Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.481
Filtrar
2.
Ann Med ; 53(1): 581-586, 2021 12.
Artículo en Inglés | MEDLINE | ID: mdl-33825598

RESUMEN

Although coronavirus disease 2019 (COVID-19) is a pandemic, it has several specificities influencing its outcomes due to the entwinement of several factors, which anthropologists have called "syndemics". Drawing upon Singer and Clair's syndemics model, I focus on synergistic interaction among chronic kidney disease (CKD), diabetes, and COVID-19 in Pakistan. I argue that over 36 million people in Pakistan are standing at a higher risk of contracting COVID-19, developing severe complications, and losing their lives. These two diseases, but several other socio-cultural, economic, and political factors contributing to structured vulnerabilities, would function as confounders. To deal with the critical effects of these syndemics the government needs appropriate policies and their implementation during the pandemic and post-pandemic. To eliminate or at least minimize various vulnerabilities, Pakistan needs drastic changes, especially to overcome (formal) illiteracy, unemployment, poverty, gender difference, and rural and urban difference.


Asunto(s)
/epidemiología , Diabetes Mellitus/epidemiología , Pandemias/prevención & control , Insuficiencia Renal Crónica/epidemiología , Sindémico , /prevención & control , Cambio Climático/economía , Cambio Climático/estadística & datos numéricos , Factores de Confusión Epidemiológicos , Países en Desarrollo/economía , Países en Desarrollo/estadística & datos numéricos , Diabetes Mellitus/economía , Diabetes Mellitus/prevención & control , Abastecimiento de Alimentos/economía , Abastecimiento de Alimentos/estadística & datos numéricos , Alfabetización en Salud/economía , Alfabetización en Salud/estadística & datos numéricos , Humanos , Pakistán/epidemiología , Pandemias/economía , Política , Pobreza/economía , Pobreza/estadística & datos numéricos , Insuficiencia Renal Crónica/economía , Insuficiencia Renal Crónica/prevención & control , Desempleo/estadística & datos numéricos
3.
BMJ ; 372: n534, 2021 03 24.
Artículo en Inglés | MEDLINE | ID: mdl-33762259

RESUMEN

OBJECTIVE: To evaluate the short term associations between nitrogen dioxide (NO2) and total, cardiovascular, and respiratory mortality across multiple countries/regions worldwide, using a uniform analytical protocol. DESIGN: Two stage, time series approach, with overdispersed generalised linear models and multilevel meta-analysis. SETTING: 398 cities in 22 low to high income countries/regions. MAIN OUTCOME MEASURES: Daily deaths from total (62.8 million), cardiovascular (19.7 million), and respiratory (5.5 million) causes between 1973 and 2018. RESULTS: On average, a 10 µg/m3 increase in NO2 concentration on lag 1 day (previous day) was associated with 0.46% (95% confidence interval 0.36% to 0.57%), 0.37% (0.22% to 0.51%), and 0.47% (0.21% to 0.72%) increases in total, cardiovascular, and respiratory mortality, respectively. These associations remained robust after adjusting for co-pollutants (particulate matter with aerodynamic diameter ≤10 µm or ≤2.5 µm (PM10 and PM2.5, respectively), ozone, sulfur dioxide, and carbon monoxide). The pooled concentration-response curves for all three causes were almost linear without discernible thresholds. The proportion of deaths attributable to NO2 concentration above the counterfactual zero level was 1.23% (95% confidence interval 0.96% to 1.51%) across the 398 cities. CONCLUSIONS: This multilocation study provides key evidence on the independent and linear associations between short term exposure to NO2 and increased risk of total, cardiovascular, and respiratory mortality, suggesting that health benefits would be achieved by tightening the guidelines and regulatory limits of NO2.


