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The twin deficit hypothesis suggests that budget deficits are crucial factors leading to current account deficits, and substantial empirical evidence documents a significant positive statistical correlation between budget and current account deficits. However, such evidence generally suffers from endogeneity problems due to reverse causality, thereby making it difficult to provide solid evidence to support policy implementation. We use extensive cross-national panel data from developed and developing countries and military expenditure as an instrumental variable to reexamine the impact of budget deficits on the current account and test the validity of the twin deficit hypothesis. Our results demonstrate that budget deficits lead to current account deficits in both developed and developing countries, supporting the twin deficit hypothesis. After considering various factors that may affect the exogeneity of military expenditures, approximating the instrumental variable as exogenous, and performing multiple robustness tests, the hypothesis still holds. This study provides solid evidence supporting the use of fiscal policies to deal with current account imbalances., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Liu, Ren. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Until local healthcare infrastructure is strengthened, cardiac surgical care in low- and middle-income countries is often provided by non-governmental organizations by way of visiting healthcare teams. This is generally considered to be a cost-effective alternative to transporting patients to high income countries for surgical care, but the costs of cardiac surgery consumables under this model are poorly understood. Our objective was to identify the per-patient cost of cardiac surgery consumables used in single and double valve replacements performed by a non-governmental organization in Rwanda., Methods: Financial data from 2020 were collected from Team Heart, a non-governmental organization that supports cardiac surgical care in Rwanda. A comprehensive list of consumables was generated, including surgical, perfusion, anesthesia, and inpatient supplies and medications. Acknowledging the variability in perioperative needs, the quantities of consumables were calculated from an average of six patients who underwent single or double-valve replacement in 2020. Total costs were calculated by multiplying purchasing price by average quantity per patient. Costs absorbed by the local hospital were excluded from the calculations., Results: The total cost per patient was estimated at $9,450. Surgical supplies comprised the majority of costs ($6,140 per patient), with the most substantial cost being that of replacement valves ($3,500 per valve), followed by surgical supplies ($1,590 per patient)., Conclusions: This preliminary analysis identifies a cost of just over $9,000 per patient for consumables used in cardiac valve surgery in Rwanda, which is lower than the estimated costs of transporting patients to centers in high income countries. This work highlights the relative cost effectiveness of cardiac surgical care in low- and middle- income countries under this model and will be instrumental in guiding the allocation of local and international resources in the future., (© 2024. The Author(s).)

Operating microscope is a backbone for the development of micro neurosurgery. In resource-limited setups and low-income countries, the volume of annual microsurgical procedures is low due to lack of the required equipment, one of which is the operating microscope. The price of currently available operating microscopes makes it difficult to address this issue in resource-constrained areas and low-income countries. Exoscope with a relatively lower price and the same even better imaging qualities can be used as an option for this problem., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

The COVID-19 pandemic has wrought unprecedented disruption on global economies, leading to widespread income insecurity among individuals and households. This study investigates the impact of the pandemic on income insecurity across different income groups and assesses the role of social protection measures in mitigating these effects. Using cross-country data, we analyze the prevalence of income reduction and the effectiveness of social assistance programs in high-income, upper middle-income, lower middle-income, and low-income countries. Our findings reveal significant variations in income insecurity and social protection responses across these groups. the pandemic had a significant impact on household incomes globally, with lower-middle-income countries experiencing the most significant income reductions. The average per capita transfer amounts show a general decrease over time, which could be due to the economic strain on governments and the need for more sustainable social protection programs. The correlation between transfer amounts and the proportion of households with reduced income indicates that countries with higher income reduction rates tended to have lower average per capita transfer amounts, suggesting a potential lack of adequate support for those in need. The study highlights the importance of robust social safety nets in cushioning the economic blow of the pandemic, particularly for vulnerable populations in lower-income countries., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Chen Na. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: COPD is the 3 rd leading cause of death worldwide, affecting an estimated 212.3 million people. More than 80% of this burden occurs in low- and middle-income countries. One of the major reasons for this growing burden, is the lack of awareness of COPD among all levels., Areas Covered: In this review article, we studied the level of awareness of COPD among lay people, health care providers and policy makers in the LMICs. Search engines including Google Scholar, PubMed, and Scopus were used for relevant articles. Articles spanning from 1990 to March 2024 were screened on COPD awareness in LMICs and its treatment implications using a combination of key words., Expert Opinion: We report that the overall awareness of COPD is low at all levels. There are several reasons such as poverty, illiteracy, societal beliefs, cultural beliefs, and misconceptions. This is associated with increase in suffering, deaths, and economic loss, due to poor adaption correct prescription and compliance to treatment. And very little is being done to improve the current status. COPD needs to be highlighted in the national programs in LMICs.

Objective: This review will synthesize studies on costs, the impact of these costs, and the cost-effectiveness of treatments for rheumatic heart disease (RHD) in low- and middle-income countries., Introduction: RHD incurs high costs owing to its clinical complexity, surgical treatments, and prolonged hospital stays. Thus, the disease has a substantial economic impact on the health system, patients, and their families. No systematic review on economic evidence of treatments for RHD has been published to date., Inclusion Criteria: This review will consider all cost and cost-effectiveness studies on RHD treatments for children and young adults (5─30 years) residing in low- and middle-income countries., Methods: The review will follow the JBI methodology for systematic reviews of economic evaluation evidence. The search strategy will locate published and unpublished studies in English. Systematic searches will be conducted in MEDLINE (PubMed), MEDLINE (Ovid), Embase (Ovid), Scopus, CINAHL (EBSCOhost), National Health Service Economic Evaluation Databases, Pediatric Economic Database Evaluation, and Cost-Effectiveness Analysis Registry. Two independent reviewers will screen titles and abstracts, followed by a full-text review based on the inclusion criteria. Data will be extracted using a modified JBI data extraction form for economic evaluations. JBI's Dominance Ranking Matrix for economic evaluations will be used to summarize and compare the results of cost and cost-effectiveness studies. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach will be used to assess the certainty of economic evidence for outcomes related to resource use., Review Registration: PROSPERO CRD42023425850., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 JBI.)

