International Journal for Equity in Health最新文献

Background: Mycetoma is a neglected tropical disease with significant physical, social, and economic consequences. In Sudan, biomedical services dominate health policy and funding, often marginalising coexisting traditional healing systems. Understanding the interplay between these parallel systems is essential for improving patient outcomes.

Objective: To explore the role of traditional healers in mycetoma management in Sudan, examine patients' health-seeking behaviours, and analyse the power dynamics shaping healthcare pathways.

Methods: We conducted a qualitative study using a critical medical anthropology framework. Data were collected through in-depth interviews, focus group discussions, and environmental observations, including analysis of health promotion materials. Participants included individuals with mycetoma, their families, carers, biomedical practitioners, and traditional healers. Data were thematically analysed to identify patterns in help-seeking, treatment experiences, and inter-system relationships.

Results: Traditional healers were found to be the first point of contact for most people with mycetoma. Reliance on healers was influenced not only by economic barriers but also by cultural trust, social support, and systemic inequities. Biomedical practitioners frequently perceived healers as a cause of treatment delays, reflecting entrenched power asymmetries between health systems. Health promotion materials reinforced biomedical dominance and contributed to the marginalisation of traditional healing. Patients' experiences were shaped by both interpersonal and institutional power relations.

Conclusions: Traditional healers play a crucial role in sustaining access to care for people with mycetoma in Sudan. Effective collaboration between health systems will require addressing the structural and relational power imbalances that currently hinder integration. Recognising traditional healers as healthcare stakeholders is essential for culturally appropriate and equitable health interventions.

Despite bearing a disproportionate share of the global disease burden, low- and middle-income countries (LMICs) contribute minimally to clinical trial data. Using the Palestinian Territories as a case study, this commentary explores how structural barriers in conflict-affected health systems create gaps in clinical evidence. Fragmented health services and inequitable publishing opportunities disrupt continuity of care and limit participation in global research. These barriers are rarely acknowledged in the medical literature, yet they profoundly shape clinical outcomes and research capacity. Addressing this evidence gap requires structural reform, equitable authorship, and locally led research agendas. Without including structurally excluded regions in evidence production, global clinical guidelines remain incomplete and inequitable.

Background: Across the globe, Indigenous women in subordinate social positions (minoritized, racialized, facing discrimination) experience poorer health outcomes and greater social inequalities than non-Indigenous women. Although intimate partner violence (IPV) may significantly exacerbate these disparities, the extent of IPVs contribution to the excess of health inequality has not been systematically quantified.

Methods: We estimated IPVs relative contribution to the excess of health inequalities between Indigenous Palestinian (N = 436) and Jewish women (N = 965) citizens in Israel, aged 18-50. We calculated adjusted odds ratios (AORs) and 95% confidence intervals for 10 mental and physical health conditions, considering socioeconomic and demographic factors. Mental health outcomes included: postpartum depression (PPD; EPDS ≥ 10), depressive symptoms (CES > 0.9), anxiety (STAI ≥14), self-rated health (SRH). Physical health included: abortions, miscarriages, preterm birth, unplanned pregnancy, chronic illness. Multimorbidity included: two-plus above conditions. IPVs specific contribution to health inequalities was calculated by % change (Δ) in AORs from adjusted model (socioeconomics and demographics) to a model that also considered IPV.

Results: Palestinian women had significantly poorer health than Jewish women for 7 of 10 conditions: OR (95%CI): PPD = 3.57 (2.41-5.31); depression = 3.46 (2.40-4.99); anxiety = 2.06 (1.63-2.60); unplanned pregnancy = 4.83 (3.18-7.34); miscarriages = 1.89 (1.47-2.71); preterm birth = 1.97 (1.51-2.57); multimorbidity = 1.48 (1.10-1.99). OR for chronic illness was significantly lower among Palestinian women (0.11, 0.05-0.23). Abortions and SRH were non-significant. Adjusting for IPV above socioeconomic and demographic factors, AORs for ethnonational inequalities were attenuated: physical health, 0.09% to 50.4%; mental health, 23.3% to 57.8%; multimorbidity, 29.7% (non-significant). The net contribution of IPV to the excess of ethnonational health inequalities was as follows: depression = 16.76%, anxiety = 20.39%, PPD = 20.19%, SRH = 14.65%, chronic illness = no contribution, abortions = 2.60%, miscarriages = 3.17%, preterm birth = 4.09, planned pregnancy = 24.43%, and multimorbidity = 24.33%.

Conclusions: Intimate partner violence (IPV) is a structural phenomenon shaped by intersecting social, economic, and systemic determinants that intensify health disparities between Palestinian and Jewish women during pregnancy and the postpartum period, and beyond what can be explained by socioeconomic or sociodemographic factors alone. Effectively addressing IPV and its underlying structural and social causes is essential for mitigating these persistent health inequalities.

Background: People with disabilities face profound health disparities and systemic barriers to healthcare access, especially in low- and middle-income countries. These barriers range from inaccessible infrastructure and communication formats to negative attitudes and limited training among healthcare workers. This paper focuses on the co-design of the Disability Awareness Toolkit (DAT), a practical, contextually grounded toolkit to promote inclusion and accessibility in health and post-GBV clinical services in South Africa.

