Medium-income Countries Research Articles

Antihypertensive medicine use differs between Ghana and Nigeria

BackgroundNon-communicable diseases are a growing burden in many African countries; cardiovascular disease is the main disease. Antihypertensive medicines (AHM) are a common treatment option but we know little about community use in most low- and medium-income countries (LMIC). We aimed to describe the use of antihypertensive medicines (AHM) in Ghana and Nigeria using a novel data source.MethodsWe used data from mPharma—a health and pharmaceutical company which distributes pharmaceuticals to hospital and retail pharmacies. We extracted data using the anatomical therapeutic chemical (ATC) classification codes and calculated use in defined daily doses and explored patterns by class, medicines, dose, and originator or generic product.ResultsAHM use differed between Ghana and Nigeria. The most used classes in Ghana were angiotensin receptor blockers (ARB) followed by calcium channel blockers (CCB) and angiotensin-converting-enzyme inhibitors (ACEi). The five most used products were 16 mg candesartan, 30 mg nifedipine, 10 mg lisinopril, 5 mg amlodipine and 50 mg losartan. In Nigeria ARB, CCB and diuretics were widely used; the top five products were 50 mg losartan, 10 mg lisinopril, 30 mg nifedipine, 40 mg furosemide, and 5 mg amlodipine. More originator products were used in Ghana than Nigeria.ConclusionThe differences between Ghana and Nigeria may result from a combination of medical, contextual and policy evidence and reflect factors related to clinical guidance (e.g. standard treatment guidelines), accessibility to prescribers and the role of community pharmacies, and structure of the health system and universal health coverage including funding for medicines. We show the feasibility of using novel data sources to gain insights on medicines use in the community.

Association between density of convenience and small grocery stores with diet quality in adults living in Mexico City: A cross sectional study.

There is evidence of the association between different retail stores and food consumption, yet research is still limited in low- and medium-income countries, where the context of the food retail environment is different from that observed in high-income countries. Specifically, less is known about how convenience and small grocery stores, which offer products with immediate access, are associated with the diet as a whole. The present study assessed the association between density of convenience and small grocery stores and diet quality in adults from the Mexico City Representative Diabetes Survey 2015. A final sample size of 1,023 adults aged 20–69 years was analyzed. The density of stores was measured using Euclidean buffers within 500 meters of each participant's home. The Mexican Alternate Healthy Eating Index (MxAHEI) was used to assess diet quality. Multivariable Poisson models were used to test the association of convenience and small grocery stores densities with the MxAHEI. Although our results were not statistically significant, we observed a lower diet quality score among adults from Mexico City living in areas with a higher density of small grocery and convenience stores. More research is needed on the influence of environmental food retail on food consumption.

Environmental Pollutants and Oxidative Stress in Terrestrial and Aquatic Organisms: Examination of the Total Picture and Implications for Human Health.

There is current great international concern about the contribution of environmental pollution to the global burden of disease particularly in the developing, low- and medium-income countries. Industrial activities, urbanization, developmental projects as well as various increased anthropogenic activities involving the improper generation, management and disposal of pollutants have rendered today’s environment highly polluted with various pollutants. These pollutants include toxic metals (lead, cadmium, mercury, arsenic), polycyclic aromatic hydrocarbons, polychlorinated biphenyls, pesticides and diesel exhaust particles most of which appear to be ubiquitous as well as have long-term environmental persistence with a wide range of toxicities such as oxidative stress among others. Oxidative stress, which may arise from increased production of damaging free radicals emanating from increased pollutant burden and depressed bioavailability of antioxidant defenses causes altered biochemical and physiological mechanisms and has been implicated in all known human pathologies most of which are chronic. Oxidative stress also affects both flora and fauna and plants are very important components of the terrestrial environment and significant contributors of nutrients for both man and animals. It is also remarkable that the aquatic environment in which sea animals and creatures are resident is also highly polluted, leading to aquatic stress that may affect the survival of the aquatic animals, sharing in the oxidative stress. These altered terrestrial and aquatic environments have an overarching effect on human health. Antioxidants neutralize the damaging free radicals thus, they play important protective roles in the onset, progression and severity of the unmitigated generation of pollutants that ultimately manifest as oxidative stress. Consequently, human health as well as that of aquatic and terrestrial organisms may be protected from environmental pollution by mitigating oxidative stress and employing the principles of nutritional medicine, essentially based on antioxidants derived mainly from plants, which serve as the panacea of the vicious state of environmental pollutants consequently, the health of the population. Understanding the total picture of oxidative stress and integrating the terrestrial and aquatic effects of environmental pollutants are central to sustainable health of the population and appear to require multi-sectoral collaborations from diverse disciplinary perspectives; basically the environmental, agricultural and health sectors.

