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Exploring the association between multidimensional poverty and antenatal care utilization in two provinces of Papua New Guinea: a cross-sectional study. 探索巴布亚新几内亚两个省的多维贫困与产前护理利用率之间的关联:一项横断面研究。
IF 4.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-02 DOI: 10.1186/s12939-024-02241-0
Olga P M Saweri, William S Pomat, Andrew J Vallely, Virginia Wiseman, Neha Batura

Background: Although global poverty rates have declined in the last decade, the fall in the Asia-Pacific region has been slow relative to the rest of the world. Poverty continues to be a major cause of poor maternal and newborn health, and a barrier to accessing timely antenatal care. Papua New Guinea has one of the highest poverty rates and some of the worst maternal and neonatal outcomes in the Asia-Pacific region. Few studies have investigated equity in antenatal care utilization in this setting. We explored equity in antenatal care utilization and the determinants of service utilization, which include a measure of multidimensional poverty in Papua New Guinea.

Methods: To explore the association between poverty and antenatal care utilization this study uses data from a ten-cluster randomized controlled trial. The poverty headcount, average poverty gap, adjusted poverty headcount, and multidimensional poverty index of antenatal clinic attendees are derived using the Alkire-Foster method. The distribution of service utilization is explored using the multidimensional poverty index, followed by multivariate regression analyses to evaluate the determinants of service utilization.

Results: The poverty headcount was 61.06%, the average poverty gap 47.71%, the adjusted poverty headcount 29.13% and the average multidimensional poverty index was 0.363. Further, antenatal care utilization was regressive with respect to poverty. The regression analyses indicated that older women; being a widow (small number of widows (n = 3) asserts interpreting result with caution); or formally employed increase the likelihood of accessing antenatal care more often in pregnancy. Travelling for over an hour to receive care was negatively associated with utilization.

Conclusion: This study indicated high levels of multidimensional poverty in PNG and that ANC utilization was regressive; highlighting the need to encourage pregnant women, especially those who are economically more vulnerable to visit clinics regularly throughout pregnancy.

背景:尽管全球贫困率在过去十年中有所下降,但与世界其他地区相比,亚太地区的贫困率下降缓慢。贫困仍然是导致孕产妇和新生儿健康状况不佳的一个主要原因,也是及时获得产前护理的一个障碍。巴布亚新几内亚是亚太地区贫困率最高的国家之一,也是孕产妇和新生儿死亡率最高的国家之一。在这种情况下,很少有研究对产前保健利用的公平性进行调查。我们探讨了巴布亚新几内亚产前保健利用的公平性和服务利用的决定因素,其中包括对多维贫困的衡量:为了探讨贫困与产前保健利用率之间的关系,本研究使用了来自 10 个群组随机对照试验的数据。使用 Alkire-Foster 方法得出了产前检查诊所就诊者的贫困人口、平均贫困差距、调整后贫困人口和多维贫困指数。利用多维贫困指数探讨了服务利用率的分布情况,随后进行了多变量回归分析,以评估服务利用率的决定因素:结果:贫困人口比例为 61.06%,平均贫困差距为 47.71%,调整后的贫困人口比例为 29.13%,平均多维贫困指数为 0.363。此外,产前保健利用率与贫困率呈递减关系。回归分析表明,年龄较大的妇女、寡妇(寡妇人数较少(n = 3),因此对结果的解释需谨慎)或有正式工作的妇女更有可能在怀孕期间更频繁地接受产前护理。旅行时间超过一小时接受护理与使用率呈负相关:这项研究表明,巴布亚新几内亚的多层面贫困程度很高,产前护理的利用率呈倒退趋势;这突出表明,有必要鼓励孕妇,尤其是那些经济上较为脆弱的孕妇,在整个孕期定期到诊所就诊。
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引用次数: 0
Power and positionality in the practice of health system responsiveness at sub-national level: insights from the Kenyan coast. 国家以下各级卫生系统响应实践中的权力和地位:肯尼亚沿海地区的启示。
IF 4.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-02 DOI: 10.1186/s12939-024-02258-5
Nancy Kagwanja, Sassy Molyneux, Eleanor Whyle, Benjamin Tsofa, Hassan Leli, Lucy Gilson

Background: Health system responsiveness to public priorities and needs is a broad, multi-faceted and complex health system goal thought to be important in promoting inclusivity and reducing system inequity in participation. Power dynamics underlie the complexity of responsiveness but are rarely considered. This paper presents an analysis of various manifestations of power within the responsiveness practices of Health Facility Committees (HFCs) and Sub-county Health Management Teams (SCHMTs) operating at the subnational level in Kenya. Kenyan policy documents identify responsiveness as an important policy goal.

Methods: Our analysis draws on qualitative data (35 interviews with health managers and local politicians, four focus group discussions with HFC members, observations of SCHMT meetings, and document review) from a study conducted at the Kenyan Coast. We applied a combination of two power frameworks to interpret our findings: Gaventa's power cube and Long's actor interface analysis.

Results: We observed a weakly responsive health system in which system-wide and equity in responsiveness were frequently undermined by varied forms and practices of power. The public were commonly dominated in their interactions with other health system actors: invisible and hidden power interacted to limit their sharing of feedback; while the visible power of organisational hierarchy constrained HFCs' and SCHMTs' capacity both to support public feedback mechanisms and to respond to concerns raised. These power practices were underpinned by positional power relationships, personal characteristics, and world views. Nonetheless, HFCs, SCHMTs and the public creatively exercised some power to influence responsiveness, for example through collaborations with political actors. However, most resulting responses were unsustainable, and sometimes undermined equity as politicians sought unfair advantage for their constituents.

