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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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Murphy A, Palafox B, Walli-Attaei M, Powell-Jackson T, Rangarajan S, Alhabib KF, Avezum AJ, Calik KBT, Chifamba J, Choudhury T, Dagenais G, Dans AL, Gupta R, Iqbal R, Kaur M, Kelishadi R, Khatib R, Kruger IM, Kutty VR, Lear SA, Li W, Lopez-Jaramillo P, Mohan V, Mony PK, Orlandini A, Rosengren A, Rosnah I, Seron P, Teo K, Tse LA, Tsolekile L, Wang Y, Wielgosz A, Yan R, Yeates KE, Yusoff K, Zatonska K, Hanson K, Yusuf S, McKee M. The household economic burden of non-communicable diseases in 18 countries. BMJ Glob Health 2020; 5:e002040. [PMID: 32133191 PMCID: PMC7042605 DOI: 10.1136/bmjgh-2019-002040] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/07/2020] [Accepted: 01/09/2020] [Indexed: 11/29/2022] Open
Abstract
Background Non-communicable diseases (NCDs) are the leading cause of death globally. In 2014, the United Nations committed to reducing premature mortality from NCDs, including by reducing the burden of healthcare costs. Since 2014, the Prospective Urban and Rural Epidemiology (PURE) Study has been collecting health expenditure data from households with NCDs in 18 countries. Methods Using data from the PURE Study, we estimated risk of catastrophic health spending and impoverishment among households with at least one person with NCDs (cardiovascular disease, diabetes, kidney disease, cancer and respiratory diseases; n=17 435), with hypertension only (a leading risk factor for NCDs; n=11 831) or with neither (n=22 654) by country income group: high-income countries (Canada and Sweden), upper middle income countries (UMICs: Brazil, Chile, Malaysia, Poland, South Africa and Turkey), lower middle income countries (LMICs: the Philippines, Colombia, India, Iran and the Occupied Palestinian Territory) and low-income countries (LICs: Bangladesh, Pakistan, Zimbabwe and Tanzania) and China. Results The prevalence of catastrophic spending and impoverishment is highest among households with NCDs in LMICs and China. After adjusting for covariates that might drive health expenditure, the absolute risk of catastrophic spending is higher in households with NCDs compared with no NCDs in LMICs (risk difference=1.71%; 95% CI 0.75 to 2.67), UMICs (0.82%; 95% CI 0.37 to 1.27) and China (7.52%; 95% CI 5.88 to 9.16). A similar pattern is observed in UMICs and China for impoverishment. A high proportion of those with NCDs in LICs, especially women (38.7% compared with 12.6% in men), reported not taking medication due to costs. Conclusions Our findings show that financial protection from healthcare costs for people with NCDs is inadequate, particularly in LMICs and China. While the burden of NCD care may appear greatest in LMICs and China, the burden in LICs may be masked by care foregone due to costs. The high proportion of women reporting foregone care due to cost may in part explain gender inequality in treatment of NCDs.
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Affiliation(s)
- Adrianna Murphy
- London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Benjamin Palafox
- London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Marjan Walli-Attaei
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Timothy Powell-Jackson
- London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Khalid F Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | | | - Jephat Chifamba
- Department of Physiology, University of Zimbabwe, Harare, Zimbabwe
| | | | - Gilles Dagenais
- Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, Ontario, Canada
| | - Antonio L Dans
- Department of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Rajeev Gupta
- Eternal Heart Care Centre and Research Institute, Jaipur, India
| | - Romaina Iqbal
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Manmeet Kaur
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Roya Kelishadi
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, the Islamic Republic of Iran
| | - Rasha Khatib
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Iolanthe Marike Kruger
- Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa
| | | | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Wei Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, University Teknologi MARA, Beijing, China
| | | | - Viswanathan Mohan
- Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, Chennai, India
| | - Prem K Mony
- St John's Medical College and Research Institute, Bangalore, India
| | | | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University, Gothenburg, Sweden
| | - Ismail Rosnah
- Community Health Department, Faculty of Medicine, UKM Medical Centre, Kuala Lumpur, Malaysia
| | - Pamela Seron
- Facultad de Medicina, Universidad de La Frontera, Temucu, Chile
| | - Koon Teo
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Lap Ah Tse
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Lungiswa Tsolekile
- School of Public Health, University of the Western Cape, Bellville, Western Cape, South Africa
| | - Yang Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Andreas Wielgosz
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ruohua Yan
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Karen E Yeates
- Department of Medicine, Queen's University, Kingston, New Hampshire, Canada
| | - Khalid Yusoff
- UiTM, Selayang, Selangor and UCSI University, Cheras, Kuala Lumpur, Malaysia
| | - Katarzyna Zatonska
- Department of Social Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Kara Hanson
- London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Martin McKee
- London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
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Hefty fee for a healthy life: finding predictors by econometric comparison. J Public Health (Oxf) 2020. [DOI: 10.1007/s10389-020-01212-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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104
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Wolde HF, Derso T, Biks GA, Yitayal M, Ayele TA, Gelaye KA, Demissie GD, Azale T, Misganaw B, Kebede A, Teshome DF, Dellie E, Gebremedhin T, Atnafu A. High Hidden Burden of Diabetes Mellitus among Adults Aged 18 Years and Above in Urban Northwest Ethiopia. J Diabetes Res 2020; 2020:9240398. [PMID: 33299894 PMCID: PMC7704177 DOI: 10.1155/2020/9240398] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/18/2020] [Accepted: 10/27/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Ethiopia is one of the sub-Saharan African countries with a rapidly increasing burden of diabetes mellitus (DM). There is limited updated information about the community-based burden of the disease and its associated factors in Ethiopia which is very crucial to plan effective prevention and control measures against the disease. This study is aimed at determining the burden of DM and its associated factors in urban northwest Ethiopia. METHODS A community-based cross-sectional study was conducted from April to May 2019 among residents aged ≥ 18 years in Gondar town and urban kebeles (lowest administrative units of the country) of Health and Demographic Surveillance System site (HDSS) in Dabat district. A multistage sampling technique was used to select 773 participants. World Health Organization (WHO) stepwise approach for noncommunicable disease surveillance was used to collect the data. Fasting blood glucose (FBS) ≥ 126 mg/dl was used to diagnose DM. Descriptive statistics were done to describe the variables of the study. Prevalence with its 95% confidence interval (CI) was estimated. Binary logistic regression model was fitted, variables with p value < 0.05 were considered to have a significant association with the outcome, and odds ratio (OR) was used to measure the strength of association. RESULT Of the total participants, 6.34% (95% CI; 4.82, 8.29) were found to be diabetic. Of these, 40 (81.6%) were newly diagnosed. Besides, the prevalence of prediabetes was 9.31% (95% CI: 7.45, 11.58). Increased age (AOR = 1.06, 95% CI; 1.04, 1.09) and eating vegetables one to three days per week (AOR =0.29, 95% CI; 0.13, 0.65) were significantly associated with diabetes. CONCLUSION The overall prevalence of DM is a bit higher than the national estimate, while the proportion of undiagnosed DM which can easily progress to disabling and life-threatening complications was alarmingly high. Age and frequency of eating vegetables per week were associated with diabetes. In light of this finding, future prevention and control measures against the diseases should consider the identified factors. There should also be improved access to screening services.
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Affiliation(s)
- Haileab Fekadu Wolde
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Terefe Derso
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Dabat Health and Demographic Surveillance System Research Centre, Institute of Public Health College of Medicine and Health Science, University of Gondar, Ethiopia
| | - Gashaw Andargie Biks
- Dabat Health and Demographic Surveillance System Research Centre, Institute of Public Health College of Medicine and Health Science, University of Gondar, Ethiopia
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mezgebu Yitayal
- Dabat Health and Demographic Surveillance System Research Centre, Institute of Public Health College of Medicine and Health Science, University of Gondar, Ethiopia
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Awoke Ayele
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Dabat Health and Demographic Surveillance System Research Centre, Institute of Public Health College of Medicine and Health Science, University of Gondar, Ethiopia
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Dabat Health and Demographic Surveillance System Research Centre, Institute of Public Health College of Medicine and Health Science, University of Gondar, Ethiopia
| | - Getu Debalkie Demissie
- Department of Health Promotion and Behavioral Sciences, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Telake Azale
- Dabat Health and Demographic Surveillance System Research Centre, Institute of Public Health College of Medicine and Health Science, University of Gondar, Ethiopia
- Department of Health Promotion and Behavioral Sciences, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bisrat Misganaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Dabat Health and Demographic Surveillance System Research Centre, Institute of Public Health College of Medicine and Health Science, University of Gondar, Ethiopia
| | - Adane Kebede
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Destaw Fetene Teshome
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Endalkachew Dellie
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tsegaye Gebremedhin
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Asmamaw Atnafu
- Dabat Health and Demographic Surveillance System Research Centre, Institute of Public Health College of Medicine and Health Science, University of Gondar, Ethiopia
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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105
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"There's Not Really Much Consideration Given to the Effect of the Climate on NCDs"-Exploration of Knowledge and Attitudes of Health Professionals on a Climate Change-NCD Connection in Barbados. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010198. [PMID: 31892174 PMCID: PMC6982231 DOI: 10.3390/ijerph17010198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 12/17/2019] [Accepted: 12/23/2019] [Indexed: 11/21/2022]
Abstract
Despite widespread awareness of the rise of non-communicable diseases (NCDs) and the growing threat of climate change, little research has explored future health outcomes that will occur at the intersection of these challenges. Ten Barbadian health professionals were interviewed to assess their knowledge of health risks of climate change as it relates to NCDs in Barbados as a case study of a small island state at risk. There is widespread concern among health professionals about the current and future prevalence of non-communicable diseases among Barbadians. There is less concern about the future burden of NCDs in the context of a changing climate, largely because of a lack of knowledge among the majority of the health experts interviewed. Those knowledgeable about potential connections noted the difficulty that climate change would pose to the prevention and management of NCDs, given the impacts of climate stressors to food security, the built environment, and physiological and psychosocial health impacts. Lack of awareness among health professionals of the risk climate change poses to NCD prevalence and impact is reflective of the country’s health priorities that fail to recognize the risk of climate change. We recommend efforts to disseminate information about climate change to stakeholders in the health sector to increase awareness.
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Mitáš J, Cerin E, Reis RS, Conway TL, Cain KL, Adams MA, Schofield G, Sarmiento OL, Christiansen LB, Davey R, Salvo D, Orzanco-Garralda R, Macfarlane D, Hino AAF, De Bourdeaudhuij I, Owen N, Van Dyck D, Sallis JF. Do associations of sex, age and education with transport and leisure-time physical activity differ across 17 cities in 12 countries? Int J Behav Nutr Phys Act 2019; 16:121. [PMID: 31796070 PMCID: PMC6888920 DOI: 10.1186/s12966-019-0894-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 11/28/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Leisure-time and transport activity domains are studied most often because they are considered more amenable to intervention, but to date evidence on these domains is limited. The aim of the present study was to examine patterns of socio-demographic correlates of adults' leisure-time and transport physical activity and how these associations varied across 17 cities in 12 countries. METHODS Participants (N = 13,745) aged 18-66 years in the IPEN Adult study and with complete data on socio-demographic and self-reported physical activity characteristics were included. Participants reported frequency and duration of leisure-time and transport activities in the last 7 days using the self-administered International Physical Activity Questionnaire-Long Form. Six physical activity outcomes were examined in relation with age, education, and sex, and analyses explored variations by city and curvilinear associations. RESULTS Sex had the most consistent results, with five of six physical activity outcomes showing females were less active than males. Age had the most complex associations with self-report transport and leisure-time physical activity. Compared to older people, younger adults were less likely to engage in transport physical activity, but among those who did, younger people were likely to engage in more active minutes. Curvilinear associations were found between age and all three leisure-time physical activity outcomes, with the youngest and the oldest being more active. Positive associations with education were found for leisure-time physical activity only. There were significant interactions of city with sex and education for multiple physical activity outcomes. CONCLUSIONS Although socio-demographic correlates of physical activity are widely studied, the present results provide new information. City-specific findings suggest there will be value in conducting more detailed case studies. The curvilinear associations of age with leisure-time physical activity as well as significant interactions of leisure-time activity with sex and education should be further investigated. The findings of lower leisure-time physical activity among females as well as people with low education suggest that greater and continued efforts in physical activity policies and programs tailored to these high-risk groups are needed internationally.
