scholarly journals Trends, composition and distribution of nurse workforce in China: a secondary analysis of national data from 2003 to 2018

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e047348
Author(s):  
Han Lu ◽  
Luoya Hou ◽  
Weijiao Zhou ◽  
Liqiong Shen ◽  
Shida Jin ◽  
...  
Keyword(s):  
Gini Coefficient ◽  
Rural Areas ◽  
Work Experience ◽  
Urban Areas ◽  
Secondary Analysis ◽  
Secondary Outcome ◽  
Theil Index ◽  
Ageing Population ◽  
The Gini Coefficient ◽  
Nurse Workforce

ObjectivesGiven the increased ageing population and frequent epidemic challenges, it is vital to have the nurse workforce of sufficient quantity and quality. This study aimed to demonstrate the trends, composition and distribution of nurse workforce in China.DesignSecondary analysis using national public datasets in China from 2003 to 2018.Setting/participantsNational population, nurse workforce and physician workforce.Primary and secondary outcome measuresFrequency and proportion were used to demonstrate: (1) the longitudinal growth of nurse workforce; (2) the diversity of nurse workforce in gender, age, work experience and education level; and (3) the distribution of nurse workforce among provinces, rural–urban areas and hospital/community settings. The Gini coefficient and Theil L index were used to measure the inequality trends of nurse workforce.ResultsThe total number of nurses increased from 1.3 million to 4.1 million and the density increased from 1 to 2.94 per 1000 population over 2003–2018. The nurses to physician ratio changed from 0.65:1 to 1.14:1. The majority of the nurse workforce was female, under 35 years old, with less than 30 years of work experience, with an associate’s degree and employed within hospitals. Central and eastern regions had more nurses and there were 5.08 nurses per 1000 population in urban areas while less than two in rural areas in 2018. The Gini coefficient and between-provincial Theil index experienced a consistent decline. Within-province inequality accounted for overall inequality has risen from 52.38% in 2010 to 71.43% in 2018 suggested that the differences of distribution are mainly reflected in urban and rural areas.ConclusionChinese nurse workforce has been changed significantly in the past 15 years that may be associated with the reformations of policy, nursing education in China. Our study suggests current features in the nurse workforce and can be used to strengthen future health services.

scholarly journals The degree of equity and coupling coordination of staff in primary medical and health care institutions in China 2013–2019

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Weicun Ren ◽  
Clifford Silver Tarimo ◽  
Lei Sun ◽  
Zihan Mu ◽  
Qian Ma ◽  
...  
Keyword(s):  
Health Care ◽  
Gini Coefficient ◽  
Rural Areas ◽  
Urban Areas ◽  
Population Based ◽  
Health Care Facilities ◽  
Living Standards ◽  
The Gini Coefficient ◽  
Health Care Institutions ◽  
The Government

Abstract Background Primary medical and health care facilities are the first lines of defense for the health of population. This study aims to evaluate the current state and trend of equity and coupling coordination degree (CCD) of staff in primary medical and health care institutions (SPMHCI) based on the quantity and living standards of citizens in China 2013–2019. The research findings are expected to serve as a guideline for the allocation of SPMHCI. Methods The data used in this study including the quantity and living standards of citizens, as well as the number of SPMHCI in 31 provincial administrative regions of China, were obtained from the China Statistical Yearbook and the China Health Statistics Yearbook. The equity and CCD for SPMHCI were analyzed by using the Gini coefficient and the CCD model, and the Grey forecasting model GM (1, 1) (GM) was used to predict the equity and CCD from 2020 to 2022. Results Between 2013 and 2019, the number of SPMHCI increased from 3.17 million to 3.50 million, and the population-based Gini coefficient declined from 0.0704 to 0.0513. In urban and rural areas, the Gini coefficients decreased from 0.1185 and 0.0737 to 0.1025 and 0.0611, respectively. The CCD between SPMHCI and citizens’ living standards (CLS) changed from 0.5691, 0.5813, 0.5818 to 0.5650, 0.5634, 0.6088 at national, urban, and rural levels, respectively. The forecasting results of GM revealed that at the national, urban and rural levels from 2020 to 2022, the Gini coefficient would rise at a rate of − 13.53, − 5.77%, and − 6.10%, respectively, while the CCD would grow at a rate of - 0.89, 1.06, and 0.87%, respectively. Conclusions In China, the number of SPMHCI has increased significantly, with an equitable allocation based on the population. The interaction between SPMHCI and CLS is sufficient, but the degree of mutual promotion is moderate. The government could optimize SPMHCI and improve the chronic disease management services to improve CLS and to ensure the continued operation of primary medical and health care institutions in urban areas.

