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Rahmawati T, Hsieh HM, Liang FW. Inequalities in women's health insurance coverage before and after the implementation of universal health insurance in Indonesia. J Public Health Policy 2024:10.1057/s41271-024-00480-7. [PMID: 38609498 DOI: 10.1057/s41271-024-00480-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/14/2024]
Abstract
Indonesia implemented a National Social Security System (Jaminan Kesehatan Nasional, JKN) in 2014. To examine the changes in the magnitude of socioeconomic inequity in women's health insurance coverage among those of reproductive age, we conducted a repeated cross-sectional study design using data from the Indonesia Demographic and Health Surveys conducted in 2012 and 2017, before and after the implementation of JKN. Results showed that while the JKN program helped to increase health insurance coverage among Indonesian women of childbearing age, low education level and household wealth status were associated with an increase in inequalities in health insurance coverage. The findings highlight the need to sustain coverage for citizens and to extend the JKN program to informal workers to reduce health coverage disparities. Further research is required to explore the mechanisms responsible for health coverage inequality based on socioeconomic indicators.
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Affiliation(s)
- Tati Rahmawati
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hui-Min Hsieh
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
- Department of Community Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
- Center for Big Data Research, Kaohsiung Medical University, 100 Shih-Chung 1st Road, San-Ming Dist., Kaohsiung, Taiwan.
| | - Fu-Wen Liang
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Big Data Research, Kaohsiung Medical University, 100 Shih-Chung 1st Road, San-Ming Dist., Kaohsiung, Taiwan
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Abu El Kheir-Mataria W, Khadr Z, El Fawal H, Chun S. COVID-19 vaccine intercountry distribution inequality and its underlying factors: a combined concentration index analysis and multiple linear regression analysis. Front Public Health 2024; 12:1348088. [PMID: 38577285 PMCID: PMC10993910 DOI: 10.3389/fpubh.2024.1348088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/21/2024] [Indexed: 04/06/2024] Open
Abstract
Introduction Inequitable access to COVID-19 vaccines among countries is a pressing global health issue. Factors such as economic power, political power, political stability, and health system strength contribute to disparities in vaccine distribution. This study aims to assess the inequality in vaccine distribution among countries based on these factors and identify their relationship with COVID-19 vaccine distribution. Methods A Concentration Index (CI) analysis was conducted to evaluate inequalities in the distribution of COVID-19 vaccines among countries based on four separate variables: GDP per capita, political stability (PS), World Power Index (WPI), and Universal Health Coverage (UHC). Additionally, Multiple Linear Regression (MLR) analysis was employed to explore the relationship between vaccine distribution and these independent variables. Two vaccine distribution variables were utilized for result reliability. Results The analysis revealed significant inequalities in COVID-19 vaccine distribution according to the countries' GDP/capita, PS, WPI, and UHC. However, the multiple linear regression analysis showed that there is no significant relationship between COVID-19 vaccine distribution and the countries' GDP/capita and that UHC is the most influential factor impacting COVID-19 vaccine distribution and accessibility. Discussion The findings underscore the complex interplay between economic, political, and health system factors in shaping vaccine distribution patterns. To improve the accessibility to vaccines in future pandemics, Global Health Governance (GHG) and countries should consider working on three areas; enhance political stabilities in countries, separate the political power from decision-making at the global level and most importantly support countries to achieve UHC.
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Affiliation(s)
| | - Zeinab Khadr
- The Social Research Center, The American University in Cairo, New Cairo, Egypt
- Department of Statistics, Faculty of Economics and Political Sciences, Cairo University, Giza, Egypt
| | - Hassan El Fawal
- Institute of Global Health and Human Ecology, The American University in Cairo, New Cairo, Egypt
| | - Sungsoo Chun
- Institute of Global Health and Human Ecology, The American University in Cairo, New Cairo, Egypt
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Al-kassab-Córdova A, Mendez-Guerra C, Robles-Valcarcel P, Iberico-Bellomo L, Alva K, Herrera-Añazco P, Benites-Zapata VA. Inequalities in anemia among Peruvian children aged 6–59 months: A decomposition analysis. Front Public Health 2023; 11:1068083. [PMID: 37064707 PMCID: PMC10102391 DOI: 10.3389/fpubh.2023.1068083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 03/07/2023] [Indexed: 04/03/2023] Open
Abstract
ObjectiveTo quantify the inequalities of anemia in Peruvian children aged 6–59 months and uncover its contributing factors.Materials and methodsWe conducted a cross-sectional study based on the secondary data analysis of the 2021 Peruvian Demographic and Health Survey (DHS). Our sample included Peruvian children aged 6–59 months with complete data for the variables of interest. Anemia was defined as having a hemoglobin level of less than 11 g/dL, adjusted by altitude. Erreygers Concentration Index (ECI) and concentration curves were computed to estimate the socio-economic inequality in anemia among Peruvian children. Moreover, ECI was decomposed to figure out the contributing factors to the inequality of anemia and the residual variation.ResultsNationwide, the prevalence of anemia in Peruvian children was 29.47%. We found a pro-poor inequality regarding anemia at the national level (ECI = −0.1848). The determinants included in the model explained 81.85% of the overall socio-economic inequality in anemia. The largest contribution to inequality was from household- and community-related factors. Having a higher mother’s education level (26.26%) and being from the highlands (24.91%) were the major significant contributors to the overall health inequality.ConclusionAlmost one-third of Peruvian children have anemia. A pro-poor inequality of anemia in Peruvian children was found. Public policies ought to address the major contributing factors of anemia inequality.
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Affiliation(s)
- Ali Al-kassab-Córdova
- Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Universidad San Ignacio de Loyola, Lima, Peru
- *Correspondence: Ali Al-kassab-Córdova,
| | | | | | | | - Kenedy Alva
- Escuela de Negocios y Administración de Empresas, Universidad de Murcia, Murcia, España
| | - Percy Herrera-Añazco
- Facultad de Ciencias de la Salud, Universidad Privada del Norte, Trujillo, Peru
- Red Peruana de Salud Colectiva, Lima, Peru
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Grueso DI, García-Zapata LM. [The 'right to health': difficulties, achievements, and challenges]. Rev Salud Publica (Bogota) 2023; 22:552-555. [PMID: 36753225 DOI: 10.15446/rsap.v22n5.80161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 09/27/2020] [Indexed: 11/09/2022] Open
Abstract
The right to health as a right has been part of the social slogans of recent times, this article analyzes it as a positive human right and delves into what it means to define health as a right applied to the Colombian context.
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Affiliation(s)
- Delfín I Grueso
- DG: Filósofo y Sociólogo. Profesor, Departamento de Filosofía, Universidad del Valle. Grupo de Investigación Praxis de Investigación en Ética y Filosofía Política. Cali, Colombia.
| | - Lina M García-Zapata
- LM: OD. M. Sc. Epidemiología. Ph. D. Salud. Docente, Escuela de Odontología, Facultad de Salud Universidad del Valle. Integrante Grupo Pacífico, Siglo XXI y CURPES. Cali, Colombia.