Asunto(s)
Contaminantes Atmosféricos/toxicidad , Contaminación del Aire/efectos adversos , Enfermedades Cardiovasculares/mortalidad , Salud Global/estadística & datos numéricos , Dióxido de Nitrógeno/toxicidad , Enfermedades Respiratorias/mortalidad , Salud Urbana/estadística & datos numéricos , Enfermedades Cardiovasculares/inducido químicamente , Ciudades , Países Desarrollados/estadística & datos numéricos , Países en Desarrollo/estadística & datos numéricos , Exposición a Riesgos Ambientales/efectos adversos , Humanos , Modelos Lineales , Enfermedades Respiratorias/inducido químicamente
4.
Ugeskr Laeger ; 183(11)2021 03 15.
Artículo en Danés | MEDLINE | ID: mdl-33734073

RESUMEN

The COVID-19 pandemic may not only increase mortality due to the virus but also due to the indirect effects. The disease continues to ravage health and economic metrics globally, which is likely to increase maternal and under five-year child mortality in low- and middle-income countries. This review highlights key areas of concern for maternal and under five-year child mortality due to the indirect effects of the COVID-19 pandemic in low- and middle-income countries.


Asunto(s)
/epidemiología , Países en Desarrollo/estadística & datos numéricos , Mortalidad Materna , Madres/estadística & datos numéricos , Pandemias , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Desnutrición/epidemiología , Servicios de Salud Materna , Salud Mental , Pobreza , Embarazo , Complicaciones Infecciosas del Embarazo
5.
Pathog Glob Health ; 115(3): 178-187, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33657984

RESUMEN

During the Covid-19 pandemic, rich countries employed lockdown and physical distancing policies for transmission control. However, the question still remains whether these measures are also suitable in countries with a fragile economy, which rests mainly on the informal sector. The impacts of lockdown measures in disadvantaged population strata in six low- and middle-income countries (LMICs) were reviewed using i) 93 media reports and ii) 17 published scientific papers. This review showed that those who suffered the most from the lockdown were migrants, workers in the large informal sector, small businesses, slum dwellers, women and elderly, revealing the social, cultural and economic inequalities of societies. Financial and food support for the poor was inadequate and sometimes mismanaged. In the better organized societies, the resilience was stronger (South Korea, Kerala/India) but here also the poor had to suffer the most. It is strongly recommended that outbreak response strategies should particularly focus on the poor and vulnerable population.


Asunto(s)
/economía , Países en Desarrollo/economía , Asia/epidemiología , /psicología , Países en Desarrollo/estadística & datos numéricos , Humanos , Medios de Comunicación de Masas/estadística & datos numéricos , Pandemias , Publicaciones/estadística & datos numéricos , Factores Socioeconómicos
6.
Int J Hyg Environ Health ; 234: 113715, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33735823

RESUMEN

In March 2020, the World Health Organization (WHO) issued a set of public guidelines for Coronavirus Disease 2019 (COVID-19) prevention measures that highlighted handwashing, physical distancing, and household cleaning. These health behaviors are severely compromised in parts of the world that lack secure water supplies, particularly in low- and middle-income countries (LMICs). We used empirical data gathered in 2017-2018 from 8,297 households in 29 sites across 23 LMICs to address the potential implications of water insecurity for COVID-19 prevention and response. These data demonstrate how household water insecurity presents many pathways for limiting personal and environmental hygiene, impeding physical distancing and exacerbating existing social and health vulnerabilities that can lead to more severe COVID-19 outcomes. In the four weeks prior to survey implementation, 45.9% of households in our sample either were unable to wash their hands or reported borrowing water from others, which may undermine hygiene and physical distancing. Further, 70.9% of households experienced one or more water-related problems that potentially undermine COVID-19 control strategies or disease treatment, including insufficient water for bathing, laundering, or taking medication; drinking unsafe water; going to sleep thirsty; or having little-to-no drinking water. These findings help identify where water provision is most relevant to managing COVID-19 spread and outcomes.


Asunto(s)
Control de Enfermedades Transmisibles/estadística & datos numéricos , Composición Familiar , Pobreza/estadística & datos numéricos , Control de Enfermedades Transmisibles/métodos , Países en Desarrollo/estadística & datos numéricos , Desinfección de las Manos , Conductas Relacionadas con la Salud , Humanos , Higiene
8.
Econ Hum Biol ; 41: 100990, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33631439