Guidance for planning, designing and running a HPV-based primary cervical cancer screening clinic in sub-Saharan Africa

Cervical cancer is an important healthcare problem in sub-Saharan Africa and emphasis should be placed on implementing and strengthening capacities for screening and treating precancerous lesions. The World Health Organization’s recommendation for low- and medium-income countries to accelerate cervical cancer elimination is human papillomavirus-based primary screening followed directly by treatment or by triage with visual inspection with acetic acid then followed by treatment. To promote these approaches in a community health-care facility, a structurally and functionally dedicated cervical cancer screening and treatment clinic is required. Publications with practical details are rare in literature, imposing a challenge in such planning. In order to provide a toolkit and guidance for health professionals who plan to set up such a clinic, we herein report our experiences in the implementation and running of a cervical cancer screening and treatment clinic adapted to a district level.

Implementing the HEART score in an NHS emergency department: can identity leadership combined with quality improvement promote racial equality?

PurposeThe purpose of this paper is to report on the dynamics of “identity leadership” with a quality improvement project undertaken by an International Medical Graduate (IMG) from Sri Lanka, on a two year Medical Training Initiative (MTI) placement in the National Health Service (NHS) [Academy of Medical Royal Colleges (AoMRC), 2017]. A combined MTI rotation with an integrated Fellowship in Quality Improvement (Subedi et al., 2019) provided the driver to implement the HEART score (HS) in an NHS Emergency Department (ED) in the UK. The project was undertaken across ED, Acute Medicine and Cardiology at the hospital, with stakeholders emphasizing different and conflicting priorities to improve the pathway for chest pain patients.Design/methodology/approachA social identity approach to leadership provided a framework to understand the insider/outsider approach to leadership which helped RH to negotiate and navigate the conflicting priorities from each departments’ perspective. A staff survey tool was undertaken to identify reasons for the lack of implementation of a clinical protocol for chest pain patients, specifically with reference to the use of the HS. A consensus was reached to develop and implement the pathway for multi-disciplinary use of the HS and a quality improvement methodology (with the use of plan do study act (PDSA) cycles) was used over a period of nine months.FindingsThe results demonstrated significant improvements in the reduction (60%) of waiting time by chronic chest pain patients in the ED. The use of the HS as a stratified risk assessment tool resulted in a more efficient and safe way to manage patients. There are specific leadership challenges faced by an MTI doctor when they arrive in the NHS, as the MTI doctor is considered an outsider to the NHS, with reduced influence. Drawing upon the Social Identity Theory of Leadership, NHS Trusts can introduce inclusion strategies to enable greater alignment in social identity with doctors from overseas.Research limitations/implicationsMore than one third of doctors (40%) in the English NHS are IMGs and identify as black and minority ethnic (GMC, 2019a) a trend that sees no sign of abating as the NHS continues its international medical workforce recruitment strategy for its survival (NHS England, 2019; Beech et al., 2019). IMGs can provide significant value to improving the NHS using skills developed from their own health-care system. This paper recommends a need for reciprocal learning from low to medium income countries by UK doctors to encourage the development of an inclusive global medical social identity.Originality/valueThis quality improvement research combined with identity leadership provides new insights into how overseas doctors can successfully lead sustainable improvement across different departments within one hospital in the NHS.

