scholarly journals Early Detection of CKD: Implications for Low-Income, Middle-Income, and High-Income Countries

2020 ◽  
Vol 31 (9) ◽  
pp. 1931-1940 ◽  
Author(s):  
Marcello Tonelli ◽  
James A. Dickinson
Keyword(s):  
Early Detection ◽  
Low Income ◽  
Population Based ◽  
Case Finding ◽  
High Income ◽  
Opportunity Costs ◽  
Middle Income ◽  
Middle Income Countries ◽  
Use Of Resources ◽  
Low And Middle Income

CKD is common, costly, and associated with adverse health outcomes. Because inexpensive treatments can slow the rate of kidney function loss, and because CKD is asymptomatic until its later stages, the idea of early detection of CKD to improve outcomes ignites enthusiasm, especially in low- and middle-income countries where renal replacement is often unavailable or unaffordable. Available data and prior experience suggest that the benefits of population-based screening for CKD are uncertain; that there is potential for harms; that screening is not a wise use of resources, even in high-income countries; and that screening has substantial opportunity costs in low- and middle-income countries that offset its hypothesized benefits. In contrast, some of the factors that diminish the value of population-based screening (such as markedly higher prevalence of CKD in people with diabetes, hypertension, and cardiovascular disease, as well as high preexisting use of kidney testing in such patients) substantially increase the appeal of searching for CKD in people with known kidney risk factors (case finding) in high-income countries as well as in low- and middle-income countries. For both screening and case finding, detection of new cases is the easiest component; the real challenge is ensuring appropriate management for a chronic disease, usually for years or even decades. This review compares and contrasts the benefits, harms, and opportunity costs associated with these two approaches to early detection of CKD. We also suggest criteria (discussed separately for high-income countries and for low- and middle-income countries) to use in assessing when countries should consider case finding versus when they should consider foregoing systematic attempts at early detection and focus on management of known cases.

scholarly journals Population genomics of Cryptosporidium hominis across five continents identifies two subspecies that have diverged and recombined during 500 years of evolution

2021 ◽  
Author(s):  
Swapnil Tichkule ◽  
Simone M. Cacciò ◽  
Guy Robinson ◽  
Rachel M. Chalmers ◽  
Ivo Mueller ◽  
...  
Keyword(s):  
Gene Flow ◽  
Low Income ◽  
Population Genomics ◽  
Balancing Selection ◽  
Public Health Problem ◽  
High Income ◽  
Secondary Contact ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

AbstractCryptosporidium is a significant public health problem and one of the primary causes of diarrhoea in humans, particularly in very young children living in low- and middle-income countries. While the zoonotic Cryptosporidium parvum and anthroponotic C. hominis species collectively account for most cases globally, the latter is predominant in low- and middle-income countries. Here, we present a comprehensive whole genome study of C. hominis, comprising 114 isolates from 16 countries within five continents. We detect two highly diverged lineages with a distinct biology and demography that have diverged circa 500 years ago. We consider these lineages as two subspecies, and provisionally propose the names C. hominis hominis (clade 1) and C. hominis aquapotentis (clade 2 or gp60 subtype IbA10G2). C. h. hominis is mostly found in low-income countries in Africa and Asia, and it appears to have recently undergone population contraction. In marked contrast, C. h. aquapotentis was found in high-income countries, mainly in Europe, North America and Oceania, and we reveal a signature of population expansion. Moreover, we detected genomic regions of introgression representing gene flow after a secondary contact between the subspecies from low- and high-income countries. We demonstrate that this gene flow resulted in genomic island of high diversity and divergence, and that this diversity at potential virulence genes is maintained by balancing selection, suggesting that they are involved in a coevolutionary arms race.

