Low Middle Income Research Articles

Analysis of the Ghanaian Health System and Patients Safety within the IHI Triple Aim Framework

Objective: To analyze Ghana’s healthcare system challenges through the Institute for Healthcare Improvement’s Triple Aim framework encompassing population health, patient experience and per capita cost metrics. Method: Dimensional analysis of peer-reviewed papers, government data and case studies assessed population health indicators and equity, literature on patient perspectives regarding quality and responsiveness of care along with evaluation of cost trends and deficiencies driving expenditure growth. Results: Gaps persist in universal health coverage amid rural-urban disparities in access and financial protection. Care experiences vary significantly by socioeconomic status and geography. Rising costs attributed to inefficiencies in areas like procurement and prescriber practices. Scientific Novelty: Unique application of Triple Aim framework for structured health systems analysis in a lower-middle income sub-Saharan country enabling robust diagnosis of coverage, quality, sustainability gaps. Practical Significance: Demonstrates utility of balanced Triple Aim methodology for health policymakers in low-resource settings to systematically evaluate healthcare priorities across access, outcomes, experiences and costs.

Interventions that address interpersonal violence experienced by adolescents globally: a systematic review of reviews

Globally, adolescents experience a significant burden of interpersonal violence, impacting their health, well-being and life trajectory. To address this, decision-makers need reliable evidence on effective interventions across various contexts.ObjectivesSynthesise the...

Pediatric shunt failure in a resource limited Lower-Middle Income Country (LMIC) institution in La Paz, Bolivia.

Shunt failure is an undesirable but common occurrence following neurosurgical shunting for pediatric hydrocephalus. Little is known about the occurrence of failure in lower-middle income country (LMIC) settings in South America. The objective of this study was to evaluate shunt failure in the sole publicly funded pediatric hospital in La Paz, Bolivia, with limited resources. A retrospective review of all patients at the Children's Hospital of La Paz, Bolivia (Hospital del Niño "Dr. Ovidio Aliaga Uria"), was conducted to identify all patients whose index surgical shunting for hydrocephalus was performed between 2019 and 2023. Categorical, continuous, and shunt failure data were statistically summarized. A total of 147 unique pediatric patients underwent index ventriculoperitoneal shunting for hydrocephalus in the study period. There were 90 (61%) male and 57 (39%) female patients, with a median age of 2.2months at index shunting procedure. The most common surgical indications were congenital hydrocephalus (n = 95, 65%), followed by hydrocephalus secondary to congenital defect (n = 25, 17%) and tumor (n = 18, 12%). A total of 18 (12%) of patients experienced inpatient failure during index admission requiring surgical revision at a median time of 12.5days after index shunting. Postoperative imaging (OR 2.97, P = 0.037) and postoperative infection (OR 3.26, P = 0.032) during index admission both independently and statistically predicted inpatient failure. Of the 96 patients (65%) with postoperative follow-up, 16 (n = 16/96, 17%) patients experienced outpatient failure requiring readmission to hospital and surgical revision at a median time of 3.7months after discharge. Kaplan-Meier estimations of overall inpatient and outpatient failure in this cohort were 23% (95% CI 14-37) and 28% (95% CI 15-49), respectively. Both inpatient and outpatient shunt failures are significant complications in the management of pediatric hydrocephalus in La Paz, Bolivia. We identify multiple avenues to improve these outcomes which are institution-specific based on the review of these failures. Lessons learnt may be applicable to other similarly resourced institutions across South American LMICs.

Cost-utility analysis of early reconstruction surgery versus conservative treatment for anterior cruciate ligament injury in a lower-middle income country

