scholarly journals Experiences of seeking healthcare across the border: lessons to inform upstream policies and system developments on cross-border health in East Africa

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e045575
Author(s):  
Freddie Ssengooba ◽  
Doreen Tuhebwe ◽  
Steven Ssendagire ◽  
Susan Babirye ◽  
Martha Akulume ◽  
...  
Keyword(s):  
Linear Regression ◽  
East Africa ◽  
Quantitative Methods ◽  
Healthcare Access ◽  
Hiv Treatment ◽  
Border Crossing ◽  
Health Access ◽  
Health Coverage ◽  
Access Barriers ◽  
Cross Sectional

ObjectivesThis study explored the experiences of accessing care across the border in East Africa.ParticipantsFrom February to June 2018, a cross-sectional study using qualitative and quantitative methods was conducted among 279 household adults residing along selected national border sites of Uganda, Kenya and Rwanda and had accessed care from the opposite side of the border 5 years prior to this study.SettingAccess to HIV treatment, maternal delivery and childhood immunisation services was explored. We applied the health access framework and an appreciative inquiry approach to identify factors that enabled access to the services.MeasuresExploratory factor analysis and linear regression were used for quantitative data, while deductive content analysis was done for the qualitative data on respondent’s experiences navigating health access barriers.ResultsThe majority of respondents (83.9%; 234/279) had accessed care from public health facilities. Nearly one-third (77/279) had sought care across the border more than a year ago and 22.9% (64/279) less than a month ago. From the linear regression, the main predictor for ease of access for healthcare were ‘‘ease of border crossing’ (regression coefficient (RegCoef) 0.381); ‘services being free’ (RegCoef 0.478); ‘services and medicines availability’ (RegCoef 0.274) and ‘acceptable quality of services’ (RegCoef 0.364). The key facilitators for successful navigation of access barriers were related to the presence of informal routes, speaking a similar language and the ability to pay for the services.ConclusionCommunities resident near national borders were able to cross borders to seek healthcare. There is need for a policy environment to enable East Africa invest better and realise synergies for these communities. This will advance Universal Health Coverage goals for communities along the border who represent the far fang areas of the health system with multiple barriers to healthcare access.

scholarly journals Inequity of healthcare access and use and catastrophic health spending in slum communities: a retrospective, cross-sectional survey in four countries

2021 ◽  
Vol 6 (11) ◽  
pp. e007265
Author(s):  
Keyword(s):  
Health Expenditure ◽  
Healthcare Access ◽  
Health Spending ◽  
Catastrophic Health Expenditure ◽  
Small Scale ◽  
Health Coverage ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Gini Coefficients ◽  
Country Level

IntroductionTracking the progress of universal health coverage (UHC) is typically at a country level. However, country-averages may mask significant small-scale variation in indicators of access and use, which would have important implications for policy choice to achieve UHC.MethodsWe conducted a retrospective cross-sectional household and individual-level survey in seven slum sites across Nigeria, Kenya, Bangladesh and Pakistan. We estimated the adjusted association between household capacity to pay and report healthcare need, use and spending. Catastrophic health expenditure was estimated by five different methods.ResultsWe surveyed 7002 households and 6856 adults. Gini coefficients were wide, ranging from 0.32 to 0.48 across the seven sites. The total spend of the top 10% of households was 4–47 times more per month than the bottom 10%. Households with the highest budgets were: more likely to report needing care (highest vs lowest third of distribution of budgets: +1 to +31 percentage points (pp) across sites), to spend more on healthcare (2.0 to 6.4 times higher), have more inpatient and outpatient visits per year in five sites (1.0 to 3.0 times more frequently), spend more on drugs per visit (1.1 to 2.2 times higher) and were more likely to consult with a doctor (1.0 to 2.4 times higher odds). Better-off households were generally more likely to experience catastrophic health expenditure when calculated according to four methods (−1 to +12 pp), but much less likely using a normative method (−60 to −80 pp).ConclusionsSlums have a very high degree of inequality of household budget that translates into inequities in the access to and use of healthcare. Evaluation of UHC and healthcare access interventions targeting these areas should consider distributional effects, although the standard measures may be unreliable.

