scholarly journals A systematic review and meta-analysis of non-adherence to anti-diabetic medication: Evidence from low‐ and middle‐income countries

2021 ◽  
Author(s):  
Md Azharuddin ◽  
Mohammad Adil ◽  
Manju Sharma ◽  
Bishal Gyawali
Keyword(s):  
Medication Adherence ◽  
Selection Process ◽  
Meta Analysis ◽  
World Health ◽  
Middle Income ◽  
Factors Associated ◽  
Middle Income Countries ◽  
Morisky Medication Adherence Scale ◽  
Adherence Scale ◽  
Low And Middle Income

Objective: There is lack of evidence on the burden of and factors associated with non-adherence to anti-diabetic medication among individuals living with diabetes in low-and middle-income countries (LMICs). Therefore, we carried out a systematic literature review and meta-analytic synthesis to estimate non-adherence to anti-diabetic medication reported among adults in LMICs and to explore factors affecting non-adherence. Methods: We systematically searched MEDLINE and Embase to identify studies investigating non-adherence to anti-diabetic medications published between January 2000 and May 2020. Cross-sectional studies that had been conducted among individuals with diabetes in LMICs were eligible for the selection process. Critical appraisal of the included studies was carried out using the Newcastle Ottawa Scale. Meta-analysis was carried out using Stata 14.2. Random effects model was used to compute the pooled proportion at 95% confidence interval. Results: Forty-three studies met the inclusion criteria, of which 13 studies were used in meta-analysis. The pooled proportion of non-adherence to anti-diabetic medications using the eight-item Morisky Medication Adherence Scale (MMAS) was 43.4% (95% CI: 17.5–69.4; p=0.000) and 29.1% (95% CI: 19.8–38.4; p=0.000) when using the cut-off at 80 or 90%. The pooled proportion of non-adherence was 29.5% (95% CI: 25.5–33.5; p=0.098) when using the four-item Morisky Medication Adherence Scale. The factors for non-adherence based on World Health Organization demonstrated considerable variation of non-adherence to ant-diabetic medication in LMICs depending on the methods used to estimate non-adherence. Conclusions: These findings demonstrate a significantly higher proportion of medication non-adherence among individuals with diabetes in LMIC settings when MMAS-8 item scale was used and low when 80-90% cut-off scales were used. Various factors, such as disease factors, therapy-related factors, healthcare system factor, patient-centered factors, and social and economic factors contributed to non-adherence. Therefore, comprehensive multifaceted strategies are urgently needed to address factors associated with anti-diabetic medication non-adherence.

Physical injury and psychotic experiences in 48 low- and middle-income countries

2019 ◽  
pp. 1-8 ◽  
Author(s):  
A. Stickley ◽  
T. Sumiyoshi ◽  
Z. Narita ◽  
H. Oh ◽  
J. E. DeVylder ◽  
...  
Keyword(s):  
Mental Health ◽  
Meta Analysis ◽  
World Health ◽  
Multivariable Logistic Regression Analysis ◽  
Psychotic Experiences ◽  
Mental Health Systems ◽  
World Health Survey ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

AbstractBackgroundPsychotic experiences (PEs) may be associated with injuries, but studies focusing specifically on low- and middle-income countries (LAMICs) are scarce. Thus, the current study examined the link between injuries and PEs in a large number of LAMICs.MethodCross-sectional data were used from 242 952 individuals in 48 LAMICs that were collected during the World Health Survey in 2002–2004 to examine the association between traffic-related and other (non-traffic-related) forms of injury and PEs. Multivariable logistic regression analysis and meta-analysis were used to examine associations while controlling for a variety of covariates including depression.ResultsIn fully adjusted analyses, any injury [odds ratio (OR) 2.07, 95% confidence interval (CI) 1.85–2.31], traffic injury (OR 1.84, 95% CI 1.53–2.21) and other injury (OR 2.09, 95% CI 1.84–2.37) were associated with higher odds for PEs. Results from a country-wise analysis showed that any injury was associated with significantly increased odds for PEs in 39 countries with the overall pooled OR estimated by meta-analysis being 2.46 (95% CI 2.22–2.74) with a moderate level of between-country heterogeneity (I2 = 56.3%). Similar results were observed across all country income levels (low, lower-middle and upper-middle).ConclusionsDifferent types of injury are associated with PEs in LAMICs. Improving mental health systems and trauma capacity in LAMICs may be important for preventing injury-related negative mental health outcomes.

