scholarly journals Multimorbidity and Anxiety Symptoms among Adults Aged 50 Years and Over from Six Low- and Middle-Income Countries

2021 ◽  
Vol 1 (1) ◽  
pp. 36-47
Author(s):  
Lee Smith ◽  
Guillermo F. López Sánchez ◽  
Jae Il Shin ◽  
Pinar Soysal ◽  
Nicola Veronese ◽  
...  
Keyword(s):  
Chronic Conditions ◽  
Meta Analysis ◽  
Anxiety Symptoms ◽  
Adult Health ◽  
Cross Sectional ◽  
Middle Income ◽  
Middle Income Countries ◽  
Nationally Representative ◽  
Meta Analyses ◽  
Low And Middle Income

Currently, there are limited data on the association between multimorbidity (i.e., ≥ 2 chronic conditions) and anxiety, especially among the older population in low- and middle-income countries (LMICs). Thus, the aim of the present study was to examine the association between multimorbidity and anxiety symptoms in a large sample of adults aged ≥ 50 years from six LMICs (China, India, Ghana, Mexico, Russia, South Africa). Cross-sectional, nationally representative, community-based data from the Study on Global Ageing and Adult Health (SAGE) were analysed. A total of 11 chronic physical conditions were assessed. Anxiety symptoms referred to extreme/severe problems with worry or anxiety in the past 30 days. Multivariable logistic regression and meta-analyses were conducted. Data on 34,129 adults aged ≥ 50 years were analysed (mean (SD) age 62.4 (16.0) years; 52.1% females). Compared with no chronic conditions, 2, 3, 4, and ≥ 5 chronic conditions were significantly associated with 1.47 (95% CI = 1.08–1.98), 2.46 (95% CI = 1.74–3.47), 3.04 (95% CI = 2.15–4.30), and 4.70 (95% CI = 2.99–7.38) times higher odds of anxiety symptoms, respectively. A country-wise analysis showed that multimorbidity was significantly associated with anxiety symptoms in all six countries (OR = 1.78–12.39) with the overall estimate based on a meta-analysis being OR = 2.29 (95% CI = 1.71–3.07). Multimorbidity was associated with higher odds of anxiety symptoms among older adults in LMICs. Future longitudinal studies are warranted to assess the temporal associations and mechanisms underlying this association.

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 Secondhand Smoking and Obesity Among Nonsmoking Adolescents Aged 12–15 Years From 38 Low- and Middle-Income Countries

2020 ◽  
Vol 22 (11) ◽  
pp. 2014-2021
Author(s):  
Ai Koyanagi ◽  
Lee Smith ◽  
Hans Oh ◽  
Lin Yang ◽  
Sarah E Jackson ◽  
...  
Keyword(s):  
Secondhand Smoke ◽  
Child Growth ◽  
Cross Sectional ◽  
Middle Income ◽  
Daily Exposure ◽  
Middle Income Countries ◽  
Secondhand Smoking ◽  
Country Study ◽  
Meta Analyses ◽  
Low And Middle Income

Abstract Introduction Secondhand smoking (SHS) may be a risk factor for obesity in adolescence, but data on the association between SHS and obesity are scarce, especially from low- and middle-income countries (LMICs). Therefore, the aim of this study was to assess the association between SHS and obesity among adolescents aged 12–15 years from 38 LMICs. Methods Cross-sectional data from 38 LMICs that participated in the Global School-based Student Health Survey (GSHS) were analyzed. Body mass index was calculated based on measured weight and height. The 2007 WHO Child Growth reference was used to define obesity. SHS was categorized as no exposure, non-daily exposure (ie, 1–6 days), and daily exposure (ie, 7 days) based on the number of days exposed to secondhand smoke in the past 7 days. Multivariable logistic regression and meta-analyses were conducted to assess the associations. Results The analyzed sample consisted of 88 209 adolescents aged 12–15 years who never smoked. The overall prevalence of non-daily and daily SHS was 34.2% and 15.7%, respectively. After adjustment for potential confounders, compared with no SHS, there was no significant association between non-daily SHS and obesity (odds ratio [OR] = 0.94; 95% confidence interval [CI] = 0.86–1.02), but adolescents who reported daily SHS were significantly more likely to have obesity (OR = 1.19; 95% CI = 1.06–1.34). Conclusions The prevalence of SHS was high among adolescents in LMICs, and daily SHS was associated with a significant increase in odds of obesity. Future studies with longitudinal designs are warranted to assess causality and whether prevention of SHS can reduce the risk of obesity in adolescence. Implications In the present large multi-country study on adolescents aged 12–15 years from LMICs, nearly half of the students were exposed to non-daily or daily secondhand smoke. Overall, while non-daily SHS was not significantly associated with obesity, adolescents who reported daily SHS had a significant 1.19 (95% CI = 1.06–1.34) times higher odds of obesity than those who reported no exposure to secondhand smoke. To the best of our knowledge, this is the first multi-country study on SHS and obesity from LMICs, and also the largest study on this topic to date.