Conclusion: Our findings illuminate the structures and mechanisms that contribute to weak health system responsiveness even in contexts where it is prioritised in policy documents. Supporting inclusion and participation of the public in feedback mechanisms can strengthen receipt of public feedback; however, measures to enhance public agency to participate are also needed. In addition, an organisational environment and culture that empowers health managers to respond to public inputs is required.

背景:卫生系统响应公众的优先事项和需求是一个广泛、多方面和复杂的卫生系统目标,被认为对促进包容性和减少系统参与中的不公平现象非常重要。权力动态是响应能力复杂性的基础,但很少被考虑在内。本文分析了肯尼亚国家以下各级卫生机构委员会(HFCs)和县级卫生管理小组(SCHMTs)在响应性实践中的各种权力表现形式。肯尼亚的政策文件将响应性作为一项重要的政策目标:我们的分析借鉴了在肯尼亚海岸进行的一项研究中获得的定性数据(与卫生管理人员和当地政治家进行的 35 次访谈、与 HFC 成员进行的 4 次焦点小组讨论、对 SCHMT 会议的观察以及文件审查)。我们综合运用了两种权力框架来解释我们的研究结果:结果:结果:我们发现,在一个反应乏力的医疗系统中,各种形式和做法的权力经常破坏整个系统的反应能力和公平性。公众在与其他卫生系统参与者的互动中通常处于主导地位:无形和隐性权力相互作用,限制了他们分享反馈意见;而组织等级制度的显性权力则限制了卫生保健中心和医疗卫生管理委员会支持公众反馈机制和回应所提出问题的能力。这些权力做法的基础是地位权力关系、个人特征和世界观。尽管如此,总部外协调中心、斯德哥尔摩公约监测与评估中心和公众还是创造性地行使了一些权力,例如通过与政治行动者合作来影响应对措施。然而,大多数由此产生的应对措施都是不可持续的,有时还会破坏公平,因为政治家们会为其选民谋取不公平的利益:我们的研究结果揭示了导致卫生系统应对能力薄弱的结构和机制,即使在政策文件将其列为优先事项的情况下也是如此。支持将公众纳入反馈机制并让其参与其中,可以加强对公众反馈意见的接收;但是,还需要采取措施加强公众参与的积极性。此外,还需要营造一种组织环境和文化,赋予卫生管理人员回应公众意见的权力。
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引用次数: 0
Sustaining the mobile medical units to bring equity in healthcare: a PLS-SEM approach. 维持流动医疗队以实现医疗保健的公平性:PLS-SEM 方法。
IF 4.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-02 DOI: 10.1186/s12939-024-02260-x
Jignesh Patel, Sangita More, Pravin Sohani, Shrinath Bedarkar, Kamala Kannan Dinesh, Deepika Sharma, Sanjay Dhir, Sushil Sushil, Gunjan Taneja, Raj Shankar Ghosh

Background: Equitable access to healthcare for rural, tribal, and underprivileged people has been an emerging area of interest for researchers, academicians, and policymakers worldwide. Improving equitable access to healthcare requires innovative interventions. This calls for clarifying which operational model of a service innovation needs to be strengthened to achieve transformative change and bring sustainability to public health interventions. The current study aimed to identify the components of an operational model of mobile medical units (MMUs) as an innovative intervention to provide equitable access to healthcare.

Methods: The study empirically examined the impact of scalability, affordability, replicability (SAR), and immunization performance on the sustainability of MMUs to develop a framework for primary healthcare in the future. Data were collected via a survey answered by 207 healthcare professionals from six states in India. Partial least squares structural equation modeling (PLS-SEM) was conducted to empirically determine the interrelationships among various constructs.

Results: The standardized path coefficients revealed that three factors (SAR) significantly influenced immunization performance as independent variables. Comparing the three hypothesized relationships demonstrates that replicability has the most substantial impact, followed by scalability and affordability. Immunization performance was found to have a significant direct effect on sustainability. For evaluating sustainability, MMUs constitute an essential component and an enabler of a sustainable healthcare system and universal health coverage.

Conclusion: This study equips policymakers and public health professionals with the critical components of the MMU operational model leading toward sustainability. The research framework provides reliable grounds for examining the impact of scalability, affordability, and replicability on immunization coverage as the primary public healthcare outcome.

背景:让农村、部落和弱势群体公平获得医疗保健服务一直是全球研究人员、学者和政策制定者关注的新领域。改善医疗保健的公平获取需要创新的干预措施。这就要求明确需要加强服务创新的哪种运作模式,以实现转型变革,并使公共卫生干预措施具有可持续性。本研究旨在确定流动医疗单位(MMUs)运作模式的组成部分,以此作为提供公平医疗服务的创新干预措施:本研究通过实证研究探讨了可扩展性、可负担性、可复制性(SAR)和免疫效果对流动医疗单位可持续性的影响,从而为未来的初级医疗保健制定一个框架。数据是通过一项调查收集的,来自印度六个邦的 207 名医疗保健专业人员回答了调查问卷。采用偏最小二乘法结构方程模型(PLS-SEM)来实证确定各种结构之间的相互关系:标准化路径系数显示,作为自变量的三个因素(SAR)对免疫接种绩效有显著影响。比较三个假设关系表明,可复制性的影响最大,其次是可扩展性和可负担性。研究发现,免疫接种绩效对可持续性有重大直接影响。为评估可持续性,多指标类集单位是可持续医疗保健系统和全民医保的重要组成部分和推动因素:本研究为政策制定者和公共卫生专业人员提供了多学科医疗单位运作模式的关键组成部分,从而实现可持续发展。研究框架为研究可扩展性、可负担性和可复制性对作为主要公共医疗成果的免疫接种覆盖率的影响提供了可靠的依据。
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引用次数: 0
Inclusion of people with disabilities in Chilean health policy: a policy analysis. 将残疾人纳入智利卫生政策:政策分析。
IF 4.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-08-29 DOI: 10.1186/s12939-024-02259-4
Danae Rodríguez Gatta, Pamela Gutiérrez Monclus, Jane Wilbur, Johanna Hanefeld, Lena Morgon Banks, Hannah Kuper

