Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries : a prospective, international, multicentre cohort study

Background Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p<0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p<0·001). Interpretation Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

A simple guide to ultrasound screening for placenta accreta spectrum for improving detection and optimizing management in resource limited settings

Placenta accreta spectrum is a pregnancy complication associated with severe morbidity and maternal mortality especially when not suspected antenatally and appropriate management instigated. Women in resource-limited settings are more likely to face adverse outcomes due to logistic, technical, and resource inadequacies. Accurate prenatal imaging is an important step in ensuring good outcomes because it allows adequate preparation and an appropriate management approach. This article provides a simple three-step approach aimed at guiding clinicians and sonographers with minimal experience in placental accreta spectrum through risk stratification and basic prenatal screening for this condition both with and without Doppler ultrasound

Development cooperation with middle-income countries

Only flows to countries that are on the DAC list of recipients can be labelled Official Development Assistance (ODA). The countries on that list however are a mixed bag. Based on a World Bank classification, the DAC list for instance includes Burundi, with an income per capita in 2009 of $150, and Brazil, with an income per capita in 2009 of$ 8840. Burundi, on this count, is 59 times poorer than Brazil. And there is not just income. Burundi is small, landlocked, politically and institutionally unstable, with an unimpressive record in terms of economic growth, a modest player in Africa and an insignificant player in the world. Brazil by contrast is huge, rich in natural resources, technologically sophisticated, growing fast, ambitious, and a major player on the world scene. Recently, it has even started to think about setting up its own aid agency (The Economist, 2011a). How more heterogeneous can one get? One can pick similar contrasting pairs from the DAC list, such as DRCongo and China, or Niger and India. How much aid, in pursuit of which development objectives, addressing which constraints in which sectors, using which modalities and channels: surely no single strategy can fit such dissimilar realities. What constitutes a sensible donor strategy in one country may be very inadequate in another. A differentiated strategy is called for.

Global Dialogue Report - Middle Income Countries: Hungary

The consultation addressed the trends, opportunities and challenges for the future of philanthropy in Middle Income Countries. Trends which can be observed are: growing local resource mobilisation; greater use of new technologies; continued lack of a culture of giving; lack of credibility of the non-profit sector; no tax deductions or complicated procedures for charitable giving; suspicion by government of foreign funding; greater involvement of younger people in decision-making

Growth divergence and income inequality in OECD countries: the role of trade and financial openness. LEQS Paper No. 148/2018 October 2019

This paper analyses trade and financial openness effects on growth and income inequality in 35 OECD countries. Our model takes into account both short run and long run effects of factors explaining income divergence between and within the countries. We estimate, for the period 1995-2016, an error correction model in which per capita GDP and inequality are driven by changes over time of selected factors and by the deviation from a long run relationship. Stylised facts suggest that trade and financial openness reduce the growth gaps across the countries but not income inequality, and the effects of finance are stronger in high income countries. Nevertheless, low and middle income countries benefit more from international trade. Our contribution to the existing literature is threefold: i) we study the short and long run effects of trade and financial openness on income level and distribution, ii) we focus on developed countries (OECD) rather than on developing and iii) we provide a sensitivity analysis including in our baseline equation an institutional indicator, a trade agreement proxy and a dummy of global financial crisis. Estimates results indicate that trade openness significantly improved the conditions of OECD low income countries both in short and long run mostly, consistently with the catching up theory. It also decreased inequality, but only in low and middle income countries. Differently financial openness had a positive and significant impact only in the short run on middle income countries and increased income disparities within countries in the short term in low income countries and in the long term in high income countries

Foreign capital in a growth model

Within an endogenous growth framework, this paper empirically investigates the impact of financial capital on economic growth for a panel of 60 developing countries, through the channel of domestic capital formation. By estimating the model for different income groups, it is found that while private FDI flows exert beneficial complementarity effects on the domestic capital formation across all income-group countries, the official financial flows contribute to increasing investment in the middle income economies, but not in the low income countries. The latter appears to demonstrate that the aid-growth nexus is supported in the middle income countries, whereas the misallocation of official inflows is more likely to exist in the low income countries, suggesting that aid effectiveness remains conditional on the domestic policy environment

The problem of middle income trap in the context of the Polish economy

Middle income trap is a phenomenon that occurs at the time of entry of the economy in the cycle of overheating, which in turn leads to economic stagnation or even recession in developing countries. This phenomenon is most common among the developing countries aspiring to catch up with developed countries in economic development. The purpose of this article is to analyze the degree of risk of the Polish economy of middle income trap. Furthermore, in the article it has been indicated action of the economic authorities in Poland, which are unavoidable in order not to fall into middle income trap. To achieve this objective the following research methods were used: a review of the scientific literature and methods of statistical presentation of economic phenomena. The paper identified a number of factors which pose a real threat of falling into the middle income trap in Poland. The originality of this study lies in noticing and highlighting the significance of the middle income trap problem for the Polish economy

The Impact of Urbanization on CO2 Emissions: Evidence from Developing Countries

This paper analyzes the impact of urbanization on CO2 emissions in developing countries, taking into account the presence of heterogeneity in the sample of countries and testing for the stability of the estimated elasticities over time. The sample covers the period from 1975 through 2003 for different groups of countries, classified according to their income levels. Our results show that, whereas the impact of population growth on emissions is above unity and only slightly different for upper, middle, and low- income countries, urbanization, demonstrate a very different impact on emissions for low and lower-middle-income countries and upper-middle income countries.CO2 emissions, developing countries, panel data, population growth, urbanization

Financial development, trade openness and financial openness: do income levels matter for developing countries?

Using a panel of 29 African middle and low income countries with data spanning from 1988 to 2007, we analyze linkages between openness and financial intermediary development when income levels matter. Main findings are four: firstly, openness in the last two decades has not been the effect of growth and welfare, but of structural adjustment policies imposed by the IMF and World Bank; secondly, but for the positive impact of trade openness on the financial depth of low income countries, openness in sampled countries fail to bring about financial intermediary development; thirdly, financial openness brings trade openness for both income levels, but the reverse is true only for middle income countries; lastly, low income countries will benefit more from trade openness through financial deepening and financial openness than their middle income counterparts.Openness, financial intermediary development, income levels, panel, Africa.

Bringing Financial Literacy and Education to Low and Middle Income Countries: The Need to Review, Adjust, and Extend Current Wisdom

This paper presents a World Bank led and Russia trust fund financed work program to measure financial capability and the effectiveness of financial education in low and middle income countries. The two activities and their staging have been motivated by the lessons of high-income countries with financial literacy programs and the deviating characteristics of low and middle income countries. While progress has been made in high-income countries to measure financial capability, there is little robust empirical evidence that financial education can improve it. While applying the financial capability concept in low and middle-income countries looks promising it will need to be adjusted to their characteristic and supported by innovative interventions and rigorous impact evaluation to improve it.financial literacy, financial capability, financial education, impact evaluation