Dissertations / Theses on the topic 'Lower- and Middle-Income Countries'
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1
Yu, Weiyu. "Spatial analysis and modelling of drinking water service in low and lower-middle income countries." Thesis, University of Southampton, 2018. https://eprints.soton.ac.uk/422173/.
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Drinking water is a basic necessity and plays a vital role in improving general health and wellbeing. Following recognition of the essential human right to drinking water, Sustainable Development Goals (SDGs) have included a dedicated Goal 6 (Target 6.1) for drinking water, which addresses a broad range of issues such as availability, accessibility, water quality, and inequalitiesin service. The expanded need for more sophisticated SDG monitoring therefore places high demands on data sources. By combining spatial analysis and modelling techniques with water point data sets, this study proposes several approaches to combine scarce information relating to drinking water services and thereby to facilitate national SDG monitoring. Specifically, spatial integration with water point data was found to be an effective way to add value to conventional data sources such as censuses for monitoring drinking water. In addition, MaxEnt-based predictive modelling method was employed to predict the potential geographical distribution of drinking water supply in the absence of completely surveyed national water point inventories; outputs for Cambodian and Tanzanian examples showed good discriminatory power based on AUCs (0.791 and 0.860 respectively). Although the MaxEnt modelled surface could not replace real water point surveys, it could reasonably give an indication of the potential distribution of water supply and thereby to be used to reveal hidden inequalities in drinking water services, or to investigate surrounding issues by combing with other geospatial data sets.
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Mumuni, Zakari. "Essays on macroeconomic policy and inflation in lower-income countries." Thesis, University of Nottingham, 2018. http://eprints.nottingham.ac.uk/52432/.
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This thesis critically analyses the deficits-inflation nexus and inflation targeting in lower-income countries. Previous research has found a significant relationship between fiscal deficits and inflation in low-income countries, but not in high-income countries. It is shown here that the crucial factor is the quality of institutions. The relationship holds in countries with weak institutions, but not in those with strong institutions, even if their per capita GDP is quite low. The implication is that institutional improvements can enhance macroeconomic outcomes in poor countries. The robustness of the findings is tested using various measures of institutional quality. On the other hand, we provide new insights on inflation targeting (IT) in low-income countries. Previous research on inflation targeting has focused on high-income and emerging market economies since low-income countries (LICs) were slow to adopt the framework. Only recently has enough data accumulated for the performance of IT in LICs to be assessed. We show that unlike in emerging markets, in LICs IT is not been effective in reducing inflation. Weak institutions, a typical feature in LICs, do help explain this especially when we examine their role under floating exchange rate regimes. Finally, we characterise monetary policy in Ghana, one of the earliest low-income countries to adopt an IT framework, but where IT has not been very successful in reducing the levels and volatility of inflation within a modified Taylor rule. We investigate whether poor conduct of monetary policy is responsible for the poor performance of IT and find that is not. Monetary policy reaction functions are similar to those estimated for countries with successful monetary policies, and interest rates respond in the theoretically recommended way to inflation shocks.
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Lundmark, Albin, and Emma Roxström. "Urbanization and economic freedom - are they threats to air quality? : Evidence from a panel study of low and lower-middle-income countries." Thesis, Uppsala universitet, Nationalekonomiska institutionen, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-435088.
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Air pollution (in terms of PM2.5) is severe in developing countries, and the rapid population growth accompanied by urbanization may limit their potential economic development. This paper aims to investigate if urbanization and economic freedom cause higher levels of PM2.5 in developing countries. By measuring the potential effect of economic freedom on PM2.5 with the Ease of Doing Business-score by the World Bank, a new measure is introduced to the research on socioeconomic factors’ influence on air pollution. It is done by running both fixed effects- and system GMM regressions on a panel consisting of 63 low- and lower-middle-income economies between 2010-2017. The results indicate that PM2.5 is insensitive to changes in both variables and that urbanization’s effect on PM2.5 depends on the level of economic freedom and vice versa. However, both estimators may suffer from bias, and thus, the real relationship of urbanization and economic freedom on PM2.5 remains uncertain.
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Burr, Peter William. "The financial costs of delivering rural water and sanitation services in lower-income countries." Thesis, Cranfield University, 2014. http://dspace.lib.cranfield.ac.uk/handle/1826/9312.
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Despite the impressive progress over the last two decades in which millions of people worldwide have gained first time access to improved water and sanitation infrastructure, the reality for many is that shortly after infrastructure construction the actual service received by users slips back to unacceptably low levels. However, due to inadequate research and inconsistencies with how data and cost data has been collected and reported, very little is known of the necessary levels of expenditure required to sustain an acceptable (so called “basic”) water and sanitation service and this inhibits effective financial planning for households, communities, governments and donors alike. This thesis sought to provide a better understanding of what has historically been spent to provide different levels of water and sanitation services as a means to better understand the necessary expenditure required. Empirical findings are based on a large data sample of nearly 2,000 water points, over 4,000 latrines, and over 12,000 household surveys, which have been collected as part of three research projects (WASHCost, Triple-S, and WASHCost Sierra Leone), across five country research areas (Andhra Pradesh (India), Burkina Faso, Ghana, Mozambique, and Sierra Leone). Findings for water supply systems show that the combination of high capital investments of: $19 and $69 per person for community point sources and $33 – $216 per person for piped systems; and low recurrent expenditures of: $0.06 - $0.37 per person per year for point sources and $0.58 - $7.87 per person per year for piped systems; results in less than half of users receiving a “basic” level of service. Evidence based estimates of the required expenditure for acceptable services are found to be far greater than the “effective demand” expressed in terms of the willingness to pay of service users and national government for these services. Findings for sanitation show that constructing a household latrine that achieves “basic” service standards requires a financial investment of at least $40 that is likely to be an unaffordable barrier for many households in lower income countries. In addition the costs and affordability of periodic pit emptying remains a concern. Ultimately this research suggests that if international standard of improved water and sanitation services are to be sustained in rural areas, the international sector will likely have to provide additional investments to meet a significant proportion of the recurrent costs of delivering these services.
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Pimenta, de Castro Fonseca Catarina. "The death of the communal handpump? : rural water and sanitation household costs in lower-income countries." Thesis, Cranfield University, 2014. http://dspace.lib.cranfield.ac.uk/handle/1826/8512.
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Rural water supply and sanitation in low and middle income countries face the same challenges now as in the 1970s. Despite massive efforts in providing communal “borehole with handpump” and “improved latrines” to improve the lives of millions of people, this traditional approach to development is failing to deliver long lasting improved services - even if for the last 40 years many attempts have been made to solve problems in the approach. The main research question is “Can low-income rural families pay for rural water supply and sanitation?” This thesis has analysed household poverty and costs on water and sanitation services in Mozambique and Ghana based on 3,049 surveys collected between 2009-2010 by the IRC International Water and Sanitation Centre WASHCost project. Evidence shows that even extreme poor households can and do pay for improved water and sanitation services. However, households prefer to pay for more expensive services to reduce the distance required to collect water instead of paying for the cheaper maintenance of communal (further away) sources. For sanitation, without targeted support towards the poorest, improved latrines might be unaffordable. Also, without follow up support, behaviour change and health impact will not be sustained. Small increases in the wealth of the poorest have a large impact on the services demanded in terms of quantity, distance and time spend as well as an increase in the level of capital and maintenance expenditure. Ultimately, the world now is not the same as in the 1970s and for achieving universal sustainable coverage for water and sanitation we need to rethink the failed traditional approach to development in low income countries with a deeper understanding of the market segmentation in the lowest quintile of the population and their real aspirations and demand.
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Alzien, Salahadein Ahmed [Verfasser], Rafig [Akademischer Betreuer] Azzam, and Holger [Akademischer Betreuer] Weiß. "Rehabilitation of sites contaminated with petroleum hydrocarbon by using sustainable remediation approach in lower and middle-income countries : Libya as a case study / Salahadein Ahmed Alzien ; Rafig Azzam, Holger Weiß." Aachen : Universitätsbibliothek der RWTH Aachen, 2018. http://d-nb.info/1189672022/34.
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Viglietti, Paola. "Maternal alcohol consumption and socio-demographic determinants of neurocognitive function of school children in the rural Western Cape." Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/33095.
