Child stunting due to chronic malnutrition is a major problem in low- and middle-income countries due, in part, to inadequate nutrition-related practices and insufficient access to services. Limited ...budgets for nutritional interventions mean that available resources must be targeted in the most cost-effective manner to have the greatest impact. Quantitative tools can help guide budget allocation decisions.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The coronavirus 2019 (COVID-19 pandemic) and associated responses have significantly disrupted healthcare. We aimed to estimate the magnitude of and reasons for households reporting healthcare ...disruption in 14 Latin America and the Caribbean (LAC) region countries from mid-2020 to mid-2021, and its relationship with country contextual factors.
We used COVID-19 high-frequency phone surveys (HFPS) conducted in 14 LAC countries in three rounds in 2020 and one in 2021. We classified the reasons reported for healthcare disruption into four groups: concerns about contracting COVID-19, healthcare supply constraints, financial reasons, and public health measures (PHMs). We used bivariate and multivariate regressions to examine correlates of reported healthcare disruption with the above groups and country context as control variables.
On average, 20% of households reported a disruption in May-June 2020 (45% to 10% at country level), dropping to 9% in June-July 2020 (31% to 3%) and July-August 2020 (26% to 3%), and declining to 3% in May-July 2021 (11% to 1%). The most common reason reported for disruption was healthcare supply constraints, followed by concerns about contracting COVID-19, PHM, and financial reasons. In multivariable regression analyses, we found that a higher incidence of new COVID-19 cases (regression coefficient (β) = 0.018, P < 0.01), stricter PHM (β = 0.002, P < 0.01), fewer hospital beds per population (β = -0.011, P < 0.01), and lower out-of-pocket health spending (β = -0.0008, P < 0.01) were associated with higher levels of disrupted care. A higher care disruption was associated with a lower gross domestic product (GDP) per person (β = -0.00001, P < 0.01) and lower population density (β = -0.056, P < 0.01).
Healthcare services for households in LAC were substantially disrupted during the COVID-19 pandemic. Findings about supply and financial constraints can inform the recovery of postponed healthcare services, while public health and contextual factors findings can inform future health system resilience efforts in LAC and elsewhere.
Childhood stunting, being short for one’s age, has life-long consequences for health, human capital and economic growth. Being stunted in early childhood is associated with slower cognitive ...development, reduced schooling attainment and adult incomes decreased by 5–53%. The World Health Assembly has endorsed global nutrition targets including one to reduce the number of stunted children under five by 40% by 2025. The target has been included in the Sustainable Development Goals (SDG target 2.2). This paper estimates the cost of achieving this target and develops scenarios for generating the necessary financing. We focus on a key intervention package for stunting (KIPS) with strong evidence of effectiveness. Annual scale-up costs for the period of 2016–25 were estimated for a sample of 37 high burden countries and extrapolated to all low and middle income countries. The Lives Saved Tool was used to model the impact of the scale-up on stunting prevalence. We analysed data on KIPS budget allocations and expenditure by governments, donors and households to derive a global baseline financing estimate. We modelled two financing scenarios, a ‘business as usual’, which extends the current trends in domestic and international financing for nutrition through 2025, and another that proposes increases in financing from all sources under a set of burden-sharing rules. The 10-year financial need to scale up KIPS is US$49.5 billion. Under ‘business as usual’, this financial need is not met and the global stunting target is not reached. To reach the target, current financing will have to increase from US$2.6 billion to US$7.4 billion a year on average. Reaching the stunting target is feasible but will require large coordinated investments in KIPS and a supportive enabling environment. The example of HIV scale-up over 2001–11 is instructive in identifying the factors that could drive such a global response to childhood stunting.
