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Strategies for the prevention, diagnosis and treatment of COPD in low- and middle- income countries: the importance of primary care

Rossaki FM, Hurst JR, van Gemert F, Kirenga BJ, Williams S, Khoo EM, et al.

Expert Rev Respir Med, 2021 12;15(12):1563-1577.
PMID: 34595990 DOI: 10.1080/17476348.2021.1985762

INTRODUCTION: Low- and middle-income countries (LMICs) bear a high proportion of the global morbidity and mortality caused by COPD. Increased exposure to risk factors throughout life (e.g. malnutrition, indoor and outdoor air pollution, and smoking) is associated with higher COPD prevalence in LMICs and the lack of treatment availability increases avoidable harm.
AREAS COVERED: This review covers the epidemiology and burden of COPD in LMICs, and challenges and recommendations related to health-care systems, prevention, diagnosis, and treatment. Main challenges are related to under-resourced health-care systems (such as limited availability of spirometry, rehabilitation, and medicines). Lack of policy and practical local guidelines on COPD diagnosis and management further contribute to the low diagnostic and treatment rates. In the absence of, or limited number of respiratory specialists, primary care practitioners (general practitioners, nurses, pharmacists, physiotherapists, and community health workers) play an even more pivotal role in COPD management in LMICs.
EXPERT OPINION: Raising awareness on COPD, educating health-care workers, patients, and communities on cost-effective preventive measures as well as improving availability, affordability and proper use of diagnostic and pharmacological and non-pharmacologic treatment in primary care are the key interventions needed to improve COPD prevention, diagnosis, and care in LMICs.

Matched MeSH terms: Poverty
Fulltext Disparities in Prevalence and Barriers to Hypertension Control: A Systematic Review

Elnaem MH, Mosaad M, Abdelaziz DH, Mansour NO, Usman A, Elrggal ME, et al.

Int J Environ Res Public Health, 2022 Nov 06;19(21).
PMID: 36361453 DOI: 10.3390/ijerph192114571

Controlling hypertension (HTN) remains a challenge, as it is affected by various factors in different settings. This study aimed to describe the disparities in the prevalence and barriers to hypertension control across countries of various income categories. Three scholarly databases-ScienceDirect, PubMed, and Google Scholar-were systematically examined using predefined search terms to identify potentially relevant studies. Original research articles published in English between 2011 and 2022 that reported the prevalence and barriers to HTN control were included. A total of 33 studies were included in this systematic review. Twenty-three studies were conducted in low and middle-income countries (LMIC), and ten studies were from high-income countries (HIC). The prevalence of hypertension control in the LMIC and HIC studies ranged from (3.8% to 50.4%) to (36.3% to 69.6%), respectively. Concerning barriers to hypertension control, patient-related barriers were the most frequently reported (n = 20), followed by medication adherence barriers (n = 10), lifestyle-related barriers (n = 8), barriers related to the affordability and accessibility of care (n = 8), awareness-related barriers (n = 7), and, finally, barriers related to prescribed pharmacotherapy (n = 6). A combination of more than one category of barriers was frequently encountered, with 59 barriers reported overall across the 33 studies. This work reported disparities in hypertension control and barriers across studies conducted in LMIC and HIC. Recognizing the multifactorial nature of the barriers to hypertension control, particularly in LMIC, is crucial in designing and implementing customized interventions.

Matched MeSH terms: Poverty
Fulltext Cost of Illness Analysis of Type 2 Diabetes Mellitus: The Findings from a Lower-Middle Income Country

Butt MD, Ong SC, Wahab MU, Rasool MF, Saleem F, Hashmi A, et al.