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Background. Within the South African context there is a large body of research regarding the associations between maternal gestational drinking and diagnosable child FASDs. However, there remains a paucity of local research regarding the impacts of other kinds of maternal drinking behaviours (e.g. past and present maternal drinking) and related socio-demographic factors on developmentally sensitive areas of child neurocognitive functioning, such as executive functioning (EF). Methods. This study was cross-sectional in design, utilising a gender balanced sample of N=464 children between the ages of 9.00 and 15.12 (year.months) in three rural areas within the Western Cape. Information regarding maternal drinking behaviours (before, during and after pregnancy) and related socio-demographic factors was collected via structured interviews with mothers or proxy respondents. Six subtests from the Cambridge Automated Neuropsychological Battery (CANTAB), were used to assess three aspects of child EF namely: (1) processing speed, assessed by the MOT and RTI subtests, (2) attention, assessed by the MTT and RVP subtests and (3) memory, assessed by the SWM and PAL subtests. Findings. For all three maternal alcohol use behaviours examined, there was an apparent non-significant trend whereby children of mothers who reported alcohol use (before, during and after pregnancy) performed worse (on average) than children of mothers reporting non-alcohol use on the EF subtests. Several of the socio-demographic factors were found to act as significant predictors of subtest specific EF performance including child sex (RTI: B=.46, p<. 01; MTT: B=.05, p<.05), child age (RTI: B=.27, p<.05; MTT: B=.11, p<.01), home language (MOT: B=- .13, p<.05), maternal employment (MTT: B=-.04, p<.05) and household size (SWM: B=-1.29, p<.05). Conclusions. These study findings provide initial insights into the impacts of different types of maternal drinking behaviours and related socio-demographic factors on child EF outcomes within the context of an LMIC, South Africa.
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Yuan, Ling. "Intra-industry trade between Sweden and middle income countries." Thesis, KTH, Samhällsekonomi, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-98301.
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Liu, Zhaorui. "Economic costs of dementia in low and middle income countries." Thesis, King's College London (University of London), 2013. https://kclpure.kcl.ac.uk/portal/en/theses/economic-costs-of-dementia-in-low-and-middle-income-countries(9d90e06c-022d-4db0-a877-e84f859531e4).html.
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The aim of the study is to assess the impact of dementia in low and middle income countries (LAMICs) on service and family costs and to assess the impact of dependency and other factors on costs. A prevalence-based bottom up cost-of-illness study was carried out using the database of the 10/66 dementia project in seven LAMICs (11sites, n=15,022). The total cost was divided into cost of medical care, informal care and paid home care. The perspective of costs included both the public and private level. Cost of medical care at the private level was the out-of-pocket expenses. Health service use was valued according to country specific unit cost based on UK unit costs and WHO-CHOICE ratios. Cost of informal care at the private level was valued based on real salary loss and on average wages at the public level. Regression models were used to identify predictors of cost and attributable costs of dementia. The results showed that the average total costs for people with dementia were I$1887 at the private level and I$6750 at the public level. At the public level, 94% of total costs were due to social care, and 90.4% of social care costs were due to informal care. Physical impairment and Behavioural and psychological symptoms of dementia (BPSD) led to higher costs of informal care, but not for medical care. Average attributable costs of dementia were I$5164, and were higher than for depression and other chronic diseases. Costs increased with dementia severity. Estimates of total dementia costs are substantial and most of the care is due to support from unpaid family members. Interventions should be introduced both for dementia patients and their carers in the early stages of the condition dementia, so as to decrease the cost as well as improving quality of life.
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Seuring, Till. "The economics of type 2 diabetes in middle-income countries." Thesis, University of East Anglia, 2017. https://ueaeprints.uea.ac.uk/63278/.
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This thesis researches the economics of type 2 diabetes in middle-income countries (MICs). Given the high prevalence of type 2 diabetes in MICs, in-depth country specific analysis is key for understanding the economic consequences of type 2 diabetes. The thesis consists of four studies with the unifying theme of improving the understanding of the causal impact of diabetes on economic outcomes. Study (1) provides an updated overview, critically assesses and identifies gaps in the current literature on the economic costs of type 2 diabetes using a systematic review approach; study (2) investigates the effects of self-reported diabetes on employment probabilities in Mexico, using cross-sectional data and making use of a commonly used instrumental variable approach; study (3) revisits and extends these results via the use of a fixed effects panel data analysis, also considering a broader range of outcomes, including wages and working hours. Further, it makes use of cross-sectional biomarker data that allow for the investigation of undiagnosed diabetes. Study (4) researches the effect of a diabetes diagnosis on employment as well as behavioural risk factors in China, using longitudinal data and applying an alternative identification strategy, marginal structural models estimation, while comparing these results with fixed effects estimation results. The thesis identifies a considerable economic burden of diabetes in middle-income countries and uncovers several inequities affecting women, the poor and the uninsured. Biomarker results indicate that the adverse effects are limited to those aware of their diabetes. Finally, women are also found to achieve fewer positive changes of their behavioural risk factors after a diabetes diagnosis than men, offering a potential explanation for their more adverse employment outcomes compared to men. To reduce the economic burden, the groups most affected by the identified inequities should be targeted. Further, the underlying reasons for the found sex differences need to be identified.
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Sinclair, David Jonathan. "Towards evidence-based malaria guidelines in low- and middle-income countries." Thesis, University of Warwick, 2017. http://wrap.warwick.ac.uk/98542/.
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This PhD submission presents a case study of an academic group working as infomediaries at the interface between research and global policy, and at the interface between global policy and national decisions: advising on methodological issues, conducting systematic evidence reviews in response to information needs, and developing approaches for reinterpreting global guidance for national decision-making. The included systematic reviews were among the first to adopt innovative elements such as: summary of findings tables, standardized language reflecting the level of certainty in effect estimates, logic frameworks, and brief economic summaries; and have contributed to the further development of these methods. This work has helped to establish formal and transparent methods within global malaria guidance, and contributed to improved standards in global guidance more broadly.
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Owusu, Daniel, Megan Quinn, K. Wang, J. Aibangbee, S. Veeranki, and H. Mamudu. "Intention to Quit Smoking in 14 Low and Middle Income Countries." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/6790.
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Blecher, Evan. "The economics of tobacco control in low- and middle-income countries." Doctoral thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/10115.
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Includes bibliographical references (p. 174-189).Global best practice in tobacco control policy is anchored by the Framework Convention on Tobacco Control which recommends that countries use, amongst other things, tax increases and advertising bans to reduce tobacco consumption. Furthermore, this is supplemented by various policy documents and technical manuals produced by the World Health Organisation and the World Bank which provide a more thorough justification of these policy measures. This thesis seeks to examine the application of these tobacco control policy measures on tobacco consumption in low and middle-income countries. The thesis focuses on tax policy in low- and middle-income countries by moving the metric from price to affordability (which considers price and income simultaneously). This is important since many low- and middle-income countries are growing rapidly and price increases may not be reducing consumption.
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Rahman, Mohammed Mahbubur. "Urban lower-middle- and middle-income housing : an investigation in affordability and options, Dhaka, Bangladesh." Thesis, University of Nottingham, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.280106.
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Ngo, Ngoc Qui. "FDI and Economic Growth : An Empirical Study of Lower-middle Income Economies." Thesis, Högskolan i Jönköping, Internationella Handelshögskolan, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-44025.
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Within a panel data context with fixed effects method, using data on a sample of 40 lower- middle income economies, this paper investigates whether and to what extent FDI stimulates economic growth over the period 2007-2017. The main finding of this paper highlights the complementary effects between FDI and education, suggesting that a certain level of education must be reached in order for FDI to contribute positively on economic growth. Further, the level of education in this sample set is below the level that is considered as adequate in order to spur economic growth and thus this affects the absorptive capacity. This paper can only confirm that there is a certain association between FDI and economic growth and cannot confirm the widespread belief that FDI stimulates economic growth due to that the estimated models more often than not provided insignificant results.
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Forsberg, Birger C. "Diarrhoeal diseases in low- and middle-income countries : trends, management and control /." Stockholm, 2007. http://diss.kib.ki.se/2007/978-91-7357-263-7/.
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Houweling, Antonia Jannetje. "Socio-economic inequaltities in childhood mortality in low and middle income countries." [S.l.] : Rotterdam : [The Author] ; Erasmus University [Host], 2007. http://hdl.handle.net/1765/11023.
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SROUR, ILINA MOUSTAFA. "TRADE LIBERALIZATION, TECHNOLOGY TRANSFER AND EMPLOYMENT IN MIDDLE AND LOW INCOME COUNTRIES." Doctoral thesis, Università Cattolica del Sacro Cuore, 2014. http://hdl.handle.net/10280/4373.
