Middle Income Group Countries Research Articles

The Disconnect Between Policy Makers And Researchers – Time To Build Bridges

<p>According to World Health Organization, Pakistan and Afghanistan are the last bastions of Poliomyelitis. Rest of the world has become Polio Free. They achieved this freedom after becoming part of Polio Eradication Initiative which was created in 1988 just after the World Health Assembly resolved to eradicate Polio Myelitis from the globe. The woes of Pakistan do not end here. According to “Health Financing Progress Matrix Assessment Pakistan 2023. Summary of findings and recommendations” by World Health Organization, the service coverage index of Pakistan despite showing a consistent surge over the years was still significantly lower with a score of 45 against an average of 58 amongst the low middle income group countries in year 2021. This calls for a need to revisit our strategic policy making in all spheres of life but especially in health and health education. Dr Vaqar Ahmed in <a href="https://global.oup.com/academic/product/pakistans-agenda-for-economic-reforms-9780199406050?cc=au&lang=en&">Pakistan’s Agenda of Economic Reforms</a>, identified that this country faces a serious and lingering lack of institutional arrangement within our framework for research-based policy formulation, and post implementation feedback.</p>

Postpartum Depression; A Survey of Mothers Attending Paediatric Outpatient Department in A Tertiary Care Centre

Postpartum maternal depression (PPD) prevalence is around 15-20% in low- and middle-income group countries, and it harms the mother and child unit The aim of the study was to find the prevalence of Postpartum maternal depression in mothers attending Paediatric Out Patient Department OPD and to find if there is any correlation with Socio-Economic-Status SES, maternal health condition, pregnancy or obstetric complication, gender of the child, etc. with postpartum depression. A total of 200 mothers attending the pediatric OPD of a tertiary care hospital in a sub-urban area of South India were enrolled. They were interviewed with a semi-structured questionnaire. Details regarding demographic details, education level, employment, marital status, type of family, availability of help to look after the child and to do household chores, substance use in the family members, mental and physical abuse experienced by the mother, if any. Details of psychiatric illness in the family or history of previous postpartum depression were also collected. Screening for postpartum depression was done using Edinburgh postnatal depression scale. The prevalence of PPD was 9%, and interference with child rearing and perception of difficulty in daily activities were significantly associated with PPD. PPD is an underdiagnosed condition. Mothers can be easily screened for pediatric OPD, and treatment can be offered, leading to healthy mothers and children.

The Moderating Role of Financial Development on the Relationship between Financial Inclusion & FDI: Case of Lower- Middle Income Group of Countries

The Moderating Role of Financial Development on the Relationship between Financial Inclusion & FDI: Case of Lower- Middle Income Group of Countries

Effectiveness of Gatekeeper Training Program (GTP) on awareness, attitude, mental help seeking intention and gatekeeper behavior among Koraga tribe: A study protocol.

Aim: This study aims to build the capacity of the people at grass root level as gatekeepers of mental health. It will assess the effectiveness of the Gatekeeper Training Program (GTP) on gatekeeper behaviour, awareness, attitude, and mental help seeking intention. Design: An evaluative research approach in two phases. Phase 1: Cross-sectional house-to-house exploratory survey. Phase 2: A quasi-experimental design with multiple follow ups at 0, 6 and 12 months. Method: Data will be collected using standardized tools like Mental Health Knowledge Questionnaire (MHKQ), Community Attitude towards Mentally Ill (CAMIS), Mental Help Seeking Intention (MHSIS) and Gatekeeper Behavior Scale (GBS). For Phase 1, a house-to-house survey will be conducted among the selected colonies of Koraga tribe to determine their awareness, attitude, and mental help seeking intention regarding common mental health problems. Phase 2 includes identification of the leaders/representatives of the selected tribal colonies, and involving them in GTP. Pre-test and multiple post-test will be conducted in Phase 2 at 0, 6, 12 months. The study is funded by Indian Council of Medical Research from 16 August 2021 for 3 years duration. Discussion: Treatment gap in psychiatric disorders remains an issue of great concern. Evidence based research promotes task shifting approaches in dealing with mental health problems in the community. Capacity building programs like GTP for the underprivileged section of the society are important especially in low and middle income group of countries. Impact: This need based GTP, will ensure mental health first aid in the society. Early identification of people with mental health problems at their doorsteps has huge impact on the prognosis of the illness, closing the treatment gap and stigma reduction.

