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Journal of Global Health Jun 2024Achieving universal health coverage (UHC) is a crucial target shared by the Sustainable Development Goals (SDGs). As UHC levels are influenced by factors such as the... (Observational Study)
Observational Study
BACKGROUND
Achieving universal health coverage (UHC) is a crucial target shared by the Sustainable Development Goals (SDGs). As UHC levels are influenced by factors such as the regional economy and resource allocation, subnational evidence in China is urgently needed. This study aimed to monitor provincial progress from 2016 to 2021, thereby informing the development of region-specific strategies.
METHODS
Based on the UHC monitoring framework proposed by the World Health Organization, a UHC index was constructed comprising the service coverage dimension (16 indicators) and financial protection dimension (four indicators). In this observational study, routinely collected health data from 25 provinces (autonomous regions and municipalities) in mainland China were obtained from statistical yearbooks, relevant literature, and nationally representative surveys. The indices were calculated using geometric means. Socioeconomic inequalities among provinces were quantified using the slope index of inequality (SII) and relative index of inequality (RII).
RESULTS
From 2016 to 2021, China made laudable progress towards achieving UHC, with the index rising from 56.94 in 2016 to 63.03 in 2021. Most provinces demonstrated better performance in service coverage. Western provinces generally presented faster rates of progress, which were attributed to more substantial increases in financial protection. Despite significant disparities, with the UHC index ranging from 77.94 in Shanghai to 54.61 in Fujian in 2021, the overall equity of UHC has improved across the 25 provinces. SII decreased from 17.78 (95% confidence interval (CI) = 11.64, 23.93) to 12.25 (95% CI = 5.86, 18.63) and RII from 1.38 (95% CI = 1.29, 1.46) to 1.22 (95% CI = 1.16, 1.29). However, the non-communicable disease (NCD) domain experienced a drop in both index score and equity, underscoring the need for prioritised attention.
CONCLUSIONS
In the context of SDGs and the 'Healthy China 2030' initiative, China has made commendable progress towards UHC, and inter-provincial equity has improved. However, substantial differences persisted. The equitable realisation of UHC necessitates prioritising the enhancement of service capacity and financial protection in less developed regions, particularly by addressing shortages in the general practitioner workforce and mitigating catastrophic payments. Developed regions should focus on preventing NCDs through effective interventions targeting key risk factors. This study provides insights for other countries to adopt comprehensive monitoring frameworks, identify subnational disparities, and introduce targeted policy initiatives.
Topics: Humans; China; Universal Health Insurance; Socioeconomic Factors; Healthcare Disparities; Sustainable Development
PubMed: 38939928
DOI: 10.7189/jogh.14.04122 -
Labor Studies Journal Dec 2023Precarious employment is an important social determinant of health inequities. Through in-depth qualitative interviews ( = 35), we examine precarious employment and...
Precarious employment is an important social determinant of health inequities. Through in-depth qualitative interviews ( = 35), we examine precarious employment and labor exploitation, their potential impact on the working environment, and, ultimately, the health of farmworkers. We present results from the community-based participatory Michigan Farmworker Project. Our analysis identified dimensions of precarious employment and labor exploitation that involved lacking access to fundamental labor and social rights-including dehumanization-discriminatory occupational practices, and insufficient access to health care and social benefits. Policy reform is needed to address precarious employment and labor exploitation among farmworkers due to their potential long-lasting health effects.
PubMed: 38939876
DOI: 10.1177/0160449x231196227 -
Frontiers in Global Women's Health 2024The introduction of vaccines marked a game changer in the fight against COVID-19. In sub-Saharan Africa, studies have documented the intention to vaccinate and the...
