Conceptualising the effect of access to electricity on health in low- and middle-income countries: A systematic review

The impact of access to electricity on mental health in conflict-affected territories: An exploratory study in Gaza

BACKGROUND

Access to affordable and clean energy is an essential component of the Sustainable Development Goals and a determinant of physical and mental health. However, the occupied Palestinian territory, the Gaza Strip, has experienced prolonged issues with electricity, water and gas supplies. This has significantly impacted on daily life and the area is on the verge of disaster. This research focused on the mental health effects of the lack of electricity in Gaza which have not been previously documented.

METHODS

A cross-sectional analytic approach was adopted. A survey was administrated face-to-face with respondents from 350 participating households. Inferential statistical analysis was used to examine the relationship between the domains of anxiety, depression, wellbeing and electricity supply factors. A multiple linear regression model was also utilised.

RESULTS

There is a highly statistically significant link between continuity of electricity and level of anxiety (p < .001). The same effect was reported in the level of depression, and a higher level was observed among residents with an intermittent or disrupted electricity supply, with a statistically significant link between the level of depression and continuity of electricity.

CONCLUSION

Electricity issues, especially when combined with other stressors associated with living in Gaza, lead to serious mental health concerns. Urgent attention must be given to developing sustainable, reliable and affordable energy supplies for short- and long-term health and community development.

Multidimensional energy poverty and acute respiratory infection in children under 5 years of age: evidence from 22 low-income and middle-income countries

BACKGROUND

In low-income and middle-income countries (LMICs), energy poverty has predominantly been studied from the unidimensional perspective of indoor air pollution. Acute respiratory infection (ARI) in children under 5 years of age is the most important disease associated with indoor air pollution attributable to solid fuel use in LMICs. This study aimed to extend the existing knowledge on the association between energy poverty and ARI among children under 5 years of age in LMICs, by adopting a multidimensional perspective.

METHODS

Using Demographic and Health Surveys from 22 LMICs, data from 483 088 children were analysed (mean age 2.00 years (SD 1.41); 51.3% male). Energy poverty was measured using the Multidimensional Energy Poverty Index (MEPI) (range 0-1), which comprises five dimensions of essential energy services. Binary logistic regression models were conducted to study the association between MEPI and ARI, adjusting for child, maternal, household and environmental characteristics.

RESULTS

A 0.1 increase in MEPI score was associated with greater odds of ARI (aOR 1.05; 95% CI 1.04 to 1.07). Likewise, MEPI indicators using biomass for cooking (aOR 1.15; 95% CI 1.07 to 1.23) and lack of access to electricity (aOR 1.17; 95% CI 1.10 to 1.26), entertainment/education appliances (aOR 1.07; 95% CI 1.02 to 1.13) and household appliances (aOR 1.12; 95% CI 1.04 to 1.21) were associated with greater odds of ARI.

CONCLUSION

Multidimensional energy poverty was associated with greater odds of ARI in children under 5 years of age living in 22 LMICs. Hence, our findings justify the design and implementation of interventions that address energy poverty from a multidimensional perspective, integrating energy affordability and accessibility.

Circular Health: exploiting the SDG roadmap to fight AMR

Circular Health is a novel approach to address complex health issues that is based on the expansion of the One Health Paradigm. Circular health recognizes the need for a multidisciplinary convergence effort to complement the biomedical dimension of health. Antimicrobial resistance (AMR) is one of the greatest global concerns for public health that is likely on the rise, given the extensive use of antibiotics during the early Covid-19 years. Prior to the Covid-19 pandemic, an expert group chaired by Jim O'Neill published "The Review on Antimicrobial Resistance", which contains a final report and recommendations on how to tackle AMR. The report, for the first time, considers AMR from a multi-perspective viewpoint highlighting how it cannot be successfully addressed unless there is a converging approach encompassing many dimensions of the problem. In this perspective, we propose to include the recommendations from that seminal report and other more recent reviews which include the lessons learnt from the Covid-19 pandemic, into the operational framework of the sustainable development goals (SDGs). AMR represents a perfect case study to explore how the SDG roadmap has the potential of becoming the driving force and implementation tool to address complex health issues by pursuing the optimization of resources and actions via a convergent and multi-stakeholder approach. The implementation of health-related policies through the whole spectrum of the SDGs could be both a novel and a well-established framework to inform multi-dimensional policies for more sustainable health in the future.

