Low-income Regions Research Articles

Adolescent psychopathology and psychological wellbeing: a network analysis approach

BackgroundThe extent to which psychological wellbeing may play a preventive and therapeutic role in the development and maintenance of adolescent emotional disorders depends, in part, on the nature of the overlap between these two constructs. We estimated network analysis to examine the relationship between adolescent psychopathology (measured by depression and anxiety symptoms) and psychological wellbeing (measured by happiness, optimism, social support, perceived control, and gratitude).MethodsThis was a cross-sectional study with a large community sample of Kenyan adolescents (N = 2192, aged 13–18). Network analyses were conducted to examine the topology, stability, centrality, and bridge nodes of a network of psychopathology and psychological wellbeing measures.ResultsTwo distinct community clusters emerged, one for psychopathology nodes and another for wellbeing nodes, suggesting that these are two distinct but connected concepts. Central and bridge nodes of the wellbeing and psychopathology network were identified. The most central nodes in the network were family provides emotional help and support and self-blame; the strongest negative edges between psychopathology and psychological wellbeing were depressed mood—I love life and irritability—I am a joyful person; the main bridge nodes were family helps me and I can talk to family about problems.ConclusionsOur findings expand understanding of the relationship between psychopathology and wellbeing in an understudied population and are suggestive of how psychological wellbeing can inform psychopathological treatment and preventive efforts in low-income regions such as those in Sub Saharan Africa.

What Determines the Geography of Entrepreneurship? A Comparative Study Between Sub-Saharan Africa and South-East Asia

There is a clear disparity between different regions of the world regarding the type and number of entrepreneurs. These differences are most prominent between low-income regions like Africa and middle- to high-income regions such as South-East Asia. Thirty years ago, Asian and African countries were at similar stages of development, but today their difference in entrepreneurship and economic development is massive, which makes them intriguing cases to compare. To investigate the extent of this and explain why it happens, this study identifies the main influences on entrepreneurial activity, according to entrepreneurship ecosystem (EE) theory and knowledge spillover theory. Making use of multivariate analysis of variance, the most prominent factors responsible for the difference in entrepreneurship capacity in the regions were found to be technology development, political situation and the quality of public institutions. South-East Asia provides these to a sufficient degree thereby giving rise to a healthy EE, while Africa’s ability to build this infrastructure is still in its embryonic stage. This study’s efficacy is to inform on possible policies that low- and middle-income nations can follow to build entrepreneurship in their current economic situations, as well as to expand EE theory in the underexplored context of developing countries.

The Long-Run Economic Consequences of Iodine Supplementation

We present evidence on the impacts of a large-scale iodine supplementation program in Tanzania on individuals’ long-term economic outcomes. Exploiting the timing and location of the intervention, we document that in utero exposure to the program increased completed years of education and income scores in adulthood. We find no increase in total employment, but a significant change in the occupational structure. Cohorts exposed to the program are less likely to work in agricultural self-employment and more likely to hold skilled jobs that typically demand higher levels of education. Together, these results demonstrate that iodine deficiency can have long-run implications for occupational choices and labor market incomes in low-income regions.

Virological Characterization of Roof-Harvested Rainwater of Densely Urbanized Low-Income Region.

Roof-harvested rainwater (RHRW) is considered relatively clean water, even though the possible presence of pathogens in the water may pose human health risks. In this study, we investigated the occurrence of enteric viruses in the first flush (10mm) of RHRW from a densely populated and low-income urbanized region of Rio de Janeiro. One hundred samples (5 L) were collected from 10 rainfall events between April 2015 and March 2017. RNA and DNA viruses were concentrated using the skimmed milk flocculation method and analyzed using the TaqMan® quantitative RT-qPCR and qPCR. Human adenoviruses, noroviruses, rotaviruses A, and avian parvoviruses were detected in 54%, 31%, 12%, and 12% of the positive samples. JC polyomavirus, also targeted, was not detected. Virus concentrations ranged from 1.09 × 101 to 2.58 × 103 genome copies/Liter (GC/L). Partial nucleotide sequence confirmed the presence of HAdV type 41, norovirus genotype GII.4, and avian parvovirus 1. The results suggest that the first flush diversion devices may not adequately remove enteric virus from the rainwater. Additional treatment of RHRW is required to mitigate potential health risks from potable use of captured water.

