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Wang QS, Hua YF, Tao R, Moldovan NC. Can Health Human Capital Help the Sub-Saharan Africa Out of the Poverty Trap? An ARDL Model Approach. Front Public Health 2021; 9:697826. [PMID: 34178934 PMCID: PMC8222539 DOI: 10.3389/fpubh.2021.697826] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 04/30/2021] [Indexed: 11/24/2022] Open
Abstract
This article explores the impact of health human capital on the poverty trap in Sub-Saharan Africa by autoregressive distribution lag model. In the long run, there is no evidence that health human capital can help the Sahara out of the poverty trap. While health human capital has a significant effect on poverty reduction in the short term. There is a threshold effect in the poverty reduction model of healthy human capital. When the economic development level reaches the threshold, the effect of poverty reduction is more obvious and deeper. The extended Solow economic growth model also proved that if the external human capital breaks through the threshold, it can make developing countries get rid of the poverty trap. Therefore, the economic development brought about by health care expenditure must benefit the poor in Sub-Saharan Africa and allow them to enjoy the welfare of social security.
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Affiliation(s)
- Qiu-Su Wang
- School of Economics, Qingdao University, Qingdao, China
| | - Yu-Fei Hua
- School of Economics, Qingdao University, Qingdao, China
| | - Ran Tao
- Qingdao Municipal Center for Disease Control & Preventation, Qingdao, China
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Health shocks, medical insurance and household vulnerability: Evidence from South Africa. PLoS One 2020; 15:e0228034. [PMID: 32032350 PMCID: PMC7006899 DOI: 10.1371/journal.pone.0228034] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 01/06/2020] [Indexed: 11/19/2022] Open
Abstract
Background South Africa has a dual system of healthcare model differentiated across socio-economic lines. While on the one hand there exists high quality private facilities that is expensive and accessible to the minority, on the other is the free but stretched and over-crowded public healthcare that the rest of the population relies on. Accessing private facilities requires private medical insurance or requires coping strategies that can lead to household vulnerability. Objective The objective of this study is to analyse the relationship between health shocks and household vulnerability in the South African context of high poverty and low medical insurance penetration rate. Data The study employs data from waves three to five of South Africa’s nationally representative National Income Dynamics Study (NIDS) conducted between the period 2012–2017 in approximately two-year intervals. Methods Using food expenditure shock as an indicator for vulnerability, the study utilises a range of econometric techniques from panel logit regression to quasi-experimental design based difference in difference regressions to assess the association between health shocks, medical insurance and household vulnerability. Findings The main finding of the study is that a significant proportion of households in the upper income quintile utilise private healthcare even when not covered by private medical insurance. This preference for private over public health facilities make them vulnerable to health shocks as they cope by sacrificing food consumption to incur additional health expenditure. In contrast, lower income households that are unable to access the high-cost private healthcare tend to rely on the strained public healthcare system. They are not able to use their constrained food expenditure as a coping strategy for private or out-of-pocket medical expenses because their food consumption is already at a bare minimum. Conclusion The results confirm that access to quality healthcare is a privilege in South Africa, available only to the minority of the population. The study paints a grim picture of household vulnerability in South Africa and underlines the need for a National Health Insurance that would enable universal access to quality healthcare in the country.