Fenofibrate, a drug for COVID-19? All we need to know

Fenofibrate, a cholesterol-lowering medication, also destabilizes the spike protein on SARS-CoV-2 and prevents it from attaching to human cells. It was efficacious even against SARS-CoV-2 variants investigated in vitro by the researchers.1 According to laboratory tests, a low-cost generic medication decreases SARS-CoV-2 contamination in human cells by up to 70%.2 One medicine that individuals used to regulate cholesterol levels might be an effective therapy against COVID-19, according to a multinational initiative comprising scientists from San Raffaele Scientific Institute in Milan, University of Birmingham, and the University of Keele in the United Kingdom. The study's findings will be published in the journal Frontiers in Pharmacology.1,2In the beginning, researchers tested a number of approved medicines on animals. For COVID-19 therapy, they were seeking medicines that disrupted interactions between the viral spike protein and human cell surface. Dr. Alan Richardson, a co-author of the study, told a source that they have evaluated above 100 medicines and discovered that fibric acids had the most potential. Fenofibrate proved to be a better alternative to clofibrate because of its unfavorable side effects.”3 Fenofibrate was developed by scientists in the 1980s, and it was frequently prescribed by Physicians to lower cholesterol levels in patients.2 It was incredibly popular, until statins were discovered, to reduce the risk of heart disease. Statins are currently taken by over 30 million people in the United States and throughout the world. Fenofibrate, on the other hand, is used by patients who cannot tolerate statins.4Currently, the medication is efficacious against the Beta and Alpha strains of SARS-CoV-2, and the team is researching its efficacy against the Delta variant nowadays. “\Resistance will be tougher to develop since the medication hits several targets, not only the spike protein, thus future variations should not be able to escape the effect.2 Fenofibrate was shown to be just as efficient against a live virus as the isolated protein.3 Dr. Farhat Khanim, a co-author of the paper, tested the medication against a live virus. She had high hopes for it. The scientists are cautiously and extremely enthusiastic about the possibilities. They further opined that we must not lose sight of the reality that there are high-risk categories of individuals for whom the vaccination will not function. In order to treat SARS-CoV-2, we must urgently increase our arsenal of medicines.4According to Dr. Khanim: “The medication appears to work, regardless of spike mutations.”4When infected cells were given fenofibrate in vitro, the researchers looked at the amount of virus that was released from them. When compared to untreated cells, they discovered that viral release was reduced by 60%. Statins, for example, did not have the same impact.5 Fascinatingly, fenofibrate can be taken orally and is extremely inexpensive, so if scientists duplicate the findings in clinical trials, it might be helpful for poor and medium-income countries that have struggled with vaccinations in the past. Fenofibrate is readily available, according to the estimates, a course of therapy would cost between £10 and £20.6If this in vitro result translates into a beneficial clinical impact, it may add another medication to our arsenal, according to Dr. Peter English. This is all theoretical at the moment, he says, because the medication hasn't been tested outside of the laboratory yet. The study's authors urge caution in interpreting their conclusions because they are based on laboratory experiments. For COVID-19, they are eager to begin clinical studies with fenofibrate.7As Dr. Khanim told, “I'd want to see clinical studies in high-risk people in the community with symptoms, initiating therapy early to see whether it reduces hospitalization.”2

How much does it cost to collect recyclable and residual waste in medium-income countries? A case study in the Chilean waste sector