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Affiliation(s)
- Josef Mitáš
- Institute of Active Lifestyle, Faculty of Physical Culture, Palacký University, Olomouc, Czech Republic.
| | - Ester Cerin
- Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
- School of Public Health, The University of Hong Kong, Pok Fu Lam, Hong Kong, China
| | - Rodrigo Siqueira Reis
- Prevention Research Center, Brown School, Washington University in St. Louis, Saint Louis, MO, USA
- Urban Management Graduate Program, Pontifical Catholic University of Parana, Curitiba, Brazil
| | - Terry L Conway
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Kelli L Cain
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Marc A Adams
- Global Institute of Sustainability, College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Grant Schofield
- Faculty of Health and Environmental Sciences, AUT University, Auckland, New Zealand
| | | | - Lars B Christiansen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Rachel Davey
- Health Research Unit, University of Canberra, Canberra, Australia
| | - Deborah Salvo
- Prevention Research Center, Brown School, Washington University in St. Louis, Saint Louis, MO, USA
| | | | - Duncan Macfarlane
- Centre for Sports and Exercise, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Adriano Akira F Hino
- Health Technology Graduate Program, Pontifical Catholic University of Parana, Curitiba, Brazil
| | - Ilse De Bourdeaudhuij
- Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium
| | - Neville Owen
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Swinburne University of Technology, Melbourne, Australia
| | - Delfien Van Dyck
- Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium
- Research Foundation Flanders, Brussels, Belgium
| | - James F Sallis
- Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
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Yang C, Hu S, Zhu Y, Zhu W, Li Z, Fang Y. Evaluating access to oral anti-diabetic medicines: A cross-sectional survey of prices, availability and affordability in Shaanxi Province, Western China. PLoS One 2019; 14:e0223769. [PMID: 31618273 PMCID: PMC6795464 DOI: 10.1371/journal.pone.0223769] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 09/28/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To assess the availability and affordability of oral anti-diabetic medicines in Shaanxi Province, Western China. METHODS In 2015, the prices and availability of 8 anti-diabetic medicines covering 31 different dosage forms and strengths were collected in six cities of Shaanxi Province. A total of 72 public hospitals and 72 private pharmacies were sampled, using a modified methodology developed by the World Health Organization (WHO) and Health Action International (HAI). Medicine prices were compared with international reference prices to obtain a median price ratio. For urban residents, affordability was assessed as the lowest-paid unskilled government workers to purchase cost of standard treatment in days' wages; for rural residents, days' net income was used. RESULTS The mean availabilities of originator brands (OBs) and generics were 34.3% and 28.7% in public hospitals, and 44.1% and 64.4% in the private pharmacies. OBs and the lowest priced generics (LPGs) were procured at 12.38 and 4.52 times the international reference price in public hospitals, and 10.26 and 2.81 times the international reference prices in private pharmacies. Treatments with OBs were unaffordable even for urban residents. The affordability of the LPGs was good, except for acarbose, repaglinide and pioglitazone. CONCLUSIONS Most anti-diabetic medicines cannot met the WHO's availability target (80% availability) in Shaanxi Province. The high prices of OBs had severely influenced the affordability of medicines, especially for the rural residents. Effective policies should be initiated to ensure the Chinese people a better access to more affordable anti-diabetic medicines.
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Affiliation(s)
- Caijun Yang
- The Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi’an, China
- The Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi’an, China
| | - Shuchen Hu
- The Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi’an, China
- The Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi’an, China
| | - Yanbing Zhu
- Department of Pharmacology, Health Science Center, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Food and Drug Administration, Xi’an, China
| | - Wenwen Zhu
- The Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi’an, China
- The Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi’an, China
| | - Zongjie Li
- The Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi’an, China
- The Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi’an, China
| | - Yu Fang
- The Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi’an, China
- The Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi’an, China
- * E-mail:
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Giang NH, Oanh TTM, Anh Tuan K, Hong Van P, Jayasuriya R. Is Health Insurance Associated with Health Service Utilization and Economic Burden of Non-Communicable Diseases on Households in Vietnam? Health Syst Reform 2019; 6:1-15. [PMID: 31592715 DOI: 10.1080/23288604.2019.1619065] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
The rising burden of Non-Communicable Diseases (NCDs) in developing countries has caused high out-of-pocket (OOP) health spending leading to many households suffering Catastrophic Health Expenditure (CHE). This study examined the association between health insurance (HI) on health-care utilization and the burden of OOP expenditure among people with reported NCDs and on their households in Vietnam.The study draws on a cross-sectional household survey of accessibility and utilization of health services in Vietnam. Data were obtained from three provinces to represent urban, rural and mountainous areas of the country. The study used a sample of 2,038 individuals with reported NCD aged over 18 years from 1,642 households having at least one person with reported NCD.The results show that people with reported NCD who had HI were twice as likely to use outpatient care compared with those without HI. Having more than one member with reported NCD resulted in double the odds of a household suffering CHE. Households in the three lowest wealth quintiles were more likely to encounter CHE and financial distress than economically better-off households. HI did not provide a protective effect to households, as there was no significant association between the HI status of household members with reported NCD and CHE or financial distress. Seeking care at higher-level facilities was significantly associated with CHE.This study highlights the need for evidence to design future HI-based interventions targeting susceptible populations to narrow the gaps in health service utilization among the population and mitigate financial catastrophe associated with NCDs.Abbreviations: NCD: Noncommunicable diseases; UHC: Universal Health Coverage; HI: Health insurance; CHE: Catastrophic health expenditure; OOP: Out of Pocket.
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Affiliation(s)
| | | | | | - Phan Hong Van
- Health Strategy and Policy Institute, Hanoi, Vietnam
| | - Rohan Jayasuriya
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, Australia
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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 2019; 34:i26-i37. [PMID: 31644799 PMCID: PMC6807511 DOI: 10.1093/heapol/czz006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [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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Tannor EK, Sarfo FS, Mobula LM, Sarfo‐Kantanka O, Adu‐Gyamfi R, Plange‐Rhule J. Prevalence and predictors of chronic kidney disease among Ghanaian patients with hypertension and diabetes mellitus: A multicenter cross-sectional study. J Clin Hypertens (Greenwich) 2019; 21:1542-1550. [PMID: 31465141 PMCID: PMC8030392 DOI: 10.1111/jch.13672] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/24/2019] [Accepted: 08/02/2019] [Indexed: 01/10/2023]
Abstract
The burden of chronic kidney disease (CKD) is rapidly rising in developing countries due to astronomical increases in key risk factors including hypertension and diabetes. We sought to assess the burden and predictors of CKD among Ghanaians with hypertension and/or diabetes mellitus in a multicenter hospital-based study. We conducted a cross-sectional study in the Ghana Access and Affordability Program (GAAP) involving adults with hypertension only (HPT), hypertension with diabetes mellitus (HPT + DM), and diabetes mellitus only (DM) in 5 health facilities in Ghana. A structured questionnaire was administered to collect data on demographic variables, medical history, and clinical examination. Serum creatinine and proteinuria were measured, and estimated glomerular filtration rate derived using the CKD-EPI formula. A multivariable logistic regression model was used to identify factors associated with CKD. A total of 2781 (84.4%) of 3294 participants had serum creatinine and proteinuria data available for analysis. The prevalence of CKD was 242 (28.5%) among participants with both DM and HPT, 417 (26.3%) among participants with HPT, and 56 (16.1%) among those with DM alone. Predictors of CKD were increasing age aOR 1.26 (1.17-1.36), low educational level aOR 1.7 (1.23-2.35), duration of HPT OR, 1.02 (1.01-1.04), and use of herbal medications aOR 1.39 (1.10-1.75). Female gender was protective of CKD aOR 0.75 (0.62-0.92). Among patients with DM, increasing age and systolic blood pressure were associated with CKD. There is high prevalence of CKD among DM and hypertension patients in Ghana. Optimizing blood pressure control and limiting the use of herbal preparations may mitigate CKD occurrence in high cardiovascular risk populations in developing countries.
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Affiliation(s)
| | - Fred Stephen Sarfo
- Komfo Anokye Teaching HospitalKumasiGhana
- Kwame Nkrumah University of Science & TechnologyKumasiGhana
| | - Linda M. Mobula
- Johns Hopkins University School of MedicineBaltimoreMDUSA
- Johns Hopkins University Bloomberg School of Public HealthBaltimoreMDUSA
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Manning K, Senekal M, Harbron J. Group-based intervention in a primary healthcare setting was more effective for weight loss than usual care. Health SA 2019; 24:1172. [PMID: 31934428 PMCID: PMC6917430 DOI: 10.4102/hsag.v24i0.1172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 04/10/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Literature and practice recommendations for lifestyle interventions to treat the increasing number of obese patients with non-communicable diseases (NCDs) or risk factors for NCDs attending resource-constrained public healthcare facilities in South Africa are scarce. AIM To compare the impact of a facility-based therapeutic group (FBTG) intervention with usual care on weight in obese participants, with NCDs or risk factors for NCDs. SETTING Public healthcare facility providing primary healthcare services in Cape Town, South Africa. METHODS A quasi-experimental study design was used where participants chose to receive weight loss treatment with either the FBTG or usual care interventions. Both interventions involved a one-on-one medical and dietetic consultation, while FBTG participants had six additional group sessions. Follow-up assessments took place 6 months after baseline. Socio-demographic variables, blood pressure, smoking status, weight, height, waist circumference, dietary intake, physical activity and stage of change were measured. RESULTS Of the 193 obese adults enrolled, 96 selected the FBTG and 97 selected usual care. There were no significant differences at baseline between the two groups. Weight loss over 6 months was greater (p < 0.001) in FBTG (median [IQR] of -2.9 [-5.1; -0.3] kg) than usual care (-0.9 [-0.9; 0.6] kg) participants. At 6 months, more FBTG completers reached the weekly target of 150 min (p = 0.009), while both groups showed improvements in dietary intake. More FBTG (74%) than usual care (49%) participants were in the action stage of change by 6 months (p = 0.010). CONCLUSIONS The group-based intervention was more effective than usual care in weight reduction as well as improvements in physical activity and stage of change.
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Affiliation(s)
- Kathryn Manning
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Marjanne Senekal
- Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Janetta Harbron
- Department of Human Biology, University of Cape Town, Cape Town, South Africa
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112
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Erlangga D, Suhrcke M, Ali S, Bloor K. The impact of public health insurance on health care utilisation, financial protection and health status in low- and middle-income countries: A systematic review. PLoS One 2019; 14:e0219731. [PMID: 31461458 PMCID: PMC6713352 DOI: 10.1371/journal.pone.0219731] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 07/02/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Expanding public health insurance seeks to attain several desirable objectives, including increasing access to healthcare services, reducing the risk of catastrophic healthcare expenditures, and improving health outcomes. The extent to which these objectives are met in a real-world policy context remains an empirical question of increasing research and policy interest in recent years. METHODS We reviewed systematically empirical studies published from July 2010 to September 2016 using Medline, Embase, Econlit, CINAHL Plus via EBSCO, and Web of Science and grey literature databases. No language restrictions were applied. Our focus was on both randomised and observational studies, particularly those including explicitly attempts to tackle selection bias in estimating the treatment effect of health insurance. The main outcomes are: (1) utilisation of health services, (2) financial protection for the target population, and (3) changes in health status. FINDINGS 8755 abstracts and 118 full-text articles were assessed. Sixty-eight studies met the inclusion criteria including six randomised studies, reflecting a substantial increase in the quantity and quality of research output compared to the time period before 2010. Overall, health insurance schemes in low- and middle-income countries (LMICs) have been found to improve access to health care as measured by increased utilisation of health care facilities (32 out of 40 studies). There also appeared to be a favourable effect on financial protection (26 out of 46 studies), although several studies indicated otherwise. There is moderate evidence that health insurance schemes improve the health of the insured (9 out of 12 studies). INTERPRETATION Increased health insurance coverage generally appears to increase access to health care facilities, improve financial protection and improve health status, although findings are not totally consistent. Understanding the drivers of differences in the outcomes of insurance reforms is critical to inform future implementations of publicly funded health insurance to achieve the broader goal of universal health coverage.
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Affiliation(s)
- Darius Erlangga
- Department of Health Sciences, University of York, York, England, United Kingdom
| | - Marc Suhrcke
- Centre of Health Economics, University of York, York, England, United Kingdom
- Luxembourg Institute of Socio-economic Research (LISER), Luxembourg
| | - Shehzad Ali
- Department of Health Sciences, University of York, York, England, United Kingdom
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Karen Bloor
- Department of Health Sciences, University of York, York, England, United Kingdom
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Murphy A, McGowan C, McKee M, Suhrcke M, Hanson K. Coping with healthcare costs for chronic illness in low-income and middle-income countries: a systematic literature review. BMJ Glob Health 2019; 4:e001475. [PMID: 31543984 PMCID: PMC6730576 DOI: 10.1136/bmjgh-2019-001475] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 06/25/2019] [Accepted: 06/29/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Experiencing illness in low-income and middle-income countries (LMICs) can incur very high out-of-pocket (OOP) payments for healthcare and, while the existing literature typically focuses on levels of expenditure, it rarely examines what happens when households do not have the necessary money. Some will adopt one or more 'coping strategies', such as borrowing money, perhaps at exorbitant interest rates, or selling assets, some necessary for their future income, with detrimental long-term effects. This is particularly relevant for chronic illnesses that require consistent, long-term OOP payments. We systematically review the literature on strategies for financing OOP costs of chronic illnesses in LMICs, their correlates and their impacts on households. METHODS We searched MEDLINE, EconLit, EMBASE, Global Health and Scopus on 22 October 2018 for literature published on or after 1 January 2000. We included qualitative or quantitative studies describing at least one coping strategy for chronic illness OOP payments in a LMIC context. Our narrative review follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. RESULTS Forty-seven papers were included. Studies identified coping strategies for chronic illness costs that are not traditionally addressed in financial risk protection research (eg, taking children out of school, sending them to work, reducing expenditure on food or education, quitting work to give care). Twenty studies reported socioeconomic or other correlates of coping strategies, with poorer households and those with more advanced disease more vulnerable to detrimental strategies. Only six studies (three cross-sectional and three qualitative) included evidence of impacts of coping strategies on households, including increased labour to repay debts and discontinuing treatment. CONCLUSIONS Monitoring of financial risk protection provides an incomplete picture if it fails to capture the effect of coping strategies. This will require qualitative and longitudinal research to understand the long-term effects, especially those associated with chronic illness in LMICs.
