Poor Income Groups Research Articles

Income disparities in COVID-19 vaccine and booster uptake in the United States: An analysis of cross-sectional data from the Medical Expenditure Panel Survey.

COVID-19 vaccination has significantly decreased morbidity, hospitalizations, and death during the pandemic. However, disparities in vaccination uptake threatens to stymie the progress made in safeguarding the health of Americans. Using a nationally representative adult (≥18 years old) sample from the 2021 Medical Expenditure Panel Survey (MEPS), we aimed to explore disparities in COVID-19 vaccine and booster uptake by income levels. To reflect the nature of the survey, a weighted logistic regression analysis was used to explore factors associated with COVID-19 vaccine and booster uptake. A total of 241,645,704 (unweighted n = 21,554) adults were included in the analysis. Average (SD) age of the population was 49 (18) years old, and 51% were female. There were disparities in COVID-19 vaccine and booster uptake by income groups. All other income groups were less likely to receive COVID-19 vaccines and booster shot than those in the high-income group. Those in the poor income group had 55% lower odds of being vaccinated for COVID-19 (aOR = 0.45, p<0.01). Considering the female population only, women with lower incomes may have greater disparities in access to COVID-19 vaccines than do males with lower incomes. Disparities in COVID-19 vaccination by income may have even greater implications as the updated vaccines are rolled out in the US without the government covering the cost as before.

Cross-country comparison of income-related inequality in physical functional disability among middle-aged and older adults: Evidence from 33 countries

Physical functional disability is prevalent among middle-aged and older adults, with substantial health inequality. This study compared cross-country variation in the prevalence and inequality of physical functional disability and investigated the potential determinants of household income-related inequality.This cross-sectional study used data from 33 countries between 2017 and 2020, containing 141 016 participants aged 55 years and older. Physical functions were grouped into three domains: activities of daily living (ADLs), instrumental activities of daily living (IADLs), and mobility function. Physical functional disability of each domain was indicated by having some difficulty with the activity. We first estimated the prevalence of physical functional disability in each country. Second, the concentration index was used to quantify household income-related health inequality. Finally, recentred influence function (RIF) decomposition method was used to decompose the inequality into individual and country-level determinants.Physical functional disability prevalence was higher in lower-middle-income countries than in high-income countries and more prevalent in the poor-income groups in all study countries. Besides, health inequality in different domains of disability was higher in high-income countries than in low-income countries. Regarding determinants of health inequality, we found that individual married, tertiary education, and country-level health infrastructure and resources were associated with reduced health inequality. In contrast, age, unhealthy lifestyles, and chronic diseases were associated with increased health inequality.Inequality in physical functional disability among middle-aged and older adults varies substantially across countries, with individual and macro determinants being contributing factors. Policies to achieve healthy ageing and reduce the inequality of physical function disability can focus on improving individual healthy lifestyles and country health care facilities.

DISTRIBUTIONAL INCIDENCE OF INDIRECT TAXATION: AN EMPIRICAL REVIEW

In this article, we reviewed the published Research works on indirect tax incidence, which describes the way of distributing indirect tax burden among households, and the purpose of this review is to identify the distributional impact of the burden of indirect tax on different groups, such as income groups, expenditure groups, commodity groups, and demographic groups, etc. The process of systematic review has been implemented in order to search, select, appraise, synthesize, and report the findings of previous studies. A government's revenue depends on several sources. Among them, indirect taxes are used as a major form of collecting government revenue, especially in developing countries. We observed major findings that there is a regressive type picture of the overall indirect tax system, which mainly impacts the vulnerable groups in a country. Indirect taxes will be paid by every household irrespective of income level. Even though the incidence theory of taxation describes the burden of indirect tax distributed among producers and consumers as per the elasticity of demand and supply, that would not happen practically. The imposition of indirect taxes leads to an increase in raw materials, then increase the cost of production and ultimately increases the price level of the country, which creates cost-push inflation. The entire portion of the indirect tax will be shifted to the end consumer. The increase in indirect taxes will be led to a rise in the tax burden on households. The burden of indirect taxation highly damages the living standards of the low-income groups in a country, especially due to the consumption tax. Households that are earning low incomes will be paid a relatively higher portion of indirect taxes than the households that have higher incomes. Past researchers have emphasized the importance of eliminating the consumption taxes on essential and most sensitive commodities, which are mostly consumed by the poor income groups.

