Low-income Nations Research Articles

Adequacy of haemodialysis in two centres in Southwestern Nigeria: Determinants and clinical correlates

Background: Dialysis remains the most common modality of renal replacement therapy for managing end-stage kidney disease. Optimisation of various measures is needed for its efficient delivery. Inadequate dialysis is common in many low-income nations, and there could be inter-centre differences in the delivered dose.Aim: We assessed the dialysis adequacy and factors associated with inter-centre variation.Materials and Methods: This was a two-centre comparative study. Participants' sociodemographic and examination findings were documented and dialysis was prescribed. Pre- and post-dialysis blood for electrolytes, urea and creatinine were taken, and urea reduction ratio and fractional urea clearance as a function of its distribution volume (Kt/V) were calculated.Results: Two hundred and thirty-two participants had 1248 dialysis sessions. Participants' mean age was 49.9 ± 4.6 years. More males participated in the study, and males also received more sessions per participant. A greater proportion of the participants had tertiary education and had hypertensive nephropathy as the cause of kidney disease. The internal jugular access was used for dialysis in majority (60.6%) of the dialysis sessions. Dialysis dose (DD) was adequate in only 115 (9.2%) sessions. The mean DD was 1.02 ± 0.4; in the two centres, it was 0.86 ± 0.2 and 1.11 ± 0.5.Conclusion: DD is low in many low-income nations including Nigeria. The DD was directly related to the blood flow rate, dialysis duration and frequency of erythropoietin use. In addition to other factors, inability to afford prescribed dialysis regimen is a major contributor to the low DD in low-income settings.

Strengthening epilepsy-related prevention and control services in middle- and low-income nations

Strengthening epilepsy-related prevention and control services in middle- and low-income nations

Role of leadership in ensuring road safety in low- and middle-income nations: World Health Organization

The global consensus is that road traffic deaths and injuries are an unacceptable and alarming outcome for the sake of mobility. Even though, road safety has been recognized as a public health concern and efforts have been taken to improve the same, the reality is that the number of road traffic deaths is still increasing. Acknowledging the magnitude of the problem and its preventable nature, it is the need of the hour to have a more effective leadership, both from the government and the private sector in ensuring road safety. In order to improve the leadership in road safety, the World Health Organization has come up with a holistic policy on road safety and management of vehicles. In conclusion, the presence of a strong leadership is the crucial element which has to be addressed in the low and middle income nations and it is high time that all the concerned stakeholders work in a coordinated manner to deal with the preventable problem of road traffic injuries.

Nanosilver Fluoride—A Paradigm Shift for Arrest in Dental Caries in Primary Teeth of Schoolchildren: A Randomized Controlled Clinical Trial

ABSTRACTBackgroundDue to limited financial resources, poor access to basic oral care, and the high cost of restorative treatment, children of low-income nations have their general health, social well-being, and education opportunities affected by untreated dental caries. Arresting caries treatment (ACT) has been proposed to manage untreated dental caries in children of disadvantaged communities.Aims and objectivesThe purpose of the present controlled clinical trial is to investigate the effectiveness of a new anticaries agent, nanosilver fluoride (NSF), preventing and arresting caries in children.Materials and methodsA total of 100 deciduous molars both maxillary and mandibular are randomly selected from 60 children of 4–9 years of age group, which were randomly divided into NSF experimental group and saline control group. Teeth were clinically diagnosed and treated by one masked examiner and followed up at 7 days, 5 months and 12 months by another calibrated examiner who was blinded to the type of treatment. The criteria of the ICDAS II were followed to determine the activity of lesion and the diagnosis of caries. The Pearson's Chi-square test was used to compare the groups during different follow-up examinations.ResultsSeventy-eight percent of decayed teeth showed hard arrested dentine at 7 days; after 5-month analysis in the NSF group, 72.91% of the teeth showed arrested caries; and in the control group, only 34% of teeth showed arrest of caries. At 12-month analysis in the NSF group, 65.21% of teeth showed arrested cavities, and in the control group, 28.88% of teeth showed arrest of caries.ConclusionThe present study proves that NSF is an anticaries agent and presents a noninvasive option for caries arrest and treatment when applied directly to dentin caries lesions.How to cite this articleNagireddy VR, Reddy D, Kondamadugu S, et al. Nanosilver Fluoride—A Paradigm Shift for Arrest in Dental Caries in Primary Teeth of Schoolchildren: A Randomized Controlled Clinical Trial. Int J Clin Pediatr Dent 2019;12(6):484–490.