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Affiliation(s)
- Adrianna Murphy
- Centre for Global Chronic Conditions, Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Catherine McGowan
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
- Humanitarian Public Health Technical Unit, Save the Children UK, London, United Kingdom
| | - Martin McKee
- Centre for Global Chronic Conditions, Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Marc Suhrcke
- Centre for Health Economics, University of York, York, UK
- Luxembourg Institute of Socio-economic Research (LISER), Belval, Luxembourg
| | - Kara Hanson
- Department of Global Health Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Shah S, Abbas G, Hanif M, Anees-Ur-Rehman, Zaman M, Riaz N, Altaf A, Hassan SU, Saleem U, Shah A. Increased burden of disease and role of health economics: Asia-pacific region. Expert Rev Pharmacoecon Outcomes Res 2019; 19:517-528. [DOI: 10.1080/14737167.2019.1650643] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Shahid Shah
- Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Pakistan
| | - Ghulam Abbas
- Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Pakistan
| | - Muhammad Hanif
- Department of Pharmaceutics, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Anees-Ur-Rehman
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Penang, Malaysia
| | - Muhammad Zaman
- Faculty of Pharmacy, University of Central Punjab, Lahore, Pakistan
| | - Nabeel Riaz
- Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Pakistan
| | - Arslan Altaf
- Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Pakistan
| | - Shams Ul Hassan
- Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Pakistan
| | - Usman Saleem
- Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Pakistan
| | - Abid Shah
- Pediatric Medicine Department, Mukhtar Ahmad Sheikh Hospital, Multan, Pakistan
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115
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Draper CE, Tomaz SA, Zihindula G, Bunn C, Gray CM, Hunt K, Micklesfield LK, Wyke S. Development, feasibility, acceptability and potential effectiveness of a healthy lifestyle programme delivered in churches in urban and rural South Africa. PLoS One 2019; 14:e0219787. [PMID: 31365557 PMCID: PMC6668772 DOI: 10.1371/journal.pone.0219787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 07/01/2019] [Indexed: 11/19/2022] Open
Abstract
Rising levels of obesity in South Africa require innovation in community-level lifestyle change programmes. Our aim was to co-develop Impilo neZenkolo ('Health through Faith'), a healthy lifestyle programme for low-income, black South Africans delivered through churches, and evaluate its feasibility, acceptability and potential effectiveness. In the first phase we developed programme materials with church members. In the second phase we trained lay leaders to deliver the programme and assessed feasibility, acceptability (observation, focus groups and interviews) and potential effectiveness (pre and post measurement of weight, hip and waist circumferences, blood pressure, self-reported physical activity, dietary habits, health status, self-esteem, psychological distress). The study was conducted in four churches in urban and rural South Africa. The development workshops led to increased focus on positive benefits of participation, widening inclusion criteria to all adults and greater emphasis on Christian ethos. Challenges to feasibility included: recruitment of churches; scheduling of programme sessions (leading to one church not delivering the programme); attendance at the programme (63% attended more than half of the 12 weekly sessions); and poor programme fidelity (in particular in teaching behaviour change techniques). Aspects of the programme were acceptable, particularly the way in which the programme was aligned with a Christian ethos. There was some indication that amongst the 42/68 (62%) for whom we were obtained pre- and post-programme measurements the programme has potential to support weight loss. We conclude that a healthy lifestyle programme for low-income, black South Africans, delivered through churches, may be viable with extensive re-development of delivery strategies. These include finding external funding for the programme, endorsement from national level denominational organisations and the professionalization of programme leadership, including paid rather than volunteer leaders to ensure sufficient time can be spent in training.
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Affiliation(s)
- Catherine Elizabeth Draper
- Division of Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
- MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Simone Annabella Tomaz
- Division of Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
| | - Ganzamungu Zihindula
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- University of KwaZulu-Natal, Durban, South Africa
| | - Christopher Bunn
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Cindy M. Gray
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Kate Hunt
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- Institute for Social Marketing, Faculty of Health and Sports Sciences, University of Stirling, Stirling, United Kingdom
| | - Lisa Kim Micklesfield
- Division of Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
- MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sally Wyke
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- * E-mail:
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Jakovljevic M, Jakab M, Gerdtham U, McDaid D, Ogura S, Varavikova E, Merrick J, Adany R, Okunade A, Getzen TE. Comparative financing analysis and political economy of noncommunicable diseases. J Med Econ 2019; 22:722-727. [PMID: 30913928 DOI: 10.1080/13696998.2019.1600523] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The pandemic of chronic non-communicable diseases (NCDs) poses substantial challenges to the health financing sustainability in high-income and low/middle income countries (LMICs). The aim of this review is to identify the bottle neck inefficiencies in NCDs attributable spending and propose sustainable health financing solutions. The World Health Organization (WHO) introduced the "best buy" concept to scale up the core intervention package against NCDs targeted for LMICs. Population- and individual-based NCD best buy interventions are projected at US$170 billion over 2011-2025. Appropriately designed health financing arrangements can be powerful enablers to scale up the NCD best buys. Rapidly developing emerging nations dominate the landscape of LMICs. Their capability and willingness to invest resources for eradicating NCDs could strengthen WHO outreach efforts in Asia, Africa, and Latin America, much beyond current capacities. There has been a declining trend in international donor aid intended to cope with NCDs over the past decade. There is also a serious misalignment of these resources with the actual needs of recipient countries. Globally, the momentum towards the financing of intersectoral actions is growing, and this presents a cost-effective solution. A budget discrepancy of 10:1 in WHO and multilateral agencies remains in donor aid in favour of communicable diseases compared to NCDs. LMICs are likely to remain a bottleneck of NCDs imposed financing sustainability challenge in the long-run. Catastrophic household health expenditure from out of pocket spending on NCDs could plunge almost 150 million people into poverty worldwide. This epidemiological burden coupled with population ageing presents an exceptionally serious sustainability challenge, even among the richest countries which are members of the Organization for Economic Co-operation and Development (OECD). Strategic and political leadership of WHO and multilateral agencies would likely play essential roles in the struggle that has just begun.
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Affiliation(s)
- Mihajlo Jakovljevic
- a Department of Global Health Economics and Policy , University of Kragujevac , Kragujevac , Serbia
| | - Melitta Jakab
- b World Health Organization Regional Office for Europe , WHO Barcelona Office for Health Systems Strengthening , Barcelona , Spain
| | - Ulf Gerdtham
- c Division of Health Economics , Lund University , Lund , Sweden
| | - David McDaid
- d London School of Economics and Political Science , London , UK
| | - Seiritsu Ogura
- e Faculty of Economics , Hosei University , Tokyo , Japan
| | - Elena Varavikova
- f Federal Research Institute of Public Health , Moscow , Russian Federation
| | - Joav Merrick
- g Division of Pediatrics , Hadassah Hebrew University Medical Center , Mt Scopus Campus , Israel
| | - Roza Adany
- h Department of Preventive Medicine, Faculty of Public Health , University of Debrecen MTA-DE Public Health Research Group , Debrecen , Hungary
| | - Albert Okunade
- i Fogelman College of Business & Economics , University of Memphis , Memphis , TN , USA
| | - Thomas E Getzen
- j Insurance and Health Management at the Fox School of Business , Temple University , Philadelphia , PA , USA
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Misra A, Gopalan H, Jayawardena R, Hills AP, Soares M, Reza-Albarrán AA, Ramaiya KL. Diabetes in developing countries. J Diabetes 2019; 11:522-539. [PMID: 30864190 DOI: 10.1111/1753-0407.12913] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/27/2019] [Accepted: 03/08/2019] [Indexed: 12/24/2022] Open
Abstract
There has been a rapid escalation of type 2 diabetes (T2D) in developing countries, with varied prevalence according to rural vs urban habitat and degree of urbanization. Some ethnic groups (eg, South Asians, other Asians, and Africans), develop diabetes a decade earlier and at a lower body mass index than Whites, have prominent abdominal obesity, and accelerated the conversion from prediabetes to diabetes. The burden of complications, both macro- and microvascular, is substantial, but also varies according to populations. The syndemics of diabetes with HIV or tuberculosis are prevalent in many developing countries and predispose to each other. Screening for diabetes in large populations living in diverse habitats may not be cost-effective, but targeted high-risk screening may have a place. The cost of diagnostic tests and scarcity of health manpower pose substantial hurdles in the diagnosis and monitoring of patients. Efforts for prevention remain rudimentary in most developing countries. The quality of care is largely poor; hence, a substantial number of patients do not achieve treatment goals. This is further amplified by a delay in seeking treatment, "fatalistic attitudes", high cost and non-availability of drugs and insulins. To counter these numerous challenges, a renewed political commitment and mandate for health promotion and disease prevention are urgently needed. Several low-cost innovative approaches have been trialed with encouraging outcomes, including training and deployment of non-medical allied health professionals and the use of mobile phones and telemedicine to deliver simple health messages for the prevention and management of T2D.
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Affiliation(s)
- Anoop Misra
- National-Diabetes, Obesity and Cholesterol Foundation, Safdarjung Development Area, New Delhi, India
- Diabetes Foundation (India), New Delhi, India
- Fortis C-DOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, New Delhi, India
| | - Hema Gopalan
- National-Diabetes, Obesity and Cholesterol Foundation, Safdarjung Development Area, New Delhi, India
| | | | - Andrew P Hills
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Mario Soares
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Alfredo A Reza-Albarrán
- Endocrinology and Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Jiang J, Chen S, Xin Y, Wang X, Zeng L, Zhong Z, Xiang L. Does the critical illness insurance reduce patients' financial burden and benefit the poor more: a comprehensive evaluation in rural area of China. J Med Econ 2019; 22:455-463. [PMID: 30744446 DOI: 10.1080/13696998.2019.1581620] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Critical illness insurance (CII) is one kind of health insurance that is gradually gaining attention worldwide. China implemented CII in 2012 to decrease patients' out-of-pocket (OOP) medical payments. The aims of this study were to determine if the project had positive impacts on relieving financial burden and improving health equity. METHODS A series of questionnaire surveys were undertaken in two counties before and after the intervention in rural China. OOP expenditure, catastrophic Health Expenditure (CHE) incidence, and associated average gap (AG) were assessed across different income groups and project durations, measuring short-term direct medical cost. Medical debt rate and amount were used to measure long-term financial burden; concentration index (CI) was calculated for equity. All data were evaluated by descriptive statistics and multi-variate variance analysis. The linear regression and logit regression with random effect analysis upon area was used to evaluate the effect of CII. RESULTS Six hundred and thirteen and 834 patients were surveyed at baseline and final evaluation. After the program, the OOP payments of hospitalizations sharply decreased from RMB 39,363.2 to RMB 28,426.1 (p < 0.001), with the largest decrease for lowest income patients (from RMB 44,507.6 to RMB 29,214.2). With longer duration of CII, more OOP medical payments decreased. The amount of medical debt was decreased by RMB 7,209.4 among all the patients, and the decrease was highest in the highest income group (RMB 8,119.9). The CI of AG changed a lot (from -0.858 to -0.670). CONCLUSION The CII has effectively reduced the financial burden of patients with high medical cost, whether in the short-term or a longer length of time. It also improved health equity in health service utilization and expenditure. However, rich householders still receive more benefits from the policy, government health insurance financing is increased, and the policy needs to further benefit the poor.
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Affiliation(s)
- Junnan Jiang
- a School of Medicine and Health Management , Huazhong University of Science and Technology , Wuhan , China
| | - Shanquan Chen
- b Jockey Club School of Public Health and Primary Care , Chinese University of Hong Kong , Hong Kong , China
| | - Yanjiao Xin
- a School of Medicine and Health Management , Huazhong University of Science and Technology , Wuhan , China
| | - Xuefeng Wang
- a School of Medicine and Health Management , Huazhong University of Science and Technology , Wuhan , China
| | - Li Zeng
- a School of Medicine and Health Management , Huazhong University of Science and Technology , Wuhan , China
| | - Zhengdong Zhong
- a School of Medicine and Health Management , Huazhong University of Science and Technology , Wuhan , China
| | - Li Xiang
- a School of Medicine and Health Management , Huazhong University of Science and Technology , Wuhan , China
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119
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Batmyagmar D, Kundi M, Ponocny-Seliger E, Lukas I, Lehrner J, Haslacher H, Winker R. High intensity endurance training is associated with better quality of life, but not with improved cognitive functions in elderly marathon runners. Sci Rep 2019; 9:4629. [PMID: 30874592 PMCID: PMC6420638 DOI: 10.1038/s41598-019-41010-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 02/25/2019] [Indexed: 12/26/2022] Open
Abstract
Impairment of cognitive functions in advanced age leads to a reduced quality of life and impaired ability to perform everyday tasks. The positive impact of physical exercise on the quality of life and well-being, also at a later age, is well established. However, the effect of endurance exercises, including long distance running and cycling, on cognitive function and mental health within the elderly population has still to be elucidated. To this end, elderly active marathoners (N = 50) aged over 60 years and non-athlete controls (N = 49) were followed for four years. Cognitive function was assessed using the CERAD test battery. In addition, the Short Form Health Survey (SF-36) was applied to assess self-reported physical, mental, and emotional health. Except for age, sex and education-corrected z-values of the test “Word list recall”, with marathon runners showing a decline compared to an improvement in controls (p < 0.05), there was no statistically significant difference in time trend between groups. In contrast, concerning self-reported health, scores in all eight domains of the SF-36 remained stable over time and, in nearly all of them, marathon runners showed higher self-reported health than controls. The results indicated that extensive endurance exercise is associated with improved subjective health but does not lead to better scores in cognitive performance tests in elderly persons.
