ArticleLiterature Review

The double burden of communicable and non-communicable diseases in developing countries

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Abstract

Now, at the dawn of the third millennium, non-communicable diseases are sweeping the entire globe. There is an increasing trend in developing countries, where the demographic and socio-economic transition imposes more constraints on dealing with the double burden of infectious and non-infectious diseases in a poor environment, characterized by ill-health systems. It is predicted that, by 2020, non-communicable diseases will cause seven out of every ten deaths in developing countries. Among non-communicable diseases, special attention is devoted to cardiovascular disease, diabetes, cancer and chronic pulmonary disease. The burden of these conditions affects countries worldwide but with a growing trend in developing countries. Preventative strategies must take into account the growing trend of risk factors correlated to these diseases. In parallel, despite the success of vaccination programmes for polio and some childhood diseases, other diseases like AIDS, tuberculosis, malaria and dengue are still out of control in many regions of the globe. This paper is a brief review of recent literature dealing with communicable and non-communicable diseases in developing countries. It gives a global view of the main diseases and their impact on populations living in low- and middle-income nations.

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... CDs were the prime cause of death worldwide for a very long time [11]. NCDs were initially considered diseases of the rich and burdened healthcare systems only in developed countries [11]. ...
... CDs were the prime cause of death worldwide for a very long time [11]. NCDs were initially considered diseases of the rich and burdened healthcare systems only in developed countries [11]. Off late, NCDs seemed to be sweeping the globe, a trend that is becoming more prominent in developing countries [11]. ...
... NCDs were initially considered diseases of the rich and burdened healthcare systems only in developed countries [11]. Off late, NCDs seemed to be sweeping the globe, a trend that is becoming more prominent in developing countries [11]. India is also experiencing an increasing burden of NCD among elderly [12,13]. ...
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Background A rising proportion of elderly in India has infused notable challenges to the healthcare system, which is already underdeveloped. On one side, NCDs are increasing among the elderly in India; however, on the other side, CDs are also a cause of concern among the elderly in India. While controlling the outbreak of communicable diseases (CDs) remained a priority, non-communicable diseases (NCDs) are placing an unavoidable burden on the health and social security system. India, a developing nation in South Asia, has seen an unprecedented economic growth in the past few years; however, it struggled to fight the burden of communicable and non-communicable diseases. Therefore, this study aimed at examining the burden of CDs and NCDs among elderly in India. Methods Data from Longitudinal Ageing Study in India (LASI Wave-I, 2017–18) were drawn to conduct this study. The LASI is a large-scale nationwide scientific study of the health, economics, and social determinants and implications of India's aged population. The LASI is a nationally representative survey of 72,250 aged 45 and over from all Indian states and union territories. Response variables were the occurrence of CDs and NCDs. The bi-variate and binary logistic regression were used to predict the association between communicable and non-communicable diseases by various socio-demographic and health parameters. Furthermore, to understand the inequalities of communicable and non-communicable diseases in urban and rural areas, the Fairlie decomposition technique was used to predict the contribution toward rural–urban inequalities in CDs and NCDs. Results Prevalence of communicable diseases was higher among uneducated elderly than those with higher education (31.9% vs. 17.3%); however, the prevalence of non-communicable diseases was higher among those with higher education (67.4% vs. 47.1%) than uneducated elderly. The odds of NCDs were higher among female elderly (OR = 1.13; C.I. = 1–1.27) than their male counterparts. Similarly, the odds of CDs were lower among urban elderly (OR = 0.70; C.I. = 0.62–0.81) than rural elderly, and odds of NCDs were higher among urban elderly (OR = 1.85; C.I. = 1.62–2.10) than their rural counterparts. Results found that education (50%) contributes nearly half of the rural–urban inequality in the prevalence of CDs among the elderly. Education status and current working status were the two significant predictors of widening rural–urban inequality in the prevalence of NCDs among the elderly. Conclusion The burden of both CD and NCD among the elderly population requires immediate intervention. The needs of men and women and urban and rural elderly must be addressed through appropriate efforts. In a developing country like India, preventive measures, rather than curative measures of communicable diseases, will be cost-effective and helpful. Further, focusing on educational interventions among older adults might bring some required changes.
... The prevalence of non-communicable diseases (NCD) has increased dramatically for decades. Such diseases affect about 67% of people globally [1]. The diseases affect almost all age groups but mostly the elderly. ...
... Asia is experiencing the fastest growth of T2DM, mainly in China and India [3]. In South-East Asia, the prevalence increased from 4.1% in 1980 to 8.6% in 2014 [1]. It was estimated that there are around 72 million people with DM. ...
... This number will increase to exceed 123 million in 2035 [4]. NCD's main risk factors are unhealthy dietary patterns, smoking, sedentary lifestyle, obesity, and alcoholism [1]. Thus, modifying the risk factors is the best strategy for reducing morbidity and mortality. ...
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Introduction. Aerobic dance (AD) has grown as a popular aerobic exercise treating metabolic diseases. However, its beneficial effects on type 2 diabetes mellitus (T2DM) compared with other types of aerobic exercise have not been known. This study aimed to compare the influence of AD and static cycling (SC) on anthropometric measures, systolic blood pressure (SBP), blood glucose, and total cholesterol. Material and Methods. The design of this study was a randomized controlled study (RCT). Thirty T2DM subjects were assigned to three groups, i.e. control (C), aerobic dance exercise (AD), and static cycling exercise (SC), ten subjects in each group. AD and SC were performed three times a week for eight weeks. On the follow-up, four subjects were withdrawn. Waist and hip circumference (WC and HC), BMI, and blood pressure (BP) were measured. Blood glucose (fasting (FBG) and 2 hours postprandial (2-h PPBG)) and total cholesterol were checked using a simple, instant blood examination device. A paired t-test, Anova and Tamhane’s T2 post hoc test were applied. Significance was set at p < 0.05. Results. Student’s t-test showed that post-exercise waist circumference was significantly increased in the control group (92.7 ± 13.5 cm, p = 0.04), while post-exercise FBG and 2-h PPBG were significantly reduced in the SC group (112.5 ± 12.0 mg/dL, p = 0.04 and 155.0 ± 45.3 mg/dL, p = 0.02, respectively). Tamhane’s T2 post hoc indicates that 2-h PPBG in SC was lower than in the case of AD (155.0 ± 45.3 vs 171.3 ± 19.7 mg/dL, p = 0.04) and SC vs control (155.0 ± 45.3 vs 183.0 ± 24.1 mg/dL, p = 0.02). Systolic was significantly reduced in SC compared to the control group (126.9 ± 7.5 vs. 143.3 ± 17.5 mmHg, p = 0.04). The magnitude of reduced (Δ) in 2-h PPBG in SC was significantly different from control (Δ-18.75 ± 10.9 vs. Δ2.75 ± 12.4, p = 0.04) and AD (Δ-18.75 ± 10.9 vs. Δ6.37 ± 11.8, p = 0.02). Conclusions. Static cycling exercise improved 2-hour postprandial blood glucose and systolic blood pressure significantly more than aerobic dance in T2DM.
... No communicable diseases (NCDs) like hypertension, cardiovascular disease, cancer, chronic lung disease, and diabetes can cause high morbidity and mortality rates globally. NCDs caused approximately 38 million deaths (68%) in 2012; by 2030, this number is expected to reach 52 million [35,36]. Around 80 percent of NCD deaths occur in low-and middle-income countries, and 42 percent occur before age 70 [35]. ...
... Around 80 percent of NCD deaths occur in low-and middle-income countries, and 42 percent occur before age 70 [35]. NCDs now cause 7.9 million deaths annually in South-East Asia Region (SEAR) or 55 percent of all deaths [36]. Self-management is key to preventing NCDs through continuous access to healthcare facilities. ...
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Access to healthcare is a fundamental human right and a pillar of the country’s sustainable development. Rural residents face a variety of challenges to accessing healthcare across the world. The Geneva report by the International Labour Organization shows that 56 percent of rural residents lack access to essential healthcare services. The study’s primary objective was to address the challenges of healthcare accessibility in rural areas of developing countries. In this research article, we have addressed the significant barriers to access to healthcare existing in the community. Every year, over 600,000 women die from preventable causes. These women die without skilled care or due to traditional, harmful birth practices used by their families or untrained attendants. Vaccines are estimated to save children under five from 2.5 million deaths annually. Lifesaving vaccinations are unavailable to one out of every five children. One major issue is shortages of workers, which are made worse by imbalances in the workforce. Transport barriers often hinder healthcare access in rural areas. Globally, many countries are working with the World Health Organization to provide essential health services to the most vulnerable and needy. Governments and other international organizations can introduce new policies to improve the health and life expectancy of rural populations in developing countries by increasing access to healthcare.
... [21][22][23] The impact of this burden is greater on LMICs as a result of their vulnerability to socioeconomic, geographic, and demographic factors. [24] The double burden of communicable and non-communicable diseases threatens survival, obstructs education, and reduces productivity, impeding socioeconomic growth. [24] This is further compounded by poverty and out-of-pocket health expenditure, which inhibits people from accessing healthcare services for the most treatable conditions. ...
... [24] The double burden of communicable and non-communicable diseases threatens survival, obstructs education, and reduces productivity, impeding socioeconomic growth. [24] This is further compounded by poverty and out-of-pocket health expenditure, which inhibits people from accessing healthcare services for the most treatable conditions. [25] As a part of the sustainable development goals 3.8, palliative care was recognised as a fundamental component of universal health coverage. ...
Article
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The rising trend of chronic life-threatening illnesses is accompanied by an exponential increase in serious health-related suffering. Palliative care is known to ameliorate physical and psychosocial suffering and restore quality of life. However, the contemporary challenges of palliative care delivery, such as changing demographics, social isolation, inequity in service delivery, and professionalisation of dying, have prompted many to adopt a public health approach to palliative care delivery. A more decentralised approach in which palliative care is integrated into primary care will ensure that the care is available locally to those who need it and at a cost that they can afford. General practitioners (GPs) play a pivotal role in providing primary palliative care in the community. They ensure that care is provided in alignment with patients’ and their families’ wishes along the trajectory of the life-threatening illness and at the patient’s preferred place. GPs use an interdisciplinary approach by collaborating with specialist palliative care teams and other healthcare professionals. However, they face challenges in providing end-of-life care in the community, which include identification of patients in need of palliative care, interpersonal communication, addressing patients’ and caregivers’ needs, clarity in roles and responsibilities between GPs and specialist palliative care teams, coordination of service with specialists and lack of confidence in providing palliative care in view of deficiencies in knowledge and skills in palliative care. Multiple training formats and learning styles for GPs in end-of-life care have been explored across studies. The research has yielded mixed results in terms of physician performance and patient outcomes. This calls for more research on GPs’ views on end-of-life care learning preferences, as this might inform policy and practice and facilitate future training programs in end-of-life care.
... CAD was previously thought to be rare in sub -Saharan Africa [4] but its prevalence is now reported to have increased. [1,2,[5][6][7][8][9] At present Ischemic heart disease (IHD) is becoming a modern epidemic in developing countries partly as a consequence of urbanization, poor lifestyle and increasing longevity [3,10]. The risk factors of Ischemic heart disease are also on an increase in Nigeria especially in the last decades [5,[11][12][13][14]. ...
... Our study also corroborated previous works that have shown rarity of acute coronary syndromes in adolescence [2,8,9,27,28]. However, epidemiological shift has being noted and ischemic heart disease had been reported in younger people [5,10]. ...
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Background: The prevalence of acute coronary syndrome (ACS) in Nigeria is on the rise with dire morbidity and mortality risks. Cardiac biomarkers are rapid and sensitive tools used as adjunct in the diagnosis of ACS. The clinical utility of cardiac biomarkers is yet to be well explored in Nigerian setting. Objectives: To determine the indications and clinical utility of cardiac biomarkers as well as their electrocardiographic (ECG) changes. Methods: This study is a retrospective review of all patients who had point-of-care serum Troponin-I, Creatine kinase MB isoenzyme and myoglobin done at the medical emergency department of LASUTH over a three year period (January 2017 to December 2019). Their records were retrieved; demographics, indications for testing and ECG findings were recorded. Data was analyzed using SPSS version 20.0 software. Results: 593 tests were done in the 3 years period of study. Only 397 patients had complete records. 48.6% were male. The mean age of the study population was 55.02 + 16.64 years (range 13-94 years). Chest pain was the commonest indication for test (91%). Other indications are loss of consciousness, palpitations, seizures and unexplained dyspnea. Mean duration of chest pain prior to presentation was 9 days. 16.1% (64 patients) of patients tested had elevated cardiac biomarkers and 87.5% of those with elevated cardiac biomarkers had abnormal ECG suggestive of ACS. Conclusion: This study showed that cardiac biomarker is an important point-of-care test in the evaluation of chest pain. Cardiac biomarkers should therefore be a routine test in the emergency room.
... La inactividad física en la población cada día sigue en aumento debido a diferentes factores. Además que se asocia a enfermedades no transmisibles a nivel mundial (Boutayeb, 2006;Haskell et al., 2007;Stevens et al., 2008;Gutierez et al., 2012;Reiner, Niermann, Jekauc & Woll, 2013). Además ha sido descrita como factor de riesgo (Kohl et al., 2012;R Reiner, Niermann, Jekauc & Woll, 2013), asociada a la depresion, cancer de colón, sindrome metabolico, obesidad, sobrepeso, enfermedades crónico degenerativas (Lee, 2012) a un inapropiado consumo alimenticio (Gutierez et al., 2012). ...
