scholarly journals Pediatric Solid Tumors in Resource-Constrained Settings: A Review of Available Evidence on Management, Outcomes, and Barriers to Care

Children ◽  
2018 ◽  
Vol 5 (11) ◽  
pp. 143 ◽  
Author(s):  
Nicholas Carter ◽  
Andrew Avery ◽  
Jaime Libes ◽  
Harold Lovvorn ◽  
Erik Hansen
Keyword(s):  
Solid Tumors ◽  
Barriers To Care ◽  
Wilms Tumor ◽  
Tumor Biology ◽  
Sub Saharan Africa ◽  
Pediatric Care ◽  
Middle Income ◽  
Pediatric Solid Tumors ◽  
Sub Saharan ◽  
Poor Outcomes

International disparities in outcomes from pediatric solid tumors remain striking. Herein, we review the current literature regarding management, outcomes, and barriers to care for pediatric solid tumors in low- and middle-income countries (LMICs). In sub-Saharan Africa, Wilms Tumor represents the most commonly encountered solid tumor of childhood and has been the primary target of recent efforts to improve outcomes in low-resource settings. Aggressive and treatment-resistant tumor biology may play a role in poor outcomes within certain populations, but socioeconomic barriers remain the principal drivers of preventable mortality. Management protocols that include measures to address socioeconomic barriers have demonstrated early success in reducing abandonment of therapy. Further work is required to improve infrastructure and general pediatric care to address disparities.

scholarly journals BioLPG for Clean Cooking in Sub-Saharan Africa: Present and Future Feasibility of Technologies, Feedstocks, Enabling Conditions and Financing

Energies ◽  
2021 ◽  
Vol 14 (13) ◽  
pp. 3916
Author(s):  
Kimball C. Chen ◽  
Matthew Leach ◽  
Mairi J. Black ◽  
Meron Tesfamichael ◽  
Francis Kemausuor ◽  
...  
Keyword(s):  
Agricultural Waste ◽  
Sub Saharan Africa ◽  
Green Economy ◽  
Energy Access ◽  
Liquefied Petroleum Gas ◽  
Public And Private ◽  
Middle Income ◽  
Private Sector Investment ◽  
Sub Saharan ◽  
Public And Private Sector

Energy supply for clean cooking is a priority for Sub-Saharan Africa (SSA). Liquefied petroleum gas (LPG, i.e., propane or butane or a mixture of both) is an economically efficient, cooking energy solution used by over 2.5 billion people worldwide and scaled up in numerous low- and middle-income countries (LMICs). Investigation of the technical, policy, economic and physical requirements of producing LPG from renewable feedstocks (bioLPG) finds feasibility at scale in Africa. Biogas and syngas from the circular economic repurposing of municipal solid waste and agricultural waste can be used in two groundbreaking new chemical processes (Cool LPG or Integrated Hydropyrolysis and Hydroconversion (IH2)) to selectively produce bioLPG. Evidence about the nature and scale potential of bioLPG presented in this study justifies further investment in the development of bioLPG as a fuel that can make a major contribution toward enabling an SSA green economy and universal energy access. Techno-economic assessments of five potential projects from Ghana, Kenya and Rwanda illustrate what might be possible. BioLPG technology is in the early days of development, so normal technology piloting and de-risking need to be undertaken. However, fully developed bioLPG production could greatly reduce the public and private sector investment required to significantly increase SSA clean cooking capacity.

scholarly journals Gestational weight gain in low-income and middle-income countries: a modelling analysis using nationally representative data

2020 ◽  
Vol 5 (11) ◽  
pp. e003423
Author(s):  
Dongqing Wang ◽  
Molin Wang ◽  
Anne Marie Darling ◽  
Nandita Perumal ◽  
Enju Liu ◽  
...  
Keyword(s):  
Weight Gain ◽  
North Africa ◽  
Low Income ◽  
Sub Saharan Africa ◽  
Middle Income ◽  
Middle Income Countries ◽  
Gestational Weight ◽  
Latin America And Caribbean ◽  
Nationally Representative ◽  
Sub Saharan