RESUMEN

This paper studies BMI as a correlate of the early spatial distribution and intensity of Covid-19 across the districts of India and finds that conditional on a range of individual, household and regional characteristics, adult BMI significantly predicts the likelihood that the district is a hotspot, the natural log of the confirmed number of cases, the case fatality rate, and the propensity that the district is a red zone. Controlling for air-pollution, rainfall, temperature, demographic factors that measure population density, the proportion of the elderly, and health infrastructure including per capita health spending and the proportion of respiratory cases, does not diminish the predictive power of BMI in influencing the spatial incidence and spread of the virus. The association between adult BMI and measures of spatial outcomes is especially pronounced among educated populations in urban settings, and impervious to conditioning on differences in testing rates across states. We find that among women, BMI proxies for a range of comorbidities (hemoglobin, high blood pressure and high glucose levels) that affects the severity of the virus while among men, these health indicators are also important, as is exposure to risk of contracting the virus as measured by work propensities. We conduct sensitivity checks and control for differences that may arise due to variations in timing of onset. Our results provide a readily available health marker that may be used to identify and protect especially at-risk populations in developing countries like India.


Asunto(s)
Índice de Masa Corporal , Países en Desarrollo/estadística & datos numéricos , Adulto , Factores de Edad , Anciano , Comorbilidad , Femenino , Humanos , Incidencia , India/epidemiología , Masculino , Persona de Mediana Edad , Características de la Residencia , Factores de Riesgo , Factores Sexuales , Factores Socioeconómicos , Análisis Espacial , Población Urbana
9.
Arch Dis Child ; 106(4): 333-337, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33574028

RESUMEN

In a companion paper, we showed how local hospital leaders could assess systems and identify key safety concerns and targets for system improvement. In the present paper, we consider how these leaders might implement practical, low-cost interventions to improve safety. Our focus is on making immediate safety improvements both to directly improve patient care and as a foundation for advancing care in the longer-term. We describe a 'portfolio' approach to safety improvement in four broad categories: prioritising critical processes, such as checking drug doses; strengthening the overall system of care, for example, by introducing multiprofessional handovers; control of known risks, such as only using continuous positive airway pressure when appropriate conditions are met; and enhancing detection and response to hazardous situations, such as introducing brief team meetings to identify and respond to immediate threats and challenges. Local clinical leaders and managers face numerous challenges in delivering safe care but, if given sufficient support, they are nevertheless in a position to bring about major improvements. Skills in improving safety and quality should be recognised as equivalent to any other form of (sub)specialty training and as an essential element of any senior clinical or management role. National professional organisations need to promote appropriate education and provide coaching, mentorship and support to local leaders.


Asunto(s)
Recursos en Salud/economía , Neonatología/organización & administración , Seguridad del Paciente/normas , Calidad de la Atención de Salud/organización & administración , Países en Desarrollo/economía , Países en Desarrollo/estadística & datos numéricos , Personal de Salud/educación , Recursos en Salud/estadística & datos numéricos , Investigación sobre Servicios de Salud/métodos , Humanos , Recién Nacido , Kenia/epidemiología , Liderazgo , Tutoría/métodos , Madres/educación , Madres/psicología , Neonatología/normas , Seguridad del Paciente/estadística & datos numéricos , Mejoramiento de la Calidad
10.
Curr Opin Clin Nutr Metab Care ; 24(3): 271-275, 2021 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-33631771

RESUMEN

PURPOSE OF REVIEW: Undernutrition, including micronutrient deficiencies, continues to plague children across the world, particularly in low and middle-income countries (LMICs). The situation has worsened alongside the SARS-CoV-2 pandemic because of major systemic disruptions to food supply, healthcare, and employment. Large-scale food fortification (LSFF) is a potential strategy for improving micronutrient intakes through the addition of vitamins and minerals to staple foods and improving the nutritional status of populations at large. RECENT FINDINGS: Current evidence unquestionably supports the use of LSFF to improve micronutrient status. Evidence syntheses have also demonstrated impact on some functional outcomes, including anemia, wasting, underweight, and neural tube defects, that underpin poor health and development. Importantly, many of these effects have also been reflected in effectiveness studies that examine LSFF in real-world situations as opposed to under-controlled environments. However, programmatic challenges must be addressed in LMICs in order for LSFF efforts to reach their full potential. SUMMARY: LSFF is an important strategy that has the potential to improve the health and nutrition of entire populations of vulnerable children. Now more than ever, existing programs should be strengthened and new programs implemented in areas with widespread undernutrition and micronutrient deficiencies.


