Key Factors to Consider When Introducing a New Vaccine in Low-Income Settings: Lessons from Malawi Expanded Program on Immunization

Introduction: As new vaccines become available, countries must assess the relevance to introduce them into their vaccination schedules. Malawi has recently introduced several new vaccines and plans to introduce more. This study was conducted to identify key factors that need to be considered when deciding to introduce a new vaccine and current challenges faced by low and middle income countries using Malawi as an example. Methodology: The study employed a desk review approach, examining published literature from various sources such as PubMed, Medline, and Google Scholar. Policy documents from organizations like the World Health Organization, GAVI the Alliance, and the Ministry of Health for Malawi were also included. A total of 99 articles and documents on new vaccine introduction, challenges of immunization, policy documents in immunization and health systems strengthening were included. The review focused on addressing five key areas critical to new vaccine introduction namely: the need for a vaccine, availability of the vaccine, safety and effectiveness of the vaccine, demand for the vaccine, and the prudent use of public or private funds. Results: Malawi considered the burden of cervical cancer and the significance of malaria in the country when introducing the HPV and malaria vaccines. The country opted for vaccines that can be handled by the cold chain capacity and available human resources. Despite that malaria vaccine and Typhoid Conjugate Vaccine trials were done in country, there are limited vaccine safety and efficacy trials conducted in Malawi, leading to a reliance on WHO-prequalified vaccines. Demand for newly introduced vaccines varied, with high demand for Oral Cholera Vaccine during a cholera outbreak, while demand for COVID-19 vaccines decreased over time. Although cost-effectiveness studies were limited in the country, 2 studies indicated that Typhoid Conjugate Vaccine and malaria vaccine would be cost effective. All these have been implemented despite having challenges like lack of accurate surveillance data, inadequate cold chain capacity, limited safety and efficacy vaccine clinical trials, political influence, and limited funding. Conclusion: Despite several challenges Malawi set a good example of the careful considerations required before introducing a new vaccine. The process involves data review, priority setting, precise planning, and consultation with stakeholders. Low-income countries should invest in vaccine safety, efficacy, and cost-effectiveness trials.

Characteristics of Infertile Clientele Attending a Public in Vitro Fertilization Clinic: Appraising Priorities in a Low-Income Country

Introduction: Infertilityaffects one in six couples, and it is an important public health issue largely due to thepervasive effects on the emotional and psychological wellbeing of affected couples. In many developing nations emphasis is placed on childbirth and inability to fulfill this role can be very distressing. There is an unmet need for assisted reproductive technology (ART) in many developing countries and where facilities exist, they are mostly privately owned, expensive and concentrated in urban areas. To bridge this gap, public fertility clinics have been established to provide subsidized care. Evaluating the characteristics and peculiarities of clientele presenting at these public facilities will aid planning and prioritization of care. Methodology: A descriptive retrospective study of 116 infertile patients presenting to the fertility clinic of the University College Hospital, Ibadan, Nigeria from inception on the 14th of February 2019 and 31st of December 2022.Data was analyzed using the Statical Package for Social Sciences (IBM, SPSS, New York) version 23. Descriptive statistics were used to summarize the results which were presented with the aid of bar charts and frequency tables. Result: The mean age of the patients was 40.70 ± 6.62 years. Post-menopausal patients accounted for about one-fifth of the study population while 80.2% (93 women) were older than 35 years. The mean duration of infertility was 9.39 ± 6.11years and nine patients (7.8%) had a duration greater than 2 decades. Secondary infertility occurred in 67.2% of the women. Twenty-nine women (25%) had undergone myomectomy prior to presentation. Hypertension (11.2%) was the most prevalent comorbidity. Nineteen patients (16.4%) had used contraceptives in the past with the male condom (36.8%)being the most preponderant. Sixty-seven patients had experienced pregnancy losses before 28 weeks of gestation while just 16 patients (13.8%) had undergone ART, and none was successful. Conclusion: Secondary infertility was the prevalent type of infertility and may not be unconnected with the low contraceptive usage and high risk of sexually transmitted infection. Late presentation coupled with a large proportion of post-menopausal clientele suggests delayed health-seeking behavior most probably due to the prohibitive cost of ART. The need to streamline services offered in public fertility clinics is paramount in low-income countries grappling with scarce resources. A pragmatic approach will involve the provision of low-cost ART, while enhancing gamete donation programs through the implementation of gamete sharing policies. This will invariably bridge the unmet need and skewed access to ART in developing countries.

