People In Low-income Countries Research Articles

Happy without money: Minimally monetized societies can exhibit high subjective well-being

Economic growth is often assumed to improve happiness for people in low income countries, although the association between monetary income and subjective well-being has been a subject of debate. We test this assumption by comparing three different measures of subjective well-being in very low-income communities with different levels of monetization. Contrary to expectations, all three measures of subjective well-being were very high in the least-monetized sites and comparable to those found among citizens of wealthy nations. The reported drivers of happiness shifted with increasing monetization: from enjoying experiential activities in contact with nature at the less monetized sites, to social and economic factors at the more monetized sites. Our results suggest that high levels of subjective well-being can be achieved with minimal monetization, challenging the perception that economic growth will raise life satisfaction among low income populations.

Understanding the Potential Role of Therapeutics in Preventing Deaths Due to COVID-19: A Modelling Analysis

Background: The unprecedented public health impact of the COVID-19 pandemic has motivated a rapid search for potential therapeutics, with some key successes. However, the potential impact of current and proposed treatments, and consequently research and procurement priorities, have not been clear. Methods: First, we used a model of SARS-CoV-2 transmission, COVID-19 disease and clinical care pathways to explore the potential impact of dexamethasone - the main treatment currently for hospitalised COVID-19 patients - under scenarios varying: i) healthcare capacity, ii) epidemic trajectories; and iii) the efficacy of dexamethasone in the absence of supportive care. We then fit the model to the observed epidemic trajectory to-date in 165 countries and analysed the potential future impact of dexamethasone in different countries, regions, and country-income strata. Finally, we constructed hypothetical profiles of novel therapeutics based on current trials, and compared the potential impact of each under different circumstances. In each case, the outcome of interest was the number of COVID-19 deaths averted in scenarios with the therapeutic compared to scenarios without. Findings: We find the potential benefit dexamethasone is severely limited in settings where healthcare capacity is lowest or where uncontrolled epidemics result in hospitals being overwhelmed. As such, it may avert 22% of deaths in high-income countries but only 8% in low-income countries (assuming R=1.35). However, therapeutics for different patient populations (in particular, those not in hospital and early in the course of infection) and types of benefit (in particular, reducing disease severity or infectiousness) could have much greater benefits. Such therapeutics would have particular value in resource-poor settings facing large epidemics, even if the efficacy or achievable coverage of such therapeutics is lower in comparison to other types. Interpretation: People in low-income countries will benefit the least from advances in the treatment of COVID-19 to date, which have focussed on hospitalised-patients with adequate access to supportive care. Therapeutics that can feasibly be delivered to those earlier in the course of infection that reduce the need for healthcare or reduce infectiousness could have much greater impact. Such therapeutics may be feasible and research into their efficacy and means of delivery should be a priority. Funding: None to declare. Declaration of Interest: None to declare.

Patent Protection and Access to COVID-19 Medical Products in Developing Countries

Several new vaccines that have been developed for COVID-19 are patent protected. The patentees control the production, supply and pricing of these vaccines. Most people in low-income countries have been unable to access the vaccines. India and South Africa supported by a large number of developing countries have submitted a proposal to the TRIPS Council of the WTO requesting a temporary waiver to eliminate patent and other intellectual property barriers for the development, production and supply of all COVID-19 medical products. Nine months have passed since the proposal was first made in October 2020 but still no decision could be taken because of the opposition from developed countries. The disagreements essentially revolve around four issues: whether suspension of patent rights will act as a disincentive for the development of new medical products; whether patented products can be manufactured in the absence of manufacturing capacities; whether voluntary initiatives are better than a patent waiver; and whether a waiver is necessary in view of compulsory licensing and other measures which TRIPS permits. The paper briefly reviews these issues and also provides some suggestions about what developing countries can do to make COVID-19 medical products affordable and accessible.

Moving Towards Decent Work for Street Vendors in Tanzania

Abstract Street vending is an important employment opportunity for the millions of youth, women, anyone with very few resources and the least-skilled people in low-income countries. Its popularity is due to the ease of entry into the business as far as costs, legal eligibility, and level of education. Despite their importance to local economies, street vendors operate in challenging environments that limit the productivity, the decency, and the sustainability of this kind of work. Governments should play a central role in improving the quality of work in this sector, particularly in countries where it constitutes a large proportion of the nation’s work force, and provides goods and services to so many people.

