1
|
Kidman R, Breton E, Behrman J, Rui YT, Kohler HP. Prevalence and early-life predictors of adverse childhood experiences: Longitudinal insights from a low-income country. CHILD ABUSE & NEGLECT 2024; 154:106895. [PMID: 38870710 DOI: 10.1016/j.chiabu.2024.106895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
BACKGROUND A sizeable literature shows that adverse childhood experiences (ACEs) are associated with poor health outcomes in later life. However, most studies on the prevalence and predictors of ACEs have been carried out in high-income countries using cross-sectional approaches. OBJECTIVE The present study explores the prevalence and predictors of ACEs in Malawi, a low-income country, using prospective longitudinal data collected on adolescents. PARTICIPANTS We use data on 1375 adolescents and their biological mothers from the Malawi Longitudinal Study of Families and Health (MLSFH). ACEs were reported by adolescents over two survey waves, in 2017-18 and 2021. Predictors were reported by mothers in 2008 and 2010. METHODS Multivariate ordinary least square and logistic regression analyses of ACEs exposure reported by adolescents on indicators of family arrangements and resources. RESULTS Adolescents report having been exposed to nearly seven ACEs on average. Among indicators of family arrangements and resources, the only significant predictors of cumulative ACEs exposure are polygyny (linked to parental absence) and mother's SF-12 mental health score (linked to physical abuse and witnessing domestic violence). CONCLUSIONS ACEs are much more prevalent in the low-income country under study than in middle- and high-income countries surveyed in prior research. Despite adversity being widespread, most indicators of family arrangements and resources highlighted in prior studies are not associated with adolescents' cumulative ACEs exposure in this context. Mothers' mental health in childhood nevertheless emerges as a significant predictor of adolescents' self-reported ACEs. These findings inform efforts aimed at preventing ACEs in high-adversity contexts.
Collapse
Affiliation(s)
- Rachel Kidman
- Program in Public Health and Department of Family, Population and Preventive Medicine, Stony Brook University (State University of New York), Stony Brook, NY 11794, United States of America.
| | - Etienne Breton
- Population Aging Research Center, University of Pennsylvania, Philadelphia, PA 19104-6298, United States of America.
| | - Jere Behrman
- Population Aging Research Center, University of Pennsylvania, Philadelphia, PA 19104-6298, United States of America; Department of Economics, University of Pennsylvania, Philadelphia, PA 19104-6298, United States of America; Department of Sociology, University of Pennsylvania, Philadelphia, PA 19104-6298, United States of America.
| | - Yang Tingting Rui
- Population Aging Research Center, University of Pennsylvania, Philadelphia, PA 19104-6298, United States of America
| | - Hans-Peter Kohler
- Population Aging Research Center, University of Pennsylvania, Philadelphia, PA 19104-6298, United States of America; Department of Sociology, University of Pennsylvania, Philadelphia, PA 19104-6298, United States of America.
| |
Collapse
|
2
|
Eyowas FA, Schneider M, Alemu S, Getahun FA. Multimorbidity and adverse longitudinal outcomes among patients attending chronic outpatient medical care in Bahir Dar, Northwest Ethiopia. Front Med (Lausanne) 2023; 10:1085888. [PMID: 37250625 PMCID: PMC10213652 DOI: 10.3389/fmed.2023.1085888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 04/26/2023] [Indexed: 05/31/2023] Open
Abstract
Background Multimorbidity is becoming more prevalent in low-and middle-income countries (LMICs). However, the evidence base on the burden and its longitudinal outcomes are limited. This study aimed to determine the longitudinal outcomes of patients with multimorbidity among a sample of individuals attending chronic outpatient non communicable diseases (NCDs) care in Bahir Dar, northwest Ethiopia. Methods A facility-based longitudinal study was conducted among 1,123 participants aged 40+ attending care for single NCD (n = 491) or multimorbidity (n = 633). Data were collected both at baseline and after 1 year through standardized interviews and record reviews. Data were analyzed using Stata V.16. Descriptive statistics and longitudinal panel data analyzes were run to describe independent variables and identify factors predicting outcomes. Statistical significance was considered at p-value <0.05. Results The magnitude of multimorbidity has increased from 54.8% at baseline to 56.8% at 1 year. Four percent (n = 44) of patients were diagnosed with one or more NCDs and those having multimorbidity at baseline were more likely than those without multimorbidity to develop new NCDs. In addition, 106 (9.4%) and 22 (2%) individuals, respectively were hospitalized and died during the follow up period. In this study, about one-third of the participants had higher quality of life (QoL), and those having higher high activation status were more likely to be in the higher versus the combined moderate and lower QoL [AOR1 = 2.35, 95%CI: (1.93, 2.87)] and in the combined higher and moderate versus lower level of QoL [AOR2 = 1.53, 95%CI: (1.25, 1.88)]. Conclusion Developing new NCDs is a frequent occurrence and the prevalence of multimorbidity is high. Living with multimorbidity was associated with poor progress, hospitalization and mortality. Patients having a higher activation level were more likely than those with low activation to have better QoL. If health systems are to meet the needs of the people with chronic conditions and multimorbidity, it is essential to understand diseases trajectories and of impact of multimorbidity on QoL, and determinants and individual capacities, and to increase their activation levels for better health improve outcomes through education and activation.