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Negli anni ’80, paesi in via di sviluppo (DCs) e paesi meno sviluppati (PMS) hanno subito cambiamenti strutturali, muovendosi da politiche di sostituzione di importazione a strategie di liberalizzazione. Questi paesi hanno assistito ad una crescita dinamica risultata dall’aumento della produttività dovuto alla maggiore esposizione delle industrie locali alla concorrenza, dall'aumento delle importazioni tecnologiche incarnate in capitale e in beni intermedi, e ad una maggiore diffusione di conoscenze e informazioni. Questo lavoro esamina come liberalizzazione commerciale ed aggiornamento tecnologico abbiano influito sull’occupazione in paesi DCs e PMS, e studia il fenomeno del cambiamento tecnologico skill biased. Si esaminano il settore manifatturiero turco tra il 1980-2001 e quello etiope tra il 1996-2004. Questo studio, basato sul System Generalized Method of Moments (GMM-SYS), implementa un quadro dinamico di due equazioni che raffigurano tendenze occupazionali a livello enterprise per lavoratori qualificati e non qualificati. I risultati confermano l'aspettativa teorica che DCs e LDC affrontano fenomeni di skill-biased technological change e incrementano il potere d’importazione di tecnologia, aumentando il divario d’occupazione tra lavoratori qualificati e non qualificati. Tuttavia, le cause specifiche di skill-bias e la portata del loro effetto possono variare in base a diverse infrastrutture istituzionali e capacità nazionali.In the 1980's developing countries (DCs) and least developed countries (LDCs) underwent structural changes, moving from import substitution policies to liberalization strategies. These countries witnessed a dynamic growth effect that emerges from productivity growth due to increased exposure of local industries to competition, increased technological imports embodied in capital and intermediate goods, and to the transfer of knowledge. This work looks into the employment impact of trade liberalization and technological upgrading in DCs and LDCs, and studies the phenomenon of skill biased technological change in those countries. It takes the case of the Turkish manufacturing sector for the period 1980 - 2001, and the case of the Ethiopian manufacturing sector for the period 1996 - 2004. It deploys System Generalized Method of Moments (GMM-SYS) procedure to this effect, implementing a two-equation dynamic framework that depicts enterprise-level employment trends separately for skilled and unskilled workers. The results confirm the theoretical expectation that DCs and LDCs face the phenomena of skill-biased technological change and skill-enhancing technology import, both leading to increasing the employment gap between skilled and unskilled workers. However, the specific determinants of skill bias and the size of their effect can differ due to diverse institutional infrastructures and national capabilities.
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Burns, Darren. "Foreign direct investment and population health in low and middle income countries." Thesis, University of East Anglia, 2018. https://ueaeprints.uea.ac.uk/67678/.
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Opinions are divided on the health impacts of multi-national corporations (MNCs), and their foreign direct investment (FDI) projects in low and middle income countries (LMICs). MNCs in LMICs have been associated with unsafe or unsanitary working conditions, pollution, and aggressively marketing of unhealthy foods. This suggests a harmful impact on population health. Yet, FDI also generates employment, income, and growth, implying some benefits to population health. FDI flows may not be the only factor determining their ultimate impact on health. It is currently unclear whether FDI into different industries or whole sectors is related to health impacts, and also whether geographic clustering of FDI is associated with an impact on population health. The relationship between FDI and population health is investigated here, beginning with a systematic review of quantitative literature surrounding international trade and non-nutritional health outcomes. This highlights four important messages: FDI is likely a determinant of health in LMICs; the importance of sample selection and considering heterogeneity; bi-directional causality between FDI and health; and the underuse of individual level datasets to investigate the association. Later chapters seek to respond in different ways to these messages, firstly using instrumental variable methods to investigate FDI and overall population health in LMICs. This indicates FDI to be associated with overall population health benefits, yet provides some evidence that manufacturing FDI is associated with harm. The second study utilises individual level data and spatial techniques to investigate FDI and nutritional health in Chinese adults, indicating that FDI is positively associated with increased BMI amongst Chinese adults. The final study investigates FDI and smoking in Russian adults, suggesting that FDI is associated with increased smoking. Overall, this thesis suggests that FDI has a positive effect in general on overall health, yet is harmful when looking in more specific contexts.
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Razafimandimby, Andrianjaka Riana Ny Aina. "Three essays on economic transformation and distributional changes in middle-income countries." Thesis, Bordeaux, 2019. http://www.theses.fr/2019BORD0364.
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Cette thèse explore les changements économiques et distributifs dans les pays à revenu intermédiaire. Le premier chapitre propose une analyse empirique des déterminants de la trappe à revenu intermédiaire en mettant l’accent sur les problématiques d’appariement sur le marché du travail, d’inégalités de revenu et de redistribution. Les deux chapitres restant se concentrent sur la question des classes moyennes émergentes. Le deuxième chapitre s’intéresse aux impacts macroéconomiques de l’expansion de la classe moyenne globale sur le développement à travers divers canaux dont la consommation, l’investissement, les dépenses publiques et la transformation productive. Le dernier chapitre adopte une démarche microéconomique et examine la mobilité absolue et inter-classe de la classe moyenne Turque entre 2010 et 2013. Nos résultats suggèrent que des mécanismes de reproduction sociale et de (dés) avantages cumulatifs déterminent la mobilité économique de certains ménagesThis thesis studies distributional and economic changes in middle-income countries. After reviewing the literature on the middle-income trap, the first essay proposes a straightforward identification and empirical investigation of the differentiating patterns of productive and distributive changes inside the trap. We find evidence of misallocation issues and adverse effect of redistribution on medium-run growth. The focus of the remaining chapters is then put on the middle-class. In the second essay, we estimate the impacts of the middle-class on growth through various channels including household consumption, investment, redistribution and productive transformation. The last essay takes a micro approach by analyzing absolute and intra-class mobility of the middle-class in Turkey between 2010 and 2013. The results suggest the existence of mechanisms of social reproduction and cumulative (dis)advantages that prevent some households from climbing up the ladder
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Edlund, Karolina. "Does economic freedom affect the growth rate? : Evidence from middle-income countries." Thesis, Umeå universitet, Nationalekonomi, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-138390.
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Despite half a century of aid programs, many countries have not shown a sufficient degree of economic development, leaving their population in poverty. The varying level of productivity has contributed to these dissimilarities and many economists argue that the degree of freedom experienced by citizens is the underlying source of differences in productivity, as it influences the freedom to perform economic activity. In this study, I examine the effect economic freedom has on the growth rate in middle-income countries. Liberal economists are arguing that higher degree of freedom surrounding economic activities is fundamental for economic growth. This point of view is largely adopted by a major lender to less developed countries; the IMF. Common conditions for loans provided by the IMF is to decrease the size of government, privatize public companies, and open up the nation to international trade. I my analysis, including 48 middle-income countries, I test whether these variables affect the economic growth though regression analysis during the years of 2000 to 2014. My results show that economic freedom is an important factor for economic growth, but that the components of economic freedom have different effects on the growth rate. Furthermore, the results differ greatly when comparing the richer and the poorer sections of middle-income countries. I find no evidence that the conditions of the IMF is a good model for development, rather that the countries have different characteristics and are affected differently. The legal system and respect for property rights is shown to have a positive effect on growth, as well as regulating the product, capital, and labor market, while high inflation is associated with low economic growth.
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Hartono, Arif. "Innovation in middle-income and high-income countries : a comparative study of Indonesia and UK manufacturing firms." Thesis, University of Warwick, 2017. http://wrap.warwick.ac.uk/99344/.
