Middle-income Nations Research Articles

A call to action: gastric cancer in low- and middle-income nations and the value of screening

A call to action: gastric cancer in low- and middle-income nations and the value of screening

Prediction of the risk of developing heart disease using logistic regression

Heart disease (HD) accounts for more deaths every year than other illnesses. World Health Organization (WHO) assessed 17.9 million life losses caused by heart disease in 2016, demonstrating 31% of all international life losses. Three-quarters of these life losses occur in low and middle-income nations. Machine learning (ML), due to advanced precision in pattern recognition and classification, demonstrates to be in effect in complementing decision-making and threat prediction from the huge number of HD data created by the healthcare sector. Thus, this study aims to develop a logistic regression model (LRM) for predicting the risk of getting HD in ten years. The study explores the different methodologies for improving the performance of base LRM for predicting whether a person gets HD after ten years or not. The result demonstrates the capability of LRM in predicting the risks of getting HD after ten years. The LRM achieves 97.35% accuracy with the recursive feature elimination and random under-sampling. This implies that the LRM can play an important role in precautionary methods to avoid the risk of HD.

Assessment of knowledge about neonatal danger signs among primiparous women at discharge from healthcare facilities.

This study explores the evaluation of knowledge regarding neonatal danger signs (NDS) among first-time mothers in Pakistan during their discharge from healthcare facilities. The investigation aimed to establish connections between their understanding of NDS and factors such as sociodemographic background, prenatal check-ups, and educational measures. Considering the persistently high neonatal mortality rates in low- and middle-income nations, recognizing maternal NDS awareness becomes crucial for promoting early medical attention and reducing neonatal health risks. Existing research highlights the role of maternal knowledge in shaping neonatal well-being; however, gaps in knowledge remain prevalent, especially among first-time mothers. Using a cross-sectional approach, data were gathered through structured questionnaires, revealing significant relationships among maternal NDS awareness, sociodemographic aspects, prenatal care, and educational interventions. It is noteworthy that first-time mothers demonstrated lower NDS knowledge than mothers with multiple childbirth experiences, while those with higher education displayed greater awareness The effects of educational interventions were diverse, and antenatal visits were linked to enhanced knowledge. This study highlights the significance of focused treatments that target knowledge deficiencies, which can empower women and contribute to the reduction of infant health problems and mortality. encouraging further exploration of effective strategies to augment maternal knowledge and proactive healthcare-seeking behaviors.

Burden of HIV on Society Current Management Options and Future Prospective

Nevertheless, there is still a disparity in the availability of antiretroviral therapy (ART), especially in low- and middle-income nations, due to obstacles such as financial constraints, inadequate infrastructure,and on going social stigma. The future outlook for HIV management is optimistic, as current research is dedicated to exploring innovative treatment methods such as long-acting injectable, gene editing medicines, and therapeutic vaccinations. Furthermore, progress in pre-exposure prophylaxis (PrEP) and other preventive measures provide optimism for decreasing the number of new infections. Furthermore, it is crucial to make endeavors towards tackling societal factors that influence health outcomes, such as poverty, education, and gender inequality, as they play a vital role in attaining long-lasting advancements in HIV prevention and care. Notwithstanding these progressions, there are still obstacles to overcome, such as the rise of drug-resistant variations, deficiencies in testing and diagnosis, and enduring social obstacles. To tackle these difficulties, a comprehensive strategy is needed that combines biological, behavioral, and structural interventions, with a focus on fairness and human rights. To reduce the impact of HIV/AIDS on society and achieve the objective of ending the epidemic, it is important to continue investing in research, improving health systems, and promoting collaboration across all sectors.

