Health Services Administration Commons^™

Temporal Geospatial Analysis Of Covid-19 Pre-Infection Determinants Of Risk In South Carolina, Tianchu Lyu, Nicole L. Hair, Nicholas Yell, Zhenlong Li, Shan Qiao, Chen Liang, Xiaoming Li

Faculty Publications

Disparities and their geospatial patterns exist in morbidity and mortality of COVID-19 patients. When it comes to the infection rate, there is a dearth of research with respect to the disparity structure, its geospatial characteristics, and the pre-infection determinants of risk (PIDRs). This work aimed to assess the temporal–geospatial associations between PIDRs and COVID-19 infection at the county level in South Carolina. We used the spatial error model (SEM), spatial lag model (SLM), and conditional autoregressive model (CAR) as global models and the geographically weighted regression model (GWR) as a local model. The data were retrieved from multiple sources including …

Examining Associations Between Knowledge And Vaccine Uptake Using The Human Papillomavirus Knowledge Questionnaire (Hpv-Kq), Sayward Harrison, Valerie Yelverton, Jan Ostermann Ph.D., Laura J. Fish, Charnetta L. Williams, Lavanya Vasudevan, Emmanuel B. Walter

Faculty Publications

Objectives: Understanding the relationship between human papillomavirus (HPV) knowledge and vaccination behavior is important to inform public health interventions, yet few validated HPV knowledge scales exist. This study describes development of the Human Papillomavirus Knowledge Questionnaire (HPV-KQ) and its validation with parents residing in the southern United States (US). Methods: Drawing on previously published measures, we developed the 13-item HPV-KQ and administered the scale via Web-based survey to parents (N=1105) of adolescents ages 9 to 17 years. Dimensionality, internal consistency, model fit, and predictive validity were assessed. Results: The scale was bidimensional. One factor captured general HPV knowledge, and the …

What Factors Influence Hiv Testing? Modeling Preference Heterogeneity Using Latent Classes And Class-Independent Random Effects, Jan Ostermann Ph.D., Brian P. Flaherty, Derek S. Brown, Bernard Njau, Amy M. Hobbie, Tara B. Mtuy, Max Masnick, Axel C. Mühlbacher, Nathan M. Thielman

Faculty Publications

Efforts to eliminate the HIV epidemic will require increased HIV testing rates among high-risk populations. To inform the design of HIV testing interventions, a discrete choice experiment (DCE) with six policy-relevant attributes of HIV testing options elicited the testing preferences of 300 female barworkers and 440 male Kilimanjaro mountain porters in northern Tanzania. Surveys were administered between September 2017 and July 2018. Participants were asked to complete 12 choice tasks, each involving first- and second-best choices from 3 testing options. DCE responses were analyzed using a random effects latent class logit (RELCL) model, in which the latent classes summarize common …

Demographic Disparities In Clinical Outcomes Of Covid-19: Data From A Statewide Cohort In South Carolina, Xueying Yang, Jiajia Zhang Ph.D., Shujie Chen, Bankole Olatosi Ph.D., Larisa Bruner, Abdoulaye Diedhiou, Cheryl Scott, Ali Mansaray, Sharon Weissman, Xiaoming Li Ph.D.

Faculty Publications

Background:

Current literature examining the clinical characteristics of coronavirus disease 2019 (COVID-19) patients under-represent COVID-19 cases who were either asymptomatic or had mild symptoms.

Methods:

We analyzed statewide data from 280 177 COVID-19 cases from various health care facilities during March 4-December 31, 2020. Each COVID-19 case was reported using the standardized Case Report Form (CRF), which collected information on demographic characteristics, symptoms, hospitalization, and death. We used multivariable logistic regression to analyze the associations between sociodemographics and disease severity, hospitalization, and mortality.

Results:

Among a total of 280 177 COVID-19 cases, 5.2% (14 451) were hospitalized and 1.9% (5308) …

Examining The Cost And Quality Relationship In Medicare, Alexandria Fleming Delage

Theses and Dissertations

Purpose.

The purpose of this study is to evaluate the cost and quality of care dynamic among physicians billing under Medicare Fee for Service in 2018 to examine the relationship between quality and total cost of care at the physician level. Examining this relationship will advance scientific knowledge regarding the impact of increasing high value service use on healthcare costs and will provide insight in terms of expected cost outcomes of quality programs for healthcare policymakers (Salmond and Echevarria 2017; Williams, Brown, and Healy 2018).

