Less-developed Nations Research Articles

Epidermolysis Bullosa: Practical Clinical Tips From the Field.

Epidermolysis bullosa (EB) is a rare genetic condition characterized by fragile skin caused by impaired adhesion between the dermis and epidermis. EB is present at or near birth. There is no cure and treatments are supportive. Children with EB are at elevated risk of squamous cell cancer. Under ideal circumstances, EB patients benefit from interdisciplinary care teams who can offer state-of-the-art treatments. In reality and particularly in less-developed nations, care can be limited.In all cases, families dealing with a member with EB face great challenges in caregiving, much of which is managed at home, and incur great financial expenses for dressings, equipment, transportation, and out-of-pocket expenses. While research groups are working to find a cure for EB, clinicians working with EB patients around the worldhave found practical and relatively inexpensive tips to make life easier for people with EB. NoBabyBlisters.org, a nonprofit organization actively supplying monthly medical supplies for EB children on five continents and working on EB research, has innovated, developed, collected, and now offers here seven such practical and actionable items learned from its experience in the real world assisting children in less-developed nations, typically with hot climates. These are based on real-world clinical experience dealing with a complex disorder under challenging circumstances. The goal of this short paper is to provide advice to EB caregivers and their loved ones that may make things easier and enhance quality of life, including blister and pain reduction.

Corporate Social Responsibility (CSR) Effect on Teaching and Learning: Evidence from an Emerging Economy

This study examined the concept of Corporate Social Responsibility (CSR) and the effect of CSR initiatives on teaching and learning from teachers, students, and heads' perspectives. The study relied on in-depth interviews and focus-group discussions to obtain data. The participating schools were selected through a stratified sampling technique, with the individual respondents purposively sampled. Interviews and discussions were tape-recorded and subsequently transcribed, sorted to identify central and recurrent themes in the data. The study showed that corporate bodies have contributed immensely to the teaching and learning processes through improved school infrastructural facilities. It also found that CSR activities have enhanced teaching and learning processes. Thus, resulting in improved quality of teaching delivery, students' academic performance and beneficiary schools' societal status. The findings, however, focused mainly on the perspectives of teachers, students, and heads of schools. The findings are expected to maximize the effective deployment of CSR resources in education service and infrastructure provision in less-developed countries. The results are expected to engender further debate among corporations and other relevant stakeholders on the need for concerted efforts in tackling the school infrastructure deficit prevalent in less-developed nations. This study is one of its kinds on the effect of CSR initiatives on teaching and learning from direct beneficiaries' perspectives within the African context. This study also provides evidence of the need for a deliberate effort to encourage private-sector investment in school infrastructure.
 Keywords: Corporate Social Responsibility, Education financing, Emerging Economy, Teaching and Learning

Slow Sand Filters for the 21st Century: A Review.

Safe drinking water remains a major global challenge, especially in rural areas where, according to UNICEF, 80% of those without access to improved water systems reside. While water, sanitation, and hygiene (WASH)-related diseases and deaths are common outcomes of unsafe water, there is also an economic burden associated with unsafe water. These burdens are most prominent in rural areas in less-developed nations. Slow sand filters (SSFs), or biological sand filters (BSFs), are ideal water treatment solutions for these low-resource regions. SSFs are the oldest municipal drinking water treatment systems and improve water quality by removing suspended particles, dissolved organic chemicals, and other contaminants, effectively reducing turbidity and associated taste and odor problems. The removal of turbidity and dissolved organic compounds from the water enables the use of low-cost disinfection methods, such as chlorination. While the working principles of slow sand filtration have remained the same for over two centuries, the design, sizes, and application of slow sand filters have been customized over the years. This paper reviews these adaptations and recent reports on performance regarding contaminant removal. We specifically address the removal of turbidity and microbial contaminants, which are of great concern to rural populations in developing countries.

