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Denekew TW, Gautam Y, Bhandari D, Gautam GP, Sherchand JB, Pokhrel AK, Jha AR. Prevalence and determinants of hypertension in underrepresented indigenous populations of Nepal. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000133. [PMID: 36962278 PMCID: PMC10021878 DOI: 10.1371/journal.pgph.0000133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/29/2021] [Indexed: 11/19/2022]
Abstract
Indigenous populations residing in low- and middle-income countries (LMICs) are highly underrepresented in medicine and public health research. Specifically, data on non-communicable diseases (NCDs) from indigenous populations remains scarce. Despite the increasing burden of NCDs in the Himalayan region, their prevalence in many indigenous populations remains understudied. The nationally representative public health surveys often do not include the indigenous communities, especially those that reside in rural areas or exist in small numbers. This observational cross-sectional survey study aimed to assess the prevalence of three NCD risk factors namely obesity, hypertension, and tachycardia and identify dietary and lifestyle variables associated with them across underrepresented indigenous populations of Nepal. A total of 311 individuals (53.3% women, 46.7% men) with mean age 43±15 years from 12 indigenous Nepali communities residing in rural (47.9%) or semi-urban (52.1%) areas volunteered to participate in this study. Univariate tests and multivariable logistic regressions were used to analyze the survey data. The mean systolic and diastolic blood pressures were 121.3±19.5 mmHg and 81.3±11.8 mmHg respectively. Overall, the prevalence of obesity and tachycardia was low (0.64% and 3.22%, respectively) but hypertension was prevalent at 23.8%. Hypertension was not significantly different across populations, but it was associated with age, BMI, and tobacco use, and collectively, these variables explained 13.9% variation in hypertension prevalence. Although we were unable to detect direct associations between individual determinants of hypertension identified in non-indigenous Nepalis, such as education levels, alcohol consumption, and smoking in this study, having one or more determinants increased the odds of hypertension in the indigenous participants. Furthermore, ~14% of the hypertensive individuals had none of the universally identified hypertension risk factors. The lack of association between previously identified risk factors for hypertension in these individuals indicates that the additional determinants of hypertension remain to be identified in indigenous Nepali populations.
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Affiliation(s)
- Tsedenia Workneh Denekew
- Genetic Heritage Group, Program in Biology, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Yoshina Gautam
- Genetic Heritage Group, Program in Biology, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
- Himalayan Diversity Project, Department of Biomedical Data Science, Stanford University, Stanford, Palo Alto, United States of America
| | - Dinesh Bhandari
- School of Public Health, University of Adelaide, Adelaide, Australia
- Public Health Research Lab, Tribhuvan University Institute of Medicine, Maharajgunj, Nepal
| | | | | | - Amod K Pokhrel
- Society for Legal and Environmental Analysis and Development Research, Kathmandu, Nepal
- On-Campus/On-Line MPH program, School of Public Health, University of California, Berkeley, CA, United States of America
| | - Aashish R Jha
- Genetic Heritage Group, Program in Biology, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
- Himalayan Diversity Project, Department of Biomedical Data Science, Stanford University, Stanford, Palo Alto, United States of America
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Malta DC, Bernal RTI, Gomes CS, Cardoso LSDM, Lima MG, Barros MBDA. Inequalities in the use of health services by adults and elderly people with and without noncommunicable diseases in Brazil, 2019 National Health Survey. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2021; 24:e210003. [PMID: 34910057 DOI: 10.1590/1980-549720210003.supl.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/26/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The objective of this study was to investigate the use of health services and limitations in performing usual activities by adults and elderly people with and without noncommunicable chronic diseases (NCDs), according to sociodemographic strata. METHODS This is a cross-sectional study in which data from the 2019 National Health Survey were analyzed. The final sample corresponded to 88,531 households with interviews carried out, referring to individuals aged 18 years and above. The prevalence of use of services by the population with NCDs was compared with that of the population without NCDs and stratified by socioeconomic and demographic variables. Prevalence ratios (PRs) and 95% confidence intervals (95%CI) were calculated. RESULTS In 2019, 47.6% (95%CI 47.0-48.3) of the population reported having one or more NCDs. Population with NCDs had more medical consultations in the last 12 months (adjusted PR [APR]=1.21; 95%CI 1.20-1.23), used more health services in the last 2 weeks (APR=2.01; 95%CI 1.91-2.11), were referred to more hospitalization (APR=2.11; 95%CI 1.89-2.36), and had more limitations in performing usual activities (APR=2.52; 95%CI 2.30-2.76), compared with the population without NCDs. A positive dose-response gradient was observed between the number of comorbidities and the use of services. In all socioeconomic and demographic strata, the prevalence of indicators was higher in people with NCDs. CONCLUSION The presence of NCDs was associated with a higher frequency of use of health services (i.e., consultation, use of services, and hospitalization) and the restriction of usual activities in all socioeconomic and demographic strata.
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Affiliation(s)
- Deborah Carvalho Malta
- Department of Maternal and Child Nursing and Public Health, School of Nursing, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil.,Postgraduate Program in Public Health, Faculty of Medicine, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
| | - Regina Tomie Ivata Bernal
- Postgraduate Program in Nursing, School of Nursing, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
| | - Crizian Saar Gomes
- Postgraduate Program in Public Health, Faculty of Medicine, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
| | | | - Margareth Guimarães Lima
- Department of Collective Health, Faculty of Medical Sciences, Universidade de Campinas - Campinas (SP), Brazil
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Behera S, Pradhan J. Uneven economic burden of non-communicable diseases among Indian households: A comparative analysis. PLoS One 2021; 16:e0260628. [PMID: 34890400 PMCID: PMC8664228 DOI: 10.1371/journal.pone.0260628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 11/14/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) are the leading global cause of death and disproportionately concentrate among those living in low-income and middle-income countries. However, its economic impact on households remains less well known in the Indian context. This study aims to assess the economic impact of NCDs in terms of out-of-pocket expenditure (OOPE) and its catastrophic impact on NCDs affected households in India. MATERIALS AND METHODS Data were collected from the 75th round of the National Sample Survey Office, Government of India, conducted in the year 2017-18. This is the latest round of data available on health, which constitutes a sample of 113,823 households. The collection of data is based on a stratified multi-stage sampling method. Generalised Linear Regression model was employed to identify the socio-economic covariates associated with the catastrophic health expenditure (CHE) on hospitalisation. RESULTS The result shows a higher burden of OOPE on NCDs affected households. The mean expenditure by NCDs households in public hospitals is INR 13,170 which is more than twice as compared to the non-NCDs households INR 6,245. Particularly, the proportion of total medical expenditure incurred on medicines (0.39) and diagnostics (0.15) is troublesome for households with NCDs, treated in public hospitals. Moreover, results from the generalised linear regression model confirm the significant relationship between CHE with residence, caste, religion, household size, and economic status of households. The intensity of CHE is more for the households who are poor, drinking unsafe water, using firewood as cooking fuel, and household size of 1-5 members. CONCLUSION Therefore, an urgent need for a prevention strategy should be made by the government to protect households from the economic burden of NCDs. Specifically, to reduce the burden of CHE associated with NCDs, a customised disease-specific health insurance package should be introduced by the government of India in both public and private facilities.
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Affiliation(s)
- Sasmita Behera
- Department of Humanities and Social Sciences, National Institute of Technology, Rourkela, India
| | - Jalandhar Pradhan
- Department of Humanities and Social Sciences, National Institute of Technology, Rourkela, India
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Levenets O, Stepurko T, Polese A, Pavlova M, Groot W. Coping with cancer in post-communist Europe: a systematic literature review. Health Policy Plan 2021; 36:1690-1704. [PMID: 34595512 DOI: 10.1093/heapol/czab121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 09/20/2021] [Accepted: 09/24/2021] [Indexed: 11/13/2022] Open
Abstract
In the post-communist countries, limited access to treatment, lack of financial protection mechanisms, lack of information and low quality of health care frequently imposes an enormous burden on family's well-being when cancer is diagnosed. While many studies have explored barriers to cancer treatment, little attention is paid to the question how patients and their caregivers cope with cancer. In this paper, we systematically review the evidence on patients' coping strategies with cancer in post-communist countries. We performed a literature search in PubMed, JSTOR, Web of Science and EBSCO (CINAHL) to identify papers that describe patients' coping strategies because of organizational and financial barriers to cancer treatment. Papers published between January 1991 and January 2020 were included if they described individual experiences of patients at any stage of cancer treatment. We applied the Preferred Reporting Items for Systematic Literature Review as a guide for our review. In total, 28 publications from post-communist countries were included in this review. They presented evidence on coping strategies and barriers faced by patients when coping with poor access to cancer treatment, lack of finances, lack of information and low quality of health care services. Most sought coping strategies included using personal finances to pay for medical services, medicines and supplies, charitable contributions to the hospital and informal payments; visiting a private medical doctor; using personal connections and looking for additional information. We conclude that coping strategies are similar across post-communist countries and can be seen as an indicator of the shortcomings in cancer treatment. This evidence can be used to study and/or improve access to cancer treatment and improve health care policies. Research on the prevalence and quantification of coping strategies is needed to provide evidence-informed policies for countries that face gaps in cancer treatment.
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Affiliation(s)
- Olena Levenets
- Department of Health Services Research, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Tetiana Stepurko
- School of Public Health, National University Kyiv Mohyla Academy, 2 Skovorody Street, 04655 Kyiv, Ukraine
| | - Abel Polese
- Tallinn School of Business and Governance, Tallinn University of Technology, Akadeemia Tee 3, 12611 Tallinn, Estonia
| | - Milena Pavlova
- Department of Health Services Research; CAPHRI, Maastricht University Medical Center, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Wim Groot
- Top Institute Evidence-Based Education Research (TIER), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
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Zeru MA, Tesfa E, Mitiku AA, Seyoum A, Bokoro TA. Prevalence and risk factors of type-2 diabetes mellitus in Ethiopia: systematic review and meta-analysis. Sci Rep 2021; 11:21733. [PMID: 34741064 PMCID: PMC8571297 DOI: 10.1038/s41598-021-01256-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 10/26/2021] [Indexed: 01/09/2023] Open
Abstract
Diabetes mellitus (DM) is a public health problem in developing as well as developed nations. DM leads to many complications that are associated with higher morbidity and mortality worldwide. Therefore, the current study was planned to assess the prevalence and risk factors of type-2 DM in Ethiopian population. Six electronic databases such as: PubMed, Scopus, Hinari, Web of science, Google Scholar, and African Journals Online were searched for studies published in English up December 30, 2020. Newcastle-Ottawa Scale was used for quality assessment of the included studies. The data was extracted by Microsoft excel and analyzed through Stata version 16 software. The random effect meta-regression analysis was computed at 95% CI to assess the pooled prevalence and risk factors of type-2 DM. Forty observational studies were included in this systematic review and meta-analysis. The pooled prevalence of DM in Ethiopia was 6.5% (95% CI (5.8, 7.3)). The sub-group analysis revealed that the highest prevalence of DM was found in Dire Dawa city administration (14%), and the lowest prevalence was observed in Tigray region (2%). The pooled prevalence of DM was higher (8%) in studies conducted in health facility. Factors like: Age ≥ 40 years ((Adjusted Odds Ratio (AOR): 1.91 (95% CI: 1.05, 3.49)), Illiterate (AOR: 2.74 (95% CI: 1.18, 6.34)), Cigarette smoking (AOR: 1.97 (95% CI: 1.17, 3.32)), Body mass index (BMI) ≥ 25 kg/m2 (AOR: 2.01 (95 CI: 1.46, 2.27)), family history of DM (AOR: 6.14 (95% CI: 2.80, 13.46)), history of hypertension (AOR: 3.00 (95% CI: 1.13, 7.95)) and physical inactivity (AOR: 5.79 (95% CI: 2.12, 15.77)) were significantly associated with type-2 DM in Ethiopian population. In this review, the prevalence of type-2 DM was high. Factors like: Older age, illiteracy, cigarette smoking, MBI ≥ 25, family history of DM, history of hypertension and physical inactivity were an identified risk factors of type-2 DM. Therefore, health education and promotion will be warranted. Further, large scale prospective studies will be recommended to address possible risk factors of type-2 DM in Ethiopian population.
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Affiliation(s)
- Melkamu A. Zeru
- grid.442845.b0000 0004 0439 5951Department of Statistics, College of Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Endalamaw Tesfa
- grid.442845.b0000 0004 0439 5951Department of Biochemistry, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Aweke A. Mitiku
- grid.442845.b0000 0004 0439 5951Department of Statistics, College of Science, Bahir Dar University, Bahir Dar, Ethiopia ,grid.16463.360000 0001 0723 4123School of Mathematics, Statistics and Computer Science, College of Agriculture Engineering and Science, University of KwaZulu-Natal, Durban, South Africa
| | - Awoke Seyoum
- grid.442845.b0000 0004 0439 5951Department of Statistics, College of Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tesfaye Abera Bokoro
- grid.192267.90000 0001 0108 7468Department of Statistics, College Computing and Informatics, Haramaya University, Dire Dawa, Ethiopia
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Aljadeeah S, Nagel E, Wirtz VJ. Outpatient cardiovascular diseases and diabetes medicines dispensing in the population with government health insurance in Syria between 2018 and 2019: a retrospective analysis. BMC Health Serv Res 2021; 21:1088. [PMID: 34645430 PMCID: PMC8515648 DOI: 10.1186/s12913-021-07124-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/27/2021] [Indexed: 12/03/2022] Open
Abstract
Background Low- and middle-income countries bear the highest burden of non-communicable diseases (NCDs) mortality and morbidity. Syria has undergone an epidemiological transition from infectious diseases to NCDs in the past decades. Despite the high prevalence of cardiovascular diseases (CVDs) and diabetes in Syria, little is known about medicines utilization or prescriptions for these diseases. The aims of this study are to present the patterns and rates of dispensing medicines used for CVDs and diabetes among patients with government health insurance in Syria and examine age, sex, and regional variation in the dispensing of these medicines. Methods Outpatient data from June 2018 to May 2019 on dispensed medicines for 81,314 adults with government health insurance were obtained. The dispensing rate was expressed as the number of defined daily doses (DDDs) per 1000 beneficiaries per day (DID). The DID is a measurement that is used in drug utilization research to control for differences or changes in population size between or within countries. The number of DIDs was adjusted according to beneficiaries’ sex, age, and governorate. Results Beneficiaries received 302.09 DIDs of CVDs medicines and 35.66 DIDs of diabetes medicines, including 0.96 DID of insulin (2.99% of the total of diabetes medicines). CVDs and diabetes medicine dispensing rates were low during the study period and included very low rates of insulin dispensing compared to the dispensing rates of these medicines in other countries in East Mediterranean Region or in Europe. We found lower dispensing rates of CVDs medicines among female beneficiaries (249.59 DIDs) than male beneficiaries (388.80 DIDs). Similarly, the dispensing rates of diabetes medicines among female beneficiaries (29.42 DIDs) were lower than those among male beneficiaries (45.98 DIDs). In addition, there were lower rates of CVDs and diabetes medicines and very low to no dispensing of insulin in some governorates that were partly controlled by the Syrian government compared to other governorates that were completely or mostly controlled by the Syrian government. Conclusions Additional efforts are needed to raise awareness about the prevention and management of CVDs and diabetes especially among females in Syria and consider cultural issues that might influence access to healthcare services. There is a crucial need to address the political and geographical challenges caused by the conflict which have limited access to CVDs and diabetes medicines in some regions in Syria. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07124-6.
