Income Nations Research Articles

Determinants of stillbirth in hospitals of North Shoa Zone, Oromia region, Central Ethiopia: A case control study

BackgroundWorld Health Organization defined stillbirth as birth of fetus at 28 weeks or above gestation with a birth weight of ≥1000 g or body length of ≥35 cm. Majority of stillbirths occur in low and middle income nations. Efforts made in Ethiopia to improve maternal and child health are showing encouraging results, even though the magnitude didn't reach the expected level. Identification of determinants of stillbirth is quite substantial to apply further meaningful actions. ObjectiveTo assess the determinants of stillbirth in hospitals of North Shoa Zone, Oromia region, Central Ethiopia. MethodInstitution based unmatched Case control study was conducted from March 01 to May 30/2019 among 342 women who gave birth in Fitche, Kuyu, Gundomeskel, and Muketurihospitals. Sample size was calculated by using Epi-info version 7.1.1 software package. Statistical Package for Social Sciences version 25 was used to analyze the data. Descriptive statistics, bivariate and multivariate logistic regression analysis were conducted. Variables having P-value ≤ 0.05 in multivariable logistic regression were considered as statistically significant. ResultType of labor (AOR = 3.79, 95%CI = 1.53, 9.38), duration of labor (AOR = 3.59, 95% CI = 1.53, 8.33), mal-presentation (AOR = 3.45, 95%CI = 1.99, 9.8), preeclampsia/eclampsia (AOR = 4.58, 95%CI = 1.45, 14.48) and birth defect (AOR = 3.05, 95%CI = 1.31, 7.1) were found to be the determinants of stillbirth. Conclusion and recommendationCauses of still birth in more than two third of the cases were identified. Type of labor, duration of labor, mal presentation, preeclampsia/eclampsia were identified as determinants of stillbirth from mothers’ side while birth defect was found to be determinant of stillbirth from fetal side. Heath care providers, policy makers, and other stakeholders, should focus on identified factors to combat problems associated with still birth.

Reconnoitering the Sustainable Relationship between Revenue Income and GDP: A Comparative Study of Asymmetric Countries in the World

This paper applies panel unit root test, country Pedroni cointegration test (PCT), Phillips-Peron cross section test (PPCST), vector error correction test and Johansen normalized cointegrating test (JNCT) for estimates the coefficients in the short-run and in the long-run to examine the inter-temporal relationship between the government revenues income and GDP. The paper took into account fifteen asymmetric countries with three income groups over the period from 2001 to 2016. The study justified the long run relationship between the articulated variables in the country PCT and the test results unearthed that four statistics out of seven on different indexes exhibited one percent level of significance. In the upper middle income country category, other than Brazil and Sri Lanka, rest of three countries showed a long run relationship, i.e. the study outcome reconnoitered the existence of a long run relationship between the two articulated variables. Decisively, the outcome of JNCT suggests that in the long run if the government revenue upsurge one percentage point then GDP growth rate will rise 0.037 and 0.28 percentage point for the countries that belong to high income and the upper middle income respectively. Meanwhile, the test find a negative result that allied to lower middle income nations, GDP growth rate will plummet 0.039 percent point due to one percent rise in revenue income.

Sleep your baby supine, but mums-to-be should sleep on their side.

Sleep your baby supine, but mums-to-be should sleep on their side.

Road traffic injury mortality and morbidity by country development status, 2011-2017

