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2.
Lancet ; 395(10239): 1779-1801, 2020 06 06.
Artículo en Inglés | MEDLINE | ID: mdl-32513411

RESUMEN

BACKGROUND: Across low-income and middle-income countries (LMICs), one in ten deaths in children younger than 5 years is attributable to diarrhoea. The substantial between-country variation in both diarrhoea incidence and mortality is attributable to interventions that protect children, prevent infection, and treat disease. Identifying subnational regions with the highest burden and mapping associated risk factors can aid in reducing preventable childhood diarrhoea. METHODS: We used Bayesian model-based geostatistics and a geolocated dataset comprising 15 072 746 children younger than 5 years from 466 surveys in 94 LMICs, in combination with findings of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, to estimate posterior distributions of diarrhoea prevalence, incidence, and mortality from 2000 to 2017. From these data, we estimated the burden of diarrhoea at varying subnational levels (termed units) by spatially aggregating draws, and we investigated the drivers of subnational patterns by creating aggregated risk factor estimates. FINDINGS: The greatest declines in diarrhoeal mortality were seen in south and southeast Asia and South America, where 54·0% (95% uncertainty interval [UI] 38·1-65·8), 17·4% (7·7-28·4), and 59·5% (34·2-86·9) of units, respectively, recorded decreases in deaths from diarrhoea greater than 10%. Although children in much of Africa remain at high risk of death due to diarrhoea, regions with the most deaths were outside Africa, with the highest mortality units located in Pakistan. Indonesia showed the greatest within-country geographical inequality; some regions had mortality rates nearly four times the average country rate. Reductions in mortality were correlated to improvements in water, sanitation, and hygiene (WASH) or reductions in child growth failure (CGF). Similarly, most high-risk areas had poor WASH, high CGF, or low oral rehydration therapy coverage. INTERPRETATION: By co-analysing geospatial trends in diarrhoeal burden and its key risk factors, we could assess candidate drivers of subnational death reduction. Further, by doing a counterfactual analysis of the remaining disease burden using key risk factors, we identified potential intervention strategies for vulnerable populations. In view of the demands for limited resources in LMICs, accurately quantifying the burden of diarrhoea and its drivers is important for precision public health. FUNDING: Bill & Melinda Gates Foundation.


Asunto(s)
Países en Desarrollo/estadística & datos numéricos , Diarrea/epidemiología , Diarrea/mortalidad , Carga Global de Enfermedades/estadística & datos numéricos , Salud Global/estadística & datos numéricos , Disparidades en Atención de Salud/estadística & datos numéricos , Teorema de Bayes , Preescolar , Diarrea/prevención & control , Humanos , Incidencia , Prevalencia
3.
Medicine (Baltimore) ; 99(19): e20118, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32384488

RESUMEN

Optimal birth spacing (defined as a birth spacing of 24-59 months) is incontrovertibly linked to better health outcomes for both mothers and babies. Using the most recent available Demographic and Health Survey data, we examined the patterns and determinants of short and long birth intervals among women in selected sub-Saharan African (SSA) countries.Reproductive health and sociodemographic data of 98,934 women from 8 SSA countries were analyzed. Unadjusted and adjusted multinomial logistic regression models were used to examine the net relationship between all the independent variables and short and long birth intervals.Overall, the majority of women in all the countries optimally spaced births. However, a significant proportion of women had short birth intervals in Chad (30.2%) and the Democratic Republic of Congo (Congo DRC) (27.1%). Long birth spacing was more common in Eastern and Southern African countries, with Zimbabwe having the highest rate of long term birth interval (27.0%). Women who were aged 35 years and above in Uganda (RRR = 0.72, CI = 0.60-0.87), Tanzania (RRR = 0.62, CI = 0.49-0.77), Zimbabwe (RRR = 0.52, CI = 0.31-0.85), Nigeria (RRR = 0.82, CI = 0.72-0.94) and Togo (RRR = 0.67, CI = 0.46-0.96) had significantly lower odds of having short birth intervals compared to women aged 15-24 years. Older women (above 34 years) had increased odds for long birth intervals in all countries studied (Chad (RRR = 1.44, CI = 1.18-1.76), Congo DRC (RRR = 1.73, CI = 1.33-2.15), Malawi (RRR = 1.54, CI = 1.23-1.94) Zimbabwe (RRR = 1.95, CI = 1.26-3.02), Nigeria (RRR = 1.85 CI = 1.56-2.20), Togo (RRR = 2.12, CI = 1.46-3.07), Uganda (RRR = 1.48, CI = 1.15-1.91), Tanzania RRR = 2.12, CI = 1.53-2.93).The analysis suggested that the determinants of long and birth intervals differ and varies from country to country. The pattern of birth spacing found in this study appears to mirror the contraceptive use and fertility rate in the selected SSA countries. Birth intervals intervention addressing short birth intervals should target younger women in SSA, especially in Chad and Congo DRC, while intervention for long birth spacing should prioritize older, educated and wealthy women.