... c) Disminuye riesgos de enfermedades: a) Es factor de riesgo en adultos (Kohl et al., 2012;Reiner Niermann, Jekauc & Woll, 2013). b) Se asocian a 3.2 millones de muerte al año (Lim, et al., 2012 (Boutayeb et al., 2006;Haskell et al., 2007;Reiner, Niermann, Jekauc & Woll, 2013). d) Estan altamente asociadas a todos las causas de muerte cardivascular. ...
Article
Un observatorio de la actividad física tiene como objetivo estudiar numerosas actividades físicas en diferentes poblaciones con la intención de conocer sus efectos a partir de sus hábitos y de reducir la inactividad física que ha sido descrita como un factor de riesgo que afecta a toda la población a nivel mundial. El observatorio de actividad física deberá estar conformado por un grupo de expertos, que apliquen el conocimiento en beneficio de la sociedad sobre actividad física a nivel local, municipal, estatal, nacional o internacional. De esta forma, se puede ayudar a realizar acciones objetivas en actividad física para la población, mejorando su calidad de vida. Palabras clave: Observatorio, actividad física, inactividad física y sociedad.
... Non communicable diseases (NCD's) are on the increase in developing countries, with cardiovascular diseases becoming a leading cause of mortality. In time past, Sub-Saharan Africa had more of infectious diseases but with rapid urbanization, change in diet and a westernized lifestyle we now face a double burden of disease [22]. ...
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Background: Cardiovascular disease is a leading cause of mortality globally. Approximately 80% of deaths occur in low-and middle-income countries like Nigeria, where preventive health practices are poor or non-existent. The aim of this study was to assess the pattern of cardiovascular disease admissions and mortality over a 5-year period in a tertiary hospital in Rivers State, Nigeria. Methods: Admissions records of patients admitted into the medical wards within the study period (January 2017 to December 2021) were reviewed and relevant information pertaining to the study objectives was retrieved for analysis. Data obtained from the records were the age, sex, final diagnosis, co-morbidities, duration of admission and outcome. Results: There were a total of 1901 cardiovascular admissions with a male to female ratio of 1.3 to 1. Cardiovascular mortality was also higher in males with a ratio of 1.0 to 0.9. Cerebrovascular accident accounted for 44.9% of total admissions which was closely followed by heart failure (39.4%), hypertensive crises (10.2%) and pulmonary embolism also accounted for 3.5% of cases. Acute coronary syndrome, arrhythmias, pericarditis, and peripheral vascular disease accounted collectively for less than 2% of cases. Cardiovascular related mortality accounted for 20.6% over the 5-year study period. Males had significantly higher cases of heart failure during the study period. Conclusion: A high burden of cardiovascular disease related admissions and mortality was found with an exponential increase over the 5-year study period. Cerebrovascular accident and heart failure accounted for the commonest cause of CV mortality. Preventive measures to reduce the burden of CV disease is essential to curtail this growing menace.
... Millions of people worldwide are affected by HIV/AIDS and other chronic diseases, and CMetS is increasingly becoming a major concern that necessitates prevention, routine monitoring, and proper treatment [15,16]. In the sub-Saharan African region (SSA), where two-thirds of the world's HIVpositive people live, HIV has established itself as a cause of chronic illness and high mortality [17]. ...
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Unlabelled: Cardiometabolic syndrome (CMetS) has recently emerged as a serious public health concern, particularly for individuals living with chronic conditions. This study aimed to determine the incidence and prevalence of CMetS, as well as the risk factors linked with it, in HIV-positive and HIV-negative adult patients. Methods: A comparative cohort study was designed. The National Cholesterol Education Program (NCEP) and the International Diabetes Federation (IDF) tools were used to determine the outcome variables. Association studies were done using logistic regression. Result: CMetS was found to have a greater point and period prevalence, and incidence estimation in HIV-negative than HIV+ patients using both the NCEP and the IDF tools. Using the NCEP tool, the risk of obesity was 44.1% [odds ratio (OR) = 0.559, 95% confidence interval (CI), (0.380-0.824); P = 0.003] lower in HIV+ than in HIV-negative participants. By contrast, no apparent difference was noted using the IDF tool. Similarly, hyperglycemia [OR = 0.651, 95% CI (0.457-0.926); P = 0.017], and hypertension [OR = 0.391, 95% CI (0.271-0.563); P < 0.001] were shown to be lower in HIV+ patients than HIV-negative patients by 34.9% and 60.9%, respectively. The study revealed significant variation in all biomarkers across the follow-up period in both HIV+ and HIV-negative participants, except for SBP. Conclusions: CMetS caused more overall disruption in HIV-negative people with chronic diseases than in HIV-positive people. All of the indicators used to assess the increased risk of CMetS were equally meaningful in HIV+ and HIV-negative subjects.
... Chronic non-communicable diseases represent a major source of morbidity and mortality in worldwide, resulting 71% of all deaths and serious global economic burden ( Fig. 1) [8]. Chronic non-communicable diseases mainly include cardiovascular disease, cancer, respiratory diseases, diabetes, hypertension, Alzheimer's disease, dyslipidemia, asthma, chronic obstructive and pulmonary disease [9]. The top four chronic non-communicable disease killers account for more than 80% of all deaths including cardiovascular diseases, cancers, respiratory diseases, and diabetes [8]. ...
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Vaccines are one of the most effective medical interventions to combat newly emerging and re-emerging diseases. Prophylactic vaccines against rabies, measles, etc., have excellent effectiveness in preventing viral infection and associated diseases. However, the host immune response is unable to inhibit virus replication or eradicate established diseases in most infected people. Therapeutic vaccines, expressing specific endogenous or exogenous antigens, mainly induce or boost cell-mediated immunity via provoking cytotoxic T cells or elicit humoral immunity via activating B cells to produce specific antibodies. The ultimate aim of a therapeutic vaccine is to reshape the host immunity for eradicating a disease and establishing lasting memory. Therefore, therapeutic vaccines have been developed for the treatment of some infectious diseases and chronic noncommunicable diseases. Various technological strategies have been implemented for the development of therapeutic vaccines, including molecular-based vaccines (peptide/protein, DNA and mRNA vaccines), vector-based vaccines (bacterial vector vaccines, viral vector vaccines and yeast-based vaccines) and cell-based vaccines (dendritic cell vaccines and genetically modified cell vaccines) as well as combinatorial approaches. This review mainly summarizes therapeutic vaccine-induced immunity and describes the development and status of multiple types of therapeutic vaccines against infectious diseases, such as those caused by HPV, HBV, HIV, HCV, and SARS-CoV-2, and chronic noncommunicable diseases, including cancer, hypertension, Alzheimer’s disease, amyotrophic lateral sclerosis, diabetes, and dyslipidemia, that have been evaluated in recent preclinical and clinical studies.
... This so-called 'double burden' of infectious and NCDs has placed immense pressure on health systems to support population health outcomes with limited resources. 4 In this context, governments have sought to establish integrated care models that more efficiently address comorbid conditions that clients present with at health clinics. [5][6][7][8][9][10][11] For example, the Study of HIV and Antenatal Care Integration in Pregnancy Initiative in rural Kenya has integrated HIV services into antenatal care clinics, using a model through which clinicians receive week-long training and on-the-job mentorship. ...
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Objective To evaluate the costs and client outcomes associated with integrating screening and treatment for non-communicable diseases (NCDs) into HIV services in a rural and remote part in southeastern Africa. Design Prospective cohort study. Setting Primary and secondary level health facilities in Neno District, Malawi. Participants New adult enrollees in Integrated Chronic Care Clinics (IC3) between July 2016 and June 2017. Main outcome measures We quantified the annualised total and per capita economic cost (US$2017) of integrated chronic care, using activity-based costing from a health system perspective. We also measured enrolment, retention and mortality over the same period. Furthermore, we measured clinical outcomes for HIV (viral load), hypertension (controlled blood pressure), diabetes (average blood glucose), asthma (asthma severity) and epilepsy (seizure frequency). Results The annualised total cost of providing integrated HIV and NCD care was $2 461 901 to provide care to 9471 enrollees, or $260 per capita. This compared with $2 138 907 for standalone HIV services received by 6541 individuals, or $327 per capita. Over the 12-month period, 1970 new clients were enrolled in IC3, with a retention rate of 80%. Among clients with HIV, 81% achieved an undetectable viral load within their first year of enrolment. Significant improvements were observed among clinical outcomes for clients enrolled with hypertension, asthma and epilepsy (p<0.05, in all instances), but not for diabetes (p>0.05). Conclusions IC3 is one of the largest examples of fully integrated HIV and NCD care. Integrating screening and treatment for chronic health conditions into Malawi’s HIV platform appears to be a financially feasible approach associated with several positive clinical outcomes.
... Sumado a esto, la esperanza de vida está aumentando, de 65 años para los hombres y 69 para las mujeres en 2005, a 71 para los hombres y 75 para las mujeres en 2020 (Banco Mundial, 2020), con una población de mayor edad con mayor carga de enfermedad que exige más atención médica (Boutayeb, 2006) y más años perdidos por discapacidad (Murray CJ, 2000). ...
Book
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Situation of Chronic Kidney Disease 2022 in the Andean countries (Bolivia, Chile, Colombia, Ecuador, Peru and Venezuela)
... Developing countries experience high incidents of communicable diseases such as hypertension, obesity, heart disease and diabetes [40]. Boutayeb [41] describes the combined effect of chronic communicable and non-communicable diseases as a burden for developing countries. ...
Chapter
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Ageing is a crucial era at the last stage in the lifespan of human beings, particularly for those who survive and pass through other stages of the life cycle. There has been a considerable increase in the number of people who reach this stage and live longer across the globe. The rampant increase of this population group has yielded unprecedented challenges to the both the developed and underdeveloped world due to the psychological, health, economic and social needs of this population cohort. In most developing countries, these social challenges faced by older the older persons are to a certain extent mitigated by the cohesive structure within the community. However, the social, living arrangements from families and communities that are available to the older population are under threat due ongoing demise in the traditional forms of care is as a result of families having suffered from the impact of social change, including urbanisation, geographical spread, migration, the trend towards nuclear families, and participation of women in the workforce. Ageism as a concept is viewed as the theoretical, policy and practical underpinning for how ageism is perceived and dealt with. The negative stereotypes that often shape the theoretical framework with regard to ageism is the root cause of negative attributes associated with ageing. This chapter therefore, concludes with the key recommendation that governments from the developing economies should strive towards development of policies for the protection of advancement of the wellbeing of older population and make resources available for the implementation of the policies.
... Sub-Saharan Africa now has a double burden of both communicable and non-communicable diseases [16,56]. Considering the region's health systems and policies, this poses a serious challenge to achieving the zero malaria targets. ...
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The global burden of malaria continues to be a significant public health concern. Despite advances made in therapeutics for malaria, there continues to be high morbidity and mortality associated with this infectious disease. Sub-Saharan Africa continues to be the most affected by the disease, but unfortunately the region is burdened with indigent health systems. With the recent increase in lifestyle diseases, the region is currently in a health transition, complicating the situation by posing a double challenge to the already ailing health sector. In answer to the continuous challenge of malaria, the African Union has started a "zero malaria starts with me” campaign that seeks to personalize malaria prevention and bring it down to the grass-root level. This review discusses the contribution of sub-Saharan Africa, whose population is in a health transition, to malaria elimination. In addition, the review explores the challenges that health systems in these countries face, that may hinder the attainment of a zero-malaria goal.
... Studies showed that obesity and hypertension are often occurred together and increased the risk of cardiovascular mortality [10]. It has been reported that both demographic, nutrition and socioeconomic transitions have contributed to the burden of obesity and hypertension in developing countries [11] and the epidemiological transition from infectious diseases to non-infectious diseases [12]. Bangladesh is a developing country in South Asia, with the rapid urbanization and industrialization in recent years, the prevalence of obesity and hypertension has increased remarkably in this country. ...
Article
Background and aim: Obesity and hypertension are public health concerns. An increase in body weight is typically followed by an increase in blood pressure. This study aimed to investigate the association of general and central obesity with hypertension in Bangladeshi adults using WHO classification. Methods: A Cross-sectional study of Bangladeshi adults (both males and females) aged (20-65 years). General obesity was determined by BMI in kg/m2. WHO classification for BMI for Asian population are underweight (BMI <18.5), normal (BMI 18.5-23.5), overweight (BMI 23.5-27.5) and obese (BMI ˃27.5). Central obesity was defined as a WC≥80 cm for females and ≥90 cm for males. Hypertension was defined by systolic blood pressure (SBP) ≥140mmHg and/or, diastolic blood pressure (DBP) ≥90mmHg and/ or, intake of anti-hypertensive drugs at the time of data collection. Prehypertension was defined as SBP 120–139mmHg; and/or DBP 80–89mmHg. Multinomial logistic regression analyses were performed to assess the association of general and central obesity with hypertension. Results: In this study, the overall prevalence of hypertension in Bangladeshi males and females was 15.3% and 6.0% respectively. The males had a higher prevalence of general obesity (13.3%), central obesity (35.3%) and hypertension (15.3%) compared to the females (13.0, 28.5, and 6.0%, respectively). The odds of having hypertension for general and central obesity were 2.18 95% CI (1.12-4.23), 1.53 95% CI (0.94-2.5) while adjusted odds ratio (aOR) were 1.31 95% CI (0.76-2.27) and 1.67 95% CI 0.97-2.87 respectively. Conclusion: Thus, not only general obesity but also central obesity should be used to assess obesity in Bangladeshi adults.
