Adults In Low- And Middle-income Countries Research Articles

Debate: How much should nonspecialists be involved in mental health care when resources are limited? A perspective from low- and middle-income countries.

Millions of children and young people (CYP) in low- and middle-income countries (LMICs) have no access to mental health care. This huge treatment gap is primarily due to limited availability of trained mental health professionals. We propose task-sharing as a scalable strategy to expand access to child and adolescent mental health (CAMH) interventions in LMICs. Task-sharing involves using the few mental health specialists in LMICs to train and supervise nonspecialists to provided CAMH interventions. There is strong evidence of clinical and cost effectiveness of task-shared mental health interventions for adults in LMICs and promising evidence for CYP. To succeed, task-shared programmes need to be embedded in a balanced system-wide care setting that includes stakeholder involvement. The existing mental health specialists may require additional training in leadership, supervision, mentoring, service design and evaluation in order to meet the additional expectations of managing task-sharing programmes. The nonspecialists to be trained would need assurances about workload, ongoing supervision, clinical back up for cases that exceed their expertise, certification for their training and career progression. CAMH task-sharing offers good promise for increasing CYP's access to mental health interventions in LMICs. However, planners need to be aware of the important practical, ethical and contextual considerations necessary for success and sustainability.

Association between self-reported visual symptoms (suggesting cataract) and self-reported fall-related injury among adults aged ≥ 65 years from five low- and middle-income countries.

Cataracts may increase risk for falls but studies on this topic from low- and middle-income countries (LMICs) are scarce. Therefore, we examined the cross-sectional association between self-reported visual symptoms (suggesting cataract) and self-reported injurious falls in nationally representative samples of adults aged ≥ 65 years from five LMICs (China, Ghana, India, Mexico, and Russia). Data from the WHO Study on global AGEing and adult health (SAGE) were analysed. Self-reported information on past 12-month fall-related injury and cataract based on symptoms were collected. Multivariable logistic regression and meta-analyses were conducted to assess associations. Data on 13,101 people aged ≥ 65 years were analysed [mean (SD) age 72.5 (11.3) years; 45.2% males]. The overall prevalence of self-reported fall-related injury and visual symptoms (suggesting cataract) were 4.9% and 29.4%, respectively. There was a positive association between self-reported visual symptoms (suggesting cataract) and fall-related injury (i.e., OR > 1) in all five countries but statistical significance was reached in three: China (OR = 1.60; 95% CI = 1.08-2.35), India (OR = 1.96; 95% CI = 1.15-3.35), and Russia (OR = 3.58; 95% CI = 2.06-6.24). The pooled OR including all five countries based on a meta-analysis was OR = 1.88 (95% CI = 1.32-2.68). Self-reported visual symptoms (suggesting cataract) were associated with higher odds for self-reported injurious falls among older adults in LMICs. Expanding availability of cataract surgery in LMICs may also have the additional benefit of reducing falls among older people.

Long-term health effects of outdoor air pollution on asthma and respiratory symptoms among adults in low-and middle-income countries (LMICs): a systematic review and meta-analysis