Asunto(s)
Intervalo entre Nacimientos/estadística & datos numéricos , Países en Desarrollo/estadística & datos numéricos , Adolescente , Adulto , África del Sur del Sahara/epidemiología , Factores de Edad , Femenino , Humanos , Características de la Residencia/estadística & datos numéricos , Factores de Riesgo , Factores Socioeconómicos , Adulto Joven
4.
Lancet Glob Health ; 8(7): e901-e908, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32405459

RESUMEN

BACKGROUND: While the COVID-19 pandemic will increase mortality due to the virus, it is also likely to increase mortality indirectly. In this study, we estimate the additional maternal and under-5 child deaths resulting from the potential disruption of health systems and decreased access to food. METHODS: We modelled three scenarios in which the coverage of essential maternal and child health interventions is reduced by 9·8-51·9% and the prevalence of wasting is increased by 10-50%. Although our scenarios are hypothetical, we sought to reflect real-world possibilities, given emerging reports of the supply-side and demand-side effects of the pandemic. We used the Lives Saved Tool to estimate the additional maternal and under-5 child deaths under each scenario, in 118 low-income and middle-income countries. We estimated additional deaths for a single month and extrapolated for 3 months, 6 months, and 12 months. FINDINGS: Our least severe scenario (coverage reductions of 9·8-18·5% and wasting increase of 10%) over 6 months would result in 253 500 additional child deaths and 12 200 additional maternal deaths. Our most severe scenario (coverage reductions of 39·3-51·9% and wasting increase of 50%) over 6 months would result in 1 157 000 additional child deaths and 56 700 additional maternal deaths. These additional deaths would represent an increase of 9·8-44·7% in under-5 child deaths per month, and an 8·3-38·6% increase in maternal deaths per month, across the 118 countries. Across our three scenarios, the reduced coverage of four childbirth interventions (parenteral administration of uterotonics, antibiotics, and anticonvulsants, and clean birth environments) would account for approximately 60% of additional maternal deaths. The increase in wasting prevalence would account for 18-23% of additional child deaths and reduced coverage of antibiotics for pneumonia and neonatal sepsis and of oral rehydration solution for diarrhoea would together account for around 41% of additional child deaths. INTERPRETATION: Our estimates are based on tentative assumptions and represent a wide range of outcomes. Nonetheless, they show that, if routine health care is disrupted and access to food is decreased (as a result of unavoidable shocks, health system collapse, or intentional choices made in responding to the pandemic), the increase in child and maternal deaths will be devastating. We hope these numbers add context as policy makers establish guidelines and allocate resources in the days and months to come. FUNDING: Bill & Melinda Gates Foundation, Global Affairs Canada.


Asunto(s)
Mortalidad del Niño , Infecciones por Coronavirus/epidemiología , Países en Desarrollo/estadística & datos numéricos , Mortalidad Materna , Pandemias , Neumonía Viral/epidemiología , Preescolar , Prestación de Atención de Salud/organización & administración , Femenino , Abastecimiento de Alimentos/estadística & datos numéricos , Humanos , Lactante , Modelos Estadísticos , Embarazo
7.
PLoS One ; 15(3): e0230744, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32231387

RESUMEN

Non-communicable diseases, such as cardiovascular diseases (CVDs), diabetes and cancer account for more than half of the global disease burden, and 75% of related deaths occur in low- and middle-income countries (LMICs). Despite large regional variations in CVD incidence and prevalence, CVDs remain the leading causes of death worldwide. With urbanisation, developing nations are undergoing unprecedented labour-force transitions out of agriculture and into types of non-agricultural employment, mainly in the industry and service sectors. There are few studies on the effect of these transitions on CVDs and CVD risk factors in LMICs. We systematically searched MEDLINE, PubMed, EMBASE and the Cochrane Library from January 1950 to January 2017 to assess the association of engaging in agriculture compared to types of non-agricultural employment (e.g. services and manufacturing) with CVD incidence, prevalence and risk factors. Studies were included if they: included participants who engaged in agriculture and participants who did not engage in agriculture; measured atherosclerotic CVDs or their modifiable risk factors; and involved adults from LMICs. We assessed the quality of evidence in seven domains of each study. Prevalence ratios with 95% confidence intervals were calculated and compared in forest plots across studies. Study heterogeneity did not permit formal meta-analyses with pooled results. There was a lack of publications on the primary outcomes, atherosclerotic CVDs (n = 2). Limited evidence of varying consistency from 13 studies in five countries reported that compared with non-agricultural workers, mainly living in urban areas, rural agriculture workers had a lower prevalence of hypertension, overweight and obesity; and a higher prevalence of underweight and smoking. High quality evidence is lacking on the associations of engaging in and transitioning out of agriculture with atherosclerotic CVDs and their modifiable risk factors in LMICs. There is a need for interdisciplinary longitudinal studies to understand associations of types of employment and labour-force transitions with CVD burdens in LMICs.


