Category: Low and middle income countries

Why we need a new measure of maternal health: the “lifetime risk of maternal near miss”

Ursula Gazeley

According to the most recent data from the World Health Organization, the lifetime risk of maternal death for a girl in Chad is a staggering 1 in 15, compared with 1 in 43,000 in Norway. This means that a girl in Chad has an almost 3000 times greater risk of dying from a maternal cause during her reproductive lifetime than a girl in Norway. The lifetime risk of maternal death is a useful measure to help us understand this global inequality in maternal mortality.

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Could biomass fuel use perpetuate the poverty trap through cardiovascular disease and all-cause mortality?

Shuyi Qiu and John S Ji

Many people around the world are still using biomass as a fuel for cooking and heating. Inefficient combustion of solid fuels is the primary cause of indoor household air pollution, estimated to be responsible for 4.3 million premature deaths in 2012 (7.7% of total mortality).

The World Health Organization’s latest global air quality guidelines point out that indoor air pollution causes a health burden that mostly affects people in low- and middle-income countries. Many global development agencies are working with governments of developing countries to reduce household air pollution. For example, China’s Relocation Program in the poorest provinces is a significant part of China’s poverty eradication plans. This large-scale program relocates millions of residents in absolute poverty to places with better living conditions, including fuel type.

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Childhood diarrhoeal illness may be underestimated in national health surveys

Katie Overbey, Kellogg Schwab and Natalie Exum

For children in low-income countries, diarrhoea remains a major cause of death and can lead to long-term health consequences. Accurate estimates of childhood diarrhoeal illness are crucial to evaluating the success of campaigns to defeat diarrhoea and improve health in countries where the burden of diarrhoea is high.

In our study, recently published in the IJE, we found that caregivers may underestimate diarrhoeal diseases in children aged under 5 years when asked to recall whether the children had diarrhoea in the previous 2 weeks. Compared with a 1-week recall period, there was a consistent underestimation of the prevalence of diarrhoea across five countries in sub-Saharan Africa.

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Hygiene gaps: between access and practice, and from region to region

Jennyfer Wolf, Richard Johnston, Matthew C Freeman and Annette Prüss-Ustün

Handwashing with soap after faecal contact is key to preventing disease and death from enteric infectious diseases. Our study, recently published in the IJE, is the first to provide global, regional and country estimates of handwashing with soap after potential contact with human faeces, based on representative data on access to handwashing facilities collected for monitoring of the Sustainable Development Goals (SDGs). Our results show that handwashing with soap after using the toilet or other potential contact with human faeces is poorly practised worldwide and that even the necessary equipment – handwashing facilities with soap and water – are inaccessible to billions of people.

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What has contributed to the reduction in mortality rate for children aged under 5 in sub-Saharan Africa?

Yoko Akachi, Maria Steenland and Günther Fink

Akachi authors

Reducing child mortality remains one of the key objectives of the Sustainable Development Goals. Remarkable progress has been made over the past 25 years, with the global number of deaths of children aged under 5 falling from 13 million in 1990 to six million in 2015. Yet little is known about the relative contributions of specific public health interventions and general improvements in socioeconomic status and educational attainment over the same period.

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Can women talking save lives? Reducing inequalities in newborn mortality in India, Nepal, Bangladesh and Malawi

Tanja AJ Houweling, David Osrin, Kishwar Azad, Dharma S Manandhar, Prasanta Tripathy, Tambosi Phiri, Joanna Morrison and Anthony Costello

In low- and middle-income countries, the odds of surviving the first 28 days of life are grossly unequal between infants born in deprived and better-off families, even among children living in the same community. In our study, recently published in the IJE, we have shown that women’s groups are able to address this problem. Under the guidance of a facilitator, women came together every month to discuss problems during pregnancy, delivery and the newborn period, and then designed and implemented strategies to overcome these problems with the help of the entire community.

Ekjut
Ekjut women’s group in rural India

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Smoke exposure in early life and Rheumatic Heart Disease

david-phillipsDavid Phillips

Rheumatic Heart Disease (RHD) is caused by a bacterial (streptococcal) throat infection acquired in childhood.  Although this type of infection is common and widespread, a small proportion of children so affected go on to develop an inflammatory condition that leads to scarring and narrowing of the heart valves and, in time, heart failure. Early on in the course of the disease the joints may be affected – hence the term “rheumatic”.