Overcoming vaccine hesitancy in low-income and middle-income regions.

Vaccine hesitancy is prevalent in all demographic groups and settings; however, it remains vastly understudied in low-income and middle-income regions. Successful strategies to address hesitancy require an understanding of regional, cultural, and economic factors, and tailored training of health-care professionals. Vaccine confidence crises should be addressed swiftly. Further research is needed to optimize approaches. Vaccine hesitancy is considered a threat to global health and has been rising worldwide, particularly in resource-limited settings. This Comment discusses this issue and highlights the multiple strategies that can be implemented to address it.

Trading with richer and poorer countries: trade integration and regional inequality in Greece

This paper examines the link between increased trade and regional GDP growth across the regional income distribution in Greece during the post-EMU period (2000–2013). By means of quantile regression techniques, panel fixed effects and system generalized method of moments (GMM), we disentangle the effects of EU trade—trading with generally richer countries—versus global trade—in the case of Greece, mostly trading with poorer countries—at several points of the regional income distribution to identify differences in trade elasticities. The analysis finds that the impact of EU trade is highly heterogeneous and mainly affects negatively the economy of the richer regions in Greece. In contrast, the effects of EU trade display insignificant results for the lower-income regions, attributed to the absence of direct substitution effects.

Resilience to dealing with COVID-19: university perspective in a low-income health Brazilian region

Abstract The COVID-19 pandemic draws into focus the need to rebuild resilient health systems with increased access to quality health services. Reaction ability to changing demand is crucial. Resilience is relevant because all countries have vulnerable communities. One could push the argument further, using as an example the resilience particularly present on the agenda of meetings of the World Health Organization. More critical than ever, it is to take stock of the lessons learned. The stakeholders need to work together to accelerate progress towards universal access to essential health information through resilience. Regarding major societal challenges, which have a local dimension, universities have a key role to play in the knowledge creation of innovative products and services. The need for timely, accurate, and reliable data about the Vale do Jequitinhonha in the health system is unarguably overdue for a real-time, technology-driven, surveillance and reporting infrastructure to respond effectively to public health emergencies. Health system resilience is one of the focuses in low-income region framework and it is an indispensable university strategy for managing the health risks of older adults, and chronic disease patients. COVID-19 can cause disruption in health systems. Disruptions to health service infrastructure can result in loss of life, negative economic impact, and harm to communities. Focused actions include investing in Primary Health Care (PHC) and this encompasses basic preventive, promotive, and curative health cares for enhancing the health status of the people by reducing morbidity and mortality rates. Given the key role of such information for health, the university located in a low-income health region has a fundamental role. The reflections and shreds of evidence showed during this essay can serve as a framework for health policies in post-pandemic reality and university acting in the population.

Detection of Multiple Breast Cancer ESR1 Mutations on an ISFET Based Lab-on-Chip Platform.

ESR1 mutations are important biomarkers in metastatic breast cancer. Specifically, p.E380Q and p.Y537S mutations arise in response to hormonal therapies given to patients with hormone receptor positive (HR+) breast cancer (BC). This paper demonstrates the efficacy of an ISFET based CMOS integrated Lab-on-Chip (LoC) system, coupled with variant-specific isothermal amplification chemistries, for detection and discrimination of wild type (WT) from mutant (MT) copies of the ESR1 gene. Hormonal resistant cancers often lead to increased chances of metastatic disease which leads to high mortality rates, especially in low-income regions and areas with low healthcare coverage. Design and optimization of bespoke primers was carried out and tested on a qPCR instrument and then benchmarked versus the LoC platform. Assays for detection of p.Y537S and p.E380Q were developed and tested on the LoC platform, achieving amplification in under 25 minutes and sensitivity of down to 1000 copies of DNA per reaction for both target assays. The LoC system hereby presented, is cheaper and smaller than other standard industry equivalent technologies such as qPCR and sequencing. The LoC platform proposed, has the potential to be used at a breast cancer point-of-care testing setting, offering mutational tracking of circulating tumour DNA in liquid biopsies to assist patient stratification and metastatic monitoring.