Background: Making neurosurgical care accessible to a larger portion of the population in low- and middle-income countries (LMICs) is integral due to the high mortality and morbidity associated with brain tumors. However, the high cost of care often makes it financially out of reach for many individuals. Therefore, this review aims to identify barriers to neurosurgical care of brain tumors in terms of financing in LMICs., Methods: Without restriction to language, a search of the literature was undertaken in a number of databases, including PubMed, Scopus, Google Scholar, and CINAHL, in order to find the most pertinent research involving financing of brain tumors in LMICs. The last day of the search was October 20, 2022. Following screening and data extraction, significant themes were found and categorized using thematic analysis., Results: A total of 28 studies were analyzed in this review. The review highlighted some of the barriers to providing surgical care of brain tumors in LMICs. In the cited studies, surgical expenses (41%), neuroimaging costs (30%), and care-related expenses (33%) were the primary concerns. Addressing these challenges involves cross-border collaboration (23%), transparent financing systems (46%), awake craniotomy (15%), cost-effective/reusable intra-operative supplies (8%), and optimizing resources in healthcare systems (8%)., Conclusions: This study explored barriers and challenges to financing neurosurgical care of brain tumors in LMICs. Government support and transparency in healthcare financing should be prioritized to ensure that all individuals have access to surgical care of brain tumors., (Copyright © 2024 Elsevier Inc. All rights reserved.)

This study estimates the monetary policy reaction function (MPRF) in a Dynamic Stochastic General Equilibrium (DSGE) framework using Bayesian analysis for the emerging economies. DSGE models are suitable for the policy analysis because of their simplicity and prominent role of forward-looking variables. This is a pioneer study investigating the combined effects of credit spreads, fiscal imbalances, and monetary autonomy on interest rates for BRICS member countries. Using real data for the period 1970-2021, the posterior estimates confirm that both credit spread and fiscal imbalance significantly contribute to fluctuations in output, inflation, and interest rates in all the sample economies. The estimates show that fluctuations in the inflation rate are due to supply shocks. The empirical estimates also reveal that fiscal imbalances shock significantly affect output in Brazil, India, and South Africa, whereas, based on real data inflation and interest rate are significantly affected by fiscal imbalance shocks in China and South Africa. Yet, the findings suggest that the effects of various shocks on output and interest rates vary across countries., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Waheed et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: To evaluate the leading challenges in developing countries' traumatic spinal cord injury (TSCI) care., Methods: We conducted a systematic search in electronic databases of PubMed, SCOPUS, Web of Science, EMBASE, and Cochrane Library on 16 April 2023. Studies that investigated challenges associated with the management of TSCI in developing countries were eligible for review. We extracted related outcomes and categorized them into four distinct parts: injury prevention, pre-hospital care, in-hospital care, and post-hospital care., Results: We identified 82 articles that met the eligibility criteria including 13 studies on injury prevention, 25 on pre-hospital care, 32 on in-hospital care, and 61 on post-hospital care. Challenges related to post-hospital problems including the personal, financial, and social consequences of patients' disabilities and the deficiencies in empowering people with TSCI were foremost studied. Lack of trained human resources, insufficient public education and delays in care delivery were barriers in the acute and chronic management of TSCI. A well-defined pre-hospital network and standard guidelines for the management of acute neurotrauma are needed. Critical challenges in injury prevention include deficiencies in infrastructure and supportive legislation., Conclusion: Studies focusing on injury prevention and pre-hospital care in TSCI management in developing countries warrant further investigation. It is imperative to develop systematic and evidence-based initiatives that are specifically tailored to the unique circumstances of each country to address these challenges effectively. By understanding the primary obstacles, policymakers and healthcare providers can establish goals for improving education, planning, legislation, and resource allocation., Competing Interests: AV receives royalties from Stryker, Globus, Medtronic, Atlas, Alphatech Spine, Elsevier, Jaypee, Taylor Francis/Hodder and Stoughton, and Thieme; has stock or stock options in Accelus, Advanced Spinal Intellectual Properties, Atlas, Avaz Surgical, AVKN Patient Driven Care, Cytonics, Deep Health, Dimension Orthotics LLC, Electocore, Flagship Surgical, FlowPharma, Globus, Harvard MedTech, Innovative Surgical Design, Jushi (Haywood), Nuvasive, Orthobullets, Parvizi Surgical Innovation, Progressive Spinal Technologies, Replication Medica, Sentryx, Stout Medical, ViewFi Health; and is a consultant for Globus. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Ranjbar Hameghavandi, Khodadoust, Hassan Zadeh Tabatabaei, Farahbakhsh, Ghodsi, Rostamkhani, Ghashghaie, Abbaszade, Arbabi, Hossieni, Sadeghi-Naini, Atlasi, Kankam, Vaccaro, Guest, Fehlings and Rahimi-Movaghar.)

Competing Interests: I declare no competing interests.

