Abstract P140: High Poverty Among Patients With Noncommunicable Diseases in Rural Haiti

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Gene F Kwan ◽  
Benito Isaac ◽  
Lily Yan ◽  
Waking Jean-Baptiste ◽  
Densa Belony ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Low Income ◽  
Child Death ◽  
Health Spending ◽  
Low Income Countries ◽  
Noncommunicable Diseases ◽  
Major Barrier ◽  
Catastrophic Health Spending ◽  
Poverty Indicators ◽  
Clinic Visits

Background: Noncommunicable diseases (NCDs) are a major and growing cause of death and disability in low-income countries, and contribute a substantial portion of outpatient clinic visits. Poverty can be a major barrier to accessing healthcare in rural low-income countries. The objective of this study is to describe the demographics and socioeconomic status of patients attending an NCD clinic in rural Haiti, where poverty is highly prevalent. Methods: We analyzed routinely collected clinic data from adult patients in rural Haiti presenting to the NCD clinic at Hôpital Universitaire de Mirebalais. We collected data during routine initial clinic visits from July 2013 through October 2016. We performed descriptive statistics to assess patient demographics and socioeconomic status using available data. We evaluated poverty based on the Multidimensional Poverty Index by evaluating 9 indicators within three dimensions: health, education, and standard of living - we did not assess electricity. We assessed deprivation within each indicator. The “poorest” patients were defined as those deprived in 4 of the 9 poverty indicators. We also assessed measures of catastrophic health spending. Results: A total of 518 adults were included, with 72% (373/508) women. The mean overall age was 52.8 years (SD 14.7) and 21% (108/518) were 40 years old or younger. Of the patients, 32% had only hypertension, 18% had only diabetes, 32% had both diabetes and hypertension, 5% had heart failure, and 13% had no recorded diagnosis. 45% of patients travel more than 1 hour for clinic visits. Almost half (49%, 146/296) of adults sold belongings and 61% (178/292) borrowed money to pay for healthcare. Among the poverty measures, the top indicators with deprivation were cooking fuel with charcoal or wood (96%, 290/302), child death in household (70%, 169/243), and no household members completing primary school (25%, 83/324), lack of household assets (25%, 79/313), poor sanitation (19%, 59/304), dirt floor (16%, 50/304), and lack of improved drinking water (9%, 29/308). Of all patients, 21% (78/378) were among the poorest. Throughout Haiti, however, 55% of the population are among the poorest. There were more patients among the poorest living closer to the hospital (27%) than living farther away (10%). Interpretation: The great majority of patients were middle-aged women, with predominantly hypertension and/or diabetes. Socioeconomic deprivation was high among many poverty indicators and most patients experienced catastrophic health spending. At this clinic in rural Haiti, the proportion of patients presenting for care who are among the poorest is less than that overall in Haiti. Patients who travel far distances have less poverty. Health systems for chronic disease management in rural low-income countries must account for patient poverty.

scholarly journals Factors associated with the disbursements of development assistance for health in low-income and middle-income countries, 2002–2017

2021 ◽  
Vol 6 (4) ◽  
pp. e004858
Author(s):  
Modhurima Moitra ◽  
Ian Cogswell ◽  
Emilie Maddison ◽  
Kyle Simpson ◽  
Hayley Stutzman ◽  
...  
Keyword(s):  
Low Income ◽  
Development Assistance ◽  
Health Spending ◽  
Recipient Country ◽  
Health Systems Strengthening ◽  
Low Income Countries ◽  
Middle Income ◽  
Development Assistance For Health ◽  
Country Characteristics ◽  
Health Accounts