A Study on Trading partner’s Time Varying GDP Effect on Export

본 논문은 교역 상대국의 소득이 우리나라의 수출에 미치는 영향에 대해 분석하였다. 우리나라의 주요 교역상대국, 43개국의 1991년부터 2016년까지의 패널자료를 사용하여 함수계수패널모형으로 ‘수출함수’를 설정하고 수출에 대한 소득의 영향을 소득계수로 추정하였다. 추정된 소득계수의 변화 요인을 소득수준과 시간으로 분해한 결과, 소득계수는 시간에 따라 상승하고, 그 상승 정도가 감소하는 형태를 보이고, 저소득 국가일수록 상승하는 기울기는 컸다. 이러한 추정결과는 기술발전 등으로 각종 무역장벽들이 약화되면서 교역이 활발해지는 현상(소득계수의 상승)과 국제분업화의 심화로 저소득 국가들, 특히 중국과 동남아 국가들과의 중간재 교역이 활발하게 일어나는 현상(저소득국가의 큰 기울기)으로 설명할 수 있었다. 본 논문의 연구결과는 소득의 수출유발효과의 변화를 요인별로 제시했다는 측면에서 의미가 크며, 추정결과는 국가별 수출 장기전망이나 국가별수출전략을 세우는데 참고자료로 활용될 수 있을 것이다.This paper investigates the relationship between the GDP per capita (GDPPC) of Korea’s trading partners and Korean exports. We model export demand functions using a functional coefficient panel model using panel data from 1991 to 2016 with 43 partner countries. The GDPPC coefficient of our model is a function both of time, allowing temporal changes in an otherwise linear model, and of the GDPPC itself. Estimated income coefficients increase over time but that the degree of increase gradually decreases. Furthermore, for lower-income nations, the slope of increase was found to be greater. These results can help explain how trade increases as technological developments break down trade barriers (increases of income coefficient), and active trade in intermediary goods with China and Southeast Asian nations (high slope in low-income country). Our empirical results could be profitably referenced in coordinating long-term export policies aimed at specific countries or blocs.

Pleuropulmonary parasitic infections of present times-A brief review

Pleuropulmonary
 infections are not uncommon in tropical and subtropical countries. Its
 distribution and prevalence in developed nations has been curtailed by various
 successfully implemented preventive health measures and geographic conditions.
 In few low and middle income nations, pulmonary parasitic infections still
 remain a problem, although not rampant. With increase in immunocompromised
 patients in these regions, there has been an upsurge in parasites isolated and
 reported in the recent past. J Microbiol
 Infect Dis 2018; 8(4):165-179

Antiplasmodial Anthraquinones from Medicinal Plants: The Chemistry and Possible Mode of Actions

Malaria killed nearly half a million people in 2015, and 70% of this victims were young children. Malarial chemotherapy makes use of several drugs, each with its own pharmacological limitations, and with parasite resistance being the most challenging. People of low income nations often rely on traditional medicine as a treatment due to limited access to modern healthcare services. Despite uncertainties present in the outcome of traditional medicine, ethnomedicine approach has yielded important lead candidates. The investigation of medicinal plants utilized in the malaria endemic region yielded many antiplasmodial compounds with anthraquinone moiety. This paper describes natural anthraquinones extracted from medicinal plants utilized in traditional medicine for the treatment of malaria. In addition, the insight on structure-activity relationship and their mode of actions are also elaborated.