Asunto(s)
Agricultura , Enfermedades Cardiovasculares/epidemiología , Países en Desarrollo/estadística & datos numéricos , Estudios Observacionales como Asunto , Humanos , Incidencia , Prevalencia , Factores de Riesgo
8.
Orthop Clin North Am ; 51(2): 131-139, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32138851

RESUMEN

In this review article, the authors present the many challenges that orthopedic surgeons in developing countries face when implementing arthroplasty programs. The issues of cost, sterility, and patient demographics are specifically addressed. Despite the many challenges, developing countries are beginning to offer hip and knee reconstructive surgery to respond to the increasing demand for such elective operations as the prevalence of osteoarthritis continues to increase. The authors shed light on these nascent arthroplasty programs.


Asunto(s)
Artroplastia de Reemplazo/normas , Países en Desarrollo , Osteoartritis/cirugía , Desarrollo de Programa/normas , Artroplastia de Reemplazo/economía , Artroplastia de Reemplazo/estadística & datos numéricos , Países en Desarrollo/estadística & datos numéricos , Femenino , Salud Global/economía , Salud Global/normas , Humanos , Masculino , Misiones Médicas/economía , Misiones Médicas/normas , Misiones Médicas/estadística & datos numéricos , Osteoartritis/economía , Osteoartritis/epidemiología , Desarrollo de Programa/economía , Sistema de Registros/estadística & datos numéricos
9.
PLoS One ; 15(3): e0230454, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32182278

RESUMEN

Insufficient physical activity (PA) is the fourth major risk factor for many non-communicable diseases and premature mortality worldwide. Features of the built environment (BE) play a considerable role in determining population PA behaviors. The majority of evidence for PA-BE relationships comes from high-income countries and may not be generalizable to low- and middle-income countries (LMICs). We aim to systematically review the literature and assess the associations between perceived and/or objective BE characteristics and PA domains in LMICs. This review adopted a systematic search strategy for English language articles published between January 2000 and June 2019 from four electronic databases-Medline, Embase, Web of Science and PubMed-adhering to the PRISMA guidelines. Studies addressing the associations between self-reported and/or objective BE and PA were only included if they were conducted in LMICs, according to the World Bank classification list. Articles investigating PA-BE relationships across any age groups were included, and all study designs were eligible, except for qualitative studies and reviews. Thirty-three studies were included for evidence synthesis. Cross-sectional studies were the most prevailing study design (97%), revealing a notable gap in longitudinal PA-BE research in LMICs. A majority of the BE factors were not associated with different PA domains while others (e.g., density, proximity to services, aesthetics) exhibited an inconsistent association. Land-use mix diversity was positively associated with transport PA and the presence of recreation facilities resulted in an increase in PA during leisure-time. Increased safety from crime at night consistently increased total PA and walking levels. Research exploring the associations between BE attributes and PA behaviors in LMICs appears to be limited and is primarily cross-sectional. Longitudinal research studies with objective measures are needed for inferring well-grounded PA-BE causal relationships and informing the design of evidence-based environmental interventions for increasing PA levels in LMICs.


Asunto(s)
Ejercicio Físico , Entorno Construido/estadística & datos numéricos , Estudios Transversales , Países en Desarrollo/estadística & datos numéricos , Planificación Ambiental/estadística & datos numéricos , Femenino , Humanos , Masculino
10.
PLoS One ; 15(3): e0230370, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32196524