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Rodriguez-Villamizar LA, Marín D, Piñeros-Jiménez JG, Rojas-Sánchez OA, Serrano-Lomelin J, Herrera V. Intraurban Geographic and Socioeconomic Inequalities of Mortality in Four Cities in Colombia. Int J Environ Res Public Health 2023; 20:992. [PMID: 36673751 PMCID: PMC9859133 DOI: 10.3390/ijerph20020992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
Mortality inequalities have been described across Latin American countries, but less is known about inequalities within cities, where most populations live. We aimed to identify geographic and socioeconomic inequalities in mortality within the urban areas of four main cities in Colombia. We analyzed mortality due to non-violent causes of diseases in adults between 2015 and 2019 using census sectors as unit of analysis in Barranquilla, Bogotá, Cali, and Medellín. We calculated smoothed Bayesian mortality rates as main health outcomes and used concentration indexes (CInd) for assessing inequalities using the multidimensional poverty index (MPI) as the socioeconomic measure. Moran eigenvector spatial filters were calculated to capture the spatial patterns of mortality and then used in multivariable models of the association between mortality rates and quintiles of MPI. Social inequalities were evident but not consistent across cities. The most disadvantaged groups showed the highest mortality rates in Cali. Geographic inequalities in mortality rates, regardless of the adults and poverty distribution, were identified in each city, suggesting that other social, environmental, or individual conditions are impacting the spatial distribution of mortality rates within the four cities.
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Affiliation(s)
| | - Diana Marín
- School of Medicine, Universidad Pontificia Bolivariana, Medellin 050031, Colombia
| | | | - Oscar Alberto Rojas-Sánchez
- Division of Public Health Research, Project Bank Team, National Institute of Health-INS Colombia, Bogotá 111321, Colombia
| | | | - Victor Herrera
- Department of Public Health, School of Medicine, Universidad Industrial de Santander, Bucaramanga 681012, Colombia
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Anik AI, Ahmed T, Nandonik AJ, Parvez A, Das Pooja S, Kabir ZN. Evidence of mental health-related morbidities and its association with socio-economic status among previously hospitalized patients with symptoms of COVID-19 in Bangladesh. Front Public Health 2023; 11:1132136. [PMID: 36908471 PMCID: PMC9998677 DOI: 10.3389/fpubh.2023.1132136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 02/07/2023] [Indexed: 03/14/2023] Open
Abstract
Introduction The long-term impact of COVID-19 on mental health, particularly in relation to socio-economic vulnerabilities, has received little attention. This study reports the prevalence of mental health-related symptoms among previously hospitalized patients after recovery from COVID-19, and its association with socio-economic status (SES). Methods Data collection of this cross-sectional study was conducted during February-April 2021, among previously hospitalized patients with COVID-19 like symptoms, on average six months after their discharge from the hospital. Using DASS-21, a validated scale to document symptoms of depression, anxiety, and stress, information on mental health-related symptoms were recorded from 481 respondents along with sociodemographic and economic information through telephone interviews. Chi-square tests were performed to identify significant group differences. Multinomial logistic regression analyzed the association between the changes in socioeconomic characteristics and mental health-related symptoms. Relative index of inequality (RII), slope index of inequality (SII), and concentration index (CIX) were applied to capture relevant inequalities in relation to mental health-related symptoms. Results Eleven percent of the respondents reported changes in employment status, nearly half changes in income and expenditure. Forty-five percent reported symptoms of depression, anxiety and/or stress, and 12% reported coexistence of all three symptoms. Women [Adjusted Odds Ratio, AOR: 2.95; 95% Confidence Interval, CI: 1.39-5.68], and those who reported changes in occupation [AOR: 3.04; 95% CI: 1.01-9.08] and expenditure [AOR: 2.46; 95% CI: 1.12-5.37] were more likely to report all three mental health-related symptoms compared to men and those without changes in occupation and expenditure. The older age group was less likely [AOR: 0.96; 95%CI: 0.93-0.99] to report coexistence of all three symptoms compared to their younger counterparts. Negative values of concentration index (CIX) indicate that any one mental health-related symptom was significantly concentrated among those with lower expenditure and poor SES. Conclusion This study will help in addressing mental health-related challenges after recovery from COVID-19 among the identified vulnerable groups through relevant community-based and clinical response, including counseling services, in Bangladesh and similar LMIC contexts.
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Affiliation(s)
- Asibul Islam Anik
- Department of Research, Monitoring and Evaluation, SAJIDA Foundation, Dhaka, Bangladesh
| | - Tanvir Ahmed
- Department of Research, Monitoring and Evaluation, SAJIDA Foundation, Dhaka, Bangladesh
| | - Ahmed Jojan Nandonik
- Department of Research, Monitoring and Evaluation, SAJIDA Foundation, Dhaka, Bangladesh
| | - Anwar Parvez
- Department of Research, Monitoring and Evaluation, SAJIDA Foundation, Dhaka, Bangladesh
| | - Shangjucta Das Pooja
- Department of Research, Monitoring and Evaluation, SAJIDA Foundation, Dhaka, Bangladesh
| | - Zarina Nahar Kabir
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
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Díaz-Alvites AL, Yrala-Castillo G, Al-kassab-Córdova A, Munayco CV. Associated factors, inequalities, and spatial distribution of the use of modern contraceptive methods among women of reproductive age in Peru: a population-based cross-sectional study. BMC Public Health 2022; 22:2267. [PMID: 36471291 PMCID: PMC9720945 DOI: 10.1186/s12889-022-14629-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/07/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The use of contraceptive methods in Peru has remarkably increased in recent decades. Nevertheless, despite the completeness and accessibility of family planning methods, modern contraceptive methods utilization in Peru remains below the South American average. Thus, this study aimed to elucidate the factors associated with modern contraceptive use, as well as the presence of inequalities and the spatial distribution in Peruvian women aged 15-49 years in 2019. METHODS A secondary data analysis was conducted using information from the 2019 Peruvian Demographic and Health Survey. We performed descriptive statistics, bivariate analysis, and Poisson multiple regression. Inequalities were estimated through concentration curves and Erreygers' normalized concentration index. Spatial analysis included choropleth map, Global Moran's I, Kriging interpolation and Getis-Ord-Gi* statistic. RESULTS The prevalence of modern contraceptive use was 39.3% among Peruvian women of reproductive age. Modern contraceptive use was directly associated with youth (aPR 1.39), women having their first sexual intercourse before the age of 18 (aPR 1.41), and being married but not together (aPR 1.87). In addition, speaking Quechua or Aymara (aPR 0.87) and having no children (aPR 0.59) were inversely associated with utilization of modern contraceptives. We found the presence of inequalities in the use of contraceptive methods (pro-rich distribution), although the magnitude was low. Spatial analysis unveiled the presence of a clustered distribution pattern (Moran's Index = 0,009); however, there was inter-departmental and intra-departmental heterogeneity in the predicted prevalence of the use of modern contraceptives. In addition, significant hot and cold spots were found in Peru. CONCLUSION Two out of five Peruvian women of reproductive age used modern contraceptives. It was associated with younger women's age, younger age at first sexual intercourse, being married or cohabitant, among others. No substantial inequality was found in modern contraceptive use. The prevalence was heterogeneous at the intra- and inter-departmental level. Those departments located in the south, south-east, and north-east had the lowest prevalence. Therefore, nonfinancial barriers must be tackled through multi- and cross-sectoral efforts and continue to universally provide modern contraceptives.