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Gangopadhyay S, Sur S. Burden of NCDs among Nuclear Families. JOURNAL OF HEALTH MANAGEMENT 2017. [DOI: 10.1177/0972063417727623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Soumik Gangopadhyay
- Associate Professor & Head (Department of Management Studies), Eminent College of Management & Technology, Moshpukur, Barbaria, Kolkata, India
| | - Soma Sur
- Dean, Commerce & Management, St. Xavier’s University, Kolkata, West Bengal, India
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Arokiasamy P, Uttamacharya, Kowal P, Capistrant BD, Gildner TE, Thiele E, Biritwum RB, Yawson AE, Mensah G, Maximova T, Wu F, Guo Y, Zheng Y, Kalula SZ, Salinas Rodríguez A, Manrique Espinoza B, Liebert MA, Eick G, Sterner KN, Barrett TM, Duedu K, Gonzales E, Ng N, Negin J, Jiang Y, Byles J, Madurai SL, Minicuci N, Snodgrass JJ, Naidoo N, Chatterji S. Chronic Noncommunicable Diseases in 6 Low- and Middle-Income Countries: Findings From Wave 1 of the World Health Organization's Study on Global Ageing and Adult Health (SAGE). Am J Epidemiol 2017; 185:414-428. [PMID: 28399566 PMCID: PMC6075549 DOI: 10.1093/aje/kww125] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 05/01/2016] [Accepted: 05/02/2016] [Indexed: 12/20/2022] Open
Abstract
In this paper, we examine patterns of self-reported diagnosis of noncommunicable diseases (NCDs) and prevalences of algorithm/measured test-based, undiagnosed, and untreated NCDs in China, Ghana, India, Mexico, Russia, and South Africa. Nationally representative samples of older adults aged ≥50 years were analyzed from wave 1 of the World Health Organization's Study on Global Ageing and Adult Health (2007-2010; n = 34,149). Analyses focused on 6 conditions: angina, arthritis, asthma, chronic lung disease, depression, and hypertension. Outcomes for these NCDs were: 1) self-reported disease, 2) algorithm/measured test-based disease, 3) undiagnosed disease, and 4) untreated disease. Algorithm/measured test-based prevalence of NCDs was much higher than self-reported prevalence in all 6 countries, indicating underestimation of NCD prevalence in low- and middle-income countries. Undiagnosed prevalence of NCDs was highest for hypertension, ranging from 19.7% (95% confidence interval (CI): 18.1, 21.3) in India to 49.6% (95% CI: 46.2, 53.0) in South Africa. The proportion untreated among all diseases was highest for depression, ranging from 69.5% (95% CI: 57.1, 81.9) in South Africa to 93.2% (95% CI: 90.1, 95.7) in India. Higher levels of education and wealth significantly reduced the odds of an undiagnosed condition and untreated morbidity. A high prevalence of undiagnosed NCDs and an even higher proportion of untreated NCDs highlights the inadequacies in diagnosis and management of NCDs in local health-care systems.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Somnath Chatterji
- Correspondence to Dr. Somnath Chatterji, Division of Information, Evidence and Research, World Health Organization, Avenue Appia, CH 1211 Geneva, Switzerland (e-mail: or )
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Baruah S, Chaliha MS, Borah PK, Rajkakati R, Borua PK, Mahanta J. Insertion/Insertion Genotype of Angiotensin I-Converting-Enzyme Gene Predicts Risk of Myocardial Infarction in North East India. Biochem Genet 2015; 54:134-46. [PMID: 26687160 DOI: 10.1007/s10528-015-9706-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
Abstract
Myocardial infarction (MI) is common in India and the disease occurs at a relatively younger age. We wanted to look for association of Angiotensin I-converting enzyme (ACE) gene with MI in North East India. We also wanted to examine possible environmental interaction of ACE gene with established cardiovascular risk factors in causation of MI. In the study carried out in Assam Medical College, 200 consecutive confirmed cases of MI were recruited. Equal numbers of age- and sex-matched control subjects from hospital workers and patients attending the hospital for diseases unrelated to cardiovascular disease were enrolled. Structured questionnaires were used to note demographic and clinical factors. Cardiovascular risk factors were determined from history, physical examination and biochemical investigations. ACE insertion/deletion (I/D) polymorphism was determined by PCR method. Interaction of ACE gene with other risk factors was noted. The study identified ACE II genotype (odds ratio = 3.02; 95% CI 1.40-6.51), smoking, hypertension, diabetes and serum triglyceride > 150 mg/dl as independent risk factors for MI. ACE II genotype showed greater risk in non-smokers, non-hypertensives, non-diabetics and in subjects with LDL-C < 130 mg/dl. Low HDL cholesterol enhanced the genetic risk. Subjects with ACE II genotype have an independent risk of developing MI, specially in low cardiovascular risk subjects.
