The impact of cash transfers on social determinants of health and health inequalities in sub-Saharan Africa: a systematic review

BACKGROUND Caregivers provide crucial support to older adults so they can remain safely in their homes as they age. Over time, caregivers’ own health can be negatively impacted by their caregiving role. The social determinants of health, such as gender and socioeconomic status, can influence assuming a caregiving role as well as the impacts of caregiving on the caregiver. While programs exist to support caregivers, uptake of these services does not match the need for services expressed by caregivers. Research suggests that supportive interventions offered via mobile health technologies have the potential to increase caregiver accessibility of supportive services. However, a knowledge gap exists regarding the extent to which the social determinants of health are considered in the design, implementation, and evaluation of mobile health (mHealth) interventions intended to support caregivers of older adults. Furthermore, a comprehensive review of the impact of mHealth interventions in this population does not exist. OBJECTIVE To conduct a systematic review to: (1) determine how health inequities are considered in the design, implementation, and evaluation of mHealth interventions for caregivers of older adults using Cochrane-Equity's PROGRESS-Plus framework; and (2) synthesize evidence of the impacts of caregiver-focused mHealth interventions. METHODS A systematic review was conducted in five databases and articles published between January 2010 and June 2021 were included if they evaluated or explored the impacts of mHealth interventions on the health and wellbeing of informal caregivers of older adults. mHealth interventions were defined as those that caregivers of older adults accessed via mobile or wireless devices. RESULTS A total of 28 articles met the inclusion criteria and were included in the systematic review. The interventions evaluated by the included studies sought to help caregivers make connections with services, facilitate the caregiving process, and promote the caregivers’ health and wellbeing. The PROGRESS-Plus framework factors were mainly considered in the results, discussion, and limitations sections of included studies. Some PROGRESS-Plus factors such as sexual orientation, religion and occupation, received little to no consideration in all phases of intervention design, implementation, or evaluation. Overall, findings of this review suggest that mHealth interventions were positively received by users. Such interventions may have the potential to reduce caregiver burden and positively impact caregivers’ physical and mental health while supporting them in their caregiving role. Study findings highlight the importance of available supports to help facilitate caregivers’ use of mHealth interventions particularly early on as well as the use of appropriate language and text. CONCLUSIONS Successful uptake and spread of mHealth interventions to support caregivers of older adults will depend on creating opportunities for inclusive involvement of a broad range of stakeholders at all stages of design, implementation, and assessment. CLINICALTRIAL PROSPERO CRD42021239584; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=239584

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Pro-equity legislation, health policy and utilisation of sexual and reproductive health services by vulnerable populations in sub-Saharan Africa: a systematic review

Global Health Promotion ◽

10.1177/1757975920941435 ◽

2020 ◽

Vol 27 (4) ◽

pp. 97-106

Author(s):

Muriel Mac-Seing ◽

Kate Zinszer ◽

Charity Oga Omenka ◽

Pierre de Beaudrap ◽

Fereshteh Mehrabi ◽

...

Keyword(s):

Systematic Review ◽

Reproductive Health ◽

Health Service ◽

Social Determinants Of Health ◽

Vulnerable Populations ◽

Social Determinants ◽

Sexual And Reproductive Health ◽

Sub Saharan Africa ◽

Service Utilisation ◽

Sub Saharan

Twenty-five years ago, the International Conference on Population and Development highlighted the need to address sexual and reproductive health (SRH) rights on a global scale. The sub-Saharan Africa region continues to have the highest levels of maternal mortality and HIV, primarily affecting the most vulnerable populations. Recognising the critical role of policy in understanding population health, we conducted a systematic review of original primary research which examined the relationships between equity-focused legislation and policy and the utilisation of SRH services by vulnerable populations in sub-Saharan Africa. We searched nine bibliographic databases for relevant articles published between 1994 and 2019. Thirty-two studies, conducted in 14 sub-Saharan African countries, met the inclusion criteria. They focused on maternal health service utilisation, either through specific fee reduction/removal policies, or through healthcare reforms and insurance schemes to increase SRH service utilisation. Findings across most of the studies showed that health-related legislation and policy promoted an increase in service utilisation, over time, especially for antenatal care, skilled birth attendance and facility-based delivery. However, social health inequalities persisted among subgroups of women. Neither the reviewed studies nor the policies specifically addressed youth, people living with HIV and people with disabilities. In the era of the sustainable development goals, addressing health inequities in the context of social determinants of health becomes unavoidable. Systematic and rigorous quantitative and qualitative research, including longitudinal policy evaluation, is required to understand the complex relationships between policy addressing upstream social determinants of health and health service utilisation.

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Addressing Social Determinants of Health and Health Inequalities

JAMA ◽

10.1001/jama.2016.14058 ◽

2016 ◽

Vol 316 (16) ◽

pp. 1641 ◽

Cited By ~ 87

Author(s):

Nancy E. Adler ◽

M. Maria Glymour ◽

Jonathan Fielding

Keyword(s):

Social Determinants Of Health ◽

Health Inequalities ◽

Social Determinants ◽

Determinants Of Health ◽

Health And Health Inequalities

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Impact and variability of social determinants of health on the transmission and outcomes of COVID-19 across the world: a systematic review protocol

BMJ Open ◽

10.1136/bmjopen-2021-053481 ◽

2021 ◽

Vol 11 (12) ◽

pp. e053481

Author(s):

Minhazul Abedin ◽

Abrar Wahab ◽

Farah Naz Rahman ◽

Fardina Rahman Omi ◽

Saadia Shareen ◽

...

Keyword(s):

Systematic Review ◽

Social Determinants Of Health ◽

Social Determinants ◽

Observational Studies ◽

Meta Analysis ◽

Geographical Location ◽

Determinants Of Health ◽

Wide Range ◽

Meta Analyses ◽

The Impact

IntroductionThe COVID-19 pandemic has exacerbated health inequalities across the globe, disproportionately affecting those with poor social determinants of health (SDOHs). It is imperative to understand how SDOH influences the transmission and outcomes (positive case, hospitalisation and mortality) of COVID-19. This systematic review will investigate the impact of a wide range of SDOHs across the globe on the transmission and outcomes of COVID-19.Methods and analysisThis review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol guidelines. We will search three electronic bibliographical databases (MEDLINE via PubMed, Embase and Scopus), as well as the WHO COVID-19 Global Research on Coronavirus Disease database. We will consider observational studies that report statistical relationships between the SDOHs (as listed in PROGRESS-Plus and Healthy People 2020) and COVID-19 transmission and outcomes. There will be no limitation on the geographical location of publications. The quality of included observational studies will be assessed using a modified version of the Newcastle-Ottawa Scale. A narrative synthesis without meta-analysis reporting standards will be used to report the review findings.Ethics and disseminationThis review will be based on published studies obtained from publicly available sources, and therefore, ethical approval is not required. We will publish the results of this review in a peer-reviewed journal, as well as present the study findings at a national conference.PROSPERO registration numberCRD42021228818.

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