Asunto(s)
Salud del Niño/tendencias , Trastornos de la Nutrición del Niño/terapia , Alimentos Fortificados/provisión & distribución , Micronutrientes/administración & dosificación , Niño , Trastornos de la Nutrición del Niño/epidemiología , Países en Desarrollo/estadística & datos numéricos , Femenino , Humanos , Masculino , Estado Nutricional , Pobreza/estadística & datos numéricos
11.
J Prev Med Public Health ; 54(1): 73-80, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33618502

RESUMEN

OBJECTIVES: Household overcrowding (HC) can contribute to both physical and mental disorders among the members of overcrowded households. This study aimed to measure the status of HC and its main determinants across the provinces of Iran. METHODS: Data from 39 864 households from the 2016 Iranian Household Income and Expenditures Survey were used in this study. The Equivalized Crowding Index (ECI) and HC index were applied to measure the overcrowding of households. Regression models were estimated to show the relationships between different variables and the ECI. RESULTS: The overall, urban, and rural prevalence of HC was 8.2%, 6.3%, and 10.1%, respectively. The highest prevalence of HC was found in Sistan and Baluchestan Province (28.7%), while the lowest was found in Guilan Province (1.8%). The number of men in the household, rural residency, the average age of household members, yearly income, and the household wealth index were identified as the main determinants of the ECI and HC. CONCLUSIONS: The study demonstrated that the ECI and HC were higher in regions near the borders of Iran than in other regions. Therefore, health promotion and empowerment strategies are required to avoid the negative consequences of HC, and screening programs are needed to identify at-risk families.


Asunto(s)
Aglomeración , Composición Familiar , Salud Pública/métodos , Adolescente , Adulto , Países en Desarrollo/economía , Países en Desarrollo/estadística & datos numéricos , Femenino , Mapeo Geográfico , Humanos , Renta/estadística & datos numéricos , Irán , Masculino , Persona de Mediana Edad , Prevalencia , Salud Pública/normas , Salud Pública/estadística & datos numéricos , Factores Socioeconómicos , Encuestas y Cuestionarios
12.
Cochrane Database Syst Rev ; 12: CD004265, 2021 01 06.
Artículo en Inglés | MEDLINE | ID: mdl-33539552

RESUMEN

BACKGROUND: Diarrhoea accounts for 1.8 million deaths in children in low- and middle-income countries (LMICs). One of the identified strategies to prevent diarrhoea is hand washing. OBJECTIVES: To assess the effects of hand-washing promotion interventions on diarrhoeal episodes in children and adults. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, nine other databases, the World Health Organization (WHO) International Clinical Trial Registry Platform (ICTRP), and metaRegister of Controlled Trials (mRCT) on 8 January 2020, together with reference checking, citation searching and contact with study authors to identify additional studies. SELECTION CRITERIA: Individually-randomized controlled trials (RCTs) and cluster-RCTs that compared the effects of hand-washing interventions on diarrhoea episodes in children and adults with no intervention. DATA COLLECTION AND ANALYSIS: Three review authors independently assessed trial eligibility, extracted data, and assessed risks of bias. We stratified the analyses for child day-care centres or schools, community, and hospital-based settings. Where appropriate, we pooled incidence rate ratios (IRRs) using the generic inverse variance method and a random-effects model with a 95% confidence interval (CI). We used the GRADE approach to assess the certainty of the evidence. MAIN RESULTS: We included 29 RCTs: 13 trials from child day-care centres or schools in mainly high-income countries (54,471 participants), 15 community-based trials in LMICs (29,347 participants), and one hospital-based trial among people with AIDS in a high-income country (148 participants). All the trials and follow-up assessments were of short-term duration. Hand-washing promotion (education activities, sometimes with provision of soap) at child day-care facilities or schools prevent around one-third of diarrhoea episodes in high-income countries (incidence rate ratio (IRR) 0.70, 95% CI 0.58 to 0.85; 9 trials, 4664 participants, high-certainty evidence) and may prevent a similar proportion in LMICs, but only two trials from urban Egypt and Kenya have evaluated this (IRR 0.66, 95% CI 0.43 to 0.99; 2 trials, 45,380 participants; low-certainty evidence). Only four trials reported measures of behaviour change, and the methods of data collection were susceptible to bias. In one trial from the USA hand-washing behaviour was reported to improve; and in the trial from Kenya that provided free soap, hand washing did not increase, but soap use did (data not pooled; 3 trials, 1845 participants; low-certainty evidence). Hand-washing promotion among communities in LMICs probably prevents around one-quarter of diarrhoea episodes (IRR 0.71, 95% CI 0.62 to 0.81; 9 trials, 15,950 participants; moderate-certainty evidence). However, six of these nine trials were from Asian settings, with only one trial from South America and two trials from sub-Saharan Africa. In seven trials, soap was provided free alongside hand-washing education, and the overall average effect size was larger than in the two trials which did not provide soap (soap provided: RR 0.66, 95% CI 0.58 to 0.75; 7 trials, 12,646 participants; education only: RR 0.84, 95% CI 0.67 to 1.05; 2 trials, 3304 participants). There was increased hand washing at major prompts (before eating or cooking, after visiting the toilet, or cleaning the baby's bottom) and increased compliance with hand-hygiene procedure (behavioural outcome) in the intervention groups compared with the control in community trials (data not pooled: 4 trials, 3591 participants; high-certainty evidence). Hand-washing promotion for the one trial conducted in a hospital among a high-risk population showed significant reduction in mean episodes of diarrhoea (1.68 fewer) in the intervention group (mean difference -1.68, 95% CI -1.93 to -1.43; 1 trial, 148 participants; moderate-certainty evidence). Hand-washing frequency increased to seven times a day in the intervention group versus three times a day in the control arm in this hospital trial (1 trial, 148 participants; moderate-certainty evidence). We found no trials evaluating the effects of hand-washing promotions on diarrhoea-related deaths or cost effectiveness. AUTHORS' CONCLUSIONS: Hand-washing promotion probably reduces diarrhoea episodes in both child day-care centres in high-income countries and among communities living in LMICs by about 30%. The included trials do not provide evidence about the long-term impact of the interventions.