BackgroundFew studies have investigated the association between long-term exposure to outdoor air pollution and the risk of asthma and respiratory symptoms in low-and middle-income countries (LMICs).ObjectiveTo systematically evaluate the epidemiological evidence regarding the associations between long-term exposure to outdoor air pollution and respiratory symptoms in LMICs.MethodsWe searched for literature published between January 1946 and September 2022 in Embase (Ovid), Medline (Ovid), and Web of Science (Core Collection). The air and gaseous pollutants studied included particulate matter (PM2.5 and PM10), nitrogen dioxide (NO2), and black carbon (BC), and exposure was 1-year duration or more. We conducted a systematic review and meta-analysis with a random-effects model to calculate the relative risk (RR) estimates. A rerun of the databases was conducted in November 2023 with no eligible studies found.ResultsOf the 1,346 studies identified, only six met our inclusion criteria, and these six reported PM2.5, PM10, and NO2 with asthma as the main outcome. Three of these included studies were further included in the meta-analysis because they had data on the same exposure and outcome (PM2.5 and asthma). The main result of our study showed a borderline significant association between a 10 µg/m3 increase in exposure to PM2.5 and an increased risk of asthma (RR 1.21, 95% CI 0.93, 1.50). There was evidence of considerable heterogeneity (I2 = 75.87%). The regression-based Egger test for small-study effects showed no significant publication bias among these three studies.ConclusionOur results indicate that long-term exposure to PM2.5 increases the risk of asthma in LMICs, but studies are scarce and there is a large need for more research in LMICs in this field.Systematic Review Registrationhttps://journals.plos.org/plosone/article?id=10.1371/journal.pone.0288667, PROSPERO (CRD42022311326).

A protocol of a systematic review and meta-analysis on the prevalence of mental health disorders among older adults and synthesis of community-based interventions among them in low- and middle-income countries

Background: Older adults of low- and middle-income countries (LMICs) have a higher prevalence of mental health disorders compared to high-income countries, which can be attributed to a combination of social factors (such as isolation and loss of spouse), declining physical well-being, and the cumulative impact of life stressors, all of which contribute to an increased vulnerability in mental health. Objectives: The objective of this study was to determine the pooled prevalence of mental health disorders among older adults in LMICs and to identify community-based mental health intervention measures to tackle mental health problems in LMICs. Methods: Articles will be retrieved from databases such as PubMed, Scopus, and Cochrane Central using MeSH terms, keywords, and text words for each concept. Preprint search servers (MedRx, Cogprints, IndiaRxiv, medRxiv, and SSRN) will also be accessed. Data analysis will be conducted as per guidelines provided in the Handbook of Cochrane Systematic Review. RevMan version 5.4 software will be used for pooled analysis. Expected outcome: This systematic review will be able to identify the pooled prevalence of mental health among older adults and will also identify the evidence-based mental health intervention measures in community settings among older adults of LMICs.

Operationalization, characterization and validation of a healthy lifestyle index in 35 LMICs

Abstract Background For low- and middle-income countries (LMICs), there is no comprehensive and valid index reflecting overall lifestyle. This study aimed to operationalize, characterize, and validate a healthy lifestyle index (HLI), based on the World Health Organization (WHO) recommendations. Methods We used cross-sectional, complete-case data from individual-level, nationally representative surveys among non-pregnant adults in 35 LMICs, applying the WHO STEPwise approach to NCD risk factor surveillance (2009-2019; N = 125,607). The HLI was constructed based on WHO recommendations for fruit and vegetable intake, physical activity, smoking, and alcohol intake (unhealthiest = 0 points; healthiest = 16 points). We calculated the distributions of the HLI and its subcomponents across socio-demographic and geographic strata, accounting for the survey design and each country's World Bank population estimate. Partial Spearman correlations were calculated for the HLI with its subcomponents and cardio-metabolic risk markers. Results In this study (females: 51%, median age: 35.4 years), median HLI-score was 10.3 (interquartile range: 8.2-12.3), being highest in females (versus males) and low-income countries (versus middle-income countries). Twenty-two percent had at least five servings of fruits and vegetables per day (males: 20%, females: 24%); 82% exercised at least 600 MET-min/week (males: 87%, females: 78%); 69% never smoked (males: 40%, females: 97%); 64% were alcohol abstainers (males: 50%, females: 78%). Correlations of the HLI with its subcomponents were moderate and positive, ranging between r = 0.35 and r = 0.64; correlations with cardio-metabolic risk markers were weak, ranging between r = |0.02| and r =|0.12|. Conclusions The majority of adults in LMICs appear to live a healthy lifestyle, particularly women and individuals in low-income countries. Low fruit and vegetable intakes are a major concern. The HLI shows good content but poor construct validity. Key messages • There is an urgent need for interventions to promote fruit and vegetable consumption in LMICs. • The HLI is suitable to monitor lifestyles in LMICs on individual-, country- and WHO region-level.

