Middle-income Countries In Asia Research Articles

Infectious etiologies of persistent and chronic diarrhea in Asian developing countries: A systematic review and meta-analysis.

Infectious causes of diarrhea contribute significantly to morbidity in Asia. We conducted a systematic review and meta-analysis of the prevalence of infectious etiologies of persistent and chronic diarrhea in Asian adults. Searches were performed on PubMed and Scopus for studies from January 1, 1970, to May 30, 2023. Sixteen studies were identified and included. The meta-analysis was conducted with the random-effects method, estimating the pooled prevalence of groups of infectious pathogens as causes of persistent and chronic diarrhea among Asian adults. The findings were highly heterogeneous and indicative of publication bias. The majority of studies were conducted on persons living with human immunodeficiency virus infection (PLHIV). The studies were predominantly from low-income and middle-income Asian countries. The most common cause was parasitic, with a pooled prevalence of 0.52 (95% confidence interval 0.28-0.65, I2=99%, Cochran's Q=1027.44, P<0.01), followed by bacterial, fungal, and viral causes, which were substantially rarer. Negative microbiological testing was also common, with a pooled prevalence for a negative test being 0.37 (95% confidence interval 0.17-0.52, I2=99%, Cochran's Q=1027.44, P<0.01). Subgroup analyses of studies conducted among PLHIV, from year 2000 and among those conducted in Southeast Asia showed a similar prevalence of parasitic causes of diarrhea. In conclusion, inAsian adults with persistent and chronic diarrhea, parasitic causes were most prevalent. However, the estimate of true prevalence is limited by significant heterogeneity among the available studies. More study in this field is required, especially examining PLHIV in the post-antiretroviral therapy era and from high-income countries.

The impact of economic globalization on income inequality in middle-income countries in Asia: An empirical analysis from 2018 to 2021

This study investigates the relationship between economic globalization and income inequality in Asia during the period from 2018 to 2021. The research aims to contribute to the academic and policy debates on the impact of globalization on income inequality and to identify effective policy measures that can help mitigate the negative effects of globalization on income distribution in Asian countries. In this study, the relationship between income inequality and economic globalization is analyzed using the Random Effects Model (REM) and Generalized Least Squares (GLS) estimation to address the issues of auto-correlated errors and heteroscedasticity in the selected model. The study utilizes secondary data from the World Bank about 28 middle-income countries in Asia, spanning the period from 2018 to 2021, the International Monetary Fund, and the United Nations Development Program. The results of the study indicate that economic globalization is positively correlated with income inequality. The findings of this study provide insights and recommendations that can help policymakers, academics, and other stakeholders better understand the complex relationship between economic globalization and income inequality and identify strategies for promoting more equitable economic growth and development in Asia.

A descriptive study of stroke types, risk factors, clinical features, and outcomes in a tertiary hospital in Myanmar

BackgroundStroke is a leading cause of death in the world, and the burden of stroke is higher in low- and middle-income countries. Understanding the risk factors, complications, and outcomes of stroke are useful for healthcare planning and resource allocation. Little information on stroke is available for many low- and middle-income Asian countries; including Myanmar, which is the focus of this study.MethodsA review was conducted of medical records for stroke admissions during 2017 in a tertiary hospital in Myanmar. The final diagnoses, risk factors, clinical features, complications, and outcomes were systematically collected from computer- and paper-based medical records.ResultsOf 908 cases analysed, haemorrhagic stroke was the most common type (49%), followed by ischaemic stroke (43%). Unimproved cases were 32%. Identified risk factors of unimproved cases were ‘haemorrhagic stroke’ [adjusted odds ratio (aOR): 1.73], ‘having fever during hospitalization’ [aOR: 2.49], ‘Glasgow Coma Scale (GCS) at the admission between 9 and 14’ [aOR: 4.33], and GCS less than 9 [aOR: 42.86].ConclusionThis study is based on hospital medical records to assess stroke types, risk factors, clinical features, and outcomes in a tertiary hospital, in Nay Pyi Daw, Myanmar. The findings indicated that early case admission, improved hospital care management, and increased awareness of the modifiable risk factors within populations are crucial for preventing stroke incidents.