scholarly journals Cesarean delivery and its social determinants in women of childbearing age: analysis of Benin’s DHS

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
A Kpozehouen ◽  
Y Glèlè Ahanhanzo ◽  
E Klikpo ◽  
C Azandjeme ◽  
C Metonnou ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Cesarean Delivery ◽  
Rural Areas ◽  
Urban Areas ◽  
Caesarean Delivery ◽  
Social Inequalities ◽  
Secondary Analysis ◽  
Well Being ◽  
Demographic Characteristics ◽  
Childbearing Age

Abstract Background Caesarean delivery, usually performed on a medical indication, is intended for maternal or fetal rescue. Accessibility issues justify setting up a so-called model of “free caesarean” in several developing countries, including Benin, in order to reduce social inequalities and contribute to the reduction of maternal and neonatal mortality. The study aimed to identify the determinants associated with caesarean delivery in women aged 15-49 in Benin. Methods This is a secondary analysis of data from Benin’s Demographic and Health Survey (DHS) 2017 - 2018. It was limited to mothers aged 15 to 49 who gave birth to at least one child in the 5 years preceding the survey. The socio-demographic characteristics of the mother and the variables related to pregnancy were the independent variables. Association between cesarean delivery and its determinants was assessed by odds ratios and their 95% confidence interval using a logistic regression. Results The percentage of mothers who gave birth by caesarean was 6.84%, 95% CI = [6.07; 7.59]. The average age was 29.37 years, 95% CI = [29.20; 29.55]. The probability of cesarean delivery was higher with women aged 45 years and older (OR = 3.33, 95% CI = [1.85, 6.01]), living in urban areas (OR = 1.41, 95% CI = [1.08 1.84]), from rich or very rich households (OR = 1.98, 95% CI = [1.29, 3.05], OR = 1.87, 95% CI = [1.19, 2.96] respectively) and educated (OR = 1.63 95% CI = [1.19, 2.24] and OR = 1.81, 95% CI = [0.97, 3.39] for the secondary and upper levels respectively). Conclusions This analysis shows that cesarean delivery remains associated with the socio-demographic characteristics of the mother, including the level of economic well-being. The current financing model of cesarean should be evaluated for effectiveness and further interventions need to be implemented to account for other factors of disparity. Key messages Benin health authorities should improve the geographical accessibility of Cesarean section, especially in rural areas. The strategies proposed to improve the financial accessibility of cesarean section do not seem effective, so the Beninese authorities should think about revising them.

Household consumption expenditure and inequality: evidence from Nigerian data

2018 ◽  
Vol 17 (3) ◽  
pp. 266-287 ◽  
Author(s):  
Emmanuel O. Nwosu ◽  
Obed Ojonta ◽  
Anthony Orji
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Significant Proportion ◽  
Household Consumption ◽  
Theil Index ◽  
Consumption Expenditure ◽  
Inequality Decomposition ◽  
Content Type ◽  
Food Expenditure ◽  
Urban And Rural Areas

Purpose Enhancing household consumption and reducing inequality are among the fundamental goals of many developing countries. The purpose of this study therefore is to disaggregate household consumption expenditure into food and non-food and, thus, decompose inequality into within- and between-groups. Design/methodology/approach The study adopts generalised entropy (GE) measures. Second, the study uses regression-based inequality decomposition to ascertain the determinants of inequality in food and non-food expenditure using household demographic and socioeconomic characteristics as covariates. Findings The results show that non-food expenditure is the major source of inequality in household consumption expenditure in both urban and rural areas with inequality coefficients of above 0.6 compared to about 0.4 for food expenditure. The decompositions also show that within-group inequalities for non-food and food expenditure are, respectively, 0.97 and 0.365 using the Theil index, while between-group inequalities for non-food and food are, respectively, 0.016 and 0.035. Furthermore, the regression-based inequality decompositions show that variables such as living in rural areas, household size, household dwelling and household dwelling characteristics account for the significant proportion of inequality in food and non-food expenditure. Originality/value The policy implication of the findings, among others, is that policies should focus on addressing inequality within rural and urban areas, especially with respect to non-food expenditure than in inequality existing between urban and rural areas. These non-food expenditures include expenditure in education, health, energy, accommodation, water and sanitation.

scholarly journals Sociodemographic inequalities in cardiovascular risk factors among adolescents from indigenous areas of Chiapas, Mexico