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Affiliation(s)
- D Batmyagmar
- Centre for Public Health, Medical University of Vienna, Vienna, Austria
| | - M Kundi
- Centre for Public Health, Medical University of Vienna, Vienna, Austria
| | | | - I Lukas
- Health and Prevention Centre, Sanatorium Hera, Vienna, Austria
| | - J Lehrner
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - H Haslacher
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria.
| | - R Winker
- Health and Prevention Centre, Sanatorium Hera, Vienna, Austria
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Chhabra M, Sharma A, Ajay KR, Rathore MS. Assessment of risk factors, cost of treatment, and therapy outcome in stroke patients: evidence from cross-sectional study. Expert Rev Pharmacoecon Outcomes Res 2019; 19:575-580. [DOI: 10.1080/14737167.2019.1580574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Manik Chhabra
- Department of Pharmacy Practice, ISF College of Pharmacy, Moga, India
| | - Amit Sharma
- Department of Pharmacy Practice, ISF College of Pharmacy, Moga, India
| | | | - Mahendra Singh Rathore
- Department of Pharmacy Practice, MM College of Pharmacy, Maharishi Markandeshwar (Deemed to be University), Ambala, India
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121
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Juma K, Juma PA, Mohamed SF, Owuor J, Wanyoike A, Mulabi D, Odinya G, Njeru M, Yonga G. First Africa non-communicable disease research conference 2017: sharing evidence and identifying research priorities. J Glob Health 2019; 8:020301. [PMID: 30774938 PMCID: PMC6370979 DOI: 10.7189/jogh.09.010201] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Non-communicable diseases (NCDs) prevalence is rising fastest in lower income settings, and with more devastating outcomes compared to High Income Countries (HICs). While evidence is consistent on the growing health and economic consequences of NCDs in sub-Saharan Africa (SSA), specific efforts aimed at addressing NCD prevention and control remain less than optimum and country level progress of implementing evidence backed cost-effective NCD prevention approaches such as tobacco taxation and restrictions on marketing of unhealthy food and drinks is slow. Similarly, increasing interest to employ multi-sectoral approaches (MSA) in NCD prevention and policy is impeded by scarce knowledge on the mechanisms of MSA application in NCD prevention, their coordination, and potential successes in SSA. In recognition of the above gaps in NCD programming and interventions in Africa, the East Africa NCD alliance (EANCDA) in partnership with the African Population and Health Research Center (APHRC) organized a three-day NCDs conference in Nairobi. The conference entitled “First Africa Non-Communicable Disease Research Conference 2017: Sharing Evidence and Identifying Research Priorities” drew more than one hundred fifty participants and researchers from several institutions in Kenya, South Africa, Nigeria, Cameroon, Uganda, Tanzania, Rwanda, Burundi, Malawi, Belgium, USA and Canada. The sections that follow provide detailed overview of the conference, its objectives, a summary of the proceedings and recommendations on the African NCD research agenda to address NCD prevention efforts in Africa.
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Affiliation(s)
- Kenneth Juma
- African Population and Health Research Center, Nairobi, Kenya.,Clinical Epidemiology Unit, Makerere University, Kampala, Uganda
| | - Pamela A Juma
- African Population and Health Research Center, Nairobi, Kenya
| | | | - Jared Owuor
- African Institute for Health and Development, Nairobi, Kenya.,East Africa NCD Alliance, Kampala, Uganda.,NCD Alliance Kenya, Nairobi, Kenya
| | | | - David Mulabi
- East Africa NCD Alliance, Kampala, Uganda.,NCD Alliance Kenya, Nairobi, Kenya
| | | | | | - Gerald Yonga
- East Africa NCD Alliance, Kampala, Uganda.,NCD Alliance Kenya, Nairobi, Kenya.,University of Nairobi, Kenya
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Oyando R, Njoroge M, Nguhiu P, Kirui F, Mbui J, Sigilai A, Bukania Z, Obala A, Munge K, Etyang A, Barasa E. Patient costs of hypertension care in public health care facilities in Kenya. Int J Health Plann Manage 2019; 34:e1166-e1178. [PMID: 30762904 PMCID: PMC6618067 DOI: 10.1002/hpm.2752] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 01/16/2019] [Indexed: 11/09/2022] Open
Abstract
Background Hypertension in low‐ and middle‐income countries, including Kenya, is of economic importance due to its increasing prevalence and its potential to present an economic burden to households. In this study, we examined the patient costs associated with obtaining care for hypertension in public health care facilities in Kenya. Methods We conducted a cross‐sectional study among adult respondents above 18 years of age, with at least 6 months of treatment in two counties. A total of 212 patients seeking hypertension care at five public facilities were interviewed, and information on care seeking and the associated costs was obtained. We computed both annual direct and indirect costs borne by these patients. Results Overall, the mean annual direct cost to patients was US$ 304.8 (95% CI, 235.7‐374.0). Medicines (mean annual cost, US$ 168.9; 95% CI, 132.5‐205.4), transport (mean annual cost, US$ 126.7; 95% CI, 77.6‐175.9), and user charges (mean annual cost, US$ 57.7; 95% CI, 43.7‐71.6) were the highest direct cost categories. Overall mean annual indirect cost was US$ 171.7 (95% CI, 152.8‐190.5). The incidence of catastrophic health care costs was 43.3% (95% CI, 36.8‐50.2) and increased to 59.0% (95% CI, 52.2‐65.4) when transport costs were included. Conclusions Hypertensive patients incur substantial direct and indirect costs. High rates of catastrophic costs illustrate the urgency of improving financial risk protection for these patients and strengthening primary care to ensure affordability of hypertension care.
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Affiliation(s)
- Robinson Oyando
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Martin Njoroge
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Peter Nguhiu
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Fredrick Kirui
- Clinical Unit, KEMRI Centre for Clinical Research, Nairobi, Kenya
| | - Jane Mbui
- Clinical Unit, KEMRI Centre for Clinical Research, Nairobi, Kenya
| | - Antipa Sigilai
- Epidemiology and Demography, KEMRI Centre for Geographic Medicine Research, Coast, Kilifi, Kenya
| | - Zipporah Bukania
- Public health nutrition, maternal and child health unit, KEMRI Centre for Public Health Research, Nairobi, Kenya
| | - Andrew Obala
- Medical Microbiology and Parasitology, Moi University, Eldoret, Kenya
| | - Kenneth Munge
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Anthony Etyang
- Epidemiology and Demography, KEMRI Centre for Geographic Medicine Research, Coast, Kilifi, Kenya
| | - Edwine Barasa
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.,Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Haakenstad A, Coates M, Marx A, Bukhman G, Verguet S. Disaggregating catastrophic health expenditure by disease area: cross-country estimates based on the World Health Surveys. BMC Med 2019; 17:36. [PMID: 30755209 PMCID: PMC6372998 DOI: 10.1186/s12916-019-1266-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 01/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Financial risk protection (FRP) is a key objective of national health systems and a core pillar of universal health coverage (UHC). Yet, little is known about the disease-specific distribution of catastrophic health expenditure (CHE) at the national level. METHODS Using the World Health Surveys (WHS) from 39 countries, we quantified CHE, or household health spending that surpasses 40% of capacity-to-pay by key disease areas. We restricted our analysis to households in which the respondent used health care in the last 30 days and categorized CHE into disease areas included as WHS response options: maternal and child health (MCH); high fever, severe diarrhea, or cough; heart disease; asthma; injury; surgery; and other. We compared disease-specific CHE estimates by income, pooled funding as a share of total health expenditure, share of the population affected by the different diseases, and poverty status. RESULTS Across countries, an average of 45.1% of CHE cases could not be tied to a specific cause; 37.6% (95% UI 35.4-39.9%) of CHE cases were associated with high fever, severe cough, or diarrhea; 3.9% (3.0-4.9%) with MCH; and 4.1% (3.3-4.9%) with heart disease. Injuries constituted 5.2% (4.2-6.4%) of CHE cases. The distribution of CHE varied substantially by national income. A 10% increase in heart disease prevalence was associated with a 1.9% (1.3-2.4%) increase in heart disease CHE, an association stronger than any other disease area. CONCLUSIONS Our approach is comparable, comprehensive, and empirically based and highlights how financial risk protection may not be aligned with disease burden. Disease-specific CHE estimates can illuminate how health systems can target reform to best protect households from financial risk.
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Affiliation(s)
- Annie Haakenstad
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA.
| | - Matthew Coates
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
| | - Andrew Marx
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
| | - Gene Bukhman
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA
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Dias RD, Barros JVD. Burden of hospitalisation among older people in the Brazilian public health system: a big data analysis from 2009 to 2015. J Epidemiol Community Health 2019; 73:537-543. [PMID: 30728202 DOI: 10.1136/jech-2018-210783] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 12/09/2018] [Accepted: 01/14/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND The world's population is progressively ageing, and this trend imposes several challenges to society and governments. The aim of this study was to investigate the burden generated by the hospitalisation of older (>60 years) compared with non-older population, as well as the epidemiology of these hospital admissions. METHODS Using the Brazilian Unified Health System (known as 'Sistema Único de Saúde' (SUS)), an analysis of all hospital admissions of adult patients in the SUS from 2009 to 2015 was undertaken. The following indicators were used: hospital admission rate, intensive care unit (ICU) admission rate, average length of hospital and ICU stay, hospital mortality and average reimbursement per hospitalisation. RESULTS A total of 61 958 959 admissions during the 7-year period, were analysed, encompassing 17 893 392 (28.9%) older patients. Elderly represent 15% (n=21 294 950) of the Brazilian adult population, but are responsible for 29% (n=17 893 392) of hospitalisations, 52% (n=1 731 299) of ICU admissions and 66% (n=1 885 291) of hospital mortality. Among the adults, elderly represents 39% of the total reimbursement made related to admission/hospitalisation. For 2009 to 2015, while the older population increased 27%, ICU admission rate increased 20%; the average length of ICU stay was 12% higher in 2015 (6.5 days) compared with 2009 (5.8 days); and the hospital mortality increased from 9.8% to 11.2%. CONCLUSION These findings illustrate the current panorama of the burden due to hospitalisation of older people in the Brazilian public health system, and evidence the consolidation of the epidemiological transition toward the predominance of non-communicable diseases as the main cause of hospitalisation among the elderly in Brazil.
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Affiliation(s)
- Roger Daglius Dias
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA.,STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, MA, USA
| | - Jacson Venancio de Barros
- Department of Information Technology, Hospital das Clínicas of the University of São Paulo Medical School, Sao Paulo, Brazil
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125
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Chong SP, Appannah G, Sulaiman N. Predictors of Diet Quality as Measured by Malaysian Healthy Eating Index among Aboriginal Women (Mah Meri) in Malaysia. Nutrients 2019; 11:nu11010135. [PMID: 30634596 PMCID: PMC6356371 DOI: 10.3390/nu11010135] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 12/30/2018] [Accepted: 01/07/2019] [Indexed: 11/24/2022] Open
Abstract
Socioeconomic status and nutrition knowledge are the determining factors of food choices. However, their relationship with diet quality is ambiguous among aboriginal women in Malaysia. Henceforth, the objective of this study was to examine diet quality and its predictors among the aboriginal women from the Mah Meri ethnic group in Malaysia. Data on socioeconomic characteristics, nutrition knowledge, and 24-h dietary recalls were obtained through face-to-face interviews with the respondents. Household food insecurity was assessed using Radimer/Cornell Hunger and Food Insecurity Instrument. The Malaysian Healthy Eating Index (HEI) was used to measure the diet quality of this population. The overall diet quality of the respondents was poor, with a mean Malaysian HEI score of 45.3%. Household income (r = 0.242, p < 0.001) and nutrition knowledge (r = 0.150, p < 0.05) were positively correlated with diet quality. More importantly, the predictors of diet quality were marital status (β = 0.181, p < 0.01), household income (β = 0.237, p < 0.001), food security status (β = −0.151, p < 0.01), and fat intake (β = −0.438, p < 0.001). Women being married and those with higher household income was associated with a better diet quality among Malaysian aborigines.
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Affiliation(s)
- Su Pei Chong
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor 43400, Malaysia.
| | - Geeta Appannah
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor 43400, Malaysia.
| | - Norhasmah Sulaiman
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor 43400, Malaysia.
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Datta BK, Husain MJ, Fatehin S, Kostova D. Consumption displacement in households with noncommunicable diseases in Bangladesh. PLoS One 2018; 13:e0208504. [PMID: 30543648 PMCID: PMC6292644 DOI: 10.1371/journal.pone.0208504] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 11/07/2018] [Indexed: 11/18/2022] Open
Abstract
The economic burden of noncommunicable diseases (NCDs), including treatment costs and income and productivity losses, is a growing concern in developing countries, where NCD medical expenditure may offset consumption of other essential commodities. This study examines the role of NCDs in household resource allocation in Bangladesh. We use the Bangladesh Household Income and Expenditure Survey (HIES) 2010 to obtain expenditure data on 11 household expenditure categories and 12 food expenditure sub-categories for 12,240 households. Household NCD status was determined through self-report of at least one of the six major NCDs within the household-heart disease, hypertension, diabetes, kidney diseases, asthma, and cancer. We estimated unadjusted and regression-adjusted differences in household expenditure shares between NCD and non-NCD households. We further investigated how consumption of different food sub-categories is related to NCD status, distinguishing between household economic levels. The medical expenditure share was estimated to be 59% higher for NCD households than non-NCD households, and NCD households had lower expenditure shares on food, clothing, hygiene, and energy. Regression results indicated that presence of NCDs was associated with lower relative expenditure on clothing and housing in all economic subgroups, and with lower expenditure on food among marginally poor households. Having an NCD was significantly associated with higher household spending on tobacco and higher-calorie foods such as sugar, beverages, meat, dairy, and fruit, and with lower spending on fish, vegetables, and legumes. The findings indicate a link between NCDs and the possibility of adverse economic effects on the household by highlighting the potential displacement effect on household consumption that might occur through higher medical expenditure and lower spending on essentials. The findings might also point to a need for raising awareness about the link between NCDs and diet in Bangladesh.
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Affiliation(s)
- Biplab Kumar Datta
- Global Noncommunicable Diseases Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Muhammad Jami Husain
- Global Noncommunicable Diseases Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Sohani Fatehin
- Department of Economics, Dickinson College, Carlisle, PA, United States of America
| | - Deliana Kostova
- Global Noncommunicable Diseases Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
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Parkin CG, Homberg A, Hinzmann R. 11th Annual Symposium on Self-Monitoring of Blood Glucose: April 12-14, 2018, Oslo, Norway. Diabetes Technol Ther 2018; 20:857-880. [PMID: 30285477 DOI: 10.1089/dia.2018.0284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A panel of international experts in the field of diabetes and diabetes technology met in Oslo, Norway, for the 11th Annual Symposium on Self-Monitoring of Blood Glucose. The goal of these meetings is to share current knowledge, facilitate new collaborations, and encourage further research projects that can improve the lives of people with diabetes. The 2018 meeting comprised a comprehensive scientific program and four keynote lectures.