The effect of social pension on health-related quality of life of the rural older people: a panel study from China

BackgroundSocial pensions, social assistance systems for older people in rural areas, have been put into place in many nations and have positively impacted health. The long-term health consequences of social pension programs in China are uncertain. The aim of this study is to evaluate the long-term health consequences of the new rural social pension (NRSP) for the rural older people in China.MethodsBased on the 2011 and 2018 China Health and Retirement Longitudinal Study, we compared the scores on eight Health-Related Quality of Life (HRQoL) subscales of the rural older people before and after participation in the NRSP. The propensity score matching and difference-in-difference methods were used in data analysis. We also conducted a heterogeneity analysis for subgroups with different characteristics and pension enrolment times.ResultsThe NRSP significantly enhanced scores on physical functioning, role-physical, and self-rated mental health of old rural participants by 1.90 (p < 0.01), 2.05 (p < 0.01), and 2.93 (p < 0.05), respectively. After excluding newly enrolled individuals, the beneficial health effects of the NRSP remained significant. There were no significant changes due to NRSP in the other five scores on the HRQoL subscale of the rural older people. The NRSP had more health benefits for older people in underdeveloped areas without formal schooling.ConclusionsThe NRSP reduced health disparities and had long-term benefits on the physical and mental health of the rural older people. We suggest continuously expanding the NRSP throughout rural China and further improving the social support system to enhance the overall quality of life of the rural older people. Comparable social pension programs aimed at underprivileged groups could also be conducted in other low- or middle-income nations.

Assessing bacterial prevalence and resistance in paediatric meningitis: safeguarding the central nervous system.

Paediatric bacterial meningitis (PBM) represents a major contributor to childhood morbidity and mortality globally, with heightened susceptibility in low- and middle-income nations where antimicrobial resistance (AMR) is highly prevalent. Pakistan exemplifies this setting, with widespread antibiotic overuse driving AMR expansion. Thus, expediting PBM diagnosis and targeted antibiotic therapy is imperative yet challenged by the dynamic local epidemiology. This study aimed to delineate the recent bacterial etiologies and AMR profiles of PBM from a major Pakistani diagnostics laboratory to inform empirical treatment. This prospective observational investigation evaluated PBM epidemiology in patients under 18 years old admitted to the study hospital. Standard cerebrospinal fluid analysis identified bacterial pathogens and antibiotic susceptibility patterns. Among 171 PBM cases, 152 (88.9%) had bacterial isolates confirmed via culture. The cohort was 42.7% male with a mean age of 3 months. The most prevalent pathogens among infants younger than 3 months were Escherichia coli, Enterococcus faecium, and Staphylococcus epidermidis, contrasting with S. epidermidis, Streptococcus pneumoniae, and Staphylococcus hominis predominating in older children. Staphylococcal isolates exhibited considerable penicillin and erythromycin resistance but maintained vancomycin and linezolid susceptibility. Other resistance patterns varied. These findings highlight the pressing threat of paediatric AMR in Pakistan, underscoring the need for vigilant AMR surveillance and judicious antimicrobial use. This study provides a reference to current PBM epidemiology to guide context-specific empirical therapy.

Protecting our Youth Online: A Comprehensive Review on Strategies to Safeguard Children from Online Threats

The evidence about the potential benefits and hazards associated with children's internet usage is expanding along with the global interest in this topic. In order to facilitate comparative study of research findings from lower- and middle-income nations like South Africa, Serbia, the Philippines, Brazil, and Argentina, the Global Kids Online program provides tools and guidelines to national researchers. This study looks at how present child rights laws, particularly those pertaining to the internet, correspond with the expanding body of data. It also looks at ways to influence future policy orientations. It provides information and recommendations for protecting children online based on current research and policy studies [1

Predictors of postoperative delirium in paediatric patients undergoing surgery under general anaesthesia at Amhara Regional State Tertiary Hospitals: a multicenter prospective study.