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Affiliation(s)
- Saleh Aljadeeah
- University of Bayreuth, Institute of Medical Management and Health Sciences, Prieserstr. 2, 95440, Bayreuth, Germany.
| | - Eckhard Nagel
- University of Bayreuth, Institute of Medical Management and Health Sciences, Prieserstr. 2, 95440, Bayreuth, Germany
| | - Veronika J Wirtz
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, 3rd floor, Boston, MA, 02118, USA
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Alhamdan F, Marsh LM, Pedersen F, Alhamwe BA, Thölken C, Pfefferle PI, Bahmer T, Greulich T, Potaczek DP, Garn H. Differential Regulation of Interferon Signaling Pathways in CD4 + T Cells of the Low Type-2 Obesity-Associated Asthma Phenotype. Int J Mol Sci 2021; 22:ijms221810144. [PMID: 34576307 PMCID: PMC8469911 DOI: 10.3390/ijms221810144] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 12/14/2022] Open
Abstract
In the era of personalized medicine, insights into the molecular mechanisms that differentially contribute to disease phenotypes, such as asthma phenotypes including obesity-associated asthma, are urgently needed. Peripheral blood was drawn from 10 obese, non-atopic asthmatic adults with a high body mass index (BMI; 36.67 ± 6.90); 10 non-obese, non-atopic asthmatic adults with normal BMI (23.88 ± 2.73); and 10 healthy controls with normal BMI (23.62 ± 3.74). All asthmatic patients were considered to represent a low type-2 asthma phenotype according to selective clinical parameters. RNA sequencing (RNA-Seq) was conducted on peripheral blood CD4+ T cells. Thousands of differentially expressed genes were identified in both asthma groups compared with heathy controls. The expression of interferon (IFN)-stimulated genes associated with IFN-related signaling pathways was specifically affected in obese asthmatics, while the gap junction and G protein-coupled receptor (GPCR) ligand binding pathways were enriched in both asthma groups. Furthermore, obesity gene markers were also upregulated in CD4+ T cells from obese asthmatics compared with the two other groups. Additionally, the enriched genes of the three abovementioned pathways showed a unique correlation pattern with various laboratory and clinical parameters. The specific activation of IFN-related signaling and viral infection pathways might provide a novel view of the molecular mechanisms associated with the development of the low type-2 obesity-associated asthma phenotype, which is a step ahead in the development of new stratified therapeutic approaches.
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Affiliation(s)
- Fahd Alhamdan
- Translational Inflammation Research Division & Core Facility for Single Cell Multiomics, Member of the German Center for Lung Research (DZL) and the Universities of Giessen and Marburg Lung Center, Medical Faculty, Philipps University of Marburg, D-35043 Marburg, Germany; (F.A.); (D.P.P.)
| | - Leigh M. Marsh
- Ludwig Boltzmann Institute for Lung Vascular Research, A-8010 Graz, Austria;
| | - Frauke Pedersen
- Lungen Clinic Grosshansdorf GmbH, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), D-22927 Großhansdorf, Germany; (F.P.); (T.B.)
| | - Bilal Alashkar Alhamwe
- Clinic for Hematology, Oncology and Immunology, Center for Tumor Biology and Immunology, Institute of Tumor Immunology, Medical Faculty, Philipps University of Marburg, D-35043 Marburg, Germany;
- College of Pharmacy, International University for Science and Technology (IUST), Daraa 15, Syria
| | - Clemens Thölken
- Institute of Medical Bioinformatics and Biostatistics, Medical Faculty, Philipps University of Marburg, D-35037 Marburg, Germany;
| | - Petra Ina Pfefferle
- Comprehensive Biobank Marburg (CBBMR), Member of the German Biobank Alliance (GBA) and the German Center for Lung Research (DZL), Medical Faculty, Philipps University of Marburg, D-35043 Marburg, Germany;
| | - Thomas Bahmer
- Lungen Clinic Grosshansdorf GmbH, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), D-22927 Großhansdorf, Germany; (F.P.); (T.B.)
- Department for Internal Medicine I, Campus Kiel, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), University Hospital Schleswig-Holstein, D-24105 Kiel, Germany
| | - Timm Greulich
- Pulmonary and Critical Care Medicine, Member of the German Center for Lung Research, University Medical Center Giessen and Marburg, Department of Medicine, D-35043 Marburg, Germany;
| | - Daniel P. Potaczek
- Translational Inflammation Research Division & Core Facility for Single Cell Multiomics, Member of the German Center for Lung Research (DZL) and the Universities of Giessen and Marburg Lung Center, Medical Faculty, Philipps University of Marburg, D-35043 Marburg, Germany; (F.A.); (D.P.P.)
| | - Holger Garn
- Translational Inflammation Research Division & Core Facility for Single Cell Multiomics, Member of the German Center for Lung Research (DZL) and the Universities of Giessen and Marburg Lung Center, Medical Faculty, Philipps University of Marburg, D-35043 Marburg, Germany; (F.A.); (D.P.P.)
- Correspondence: ; Tel.: +49-6421-2866040
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Chaurasia H, Srivastava S, Debnath P. Does Socio-Economic Inequality Exist in Low Subjective Well-Being Among Older Adults in India? A Decomposition Analysis Approach. AGEING INTERNATIONAL 2021. [DOI: 10.1007/s12126-021-09453-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Jain S, Jha S, Shetty G, Ram CS. Patient Expectations From Consultation and Treatment of Spine Pain in a Private Spine Rehabilitation Clinic in Urban India. J Patient Exp 2021; 8:23743735211034076. [PMID: 34377771 PMCID: PMC8326608 DOI: 10.1177/23743735211034076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Despite high prevalence of spine pain among the Indian population, patient expectations regarding consultation and its treatment are unknown. We aimed to determine consultation and treatment expectations among patients visiting a spine rehabilitation clinic in urban India. We included 194 consecutive patients who completed a consultation expectation (CE) and treatment outcome expectation (OE) questionnaires and the Patient-Centered Outcome Questionnaire (PCOQ). To learn about the most suitable treatment for their problem (98%), and to know what kind of activities they could do and should avoid (96%) were the most important CEs, and to achieve complete relief of symptoms (96%), and prevent recurrence of pain (95%) were the most important OEs. For successful treatment, patients expected PCOQ pain levels of 2.0 (96.5% reduction) and interference levels of 1.5 (96% reduction). Patients expected to know the most suitable treatment, activities they could do and avoid after consultation, and to achieve complete relief of symptoms and prevent recurrence after treatment. Incorporating and addressing these expectations may help improve outcomes and satisfaction with the consultation and treatment of spine pain.
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Affiliation(s)
| | | | | | - C S Ram
- I.T.S College of Physiotherapy, Ghaziabad, Uttar Pradesh, India
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Cancer Drugs in Asian Populations: Availability, Accessibility, and Affordability. ACTA ACUST UNITED AC 2021; 26:323-329. [PMID: 32732675 DOI: 10.1097/ppo.0000000000000460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Accessibility to effective cancer treatments is a goal of Universal Health Coverage; yet, achieving this in the context of escalating costs in a diversity of Asian nations with different socioeconomic development is extremely challenging. Value-based assessments within the context of each health care system, financing infrastructure that will facilitate appropriate prioritization of high-cost medications, transparency in international pricing and reducing out-of-pocket costs through national insurance programs are measures that Asian countries should take toward Universal Health Coverage for cancer care. Encouraging sharing data on pricing through the World Health Organization, sharing expertise in health technology assessments and regulatory approvals, and exploring bulk negotiations would also strengthen the process of price control. For each individual country, rational selection of national cancer formulary, aiming at price reduction and sound procurement strategies for each drug, is important toward ensuring affordable access to quality cancer medications.
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Grifferty G, Shirley H, McGloin J, Kahn J, Orriols A, Wamai R. Vulnerabilities to and the Socioeconomic and Psychosocial Impacts of the Leishmaniases: A Review. Res Rep Trop Med 2021; 12:135-151. [PMID: 34188584 PMCID: PMC8236266 DOI: 10.2147/rrtm.s278138] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 05/06/2021] [Indexed: 11/23/2022] Open
Abstract
The leishmaniases are a group of four vector-borne neglected tropical diseases (NTDs) with 1.6 billion people in some 100 countries at risk. They occur in certain eco-epidemiological foci that reflect manipulation by human activities, such as migration, urbanization and deforestation, of which poverty, conflict and climate change are key drivers. Given their synergistic impacts, risk factors and the vulnerabilities of poor populations and the launch of a new 2030 roadmap for NTDs in the context of the global sustainability agenda, it is warranted to update the state of knowledge of the leishmaniases and their effects. Using existing literature, we review socioeconomic and psychosocial impacts of leishmaniasis within a framework of risk factors and vulnerabilities to help inform policy interventions. Studies show that poverty is an overarching primary risk factor. Low-income status fosters inadequate housing, malnutrition and lack of sanitation, which create and exacerbate complexities in access to care and treatment outcomes as well as education and awareness. The co-occurrence of the leishmaniases with malnutrition and HIV infection further complicate diagnosis and treatment, leading to poor diagnostic outcomes and therapeutic response. Even with free treatment, households may suffer catastrophic health expenditure from direct and indirect medical costs, which compounds existing financial strain in low-income communities for households and healthcare systems. The dermatological presentations of the leishmaniases may result in long-term severe disfigurement, leading to stigmatization, reduced quality of life, discrimination and mental health issues. A substantial amount of recent literature points to the vulnerability pathways and burden of leishmaniasis on women, in particular, who disproportionately suffer from these impacts. These emerging foci demonstrate a need for continued international efforts to address key risk factors and population vulnerabilities if leishmaniasis control, and ultimately elimination, is to be achieved by 2030.
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Affiliation(s)
- Grace Grifferty
- Department of Biology, Northeastern University, College of Science, Boston, MA, USA
| | - Hugh Shirley
- Department of Biochemistry, Northeastern University, College of Science, Boston, MA, USA.,Program in Medical Education, Harvard Medical School, Boston, MA, USA
| | - Jamie McGloin
- Department of Health Sciences, Northeastern University, Bouvé College of Health Sciences, Boston, MA, USA
| | - Jorja Kahn
- Department of Behavioral Neuroscience, Northeastern University, College of Science, Boston, MA, USA
| | - Adrienne Orriols
- Department of Behavioral Neuroscience, Northeastern University, College of Science, Boston, MA, USA
| | - Richard Wamai
- Department of Cultures, Societies and Global Studies, Northeastern University, College of Social Sciences and Humanities, Integrated Initiative for Global Health, Boston, MA, USA
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Kazibwe J, Tran PB, Annerstedt KS. The household financial burden of non-communicable diseases in low- and middle-income countries: a systematic review. Health Res Policy Syst 2021; 19:96. [PMID: 34154609 PMCID: PMC8215836 DOI: 10.1186/s12961-021-00732-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 04/30/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The chronic nature of noncommunicable diseases (NCD) and costs associated with long-term care can result in catastrophic health expenditure for the patient and their household pushing them deeper into poverty and entrenching inequality in society. As the full financial burden of NCDs is not known, the objective of this study was to explore existing evidence on the financial burden of NCDs in low- and middle-income countries (LMICs), specifically estimating the cost incurred by patients with NCDs and their households to inform the development of strategies to protect such households from catastrophic expenditure. METHODS This systematic review followed the PRISMA guidelines, PROSPERO: CRD42019141088. Eligible studies published between 1st January 2000 to 7th May 2020 were systematically searched for in three databases: Medline, Embase and Web of Science. A two-step process, comprising of qualitative synthesis proceeded by quantitative (cost) synthesis, was followed. The mean costs are presented in 2018 USD. FINDINGS 51 articles were included, out of which 41 were selected for the quantitative cost synthesis. Most of the studies were cross-sectional cost-of-illness studies, of which almost half focused on diabetes and/or conducted in South-East Asia. The average total costs per year to a patient/household in LMICs of COPD, CVD, cancers and diabetes were $7386.71, $6055.99, $3303.81, $1017.05, respectively. CONCLUSION This review highlighted major data and methodological gaps when collecting data on costs of NCDs to households along the cascade of care in LMICs. More empirical data on cost of specific NCDs are needed to identify the diseases and contexts where social protection interventions are needed most. More rigorous and standardised methods of data collection and costing for NCDs should be developed to enable comprehensive and comparable evidence of the economic and financial burden of NCDs to patients and households in LMICs. The available evidence on costs reveals a large financial burden imposed on patients and households in seeking and receiving NCD care and emphasizes the need for adequate and reliable social protection interventions to be implemented alongside Universal Health Coverage.
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Affiliation(s)
- Joseph Kazibwe
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
- The Health and Social Protection Action Research and Knowledge Sharing Network (SPARKS), Solna, Sweden
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Phuong Bich Tran
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
- The Health and Social Protection Action Research and Knowledge Sharing Network (SPARKS), Solna, Sweden
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Kristi Sidney Annerstedt
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden.
- The Health and Social Protection Action Research and Knowledge Sharing Network (SPARKS), Solna, Sweden.
