International Journal for Equity in Health最新文献

Background: Gender-based discrimination (GBD) remains a pervasive determinant of health inequity for women globally, yet its systemic and culturally embedded forms in low- and middle-income countries are underexplored. This study explores women's lived experiences of GBD in Burkina Faso, Ghana and Tanzania, highlighting how intersecting social and institutional norms influence access to health care, education, employment, financial resources and the resulting impacts on women's health.

Methods: Between February and May 2022, 17 focus group discussions and 32 in-depth interviews were conducted with 167 women across twelve regions in the three countries. Thematic analysis was employed to identify core patterns in how women perceive and navigate GBD in their daily lives.

Results: Across all sites, participants conceptualized GBD as a normalized, systemic structure embedded in both public and private spheres. Women described GBD as omnipresent and internalized, upheld by cultural, religious, economic and educational norms that reinforced power imbalances, particularly in household decision-making. These structural constraints limited women's access to education, employment, healthcare, and financial autonomy, and positioned them as both subjects of and gatekeepers to gendered hierarchies. GBD was identified as a key barrier to maternal care such as reproductive autonomy, with male dominance over contraceptive use, and pregnancy-related decisions. This lack of autonomy, compounded by institutional biases and sociocultural stigma, was perceived to contribute to delayed care, emotional distress, and adverse physical and mental health outcomes.

Conclusion: The findings underscore the need for multisectoral strategies to address women's health inequities. Efforts must focus on dismantling entrenched gender norms, enhancing women's decision-making power, and ensuring institutional accountability for gender equity within health systems - not only in Burkina Faso, Ghana, and Tanzania.

Background: Early childhood development (ECD) is a critical foundation for health, learning, and social well-being. In Egypt, many children suffer from developmental delays, particularly in rural areas where early nurturing care is neglected.

Aim: This study evaluated the effectiveness of a community-based intervention, based on the framework of WHO/UNICEF Care for Early Child Development, in improving caregiving practices and developmental outcomes among children under six years in a rural Egyptian district.

Methods: A quasi-experimental longitudinal study with a post-test-only control group was implemented in one intervention and one control village. The intervention involved structured caregiver education, skill-building sessions, and continuous home-based support delivered by trained community health workers. Family Care Indicators (FCIs) from the Multiple Indicator Cluster Surveys and child development assessments using the Denver II Screening Tool were applied to evaluate progress. Statistical analyses were conducted using SPSS v24. Descriptive comparisons used Chi-square and paired t-tests. Multivariable logistic regression analyses were performed to control for potential confounders and to identify independent predictors of positive family care and developmental outcomes. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were calculated, with significance set at p ≤ 0.05.

Results: Adjusted regression analyses showed significant associations between intervention participation and improved outcomes across all domains. Families in the intervention village had higher odds of Availability of ≥ 3 children's books (AOR = 3.41, 95% CI 1.87-6.24), and engaging in ≥ 4 caregiver-child interactive activities (AOR = 3.22, 95% CI 1.97-5.25). Children carried more odds to attend preschool (AOR = 3.76, 95% CI 2.01-7.02) and demonstrate normal fine-motor (AOR = 3.18, 95% CI 1.92-5.26), language (AOR = 2.64, 95% CI 1.63-4.27), gross-motor (AOR = 2.93, 95% CI 1.75-4.91), and personal-social development (AOR = 3.83, 95% CI 2.07-7.09), (all p < 0.001).

Conclusion: Participation in the community-based program was positively associated with improved nurturing-care practices and developmental performance after controlling for key sociodemographic factors. The findings suggest that integrating similar caregiver training and early stimulation programs into national child health strategies may help promote equitable early childhood development.

Introduction: Lower limb amputation has a significant impact on an individual's overall quality of life, with prosthetic devices serving as essential tools for rehabilitation and mobility restoration. In Syria, where access to advanced medical care remains constrained, identifying the key factors affecting the well-being of prosthesis users is crucial for enhancing rehabilitation strategies. This study examines the sociodemographic and health-related determinants influencing the quality of life among lower-limb amputees who rely on prosthetic devices in Syria.

Methods: This research employed a cross-sectional design at a highly specialized disability care facility within a tertiary hospital. A total of 233 individuals with lower limb amputations, all of whom had been using prosthetic limbs for at least five years, participated in the study. The sample was drawn from patients receiving treatment at the same medical institution. Data collection encompassed sociodemographic details, health status, and pain-related experiences. The SF-12 questionnaire was utilized to assess health-related quality of life (HrQoL), categorizing scores above 50 as indicative of good HrQoL in both the Mental Component Summary (MCS) and Physical Component Summary (PCS), while scores below 50 denoted poor HrQoL. Statistical analysis involved the Chi-square (χ²) test, applied with a 95% confidence level to examine associations among the study variables.

Results: The study assessed health-related quality of life among individuals with lower limb amputations, indicating that 62.23% had high mental health scores, while 66.09% demonstrated high physical health scores. Analysis revealed significant links between age and marital status with both the MCS and PCS. Furthermore, the cause of amputation and the occurrence of phantom pain were associated with MCS. Several pain-related factors, including residual limb pain treatment, its perceived effectiveness, and residual residual limb pain, showed significant associations with both MCS and PCS. Additionally, extremity dominance and actions taken to manage residual limb pain were notably linked to PCS. Lastly, a significant relationship was observed between the level of amputation and the treatment of phantom pain.

Conclusion: These findings emphasize the significant impact of age, marital status, limb dominance, cause of amputation, and residual limb pain treatment on the quality of life of lower limb amputees. They highlight the need for comprehensive rehabilitation programs that prioritize effective pain management, social support, and personalized care tailored to the unique demographic and clinical needs of each individual.

Background: Asylum seekers and refugees in Switzerland face major barriers to oral health care services, often limited to urgent treatments like tooth extractions. Access depends largely on legal status, canton of residence and duration in the country, whereby it is largely unclear for those affected as to which treatments are actually covered.

Methods: Sixteen interviews and three in-clinic observations were conducted with Arabic-speaking asylum seekers and refugees in Basel-Stadt and Basel-Landschaft, two German-speaking Swiss cantons.

Results: It was documented that financial constraints, permit restrictions, communication challenges, and limited autonomy often led participants to delay or avoid dental care, worsening their oral health. While frameworks like Levesque's model help explain access challenges, they do not fully capture how systemic barriers shape asylum seekers and refugees' abilities to recognize needs, seek care, and participate in their own health decisions. If these deeper structural issues are not addressed, there is a risk that efforts to improve care will fall short.

Conclusion: The current findings point to the need for systemic reforms to improve coverage, communication, and preventive care, while promoting equitable, tooth-preserving treatment options for asylum seekers and refugees.