Objective: The objective of this systematic review is to provide an overview of economic evaluation studies of interventions for neglected tropical diseases in low- and/or middle-income countries., Introduction: The majority of people most susceptible to neglected tropical diseases reside in low- and middle-income countries and suffer significant economic impact due to these diseases. The World Health Organization suggests utilizing a systematic and cross-cutting approach with multiple interventions to lessen the neglected tropical disease burden., Inclusion Criteria: Studies will be eligible for inclusion if they include economic evaluations of interventions for neglected tropical diseases and are conducted in low- and/or middle-income country settings., Methods: A preliminary search of MEDLINE (PubMed) was undertaken using MeSH terms, such as neglected tropical disease, economic evaluation, therapeutics, low- and/or middle-income countries . Two reviewers will screen titles and abstracts independently, followed by a full-text review against the inclusion criteria. Disagreements will be resolved by discussion or with a third reviewer. To assess methodological quality, the JBI checklist for economic evaluations will be used. For economic evaluations, data will be extracted using the standardized JBI data extraction form. The Dominance Ranking Matrix will be used to summarize and compare the results of different types of economic evaluations. Cost per quality adjusted life year gained and cost per disability adjusted life year averted will be measures for economic evaluation. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach will be used to assess the certainty of economic evidence, such as resource use and costs., Review Registration: PROSPERO CRD42017070386., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 JBI.)

Purpose: To review the economic burden assessment of cervical cancer in low- and middle-income countries (LMICs) and use the findings to develop a pragmatic, standardized framework for such assessment., Methods: We first systematically reviewed articles indexed in scientific databases reporting the methodology for collecting and calculating costs related to the cervical cancer burden in LMICs. Data on study design, costing approach, cost perspective, costing period, and cost type (direct medical costs [DMC], direct nonmedical costs [DNMC], and indirect costs [IC]) were extracted. Finally, we summarized the reported limitations in the methodology and used the solutions to inform our framework., Results: Cervical cancer treatment costs across LMICs vary greatly and can be extremely expensive, up to 70,968 International US dollars. Economic and financial assessment methods also vary greatly across countries. Of the 28 reviewed articles, 25 studies reported DMC for cervical cancer treatment by extracting cost information from billing or insurance databases (eight studies), conducting surveys (five), and estimating the costs (12). Only 11 studies-mainly through surveys-reported DNMC and IC. The economic burden assessment framework includes health care/payer and societal perspectives (DMC, DNMC, IC, and human capital loss) across the cervical cancer screening and treatment continuum. To assess health care/payer costs, we recommend combining the predefined treatment standards with actual local treatment practices, multiplied by unit costs. To assess societal costs, we recommend conducting a cost survey in line with a standardized yet adaptable protocol., Conclusion: Our standardized, pragmatic framework allows assessment of economic and financial burden of cervical cancer in LMICs despite the different levels of available resources across countries. This framework will facilitate global comparisons and monitoring and may also be applied to other cancers.