Impact of more variations on in‐hospital mortality among patients with confirmed COVID‐19

Thanks for Aftab and co-authors’ feedback on this systematic review. Three questions were raised in their letter. We tried to respond to the best of our knowledge, in this letter. Question 1. In-hospital mortality rates decreased in the US over 2020. A retrospective analysis during this time period would be strengthened by accounting for the variation. Response: Several factors may influence mortality rate, for example, optimized treatment plan, viral toxicity attenuation and so on. Most of the included studies in our systematic review were carried out in early stage of the global pandemic (i.e., up to June 2020) in hospital setting with inpatients, thus we were unable to make inference across time. Patients in those earlier studies experienced similar level of improvement despite of the status of angiotensin converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) use. Nevertheless, following Aftab's feedback and example of differential findings across time in US studies, we double checked data from the three US studies included in our review to examine if such trend was present. Those three studies were conducted in April, May, and June 2020, and none showed clear difference between groups. There might have been a change to the above finding in studies conducted beyond this period, with consideration to virus mutation and the use of vaccination, hence we urge future reviews to explore the time factor. Question 2. Socioeconomic and sociocultural variations in mortality should be considered. Response: We suggest to look at the impact of this from the angles of in-hospital mortality and mortality in community settings. We agree with Aftab and co-authors that in-hospital mortality may be impacted by socioeconomic and sociocultural factors. The in-hospital mortality rate varied between 7% and 30%1-5 across different countries. Tereshchenko's study6 published in 2021 indicated unhealth life style, poverty, lack of health insurance, poor education may influence the application of ACEI/ARB. Compared with less-developed nations, patients in developed nations may have higher chance of receiving ACEI/ARB drugs, hospitalization, more aggressive treatment and vaccination. However, earlier Covid-19 studies at the start of the global pandemic lacked reporting or relevant stratification by these socioeconomic factors. In absence of individual data or subgroup data on these domains, we were unable to carry out further analysis. But we agree this is an important issue which should be addressed in further analysis. We appeal to clinical researchers to record and report such information in future clinical studies. While we also agree with Aftab and co-authors that socioeconomic and sociocultural variation may alter the risk of mortality in general (beyond hospital setting), this is an epidemiological investigation which is beyond the scope of our study (which focuses on in-hospital outcomes). Question 3. Continuation or discontinuation of the ACEI/ARB after discharge from the hospital was not controlled. Response: Aftab and co-authors highlighted an important issue. This was taken into account in our protocol design. We planned to do subgroup analysis on continuation versus discontinuation of ACEI/ARB, but we had only a single randomized control trial (NCT04338009) included in the review, hence were unable to carry out subgroup analysis. The single RCT showed that the mortality rate between discontinuation and continuation of ACEI/ARB was 12.99% versus 14.67%, which is higher than the finding from the Brazil study.7 This could be resulted by varied disease severity and existing comorbidities, but we are not sure. In conclusion, we thank Aftab and co-authors for their thought-provoking feedback. In general, we agree that these are important confounding issues which begs for further investigation, should data becomes available in future updates. The authors have no conflict of interest.

Conquering COVID: How Global Vaccine Inequality Risks Prolonging the Pandemic.

The development of effective vaccines during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has been deemed a towering achievement in modern science. Since the end of 2020, the vaccine rollout has offered the promise of vanquishing the pandemic in the United States and other developed countries. Even as the United States and other wealthier nations encounter both setbacks and successes in their coronavirus disease 2019 (COVID-19) eradication efforts, developing countries around the world are likely to face far less fortunate fates. With much of the world’s vaccine production and distribution capacity reserved by wealthier nations, impoverished countries stand to face devastating financial, social, and health-related impacts. The consequences of this disparity will resonate deeply into the collective fabric of these countries, ensuring that the economic and geopolitical imbalance between developed and developing nations will widen even more substantially. Wealthier countries must do more to eliminate the inequality that exists in widespread SARS-CoV-2 vaccine availability in less-developed nations. Like HIV, tuberculosis, malaria, and other global epidemics, COVID-19 cannot be forgotten just because the pandemic is eventually contained from the shores of wealthier nations. For as long as the pandemic rages in any corner of the globe, the world will never be truly rid of COVID-19. And all nations, rich or poor, will suffer the consequences.

