Barriers to neurotrauma care in low- to middle-income countries: an international survey of neurotrauma providers

2021 ◽  
pp. 1-10
Keyword(s):  
At Risk ◽  
Geographic Distance ◽  
Geographic Region ◽  
Global Surgery ◽  
World Health ◽  
Cross Sectional ◽  
Middle Income ◽  
Middle Income Countries ◽  
Populations At Risk ◽  
Three Delays

OBJECTIVE Delays along the neurosurgical care continuum are associated with poor outcomes and are significantly greater in low- to middle-income countries (LMICs), with timely access to neurotrauma care remaining one of the most significant unmet neurosurgical needs worldwide. Using Lancet Global Surgery metrics and the Three Delays framework, the authors of this study aimed to identify and characterize the most significant barriers to the delivery of neurotrauma care in LMICs from the perspective of local neurotrauma providers. METHODS The authors conducted a cross-sectional study through the dissemination of a web-based survey to neurotrauma providers across all World Health Organization geographic regions. Responses were analyzed with descriptive statistics and Kruskal-Wallis testing, using World Bank data to provide estimates of populations at risk. RESULTS Eighty-two (36.9%) of 222 neurosurgeons representing 47 countries participated in the survey. It was estimated that 3.9 billion people lack access to neurotrauma care within 2 hours. Nearly 3.4 billion were estimated to be at risk for impoverishing expenditure and 2.9 billion were at risk of catastrophic expenditure as a result of paying for care for neurotrauma injuries. Delays in seeking care were rated as slightly common (p < 0.001), those in reaching care were very common (p < 0.001), and those in receiving care were slightly common (p < 0.05). The most significant causes for delays were associated with reaching care, including geographic distance from a facility, lack of ambulance service, and lack of finances for travel. All three delays were correlated to income classification and geographic region. CONCLUSIONS While expanding the global neurosurgical workforce is of the utmost importance, the study data suggested that it may not be entirely sufficient in gaining access to care for the emergent neurosurgical patient. Significant income and region-specific variability exists with regard to barriers to accessing neurotrauma care. Highlighting these barriers and quantifying worldwide access to neurotrauma care using metrics from the Lancet Commission on Global Surgery provides essential insight for future initiatives aiming to strengthen global neurotrauma systems.

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).

scholarly journals Patients with more comorbidities have better detection of chronic conditions, but poorer management and control: findings from six middle-income countries

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Grace Sum ◽  
Gerald Choon-Huat Koh ◽  
Stewart W. Mercer ◽  
Lim Yee Wei ◽  
Azeem Majeed ◽  
...  
Keyword(s):  
Chronic Conditions ◽  
World Health Organisation ◽  
World Health ◽  
Uncontrolled Hypertension ◽  
Adult Health ◽  
Cross Sectional ◽  
Middle Income ◽  
Middle Income Countries ◽  
Increased Risk ◽  
And Control

Abstract Background The burden of non-communicable diseases (NCDs) is rising rapidly in middle-income countries (MICs), where NCDs are often undiagnosed, untreated and uncontrolled. How comorbidity impacts diagnosis, treatment, and control of NCDs is an emerging area of research inquiry and have important clinical implications as highlighted in the recent National Institute for Health and Care Excellence guidelines for treating patients suffering from multiple NCDs. This is the first study to examine the association between increasing numbers of comorbidities with being undiagnosed, untreated, and uncontrolled for NCDs, in 6 large MICs. Methods Cross-sectional analysis of the World Health Organisation Study of Global Ageing and Adult Health (WHO SAGE) Wave 1 (2007–10), which consisted of adults aged ≥18 years from 6 populous MICs, including China, Ghana, India, Mexico, Russia and South Africa (overall n = 41, 557). Results A higher number of comorbidities was associated with better odds of diagnosis for hypertension, angina, and arthritis, and higher odds of having treatment for hypertension and angina. However, more comorbidities were associated with increased odds of uncontrolled hypertension, angina, arthritis, and asthma. Comorbidity with concordant conditions was associated with improved diagnosis and treatment of hypertension and angina. Conclusion Patients with more comorbidities have better diagnosis of chronic conditions, but this does not translate into better management and control of these conditions. Patients with multiple NCDs are high users of health services and are at an increased risk of adverse health outcomes. Hence, improving their access to care is a priority for healthcare systems.