Evaluating efficiency and equity of prevention and control strategies for rheumatic fever and rheumatic heart disease in India: an extended cost-effectiveness analysis

There is a dearth of evidence on the cost-effectiveness of a combination of population-based primary, secondary, and tertiary prevention and control strategies for rheumatic fever and rheumatic heart disease. The present analysis evaluated the cost-effectiveness and distributional effect of primary, secondary, and tertiary interventions and their combinations for the prevention and control of rheumatic fever and rheumatic heart disease in India. A Markov model was constructed to estimate the lifetime costs and consequences among a hypothetical cohort of 5-year-old healthy children. Both health system costs and out-of-pocket expenditure (OOPE) were included. OOPE and health-related quality-of-life were assessed by interviewing 702 patients enrolled in a population-based rheumatic fever and rheumatic heart disease registry in India. Health consequences were measured in terms of life-years and quality-adjusted life-years (QALY) gained. Furthermore, an extended cost-effectiveness analysis was undertaken to assess the costs and outcomes across different wealth quartiles. All future costs and consequences were discounted at an annual rate of 3%. A combination of secondary and tertiary prevention strategies, which had an incremental cost of ₹23 051 (US$30) per QALY gained, was the most cost-effective strategy for the prevention and control of rheumatic fever and rheumatic heart disease in India. The number of rheumatic heart disease cases prevented among the population belonging to the poorest quartile (four cases per 1000) was four times higher than the richest quartile (one per 1000). Similarly, the reduction in OOPE after the intervention was higher among the poorest income group (29·8%) than among the richest income group (27·0%). The combined secondary and tertiary prevention and control strategy is the most cost-effective option for the management of rheumatic fever and rheumatic heart disease in India, and the benefits of public spending are likely to be accrued much more by those in the lowest income groups. The quantification of non-health gains provides strong evidence for informing policy decisions by efficient resource allocation on rheumatic fever and rheumatic heart disease prevention and control in India. Department of Health Research, Ministry of Health and Family Welfare, New Delhi.

Access to Finance and Human Development in Sub-Saharan Africa

The study examines the relationship between access to finance and human development in Sub-Saharan Africa. The study used a panel data covering the period 2004–2021and employed the two-step system Generalized Method of Moments for the analysis of the data. The indicators of financial access used in the study are number of bank branches, commercial bank private sector credits and number of automatic teller machines (ATM) per. The study found that commercial bank private sector credits and number of number of automatic teller machines per 1000 adults have a positive and significant relationship with human development index in Sub-Saharan Africa. Base on the findings, the study recommends that the government of various Sub-Saharan African countries should intensify efforts to increase the access to financial services for the poor and low income group. This include reducing the costs and charges on credits for the low income earners and building more bank agents and automatic teller machines that will provide financial services to the populace especially the unbanked. The findings of the study lead to the conclusion that most Sub-Saharan African countries need to do more to boost access to finance for the unbanked and low income earners.

Effectiveness of post-disaster coping strategies among the farming households in the coastal districts of Odisha, India

Farmers in developing countries generally faced vulnerability in consumption due to income shocks caused by crop damage, price falls, disasters, etc. The ability to respond to such income shocks is determined by their asset structure labour endowment, access to credit and so on. Using information from 459 sample households in the three coastal districts of Odisha; India, this paper examines the effectiveness of ex-post coping strategies adopted by the farming households in the study regions. Based on wealth index score, we classified the sample households in to poor, medium and rich income groups for a deeper understanding of the impact floods on their consumption patterns. Ordinary least square (OLS) regression model was used for examining the effectiveness of post disaster coping strategies adopted the sample households. The results of regression model show that the practice of borrowing money from formal/informal sources is one of the most effective strategies resorted by the sample households in the study regions. Seasonal migration is an alternative strategy followed by poor and middle-income households in the study regions, whereas accessing to government or non-governmental assistance measures is an effective strategy on the part of richer households. Among the socio-economic characteristics, the educational attainment of household heads and the landholding size possessed by households have had a significant influence on narrowing down the consumption gaps. In this scenario, along with an effective implementation of welfare and employment generation programmes like Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS), a widen access to the formal loan market helps farmers reduce migration and provide a secure income to the people which, in turn, helps them reduce their relative consumption gaps.