Associations Between Physical Function and Subjective Well-Being in Older Adults From Low- and Middle-Income Countries: Results From the Study on Global AGEing and Adult Health (SAGE).

Physical function is positively associated with subjective well-being in older adults from high-income nations. This study tests whether this association is evident in low- and middle-income countries. Data were drawn from the study on global AGEing and adult health, using nationally representative samples of individuals over 50 years old from China, Ghana, India, Mexico, Russia, and South Africa. Participant interviews measured well-being (quality of life, mood, and happiness) and physical function (grip strength, usual and rapid gait speed). Logistic regressions tested relations between physical function and well-being variables within each country. Higher physical function measures exhibited moderate, yet significant, associations with increased odds of highly rated well-being (p < .05). However, higher gait speeds were unexpectedly associated with decreased odds of highly rated well-being (p < .05) in South Africa and Russia. These results suggest that physical function is generally positively associated with perceived well-being in older individuals from lower income nations.

The prognosis of heart failure patients: Does sodium level play a significant role?

IntroductionHeart failure (HF), a major cardiovascular disorder, remains a grievous clinical condition regardless of advances in medical care. Hyponatremia is classified as a serum sodium concentration of <135 mEq/L, and the prevalence, clinical impact and prognostic factor of hyponatremia in heart failure patients varies widely. The current study was conducted with the aim of assessing the prevalence of hyponatremia in patients hospitalized with a diagnosis of HF and comparing baseline clinical characteristic of HF patients based on their sodium status. Survival difference between patients with hyponatremia and normonatremia was also assessed and the clinical prognostic indicators of overall mortality in HF patients were evaluated.MethodA retrospective cohort study was conducted to assess medical records of heart failure patients who were admitted to Gondar University Referral Hospital. Patients were categorized based on their sodium level status at their first admission to the internal medicine department. Each patient was assigned to either of the following groups: hyponatremia if sodium < 135 mmol/L, or normonatremia if sodium ≥ 135 mmol/L.ResultAmong 388 participants, the prevalence of hyponatremia in the study cohorts was 51.03%. Kaplan-Meier survival curves showed that there was a significant difference in survival status of HF patients among the two cohorts (Log—Rank test, P <0.0001). Hence, patients with normal sodium levels had a higher chance of survival over hyponatremic patients. Multivariate Cox regression has revealed a statistically significant association of mortality with the following variables: advanced age (AHR = 1.035 (1.012–1.058), P = 0.003), hyponatremia (AHR = 4.003 (1.778–9.009), P = 0.001), higher creatinine level (AHR = 1.929 (1.523–2.443), P = <0.0001) and, prescription of angiotensin-converting enzyme inhibitors (AHR = 0.410 (0.199–0.842), P = 0.015) and spironolactone (AHR = 0.511 (0.275–0.949), P = 0.033.ConclusionIn conclusion, hyponatremia is one of the crucial factors in the clinical prognosis of heart failure patients. However, as other prognostic factors (i.e. medication, creatine level, and age) also played vital roles in overall survival, well-controlled clinical trials (complete with medication dosing, laboratory outputs and long-term prospective follow up) are required to further study the impact of hyponatremia in HF patient’s prognosis in low income nations.

Newborn self-inflating manual resuscitators: precision robotic testing of safety and reliability

AimA controlled bench test was undertaken to determine the performance variability among a range of neonatal self-inflating bags (SIB) compliant with current International Standards Organisation (ISO).IntroductionUse of SIB to provide...

The Income Elasticity of Global Values of a Statistical Life: Stated Preference Evidence

Examination of estimates of the income elasticity of the value of a statistical life based on international stated preference studies yields an average between 0.94 and 1.05 overall and 0.65 and 0.80 after controlling for covariates. Quantile regression estimates indicate that the income elasticity is about 0.55 for more affluent counties and 1.0 for lower income nations, i.e., those countries that have estimates of the value of a statistical life below $2 million or per capita income levels below $3,212. The estimates distinguish the values of the income elasticity across country either by income level or by the value of a statistical life. These elasticities are similar to those found in revealed preference labor market studies. The estimates are robust, controlling for possible sample selection bias and the influence of covariates, such as the type of risk.