The introduction of vaccines marked a game changer in the fight against COVID-19. In sub-Saharan Africa, studies have documented the intention to vaccinate and the uptake of COVID-19 vaccines. However, little is documented about how sex differences could have impacted COVID-19 vaccination. We conducted a multi-country cross-sectional study to assess the sex differences in COVID-19 vaccine uptake and intention to vaccinate in the Democratic Republic of Congo (DRC), Nigeria, Senegal, and Uganda. This study involved analysis of data from mobile surveys conducted between March and June 2022 among nationally constituted samples of adults in each country. Bivariate and multivariable logistic regression models were run. The self-reported uptake of COVID-19 vaccines was not significantly different between males and females (= 0.47), while the intention to vaccinate was significantly higher among males ( = 0.008). Among males, obtaining COVID-19 information from health workers, testing for COVID-19, and having high trust in the Ministry of Health were associated with higher vaccination uptake. Among females, having high trust in the government was associated with higher vaccination uptake. For intention to vaccinate, males who resided in semi-urban areas and females who resided in rural areas had significantly higher vaccination intention compared to their counterparts in urban areas. Other factors positively associated with vaccination intention among males were trust in the World Health Organization and perceived truthfulness of institutions, while males from households with a higher socio-economic index and those who had declined a vaccine before had a lower vaccine intention. Overall, the factors differentiating vaccine uptake and intention to vaccinate among males and females were mostly related to trust in government institutions, perceived truthfulness of institutions, and respondent's residence. These factors are key in guiding the tailoring of interventions to increase COVID-19 vaccine uptake in sub-Saharan Africa and similar contexts.
PubMed: 38939751
DOI: 10.3389/fgwh.2024.1356609 -
Current Tropical Medicine Reports Dec 2023Human African Trypanosomiasis (HAT), also known as sleeping sickness, is a vector-borne parasitic neglected tropical disease (NTD) endemic in sub-Saharan Africa. This...
PURPOSE OF REVIEW
Human African Trypanosomiasis (HAT), also known as sleeping sickness, is a vector-borne parasitic neglected tropical disease (NTD) endemic in sub-Saharan Africa. This review aims to enhance our understanding of HAT and provide valuable insights to combat this significant public health issue by synthesizing the latest research and evidence.
RECENT FINDINGS
HAT has reached a historical < 1000 cases in 2018. In patients without neurologic symptoms and signs, the likelihood of a severe meningoencephalitic stage is deemed low, obviating the need for a lumbar puncture to guide treatment decisions using fexinidazole.
SUMMARY
Both forms of the disease, gambiense HAT (gHAT) and rhodesiense HAT (rHAT), have specific epidemiology, risk factors, diagnosis, and treatment. Disease management still requires a high index of suspicion, infectious disease expertise, and specialized medical care. Essential stakeholders in health policy are critical to accomplishing the elimination goals of the NTD roadmap for 2021-2030.
PubMed: 38939748
DOI: 10.1007/s40475-023-00304-w -
Open Research Europe 2023This study addresses the underexplored issue of climate migration in non-governmental organisations (NGOs) communication, which is particularly relevant given the...
This study addresses the underexplored issue of climate migration in non-governmental organisations (NGOs) communication, which is particularly relevant given the anticipated effects of climate change on migratory patterns. It paints a richer picture of NGOs' visual and textual discourses on climate migration and delves into the ways in which NGOs' depictions of climate migrants reinforce the 'us' and 'them' dichotomy that characterises policy and media circuits' wider debate on this issue. NGOs visual practises and textual narratives depoliticize climate migrants by underlining their otherness and propensity to bring social instability and disturbance. This raises doubts about the efficacy of climate migration-related online public education and policy advocacy efforts run by NGOs. This paper innovates as it encourages NGOs to create new ways of depicting climate refugees. It provides a framework for thinking about the role that NGOs could play in creating new ways of discussing climate migration.
PubMed: 38939737
DOI: 10.12688/openreseurope.16232.2 -
JACC. Advances Apr 2024Major adverse cardiovascular events (MACE) are a leading cause of morbidity and mortality among adults with type 2 diabetes. Currently, available MACE prediction models...
BACKGROUND
Major adverse cardiovascular events (MACE) are a leading cause of morbidity and mortality among adults with type 2 diabetes. Currently, available MACE prediction models have important limitations, including reliance on data that may not be routinely available, narrow focus on primary prevention, limited patient populations, and longtime horizons for risk prediction.
OBJECTIVES
The purpose of this study was to derive and internally validate a claims-based prediction model for 1-year risk of MACE in type 2 diabetes.