Int J Environ Res Public Health, 2022 Oct 02;19(19).
PMID: 36231911 DOI: 10.3390/ijerph191912611

BACKGROUND: Diabetes is a major chronic illness that negatively influences individuals and society. Therefore, this research aimed to analyze and evaluate the cost associated with diabetes management, specific to the Pakistani Type 2 diabetes population. Research scheme and methods: A survey randomly collected information and data from diabetes patients throughout Pakistan out-patient clinics. Direct and indirect costs were evaluated, and data were analyzed with descriptive and inferential statistics.
RESULTS: An overall of 1839 diabetes patients participated in the study. The results have shown that direct and indirect costs are positively associated with the participants' socio-demographic characteristics, except for household income and educational status. The annual total cost of diabetes care was USD 740.1, amongst which the share of the direct cost was USD 646.7, and the indirect cost was USD 93.65. Most direct costs comprised medicine (USD 274.5) and hospitalization (USD 319.7). In contrast, the productivity loss of the patients had the highest contribution to the indirect cost (USD 81.36).
CONCLUSION: This study showed that direct costs significantly contributed to diabetes's overall cost in Pakistan and overall diabetes management estimated to be 1.67% (USD 24.42 billion) of the country's total gross domestic product. The expense of medications and hospitalization mostly drove the direct cost. Additionally, patients' loss of productivity contributed significantly to the indirect cost. It is high time for healthcare policymakers to address this huge healthcare burden. It is time to develop a thorough diabetes management plan to be implemented nationwide.

Matched MeSH terms: Poverty
Stochastic convergence in carbon emissions based on a new Fourier-based wavelet unit root test

Erdogan S, Solarin SA

Environ Sci Pollut Res Int, 2021 May;28(17):21887-21899.
PMID: 33410083 DOI: 10.1007/s11356-020-12033-y

Most of the existing studies on stochastic convergence of emission have not adequately considered smooth structural changes. The primary purpose of this paper is to examine the validity of stochastic convergence at different income levels by recently proposed Fourier-based wavelet augmented Dickey-Fuller test with smooth shifts. Empirical results can be summed up as follows: (i) carbon emission per capita follows the stationarity process in 35 high-income countries, while carbon emission per capita follows the stationarity process in 27 upper-middle-income countries; (ii) besides, carbon emission per capita follows stationarity process in 30 lower-middle-income countries, while carbon emission per capita follows stationarity process in 13 low-income countries; (iii) in light of these findings, it can be said that stochastic convergence among different income groups is valid. The implications of the empirical findings for environmental planning and management are discussed in the body of the paper.

Matched MeSH terms: Poverty
The control of corruption and energy efficiency relationship: an empirical note

Ozturk I, Al-Mulali U, Solarin SA

Environ Sci Pollut Res Int, 2019 Jun;26(17):17277-17283.
PMID: 31012074 DOI: 10.1007/s11356-019-05016-1

This study aims at exploring the impact of corruption control on energy efficiency in 60 countries categorized by income: lower middle (LMI), upper middle (UMI), and high (HI). Panel methodology was utilized taking the period of 2000-2017. As cross-sectional dependence is confirmed among the tested equations, the Pesaran (J Appl Econ 22(2):265-312, 2007) unit root test and the augmented mean group estimator proposed by Eberhardt and Teal (2010) were utilized to overcome this matter. The results in general indicate that the lower the corruption is, the more the energy efficiency for all income group economies. Moreover, renewable energy reduces energy efficiency in lower-middle income and high-income economies while its effect is positive in middle-income economies. In addition, the environmental Kuznets curve (EKC) found to be present in all income group economies. Lastly, causality relationships among energy efficiency, corruption, and GDP were present mostly in upper-middle income and high-income economies. From the results, it was recommended that the countries from all income groups should increase their corruption control for the purpose of enhancing energy efficiency.

Matched MeSH terms: Poverty
Effects of energy consumption, economic growth, and financial development on carbon emissions: evidence from heterogeneous income groups

Ehigiamusoe KU, Lean HH

Environ Sci Pollut Res Int, 2019 Aug;26(22):22611-22624.
PMID: 31165972 DOI: 10.1007/s11356-019-05309-5

This paper examines the effects of energy consumption, economic growth, and financial development on carbon emissions in a panel of 122 countries. We employ both first-generation and second-generation cointegration and estimation procedures in order to address diverse economic and econometric issues such as heterogeneity, endogeneity, and cross-sectional dependence. We find a cointegration relationship between the variables. Energy consumption, economic growth, and financial development have detrimental effects on carbon emissions in the full sample. When the sample is split into different income groups, we reveal that economic growth and financial development mitigate carbon emissions in high-income group but have the opposite effects in low-income and middle-income groups. The implication of the findings is that energy consumption increases carbon emissions. While high levels of income and financial development decrease carbon emissions, low levels of income and financial development intensify it. Based on the findings, the paper makes some policy recommendations.

