scholarly journals Inequalities in Delayed Initiation of Breastfeeding: Evidence from Health Surveys in 58 Low- and Middle-Income Countries (2012-2017)

2021 ◽  
Author(s):  
Shahreen Raihana ◽  
Michael J Dibley ◽  
Sabrina Sharmin Priyanka ◽  
Ashraful Alam ◽  
Tanvir M Huda
Keyword(s):  
Wealth Quintile ◽  
Sociodemographic Factors ◽  
Sub Saharan Africa ◽  
Breastfeeding Initiation ◽  
Global Pattern ◽  
Middle Income ◽  
Ample Evidence ◽  
Middle Income Countries ◽  
Over Time ◽  
Low And Middle Income

Abstract Background: Delay in breastfeeding initiation beyond 1 hour of birth increases the risk of neonatal deaths and illnesses. Despite ample evidence highlighting its importance, wealth-related inequalities exist in delayed breastfeeding initiation rates in many low- and middle-income countries (LMICs). Our goal was to examine the magnitude and trend of socio-economic inequalities in delayed breastfeeding initiation rates in LMICs.Methods: We used data from 58 low- and middle-income countries from their most recent Demographic and Health Survey and Multiple Indicator Cluster Survey to present delayed breastfeeding initiation rates across wealth quintile and area of residence. To assess the wealth-related inequalities in delayed breastfeeding initiation rates, we calculated two indicators- the difference, in percentage points, between the rates recorded for the poorest and wealthiest quintiles and the ratio of the same two values. To present the change over time, we calculated- the annual absolute change and annual absolute excess change. Results: Within countries, the prevalence of delayed breastfeeding initiation was higher among the wealthiest quintile (median 47.4%) and lower in the poorest quintile (median 42.6%). In 37 study countries, the prevalence of delayed breastfeeding initiation was higher among the wealthiest than among the poorest. The highest prevalence of delayed breastfeeding initiation was in South Asia, and the largest levels of pro-rich inequality were in Latin America and Caribbean. Pro-poor inequality was more common in Sub-Saharan Africa. Delayed breastfeeding initiation rates decreased faster in the poorest quintile (median -1.3 percent-points per year) compared to the wealthiest quintile (median -0.8 percent-points per year), indicating an increase in pro-poor inequality over time.Conclusions: There is no distinguishable global pattern for wealth-related inequality in the prevalence of delayed breastfeeding initiation. The prevailing inequality may be due to a combination of sociodemographic factors and is largely preventable by incorporating adequate infrastructure towards creating a pro-breastfeeding environment.

scholarly journals Are low and middle-income countries prioritising high-value healthcare interventions?

2020 ◽  
Vol 5 (2) ◽  
pp. e001850
Author(s):  
Ashley A Leech ◽  
David D Kim ◽  
Joshua T Cohen ◽  
Peter J Neumann
Keyword(s):  
Cost Effectiveness ◽  
Cost Saving ◽  
National Health ◽  
Sub Saharan Africa ◽  
Health Plans ◽  
Middle Income ◽  
Middle Income Countries ◽  
Health Priority ◽  
Sub Saharan ◽  
Low And Middle Income

IntroductionSince resources are finite, investing in services that produce the highest health gain ‘return on investment’ is critical. We assessed the extent to which low and middle-income countries (LMIC) have included cost-saving interventions in their national strategic health plans.MethodsWe used the Tufts Medical Center Global Health Cost-Effectiveness Analysis Registry, an open-source database of English-language cost-per-disability-adjusted life year (DALY) studies, to identify analyses published in the last 10 years (2008–2017) of cost-saving health interventions in LMICs. To assess whether countries prioritised cost-saving interventions within their latest national health strategic plans, we identified 10 countries, all in sub-Saharan Africa, with the highest measures on the global burden of disease scale and reviewed their national health priority plans.ResultsWe identified 392 studies (63%) targeting LMICs that reported 3315 cost-per-DALY ratios, of which 207 ratios (6%) represented interventions reported to be cost saving. Over half (53%) of these targeted sub-Saharan Africa. For the 10 countries we investigated in sub-Saharan Africa, 58% (79/137) of cost-saving interventions correspond with priorities identified in country plans. Alignment ranged from 95% (21/22 prioritised cost-saving ratios) in South Africa to 17% (2/12 prioritised cost-saving ratios) in Cameroon. Human papillomavirus vaccination was a noted priority in 70% (7/10) of national health prioritisation plans, while 40% (4/10) of countries explicitly included prenatal serological screening for syphilis. HIV prevention and treatment were stated priorities in most country health plans, whereas 40% (2/5) of countries principally outlined efforts for lymphatic filariasis. From our sample of 45 unique interventions, 36% of interventions (16/45) included costs associated directly with the implementation of the intervention.ConclusionOur findings indicate substantial variation across country and disease area in incorporating economic evidence into national health priority plans in a sample of sub-Saharan African countries. To make health economic data more salient, the authors of cost-effectiveness analyses must do more to reflect implementation costs and other factors that could limit healthcare delivery.