Le retard de croissance de l’enfance, à savoir, ne pas avoir la taille correspondant à son âge, a des conséquences vitales pour la santé, le capital humain et la croissance économique. Souffrir d’un retard de croissance dès la tendre enfance est en corrélation avec un développement cognitif plus lent, une baisse du niveau de scolarité et une diminution des revenus des adultes de 5 à 53%. L’Assemblée mondiale de la santé a approuvé les objectifs mondiaux en matière de nutrition, notamment celui visant à réduire de 40% avant fin 2025, le nombre d’enfants de moins de cinq ans souffrant d’un retard de croissance. Ce thème a été inclus dans les objectifs de développement durable (cible ODD 2.2). Le présent article estime le coût de réalisation de cet objectif et élabore des scénarios visant à générer les financements nécessaires. Nous nous concentrons sur un ensemble d’interventions clés relatifs au retard de croissance (KIPS) dont l’efficacité s’appuie fortement sur des données probantes. Les coûts annuels de mise à l’échelle pour la période de 2016 à 25 ont été estimés pour un échantillon de 37 pays à forte charge et extrapolés à tous les pays à revenu faible ou intermédiaire. L’outil « Lives Saved » a été utilisé pour modéliser l’impact de la mise à l’échelle sur la prévalence du retard de croissance. Nous avons analysé les données du KIPS relatives aux allocations budgétaires et aux dépenses des gouvernements, des donateurs et des ménages afin d’en déduire une estimation globale du financement de base. Nous avons modélisé deux scénarios de financement, une approche «business as usual», qui développe les tendances actuelles en matière de financement interne et international jusqu’en 2025, et une autre qui propose un accroissement des financements quel qu’en soit la source en vertu d’un ensemble de règles de partage des charges. Le besoin financier pour la mise à niveau du KIPS sur une période de 10 ans est de 49,5 milliards de dollars américains. Dans le cadre de l’approche «business as usual», ce besoin financier n’est pas satisfait et l’objectif global de lutte contre le retard de croissance n’est pas atteint. Pour ce faire, le financement actuel devra passer de 2,6 milliards USD à 7,4 milliards USD par an en moyenne. Il est tout à fait possible d’atteindre l’objectif de lutte contre le retard de croissance, mais cela nécessite d’importants investissements coordonnés pour la mise en œuvre du KIPS et un environnement propice à la promotion de ce programme. L’intensification de la lutte contre le VIH au cours de la période 2001-11 est un exemple instructif pour identifier les facteurs qui peuvent induire une telle réponse globale au problème de retard de croissance des enfants.
儿童生长迟缓, 即身高低于同龄人, 对健康、人力资本和经济 发展有着长期影响。儿童早期生长迟缓者认知发展缓慢, 教育 水平和成年后收入减少5-53%。世界卫生大会支持的全球营 养目标中包括五岁以下生长迟缓儿童数量到2025年时减少 40%。该目标也包含在可持续发展目标中 （SDG目标2.2） 。 本文估算实现这一目标的成本, 提出可产生必要资金的情境。 我们集中讨论有效性证据较强的生长迟缓关键干预项目 （KIPS） 。估算37个高负担国家样本2016-2025年项目扩大 的年度成本, 外推至所有中低收入国家。采用挽救生命工具模 拟项目扩大对生长迟缓患病率的影响。我们按政府、捐助者 和家庭分析了KIPS预算分配和支出, 形成全球基线资金估 值。我们模拟了两个筹资情境, 一个是”一切照旧”, 将目前 国内和国际针对营养的筹资趋势延续至2025； 另一个是提倡 在责任分担规则下增加所有来源的资金。十年间扩大KIPS所 需的资金是495亿美元。在”一切照旧”情境下, 这一资金需 求不能得到满足, 无法达到全球减少生长迟缓目标。为实现这 一目标, 筹资水平应从现在的每年26亿美元增加至平均每年74 亿美元。生长迟缓减少的目标是可行的, 但需要对KIPS和支 持环境的大规模协调投入。2001-2011年HIV项目扩大的实例 有助于明确可以驱动全球应对儿童生长迟缓的因素。
El retraso en el crecimiento de la niñez, definido como estatura baja para la edad, tiene consecuencias para la salud a lo largo de la vida, el capital humano y el crecimiento económico. El retraso en el crecimiento en la primera infancia se asocia con un desarrollo cognitivo más lento, menor escolaridad e ingresos en edad adulta disminuidos en 5-53%. La Asamblea Mundial de la Salud ha respaldado los objetivos nutricionales globales, incluyendo uno para reducir el número de niños menores de cinco años con retraso de crecimiento en 40% para el 2025. El objetivo ha sido incluido en los Objetivos de Desarrollo Sostenible (ODS objetivo 2.2). Este documento estima el costo de alcanzar este objetivo y desarrolla los escenarios para generar la financiación necesaria. Nos enfocamos en un paquete de intervenciones claves para el retraso del crecimiento (PICRC) con una fuerte evidencia de eficacia. Se estimó el aumento de los costos anuales para el período 2016-25 para una muestra de 37 países de alta carga y se extrapolaron a todos los países de ingresos bajos y medios. Se usó la Herramienta de Supervivencia para modelar el impacto de la ampliación en la prevalencia del retraso del crecimiento. Analizamos los datos sobre las