ABSTRACT Improper municipal solid waste (MSW) management leads to contamination of water, soil and air with negative impacts on human health. Moreover, not dealing with residual waste has huge implications for meeting circular economy targets. Understanding how much it costs could lead to a better quality of service and boost environmental sustainability. This study estimates an input distance function using econometric techniques to measure the technical efficiency of the MSW sector in Chile. This approach further allows us to estimate the shadow price of residual waste in terms of total costs. The results indicated that the average technical efficiency of the waste sector was 0.592. This means that the potential savings in costs and residual waste among municipalities could be at the level of 40.8%. Large divergences among municipalities were found since efficiency scores ranged between 0.029 and 0.863. It is found that for 53% of the municipalities evaluated, efficiency scores varied between 0.61 and 0.80. On average, the cost of reducing residual waste was 81.10 US $ per kilogram. This means that on average the cost of preventing one more kilogram of residual waste not being collected and recycled was 81.10 US $. It was also found that on average as population density increased, the shadow price of residual waste increased as well.Implications: The study provides a methodology that allows the policy makers to estimate the efficiency of the solid waste sector where limited available statistical data usually exists in developing and medium-income countries. They have the opportunity to understand what drives costs and identify the best and worst performers. This information is essential to develop local initiatives to enhance waste recycling and therefore, achieving the targets established at national level. Managers can also see if there are other operating factors that could influence performance such as population density. The proposed methodology allows integrating other exogenous variables that might be interesting to policy makers. For instance, a tourism index could be included in the assessment to evaluate whether tourism impacts on the efficiency of municipalities in the provision of municipal solid waste services and therefore, to analyze the implementation of an eco-tax for tourists.

Investigating the effects of environmental taxes on economic growth: Evidence from empirical analysis in European countries

This paper empirically analyze the effects of environmental taxes on economic growth using data spanning the period 2009–2019 across 31 European countries (28 from the European Union, including the UK before Brexit, Iceland and Norway, which are candidates to join the EU, and Switzerland). The selected countries are also members of the European Environmental Agency countries (EEA-32). Baseline scenario with Pooled Ordinary Least Squares leads to the evidence that an increase of the environmental taxes in case of any tax policy reform will exacerbate economic growth. Robustness checks by introducing more control variables in response to omitted variables bias, coupling with GMM estimations that control for endogeneity concerns, consistently confirm the results. Deeping more with quantile analysis regression, a negative effect is confirmed in each quantile, and the results are significant at 1%. Nevertheless, there is a discrepancy between each quantile that allows highlighting evidence of countries’ threshold effects. In fact, low-income countries are more negatively affected than upper and medium-income countries. As the official communication of the EU Commission is always in demand of empirical research concerning the economic impacts of environmental policy instruments, the paper sheds light on the possibility of discussing and adapting the EU strategy based on a harmonization system. This evidence of differentiated effects among countries’ thresholds in the absence of any compensation may raise equity considerations within heterogeneous countries. Therefore, this paper fulfills the gaps in the inconclusive results in the existing literature. AcknowledgmentsAuthors would like to sincerely thank Ange Jusse Tchouto, Isaac Ketu, Arsene Mouongue Kelly for their invaluable support in this work, their helpful comments and suggestions on the previous draft of this paper. The usual disclaimer apply and views are the sole responsibility of the authors.

Identifying degrees of deprivation from space using deep learning and morphological spatial analysis of deprived urban areas