Epidemiology

2019 ◽  
pp. 14-23
Author(s):  
Navneet Kapur ◽  
Robert Goldney
Keyword(s):  
Suicidal Behaviour ◽  
Large Population ◽  
Population Based ◽  
High Income ◽  
Middle Income ◽  
Middle Income Countries ◽  
Global Epidemiology ◽  
Current Concern ◽  
A Current ◽  
Low And Middle Income

This chapter examines the global epidemiology of suicidal behaviour. Up to one million people die by suicide every year, and about three quarters of these are in low- and middle-income countries. Twenty to thirty times this number harm themselves or attempt suicide. Global rates are probably under-reported, and the iceberg model of suicidal behaviour (showing that much suicidal behaviour is ‘under the waterline’ and thus hidden) is a helpful way of conceptualizing this. In most countries, men are greatly over-represented amongst people who die by suicide. There is a current concern about men in midlife in many high-income settings. Although suicidal behaviour can vary widely in incidence, it tends to share common antecedents. However, it should be borne in mind that the results of large population-based studies do not always apply to individuals.

scholarly journals Global Health Equity: Cancer Care Outcome Disparities in High-, Middle-, and Low-Income Countries

2016 ◽  
Vol 34 (1) ◽  
pp. 6-13 ◽  
Author(s):  
Jonas A. de Souza ◽  
Bijou Hunt ◽  
Fredrick Chite Asirwa ◽  
Clement Adebamowo ◽  
Gilberto Lopes
Keyword(s):  
Low Income ◽  
Cancer Care ◽  
Task Force ◽  
Cancer Control ◽  
The United States ◽  
High Income ◽  
Low Income Countries ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Breakthroughs in our global fight against cancer have been achieved. However, this progress has been unequal. In low- and middle-income countries and for specific populations in high-income settings, many of these advancements are but an aspiration and hope for the future. This review will focus on health disparities in cancer within and across countries, drawing from examples in Kenya, Brazil, and the United States. Placed in context with these examples, the authors also draw basic recommendations from several initiatives and groups that are working on the issue of global cancer disparities, including the US Institute of Medicine, the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries, and the Union for International Cancer Control. From increasing initiatives in basic resources in low-income countries to rapid learning systems in high-income countries, the authors argue that beyond ethics and equity issues, it makes economic sense to invest in global cancer control, especially in low- and middle-income countries.

scholarly journals Challenges of clinical trials in low- and middle-income countries

2012 ◽  
Vol 9 (2) ◽  
pp. 30-31
Author(s):  
Akwasi Osei
Keyword(s):  
Clinical Trials ◽  
Low Income ◽  
High Income ◽  
International Standards ◽  
Low Income Countries ◽  
Profit Motive ◽  
High Quality ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Clinical trials have been conducted almost wholly in high-income countries until recently, yet their results may not always be valid or applicable in middle- and low-income countries. Clinical trials are now, though, increasingly being done in less wealthy countries. While this is welcome, there is a need to ensure the profit motive does not override the benefits. Partnership with local counterparts while adhering to international standards should help to maintain high-quality output from clinical trials.

scholarly journals Contributions to the American Society of Hematology Meeting From Low- and Middle-Income Countries: An In-Depth Analysis and Call to Action

2021 ◽  
pp. 622-631
Author(s):  
Andrés Gómez-De León ◽  
Perla R. Colunga-Pedraza ◽  
Luz Tarín-Arzaga ◽  
Emmanuel Bugarín-Estrada ◽  
Lilian Sung ◽  
...  
Keyword(s):  
Low Income ◽  
High Income ◽  
Income Country ◽  
High Income Country ◽  
Low Income Countries ◽  
Middle Income ◽  
Middle Income Countries ◽  
Depth Analysis ◽  
American Society ◽  
Low And Middle Income