PurposeThis research examined road traffic injury mortality and morbidity disparities across of country development status, and discussed the possibility of reducing country disparities by various actions to accelerate the pace of achieving Sustainable Development Goals target 3.6 – to halve the number of global deaths and injuries from road traffic accidents by 2020. MethodsData for road traffic mortality, morbidity, and socio-demographic index (SDI) were extracted by country from the estimates of the Global Burden of Disease study, and the implementation of the three types of national actions (legislation, prioritized vehicle safety standards, and trauma-related post-crash care service) were extracted from the Global Status Report on Road Safety by World Health Organization. We fitted joinpoint regression analysis to identify and quantify the significant rate changes from 2011 to 2017. ResultsAge-adjusted road traffic mortality decreased substantially for all the five SDI categories from 2011 to 2017 (by 7.52%–16.08%). Age-adjusted road traffic mortality decreased significantly as SDI increased in the study time period, while age-adjusted morbidity generally increased as SDI increased. Subgroup analysis by road user yielded similar results, but with two major differences during the study period of 2011 to 2017: (1) pedestrians in the high SDI countries experienced the lowest mortality (1.68–1.90 per 100,000 population) and morbidity (110.45–112.72 per 100,000 population for incidence and 487.48–491.24 per 100,000 population for prevalence), and (2) motor vehicle occupants in the high SDI countries had the lowest mortality (4.07–4.50 per 100,000 population) but the highest morbidity (428.74–467.78 per 100,000 population for incidence and 1025.70–1116.60 per 100,000 population for prevalence). Implementation of the three types of national actions remained nearly unchanged in all five SDI categories from 2011 to 2017 and was consistently stronger in the higher SDI countries than in the lower SDI countries. Lower income nations comprise the heaviest burden of global road traffic injuries and deaths. ConclusionGlobal road traffic deaths would decrease substantially if the large mortality disparities across country development status were reduced through full implementation of proven national actions including legislation and law enforcement, prioritized vehicle safety standards and trauma-related post-crash care services.

Technology Matters: SPARX - computerised cognitive behavioural therapy for adolescent depression in a game format.

Adolescent depression is common, and its prevalence is thought to be increasing in many high income nations. Addressing adolescent depression has proven challenging using traditional face-to-face psychotherapies, with major barriers including workforce shortages internationally and reluctance to seek help among some adolescents. There is substantial evidence to support the use of digital tools to treat mental health problems, with the National Institute for Health and Care Excellence (NICE) now recommending such tools as a first-line treatment. In this article, we outline the evidence base for SPARX, a digital tool named specifically in NICE guideline NG134, and discuss its use in clinical settings. We also consider implementation issues and future research directions.

Hyperuricemia in Hypertension and Chronic Kidney Disease: Risk Factors, Prevalence and Clinical Correlates: A Descriptive Comparative Study

Introduction: Uric acid is a product of purine metabolism and elevated serum concentration are very common in, and linked with hypertension and chronic kidney disease, conditions associated with heavy health burden and cardiovascular complications particularly in sub Sahara Africa. An assessment of factors relating hyperuricemia to hypertension and chronic kidney disease would therefore be necessary as way of mitigating the poor quality of life, morbidity and mortality associated with these diseases in low income nations. Methods: A single centre, descriptive comparative study in which the demographic, clinical and laboratory data of hypertensive and non-dialyzed chronic kidney disease (CKD) patients were analyzed. Serum biochemical parameters with uric acid, hematocrit and urine dip strip protein were assessed. Predictors of hyperuricemia were determined using multivariate analysis. Results: One hundred and thirty nine hypertensives and 69 CKD were studied. The mean age of the participants was 54.3 ± 11.7 years, hypertensives (52.9 ± 15.7 years) and CKD (57.3 ± 16.1 years). Both groups had more males, P = 0.8. Majority (78.3%) of the CKD cohorts had stage 4 or 5 (non-dialyzed) disease. The systolic and diastolic blood pressure, creatinine and uric acid were lower in hypertension than in CKD, P = 0.07, P = 0.05, P < 0.001 and P = 0.004 respectively. The hematocrit, albumin and GFR were higher in HTN than CKD, P < 0.001, P < 0.001 and P < 0.001 respectively. The prevalence of hyperuricemia was 56.2%. The mean uric acid was 505.9 ± 23.6 mmol/L, 382 7 ± 10.5 mmol/L for hypertensive and 755.9 ± 14.8 mmol/L for CKD, P < 0.001. The prevalence of systolic HTN, proteinuria, hypoalbuminemia and anemia were 51%, 75%, 46% and 59%, and were higher in males. Hyperuricemia was related to advancing age, proteinuria, elevated creatinine, hypoalbuminemia, anemia and hypertriglyceridemia. Proteinuria (OR—4.66, 95% CI—2.42 - 9.65), elevated creatinine (OR—3.12, 95% CI—2.40 - 6.92), hypoalbuminemia (OR—2.92, 95% CI—1.83 - 5.78) and anemia (OR—4.01, 95% CI—3.78 - 7.99) independently predicted hyperuricemia. Conclusion: Hyperuricemia is commoner in CKD than hypertension and was higher in males and positively correlated with the blood pressure, proteinuria and creatinine, but negatively related to hematocrit, albumin and glomerular filtration rate. Independent predictors of hyperuricemia were proteinuria, elevated creatinine, hypoalbuminemia and anemia. Measures are needed to prevent and treat hyperuricemia to reduce the health burden associated with hypertension and CKD.