2020 ◽  
Author(s):  
Elena Flores-Guillen ◽  
Itandehui Castro-Quezada ◽  
Hector Ochoa ◽  
Rosario Garcia-Miranda ◽  
Miguel Cruz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Rural Areas ◽  
Urban Areas ◽  
Descriptive Analysis ◽  
Geographic Area ◽  
Secondary Outcome ◽  
Cross Sectional

Objectives: The objective of this study was to determine the prevalence of cardiovascular risk factors among different sociodemographic and geographic areas of adolescents from indigenous areas of Chiapas, Mexico. Design: A cross-sectional study. Setting: Communities in the Totzil - Tseltal and Selva region of Chiapas, Mexico, were studied. Urban and rural areas of high marginalization according to the Human Development Index. Participants: 253 adolescents were studied, of which 48.2% were girls and 51.8% were boys. Primary and secondary outcome measures: a descriptive analysis of the quantitative variables was performed through central tendency and dispersion measures. Prevalence of cardiovascular risk factors and 95% confidence intervals (95% CI), stratified by sex, geographic area (rural/urban), schooling and ethnicity of mothers were estimated. Results: the predominant risk factor in the study population was low HDL-c (51%). Higher prevalences of abdominal obesity and high triglycerides in girls were found and abnormal diastolic blood pressure in boys was identified. In urban areas were found greater prevalences of overweight/obesity and of insulin resistance while abnormal blood pressure levels were more prevalent in rural areas. Differences were found in the educational levels and ethnicity of the adolescents' mothers. Prevalence of metabolic syndrome was 10% according to NCEP-ATPIII. Conclusions: In this study, sociodemographic and geographical disparities were found in cardiovascular risk factors. Prevalence of risk factors was high, affecting mostly girls and urban population. Thus, there is a great need to promote healthy lifestyles and health, social and economic interventions to prevent chronic diseases in adulthood.

scholarly journals Income Inequality and Noncash Food Assistance Program in Central Java Province

2021 ◽  
Vol 16 (2) ◽  
Author(s):  
Yusuf Munandar
Keyword(s):  
Income Inequality ◽  
Gini Coefficient ◽  
Rural Areas ◽  
Food Assistance ◽  
Population Increase ◽  
Assistance Program ◽  
Central Java ◽  
The Gini Coefficient ◽  
Central Java Province

One measure of income inequality that is often used is the Gini Coefficient. In Central Java Province, the income inequality in March 2019 was increasing compared to income inequality in September 2018. To reduce this income inequality, the government is focusing on increasing government spending in the field of social assistance, including Non-Cash Food Assistance (Bantuan Pangan Non Tunai/BPNT). Thus, this study aims to calculate and obtain a reduction in the Gini Coefficient as a result of the implementation of the BPNT program in the Central Java Province of Indonesia. This study uses the Counter Factual Analysis (CFA) method and the March 2019 Susenas data. This study concludes that the implementation of the BPNT program in 2019 is quite effective in reducing the level of income inequality in the Central Java Province of Indonesia, which is able to reduce the Gini Coefficient of Central Java Province by -1.20%. The implementation of the BPNT program was able to make the expenditure of the lower class population increase faster than the expenditure of upper and middle class population. The implementation of the BPNT program changes the map of the income inequality level of 35 districts/cities in the Central Java Province of Indonesia but does not change the map of the level of income inequality between urban and rural areas in the Central Java Province of Indonesia. In addition, the implementation of the BPNT program in the Central Java Province of Indonesia has not been able to change the category of income inequality in the Central Java Province of Indonesia, namely that it remains in the moderate category. This study recommends improvements in terms of the target recipients of BPNT, the quality of the human resources of the companions, the time for receiving assistance, the quality of rice, and the readiness of e-warong in 35 districts/cities in the Province of Central Java, Indonesia.

scholarly journals The association between area of residence and sufficient antenatal tetanus vaccination in women ages 15–49 in Afghanistan: an analysis of the 2015 DHS dataset

2020 ◽  
Vol 5 (1) ◽  
Author(s):  
Jillian Sherley ◽  
Sam Newton
Keyword(s):  
Live Birth ◽  
Rural Women ◽  
Rural Areas ◽  
Urban Areas ◽  
Secondary Analysis ◽  
Education Level ◽  
Multivariable Logistic Regression Model ◽  
Mother’S Education ◽  
Tetanus Vaccination ◽  
Mother's Education