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Amu H, Darteh EKM, Tarkang EE, Kumi-Kyereme A. Management of chronic non-communicable diseases in Ghana: a qualitative study using the chronic care model. BMC Public Health 2021; 21:1120. [PMID: 34116657 PMCID: PMC8196497 DOI: 10.1186/s12889-021-11170-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background While the burden and mortality from chronic non-communicable diseases (CNCDs) have reached epidemic proportions in sub-Saharan Africa (SSA), decision-makers and individuals still consider CNCDs to be infrequent and, therefore, do not pay the needed attention to their management. We, therefore, explored the practices and challenges associated with the management of CNCDs by patients and health professionals. Methods This was a qualitative study among 82 CNCD patients and 30 health professionals. Face-to-face in-depth interviews were used in collecting data from the participants. Data collected were analysed using thematic analysis. Results Experiences of health professionals regarding CNCD management practices involved general assessments such as education of patients, and specific practices based on type and stage of CNCDs presented. Patients’ experiences mainly centred on self-management practices which comprised self-restrictions, exercise, and the use of anthropometric equipment to monitor health status at home. Inadequate logistics, work-related stress due to heavy workload, poor utility supply, and financial incapability of patients to afford the cost of managing their conditions were challenges that militated against the effective management of CNCDs. Conclusions A myriad of challenges inhibits the effective management of CNCDs. To accelerate progress towards meeting the Sustainable Development Goal 3 on reducing premature mortality from CNCDs, the Ghana Health Service and management of the respective hospitals should ensure improved utility supply, adequate staff motivation, and regular in-service training. A chronic care management policy should also be implemented in addition to the review of the country’s National Health Insurance Scheme (NHIS) by the Ministry of Health and the National Health Insurance Authority to cover the management of all CNCDs. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11170-4.
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Affiliation(s)
- Hubert Amu
- Department of Population and Behavioural Sciences, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana. .,Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
| | | | - Elvis Enowbeyang Tarkang
- Department of Population and Behavioural Sciences, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Akwasi Kumi-Kyereme
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
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Meskarpour Amiri M, Kazemian M, Motaghed Z, Abdi Z. Systematic review of factors determining health care expenditures. HEALTH POLICY AND TECHNOLOGY 2021. [DOI: 10.1016/j.hlpt.2021.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Jaung MS, Willis R, Sharma P, Aebischer Perone S, Frederiksen S, Truppa C, Roberts B, Perel P, Blanchet K, Ansbro É. Models of care for patients with hypertension and diabetes in humanitarian crises: a systematic review. Health Policy Plan 2021; 36:509-532. [PMID: 33693657 PMCID: PMC8128021 DOI: 10.1093/heapol/czab007] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 01/02/2023] Open
Abstract
Care for non-communicable diseases, including hypertension and diabetes (HTN/DM), is recognized as a growing challenge in humanitarian crises, particularly in low- and middle-income countries (LMICs) where most crises occur. There is little evidence to support humanitarian actors and governments in designing efficient, effective, and context-adapted models of care for HTN/DM in such settings. This article aimed to systematically review the evidence on models of care targeting people with HTN/DM affected by humanitarian crises in LMICs. A search of the MEDLINE, Embase, Global Health, Global Indexus Medicus, Web of Science, and EconLit bibliographic databases and grey literature sources was performed. Studies were selected that described models of care for HTN/DM in humanitarian crises in LMICs. We descriptively analysed and compared models of care using a conceptual framework and evaluated study quality using the Mixed Methods Appraisal Tool. We report our findings according to PRISMA guidelines. The search yielded 10 645 citations, of which 45 were eligible for this review. Quantitative methods were most commonly used (n = 34), with four qualitative, three mixed methods, and four descriptive reviews of specific care models were also included. Most studies detailed primary care facility-based services for HTN/DM, focusing on health system inputs. More limited references were made to community-based services. Health care workforce and treatment protocols were commonly described framework components, whereas few studies described patient centredness, quality of care, financing and governance, broader health policy, and sociocultural contexts. There were few programme evaluations or effectiveness studies, and only one study reported costs. Most studies were of low quality. We concluded that an increasing body of literature describing models of care for patients with HTN/DM in humanitarian crises demonstrated the development of context-adapted services but showed little evidence of impact. Our conceptual framework could be used for further research and development of NCD models of care.
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Affiliation(s)
- Michael S Jaung
- Department of Health Services Research & Policy and Centre for Global Chronic Conditions, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
- Department of Emergency Medicine, Baylor College of Medicine, 1504 Ben Taub Loop, Houston, 77030, TX, USA
| | - Ruth Willis
- Department of Health Services Research & Policy and Centre for Global Chronic Conditions, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Piyu Sharma
- Department of Health Services Research & Policy and Centre for Global Chronic Conditions, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Sigiriya Aebischer Perone
- Health Unit, international Committee of the Red Cross, Avenue de la Paix 19, 1202 Geneva, Switzerland
| | | | - Claudia Truppa
- Health Unit, international Committee of the Red Cross, Avenue de la Paix 19, 1202 Geneva, Switzerland
| | - Bayard Roberts
- Department of Health Services Research & Policy and Centre for Global Chronic Conditions, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Pablo Perel
- Department of Non-Communicable Disease Epidemiology and Centre for Global Chronic Conditions, Faculty of Epidemiology and Population Health, Keppel Street, London WC1E 7HT, UK
| | - Karl Blanchet
- Geneva Centre of Humanitarian Studies, University of Geneva, 24 rue du Général-Dufour, Geneva, Switzerland
| | - Éimhín Ansbro
- Department of Health Services Research & Policy and Centre for Global Chronic Conditions, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
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Eisavi M, Mazaheri E, Rezapour A, Vahedi S, Hadian M, Jafari A. The Cost-Effectiveness and Cost-Utility of Statin Drug for the Treatment of Patients with Cardiovascular Disease, A Systematic Review. Int J Prev Med 2021; 12:39. [PMID: 34249288 PMCID: PMC8218807 DOI: 10.4103/ijpvm.ijpvm_125_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/14/2020] [Indexed: 12/02/2022] Open
Abstract
Cardiovascular diseases impose a burden of disease and economic burden on society. With regard to different drugs are used to treat cardiovascular disease; these interventions should be economically evaluated and them that the most cost-effective were selected. The aim of this study was to investigate the studies carried on the cost-effectiveness and cost-utility of statin drugs for the treatment of patients with cardiovascular disease between 2004 and 2020. Quality assessment of the articles was examined by Drummond's checklist. Given that the inclusion criteria, 26 articles included in the review. The results of this review showed that many articles related to the economic evaluation of statin drugs adhered international standards for performing economic evaluation studies. All the studies mentioned the source of effectiveness (the second criteria) and alternative options for the comparison (the third criteria). Atorvastatin and rosuvastatin drugs were the main options for the comparison in the studies. Although the results of the studies were different in some aspects, such as the type of modeling, costs items and the study perspective, they reached the same results which the use of statin drugs versus no-drug can decrease cost, cardiovascular events and deaths and increase QALY. The results were nearly different due to study design, time horizon, efficacy, and drug prices.
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Affiliation(s)
- Mahmoud Eisavi
- Assistant Professor, Faculty of Economics, Allameh Tabataba'i University, Tehran, Iran
| | - Elaheh Mazaheri
- Department of Medical Library and Information Sciences, Health Information Technology Research Center, Student Research Committee, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Aziz Rezapour
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sajad Vahedi
- Department of Health Services Management, School of Health, Ahvaz University of Medical Sciences, Ahvaz, Iran
| | - Marziye Hadian
- Department of Health Care Management, Health Management and Economics Research Center, Student Research Committee, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abdosaleh Jafari
- Health Human Resources Research Centre, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Ng G, Raskin E, Wirtz VJ, Banks KP, Laing RO, Kiragu ZW, Rockers PC, Onyango MA. Coping with access barriers to non-communicable disease medicines: qualitative patient interviews in eight counties in Kenya. BMC Health Serv Res 2021; 21:417. [PMID: 33941177 PMCID: PMC8094552 DOI: 10.1186/s12913-021-06433-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 04/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background There is rich literature on barriers to medicines access for the treatment of non-communicable diseases (NCDs) in high-income countries. Less is known about low- and middle-income countries, in particular the differences in coping with medicines access barrier by household wealth and disease. The aim of this study was to compare the coping mechanisms of patients with the lack of availability and affordability of cardio-vascular diseases, diabetes and asthma medicines in Kenya. Methods This qualitative study was part of a larger mixed methods evaluation study conducted in eight counties of Kenya from 2016 to 2019. Forty-nine patient interviews at study end line explored their NCD journey, perceptions of availability, stockouts and affordability of NCD medicines, their enrollment in health insurance, and their relationship with the private chemists. Transcribed interviews were coded using Nvivo software. A two-step thematic approach was used, first conducting a priority coding which was followed by coding emerging and divergent themes. Results Overall, we found that patients across all disease types and wealth level faced frequent medicine stock-outs at health facilities. In the absence of NCD medicines at health facilities, patients coped by purchasing medicines from local chemists, switching health facilities, requesting a different prescription, admitting oneself to an inpatient facility, establishing connections with local staff to receive notifications of medicine stock, stocking up on medicines, utilizing social capital to retrieve medicines from larger cities and obtaining funds from a network of friends and family. Categorizing by disease revealed patterns in coping choices that were based on the course of the disease, severity of the symptoms and the direct and indirect costs incurred as a result of stockouts of NCD medicines. Categorizing by wealth highlight differences in households’ capacity to cope with the unavailability and unaffordability of NCD medicines. Conclusions The type of coping strategies to access barriers differ by NCD and wealth group. Although Kenya has made important strides to address NCD medicines access challenges, prioritizing enrollment of low wealth households in county health insurance programs and ensuring continuous availability of essential NCD medicines at public health facilities close to the patient homes could improve access.
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Affiliation(s)
- Gloria Ng
- Department of Global Health, Boston University School of Public Health, Crosstown, 3rd floor, 801 Massachusetts Avenue, MA, 02118, Boston, USA
| | - Elizabeth Raskin
- Department of Global Health, Boston University School of Public Health, Crosstown, 3rd floor, 801 Massachusetts Avenue, MA, 02118, Boston, USA
| | - Veronika J Wirtz
- Department of Global Health, Boston University School of Public Health, Crosstown, 3rd floor, 801 Massachusetts Avenue, MA, 02118, Boston, USA.
| | - Kathleen P Banks
- Department of Global Health, Boston University School of Public Health, Crosstown, 3rd floor, 801 Massachusetts Avenue, MA, 02118, Boston, USA
| | - Richard O Laing
- Department of Global Health, Boston University School of Public Health, Crosstown, 3rd floor, 801 Massachusetts Avenue, MA, 02118, Boston, USA.,School of Public Health, Faculty of Community and Health Sciences, University of Western Cape, Cape Town, South Africa
| | - Zana W Kiragu
- Department of Global Health, Boston University School of Public Health, Crosstown, 3rd floor, 801 Massachusetts Avenue, MA, 02118, Boston, USA
| | - Peter C Rockers
- Department of Global Health, Boston University School of Public Health, Crosstown, 3rd floor, 801 Massachusetts Avenue, MA, 02118, Boston, USA
| | - Monica A Onyango
- Department of Global Health, Boston University School of Public Health, Crosstown, 3rd floor, 801 Massachusetts Avenue, MA, 02118, Boston, USA
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Abstract
OBJECTIVE Sub-Saharan Africa faces twin epidemics of HIV and noncommunicable diseases including hypertension. Integrating hypertension care into chronic HIV care is a global priority, but cost estimates are lacking. In the SEARCH Study, we performed population-level HIV/hypertension testing, and offered integrated streamlined chronic care. Here, we estimate costs for integrated hypertension/HIV care for HIV-positive individuals, and costs for hypertension care for HIV-negative individuals in the same clinics. DESIGN Microcosting analysis of healthcare expenditures within Ugandan HIV clinics. METHODS SEARCH (NCT: 01864603) conducted community health campaigns for diagnosis and linkage to care for both HIV and hypertension. HIV-positive patients received hypertension/HIV care jointly including blood pressure monitoring and medications; HIV-negative patients received hypertension care at the same clinics. Within 10 Ugandan study communities during 2015-2016, we estimated incremental annual per-patient hypertension care costs using micro-costing techniques, time-and-motion personnel studies, and administrative/clinical records review. RESULTS Overall, 70 HIV-positive and 2355 HIV-negative participants received hypertension care. For HIV-positive participants, average incremental cost of hypertension care was $6.29 per person per year, a 2.1% marginal increase over prior estimates for HIV care alone. For HIV-negative participants, hypertension care cost $11.39 per person per year, a 3.8% marginal increase over HIV care costs. Key costs for HIV-positive patients included hypertension medications ($6.19 per patient per year; 98% of total) and laboratory testing ($0.10 per patient per year; 2%). Key costs for HIV-negative patients included medications ($5.09 per patient per year; 45%) and clinic staff salaries ($3.66 per patient per year; 32%). CONCLUSION For only 2-4% estimated additional costs, hypertension care was added to HIV care, and also expanded to all HIV-negative patients in prototypic Ugandan clinics, demonstrating substantial synergy. Our results should encourage accelerated scale-up of hypertension care into existing clinics.
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Socioeconomic Impact of Hospitalization Expenditure for Treatment of Noncommunicable Diseases in India: A Repeated Cross-Sectional Analysis of National Sample Survey Data, 2004 to 2018. Value Health Reg Issues 2021; 24:199-213. [PMID: 33845450 DOI: 10.1016/j.vhri.2020.12.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/17/2020] [Accepted: 12/27/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES This article explores the consequences of hospitalization expenditure on noncommunicable diseases (NCD) and its impact on out-of-pocket expenditure (OOPE), catastrophic health expenditure, impoverishment, and hardship financing of households in India. METHODS Data on hospitalized cases of NCDs from the 3 rounds of National Sample Surveys (NSS) (2004, 2014, 2018) were used. Bivariate and multivariate analyses were conducted to investigate the socioeconomic differentials of the impact of OOPE on catastrophic health expenditure, impoverishment, and exposure to hardship financing. RESULTS Rural households had greater exposure to catastrophic health expenditure but urban households had higher risk of impoverishment due to OOPE. Older patients (aged ≥60 years) had the highest hospitalization rate per 100 000, including increase in average healthcare expenditure from 2004 to 2018. At 10% and 30% thresholds, 50% and 25% of the households, respectively, faced catastrophic health expenditure across all the 3 rounds. Due to OOPE on hospitaliation treatment for NCDs, about 3.8%, 7.4% and 4.8% of households fell below poverty line, and percentage shortfall in income for the population from the poverty line was 3%, 4.9% and 3%, in 2004, 2014 and 2018 respectively. Percentage of households facing hardship financing reduced from 49.2% in 2004 to 24.4% 2014 and 12.7% in 2018. CONCLUSION OOPE by households are still very high and hence the higher effects of CHE, impoverishment and exposure to hardship financing due to health expenditure in India. This study proposes that along with increase in budgetary allocations for healthcare, the government should develop suitable policies to expand the effectiveness of government-sponsored health insurance, such as developing a specific NCD service package to be included in the health insurance program.