Purpose of Review: Access to and quality of kidney care is not equitable between or within countries. A natural question is whether global kidney care inequities are always unjustifiable and unfair, or are sometimes due to unavoidable competing or conflicting ethical duties or responsibilities., Recent Findings: Health is a fundamental right for all people. People with kidney conditions should have the same claim on this human right as others. Countries have an obligation to progressively fulfil this right and a duty to do so equitably, but global progress has been slow. Countries with limited resources or faced with humanitarian emergencies must set priorities to allocate resources fairly. This process involves trade-offs and often people requiring kidney replacement therapy are left out because of costs, logistics and lack of data. Major burdens are placed on clinicians who grapple between their duty to their patient and professional codes and their responsibility to a 'greater good'. These dilemmas apply also to industry, governments and the international community who must recognize their share in these duties., Summary: Inequities in kidney health and care must be acknowledged and sustainable and collaborative solutions urgently found such that right to kidney care is progressively upheld for everyone everywhere., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Human capital is a nation's primary source of inner strength to achieve sustainable economic growth and development. Meanwhile, income inequality is a critical issue preventing sustainable economic growth and social transformation, especially in developing countries. This paper investigates the effect of human capital on income inequality in both the short and long term using the mean group, pooled mean group, and threshold regressions for the ASEAN-7 (including Indonesia, Laos, Malaysia, the Philippines, Singapore, Thailand, and Vietnam) from 1992 to 2018. The paper develops a theoretical linkage between human capital and income inequality by combining the learning theory and the Kuznets hypothesis. This linkage is then tested using data from the ASEAN countries. Findings from the paper indicate that human capital reduces income inequality in the short run in the ASEAN countries. However, the effect is reverted in the long run, suggesting that human capital may increase the income gap in these countries. Particularly, the inverted U-shaped relationship between human capital and income inequality is established for the ASEAN countries whose GDP per capita is lower than USD 8.2 thousand per year. In contrast, the U-shaped relationship is found for the countries with income per capital of more than USD 8.2 thousand. All these findings suggest that social policies targeting reducing income inequality should be prioritized and stay at the centre of any economic policies to achieve sustainable economic growth and development in the ASEAN countries., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Vo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Using a two-step approach GMM, this study examines the short- and long-term effects of fiscal deficit on the economic growth of 42 Sub-Saharan African nations between 2011 and 2021. The World Development Index, the most reliable source, is where the panel data is taken from. Using the Levin-Lin-Chu and Hadri LM tests for unit root, it was determined that there is no risk of a random walk in the data. The study's findings indicate that while the fiscal deficit has short-term, positive, and significant benefits on the economic growth of SSA countries, it has long-term, negative repercussions. According to the system GMM's results, an increase in the fiscal deficit of SSA countries is linked to a short-term increase in economic growth of 0.036 percent, while an increase in the fiscal deficit of one percentage point is linked to a long-term decline in economic growth of SSA countries of 0.013 percent, holding all other factors constant. The study's findings also showed that the budget deficit has a larger positive short-run coefficient than a negative long-run coefficient. The study also revealed that while real effective exchange rates and inflation short-term hinder economic growth, gross fixed capital creation and real interest rates are the primary drivers of economic expansion. Long-term economic growth in the SSA countries is also found to be positively and significantly impacted by gross fixed capital formation. According to the study, SSA nations should manage their fiscal deficits and, in the long run, provide more funds for gross fixed capital development., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Sore et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Studies on breastfeeding promotion and support interventions suggest some economic benefits. This study assessed the direct and indirect costs of a multicomponent breastfeeding promotion and support intervention during the first two years of the infant's life., Methods: This is a cost-benefit analysis of data generated from a randomized controlled trial that investigated whether provision of a multicomponent breastfeeding promotion and support intervention to Lebanese mothers in the first six months postpartum would improve breastfeeding rates compared to standard obstetric and pediatric care. Data of 339 participants on sociodemographics, mother and infant health, infant nutrition, direct and indirect costs of the intervention were used to assess the benefit-cost ratio (BCR) of the intervention at one, six, 12, and 24 months as primary outcome. Secondary outcomes included overall costs of infant nutrition and infant-mother dyad health costs during the first two years. Multiple linear regression models explored the effect of the intervention on the overall infant nutrition cost and mother-infant health costs. Similar regression models investigated the association between cost variables and infant nutrition types (exclusive breastfeeding, mixed feeding, artificial milk). Intention to treat analyses were conducted using SPSS (version 24). Statistical significance was set at a p-value below 0.05., Results: The prevalence of Exclusive/Predominant breastfeeding among participants declined from 51.6% in the first month to 6.6% at the end of second year. The multicomponent breastfeeding intervention incurred 485 USD more in costs than the control group during the first six months but was cost-efficient at one year (incremental net benefits of 374 USD; BCR = 2.44), and two years (incremental net benefits of 472 USD; BCR = 2.82). In adjusted analyses, the intervention was significantly associated with fewer infant illness visits in the first year (p = 0.045). Stratified analyses by the infant nutrition type revealed that infants who were on Exclusive/Predominant, or Any Breastfeeding had significantly more favorable health outcomes at different time points during the first two years (p<0.05) compared to infants receiving Artificial Milk only, with health benefits being highest in the Exclusive/Predominant breastfeeding group. Moreover, Exclusive/Predominant and Any Breastfeeding had significantly lower costs of infant illness visits, hospitalizations, and infant medications during the two years (p<0.05) but had additional cost for maternal non-routine doctor visits due to breastfeeding (all p values <0.05). Whereas the overall cost (direct and indirect) during the first six months was significantly lower for the Exclusive/Predominant breastfeeding infants (p = 0.001), they were similar in infants on Mixed Feeding or Artificial Milk., Conclusions: Breastfeeding is associated with significant economic and infant health benefits in the first two years. In the context of the current economic crisis in Lebanon, this study provides further evidence to policymakers on the need to invest in national breastfeeding promotion and support interventions., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Basbous et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Globalization, income growth and changing cultural trends are believed to prompt consumers in low-income countries to adopt the more affluent diet of high-income countries. This study investigates the convergence of food expenditure patterns worldwide, focusing on total food expenditure, raw food categories and ultra-processed foods and beverages across more than 90 countries over the past decades. Contrary to prior belief, we find that food expenditure patterns of lower-income countries do not universally align with those of higher-income nations. This trend is evident across most raw food categories and ultra-processed foods and beverages, as the income level of a country continues to play a crucial role in determining its food expenditure patterns. Importantly, expenditure patterns offer estimates rather than a precise idea of dietary intake, reflecting consumer choices shaped by economic constraints rather than exact dietary consumption., (© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)

Cambodia has experienced exponential economic growth in recent years and is expected to graduate from least developed country (LDC) status within the next decade. Membership of the World Trade Organization (WTO) will require Cambodia to grant product and process patents for pharmaceuticals upon LDC graduation. This study aims to measure the impact of the WTO Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) on the price of HIV and hepatitis C medicine in Cambodia once it graduates from LDC status and is obliged to make patents available for pharmaceutical products and processes. Using scenarios based on likely outcomes of accession to the TRIPS Agreement, it measures the impact on the price of the HIV treatment program and compares that impact with the hepatitis C treatment program. Graduation from LDC status would be expected to result in a modest increase in the cost of the antiretroviral (ARV) treatment program and very large increases in the cost of the direct acting antivirals (DAA) treatment program. If annual treatment budgets remain constant, patent protection could see 1,515 fewer people living with HIV able to access ARV treatment and 2,577 fewer people able to access DAA treatment (a drop in treatment coverage of 93%)., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Although biotherapeutic drugs have the potential of transforming the management of many life-threatening diseases, their affordability and accessibility remain an issue. This study offers an overview of the global affordability of biotherapeutic products. For this, prices for 10 representative biotherapeutic products were examined in 40 countries, including high-income countries (HICs), upper middle-income countries (UMICs), lower middle-income countries (LMICs), and low-income countries (LICs). The affordability of these biotherapeutics was calculated based on the World Health Organization/Health Action International (WHO/HAI) method. As expected, affordability was found to be better in HICs, followed by UMICs, LMICs, and finally, LICs. Furthermore, based on the trend of per capita income, we predict that in UMICs and LMICs, the affordability of high molecular weight biologics will worsen by 1.5× and 2× by 2030, respectively, and further by 4× and 6× by 2040. On the other hand, affordability will stay nearly the same for people living in HICs in the coming decades. Our analysis suggests that it is imperative that measures be taken to make this class of products more affordable and accessible. Governments can contribute by creating conducive policies. Global institutions like the WHO can play a significant role as well. Finally, manufacturers need to invest in and implement manufacturing innovations., (© 2024 The New York Academy of Sciences.)