Abstract Background Neonatal tetanus (NT) is a deadly nervous system disorder that is endemic to Afghanistan. Administering sufficient doses of tetanus toxoid containing vaccine (TTCV) during pregnancy can pass antibodies to the fetus and therefore prevent NT. Using survey data, we investigated the association between area of residence (urban or rural) and sufficient antenatal TTCV coverage among women aged 15–49 years in Afghanistan during their most recent pregnancy in the past 5 years that resulted in a live birth. Mother’s education level was also assessed as a potential effect modifier. Methods Secondary analysis was performed on data from the 2015 Afghanistan Demographic and Health Survey (AfDHS). The 2015 AfDHS was a nationally representative survey with participants selected in a stratified two-stage sample design from urban and rural areas across Afghanistan’s 34 provinces. Data were analyzed on 19,737 women ages 15–49 that had a live birth in the 5 years preceding the survey. The relationship between area of residence and sufficient antenatal TTCV was assessed in a multivariable logistic regression model, adjusting for several confounding variables. Results 55.1% (95% CI = 51.6–58.5%) of urban women and 53.9% (95% CI = 49.7–57.9%) of rural women had sufficient tetanus vaccination coverage in their most recent pregnancy. In multivariate analysis, there was strong evidence for greater odds of sufficient antenatal tetanus vaccination in rural areas (OR = 1.62; 95% CI = 1.18–2.24, p = 0.003). There was no effect modification on this association by mother’s education level. Conclusions Women in rural areas of Afghanistan have greater odds of receiving sufficient antenatal tetanus vaccination than women in urban areas. Further study into factors contributing to this urban-rural disparity is needed. Targeted antenatal tetanus vaccination strategies for urban and rural women will be necessary as Afghanistan continues to work towards NT eradication.

Acupuncture in Australian General Practice: Trends in Reimbursed Acupuncture Services from 1995 to 2011

2013 ◽  
Vol 31 (1) ◽  
pp. 45-50 ◽  
Author(s):  
Jonathan Lee Wardle ◽  
Jon Adams ◽  
David William Sibbritt
Keyword(s):  
General Practice ◽  
Rural Areas ◽  
Urban Areas ◽  
Secondary Analysis ◽  
Medical Practitioner ◽  
Medical Practitioners ◽  
Factors Affecting ◽  
Australian General Practice ◽  
National Patient ◽  
To Receive

Objectives To ascertain the extent of and trends in the use of acupuncture in Australian general practice and the characteristics of patients receiving publicly subsidised acupuncture services from general practitioners (GPs). Design Secondary analysis of national patient Medicare data for claims by all non-specialist medical practitioners for Medicare Benefits Schedule items for an attendance where acupuncture was performed by a medical practitioner from 1995 to 2011. Main Outcome Measures Use of acupuncture by GPs, patients’ sex and age and the socioeconomic disadvantage index of GP's practice. Results There has been a 47.7% decline in the number of acupuncture claims by GPs per 100 000 population in the period from 1995 to 2011. Acupuncture claims were made by 3.4% of GPs in 2011. Women were almost twice as likely to receive acupuncture from a GP as men, and patients in urban areas were more than twice as likely to receive acupuncture from a GP as patients in rural areas. Acupuncture claims were highest in areas that were socioeconomically advantaged. Conclusions Claims for reimbursement for acupuncture by GPs have declined significantly in Australian general practice even though the use of acupuncture by the Australian public has increased. This may be due to increased use of referrals or use of non-medical practitioners, barriers to acupuncture practice in general practice or non-specific factors affecting reimbursement for non-vocationally registered GPs.

scholarly journals Is there an equality in the spatial distribution of urban vitality: A case study of Wuhan in China

2021 ◽  
Vol 13 (1) ◽  
pp. 469-481
Author(s):  
Guoliang Ou ◽  
Min Zhou ◽  
Zhongping Zeng ◽  
Qingsong He ◽  
Chaohui Yin
Keyword(s):  
Spatial Distribution ◽  
Gini Coefficient ◽  
Urban Areas ◽  
Housing Prices ◽  
High Grade ◽  
Residential Areas ◽  
Multiple Sources ◽  
The Gini Coefficient ◽  
Residential District

Abstract Urban vitality is a spatial phenomenon and a public service. Previous studies often did not measure the fairness of the accessibility of urban vitality. This research analyzed the spatial distribution of urban vitality in Wuhan as a case study area using big data from multiple sources. The study used the two-step floating catchment area method (2SFCA) to measure the accessibility level of each residential district to the vibrant zones (VZs). Furthermore, the inequality in the level of accessibility of residential areas with different housing prices was assessed on the basis of the Gini coefficient. The main conclusions are as follows: (1) the Gini coefficient of reaching the accessibility level of high-grade VZs is 0.426, and the corresponding sub-high-grade Gini coefficient is 0.274. This shows that the inequality in accessibility of different residential areas is more obvious as the level of vitality is higher and (2) residential areas with high housing prices have greater accessibility than those areas with low housing prices. It was also noticed that the level of accessibility and fairness in vitality is generally higher in central urban areas than in suburban areas. The Gini coefficient of high-grade vitality is generally higher than that of sub-high-grade. The results of this study provide a reference for researching the accessibility level of urban vitality, which considers the needs of population, and can also provide guidelines in urban planning regarding the allocation of services and resources.