Effectiveness of Gatekeeper Training Program (GTP) on awareness, attitude, mental help seeking intention and gatekeeper behavior among Koraga tribe: A study protocol.

Aim: This study aims to build the capacity of the people at grass root level as gatekeepers of mental health. It will assess the effectiveness of the Gatekeeper Training Program (GTP) on gatekeeper behaviour, awareness, attitude, and mental help seeking intention. Design: An evaluative research approach in two phases. Phase 1: Cross-sectional house-to-house exploratory survey. Phase 2: A quasi-experimental design with multiple follow ups at 0, 6 and 12 months. Method: Data will be collected using standardized tools like Mental Health Knowledge Questionnaire (MHKQ), Community Attitude towards Mentally Ill (CAMIS), Mental Help Seeking Intention (MHSIS) and Gatekeeper Behavior Scale (GBS). For Phase 1, a house-to-house survey will be conducted among the selected colonies of Koraga tribe to determine their awareness, attitude, and mental help seeking intention regarding common mental health problems. Phase 2 includes identification of the leaders/representatives of the selected tribal colonies, and involving them in GTP. Pre-test and multiple post-test will be conducted in Phase 2 at 0, 6, 12 months. The study is funded by Indian Council of Medical Research from 16 August 2021 for 3 years duration. Discussion: Treatment gap in psychiatric disorders remains an issue of great concern. Evidence based research promotes task shifting approaches in dealing with mental health problems in the community. Capacity building programs like GTP for the underprivileged section of the society are important especially in low and middle income group of countries. Impact: This need based GTP, will ensure mental health first aid in the society. Early identification of people with mental health problems at their doorsteps has huge impact on the prognosis of the illness, closing the treatment gap and stigma reduction.

Antibiotics in the environment: A review

Due to overuse and misuse of antibiotics in human medicines, veterinary medicines, agriculture, aquaculture and their persistence, before the covid-19 pandemic, antibiotics were considered as most emerging pollutants of the 21st century. Due to population growth, economic development and longevity during the last 25 years in the low and middle-income group countries the prescription and use of antibiotics have increased many folds. This results in presence of antibiotics in all the compartments of the environment i.e. surface water, groundwater, soil, milk, plants, vegetables, fruits and fish. Wastewater generated from hospitals, households, aquaculture is the hotspot of the residual antibiotics. Human health is adversely affected by consuming antibiotics contaminated plant and animal food and by drinking antibiotics contaminated water. Antibiotics not only causes the development of antibiotic-resistant bacteria and genes resistant to antibiotics but also affects the ecosystem, biogeochemical cycling, microbial growth and microbial population. The major threat to humans due to the indiscriminate use of antibiotics is the development of multiple antibiotic-resistant bacteria. The concentration of the antibiotics in the aquatic environment, milk samples, plants, vegetables, and fruits consumed by humans and their impact on animals and humans are documented in this review.

Uptake of next-generation sequencing in children with end-stage renal disease secondary to focal segmental glomerulosclerosis and parental decision for kidney transplantation-Experience from a low resource setting: A Retrospective Cohort Study.