Methods.

The study used publicly available data sets provided by the Center for Medicare and …

A Cost Effectiveness Analysis Of The Nutritious Eating With Soul Study, Mary Jones Wilson

Theses and Dissertations

PURPOSE Historically, African Americans (AA) have been underrepresented in nutritionrelated behavioral research despite their disproportionate higher risk of cardiovascular disease (CVD). The Nutritious Eating with Soul (NEW Soul) Study is one of the first of its kind to recruit an AA only study group to examine CVD prevention via a clinical trial to examine changes in CVD risk factors across two cohorts who are randomly assigned to a plant-based, soul food vegan diet or low-fat omnivorous (omni) diet. The purpose of cost effectiveness analysis (CEA) is to inform clinical and policy decisions and the costs of interventions that society is …

Risk Of Early-Onset Dementia Among Persons With Tinnitus: A Retrospective Case–Control Study, Yen-Fu Cheng, Sudha Xirasagar Mbbs. Ph.D., Tzong- Han Yang, Chuan-Song Wu, Yi-Wei Kao, Herng-Ching Lin

Faculty Publications

Higher rates of poor cognitive performance are known to prevail among persons with tinnitus in all age groups. However, no study has explored the association between tinnitus and early-onset dementia. We hypothesize that tinnitus may precede or occur concurrently with subclinical or early onset dementia in adults younger than 65 years of age. This case–control study used data from the Taiwan National Health Insurance Research Database, identifying 1308 patients with early-onset dementia (dementia diagnosed before 65 years of age) and 1308 matched controls. We used multivariable logistic regressions to estimate odds ratios (ORs) for prior tinnitus among patients with dementia …

A Nationwide Population-Based Study On The Association Between Land Transport Accident And Peripheral Vestibular Disorders, Herng-Ching Lin, Sudha Xirasagar Mbbs,Ph.D., Chia-Hui Wang, Yen-Fu Cheng, Tsai-Ching Liu, Tzong-Hann Yang

Faculty Publications

This case-control study aimed to investigate the association of peripheral vestibular disorders (PVD) with subsequent land transport accidents. Data for this study were obtained from Taiwan's National Health Insurance (NHI) dataset. We retrieved 8704 subjects who were newly found to have land transport accidents as cases. Their diagnosis date was used as their index date. Controls were identified by propensity score matching (one per case, n = 8704 controls) from the NHI dataset with their index date being the date of their first health service claim in 2017. Multiple logistic regressions were performed to calculate the prior PVD odds ratio …

Spatial-Temporal Relationship Between Population Mobility And Covid-19 Outbreaks In South Carolina: Time Series Forecasting Analysis, Chengbo Zeng, Jiajia Zhang Ph.D., Zhenlong Li Ph.D., Xiaowen Sun, Bankole Olatosi Ph.D., Sharon Weissman, Xiaoming Li Ph.D.

Faculty Publications

Background: Population mobility is closely associated with COVID-19 transmission, and it could be used as a proximal indicator to predict future outbreaks, which could inform proactive nonpharmaceutical interventions for disease control. South Carolina is one of the US states that reopened early, following which it experienced a sharp increase in COVID-19 cases.

Objective: The aims of this study are to examine the spatial-temporal relationship between population mobility and COVID-19 outbreaks and use population mobility data to predict daily new cases at both the state and county level in South Carolina.

Methods: This longitudinal study used disease surveillance …

Association Of Erectile Dysfunction With Tinnitus: A Nationwide Population-Based Study, Yen-Fu Cheng, Sudha Xirasagar Mbbs., Ph.D., Nai-Wen Kuo, Shiu-Dong Chung, Herng-Ching Lin

Faculty Publications

With many previous studies indicating a higher prevalence of sexual problems in patients with tinnitus, the association between tinnitus and erectile dysfunction (ED) has become an interesting topic that warrants further research. In our study, we hypothesized that tinnitus may be associated with ED and aimed to further explore the relationship between these two medical conditions using a nationwide population-based database. After retrieving data of 19,329 patients with ED and 19,329 propensity score-matched patients without ED (controls) from Taiwan’s National Health Insurance Dataset, we defined the diagnosis date (the date of the first ED claim) for patients with ED as …