scholarly journals Association of the quality of antenatal care with neonatal mortality: meta-analysis of individual participant data from 60 low- and middle-income countries

2019 ◽  
Vol 11 (6) ◽  
pp. 596-604 ◽  
Author(s):  
Subas Neupane ◽  
David Teye Doku
Keyword(s):  
Antenatal Care ◽  
Neonatal Mortality ◽  
Lower Risk ◽  
Meta Analysis ◽  
Cox Proportional Hazards ◽  
Cross Sectional ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

AbstractBackgroundWe investigated the quality of antenatal care (ANC) and its effect on neonatal mortality in 60 low- and middle-income countries (LMICs).MethodsWe used pooled comparable cross-sectional surveys from 60 LMICs (n=651 681). Cox proportional hazards multivariable regression models and meta-regression analysis were used to assess the effect of the quality of ANC on the risk of neonatal mortality. Kaplan–Meier survival curves were used to describe the time-to-event patterns of neonatal survival in each region.ResultsPooled estimates from meta-analysis showed a 34% lower risk of neonatal mortality for children of women who were attended to at ANC by skilled personnel. Sufficient ANC advice lowered the risk of neonatal mortality by 20%. Similarly, children of women who had adequate ANC had a 39% lower risk of neonatal mortality. The pooled multivariable model showed an association of neonatal mortality with the ANC quality index (HR 0.85, 95% CI 0.77 to 0.93).ConclusionsImprovement in the quality of ANC can reduce the risk of neonatal mortality substantially. Pursuing sustainable development goal 3, which aims to reduce neonatal mortality to 12 per 1000 live births by 2030, should improve the quality of ANC women receive in LMICs.

scholarly journals Effectiveness of interventions for dementia in low- and middle-income countries: protocol for a systematic review, pairwise and network meta-analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e027851
Author(s):  
Maximilian Salcher-Konrad ◽  
Huseyin Naci ◽  
David McDaid ◽  
Suvarna Alladi ◽  
Deborah Oliveira ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Secondary Analysis ◽  
Routine Care ◽  
Middle Income ◽  
Middle Income Countries ◽  
Cochrane Database ◽  
Registration Number ◽  
Meta Analyses ◽  
Low And Middle Income

IntroductionThere are more people living with dementia in low- and middle-income countries (LMICs) than in high-income countries. Evidence-based interventions to improve the lives of people living with dementia and their carers are needed, but a systematic mapping of methodologically robust studies in LMICs and synthesis of the effectiveness of dementia interventions in these settings is missing.Methods and analysisA systematic review and meta-analysis will be conducted to answer the question: Which dementia interventions were shown to be effective in LMICs and how do they compare to each other? Electronic database searches (MEDLINE, EMBASE, PsycINFO, CINAHL Plus, Global Health, WHO Global Index Medicus, Virtual Health Library, Cochrane CENTRAL, Social Care Online, BASE, MODEM Toolkit, Cochrane Database of Systematic Reviews) will be complemented by hand searching of reference lists and local knowledge of existing studies from an international network of researchers in dementia from LMICs. Studies will be eligible for inclusion if they were published between 2008 and 2018, conducted in LMICs and evaluated the effectiveness of a dementia intervention using a study design that supports causal inference of the treatment effect. We will include both randomised and non-randomised studies due to an anticipated low number of well-conducted randomised trials in LMICs and potentially greater external validity of non-randomised studies conducted in routine care settings. In addition to narrative synthesis of the interventions, feasibility of pairwise and network meta-analyses will be explored to obtain pooled effects of relative treatment effects.Ethics and disseminationSecondary analysis of published studies, therefore no ethics approval required. Planned dissemination channels include a peer-reviewed publication as well as a website, DVD and evidence summaries.Prospero registration numberCRD42018106206.

