Middle-income Countries In South Asia Research Articles

Managing Gender Inclusive, Just Energy Transitions in South Asia

Abstract The demand for a Just Transition is gaining momentum internationally and has important implications for the energy and power sectors. This paper draws on over ten years of practice integrating gender equality and social inclusion considerations in the energy and power sectors in low and middle-income countries in South Asia and examines just transitions in the energy and power sectors with a focus on gender equality. It includes a brief history of just transition frameworks. The paper outlines the energy transition in South Asia, including progress towards net zero based on countries Nationally Determined Contributions and some country strategies for integrating gender elements. It includes a brief energy audit which examines trends towards the incorporation of greater shares of renewables over the past two decades, the gender related implications of distributed generation and demand side participation and the gender related impacts on employment. Drawing on this landscape, the paper goes on to examine the transformation of the energy sector in the Maldives as a case study, with a focus on gender considerations and draws out some key lessons for a gender inclusive just energy transition. The paper then proposes a gender and socially inclusive domains framework to guide policy and planning.

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.

Evaluation of the impact of continuous Kangaroo Mother Care (KMC) initiated immediately after birth compared to KMC initiated after stabilization in newborns with birth weight 1.0 to < 1.8 kg on neurodevelopmental outcomes: Protocol for a follow-up study

BackgroundPreterm birth or low birth weight is the single largest cause of death in newborns, however this mortality can be reduced through newborn care interventions, including Kangaroo Mother Care (KMC). Previously, a multi-country randomized controlled trial, coordinated by the World Health Organization (WHO), reported a significant survival advantage with initiation of continuous KMC immediately after birth compared with initiation of continuous KMC a few days after birth when the baby is considered clinically stable.Whether the survival advantage would lead to higher rates of neurodevelopmental morbidities, or the immediate KMC will also have a beneficial effect on cognitive development also, has not been investigated. We therefore propose to test the hypothesis that low-birth-weight infants exposed to immediate KMC will have lower rates of neurodevelopmental impairment in comparison to traditional KMC-treated infants, by prospectively following up infants already enrolled in the immediate KMC trial for the first 2 years of life, and assessing their growth and neurodevelopment.MethodsThis prospective cohort study will enroll surviving neonates from the main WHO immediate KMC trial. The main trial as well as this follow-up study are being conducted in five low- and middle-income countries in South Asia and sub-Saharan Africa. The estimated sample size for comparison of the risk of neurodevelopmental impairment is a total of 2200 children. The primary outcome will include rates of cerebral palsy, hearing impairment, vision impairment, mental and motor development, and epilepsy and will be assessed by the age of 3 years. The analysis will be by intention to treat.DiscussionImmediate KMC can potentially reduce low-birth-weight-associated complications such as respiratory disease, hypothermia, hypoglycemia, and infection that can result in impaired neurocognitive development. Neuroprotection may also be mediated by improved physiological stabilization that may lead to better maturation of neural pathways, reduced risk of hypoxia, positive parental impact, improved sleep cycles, and improved stress responses. The present study will help in evaluating the overall impact of KMC by investigating the long-term effect on neurodevelopmental impairment in the survivors.Trial registrationClinical Trials Registry-India CTRI/2019/11/021899. Registered on 06 November 2019.Trials registration of parent trial: ACTRN12618001880235; Clinical Trials Registry-India: CTRI/2018/08/015369.

Respiratory distress syndrome management in resource limited settings-Current evidence and opportunities in 2022.

