Assessment of acute burn management in 32 low- and middle-income countries

BACKGROUND: The purpose of this study is to ascertain whether acute burn management (ABM) is available at health facilities in low- and middle-income countries (LMICs). METHOD: The study used the World Health Organization situational analysis tool (SAT) which is designed to assess emergency and essential surgical care and includes data points relevant to the acute management of burns. The SAT was available for 1413 health facilities in 59 countries. RESULTS: A majority (1036, 77.5 %) of the health facilities are able to perform ABM. The main reasons for the referral of ABM are lack of skills (53.4 %) and non-functioning equipment (52.2 %). Considering health centres and district/rural/community hospitals that referred due to lack of supplies/drugs and/or non-functioning equipment, almost half of the facilities were not able to provide continuous and consistent access to the equipment required either for resuscitation or to perform burn wound debridement. Out of the facilities that performed ABM, 379 (36.6 %) are capable of carrying out skin grafts and contracture release, which is indicative of their ability to manage full thickness burns. However the magnitude of full thickness burns managed was limited in half of these facilities, as they did not have access to a blood bank. CONCLUSION: The initial management of acute burns is generally available in LMICs, however it is constrained by the inability to perform resuscitation (19 %) and/or burn wound debridement (10 %). For more severe burns, an inability to perform skin grafting or contracture release limits definitive management of full thickness burns, whilst lack of availability to blood further compromises the treatment of major burns.

Bureaucratic corruption and income : evidence from the land sector in Bangladesh

We examine, for the first time, the effects of corruption on income using household survey data from a developing country. Estimating the effects of corruption on income is challenging because of the simultaneous relationship between the two variables. We use a two-step instrumental variable approach to identify the effects of corruption on income. We find that after adjusting for simultaneity bias the act of bribery reduces income and that higher bribes have a negative effect on income. Taken together, our results provide a possible explanation why a vicious cycle between corruption and income inequality does not exist in the land sector in Bangladesh.

The impact of gender inequality in education on income in Africa and the Middle East

We use data for a group of sub-Saharan African, North African and Middle Eastern countries to explore the impact of gender inequality in education on levels of income per capita. Two gender inequality indicators are used: the gap in female to male primary education enrolment ratios and the gap in female to male secondary education enrolment ratios. Estimation results indicate that gender inequality in primary and secondary education has a statistically significant negative effect on income, especially in North African and Middle Eastern countries. In relatively open economies, gender inequality in education seems to have an additional effect, but this effect is consistently positive, suggesting that while trade contributes to higher income it may be accompanied by greater inequality. Overall, the results in this paper provide further evidence that the international development community's focus on reducing gender inequality and achieving universal primary education is well founded.

'Low income doesn't mean stupid and destined for failure': Challenging the deficit discourse around students from low SES backgrounds in higher education

The discourse around students from low socio-economic backgrounds often adopts a deficit conception in which these students are seen as a problem in higher education. In light of recent figures pointing to an increase in the number and proportion of these students participating in higher education [Pitman, T. 2014. "More Students in Higher ed, But it's no more Representative." The Conversation 28: 1-4] and an absence of evidence to support deficit thinking, this deficit discourse requires re-examination. Qualitative data from 115 interviews carried out across 6 Australian universities as part of a national study reveal that, contrary to the conception of these students as a problem, students from low SES backgrounds demonstrate high levels of determination and academic skills and that they actively seek high standards in their studies. This paper critically examines deficit conceptions of these students, drawing on findings from qualitative interviews with 89 successful students from low SES backgrounds and 26 staff members recognised as exemplary in their provision of teaching and support of students from low SES backgrounds. Drawing on these findings, this paper challenges the deficit discourse and argues for a more affirmative and nuanced conception of students from low SES backgrounds.

Bellwether procedures for monitoring and planning essential surgical care in low- and middle-income countries: caesarean delivery, laparotomy and treatment of open fractures

BACKGROUND: Surgical conditions represent a significant proportion of the global burden of disease, and therefore, surgery is an essential component of health systems. Achieving universal health coverage requires effective monitoring of access to surgery. However, there is no widely accepted standard for the required capabilities of a first-level hospital. We aimed to determine whether a group of operations could be used to describe the delivery of essential surgical care.

METHODS: We convened an expert panel to identify procedures that might indicate the presence of resources needed to treat an appropriate range of surgical conditions at first-level hospitals. Using data from the World Health Organization Emergency and Essential Surgical Care Global database, collected using the WHO Situational Analysis Tool (SAT), we analysed whether the ability to perform each of these procedures-which we term "bellwether procedures"-was associated with performing a full range of essential surgical procedures.

FINDINGS: The ability to perform caesarean delivery, laparotomy, and treatment of open fracture was closely associated with performing all obstetric, general, basic, emergency, and orthopaedic procedures (p < 0.001) in the population that responded to the WHO SAT Survey. Procedures including cleft lip, cataract, and neonatal surgery did not correlate with performing the bellwether procedures.

INTERPRETATION: Caesarean delivery, laparotomy, and treatment of open fractures should be standard procedures performed at first-level hospitals. With further validation in other populations, local managers and health ministries may find this useful as a benchmark for what first-level hospitals can and should be able to perform on a 24/7 basis in order to ensure delivery of emergency and essential surgical care to their population. Those procedures which did not correlate with the bellwether procedures can be referred to a specialized centre or collected for treatment by a visiting specialist team.

Older adults' quality of life - exploring the role of the built environment and social cohesion in community-dwelling seniors on low income

The built environment and social cohesion are increasingly recognized as being associated with older adults' quality of life (QoL). However, limited research in this area still exists and the relationship has remained unexplored in the area of Metro Vancouver, Canada. This study examined the association between the built environment and social cohesion with QoL of 160 community-dwelling older adults (aged ≥ 65 years) on low income from Metro Vancouver. Cross-sectional data acquired from the Walk the Talk (WTT) study were used. Health-related QoL (HRQoL) and capability wellbeing were assessed using the EQ-5D-5L and the ICECAP-O, respectively. Measures of the environment comprised the NEWS-A (perceived built environment measure), the Street Smart Walk Score (objective built environment measure), and the SC-5PT (a measure of social cohesion). The primary analysis consists of Tobit regression models to explore the associations between environmental features and HRQoL as well as capability wellbeing. Key findings indicate that after adjusting for covariates, older adults' capability wellbeing was associated with street connectivity and social cohesion, while no statistically significant associations were found between environmental factors and HRQoL. Our results should be considered as hypothesis-generating and need confirmation in a larger longitudinal study.

Improving compliance of income tax in developing countries: Bangladesh perspective

The thesis examines tax compliance issues in developing countries in the field of income tax with special emphasis on Bangladesh. The thesis explores the state and taxpayers relationship as a fiduciary one. The effectiveness of specific legal tools in Bangladesh are discussed critically. Policy suggestions are made to improve compliance