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Identidad de Género , Masculino , Femenino , Humanos , Estándares de Referencia , Organización Mundial de la SaludRESUMEN
AIMS: The effect of the COVID-19 pandemic on care and outcomes across non-COVID-19 cardiovascular (CV) diseases is unknown. A systematic review and meta-analysis was performed to quantify the effect and investigate for variation by CV disease, geographic region, country income classification and the time course of the pandemic. METHODS AND RESULTS: From January 2019 to December 2021, Medline and Embase databases were searched for observational studies comparing a pandemic and pre-pandemic period with relation to CV disease hospitalisations, diagnostic and interventional procedures, outpatient consultations, and mortality. Observational data were synthesised by incidence rate ratios (IRR) and risk ratios (RR) for binary outcomes and weighted mean differences for continuous outcomes with 95% confidence intervals. The study was registered with PROSPERO (CRD42021265930). A total of 158 studies, covering 49 countries and 6 continents, were used for quantitative synthesis. Most studies (80%) reported information for high-income countries (HICs). Across all CV disease and geographies there were fewer hospitalisations, diagnostic and interventional procedures, and outpatient consultations during the pandemic. By meta-regression, in low-middle income countries (LMICs) compared to HICs the decline in ST-segment elevation myocardial infarction (STEMI) hospitalisations (RR 0.79, 95% confidence interval [CI] 0.66-0.94) and revascularisation (RR 0.73, 95% CI 0.62-0.87) was more severe. In LMICs, but not HICs, in-hospital mortality increased for STEMI (RR 1.22, 95% CI 1.10-1.37) and heart failure (RR 1.08, 95% CI 1.04-1.12). The magnitude of decline in hospitalisations for CV diseases did not differ between the first and second wave. CONCLUSIONS: There was substantial global collateral CV damage during the COVID-19 pandemic with disparity in severity by country income classification.
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COVID-19 , Enfermedades Cardiovasculares , Infarto del Miocardio con Elevación del ST , COVID-19/epidemiología , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/terapia , Mortalidad Hospitalaria , Hospitalización , Humanos , PandemiasRESUMEN
OBJECTIVE: To assess the availability and gaps in data for measuring progress towards health-related sustainable development goals and other targets in selected low- and middle-income countries. METHODS: We used 14 international population surveys to evaluate the health data systems in the 47 least developed countries over the years 2015-2020. We reviewed the survey instruments to determine whether they contained tools that could be used to measure 46 health-related indicators defined by the World Health Organization. We recorded the number of countries with data available on the indicators from these surveys. FINDINGS: Twenty-seven indicators were measurable by the surveys we identified. The two health emergency indicators were not measurable by current surveys. The percentage of countries that used surveys to collect data over 2015-2020 were lowest for tuberculosis (2/47; 4.3%), hepatitis B (3/47; 6.4%), human immunodeficiency virus (11/47; 23.4%), child development status and child abuse (both 13/47; 27.7%), compared with safe drinking water (37/47; 78.7%) and births attended by skilled health personnel (36/47; 76.6%). Nineteen countries collected data on 21 or more indicators over 2015-2020 while nine collected data on no indicators; over 2018-2020 these numbers reduced to six and 20, respectively. CONCLUSION: Examining selected international surveys provided a quick summary of health data available in the 47 least developed countries. We found major gaps in health data due to long survey cycles and lack of appropriate survey instruments. Novel indicators and survey instruments would be needed to track the fast-changing situation of health emergencies.