Epidemiological, Clinical Aspects and Outcome of Measles in a Low-Income Country in 2023

Introduction: Measles remains a worrying health problem in sub-Saharan African countries. There have been measles outbreaks in Cameroon with the most recent occurring between October 2022 and September 2023. The Centre region of Cameroon was the most affected in the country and being at the frontline of the fight against this illness, we conducted this study in order to determine the epidemiological and clinical characteristics as well as the outcome of children who contracted the measles and were hospitalized at the Yaoundé Gynaeco-Obstetric and Pediatric Hospital. Methodology: We conducted a cross-sectional descriptive and prospective study for one year from October 2022 to November 2023 corresponding to the duration of the outbreak. We included all children admitted in the pediatric unit for measles and its complications during this period. Results: In total, 60 children were enrolled. Their caregivers were mostly their mothers who had a mean age of 34.71 ± 9.55 years living in significant precarious conditions for the majority. The median age of children was 16 months (09 - 30 months). Twenty six percent of children (16) were less than 9 months. Girls were predominant (55%). Most children were not up to date with their routine EPI vaccination (80%) and most did not receive the measles and Rubella vaccine (76.67%). Clinical manifestations, included fever, conjunctivitis, and cough. Skin rash and catarrh (98.33% and 86.67% respectively) are the case definition signs of measles. The outcome was unfavorable for 4 children. One had a neurological disorder: coma and three presented with pneumonia and severe respiratory distress (6.67%). Conclusion: Measles is still being a reality and claiming lives in our context, emphasis should be made on immunization coverage and if possible, advocacies should be formulated to decrease the age of measles vaccine administration.

Economic and Social Impact Assessment of Chronic Diseases Among the Low-Income Population in Southern Punjab,Pakistan

Introduction:Chronic diseases are becoming more prevalent worldwide.The effects of chronic illnesses are disastrous not only for the diagnosed person but also for their entire family.This study explores chronic diseases’social and economic impact on low-income families.The study aims to determine the economic and social implications of various chronic diseases and the loss of income due to these conditions among low-income individuals in Southern Punjab,Pakistan.Methodology:A sample of 424 patients was selected from different areas of Southern Punjab.Data were collected using a questionnaire that included questions about economic status,self-reported health status,social status,management strategies,and health insurance,among other factors.Results:The mean monthly income of the respondents was found to be 57,097.6 Pakistani rupee(PKR),and the mean monthly expenses for treatment were 8,256.1 PKR.The loss of income was calculated at 15%.Additionally,62%of patients spent more than 10%of their monthly income on managing their disease.Approximately 85%of the respondents reported that chronic diseases affected their social life.Furthermore,80%of patients lacked health insurance.Conclusion:Chronic diseases impose significant economic and social burdens on patients and their families in Southern Punjab.To reduce the burden of chronic diseases,the government should enhance healthcare services in this region and provide health insurance to low-income families.

