scholarly journals Income-related inequalities in health care utilization among old adults in six LMICs: China, Ghana, India, Mexico, Russian and South Africa

2021 ◽  
Author(s):  
Hangqing Ruan
Keyword(s):  
South Africa ◽  
Health Care ◽  
Health Care Utilization ◽  
Service Utilization ◽  
Care Utilization ◽  
Middle Income ◽  
Middle Income Countries ◽  
Inequality In Health ◽  
High Degree ◽  
Low And Middle Income

Common and long-running concern across the world relates to the impact of increasing population aging on health care utilization and more evidence about the inequality in health care utilization by older adults in low- and middle-income countries (LMICs) is necessary for assessing the capacity of health care systems in LMICs to align with the universal health coverage agenda. In this paper, using data from WHO Study on Global Ageing and adult health (SAGE) in China, Ghana, India, Mexico, Russian Federation and South Africa, the multi-national magnitude in inequality of health care use is measured by concentration index in each country. The results show that a pro-rich inequality in health care utilization existed: China Mexico and Ghana show up with a high degree of inequality in outpatient service utilization; most of the countries show up with a low level of inequality for inpatient service (except China). Then especially India, but also Ghana, South Africa, and China, show up with a high degree of inequality and inequity in chronic diseases service utilization. However, there doesn’t appear to be one system characteristic of inequality in health care utilization since these six countries all have very diverse characteristics with different stages of the demographic and epidemiological transitions. The decomposition shows that income itself is the most important but not the only driving factor. And the distribution of education, health insurance, and urban/rural residents are the prime other contributors to health inequality. Also, this paper shows that inequalities for non-communicative diseases service utilization in LMICs produce big challenges, which underlines the role of prevention and health promotion throughout the life course to help reduce the burden due to non-communicable diseases. This paper provides a number of new insights on population aging’s impact on health care utilization in low- and middle-income countries.

scholarly journals Hospitalization of Pediatric Enteric Fever Cases, Dhaka, Bangladesh, 2017–2019: Incidence and Risk Factors

2020 ◽  
Vol 71 (Supplement_3) ◽  
pp. S196-S204 ◽  
Author(s):  
Shampa Saha ◽  
K M Ishtiaque Sayeed ◽  
Senjuti Saha ◽  
Md Shafiqul Islam ◽  
Afiour Rahaman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Health Care Utilization ◽  
Enteric Fever ◽  
Salmonella Typhi ◽  
Care Utilization ◽  
Community Based ◽  
Middle Income ◽  
Middle Income Countries ◽  
Adjusted Incidence

Abstract Background Enteric fever causes substantial morbidity and mortality in low- and middle-income countries. Here, we analyzed Surveillance for Enteric Fever in Asia Project (SEAP) data to estimate the burden of enteric fever hospitalization among children aged <15 years and identify risk factors for hospitalization in Bangladesh. Methods SEAP used hospital surveillance paired with a community-based health-care utilization assessment. In SEAP hospital surveillance, blood was obtained for culture from children aged <15 years with ≥3 days of fever. In the hospital catchment area, a health-care utilization survey (HCUS) was conducted to estimate the proportion of febrile children hospitalized at the study hospitals. We analyzed hospital surveillance and HCUS data to estimate the health care–adjusted incidence of enteric fever hospitalization, and conducted univariable and multivariable logistic regressions. Results From July 2017 through June 2019, 2243 laboratory-confirmed enteric fever cases were detected in 2 study hospitals; 673 (30%) were hospitalized. The health care–adjusted incidence of enteric fever hospitalization among children <15 years old was 303/100 000 children/year (95% confidence interval [CI], 293–313). Salmonella Typhi contributed most to the enteric fever hospitalization incidence (277/100 000 children/year; 95% CI, 267–287). The incidence was highest among children aged 2 to <5 years (552/100 000 children/year; 95% CI, 522–583), followed by those aged <2 years (316/100 000 children/year; 95% CI, 288–344). Factors independently associated with enteric fever hospitalization included fever duration, diarrhea, vomiting, abdominal pain, and leukocytopenia. Conclusions We estimated a high burden of hospitalization due to enteric fever among children aged <5 years in Bangladesh. The introduction of a typhoid conjugate vaccine would protect children from typhoid and avert typhoid hospitalizations.

