scholarly journals Potential for health economics to influence policies on tobacco use during pregnancy in low-income and middle-income countries: a qualitative case study

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e045624
Author(s):  
Tuba Saygın Avşar ◽  
Louise Jackson ◽  
Hugh McLeod
Keyword(s):  
Health Economics ◽  
Pregnant Women ◽  
Tobacco Use ◽  
Low Income ◽  
Tobacco Cessation ◽  
Qualitative Case Study ◽  
Middle Income ◽  
Middle Income Countries ◽  
Country Specific

IntroductionTobacco control during pregnancy is a policy priority in high-income countries (HICs) because of the significant health and inequality consequences. However, little evidence exists on interventions to reduce tobacco use in low-income and middle-income countries (LMICs), especially for pregnant women. This study aimed to assess how health economics evidence, which is mainly produced in HICs, could be adopted for tobacco cessation policies for pregnant women in LMICs.MethodsA qualitative case study was conducted in an international public health organisation. The organisation was chosen due to its capacity to influence health policies around the world. Tobacco control experts working in the organisation were identified through purposeful sampling and snowballing. Semistructured interviews were conducted with 18 informants with relevant experience of countries from all of the regions covered by the organisation. Data were analysed using the framework method.ResultsIn practice, tobacco cessation during pregnancy was not viewed as a priority in LMICs despite international recognition of the issue. In LMICs, factors including the recorded country-specific prevalence of tobacco use during pregnancy, availability of healthcare resources and the characteristics of potential interventions all affected the use of health economics evidence for policy making.ConclusionThe scale of tobacco use among pregnant women might be greater than reported in LMICs. Health economics evidence produced in HICs has the potential to inform health policies in LMICs around tobacco cessation interventions if the country-specific circumstances are addressed. Economic evaluations of cessation interventions integrated into antenatal care with a household perspective would be especially relevant in LMICs.

scholarly journals Tobacco use in pregnant women: analysis of data from Demographic and Health Surveys from 54 low-income and middle-income countries

2014 ◽  
Vol 2 (9) ◽  
pp. e513-e520 ◽  
Author(s):  
Rishi Caleyachetty ◽  
Christopher A Tait ◽  
Andre P Kengne ◽  
Camila Corvalan ◽  
Ricardo Uauy ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Tobacco Use ◽  
Low Income ◽  
Health Surveys ◽  
Demographic And Health Surveys ◽  
Middle Income ◽  
Middle Income Countries

Generation of national political priority for surgery: a qualitative case study of three low-income and middle-income countries

The Lancet ◽  
2015 ◽  
Vol 385 ◽  
pp. S54 ◽  
Author(s):  
Anna J Dare ◽  
Josh Bleicher ◽  
Katherine C Lee ◽  
Alex E Elobu ◽  
Thaim B Kamara ◽  
...  
Keyword(s):  
Low Income ◽  
Qualitative Case Study ◽  
Middle Income ◽  
Middle Income Countries ◽  
Political Priority

scholarly journals Tobacco intervention research in low- and middle-income countries: lessons learned and future directions

2016 ◽  
Vol 11 (2) ◽  
pp. 61-64 ◽  
Author(s):  
Kenneth D. Ward
Keyword(s):  
Tobacco Control ◽  
Tobacco Use ◽  
Tobacco Cessation ◽  
Tobacco Dependence ◽  
Lessons Learned ◽  
Future Directions ◽  
Middle Income ◽  
Middle Income Countries ◽  
Country Level ◽  
Tobacco Intervention

Treating tobacco dependence is paramount for global tobacco control efforts, but is often overshadowed by other policy priorities. As stated by Jha (2009), “cessation by current smokers is the only practical way to avoid a substantial proportion of tobacco deaths worldwide before 2050.” Its importance is codified in Article 14 of the Framework Convention on Tobacco Control (FCTC), and in the WHO's MPOWER package of effective country-level policies. Unfortunately, only 15% of the world's population have access to appropriate cessation support (WHO, 2015). Moreover, parties to the FCTC have implemented only 51% of the indicators within Article 14, on average, which is far lower than many other articles (WHO, 2014). Further, commenting on the use of “O” measures (Offer help to quit tobacco use) in the MPOWER acronym, WHO recently concluded, “while there has been improvement in implementing comprehensive tobacco cessation services, this is nonetheless a most under-implemented MPOWER measure in terms of the number of countries that have fully implemented it” (WHO, 2015). To the detriment of global tobacco control efforts, only one in eight countries provides comprehensive cost-covered services, only one in four provide some cost coverage for nicotine replacement therapy, and fewer than one third provide a toll-free quit line (WHO, 2015).

Educational and wealth inequalities in tobacco use among men and women in 54 low-income and middle-income countries

2016 ◽  
Vol 27 (1) ◽  
pp. 26-34 ◽  
Author(s):  
Chandrashekhar T Sreeramareddy ◽  
Sam Harper ◽  
Linda Ernstsen
Keyword(s):  
Tobacco Use ◽  
Smokeless Tobacco ◽  
Low Income ◽  
Socioeconomic Inequalities ◽  
Educational Inequalities ◽  
Middle Income ◽  
Men And Women ◽  
Middle Income Countries ◽  
Index Of Inequality ◽  
Wealth Inequalities

