The Great Lockdown in the Wake of COVID-19 and Its Implications: Lessons for Low and Middle-Income Countries

Concern for public health has been growing with the increasing volume of cases of COVID-19 in India. To combat this pandemic, India has implemented nationwide lockdowns, and unlocking phases continue with certain restrictions in different parts of the country. The lockdown has required people to adopt social-distance measures to minimize contacts in order to reduce the risks of additional infection. Nevertheless, the lockdown has already impacted economic activities and other dimensions of the health of individuals and society. Although many countries have helped their people through advanced welfare protection networks and numerous support aids, several emerging economies face specific difficulties to adapt to the pandemic due to vulnerable communities and scarce resources. However, certain lower-income countries need more rigorous analysis to implement more effective strategies to combat COVID-19. Accordingly, the current systematic review addresses the impacts of the COVID-19 pandemic and lockdowns in India in relation to health and the economy. This work also provides further information on health inequalities, eco-nomic and social disparities in the country due to the COVID-19 pandemic and lockdowns and also contributes pragmatic suggestions for overcoming these challenges. These observations will be useful to the relevant local and national officials for improving and adopting novel strategies to face lockdown challenges

Access courses and their contribution to the widening participation agenda in the UK

Reasons for mental health nursing shortages in the UK are many and complex. The COVID-19 pandemic has highlighted the need to fill vacant posts, while at the same time negatively impacting on the UK's international recruitment strategy. Whereas international recruitment is essential to reduce workforce shortages, it offers only a short-term solution and potentially leaves lower-income countries with increased nursing shortages themselves. This article considers that a long-term domestic approach to recruitment is needed to reduce future workforce deficits. It is argued that benefits of access courses are increased if delivered by the university directly, as a familiarity with systems, the campus and supportive networks are promoted, and the potential for targeted support is increased. Further research is needed to establish the benefits, but access courses delivered this way may provide a more sustainable solution to nursing workforce shortages in the UK and beyond.

Hierarchical Bayesian classification methods to identify topics by journal quartile with an application in biological sciences

This manuscript builds on a novel, automatic, freely-available Bayesian approach to extract information in abstracts and titles to classify research topics by quartile. This approach is demonstrated for all N= 149,129 ISI-indexed publications in biological sciences journals during 2017. A Bayesian multinomial inverse regression approach is used to extract rankings of topics without the need of a pre-defined dictionary. Bigrams are used for extraction of research topics across manuscripts, and rankings of research topics are constructed by quartile. Worldwide and local results (e.g., comparison between two peer/aspirational research institutions in Colombia) are provided, and differences are explored both at the global and local levels. Some topics persist across quartiles, while the relevance of others is quartile-specific. Challenges in sustainable development appear as more prevalent in top quartile journals across institutions, while the two Colombian institutions favour plant and microorganism research. This approach can reduce information inequities, by allowing young/incipient researchers in biological sciences, especially within lower income countries or universities with limited resources, to freely assess the state of the literature and the relative likelihood of publication in higher impact journals by research topic. This can also serve institutions of higher education to identify missing research topics and areas of competitive advantage.

Application of a bottom-up approach to reduce healthcare disparity between the urban and rural areas

Disparity in access to healthcare between the rural and urban regions occurs world-wide, both in higher and lower income countries. In order to offset poor health outcomes, a number of approaches to structuring healthcare services can be used. Several factors have been identified to play a role; nevertheless, they contribute to the healthcare gap to various - depending on whether a higher or lower income country undergoes evaluation. Traditionally, healthcare systems worldwide adopt a top-down approach, which is initiated by large institutions providing resources required for large scale projects along with the centralisation of efforts. Therefore, although it does lead to change, the results can be short-lived. The authors discuss the bottom-up approach used in ASHWINI organisation in Gudalur, India which allowed for the development of accessible and sustainable healthcare system managed by the community. Other projects, based in part on the principles of a bottom-up approach, have been applied in other countries to reduce healthcare disparities. A bottom-up approach, designed to deliver geographically-accessible, locally managed, culturally appropriate care, can provide sustainable results, and since it is universal in nature, it can be applied in other setting with similar structures.

High Lead Exposure Associated With Higher Blood Pressure in Haiti: a Warning Sign for Low-Income Countries