Charging of overseas visitors within England and achieving Universal Health Coverage: A cross sectional analysis of a freedom of information request of NHS trusts in England

2019 ◽  
Author(s):  
Joanna Dobbin ◽  
Adrienne Milner ◽  
Alexander Dobbin ◽  
Jessica Potter
Keyword(s):  
Health Care ◽  
Linear Regression ◽  
Reproductive Age ◽  
Freedom Of Information ◽  
Health Coverage ◽  
Cross Sectional ◽  
Information Request ◽  
Cost Of Health Care ◽  
The Cost ◽  
Universal Health

Abstract Background Not everybody living in or visiting the UK is eligible for free NHS care. Individuals from outside the European Economic Area who have not paid the immigration surcharge are chargeable for NHS care at 150% of cost. In 2017, new regulations introduced upfront charging for non-urgent care. Following this, reports of individuals being denied treatment – in particular British people from the Windrush generation appeared. This research provides the first large scale dataset examining the demographics of those charged. Methods A freedom of information request was sent to 135 acute non-specialist NHS trusts in England to create a database of non-EEA overseas visitors charges from 2016/17 and 2017/18. This cross sectional survey was analysed using multiple linear regression to explore the relationship between sex, age, nationality, ethnicity, urgency and the cost of health care. Results Of 135 acute non-specialist trusts in England 64 replied, providing a data set of 13,484 patients. Women were found to be invoiced higher amounts than men (p=0.002). Patients were more likely to be women (63% vs. 37% men), and within this group, almost half of patients were of reproductive age, with 47.9% (3165) aged 16 to 40 years old. Multiple linear regression by age group showed that age is significantly related to the cost of health care with patients over 65 paying more than those aged 16-40, and 41-64 (p=0.011), and children under 16 paying less (p<0.001). The urgency of treatment was significantly related to cost, with the most urgent (immediantly necessary) treatment costing the most (p<0.001). Conclusions The demographics of those charged as overseas visitors alligns with the pattern of estimated costs of care for NHS care overall, where women of reproductive age and older patients require a higher amount of medical care. This research reflects current concerns of migrants being left behind in the strive towards universal health coverage which should be based upon quality, equality, and financial protection for patients. A key limitation was the low response rate.. The limitation of missing data has meant that questions surrounding possible charging discrimination of ethnic grounds cannot be answered.

scholarly journals A cross-sectional analysis of the relationship between diabetes and health access barriers in an urban First Nations population in Canada

BMJ Open ◽  
2018 ◽  
Vol 8 (1) ◽  
pp. e018272 ◽  
Author(s):  
Michael Beckett ◽  
Michelle A Firestone ◽  
Constance D McKnight ◽  
Janet Smylie ◽  
Michael A Rotondi
Keyword(s):  
First Nations ◽  
Health Access ◽  
Access Barriers ◽  
Cross Sectional ◽  
Cross Sectional Analysis ◽  
Sectional Analysis ◽  
The Relationship

scholarly journals Impact of healthcare access and HIV testing on utilisation of cervical cancer screening among US women at high risk of HIV infection: cross-sectional analysis of 2016 BRFSS data

BMJ Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. e031823 ◽  
Author(s):  
Dongyu Zhang ◽  
Shailesh Advani ◽  
Megan Huchko ◽  
Dejana Braithwaite
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
High Risk ◽  
Hiv Infection ◽  
Hiv Testing ◽  
Cervical Cancer Screening ◽  
Healthcare Access ◽  
Health Coverage ◽  
Cross Sectional ◽  
History Of

