Middle-income Countries Research Articles

Working horse welfare in Senegal is linked to owner's socioeconomic status, their attitudes and belief in horse sentience.

The role that working equids play in both rural and urban communities in low and middle-income countries is invaluable. They contribute to daily tasks such as carrying food, water and people, support income generation, and are of social and cultural importance. Despite their importance, global standards of working equid welfare are low. Many variables can impact the welfare status of animals under human care, but often specific factors are explored in isolation. Factors can include, but are not limited to an owner's socioeconomic status and their attitudes and beliefs towards animals. In this study we assessed the relationships between 1.) Attitudes and belief in horse sentience, 2.) Owner's socioeconomic status (including household income, coverage of needs and education) and 3.) Horse welfare status. The study, consisting of an owner questionnaire and a welfare assessment of their horses, was conducted in three regions in Senegal; participants included 299 owners and their horses. Overall, our findings show that a more positive attitude towards horses, stronger belief in horse sentience, a higher standard of living and a greater ability to cover the needs of the household was associated with more positive horse welfare. A stronger belief in horse sentience was a significant predictor of horse's body condition, larger households and those with a higher income were more likely to own a horse in good general health. Our findings demonstrate a complex relationship between working horse welfare, their owner's attitudes, and their socioeconomic status. It is the first study we are aware of that has explored the relationships between these different variables. The findings from this study provide valuable insights into the interconnected factors which impact upon working equid welfare in Senegal and potentially more widely.

E-cigarette retail outlets in Mexico: a country that bans the sale.

Restrictive e-cigarette policies have not allowed for the characterization of the sale of these tobacco products in the countries where they are implemented. This is because it is believed that there are no stores. However, the use of e-cigarettes persists in these countries. A content analysis of electronic cigarette points of sale through the internet in Mexico was conducted. Cross-sectional study. Structured searches were performed in the Google Maps search engine with the terms "electronic cigarette store" and "vape store" in combination with the name of each state of Mexico, in the period from October 2021 to February 2022. A total of 695 e-cigarette stores were located, of which 481 (69.2%) were physical stores, 207 hybrid stores (29.8%), 4 online stores (0.6%) and 3 (0.4%) vending machines. A total of 316 e-cigarette brands and 578 vape liquid brands were identified. The sales attraction strategy they used the most was free shipping of products (85.8%). Stores used WhatsApp (92.5%), Facebook (86.3%) and Instagram (74.4%) to promote their products. Only 35.1% of stores checked the age of their customers, of which, 95.9% asked if the customer was of legal age and 4.1% asked for the date of birth. In addition, 25.6% of the stores warned about nicotine addiction and 24.2% specifically about the ingredients of the liquids. E-cigarettes are widely available and marketed in a variety of retail outlets in Mexico. The high number of stores, brands of liquids, and e-cigarettes indicates non-compliance with existing regulations. E-cigarette consumption has increased globally, even in countries with restrictive regulations. However, there is limited data on the density and characteristics of vape stores in low- and middle-income countries with restrictive regulations. This study found no significant differences in e-cigarette sales between countries with permissive and restrictive regulations. Therefore, it is suggested that, in addition to establishing restrictive policies on the sale of e-cigarettes, their enforcement should also be monitored. Countries with restrictive measures should regulate Internet sales and promotion of e-cigarettes with greater emphasis.

Systems modelling and simulation to guide targeted investments to reduce youth suicide and mental health problems in a low–middle-income country