BackgroundThe ideal approach for treating anterior cruciate ligament (ACL) injury is still disputed. This study aimed to determine the more cost-effective strategy by comparing early ACL reconstruction (ACLR) surgery to conservative treatment (rehabilitation with optional delayed reconstruction) for ACL injury in a lower/middle-income country (LMIC), Indonesia.MethodsA decision tree model was constructed for cost-utility analysis of early ACLR versus conservative treatment. The transition probabilities between states were obtained from the literature review. Utilities were measured by the EQ-5D-3 L from a prospective cohort study in a local hospital. The costs were obtained from a previous study that elaborated on the burden and cost of ACLR in Indonesia. Effectiveness was expressed in quality-adjusted life years gained (QALYs). Principal outcome measure was the incremental cost-effectiveness ratios (ICER). Willingness-to-pay was set at US$12,876 — three times the Indonesian GDP per capita in 2021 — the currently accepted standard in Indonesia as suggested by the World Health Organization Choosing Interventions that are Cost-Effective criterion (WHO-CHOICE).ResultsThe early ACLR group showed an incremental gain of 0.05 QALYs over the conservative treatment group, with a higher overall cost to society of US$976. The ICER of ACLR surgery was US$19,524 per QALY, above the WTP threshold of US$12,876. The ICER was sensitive to cost of conservative treatment, cost of ACLR, and rate of cross-over to delayed ACLR numbers in the conservative treatment group. Using the WTP threshold of US$12,876, the probability of conservative treatment being preferred over early ACLR was 64%.ConclusionsBased on the current model, early ACLR surgery does not seem more cost-effective compared to conservative treatment for ACL injury patients in Indonesia. Because the result was sensitive to the rate of cross-over probabilities from the conservative treatment alone to delayed ACLR, a future study with a long-term perspective is needed to further elucidate its impact.

Assessing Practice Variation of Anesthetic Management for Endovascular Thrombectomy in Acute Ischemic Stroke: A Comprehensive Multicenter Survey.

This study explored the current global landscape of periprocedural care of acute ischemic stroke patients undergoing endovascular thrombectomy (EVT). An anonymous, 54-question electronic survey was sent to 354 recipients in hospitals worldwide. The responses were stratified by World Bank country income level into high-income (HICs) and low/middle-income (LMICs) countries. A total of 354 survey invitations were issued. Two hundred twenty-three respondents started the survey, and 87 fully completed surveys were obtained from centers in which anesthesiologists were routinely involved in EVT care (38 in HICs; 49 in LMICs). Respondents from 35 (92.1%) HICs and 14 (28.6%) LMICs reported that their centers performed >50 EVTs annually. Respondents from both HICs and LMICs reported low rates of anesthesiologist involvement in pre-EVT care, though a communication system was in place in 100% of HIC centers and 85.7% of LMIC centers to inform anesthesiologists about potential EVTs. Respondents from 71.1% of HIC centers and 51% of LMIC centers reported following a published guideline during EVT management, though the use of cognitive aids was low in both (28.9% and 24.5% in HICs and LMICs, respectively). Variability in multiple areas of practice, including choice of anesthetic techniques, monitoring and management of physiological variables during EVT, and monitoring during intrahospital transport, were reported. Quality metrics were rarely tracked or reported to the anesthesiology teams. This study demonstrated variability in anesthesiology involvement and in clinical care during and after EVT. Centers may consider routinely involving anesthesiologists in pre-EVT care, using evidence-based recommendations for EVT management, and tracking adherence to published guidelines and other quality metrics.

Incidence and outcome of Acute Kidney Injury in patients admitted in a level III ICU in Nepal: A retrospective, observational study

Background and aims: Acute kidney injury (AKI) is associated with increased mortality, morbidity, and hospital stay. AKI is seen in 20-60% of patients admitted to the intensive care unit (ICU), and mortality is as high as 50% if not managed timely. Burden of AKI is more in developing countries as compared to the developed ones. There is a paucity of published literature regarding incidence and outcome of AKI in critically ill patients from lower-middle income countries like Nepal. This study aimed to determine the incidence and outcome of AKI in patients admitted to a level III ICU in Nepal. Methods: This observational study was conducted in the ICU of Hospital for Advanced Medicine and Surgery (HAMS) Hospital, Kathmandu, Nepal. Data over a period of one year was curated from ICU registry. Eligible patients were screened and the incidence of AKI in ICU admitted patients along with their outcomes (length of ICU stay, need of RRT and ICU mortality) were observed. Results: Among 881 patients admitted to the ICU, 660 patients were enrolled for analysis. Of them, 14.2% of patients developed AKI during ICU stay, out of which 5.3% received RRT and 19.1% died. The median (IQR) length of ICU stay for those who developed AKI was 4 (3-7) days. The 34.0% patients who developed AKI had sepsis. Conclusion: Patients admitted to ICU in this study have high incidence of AKI. In patients who developed AKI, sepsis was the leading cause of ICU admission.

