10 research outputs found
Secondary schooling and rural youth transitions in Lesotho and Zimbabwe
Based on case studies centred on two rural secondary schools in Lesotho and Zimbabwe, this paper examines the gendered impacts of schooling on young people’s transitions to adulthood. School attendance is shown, first, to disrupt the conventional pathways to adulthood: young people attending school may leave home sooner than they otherwise would, and take responsibility for their day-to-day survival, while marriage and childbearing are often delayed. More significantly, secondary schooling reflects, and contributes to, a growing sense that adulthood itself is not fixed. An alternative version of adulthood is promoted through schools in which formal sector employment is central. Yet while young people are encouraged to opt for, and work towards, this goal, only a minority are able to obtain paid employment. The apparent possibility of determining one’s own lifecourse serves to cast the majority of young people as failures in their transitions to adulthood
Household, community, sub-national and country-level predictors of primary cooking fuel switching in nine countries from the PURE study
Introduction. Switchingfrom polluting (e.g. wood, crop waste, coal)to clean (e.g. gas, electricity) cooking
fuels can reduce household air pollution exposures and climate-forcing emissions.While studies have
evaluated specific interventions and assessed fuel-switching in repeated cross-sectional surveys, the role
of different multilevel factors in household fuel switching, outside of interventions and across diverse
community settings, is not well understood. Methods.We examined longitudinal survey data from
24 172 households in 177 rural communities across nine countries within the Prospective Urban and
Rural Epidemiology study.We assessed household-level primary cooking fuel switching during a
median of 10 years offollow up (∼2005–2015).We used hierarchical logistic regression models to
examine the relative importance of household, community, sub-national and national-level factors
contributing to primary fuel switching. Results. One-half of study households(12 369)reported
changing their primary cookingfuels between baseline andfollow up surveys. Of these, 61% (7582)
switchedfrom polluting (wood, dung, agricultural waste, charcoal, coal, kerosene)to clean (gas,
electricity)fuels, 26% (3109)switched between different polluting fuels, 10% (1164)switched from clean
to polluting fuels and 3% (522)switched between different clean fuels
Household, community, sub-national and country-level predictors of primary cooking fuel switching in nine countries from the PURE study
Global differences in lung function by region (PURE): an international, community-based prospective study.
Availability and affordability of blood pressure-lowering medicines and the effect on blood pressure control in high-income, middle-income, and low-income countries: an analysis of the PURE study data
Background: Hypertension is considered the most important risk factor for cardiovascular diseases, but its control is poor worldwide. We aimed to assess the availability and affordability of blood pressure-lowering medicines, and the association with use of these medicines and blood pressure control in countries at varying levels of economic development.
Methods: We analysed the availability, costs, and affordability of blood pressure-lowering medicines with data recorded from 626 communities in 20 countries participating in the Prospective Urban Rural Epidemiological (PURE) study. Medicines were considered available if they were present in the local pharmacy when surveyed, and affordable if their combined cost was less than 20% of the households' capacity to pay. We related information about availability and affordability to use of these medicines and blood pressure control with multilevel mixed-effects logistic regression models, and compared results for high-income, upper-middle-income, lower-middle-income, and low-income countries. Data for India are presented separately because it has a large generic pharmaceutical industry and a higher availability of medicines than other countries at the same economic level.
Findings: The availability of two or more classes of blood pressure-lowering drugs was lower in low-income and middle-income countries (except for India) than in high-income countries. The proportion of communities with four drug classes available was 94% in high-income countries (108 of 115 communities), 76% in India (68 of 90), 71% in upper-middle-income countries (90 of 126), 47% in lower-middle-income countries (107 of 227), and 13% in low-income countries (nine of 68). The proportion of households unable to afford two blood pressure-lowering medicines was 31% in low-income countries (1069 of 3479 households), 9% in middle-income countries (5602 of 65 471), and less than 1% in high-income countries (44 of 10 880). Participants with known hypertension in communities that had all four drug classes available were more likely to use at least one blood pressure-lowering medicine (adjusted odds ratio [OR] 2·23, 95% CI 1·59–3·12); p<0·0001), combination therapy (1·53, 1·13–2·07; p=0·054), and have their blood pressure controlled (2·06, 1·69–2·50; p<0·0001) than were those in communities where blood pressure-lowering medicines were not available. Participants with known hypertension from households able to afford four blood pressure-lowering drug classes were more likely to use at least one blood pressure-lowering medicine (adjusted OR 1·42, 95% CI 1·25–1·62; p<0·0001), combination therapy (1·26, 1·08–1·47; p=0·0038), and have their blood pressure controlled (1·13, 1·00–1·28; p=0·0562) than were those unable to afford the medicines.
Interpretation: A large proportion of communities in low-income and middle-income countries do not have access to more than one blood pressure-lowering medicine and, when available, they are often not affordable. These factors are associated with poor blood pressure control. Ensuring access to affordable blood pressure-lowering medicines is essential for control of hypertension in low-income and middle-income countries.
Funding: Population Health Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, Canadian Institutes of Health Research Strategy for Patient Oriented Research through the Ontario SPOR Support Unit, the Ontario Ministry of Health and Long-Term Care, pharmaceutical companies (with major contributions from AstraZeneca [Canada], Sanofi Aventis [France and Canada], Boehringer Ingelheim [Germany amd Canada], Servier, and GlaxoSmithKline), Novartis and King Pharma, and national or local organisations in participating countries
Global Impact of COVID-19 on Stroke Care and IV Thrombolysis
OBJECTIVE: To measure the global impact of COVID-19 pandemic on volumes of IV thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with 2 control 4-month periods. METHODS: We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases. RESULTS: There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95% confidence interval [CI] -11.7 to -11.3, p < 0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95% CI -13.8 to -12.7, p < 0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95% CI -13.7 to -10.3, p = 0.001). Recovery of stroke hospitalization volume (9.5%, 95% CI 9.2-9.8, p < 0.0001) was noted over the 2 later (May, June) vs the 2 earlier (March, April) pandemic months. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was noted in 3.3% (1,722/52,026) of all stroke admissions. CONCLUSIONS: The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID-19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months. © 2021 American Academy of Neurology