IntroductionGestational weight gain (GWG) has important implications for maternal and child health and is an ideal modifiable factor for preconceptional and antenatal care. However, the average levels of GWG across all low-income and middle-income countries of the world have not been characterised using nationally representative data.MethodsGWG estimates across time were computed using data from the Demographic and Health Surveys Program. A hierarchical model was developed to estimate the mean total GWG in the year 2015 for all countries to facilitate cross-country comparison. Year and country-level covariates were used as predictors, and variable selection was guided by the model fit. The final model included year (restricted cubic splines), geographical super-region (as defined by the Global Burden of Disease Study), mean adult female body mass index, gross domestic product per capita and total fertility rate. Uncertainty ranges (URs) were generated using non-parametric bootstrapping and a multiple imputation approach. Estimates were also computed for each super-region and region.ResultsLatin America and Caribbean (11.80 kg (95% UR: 6.18, 17.41)) and Central Europe, Eastern Europe and Central Asia (11.19 kg (95% UR: 6.16, 16.21)) were the super-regions with the highest GWG estimates in 2015. Sub-Saharan Africa (6.64 kg (95% UR: 3.39, 9.88)) and North Africa and Middle East (6.80 kg (95% UR: 3.17, 10.43)) were the super-regions with the lowest estimates in 2015. With the exception of Latin America and Caribbean, all super-regions were below the minimum GWG recommendation for normal-weight women, with Sub-Saharan Africa and North Africa and Middle East estimated to meet less than 60% of the minimum recommendation.ConclusionThe levels of GWG are inadequate in most low-income and middle-income countries and regions. Longitudinal monitoring systems and population-based interventions are crucial to combat inadequate GWG in low-income and middle-income countries.

scholarly journals Are low and middle-income countries prioritising high-value healthcare interventions?

2020 ◽  
Vol 5 (2) ◽  
pp. e001850
Author(s):  
Ashley A Leech ◽  
David D Kim ◽  
Joshua T Cohen ◽  
Peter J Neumann
Keyword(s):  
Cost Effectiveness ◽  
Cost Saving ◽  
National Health ◽  
Sub Saharan Africa ◽  
Health Plans ◽  
Middle Income ◽  
Middle Income Countries ◽  
Health Priority ◽  
Sub Saharan ◽  
Low And Middle Income

IntroductionSince resources are finite, investing in services that produce the highest health gain ‘return on investment’ is critical. We assessed the extent to which low and middle-income countries (LMIC) have included cost-saving interventions in their national strategic health plans.MethodsWe used the Tufts Medical Center Global Health Cost-Effectiveness Analysis Registry, an open-source database of English-language cost-per-disability-adjusted life year (DALY) studies, to identify analyses published in the last 10 years (2008–2017) of cost-saving health interventions in LMICs. To assess whether countries prioritised cost-saving interventions within their latest national health strategic plans, we identified 10 countries, all in sub-Saharan Africa, with the highest measures on the global burden of disease scale and reviewed their national health priority plans.ResultsWe identified 392 studies (63%) targeting LMICs that reported 3315 cost-per-DALY ratios, of which 207 ratios (6%) represented interventions reported to be cost saving. Over half (53%) of these targeted sub-Saharan Africa. For the 10 countries we investigated in sub-Saharan Africa, 58% (79/137) of cost-saving interventions correspond with priorities identified in country plans. Alignment ranged from 95% (21/22 prioritised cost-saving ratios) in South Africa to 17% (2/12 prioritised cost-saving ratios) in Cameroon. Human papillomavirus vaccination was a noted priority in 70% (7/10) of national health prioritisation plans, while 40% (4/10) of countries explicitly included prenatal serological screening for syphilis. HIV prevention and treatment were stated priorities in most country health plans, whereas 40% (2/5) of countries principally outlined efforts for lymphatic filariasis. From our sample of 45 unique interventions, 36% of interventions (16/45) included costs associated directly with the implementation of the intervention.ConclusionOur findings indicate substantial variation across country and disease area in incorporating economic evidence into national health priority plans in a sample of sub-Saharan African countries. To make health economic data more salient, the authors of cost-effectiveness analyses must do more to reflect implementation costs and other factors that could limit healthcare delivery.