Transplantation is the optimal modality for children with ESRD. High risk of disease recurrence and graft loss with FSGS, and its financial implications, may result in families refusing transplantation. Deceased donation is often preferred for FSGS, but access is limited in many low- and middle-income group countries (LMIC; per capita gross national income between $1026 and $3995). As FSGS secondary to an underlying genetic etiology has low recurrence risk, we hypothesized that in LMIC such as India, families with children in ESRD secondary to FSGS with proven pathogenic mutation are more likely to consent for transplantation than those with unknown etiology. Prospective cross-sectional study with retrospective chart review was undertaken (March 2011 and February 2019) to identify children with ESRD from FSGS. The objective was to ascertain NGS uptake and findings, parental decision for transplantation, and transplant outcome. 28 children with FSGS started transplant workup, and 15 (54%) families agreed for NGS testing. Pathogenic mutation (NPHS1 x 2, WT1 x 2, COL4A3 x 2, CD2AP, CRB2, COL4A5, INF 2, ACTN4, NPHP4: 1 each) was identified in 12 (80%). 92% (11/12) agreed to proceed with transplantation in contrast to 13% (2/16) who either did not undergo NGS testing or had no pathogenic mutation identified (P=.001). No disease recurrences were noted in those with a known pathogenic mutation. In LMIC, NGS results are useful in transplant discussions with families for children with ESRD secondary to FSGS.

FDI & economic growth in selected Country groups for (1989-2018)

Theoretically, it is heavily believed that FDI is as a source of development, modernization, income, and employment growth and that FDI boosts the productivity of host countries and promotes economic growth. This paper examines, within a growth theory framework, the role which foreign direct investment (FDI) plays in the growth process in the context of different income group countries characterized by their per capita income. The paper tests (using time series data relating High, Middle- and Low-income countries) the hypothesis adopted is that FDI, enhance economic growth. The estimated indicators show evidence of rejecting Null hypothesis in the case of High- and Middle-income group countries but, vice versa the Null hypothesis is accepted for Low-income group countries.

Determinants of CO2 emissions in upper middle-income group countries: an empirical investigation.

This study investigates the kinked exponential growth, degree of association, and causation between economic growth, energy consumption, population, trade openness, and carbon dioxide (CO2) emissions in 25 upper middle-income group countries spanning data from 1985 to 2014. The study employed first-generation and second-generation unit root tests; prior to that, the cross-sectional dependence test is also applied and panel cointegration techniques, panel FMOLS and DOLS, and panel causality techniques are employed to test the degree of association and causation among the variables. The study reveals a long-run cointegration among the variables. Results of FMOLS declare that there are negative associations between economic growth and CO2 emissions, trade openness, and carbon dioxide emissions respectively, whereas it was found that there are positive relations between energy consumption and CO2 emissions, population, and CO2 emissions. While analyzing the association through DOLS, we find that all the selected determinants of carbon dioxide emissions are directly proportional to CO2 emissions in these countries. The panel Granger causality test indicates that there is bi-directional causality between population and economic growth and between trade openness and economic growth. Finally, the study ends with some policy suggestions and new avenues for future research.

ES09.04 How I Decide 2nd Line Treatment Options for Relapsed/Refractory Metastatic NSCLC

ES09.04 How I Decide 2nd Line Treatment Options for Relapsed/Refractory Metastatic NSCLC

Relevance of laparoscopic appendicectomy in Indian scenario: An analytical study

Introduction: This article by means of data analysis obtained from our study have tried to evaluate feasibility and acceptability of laparoscopic appendicectomy in Indian scenario. Objective: Through this prospective study an effort have been made to find ideal technique for appendicectomy which can serve masses in low middle income group countries like India where patient load outnumber resources both in expertise and facilities. Methods: A prospective analysis of two groups of population which have undergone appendicectomy (laparoscopic versus open conventional) was done as per inclusion criteria. Results obtained were analysed on grounds of cost benefit, time taken for surgery, pain, post-operative complications, hospital stay, time to resume routine activities, subjective cosmesis and finally patients preference. Data obtained was statistically analysed. Results: The mean age of patients in laparoscopic group was 22.5 years and 27.6 years in open appendicectomy group. Out of 287 patients included as per inclusion criteria 69.69% (200) patients opted for open appendicectomy. Mean operative time for laparoscopic procedure was more than open conventional procedure (98 minutes compared to 51 minutes). Post-operative complications and median length of hospital stay were comparable in both groups. There was no significant statistical difference related to pain, time duration to resume routine activities, and subjective cosmesis. Cost of overall procedure in laparoscopic appendicectomy was significantly higher than open conventional group. Conclusion: conventional open appendicectomy is reliable, easy, safe and cost-effective technique and its use can dramatically reduce cost burden of surgery as compared to laparoscopic surgery.

