International Journal for Equity in Health最新文献

Background: Female paid domestic workers are among the most vulnerable occupational groups globally, often lacking formal social protection and limited labour rights. The COVID-19 pandemic may have exacerbated these vulnerabilities, yet quantitative evidence from low and middle income countries is scarce. This study examines health disparities in Peru between female paid domestic workers and females employed in the formal service sector before, during, and after the pandemic.

Methods: We used pooled cross sectional data from the Peruvian National Household Survey (ENAHO, 2018-2023). The primary outcomes were self reported illness symptoms and healthcare seeking behaviour. We compared female paid domestic workers to female formal workers in other service occupations-including both personal and nonpersonal services-across three time periods: prepandemic (January 2018 - February 2020), pandemic (March 2020 - October 2022), and postpandemic (November 2022 - December 2023). Analyses involved comparing differences in proportions and conducting Wald tests. We also stratified results by key social determinants of health, including education, ethnicity, age, income, chronic disease status, household head status, and access to labour rights.

Results: Female paid domestic workers reported more illness symptoms and sought less healthcare than females working in nonpersonal service roles, especially during the pandemic. The difference in proportions - 5.9 percentage points (pp.) for illness symptoms and 16.5 pp. for healthcare-seeking behaviour- became smaller after one year. There were no significant differences when comparing female paid domestic workers to other personal service workers. Stratified results indicated that outcome differences between female paid domestic workers and female working in non-personal services were wider among household heads, those with chronic conditions, and those with limited access to labour rights. Post-pandemic disparities were especially pronounced among younger females, low-wage earners, and those with less education.

Conclusion: In Peru, female paid domestic workers experienced persistent health disadvantages before, during, and after the COVID-19 pandemic when compared with females with formal employment. Addressing these disparities requires comprehensive policies that promote formalization and social security coverage to advance progress on Sustainable Development Goal 3.

Background: Scabies is a neglected stigmatizing skin disease which is common in resource-limited tropical areas. Due to their living conditions, street children are highly vulnerable to scabies infestation. Efforts to prevent and control scabies rely heavily on access to health services, hygienic conditions, and other aspects of health-seeking behavior of a population. The purpose of this research was to identify the health-seeking behavior of street children and the state of interventions to respond to their health service needs in selected areas of Ethiopia.

Methods: The study employed an ethnographic design with multiple methods, datasets, and investigators. Data collection methods were: in-depth interviews, key informant interviews, non-participant observations, and FGDs with a drawing exercise in which children were given the opportunity to actively participate. We collected rich qualitative data from street children, parents, government officials, health professionals, and leaders of NGOs working on street children selected through purposive sampling techniques. In addition to taking field notes, audio records were transcribed, translated, and collaboratively coded to identify themes and sub-themes.

Results: Scabies was a common health problem in all the study sites. The street children lacked awareness about the causes, treatments, and consequences of scabies, shaping their response to their perceived risk and experience of scabies infestation. Low perceived severity of scabies, lack of access to sanitary amenities, the nature of interaction with health professionals, inaccessibility of public health services and lack of money to pay for healthcare contributed to poor primary and secondary health-seeking behavior. Variations in experience of engaging in preventive activities and treatment seeking behavior existed between street children of different sociodemographic characteristics, and regional differences in interventions were identified.

Conclusions: With the absence of adequate targeted interventions and policy frameworks, responding to the healthcare and other needs of street children infested with scabies remains a highly neglected issue. Identifying street children's access to healthcare services and the intricacies of policy environments driving morbidity from scabies, this study indicated the important steps that should be taken toward addressing inequity related to a neglected tropical disease.

Background: Multiple factors influence the health of working children, including cultural, behavioral, and environmental determinants. Identifying and understanding these factors is essential for developing effective interventions. This study aimed to identify and critically analyze the factors-termed "health terminators"-that undermine the physical and mental health of working children, considering cultural, behavioral, and environmental influences.

Methods: This study is the second part of a larger ethnographic research conducted in Tehran, employing a qualitative critical ethnographic design over four years. Data collection included prolonged participant observation in workplaces, homes, and schools, semi-structured interviews with children aged 10-18 and key informants, informal conversations, and analysis of documents and children's drawings. Data were coded and analyzed following Carspecken's framework, with triangulation, member checking, and peer debriefing used to ensure trustworthiness.

Results: Analysis generated 3,057 low-level codes, with approximately one thousand assigned to the main theme "health terminators," comprising five intermediate categories: cultural beliefs, self-harming behaviors, living in unhealthy environments, forgotten children, and social abandonment and vulnerability. Key issues identified included superstition, risky behaviors, neglect of preventive health measures, unsafe housing, educational and emotional neglect, and restricted access to health services.

Conclusions: Working children face multifaceted health risks driven by cultural, behavioral, and structural factors. Comprehensive, equity-oriented policies addressing physical needs, cultural beliefs, health behaviors, and environmental conditions are essential. Interventions such as culturally sensitive health education, improved living conditions, health insurance coverage, and social support can reduce vulnerability and promote equitable health outcomes, contributing to health justice for marginalized children.

Background: Over the past two decades, Chile has undertaken numerous initiatives to reform its healthcare system. However, health equity is influenced by factors beyond the healthcare system. Particularly in hearing health, the access to hearing loss treatment has been reported as hampered at many levels. This scoping review aimed to map the available evidence on hearing health to identify local determinants and barriers that may contribute to disparities in access to treatment for hearing loss in Chile.

Methods: The Joanna Briggs Institute guidance for scoping reviews was followed. The PCC mnemonic (Population, Concept, and Context) was used to guide the development of the search strategy. Searches were conducted in MEDLINE via PubMed, Cochrane and Science Direct databases, limited to publications from 2000 to June 2025, with no language nor type of publication restrictions, and was supplemented by manual search. Two independent reviewers screened all retrieved references, assessed the eligibility, and charted data of the eligible publications. Disagreements were solved through discussion with a third reviewer. Basic content analysis was used to identify the local determinants and barriers in access to hearing loss treatment, which were narratively described and presented along visual summary tools.

Results: Of the 940 unique records identified for screening, the full text of 135 publications were assessed and 50 were included in the review. The principal determinants of hearing care were identified as age, and type and degree of hearing loss. Individuals with severe to profound bilateral sensorineural hearing loss have access to appropriate treatment at any stage of their lives through publicly funded programs. However, youth and adults with mixed or conductive hearing loss do not have a clear pathway to rehabilitation. Barriers to accessing hearing care services in Chile included lower education and income levels, unemployment, limited awareness of treatment options, insufficient family or social support, and residing in remote areas.

Conclusion: Despite public health advancements in providing hearing loss treatment, gaps persist in certain populations. Reducing these disparities requires improving access to services, expanding hearing screening, and providing hearing technologies across all ages and for all types and degrees of hearing loss.