International Journal for Equity in Health
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2010
(FIVE YEARS 692)

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53
(FIVE YEARS 10)

Published By Springer (Biomed Central Ltd.)

1475-9276, 1475-9276

2022 ◽  
Vol 21 (1) ◽  
Author(s):  
Sumirtha Gandhi ◽  
Umakant Dash ◽  
M. Suresh Babu

Abstract Background Continuum of Maternal Health Care Services (CMHS) has garnered attention in recent times and reducing socio-economic disparity and geographical variations in its utilisation becomes crucial from an egalitarian perspective. In this study, we estimate inequity in the utilisation of CMHS in India between 2005 and 06 and 2015-16. Methods We used two rounds of National Family Health Survey (NFHS) - 2005-06 and 2015-16 encompassing a sample size of 34,560 and 178,857 pregnant women respectively. The magnitude of horizontal inequities (HI) in the utilisation of CMHS was captured by adopting the Erreygers Corrected Concentration indices method. Need-based standardisation was conducted to disentangle the variations in the utilisation of CMHS across different wealth quintiles and state groups.  Further, a decomposition analysis was undertaken to enumerate the contribution of legitimate and illegitimate factors towards health inequity. Results The study indicates that the pro-rich inequity in the utilisation of CMHS has increased by around 2 percentage points since the implementation of National Rural Health Mission (NRHM), where illegitimate factors are dominant. Decomposition analysis reveals that the contribution of access related barriers plummeted in the considered period of time. The results also indicate that mother’s education and access to media continue to remain major contributors of pro-rich inequity in India. Considering, regional variations, it is found that the percentage of pro-rich inequity in high focus group states increased by around 3% between 2005 and 06 and 2015-16. The performance of southern states of India is commendable. Conclusions Our study concludes that there exists a pro-rich inequity in the utilisation of CMHS with marked variations across state boundaries. The pro-rich inequity in India has increased between 2005 and 06 and high focus group states suffered predominantly. Decentralisation of healthcare policies and  granting greater power to the states might lead to equitable distribution of CMHS.


2022 ◽  
Vol 21 (1) ◽  
Author(s):  
Clare Bambra

AbstractThe frequency and scale of Emerging Infectious Diseases (EIDs) with pandemic potential has been increasing over the last two decades and, as COVID-19 has shown, such zoonotic spill-over events are an increasing threat to public health globally. There has been considerable research into EIDs – especially in the case of COVID-19. However, most of this has focused on disease emergence, symptom identification, chains of transmission, case prevalence and mortality as well as prevention and treatment. Much less attention has been paid to health equity concerns and the relationship between socio-economic inequalities and the spread, scale and resolution of EID pandemics. This commentary article therefore explores socio-economic inequalities in the nature of EID pandemics. Drawing on three diverse case studies (Zika, Ebola, COVID-19), it hypothesises the four main pathways linking inequality and infectious disease (unequal exposure, unequal transmission, unequal susceptibility, unequal treatment) – setting out a new model for understanding EIDs and health inequalities. It concludes by considering the research directions and policy actions needed to reduce inequalities in future EID outbreaks.


2022 ◽  
Vol 21 (1) ◽  
Author(s):  
Laila Rahman ◽  
Janice Du Mont ◽  
Patricia O’Campo ◽  
Gillian Einstein

Abstract Background Physical intimate partner violence (IPV) risk looms large for younger women in Bangladesh. We are, however, yet to know the association between their intersectional social locations and IPV across communities. Drawing on intersectionality theory’s tenet that interacting systems of power, oppressions, and privileges work together, we hypothesized that (1) younger, lower educated or poor women’s physical IPV experiences will be exacerbated in disadvantaged communities; and conversely, (2) younger, higher educated or nonpoor women’s physical IPV experiences will be ameliorated in advantaged communities. Methods We applied intercategorical intersectionality analyses using multilevel logistic regression models in 15,421 currently married women across 911 communities from a national, cross-sectional survey in 2015. To test the hypotheses, women’s probabilities of currently experiencing physical IPV among intersectional social groups were compared. These comparisons were made, at first, within each type of disadvantaged (e.g., younger or poor) and advantaged (e.g., older or nonpoor) communities; and then, between different types of communities. Results While our specific hypotheses were not supported, we found significant within community differences, suggesting that younger, lower educated or poor women were bearing the brunt of IPV in almost every community (probabilities ranged from 34.0–37.1%). Younger, poor compared to older, nonpoor women had significantly higher IPV probabilities (the minimum difference = 12.7, 95% CI, 2.8, 22.6) in all communities. Similar trend was observed between younger, lower educated compared to older, higher educated women in all except communities that were poor. Interestingly, younger women’s advantage of higher education and material resources compared to their lower educated or poor counterparts was observed only in advantaged communities. However, these within community differences did not vary between disadvantaged and advantaged communities (difference-in-differences ranged from − 0.9%, (95% CI, − 8.5, 6.7) to − 8.6%, (95% CI, − 17.6, 0.5). Conclusions Using intersectionality theory made visible the IPV precarity of younger, lower educated or poor women across communities. Future research might examine the structures and processes that put them at these precarious locations to ameliorate their socio-economic-educational inequalities and reduce IPV in all communities. For testing hypotheses using intersectionality theory, this study might advance scholarship on physical IPV in Bangladesh and quantitative intersectionality globally.


