Individuals In Low-income Countries Research Articles

COVID-19: vaccination, therapeutics and a review of the science and public health.

COVID-19, stemming from the SARS-CoV-2 virus, has initiated a worldwide respiratory pandemic. Remarkable headway has been made in the realm of vaccination, as nearly every nation has initiated COVID-19 vaccine deployment. However, a mere 32.6% of individuals in low-income countries have received only a single vaccine dose. Unprecedented research and development endeavors have yielded over 170 COVID-19 vaccines, several of which are now in practical use. These vaccines have demonstrated remarkable efficacy in averting severe illness, hospitalization, and fatalities from COVID-19, even against emerging variants. Research pursuits persist, concentrating on novel vaccine technologies, oral and nasal vaccines, broader coronavirus protection, and vaccine combinations. In the realm of therapeutics, there have been significant strides in developing oral antiviral medications and monoclonal antibodies. Nonetheless, challenges in COVID-19 vaccination persist, encompassing issues of hesitancy, accessibility, financial barriers, knowledge gaps, and logistical hindrances. Robust monitoring via global agencies and reporting systems remains pivotal. Strategies for enhancing vaccination efficacy are rooted in fostering trust, countering misinformation, and expanding access. As for therapeutics, the approach involves dedicated research, clinical trials, regulatory streamlining, stockpiling, and international collaboration. Telemedicine and public awareness campaigns play integral roles in this effort, with coordination being the linchpin for preserving lives and mitigating the disease's impact. The global campaign against COVID-19 has witnessed substantial advancements, with an ongoing research focus on developing vaccines and therapeutics that are not only more accessible and affordable but also more effective, particularly for populations in low-income countries and vulnerable communities.

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.

Design and Development of a Non-invasive Glucometer System

The outbreak of Covid-19 disease has caused issues in public health, and its impact has grown in population with non-communicable diseases like diabetes, a life-threatening condition, worldwide. Individuals in low-income countries with limited diagnosis and monitoring systems require continuous and regular blood glucose monitoring. Invasive or minimally invasive blood glucose monitoring has been utilised with good accuracy but a high risk of infections and complications. Non-invasive monitoring technology is critical and recommended worldwide, with the potential of improving safety and reducing workload in blood glucose control. The design, development, and evaluation analysis of a non-invasive GSM (Glucose Screening Measurement) module glucometer using near-infrared sensors at 1550nm wavelength as an emitter, transmitting through the fingertip and the ATMega38 microcontroller as the controller to determine the glucose level in human blood are presented in this study. A total of forty individuals were recruited in the investigation. Repeatability, validity, and reliability were evaluated using the Bland and Altman Analysis, the concurrent validity, and the reliability analysis. Passing and Boblok Regression Analysis was used to assess the statistical significance further. Repeatability showed no significant difference with a 95% confidence interval and 0.6895 bias. The linear relationship showed 99.72% agreement and 99.9% reliability using regression analysis. This study revealed that using a non-invasive GSM module glucometer to measure blood glucose effectively enhances patient surveillance in diabetes insulin treatment.

Fish or steel? New evidence on the environment-economy trade-off in developing Vietnam

• Conventional thinking on the trade-off between economic growth and environmental protection provides an important but limited understanding of the way individuals in developing countries weigh development and environmental considerations; the environment is far more important to their calculus than previously understood. • Unique public opinion data across three years (2017, 2018, 2019) with nationally representative samples of the Vietnamese population is used to model how environmental factors affect individuals’ investment policy preferences when there is a potential trade-off. • In all three years, a conjoint survey experiment identifies multi-dimensional policy preferences and provides shielding, so responsents can answer honestly. Citizens do not blindly prioritize economic goals over environmental quality. Their preferences are most strongly driven by the perceived potential environmental consequences of the investment. Specifically, the larger the potential environmental costs, the less likely respondents were to support the business’ investment license application. While individuals are tolerant of some environmental damage in exchange for jobs or other economic benefits, there is a clear threshold beyond which people are unwilling to tolerate greater environmental costs regardless of the size of economic benefits. This preference for environmental quality remains consistent across different demographic groups and subnational locations. Trade and investment have contributed to the improvement of living standards in developing countries, but have also put severe pressure on natural environments. How do citizens in low-income countries manage this trade-off between economic growth and environmental protection? Using a discrete choice experiment conducted as part of three large, face-to-face nationally representative surveys of Vetnamese citizens (N=>12,500 respondents per wave), we find that prospective economic benefits increase public support for investment projects, whereas potential environmental harm resulting from investment decreases the public appetite for them. When economic and environmental factors are considered jointly, our results point to the existence of an environmental risk threshold. Environmental costs beyond that threshold lead citizens to reject investment projects, even when they generate considerable economic benefits. Our results challenge the theory that individuals in low-income countries prioritize development over environmental protection, and have implications for political leaders in designing their countries’ future investment policies.