Impact of global smoking prevalence on mortality: a study across income groups

BackgroundSmoking significantly contributes to the mortality rates worldwide, particularly in non-communicable and preventable diseases such as cardiovascular ailments, respiratory conditions, stroke, and lung cancer. This study aims to analyse the impact of smoking on global deaths, and its association with mortality across the main income groups.MethodsThe comprehensive analysis spans 199 countries and territories from 1990 to 2019. The study categorises countries into four income groups: high income, upper middle income, lower middle income, and low income.ResultsThe findings underscore the profound impact of global tobacco smoking on mortality. Notably, cardiovascular disease mortality is notably affected in both upper-middle-income and high-income groups. Chronic respiratory disease mortality rates show a significant impact across all income groups. Moreover, stroke-related mortality is observed in the lower-middle, upper-middle, and high-income groups. These results highlight the pervasive influence of smoking prevalence on global mortality, affecting individuals across various socioeconomic levels.ConclusionThe study underscores the critical implications of smoking on mortality rates, particularly in high-income countries. It emphasises the urgency of targeted interventions in these regions to address the specific challenges posed by tobacco smoking on public health. Policy recommendations include implementing prohibitive measures extending to indoor public areas such as workplaces and public transportation services. Furthermore, allocating funds for research on tobacco and health, is imperative to ensure policymakers are consistently informed about emerging facts and trends in this complex domain.

ASO Visual Abstract: A Prospective Questionnaire-Based Study Evaluating Genetic Literacy and Impact of Brief Educational Intervention Among Breast Cancer Patients in a Low-Middle Income Country.

ASO Visual Abstract: A Prospective Questionnaire-Based Study Evaluating Genetic Literacy and Impact of Brief Educational Intervention Among Breast Cancer Patients in a Low-Middle Income Country.

Evaluation history of dietary food groups and nutritional habits of individuals diagnosed with a memory disorder: a case–control study

PurposeCognitive decline and dementia are major causes of disability. Research has suggested a relationship between dietary intake and memory problems in individuals. This study aims to examine the dietary histories of participants with newly diagnosed memory problems.Design/methodology/approachA total of 285 subjects (129 cases and 156 controls) were included in this retrospective case−control study. This paper used a food frequency questionnaire to determine the intake of dietary food groups in the previous year and a general questionnaire to assess food habits. The strength of the association between dietary history and memory problems was assessed using logistic regression and Pearson’s tests.FindingsIn this study, 73% of participants had a lower middle income and consumed less than the recommended number of meats, fruits and vegetables (1.2, 1.8 and 0.99 units/day, respectively). Participants with memory problems were more likely to take supplements than those without (P = 0.01). There was no significant difference in energy intake between the case and control groups (1634 Kcal vs 1656 Kcal). The results of the logistic regression showed that consuming any of the food groups in the previous nine months was not associated with memory problems. However, the Pearson test showed that an increase in the consumption of high-quality protein and vegetables had a slightly nonsignificant relationship with a decrease in the severity of memory disorder.Originality/valueIt is safe to suggest consuming adequate amounts of high-quality protein and affordable protein from sources such as dairy products, meats and vegetables. Research is insufficient to recommend the use of dietary supplements as a means of preventing memory disorders.

Risk Factor Analysis of Stunting in Children Aged 6-23 Months in Tanralili District, Maros Regency, Indonesia

Background: The high rate of stunting is still a nutritional problem in children in Indonesia which has an impact on the quality of future generations. The study aims to determine the risk factors for stunting in children aged 6-23 months in Tanralili District, Maros Regency. Methodology: This study used a case control study design. The sampling technique uses the side exhaustive method with a ratio of 1: 1, as many as 260 samples consisting of 130 cases and 130 controls. Stata program version 17 is used for data analysis. Results: Risk factors associated with stunting were maternal age <20 or 35 years (OR=1.953), lower-middle family income (OR=1.947), antenatal care <4 visits (OR=1,820), anemia (OR=2.252), chronic energy deficiency (OR=2.261), low birth weight (OR=2,595), exclusive breastfeeding (OR=2.448), poor home sanitation (OR=2.226;). Working mothers are a protective factor against stunting (OR=0.819). Multivariate analysis shows that exclusive breastfeeding is the dominant risk factor for stunting. Conclusion: Risk factors for stunting come from mother, child, as well as environmental and family economic factors. The need for integrated and multisectoral programs to increase family income, access to proper home sanitation, maternal education on pregnancy and nutrition and exclusive breastfeeding to reduce the incidence of stunting.

