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Cardiovascular diseases, principally ischemic heart disease (IHD), are the most important cause of death and disability in the majority of low- and lower-middle-income countries (LLMICs). In these countries, IHD mortality rates are significantly gre
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ater in individuals of a low socioeconomic status (SES).
Three important focus areas for decreasing IHD mortality among those of low SES in LLMICs are (1) acute coronary care; (2) cardiac rehabilitation and secondary prevention; and (3) primary prevention. Greater mortality in low SES patients with acute coronary syndrome is due to lack of awareness of symptoms in patients and primary care physicians, delay in reaching healthcare facilities, non-availability of thrombolysis and coronary revascularization, and the non-affordability of expensive medicines (statins, dual anti-platelets, renin-angiotensin system blockers). Facilities for rapid diagnosis and accessible and affordable long-term care at secondary and tertiary care hospitals for IHD care are needed. A strong focus on the social determinants of health (low education, poverty, working and living conditions), greater healthcare financing, and efficient primary care is required. The quality of primary prevention needs to be improved with initiatives to eliminate tobacco and trans-fats and to reduce the consumption of alcohol, refined carbohydrates, and salt along with the promotion of healthy foods and physical activity. Efficient primary care with a focus on management of blood pressure, lipids and diabetes is needed. Task sharing with community health workers, electronic decision support systems, and use of fixed-dose combinations of blood pressure-lowering drugs and statins can substantially reduce risk factors and potentially lead to large reductions in IHD. Finally, training of physicians, nurses, and health workers in IHD prevention should be strengthened.
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The incidence of circulatory disorders is increasing worldwide, affecting both low- and middle-income countries and some high-income countries. There is evidence of rising incidence and prevalence r
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ates, even among younger individuals, along with an increasing prevalence of risk factors such as high blood pressure, diabetes, and obesity. These indicators suggest that current approaches are not
effective in managing and reducing the burden of conditions affecting circulatory health.
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Global burden of cardiovascular diseases and risks, 1990-2022
Mensah, G.A.; Fuster, V.; Murray, C.J.L. et al.
Journal of the American College of Cardiology
(2023)
CC
Age-standardized cardiovascular disease (CVD) mortality rates by region ranged from 73.6 per 100,000 in High-income Asia Pacific to 432.3 per 100,000 in Eastern Europe in 2022. Global CVD mortality decreased by 34.9% from 1990 to 2022. Ischemic hear
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t disease had the highest global age-standardized DALYs of all diseases at 2,275.9 per 100,000. Intracerebral hemorrhage and ischemic stroke were the next highest CVD causes for age-standardized DALYs. Age-standardized CVD prevalence ranged from 5,881.0 per 100,000 in South Asia to 11,342.6 per 100,000 in Central Asia. High systolic blood pressure accounted for the largest number of attributable age-standardized CVD DALYs at 2,564.9 per 100,000 globally. Of all risks, household air pollution from solid fuels had the largest change in attributable age-standardized DALYs from 1990 to 2022 with a 65.1% decrease.
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Non- Communicable Diseases (NCDs) over the years have not been given much attention in Ghana and in most Low and Middle- Income Countries (LMICs). The overwhelming burden of communicable diseases and the scarcity of resources has led to the health o
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f all residents in Ghana, NCDs still remain largely underfunded and less prioritized. Attempts in the past have achieved little success. The formulation of Ghana´s NCD policy in 2014 and the accompanying strategic plan is one such effort.
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Background
Asthma remains highly prevalent, with more severe symptoms in low-income to middle-income countries (LMICs) compared with high-income
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countries. Identifying risk factors for severe asthma symptoms can assist with improving outcomes. We aimed to determine the prevalence, severity and risk factors for asthma in adolescents in an LMIC.
Methods
A cross-sectional survey using the Global Asthma Network written and video questionnaires was conducted in adolescents aged 13 and 14 from randomly selected schools in Durban, South Africa, between May 2019 and June 2021.