Examining Research Partnership Needs of Ghanaian Higher/Tertiary Education Institutions

In the research partnership development literature, developing effective research partnerships between educational institutions calls for the construction of a ‘knowledge sharing culture’ within which the principle of ‘mutual learning’ takes centre stage. Yet in the higher education landscape of many low-income countries, where there are a limited number of research partnership collaborations but yet a myriad of partnership challenges, ‘borrowing’ and ‘replication’ of policies and programmes appear to be the order of the day. This article seeks to understand partnership challenges of Ghanaian institutions of higher learning. Using insights from self-administered questionnaires and semi-structured case study interviews conducted, the article examines: (1) the partnership needs of Ghanaian HEI/TEIs and (2) the means by which these institutions undertake their partnership needs assessments. Regarding the former of these research purposes, the findings reveal that the views articulated by participants are not any different from those espoused in the partnership development literature concerning the partnership needs of HEIs in low-income regions. Concerning the article’s latter research purpose, we observe that the partnership needs assessments of Ghanaian HEIs/TEIs are largely students-driven with less inputs from staff, peer institutions and industry. Against this backdrop, we conclude that Ghanaian HEI/TEIs could amelioratemost of their peculiar partnership challenges if they make concerted efforts to broaden the processes by which they undertake partnership needs assessments.

Consensus Middle East and North Africa Registry on Inborn Errors of Immunity

BackgroundInborn errors of immunity (IEIs) are a heterogeneous group of genetic defects of immunity, which cause high rates of morbidity and mortality mainly among children due to infectious and non-infectious complications. The IEI burden has been critically underestimated in countries from middle- and low-income regions and the majority of patients with IEI in these regions lack a molecular diagnosis.MethodsWe analyzed the clinical, immunologic, and genetic data of IEI patients from 22 countries in the Middle East and North Africa (MENA) region. The data was collected from national registries and diverse databases such as the Asian Pacific Society for Immunodeficiencies (APSID) registry, African Society for Immunodeficiencies (ASID) registry, Jeffrey Modell Foundation (JMF) registry, J Project centers, and International Consortium on Immune Deficiency (ICID) centers.ResultsWe identified 17,120 patients with IEI, among which females represented 39.4%. Parental consanguinity was present in 60.5% of cases and 27.3% of the patients were from families with a confirmed previous family history of IEI. The median age of patients at the onset of disease was 36 months and the median delay in diagnosis was 41 months. The rate of registered IEI patients ranges between 0.02 and 7.58 per 100,000 population, and the lowest rates were in countries with the highest rates of disability-adjusted life years (DALY) and death rates for children. Predominantly antibody deficiencies were the most frequent IEI entities diagnosed in 41.2% of the cohort. Among 5871 patients genetically evaluated, the diagnostic yield was 83% with the majority (65.2%) having autosomal recessive defects. The mortality rate was the highest in patients with non-syndromic combined immunodeficiency (51.7%, median age: 3.5 years) and particularly in patients with mutations in specific genes associated with this phenotype (RFXANK, RAG1, and IL2RG).ConclusionsThis comprehensive registry highlights the importance of a detailed investigation of IEI patients in the MENA region. The high yield of genetic diagnosis of IEI in this region has important implications for prevention, prognosis, treatment, and resource allocation.

Dengue Virus Infection in Sub-Saharan Africa Between 2010 and 2020: A Systematic Review and Meta-Analysis.