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Países en Desarrollo , Objetivos , Niño , Humanos , Renta , Desarrollo Sostenible , Organización Mundial de la SaludAsunto(s)
Síndrome de Inmunodeficiencia Adquirida , Infecciones por VIH , Malaria , Tuberculosis , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Síndrome de Inmunodeficiencia Adquirida/prevención & control , Humanos , Malaria/epidemiología , Malaria/prevención & control , Tuberculosis/epidemiología , Tuberculosis/prevención & controlRESUMEN
The expansion in the scope, scale, and sources of data on the wider social determinants of health (SDH) in the last decades could bridge gaps in information available for decision-making. However, challenges remain in making data widely available, accessible, and useful towards improving population health. While traditional, government-supported data sources and comparable data are most often used to characterize social determinants, there are still capacity and management constraints on data availability and use. Conversely, privately held data may not be shared. This study reviews and discusses the nature, sources, and uses of data on SDH, with illustrations from two middle-income countries: Kenya and the Philippines. The review highlights opportunities presented by new data sources, including the use of big data technologies, to capture data on social determinants that can be useful to inform population health. We conducted a search between October 2010 and September 2020 for grey and scientific publications on social determinants using a search strategy in PubMed and a manual snowball search. We assessed data sources and the data environment in both Kenya and the Philippines. We found limited evidence of the use of new sources of data to study the wider SDH, as most of the studies available used traditional sources. There was also no evidence of qualitative big data being used. Kenya has more publications using new data sources, except on the labor determinant, than the Philippines. The Philippines has a more consistent distribution of the use of new data sources across the HEALTHY determinants than Kenya, where there is greater variation of the number of publications across determinants. The results suggest that both countries use limited SDH data from new data sources. This limited use could be due to a number of factors including the absence of standardized indicators of SDH, inadequate trust and acceptability of data collection methods, and limited infrastructure to pool, analyze, and translate data.
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Países en Desarrollo , Determinantes Sociales de la Salud , Humanos , Renta , Almacenamiento y Recuperación de la Información , KeniaRESUMEN
Depression accounts for a large share of the global disease burden, with an estimated 264 million people globally suffering from depression. Despite being one of the most common kinds of mental health (MH) disorders, much about depression remains unknown. There are limited data about depression, in terms of its occurrence, distribution, and wider social determinants. This work examined the use of novel data sources for assessing the scope and social determinants of depression, with a view to informing the reduction of the global burden of depression.This study focused on new and traditional sources of data on depression and its social determinants in two middle-income countries (LMICs), namely, Brazil and India. We identified data sources using a combination of a targeted PubMed search, Google search, expert consultations, and snowball sampling of the relevant literature published between October 2010 and September 2020. Our search focused on data sources on the following HEALTHY subset of determinants: healthcare (H), education (E), access to healthy choices (A), labor/employment (L), transportation (T), housing (H), and income (Y).Despite the emergence of a variety of data sources, their use in the study of depression and its HEALTHY determinants in India and Brazil are still limited. Survey-based data are still the most widely used source. In instances where new data sources are used, the most commonly used data sources include social media (twitter data in particular), geographic information systems/global positioning systems (GIS/GPS), mobile phone, and satellite imagery. Often, the new data sources are used in conjunction with traditional sources of data. In Brazil, the limited use of new data sources to study depression and its HEALTHY determinants may be linked to (a) the government's outsized role in coordinating healthcare delivery and controlling the data system, thus limiting innovation that may be expected from the private sector; (b) the government routinely collecting data on depression and other MH disorders (and therefore, does not see the need for other data sources); and (c) insufficient prioritization of MH as a whole. In India, the limited use of new data sources to study depression and its HEALTHY determinants could be a function of (a) the lack of appropriate regulation and incentives to encourage data sharing by and within the private sector, (b) absence of purposeful data collection at subnational levels, and (c) inadequate prioritization of MH. There is a continuing gap in the collection and analysis of data on depression, possibly reflecting the limited priority accorded to mental health as a whole. The relatively limited use of data to inform our understanding of the HEALTHY determinants of depression suggests a substantial need for support of independent research using new data sources. Finally, there is a need to revisit the universal health coverage (UHC) frameworks, as these frameworks currently do not include depression and other mental health-related indicators so as to enable tracking of progress (or lack thereof) on such indicators.
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Países en Desarrollo , Determinantes Sociales de la Salud , Depresión/epidemiología , Humanos , Renta , Cobertura Universal del Seguro de SaludRESUMEN
The COVID-19 (coronavirus disease 2019) pandemic has underscored the critical need for all countries to strengthen their health data and information systems and ensure the routes the data travel, from submission to use, are unobstructed. Timely, credible, reliable, and actionable data are key to ensuring that political decisions are data driven and facilitate understanding, monitoring, and forecasting. To ensure that critical decisions related to the wider health and socioeconomic effects of this pandemic are data driven, each country needs to develop or enhance a national data governance plan that includes a clear coordination mechanism, well-defined and documented data processes (manual or electronic), the exchange of data, and a data culture to empower users. In addition, countries should now more than ever invest and enhance their data and health information systems to ensure that all decisions are data driven and that they are prepared for what is next.