Cancer incidence estimates in adults aged 60 years and older living in low-and-middle-income countries for the years 2020 and 2040.

Previous studies have shown a disproportionate rise in cancer incidence in low-and-middle-income countries (LMICs) due to rapid population ageing. This study aims to describe the cancer incidence in adults aged 60 years and older in LMICs to inform cancer control planning. Using the latest GLOBOCAN estimates for 2020, we describe the cancer incidence and the top five cancer sites among adults aged 60 years and older living in LMICs. We also project the incidence in 2040 by applying population projections, assuming no changes in incidence rates and risk profiles over time. In 2020, 6.3 million new cancer cases were diagnosed in older adults in LMICs, constituting over half of the global incidence burden (55%). In females aged 60 years and older living in LMICs, breast, lung, colon, stomach, and cervix uteri were the most frequent cancer types representing 51% of the total number of new cancer cases in older females. In males aged 60 years and older living in LMICs, lung, prostate, stomach, liver and colon were the most frequent cancer types representing 58% of the total number of new cancer cases in this subgroup. Variations were observed between income categories. The number of new cancer diagnoses in adults aged 60 years and older living in LMICs will almost double by 2040, reaching 11.5 million new cancer cases. The greatest increase is expected to happen in lower-income countries (+158% in lower-middle-income countries (excluding India) and +99% in low-income countries versus +38% in upper-middle-income countries). In conclusion, our findings call for an urgent adaptation of healthcare systems in LMICs by developing geriatric oncology and by including older adults in research, clinical guidelines, insurance schemes and cancer prevention policies.

Food insecurity and subjective cognitive complaints among adults aged ≥ 65 years from low- and middle-income countries

PurposeTo date, no study has investigated the association between food insecurity and subjective cognitive complaints (SCC). Thus, the aims of the present study were to examine this association among older adults in low- and middle-income countries (LMICs), and to identify the potential mediators in this association, given the importance of SCC in dementia risk among older people, and the projected particularly large increase in dementia in this setting.MethodsCross-sectional, community-based, nationally representative data from the World Health Organization (WHO) Study on global AGEing and Adult Health (SAGE) collected between 2007 and 2010 were analyzed. Two questions on subjective memory and learning complaints in the past 30 days were used to create a SCC scale ranging from 0 (No SCC) to 100 (worse SCC). Past 12 month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Multivariable linear regression and mediation (Karlson–Holm–Breen method) analyses were conducted to assess associations.ResultsData on 14,585 individuals aged ≥ 65 years [mean (SD) age 72.6 (11.5) years; 55.0% females] were analyzed. Severe food insecurity (vs. no food insecurity) was associated with 9.16 (95% CI = 6.95–11.37) points higher mean SCC score. Sleep/energy (mediated% 37.9%; P < 0.001), perceived stress (37.2%; P = 0.001), and depression (13.7%; P = 0.008) partially explained the association between severe food insecurity and SCC.ConclusionFood insecurity was associated with SCC among older adults in LMICs. Future studies should assess whether addressing food insecurity among older adults in LMICs can improve cognitive health.

My Parent, Myself, or My Child: Whose Education Matters Most for Trajectories of Cognitive Aging in Middle Age?