METHODS
Using medical and pharmacy claims for adults with type 2 diabetes enrolled in commercial, Medicare Advantage, and Medicare fee-for-service plans between 2014 and 2021, we derived and internally validated the annualized claims-based MACE estimator (ACME) model to predict the risk of MACE (nonfatal acute myocardial infarction, nonfatal stroke, and all-cause mortality). The Cox proportional hazards model was composed of 30 covariates, including patient age, sex, comorbidities, and medications.
RESULTS
The study cohort comprised 6,623,526 adults with type 2 diabetes, mean age 68.1 ± 10.6 years, 49.8% women, and 73.0% Non-Hispanic White. ACME had a concordance index of 0.74 (validation index range: 0.739-0.741). The predicted 1-year risk of the study cohort ranged from 0.4% to 99.9%, with a median risk of 3.4% (IQR: 2.3%-6.5%).
CONCLUSIONS
ACME was derived in a large usual care population, relies on routinely available data, and estimates short-term MACE risk. It can support population risk stratification at the health system and payer levels, participant identification for decentralized clinical trials of cardiovascular disease, and risk-stratified observational studies using real-world data.
PubMed: 38939660
DOI: 10.1016/j.jacadv.2024.100852 -
Innovation in Aging 2024Fall injuries are prevalent in older adults, yet whether higher spending occurs after nonfracture (NFFI) and fracture is unknown. We examined whether incident fall...
BACKGROUND AND OBJECTIVES
Fall injuries are prevalent in older adults, yet whether higher spending occurs after nonfracture (NFFI) and fracture is unknown. We examined whether incident fall injuries, including NFFI and fractures, were associated with higher Medicare spending in 12 months after incident events in older adults.
RESEARCH DESIGN AND METHODS
The Health, Aging, and Body Composition Study included 1 595 community-dwelling adults (53% women, 37% Black; 76.7 ± 2.9 years) with linked Medicare Fee-For-Service (FFS) claims at 2000/01 exam. Incident outpatient and inpatient fall injuries ( = 448) from 2000/01 exam to December 31, 2008 were identified using the first claim with a nonfracture injury diagnosis code with a fall E-code, or a fracture diagnosis code with/without an E-code. Up to 3 participants without fall injuries ( = 1 147) were matched on nonfall events to 448 participants in the fall injury month. We calculated the change in monthly FFS spending in 12 months before versus after index events in both groups. Generalized linear regression with centered outcomes and gamma distributions examined the association of prepost expenditure changes with fall injuries (including NFFI and fractures) adjusting for related covariates.
RESULTS
Monthly spending increased after versus before fall injuries (USD$2 261 vs $981), nonfracture ( = 105; USD$2 083 vs $1 277), and fracture ( = 343; USD$2 315 vs $890) injuries (all < .0001). However, after adjusting for covariates in final models, fall injuries were not significantly associated with larger increases in spending/month versus nonfall events (differential increase: USD$399.58 [95% CI: -USD$44.95 to $844.11]). Fracture prepost change in monthly spending was similar versus NFFI (differential increase: USD$471.93 [95% CI: -USD$21.17 to $965.02]).
DISCUSSION AND IMPLICATIONS
Although substantial increases occurred after injuries, with fracture and NFFI increasing similarly, changes in monthly spending after fall injury were not different compared to nonfall events. Our results contribute to the understanding of subsequent spending after fall injury that may inform further research on fall injury-related health care spending.
PubMed: 38939652
DOI: 10.1093/geroni/igae051 -
Health Care Science Aug 2023The Coronavirus 2019 disease (COVID-19) brought many healthcare systems around the world to the point of collapse all the while putting the lives of healthcare workers...
BACKGROUND
The Coronavirus 2019 disease (COVID-19) brought many healthcare systems around the world to the point of collapse all the while putting the lives of healthcare workers at risk. This study forgoes an institutional look at healthcare to center individual healthcare personnel in Malawi to better understand (1) how the worldviews of healthcare workers impact their work in the context of COVID-19, (2) how COVID-19 impacted healthcare workers, and (3) the unique conditions faced by being a healthcare worker in a low-income nation.