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COVID-19 , Sistemas de Información en Salud , Política de Salud , Práctica de Salud Pública , Macrodatos , Humanos , Difusión de la InformaciónRESUMEN
Background Access to medicines is important for long-term care of cardiovascular diseases and hypertension. This study provides a cross-country assessment of availability, prices, and affordability of cardiovascular disease and hypertension medicines to identify areas for improvement in access to medication treatment. Methods and Results We used the World Health Organization online repository of national essential medicines lists (EMLs) for 53 countries to transcribe the information on the inclusion of 12 cardiovascular disease/hypertension medications within each country's essential medicines list. Data on availability, price, and affordability were obtained from 84 surveys in 59 countries that used the World Health Organization's Health Action International survey methodology. We summarized and compared the indicators across lowest-price generic and originator brand medicines in the public and private sectors and by country income groups. The average availability of the select medications was 54% in low- and lower-middle-income countries and 60% in high- and upper-middle-income countries, and was higher for generic (61%) than brand medicines (41%). The average patient median price ratio was 80.3 for brand and 16.7 for generic medicines and was higher for patients in low- and lower-middle-income countries compared with high- and upper-middle-income countries across all medicine categories. The costs of 1 month's antihypertensive medications were, on average, 6.0 days' wage for brand medicine and 1.8 days' wage for generics. Affordability was lower in low- and lower-middle-income countries than high- and upper-middle-income countries for both brand and generic medications. Conclusions The availability and accessibility of pharmaceuticals is an ongoing challenge for health systems. Low availability and high costs are major barriers to the use of and adherence to essential cardiovascular disease and antihypertensive medications worldwide, particularly in low- and lower-middle-income countries.
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Antihipertensivos/provisión & distribución , Fármacos Cardiovasculares/provisión & distribución , Países en Desarrollo , Medicamentos Esenciales/provisión & distribución , Medicamentos Genéricos/provisión & distribución , Accesibilidad a los Servicios de Salud , Disparidades en Atención de Salud , Antihipertensivos/economía , Fármacos Cardiovasculares/economía , Costos y Análisis de Costo , Países en Desarrollo/economía , Costos de los Medicamentos , Medicamentos Esenciales/economía , Medicamentos Genéricos/economía , Accesibilidad a los Servicios de Salud/economía , Disparidades en Atención de Salud/economía , Humanos , Sector Privado , Sector PúblicoRESUMEN
Trans-fatty acid (TFA) intake can increase the risk of coronary heart disease (CHD) morbidity and mortality and all-cause mortality. Industrially produced TFAs and ruminant TFAs are the major sources in foods. TFA intake and TFA-attributed CHD mortality vary widely worldwide. Excessive TFA intake is a health threat in high-income countries; however, it is also a threat in low- and middle-income countries (LMICs). Data on TFA intake are scarce in many LMICs and an urgent need exists to monitor TFAs globally. We reviewed global TFA intake and TFA-attributed CHD mortality and current progress toward policy or regulation on elimination of industrially produced TFAs in foods worldwide. Human biological tissues can be used as biomarkers of TFAs because they reflect actual intake from various foods. Measuring blood TFA levels is a direct and reliable method to quantify TFA intake.
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Enfermedad Coronaria/mortalidad , Ácidos Grasos trans/efectos adversos , Enfermedad Crónica/mortalidad , Salud Global , Política de Salud , Humanos , Factores de Riesgo , Ácidos Grasos trans/administración & dosificación , Ácidos Grasos trans/sangreRESUMEN
BACKGROUND: Treatment of non-communicable diseases (NCDs) in low-and-middle-income countries (LMICs) is costly and could expose households to financial hardship and vulnerability. This paper examines the association between medication costs of two major NCDs - hypertension (blood pressure) and diabetes, and household-level incidences of catastrophic health expenditure (CHE) in a South Asian LMIC, Pakistan. METHODS: The study analyzes self-reported blood pressure and diabetes (BPD) medication expenditure from the latest version (2015-16) of the Household Integrated Economic Survey (HIES) of Pakistan, a nationally representative survey of 24,238 households. The incidence of CHE is defined as households' out-of-pocket (OOP) medical expenditure exceeding 10% of the total household expenditure. Using a linear probability model, we estimate the adjusted differences in CHE incidence between households that are spending and 'not' spending on BPD medication. We also analyze several hypothetical scenarios of BPD medication cost coverage, and compare the estimated CHE incidences of respective scenarios with the status quo. RESULTS: We find that the average monthly medical expenditure, and average medical expenditure share are significantly higher for households spending on BPD medication, compared to households 'not' spending. The incidence of CHE is found 6.7 percentage point higher for the households consuming BPD medication, after controlling for relevant socioeconomic attributes. If 25, 50, and 100% of the BPD medication OOP cost is covered, then the CHE incidence would reduce respectively by 5.9, 12.7, and 21.4% compared to the status quo. CONCLUSION: Medication cost for managing two major NCDs and household catastrophic health expenditure have strong associations. The findings inform policies toward ensuring access to necessary healthcare services, and protecting households from NCD treatment related financial hardship.