Postoperative delirium in paediatric patients is a recognised issue. Nevertheless, in low- and middle-income nations, researchers have had luck in determining its extent and predictors. Identifying predictors of postoperative delirium in paediatric patients having general anaesthesia at Tertiary Hospitals in Ethiopia was the aim of this study. A multicenter, prospective follow up study was conducted from April 15 to June 15, 2023 at the study settings. During the study period a total of 424 paediatric surgical patients treated under general anaesthesia in all study locations, ranging in age from birth to sixteen were candidates for this study. Charts and direct observation of patient's with assessment tool [Cornell Assessment of Pediatric Delirium (CAPD)] were used from each available patient. Binary logistic regression analysis was performed to determine predictors of postoperative delirium in paediatric patients undergoing surgery under general anaesthesia. Postoperative delirium occurred in 160 of the 404 paediatric patients who underwent surgery under general anaesthesia. Ophthalmic surgery, corticosteroid use, anticholinergic use, severe postoperative pain, and preoperative anxiety were found to be predictors of postoperative delirium; whereas, sedative medication premedication and paracetamol used for analgesia were found to be protective against postoperative delirium. The postoperative delirium in paediatric patients undergoing surgery under general anaesthesia was higher compared to developed countries. Ophthalmic surgery, corticosteroids, anticholinergic medications, postoperative pain, and preoperative anxiety were found to be predictors. The impact of postoperative delirium might be lessened by concentrating on its screening and factor control.

Critical Review on Vajikarana yogas Mentioned in Ashtanga Hrudaya

Vajeekarana, also known as Vrishya Chikitsa, is one of the eight key specialties of Ashtanga Ayurveda. Vajikarana is concerned with aphrodisiacs, virility, and increasing the health of offspring. Ashtanga Hridaya is one Among Bruhatrayee (Greater Trio). Acharya Vagbhata writen the two most important classics like Ashtanga Sangraha and Ashtanga Hridaya. Due to its superior organisation and concision over Ashtanga Sangraha, Ashtanga Hridaya is a far more approachable classic. Vajeekarana vidhi (Aphrodisiac therapy) is explained in the last chapter of Uttarasthana of Ashtanga hrudaya.&#x0D; According to WHO, Millions of people battle with infertility. One in six people who are of reproductive age worldwide are predicted to become infertile at some point in their lives. Several parts of the world, particularly low- and middle-income nations, still lack access to most modern therapies and their cost is prohibitive. Many Vajikarana yogas are (Aphrodisiac Formulations) mentioned in Ayurvedic classics which are cheaper,easier to prepare, safer and effective. This review Article focuses on unique contribution on Vajeekarana yogas mentioned by Acharya Vagbhata in Ashtanga Hridaya.

In-hospital mortality of patients with acute coronary syndrome (ACS) after implementation of national health insurance (NHI) in Indonesia

BackgroundThe National Health Insurance (NHI) was implemented in Indonesia in 2014, and cardiovascular diseases are one of the diseases that have overburdened the healthcare system. However, data concerning the relationship between NHI and cardiovascular healthcare in Indonesia are scarce. We aimed to describe changes in cardiovascular healthcare after the implementation of the NHI while determining whether the implementation of the NHI is related to the in-hospital mortality of patients with acute coronary syndrome (ACS).MethodsThis is a retrospective comparative study of two cohorts in which we compared the data of 364 patients with ACS from 2013 to 2014 (Cohort 1), before and early after NHI implementation, with those of 1142 patients with ACS from 2018 to 2020 (Cohort 2), four years after NHI initiation, at a tertiary cardiac center in Makassar, Indonesia. We analyzed the differences between both cohorts using chi-square test and Mann-Whitney U test. To determine the association between NHI and in-hospital mortality, we conducted multivariable logistic regression analysis.ResultsWe observed an increase in NHI users (20.1% to 95.6%, p < 0.001) accompanied by a more than threefold increase in patients with ACS admitted to the hospital in Cohort 2 (from 364 to 1142, p < 0.001). More patients with ACS received invasive treatment in Cohort 2, with both thrombolysis and percutaneous coronary intervention (PCI) rates increasing more than twofold (9.2% to 19.2%; p < 0.001). There was a 50.8% decrease in overall in-hospital mortality between Cohort 1 and Cohort 2 (p < 0.001).ConclusionsThis study indicated the potential beneficial effect of universal health coverage (UHC) in improving cardiovascular healthcare by providing more accessible treatment. It can provide evidence to urge the Indonesian government and other low- and middle-income nations dealing with cardiovascular health challenges to adopt and prioritize UHC.

Spatial Clustering of Malnutrition and Anemia Among Reproductive Women and Its Associated Risk Factors in India: Evidence From National Family Health Survey-5.