Yeast-based high-throughput screens for discovery of kinase inhibitors for neglected diseases.

The discovery and development of a new drug is a complex, time consuming and costly process that typically takes over 10 years and costs around 1 billion dollars from bench to market. This scenario makes the discovery of novel drugs targeting neglected tropical diseases (NTDs), which afflict in particular people in low-income countries, prohibitive. Despite the intensive use of High-Throughput Screening (HTS) in the past decades, the speed with which new drugs come to the market has remained constant, generating doubts about the efficacy of this approach. Here we review a few of the yeast-based high-throughput approaches that can work synergistically with parasite-based, in vitro, or in silico methods to identify and optimize novel antiparasitic compounds. These yeast-based methods range from HTP screens to identify novel hits against promising parasite kinase targets to the identification of potential antiparasitic kinase inhibitors extracted from databases of yeast chemical genetic screens.

Conservation Agriculture and Integrated Pest Management Practices Improve Yield and Income while Reducing Labor, Pests, Diseases and Chemical Pesticide Use in Smallholder Vegetable Farms in Nepal

Improving smallholder vegetable farms are critical for improving food security and livelihoods of people in low-income countries. Vegetable production is labor intensive and prone to pests and diseases. Conservation agriculture (CA) and integrated pest management (IPM) practices provide options to increase yields and minimize the use of chemical pesticides. We compared integration of CA and IPM practices (improved alternative system) with farmers’ traditional practice (conventional system) under replicated on-farm tests in four different locations (Lalitpur, Banke, Surkhet, and Dadeldhura) in Nepal. Data on yield, benefit–cost ratio (B:C), labor requirement, insect and disease infestation, and pesticide sprays on five major vegetable crops (tomato, cucumber, bitter gourd, cabbage, cauliflower) were measured. In tomatoes, cucumbers, and bitter gourds, the improved alternative system produced a significantly higher yield, greater benefit-cost ratio, reduced labor, decreased the infestation of pests and diseases, and required fewer pesticidal sprays. Average yield and net income were superior in cabbages and cauliflowers, but nonsignificant. Improved alternative system for all the vegetables were sprayed significantly fewer times than the conventional system. Overall, the improved alternative system for vegetable crops contributed not only to the improved income and livelihoods of people, but also can improve environment and human health due to the reduced use of pesticides. Further research on scaling these improved alternative practices through appropriate farmer organizations, and government and non-government actors can enhance the adoption of CA and IPM practices by smallholder vegetable producers.

Quality of Life and the Health System: A 22-Country Comparison of the Situation of People With Spinal Cord Injury

ObjectiveTo analyze and compare how performance of the health system are linked to the self-reported quality of life (QOL) of people with spinal cord injury (SCI) in 22 countries participating in the International Spinal Cord (InSCI) community survey. DesignCross-sectional survey. SettingTwenty-two countries representing all 6 World Health Organization regions, community setting. ParticipantsPersons (N=12,591) with traumatic or nontraumatic SCI aged ≥18 years. InterventionsNot applicable. Main outcomesSelf-reported satisfaction on several indicators that include: health, ability to perform daily activities, oneself, personal relationships, and living conditions. A total score of QOL was calculated using these 5 definitions. ResultsThe most important indicators for self-reported QOL of persons with SCI were social attitudes and access to health care services, followed by nursing care, access to public spaces, the provision of vocational rehabilitation, transportation, medication, and assistive devices. In general, persons with SCI living in higher-income countries reported a higher QOL than people in lower-income countries, with some exceptions. The top performing country was The Netherlands with an estimated median QOL of 66% (on a 0%-100% scale). ConclusionsThe living situation of people with SCI is highly influenced by the performance of the health system. Measuring and comparing health systems give accountability to a country’s citizens, but it also helps to determine areas for improvement.