scholarly journals Elasticity of alcohol consumption, alcohol-related harms, and drinking initiation in low- and middle-income countries: A systematic review and meta-analysis

2013 ◽  
Vol 2 (1) ◽  
pp. 45-58 ◽  
Author(s):  
Bundit Sornpaisarn ◽  
Kevin Shield ◽  
Joanna Cohen ◽  
Robert Schwartz ◽  
Jürgen Rehm
Keyword(s):  
Systematic Review ◽  
Alcohol Consumption ◽  
Publication Bias ◽  
Meta Analysis ◽  
World Health ◽  
Middle Income ◽  
Middle Income Countries ◽  
Meta Analyses ◽  
Alcohol Price ◽  
Low And Middle Income

Sornpaisarn, B., Shield, K. Cohen, J., Schwartz, R. & Rehm, J. (2013). Elasticity of alcohol consumption, alcohol-related harms, and drinking initiation in low- and middle-income countries: A systematic review and meta-analysis. International Journal of Alcohol and Drug Research, 2(1), 45-58.  doi: 10.7895/ijadr.v2i1.50 (http://dx.doi.org/10.7895/ijadr.v2i1.50)Aim: To systematically review research outlining the effects of price and taxation on alcohol consumption, alcohol-related harms, and drinking initiation in low- and middle-income countries (LMIC).Design: The systematic review and meta-analyses were conducted according to internationally standardized protocols (Preferred Reporting Items for Systematic Review and Meta-Analysis; PRISMA). Data were collected up to June 2011 by searching the peer-reviewed article databases MEDLINE, EMBASE, PsycINFO, and EconLit, along with the World Health Organization’s gray literature Database of Abstracts of Reviews of Effects, and by reference tracking. The meta-analyses were performed using random effects analysis, tests for publication bias, and sensitivity analyses.Measures: Any type of association between alcohol price and/or taxation and alcohol consumption, alcohol-related harms, and alcohol drinking initiation in LMIC.Findings: Our systematic search disclosed 12 studies that outlined an association between alcohol price or taxation and alcohol consumption in LMIC, while no articles were found that outlined a relationship between taxation and/or price and alcohol-related harms or drinking initiation in LMIC. The elasticity estimates were –0.64 (95% CI: –0.80 to –0.48) for total consumption of alcohol, –0.50 (95% CI: –0.78 to –0.21) for consumption of beer, and –0.79 (95% CI: –1.09 to –0.49) for consumption of other alcoholic beverages. Publication bias did not significantly affect the estimated elasticities.Conclusion: Price elasticity of demand for alcohol in LMIC is similar to that found in high-income countries. There is an imperative need for research on the association between alcohol price or taxation and alcohol-related harms and drinking initiation in LMIC.

Depression and physical health multimorbidity: primary data and country-wide meta-analysis of population data from 190 593 people across 43 low- and middle-income countries

2017 ◽  
Vol 47 (12) ◽  
pp. 2107-2117 ◽  
Author(s):  
B. Stubbs ◽  
D. Vancampfort ◽  
N. Veronese ◽  
K. G. Kahl ◽  
A. J. Mitchell ◽  
...  
Keyword(s):  
Physical Health ◽  
Depressive Episode ◽  
Meta Analysis ◽  
The Philippines ◽  
World Health ◽  
World Health Survey ◽  
Middle Income ◽  
Middle Income Countries ◽  
Subsyndromal Depression ◽  
Low And Middle Income