Many cities in low- and medium-income countries (LMICs) are facing rapid unplanned growth of built-up areas, while detailed information on these deprived urban areas (DUAs) is lacking. There exist visible differences in housing conditions and urban spaces, and these differences are linked to urban deprivation. However, the appropriate geospatial information for unravelling urban deprivation is typically not available for DUAs in LMICs, constituting an urgent knowledge gap. The objective of this study is to apply deep learning techniques and morphological analysis to identify degrees of deprivation in DUAs. To this end, we first generate a reference dataset of building footprints using a participatory community-based crowd-sourcing approach. Secondly, we adapt a deep learning model based on the U-Net architecture for the semantic segmentation of satellite imagery (WorldView 3) to generate building footprints. Lastly, we compute multi-level morphological features from building footprints for identifying the deprivation variation within DUAs. Our results show that deep learning techniques perform satisfactorily for predicting building footprints in DUAs, yielding an accuracy of F1 score = 0.84 and Jaccard Index = 0.73. The resulting building footprints (predicted buildings) are useful for the computation of morphology metrics at the grid cell level, as, in high-density areas, buildings cannot be detected individually but in clumps. Morphological features capture physical differences of deprivation within DUAs. Four indicators are used to define the morphology in DUAs, i.e., two related to building form (building size and inner irregularity) and two covering the form of open spaces (proximity and directionality). The degree of deprivation can be evaluated from the analysis of morphological features extracted from the predicted buildings, resulting in three categories: high, medium, and low deprivation. The outcome of this study contributes to the advancement of methods for producing up-to-date and disaggregated morphological spatial data on urban DUAs (often referred to as ‘slums’) which are essential for understanding the physical dimensions of deprivation, and hence planning targeted interventions accordingly.

A registry-based investigation of road traffic fatality risk factors using police data: A case study of Hyderabad, India

This study presents a comprehensive methodological approach for the identification and segmentation of the key risk factors associated with fatal road crashes. Hyderabad, an Indian metropolis with significant annual fatal crashes, is selected as the case study city. Data containing the date, time, and location of the crash, number of injuries and fatalities, accused and victim vehicle details are collected from Hyderabad Traffic Police, and a comprehensive registry-based crash database is developed. Based on the database, a Cross-sectional study is conducted, and risk ratio (RR) is used as a measure to test the association between the risk factors and fatal outcomes. Logistic regression, log-binomial regression, and robust Poisson regression models were also used to understand the association of fatal crash outcomes with different attributes. RR and associated confidence intervals are further used to classify the factors into three groups: significant, insignificant, and non-risk factors. Subsequently, the Apriori algorithm is used to determine the interrelationship/association between the risk factors leading to a fatal crash outcome. Using the Apriori algorithm, a set of association rules involving three factors leading to a significant number of fatal crashes are identified. Finally, the derived results are combined to segment the factors associated with fatal crashes into six specific segments: Very high, High, Moderate, Low, Very low, and Extremely Low-risk factors. Such identification and segmentation of potential risk factors associated with fatal crashes would help the planning agencies to formulate mitigation measures for a low and medium-income country (LMIC) like India.

Abstract #1180080: Adrenal Paracoccidioidomycosis. An infrequent etiology of Primary Adrenal Insufficiency

Primary adrenal insufficiency (PAI) is an uncommon entity. In developed countries the main cause is autoimmunity. In low- and medium-income countries infectious agents are the principal etiology. Paracoccidiomycosis (PCM) as an etiological agent of PAI is infrequent and is considered a fungus exclusive of South America. We describe a series of cases of four patients who presented PAI secondary to PCM.

Development of a UAV-Based Gamma Spectrometry System for Natural Radionuclides and Field Tests at Central Asian Uranium Legacy Sites

Uranium mining and processing had been widespread in Central Asia since the mid-1940s. However, with the establishment of the newly independent states in the 1990s, many of the former uranium mining and processing facilities and their associated wastes (dumps and tailings) were abandoned and have since posed a threat to the environment. The fact that the sites were left behind without proper remediation for a long time has led to the uncontrolled spread of radioactive and toxic contaminants in the environment due to landslides or flooding. Knowledge of the exact location of some waste facilities was lost as a result of social disruptions during the 1990s. In order to assess radiological risks and plan and implement adequate, sustainable, and environmental remediation measures, the radiological situation at the uranium legacy sites must be repeatedly mapped with the best possible accuracy in terms of both sensitivity and spatial resolution. In this paper, we present the experimental use of an unmanned aerial vehicle (UAV) equipped with gamma spectrometry systems as a novel tool for mapping, assessing, and monitoring radioactivity at sites affected by uranium mining and processing and other activities related to enhanced natural radioactivity. Special emphasis is put on the practical conditions of using UAV-based gamma spectrometry in an international context focusing on low- and medium-income countries. Challenges and opportunities of this technology are discussed, and its reliability and robustness under field conditions are critically reviewed. The most promising future application of the technology appears to be the radiological monitoring, institutional control, and quality assurance of legacy sites during and after environmental remediation. One-off administrative and logistical challenges of the technology are outweighed by the significant amount of time and cost saved once a UAV-based gamma spectrometry survey system is set up.