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This PhD thesis aims to investigate innovation activities in developing and developed countries and it comprises three papers. More specifically, it compares innovation activities between manufacturing firms in Indonesia and in the UK. The first paper (Chapter 2) aims to identify and compare the variations in the knowledge sourcing strategies (KSS) employed, and innovation barriers faced, by manufacturing firms in high-income (HI) and middle-income (MI) countries by using global innovation data derived from the UNESCO Institute of Statistics (UIS). The paper shows that manufacturing firms in HI and MI income countries have different types and levels of KSS. Knowledge from internal R&D is sourced more frequently by manufacturing firms in HI countries than by their counterparts in MI countries. While external knowledge from government or public research institutes; conference, trade fairs and exhibitions; scientific journals and trade/technical publications are sourced more frequently by manufacturing firms in MI countries. This paper also reveals that manufacturing firms in MI countries face greater innovation barriers internally and externally than those in HI countries. Internally, manufacturing firms in MI countries face greater obstacles related to costs/funding and knowledge. Externally, firms in MI countries face greater constraints related to costs/funding, knowledge, the market and other reasons in regard to not innovating than their counterparts in HI countries. Lastly, innovation policy implications are drawn from this paper. The second paper (Chapter 3) investigates and models the innovation value chain (IVC) that encompasses knowledge sourcing, transformation, and exploitation activities among Indonesian manufacturing firms by using data from the Indonesia Innovation Survey (IIS) 2011. This paper is different from the previous IVC studies in a number of ways. First, in this study a range source of knowledge (i.e. R&D activities, informal interactions with various external actors, and formal cooperation with various external partners) is tested. Second, the relationship between a wide range of innovation barriers and the IVC, which to date has received little attention, is also investigated. Lastly, wider innovation (i.e. organisational and marketing innovation) is assessed. The study finds the existence of a synergistic relationship between internal and external sources of knowledge as well as among external sources of knowledge in the first link of the IVC. In terms of the second link of the IVC, internal R&D plays an important role that positively influences knowledge transformation into all types of innovation and innovation success. External knowledge that has a similar pattern in shaping innovation mainly comes from market/commercials (i.e. customers and competitors), open sources (i.e. events) and formal cooperation with suppliers. Scientific institutions tend to contribute to innovation in a negative manner, and few positive impacts on process innovation are observed from government R&D and non-profit R&D institutions. The study also finds that informal knowledge is more strongly associated with innovation and innovation success than formal knowledge. Both informal knowledge and formal cooperation are more likely to influence traditional innovation (i.e. product and process innovation) than wider-innovation (i.e. organisational and marketing innovation). In general, the hampering factors with regard to innovation are financial and knowledge factors. Striking findings in the last link of the IVC are innovation new to the market, innovation new to the firm, and innovation success do not lead to the firms’ performance. Lastly, relevant innovation policies are drawn from this paper. The third paper (Chapter 4) compares the IVC which consists of knowledge sourcing, transformation, and exploitation performed by Indonesian and UK manufacturing firms. This study is worthwhile for the following reasons. First, despite comparative studies on the IVC not being new to the literature, it is interesting to understand and compare the IVC between developing and developed economies as up to now, this has not been done. This study provides a new insight on a micro-level analysis of the IVC comparison between developing and developed countries by modelling which specific knowledge is sourced by firms, the impact of the sourced knowledge on innovation, and the impact of innovation on firms’ performance. Second, this study investigates a broader source of knowledge that is classified into R&D activities, informal knowledge and formal cooperation. Third, implementing traditional innovation in isolation has been criticised, and hence, in this study the impact of knowledge transformation on both traditional and wider innovation as well as the exploitation of both types innovation on firms’ performance is tested. In terms of the first link in the IVC, for both countries, synergistic relationships exist within and between each group source of knowledge (i.e. R&D, informal knowledge and formal cooperation). However, the nature of these complementarities tends to differ across the two countries. In regard to the second link in the IVC, in UK firms, both internal and external R&D appear to have a direct impact on innovation. While for Indonesia, the positive and significant impact of internal R&D on diverse types of innovation is stronger than that of external R&D; informal knowledge sourced from market/commercials makes a greater contribution to innovation and innovation success for Indonesian firms than UK firms. By contrast, formal cooperation provides a greater contribution to innovation for the UK than for Indonesia. However, such cooperation is more likely to be conducted with market/commercials network. In terms of the last link in the IVC, there is no single positive and significant contribution in terms of the link between product innovation (including new to the market and firm innovations) and firms’ performance, or between innovation success and firm performance in either country. In addition, for both countries, different types of innovation affect firms’ performance differently. For Indonesian firms, both traditional and wider innovation positively and significantly impact firms’ performance, while for UK firms only traditional innovation that has such effect.
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Chundu, Mwanja. "Perceived parenting style and suicidal/Non-suicidal self-Injury in students at the University of Cape Town." Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/33601.
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Background: Low- and middle-income countries like South Africa carry the greatest suicide burden, with local general population suicide attempt rates of 2.9–22.7%, in comparison to 0.7–9% in international literature. Non-suicidal self-injury (NSSI) commonly co-occurs with suicidal behaviours and estimates range from 5.5% internationally to 19.4% in South Africa. As a subgroup of the general population, university students are at higher risk both of suicidal behaviours and NSSI (S/NSSI). Risk factors for S/NSSI include parenting style; however, very little is known about the relationship between parenting styles and S/NSSI in university students in the South African context. Objectives: In this dissertation we set out to perform a literature review relating to explanatory models and risk factors associated with S/NSSI and then proceeded to collect novel data from students at the University of Cape Town. This research study aimed to describe the rates of S/NSSI behaviours and to explore the relationship between the Baumrind parenting style typography and S/NSSI in university students. The study hypothesised that authoritative parenting would negatively correlate with S/NSSI. No a priori hypotheses were made about the other parenting styles investigated. Methods: In chapter 1, we performed a literature review of peer-reviewed publications on Pubmed, Psychinfo via EBSCOHost and MEDLINE via EBSCOHost identified through search terms that were relevant to the focus of the study. In chapter 2 novel data were collected. Students from all faculties at the University of Cape Town were invited to complete an anonymous, online electronic survey. Data collection included a socio-demographic questionnaire, Parenting Styles and Dimensions Questionnaire and Self-Harming Behaviours Questionnaire. Descriptive statistics quantified parenting styles, suicidal behaviours and NSSI. Spearman's correlation coefficients examined the association between parenting style and S/NSSI. Results: Literature review provided a topline review of explanatory models and risk factors associated with S/NSSI and identified relevant literature about parenting styles using the Baumrind typology. In the electronic survey of university students, the rate of suicidal attempts was 6.3% and of NSSI was 22.7%. Suicide threats, suicidal thoughts, and thoughts of dying were reported by 5.9%, 35.7% and 50.7% respectively. No significant differences were seen between male and female students. We observed no significant association between authoritative parenting and suicidal behaviours, but authoritative mothers and fathers were significantly associated with a history of NSSI. Both permissive mothers and fathers were associated with suicide attempts, threats, and thoughts, whereas only permissive mothers were associated with NSSI. Conclusion: This study replicated previously reported high rates of S/NSSI in South African university students in comparison to general population and international data. Contrary to our hypothesis, authoritative parenting style was positively correlated with NSSI, but not with suicidal behaviours. Further studies are warranted to examine parenting style, and permissive parenting, in particular, in relation to S/NSSI
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Allaby, Martin Arnold Kenworthy. "Economic inequality, corruption and the Christian churches in low- and middle-income countries." Thesis, Oxford Centre for Mission Studies, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.732940.
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Nindl, Elisabeth. "An empirical assessment of Fairtrade: A perspective for low-and middle-income countries?" WU Vienna University of Economics and Business, 2014. http://epub.wu.ac.at/4069/1/wp160.pdf.
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This paper presents the first cross-country empirical evidence on the determinants of participation
in Fairtrade and the impact of the export of Fairtrade certified products on
agricultural growth in low- and middle-income countries. Using the number of certified
producer organizations per country in 2006-2010 as a proxy for Fairtrade exports, estimation
results indicate a small but significantly positive effect on the growth rate of per
capita value added in agriculture that is largest in upper middle income countries. Given
the particularly poverty-reducing effect of agricultural growth, we find empirical evidence
that Fairtrade certification is indeed able to deliver its core values, but misses to target
the very poor. (author's abstract)Series: Department of Economics Working Paper Series
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Diaconu, Karin-Daniela. "Methods for medical device and equipment procurement in low and middle-income countries." Thesis, University of Birmingham, 2016. http://etheses.bham.ac.uk//id/eprint/7063/.
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40-70% of medical devices and equipment in low- and middle-income countries (LMICs) are broken, unused or unfit for purpose: ad-hoc, undiscerning and inefficient procurement methods and processes contribute towards this problem. This thesis presents the findings of four original studies on medical device and equipment procurement within LMICs. Chapter I reports findings of a systematic literature review on procurement and prioritization methods; recommendations from reviewed literature are synthesised. Chapter II describes fieldwork conducted in The Gambia and Romania to explore the processes and dynamics behind medical device procurement in contrasting settings. Findings suggest procurement processes are strongly influenced by political/cultural power dynamics; health technology assessment evidence is rarely considered. Chapter III discusses the feasibility of conducting medical device specific economic evaluations for informing procurement planning. A case study on the costeffectiveness of alternative treatment interventions for femur-shaft fracture fixation in Sub-Saharan Africa is presented. Chapter IV consists of a critical appraisal of the medical device specific elements of the One Health Tool for health system planning. The thesis concludes with a discussion contextualizing the findings and suggestions for further research.
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Sosa-Ortiz, Ana Luisa. "Constructs underlying mild cognitive impairment of relevance to low and middle income countries." Thesis, King's College London (University of London), 2012. https://kclpure.kcl.ac.uk/portal/en/theses/constructs-underlying-mild-cognitive-impairment-of-relevance-to-low-and-middle-income-countries(894f3523-9196-47cb-91ab-6b7e4aa6b037).html.