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128
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Saleh S, El Harakeh A, Baroud M, Zeineddine N, Farah A, Sibai AM. Costs associated with management of non-communicable diseases in the Arab Region: a scoping review. J Glob Health 2018; 8:020410. [PMID: 30546867 PMCID: PMC6287209 DOI: 10.7189/jogh.08.020410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Global mortality rates resulting from non-communicable diseases (NCDs) are reaching alarming levels, especially in low- and middle-income countries, imposing a considerable burden on individuals and health systems as a whole. This scoping review aims at synthesizing the existing literature evaluating the cost associated with the management and treatment of major NCDs across all Arab countries; at evaluating the quality of these studies; and at identifying the gap in existing literature. METHODS A systematic search was conducted using Medline electronic database to retrieve articles evaluating costs associated with management of NCDs in Arab countries, published in English between January 2000 and April 2016. 55 studies met the eligibility criteria and were independently screened by two reviewers who extracted/calculated the following information: country, theme (management of NCD, treatment/medication, or procedure), study design, setting, population/sample size, publication year, year for cost data cost conversion (US$), costing approach, costing perspective, type of costs, source of information and quality evaluation using the Newcastle-Ottawa Scale (NOS). RESULTS The reviewed articles covered 16 countries in the Arab region. Most of the studies were observational with a retrospective or prospective design, with a relatively low to very low quality score. Our synthesis revealed that NCDs' management costs in the Arab region are high; however, there is a large variation in the methods used to quantify the costs of NCDs in these countries, making it difficult to conduct any type of comparisons. CONCLUSIONS The findings revealed that data on the direct costs of NCDs remains limited by the paucity of this type of evidence and the generally low quality of studies published in this area. There is a need for future studies, of improved and harmonized methodology, as such evidence is key for decision-makers and directs health care planning.
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Affiliation(s)
- Shadi Saleh
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Amena El Harakeh
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Maysa Baroud
- Refugee Research and Policy Program, Issam Fares Institute for Public Policy and International Affairs. American University of Beirut, Beirut, Lebanon
| | - Najah Zeineddine
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Angie Farah
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Abla Mehio Sibai
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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129
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Rijal A, Adhikari TB, Khan JAM, Berg-Beckhoff G. The economic impact of non-communicable diseases among households in South Asia and their coping strategy: A systematic review. PLoS One 2018; 13:e0205745. [PMID: 30462648 PMCID: PMC6248902 DOI: 10.1371/journal.pone.0205745] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 10/01/2018] [Indexed: 12/31/2022] Open
Abstract
Background Out of pocket payment (OOPP), is the major health financing mechanism in South Asia region. With the rising burden of non-communicable diseases (NCDs), the region is facing a high financial burden. However, the extent and nature of economic impact caused by treatment and management of NCDs at the household level is yet unknown. Method We conducted a systematic review using Medline and Embase databases. Only peer-reviewed quantitative studies published between January 2000 to December 2016 assessing OOPP or catastrophic health expenditure or impoverishment or financial coping strategy due to at least one of the four major NCDs—cardiovascular diseases(CVDs), diabetes, cancer, chronic respiratory disease in South Asia region was included in the review. The review is registered in PROSPERO no: CRD42017059345. Results A total of 21 studies (of 2693 records identified) met the inclusion criteria. The economic impact was most frequently studied in CVDs and in terms of OOPP. The studies collectively indicated high OOPP, higher likelihood of catastrophic expenditure and impoverishment for inpatient care for these major NCDs which was visible in all income levels. Borrowing and selling off assets were the most common forms of coping strategies adopted and varied inconsistently between urban and rural households. The true extent of the economic impact, however, remains difficult to determine due to methodological heterogeneity regarding outcomes reported and measures employed for calculation of OOPP, catastrophic expenditure, and impoverishment across these four major NCDs and between nations. Conclusion The economic impact due to treatment and management of CVDs, diabetes, cancer and chronic respiratory diseases among households in South Asia seems dire. Given the lack of sufficient evidence the review stresses the need for further research in the region to develop evidence-informed nationally tailored prepayment mechanisms covering NCDs to reduce economic vulnerability and standardization of tools measuring the economic impact for generating comparable estimates.
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Affiliation(s)
- Anupa Rijal
- Young Earth, Kathmandu, Nepal
- Nepal Development Society, Chitwan, Nepal
- * E-mail:
| | - Tara Ballav Adhikari
- Nepal Development Society, Chitwan, Nepal
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Jahangir A. M. Khan
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden
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Wamai RG, Kengne AP, Levitt N. Non-communicable diseases surveillance: overview of magnitude and determinants in Kenya from STEPwise approach survey of 2015. BMC Public Health 2018; 18:1224. [PMID: 30400841 PMCID: PMC6218983 DOI: 10.1186/s12889-018-6051-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Richard G Wamai
- Integrated Initiative for Global Health, Department of Cultures, Societies and Global Studies, Northeastern University, Boston, MA USA
| | - Andre Pascal Kengne
- Non Communicable Diseases Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town, Western Cape South Africa
| | - Naomi Levitt
- Diabetic Medicine and Endocrinology, University of Cape Town, J47/86 Old Main Building Groote Schuur Hospital, Observatory, Cape Town, 7925 South Africa
- Chronic Disease Initiative for Africa (CDIA), University of Capetown, J47/86 Old Main Building Groote Schuur Hospital, Observatory, Cape Town, 7925 South Africa
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131
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Mohamed SF, Mwangi M, Mutua MK, Kibachio J, Hussein A, Ndegwa Z, Owondo S, Asiki G, Kyobutungi C. Prevalence and factors associated with pre-diabetes and diabetes mellitus in Kenya: results from a national survey. BMC Public Health 2018; 18:1215. [PMID: 30400865 PMCID: PMC6218998 DOI: 10.1186/s12889-018-6053-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Diabetes Mellitus is one of the four major non-communicable diseases causing about 4 million deaths in 2017. By 2040, low income countries are projected to experience 92% increase in mortality due to diabetes. Undiagnosed diabetes poses a public health concern with costly public health implications especially in Africa. It is therefore crucial to examine the burden and risk factors for diabetes at national level to inform policy and national programs. METHODS Data from the 2015 Kenya national STEPs survey of adults aged 18-69 years were used. Pre-diabetes was defined as impaired fasting blood glucose level (6.1 mmol/l to < 7 mmol/l) while diabetes was defined as impaired fasting blood glucose level ≥ 7 mmol/l. Descriptive statistics were used to determine the prevalence of pre-diabetes and diabetes and logistic regression was used to identify associated factors. RESULTS Complete data for 4069 respondents (51% females), with 46% aged 18-29 and 61% in rural areas were analyzed. The age-standardized prevalence for pre-diabetes and diabetes were 3.1% (95% CI: 2.2, 4.0) and 2.4% (1.8, 3.0) respectively. Only 43.7% were aware of their glycemic condition, one in five of those who had diabetes had received treatment, and only 7% of those diagnosed with diabetes had their blood glucose under control. Primary education ((both incomplete (0.21, 95%CI 0.10-0.47) and complete (0.40, 95%CI 0.23-0.71)) were associated with lower odds of pre-diabetes. Older age (60-69 years, AOR; 5.6, 95%CI 2.1-15.1) and raised blood pressure (2.8, 95% CI 1.5-5.0) were associated diabetes while overweight/obesity among women was associated with diabetes. CONCLUSION The overall diabetes prevalence in Kenya is consistent with what has been reported in other sub-Saharan African countries. Of concern is the higher prevalence of pre-diabetes and undiagnosed diabetes that can progress to complications in the absence of interventions and the low diabetes awareness and control. This is the first nationally representative study to identify important groups at risk of pre-diabetes and diabetes that can be targeted for screening, health promotion and treatment.
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Affiliation(s)
- Shukri F Mohamed
- Health and Systems for Health Unit, African Population and Health Research Center (APHRC), Nairobi, Kenya
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Martin Mwangi
- Field Epidemiology and Laboratory Training Programme, Ministry of Health, Nairobi, Kenya
- NCD unit, Ministry of Health, Nairobi, Kenya
| | - Martin K Mutua
- Health and Systems for Health Unit, African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Joseph Kibachio
- NCD unit, Ministry of Health, Nairobi, Kenya
- The Institute of Global Health, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland
| | - Abubakar Hussein
- Field Epidemiology and Laboratory Training Programme, Ministry of Health, Nairobi, Kenya
- NCD unit, Ministry of Health, Nairobi, Kenya
| | | | | | - Gershim Asiki
- Health and Systems for Health Unit, African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Catherine Kyobutungi
- Health and Systems for Health Unit, African Population and Health Research Center (APHRC), Nairobi, Kenya
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Wekesah FM, Nyanjau L, Kibachio J, Mutua MK, Mohamed SF, Grobbee DE, Klipstein-Grobusch K, Ngaruiya C, Haregu TN, Asiki G, Kyobutungi CK. Individual and household level factors associated with presence of multiple non-communicable disease risk factors in Kenyan adults. BMC Public Health 2018; 18:1220. [PMID: 30400905 PMCID: PMC6219015 DOI: 10.1186/s12889-018-6055-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs), are increasing globally, causing about 60% of disability-adjusted life years and 39.8 million deaths in 2015. Risk factors often cluster and interact multiplicatively in an individual and this is strongly associated with the development and severity of NCDs. We assessed the sociodemographic factors associated with the presence of multiple NCD risk factors among individuals aged 18 years and older in the Kenyan population. METHODS We used national representative data from 4066 individuals out of 4500 who participated in the WHO STEPs study in 2015. NCD risk factor counts were derived by summing the risk factors present in an individual and categorising into 1-3, 4-6 and 7+ risk factors in any combination of the 12 assessed NCD risk factors (hypertension, diabetes mellitus, cholesterol, insufficient physical activity, excessive alcohol use, tobacco use and obesity, excess sugar intake, insufficient fruit and vegetables intake, high salt consumption, and use of unhealthy cooking fats and oils). Ordered logistic regression was used to investigate the sociodemographic factors associated with an individual possesing multiple NCD risk factors. RESULTS Majority (75.8%) of the individuals in the study possesed 4-6 and 10% had ≥7 NCDs risk factors. Nearly everyone (99.8%) had insufficient fruits and vegetable intakes, 89.5% consumed high salt in their diet and 80.3% did not engage in sufficient physical activity. Apart from NCD risk count which increased with age among both men and women, associations with other socio-demographic factors differed between men and women. A woman of Akamba ethinicity had lower odds (0.43) while Meru women had higher odds (3.58) of higher NCD risk factor count, compared to the Kalenjin women. Among men, being a Kisii or Luo was associated with lower odds (0.48 and 0.25 respectively) of higher NCD risk factor count. Women in a marital union had higher odds (1.58) of a higher NCD risk factor count. CONCLUSION Majority of Kenyan adults possess more than four NCD risk factors; a clear indication of an emerging epidemic of NCDs in this population. Effective and multi-sectoral interventions targeting multiple risk factors in individuals are required to mitigate especially the behavioural and modifiable NCD risk factors in Kenya.
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Affiliation(s)
- Frederick M Wekesah
- African Population and Health Research Center, 2nd Floor, APHRC Campus, Manga Close, Off Kirawa Road, Kitisuru, P.O. Box 10787 00100, Nairobi, Kenya
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, Netherlands
| | - Loise Nyanjau
- Division of Non Communicable Diseases, Ministry of Health, Nairobi, Kenya
| | - Joseph Kibachio
- Division of Non Communicable Diseases, Ministry of Health, Nairobi, Kenya
- The Institute of Global Health, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland
| | - Martin K Mutua
- African Population and Health Research Center, 2nd Floor, APHRC Campus, Manga Close, Off Kirawa Road, Kitisuru, P.O. Box 10787 00100, Nairobi, Kenya
| | - Shukri F Mohamed
- African Population and Health Research Center, 2nd Floor, APHRC Campus, Manga Close, Off Kirawa Road, Kitisuru, P.O. Box 10787 00100, Nairobi, Kenya
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, Netherlands
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Tilahun N Haregu
- African Population and Health Research Center, 2nd Floor, APHRC Campus, Manga Close, Off Kirawa Road, Kitisuru, P.O. Box 10787 00100, Nairobi, Kenya
| | - Gershim Asiki
- African Population and Health Research Center, 2nd Floor, APHRC Campus, Manga Close, Off Kirawa Road, Kitisuru, P.O. Box 10787 00100, Nairobi, Kenya
| | - Catherine K Kyobutungi
- African Population and Health Research Center, 2nd Floor, APHRC Campus, Manga Close, Off Kirawa Road, Kitisuru, P.O. Box 10787 00100, Nairobi, Kenya
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Lankoandé B, Duthé G, Soura A, Pison G. Returning home to die or leaving home to seek health care? Location of death of urban and rural residents in Burkina Faso and Senegal. Glob Health Action 2018; 11:1475040. [PMID: 29869949 PMCID: PMC5990939 DOI: 10.1080/16549716.2018.1475040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background: In sub-Saharan Africa, the literature on end of life is limited and focuses on place of death as an indicator of access and utilization of health-care resources. Little is known about population mobility at the end of life. Objective: To document the magnitude, motivations and associated factors of short-term mobility before death among adults over 15 years of age in Burkina Faso and Senegal. Methods: The study was based on deaths of adult residents reported in three Health and Demographic Surveillance System (HDSS) sites in urban (Ouagadougou) and semi-rural areas (Kaya) of Burkina Faso, and rural areas of Senegal (Mlomp). After excluding deaths from external causes, the analysis covered, respectively, 536 and 695 deaths recorded during the period 2012–2015 in Ouagadougou and Kaya. The period was extended to 2000–2015 in Mlomp, with a sample of 708 deaths. Binary logistic regressions were used to examine the effects of socio-demographic characteristics on place of death (health facility or not) and location of death (within or outside the HDSS). Results: In Mlomp, Kaya and Ouagadougou, respectively 20.6%, 5.3% and 5.9% of adults died outside the HDSS site. In Mlomp and Kaya, these deaths were more likely to occur in a health facility than deaths that occurred within the site. The reverse situation was found in Ouagadougou. Age is the strongest determinant of mobility before death in Mlomp and Kaya. In Mlomp, young adults (15–39) were 10 times more likely to die outside the site than adults in the 60–79 age group. In Ouagadougou, non-natives were three times more likely to die outside the city than natives. Conclusions: At the end of life, some rural residents move to urban areas for medical treatment while some urban dwellers return to their village for supportive care. These movements of dying individuals may affect the estimation of urban/rural mortality differentials.