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Tuberculosis and Non-Communicable Disease Multimorbidity: An Analysis of the World Health Survey in 48 Low- and Middle-Income Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052439. [PMID: 33801381 PMCID: PMC7967573 DOI: 10.3390/ijerph18052439] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/23/2021] [Accepted: 02/26/2021] [Indexed: 01/02/2023]
Abstract
Tuberculosis (TB) is a leading cause of mortality in low- and middle-income countries (LMICs). TB multimorbidity [TB and ≥1 non-communicable diseases (NCDs)] is common, but studies are sparse. Cross-sectional, community-based data including adults from 21 low-income countries and 27 middle-income countries were utilized from the World Health Survey. Associations between 9 NCDs and TB were assessed with multivariable logistic regression analysis. Years lived with disability (YLDs) were calculated using disability weights provided by the 2017 Global Burden of Disease Study. Eight out of 9 NCDs (all except visual impairment) were associated with TB (odds ratio (OR) ranging from 1.38-4.0). Prevalence of self-reported TB increased linearly with increasing numbers of NCDs. Compared to those with no NCDs, those who had 1, 2, 3, 4, and ≥5 NCDs had 2.61 (95% confidence interval (CI) = 2.14-3.22), 4.71 (95%CI = 3.67-6.11), 6.96 (95%CI = 4.95-9.87), 10.59 (95%CI = 7.10-15.80), and 19.89 (95%CI = 11.13-35.52) times higher odds for TB. Among those with TB, the most prevalent combinations of NCDs were angina and depression, followed by angina and arthritis. For people with TB, the YLDs were three times higher than in people without multimorbidity or TB, and a third of the YLDs were attributable to NCDs. Urgent research to understand, prevent and manage NCDs in people with TB in LMICs is needed.
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Liu X, Cao H, Zhu H, Zhang H, Niu K, Tang N, Cui Z, Pan L, Yao C, Gao Q, Wang Z, Sun J, He H, Guo M, Guo C, Liu K, Peng H, Peng W, Sun Y, Xie Y, Li B, Shan G, Zhang L. Association of chronic diseases with depression, anxiety and stress in Chinese general population: The CHCN-BTH cohort study. J Affect Disord 2021; 282:1278-1287. [PMID: 33601707 DOI: 10.1016/j.jad.2021.01.040] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/09/2021] [Accepted: 01/12/2021] [Indexed: 01/26/2023]
Abstract
Background Large-scale epidemiological surveys focusing on characteristic differences in psychological and physical health conditions in Chinese adults are lacking. Objective To investigate the association of noncommunicable chronic diseases (NCDs) with depression, anxiety and stress in the Chinese general population. Methods A total of 13784 participants were recruited from the baseline survey of the Cohort Study on Chronic Disease of Communities Natural Population in Beijing, Tianjin and Hebei (CHCN-BTH) from 2017 to 2019. Sociodemographic characteristics, lifestyle and NCDs were assessed via questionnaire. Stress, anxiety and depression were assessed by the Depression-Anxiety-Stress Scale (DASS-21). The relationship of NCDs with psychological symptoms was determined through logistic regression analysis. Results Multivariate logistic regression analysis revealed that the prevalence of stress (OR = 1.640; 95% CI: 1.381-1.949), anxiety (OR = 1.654; 95% CI: 1.490-1.837) and depression (OR = 1.460; 95% CI: 1.286-1.658) symptoms were all significantly higher in patients with NCDs. Multimorbidities were associated with a higher risk of stress (OR = 2.310; 95% CI: 1.820-2.931), anxiety (OR = 2.119; 95% CI: 1.844-2.436) and depression (OR = 2.785; 95% CI: 1.499-2.126) than single NCDs. A course of disease within 1 year or more than 5 years also was associated with a higher risk. Limitations The cross-sectional design could not examine the causal link between psychological symptoms and NCDs. Conclusion Psychological symptoms were more prevalent among individuals with NCDs in the Chinese general population. This study suggests that more attention should be paid to the mental health problems of patients with NCDs.
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Affiliation(s)
- Xiaohui Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China
| | - Han Cao
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China
| | - Huiping Zhu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China
| | - Han Zhang
- Health Management Center, Beijing Aerospace General Hospital, Beijing, 100076, China
| | - Kaijun Niu
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, 300070, China
| | - Naijun Tang
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, and Tianjin Key Laboratory of Environment, Nutrition, and Public Health, Tianjin 300070, China
| | - Ze Cui
- Department of Chronic and Noncommunicable Disease Prevention and Control, Hebei Provincial Center for Disease Prevention and Control, Shijiazhuang, Hebei Province, 050021, China
| | - Li Pan
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing 100730, China
| | - Changqiang Yao
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing 100730, China
| | - Qi Gao
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China
| | - Zhengfang Wang
- Health Management Center, Beijing Aerospace General Hospital, Beijing, 100076, China
| | - Jixin Sun
- Department of Chronic and Noncommunicable Disease Prevention and Control, Hebei Provincial Center for Disease Prevention and Control, Shijiazhuang, Hebei Province, 050021, China
| | - Huijing He
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing 100730, China
| | - Ming Guo
- Department of Disease Prevention and Control, Dingzhou Center for Disease Prevention and Control, Baoding, Hebei Province, 073099, China
| | - Chunyue Guo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China
| | - Kuo Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China
| | - Hai Peng
- Department of Disease Prevention and Control, Dingzhou Center for Disease Prevention and Control, Baoding, Hebei Province, 073099, China
| | - Wenjuan Peng
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China
| | - Yanyan Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China
| | - Yunyi Xie
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China
| | - Bingxiao Li
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China
| | - Guangliang Shan
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing 100730, China
| | - Ling Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China..
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Cha M, Cha C, Singh K, Lima G, Ahn YY, Kulshrestha J, Varol O. Prevalence of Misinformation and Factchecks on the COVID-19 Pandemic in 35 Countries: Observational Infodemiology Study. JMIR Hum Factors 2021; 8:e23279. [PMID: 33395395 PMCID: PMC7909456 DOI: 10.2196/23279] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/28/2020] [Accepted: 12/23/2020] [Indexed: 12/13/2022] Open
Abstract
Background The COVID-19 pandemic has been accompanied by an infodemic, in which a plethora of false information has been rapidly disseminated online, leading to serious harm worldwide. Objective This study aims to analyze the prevalence of common misinformation related to the COVID-19 pandemic. Methods We conducted an online survey via social media platforms and a survey company to determine whether respondents have been exposed to a broad set of false claims and fact-checked information on the disease. Results We obtained more than 41,000 responses from 1257 participants in 85 countries, but for our analysis, we only included responses from 35 countries that had at least 15 respondents. We identified a strong negative correlation between a country’s Gross Domestic Product per-capita and the prevalence of misinformation, with poorer countries having a higher prevalence of misinformation (Spearman ρ=–0.72; P<.001). We also found that fact checks spread to a lesser degree than their respective false claims, following a sublinear trend (β=.64). Conclusions Our results imply that the potential harm of misinformation could be more substantial for low-income countries than high-income countries. Countries with poor infrastructures might have to combat not only the spreading pandemic but also the COVID-19 infodemic, which can derail efforts in saving lives.
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Affiliation(s)
- Meeyoung Cha
- School of Computing, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea.,Data Science Group, Institute for Basic Science, Daejeon, Republic of Korea
| | - Chiyoung Cha
- College of Nursing, Ewha Womans University, Seoul, Republic of Korea
| | - Karandeep Singh
- Data Science Group, Institute for Basic Science, Daejeon, Republic of Korea
| | - Gabriel Lima
- School of Computing, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea.,Data Science Group, Institute for Basic Science, Daejeon, Republic of Korea
| | - Yong-Yeol Ahn
- Center for Complex Networks and Systems Research, Luddy School of Informatics, Computing, and Engineering, Indiana University, Bloomington, IN, United States.,Indiana University Network Science Institute, Indiana University, Bloomington, IN, United States.,Connection Science, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Juhi Kulshrestha
- GESIS - Leibniz Institute for the Social Sciences, Cologne, Germany
| | - Onur Varol
- Computer Science Department, Sabanci University, Istanbul, Turkey
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Perera SK, Jacob S, Wilson BE, Ferlay J, Bray F, Sullivan R, Barton M. Global demand for cancer surgery and an estimate of the optimal surgical and anaesthesia workforce between 2018 and 2040: a population-based modelling study. Lancet Oncol 2021; 22:182-189. [PMID: 33485458 DOI: 10.1016/s1470-2045(20)30675-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/14/2020] [Accepted: 10/27/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The growing demand for cancer surgery has placed a global strain on health systems. In-depth analyses of the global demand for cancer surgery and optimal workforce requirements are needed to plan service provision. We estimated the global demand for cancer surgery and the requirements for an optimal surgical and anaesthesia workforce, using benchmarks based on clinical guidelines. METHODS Using models of benchmark surgical use based on clinical guidelines, we estimated the proportion of cancer cases with an indication for surgery across 183 countries, stratified by income group. These proportions were multiplied by age-adjusted national estimates of new cancer cases using GLOBOCAN 2018 data and then aggregated to obtain the estimated number of surgical procedures required globally. The numbers of cancer surgical procedures in 44 high-income countries were divided by the actual number of surgeons and anaesthetists in the respective countries to calculate cancer procedures per surgeon and anaesthetist ratios. Using the median (IQR) of these ratios as benchmarks, we developed a three-tiered optimal surgical and anaesthesia workforce matrix, and the predictions were extrapolated up to 2040. FINDINGS Our model estimates that the number of cancer cases globally with an indication for surgery will increase by 5 million procedures (52%) between 2018 (9 065 000) and 2040 (13 821 000). The greatest relative increase in surgical demand will occur in 34 low-income countries, where we also observed the largest gaps in workforce requirements. To match the median benchmark for high-income countries, the surgical workforce in these countries would need to increase by almost four times and the anaesthesia workforce by nearly 5·5 times. The greatest increase in optimal workforce requirements from 2018 to 2040 will occur in low-income countries (from 28 000 surgeons to 58 000 surgeons; 107% increase), followed by lower-middle-income countries (from 166 000 surgeons to 277 000 surgeons; 67% increase). INTERPRETATION The global demand for cancer surgery and the optimal workforce are predicted to increase over the next two decades and disproportionately affect low-income countries. These estimates provide an appropriate framework for planning the provision of surgical services for cancer worldwide. FUNDING University of New South Wales Scientia Scholarship and UK Research and Innovation Global Challenges Research Fund.
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Affiliation(s)
- Sathira Kasun Perera
- Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute of Applied Medical Research, South West Clinical School, University of New South Wales, Sydney, NSW, Australia.
| | - Susannah Jacob
- Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute of Applied Medical Research, South West Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Brooke E Wilson
- Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute of Applied Medical Research, South West Clinical School, University of New South Wales, Sydney, NSW, Australia; Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
| | - Jacques Ferlay
- Section of Cancer Surveillance, International Agency for Research on Cancer, World Health Organization, Geneva, Switzerland
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, World Health Organization, Geneva, Switzerland
| | - Richard Sullivan
- Institute of Cancer Policy, School of Cancer Sciences, Kings College, London, UK
| | - Michael Barton
- Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute of Applied Medical Research, South West Clinical School, University of New South Wales, Sydney, NSW, Australia
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Thongpeth W, Lim A, Wongpairin A, Thongpeth T, Chaimontree S. Comparison of linear, penalized linear and machine learning models predicting hospital visit costs from chronic disease in Thailand. INFORMATICS IN MEDICINE UNLOCKED 2021. [DOI: 10.1016/j.imu.2021.100769] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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75
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Ranasinghe C, Devage S, Constantine GR, Katulanda P, Hills AP, King NA. Glycemic and cardiometabolic effects of exercise in South Asian Sri Lankans with type 2 diabetes mellitus: A randomized controlled trial Sri Lanka diabetes aerobic and resistance training study (SL-DARTS). Diabetes Metab Syndr 2021; 15:77-85. [PMID: 33310265 DOI: 10.1016/j.dsx.2020.12.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/24/2020] [Accepted: 12/02/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS To examine the effects of aerobic training (AT) and resistance training (RT) compared to standard care on glycemic control in South Asian Sri Lankan adults with Type 2 Diabetes Mellitus (T2DM). METHODS Randomized controlled trial (RCT) with parallel-group design recruited 86 sedentary Sri Lankans (aged 35-65 years) with T2DM into aerobic training (AT, n = 28), resistance training (RT, n = 28) and control (CN, n = 30) groups. Supervised progressive exercise training consisting of 75 min per session, 2 days per week for 12 weeks was conducted. The primary outcome was pre- and post-intervention absolute change in hemoglobin A1c (HBA1c). Secondary outcomes were serum lipids, liver enzymes, chronic inflammatory status, anthropometry, body composition and blood pressure. RESULTS The absolute change in HbA1c of RT vs. CN was -0.08% (95% CI, 0.8% to -0.7%, p = 0.8) and AT vs. CN was -0.22% (95% CI, 0.95% to -0.5%). Subgroup analysis (n = 49) with a high baseline HbA1c (>7.5%), absolute reduction in HbA1c in exercise groups were statistically significant (RT vs. CN was -0.37%; 95% CI 1.3% to -0.6%, p = 0.04 and AT vs. CN was -0.57%; 95% CI 1.7% to -0.6%, p = 0.03). The effect sizes (total and subgroup HbA1c >7.5%) ranged from 0.7 to 1.0 in AT, 0.4 to 1.1 in RT compared to 0.35 to 0.6 for the CN. Secondary outcomes did not significantly differ among groups. CONCLUSIONS Exercise training 2 days/week improved glycemic control in Sri Lankan adults with T2DM and the effects were significant in high baseline HbA1c (>7.5%) groups (RT > AT).