The shifting burden of neurosurgical disease: Vietnam and the middle-income nations.

The Global Burden of Disease (GBD) is an international collaboration and the largest comprehensive investigation of global health disease burden ever conducted. It has been particularly insightful for understanding disease demographics in middle-income nations undergoing rapid development, such as Vietnam, where 6 of the top 10 causes of death are relevant to the neurosurgeon. The burden of stroke-the number one cause of death in Vietnam-is particularly impressive. Likewise, road injuries, with a disproportionate rate of traumatic brain injury, continue to increase in Vietnam following economic development. Low-back and neck pain is the number one cause of disability. Simultaneously, more patients have access to care, and healthcare spending is increased. It is imperative that neurosurgical capital and infrastructure keep pace with Vietnam's growth. The authors searched the existing literature for assessments of neurosurgical infrastructure or initiatives to address neurosurgical disease burden. Using GBD data, the authors also abstracted data for death by cause and prevalence of years of life lost due to disability (YLD) for common neurosurgical pathologies for Vietnam and comparison nations. Interventions aimed at primary prevention of risk factors for neurosurgical disease and focused on the transference of self-sustainable technical skills were found to be analogous to those that have been successful in other regions. Efforts toward stroke prevention have been focused on causal risk factors. Multiple investigators have found that interventions aimed at increasing helmet use were successful in preventing traumatic brain injury. Government-led reforms and equipment donation programs have improved technical capacity. Nevertheless, Vietnam lags behind other nations in neurosurgeons per capita; cause-attributable death and YLD attributable to neurosurgical disease are considerably higher in Vietnam and middle-income nations compared to both lower-income nations and upper-income nations. More than two-thirds of deaths attributable to neurosurgical pathologies in Vietnam and other middle-income nations were due to stroke, and one-fifth of both cause-attributable death and YLD was associated with neurosurgical pathologies. Vietnam and other middle-income nations continue to assume a global burden of disease profile that ever more closely resembles that of developed nations, with particular cerebrovascular, neurotrauma, and spinal disease burdens, leading to exponentially increased demand for neurosurgeons that threatens to outpace the training of neurosurgeons.

Safety in Anesthesia: Latin American Perspective

This review intends to broadly illustrate the current anesthesia safety issues in Latin America, discussing the residency training schemes, anesthesia workforce shortages, equipment shortages, and safety initiatives in Latin America that include minimum standards and adverse event reporting systems. Latin America’s distinction is that of a continent of major contrasts which poses major difficulties as quality of anesthesia care ranges between that of high-income countries to that of very low income nations. A major effort to attenuate these is the creation and adoption of mandatory national standards that aim to guarantee that even in the worst conditions, minimal safety strategies are met to safeguard patients. Colombia’s and Brazil’s anesthesia societies have been at the forefront in Latin America in developing strategies to promote anesthesia safety. The creation, promotion, and adoption of Minimal Standards has been key to improve anesthesia safety in the continent.

No Strings Attached: The Impact of an Unconditional Prenatal Income Supplement on First Nations Birth and Early Childhood Outcomes