RESUMEN

Adolescent girls in West Africa are migrating in search of educational and livelihood opportunities. In Mali, early marriage (before the legal age of 16) is a common practice. This paper builds on prior research on female migration that focused on the direct influences of migration on marriage and explores the wider social impact of rising female migration in sending communities by examining direct and indirect effects and intended and unintended consequences. This study examines perceptions about migration among girls and their parents including how it influences marital timing, marriage preparations, marriage practices, and marital relations. Qualitative data were collected from 140 adolescent girls and 115 parents of adolescent girls in rural areas in focus group discussions (FGDs) (n = 31) and in-depth interviews (IDIs) (n = 41) to inform how girls' migration patterns might influence program recruitment strategies and content for an intervention aimed at addressing early marriage in Mali. Our findings concur with earlier studies that migration has direct effects on marriage because it allows girls to both avoid early marriage and prepare for marriage through the assembly of goods and wares to bring to their conjugal homes. Despite some of the perceived risks of migration on marriage, the indirect effects of migration include allowing girls to see different types of marriage practices and marital relationships between husbands and wives and potentially allowing migrant girls to exert more influence over the marital process compared to non-migrants. However, migration can expose girls to new ideas and alternatives that may be incongruent with cultural expectations for them once they return to their communities. This study suggests that migration is seen as an inevitable part of life for many adolescent girls in Mali. Girls who migrate may return to their villages with not only items or income that provide direct benefits to a marriage, but also viewpoints on the expectations for women and girls in their communities that indirectly influence marital relationships. Although this can be challenging for individual returned girls in terms of reintegration, these new expectations may, over time, lead to social changes that influence migrants and non-migrants. Program strategies and approaches must consider the possibility of migration as an important aspect of every adolescent girl's opportunity structure. The qualitative data suggests that certain skills are critical for adolescent girls. Programs should emphasize the acquisition of relevant skills such as communication, risk assessment, negotiation and money management in ways that are relevant for migrants and non-migrants.


Asunto(s)
Conducta del Adolescente/psicología , Emigración e Inmigración/estadística & datos numéricos , Matrimonio/psicología , Factores Socioeconómicos , Migrantes/psicología , Adolescente , Factores de Edad , Niño , Países en Desarrollo/estadística & datos numéricos , Femenino , Grupos Focales , Humanos , Masculino , Malí , Matrimonio/legislación & jurisprudencia , Matrimonio/estadística & datos numéricos , Persona de Mediana Edad , Padres/psicología , Investigación Cualitativa , Migrantes/estadística & datos numéricos , Adulto Joven
11.
PLoS One ; 15(3): e0229906, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32163440

RESUMEN

BACKGROUND: Caesarean section is considered a relatively preferable and safe method of delivery as compared to normal delivery. Since the last decade, its prevalence has increased in both developed and developing countries. In the context of developing countries viz., South Asia (the highest populated region) and South-East Asia (the third-highest populated region), where a significant proportion of home deliveries were reported,however, the preference for, caesarean delivery and its associated factors are not well understood. OBJECTIVE: To study the caesarean delivery in the South and South-East Asian countries and to determine the factors associated with the preference for caesarean delivery. METHODOLOGY: Demographic and Health Survey Data on from ever-married women of nine developing countries of South and South-East Asia viz., Vietnam, India, Maldives, Timor-Leste, Nepal, Indonesia, Pakistan, Bangladesh, and Cambodia have been considered. Both bivariate and binary logistic regression models were used to estimate the propensity of a woman undergoing for caesarean delivery and to assess the influence of maternal socioeconomic characteristics towards the preference for caesarean delivery. RESULTS: Obtained results have shown an inclination of caesarean delivery among urban than rural women and are quite conspicuous, but is found to be underestimated mostly among rural women. Caesarean delivery in general is mostly predisposed among women whose baby sizes are either very large or smaller than average, have a higher level of education and place of delivery is private medical institutions. The logistic regression also revealed the influence of maternal socioeconomic characteristics towards the preference for caesarean delivery. Based on nine South and South-East Asian countries an overall C-section prevalence of 13%, but based on institutional births its increase to 19%. The forest plot demonstrated that a significant inclination of C-section among urban than rural regions. In Meta-Analysis, very high and significant heterogeneity among countries is observed, but confirms that in terms of prevalence of C-section all of the countries follow independent pattern. CONCLUSION: Study of seven urban and four rural regions of nine South and South- East Asian countries showed, a significant inclination towards the caesarean delivery above the more recent outdated WHO recommended an optimal range of 10-15%and are associated maternal socioeconomic characteristics. In order to control unwanted caesarean delivery, the government needs to develop better healthcare infrastructure and along with more antenatal care related schemes to reduce the risks associated with increased caesarean delivery.