Introduction: Approximately 33 million people suffer catastrophic health expenditure (CHE) from surgery and/or anesthesia costs. The aim of this systematic review is to evaluate catastrophic and impoverishing expenditure associated with surgery and anesthesia in low- and middle-income countries (LMICs)., Methods: We performed a systematic review of all studies from 1990 to 2021 that reported CHE in LMICs for treatment of a condition requiring surgical intervention, including cesarean section, trauma care, and other surgery., Results: 77 studies met inclusion criteria. Tertiary facilities (23.4%) were the most frequently studied facility type. Only 11.7% of studies were conducted in exclusively rural health-care settings. Almost 60% of studies were retrospective in nature. The cost of procedures ranged widely, from $26 USD for a cesarean section in Mauritania in 2020 to $74,420 for a pancreaticoduodenectomy in India in 2018. GDP per capita had a narrower range from $315 USD in Malawi in 2019 to $9955 USD in Malaysia in 2015 (Median = $1605.50, interquartile range = $1208.74). 35 studies discussed interventions to reduce cost and catastrophic expenditure. Four of those studies stated that their intervention was not successful, 18 had an unknown or equivocal effect on cost and CHE, and 13 concluded that their intervention did help reduce cost and CHE., Conclusions: CHE from surgery is a worldwide problem that most acutely affects vulnerable patients in LMICs. Existing efforts are insufficient to meet the true need for affordable surgical care unless assistance for ancillary costs is given to patients and families most at risk from CHE., (Copyright © 2024 Elsevier Inc. All rights reserved.)

CKD affects about 850 million people worldwide and is projected to be the fifth leading cause of death by 2040. Individuals from low- and middle-income countries (LMICs) bear the bulk of CKD. They face challenges including lack of awareness among the general population, as well as health care providers, unique risk factors such as genetic predispositions, infectious diseases, and environmental toxins, limited availability and affordability of diagnostic tests and medications, and limited access to KRTs. The inadequate health system infrastructure, human resources, and financing mechanisms to support comprehensive and integrated kidney care worsen the situation. Overcoming these challenges needs concerted efforts toward early detection, intervention, and multidisciplinary follow-up, policy, collaboration, advocacy, and financing. To achieve this, there is need for individual governments to include kidney health among the key health priorities and build capacity toward resilient health care systems. Integrating kidney care using the roadmaps of well-established management systems for other chronic diseases, such as HIV, has the potential to expedite the widespread adoption of kidney health. The aim of this article is to provide an overview of the current state and future prospects of kidney care in LMICs, highlighting the main challenges, ongoing efforts, and opportunities for improvement. We present case studies of exemplary efforts from three continents of the world with the highest densities of LMICs and propose potential strategies for a sustainable solution., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Nephrology.)