Collapse
Affiliation(s)
- Fantu Abebe Eyowas
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Marguerite Schneider
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Shitaye Alemu
- School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fentie Ambaw Getahun
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| |
Collapse
|
3
|
Santomauro DF, Purcell C, Whiteford HA, Ferrari AJ, Vos T. Grading disorder severity and averted burden by access to treatment within the GBD framework: a case study with anxiety disorders. Lancet Psychiatry 2023; 10:272-281. [PMID: 36931778 PMCID: PMC10017349 DOI: 10.1016/s2215-0366(23)00037-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/08/2022] [Accepted: 01/17/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND The Global Burden of Disease Study (GBD) estimates burden by cause with major relevance for resource allocators globally. Non-fatal burden estimates are influenced by disorder severity. However, for many disorders, global severity is sourced from a single high-income country survey. We aimed to estimate severity distributions that vary by Healthcare Access Quality Index (HAQI) using anxiety disorders as a case study and present the usefulness of this method in simulating averted and avoidable burden globally. METHODS In this case study, we estimated treatment use among respondents with anxiety disorder in the 1997 Australian National Survey of Mental Health and Wellbeing (NSMHWB), the source used to estimate severity of anxiety disorders in GBD. Treatment effects were sourced from the Cochrane Database of Systematic Reviews and pooled via network meta-analysis. Severity distribution was established via a meta-regression of their disability weights, derived from 12-item short form survey scores. We simulated the shift in severity across scenarios without access to treatment and with full access to optimal treatment (cognitive behavioural therapy and antidepressants). We interpolated this shift linearly along the HAQI, extrapolated country-specific severity from HAQI scores, and calculated averted and avoidable burden. FINDINGS The database review sourced 56 reviews, of which eight were eligible for inclusion. These eight reviews reported on 156 randomised controlled trials, with 194 treatment effects. Respondents to the 1997 NSMHWB consisted of 5936 women (55·8%) and 4705 (44·2%) men aged 18 years or older (mean age and ethnicity data not available). The survey-weighted treatment effect size was -0·28 (95% uncertainty interval -0·45 to -0·12). The pooled treatment effect for full coverage optimal treatment was -1·07 (-1·47 to -0·64). The sequela-weighted disability weight among people with anxiety disorder in the NSMHWB was 0·141 (0·042 to 0·275). The estimated disability weight was 0·188 (0·070 to 0·341) after removing the benefits of treatment and 0·056 (0·013 to 0·140) after providing all people with anxiety disorder access to optimal treatment. Globally, 12·5% (4·6 to 21·5) of anxiety disorder burden was averted because of available treatment. However, 71·1% (46·2 to 87·6) of global anxiety disorder burden could be averted if all people with anxiety disorders had access to optimal treatment. INTERPRETATION Because it is based on guidance from a single survey done in one high-income country, the burden of anxiety disorders in low-income and middle-income countries is probably underestimated by GBD. Despite the availability of effective treatments, low use of these treatments means that most burden is still avoidable. Most of the burden could be averted if all people with anxiety disorders had access to optimal treatment, highlighting the importance of public promotion and referral pathways of treatment for anxiety disorders. Location-specific severity distributions in GBD would greatly increase precision in burden estimates and highlight avertable burden to clinicians, public health practitioners, and policy makers. FUNDING Queensland Health and Bill & Melinda Gates Foundation.