BackgroundDespite suicide’s public health significance and global mental health awareness, current suicide prevention efforts show limited impact, posing a challenge for low- and middle-income countries. This study aimed to develop a dynamic simulation model that could be used to examine the potential effectiveness of alternative interventions for reducing youth mental health problems and suicidal behavior in Bogotá, Colombia.MethodsA system dynamics model was designed using a participatory approach involving three workshops conducted in 2021 and 2022. These workshops engaged 78 stakeholders from various health and social sectors to map key mental health outcomes and influential factors affecting them. A model was subsequently developed, tested, and presented to the participants for interactive feedback, guided by a moderator. Simulation analyses were conducted to compare projected mental health outcomes for a range of intervention scenarios with projections for a reference scenario corresponding to business-as-usual.ResultsA total of 6670 suicide attempts and 347 suicides are projected among 7 − 17-year-olds from January 1, 2023, to early 2031 under the business-as-usual scenario. Mental health issues among 12 − 17-year-olds are projected to increase from 18.9% (2023) to 27.8% (2031), and substance use issues from 2.29 to 2.49% over the same period. School-based suicide prevention and gatekeeper training are the most effective strategies, reducing total numbers of suicide attempts and suicides by more than 20% (i.e., compared to business-as-usual). However, discontinuous funding significantly hinders these effective suicide prevention efforts.ConclusionsSystems modelling is an important tool for understanding where the best strategic financial and political investments lie for improving youth mental health in resource-constrained settings.

Zinc: A Critical Micronutrient for Children’s Health

Zinc is one of the most abundant micronutrients in the human body, found in all tissues and playing an important role in vital structural, regulatory, hormonal and catalytic functions. Zinc deficiency is a major public health problem that affects almost one fifth of the world's population, being more common in low-income countries, where diets are poor in zinc sources, impacting morbidity and mortality rates, especially among children under five years of age. This narrative review updates the state of the art on the subject, highlighting the importance of zinc for metabolism, its metabolic roles and absorption issues, the clinical repercussions of deficiency conditions among children and points out some actions that can be implemented to reduce the severity of the problem, like supplementation, fortification, and biofortification that are proposed to mitigate zinc deficiency.

Urology Practice in Low- to Middle-Income Countries

The global burden of urological diseases is rising, particularly in low- and middle-income countries (LMICs) undergoing rapid demographic and epidemiological changes [...]

Promoting new crop cultivars in low-income countries requires a transdisciplinary approach.

Promoting new crop cultivars in low-income countries requires a transdisciplinary approach.

Passport discrimination from the lens of critical phenomenological perspective

PurposeLittle is known about how international individuals and travelers face and experience discrimination due to their passport. The purpose of this study is to explore factors that contribute to a new form of discrimination, i.e. passport discrimination. There exists a dominant gap in the literature, both empirically and theoretically, which explores this dimension of discrimination. To better understand this central phenomenon, this study amalgamated the concepts from the theories of social identity, self-categorization and system justification.Design/methodology/approachTo delve into the essence of the participants’ lived experiences with passport discrimination, this study employed the existential-phenomenological philosophy of a qualitative research design. Data were gathered from personal interviews with 10 passport holders from different Asian countries.FindingsThe findings of this study revealed that citizens of developing and underdeveloped countries commonly experience passport discrimination in salary structure, promotions, training and hiring processes. Additionally, they face passport discrimination during visa issuance and proceedings at immigration counters.Originality/valueThis study unlocks the door for researchers to explore new dimensions of discrimination. Future studies may investigate the level of impact of passport discrimination from a human resource perspective through a positivist approach.

Global view of haematolymphoid tumor classifications and their application in low- and middle-income countries.

The accurate diagnosis of haematolymphoid malignancies is crucial for effective cancer care, but major obstacles to diagnosis exist in low- and middle-income countries (LMICs). This article explores the global applicability of current haematolymphoid classification systems, which are predominantly derived from data generated in high-income countries (HICs). Although disproportionately burdened with poor cancer outcomes, LMICs are generally faced with limited diagnostic resources, suboptimal access to therapeutics, and inadequate healthcare infrastructure. The article highlights the challenges faced by LMICs, including inconsistent access to high-quality pathology services, limited availability of advanced diagnostic techniques, and a lack of population-based cancer registry data. It also discusses the progress made in narrowing the gap between LMICs and HICs, such as the introduction of resource-adapted classifications, improved guidance on essential diagnostic tools, and strengthening of in-country professional pathology networks. Innovative diagnostic approaches, including gene expression profiling and machine learning, represent potential solutions for improving the diagnostic accuracy in LMICs, but addressable gaps remain. Recommendations are suggested for sustainable investments in diagnostic infrastructure, capacity-building, and population-based cancer registries to enhance the global applicability of haematolymphoid classification systems and improve outcomes for patients in LMICs.