Malnutrition and anemia are 2 severe public health concerns, predominantly in low-and middle-income nations. Malnutrition is defined as poor nutritional condition that encompass both under nutrition and over nutrition. The prevalence of overweight or obesity and anemia has increased in India from 2016 to 2021. The study aims to investigate the spatial clustering and factors responsible for underweight, overweight/obesity, and anemia among reproductive women (15-49 years) in India using the data from National Family and Health Survey-5 (2019-2021). We conducted hot-spot analysis using Moran's Index (MI) with the help spatial analysis software (i.e., GeoDa 1.18 and ArcGIS 10.8). It also demonstrates the autocorrelation. Multivariable logistic regression analysis has been performed to examine different determinants and risk associated with underweight, overweight/obesity, and anemia with various dependent variable by using Stata-14 software. Moran's Index for underweight (MI = 0.68), overweight/obesity (MI = 0.72), and anemia (MI = 0.62) indicates a high level of spatial-autocorrelation (P < .001) exists across the districts in India. As a result, a total of 156, 143, and 126 hot-spot districts are detected for underweight, overweight/obesity, and anemia, respectively. The burden of undernutrition and anemia is higher in rural areas. Risk of under nutrition and anemia are both reduced by media exposure and eating habits. Moreover, low income and low education level raises the risk of anemia and undernutrition, while obesity shows an inverse trend with income and education level. The study recommends targeting hot-spot districts for malnutrition and anemia, and policy level initiatives by addressing the responsible risk factors.

Community health workers for health systems resilience during COVID-19: protocol for qualitative evidence synthesis

IntroductionCOVID-19 exposed the fragility of health systems, where even the most basic health services in high-income and low-income and middle-income nations could not withstand the health systems shock due to...

Property and Pa-Tree-Archy

Abstract Although previous studies have examined the causes of deforestation from a cross-national, quantitative perspective, these studies tend to neglect the role of women in mitigating forest loss. Yet, evidence from case studies shows that when women own land they tend to protect forests, replant trees, and engage in agricultural practices that place less pressure on forests. Building on this work, we use ordinary least squares regression models to analyze data on forest loss derived from satellite imagery for a sample of 67 low- and middle-income nations. The results suggest that improving gender equality in immovable property rights does help save trees. Furthermore, our analysis also suggests that men and women have different priorities when it comes to forest sustainability. Women's rights have a protective effect on forests, while men's rights have no statistically significant effect. Given the extent to which we rely on forests for health, environmental, and economic reasons, these findings imply that when women's rights are curtailed, the consequences extend beyond women themselves.

Risk Factors Associated with Cardiovascular Disorders

Cardiovascular diseases (CVDs) constitute the primary cause of mortality worldwide. 32% of all fatalities globally in 2019 were attributed to CVDs, with an estimated 17.9 million deaths. Heart attacks and strokes were the significant cause of 85% of these fatalities. More than 75% of fatalities from CVD occur in low- and middle-income nations. In 2019, non-communicable illnesses accounted for 17 million premature fatalities (deaths under 70 years of age) of which 38% were attributable to CVDs. An increased risk of acquiring high blood pressure (hypertension), high cholesterol, and Type 2 diabetes can also be attributed to a family history of these disorders. These conditions can also raise an individual's risk of cardiovascular disease. By addressing behavioral risk factors such as tobacco use, bad food and obesity, physical inactivity, and problematic alcohol consumption, most cardiovascular illnesses may be averted. Early detection of cardiovascular illness is crucial for the commencement of medication and counseling-based therapy.

Application of Artificial Intelligence (AI) System in Opportunistic Screening and Diagnostic Population in a Middle-income Nation.