scholarly journals Diversity in the Factors Associated with ADL-Related Disability among Older People in Six Middle-Income Countries: A Cross-Country Comparison

2019 ◽  
Vol 16 (8) ◽  
pp. 1341 ◽  
Author(s):  
Septi Kurnia Lestari ◽  
Nawi Ng ◽  
Paul Kowal ◽  
Ailiana Santosa
Keyword(s):  
South Africa ◽  
Older People ◽  
Health Behaviours ◽  
World Health ◽  
Adult Health ◽  
Cross Sectional ◽  
Middle Income ◽  
Factors Associated ◽  
Middle Income Countries ◽  
Adl Disability

The low- and middle-income countries (LMICs) are experiencing rapid population ageing, yet knowledge about disability among older populations in these countries is scarce. This study aims to identify the prevalence and factors associated with disability among people aged 50 years and over in six LMICs. Cross-sectional data from the World Health Organization (WHO) Study on global AGEing and adult health Wave 1 (2007–2010) in China, Ghana, India, Mexico, the Russian Federation, and South Africa was used. Multivariable logistic regression analyses were undertaken to examine the association between sociodemographic factors, health behaviours, chronic conditions, and activities of daily living (ADL) disability. The prevalence of disability among older adults ranged from 16.2% in China to 55.7% in India. Older age, multimorbidity, and depression were the most common factors related to disability in all six countries. Gender was significant in China (OR = 1.14, 95% CI: 1.01–1.29), Ghana (OR = 1.22, 95% CI: 1.01–1.48) and India (OR = 1.65, 95% CI: 1.37–1.99). Having no access to social capital was significantly associated with ADL disability in China (OR = 2.57, 95% CI: 1.54–4.31) and South Africa (OR = 4.11, 95% CI: 1.79–9.43). Prevalence data is valuable in these six ageing countries, with important evidence on mitigating factors for each. Identifying determinants associated with ADL disability among older people in LMICs can inform how to best implement health prevention programmes considering different country-specific factors.

scholarly journals Household Air Pollution and Angina Pectoris in Low- and Middle-Income Countries: Cross-Sectional Evidence from the World Health Survey 2002–2003

2020 ◽  
Vol 17 (16) ◽  
pp. 5802
Author(s):  
Ishwar Tiwari ◽  
Raphael M. Herr ◽  
Adrian Loerbroks ◽  
Shelby S. Yamamoto
Keyword(s):  
Air Pollution ◽  
Angina Pectoris ◽  
Health Survey ◽  
Solid Fuel ◽  
Household Air Pollution ◽  
World Health ◽  
World Health Survey ◽  
Cross Sectional ◽  
Middle Income ◽  
Middle Income Countries

The evidence regarding the effects of household air pollution on angina pectoris is limited in low-and middle-income countries (LMICs). We sought to examine the association between household air pollution and angina pectoris across several countries. We analyzed data of individuals from 46 selected countries participating in the cross-sectional World Health Survey (WHS) 2002–2003. Pooled and stratified (sex, continent) logistic regression with sampling weights was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to quantify associations between the use of different household fuels with angina pectoris. In the pooled sample, we observed lower odds of angina pectoris with electricity use (OR: 0.68, 95% CI: 0.56–0.83) compared to those households reporting the use of gas as a household fuel. Increased odds of angina pectoris were observed with the use of agriculture/dung/shrub/other (OR: 1.65, 95% CI: 1.30–2.09), mixed (solid and non-solid fuels) (OR: 1.31, 95% CI: 1.09–1.56), and mixed solid fuel use (OR: 1.59, 95% CI: 1.12–2.25). Higher odds of angina pectoris were observed mainly with solid fuel use. The results highlight the importance of addressing these issues, especially in regions with a high proportion of solid fuel users and increasing levels of cardiovascular disease.

scholarly journals Maternal-focused interventions to improve infant growth and nutritional status in low-middle income countries: A systematic review of reviews