Functional Outcome Following Lower Extremity Amputation: A Review of Contextual Factors Influencing Function in Low- to Middle-Income Group Countries

Functional Outcome Following Lower Extremity Amputation: A Review of Contextual Factors Influencing Function in Low- to Middle-Income Group Countries

Financial Literacy in Developing Countries

Focusing on different facades of financial well-being such as wealth accumulation and retirement planning, various determinants of financial well-being have been unearthed, and financial literacy has emerged as a crucial factor that increases financial well-being. Hence, financial literacy has been an important policy instrument to increase the financial well-being of individuals, particularly given that it is relatively easy to implement. This paper is an attempt to pave the way for such policies in a group of middle income countries, namely Mexico, Lebanon, Uruguay, Colombia and Turkey. After establishing financial literacy levels, we identify the least financially literate groups in each country to facilitate targeting of public policy. We find that women, younger adults and individuals who cannot read or write in the official language of their country of residence have lower financial literacy scores. In line with the previous findings in the literature on the developed countries, our results indicate that financial literacy increases with education. We also show that it is not only the years of education, but also the quality. In Mexico and Turkey, there are large regional differences that must be addressed. We also find that differences in financial literacy across countries persist even when differences in structural characteristics are taken into account. A partial explanation may be provided by differences in financial inclusion.

Effectiveness of a new low-cost psychosocial rehabilitative model to reduce burden of disease among persons with severe mental illness: An interventional follow-up study.

Context:Mental health disorders are an important factor contributing to the global burden to disease. Less than 1% of the health budgets in 62% of developing nations and 16% of developed nations are spent on mental health services. The availability of mental health rehabilitative services remains minimal.Aims:This study aims to find the effectiveness of a new low-cost psychosocial rehabilitation model.Setting and Design:The study was conducted at a rehabilitation center. An interventional follow-up study was designed.Materials and Methods:A new low-cost psychosocial rehabilitative model was employed for 6 months for persons residing at a rehabilitation center. The World Health Organization Quality of Life (WHOQOL-BREF) instrument, WHO Disability Assessment Schedule (WHODAS) 2.0, and WHO (Five) Well-Being Index would be scored before and after the intervention.Statistical Analysis:The differences between the scores were analyzed using paired t-test or Wilcoxon signed rank test, whichever is applicable. P < 0.05 was taken as statistically significant.Results:Sample size was 110. 29.1% were rehabilitated and 68.2% remained at the rehabilitation center at 6 months. The pre- and post-test scores using the new model showed improvement in the scores. The mean scores for WHO-BREF, WHO-5 score, WHODAS-2 score were 73.2, 51.14, and 20.34, respectively. On follow-up, the scores improved to 82.6, 67.09, and 15.96, respectively.Conclusions:The low-cost psychosocial rehabilitative model was found to be effective. This could serve as a model not only for other similar centers in India and but also for other low- and middle-income group countries.

The dynamic links between carbon dioxide (CO2) emissions, health spending and GDP growth: A case study for 51 countries

This document investigated the causal relationship between carbon dioxide (CO2) emissions, health spending and GDP growth for 51 countries (divided into three groups of countries: low-income countries; group of countries with lower and upper middle income; group of middle income countries) covering the annual period 1995–2013. Dynamic simultaneous-equations models and generalized method of moments (GMM) are used to investigate this relationship. The main results provide evidence of a causal relationship between the three variables. The empirical results show that there is a bidirectional causality between CO2 emissions and GDP per capita, between health spending and economic growth for the three groups of estimates. The results also indicate that there is a unidirectional causality from CO2 emissions to health spending, except low income group countries. We found that health plays an important role in GDP per capita; it limits its effect on a growing deterioration in the quality of the environment.