scholarly journals Prevalence and trends in the childhood dual burden of malnutrition in low- and middle-income countries, 1990–2012

2016 ◽  
Vol 19 (8) ◽  
pp. 1375-1388 ◽  
Author(s):  
Emma Tzioumis ◽  
Melissa C Kay ◽  
Margaret E Bentley ◽  
Linda S Adair
Keyword(s):  
Demographic And Health Surveys ◽  
Cross Sectional ◽  
Middle Income ◽  
Individual Level ◽  
Middle Income Countries ◽  
Country Level ◽  
Before And After ◽  
Dual Burden ◽  
Nationally Representative ◽  
Low And Middle Income

AbstractObjectiveTo describe trends in country- and individual-level dual burden of malnutrition in children <5 years, and age-stratified (<2 years, ≥2 years) country-level trends, in thirty-six low- and middle-income countries (LMIC).DesignUsing repeated cross-sectional nationally representative data, we calculated the prevalence of malnutrition (stunting, wasting, overweight) at each survey wave, annualized rates of prevalence change for each country over time, and trends before and after 2000, for all children <5 years and separately for those </≥2 years. We examined country- (ratio of stunting to overweight) and individual-level (coexistence of stunting and overweight) dual burden in children <5 years.SettingDemographic and Health Surveys from thirty-six LMIC between 1990 and 2012.SubjectsChildren <5 years.ResultsOverall malnutrition prevalence decreased in children <5 years, driven by stunting decreases. Stunting rates decreased in 78 % of countries, wasting rates decreased in 58 % of countries and overweight rates increased in 36 % of countries. Rates of change differed for children </≥2 years, with children <2 years experiencing decreases in stunting in fewer countries yet increases in overweight in more countries. Countries with nearly equal prevalences of stunting and overweight in children <5 years increased from 2000 to the final year. Within a country, 0·3–10·9 % of children <5 years were stunted and overweight, and 0·6–37·8 % of stunted children <5 years were overweight.ConclusionsThe dual burden exists in children <5 years on both country and individual levels, indicating a shift is needed in policies and programmes to address both sides of malnutrition. Children <2 years should be identified as a high-risk demographic.

scholarly journals Surgical outcomes for medically intractable epilepsy in low- and middle-income countries: a systematic review and meta-analysis

2019 ◽  
Vol 131 (4) ◽  
pp. 1068-1078 ◽  
Author(s):  
Alireza Mansouri ◽  
Shervin Taslimi ◽  
Aram Abbasian ◽  
Jetan H. Badhiwala ◽  
Muhammad Ali Akbar ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Intractable Epilepsy ◽  
Temporal Lobectomy ◽  
Publication Date ◽  
Seizure Freedom ◽  
Mesial Temporal Sclerosis ◽  
Middle Income ◽  
Middle Income Countries ◽  
Meta Analyses ◽  
Low And Middle Income

OBJECTIVEThe aim of this study was to describe the current state of epilepsy surgery and establish estimates of seizure outcomes following surgery for medically intractable epilepsy (MIE) in low- and middle-income countries (LMICs).METHODSThe MEDLINE and Embase databases were searched without publication date restriction. This search was supplemented by a manual screen of key epilepsy and neurosurgical journals (January 2005 to December 2016). Studies that reported outcomes for at least 10 patients of any age undergoing surgery for MIE in LMICs over a defined follow-up period were included. A meta-analysis with a random-effects model was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement and MOOSE (Meta-analysis of Observational Studies in Epidemiology) guidelines. Pooled estimates of seizure freedom and favorable seizure outcomes following anterior temporal lobectomy with or without amygdalohippocampectomy (ATL ± AH) were reported.RESULTSTwenty studies were selected, of which 16 were from Asian centers. The average age at surgery in all studies was less than 30 years, and the average preoperative duration of epilepsy ranged from 3 to 16.1 years. Mesial temporal sclerosis accounted for 437 of 951 described pathologies, and 1294 of the 1773 procedures were ATL ± AH. Based on 7 studies (646 patients) the pooled seizure freedom estimate following ATL ± AH was 68% (95% CI 55%–82%). Based on 8 studies (1096 patients), the pooled estimate for favorable seizure outcomes was 79% (95% CI 74%–85%).CONCLUSIONSSurgery for MIE in LMICs shows a high percentage of seizure freedom and favorable outcomes. These findings call for a concerted global effort to improve timely access to surgery for MIE patients in these regions, including investments aimed at refining existing and establishing additional centers.