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0256188
Author(s):  
Victoria von Salmuth ◽  
Eilise Brennan ◽  
Marko Kerac ◽  
Marie McGrath ◽  
Severine Frison ◽  
...  
Keyword(s):  
Systematic Review ◽  
At Risk ◽  
Infant Growth ◽  
World Health ◽  
Sufficient Evidence ◽  
Middle Income ◽  
Infant Outcomes ◽  
Health Technologies ◽  
Middle Income Countries ◽  
Review Of Reviews

Background Small and nutritionally at-risk infants under 6 months (<6m) are a vulnerable group at increased risk of mortality, morbidity, poor growth and sub-optimal development. Current national and international (World Health Organization) management guidelines focus mainly on infants’ needs, yet growing evidence suggests that maternal factors also influence infant outcomes. We aimed to inform future guidelines by exploring the impacts of maternal-focused interventions on infant feeding and growth. Methods We conducted a systematic review of reviews published since 2008 (PROSPERO, register number CRD 42019141724). We explored five databases and a wide variety of maternal-focused interventions based in low- and middle-income countries. Infant outcomes of interest included anthropometric status, birthweight, infant mortality, breastfeeding and complementary feeding practices. Given heterogenous interventions, we present a narrative synthesis of the extracted data. Results We included a total of 55 systematic reviews. Numerous maternal interventions were effective in improving infant growth or feeding outcomes. These included breastfeeding promotion, education, support and counselling interventions. Maternal mental health, while under-researched, showed potential to positively impact infant growth. There was also some evidence for a positive impact of: women’s empowerment, m-health technologies, conditional cash transfers, water, sanitation and hygiene and agricultural interventions. Effectiveness was increased when implemented as part of a multi-sectoral program. Antenatal supplementation with macronutrient, multiple micronutrients, Vitamin D, zinc, iron folic acid and possibly calcium, iodine and B12 in deficient women, improved birth outcomes. In contrast, evidence for postnatal supplementation was limited as was evidence directly focusing on small and nutritionally at-risk infants; most reviews focused on the prevention of growth faltering. Conclusion Our findings suggest sufficient evidence to justify greater inclusion of mothers in more holistic packages of care for small and nutritionally at-risk infants aged <6m. Context specific approaches are likely needed to support mother-infant dyads and ensure infants survive and thrive.

scholarly journals Comparative health system performance in six middle-income countries: cross-sectional analysis using World Health Organization study of global ageing and health

2017 ◽  
Vol 110 (9) ◽  
pp. 365-375 ◽  
Author(s):  
Riyadh Alshamsan ◽  
John Tayu Lee ◽  
Sangeeta Rana ◽  
Hasan Areabi ◽  
Christopher Millett
Keyword(s):  
Health System ◽  
System Performance ◽  
World Health ◽  
Health System Performance ◽  
Health Coverage ◽  
Cross Sectional ◽  
Middle Income ◽  
Middle Income Countries ◽  
Health Organization ◽  
Sectional Analysis

Objective To assess and compare health system performance across six middle-income countries that are strengthening their health systems in pursuit of universal health coverage. Design Cross-sectional analysis from the World Health Organization Study on global AGEing and adult health, collected between 2007 and 2010. Setting Six middle-income countries: China, Ghana, India, Mexico, Russia and South Africa. Participants Nationally representative sample of adults aged 50 years and older. Main outcome measures We present achievement against key indicators of health system performance across effectiveness, cost, access, patient-centredness and equity domains. Results We found areas of poor performance in prevention and management of chronic conditions, such as hypertension control and cancer screening coverage. We also found that cost remains a barrier to healthcare access in spite of insurance schemes. Finally, we found evidence of disparities across many indicators, particularly in the effectiveness and patient centredness domains. Conclusions These findings identify important focus areas for action and shared learning as these countries move towards achieving universal health coverage.

scholarly journals Cross-national differences in the prevalence and correlates of burden among older family caregivers in the World Health Organization World Mental Health (WMH) Surveys

