Abstract: Before the COVID-19 pandemic, chronic noncommunicable diseases (NCDs), represented a high burden for low and middle-income countries. Patients with NCDs are at higher risk of COVID-19 and suffer worse clinical outcomes. We present mortality trends for myocardial infarction (AMI), stroke, hypertension (HT), and type-2 diabetes mellitus (T2DM) from 2005 to 2021 in Ecuador. The greatest increase in mortality observed in the pandemic was in AMI, T2DM, and HT. Factors related to COVID-19, health services, and patients with NCDs could contribute to these important increases in mortality. Published on 2023-04-05 10:11:29
Abstract: Objectives: Between the 1980s and 2000s, an epidemic of silicosis was identified in migrant black goldminers, many from neighbouring countries, on the South African gold mines. This studies aimed to use the newly available employment database of a large goldmining company to demonstrate how a sustained rise in employment duration in a new cohort of black migrant workers resulted from changes in recruitment policy, and the implications for current surveillance and redress of silicosis.Methods: Contract data of 300,774 workers from the employment database of a multi-mine goldmining company were analysed for 1973-2018. Piecewise logistic regression was applied to determine trends in cumulative employment, including South African versus cross-border miners. The proportions with cumulative employment >10, 15 or 20 years, typical thresholds for chronic silicosis, were also calculated.Results: Five calendar phases were identified between 1973 and 2018. During the second phase, 1985-2013, mean cumulative employment rose five-fold, from four to 20 years. Cumulative employment continued to rise, although more slowly, before peaking in 2014 and falling thereafter. Over most of the 1973-2018 period, cross-border miners had greater cumulative employment than South African miners. Overall, the proportion of miners exiting with >15 years, rose from 5% in 1988 to 75% in 2018. The record of changes in labour recruitment in the 1970s is consistent with the emergence of this epidemic, with no corresponding evidence of a sustained rise in dust concentrations.Conclusions: These new data support the hypothesis of a silicosis epidemic driven by increasing cumulative dust exposure in a new cohort of circular migrant workers from the 1970s. They inform current programmes to examine and compensate this neglected population for silicosis and related disease, while highlighting the lack of information on cumulative employment and silicosis among migrant miners in previous decades. The findings also have relevance to the plight of such migrant workers in hazardous occupations globally. Published on 2023-03-27 10:01:05
Abstract: Background: Physician-anthropologist Paul Farmer theorizes a process of “socialization for scarcity” (SfS), which assumes permanent and unchangeable resource scarcity for the world’s poor. International health and poverty decisions that are based off of this premise are therefore used to justify inadequate care for vulnerable populations.Objectives: The theory of SfS has predominantly been applied to the context of global health and development. This paper aims to apply SfS to the field of emergency management, asking, “How does SfS function in the context of humanitarian crises, and what implications does this have for emergency management'”Methods: This paper reviewed Farmer’s own descriptions of SfS as well as articles by colleagues and other scholars who elaborated on his theory, analyzing their contributions to issues relevant in emergency management.Findings: This review finds that SfS is both applicable to and amplified within emergency management because of the uncertain, competitive, and urgent nature of humanitarian crises. The paper then describes potential approaches to combating SfS in emergency contexts.Conclusions: SfS is the result of deficient effort toward discovering approaches to managing emergencies that do not presume scarcity. The assumption of permanent resource scarcity, especially in low- and middle-income countries (LMICs), is a matter of inequity and injustice and stands opposed to imperative systemic change. Emergency managers must work to eradicate dangerous presumptions that leave already suffering individuals even further from the dignified, appropriate and adequate care they require and deserve. Published on 2023-03-24 10:25:45