Dengue virus (DENV) infection has garnered a global interest in the past few decades. Nevertheless, its epidemiology in certain developing and low-income regions remains poorly understood, due to the absence of comprehensive surveillance and reporting systems. This systematic review and meta-analysis aimed to determine the prevalence of DENV infection in the population of Sub-Saharan Africa using DENV infection markers, and to track any changes in its prevalence during the past ten years. It was conducted in accordance with the PRISMA guidelines, targeting the literature available at MEDLINE/PubMed, ScienceDirect, Cochrane library and Google Scholar. All articles published in English language between January 2010 and June 2020 were screened for eligibility. Random effects model was used to calculate the pooled prevalence of all infection markers. The Inconsistency Index (I 2) was used to assess the level of heterogeneity between studies. Subgroup analysis according to country and time-frame of studies was conducted to provide possible explanations to substantial heterogeneity. The critical appraisal tool for prevalence studies designed by the Joanna Briggs Institute (JBI) was used to assess the risk of bias in all included studies. A total of 84 articles, covering 21 countries, were included in this review. Quantitative meta-analysis estimated a pooled IgG prevalence of 25% (95% CI: 21-29%, I 2 = 99%), a pooled IgM prevalence of 10% (95% CI: 9-11%, I 2 = 98%) and a pooled DENV RNA prevalence of 14% (95% CI: 12-16%, I 2 = 99%). Evidence for possible publication bias was also found in all three meta-analyses. Subgroup analysis according to the time of sample collection was performed to closely track the changing prevalence of DENV infection markers between 2010 and 2019. This meta-analysis estimates a high prevalence of DENV infection in Sub-Saharan Africa. More cost-efficient vector control strategies should be designed and implemented in order to adapt to the low-resource nature of this region.

Bayesian belief network modelling of household food security in rural South Africa

BackgroundAchieving food security remains a key challenge for public policy throughout the world. As such, understanding the determinants of food insecurity and the causal relationships between them is an important scientific question. We aim to construct a Bayesian belief network model of food security in rural South Africa to act as a tool for decision support in the design of interventions.MethodsHere, we use data from the Agincourt Health and Socio-demographic Surveillance System (HDSS) study area, which is close to the Mozambique border in a low-income region of South Africa, together with Bayesian belief network (BBN) methodology to address this question.ResultsWe find that a combination of expert elicitation and learning from data produces the most credible set of causal relationships, as well as the greatest predictive performance with 10-fold cross validation resulting in a Briers score 0.0846, information reward of 0.5590, and Bayesian information reward of 0.0057. We report the resulting model as a directed acyclic graph (DAG) that can be used to model the expected effects of complex interventions to improve food security. Applications to sensitivity analyses and interventional simulations show ways the model can be applied as tool for decision support for human experts in deciding on interventions.ConclusionsThe resulting models can form the basis of the iterative generation of a robust causal model of household food security in the Agincourt HDSS study area and in other similar populations.

Prescription medication use and crash risk: taking responsibility for a new global challenge

Each year over 1·3 million people are killed, and between 20 and 50 million more sustain life-changing injuries due to road traffic collisions.1 Road trauma accounts for a considerable proportion of global macroeconomic and health burden; much of which is unequally distributed, and disproportionally borne by low-income and middle-income regions.2 With many contributors to collision causality being potentially modifiable through changes to infrastructure, policy, car manufacturing, and driver behaviour, the responsibility for crash avoidance should be a shared proposition for the global community of road users.

Mapping Vulnerability of Cotton to Climate Change in West Africa: Challenges for Sustainable Development

Climate models project vulnerability to global warming in low-income regions, with important implications for sustainable development. While food crops are the priority, smallholder cash crops support food security, education, and other priorities. Despite its importance as a populous region subject to substantial climate change, West Africa has received relatively slight attention in spatial assessments of climate impacts. In this region, rainfed cotton (Gossypium hirsutum) provides essential smallholder income. We used a spatially explicit species distribution model to project likely changes in the spatial distribution of suitable climates for rainfed cotton in West Africa. We modeled suitable climate conditions from the recent past (1970–2000) and projected the range of those conditions in 2050 (Representative Concentration Pathways (RCP) 4.5 and 8.5). The suitable area declined by 60 percent under RCP4.5 and by 80 percent under RCP8.5. Of 15 countries in the study area, all but two declined to less than ten percent suitable under RCP8.5. The annual precipitation was the most influential factor in explaining baseline cotton distribution, but 2050 temperatures appear to become the limiting factor, rising beyond the range in which rainfed cotton has historically been grown. Adaptation to these changes and progress on sustainable development goals will depend on responses at multiple scales of governance, including global support and cooperation.