IntroductionIn Manitoba, low-income pregnant women are eligible for the Healthy Baby Prenatal Benefit (HBPB), an unconditional income supplement provided during the second and third trimester of pregnancy. HBPB is associated with improved birth outcomes for Manitoba women; its association with birth outcomes for First Nations (Indigenous) women is unknown.&#x0D; Objectives and ApproachTo determine the association between HBPB and First Nations’ (FN) newborn and early childhood outcomes, we linked whole-population data from health, public health, family services and education. We included only FN women receiving income assistance during pregnancy (n=7074) to develop comparable treatment (received HBPB; n=5283) and comparison (no HBPB; n=1791) groups. Propensity score weighting adjusted for differences in maternal characteristics between groups. Multi-variable regressions compared groups on breastfeeding initiation, low birth weight, preterm birth, small- and large-for-gestational age, Apgar scores, complete immunizations at 1 and 2 years, and developmental vulnerability in kindergarten measured with the Early Development Instrument (EDI).&#x0D; ResultsReceipt of the HBPB was associated with reductions in low birth weight births (adjusted Relative Risk (aRR): 0.77; 95% CI: 0.63, 0.93) and preterm births (aRR: 0.78 (0.68, 0.90)), and increases in breastfeeding initiation (aRR: 1.05 (1.00, 1.09)) and large-for-gestational age births (aRR: 1.11 (1.01, 1.23)). HBPB receipt during pregnancy was also associated with increases in 1- and 2-year immunizations for FN children (aRR: 1.14 (1.09, 1.19), and aRR: 1.28 (1.19, 1.36), respectively). Reductions in the risk of being developmentally vulnerable in the language and cognitive domain of the EDI were also found for FN children whose mothers had received the HBPB during pregnancy (aRR: 0.85 (0.74, 0.97).&#x0D; Conclusion/ImplicationsA modest unconditional income supplement during pregnancy was associated with improved birth outcomes, increased immunization rates, and improved language and cognitive development at kindergarten for children born to low-income First Nations women. Long-term strategies to address structural inequities and the ongoing effects of colonization are also needed.

Wealthy countries dominate industrial fishing.

The patterns by which different nations share global fisheries influence outcomes for food security, trajectories of economic development, and competition between industrial and small-scale fishing. We report patterns of industrial fishing effort for vessels flagged to higher- and lower-income nations, in marine areas within and beyond national jurisdiction, using analyses of high-resolution fishing vessel activity data. These analyses reveal global dominance of industrial fishing by wealthy nations. Vessels flagged to higher-income nations, for example, are responsible for 97% of the trackable industrial fishing on the high seas and 78% of such effort within the national waters of lower-income countries. These publicly accessible vessel tracking data have important limitations. However, insights from these new analyses can begin to strategically inform important international- and national-level efforts underway now to ensure equitable and sustainable sharing of fisheries.

Persistence in incarcerations: global comparative evidence

Purpose The purpose of this paper is to assess how incarcerations persist across the world. The focus is on 163 countries for the period 2010-2015. Design/methodology/approach The empirical evidence is based on generalized method of moments. In order to increase room for policy implications, the data set is decomposed into sub-samples based on income levels, religious domination, openness to the sea, regional proximity and legal origins. Findings The following main findings are established. Incarcerations are more persistent in low income, Christian-protestant and Latin American countries while comparative evidence is not feasible on the basis of landlockedness and legal origins owing to unfavorable post-estimation diagnostic tests. Justifications for the comparative advantages and relevance of findings to theory building in public economics are discussed. Practical implications First, income levels matter in the persistence of incarcerations because low-income nations vis-à-vis their high-income counterparts have less financial resources with which to prevent and deal with events like terrorism, political instability and violence that lead to incarcerations. Second, the intuition for religious domination builds on the fact that liberal societies can be more associated with incarcerations compared to conservative societies. The main theoretical contribution of this study to the literature is that the authors have built on empirical validity to provide theoretical justification as to why categorizing countries on the basis of selected fundamental characteristics determine cross-country variations in incarcerations. Such evidence is important for theory building in public economics. Originality/value It is important for policy makers to understand the persistence of incarcerations across nations because resources could be allocated to regions and countries, contingent on the relative importance of future incarceration tendencies.