Cardiovascular disease is the leading cause of death in lower-income countries including Haiti. Environmental lead exposure is associated with high blood pressure and cardiovascular mortality in high-income countries but has not been systematically measured and evaluated as a potential modifiable cardiovascular risk factor in lower-income countries where 6.5 billion people reside. We hypothesized lead exposure is high in urban Haiti and associated with higher blood pressure levels. Blood lead levels were measured in 2504 participants ≥18 years enrolled in a longitudinal population-based cohort study in Port-au-Prince. Lead screening was conducted using LeadCare II (detection limit ≥3.3 µg/dL). Levels below detection were imputed by dividing the level of detection by √2. Associations between lead (quartiles) and systolic blood pressure and diastolic blood pressure were assessed, adjusting for age, sex, obesity, smoking, alcohol, physical activity, income, and antihypertensive medication use. The median age of participants was 40 years and 60.1% were female. The geometric mean blood lead level was 4.73µg/dL, 71.1% had a detectable lead level and 42.3% had a blood lead level ≥5 µg/dL. After multivariable adjustment, lead levels in quartile four (≥6.5 µg/dL) compared with quartile 1 (<3.4 µg/dL) were associated with 2.42 mm Hg (95% CI, 0.36–4.49) higher systolic blood pressure and 1.96 mm Hg (95% CI, 0.56–3.37) higher diastolic blood pressure. In conclusion, widespread environmental lead exposure is evident in urban Haiti, with higher lead levels associated with higher systolic and diastolic blood pressure. Lead is a current and potentially modifiable pollutant in lower-income countries that warrants urgent public health remediation. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03892265.

Does Premature Deindustrialization Matter? The Role of Manufacturing versus Services in Development

“Premature deindustrialization” typically reflects the fact that the services sector has grown faster than manufacturing at lower levels of per capita income compared to the past. This paper, based on cross-country data, shows that the rising share of services is largely not driven by a statistical artifact whereby what was earlier subsumed in manufacturing value added is now accounted for as service sector contributions. Yet, this matters less for development opportunities because features of manufacturing that were thought of as uniquely special for productivity growth are also shared by some services. And the growth of these high-productivity services is not closely linked to a manufacturing base as it draws on both intermediate demand from other sectors as well as final demand from home and abroad. The prospect of services-led development in lower-income countries however, is limited by the fact that a given service subsector is unlikely to provide opportunities for productivity growth and job creation for unskilled labor simultaneously.

Urban Water Disinfection and Mortality Decline in Lower-Income Countries

Historically, improvements in municipal water quality led to substantial mortality decline in today’s wealthy countries. However, water disinfection has not consistently produced large benefits in lower-income countries. We study this issue by analyzing a large-scale municipal water disinfection program in Mexico that increased water chlorination coverage in urban areas from 58 percent to over 90 percent within 18 months. We estimate that the program reduced childhood diarrheal disease mortality rates by 45 to 67 percent. However, inadequate sanitation infrastructure and age (degradation) of water pipes may have attenuated these benefits substantially. (JEL I12, I18, L95, O13, O18, Q25, Q53)

Clustering of Physical Activity, Diet and Sedentary Behavior among Youth from Low-, Middle-, and High-Income Countries: A Scoping Review

Background: The interaction between physical activity (PA), diet, and sedentary behavior (SB) plays an important role on health-related outcomes. This scoping review (Prospero CRD42018094826) aims to identify and appraise clusters of PA, diet, and SB among youth (0–19 years) according to country income. Methods: Five databases were searched. Fifty-seven articles met the inclusion criteria. Results: Fifty-five cluster types were identified, with greater variety in high-income than lower income countries. The most prevalent profiles were “High SB and consumption of sugar, salt, and beverages (SSB)” (n = 17) and “High PA” (n = 13–5), both of which presented in all income countries. The healthiest profile, “High PA and fruit and vegetables (F&V); Low SB and SSB” (n = 12), was present in upper-middle and high-income countries, while the unhealthiest “Low PA and F&V; High SB and SSB” (n = 6) was present only in high-income countries. Conclusions: High SB and unhealthy diet (SSB) were more prevalent in clusters, mainly in high-income countries. The results support the need for multi-component actions targeting more than one behavior at the same time.

Pharmaceutical Industry’s Engagement in the Global Equitable Distribution of COVID-19 Vaccines: Corporate Social Responsibility of EUL Vaccine Developers

(1) Objectives: Inequality in the global distribution of COVID-19 vaccines has brought about great challenges in terms of resolving the pandemic. Although vaccine manufacturers are undoubtedly some of the most influential players, studies on their role in global vaccine distribution have been scarce. This study examined whether the pharmaceutical industry is acting according to the principles of corporate social responsibility (CSR) during the pandemic. (2) Methods: Three categories were used to analyze the CSR of vaccine developers. The first was research and development: effectiveness, funding, and profits were measured. The second was transparency and accountability: the transparency of clinical trials and vaccine contracts was analyzed. The final was vaccine delivery: the status of the provision of vaccines to COVAX and lower-income countries, intellectual property management, manufacturing agreements, and equitable pricing were measured. (3) Results: Vaccine developers have acquired large profits. The vaccine delivery category faces the most challenges. Participation of pharmaceutical companies through COVAX was significantly low, and most vaccine supply agreements were secretive, bilateral deals. It was not clear if companies were maintaining equitable pricing. The evaluation indicated that the companies’ CSR practices have differed during the pandemic. (4) Conclusions: Our study contributes to the methodology of assessing the CSR of vaccine developers. This would help understand the current COVID-19 vaccine distribution inequality and propose that pharmaceutical companies re-examine their roles and social responsibilities.