IntroductionIn 2017, development assistance for health (DAH) comprised 5.3% of total health spending in low-income countries. Despite the key role DAH plays in global health-spending, little is known about the characteristics of assistance that may be associated with committed assistance that is actually disbursed. In this analysis, we examine associations between these characteristics and disbursement of committed assistance.MethodsWe extracted data from the Creditor Reporting System of the Organization for Economic Co-operation and Development, Institute for Health Metrics and Evaluation, and the WHO National Health Accounts database. Factors examined were off-budget assistance, administrative assistance, publicly sourced assistance and assistance to health systems strengthening. Recipient-country characteristics examined were perceived level of corruption, civil fragility and gross domestic product per capita (GDPpc). We used linear regression methods for panel of data to assess the proportion of committed aid that was disbursed for a given country-year, for each data source.ResultsFactors that were associated with a higher disbursement rates include off-budget aid (p<0.001), lower administrative expenses (p<0.01), lower perceived corruption in recipient country (p<0.001), lower fragility in recipient country (p<0.05) and higher GDPpc (p<0.05).ConclusionSubstantial gaps remain between commitments and disbursements. Characteristics of assistance (administrative, publicly sourced) and indicators of government transparency and fragility are also important drivers associated with disbursement of DAH. There remains a continued need for better aid flow reporting standards and clarity around aid types for better measurement of DAH.

scholarly journals Physical Activity and Associated Socioeconomic Determinants in Rural and Urban Tanzania: Results from the 2012 WHO-STEPS Survey

2018 ◽  
Vol 2018 ◽  
pp. 1-10 ◽  
Author(s):  
Fredirick L. Mashili ◽  
Gibson B. Kagaruki ◽  
Joseph Mbatia ◽  
Alphoncina Nanai ◽  
Grace Saguti ◽  
...  
Keyword(s):  
Physical Activity ◽  
Low Income ◽  
Physical Inactivity ◽  
Social Economic ◽  
Statistical Significance ◽  
Female Gender ◽  
Low Income Countries ◽  
Noncommunicable Diseases ◽  
Rural And Urban ◽  
Steps Survey

Background. Physical inactivity contributes to the rising prevalence of noncommunicable diseases (NCDs). Given the rapidly increasing prevalence of NCDs in Low-Income Countries (LICs), comprehensive evaluation and documentation of physical activity (PA) status in this setting are crucial. Methods. We examined the demographic and social-economic antecedents of PA among adults (5398) from the 2012 Tanzania STEPS survey data. Statistical significance at the level of 0.05 was used to measure the strength of associations. Results. Majority of study participants attained the WHO-recommended levels of physical activity (96.7%). Levels were higher among those living in rural than in urban settings (98% versus 92%,  p<0.0001) and generally, urban residency, female gender, higher education achievement, and employment were significantly associated with low levels of PA. Participation in the different domains of PA (work, transport, and recreational) varied with living setting, levels of education, and employment status. Conclusion. These results describe PA status and associated social-economic determinants among adults in rural and urban Tanzania. The findings contribute to the growing evidence that implicates urbanization as a key driver for the growing prevalence of physical inactivity in LICs and underscore the need for tailored PA interventions based on demography and social-economic factors.

scholarly journals Health spending and vaccination coverage in low-income countries

2020 ◽  
Author(s):  
Francisco Castillo-Zunino ◽  
Pinar Keskinocak ◽  
Dima Nazzal ◽  
Matthew C Freeman
Keyword(s):  
Vaccination Coverage ◽  
Low Income ◽  
National Income ◽  
Health Spending ◽  
Gross National Income ◽  
Low Income Countries ◽  
Childhood Immunization ◽  
Government Health ◽  
Per Capita ◽  
The Impact

SummaryBackgroundRoutine childhood immunization is a cost-effective way to save lives and protect people from disease. Some low-income countries (LIC) have achieved remarkable success in childhood immunization, despite lower levels of gross national income or health spending compared to other countries. We investigated the impact of financing and health spending on vaccination coverage across LIC and lower-middle income countries (LMIC).MethodsAmong LIC, we identified countries with high-performing vaccination coverage (LIC+) and compared their economic and health spending trends with other LIC (LIC-) and LMIC. We used cross-country multi-year linear regressions with mixed-effects to test financial indicators over time. We conducted three different statistical tests to verify if financial trends of LIC+ were significantly different from LIC- and LMIC; p-values were calculated with an asymptotic χ2 test, a Kenward-Roger approximation for F tests, and a parametric bootstrap method.FindingsDuring 2014–18, LIC+ had a mean vaccination coverage between 91–96% in routine vaccines, outperforming LIC- (67–80%) and LMIC (83–89%). During 2000–18, gross national income and development assistance for health (DAH) per capita were not significantly different between LIC+ and LIC- (p > 0·13, p > 0·65) while LIC+ had a significant lower total health spending per capita than LIC- (p < 0·0001). Government health spending per capita per year increased by US$0·42 for LIC+ and decreased by US$0·24 for LIC- (p < 0·0001). LIC+ had a significantly lower private health spending per capita than LIC- (p < 0·012).InterpretationLIC+ had a difference in vaccination coverage compared to LIC- and LMIC that could not be explained by economic development, total health spending, nor aggregated DAH. The vaccination coverage success of LIC+ was associated with higher government health spending and lower private health spending, with the support of DAH on vaccines.