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Background: Numbers of older people are increasing rapidly in most low and middle income countries and there is a pressing need for adequate information on dementia and cognitive disorders in these regions. Mild cognitive impairment is increasingly recognized as an important ‘transition’ prior to dementia onset, but is poorly understood outside Western settings, as are key constructs underlying this concept: namely, subjective memory complaints, informant-reported memory deficits and the relationship between cognition and disability. Methods: Data were analysed in relation to these questions from a series of catchment area surveys of older people carried out following identical methodologies in Cuba, Mexico, Dominican Republic, Peru, Venezuela, India and China, involving over 15,000 participating residents aged 65 years and over. Measurements had been rigorously assessed for cross-cultural applicability and were identically administered. Results: Normative data for cognitive function are described and compared, followed by the prevalence of amnestic mild cognitive impairment. Substantial variations were found between sites in the prevalence of subjective memory complaints and informant-reported memory deficits, and in their associations with dementia, and with cognitive function in participants without dementia. Variation was also found in the association between cognitive function and informant-reported disability in participants. For example, subjective memory complaints in China were relatively rare but much more strongly associated with dementia and/or cognitive function than in other sites. Conclusions: The high level of between-site variability in the associations in question suggests that mild cognitive impairment as a construct is strongly influenced by cultural factors which need to be taken into account when interpreting it or applying it in healthcare.
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Nyarkoa, Renaity, and Ibrahim Kaya. "The Impact of Financial Development on the Environment : Focus on Middle-Income Countries." Thesis, Linköpings universitet, Nationalekonomi, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-177991.
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Taylor, Jennifer. "Exploring Pediatric Healthcare Initiatives of Non-Governmental Organizations in Low-and Middle-Income Countries." Thesis, Université d'Ottawa / University of Ottawa, 2020. http://hdl.handle.net/10393/40670.
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Objective: To explore and describe how healthcare non-governmental organizations provide and evaluate programs and services that result in positive and sustainable health outcomes in children and adolescents living in low-and middle-income countries and to better understand the role of nursing within these organizations.
Scoping Review: A scoping review informed by the Arksey & O’Malley framework was completed to explore the research on the delivery of pediatric health services by non-governmental organizations in low-and middle-income countries.
Qualitative Study: Semi-structured interviews were conducted to share the voices and experiences of stakeholders working in the field of NGO practice to provide clarity, further insight and depth to the results from the scoping review and broaden the understanding of the role of nursing on this topic.
Conclusions: Despite variability in practice and a multitude of competing priorities, outcome evaluation is growing within the field of pediatric NGO practice, and progress is being made towards evaluation of broader health outcomes besides unidimensional health indicators or outputs. Nurses can play a significant role in improving pediatric NGO program development and evaluation practices and are well positioned to be global health leaders who can influence policy and practice for the achievement of positive and sustainable health outcomes in children and adolescents in low-and middle-income countries.
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Calistus, Wilunda. "Caesarean delivery and anaemia risk in children in 45 low- and middle- income countries." Kyoto University, 2018. http://hdl.handle.net/2433/232310.
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Barroy, Hélène. "Toward Universal Health Coverage : Assessing Health Financing Reforms in Low and Middle Income Countries." Thesis, Clermont-Ferrand 1, 2014. http://www.theses.fr/2014CLF10459.
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La Couverture Santé Universelle (CSU) vise permettre à chaque individu d’utiliser les services de santé dont il a besoin sans risque de ruine financière ou d’appauvrissement. Bien que le concept de CSU offre un cadre directeur important pour une nation, tous les pays, quel que soit leur niveau de revenu, sont aux prises avec la réalisation ou le maintien de la couverture universelle. Dans ce contexte, générer des preuves sur les expériences des pays et partager les leçons sur les principales contraintes et les choix stratégiques utilisés pour surmonter les barrières techniques serait susceptible de permettre aux pays à revenus faibles ou intermédiaires d’aller de l'avant et de progresser plus rapidement vers la CSU. La thèse propose une analyse comparative de plusieurs instruments politiques, utilisés par cinq cas pays (Niger, Vietnam, Bangladesh, Gabon, France), pour étendre la couverture sanitaire et la protection financière. L’analyse montre que les interventions simples, comme la suppression des frais des utilisateurs (Niger) ou de l'assurance santé à base communautaire (Bangladesh), peuvent accroître l'utilisation des services pour les groupes les plus défavorisés, mais font face à de fortes limitations dans l’atteinte de plus grandes ambitions. Des réformes plus articulées ont démontré des gains importants dans le développement de la couverture santé, mais font également face à des défis pour trouver l'espace budgétaire suffisant (Gabon) et améliorer l’efficience et l'équité du système (Vietnam). Enfin, la thèse analyse les effets de différentes réformes utilisées pour maintenir les gains de la CSU dans des systèmes de santé mûrs, tel que la France. Dans l'ensemble, la thèse a démontré que le menu des réformes vers la couverture universelle est vaste, complexe et perpétuel mais que certains chemins peuvent conduire au succèsUniversal Health Coverage (UHC) is to ensure that everyone can use the health services they need without risk of financial ruin or impoverishment. While the UHC concept offers a powerful framework for a nation, all countries, irrespective of their income level, are struggling with achieving or sustaining universal coverage. In this context, generating evidence about countries’ experiences and sharing lessons on key constraints and strategic choices used to overcome technical barriers would likely enable low-and-middle countries to move forward and make faster progress toward UHC. The thesis provides a comparative analysis of policy instruments used by five selected country cases (Niger, Vietnam,Bangladesh, Gabon and France), to expand health coverage and financial coverage. Analysis shows that single interventions, like user fee removal (Niger) or community-based insurance (Bangladesh), can increase service utilization for the most disadvantaged groups but face strong limitations toward greater ambitions. More articulated reforms have demonstrated significant gains in expanding health coverage but also face challenges in finding the adequate fiscal space (Gabon) and in strengthening system’s efficiency and equity (Vietnam). Finally, the thesis analyzed the effects of different reforms used to sustain gains of UHC in mature health systems, like France. Overall, the thesis demonstrated that the reform agenda for universal coverage is large, complex and perpetual but that certain pathways can ensure success
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McCabe, Chris. "Training of Community Health Workers: Recognition of Maternal, Neonatal and Pediatric Illness." Thesis, The University of Arizona, 2017. http://hdl.handle.net/10150/623487.
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A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.This systematic review focuses on improving recognition and treatment of acute medical conditions in pregnant women, infants and children in low and middle income countries by Community Health Workers (CHWs). By examining critically selected articles from different electronic databases, this review seeks to organize and present the important characteristics of a training program aimed at reducing maternal, neonatal and childhood mortality. Data in the form of peer‐reviewed and published articles were collected using three public databases – PubMed, Ovid and EMBASE – using specific search terms. Greater than 300 articles where found using the specific search terms. Those articles were then processed through a series of inclusion and exclusion criteria resulting in a cohort of papers which were then individually analyzed for content. After critical analysis of all 15 publications included in the study, it becomes clear that training programs are incredibly diverse. These four aspects of training programs appear to be the most variable between the studies: size of the training program, length of the training program, training assessment and follow‐up refresher courses. Training programs that are shorter in duration or greater in class number do not seem to be any less effective than longer programs with fewer participants. Future studies should be performed in which one training program with identical training techniques, lengths, and focuses is taught in different regions. The impact that this study has on the literature is as follows: Training programs of shorter duration seem to be as effective as their longer counterparts. Finally, there is a clear need for more robust, standardized and geographically and culturally diverse training programs to more effectively study training methods.
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Yuen, Shan-shan Rebecca, and 袁珊珊. "Promotion of home ownership for middle-and lower-income classes in Hong Kong: alternative methods." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1997. http://hub.hku.hk/bib/B31259571.
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Yuen, Shan-shan Rebecca. "Promotion of home ownership for middle-and lower-income classes in Hong Kong : alternative methods /." Hong Kong : University of Hong Kong, 1997. http://sunzi.lib.hku.hk/hkuto/record.jsp?B19131094.
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Curto, Tirado Ariadna 1987. "Exposure to air pollution and links with cardiometabolic health in low- and middle-income countries." Doctoral thesis, Universitat Pompeu Fabra, 2019. http://hdl.handle.net/10803/666202.
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The aims of this thesis are: 1) to evaluate the performance of low-cost air quality monitors to monitor long-term exposure in rural areas from low- and middle-income countries; 2) to identify the determinants of personal air pollution exposure among women from a semi-rural area in Mozambique; and 3) to evaluate the associations between long-term exposure to ambient air pollution and cardiometabolic health in adults from a peri-urban area in India. We used data from: an experimental study, an observational study, and a cross-sectional epidemiologic study (CHAI). Main results: 1) the performance of low-cost monitors is not reliable yet to replace more expensive research-grade monitors; 2) kerosene-based lighting increased personal air pollution exposure in women from Mozambique; 3) long-term air pollution is associated with elevated blood pressure in women from India; and 4) we found no evidence that long-term air pollution is associated with higher blood glucose levels in peri-urban India.Els objectius d’aquesta tesi són: 1) avaluar el rendiment dels monitors de qualitat de l’aire de baix cost per monitoritzar l’exposició a llarg termini en àrees rurals en països de renda baixa o mitjana; 2) identificar els determinants de l’exposició personal a la contaminació de l’aire en dones d’una àrea semi-rural de Moçambic; i 3) avaluar les associacions a llarg termini entre l’exposició ambiental a la contaminació de l’aire i la salut cardiometabòlica en adults d’una àrea peri-urbana de la Índia. Hem utilitzat dades provinents de: un estudi experimental, un estudi observacional i un estudi epidemiològic transversal (CHAI). Resultats principals: 1) el rendiment de monitors de baix cost encara no és prou fiable per reemplaçar a monitors més cars i establerts en recerca; 2) la il·luminació amb querosè va incrementar l’exposició personal a la contaminació de l‘aire en dones de Moçambic; 3) l’exposició a llarg termini de la contaminació de l’aire està associada a una major pressió arterial en dones de la Índia; i 4) no hem trobat evidència que la exposició a la contaminació de l’aire estigui associada a nivells més alts de glucosa en sang a la Índia peri-urbana.