Background: Around 18% of the population in Chile has disabilities. Evidence shows that this population has greater healthcare needs, yet they face barriers to accessing healthcare due to health system failures. This paper aims to assess the inclusion of people with disabilities in health policy documents and to explore the perceptions of key national stakeholders regarding the policy context, policy processes, and actors involved.

Methods: A policy content analysis was conducted of 12 health policy documents using the EquiFrame framework, adapted to assess disability inclusion. Documents were reviewed and rated on their quality of commitment against 21 core concepts of human rights in the framework. Key national stakeholders (n = 15) were interviewed, and data were thematically analysed under the Walt and Gilson Policy Analysis Triangle, using NVivo R1.

Results: Core human rights concepts of disability were mentioned at least once in nearly all health policy documents (92%). However, 50% had poor policy commitments for disability. Across policies, Prevention of health conditions was the main human rights concept reflected, while Privacy of information was the least referenced concept. Participants described a fragmented disability movement and health policy, related to a dominant biomedical model of disability. It appeared that disability was not prioritized in the health policy agenda, due to ineffective mainstreaming of disability by the Government and the limited influence and engagement of civil society in policy processes. Moreover, the limited existing policy framework on disability inclusion is not being implemented effectively. This implementation gap was attributed to lack of financing, leadership, and human resources, coupled with low monitoring of disability inclusion.

Conclusions: Improvements are needed in both the development and implementation of disability-inclusive health policies in Chile, to support the achievement of the right to healthcare for people with disabilities and ensuring that the health system truly "leaves no one behind".

背景:智利约有 18% 的残疾人口。有证据表明,这一人群有更大的医疗保健需求,但由于医疗系统的失灵,他们在获得医疗保健服务方面面临障碍。本文旨在评估将残疾人纳入医疗政策文件的情况,并探讨国内主要利益相关者对政策背景、政策过程和相关参与者的看法:方法:采用 EquiFrame 框架对 12 份卫生政策文件进行了政策内容分析,该框架经调整后可用于评估对残疾人的包容性。根据框架中 21 项核心人权概念,对文件的承诺质量进行了审查和评级。对主要的国家利益相关者(n = 15)进行了访谈,并根据 Walt 和 Gilson 政策分析三角,使用 NVivo R1 对数据进行了专题分析:几乎所有的卫生政策文件(92%)都至少提到过一次有关残疾的核心人权概念。然而,50%的政策对残疾问题的承诺不明确。在所有政策中,预防健康状况是主要的人权概念,而信息隐私是最少被提及的概念。与会者描述了与占主导地位的残疾生物医学模式有关的支离破碎的残疾运动和卫生政策。由于政府没有有效地将残疾问题纳入主流,民间社会对政策进程的影响和参与有限,残疾问题似乎没有在卫生政策议程中得到优先考虑。此外,有限的现有残疾包容政策框架也没有得到有效实施。这一执行差距可归因于缺乏资金、领导力和人力资源,以及对残疾包容的监测不足:智利在制定和实施包容残疾的卫生政策方面都需要改进,以支持实现残疾人的医疗保健权,确保卫生系统真正做到 "不落下任何人"。
{"title":"Inclusion of people with disabilities in Chilean health policy: a policy analysis.","authors":"Danae Rodríguez Gatta, Pamela Gutiérrez Monclus, Jane Wilbur, Johanna Hanefeld, Lena Morgon Banks, Hannah Kuper","doi":"10.1186/s12939-024-02259-4","DOIUrl":"10.1186/s12939-024-02259-4","url":null,"abstract":"<p><strong>Background: </strong>Around 18% of the population in Chile has disabilities. Evidence shows that this population has greater healthcare needs, yet they face barriers to accessing healthcare due to health system failures. This paper aims to assess the inclusion of people with disabilities in health policy documents and to explore the perceptions of key national stakeholders regarding the policy context, policy processes, and actors involved.</p><p><strong>Methods: </strong>A policy content analysis was conducted of 12 health policy documents using the EquiFrame framework, adapted to assess disability inclusion. Documents were reviewed and rated on their quality of commitment against 21 core concepts of human rights in the framework. Key national stakeholders (n = 15) were interviewed, and data were thematically analysed under the Walt and Gilson Policy Analysis Triangle, using NVivo R1.</p><p><strong>Results: </strong>Core human rights concepts of disability were mentioned at least once in nearly all health policy documents (92%). However, 50% had poor policy commitments for disability. Across policies, Prevention of health conditions was the main human rights concept reflected, while Privacy of information was the least referenced concept. Participants described a fragmented disability movement and health policy, related to a dominant biomedical model of disability. It appeared that disability was not prioritized in the health policy agenda, due to ineffective mainstreaming of disability by the Government and the limited influence and engagement of civil society in policy processes. Moreover, the limited existing policy framework on disability inclusion is not being implemented effectively. This implementation gap was attributed to lack of financing, leadership, and human resources, coupled with low monitoring of disability inclusion.</p><p><strong>Conclusions: </strong>Improvements are needed in both the development and implementation of disability-inclusive health policies in Chile, to support the achievement of the right to healthcare for people with disabilities and ensuring that the health system truly \"leaves no one behind\".</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11360718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142092852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Research on government regulation methods for the spatial layout of retail pharmacies: practice in Shanghai, China. 零售药店空间布局的政府监管方法研究:中国上海的实践。
IF 4.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-08-28 DOI: 10.1186/s12939-024-02254-9
Qian Wang, Ruiming Dai, Qianqian Yu, Tiantian Zhang