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Affiliation(s)
- Ana Lucía Díaz-Alvites
- grid.441917.e0000 0001 2196 144XFaculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru ,grid.441917.e0000 0001 2196 144XSociedad Científica de Estudiantes de Medicina de La Universidad Peruana de Ciencias Aplicadas (SOCIEMUPC), Lima, Peru
| | - Gonzalo Yrala-Castillo
- grid.441917.e0000 0001 2196 144XFaculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru ,grid.441917.e0000 0001 2196 144XSociedad Científica de Estudiantes de Medicina de La Universidad Peruana de Ciencias Aplicadas (SOCIEMUPC), Lima, Peru
| | - Ali Al-kassab-Córdova
- grid.441908.00000 0001 1969 0652Center of Excellence in Economic and Social Research in Health, Universidad San Ignacio de Loyola, Lima, Peru
| | - César V. Munayco
- grid.441917.e0000 0001 2196 144XFaculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
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Szwarcwald CL, Almeida WDSD, Souza Júnior PRBD, Rodrigues JM, Romero DE. Socio-spatial inequalities in healthy life expectancy in the elderly, Brazil, 2013 and 2019. CAD SAUDE PUBLICA 2022; 38Suppl 1:e00124421. [PMID: 35544919 DOI: 10.1590/0102-311x00124421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 09/09/2021] [Indexed: 11/22/2022] Open
Abstract
The growth in longevity in Brazil has drawn attention to more useful population health measures to complement mortality. In this paper, we investigate socio-spatial differences in life expectancy and healthy life expectancy based on information from the Brazilian National Health Survey (PNS), 2013 and 2019. A three-stage cluster sampling with stratification of the primary sampling units and random selection in all stages was used in both PNS editions. Healthy life expectancy was estimated by Sullivan's method by sex, age, and Federated Units (UF). Severe limitations to at least one noncommunicable chronic disease (NCD) or poor self-rated health were used to define the unhealthy state. Inequality indicators and a Principal Component analysis were used to investigate socio-spatial inequalities. From 2013 to 2019, both life expectancy and healthy life expectancy increased. The analysis by UF show larger disparities in healthy life expectancy than in life expectancy, with healthy life expectancy at age 60 varying from 13.6 to 19.9 years, in 2013, and from 14.9 to 20.1, in 2019. Healthy life expectancy in the wealthiest quintile was 20% longer than for those living in the poorest quintile. Wide socio-spatial disparities were found with the worst indicators in the UF located in the North and Northeast regions, whether considering poverty concentration or health care utilization. The socio-spatial inequalities demonstrated the excess burden of poor health experienced by older adults living in the less developed UF. The development of strategies at subnational levels is essential not only to provide equal access to health care but also to reduce risk exposures and support prevention policies for adoption of health behaviors.
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Affiliation(s)
- Celia Landmann Szwarcwald
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Wanessa da Silva de Almeida
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | - Jéssica Muzy Rodrigues
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Dalia Elena Romero
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Colomé-Hidalgo M, Campos JD, de Miguel ÁG. Exploring wealth-related inequalities in maternal and child health coverage in Latin America and the Caribbean. BMC Public Health 2021; 21:115. [PMID: 33423659 PMCID: PMC7798299 DOI: 10.1186/s12889-020-10127-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 12/23/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Maternal and child health have shown important advances in the world in recent years. However, national averages indicators hide large inequalities in access and quality of care in population subgroups. We explore wealth-related inequalities affecting health coverage and interventions in reproductive, maternal, newborn, and child health in Latin America and the Caribbean. METHODS We analyzed representative national surveys from 15 countries conducted between 2001 and 2016. We estimated maternal-child health coverage gaps using the Composite Coverage Index - a weighted average of interventions that include family planning, maternal and newborn care, immunizations, and treatment of sick children. We measured absolute and relative inequality to assess gaps by wealth quintile. Pearson's correlation coefficient was used to test the association between the coverage gap and population attributable risk. RESULTS The Composite Coverage Index showed patterns of inequality favoring the wealthiest subgroups. In eight countries the national coverage was higher than the global median (78.4%; 95% CI: 73.1-83.6) and increased significantly as inequality decreased (Pearson r = 0.9; p < 0.01). CONCLUSIONS There are substantial inequalities between socioeconomic groups. Reducing inequalities will improve coverage indicators for women and children. Additional health policies, programs, and practices are required to promote equity.
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Affiliation(s)
| | | | - Ángel Gil de Miguel
- Instituto Tecnológico de Santo Domingo, Universidad Rey Juan Carlos, Madrid, Spain
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Rivillas-García JC, Sanchez SM, Rivera-Montero D. [Social inequalities related to antimicrobial resistance in N. gonorrhoeae in ColombiaDesigualdades sociais relacionadas à resistência antimicrobiana de N. gonorrhoeae na Colômbia]. Rev Panam Salud Publica 2020; 44:e49. [PMID: 32973901 PMCID: PMC7498285 DOI: 10.26633/rpsp.2020.49] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 03/12/2020] [Indexed: 11/29/2022] Open
Abstract
Objetivo. Medir desigualdades sociales en la resistencia antimicrobiana de la Neisseria gonorrhoeae en Colombia. Métodos. Estudio ecológico utilizando un multipanel de datos desagregado a nivel subnacional de los aislamientos en la N. gonorrhoeae como proxy de resistencia antimicrobiana (RAM) entre 2009 y 2018. Se llevó a cabo una caracterización sociodemográfica, un análisis de la sensibilidad antimicrobiana de aislamientos de N. gonorrhoeae, y una medición de desigualdades en la RAM para la N. gonorrhoeae mediante el índice de desigualdad de la pendiente, el índice de desigualdad relativo y el índice de concentración. Resultados. Los hallazgos indican resistencia antimicrobiana de aislamientos de N. gonorrhoeae a penicilina (50,7%) y tetraciclina (67,3%); y la existencia de desigualdades absolutas y relativas durante el período analizado. Las barreras de acceso a servicios de salud, no haber recibido información de prevención de las infecciones de transmisión sexual, necesidades básicas insatisfechas y analfabetismo explicaron las desigualdades en la RAM de la N. gonorrhoeae. Conclusiones. Seis recomendaciones emergen para contener en gran medida la RAM en la N. gonorrhoeae: i) aumentar conciencia sobre la salud sexual y reproductiva segura; ii) repensar cómo entregar mensajes claves con enfoque de equidad; iii) mejorar los sistemas de información, prescripción y cadena de medicamentos; iv) crear coaliciones para mejorar la respuesta y compartir objetivos con el sector privado; v) mejorar la disponibilidad y desagregación de los datos; y vi) apoyar investigaciones en desigualdades en RAM.