asignaciones presupuestarias del PICRC y los gastos de los gobiernos, los donantes y los hogares para obtener un estimativo de la financiación básica global. Modelamos dos escenarios de financiación, uno “lo mismo de siempre”, que amplía las tendencias actuales en la financiación nacional e internacional para la nutrición hasta 2025, y otro que propone aumentos en la financiación de todas las fuentes bajo un conjunto de reglas de reparto de la carga. La necesidad financiera a 10 años para aumentar el PICRC es de US$49.5 billones. Bajo el escenario “lo mismo de siempre”, esta necesidad de financiación no secumple y no se alcanza el objetivo de crecimiento global. Para alcanzar el objetivo, la financiación actual deberá aumentar de US$2.6 billones a US$7.4 billones al año en promedio. Obtener el objetivo de retraso del crecimiento es factible, pero requerirá grandes inversiones coordinadas en PICRC y un entorno propicio de apoyo. El ejemplo de la ampliación del VIH durante 2001-11 es instructivo en la identificación de los factores que podrían impulsar una respuesta global al retraso del crecimiento de la niñez.
It has been highlighted that the original manuscript 1 contains a typesetting error in the name of Meera Shekar. This had been incorrectly captured as Meera Shekhar in the original article which has ...since been updated.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background:
A therapy based on ready-to-use therapeutic food (RUTF) in outpatient settings is considered the gold standard in the treatment of severe acute malnutrition in children younger than 5 ...years. The price of RUTF is the key cost driver of the therapy. However, no studies to date have systematically examined the determinants of RUTF prices.
Objective:
This article presents the first analysis of factors associated with the prices of RUTF, focusing on the impact of competition and tendering.
Methods:
This article examines data on the prices of RUTF purchased by UNICEF Supply Division from 2006 through 2015 (90% of RUTF purchased globally). To assess the association between price, competition, and tender introduction, controlling for potential confounding factors, regression analysis using a generalized estimating equation was used.
Results:
Competition, measured as the number of suppliers, was negatively associated with RUTF price. On the other hand, no statistically significant association was found between RUTF price tendering. Quantities sold were also significantly associated with RUTF prices.
Conclusions:
Significant price reductions have been achieved by increasing competition in the RUTF market. In contrast, introduction of tendering did not result in decreases in prices. Tendering is an effective price-lowering mechanism because it awards the bidder(s) with the lowest price with market exclusivity. However, the current tender system promotes market fragmentation and reduces the incentives for price reductions. Further reduction in RUTF prices can likely be achieved by modifying the current tendering procedures and putting a greater emphasis on price competition.
We report on an outcomes assessment of the Summer Undergraduate Research Experience (SURE) Program at Emory University in Atlanta, GA. Using follow-up survey data and academic transcripts, we gauge ...SURE's impact on levels of interest in, preparedness for, and actual pursuit of graduate study and professional careers in the sciences for the program's first 15 summer cohorts (1990-2004). Our follow-up survey indicated significant increases in all research preparedness skills considered, notably in ability to give a poster research presentation, to discuss research at a graduate school interview, and to apply research ethics principles. About a third of SURE graduates went on to complete a graduate degree greater than 90% considered SURE as important or very important in their academic development. Respondents reported postprogram increases in the level of interest in academic and research careers, and reported high levels of employment in science careers and job satisfaction. Regression analyses of Emory SURE participant transcripts revealed that participants take significantly more science courses as seniors and earn higher grades in those courses than nonparticipants. This trend held after correcting for indicators of prior interest (first-year course work, GPA, and math SAT scores), gender, and minority status. We also report on an external survey completed by SURE participants. (Contains 8 tables, 1 figure and 3 footnotes.)