Strategies used to establish palliative care in rural low- and middle-income countries: an integrative review

2020 ◽  
Vol 35 (8) ◽  
pp. 1110-1129
Author(s):  
Atsede Aregay ◽  
Margaret O’Connor ◽  
Jill Stow ◽  
Nicola Ayers ◽  
Susan Lee
Keyword(s):  
Palliative Care ◽  
Low Income ◽  
Rural Areas ◽  
Urban Areas ◽  
Care Home ◽  
Sub Saharan Africa ◽  
Integrative Review ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Abstract Globally, 40 million people need palliative care; about 69% are people over 60 years of age. The highest proportion (78%) of adults are from low- and middle-income countries (LMICs), where palliative care still developing and is primarily limited to urban areas. This integrative review describes strategies used by LMICs to establish palliative care in rural areas. A rigorous integrative review methodology was utilized using four electronic databases (Ovid MEDLINE, Ovid Emcare, Embase classic+Embase and CINAHL). The search terms were: ‘palliative care’, ‘hospice care’, ‘end of life care’, ‘home-based care’, ‘volunteer’, ‘rural’, ‘regional’, ‘remote’ and ‘developing countries’ identified by the United Nations (UN) as ‘Africa’, ‘Sub-Saharan Africa’, ‘low-income’ and ‘middle- income countries’. Thirty papers published in English from 1990 to 2019 were included. Papers were appraised for quality and extracted data subjected to analysis using a public health model (policy, drug availability, education and implementation) as a framework to describe strategies for establishing palliative care in rural areas. The methodological quality of the reviewed papers was low, with 7 of the 30 being simple programme descriptions. Despite the inclusion of palliative care in national health policy in some countries, implementation in the community was often reliant on advocacy and financial support from non-government organizations. Networking to coordinate care and medication availability near-patient homes were essential features of implementation. Training, role play, education and mentorship were strategies used to support health providers and volunteers. Home- and community-based palliative care services for rural LMICs communities may best be delivered using a networked service among health professionals, community volunteers, religious leaders and technology.

scholarly journals Who actually cares for children in slums? Why we need to think, and do, more about paid childcare in urbanizing sub-Saharan Africa

2021 ◽  
Vol 376 (1827) ◽  
Author(s):  
Robert C. Hughes ◽  
Patricia Kitsao-Wekulo ◽  
Ruth Muendo ◽  
Sunil S. Bhopal ◽  
Elizabeth Kimani-Murage ◽  
...  
Keyword(s):  
Public Health Practice ◽  
Developmental Trajectory ◽  
Early Years ◽  
Sub Saharan Africa ◽  
Maternal Child Health ◽  
Middle Income ◽  
Middle Income Countries ◽  
Sub Saharan ◽  
Low And Middle Income ◽  
Childcare Providers

The early years are critical and inform the developmental trajectory of children. This is justifiably attracting growing policy attention. Much of this attention is focused on interventions and policies directed at parents, especially mothers. Yet emerging evidence suggests that increasing numbers of children in rapidly urbanizing low- and middle-income countries are now spending much of their day with other formal and informal childcare providers, including largely unregulated paid childcare providers. This paper summarizes the limited literature about the use of such paid childcare in low- and middle-income countries in sub-Saharan Africa, before considering possible reasons behind the lack of research evidence. Finally, key research gaps and their implications for public health practice are explored, with reference to the ongoing British Academy funded Nairobi Early Childcare in Slums research programme in Nairobi, Kenya. We argue that improving childcare may be an under-explored strategy to help some of the world's most disadvantaged children in the most important period of their lives, and that interventions in this largely informal market should be built on a rigorous research base. This article is part of the theme issue ‘Multidisciplinary perspectives on social support and maternal–child health’.

scholarly journals Essential healthcare services provided to conflict-affected internallydisplaced populations in low and middle-income countries: A systematicreview

2020 ◽  
Vol 10 (1) ◽  
pp. 24-37
Author(s):  
Winifred Ekezie ◽  
Enemona Emmanuel Adaji ◽  
Rachael L Murray
Keyword(s):  
Disease Surveillance ◽  
Health Resources ◽  
Healthcare Services ◽  
Outcome Data ◽  
Sub Saharan Africa ◽  
Middle Income ◽  
Internally Displaced ◽  
Middle Income Countries ◽  
Food And Nutrition ◽  
Low And Middle Income