Results
A total of 3957 adolescents (51.9% female) were included. The prevalence of lifetime, current and severe asthma was 24.6%, 13.7% and 9.1%, respectively. Of those with current and severe asthma symptoms; 38.9% (n=211/543) and 40.7% (n=147/361) had doctor-diagnosed asthma; of these, 72.0% (n=152/211) and 70.7% (n=104/147), respectively, reported using inhaled medication in the last 12 months. Short-acting beta agonists (80.4%) were more commonly used than inhaled corticosteroids (13.7%). Severe asthma was associated with: fee-paying school quintile (adjusted OR (CI)): 1.78 (1.27 to 2.48), overweight (1.60 (1.15 to 2.22)), exposure to traffic pollution (1.42 (1.11 to 1.82)), tobacco smoking (2.06 (1.15 to 3.68)), rhinoconjunctivitis (3.62 (2.80 to 4.67)) and eczema (2.24 (1.59 to 3.14)), all p<0.01.
Conclusion
Asthma prevalence in this population (13.7%) is higher than the global average (10.4%). Although common, severe asthma symptoms are underdiagnosed and associated with atopy, environmental and lifestyle factors. Equitable access to affordable essential controller inhaled medicines addressing the disproportionate burden of asthma is needed in this setting.
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Asthma is the commonest chronic respiratory tract disease in children. In low-income countries, challenges exist in asthma diagnosis. In surveys done in children, the prevalence of ‘asthma’ defined by symptoms is high compared to ‘doctor diagn
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osed asthma’. The questions answered by this review are What challenges have been experienced in the diagnosis of asthma in children? What solutions will address these challenges?
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Over 90% of the morbidity and mortality related to chronic obstructive pulmonary disease (COPD) and asthma occurs in low-income and middle-income countries (LMICs) due to well documented factors inc
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luding decreased access to screening, trained health professionals, and therapies for disease management. Inhaler therapy (eg, aerosolised medications by inhalation, nebulisation, or propellant) is the mainstay of treatment for COPD and asthma. Adherence to maintenance medications for COPD and asthma results in improved lung function and quality of life, as well as decreased hospitalisation and mortality. WHO have included short-acting beta-agonists, long-acting muscarinic antagonists, and inhaled corticosteroids on the essential medications list, with a target goal of achieving 80% availability of these medications in public and private facilities. However, despite these efforts, accessibility, and affordability of medications for COPD and asthma remains scarce.
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Technical Brief Workforce Development
recommended
The World Health Organization (WHO) projects a global shortfall of 18 million health workers by 2030, mostly in low- and lower-middle-income countries. Contributing to the global deficit are chronic under-investment in education and training of heal
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th workers; workforce migration; an aging health workforce; rapid increases in chronic diseases; and inability to track existing human resources using health information systems. Health care worker shortages are compounded by the increased portability and virulence of infections. Rapid population growth, climate change, deforestation, international travel, migration, poverty, and social inequality have dramatically increased the risk of pandemics and highlighted the need for skilled health workforce to effectively respond to emerging health threats. This is evident now more than ever as COVID-19 exacerbates health inequity and barriers to access, and further strains the already fragile health systems in many countries.
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Development assistance for health (DAH)
plays a vital role in supporting health programmes in lowand middle-income countries. While DAH has historically
focused on infectious diseases and maternal and child
health, there is a lack of comprehensiv
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e analysis of DAH
trends, strategic shifts and their impact on health systems
and outcomes. This study aims to provide a comprehensive
review of DAH from 1990 to 2022, examining its evolution
and funding allocation shifts.
more
In an effort to improve the capabilities and accountability of humanitarian and economic practitioners, the SEEP (Small Enterprise Education and Promotion) Network's Minimum Economic Recovery Standards focus on minimum industry standards for facilitating economic recovery in crisis situations.
Th
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e handbook sets out strategies and interventions designed to improve income, cash flow, asset management, and growth among crisis-affected households and enterprises. These include financial services, productive assets, employment, and enterprise development. It emphasizes encouraging the re-start of enterprises and livelihoods strategies, and improving market productivity and governance
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Technologies for global health
Peter Howitt, Ara Darzi, Guang-Zhong Yang, et al.