The Intersection Of Rural Residence And Minority Race/Ethnicity In Cancer Disparities In The United States, Whitney E. Zhand, Cathryn Murphy, Marie Knoll, Gabriel A. Benavidez, Kelsey R. Day, Radhika Ranganathan, Parthenia Luke, Anja Zgodic, Kewei Shi, Melinda A. Merrell, Elizabeth L. Crouch, Heather M. Brandt, Jan M. Eberth

Faculty Publications

One in every twenty-five persons in America is a racial/ethnic minority who lives in a rural area. Our objective was to summarize how racism and, subsequently, the social determinants of health disproportionately affect rural racial/ethnic minority populations, provide a review of the cancer disparities experienced by rural racial/ethnic minority groups, and recommend policy, research, and intervention approaches to reduce these disparities. We found that rural Black and American Indian/Alaska Native populations experience greater poverty and lack of access to care, which expose them to greater risk of developing cancer and experiencing poorer cancer outcomes in treatment and ultimately survival. There …

A Nationwide Population-Based Study On The Incidence Of Parapharyngeal And Retropharyngeal Abscess-A 10-Year Study, Tzong-Hann Yang, Sudha Xirasagar Mbbs., Ph.D., Yen-Fu Cheng, Chuan-Song Wu, Yi-Wei Kao, Herng-Ching Lin

Faculty Publications

This study aimed to investigate the annual incidence of parapharyngeal and retropharyngeal abscess (PRPA) based on 10-year population-based data. Patients with PRPA were identified from the Taiwan Health Insurance Research Database, a database of all medical claims of a randomly selected, population-representative sample of over two million enrollees of the National Health Insurance system that covers over 99% of Taiwan’s citizens. During 2007–2016, 5779 patients received a diagnosis of PRPA. We calculated the population-wide incidence rates of PRPA by sex and age group (20–44, 45–64, and >64) as well as in-hospital mortality. The annual incidence rate of PRPA was 2.64 …

Monitoring The Spatial Spread Of Covid-19 And Effectiveness Of Control Measures Through Human Movement Data: Proposal For A Predictive Model Using Big Data Analytics, Zhenlong Li, Xiaoming Li, Dwayne Porter Ph.D., Jiajia Zhang Ph.D., Yuqin Jiang, Bankole Olatosi Ph.D., Sharon Weissman

Faculty Publications

Background: Human movement is one of the forces that drive the spatial spread of infectious diseases. To date, reducing and tracking human movement during the COVID-19 pandemic has proven effective in limiting the spread of the virus. Existing methods for monitoring and modeling the spatial spread of infectious diseases rely on various data sources as proxies of human movement, such as airline travel data, mobile phone data, and banknote tracking. However, intrinsic limitations of these data sources prevent us from systematic monitoring and analyses of human movement on different spatial scales (from local to global). Objective: Big data from social …

Parental Concerns And Uptake Of Childhood Vaccines In Rural Tanzania – A Mixed Methods Study, Lavanya Vasudevan, Joy Noel Baumgartner, Sara Moses, Esther Ngadaya, Sayoki Godfrey Mfinanga, Jan Ostermann

Faculty Publications

Background

Vaccine hesitancy has been recognized as an important barrier to timely vaccinations around the world, including in sub-Saharan Africa. In Tanzania, 1 in 4 children is not fully vaccinated. The objective of this mixed methods study was to describe and contextualize parental concerns towards vaccines in Tanzania.

Methods

Between 2016 and 2017, we conducted a cross-sectional survey (n = 134) and four focus group discussions (FGDs, n = 38) with mothers of children under 2 years of age residing in Mtwara region in Southern Tanzania. The survey and FGDs assessed vaccination knowledge and concerns and barriers to timely vaccinations. …

Maternal Preventive Dental Services Utilization: The Role Of Preconception Oral Health Counseling In And The Association With Birth Outcomes: Evidence From South Carolina Prams, Monique Johnette Williams

Theses and Dissertations

ABSTRACTThe purpose of this study is to examine maternal preventive dental services utilization by analyzing the role of preconception oral health counseling in utilization of dental cleaning services before or during pregnancy and the association of utilization with preterm birth (<37 weeks) and small for gestational age (SGA) (same sex newborns having birth weight for gestational age below the 10th percentile of the reference population as defined by the World Health Organization (WHO)). Studies suggest that unfavorable maternal oral conditions have significance in birth outcomes, specifically periodontal disease (periodontitis), an oral inflammatory condition which is shown to be a risk factor for preterm birth and low birth weight (Dortbudak et al., 2005; Guimarães et al., 2012; Tejada et al., 2012). Dental cleaning before and during pregnancy is effective in the prevention of oral disease including gingivitis and periodontitis (Johnson et al., 2006; Kurien et al., 2013; Steinberg et al., 2013).