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Dorvil, Louigueur. "Private sector participation in integrated sustainable solid waste management in low- and middle income countries." kostenfrei, 2007. http://www.unisg.ch/www/edis.nsf/wwwDisplayIdentifier/3381.
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Tapsoba, Palingwindé Yann. "Sustainable health financing for progress towards universal health coverage in low- and middle-income countries." Thesis, Université Clermont Auvergne (2017-2020), 2017. http://www.theses.fr/2017CLFAD022/document.
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Cette thèse s’intéresse aux questions de soutenabilité dans le financement de la santé au sein des pays à revenus faible et intermédiaire. Elle est articulée autour de quatre chapitres. Les deux premiers chapitres proposent respectivement d’explorer les déterminants de l’efficience technique des dépenses de santé et de leur niveau par habitant dans les pays à revenus faible et intermédiaire. Le premier chapitre analyse l’effet de l’ouverture commerciale sur l’efficience technique des dépenses de santé. Le second chapitre étudie l’effet de la pollution de l’air sur les dépenses de santé. Dans les deux derniers chapitres, nous nous focalisons sur les pays d’Afrique subsaharienne. Le troisième chapitre étudie le rôle que joue le financement prépayé de la santé pour l’amélioration de la santé dans les ménages tandis que le quatrième chapitre se fixe pour objectif d’analyser les déterminants des dépenses prépayées de santé en se focalisant plus particulièrement sur l’instabilité politiqueThis thesis focuses on the sustainability issues in health financing in low-and middle –income countries. It is articulated around four chapters. The two first chapters propose to respectively explore the determinants of technical efficiency of health expenditures and their level per capita in low-and middle –income countries. The first chapter analyzes trade openness effect on the technical efficiency of health expenditures. The second chapter investigates air pollution effect on health expenditures. In the two last chapters, we focus on Sub-Saharan African countries. The third chapter studies the role that plays prepayment health financing for health improvement in households whereas the fourth one sets the goal to analyze the determinants of prepayment health expenditures, by particularly focusing on political instability
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Walker, Damian. "Efficiency of primary health care in low and middle-income countries : case studies from Bangladesh." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2006. http://researchonline.lshtm.ac.uk/878721/.
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Most of the research concerned with the economics of health systems has focussed on allocative efficiency. Specifically, much effort has been devoted to the development and application of techniques of economic evaluation. The consideration of technical efficiency has figured less prominently in the search for 'solutions' to the problems of health systems. Those working on the economic evaluation of health care interventions have adopted the assumption that interventions are being, or will be, produced in a technically efficient manner. The aim of this thesis is to challenge this assumption and illustrate the potential implications of assuming technical efficiency when allocating scarce resources. Two case studies from Bangladesh are presented: vaccination services in Dhaka City and primary health care in rural Bangladesh. The specific objectives of this thesis are to: estimate the cost of these services using standard costing methods; and analyse the same data sets using parametric (stochastic frontier analysis) and non-parametric (data envelopment analysis) techniques in order to identify whether, and to what degree, the services were being delivered efficiently. Applying efficiency measurement techniques illustrated that standard costing methods disguise a high degree of inefficiency. By investigating production practices, costs related to inefficiencies can be identified and addressed. The thesis illustrates that if something is deemed worth doing then it should be carried out in a way which ensures the optimum use of scarce resources. An exclusive focus on switching resources from less cost-effective to more cost-effective activities will not realise the full benefits in terms of improved allocative efficiency if providers on the ground are not producing services at lowest cost. Recommendations are made for policy-makers on how technical efficiency can be improved. Recommendations for future research are also made.
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Shine, Ritta Sabbas. "Donor funding and crowding out of public spending: Evidence from low and middle-income countries." Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/29047.
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In many low-resource settings agricultural output and public spending on agriculture are in decline, raising questions about the effectiveness of agricultural aid. To understand why these trends are occurring, we examined factors that affect the share of government spending on agriculture. Using a sample of 66 low- and middle-income countries from 1996-2010 we use dynamic panel regression models to explore: (1) the impact of agricultural aid on public expenditure to agriculture, and (2) the impact of aid on domestic resource mobilisation, which indirectly affects public expenditures. Our results provide evidence of a strong substitution effect, especially in low-income countries, suggesting aid to agriculture is treated as fungible. We also found evidence that aid loans resulted in higher tax revenues, while aid grants decreased tax effort, which may account for decreasing public investment in agriculture. To improve aid effectiveness, donors need to work with recipients to understand country needs and the fiscal environment of the receiving government.
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Amponsah-Dacosta, Edina. "Health systems constraints and facilitators of national immunization programs in low- and middle- income countries." Master's thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/31311.
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Like most health interventions, National Immunization Programs (NIPs) are embedded within health systems. This means that NIPs and health systems exist in a constant interaction. Vaccine preventable diseases are widely recognized as the chief cause of morbidity, disability and mortality worldwide and NIPs are understood to be one of the most cost-effective interventions against this burden. In low and middle- income countries (LMICs), where the burden of disease is high, NIPs have been reported to perform at suboptimal levels. It has been suggested that this suboptimal performance of NIPs can be associated with the poor state of health systems in LMIC. Despite this, the interaction between NIPs and health systems is poorly understood. In addition to this, systematic evidence on how health systems constraints and facilitators impact on the performance of NIPs in LMICs is scarce. To address this evidence gap, a systematic review study was conducted, that involved an initial scoping review of the evidence-base on NIPs and health systems in LMICs from which a logic model was developed. This logic model was then applied as a guide for a qualitative systematic review aimed at assessing the health systems constraints and facilitators of NIP performance in sub-Saharan Africa. The findings of this review suggest that well-performing NIPs are those that operate within enabling health systems, characterized by the availability of strong political endorsement for vaccines, clear governance structures and effective collaboration with global partners. Despite this, significant health systems constraints persist and include the limited capacity of health workers in sub-Saharan Africa, weak country infrastructure, poor service delivery, inadequate vaccine communication and ineffective community engagement in immunization programs. This systematic review study contributes to our limited understanding of the interaction between NIPs and health systems. In addition, the findings show how system-wide constraints and facilitators impact on the performance of NIPs. These findings have relevance for ongoing health systems strengthening initiatives, especially where NIPs are concerned.
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Reddell, Autumn. "Assessing the Impact of Educational Attainment on Development Outcomes in Low- and Middle-Income Countries." Bowling Green State University / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=bgsu1493655904248496.
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Nnorom, Chinonso Esther. "Health System Predictors of Access to Maternal Health Medicines In Low and Middle Income Countries." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4396.
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The strength of health systems predict access to medicines that prevent death from pregnancy related complications (essential maternal health medicines). But little is known about the relative impact of each health system building block on access. This quantitative cross-sectional study applied Ishikawa model to examine the relative effect of health systems governance, facilities, service delivery, financing and medicine procurement and distribution (independent variables), on availability, affordability and accessibility (dependent variables) of maternal health medicines in resource poor settings. Data analyzed was pulled from 37 WHO pharmaceutical country profiles and USAID MCHIP survey that assessed national programs for the prevention and management of Postpartum hemorrhage and Pre-Eclampsia/Eclampsia. Data analysis included bivariate and multivariate logistic regressions. All independent variables, except for quality of health services showed statistically significant association with access to maternal health medicines and achieved a p-value < .05 in bivariate analysis. Only three predictors however explained 27% of the variance (R2 =.266, F(5,162)=13.12, p<.01). The strength of medicine procurement and distribution systems significantly predicted access to essential maternal health medicines (β= -.41, p<.001), as did robustness of health system financing (β= -.51, p<.001), and quality of health facilities (β= -.34, p<.05). Authorities may prioritize investments in quality improvement, supply chain strengthening programs, and incentives for private sector financing and public-private partnerships for health system strengthening. This study contributes to positive social change by identifying key health system considerations that can inform future efforts to close geographical gaps in MCH outcomes.