Asunto(s)
Diarrea/prevención & control , Desinfección de las Manos/métodos , Adulto , Sesgo , Niño , Jardines Infantiles/estadística & datos numéricos , Infecciones Comunitarias Adquiridas/prevención & control , Infección Hospitalaria/prevención & control , Países Desarrollados/estadística & datos numéricos , Países en Desarrollo/estadística & datos numéricos , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Instituciones Académicas/estadística & datos numéricos , Jabones
13.
Acad Med ; 96(6): 795-797, 2021 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-33394665

RESUMEN

Global health and its predecessors, tropical medicine and international health, have historically been driven by the agendas of institutions in high-income countries (HICs), with power dynamics that have disadvantaged partner institutions in low- and middle-income countries (LMICs). Since the 2000s, however, the academic global health community has been moving toward a focus on health equity and reexamining the dynamics of global health education (GHE) partnerships. Whereas GHE partnerships have largely focused on providing opportunities for learners from HIC institutions, LMIC institutions are now seeking more equitable experiences for their trainees. Additionally, lessons from the COVID-19 pandemic underscore already important lessons about the value of bidirectional educational exchange, as regions gain new insights from one another regarding strategies to impact health outcomes. Interruptions in experiential GHE programs due to COVID-19-related travel restrictions provide an opportunity to reflect on existing GHE systems, to consider the opportunities and dynamics of these partnerships, and to redesign these systems for the equitable benefit of the various partners. In this commentary, the authors offer recommendations for beginning this process of change, with an emphasis on restructuring GHE relationships and addressing supremacist attitudes at both the systemic and individual levels.


Asunto(s)
Países en Desarrollo/economía , Salud Global/educación , Equidad en Salud/estadística & datos numéricos , Apoyo a la Formación Profesional/métodos , /diagnóstico , /virología , Países en Desarrollo/estadística & datos numéricos , Educación en Salud/estadística & datos numéricos , Equidad en Salud/tendencias , Humanos , Comunicación Interdisciplinaria , Cooperación Internacional , Liderazgo , /aislamiento & purificación
14.
Value Health ; 24(1): 61-66, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33431154