Ethnic Differences in the Prevalence of Hypertension in Colombia: Association With Education Level.

A higher prevalence of hypertension is reported among Afro-descendants compared with other ethnic groups in high-income countries; however, there is a paucity of information in low- and medium-income countries. We evaluated 3,745 adults from 3 ethnic groups (552 White, 2,746 Mestizos, 447 Afro-descendants) enrolled in the prospective population-based cohort study (PURE)-Colombia. We assessed associations between anthropometric, socioeconomic, behavioral factors, and hypertension. The overall prevalence of hypertension was 39.2% and was higher in Afro-descendants (46.3%) than in Mestizos (37.6%) and Whites (41.5%), differences that were due to the higher prevalence in Afro-descendant women. Hypertension was associated with older age, increased body mass index, waist circumference and waist-to-hip ratio, independent of ethnicity. Low education was associated with hypertension in all ethnic groups, and particularly in Afro-descendants, for whom it was the factor with the strongest association with prevalence. Notably, 70% of Afro-descendants had a low level of education, compared with 52% of Whites-26% of Whites were university graduates while only 7% of Afro-descendants were. We did not find that education level alone had a mediator effect, suggesting that it is not a causal risk factor for hypertension but is an indicator of socioeconomic status, itself an important determinant of hypertension prevalence. We found that a higher prevalence of hypertension in Colombian Afro-descendants than other ethnic groups. This was principally associated with their lower mean educational level, an indicator of lower socioeconomic status.

Study on the Effect of Bio-Based Materials’ Natural Degradation in the Environment

The article presents an analysis of the impact of bio-based materials on the environment, with a special focus on polylactic acid (PLA), as it is considered one of the most popular bioplastics in the market. The results show that there are several factors that must be taken into account when choosing the best end-of-life option for this type of material, in agreement with the newly introduced concept of the circular economy, according to the physical–chemical analysis obtained at the end of this study. The ecotoxicity tests showed that all tested materials (PLA spoon, PLA filament, b2w technology bag and cocoa paper tray) could be suitable for incineration with energy recovery without producing dioxines during combustion (chlorine content in all tested materials was below 1.00% w/w). It was also determined that PLA was the material with the highest potential for energy recovery since it presented the highest calorific value and highest carbon content (18.73 MJ/kg and 52.23%, respectively). The biodegradation rate of the different bio-based materials was also tested under different environments during three months, with Baltic Sea water and medium-grain sand being the environments in which the majority of the bio-based materials showed the lowest degradation rates. An additional test in a small-scale electric composter with microbe technology was carried out in order to evaluate the degradation of the studied materials in an environment with controlled conditions, and results showed high values of weight loss for the majority of the bio-based materials (all above 80% weight loss) due to the high temperature that the device could reach during the composting process. Finally, a strategy for providing guidance in selecting routes for the waste management of bioplastics, depending mainly on the available infrastructure and material properties, was proposed as a result of this work. For the case of low- and medium-income countries, an Extended Producer Responsibility (EPR) policy is proposed as a provisional solution to control plastic waste pollution, which should be complemented by regulations and systems aimed at the successful introduction of bioplastics.

Prevalence and correlates of meeting physical activity, screen time, and sleep duration guidelines among Brazilian adolescents: findings from ERICA.