BackgroundDespite the known heightened risk and burden of various somatic diseases in people with depression, very little is known about physical health multimorbidity (i.e. two or more physical health co-morbidities) in individuals with depression. This study explored physical health multimorbidity in people with clinical depression, subsyndromal depression and brief depressive episode across 43 low- and middle-income countries (LMICs).MethodCross-sectional, community-based data on 190 593 individuals from 43 LMICs recruited via the World Health Survey were analysed. Multivariable logistic regression analysis was done to assess the association between depression and physical multimorbidity.ResultsOverall, two, three and four or more physical health conditions were present in 7.4, 2.4 and 0.9% of non-depressive individuals compared with 17.7, 9.1 and 4.9% among people with any depressive episode, respectively. Compared with those with no depression, subsyndromal depression, brief depressive episode and depressive episode were significantly associated with 2.62, 2.14 and 3.44 times higher odds for multimorbidity, respectively. A significant positive association between multimorbidity and any depression was observed across 42 of the 43 countries, with particularly high odds ratios (ORs) in China (OR 8.84), Laos (OR 5.08), Ethiopia (OR 4.99), the Philippines (OR 4.81) and Malaysia (OR 4.58). The pooled OR for multimorbidity and depression estimated by meta-analysis across 43 countries was 3.26 (95% confident interval 2.98–3.57).ConclusionsOur large multinational study demonstrates that physical health multimorbidity is increased across the depression spectrum. Public health interventions are required to address this global health problem.

scholarly journals Injury and depression among 212 039 individuals in 40 low- and middle-income countries

2019 ◽  
Vol 29 ◽  
Author(s):  
A. Stickley ◽  
H. Oh ◽  
T. Sumiyoshi ◽  
M. McKee ◽  
A. Koyanagi
Keyword(s):  
Mental Health ◽  
Health Survey ◽  
Meta Analysis ◽  
World Health ◽  
Care Providers ◽  
Middle Income ◽  
Middle Income Countries ◽  
Traffic Injury ◽  
The World ◽  
Low And Middle Income

Abstract Aims Although injuries have been linked to worse mental health, little is known about this association among the general population in low- and middle-income countries (LAMICs). This study examined the association between injuries and depression in 40 LAMICs that participated in the World Health Survey. Methods Cross-sectional information was obtained from 212 039 community-based adults on the past 12-month experience of road traffic and other (non-traffic) injuries and depression, which was assessed using questions based on the World Mental Health Survey version of the Composite International Diagnostic Interview. Multivariable logistic regression analysis and meta-analysis were used to examine associations. Results The overall prevalence (95% CI) of past 12-month traffic injury, other injury, and depression was 2.8% (2.6–3.0%), 4.8% (4.6–5.0%) and 7.4% (7.1–7.8%), respectively. The prevalence of traffic injuries [range 0.1% (Ethiopia) to 5.1% (Bangladesh)], and other (non-traffic) injuries [range 0.9% (Myanmar) to 12.1% (Kenya)] varied widely across countries. After adjusting for demographic variables, alcohol consumption and smoking, the pooled OR (95%CI) for depression among individuals experiencing traffic injury based on a meta-analysis was 1.72 (1.48–1.99), and 2.04 (1.85–2.24) for those with other injuries. There was little between-country heterogeneity in the association between either form of injury and depression, although for traffic injuries, significant heterogeneity was observed between groups by country-income level (p = 0.043) where the pooled association was strongest in upper middle-income countries (OR = 2.37) and weakest in low-income countries (OR = 1.46). Conclusions Alerting health care providers in LAMICs to the increased risk of worse mental health among injury survivors and establishing effective trauma treatment systems to reduce the detrimental effects of injury should now be prioritised.

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.

scholarly journals Hierarchical disentanglement of contextual from compositional risk factors of diarrhoea among under-five children in low- and middle-income countries

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Adeniyi Francis Fagbamigbe ◽  
A. Olalekan Uthman ◽  
Latifat Ibisomi
Keyword(s):  
Risk Factors ◽  
National Level ◽  
Cross Sectional ◽  
Middle Income ◽  
Contextual Risk ◽  
Under Five ◽  
Factors Associated ◽  
Under Five Children ◽  
Middle Income Countries ◽  
Low And Middle Income