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Affiliation(s)
- Bruno Lankoandé
- a Center for Demographic Research , Université catholique de Louvain , Louvain-la-Neuve , Belgium
| | | | - Abdramane Soura
- c Institut supérieur des sciences de la population , Université de Ouagadougou , Ouagadougou , Burkina Faso
| | - Gilles Pison
- b French Institute for Demographic Studies , Paris , France.,d Museum national d'histoire naturelle , Paris , France
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Njagi P, Arsenijevic J, Groot W. Understanding variations in catastrophic health expenditure, its underlying determinants and impoverishment in Sub-Saharan African countries: a scoping review. Syst Rev 2018; 7:136. [PMID: 30205846 PMCID: PMC6134791 DOI: 10.1186/s13643-018-0799-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 08/20/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND To assess the financial burden due to out of pocket (OOP) payments, two mutually exclusive approaches have been used: catastrophic health expenditure (CHE) and impoverishment. Sub-Saharan African (SSA) countries primarily rely on OOP and are thus challenged with providing financial protection to the populations. To understand the variations in CHE and impoverishment in SSA, and the underlying determinants of CHE, a scoping review of the existing evidence was conducted. METHODS This review is guided by Arksey and O'Malley scoping review framework. A search was conducted in several databases including PubMed, EBSCO (EconLit, PsychoInfo, CINAHL), Web of Science, Jstor and virtual libraries of the World Health Organizations (WHO) and the World Bank. The primary outcome of interest was catastrophic health expenditure/impoverishment, while the secondary outcome was the associated risk factors. RESULTS Thirty-four (34) studies that met the inclusion criteria were fully assessed. CHE was higher amongst West African countries and amongst patients receiving treatment for HIV/ART, TB, malaria and chronic illnesses. Risk factors associated with CHE included household economic status, type of health provider, socio-demographic characteristics of household members, type of illness, social insurance schemes, geographical location and household size/composition. The proportion of households that are impoverished has increased over time across countries and also within the countries. CONCLUSION This review demonstrated that CHE/impoverishment is pervasive in SSA, and the magnitude varies across and within countries and over time. Socio-economic factors are seen to drive CHE with the poor being the most affected, and they vary across countries. This calls for intensifying health policies and financing structures in SSA, to provide equitable access to all populations especially the most poor and vulnerable. There is a need to innovate and draw lessons from the 'informal' social networks/schemes as they are reported to be more effective in cushioning the financial burden.
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Affiliation(s)
- Purity Njagi
- United Nations University - Maastricht Economic and social Research institute on Innovation and Technology(UNU-MERIT), Maastricht University, Maastricht, The Netherlands
| | - Jelena Arsenijevic
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Faculty of Law, Economics and Governance, Utrecht University, Utrecht, The Netherlands
| | - Wim Groot
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Nascimben J, Cubbison C, Lape EC, Katz JN. Strategies for Managing the Costs of Chronic Illness in the Context of Limited Financial Resources: A Qualitative Study in Dominican Persons With Arthritis. Arthritis Care Res (Hoboken) 2018; 71:1379-1386. [PMID: 30171806 DOI: 10.1002/acr.23742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 08/28/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Persons who reside in low- and middle-income countries often have insufficient resources to pay for treatments prescribed for their medical conditions. The aim of this study was to determine, using qualitative methods, how patients with arthritis in the Dominican Republic manage the costs associated with chronic illnesses. METHODS We conducted individual interviews with 17 Dominican adults with advanced arthritis who were undergoing total knee replacement or total hip replacement at a hospital in Santo Domingo, Dominican Republic. Interviewers followed a moderator's guide with questions pertaining to the financial demands of arthritis treatment and the strategies participants used to pay for treatments. Interviews were audio recorded, transcribed verbatim, and translated into English. We used thematic analysis to identify salient themes. RESULTS The thematic analysis suggested that health system factors (such as the extent of reimbursement for medications available in the public health care system) along with personal factors (such as disposable income) shaped individuals' experiences of managing chronic illness. These systemic and personal factors contributed to a sizeable gap between the cost of care and the amount most participants were able to pay. Participants managed this resource gap using a spectrum of strategies ranging from acceptance (or, "making do with less") to resourcefulness (or, "finding more"). Participants were aided by strong community bonds and religiously oriented resilience. CONCLUSION This qualitative study illuminates the range of strategies Dominican individuals with limited resources use to obtain health care and manage chronic illness. The findings raise hypotheses that warrant further study and could help guide provider-patient conversations regarding treatment adherence.
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Affiliation(s)
| | - Caroline Cubbison
- Massachusetts General Hospital, Boston Massachusetts and Universidad Iberoamericana, Santo Domingo, Dominican Republic
| | - Emma C Lape
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Jeffrey N Katz
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Pallegedara A. Impacts of chronic non-communicable diseases on households' out-of-pocket healthcare expenditures in Sri Lanka. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2018; 18:301-319. [PMID: 29322278 DOI: 10.1007/s10754-018-9235-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/03/2018] [Indexed: 06/07/2023]
Abstract
This article examines the effects of chronic non-communicable diseases (NCDs) on households' out-of-pocket health expenditures in Sri Lanka. We explore the disease specific impacts on out-of-pocket health care expenses from chronic NCDs such as heart diseases, hypertension, cancer, diabetics and asthma. We use nationwide cross-sectional household income and expenditure survey 2012/2013 data compiled by the department of census and statistics of Sri Lanka. Employing propensity score matching method to account for selectivity bias, we find that chronic NCD affected households appear to spend significantly higher out-of-pocket health care expenditures and encounter grater economic burden than matched control group despite having universal public health care policy in Sri Lanka. The results also suggest that out-of-pocket expenses on medicines and other pharmaceutical products as well as expenses on medical laboratory tests and other ancillary services are particularly higher for households with chronic NCD patients. The findings underline the importance of protecting households against the financial burden due to NCDs.
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Affiliation(s)
- Asankha Pallegedara
- Department of Industrial Management, Faculty of Applied Sciences, Wayamba University of Sri Lanka, Kuliyapitiya, 60200, Sri Lanka.
- Chair of Development Economics, Faculty of Business Administration and Economics, University of Passau, Innstrasse 29, 94032, Passau, Germany.
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137
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Wang L, Li Y, Deng W, Dong Z, Li X, Liu D, Zhao L, Fu W, Cho K, Niu H, Guo D, Cheng J, Jiang B. Cardio-protection of ultrafine granular powder for Salvia miltiorrhiza Bunge against myocardial infarction. JOURNAL OF ETHNOPHARMACOLOGY 2018; 222:99-106. [PMID: 29694847 DOI: 10.1016/j.jep.2018.04.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 04/19/2018] [Accepted: 04/20/2018] [Indexed: 05/22/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Myocardial infarction (MI) is considered as the major inducer to the morbidity and mortality related to coronary occlusion. Salvia miltiorrhiza Bunge is widely applied in the clinic for the prevention and treatment of heart diseases. The preparation of traditional herb decoction (THD) is not only time consuming but also difficult to keep uniform for every time. New usage form of Salvia miltiorrhiza Bunge with characteristics of convenience, uniform and efficiency is needed. AIM OF THE STUDY The aims of present study were to investigate the cardio-protection of ultrafine granular powder (UGP) of Salvia miltiorrhiza Bunge; and further compare the characteristics of UGP with THD. MATERIALS AND METHODS MI was induced by ligation of the left anterior descending coronary artery near the main pulmonary artery. Cardio-protection of UGP or THD was evaluated based on two sets of experiments, one was acute myocardial infarction (AMI) through 7 days preventive administration, and the other one was chronic cardiac remodeling through 28 days therapeutic administration. Hemodynamic measurement was conducted to evaluate heart function and histopathological detection was used to evaluate heart structure. RESULTS No significant improvement of heart structure and function was detected for preventive administration of UGP or THD on AMI rats. While, more significant improvements on left ventricular systolic and diastolic function were detected with therapeutic treatment with 0.81 g/kg UGP than same dose of THD on rats against chronic cardiac remodeling. Both UGP and THD showed the protective effects on heart structure, especially against fibrosis with long-term therapeutic treatment. CONCLUSIONS As a new usage form of Salvia miltiorrhiza Bunge, UGP showed significant cardio-protection against myocardial remodeling with therapeutic treatment. Comparing with THD, UGP also holds the advantages of uniform, convenience and efficiency.
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Affiliation(s)
- Linlin Wang
- Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China
| | - Yuanmin Li
- Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China
| | - Wen Deng
- Key Laboratory of Technologies and Applications of Ultrafine Granular Powder of Chinese Materia Medica, State Administration of Traditional Chinese Medicine, China
| | - Zhihui Dong
- Departments of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xue Li
- Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China
| | - Dan Liu
- Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China
| | - Lijie Zhao
- Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China
| | - Weiguo Fu
- Departments of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kenka Cho
- Takarazuka University of Medical and Health Care, Hanayashiki-Midorigaoka, Takarazuka City, Japan
| | | | - Dean Guo
- Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China
| | - Jinle Cheng
- Key Laboratory of Technologies and Applications of Ultrafine Granular Powder of Chinese Materia Medica, State Administration of Traditional Chinese Medicine, China.
| | - Baohong Jiang
- Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China.
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Gheorghe A, Griffiths U, Murphy A, Legido-Quigley H, Lamptey P, Perel P. The economic burden of cardiovascular disease and hypertension in low- and middle-income countries: a systematic review. BMC Public Health 2018; 18:975. [PMID: 30081871 PMCID: PMC6090747 DOI: 10.1186/s12889-018-5806-x] [Citation(s) in RCA: 225] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 07/05/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The evidence on the economic burden of cardiovascular disease (CVD) in low- and middle- income countries (LMICs) remains scarce. We conducted a comprehensive systematic review to establish the magnitude and knowledge gaps in relation to the economic burden of CVD and hypertension on households, health systems and the society. METHODS We included studies using primary or secondary data to produce original economic estimates of the impact of CVD. We searched sixteen electronic databases from 1990 onwards without language restrictions. We appraised the quality of included studies using a seven-question assessment tool. RESULTS Eighty-three studies met the inclusion criteria, most of which were single centre retrospective cost studies conducted in secondary care settings. Studies in China, Brazil, India and Mexico contributed together 50% of the total number of economic estimates identified. The quality of the included studies was generally low. Reporting transparency, particularly for cost data sources and results, was poor. The costs per episode for hypertension and generic CVD were fairly homogeneous across studies; ranging between $500 and $1500. In contrast, for coronary heart disease (CHD) and stroke cost estimates were generally higher and more heterogeneous, with several estimates in excess of $5000 per episode. The economic perspective and scope of the study appeared to impact cost estimates for hypertension and generic CVD considerably less than estimates for stroke and CHD. Most studies reported monthly costs for hypertension treatment around $22. Average monthly treatment costs for stroke and CHD ranged between $300 and $1000, however variability across estimates was high. In most LMICs both the annual cost of care and the cost of an acute episode exceed many times the total health expenditure per capita. CONCLUSIONS The existing evidence on the economic burden of CVD in LMICs does not appear aligned with policy priorities in terms of research volume, pathologies studied and methodological quality. Not only is more economic research needed to fill the existing gaps, but research quality needs to be drastically improved. More broadly, national-level studies with appropriate sample sizes and adequate incorporation of indirect costs need to replace small-scale, institutional, retrospective cost studies.
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Affiliation(s)
- Adrian Gheorghe
- Oxford Policy Management Ltd, Level 3 Clarendon House, 52 Cornmarket St, Oxford, OX1 3HJ UK
- Department of Global Health and Development, LSHTM, Keppel Street, London, WC1E 7HT UK
| | - Ulla Griffiths
- UNICEF, 3 United Nations Plaza, New York, NY 10017 USA
- Department of Global Health and Development, LSHTM, Keppel Street, London, WC1E 7HT UK
| | - Adrianna Murphy
- Centre for Global Chronic Conditions, LSHTM, Keppel Street, London, WC1E 7HT UK
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore, 117549 Singapore
- LSHTM, Keppel Street, London, WC1E 7HT UK
| | - Peter Lamptey
- Department of Non-communicable Disease Epidemiology, LSHTM, Keppel Street, London, WC1E 7HT UK
| | - Pablo Perel
- Centre for Global Chronic Conditions, LSHTM, Keppel Street, London, WC1E 7HT UK
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Gutierrez JP, Garcia-Saiso S, Aracena BM. Mexico's household health expenditure on diabetes and hypertension: What is the additional financial burden? PLoS One 2018; 13:e0201333. [PMID: 30052668 PMCID: PMC6063432 DOI: 10.1371/journal.pone.0201333] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 07/13/2018] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE This study aimed to estimate the magnitude of the association between overall household health expenditures & the presence of members with a chronic disease in the household. RESEARCH DESIGN & METHODS This was a cross-sectional analysis of a probabilistic household survey, which gathered data on previously diagnosed type 2 diabetes mellitus and hypertension as well as health expenditure in Mexico. From an analytic sample of 44,000 households, we identified those having at least one member with diabetes or hypertension and determined their health expenditure. Using matching procedures, we compared these data with those of households lacking such individuals. RESULTS We found that 24% of the households had at least one member who had been diagnosed with diabetes, hypertension, or both. Households with such members reported health expenditures that were 25%-34% (P <0.01) higher than households without such individuals. Such differences were more pronounced among households at lower socioeconomic levels and among those with no or limited health insurance. CONCLUSIONS In addition to their impact on individual health, chronic ailments exert financial pressure on households. The additional health-care expenditure for households owing to such diseases leaves them financially exposed-especially households with lower income levels.