BackgroundSocioeconomic differentials of tobacco smoking in high-income countries are well described. However, studies to support health policies and place monitoring systems to tackle socioeconomic inequalities in smoking and smokeless tobacco use common in low-and-middle-income countries (LMICs) are seldom reported. We aimed to describe, sex-wise, educational and wealth-related inequalities in tobacco use in LMICs.MethodsWe analysed Demographic and Health Survey data on tobacco use collected from large nationally representative samples of men and women in 54 LMICs. We estimated the weighted prevalence of any current tobacco use (including smokeless tobacco) in each country for 4 educational groups and 4 wealth groups. We calculated absolute and relative measures of inequality, that is, the slope index of inequality (SII) and relative index of inequality (RII), which take into account the distribution of prevalence across all education and wealth groups and account for population size. We also calculated the aggregate SII and RII for low-income (LIC), lower-middle-income (lMIC) and upper-middle-income (uMIC) countries as per World Bank classification.FindingsMale tobacco use was highest in Bangladesh (70.3%) and lowest in Sao Tome (7.4%), whereas female tobacco use was highest in Madagascar (21%) and lowest in Tajikistan (0.22%). Among men, educational inequalities varied widely between countries, but aggregate RII and SII showed an inverse trend by country wealth groups. RII was 3.61 (95% CI 2.83 to 4.61) in LICs, 1.99 (95% CI 1.66 to 2.38) in lMIC and 1.82 (95% CI 1.24 to 2.67) in uMIC. Wealth inequalities among men varied less between countries, but RII and SII showed an inverse pattern where RII was 2.43 (95% CI 2.05 to 2.88) in LICs, 1.84 (95% CI 1.54 to 2.21) in lMICs and 1.67 (95% CI 1.15 to 2.42) in uMICs. For educational inequalities among women, the RII varied much more than SII varied between the countries, and the aggregate RII was 14.49 (95% CI 8.87 to 23.68) in LICs, 3.05 (95% CI 1.44 to 6.47) in lMIC and 1.58 (95% CI 0.33 to 7.56) in uMIC. Wealth inequalities among women showed a pattern similar to that of men: the RII was 5.88 (95% CI 3.91 to 8.85) in LICs, 1.76 (95% CI 0.80 to 3.85) in lMIC and 0.39 (95% CI 0.09 to 1.64) in uMIC. In contrast to men, among women, the SII was pro-rich (higher smoking among the more advantaged) in 13 of the 52 countries (7 of 23 lMIC and 5 of 7 uMIC).InterpretationOur results confirm that socioeconomic inequalities tobacco use exist in LMIC, varied widely between the countries and were much wider in the lowest income countries. These findings are important for better understanding and tackling of socioeconomic inequalities in health in LMIC.

Tobacco use and secondhand smoke exposure among pregnant women in low- and middle-income countries: a call to action

2010 ◽  
Vol 89 (4) ◽  
pp. 418-422 ◽  
Author(s):  
Michele Bloch ◽  
Van T. Tong ◽  
Thomas E. Novotny ◽  
Lucinda J. England ◽  
Patricia M. Dietz ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Tobacco Use ◽  
Secondhand Smoke ◽  
Smoke Exposure ◽  
Secondhand Smoke Exposure ◽  
Middle Income ◽  
Call To Action ◽  
Middle Income Countries ◽  
Low And Middle Income

scholarly journals Not just a number: examining coverage and content of antenatal care in low-income and middle-income countries

2018 ◽  
Vol 3 (2) ◽  
pp. e000779 ◽  
Author(s):  
Lenka Benova ◽  
Özge Tunçalp ◽  
Allisyn C Moran ◽  
Oona Maeve Renee Campbell
Keyword(s):  
Antenatal Care ◽  
Low Income ◽  
Blood Pressure Measurement ◽  
First Trimester ◽  
Care Quality ◽  
Urine Test ◽  
Middle Income ◽  
Middle Income Countries ◽  
Content Of Care ◽  
Country Specific

IntroductionAntenatal care (ANC) provides a critical opportunity for women and babies to benefit from good-quality maternal care. Using 10 countries as an illustrative analysis, we described ANC coverage (number of visits and timing of first visit) and operationalised indicators for content of care as available in population surveys, and examined how these two approaches are related.MethodsWe used the most recent Demographic and Health Survey to analyse ANC related to women’s most recent live birth up to 3 years preceding the survey. Content of care was assessed using six components routinely measured across all countries, and a further one to eight additional country-specific components. We estimated the percentage of women in need of ANC, and using ANC, who received each component, the six routine components and all components.ResultsIn all 10 countries, the majority of women in need of ANC reported 1+ ANC visits and over two-fifths reported 4+ visits. Receipt of the six routine components varied widely; blood pressure measurement was the most commonly reported component, and urine test and information on complications the least. Among the subset of women starting ANC in the first trimester and receiving 4+ visits, the percentage receiving all six routinely measured ANC components was low, ranging from 10% (Jordan) to around 50% in Nigeria, Nepal, Colombia and Haiti.ConclusionOur findings suggest that even among women with patterns of care that complied with global recommendations, the content of care was poor. Efficient and effective action to improve care quality relies on development of suitable content of care indicators.

Implementing Evidence-Based Tobacco Use Treatment in Community Health Centers in Vietnam

2018 ◽  
Author(s):  
Mark Parascandola ◽  
Donna Shelley
Keyword(s):  
Tobacco Control ◽  
Tobacco Use ◽  
Community Health Centers ◽  
Evidence Based ◽  
Middle Income ◽  
Global Epidemic ◽  
Middle Income Countries ◽  
Tobacco Control Policies ◽  
Policies And Programs

Although tobacco use has been declining in most high-income countries, it has remained constant or increased in other areas of the world, shifting to low- and middle-income countries (LMICs). The Framework Convention on Tobacco Control (FCTC) was adopted in 2003 to address the growing global epidemic of tobacco use. The 181 countries that are parties to the treaty are required to adopt a range of evidence-based tobacco control policies and programs, including access to tobacco use treatment. This case study provides an overview of the progress and gaps in implementing the FCTC and demonstrates the application of implementation science methods to identify and address barriers to implementing a cessation interventions in the context of a health system in an LMIC.

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