Gender differences in quality of life among community-dwelling older adults in low- and middle-income countries: results from the Study on global AGEing and adult health (SAGE)

Background Quality of life (QoL) is an important component of individuals’ general well-being, particularly in older adults. However, factors influencing QoL among older adults in low- and middle-income countries (LMICs) have not been fully examined. Furthermore, the role of gender differences in relation to QoL in multiple LMICs has also not been examined in detail. Methods This study used data from the World Health Organization’s Study on global AGEing and adult health (SAGE), Wave-1. Based on a literature review of existing works, a set of variables—an independent variable and covariates—were selected. The study sample consisted of 33,019 participants aged 50 years and above from China, Ghana, India, Russia, and South Africa. Multivariate linear regression models were estimated with the World Health Organization QoL scores as the dependent variable. To preserve the analytical sample size, multiple imputation was used to account for missing data. Results The results showed that generally, male older adults reported a better QoL than female older adults across all of the countries. The associations between QoL and sociodemographic factors, health-related factors, and social support factors among older adults differed according to country. Conclusions This study provides a better understanding of QoL among older adults in LMICs, which can help prepare LMICs to better address the QoL of older adults. The results of this study can be used to develop programs to promote better living standards and services to reduce gender disparities and ultimately, to improve the QoL among older adults in LMICs.ope

Comparison of Antiretroviral Therapy Adherence Among HIV-Infected Older Adults with Younger Adults in Africa: Systematic Review and Meta-analysis.

As access to antiretroviral treatment in low- and middle-income countries improves, the number of older adults (aged ≥ 50 years) living with HIV is increasing. This study compares the adherence to antiretroviral treatment among older adults to that of younger adults living in Africa. We searched PubMed, Medline, Cochrane CENTRAL, CINAHL, Google Scholar and EMBASE for keywords (HIV, ART, compliance, adherence, age, Africa) on publications from 1st Jan 2000 to 1st March 2016. Eligible studies were pooled for meta-analysis using a random-effects model, with the odds ratio as the primary outcome. Twenty studies were included, among them were five randomised trials and five cohort studies. Overall, we pooled data for 148,819 individuals in two groups (older and younger adults) and found no significant difference in adherence between them [odds ratio (OR) 1.01; 95% CI 0.94-1.09]. Subgroup analyses of studies using medication possession ratio and clinician counts to measure adherence revealed higher proportions of older adults were adherent to medication regimens compared with younger adults (OR 1.06; 95% CI 1.02-1.11). Antiretroviral treatment adherence levels among older and younger adults in Africa are comparable. Further research is required to identify specific barriers to adherence in the aging HIV affected population in Africa which will help in development of interventions to improve their clinical outcomes and quality of life

The epidemiology of frailty and its association with disability and quality of life among rural community-dwelling older adults in Kegalle district of Sri Lanka

Background and aim: Frailty is an important age related medical condition that predicts numerous adverse health outcomes. Many low-and middle-income countries (LMICs) are ageing rapidly but we know little about the epidemiology of frailty in these countries. This thesis describes the epidemiology of frailty and its association with disability and quality of life among rural community-dwelling older adults in Kegalle district of Sri Lanka. Methods: Part A) A systematic review and meta-analysis on prevalence of frailty and pre-frailty among community-dwelling older adults in LMICs. Part B) A population-based cross-sectional study conducted in 2016 to i) estimate the prevalence of frailty, ii) describe factors associated with frailty, and iii) evaluate the association of frailty with disability and quality of life among rural community-dwelling older adults in Kegalle district. A three stage probability sampling was used to recruit 746 older adults aged ≥60 years. Frailty was assessed using the Fried phenotype. Results: Part A) Limited evidence was found on the prevalence of frailty in low-income and lower middle-income countries. The random-effects pooled prevalence of frailty and pre-frailty in community-dwelling older adults in LMICs was 17.4% (95% CI: 14.4%, 20.7%) and 49.3% (95% CI: 46.4%, 52.2%) respectively. Part B) The prevalence of frailty and pre-frailty among rural community-dwelling older adults aged ≥60 years in Kegalle district of Sri Lanka was estimated as 15.2% (95% CI: 12.3%, 18.6%) and 48.5% (95% CI: 43.8%, 53.2%) respectively. The prevalence of limitations in instrumental activities of daily living (≥1 IADL) assessed with Lawton IADL scale was high (84.4%) in frail older adults. The prevalence of basic activities of daily living (≥1 BADL) assessed with Barthel index was 38.7% in frail older adults. Being frail lowered the odds of having no IADL limitations and was associated with a four times higher count of IADL limitations compared with non-frail counterparts. Frailty was associated with a small but significant lower quality of life in this rural Sri Lankan population. Conclusions: The prevalence of frailty appears higher in rural community-dwelling older adults in Sri Lanka compared with upper middle-income and high-income countries with a significant impact on IADL limitations but with lower than anticipated impact on BADL limitations and quality of life