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Bollyky TJ, Templin T, Cohen M, Dieleman JL. Lower-Income Countries That Face The Most Rapid Shift In Noncommunicable Disease Burden Are Also The Least Prepared. Health Aff (Millwood) 2018; 36:1866-1875. [PMID: 29137514 PMCID: PMC7705176 DOI: 10.1377/hlthaff.2017.0708] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Demographic and epidemiological changes are shifting the disease burden from communicable to noncommunicable diseases in lower-income countries. Within a generation, the share of disease burden attributed to noncommunicable diseases in some poor countries will exceed 80 percent, rivaling that of rich countries, but this burden is likely to affect much younger people in poorer countries. The health systems of lower-income countries are unprepared for this change. We examined the shift to noncommunicable diseases and estimated preparedness for the shift by ranking 172 nations using a health system capacity index for noncommunicable disease. We project that the countries with the greatest increases in the share of disease burden attributable to noncommunicable disease over the next twenty-five years will also be the least prepared for the change, as they ranked low on our capacity index and are expected to have the smallest increases in national health spending. National governments and donors must invest more in preparing the health systems of lower-income countries for the dramatic shift to noncommunicable diseases and in reducing modifiable noncommunicable disease risks.
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Affiliation(s)
- Thomas J Bollyky
- Thomas J. Bollyky is a senior fellow for global health, economics, and development at the Council on Foreign Relations, in Washington, D.C
| | - Tara Templin
- Tara Templin is a graduate student in the Department of Health Research and Policy, Stanford University, in Palo Alto, California
| | - Matthew Cohen
- Matthew Cohen is a research associate for global health, economics, and development at the Council on Foreign Relations
| | - Joseph L Dieleman
- Joseph L. Dieleman ( ) is an assistant professor at the Institute for Health Metrics and Evaluation, University of Washington, in Seattle
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Yu X, Wang X, Zeng S, Tuo X. Protective effects of primary neural stem cell treatment in ischemic stroke models. Exp Ther Med 2018; 16:2219-2228. [PMID: 30186461 PMCID: PMC6122422 DOI: 10.3892/etm.2018.6466] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 08/10/2017] [Indexed: 12/13/2022] Open
Abstract
Strokes are a major cause of neurological disability. Stem cell replacement therapy is a potential novel strategy of treating patients that have experienced strokes. The present study examined the protective role of neural stem cell (NSC) administration in oxygen-glucose deprivation (OGD) injury and ischemic stroke animal models. Primary cultured embryonic NSCs and brain microvascular endothelial cells were indirectly co-cultured for in vitro testing. A rat model of embolic middle cerebral artery occlusion (MCAO) was used to assess the morphological and functional changes that occur following treatment with NSCs. The role of the phosphoinositide 3-kinase/protein kinase b/glycogen synthase kinase 3β (PI3K/Akt/GSK-3β) signaling pathway in the neuroprotective effects of NSC treatment was also determined. It was demonstrated in vivo and in vitro that NSC administration may attenuate the brain injury caused by stroke. Furthermore, the results suggest that activation of PI3k/Akt/GSK-3β signaling pathway serves a role in attenuating OGD injury. Inflammation, synaptic remodeling and autophagy may be improved following NSC treatment and behavioral testing suggests that treatment with NSCs improves functional recovery in rats following MCAO.
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Affiliation(s)
- Xiaowen Yu
- Department of Gerontology, Changhai Hospital, The Second Military Medical University, Shanghai 200433, P.R. China
| | - Xiaoqing Wang
- Department of Neurology, Changhai Hospital, The Second Military Medical University, Shanghai 200433, P.R. China
| | - Shuxiong Zeng
- Department of Urology, Changhai Hospital, The Second Military Medical University, Shanghai 200433, P.R. China
| | - Xiping Tuo
- Department of Gerontology, Changhai Hospital, The Second Military Medical University, Shanghai 200433, P.R. China
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142
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Okoroh J, Essoun S, Seddoh A, Harris H, Weissman JS, Dsane-Selby L, Riviello R. Evaluating the impact of the national health insurance scheme of Ghana on out of pocket expenditures: a systematic review. BMC Health Serv Res 2018; 18:426. [PMID: 29879978 PMCID: PMC5992790 DOI: 10.1186/s12913-018-3249-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 05/29/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Approximately 150 million people suffer from financial catastrophe annually because of out-of-pocket expenditures (OOPEs) on health. Although the National Health Insurance Scheme (NHIS) of Ghana was designed to promote universal health coverage, OOPEs as a proportion of total health expenditures remains elevated at 26%, exceeding the WHO's recommendations of less than 15-20%. To determine whether enrollment in the NHIS reduces the likelihood of OOPEs and catastrophic health expenditures (CHEs) in Ghana, we undertook a systematic review of the published literature. METHODS We searched for quantitative articles published in English between January 1, 2003 and August 22, 2017 in PubMed, Google Scholar, Economic Literature, Global Health, PAIS International, and African Index Medicus. Two independent authors (J.S.O. & S.E.) reviewed the articles for inclusion, extracted the data, and conducted a quality assessment of the studies. We accepted the World Health Organization definition of catastrophic health expenditures which is out of pocket payments for health care which exceeds 20% of annual house hold income, 10% of household expenditures, or 40% of subsistence expenditures (total household expenditures net food expenditures). RESULTS Of the 1094 articles initially identified, 7 were eligible for inclusion. These were cross-sectional household studies published between 2008 and 2016 in Ghana. They demonstrated that the uninsured paid 1.4 to 10 times more in out-of-pocket payments (OOPs) and were more likely to incur CHEs than the insured. Yet, 6 to 18% of insured households made catastrophic payments for healthcare and all studies reported insured members making OOPs for medicines. CONCLUSION Evidence suggests that the national health insurance scheme of Ghana over the last 14 years has made some impact on reducing OOPEs, and yet healthcare costs remain catastrophic for a large proportion of insured households in Ghana. Future studies need to explore reasons for the persistence of OOPs for medicines and services that are covered under the scheme.
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Affiliation(s)
- Juliet Okoroh
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA USA
- Department of Surgery, Korle-Bu Teaching Hospital, Accra, Ghana
- Department of Surgery, University of California San Francisco, 513 Parnassus Ave S-321, San Francisco, CA 94143 USA
- Fogarty International Center, National Institute of Health, GloCal Consortium, Bethesda, USA
| | - Samuel Essoun
- Department of Surgery, Korle-Bu Teaching Hospital, Accra, Ghana
| | | | - Hobart Harris
- Department of Surgery, University of California San Francisco, 513 Parnassus Ave S-321, San Francisco, CA 94143 USA
| | - Joel S. Weissman
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA USA
| | | | - Robert Riviello
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA USA
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143
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Yebyo HG, Aschmann HE, Yu T, Puhan MA. Should statin guidelines consider patient preferences? Eliciting preferences of benefit and harm outcomes of statins for primary prevention of cardiovascular disease in the sub-Saharan African and European contexts. BMC Cardiovasc Disord 2018; 18:97. [PMID: 29776337 PMCID: PMC5960214 DOI: 10.1186/s12872-018-0838-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 05/10/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Patient preferences are key parameters to evaluate benefit-harm balance of statins for primary prevention but they are not readily available to guideline developers and decision makers. Our study aimed to elicit patient preferences for benefit and harm outcomes related to use of statins for primary cardiovascular disease prevention and to examine how the preferences differ across economically and socio-culturally different environments. METHODS We conducted preference-eliciting surveys using best-worst scaling designed with a balanced incomplete-block design (BIBD) on 13 statins-related outcomes on 220 people in Ethiopia and Switzerland. The participants made tradeoff decisions and selected the most and least worrisome outcomes concurrently from each scenario generated using the BIBD. The design yielded 34,320 implied paired-comparisons and 2860 paired-responses as unit of analysis for eliciting the preferences that were analyzed using a conditional-logit model on a relative scale and surface under the cumulative ranking curve from multivariate random-effects meta-analysis model on a scale of 0 to 1. RESULTS There was high internal consistency of responses and minimal amount of measurement error in both surveys. Severe stroke was the most worrisome outcome with a ceiling preference of 1 (on 0 to 1 scale) followed by severe myocardial infarction, 0.913 (95% CI, 0.889-0.943), and cancer, 0.846 (0.829-0.855); while treatment discontinuation, 0.090 (0.023-0.123), and nausea/headache, 0.060 (0.034-0.094) were the least worrisome outcomes. Preferences were similar between Ethiopia and Switzerland with overlapping uncertainty intervals and concordance correlation of 0.97 (0.90-0.99). CONCLUSIONS Our study provides much needed empirical evidence on preferences that help clinical guidelines consider for weighing the benefit and harm outcomes when recommending for or against statins for primary prevention of cardiovascular disease. The preferences are consistent across the disparate settings; however, we recommend inclusion of more countries in future studies to ensure the generalizability of the preferences to all environments.
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Affiliation(s)
- Henock G Yebyo
- Department of Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Hirschengraben 84, CH-8001, Zurich, Switzerland.,School of Public Health, College of Health Sciences, Mekelle University, Ayder, Mekelle, Ethiopia
| | - Hélène E Aschmann
- Department of Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Hirschengraben 84, CH-8001, Zurich, Switzerland
| | - Tsung Yu
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Milo A Puhan
- Department of Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Hirschengraben 84, CH-8001, Zurich, Switzerland.
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Dugee O, Munaa E, Sakhiya A, Mahal A. Mongolia's Public Spending On Noncommunicable Diseases Is Similar To The Spending Of Higher-Income Countries. Health Aff (Millwood) 2018; 36:918-925. [PMID: 28461360 DOI: 10.1377/hlthaff.2016.0711] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Although there is increased recognition of the global challenge posed by noncommunicable diseases (NCDs), translating that awareness into resources for action requires better data than typically available in low- and middle-income countries. One middle-income country that does have good-quality information is Mongolia. Using detailed administrative data from Mongolia and supplementary survey-based information, we estimated public spending on four NCDs in Mongolia and reached four main conclusions. First, Mongolia's public spending patterns on NCDs are similar to NCD spending observed in countries with much higher per capita incomes. Second, public spending for NCDs is low relative to the NCD disease burden in Mongolia. Third, public-sector NCD spending is dominated by inpatient care and hospital-based specialist outpatient services, which suggests inefficiency in resource use. Finally, while public spending on cardiovascular disease is evenly distributed across regions, for cancers it is heavily concentrated in the nation's capital.
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Affiliation(s)
- Otgontuya Dugee
- Otgontuya Dugee is a doctoral student in the School of Public Health and Preventive Medicine at Monash University, in Melbourne, Australia; and a researcher in the Public Health Institute of the Ministry of Health of Mongolia, in Ulaanbaatar
| | - Enkhtuya Munaa
- Enkhtuya Munaa is director of the Monitoring and Evaluation Department in the Social Insurance General Office, in Ulaanbaatar
| | - Ariuntuya Sakhiya
- Ariuntuya Sakhiya is head of the Statistics and Monitoring Division of the Ulaanbaatar City Health Department
| | - Ajay Mahal
- Ajay Mahal is a professor of health economics and health systems at the Nossal Institute for Global Health, University of Melbourne; and an adjunct professor in the School of Public Health and Preventive Medicine, Monash University
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145
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A retrospective study on association between obesity and cardiovascular risk diseases with aging in Chinese adults. Sci Rep 2018; 8:5806. [PMID: 29643416 PMCID: PMC5895579 DOI: 10.1038/s41598-018-24161-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 03/26/2018] [Indexed: 01/14/2023] Open
Abstract
This study aimed to investigate the prevalence of overweight and obesity and its relationship with cardiovascular risk diseases among different sex and age groups in an urban Chinese adult population. A retrospective analysis was performed on 384,061 Chinese adults aged 20 years and older in Nanjing. The age-standardized prevalence of overweight and obesity was 42.8% and 13.2% in men and 23.9% and 6.6% in women. A gradually increasing trend was observed in the prevalence of overweight and obesity from 2008 to 2016, especially in individuals aged 20~39 years. Overweight and obesity were significantly associated with increased risks of dyslipidemia, diabetes mellitus, hypertension, and hyperuricemia. Age weakened such relationship for both genders, which spiked in individuals aged 20~39 years. For men and women aged 20~39 years, the OR (95% CI) of obesity reached 4.23 (4.01–4.47) and 5.29 (4.63–6.04) for dyslipidemia, 3.70 (2.97–4.60) and 6.38 (3.86–10.55) for diabetes mellitus, 6.19 (5.76–6.64) and 9.36 (7.86–11.13) for hypertension, and 3.66 (3.45–3.88) and 6.65 (5.70–7.74) for hyperuricemia, respectively. The increasing trend in the epidemic of overweight and obesity is a risk factor for cardiovascular risk diseases in Chinese adults, especially in individuals aged 20~39 years.
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146
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Paanalahti M, Berzina G, Lundgren-Nilsson Å, Arndt T, Sunnerhagen KS. Examination of the relevance of the ICF cores set for stroke by comparing with the Stroke Impact Scale. Disabil Rehabil 2018; 41:508-513. [PMID: 29502463 DOI: 10.1080/09638288.2017.1396368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE To examine if the International Classification of Functioning (ICF) core set for stoke contains problems that are relevant for the persons living with stroke as expressed in the Stroke Impact Scale (SIS). METHODS Cross-sectional study of 242 persons with previous stroke. The agreement between the perceived problems in the SIS items and problems in the categories of Comprehensive ICF Core Set for stroke were analyzed using percent of agreement and Kappa statistic. RESULTS The analyses between 57 items of the SIS and 31 second-level categories of the ICF were conducted. The problems in domains of "Mobility", "Activities of daily living", "Hand function", "Strength" in the SIS had moderate agreement when compared to ICF categories. The SIS domains of "Emotion" and "Communication", as well as some aspects of the "Memory" had slight or fair agreement with corresponding ICF categories. The results of the study suggest that there is acceptable agreement between persons after stroke and health professionals in the physical aspects, but rather poor agreement in the cognitive and emotional aspects of functioning. CONCLUSIONS Health professionals do not fully capture the magnitude of emotional or social problems experienced by persons after stroke when using the ICF Core Set as a framework for evaluation. Implications for Rehabilitation The ICF Core Set for Stroke provides comprehensive list of possible health and health related outcomes for persons after stroke. Problems reported in condition-specific patient-reported outcome scales can be important in decision making in rehabilitation. Patients and health professionals tend to agree more on physical than cognitive problems. Examination of the relevance of the ICF cores set for stroke by comparing with the Stroke Impact Scale.