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Affiliation(s)
- Juan Carlos Rivillas-García
- Dirección de Investigaciones, Asociación Profamilia Bogotá D.C. Colombia Dirección de Investigaciones, Asociación Profamilia, Bogotá, D.C., Colombia
| | - Sandra Marcela Sanchez
- Dirección de Investigaciones, Asociación Profamilia Bogotá D.C. Colombia Dirección de Investigaciones, Asociación Profamilia, Bogotá, D.C., Colombia
| | - Danny Rivera-Montero
- Dirección de Investigaciones, Asociación Profamilia Bogotá D.C. Colombia Dirección de Investigaciones, Asociación Profamilia, Bogotá, D.C., Colombia
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Tullo E, Lerea MJ, González R, Galeano J, Insfrán MD, Muñoz M, Aragón M, Sanhueza A. [Health and social inequalities in maternal and child health in Paraguay]. Rev Panam Salud Publica 2020; 44:e107. [PMID: 32905374 PMCID: PMC7469975 DOI: 10.26633/rpsp.2020.107] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/02/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To describe health and social inequalities in maternal and child health indicators defined in Sustainable Development Goal (SDG) 3.1 and SDG 3.2 targets based on administrative data among the departments of Paraguay in 2017. METHODS Quantitative descriptive study with ecological design. Simple gap measures and complex gradient measures based on the adjustment of negative binomial and logistic regression models were used. RESULTS Fifty percent of Paraguay's departments have estimated maternal mortality ratio (MMR) values higher than the national value. The percentage of births attended by a qualified professional in the country is 98.1%, with a range between 82.4% and 99.9%. In 13 of 18 departments, under-five mortality rate (U5MR) is higher than the national average, ranging from 4.2 to 49.2 deaths per 1 000 live births. Neonatal mortality rates (NMR) in the departments vary from 2.6 to 45.1 deaths per 1 000 live births. There are major health and social inequalities in the MMR, U5MR and NMR between the departments. There are no high inequalities in the percentage of births attended by a qualified professional between the departments. CONCLUSIONS Paraguay needs to make significant efforts to reduce the health and social inequalities that exist in the MMR, U5MR and NMR between departments. Numerical targets must be established to improve national values and reduce inequalities in these indicators, which will allow for accountability on the commitment to "leave no one behind" established in the SDG, and will help generate strategies to improve the health of women and children in Paraguay.
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Affiliation(s)
- Edgar Tullo
- Dirección General de Información Estratégica en Salud, Ministerio de Salud Pública y Bienestar SocialParaguayDirección General de Información Estratégica en Salud, Ministerio de Salud Pública y Bienestar Social, Paraguay.
| | - María Jose Lerea
- Dirección General de Información Estratégica en Salud, Ministerio de Salud Pública y Bienestar SocialParaguayDirección General de Información Estratégica en Salud, Ministerio de Salud Pública y Bienestar Social, Paraguay.
| | - Rosa González
- Dirección General de Información Estratégica en Salud, Ministerio de Salud Pública y Bienestar SocialParaguayDirección General de Información Estratégica en Salud, Ministerio de Salud Pública y Bienestar Social, Paraguay.
| | - Julio Galeano
- Dirección General de Información Estratégica en Salud, Ministerio de Salud Pública y Bienestar SocialParaguayDirección General de Información Estratégica en Salud, Ministerio de Salud Pública y Bienestar Social, Paraguay.
| | - María Delasnieve Insfrán
- Dirección General de Problemas de Salud, Ministerio de Salud Pública y Bienestar SocialParaguayDirección General de Problemas de Salud, Ministerio de Salud Pública y Bienestar Social, Paraguay.
| | - Mara Muñoz
- Organización Panamericana de la SaludAsunciónParaguayOrganización Panamericana de la Salud, Asunción, Paraguay.
| | - Miguel Aragón
- Organización Panamericana de la SaludAsunciónParaguayOrganización Panamericana de la Salud, Asunción, Paraguay.
| | - Antonio Sanhueza
- Organización Panamericana de la SaludWashington D.C.Estados Unidos de AméricaOrganización Panamericana de la Salud, Washington D.C., Estados Unidos de América.
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Rauniyar SK, Rahman MM, Rahman MS, Abe SK, Nomura S, Shibuya K. Inequalities and risk factors analysis in prevalence and management of hypertension in India and Nepal: a national and subnational study. BMC Public Health 2020; 20:1341. [PMID: 32883278 PMCID: PMC7469349 DOI: 10.1186/s12889-020-09450-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 08/25/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Hypertension is one of the leading risk factors for cardiovascular diseases in India and Nepal. Socio-economic disparity in these two countries has created wide gap in management of hypertension. However, inequalities in prevalence and management (awareness, treatment, and control) of hypertension is poorly assessed. This study analyzes the risk factors associated with prevalence and management of hypertension in India and Nepal and assesses the wealth-and education-based inequalities in them. METHODS This study used data from the Demographic and Health Survey; a cross-sectional survey conducted between January 2015 to December 2016 in India and June 2016 to January 2017 in Nepal. A total of 787,713 individuals in India and 14,454 individuals in Nepal aged between 15 and 49 years were included in the study. Respondents were classified as being hypertensive if their systolic blood pressure (SBP) readings were at least 140 mmHg or diastolic blood pressure (DBP) readings were at least 90 mmHg, or if they reported currently taking anti-hypertensive medication. Multilevel logistic regression models with random intercepts at household-and community-levels were used to identify the risk factors associated with prevalence and management of hypertension. For inequality assessment, slope index and relative index of inequalities in prevalence and management of hypertension were estimated. RESULTS Overall prevalence of hypertension in India and Nepal were 11.4% (95% confidence interval (CI), 11.4-11.5) and 19.6% (95% CI, 18.9-20.2), respectively. Less than one-third of the hypertensive population received treatment and below 20% among them had their blood pressure controlled. In both countries, wealth-and education-based inequalities in awareness, treatment, and control of hypertension were significantly high in urban and rural areas. CONCLUSION Wealth- and education-based inequalities in prevalence and management of hypertension were high among different socio-economic groups at national and sub-national levels. Tailored strategies are required to effectively manage hypertension in different regions by considering socio-economic and demographic factors.