Factors influencing poor medication adherence amongst patients with chronic disease in low-and-middle-income countries: a systematic scoping review

Background: Poor medication adherence among patients with Chronic Diseases is one of the significant health problems globally. Despite this, evidence on chronic medication adherence in low and middle-income countries is unclear. Objective: This scoping review aimed to identify factors influencing poor medication adherence amongst patients with chronic diseases in low and middle-income countries. Methods: We searched studies exploring factors influencing poor medication adherence amongst patients in low and middle-income countries across the following databases published between 2008 to 2018: Public or publisher Medline, Google scholar, Cumulated Index to Nursing and Allied Health Literature, Health Source, and Medline with full text via Elton B. Stephen's Company host. Methodological quality assessment of the primary studies was done as recommended by Levac, Colquhoun, and O'Brien (2010) review using a Mixed-Method Appraisal Tool 2018. We reported the results following the Preferred Reporting Item for Systematic reviews and Meta-Analyses extension for Scoping Review guidelines. Results: From the initial 154 records screened, we identified six (6) eligible studies that presented evidence on factors influencing poor medication adherence amongst patients in low and middle-income countries. Studies included were from the following countries: Jordan, South Africa, Guatemala, Ethiopia, Indonesia, India, and Palestine. Kappa agreement of the full article screening shows that there was 76.92% agreement versus 58.12% expected by chance which constitutes a considerably good agreement between screeners (Kappa statistic = 0.45 and p-value <0.05). Of the six included studies that underwent methodological quality, five scored 100%, which is regarded as the highest score the remaining one scored between 50–75%, indicating a moderate to low risk bias overall. All included studies presented evidence on medication adherence as being in either knowledge of the diseases, attitudes towards medication taking, beliefs that a patient holds about the treatment or disease, and quality control amongst chronic diseases patients. Conclusions: Our scoping review provides evidence that poor medication adherence in LMICs is influenced by a lack of knowledge, negative attitudes, and negative beliefs, leading to poor quality of life. There is limited research evidence on the effect of patients' beliefs and perceptions on medication adherence in low and middle-income countries. We call upon further research on beliefs, perceptions, and effectiveness of interventions towards chronic medication adherence in low and middle-income countries

Contextual factors influencing the urban mobility infrastructure interventions and policies for older adults in low- and middle-income countries: A realist review

Transportation is among the key aspects that influence active ageing. This realist review intends to understand the mechanisms of urban mobility infrastructure interventions and policies in low- and middle-income countries for older adults and to identify factors, which influenced the success or failure of interventions. We followed the steps suggested by Pawson and colleagues for a realist review. Electronic databases were searched from inception until August 2020. Studies were screened based on titles, abstracts and full text. The quality of included studies was assessed based on rigour and relevance. The evidence was obtained from 36 articles with diverse study designs conducted in 36 low- and middle-income countries. Findings were validated through stakeholder consultations from three low- and middle-income countries. Of the various individual factors identified, behaviour change communication interventions were low-cost, had a long-term impact and were efficient in increasing awareness among users to improve safety, social inclusion and about transport schemes for older adults. Improved transport infrastructure resulted in a shift from private to public transportation. For a sustainable urban transport infrastructure, good governance and involvement of stakeholders for planning and implementing transport interventions were considered necessary. Lack of evaluation, experience of transport planners, and inter-sectoral coordination were key challenges to successful interventions. The review highlighted a lack of older adult-specific transportation policies, and gender-targeted interventions for older women, suggesting a need for interventions and policies based on the contextual factors existing in a region

Factors influencing utilisation of maternal health services by adolescent mothers in Low-and middle-income countries: a systematic review

