Country Case Research Articles

The impact of covid-19 pandemic on Albanian health emergency operation centre

Abstract During the COVID-19 pandemic, each State adopted different health emergency strategies to face this new challenge. After the first hospital centred answer, these strategies promoted the strengthening of the territorial health assistance as better response to population health needs at worldwide level. This approach was especially important in the countries in transition, where the hospital systems are weaker. This research aims to assess the impact of these new health policy strategies on health emergency operation centre (HEOC) in a country in transition. Country case study was found to be the most effective methodology. Albania was a significant case study due to its ongoing efforts to align its national healthcare system with European health standards being in pre-adhesion to the European Union. Moreover, this country has recently implemented a modern national HEOC (2018). The data shows that at the beginning to COVID-19 pandemic, the response by HEOC was limited and mainly hospital-centred. In 2020 only 8% of the calls for COVID-19 to the HEOC had an intervention, that was in the 49% a transport in hospital. Medical consultations and treatments on site were only the 4%. In 2021, the issue of guidelines aimed at giving priority to the territorial health assistance brought to a relevant reduction of calls (-64%). It allowed the HEOC to enlarge its response until to give a response to the 34% of calls. The 15% of calls were managed by medical consultations and 18% by treatments on site. The cases transported in hospital were always the 50% but they decreased off -63% in absolute value. In Albania the implementation of national health policy strategies that have enhanced the territorial response to COVID-19 pandemic, relieved the pressure on HEOC by calls’ reduction. In this way, HEOC focused its efforts on the applications of territorial responses instead of hospitalization, according to national health policy strategies, increasing its responsiveness. Key messages • The enhancement of the territorial response to COVID-19 pandemic has eased the pressure on the Albanian HEOC. • The territorial response to COVID-19 pandemic by the Albanian HEOC especially focused on mainly the provision of medical consultations and treatments on site.

Analyzing the effects of energy productivity: the case of European Union countries.

The surge in fossil fuel consumption, culminating in global warming and climate change, compels nations to implement protective measures. Consequently, the concepts of "sustainable growth" and the "green economy" have gained prominence in response to heightened environmental consciousness. In light of these imperatives, nations have embarked on the formulation of sustainable and environmentally conscious policies, with the dual objective of safeguarding the environment and fostering economic growth. These factors have collectively contributed to the growing significance of energy policies within European nations, spurring a burgeoning momentum in research areas pertaining to energy efficiency and energy productivity. While extant literature has demonstrated the positive environmental impact of energy productivity, there exists a paucity of research pertaining to its economic implications. Energy productivity, defined as achieving equivalent or greater output with reduced energy consumption, bears the potential to influence economic output, thereby exerting cascading effects on various facets of the economy, including growth and exports. The principal aim of this study is to highlight that the augmentation of energy productivity can yield not only environmental advantages but also economic benefits. To achieve this objective, we conduct econometric analyses on panel data spanning the years 2000 to 2020 across the 27 member states of the European Union. Specifically, we explore the effects of energy productivity on diverse economic parameters, encompassing economic growth, high technology exports, medium and high technology exports, total exports, and trade volume. Employing the Driscoll-Kraay standard errors estimator, our findings evince that energy productivity exerts statistically significant and positive influences on economic growth, medium and high technology exports, total exports, and trade volume.

‘Stop the Pact‘! The Foreign Policy Impact of the Far-Right Campaigning Against the Global Compact for Migration

ABSTRACT In 2018, the UN Global Compact for Migration (GCM) was signed by a majority of countries. The GCM was the first intergovernmentally negotiated agreement, prepared under the auspices of the United Nations, to cover all dimensions of international migration in a holistic and comprehensive manner. Seventeen countries, among them Italy, Austria, Hungary and Poland, abstained or voted against this non-binding agreement as they feared interference in their national sovereignty. The polarising potential of the GCM, that supposedly sets global regulations against national policies, has been fuelled by far-right actors throughout Europe. Framing the decision on the GCM as a referendum against the allegedly liberal governance of migration in the European Union, movements and parties launched a multi-faceted campaign that generated protest and spurred advocacy networks transnationally. In this paper, we analyse the extent to which the campaign against the GCM influenced foreign policy in the narrow sense of countries signing or not signing the pact (short-term impact), but also in terms of discourse and policy on immigration (long-term impact), more broadly. We explore the relative role of campaigning against the GCM by contrasting four country cases – Austria, Belgium, Germany, and Italy, each of which had different governmental constellations and previous extra-parliamentary mobilisation on migration. Our work offers a first in-depth comparative study of this key campaign that has otherwise remained understudied in the field of protest, media and extremism studies. By providing a comparative analysis of the same campaign in four European countries, we aim to offer important insights on how the far right is attempting to impact decision making in foreign policy contexts and what factors might explain its mobilisation and influence capacity.

