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      The global burden of child burn injuries in light of country level economic development and income inequality

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          Abstract

          Child burn mortality differs widely between regions and is closely related to material deprivation, but reports on their global distribution are few. Investigating their country level distribution in light of economic level and income inequality will help assess the potential for macro-level improvements. We extracted data for child burn mortality from the Global Burden of Disease study 2013 and combined data into 1–14 years to calculate rates at country, region and income levels. We also compiled potential lives saved. Then we examined the relationship between country level gross domestic product per capita from the World Bank and income inequality (Gini Index) from the Standardized World Income Inequality Database and child burn mortality using Spearman coefficient correlations. Worldwide, the burden of child burn deaths is 2.5 per 100,000 across 103 countries with the largest burden in Sub-Saharan Africa (4.5 per 100,000). Thirty-four thousand lives could be saved yearly if all countries in the world had the same rates as the best performing group of high-income countries; the majority in low-income countries. There was a negative graded association between economic level and child burns for all countries aggregated and at regional level, but no consistent pattern existed for income inequality at regional level. The burden of child burn mortality varies by region and income level with prevention efforts needed most urgently in middle-income countries and Sub-Saharan Africa. Investment in safe living conditions and access to medical care are paramount to achieving further reductions in the global burden of preventable child burn deaths.

          Highlights

          • Burden of child burn deaths is 2.5/100,000, largest burden in Sub-Saharan-Africa.

          • 34,000 lives could be saved yearly from burns if all countries had similar rates.

          • Globally child burns decrease as economic wealth increases.

          • Prevention efforts needed urgently in middle-income countries, Sub-Saharan-Africa.

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          The Standardized World Income Inequality Database*

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            Epidemiology of burn injuries in the East Mediterranean Region: a systematic review

            Background Burn injuries remain one of the leading causes of injury morbidity and mortality in the World Health Organization's East Mediterranean Region. To provide an overview on the epidemiology of burn injuries in this region, a systematic review was undertaken. Methods Medline, Embase and CINAHL were searched for publications on burns in this region published between 01/01/1997 and 16/4/2007. Data were extracted to a standard spreadsheet and synthesised using a narrative synthesis. No attempt has been made to quantitatively synthesise the data due to the large degree of clinical heterogeneity between study populations. Results Seventy one studies were included in the review, from 12 countries. Burn injuries were found to be one of the leading causes of injury morbidity and mortality. The reported incidence of burns ranged from 112 to 518 per 100,000 per year. Burn victims were more frequently young and approximately one third of the victims were children aged 0-5 years. Hospital mortality ranged from 5 to 37%, but was commonly above 20%. Intentional self-harm burns particularly involving women were common in some countries of the region and were associated with a very high mortality of up to 79%. Conclusion Burn injuries remain an important public health issue in the East Mediterranean Region therefore further research is required to investigate the problem and assess the effectiveness of intervention programmes.
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              Quality of governance, public spending on health and health status in Sub Saharan Africa: a panel data regression analysis

              Background The population in Sub Saharan Africa (SSA) suffers poor health as manifested in high mortality rates and low life expectancy. Economic growth has consistently been shown to be a major determinant of health outcomes. However, even with good economic growth rates, it is not possible to achieve desired improvements in health outcomes. Public spending on health (PSH) has long been viewed as a potential complement to economic growth in improving health. However, the relationship between PSH and health outcomes is inconclusive and this inconclusiveness may, in part, be explained by governance-related factors which mediate the impact of the former on the latter. Little empirical work has been done in this regard on SSA. This paper investigates whether or not the quality of governance (QoG) has a modifying effect on the impact of public health spending on health outcomes, measured by under-five mortality (U5M) and life expectancy at birth (LE), in SSA. Methods Using two staged least squares regression technique on panel data from 43 countries in SSA over the period 1996–2011, we estimated the effect of public spending on health and quality of governance U5M and LE, controlling for GDP per capita and other socio-economic factors. We also interacted PSH and QoG to find out if the latter has a modifying effect on the former’s impact on U5M and LE. Results Public spending on health has a statistically significant impact in improving health outcomes. Its direct elasticity with respect to under-five mortality is between −0.09 and −0.11 while its semi-elasticity with respect to life expectancy is between 0.35 and 0.60. Allowing for indirect effect of PSH spending via interaction with quality of governance, we find that an improvement in QoG enhances the overall impact of PSH. In countries with higher quality of governance, the overall elasticity of PSH with respect to under-five mortality is between −0.17 and −0.19 while in countries with lower quality of governance, it is about −0.09. The corresponding semi elasticities with respect to life expectancy are about 6 in countries with higher QoG and about 3 in countries with lower QoG. Discussion Public spending on health improves health outcomes. Its impact is mediated by quality of governance, having the higher impact on health outcomes in countries with higher quality of governance and lower impact in countries with lower quality of governance. This may be due to increased efficiency in the use of available resources and better allocation of the same as QoG improves. Conclusion Improving QoG would improve health outcomes in SSA. The same increase in PSH is twice as effective in reducing U5M and increasing LE in countries with good QoG when compared with countries with poor QoG.
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                Author and article information

                Contributors
                Journal
                Prev Med Rep
                Prev Med Rep
                Preventive Medicine Reports
                Elsevier
                2211-3355
                02 March 2017
                June 2017
                02 March 2017
                : 6
                : 115-120
                Affiliations
                [a ]Karolinska Institutet, Department of Public Health Sciences, Stockholm, Sweden
                [b ]World Health Programme, Université du Québec en Abitibi-Témiscamingue (UQAT), Québec, Canada
                [c ]University of South Africa, Institute for Social and Health Sciences, P.O. Box 1087, Lenesia, 1820 Johannesburg, South Africa
                [d ]South African Medical Research Council, University of South Africa, Injury and Peace Research Unit, PO Box 19070, Tygerberg, 7505 Cape Town, South Africa
                Author notes
                [* ]Corresponding author at: Karolinska Institutet, Department of Public Health Sciences, Widerströmska Huset, Tomtebodavägen 18 A, 171 77 Stockholm, Sweden.Karolinska InstitutetDepartment of Public Health SciencesWiderströmska HusetTomtebodavägen 18 AStockholm171 77Sweden mathilde.sengoelge@ 123456ki.se
                Article
                S2211-3355(17)30040-2
                10.1016/j.pmedr.2017.02.024
                5345966
                28316905
                f82dddf6-2ab6-4981-adc1-1b13ee13bf8d
                © 2017 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 13 October 2016
                : 23 February 2017
                : 25 February 2017
                Categories
                Regular Article

                child,burn,mortality,income inequality
                child, burn, mortality, income inequality

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