Cross-sectional 2012-2015 data from the South Carolina Pregnancy Risk Assessment Monitoring System (SC PRAMS) survey, a population-based surveillance system on prenatal, perinatal and postpartum experiences of resident mothers who recently delivered a live-born infant, were analyzed using weighted analyses in SAS. Analyses included demographic univariate analyses, Rao-Scott Chi-squared tests of significance to study differences between groups, and multivariate logistic …

Examining Parental Perceptions And Decisions To Uptake Child Influenza Immunizations: Assessing Pandemic And Policy Impacts On Vaccination Rates Following The H1n1 Pandemic, And The Acip Laiv Preferential Recommendation Revocation, Amir H. Mehrabi

Theses and Dissertations

Introduction

2009 H1N1 Pandemic: The historical 2009 H1N1 Influenza pandemic, which had a CDC estimated accrued disease burden of 100.5 million illnesses, 936,000 hospitalizations, and 75,000 deaths from 2009 to 2018, resulted in a declared state of emergency nationally, with ensuing diminished vaccine confidence and amplified fears of infection, prompting some to pursue flu vaccination, and others to forego. Although the Centers for Disease Control and Prevention (CDC), and its Advisory Committee on Immunization Practices (ACIP) recommend an annual flu vaccine for individuals 6 months of age and older as the “first and best” defense against influenza, a low percentage …

Effect Of Lifestyle, Medical School Culture And Income On Medical Students' Decision To Pursue A Primary Care Career In Saudi Arabia, Ahmed Abdullah Alhussain

Theses and Dissertations

This study aims to examine the relationship of medical school students who select primary care as their career specialty. Based on extensive literature review, we focused on the three main factors that influence students to consider career specialty: lifestyle, income, and medical school culture. With a paper questionnaire of a cross-sectional study survey at ten medical schools, we were able to collect 1,006 participants from fourth and fifth year students. The clear majority of students considered lifestyle characteristics to be a significant influence in their career decision (PP<.05). Also, we found there was a significant relationship between students’ specialty choices and income variables. The result showed us that medical school culture played a notable role in terms of forming the students’ decisions in different ways. First, specialty characteristics were strongly correlated with career consideration. Second, having advising and mentoring within the medical school enhanced the probability of choosing primary care specialty. Finally, the effect of the primary care course was significant and closely related to the choice of the primary care specialty. In conclusion, the study demonstrated the impact of lifestyle, income, and medical school culture on student career selection. These results are in parallel with previous studies conducted in many countries around the world.

Erratum: Increased Risk Of Tinnitus Following A Trigeminal Neuralgia Diagnosis: A One-Year Follow-Up Study (J Headache Pain (2020) 21 (46) Doi: 10.1186/S10194-020-01121-6), Yen Fu Cheng, Sudha Xirasagar Mbbs., Ph.D, Tzong Han Yang, Chuan Song Wu, Yi Wei Kao, Ben Chang Shia, Herng Ching Lin

Publications

Following publication of the original article [1], we were notified that the following affiliations need to be added for the first author Yen-Fu Cheng: Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan.

