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1.
Ugeskr Laeger ; 183(11)2021 03 15.
Artigo em Dinamarquês | MEDLINE | ID: mdl-33734073

RESUMO

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.


Assuntos
/epidemiologia , Países em Desenvolvimento/estatística & dados numéricos , Mortalidade Materna , Mães/estatística & dados numéricos , Pandemias , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Desnutrição/epidemiologia , Serviços de Saúde Materna , Saúde Mental , Pobreza , Gravidez , Complicações Infecciosas na Gravidez
3.
BMJ ; 372: n534, 2021 03 24.
Artigo em Inglês | MEDLINE | ID: mdl-33762259

RESUMO

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.


Assuntos
Poluentes Atmosféricos/toxicidade , Poluição do Ar/efeitos adversos , Doenças Cardiovasculares/mortalidade , Saúde Global/estatística & dados numéricos , Dióxido de Nitrogênio/toxicidade , Doenças Respiratórias/mortalidade , Saúde da População Urbana/estatística & dados numéricos , Doenças Cardiovasculares/induzido quimicamente , Cidades , Países Desenvolvidos/estatística & dados numéricos , Países em Desenvolvimento/estatística & dados numéricos , Exposição Ambiental/efeitos adversos , Humanos , Modelos Lineares , Doenças Respiratórias/induzido quimicamente
4.
J Prev Med Public Health ; 54(1): 73-80, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33618502

RESUMO

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.


Assuntos
Aglomeração , Características da Família , Saúde Pública/métodos , Adolescente , Adulto , Países em Desenvolvimento/economia , Países em Desenvolvimento/estatística & dados numéricos , Feminino , Mapeamento Geográfico , Humanos , Renda/estatística & dados numéricos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Prevalência , Saúde Pública/normas , Saúde Pública/estatística & dados numéricos , Fatores Socioeconômicos , Inquéritos e Questionários
5.
Cochrane Database Syst Rev ; 12: CD004265, 2021 01 06.
Artigo em Inglês | MEDLINE | ID: mdl-33539552

RESUMO

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.


Assuntos
Diarreia/prevenção & controle , Desinfecção das Mãos/métodos , Adulto , Viés , Criança , Creches/estatística & dados numéricos , Infecções Comunitárias Adquiridas/prevenção & controle , Infecção Hospitalar/prevenção & controle , Países Desenvolvidos/estatística & dados numéricos , Países em Desenvolvimento/estatística & dados numéricos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Instituições Acadêmicas/estatística & dados numéricos , Sabões
6.
Curr Opin Clin Nutr Metab Care ; 24(3): 271-275, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33631771

RESUMO

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.


Assuntos
Saúde da Criança/tendências , Transtornos da Nutrição Infantil/terapia , Alimentos Fortificados/provisão & distribução , Micronutrientes/administração & dosagem , Criança , Transtornos da Nutrição Infantil/epidemiologia , Países em Desenvolvimento/estatística & dados numéricos , Feminino , Humanos , Masculino , Estado Nutricional , Pobreza/estatística & dados numéricos
7.
Value Health ; 24(1): 61-66, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33431154

RESUMO

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.


Assuntos
Análise Custo-Benefício/estatística & dados numéricos , Países em Desenvolvimento/estatística & dados numéricos , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/administração & dosagem , Vacinas contra Papillomavirus/economia , Países em Desenvolvimento/economia , Saúde Global , Humanos , Programas de Imunização/economia , Programas de Imunização/estatística & dados numéricos , Modelos Econômicos , Infecções por Papillomavirus/economia , Infecções por Papillomavirus/epidemiologia , Anos de Vida Ajustados por Qualidade de Vida
9.
Value Health ; 24(1): 70-77, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33431156

RESUMO

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.