scholarly journals Understanding cause of stillbirth: a prospective observational multi-country study from sub-Saharan Africa

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Mamuda Aminu ◽  
Sarah Bar-Zeev ◽  
Sarah White ◽  
Matthews Mathai ◽  
Nynke van den Broek
Keyword(s):  
Sierra Leone ◽  
Cause Of Death ◽  
Expert Panel ◽  
Healthcare Providers ◽  
Sub Saharan Africa ◽  
Primary Data ◽  
Middle Income ◽  
Computer Based ◽  
Sub Saharan ◽  
Low And Middle Income

Abstract Background Every year, an estimated 2.6 million stillbirths occur worldwide, with up to 98% occurring in low- and middle-income countries (LMIC). There is a paucity of primary data on cause of stillbirth from LMIC, and particularly from sub-Saharan Africa to inform effective interventions. This study aimed to identify the cause of stillbirths in low- and middle-income settings and compare methods of assessment. Methods This was a prospective, observational study in 12 hospitals in Kenya, Malawi, Sierra Leone and Zimbabwe. Stillbirths (28 weeks or more) were reviewed to assign the cause of death by healthcare providers, an expert panel and by using computer-based algorithms. Agreement between the three methods was compared using Kappa (κ) analysis. Cause of stillbirth and level of agreement between the methods used to assign cause of death. Results One thousand five hundred sixty-three stillbirths were studied. The stillbirth rate (per 1000 births) was 20.3 in Malawi, 34.7 in Zimbabwe, 38.8 in Kenya and 118.1 in Sierra Leone. Half (50.7%) of all stillbirths occurred during the intrapartum period. Cause of death (range) overall varied by method of assessment and included: asphyxia (18.5–37.4%), placental disorders (8.4–15.1%), maternal hypertensive disorders (5.1–13.6%), infections (4.3–9.0%), cord problems (3.3–6.5%), and ruptured uterus due to obstructed labour (2.6–6.1%). Cause of stillbirth was unknown in 17.9–26.0% of cases. Moderate agreement was observed for cause of stillbirth as assigned by the expert panel and by hospital-based healthcare providers who conducted perinatal death review (κ = 0.69; p < 0.0005). There was only minimal agreement between expert panel review or healthcare provider review and computer-based algorithms (κ = 0.34; 0.31 respectively p < 0.0005). Conclusions For the majority of stillbirths, an underlying likely cause of death could be determined despite limited diagnostic capacity. In these settings, more diagnostic information is, however, needed to establish a more specific cause of death for the majority of stillbirths. Existing computer-based algorithms used to assign cause of death require revision.

scholarly journals Preventing Multimorbidity with Lifestyle Interventions in Sub-Saharan Africa: A New Challenge for Public Health in Low and Middle-Income Countries

2021 ◽  
Vol 18 (23) ◽  
pp. 12449
Author(s):  
Ahmad Alkhatib ◽  
Lawrence Achilles Nnyanzi ◽  
Brian Mujuni ◽  
Geofrey Amanya ◽  
Charles Ibingira
Keyword(s):  
Public Health ◽  
Cardiovascular Disease ◽  
Sub Saharan Africa ◽  
Lifestyle Interventions ◽  
African Countries ◽  
Middle Income ◽  
Non Communicable Diseases ◽  
Economic Disparity ◽  
Middle Income Countries ◽  
Sub Saharan