Still an important disease
At one time Rheumatic Heart Disease was common throughout the UK, Europe and the US; it was the most important cause of heart disease among young adults in Victorian Britain and probably caused the death of Mozart.  Although rare now in most developed countries, it remains an important public health problem in many low and middle income countries. The disease is widespread in the Middle East and Asia, and the the poor indigenous populations of some wealthy countries, for example among Australian Aboriginees and New Zealand Maoris. It is particularly prevalent in sub-Saharan Africa, where it is one of the commonest causes of heart disease, typically affecting children or young adults. There it carries a grim prognosis because of the lack of specialised treatment. Continue reading “Smoke exposure in early life and Rheumatic Heart Disease” →

Increased risk of heart attacks – An unmeasured cost of the war on drugs in Mexico

Eileen Lee and Tim Bruckner

Bruckner PicLee Pic 3_croppedSince the start of the Mexican Drug War in December 2006, over 100,000 people have been murdered and over 20,000 are still missing. The escalation of violence has led to questions regarding the legitimacy and ability of political institutions, including law enforcement, to protect the public. A yet unmeasured cost of the drug war, related to living in an insecure environment, is the increased risk of dying from a heart attack.

We recently found that heart attack deaths among the elderly rose in months when Mexico’s homicide rate also rose. Our study adds to the growing literature on the collateral consequences of violence among persons who do not directly know the perpetrators or the victims. We believe that a threat, or perceived threat, to security from Mexico’s rising homicides, and the attendant media coverage, may have induced a stress response that triggered an excess of heart attacks. Given the high homicide rate in Mexico, the country provided a reasonable setting for us to test how population health responds to threats to security. Continue reading “Increased risk of heart attacks – An unmeasured cost of the war on drugs in Mexico” →

Are We There Yet? Assessing the Burden of Travel on Maternal Health Care Utilization and Child Mortality in Developing Countries

Mahesh Karra, Günther Fink, David Canning

David Canning Guenther FinkMahesh Karra

 

The problem
Over the past two decades, low- and middle-income countries (LMICs) have made considerable progress towards reducing child mortality. In spite of these achievements, almost six million children under the age of five are estimated to have died in 2015. Many of these deaths could likely be avoided if high quality antenatal care and delivery at health facilities were available to mothers and their children. Yet access to high quality health services remains low in many settings.

Distance to health care facilities has been identified as one of the main potential barriers to health service access. However, while there is strong evidence that long distances to facilities lead to lower utilization of health services, the evidence is less clear about whether long distances to facilities are linked to poor health outcomes. Continue reading “Are We There Yet? Assessing the Burden of Travel on Maternal Health Care Utilization and Child Mortality in Developing Countries” →

Lessons from the recent trial of a pay-for-performance programme in Afghanistan

Elina Dale, Anubhav Agarwal, Cyrus Engineer
Dale et al

Significant resources in global health are spent on pay-for-performance (P4P), also known under a more general term as results-based financing (RBF). Originating in the UK and USA, P4P has now become – to borrow a phrase from Cheryl Cashin – the new “it-girl” in health financing. However, as recent experience from Afghanistan shows, implementation is not always easy and P4P interventions must be better designed if they are to achieve real population health gains.

From 2010 to 2012 a P4P programme in Afghanistan provided quarterly bonus payments to health-care providers for increases in the use of maternal and child health (MCH) services, adjusted by a quality of care score. Our study, a large-scale cluster randomized trial, demonstrates that the programme did not produce the intended results. There were no observable improvements in any of the five key MCH coverage indicators measuring contraceptive prevalence, skilled birth attendances, vaccinations, and antenatal and postnatal check-ups. No changes were observed in the equity of care. While the programme appeared to increase time spent with patients, resulting in more complete histories and physical examinations, and improved patient counselling, other measures of quality, such as availability of medicines and supplies, did not substantially change. Continue reading “Lessons from the recent trial of a pay-for-performance programme in Afghanistan” →