Developing Economies Benefit the Most From Inflation Targeting for Attracting FDI

This study investigates if developing nations implementing the inflation targeting monetary policy are more successful in attracting FDI cash flows relative to both developed nations practicing inflation targeting, as well as nations utilizing alternative monetary policies. Subsequently, we investigate based on regional-cultural clusters where inflation targeting is most successful for attracting FDI. Our results provide two primary contributions to the inflation targeting literature: (i) inflation targeting has a positive impact on attracting FDI for Lower-Middle Income nations, but not for Upper-Middle Income or High Income nations; (ii) inflation targeting is most successful in regional-cultural clusters with a larger representation of Middle Income nations rather than High Income Nations.

NEEDED: Grassroots Leaders to Lead Systems Change Efforts that Reduce Infant Mortality

The death of an infant devastates a mother, family and community. The United States has one of the highest infant mortality rates among the world’s high income nations. Infant mortality is a key indicator of a population’s health and societal well-being, yet interventions aimed at improving societal well-being are rarely a priority when devising infant mortality reduction strategies. Historically, grassroots movements have been critical in advancing social change to improve women’s health and empowerment in marginalized communities. Understanding strategic and infrastructure elements of these grassroots movements is a critical first step to efficiently growing USA grassroots movements to address social systems associated with poor birth outcomes. We provide an analysis of the diverse array of grassroots structures and strategies utilized to improve maternal and child health outcomes. It is time for grassroots movements to form and be recognized as vital players in efforts to sustainably reduce infant mortality in the United States. It is essential to foster grassroots leaders and movements that improve long standing social structures that contribute to poor birth outcomes. The personal and community knowledge of these leaders and community members are desperately needed to save women and infants in our nation.

Trace Element Exposures and Blood Pressure along the Interoceanic Highway, Madre de Dios, Peru

Urbanization and economic development in lower and middle income nations (LMICs) have facilitated epidemiologic and nutritional transitions. Cardiovascular disease is the leading cause of death worldwide and prevalence of hypertension, a main risk factor, is projected to grow 80% by 2025 in LMICs. The completion of the Interoceanic Highway in 2011 in the Amazonian Department of Madre de Dios (MDD), Peru spurred rapid development, leading to population health concerns over environmental contamination due to gold mining. In addition to lifestyle exposures, elevated levels of lead, mercury, cadmium, and arsenic have been associated with hypertension in both animal studies and epidemiological analyses, although some population-based studies have failed to measure a statistically significant association. The essential element selenium potentially exerts a protective influence on hypertension. To gain insight into these potentially complex relationships, we analyzed joint arsenic, cadmium, mercury, lead, and selenium exposures in nails and systolic and diastolic blood pressure (SBP, DBP) of 389 adults in the Investigacion de Migracion, Ambiente, y Salud (IMAS) (Migration, Environment, and Health Study) conducted in MDD. Relationships were analyzed using linear mixed models with a household random intercept, and Bayesian kernel machine regressions (BKMR) to capture potential interactive and non-linear effects with trace elements. Visual inspection of the exposure-response surface estimated under BKMR, and estimation of parameters quantifying potential interaction, did not reveal evidence of interactive effects. In the linear mixed model, SBP was significantly associated with age (B=0.19, SE=0.06, p=.0025), female sex (B=-14.08, SE=4.2, p=.0011) and BMI (B=.48, SE=0.15, p=0017). Positive associations were observed between DBP and BMI (B=0.34, SE=0.10, p=.0010) and log mercury (ng/g) (B=1.08, SE=0.56, p=.0586). When stratified by sex there were additional suggested inverse associations between SPB and Western diet and selenium among men. The prevalence of artisanal gold mining and resultant mercury contamination in the region warrants further investigation.