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Affiliation(s)
- Santosh Kumar Rauniyar
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Md Mizanur Rahman
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Md Shafiur Rahman
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Sarah Krull Abe
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Shuhei Nomura
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kenji Shibuya
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Institute for Population Health Science, King's College London, London, UK
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Montañez-Hernández JC, Alcalde-Rabanal J, Reyes-Morales H. Socioeconomic factors and inequality in the distribution of physicians and nurses in Mexico. Rev Saude Publica 2020; 54:58. [PMID: 32555978 PMCID: PMC7274212 DOI: 10.11606/s1518-8787.2020054002011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/30/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To describe the human resources for health and analyze the inequality in its distribution in Mexico. METHODS Cross-sectional study based on the National Occupation and Employment Survey (ENOE in Spanish) for the fourth quarter of 2018 in Mexico. Graduated physicians and nurses, and auxiliary/technician nurses with completed studies were considered as human resources for health. States were grouped by degree of marginalization. Densities of human resources for health per 1,000 inhabitants, Index of Dissimilarity (DI) and Concentration Indices (CI) were estimated as measures of unequal distribution. RESULTS The density of human resources for health was 4.6 per 1,000 inhabitants. We found heterogeneity among states with densities from 2.3 to 10.5 per 1,000 inhabitants. Inequality was higher in the states with a very low degree of marginalization (CI = 0.4) than those with high marginalization (CI = 0.1), and the inequality in the distribution of physicians (CI = 0.5) was greater than in graduated nurses (CI = 0.3) among states. In addition, 17 states showed a density above the threshold of 4.5 per 1,000 inhabitants proposed in the Global Strategy on Human Resources for Health. That implies a deficit of nearly 60,000 human resources for health among the 15 states below the threshold. For all states, to reach a density equal to the national density of 4.6, about 12.6% of human health resources would have to be distributed among states that were below national density. CONCLUSIONS In Mexico, there is inequality in the distribution of human resources for health, with state differences. Government mechanisms could support the balance in the labor market of physicians and nurses through a human resources policy.
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Affiliation(s)
| | - Jacqueline Alcalde-Rabanal
- Instituto Nacional de Salud Pública, Centro de Investigación en Sistemas de Salud, Cuernavaca, Mor, México
| | - Hortensia Reyes-Morales
- Instituto Nacional de Salud Pública, Centro de Investigación en Sistemas de Salud, Cuernavaca, Mor, México
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Colomé-Hidalgo M, Donado Campos J, Gil de Miguel Á. Monitoring inequality changes in full immunization coverage in infants in Latin America and the Caribbean. Rev Panam Salud Publica 2020; 44:e56. [PMID: 32523606 PMCID: PMC7279119 DOI: 10.26633/rpsp.2020.56] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 03/05/2020] [Indexed: 01/02/2023] Open
Abstract
Objective. To compare inequalities in full infant vaccination coverage at two different time points between 1992 and 2016 in Latin American and Caribbean countries. Methods. Analysis is based on recent available data from Demographic and Health Surveys, Multiple Indicator Cluster Surveys, and Reproductive Health Surveys conducted in 18 countries between 1992 and 2016. Full immunization data from children 12–23 months of age were disaggregated by wealth quintile. Absolute and relative inequalities between the richest and the poorest quintile were measured. Differences were measured for 14 countries with data available for two time points. Significance was determined using 95% confidence intervals. Results. The overall median full immunization coverage was 69.9%. Approximately one-third of the countries have a high-income inequality gap, with a median difference of 5.6 percentage points in 8 of 18 countries. Bolivia, Colombia, El Salvador, and Peru have achieved the greatest progress in improving coverage among the poorest quintiles of their population in recent years. Conclusion. Full immunization coverage in the countries in the study shows higher-income inequality gaps that are not seen by observing national coverage only, but these differences appear to be reduced over time. Actions monitoring immunization coverage based on income inequalities should be considered for inclusion in the assessment of public health policies to appropriately reduce the gaps in immunization for infants in the lowest-income quintile.
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Affiliation(s)
- Manuel Colomé-Hidalgo
- Universidad Rey Juan Carlos Universidad Rey Juan Carlos Madrid Spain Universidad Rey Juan Carlos, Madrid, Spain
| | - Juan Donado Campos
- Universidad Autónoma de Madrid Universidad Autónoma de Madrid Madrid Spain Universidad Autónoma de Madrid, Madrid, Spain
| | - Ángel Gil de Miguel
- Universidad Rey Juan Carlos Universidad Rey Juan Carlos Madrid Spain Universidad Rey Juan Carlos, Madrid, Spain
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Bright T, Mújica OJ, Ramke J, Moreno CM, Der C, Melendez A, Lara Ovares E, Sandoval Domingues EI, Santana Hernandez DJ, Chadha S, Silva JC, Peñaranda A. Inequality in the distribution of ear, nose and throat specialists in 15 Latin American countries: an ecological study. BMJ Open 2019; 9:e030220. [PMID: 31326937 PMCID: PMC6661698 DOI: 10.1136/bmjopen-2019-030220] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To explore sociogeographical inequalities in the availability and distribution of ear, nose and throat specialists (ENTs) in 15 Latin American (LA) countries. DESIGN Ecological. SETTING Spanish and Portuguese-speaking countries of LA.The number of registered ENTs in 2017 was obtained from the National ENT Society in each country. OUTCOME MEASURES The ENT rate/million population was calculated at the national and subnational (eg, state) level. Three measures were calculated to assess subnational distributive inequality of ENTs: (1) absolute and (2) relative index of dissimilarity; and (3) concentration index (using the Human Development Index as the equity stratifier). Finally, the ratio of ENTs/million population in the capital area compared with the rest of the country was calculated. RESULTS There was more than a 30-fold difference in the number of ENTs/million population across the included countries-from 61.0 in Argentina (95% CI 58.7 to 63.4) to 2.8 in Guatemala (95% CI 2.1 to 3.8). In all countries, ENTs were more prevalent in advantaged areas and in capital areas. To attain distributive equality, Paraguay would need to redistribute the greatest proportion of its ENT workforce (67.3%; 95% CI 57.8% to 75.6%) and Brazil the least (18.5%; 95% CI 17.6% to 19.5%). CONCLUSIONS There is high inequality in the number and distribution of ENTs between and within the 15 studied countries in LA. This evidence can be used to inform policies that improve access to ear and hearing services in the region, such as scale-up of training of ENTs and incentives to distribute specialists equally. These actions to reduce inequities, alongside addressing the social determinants of ear and hearing health, are essential to realise Universal Health Coverage.