The role of income in the lives of people with long-term disabilities: A multi-country analysis

Abstract Background Health is a fundamental human right. Yet, people become ill and die because they do not have enough money to access the necessary healthcare. Studies confirm that on average, more income translates to better health status. The magnitude of this relationship and its consequences beyond health like reintegration or spillovers are not widely understood but are expected to be significantly different among countries. This is especially the case in vulnerable populations like those with a spinal cord injury (SCI). This study aims to better understand the role that income plays in promoting health in people with SCI and their differences across countries. Methods The research focus on three aspects, one, the estimation of the health income gap using years after the injury and a comorbidity index, two, the decomposition of different factors of this inequality with a special interest in the unmet healthcare needs, and three, their consequences in their social participation measured by the reasons of unemployment. Results There are significant differences in health status by income and between countries. On average, the poorest income groups with SCI are up to 40 times more likely to be ill than people in the richest groups and live 4-6 years less after the injury. The working conditions and the unmet health care needs are important factors that explain that differences. In addition, the health status, the lack of sustainable employment opportunities, and workplace accessibility issues are the main issues to reintegrating into the labor market. Conclusions Health inequalities are a global problem that affects people with long-term health conditions disproportionately to others without. Even in more equal and high-income countries with a universal health system, there are different realities for the people according to their income, where the estimations and solutions for the ‘average’ individual do not target the needs of people in the extremes. Key messages • This study generates evidence about the role of income in health, lack of health services, and consequences in people with SCI across and within countries. • To achieve the goal of health equity, it is important to target the different realities focusing on the needs of people who most need which goes beyond the health system and changes by income level.

Study on livelihood of street food vendors

The street food being an informal food supply system provided livelihood and substantial amount of household income to the middle and low income urban population, who would otherwise be unemployed or under employed. Street foods play an important role in achieving food and nutritional security of the poor income groups, who would otherwise be insecure owing to the cost, accessibility and affordability of food. The present study was carried out with a view to analyze the overall performance of street food vendors in Coimbatore city of Tamil Nadu. The study was undertaken to analyze both the positive and negative effects of street food vending. The conventional and percentage analysis were carried out to draw meaningful inferences. The multiple linear regression was used to analyse the sales revenue of street food vendor.

The Effects of Solidarity, Income, and Reliance on the State on Personal Income Tax Preferences. The Case of the Czech Republic

The current increase in government spending, caused by COVID epidemics and the increasing visibility of leftist political groups in public media, emphasizes the short-term need for sustainable income taxation. In the long run, rising inequality worldwide makes taxation of high-incomes indispensable for sustainable economic development. This paper empirically studies public attitudes on taxation related to income, preferences for solidarity vs. individual performance, and reliance on the state in the Czech Republic. In this Eastern European country, the dichotomies above bear even more importance due to the communist past. We apply the hierarchical regression analysis with smoothing spline transformations to a representative sample of public opinion data (N = 1104, aged 15–95 years, M ± SD: 47.74 ± 17.39; 51.2% women, 18.50% with higher education). The results suggest that income was associated with the perception that taxes for the rich are inadequately high but was unrelated to perceptions of tax adequacy for average and poor groups of respondents. Higher solidarity and reliance on the state were associated with the desire to increase taxation of high-incomes and decrease taxation of poor income groups. Surprisingly, the reliance on the state was associated with a desire to decrease taxation of average-incomes and total taxation while increasing tax progressivity. Preferences for solidarity were associated with higher preferred overall taxation and more tax progressivity. The explanatory powers of preferences for solidarity and reliance on the state in explaining the variation in tax preferences are at least equivalent and, in some cases, twice as large as the explanatory power of the age, gender, education, and income altogether. The results above present new mechanisms that can contribute to sustainable endogenous economic development.

