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Surviving spinal cord injury in low income countries

August 2014

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Life expectancy and the situation of persons living with Spinal Cord Injury (SCI) in low income settings was explored. Mortality rates from injuries and challenges in daily lives of people with injuries from poorer economic backgrounds are were investigated and are compared with those with higher incomes. Literature studies and qualitative methods were used. Qualitative data was collected through semi-structured interviews with 23 informants from four study sites in Zimbabwe representing persons with SCI, their relatives and rehabilitation professionals.

There are few publications available about life expectancy and the daily life of persons with SCI in low income countries. Those few publications identified and the study findings confirm that individuals with SCI are experiencing a high occurrence of pressure sores and urinary tract infections leading to unnecessary suffering, often causing premature death. Pain and depression are frequently reported and stigma and negative attitudes are experienced in society. Lack of appropriate wheelchairs and services, limited knowledge about SCI amongst health care staff, limited access to health care and rehabilitation services, loss of employment and lack of financial resources worsen the daily challenges.

Conclusion: The study indicates that life expectancy for individuals with SCI in low income settings is shorter than for the average population and also with respect to individuals with SCI in high income countries. Poverty worsened the situation for individuals with SCI, creating barriers that increase the risk of contracting harmful pressure sores and infections leading to premature death. Further explorations on mortality and how individuals with SCI and their families in low income settings are coping in their daily life are required to provide comprehensive evidences.

World Health Statistics 2012


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"World Health Statistics 2012 contains WHO’s annual compilation of health-related data for its 194 Member States, and includes a summary of the progress made towards achieving the health-related Millennium Development Goals (MDGs) and associated targets. This year, it also includes highlight summaries on the topics of noncommunicable diseases, universal health coverage and civil registration coverage"
Note: The summary brochure, full report, report in English by section, the indicator compendium and printed copy order forms are available from the link above

World health statistics 2009


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This book contains WHO’s annual compilation of data from its 193 Member States, and includes a summary of progress towards the health-related Millennium Development Goals (MDGs) and targets. This edition also contains a new section on reported cases of selected infectious diseases. An online version of this publication and metadata describing the sources, estimation methods and the quality of estimates is available at The online version will be regularly updated as new data become available during 2009

Cost-effectiveness analysis in health. A practical approach (2nd edition)


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Cost-effectiveness analysis is used to evaluate medical interventions worldwide, in both developed and developing countries. This book provides process-specific instruction in a concise, structured format to provide a robust working knowledge of common methods and techniques. Each chapter includes real-world examples and tips that highlight key information. Calculations concerning disability life adjusted years are covered. The third edition contains new discussion on meta-analysis and advanced modelling techniques and a long worked example.

Disease control priorities in developing countries. 2nd edition. Chapter 2. Intervention cost-effectiveness: overview of main messages.

et al

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Drawing from the collective knowledge and analytical work of the many experts who have contributed to this volume, this chapter provides a broader perspective on the relative efficiency and effect on health of a number of interventions than is possible in a single, condition-specific chapter. The objective is to provide information on the cost-effectiveness estimates for 319 interventions covering nearly every disease condition considered in the volume, and the resulting avertable burden of disease. This chapter provides broad conclusions on the economic efficiency of using these interventions to improve health.


Disease control priorities in developing countries. 2nd edition. Chapter 15. Cost-effectiveness analysis for priority setting.


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What cost-effectiveness analysis (CEA) does and does not provide, how it is related to the concept of burden of disease, and how it can be used, along with other criteria, in setting priorities is discussed. The several meanings of the term CEA and the way that interventions are classified and evaluated are described. Estimating the effectiveness of an intervention requires specifying the units which in turn requires choices of several parameter values, including, in the analyses reported here, the discount rate applied to future years; the disability weights that describe the severity of diseases and conditions, corresponding to the health losses that they cause; and the life expectancy at different ages. Costs of interventions to include in the analysis, and conversion of costs to equivalents in U.S. dollars for international comparisons are described. Variations of results and uncertainty of estimates are discussed. Two ways are suggested to consider costs and outcomes at the population level, allowing for large differences among countries in the size of population; the incidence or prevalence of a disease, condition, or risk factor; and the amount spent or available to spend on an intervention

Use of Cost-Effectiveness Analysis in Health-Care Resource Allocation Decision-Making: How Are Cost-Effectiveness Thresholds Expected to Emerge?

EICHLER, Hans-Georg
et al
September 2004

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An overview is presented of the use of cost-effectiveness analysis in healthcare resource allocation decision-making. Threshold figures (i.e. cost per unit of health gain) currently proposed for, or applied to, resource-allocation decisions are reviewed. Disability Adjusted Life-Years (DALY) are mentioned. A table of data provides a summary of cost-effectiveness thresholds and CE ratios in terms of either QALYs (quality-adjusted life-year) or  LYGs (life-year gained). Threshold figures and evolution of thresholds are discussed.


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