The unfinished health agenda: Neonatal mortality in Cambodia.

BackgroundReduction of neonatal and under-five mortality rates remains a primary target in the achievement of universal health goals, as evident in renewed investments of Sustainable Development Goals. Various studies attribute declines in mortality to the combined effects of improvements in health care practices and changes in socio-economic factors. Since the early nineties, Cambodia has managed to evolve from a country devastated by war to a nation soon to enter the group of middle income countries. Cambodia's development efforts are reflected in some remarkable health outcomes such as a significant decline in child mortality rates and the early achievement of related Millennium Development Goals. An achievement acknowledged through the inclusion of Cambodia as one of the ten fast-track countries in the Partnership for Maternal, Newborn and Child Health. This study aims to highlight findings from the field so to provide evidence for future programming and policy efforts. It will be argued that to foster further advances in health, Cambodia will need to keep neonatal survival and health high on the agenda and tackle exacerbating inequities that arise from a pluralistic health system with considerable regional differences and socio-economic disparities.Methods/FindingsData was drawn from Demographic Health Surveys (2000, 2005, 2010, 2014). Information on a series of demographic and socio-economic household characteristics and on child anthropometry, feeding practices and child health were collected from nationally representative samples. To reach the required sample size, live-births that occurred over the past 10 years before the date of the interview were included. Demographic variables included: gender of the child, living area (urban or rural; four ecological regions (constructed by merging provinces and the capital), mother’s age at birth (<20, 20–35, 35+), birth interval (long, short) and birth order (1st, 2–3, 4–6, 7+). Socio-economic variables included: mother education level (none, primary, secondary+) and household wealth (asset-based index). Data on antenatal care, tetanus injection and skilled assistance at birth were used for the mother's last child.Between 2000 and 2014, Cambodia achieved a considerable reduction in neonatal mortality (46% reduction rate). By 2014, gender inequities became almost non-existent (for all measures of equality); inequity related to mother’s education decreased for all time periods; improvements were observed for differences in neonatal mortality by preceding birth interval; and a reduction in neonatal mortality rates could be noted among all the regional subgroups. Inequities increased between mothers who had limited antenatal care and those who received more than four antenatal care visits. In most scale indicators, the Slope Index of Inequality and Relative Index of Inequality estimates for all four rounds of the survey suggest inequity exacerbated in deprived communities. Also, wealth and residence (urban/rural divide) continued to be major determinants in neonatal mortality rates and related inequity trends.ConclusionAnalysis highlighted some of the complex patterns and determinants of neonatal mortality, in Cambodia. There has been a considerable decline in neonatal mortality which echoes global trends. Our analysis reveals that despite these advances, additional socio-economic and demographic characteristics considerably affected neonatal mortality rates and its inequities. There continue to be pockets of vulnerable groups that are lagging behind. This analysis highlights the determinants along the urban-rural and rich-poor divides in neonatal mortality inequities and how these affect access to and utilization of quality basic health services. This calls for future policy and programming efforts to be deliberate in their equity approach. Quality improvements in health services and targeted interventions for specific socio-economic groups will be required to further accelerate progress in reducing neonatal mortality and address Cambodia’s pressing unfinished agenda in health.

A global prospective of income distribution and its effect on life cycle assessment of municipal solid waste management: a review

This study reviewed the municipal solid waste (MSW) composition, the management practices, and the use of life cycle assessment (LCA) tool for MSW management (MSWM) options in the various income group countries. LCA studies require inventory data, which is difficult to procure for any country including higher income group countries, and this issue gets compounded in low-income and lower middle-income group countries, which limits the implementation of LCA. This paper compared the use of LCA for MSWM between high-income and low-income group countries and also highlights the gap in using LCA for MSWM. A very limited number of LCA studies on MSWM were found for low-income group countries in comparison to high-income group countries. The study also provided a critical discussion on the challenges in applications of LCA in MSWM for better solid waste management in low-income and lower middle-income group countries. The study will help in taking up LCA studies in low-income countries to improve the overall MSWM efficiency.