Collapse
Affiliation(s)
- Damian F Santomauro
- School of Public Health, University of Queensland, Herston, Queensland, Australia; Queensland Centre for Mental Health Research, Wacol, Queensland, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.
| | - Caroline Purcell
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Harvey A Whiteford
- School of Public Health, University of Queensland, Herston, Queensland, Australia; Queensland Centre for Mental Health Research, Wacol, Queensland, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Alize J Ferrari
- School of Public Health, University of Queensland, Herston, Queensland, Australia; Queensland Centre for Mental Health Research, Wacol, Queensland, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| |
Collapse
|
4
|
South A, Dhesi P, Tweed CD, Tsogt B, Staples S, Tukvadze N, Dorj G, Zaca S, Sanikidze E, Purev N, Esmail H, Burgess R. Patients' priorities around drug-resistant tuberculosis treatment: A multi-national qualitative study from Mongolia, South Africa and Georgia. Glob Public Health 2023; 18:2234450. [PMID: 37431789 PMCID: PMC7616316 DOI: 10.1080/17441692.2023.2234450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 07/04/2023] [Indexed: 07/12/2023]
Abstract
We conducted qualitative research exploring the treatment experience of people with DR-TB. We held nine focus group discussions with 57 adults undergoing/recently completed treatment for DR-TB in Georgia, Mongolia and South Africa. Translated transcripts were analysed using thematic analysis. We identified three higher order themes: (1) Treatment experience and the role of good relationships with healthcare providers: Treatment duration, pill burden and side-effects were challenging aspects of treatment. Side-effects/symptoms that were visible signs of illness were particularly troubling. Good relations with clinical staff helped combat fear and uncertainty regarding treatment. (2) Mental distress and opportunities for wellbeing: The shame, stigma and isolation people experienced as a result of their DR-TB diagnosis was an important cause of mental distress. No longer being infectious enabled people to resume work and socialising. Positive emotions emerged with good treatment outcomes. (3) Fear and worry along the treatment journey: Participants expressed fears about TB: infecting others; whether they would be able to endure treatment; side-effects; health consequences of treatment. Worries mostly disappeared with successful treatment. Alongside measuring side-effects, time to culture conversion and cure rates, future trials of DR-TB treatments should capture how quickly visible symptoms resolve, quality of life measures, and mental health outcomes.
Collapse
Affiliation(s)
| | | | | | | | - Suzanne Staples
- THINK: TB and HIV Investigative Network, Durban, South Africa
| | - Nestani Tukvadze
- TB Clinical Research Unit, National Centre for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - Gantsetseg Dorj
- TB Research and Surveillance Department, National Center for Communicable Diseases, Ulaanbaatar, Mongolia
| | - Sindisiwe Zaca
- THINK: TB and HIV Investigative Network, Durban, South Africa
| | | | - Nasanjargal Purev
- TB Research and Surveillance Department, National Center for Communicable Diseases, Ulaanbaatar, Mongolia
| | - Hanif Esmail
- MRC Clinical Trials Unit at UCL, UCL, London, UK
| | | |
Collapse
|
5
|
Eyowas FA, Schneider M, Balcha SA, Pati S, Getahun FA. Multimorbidity and health-related quality of life among patients attending chronic outpatient medical care in Bahir Dar, Northwest Ethiopia: The application of partial proportional odds model. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001176. [PMID: 36962679 PMCID: PMC10021695 DOI: 10.1371/journal.pgph.0001176] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/04/2022] [Indexed: 06/03/2023]
Abstract
BACKGROUND Multimorbidity, the presence of two or more chronic non-communicable diseases (NCDs) in a given person affects all aspects of people's lives. Poor quality of life (QoL) is one of the major consequences of living with multimorbidity. Although healthcare should support multimorbid individuals to achieve a better quality of life, little is known about the effect of multimorbidity on the QoL of patients living with chronic conditions. This study aimed to determine the influence of multimorbidity on QoL among clients attending chronic outpatient medical care in Bahir Dar, Northwest Ethiopia. METHODOLOGY A multi-centered facility-based study was conducted among 1440 participants aged 40+ years. Two complementary methods were employed to collect sociodemographic and disease related data. We used the short form (SF-12 V2) instrument to measure quality of life (QoL). The data were analyzed by STATA V.16, and a multivariate partial proportional odds model was fitted to identify covariates associated with quality of life. Statistical significance was considered at p-value <0.05. PRINCIPAL FINDINGS Multimorbidity was identified in 54.8% (95% CI = 52.2%-57.4%) of the sample. A significant proportion (33.5%) of the study participants had poor QoL and a quarter (25.8%) of them had moderate QoL. Advanced age, obesity and living with multimorbidity were the factors associated with poor QoL. Conversely, perceived social support and satisfaction with care were the variables positively associated with better QoL. CONCLUSION The magnitude of multimorbidity in this study was high and individuals living with multimorbidity had a relatively poorer QoL than those without multimorbidity. Care of people with chronic multiple conditions has to be oriented to the realities of multimorbidity burden and its implication on QoL. It is also imperative to replicate the methods we employed to measure and analyze QoL data in this study for facilitating comparison and further development of the approaches.