Background: In China, retail pharmacies are critical sources for obtaining medications and play a vital role in residents' daily access to drugs and treatment of common illnesses. Effectively guiding the placement of these pharmacies in areas of need through government regulation is crucial for enhancing medication access. In this study, we used population and retail pharmacy spatial distribution data from Shanghai to design guidance and supplementary methods for optimizing the spatial layout of retail pharmacies and medical insurance designated pharmacies based on regional characteristics.

Methods: Population distribution, road traffic network, administrative division and retail pharmacy data from Shanghai in 2018 were collected from relevant government departments. ArcGIS 10.3 was used to map the retail pharmacies and population distribution. Based on the spatial distribution of population and the service standards of pharmacies, service circles with insufficient pharmacies were identified, and supplementary methods for retail pharmacies and medical insurance designated pharmacies were developed.

Results: In 2018, Shanghai had 3009 retail pharmacies, each serving an average of 6412 residents. The city was divided into 2188 basic pharmaceutical service circles, each within a 15-minute walking distance. The results indicated that there were 1387 service circles without any pharmacies, 151 of which had populations exceeding 5000. Additionally, 356 service circles had pharmacies but lacked medical insurance designated ones. After supplementation, 841 retail pharmacies were planned to be added in residential areas. Compared with before, the coverage area and population served of the pharmacies increased significantly.

Conclusions: This study mapped the spatial distribution of population and retail pharmacies in Shanghai, and designed government guidance and supplementary methods for optimizing the layout of retail pharmacies. The findings offer valuable insights for government agencies in low- and middle-income countries to improve the spatial distribution of retail pharmacies.

背景:在中国,零售药店是获取药品的重要渠道,在居民日常用药和常见病治疗中发挥着重要作用。通过政府监管,有效引导这些药店在有需求的地区布点,对于提高药品可及性至关重要。在本研究中,我们利用上海的人口和零售药店空间分布数据,设计了根据区域特点优化零售药店和医保定点药店空间布局的指导和辅助方法:从相关政府部门收集2018年上海市人口分布、道路交通网络、行政区划和零售药店数据。使用 ArcGIS 10.3 绘制零售药店和人口分布图。根据人口空间分布和药店服务标准,确定了药店不足的服务圈,并制定了零售药店和医保定点药店的补充办法:2018年,上海共有零售药店3009家,平均每家药店服务居民6412人。全市被划分为 2188 个基本药物服务圈,每个服务圈的步行距离为 15 分钟。结果显示,有 1387 个服务圈没有任何药店,其中 151 个服务圈的人口超过 5000 人。此外,356 个服务圈有药店,但缺少医保定点药店。经过补充,计划在居民区增加 841 家零售药店。与之前相比,药店的覆盖面积和服务人口均有显著增加:本研究绘制了上海人口和零售药店的空间分布图,并设计了政府指导和补充方法,以优化零售药店的布局。研究结果为中低收入国家的政府机构改善零售药店的空间分布提供了有价值的启示。
{"title":"Research on government regulation methods for the spatial layout of retail pharmacies: practice in Shanghai, China.","authors":"Qian Wang, Ruiming Dai, Qianqian Yu, Tiantian Zhang","doi":"10.1186/s12939-024-02254-9","DOIUrl":"10.1186/s12939-024-02254-9","url":null,"abstract":"<p><strong>Background: </strong>In China, retail pharmacies are critical sources for obtaining medications and play a vital role in residents' daily access to drugs and treatment of common illnesses. Effectively guiding the placement of these pharmacies in areas of need through government regulation is crucial for enhancing medication access. In this study, we used population and retail pharmacy spatial distribution data from Shanghai to design guidance and supplementary methods for optimizing the spatial layout of retail pharmacies and medical insurance designated pharmacies based on regional characteristics.</p><p><strong>Methods: </strong>Population distribution, road traffic network, administrative division and retail pharmacy data from Shanghai in 2018 were collected from relevant government departments. ArcGIS 10.3 was used to map the retail pharmacies and population distribution. Based on the spatial distribution of population and the service standards of pharmacies, service circles with insufficient pharmacies were identified, and supplementary methods for retail pharmacies and medical insurance designated pharmacies were developed.</p><p><strong>Results: </strong>In 2018, Shanghai had 3009 retail pharmacies, each serving an average of 6412 residents. The city was divided into 2188 basic pharmaceutical service circles, each within a 15-minute walking distance. The results indicated that there were 1387 service circles without any pharmacies, 151 of which had populations exceeding 5000. Additionally, 356 service circles had pharmacies but lacked medical insurance designated ones. After supplementation, 841 retail pharmacies were planned to be added in residential areas. Compared with before, the coverage area and population served of the pharmacies increased significantly.</p><p><strong>Conclusions: </strong>This study mapped the spatial distribution of population and retail pharmacies in Shanghai, and designed government guidance and supplementary methods for optimizing the layout of retail pharmacies. The findings offer valuable insights for government agencies in low- and middle-income countries to improve the spatial distribution of retail pharmacies.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11351294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142080250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Access to community-based eye services in Meru, Kenya: a cross-sectional equity analysis. 肯尼亚梅鲁的社区眼科服务:横断面公平分析。
IF 4.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-08-26 DOI: 10.1186/s12939-024-02244-x
Luke N Allen, Sarah Karanja, Michael Gichangi, Cosmas Bunywera, Hillary Rono, David Macleod, Min Jung Kim, Malebogo Tlhajoane, Matthew J Burton, Jacqueline Ramke, Nigel M Bolster, Andrew Bastawrous