... The spectrum of these respiratory ailments ranges from acute communicable infections to chronic non-communicable diseases (Xie et al., 2020). Zimbabwe is predominantly affected by acute respiratory infections, chronic obstructive pulmonary disease, asthma, tuberculosis (TB), and lung cancer (Boutayeb, 2006;Rivera-Ortega and Molina-Molina, 2019). Both adults and children alike have over the years been vulnerable to respiratory diseases. ...
Article
Respiratory diseases have in the recent past become a health concern globally. More than 523 million cases of coronavirus disease (COVID19), a recent respiratory diseases have been reported, leaving more than 6 million deaths worldwide since the start of the pandemic. In Zimbabwe, respiratory infections have largely been managed using traditional (herbal) medicines, due to their low cost and ease of accessibility. This review highlights the plants’ toxicological and pharmacological evaluation studies explored. It seeks to document plants that have been traditionally used in Zimbabwe to treat respiratory ailments within and beyond the past four decades. Extensive literature review based on published papers and abstracts retrieved from the online bibliographic databases, books, book chapters, scientific reports and theses available at Universities in Zimbabwe, were used in this study. From the study, there were at least 58 plant families comprising 160 medicinal plants widely distributed throughout the country. The Fabaceae family had the highest number of medicinal plant species, with a total of 21 species. A total of 12 respiratory ailments were reportedly treatable using the identified plants. From a total of 160 plants, colds were reportedly treatable with 56, pneumonia 53, coughs 34, chest pain and related conditions 29, asthma 25, tuberculosis and spots in lungs 22, unspecified respiratory conditions 20, influenza 13, bronchial problems 12, dyspnoea 7, sore throat and infections 5 and sinus clearing 1 plant. The study identified potential medicinal plants that can be utilised in future to manage respiratory infections.
... Studies showed that obesity and hypertension are often occurred together [15] and increased the risk of cardiovascular mortality [16,17]. It has been reported that both demographic and socioeconomic transitions have contributed to the burden of obesity and hypertension in developing countries [18,19] and the epidemiologic transition from infectious diseases to non-infectious diseases [20,21]. Bangladesh is a developing country in South Asia, with the rapid urbanization and industrialization in recent years, the prevalence of obesity and hypertension has increased remarkably in this country. ...
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Background: Obesity and hypertension are global health concerns. Both are linked with increased risks of all-cause and cardiovascular mortality. Several early studies reported the prevalence of obesity and hypertension in Bangladeshi adults, but the associated factors in this country population are not clear yet. We aimed to estimate the prevalence and related risk factors of general and abdominal obesity and hypertension in rural and urban adults in Bangladesh. Methods: In this cross-sectional study, data (n=1410) was collected on rural (n=626) and urban (n=784) adults from eight divisional regions of Bangladesh. Both anthropometric and socio-demographic measurements were recorded in a standardized questionnaire form. General and abdominal obesity were defined based on WHO proposed cut-off values and hypertension was defined by SBP≥140 mm Hg and/or, DBP≥90 mm Hg and/or, intake of anti-hypertensive drugs at the time of data collection. Multivariable logistic regression analyses were performed to assess the relationship of general and abdominal obesity and hypertension with various factors. Results: The overall prevalence of general obesity, abdominal obesity and hypertension was 18.2%, 41.9% and 30.9%, respectively. The women had a higher prevalence of general obesity (25.2%), abdominal obesity (56.1%) and hypertension (32.3%) compared to the men (12.2%, 29.0%, and 29.7%, respectively). The prevalence of both general and abdominal obesity was higher in urban participants (21.7% and 46.6%, respectively) than in the rural participants (13.8% and 35.1%, respectively), whereas, the rural participants had a higher prevalence of hypertension (35.1%) compared to the urban participants (27.5%). In geographical region comparison, the prevalence of general and abdominal obesity and hypertension were higher in participants enrolled from Dhaka (30.8%), Khulna (63.6%) and Mymensingh (43.5%) regions, respectively compared to other regions. In regression analysis, increased age, place of residence and less physical activity were positively associated with the increased risk of both types of obesity and hypertension. The analysis also showed a significant positive association between high BMI and an increased risk of hypertension. Conclusion: This study shows a high prevalence of obesity and hypertension in rural and urban adults. Increased age, inadequate physical activity and place of residence were significant determinants of general and abdominal obesity and hypertension. A comprehensive intervention program focusing on modifiable risk factors such as lifestyles and food habits is needed to increase awareness and prevent the burden of obesity and hypertension in the Bangladeshi population.
... Many individuals with multimorbidity become economically and socially dependent on their support networks and communities. 9,11,12 Owing to the complexity of multimorbidity care, patients are prescribed multiple medication which increases their risk of drug interactions. Subsequently, they also develop poor medication adherence. ...
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Objective The aim of this systematic review is to analyse existing evidence on prevalence, patterns, determinants, and healthcare challenges of communicable and non-communicable disease multimorbidity in low- and middle-income countries (LMICs). Methods PubMed, Cochrane, and Embase databases were searched from 1 st January 2000 to 31 st July 2020. The National Institute of Health (NIH) quality assessment tool was used to critically appraise studies. Findings were summarized in a narrative synthesis. The review was registered with PROSPERO (CRD42019133453). Results Of 3718 articles screened, 79 articles underwent a full text review of which 11 were included for narrative synthesis. Studies reported on 4 to 20 chronic communicable and non-communicable diseases; prevalence of multimorbidity ranged from 13% in a study conducted among 242,952 participants from 48 LMICS to 87% in a study conducted among 491 participants in South Africa. Multimorbidity was positively associated with older age, female sex, unemployment, and physical inactivity. Significantly higher odds of multimorbidity were noted among obese participants (OR 2.33; 95% CI: 2.19–2.48) and those who consumed alcohol (OR 1.44; 95% CI: 1.25–1.66). The most frequently occurring dyads and triads were HIV and hypertension (23.3%) and HIV, hypertension, and diabetes (63%), respectively. Women and participants from low wealth quintiles reported higher utilization of public healthcare facilities. Conclusion The identification and prevention of risk factors and addressing evidence gaps in multimorbidity clustering is crucial to address the increasing communicable and non-communicable disease multimorbidity in LMICs. To identify communicable and non-communicable diseases trends over time and identify causal relationships, longitudinal studies are warranted.
... 19 For example, as antimicrobials become increasingly accessible, they may be overly used by healthcare professionals to meet shortfalls in other healthcare resources and to prevent infection outbreaks where these are of imminent concern. 2, 21,22 In the context of community pharmacy, motivational drivers associated with running a sustainable business may conflict with optimal antimicrobial stewarding behaviour. For example, healthcare providers may be motivated to provide antimicrobials to secure customer loyalty, in the face of increased customer demand, and to turnover stock. ...
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Background Pharmacists have important antimicrobial stewardship (AMS) roles yet limited literature exists on pharmacists’ knowledge and beliefs about antimicrobial resistance (AMR) and antimicrobials and how these beliefs influence antimicrobial supply in different countries. Methods A cross-sectional survey was disseminated to pharmacists around the world via the Commonwealth Pharmacists’ Association and related networks. Data were collected on demographics, antibiotic supply practices, and knowledge and beliefs about AMR. Results A total of 546 pharmacists responded from 59 countries, most commonly from Africa (41%) followed by Asia (26%) and Oceania (22%). Respondents supplied a mean of 46 ± 81 antibiotic prescriptions/week, 73%±35% of which were given in response to a prescription. Overall, 60.2% dispensed antibiotics at least once without a prescription. Respondents had good knowledge (mean 9.6 ± 1.3 (out of 12), and held positive beliefs about AMR [mean 3.9 ± 0.6 (out of 5)]. Knowledge about antibiotics and beliefs about AMR were positively correlated. The odds of supplying antibiotics without a prescription were 7.4 times higher among respondents from lower income countries [adjusted odds ratio (AOR) = 7.42, 95% CI 4.16–13.24]. Conversely, more positive AMR beliefs were associated with a lower odds of supplying antibiotics without a prescription (AOR = 0.91, 95% CI 0.86–0.95). Conclusions Most pharmacists had the good knowledge about antibiotics and positive beliefs about AMR. These beliefs were influenced by knowledge, work setting, and country income. A proportion of respondents provided antibiotics without a prescription; the likelihood of this occurring was higher in those who held more negative beliefs about AMR.
... Improving quality of pediatric emergency care through the rapid identification, efficient prioritization, and appropriate treatment of children with acute, severe, and reversible disease is essential to closing the wide gap between international goals for reducing child mortality and stagnating or worsening under-five mortality rates in many LMICs (Baker, 2009;Liu et al., 2016;UNICEF, 2015). The urgency of this need to reduce child mortality is greatest in countries like Pakistan that face a 'double disease burden' of infectious diseases on top of the health challenges of a rapidly industrializing society such as injuries (Boutayeb, 2006;Jafar et al., 2013). This situation has contributed to Pakistan having one of the highest under-five mortality rates in the world: 74 deaths per 1,000 live births, according to the most recent Demographic and Health Survey (DHS) (National Institute of Population Studies -NIPS/Pakistan and ICF, 2019). ...
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While telemedicine applications in low- and middle-income countries are growing rapidly, few studies address the social and organizational factors of implementation essential to sustaining clinician engagement. This study aims to explore clinician experiences and perspectives of a pediatric emergency teleconsultation support program in Sindh, Pakistan, and theories of use behind its implementation in government hospitals. We conducted in-depth interviews with 20 stakeholders of the teleconsultation program, including program administrators (n = 3), teleconsultants (n = 7) and on-site physicians and nurses (n = 10) purposively sampled for maximum variation across perceived fidelity and acceptability on a preliminary questionnaire. Interview questions and probes were designed to elicit rich perspectives on communication structures, enabling and constraining factors, and overall effects of teleconsultation on clinical routines and quality of care. Transcripts were analyzed thematically using combined inductive and deductive coding. We found that, behind the technical adaptation to using telemedicine in the resuscitation room, providers perceived a dynamic reconfiguration of professional roles and routines of consultation according to opportunities and constraints associated with mutual confidence or trust, constructions of distance, subjectivity of information, and the interface of technological artifacts with medical practice. Descriptions of communication patterns revealed an unstable tension between two competing theories of use premised on either inherent contextual differences or presumed asymmetries in expertise. Long-term sustainability of telemedicine applications to pediatric emergency care requires serious consideration of how such conflicting theories of use and their associated assumptions about end-user needs crystallize in practice and affect clinician engagement and perceived benefits to patient care in the future.
... Many low and middle-income countries (LMICs), including Ethiopia, currently face a double burden of malnutrition [26]. While LMICs are dealing with problems of infectious diseases and undernutrition, they also experience a rapid increase in non-communicable disease risk factors including overweight and obesity [1, [27][28][29]. The emergence of the Coronavirus Disease (COVID- 19) pandemic has further challenged health systems, economies, and populations across the globe, with LMICs being severely affected [30,31]. ...
Article
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Background Obesity and overweight are known public health problems that affect populations across the world. These conditions have been associated with a wide range of chronic diseases including type 2 diabetes mellitus, cardiovascular disease, and cancers. In Ethiopia, the literature regarding the burden of central (abdominal) obesity is scarce. This study aimed to fill this gap by assessing the prevalence and risk factors associated with central obesity among adults in Ethiopia. Methods From May to July 2021, a community-based cross-sectional survey was conducted on a sample of 694 adults aged ≥18 years in administrative towns of Bale zone, Southeast Ethiopia. Multi-stage sampling followed by systematic random sampling was employed to identify study participants. Waist and hip circumferences were measured using standard protocols. The World Health Organization STEPS wise tool was used to assess risk factors associated with central obesity. Bi-variable and multi-variable binary logistic regression were used to identify factors associated with central obesity. Adjusted odds ratios (AOR) and their corresponding 95% confidence intervals (CI) have been reported to estimate the strength of associations. Results The overall prevalence of central obesity using waist circumference was 39.01% [(95% CI: 35.36–42.76; 15.44% for men and 53.12% for women)]. Multi-variable binary logistic regression analysis revealed that female sex (AOR = 12.93, 95% CI: 6.74–24.79), Age groups: 30–39 years old (AOR = 2.8, 95% CI: 1.59–4.94), 40–49 years (AOR = 7.66, 95% CI: 3.87–15.15), 50–59 years (AOR = 4.65, 95% CI: 2.19–9.89), ≥60 years (AOR = 12.67, 95% CI: 5.46–29.39), occupational status like: housewives (AOR = 5.21, 95% CI: 1.85–14.62), self-employed workers (AOR = 4.63, 95% CI: 1.62–13.24), government/private/non-government employees (AOR = 4.68, 95% CI: 1.47–14.88), and skipping breakfast (AOR = 0.46, 95% CI: 0.23–0.9) were significantly associated with central obesity. Conclusions Abdominal obesity has become an epidemic in Bale Zone’s towns in Southeastern Ethiopia. Female sex, age, being employed were positively associated with central obesity, while skipping breakfast was a protective factor.
... 4 These parts of the continents continue to face health problems characterized by the spread of tropical infectious diseases and high infant mortality and maternal mortality. 5 As a result, information communication technology is expected to improve health care delivery by fostering a culture of communication and data management. 6,7 Additionally, ICT allows health professionals and patients to support primary care and encourage preventive healthcare. ...