BACKGROUND: Adolescent mothers aged 15-19 years are known to have greater risks of maternal morbidity and mortality compared with women aged 20-24 years, mostly due to their unique biological, sociological and economic status. Nowhere Is the burden of disease greater than in low-and middle-income countries (LMICs). Understanding factors that influence adolescent utilisation of essential maternal health services (MHS) would be critical in improving their outcomes. METHODS: We systematically reviewed the literature for articles published until December 2015 to understand how adolescent MHS utilisation has been assessed in LMICs and factors affecting service utilisation by adolescent mothers. Following data extraction, we reported on the geographical distribution and characteristics of the included studies and used thematic summaries to summarise our key findings across three key themes: factors affecting MHS utilisation considered by researcher(s), factors assessed as statistically significant, and other findings on MHS utilisation. RESULTS: Our findings show that there has been minimal research in this study area. 14 studies, adjudged as medium to high quality met our inclusion criteria. Studies have been published in many LMICs, with the first published in 2006. Thirteen studies used secondary data for assessment, data which was more than 5 years old at time of analysis. Ten studies included only married adolescent mothers. While factors such as wealth quintile, media exposure and rural/urban residence were commonly adjudged as significant, education of the adolescent mother and her partner were the commonest significant factors that influenced MHS utilisation. Use of antenatal care also predicted use of skilled birth attendance and use of both predicted use of postnatal care. However, there may be some context-specific factors that need to be considered. CONCLUSIONS: Our findings strengthen the need to lay emphasis on improving girl child education and removing financial barriers to their access to MHS. Opportunities that have adolescents engaging with health providers also need to be seized. These will be critical in improving adolescent MHS utilisation. However, policy and programmatic choices need to be based on recent, relevant and robust datasets. Innovative approaches that leverage new media to generate context-specific dis-aggregated data may provide a way forward

CONTEXTUAL AND INDIVIDUAL LEVEL FACTORS INFLUENCING CHILD HEALTH IN LOW AND MIDDLE INCOME COUNTRIES

This thesis examined contextual and individual-level determinants of child health in low and middle income countries, with specific focuses on slum residency, maternal use of cesarean section (CS) during delivery and malaria prevention campaigns. It also examined parental HIV preventive behaviors that could ultimately be associated with child health outcomes (although this was not studied in this thesis). The thesis is presented as four separate projects that examine the following: (1) associations of urban slum residency with infant mortality and child stunting in 45 countries and factors modifying these associations; (2) relations between individual-level CS and neonatal mortality in 46 countries and the moderating influence of country-level CS rates on these relations; (3) determinants of consistent condom use based on the perspectives of both husband and wife where at least one partner is HIV infected and resident in three sub-Saharan African countries with high HIV prevalence; and (4) evaluation of the associations between long-lasting insecticidal nets (LLIN) mass distribution campaigns led by different organizations (the World Bank, UNICEF, or Global Fund) and malaria among children in Nigeria. Data were from nationally representative Demographic and Health Surveys (DHS) for the first three projects and Nigeria Malaria Indicator Survey (NMIS) for the fourth project. The research objectives were addressed using multilevel modeling for projects 1, 3, and 4 and propensity score matching, meta-analysis and meta-regression for project 2. Results of each separate project of this thesis showed that: (1) after controlling for the socio-economic circumstances of individual families, residency in a slum community was associated with infant mortality. This association was attenuated among children born to women who had received antenatal care from a health professional. Finally, residency in a slum community exacerbated the risk of stunting among older versus younger children; (2) individual-level CS increased the risk of neonatal mortality and that this risk was the highest in countries with the lowest CS rates; (3) couples were more likely to have used condoms consistently if the husband was HIV positive, and was the only one in the couple who knew his HIV test result. This association was stronger if the HIV-positive husband was aware of his HIV test result and his HIV-negative wife aware of her test result. No corresponding associations were observed for HIV-positive wives; (4) compared with children living in areas with no LLIN mass distribution campaigns, those in the World Bank Booster Project areas were significantly less likely to test positive for malaria but no significant differences in child malaria infections were found between other campaigns and non-campaign areas. Results also showed that community-level wealth, community-level maternal knowledge regarding malaria prevention, and child-level use of insecticidal nets were negatively associated with child malaria. Taken together, the findings suggest that improving the material circumstances of slum neighborhoods and increasing antenatal care coverage among women living in these neighborhoods could help reduce stunted child growth and infant mortality associated with slum residency. Results also indicate the need of improving the quality of maternal and newborn health care services, especially in countries with low CS rates in order to reduce neonatal mortality associated with CS. In addition to LLIN mass distribution campaigns, improving maternal knowledge on malaria prevention at the community level might be helpful in preventing child malaria. Finally, results show that increasing HIV testing and awareness of results among husbands could help reduce HIV transmission among couples.Doctor of Philosophy (PhD

Health needs of older populations affected by humanitarian crises in low- and middle-income countries: a systematic review.