scholarly journals Association between Household Crowding and Violent Discipline and Neglect of Children: Analysis of Multiple Indicator Cluster Surveys in 26 Low- and Middle-Income Countries

2021 ◽  
Vol 18 (4) ◽  
pp. 1685
Author(s):  
Yaqing Gao ◽  
Xiaoyi Mi ◽  
Yinping Wang ◽  
Siyu Zou ◽  
Hong Zhou
Keyword(s):  
Child Neglect ◽  
Physical And Mental Health ◽  
Cross Sectional ◽  
Middle Income ◽  
Logistic Regression Models ◽  
Middle Income Countries ◽  
Multiple Indicator ◽  
Household Crowding ◽  
Meta Analyses ◽  
Low And Middle Income

The influence of household crowding on physical and mental health has been well documented. However, research on the influence of household crowding on violent discipline and neglect of children is scarce. Therefore, we aimed to investigate whether household crowding was associated with violent discipline and neglect of children in low- and- middle-income countries (LMICs). Cross-sectional data for 280,005 and 73,030 children in 26 LMICs surveyed using the Multiple Indicator Cluster Survey were analyzed for (1) violent discipline and (2) neglect, respectively. In each country, we used logistic regression models to estimate the effects of household crowding on multiple forms of violent discipline and stimulation activities (as a proxy of the level of child neglect). Estimates were pooled using random effects meta-analyses. After adjusting for confounding variables, household crowding was associated with higher odds of any violent discipline (odds ratio (OR) = 1.09, 95% CI 1.03 to 1.15, p = 0.002) and lower odds of engaging in four or more stimulation activities (OR = 0.88, 95% CI 0.83 to 0.94, p < 0.001). The associations were stronger for urban children and children living in low- and lower-middle-income countries. The findings suggest that screenings and interventions aimed at reducing the effects of household crowding might be effective in preventing and controlling violent discipline and neglect of children in LMICs.

scholarly journals Association of objective visual impairment with suicidal ideation and suicide attempts among adults aged ≥50 years in low/middle-income countries

2021 ◽  
pp. bjophthalmol-2021-318864
Author(s):  
Lee Smith ◽  
Jae Il Shin ◽  
Yvonne Barnett ◽  
Peter M Allen ◽  
Rosie Lindsay ◽  
...  
Keyword(s):  
Older Adults ◽  
Suicidal Ideation ◽  
Visual Impairment ◽  
Suicide Attempts ◽  
Adult Health ◽  
Cross Sectional ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low Middle Income Countries ◽  
Nationally Representative

BackgroundThere is currently limited literature on the association between visual impairment and suicidal thoughts and behaviours, especially among older adults from low/middle-income countries (LMICs). Thus, we aimed to investigate the associations of objectively measured distance visual impairment with suicidal ideation and suicide attempts among adults aged ≥50 years from six LMICs and to identify potential mediators.MethodsCross-sectional, community-based, nationally representative data from the WHO Study on global AGEing and adult health were analysed. Objective distance visual acuity was measured using the tumbling E logMAR chart, and vision impairment was categorised as none, mild, moderate and severe. Self-reported information on past 12-month suicidal ideation and suicide attempts was also collected. Multivariable logistic regression and mediation analysis were conducted.ResultsData on 34 129 individuals aged ≥50 years (mean (SD) age, 62.4 (16.0) years; 47.9% men) were analysed. After adjustment for potential confounders, compared with no visual impairment, severe visual impairment was significantly associated with suicidal ideation (OR=9.50; 95% CI=2.47 to 36.52). Moderate and severe visual impairment were significantly associated with a 2.22 (95% CI=1.14 to 4.35) and 11.50 (95% CI=1.44 to 91.88) times higher odds of suicide attempts, respectively. Disability, poor self-rated health, mobility and loneliness explained 14.0%, 9.3%, 7.2% and 6.3% of the association between moderate/severe visual impairment and suicide attempts, respectively.ConclusionInterventions to reduce suicidal ideation and suicide attempts among older adults with visual impairment in LMICs are required, targeting identified mediators, while using tested strategies for suicide prevention per se in LMICs may yield beneficial outcomes.

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