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Affiliation(s)
- Chathuranga Ranasinghe
- Sports and Exercise Medicine Unit & Department of Allied Health Sciences, Faculty of Medicine, University of Colombo, Sri Lanka; School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Australia.
| | - Sabeena Devage
- Sports and Exercise Medicine Unit & Department of Allied Health Sciences, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Godwin R Constantine
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Prasad Katulanda
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Andrew P Hills
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Australia; School of Health Sciences, University of Tasmania, Launceston, Australia; Mater Research Institute, The University of Queensland, Brisbane, Australia
| | - Neil A King
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Australia
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76
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Zou S, Wang Z, Bhura M, Zhang G, Tang K. Prevalence and associated socioeconomic factors of multimorbidity in 10 regions of China: an analysis of 0.5 million adults. J Public Health (Oxf) 2020; 44:36-50. [PMID: 33300571 DOI: 10.1093/pubmed/fdaa204] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 08/13/2020] [Accepted: 10/22/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The epidemiology of multiple chronic conditions in China is poorly understood. We investigated the prevalence of multimorbidity among the middle-aged and elderly population in China and analyzed its demographic and socioeconomic correlates. METHODS Data were obtained from the baseline of the China Kadoorie Biobank Study, which recruited over 0.5 million participants between 2004 and 2008. We calculated the prevalence by the characteristics of multimorbidity. The demographic and socioeconomic correlates were analyzed using a multivariable logistic regression model. RESULTS 15.9% of the participants were multimorbid. Although the prevalence of multimorbidity increased with age, the absolute number of people with multimorbidity was much higher among middle-aged adults (30-60 years, n = 42 041) than the elderly group (>60 years, n = 38 834). The odd of multimorbidity was higher in males (aOR =1.09, 95% CI: 1.07-1.11) and among those who were unemployed (aOR = 1.58, 95% CI: 1.55-1.62). Those who received the highest level of education were most likely to be multimorbid compared with those with no education (aOR = 1.14, 95% CI: 1.09-1.19). Such an association was similar when treating multimorbidity as multinomial variable. CONCLUSIONS Multimorbidity is a public health concern, with higher prevalence among the elderly, males and those who belong to a lower socioeconomic stratum. Actions are needed to curb multimorbidity epidemic in China.
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Affiliation(s)
- Siyu Zou
- Vanke School of Public Health, Tsinghua University, Beijing 100084, China.,School of Public Health, Peking University Health Science Center, Beijing 100191, China
| | - Zhicheng Wang
- Vanke School of Public Health, Tsinghua University, Beijing 100084, China.,Research Center for Public Health, Tsinghua University, Beijing 100084, China
| | - Maria Bhura
- Department of Paediatrics and Child Health, Aga Khan University, Karachi 74800, Pakistan
| | - Guoting Zhang
- School of Health Humanities, Peking University Health Science Center, Beijing 100191, China
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, Beijing 100084, China
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Fernando G, Durham J, Vlack S, Townsend N, Wickramasinghe K, Gouda H. Examining the evidence of microfinance on non-communicable disease health indicators and outcomes: A systematic literature review. Glob Public Health 2020; 17:165-179. [PMID: 33301691 DOI: 10.1080/17441692.2020.1858135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Microfinance has emerged as an effective approach to address health outcomes, particularly infectious diseases and maternal and child health. However, there remains a significant knowledge gap about microfinance and Non-Communicable Diseases (NCDs). This review synthesises current evidence on microfinance and NCDs, including NCD-specific modifiable risks, health-seeking behaviour, and financing mechanisms of adults using microfinance services. Studies were identified through a systematic search of seven electronic databases, extracted for full-text screening, and analysed using a narrative analysis. A total of twelve articles that covered thirteen countries and four global regions were included in the review. Variations in study designs and reporting in the articles limited the ability to draw strong conclusions about microfinance and NCDs. However, the review revealed that microfinance may reduce modifiable risk factors, promote health-seeking behaviour, and reduce out-of-pocket health expenditure and catastrophic health expenditure related to NCDs. One study, however, found microfinance to be associated with negative effects of higher waist circumference, BMI and obesity rates. Overall, the review helped to identify the current gaps in knowledge, and highlighted the need to focus future research and publication on the use of microfinance to target NCDs of the poor.
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Affiliation(s)
- Gabriela Fernando
- Faculty of Medicine, School of Public Health, University of Queensland, Brisbane, Australia
| | - Jo Durham
- Faculty of Health, School of Social Work and Public Health, Queensland University of Technology, Brisbane, Australia
| | - Sue Vlack
- Faculty of Medicine, School of Public Health, University of Queensland, Brisbane, Australia
| | | | - Kremlin Wickramasinghe
- WHO European Office for the Prevention and Control of Noncommunicable Diseases, Moscow, Russia
| | - Hebe Gouda
- Faculty of Medicine, School of Public Health, University of Queensland, Brisbane, Australia
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Pandey AR, Chalise B, Shrestha N, Ojha B, Maskey J, Sharma D, Godwin P, Aryal KK. Mortality and risk factors of disease in Nepal: Trend and projections from 1990 to 2040. PLoS One 2020; 15:e0243055. [PMID: 33270728 PMCID: PMC7714223 DOI: 10.1371/journal.pone.0243055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 11/15/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Between 1990 and 2017, Nepal experienced a shift in the burden of disease from communicable, maternal, neonatal and nutritional (CMNN) diseases to non-communicable diseases (NCDs). With an increasing ageing population and life-style changes including tobacco use, harmful alcohol consumption, unhealthy diets, and insufficient physical activity, the proportion of total deaths from NCDs will continue to increase. An analysis of current diseases pattern and projections of the trends informs planning of health interventions. This analysis aims to project the mortality and risk factor of disease until 2040, based on past trends. METHODS This study uses secondary data from the Global Burden of Disease (GBD) Study which analyses historic data from 1990 to 2016 to predict key variables such as, the mortality rates, life expectancy and Years of Life Lost for different causes of death from 2017 to 2040. 'GBD Foresight Visualization', a visualisation tool publicly available in the webpage of Institute for Health Metrics and Evaluation was the source of data for this analysis. GBD forecasting uses three-component modelling process: the first component captures variations due to risk factors and interventions, the second takes into consideration the variation due to measures of development quantified as social development index and the third uses an autoregressive integrated moving average model to capture the unexplained component correlated over time. We extracted Nepal specific data from it and reported number of deaths, mortality rates (per 100,000 population) as well as causes of death for the period 1990 to 2040. RESULTS In 1990, CMNN diseases were responsible for approximately two-thirds (63.6%) of total deaths in Nepal. The proportion of the deaths from the CMNN diseases has reduced to 26.8% in 2015 and is estimated to be about a fifth of the 1990 figure (12.47%) in 2040. Conversely, deaths from NCDs reflect an upward trend. NCDs claimed a third of total deaths (29.91%) in the country in 1990, while in 2015, were responsible for about two-thirds of the total deaths (63.31%). In 2040, it is predicted that NCDs will contribute to over two-thirds (78.64%) of total deaths in the country. Less than a tenth (6.49%) of the total deaths in Nepal in 1990 were associated with injuries which increased to 13.04% in 2015 but is projected to decrease to 8.89% in 2040. In 1990, metabolic risk factors including high systolic blood pressure, high total cholesterol, high fasting plasma glucose, high body mass index and impaired kidney functions collectively contributed to a tenth of the total deaths (10.38%) in Nepal, whereas, in 2040 more than a third (37.31%) of the total deaths in the country could be attributed to it. CONCLUSION A reverse of the situation in 1990, NCDs are predicted to be the leading cause of deaths and metabolic risk factors are predicted to contribute to the highest proportion of deaths in 2040. NCDs could demand a major share of resources within the health sector requiring extensive multi-sectoral prevention measures, re-allocation of resources and re-organisation of the health system to cater for long-term care.
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Affiliation(s)
- Achyut Raj Pandey
- Nepal Health Sector Programme 3 / Monitoring, Evaluation and Operational Research, Abt Associates, Kathmandu, Nepal
| | - Binaya Chalise
- Graduate School for International Development and Cooperation, Hiroshima University, Hiroshima, Japan
| | - Niraj Shrestha
- Nepal Health Sector Programme 3 / Monitoring, Evaluation and Operational Research, Abt Associates, Kathmandu, Nepal
| | - Biwesh Ojha
- Nepal Health Sector Programme 3 / Monitoring, Evaluation and Operational Research, Abt Associates, Kathmandu, Nepal
| | - Jasmine Maskey
- Nepal Health Sector Programme 3 / Monitoring, Evaluation and Operational Research, Abt Associates, Kathmandu, Nepal
| | - Dikshya Sharma
- Nepal Health Sector Programme 3 / Monitoring, Evaluation and Operational Research, Abt Associates, Kathmandu, Nepal
| | - Peter Godwin
- Nepal Health Sector Programme 3 / Monitoring, Evaluation and Operational Research, Abt Associates, Kathmandu, Nepal
| | - Krishna Kumar Aryal
- Nepal Health Sector Programme 3 / Monitoring, Evaluation and Operational Research, Abt Associates, Kathmandu, Nepal
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Devi R, Kanitkar K, Narendhar R, Sehmi K, Subramaniam K. A Narrative Review of the Patient Journey Through the Lens of Non-communicable Diseases in Low- and Middle-Income Countries. Adv Ther 2020; 37:4808-4830. [PMID: 33052560 PMCID: PMC7553852 DOI: 10.1007/s12325-020-01519-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/28/2020] [Indexed: 01/08/2023]
Abstract
Low- and middle-income countries (LMICs) are challenged with a disproportionately high burden of noncommunicable diseases (NCDs) and limited healthcare resources at their disposal to tackle the NCD epidemic. Understanding the patient journey for NCDs from the patients' perspective can help healthcare systems in these settings evolve their NCD care models to address the unmet needs of patients, enhance patient participation in their management, and progress towards better outcomes and quality of life. This paper aims to provide a theoretical framework outlining common touchpoints along the patient journey for NCDs in LMICs. It further aims to review influencing factors and recommend strategies to improve patient experience, satisfaction, and disease outcomes at each touchpoint. The co-occurrence of major NCDs makes it possible to structure the patient journey for NCDs into five broad touchpoints: awareness, screening, diagnosis, treatment, and adherence, with integration of palliative care along the care continuum pathway. The patients' perspective must be considered at each touchpoint in order to inform interventions as they experience first-hand the impact of NCDs on their quality of life and physical function and participate substantially in their disease management. Collaboratively designed health communication programs, shared decision-making, use of appropriate risk assessment tools, therapeutic alliances between the patient and provider for treatment planning, self-management tools, and improved access to palliative care are some strategies to help improve the patient journeys in LMICs. Long-term management of NCDs entails substantial self-management by patients, which can be augmented by pharmacists and nurse-led interventions. The digital healthcare revolution has heralded an increase in patient engagement, support of home monitoring of patients, optimized accurate diagnosis, personalized care plans, and facilitated timely intervention. There is an opportunity to integrate digital technology into each touchpoint of the patient journey, while ensuring minimal interruption to patients' care in the face of global health emergencies.
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Chamie G, Hickey MD, Kwarisiima D, Ayieko J, Kamya MR, Havlir DV. Universal HIV Testing and Treatment (UTT) Integrated with Chronic Disease Screening and Treatment: the SEARCH study. Curr HIV/AIDS Rep 2020; 17:315-323. [PMID: 32507985 DOI: 10.1007/s11904-020-00500-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW The growing burden of untreated chronic disease among persons with HIV (PWH) threatens to reverse heath gains from ART expansion. Universal test and treat (UTT)'s population-based approach provides opportunity to jointly identify and treat HIV and other chronic diseases. This review's purpose is to describe SEARCH UTT study's integrated disease strategy and related approaches in Sub-Saharan Africa. RECENT FINDINGS In SEARCH, 97% of adults were HIV tested, 85% were screened for hypertension, and 79% for diabetes at health fairs after 2 years, for an additional $1.16/person. After 3 years, population-level hypertension control was 26% higher in intervention versus control communities. Other mobile/home-based multi-disease screening approaches have proven successful, but data on multi-disease care delivery are extremely limited and show little effect on clinical outcomes. Integration of chronic disease into HIV in the UTT era is feasible and can achieve population level effects; however, optimization and implementation remain a huge unmet need.
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Affiliation(s)
- Gabriel Chamie
- Division of HIV, Infectious Diseases & Global Medicine, San Francisco General Hospital / University of California, San Francisco, UCSF Box 0874, San Francisco, CA, 94143-0874, USA.
| | - Matthew D Hickey
- Division of HIV, Infectious Diseases & Global Medicine, San Francisco General Hospital / University of California, San Francisco, UCSF Box 0874, San Francisco, CA, 94143-0874, USA
| | | | | | - Moses R Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda.,Makerere University College of Health Sciences, Kampala, Uganda
| | - Diane V Havlir
- Division of HIV, Infectious Diseases & Global Medicine, San Francisco General Hospital / University of California, San Francisco, UCSF Box 0874, San Francisco, CA, 94143-0874, USA
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Luyckx VA, Al-Aly Z, Bello AK, Bellorin-Font E, Carlini RG, Fabian J, Garcia-Garcia G, Iyengar A, Sekkarie M, van Biesen W, Ulasi I, Yeates K, Stanifer J. Sustainable Development Goals relevant to kidney health: an update on progress. Nat Rev Nephrol 2020; 17:15-32. [PMID: 33188362 PMCID: PMC7662029 DOI: 10.1038/s41581-020-00363-6] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 12/13/2022]
Abstract
Globally, more than 5 million people die annually from lack of access to critical treatments for kidney disease — by 2040, chronic kidney disease is projected to be the fifth leading cause of death worldwide. Kidney diseases are particularly challenging to tackle because they are pathologically diverse and are often asymptomatic. As such, kidney disease is often diagnosed late, and the global burden of kidney disease continues to be underappreciated. When kidney disease is not detected and treated early, patient care requires specialized resources that drive up cost, place many people at risk of catastrophic health expenditure and pose high opportunity costs for health systems. Prevention of kidney disease is highly cost-effective but requires a multisectoral holistic approach. Each Sustainable Development Goal (SDG) has the potential to impact kidney disease risk or improve early diagnosis and treatment, and thus reduce the need for high-cost care. All countries have agreed to strive to achieve the SDGs, but progress is disjointed and uneven among and within countries. The six SDG Transformations framework can be used to examine SDGs with relevance to kidney health that require attention and reveal inter-linkages among the SDGs that should accelerate progress. Working towards sustainable development is essential to tackle the rise in the global burden of non-communicable diseases, including kidney disease. Five years after the Sustainable Development Goal agenda was set, this Review examines the progress thus far, highlighting future challenges and opportunities, and explores the implications for kidney disease. Each Sustainable Development Goal (SDG) has the potential to improve kidney health and prevent kidney disease by improving the general health and well-being of individuals and societies, and by protecting the environment. Achievement of each SDG is interrelated to the achievement of multiple other SDGs; therefore, a multisectoral approach is required. The global burden of kidney disease has been relatively underestimated because of a lack of data. Structural violence and the social determinants of health have an important impact on kidney disease risk. Kidney disease is the leading global cause of catastrophic health expenditure, in part because of the high costs of kidney replacement therapy. Achievement of universal health coverage is the minimum requirement to ensure sustainable and affordable access to early detection and quality treatment of kidney disease and/or its risk factors, which should translate to a reduction in the burden of kidney failure in the future.