Utilization of access to colorectal cancer screening modalities in low-income populations after medicaid expansion

BACKGROUND Colorectal cancer(CRC)remains a relevant public health problem.Current research suggests that racial,economic and geographic disparities impact access.Despite the expansion of Medicaid eligibility as a key component of the Affordable Care Act(ACA),there is a dearth of information on the utilization of newly gained access to CRC screening by low-income individuals.This study investigates the impact of the ACA’s Medicaid expansion on utilization of the various CRC screening modalities by low-income participants.Our working hypothesis is that Medicaid expansion will increase access and utilization of CRC screening by low-income participants.AIM To investigate the impact of the Affordable Care Act and in particular the effect of Medicaid expansion on access and utilization of CRC screening modalities by Medicaid state expansion status across the United States.METHODS This was a quasi-experimental study design using data from the Behavioral Risk Factor Surveillance System,a large health system survey for participants across the United States and with over 2.8 million responses.The period of the study was from 2011 to 2016 which was dichotomized as pre-ACA Medicaid expansion(2011-2013)and post-ACA Medicaid expansion(2014-2016).The change in utilization of access to CRC screening strategies between the expansion periods were analyzed as the dependent variables.Secondary analyses included stratification of the access by ethnicity/race,income,and education status.RESULTS A greater increase in utilization of access to CRC screening was observed in Medicaid expansion states than in nonexpansion states[+2.9%;95%confidence interval(95%CI):2.12,3.69].Low-income participants showed a+4.02%(95%CI:2.96,5.07)change between the expansion periods compared with higher income groups+3.19%(1.70,4.67).Non-Hispanic Whites and Hispanics[+3.01%(95%CI:2.16,3.85)vs+5.51%(95%CI:2.81,8.20)]showed a statistically significant increase in utilization of access but not in Non-Hispanic Blacks,or Multiracial.There was an increase in utilization across all educational levels.This was significant among those who reported having a high school graduate degree or more+4.26%(95%CI:3.16,5.35)compared to some high school or less+1.59%(95%CI:-1.37,4.55).CONCLUSION Medicaid expansion under the Affordable Care Act led to an overall increase in self-reported use of CRC screening tests by adults aged 50-64 years in the United States.This finding was consistent across all low-income populations,but not all races or levels of education.

Low-income and overweight in China:Evidence from a life-course utility model

Previous literature has demonstrated that low-income people are more likely to settle for poor health choices in developed countries. By using income as a budget constraint and signal for future wellbeing in a life-course utility model, we examine the association amongst income and overweight. The data used for this study are from the China Health and Nutrition Survey(CHNS). Estimations are conducted for overweight initiation, cessation, and participation mirroring a decision to begin and a past decision to not terminate. Our findings propose that body weight and the likelihood of overweight commencement rise with additional income but at a diminishing degree, representing a concave relation;while the likelihood of overweight discontinuance declines with additional income but at an accelerating degree, suggesting a convex relation.We presume that, as opposed to developed countries, low-income people are less inclined to be overweight in China, a country in transition. This could be explained by an income constraint for unhealthy foodstuff. Nevertheless, it will switch when income surpasses the critical threshold of the concave or inverted U-shape curve indicating that low-income people appear to receive not as much utility from future health. Specifically, this adjustment seems to occur earlier for females and inhabitants of urban areas.

Characteristics of Hypertension Death in Low-income Regions of Inner Mongolia, China

Hypertension has been a major risk factor for cardiovascular disease[1].Hypertension overall prevalence in adults is 30%–45%,becoming>60%in people aged above 60 years[2],with a worldwide agestandardised prevalence of 20 and 24%in women and men,respectively[3].

Distribution of primary school based on spatial network comprehensive model in low-income mountainous cities： a case study in Wanyuan, China

Focusing on the peculiarities of urban construction resulting from specific mountain terrains, the purpose of this study is to find out a suitable method based on a Spatial Network Comprehensive Model(SNCM) to reasonably plan and distribute primary schools in low-income mountain cities. The construction principles and advantages of the SNCM method are proposed and the method tested in Wanyuan city of Qinba Mountain area(Southwest China) to verify its feasibility and optimization. Taking account of the mountain terrain and its influence on user behavior, we used the SNCM method to build a comprehensive model which integrates the road slope and the walking speed of pupils into the basic spatial model. The model is used to calculate a reasonable layout of the primary schools and to validate the rationale. The results show that the SNCM method can be effectively applied in low-income mountainous cities. It can not only improve the accessibility and service efficiency of primary schools using as little capital-investment as possible, but also help the city grow in an intensive and efficient way.