Surgical Capacity Building in Low- and Middle-Income Countries: Lessons for Thoracic Surgery

There is great need for intentional investment in capacity building for thoracic surgical conditions. This article provides a brief overview of thoracic surgical capacity building for low- and middle-income countries using the Lancet framework of infrastructure, workforce, financing, and information management. The authors highlight the needs, opportunities, and challenges that are relevant for the thoracic surgical community, as it aims to increase care for patients with these conditions globally.

Building power-ful health systems: the impacts of electrification on health outcomes in LMICs

Critical disparities threaten health care in developing countries and hinder progress towards global development commitments. Almost a billion people and thousands of public services are not yet connected to electricity - a majority in sub-Saharan Africa. In economically fragile settings, clinics and health services struggle to gain and maintain their access to the most basic energy infrastructure. Less than 30% of health facilities in LMICs report access to reliable energy sources, truncating health outcomes and endangering patients in critical conditions. While 'universal health coverage' and 'sustainable energy for all' are two distinct SDGs with their respective targets, this review challenges their disconnect and inspects their interdependence in LMICs. To evaluate the impact of electrification on healthcare facilities in LMICs, this systematic review analysed relevant publications up to March 2021, using MEDLINE, Embase, Scopus, CENTRAL, clinicaltrials.gov and CINAHL. Outcomes captured were in accordance with the WHO HHFA modules. A total of 5083 studies were identified, 12 fulfilled the inclusion criteria of this review - most were from Africa, with the exception of two studies from India and one from Fiji. Electrification was associated with improvements in the quality of antenatal care services, vaccination rates, emergency capabilities and primary health services; with many facilities reporting high-quality, reliable and continuous oxygen supplies, refrigeration and enhanced medical supply chains. Renewable energy sources were considered in six of the included studies, most highlighting their suitability for rural health facilities. Notably, solar-powered oxygen delivery systems reduced childhood mortality and length of hospital stay. Unavailable and unreliable electricity is a bottleneck to health service delivery in LMICs. Electrification was associated with increased service availability, readiness and quality of care - especially for women, children and those under critical care. This study indicates that stable and clean electrification allows new heights in achieving SDG 3 and SDG7 in LMICs.

The role of access to electricity, female education, and public health expenditure on female health outcomes: evidence from SAARC-ASEAN countries

BACKGROUND

The importance of the status of female health should have research priority due to the unique medical needs of women. Hence this paper attempts to explore the nexus of access to electricity, female education, and public health expenditure with female health outcomes in the SAARC-ASEAN countries.

METHODS

Using the data of 2002-2018, and applying the cross-sectional dependence test, Modified Wald test, Wooldridge test, the Panel corrected standard error (PCSE) model, the Feasible generalized least square (FGLS) model, and the pair-wise Granger causality test, the robust outcomes on female health are found.

RESULTS

Access to electricity, female education rate, public health expenditure, economic growth, and immunization rate, all have a positive effect on female life expectancy at birth, and a negative effect on the female adult mortality rate. The urbanization rate has a significantly positive impact on female life expectancy at birth but an insignificant impact on female adult mortality rate. The one-way causal relationship between the variables are also revealed.

CONCLUSIONS

All the results are rational and have important milestone for the health sector. The health status of females should be improved and protected by formulating effective policies on access to electricity, female education, public health expenditure, immunization, economic growth, and urbanization.

Strategies to increase uptake of maternal pertussis vaccination

INTRODUCTION

Pertussis is a highly contagious respiratory disease that results in disproportionate morbidity and mortality in infants who have yet to receive the primary diphtheria-tetanus-pertussis vaccine series. In the preceding decades numerous countries began to pursue either prenatal vaccination of pregnant women or postpartum vaccination of caregivers to protect infants. Despite proven benefit, maternal uptake of pertussis vaccine continues to remain suboptimal.