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Affiliation(s)
- Valerie A Luyckx
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. .,Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa. .,Institute of Biomedical Ethics and the History of Medicine, University of Zürich, Zürich, Switzerland.
| | - Ziyad Al-Aly
- Department of Medicine, Washington University in Saint Louis, Saint Louis, MO, USA.,Clinical Epidemiology Center, Veterans Affairs Saint Louis Health Care System, Saint Louis, MO, USA
| | - Aminu K Bello
- Division of Nephrology & Immunology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | | | - Raul G Carlini
- Sección de Investigación, Servicio de Nefrología y Trasplante Renal, Hospital Universitario de Caracas, Caracas, Venezuela
| | - June Fabian
- Wits Donald Gordon Medical Centre, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Witwatersrand, South Africa
| | - Guillermo Garcia-Garcia
- Nephrology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, University of Guadalajara Health Sciences Center, Hospital, 278, Guadalajara, Mexico
| | - Arpana Iyengar
- Department of Paediatric Nephrology, St. John's National Academy of Health Sciences, Bangalore, India
| | | | - Wim van Biesen
- Renal Division, Ghent University Hospital, Ghent, Belgium
| | - Ifeoma Ulasi
- Renal Unit, Department of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Karen Yeates
- Division of Nephrology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - John Stanifer
- Munson Nephrology, Munson Healthcare, Traverse City, MI, USA
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Jayasinghe S, Byrne NM, Patterson KAE, Ahuja KDK, Hills AP. The current global state of movement and physical activity - the health and economic costs of the inactive phenotype. Prog Cardiovasc Dis 2020; 64:9-16. [PMID: 33130190 DOI: 10.1016/j.pcad.2020.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 01/23/2023]
Abstract
Physical inactivity is one of the major contributing factors to the global pandemic of non-communicable diseases. Unfortunately, low levels of habitual movement and physical activity (PA) are seen in an increasing proportion of populations across low- and middle-income countries and high-income countries alike. This new normal - the inactive phenotype - is a significant contributor to multiple health and economic costs. Here we provide a brief historical overview of societal declines in PA, roughly consistent with major transitions in PA and nutrition in recent decades. This is followed by a synthesis of research evidence linking inactivity with poor health outcomes and prevention approaches needed to impact a perpetuation of poor lifestyle behaviors. A major focus of the paper is on the economic/health costs and the reduction of the inactive phenotype. In summary, we demonstrate that the consequences of insufficient PA are manifold, and if sustained, impact short and long-term health and quality of life, along with substantial economic costs.
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Affiliation(s)
- Sisitha Jayasinghe
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia
| | - Nuala M Byrne
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia
| | - Kira A E Patterson
- Faculty of Education, University of Tasmania, Launceston, TAS, Australia
| | - Kiran D K Ahuja
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia
| | - Andrew P Hills
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia.
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Jayathilaka R, Joachim S, Mallikarachchi V, Perera N, Ranawaka D. Do chronic illnesses and poverty go hand in hand? PLoS One 2020; 15:e0241232. [PMID: 33095818 PMCID: PMC7584216 DOI: 10.1371/journal.pone.0241232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/11/2020] [Indexed: 01/28/2023] Open
Abstract
In the global context, the health and quality of life of people are adversely affected by either one or more types of chronic diseases. The chronic pain associated with diagnosed patients may include heavy medical expenditure along with the physical and mental suffering they undergo. Usually, unbearable amounts of medical expenses are incurred, to improve or sustain the health condition of the patient. Consequently, the heavy financial burden tends to push households from a comfortable or secure life, or even from bad to worse, towards the probability of becoming poor. Hence, this study is conducted to identify the impact chronic illnesses have on poverty using data from a national survey referred as the Household Income and Expenditure Survey (HIES), with data gathered by the Department of Census and Statistics (DCS) of Sri Lanka in 2016. As such, this study is the first of its kind in Sri Lanka, declaring the originality of the study based on data collected from the local arena. Accordingly, the study discovered that married females who do not engage in any type of economic activity, in the age category of 40-65, having an educational level of tertiary level or below and living in the urban sector have a higher likelihood of suffering from chronic diseases. Moreover, it was inferred that, if a person is deprived from access to basic education in the level of education, lives in the rural or estate sector, or suffers from a brain disease, cancer, heart disease or kidney disease, he is highly likely to be poor. Some insights concluded from this Sri Lankan case study can also be applied in the context of other developing countries, to minimise chronic illnesses and thereby the probability of falling into poverty.
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Affiliation(s)
- Ruwan Jayathilaka
- Department of Business Management, SLIIT Business School, Sri Lanka Institute of Information Technology, Malabe, Sri Lanka
| | - Sheron Joachim
- Department of Business Management, SLIIT Business School, Sri Lanka Institute of Information Technology, Malabe, Sri Lanka
| | - Venuri Mallikarachchi
- Department of Business Management, SLIIT Business School, Sri Lanka Institute of Information Technology, Malabe, Sri Lanka
| | - Nishali Perera
- Department of Business Management, SLIIT Business School, Sri Lanka Institute of Information Technology, Malabe, Sri Lanka
| | - Dhanushika Ranawaka
- Department of Business Management, SLIIT Business School, Sri Lanka Institute of Information Technology, Malabe, Sri Lanka
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Gupta P, Singh K, Shivashankar R, Singh K, Vamadevan A, Mohan V, Kadir MM, Tandon N, Narayan KM, Prabhakaran D, Ali MK. Healthcare utilisation and expenditure patterns for cardio-metabolic diseases in South Asian cities: the CARRS Study. BMJ Open 2020; 10:e036317. [PMID: 32998917 PMCID: PMC7528361 DOI: 10.1136/bmjopen-2019-036317] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 07/20/2020] [Accepted: 08/07/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To estimate average annual expenditures per person, total economic burden and distress health financing associated with the treatment of five cardio-metabolic diseases (CMDs-hypertension, diabetes, heart disease (angina, myocardial infarction and heart failure), stroke and chronic kidney disease) in three metropolitan cities in South Asia. DESIGN Cross-sectional surveys. SETTING We analysed community-based baseline data from the Centre for cArdio-metabolic Risk Reduction in South Asia (CARRS) Study collected in 2010-2011 representing Chennai and New Delhi (India), and Karachi (Pakistan). PARTICIPANTS We used data from non-pregnant adults (≥20 years) from the aforementioned cities that responded to a cost-of-illness questionnaire. We estimated health utilisation and expenditures among those reporting taking treatment(s) for the aforementioned CMDs in the last 1 year. We converted all costs to International Dollars (Int$ 2011) and inflated to 2018 values. The annual costs per person were stratified by city, sociodemographic characteristics, contributor of costs and financing methods. The total economic burden of CMDs for each city was projected using age-standardised prevalence and per-person costs of diseases reported in CARRS, applying these to population data from the most recent census. We also calculated distress financing (DF) as having to borrow or sell assets to pay for CMD treatment and identified sociodemographic groups at most risk of DF using multiple regression. RESULTS Of 16 287 CARRS participants, 2883 (17.7%) reported receiving treatment for CMDs. The total annual expenditures reported per patient for CMDs ranged from Int$358 to Int$2425. Medications constituted 46% of total direct expenditures and out-of-pocket (OOP) expenditures accounted for nearly 80% of financing these health expenditures. Total economic burdens of CMDs were Int$0.42 billion, Int$3.4 billion and Int$1.4 billion in Chennai, New Delhi and Karachi, respectively. Overall, 36.1% experienced DF, and women (OR=4.4), unemployed (OR=10.7) and uninsured (OR=8.1) adults experienced higher odds of DF. CONCLUSION CMDs are associated with large economic burdens in South Asia. Due to most payments coming from OOP expenditures and limited insurance, the odds of DF are high.
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Affiliation(s)
- Priti Gupta
- Centre for Chronic Disease Control, New Delhi, India
| | - Kalpana Singh
- Centre for Chronic Disease Control, New Delhi, India
| | | | - Kavita Singh
- The Centre for Chronic Conditions and Injuries (CCCI), Public Health Foundation of India, New Delhi, India
| | | | - V Mohan
- Madras Diabetes Research Foundation, Chennai, India
| | | | - Nikhil Tandon
- Department of Endocrinology, Metabolism & Diabetes, All India Institute of Medical Sciences, New Delhi, India
| | - K M Narayan
- Global Health, Emory University School of Public Health, Atlanta, Georgia, USA
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India
- The Centre for Chronic Conditions and Injuries (CCCI), Public Health Foundation of India, New Delhi, India
| | - Mohammed K Ali
- Hubert Department of Global Health, Emory University, Atlanta, Georgia, USA
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85
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Opara CC, Aghassibake N, Watkins DA. Economic consequences of rheumatic heart disease: A scoping review. Int J Cardiol 2020; 323:235-241. [PMID: 32920073 DOI: 10.1016/j.ijcard.2020.09.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/07/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Rheumatic heart disease (RHD) remains endemic in less-resourced regions and countries and results in high medical and non-medical costs to households, health systems, and society. This scoping review maps out the available evidence on the economic impact of RHD and its antecedents and suggests future research priorities. METHOD We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. We identified articles through systematic electronic database search supplemented by expert knowledge of unpublished literature. Studies were included if they collected empirical RHD-related costing data as a primary or secondary objective and if the data were collected from 2000 onward. Main quantitative findings by intervention, costing perspective, and location were charted, and a standardized quality assessment tool was used to appraise included studies. RESULTS The index search identified 2519 electronic records and two grey-literature graduate theses. Six full texts were included in the review. Primary prevention costs were modest, while secondary and especially tertiary prevention were more costly. Most estimates were of health sector costs and for tertiary interventions. Only two studies described RHD-related costs in non-high-income countries. Most studies were of adequate methodological quality. CONCLUSION Research into the costs of RHD has mostly been done in wealthy countries. Costs from the household perspective, which are particularly important in countries with limited public healthcare finance, are lacking. To inform advocacy and guide implementation of the 2018 World Health Assembly resolution on RHD, high-quality, local cost estimates will be needed from a range of representative, RHD-endemic countries.
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Affiliation(s)
- Chinonso C Opara
- Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - David A Watkins
- Department of Medicine, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA.
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Singh MP, Chauhan AS, Rai B, Ghoshal S, Prinja S. Cost of Treatment for Cervical Cancer in India. Asian Pac J Cancer Prev 2020; 21:2639-2646. [PMID: 32986363 PMCID: PMC7779435 DOI: 10.31557/apjcp.2020.21.9.2639] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 09/18/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Cervical cancer is a major public health problem in India leading to high economic burden, which is disproportionately borne by the patients as out-of-pocket expenditure (OOPE). Several publicly financed health insurance schemes (PFHIs) in India cover the treatment for cervical cancer. However, the provider payment rates for health benefit packages (HBP) under these PFHIs are not based on scientific evidence. We undertook this study to estimate the cost of services provided for treatment of cervical cancer and cost of the package of care for cervical cancer in India. METHODS The study was undertaken at a large public tertiary hospital in North India. The health system cost was assessed using a mixed micro-costing approach. The data were collected for all the resources utilized during service delivery for cervical cancer patients. To evaluate the OOPE, randomly selected 248 patients were interviewed following the cost of illness approach. Logistic regression was used to assess the factors associated with catastrophic health expenditure (CHE). RESULTS Health system cost for different cervical cancer treatment modalities i.e. radiotherapy, brachytherapy, chemotherapy and surgery, ranges from INR 19,494 to 41,388 (USD 291 - 617). Furthermore, patients spent INR 4,042 to 23,453 ( USD 60 - 350) as OOPE. Nearly 62% patients incurred CHE, and 30% reported distress financing. The odds of CHE (OR: 25.39, p-value: <0.001) and distress financing (OR: 15.37, p-value: 0.001) were significantly higher in poorest-income quintile. The HBP cost varies from INR 45,364 to 64,422 (USD 676 - 960) for brachytherapy and radiotherapy respectively. CONCLUSION Cervical cancer treatment leads to high OOPE in India, which imposes financial hardship, especially for the poorest. The coverage of risk pooling mechanisms like PHFIs should be enhanced. The findings of our study should be used to set the reimbursement rates of providing cervical cancer treatment under PFHI schemes.
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Affiliation(s)
- Maninder Pal Singh
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Akashdeep Singh Chauhan
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Bhavana Rai
- Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Sushmita Ghoshal
- Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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Tesfaye Yunka T, Berhanu Mogas S, Zawdie B, Tamiru D, Tesfaye Y, Kebede A, Tadesse M, Kebede Gudina E, Sena Dadi L. The Hidden Burden of Diabetes Mellitus in an Urban Community of Southwest Ethiopia. Diabetes Metab Syndr Obes 2020; 13:2925-2933. [PMID: 32904561 PMCID: PMC7457551 DOI: 10.2147/dmso.s269386] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 08/05/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Early detection of the unrecognized diabetes mellitus (DM) and its risk factors in the community is crucial to minimizing the burden of DM and associated complications. Hence, this study aimed to assess unrecognized DM and its relationship with behavioral characteristics, physical characteristics, and lipid profile among adults in Jimma Town, Southwest Ethiopia. METHODS A community-based cross-sectional study was conducted on 915 adults in Jimma Town from June 17 to July 27, 2019. Physical measurements, lipid profile, and blood sugar levels were measured. The collected data were entered and analyzed using Epi Data 3.1 and SPSS version 21, respectively. Multivariable logistic regression was fitted to assess predictors of unrecognized DM where adjusted odds ratio (AOR) with its corresponding 95% confidence interval (CI) was used to assess the strength of association at P-value ≤05. RESULTS The prevalence of unrecognized DM and impaired glucose metabolism (pre-diabetes) were 3.1% (95% CI; 2.0-4.4) and 14.8% (95% CI; 12.5-17.2), respectively. The risk of unrecognized DM was higher among male participants (AOR = 2.94, 95% CI: 1.19, 7.29), age group of 35 years and above (AOR = 3.45, 95% CI: 1.16, 10.27), and high waist circumference (AOR = 4.21, 95% CI: 1.72, 10.33). On the other hand, participants who perform sufficient physical activity (AOR = 0.14, 95% CI: 0.03, 0.58) had low risk of undetected DM. CONCLUSION The prevalence of unrecognized diabetes mellitus was relatively high. Male sex, advanced age, physical inactivity, and high waist circumference were found to be predictors of unrecognized DM. Thus, awareness needs to be created among the community to practice regular physical activity and maintaining normal body weight. Additionally, screening of DM should be promoted for early detection, prevention, and treatment.