BACKGROUND: The combination of global demographic changes and a growing number of humanitarian crises in middle-income countries that have a higher life expectancy has led to an increase in the number of older populations affected by humanitarian crises. The aim of this review was to systematically examine evidence on the health needs of older populations in humanitarian crises, including both armed conflicts and natural disasters, in low- and middle-income countries (LMICs). METHODS: A systematic review methodology was used. The search strategy used terms related to older populations and humanitarian crises in LMICs. Five bibliographic databases were used, along with relevant grey literature sources. Descriptive analysis was used, and a quality assessment conducted using the Newcastle-Ottawa Scale and CASP instruments. RESULTS: A total of 36 studies were eligible for review. The majority of the studies were cross-sectional, three were cohort studies, and four used qualitative methodologies. The main health outcomes were mental health, physical health, functioning, and nutrition. Vulnerability factors included older age, female gender, being widowed, increased exposure to traumatic events, prior mental health problems, low income and education, and rural residency. Ten studies addressed the responsiveness of health systems and access to such services. The quality of the included studies was generally low. CONCLUSIONS: There is an urgent need to strengthen the evidence base on the health needs of older populations in humanitarian crises

Factors influencing poor medication adherence amongst patients with chronic disease in low-and-middle-income countries : a systematic scoping review

BACKGROUND: Poor medication adherence among patients with Chronic Diseases is one of the significant health problems globally. Despite this, evidence on chronic medication adherence in low and middle-income countries is unclear. OBJECTIVE: This scoping review aimed to identify factors influencing poor medication adherence amongst patients with chronic diseases in low and middle-income countries. METHODS: We searched studies exploring factors influencing poor medication adherence amongst patients in low and middle-income countries across the following databases published between 2008 to 2018: Public or publisher Medline, Google scholar, Cumulated Index to Nursing and Allied Health Literature, Health Source, and Medline with full text via Elton B. Stephen's Company host. Methodological quality assessment of the primary studies was done as recommended by Levac, Colquhoun, and O'Brien (2010) review using a Mixed-Method Appraisal Tool 2018. We reported the results following the Preferred Reporting Item for Systematic reviews and Meta-Analyses extension for Scoping Review guidelines. RESULTS: From the initial 154 records screened, we identified six (6) eligible studies that presented evidence on factors influencing poor medication adherence amongst patients in low and middle-income countries. Studies included were from the following countries: Jordan, South Africa, Guatemala, Ethiopia, Indonesia, India, and Palestine. Kappa agreement of the full article screening shows that there was 76.92% agreement versus 58.12% expected by chance which constitutes a considerably good agreement between screeners (Kappa statistic = 0.45 and p-value <0.05). Of the six included studies that underwent methodological quality, five scored 100%, which is regarded as the highest score the remaining one scored between 50-75%, indicating a moderate to low risk bias overall. All included studies presented evidence on medication adherence as being in either knowledge of the diseases, attitudes towards medication taking, beliefs that a patient holds about the treatment or disease, and quality control amongst chronic diseases patients. CONCLUSIONS: Our scoping review provides evidence that poor medication adherence in LMICs is influenced by a lack of knowledge, negative attitudes, and negative beliefs, leading to poor quality of life. There is limited research evidence on the effect of patients' beliefs and perceptions on medication adherence in low and middle-income countries. We call upon further research on beliefs, perceptions, and effectiveness of interventions towards chronic medication adherence in low and middle-income countries.University of KwaZulu-Natal [College of Health Sciences Research Scholarship].https://www.cell.com/heliyon/homeSchool of Health Systems and Public Health (SHSPH

Protective psychosocial factors of geriatric depression in community dwelling older adults: A review article

Context: Depression is a major health problem in geriatric population and has many adverse consequences. The aim of this study was to review the existing literature on psychosocial factors that protect against depression in later life. Evidence Acquisition: A MEDLINE systematic search was done via Pubmed and Sciencedirect web pages to gather the published articles on psychosocial factors of late life depression First, the titles and abstracts reviewed and relevant articles were selected according to the inclusion criteria. Then full texts of the selected articles obtained, read, and data were extracted and categorized. Results: There were 204 articles on psychosocial factors of late life depression in community dwelling older adults and among them 29 articles included protective factors. Reading them carefully, protective factors were extracted and organized into 5 main categories: Demographic factors, psychological factors, social factors, health related factors and also spiritual factors. Conclusion: Psychosocial factors protecting older adults against depression are diverse. Identification of the modifiable ones and provision of appropriate interventions to enhance them, can be helpful in preventing geriatric depression. ©2018, Iranian Journal of Psychiatry and Behavioral Sciences