Pilot study of radiation oncology peer review in low middle income country (LMIC) through cloud-based platform

ABSTRACT Purpose: Peer review is an essential step in clinical quality assurance for radiation therapy. There are very little data on peer reviews from low-middle-income countries (LMIC). With increasing access to advanced technologies in LMIC also, peer review is becoming more important to ensure quality and standard of care. We evaluated cloud-based e-Peer review in our network of cancer centers in India with an aim to study its feasibility and impact on care. Materials and Methods: Four out of 13 cancer centers across India were selected for this pilot study. All team members were trained on the e-Peer review platform before the initiation of the study. A lead dosimetrist from a centralized planning site was selected to share new cases every week. Cases treated with only definitive intent were selected. The link to the cases was sent through an email to reviewing physicians. The following aspects were reviewed for each case. 1) Work up and staging. 2) Treatment intent and prescription. 3) Target contours. 4) Normal organ at risk contours. 5) Dose–volume–histogram (DVH) with clinical goals attached. Cases were marked as “Not Appropriate,” “Appropriate,” “Appropriate with minor finding,” and “Represent with major revisions” as per volume and plan review. Results: Over a period of 3 months, 100 cases underwent peer review before the start of treatment. Median turnover time was 48 (interquartile range: 24-96) hours. The median time for review was 8 min with time to review cases requiring major and minor changes being 12 and 6 min, respectively (P < 0.001). Of all the cases reviewed, no changes, minor changes, and major changes were suggested for 36%, 48%, and 16% of cases, respectively. The most frequent reason for major changes was contouring corrections (15%). Also, 31.3% of major changes underwent recontouring and replanning before initiation of treatment. Conclusion: Peer review was feasible in our setting through this cloud-based peer review system, with median turnover time and time taken for review being 48 h and 8 min, respectively. Like published data from the Western world, peer review led to changes that could impact patient care delivery and outcome. We plan to implement this across the remaining centers in our network.

Prevalence, clinical and haematological profile and outcome of BCR-ABL1-like acute lymphoblastic leukaemia in Indian children: A prospective observational study

BackgroundBCR-ABL1-like acute lymphoblastic leukaemia (ALL) represents a perplexing subclass of ALL mainly due to genomic heterogeneity and non-availability of standardized diagnostic tests. The data on prevalence, clinical–haematological profile and outcome are limited, more so from low-middle income countries. MethodsThis prospective observational study enrolled children<14 years with B-ALL. Recurrent genetic/chromosomal aberrations were excluded. BCR-ABL1-like aberrations were analysed using Polymerized Chain Reaction (PCR) or Next-Generation Sequencing (NGS). Two groups with/without BCR-ABL1-like ALL (Mut+/Mut-) were compared. ResultsOut of 214 eligible children; 75 with “B-other ALL” were analysed for BCR-ABL1-like aberrations. Their prevalence was 34/214 (15.8%) in B-ALL and 34/75 (45.3%) in “B-other” ALL (PCR:33.3% and NGS:53.3%). Majority of the aberrations were JAK2E16 and ILR7e5/ILR7e6 with PCR and RAS pathway and PAX5 fusion with NGS. Baseline demographic, clinical and laboratory parameters including aberrant flowcytometry were comparable in Mut+ and Mut-groups. Children with day-8 absolute blast count (ABC) were higher in Mut+ group. High end-induction minimal residual disease (MRD) was comparable in two groups. Number of NCI-standard risk (SR) at diagnosis with high D-8 ABC or high MRD was higher in Mut+ group. Similar results were found when aberrations were analysed by NGS alone. In all 56 children are alive, 19 had an event (relapse/death). The outcomes were comparable in two groups with median follow-up of 1075 days (IQR: 660–1527); when analysis was based on combined as well as NGS-based methodology alone. ConclusionsWe report 15.8% prevalence of BCR-ABL1-like ALL in children by PCR or NGS. High D-8 ABC was associated with BCR-ABL1-like ALL with no impact on outcomes.

Commodity prices and economic growth: Empirical evidence from countries with different income groups

The purpose of this paper is to examine the effect of global commodity prices such as beverage, energy, fertilizer, food, metal and mineral, precious metal and agricultural raw material on GDP per capita of countries with different income levels which are low, lower-middle, upper-middle, and high. The results of the study using panel system GMM method over the period 2007–2021 showed that for all income group countries, the impact of energy and fertilizer prices on GDP per capita is negative, while the impact of food and metal and mineral prices is positive on GDP per capita. The study also found that rising prices of agricultural raw materials reduces GDP per capita of all income group countries except lower-middle income countries. Moreover, according to the results of the study, rising beverage prices increased the GDP per capita only of high-income countries, while rising precious metal prices decreased the GDP per capita of lower-middle and high-income countries. The study revealed that price changes in all commodity groups have an impact on the GDP per capita of high-income countries. It is demonstrated that price changes in all commodity groups have an impact in both directions on the GDP per capita of all income groups, depending on whether they are net producers or net consumers. The results of the study showed that, contrary to the literature, the countries most affected by commodity prices are high-income countries. Based on the empirical findings, this study point to the need for international cooperation to minimize the adverse effects of commodity price changes.

