Low-income Nations Research Articles

Evaluation of toxicological impacts on Sprague–Dawley rat by successively low dose of aflatoxin B1

Aflatoxins (AFs) are a group of potent mycotoxins that frequently pollute agro-products and animal feeds. For complex reasons, the regulatory limits of AFs differ from nation to nation. In this study, feedstuffs contaminated with various concentrations of aflatoxin B1 (AFB1) corresponding to AF regulatory limits of major agro-product importing and exporting nations were tested in Sprague-Dawley rats, and the toxicological results were evaluated. During the trial period, no poisoning behavior was observed and no animals died. No significant differences in body weight were observed between AFB1-contaminated and control rats. However, various negative impacts on liver and kidney functions were observed in AFB1-contaminated groups, and these negative impacts were positively correlated with AFB1 concentrations. At concentrations of 4-50 µg kg(-1) , AFB1 tolerance was observed for the liver after 15 days of testing, but this tolerance was not observed for the kidney. Low concentrations of AFB1 still induced obvious toxicological impacts on Sprague-Dawley rats, and the negative effects were aggravated by increasing the AFB1 dose and feeding time. Therefore strict AF regulatory limits are suggested for food safety administration, especially for the low-income nations with higher hepatitis B virus prevalence.

Determining minimum food intake amounts for diet diversity scores to maximize associations with nutrient adequacy: an analysis of schoolchildren's diets in rural Kenya.

To explore multiple methods of calculating diet diversity scores (DDS) to maximize associations with predicted dietary micronutrient adequacy among schoolchildren in rural Kenya. Up to three 24 h recall interviews were administered for each child for a total of 1544 d of intake from all schoolchildren. Daily amounts of food consumed were assigned to one of eight food groups. Five DDS were developed based on various minimum intake amounts from each food group: (i) 1 g; (ii) 15 g; (iii) a variable minimum based on the content of a target nutrient for each group; (iv) the median intake level for each group; and (v) the 90th percentile intake level for each group. A diet was assigned 1 point towards the daily DDS if the food group intake was above the defined minimum level. Five scores were calculated for each child, and bivariate longitudinal random-effects models were used to assess the correlation between each DDS and the mean probability of adequacy for fourteen nutrients. Embu District, Kenya. Schoolchildren (n 529), mean age 7·00 (sd 1·41) years. Only DDS based on a 15 g minimum and DDS based on nutrient content were significantly associated with mean probability of adequacy after adjusting for energy intake (0·21 and 0·41, respectively). A DDS using minimum intakes based on nutrients contributed by a food group best predicted nutrient adequacy in this population. These analyses contribute to the continued search for simpler and more valid dietary quality indicators among low-income nations.

A comparison of exchange rate regime choice in emerging markets with advanced and low income nations for 1999–2011

The recent global financial crisis has sparked a renewal of debate on the choice of exchange rate regimes. Creating a tripartite regime classification, the present study examines their determinants for 137 nations spanning the period 1999–2011. I find that trade openness, economic development, foreign-currency liabilities, and foreign exchange reserve holdings increase the likelihood of choosing a fixed-type regime in emerging markets while economic size, export concentration ratios and financial development lower such a chance. Capital controls, inflation differential with an anchor nation and land size significantly influence regime-choice in advanced and low income countries, but are largely insignificant in emerging markets.

Cross-national and historical differences in subjective well-being

There is a growing body of population survey data on national subjective well-being which allows comparisons across countries and across periods. Key issues in this work are as follows. Can response to questions on well-being be meaningfully compared across countries and periods? What social conditions are associated with greater well-being both between countries and across periods? Are there lessons for how global well-being might be improved? This review aims to give an overview of this area and its relevance to psychiatric epidemiology. Systematic searches of the literature were carried out using eight academic databases between August 2012 and January 2013. Subjective well-being involves multiple components, including cognitive evaluation of satisfaction with life and emotional state, and these are separable from mental ill health. Although there are difficulties in measuring subjective well-being in comparable ways cross-culturally, there is sufficient evidence of validity to make comparisons meaningful. The subjective well-being of nations increases with income per capita, but gains are smaller in higher-income countries. Other national factors that affect well-being include income inequality, social welfare, individualism, democracy and freedom, social capital and physical health. Economic growth of lower-income nations will improve global subjective well-being. However, this needs to be sustainable or it will reduce the well-being of future generations. Higher-income nations need to focus on other determinants of well-being. Research on cross-national well-being suggests a number of directions that may be profitably pursued in psychiatric epidemiology.