Factors identifying musician entrepreneurship in a less-developed country: a case of Indonesia's independent musician

Purpose This paper aims to examine Indonesian independent musicians' (indie) adaptation to the environmental business model. The research on institutional entrepreneurship (IE) has been used in organizational studies, including the music profession. However, the music industry's information and technology advancement has not been scrutinized in a less developed country (LDC) context. Design/methodology/approach A qualitative approach is used to conduct semi-structured interviews with 14 independent music professionals and enthusiasts. The interview result was three stages of coding, including open, axial and selective, as well as generating appropriate themes. Findings The results summarize entrepreneurial behavior, socio-economy and technology factors. The existing literature supports these results, though new perspectives are only identified in the LDC context. Internal factors drive IE, while socio-economy, including music literacy, education and legal issues, influence its sub-setting. On the other hand, technology positively or negatively impacts IE based on individual utilization. Research limitations/implications Despite the massive piracy and copyright issues, independent musicians require creativity and innovation beyond product creation. Weak and unclear regulations in Indonesia prevent musicians from revealing their identity and publishing their artwork, preventing or obstructing them from their goals. Practical implications This paper illustrates the urgency to implement copyright regulations for musicians in Indonesia, which are insufficiently enforced by law enforcement. Such conditions prevents musicians from revealing their identity and publishing their artwork. Social implications This paper addresses the extent to which a community such as independent musician, struggles to find its identity toward the changing of its business model. By mapping the factors associated with an independent musician, the paper suggests that this community has strategic economic potential as a creative entity. Originality/value This paper examines the music industry in less-developed nations by contextualizing their institutions using the IE framework. It contributes to identifying the environmental factors influencing independent institutional musicians. Internal and external factors significantly contribute to identifying Indonesia's independent musician setting through IE.

Developing Developing-Country Tax Systems

Experts from the North have long tried to teach countries in the South how to tax. For decades, they assumed the main challenges were domestic and there was a right answer to be found somewhere in the developed world that could be replicated everywhere else. Only more recently have they dedicated more attention to the international realm, yet their solutions remain tied to technical rules designed by a few specialists, as exemplified by the OECD Secretariat’s “Unified Approach” for the taxation of the digital economy. From a critical and historical socio-legal perspective, this Article argues that such technocratic approaches are set to fail less-developed nations for as long as we continue to overlook the background causes of weak taxation at both the national and international levels. These involve difficulties in applying complex rule sets, but also the very way in which global tax policy is developed, who influences the process, and the resulting distributive consequences.

A Review of Urban Ecosystem Services Research in Southeast Asia

Urban blue-green spaces hold immense potential for supporting the sustainability and liveability of cities through the provision of urban ecosystem services (UES). However, research on UES in the Global South has not been reviewed as systematically as in the Global North. In Southeast Asia, the nature and extent of the biases, imbalances and gaps in UES research are unclear. We address this issue by conducting a systematic review of UES research in Southeast Asia over the last twenty years. Our findings draw attention to the unequal distribution of UES research within the region, and highlight common services, scales and features studied, as well as methods undertaken in UES research. We found that while studies tend to assess regulating and cultural UES at a landscape scale, few studies examined interactions between services by assessing synergies and tradeoffs. Moreover, the bias in research towards megacities in the region may overlook less-developed nations, rural areas, and peri-urban regions and their unique perspectives and preferences towards UES management. We discuss the challenges and considerations for integrating and conducting research on UES in Southeast Asia based on its unique and diverse socio-cultural characteristics. We conclude our review by highlighting aspects of UES research that need more attention in order to support land use planning and decision-making in Southeast Asia.

Analyzing the impact of agricultural donor aid on food security in West Africa

Despite the abundance of agricultural donor aid to the less-developed nations, especially in West African countries, little is known regarding its role in enhancing food security. This study argues that the flow of aid to the productive sector would have a sustainable impact since it has a multiplier effect on the recipient countries by enhancing productivity in the agricultural sector. Therefore, by filling this gap, the research aims to analyze the impact of agricultural donor aid on food security in 16 West African countries between 2009-2018. The study adopted quantitative cross-country panel data and utilized the Two-Stage Least Square Regression model (2SLS) to examine to what extent agricultural aid has impacted food security in the sub-region. This method was adopted to address the endogeneity problems in this research model specification, where it is assumed that there is a reverse causality between donor aid and food security. The findings indicate that agricultural aid has impacts on food accessibility, and utilization in West Africa. This impact is based on good governance and the institutional qualities of recipient countries.

