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Background Diarrheal diseases remain a major global public health challenge. Hand hygiene is one of the most cost-effective interventions for preventing the transmission of diarrheal diseases. However, billions of people around the world still lack access to soap and handwashing facilities. Methods Using the Global Burden of Disease (GBD) 2021 database, we quantified the burden of diarrhea attributable to a lack of access to handwashing facilities across 204 countries and territories from 1990 to 2021. We assessed disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs), stratified by age, sex, Sociodemographic Index (SDI), and GBD region. Long-term trends were analyzed using age-standardized rates (ASRs) and estimated annual percentage changes (EAPCs). Potential non-linear associations were explored through locally weighted scatterplot smoothing (LOESS) regression. Results Globally, the age-standardized death rate (ASDR) from diarrhea attributable to the lack of handwashing facilities declined from 14.20 (2.10–26.04) to 3.04 (0.42–5.64) per 100,000 between 1990 and 2021, with an average annual decrease of 4.89% (4.64 to 5.14). During the same period, the DALY rate decreased by 76.6%, the YLL rate by 77.9%, and the YLD rate by 32.0%. In 2021, West and East Africa remained high-burden regions, with DALY rates exceeding 600 per 100,000. South Asia recorded the largest absolute number of deaths, with nearly 90,000 fatalities. Countries with low SDI exhibited an ASDR of 17.8 (2.51–33.44) per 100,000, approximately 60 times higher than that of high-SDI countries. Mortality risk was highest among boys under five, and the absolute number of deaths increased among adults aged ≥ 70 years. YLDs were consistently higher in females than in males. Projections suggest continued declines in burden through 2035, although at a slower pace, especially in low-SDI settings. Conclusions Although global diarrhea burdens tied to unavailable handwashing facilities have declined markedly since 1990, stark inequities persist across regions, age groups and development levels. Sustained expansion of WASH infrastructure, targeted hygiene promotion and strengthened surveillance are essential to accelerate progress toward zero preventable diarrheal deaths and universal health coverage.

The COVID-19 pandemic brought to light significant health disparities in illness and death due to a person's race, ethnicity, and socioeconomic status. Also, those factors cause significant inequities in access to palliative and end-of-life care that remain largely unaddressed. The quality of care people receive once they are given a life-threatening diagnosis or as they approach the end of their life depends upon race, ethnicity, socioeconomic status, and who they love. Such disparities in treatment are unconscionable and must be addressed. They warrant serious attention from policymakers and clinicians as well as focused efforts to find solutions.

This volume examines crucial concerns in palliative care, including the proper balance between comfort and cure for the patient, the integration of spiritual well-being, and the challenges of providing care in the absence of basic medical services and supplies. In the first section, palliative-care pioneers Constance Dahlin, Eduardo Bruera, Neil MacDonald, and Declan Walsh recount the early history of the discipline. Part 2 discusses the role of poetry, prose, plays, and other aspects of the humanities in the practice of palliative care. Part 3 explores essential current issues in the field, including autonomy, the use of opioids, and the impact of artificial intelligence on the evolution of palliative care. The final section focuses on the spiritual dimensions of pain and suffering. Rich with anecdotes and personal stories and featuring contributions from pioneers and current practitioners, The Pursuit of Life is an essential assessment of the past, present, and future of palliative care. In addition to the editors, the contributors include W. Andrew Achenbaum, Stacy L. Auld, Elena Pagani Bagliacca, Costantino Benedetti, Courtenay Bruce, Eduardo Bruera, Joseph Calandrino, Jim Cleary, Constance Dahlin, Andrea Ferrari, Mauro Ferrari, Joseph J. Fins, Bettie Jo Tennon Hightower, Kathryn B. Kirkland, Robin W. Lovin, Neil MacDonald, Charles Millikan, Dominique J. Monlezun, Tullio Proserpio, Giovanna Sironi, Daniel P. Sulmasy, and Declan Walsh.

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PurposeThis paper aims to define a methodology to assess the impact of introducing Islamic finance on financial inclusion.Design/methodology/approachThe paper is based on a literature review to understand the link between Islamic finance and financial inclusion. The second part of the paper presents a conceptual framework to assess the impact of introducing Islamic finance on financial inclusion in a defined context based on the profiling of people interested in Islamic finance.FindingsThe paper brings an insight on the impact of introducing Islamic finance. Indeed, it could cause a financial migration to Islamic banks that can take many forms and depends on many factors that call for deep analysis.Research limitations/implicationsThe paper would help financial authorities and financial institutions to measure the impact of introducing Islamic finance on their businesses and the stability of the whole system.Practical implicationsIslamic finance can not only enhance financial inclusion but also create financial migration. The two implications can vary from one context to another.Social implicationsIslamic finance can contribute in the effort of including “self-excluded” people with religious concerns as well as people without access to financial services.Originality/valueThis paper promotes the idea that Islamic finance is not exclusively a way to enhance financial inclusion.