Social Inequities and Exclusions in Kerala’s ‘Egalitarian’ Development

Social inequalities and exclusions can devastate people's lives, especially when they are far from the centers of power and control. This wreckage can be seen in many different parts of their lives, but particularly in their health. The health of any given country's population is primarily determined by politics, and public policies play a critical role. All over the world, countries with a history of egalitarian ideologies, and corresponding policies aimed at reducing social inequalities, have healthier populations. The Indian state of Kerala, which has a long-running radical political tradition and a history of social-reform movements in the early twentieth century, is acclaimed for its achievements in health and social-sector development, including low levels of mortality and fertility, and high levels of life expectancy and literacy—all despite its low-performing economy. Kerala has become a veritable mecca for other low-income nations in social development and health advancement.This article can also be found at the Monthly Review website, where most recent articles are published in full.Click here to purchase a PDF version of this article at the Monthly Review website.

Maternal Mortality Interventions: A Systematic Review

Background: In order to achieve the World Health Organization’s Millennium Development Goal of reducing maternal mortality by three quarters by 2015, a strong global commitment is needed to address this issue in low-income nations where the risk to women is greatest. A comprehensive international effort must include provision of obstetric and general medical care as well as community-based interventions, with an emphasis on the latter in nations where the majority of women deliver babies at home without a trained attendant. Methods: This systematic analysis evaluates interventions published in Medline and CINAHL whose outcome measure is maternal mortality. Analysis includes components of the intervention, nation and maternal death rates. Results: Nine studies documented the effectiveness of various clinical and community-based interventions, including specific drug regimens and procedures, in reducing the risk of maternal death. Six studies reported interventions that did not significantly alter maternal mortality outcomes, and the intervention in one study demonstrated increased risk of maternal death. Conclusion: The dearth of evidence highlights the need for increased focus on translational research that bridges the gap between medical advances and community-based interventions that are feasible in low-income nations. This cannot be accomplished without a stronger commitment to reducing maternal mortality by global health practitioners and researchers.

The status of childhood blindness and functional low vision in the Eastern Mediterranean region in 2012.

Childhood blindness and visual impairment (CBVI) are major disabilities that compromise the normal development of children. Health resources and practices to prevent CBVI are suboptimal in most countries in the Eastern Mediterranean Region (EMR). We reviewed the magnitude and the etiologies of childhood visual disabilities based on the estimates using socioeconomic proxy indicators such as gross domestic product (GDP) per capita and <5-year mortality rates. The result of these findings will facilitate novel concepts in addressing and developing services to effectively reduce CBVI in this region. The current study determined the rates of bilateral blindness (defined as Best corrected visual acuity(BCVA)) less than 3/60 in the better eye or a visual field of 10° surrounding central fixation) and functional low vision (FLV) (visual impairment for which no treatment or refractive correction can improve the vision up to >6/18 in a better eye) in children <15 years old. We used the 2011 population projections, <5-year mortality rates and GDP per capita of 23 countries (collectively grouped as EMR). Based on the GDP, we divided the countries into three groups; high, middle- and low-income nations. By applying the bilateral blindness and FLV rates to high, middle- and low-income countries from the global literature to the population of children <15 years, we estimated that there could be 238,500 children with bilateral blindness (rate 1.2/1,000) in the region. In addition, there could be approximately 417,725 children with FLV (rate of 2.1/1,000) in the region. The causes of visual disability in the three groups are also discussed based on the available data. As our estimates are based on hospital and blind school studies in the past, they could have serious limitations for projecting the present magnitude and causes of visual disabilities in children of EMR. An effective approach to eye health care and screening for children within primary health care and with the available resources are discussed. The objectives, strategies, and operating procedures for child eye-care are presented. Variables impacting proper screening are discussed. To reach the targets, we recommend urgent implementation of new approaches to low vision and rehabilitation of children.