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Affiliation(s)
| | | | - Belay Zawdie
- Department of Biomedical Sciences, Jimma University, Jimma, Oromia Region, Ethiopia
| | - Dessalegn Tamiru
- Department of Nutrition and Dietetics, Jimma University, Jimma, Oromia Region, Ethiopia
| | - Yonas Tesfaye
- Department of Psychiatry, Jimma University, Jimma, Oromia Region, Ethiopia
| | - Ayantu Kebede
- Department of Epidemiology, Jimma University, Jimma, Oromia Region, Ethiopia
| | - Mulualem Tadesse
- Department of Medical Laboratory, Jimma University, Jimma, Oromia Region, Ethiopia
| | - Esayas Kebede Gudina
- Department of Internal Medicine, Jimma University, Jimma, Oromia Region, Ethiopia
| | - Lelisa Sena Dadi
- Department of Epidemiology, Jimma University, Jimma, Oromia Region, Ethiopia
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Idris IO, Oguntade AS, Mensah EA, Kitamura N. Prevalence of non-communicable diseases and its risk factors among Ijegun-Isheri Osun residents in Lagos State, Nigeria: a community based cross-sectional study. BMC Public Health 2020; 20:1258. [PMID: 32811462 PMCID: PMC7437062 DOI: 10.1186/s12889-020-09349-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The rapid epidemiologic transition of diseases has adverse implications for low-and middle-income countries (LMICs) like Nigeria due to their limited healthcare, weaker health systems and the westernization of lifestyle. There is a need to evaluate the enormity or otherwise of non-communicable diseases (NCDs) burden in such low resource settings. We performed this survey to determine the prevalence of NCDs and its risk factors among the Ijegun- Isheri Osun community residents of Lagos, Nigeria. METHODS A community-based cross-sectional survey was performed on 215 respondents recruited consecutively during a population preventive health campaign. Prevalence of three NCDs (hypertension, diabetes and dyslipidaemia) were calculated. Associations between each of these NCDs and selected risk factors were determined using chi square test. Multivariable logistic regression was used to estimate the risk factors of each of the three NCDs. RESULTS The prevalence of hypertension was 35.3% (95% CI 29.0-42.1), diabetes 4.6% (95% CI 2.2-8.4) and dyslipidaemia 47.1% (95% CI 41.1-54.8). Among the NCD risk factors, the prevalence of smoking was 41.3% (95% CI 34.2-48.6), alcohol consumption 72.5% (95% CI 65.5-78.7), and physical activity 52.9 (95% CI 45.5-60.2). The independent significant predictors of hypertension were age ≥ 60 years (aOR 4.56; 95% CI: 1.72-12.09) and dyslipidaemia (aOR 5.01; 95% CI: 2.26-11.13). Age ≥ 60 years (aOR 8.83; 95% CI: 1.88-41.55) was an independent predictor of diabetes. Age ≥ 60 years (aOR 29.32; 95% CI: 4.78-179.84), being employed (aOR 11.12; 95% CI: 3.10-39.92), smoking (aOR 2.34; 95% CI: 1.03-5.33) and physical activity (aOR 0.34; 95% CI: 0.15-0.76) were independent predictors of having dyslipidaemia. CONCLUSIONS The prevalence of hypertension, diabetes and dyslipidaemia and their associated risk factors are high among the respondents of Ijegun-Isheri Osun community of Lagos state, Nigeria. This highlights the need for further implementation research and policy directions to tackle NCD burden in urban communities in Nigeria. These strategies must be community specific, prioritizing the various risk factors and addressing them accordingly.
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Affiliation(s)
- Israel Oluwaseyidayo Idris
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, University of London, London, UK
- Disease Control and Surveillance Team, Department of Primary Health Programmes, NAIJAHEALTH Initiative, Lagos, Nigeria
- Department of Social and Preventive Medicine, V. N Karazin Kharkiv National University, Kharkiv, Ukraine
- Health Policy and Governance Unit, Department of State Management and Public Administration, Kharkiv National University of Economics, Kharkiv, Ukraine
| | - Ayodipupo Sikiru Oguntade
- Disease Control and Surveillance Team, Department of Primary Health Programmes, NAIJAHEALTH Initiative, Lagos, Nigeria.
- Department of Medicine, University College Hospital, Ibadan, Nigeria.
- Institute of Cardiovascular Science, University College London, London, UK.
| | - Ekow Adom Mensah
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, University of London, London, UK
- Disease Control and Surveillance Team, Department of Primary Health Programmes, NAIJAHEALTH Initiative, Lagos, Nigeria
- Department of Family Medicine, Korle-Bu Polyclinic, Accra, Ghana
| | - Noriko Kitamura
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, University of London, London, UK
- Disease Control and Surveillance Team, Department of Primary Health Programmes, NAIJAHEALTH Initiative, Lagos, Nigeria
- Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- Department of Disease Control, Graduate School of Public Health and Tropical Medicine, Tulane University, New Orleans, USA
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Sui M, Zeng X, Tan WJ, Tao S, Liu R, Liu B, Ma W, Huang W, Yu H. Catastrophic health expenditures of households living with pediatric leukemia in China. Cancer Med 2020; 9:6802-6812. [PMID: 32697427 PMCID: PMC7520357 DOI: 10.1002/cam4.3317] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/07/2020] [Accepted: 06/29/2020] [Indexed: 11/11/2022] Open
Abstract
Background Leukemia can create a significant economic burden on the patients and their families. The objective of this study is to assess the medical expenditure and compensation of pediatric leukemia, and to explore the incidence and determinants of catastrophic health expenditure (CHE) among households with pediatric leukemia patients in China. Methods A cross‐sectional interview was conducted among households living with pediatric leukemia using a questionnaire in two tertiary hospitals. CHE was defined as out‐of‐pocket (OOP) payments that were greater than or equal to 40% of a household's capacity to pay (CTP). Chi‐square tests and logistic regression analysis were performed to identify the determinants of CHE. Results Among 242 households living with pediatric leukemia, the mean OOP payment for pediatric leukemia healthcare was $9860, which accounted for approximately 35.7% of the mean household's CTP. The overall incidence of CHE was 43.4% and showed a downward trend with the lowest income group at 69.0% to the highest income group at 16.1%. The logistic regression model found that medical insurance, frequency of hospital admissions, charity assistance, and income level were significant predictors of CHE. Conclusion The results revealed that pediatric leukemia had a significant catastrophic effect on families, especially those with lower economic status. The occurrence of CHE in households living with pediatric leukemia could be reduced by addressing income disparity. In addition, extending coverage and improving compensation from medical insurance could also alleviate CHE. Some other measures that can be implemented are to address the barriers of charity assistance for vulnerable groups.
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Affiliation(s)
- Mingjie Sui
- School of Health Management, Harbin Medical University, Harbin, China
| | - Xueyun Zeng
- School of Health Management, Harbin Medical University, Harbin, China
| | - Wan Jie Tan
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Sihai Tao
- North China University of Science and Technology, Hebei, China
| | - Rui Liu
- School of Health Management, Harbin Medical University, Harbin, China
| | - Bo Liu
- School of Health Management, Harbin Medical University, Harbin, China
| | - Wenrui Ma
- School of Public Health, The University of Queensland, Brisbane, Qld, Australia
| | - Weidong Huang
- School of Health Management, Harbin Medical University, Harbin, China
| | - Hongjuan Yu
- Department of Hematology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
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90
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Hessel P, Rodríguez-Lesmes P, Torres D. Socio-economic inequalities in high blood pressure and additional risk factors for cardiovascular disease among older individuals in Colombia: Results from a nationally representative study. PLoS One 2020; 15:e0234326. [PMID: 32516351 PMCID: PMC7282633 DOI: 10.1371/journal.pone.0234326] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 05/24/2020] [Indexed: 12/19/2022] Open
Abstract
Background Studies in high-income countries have documented a consistent gradient between socio-economic status (SES) and high blood pressure (HBP), a key risk factor for cardiovascular disease (CVD). However, evidence from Latin American countries (LA) remains comparatively scarce and inconclusive. Data Data for 3,984 individuals came from a nationally representative survey of individuals aged 60 years or above in Colombia (Encuesta de Salud, Bienestar y Envejecimiento) (SABE) conducted in 2015. SES was measured by educational achievement and household assets. CVD risk factors included objectively measured HBP and body mass index (BMI), as well as behaviors (smoking, alcohol consumption, fruit and vegetables intake, and physical activity). Methods Bivariate methods and multivariate regression models were used to assess associations between SES with HBP as well as additional risk factors for CVD. Results Individuals with lower SES have significantly higher risk of suffering from HBP. Compared to those with no formal education, individuals with secondary or post-secondary education have a 37% lower risk of HBP (odds ratio [OR] = 0.63, P-value<0.001). Being in the highest asset quartile (most affluent) is associated with a 44% lower risk (OR = 56, P-value = 0.001) of HBP compared to those in the lowest asset quartile (most deprived). Individuals with lower SES are more likely to smoke, not engage in regular physical activity and not regularly consume fruits or vegetables. In contrast, individuals with higher SES are more likely to consume alcohol and, those with more assets, more likely to be obese. Conclusions Among older Colombians there exists a marked SES gradient in HBP as well as several additional risk factors for CVD. The results highlight the importance of a public health approach towards HBP and additional CVD risk factors that takes into account the specific conditions of older individuals, especially among disadvantaged groups.
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Affiliation(s)
- Philipp Hessel
- University of the Andes, Alberto Lleras Camargo School of Government, Bogotá, Colombia
- * E-mail:
| | | | - David Torres
- University of the Andes, Alberto Lleras Camargo School of Government, Bogotá, Colombia
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91
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Remme M, Vassall A, Fernando G, Bloom DE. Investing in the health of girls and women: a best buy for sustainable development. BMJ 2020; 369:m1175. [PMID: 32487585 PMCID: PMC7265042 DOI: 10.1136/bmj.m1175] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Human rights, theory, evidence, and common sense all suggest that greater investment in women’s health could be among the “best buys” for broader economic development and societal wellbeing, say Michelle Remme and colleagues
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Affiliation(s)
- Michelle Remme
- United Nations University International Institute for Global Health, Kuala Lumpur, Malaysia
| | - Anna Vassall
- London School of Hygiene and Tropical Medicine, London, UK
| | - Gabriela Fernando
- United Nations University International Institute for Global Health, Kuala Lumpur, Malaysia
| | - David E Bloom
- Harvard TH Chan School of Public Health, Harvard University, Boston, USA
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Gibbs N, Kwon J, Balen J, Dodd PJ. Operational research to support equitable non-communicable disease policy in low-income and middle-income countries in the sustainable development era: a scoping review. BMJ Glob Health 2020; 5:e002259. [PMID: 32605934 PMCID: PMC7328817 DOI: 10.1136/bmjgh-2019-002259] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 05/11/2020] [Accepted: 05/13/2020] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Non-communicable diseases (NCDs) represent a growing health burden in low-income and middle-income countries (LMICs). Operational research (OR) has been used globally to support the design of effective and efficient public policies. Equity is emphasised in the Sustainable Development Goal (SDG) framework introduced in 2015 and can be analysed within OR studies. METHODS We systematically searched MEDLINE, Embase, Scopus and Web of Science for studies published between 2015 and 2018 at the intersection of five domains (OR, LMICs, NCDs, health and decision-making and/or policy-making). We categorised the type of policy intervention and described any concern for equity, which we defined as either analysis of differential impact by subgroups or, policy focus on disadvantaged groups or promoting universal health coverage (UHC). RESULTS A total of 149 papers met the inclusion criteria. The papers covered a number of policy types and a broad range of NCDs, although not in proportion to their relative disease burden. A concern for equity was demonstrated by 88 of the 149 papers (59%), with 8 (5%) demonstrating differential impact, 47 (32%) targeting disadvantaged groups, and 68 (46%) promoting UHC. CONCLUSION Overall, OR for NCD health policy in the SDG era is being applied to a diverse set of interventions and conditions across LMICs and researchers appear to be concerned with equity. However, the current focus of published research does not fully reflect population needs and the analysis of differential impact within populations is rare.
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Affiliation(s)
- Naomi Gibbs
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Joseph Kwon
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Julie Balen
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Peter J Dodd
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
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Dwivedi R, Pradhan J. Does affordability matter? Examining the trends and patterns in health care expenditure in India. Health Serv Manage Res 2020; 33:207-218. [PMID: 32447992 DOI: 10.1177/0951484820923921] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Absence of better financing mechanism results in higher out of pocket expenditure and catastrophe, which leads to impoverishment and poverty especially among low- and middle-income countries like India. This paper examines the major characteristics associated with the higher out of pocket expenditure and provides an insight from Andersen's behavioural model that how predisposing, enabling and need factors influence the level and pattern of out of pocket expenditure in India. METHODS Data has been extracted from three rounds of nationally representative consumer expenditure surveys, i.e. 1993-1994, 2004-2005 and 2011-2012 conducted by the Government of India. States were categorized based on regional classification, and adult equivalent scale was used to adjust the household size. Multiple Generalized-Linear-Regression-Model was employed to explore the relative effect of various socio-economic covariates on the level of out of pocket expenditure. RESULTS The gap has widened between advantaged and disadvantaged segment of the population along with noticeable regional disparities among Indian states. Generalized-Linear-Regression-Model indicates that the most influential predisposing and enabling factor determining the level of out of pocket expenditure were age composition, religion, social-group, household type, residence, economic status, sources of cooking and lighting arrangements among the households. CONCLUSIONS Present study suggests the need for strengthening the affordability mechanism of the households to cope with the excessive burden of health care payments. Furthermore, special consideration is required to accommodate the needs of the elderly, rural, backward states and impoverishment segment of population to reduce the unjust burden of out of pocket expenditure in India.
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Affiliation(s)
- Rinshu Dwivedi
- Department of Humanities and Social Sciences, Indian Institute of Information Technology, Tiruchirappalli, Tamil Nadu, India
| | - Jalandhar Pradhan
- Department of Humanities and Social Sciences, National Institute of Technology Rourkela, Rourkela, India
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94
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Byiringiro S, Nyirimanzi N, Mucumbitsi J, Kamanzi ER, Swain J. Cardiac Surgery: Increasing Access in Low- and Middle-Income Countries. Curr Cardiol Rep 2020; 22:37. [PMID: 32430786 DOI: 10.1007/s11886-020-01290-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF THE REVIEW Low- and middle-income countries (LMICs) have long-battled communicable diseases, and now, a rise in non-communicable diseases (NCD) is conferring tremendous burden in these areas. Cardiovascular disease (CVD) remains the number one cause of death among NCDs across the globe. The current review provides insight regarding this disease burden and highlights challenges as well as strategies for establishing functional cardiac surgery centers and sustainable access to comprehensive cardiovascular care within LMICs. RECENT FINDINGS Without effective prevention and treatment strategies, estimates suggest that deaths from CVDs will reach 24 million by the year 2030. Surgery exists as a limited option for selected patients with advanced cardiac disease in LMICs in comparison with its availability in developed countries. Multi-lateral or public-private initiatives, government investment, philanthropic efforts, innovative financing systems to strengthen Universal Health Coverage, and expansion of training options through centers of excellence appear to be the way forward to broadening the availability of cardiovascular services, inclusive of surgery, to LMICs.