The growing body of evidence linking intergenerational education and late-life cognitive decline is almost exclusively from high-income countries, despite rapid intergenerational changes in education in low- and middle-income countries (LMICs). We used data from the Mexican Health and Aging Study (n=8,822), a cohort study of Mexican adults aged ≥50 years (2001-2018), to evaluate whether parental education (none vs. any formal schooling), one's own education (less than primary school vs. completion of primary school), or an adult child's education (less than high school vs. completion of high school) was associated with verbal memory z scores. We used linear mixed models with inverse probability of attrition weights. Educational attainment in all 3 generations was associated with baseline verbal memory scores, independent of the prior generation's education. Lower parental (β=-0.005, 95% confidence interval: -0.009, -0.002) and respondent (β=-0.013, 95% confidence interval: -0.017, -0.010) educational level were associated with faster decline in delayed (but not immediate) verbal memory z scores. Associations between adult child's education and respondent's verbal memory decline varied by exposure specification. The educational attainment of parents and adult children may influence the cognitive aging of middle-aged and older adults in LMICs. These results have important implications given recent structural shifts in educational attainment in many LMICs.

Leisure-time physical activity and sarcopenia among older adults from low- and middle-income countries.

There are no data on the association between leisure-time physical activity (LTPA) and sarcopenia in older adults from low- and middle-income countries (LMICs). This study aimed to investigate the association between LTPA and sarcopenia in individuals aged ≥65years living in six LMICs. Cross-sectional data from the Study on Global AGEing and Adult Health (China, Ghana, India, Mexico, Russia and South Africa) were analysed. Sarcopenia referred to the presence of both low skeletal muscle mass and weak handgrip strength. LTPA was assessed using the Global Physical Activity Questionnaire and was analysed as a dichotomized variable [high LTPA (>150min/week of moderate-to-vigorous LTPA) or low LTPA (≤150min/week)]. Multivariable logistic regression analysis was conducted to assess associations. There were 14585 individuals included in this study [mean (SD) age 72.6 (11.5) years; 55.0% women]. The prevalence of high LTPA and sarcopenia was 8.9% and 12.0%, respectively. After adjusting for potential confounders, low LTPA was significantly associated with higher odds for sarcopenia [prevalence odds ratio (POR)=1.85, 95% confidence interval (CI)=1.29-2.65] compared with high LTPA. Significant associations were found in women (POR=3.22, 95% CI=1.82-5.68) but not in men (POR=1.52, 95% CI=0.99-2.35). A positive and significant association between low LTPA and sarcopenia was found among older adults from LMICs. The promotion of LTPA among older adults in LMICs may aid in the prevention of sarcopenia, especially among females, pending future longitudinal research.

Physical multimorbidity, suicidal ideation, and suicide attempts among adults aged ≥50years from low- and middle-income countries.

The association between physical multimorbidity and suicidal ideation or suicide attempts among older adults from low- and middle-income countries (LMICs) is largely unknown. We aimed to assess this association as well as its mediators using nationally representative data from six LMICs. Cross-sectional, community-based data from the Study on Global Aging and Adult Health were analyzed. A total of 11 chronic physical conditions were assessed. Self-reported information on past 12-month suicidal ideation and suicide attempts was also collected. Multivariable logistic regression and mediation analyses were conducted. The final sample consisted of 34,129 adults aged ≥50years (mean [SD] age 62.4 (16.0) years; maximum age 114years; 52.1% females). In the overall sample, physical multimorbidity was associated with increased odds for suicidal ideation (OR=2.99; 95% CI=2.06-4.34) and suicide attempts (OR=2.79; 95% CI=1.58-4.95), with the association being stronger in males than females. The association between multimorbidity and suicidal ideation or suicide attempts was largely mediated by pain/discomfort (mediated% 33.3%-44.2%), sleep/energy (28.2%-33.8%), and mobility limitations (26.6%-34.8%). Physical multimorbidity among older adults in LMICs was associated with a substantially increased risk for suicidal ideation and suicide attempts. Addressing the identified mediators in people with physical multimorbidity may aid in the prevention of suicidal ideation and suicide attempts.