2022 ◽  
Vol 21 (1) ◽  
Author(s):  
Marije van der Hulst ◽  
Suzanne Polinder ◽  
Rianne Kok ◽  
Peter Prinzie ◽  
Marijke W. de Groot ◽  
...  

Abstract Background Children with low socioeconomic status (SES) have an increased risk of a suboptimal start in life with ensuing higher healthcare costs. This study aims to investigate the effects of individual- (monthly household income) and contextual-level SES (household income and neighborhood deprivation), and perinatal morbidity (preterm birth and small for gestational age ((<10th percentile), SGA)) on healthcare costs in early life (0–3 years of age). Methods Individual-linked data from three national registries (Perinatal Registry Netherlands, Statistics Netherlands, and Healthcare Vektis) were obtained of all children born between 2011 and 2014 (N = 480,471) in the Netherlands. Binomial logistic regression was used to model annual healthcare costs as a function of their household income (per €1000), neighborhood deprivation index (range − 13.26 – 10.70), their perinatal morbidity and demographic characteristics. Annual healthcare cost were dichotomized into low healthcare costs (Q1-Q3 below €1000) and high healthcare costs (Q4 €1000 or higher). Results Children had a median of €295 annual healthcare costs, ranging from €72 to €4299 (5–95%). Binomial logistic regression revealed that for every €1000 decrease in monthly household income, the OR for having high healthcare costs is 0.99 (0.99–0.99). Furthermore, for every one-unit increase in neighborhood deprivation the OR for having high healthcare costs increase 1.02 (1.01–1.02). Finally, the model revealed an OR of 2.55 (2.48–2.61) for preterm born children, and an OR of 1.44 (1.41–1.48) for children SGA, to have high healthcare costs compared to their healthy peers. Conclusion More neighborhood deprivation was directly related to higher healthcare costs in young children. On top of this, lower household income was consistently and independently related to higher healthcare costs. By optimizing conditions for low SES populations, the impact of low SES circumstances on their healthcare costs can be positively influenced. Additionally, policies that influence more timely and appropriate healthcare use in low SES populations can reduce healthcare costs further.


2022 ◽  
Vol 21 (1) ◽  
Author(s):  
Nirukshi Perera ◽  
Komla Tsey ◽  
Marion Heyeres ◽  
Mary Whiteside ◽  
Leslie Baird ◽  
...  

Abstract Background An Aboriginal-developed empowerment and social and emotional wellbeing program, known as Family Wellbeing (FWB), has been found to strengthen the protective factors that help Indigenous Australians to deal with the legacy of colonisation and intergenerational trauma. This article reviews the research that has accompanied the implementation of the program, over a 23 year period. The aim is to assess the long-term impact of FWB research and identify the key enablers of research impact and the limitations of the impact assessment exercise. This will inform more comprehensive monitoring of research impact into the future. Methods To assess impact, the study took an implementation science approach, incorporating theory of change and service utilisation frameworks, to create a logic model underpinned by Indigenous research principles. A research impact narrative was developed based on mixed methods analysis of publicly available data on: 1) FWB program participation; 2) research program funding; 3) program outcome evaluation (nine studies); and 4) accounts of research utilisation (seven studies). Results  Starting from a need for research on empowerment identified by research users, an investment of $2.3 million in research activities over 23 years produced a range of research outputs that evidenced social and emotional wellbeing benefits arising from participation in the FWB program. Accounts of research utilisation confirmed the role of research outputs in educating participants about the program, and thus, facilitating more demand (and funding acquisition) for FWB. Overall research contributed to 5,405 recorded participants accessing the intervention. The key enablers of research impact were; 1) the research was user- and community-driven; 2) a long-term mutually beneficial partnership between research users and researchers; 3) the creation of a body of knowledge that demonstrated the impact of the FWB intervention via different research methods; 4) the universality of the FWB approach which led to widespread application. Conclusions The FWB research impact exercise reinforced the view that assessing research impact is best approached as a “wicked problem” for which there are no easy fixes. It requires flexible, open-ended, collaborative learning-by-doing approaches to build the evidence base over time. Steps and approaches that research groups might take to build the research impact knowledge base within their disciplines are discussed.