Article
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Background: Ethiopia's government has planned to digitize the healthcare industry. However, most implementations fail due to various technological and personnel barriers. As a result, this systematic review aimed to comprehensively examine evidence regarding the barriers to adopting information communication technology in the Ethiopian healthcare system. Methods: This systematic review was conducted by searching the major databases, such as Medline, PubMed, Scopus, Science Direct, Google, Google Scholar, and other online databases. The authors looked for, analyzed, and summarized information about barriers to ICT adoption in the healthcare system. This study included nine articles that described barriers to ICT adoption in the Ethiopian healthcare system. Results: This systematic review identified 15 barriers to adopting ICT in the healthcare system. The reviewed articles looked into technological barriers to ICT adoption, such as ICT skill, ICT knowledge, a lack of training opportunities, a lack of computer literacy, a lack of computer access, inadequate internet connectivity, and a lack of experience with ICT were cited as barriers to ICT implementation in Ethiopia's healthcare system. Furthermore, organizational components such as Lack of job satisfaction, Lack of Refreshment training, poor staff initiation, management problem, poor infrastructure, and lack of resources remained barriers to ICT adoption in Ethiopia's healthcare system. Conclusion: This review confirmed that lack of training in ICT, poor ICT knowledge, Poor ICT skill, and a lack of computer access were the most common barriers to adopting ICT in the Ethiopian healthcare system. Therefore, it is recommended that the emphasized barriers to ICT adoption be addressed in order to modernize the current Ethiopian healthcare system.
... During the nineteenth century public health experts and demographers anticipated that in succession of twentyfirst century, developing countries would experience a demographic and epidemiological transition. As a result of these transitions chronic non-communicable diseases would appear as serious problems for the health systems of the developing world as diseases such as: cardiovascular complications, cancer, chronic respiratory diseases, hypertension and diabetics will be account for almost three quarters of all deaths howbeit communicable diseases will take a limited toll [1][2][3] . Over the past few decades noncommunicable diseases (NCDs) have emerged as the major cause of morbidity and mortality in lower and middle income countries. ...
Article
The rapid rise of diabetes, cardiovascular disease (CVD) and chronic respiratory disease (CRD) are causing serious challenges forBangladesh to achieve the sustainable development goal (SDG) target 3.4 by 2030. The study aims to describe the state of healthcarefacilities to provide diagnosis and treatment for diabetes, CVD and CRD related services in Bangladesh. This cross-sectional studyused data from 2017 Bangladesh Health Facility Survey (BHFS). A total of 406 health facilities providing all three services wereconsidered for this study. Findings of the study illustrated that there were rural-urban disparities in healthcare facilities to providediabetics, CVD, CRD related services. Diabetics and CRD related services were significantly higher in public healthcare facilitiesof urban areas compared to rural areas (P <0.008 and P<0.001, respectively). Also, public health facilities of urban areas were morelikely to provide CVD related services compared to rural areas. While private healthcare facilities of urban areas were more likelyto provide CVD, CRD related services than rural areas. Private healthcare facilities of rural areas were in better condition to providediabetes related services than urban areas. However, the country is yet to attain optimal progress in the overall status of health sector.Therefore, in order to cope up with the rising burden of diabetes, CVD and CRD and to minimize the burden of disease specific outofpocket healthcare expenses, recommendations include strengthening and improving stewardship, improving quality of servicesand improving monitoring as well as supervision of decentralized healthcare facilities. Dhaka Univ. J. Sci. 70(1): 14-21, 2022 (January)
... Many low and middle-income countries including Ethiopia are suffering from the double burden of communicable and non-communicable diseases. 1,2 The majority of these can be due to behavioral factors which cannot be overcome by taking medication and call for the need for health education at the individual, group, and community level. 3,4 It was recognized as the most essential component of primary health care to reach the goal of "health for all". ...
Article
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Background: Information, education, and communication (IEC) materials have paramount relevance in primary health care which mainly focused on disease prevention and control. They are a cost-effective approach for achieving better health outcomes in all clinical and public health interventions. This study aimed to explore enablers and barriers to utilize printed IEC materials among healthcare providers of North Shoa Zone, Oromia, Ethiopia, 2020. Methods: A descriptive, qualitative study was conducted from December 1, 2020, to December 30, 2020, among health care providers. A judgmental sampling technique was used and 20 key informants were recruited considering their educational level, professional categories, working units, work experience, and types of health facilities. The data were collected by using a semi-structured interview guide. The transcribed data were uploaded into ATLAS. ti version 7.5.18 software. Then, the inductive process of thematic analysis was employed and the data were coded, categorized, and thematized. Direct quotations were presented with a thick description of the findings. Results: The findings of the study were discussed under four themes of enablers and four themes of barriers. The four themes of enablers were availability of printed IEC materials, distribution of printed IEC material, perceived usefulness of printed IEC materials, and support from the non-government organization. The four themes of barriers were printed IEC materials-related factors, patients related factors, health care provider's related factors, and government-related factors. Conclusion: In this study, we found that the utilization of IEC materials was influenced by a number of facilitators and barriers. Thus, all concerned bodies need to give due attention to IEC materials and work towards the improvement of the quality of IEC materials, provide training for health care providers, work to increase the availability of IEC materials, and distribute them to the health facilities.
... This situation is further worsened with COVID-19 associated myocardial injury. The substantial epidemiological double burden of communicable diseases and NCDs in many resource-constrained countries [14], and limited guidelines on resource-efficient approaches to cardiac evaluations, and management of myocarditis and other cardiac complications caused by COVID-19 constitutes a dire predicament in LMICs and may exponentially increase the burden of cardiovascular conditions. ...
... The impact of MDA-azithromycin on childhood chronic diseases, such as asthma and obesity, has also not been assessed to date. Monitoring these diseases is critical, as LMICs could subsequently face a greater dual burden of communicable and non-communicable diseases [67]. The WHO launched the Global Antimicrobial Resistance Surveillance System (GLASS) in 2015 to support global surveillance to strengthen the evidence base on antimicrobial resistance [68]. ...
Article
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Background: Mass drug administration (MDA) is a strategy to improve health at the population level through widespread delivery of medicine in a community. We surveyed the literature to summarize the benefits and potential risks associated with MDA of antibacterials, focusing predominantly on azithromycin as it has the greatest evidence base. Main body: High-quality evidence from randomized controlled trials (RCTs) indicate that MDA-azithromycin is effective in reducing the prevalence of infection due to yaws and trachoma. In addition, RCTs suggest that MDA-azithromycin reduces under-five mortality in certain low-resource settings that have high childhood mortality rates at baseline. This reduction in mortality appears to be sustained over time with twice-yearly MDA-azithromycin, with the greatest effect observed in children < 1 year of age. In addition, observational data suggest that infections such as skin and soft tissue infections, rheumatic heart disease, acute respiratory illness, diarrheal illness, and malaria may all be treated by azithromycin and thus incidentally impacted by MDA-azithromycin. However, the mechanism by which MDA-azithromycin reduces childhood mortality remains unclear. Verbal autopsies performed in MDA-azithromycin childhood mortality studies have produced conflicting data and are underpowered to answer this question. In addition to benefits, there are several important risks associated with MDA-azithromycin. Direct adverse effects potentially resulting from MDA-azithromycin include gastrointestinal side effects, idiopathic hypertrophic pyloric stenosis, cardiovascular side effects, and increase in chronic diseases such as asthma and obesity. Antibacterial resistance is also a risk associated with MDA-azithromycin and has been reported for both gram-positive and enteric organisms. Further, there is the risk for cross-resistance with other antibacterial agents, especially clindamycin. Conclusions: Evidence shows that MDA-azithromycin programs may be beneficial for reducing trachoma, yaws, and mortality in children < 5 years of age in certain under-resourced settings. However, there are significant potential risks that need to be considered when deciding how, when, and where to implement these programs. Robust systems to monitor benefits as well as adverse effects and antibacterial resistance are warranted in communities where MDA-azithromycin programs are implemented.
... There is growing evidence that women in low-income countries marginally suffer higher morbidity and mortality from preventable diseases (Abotchie, Mphil, and Shokar, 2009). It's reported that 1 in 4 deaths among adult women are caused by non-communicable diseases such as heart disease, cancer, and diabetes (Boutayeb, 2010) and it is worrisome the alarming rate of one of the most preventable cancers among women in low-income countries Al-cytological testing (Papanicolaou test) to identify cell abnormalities that may indicate or precede cervical cancer which is the only way to achieve a better prognosis (WHO, 2019) and a key aspect of its prevention (Dim, 2013). Despite this easy way out, death caused by this disease continued to be on the increase in African countries like Nigeria. ...
Article
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Objective: This survey examined the barriers to cervical cancer screening uptake by adult women in Nnewi, a town located in southeast Nigeria. Methods: In this descriptive survey, data were collected data from 379women aged between 21 and 65 years using the adapted version of the Health Belief Model Scale for Cervical Cancer and Pap smear test questionnaire. Results: The major perceived barriers to the practice of cervical cancer screening were fear of the result (2.32±1.05), lack of knowledge of what pap smear is (2.32±0.90), and lack of information about when and where pap smear could be done (2.25±1.07). The logistic regression model showed that the following perceived barriers predicted uptake of cervical cancer screening (P< 0.05): time constraint (P = 0.001, OR= 3.368, CI= 1.455, 4.11); attitude of healthcare workers (P = 0.008, OR= 6.642; CI= 2.764, 18.196); knowledge of test frequency (P = 0.005, OR= 1.443; CI 0.946, 3.811); fear of result(P = 0.001, OR= 3.660, CI=0.679, 4.061); lack of information on when and where pap smear could be obtained (P = 0.010; OR= 6.732; CI= 2.286, 10.490); distance from test centre (P = 0.003; OR= 1.387; CI=0.126, 2.193); not knowing what it is for (P = 0.024, OR10.895, CI = 2.938, 14.401).
... 32 This double burden of infectious and noninfectious diseases represents a challenge for population health and health systems in LMICs. 31,33 The rapid increase in chronic diseases Comparing to high-income countries, the burden of NCDs in LMICs is not only increasing at a higher pace but also occurring at younger ages. 34 Behavioral risks in LMICs, such as consuming high volumes of ultra-processed foods are increasing across all ages, but more so in adolescents and young adults, increasing the burden of NCDs in these age groups. ...
Article
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Multimorbidity is a complex challenge affecting individuals, families, caregivers, and health systems worldwide. The burden of multimorbidity is remarkable in low- and middle-income countries (LMICs) given the many existing challenges in these settings. Investigating multimorbidity in LMICs poses many challenges including the different conditions studied, and the restriction of data sources to relatively few countries, limiting comparability and representativeness. This has led to a paucity of evidence on multimorbidity prevalence and trends, disease clusters, and health outcomes, particularly longitudinal outcomes. In this paper, based on our experience of investigating multimorbidity in LMICs contexts, we discuss how the structure of the health system does not favor addressing multimorbidity, and how this is amplified by social and economic disparities and, more recently, by the COVID-19 pandemic. We argue that generating epidemiologic data around multimorbidity with similar methods and definition is essential to improve comparability, guide clinical decision-making and inform policies, research priorities, and local responses. We call for action on policy to refinance and prioritize primary care and integrated care as the center of multimorbidity.
... • Bio-larvicides were an effective controlling tool for mosquitoes in Kahramanmars. malaria, filariasis, yellow fever, and dengue, and these diseases are highly fatal to humans and animals [1,2]. Microorganisms that cause serious diseases to humans are transmitted during the sucking of these insects [3]. ...
... Understanding the underlying mechanism that played a positive role for individuals dealing with such a situation demands attention . Drawing attention to this phenomenon would be helpful for policymakers and university management to devise strategies for the expected burden of communicable diseases (Boutayeb, 2006;Casal & López, 2021). ...
... With the monumental developments in medicine over the last century, more developed nations have largely been able to overcome the so-called "double burden of disease," where nations face health crises from both quickly moving infectious disease and dormant chronic illnesses (Boutayeb, 2006). With some notable exceptions, the United States has largely been able to mitigate the spread of infectious disease, with heart disease, cancer, stroke, and diabetes being among the leading causes of mortality within the nation in 2019 (United States Centers for Disease Control and Prevention [USCDC], 2019). ...
Thesis
Exposure to lead has long been known as a human health risk, with the hallmark symptom of disease being neurological impairment. However, there have been developments in the field of medicine that suggest exposure to lead also is responsible for cardiovascular disease, both in onset and increasing the severity thereof. With the levels of ambient exposure to lead from our infrastructure, in soil, lead paint, and lead pipes, there is no shortage of routes of exposure to lead both domestically and abroad. It has long been recognized that no safe level of lead exposure exists, especially in pediatric patients, although recent events in Flint, Michigan, and Pittsburgh, PA, have shown that lead exposure is not just a relic of the past, but a problem that still very much exists in the world today (National Public Radio [NPR], 2016; Pieper et al, 2018; Lidsky & Schneider, 2003; O’Connor, 2018; Flora, Gupta, & Tiwari, 2012; USCDC, 2012).). With the global burden of cardiovascular disease resulting in 1 in 3 deaths in this country and being among the top 10 causes of death across the world, combined with growing speculation that lead exposure is related to the severity and incidence of cardiovascular disease, the questions become is there enough evidence to prove such a claim, and what methods are available to find the truth if it remains unknown. Finally, should there be definitive proof of this link one day, what would the most feasible and reasonable path forward be?
... Understanding the underlying mechanism that played a positive role for individuals dealing with such a situation demands attention . Drawing attention to this phenomenon would be helpful for policymakers and university management to devise strategies for the expected burden of communicable diseases (Boutayeb, 2006;Casal & López, 2021). ...