Assuntos
Países em Desenvolvimento/estatística & dados numéricos , Saúde Global , Programas de Imunização/economia , Programas de Imunização/estatística & dados numéricos , Cobertura Vacinal/economia , Efeitos Psicossociais da Doença , Custos e Análise de Custo , Países em Desenvolvimento/economia , Recursos em Saúde/organização & administração , Humanos , Modelos Econômicos , Vacinas/economia , Vacinas/provisão & distribução
10.
Value Health ; 24(1): 78-85, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33431157

RESUMO

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.


Assuntos
Países em Desenvolvimento/estatística & dados numéricos , Programas de Imunização/economia , Programas de Imunização/estatística & dados numéricos , Cobertura Vacinal/economia , Efeitos Psicossociais da Doença , Custos e Análise de Custo , Países em Desenvolvimento/economia , Saúde Global , Humanos , Modelos Econômicos , Vacinas/economia , Vacinas/provisão & distribução
11.
Maturitas ; 143: 157-164, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33308622

RESUMO

OBJECTIVES: Higher levels of sedentary behavior (SB) may be associated with decreased happiness but there are no studies on this topic. Thus, we investigated this association, and its influential factors among middle-aged and older adults using nationally representative datasets from six low- and middle-income countries (LMICs). STUDY DESIGN: Community-based cross-sectional data from the Global Ageing and Adult Health study were analyzed. SB was assessed with the Global Physical Activity Questionnaire. Multivariable ordinal logistic regression and mediation analyses were performed. MAIN OUTCOME MEASURES: Happiness was assessed with a cross-culturally validated single-item question (5-point scale) with higher scores indicating higher levels of happiness. RESULTS: The final sample included 34,129 adults aged 50 years or more (mean age = 62.4 ±â€¯SD 16 years; 51.9 % female). After adjusting for multiple confounders, increased time spent in SB (hours/day) was associated with lower happiness levels (OR = 0.96; 95 % CI = 0.94-0.98). Mobility limitations, cognitive complaints, pain/discomfort, sleep problems and disability explained the largest proportion of the association between SB and happiness. CONCLUSIONS: SB was linked with lower levels of happiness in middle-aged and older adults from LMICs, although a high level of between-country heterogeneity was observed. Longitudinal and interventional studies among older people in LMICs are warranted to assess directionality and the potential for reduction in SB to improve mental well-being in this population.


Assuntos
Países em Desenvolvimento/estatística & dados numéricos , Felicidade , Comportamento Sedentário , Idoso , Idoso de 80 Anos ou mais , Transtornos Cognitivos/epidemiologia , Estudos Transversais , Pessoas com Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Limitação da Mobilidade , Dor/epidemiologia , Transtornos do Sono-Vigília/epidemiologia
12.
J Psychiatr Res ; 132: 13-17, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33035760

RESUMO

OBJECTIVE: Studies have documented the significant direct and indirect psychological, social, and economic consequences of the Coronavirus disease 2019 (COVID-19) in many countries but little is known on its impact in low- and middle-income countries (LMICs) already facing difficult living conditions and having vulnerable health systems that create anxiety among the affected populations. Using a multinational convenience sample from four LMICs (DR Congo, Haiti, Rwanda, and Togo), this study aims to explore the prevalence of anxiety symptoms and associated risk and protective factors during the COVID-19 pandemic. METHODS: A total of 1267 individuals (40.8% of women) completed a questionnaire assessing exposure and stigmatization related to COVID-19, anxiety, and resilience. Analyses were performed to examine the prevalence and predictors of anxiety. RESULTS: Findings showed a pooled prevalence of 24.3% (9.4%, 29.2%, 28.5%, and 16.5% respectively for Togo, Haiti, RDC, and Rwanda, x2 = 32.6, p < .0001). For the pooled data, exposure to COVID-19 (ß = 0.06, p = .005), stigmatization related to COVID-19 (ß = 0.03, p < .001), and resilience (ß = -0.06, p < .001) contributed to the prediction of anxiety scores. Stigmatization related to COVID-19 was significantly associated to anxiety symptoms in all countries (ß = 0.02, p < .00; ß = 0.05, p = .013; ß = 0.03, p = .021; ß = 0.04, p < .001, respectively for the RDC, Rwanda, Haiti, and Togo). CONCLUSIONS: The findings highlight the need for health education programs in LMICs to decrease stigmatization and the related fears and anxieties, and increase observance of health instructions. Strength-based mental health programs based on cultural and contextual factors need to be developed to reinforce both individual and community resilience and to address the complexities of local eco-systems.


