The past two decades have shown an increase in the prevalence of non-communicable diseases (NCDs), affecting high-income as well as low- and middle-income countries. In fact, 63% of all deaths worldwide were due at least in part to NCDs, and around three quarters of the world’s chronic disease-related deaths that year occurred in low- and middle-income countries. These countries have to contend with a dual burden of infectious and non-communicable diseases, which pose not only a health burden, but also an economic burden. Three studies published in BMC Medicine this week explore some of these important issues.
Mental health disorders in Ethiopian homeless
Despite being a leading cause of disability and ill health globally, mental health continues to be ignored in international development and global health. These issues have been touched upon previously in an interview with Vikram Patel. Mental health problems are thought to be particularly prevalent in homeless people in low-income countries due to underdeveloped social welfare and health systems. Understanding the types of mental health problems in this population can help drive policy changes to alleviate the burden.
A cross-sectional survey was conducted among street homeless adults in Addis Ababa, Ethiopia by Martin Prince and colleagues to determine the burden of psychotic disorders and associated unmet needs. They found that psychosis, alcohol abuse and other mental disorders were common in street homeless people. The majority of the individuals surveyed had experienced both mental health and alcohol use disorders, which was linked to chronicity of homelessness. Therefore, strategies to improve conditions for the homeless in low-income countries should include treatment for both mental disorders and alcohol abuse.
Predictors of HIV drug adherence
Advances in HIV drug development mean that those infected with HIV are able to live a long a healthy life, with a life expectancy that is no different to that of the general population. This, however, is dependent on proper management, part of which comprises taking daily combination antiretroviral therapy (ART). Patient adherence to this regimen is a key predictor of HIV treatment success, therefore insight into predictors or correlates of non-adherence to ART may help to guide targets for the development of adherence enhancing interventions.
A meta-analysis conducted by Pythia Nieuwkerk and colleagues involving 170 studies explored the factors affecting adherence to ART in HIV-infected adults. The study indicated that psychological factors, including self-efficacy and belief about the necessity of ART, should be targeted to improve adherence.
Coping with diabetes in Latin America
The growing burden of NCDs, primarily due to lifestyle factors, disproportionally affect those in low- and middle-income countries. One such example is type 2 diabetes, which, in an Opinion article this week, Armando Arrendondo discusses in the context of healthcare systems in Latin America.
Given the epidemiological transition of increasing prevalence of type 2 diabetes, and the subsequent economic burden of the demand for services to treat such problems, Latin American healthcare is straining to cope. The author highlights the need for more resources to be allocated to preventive medicine rather than purely treatment, and discusses ways in which this may be achieved in these settings.
These articles appear in our Medicine for Global Health article collection. Later this year, BMC Medicine will be re-launching this collection with a special focus on ‘Big Risks – the challenges and opportunities in addressing the biggest global causes of premature mortality’ to highlight the leading causes of health loss in populations throughout the world. If you have any research you would like us to consider for inclusion in this article collection, please email firstname.lastname@example.org
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