The prevalence of meeting movement guidelines is low in developed countries; however, there is a lack of data among medium-income countries, including Brazil. We evaluated the prevalence and correlates of meeting physical activity, screen time, and sleep guidelines in Brazilian adolescents. Employing a cross-sectional design, Brazilian adolescents (aged 12-17years) were surveyed about their physical activity levels, sleep, and screen time. Data were collected at schools through a self-administered questionnaire using a personal digital assistant for entering the data. Poisson regression models were used to examine the associations between correlates (sex, age, socioeconomic status, region, skin colour, and shift of school) and meeting movement guidelines. A total of 58 535 adolescents were included. Although only 8.7% of the adolescents met all three movement guidelines, the prevalence of those who met physical activity, screen time, and sleep duration guidelines was 46.4%, 42.5%, and 40%, respectively. Moreover, male sex, age 14-15 years, black or brown skin colour, afternoon shift of school, and living in the Northern and Northeastern regions were associated with a higher prevalence of meeting all movement guidelines. The prevalence of adolescents who met all three movement guidelines was low among Brazilian adolescents. Adolescents living in less developed regions showed greater adherence to movement guidelines, suggesting a possible impact of the urbanization process on these behaviours. Novelty: The prevalence of Brazilian adolescents who met all three movement behaviour guidelines was around 9%. Among all adolescents, 40% met only one movement guideline.

A five-year prospective study of the Aetiology, Pattern of Presentation, and Management of patients with burns in Ekiti State University Teaching Hospital

Background: Burns constitute a significant public health problem worldwide, with most reported mortalities occurring in low and medium-income countries (LMICs). Therefore, this study aimed to generate epidemiological data on the aetiologies, patterns of presentations, and outcomes of burn injuries in Ado Ekiti, the capital of Ekiti State. Methodology: This was a five-year prospective study of all patients with burns managed at Ekiti State University Teaching Hospital. The required information was entered into a hospital-based burn data collection form from admission to discharge. The data generated were exported to IBM SPSS version 23 for analysis. Results: A total of 160 patients were included in this study. The median age was 10.5 years (IQR 2 – 33). Half of the patients were aged <10 years old. About 66.9% of the injuries occurred indoors, with the kitchen being the most common injury site (49.4%). Scald was the most common aetiology, and most injuries occurred in the morning. While 71.9% had first aid at the injury site, the first aid agents used were potentially harmful in most cases. The injuries were predominantly partial-thickness with a mean TBSA burn of 14% and a median ABSI of 4 (IQR 3 – 5). The lower limbs were the most frequently affected body regions, with an overall mortality rate of 5%. Conclusion: Scalds are the most common aetiology of burns in Ado Ekiti, with most injuries occurring in the kitchen. The populace needs to be adequately educated on the suitable materials to provide first aid to burn victims

Genotype-specific high-risk human papillomavirus infections and risk factors for cervical dysplasia in women with human immunodeficiency virus in Germany: results from a single-center cross-sectional study

ObjectiveWomen living with HIV have an increased risk of human papillomavirus (HPV) infection and cervical cancer. Little is known about genotype-specific HPV prevalence, the impact of antiretroviral therapy, immunological status,...

Hidradenitis suppurativa: racial and socioeconomic considerations in management.

Studies on hidradenitis suppurativa (HS) have found an increased prevalence of HS in skin of color and lower socioeconomic status patients, although the reasons for these differences are unclear. Demographic and therapeutic studies of HS originate primarily from developed Western countries, and data from low- and medium-income countries (LMIC) remain comparatively limited. In this review paper, we discuss differences in clinical presentation and comorbidities between racial and socioeconomic subpopulations and describe the genetic, biomedical, psychosocial, and ecological factors that may explain the associations between HS and skin of color and socioeconomic status. We highlight biomedical treatment considerations for LMIC including cost effective and less complex treatment strategies. We touch on population-based strategies to address the social determinants of health in HS management and discuss additional challenges arising from the COVID-19 pandemic.