Portfolio optimization of electricity generating resources in Kenya

Affordable and reliable electricity is a development priority, but many people in low-income countries continue to live without it. The main challenge to ensuring universal access to electricity is the energy trilemma: striking a balance between costs, security, and environmental sustainability. Kenya is one of the countries that face energy trilemma as the electricity demand expands. We use modern portfolio theory (MPT) from the finance sector to address this challenge by deriving a theoretical efficient frontier for electricity generation in Kenya. The study finds that although the current portfolio of electricity generation in Kenya is not optimal, it is possible to shift to an efficient portfolio that has lower costs, is diversified, and environmentally sustainable. We conclude that MPT addresses the energy trilemma and therefore, it can help in the planning of electricity generation in countries whose electricity sectors are still developing. Our study adds to the literature about the applicability of MPT in the electricity sector and proposes ways for Kenya to improve the electricity-generating portfolio. We anticipate that the results will encourage electricity sector planners to consider portfolio planning for electricity generation.

Comparing Alcohol Use Disorders Identification Test (AUDIT) with Timeline Follow Back (TLFB), DSM-5 and Phosphatidylethanol (PEth) for the assessment of alcohol misuse among young people in Ugandan fishing communities

BackgroundValidated tools for assessing alcohol use among young people in low-income countries are needed to estimate prevalence and evaluate alcohol-reduction interventions. We validated Alcohol Use Disorders Identification Test (AUDIT) against Timeline Follow Back (TLFB), Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and phosphatidylethanol (PEth); and the 30-day-AUDIT against the 12-months-AUDIT among young Ugandans. MethodsIn 2018, we collected retrospective data on 30-day and 12-month AUDIT, TLFB and DSM-5 in a cross-sectional study of 15–24 year old residents of Ugandan fishing communities. AUDIT was administered by Audio Computer Assisted Self-Interviewing (ACASI) and DSM-5 and TLFB by psychiatric nurses. We determined PEth16:0/18:1 levels from dried blood spots using liquid chromatography tandem-mass spectrometry (heavy usage, ≥210 ng/mL) and calculated sensitivity and specificity of AUDIT against the other measures. ResultsAmong 1281 participants (52.7% male, mean age 20 years), half (n = 659; 51.4%) reported ever drinking alcohol, 19.4% had 12-month-AUDIT ≥ 8 (21.5% men; 17.0% women), and 24.2% had 30-day-AUDIT ≥ 8 (29.0% men; 18.9% women). Twenty percent of participants had detectable PEth with 55 (4.3%) classified as heavy drinkers; 50.7% reported ≥ 2 symptoms on DSM-5 and 6.3% reported binge drinking in the previous month based on TLFB (8.9% men, 3.5% women). The 30-day-AUDIT ≥ 8 had sensitivity 86.7%, 95%CI: 81.8%–90.7% and specificity 90.9%, 95%CI:89.0%–92.6% versus 12-month-AUDIT ≥ 8. Both 30-day and 12-month-AUDIT ≥ 8 were sensitive and specific markers of heavy drinking by PEth (12-month-AUDIT sensitivity = 80.0%; 95%CI:67.0%–89.6%; specificity = 83.3%; 95%CI:81.1%–85.3%). The 30-day-AUDIT was a sensitive and specific marker of binge drinking based on TLFB (sensitivity = 82.7%; 95%CI:72.7%–90.2%, specificity = 79.8%; 95%CI:77.4%–82.1%); 12-month-AUDIT had lower sensitivity. Both 30-day and 12-month AUDIT ≥ 8 were highly specific but insensitive markers of having DSM-5 ≥ 2 symptoms. ConclusionAmong young people in Uganda, ACASI-administered 30-day and 12-month-AUDIT have good diagnostic properties compared to PEth, DSM-5 and TLFB. Self-reported AUDIT provides a quick and valid means of assessing alcohol misuse in these communities.

A cascade of care for people with epilepsy: learning from "HIV/AIDS 90-90-90".