scholarly journals Rumor surveillance in support of minimally invasive tissue sampling for diagnosing the cause of child death in low-income countries: A qualitative study

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0244552
Author(s):  
Md Saiful Islam ◽  
Abdullah Al-Masud ◽  
Maria Maixenchs ◽  
Saquina Cossa ◽  
Rui Guilaze ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Cause Of Death ◽  
Low Income ◽  
Child Death ◽  
The Body ◽  
Low Income Countries ◽  
Tissue Sampling ◽  
Middle Income ◽  
Additional Information ◽  
Tissue Specimens

In low-and middle-income countries, determining the cause of death of any given individual is impaired by poor access to healthcare systems, resource-poor diagnostic facilities, and limited acceptance of complete diagnostic autopsies. Minimally invasive tissue sampling (MITS), an innovative post-mortem procedure based on obtaining tissue specimens using fine needle biopsies suitable for laboratory analysis, is an acceptable proxy of the complete diagnostic autopsy, and thus could reduce the uncertainty of cause of death. This study describes rumor surveillance activities developed and implemented in Bangladesh, Mali, and Mozambique to identify, track and understand rumors about the MITS procedure. Our surveillance activities included observations and interviews with stakeholders to understand how rumors are developed and spread and to anticipate rumors in the program areas. We also engaged young volunteers, local stakeholders, community leaders, and study staff to report rumors being spread in the community after MITS launch. Through community meetings, we also managed and responded to rumors. When a rumor was reported, the field team purposively conducted interviews and group discussions to track, verify and understand the rumor. From July 2016 through April 2018, the surveillance identified several rumors including suspicions of organs being harvested or transplanted; MITS having been performed on a living child, and concerns related to disrespecting the body and mistrust related to the study purpose. These rumors, concerns, and cues of mistrust were passed by word of mouth. We managed the rumors by modifying the consent protocol and giving additional information and support to the bereaved family and to the community members. Rumor surveillance was critical for anticipating and readily identifying rumors and managing them. Setting up rumor surveillance by engaging community residents, stakeholders, and volunteers could be an essential part of any public health program where there is a need to identify and react in real-time to public concern.

Formal assessment of teamwork among cancer health care professionals in 3 large tertiary centers in Nigeria.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18126-e18126 ◽  
Author(s):  
Abiola Falilat Ibraheem ◽  
Olutosin Alaba Awolude ◽  
Myhammad-yaqub Murtazha Habeebu ◽  
Anthonia Chima Sowunmi ◽  
Popoola Abiodun Olaniyi ◽  
...  
Keyword(s):  
Health Care ◽  
Low Income ◽  
Health Care Professionals ◽  
Cancer Care ◽  
Developing World ◽  
Low Income Countries ◽  
Major Barrier ◽  
Optimal Outcomes ◽  
Quality Cancer Care ◽  
Key Stakeholders