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Affiliation(s)
- Tess Bright
- International Centre for Evidence in Disability, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Oscar J Mújica
- Intelligence for Action in Health, Pan American Health Organization, PAHO/WHO, Washington, District of Columbia, USA
| | - Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Claudia M Moreno
- Pan American Health Organization, Washington, District of Columbia, USA
| | - Carolina Der
- Facultad de Medicina Universidad del Desarrollo, Clínica Alemana de Santiago, Santiago, Chile
| | | | - Ericka Lara Ovares
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | | | | | - Shelly Chadha
- WHO Programme for Prevention of Deafness and Hearing Loss, The World Health Organization, Geneva, Switzerland
| | - Juan Carlos Silva
- Pan American Health Organization, Washington, District of Columbia, USA
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Herran OF, Patiño GA, Gamboa EM. Socioeconomic inequalities in the consumption of fruits and vegetables: Colombian National Nutrition Survey, 2010. CAD SAUDE PUBLICA 2019; 35:e00031418. [PMID: 30892423 DOI: 10.1590/0102-311x00031418] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 09/20/2018] [Indexed: 11/21/2022] Open
Abstract
The objective of this study was to estimate inequalities in the consumption of fruits and vegetables. A multilevel study was performed based on cross-sectional data of adults from 18 to 64 years of age (n = 5,217) and in geodemographic units (n = 33). The consumption of fruits and vegetables was estimated with a food frequency questionnaire administered as part of the 2010 Colombian National Nutrition Survey (ENSIN). Inequality indices for the consumption of whole fruits and fruit juice and for raw and cooked vegetables were estimated using data on wealth, food security, geographical area and monetary poverty. The prevalence of the consumption of cooked vegetables was 64.8% (95%CI: 59.2-70.4) among men and the prevalence of the consumption of fruit juice was 86.1% (95%CI: 82.4-89.8) among women. The frequency of the consumption of fruit juice was 1.03 times/day (95%CI: 0.93-1.14) among women. The prevalence and frequency fruits and vegetables consumption per day for the three socioeconomic variables considered in this study are higher according to the higher socioeconomic level (p < 0.05), except for the consumption frequency of whole fruits/day (p = 0.24). At the individual level, the Gini coefficient for frequency/day ranged from 0.51 to 0.62. At the ecological level, the Gini index for prevalence ranged from 0.04 to 0.14; and for frequency/day ranged from 0.03 to 0.11. The Colombian population does not meet fruits and vegetables consumption recommendations. Men and women favor the consumption of fruit juice over whole fruits. The inequality in vegetable consumption is clear, with men at a disadvantage. The poor eat fewer fruits and vegetables.
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Mújica ÓJ, Moreno CM. [From words to action: measuring health inequalities to "leave no one behind"Da retórica à ação: mensurar as desigualdades em saúde para não deixar ninguém atrás]. Rev Panam Salud Publica 2019; 43:e12. [PMID: 31093236 PMCID: PMC6393735 DOI: 10.26633/rpsp.2019.12] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 10/11/2018] [Indexed: 02/05/2023] Open
Abstract
Health equity is a guiding principle for public health action. Its noble purpose is to build healthier, sustainable societies that are also more just and inclusive. This is reflected in the global commitment to "leave no one behind", expressed in the 2030 Agenda for Sustainable Development, although none of the Agenda's 169 targets focuses on reducing health inequalities, either conceptually or quantitatively. Recognizing the urgency to go beyond words and move forward decidedly in the design and implementation of pro-equity social and health policies at both the local and global levels, this special report reviews the conceptual and methodological framework for tackling health equity. Concepts and methodology are explicitly linked in a practical proposal that promotes the analytical use of subnationally disaggregated administrative data to inform decision-making in that area. This report concludes by proposing the need to institutionalize the measurement, analysis, and monitoring of social disparities in health to create effective national capacity to act on the social and environmental determinants of health and ensure accountability in the commitment to "leave no one behind" on the road to sustainable development, universal health, and social justice.
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Affiliation(s)
- Óscar J Mújica
- Unidad de Análisis de Salud, Métricas y Evidencia, Departamento de Evidencia e Inteligencia para la Acción en Salud, Organización Panamerica de la Salud, Washington DC, Estados Unidos de América
| | - Claudia M Moreno
- Dirección de Epidemiología y Demografía, Ministerio de Salud y Protección Social, Bogotá DC, Colombia
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Tetamanti JMD, Rocha E, Munsberg G, Peixoto Castro JH, Neutzling ADS, Jaime SF, Schuler LJ. [Development of a georeferenced system for the management, mobility and monitoring of primary care in community health]. Salud Colect 2018; 14:121-37. [PMID: 30020355 DOI: 10.18294/sc.2018.1210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 08/10/2017] [Indexed: 11/24/2022] Open
Abstract
Community health agents carry out significant actions on the ground to provide prevention and care and bring health services to families. These practices in the field constitute a constant collective mapping process using the knowledge of the territory that the agents possess. Based on intensive fieldwork starting in 2012 in conjunction with local social organizations and health institutions in Brazil and Argentina, the binational project App+Health (App+Salud in Spanish and App+Saúde in Portugués) was initiated. The project's objective was to develop a monitoring and georeferencing system for community health management in the form of an application for cell phones or tablets with internet access, which would take into account the basic conditions of the environment and movement history of users and connect map updating methodologies using social cartography with free collaborative mapping platforms. As a result, the beta version of App+Health was developed, through a heightened process of exchange of interdisciplinary knowledge.
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Alvis-Zakzuk NJ, Castañeda-Orjuela C, Díaz DP, Castillo L, Cotes KP, Chaparro P, Paternina-Caicedo ÁJ, Alvis-Guzmán NR, De la Hoz FP. Inequalities on mortality due to acute respiratory infection in children: A Colombian analysis. Biomedica 2018; 38:586-93. [PMID: 30653873 DOI: 10.7705/biomedica.v38i4.4062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 06/04/2018] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Acute respiratory infections (ARI) are a leading public health issue worldwide. OBJECTIVE To explore the inequalities in ARI mortality rates in under-5, according to socioeconomic characteristics. MATERIALS AND METHODS We conducted an ecological analysis to study inequalities at municipal level due to ARI mortality in children under 5 years. The data were obtained from official death records of the Departamento Administrativo Nacional de Estadística. The analysis of inequalities in the under-5 mortality rate (U5MR) included: 1) Classification of the population in different socio-economic strata, and 2) measurement of the degree of inequality. We used the ARI-U5MR as an outcome measurement.The mortality rates were estimated at national and municipal levels for the years 2000, 2005, 2010, and 2013. Rate ratios, rates differences, and concentration curves were calculated to observe the inequalities. RESULTS A total of 18,012 children under 5 years died by ARI in Colombia from 2000 to 2013. ARIU5MR was greater in boys than in girls. During this period, an increase in the infant mortality relative gap in both boys and girls was observed. In 2013, the U5MR evidenced that for boys from municipalities with the highest poverty had a 1.6-fold risk to die than those in municipalities with the lowest poverty (low tercile). In girls, the ARI-U5MR for 2005 and 2013 in the poorest tercile was 1.5 and 2 times greater than in the first tercile, respectively. CONCLUSION Colombian inequalities in the ARI mortality rate among the poorest municipalities compared to the richest ones continue to be a major challenge in public health.