Background: Over 80% of blindness in Kenya is due to curable or preventable causes and 7.5 m Kenyans currently need eye services. Embedding sociodemographic data collection into screening programmes could help identify the groups facing systematic barriers to care. We aimed to determine the sociodemographic characteristics that were associated with access among patients diagnosed with an eye problem and referred for treatment in the Vision Impact Programme, currently operating in Meru County.

Method: We used an embedded, pragmatic, cross-sectional design. A list of sociodemographic questions was developed with input from key stakeholders. The final question set included the following domains: age, gender, religion, marital status, disability, education, occupation, income, housing, assets, and health insurance. These were integrated into an app that is used to screen, refer, and check-in (register) participants within a major eye screening programme. We gathered data from 4,240 people who screened positive and were referred to their local outreach treatment clinic. We used logistic regression to identify which groups were facing the greatest barriers to accessing care.

Results: A quarter of those screened between April - July 2023 were found to have an eye problem and were referred, however only 46% of these people were able to access care. In our fully adjusted model, at the 0.05 level there were no statistically significant differences in the odds of attendance within the domains of disability, health insurance, housing, income, or religion. Strong evidence (p < 0.001) was found of an association between access and age, gender, and occupation; with males, younger adults, and those working in sales, services and manual jobs the least likely to receive care.

Conclusions: Access to essential eye services is low and unequal in Meru, with less than a third of those aged 18-44 receiving the care they need. Future work should explore the specific barriers faced by this group.

背景:在肯尼亚,超过 80% 的失明是由于可治愈或可预防的原因造成的,目前有 750 万肯尼亚人需要眼科服务。将社会人口学数据收集纳入筛查计划有助于确定哪些群体在接受治疗时面临系统性障碍。我们的目的是确定与目前在梅鲁县开展的 "视觉影响计划 "中被诊断出有眼疾并转诊治疗的患者接受治疗有关的社会人口特征:我们采用了嵌入式、务实、横断面设计。在征求主要利益相关者的意见后,我们制定了一份社会人口学问题清单。最终的问题集包括以下方面:年龄、性别、宗教、婚姻状况、残疾、教育、职业、收入、住房、资产和医疗保险。这些问题被整合到一个应用程序中,该应用程序用于在一个大型眼科筛查项目中对参与者进行筛查、转介和签到(登记)。我们收集了 4240 名筛查结果呈阳性并被转诊到当地外展治疗诊所的患者的数据。我们使用逻辑回归法来确定哪些群体在接受治疗时面临最大的障碍:在 2023 年 4 月至 7 月期间接受筛查的人中,有四分之一被发现患有眼疾并被转诊,但其中只有 46% 的人能够获得治疗。在我们的完全调整模型中,在 0.05 的水平上,残疾、医疗保险、住房、收入或宗教等领域的就诊几率没有明显的统计学差异。有力证据(p 结论:在梅鲁,获得基本眼科服务的机会很少且不平等,18-44 岁的人群中只有不到三分之一的人获得了所需的护理。今后的工作应探讨这一群体面临的具体障碍。
{"title":"Access to community-based eye services in Meru, Kenya: a cross-sectional equity analysis.","authors":"Luke N Allen, Sarah Karanja, Michael Gichangi, Cosmas Bunywera, Hillary Rono, David Macleod, Min Jung Kim, Malebogo Tlhajoane, Matthew J Burton, Jacqueline Ramke, Nigel M Bolster, Andrew Bastawrous","doi":"10.1186/s12939-024-02244-x","DOIUrl":"10.1186/s12939-024-02244-x","url":null,"abstract":"<p><strong>Background: </strong>Over 80% of blindness in Kenya is due to curable or preventable causes and 7.5 m Kenyans currently need eye services. Embedding sociodemographic data collection into screening programmes could help identify the groups facing systematic barriers to care. We aimed to determine the sociodemographic characteristics that were associated with access among patients diagnosed with an eye problem and referred for treatment in the Vision Impact Programme, currently operating in Meru County.</p><p><strong>Method: </strong>We used an embedded, pragmatic, cross-sectional design. A list of sociodemographic questions was developed with input from key stakeholders. The final question set included the following domains: age, gender, religion, marital status, disability, education, occupation, income, housing, assets, and health insurance. These were integrated into an app that is used to screen, refer, and check-in (register) participants within a major eye screening programme. We gathered data from 4,240 people who screened positive and were referred to their local outreach treatment clinic. We used logistic regression to identify which groups were facing the greatest barriers to accessing care.</p><p><strong>Results: </strong>A quarter of those screened between April - July 2023 were found to have an eye problem and were referred, however only 46% of these people were able to access care. In our fully adjusted model, at the 0.05 level there were no statistically significant differences in the odds of attendance within the domains of disability, health insurance, housing, income, or religion. Strong evidence (p < 0.001) was found of an association between access and age, gender, and occupation; with males, younger adults, and those working in sales, services and manual jobs the least likely to receive care.</p><p><strong>Conclusions: </strong>Access to essential eye services is low and unequal in Meru, with less than a third of those aged 18-44 receiving the care they need. Future work should explore the specific barriers faced by this group.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11346173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142072712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Prevalence and factors associated with undocumented children under-five in Haiti. 海地五岁以下无证儿童的流行率和相关因素。
IF 4.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-08-26 DOI: 10.1186/s12939-024-02255-8
Bénédique Paul, David Jean Simon, Vénunyé Claude Kondo Tokpovi, Mickens Mathieu, Clavie Paul