The Impact of Dementia on the Psychosocial Well-Being of Informal Caregivers in Asia: A Scoping Review Comparing High-Income and Low–Middle-Income Countries

The need for informal caregiving has become a crucial topic for researchers and policymakers. This review explores the psychosocial impact on caregivers providing dementia care in high-income and low–middle-income Asian countries. A scoping review was undertaken following the Joanna Briggs Institute (JBI) protocol. A systematic search of four databases (PubMed, ProQuest, Medline, and Medline Complete) was conducted. Articles were screened following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Fourteen articles (11 cross-sectional, 1 longitudinal, 1 case-control, and 1 descriptive phenomenological study) were selected for the final analysis. The most frequently reported findings from low–middle-income countries were dementia caregivers working longer hours and experiencing financial issues, poor physical health, and lower life satisfaction, which progressively and collectively affected caregivers’ psychosocial well-being and quality of life. However, the impact was less significant in high-income Asian countries, particularly those where efforts are being made to identify the burdens associated with caring for people with dementia and providing appropriate support. This review demonstrates clear evidence that caring for people with dementia may affect informal caregivers’ quality of life, particularly in low–middle-income Asian countries. Systematic reviews and meta-analyses may be needed to confirm these findings.

Early to mid-pregnancy HbA1c levels and its association with adverse pregnancy outcomes in three low middle-income countries in Asia and Sub-Saharan Africa

BackgroundHyperglycemia during pregnancy leads to adverse maternal and fetal outcomes. Thus, strict monitoring of blood glucose levels is warranted. This study aims to determine the association of early to mid-pregnancy HbA1c levels with the development of pregnancy complications in women from three countries in South Asia and Sub-Saharan Africa.MethodsWe performed a secondary analysis of the AMANHI (Alliance for Maternal and Newborn Health Improvement) cohort, which enrolled 10,001 pregnant women between May 2014 and June 2018 across Sylhet-Bangladesh, Karachi-Pakistan, and Pemba Island-Tanzania. HbA1c assays were performed at enrollment (8 to < 20 gestational weeks), and epidemiological data were collected during 2–3 monthly household visits. The women were followed-up till the postpartum period to determine the pregnancy outcomes. Multivariable logistic regression models assessed the association between elevated HbA1c levels and adverse events while controlling for potential confounders.ResultsA total of 9,510 pregnant women were included in the analysis. The mean HbA1c level at enrollment was found to be the highest in Bangladesh (5.31 ± 0.37), followed by Tanzania (5.22 ± 0.49) and then Pakistan (5.07 ± 0.58). We report 339 stillbirths and 9,039 live births. Among the live births were 892 preterm births, 892 deliveries via cesarean section, and 532 LGA babies. In the multivariate pooled analysis, maternal HbA1c levels of ≥ 6.5 were associated with increased risks of stillbirths (aRR = 6.3, 95% CI = 3.4,11.6); preterm births (aRR = 3.5, 95% CI = 1.8–6.7); and Large for Gestational Age (aRR = 5.5, 95% CI = 2.9–10.6).ConclusionMaternal HbA1c level is an independent risk factor for predicting adverse pregnancy outcomes such as stillbirth, preterm birth, and LGA among women in South Asia and Sub-Saharan Africa. These groups may benefit from early interventional strategies.

Descriptive analysis to assess seasonal patterns of COVID-19 and influenza in low-income and middle-income countries in Asia, the Middle East and Latin America

ObjectivesUnderstanding disease seasonality can help predict the occurrence of outbreaks and inform public health planning. Respiratory diseases typically follow seasonal patterns; however, knowledge regarding the seasonality of COVID-19 and its...

Capturing Data on Antimicrobial Resistance Patterns and Trends in Use in Regions of Asia (CAPTURA).