Assuntos
Ansiedade/epidemiologia , Países em Desenvolvimento/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Resiliência Psicológica , Estigma Social , Adulto , Ansiedade/etiologia , Congo/epidemiologia , Feminino , Haiti/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Proteção , Fatores de Risco , Ruanda/epidemiologia , Togo/epidemiologia
13.
Vaccine ; 39(3): 495-504, 2021 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-33342632

RESUMO

The addition of other respiratory illnesses such as flu could cripple the healthcare system during the coronavirus disease 2019 (COVID-19) pandemic. An annual seasonal influenza vaccine is the best way to help protect against flu. Fears of coronavirus have intensified the shortage of influenza shots in developing countries that hope to vaccinate many populations to reduce stress on their health services. We present an inventory-location mixed-integer linear programming model for equitable influenza vaccine distribution in developing countries during the pandemic. The proposed model utilizes an equitable objective function to distribute vaccines to critical healthcare providers and first responders, elderly, pregnant women, and those with underlying health conditions. We present a case study in a developing country to exhibit efficacy and demonstrate the optimization model's applicability.


Assuntos
/epidemiologia , Países em Desenvolvimento/estatística & dados numéricos , Equipamentos e Provisões , Vacinas contra Influenza/provisão & distribução , Saúde Pública/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Pessoal de Saúde , Humanos , Vacinas contra Influenza/administração & dosagem , Influenza Humana/prevenção & controle , Gravidez , Vacinação
14.
J Surg Res ; 257: 419-424, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32892140

RESUMO

BACKGROUND: In many resource-limited settings, patients with biliary atresia present too late for surgical correction to be offered, and the diagnosis is fatal. As pediatric surgical and anesthesia capabilities have improved, patients in Rwanda have been offered surgical exploration. This study explores initial outcomes. METHODS: Patients presenting with direct hyperbilirubinemia and clinical suspicion of biliary atresia were identified at the main university teaching hospital in Kigali, Rwanda, from January 2016 to June 2019. Patient demographics, referral history, geographic location, preoperative imaging, preoperative laboratory studies, operative details, postoperative laboratory studies, in-hospital complications, length of stay, and survival were abstracted from retrospective chart review. Descriptive analysis was performed, and univariate analysis evaluated survival and complications. RESULTS: Seventeen patients were identified with biliary atresia, and thirteen were offered surgery. The median age of admission was 77 d (interquartile range [IQR] 63-92 d), with the median time wait for the operation being 19 d (IQR 9-27 d). The median age at operation was 93 d (IQR 76-123 d). In-hospital postoperative mortality was 15.4% (n = 2) and postoperative complications occurred in 46.2% (n = 6). Eleven patients survived to hospital discharge (84.6%), with a median length of stay of 8 d (IQR 6-13 d). CONCLUSIONS: While future studies are needed to evaluate the long-term outcomes, this series shows that surgical treatment of biliary atresia can be safely performed in Rwanda. Early referral of direct hyperbilirubinemia is essential, particularly as limited resources and personnel may impact the time from diagnosis to operation.