Gendered Inequalities in HIV/AIDS: Investigating Linkages between Degradation, Disenfranchisement, Unemployment and Disease

The purpose of this paper is to examine the social, political, economic, and environmental forces that shape disproportionate HIV rates among women in less-developed countries. Specifically, we analyze how environmental degradation and women’s property rights condition female unemployment rates in poor nations and ultimately, patterns of disease. Using data from 105 less-developed nations, we construct a structural equation model to analyze influences on the proportion of HIV cases among women. We find that environmental degradation is an important, though often overlooked factor contributing to the female HIV burden across nations, through mechanisms such as female unemployment, disenfranchisement, and poor access to socio-health services. We also find that restrictions on property rights for women impact female unemployment and access to health services. Conclusions point to the efficacy of incorporating ecofeminist frameworks that emphasize ecological conditions alongside political, economic, and social forces to explain global health and gender inequalities in HIV/AIDS.

New Metrics for Cross-Country Comparison of Scientific Impact.

Comparing scientific impact among countries is fundamental for the development of effective strategies for science financing and assessment (Vinkler, 1986; King, 2004; Hermes-Lima et al., 2007a; Wagner et al., 2018). Such comparisons allow the definition of funding strategies based on inputs and outputs of the Research and Development (RD Leydesdorff et al., 2019). These top performer countries, in turn, can be emulated by less-developed nations. Usually, the number of scientific papers and the number of citations of a country are the main variables used for these comparisons. These metrics are frequently combined in a single indicator, such as the Citations Per Publication (CPP) (Lehmann et al., 2003; Moed, 2005; Waltman and van Eck, 2009; Vinkler, 2010) or the well-known h-index (Hirsch, 2005; Egghe, 2006; Glanzel, 2006; Hermes-Lima et al., 2007b; Franceschini and Maisano, 2010). However, each index has its caveats, and identifying simple, meaningful metrics for scientific productivity evaluation at country level has been a challenge (King, 2004; Leydesdorff et al., 2019). The limitations of the h-index have been vastly discussed in the literature (Bornmann and Daniel, 2005; Waltman and van Eck, 2012); and inter-country comparisons using the CPP have problems related to the time frame of an analysis. Thus, early publications from a given country will have more citations (therefore resulting in a higher CPP) than later publications, simply because papers published earlier had more time to be cited. For instance, Belgium was the country with the highest research impact in Medicine in 2019 (Scimago data), with a CPP value of 1.38 (12,768 publications; 17,595 citations), whereas its CPP value for 2016 is 17.73 (11,766 publications; 208,622 citations) and for 2013, 30.91 (22 times higher than in 2019). This limitation leads to the question: How can one avoid this caveat and meaningfully compare research impact among countries in a year-per-year basis? In this essay we present two simple methods to standardize CPP values along time, thus allowing for comparisons among countries in a time-independent fashion. Therefore, two metrics are presented: The Relative CPP and the Impact-Relative Rank Score (IRRS). Both of these procedures are based on the principle of normalizing the metric according to maximum-minimum values in the common set of observational units (countries) used for comparison.

Drought and disproportionate disease: an investigation of gendered vulnerabilities to HIV/AIDS in less-developed nations

Environmental change and climate-related disasters are an under-examined factor impacting women’s health, globally. Drawing on ecofeminist theory, we conduct analyses examining if the HIV burden among women is higher in nations that experience suffering from droughts. Specifically, we posit that droughts, which typically impact more people and for greater lengths of time than other climate-related disasters, have a unique impact on women’s vulnerability to HIV/AIDS. We use a cross-national dataset of less-developed countries and ordinary least squares (OLS) regression to explore and compare relationships between suffering from drought and total HIV prevalence and suffering from drought and women’s proportion of HIV cases. Overall, the results demonstrate that while droughts have an inconsistent impact on total HIV prevalence, suffering from drought significantly increases the proportion of HIV cases among women in comparison to men, net of the impact of common economic, social, cultural, and political predictors. The findings suggest that suffering from drought differentially impacts women’s health in less-developed countries, where a number of mechanisms, such as transactional sex or displacement, likely underlie the associations identified.