Background: Despite many efforts to provide children with legal existence over the last decades, 1 in 4 children under the age of 5 (166 million) do not officially exist, with limited possibility to enjoy their human rights. In Latin America and the Caribbean, Haiti has one of the highest rates of undocumented births. This study aimed to analyze the prevalence and the determinant factors of undocumented childhood in Haiti.

Methods: For analysis of undocumented childhood and related socioeconomic determinants, data from the 2016/17 Haiti demographic and health survey were used. The prevalence and the associated factors were analyzed using descriptive statistics and the binary logistic regression model.

Results: The prevalence of undocumented childhood in Haiti was 23% (95% CI: 21.9-24.0) among children under-five. Among the drivers of undocumented births, mothers with no formal education (aOR = 3.88; 95% CI 2.21-6.81), children aged less than 1 year (aOR = 20.47; 95% CI 16.83-24.89), children adopted or in foster care (aOR = 2.66; 95% CI 1.67-4.24), children from the poorest regions like "Artibonite" (aOR = 2.19; 95% CI 1.63-2.94) or "Centre" (aOR = 1.51; 95% CI 1.09-2.10) or "Nord-Ouest" (aOR = 1.61; 95% CI 1.11-2.34), children from poorest households (aOR = 6.25; 95% CI 4.37-8.93), and children whose mothers were dead (aOR = 2.45; 95% CI 1.33-4.49) had higher odds to be undocumented.

Conclusion: According to our findings, there is an institutional necessity to bring birth documentation to underprivileged households, particularly those in the poorest regions where socioeconomic development programs are also needed. Interventions should focus on uneducated mothers who are reknown for giving birth outside of medical facilities. Therefore, an awareness campaign should be implemented to influence the children late-registering behavior.

背景:尽管在过去的几十年里为儿童的合法存在做出了许多努力,但每 4 个 5 岁以下的儿童中就有 1 个(1.66 亿)没有正式存在,享有人权的可能性有限。在拉丁美洲和加勒比地区,海地是无证生育率最高的国家之一。本研究旨在分析海地无证儿童的普遍程度和决定因素:为了分析无证儿童和相关的社会经济决定因素,使用了 2016/17 年海地人口与健康调查的数据。采用描述性统计和二元逻辑回归模型对流行率和相关因素进行了分析:海地五岁以下儿童的无证生育率为 23%(95% CI:21.9-24.0)。在无证生育的驱动因素中,未受过正规教育的母亲(aOR = 3.88;95% CI 2.21-6.81)、年龄小于 1 岁的儿童(aOR = 20.47;95% CI 16.83-24.89)、被收养或寄养的儿童(aOR = 2.66;95% CI 1.67-4.24)、来自 "阿蒂博尼特 "等最贫困地区的儿童(aOR = 2.19;95% CI 1.63-2.94)或 "中部"(aOR = 1.51;95% CI 1.09-2.10)或 "西北部"(aOR = 1.61;95% CI 1.11-2.34)、最贫困家庭(aOR = 6.25;95% CI 4.37-8.93)和母亲死亡(aOR = 2.45;95% CI 1.33-4.49)的儿童无证的几率更高:根据我们的研究结果,有必要从制度上为贫困家庭提供出生证明,尤其是那些需要社会经济发展计划的最贫困地区的家庭。干预措施应侧重于未受过教育的母亲,她们因在医疗设施外分娩而出名。因此,应开展宣传活动,以影响儿童延迟登记的行为。
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引用次数: 0
Skin diseases among the tribal population of Kerala: the challenges and way forward. 喀拉拉邦部落人口中的皮肤病:挑战与前进之路。
IF 4.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-08-26 DOI: 10.1186/s12939-024-02237-w
Surendran Maheswari Simi, Regi Jose, Thekkumkara Surendran Anish

Background: Kerala has a history of achievements in health through acting on the distal social determinants, but certain communities like tribals were pushed back from the stream of social development and health achievements. Subsequently, the lifestyle and the poor living conditions of tribes make them more prone to several diseases including skin diseases. However, neither the burden nor the situation of the same in the tribal population in several parts including Kerala is seldom assessed.

Main body: The lack of awareness about the symptoms, complications, and management options as a part of the social backwardness has led to the concentration of certain diseases like Leprosy among the tribal community. In addition, the tribal population is under the threat of infectious diseases of public health significance like Leishmaniasis (CL). The tribal population owing to ignorance neglects the skin lesions or uses their local remedies. Tribes might have been using many local remedies for their issues, but the emerging skin diseases may not be amenable to local remedies and often impose significant public health concerns. Developing and maintaining an effectively functioning health system in these difficult-to-reach terrains is also a challenge. The pattern of skin diseases among tribals residing in environmentally sensitive localities is an indicator for the need for more social, economic and geospatial inclusion. Skin lesions of the tribal population should be kept under active surveillance activities through the integrated health information platform (IHIP) and it should follow a vigilant public health response if there are clusterings. A dedicated evidence-based system should be developed to diagnose and treat skin diseases of tribal people residing away from the availability of specialist care using local resources and community-level workers.