Article
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History Purpose: The purpose of this paper is to investigate the linkage between COVID-19 related experiences and the academic performance of university students. COVID-19, in general, has impacted the whole world financially, socially, and psychologically through its adverse effects in the form of closure of business, financial crisis, downsizing, psychological distress, etc. Evidence suggests the prevalence of COVID-19 related issues among university students who faced stressful conditions due to lockdown and isolation. Methodology: Drawing on the behavioral theory of plasticity, the present study adopted a two-wave methodology for data collection. We collected data with the help of structured questionnaires from students (n=1473) of an international university in Australia. We used the structural equation modeling (SEM) technique to test the moderated mediation model in Smart PLS3. Findings: Results indicated that COVID-19 related experiences were negatively associated with students' academic performance and positively with online leisure crafting. Whereas online leisure crafting was positively associated with academic performance and partially mediated the COVID-19 related experiences and academic performance. Uncertainty avoidance significantly buffered the effect of COVID-19 related experiences on online leisure crafting. The f indings supported the research framework of the study. Conclusion: This study helps make clear the 'how' and 'why' of the impact of COVID-19 related experiences on university students' academic performance through the mediation of online leisure crafting and moderation of uncertainty avoidance. The implications for university management and policymakers are discussed.
... In a developing economy, this rise will worsen the double burden of managing communicable and noncommunicable illnesses. 14 The duration after disease for majority, i.e., 91 cases (71.65%) was between 1 month to 1 year, in 33 cases (25.98%) it was more than 1 year and in 3 cases (2.36 %) the duration after diagnosis was < 1 month. Out of 127 cases, 94 (74.01 percent, 66 males and 28 females) were having end stage renal disease/ stage 5 (eGFR of less than 15ml/min/1.73m2), ...
Article
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With the aging of the population chronic kidney disease (CKD) has become one of the most common noncommunicable disease in the world as well as a leading cause of mortality. The present study was designed to describe the clinicodemographic profile of CKD patients and its manifestations on oral cavity and throat in central India, Madhya Pradesh (M.P.). This was a cross sectional, analytic study conducted in the Department of Medicine, Sanjay Gandhi Memorial Hospital (SHMH), associated with Shyam Shah Medical College (SSMC), Rewa, in the central India, M.P. between February 2019 and August 2020.Data of 127 patients with CKD were recorded and studied. The mean age of patients was 50.86±17.28 yr, 70.07 percent males and 29.93 percent female’s .84.70 percent were from rural area, mostly having >1 month of duration of CKD. 74.02% patients were in stage 5 of CKD, all on dialysis. 44.09% were associated with diabetes & 72.44% with hypertension. Most patients have Serum urea levels of >101 mg/dl with a mean level of 146.85 mg/dl, serum creatinine of >5mg/dl in most patients, serum hemoglobin levels of <7gm% in 54.33% and most have albuminuria.
... The world is currently witnessing a rise in the burden of both communicable and non-communicable diseases and may further increase the cost of healthcare on governments [14]. The majority of communicable and noncommunicable diseases (with 80% of global deaths from chronic diseases) are due to poor personal hygiene and environmental conditions that influence a person's wellbeing [4]. ...
Article
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Background Removing financial barriers and making healthcare accessible to all who need it remains an essential component of the United Nations’ sustainable development goals. Pro-poor healthcare financing schemes are policies that enable patients to concentrate on obtaining absolute medical care when needed rather than worrying about the cost of care. The demand for health services in healthcare facilities has increased tremendously due to the increasing burden of communicable and non-communicable diseases. This potentially threatens the sustainability of pro-poor health financing schemes. This study seeks to synthesize literature and map evidence on the use of health promotion and disease prevention interventions as a strategy to sustaining pro-poor health financing schemes globally. Methods We will conduct a systematic scoping review utilizing the Arksey and O’Malley framework, Levac et al. recommendations, and the Joanna Briggs Institute guidelines. A comprehensive keyword search for relevant published articles will be conducted in MEDLINE through PubMed, Web of Science, Google Scholar, SCOPUS, CINAHL, and Science Direct from 1 January 2000 to the last search date in 2021. Limiters such as date and language (English) will be applied, but study design limitations will be removed during the search. Boolean term AND/OR Medical Subject Heading terms will also be included. The reference list of all included articles will also be searched for potentially eligible articles. Two investigators will independently screen the articles in parallel at the abstract and full-text stages using the eligibility criteria designed in a Google form. Charting of data will also be conducted independently by two investigators using a piloted data abstraction form and thematic analysis conducted. The emerging themes will be collated, summarized, and the results reported. Discussion We hope to provide evidence of diverse health promotion and disease prevention policies/strategies used by countries to sustain their pro-poor health financing schemes for possible adoption by other countries. We also anticipate finding research gaps for further studies to help find innovative contextualized health prevention and promotion strategies to sustain pro-poor health financing schemes especially those in LMICs. The findings will be comprehensively discussed and disseminated at conferences and publication in a peer-reviewed journal.
... Infection with AMR leads to serious illnesses, treatment failure, prolonged hospital stays and increased healthcare costs [5,6]. LMICs bear the consequences of AMR owing to the high cost and poor access to effective antibiotics to treat MDR infections [7]. MDR colonization is a risk factor for subsequent MDR infections [8][9][10] due to the fact that these MDR pathogens may serve as endogenous reservoirs for overt clinical infections. ...
Article
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Colonization of multidrug resistant (MDR) bacteria is associated with subsequent invasive infections in children with comorbidities. This study aimed to determine the resistance profile and factors associated with MDR pathogen colonization among HIV-and HIV+ children below five years of age in Mwanza, Tanzania. A total of 399 (HIV- 255 and HIV+ 144) children were enrolled and investigated for the presence of MDR bacteria. The median [IQR] age of children was 19 (10-36) months. Out of 27 Staphylococcus aureus colonizing the nasal cavity, 16 (59.5%) were methicillin resistant while 132/278 (47.2%) of Enterobacteriaceae from rectal swabs were resistant to third generation cephalosporins, with 69.7% (92/132) exhibiting extended spectrum beta lactamase (ESBL) phenotypes. The proportion of resistance to gentamicin, amoxicillin/clavulanic acid and meropenem were significantly higher among HIV+ than HIV- children. A history of antibiotic use in the last month OR 2.62 [1.1, 6.9] (p = 0.04) and history of a relative admitted from the same household in the past three months OR 3.73 [1.1, 13.2] (p = 0.03) independently predicted ESBL rectal colonization. HIV+ children had significantly more fecal carriage of isolates resistant to uncommonly used antibiotics. There is a need to strengthen antimicrobial stewardship and Infection Prevention and Control (IPC) programs to prevent the emergence and spread of MDR pathogens in children.
Article
Consumption of commercial probiotics for health improvement and disease treatment has increased in popularity among the public in recent years. The local shops and pharmacies are brimming with various probiotic products such as probiotic food, dietary supplement and pharmaceuticals that herald a range of health benefits, from nutraceutical benefits to pharmaceutical effects. However, although the probiotic market is expanding rapidly, there is increasing evidence challenging it. Emerging insights from microbiome research and public health demonstrate several potential limitations of the natural properties, regulatory frameworks, and market consequences of commercial probiotics. In this review, we highlight the potential safety and performance issues of the natural properties of commercial probiotics, from the genetic level to trait characteristics and probiotic properties and further to the probiotic-host interaction. Besides, the diverse regulatory frameworks and confusing probiotic guidelines worldwide have led to product consequences such as pathogenic contamination, overstated claims, inaccurate labeling and counterfeit trademarks for probiotic products. Here, we propose a plethora of available methods and strategies related to strain selection and modification, safety and efficacy assessment, and some recommendations for regulatory agencies to address these limitations to guarantee sustainability and progress in the probiotic industry and improve long-term public health and development.
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Angesichts zunehmender Aufmerksamkeit für globale Herausforderungen erfährt auch der Begriff „Global Health“ zunehmend akademisches und politisches Interesse. Globale Gesundheit löst den Begriff der „internationalen Gesundheit“ ab und erfährt derzeit eine neue akademische Diskussion und den Versuch einer Begriffsbestimmung. Globale Gesundheit ist besonders verbunden mit transnationalen und internationalen Herausforderungen der Globalisierung wie Migration und Urbanisierung oder globaler Mobilität wie aktuell in der COVID-19 Pandemie. Entwicklungen sind dabei stark angebunden an die globale politische Agenda-Setzung, wie zum Beispiel an den Entwicklungszielen zur Nachhaltigkeit (Sustainable Development Goals, SDGs) der Vereinten Nationen. Akademische Studienangebote zur Professionalisierung von Fachkräften für globale Gesundheit sind in Deutschland noch selten und erst in der Entwicklung.
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Introduction: Non-communicable disease (NCD) risk is influenced by environmental factors that are highly variable worldwide, yet prior research has focused mainly on high-income countries where most people are exposed to relatively homogeneous and static environments. Understanding the scope and complexity of environmental influences on NCD risk around the globe requires more data from people living in diverse and changing environments. Our project will investigate the prevalence and environmental causes of NCDs among the indigenous peoples of Peninsular Malaysia, known collectively as the Orang Asli, who are currently undergoing varying degrees of lifestyle and sociocultural changes that are predicted to increase vulnerability to NCDs, particularly metabolic disorders and musculoskeletal degenerative diseases. Methods and analysis: Biospecimen sampling and screening for a suite of NCDs (eg, cardiovascular disease, type II diabetes, osteoarthritis and osteoporosis), combined with detailed ethnographic work to assess key lifestyle and sociocultural variables (eg, diet, physical activity and wealth), will take place in Orang Asli communities spanning a gradient from remote, traditional villages to acculturated, market-integrated urban areas. Analyses will first test for relationships between environmental variables, NCD risk factors and NCD occurrence to investigate how environmental changes are affecting NCD susceptibility among the Orang Asli. Second, we will examine potential molecular and physiological mechanisms (eg, epigenetics and systemic inflammation) that mediate environmental effects on health. Third, we will identify intrinsic (eg, age and sex) and extrinsic (eg, early-life experiences) factors that predispose certain people to NCDs in the face of environmental change to better understand which Orang Asli are at greatest risk of NCDs. Ethics and dissemination: Approval was obtained from multiple ethical review boards including the Malaysian Ministry of Health. This study follows established principles for ethical biomedical research among vulnerable indigenous communities, including fostering collaboration, building cultural competency, enhancing transparency, supporting capacity building and disseminating research findings.
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The coronavirus disease 2019 (COVID-19) has caused many global challenges, especially in resource-constrained countries. Africa, a continent with a large number of low-and middle-income countries (LMICs), shares this burden disproportionately compared to developed countries. Here we review some of the major challenges African countries face in the fight against COVID-19 and propose some mitigation measures. Studies have reported low adherence to COVID-19 prevention measures in most African countries. Additionally, there has been a shortage of healthcare workers, inadequate surveillance and diagnostic tools, unavailability of drugs in healthcare facilities, increased wrong beliefs, myths, misinformation and misconceptions about COVID-19 and vaccinations, and an already existing burden of infectious and non-infectious diseases across the African continent. Despite being very challenging to implement across African countries, telehealth is a critical solution to offer healthcare services during disease outbreaks. Many African countries have faced challenges in the fight against COVID-19. The training of healthcare workers (HCWs) must be strengthened to help address the shortage. In addition, African countries should strive to invest in research and capacity-building to be self-reliant regarding diagnostic tests. Thus, there is an urgent need to address the challenges faced by African countries in this fight, which may even include increased collaborations with other countries.
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The present paper examines the childhood mortality differential among urban poor and rural India using data from two rounds of National Family Health Survey Conducted in 2005-06 and 2015-16. Concentration index (CI), and cox regression were applied to address the research problem. Furthermore predicted probability was used to identify the potential predictors of infant and child mortality after adjusting the predictor variables. The findings suggest a decreasing trend in in infant mortality and child mortality both urban poor and rural India during this period. The economic inequalities respect to child mortality is higher in urban poor than in rural India. Hazard regression suggested that higher risk of child mortality in urban areas, due to poverty, low female literacy, low coverage antenatal care and safe delivery in the community. Even after controlling the possible bio-demographic variables, the study reveals that percentage declined mortality in rural areas higher than the urban poor but inequality is more widened in urban poor in India. The health program should be initiatives a major role to reducing infant and child mortality rates for both urban poor and rural India.