Objectives: Low and Middle-Income Countries are experiencing a fast-paced epidemiological rise in clusters of non-communicable diseases such as diabetes and cardiovascular disease, forming an imminent rise in multimorbidity. However, preventing multimorbidity has received little attention in LMICs, especially in Sub-Saharan African Countries. Methods: Narrative review which scoped the most recent evidence in LMICs about multimorbidity determinants and appropriated them for potential multimorbidity prevention strategies. Results: MMD in LMICs is affected by several determinants including increased age, female sex, environment, lower socio-economic status, obesity, and lifestyle behaviours, especially poor nutrition, and physical inactivity. Multimorbidity public health interventions in LMICs, especially in Sub-Saharan Africa are currently impeded by local and regional economic disparity, underdeveloped healthcare systems, and concurrent prevalence of communicable and non-communicable diseases. However, lifestyle interventions that are targeted towards preventing highly prevalent multimorbidity clusters, especially hypertension, diabetes, and cardiovascular disease, can provide early prevention of multimorbidity, especially within Sub-Saharan African countries with emerging economies and socio-economic disparity. Conclusion: Future public health initiatives should consider targeted lifestyle interventions and appropriate policies and guidelines in preventing multimorbidity in LMICs.

A Comparative Analysis of South Africa as a Semi-Industrialised Developing Country

1988 ◽  
Vol 26 (3) ◽  
pp. 473-493 ◽  
Author(s):  
J. B. Knight
Keyword(s):  
South Africa ◽  
Developing Economies ◽  
Developed Countries ◽  
Sub Saharan Africa ◽  
Middle Income ◽  
The World Bank ◽  
The World ◽  
Per Capita ◽  
Sub Saharan ◽  
Industrialised Countries

South Africa has neither a developed nor a typical underdeveloped economy. Too often it has been wrongly classified, along with, say, Australia and New Zealand, as one of the peripheral developed countries, because only a part of the economy and population have the characteristics we associate with that group. Yet its economy is distinctly different from others in sub-Saharan Africa. South Africa falls squarely into the category which the World Bank classifies as ‘upper middle-income’ developing economies, with G.N.P. per capita in 1982 ranging from $2,000 to $7,000 and averaging $2,500, thereby including South Africa, with $2,700.1 (By contrast, Kenya's G.N.P. per capita was $400 and Britain's $10,000). The World Bank's group includes Algeria, Argentina, Brazil, Chile, Mexico, South Korea, Venezuela, and Yugoslavia. South Africa shares many structural economic characteristics with these semi-industrialised countries.

Self Supply

2021 ◽  
Author(s):  
Sally Sutton ◽  
John Butterworth
Keyword(s):  
Universal Access ◽  
Cost Effective ◽  
Sub Saharan Africa ◽  
Full Potential ◽  
Public Provision ◽  
Middle Income ◽  
Private And Public ◽  
Access To Water ◽  
Sub Saharan ◽  
Water Provision

While governments and development partners focus on improving community and utility-managed water supplies to ensure access for all, hundreds of millions of people are taking actions to supply their own water. In the WASH sector household investment in construction and improvement of facilities is widely employed in sanitation but in water similar efforts are ignored. Recognition of the contribution of self-supply towards universal access to water and its full potential, is hampered by a lack of data, analysis and guidance. This well-reasoned source book highlights the magnitude of the contribution of self-supply to urban and rural water provision world-wide, and the gains that are possible when governments recognise and support household-led supply development and up-grading. With limited public finances in low- (and many middle-) income countries, self-supply can fill gaps in public provision, especially amongst low-density rural populations. The book focuses on sub-Saharan Africa as the region with the greatest predicted shortfall in achieving the 2030 Sustainable Development Goal for water. Household supplies can be created, or accelerated to basic or safely managed levels, through approaches that build on the investment and actions of families, with the availability of technology options and cost-effective support from the private and public sectors. The role of self-supply needs greater recognition and a change in mindset of governments, development partners and practitioners if water services are to be extended to all and no-one is to be left behind.