Chronic physical conditions, physical multimorbidity, and quality of life among adults aged ≥ 50 years from six low- and middle-income countries

PurposeMultimorbidity (i.e., ≥ 2 chronic conditions) poses a challenge for health systems and governments, globally. Several studies have found inverse associations between multimorbidity and quality of life (QoL). However, there is a paucity of studies from low- and middle-income countries (LMICs), especially among the older population, as well as studies examining mediating factors in this association. Thus, the present study aimed to explore the associations, and mediating factors, between multimorbidity and QoL among older adults in LMICs.MethodsCross-sectional nationally representative data from the Study on Global Ageing and Adult Health were analyzed. A total of 11 chronic conditions were assessed. QoL was assessed with the 8-item WHO QoL instrument (range 0–100) with higher scores representing better QoL. Multivariable linear regression and mediation analyses were conducted to assess associations.ResultsThe final sample consisted of 34,129 adults aged ≥ 50 years [mean (SD) age 62.4 (16.0) years; age range 50–114 years; 52.0% females]. Compared to no chronic conditions, 2 (b-coefficient − 5.89; 95% CI − 6.83, − 4.95), 3 (− 8.35; − 9.63, − 7.06), 4 (− 10.87; − 12.37, − 9.36), and ≥ 5 (− 13.48; − 15.91, − 11.06) chronic conditions were significantly associated with lower QoL, dose-dependently. The mediation analysis showed that mobility (47.9%) explained the largest proportion of the association between multimorbidity and QoL, followed by pain/discomfort (43.5%), sleep/energy (35.0%), negative affect (31.9%), cognition (20.2%), self-care (17.0%), and interpersonal activities (12.0%).ConclusionA greater number of chronic conditions was associated with lower QoL dose-dependently among older adults in LMICs. Public health and medical practitioners should aim to address the identified mediators to improve QoL in patients with multimorbidity.

Food Insecurity Among Older Adults Living in Low- and Middle-Income Countries: AScoping Review.

Food insecurity is considered an increasing public health problem worldwide with adverse effects, especially among older adults. Although the literature related to food insecurity among older adults in low- and middle-income countries (LMIC) are expanding, little is known about existing patterns and knowledge gaps in these settings. This scoping review aims to provide a comprehensive overview of the current research related to food insecurity among older adults in LMIC. A systematic search was conducted in November 2021 and revised in July 2022 on six databases using terms related to food insecurity and older adults. Data were extracted, and the emerging themes from the main findings were summarized using a social-ecological model (SEM). Forty-one studies met the inclusion criteria. Almost half (48.8%) were published in the last 2years and utilized a quantitative approach (n=38). Only one study was conducted in a low-income country. Using the SEM, most studies included in this review focused on addressing the relationship between food insecurity with intrapersonal factors. Several gaps in the current literature were identified. There is a lack of longitudinal and qualitative studies available on this topic. Also, only 15 LMIC were represented in the literature. Acritical point in this review is that only a few studies addressed the relationship between food insecurity and the policy/social structure, institutional, community, and interpersonal levels. These identified gaps can serve as a guide for future research on this topic.

Association between sarcopenia and quality of life among adults aged ≥ 65years from low- and middle-income countries.

Sarcopenia has been associated with a lower quality of life (QoL). However, studies on this association from low- and middle-income countries (LMICs) are scarce. To examine the association between sarcopenia and QoL, in a large nationally representative sample of older adults from six LMICs. Cross-sectional, community-based data from the WHO study on global ageing and adult health (SAGE) were analysed. Non-severe sarcopenia was defined as having low skeletal muscle mass (SMM) and weak handgrip strength but no slow gait speed, while severe sarcopenia was defined as having low SMM, weak handgrip strength, and slow gait speed. QoL was assessed with the 8-item WHO QoL instrument (range 0-100) with higher scores representing better QoL. Multivariable linear regression analysis was conducted. Data on 14,585 people aged ≥ 65years were analyzed [mean (SD) age 72.6 (11.5) years; 55.0% female]. After adjustment for potential confounders, compared to no sarcopenia, severe sarcopenia was associated with a significant -3.37 points [95% CI -5.56, -1.18] lower QoL score. Non-severe sarcopenia was not significantly associated with lower QoL. The association between sarcopenia and QoL observed in our study may be explained by factors such as functional impairment and disability related with sarcopenia. In this large representative sample of older adults from multiple LMICs, compared to no sarcopenia, only severe sarcopenia was associated with a significantly lower QoL score. Interventions to prevent or manage sarcopenia among older adults in LMICs may contribute to better QoL in this population.