Abstract: Background: Plastics have conveyed great benefits to humanity and made possible some of the most significant advances of modern civilization in fields as diverse as medicine, electronics, aerospace, construction, food packaging, and sports. It is now clear, however, that plastics are also responsible for significant harms to human health, the economy, and the earth’s environment. These harms occur at every stage of the plastic life cycle, from extraction of the coal, oil, and gas that are its main feedstocks through to ultimate disposal into the environment. The extent of these harms not been systematically assessed, their magnitude not fully quantified, and their economic costs not comprehensively counted.Goals: The goals of this Minderoo-Monaco Commission on Plastics and Human Health are to comprehensively examine plastics’ impacts across their life cycle on: (1) human health and well-being; (2) the global environment, especially the ocean; (3) the economy; and (4) vulnerable populations—the poor, minorities, and the world’s children. On the basis of this examination, the Commission offers science-based recommendations designed to support development of a Global Plastics Treaty, protect human health, and save lives.Report Structure: This Commission report contains seven Sections. Following an Introduction, Section 2 presents a narrative review of the processes involved in plastic production, use, and disposal and notes the hazards to human health and the environment associated with each of these stages. Section 3 describes plastics’ impacts on the ocean and notes the potential for plastic in the ocean to enter the marine food web and result in human exposure. Section 4 details plastics’ impacts on human health. Section 5 presents a first-order estimate of plastics’ health-related economic costs. Section 6 examines the intersection between plastic, social inequity, and environmental injustice. Section 7 presents the Commission’s findings and recommendations.Plastics: Plastics are complex, highly heterogeneous, synthetic chemical materials. Over 98% of plastics are produced from fossil carbon- coal, oil and gas. Plastics are comprised of a carbon-based polymer backbone and thousands of additional chemicals that are incorporated into polymers to convey specific properties such as color, flexibility, stability, water repellence, flame retardation, and ultraviolet resistance. Many of these added chemicals are highly toxic. They include carcinogens, neurotoxicants and endocrine disruptors such as phthalates, bisphenols, per- and poly-fluoroalkyl substances (PFAS), brominated flame retardants, and organophosphate flame retardants. They are integral components of plastic and are responsible for many of plastics’ harms to human health and the environment.Global plastic production has increased almost exponentially since World War II, and in this time more than 8,300 megatons (Mt) of plastic have been manufactured. Annual production volume has grown from under 2 Mt in 1950 to 460 Mt in 2019, a 230-fold increase, and is on track to triple by 2060. More than half of all plastic ever made has been produced since 2002. Single-use plastics account for 35–40% of current plastic production and represent the most rapidly growing segment of plastic manufacture.Explosive recent growth in plastics production reflects a deliberate pivot by the integrated multinational fossil-carbon corporations that produce coal, oil and gas and that also manufacture plastics. These corporations are reducing their production of fossil fuels and increasing plastics manufacture. The two principal factors responsible for this pivot are decreasing global demand for carbon-based fuels due to increases in ‘green’ energy, and massive expansion of oil and gas production due to fracking.Plastic manufacture is energy-intensive and contributes significantly to climate change. At present, plastic production is responsible for an estimated 3.7% of global greenhouse gas emissions, more than the contribution of Brazil. This fraction is projected to increase to 4.5% by 2060 if current trends continue unchecked.Plastic Life Cycle: The plastic life cycle has three phases: production, use, and disposal. In production, carbon feedstocks—coal, gas, and oil—are transformed through energy-intensive, catalytic processes into a vast array of products. Plastic use occurs in every aspect of modern life and results in widespread human exposure to the chemicals contained in plastic. Single-use plastics constitute the largest portion of current use, followed by synthetic fibers and construction.Plastic disposal is highly inefficient, with recovery and recycling rates below 10% globally. The result is that an estimated 22 Mt of plastic waste enters the environment each year, much of it single-use plastic and are added to the more than 6 gigatons of plastic waste that have accumulated since 1950. Strategies for disposal of plastic waste include controlled and uncontrolled landfilling, open burning, thermal conversion, and export. Vast quantities of plastic waste are exported each year from high-income to low-income countries, where it accumulates in landfills, pollutes air and water, degrades vital ecosystems, befouls beaches and estuaries, and harms human health—environmental injustice on a global scale. Plastic-laden e-waste is particularly problematic.Environmental Findings: Plastics and plastic-associated chemicals are responsible for widespread pollution. They contaminate aquatic (marine and freshwater), terrestrial, and atmospheric environments globally. The ocean is the ultimate destination for much plastic, and plastics are found throughout the ocean, including coastal regions, the sea surface, the deep sea, and polar sea ice. Many plastics appe...