Background: Conflict and violent crises have resulted in over 40 million of internally displaced persons (IDPs). Most affected regions lack access to basic health resources and generally rely on humanitarian support. The objective of this review was to appraise primary health service interventions among conflict-induced internally displaced populations in low and middle income countries between 2000 and 2019. Methods: A systematic review of literature in the following databases: Embase, MEDLINE, PsyArticles, PsycINFO, Scopus, Web of Science, LILAC and CAB Articles, was performed to identify interventions implemented in conflict IDP settings. Results: Initial searches yielded 4578 papers and 30 studies met the inclusion criteria. Descriptivesynthesis analysis was used, and the final selections were assessed using a customized CriticalAppraisal Skills Programme (CASP) checklist. Included papers were from Sub-Saharan Africa, South Asia and the Middle East regions. Most studies were on prevention interventions, especially water treatment and maternal health. Treatment interventions mostly focused on onmalaria and mental health. Only one food and nutrition study with outcome data was identified, indicating limitations in IDP health-related intervention publications. Reported interventions were conducted between one week to five years, and the study qualities were moderate. The most effective interventions were integrated programmes and common challenges were weakstudy methodology and data reporting. Conclusion: Regardless of the intervention types and durations, the services offered were beneficial to the IDPs. More intervention evidence are, however required as shown in gaps around food and nutrition, health education and disease surveillance.

scholarly journals Cost and cost-effectiveness analysis of treatment for child undernutrition in low- and middle-income countries: A systematic review

2020 ◽  
Vol 5 ◽  
pp. 62
Author(s):  
Rebecca G Njuguna ◽  
James A Berkley ◽  
Julie Jemutai
Keyword(s):  
Systematic Review ◽  
Cost Effectiveness ◽  
Service Providers ◽  
Productivity Loss ◽  
Sub Saharan Africa ◽  
Economic Evaluations ◽  
Middle Income ◽  
Child Undernutrition ◽  
Middle Income Countries ◽  
Low And Middle Income

Background: Undernutrition remains highly prevalent in low- and middle-income countries, with sub-Saharan Africa and Southern Asia accounting for majority of the cases. Apart from the health and human capacity impacts on children affected by malnutrition, there are significant economic impacts to households and service providers. The aim of this study was to determine the current state of knowledge on costs and cost-effectiveness of child undernutrition treatment to households, health providers, organizations and governments in low and middle-income countries (LMICs). Methods:  We conducted a systematic review of peer-reviewed studies in LMICs up to September 2019. We searched online databases including PubMed-Medline, Embase, Popline, Econlit and Web of Science. We identified additional articles through bibliographic citation searches. Only articles including costs of child undernutrition treatment were included. Results: We identified a total of 6436 articles, and only 50 met the eligibility criteria. Most included studies adopted institutional/program (45%) and health provider (38%) perspectives. The studies varied in the interventions studied and costing methods used with treatment costs reported ranging between US$0.44 and US$1344 per child. The main cost drivers were personnel, therapeutic food and productivity loss. We also assessed the cost effectiveness of community-based management of malnutrition programs (CMAM). Cost per disability adjusted life year (DALY) averted for a CMAM program integrated into existing health services in Malawi was $42. Overall, cost per DALY averted for CMAM ranged between US$26 and US$53, which was much lower than facility-based management (US$1344). Conclusion: There is a need to assess the burden of direct and indirect costs of child undernutrition to households and communities in order to plan, identify cost-effective solutions and address issues of cost that may limit delivery, uptake and effectiveness. Standardized methods and reporting in economic evaluations would facilitate interpretation and provide a means for comparing costs and cost-effectiveness of interventions.

scholarly journals Human Papilloma Virus self-sampling performance in low- and middle-income countries

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ashwini Kamath Mulki ◽  
Mellissa Withers
Keyword(s):  
Cervical Cancer ◽  
Health Workers ◽  
Sub Saharan Africa ◽  
Screening Methods ◽  
Middle Income ◽  
Middle Income Countries ◽  
Novel Approach ◽  
Very High ◽  
Low And Middle Income