Multimorbidity patterns and function among adults in low- and middle-income countries: a scoping review protocol

BackgroundA fifth of adults in low- and middle-income countries (LMICs) have multimorbid conditions, which are linked to socio-economic deprivation and aging. Multimorbidity is associated with high rates of functional problems and disability, increased healthcare utilization, and lower quality of life. Literature on multimorbidity and associations with function is mostly from high-income countries (HICs) and focused among older adults. Moreover, data regarding disease patterns and their impact on person-centered outcomes are limited. There is a need for research into understanding common patterns of multimorbidity, and their association with functional impairments, particularly in LMICs. Such information may contribute towards evidence-based and context-relevant strategic policy, planning, and delivery models for health and rehabilitation services, which is imperative in attaining Universal Health Coverage (UHC). The planned scoping review aims to provide an overview of the scope and nature of existing literature on multimorbidity patterns and function among adults in LMICs.MethodsA scoping review will be conducted using a five-step framework and reported according to the PRISMA-ScR guidelines. A comprehensive electronic search of PubMed/MEDLINE, Scopus, EBSCOhost, Scielo, Cochrane and Google Scholar will be conducted and updated from the last pilot search ran in September 2020. Studies of any design will be included if they are reported in English, published (between January 1976 and the last search date) in a peer-reviewed journal, and describe multimorbidity patterns and associations with physical functional impairments, activity limitations or participation restrictions among adults in LMICs. Search results will be independently screened by two reviewers and data extraction will cover study characteristics, participants’ characteristics, multimorbidity measures, patterns analysis, and functional measures. Descriptive statistics and narrative synthesis will be used to synthesize and summarize findings.DiscussionPatients with multimorbidity have unique and cross-cutting needs, hence the need for integrated and person-centered approaches to policy, planning, and delivery of medical and rehabilitation services. Considering the shift towards UHC and primary healthcare-led management of chronic diseases, the proposed scoping review is timely. Findings will provide insights into the current extent and scope of multimorbidity research, and guide future inquiry in the field.Trial registrationOpen Science Framework (OSF), https://osf.io/gcy7z/

Simultaneously Developing Interventions for Low-/Middle-Income and High-Income Settings: Considerations and Opportunities.

Most older adults reside in low- and middle-income countries (LMICs) but most research dollars spent on interventions to improve the lives of older adults are awarded to researchers in high-income countries (HICs). One approach to improve the implementation of evidence-based innovations for older adults in LMICs is designing interventions that are relevant to LMICs and HICs simultaneously. We propose that researchers in HICs could partner with stakeholders in an LMIC throughout the intervention design process to better position their intervention for the implementation in that LMIC. We provide an example study from an adaptation of the Resources for Enhancing Caregiver Health II in Vietnam, which did not use this strategy but may have benefited from this strategy. We then turn to several considerations that are important for researchers to contemplate when incorporating this strategy. Finally, we explore incentives for creating interventions that are relevant to both HICs and LMICs for funders, intervention designers, and intervention receivers. Although this is not the only strategy to bring interventions to LMICs, it may represent another tool in researchers' toolboxes to help expedite the implementation of efficacious interventions in LMICs.