PURPOSE: Establishing research capacity in low- and middle-income countries (LMICs) is key for improving the outcomes of patients with hematologic diseases globally. Few studies have analyzed the contributions of LMICs to global hematology. The American Society of Hematology Meeting (ASH) is the largest international academic event where peer-reviewed contributions in our field are presented. METHODS: In this cross-sectional analysis, all abstracts accepted to ASH 2018 selected for a poster or oral presentation were reviewed. Those that had a contributing author from an LMIC were identified. The proportion of LMIC abstracts across categories was analyzed. Country of origin, high-income country participation, the presence of a conflict of interest (COI), and sponsorship were determined. RESULTS: From 4,871 abstracts reviewed, 506 had a contributing author from an LMIC (10.4%), with 277 (54.7%) contributions in partnership with a high-income country. LMIC-independent contributions corresponded to 19 of 1,026 oral abstracts (1.9%) and 209 of 3,845 posters (5.4%). Most abstracts from LMICs were clinical (n = 311; 61.5%) and multicentric in nature (n = 353; 69.8%). COI statements with the pharmaceutical industry were common (n = 214; 42.3%). Collaboration between LMICs was infrequent (n = 33; 6.5%). Upper-middle–income countries had 466 participations (81.5%), in comparison with 96 (16.8%) in low-middle–income and 10 (1.7%) in low-income countries. CONCLUSION: LMICs were responsible for a small fraction of abstracts at ASH18; low-income countries were practically absent. Almost half of accepted works represented a form of international collaboration, with clinical, multicenter studies predominating and COI disclosures a frequent and unexpected feature, reflecting the instrumental nature of LMIC participation and a lack of independent, robust, locally developed hematology research.

scholarly journals Socioeconomic Status and Its Relation to Hypertension in Rural Nepal

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Sanju Bhattarai ◽  
Birgit Tandstad ◽  
Archana Shrestha ◽  
Biraj Karmacharya ◽  
Abhijit Sen
Keyword(s):  
Blood Pressure ◽  
Socioeconomic Status ◽  
Socioeconomic Factors ◽  
Low Income ◽  
Lifestyle Factors ◽  
High Income ◽  
Middle Income ◽  
Middle Income Countries ◽  
Rural Nepal ◽  
Low And Middle Income

Introduction. Hypertension and its association with socioeconomic positions are well established. However, the gradient of these relationships and the mediating role of lifestyle factors among rural population in low- and middle-income countries such as Nepal are not fully understood. We sought to assess the association between socioeconomic factors (education, income, and employment status) and hypertension. Also, we assessed whether the effect of education and income level on hypertension was mediated by lifestyle factors. Methods. This cross-sectional study was conducted among 260 participants aged ≥18 years attending a rural health center in Dolakha, Nepal. Self-reported data on demographic, socioeconomic, and lifestyle factors were collected, and blood pressure, weight, and height were measured for all study participants. Those with systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg or administrating high blood pressure-lowering medicines were regarded as hypertensives. Poisson regression models were used to estimate the prevalence ratios and corresponding 95% confidence intervals to assess the association between socioeconomic factors and hypertension. We explored mediation, using the medeff command in Stata for causal mediation analysis of nonlinear models. Results. Of the 50 hypertensive participants, sixty percent were aware of their status. The age-standardized prevalence of hypertension was two times higher for those with higher education or high-income category. Compared to low-income and unemployed groups, the prevalence ratio of hypertension was 1.33 and 2.26 times more for those belonging to the high-income and employed groups, respectively. No evidence of mediation by lifestyle factors was observed between socioeconomic status and hypertension. Conclusions. Socioeconomic positions were positively associated with hypertension prevalence in rural Nepal. Further studies using longitudinal settings are necessary to validate our findings especially in low- and middle-income countries such as Nepal.

Abstract 32: Global Burden and Control of Hypertension in 2010: Analysis of Population-Based Studies from 89 Countries

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Katherine T Mills ◽  
Joshua D Bundy ◽  
Tanika N Kelly ◽  
Jennifer E Reed ◽  
Patricia M Kearney ◽  
...  
Keyword(s):  
Global Health ◽  
Population Based ◽  
High Income ◽  
Global Burden ◽  
Middle Income ◽  
Middle Income Countries ◽  
Preventable Risk Factor ◽  
High Prevalence ◽  
And Control ◽  
Low And Middle Income