Nutritional Status of Under-five Children from Urban Low-income Families in Xiangtan and Jilin in China

There have been many studies on the nutrition and the growth status of children from rural and remote western regions of China, whereas researches on children from urban low-income families are scarce. This study aimed to investigate the growth and nutritional status of children under five years of age from urban low-income families in China. There were 169 children aged 25–60 months recruited from Xiangtan and Jilin, two cities with a population of 2.81 million and 4.26 million respectively, in China in this cluster cross-sectional study. Data were collected on demographic and socioeconomic characteristics, the feeding practices and the incidence of anemia and diarrhea. The results showed that the prevalence of low birth weight and macrosomia was 7.1% and 9.5% for the two cities, respectively, which was higher than that for other cities in China（1.5% and 5.9%）. Of all the sampled children, 14.6% and 8.2% suffered anemia and diarrhea, respectively. Multivariate analysis showed that legumes or nuts fed in a 24-h recall increased the risk of anemia（OR=4.9）. Children whose caregivers began to introduce complementary foods relatively late would have high diarrhea prevalence（OR=1.4）. In conclusion, the prevalence of anemia and diarrhea in under-five children from urban low-income families in China is relatively high. The growth and nutritional status of these children is greatly affected by feeding practices. A series of measures should be taken by relevant government departments to improve the health of these children.

Application of Containers to Low-Income Housing in Context of New Urbanization

This paper explores how to use container buildings to resolve the housing problem of migrant workers in the context of urbanization, and ascertains the characteristics of the container housing and public space through the analysis of excellent examples of the container recycling project at home and abroad. In terms of the material, economic benefits, environmental protection and industrialization, those characteristics are summarized as follows.(1) Being sturdy, corrosion-resisting, waterproof and insulated, building materials are able to resist bad weather.(2) Their economic results lie in the short constructive cycle so that the cost of reinforced concrete per unit area reduces 20% on year-on-year basis.(3) Their environmental protection rests with the recyclability of materials, less construction waste and less noise in the construction process.(4) Their industrialization is embedded in their modular design and standardized specifications as well as the flexibility and replaceability.

Evaluation of Embodied Energy and Construction Costs for the Design of Low-Rise Apartments for Low-Income Residents in Surabaya, Indonesia

Low-rise apartments for low-income residents have been built in Surabaya in recent years. They have four stories and many rooms, and the dwellers are all small traders. Because these projects are built with funds from the government, the buildings are designed to consider the cost of construction, without consideration of embodied energy material. As a result, the buildings are not optimal in terms of embodied energy and construction cost. At present, because there are both concerns over global warning and a worldwide energy crisis, the embodied energy in a building is a very important concept for building design, because it can determine usage of energy in relation to natural sources, especially fossil fuels. This is part of the sustainable design concept. This paper describes research regarding： differences in embodied energy and construction cost between different wall materials, including brick, corn block and lightweight concrete in low rise apartments; the optimal relationship between embodied energy and building cost; and which factors determine these differences. The findings of this research show that lightweight concrete is the best material for the building walls; apartments for low-income in Surabaya still do not represent optimal construction design; and that sustainable buildings are cheaper than those that do not use this concept.

The Influence of Displacement to the Success of Sustainable Multi-Storey Housing Development for Low-Income Society in Urban Area： Case Study- Multi-Storey Housing in Jakarta

Multi-storey housing for low income society is a concept of redevelopment from many alternatives of housing development for slum in Jakarta. However, redevelopment directly or indirectly leads to displacement of low-income residents. The new residents would be of a higher socio-economic status than the previous occupants. For controlling this phenomenon, a study about the influence of displacement to the successful of sustainable multi-storey housing development for low-income society has been done with descriptive method, observation and literature study. The result of this study give knowledge that displacement always happened when the quality of building and environment is increase, the location of multi-storey housing is near city center and commercial area. Low income society voluntary displaced their units to middle or high income society, because they are not affordable for paying operational and maintenance costs. The government has to make regulations for controlling displacement on multi-storey housing for low-income society and for the successful of sustainable multi-storey housing development in urban area.