The Economic Cost of Violence Against Women and Girls in Low- and Middle-Income Countries: A Systematic Review of the Evidence

2021 ◽  
pp. 152483802110160
Author(s):  
Seema Vyas ◽  
Melissa Meinhart ◽  
Katrina Troy ◽  
Hannah Brumbaum ◽  
Catherine Poulton ◽  
...  
Keyword(s):  
South Africa ◽  
Systematic Review ◽  
Violence Against Women ◽  
Economic Burden ◽  
Data Availability ◽  
Female Genital Cutting ◽  
Middle Income ◽  
Middle Income Countries ◽  
Women And Girls ◽  
Low And Middle Income

Evidence demonstrating the economic burden of violence against women and girls can support policy and advocacy efforts for investment in violence prevention and response programming. We undertook a systematic review of evidence on the costs of violence against women and girls in low- and middle-income countries published since 2005. In addition to understanding costs, we examined the consistency of methodological approaches applied and identified and assessed common methodological issues. Thirteen articles were identified, eight of which were from sub-Saharan Africa. Eight studies estimated costs associated with domestic or intimate partner violence, others estimated the costs of interpersonal violence, female genital cutting, and sexual assaults. Methodologies applied to estimate costs were typically based on accounting approaches. Our review found that out-of-pocket expenditures to individuals for seeking health care after an episode of violence ranged from US$29.72 (South Africa) to US$156.11 (Romania) and that lost productivity averaged from US$73.84 to US$2,151.48 (South Africa) per facility visit. Most studies that estimated provider costs of service delivery presented total programmatic costs, and there was variation in interventions, scale, and resource inputs measured which hampered comparability. Variations in methodological assumptions and data availability also made comparisons across countries and settings challenging. The limited scope of studies in measuring the multifaceted impacts of violence highlights the challenges in identifying cost metrics that extend beyond specific violence episodes. Despite the limited evidence base, our assessment leads us to conclude that the estimated costs of violence against women and girls are a fraction of its true economic burden.

scholarly journals Breast Cancer in Low- and Middle-Income Countries: An Emerging and Challenging Epidemic

2010 ◽  
Vol 2010 ◽  
pp. 1-5 ◽  
Author(s):  
Arafat Tfayli ◽  
Sally Temraz ◽  
Rachel Abou Mrad ◽  
Ali Shamseddine
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Low Income ◽  
Therapeutic Interventions ◽  
Low Income Countries ◽  
Middle Income ◽  
Major Health ◽  
Middle Income Countries ◽  
Low And Middle Income

Breast cancer is a major health care problem that affects more than one million women yearly. While it is traditionally thought of as a disease of the industrialized world, around 45% of breast cancer cases and 55% of breast cancer deaths occur in low and middle income countries. Managing breast cancer in low income countries poses a different set of challenges including access to screening, stage at presentation, adequacy of management and availability of therapeutic interventions. In this paper, we will review the challenges faced in the management of breast cancer in low and middle income countries.

scholarly journals An International Analysis of Dialysis Services Reimbursement

2018 ◽  
Vol 14 (1) ◽  
pp. 84-93 ◽  
Author(s):  
Arjan van der Tol ◽  
Norbert Lameire ◽  
Rachael L. Morton ◽  
Wim Van Biesen ◽  
Raymond Vanholder
Keyword(s):  
Health Care ◽  
Peritoneal Dialysis ◽  
Replacement Therapy ◽  
Gdp Per Capita ◽  
Middle Income ◽  
Middle Income Countries ◽  
Number Of Patients ◽  
Kidney Replacement Therapy ◽  
Per Capita ◽  
Low And Middle Income

Background and objectivesThe prevalence of patients with ESKD who receive extracorporeal kidney replacement therapy is rising worldwide. We compared government reimbursement for hemodialysis and peritoneal dialysis worldwide, assessed the effect on the government health care budget, and discussed strategies to reduce the cost of kidney replacement therapy.Design, setting, participants, & measurementsCross-sectional global survey of nephrologists in 90 countries to assess reimbursement for dialysis, number of patients receiving hemodialysis and peritoneal dialysis, and measures to prevent development or progression of CKD, conducted online July to December of 2016.ResultsOf the 90 survey respondents, governments from 81 countries (90%) provided reimbursement for maintenance dialysis. The prevalence of patients per million population being treated with long-term dialysis in low- and middle-income countries increased linearly with Gross Domestic Product per capita (GDP per capita), but was substantially lower in these countries compared with high-income countries where we did not observe an higher prevalence with higher GDP per capita. The absolute expenditure for dialysis by national governments showed a positive association with GDP per capita, but the percent of total health care budget spent on dialysis showed a negative association. The percentage of patients on peritoneal dialysis was low, even in countries where peritoneal dialysis is better reimbursed than hemodialysis. The so-called peritoneal dialysis–first policy without financial incentive seems to be effective in increasing the utilization of peritoneal dialysis. Few countries actively provide CKD prevention.ConclusionsIn low- and middle-income countries, reimbursement of dialysis is insufficient to treat all patients with ESKD and has a disproportionately high effect on public health expenditure. Current reimbursement policies favor conventional in-center hemodialysis.

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