In 2015, the UK government established the Fleming Fund with the aim to address critical gaps in surveillance of antimicrobial resistance (AMR) in low- and middle-income countries in Asia and Africa. Among a large portfolio of grants, the Capturing Data on Antimicrobial Resistance Patterns and Trends in Use in Regions of Asia (CAPTURA) project was awarded with the specific objective of expanding the volume of historical data on AMR, consumption (AMC), and use (AMU) in the human healthcare sector across 12 countries in South and Southeast Asia. Starting in early 2019, the CAPTURA consortium began working with local governments and >100 relevant data-holding facilities across the region to identify, assess for quality, prioritize, and subsequently retrieve data on AMR, AMC, and AMU. Relevant and shared data were collated and analyzed to provide local overviews for national stakeholders as well as regional context, wherever possible. From the vast information resource generated on current surveillance capacity and data availability, the project has highlighted gaps and areas for quality improvement and supported comprehensive capacity-building activities to optimize local data-collection and -management practices. The project has paved the way for expansion of surveillance networks to include both the academic and private sector in several countries and has actively engaged in discussions to promote data sharing at the local, national, and regional levels. This paper describes the overarching approach to, and emerging lessons from, the CAPTURA project, and how it contributes to other ongoing efforts to strengthen national AMR surveillance in the region and globally.

Methodological Approach to Identify and Expand the Volume of Antimicrobial Resistance (AMR) Data in the Human Health Sector in Low- and Middle-Income Countries in Asia: Implications for Local and Regional AMR Surveillance Systems Strengthening.

Antimicrobial resistance (AMR) is a multifaceted global health problem disproportionately affecting low- and middle-income countries (LMICs). The Capturing data on Antimicrobial resistance Patterns and Trends in Use in Regions of Asia (CAPTURA) project was tasked to expand the volume of AMR and antimicrobial use data in Asia. The CAPTURA project used 2 data-collection streams: facility data and project metadata. Project metadata constituted information collected to map out data sources and assess data quality, while facility data referred to the retrospective data collected from healthcare facilities. A down-selection process, labelled "the funnel approach" by the project, was adopted to use the project metadata in prioritizing and selecting laboratories for retrospective AMR data collection. Moreover, the metadata served as a guide for understanding the AMR data once they were collected. The findings from CAPTURA's metadata add to the current discourse on the limitation of AMR data in LMICs. There is generally a low volume of AMR data generated as there is a lack of microbiology laboratories with sufficient antimicrobial susceptibility testing capacity. Many laboratories in Asia are still capturing data on paper, resulting in scattered or unused data not readily accessible or shareable for analyses. There is also a lack of clinical and epidemiological data captured, impeding interpretation and in-depth understanding of the AMR data. CAPTURA's experience in Asia suggests that there is a wide spectrum of capacity and capability of microbiology laboratories within a country and region. As local AMR surveillance is a crucial instrument to inform context-specific measures to combat AMR, it is important to understand and assess current capacity-building needs while implementing activities to enhance surveillance systems.

Perceived Urban Design Across Urban Typologies in Hanoi

In light of the rapid global urbanization, urban design has been shown to contribute largely to promoting the health and well-being of urban citizens. However, studies of urban design are underrepresented in low- and middle-income countries in Asia, where urban forms are traditionally compact and complex with multiple layers. Hanoi, a typical city in low- and middle-income countries, exhibits five unique urban typologies generated through official planning, unregulated development, and historical fluctuations. This study examines the perceived urban design from a sample of 218 participants across five urban typologies in Hanoi using an established scale. The findings suggest that perceived urban design is significantly influenced by urban typologies. Old urban typologies tend to report higher scores of land use mix and access to services but lower scores of walking facilities and street connectivity than modern urban typologies. The study contributes to our understanding of urban design in Hanoi, providing policymakers and urban designers with essential insights for sustainable urban development.