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Wouters, Olivier. "Essays on prices, volumes, and policies in generic drug markets in high- and middle-income countries." Thesis, London School of Economics and Political Science (University of London), 2018. http://etheses.lse.ac.uk/3827/.
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Background and importance: Rising drug prices are putting pressure on health care budgets. Policymakers are assessing how they can save money through generic drugs. Objective: The aim of this Ph.D. was to explore issues relating to the prices and usage of generic medicines in high- and middle-income countries in five articles. This was done using quantitative and qualitative methods, including price and Herfindahl-Hirschman indexes, difference-in-differences regression analyses, semi-structured stakeholder interviews, and literature reviews. As a Ph.D. "thesis by papers", each of the five articles should be read as a stand-alone piece. However, the thesis presents an overarching narrative, outlined at the end of Chapter 1. Novelty and empirical contribution: My original contributions to knowledge are: (i) updated analyses of generic drug policies, prices, and usage rates in high-income countries, based on a large, representative sample of generic medicines from 2013 (Chapters 2 and 3); (ii) evidence on the impact of a pharmaceutical tendering system on medicines prices, demand, and competition over a 15-year period (Chapter 4); (iii) quantitative data on the impact of therapeutic tendering on drug spending and prices (Chapter 5); and (iv) qualitative data on how a country can move from a fragmented health-care system to a single-payer one, using tendering as the basis for a comprehensive drug-benefit plan (Chapter 6). Key findings: The prices and market shares of generics varied widely across Europe. For example, prices charged by manufacturers in Switzerland were, on average, more than 2.5 times those in Germany and more than 6 times those in the United Kingdom, based on the results of a commonly used price index. However, the results varied depending on the choice of index, base country, unit of volume, method of currency conversion, and therapeutic category. The results also differed depending on whether one looked at the prices charged by manufacturers or those charged by pharmacists. The proportion of prescriptions filled with generics ranged from 17% in Switzerland to 83% in the United Kingdom. The results of the first two studies indicated that the countries which used tender or tender-like systems to set generic drug prices in retail pharmacies (ie, Denmark, Germany, the Netherlands, and Sweden) had among the lowest prices among the countries included in the studies. Tendering can be an effective policy to procure essential medicines at low prices, based on analysis of data from South Africa and Cyprus. For instance, the average prices of antiretroviral therapies, anti-infective medicines, small-volume parenterals, drops and inhalers, solid-dose medicines, and family-planning agents dropped by roughly 40% or more between 2003 and 2016 in South Africa. Many tender contracts in South Africa remained competitive over time, based on the Herfindahl-Hirschman results, with some notable exceptions. However, the number of different firms winning contracts decreased over time in most tender categories. Also, there were large discrepancies between the drug quantities the health ministry estimated it would need to meet patient demand and the quantities the ministry went on to procure during tender periods. In South Africa, the introduction of therapeutic tendering was associated with an estimated 33% to 44% reduction in the prices of solid-dose drugs in 2014. National governments in countries aiming to introduce national health systems (eg, Cyprus and South Africa) will need to adapt their tendering systems and other pharmaceutical policies during transition periods. Future research directions: More research is needed to better understand the drivers of differences in generic drug prices between countries. It is also important to examine why there are large differences in the prices of drugs in various therapeutic areas, both within and between countries. Also, data from more countries, especially low- and middle-income ones, are needed to determine which features of tendering systems are associated with lower prices. Future studies should re-examine the South African therapeutic tendering system once data from more post-intervention periods are available, possibly using other research designs like interrupted time-series models (ie, segmented regression analysis). Policy implications: Price indexes are useful statistical approaches for comparing drug prices across countries, but policymakers should interpret price indexes with caution given their limitations. This thesis offers useful data for policymakers using, or planning to introduce, tendering systems, especially in countries aiming for universal health coverage, like Cyprus (Chapter 6) and South Africa (Chapters 4 and 5).
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Sancak, Merve. "Finding skills in middle-income countries : the case of auto parts suppliers in Mexico and Turkey." Thesis, University of Cambridge, 2019. https://www.repository.cam.ac.uk/handle/1810/288420.
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This thesis studies the determinants and outcomes of the skill systems in Mexico and Turkey, two crucial cases of middle-income countries (MICs). Despite the similarities in their previous institutional environments and links to the global economy, Turkey has experienced higher economic growth and better social development compared to Mexico. This PhD project focuses on the Mexican and Turkish skill systems, which have been significant institutions that affect the (different) economic and social characteristics of advanced industrialised countries in the literature on comparative capitalisms (CCs). This study builds its theoretical approach on the arguments of CCs literature and the claims of globalisation, where it draws from the studies on global value chains (GVCs). It scrutinises the patterns of convergence due to globalisation and ongoing divergence because of the variation of institutional structures. It examines the complementarities and outcomes of the skill systems, which will then help to understand the divergence of development experiences between Mexico and Turkey. This PhD project carries out a multi-level research and focuses the empirical study on auto parts-automotive value chains (AACs), which is an important industry for many MICs including Mexico and Turkey. The multi-level research first includes a macro-level study of local institutions in Mexico and Turkey, as well as the convergence patterns through the AACs. This is complemented with a micro-level analysis of firms' strategies to find workers with technical skills in production functions. The findings show that while there is some convergence in the Mexican and Turkish auto parts producers' skill needs, firms from these two countries adopt different strategies to address their needs. The distinctive national institutions in Mexico and Turkey, which are shaped by the differences in the state's involvement, are the main reasons for this divergence. The differences between the Mexican and Turkish skill systems have created different outcomes for both the firms and workers in these countries, and hence are expected to have contributed to their diverging development paths.
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Hoskins, S. J. "Monitoring the treatment and health of patients accessing HIV care in low and middle-income countries." Thesis, University College London (University of London), 2014. http://discovery.ucl.ac.uk/1434108/.
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Monitoring patient health in low and middle-income country HIV care programmes is challenging, as, without evidence, measurement tools derived from high-income country studies have been adapted and paper-based monitoring systems quickly developed. An accurate understanding of the population in care may be compromised. This thesis examines aspects of HIV care: access to Cotrimoxazole preventive therapy (CPT), prevalence of common mental disorders (CMD), and tools used to measure outcomes on antiretroviral therapy (ART). CPT access is frequently cited as being as low as 4% with few studies estimating long-term access. Estimated prevalence of CMD varies widely as little standardisation in measurement tools exists. And, while international ART programme monitoring recommendations exist, no study has compared the concordance, or otherwise, between information collected in different countries. The first study in this thesis, in Ugandan and Tanzanian patients, estimates time from HIV diagnosis to CPT initiation, time spent on CPT and associated factors. These estimates are compared to reported data. CPT coverage and time on CPT were poor. The absence of unique patient identifiers means monitoring data cannot distinguish patients who were diagnosed and initiate CPT in different reporting periods. Furthermore, no long-term data are officially reported. The second study estimates CMD prevalence and associated factors among HIV-positive Ugandans, and validates measurement tools for this. Prevalence was around 10% but no routinely-collected data identified at-risk patients. Measurement tool validity was poor, and their use substantially overestimates prevalence. The third study compares ART programme monitoring systems in Malawi, Uganda, Ukraine and Tanzania. There was little concordance with international recommendations, and discordance in additional data-items and paediatric age-groupings. This signalled a lack of understanding of how best to monitor the health of treated populations. Finally, a fourth study is proposed with the aim of assessing the validity and predictive value of existing programmatic monitoring systems.
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Hennegan, Julie. "Understanding interventions to improve menstrual health in low and middle income countries : evidence and future directions." Thesis, University of Oxford, 2017. https://ora.ox.ac.uk/objects/uuid:4afbd97f-52fe-459c-b82e-57045e598363.