Frailty and physical performance in the context of extreme poverty: a population-based study of older adults in rural Burkina Faso

Background: Little is known about the prevalence of frailty and about normal values for physical performance among older individuals in low-income countries, in particular those in sub-Saharan Africa. We describe the prevalence of phenotypic frailty, and values and correlates of several physical performance measures in a cohort of middle-aged and older people living in rural Burkina Faso, one of the world’s poorest communities. Methods: We analysed data collected from participants aged over 40 in Nouna district, Burkina Faso. We measured handgrip strength, four metre walk speed, chair rise time, and derived the Fried frailty score based on grip strength, gait speed, body mass index, self-reported exhaustion, and physical activity. Frailty and physical performance indicators were then correlated with health and sociodemographic variables including comorbid disease, marital status, age, sex, wealth and activity impairment. Results: Our sample included 2973 individuals (1503 women), mean age 54 years. 1207 (43%) were categorised as non-frail, 1324 (44%) as prefrail, 212 (7%) as frail, and 167 (6%) were unable to complete all five frailty score components. Lower grip strength, longer chair stand time, lower walk speed and prevalence of frailty rose with age. Frailty was more common in women than men (8% vs 6%, p=0.01) except in those aged 80 and over. Frailty was strongly associated with impairment of activities of daily living and with lower wealth, being widowed, diabetes mellitus, hypertension, and self-reported diagnoses of tuberculosis or heart disease. With the exception of grip strength, which was higher in women than prior international normative values, women had greater deficits than men in physical performance. Conclusions: Phenotypic frailty and impaired physical performance were associated as expected with female sex, co-morbidities, increasing age and impaired activities of daily living. These results support the use of frailty measurements for classification of ageing related syndromes in this setting.

Frailty and physical performance in the context of extreme poverty: a population-based study of older adults in rural Burkina Faso.

Background: Little is known about the prevalence of frailty and about normal values for physical performance among older individuals in low-income countries, in particular those in sub-Saharan Africa. We describe the prevalence of phenotypic frailty, and values and correlates of several physical performance measures in a cohort of middle-aged and older people living in rural Burkina Faso, one of the world's poorest communities. Methods: We analysed data collected from participants aged over 40 in Nouna district, Burkina Faso. We measured handgrip strength, four metre walk speed, chair rise time, and derived the Fried frailty score based on grip strength, gait speed, body mass index, self-reported exhaustion, and physical activity. Frailty and physical performance indicators were then correlated with health and sociodemographic variables including comorbid disease, marital status, age, sex, wealth and activity impairment. Results: Our sample included 2973 individuals (1503 women), mean age 54 years. 1207 (43%) were categorised as non-frail, 1324 (44%) as prefrail, 212 (7%) as frail, and 167 (6%) were unable to complete all five frailty score components. Lower grip strength, longer chair stand time, lower walk speed and prevalence of frailty rose with age. Frailty was more common in women than men (8% vs 6%, p=0.01) except in those aged 80 and over. Frailty was strongly associated with impairment of activities of daily living and with lower wealth, being widowed, diabetes mellitus, hypertension, and self-reported diagnoses of tuberculosis or heart disease. With the exception of grip strength, which was higher in women than prior international normative values, women had greater deficits than men in physical performance. Conclusions: Phenotypic frailty and impaired physical performance were associated as expected with female sex, co-morbidities, increasing age and impaired activities of daily living. These results support the use of frailty measurements for classification of ageing related syndromes in this setting.