Introduction

ESC CardioMed ◽  
2018 ◽  
pp. 1185-1186
Author(s):  
Nombulelo P. Magula ◽  
Akira Singh
Keyword(s):  
Black Women ◽  
Hiv Infection ◽  
The United States ◽  
Sub Saharan Africa ◽  
Middle Income ◽  
High Burden ◽  
Immunodeficiency Virus ◽  
Widespread Availability ◽  
Sub Saharan ◽  
Young Black Women

Life expectancy has increased significantly with the widespread availability of antiretroviral therapy. Despite this, new human immunodeficiency virus (HIV) infection rates in low- to middle-income, high-burden countries remain a cause for concern. The greatest impact of infection remains in sub-Saharan Africa, among young black women. However, the majority of studies investigating cardiovascular disease associated with HIV infection have been conducted in the United States and Europe, in predominantly male cohorts.

P1586Research network in Africa (RNA): antihypertensive drugs strategies in 12 African countries

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Kane ◽  
P Cavagna ◽  
I B Diop ◽  
B Gaye ◽  
J B Mipinda ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Low Income ◽  
Democratic Republic ◽  
Antihypertensive Drugs ◽  
Sub Saharan Africa ◽  
Low Income Countries ◽  
African Countries ◽  
Middle Income ◽  
Middle Income Countries ◽  
Sub Saharan

Abstract Background High Blood Pressure is the worldwide leading global burden of disease risk factor. In Sub-Saharan Africa, the number of adults with raised blood pressure has alarmingly increased from 0.59 to 1.13 billion between 1975 and 2015. Blood pressure-lowering medicines are cornerstone of cardiovascular risk reduction. Data on management of anti-hypertensive drugs in sub-Saharan Africa are squarce. Purpose Our study aims to describe antihypertensive drugs strategies in Africa. Methods We conducted a cross-sectional survey in urban clinics during outpatient consultation specialized in hypertension cardiology departments of 29 medical centers from 17 cities across 12 African countries (Benin, Cameroon, Congo, Democratic Republic of Congo, Gabon, Guinea, Ivory Coast, Mauritania, Mozambic, Niger, Senegal, Togo). Data were collected on demographics, treatment and standardized BP measures were made among the hypertensive patients attending the clinics. Country income was retrieved from the World Bank database. All analyses were performed through scripts developed in the R software (3.4.1 (2017–06–30)). Results A total of 2198 hypertensive patients (58.4±11.8 years; 39.9% male) were included. Among whom 2123 (96.6%) had at least one antihypertensive drug. Overall, 30.8% (n=653) received monotherapy and calcium-channel blockers (49.6%) were the most common monotherapy prescribed follow by diuretics (18.7%). Two-drug strategies were prescribed for 927 patients (43.6%). Diuretics and Angiotensin-converting enzyme inhibitors was the combination most frequently prescribed (33.7%). Combination of three drugs or more was used in 25.6% (n=543) of patients. The proportion of drugs strategies differed significantly according to countries (p<0.001), monotherapy ranged from 12.7% in Niger to 47.1% in Democratic Republic of the Congo (figure). Furthermore we observed a significantly difference of strategies between low and middle income countries (55.3% and 44.7% of monotherapy respectively) (p<0.001). According to hypertension grades 1, 2 and 3, the proportion of three-drugs or more combination was 25%, 28% and 34% in middle-income and lower in low-income countries (18%, 19% and 25%). Furthermore, Grade 3 hypertension in low income countries was still treated with monotherapy (36%) instead of 19% in middle income countries (p<0.01). Antihypertensive strategies by country Conclusion Our study described antihypertensive drugs use across 12 sub-Saharan countries, and identified disparities specific to the income context. Inequity in access to drugs combination is a serious barrier to tackle the burden of hypertension in Africa.

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