Reorienting women's health in low- and middle-income countries: the case of depression and Type 2 diabetes (original) (raw)

Diabetes and depression comorbidity and socioeconomic status in low and middle income countries

Non-communicable diseases account for more than 50% of deaths in adults aged 15-59 years in most low income countries. Depression and diabetes carry an enormous public health burden, making the identification of risk factors for these disorders an important strategy. While socio-economic inequalities in chronic diseases and their risk factors have been studied extensively in high-income countries, very few studies have investigated social inequalities in chronic disease risk factors in low or middle-income countries. Documenting chronic disease risk factors is important for understanding disease burdens in poorer countries and for targeting specific populations for the most effective interventions. The aim of this review is to systematically map the evidence for the association of socio-economic status with diabetes and depression comorbidity in low and middle income countries. The objective is to identify whether there is any evidence on the direction of the relationship: do co-morbidities have an impact on socio-economic status or vice versa and whether the prevalence of diabetes combined with depression is associated with socio-economic status factors within the general population. To date no other study has reviewed the evidence for the extent and nature of this relationship. By systematically mapping the evidence in the broader sense we can identify the policy and interventions implications of existing research, highlight the gaps in knowledge and suggest future research. Only 14 studies were found to analyse the associations between depression and diabetes comorbidity and socio-economic status. Studies show some evidence that the occurrence of depression among people with diabetes is associated with lower socio-economic status. The small evidence base that considers diabetes and depression in low and middle income countries is out of step with the scale of the burden of disease.

Meeting the changing health needs of women in developing countries

Social Science & Medicine, 1995

Demographic, epidemiological and socio-economic trends in developing countries are creating new mortality and morbidity patterns for both women and men. Women's health needs will increasingly include problems beyond reproduction, and health interventions must take into consideration the important characteristics of women's lives that affect their ability to address these problems. Meeting the changing health needs of women in developing countries will require more comprehensive health interventions guided by innovative, interdisciplinary research. A broader conceptualization of women's health needs, and the constraints and opportunities associated with meeting those needs, is necessary to avoid overly simplistic assigning of responsibility, which can lead to blaming organizations, disciplines and individuals, including women themselves, for persistent health problems and underutilization of existing services.

Beyond reproduction: Women's health in today's developing world

International Journal of Epidemiology, 2005

Background The concept of women's health is tethered strongly to reproductive health. At present, international attention and resources are focused on obstetric events and, recently, HIV/AIDS because of the significance of these problems in the least developed nations. This limited concept of women's health, however, is decreasingly relevant to the global community, and needs to be revisited in the light of decreasing fertility and increasing life expectancy in many countries where it was previously applicable. It should be expanded to embrace the full spectrum of health experienced by women, and preventive and remedial approaches to the major conditions that afflict women. Allocation of health service resources should be aligned with the epidemiological realities of these threats to women's health. Methods Cause of death data for women aged 15-34 years and 35-44 years were examined for nine less developed countries. Deaths associated with pregnancy and child birth, and HIV were compared with deaths due to three chronic disease categories (cancer, cardiovascular disease, and diabetes). The women's health research literature for developing countries appearing in the American Journal of Public Health and British Medical Journal was also examined. Results In seven out of the nine countries, among women aged 15-34 years, chronic diseases caused over 20% of deaths, while reproductive causes and HIV together accounted for ~10% of deaths, in all countries except in India. Among women aged 35-44 years, in all but India, chronic diseases accounted for over four times the deaths attributable to reproductive causes and HIV. The causes of death were not related to the level of development in these countries as measured by GNI PPP. Papers pertaining to women's health published in public health and medical research journals focused principally on reproduction. Conclusions Extending the definition of women's health to include a concern for chronic diseases is critical if the needs of women in less developed nations are to be met. In less developed countries, chronic disease is the most important cause of female death even during childbearing years and for women with young families. Development agencies and private philanthropy must begin to fund the studies that will further refine our understanding of the role of chronic diseases in women's health in the developing world.

Women and Health: the key for sustainable development

The Lancet, 2015

Girls' and women's health is in transition and, although some aspects of it have improved substantially in the past few decades, there are still important unmet needs. Population ageing and transformations in the social determinants of health have increased the coexistence of disease burdens related to reproductive health, nutrition, and infections, and the emerging epidemic of chronic and non-communicable diseases (NCDs). Simultaneously, worldwide priorities in women's health have themselves been changing from a narrow focus on maternal and child health to the broader framework of sexual and reproductive health and to the encompassing concept of women's health, which is founded on a life-course approach. This expanded vision incorporates health challenges that aff ect women beyond their reproductive years and those that they share with men, but with manifestations and results that aff ect women disproportionally owing to biological, gender, and other social determinants.

The Psychosocial Impact of Diabetes and its Management in Women: A Review of Current Status

Endocrinology and Disorders, 2021

Diabetes mellitus (DM) is a chronic debilitating disease affecting 463 million people which accounts for 9.3% of the population globally as of 2019. Although diabetes affects men and women equally (prevalence in men: 9.6%, women: 9%), women are more severely impacted by its complications such as heart disease, retinopathy, and neuropathy. This gender difference in consequences of DM may be due to biological reasons, it is also a reality that globally women tend to receive less intensive care and treatment for diabetes compared to men. In low-income countries, women suffer unduly from economic, political, and social discrimination, and subsequently from poor health, lack of education, and employment.

Women of low socioeconomic status living with diabetes: Becoming adept at handling a disease

SAGE open medicine, 2015

The objective of this study was to explore how Thai women of low socioeconomic status handle their type 2 diabetes. A qualitative interpretative method was used to study 19 women with type 2 diabetes in a suburban community in Thailand. Data were collected via semi-structured interviews and were analysed using inductive and constructive processes. Participants' lives underwent many changes between their initial diagnoses and later stages when they became adept at handling diabetes. Two themes emerged, which involved (1) the transition to handling diabetes and (2) the influences of the social environment. The first theme encompassed confronting the disease, reaching a turning point in the process of adaptation and developing expertise in handling diabetes. The second theme involved threats of loss of status and empowerment by families. These findings showed that becoming adept at handling diabetes required significant changes in women's behaviours and required taking advantag...