Typhoid fever is responsible for a substantial health burden in low- and middle-income countries (LMICs). New means of prevention became available with the prequalification of typhoid conjugate vaccines (TCV) by the World Health Organization (WHO) in 2018. Policymakers require evidence to inform decisions about TCV. The economic burden related to typhoid fever can be considerable, both for healthcare providers and households, and should be accounted for in the decision-making process. We aimed to understand the breadth of the evidence on the cost of typhoid fever by undertaking a scoping review of the published literature. We searched scientific databases with terms referring to typhoid fever cost of illness to identify published studies for the period January 1st 2000 to May 24th 2024. We also conferred with stakeholders engaged in typhoid research to identify studies pending completion or publication. We identified 13 published studies reporting empirical data for 11 countries, most of them located in Asia. The total cost of a typhoid episode ranged from $23 in India to $884 in Indonesia (current 2022 United States Dollar [USD]). Household expenditures related to typhoid fever were characterized as catastrophic in 9 studies. We identified 5 studies pending completion or publication, which will provide evidence for 9 countries, most of them located in Africa. Alignment in study characteristics and methods would increase the usefulness of the evidence generated and facilitate cross-country and regional comparison. The gap in evidence across regions should be mitigated when studies undertaken in African countries are published. There remains a lack of evidence on the cost to treat typhoid in the context of increasing antimicrobial resistance. Decision-makers should consider the available evidence on the economic burden of typhoid, particularly as risk factors related to antimicrobial resistance and climate change increase typhoid risk. Additional studies should address typhoid illness costs, using standardized methods and accounting for the costs of antimicrobial resistance., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Debellut et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The Global Investment Report 2023 revealed that after a sharp decline in 2020 and a strong rebound in 2021, global foreign direct investment (FDI) declined by 12 percent to $1.3 trillion in 2022. However, in developing countries, FDI increased by 4% to $916 billion, a record share of more than 70% of global flows. The number of greenfield investment projects in developing countries increased by 37 percent and international project finance transactions by 5 percent. Foreign investment from China, the second largest recipient of foreign investment globally, increased by 5 percent. The service industry has become the mainstream industry in the global FDI structure. The global industry is accelerating its transformation to a "service-based economy," international FDI in productive service industries has become an essential means of industrial transfer in developed countries and a meaningful way to upgrade the industrial structure and high-quality development in emerging economies. As a representative province in central China, Hubei Province has unique advantages in human capital, factor cost, and market potential, which provide preferential conditions to attract foreign investment. This paper first introduced the concept of the productive service industry, based on the relevant statistical data from 2011 to 2022, focused on the current situation of foreign investment utilization in five major sub-sectors of the productive service industry in Hubei Province in the past ten years, and empirically investigated the impact of foreign investment utilization in five major sub-sectors of the productive service industry on the economic growth of Hubei Province, and obtained that the level of foreign investment attraction varied significantly among the regions in Hubei Province. The three productive service industries, namely transportation, storage and postal services, information transmission, software and information technology services, and financial services, played a significant role in the active attraction and optimal utilization of foreign capital and the economic development of Hubei Province. Based on this, it was proposed to build a market-oriented rule of law and internationalized business environment, improve the infrastructure construction in different regions of the province, focus on the training of professional talents for the development of productive service industries, and pay attention to the improvement of independent innovation capacity., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Zhou et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Public procurement related expenditure is approximately fifty to seventy percent of the national budget of developing countries and accounts for almost a third of the gross domestic product. Cognizant of the significant funds committed in public procurement, the quest for value for money is critical. This study sought to determine the effect of procurement practices on value for money in State Corporations in Kenya. Specifically, the study investigated the effect of procurement planning, supplier sourcing, supplies management and E-procurement on value for money. Data collected from 87 State Corporations in Kenya was used in this study. The results of the study indicated that procurement planning, supplier sourcing, supplies management and e-procurement positively and significantly affect the value for money in state corporations in Kenya. The study concluded that proper procurement practices positively and significantly affect the value for money in state corporations in Kenya. The findings of this study contributes to literature by providing an empirical examination on the impact of procurement practices and value for money from a developing country perspective., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Waci et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Although radiotherapy continues to evolve as a mainstay of the oncological armamentarium, research and innovation in radiotherapy in low-income and middle-income countries (LMICs) faces challenges. This third Series paper examines the current state of LMIC radiotherapy research and provides new data from a 2022 survey undertaken by the International Atomic Energy Agency and new data on funding. In the context of LMIC-related challenges and impediments, we explore several developments and advances-such as deep phenotyping, real-time targeting, and artificial intelligence-to flag specific opportunities with applicability and relevance for resource-constrained settings. Given the pressing nature of cancer in LMICs, we also highlight some best practices and address the broader need to develop the research workforce of the future. This Series paper thereby serves as a resource for radiation professionals., Competing Interests: Declaration of interests RK reports receiving support from the University of Utah Huntsman Cancer Institute for attending meetings and for travel. PGSP declares support from the National Cancer Institute's Radiation Research Program for contributions to this Series paper and for attending meetings and conferences. MM reports receiving grants from the Australian National Health and Medical Research Council for clinical trials paid to his institution; a grant for an investigator-initiated clinical trial that Varian has agreed to, but the payment of this grant is pending; travel support from Varian to deliver a presentation at a national research meeting; and honoraria for lectures from Varian that have been donated to his institution. PK is a recipient of grants from the Australian Government National Health and Medical Research Council and the Cancer Institute NSW Translational Program; has US patents on MRI-LINAC radiotherapy and x-ray-guided radiotherapy; and has stock in SeeTreat. NAM is a recipient of payment for expert testimony as a consultant in a medical legal case whose subject matter was unrelated to the field of research in this manuscript; and has served in a leadership role on the committee of the Radiosurgery Society: the Clinical Working Group of the GRID, LATTICE, Microbeam, and FLASH Working Group. BAJ-F is a recipient of institutional grants from Accuray, the Italian Association for Cancer Research, and the Fondazione Instituto Europeo di Oncologia-Centro Cardiologico Monzino for her institution; has received honoraria from the European Society for Radiotherapy and Oncology for lectures and presentations, from the European School of Oncology and the American Society of Clinical Oncology for lectures and masterclasses, and from Roche, Bayer, Janssen, Carl Zeiss, Accuray, Astellas, Elekta, IBA, Technologie Avanzate, and ACCMED for lectures; and has participated on advisory boards for Janssen, AstraZeneca, and Bayer, and on a steering committee for Seagen. AA reports receiving an Advanced Fellowship from the National Institute for Health Research. F-MSK has received research grants from Varian Medical, Merck, and Shenzhen Science and Technology Commission Programme (KQTD20180411185028798); she has also received a speaker's honorarium from AstreZeneca. All other authors declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)

The revised classification of tumors of the central nervous system (CNS) by the World Health Organization (WHO) in 2021 was hailed as a major advance and improvement in the management of brain tumor patients. However, the increased reliance on sophisticated technology and molecular analysis posed a major challenge to healthcare systems in low- and middle-income countries. A few recent publications have drawn attention to the issue of the applicability of the new CNS WHO 2021 worldwide, but the exuberant enthusiasm observed in high-income countries seems to have stifled such a concern. In this study, we present data on the practical utility of the changes that occurred in CNS WHO 2021 in four institutions with limited resources. Our findings demonstrate no major alterations in patient management in low resource settings and significant added financial impact. While there is no doubt that the revised classification provides greater insight into tumor biology and molecular/genetic features of CNS tumors, its practical benefit and applicability in the majority of cases worldwide are limited, and attempts to improve its utility in low resource settings are warranted., (© 2023 The Authors. Neuropathology published by John Wiley & Sons Australia, Ltd on behalf of Japanese Society of Neuropathology.)