Autocratisation and universal health coverage: synthetic control study

ObjectiveTo assess the relation between autocratisation—substantial decreases in democratic traits (free and fair elections, freedom of civil and political association, and freedom of expression)—and countries’ population health outcomes and progress...

Dementia Rates May Be Dropping in Some Countries

Dementia Rates May Be Dropping in Some Countries

The impact of globalization on youth education: Empirical evidence from China's WTO accession

This paper presents empirical evidence that export growth in China after its WTO accession in 2001 has altered education attainment for Chinese youths. On one hand, China's export expansion after the WTO entry has increased the opportunity cost of schooling and thus has induced many youths to drop out of school at younger ages; but on the other hand, the subsequent trade upgrading has also led to increased demand for additional education at the college level. This paper exploits variation in trade exposure in the timing of youth education decision and trade exposure variation among regions to identify the existence and the relative importance of these two effects of China's WTO accession. We document statistically significant and robust evidence that while export expansion has caused 2 months' reduction in youth schooling on average, it has led to 2 months increase for individuals with at least a high school education. Moreover, we find that the reduction in education is mainly caused by processing exports and predominantly experienced by youths in rural areas and from families with siblings, while the improvement in education can be largely attributed to exports to high income nations and is largely observed for youths from urban areas. Consistent with individuals making rational choices when faced with additional employment opportunities arising from globalization, these findings have important consequences for income distribution in China.

Letter: The Impact of the Coronavirus (COVID-19) Pandemic on Neurosurgeons Worldwide.

Letter: The Impact of the Coronavirus (COVID-19) Pandemic on Neurosurgeons Worldwide.

Men and masculinities in qualitative research on vasectomy: perpetuation or progress?

ABSTRACT Although vasectomy is a safe and highly effective method of contraception, uptake is variable globally, with scope for increased engagement in high income nations. Very little qualitative research has been published in recent years to explore men’s perspectives on vasectomy, which represents a key opportunity to better understand and strengthen men’s contribution to reproductive and contraception equality. This paper takes a scoping review approach to identify key findings from the small but important body of qualitative literature. Recent masculinities research argues that, despite some expansion in ways of being masculine, an underpinning ethos of masculinist dominance remains. Extant research on men’s attitudes to vasectomy supports this ambivalent picture, indicating that while there are extending repertoires of masculinity for men to draw on in making sense of vasectomy, many remain underpinned by masculinist narratives. There remains scope for education and health promotion ensuring vasectomy is viewed as a suitable and safe option by more men of reproductive age. Increased uptake of vasectomy may also help shift the longstanding social expectation that women take primary responsibility for contraceptive practices, challenging gender discourses on contraception.

Radiotherapy after esophageal cancer stenting (ROCS): A pragmatic randomized controlled trial evaluating the role of palliative radiotherapy in maintaining swallow.