2022 ◽  
Vol 21 (1) ◽  
Author(s):  
Sonja Hartnack

AbstractAlthough preventable by vaccines, approximately 60′000 humans die due to canine transmitted rabies annually, mostly in Africa and Asia. The aim of this paper is to advocate for including animal health aspects into considerations of human health and human rights, and for equitable access to rabies vaccination for both animals and humans. An infringement of human - in particular of children’s - right to health will be illustrated with the case of rabies and poor dog management in Uganda.


2022 ◽  
Vol 21 (1) ◽  
Author(s):  
Laura de la Torre-Pérez ◽  
Alba Oliver-Parra ◽  
Xavier Torres ◽  
Maria Jesús Bertran

Abstract Background Gender discrimination (GD) has been frequently linked to mental health. The heterogeneity of how GD is defined has led to variation around the analysis of GD. This might affect the study of the association between GD and health outcomes. The main goal of this systematic scoping review is to operationalize the definition of the GD construct. Methods Three search strategies were set in Pubmed, CINAHL and PsycINFO. The first strategy obtained results mainly about women, while the second focused on men. The third strategy focused on the identification of GD questionnaires. The prevalence of GD, factors and consequences associated with GD perception, and forms of discrimination were the principal variables collected. Risk of bias was assessed (PROSPERO:CRD42019120719). Results Of the 925 studies obtained, 84 were finally included. 60 GD questionnaires were identified. GD prevalence varied between 3.4 and 67 %. Female gender and a younger age were the factors most frequently related to GD. Poorer mental health was the most frequent consequence. Two components of the GD construct were identified: undervaluation (different recognition, opportunities in access, evaluation standards and expectations) and different treatment (verbal abuse and behaviour). Conclusions Two-component GD definition can add order and precision to the measurement, increase response rates and reported GD.


2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Tarun Shankar Choudhary ◽  
Sarmila Mazumder ◽  
Øystein Ariansen Haaland ◽  
Sunita Taneja ◽  
Rajiv Bahl ◽  
...  

Abstract Background Kangaroo mother care (KMC) can substantially enhance overall survival of low birthweight babies. In a large randomized controlled trial, we recently showed that supporting mothers to provide community initiated KMC (ciKMC) can reduce mortality among infants up to 180 days of life by 25% (hazard ratio (HR) 0.75). With the current analysis, we aimed to explore if ciKMC promotion leads to increased inequity in survival. Methods In the trial we randomized 8402 low birthweight babies to a ciKMC (4480 babies) and a control (3922 babies) arm, between 2015 and 2018 in Haryana, India. We estimated the difference in concentration indices, which measure inequality, between babies in the ciKMC and control arms for survival until 180 days of life. Further, we compared the effect of ciKMC promotion across subgroups defined by socioeconomic status, caste, maternal literacy, infant’s sex, and religion. Results Our intervention did not increase survival inequity, as the concentration index in the ciKMC arm of the trial was 0.05 (95% CI -0.07 to 0.17) lower than in the control arm. Survival impact was higher among those belonging to the lower two wealth quintiles, those born to illiterate mothers and those belonging to religions other than Hindu. Conclusions We found that ciKMC promotion did not increase inequity in survival associated with wealth. The beneficial impact of ciKMC tended to be larger among vulnerable groups. Supporting mothers to provide KMC at home to low birthweight babies will not increase and could indeed reduce inequities in infant survival. Trial registration ClinicalTrials.gov, NCT02653534. Registered January 12, 2016—Retrospectively registered.


2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Oscar A. Martínez-Martínez ◽  
Karla A. Valenzuela-Moreno ◽  
Brenda Coutiño

Abstract Background Comorbidities increase the risk of death for patients with COVID-19, however, little is known about how it affects the prognosis of migrants who contract the virus. Therefore, this article aims to determine which comorbidities and risk conditions are associated with the probability of death among migrants infected with COVID-19 in Mexico. Methods We use a sample of migrants with a positive diagnosis for COVID-19 (N = 2126) registered in the public database published in the National Epidemiological Surveillance System of the Mexican Ministry of Health; the technique used was a Probit regression. Results The findings show that most of the comorbidities commonly associated with death from COVID-19 in the native-born population were actually not significant when present in migrants infected with COVID-19. Additionally, migrants have lower comorbidities than locals. The results further indicate that the factors related to the death of migrants infected with COVID-19 are: age, intubation, nationality group, pneumonia and the Health Care Management of Patients. Conclusions In contrast to preceding studies with native-born populations with COVID-19, where pre-existing diseases aggravated the diagnosis of COVID-19 and sometimes led to death, in the case of migrants, only pneumonia was the significant comorbidity associated with mortality among migrants diagnosed with COVID-19.


2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Kathleen A. Culhane-Pera ◽  
Shannon L. Pergament ◽  
Maiyia Y. Kasouaher ◽  
Andrew M. Pattock ◽  
Naima Dhore ◽  
...  

An amendment to this paper has been published and can be accessed via the original article.


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