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Dimitrovová K, Costa C, Santana P, Perelman J. "Evolution and financial cost of socioeconomic inequalities in ambulatory care sensitive conditions: an ecological study for Portugal, 2000-2014". Int J Equity Health 2017; 16:145. [PMID: 28810869 PMCID: PMC5558734 DOI: 10.1186/s12939-017-0642-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 08/06/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hospitalizations for Ambulatory Care Sensitive Conditions (ACSC) are specific conditions for which hospitalization is thought to be avoidable through patient education, health promotion initiatives, early diagnosis and by appropriate chronic disease management, and have been shown to be greatly influenced by socioeconomic (SE) characteristics. We examined the SE inequalities in hospitalization rates for ACSC in Portugal, their evolution over time (2000-2014), and their associated financial burden. METHODS We modeled municipality-level ACSC hospitalization rates per 1000 inhabitants and ACSC hospitalization-related costs per inhabitant, for the 2000-2014 period (n = 4170), as a function of SE indicators (illiteracy and purchasing power, in quintiles), controlling for the proportion of elderly, sex, disease specific mortality rate, population density, PC supply, and time trend. The evolution of inequalities was measured interacting SE indicators with a time trend. Costs attributable to ACSC related hospitalization inequalities were measured by the predicted values for each quintile of the SE indicators. RESULTS Hospitalization rate for ACSC was significantly higher in the 4th quintile of illiteracy compared with the 1st quintile (beta = 1.97; p < 0.01), and significantly lower in the 5th quintile of purchasing power, compared with the 1st quintile (beta = - 1.19; p < 0.05). ACSC hospitalization-related costs were also significantly higher in the 4th quintile of illiteracy compared with the 1st quintile (beta = 4.04€; p < 0.05), and significantly lower in the 5th quintile of purchasing power, compared with the 1st quintile (beta = - 4,69€; p < 0.01). The SE gradient significantly increased over the 2000-2014 period, and the annual cost of inequalities were estimated at more than 15 million euros for the Portuguese NHS. CONCLUSION There was an increasing SE patterning in ACSC related hospitalizations, possibly reflecting increasing SE inequalities in early and preventive high-quality care, imposing a substantial financial burden to the Portuguese NHS.
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Affiliation(s)
- Klára Dimitrovová
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560 Lisbon, Portugal
| | - Cláudia Costa
- Centre of Studies on Geography and Spatial Planning, University of Coimbra, Faculdade de Letras Colégio de S. Jerónimo, 3004-530 Coimbra, Portugal
| | - Paula Santana
- Centre of Studies on Geography and Spatial Planning, Department of Geography, University of Coimbra, Faculdade de Letras Colégio de S. Jerónimo, 3004-530 Coimbra, Portugal
| | - Julian Perelman
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560 Lisbon, Portugal
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560 Lisbon, Portugal
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Szwarcwald CL, Montilla DER, Marques AP, Damacena GN, Almeida WDSD, Malta DC. Inequalities in healthy life expectancy by Federated States. Rev Saude Publica 2017; 51:7s. [PMID: 28591354 PMCID: PMC5676373 DOI: 10.1590/s1518-8787.2017051000105] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 10/23/2016] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To estimate the healthy life expectancy at 60 years by sex and Federated States and to investigate geographical inequalities by socioeconomic status. METHODS Healthy life expectancy was estimated by the Sullivan method, based on the information of the National Survey on Health, 2013. Three criteria were adopted for the definition of “unhealthy state”: self-assessment of bad health, functionality for performing the activities of daily living, and the presence of noncommunicable disease with intense degree of limitation. The indicator of socioeconomic status was built based on the number of goods at household and educational level of the head of household. To analyze the geographical inequalities and socioeconomic level, inequality measures were calculated, such as the ratio, the difference, and the angular coefficient. RESULTS Healthy life expectancy among men ranged from 13.8 (Alagoas) to 20.9 (Espírito Santo) for the self-assessment criterion of bad health. Among women, the corresponding estimates were always higher and ranged from 14.9 (Maranhão) to 22.2 (São Paulo). As to the ratio of inequality by Federated State, the medians were always higher for healthy life expectancy than for life expectancy, regardless of the definition adopted for healthy state. Regarding the differences per Federated State, the healthy life expectancy was seven years higher in one state than in another. By socioeconomic status, differences of three and four years were found, approximately, between the last and first fifth, for men and women, respectively. CONCLUSIONS Despite the association of the mortality indicators with living conditions, the inequalities are even more pronounced when the welfare and the limitations in usual activities are considered, showing the necessity to promote actions and programs to reduce the socio-spatial gradient.
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Affiliation(s)
- Célia Landmann Szwarcwald
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Dália Elena Romero Montilla
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Aline Pinto Marques
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Giseli Nogueira Damacena
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Wanessa da Silva de Almeida
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Deborah Carvalho Malta
- Departamento de Enfermagem Materno Infantil e Saúde Pública. Escola de Enfermagem. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
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Abstract
BACKGROUND No comprehensive study currently exists on the supply of ophthalmologists across Latin America. We explored sociogeographic inequalities in the availability and distribution of ophthalmologists across 14 Latin American countries. METHODS The National Ophthalmologic Societies of Argentina, Bolivia, Brazil, Colombia, Costa Rica, Chile, the Dominican Republic, Ecuador, Guatemala, Mexico, Paraguay, Peru, Uruguay and Venezuela provided data on affiliated ophthalmologists by first-order subnational divisions in 2013. Human Development Index (HDI) estimates at the corresponding subnational division were used as equity stratifiers. Distributional inequality of ophthalmologists within each country was assessed by the health concentration index (HCI) and the index of dissimilarity (ID), along with the mean level of ophthalmologists per population. RESULTS Across all countries studied, there were 5.2 ophthalmologists per 100 000 population on average (95% CI 5.0 to 5.4) in 2013, with a mean HCI of 0.26 (0.16 to 0.37) and a mean relative ID of 22.7% (20.9% to 24.7%). There was wide inequality in ophthalmologist availability between countries, ranging from 1.2 (1.1 to 1.4) in Ecuador to 8.6 (8.5 to 8.8) in Brazil. All countries had positive (ie, pro-rich) HCI values ranging from 0.68 (0.66 to 0.71) in Guatemala to 0.02 (-0.11 to 0.14) in Venezuela. Correspondingly, redistributive potential to achieve equity was closest in Venezuela (ID: 1.5%) and farthest in Guatemala (ID: 60.3%). Benchmarked against regional averages, most countries had a lower availability of ophthalmologists and higher relative inequality. CONCLUSIONS There is high inequality in the level and distribution of ophthalmologists between and within countries in Latin America, with a disproportionate number concentrated in more developed, socially advantaged areas. More equitable access to ophthalmologists could be achieved by implementing incentivised human resources redistribution programmes and by improving the social determinants of health in underserved areas.