Asunto(s)
Cesárea/estadística & datos numéricos , Países en Desarrollo/estadística & datos numéricos , Determinantes Sociales de la Salud/estadística & datos numéricos , Factores Socioeconómicos , Adolescente , Adulto , Asia Sudoriental , Asia Occidental , Cesárea/tendencias , Femenino , Encuestas Epidemiológicas/estadística & datos numéricos , Humanos , Modelos Logísticos , Edad Materna , Embarazo , Prevalencia , Población Rural/estadística & datos numéricos , Población Rural/tendencias , Población Urbana/estadística & datos numéricos , Población Urbana/tendencias , Adulto Joven
12.
Bull Cancer ; 107(3): 328-332, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32059813

RESUMEN

INTRODUCTION: Dermatofibrosarcoma (DFS) is a common dermic sarcoma. It is a local malignant tumor occurring in young adults. The recurrence potential justifies an R0-type surgery with a three centimeters margin. We report our experience of the management of locally advanced DFS by resection and reconstructive surgery. METHODS: It is an ongoing descriptive study spanned from June 2005 to December 2018. We included all DFS cases treated by curative resection and reconstruction. A total of eight cases of DFS among 108 soft tissue sarcomas were studied. All patients were males. The mean age was 41.8 years [32-60]. Carcinologic results, cosmetic results, and outcomes were analyzed. RESULTS: R0-type resection was performed in six cases. In two cases, the resection was R1-type and resulted in amputation. In four cases, it was an iterative surgery. Average desease duration was 4 years [1-8]. Reconstructive surgery was needed for wound closure in six cases. Wounds healed in 28 days [18-90]. Outcomes showed hyperchromic keloid scars (N=2) at the trunk localization. CONCLUSION: DFS is a common cancer with a good outcome if managed earliest. Delayed diagnoses and inadequate first-time surgery led to tumor extension and recurrences. Locally advanced tumors management needs extensive resections and reconstructive surgery. In addition to surgery, Imatinib and radiotherapy improve outcomes, but are not available in our context.


Asunto(s)
Dermatofibrosarcoma/cirugía , Procedimientos Quirúrgicos Dermatologicos/métodos , Países en Desarrollo , Neoplasias Cutáneas/cirugía , Adulto , Burkina Faso/epidemiología , Dermatofibrosarcoma/epidemiología , Dermatofibrosarcoma/patología , Procedimientos Quirúrgicos Dermatologicos/efectos adversos , Países en Desarrollo/estadística & datos numéricos , Humanos , Queloide/etiología , Masculino , Ilustración Médica , Persona de Mediana Edad , Fotograbar , Complicaciones Posoperatorias/etiología , Neoplasias Cutáneas/epidemiología , Neoplasias Cutáneas/patología , Resultado del Tratamiento , Técnicas de Cierre de Heridas/estadística & datos numéricos , Cicatrización de Heridas
14.
Afr J AIDS Res ; 19(1): 40-47, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32079486

RESUMEN

The uptake of HIV testing has always been found to be lower among men compared with women in many developing countries. The aim of this study was to ascertain the level and determinants of HIV testing uptake among men aged 15 to 59 in Ghana. This article was based on data from the 2003, 2008 and 2014 Ghana Demographic and Health Surveys. A bivariate statistical method was used to calculate the levels of uptake while three logit models were fitted to estimate the determinants of HIV uptake among the respondents. The total levels of the uptake of HIV testing among the respondents were 9.1%, 14.7% and 22.7% for 2003, 2008 and 2014, respectively; 15% overall. These were significantly determined by age, educational attainment, religious affiliation, wealth and work status, region of residence and media exposure. HIV testing uptake is very low among men in Ghana, albeit it has seen consistent improvements over the past years. Specially tailored HIV education and prevention programmes should be targeted at men in areas of low uptake, based on their different characteristics, in order to increase uptake.


Asunto(s)
Infecciones por VIH/diagnóstico , Infecciones por VIH/prevención & control , Tamizaje Masivo/estadística & datos numéricos , Adolescente , Adulto , Países en Desarrollo/estadística & datos numéricos , Femenino , Ghana , Humanos , Masculino , Persona de Mediana Edad , Conducta Sexual/estadística & datos numéricos , Adulto Joven
15.
PLoS One ; 15(2): e0228056, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32059033