The complications of prematurity are the leading cause of neonatal mortality worldwide, with the highest burden in the low- and middle-income countries of South Asia and Sub-Saharan Africa. A major driver of this prematurity-related neonatal mortality is respiratory distress syndrome due to immature lungs and surfactant deficiency. The World Health Organization's Every Newborn Action Plan target is for 80% of districts to have resources available to care for small and sick newborns, including premature infants with respiratory distress syndrome. Evidence-based interventions for respiratory distress syndrome management exist for the peripartum, delivery and neonatal intensive care period- however, cost, resources, and infrastructure limit their availability in low- and middle-income countries. Existing research and implementation gaps include the safe use of antenatal corticosteroid in non-tertiary settings, establishing emergency transportation services from low to high level care facilities, optimized delivery room resuscitation, provision of affordable caffeine and surfactant as well as implementing non-traditional methods of surfactant administration. There is also a need to optimize affordable continuous positive airway pressure devices able to blend oxygen, provide humidity and deliver reliable pressure. If the high prematurity-related neonatal mortality experienced in low- and middle-income countries is to be mitigated, a concerted effort by researchers, implementers and policy developers is required to address these key modalities.

The role of cardiovascular risk assessment in addressing prevention of cardiovascular disease and cardiovascular complications of diabetes in South Asia

In the face of the rising incidence of cardiovascular diseases (CVD) and diabetes in low-income and middle-income countries in South Asia, the most cost-effective and equitable strategies for prevention of heart attacks, strokes and vascular complications of diabetes need to be incorporated into primary care services. Health system and resource limitations in these countries call for directing preventive services and pharmacological treatment to people with high cardiovascular risk, identified by risk stratification using hypertension and diabetes as entry points. Absolute cardiovascular risk prediction scores should be used routinely in primary care. Individual management guidelines for hypertension, dyslipidemia and diabetes need to be replaced by integrated and simplified cardiovascular risk management guidelines.

Depression and Diabetes Distress in South Asian Adults Living in Low- and Middle-Income Countries: A Scoping Review

ObjectivesIn this study, we conducted a scoping review to identify the prevalence of both depression and diabetes distress in patients with type 2 diabetes in low- and middle-income countries in South Asia. MethodsThis scoping review was grounded in the methodology of Arksey and O’Malley by searching for relevant studies using Ovid MEDLINE, PsycINFO and Cumulative Index of Nursing and Allied Health Literature databases, as well as grey literature sources and hand searches. Two reviewers independently screened and extracted data from articles that met the inclusion criteria. ResultsA total of 46 studies were included, with only 1 addressing both depression and diabetes distress. We present 42 total articles on depression and 5 on diabetes distress. The prevalence of type 2 diabetes and elevated depressive symptoms ranged from 11.6% to 67.5%, whereas the prevalence of diabetes distress ranged from 18.0% to 76.2%. ConclusionsThe prevalence of elevated depressive symptoms was found to be much higher than that reported in data from high-income countries and in data on South Asians living in high-income countries. Diabetes distress was found to be lower compared with other studies; however, the scarcity of data makes this observation inconclusive. Variations in depression inventories, lack of culturally tailored inventories and the focus on urban clinic-based populations are identified as limitations and areas requiring further research. Our review provides evidence for the need of increased mental health screening and treatment in diabetes care in South Asian countries.

Linkages between Financial Development and Economic Growth in the Middle-Income Countries of South Asia: A Panel Data Investigation

The present study intends to investigate the impact of financial sector development on GDP growth in the four middle-income countries of South Asia over the period of 1990–2016. Using pooled mean group (PMG) estimation, this study tries to examine whether in these developing countries, GDP growth has been influenced by size of market capitalization and size of market turnover in the long run which are used as proxy for stock market development. Similarly, domestic credit to private sector is used as proxy for banking sector development while assessing its long-run impact on GDP growth. Furthermore, by incorporating a dummy variable for the global financial crisis (2007–2008), this study investigates whether these economies are vulnerable to external shocks or not. The outcomes of this study find that relatively, the impact of banking sector on GDP growth has remained low in the region. Nevertheless, the development in both sectors has positively influenced economic growth in the long run. The outcomes of this study suggest that both, i.e. stock market and banking sector, are vital determinants of long-run economic growth in the South Asian countries. Therefore, to achieve the sustainable growth, policymakers need to adopt the global approach which can be ensured by improving the quality and scope of financial services in these countries.

Strategies for optimising antenatal corticosteroid administration for women with anticipated preterm birth.

Strategies for optimising antenatal corticosteroid administration for women with anticipated preterm birth.