Collapse
Affiliation(s)
- Fantu Abebe Eyowas
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Marguerite Schneider
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health University of Cape Town, Cape Town, South Africa
| | - Shitaye Alemu Balcha
- School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | | | - Fentie Ambaw Getahun
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| |
Collapse
|
6
|
Kohler IV, Ciancio A, Kämpfen F, Kohler HP, Mwapasa V, Chilima B, Vinkhumbo S, Mwera J, Maurer J. Pain Is Widespread and Predicts Poor Mental Health Among Older Adults in Rural Malawi. Innov Aging 2022; 6:igac008. [PMID: 35542563 PMCID: PMC9074811 DOI: 10.1093/geroni/igac008] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Indexed: 12/05/2022] Open
Abstract
Background and Objectives Pain is common among older persons and has been documented as an important predictor of disability, health, and economic outcomes. Evidence about its prevalence and relationship to well-being is scarce in rural sub-Saharan Africa (SSA), where work is frequently physically demanding, and pain prevention or treatment options are limited. We investigate the prevalence of pain and its association with mental health and subjective well-being in a population-based study of older adults in rural Malawi. Research Design and Methods We estimate the prevalence, severity, and duration of pain along with its sociodemographic distribution in a sample of 1,577 individuals aged 45 and older. We assess the association of pain with clinically validated measures of mental health, including depression and anxiety, and subjective well-being. Results Pain is widespread in this mature population with an average age of 60 years: 62% of respondents report the experience of at least minor pain during the last year, and half of these cases report severe or disabling pain. Women are more likely to report pain than men. Pain is a strong predictor of mental health and subjective well-being for both genders. More severe or longer pain episodes are associated with worse mental states. Individuals reporting pain are more likely to suffer from depression or express suicidal thoughts. Discussion and Implications Our study identifies key subpopulations such as older women in a SSA low-income context who are particularly affected by the experience of pain in daily life and calls for interventions targeting pain and its consequences for mental health and subjective well-being.
Collapse
Affiliation(s)
- Iliana V Kohler
- Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Sociology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alberto Ciancio
- Adam Smith Business School, University of Glasgow, Glasgow, UK
| | - Fabrice Kämpfen
- School of Economics, University College Dublin, Dublin, Ireland
| | - Hans-Peter Kohler
- Department of Sociology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Population Aging Research Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | - Steve Vinkhumbo
- Ministry of Gender, Children, Disability and Social Welfare, Lilongwe, Malawi
| | - James Mwera
- Invest in Knowledge Initiative, Zomba, Malawi
| | - Jürgen Maurer
- Department of Economics, University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
7
|
Ohrnberger J, Fichera E, Sutton M, Anselmi L. The worse the better? Quantile treatment effects of a conditional cash transfer programme on mental health. Health Policy Plan 2021; 35:1137-1149. [PMID: 32879960 PMCID: PMC7810405 DOI: 10.1093/heapol/czaa079] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2020] [Indexed: 12/19/2022] Open
Abstract
Poor mental health is a pressing global health problem, with high prevalence among poor populations from low-income countries. Existing studies of conditional cash transfer (CCT) effects on mental health have found positive effects. However, there is a gap in the literature on population-wide effects of cash transfers on mental health and if and how these vary by the severity of mental illness. We use the Malawian Longitudinal Study of Family and Health containing 790 adult participants in the Malawi Incentive Programme, a year-long randomized controlled trial. We estimate average and distributional quantile treatment effects and we examine how these effects vary by gender, HIV status and usage of the cash transfer. We find that the cash transfer improves mental health on average by 0.1 of a standard deviation. The effect varies strongly along the mental health distribution, with a positive effect for individuals with worst mental health of about four times the size of the average effect. These improvements in mental health are associated with increases in consumption expenditures and expenditures related to economic productivity. Our results show that CCTs can improve adult mental health for the poor living in low-income countries, particularly those with the worst mental health.