Potential of Underutilized Wild Edible Plants as the Food for the Future – A Review

Today, it has been a big challenge to provide a safe, healthy and nutritious source of food for people, especially for poor income groups and undernourished populations of the developing world. Finding cheap and alternative sources of healthy and nutritious food has become a critical issue due to the food scarcity, high cost and unreliable supply of healthy food in developing and undeveloped countries. Tapping in to the world of Underutilized Wild Edible Plants (UWEP) will allow us to provide a substantial solution for food insecurity. UWEP have been identified as a reliable and long term solution due to the availability of micronutrients, bioactive compounds and their pharmacological importance. UWEP based diet should be expanded around the world, after conducting researches to fill the missing information such as micronutrient bioaccessibility, anti-nutrients, elimination of anti-nutrients and novel trends. The purpose of this paper is to explain the potentials of UWEP to cope up with malnutrition and food insecurity, which are burning issues that needs immediate attention.

COVID-19 syndemic, stigmatization, and social vulnerabilities: A case of Bangladesh

ABSTRACT The global spread of COVID -19 accompanied with the behavioral, psychosocial, and structural elements of social stigma engendered social and bio-medical complexity due to the COVID -19 syndemic. The study aims to explore the process of stigmatization and the extent of social vulnerabilities affected COVID -19 people of Bangladesh. The study used purposive sampling, where a total of 15 different cases were selected from 11 online newspapers in Bangladesh. Results revealed that infected and suspected patients were largely stigmatized through local hatred and eviction, forced quarantining, impeding burial process, hospital and local administration’s mistreating, family-negligence, relatives’ avoidance, and the land owners’ disgracing. The excessive media coverage of maintaining lockdown, quarantining, and physical distance were the major causes of increasing rumor where the poor-income group, female workers, and employees of health-care services were seriously vulnerable. The study findings recommend several guidelines forrecognizing practicability and capability for combatting COVID 19 syndemic.

EGYPT: Egypt's Housing Crises: The Shaping of Urban Space, by Yahia Shawkat. Cairo: American University in Cairo Press, 2020. 312 pages. $49.95.

Book review of Egypt's Housing Crises: The Shaping of Urban Space by Yahia Shawkat. The American University in Cairo (AUC) Press, ISBN 9789774169571. Approaching a century of crises, housing in Egypt has been, and continues to be, produced and reproduced within a very complex milieu which can be portrayed by an obsession with top-down approaches while encompassing a multitude of intersecting economic, social, and political factors. Over the past four decades, this has been coupled with a deteriorating urban infrastructure, and in tandem, the rapid urban growth and the surge in the development of new communities, satellite cities, and the associated policies that support these endeavours. While these factors continue to agglomerate and impact the mainstream urban poor and lower income groups, recent efforts of the public sector attempt to address these complexities, but strikingly aspire to reshape the production of housing with a desire to mimic hyper-capitalist approaches adopted in some of the neighbouring affluent countries. In essence, this manifests to accommodate the growing population, the emerging socio-economic trends, and the accompanying incipient lifestyles of specific higher-income segments of the Egyptian society. In this book, Yahia Shawkat, a housing and urban policy researcher, known of his interest and advocacy for spatial justice and fair housing, constructs a convincing, well-articulated argument on the need for serious reform. Egypt's Housing Crises: The Shaping of Urban Space offers a comprehensive analysis and a series of vigorous discussions, characterised by an impartial candidness, on the evolutionary nature of crises and the contemporary condition of housing in Egypt.

Incorporating equity in infectious disease modeling: Case study of a distributional impact framework for measles transmission