Relationship between BMI and prognosis of chronic heart failure outpatients in Vietnam: a single-center study

BackgroundInsufficient data exists regarding the relationship between body mass index (BMI) and the prognosis of chronic heart failure (CHF) specifically within low- and middle-income Asian countries. The objective of this study was to evaluate the impact of BMI on adverse outcomes of ambulatory patients with CHF in Vietnam.MethodsBetween 2018 and 2020, we prospectively enrolled consecutive outpatients with clinically stable CHF in an observational cohort, single-center study. The participants were stratified according to Asian-specific BMI thresholds. The relationships between BMI and adverse outcomes (all-cause death and all-cause hospitalization) were analyzed by Kaplan–Meier survival curves and Cox proportional-hazards model.ResultsAmong 320 participants (age 63.5 ± 13.3 years, 57.9% male), the median BMI was 21.4 kg/m2 (IQR 19.5–23.6), and 10.9% were underweight (BMI &amp;lt;18.50 kg/m2). Over a median follow-up time of 32 months, the cumulative incidence of all-cause mortality and hospitalization were 5.6% and 19.1%, respectively. After multivariable adjustment, underweight patients had a significantly higher risk of all-cause mortality than patients with normal BMI (adjusted hazard ratios = 3.03 [95% CI: 1.07–8.55]). Lower BMI remained significantly associated with a worse prognosis when analyzed as a continuous variable (adjusted hazard ratios = 1.27 [95% CI: 1.03–1.55] per 1 kg/m2 decrease for all-cause mortality). However, BMI was not found to be significantly associated with the risk of all-cause hospitalization (p &amp;gt; 0.05).ConclusionIn ambulatory patients with CHF in Vietnam, lower BMI, especially underweight status (BMI &amp;lt; 18.5 kg/m2), was associated with a higher risk of all-cause mortality. These findings suggest that BMI should be considered for use in risk classification, and underweight patients should be managed by a team consisting of cardiologists, nutritionists, and geriatricians.

64P Unmet needs following metastatic breast cancer in a middle-income Asian country

64P Unmet needs following metastatic breast cancer in a middle-income Asian country

Needs of older people living with dementia in low and middle-income Asian countries: A scoping review.

Population ageing in low and middle-income Asian countries is associated with increased prevalence of dementia. The proportion of people with dementia in countries such as Bangladesh and Thailand are increasing. People with dementia can have complex care and health service needs. If these needs are not adequately met, this can result in a decreased quality of life and burden on the health system. There is considerable research into the needs of people with dementia in high-income countries. However, research on the needs of people living with dementia in low and middle-income countries remains underexplored. The aim of this study was to review and summarise the literature on the health and social care needs of older people with dementia in low and middle-income Asian countries. Five online databases (PubMed, Scopus, Web of Science, CINAHL and PsycINFO) and google scholar were searched. The databases were searched using a selection of key words. PRISMA-ScR approach was followed in reporting the process. We extracted eight studies related to the health and social care needs of people with dementia that met our inclusion criteria. From the available literature, needs were categorised across five categories: (i) social, cognitive, and mental health needs; (ii) physical needs; (iii) care and service needs; (iv) knowledge-related needs; and (v) spiritual care needs. While eight papers were located which discussed the needs of people with dementia across a range of domains, this review demonstrates a deficit in the current evidence-base about the health and social care needs of people living with dementia in low and middle-income Asian countries. Further research is needed to identify health and care needs of people with dementia and how these needs are being met.

Killing Protests with Kindness: Anti-China Protests and China's Public Diplomacy

Abstract Anti-China protests have posed challenges to China's ambition to further expand its political and economic influence globally. How does Beijing respond to anti-China protests? And how do anti-China protests affect Beijing's use of public diplomatic resources? We address these questions by examining the effect of anti-China protests on China's public diplomatic engagement across low- and middle-income countries in Asia. We argue that anti-China protests lead to an increased level of non-financial public diplomatic engagement (e.g., elite visits) as well as financial engagement through foreign aid. We further argue that the effect of anti-China protests on increasing public diplomatic engagement is contingent on regime type. This is because China takes the anti-China message from autocracies more seriously given the higher political costs of participating in public protests in autocracies. Compared to democracies, autocracies are also in a better position to use anti-China protests as a means to signal their political constraints, compelling China to invest more public diplomatic resources for the countries.