This study evaluates the effectiveness of artificial intelligence (AI) in mammography in a diverse population from a middle-income nation and compares it to traditional methods. A retrospective study was conducted on 543 mammograms of 467 Malays, 48 Chinese, and 28 Indians in a middle-income nation. Three breast radiologists interpreted the examinations independently in two reading sessions (with and without AI support). Breast density and BI-RADS categories were assessed, comparing the accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) results. Of 543 mammograms, 69.2% had lesions detected. Biopsies were performed on 25%(n=136), with 66(48.5%) benign and 70(51.5%) malignant. Substantial agreement in density assessment between the radiologist and AI software (κ =0.606, p < 0.001) and the BI-RADS category with and without AI (κ =0.74, p < 0.001). The performance of the AI software was comparable to the traditional methods. The sensitivity, specificity, PPV, and NPV or radiologists alone, radiologist + AI, and AI alone were 81.9%,90.4%,56.0%, and 97.1%; 81.0%, 93.1%,55.5%, and 97.0%; and 90.0%,76.5%,36.2%, and 98.1%, respectively. AI software enhances the accuracy of lesion diagnosis and reduces unnecessary biopsies, particularly for BI-RADS 4 lesions. The AI software results for synthetic were almost similar to the original 2D mammography, with AUC of 0.925 and 0.871, respectively. AI software may assist in the accurate diagnosis of breast lesions, enhancing the efficiency of breast lesion diagnosis in a mixed population of opportunistic screening and diagnostic patients. • The use of artificial intelligence (AI) in mammography for population-based breast cancer screening has been validated in high-income nations, with reported improved diagnostic performance. Our study evaluated the usage of an AI tool in an opportunistic screening setting in a multi-ethnic and middle-income nation. • The application of AI in mammography enhances diagnostic accuracy, potentially leading to reduced unnecessary biopsies. • AI integration into the workflow did not disrupt the performance of trained breast radiologists, as there is a substantial inter-reader agreement for BI-RADS category assessment and breast density.

The impact of the knowledge economy on the financing constraints of firms: within and between country effects

PurposeThis study employs firm-level data to evaluate how the knowledge economy impacts the financing constraints of businesses across 106 low- and middle-income nations, focusing on the influence of technological transformation on corporate financing choices.Design/methodology/approachThe research centers on privately held, unlisted firms and examines the distinct effects of knowledge at both the within-country and between-country levels using a panel dataset. Rigorous sensitivity and endogeneity analyses are conducted to ensure the reliability of the findings.FindingsThe findings indicate that greater levels of the knowledge economy correlate with reduced financing constraints for firms. However, this effect varies depending on the location within a country and across different geographical regions. Firms situated in larger urban centers and more innovative regions reap the most significant benefits from the knowledge economy when seeking external funding. Conversely, firms in smaller cities, rural areas and regions characterized by structural and institutional inefficiencies in knowledge generation experience fewer advantages.Originality/valueThe impact of knowledge exhibits variability not only within and among countries but also between poor and affluent developing nations, as well as between larger and smaller countries. The knowledge effect on firms' access to external finance is influenced by factors such as financial openness and development, educational quality, technological absorption capabilities and agglomeration conditions within each country.

CLINICAL STUDY OF YOGASANA AND PATHYAAHARA IN MANAGEMENT OF MADHUMEHA (DIABETES MELLITUS-2)

Introduction: About 422 million people worldwide, most of whom reside in low and middle-income nations, have diabetes (metabolic lifestyle disorder), according to the World Health Organisation, contributing to 1.5 mil-lion deaths annually. Aahara (diet) and Yoga asanas are essential for controlling and preventing lifestyle disor-ders. Thus, this study assessed how yoga techniques and the Aahara contribute to managing diabetes mellitus. Methodology: A single arm open randomised clinical study was conducted on 30 clinically diagnosed patients with diabetes mellitus 2 for Yoga asanas (Mandukasana, Kurmasana, Vakrasana, and Ardhamatsyendrasana) and Ayurvedic Aahara plan in the Postgraduate Institute of Ayurved, DSRRAU, Jodhpur. The study evaluates their role in the management of Prabhoot Mutrata (Polyuria), Avila Mutrata (Urine turbidity), Pipasadhikya (Polydipsia), Kshuda Adhikya (Polyphagia), Sweda Adhikya (The excessive sweating) The, Dourbalya The (Weakness The/Tiredness The), The Alasya (The Laziness) The, Atinidra (Excessive sleep), Karpada Daha (Burning sensation in hands and feet) and blood sugar level (i.e. FBS and PPBS, HbA1c). Result: The result of the study depicts that Yoga asanas and Ayurvedic Aahara have significantly helped in reducing the Prabhoot Mutrata, Avila Mutrata, Pipasadhikya, Kshuda Adhikya, Sweda Adhikya, Dourbalya, Alasya, Atinidra, Karpada Daha and blood sugar level. Conclusion: The study concluded that Yoga therapy and the Aahara plan have a role in managing diabetes mellitus by lowering medication dosages, increasing physical and mental alertness, and preventing complications. Results should be validated in larger sample sizes and multicentric models to es-tablish it as a well-known treatment.