Collapse
Affiliation(s)
- Julius Ohrnberger
- School of Public Health, Department of Infectious Disease Epidemiology, Imperial College London, Medical School Building, St Mary's Campus, Norfolk Place, W2 1PG, London, UK
| | - Eleonora Fichera
- Department of Economics, University of Bath, Claverton Down, Bath BA2 7JP, Bath, UK
| | - Matt Sutton
- Institute for Health Policy and Organisation, University of Manchester, Booth Street West, M15 6PB, Manchester, UK
| | - Laura Anselmi
- Institute for Health Policy and Organisation, University of Manchester, Booth Street West, M15 6PB, Manchester, UK
| |
Collapse
|
8
|
Myroniuk TW, Kohler HP, Kohler IV. Marital dissolutions and changes in mental health: Evidence from rural Malawi. DEMOGRAPHIC RESEARCH 2021; 44:993-1022. [PMID: 36819791 PMCID: PMC9937544 DOI: 10.4054/demres.2021.44.41] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Advancing efforts to unpack the complex relationship between marital dissolutions and health outcomes increasingly requires assessing the marital histories and health of individuals who have lived long enough to experience divorce or widowhood ‒ or even multiples of each ‒ and measurable changes in health. OBJECTIVE To explore this line of inquiry, we chose a sample from rural Malawi where a high prevalence of marital dissolutions and remarrying exists, as an ideal theoretical foil to the predominant literature found in high-income countries (HICs). We examine if changes in having experienced a marital dissolution, one's total number of dissolutions, and the percentage of one's life spent outside of marriage since first becoming married are associated with changes in mental health. METHODS Our analyses focus on 1,266 respondents aged 45 years and older who participated in the 2012 Mature Adults Cohort of the Malawi Longitudinal Study of Families and Health (MLSFH-MAC), linked back to cohort information from 2008 and 2010 available through the MLSFH. Fixed-effects regressions guide our inferences over the 2008, 2010, and 2012 waves of data. RESULTS For men, spending more life outside of marriage is associated with worse mental health, while more marital dissolutions are surprisingly associated with better mental health for women. CONCLUSIONS These results could suggest that larger portions of one's life spent unmarried are associated with a type of role strain for men or simply that men are burdened with taking up tasks that their spouses had previously done in order to survive. For women, many may have gotten out of 'bad' marriages that otherwise would have been detrimental to their mental health and/or those in good mental health are the ones able to remarry. CONTRIBUTIONS Our research from rural Malawi provides a type of litmus test for many HICs where marriage, remarriage, and dissolution rates are lower but quite consequential for mental health outcomes. Measuring time outside of marriage should be more strongly considered in such settings. These results also inform increasingly important research on the relationship between marital dissolutions and mental health in other African nations as noncommunicable diseases play a continually more important role in people's lives.
Collapse
Affiliation(s)
- Tyler W Myroniuk
- University of Missouri, Department of Public Health, 825 Lewis Hall, 65211 Columbia, MO, USA
| | - Hans-Peter Kohler
- Population Aging Research Center (PARC) and Department of Sociology, University of Pennsylvania., USA
| | - Iliana V Kohler
- Population Studies Center (PSC) and Department of Sociology, University of Pennsylvania, USA
| |
Collapse
|
9
|
Ciancio A, Kämpfen F, Kohler HP, Kohler IV. Health screening for emerging non-communicable disease burdens among the global poor: Evidence from sub-Saharan Africa. JOURNAL OF HEALTH ECONOMICS 2021; 75:102388. [PMID: 33249266 PMCID: PMC7855787 DOI: 10.1016/j.jhealeco.2020.102388] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 07/19/2020] [Accepted: 09/14/2020] [Indexed: 06/01/2023]
Abstract
Evidence for the effectiveness of population health screenings to reduce the burden of non-communicable diseases in low-income countries remains very limited. We investigate the sustained effects of a health screening in Malawi where individuals received a referral letter if they had elevated blood pressure. Using a regression discontinuity design and a matching estimator, we find that receiving a referral letter reduced blood pressure and the probability of being hypertensive by about 22 percentage points four years later. These lasting effects are explained by a 20 percentage points increase in the probability of being diagnosed with hypertension. There is also evidence of an increase in the uptake of medication, while we do not identify improvements in hypertension-related knowledge or risk behaviors. On the contrary, we find an increase in sugar intake and a decrease in physical activity both of which are considered risky behaviors in Western contexts. The health screening had some positive effects on mental health. Overall, this study suggests that population-based hypertension screening interventions are an effective tool to improve health in low-income contexts.