AbstractSeveral studies have documented the burden and risk factors associated with diarrhoea in low and middle-income countries (LMIC). To the best of our knowledge, the contextual and compositional factors associated with diarrhoea across LMIC were poorly operationalized, explored and understood in these studies. We investigated multilevel risk factors associated with diarrhoea among under-five children in LMIC. We analysed diarrhoea-related information of 796,150 under-five children (Level 1) nested within 63,378 neighbourhoods (Level 2) from 57 LMIC (Level 3) using the latest data from cross-sectional and nationally representative Demographic Health Survey conducted between 2010 and 2018. We used multivariable hierarchical Bayesian logistic regression models for data analysis. The overall prevalence of diarrhoea was 14.4% (95% confidence interval 14.2–14.7) ranging from 3.8% in Armenia to 31.4% in Yemen. The odds of diarrhoea was highest among male children, infants, having small birth weights, households in poorer wealth quintiles, children whose mothers had only primary education, and children who had no access to media. Children from neighbourhoods with high illiteracy [adjusted odds ratio (aOR) = 1.07, 95% credible interval (CrI) 1.04–1.10] rates were more likely to have diarrhoea. At the country-level, the odds of diarrhoea nearly doubled (aOR = 1.88, 95% CrI 1.23–2.83) and tripled (aOR = 2.66, 95% CrI 1.65–3.89) among children from countries with middle and lowest human development index respectively. Diarrhoea remains a major health challenge among under-five children in most LMIC. We identified diverse individual-level, community-level and national-level factors associated with the development of diarrhoea among under-five children in these countries and disentangled the associated contextual risk factors from the compositional risk factors. Our findings underscore the need to revitalize existing policies on child and maternal health and implement interventions to prevent diarrhoea at the individual-, community- and societal-levels. The current study showed how the drive to the attainment of SDGs 1, 2, 4, 6 and 10 will enhance the attainment of SDG 3.

scholarly journals Effectiveness of Breastfeeding Support Packages in Low- and Middle-Income Countries for Infants under Six Months: A Systematic Review

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 681
Author(s):  
Ritu Rana ◽  
Marie McGrath ◽  
Ekta Sharma ◽  
Paridhi Gupta ◽  
Marko Kerac
Keyword(s):  
At Risk ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
World Health ◽  
Cochrane Library ◽  
Breastfeeding Support ◽  
Middle Income ◽  
Middle Income Countries ◽  
Breastfeeding Practices ◽  
Low And Middle Income

Small and nutritionally at-risk infants under six months, defined as those with wasting, underweight, or other forms of growth failure, are at high-risk of mortality and morbidity. The World Health Organisation 2013 guidelines on severe acute malnutrition highlight the need to effectively manage this vulnerable group, but programmatic challenges are widely reported. This review aims to inform future management strategies for small and nutritionally at-risk infants under six months in low- and middle-income countries (LMICs) by synthesising evidence on existing breastfeeding support packages for all infants under six months. We searched PubMed, CINAHL, Cochrane Library, EMBASE, and Global Health databases from inception to 18 July 2018. Intervention of interest were breastfeeding support packages. Studies reporting breastfeeding practices and/or caregivers’/healthcare staffs’ knowledge/skills/practices for infants under six months from LMICs were included. Study quality was assessed using NICE quality appraisal checklist for intervention studies. A narrative data synthesis using the Synthesis Without Meta-analysis (SWiM) reporting guideline was conducted and key features of successful programmes identified. Of 15,256 studies initially identified, 41 were eligible for inclusion. They were geographically diverse, representing 22 LMICs. Interventions were mainly targeted at mother–infant pairs and only 7% (n = 3) studies included at-risk infants. Studies were rated to be of good or adequate quality. Twenty studies focused on hospital-based interventions, another 20 on community-based and one study compared both. Among all interventions, breastfeeding counselling (n = 6) and education (n = 6) support packages showed the most positive effect on breastfeeding practices followed by breastfeeding training (n = 4), promotion (n = 4) and peer support (n = 3). Breastfeeding education support (n = 3) also improved caregivers’ knowledge/skills/practices. Identified breastfeeding support packages can serve as "primary prevention" interventions for all infants under six months in LMICs. For at-risk infants, these packages need to be adapted and formally tested in future studies. Future work should also examine impacts of breastfeeding support on anthropometry and morbidity outcomes. The review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO 2018 CRD42018102795).

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