FRAMEWORK FOR INTEGRATION OF VERTICAL PUBLIC HEALTH SUPPLY CHAIN SYSTEMS: A CASE STUDY OF NIGERIA


 
 
 
 
 FRAMEWORK FOR INTEGRATION OF VERTICAL PUBLIC HEALTH SUPPLY CHAIN SYSTEMS: A CASE STUDY OF NIGERIA
 
 Jibrailu L. Maliyogbinda, Sr and Usman Tijjani
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 FRAMEWORK FOR INTEGRATION OF VERTICAL PUBLIC HEALTH SUPPLY CHAIN SYSTEMS: A CASE STUDY OF NIGERIA
 Jibrailu L. Maliyogbinda, Sr.,
 1 (BPharm, MBA, MIAD, MSc., MCIPS, PMP), # 3 MAJILO Street, Plot 563 Kubwa Ext. 2 (Relocation), Abuja-FCT, Nigeria. jibrailu@outlook.com, +234(0)809 599 9911
 
 Usman Tijjani
 BSc. (Hons), MSc, MPH., Consultant of Monitoring, Evaluation & Learning (MEL) of Public Health Programs, # 8., Guava Road, Unguwan Dosa, Kaduna, Kaduna state. tijjaniusman100@gmail.com. +234(0)8065554283.
 Abstract
 Purpose: The purpose of this research study is to explore the opinion of public health supply chain experts in Nigeria on the modalities for the integration of vertical public health supply chain systems and to proffer a practical and systematic contextual framework for achieving a seamless integration of vertical supply chain systems in the public health sector.
 Methodology: This research study was a qualitative thematic content analysis of the views of fifteen respondents from the six geopolitical zones of Nigeria using an interpretive philosophical approach through the theoretical lens of constructivism. Respondents in this study had at least three years’ experience in the management of pharmaceuticals and other health products in one or more public health intervention programs including HIV/AIDS, Tuberculosis & Leprosy, Malaria, Reproductive Health and Family Planning, Vaccines and Immunisation, Neglected Tropical Diseases and Essential Medicines Programmes.
 Findings: The findings of the research study were based on a holistic and comprehensive approach that included cost benefit analysis, justifications, and circumstances for viable integration of vertical public health supply chain systems, which are relationship management, information integration, product integration and coordination called the four modalities/dimensions/practices of supply chain integration and need to exist in a continuum driven by purposeful leadership. Even though the data collected through semi-structured interviews did not allow for differing views among respondents, the opportunity to freely express one’s opinion resulted in a rich data. Going forward, the government and its development partners need to demonstrate political and financial commitment to the course of integrating vertical public health supply chain systems in the country. The research study for the first time presented a practical and contextual framework for the seamless integration of public health supply chain systems, especially for low- and medium-income countries.
 Unique contribution to theory, practice, and policy: This research study contributes to the integration of vertical public health supply chain system in Nigeria and proffer practical and systematic contextual framework for achieving a seamless integration of vertical supply chain systems in the public health.

Natural Resource Rents and Social Capital Interaction: New Evidence on the Role of Financial Development

The varied opinions on financial developmental impacts on growth in different economies have been the subject of considerable debates among economists during the last two decades, especially in natural-resource-rich countries. However, the role of financial development on a crucial channel of growth, i.e. social capital, has been neglected. Unlike previous studies, the level of income in resource-based economies has been considered an important factor influencing the way financial development affects social capital-resource rents’ interactions. Thus, in this paper, the impact of financial development as an infrastructure to turn natural capital into social capital has been investigated in two groups of resource-abundant countries using a panel data model during 2009:Q1-2016:Q4. The empirical results in the case of high-income economies show that a high level of financial development can ensure resource rents, positively influencing social capital. However, findings indicate an adverse impact of natural resource rents on social capital in medium-income countries.