A population-based analysis of suicidality and its correlates: findings from the National Mental Health Survey of India, 2015–16

India accounts for 18% of the global population and 26·6% of global suicide deaths. However, robust population-based, nationally representative data on suicidality are not readily available to plan and implement suicide prevention programmes in India. We aimed to investigate the prevalence and sociodemographic differentials of suicidality using data from the National Mental Health Survey (NMHS) of India, 2015-16. Trained field data collectors from the NMHS obtained information on suicidality (during the past month) from a community sample of adults aged 18 years and older using the suicidality module of the Mini-International Neuropsychiatric Interview (version 6.0). Suicidality was categorised as low, moderate, high, and overall (representing any suicidality), and examined for sociodemographic differentials using normalised sampling weights. For each of the 12 surveyed states, we calculated the age-standardised suicidality prevalence for men and women, men-to-women ratio of weighted suicidality prevalence, ratio of suicidality to suicide deaths, and ratio of suicide attempts to suicide deaths. We used logistic regression analysis to examine the association between sociodemographic factors and overall suicidality and severity. Among 34 748 participants with complete interviews, 5·1% (95% CI 4·7-5·6) had some level of suicidality, and 0·3% (0·2-0·4) had at least one suicide attempt in the past month. The prevalence of overall suicidality was higher in women (6·0% [5·4-6·6]) than in men (4·1% [3·7-4·6]). The prevalence of overall suicidality was highest in those aged 40-49 years among women and in those aged 60 years or older among men. Compared with their counterparts, individuals with lower educational attainment, individuals residing in urban metropolitan cities, individuals who were widowed, separated, or divorced, and unemployed individuals had a higher prevalence of overall suicidality. The men-to-women ratio of overall suicidality prevalence for India was 0·68 (range 0·55-0·85). For every death by suicide in India, there were more than 200 people with suicidality and more than 15 suicide attempts. We found variations for various severities of suicidality. We found an increased risk for overall suicidality in women versus men (odds ratio [OR] 1·54 [95% CI 1·31-1·81]; p<0·0001) and in individuals residing in urban metropolitan cities versus those residing in rural areas (1·75 [1·30-2·35]; p=0·0002). Individuals belonging to the lowest income quintile (reference group with OR <1·00 and p<0·05 for other income quintiles), those with depressive disorders (28·78 [20·04-41·33]; p<0.0001) and those with alcohol use disorders (6·52 [3·83-11·10]; p<0.0001) had an increased risk for high suicidality, compared with their corresponding counterparts. A national suicide prevention strategy that is comprehensive, using multisectoral approaches, is required to address the prevailing sociodemographic and other risk factors for reducing suicidality and suicide deaths in India. This study also has implications for other low-income and middle-income countries in south Asia, where sociodemographic factors play a crucial role for suicide prevention. Ministry of Health and Family Welfare, Government of India.

Protocol for establishing a child and adolescent twin register for mental health research and capacity building in Sri Lanka and other low and middle-income countries in South Asia

IntroductionWorldwide, 10%–20% of children and adolescents experience mental health conditions. However, most such disorders remain undiagnosed until adolescence or adulthood. Little is known about the factors that influence mental health...

Strengthening Noncommunicable Disease Research Capacity and Chronic Disease Outcomes in Low- and Middle-Income Countries in South Asia: Implementation and Evaluation of the ASCEND Program.

This article describes the design, outcomes, challenges, and lessons learned from the ASian Collaboration for Excellence in Non-Communicable Disease (ASCEND) program, implemented between 2011 and 2015 in India, Sri Lanka, and Malaysia. The program involved a blended-delivery model, incorporating online and face-to-face training, mentoring, and supervision of trainees' research projects. Evaluation data were collected at baseline, 6, 12, 18, and 24 months. Intended outcomes, lessons, and challenges were summarized using a logic model. During the program period, 48 participants were trained over 2 cohorts in June 2011 and 2012. The trainees published 83 peer-reviewed articles between 2011 and 2015. Additionally, 154 presentations were given by trainees at national and international conferences. Underutilization of the online learning management system was an important challenge. Utilizing a combination of intensive face-to-face and online learning and mentoring of early career researchers in low- and middle-income countries has great potential to enhance the research capacity, performance, and outputs.