Molecular detection of Enteropathogens from diarrheic stool of HIV positive patients in Gondar, Ethiopia

BackgroundInfectious diarrhea is a common problem in the developing world, especially among people living with HIV/AIDS. Traditional diagnostic methods such as stool culture and microscopic examination are limited by resources and poor sensitivity. The use of molecular diagnostics for enteropathogen detection in this region of sub-Saharan Africa has not been fully explored. We sought to identify risk factors and characterize enteropathogens from diarrheic stools of HIV-positive patients in Gondar, Ethiopia using multiplex molecular panels targeting key infectious agents.MethodsA cross-sectional study of 100 stool samples was performed. Samples were collected consecutively from HIV- positive patients presenting with diarrhea at University of Gondar Hospital clinic, a major center in NW Ethiopia. Genomic DNA was extracted from stool and processed using a multiplex molecular panel Allplex™ [Seegene, Canada]. Correlations between patient characteristics, symptoms, public health risk factors, and enteropathogen type (s) were studied. Eighty-six samples were successfully analyzed by molecular methods.ResultsThe mean age was 35 with 43% male. Eighty percent lived in an urban area, 18% had access to well water only, and 81% practiced proper hand hygiene. The majority of patients (72%) were receiving HAART with a median CD4 cell count of 362/μL. Multiple pathogens were detected in 94% of specimens, with an average of 5 enteropathogens per sample. Common bacteria, viruses, and parasites detected were Shigella spp./enteroinvasive E. coli (80%), enterotoxigenic E. coli (73%), Norovirus (16%) and B. hominis (62%). CD4 cell count < 500/ μL was associated with the presence of viruses (p = 0.004) and the absence of STEC (p = 0.010). The use of HAART or CD4 levels was not associated with the number of enteropathogens detected.ConclusionsDiarrheic stool from HIV-positive outpatients in Gondar, Ethiopia had on average 5 enteropathogens present in their stool. Shigellaspp./enteroinvasive E. coli and enterotoxigenic E. coli are the major pathogens, not dissimilar to immunocompetent individuals in low income countries.

Food Security and the 2015–2030 Sustainable Development Goals: From Human to Planetary Health

Food security exists when “all people, at all times have physical and economic access to sufficient, safe and nutritious food that meets their dietary needs and food preferences for an active and healthy life” (http://www.fao.org/wfs/index_en.htm). Close to 800 million individuals do not have access to enough food, >2 billion individuals experience key micronutrient deficiencies, and ∼60% of individuals in low-income countries are food insecure. Food insecurity negatively affects human physical, social, emotional, and cognitive development throughout the life course and is a major social and environmental disruptor with serious repercussions for planetary health (i.e., the health of human civilization and the state of the natural systems on which it depends). Food security is related to all of the United Nations Sustainable Development Goals (SDGs). Improved food security governance based on sound, equitable, and sustainable food systems that benefit from modern information and sustainable and equitable agricultural technologies is essential for countries to meet the SDGs.

Community-level effect of the reproductive health vouchers program on out-of-pocket spending on family planning and safe motherhood services in Kenya.

BackgroundAlthough vouchers can protect individuals in low-income countries from financial catastrophe and impoverishment arising from out-of-pocket expenditures on healthcare, their effectiveness in achieving this goal depends on whether both service and transport costs are subsidized as well as other factors such as service availability in a given locality and community perceptions about the quality of care. This paper examines the community-level effect of the reproductive health vouchers program on out-of-pocket expenditure on family planning, antenatal, delivery and postnatal care services in Kenya.MethodsData are from two rounds of cross-sectional household surveys in voucher and non-voucher sites. The first survey was conducted between May 2010 and July 2011 among 2,933 women aged 15–49 years while the second survey took place between July and October 2012 among 3,094 women of similar age groups. The effect of the program on out-of-pocket expenditure is determined by difference-in-differences estimation. Analysis entails comparison of changes in proportions, means and medians as well as estimation of multivariate linear regression models with interaction terms between indicators for study site (voucher or non-voucher) and period of study (2010–2011 or 2012).ResultsThere were significantly greater declines in the proportions of women from voucher sites that paid for antenatal, delivery and postnatal care services at health facilities compared to those from non-voucher sites. The changes were also consistent with increased uptake of the safe motherhood voucher in intervention sites over time. There was, however, no significant difference in changes in the proportions of women from voucher and non-voucher sites that paid for family planning services. The results further show that there were significant differences in changes in the amount paid for family planning and antenatal care services by women from voucher compared to those from non-voucher sites. Although there were greater declines in the average amount paid for delivery and postnatal care services by women from voucher compared to those from non-voucher sites, the difference-in-differences estimates were not statistically significant.ConclusionsThe reproductive health vouchers program in Kenya significantly contributed to reductions in the proportions of women in the community that paid out-of-pocket for safe motherhood services at health facilities.