Observing the Unobserved: A Newspaper Based Dengue Surveillance System for the Low-Income Regions of Bangladesh

Dengue is one of the emerging diseases of this century, which established itself as both endemic and epidemic - particularly in the tropical and subtropical-regions. Because of its high morbidity and mortality rates, Dengue is a significant economic and health burden for middle to lower-income countries. The lack of a stable, cost-effective, and suitable surveillance system has made the identification of dengue zones and designing potential control programs very challenging. As a result, it is not feasible to assess the effect of the intervention actions properly. Therefore, most of the prevention and mitigation efforts by the associated health officials are failing. In this work, we chose Bangladesh, a developing country from the South-East Asia region with its occasional history of dengue outbreaks and with a high out-of-pocket medical expenditure, as a use case. We use some well known data-mining techniques on the local newspapers, written in Bengali, to unearth valuable insights and develop a dengue news surveillance system. We categorize dengue-news and detect the spatio-temporal trends among crucial variables. Our technique provides an f-score of 91.45\% and very closely follows the ground truth of reported cases. Additionally, we identify the under-reported regions of the country effectively while establishing a meaningful relationship between complex socio-economic factors and reporting of dengue.

An overview of factors affecting the rate of generation and Physical Composition of Municipal Solid Waste

An efficient waste management strategy requires a detailed waste characterization, quantification and prediction of the rate of generation and physical components of waste, which is also an index of the recoverable energy. A comprehensive data of waste generation and composition creates awareness for the concerned policy makers and organization responsible for waste management. The objective of studies on estimation of waste generation and physical content is to provide baseline data for effective waste management planning. Several factors account for the variation in the rate of generation and the physical content of waste generated at different places. This study aims at identifying and analyzing some of these factors. The review reveals that waste generation and composition follows different patterns in different places at different locations at different times and season. A major factor that influences the rate of generated waste per year and the percentage composition of each physical waste stream is the socio-economic level. Moreover, the organic stream of the waste depends largely on the income level. High content of organic waste is identified in the low-income region, this paper, therefore, recommends the setting up of treatment facilities for organic waste at the organic-rich region.

Effectiveness of the oral human attenuated pentavalent rotavirus vaccine (RotaTeq™) postlicensure: a meta-analysis—2006–2020

ABSTRACT Background Rotavirus (RV), which causes RV-associated gastroenteritis (RVGE), has accounted for considerable morbidity. We aimed to assess the effectiveness (VE) of the oral pentavalent RV vaccine (RotaTeq™) in real-world settings in children and infants with gastroenteritis. Methods We performed a systematic search for peer-reviewed studies published between 1 January 2006 and 1 May 2020 and a meta-analysis to calculate the VE of RotaTeq™ vaccine. The primary outcome was the pooled three-dose vaccine VE. Stratified analysis of the vaccine VEs was performed according to dosages, study design, population age, socioeconomic status (SES), introduction condition, control group types, outcomes of RV disease, and RV strains. Results After screening 2359 unique records, 28 studies were included and meta-analyzed. The overall VE estimate was 84% (95% confidence interval [CI], 80–87%). Stratified analyses revealed a nonnegligible impact of factors such as study design and SES. Other factors did not show great impart to VE with no significant differences between groups. Conclusions RotaTeq™ is effective against RV infection, especially in high-income countries. Adopting suitable study methods and expansion of RV surveillance in low-income regions is crucial to assess VE in real-life settings and provide feasible vaccine regimens to improve vaccine VE.

Socioeconomic Status and Outcomes in Heart Failure With Reduced Ejection Fraction From Asia.

