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Scheve A, Bandawe C, Kohler HP, Kohler IV. Mental health and life-course shocks in a low-income country: Evidence from Malawi. SSM Popul Health 2022; 19:101098. [PMID: 35711726 PMCID: PMC9194642 DOI: 10.1016/j.ssmph.2022.101098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/31/2022] [Accepted: 04/12/2022] [Indexed: 11/26/2022] Open
Abstract
Economic insecurity has been widely hypothesized to be an important determinant of mental health, but this relationship has not been well-documented in low-income countries. Using data from the Mature Adults Cohort of the Malawi Longitudinal Study of Families and Health (MLSFH-MAC), we investigate the association of negative economic shocks with mental health outcomes such as depression and anxiety among adults aged 45+ years living in a low-income country. Using fixed effects estimates that control for time-invariant unobserved individual heterogeneity, we find that increased economic instability caused by events such as death of a family member, yield loss, or income loss is positively associated with worse mental health outcomes as measured by the PHQ-9 and GAD-7 instruments. Our results suggest that costly economic events are a key component to worsening mental health in settings characterized by pervasive poverty and underscore the importance of mental health as a public health and development target.
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Affiliation(s)
| | | | - Hans-Peter Kohler
- Population Aging Research Center (PARC), University of Pennsylvania, USA
| | - Iliana V. Kohler
- Population Studies Center (PSC), University of Pennsylvania, USA
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Lepard JR, Mediratta S, Rubiano AM, Park KB. The Application of Guideline-Based Care for Traumatic Brain and Spinal Cord Injury in Low- and Middle-Income Countries: A Provider-Based Survey. World Neurosurg X 2022; 15:100121. [PMID: 35515346 DOI: 10.1016/j.wnsx.2022.100121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 03/04/2022] [Indexed: 11/22/2022] Open
Abstract
Objective Neurosurgical guidelines have resulted in improved clinical outcomes and more optimized care for many complex neurosurgical pathologies. As momentum in global neurosurgical efforts has grown, there is little understanding about the application of these guidelines in low- and middle-income countries. Methods A 29-question survey was developed to assess the application of specific recommendations from neurosurgical brain and spinal cord injury guidelines. Surveys were distributed to an international cohort of neurosurgeons and neurotrauma stakeholders. Results A total of 82 of 222 (36.9%) neurotrauma providers responded to the survey. The majority of respondents practiced in low- and middle-income countries settings (49/82, 59.8%). There was a significantly greater mean traumatic brain injury volume in low-income countries (56% ± 13.5) and middle-income countries (46.5% ± 21.3) compared with high-income countries (27.9% ± 13.2), P < 0.001. Decompressive hemicraniectomy was estimated to occur in 61.5% (±30.8) of cases of medically refractory intracranial pressure with the lowest occurrence in the African region (44% ± 37.5). The use of prehospital cervical immobilization varied significantly by income status, with 36% (±35.6) of cases in low-income countries, 52.4% (±35.5) of cases in middle-income countries, and 95.2% (±10) in high-income countries, P < 0.001. Mean arterial pressure elevation greater than 85 mm Hg to improve spinal cord perfusion was estimated to occur in 71.7% of cases overall with lowest occurrence in Eastern Mediterranean region (55.6% ± 24). Conclusions While some disparities in guideline implementation are inevitably related to the availability of clinical resources, other differences could be more quickly improved with accessibility of current evidence-based guidelines and development of local data.
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Key Words
- AMR-US/Can, Region of the Americas (US and Canada)
- CT, Computed tomography
- Evidence-based guidelines
- Global neurosurgery
- HIC, High-income country
- ICP, Intracranial pressure
- LIC, Low-income country
- LMICs, Low- and middle-income countries
- Low- and middle-income countries
- MAP, Mean arterial pressure
- MIC, Middle-income country
- Neurotrauma
- Spinal cord injury
- TBI, Traumatic brain injury
- TSI, Traumatic spinal injury
- Traumatic brain injury
- WHO, World Health Organization
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Weiss HK, Garcia RM, Omiye JA, Vervoort D, Riestenberg R, Yerneni K, Murthy N, Wescott AB, Hutchinson P, Rosseau G. A Systematic Review of Neurosurgical Care in Low-Income Countries. World Neurosurg X 2020; 5:100068. [PMID: 31956859 PMCID: PMC6957821 DOI: 10.1016/j.wnsx.2019.100068] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 11/29/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE More than 5 billion individuals lack access to essential surgical care. Neurosurgical care is especially limited in low-income countries (LICs). Studies describing neurosurgical care in LICs are critical for understanding global disparities in access to neurosurgical procedures. To better understand these disparities, we conducted a systematic review of the literature identifying neurosurgical patients in LICs. METHODS MEDLINE (PubMed), Embase (embase.com), and Cochrane Library (Wiley) databases were systematically searched to retrieve studies describing neurosurgical care in LICs as defined by the World Bank Country and Lending Groups income classification. All databases were searched from their inception; no date or language limits were applied. All the articles were blindly reviewed by 2 individuals. Data from eligible studies were extracted and summarized. RESULTS Of the 4377 citations screened, 154 studies met inclusion criteria. The number of publications substantially increased over the study period, with 49% (n = 76) of studies published in the last 5 years. Twenty-six percent (n = 40) of studies had a first author, and 30% (n = 46) had a senior author, affiliated with a country different from the LIC of study. The most common neurosurgical diagnosis was traumatic brain injury (24%, n = 37), followed by hydrocephalus (26%, n = 40), and neoplastic intracranial mass (10%, n = 16). Of LICs, 43% (n = 15/35) had no published neurosurgical literature. CONCLUSIONS There is a significant deficit in the literature on neurosurgical care in LICs. Efforts must focus on supporting research initiatives in LICs to improve publication bias and understand disparities in access to neurosurgical care in the lowest-resource countries.
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Affiliation(s)
- Hannah K. Weiss
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Neurosurgery, Northwestern University, Chicago, Illinois, USA
| | - Roxanna M. Garcia
- Department of Neurosurgery, Northwestern University, Chicago, Illinois, USA
- Institute for Public Health and Medicine (IPHAM), Center for Healthcare Studies, Northwestern University, Chicago, Illinois, USA
| | | | - Dominique Vervoort
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert Riestenberg
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Neurosurgery, Northwestern University, Chicago, Illinois, USA
| | - Ketan Yerneni
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Neurosurgery, Northwestern University, Chicago, Illinois, USA
| | - Nikhil Murthy
- Department of Neurosurgery, Northwestern University, Chicago, Illinois, USA
| | - Annie B. Wescott
- Galter Health Sciences Library & Learning Center, Northwestern University, Chicago, Illinois, USA
| | - Peter Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital and University of Cambridge, Cambridge, United Kingdom
| | - Gail Rosseau
- Midwest Neurosurgical Associates, Oak Brook, Illinois, USA
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