Childhood adversity and borderline personality disorder

This article explores recent research in the field of childhood exposure to trauma and the development of borderline personality disorder in adolescence. Adolescence is a critical period of development. Exposure to trauma, specifically sexual abuse, prior to and during puberty has specific implications for personality development and heightens risk for borderline personality disorder. Elevated symptom levels in adolescence are likely to decline across adulthood, but social and vocational impairments remain. Impulsivity, difficulties in emotion regulation, and suicidality may characterize adolescent expression of borderline personality disorder, whereas negative affect and functional impairment are more stable features of the disorder. Preliminary findings in treatment models for adults have potential for benefit among adolescence. Further research is required to examine treatment effectiveness and efficiency. Greater attention to low-income and middle-income nations, which are disproportionately affected by adversity, is needed to determine cross-cultural validity and the impact of trauma in adolescent populations.

Microbially synthesized modular virus‐like particles and capsomeres displaying group A streptococcus hypervariable antigenic determinants

Effective and low-cost vaccines are essential to control severe group A streptococcus (GAS) infections prevalent in low-income nations and the Australian aboriginal communities. Highly diverse and endemic circulating GAS strains mandate broad-coverage and customized vaccines. This study describes an approach to deliver cross-reactive antigens from endemic GAS strains using modular virus-like particle (VLP) and capsomere systems. The antigens studied were three heterologous N-terminal peptides (GAS1, GAS2, and GAS3) from the GAS surface M-protein that are specific to endemic strains in Australia Northern Territory Aboriginal communities. In vivo data presented here demonstrated salient characteristics of the modular delivery systems in the context of GAS vaccine design. First, the antigenic peptides, when delivered by unadjuvanted modular VLPs or adjuvanted capsomeres, induced high titers of peptide-specific IgG antibodies (over 1 × 10(4) ). Second, delivery by capsomere was superior to VLP for one of the peptides investigated (GAS3), demonstrating that the delivery system relative effectiveness was antigen-dependant. Third, significant cross-reactivity of GAS2-induced IgG with GAS1 was observed using either VLP or capsomere, showing the possibility of broad-coverage vaccine design using these delivery systems and cross-reactive antigens. Fourth, a formulation containing three pre-mixed modular VLPs, each at a low dose of 5 μg (corresponding to <600 ng of each GAS peptide), induced significant titers of IgGs specific to each peptide, demonstrating that a multivalent, broad-coverage VLP vaccine formulation was possible. In summary, the modular VLPs and capsomeres reported here demonstrate, with promising preliminary data, innovative ways to design GAS vaccines using VLP and capsomere delivery systems amenable to microbial synthesis, potentially adoptable by developing countries.

Corporal punishment and children's externalizing problems: A cross-sectional study of Tanzanian primary school aged children

The adverse effect of harsh corporal punishment on mental health and psychosocial functioning in children has been repeatedly suggested by studies in industrialized countries. Nevertheless, corporal punishment has remained common practice not only in many homes, but is also regularly practiced in schools, particularly in low-income countries, as a measure to maintain discipline. Proponents of corporal punishment have argued that the differences in culture and industrial development might also be reflected in a positive relationship between the use of corporal punishment and improving behavioral problems in low-income nations. In the present study we assessed the occurrence of corporal punishment at home and in school in Tanzanian primary school students. We also examined the association between corporal punishment and externalizing problems. The 409 children (52% boys) from grade 2 to 7 had a mean age of 10.49 (SD=1.89) years. Nearly all children had experienced corporal punishment at some point during their lifetime both in family and school contexts. Half of the respondents reported having experienced corporal punishment within the last year from a family member. A multiple sequential regression analysis revealed that corporal punishment by parents or by caregivers was positively related to children's externalizing problems. The present study provides evidence that Tanzanian children of primary school age are frequently exposed to extreme levels of corporal punishment, with detrimental consequences for externalizing behavior. Our findings emphasize the need to inform parents, teachers and governmental organizations, especially in low-income countries, about the adverse consequences of using corporal punishment be it at home or at school.

