Journal of Epidemiology & Community Health
May 2015, Volume 69, Issue 5
http://jech.bmj.com/content/current

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Commentary
Impact evaluations of mental health programmes: the missing piece in global mental health
Mary J De Silva
The missing piece…
The past 10 years have witnessed a remarkable rise in the visibility of the field of global mental health, which applies the core principles of global health (improving health and equity in health for all people worldwide1) to mental health. The stated goal of global mental health is to reduce the burden of mental disorders using an evidence-based and human rights approach with a focus on low and middle income countries (LMIC) as this is where inequity in mental health treatment and care is the greatest.2…

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Health service use, out-of-pocket payments and catastrophic health expenditure among older people in India: The WHO Study on global AGEing and adult health (SAGE)
Ethel Mary Brinda1, Paul Kowal2,3, Jørn Attermann4, Ulrika Enemark1
Author Affiliations
1Section for Health Promotion and Health Services Research, Department of Public health, Aarhus University, Aarhus, Denmark
2Department of Health Statistics and Information Systems, World Health Organization, Geneva, Switzerland
3Research Centre for Gender, Health and Ageing, University of Newcastle, New South Wales, Australia
4Section of Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
Published Online First 9 January 2015
Abstract
Background
Healthcare financing through out-of-pocket payments and inequities in healthcare utilisation are common in low and middle income countries (LMICs). Given the dearth of pertinent studies on these issues among older people in LMICs, we investigated the determinants of health service use, out-of-pocket and catastrophic health expenditures among older people in one LMIC, India.
Methods
We accessed data from a nationally representative, multistage sample of 2414 people aged 65 years and older from the WHO’s Study on global Ageing and adult health in India. Sociodemographic characteristics, health profiles, health service utilisation and out-of-pocket health expenditure were assessed using standard instruments. Multivariate zero-inflated negative binomial regression models were used to evaluate the determinants of health service visits. Multivariate Heckman sample selection regression models were used to assess the determinants of out-of-pocket and catastrophic health expenditures.
Results
Out-of-pocket health expenditures were higher among participants with disability and lower income. Diabetes, hypertension, chronic pulmonary disease, heart disease and tuberculosis increased the number of health visits and out-of-pocket health expenditures. The prevalence of catastrophic health expenditure among older people in India was 7% (95% CI 6% to 8%). Older men and individuals with chronic diseases were at higher risk of catastrophic health expenditure, while access to health insurance lowered the risk.
Conclusions
Reducing out-of-pocket health expenditure among older people is an important public health issue, in which social as well as medical determinants should be prioritised. Enhanced public health sector performance and provision of publicly funded insurance may protect against catastrophic health expenses and healthcare inequities in India.

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Review
Birth weight and childhood wheezing disorders: a systematic review and meta-analysis
Teumzghi F Mebrahtu, Richard G Feltbower, Darren C Greenwood, Roger C Parslow
Author Affiliations
Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, Leeds, UK
Published Online First 22 December 2014
Abstract
Background
Previous observational studies have claimed that birth weight and childhood wheezing disorders are associated although the results remained inconsistent. One systematic review and two systematic reviews that included meta-analyses reported inconsistent results. We aimed to conduct a systematic review and meta-analysis to investigate this.
Methods
An online search of published papers linking childhood asthma and wheezing disorders with birth weight up to February 2014 was carried out using EMBASE and Medline medical research databases. Summary ORs were estimated using random-effects models. Subgroup meta-analyses were performed to assess the robustness of risk associations and between-study heterogeneity.
Results
A total of 37 studies comprising 1 712 737 participants were included in our meta-analysis. The unadjusted summary ORs for risk of childhood wheezing disorders associated with low birth weight (<2.5 kg) were 1.60 (95% CI 1.39 to 1.85, p<0.001) and 1.37 (95% CI 1.05 to 1.79, p=0.02) when compared with ≥2.5 and 2.5–4.0 kg birthweight groups, respectively. The overall summary OR for high birth weight (>4 kg) as compared to the 2.5–4.0 kg birthweight group was 1.02 (95% CI 0.99 to 1.04, p=0.13). There was substantial heterogeneity in the unadjusted low birth weight risk estimates which was not accounted for by predefined study characteristics. There was no significant heterogeneity in the high birth weight risk estimates. There was some evidence of funnel plot asymmetry and small study effects in the low birth weight (2.5 vs ≥2.5 kg and <2.5 vs 2.5–4 kg) OR estimates.
Conclusions
Our results suggest that low birth (<2.5 kg) is an independent risk factor for wheezing disorders during childhood and adolescence although there was substantial heterogeneity among the risk estimates. However, we found no significant association of high birth weight with wheezing disorders.