Global health enabling systems

This think piece argues for the importance of administrative and bureaucratic labor –‘mundane’ things – in maintaining US-African global health research partnerships and the power relations within them. The daily work of accounting, compliance, and risk management undertaken by global health ‘enabling systems’ created by US universities contrasts with global health’s heroic self-image and conjures up negative imaginaries of intransigent African bureaucracies, crumbling communication infrastructure, and corruption. These negative imaginaries help to authorize forms of US fiscal and administrative control that may contradict global health’s ethic of partnership and its related goal of ‘building capacity’ in low-income partner nations, as well as feed ‘creative accounting’ practices by both partner entities. Critiquing these inequalities may seem risky in an era of ‘America First’ and threatened cuts to global health funding. In fact, advocating for equity in global health partnerships and prioritizing the building of African institutional capacity are only made more urgent by the current political climate.

Adaptation financing for projects focused on food systems through the UNFCCC

ABSTRACTInvestments in adaptation are required to reduce vulnerability and strengthen the resilience of food systems to the impacts of climate change. For low-income nations, international financing plays a central role in supporting adaptation. In this article, we document and examine adaptation projects targeting food systems financed through funding bodies of the United Nations Framework Convention on Climate Change (UNFCCC). We find that between 2004 and 2015, 3% (n = 96) of adaptation projects supported through the UNFCCC explicitly focused on the production, processing, distribution, preparation and/or consumption of food, with US$546 m mobilized through funding bodies directly and US$1.44bn through co-financing. Agriculture is the most common sector supported, with extreme weather events the primary climate change-related impact motivating nations to apply for adaptation financing. The majority of actions are documented to adapt the food production component of food systems, with limited focus within projects on the full range of food system vulnerability and the implications on food security.Key policy insightsEnhanced international adaptation financing targeting food systems is needed, and in particular financing to address limited adaptation readinessSupported food system projects should include holistic assessments of the entire food system in order to prioritize sector and food system component issue areas for short- and long-term efficiencyTo better analyse food system linkages and aid in the prioritization of adaptation activities, adaptation-directed funds should consider placing a higher emphasis on a cross-sectoral approach within projectsLinkages between official development assistance and adaptation-directed funds could help optimize financing for food systems and mainstream food system adaptation efforts

Expansion of the Priority Review Voucher Program Under the 21st Century Cures Act: Implications for Innovation and Public Health.

The U.S. federal government awards a priority review voucher (“PRV”) to a pharmaceutical manufacturer after the Food and Drug Administration (“FDA”) approves a product for one of a list of voucher-eligible indications. The voucher, which can be transferred or sold, allows the company to accelerate the review timeline of another product for any indication. The PRV program was proposed in 2006 as an incentive for research and development for neglected diseases, such as dengue and leishmaniasis.Neglected tropical diseases (“NTDs”) predominantly affect the world’s poorest populations and are associated with significant morbidity and mortality. Despite their global public health importance, neglected diseases were estimated to account for less than 1% of pharmaceutical research and development expenditures. The voucher program was intended to address this gap between investment and disease burden: “[t]he major obstacle to stimulating the R&amp;D of new medicines for neglected diseases is lowincome nations' inability to pay for such medicines.” The voucher would provide an additional financial incentive to fund clinical development of these products without requiring additional appropriations from Congress.

International nurse migration from India and the Philippines: the challenge of meeting the sustainable development goals in training, orderly migration and healthcare worker retention

ABSTRACTThis paper examines nurse migration from India and the Philippines through the lens of the sustainable development goals (SDGs) 4.3 (access to training), 10.7 (orderly and responsible migration) and 3.c (retention of health workers). The international migration of health workers has increasingly featured on the agenda of global health agencies. Ameliorating the negative impact of international nurse emigration from low-income nations has been addressed by several western governments with the adoption of ethical recruitment guidelines, one element of an orderly migration framework. One of the challenges in creating such guidelines is to understand how the emigration of trained nurses influences health education and clinical training systems within nurse exporting nations such as India and the Philippines, and how these relate to various SDGs. This paper maps the connections between India’s and the Philippines’ increasing role in the provision of nurses for international markets and the SDGs related to training and migration governance and the retention of health workers. The paper calls for greater attention to the global structuring of migrant mobility in order to assess national abilities to meet SDG goals in these areas.