Comparative effectiveness of in-person vs. remote delivery of the Common Elements Treatment Approach for addressing mental and behavioral health problems among adolescents and young adults in Zambia: protocol of a three-arm randomized controlled trial

BackgroundIn low- and middle-income countries (LMIC), there is a substantial gap in the treatment of mental and behavioral health problems, which is particularly detrimental to adolescents and young adults (AYA). The Common Elements Treatment Approach (CETA) is an evidence-based, flexible, transdiagnostic intervention delivered by lay counselors to address comorbid mental and behavioral health conditions, though its effectiveness has not yet been tested among AYA. This paper describes the protocol for a randomized controlled trial that will test the effectiveness of traditional in-person delivered CETA and a telehealth-adapted version of CETA (T-CETA) in reducing mental and behavioral health problems among AYA in Zambia. Non-inferiority of T-CETA will also be assessed.MethodsThis study is a hybrid type 1 three-arm randomized trial to be conducted in Lusaka, Zambia. Following an apprenticeship model, experienced non-professional counselors in Zambia will be trained as CETA trainers using a remote, technology-delivered training method. The new CETA trainers will subsequently facilitate technology-delivered trainings for a new cohort of counselors recruited from community-based partner organizations throughout Lusaka. AYA with mental and behavioral health problems seeking services at these same organizations will then be identified and randomized to (1) in-person CETA delivery, (2) telehealth-delivered CETA (T-CETA), or (3) treatment as usual (TAU). In the superiority design, CETA and T-CETA will be compared to TAU, and using a non-inferiority design, T-CETA will be compared to CETA, which is already evidence-based in other populations. At baseline, post-treatment (approximately 3–4 months post-baseline), and 6 months post-treatment (approximately 9 months post-baseline), we will assess the primary outcomes such as client trauma symptoms, internalizing symptoms, and externalizing behaviors and secondary outcomes such as client substance use, aggression, violence, and health utility. CETA trainer and counselor competency and cost-effectiveness will also be measured as secondary outcomes. Mixed methods interviews will be conducted with trainers, counselors, and AYA participants to explore the feasibility, acceptability, and sustainability of technology-delivered training and T-CETA provision in the Zambian context.DiscussionAdolescents and young adults in LMIC are a priority population for the treatment of mental and behavioral health problems. Technology-delivered approaches to training and intervention delivery can expand the reach of evidence-based interventions. If found effective, CETA and T-CETA would help address a major barrier to the scale-up and sustainability of mental and behavioral treatments among AYA in LMIC.Trial registrationClinicalTrials.govNCT03458039. Prospectively registered on May 10, 2021

The effect of polluting cooking fuels on depression among older adults in six low- and middle-income countries

BackgroundLittle is known about the association between polluting cooking fuel and depression among older adults living in low- and middle-income countries (LMICs). ObjectiveTo evaluate the association between polluting cooking fuel and depression in older population of LMICs. MethodsWe derived data from WHO Study on global AGEing and adult health (SAGE), which was conducted in six LMICs including China, India, Ghana, South Africa, Mexico and Russia. We applied logistic regression with the propensity score method to examine the relationship of polluting cooking fuel and depression among adults ≥50 years old. ResultsOverall, the odds ratio (OR) of depression was 1.57 [95% confidence intervals (CIs), 1.26–1.93] for older adults relying on polluting cooking fuel in six LMICs. In India and China, polluting cooking fuel was associated with depression with ORs of 2.06 (95%CI, 1.44–2.94) and 1.59 (95%CI, 1.01–2.49), respectively. Positive OR of depression was identified for those polluting cooking fuel users aged over 65 years old (OR, 1.65; 95%CI,1.16–2.36) and those aged 50–65 (OR, 1.50; 95%CI,1.14–1.97). Polluting cooking fuel was associated with depression for females (OR, 1.80; 95%CI, 1.32–2.46), however we did not observe significant association for males. Positive effect of polluting cooking fuel was identified in both rural (OR, 1.72; 95%CI, 1.26–2.34) and urban areas (OR, 1.44; 95%CI, 1.07–1.95). For individuals relying on solid fuel, cooking in a room used for living/sleeping and using open stove/fire was associated with depression with ORs of 1.30 (95%CI, 1.14–1.48) and 1.15 (95%CI, 1.01–1.31), respectively. However, no significant effect was identified for hood. ConclusionPolluting cooking fuel was related to depressive symptoms among older adults in LMICs. In addition, cooking ventilation could be useful intervention to control health hazard of solid fuel.