ObjectivesThis study aims to estimate the levels of COVID-19 vaccine hesitancy in 53 low-income and middle-income countries, differences across population groups in hesitancy, and self-reported ...reasons for being hesitant to take the COVID-19 vaccine.MethodsThis paper presents new evidence on levels and trends of vaccine hesitancy in low-income and middle-income countries based on harmonised high-frequency phone surveys from more than 120 000 respondents in 53 low-income and middle-income countries collected between October 2020 and August 2021. These countries represent a combined 53% of the population of low-income and middle-income countries excluding India and China.ResultsOn average across countries, one in five adults reported being hesitant to take the COVID-19 vaccine, with the most cited reasons for hesitancy being concerns about the safety of the vaccine, followed by concerns about its efficacy. Between late 2020 and the first half of 2021, there tended to be little change in hesitancy rates in 11 of the 14 countries with available data, while hesitancy increased in Iraq, Malawi and Uzbekistan. COVID-19 vaccine hesitancy was higher among female, younger adults and less educated respondents, after controlling for selected observable characteristics.ConclusionsCountry estimates of vaccine hesitancy from the high-frequency phone surveys are correlated with but lower than those from earlier studies, which often relied on less representative survey samples. The results suggest that vaccine hesitancy in low-income and middle-income countries, while less prevalent than previously thought, will be an important and enduring obstacle to recovery from the pandemic.
The recent increase in the attention given to issues related to nutrition has been precipitated partially by the growing body of knowledge related to the economic impact of malnutrition as well as ...the cost and benefits of scaling up key nutrition actions. One key and persistent question asked by policy makers and nutrition and health program managers which has not been addressed todate is: what allocation of funding across different interventions would allow us to maximize nutrition and health impact while minimizing costs? The existing analytic tools do not address this critical question. A few existing ones, including LiST, OneHealth, Profiles, the World Breastfeeding Costing Initiative tool, and the FANTA CMAM costing tool, estimate either costs or impacts of different nutrition interventions. Each has its strengths but none offers the analytical capability to integrate all of the following features: (i) combine the estimates of cost, health impacts, and economic impacts of scaling up nutrition interventions; (ii) compare cost-effectiveness of different intervention and scale-up options; (iii) systematically assess allocative efficiency of different scaleup options (iv) use a formal mathematical optimization model to identify the optimal allocation of a given level of resources to reach specific nutrition and/or health outcomes. This session introduces Optima nutrition, a mathematical model that uses an integrated analysis of nutrition status, program, and cost data to determine an optimal distribution of investment at different funding levels to better serve the needs of decision-makers and planners. An initial pilot application for Optima nutrition has been developed through a partnership between the World Bank, the Bill and Melinda Gates Foundation, and the Burnett Institute. Currently, the application is focusing on child stunting and the plan is to incorporate other outcomes such as anemia and wasting over time. The application allows the user to 1) estimate the impact an intervention scale-up will have on stunting prevalence and child mortality; 2) calculate the cost of scale up under different cost function assumptions; 3) for a given budget, calculate the optimal allocation of resources among the seven interventions (that is, identify an allocation that will produce maximum reductions in stunting or/and mortality); 4) for a given budget, calculate the optimal allocation of resources among different geographic regions in a given country. This session presents the structure of the model, and illustrates how the model can be used with preliminary application in two countries.
In addition to the direct health effects of the Coronavirus disease (COVID-19) pandemic, the pandemic has increased the risks of foregone non-COVID-19 healthcare. Likely, these risks are greatest in ...low- and middle-income countries (LMICs), where health systems are less resilient and economies more fragile. However, there are no published studies on the prevalence of foregone healthcare in LMICs during the pandemic. We used pooled data from phone surveys conducted between April and August 2020, covering 73 638 households in 39 LMICs. We estimated the prevalence of foregone care and the relative importance of various reported reasons for foregoing care, disaggregated by country income group and region. In the sample, 18.8% (95% CI 17.8-19.8%) of households reported not being able to access healthcare when needed. Financial barriers were the most-commonly self-reported reason for foregoing care, cited by 31.4% (28.6-34.3%) of households. More households in wealthier countries reported foregoing care for reasons related to COVID-19 27.2% (22.5-31.8%) in upper-middle-income countries compared to 8.0% (4.7-11.3%) in low-income countries; more households in poorer countries reported foregoing care due to financial reasons 65.6% (59.9-71.2%) compared to 17.4% (13.1-21.6%) in upper-middle-income countries. A substantial proportion of households in LMICs had to forgo healthcare in the early months of the pandemic. While in richer countries this was largely due to fear of contracting COVID-19 or lockdowns, in poorer countries foregone care was due to financial constraints.
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