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Affiliation(s)
- Sukanya Baruah
- Regional Medical Research Centre-NE-Region (Indian Council of Medical Research), Post Box No-105, Dibrugarh, Assam, 786001, India
| | | | - Prasanta K Borah
- Regional Medical Research Centre-NE-Region (Indian Council of Medical Research), Post Box No-105, Dibrugarh, Assam, 786001, India
| | | | | | - Jagadish Mahanta
- Regional Medical Research Centre-NE-Region (Indian Council of Medical Research), Post Box No-105, Dibrugarh, Assam, 786001, India.
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Pakhare A, Kumar S, Goyal S, Joshi R. Assessment of primary care facilities for cardiovascular disease preparedness in Madhya Pradesh, India. BMC Health Serv Res 2015; 15:408. [PMID: 26399634 PMCID: PMC4580030 DOI: 10.1186/s12913-015-1075-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 09/18/2015] [Indexed: 11/10/2022] Open
Abstract
Background Government of India has launched National Program for Prevention & Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) to address high prevalence of non-communicable diseases (NCDs) in India. Cardiovascular diseases (CVDs) constitute a significant portion of NCD burden. While this program is yet to be launched in all districts of Madhya Pradesh state of India, we performed this study to understand facility-level gaps that need to be addressed to improve CVD services in primary care provided by the public sector. Methods This is a cross-sectional questionnaire based study. A standardized questionnaire was self-administered to 85 medical officers from as many primary care facilities from 24 districts of the state. These medical officers were working in two types of primary care facilities – primary health center (PHC) and community health centers (CHC). Facilities were assessed for 36 items in 5 domains (human-resource, equipment, drug supplies, point-of-care tests and laboratory services) with a focus on management of hypertension and diabetes mellitus in primary-care. Each item was to be answered as either present or absent at the facility where medical officer was working. We compared availability of an item across two levels of primary care facilities. All statistical analysis were done using Microsoft Excel. Results Availability of facilities was least in laboratory services, and human resource domains followed by drugs, and better in equipment and point-of-care supply domains. Across these domains, availability of items in CHCs was (37.1, 49.0, 56.1, 67.9 and 80.9 % respectively) and in PHCs (11.8, 18.2, 44.2, 55.1, and 55.3 % respectively). Discussion Current facility assessment study shows critical gaps in key items required for management of NCDs at primary care level. Human resource and laboratory services need to be strengthened the most, followed by sustained availability of all required drug classes, equipment and related supplies, and upgrading point-of-care testing. There are larger gaps in PHCs, which are level 1 facilities, as compared to CHCs, which are level 2 facilities in primary-care. Conclusions Increasing burden of NCDs like hypertension and diabetes mellitus necessitates public health response through health systems. Therefore health system preparedness in form of trained human resources, functional laboratories and well stocked pharmacies are essential in primary care facilities.
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Affiliation(s)
- Abhijit Pakhare
- Department of Community and Family Medicine, All India Institute of Medical Sciences Bhopal, Bhopal, India.
| | - Sanjeev Kumar
- Department of Community and Family Medicine, All India Institute of Medical Sciences Bhopal, Bhopal, India.
| | | | - Rajnish Joshi
- Department of General Medicine, All India Institute of Medical Sciences Bhopal, Bhopal, India.