e18126 Background: Cancer is fast becoming a common cause of death in developing world. Over the last decade, there have been strategies to bring quality cancer care to underserved patients around the world. In low-income countries, poor utilization of principles of teamwork is a major barrier to achieving quality services. The intent of this study is to assess teamwork as perceived by the health care workers caring for cancer patients Methods: We conducted a survey among health care professionals involved in cancer care in 3 tertiary centers in the southwestern part of Nigeria from July to November 2016. Respondents rated teamwork using the previously validated ÒSafety Attitudes QuestionnaireÓ. For this analysis we focused on the teamwork climate subscale. This subscale is scored on a scale of 0-100 with mean (SD) values,in US ambulatory population of 69.7 (17). We compared ratings by professionals using analysis of variance Results: Overall 373 professionals completed the survey: Physicians (47%), nurses (14%), pharmacists (6%) and others (33%). Some results are shown in table Conclusions: Cancer care is complex and depends on teamwork amongst health care professionals to achieve optimal outcomes. While overall teamwork scores was consistent with US ambulatory studies , there are important variations that provide targets for intervention. Physicians rated teamwork poorly both intra and inter professionally. Pharmacists rated inter professional teamwork with nurses particularly poorly. Further data on additional subscales of the instrument and by individual centers will be presented. Efforts to transform cancer care need to focus on building trust among the key stakeholders. This is true in developing world where there is a need to maximize the use of limited resources to improve patient outcomes. [Table: see text]

scholarly journals Financial crises and the attainment of the SDGs: an adjusted multidimensional poverty approach

2019 ◽  
Vol 15 (6) ◽  
pp. 1683-1698 ◽  
Author(s):  
Andreas Antoniades ◽  
Indra Widiarto ◽  
Alexander S. Antonarakis
Keyword(s):  
Low Income ◽  
Financial Distress ◽  
Financial Crises ◽  
Multidimensional Poverty ◽  
Low Income Countries ◽  
Domino Effect ◽  
Average Decrease ◽  
Poverty Indicators ◽  
The Impact ◽  
Dynamic Linkages

AbstractThis paper analyses the impact of financial crises on the Sustainable Development Goal of eradicating poverty. To do so, we develop an adjusted Multidimensional Poverty Framework (MPF) that includes 15 indicators that span across key poverty aspects related to income, basic needs, health, education and the environment. We then use an econometric model that allows us to examine the impact of financial crises on these indicators in 150 countries over the period 1980–2015. Our analysis produces new estimates on the impact of financial crises on poverty’s multiple social, economic and environmental aspects and equally important captures dynamic linkages between these aspects. Thus, we offer a better understanding of the potential impact of current debt dynamics on Multidimensional Poverty and demonstrate the need to move beyond the boundaries of SDG1, if we are to meet the target of eradicating poverty. Our results indicate that the current financial distress experienced by many low-income countries may reverse the progress that has been made hitherto in reducing poverty. We find that financial crises are associated with an approximately 10% increase of extreme poor in low-income countries. The impact is even stronger in some other poverty aspects. For instance, crises are associated with an average decrease of government spending in education by 17.72% in low-income countries. The dynamic linkages between most of the Multidimensional Poverty indicators, warn of a negative domino effect on a number of SDGs related to poverty, if there is a financial crisis shock. To pre-empt such a domino effect, the specific SDG target 17.4 on attaining long-term debt sustainability through coordinated policies plays a key role and requires urgent attention by the international community.

scholarly journals Financial protection against out-of-pocket health expenditure in Poland

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Tambor ◽  
M Pavlova
Keyword(s):  
European Union ◽  
Low Income ◽  
Health Spending ◽  
Financial Hardship ◽  
Financial Protection ◽  
Health Coverage ◽  
Over The Counter ◽  
Catastrophic Health Spending ◽  
Out Of Pocket Payments ◽  
European Union Countries

Abstract Background Protecting people against financial hardship associated with using health care, is crucial for achieving universal health coverage. Despite the significant improvement happening in the last two decades, household out-of-pocket payments in Poland account for 23% of current spending on health, which is more than in many European Union countries. This implies an incased risk of financial hardship for Polish households. Methods The aim of this study was to assess the extent to which people in Poland experience financial hardship when they use health services. The analysis draws on household budget survey data collected annually by the Central Statistical Office of Poland between 2005 and 2014. It focuses on two indicators of financial protection: catastrophic health spending and impoverishing health spending. The study is a part of WHO country-based studies generating new evidence on financial protection in European health systems. Results In 2014, 8.6% of Polish households experienced catastrophic health spending, while 3.8% of households were impoverished or further impoverished due to health spending. Financial hardship is heavily concentrated among the poorest households for whom the incidence of catastrophic spending is 30%. Outpatient medicines are the largest single driver of catastrophic health spending across all consumption quintiles except the richest. For the richest households, payments for medical products and dental care are the main causes of financial hardship. Although financial protection improved between 2005 and 2014, the improvement among the poorest was marginal. Conclusions Policy attention should focus on protecting households against high spending on outpatient medicines, e.g. revising patient cost-sharing for prescribed medicines and strengthen regulation for over-the-counter medicines. The protection mechanisms should be targeted at low-income households (people living on social benefits, disability or survivor's pensioners). Key messages Financial protection is fairly weak in Poland compared to many European Union countries. Out-of-pocket payments for medicines (prescribed and over-the-counter) are the main cause of financial hardship for Polish households.