ObjectivePrevious studies identified several factors associated with cervical cancer screening. However, many of them used samples from the general population and limited studies focused on women with high-risk health behaviours. We aimed to disentangle the association of cervical cancer screening with healthcare access and HIV testing among women at a high risk of HIV infection.DesignNationwide cross-sectional survey in the USA.Setting2016 Behavioral Risk Factor Surveillance System.Participants3448 women with a history of high-risk behaviours associated with HIV infectionExposure and outcomeClinical check-up, having personal healthcare provider, health coverage and HIV testing history were treated as exposures. Appropriate cervical cancer screening, which was defined according to 2016 US Preventive Services Task Force guideline, was treated as the outcome of interest.Data analysisMultivariable logistic regression model was performed to evaluate associations of healthcare access and HIV testing with the uptake of cervical cancer screening; adjusted odds ratio (aOR) and 95% CI were reported. We further investigated if educational attainment modified associations identified in the primary multivariable model.ResultsA total of 2911 (84.4%) high-risk women in our sample underwent cervical cancer screening. In the multivariable model, delayed clinical check-up (≥5 years ago vs within the past year: aOR: 0.19, 95% CI: 0.14 to 0.26), having no health insurance (aOR: 0.60, 95% CI: 0.46 to 0.79) and no history of HIV testing (no testing vs testing within the past year: aOR: 0.46, 95% CI: 0.35 to 0.61) were inversely associated with cervical cancer screening utilisation.ConclusionFactors reflecting healthcare access, specifically clinical check-up and health coverage, as well as history of HIV testing were associated with cervical cancer screening in this population-based study of high-risk women. Targeted interventions are warranted to further increase cervical cancer screening among women at high risk of HIV infection.

scholarly journals A Cross Sectional Survey of Factors Influencing Healthcare Access in Older Women of South India

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 836-836
Author(s):  
Sreejith Sudhakar ◽  
Justin Jose ◽  
Shanuga Cherayi
Keyword(s):  
Older Women ◽  
Healthcare Access ◽  
Treatment Seeking ◽  
Access Barriers ◽  
Cross Sectional Survey ◽  
Self Medication ◽  
Cross Sectional ◽  
Factors Influencing ◽  
Long Duration

Abstract We examined the determinants of healthcare access barriers, treatment-seeking, and self-medication in older women aged 60 years and more, using a cross-sectional survey design. Using a structured interview format, we interviewed 1005 older women from 7 out of 14 districts in the state through a stratified random sampling procedure. Multiple linear regression analysis results reveal that older women's healthcare access barriers significantly increased when they experienced a long duration of multimorbidity alongside poor recognition of autonomy and basic amenities available at health facilities. However, confidentiality, the ability to pay for healthcare expenditure, and the type of health care significantly improved healthcare access. In factors influencing older women's delay in treatment-seeking, optimal instrumental functionality in daily living, optimal quality of life and access to healthcare services significantly reduced delay in treatment initiation. Whereas poor health-seeking behaviors, long duration of multimorbidity, and the quality of basic amenities at hospitals significantly increased treatment initiation delay and explained 13.6% of the variance. In factors influencing older women's use of self-medication, advancing age, living in rural areas, optimal functionality, perception of providers' respect for confidentiality were associated with increased self-medication frequency. Whereas, better wealth status, prompt attention to older women's health needs, and basic amenities at hospitals significantly reduced their self-medication practice. Therefore, the optimal functional abilities, fewer morbidities, and optimal health system responsiveness significantly reduce healthcare access barriers and self-medication while improving older women's treatment-seeking behaviors.

Faktor Predisposisi Dan Pemungkin Perilaku Penggunaan Kondom Padapelanggan WPS Di Semampir Kediri

1970 ◽  
Vol 5 (1) ◽  
pp. 09
Author(s):  
Shinta Kristianti
Keyword(s):  
Sexual Behavior ◽  
Condom Use ◽  
Risky Sexual Behavior ◽  
Sex Workers ◽  
Quantitative Methods ◽  
Group Discussion ◽  
Chi Square ◽  
Cross Sectional ◽  
Influential Variable ◽  
Use Behavior

Transmission of HIV-AIDS in Indonesia is growing fast, one of the triggers are due to risky sexual behavior, including sexual behavior in FSW’s clients. This study aimed to analyze the factors that influence the behavior of condom use on the FSW’s clients in Semampir Kediri. This study used quantitative methods to the design of explanatory research with cross sectional approach. A triangulation of qualitative data used to support the results of quantitative analysis were excavated from WPS and pimps as a cross check answers FSW’s clients, the means used was to in-depth interviews and FGDs (Focus Group Discussion) on the FSW and pimps. Sample size was 66 people. Univariate data analysis, with chi-square bivariate and multivariate logistic regression. Results showed most respondents (71.2%) behave consistent in using condoms.Variables related to condom use behavior in FSW were knowledge, perception of vulnerability, severity perceived, benefits perceived, barriers perceived and perceived ability to self (self-efficacy), the availability of condoms, condom regulation, support of friends and support of FSW. Support of friend was the most influential variable on the practice of using condoms to FSW’s clients and the OR value was 19.218.; Key words: female sex workers (FSW), FSW’s clients, condom, consistent 