Analysis of the Ghanaian Health System and Patients Safety within the IHI Triple Aim Framework

Abstract Objective: To analyze Ghana’s healthcare system challenges through the Institute for Healthcare Improvement’s Triple Aim framework encompassing population health, patient experience and per capita cost metrics. Method: Dimensional analysis of peer-reviewed papers, government data and case studies assessed population health indicators and equity, literature on patient perspectives regarding quality and responsiveness of care along with evaluation of cost trends and deficiencies driving expenditure growth. Results: Gaps persist in universal health coverage amid rural-urban disparities in access and financial protection. Care experiences vary significantly by socioeconomic status and geography. Rising costs attributed to inefficiencies in areas like procurement and prescriber practices. Scientific Novelty: Unique application of Triple Aim framework for structured health systems analysis in a lower-middle income sub-Saharan country enabling robust diagnosis of coverage, quality, sustainability gaps. Practical Significance: Demonstrates utility of balanced Triple Aim methodology for health policymakers in low-resource settings to systematically evaluate healthcare priorities across access, outcomes, experiences and costs.

Cancer survivorship in low-middle income countries - Does quality of life matter?

Cancer survivorship has improved in the recent years due to screening facilities, modernized treatment options and advanced cancer care in specialized centers globally. However, in low-middle-income countries cancer survivorship is not yet improved to that stature. There are multifaceted issues including delay in diagnosis, financial burden and in certain situations in appropriate treatment creates long term effects not only on patients but also on their families. Multidisciplinary approach is a limitation in the LMIC and the mental health aspects are least studies in cancer survivors. Therefore, a revised more focused and evidence based management plan along with long term quality of life issues needs to be focused in patients from LMIC.

Workplace violence against community health workers in LowerMiddle Income Country-India

Workplace violence against community health workers in LowerMiddle Income Country-India

Family expectations and demand for home-based videogaming therapy in children with cerebral palsy in Costa Rica: a mixed methods study

Purpose To understand the expectations and demand for a movement-tracking videogame (Bootle Blast) for home-based, upper limb (UL) rehabilitation among Costa Rican children with cerebral palsy (CP). Methods Data were collected via telephone screening (demand) and child-parent dyads Zoom interviews (expectations). Descriptive statistics and data transformation were used to report on demand success criteria (i.e., recruitment rate, having an appropriate screen and space to play, setting a weekly play time goal (PTG) ≥45 min, identifying one UL therapy goal). The DEPICT model for collaborative qualitative analysis was used in the thematic analysis of interview data. Results Fifteen dyads participated (1.6 ± 1 recruited/month). All had a flat-screen TV in a suitable location to play, were able to set a UL therapy goal, and established PTGs ranging from 45–120 min per week. Identified themes were: 1) Socio-cultural factors heighten demand, 2) Feelings of hope prevail for the intervention, and 3) Collaborative goal setting supports realistic expectations for Bootle Blast. Conclusions Dyads had positive and realistic expectations about implementing the proposed videogaming intervention. This study provides insights on tailoring a family-centered, therapy gaming intervention to improve access to motor rehabilitation for children with CP in rural/remote settings and low-middle income countries.

Physician Burnout during Covid-19 Pandemic in Pediatric Emergency Rooms of Low-Middle Income Country, Pakistan