Orthopaedic Trauma in the Developing World: Where Are the Gaps in Research and What Can Be Done?

There are an estimated 1.2 million deaths from road traffic injuries annually, disproportionately affecting patients in low-resource settings. The purpose of this scoping review is to identify knowledge gaps in global orthopaedic trauma in an effort to help prioritize future research. Using the 6-stage Arksey and O'Malley framework for conducting a scoping review, orthopaedic trauma literature was reviewed over a ten-year period from 2004 to 2014. Studies from low-resource settings were included and categorized by geographic location, anatomic region, study type, and level of evidence. Of 548 included studies, 51.4% were from low- and middle-income countries in South Asia and 33.7% were from sub-Saharan Africa. Therapeutic (53.3%), epidemiologic (26.4%), and qualitative (8.9%) studies were most common. Only 10.2% of the studies were considered high level of evidence, whereas the vast majority (89.8%) was level 3 or below. Overall, lower extremity injuries were much more frequently represented in the literature compared with upper extremity injuries (233 vs. 78). Pelvic and acetabular fractures were the least studied anatomic region of the lower extremity (3.4%). Our study identified a lack of cost-effectiveness analyses pertaining to injury and intervention, paucity of high-quality research, and under-representation of pelvic, acetabular, and upper extremity injuries. Improved and prioritized research in low- and middle-income countries may help optimize care and inform policy makers of how to reduce the global burden of musculoskeletal trauma.

Assessing Dynamism of Crude Oil Demand in Middle-Income Countries of South Asia: A Panel Data Investigation

Using pooled mean group (PMG) estimation, the article tries to examine the impact of crude oil price, income, primary energy sources, electricity and financial crisis on the demand for crude oil in the six middle-income countries of South Asia over the period of 1988–2016, that is, 29 years. The use of PMG estimation enables us to get the short-run and long-run coefficients of comprised variables. Thereafter, dynamic ordinary least squares (DOLS) and fully modified ordinary least squares (FMOLS) panel co-integration techniques are performed to corroborate the outcomes of PMG estimation. Unlike PMG, DOLS and FMOLS panel co-integration methods examine the long-run determinants of oil demand in the presence of heterogeneity. Except for electricity, the coefficients of all other determinants are found in line with the results of PMG. However, the direction of the electricity coefficient is the same in the PMG and DOLS techniques. Therefore, the present study proposes the results of PMG estimation. The results suggest that the demand for crude oil is price inelastic and income elastic in the region. Further, the negative coefficient of electricity confirms that in the long run, electricity acts as a substitute for crude oil. Thus, the extensive use of electricity may help in reducing the demand for crude oil in the South-Asian countries. On the other hand, the primary energy is found complementary to crude oil in the selected countries over the study period. Finally, the coefficient of financial crisis, which is represented by a dummy variable, advocates that the financial crisis has a negative and significant impact on the demand for crude oil in the middle-income countries of South Asia.

Can self-help group programs improve women’s empowerment? A systematic review

ABSTRACT This mixed-methods systematic review focuses on the impact of women’s self-help groups (SHGs) on women’s economic, social, psychological, and political empowerment. Both governmental and non-governmental institutions spend formidable resources facilitating SHGs in low-and middle-income countries in South Asia and other developing countries, under the premise that access to microfinance, training, and group support can enhance women’s empowerment. We found that women’s economic SHGs have positive effects on economic and political empowerment, women’s mobility, and women’s control over family planning. The estimated effect sizes range from 0.06–0.41 standardised mean differences. We did not find evidence for positive effects of SHGs on psychological empowerment. The qualitative research further suggests that the positive effects of SHGs on empowerment run through mechanisms that are associated with familiarity in handling money, independence in financial decision-making, solidarity, social networks, and respect from the household and other community members. However, the included evaluations often did not include sufficient information about the specifics of the activities that were implemented by the SHGs. As a result, it remains unclear which of the various SHG models are most effective. Finally, our triangulation of the quantitative and qualitative findings indicates that SHGs do not have adverse consequences for domestic violence.