Assuntos
Atresia Biliar/cirurgia , Países em Desenvolvimento/estatística & dados numéricos , Portoenterostomia Hepática/mortalidade , Atresia Biliar/mortalidade , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Ruanda/epidemiologia
15.
J Surg Res ; 257: 442-448, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32892143

RESUMO

BACKGROUND: Burn injuries are a major cause of morbidity and mortality within low- and middle-income countries (LMICs). The World Health Organization developed the Global Burn Registry to centralize data collection for the guidance of burn prevention programs. This study analyzed the epidemiologic and hospital-specific factors associated with burn injury outcomes in LMICs and high-income countries (HICs). METHODS: A retrospective review was performed using the Global Burn Registry over 3 y. Patients were stratified by income region. Bivariate analyses and stepwise regressions were performed to evaluate patient and hospital demographics and variables associated with injury patterns and outcomes. Outcomes of interest included mortality and length of stay. RESULTS: Over the study period, data were collected on 1995 patients from 10 LMICs (20 hospitals) and four HICs (four hospitals). Significantly higher mortality was seen in LMICs compared with HICs (17% versus 9%; P < 0.001). There was no significant difference between income regions for injury patterns (P = 0.062) or total body surface area of the burn injury (P = 0.077). Of the LMIC hospitals in this data set, 11% did not have reliable access to an operating theater. CONCLUSIONS: HICs had a lower overall mortality even with higher rates of concurrent injuries, as well as longer length of stay. LMIC hospitals had fewer resources available, which could explain increased mortality, given similar total body surface area. This study highlights how investing in health care infrastructure could lead to improved outcomes for patients in low-resource settings.


Assuntos
Unidades de Queimados/estatística & dados numéricos , Queimaduras/mortalidade , Países em Desenvolvimento/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Saúde Global , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
16.
Front Public Health ; 8: 548708, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33330304

RESUMO

The COVID-19 outbreak was declared by the World Health Organization (WHO) as global pandemic in March 2020. Considering the necessity to implement rapid response to control the pandemic and the fragility and the state of need of low income countries, it will be mandatory to develop a global approach in order to reduce the spread of infection and the creation of community viral reservoirs. So far, we could hypothesize a worst case scenario in which when the COVID-19 outbreak hits a peak in Africa and in low-income countries, the majority of such countries will be unprepared, with low resources allocated for affording the viral emergency and the consequences will be catastrophic with no lesson learnt. In the best case scenario, the COVID-19 will not affect Africa or South America on a large scale and, if the prevention measures will be implemented, we could register a lower incidence of hygiene linked diseases that still represent leading causes of death.


Assuntos
/epidemiologia , Países em Desenvolvimento/estatística & dados numéricos , Surtos de Doenças/prevenção & controle , Surtos de Doenças/estatística & dados numéricos , Política de Saúde , Saúde Pública/estatística & dados numéricos , África , Humanos , Incidência , América do Sul
18.
PLoS One ; 15(12): e0242803, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33326451

RESUMO

Not everybody is benefiting equally from rising mean incomes. We discuss the mean-income population share (MPS), the population percentage of earners below mean income, whose evolution can capture how representative rising mean values are for middle income households. Tracking MPS and its associated income share MIS over time indicates to what extent economic growth is inclusive of both the middle and the bottom of the income distribution. We characterize MPS and MIS analytically under different growth scenarios and compare their parametric estimation using micro-level and grouped income data. Our empirical application with panel data of 16 high- and middle-income countries shows that in the last decades rising mean incomes have mostly not favored middle income households in relative perspective, while the overall welfare effects of the changes in MPS and the correlation structure with the Gini coefficient are mixed.


Assuntos
Renda/estatística & dados numéricos , Países em Desenvolvimento/estatística & dados numéricos , Humanos , Pobreza/estatística & dados numéricos , Seguridade Social/estatística & dados numéricos , Fatores de Tempo
19.
BMC Med ; 18(1): 397, 2020 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-33317544