Doctor Retention in Ireland - What it may mean for the Global Health Workforce Reform Agenda Comment on "Doctor Retention: A Cross-sectional Study of How Ireland Has Been Losing the Battle"

2020 ◽  
Author(s):  
Bernard Hope Taderera
Keyword(s):  
Global Health ◽  
Health Workforce ◽  
Cross Sectional Study ◽  
Early Career ◽  
Healthcare Personnel ◽  
Health Coverage ◽  
Cross Sectional ◽  
Middle Income ◽  
Reform Agenda ◽  
Medical Graduates

The study of healthcare personnel migration in Ireland reports that most medical graduates plan to leave the country’s health system. It may be possible to address this challenge by understanding and addressing the reasons why young doctors plan to leave. Future studies should contribute to the retention of early career doctors in highincome countries such as Ireland. This will help reduce the migration of doctors from low- and middle-income countries in order to address the global health workforce crisis and its impact on the attainment of universal health coverage in all health systems.

Folate Nutritional Status among Psoriasis Patients not Exposed to Antifolate Drug

2020 ◽  
Vol 16 (4) ◽  
pp. 543-553
Author(s):  
Luciana Y. Tomita ◽  
Andréia C. da Costa ◽  
Solange Andreoni ◽  
Luiza K.M. Oyafuso ◽  
Vânia D’Almeida ◽  
...  
Keyword(s):  
Folic Acid ◽  
Linear Regression ◽  
Multiple Linear Regression Model ◽  
Folate Intake ◽  
Serum Folate ◽  
Linear Regression Models ◽  
Cross Sectional ◽  
Folic Acid Fortification ◽  
Plasma Folate ◽  
Psoriasis Severity

Background: Folic acid fortification program has been established to prevent tube defects. However, concern has been raised among patients using anti-folate drug, i.e. psoriatic patients, a common, chronic, autoimmune inflammatory skin disease associated with obesity and smoking. Objective: To investigate dietary and circulating folate, vitamin B12 (B12) and homocysteine (hcy) in psoriatic subjects exposed to the national mandatory folic acid fortification program. Methods: Cross-sectional study using the Food Frequency Questionnaire, plasma folate, B12, hcy and psoriasis severity using the Psoriasis Area and Severity Index score. Median, interquartile ranges (IQRs) and linear regression models were conducted to investigate factors associated with plasma folate, B12 and hcy. Results: 82 (73%) mild psoriasis, 18 (16%) moderate and 12 (11%) severe psoriasis. 58% female, 61% non-white, 31% former smokers, and 20% current smokers. Median (IQRs) were 51 (40, 60) years. Only 32% reached the Estimated Average Requirement of folate intake. Folate and B12 deficiencies were observed in 9% and 6% of the blood sample respectively, but hyperhomocysteinaemia in 21%. Severity of psoriasis was negatively correlated with folate and B12 concentrations. In a multiple linear regression model, folate intake contributed positively to 14% of serum folate, and negative predictors were psoriasis severity, smoking habits and saturated fatty acid explaining 29% of circulating folate. Conclusion: Only one third reached dietary intake of folate, but deficiencies of folate and B12 were low. Psoriasis severity was negatively correlated with circulating folate and B12. Stopping smoking and a folate rich diet may be important targets for managing psoriasis.

scholarly journals Assessment of serum macrophage migration inhibitory factor (MIF), adiponectin, and other adipokines as potential markers of proteinuria and renal dysfunction in lupus nephritis: a cross-sectional study

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Jorge Ivan Gamez-Nava ◽  
Valeria Diaz-Rizo ◽  
Edsaul Emilio Perez-Guerrero ◽  
Jose Francisco Muñoz-Valle ◽  
Ana Miriam Saldaña-Cruz ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Linear Regression ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Macrophage Migration Inhibitory Factor ◽  
Cross Sectional Study ◽  
Macrophage Migration ◽  
Sectional Study ◽  
Systemic Lupus ◽  
Cross Sectional