Perception of African Youth on Personal Computer Utilization

The tendency to pursue innovativeness and adopt new technologies has been found more likely with younger individuals and a strong relationship between attitude and personal computer (PC) utilization has been found. However, research in these areas is mainly focused on high-income countries. Do these findings hold for low-income countries? What are the perceptions of African youth on the factors that impact PC use? There is a dearth of micro-level studies that promote understanding about the behavior of individuals in low-income countries. This study looked at demographic data including age, gender, grade level, region, and prior experience among 228 youth from Ethiopia and Rwanda. PC utilization constructs including complexity, long-term consequences, and facilitating conditions were studied. The author found access to PCs at least three times a week and providing structured computer training programs as major factor for increased PC utilization. Computer centers with more female instructors were found to have larger female enrollment. The author also found younger groups (15 year olds and younger) disagreed about PC utilization factors. Implications and directions for future research are also included.

The contribution of ethics to public health

While ethics in health care dates back at least to the times of Hippocrates, Sun Si Miao,1 and Ibn Sina (Avicenna),2 the field of “bioethics” did not emerge until after World War Two. The birth of bioethics was stimulated by a confluence of factors. First, the Nazis’ medical experiments on concentration camp prisoners heightened concerns about the vulnerability of human subjects in medical research. Second, rapid advances in medicine, including reproductive health, organ transplantation and genetics, raised questions about the purpose and limits of medical technology. Third, post-war civil rights movements led to growing attention to the power imbalances between physicians and patients and the corresponding need to empower patients to control their own health-care decisions. In recent years, there have been efforts to broaden the scope of ethical analysis in health care to focus more directly on public-health issues.3 In contrast to the traditional emphasis of bioethicists on the physician–patient relationship, public-health ethics focuses on the design and implementation of measures to monitor and improve the health of populations. In addition, public-health ethics looks beyond health care to consider the structural conditions that promote or inhibit the development of healthy societies. From a global perspective, key issues in public health ethics include the following: Disparities in health status, access to health care and to the benefits of medical research – For example, questions about resource allocation depend in part on value judgments about the relative importance of small improvements in quality of life for a large portion of the population as compared with a life-saving intervention that would benefit only a few people. Responding to the threat of infectious diseases – Efforts to contain the spread of infectious diseases raise difficult questions about the appropriateness of restricting individual choices to safeguard other people’s welfare. Examples include the use of isolation and quarantine for tuberculosis and pandemic influenza. International cooperation in health monitoring and surveillance – The implementation of the International Health Regulations4 reflects the commitment of countries to collective action in the face of public-health emergencies. Defining the scope of countries’ obligations to act collectively, and determining how those obligations should be enforced, will inevitably raise difficult ethical dilemmas. Exploitation of individuals in low-income countries – Current practices in medical research, for example, may expose participants to significant risks without a benefit for themselves or their communities. Defining and enforcing foreign research sponsors’ obligations to local participants is therefore a critical ethical issue. In the area of organ transplantation, the growing practice of “transplant tourism” exposes individuals living in poverty to significant health risks while also raising broader questions about the commodification of the human body. Health Promotion – The growing public-health threats of noncommunicable diseases, including those caused in part by unhealthy behaviours such as smoking, poor diet or lack of exercise, have raised the question of the extent to which public-health authorities should interfere with personal choices on health. Participation, transparency, and accountability – As an ethical matter, the process by which decisions are made is as important as the outcome of the decisions. In the area of medical research, much attention has been devoted in recent years to strengthening systems for informed consent and community oversight. Once such systems are in place, the next step will be to develop mechanisms for evaluating their effectiveness. Since it was founded 60 years ago, ethics has been at the heart of WHO’s mission to protect and promote the global community’s health. Activities in ethics have been undertaken by many programmes and departments, as well as WHO’s regional offices. For example, in 1994, the Regional Office for the Americas (AMRO/PAHO) created a regional programme on bioethics5,6 In 2002, WHO’s Director-General Dr Gro Harlem Brundtland created an Ethics and Health Initiative, which has since served as a focal point for the ethics activities throughout the organization. Examples include the publication of Guidance on ethics and equitable access to HIV treatment and care (jointly with UNAIDS)7 and of Ethical considerations in developing a public health response to pandemic influenza.8 WHO also contributes to regional capacity-strengthening efforts in ethics, in close collaboration with Member States. For example, the project Networking for Ethics on Biomedical Research in Africa (NEBRA) sought to strengthen African countries’ capacity to engage in effective ethical review processes.9 Articulating ethical and evidence-based policy options is one of WHO’s six core functions.10 WHO’s 60th anniversary and the 30th anniversary of Alma-Ata provide a particular opportunity to reflect on ethical values and dilemmas arising in the field of public health. ■