Influence of social media and the digital environment on international migration of health workforce from low- and middle-income countries post COVID-19 pandemic: a scoping review protocol

IntroductionMigration of the health workforce from low- and middle-income countries (LMCIs) is increasingly becoming a phenomenon of interest within migration governance systems. The COVID-19 pandemic aggravated health workforce shortages that...

Ischemic Stroke in Young Adults in India: Predictors of Recurrence and Functional Outcome.

Ischemic stroke (IS) in young is increasingly recognized as an important health problem in low- and middle-income countries (LMICs). Limited data is available from LMICs about the predictors of outcome and recurrence of IS in young. The study aims to assess the predictors of short-term and long-term functional outcome and the recurrence of the first-ever IS and transient ischemic attack in young. The clinical, radiological data, functional outcome, and recurrence of 569 IS patients aged 18-50 years were recorded. The etiological classification was done. The functional outcome was assessed using the modified Rankin scale (mRS), with a good outcome being mRS 0-2. Logistic regression was used to analyze the predictors of recurrence and outcome. The most common risk factors were hypertension (40.3%) and diabetes mellitus (34.3%). Stroke of undetermined etiology (33.6%) was the most common etiological subtype. Among the cardioembolic subtypes, rheumatic heart disease constituted 47.4%. A good functional outcome at 1 year was seen in 76.3%. While baseline stroke severity predicted both the 3-month and 1-year functional outcome, age ≥40 years and male gender predicted poor outcome at 1 year. The risk of recurrent strokes at 1 year was 2.5%. On multiple logistic regression analysis, diabetes mellitus independently predicted recurrent vascular events at 1 year (odds ratio = 2.43, 95% confidence interval 1.07-5.50). We found a good functional outcome with a relatively low recurrence at 1 year among young IS patients. Baseline stroke severity, age, and male gender predicted a poor 1-year functional outcome.

Association of Abdominal Obesity and Diabetes among the Adult Tribal Population in Tamil Nadu

Background: Previously overweight and obesity are considered to be an issue of high-income countries but now increasingly becoming more prevalent in low-income and middle-income countries. Obesity and overweight are growing health issues in India. It is important to determine the quantum of the risk contribution by individual risk factor siuch as abdominal obesity. Aims: To find out the association of abdominal obesity and diabetes among the adult tribal population. Methods and Material: A cross-sectional study was conducted using multi-stage random sampling techniques. Using a pretested validated modified Stepwise questionnaire, a detailed interview with the participants aged above 30 years were performed. Random blood sugar and anthropometric parameters were estimated for all the participants. Chi-square test and multivariate regression analysis were used to study association. Results: Prevalence of abdominal obesity was 49.6% [211] among the study participants. Prevalence of diabetes was 7.8% [33] among the study population and 92.2% [392] of them were nondiabetic. Normal WHR was seen among 27.3% [9] of the diabetic individuals. High WHR was seen among 72.7% [24] of diabetic individuals. Gender, Illiterate, BMI, and waist-hip ratio shows significant association with diabetes. Conclusions: The prevalence of abdominal obesity was higher in the study population. As this burden among tribal people is on the increasing trend when compared with other general populations, effective strategies to prevent this have to be devised among the tribal population.

Beliefs surrounding the use of inhaled asthma medication in The Gambia: a qualitative study of asthma patients and healthcare workers

Asthma-related mortality is high in low- and middle-income countries. Little is known about public perceptions of inhaled medicines. We conducted semi-structured interviews with asthma patients and healthcare workers at three secondary care facilities in The Gambia, between August and November 2022. Thematic analysis was used to interpret these data. A total of 20 patients and 15 healthcare workers were interviewed. Both groups noted limited access to inhalers was an issue resulting in continued use of oral medications. Some patients recognised the benefits of inhalers, yet beliefs that inhalers were dangerous were common. Reliance on oral short-acting beta agonists meant patients saw asthma as a recurrent acute condition resulting in an emphasis on hospital management with little awareness of inhaled preventative medicines. Increasing access to inhaled medicines has the potential to reduce costly avoidable admissions, but socio-cultural factors, in addition to medication supply, need addressing.