Conclusion: The rampant skin diseases among tribals are the product of their unacceptable socio-economic status and living conditions. It could only improve through interventions focusing on social determinants of health. Improvements in the living conditions of tribals are sustainable long-term solutions, but such solutions should be coupled with medium-term and short-term strategies.

背景:喀拉拉邦通过对远端社会决定因素采取行动,在健康方面取得了一定的成就,但某些社区(如部落)却被排斥在社会发展和健康成就之外。因此,部落的生活方式和恶劣的生活条件使他们更容易患上包括皮肤病在内的多种疾病。然而,包括喀拉拉邦在内的一些地区很少对部落人口的皮肤病负担和状况进行评估:主体:由于社会落后,人们对麻风病的症状、并发症和治疗方法缺乏了解,导致麻风病等疾病在部落群体中集中流行。此外,部落人口还受到利什曼病(CL)等具有公共卫生意义的传染病的威胁。由于无知,部落居民忽视了皮肤病的治疗,或使用当地的治疗方法。部落可能一直在使用许多本地疗法来解决他们的问题,但新出现的皮肤病可能不适合使用本地疗法,而且往往会造成严重的公共卫生问题。在这些难以进入的地区发展和维持一个有效运作的卫生系统也是一项挑战。居住在环境敏感地区的部落的皮肤病模式表明,需要更多的社会、经济和地理空间包容。应通过综合卫生信息平台(IHIP)对部落人口的皮肤病进行积极监测,如果出现聚集性皮肤病,应采取警惕的公共卫生应对措施。应建立一个专门的循证系统,利用当地资源和社区工作人员,诊断和治疗居住在远离专科医疗机构的部落居民的皮肤病:结论:部落居民皮肤病肆虐是其社会经济地位和生活条件令人难以接受的产物。只有通过对健康的社会决定因素进行干预,才能改善这种状况。改善部落居民的生活条件是可持续的长期解决方案,但这种解决方案应与中短期战略相结合。
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引用次数: 0
Exploring health equity integration among health service and delivery systems in Nova Scotia: perspectives of health system partners. 探索新斯科舍省卫生服务和提供系统之间的卫生公平整合:卫生系统合作伙伴的观点。
IF 4.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-08-26 DOI: 10.1186/s12939-024-02256-7
Joshua Yusuf, Ninoshka J D'Souza, Hilary A T Caldwell, Sarah Meaghan Sim, Mark Embrett, Sara F L Kirk

Background: Achieving health equity is important to improve population health; however, health equity is not typically well defined, integrated, or measured within health service and delivery systems. To improve population health, it is necessary to understand barriers and facilitators to health equity integration within health service and delivery systems. This study aimed to explore health equity integration among health systems workers and identify key barriers and facilitators to implementing health equity strategies within the health service and delivery system in Nova Scotia, ahead of the release of a Health Equity Framework, focused on addressing inequities within publicly funded institutions.

Methods: Purposive sampling was used to recruit individuals working on health equity initiatives including those in high-level leadership positions within the Nova Scotia health system. Individual interviews and a joint interview session were conducted. Topics of discussion included current integration of health equity through existing strategies and perceptions within participant roles. The Consolidated Framework for Implementation Research (CFIR) was used to guide coding and analysis, with interviews transcribed and deductively analyzed in NVivo. Qualitative description was employed to describe study findings as barriers and facilitators to health equity integration.

Results: Eleven individual interviews and one joint interview (n = 5 participants) were conducted, a total of 16 participants. Half (n = 8) of the participants were High-level Leaders (i.e., manager or higher) within the health system. We found that existing strategies within the health system were inadequate to address inequities, and variation in the use of indicators of health equity was indicative of a lack of health equity integration. Applying the CFIR allowed us to identify barriers to and facilitators of health equity integration, with the power of legislation to implement a Health Equity Framework, alongside the value of partnerships and engagement both being seen as key facilitators to support health equity integration. Barriers to health equity integration included inadequate resources devoted to health equity work, a lack of diversity among senior system leaders and concerns that existing efforts to integrate health equity were siloed.

Conclusion: Our findings suggest that health equity integration needs to be prioritized within the health service and delivery system within Nova Scotia and identifies possible strategies for implementation. Appropriate measures, resources and partnerships need to be put in place to support health equity integration following the introduction of the Health Equity Framework, which was viewed as a key driver for action. Greater diversity within health system leadership was also identified as an important strategy to support integration. Our findings have im