Abstract: Background: Family planning averts unintended pregnancies, unsafe abortions, and maternal deaths, while improving child health and socio-economic progress, but an estimated 218 million women and girls in low- and middle-income countries, especially in sub-Saharan Africa, have an unmet need for modern family planning. Faith leaders can impact the demand and uptake of family planning. However, there is limited understanding of the mechanisms for effective family planning advocacy by faith leaders. Channels of Hope (CoH) is World Vision’s process that engages faith leaders and faith communities to address health issues.Objectives: To determine the impact of CoH on promoting healthy timing and spacing of pregnancies and family planning (HTSP/FP) by mothers of children under two years old in select parts of Kenya and Ghana. To also determine faith leaders’ attitudes, perceptions, and potential roles in influencing HTSP/FP after exposure to CoH.Methods: A mixed methods operations research comprising quantitative (quasi-experimental design with surveys of 4,372 mothers of children under two years old) and qualitative arms (in-depth interviews of 17 faith leaders and their seven spouses) was implemented.Findings: Taking both countries together, male sterilization, female condom, and LAM were the only FP methods that did not show increases from baseline to endline. Methods with the highest knowledge increases between intervention areas and control areas were implants, injectables and pills, with 18.4, 12.1 and 11.2 percentage point increases, respectively. The faith leaders in both countries reported that their views on healthy timing and spacing of pregnancies changed due to the Channels of Hope workshops.Conclusion: The HTSP/FP model has potential for positive health and social transformation that is built on the trust of faith leaders. Ghana and Kenya provide great examples of possible scenarios in order to help prepare implementers to scale the learnings of this operations research across sub-Saharan Africa. Published on 2023-03-16 10:22:39
Abstract: Background: Surgical capacity is critical for ensuring optimum access to safe, affordable, and timely emergency and essential surgical care (EESC) in low- and middle-income countries (LMICs) like Ethiopia. A five-year strategic plan has been implemented during 2016–2020 in Ethiopia to improve surgical capacity.Objectives: This study aims to evaluate the impact of the five-year strategy in surgical capacity in the country.Methods: A cross sectional survey was conducted in 172 health care facilities in Ethiopia from December 30, 2020, to June 10, 2021. Descriptive statistical analysis was done using STATA statistical software Version 15.Findings: A total of 2,312 surgical workforces were available and, the surgical workforce to population ratio ranged from 1.13:100,000 for public specialized hospitals to 10.8:100,000 for health centre operation room (OR) blocks. Surgical bed to population ratio was 0.03:1000 population, and the average numbers of OR tables per facility were 34. Nearly 25% and 10% of OR tables were not functional in public primary hospitals and private hospitals, respectively. The average surgical volume to population ratio was 189:100,000.Conclusions: Following the implementation of surgical care strategy, the surgical workforce density has increased. However, the study revealed that there is still a huge unmet gap in surgical capacity. The improvement in surgical volume is very low compared to the increment in the surgical workforce density. In addition to the investment being made to build surgical capacity, emphasis needs to be put on surgical system design and strengthening surgical system efficiency. Published on 2023-03-09 09:54:25
Abstract: Background: There is growing concern about the sustainability and long-term impact of short-term medical missions (STMMs)—an increasingly common form of foreign medical aid—given that brief engagements do little to address the underlying poverty and fragmented healthcare system that plagues many low- and middle-income countries (LMICs). In the absence of formal evaluations, unintended but serious consequences for patients and local communities may arise, including a lack of continuity of patient care, poor alignment with community needs, and cultural and language barriers.Objective: We conducted semi-structured interviews with Honduran healthcare providers (n = 88) in 2015 to explore local providers’ perceptions of the impact and sustainability of foreign medical aid on patient needs, community health, and the country’s healthcare system.Methods: Respondents represented a random sample of Honduran healthcare providers (physicians, dentists, nurses) who worked for either a government-run rural clinic or non-governmental organization (NGO) in Honduras.Findings: Honduran healthcare providers largely framed foreign medical teams as being assets that help to advance community health through the provision of medical personnel and supplies. Nonetheless, most respondents identified strategies to improve implementation of STMMs and reduce negative impacts. Many respondents emphasized a need for culturally- and linguistically-tailored medical care and health education interventions. Participants also recommended strengthening local partnerships to mitigate the risk of dependence, including on-going training and support of community health workers to promote sustainable change.Conclusions: Guidelines informed by local Honduran expertise are needed to increase accountability for more robust training of foreign physicians in the provision of context-appropriate care. These findings provide valuable local perspectives from Honduran healthcare providers to improve the development and implementation of STMMs, informing strategies that can complement and strengthen healthcare systems in LMICs. Published on 2023-03-03 09:42:56
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