Challenges Encountered During the Veterinary Disaster Response: An Example from Chile.

Simple SummaryDisaster preparedness for companion animals has economic, social and welfare benefits, yet many countries continue to omit dogs and cats from their national and regional contingency planning. Responses therefore, are often chaotic, inefficient and uncoordinated, or absent altogether. Documented experiences in Chile contribute to the information supporting the inclusion of companion animals into locally relevant disaster plans. These plans serve to prepare communities and authorities, identify resources available, establish a chain of command, develop local priorities, and subsequently reduce the negative impacts on both human and animal communities.Large-scale disasters have immeasurable effects on human and animal communities. Evaluating and reporting on the response successes and difficulties encountered serves to improve existing preparedness documents and provide support to those in the process of developing plans. Although the majority of disasters occur in low and middle income nations, less than 1% of the disaster literature originates from these countries. This report describes a response to a disease outbreak in domestic dogs in Dichato, Chile following the 2010 earthquake/tsunami. With no national plan coordinating the companion animal response, there was a chaotic approach among animal welfare organizations towards rescue, diagnosis, treatment and record-keeping. Similar to the medical response following the 1985 earthquake near Santiago, we experienced problems within our own teams in maintenance of data integrity and protocol compliance. Loss of infrastructure added complications with transportation, communications and acquisition of supplies. Similar challenges likely occur in most disasters, but can be reduced through pro-active planning at national and local levels. There is sufficient information to support the human and animal welfare benefits of including companion animals in national planning, and lessons learned through this and other experiences can assist planners in the development of comprehensive and locally relevant contingency plans.

The Resilience Complex

The Resilience Complex

How do Ontario family medicine residents perform on global health competencies? A multi-institutional survey

There is an increased interest in global health among medical students, family medicine residents, and medical educators. This paper is based on research to assess confidence in knowledge and skills in global health in family medicine residents in five universities across Ontario. A web-based survey was sent to 166 first-year family medicine residents from five universities within Ontario. Descriptive statistics were used to analyze residents' confidence in their knowledge and skills in global health. The strength of association between each of the self-perceived knowledge and skills variables was assessed by the Spearman correlation coefficient. The response rate ranged from 29% to 66% across the five universities. Self-perceived knowledge scores revealed that 34.3% of the respondents were very confident, 51.9% were somewhat confident, and 13.8% were not at all confident about their global health knowledge. Participants' confidence scores were lower in relation to knowledge of access to health care for low income nations (44.3%), and were better on their global health skills related to working in a team (70.9%) and listening actively to patients' concerns (64.6%). The global health competency scale has identified key areas of strengths and weaknesses of family medicine programs in global health education. This can be used to evaluate and analyze progress over time.

Accelerating action towards universal health coverage by applying a gender lens

Accelerating action towards universal health coverage by applying a gender lens

S06.4 New Directions in HIV Partner Services: An Evolving Model of Global, Integrated Field Services

Partner services are a longstanding component of public health efforts to control sexually transmitted infections (STI). However, they have not been a consistent part of HIV prevention efforts either in...

Health needs assessment for medical genetic services for congenital disorders in middle- and low-income nations.

Medical genetic services for the care and prevention of congenital disorders have received little attention in most middle- and low-income countries to date. In 2010, the World Health Organisation prioritized services for the care and prevention of birth defects in these nations, emphasising their importance in assisting such countries to reach their Millennium Development Goals. Health Needs Assessment is an inclusive, rational, epidemiological-assisted approach for providing information to plan, introduce and beneficially change health care services to improve the health of populations. It is intrinsic to much of the development of health care systems in industrialised nations. Its use by middle- and low-income countries to introduce and develop medical genetic services commensurate with their needs and circumstances would be beneficial. An approach to applying Health Needs Assessment in these circumstances is described.