背景:实现健康公平对改善人口健康非常重要;然而,健康公平通常没有在医疗服务和交付系统中得到很好的定义、整合或衡量。为了改善人口健康,有必要了解在医疗服务和交付系统中整合健康公平的障碍和促进因素。本研究旨在探讨卫生系统工作人员之间的卫生公平整合问题,并确定在新斯科舍省卫生服务和提供系统内实施卫生公平战略的主要障碍和促进因素,在卫生公平框架发布之前,重点解决公共资助机构内的不公平问题:方法:采用有目的的抽样调查,招募从事健康公平倡议工作的人员,包括在新斯科舍省卫生系统中担任高级领导职务的人员。进行了个别访谈和联合访谈。讨论的主题包括目前通过现有战略整合健康公平的情况以及参与者角色的看法。实施研究综合框架(CFIR)用于指导编码和分析,访谈内容在 NVivo 中进行转录和演绎分析。研究采用定性描述的方法,将研究结果描述为健康公平整合的障碍和促进因素:共进行了 11 次个别访谈和 1 次联合访谈(n = 5 名参与者),共有 16 名参与者。半数参与者(n = 8)是卫生系统中的高层领导(即经理或以上级别)。我们发现,医疗系统内的现有策略不足以解决不公平问题,而在使用健康公平指标方面的差异表明缺乏健康公平整合。通过应用 "健康公平框架",我们确定了实现健康公平整合的障碍和促进因素,其中,实施 "健康公平框架 "的立法权以及伙伴关系和参与的价值都被视为支持健康公平整合的关键促进因素。健康公平整合的障碍包括用于健康公平工作的资源不足,系统高层领导缺乏多样性,以及对现有健康公平整合工作各自为政的担忧:我们的研究结果表明,需要在新斯科舍省的医疗服务和提供系统中优先考虑健康公平整合问题,并确定了可能的实施策略。在引入 "健康公平框架"(Health Equity Framework)之后,需要采取适当的措施、资源和合作关系来支持健康公平整合,该框架被视为行动的关键驱动力。卫生系统领导层的更大多样性也被认为是支持整合的一项重要战略。我们的研究结果对其他寻求在医疗服务和提供系统中推进健康公平的辖区具有借鉴意义。
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引用次数: 0
A scoping review of costing methodologies used to assess interventions for underserved pregnant people and new parents. 对用于评估针对服务不足的孕妇和新生儿父母的干预措施的成本计算方法进行范围界定审查。
IF 4.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-08-22 DOI: 10.1186/s12939-024-02252-x
Elizabeth K Darling, Aisha Jansen, Bismah Jameel, Jean-Éric Tarride

Background: Lack of evidence about the long-term economic benefits of interventions targeting underserved perinatal populations can hamper decision making regarding funding. To optimize the quality of future research, we examined what methods and costs have been used to assess the value of interventions targeting pregnant people and/or new parents who have poor access to healthcare.

Methods: We conducted a scoping review using methods described by Arksey and O'Malley. We conducted systematic searches in eight databases and web-searches for grey literature. Two researchers independently screened results to determine eligibility for inclusion. We included economic evaluations and cost analyses of interventions targeting pregnant people and/or new parents from underserved populations in twenty high income countries. We extracted and tabulated data from included publications regarding the study setting, population, intervention, study methods, types of costs included, and data sources for costs.

Results: Final searches were completed in May 2024. We identified 103 eligible publications describing a range of interventions, most commonly home visiting programs (n = 19), smoking cessation interventions (n = 19), prenatal care (n = 11), perinatal mental health interventions (n = 11), and substance use treatment (n = 10), serving 36 distinct underserved populations. A quarter of the publications (n = 25) reported cost analyses only, while 77 were economic evaluations. Most publications (n = 82) considered health care costs, 45 considered other societal costs, and 14 considered only program costs. Only a third (n = 36) of the 103 included studies considered long-term costs that occurred more than one year after the birth (for interventions occurring only in pregnancy) or after the end of the intervention.

Conclusions: A broad range of interventions targeting pregnant people and/or new parents from underserved populations have the potential to reduce health inequities in their offspring. Economic evaluations of such interventions are often at risk of underestimating the long-term benefits of these interventions because they do not consider downstream societal costs. Our consolidated list of downstream and long-term costs from existing research can inform future economic analyses of interventions targeting poorly served pregnant people and new parents. Comprehensively quantifying the downstream and long-term benefits of such interventions is needed to inform decision making that will improve health equity.

背景:缺乏针对服务不足的围产期人群的干预措施所带来的长期经济效益的证据,会阻碍有关资金的决策。为了优化未来研究的质量,我们研究了采用哪些方法和成本来评估针对医疗条件较差的孕妇和/或新生儿父母的干预措施的价值:我们采用 Arksey 和 O'Malley 所描述的方法进行了一次范围界定审查。我们在八个数据库中进行了系统搜索,并在网上搜索了灰色文献。两名研究人员对结果进行独立筛选,以确定是否符合纳入条件。我们纳入了针对 20 个高收入国家服务不足人群中的孕妇和/或新生儿父母的干预措施的经济评估和成本分析。我们从收录的出版物中提取了有关研究环境、人群、干预措施、研究方法、收录的成本类型以及成本数据来源的数据并制成表格:最终检索于 2024 年 5 月完成。我们确定了 103 篇符合条件的出版物,这些出版物介绍了一系列干预措施,其中最常见的是家访计划(n = 19)、戒烟干预措施(n = 19)、产前护理(n = 11)、围产期心理健康干预措施(n = 11)和药物使用治疗(n = 10),服务于 36 个不同的服务不足人群。四分之一的出版物(n = 25)仅报告了成本分析,77 份为经济评估。大多数出版物(n = 82)考虑了医疗成本,45 份考虑了其他社会成本,14 份仅考虑了项目成本。在 103 项纳入的研究中,只有三分之一(n = 36)考虑了产后一年以上(仅针对孕期干预)或干预结束后的长期成本:针对来自服务不足人群的孕妇和/或新生儿父母的各种干预措施都有可能减少其后代的健康不平等现象。对此类干预措施的经济评估往往有可能低估这些干预措施的长期效益,因为它们没有考虑下游社会成本。我们从现有研究中整理出的下游成本和长期成本清单,可以为未来针对服务不佳的孕妇和新生儿父母的干预措施进行经济分析提供参考。需要全面量化这些干预措施的下游和长期效益,以便为决策提供信息,从而提高健康公平性。
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International Journal for Equity in Health
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