Matched MeSH terms: Poverty
Fulltext Developing an agenda for the decolonization of global health

McCoy D, Kapilashrami A, Kumar R, Rhule E, Khosla R

Bull World Health Organ, 2024 Feb 01;102(2):130-136.
PMID: 38313156 DOI: 10.2471/BLT.23.289949

Colonialism, which involves the systemic domination of lands, markets, peoples, assets, cultures or political institutions to exploit, misappropriate and extract wealth and resources, affects health in many ways. In recent years, interest has grown in the decolonization of global health with a focus on correcting power imbalances between high-income and low-income countries and on challenging ideas and values of some wealthy countries that shape the practice of global health. We argue that decolonization of global health must also address the relationship between global health actors and contemporary forms of colonialism, in particular the current forms of corporate and financialized colonialism that operate through globalized systems of wealth extraction and profiteering. We present a three-part agenda for action that can be taken to decolonize global health. The first part relates to the power asymmetries that exist between global health actors from high-income and historically privileged countries and their counterparts in low-income and marginalized settings. The second part concerns the colonization of the structures and systems of global health governance itself. The third part addresses how colonialism occurs through the global health system. Addressing all forms of colonialism calls for a political and economic anticolonialism as well as social decolonization aimed at ensuring greater national, racial, cultural and knowledge diversity within the structures of global health.

Matched MeSH terms: Poverty
Fulltext Digital tools for direct assessment of autism risk during early childhood: A systematic review

Mukherjee D, Bhavnani S, Lockwood Estrin G, Rao V, Dasgupta J, Irfan H, et al.

Autism, 2024 Jan;28(1):6-31.
PMID: 36336996 DOI: 10.1177/13623613221133176

The challenge of finding autistic children, and finding them early enough to make a difference for them and their families, becomes all the greater in parts of the world where human and material resources are in short supply. Poverty of resources delays interventions, translating into a poverty of outcomes. Digital tools carry potential to lessen this delay because they can be administered by non-specialists in children's homes, schools or other everyday environments, they can measure a wide range of autistic behaviours objectively and they can automate analysis without requiring an expert in computers or statistics. This literature review aimed to identify and describe digital tools for screening children who may be at risk for autism. These tools are predominantly at the 'proof-of-concept' stage. Both portable (laptops, mobile phones, smart toys) and fixed (desktop computers, virtual-reality platforms) technologies are used to present computerised games, or to record children's behaviours or speech. Computerised analysis of children's interactions with these technologies differentiates children with and without autism, with promising results. Tasks assessing social responses and hand and body movements are the most reliable in distinguishing autistic from typically developing children. Such digital tools hold immense potential for early identification of autism spectrum disorder risk at a large scale. Next steps should be to further validate these tools and to evaluate their applicability in a variety of settings. Crucially, stakeholders from underserved communities globally must be involved in this research, lest it fail to capture the issues that these stakeholders are facing.

Matched MeSH terms: Poverty
Fulltext Globalization and economic growth: empirical evidence on the role of complementarities

Samimi P, Jenatabadi HS

PLoS One, 2014;9(4):e87824.
PMID: 24721896 DOI: 10.1371/journal.pone.0087824

This study was carried out to investigate the effect of economic globalization on economic growth in OIC countries. Furthermore, the study examined the effect of complementary policies on the growth effect of globalization. It also investigated whether the growth effect of globalization depends on the income level of countries. Utilizing the generalized method of moments (GMM) estimator within the framework of a dynamic panel data approach, we provide evidence which suggests that economic globalization has statistically significant impact on economic growth in OIC countries. The results indicate that this positive effect is increased in the countries with better-educated workers and well-developed financial systems. Our finding shows that the effect of economic globalization also depends on the country's level of income. High and middle-income countries benefit from globalization whereas low-income countries do not gain from it. In fact, the countries should receive the appropriate income level to be benefited from globalization. Economic globalization not only directly promotes growth but also indirectly does so via complementary reforms.