Purpose: Chronic obstructive pulmonary disease (COPD) poses a significant global health burden despite being largely preventable and treatable. Despite the availability of guidelines, COPD care remains suboptimal in many settings, including high-income countries (HICs) and upper-middle-income countries (UMICs), with varied approaches to diagnosis and management. This study aimed to identify common and unique barriers to COPD care across six countries (Australia, Spain, Taiwan, Argentina, Mexico, and Russia) to inform global policy initiatives for improved care., Methods: COPD care pathways were mapped for each country and supplemented with epidemiological, health-economic, and clinical data from a targeted literature review. Semi-structured interviews with 17 respiratory care clinicians were used to further validate the pathways and identify key barriers. Thematic content analysis was used to generate the themes., Results: Six themes were common in most HICs and UMICs: "Challenges in COPD diagnosis", "Strengthening the role of primary care", "Fragmented healthcare systems and coordination challenges", "Inadequate management of COPD exacerbations", "Limited access to specialized care" and, "Impact of underfinanced and overloaded healthcare systems". One theme, "Insurance coverage and reimbursement challenges", was more relevant for UMICs. HICs and UMICs differ in patient and healthcare provider awareness, primary care involvement, spirometry access, and availability of specialized care. Both face issues with healthcare fragmentation, guideline adherence, and COPD exacerbation management. In addition, UMICs also grapple with resource limitations and healthcare infrastructure challenges., Conclusion: Many challenges to COPD care are the same in both HICs and UMICs, underscoring the pervasive nature of these issues. While country-specific issues require customized solutions, there are untapped possibilities for implementing global respiratory strategies that support countries to manage COPD effectively. In addition to healthcare system-level initiatives, there is a crucial need for political prioritization of COPD to allocate the essential resources it requires., Competing Interests: Orjola Shahaj, Anne Meiwald, Krishnan Puri-Sudhir, Rupert Gara Adams, and Elisabeth Adams worked at Aquarius Population Health at the time of the project. Aquarius Population Health receives consultancy and research fees from other pharmaceutical and MedTech companies that are unrelated to this work. Abelardo Elizondo Rios has served on boards for trials sponsored by AstraZeneca, Bayern, Novartis and GSK. Alexis Cazaux has no conflict of interest concerning the topic of this research. Outside of the submitted work, Sergey Avdeev reports receiving consulting fees and/or fees for attending lectures, meetings and conferences and/or travel expenses and/or research grants from AstraZeneca, Novartis, GSK, Teva, Sanofi, and Chiesi. Peter Wark has no conflict of interest concerning the topic of this research., (© 2024 Shahaj et al.)

This article investigates the dynamic impact of green energy consumption (GE), financial inclusion (FI), and military spending (MS) on environmental sustainability (ES) by utilizing a sample of 121 countries from 2003 to 2022. The dataset is divided into high-income, upper-middle income and low and lower-middle-income countries. We employed a two-step system GMM approach, which was further robust through panel Quantile and Driscoll-Kraay (D-K) regressions. The findings divulged that green energy resources benefit ES at global and all income levels because of having a significant negative impact of 5.9% on ecological footprints. At the same time, FI and MS significantly enhance ecological footprints by 7% and 6.9%, respectively, proving these factors detrimental to ES. Moreover, conflicts (CON), terrorism (TM), institutional quality (IQ), and socioeconomic conditions (SEC) also have a significantly positive association with global ecological footprints and most of the income level groups. Dissimilarly, financial inclusion and armed conflicts have a non-significant influence on ecological footprints in low-income and high-income countries, respectively. Furthermore, institutional quality enhances ES in upper-middle and low and lower-middle-income countries by negatively affecting ecological footprints. At the same time, terrorism significantly reduces ecological footprints in high-income countries. This research also provides the imperative policy inferences to accomplish various SDGs., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Murtaza et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Given the importance of ICT diffusion in the development of the financial sector, this analysis is an effort to analyze the transmission channels between the two in high-income and middle and low-income economies over 2001-2019. We have used three variables, including the ICT index, individuals using the internet, and mobile subscribers, to represent ICT and three indices, including the financial development index, financial institution index, and financial market index, to make our results reliable and robust. We utilized a GMM method for conducting the empirical analysis. Generally, our results imply that ICT diffusion positively impacts financial development in high-income economies and negatively impacts middle and low-income economies. Our findings suggest that middle- and low-income-economy policymakers should follow the footprint of the high-income economies and increase the role of ICT in the financial sector for its development., Competing Interests: The authors have declared that no competing interests exist., (Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)

BACKGROUND Economic evaluation of the testing strategies to control transmission and monitor the severity of COVID-19 after the pandemic is essential. This study aimed to review the economic evaluation of COVID-19 tests and to construct a model with outcomes in terms of cost and test acceptability for surveillance in the post-pandemic period in low-income, middle-income, and high-income countries. MATERIAL AND METHODS We performed the systematic review following PRISMA guidelines through MEDLINE and EMBASE databases. We included the relevant studies that reported the economic evaluation of COVID-19 tests for surveillance. Also, we input current probability, sensitivity, and specificity for COVID-19 surveillance in the post-pandemic period. RESULTS A total of 104 articles met the eligibility criteria, and 8 articles were reviewed and assessed for quality. The specificity and sensitivity of COVID-19 screening tests were reported as 80% to 90% and 40% to 90%, respectively. The target population presented a mortality rate between 0.2% and 19.2% in the post-pandemic period. The implementation model of COVID-19 screening tests for surveillance with a cost mean for molecular and antigen tests was US$ 46.64 (min-max US $0.25-$105.39) and US $6.15 (min-max US $2-$10), respectively. CONCLUSIONS For the allocation budget for the COVID-19 surveillance test, it is essential to consider the incidence and mortality of the post-pandemic period in low-income, middle-income, and high-income countries. A robust method to evaluate outcomes is needed to prevent increasing COVID-19 incidents earlier.

The incidence and prevalence of brain tumours have steadily increased within low- and middle-income countries, similar to patterns seen in high-income countries. In addition to the epidemiological landscape of brain tumours in Pakistan, it is important to consider the economics of brain tumour diagnosis and management to inform policy on neuro-oncological healthcare service delivery. The challenges associated with conducting economic evaluations in LMICs include the ability to receive funding for country-specific estimates, dearth of existing data and methodological development, and the need for investment in economic evaluations of health. Economic evaluations are most useful when funding support is given to country-specific initiatives to allocate resources. Cost and cost components must also be meticulously collected to enable accurate calculations of economic evidence for the decision-making process. To put neuro-oncological care at the forefront of the national health agenda, it is crucial for vigorous epidemiological and economic evidence to be available for policymakers.