4569 Background: Most patients with oesophageal cancer (OC) present with incurable disease; 80% of new cases, and deaths, occur in low and middle income nations. Median survival for advanced disease is 3-5 months, a majority requiring intervention for dysphagia. Insertion of self expanding metal stents is the commonest way of palliating, but dysphagia may recur within three months owing to tumour progression. Evidence reviews have called for trials of combination treatment for OC dysphagia. The ROCS study (funding - UK NIHR programme) examined effectiveness of palliative radiotherapy, following stent, in maintaining swallow. It also examined impact on quality of life, bleeding events, and survival. Methods: A multicentre RCT with follow up monthly for a year. Patients referred for stent insertion as primary management of dysphagia related to incurable OC were recruited in secondary care, with all planned follow up at home. Patients were randomised 1:1 to stent insertion alone or stent insertion plus palliative radiotherapy at a dose of 20Gy in five fractions or 30Gy in ten fractions. Primary outcome was difference in proportions of participants with recurrent dysphagia at 12 weeks, defined as deterioration of 11 points or more in the dysphagia scale of the EORTC QLQ-OG25 questionnaire. Secondary outcomes included quality of life, bleeding risk, survival. Results: 220 patients were randomised Dec 2013-Aug 2018 at 23 UK sites. Addition of radiotherapy did not reduce the proportion of primary events at 12 weeks: 49% in control arm vs 45% in the intervention, adjusted OR 0.82 (95%CI 0.40-1.68; p = 0.587) and it was less cost effective. Sensitivity analyses did not alter the results. Dysphagia deterioration-free survival was similar in both arms: adjusted HR 0.92 (95%CI 0.68-1.26; p = 0.618). Median survival was 19.7 weeks in control arm and 18.9 weeks in the intervention. Those in the radiotherapy arm had significantly fewer bleeding events (18.6% compared to 10.3%), giving a number needed to treat of 12. Conclusions: Palliative external beam radiotherapy is widely accessible to patients with advanced cancer. ROCS is the largest trial assessing its role in combination with stenting for OC dysphagia, and is the first to prospectively assess impact on bleeding risk. It demonstrates no reduction in risk of dysphagia recurrence at 12 weeks, nor impact on survival. Reductions in bleeding events should be considered in the context of patient described trade offs of fatigue and burdens of attending hospital. Clinical trial information: NCT01915693 .

Evaluating capacity at three government referral hospital emergency units in the kingdom of Eswatini using the WHO Hospital Emergency Unit Assessment Tool

BackgroundThe Kingdom of Eswatini, a lower-middle income nation of 1.45 million in southern Africa, has recently identified emergency care as a key strategy to respond to the national disease burden. We aimed to evaluate the current capacity of hospital emergency care areas using the WHO Hospital Emergency Unit Assessment Tool (HEAT) at government referral hospitals in Eswatini.MethodsWe conducted a cross-sectional study of three government referral hospital emergency care areas using HEAT in May 2018. This standardised tool assists healthcare facilities to assess the emergency care delivery capacity in facilities and support in identifying gaps and targeting interventions to strengthen care delivery within emergency care areas. Senior-level emergency care area employees, including senior medical officers and nurse matrons, were interviewed using the HEAT.ResultsAll sites provided some level of emergency care 24 h a day, 7 days a week, though most had multiple entry points for emergency care. Only one facility had a dedicated area for receiving emergencies and a dedicated resuscitation area; two had triage areas. Facilities had limited capacity to perform signal functions (life-saving procedures that require both skills and resources). Commonly reported barriers included training deficits and lack of access to supplies, medications, and equipment. Sites also lacked formal clinical management and process protocols (such as triage and clinical protocols).ConclusionsThe HEAT highlighted strengths and weaknesses of emergency care delivery within hospitals in Eswatini and identified specific causes of these system and service gaps. In order to improve emergency care outcomes, multiple interventions are needed, including training opportunities, improvement in supply chains, and implementation of clinical and process protocols for emergency care areas. We hope that these findings will allow hospital administrators and planners to develop effective change management plans.

Concussion Symptom Underreporting Among Incoming National Collegiate Athletic Association Division I College Athletes.