RESUMEN

INTRODUCTION: Pneumonia in children is a common disease yet determining its aetiology remains elusive. OBJECTIVES: To determine the a) aetiology, b) factors associated with bacterial pneumonia and c) association between co-infections (bacteria + virus) and severity of disease, in children admitted with severe pneumonia. METHODS: A prospective cohort study involving children aged 1-month to 5-years admitted with very severe pneumonia, as per the WHO definition, over 2 years. Induced sputum and blood obtained within 24 hrs of admission were examined via PCR, immunofluorescence and culture to detect 17 bacteria/viruses. A designated radiologist read the chest radiographs. RESULTS: Three hundred patients with a mean (SD) age of 14 (±15) months old were recruited. Significant pathogens were detected in 62% of patients (n = 186). Viruses alone were detected in 23.7% (n = 71) with rhinovirus (31%), human metapneumovirus (HMP) [22.5%] and respiratory syncytial virus (RSV) [16.9%] being the commonest. Bacteria alone was detected in 25% (n = 75) with Haemophilus influenzae (29.3%), Staphylococcus aureus (24%) and Streptococcus pneumoniae (22.7%) being the commonest. Co-infections were seen in 13.3% (n = 40) of patients. Male gender (AdjOR 1.84 [95% CI 1.10, 3.05]) and presence of crepitations (AdjOR 2.27 [95% CI 1.12, 4.60]) were associated with bacterial infection. C-reactive protein (CRP) [p = 0.007]) was significantly higher in patients with co-infections but duration of hospitalization (p = 0.77) and requirement for supplemental respiratory support (p = 0.26) were not associated with co-infection. CONCLUSIONS: Bacteria remain an important cause of very severe pneumonia in developing countries with one in four children admitted isolating bacteria alone. Male gender and presence of crepitations were significantly associated with bacterial aetiology. Co-infection was associated with a higher CRP but no other parameters of severe clinical illness.


Asunto(s)
Países en Desarrollo/estadística & datos numéricos , Neumonía Bacteriana/epidemiología , Adolescente , Niño , Preescolar , Estudios de Cohortes , Coinfección/epidemiología , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Virosis/epidemiología
16.
Lancet Glob Health ; 8(3): e352-e361, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32087172

RESUMEN

BACKGROUND: The UN Sustainable Development Goals (SDGs) call for stratification of social indicators by ethnic groups; however, no recent multicountry analyses on ethnicity and child survival have been done in low-income and middle-income countries (LMICs). METHODS: We used data from Demographic and Health Surveys and Multiple Indicator Cluster Surveys collected between 2010 and 2016, from LMICs that provided birth histories and information on ethnicity or a proxy variable. We calculated neonatal (age 0-27 days), post-neonatal (age 28-364 days), child (age 1-4 years), and under-5 mortality rates (U5MRs) for each ethnic group within each country. We assessed differences in mortality between ethnic groups using a likelihood ratio test, Theil's index, and between-group variance. We used multivariable analyses of U5MR by ethnicity to adjust for household wealth, maternal education, and urban-rural residence. FINDINGS: We included data from 36 LMICs, which included 2 812 381 livebirths among 415 ethnic groups. In 25 countries, significant differences in U5MR by ethnic group were identified (all p<0·05 likelihood ratio test). In these countries, the median mortality ratio between the ethnic groups with the highest and lowest U5MRs was 3·3 (IQR 2·1-5·2; range 1·5-8·5), whereas among the remaining 11 countries, the median U5MR ratio was 1·9 (IQR 1·7-2·5; range 1·4-10·0). Ethnic gaps were wider for child mortality than for neonatal or post-neonatal mortality. In nearly all countries, adjustment for wealth, education, and place of residence did not affect ethnic gaps in mortality, with the exception of Guatemala, India, Laos, and Nigeria. The largest ethnic group did not have the lowest U5MR in any of the countries studied. INTERPRETATION: Significant ethnic disparities in child survival were identified in more than two-thirds of the countries studied. Regular analyses of ethnic disparities are essential for monitoring trends, targeting, and assessing the impact of health interventions. Such analyses will contribute to the effort towards leaving no one behind, which is at the centre of the SDGs. FUNDING: Bill & Melinda Gates Foundation, UNICEF, Wellcome Trust, Associação Brasileira de Saúde Coletiva.


Asunto(s)
Mortalidad del Niño/etnología , Países en Desarrollo/estadística & datos numéricos , Grupos Étnicos/estadística & datos numéricos , Disparidades en el Estado de Salud , Mortalidad Infantil/etnología , Preescolar , Demografía , Humanos , Lactante , Recién Nacido
17.
Lancet Psychiatry ; 7(2): 173-190, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31981539