Analysis of relationship between interpersonal trust and social and economic indicators

The paper deals with the analysis of the type and the degree of relationship between the interpersonal trust index and social and economic indicators: Income (GDP per capita), Inequality (Gini coefficient), Human development index (HDI), Corruption (Corruption perception index). The methods of correlation analysis and neural network modeling are applied. The World Bank, World Values Survey (WVS) and European Social Survey (ESS) database is used. The analysis was carried out on the sample of 105 countries, where WVS and ESS interviews were conducted. The closest correlation dependence was found out between the trust index and HDI in a group of high human development countries, as well as among high income countries. The correlation is positive in these cases. In medium and low income level countries this relationship is weak and contradictory. The correlation between trust and corruption perception has similar nature: high income countries are characterized by close positive relationship between trust and corruption intolerance, in the low-income group this relationship is weaker, and in the group of middle income countries the correlation is negative. The weakest relationship is observed between the trust and GDP per capita (in the high income group it is positive, in the low income countries it is negative). There is negative weak correlation with Gini index in all the groups, except for the countries, where trust level is high: correlation dependence is strong there). Using a neural network model based on GDP per capita, the human development index and the corruption perception index, it was shown the possibility to predict the trust index for a group of high income countries.

Macroeconomic and Political Determinants of Resource Nationalism

Resource nationalism is essentially mandatory government intervention in natural resources businesses by political or economic means in order to benefit the nation and the people. It is attacking the mining industry more and more rampantly by all kinds of means since the twenty-first century. Poor countries who count on a resource-led economic growth usually find themselves trapped into “resource curse”. The harmfulness of resource nationalism for investors is that one event can quickly escalate and lead to a chain of events which make projects commercially unavailable. In spite of historical and theoretical social investigations in the causes of resource nationalism, rare studies engaged in quantification of dominant parameters of it. The objective of this study is to find significant factors that dominate the occurrence of resource nationalism for important metal and energy resources producing countries and quantify their marginal effects. The study applies binary choice logit model for panel data using pooled method. One feature of the research is that binary data set of occurrence of resource nationalism are sorted out by authors referencing U.S. Geological Survey’s reports. The results indicate that high-technology export (% manufactured export), ores and metals exports (% merchandise exports), rule of law (world governance indicator), trade (% GDP), and natural resource rent except forest (% GDP ) dominant the occurrence of resource nationalism for high and upper middle income group countries; government effectiveness (world governance indicator), policy perception index (The Fraser Institute), high-technology export (% manufactured export), and mineral rent (% GDP) dominant the occurrence of resource nationalism for lower middle and low income countries. According to our model, probability of occurrence of resource nationalism in 90 countries are predicted. Top 10 risky countries in 2012 are estimated to be North Korea, India, Honduras, Indonesia, Kazakhstan, Burkina Faso, Mongolia, Cuba, Bolivia, and Peru. The study is a primary trial of researching on resource nationalism and provides some insights for theoretical building and simulation on the issue.

On the causal dynamics between CO2 emissions, health expenditures and economic growth

The objective of the study is to examine the causal relationship between CO2 emissions, health expenditures and economic growth using dynamic simultaneous-equations models for a global panel of 51 countries over the period 1995–2013. The study also implements these empirical models for three groups: low income group, lower middle income group and upper middle income group countries. Our empirical results show that there is bidirectional causality between CO2 emissions and economic growth, between health expenditures and economic growth for the global panel, and there is unidirectional causality from CO2 emissions to health expenditures, except low income group countries. It has also been found that health plays an important role in economic growth it limits its impact on an increasing deterioration of environmental quality. These research findings would certainly serve as usefully effective policies instruments aiming at maximizing both the environmental and health gains highly associated with economic growth and development.