Effectiveness and implementation outcomes for peer-delivered mental health interventions in low- and middle-income countries: a mixed-methods systematic review.

This review aimed to evaluate interventions led by peer counselors (PCs) for adults with common mental disorders in low- and middle-income countries (LMICs) along indices of overall effectiveness and key implementation outcomes (acceptability, feasibility, cost, fidelity, sustainability). This review followed a mixed-methods systematic review design. MEDLINE/PubMed, Embase, PsycINFO, and Global Health databases were searched for PC-led interventions for adults in LMICs targeting depressive and/or anxiety disorders or PTSD. Quantitative data was narratively synthesized, and qualitative data was thematically synthesized separately. The results from the qualitative and quantitative syntheses were then combined in a cross-study synthesis. Twenty-four papers describing thirteen PC-led interventions were included for review. Narrative synthesis results indicated mixed effectiveness of PC-led interventions in reducing depressive, anxiety, PTSD symptoms and high PC competency. Thematic synthesis revealed five descriptive themes: (1) Preferred PC characteristics; (2) Incentives and motivation for PCs; (3) Barriers to PC-led intervention implementation; (4) Helpful supervision/training practices; and (5) Overall high acceptability of PC-led interventions. Cross-study synthesis revealed high acceptability, feasibility, and fidelity, but cost and sustainability outcomes were underreported in included papers. PC-led interventions seem to show initial promise in terms of effectiveness, acceptability, feasibility, cost, fidelity, and sustainability. Future research should focus on standardizing measurements of implementation outcomes to facilitate cross-study analysis. Additional empirical attention should be paid to underrepresented implementation outcomes (e.g., cost, sustainability). Finally, researchers should adopt a participatory approach that elevates the perspectives of PCs throughout all stages of the implementation process.

Association of food insecurity with suicidal ideation and suicide attempts in adults aged ≥50 years from low- and middle-income countries

BackgroundThe aim of the present study was to investigate associations between food insecurity with suicidal ideation and suicide attempts in adults aged ≥50 years from six low- and middle-income countries (LMICs). MethodsCross-sectional, community-based data from the World Health Organisation's Study on Global Aging and Adult Health were analyzed. Self-reported information on past 12-month suicidal ideation and suicide attempts was collected. Past 12-month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Multivariable logistic regression analysis was conducted to assess the association between food insecurity and suicidal ideation or suicide attempts. ResultsThe final analytical sample included 34,129 individuals aged ≥50 years [mean (SD) age 62.4 (16.0) years; 52.1% females]. Compared to no food insecurity, severe food insecurity was associated with a significant 2.78 (95%CI = 1.73–4.45) times higher odds for suicidal ideation, while moderate and severe food insecurity were associated with 2.59 (95%CI = 1.35–4.97) and 5.15 (95%CI = 2.52–10.53) times higher odds for suicide attempts, respectively. LimitationsThe cross-sectional design, the use of self-reported wish to die as a measure of suicide ideation, and that suicidal ideation and suicide attempts were only assessed among those who had depressive symptoms, could be considered limitations of our study. ConclusionsFood insecurity was positively associated with suicidal ideation and suicide attempts. Targeting food insecurity among older adults in LMICs may lead to reduction in suicidal ideation and suicide attempts, although future longitudinal studies are warranted to confirm this.

Unconditional cash transfers for reducing poverty and vulnerabilities: effect on use of health services and health outcomes in low- and middle-income countries.

Unconditional cash transfers for reducing poverty and vulnerabilities: effect on use of health services and health outcomes in low- and middle-income countries.