Craniocervical Tetanus: A Practical Consideration During Work-up of Acute-Onset Trismus.

This clinical record revisits the classical and pathognomonic features of craniocervical tetanus in a 65-year-old farmer who presented with acute-onset trismus, multiple cranial nerve pareses (III, IX, and X), risus sardonicus, and spasm of the head-neck musculature. This paper explores the relevant literature and presents a brief pictorial analysis of the global epidemiologic data. With most countries successfully adopting the maternal and neonatal tetanus elimination (MNTE) program, the incidence and mortality of tetanus across age groups have sharply reduced in high-income and most middle-income nations. In adults, tetanus is now encountered in specialized situations like waning immunity and incomplete vaccination, in the resource-poor and low-income nations, in countries achieving MNTE recently, and as cluster cases in the aftermath of natural disasters involving human settlements. Therefore, present-day practicing otolaryngologists and residents who have limited exposure to the tell-tale clinical features of craniocervical tetanus should consider it during work-up of acute-onset trismus in adults in susceptible situations and with a conducive background. The clinical spectrum of craniocervical tetanus as depicted in this report, including the demonstration of the pathognomonic positive spatula test, provides valuable learning points for otolaryngologists in this regard.

Risk factors of self-medication with antibiotics for acute pharyngitis

Background: Self-medicating with antibiotics is prevalent in low- and middle-income nations. This research sought to assess the perspectives on antibiotic usage and self-medication in case of acute pharyngitis, as well as the factors linked to self-medication among patients of a family doctor's clinic in Lublin, Poland.&#x0D; Methods: A original, fully anonymous survey was conducted among patients of a family doctor's clinic in Lublin. The descriptive statistics of answers in questionnaires and Automatic Linear Modeling Regression (LINEAR) was applied to point out the most significant predictors of the antibiotics misuse. &#x0D; Results: A response number of 262 participants was obtained. About 15,6% (41/262) respondents had self-medicated during the last year due to acute pharyngitis symptoms. We have identified the following important risk factors of anti-health behaviours connected with self-medication: frequent occurrence of symptoms of acute pharyngitis, frequent receiving antibiotics on prescription, frequent diagnosing a bacterial cause of sore throat, higher sensitivity to pain and lower education level. Surprisingly our research shows that women present lower sensitivity to pain than men in case of pain connected with acute pharyngitis. &#x0D; Conclusion: There is a need for greater attention paid to the education of the patients presenting the aforementioned risk factors. Education should focus on the risks to the patients connected with antimicrobial resistance.

Democracy, accountability, and forest loss: a cross-national analysis of low- and middle-income nations

ABSTRACT The existing cross-national research on democracy and forest loss has produced contradictory results. On the one hand, some studies find that democracy is related to less forest loss because of electoral accountability and guaranteeing political rights and civil liberties. On the other hand, studies find that democracy is related to increased forest loss in low- and middle-income nations because leaders promote policies that prioritize economic growth over protecting the natural environment. We use this research as a starting point for our study and build upon it in two ways. First, we examine how vertical, horizontal, and diagonal accountability – three different aspects of democracy – impacts forest loss in low- and middle-income nations. Second, we address the issue of endogeneity in the vertical, horizontal, and diagonal accountability. To do so, we analyze data for 80 low- and middle-income nations using a two-stage instrumental variable regression model. We find that higher levels of horizontal and diagonal accountability are related to less forest loss. We do not find that vertical accountability is related to forest loss in low- and middle-income nations. From the findings, we arrive at our theoretical implication, which support arguments concerning how actors at different scales work individually and together to promote conservation.