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Affiliation(s)
- Samuel Byiringiro
- School of Nursing, The Johns Hopkins University, 525 North Wolfe St., Baltimore, MD, USA.
| | | | | | | | - JaBaris Swain
- Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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95
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Leung CL, Naert M, Andama B, Dong R, Edelman D, Horowitz C, Kiptoo P, Manyara S, Matelong W, Matini E, Naanyu V, Nyariki S, Pastakia S, Valente T, Fuster V, Bloomfield GS, Kamano J, Vedanthan R. Human-centered design as a guide to intervention planning for non-communicable diseases: the BIGPIC study from Western Kenya. BMC Health Serv Res 2020; 20:415. [PMID: 32398131 PMCID: PMC7218487 DOI: 10.1186/s12913-020-05199-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 04/07/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Non-communicable disease (NCD) care in Sub-Saharan Africa is challenging due to barriers including poverty and insufficient health system resources. Local culture and context can impact the success of interventions and should be integrated early in intervention design. Human-centered design (HCD) is a methodology that can be used to engage stakeholders in intervention design and evaluation to tailor-make interventions to meet their specific needs. METHODS We created a Design Team of health professionals, patients, microfinance officers, community health workers, and village leaders. Over 6 weeks, the Design Team utilized a four-step approach of synthesis, idea generation, prototyping, and creation to develop an integrated microfinance-group medical visit model for NCD. We tested the intervention with a 6-month pilot and conducted a feasibility evaluation using focus group discussions with pilot participants and community members. RESULTS Using human-centered design methodology, we designed a model for NCD delivery that consisted of microfinance coupled with monthly group medical visits led by a community health educator and a rural clinician. Benefits of the intervention included medication availability, financial resources, peer support, and reduced caregiver burden. Critical concerns elicited through iterative feedback informed subsequent modifications that resulted in an intervention model tailored to the local context. CONCLUSIONS Contextualized interventions are important in settings with multiple barriers to care. We demonstrate the use of HCD to guide the development and evaluation of an innovative care delivery model for NCDs in rural Kenya. HCD can be used as a framework to engage local stakeholders to optimize intervention design and implementation. This approach can facilitate the development of contextually relevant interventions in other low-resource settings. TRIAL REGISTRATION Clinicaltrials.gov, NCT02501746, registration date: July 17, 2015.
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Affiliation(s)
- Claudia L. Leung
- Duke University Medical Center, 10 Duke Medicine Circle, Durham, NC 27710 USA
- Division of General Internal Medicine, Duke University School of Medicine, 200 Morris St. 3rd floor, Durham, NC 27701 USA
| | - Mackenzie Naert
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029 USA
| | - Benjamin Andama
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606, Eldoret, 30100 Kenya
| | - Rae Dong
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029 USA
| | - David Edelman
- Division of General Internal Medicine, Duke University School of Medicine, 200 Morris St. 3rd floor, Durham, NC 27701 USA
| | - Carol Horowitz
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029 USA
| | - Peninah Kiptoo
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606, Eldoret, 30100 Kenya
| | - Simon Manyara
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606, Eldoret, 30100 Kenya
| | - Winnie Matelong
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606, Eldoret, 30100 Kenya
| | - Esther Matini
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606, Eldoret, 30100 Kenya
| | - Violet Naanyu
- Department of Behavioral Sciences, School of Medicine, College of Health Science, Moi University College of Health Sciences, Eldoret, Kenya
| | - Sarah Nyariki
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606, Eldoret, 30100 Kenya
| | - Sonak Pastakia
- Purdue University, Purdue University College of Pharmacy, Purdue-Kenya Partnership, West Lafayette, IN, PO Box 5760, Eldoret, 30100 Kenya
| | - Thomas Valente
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA USA
| | - Valentin Fuster
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029 USA
| | - Gerald S. Bloomfield
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029 USA
| | - Jemima Kamano
- Department of Behavioral Sciences, School of Medicine, College of Health Science, Moi University College of Health Sciences, Eldoret, Kenya
| | - Rajesh Vedanthan
- New York University Grossman School of Medicine, 180 Madison Avenue, 8th Floor, New York, NY 10016 USA
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96
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Cancer survivors' experiences with financial toxicity: A systematic review and meta‐synthesis of qualitative studies. Psychooncology 2020; 29:945-959. [DOI: 10.1002/pon.5361] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/28/2019] [Accepted: 02/10/2020] [Indexed: 12/19/2022]
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97
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Steinman L, Heang H, van Pelt M, Ide N, Cui H, Rao M, LoGerfo J, Fitzpatrick A. Facilitators and Barriers to Chronic Disease Self-Management and Mobile Health Interventions for People Living With Diabetes and Hypertension in Cambodia: Qualitative Study. JMIR Mhealth Uhealth 2020; 8:e13536. [PMID: 32329737 PMCID: PMC7210501 DOI: 10.2196/13536] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 07/04/2019] [Accepted: 09/24/2019] [Indexed: 12/15/2022] Open
Abstract
Background In many low- and middle-income countries (LMICs), heart disease and stroke are the leading causes of death as cardiovascular risk factors such as diabetes and hypertension rapidly increase. The Cambodian nongovernmental organization, MoPoTsyo, trains local residents with diabetes to be peer educators (PEs) to deliver chronic disease self-management training and medications to 14,000 people with hypertension and/or diabetes in Cambodia. We collaborated with MoPoTsyo to develop a mobile-based messaging intervention (mobile health; mHealth) to link MoPoTsyo’s database, PEs, pharmacies, clinics, and people living with diabetes and/or hypertension to improve adherence to evidence-based treatment guidelines. Objective This study aimed to understand the facilitators and barriers to chronic disease management and the acceptability, appropriateness, and feasibility of mHealth to support chronic disease management and strengthen community-clinical linkages to existing services. Methods We conducted an exploratory qualitative study using semistructured interviews and focus groups with PEs and people living with diabetes and/or hypertension. Interviews were recorded and conducted in Khmer script, transcribed and translated into the English language, and uploaded into Atlas.ti for analysis. We used a thematic analysis to identify key facilitators and barriers to disease management and opportunities for mHealth content and format. The information-motivation-behavioral model was used to guide data collection, analysis, and message development. Results We conducted six focus groups (N=59) and 11 interviews in one urban municipality and five rural operating districts from three provinces in October 2016. PE network participants desired mHealth to address barriers to chronic disease management through reminders about medications, laboratory tests and doctor’s consultations, education on how to incorporate self-management into their daily lives, and support for obstacles to disease management. Participants preferred mobile-based voice messages to arrive at dinnertime for improved phone access and family support. They desired voice messages over texts to communicate trust and increase accessibility for persons with limited literacy, vision, and smartphone access. PEs shared similar views and perceived mHealth as acceptable and feasible for supporting their work. We developed 34 educational, supportive, and reminder mHealth messages based on these findings. Conclusions These mHealth messages are currently being tested in a cluster randomized controlled trial (#1R21TW010160) to improve diabetes and hypertension control in Cambodia. This study has implications for practice and policies in Cambodia and other LMICs and low-resource US settings that are working to engage PEs and build community-clinical linkages to facilitate chronic disease management.
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Affiliation(s)
- Lesley Steinman
- Department of Health Services, University of Washington, Seattle, WA, United States
| | - Hen Heang
- MoPoTsyo Patient Information Centre, Phnom Penh, Cambodia
| | | | - Nicole Ide
- Division of General Internal Medicine, University of Washington, Seattle, WA, United States
| | - Haixia Cui
- MoPoTsyo Patient Information Centre, Phnom Penh, Cambodia
| | - Mayuree Rao
- Division of General Internal Medicine, University of Washington, Seattle, WA, United States.,General Medicine Service, VA Puget Sound Health Care System, Seattle, WA, United States
| | - James LoGerfo
- Department of Medicine, University of Washington, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States
| | - Annette Fitzpatrick
- Department of Global Health, University of Washington, Seattle, WA, United States.,Departments of Family Medicine, University of Washington, Seattle, WA, United States.,Department of Epidemiology, University of Washington, Seattle, WA, United States
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98
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Ir P, Jacobs B, Asante AD, Liverani M, Jan S, Chhim S, Wiseman V. Exploring the determinants of distress health financing in Cambodia. Health Policy Plan 2020; 34:i26-i37. [PMID: 31644799 PMCID: PMC6807511 DOI: 10.1093/heapol/czz006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2019] [Indexed: 11/14/2022] Open
Abstract
Borrowing is a common coping strategy for households to meet healthcare costs in countries where social health protection is limited or non-existent. Borrowing with interest, hereinafter termed distress health financing or distress financing, can push households into heavy indebtedness and exacerbate the financial consequences of healthcare costs. We investigated distress health financing practices and associated factors among Cambodian households, using primary data from a nationally representative household survey of 5000 households. Multivariate logistic regression was used to determine factors associated with distress health financing. Results showed that 28.1% of households consuming healthcare borrowed to pay for that healthcare with 55% of these subjected to distress financing. The median loan was US$125 (US$200 for loans with interest and US$75 for loans without interest). Approximately 50.6% of healthcare-related loans were to pay for the costs of outpatient care in the past month, 45.8% for inpatient care and 3.6% for preventive care in the past 12 months. While the average period to pay off the loan was 8 months, 78% of households were still indebted from loans taken over 12 months before the survey. Distress financing is strongly associated with household poverty-the poorer the household the more likely it is to borrow, fall into debt and unable to pay off the debt-even for members of the health equity funds, a national scheme designed to improve financial access to health services for the poor. Other determinants of distress financing were household size, use of inpatient care and outpatient consultations with private providers or with both private and public providers. In order to ensure effective financial risk protection, Cambodia should establish a more comprehensive and effective social health protection scheme that provides maximum population coverage and prioritizes services for populations at risk of distress financing, especially poorer and larger households.
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Affiliation(s)
- Por Ir
- National Institute of Public Health, Lot No. 80, Street 289, Phnom Penh, Cambodia
| | - Bart Jacobs
- Social Health Protection Programme, Deutsche Gesellschaft für Internationale Zusammenarbeit (GiZ), Lot No. 80, Street 289, Phnom Penh, Cambodia
| | - Augustine D Asante
- School of Public Health & Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Marco Liverani
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Pl, Kings Cross, London, UK
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, 1 King St Newtown, New South Wales, Australia
| | - Srean Chhim
- National Institute of Public Health, Lot No. 80, Street 289, Phnom Penh, Cambodia
| | - Virginia Wiseman
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Pl, Kings Cross, London, UK.,Kirby Institute, University of New South Wales, Wallace Wurth Building, High St, Kensington NSW, Australia
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99
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How Does Health Status Affect Marginal Utility of Consumption? Evidence from China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072234. [PMID: 32225010 PMCID: PMC7177955 DOI: 10.3390/ijerph17072234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/12/2020] [Accepted: 03/25/2020] [Indexed: 11/16/2022]
Abstract
This paper investigates how the deteriorating health status of an individual affects the marginal utility of non-medical consumption in China. By using 2011, 2013 and 2015 China Health and Retirement Longitudinal Study (CHARLS) data, we find that when the number of chronic diseases increases one standard deviation, the marginal utility of consumption will increase by 16.0% and 20.0% for samples of the middle-aged and elderly individuals over 50 and 65 years of age, respectively. This result is to some extent contrary to the findings from the US. Different economic development stages, intergenerational norms and bequest motives may be reasons for these contrasting patterns between China and the US.
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100
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Lomia N, Berdzuli N, Pestvenidze E, Sturua L, Sharashidze N, Kereselidze M, Topuridze M, Antelava T, Stray-Pedersen B, Stray-Pedersen A. Socio-Demographic Determinants of Mortality from Chronic Noncommunicable Diseases in Women of Reproductive Age in the Republic of Georgia: Evidence from the National Reproductive Age Mortality Study (2014). Int J Womens Health 2020; 12:89-105. [PMID: 32161506 PMCID: PMC7051896 DOI: 10.2147/ijwh.s235755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/27/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Worldwide, noncommunicable diseases (NCDs) are the leading cause of premature death of women, taking the highest toll in developing countries. This study aimed to identify key socio-demographic determinants of NCD mortality in reproductive-aged women (15-49 years) in Georgia. Materials and Methods The study employed the verbal autopsy data from the second National Reproductive Age Mortality Survey 2014. Univariate and multivariate logistic regression models were fitted to explore the association between each risk factor and NCD mortality, measured by crude and adjusted odds ratio (AOR) with respective 95% confidence intervals (95% CI). Results In the final sample of 843 women, 586 (69.5%) deaths were attributed to NCDs, the majority of which occurred outside a hospital (72.7%) and among women aged 45-49 years (46.8%), ethnic Georgians (85.2%), urban residents (60.1%), those being married (60.6%), unemployed (75.1%) or having secondary and higher education (69.5%), but with nearly equal distribution across the wealth quintiles. After multivariate adjustment, the odds of dying from NCDs were significantly higher in women aged 45-49 years (AOR=17.69, 95% CI= 9.35 to 33.50), those being least educated (AOR=1.55, 95% CI= 1.01 to 2.37) and unemployed (AOR=1.47, 95% CI= 1.01 to 2.14) compared, respectively, to their youngest (15-24 years), more educated and employed counterparts. Strikingly, the adjusted odds were significantly lower in "other" ethnic minorities (AOR=0.29, 95% CI= 0.14 to 0.61) relative to ethnic Georgians. Contrariwise, there were no significant associations between NCD mortality and women's marital or wealth status, place of residence (rural/urban) or place of death. Conclusion Age, ethnicity, education, and employment were found to be strong independent predictors of young women's NCD mortality in Georgia. Further research on root causes of inequalities in mortality across the socioeconomic spectrum is warranted to inform equity- and life course-based multisectoral, integrated policy responses that would be conducive to enhancing women's survival during and beyond reproduction.
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Affiliation(s)
- Nino Lomia
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nino Berdzuli
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ekaterine Pestvenidze
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lela Sturua
- Department of Noncommunicable Diseases, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Nino Sharashidze
- Department of Clinical and Research Skills, Faculty of Medicine, Iv. Javakhishvili Tbilisi State University, Tbilisi, Georgia
| | - Maia Kereselidze
- Department of Medical Statistics, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Marina Topuridze
- Health Promotion Division, Department of Noncommunicable Diseases, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | | | - Babill Stray-Pedersen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Obstetrics and Gynecology, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Arne Stray-Pedersen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
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