Association between acculturation, obesity and cardiovascular risk factors among male South Asian migrants in the United Arab Emirates--a cross-sectional study.

BackgroundApproximately 65% of the United Arab Emirates (UAE) population are economic migrants from the low- and middle-income countries of South Asia. Emerging evidence suggests that expatriate populations from low or middle-income countries that migrate to high-income countries acculturate their lifestyle with the obesogenic behaviours of the host country. Previous research has focussed on migrant populations in the United States. The objective of this study was to assess the prevalence of obesity and explore the relationship between years of residency (surrogate measure for acculturation) and obesity among South Asian (from India, Pakistan and Bangladesh) male immigrants residing in the UAE.MethodsA random sample of 1375 males was recruited from a mandatory residency visa health screening centre in Abu Dhabi (UAE). Employing a cross-sectional design, participants completed an interviewer-led adapted version of the World Health Organisation STEPS questionnaire, and anthropometric and blood pressure measurements were collected. Glycated haemoglobin (HbA1c) was measured in a random sub-sample (n = 100). Logistic regression was used to determine risk factors for being classified as obese, and to assess the relationship between years of residency and adiposity.ResultsThe overall prevalence of body mass index-derived overweight and obesity estimates and waist-to-hip-derived central obesity rates was 615 (44.7%) and 917 (66.7%) males, respectively. Hypertension was present in 419 (30.5%) of the sample and diabetes in 9 (9.0%) of the sub-sample. Living in the UAE for six to 10 years or more than 10 years was independently associated with being classified with central obesity (adjusted odds ratio [AOR] 1.63 95% confidence intervals [CI] 1.13 - 2.35, p < 0.008; AOR 1.95 95% CI 1.26 - 3.01, p < 0.002; respectively) compared to residing in the UAE for one to five years.ConclusionsOur study revealed a high prevalence of overweight, central obesity and hypertension amongst a young South Asian male migrant population in the UAE. Study findings suggest a diminished ‘Healthy Migrant Effect’ with increased years of residency possibly due to greater acculturation and a transition in lifestyle behaviours. Health initiatives targeting the maintenance of a healthy body size, coupled with regular assessments of glucose control and blood pressure are urgently required in this population.

Prevalence of vitamin A deficiency in South Asia: causes, outcomes, and possible remedies.

Vitamin A deficiency (VAD) has been recognized as a public-health issue in developing countries. Economic constraints, sociocultural limitations, insufficient dietary intake, and poor absorption leading to depleted vitamin A stores in the body have been regarded as potential determinants of the prevalence of VAD in South Asian developing countries. VAD is exacerbated by lack of education, poor sanitation, absence of new legislation and enforcement of existing food laws, and week monitoring and surveillance system. Several recent estimates confirmed higher morbidly and mortality rate among children and pregnant and non-pregnant women of childbearing age. Xerophthalmia is the leading cause of preventable childhood blindness with its earliest manifestations as night blindness and Bitot's spots, followed by blinding keratomalacia, all of which are the ocular manifestations of VAD. Children need additional vitamin A because they do not consume enough in their normal diet. There are three general ways for improving vitamin A status: supplementation, fortification, and dietary diversification. These approaches have not solved the problem in South Asian countries to the desired extent because of poor governmental support and supervision of vitamin A supplementation twice a year. An extensive review of the extant literature was carried out, and the data under various sections were identified by using a computerized bibliographic search via PubMed, Web of Science, and Google Scholar. All abstracts and full-text articles were examined, and the most relevant articles were selected for screening and inclusion in this review. Conclusively, high prevalence of VAD in South Asian developing countries leads to increased morbidity and mortality among infants, children, and pregnant women. Therefore, stem efforts are needed to address this issue of public-health significance at local and international level in lower- and middle-income countries of South Asia.