2012 ◽  
Vol 43 (4) ◽  
pp. 865-879 ◽  
Author(s):  
V. Shahly ◽  
S. Chatterji ◽  
M. J. Gruber ◽  
A. Al-Hamzawi ◽  
J. Alonso ◽  
...  
Keyword(s):  
Family Caregivers ◽  
Family Caregiving ◽  
Family Income ◽  
Financial Burden ◽  
World Health ◽  
Health Conditions ◽  
Cross Sectional ◽  
Middle Income ◽  
Middle Income Countries ◽  
National Differences

BackgroundCurrent trends in population aging affect both recipients and providers of informal family caregiving, as the pool of family caregivers is shrinking while demand is increasing. Epidemiological research has not yet examined the implications of these trends for burdens experienced by aging family caregivers.MethodCross-sectional community surveys in 20 countries asked 13 892 respondents aged 50+ years about the objective (time, financial) and subjective (distress, embarrassment) burdens they experience in providing care to first-degree relatives with 12 broadly defined serious physical and mental conditions. Differential burden was examined by country income category, kinship status and type of condition.ResultsAmong the 26.9–42.5% respondents in high-, upper-middle-, and low-/lower-middle-income countries reporting serious relative health conditions, 35.7–42.5% reported burden. Of those, 25.2–29.0% spent time and 13.5–19.4% money, while 24.4–30.6% felt distress and 6.4–21.7% embarrassment. Mean caregiving hours per week in those giving any time were 16.6–23.6 (169.9–205.8 h/week per 100 people aged 50+ years). Burden in low-/lower-middle-income countries was 2- to 3-fold higher than in higher-income countries, with any financial burden averaging 14.3% of median family income in high-, 17.7% in upper-middle-, and 39.8% in low-/lower-middle-income countries. Higher burden was reported by women than men and for conditions of spouses and children than parents or siblings.ConclusionsUncompensated family caregiving is an important societal asset that offsets rising formal healthcare costs. However, the substantial burdens experienced by aging caregivers across multiple family health conditions and geographic regions threaten the continued integrity of their caregiving capacity. Initiatives supporting older family caregivers are consequently needed, especially in low-/lower-middle-income countries.

Geographical variation and temporal trend in anemia among children 6-59 months of age in low- and middle-income countries during 2000-2018: forecasting the 2030 SDG target

2021 ◽  
pp. 1-20
Author(s):  
Md. Mehedi Hasan ◽  
Ricardo J Soares Magalhaes ◽  
Saifuddin Ahmed ◽  
Sonia Pervin ◽  
Md. Tariqujjaman ◽  
...  
Keyword(s):  
Public Health Problem ◽  
Credible Interval ◽  
World Health ◽  
Cross Sectional ◽  
Middle Income ◽  
Severe Problem ◽  
Middle Income Countries ◽  
Geographical Variations ◽  
Health Organization ◽  
Low And Middle Income

Abstract Objective: To examine geographical variations, trends, and projections in the prevalence of childhood anemia at national and subpopulation levels. Design: Repeated cross-sectional Demographic and Health Survey (DHS) conducted during 2000-2018. Setting: 53 low- and middle-income countries (LMICs) Participants: 776,689 children aged 6-59 months of age. Results: During the latest DHS rounds between 2005-2018, the prevalence of child anemia was >20% in 52 out of 53 countries and ranged from 15.9% in Armenia in 2016 to 87.8% in Burkina Faso in 2010. Out of 36 countries with at least two surveys during 2000-2018, the prevalence of child anemia decreased in 22 countries, highest in Zimbabwe (−4.2%) and increased in 14 countries, highest in Burundi (5.0%). Based on the trend, 11 and 22 out of 36 countries are projected to experience respectively moderate and severe public health problem according to the World Health Organization criteria (moderate problem: 20-39.9% and severe problem: ≥40%) due to child anemia in 2030, with the highest prevalence in Liberia (87.5%, 95% Credible Interval 52.0-98.8%). The prevalence of child anemia varied across the mother’s education and age, child sex, wealth quintiles, and place of residence, with the highest rate of child anemia among the poorest, rural, and low-educated mothers. These scenarios are projected to continue. The probability of reducing child anemia at <0.5% by 2030 is 0% for all study countries. Conclusions: The prevalence of child anemia varied between and within countries. None of the 36 LMICs is likely to eradicate child anemia by 2030.

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