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Title: Social Risk Management Strategies and Health Risk Exposure – Insights and Evidence from Ghana and Malawi. // Abstract: Risk exposure is a major cause of poverty, deprivation and persistent vulnerability worldwide. This volume analyzes individuals' and households' responses to a variety of risks, with an emphasis on health risks. The study adapts the Social Risk Management (SRM) conceptual framework and extends it considerably for academic inquiry. Using household data from Ghana and Malawi, empirical evidence is provided on the complex relationship between high risk exposure and the application of proactive and reactive SRM strategies (incl. health insurance), showing their specific contributions to risk management. // The PhD thesis has been published as monography in the series "Social Protection in Health - Challenges, Needs and Solutions in International Health Care Financing" at LIT-publisher. URL: http://lit-verlag.de/isbn/3-643-90642-7 // Die Dissertation ist als Monographie in der Reihe "Social Protection in Health - Challenges, Needs and Solutions in International Health Care Financing" des LIT-Verlages erschienen. URL: http://lit-verlag.de/isbn/3-643-90642-7
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Objectives This study examined the association of anthropometric measures related to excess body fat such as body-mass-index (BMI), waist-hip ratio (WHR), waist-height-ratio (WHtR) with cardiometabolic risk factors such as hypertension, diabetes and dyslipidemia among adult mass population in Bangladesh. Methods A large scale cross-sectional study was carried out during August–November, 2017 among the patients (male 644, female 556), who didn't have any major illness, visiting the outpatient department of a tertiary level government hospital in capital Dhaka city. To examine the association between metabolic profile and anthropometric indices two-sample t-test and multivariable logistic regression were performed separately for each risk factor and combination of them (none, 1, 2+ risk factors) after adjusting for the effect of age and sex. Further area under the receiver operating characteristics (ROC) curve was used to assess the performance of the indices in predicting cardiometabolic risks. Results All these indices are found to be significantly associated with each of the risk factors. Of them, very strong positive association is found between WHtR and hypertension with odd ratio (OR) of 1.39 (95% confidence interval, CI: 1.05–3.93) and WHR and dyslipidemia (OR:1.79 with 95% CI: 1.19–3.32) were found. Similar findings were observed when the predictive performance was assessed with the estimated area under the ROC curve. Furthermore, all these indices showed stronger association of having more than one risk factors compared to those having only one risk factor. Of them, the WHR showed relatively stronger association having both one (OR: 2.53 with 95% CI: 1.13–7.19) and multiple risk factors (OR: 3.11 with 95% CI: 1.74–5.44). Conclusions Findings suggest that for reducing the cardiometabolic risks it is essential to control of having excess body fat measured using BMI, WHtR and WHR. Therefore, urgent policies and programs should be initiated to make the people aware of keeping control bodyweight and excess fat.
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Rapid urbanization has increased human-animal interaction and consequently enhanced the chances to acquire zoonotic diseases. The current investigation is focused to uncover the genetic diversity of multidrug-resistant E. coli strains between different ecologies (i.e., humans, livestock, and environment) at the molecular level by employing antimicrobial resistance profiling, virulence genes profiling, and microbial typing approach using ERIC PCR. Based on multiple antibiotic resistance, overall, 19 antibiotic resistance patterns (R1–R19) were observed. Most of the strains (49/60) were detected to have the combinations of stx, eaeA, and hlyA genes and considered STEC/EPEC/EHEC. A total of 18 unique genetic profiles were identified based on ERIC-PCR fingerprints and most of the strains (13) belong to P1 whereas the least number of strains were showing profiles P7 and P8-P11 (one member each profile). The calculated values for Shannon index (H) for human, animal, and environment are 1.70, 1.82, and 1.78, respectively revealing the highest genetic diversity among the E. coli strains of animal origin. The study revealed that drug-resistant pathogenic E. coli strains could be transmitted bidirectionally among the environment, humans, and animals
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Background: Cardiovascular disease is a major contributor to mortality worldwide and a signicant determinant of life expectancy which is estimated at 59 years in Nigerian males and 63 years in females. It is therefore necessary to identify cardiovascular risk factors among various adult populations. Effective surveillance of cardiovascular risk factors is advocated to reduce the associated morbidities and mortalities. This study therefore set out to determine the prevalence and pattern of cardiovascular risk factors among adult male members of an elite social club in an urban metropolitan city. Methods: An opportunistic cross-sectional study that recruited 97 adult male members of an elite social club in Lagos, Nigeria during the 2019 International Society of Hypertension May Measurement month. Their demographic and anthropometric parameters were obtained. Blood pressures were measured and blood samples were taken for fasting blood sugar and fasting lipid prole while urine samples were taken for micro-albuminuria assay. Data was analyzed using SPSS version 20.0 software. Results: The mean age of the study population was 56.6 + 12.6 years (range 35-83 years). The overall prevalence of hypertension was 61.7%. Half of the hypertensive population was previously diagnosed hypertensive. Obesity and dyslipidemia were seen in 65.0% and 80.0% respectively while the prevalence of abnormal blood sugar and micro-albuminuria was 16.0% and 15.0% respectively. Conclusion: Cardiovascular risk factors are common among afuent male socialites. Targeted screening, health education, aggressive treatment and lifestyle changes will go a long way in reducing the burden of these cardiovascular disease risk factors.
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Objective: This study aimed to explore physiotherapists' perceptions in Saudi Arabia about their understanding and role in health promotion through lifestyle behaviours and risk factors assessment and management of patients with musculoskeletal pain and disabilities. Study design: Qualitative study. Method: One-to-one interviews with 12 physiotherapists (six females; mean age 34.5 ± 8) within a constructivist framework. Interviews were recorded, transcribed verbatim, and analysed using a thematic analysis approach. Result: Three themes were identified: (1) the physiotherapists' awareness and knowledge of health promotion; (2) current practice of physiotherapists to implementing health promotion practice; and (3) the physiotherapists' perceived barriers to implementing health promotion practice. Participants generally perceived health promotion to be within their scope of practice. However, their understanding and approaches to deliver this practice were varied and non-standardised. Some barriers to routine engagement in health promotion were identified, including time constraints, the beliefs of healthcare practitioners, and limited education and training. Conclusion: This study highlighted that physiotherapists acknowledged the role of health promotion in their practice. However, there were different explanations of the concept and it was informally practised.
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Background Increased mobile phone penetration allows the interviewing of respondents using interactive voice response surveys in low- and middle-income countries. However, there has been little investigation of the best type of incentive to obtain data from a representative sample in these countries. Objective We assessed the effect of different airtime incentives options on cooperation and response rates of an interactive voice response survey in Bangladesh and Uganda. Methods The open-label randomized controlled trial had three arms: (1) no incentive (control), (2) promised airtime incentive of 50 Bangladeshi Taka (US $0.60; 1 BDT is approximately equivalent to US $0.012) or 5000 Ugandan Shilling (US $1.35; 1 UGX is approximately equivalent to US $0.00028), and (3) lottery incentive (500 BDT and 100,000 UGX), in which the odds of winning were 1:20. Fully automated random-digit dialing was used to sample eligible participants aged ≥18 years. The risk ratios (RRs) with 95% confidence intervals for primary outcomes of response and cooperation rates were obtained using log-binomial regression. Results Between June 14 and July 14, 2017, a total of 546,746 phone calls were made in Bangladesh, with 1165 complete interviews being conducted. Between March 26 and April 22, 2017, a total of 178,572 phone calls were made in Uganda, with 1248 complete interviews being conducted. Cooperation rates were significantly higher for the promised incentive (Bangladesh: 39.3%; RR 1.38, 95% CI 1.24-1.55, P<.001; Uganda: 59.9%; RR 1.47, 95% CI 1.33-1.62, P<.001) and the lottery incentive arms (Bangladesh: 36.6%; RR 1.28, 95% CI 1.15-1.45, P<.001; Uganda: 54.6%; RR 1.34, 95% CI 1.21-1.48, P<.001) than those for the control arm (Bangladesh: 28.4%; Uganda: 40.9%). Similarly, response rates were significantly higher for the promised incentive (Bangladesh: 26.5%%; RR 1.26, 95% CI 1.14-1.39, P<.001; Uganda: 41.2%; RR 1.27, 95% CI 1.16-1.39, P<.001) and lottery incentive arms (Bangladesh: 24.5%%; RR 1.17, 95% CI 1.06-1.29, P=.002; Uganda: 37.9%%; RR 1.17, 95% CI 1.06-1.29, P=.001) than those for the control arm (Bangladesh: 21.0%; Uganda: 32.4%). Conclusions Promised or lottery airtime incentives improved survey participation and facilitated a large sample within a short period in 2 countries. Trial Registration ClinicalTrials.gov NCT03773146; http://clinicaltrials.gov/ct2/show/NCT03773146
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BACKGROUND AND OBJECTIVES Noncommunicable diseases (NCDs) are chronic conditions requiring health care, education, social and community services, addressing prevention, treatment, and management. This review aimed to summarize and synthesize the available evidence on interventions from systematic reviews of high-burden NCDs and risk factors among school-aged children. METHODS The following databases were used for this research: Medline, Embase, The Cochrane Library, and the Campbell library. The search dates were from 2000 to 2021. We included systematic reviews that synthesized studies to evaluate intervention effectiveness in children aged 5 to 19 years globally. Two reviewers independently extracted data and assessed methodological quality of included reviews using the AMSTAR 2 tool. RESULTS Fifty studies were included. Asthma had the highest number of eligible reviews (n = 19). Of the reviews reporting the delivery platform, 27% (n = 16) reported outpatient settings, 13% (n = 8) home and community-based respectively, and 8% (n = 5) school-based platforms. Included reviews primarily (69%) reported high-income country data. This may limit the results’ generalizability for school-aged children and adolescents in low- and middle- income countries. CONCLUSIONS School-aged children and adolescents affected by NCDs require access to quality care, treatment, and support to effectively manage their diseases into adulthood. Strengthening research and the capacity of countries, especially low- and middle- income countries, for early screening, risk education and management of disease are crucial for NCD prevention and control.
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Generally, women and children have been considered at-risk populations, especially pregnant women, and their unborn babies. In the past decade, there has been overwhelming evidence linking climate change—extreme heat and air pollution—to adverse pregnancy, reproductive, and overall maternal health outcomes across the globe. This formative report highlights the effects of climate change. Using autoethnography and an adapted Delphi method—the combination of the different expert opinions—this report makes contextualized recommendations for women to mitigate the effects of climate change on maternal health outcomes in Nigeria.
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To estimate the risk and prevalence of Mycobacterium tuberculosis (MTB) infection and tuberculosis (TB) incidence, prevalence, and mortality, including disease attributable to human immunodeficiency virus (HIV), for 212 countries in 1997. A panel of 86 TB experts and epidemiologists from more than 40 countries was chosen by the World Health Organization (WHO), with final agreement being reached between country experts and WHO staff. Incidence of TB and mortality in each country was determined by (1) case notification to the WHO, (2) annual risk of infection data from tuberculin surveys, and (3) data on prevalence of smear-positive pulmonary disease from prevalence surveys. Estimates derived from relatively poor data were strongly influenced by panel member opinion. Objective estimates were derived from high-quality data collected recently by approved procedures. Agreement was reached by (1) participants reviewing methods and data and making provisional estimates in closed workshops held at WHO's 6 regional offices, (2) principal authors refining estimates using standard methods and all available data, and (3) country experts reviewing and adjusting these estimates and reaching final agreement with WHO staff. In 1997, new cases of TB totaled an estimated 7.96 million (range, 6.3 million-11.1 million), including 3.52 million (2.8 million-4.9 million) cases (44%) of infectious pulmonary disease (smear-positive), and there were 16.2 million (12.1 million-22.5 million) existing cases of disease. An estimated 1.87 million (1.4 million-2.8 million) people died of TB and the global case fatality rate was 23% but exceeded 50% in some African countries with high HIV rates. Global prevalence of MTB infection was 32% (1.86 billion people). Eighty percent of all incident TB cases were found in 22 countries, with more than half the cases occurring in 5 Southeast Asian countries. Nine of 10 countries with the highest incidence rates per capita were in Africa. Prevalence of MTB/HIV coinfection worldwide was 0.18% and 640000 incident TB cases (8%) had HIV infection. The global burden of tuberculosis remains enormous, mainly because of poor control in Southeast Asia, sub-Saharan Africa, and eastern Europe, and because of high rates of M tuberculosis and HIV coinfection in some African countries.
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After the publication of this work [1], we noticed the typographical errors in Tables 8, 9, 16, and 17: there were inconsistencies between the ranking of cancer mortality and incidence and their corresponding figures. Here we briefly present the results along with the revisions of the relevant tables since the ranking was corrected while the figures remained the same as the original.
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In developing countries, chronic respiratory diseases represent a challenge to public health because of their frequency, severity, projected trends, and economic impact. Health care planners, for example, are faced with a dramatic increase in tobacco use and must establish priorities for the allocation of limited resources. Nevertheless, smoking prevention and standardized management programmes for asthma and chronic obstructive pulmonary disease should be implemented in developing countries whenever possible. International measures will be required to reverse tobacco smoking trends, and international agencies could define essential drugs and equipment and encourage the use of generic drugs, particularly for corticosteroids inhaled at high dosages. For such programmes to be effective, producers of high-quality generics will need to be identified, and the medications added to national lists of essential drugs and included in procurement procedures. Other recommendations for alleviating the burden of chronic respiratory diseases in developing countries are: adapting guidelines to local contexts and ensuring their distribution; upgrading equipment at district level; purchasing high-quality drugs at low prices; routine training and supervision of health services personnel; and regular monitoring of performance. Social mobilization by professional societies, nongovernmental organizations, and the mass media will also increase government commitment to tobacco control and standardized case management.
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The recent World Health Organization (WHO) agreement on the standardized classification of overweight and obese, based on body mass index (BMI), allows a comparable analysis of prevalence rates worldwide for the first time. In Asia, however, there is a demand for a more limited range for normal BMIs (i.e., 18.5 to 22.9 kg/m(2) rather than 18.5 to 24.9 kg/m(2)) because of the high prevalence of comorbidities, particularly diabetes and hypertension. In children, the International Obesity Task-Force age-, sex-, and BMI-specific cutoff points are increasingly being used. We are currently evaluating BMI data globally as part of a new millennium analysis of the Global Burden of Disease. WHO is analyzing data in terms of 20 or more principal risk factors contributing to the primary causes of disability and lost lives in the 191 countries within the WHO. The prevalence rates for overweight and obese people are different in each region, with the Middle East, Central and Eastern Europe, and North America having higher prevalence rates. In most countries, women show a greater BMI distribution with higher obesity rates than do men. Obesity is usually now associated with poverty, even in developing countries. Relatively new data suggest that abdominal obesity in adults, with its associated enhanced morbidity, occurs particularly in those who had lower birth weights and early childhood stunting. Waist measurements in nationally representative studies are scarce but will now be needed to estimate the full impact of the worldwide obesity epidemic.