Association of Ambient Temperature With the Prevalence of Intimate Partner Violence Among Partnered Women in Low- and Middle-Income South Asian Countries

Intimate partner violence (IPV), including physical, sexual, and emotional violence, constitutes a critical public health problem, particularly in low- and middle-income countries. While climate change could escalate violent events, data quantifying its possible association with IPV are scant. To evaluate the association of ambient temperature with the prevalence of IPV among partnered women in low- and middle-income countries in South Asia, and to estimate the association of future climate warming with IPV. This cross-sectional study used data from the Demographic and Health Survey and included 194 871 ever-partnered women aged 15 to 49 years from 3 South Asian countries (India, Nepal, and Pakistan). The study applied the mixed-effect multivariable logistic regression model to investigate the association of ambient temperature with IPV prevalence. The study further modeled the change in IPV prevalence under various future climate change scenarios. The data included in the analyses were collected from October 1, 2010, to April 30, 2018, and the current analyses were performed from January 2, 2022, to July 11, 2022. Annual ambient temperature exposure for each woman, estimated based on an atmospheric reanalysis model of the global climate. The prevalence of IPV and its types (physical, sexual, and emotional violence) were assessed based on self-reported questionnaires from October 1, 2010, to April 30, 2018, and the changes in the prevalence with climate changes were estimated through the 2090s. The study included 194 871 ever-partnered women aged 15 to 49 years (mean [SD] age, 35.4 [7.6] years; overall IPV prevalence, 27.0%) from 3 South Asian countries. The prevalence of physical violence was highest (23.0%), followed by emotional (12.5%), and sexual violence (9.5%). The annual temperature ranges were mostly between 20 °C and 30 °C. A significant association was found between high ambient temperature and the prevalence of IPV against women, with each 1 °C increase in the annual mean temperature associated with a mean increase in IPV prevalence of 4.49% (95% CI, 4.20%-4.78%). According to the study's projections under the unlimited emissions scenarios (SSPs [shared socioeconomic pathways], as defined by the Intergovernmental Panel on Climate Change] 5-8.5), IPV prevalence would increase by 21.0% by the end of the 21st century, while it would only moderately increase under increasingly stricter scenarios (SSP2-4.5 [9.8%] and SSP1-2.6 [5.8%]). In addition, the projected increases in the prevalence of physical (28.3%) and sexual (26.1%) violence were greater than that of emotional violence (8.9%). In the 2090s, India was estimated to experience the highest IPV prevalence increase (23.5%) among the 3 countries, compared with Nepal (14.8%) and Pakistan (5.9%). This cross-sectional, multicountry study provides ample epidemiological evidence to support that high ambient temperature may be associated with the risk of IPV against women. These findings highlight the vulnerabilities and inequalities of women experiencing IPV in low- and middle-income countries in the context of global climate warming.

Multi-dimensional Feasibility of Bangladesh’s Solar Power Target

The declining cost of solar technology and declaration of Japan, China, and Korea to not invest in new coal power plants has opened up new possibilities for the expansion of solar deployment worldwide. Bangladesh has also scrapped the plan to build new coal power plant like many other lower middle-income countries in Asia. However, the lower middle-income countries were not able to take the opportunity of the declining solar cost in last one decade and the growth of solar remained in the formative phase for most of the developing countries. Bangladesh has already missed the target to generate 10% from renewable by the year 2020. The increasing emphasis on solar globally and locally has pushed the government to set ambitious targets without considering the techno-economic, socio-technical, and political feasibility of solar. This research has used process tracing based on policy documents and interviews to explore the mechanisms through which solar deployment grew slowly in Bangladesh. Then, this paper found out the feasible, moderately feasible, ambitious, and highly ambitious solar targets of Bangladesh and identified the factors that can increase the multi-dimensional feasibility of solar targets. It shows that market mechanism alone cannot increase feasibility of the target and argues that socio-technical and political feasibility must also be considered in setting realistic target.&#x0D; Journal of the Asiatic Society of Bangladesh (Hum.), Vol. 68(1), 2023, pp.33-56

The Growing Burden of Cancer in Adolescent and Young Adults in Asia: A Call to Action.