IntroductionDeterministic compartmental models of infectious diseases like measles typically reflect biological heterogeneities in the risk of infection and severity to characterize transmission dynamics. Given the known association of socioeconomic status and increased vulnerability to infection and mortality, it is also critical that such models further incorporate social heterogeneities. MethodsHere, we aimed to explore the influence of integrating income-associated differences in parameters of traditional dynamic transmission models. We developed a measles SIR model, in which the Susceptible, Infected and Recovered classes were stratified by income quintile, with income-specific transmission rates, disease-induced mortality rates, and vaccination coverage levels. We further provided a stylized illustration with secondary data from Ethiopia, where we examined various scenarios demonstrating differences in transmission patterns by income and in distributional vaccination coverage, and quantified impacts on disparities in measles mortality. ResultsThe income-stratified SIR model exhibited similar dynamics to that of the traditional SIR model, with amplified outbreak peaks and measles mortality among the poorest income group. All vaccination coverage strategies were found to substantially curb the overall number of measles deaths, yet most considerably for the poorest, with select strategies yielding clear reductions in measles mortality disparities. DiscussionThe incorporation of income-specific differences can reveal distinct outbreak patterns across income groups and important differences in the subsequent effects of preventative interventions like vaccination. Our case study highlights the need to extend traditional modeling frameworks (e.g. SIR models) to be stratified by socioeconomic factors like income and to consider ensuing income-associated differences in disease-related morbidity and mortality. In so doing, we build on existing tools and characterize ongoing challenges in achieving health equity.

Achieving pro-poor growth and environmental sustainability agenda through information technologies: as right as rain.

The pro-poor growth and environmental sustainability are the twin agendas widely discussed in environmental science literature. The technology-embodied growth helps to attain both agendas through knowledge sharing and technology transfer, which trickle down to the poor income group and improve their living standards. Hence, the role of information and communication technologies (ICTs) is deemed crucial in boosting economic growth and is under deep consideration to establish its role in reducing poverty and environmental pollution. The current study examines the long-run relationship between ICTs, poverty reduction, and ecological degradation in Pakistan using time series data from 1975-2018. The short- and long-run parameter estimates were obtained through the Autoregressive Distributed Lag (ARDL) model for robust inferences. The results substantiate the inverted U-shaped Environmental Kuznets Curve relationship between income and emissions with a turning point at US$1000 in the short-run and US$800 in the long-run. The results confirmed the decisive intervention of ICTs factors in the poverty reduction, i.e., computer communications and mobile-telephone-broadband subscriptions support to reduce poverty incidence with the mediation of inbound FDI in a country. As far as income inequality is concerned, it shows that computer services support minimizing income inequality via a channel of high-technology exports in a country. The technology embodied emissions verified in the long-run, where mobile-telephone-broadband subscriptions increase carbon emissions. Finally, mobile-telephone-broadband subscriptions and inbound FDI both are significant contributors to amplify the country's economic growth. The results conclude that poverty reduction and environmental sustainability agenda are achieved by developing green ICT infrastructure in a country.

A STUDY ON AWARENESS ON AB-PMJAY FOR TREATMENT OF DISEASES WITH SPECIAL REFERENCE TO CANCER CARE IN THANJAVUR DISTRICT OF TAMIL NADU

Ayushman Bharat or Modicare, the Central Government aims to provide a health insurance cover of Rs 5 lakh to 500 million Indians free of cost. This includes families from lower income groups that fall under the socio-economic caste census (SECC) data of 2011. PM-JAY envisions to help mitigate catastrophic expenditure on medical treatment which pushes nearly 6 crore Indians into poverty each year. In Tamil nadu a scheme called ‘Chief Minister Kalaignar’s Insurance Scheme for Life Saving Treatments’ (KHIS) was launched in the year 2009 to ensure that poor and low income groups who cannot afford costly treatment, are able to get free treatment in Government as well as private hospitals for serious ailments. Later this scheme was modified with extended coverage in the year 2011 and re-launched in the name of ‘Chief Minister’s Comprehensive Health Insurance Scheme (CMCHIS)’. Under this scheme, the sum assured for each is revised as Rs.1 lakh every year for a total period of four years and for a total value of Rs. 4 lakh. Now, a value addition is made to the exicting CMCHIS, after the launch of PM-JAY, providing an insurance cover upto Rs 5 lakh per family, per year for secondary and tertiary hospitalization

Sociodemographic profile of primiparous mothers from nine birth cohorts in three Brazilian cities.