Little is known regarding the impact of socioeconomic factors on the use of evidence-based therapies and outcomes in patients with heart failure with reduced ejection fraction across Asia. We investigated the association of both patient-level (household income, education levels) and country-level (regional income level by World Bank classification, income disparity by Gini index) socioeconomic indicators on use of guideline-directed therapy and clinical outcomes (composite of 1-year mortality or HF hospitalization, quality of life) in the prospective multinational ASIAN-HF study (Asian Sudden Cardiac Death in Heart Failure). Among 4540 patients (mean age: 60±13 years, 23% women) with heart failure with reduced ejection fraction, 39% lived in low-income regions; 34% in regions with high-income disparity (Gini ≥42.8%); 64.4% had low monthly household income (<US$1000); and 29.5% had no/only primary education. The largest disparity in treatment across regional income levels pertained to β-blocker and device therapies, with patients from low-income regions being less likely to receive these treatments compared with those from high-income regions and even greater disparity among patients with lower education status and lower household income within each regional income strata. Higher country- and patient-level socioeconomic indicators related to higher quality of life scores and lower risk of the primary composite outcome. Notably, we found a significant interaction between regional income level and both household income and education status (Pinteraction <0.001 for both), where the association of low household income and low education status with poor outcomes was more pronounced in high-income compared with lower income regions. These findings highlight the importance of socioeconomic determinants among patients with heart failure in Asia and suggest that attention should be paid to address disparities in access to care among the poor and less educated, including those from wealthy regions. Registration: URL: https://clinicaltrials.gov; Unique Identifier: NCT01633398.

Applying natural language processing to electronic medical records for estimating healthy life expectancy

Health-adjusted life expectancy (HALE), measures the overall health of a population by adjusting life expectancy for years lived with disability. HALE allows for monitoring changes of population health over time, by providing a measure of the number of healthy years expected for different age groups. HALE calculations require data on morbidity, but even though high quality data sources are crucial for estimations of population health, such sources are not available for all countries, specifically in lower income regions [1].

Zinc supplementation for improving pregnancy and infant outcome.

It has been suggested that low serum zinc levels may be associated with suboptimal outcomes of pregnancy, such as prolonged labour, atonic postpartum haemorrhage, pregnancy-induced hypertension, preterm labour and post-term pregnancies, although these associations have not yet been established. This is an update of a review first published in 1997 and subsequently updated in 2007, 2012 and 2015. 1. To compare the effects on maternal, fetal, neonatal and infant outcomes in healthy pregnant women receiving zinc supplementation versus no zinc supplementation, or placebo. 2. To assess the above outcomes in a subgroup analysis reviewing studies performed in women who are, or are likely to be, zinc-deficient. For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (3 July 2020), and reference lists of retrieved studies. Randomised trials of zinc supplementation versus no zinc supplementation or placebo administration during pregnancy, earlier than 27 weeks' gestation. We excluded quasi-randomised controlled trials. We intended to include studies presented only as abstracts, if they provided enough information or, if necessary, by contacting authors to analyse them against our criteria; we did not find any such studies. Three review authors applied the study selection criteria, assessed trial quality and extracted data. When necessary, we contacted study authors for additional information. We assessed the certainty of the evidence using GRADE. For this update, weincluded 25randomised controlled trials (RCTs) involving over 18,000 women and their babies. The overall risk of bias was low in half of the studies. The evidence suggests that zinc supplementation may result in little or no difference in reducing preterm births (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.74 to 1.03; 21 studies, 9851 participants; low-certainty evidence). Further, zinc supplementation may make little or no difference in reducing the risk of stillbirth (RR 1.22, 95% CI 0.80 to 1.88; 7 studies, 3295 participants; low-certainty evidence), or perinatal deaths (RR 1.10, 95% CI 0.81 to 1.51; 2 studies, 2489 participants; low-certainty evidence). It is unclear whether zinc supplementation reduces neonatal death, because the certainty of the evidence is very low. Finally, for other birth outcomes, zinc supplementation may make little or no difference to mean birthweight (MD 13.83, 95% CI -15.81 to 43.46; 22 studies, 7977 participants; low-certainty evidence), and probably makes little or no difference in reducing the risk of low birthweight (RR 0.94, 95% CI 0.79 to 1.13; 17 studies, 7399 participants; moderate-certainty evidence) and small-for-gestational age babies when compared to placebo or no zinc supplementation (RR 1.02, 95% CI 0.92 to 1.12; 9 studies, 5330 participants; moderate-certainty evidence). We did not conduct subgroup analyses, as very few studies used normal zinc populations. There is not enough evidence that zinc supplementation during pregnancy results in improvements in maternal or neonatal outcomes. Future research to address ways of improving the overall nutritional status of pregnant women, particularly in low-income regions, and not looking at zinc in isolation, should be an urgent priority.