Formation of climate coalitions and preferential free trade: the case for participation linkage

We study the endogenous formation of climate coalitions linked to a preferential free trade arrangement. In a multi-stage, micro founded strategic trade and participation game, coalition and fringe countries dispose of a discriminatory tariff on dirty imports as well as emission permits imposed on domestic producers. Permits are traded on a common permit market inside the coalition and on local markets outside, respectively. We provide an analytical solution for the general equilibrium and the policy game, in the three country case, while the participation game is solved by Monte Carlo simulation. Moreover, conditional probabilities are computed for the transition to coalitions of various sizes induced by free trade. Under various regimes analyzed, we find that preferential free trade can create strong incentives for building effective climate coalitions in terms of depth and breadth. This result even holds if fringe countries are given the option of trade cooperation as a retaliation devise and is driven by a favorable shift in the coalition’s terms of trade. As a policy implication, negotiations on international climate treaties and free trade arrangements should be interlinked.

Cardiac Abnormalities in Patients With Severe Fever With Thrombocytopenia Syndrome: A Systematic Review

Abstract Since the identification of severe fever with thrombocytopenia syndrome virus (SFTSV) in 2010, there has been an increase in reported cases in China and other Asian countries. Cardiac abnormalities are highly prevalent in SFTS patients. We searched 5 Chinese and international databases for published SFTS articles and extracted patient characteristics, cardiac complications, electrocardiography findings, and imaging findings. Twenty-seven studies were identified, covering 1938 patients and 621 cardiac abnormalities. Arrhythmia was the most prevalent, reported in 24 studies and 525 cases, with a prevalence of 27.09%. The 2 major types of arrhythmias were bradycardia and atrial fibrillation. Heart failure was the second most prevalent abnormality, with 77 cases. Changes in the ST segment and T wave were the most common. Valve regurgitation, reduced ejection fraction, and pericardial effusion were also documented. We recommend that physicians pay close attention to newly onset arrhythmia and structural heart disease in SFTS patients.

Brazil’s national champions strategy (2007–13): A critical appraisal

The recent multiple crises have led to a renaissance of the role of the state in the economy throughout the world. Hence, industrial policy is once again back at the agenda of academic and policy debates in advanced as well as emerging economies. We want to contribute to this debate by discussing the controversial results of a recent case of industrial policy—the “national champions” strategy of the Brazilian National Development Bank (BNDES) between 2007 and 2013. Being the centerpiece of Brazil’s move toward a more state-led economic model in the late 2000s, its successes and failures should be of great importance to the ongoing debate about industrial policy, state capitalism, and development. The national champions strategy has become an integral part of contemporary state capitalist models, with China being the most outstanding example. By looking at the Brazilian case, an upper-middle income democracy, and therefore a more representative case for countries with similar political settings, the paper aims to provide a critical appraisal of revived industrial policies in the early 21stcentury as a separate policy tool of the newly emerging variety of state capitalism. We apply a political economy approach to highlight the context-sensitivity and institutional embeddedness of firms and the complementarities between several institutional spheres as resources and constraints for companies’ competitiveness and internationalization. The paper aims to contribute to the current debate about state-financed firm internationalization in general and the viability of a national champions strategy in particular.

Systematic Review of Factors Associated with COVID-19 Knowledge, Attitudes, and Practice among Middle School Students

Purpose: The spread of infectious disease, Coronavirus disease 2019 (COVID-19), has had a significant impact on people worldwide in the past three years. Although people's production and livelihoods are no longer strictly restricted, the fact is that the epidemic is not over. lack of understanding of the disease is one of the most common drivers of improper use of COVID-19 preventive measures, which increases the spread of the disease and the number of new cases in many countries. Although children and adolescents, are less likely to be infected with COVID-19 or to be or less symptomatic than other populations, adolescents are more likely to fail to follow strict precautions. This systematic review aimed to identify COVID-19 related KAP levels and associated factors among middle school students.