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Affiliation(s)
- Markku Paanalahti
- a Rehabilitation Medicine , Institute for Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden
| | - Guna Berzina
- b Department of Rehabilitation , Riga Stradiņš University , Riga , Latvia
| | - Åsa Lundgren-Nilsson
- a Rehabilitation Medicine , Institute for Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden
| | - Toni Arndt
- c Swedish School of Sport and Health Sciences , Stockholm , Sweden
| | - Katharina S Sunnerhagen
- a Rehabilitation Medicine , Institute for Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden
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147
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Murphy A, Palafox B, O'Donnell O, Stuckler D, Perel P, AlHabib KF, Avezum A, Bai X, Chifamba J, Chow CK, Corsi DJ, Dagenais GR, Dans AL, Diaz R, Erbakan AN, Ismail N, Iqbal R, Kelishadi R, Khatib R, Lanas F, Lear SA, Li W, Liu J, Lopez-Jaramillo P, Mohan V, Monsef N, Mony PK, Puoane T, Rangarajan S, Rosengren A, Schutte AE, Sintaha M, Teo KK, Wielgosz A, Yeates K, Yin L, Yusoff K, Zatońska K, Yusuf S, McKee M. Inequalities in the use of secondary prevention of cardiovascular disease by socioeconomic status: evidence from the PURE observational study. Lancet Glob Health 2018; 6:e292-e301. [PMID: 29433667 PMCID: PMC5905400 DOI: 10.1016/s2214-109x(18)30031-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 11/30/2017] [Accepted: 01/16/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND There is little evidence on the use of secondary prevention medicines for cardiovascular disease by socioeconomic groups in countries at different levels of economic development. METHODS We assessed use of antiplatelet, cholesterol, and blood-pressure-lowering drugs in 8492 individuals with self-reported cardiovascular disease from 21 countries enrolled in the Prospective Urban Rural Epidemiology (PURE) study. Defining one or more drugs as a minimal level of secondary prevention, wealth-related inequality was measured using the Wagstaff concentration index, scaled from -1 (pro-poor) to 1 (pro-rich), standardised by age and sex. Correlations between inequalities and national health-related indicators were estimated. FINDINGS The proportion of patients with cardiovascular disease on three medications ranged from 0% in South Africa (95% CI 0-1·7), Tanzania (0-3·6), and Zimbabwe (0-5·1), to 49·3% in Canada (44·4-54·3). Proportions receiving at least one drug varied from 2·0% (95% CI 0·5-6·9) in Tanzania to 91·4% (86·6-94·6) in Sweden. There was significant (p<0·05) pro-rich inequality in Saudi Arabia, China, Colombia, India, Pakistan, and Zimbabwe. Pro-poor distributions were observed in Sweden, Brazil, Chile, Poland, and the occupied Palestinian territory. The strongest predictors of inequality were public expenditure on health and overall use of secondary prevention medicines. INTERPRETATION Use of medication for secondary prevention of cardiovascular disease is alarmingly low. In many countries with the lowest use, pro-rich inequality is greatest. Policies associated with an equal or pro-poor distribution include free medications and community health programmes to support adherence to medications. FUNDING Full funding sources listed at the end of the paper (see Acknowledgments).
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Affiliation(s)
- Adrianna Murphy
- Centre for Global Chronic Conditions, London School of Tropical Medicine, London, UK.
| | - Benjamin Palafox
- Centre for Global Chronic Conditions, London School of Tropical Medicine, London, UK
| | - Owen O'Donnell
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, Netherlands; Faculty of Economics and Business, University of Lausanne, Lausanne, Switzerland
| | - David Stuckler
- Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
| | - Pablo Perel
- Centre for Global Chronic Conditions, London School of Tropical Medicine, London, UK
| | - Khalid F AlHabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Alvaro Avezum
- Institute of Cardiology, University of Santo Amaro, Sao Paulo, Brazil
| | - Xiulin Bai
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jephat Chifamba
- Department of Physiology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Clara K Chow
- The University of Sydney and The George Institute for Global Health, Camperdown, NSW, Australia
| | - Daniel J Corsi
- Ottawa Hospital Research Institute, OMNI Research Group, Clinical Epidemiology Program, Ottawa, ON, Canada
| | - Gilles R Dagenais
- Institut Universitaire de Cardiologie et Pneumologie de Québec, Québec City, QC, Canada
| | - Antonio L Dans
- University of the Philippines-Manila, Manila, Philippines
| | - Rafael Diaz
- Estudios Clínicos Latinoamérica (ECLA) International, Rosario, Santa Fe, Argentina
| | | | - Noorhassim Ismail
- Department of Community Health, UKM Medical Centre, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Romaina Iqbal
- Departments of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan
| | - Roya Kelishadi
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Chamran Hospital, Isfahan, Iran
| | - Rasha Khatib
- Department of Public Health Sciences, Loyola Medical Center, Maywood, IL, USA
| | | | | | - Wei Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jia Liu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Patricio Lopez-Jaramillo
- Fundación Oftalmológica de Santander-FOSCAL-FOSCAL Internacional, Floridablanca, Santander, Colombia
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation and DrMohan's Diabetes Specialities Centre, Gopalapuram, Chennai, India
| | - Nahed Monsef
- Dubai Health Authority, Dubai, United Arab Emirates
| | - Prem K Mony
- St John's Medical College and Research Insitute, Bangalore, India
| | - Thandi Puoane
- School of Public Health, University of the Western Cape, Cape Town, Western Cape Province, South Africa
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University, C2-106 DBCVSRI Hamilton General Hospital, Hamilton, ON, Canada
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital/Östra, Göteborg, Sweden
| | - Aletta E Schutte
- South African Medical Research Council Unit for Hypertension and Cardiovascular Disease, Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - Mariz Sintaha
- Independent University, Bangladesh, Dhaka, Bangladesh
| | - Koon K Teo
- Population Health Research Institute, McMaster University, C2-106 DBCVSRI Hamilton General Hospital, Hamilton, ON, Canada
| | | | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Lu Yin
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Khalid Yusoff
- Universiti Teknologi MARA, Selyang Campus, Selayang, Selangor and UCSI University, Cheras, Malaysia
| | | | - Salim Yusuf
- Population Health Research Institute, McMaster University, C2-106 DBCVSRI Hamilton General Hospital, Hamilton, ON, Canada
| | - Martin McKee
- Centre for Global Chronic Conditions, London School of Tropical Medicine, London, UK
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148
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Pigeyre M, Saqlain M, Turcotte M, Raja GK, Meyre D. Obesity genetics: insights from the Pakistani population. Obes Rev 2018; 19:364-380. [PMID: 29265593 DOI: 10.1111/obr.12644] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 10/10/2017] [Accepted: 10/15/2017] [Indexed: 01/26/2023]
Abstract
The Pakistani population is extensively diverse, indicating a genetic admixture of European and Central/West Asian migrants with indigenous South Asian gene pools. Pakistanis are organized in different ethnicities/castes based on cultural, linguistic and geographical origin. While Pakistan is facing a rapid nutritional transition, the rising prevalence of obesity is driving a growing burden of health complications and mortality. This represents a unique opportunity for the research community to study the interplay between obesogenic environmental changes and obesity predisposing genes in the time frame of one generation. This review recapitulates the ancestral origins of Pakistani population, the societal determinants of the rise in obesity and its governmental management. We describe the contribution of syndromic, monogenic non-syndromic and polygenic obesity genes identified in the Pakistani population. We then discuss the utility of gene identification approaches based on large consanguineous families and original gene × environment interaction study designs in discovering new obesity genes and causal pathways. Elucidation of the genetic basis of obesity in the Pakistani population may result in improved methods of obesity prevention and treatment globally.
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Affiliation(s)
- M Pigeyre
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Department of Nutrition, CHRU Lille, University of Lille, Lille, France
| | - M Saqlain
- Department of Biochemistry, PMAS-Arid Agriculture University Rawalpindi, Rawalpindi, Pakistan
| | - M Turcotte
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - G K Raja
- Department of Biochemistry, PMAS-Arid Agriculture University Rawalpindi, Rawalpindi, Pakistan
| | - D Meyre
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
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149
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Loerbroks A, Herr RM, Icks A, Bosch JA. The association of self-reported diabetes with impaired social functioning in low-, middle- and high-income countries: findings from the World Health Survey. Diabet Med 2018; 35:332-338. [PMID: 29315796 DOI: 10.1111/dme.13578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2018] [Indexed: 01/08/2023]
Abstract
AIM Epidemiological studies from high-income countries show that diabetes is associated with impaired social functioning. As healthcare systems in middle- and low-income countries offer fewer resources to curtail the potential social impact of diabetes, we performed a comparative study on the diabetes-social impairment link in low-, middle- and high-income countries. METHODS We use data from the cross-sectional World Health Survey (n = 235 428 from 10 low-income, 29 middle-income and 9 high-income countries). Diabetes was defined by self-reports of a diagnosis. Impaired social functioning was considered present if participants reported severe or extreme difficulties with personal relationships or participation in the community. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) in the overall sample and by income regions. ORs were corrected for demographics and health-related lifestyles, and then additionally adjusted for impairments that may explain any observed association (i.e. impaired vision, mood, cognition and mobility). RESULTS In the overall sample, we confirmed an association between self-reported diabetes and impaired social functioning (OR = 1.47, 95% CI = 1.18-1.83). The strength of that relationship increased with decreasing country income (e.g. OR in low-income countries = 2.23, 95% CI = 1.14-4.37). Associations were substantially attenuated by further correction for impairments, in particular mood problems, in the overall sample (OR = 0.92, 95% CI = 0.72-1.16) and all income regions. CONCLUSIONS Self-reported diabetes is associated with impaired social functioning in high- and middle-income countries, and this relationship is even stronger in low-income countries. Associations are largely explained by physical and mental impairments, which may be due to diabetes.
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Affiliation(s)
- A Loerbroks
- Institute of Occupational, Social and Environmental Medicine, Heidelberg University, Mannheim, Germany
| | - R M Herr
- Mannheim Institute of Public Health, Social and Preventive Medicine, Heidelberg University, Mannheim, Germany
| | - A Icks
- Institute for Health Services Research and Health Economics, University of D€usseldorf, D€usseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Centre, Düsseldorf, Germany
- German Centre for Diabetes Research, München-Neuherberg, Germany
| | - J A Bosch
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
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150
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Rahman MS, Rahman MM, Gilmour S, Swe KT, Krull Abe S, Shibuya K. Trends in, and projections of, indicators of universal health coverage in Bangladesh, 1995-2030: a Bayesian analysis of population-based household data. LANCET GLOBAL HEALTH 2018; 6:e84-e94. [PMID: 29241620 DOI: 10.1016/s2214-109x(17)30413-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 09/22/2017] [Accepted: 10/02/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Many countries are implementing health system reforms to achieve universal health coverage (UHC) by 2030. To understand the progress towards UHC in Bangladesh, we estimated trends in indicators of the health service and of financial risk protection. We also estimated the probability of Bangladesh's achieving of UHC targets of 80% essential health-service coverage and 100% financial risk protection by 2030. METHODS We estimated the coverage of UHC indicators-13 prevention indicators and four treatment indicators-from 19 nationally representative population-based household surveys done in Bangladesh from Jan 1, 1991, to Dec 31, 2014. We used a Bayesian regression model to estimate the trend and to predict the coverage of UHC indicators along with the probabilities of achieving UHC targets of 80% coverage of health services and 100% coverage of financial risk protection from catastrophic and impoverishing health payments by 2030. We used the concentration index and relative index of inequality to assess wealth-based inequality in UHC indicators. FINDINGS If the current trends remain unchanged, we estimated that coverage of childhood vaccinations, improved water, oral rehydration treatment, satisfaction with family planning, and non-use of tobacco will achieve the 80% target by 2030. However, coverage of four antenatal care visits, facility-based delivery, skilled birth attendance, postnatal checkups, care seeking for pneumonia, exclusive breastfeeding, non-overweight, and adequate sanitation were not projected to achieve the target. Quintile-specific projections showed wide wealth-based inequality in access to antenatal care, postnatal care, delivery care, adequate sanitation, and care seeking for pneumonia, and this inequality was projected to continue for all indicators. The incidence of catastrophic health expenditure and impoverishment were projected to increase from 17% and 4%, respectively, in 2015, to 20% and 9%, respectively, by 2030. Inequality analysis suggested that wealthiest households would disproportionately face more financial catastrophe than the most disadvantaged households. INTERPRETATION Despite progress, Bangladesh will not achieve the 2030 UHC targets unless the country scales up interventions related to maternal and child health services, and reforms health financing systems to avoid high dependency on out-of-pocket payments. The introduction of a national health insurance system, increased public funding for health care, and expansion of community-based clinics in rural areas could help to move the country towards UHC. FUNDING Japan Ministry of Health, Labour, and Welfare.
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Affiliation(s)
- Md Shafiur Rahman
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; Global Public Health Research Foundation, Dhaka, Bangladesh.
| | - Md Mizanur Rahman
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; Global Public Health Research Foundation, Dhaka, Bangladesh; Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh; Institute for Global Health Policy Research, National Center for Global Health and Medicine, Tokyo, Japan
| | - Stuart Gilmour
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Khin Thet Swe
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Sarah Krull Abe
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Kenji Shibuya
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; Institute for Global Health Policy Research, National Center for Global Health and Medicine, Tokyo, Japan
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