Who benefits from financial development? New methods, new evidence

This paper takes a fresh look at the impact of financial development on economic growth by using recently developed kernel methods that allow for heterogeneity in partial effects, nonlinearities and endogenous regressors. Our results suggest that while the positive impact of financial development on growth has increased over time, it is also highly nonlinear with more developed nations benefiting while low-income countries do not benefit at all. We also conduct a novel policy analysis that confirms these statistical findings. In sum, this set of results contributes to the ongoing policy debate as to whether low-income nations should scale up financial reforms.

Tobacco control in Namibia: the importance of government capacity, media coverage and industry interference

BackgroundNamibia is typical of low-income and middle-income countries with growing tobacco use, but with limited capacity to impose comprehensive tobacco control legislation. Despite initiating dialogue on national tobacco control policy...

Development and validation of a quantitative real-time polymerase chain assay for universal detection of the White Spot Syndrome Virus in marine crustaceans

BackgroundThe White Spot Syndrome Virus (WSSV), the sole member of the family Whispoviridae, is the etiological agent that causes severe mortality events in wild and farmed shrimp globally. Given its adverse effects, the WSSV has been included in the list of notifiable diseases of the Office of International Epizootic (OIE) since 1997. To date there are no known therapeutic treatments available against this lethal virus, and a surveillance program in brood-stock and larvae, based on appropriate diagnostic tests, has been strongly recommended. However, some currently used procedures intended for diagnosis of WSSV may be particularly susceptible to generate spurious results harmfully impacting the shrimp farming industry.MethodsIn this study, a sensitive one-step SYBR green-based real-time PCR (qPCR) for the detection and quantitation of WSSV was developed. The method was tested against several WSSV infected crustacean species and on samples that were previously diagnosed as being positive for WSSV from different geographical locations.ResultsA universal primer set for targeting the WSSV VP28 gene was designed. This method demonstrated its specificity and sensitivity for detection of WSSV, with detection limits of 12 copies per sample, comparable with the results obtained by other protocols. Furthermore, the primers designed in the present study were shown to exclusively amplify the targeted WSSV VP28 fragment, and successfully detected the virus in different samples regardless of their geographical origin. In addition, the presence of WSSV in several species of crustaceans, including both naturally and experimentally infected, were successfully detected by this method.ConclusionThe designed qPCR assay here is highly specific and displayed high sensitivity. Furthermore, this assay is universal as it allows the detection of WSSV from different geographic locations and in several crustacean species that may serve as potential vectors. Clearly, in many low-income import-dependent nations, where the growth of shrimp farming industries has been impressive, there is a demand for cost-effective diagnostic tools. This study may become an alternative molecular tool for a less expensive, rapid and efficient detection of WSSV.

Beyond procedural ethics: Foregrounding questions of justice in global health research ethics training for students

Interest in global health is growing among students across many disciplines and fields of study. In response, an increasing number of academic programmes integrate and promote opportunities for international research, service or clinical placements. These activities raise a range of ethical issues and are associated with important training needs for those who participate. In this paper, we focus on research fieldwork conducted in lower income nations by students from more affluent countries and the ethics preparation they would benefit from receiving prior to embarking on these projects. Global health research is closely associated with questions of justice and equity that extend beyond concerns of procedural ethics. Research takes place in and is shaped by matrices of political, social and cultural contexts and concerns. These realities warrant analysis and discussion during research ethics training. Training activities present an opportunity to encourage students to link global health research to questions of global justice, account for issues of justice in planning their own research, and prepare for ‘ethics-in-practice’ issues when conducting research in contexts of widespread inequality. Sustained engagement with questions of justice and equity during research ethics training will help support students for involvement in global health research.