The Sexual Ethics of HIV Testing and the Rights and Responsibilities of Partners

The discourse of much of the international AIDS community champions the rights of individuals in low-income countries to "just say no" to routine HIV testing in health-care settings and, if tested and found positive, not to inform their sexual partner(s) if such disclosure could result in substantial personal harm. This study contends that the right of individuals to refuse testing ignores the right of their sexual partners--male or female, regular or casual--to be informed of the health risks to which they may be exposed on entering or continuing a sexual relationship or engaging in particular sexual acts. If, as the UN has declared, all persons have the right to decide freely and responsibly on matters relating to their sexuality, including their sexual and reproductive health, free from coercion, discrimination, and violence, then all persons have the right and the responsibility to know their own and their partner's serostatus and to protect themselves and their partner(s) from sexually transmitted infections (STIs). Support by AIDS activists for policies of routine STI/HIV testing, counseling, and disclosure between both partners in a sexual relationship would help to promote an ethic of equal rights and shared responsibility for sexual behavior and its consequences.

Personal and community benefits and harms of research: views from Rakai, Uganda

To assess what individuals in low-income countries perceive as benefits and harms of population-based HIV/STD research. A total of 811 research participants, research decliners, and community opinion leaders in the Rakai District, Uganda were surveyed. Types of personal and community benefits and harms, as well as rates of reporting great personal and community benefit were assessed. Using logistic regression, demographic characteristics, participant and opinion leader status, use of Rakai Health Sciences Program (RHSP) services, and perceived research effects were entered as predictors of reported great personal and great community benefit. Most respondents thought that RHSP research was of great personal (85%) and community (88%) benefit. The perception that the RHSP was a great personal benefit was correlated with female sex, post-secondary education, frequent use of RHSP-sponsored medical services, health knowledge gains, and increased hope for future health improvements. Persons of non-Baganda ethnicity and 30-39 year-olds were less likely to believe research was personally beneficial. Regarding research as a great community benefit was associated with reported health knowledge gains, greater hope for Rakai residents' future health, and local economic benefit. Decliners were the most likely to report a personal harm, while community opinion leaders identified community harms at the highest rates. The majority of Rakai residents report that HIV/STD research has enhanced their own and their communities' welfare. Different factors were associated with the belief that research is a personal versus community benefit. Variations in participant, decliner, and community opinion leader perceptions highlight inadequacies of current community consultation mechanisms.

Understanding Political Corruption in Low Income Countries

Building on the large and growing empirical literature on the political behavior of individuals in low income countries this chapter seeks to understand corruption through the lens of political economy - particularly in terms of the political and economic differences between rich and poor countries. Our focus is on the political behavior of individuals exposed to democratic political institutions. We review the existing literature on the determinants of individual political behavior to ask whether we can understand the choice of political actors to be corrupt and, importantly, of other individuals to permit it, as a rational response to the social or the economic environment they inhabit. We also discuss the implications of this view of corruption for anti-corruption policies.

A sports wheelchair for low-income countries

Purpose. Appropriate wheelchairs for basic mobility needs are still not commonly available in low-income countries, although several organizations are working toward this goal. After basic mobility is secured it is important to provide more diverse assistive technology to allow people with disabilities to more completely participate in society and live healthy lives. Our goal was to design an affordable sports wheelchair that would allow individuals in low-income countries to participate in basketball.Methods. Design requirements established for the sports wheelchair included: removable anti-tippers, adjustable tension backrest, 24″ wheels, adjustable seat dump, variable camber, 4″ casters, fore-aft axle position, removable bumpers, height adjustable footrest, four wheels, single anti-tipper (pivot), cost less than $125 without wheels, 16″ seat width and backrest height, and nylon upholstery. The wheelchair was designed using 3D modeling, standard materials, and standard tools.Discussion. An affordable wheelchair, versatile enough to be used for a variety of sports and even everyday use, was designed and prototyped successfully. Documentation for the design including step-by-step directions, engineering drawings, and photographs are available at the Human Engineering Research Laboratories website (http://www.herlpitt.org/intw.htm). Future work on the prototype should include design refinement including adaptations for other sports, and standards testing.