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Tuberculosis is among the top ten causes of global mortality and affects low-income countries in particular. This paper examines, through a literature review, the impact of tuberculosis control measures on tuberculosis mortality and transmission, and constraints to scaling-up. It also provides estimates of the effectiveness of various interventions using a model proposed by Styblo. It concludes that treatment of smear-positive tuberculosis using the WHO directly observed treatment, short-course (DOTS) strategy has by far the highest impact. While BCG immunization reduces childhood tuberculosis mortality, its impact on tuberculosis transmission is probably minimal. Under specific conditions, an additional impact on mortality and transmission can be expected through treatment of smear-negative cases, intensification of case-finding for smear-positive tuberculosis, and preventive therapy among individuals with dual tuberculosis-HIV infection. Of these interventions, DOTS is the most cost-effective at around US$ 5-40 per disability-adjusted life year (DALY) gained. The cost for BCG immunization is likely to be under US$ 50 per DALY gained. Treatment of smear-negative patients has a cost per DALY gained of up to US$ 100 in low-income countries, and up to US$ 400 in middle-income settings. Other interventions, such as preventive therapy for HIV-positive individuals, appear to be less cost-effective. The major constraint to scaling up DOTS is lack of political commitment, resulting in shortages of funding and human resources for tuberculosis control. However, in recent years there have been encouraging signs of increasing political commitment. Other constraints are related to involvement of the private sector, health sector reform, management capacity of tuberculosis programmes, treatment delivery, and drug supply. Global tuberculosis control could benefit strongly from technical innovation, including the development of a vaccine giving good protection against smear-positive pulmonary tuberculosis in adults; simpler and shorter drug regimens for treatment of tuberculosis disease and infection; and improved diagnostics for tuberculosis infection and disease.
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Extreme obesity is recognized to be a risk factor for heart failure. It is unclear whether overweight and lesser degrees of obesity also pose a risk. We investigated the relation between the body-mass index (the weight in kilograms divided by the square of the height in meters) and the incidence of heart failure among 5881 participants in the Framingham Heart Study (mean age, 55 years; 54 percent women). With the use of Cox proportional-hazards models, the body-mass index was evaluated both as a continuous variable and as a categorical variable (normal, 18.5 to 24.9; overweight, 25.0 to 29.9; and obese, 30.0 or more). During follow-up (mean, 14 years), heart failure developed in 496 subjects (258 women and 238 men). After adjustment for established risk factors, there was an increase in the risk of heart failure of 5 percent for men and 7 percent for women for each increment of 1 in body-mass index. As compared with subjects with a normal body-mass index, obese subjects had a doubling of the risk of heart failure. For women, the hazard ratio was 2.12 (95 percent confidence interval, 1.51 to 2.97); for men, the hazard ratio was 1.90 (95 percent confidence interval, 1.30 to 2.79). A graded increase in the risk of heart failure was observed across categories of body-mass index. The hazard ratios per increase in category were 1.46 in women (95 percent confidence interval, 1.23 to 1.72) and 1.37 in men (95 percent confidence interval, 1.13 to 1.67). In our large, community-based sample, increased body-mass index was associated with an increased risk of heart failure. Given the high prevalence of obesity in the United States, strategies to promote optimal body weight may reduce the population burden of heart failure.
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Mortality estimates alone are not sufficient to understand the true magnitude of cancer burden. We present the detailed estimates of mortality and incidence by site as the basis for the future estimation of cancer burden for the Global Burden of Disease 2000 study. Age- and sex- specific mortality envelope for all malignancies by region was derived from the analysis of country life-tables and cause of death. We estimated the site-specific cancer mortality distributions from vital records and cancer survival model. The regional cancer mortality by site is estimated by disaggregating the regional cancer mortality envelope based on the mortality distribution. Estimated incidence-to-mortality rate ratios were used to back calculate the final cancer incidence estimates by site. In 2000, cancer accounted for over 7 million deaths (13% of total mortality) and there were more than 10 million new cancer cases world wide in 2000. More than 60% of cancer deaths and approximately half of new cases occurred in developing regions. Lung cancer was the most common cancers in the world, followed by cancers of stomach, liver, colon and rectum, and breast. There was a significant variations in the distribution of site-specific cancer mortality and incidence by region. Despite a regional variation, the most common cancers are potentially preventable. Cancer burden estimation by taking into account both mortality and morbidity is an essential step to set research priorities and policy formulation. Also it can used for setting priorities when combined with data on costs of interventions against cancers.
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The disabled population constitutes a class of people needing special care and necessitating important economic and social effort. In this paper, using specific parameter settings, partial differential equations are used to model the temporal change of the proportion of the disabled population in Morocco. Combining different forms and values of the parameters, a numerical method is proposed and three scenarios are considered. These forms and values are determined by data fitting and simulation. The experiments show clearly the dynamical evolution of the disabled population with time and age according to each scenario.
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The incidence and prevalence of diabetes are increasing all over the world. Complications of diabetes constitute a burden for the individuals and the whole society. In the present paper, ordinary differential equations and numerical approximations are used to monitor the size of populations of diabetes with and without complications. Different scenarios are discussed according to a set of parameters and the dynamical evolution of the population from the stage of diabetes to the stage of diabetes with complications is clearly illustrated. The model shows how efficient and cost-effective strategies can be obtained by acting on diabetes incidence and/or controlling the evolution to the stage of complications.
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The continued occurrence of congenital syphilis is an indictment of the inadequate antenatal care services and poor quality of programmes to control sexually transmitted infections. More than 1 million infants are born with congenital syphilis each year. Despite national policies on antenatal testing and the widespread use of antenatal services, syphilis screening is still implemented only sporadically in many countries, leaving the disease undetected and untreated among many pregnant women. The weak organization of services and the costs of screening are the principal obstacles facing programmes. Decentralization of antenatal syphilis screening programmes, on-site testing and immediate treatment can reduce the number of cases of congenital syphilis. Antenatal syphilis screening and treatment programmes are as cost effective as many existing public health programmes, e.g. measles immunization. Diagnosis of congenital syphilis is problematic since more than half of all infants are asymptomatic, and signs in symptomatic infants may be subtle and nonspecific. Newer diagnostic tests such as enzyme immunoassays, polymerase chain reaction and immunoblotting have made diagnosis more sensitive and specific but are largely unavailable in the settings where they are most needed. Guidelines developed for better-resourced settings are conservative and err on the side of overtreatment. They are difficult to implement in, or inappropriate for, poorly-resourced settings because of the lack of investigative ability and the pressure on health facilities to discharge infants early. This paper offers recommendations for treating infants, including an approach based solely on maternal serological status and clinical signs of syphilis in the infant.
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Antenatal syphilis control is an integral component of reproductive health policies in most countries. In many of these countries, however, the existence of a health policy does not automatically translate into an effective health programme. We argue that neglecting to take into account the perspectives of all stakeholders when planning programmes may be the reason that functional and sustained interventions for antenatal syphilis are lacking. Stakeholders may include health policy decision-makers, programme managers, service delivery personnel (on whom implementation depends), as well as the pregnant women, families, and communities who will most benefit from the intervention. We describe how to undertake a multilevel assessment in order to identify stakeholders, identify interlinked perspectives, and analyse these perspectives within the socioeconomic, cultural and political environment within which an intervention is designed to be delivered. Using this multidisciplinary approach, we propose that the barriers to, and opportunities for, turning health policy into effective practice will be identified, and the result will be the formulation of a broad programme response to ensure implementation of the policy. Undertaking a multilevel assessment is but the first step in identifying barriers to successful programmes. Currently there is a lack of strong political support for this intervention at national and international levels. Devising strategies to address these potential barriers requires a broad range of skills and approaches some of which are outlined in this paper.
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Background By the dawn of the third millennium, non communicable diseases are sweeping the entire globe, with an increasing trend in developing countries where, the transition imposes more constraints to deal with the double burden of infective and non-infective diseases in a poor environment characterised by ill-health systems. By 2020, it is predicted that these diseases will be causing seven out of every 10 deaths in developing countries. Many of the non communicable diseases can be prevented by tackling associated risk factors. Methods Data from national registries and international organisms are collected, compared and analyzed. The focus is made on the growing burden of non communicable diseases in developing countries. Results Among non communicable diseases, special attention is devoted to cardiovascular diseases, diabetes, cancer and chronic pulmonary diseases. Their burden is affecting countries worldwide but with a growing trend in developing countries. Preventive strategies must take into account the growing trend of risk factors correlated to these diseases. Conclusion Non communicable diseases are more and more prevalent in developing countries where they double the burden of infective diseases. If the present trend is maintained, the health systems in low-and middle-income countries will be unable to support the burden of disease. Prominent causes for heart disease, diabetes, cancer and pulmonary diseases can be prevented but urgent (preventive) actions are needed and efficient strategies should deal seriously with risk factors like smoking, alcohol, physical inactivity and western diet.
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Cardiovascular diseases and their nutritional risk factors--including overweight and obesity, elevated blood pressure, and cholesterol--are among the leading causes of global mortality and morbidity, and have been predicted to rise with economic development. We examined age-standardized mean population levels of body mass index (BMI), systolic blood pressure, and total cholesterol in relation to national income, food share of household expenditure, and urbanization in a cross-country analysis. Data were from a total of over 100 countries and were obtained from systematic reviews of published literature, and from national and international health agencies. BMI and cholesterol increased rapidly in relation to national income, then flattened, and eventually declined. BMI increased most rapidly until an income of about ID 5,000 (international dollars) and peaked at about ID 12,500 for females and ID 17,000 for males. Cholesterol's point of inflection and peak were at higher income levels than those of BMI (about ID 8,000 and ID 18,000, respectively). There was an inverse relationship between BMI/cholesterol and the food share of household expenditure, and a positive relationship with proportion of population in urban areas. Mean population blood pressure was not correlated or only weakly correlated with the economic factors considered, or with cholesterol and BMI. When considered together with evidence on shifts in income-risk relationships within developed countries, the results indicate that cardiovascular disease risks are expected to systematically shift to low-income and middle-income countries and, together with the persistent burden of infectious diseases, further increase global health inequalities. Preventing obesity should be a priority from early stages of economic development, accompanied by population-level and personal interventions for blood pressure and cholesterol.
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Syphilis is a major cause of adverse outcomes in pregnancy in developing countries. Fetal death and morbidity due to congenital syphilis are preventable if infected mothers are identified and treated appropriately by the middle of the second trimester. Most pregnant women with syphilis are asymptomatic and can only be identified through serological screening. Non-treponemal tests, such as the rapid plasma reagin (RPR) test, are sensitive, simple to perform, and inexpensive. However, they have often not been available at primary health-care settings because they required cold storage for reagents and electricity to operate a rotator. Additionally, as many as 28% of positive RPR results in pregnant women are biological false positives. Confirmatory assays are usually available only in reference laboratories. Technological advances have resulted in improved serodiagnostic tools for syphilis. New enzyme immunoassays are available for surveillance and for large-scale screening programmes. Decentralized antenatal screening with on-site confirmation is now possible since new RPR reagents that are stable at room temperature have become commercially available, as have solar-powered rotators and simple, rapid point-of-care treponemal tests that use whole blood and do not require electricity or equipment. These will be valuable tools for preventing or eliminating congenital syphilis. The development of a non-invasive rapid treponemal test that distinguishes between active and past infections remains a high priority in areas where syphilis is endemic.
Article
Objective: The aim of this study was to determine the prevalence of the main cardiovascular risk factors in Morocco and their distribution according to age, sex and residential area. Methods: The study was conducted during the year 2000 on a Moroccan representative sample aged 20 years and over, considering the population distribution between urban and rural areas. The crude results were weighted according to the Moroccan population distribution by age and sex. In order to allow comparison with data from other countries, means and prevalence were standardized according to world population distribution by age. Results: The participation rate was 90.1%. The prevalence of hypertension was 33.6% (30.2% for men and 37.0% for women). The means of systolic and diastolic blood pressure were 129.8 and 76.0 mmHg, respectively. The prevalence of diabetes was 6.6% and was similar for males and females. The prevalence of hypercholesterolaemia was 29.0%, and was higher in females. The means and prevalence of diabetes and hypercholesterolaemia were higher in urban areas. The prevalence of hypertension, diabetes and hypercholesterolaemia increased with age. The prevalence of obesity was markedly higher in females and in urban areas. The average body mass index was 23.8 and 25.6 kg/m2 in males and females, respectively. Thirty-four per cent of men smoked cigarettes, but women rarely smoked cigarettes (0.6%). Conclusions: The prevalence of cardiovascular risk factors was high in Morocco and it is necessary to increase action against the cardiovascular diseases and their risk factors.
Technical Report
Introduction In 1993 the World Bank sponsored a study to assess the global burden of disease in collaboration with the World Health Organization (WHO) and the Harvard School of Public Health (1-3). As well as generating comprehensive and consistent set of estimates of mortality and morbidity by age, sex and region for the world for the first time (4-6), the Global Burden of Disease (GBD) study also introduced a new metric – the disability adjusted life year (DALY) – to quantify the burden of disease. The DALY is a summary measure of population health that combines in a single indicator years of life lost from premature death and years of life lived with disabilities. One DALY can be thought of as one lost year of ‘healthy’ life and the burden of disease as a measurement of the gap between current health status and an ideal situation where everyone lives into old age free of disease and disability. In recent years, considerable international effort has been put into the development of summary measures of population health that combine information on mortality and non-fatal health outcomes into a single measure. International policy interest in such indicators is increasing
Article
During the last few decades, the incidence and prevalence of diabetes and its complications have increased all around the world. Prevention of complications such as blindness, kidney failure, heart disease and amputations would not only improve peoples quality of life, but would also reduce costs of the national health and social services alike.In the present paper, using specific parameter settings, partial differential equations are used to monitor the size of a population of diabetics in order to control the number of diabetics developing complications in each age category.A numerical method is proposed and three scenarios are considered. The results show clearly the dynamical evolution of the population from the stage of diabetes to the stage of diabetes with complications.