Abstract Background To date, the association of serum macrophage migration inhibitory factor (MIF) and serum adipokines with lupus nephritis is controversial. Objective To assess the utility of serum MIF, leptin, adiponectin and resistin levels as markers of proteinuria and renal dysfunction in lupus nephritis. Methods Cross-sectional study including 196 systemic lupus erythematosus (SLE) patients and 52 healthy controls (HCs). Disease activity was assessed by Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). Renal SLE involvement was investigated by renal-SLEDAI. MIF, adiponectin, leptin and resistin levels were quantified by ELISA. We assessed the correlations of quantitative variables by Spearman correlation (rs). Multivariable linear regression adjusted the variables associated with the severity of proteinuria. Results SLE patients had higher MIF (p = 0.02) and adiponectin (p < 0.001) than HCs. Patients with renal SLE involvement (n = 43) had higher adiponectin (19.0 vs 13.3 μg/mL, p = 0.002) and resistin (10.7 vs 8.9 ng/mL, p = 0.01) than patients with non-renal SLE (n = 153). Proteinuria correlated with high adiponectin (rs = 0.19, p < 0.009) and resistin (rs = 0.26, p < 0.001). MIF (rs = 0.27, p = 0.04). Resistin correlated with increased creatinine (rs = 0.18, p = 0.02). High renal-SLEDAI correlated with adiponectin (rs = 0.21, p = 0.004). Multiple linear regression showed that elevated adiponectin (p = 0.02), younger age (p = 0.04) and low MIF (p = 0.02) were associated with the severity of proteinuria. Low MIF and high adiponectin levels interacted to explain the association with the severity of proteinuria (R2 = 0.41). Conclusions High adiponectin combined with low MIF concentrations int+eract to explain the severity of proteinuria in renal SLE. These findings highlight the relevance of adiponectin, resistin and MIF as markers of LN.

scholarly journals Association between triglyceride-glucose index and risk of arterial stiffness: a cohort study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Shouling Wu ◽  
Luli Xu ◽  
Mingyang Wu ◽  
Shuohua Chen ◽  
Youjie Wang ◽  
...  
Keyword(s):  
Growth Rate ◽  
Linear Regression ◽  
Arterial Stiffness ◽  
Multivariate Linear Regression ◽  
Annual Growth ◽  
Annual Growth Rate ◽  
Cross Sectional ◽  
Tyg Index ◽  
Longitudinal Association ◽  
The Cross

Abstract Background Triglyceride–glucose (TyG) index, a simple surrogate marker of insulin resistance, has been reported to be associated with arterial stiffness. However, previous studies were limited by the cross-sectional design. The purpose of this study was to explore the longitudinal association between TyG index and progression of arterial stiffness. Methods A total of 6028 participants were derived from the Kailuan study. TyG index was calculated as ln [fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. Arterial stiffness was measured using brachial-ankle pulse wave velocity (baPWV). Arterial stiffness progression was assessed by the annual growth rate of repeatedly measured baPWV. Multivariate linear regression models were used to estimate the cross-sectional association of TyG index with baPWV, and Cox proportional hazard models were used to investigate the longitudinal association between TyG index and the risk of arterial stiffness. Results Multivariate linear regression analyses showed that each one unit increase in the TyG index was associated with a 39 cm/s increment (95%CI, 29–48 cm/s, P < 0.001) in baseline baPWV and a 0.29 percent/year increment (95%CI, 0.17–0.42 percent/year, P < 0.001) in the annual growth rate of baPWV. During 26,839 person-years of follow-up, there were 883 incident cases with arterial stiffness. Participants in the highest quartile of TyG index had a 58% higher risk of arterial stiffness (HR, 1.58; 95%CI, 1.25–2.01, P < 0.001), as compared with those in the lowest quartile of TyG index. Additionally, restricted cubic spline analysis showed a significant dose–response relationship between TyG index and the risk of arterial stiffness (P non-linearity = 0.005). Conclusion Participants with a higher TyG index were more likely to have a higher risk of arterial stiffness. Subjects with a higher TyG index should be aware of the following risk of arterial stiffness progression, so as to establish lifestyle changes at an early stage.

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