Life after stroke: exploring social and psychological consequences of stroke survivors and their caregivers

Aim: To explore the social and psychological consequences of stroke among stroke survivors and their caregivers in Addis Ababa, Ethiopia.Methods: We conducted in-depth interviews with stroke survivors (n=13) and their caregivers (n=13) in Addis Ababa, Ethiopia. Interviews were conducted in Amharic and were audiotaped. After repeated listening to the records and reading the transcripts, a thematic analysis was conducted.Results: Six themes emerged: explanatory model, new body, living on a bread line, psychological toll, elephant in the room, and finding a silver lining. Stroke survivors described stroke as a sudden event that changed their life forever. Some participants attributed it to the devil’s doing, spirit possession (“ልክፍት”) and their sins. Both survivors and their caregivers reported financial crises related tohe disability, inability to return to work, treatment, and transportation costs. Both survivors and caregivers described the psychological tolls such as emotional ups and downs, anxiety, frustration, sleep problem, and suicidal ideation. Survivors reported distancing themselves from social activities or events whereas; caregivers reported that they did not have enough time to be a part of one. Stroke survivors considered surviving the stroke as a blessing. Caregivers say they have set their minds to be thankful to God that they have their loved ones around despite all the limitations.Conclusion: Stroke survivors and their caregivers suffer from financial crises and emotional up and downs. This warrants the need for compressive social and psychological interventions in addition to the usual physical care provided for such cases in low-income countries.

The Open Monopolistic Competition Models: Market Equilibrium and Social Optimality

We study the monopolistic competition model of Dixit–Stiglitz–Krugman with additive separable utility and transport costs of “iceberg types”. The production costs are not necessary linear. We study two concepts: market equilibrium and social optimality. There are well-known facts in the closed economy under monopolistic competition: (1) “in market equilibrium, the elasticity of revenue equals the elasticity of total costs” and (2) “in social optimality, the elasticity of utility equals the elasticity of total costs”. Moreover, earlier Prof. Sergey Kokovin (HSE University, Russia) generated the idea that (3) “the search for equilibrium is equivalent to the problem of optimization, but revenue, not utility”. For the case of several countries, it turns out that facts (1) and (2) and prediction (3) remain mostly true.

Data-driven decision making for modelling covid-19 and its implications: A cross-country study

Grounded in big data analytics capabilities, this study aims to model the COVID-19 spread globally by considering various factors such as demographic, cultural, health system, economic, technological, and policy-based. Classified values on each country's case, death, and recovery numbers (per 1000,000 population) were used to represent COVID-19 spread. Data sets also included 29 input variables for the corresponding six factors, containing data from 159 countries. The proposed model used a Multilayer Perceptron algorithm. The results show that each of the pre-mentioned factors significantly affects disease spread. Urban population, median age, life expectancy, numbers of medical doctors and nursing personnel, current health expenditure as a % of GDP, international health regulations capacity score, continent, literacy rate, governmental response stringency index, testing policy, internet usage %, human development index and GDP per capita were identified as significant. Taking early measures and adopting open public testing policies were recommended to policymakers in fighting pandemic diseases since the created scenarios on policy-based factors revealed their importance.

The public health response to a Plasmodium malariae outbreak in Penampang district, Sabah during a COVID-19 movement control order