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Alexander T, Mullasari AS, Kaifoszova Z, Khot UN, Nallamothu B, Ramana RGV, Sharma M, Subramaniam K, Veerasekar G, Victor SM, Chand K, Deb PK, Venugopal K, Chopra HK, Guha S, Banerjee AK, Armugam AM, Panja M, Wander GS. Framework for a National STEMI Program: consensus document developed by STEMI INDIA, Cardiological Society of India and Association Physicians of India. Indian Heart J 2015; 67:497-502. [PMID: 26432748 PMCID: PMC4593854 DOI: 10.1016/j.ihj.2015.05.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 05/25/2015] [Indexed: 11/25/2022] Open
Abstract
The health care burden of ST elevation myocardial infarction (STEMI) in India is enormous. Yet, many patients with STEMI can seldom avail timely and evidence based reperfusion treatments. This gap in care is a result of financial barriers, limited healthcare infrastructure, poor knowledge and accessibility of acute medical services for a majority of the population. Addressing some of these issues, STEMI India, a not-for-profit organization, Cardiological Society of India (CSI) and Association Physicians of India (API) have developed a protocol of "systems of care" for efficient management of STEMI, with integrated networks of facilities. Leveraging newly-developed ambulance and emergency medical services, incorporating recent state insurance schemes for vulnerable populations to broaden access, and combining innovative, "state-of-the-art" information technology platforms with existing hospital infrastructure, are the crucial aspects of this system. A pilot program was successfully employed in the state of Tamilnadu. The purpose of this article is to describe the framework and methods associated with this programme with an aim to improve delivery of reperfusion therapy for STEMI in India. This programme can serve as model STEMI systems of care for other low-and-middle income countries.
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Affiliation(s)
- Thomas Alexander
- Senior Consultant and Interventional Cardiologist, STEMI INDIA Writing Group, India.
| | | | | | | | | | | | | | | | | | | | | | - P K Deb
- Cardiological Society of India (CSI), India
| | | | - H K Chopra
- Cardiological Society of India (CSI), India
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Levesque JF, Mukherjee S, Grimard D, Boivin A, Mishra S. Measuring the prevalence of chronic diseases using population surveys by pooling self-reported symptoms, diagnosis and treatments: results from the World Health Survey of 2003 for South Asia. Int J Public Health 2013; 58:435-47. [PMID: 23436012 DOI: 10.1007/s00038-013-0446-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 01/02/2013] [Accepted: 01/17/2013] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Measuring disease prevalence poses challenges in countries where information systems are poorly developed. Population surveys soliciting information on self-reported diagnosis also have limited capacity since they are influenced by informational and recall biases. Our aim is to propose a method to assess the prevalence of chronic disease by combining information on self-reported diagnosis, self-reported treatment and highly suggestive symptoms. METHODS An expanded measure of prevalence was developed using data from the World Health Survey for Bangladesh, India and Sri Lanka. Algorithms were constructed for six chronic diseases. RESULTS The expanded measures of chronic disease increase the prevalence estimates. Prevalence varies across socio-demographic characteristics, such as age, education, socioeconomic status (SES), and country. Finally, the association, as also risk factor, between chronic disease status and poor self-rated health descriptions increases significantly when one takes into account highly suggestive symptoms of diseases. CONCLUSIONS Our expanded measure of chronic disease could form a basis for surveillance of chronic diseases in countries where health information systems have been poorly developed. It represents an interesting trade-off between the bias associated with usual surveillance data and costs.
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Affiliation(s)
- J-F Levesque
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada.