RESUMEN

BACKGROUND: Evidence on the effectiveness of psychological interventions for women with common mental disorders (CMDs) who also experience intimate partner violence is scarce. We aimed to test our hypothesis that exposure to intimate partner violence would reduce intervention effectiveness for CMDs in low-income and middle-income countries (LMICs). METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PsycINFO, Web of Knowledge, Scopus, CINAHL, LILACS, ScieELO, Cochrane, PubMed databases, trials registries, 3ie, Google Scholar, and forward and backward citations for studies published between database inception and Aug 16, 2019. All randomised controlled trials (RCTs) of psychological interventions for CMDs in LMICs which measured intimate partner violence were included, without language or date restrictions. We approached study authors to obtain unpublished aggregate subgroup data for women who did and did not report intimate partner violence. We did separate random-effects meta-analyses for anxiety, depression, post-traumatic stress disorder (PTSD), and psychological distress outcomes. Evidence from randomised controlled trials was synthesised as differences between standardised mean differences (SMDs) for change in symptoms, comparing women who did and who did not report intimate partner violence via random-effects meta-analyses. The quality of the evidence was assessed with the Cochrane risk of bias tool. This study is registered on PROSPERO, number CRD42017078611. FINDINGS: Of 8122 records identified, 21 were eligible and data were available for 15 RCTs, all of which had a low to moderate risk of overall bias. Anxiety (five interventions, 728 participants) showed a greater response to intervention among women reporting intimate partner violence than among those who did not (difference in standardised mean differences [dSMD] 0·31, 95% CI 0·04 to 0·57, I2=49·4%). No differences in response to intervention were seen in women reporting intimate partner violence for PTSD (eight interventions, n=1436; dSMD 0·14, 95% CI -0·06 to 0·33, I2=42·6%), depression (12 interventions, n=2940; 0·10, -0·04 to 0·25, I2=49·3%), and psychological distress (four interventions, n=1591; 0·07, -0·05 to 0·18, I2=0·0%, p=0·681). INTERPRETATION: Psychological interventions treat anxiety effectively in women with current or recent intimate partner violence exposure in LMICs when delivered by appropriately trained and supervised health-care staff, even when not tailored for this population or targeting intimate partner violence directly. Future research should investigate whether adapting evidence-based psychological interventions for CMDs to address intimate partner violence enhances their acceptability, feasibility, and effectiveness in LMICs. FUNDING: UK National Institute for Health Research ASSET and King's IoPPN Clinician Investigator Scholarship.


Asunto(s)
Trastornos de Ansiedad/terapia , Trastorno Depresivo/terapia , Países en Desarrollo/estadística & datos numéricos , Violencia de Pareja/estadística & datos numéricos , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Psicoterapia/estadística & datos numéricos , Trastornos por Estrés Postraumático/terapia , Estrés Psicológico/terapia , Femenino , Humanos
18.
Global Health ; 16(1): 2, 2020 01 02.
Artículo en Inglés | MEDLINE | ID: mdl-31898527

RESUMEN

BACKGROUND: Non-communicable diseases (NCDs) are increasingly contributing to the morbidity and mortality burden of low and-middle income countries (LMIC). Social capital, particularly participation has been considered as a possible protective factor in the prevention and management of chronic conditions. It is also largely shown to have a negative effect on the well-being of patients. The current discourse on the well-being of individuals with NCDs is however focused more on a comparison with those with no NCDs without considering the difference between individuals with one chronic condition versus those with multiple chronic conditions (MCC). METHOD AND OBJECTIVE: We employed a multinomial logit model to examine the effect of social capital, particularly social participation, on the subjective well-being (SWB) of older adults with single chronic condition and MCC in six LMIC. FINDINGS: Social capital was associated with increased subjective well-being of adults in all the six countries. The positive association between social capital and subjective well-being was higher for those with a single chronic condition than those with multiple chronic conditions in India and South Africa. Conversely, an increase in the likelihood of having higher subjective well-being as social capital increased was greater for those with multiple chronic conditions compared to those with a single chronic condition in Ghana. DISCUSSION: The findings suggest that improving the social capital of older adults with chronic diseases could potentially improve their subjective well-being. This study, therefore, provides valuable insights into potential social determinants of subjective well-being of older adults with chronic diseases in six different countries undergoing transition. Additional research is needed to determine if these factors do in fact have causal effects on SWB in these populations.


Asunto(s)
Países en Desarrollo/estadística & datos numéricos , Autoevaluación Diagnóstica , Enfermedades no Transmisibles/epidemiología , Capital Social , Anciano , Enfermedad Crónica , Femenino , Humanos , Masculino , Persona de Mediana Edad
19.
Lancet Psychiatry ; 7(2): 162-172, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31948935