BackgroundSince 2018, no indigenous human malaria cases has been reported in Malaysia. However, during the recent COVID-19 pandemic the World Health Organization is concerned that the pandemic might erode the success of malaria control as there are reports of increase malaria cases in resource limited countries. Little is known how the COVID-19 pandemic has impacted malaria in middle-income countries like Malaysia. Here the public health response to a Plasmodium malariae outbreak occurred in a village in Sabah state, Malaysia, during a COVID-19 movement control order is reported.MethodsAn outbreak was declared following the detection of P. malariae in July 2020 and active case detection for malaria was performed by collecting blood samples from residents residing within 2 km radius of Moyog village. Vector prevalence and the efficacy of residual insecticides were determined. Health awareness programmes were implemented to prevent future outbreaks. A survey was conducted among villagers to understand risk behaviour and beliefs concerning malaria.ResultsA total of 5254 blood samples collected from 19 villages. Among them, 19 P. malariae cases were identified, including the index case, which originated from a man who returned from Indonesia. His return from Indonesia and healthcare facilities visit coincided with the movement control order during COVID-19 pandemic when the healthcare facilities stretched its capacity and only serious cases were given priority. Despite the index case being a returnee from a malaria endemic area presenting with mild fever, no malaria test was performed at local healthcare facilities. All cases were symptomatic and uncomplicated except for a pregnant woman with severe malaria. There were no deaths; all patients recovered following treatment with artemether-lumefantrine combination therapy. Anopheles balabacensis and Anopheles barbirostris were detected in ponds, puddles and riverbeds. The survey revealed that fishing and hunting during night, and self-treatment for mild symptoms contributed to the outbreak. Despite the index case being a returnee from a malaria-endemic area presenting with mild fever, no malaria test was performed at local healthcare facilities.ConclusionThe outbreak occurred during a COVID-19 movement control order, which strained healthcare facilities, prioritizing only serious cases. Healthcare workers need to be more aware of the risk of malaria from individuals who return from malaria endemic areas. To achieve malaria elimination and prevention of disease reintroduction, new strategies that include multisectoral agencies and active community participation are essential for a more sustainable malaria control programme.

The role of primary care during the pandemic: shared experiences from providers in five European countries

BackgroundThe COVID-19 pandemic necessitated wide-ranging adaptations to the organisation of health systems, and primary care is no exception. This article aims to collate insights on the role of primary care during the pandemic. The gained knowledge helps to increase pandemic preparedness and resilience.MethodsThe role of primary care during the pandemic in five European countries (Austria, Denmark, France, Hungary, Italy) was investigated using a qualitative approach, namely case study, based on document analysis and semi-structured interviews. In total, 31 interviews were conducted with primary care providers between June and August 2022. The five country case studies were subjected to an overarching analysis focusing on successful strategies as well as gaps and failures regarding pandemic management in primary care.ResultsPrimary care providers identified disruptions to service delivery as a major challenge emerging from the pandemic which led to a widespread adoption of telehealth. Despite the rapid increase in telehealth usage and efforts of primary care providers to organise face-to-face care delivery in a safe way, some patient groups were particularly affected by disruptions in service delivery. Moreover, primary care providers perceived a substantial propagation of misinformation about COVID-19 and vaccines among the population, which also threatened patient-physician relationships. At the same time, primary care providers faced an increased workload, had to work with insufficient personal protective equipment and were provided incongruous guidelines from public authorities. There was a consensus among primary care providers that they were mostly sidelined by public health policy in the context of pandemic management. Primary care providers tackled these problems through a diverse set of measures including home visits, implementing infection control measures, refurbishing used masks, holding internal meetings and relying on their own experiences as well as information shared by colleagues.ConclusionPrimary care providers were neither well prepared nor the focus of initial policy making. However, they implemented creative solutions to the problems they faced and applying the learnings from the pandemic could help in increasing the resilience of primary care. Attributes of an integrated health system with a strong primary care component proved beneficial in addressing immediate effects of the pandemic.

Neuroimmunology of rabies: New insights into an ancient disease.

Rabies is an ancient neuroinvasive viral (genus Lyssavirus, family Rhabdoviridae) disease affecting approximately 59,000 people worldwide. The central nervous system (CNS) is targeted, and rabies has a case fatality rate of almost 100% in humans and animals. Rabies is entirely preventable through proper vaccination, and thus, the highest incidence is typically observed in developing countries, mainly in Africa and Asia. However, there are still cases in European countries and the United States. Recently, demographic, increasing income levels, and the coronavirus disease 2019 (COVID-19) pandemic have caused a massive raising in the animal population, enhancing the need for preventive measures (e.g., vaccination, surveillance, and animal control programs), postexposure prophylaxis, and a better understanding of rabies pathophysiology to identify therapeutic targets, since there is no effective treatment after the onset of clinical manifestations. Here, we review the neuroimmune biology and mechanisms of rabies. Its pathogenesis involves a complex and poorly understood modulation of immune and brain functions associated with metabolic, synaptic, and neuronal impairments, resulting in fatal outcomes without significant histopathological lesions in the CNS. In this context, the neuroimmunological and neurochemical aspects of excitatory/inhibitory signaling (e.g., GABA/glutamate crosstalk) are likely related to the clinical manifestations of rabies infection. Uncovering new links between immunopathological mechanisms and neurochemical imbalance will be essential to identify novel potential therapeutic targets to reduce rabies morbidity and mortality.