Fertility reduction is a phenomenon observed in demographic transition. The demographic changes noted in female fertility represent a need for adjustment on health services regarding female health and family planning support. Thus, this study aimed to perform a descriptive analysis by tracing the sociodemographic profile of primiparous mothers belonging to nine Brazilian birth cohorts, in three cities from different states. Standardized questionnaires were applied to assess reproductive characteristics and covariables. Primiparous mothers were defined as women whose child included in birth cohorts was their firstborn child. Sample description was performed using analysis of variance (continuous variables) and chi-square (categorical variables). In total, 44,615 women were included in the analyses and 41.8% (95%CI: 41.3; 42.2) were categorized as primiparous. The primiparity rates were the lowest in Ribeirão Preto (São Paulo State) 1978 (32%; 95%CI: 30.9; 33.1) and the highest in most recent cohorts, reaching up to 50% of the participants (São Luís - Maranhão State 2010: 47.2%; 95%CI: 45.8; 48.6; Ribeirão Preto 2010: 50.2%; 95%CI: 49.1; 51.4); Pelotas (Rio Grande do Sul State) 2015: 49.4% (95%CI: 47.9; 50.9). Primiparous mothers' age and schooling increased over the years in all cohorts. Maternal age at the first childbirth behaved similarly in the three studied cities. There was an increase in the proportion of first-time mothers that were older, higher educated and belonged to richer income groups. Also, the proportion of teenage mothers (aged 15 years or younger) increased until the early 2000's and started decreasing around the years 2010, especially among women in the poorer income groups.

National sample surveys show poor households face catastrophic expenditure for oral healthcare services in India.

Introduction:Globally people pay out-of-pocket (OOP) to access Oral healthcare services. In India, there is limited evidence on estimates of OOP expenditure. We undertook an analysis of national sample survey data on household health care expenditure to understand the expenditure pattern for Oral healthcare services and the catastrophic burden.Method:The expenditure reported for Oral healthcare services from two surveys: 71st round and 75th round, published by National Sample Survey Office (NSSO) was extracted. Based on monthly household consumption expenditure three economic groups were made: poor, middle- and rich-income groups. The OOP expenditure pattern while accessing day-care services and hospitalization and in public and private sector and the catastrophic expenditure were analysed.Results:A total of 204 and 155 households from two national surveys reported to have accessed day-care Oral services respectively. The median OOP expenditure in public sector remained same at US $ 4 in both surveys. Over 35% of 78 households in 71st round and 42% of 167 in 75th round used public sector hospitalization services. The median expenditure of hospitalization doubled from US$ 58 (IQR 21–263) in 71st round to US $ 125 (IQR 45-363) in 75th round. Households from poor income groups spent seven times more for Oral healthcare services during the recent survey and faced catastrophic expenditure.Conclusion:The OOP expenditure for Oral healthcare has significant catastrophic household expenditure among the poor. There is a need to increase investment in public sector and insurance to protect poor against hospitalization expenditure in private sector.

Prelabour Rupture of Membrane : Maternal and Foetal Outcomes

Background: The leading cause of perinatal morbidity and mortality is prematurity in developed and underdeveloped countries. In one third of the patients with preterm labour, there is associated premature rupture of membranes. The study was conducted to evaluate the clinical presentation of Pre-labour Rupture of Membrane (PROM) in pregnancy and obstetric outcome.&#x0D; Materials and methods: This is a cross sectional study carried out in the Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University, Dhaka, between September 2013 to February 2014. About 50 women having PROM with more than 32 weeks gestational age who admitted in the above department for delivery were enrolled in this study.&#x0D; Results: The mean age was found 27.4 ± 4.42 years with range from 17 to 41 years. Forty eight percent of PROM patient were primi and 52.0 percent of patients were multigravida. Six percent patients were illiterate. Almost two third patients were housewives. More than half (54.0%) of the patients were came from poor class income group family. Majority (64.0%) patients had term PROM (&gt;37 weeks) gestational age and the mean gestational age was 38.1 ± 2.7 weeks with range from 32- 40 weeks. More than half (54.0%) didn't received any antenatal checkup. A total of (56.0%) patients had associated disease, out of which anaemia was more common. Twelve percent had diabetes mellitus and 8.0% had UTI infection. Almost two third (64.0%) was vaginal delivery and 18(36.0%) were caesarean section and common indication for caesarean section was fetal distress (38.9%). Two third patients were healthy and 17 patients had morbidities, wound infection is highest (29.4%). The mean birth weight was found 2.74 ± 0.7 kg. APGAR score &gt;7 at 1 minute was found (92.0%) and (94.0%) at 5 minutes of birth of baby after birth. Fetal outcome take home alive (98.0%) and neonatal death 2.0%. Among 50 foetus morbidity develop in 26 cases. Among them respiratory insufficiency is highest (38.5%).&#x0D; Conclusion: Motivation of the patients, health education, improvement of nutritional status of mother, neonatal care service, early diagnosis, treatment, overall institutional delivery is needed for reduction of neonatal morbidity and mortality, as well as maternal morbidity.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.19 (2); July 2020; Page 23-27