Elementary Classroom Teachers’ Self-Reported Use Of Movement Integration Products And Perceived Facilitators And Barriers Related To Product Use, Roddrick Dugger, Aaron Rafferty, Ethan Hunt, Michael W. Beets, Collin Andrew Webster, Brian Chen, Jeffrey Michael Rehling, Robert Glenn Weaver

Faculty Publications

Movement integration (MI) products are designed to provide children with physical activity during general education classroom time. The purpose of this study was to examine elementary classroom teachers’ self-reported use of MI products and subsequent perceptions of the facilitators of and barriers to MI product use. This study utilized a mixed-methods design. Elementary classroom teachers (n = 40) at four schools each tested four of six common MI products in their classroom for one week. Teachers completed a daily diary, documenting duration and frequency of product use. Following each product test, focus groups were conducted with teachers to assess facilitators …

Correlates Of Maternal Health Service Use And Women’S Experiences Using Antenatal Care In Ghana: A Mixed-Methods Study, Anna Cofie

Theses and Dissertations

The pace of improvements in maternal mortality has been slow in Ghana. While Ghana’s maternal mortality ratio (MMR) decreased from 635 per 100,000 live births to 319 per 100,000 live births between 1990 and 2015, the country failed to meet the 75% reduction target set by Millennium Development Goal (MDG) goal 5A, to reduce maternal mortality ratio by 75% between 1990 and 2015. Antenatal care (ANC) is critical to improving maternal morbidity and mortality and child deaths. In 2003, Ghana introduced the National Health Insurance Scheme to ensure that all pregnant women have access to free maternal care, and in …

Effectiveness And Experience Of An Integrated Maternal Mental Healthcare Intervention In Private Clinics And Public Health Facilities In Pakistan, Syeda Somyyah Owais

Theses and Dissertations

Maternal depression is often undetected or undertreated at the primary care level. Despite the growing high prevalence of depression among women of childbearing age, the usual primary care practice in Pakistan does not include depression screening. Two facility-based cluster randomized control trials, including a maternal depression intervention component, were conducted within two healthcare settings, private and public primary care facilities in Rawalpindi and Lahore. This study aimed to estimate the effectiveness of each trial in reducing maternal depression among mothers in the intervention arm compared to the control by analyzing the change in PHQ-9 (Patient Health Questionnaire-9) scores from baseline …

Effectiveness Among Community Health Center Governing Boards: An Assessment Of The Different Governing Board Members’ Perspectives, Brandi L. Wright

Theses and Dissertations

Governing boards of Community Health Centers were created with the anticipation that majority of its members be patients (users) of the Community Health Center they served. This study assessed South Carolina Community Health Center governing board members’ perception and understanding of what they believe their roles and responsibilities are, and their perceived overall effectiveness. It provides a framework for understanding the governance structure of Community Health Centers, based on examining three characteristic areas (Board Function, Board Performance and Board Development) of Community Health Centers located in South Carolina.

This study invited 234 governing board members to obtain members perceptions. Key …

Aging With Hiv In The United States: Trends And Impact Of Hospital Stays On Inpatient Resource Utilization, And Costs Of Care, 2003-2015, Khairul Alam Siddiqi

Theses and Dissertations

Background:

Due to advances in Antiretroviral Therapy (ART), people living with HIV (PLWH) live longer in the United States. Aging prolongs exposure to HIV and antiretroviral drugs, which could lead to an elevated risk of developing multiple age-related comorbidities [HIV Associated Non-AIDS (HANA) conditions], earlier for PLWH. Higher comorbidity burdens among older PLWH may require greater use of inpatient care, i.e., higher hospitalization, inpatient resource utilization, and costs. This study examined the trends and characteristics of comorbidities, resource utilization, and costs of hospital stays with HIV (HSWH) compared to hospital stays without HIV (HSWOH). We also assessed trends for resource …

The Impact Of Financial Incentives On Urban-Rural Disparities In Dental Supply: Evidence From Thailand, Rakchanok Noochpoung

Theses and Dissertations

Financial incentive is one of the common strategies used to attract healthcare workers in rural and remote areas. Both high-income and low-income countries extensively use financial strategy to tackle the disparity distribution of healthcare workers. However, most studies were conducted in developed countries and assessed positive incentives programs. Previous studies showed the effectiveness of financial incentives on recruitment and retention of healthcare workers. Current studies show that most of the financial incentives supported for education such as scholarships and loan repayment programs are effective. A few studies assessed the effectiveness of direct payment incentive programs, especially in low-middle income countries. …

Magnet Recognition (Mr) And Hospital Quality Outcomes In The U.S.A– Analysis Based On 2017 Hospital Data, Abdulmalik Alhammad

Theses and Dissertations

The American Nurse Credentialing Center (ANCC) introduced Magnet Recognition (MR) in the U.S.A in 1994. Magnet Recognition was adopted based on the findings of a comprehensive study (conducted in 1983) that tried to identify factors explaining high rates of nurses’ retention in 41 hospitals in the U.S.A.