Collapse
Affiliation(s)
- Alberto Ciancio
- Department of Economics, HEC, University of Lausanne, Switzerland
| | | | | | | |
Collapse
|
10
|
Kohler IV, Bandawe C, Ciancio A, Kämpfen F, Payne CF, Mwera J, Mkandawire J, Kohler HP. Cohort profile: the mature adults cohort of the Malawi longitudinal study of families and health (MLSFH-MAC). BMJ Open 2020; 10:e038232. [PMID: 33067285 PMCID: PMC7569924 DOI: 10.1136/bmjopen-2020-038232] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 07/18/2020] [Accepted: 08/19/2020] [Indexed: 12/03/2022] Open
Abstract
PURPOSE The Mature Adults Cohort of the Malawi Longitudinal Study of Families and Health (MLSFH-MAC) contributes to global ageing studies by providing a rare opportunity to study the processes of individual and population ageing, the public health and social challenges associated with ageing and the coincident shifts in disease burdens, in a low-income, high HIV prevalence, sub-Saharan African (SSA) context. PARTICIPANTS The MLSFH-MAC is an open population-based cohort study of mature adults aged 45+ years living in rural communities in three districts in Malawi. Enrolment at baseline is 1266 individuals in 2012. Follow-ups were in 2013, 2017 and 2018 when the cohort size reached 1626 participants in 2018. FINDINGS TO DATE Survey instruments cover ageing-related topics such as cognitive and mental health, non-communicable diseases (NCDs) and related health literacy, subjective survival expectations, measured biomarkers including HIV, grip strength, hypertension, fasting glucose, body mass index (BMI), broad individual-level and household-level social and economic information, a 2018 qualitative survey of mature adults and community officials, 2019 surveys of village heads, healthcare facilities and healthcare providers in the MLSFH-MAC study areas. Across many domains, MLSFH-MAC allows for comparative research with global ageing studies through harmonised measures and instruments. Key findings to date include a high prevalence of depression and anxiety among older adults, evidence for rapid declines in cognitive health with age, a low incidence of HIV among mature adults, rising prevalence of HIV due to increased survival of HIV-positive individuals and poor physical health with high NCD prevalence. FUTURE PLANS An additional wave of MLSFH-MAC is forthcoming in 2021, and future expansions of the cohort are planned. MLSFH-MAC data will also be publicly released and will provide a wealth of information unprecedented for ageing studies in a low-income SSA context that broadly represents the socioeconomic environment of millions of individuals in south-eastern Africa.
Collapse
Affiliation(s)
- Iliana V Kohler
- Sociology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Chiwoza Bandawe
- Department of Mental Health, University of Malawi, College of Medicine, Blantyre, Malawi
| | - Alberto Ciancio
- Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Economics, University of Lausanne, Lausanne, Switzerland
| | - Fabrice Kämpfen
- Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Collin F Payne
- School of Demography, Research School of Social Sciences, Australian National University, Canberra, New South Wales, Australia
| | - James Mwera
- Invest in Knowledge Initiative (IKI), Zomba, Malawi
| | | | - Hans-Peter Kohler
- Sociology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
11
|
Clark S, Cotton C, Margolis R, Kohler HP. The Psychological Benefits of Marriage and Children in Rural Malawi. Stud Fam Plann 2020; 51:251-272. [PMID: 32720321 PMCID: PMC7778373 DOI: 10.1111/sifp.12133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Despite an extensive literature on the psychological rewards of marriage and children in high-income countries, research on these relationships in low-income countries remains limited. This paper draws on data from 4,133 adult women and men interviewed in the Malawi Longitudinal Study of Families and Health to examine how marital status, categorized as never, formerly, monogamously, and polygynously married, and number of children are associated with psychological well-being. With respect to marital status, we find that women in polygynous unions fare worse than monogamously married women and this detrimental effect is stronger for women than for men. Formerly married men and women of reproductive age experience the worst psychological outcomes, although this association wanes with age. In contrast, the benefits of having children is only evident among older Malawian women. These findings offer novel insights into the patterns of nearly universal marriage and high fertility that characterize Malawi and much of sub-Saharan Africa.
Collapse
Affiliation(s)
- Shelley Clark
- Department of Sociology, McGill University, Montreal, Quebec, H3A 2T7, Canada
| | - Cassandra Cotton
- School of Social & Family Dynamics, Arizona State University, Tempe, AZ, 85287, USA
| | - Rachel Margolis
- Department of Sociology, Western University, London, Ontario, N6A 5C2, Canada
| | - Hans-Peter Kohler
- Department of Sociology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| |
Collapse
|