Are Personal Exemptions Succeeded to Protect Low-Income Families in Egypt From the Negative Effects of COVID-19?

This paper attempts to investigate the negative effects of the spread of COVID-19 on low-income families in Egypt.Coronavirus spread is measured by"Coronavirus cases"and"Coronavirus deaths"on a daily basis.Besides,it is measured by both"new Coronavirus cases"and"new deaths from Coronavirus",in relation to the population of Egypt.The Egyptian government is taking some measures to reduce the negative effects of COVID-19,including increasing personal exemptions by amending some provisions of the Egyptian Income Tax Law promulgated by Law No.91 of 2005 to protect low-income families.Of the negative effects of COVID-19,it is one of the most important tax policies to achieve social justice in distributing the tax burden,according to income levels,in a manner that achieves justice and equality.We find that Personal exemptions did not succeed in achieving tax justice by easing the tax burden on the low-income people in society.

A Study on Influencing Factors of Happiness of Urban Low-income Groups

With the completion of the strategic vision of building a moderately prosperous society in an all-round way in 2020,China’s economic development has entered a new normal.The concept of innovative,coordinated,green,open and shared development will lead China’s economic progress and development.However,the development of urban and rural areas and regions in China is still not coordinated,and the sudden COVID-19 outbreak has caused a serious impact on urban low-income groups.Due to the characteristics of poor employment stability,low income and single source,as well as greater family pressure of urban low-income groups,the author focuses on the influencing factors of their feelings of happiness.This paper assumes that the satisfaction degree of residents’needs is positively correlated with residents’feelings of happiness.Based on Maslow’s hierarchy of needs theory,this paper analyzes the factors that may affect the happiness of urban low-income groups in five levels,and explores the special needs and difficulties of urban low-income groups in the context of the epidemic.So as to find ways to improve the happiness of urban low-income people to provide reference.

An empirical study of everyday life information seeking behavior of urban low-income residents in the Haizhu District of Guangzhou, China

This paper reports an investigation on everyday life information seeking behavior of urban low-income group in the Haizhu District of Guangzhou City. Empirical data were collected via in-depth interviews with low-income urban residents and were analyzed using qualitative methods. This paper discusses the research findings based on the more noticeable results of information seeking behavior among these people. Our approach touches on a focused study of such issues as what the role of information seeking in their everyday life is, what information they care about, which information channels they prefer to use, which factors influence their information seeking behavior, how difficult it is to seek the information they need, and how they use public libraries. Based on our research findings, we propose that public libraries should provide customized information services for urban low-income residents according to the unique characteristics of their information seeking behavior in everyday life.

The Impact of Rising College Tuition in the United States on Students from Low-Income Families

This paper examines the multifaceted economic,social,and psychological impacts of the rising cost of college tuition in the United States,with a particular focus on students from low-income families.The escalating tuition fees have far-reaching implications,including increased student loan debt,delayed social mobility,and psychological stress among students.The paper explores the barriers to higher education imposed by financial constraints and the systemic challenges that exacerbate income inequality in access to quality education.Case studies highlight the resilience of students who overcome these obstacles,as well as the struggles of those who face significant setbacks.The paper concludes with policy implications and recommendations for future research,emphasizing the need for a comprehensive approach to address the financial barriers in higher education.It advocates for policy interventions that increase financial aid,reform educational funding,and promote innovative and affordable educational models to ensure equitable access to higher education.