AREAS COVERED

Many studies have been conducted to address the suboptimal uptake of maternal pertussis vaccination. This systematic review was undertaken to systematically identify those studies, highlight the most successful strategies and find the knowledge gaps that need to be filled over the coming years to improve vaccine uptake. Twenty-five studies were identified from six different databases.

EXPERT OPINION

Five different interventions were shown to be successful in promoting uptake of pertussis vaccination: (1) standing orders, (2) opt-in orders, (3) provider education, (4) on-site vaccination and (5) interactive patient education. Three major knowledge gaps were also identified that need to be filled over the coming years: (1) lack of studies in low- and middle-income countries, (2) lack of studies targeting midwives and/or home birth and (3) lack of studies on the process of vaccine communication.

A novel, low-cost transradial socket fabrication method using mass-producible components and expanding rigid foam

BACKGROUND

Millions of people in low- and middle-income countries lack access to prosthetic care. A well-fitting, durable socket is important for prosthesis comfort and function, but conventional fabrication techniques require highly trained clinicians and specialized equipment.

OBJECTIVES

To increase access to prosthetic care by developing a simple, low-cost socket fabrication method that does not require specialized equipment or electricity, and can be performed by persons with minimal prosthetic training.

STUDY DESIGN

Socket fabrication methods and socket function were evaluated in a pilot feasibility study.

TECHNIQUE

We describe a rapid method for fabricating a rigid foam socket directly over the residual limb, with a mass producible, strong, cosmetically appealing plastic outer shell. We fabricated sockets for four individuals with unilateral transradial amputations and evaluated socket function.

RESULTS

An individual with no formal prosthetic training was able to fabricate sockets and assemble a functional, comfortable prosthesis system within 90 min. All necessary supplies can be provided in a kit for under US$100.

DISCUSSION

Further work is required to determine durability, assess comfort, refine suspension methods, and to develop instructional materials.

CONCLUSIONS

We developed a simplified, inexpensive method to fabricate sockets on the residual limb using expandable foam with an integrated cosmetic/structural covering (i.e. an exoskeletal system), for persons with transradial amputation. A transradial prosthesis socket can be fabricated in around 90 min. and all necessary materials, tools, and written instructions for fabrication and fitting can be provided in a kit. Specialized equipment and electricity are not required. Instructions for fabrication and fitting can be provided in multiple languages using online videos.

Power Outages and Community Health: a Narrative Review

PURPOSE OF REVIEW

Power outages, a common and underappreciated consequence of natural disasters, are increasing in number and severity due to climate change and aging electricity grids. This narrative review synthesizes the literature on power outages and health in communities.

RECENT FINDINGS

We searched Google Scholar and PubMed for English language studies with titles or abstracts containing "power outage" or "blackout." We limited papers to those that explicitly mentioned power outages or blackouts as the exposure of interest for health outcomes among individuals living in the community. We also used the reference list of these studies to identify additional studies. The final sample included 50 articles published between 2004 and 2020, with 17 (34%) appearing between 2016 and 2020. Exposure assessment remains basic and inconsistent, with 43 (86%) of studies evaluating single, large-scale power outages. Few studies used spatial and temporal control groups to assess changes in health outcomes attributable to power outages. Recent research linked data from electricity providers on power outages in space and time and included factors such as number of customers affected and duration to estimate exposure. The existing literature suggests that power outages have important health consequences ranging from carbon monoxide poisoning, temperature-related illness, gastrointestinal illness, and mortality to all-cause, cardiovascular, respiratory, and renal disease hospitalizations, especially for individuals relying on electricity-dependent medical equipment. Nonetheless the studies are limited, and more work is needed to better define and capture the relevant exposures and outcomes. Studies should consider modifying factors such as socioeconomic and other vulnerabilities as well as how community resiliency can minimize the adverse impacts of widespread major power outages.