Abstract: Background: Burnout can adversely affect the mental health, quality of life and quality of work of healthcare workers. Objective: We aimed to assess the burnout rate among physicians working in pediatric emergency rooms during COVID-19 pandemic, in public sector hospitals of Pakistan. Materials and Methods: It is a descriptive study performed in March 2021. We included all physicians working in the pediatric emergency departments of 9 public sector hospitals of Sindh, Pakistan, excluding those who didn’t give consent. The participants were sent an online questionnaire based survey, comprising of Copenhagen Burnout Inventory (CBI) tool along with three added COVID-19 specific questions. It was disseminated electronically. Data was analyzed using SPSS ver22. Result: A total of n=249 physicians filled the forms out of 320, giving a response rate of 77.8%. Majority 187 (75.1%) were females. Most of the physicians were females n=187 (75.1%) and worked primarily in emergency department n=186 (74.7%). The Copenhagen Burnout Inventory (CBI) score revealed that 88 (35.3%) of the physicians had burnout (Score &gt; 50). The most common component was Personal burnout in 122 (48.9%). Physicians working in emergency department, full time shifts and at junior designations had higher rates of burnout (P value &lt;0.05). Conclusion: Burnout is a significant problem in pediatric emergency departments, specifically during the COVID-19 pandemic. Timely training and provision of supplies along with safety, security and alleviation of fear are important strategies to overcome burnout. Keywords: Burnout, Emergency departments, COVID-19, Pediatric emergency, Mental health, Health care professionals, Pandemic, Healthcare Quality indicators.

Traffic light nutrition labelling policy: A path to promoting healthier eating habits in Pakistan.

Dear Editor, While the global burden of diet-related diseases continues to escalate1, it is disheartening to see that Pakistan, like many other Lower-Middle Income Countries (LMICs)2, has not yet ultimately adopted the system that can significantly assist consumers in making healthier food decisions. In Pakistan, the prevalence of obesity, diabetes, and other non-communicable disease conditions is on the rise, posing a substantial economic and health burden on individuals and the healthcare system2. Many countries like the United States, Australia, and the United Kingdom use the traffic light nutrition labeling system, which is a valuable tool for empowering consumers to make informed food choices quickly 3. It provides a simple way for people to quickly assess the nutritional value of a product using a color-coding system3. Green labels indicate healthier options, amber labels suggest moderate consumption and red labels highlight food that should be consumed sparingly4. The simple color-coding system empowers consumers to make healthier decisions and can contribute to a reduction in diet-related diseases4. The traffic light system works particularly well in settings with high illiteracy rates, as is prevalent in Pakistan since it relies on simple color coding rather than textual information5. As consumers, we lack a clear and uniform method for evaluating the nutritional components of the food we buy. This deficiency not only obstructs the capacity to make healthy food choices but also sustains the prevalence of diet-related issues. Color-coded labeling would help people with low literacy levels to understand the nutrition information available on food products easily. However, Traffic Light nutrition labelling has not been adopted in Pakistan. To confront this challenge, policymakers, health organizations, and government authorities should take swift and decisive action. The government must take the lead in implementing clear regulations that mandate the use of traffic light nutrition labels on packaged food items. These regulations should accompany strict enforcement measures. Launching public awareness campaigns about the benefits of the traffic light system can help familiarize consumers with this approach and generate demand for healthier food products. Collaboration and engagement with food manufacturers and retailers to ensure a smooth transition to the traffic light system is imperative to encourage the production of healthier food consumption. Implement a system of periodic reviews and updates of the labeling system to ensure its collective effectiveness and relevance to the evolving nutritional landscape. ---Continue

Nexus of Human Development and Environmental Quality in Low-Income and Developing Countries: Do Renewable Energy and Good Governance Matter?

The relationship between human development and environmental quality has been explored in this study by examining the human-development status and carbon (CO2)-emissions levels of 60 countries from the low, lower-middle, and upper-middle income categories. The roles of renewable energy and some economic and institutional factors such as GDP, the rule of law, regulatory quality, and corruption control have also been investigated to ascertain their impacts on the relationship. The empirical investigations apply the generalized method of moments (GMM), fixed effects (FE), and random effects (RE) methods, and the long-run associations among the variables are investigated by applying the fully modified ordinary least squares (FMOLS) and dynamic ordinary least squares (DOLS) techniques. The robust findings support the trade-off relationship between human development and environmental quality in the selected low-income and developing countries. With evidence of an environmental Kuznets’s relationship between economic growth and environmental quality, these findings reveal that the measures pursued to improve human-development status have a contributory impact on CO2 emissions in the selected countries. However, an increased demand for renewable energy, effective enforcement of the rule of law, and improved control over corruption have a mitigating effect on CO2 emissions. The result has also highlighted the policy issues instrumental to increased emissions levels in these countries. Consequently, it is recommended to formulate policies for resolving disparities within the various dimensions of human development while also making deliberate investments in the socio-economic aspects of human development to ensure both sustainable human development and environmental quality.