Determinants of under-five mortality in informal settlements in Nairobi, Kenya from 2002 to 2018

BackgroundChildhood mortality persists as a significant public health challenge in low and middle-income countries and is uneven within countries, with poor communities such as urban informal settlements bearing the highest burden. There is limited literature from urban informal settlements on the risk factors of mortality. We assessed under-five mortality and associated risk factors from the period 2002 to 2018 in Nairobi urban informal settlements.MethodsWe used secondary data from the Nairobi Urban Health and Demographic Surveillance System (NUHDSS), a longitudinal surveillance platform that routinely collects individual and household-level data in two informal settlements (Viwandani and Korogocho) in Nairobi, Kenya. We used Kaplan-Meier curves to estimate overall survival and the Cox proportional hazard model with a frailty term to evaluate the impact of risk factors on survival time.ResultsOverall under-five survival rate was 96.8% and this improved from 82.6% (2002-2006) to 95% (2007-2012) and 98.4% (2012-2018). There was a reduced risk of mortality among children who had BCG vaccination, those born to a married mother or a mother not engaging in any income-generating activity (both from 2007 to 2011), children from singleton pregnancy, children born in Viwandani slum and ethnicity of the child.ConclusionUnder-five mortality is still high in urban informal settlements. Targeted public health interventions such as vaccinations and interventions empowering women such as single mothers, those with multiple pregnancies, and more impoverished slums are needed to further reduce under-five mortality in urban informal settlements.

Household air pollution and respiratory health in Africa: persistent risk and unchanged health burdens.

Despite evidence emerging from the Global Burden of Disease studies that biomass use and household air pollution are declining globally, with important positive health impacts for households in low- and middle-income countries, these trends have not been equally documented in African countries. This review describes the state of household air pollution exposure and its relationship with respiratory disease in Africa. African studies on this topic are limited, and generally focus on respiratory infections. Most evidence emerge from models based on the Global Burden of Disease data, and from limited individual epidemiological studies across the continent. More than 80% of the African population is exposed to household air pollution. Women and children continue to bear the substantial burden of exposure. Evidence from limited exposure-response studies strongly points to household air pollution being the major driver of acute and chronic respiratory diseases on the continent. Respiratory infections, particularly in children, and other chronic respiratory diseases, are strongly attributable to household air pollution. Elimination of such exposures through interventions such as cleaner fuels and preferably, electricity, is critical to improving respiratory health on the continent.

Mobile Phone Syndromic Surveillance for Respiratory Conditions in an Emergency (COVID-19) Context in Colombia: Representative Survey Design.

Syndromic surveillance for respiratory infections such as COVID-19 is a crucial part of the public health surveillance toolkit as it allows decision makers to detect and prepare for new waves of the disease in advance. However, it is labor-intensive, costly, and increases exposure to survey personnel. This study assesses the feasibility of conducting a mobile phone-based respiratory syndromic surveillance program in a middle-income country during a public health emergency, providing data to support the inclusion of this method in the standard infection control protocols at the population level. This study aims to assess the feasibility of a national active syndromic surveillance system for COVID-19 disease in Colombia. In total, 2 pilots of syndromic mobile phone surveys (MPSs) were deployed using interactive voice response technology in Colombia (367 complete surveys in March 2022 and 451 complete surveys in April and May 2022). Respondents aged 18 years and older were sampled using random digit dialing, and after obtaining consent, they were sent a 10-minute survey with modules on sociodemographic status, respiratory symptoms, past exposure to COVID-19 infection and vaccination status, preferences about COVID-19 vaccination, and information source for COVID-19. Pilot 1 used a nationally representative sample while pilot 2 used quota sampling to yield representative results at the regional level. In this work, we assessed the performance characteristics of the survey pilots and compared the demographic information collected with a nationally representative household survey. For both pilots, contact rates were between 1% and 2%, while participation rates were above 80%. The results revealed that younger, female, and higher educated participants were more likely to participate in the syndromic survey. Survey rates as well as demographics, COVID-19 vaccination status, and prevalence of respiratory symptoms are reported for both pilots. We found that respondents of the MPSs are more likely to be younger and female. In a COVID-19 pandemic setting, using an interactive voice response MPS to conduct syndromic surveillance may be a transformational, low-risk, and feasible method to detect outbreaks. This evaluation expects to provide a path forward to the inclusion of MPSs as a traditional surveillance method.