Background: Hypertension is an important global health challenge due to its high prevalence and resulting cardiovascular disease and chronic kidney disease. Hypertension is the leading preventable risk factor for premature death and disability worldwide. Objective: We estimated the prevalence, awareness, treatment and control of hypertension worldwide in 2010 and compared the global burden of hypertension in 2000 and 2010. Methods: We searched MEDLINE for published reports from January 1, 2001 to June 30, 2014 and supplemented with manual searches of references from retrieved articles. We included population-based studies and applied sex-age-specific prevalence of hypertension from each country to population data to assess the number of hypertensive adults in each region and globally. Proportions of awareness, treatment and control from each country were applied to hypertensive populations to obtain regional and global estimates. Results: An estimated 29.8% (95% confidence interval 29.6-30.0%) of the world’s adult population in 2010 had hypertension (30.7% [30.4-31.0%] in men and 28.8% [28.6-29.0%] in women). The estimated total number of hypertensive adults in 2010 was 1.33 billion (1.32-1.34 billion); 346 million (336-356 million) in high-income and 985 million (977-994 million) in low- and middle-income countries. From 2000 to 2010, the age-standardized prevalence of hypertension increased by 2.5% worldwide. The hypertension prevalence decreased 3.5% in high-income countries, whereas the prevalence increased 4.5% in low- and middle-income countries. In addition, from 2000 to 2010 the number of hypertensive adults increased by 354 million (334 million in low- and middle-income countries compared to 19 million in high-income countries). Proportions of hypertension awareness, treatment and control worldwide in 2010 were 43.5% (43.1-44.0%), 33.8% (33.3-34.2%), and 12.3% (12.1-12.6%), respectively. The proportion of hypertension control was 27.7% (27.0-28.3%) in high-income and 6.9% (6.7-7.1) in low- and middle-income countries. Conclusions: Prevention and treatment of hypertension should be a global health priority due to its high prevalence and low control rate globally, especially in low- and middle-income countries.

scholarly journals Tuberculosis and Non-Communicable Disease Multimorbidity: An Analysis of the World Health Survey in 48 Low- and Middle-Income Countries

2021 ◽  
Vol 18 (5) ◽  
pp. 2439
Author(s):  
Brendon Stubbs ◽  
Kamran Siddiqi ◽  
Helen Elsey ◽  
Najma Siddiqi ◽  
Ruimin Ma ◽  
...  
Keyword(s):  
Health Survey ◽  
Low Income ◽  
World Health ◽  
Low Income Countries ◽  
Multivariable Logistic Regression Analysis ◽  
World Health Survey ◽  
Middle Income ◽  
Middle Income Countries ◽  
The World ◽  
Low And Middle Income

Tuberculosis (TB) is a leading cause of mortality in low- and middle-income countries (LMICs). TB multimorbidity [TB and ≥1 non-communicable diseases (NCDs)] is common, but studies are sparse. Cross-sectional, community-based data including adults from 21 low-income countries and 27 middle-income countries were utilized from the World Health Survey. Associations between 9 NCDs and TB were assessed with multivariable logistic regression analysis. Years lived with disability (YLDs) were calculated using disability weights provided by the 2017 Global Burden of Disease Study. Eight out of 9 NCDs (all except visual impairment) were associated with TB (odds ratio (OR) ranging from 1.38–4.0). Prevalence of self-reported TB increased linearly with increasing numbers of NCDs. Compared to those with no NCDs, those who had 1, 2, 3, 4, and ≥5 NCDs had 2.61 (95% confidence interval (CI) = 2.14–3.22), 4.71 (95%CI = 3.67–6.11), 6.96 (95%CI = 4.95–9.87), 10.59 (95%CI = 7.10–15.80), and 19.89 (95%CI = 11.13–35.52) times higher odds for TB. Among those with TB, the most prevalent combinations of NCDs were angina and depression, followed by angina and arthritis. For people with TB, the YLDs were three times higher than in people without multimorbidity or TB, and a third of the YLDs were attributable to NCDs. Urgent research to understand, prevent and manage NCDs in people with TB in LMICs is needed.

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