Matched MeSH terms: Poverty/economics
Fulltext Poverty and health development

Yadav H

Med J Malaysia, 2007 Oct;62(4):278-81.
PMID: 18551928 MyJurnal
Matched MeSH terms: Poverty/prevention & control*
Poverty within watershed and environmentally protected areas: the case of the indigenous community in Peninsular Malaysia

Kari FB, Masud MM, Yahaya SR, Saifullah MK

Environ Monit Assess, 2016 Mar;188(3):173.
PMID: 26887312 DOI: 10.1007/s10661-016-5162-1

"Indigenous people" have been acknowledged as among the poorest and most socio-economically and culturally marginalized all over the world. This paper explores the socio-economic status of the indigenous people and their poverty profile within watershed and environmentally protected areas in Peninsular Malaysia. The findings of the study indicate that the "indigenous community" is likely to be poor if they live in environmentally sensitive and unprotected areas as compared to families under the new resettlement scheme. Inadequate access to basic education and employment contributed significantly to their poor economic status. The findings further reveal that the indigenous community is facing difficulties in receiving access and support in terms of basic needs such as housing, education, economic livelihood, and other social infrastructure. Moreover, the regulatory structure for the management of watershed areas as well as the emphasis for commodity crops such as palm oil and natural rubber have indirectly contributed toward the poverty level of the indigenous people.

Matched MeSH terms: Poverty*
Fulltext Prevalence of childhood asthma and allergy in an inner city Malaysian community: intra-observer reliability of two translated international questionnaires

Norzila MZ, Haifa AL, Deng CT, Azizi BHO

Med J Malaysia, 2000 Mar;55(1):33-9.
PMID: 11072488 MyJurnal

Objectives: (a) To examine the intra-observer reliability of the Malay language versions of two international respiratory questionnaires i.e. the International Study of Asthma and Allergy in Children (ISAAC) and the American Thoracic Society (ATS) questionnaires, and (b) using the more reliable of these questionnaires, to estimate the prevalence of asthma and allergy related symptoms in an ethnically homogenous inner city community in Kuala Lumpur.
Methods: The study was conducted among 7 to 12 year old school children of Malay ethnic origin living in an inner city area of Kuala Lumpur. The sample consisted of 787 children attending the only primary school in the area. The Malay versions of both questionnaires were administered twice, one month apart, and were completed by parents. Agreement between the first and second responses to the same questions were assessed by Cohen’s kappa. Kappa values <0.4 were indicative of poor intra-observer reliability, 0.4-0.59 moderate reliability, 0.6-0.79 good reliability and >0.79 excellent reliability.
Results: 77.9% and 36.3% of parents responded to the first and second administrations of the questionnaires respectively. Kappa values of >0.4 were obtained in 15/16 (93.8%) and 17/27 (63.0%) questions of the ISAAC and ATS questionnaires respectively. Excellent kappa values were obtained in 4/16 (25%) questions of the ISAAC questionnaire versus only 1/27 (3.7%) questions of the ATS questionnaire. From the ISAAC questionnaire, all questions on wheeze had good reliability while those on asthma had excellent reliability. Questions on allergic symptoms had poor to moderate reliability. In contrast, from the ATS questionnaire, questions on wheeze had moderate reliability while questions on asthma were excellent reliable. Questions on allergic symptoms had moderate to good reliability while those on cough, phlegm and bronchitis had poor reliability.
According to the ISAAC questionnaire the prevalence of ever wheeze, wheeze in the last 12 months, ever asthma and wheeze with exercise in the last 12 months was 12.5%, 6.6%, 10.3% and 5.9% respectively. The prevalence of ever sneeze or runny nose, sneeze or runny nose in the last 12 months, watery eyes in the last 12 months and ever eczema was 15.2%, 11.1%, 4.4% and 8,5% respectively.
Conclusions: The translated ISAAC questionnaire was more reliable than the translated ATS questionnaire. Asthma and related symptoms were common among Malay school children in inner city Kuala Lumpur.

Matched MeSH terms: Poverty Areas*
Rural poverty and development in West Malaysia

Peacock F

J Dev Areas, 1981 Jul;15(4):639-54.
PMID: 12337651
Matched MeSH terms: Poverty*
A survey in Singapore of low income level housing in relation to health of infants

BROWNE EM

Med J Malaya, 1954 Mar;8(3):222-39.
PMID: 13164693
Matched MeSH terms: Poverty*
Fulltext Helminthiasis among primary rural school children in Bachok, Kelantan

Anees, A.H., Zulkifli, A., Azmi, A., Syukri, M.