The objective is to compare MHs with the hospitals not recognized as “Magnet” (non-MHs) in terms of important outcomes of the health system and to examine whether the MHs themselves vary significantly in terms of the outcomes.

All the general specialty of MHs (367 hospitals) and their matched of non-MHs (380 hospitals) in …

Exploratory Qualitative Study To Understand The Underlying Motivations And Strategies Of The Private For-Profit Healthcare Sector In Urban Bangladesh, Alayne Mary Adams, Rushdia Ahmed, Tanzir Ahmed Shuvo, Sifat Shahana Yusuf, Sadika Akhter, Iqbal Anwar

Faculty Publications

Objectives This paper explores the underlying motivations and strategies of formal small and medium-sized formal private for-profit sector hospitals and clinics in urban Bangladesh and their implications for quality and access.

Methods This exploratory qualitative study was conducted in Dhaka, Sylhet and Khulna City Corporations. Data collection methods included key informant interviews (20) with government and private sector leaders, in-depth interviews (30) with clinic owners, managers and providers and exit interviews (30) with healthcare clients.

Results Profit generation is a driving force behind entry into the private healthcare business and the provision of services. However, non-financial motivations are also emphasised …

Digital Information Technology Use And Patient Preferences For Internet-Based Health Education Modalities: Cross-Sectional Survey Study Of Middle-Aged And Older Adults With Chronic Health Conditions, Nancy P. Gordon, Elizabeth L. Crouch

Faculty Publications

Background: Health information, patient education, and self-management (health information and advice, HIA) tools are increasingly being made available to adults with chronic health conditions through internet-based health and mobile health (mHealth) digital information technologies. However, there is limited information about patient preferences for using specific types of health information and advice resources and how preferences and usage differ by age group and education.

Objective:The objective of this study was to examine how use of digital information technologies and preferred methods for obtaining health information and advice varies by age group and education among middle-aged and older adults with chronic …

Prevalence And Factors Influencing Use Of Internet And Electronic Health Resources By Middle-Aged And Older Adults In A Us Health Plan Population: Cross-Sectional Survey Study, Elizabeth L. Crouch, Nancy P. Gordon

Faculty Publications

Background: Health care organizations are increasingly using electronic health (eHealth) platforms to provide and exchange health information and advice (HIA). There is limited information about how factors beyond internet access affect use of eHealth resources by middle-aged and older adults.

Objective: We aimed to estimate prevalence of use of the internet, health plan patient portal, and Web-based HIA among middle-aged and older adults; investigate whether similar sociodemographic-related disparities in eHealth resource use are found among middle-aged and older adults; and examine how sociodemographic and internet access factors drive disparities in eHealth resource use among adults who use the internet.

Methods: …

The Association Of Hospital Practices To Breastfeeding Behaviors In South Carolina: Analysis Of 2013-2015 Pregnancy Risk Assessment Monitoring System (Prams) Data, Larisa Donnette Bruner

Theses and Dissertations

Objective: The purpose of this study was to determine whether hospital practices are associated with breastfeeding initiation and breastfeeding duration for ≥10 weeks.

Methods: We analyzed the 2013-2015 South Carolina Pregnancy Risk Assessment Monitoring System (PRAMS) data. The population of interest was mothers who delivered a single live birth in the hospital. The infant was alive and living with the mother at the time of the survey. Chi-square and logistic regression were used to examine breastfeeding initiation and duration among all women who delivered in a hospital and those who stated that they initiated breastfeeding while in the …

Socioeconomic Determinants Of Broadband Non-Adoption Among Consumer Households In South Carolina, Usa, Lori Dickes, Elizabeth L. Crouch, Thomas Walker

Faculty Publications

he policy environment around broadband technology in the United States is shifting again and there are concerns about the impact these proposed changes will have on the future of rural bro- adband deployment and access. Similar to the Obama administration’s discussion of net neutrality, reclas- sifying high-speed internet is again receiving growing media and policy attention at the federal and state level in the United States. Globally, it is argued that affordable high-speed internet access is imperative to rural and regional economic development success. The global digital divide and challenges of non-adoption impact both developing and developed nations. While many …