Method: The development of the DAT followed the co-design framework established by Birds et al., structured around two design cycles. The first cycle focused on creating the Disability Awareness Checklist (DAC) and its accompanying automated reporting system. The second cycle involved the development of the DAC's implementation support tools, including an intervention menu and a training component. Each cycle incorporated (a) pre-design activities such as literature and document reviews and key interest holder mappings, (b) co-design activities such as workshops with a diverse group of interest holders-including persons with disabilities-alongside DAC facilitator training, and pilot testing in healthcare settings, and (c) post-design adaptation. Feedback was collected using accessible, structured formats to ensure clarity and inclusivity. Any conflicting feedback was resolved through follow-up discussions and consensus-building, reinforcing the participatory and inclusive nature of the process.

Results: The iterative co-design process was informed by the lived experiences of healthcare users and providers, revealing the importance of local relevance, flexibility, and power-sensitive collaboration. The final DAT consists of a comprehensive toolkit: the DAC with 53 core elements, automated reporting tools, a practical intervention menu tailored to local contexts, and an integrated training approach. The consultative process led to formally adopting appreciative inquiry as a key facilitation technique, helping participants better identify actionable, locally feasible solutions. The combination of the tool design and appreciative inquiry showed promise to create awareness and initiate change.

Conclusion: The DAT's evolution highlights the power of co-design in addressing healthcare inequalities. It demonstrates how inclusive, locally grounded, and flexible design processes can produce meaningful quality assurance tools that reflect the diverse realities of service users and providers in unequal contexts.

Background: Financial risk protection (FRP) is central to Universal Health Coverage (UHC), aiming to shield individuals from financial hardship when accessing essential healthcare services. This study estimates trends and projections for FRP indicators in Vietnam from 2010 to 2030 at both national and sub-national levels, assesses the probability of achieving UHC targets, and analyses demographic-, geographic-, and socioeconomic-related inequalities.

Methods: Data from 168,812 households collected in six nationally representative surveys (2010-2020) were analysed. FRP coverage was evaluated using indicators including catastrophic health expenditure (CHE), impoverishing health expenditure (IHE), further impoverishing health expenditure (FIE), financial hardship expenditure (FHE), and the revised SDG 3.8.2 indicator, across multiple thresholds (10%, 15%, 25%, 40%). Bayesian models projected trends and estimated the probability of achieving the 2030 UHC targets. Inequality analyses using relative, slope, and concentration indices were conducted across ethnicity, dependency ratio, urban-rural residence, region, wealth quintile, and educational level.

Findings: National FRP coverage was relatively high in 2020 (78.1%-94.9%), with modest improvements projected for 2030 (81.4%-95.4%). However, probabilities of achieving UHC targets remain low, with only protection from IHE showing moderate prospects (83.6%). Ethnic minorities, rural households, and those with high dependency ratios were consistently disadvantaged, especially regarding IHE and FHE. Regional disparities were pronounced, with lower coverage in Central highland and Central Coast regions, compared to the Southeast and Red River Delta regions. Significant socioeconomic inequalities persisted, disproportionately affecting the poorest and least educated groups. Inequality gaps widened over time, particularly among regions and educational levels.

Interpretation: Our findings suggest that Vietnam is unlikely to achieve full financial risk protection by 2030, given modest projected improvements and low probabilities of meeting UHC targets. Persistent and widening inequalities, particularly by region and educational level, underscore the need for targeted health financing reforms that prioritize disadvantaged groups such as ethnic minorities, rural households, and those with high dependency ratios. Strengthening social health insurance, expanding fiscal space for health, and integrating financial protection policies with broader poverty reduction and social development programs will be critical for advancing equity and moving closer to UHC in Vietnam.

Background: Adolescent motherhood poses a significant global public health challenge, with young mothers at twice the risk of postpartum depression compared with adults. However, qualitative insights into how multilevel social determinants shape emotional well-being in low- and middle-income Community-based Health Planning and Services (CHPS)-style primary care systems are lacking. This study focused on the postpartum emotional distress experienced by teenage mothers in Ghana, focusing on how they perceive, understand, and cope with their emotional realities.

Methods: A phenomenological study was conducted in rural southern Ghana, utilizing semi-structured, in-depth interviews with 16 adolescent mothers aged 15-19 years. The data were analyzed thematically, informed by Braun and Clarke's framework, and interpreted through an interpretative phenomenological lens.

Results: The thematic analysis revealed four key themes. These include (1) the loss of adolescence and uncertainty about their new roles; (2) the suppression of emotions due to family expectations, social stigma, and personal shame; (3) the role of faith in coping with emotional distress, which provides comfort but imposes limitations; and (4) the neglect of emotional needs in postpartum care, which prioritizes physical recovery and infant health. These themes suggest a significant gap between the mental health needs of adolescent mothers in Ghana and the support they receive.

Conclusion: There is a need for multidimensional interventions that focus on adolescent mothers' voices, address systemic inequities, and foster inclusive support networks to improve their mental health, well-being, and long-term outcomes.