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Background. Menstrual health has emerged as an under recognised barrier to women and girls' dignity, health, education, and psychosocial wellbeing in low and middle income contexts. Interventions targeting this issue have seen increasing dissemination, despite little evidence for their effectiveness and sparse research to inform intervention development or evaluation. Objectives. 1) Appraise current evidence for the effectiveness of menstrual health interventions; 2) Evaluate the effectiveness of a reusable sanitary pad and puberty education intervention for girlsâ school attendance; and, 3) Expand understanding of menstrual health to inform future research and practice. Methods. The multiple objectives of this thesis were addressed through a range of methodological approaches, reported across six manuscripts. The first collates and critically appraises existing evidence in a systematic review, while the second provides a broader overview in a position piece advocating for an evidence-based approach to menstrual health. The third paper reports on a cluster quasi-randomised control trial of reusable sanitary pad and puberty education interventions undertaken in Uganda. The fourth and fifth papers report secondary analyses of the trial survey data to investigate the prevalence and consequences of menstrual hygiene, and schoolgirlsâ experiences with menstrual absorbents. The final manuscript presents a qualitative, framework analysis to describe and compare the menstrual experiences of 27 schoolgirls in the controlled trial. Results. Systematic review identified eight controlled trials of menstrual health interventions. There was emerging evidence for the effectiveness of both education and product provision interventions, although methodological quality was poor. The controlled trial of reusable sanitary pad and puberty education provision found both interventions were similarly effective in reducing school absenteeism, with a moderate effect size. Follow-up quantitative papers provided insights into girlsâ menstrual experiences. In the first of these, the prevalence of inadequate menstrual hygiene was estimated to be 91% when measured consistently with the consensus definition, and did not differ between those using trial-provided reusable sanitary pads and those using existing methods. Aspects of menstrual hygiene were associated with shame, reduced school engagement, and health concerns. In the second follow-up, girls rated the trial-provided reusable sanitary pads favourably. However, greater perceptions of reliability did not translate into reduced rates of soiling or odour in the last menses. Finally, qualitative work provided process evaluation and nuanced understanding of the interventionsâ change mechanisms. Reduced fears of soiling improved school attendance for those provided with absorbents, while improvements in social support may have mediated the impact of the puberty education on attendance. Conclusions. This thesis represents a significant step forward in the emerging field of menstrual health research. The work provides critical appraisal of existing studies and new evidence for the effectiveness of interventions to improve outcomes for girls' in low and middle income contexts. Further, new insights on the prevalence and consequences of menstrual hygiene, girls' appraisal of menstrual absorbents, and qualitative exploration of girlsâ experiences provide guidance for the development of future interventions and evaluations.
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Owusu, Daniel, Ke Sheng Wang, Megan Quinn, Jocelyn Aibangbee, Rijo M. John, and Hadii M. Mamudu. "Health Care Provider Intervention and Utilization of Cessation Assistance in 12 Low- and Middle-Income Countries." Digital Commons @ East Tennessee State University, 2019. https://doi.org/10.1093/ntr/nty028.
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Background and Aim: There is a need to improve utilization of cessation assistance in low- and middle-income countries (LMICs), and tobacco cessation research has been identified as priority in LMICs. This study evaluates the relationship between health care provider intervention and cessation assistance utilization in LMICs.
Methods: Data from 13 967 participants (aged ≥15 years, 90.3% males) of the Global AdultsTobacco Survey conducted in 12 LMICs (74.3%-97.3% response rates) were analyzed with utilization of counseling/cessation clinic, WHO-recommended medications, and quitline as outcome variables. Health care provider intervention (“no intervention,” only “tobacco screening,” “quit advice”) was the exposure variable. Weighted multiple logistic regression models were used to examine the relationship between each outcome variable and the exposure variable, adjusting for other covariates. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) are reported.
Results: Approximately 52%, 8%, and 40% of participants received no intervention, only tobacco screening, and advice to quit, respectively. Overall, 0.4%, 1.9%, 3.0%, and 4.5% used quitline, WHO-recommended medications, counseling/cessation clinic, and any cessation assistance, respectively. Compared with no intervention, quit advice was associated with increased utilization of quitline (OR = 2.24, 95% CI = 1.2 to 4.4), WHO-recommended medications (OR = 1.67, 95% CI = 1.2 to 2.3), counseling/cessation clinic (OR = 4.41, 95% CI = 3.2 to 6.1), and any assistance (any of the three types) (OR = 2.80, 95% CI = 2.2 to 3.6).
Conclusion: The findings of this study suggest that the incorporation of quit advice by health care providers in tobacco control programs and health care systems in LMICs could potentially improve utilization of cessation assistance to improve smoking cessation in LMICs.
Implications: This first study of association between health care provider intervention and the utilization of cessation assistance in LMICs reports that there was a missed opportunity to provide quit advice to about 60% of smokers who visited a health care provider in the past year. The odds of utilization of counseling/cessation clinic, WHO-recommended medications, and quitline were significantly increased in participants who were advised to quit smoking. The results suggest that effective integration and implementation of advice to quit in tobacco control programs and the national health care systems may increase the use of cessation assistance to quit smoking.
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Schoeman, Fransien. "Digital tools for training frontline health workers in low and middle-income countries: A systematic review." Master's thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/30913.
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The World Health Organization (WHO) has forecast a global shortage of health workers by 2030, predominantly affecting low- and middle-income countries (LMICs). This sits in tension with the United Nations’ (UN) Sustainable Development Goal 3 (healthy lives and well-being) through universal health coverage (UHC). To address this problem, the WHO encourages task shifting, recruitment, training, and deployment of health workers. In lowand middle-income countries (LMICs), frontline health workers (FLHWs) are responsible for expanding the reach of the health system and providing crucial reproductive, maternal, newborn and child health (RMNCH) services. Adequate and appropriate training is fundamental to the success of FLHWs, particularly in contexts where their scope of work may evolve or expand over time. Digital health solutions (defined as the use of digital, mobile and wireless technologies to support the achievement of health objectives) are increasingly being used to support the training of FLHWs. Strategies may rely on use of digital tools, including mobile phones, as the primary modality for training or as tools which augment traditional face-to-face instruction. Digital health has potential for FLHW training as it allows for listening, learning and teaching through interactive health content accessible even on basic mobile phones. This dissertation explored the literature on FLHWs in LMICs, digital health in LMICs, digital health used by FLHWs, and digital health used for training of FLHWs in LMICs. The journal “ready” component is a systematic review which discusses the various aspects of digital training for FLHWs in LMICs. For the purposes of the systematic review, seven electronic databases were searched for articles published in English from 2008-2018. Combinations of medical subheadings (MeSH) that were used were: “mHealth”, “health worker”, “community health worker” and “low- and middle-income country”. From a total of 2628 identified studies, abstracts were screened with four filters to identify studies about “training”, and eventually a total of 16 studies were included. The included studies were critically appraised and coded descriptively to enable a narrative synthesis of findings. Of the sixteen studies, twelve used mobile and/or smartphones for FLHW training. A wide range of digital platforms were used to provide information (and where relevant enable interaction). Duration of training programs varied from five days to six months. Training content was relevant to the various health services and practice areas the FLHWs worked in. Training focused on continuing education through in-service training of new content or in-service refresher courses. Three training pedagogies were used: 1) didactic training techniques – in four studies information was provided passively without an interactive component; 2) interactive training techniques – six studies used platforms to provide information along with an interactive component via multi-media; and, 3) blended-learning approach – six studies delivered training via didactic and interactive approaches by combining live and distance training. Consistent with the literature review, all studies reported increased knowledge and positive perceptions of digital health for FLHW training. Interactive and blended learning approaches, especially when accessed through mHealth technologies, are feasible, effective, appropriate, cost effective and scalable in LMICs. The conclusion from the literature and systematic reviews were that long-term effects (e.g. change in behaviour, improved service provision) need to be researched further.
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Raga, Sharika Vinod. "Epileptic Spasms: Evidence for oral corticosteroids and implications for low and middle income countries (Systematic Review)." Master's thesis, University of Cape Town, 2020. http://hdl.handle.net/11427/32480.
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Implementation of international guidelines for the treatment of epileptic spasms, is challenging when access to adrenocorticotrophic hormone (ACTH) and vigabatrin is restricted, especially in Low and Middle Income Countries (LMIC). Oral corticosteroids are alternative interventions but evidence for the optimal agent, dose, duration, efficacy and long-term effects are lacking. A systematic review of the literature was performed to assess the quality of evidence of prednisone and prednisolone (oral corticosteroids) for the management of epileptic spasms. There is level C recommendation based on class III evidence to support the efficacy of oral corticosteroids for the acute clinical control of epileptic spasms and EEG resolution. Efficacy of oral corticosteroids in comparison to the internationally recommended intervention of ACTH has class IV evidence supporting level U recommendation. Similarly, there is no data on the risk of relapse with oral corticosteroids (class IV, level U), compared to ACTH. There is class IV evidence supporting level U recommendation for the safety of oral corticosteroids and class II evidence for level B recommendation for ACTH. In terms of oral corticosteroids and effects on long-term development there is class IV evidence leading to level U recommendation, compared to class III evidence supporting level C recommendation for ACTH. Randomized controlled studies are needed to compare oral corticosteroids with ACTH, the optimal dosage and regimen as well as the long-term neurodevelopmental outcomes. Based on the limited existing studies a treatment guideline for LMIC is proposed which could be used to standardize interventions permitting clarification of these unmet questions.
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Fröschl, Günter [Verfasser]. "Enabling researchers in low- and middle-income-countries to define their local health research agenda / Günter Fröschl." München : Universitätsbibliothek der Ludwig-Maximilians-Universität, 2021. http://d-nb.info/1233201387/34.
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