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Enfermedad Catastrófica/economía , Diabetes Mellitus/tratamiento farmacológico , Diabetes Mellitus/economía , Costos de los Medicamentos/estadística & datos numéricos , Servicios de Salud/economía , Hipertensión/tratamiento farmacológico , Hipertensión/economía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Servicios de Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Pakistán , Pobreza/estadística & datos numéricosRESUMEN
Noncommunicable diseases are the leading cause of death and disability worldwide. Initiatives that advance the prevention and control of noncommunicable diseases support the goals of global health security in several ways. First, in addressing health needs that typically require long-term care, these programs can strengthen health delivery and health monitoring systems, which can serve as necessary platforms for emergency preparedness in low-resource environments. Second, by improving population health, the programs might help to reduce susceptibility to infectious outbreaks. Finally, in aiming to reduce the economic burden associated with premature illness and death from noncommunicable diseases, these initiatives contribute to the objectives of international development, thereby helping to improve overall country capacity for emergency response.
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Control de Enfermedades Transmisibles , Enfermedades Transmisibles/epidemiología , Salud Global , Enfermedades no Transmisibles/epidemiología , Enfermedades no Transmisibles/prevención & control , Vigilancia en Salud Pública , Centers for Disease Control and Prevention, U.S. , Enfermedades Transmisibles/transmisión , Manejo de la Enfermedad , Epidemiología/educación , Humanos , Cooperación Internacional , Evaluación de Resultado en la Atención de Salud , Sistema de Registros , Nivel de Atención , Estados Unidos/epidemiologíaRESUMEN
Hypertension is the leading remediable risk factor for cardiovascular disease, affecting more than 1 billion people worldwide, and is responsible for more than 10 million preventable deaths globally each year. While hypertension can be successfully diagnosed and treated, only one in seven persons with hypertension have controlled blood pressure. To meet the challenge of improving the control of hypertension, particularly in low- and middle-income countries, the authors developed the Standardized Hypertension Treatment and Prevention Project, which involves a health systems-strengthening approach that advocates for standardized hypertension management using evidence-based interventions. These interventions include the use of standardized treatment protocols, a core set of medications along with improved procurement mechanisms to increase the availability and affordability of these medications, registries for cohort monitoring and evaluation, patient empowerment, team-based care (task shifting), and community engagement. With political will and strong partnerships, this approach provides the groundwork to reduce high blood pressure and cardiovascular disease-related morbidity and mortality.
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Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Hipertensión/terapia , Enfermedades Cardiovasculares/etiología , Protocolos Clínicos , Humanos , Hipertensión/complicaciones , Hipertensión/prevención & control , MorbilidadRESUMEN
RESUMEN La hipertensión arterial es el principal factor de riesgo corregible de las enfermedades cardiovasculares y, a nivel mundial, afecta a más de mil millones de personas y causa más de diez millones de muertes evitables cada año. Aunque puede diagnosticarse y tratarse de forma satisfactoria, solo una de cada siete personas hipertensas tiene la presión arterial controlada. A fin de abordar este reto, se ha puesto en marcha el Proyecto de Prevención y Tratamiento Estandarizado de la Hipertensión Arterial con el propósito de mejorar el control de la hipertensión, particularmente en los países de ingresos bajos y medianos. Este proyecto consiste en aplicar un enfoque de fortalecimiento de los sistemas de salud que promueva el tratamiento estandarizado de la hipertensión arterial por medio de intervenciones basadas en la evidencia, como el uso de protocolos estandarizados de tratamiento y de un conjunto básico de medicamentos, junto con mecanismos optimizados de compra para aumentar su disponibilidad y asequibilidad, el uso de registros clínicos para el seguimiento y la evaluación de cohortes de pacientes, el empoderamiento de los pacientes, el trabajo en equipo (delegación de tareas), y la participación de la comunidad. Si se dispone de voluntad política y se establecen alianzas fuertes, este enfoque permite sentar las bases para reducir la hipertensión arterial y la morbilidad y mortalidad asociadas a las enfermedades cardiovasculares.