METHODS
This research uses a hermeneutic phenomenological approach to qualitative methodology involving in-depth interviews ( = 15) with healthcare workers, traditional healers, and hospital leadership. The data collected were inductively coded and analyzed using the framework method, producing rich descriptions on how COVID-19 impacted the lifeworlds of healthcare workers in Malawi.
RESULTS
The findings reveal many of the struggles healthcare workers faced due to misaligned government policy and perceived proximity to COVID-19; outline their needs such as wanting better resources, funds, wages, and public health communication; and, exemplify the significant role that personal biases, worldviews, and sense of fear played in how healthcare workers perceived and interacted with COVID-19.
CONCLUSION
Much of what was said echoes beyond borders, reflecting common global sentiments felt by healthcare personnel, and offers directions to explore building policies, strategies, and plans in preparation for any future disease outbreaks.
PubMed: 38939524
DOI: 10.1002/hcs2.58 -
BMJ Public Health Mar 2024In Kenya, non-communicable diseases (NCDs) are estimated to account for almost one-third of all deaths and this is likely to rise by over 50% in the next 10 years. The...
INTRODUCTION
In Kenya, non-communicable diseases (NCDs) are estimated to account for almost one-third of all deaths and this is likely to rise by over 50% in the next 10 years. The Primary Health Integrated Care for Chronic Conditions (PIC4C) project aims to strengthen primary care by integrating comprehensive NCD care into existing HIV primary care platform. This paper evaluates the association of PIC4C implementation on clinical outcomes.
METHODS
Outcomes included proportion of new patients, systolic blood pressure (SBP), fasting plasma glucose (FPG), diastolic blood pressure, hypertension control, random plasma glucose, diabetes control, viral load and HIV viral suppression. We used interrupted time series and binomial regression with random effects for facility-level data and generalised mixed-effects regression for visit-level data to examine the association between PIC4C and outcomes between January 2017 and December 2021. We conducted sensitivity analysis with restrictions on sites and the number of visits.
RESULTS
Data from 66 641 visits of 13 046 patients with hypertension, 24 005 visits of 7267 patients with diabetes and 84 855 visits of 21 186 people with HIV were analysed. We found evidence of association between PIC4C and increase in proportion of new patients per month with hypertension (adjusted OR (aOR) 1.57, 95% CI 1.39 to 1.78) and diabetes (aOR 1.31, 95% CI 1.19 to 1.45), small increase in SBP (adjusted beta (aB) 1.7, 95% CI 0.8 to 2.7) and FPG (aB 0.6, 95% CI 0.0 to 1.1). There was no strong evidence of association between PIC4C and viral suppression (aOR 1.20, 95% CI 0.98 to 1.47). In sensitivity analysis, there was no strong evidence of association between PIC4C and SBP (aB 1.74, 95% CI -0.70 to 4.17) or FPG (aB 0.52, 95% CI -0.64 to 1.67).
CONCLUSIONS
PIC4C implementation was associated with increase in proportion of new patients attending clinics and a slight increase in SBP and FPG. The immediate post-PIC4C implementation period coincided with the COVID-19 pandemic, which is likely to explain some of our findings.
PubMed: 38939473
DOI: 10.1136/bmjph-2023-000146 -
Forensic Sciences Research Jun 2024Ongoing terrorist attacks in the Sahel region call for strengthening the security system by using human DNA identification technology. In this context, public opinion...
Ongoing terrorist attacks in the Sahel region call for strengthening the security system by using human DNA identification technology. In this context, public opinion must be considered when establishing solid standards and universal safeguards for one of the most invasive forms of surveillance and profiling. For this purpose, we gathered internet users' opinions in Burkina Faso (a country located in the Sahel region) on the use of DNA technology to support criminal investigations. The results revealed that 91.7% (431) of the 470 participants believed that this technology is currently necessary for the Burkina Faso's criminal justice system. However, the respondents expressed concerns about the custody and management of a national forensic DNA database. In this particular security setting, the public opinion of this study may provide leaders and political policymakers with clues for considering genetic fingerprints and implementing an national forensic DNA database to support criminal investigations in Burkina Faso whilst also considering the ethical implications.
PubMed: 38939471
DOI: 10.1093/fsr/owad056