Sustainability of Hospital Accreditation Programs in Low and Middle-Income Countries: Lessons learned from Sri Lanka

Objective: Many hospital accreditation programs developed for or implemented in Low and Middle-Income Countries (LMICs), including Sri Lanka, have been discontinued due to multiple factors. This study was conducted to elicit and analyse factors influencing the Sri Lankan hospital accreditation program that was initiated in 2015. Design: This case study employed document reviews and 18 key informant interviews with stakeholders involved in Sri Lanka's accreditation program. Collected data were thematically analysed. Setting: Sri Lankan healthcare system. Main outcome measures: Data extraction was guided by the constructs of the ACES-GLEAM Framework, which was developed based on the results of a scoping review. Results: Barriers identified were frequent changes in the leadership and strategic plans, lack of awareness and competencies on accreditation among local stakeholders, and non-alignment of accreditation standards with the local health system context hampered by resource and infrastructure constraints. Enablers for program development commonly raised were the commitment of stakeholders, the availability of institutional structures for quality assurance, donor funding from the World Bank, and technical expertise and surveyor training by the Australian Council on Healthcare Standards International. Conclusions: The study identified that multiple factors contributed to the poor sustainability of the Sri Lankan accreditation program. These findings can be useful reflections and guidelines for the accreditation stakeholders to establish sustainable and effective programs in LMICs.

Changes in global trade patterns increase global inequality towards Sustainable Development Goals

Reaching the UN's sustainable development goals (SDGs) is influenced by a country's position in global value chains and its involvement in international trade. Here, we assess how changes in global trade patterns (CGTP) during 2004 and 2014 impacted 13 SDG indicators in 141 countries/regions which are further divided into four income groups. Trade pattern is characterized by the direction, composition, and magnitude of trade, indicating an economy imports what types (composition) and magnitudes of goods or services from where (direction). We find that CGTP aggravated socioeconomic and environmental inequality between countries in two ways: 1) the amount of indicators that significantly worsened due to CGTP decreased from 8 indicators (2004–2007) to 1 (2011–2014) for high-income and upper-middle-income countries, but increased from 5 to 14 for lower-middle-income and low-income countries; 2) CGTP led to a coupling of value added with most natural resource consumption and environmental pollution indicators for low-income countries, while they strengthened decoupling or reducing coupling for other countries. The findings imply one key to achieving SDGs is to address the inequality between rich and poor countries through implementing policy interventions that influence import and vertical supply chain thereby shifting the trade patterns towards environmental-economic decoupling in poor countries.

Bacterial contamination of platelets concentrates in a lower middle-income country: Data from a single tertiary care hospital

BackgroundTransfusion of bacterially contaminated platelets may cause life threatening sepsis in the recipients. Cost of platelet screening is a major challenge for low middle income countries (LMICs). In this study, we evaluated the frequency of bacterial contamination in the platelet units (PUs) and the outcome of transfusing such platelets to the patients in a single institute at Pakistan. Material and methodsDuring 2018–2022, whole blood-derived (WB-PU) and apheresis platelets (AP) were screened by BacT-ALERT® automated system. Single sample from each AP and samples from ≤ 5 WB-PUs were pooled and cultured within 24 h-post collection. An initial positive signal was followed by re-culture, Gram’s staining, pool resolution and bacterial identification. Results were interpreted as ‘confirmed positive’ or ‘indeterminate’ and ‘confirmed negative’ based on differences in initial-reactive and final results. ResultsA total of 84246 PUs (476 AP and 83770 WB-PU) was screened, and 239 (0.28 %) culture bottles were positive on day one. Individual cultures were performed on 1378 PUs (239 bottles) for pool resolution. Seven of 1378 (0.5 %) PUs were ‘confirmed positive’ while 1371 (99.4 %) were ‘indeterminate’. No bacterial growth was observed in 82868 (82392 WB-PU and 476 AP) of 84246 (98.3 %). Overall bacterial contamination rate was low at 1 in 12000 PUs approximately. Seven patients were transfused with contaminated PUs but no transfusion reaction was observed. ConclusionAn insignificant risk of bacterial contamination was observed in this study but remains a concern for patient safety. LMICs need cost effective but efficient techniques to screen platelets for the presence of bacteria.