Accurate diagnosis of sport-related concussions relies heavily on truthful self-reporting of symptom severity. Previous studies have emphasized lack of knowledge as a factor in symptom nondisclosure. This study sought to examine concussion knowledge and the relationship of knowledge to reasons for symptom nondisclosure. Cross-sectional study. Data were collected during preparticipation athletic evaluations via electronic survey. One hundred fifty-six incoming National Collegiate Athletic Association Division I student-athletes. Survey items included previous concussion diagnosis, concussion fact and symptom knowledge, reasons and situational contexts for nondisclosure, and stakeholder attitudes. Participants, on average, had substantial concussion symptom and fact knowledge. Unexpectedly, participants with higher concussion fact knowledge endorsed more reasons that athletes may hide symptoms. Concussion symptom knowledge was unrelated to reasons for nondisclosure. Athletes believed that symptom reporting was less likely in high-stakes versus low-stakes situations and consistently identified their teammates as holding attitudes that support underreporting and athletic trainers as engaging in behaviors that support player safety. Greater concussion knowledge did not reduce the number of reasons that participants viewed as drivers for concussion nondisclosure. In other words, participants understood why athletes choose to hide symptoms even when they also understood the symptoms, risks, sequelae, and consequences of concussion (and potential harm of nondisclosure). Situational contexts and important stakeholder attitudes also appeared to importantly influence symptom disclosure decisions. A multifaceted approach that goes beyond current educational strategies to addresses situational, social, and athletic pressures may be needed to initiate a widespread cultural shift away from concussion nondisclosure.

Study on Banks’ Risk Assessment of Financing Small Medium Enterprises’ Project: the findings and experience from Uzbekistan Banking Sectors

Small-Medium Enterprises (SME) fulfill important tasks in an economy. They play main role to create jobs opportunities and generating profit for low income nation, also support social stability and significant effect to development of a private sector dynamically. Banks have played a major role in financing and helping SMEs, work to grow up access of them to provide loan. Bank lending is the most common source of external finance for SMEs. However, no comprehensive investigation has yet been focused in banks to examine risk assessment of SMEs project. They have limited access to credit resources comparing to big companies (Jaroslav B., 2010). Therefore, most of SMEs do not use annual reports, annual file accounting or main statistics figures. So, it makes challenges for banks to identify risks and deciding to finance SMEs’ project. This paper focus on analyze risk assessment of financing SMEs’ projects in banking of Uzbekistan and investigate on identify risks, examine strong risk assessment for SMEs, try to find out various tools and techniques deal with bank financing projects. Carrying out the research, both qualitative and quantitative methods were used. Questionnaires distributed to the 100 lending managers and credit specialists, consisted three parts which two parts include 29 questions and final part include 5 open questions. We used Cronbach’s alpha to estimate reliability variables and subject regression analysis conducted on research objectives. Research found that credit managers have still challenges in understanding uses techniques and tools for assessing risks. It seems to be lacking understanding and unsophisticated approach to fully identify and manage risks. According to questionnaires’ results and case study analysis, data indicated the key indicator signals to finance SMEs’ project are financial standing, past performance of SMEs, leverage ratio and evaluated project concern significantly. Data showed an optimization of lending process lead to additional interest incomes and assessing risks in early stage. The model postulates that factors in the external, operating and internal environments of individual banks can influence risk assessment decisions for financing SMEs.

Epidemiological profiling for stroke in Nepal: A need for establishing a stroke database in low income nations (43)

Epidemiological profiling for stroke in Nepal: A need for establishing a stroke database in low income nations (43)

Milton Friedman and Exchange Rates in Developing Countries

Milton Friedman’s famous 1953 essay, “The case for flexible exchange rates,” deals entirely with advanced nations. An interesting question is what Friedman thought about exchange rate and monetary regimes in emerging economies. In this paper I investigate how his views on the subject evolved through time. I analyze speeches, articles, and interviews. I examine his archives for correspondence and unpublished manuscripts. I show that for him flexible rates were a second best solution for middle income and poor nations. I also analyze Friedman’s role in Chile’s failed attempt, during the Pinochet regime, at using a fixed exchange rate to stabilize the economy and eliminate inflation.