Several literature review studies have been conducted on cost-effectiveness threshold values. However, only a few are systematic literature reviews, and most did not investigate the different methods, especially in-depth reviews of directly eliciting WTP per QALY. Our study aimed to 1) describe the different direct approach methods to elicit WTP/QALY; 2) investigate factors that contribute the most to the level of WTP/QALY value; and 3) investigate the relation between the value of WTP/QALY and GDP per capita and give some recommendations on feasible methods for eliciting WTP/QALY in low- and middle-income countries (LMICs). A systematic review concerning select studies estimating WTP/QALY from a direct approach was carried out in seven databases, with a cut off date of 03/2022. The conversion of monetary values into 2021 international dollars (i$) was performed via CPI and PPP indexes. The influential factors were evaluated with Bayesian model averaging. Criteria for recommendation for feasible methods in LMICs are made based on empirical evidence from the systematic review and given the resource limitation in LMICs. A total of 12,196 records were identified; 64 articles were included for full-text review. The WTP/QALY method and values varied widely across countries with a median WTP/QALY value of i$16,647.6 and WTP/QALY per GDP per capita of 0.53. A total of 11 factors were most influential, in which the discrete-choice experiment method had a posterior probability of 100%. Methods for deriving WTP/QALY vary largely across studies. Eleven influential factors contribute most to the level of values of WTP/QALY, in which the discrete-choice experiment method was the greatest affected. We also found that in most countries, values for WTP/QALY were below 1 x GDP per capita. Some important principles are addressed related to what LMICs may be concerned with when conducting studies to estimate WTP/QALY., Competing Interests: The authors declare that they have no conflicts of financial interests or personal relationships to influence the work reported in this paper., (Copyright: © 2024 Nu Vu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Ecosystems generate a wide range of benefits for humans, including some market goods as well as other benefits that are not directly reflected in market activity 1 . Climate change will alter the distribution of ecosystems around the world and change the flow of these benefits 2,3 . However, the specific implications of ecosystem changes for human welfare remain unclear, as they depend on the nature of these changes, the value of the affected benefits and the extent to which communities rely on natural systems for their well-being 4 . Here we estimate country-level changes in economic production and the value of non-market ecosystem benefits resulting from climate-change-induced shifts in terrestrial vegetation cover, as projected by dynamic global vegetation models (DGVMs) driven by general circulation climate models. Our results show that the annual population-weighted mean global flow of non-market ecosystem benefits valued in the wealth accounts of the World Bank will be reduced by 9.2% in 2100 under the Shared Socioeconomic Pathway SSP2-6.0 with respect to the baseline no climate change scenario and that the global population-weighted average change in gross domestic product (GDP) by 2100 is -1.3% of the baseline GDP. Because lower-income countries are more reliant on natural capital, these GDP effects are regressive. Approximately 90% of these damages are borne by the poorest 50% of countries and regions, whereas the wealthiest 10% experience only 2% of these losses., (© 2023. The Author(s).)

Growth faltering in children (low length for age or low weight for length) during the first 1,000 days of life (from conception to 2 years of age) influences short-term and long-term health and survival 1,2 . Interventions such as nutritional supplementation during pregnancy and the postnatal period could help prevent growth faltering, but programmatic action has been insufficient to eliminate the high burden of stunting and wasting in low- and middle-income countries. Identification of age windows and population subgroups on which to focus will benefit future preventive efforts. Here we use a population intervention effects analysis of 33 longitudinal cohorts (83,671 children, 662,763 measurements) and 30 separate exposures to show that improving maternal anthropometry and child condition at birth accounted for population increases in length-for-age z-scores of up to 0.40 and weight-for-length z-scores of up to 0.15 by 24 months of age. Boys had consistently higher risk of all forms of growth faltering than girls. Early postnatal growth faltering predisposed children to subsequent and persistent growth faltering. Children with multiple growth deficits exhibited higher mortality rates from birth to 2 years of age than children without growth deficits (hazard ratios 1.9 to 8.7). The importance of prenatal causes and severe consequences for children who experienced early growth faltering support a focus on pre-conception and pregnancy as a key opportunity for new preventive interventions., (© 2023. The Author(s).)

Importance: Aspirin is an effective and low-cost option for reducing atherosclerotic cardiovascular disease (CVD) events and improving mortality rates among individuals with established CVD. To guide efforts to mitigate the global CVD burden, there is a need to understand current levels of aspirin use for secondary prevention of CVD., Objective: To report and evaluate aspirin use for secondary prevention of CVD across low-, middle-, and high-income countries., Design, Setting, and Participants: Cross-sectional analysis using pooled, individual participant data from nationally representative health surveys conducted between 2013 and 2020 in 51 low-, middle-, and high-income countries. Included surveys contained data on self-reported history of CVD and aspirin use. The sample of participants included nonpregnant adults aged 40 to 69 years., Exposures: Countries' per capita income levels and world region; individuals' socioeconomic demographics., Main Outcomes and Measures: Self-reported use of aspirin for secondary prevention of CVD., Results: The overall pooled sample included 124 505 individuals. The median age was 52 (IQR, 45-59) years, and 50.5% (95% CI, 49.9%-51.1%) were women. A total of 10 589 individuals had a self-reported history of CVD (8.1% [95% CI, 7.6%-8.6%]). Among individuals with a history of CVD, aspirin use for secondary prevention in the overall pooled sample was 40.3% (95% CI, 37.6%-43.0%). By income group, estimates were 16.6% (95% CI, 12.4%-21.9%) in low-income countries, 24.5% (95% CI, 20.8%-28.6%) in lower-middle-income countries, 51.1% (95% CI, 48.2%-54.0%) in upper-middle-income countries, and 65.0% (95% CI, 59.1%-70.4%) in high-income countries., Conclusion and Relevance: Worldwide, aspirin is underused in secondary prevention, particularly in low-income countries. National health policies and health systems must develop, implement, and evaluate strategies to promote aspirin therapy.