Epilepsy is now more prevalent in many countries than HIV/AIDS. Building upon the advances of global policymaking for HIV/AIDS and creating a framework for countries and organizations to monitor progress in epilepsy care will help direct and justify much-needed novel programming. Given the clarity of the HIV/AIDS care continuum model and the UNAIDS 90-90-90 targets, I propose this same approach to the cascade of care could be used as a viable framework for people with epilepsy. In this model, the targets of success include (1) ensuring 90% of all people with epilepsy are aware of their diagnosis as a brain disorder, (2) starting 90% of people with epilepsy on quality controlled, appropriately chosen and well stocked antiepileptic drugs, and (3) achieving seizure freedom in 70% of those treated. At least 90% of all people with epilepsy must also be linked to and retained in appropriate care.Although the precise numbers may be debated, this cascade of care approach will assist in deconstructing the barriers to epilepsy care in populations better than the more familiar concept of the epilepsy treatment gap. These reflect concrete goals for health systems for epilepsy care that, if achieved, could lead to seizure freedom for the many people in lower income countries living with poorly controlled epilepsy.

A Low Cost Wearable Medical Device for Vital Signs Monitoring in Low-Resource Settings

Medical devices are often expensive, so people in low-income countries cannot afford them. This paper presents the design of a low-cost wearable medical device to measure vital signs of a patient including heart rate, blood oxygen saturation level (SpO2) and respiratory rate. The wearable medical device mainly consists of a microcontroller and two biomedical sensors including airflow thermal sensor to measure respiratory rate and pulse oximeter sensor to measure SpO2 and heart rate. We can monitor the vital signs from a smartphone using a web browser through IEEE802.11 wireless connectivity to the wearable medical device. Furthermore, the wearable medical device requires simple management to operate; hence, it can be easily used. Performance evaluation results show that the designed wearable medical device works as good as a standard SpO2 device and it can measure the respiratory rate properly. The designed wearable medical device is inexpensive and appropriate for low-resource settings. Moreover, as its components are commonly available in the market, it easy to assembly and repair locally.

ICU Risk Stratification Models Feasible for Use in Sub-Saharan Africa Show Poor Discrimination in Malawi: A Prospective Cohort Study.

Critical illness disproportionately affects people in low-income countries (LICs). Efforts to improve critical care in LICs must account for differences in demographics and infrastructure compared to high-income settings. Part of this effort includes the development and validation of intensive care unit (ICU) risk stratification models feasible for use in LICs. The purpose of this study was to validate and compare the performance of ICU mortality models developed for use in sub-Saharan Africa. This was a prospective, observational cohort study of ICU patients in a referral hospital in Malawi. Models were selected for comparison based on a Medline search for studies which developed ICU mortality models based on cohorts in sub-Saharan Africa. Model discrimination was evaluated using the area under the curve with 95% confidence intervals (CI). During the study, 499 patients were admitted to the study ICU, and after exclusions, there were 319 patients. The cohort was 62% female, with the mean age 31years (IQR: 23-41), and 74% had surgery preceding ICU admission. Discrimination for hospital mortality ranged from 0.54 (95% CI 0.48, 0.60) for the Universal Vital Assessment (UVA) to 0.72 (95% CI 0.66, 0.78) for the Malawi Intensive care Mortality Evaluation (MIME). After tenfold cross-validation, these results were unchanged. The MIME outperformed other models in this prospective study. Most ICU models developed for LICs had poor to modest discrimination for hospital mortality. Future research may contribute to a better risk stratification model for LICs by refining and enhancing the MIME.

A cascade of care for people with epilepsy: learning from “HIV/AIDS 90-90-90”

Epilepsy is now more prevalent in many countries than HIV/AIDS. Building upon the successes of global policymaking for HIV/AIDS and creating a framework for countries and organizations to monitor progress in epilepsy care will help direct and justify much-needed novel programming. Given the clarity of the HIV/AIDS care continuum model and the UNAIDS 90-90-90 targets, I propose this same approach to the cascade of care could be used as a viable framework for people with epilepsy. In this model, the targets of success include (1) ensuring 90% of all people with epilepsy are aware of their diagnosis as a brain disorder, (2) starting 90% of people with epilepsy on quality controlled, appropriately chosen and well stocked antiepileptic drugs, and (3) achieving seizure freedom in 70% of those treated. At least 90% of all people with epilepsy must also be linked to and retained in appropriate care. Although the precise numbers may be debated, this cascade of care approach will assist in deconstructing the barriers to epilepsy care in populations better than the more familiar concept of the epilepsy treatment gap. These reflect concrete goals for health systems of epilepsy care that, if achieved, could lead to seizure freedom for the many people in lower income countries living with poorly controlled epilepsy.

