Keyword(s):  
Sampling Design ◽  
Well Being ◽  
Good Health ◽  
Multiple Logistic Regression ◽  
Regression Analyses ◽  
Middle Income ◽  
Middle Income Countries ◽  
School Aged Children ◽  
Low Levels ◽  
Nationally Representative

We aimed to study the hypothesis of socioeconomic equalization in health among Armenian adolescents participating in the Health Behavior in School-Aged Children 2013/14 survey. Classes corresponding to the ages 11, 13, and 15 were selected using a clustered sampling design. Multiple logistic regression analyses were used. In a nationally representative sample of 3679 students, adolescents with a low family socioeconomic position (SEP) had greater odds of reporting less than good health (odds ratio (OR) = 2.81, 95% CI = 2.25–3.51), low psychosocial well-being (OR = 1.94, 95% CI = 1.44–2.61), or psychosomatic symptoms (OR = 1.29, 95% CI = 1.07–1.56). Low levels of material well-being were associated with a higher likelihood of reporting less than good health (OR = 1.32, 95% CI = 1.06–1.65) or low psychosocial well-being (OR = 1.27, 95% CI = 1.04–1.54). The presence of both risk factors had a synergistic effect on having low psychosocial well-being (P-interaction = 0.031). Refuting the equalization hypothesis, our results indicate that low SEP might be strongly related to adolescent health in middle-income countries such as Armenia. Low material well-being also proved important, and, for further research, we hypothesized an association via decreased peer social status and compromised popularity.

Mental Health Indicators of Suicide in Cambodian Women

2018 ◽  
Vol 30 (1) ◽  
pp. 7-18 ◽  
Author(s):  
Stephanie E. Armes ◽  
Charity M. Somo ◽  
Sareth Khann ◽  
Desiree M. Seponski ◽  
Cindy J. Lahar ◽  
...  
Keyword(s):  
Health Indicators ◽  
Middle Income ◽  
Logistic Regression Models ◽  
Young Females ◽  
Middle Income Countries ◽  
Suicide Intervention ◽  
Lack Of Information ◽  
Nationally Representative ◽  
Health Need ◽  
Critical Public Health

Global suicide rates are steadily increasing, and suicide completions in Asia outnumber those in Western countries. Young females are especially at risk, with higher rates of completion and lack of suicide support because of familial and cultural stigma and constraints. Lack of infrastructure to systematically record suicide deaths and attempts makes studying suicide in low- and middle-income countries challenging. Given the critical public health need for suicide intervention and prevention, research on suicide is crucial. The present study adds to the lack of information regarding suicide in Cambodia by exploring reports of attempted suicide by women from a nationally representative sample of Cambodian women (N = 1813). In a series of logistic regression models, findings indicate that a culturally salient measure of Cambodian syndromes, symptoms of depression, and posttraumatic stress disorder contributed to increased odds of attempting to commit suicide. Implications for policymakers and interventionists within Cambodia and Asian contexts are discussed.

scholarly journals The nutrition transition and its health implications in lower-income countries

1998 ◽  
Vol 1 (1) ◽  
pp. 5-21 ◽  
Author(s):  
Barry M Popkin
Keyword(s):  
Nutrition Transition ◽  
National Level ◽  
Adult Health ◽  
Nutrition Survey ◽  
Potential Health ◽  
Middle Income ◽  
Health Implications ◽  
Middle Income Countries ◽  
Rapid Changes ◽  
Nationally Representative

AbstractObjective:This article reviews information on the rapid changes in diet, activity and body composition that lower- and middle-income countries are undergoing and then examines some of the potential health implications of this transition.Design and Setting:Data came from numerous countries and also from national food balance (FAOSTAT) and World Bank sources. Nationally representative and nationwide surveys are used. The nationally representative Russian Longitudinal Monitoring Surveys from 1992–96 and the nationwide China Health and Nutrition Survey from 1989–93 are examined in detail.Results:Rapid changes in the structure of diet, in particular associated with urbanization, are documented. In addition, large changes in occupation types are documented. These are linked with rapid increases in adult obesity in Latin America and Asia. Some of the potential implications for adult health are noted.Conclusions:The rapid changes in diet, activity and obesity that are facing billions of residents of lower- and middle-income countries are cause for great concern. Linked with these changes will be a rapid increase in chronic diseases. Little to date has been done at the national level to address these problems.

scholarly journals Microestimates of wealth for all low- and middle-income countries

2022 ◽  
Vol 119 (3) ◽  
pp. e2113658119
Author(s):  
Guanghua Chi ◽  
Han Fang ◽  
Sourav Chatterjee ◽  
Joshua E. Blumenstock
Keyword(s):  
Survey Data ◽  
Household Survey ◽  
Heterogeneous Data ◽  
Machine Learning Algorithms ◽  
Middle Income ◽  
Middle Income Countries ◽  
Economic Development And Growth ◽  
Household Survey Data ◽  
Nationally Representative ◽  
Low And Middle Income

Many critical policy decisions, from strategic investments to the allocation of humanitarian aid, rely on data about the geographic distribution of wealth and poverty. Yet many poverty maps are out of date or exist only at very coarse levels of granularity. Here we develop microestimates of the relative wealth and poverty of the populated surface of all 135 low- and middle-income countries (LMICs) at 2.4 km resolution. The estimates are built by applying machine-learning algorithms to vast and heterogeneous data from satellites, mobile phone networks, and topographic maps, as well as aggregated and deidentified connectivity data from Facebook. We train and calibrate the estimates using nationally representative household survey data from 56 LMICs and then validate their accuracy using four independent sources of household survey data from 18 countries. We also provide confidence intervals for each microestimate to facilitate responsible downstream use. These estimates are provided free for public use in the hope that they enable targeted policy response to the COVID-19 pandemic, provide the foundation for insights into the causes and consequences of economic development and growth, and promote responsible policymaking in support of sustainable development.

scholarly journals Does issue framing shape support for COVID-19 lockdown measures? Evidence from a survey experiment in Peru

2021 ◽  
Vol 8 (2) ◽  
pp. 205316802110511
Author(s):  
Miguel Carreras ◽  
Sofia Vera ◽  
Giancarlo Visconti
Keyword(s):  
Public Support ◽  
Economic Damage ◽  
Issue Framing ◽  
Economic Costs ◽  
Middle Income ◽  
Middle Income Countries ◽  
Media Communications ◽  
Nationally Representative ◽  
Issue Frames ◽  
Vignette Experiment

Two issue frames quickly emerged in policy and media communications about COVID-19 lockdown measures. Initially, a public health frame advocated for strong quarantine policies to slow the spread of the virus. As the economic costs associated with quarantine measures became clear, an economic frame pushed for an end to (or a relaxation of) these measures to alleviate the economic damage associated with lockdowns. We do not know much about how these competing communication frames affected lockdown support, especially in poor- and middle-income countries. To explore this question, we embedded a framing experiment in a nationally representative telephone survey in May 2020 in Peru, one of the world’s hardest-hit countries by the coronavirus pandemic. The vignette experiment reveals that the economic frame produces a decrease in public support for quarantine measures in Peru. In contrast, respondents exposed to a health frame do not increase their approval of the same measures.

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