RESUMO

BACKGROUND: Cholera epidemics continue to challenge disease control, particularly in fragile and conflict-affected states. Rapid detection and response to small cholera clusters is key for efficient control before an epidemic propagates. To understand the capacity for early response in fragile states, we investigated delays in outbreak detection, investigation, response, and laboratory confirmation, and we estimated epidemic sizes. We assessed predictors of delays, and annual changes in response time. METHODS: We compiled a list of cholera outbreaks in fragile and conflict-affected states from 2008 to 2019. We searched for peer-reviewed articles and epidemiological reports. We evaluated delays from the dates of symptom onset of the primary case, and the earliest dates of outbreak detection, investigation, response, and confirmation. Information on how the outbreak was alerted was summarized. A branching process model was used to estimate epidemic size at each delay. Regression models were used to investigate the association between predictors and delays to response. RESULTS: Seventy-six outbreaks from 34 countries were included. Median delays spanned 1-2 weeks: from symptom onset of the primary case to presentation at the health facility (5 days, IQR 5-5), detection (5 days, IQR 5-6), investigation (7 days, IQR 5.8-13.3), response (10 days, IQR 7-18), and confirmation (11 days, IQR 7-16). In the model simulation, the median delay to response (10 days) with 3 seed cases led to a median epidemic size of 12 cases (upper range, 47) and 8% of outbreaks ≥ 20 cases (increasing to 32% with a 30-day delay to response). Increased outbreak size at detection (10 seed cases) and a 10-day median delay to response resulted in an epidemic size of 34 cases (upper range 67 cases) and < 1% of outbreaks < 20 cases. We estimated an annual global decrease in delay to response of 5.2% (95% CI 0.5-9.6, p = 0.03). Outbreaks signaled by immediate alerts were associated with a reduction in delay to response of 39.3% (95% CI 5.7-61.0, p = 0.03). CONCLUSIONS: From 2008 to 2019, median delays from symptom onset of the primary case to case presentation and to response were 5 days and 10 days, respectively. Our model simulations suggest that depending on the outbreak size (3 versus 10 seed cases), in 8 to 99% of scenarios, a 10-day delay to response would result in large clusters that would be difficult to contain. Improving the delay to response involves rethinking the integration at local levels of event-based detection, rapid diagnostic testing for cluster validation, and integrated alert, investigation, and response.


Assuntos
Cólera/diagnóstico , Cólera/epidemiologia , Países em Desenvolvimento/estatística & dados numéricos , Diagnóstico Precoce , Epidemias , Controle de Infecções/métodos , Conflitos Armados/estatística & dados numéricos , Cólera/prevenção & controle , Cólera/terapia , Simulação por Computador , Diagnóstico Tardio/estatística & dados numéricos , Surtos de Doenças/história , Surtos de Doenças/prevenção & controle , Surtos de Doenças/estatística & dados numéricos , Intervenção Médica Precoce/métodos , Intervenção Médica Precoce/normas , Epidemias/história , Epidemias/prevenção & controle , Epidemias/estatística & dados numéricos , História do Século XX , História do Século XXI , Humanos , Controle de Infecções/organização & administração , Controle de Infecções/normas , Modelos Estatísticos , Vigilância da População/métodos , Tempo de Reação , Refugiados/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Populações Vulneráveis/estatística & dados numéricos
20.
Pan Afr Med J ; 36: 355, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33224421

RESUMO

The outbreak of COVID-19 has been unprecedented in speed and effect. Efforts to predict the disease transmission have mostly been done using flagship models developed by the global north. These models have not accurately depicted the true rate of transmission of SARS-CoV-2 in Africa. The models have ignored Africa's unique socio-ecological makeup (demographic, social, environmental and biological) that has aided a slower and less severe spread of the virus. This paper opines on how the science of infectious disease modelling needs to evolve to accommodate contextual factors. Country-owned and tailored modelling needs to be urgently supported.


Assuntos
Betacoronavirus , Infecções por Coronavirus/transmissão , Países em Desenvolvimento/estatística & dados numéricos , Modelos Estatísticos , Pneumonia Viral/transmissão , África/epidemiologia , Infecções por Coronavirus/epidemiologia , Características Culturais , Demografia , Instalações de Saúde , Humanos , Internacionalidade , Pandemias , Pneumonia Viral/epidemiologia , Alocação de Recursos , Meio Social
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