International Journal for Equity in Health最新文献

Background: Cataract is the primary cause of blindness in China and has a low surgery uptake rate where financial factors are crucial determinants. We report updated data on the financial protection of patients with cataract surgery after the integration of urban and rural medical insurance.

Methods: A population-based survey and hospital administrative data were matched to analyze surgical and total out of pocket (OOP) costs and their burden relative to income; the proportion of total surgical costs paid OOP; and the breakdown of total surgical costs. Multivariate regressions, including key interaction terms, identified socio-demographic factors associated with OOP cost and burden.

Results: Among 348 cataract patients, the average surgical OOP cost incurred by patients after any reimbursements was RMB 2945 (USD 427) and total OOP costs averaged RMB 3442 (USD 499), accounting for 25.1% of annual household income. Total surgical costs averaged RMB 5,220 (USD 758), with 44.8% paid OOP and the remaining 55.2% covered by insurance. Material expenses made up 41.3% of the total surgical costs. Having supplementary health insurances and being registered as poverty-stricken households significantly reduced OOP expenditure and burden. However, supplementary insurance was associated with a significantly higher financial burden for lower-middle-income households, highlighting the vulnerability of the 'near poor'.

Conclusions: Financial burden relative to income has decreased after the integration of medical insurance. However, challenges for the 'near poor' population remain. Therefore, not only expand coverage but also optimize insurance benefit design are crucial for enhancing financial protection.

Background: Burkina Faso has been dealing with a worsening security situation since 2015, resulting in more than two million people being forced to leave their homes. Gender-based violence (GBV) has escalated and is a major issue in situations involving conflict and forced displacement. This research examines the views and opinions of internally displaced individuals on VBG in Burkina Faso, specifically emphasizing how ingrained social structures contribute to this problem.

Methods: This study employed a qualitative, descriptive, and exploratory research design. The research was conducted in Kaya city, a region heavily impacted by displacement. Data were collected through 58 focus group discussions, which included 352 participants. The data were thematically analyzed using NVivo 12 and the approach developed by Braun and Clarke, enabling a thorough identification of key patterns and themes.

Results: Findings enabled the identification of several critical dimensions of GBV, its root causes, and risk factors. GBV was highlighted as deeply rooted in cultural and structural determinants, with gender inequality, power imbalances, and entrenched social constructs forming its primary foundations. Economic hardship, ignorance, behavioral issues like alcohol misuse, and institutional shortcomings were seen as contributors exacerbating GBV but not necessarily its root causes. Participants emphasized heightened GBV risks during humanitarian crises, manifesting in physical, sexual, and psychological violence linked to harmful traditional practices like female genital mutilation (FGM), forced marriages, and the sexual division of labor. Though harmful practices persist, divergent views on GBV trends emerged, with some reporting reductions due to shifting behaviors or constraints. Preventive efforts, such as awareness campaigns and local interventions, were noted but insufficient against sociocultural barriers to survivor support, including stigmatization and victim-blaming.

Conclusions: This research elucidates the deep-rooted sociocultural and structural determinants of GBV, reflecting persisting gender inequities and systemic oppression. The findings underscore the pressing requirement for thorough communication plans that increase understanding of accessible services and foster participation despite the widespread stigma, shame, and fear that prevent individuals from seeking help.

Background: Pain affects an estimated 1.5 billion people globally. Cultural factors strongly influence how pain is perceived, communicated, and managed. However, it remains unclear to what extent, how, and for whom pain management approaches have been culturally tailored, and whether these adaptations have been evaluated to ensure cultural relevance and effectiveness. This scoping review addresses this gap.

Methods: We searched six electronic databases for peer-reviewed articles and grey literature, combining terms for pain and cultural tailoring. We included empirical studies (including protocols), published in English, that reported on the cultural tailoring of pain management approaches for adults (≥18 years). At least two reviewers independently screened titles and abstracts, followed by full text assessment. We charted data on study characteristics, cultural tailoring methods, and evaluation strategies, and synthesised results narratively.

Results: Our search identified 4,551 unique studies, of which we included 38. Of these, 32 (84%) were published after 2016, with 26 (68%) focusing on musculoskeletal pain. They reported the cultural tailoring of 27 unique pain management intervention approaches, of which 19 (70%) focused on racial and ethnic minorities mainly in high-income countries. Educational interventions were most commonly tailored (n = 9, 33%). Only four (15%) tailored approaches were delivered digitally. Most (n = 25, 93%) approaches underwent content adaptation through including culturally relevant language, metaphors, and gender considerations. Most employed early tailoring steps, such as information gathering (85%) and preliminary adaptation design (93%). Only six (22%) approaches used frameworks to guide the adaptation such as Intervention Mapping-Adapt, FRAME, and ADAPT-IT. The effectiveness of cultural tailoring was evaluated for 11 (41%) approaches, mainly through randomised controlled trials (n = 7, 26%).

Conclusion: This review identified several efforts to culturally tailor pain management approaches, particularly for racial and ethnic minorities with musculoskeletal pain in high-income countries. Most tailoring focused on content adaptation for in-person formats, with limited use of contextual modifications, digital delivery, or adaptation frameworks. Future research should broaden tailoring beyond content changes, make greater use of digital tools, and prioritise adaptations in low- and middle-income countries. Evaluation strategies should also expand to assess real-world implementation, and long-term outcomes.

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.