RESUMEN

OBJECTIVES: Cost-effectiveness analysis can guide decision making about health interventions, but the appropriate cost-effectiveness threshold to use is unclear in most countries. The World Health Organization (WHO) recommends vaccinating girls 9 to 14 years against human papillomavirus (HPV), but over half the world's countries have not introduced it. This study aimed to investigate whether country-level decisions about HPV vaccine introduction are consistent with a particular cost-effectiveness threshold, and to estimate what that threshold may be. METHODS: The cost-effectiveness of vaccinating 12-year-old girls was estimated in 179 countries using the Papillomavirus Rapid Interface for Modelling and Economics (PRIME) model, together with vaccine price data from World Health Organization's Market Information for Access to Vaccines database. In each year from 2006 to 2018, countries were categorized based on (1) whether they had introduced HPV vaccination, and (2) whether the incremental cost-effectiveness ratio for HPV vaccine introduction fell below a certain cost-effectiveness threshold. RESULTS: A cost-effectiveness threshold of 60% to 65% of GDP per capita has the best ability to discriminate countries that introduced vaccination, with a diagnostic odds ratio of about 7. For low-income countries the optimal threshold was lower, at 30% to 40% of GDP per capita. CONCLUSIONS: A cost-effectiveness threshold has some ability to discriminate between HPV vaccine introducer and non-introducer countries, although the average threshold is below the widely used threshold of 1 GDP per capita. These results help explain the current pattern of HPV vaccine use globally. They also inform the extent to which cost-effectiveness thresholds proposed in the literature reflect countries' actual investment decisions.


Asunto(s)
Análisis Costo-Beneficio/estadística & datos numéricos , Países en Desarrollo/estadística & datos numéricos , Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus/administración & dosificación , Vacunas contra Papillomavirus/economía , Países en Desarrollo/economía , Salud Global , Humanos , Programas de Inmunización/economía , Programas de Inmunización/estadística & datos numéricos , Modelos Económicos , Infecciones por Papillomavirus/economía , Infecciones por Papillomavirus/epidemiología , Años de Vida Ajustados por Calidad de Vida
16.
Value Health ; 24(1): 70-77, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33431156

RESUMEN

OBJECTIVES: Understanding the level of investment needed for the 2021-2030 decade is important as the global community faces the next strategic period for vaccines and immunization programs. To assist with this goal, we estimated the aggregate costs of immunization programs for ten vaccines in 94 low- and middle-income countries from 2011 to 2030. METHOD: We calculated vaccine, immunization delivery and stockpile costs for 94 low- and middle-income countries leveraging the latest available data sources. We conducted scenario analyses to vary assumptions about the relationship between delivery cost and coverage as well as vaccine prices for fully self-financing countries. RESULTS: The total aggregate cost of immunization programs in 94 countries for 10 vaccines from 2011 to 2030 is $70.8 billion (confidence interval: $56.6-$93.3) under the base case scenario and $84.1 billion ($72.8-$102.7) under an incremental delivery cost scenario, with an increasing trend over two decades. The relative proportion of vaccine and delivery costs for pneumococcal conjugate, human papillomavirus, and rotavirus vaccines increase as more countries introduce these vaccines. Nine countries in accelerated transition phase bear the highest burden of the costs in the next decade, and uncertainty with vaccine prices for the 17 fully self-financing countries could lead to total costs that are 1.3-13.1 times higher than the base case scenario. CONCLUSION: Resource mobilization efforts at the global and country levels will be needed to reach the level of investment needed for the coming decade. Global-level initiatives and targeted strategies for transitioning countries will help ensure the sustainability of immunization programs.


Asunto(s)
Países en Desarrollo/estadística & datos numéricos , Salud Global , Programas de Inmunización/economía , Programas de Inmunización/estadística & datos numéricos , Cobertura de Vacunación/economía , Costo de Enfermedad , Costos y Análisis de Costo , Países en Desarrollo/economía , Recursos en Salud/organización & administración , Humanos , Modelos Económicos , Vacunas/economía , Vacunas/provisión & distribución
17.
Value Health ; 24(1): 78-85, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33431157