Article
As the twentieth century draws to a close, it is clear that cardiovascular disease (CVD) has become a ubiquitous cause of morbidity and a leading contributor to mortality in most countries.1 2 The rise and recent decline of the CVD epidemic in the developed countries have been well documented.3 4 The identification of major risk factors through population-based studies and effective control strategies combining community education and targeted management of high risk individuals have contributed to the fall in CVD mortality rates (inclusive of coronary and stroke deaths) that has been observed in almost all industrialized countries. It has been estimated that during the period 1965 to 1990, CVD related mortality fell by ≈50% in Australia, Canada, France, and the United States and by 60% in Japan.1 Other parts of Western Europe reported more modest declines (20% to 25%). The decline in stroke mortality has been more marked compared with the decline in coronary mortality. In the United States, the decline in stroke mortality commenced nearly two decades earlier than the decline in coronary mortality and maintained a sharper rate of decline. During the period 1979 to 1989, the age-adjusted mortality from stroke declined, in that country, by about one third, whereas the corresponding decline in coronary mortality was 22%.4 5 In Japan, where stroke mortality outweighs coronary mortality, the impressive overall decline in CVD mortality is principally contributed by the former. The discordant trend of rising CVD mortality rates in Eastern Europe, however, is in sharp contrast to the decline in Western Europe.1 The emergence of the CVD epidemic in the developing countries during the past two to three decades has attracted less comment and little public health response, even within these countries. It is not widely realized that at present, the developing countries …
Article
The proceedings of the UICC 17th International Cancer Congress, held in Rio de Janeiro in August, are now available on videotape. The following videos are available: Highlights of the Congress, Interviews with the Panels, Prostate Diseases (ICUD/UICC/WHO), Global Cancer Facts and Figures (Dr. Max Parkin), The Fatal Combination in Cancer Development: Self-Stimulation and Self-Renewal (Dr. Donald Metcalf), Viral Oncology: The HPV Story (Dr. Harald zur Hausen), Nature and Nurture (Sir Richard Doll), Metastases (Dr. Max Burger), Pain Management in Cancer (Dr. Charles Cleeland), Behavioral Science (Dr. David Hill), Eurotrial 40 (Dr. Marco Rosselli del Turco), History and Development of Intravenous Feeding and Use in Cancer Therapy (Dr. Jonathan Rhoads), Cytopathology (Dr. William Frable), Laparoscopic Surgery (Dr. Bruce Ramshaw), Radiology for the Year 2000 (Dr. Carl d'Orsi), Breast Cancer (Dr. Kirby Bland), Rectal Cancer (Dr. Glen Steele), Prostate Cancer (Dr. Michael Brawer), Cervical Cancer (Dr. Hervy Averette), Lymphoma (Dr. Charles Coltman), Chronic Leukemias (Dr. Heinz Ludwig), and Soft Tissue Sarcoma (Dr. Murray Brennan).
Article
Many lifestyle-related risk factors for coronary heart disease have been identified, but little is known about their effect on the risk of disease when they are considered together. We followed 84,129 women participating in the Nurses' Health Study who were free of diagnosed cardiovascular disease, cancer, and diabetes at base line in 1980. Information on diet and lifestyle was updated periodically. During 14 years of follow-up, we documented 1128 major coronary events (296 deaths from coronary heart disease and 832 nonfatal infarctions). We defined subjects at low risk as those who were not currently smoking, had a body-mass index (the weight in kilograms divided by the square of the height in meters) under 25, consumed an average of at least half a drink of an alcoholic beverage per day, engaged in moderate-to-vigorous physical activity (which could include brisk walking) for at least half an hour per day, on average, and scored in the highest 40 percent of the cohort for consumption of a diet high in cereal fiber, marine n-3 fatty acids, and folate, with a high ratio of polyunsaturated to saturated fat, and low in trans fat and glycemic load, which reflects the extent to which diet raises blood glucose levels. Many of the factors were correlated, but each independently and significantly predicted risk, even after further adjustment for age, family history, presence or absence of diagnosed hypertension or diagnosed high cholesterol level, and menopausal status. Women in the low-risk category (who made up 3 percent of the population) had a relative risk of coronary events of 0.17 (95 percent confidence interval, 0.07 to 0.41) as compared with all the other women. Eighty-two percent of coronary events in the study cohort (95 percent confidence interval, 58 to 93 percent) could be attributed to lack of adherence to this low-risk pattern. Among women, adherence to lifestyle guidelines involving diet, exercise, and abstinence from smoking is associated with a very low risk of coronary heart disease.
Article
Faced with a difficult business environment in the United States and the falling demand for cigarettes in industrialized countries, multinational tobacco companies have been competing fiercely to expand their sales in developing countries. Because of the worldwide threat posed by smoking to health and the emphasis being placed by international tobacco companies on marketing in developing countries, an international regulatory strategy, such as the WHO proposed Framework Convention on Tobacco Control, is needed. This review describes from a public health perspective the possible scope and key considerations of protocols that should be included in the convention. The key international areas that should be considered in tobacco control are: prices, smuggling; tax-free tobacco products; advertising and sponsorship; the Internet; testing methods; package design and labelling; agriculture; and information sharing.
Article
The main task of global tuberculosis (TB) control over the next decade is to dramatically reduce TB deaths, the average duration of illness, and incidence--in that order. The best possible application of chemotherapy has the potential to cut the TB burden by more than 50% in 10 years. Mass screening for active TB has not generally been recommended, but the costs and benefits of targeted active case finding deserve further investigation. Among potential new tools for TB control, the biggest prize would be a high-efficacy vaccine that can produce long-lasting immunity. Now that good control programmes are becoming more widespread, new methods and indicators are needed to evaluate epidemiological impact. Even if morbidity and mortality are significantly reduced before 2010, tuberculosis infection will persist for much longer, acting as a sensitive indicator of public health, and as a marker of the quality of health services.
Article
Ischaemic heart disease, the largest cause of death worldwide, is rapidly becoming a major threat in low- and middle-income countries. Experience in a variety of populations has demonstrated that lowering certain risk factors, such as hypertension and hypercholesterolaemia, reduces illness and deaths from cardiovascular diseases. A dual approach is recommended: screening and intervening in cases of relatively high risk, while fostering population-wide preventive activities. This is both feasible and affordable. Now is the time to make such efforts.
Article
This two-part article provides an overview of the global burden of atherothrombotic cardiovascular disease. Part I initially discusses the epidemiologic transition which has resulted in a decrease in deaths in childhood due to infections, with a concomitant increase in cardiovascular and other chronic diseases; and then provides estimates of the burden of cardiovascular (CV) diseases with specific focus on the developing countries. Next, we summarize key information on risk factors for cardiovascular disease (CVD) and indicate that their importance may have been underestimated. Then, we describe overarching factors influencing variations in CVD by ethnicity and region and the influence of urbanization. Part II of this article describes the burden of CV disease by specific region or ethnic group, the risk factors of importance, and possible strategies for prevention.
Article
The global burden of disease due to cardiovascular diseases (CVDs) is escalating, principally due to a sharp rise in the developing countries which are experiencing rapid health transition. Contributory causes include: demographic shifts with altered population age profiles; lifestyle changes due to recent urbanisation, delayed industrialisation and overpowering globalisation; probable effects of foetal undernutrition on adult susceptibility to vascular disease and possible gene-environment interactions influencing ethnic diversity. Altered diets and diminished physical activity are critical factors contributing to the acceleration of CVD epidemics, along with tobacco use. The pace of health transition, however, varies across developing regions with consequent variations in the relative burdens of the dominant CVDs. A comprehensive public health response must integrate policies and programmes that effectively impact on the multiple determinants of these diseases and provide protection over the life span through primordial, primary and secondary prevention. Populations as well as individuals at risk must be protected through initiatives that espouse and enable nutrition-based preventive strategies to protect and promote cardiovascular health. An empowered community, an enlightened policy and an energetic coalition of health professionals must ensure that development is not accompanied by distorted nutrition and disordered health.
Article
Regular physical activity is indicated either to prevent and delay the onset of non-insulin-dependent diabetes or to assure a good control of diabetes by increasing insulin sensitivity and ameliorating the metabolism of glucose disappearance. Many studies and experiments have dealt with this subject. In this paper, we introduce the effect of physical activity via parameters of a mathematical model which allows us to compare the behaviour of blood glucose in normal, non-insulin-dependent diabetes and insulin-dependent diabetes people, with and without physical effort. Extreme cases of physical activity leading to hypoglycaemia or aggravating hyperglycaemia are also underlined.
Article
Diet-related factors are thought to account for about 30% of cancers in developed countries. Obesity increases the risk of cancers in the oesophagus, colorectum, breast, endometrium, and kidney. Alcohol causes cancers of the oral cavity, pharynx, larynx, oesophagus, and liver, and causes a small increase in the risk of breast cancer. Adequate intakes of fruit and vegetables probably lower the risk for several types of cancer, especially cancers of the gastrointestinal tract. The importance of other factors, including meat, fibre, and vitamins, is not yet clear. Prudent advice is to eat a varied diet including plenty of fruit, vegetables, and cereals to maintain a healthy bodyweight with the help of regular physical activity and to restrict consumption of alcohol.
Article
The aim of this study was to determine the prevalence of the main cardiovascular risk factors in Morocco and their distribution according to age, sex and residential area. The study was conducted during the year 2000 on a Moroccan representative sample aged 20 years and over, considering the population distribution between urban and rural areas. The crude results were weighted according to the Moroccan population distribution by age and sex. In order to allow comparison with data from other countries, means and prevalence were standardized according to world population distribution by age. The participation rate was 90.1%. The prevalence of hypertension was 33.6% (30.2% for men and 37.0% for women). The means of systolic and diastolic blood pressure were 129.8 and 76.0 mmHg, respectively. The prevalence of diabetes was 6.6% and was similar for males and females. The prevalence of hypercholesterolaemia was 29.0%, and was higher in females. The means and prevalence of diabetes and hypercholesterolaemia were higher in urban areas. The prevalence of hypertension, diabetes and hypercholesterolaemia increased with age. The prevalence of obesity was markedly higher in females and in urban areas. The average body mass index was 23.8 and 25.6 kg/m2 in males and females, respectively. Thirty-four per cent of men smoked cigarettes, but women rarely smoked cigarettes (0.6%). The prevalence of cardiovascular risk factors was high in Morocco and it is necessary to increase action against the cardiovascular diseases and their risk factors.
Article
More than 10 million children die each year, most from preventable causes and almost all in poor countries. Six countries account for 50% of worldwide deaths in children younger than 5 years, and 42 countries for 90%. The causes of death differ substantially from one country to another, highlighting the need to expand understanding of child health epidemiology at a country level rather than in geopolitical regions. Other key issues include the importance of undernutrition as an underlying cause of child deaths associated with infectious diseases, the effects of multiple concurrent illnesses, and recognition that pneumonia and diarrhoea remain the diseases that are most often associated with child deaths. A better understanding of child health epidemiology could contribute to more effective approaches to saving children's lives.
Article
This is the second of five papers in the child survival series. The first focused on continuing high rates of child mortality (over 10 million each year) from preventable causes: diarrhoea, pneumonia, measles, malaria, HIV/AIDS, the underlying cause of undernutrition, and a small group of causes leading to neonatal deaths. We review child survival interventions feasible for delivery at high coverage in low-income settings, and classify these as level 1 (sufficient evidence of effect), level 2 (limited evidence), or level 3 (inadequate evidence). Our results show that at least one level-1 intervention is available for preventing or treating each main cause of death among children younger than 5 years, apart from birth asphyxia, for which a level-2 intervention is available. There is also limited evidence for several other interventions. However, global coverage for most interventions is below 50%. If level 1 or 2 interventions were universally available, 63% of child deaths could be prevented. These findings show that the interventions needed to achieve the millennium development goal of reducing child mortality by two-thirds by 2015 are available, but that they are not being delivered to the mothers and children who need them.
Article
This is the third paper in the series on child survival. The second paper in the series, published last week, concluded that in the 42 countries with 90% of child deaths worldwide in 2000, 63% of these deaths could have been prevented through full implementation of a few known and effective interventions. Levels of coverage with these interventions are still unacceptably low in most low-income and middle-income countries. Worse still, coverage for some interventions, such as immunisations and attended delivery, are stagnant or even falling in several of the poorest countries. This paper highlights the importance of separating biological or behavioural interventions from the delivery systems required to put them in place, and the need to tailor delivery strategies to the stage of health-system development. We review recent initiatives in child health and discuss essential aspects of delivery systems, including: need for data at the subnational level to support health planning; regular monitoring of provision and use of health services, and of intervention coverage; and the need to achieve high and equitable coverage with selected interventions. Community-based initiatives can extend the delivery of interventions in areas where health services are hard to access, but strengthening national health systems should be the long-term aim. The millennium development goal for child survival can be achieved, but only if strategies for delivery interventions are greatly improved and scaled-up.