Exploring the impacts of national image, service quality, and perceived value on international tourist behaviors: A Nepali case

The dominant paradigm on tourist behaviors depicts a sequential relationship among image, quality, satisfaction, and post-purchase behavior while the alternative view argues that consumer behaviors are better understood through perceived value. Using Nepal as a case, we tested a synthetic model of tourist behaviors and applied the Fombrun-RI Country Reputation Index (CRI) that was developed in the field of nation branding to measure destination image, an elusive concept in tourism literature since long. Structural Equation Modeling (SEM) shows that the data largely supported the model, and national image has impacts on tourist behaviors. However, service quality is not a significant predictor of tourist behaviors. This corroborates the argument that perceived value is a better way to analyze tourist behaviors. The research has practical implications for nation branding programs in the less-developed nations.

Accounting for global migrant remittances flows

ABSTRACT Migrant remittances are important to some countries. According to the World Bank, they comprise more than 30% of the GDP of Kyrgyzstan, Tonga, Tajikistan, Haiti and Nepal. Compared to official development aid or foreign direct investment, remittances have lately become a prime income stream for less-developed nations. In this paper, we analyze the net spillover and feedback effects from the consumer demand generated in migrants’ home countries. We use World Bank estimates of remittances and the World Input-Output Database (WIOD) for the investigation with so-called ‘hypothetical insertion’ as the tool of choice. We find that even some developed nations, like the US, likely benefit from remittances (the largest global path for remittances is that from the US to Mexico), but that not all do (e.g. Canada does not). We stop short of making strong policy recommendations. Instead, we suggest that more attention is paid to the veracity of remittance estimates.

Architecture of “Stadium diplomacy” - China-aid sport buildings in Africa

In the past 60 years, China has constructed over 1,400 buildings in the developing world, many of them stadiums. This study examines how China uses stadiums as diplomatic means to demonstrate its cultural, economic and socio-political engagement in less-developed nations. To address the Chinese economic, cultural and intellectual intervention, this article uses three representative stadium projects built in Africa as case studies. Firstly providing physical venue for sports activities and then creating institutional network for further economic, cultural and political engagement, the Chinese built stadiums became effective catalyst for enhancing bilateral relations between China and the receipt countries. China's stadium diplomacy revealed a soft, and ultimately progressive mode of cultural engagement in transnational architectural practice. The authors argue that the implication of this architectural engagement lies in the fact that the Chinese state played a mediating role in producing and delivering architectural forms with various political motivations. Notwithstanding, the involved architects and engineers took the cultural and technical challenges and experimented adaptable design in aid projects.

Multinational life satisfaction, perceived inequality and energy affordability

We analyse subjective experiences of energy poverty to address the limitations of existing observable indicators as evidence for policy. We investigate the linkage between self-reported energy affordability and life satisfaction, health and economic inequality. A large-scale survey of 100,956 respondents across 37 nations shows that energy affordability concerns individuals in both developing and developed nations. Self-reported (perceived) values do not necessarily follow previous research and vary according to regional, economic, development and cultural factors. Contrasting this evidence with national-level data, such as healthy life expectancy and government spending on health and welfare, we identify associations between self-reported outcomes, income levels and national policy. Although national welfare spending can reduce the perceived economic gap, high income is not necessarily associated with better perceived satisfaction, health or economic outcomes. Enhancing energy access may lead to improved health outcomes in the most marginalized nations; however, lifestyle and cultural factors also play a role. Although the outcomes of less-developed nations can likely improve through development aid from more-developed nations, our results show that cultural and other factors underpin satisfaction in developing nations, which experience comparatively poorer life satisfaction. We identified that some nations had superior outcomes for health and life satisfaction despite lower income levels. This highlights the need for further research to uncover non-income-based factors that underlie life satisfaction and health, such as community connectedness or familial factors. A large multinational survey of perceived energy affordability shows that it concerns individuals regardless of the countries’ level of income, although some patterns also related to regional, economic and cultural factors.