Abstract Background Screening for HPV has led to significant reductions in cervical cancer deaths in high-income countries. However, the same results have not been achieved in low- and middle-income countries (LMICs). HPV self-sampling is a novel approach that could improve screening rates. Methods This study’s objective is to summarize the recent literature on HPV self-sampling in LMICs, focusing on sensitivity/specificity, and feasibility/acceptability of self-sampling compared to traditional screening methods. We conducted a PubMed search for articles published in English within the last 10 years on self-sampling in LMICs. Results Fifty eligible articles from 26 countries were included, 19 of which came from sub-Saharan Africa and 18 from Latin America/Caribbean. Seven studies examined sensitivity, with five reporting rates higher than 91%. Six reported on specificity, which was also very high at 86–97.8%. Six studies examined self-sampling concordance with provider-collected sampling, with concordance rates ranging from 87 to 97.5%. A total of 38 studies examined the feasibility/acceptability of HPV self-sampling. Participation rates were very high in all studies, even when self-sampling was done at participants’ homes (over 89% participation). Overall, participants reported that HPV self-sampling was easy to perform (75–97%, 18 studies), painless (60–90%, nine studies), and preferred over provider-collected sampling (57–100%, 14 studies). Eight studies reported follow-up rates for participants who completed self-sampling; however, these rates varied widely-from 13.7 to 90%. The major benefits of self-sampling include convenience of screening from home, less embarrassment, and less travel. Improved education and awareness of self-sampling, combined with support from community health workers, could reduce perceptions of self-sampling being inferior to provider-collected sampling. Improving follow-up of abnormal results and improving linkages to treatment are also essential. Conclusion Our literature review highlights HPV self-sampling is a well-performing test that shows promise in terms of expanding screening efforts for the prevention of cervical cancer-related deaths in LMICs.

Aging and the Rising Burden of Noncommunicable Diseases in Sub-Saharan Africa and other Low- and Middle-Income Countries: A Call for Holistic Action

2019 ◽  
Vol 60 (5) ◽  
pp. 806-811 ◽  
Author(s):  
Razak M Gyasi ◽  
David R Phillips
Keyword(s):  
Sub Saharan Africa ◽  
Vulnerable Groups ◽  
Noncommunicable Diseases ◽  
Mortality Data ◽  
African Countries ◽  
Middle Income ◽  
Middle Income Countries ◽  
Demographic Aging ◽  
Sub Saharan ◽  
Low And Middle Income

Abstract Noncommunicable diseases (NCDs) are a prevalent and growing burden among older cohorts in sub-Saharan Africa and other low- and middle-income countries (LMICs) as in many wealthier parts of the world. This stems from the combined effects of factors such as demographic aging, behavioral transitions, and developmental origins of health and disease. A crucial characteristic of many NCDs is that their personal and family impacts and costs are not accurately reflected in mortality data. Their effects are often chronic and long-term and can cause morbidity, loss of work ability, and impaired quality of life over a prolonged period. Unless addressed seriously, the continuing increase of NCDs and their burden in sub-Saharan African countries and other LMICs will almost certainly undermine progress toward achieving the target of reducing by 25% premature mortality from NCDs in these countries by 2025 and also one-third reduction of NCDs target by 2030. To have any chance of meeting or even getting near to these targets, this article calls for action by national and regional governments to strengthen universal health coverage (UHC), economic empowerment of vulnerable groups, public–private partnerships, effective fiscal regulation, and public education on NCDs, their risk factors and impacts in sub-Saharan Africa in particular and most LMICs globally.

scholarly journals COVID-19 preparedness—a survey among neonatal care providers in low- and middle-income countries

2021 ◽  
Author(s):  
Claus Klingenberg ◽  
◽  
Sahil K. Tembulkar ◽  
Anna Lavizzari ◽  
Charles C. Roehr ◽  
...  
Keyword(s):  
Low Income ◽  
Care Delivery ◽  
Neonatal Care ◽  
Sub Saharan Africa ◽  
World Health ◽  
Care Providers ◽  
Clinical Practices ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Abstract Objective To evaluate COVID-19 pandemic preparedness, available resources, and guidelines for neonatal care delivery among neonatal health care providers in low- and middle-income countries (LMICs) across all continents. Study design Cross-sectional, web-based survey administered between May and June, 2020. Results Of 189 invited participants in 69 LMICs, we received 145 (77%) responses from 58 (84%) countries. The pandemic provides significant challenges to neonatal care, particularly in low-income countries. Respondents noted exacerbations of preexisting shortages in staffing, equipment, and isolation capabilities. In Sub-Saharan Africa, 9/35 (26%) respondents noted increased mortality in non-COVID-19-infected infants. Clinical practices on cord clamping, isolation, and breastfeeding varied widely, often not in line with World Health Organization guidelines. Most respondents noted family access restrictions, and limited shared decision-making. Conclusions Many LMICs face an exacerbation of preexisting resource challenges for neonatal care during the pandemic. Variable approaches to care delivery and deviations from guidelines provide opportunities for international collaborative improvement.

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