Amplification of future energy demand growth due to climate change

Future energy demand is likely to increase due to climate change, but the magnitude depends on many interacting sources of uncertainty. We combine econometrically estimated responses of energy use to income, hot and cold days with future projections of spatial population and national income under five socioeconomic scenarios and temperature increases around 2050 for two emission scenarios simulated by 21 Earth System Models (ESMs). Here we show that, across 210 realizations of socioeconomic and climate scenarios, vigorous (moderate) warming increases global climate-exposed energy demand before adaptation around 2050 by 25–58% (11–27%), on top of a factor 1.7–2.8 increase above present-day due to socioeconomic developments. We find broad agreement among ESMs that energy demand rises by more than 25% in the tropics and southern regions of the USA, Europe and China. Socioeconomic scenarios vary widely in the number of people in low-income countries exposed to increases in energy demand.

Can tracking people through phone-call data improve lives?

Researchers have analysed anonymized phone records of tens of millions of people in low-income countries. Critics question whether the benefits outweigh the risks. Researchers have analysed anonymized phone records of tens of millions of people in low-income countries. Critics question whether the benefits outweigh the risks.

Adverse family events and educational outcomes of young adults: Analysis from three waves of Young Lives Data from India: Author details

There is a limited exploration in the literature of how young people’s educational outcomes respond to unexpected events or adversities in their home environment. Given the concerns about uneven educational trajectories of young people in low-income countries, such an investigation may be valuable. We analyze Young Lives data from India to contribute to this literature. We observe that over the years youth enrollment and grade attainment decline and several of them experience adversities in the form of economic loss and death and illness of a parent. Males experience similar levels of adversities as females, but their educational outcomes are generally superior to females in their cohort. Individual fixed-effects regression results indicate male enrollment is associated negatively with death of a parent. Overall however we find limited significant associations between the adversities and educational outcomes we focus on. We conclude the paper with our study’s limitation and way forward for future research.

Consumption Discount Rates, Risk Aversion and Wealth in Low-Income Countries: Evidence from a Field Experiment in Rural Ethiopia

It has been argued that people in low-income countries often have high consumption discount rates (CDRs), which contributes to under-investment in capital, such as education and soil conservation. We use a field experiment to estimate CDRs in rural Ethiopia and find that annual rates range from 43% to 106%. We evaluate whether household wealth affects CDRs and test for synergies with field experiment-derived estimates of risk aversion. We find evidence that respondents who are part of wealthier households have lower CDRs and more risk averse respondents have higher rates.

A survey of domestic wells and pit latrines in rural settlements of Mali: Implications of on-site sanitation on the quality of water supplies.

On-site sanitation is generally advocated as a means to eradicate the health hazards associated with open defecation. While this has provided a welcome upgrade to the livelihoods of millions of people in low-income countries, improved sanitation facilities are increasingly becoming a threat to domestic groundwater-based supplies. Within this context, a survey of pit latrines, domestic wells and improved water sources was carried out in a large rural village of southern Mali. All households were surveyed for water, sanitation and hygiene habits. Domestic wells and improved water sources were georeferenced and sampled for water quality (pH, electric conductivity, temperature, turbidity, total dissolved solids, thermotolerant coliforms, chloride and nitrate) and groundwater level, while all latrines were inspected and georeferenced. A GIS database was then used to evaluate the proportion of water points within the influence area of latrines, as well as to underpin multiple regression models to establish the determinants for fecal contamination in drinking supplies. Moreover, an appraisal of domestic water treatment practices was carried out. This revealed that nearly two-thirds of the population uses bleach to purify drinking supplies, but also that domestic-scale treatment as currently implemented by the population is far from effective. It is thus concluded that existing habits could be enhanced as a means to make water supplies safer. Furthermore, population, well and latrine density were all identified as statistically significant predictors for fecal pollution at different spatial scales. These findings are policy-relevant in the context of groundwater-dependent human settlements, since many countries in the developing world currently pursue the objective of eliminating open defecation.