ObjectiveTo assess neonatal and under-five mortality and the health situation for children in Dolpa, a remote rural area of Nepal.Study designMixed methods: quantitative (retrospective cross sectional) and qualitative (semistructured interviews).RationaleProgress in reducing child and newborn mortality in Nepal has reached the remote areas to a limited extent. Furthermore, there may be substantial under-reporting and data may be unreliable.Setting and participantsThe population of Dolpa district is approximately 35 000. We visited 10 randomly selected villages (plus one settlement) with approximately 12 000 inhabitants.MethodologyRecords of the number of deliveries, neonatal and under-five deaths were collected. 100 children (10 different villages) were evaluated for common diseases present during the month prior to the investigation. 20 interviews were conducted about the cultural perceptions of neonatal death and morbidity; in each village at least one interview was undertaken.ResultsThe population of the 10 villages (plus one settlement) under investigation was 12 287. 300 deliveries have taken place during the last 12 months before the study. There were 30 children reported to have died; out of those 20 were in the neonatal period. This reflects an estimated neonatal mortality rate in Dolpa district of 67/1000 live births (95% CI 41-101/1000) and an estimated under-five mortality rate of 100/1000 (95% CI 70-140/1000). In the previous month, out of 100 children surveyed there had been 11 cases of acute lower respiratory infection (ALRI), 7 cases of diarrhoea, 3 cases of isolated malnutrition and 5 cases of malnutrition combined with ALRI or diarrhoea.Based on qualitative interviews traditional beliefs still play a major role, and are partly a hindrance to progress in health. There is also mistrust in the health services and misconceptions about ‘modern’ medicine and treatment facilities.ConclusionDespite progress in child morbidity and mortality in Nepal, some areas remain underserved by health services and neonatal mortality is far above the Nepalese average, which is 29/1000 live births. There is a substantial need to increase and train health staff. Health promotion should be encouraged but cultural perceptions have to be understood if positive behavioural change is to be achieved.

We report a case of Fournier's gangrene in a 12-year-old boy from St. Boniface Hospital in Fond-des-Blancs, Haiti. Fournier's gangrene, a fulminant necrotizing fasciitis of the penis and scrotum, is a rare and life-threatening infection that requires hospitalization, broad-spectrum antibiotics, and surgical debridement.1-3 It is usually associated with impaired cellular immunity due to systemic disorders such as diabetes and liver disease.4,5 This patient had none of those risk factors, but had severe, longstanding phimosis, for which circumcision had been recommended many years before. This case illustrates how lack of access to basic surgical care for an easily treatable condition leads to advanced presentation of a severe disease process. [Full article available at http://rimed.org/rimedicaljournal-2016-12.asp].

Introduction Adult oral health is predicted by oral health in childhood. Prevention improves oral health in childhood and, consequently in adulthood, so substantial cost savings can be derived from prevention. The burden of oral disease is particularly high for disadvantaged and poor population groups in both developing and developed countries. Therefore, an appropriate and egalitarian access to dental care becomes a desirable objective if children’s dental health is to be promoted irrespective of socioeconomic status. The aim of this research is to analyse inequalities in the lack of access to dental care services for children in the Spanish National Health System by socio-economic group over the period 1987–2011. Methods Pooled data from eight editions of the Spanish National Health Survey for the years 1987–2011, as well as contextual data on state dental programmes are used. Logistic regressions are used to examine the related factors to the probability of not having ever visited the dentist among children between 6 and 14 years old. Our lack of access variable pays particular attention to the socioeconomic level of children’s household. Results The mean probability of having never been to the dentist falls considerably from 49.5% in 1987 to 8.4% in 2011. Analysis by socioeconomic level indicates that, in 1987, the probability of not having ever gone to the dentist is more than two times higher for children in the unskilled manual social class than for those in the upper non-manual social class (odds ratio 2.35). And this difference is not reduced significantly throughout the period analysed, rather it increases as in 1993 (odds of 2.39) and 2006 (odds of 3.03) to end in 2011 slightly below than in 1987 (odds ratio 1.80). Conclusion There has been a reduction in children’s lack of access to dentists in Spain over the period 1987–2011. However, this reduction has not corrected the socioeconomic inequalities in children’s access to dentists in Spain.

East Asia and the Pacific is a region of dynamic growth. Women have contributed significantly to this growth and have benefited from it through active participation in the labor market. However, women are still disproportionately represented in the informal sector and in low paid work. Efforts to identify barriers to women's business and entrepreneurial activities in the region are critical not only to facilitate inclusive growth in a national context but also to counter the increasing trend of female migratory flows in the region. This report highlights' both the challenges and the economic opportunities for businesswomen in the region offers some useful potential pointers for reform.

Countries everywhere are divided into two distinct spatial realms: one urban, one rural. Classic models of development predict faster growth in the urban sector, causing rapid migration from rural areas to cities, lifting average incomes in both places. The process continues until the marginal productivity of labor is equalized across the two realms. The pattern of rising urbanization accompanying economic growth has become one of the most visible and self-evident empirical facts of development across the world, with almost 200,000 people making the rural-to-urban trek every day, according to the United Nations. Cities across the world are powering growth, development, and modernization. The study then takes a close look at Diepsloot, a large township in the Johannesburg Metropolitan Area, to bring out more vividly the economic realities and choices of township residents. Although atypical in many ways, by the virtue of being newer, poorer, and more informal, with a bigger concentration of migrants (many of them foreign nationals), than the historically established townships, Diepsloot also retains many of the economic characteristics of South African townships: Issues of joblessness, uneven access to basic public services, and overwhelming levels of crime and violence are almost as pervasive in Diepsloot as they are in other T&IS. At the same time, an emergent informal sector more visibly pervades the township than seen in the average township, which makes it a particularly useful place to study in order to develop an understanding of the kinds of economic activities that are feasible in townships. It focuses particularly on the nature of business activity in the township, the key investment-climate constraints faced by its firms, income and expenditure patterns across households, and some aggregative social and human indicators. In a first attempt of its kind for a township, the report also develops a Social Accounting Matrix (SAM) of Diepsloot for a comprehensive and consistent picture of the place, including the circular flow of income within the township, the nature of its interaction with the rest of the South African economy, and a simple multiplier analysis of its economy.