RESUMEN

BACKGROUND: Mental health conditions are leading causes of disability worldwide. Psychosocial interventions for these conditions might have a key role in their treatment, although applicability of findings to poor-resource settings might be a challenge. We aimed to evaluate the strength and credibility of evidence generated in low-income and middle-income countries (LMICs) on the efficacy of psychosocial interventions for various mental health outcomes. METHODS: We did an umbrella review of meta-analyses of randomised studies done in LMICs. Literature searches were done in Medline, Embase, PsychINFO, CINAHL, Cochrane Library, and Epistemonikos from Jan 1, 2010, until May 31, 2019. Systematic reviews of randomised studies investigating the efficacy of psychosocial interventions for mental health conditions in LMICs were included. Systematic reviews of promotion, prevention, and protection interventions were excluded, because the focus was on treatment interventions only. Information on first author, year of publication, outcomes, number of included studies, and reported summary meta-analytic estimates was extracted from included meta-analyses. Summary effects were recalculated using a common metric and random-effects models. We assessed between-study heterogeneity, predictive intervals, publication bias, small-study effects, and whether the results of the observed positive studies were more than expected by chance. On the basis of these calculations, strength of associations was assessed using quantitative umbrella review criteria, and credibility of evidence using the GRADE approach. This study is registered with PROSPERO, number CRD42019135711. FINDINGS: 123 primary studies from ten systematic reviews were included. The evidence on the efficacy of psychosocial interventions in adults with depression in humanitarian settings (standardised mean difference 0·87, 95% CI 0·67-1·07; highly suggestive association, GRADE: moderate) and in adults with common mental disorders (0·49, 0·36-0·62; highly suggestive association, GRADE: moderate) was supported by the most robust evidence. Highly suggestive strength of association was found for psychosocial interventions in adults with schizophrenia for functional outcomes, in adults with depression, and in adults with post-traumatic stress disorder in humanitarian settings. In children in humanitarian settings, and in children with disruptive behaviour, psychosocial interventions were supported by suggestive evidence of efficacy. INTERPRETATION: A relatively large amount of evidence suggests the benefit of psychosocial interventions on various mental health outcomes in LMICs. However, strength of associations and credibility of evidence were quite variable, depending on the target mental health condition, type of population and setting, and outcome of interest. This varied evidence should be considered in the development of clinical, policy, and implementation programmes in LMICs and should prompt further studies to improve the strength and credibility of the evidence base. FUNDING: University of Verona.


Asunto(s)
Países en Desarrollo/estadística & datos numéricos , Trastornos Mentales/terapia , Metaanálisis como Asunto , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Psicoterapia/estadística & datos numéricos , Ensayos Clínicos Controlados Aleatorios como Asunto/estadística & datos numéricos , Humanos
20.
BMC Public Health ; 20(1): 99, 2020 Jan 23.
Artículo en Inglés | MEDLINE | ID: mdl-31973695

RESUMEN

BACKGROUND: Social engagement forms the basis of social relationships by providing a sense of belonging, social identity, and fulfillment. Previous research demonstrates that social engagement was associated with positive health behaviors among older adults. However, the results have been different across health-related behaviors, and mostly based on data from high-income countries. For example, studies from the US and UK showed that social engagement was protective against smoking, while others found social engagement encouraged more smoking in many Asian cultures. In this study, we aim to examine the association between social engagement and a range of health-related behaviors and subjective well-being among older adults in six low- to middle-income countries. METHODS: Data from the WHO Study on Global Ageing and Adult Health (SAGE Wave 1) were used. A total of 33,338 individuals aged 50 and older in China, Russia, India, Ghana, South Africa, and Mexico were included. Social engagement, tobacco use, alcohol consumption, fruit and vegetable intake, physical activity, sedentary behavior, sleep duration, depression symptoms, self-rated health status, and quality of life were assessed using established self-reported measures. Multiple logistic regression models were used to examine the relationship between social engagement and nine outcome variables, adjusting for socio-demographic characteristics. RESULTS: Lower levels of social engagement were positively related to physical inactivity, prolonged sitting time, unhealthy sleep duration, perceived depression, poor self-rated health, and low quality of life. However, the associations between social engagement and tobacco use, excessive drinking, and insufficient fruit and vegetable intake were mixed across countries. CONCLUSION: This international study found high social engagement as a potential health-promoting factor in some low- to middle-income countries. Although the impacts of social engagement on tobacco and alcohol use and diet were complicated and culture-specific, interventions at both individual and community levels should encourage healthy lifestyles through positive social engagement.


Asunto(s)
Países en Desarrollo/estadística & datos numéricos , Monitoreo Epidemiológico , Conductas Relacionadas con la Salud , Estado de Salud , Conducta Social , Anciano , Anciano de 80 o más Años , China , Femenino , Ghana , Humanos , India , Masculino , México , Persona de Mediana Edad , Federación de Rusia , Sudáfrica , Encuestas y Cuestionarios
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