RESUMEN

OBJECTIVES: Vaccination has prevented millions of deaths and cases of disease in low- and middle-income countries (LMICs). During the Decade of Vaccines (2011-2020), international organizations, including the World Health Organization and Gavi, the Vaccine Alliance, focused on new vaccine introduction and expanded coverage of existing vaccines. As Gavi, other organizations, and country governments look to the future, we aimed to estimate the economic benefits of immunization programs made from 2011 to 2020 and potential gains in the future decade. METHODS: We used estimates of cases and deaths averted by vaccines against 10 pathogens in 94 LMICs to estimate the economic value of immunization. We applied 3 approaches-cost of illness averted (COI), value of statistical life (VSL), and value of statistical life-year (VSLY)-to estimate observable and unobservable economic benefits between 2011 and 2030. RESULTS: From 2011 to 2030, immunization would avert $1510.4 billion ($674.3-$2643.2 billion) (2018 USD) in costs of illness in the 94 modeled countries, compared with the counterfactual of no vaccination. Using the VSL approach, immunization would generate $3436.7 billion ($1615.8-$5657.2 billion) in benefits. Applying the VSLY approach, $5662.7 billion ($2547.2-$9719.4) in benefits would be generated. CONCLUSION: Vaccination has generated significant economic benefits in LMICs in the past decade. To reach predicted levels of economic benefits, countries and international donor organizations need to meet coverage projections outlined in the Gavi Operational Forecast. Estimates generated using the COI, VSL, or VSLY approach may be strategically used by donor agencies, decision makers, and advocates to inform investment cases and advocacy campaigns.


Asunto(s)
Países en Desarrollo/estadística & datos numéricos , Programas de Inmunización/economía , Programas de Inmunización/estadística & datos numéricos , Cobertura de Vacunación/economía , Costo de Enfermedad , Costos y Análisis de Costo , Países en Desarrollo/economía , Salud Global , Humanos , Modelos Económicos , Vacunas/economía , Vacunas/provisión & distribución
18.
PLoS One ; 16(1): e0244921, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33395431

RESUMEN

BACKGROUND: Geographical accessibility to healthcare is an important component of infectious disease dynamics. Timely access to health facilities can prevent disease progression and enables disease notification through surveillance systems. The importance of accounting for physical accessibility in response to infectious diseases is increasingly recognized. Yet, there is no comprehensive review of the literature available on infectious diseases in relation to geographical accessibility to care. Therefore, we aimed at evaluating the current state of knowledge on the effect of geographical accessibility to health care on infectious diseases in low- and middle-income countries. METHODS AND FINDINGS: A search strategy was developed and conducted on Web of Science and PubMed on 4 March 2019. New publications were checked until May 28, 2020. All publication dates were eligible. Data was charted into a tabular format and descriptive data analyses were carried out to identify geographical regions, infectious diseases, and measures of physical accessibility among other factors. Search queries in PubMed and Web of Science yielded 560 unique publications. After title and abstract screening 99 articles were read in full detail, from which 64 articles were selected, including 10 manually. Results of the included publications could be broadly categorized into three groups: (1) decreased spatial accessibility to health care was associated with a higher infectious disease burden, (2) decreased accessibility was associated to lower disease reporting, minimizing true understanding of disease distribution, and (3) the occurrence of an infectious disease outbreak negatively impacted health care accessibility in affected regions. In the majority of studies, poor geographical accessibility to health care was associated with higher disease incidence, more severe health outcomes, higher mortality, and lower disease reporting. No difference was seen between countries or infectious diseases. CONCLUSIONS: Currently, policy-makers and scientists rely on data collected through passive surveillance systems, introducing uncertainty on disease estimates for remote communities. Our results highlight the need for increasing integration of geographical accessibility measures in disease risk modelling, allowing more realistic disease estimates and enhancing our understanding of true disease burden. Additionally, disease risk estimates could be used in turn to optimize the allocation of health services in the prevention and detection of infectious diseases.