ABSTRACT Hypertension is the leading remediable risk factor for cardiovascular disease, affecting more than 1 billion people worldwide, and is responsible for more than 10 million preventable deaths globally each year. While hypertension can be successfully diagnosed and treated, only one in seven persons with hypertension have controlled blood pressure. To meet the challenge of improving the control of hypertension, particularly in low- and middle-income countries, the authors developed the Standardized Hypertension Treatment and Prevention Project, which involves a health systems–strengthening approach that advocates for standardized hypertension management using evidence-based interventions. These interventions include the use of standardized treatment protocols, a core set of medications along with improved procurement mechanisms to increase the availability and affordability of these medications, registries for cohort monitoring and evaluation, patient empowerment, team-based care (task shifting), and community engagement. With political will and strong partnerships, this approach provides the groundwork to reduce high blood pressure and cardiovascular disease-related morbidity and mortality.
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Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/prevención & control , Enfermedades Cardiovasculares/epidemiología , Hipertensión/prevención & control , Hipertensión/terapiaRESUMEN
Hypertension is the leading remediable risk factor for cardiovascular disease, affecting more than 1 billion people worldwide, and is responsible for more than 10 million preventable deaths globally each year. While hypertension can be successfully diagnosed and treated, only one in seven persons with hypertension have controlled blood pressure. To meet the challenge of improving the control of hypertension, particularly in low- and middle-income countries, the authors developed the Standardized Hypertension Treatment and Prevention Project, which involves a health systems-strengthening approach that advocates for standardized hypertension management using evidence-based interventions. These interventions include the use of standardized treatment protocols, a core set of medications along with improved procurement mechanisms to increase the availability and affordability of these medications, registries for cohort monitoring and evaluation, patient empowerment, team-based care (task shifting), and community engagement. With political will and strong partnerships, this approach provides the groundwork to reduce high blood pressure and cardiovascular disease-related morbidity and mortality.
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Antihipertensivos/uso terapéutico , Enfermedades Cardiovasculares/prevención & control , Hipertensión/tratamiento farmacológico , Guías de Práctica Clínica como Asunto/normas , Presión Sanguínea , Determinación de la Presión Sanguínea , Enfermedades Cardiovasculares/mortalidad , Medicina Basada en la Evidencia/normas , Femenino , Humanos , Hipertensión/complicaciones , Hipertensión/fisiopatología , Masculino , Morbilidad , Factores de RiesgoRESUMEN
BACKGROUND: Exposure to secondhand smoke (SHS) causes premature death and illness in non-smokers. We examined SHS exposure at home and in public places, as well as susceptibility to initiate cigarette smoking among never cigarette smokers. We used 2006-2011 Global Youth Tobacco Survey (GYTS) data from 29 African countries (56,967 students). METHODS: GYTS is a nationally representative, self-administered school-based survey, conducted among students aged 13-15years. Prevalence ratio, estimates and 95% confidence intervals were computed for SHS exposure in the homes and public places separately. The two-sample t-test was used to assess the difference in susceptibility to smoking by SHS exposure among never-smoking students (α=0.05). RESULTS: Among never-smoking students, exposure to SHS at home ranged from 12.7% (Cape Verde) to 44.0% (Senegal). The prevalence ratio (PR) comparing susceptibility to smoking initiation among never smokers exposed to SHS at home to those who were not exposed at home ranged from 1.2 to 2.6. Exposure to SHS in public places ranged from 23.9% (Cape Verde) to 80.4% (Mali). Of the countries being studied, 8 countries showed a significant difference in susceptibility to smoking initiation among never smokers exposed to SHS in public places compared to those not exposed in public places. (PR ranged from 0.5-3.5). CONCLUSION: In many African countries in the study, a substantial proportion of students who never smoked are exposed to SHS at home and in public places. Majority of never smokers who were exposed to SHS at home and in public places had a higher prevalence of susceptibility to initiate smoking than those that were not exposed to SHS at home and in public places. Adoption and enforcement of smoke-free policies in public places and smoke-free rules at home could substantially contribute to reducing SHS exposure in many of these countries.