Pregnancy Outcome in Impaired Liver Function in Pre-eclampsia

Pre-eclampsia induced liver disease is a disorder unique to pregnancy and is frequently seen in third trimester. Severe pre-eclampsia is defined by extreme elevation in systemic blood pressure and evidence of organ compromise. HELLP syndrome is a unique liver related disorder of pregnancy that was first described by Weinstein in1982 as a constellation of clinical and laboratory abnormalities in pregnant women in their third trimester. This disorder was termed HELLP syndrome with (H) for haemolysis, (EL) for elevated liver enzymes and (LP) for low platelet counts. This is a severe variant of pre-eclampsia. Objective of this study was to determine the alteration of liver function in preeclampsia and its correlation with the clinical severity as well as the perinatal outcome. This was a one-year prospective observational cross sectional study included 100 patients with pre-eclampsia. Severity of the pre-eclampsia clarified clinically. Pre-eclampsia patients having history of hepatitis, cirrhosis of liver, gallbladder diseases and other pre-existing medical disorders that altered liver function were excluded from this study. The mean age of the patients was 25.3+4.9 years ranging from 18 to 37 years. One third of the patients (33.3%) were in the age group 28 to 32 years. Out of 100 patients, 58% belongs to poor income group. Among the studied samples 17% had epigastric pain and discomfort, 13% had complaints of vomiting and 43% develop severe pre-eclampsia. Among the Patients with altered hepatic enzyme level, 8.33% had complaints of epigastric pain, 6.66% complains vomiting. Maximum patients (66.6%) with elevated liver enzyme had no major complications whereas 33.4% of patients developed major complications. Patients with severe pre-eclampsia have elevated liver enzyme whereas patients of mild symptoms had normal liver enzymes level. Cases with raised serum biochemical markers had strong association with complications of severe pre-eclampsia. Pregnancy outcome in severe pre-eclampsia with hepatic involvement is grievous. Graves sequlae of pre-eclampsia can be prevented and minimized by timely institutional intervention. Post-partum followup would help to find out other parameters of pregnancy outcome. Bangladesh Med J. 2020 May; 49(2) : 9-13

Quantifying The Incidence Of A Global Oil Price Shock In Nigeria: A Roy Model With Non-Homothetic Preferences And Endogenous Transfers

In this paper, I explore the distributional effects of a negative terms-of-trade shock to an oil-exporting country. Specifically, I begin by developing a computable Roy model of the Nigerian economy with non-homothetic preferences, after-tax income effects, and government endogenous transfers through oil subsidies. I then use this model to simulate the impact of the global oil price shock that hits the Nigerian economy in 2016. In doing so, I focus on differential impacts across workers due to their different skills, locations, and comparative advantages. I find that the oil shock led to a reverse Dutch disease characterized by increases of real output, relative wage and labor in the manufacturing and agricultural sectors. Further, the combination of the shock and subsidies removal affected poor and rich income groups differently, in accordance with their labor specialization patterns across sectors and differences in the consumption bundles they consumed. More precisely, I show that the shock causes aggregate welfare losses that are concentrated in high-income groups, as they tend to specialize in the crude oil and service sectors, the most hit by the shock. Next, using a series of government budget-balancing tax policy counterfactuals, I first show that the removal of the subsidies was the best response to the shock regarding the welfare outcomes of low-income workers. Second, I show that while removing the subsidies, the government can use fiscally neutral progressive tax redistribution schemes to lessen the extent of the welfare losses, particularly on the poor populations. Finally, I show that not accounting for heterogeneity in the expenditure behavior would introduce biases in the magnitude of the welfare changes.