Asunto(s)
Brotes de Enfermedades/prevención & control , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/tendencias , Enfermedades Transmisibles/economía , Enfermedades Transmisibles/epidemiología , Países Desarrollados/estadística & datos numéricos , Países en Desarrollo/estadística & datos numéricos , Geografía/estadística & datos numéricos , Instituciones de Salud/tendencias , Humanos , Renta
19.
Acta Neurol Scand ; 143(5): 521-529, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33438764

RESUMEN

OBJECTIVE: To study the trends for pediatric epilepsy surgery between 2000 and 2014 in a tertiary epilepsy surgery center in India in order to gain a lower- and middle-income country (LMIC) perspective. METHODS: Children aged <18 years and undergoing epilepsy surgery were divided into three groups based on the year that they underwent surgery-group 1: year 2000-2004; group 2: year 2005-2009; and group 3: year 2010-2014. Data including the rate of surgery, type of surgery, and duration of epilepsy before referral were analyzed from the medical records and compared. RESULTS: Between 2000 and 2014, 463 pediatric epilepsy surgeries were performed. The proportion of pediatric epilepsy surgeries showed an increasing trend-218 (total 510 surgeries, 42.74%) in group 3, compared with 115 (total 375 surgeries, 30.66%) in group 1 and 130 (total 466 surgeries, 27.9%) in group 2. A significant decrease in the age at evaluation and duration of epilepsy before referral was noted between 2000 and 2014, particularly in patients belonging to the lowest income group. There was a two-fold increase in the number of extratemporal surgeries over time. The proportion of children undergoing surgery for benign tumors, cortical malformations, and gliosis/atrophy showed an upward trend while that for mesial temporal sclerosis did not show an increase. SIGNIFICANCE: Promising trends in pediatric epilepsy surgery were noted with increasing number of surgeries and decreasing age at presurgical evaluation. Seen from an LMIC perspective, this reflects an evolution in the practice of pediatric epilepsy surgery, mirroring trends in high-income countries.


Asunto(s)
Epilepsia/cirugía , Procedimientos Neuroquirúrgicos/tendencias , Adolescente , Niño , Preescolar , Países en Desarrollo/estadística & datos numéricos , Epilepsia/patología , Femenino , Humanos , India , Masculino , Estudios Retrospectivos
20.
Pediatr Obes ; 16(1): e12700, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32729216

RESUMEN

BACKGROUND: Data on the association between obesogenic behaviours and bullying victimization among adolescents are scarce from low- and middle-income countries. OBJECTIVES: To assess the associations between obesogenic behaviours and bullying victimization in 54 low- and middle-income countries. METHODS: Cross-sectional data from the global school-based student health survey were analyzed. Data on bullying victimization and obesogenic behaviours were collected. The association between bullying victimization and the different types of obesogenic behaviour (anxiety-induced insomnia, fast-food consumption, carbonated soft-drink consumption, no physical activity and sedentary behaviour) were assessed by country-wise multivariable logistic regression analysis adjusting for age, sex, food insecurity and obesity with obesogenic behaviours being the outcome. RESULT: The sample consisted of 153 929 students aged 12 to 15 years [mean (SD) age 13.8 (1.0) years; 49.3% girls]. Overall, bullying victimization (vs no bullying victimization) was significantly associated with greater odds for all types of obesogenic behaviour with the exception of physical activity, which showed an inverse association. Specifically, the ORs (95% CIs) were: anxiety-induced sleep problems 2.65 (2.43-2.88); fast-food consumption 1.36 (1.27-1.44); carbonated soft-drink consumption 1.14 (1.08-1.21); no physical activity 0.84 (0.79-0.89); and sedentary behaviour 1.34 (1.25-1.43). CONCLUSION: In this large representative sample of adolescents from low- and middle-income countries, bullying victimization was found to be associated with several, but not all, obesogenic behaviours.


Asunto(s)
Conducta del Adolescente , Acoso Escolar/psicología , Víctimas de Crimen/psicología , Países en Desarrollo/estadística & datos numéricos , Obesidad Pediátrica/etiología , Obesidad Pediátrica/psicología , Adolescente , Ansiedad/epidemiología , Ansiedad/etiología , Ansiedad/psicología , Acoso Escolar/estadística & datos numéricos , Niño , Víctimas de Crimen/estadística & datos numéricos , Estudios Transversales , Dieta , Femenino , Salud Global , Encuestas Epidemiológicas , Humanos , Modelos Logísticos , Masculino , Obesidad Pediátrica/epidemiología , Factores Protectores , Factores de Riesgo , Conducta Sedentaria , Autoinforme , Trastornos del Inicio y del Mantenimiento del Sueño/epidemiología , Trastornos del Inicio y del Mantenimiento del Sueño/etiología , Trastornos del Inicio y del Mantenimiento del Sueño/psicología
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...