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Rydin Y, Bleahu A, Davies M, Dávila JD, Friel S, De Grandis G, Groce N, Hallal PC, Hamilton I, Howden-Chapman P, Lai KM, Lim CJ, Martins J, Osrin D, Ridley I, Scott I, Taylor M, Wilkinson P, Wilson J. Shaping cities for health: complexity and the planning of urban environments in the 21st century. Lancet 2012; 379:2079-108. [PMID: 22651973 PMCID: PMC3428861 DOI: 10.1016/s0140-6736(12)60435-8] [Citation(s) in RCA: 294] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Temel RE, Brown JM. A new framework for reverse cholesterol transport: Non-biliary contributions to reverse cholesterol transport. World J Gastroenterol 2010; 16:5946-52. [PMID: 21157970 PMCID: PMC3007104 DOI: 10.3748/wjg.v16.i47.5946] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Reduction of low-density lipoprotein-cholesterol through statin therapy has only modestly decreased coronary heart disease (CHD)-associated mortality in developed countries, which has prompted the search for alternative therapeutic strategies for CHD. Major efforts are now focused on therapies that augment high-density lipoprotein (HDL)-mediated reverse cholesterol transport (RCT), and ultimately increase the fecal disposal of cholesterol. The process of RCT has long been thought to simply involve HDL-mediated delivery of peripheral cholesterol to the liver for biliary excretion out of the body. However, recent studies have revealed a novel pathway for RCT that does not rely on biliary secretion. This non-biliary pathway rather involves the direct excretion of cholesterol by the proximal small intestine. Compared to RCT therapies that augment biliary sterol loss, modulation of non-biliary fecal sterol loss through the intestine is a much more attractive therapeutic strategy, given that excessive biliary cholesterol secretion can promote gallstone formation. However, we are at an early stage in understanding the molecular mechanisms regulating the non-biliary pathway for RCT, and much additional work is required in order to effectively target this pathway for CHD prevention. The purpose of this review is to discuss our current understanding of biliary and non-biliary contributions to RCT with particular emphasis on the possibility of targeting the intestine as an inducible cholesterol secretory organ.
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Prasad D, Kabir Z, Dash A, Das B. Cardiovascular risk factors in developing countries: A review of clinico-epidemiological evidence. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.cvdpc.2010.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Prasad D, Kabir Z, Dash A, Das B. Coronary risk factors in South Asians: A prevalence study in an urban populace of Eastern India. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.cvdpc.2010.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Mahajan N, Malik N, Bahl A, Dhawan V. Receptor for advanced glycation end products (RAGE) and its inflammatory ligand EN-RAGE in non-diabetic subjects with pre-mature coronary artery disease. Atherosclerosis 2009; 207:597-602. [PMID: 19576587 DOI: 10.1016/j.atherosclerosis.2009.06.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Revised: 06/01/2009] [Accepted: 06/01/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Inflammation participates in atherosclerosis from its inception onwards. RAGE (receptor for advanced glycation end products) and its natural pro-inflammatory ligand, EN-RAGE (extracellular newly identified RAGE-binding protein) have been implicated in various inflammatory diseases. In present study, we determined the expression of RAGE and EN-RAGE in peripheral blood mononuclear cells (PBMCs) of subjects with pre-mature coronary artery disease (CAD) for the first time. METHODS AND RESULTS The study patients were angiographically proven non-diabetic patients with pre-mature CAD (Group I; N=100) and control group comprised of subjects with coronary risk factors and without coronary artery lesions (Group II; N=40). Semi-quantitative RT-PCR was performed to determine transcriptional expression of RAGE and EN-RAGE in PBMCs. Soluble RAGE (sRAGE) and C-reactive protein (hsCRP) levels were determined in serum of all study subjects using immunoassays. A significantly increased transcriptional expression of RAGE and EN-RAGE in PBMCs (p<0.01) of Group I patients was observed. Increased circulating hsCRP (p<0.01) levels and decreased sRAGE (p<0.01) levels were observed in Group I as compared with the Group II subjects. Severity of disease determined by Gensini score was found to be positively correlated with transcriptional expression of RAGE (r=0.530) and EN-RAGE (r=0.323). EN-RAGE expression revealed a strong association with RAGE (r=0.326), hsCRP (r=0.251) and a negative association with sRAGE (r=-0.222). CONCLUSIONS Increased expression of RAGE and EN-RAGE in non-diabetic pre-mature CAD and various associations discussed may amplify several cellular perturbations and thus significantly contribute to the pathophysiology of CAD.
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Affiliation(s)
- Nitin Mahajan
- Department of Experimental Medicine & Biotechnology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
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Chakraborty R, Bose K, Bisai S. Body mass index and blood pressure among adult Bengalee male slum dwellers of Kolkata, India. J Public Health (Oxf) 2009. [DOI: 10.1007/s10389-009-0254-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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