External Issues Affecting Teachers’ Use of Technology in Saudi Arabia: Systematic Literature Review

External issues have, for many years, had a crucial, adverse, impact upon the extent to which teachers have adopted technology for the promotion of learning, for example by introducing learning management systems (LMS). This problem has particularly affected teachers working in developing and less-developed nations. Despite this, few researchers have conducted systematic literature reviews that explore the Saudi Arabian context. The purpose of this study is to examine and scrutinize what is presented in the academic literature about the external factors that affected teachers use of technology in the teaching process in Saudi universities. The systematic review presented in this paper was carried out using a number of databases. Sources include library resources, key journals, PhD theses, master’s theses, and papers yielded by Google Scholar searches of the relevant literature published from 2008 to 2018. There were 32 studies and just 12 studies included in this systematic review. The findings of this review reveal the current state of those external factors that have for some time delayed and influenced teachers’ use of LMS and associated technologies in their teaching in the Kingdom of Saudi Arabia (KSA) between 2008 and 2018. Recommendations are made in this paper, to help Saudi institutions to limit this phenomenon going forward.

Democracy and Infant Mortality in Less-Developed Nations: Dismantling Differences in Direct and Indirect Effects Modeling

In recent years, many studies have focused on examining the relationship between democracy and health outcomes in developing nations. However, the overwhelming majority of this research utilizes direct-effect modeling approaches, assuming that increases in democracy are going to directly translate into improvements in well-being. Drawing on a sample of 136 less-developed nations, I first conduct a basic regression, where I find no significant impact of democracy on infant mortality. I then utilize structural equation modeling (SEM) to show significant indirect effects of democracy on infant deaths through public health spending. The results help place in context previous studies that have found inconsistent effects of democracy on health outcomes. The regression and SEM analyses demonstrate how erroneous findings can result from solely utilizing direct-effect approaches, which incorrectly treat key mediating mechanisms as competing predictors.

Interplay Between Socioeconomic Status and Otitis Media Disease Burden in Resource-rich and Resource-poor Nations.

To characterize global differences in otitis media (OM)-related disease burden between socioeconomically advantaged and disadvantaged nations. Using the Global Health Data Exchange, worldwide OM burden was evaluated using age-standardized disability-adjusted life years (DALYs) per 100,000 individuals in 183 countries from 1990 to 2015. Countries were organized by socioeconomic status using Human Development Index (HDI) values collected from the United Nations Development Program. Gini coefficients and concentration indices were employed to analyze disparities in OM disease burden. From 1990 to 2015, the mean DALY rate across all nations decreased by 21.9%. When considering disease burden in relation to socioeconomic status, age-standardized DALYs decreased as HDI values increased (p < 0.001). For both children and adults, DALY rates were significantly different between HDI groups (p < 0.01). Gini coefficients decreased from 0.821 in 1990 to 0.810 in 2015, indicating a modest reduction in international health inequality. Global disparities in OM disease burden, as measured by the concentration index, worsened from 1990 to 2010 before showing a small trend reversal in 2015. To our knowledge, this is the first analysis investigating socioeconomic-related global disparities in OM disease burden using HDI values, Gini coefficients, and concentration indices. While the overall mean decrease in DALY rate from 1990 to 2015 is encouraging, the net decrease in concentration index during this period suggests less-developed nations continue to shoulder a disproportionate burden. Greater resource allocation to resource-poor nations may be warranted, as disease burden negatively impacts these countries to a greater degree.

The rise of South\u2013South trade and its effect on global CO2 emissions

Economic globalization and concomitant growth in international trade since the late 1990s have profoundly reorganized global production activities and related CO2 emissions. Here we show trade among developing nations (i.e., South–South trade) has more than doubled between 2004 and 2011, which reflects a new phase of globalization. Some production activities are relocating from China and India to other developing countries, particularly raw materials and intermediate goods production in energy-intensive sectors. In turn, the growth of CO2 emissions embodied in Chinese exports has slowed or reversed, while the emissions embodied in exports from less-developed regions such as Vietnam and Bangladesh have surged. Although China’s emissions may be peaking, ever more complex supply chains are distributing energy-intensive industries and their CO2 emissions throughout the global South. This trend may seriously undermine international efforts to reduce global emissions that increasingly rely on rallying voluntary contributions of more, smaller, and less-developed nations.