Malaysian Journal of Public Health Medicine, 2003;3(2):19-22.
MyJurnal

A cross-sectional study on helminthiasis among rural primary schoolchildren aged 9 to 10 years Bachok, Kelaritan was perfumed. A total of 680 schoolchildren participated in the study. Stool specimens were examined for the presence of the ova of Ascaris lumbricoides, Trichuris trichiura and hoolcwonn. The worm load was then measured using the modified Stoll`s volumetric dilution
technique. The overall prevalence of helminthiasis was 77 .2%. Trichuris trichiura were the commonest type of heminth noted - 66.8%, compared with Ascaris lumlrricoides (49.7%) and hookworm (1.8%). Mixed infections with Ascaris lumlyricoides and Trichuris trichiura was the commonest type of infection 249(41 .5%) . For Ascaris lumbncoides, 34.6% had mild and 5 I .3% had moderate worm load while for Trichurb trichiura, 66.5% had mild and 30.8 % had moderate worm load. Only 14.1% and 2.7% 4 of the schoolchildren had a heavy load of Ascaris lumlwicoides and Trichuris trichiura respectively. All the schookhildren with hookworm were only mildly infected. Targeted mass treatment for rural Mahysian schoolchildren is still essential, especially in areas where poverty and malnutrition are still prevalent.

Matched MeSH terms: Poverty; Poverty Areas
Intention and behavior towards green consumption among low-income households

Al Mamun A, Mohamad MR, Yaacob MRB, Mohiuddin M

J Environ Manage, 2018 Dec 01;227:73-86.
PMID: 30172161 DOI: 10.1016/j.jenvman.2018.08.061

In order to address the issues of climate change through wise management of resources and environmental conservation, this study examined the intention and behavior towards green consumption among low-income households. This study was a cross-sectional that relied on 380 low-income household respondents who lived in coastal areas of Peninsular Malaysia. The findings revealed a positive effect of eco-literacy and self-efficacy on attitude towards green products. Subsequently, the findings also ascertained a positive effect of attitude and perceived behavioral control on intention and consumption of green products. In addition, both scholars and policymakers can rely on these findings to increase the intention and behavior towards the consumption of green products in order to reduce the environmental vulnerability to the coastal communities. Therefore, responsible organizations should implement programs and policies that minimize the adverse effects of climate change through resource management and environmental conservation by promoting the use of green products among Malaysians.

Matched MeSH terms: Poverty*
Fulltext Do not neglect the indigenous peoples when reporting health and nutrition issues of the socio-economically disadvantaged populations in Malaysia

Khor GL, Shariff ZM

BMC Public Health, 2019 Dec 16;19(1):1685.
PMID: 31842826 DOI: 10.1186/s12889-019-8055-8

The purpose of this correspondence is to express our disappointment with the coverage of the BMC Public Health supplement: Vol 19 (4) titled "Health and Nutritional Issues Among Low Income Population in Malaysia", which neglected to include the fundamental health and nutrition issues that are adversely affecting the lives and livelihood of the indigenous peoples. The Supplement comprised 21 papers. Two of these papers included indigenous peoples as study subjects. These two papers addressed peripheral, albeit important health issues, namely visual impairment and quality of life, and not the persistent and rising health concerns impacting this population. We will provide evidence from research and reports to justify our critique that the Supplement missed the opportunity to spotlight on the serious extent of the health and nutritional deprivations of the indigenous peoples of Malaysia. As researchers of the indigenous peoples, we ought to lend our voice to the "silenced minority" by highlighting their plight in the media including scientific journals.

Matched MeSH terms: Poverty/statistics & numerical data*
Fulltext Income and obesity in an urban poor community: a cross-sectional study

Andoy-Galvan JA, Lugova H, Patil SS, Wong YH, Baloch GM, Suleiman A, et al.