Metamorphosis:The Credit Market of Low-Income Households in a Semi-Peripheral Country

In this paper,a theoretical model is developed on the basis of systems theory,which structures the livelihood system of low-income households in a European country characterized by a semi-peripheral economy.Based on the proposed model,the complex system of network connections and formal and informal financial transactions,which households use in their daily lives to cover their expenses,becomes graspable.The proposed theoretical model is analyzed through simulations based on agent-based modelling(ABM)centred on empirical network data.Through the simulations,the author explores the mechanisms of the market and asks what formal and informal credit transactions determine its operation,how these factors shape the local social structure and how resilient the market is to crises.The results show that this dynamic,complex risk-sharing system has an inherent logic and it can mitigate the small liquidity shocks but it is not resistant to bigger financial shocks or overconsumptions.

Development of countermeasures to effectively improve pedestrian safety in low-income areas

In recent years, many departments of transportation in the US have invested more resources to enhance pedestrian safety. However, there is still a need to effectively and systematically address pedestrian safety issues in low-income areas. Statistics show that pedestrians are fatally injured at disproportionately higher rates in the nation's poorer neighborhoods. Low-income areas often are sectioned by high-volume/high-speed arterials, which compound the problem. In this study, pedestrian-vehicle crash data in lowincome areas were analyzed from two aspects: how demographic factors, road environment, and land use types influence pedestrian crash occurrence(based on frequency data)and how demographic and other factors influence severity in a pedestrian crash(based on severity data). The crash frequency modeling results show that major influential variables for higher pedestrian crash frequency include four demographic factors(proportions of older adults, commuters using public transit or biking, people with low education level,and zero-car ownership), three road environmental factors(densities of traffic signals and bus stops and proportion of higher-speed roads), and three land use factors(densities of discount stores, convenience stores, and fast-food restaurants). The injury severity modeling results show that a dark-not lighted condition is the most influential variable for severe injury pedestrian crashes, and the number of impaired pedestrians and aggressive drivers also greatly increases the probability of severe injury. Based on the analysis results,this paper makes specific recommendations for both engineering countermeasures and pedestrian safety education/outreach plans that resonate with a given area's demographics to effectively improve pedestrian safety in low-income areas.

Study on Gregarious Low-Income College Graduates in Beijing: Tangjialing Phenomenon and Its Afterefect

During China's rapid urbanization process, the survival condition of low-income college graduates who live in urban villages has become a serious issue that attracts the attention of policy-makers and sociologists. Based on existing literatures, relevant information, and independent field investigations, this paper focuses on Tangjialing, an urban village where low-income college graduates gather, investigating on their current situations of sociological features and settlements, as well as the reasons for the formation of urban villages.

Developing occupant archetypes within urban low-income housing: A case study in Mumbai, India

Rapid urbanization pressure and poverty have created a push for affordable housing within the global south.The design of affordable housing can have consequences on the thermal(dis)comfort and behaviour of the occupants,hence requiring an occupant-centric approach to ensure sustainability.This paper investigates occupant behaviour within the urban poor households of Mumbai,India and its impact on their thermal comfort and energy use.This study is a first-of-its-kind attempt to explore the socio-demographic characteristics and energy-related behaviour of low-income occupants within Indian context.Three occupant archetypes,Indifferent Consumers;Considerate Savers;and Conscious Conventionals,were identified from the behavioural and psychographic characteristics gathered through a transverse field survey.A two-step clustering approach was adopted for occupant segmentation that highlighted considerable diversity in occupants’adaptation measures,energy knowledge,energy habits,and their pro-environmental behaviour within similar socio-economic group.Building energy simulation of the representative archetype behaviour estimated up to 37%variations for air-conditioned and up to 8%variation for fan-assisted naturally ventilated housing units during peak summer months.The results from this study establish the significance of occupant factors in shaping energy demand and thermal comfort within low-income housing and pave way for developing occupant-centric building design strategies to serve this marginalized population.The developed low-income occupant archetypes would be useful for architects and energy modelers to generate realistic energy use profiles and improve building performance simulation results.