Induction therapy choices and responses in a third world country: A single center study from Pakistan

BackgroundLeukaemia accounts for approximately 2.5% of all new cancer incidence and 3.1% of cancer-related mortality with a significant number of the total presenting as Acute Lymphocytic Leukemia. Acute Lymphocytic Leukemia (ALL) poses a healthcare burden in the majority of the countries of the world but is more so a case in resource-limited countries where access to comprehensive healthcare is often limited and scarcely available. This article tries to highlight the challenges in ALL treatments in one such region by presenting the facts regarding treatments employed and patient outcomes seen. MethodThis was a retrospective single-institution study in a tertiary care setup examining Ph neg ALL patient data from Jan 2019 to Dec 2020. It was stratified according to various parameters ranging from presentation to mode of diagnosis as well as treatment strategies and responses achieved after induction including mortality. Conventional chemotherapy regimens for ALL treatment were used with corticosteroids, vincristine, anthracyclines, asparaginase, cytosar, and MTX being the backbone of ALL induction. Cytogenetics were not possible due to resource constraints. ResultsData showed 85 patients being managed during the mentioned time period. 65 percent were males and 68 percent were between the age 15 to 30 years. Approximately 80 percent had no co-morbid condition including diabetes, hypertension, ischemic heart disease or Hep B/C positivity. Around 60 percent were diagnosed on immunophenotyping by flowcytometry and 62 percent used HyperCVAD as the induction protocol. Patients who achieved CR were 62 percent after single induction and most were assessed after count recovery on (3-4 weeks) or after 6 weeks with the percentages being 32 and 41 respectively. Duration of admission was for 1-3 weeks for almost 70 percent of the patients and those alive at the end of induction were around 90 percent. ConclusionIn conclusion, the treatment of Acute Lymphocytic Leukemia in resource-limited countries remains a formidable task,sometimes requiring innovative and sustainable approaches. Due to limited resources, a resource stratified rather than risk-stratified treatment approach is often utilized to tailor therapy. This approach ensures that relatively better resourced patients receive more intensive treatment others are spared unnecessary toxicity. While the challenges in resource-limited settings are significant, the treatment strategies and chemotherapy protocols, if modified as per need and implemented effectively, hold promise in improving outcomes for patients with Ph negative Acute Lymphocytic Leukemia in regions which have limited resources at their disposal.

Opportunity or necessity entrepreneurship? A study based on the national system of entrepreneurship

This study investigates synergies between individual and national variables that promote opportunity and necessity entrepreneurship with a framework based on the national system of entrepreneurship. A qualitative comparative analysis of fuzzy sets of 39 country cases shows that institutional or individual cognitive elements are not necessary for high-opportunity or high-necessity entrepreneurship but that enhancing entrepreneurs’ ability perceptions play a universal role. The study's findings reveal optimal pathways that combine the institutional environment and individual perceptions to promote the synergistic development of opportunity and necessity entrepreneurship and reduce differences in entrepreneurial activities between countries.

COVID-19 Infections and Deaths between Rural and Urban Provinces of Zimbabwe, 2020: A Spatial Variations Analysis

Zimbabwe continues to record new COVID-19 cases as is the case in other countries. Although the Ministry of Health in Zimbabwe continues to publish daily situation reports (SitRep), and regular surveillance updates, no review of existing data has been done to establish the regional trends of the disease over time. This desk review study seeks to analyze the trends (province by province) of the COVID-19 in Zimbabwe for year 2020 in order to establish if spatial variations in infection rates and deaths exist. Ultimately, the aim is to come up with appropriate context-specific prevention and control measures. The study also seeks to establish whether or not there is a difference in COVID-19 infection rates and deaths between urban and rural provinces of Zimbabwe. A historical research design that made use of available secondary data on COVID-19 in Zimbabwe was used. COVID-19 statistics for year 2020 as provided by the Zimbabwe Ministry of Health and Child Care were accessed from the website and reviewed. A hypothesis test to determine if there was a difference in COVID-19 attack rates between urban and rural provinces of Zimbabwe was also done. An independent samples t-test using Microsoft excel was done on cumulative COVID-19 cases data for the entire year 2020. The study revealed that spatial variations in COVID-19 infections and deaths between urban and rural provinces of Zimbabwe existed. Urban provinces recorded more COVID-19 cases in 2020 compared to rural provinces. Keywords: COVID-19, Infection rate, Psychological distress, Spatial, Variations, Vaccine hesitancy.