The reality of the Noncommunicable disease policy landscape in Low Income Countries: the example of Mozambique

2021 ◽  
Author(s):  
Khatia Rebeca Munguambe ◽  
Tavares Madede ◽  
Vasco Muchanga ◽  
Claire Somerville ◽  
David Henri Beran ◽  
...  
Keyword(s):  
Low Income ◽  
Well Being ◽  
Noncommunicable Disease ◽  
Low Income Countries ◽  
Noncommunicable Diseases ◽  
Middle Income ◽  
External Resources ◽  
Low Income Country ◽  
Middle Income Countries ◽  
Government Documents

Abstract Background Noncommunicable diseases (NCD) are the leading cause of morbidity and mortality worldwide with a disproportionate burden affecting low- and middle-income countries (LMIC). Mozambique, is a low income country situated in Southern Africa with an emerging burden of NCDs, but still facing a large challenge with regards to communicable diseases. Using the policy prioritisation framework developed by Shiffman and Smith this study aims to present the different elements that have shaped the current policy landscape for NCDs in Mozambique.Results The policy review identified 18 documents, and seven KIs were interviewed. The policy community could be seen as cohesive in that a few leading experts in Mozambique agreed on both the challenges of NCDs and the possible response, but overall leadership was lacking. Although the Ministry of Health and its NCD Department were seen as the guiding institutions the Department was not resourced to be able to fulfil its mandate. Some external resources were available to assist, but these were insufficient. In addition civil society mobilisation was missing. With regards to ideas three disconnects were present: language used in overarching government documents and their translation into practice; the views of experts; and the perceptions of NCDs in a context like Mozambique in contrast to other health issues. The NCD Department and different strategies and government documents laid out the governing structure, but again a lack of resources hampered progress. This was compounded by a lack of understanding of the problem and solutions, as well as barriers to integrate the NCD response with HIV/AIDS for example. Conclusions This study shows that despite gaining prominence on the global health agenda, NCDs have yet to truly gain a strong foothold on the policy agenda of LMICs such as Mozambique. In order to do this both governments and donors need to be sensitised to this issue as well as clear guidance developed to enable countries to have practical solutions to address both prevention and treatment of NCDs in underfunded and weak health systems, but also be able to build on existing initiatives to improve the health and well-being of populations.

The Role of Nutrition in Integrative Preventive Medicine

2017 ◽  
Author(s):  
Walter C. Willett
Keyword(s):  
Low Income ◽  
Healthcare Providers ◽  
Well Being ◽  
The United States ◽  
Fellowship Training ◽  
Dietary Factors ◽  
Low Income Countries ◽  
Noncommunicable Diseases ◽  
Premature Deaths ◽  
Major Illness

Until recently, and still today in low-income countries, undernutrition during pregnancy and early childhood was a major cause of mortality. However, in recent decades, noncommunicable diseases account for the majority of premature deaths both in the United States and globally. Although dietary factors have been identified as the most important causes of this, physicians and other healthcare providers are taught little about nutrition in medical school or fellowship training. In conventional medical practice almost no attention is given to knowing what a patient is eating or providing dietary guidance that has the potential to improve dramatically their long-term health. This chapter describes what we know about the elements of a healthy diet and how these elements can be combined into an overall dietary pattern for the prevention of major illness and promotion of well-being. A brief section considers ways that this knowledge can be integrated into preventive healthcare.

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