Nutritional status among adolescent girls in children's homes: Anthropometry and dietary patterns

Malnutrition is widespread among disadvantaged people in low-income countries like Uganda. Children and adolescents living in children's homes are considered an especially vulnerable group, and malnutrition among girls is of particular concern since it has intergenerational consequences. Virtually no information exists about the nutritional status of adolescent girls living in children's homes in Uganda. We therefore conducted a cross-sectional study to assess the nutritional status by evaluating anthropometric indicators, body composition and dietary patterns. Forty-four girls aged 10-19 years living in five children's homes participated in addition to a reference group of 27 adolescent girls from three boarding schools; both in the Ugandan capital Kampala. Height and weight were measured to assess anthropometry. Body composition data was obtained by bioelectrical impedance analysis. Dietary intake was evaluated with a food frequency questionnaire, calculation of dietary diversity score, and a 24-hdietary recall. The adolescent girls living in children's homes suffered from stunting (18.6%), overweight or obesity (18.6%), and were at risk of insufficient intakes of multiple micronutrients, especially of vitamins A, B12, C, D, E and calcium. They also had a low intake of essential fatty acids. Dietary diversity was low with a median score of 3 out of 9 food groups. Animal products were rarely consumed. The majority of girls in children's homes consumed a less adequate diet compared to the reference group, thus being at risk of nutrient deficiency-related disorders.

Prevalence and burden of Toxoplasma gondii infection in HIV-infected people: a systematic review and meta-analysis

Worldwide, 30% of the world's population have antibodies to the intracellular protozoan parasite Toxoplasma gondii and about 36·7 million people are infected with HIV, but little is known about the prevalence of co-infection with T gondii and HIV. We aimed to characterise the epidemiology and burden of T gondii co-infection in people with HIV infection. In this systematic review and meta-analysis, we searched PubMed, Embase, Google Scholar, ScienceDirect, Chinese Web of Knowledge, Wanfang, and Chongqing VIP databases for studies reporting T gondii infection in HIV-infected people from inception to Feb 29, 2016. Studies were included if they investigated people with HIV infection and presented data that allowed us to establish the prevalence of T gondii infection. We excluded reviews, repeated studies, or animal studies, as well as studies that provided the final results without raw data, had a sample size less than 30 people, had unclear diagnostic methods of T gondii infection, or that included populations with increased risk of T gondii infection. We extracted the numbers of patients with HIV infection and T gondii co-infection from the identified studies. We estimated pooled prevalence of T gondii infection in HIV-infected people by a random-effects model, and evaluated its overall infection burden worldwide. Our search identified 7843 records and after removal of duplicates and initial screening, we reviewed 312 studies in full. Of these articles, 238 were excluded, leaving 74 studies that included 25 989 HIV-infected people from 34 countries. Of these people, 7326 had T gondii co-infection and we estimated the pooled worldwide prevalence of T gondii infection to be 35·8% (95% CI 30·8-40·7). 2353 of 8837 of people in Asia and the Pacific had co-infection with T gondii and HIV (prevalence 25·1%, 95% CI 19·0-31·2), and prevalence was low in this region compared with that in sub-Saharan Africa (44·9%, 32·3-57·5, 2129/5686; odds ratio [OR] 0·61), Latin America and the Caribbean (49·1%, 27·9-70·4, 510/980; OR 0·33), and North Africa and the Middle East (60·7%, 24·1-97·3, 245/439; OR 0·29). 1561 of 3780 people in low-income countries had co-infection (54·7%, 95% CI 35·8-73·5), which was higher than in middle-income countries (34·2%, 27·4-40·9, 3632/11 540; OR 1·53) and high-income countries (26·3%, 20·4-32·2, 2133/10 669; OR 2·82). Worldwide, we calculated that there were roughly 13 138 600 (95% CI 11 303 600-14 936 900) cases of T gondii co-infection in HIV-infected people, with 87·1% in sub-Saharan Africa (11 449 500 cases, 95% CI 8 236 500-14 662 500). Our findings suggest that people with HIV infection have a very high burden of T gondii infection, especially in sub-Saharan Africa, and emphasise the importance of routine surveillance for T gondii infection in all HIV-infected people. National Natural Science Foundation and the Special Fund for Agro-scientific Research in the Public Interest in China.