Did the emergence of the Omicron variant impact the COVID-19 vaccine acceptance in the Arab world? A Twitter-based sentiment analysis

Background: Low vaccine acceptance constitutes a major obstacle for achieving herd immunity against coronavirus disease 2019 (COVID-19). Data on COVID-19 show a significant rise in the number of cumulative cases in Arab countries where vaccine uptake is lower than the uptake at the global level for the 2021-2022 period. The aim of this study is to analyze sentiments related to vaccine acceptance before and after the emergence of the COVID-19 Omicron variant in the Arab-speaking world. Methods: Tweets were collected before and after the Omicron emergence period in the Arab-speaking world using Python-enabled CAMeL Tools (Arabic Natural Language Processing toolkit) libraries. A sentiment analysis on COVID-19 vaccines using Arabic hashtags and a sentiment analysis by city were conducted. Results: Two data sets pre-Omicron and post-Omicron tweets exhibited a difference in sentiments marking a shift towards less negativity and more neutrality. Sentiments by city showed most tweets in both periods coming from Riyadh and Jeddah in Saudi-Arabia, and from Salt in Jordan. Conclusions: Despite the limitations of the study, the change in sentiments detected by the study may suggest more vaccine acceptance which raises some hope and perhaps a higher vaccine uptake in the future. The sentiments by city findings may help in the design of future research.

Fishing for subsistence constitutes a livelihood safety net for populations dependent on aquatic foods around the world

Fishing for subsistence constitutes a livelihood safety net for poverty, malnutrition and gender inequality for populations dependent upon aquatic foods around the world. Here we provide global estimates showing that almost the same amount of small-scale fishers engage in subsistence fishing at some point during the year as in commercial employment and use subsistence estimates to measure small-scale fisheries’ livelihood safety net function. In 2016, we estimate that 52.8 million people were engaged in subsistence fishing at some point during the year, while another 60.2 million people were commercially employed (90% of global fisheries employment). From 14 country case studies, it was possible to estimate that the subsistence catch provided an average apparent intake of six nutrients critical for positive health outcomes, equivalent to 26% of the recommended daily nutrient intake for 112.5 million people, higher than the national average contribution of beef or poultry.

Mortality in Two Waves of COVID-19: A Comparative Analysis of a Tertiary Care Hospital in India.

Background COVID-19 has spread as two distinct surges of cases in many countries. Several countries have reported differences in disease severity and mortality in the two waves. Objective Compare the in-hospital mortality in the two COVID-19 waves at a tertiary care hospital in India. Methods We conducted a retrospective data collection. Distinct periods of surges in cases and admissions were defined as the first wave spanning from March 2020 to December 2020 and the second wave from April 2021 to June 21, 2021. The primary outcome of this study was to compare mortality rates in terms of total hospital mortality rate (TMR) and case fatality rate (CFR). Results Mortality rates of wave 2 were approximately 10 times that of wave 1 (TMR of 20.3% in wave 2 versus 2.4% in wave 1 and CFR of 1.5% versus 17.7% in wave 1 and 2, respectively). Mortalities in wave 2 had a larger proportion of severe disease at presentation, faster progression of symptoms to death, and more patients without any chronic comorbid condition dying due to the direct effect of COVID-19 acute respiratory distress syndrome (ARDS). Conclusion Our data matches the worldwide reported pooled hospital mortality figures and shows the comparative difference in disease severity between the two waves.

Advancing Empirics and Theory for a Deeper Political Economy Analysis Comment on "Health Coverage and Financial Protection in Uganda: A Political Economy Perspective".

At its core, political economy analysis involves examination of the relationship between the state and the market. A number of country case studies have emerged in recent years that aim to identify political economy factors facilitating or impeding health sector reforms towards universal coverage. In this commentary, we expand Nannini and colleagues' analysis to elaborate on how political economy analyses can better inform policy design towards more successful reforms in low- and middle-income countries (LMICs) by drawing more heavily on improved research design and theory. We suggest three ways that political economy studies could make deeper claims by historicizing analyses, going comparative and/or by grounding findings more deeply in theory.