Regional integration and export performance of Pakistan: Empirical evidence from the Shanghai Cooperation Organization (SCO).

The study examines export impact of Pakistan's integration into Shanghai Cooperation Organization (SCO) on its export's performance. We apply Poisson Pseudo-Maximum Likelihood (PPML) on augmented gravity model to estimate trade data from the period before and after permanent membership with Shanghai Cooperation Organization in 2017. The study aims to explore changes in exports volume and analyze the key mechanism through which Shanghai Cooperation Organization promotes exports. The study assesses that after integration which key exports sector such as agriculture or manufacturing sectors are affected more significantly. The initial findings suggest that SCO integration positively affect and provide access to Central Asian markets, leading to modest but noticeable promotion in exports promotion. In heterogeneity analysis we find that exports of Pakistan are more significant with low and middle-income level countries compared to higher-income level countries. Additionally, exports in the manufacturing sector benefited more than in the agriculture sector. The significant and positive findings of mechanism analysis indicate that the belt and road (B&R) initiative and bilateral trade agreements are the key factors to enhanced exports. The overall impact remains moderated by structural changes in Pakistan economy, such as poor infrastructure, deficiency in energy sector and limited trade relations with its neighbors India and Iran. The study concludes that although the SCO integration has positively promoted exports of Pakistan however, it requires to address domestic economic constraints and capitalize more effectively the benefits of SCO membership through regional cooperation mechanism. For more potential benefits in the region SCO needs to expand B&R connectivity, encourage more trade agreements, and adopt favorable environment to attract high income countries in the organization. The study provides the base for future research in depth analysis of long-term impact of SCO integration on Pakistan exports.

Collaborative governance of an integrated system for collecting contributions for social health insurance, pension, and taxes from the informal sector: a synthesis of stakeholder perspectives

BackgroundMany low-and middle-income countries have adopted social health insurance schemes. However, the collection of contributions from the large informal sector of these economies poses a significant challenge. Employing an integrated system of contribution collection from all relevant institutions may be cost-effective. We used the integrative framework for collaborative governance, to explore and explain factors that may shape the governance of an integrated system for collecting contributions for social health insurance, pension, and taxes from the informal sector in Zambia.MethodsWe undertook a qualitative case study involving 25 key informants drawn from government ministries and institutions, cooperating partners, non-governmental organizations, and association representatives in the informal sector. Data were analyzed thematically using Emerson’s integrative framework for collaborative governance.ResultsThe main drivers of collaboration included a need for comprehensive policies and legislation to oversee the integrated system for contribution collection, prevent redundancy, reduce costs, and enhance organizational effectiveness. However, challenges such as leadership issues and coordination complexities were noted. Factors affecting principled engagement within the collaborative regime consisted of communication gaps, organizational structure disparities, and the adoption of appropriate strategies to engage the informal sector. Additionally, factors influencing shared motivation involved concerns about power dynamics, self-interests, trust issues, corruption, and a lack of common understanding of the informal sector.ConclusionThis study sheds light on a multitude of factors that may shape collaborative governance of an integrated system for contribution collection for social health insurance, pension, and taxes from the informal sector, providing valuable insights for policymakers and implementers alike. Expanding social health insurance coverage to the large but often excluded informal sector will require leveraging factors identified in this study to enhance collaboration with pension and tax subsystems.