Recent estimates suggest that the lower middle income countries in Asia carry the heaviest burden of cancer among adolescents and young adults (AYAs) (defined as age 15-39 years). A larger proportion of the population in Asia is aged 15-39 compared with the developed countries. This age group is different from the pediatric or the adult group in terms of physical, social, psychological, and financial needs. Cancer incidence, disability, survivorship needs, financial toxicity, psychosocial issues, and so on are underestimated in this group, and available literature is scarce. Global data show an increasing trend of adult-onset cancers such as colorectal, breast, pancreas, and lung in the AYA population. Data suggest that the disease biology and prognosis are different in this group; however, further research is needed. An ESMO/SIOPE/SIOP Asia survey on the care of AYA cancer patients in Asia found a suboptimal availability of AYA specialized centers in the region and identified several unmet needs including lack of training, clinical trials, and high rates of treatment abandonment. There is an urgent need for cancer care systems in Asia to develop specialized services to be able to cater to this growing burden. Training and research in this area also need to be upscaled with the goal of establishing a sustainable infrastructure and quality services to ensure that this vulnerable group receives appropriate care. Management guidelines and national health policies should consider giving special attention to this group as the World Health Assembly reinforces the inclusion of children and adolescents in cancer control programs.

Effect of Structural Break on Financial Development and Economic Growth Nexus in Middle-Income Countries in Asia: Moderating Role of Technological Advancements

Asian countries have experienced many financial catastrophes and pandemics in the past couple of decades. Therefore, evaluating the effect of structural breaks on economies has taken substantive attention in the empirical literature. Thus, this study aims to investigate the effect of structural breaks on the Financial Development (FD) and Economic Growth (EG) of middle-income countries in Asia. The study considered the global financial crisis of 2008 as a key structural break. The sample consisted of 24 middle-income countries while the sample period was 20 years from 2000 to 2019. Technological Advancement was considered a moderator variable that facilitate the smooth functioning of the FD and EG. Structural Break was identified using the "xtbreak" function and the effect was analyzed with panel unit root, panel homogeneity test and short panel cointegration. The findings revealed that before the structural break, FD and moderator variables were the only significant variables but after the structural breaks, Human Capita and Private Consumption also have become significant. FD had a significant negative influence over EG before and after the structural break but the moderator variable had a positive influence. HC was not a significant factor before the structural break but has become significant after the economic downturn with a positive influence on EG. In contrast, PC shows a negative influence after the structural breaks. Hence, it guides the policymakers to decide on reducing investments for FD and direct funds to HC development and developing the technology. Moreover, they must consider making policy decisions to reduce PC.

Achieving Impact: Charting the Course to Meet the Challenges Ahead at the 12th International Conference on Typhoid and Other Invasive Salmonelloses.

Typhoid fever and other invasive salmonelloses remain a major public health concern, primarily in low- and middle-income countries in Asia and Africa, where transmission occurs through contaminated food or water. However, recent developments in research, policy, and implementation offer newfound optimism for prevention and control. Now, more than ever, a coordinated and multisectoral global response is needed. To chart the course to meet the challenges ahead, the Coalition against Typhoid, housed at the Sabin Vaccine Institute, virtually organized the 12th International Conference on Typhoid and Other Invasive Salmonelloses from December 7 to 9, 2021. This commentary provides an overview of the conference's significant findings, highlighting barriers and opportunities for prevention and control. Topics covered include diagnostics advancements, improved data methodologies for a better understanding of the disease burden, the incorporation of environmental surveillance and genomics, the threat of drug resistance, and the use of typhoid conjugate vaccines alongside other integrated solutions.

Investigating the Interplay Among Energy Consumption, Environmental Quality, and Health Status in Low- and Middle-Income Asian Countries

Investigating the Interplay Among Energy Consumption, Environmental Quality, and Health Status in Low- and Middle-Income Asian Countries

""On Being Sane in Insane Places" … it is a work half done."

""On Being Sane in Insane Places" … it is a work half done."