F1000Res, 2020;9:160.
PMID: 32399203 DOI: 10.12688/f1000research.22236.1

Background: Recent studies have shown that higher income is associated with a higher risk for subsequent obesity in low- and middle-income countries, while in high-income countries there is a reversal of the association - higher-income individuals have a lower risk of obesity. The concept of being able to afford to overeat is no longer a predictor of obesity in developed countries. In Malaysia, a trend has been observed that the prevalence of obesity increases with an increase in income among the low-income (B40) group. This trend, however, was not further investigated. Therefore, this study was performed to investigate the association of income and other sociodemographic factors with obesity among residents within the B40 income group in an urban community. Methods: This cross-sectional study used a systematic sampling technique to recruit participants residing in a Program Perumahan Rakyat (PPR), Kuala Lumpur, Malaysia. The sociodemographic characteristics were investigated through face-to-face interviews. Weight and height were measured, and body mass index (BMI) was calculated and coded as underweight, normal, overweight and obese according to the cut-off points for the Asian population. A chi-squared test was used to compare the prevalence of obesity in this study with the national prevalence. A generalized linear model was introduced to identify BMI predictors. Results: Among the 341 participants, 25 (7.3%) were underweight, 94 (27.6%) had normal weight, 87 (25.5%) were overweight, and 135 (39.6%) were obese. The proportion of obese adults (45.8%) was significantly higher than the national prevalence of 30.6% (p<0.001). Among all the tested variables, only income was significantly associated with BMI (p=0.046). Conclusion: The proportion of obesity in this urban poor community was higher compared with the national average. BMI increased as the average monthly household income decreased.

Matched MeSH terms: Poverty*
Fulltext Social sciences research in neglected tropical diseases 1: the ongoing neglect in the neglected tropical diseases

Allotey P, Reidpath DD, Pokhrel S

Health Res Policy Syst, 2010 Oct 21;8:32.
PMID: 20961461 DOI: 10.1186/1478-4505-8-32

Centuries of scientific advances and developments in biomedical sciences have brought us a long way to understanding and managing disease processes, by reducing them to simplified cause-effect models. For most of the infectious diseases known today, we have the methods and technology to identify the causative agent, understand the mechanism by which pathology is induced and develop the treatment (drugs, vaccines, medical or surgical procedures) to cure, manage or control.Disease, however, occurs within a context of lives fraught with complexity. For any given infectious disease, who gets it, when, why, the duration, the severity, the outcome, the sequelae, are bound by a complex interplay of factors related as much to the individual as it is to the physical, social, cultural, political and economic environments. Furthermore each of these factors is in a dynamic state of change, evolving over time as they interact with each other. Simple solutions to infectious diseases are therefore rarely sustainable solutions. Sustainability would require the development of interdisciplinary sciences that allow us to acknowledge, understand and address these complexities as they occur, rather than rely solely on a form of science based on reducing the management of disease to simple paradigms.In this review we examine the current global health responses to the 'neglected' tropical diseases, which have been prioritised on the basis of an acknowledgment of the complexity of the poverty-disease cycle. However research and interventions for neglected tropical diseases, largely neglect the social and ecological contextual, factors that make these diseases persist in the target populations, continuing instead to focus on the simple biomedical interventions. We highlight the gaps in the approaches and explore the potential of enhanced interdisciplinary work in the development of long term solutions to disease control.

Matched MeSH terms: Poverty
Fulltext Data on the impact of socioeconomic status on academic achievement among students in Malaysian public universities

Sulaiman NFC, Akhir NHM, Hussain NE, Jamin RM, Ramli NH

Data Brief, 2020 Aug;31:106018.
PMID: 32728602 DOI: 10.1016/j.dib.2020.106018

This data article presents the impact of parents' socioeconomic status on undergraduate students' academic achievements at a Malaysian higher education institution. The eastern parts of Peninsular Malaysia are populated by low-income citizens compared to the national average. The survey was conducted in Universiti Malaysia Terengganu. The targeted population is final year social science students. The total size of the target population is 965 students. Using Krejcie and Morgan's sampling method, a sample size of 333 students was surveyed. A descriptive research design was adopted in this study. Data were obtained from stratified random sampling comprising a total of 333 respondents in Universiti Malaysia Terengganu from 14 states across Malaysia. The data were collected through a semi-structured questionnaire. Data analysis was carried out using tables and figures. The findings revealed that most of the students stated that a parent's socioeconomic status does not influence their academic achievement.

Matched MeSH terms: Poverty

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