The Lancet Commission; The Imperial College
(2012)
Collaboration between The Lancet and Imperial College London, UK, has resulted in a new Commission, which examines how medical technology should best be used to improve health in low- and middle-income countries. The report concludes that in many ca
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ses, medical technology—almost exclusively developed in rich countries—is simply inappropriate for use in poorer nations
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Gender-based violence and child protection among Syrian refugees in Jordan, with a focus on early marriage
UNWomen
(2013)
Findings from this report reveal that, rates of early marriage are high, a significant percentage of children contribute to the household’s income or are its main source of income, and restriction
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s on the mobility of women and girls constrain their participation in social and economic activities and their access to basic services. As the overwhelming majority of refugees do not have paid employment and rely mainly on aid and dwindling family resources, the more the situation of displacement is prolonged the greater the likelihood of higher rates of child labour for boys and early marriage for girls.
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This report addresses the impact of emergency shelter programs in the development of post-relief economies and in building incomes of affected populations. It provides a review and analysis of the available literature relevant to understanding the economic impact of emergency shelter programs, addit
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ional research conducted by CHF International on income development of beneficiaries of emergency shelter programs, and the first steps toward rigorous and accurate measurement of the impact of these programs on the incomes of beneficiaries. Each of these analysis provides information useful to future programmers of relief assistance.
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The primary audience for the guideline is health programme managers, including governmental and non-governmental organizations, and policy makers who are responsible for designing maternal, newborn and child health programmes, primarily in low-income
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settings. The guideline is also aimed at health providers and teaching institutions, to increase knowledge of interventions. Development programmes and organizations supporting women’s empowerment and rights will also find this guideline of use.
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This website provides practical tools and advice for programme planners and policy makers to run inclusive social protection programmes, especially in low and middle income countries. It draws on the findings of a study conducted in 2014 in Peru and
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Tanzania by the London School of Hygiene and Tropical Medicine and the Technische Universität München, together with the national partners, SODIS and CRONICAS in Peru, and REPOA in Tanzania
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This 277 page pocketbook is a summary of the emergency components of basic neonatal and older infants hospital care from our 900 page textbook “International Maternal & Childhealth Care. A practical manual for hospitals worldwide”.
If you work in a hospital in a low
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income country - providing free care - you are probably intitled to FREE copies of these books. MCAI will send them to you, all you have to do is to read our Flyer and fill in the request form.
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The report covers possible developments in Indonesia over the next 10 months (to end 2016). Four scenarios are outlined:
Delayed Second Crop Harvest
Delayed and Reduced Second Crop Harvest
La Niña disrupts main rural sources of income
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Soaring rice prices
The scenarios were developed during a two-day workshop in Jakarta, Indonesia involving 21 organisations. Scenarios are a description of situations that could occur; a set of informed assumptions about a development that may require humanitarian action to support strategic planning, create awareness, provide early warning and promote preparedness activities for those responding to the crisis.
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Climate change is damaging human health now and is projected to have a greater impact in the future. Low- and middle-income countries are seeing the worst effects as they are most vulnerable to climate shifts and least able to adapt given weak healt
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h systems and poor infrastructure. Low-carbon approach can provide effective, cheaper care while at the same time being climate smart. Low-carbon healthcare can advance institutional strategies toward low-carbon development and health-strengthening imperatives and inspire other development institutions and investors working in this space. Low-carbon healthcare provides an approach for designing, building, operating, and investing in health systems and facilities that generate minimal amounts of greenhouse gases. It puts health systems on a climate-smart development path, aligning health development and delivery with global climate goals. This approach saves money by reducing energy and resource costs. It can improve the quality of care in a diversity of settings. By prompting ministries of health to tackle climate change mitigation and foster low-carbon healthcare, the development community can help governments strengthen local capacity and support better community health.
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There is a substantial and ever-increasing unmet need for rehabilitation worldwide, which is particularly profound in low- and middle
-income countries. The availability of accessible and affordable rehabilitation is necessary for many people with
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health conditions to remain as independent as possible, to participate in education, to be economically productive, and fulfil meaningful life roles.
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Cancer is an emerging public health problem in sub-Saharan Africa due to population growth, ageing and westernisation of lifestyles. In this piece, we use data from Mozambique over a 50-year period to illustrate cancer epidemiological trends in low-income
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and middle-income countries to hypothesise potential circumstances and factors that could explain changes in cancer burden and to discuss surveillance weaknesses and potential improvements. This epidemiological transition deserves increasing policy attention.
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