scholarly journals Changes in Determinants and Equity of Family Planning Utilization after the Implementation of a National Health Insurance Policy in Indonesia: A Secondary Analysis of The 2012-2016 National Socio-Economic Survey of Indonesia

2019 ◽  
Author(s):  
Siti Khadijah Nasution ◽  
Yodi Mahendradhata ◽  
Laksono Trisnantoro
Keyword(s):  
Health Insurance ◽  
Family Planning ◽  
National Health Insurance ◽  
National Health ◽  
Rural Areas ◽  
Urban Areas ◽  
National Level ◽  
Secondary Analysis ◽  
Insurance Policy ◽  
Economic Survey

Abstract Background The Indonesian government has been implementing the National Health Insurance Policy (Jaminan Kesehatan Nasional-JKN) since 2014. The utilization of family planning service is one of the programs to increase maternal and child health status that is included in the benefit package in JKN. This study aimed to describe determinants and to evaluate JKN based on equity indicators, especially in family planning services. Methods Data were obtained from the 2012-2016 National Socio-Economic Survey (SUSENAS) of Indonesia. Contraceptive Prevalence Rate (CPR) and Long-acting contraceptives (LACs) use were used as indicators to evaluate family planning utilization. Chi-square and logistic regression tests were used to analyze the data. Respondents were married women between 15 and 49 years of age. Results There was no progress in CPR after the implementation of JKN. At the national level, CPR decreased within five years (2012-2016). Decreasing in urban areas and in the group that does not have health insurance were more than in rural areas and in the group that has health insurance. Utilization of non-LACs, especially injection (56%-57%) and pill (21%-24%), were still high within 2012-2016. At the national level, LACs use increased 3.18% between 2012-2016 (15.54%-18.72%). Increasing in urban areas and in the group that has subsidized health insurance were more than in rural areas and in the group that does not have subsidized. Health insurance ownership, the geography factor, education, household economic correlated with contraceptive use (p<0.05) in 2015 and 2016, but this correlation was inversely proportional. Conversely, all of the determinants were positively associated with LACs use (p<0.05). Conclusions Up to 2016, the JKN program did not increase CPR. Conversely, the JKN program obtained only small increases in LACs use. LACs use in rural areas is less than in urban areas. JKN program can increase LACs use in the group that has subsidized health insurance. CPR and LACs coverage could be increased by health system improvement and the social approaches, specifically through improving supply-side and regulations, increasing coordination among multiple agencies in the family planning program, and promoting family planning based on values and norms in the society.

scholarly journals Robust Estimation of the Theil Index and the Gini Coeffient for Small Areas

2021 ◽  
Vol 37 (4) ◽  
pp. 955-979
Author(s):  
Stefano Marchetti ◽  
Nikos Tzavidis
Keyword(s):  
Gini Coefficient ◽  
Small Area ◽  
Mean Squared Error ◽  
Small Area Estimation ◽  
Parametric Bootstrap ◽  
Theil Index ◽  
Error Estimator ◽  
Area Estimation ◽  
Squared Error ◽  
The Gini Coefficient

Abstract Small area estimation is receiving considerable attention due to the high demand for small area statistics. Small area estimators of means and totals have been widely studied in the literature. Moreover, in the last years also small area estimators of quantiles and poverty indicators have been studied. In contrast, small area estimators of inequality indicators, which are often used in socio-economic studies, have received less attention. In this article, we propose a robust method based on the M-quantile regression model for small area estimation of the Theil index and the Gini coefficient, two popular inequality measures. To estimate the mean squared error a non-parametric bootstrap is adopted. A robust approach is used because often inequality is measured using income or consumption data, which are often non-normal and affected by outliers. The proposed methodology is applied to income data to estimate the Theil index and the Gini coefficient for small domains in Tuscany (provinces by age groups), using survey and Census micro-data as auxiliary variables. In addition, a design-based simulation is carried out to study the behaviour of the proposed robust estimators. The performance of the bootstrap mean squared error estimator is also investigated in the simulation study.

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