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Affiliation(s)
- Hannah Hong
- Department of Health Policy and Management, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Oscar J Mújica
- Sustainable Development and Health Equity, Pan American Health Organization, Washington District of Columbia, USA
| | - José Anaya
- Instituto Mexicano de Oftalmologia, Mexico City, Mexico
| | | | - Ellery López
- Instituto Mexicano de Oftalmologia, Mexico City, Mexico
| | - Juan Carlos Silva
- Prevención de Ceguera y Salud Ocular, Organización Panamericana de la Salud, Bogotá, Colombia
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de Souza Braga L, Lima-Costa MF, César CC, Macinko J. Social Inequalities on Selected Determinants of Active Aging and Health Status Indicators in a Large Brazilian City (2003-2010). J Aging Health 2015; 28:180-96. [DOI: 10.1177/0898264315589575] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To assess trends in social inequalities among 2,624 elderly living in Belo Horizonte, Brazil, in three domains of the World Health Organization’s Active Aging model (physical environment, social determinants, use of health services) and health status indicators. Method: Data came from two representative household surveys conducted in 2003 and 2010. Social inequality was measured by the slope and the relative index of inequality. Educational level was used to define socioeconomic status. Results: Significant improvements were observed in the prevalence rates of 7 out of 12 indicators. However, the social inequalities persisted through 10 out of 12 selected active aging and health status indicators, except for fear of falling on the sidewalks/crossing the streets and fear of being robbed. Discussion: Social inequalities persistence might be assigned to the continuity of unequal distribution of resources among groups with different educational levels.
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Affiliation(s)
| | - Maria Fernanda Lima-Costa
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Fundação Oswaldo Cruz, Belo Horizonte, Brazil
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Rothenberg R, Stauber C, Weaver S, Dai D, Prasad A, Kano M. Urban health indicators and indices--current status. BMC Public Health 2015; 15:494. [PMID: 25981640 PMCID: PMC4491866 DOI: 10.1186/s12889-015-1827-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 05/11/2015] [Indexed: 11/10/2022] Open
Abstract
Though numbers alone may be insufficient to capture the nuances of population health, they provide a common language of appraisal and furnish clear evidence of disparities and inequalities. Over the past 30 years, facilitated by high speed computing and electronics, considerable investment has been made in the collection and analysis of urban health indicators, environmental indicators, and methods for their amalgamation. Much of this work has been characterized by a perceived need for a standard set of indicators. We used publication databases (e.g. Medline) and web searches to identify compilations of health indicators and health metrics. We found 14 long-term large-area compilations of health indicators and determinants and seven compilations of environmental health indicators, comprising hundreds of metrics. Despite the plethora of indicators, these compilations have striking similarities in the domains from which the indicators are drawn--an unappreciated concordance among the major collections. Research with these databases and other sources has produced a small number of composite indices, and a number of methods for the amalgamation of indicators and the demonstration of disparities. These indices have been primarily used for large-area (nation, region, state) comparisons, with both developing and developed countries, often for purposes of ranking. Small area indices have been less explored, in part perhaps because of the vagaries of data availability, and because idiosyncratic local conditions require flexible approaches as opposed to a fixed format. One result has been advances in the ability to compare large areas, but with a concomitant deficiency in tools for public health workers to assess the status of local health and health disparities. Large area assessments are important, but the need for small area action requires a greater focus on local information and analysis, emphasizing method over prespecified content.
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Affiliation(s)
| | - Christine Stauber
- School of Public Health, Georgia State University, Atlanta, GA, USA.
| | - Scott Weaver
- School of Public Health, Georgia State University, Atlanta, GA, USA.
| | - Dajun Dai
- Department of Geosciences, College of Arts and Sciences, Georgia State University, Atlanta, GA, USA.
| | - Amit Prasad
- The World Health Organization Center for Health Development (The WHO Kobe Center), Kobe, Japan.
| | - Megumi Kano
- The World Health Organization Center for Health Development (The WHO Kobe Center), Kobe, Japan.
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Espinas JA, Aliste L, Fernández E, Argimon JM, Tresserras R, Borras JM. Narrowing the Equity Gap: The Impact of Organized versus Opportunistic Cancer Screening in Catalonia (Spain). J Med Screen 2011; 18:87-90. [DOI: 10.1258/jms.2011.010086] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives To assess the impact on equity of access of an organized breast cancer screening programme, compared with opportunistic breast and cervical cancer screening activities. Methods Two cross-sectional health interview surveys conducted in 1994 and 2006 in Catalonia (Spain), with 6382 and 7653 women participating in both surveys. The main outcome measures were having undergone regular mammography, and regular cytology. Age-standardized prevalence rates for both screening tests were computed using the direct method. The relative inequality index was computed to measure changes over time in inequality on screening utilization. Results Participation among women aged 50-69 has increased after the introduction of the organized breast screening programme; the greatest impact has been observed among those women with lower educational levels (from 17% in 1994 to 79% in 2006). Equity of access by education was particularly increased in the target group for breast cancer screening. Conclusion This study indicates that an organized screening programme could improve participation and equity of access.
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Affiliation(s)
- Josep A Espinas
- Cancer Screening Unit, Catalan Cancer Strategy, Hospital Duran i Reynals, Gran Via s/n KM 2,7, 08907-Hospitalet, Spain
| | - Luisa Aliste
- Cancer Screening Unit, Catalan Cancer Strategy, Hospital Duran i Reynals, Gran Via s/n KM 2,7, 08907-Hospitalet, Spain
| | - Esteve Fernández
- Senior Lecturer, Cancer Prevention and Control Unit, Catalan Institute of Oncology, IDIBELL, Gran Via s/n KM 2,7 08907-Hospitalet, Spain; Department of Clinical Sciences, IDIBELL, University of Barcelona, C/Feixa Ilarga s/n, 08907-Hospitalet, Spain
| | - Josep M Argimon
- Health Care Assessment Unit, Catalan Health Service, Travessera Corts 129-131; 08028-Barcelona, Spain
| | - Ricard Tresserras
- Health Plan Unit, Department of Health, Travessera Corts 129-131; 08028-Barcelona, Spain
| | - Josep M Borras
- Department of Clinical Sciences, IDIBELL, University of Barcelona, C/Feixa Ilarga s/n, 08907-Hospitalet, Spain; Catalan Cancer Strategy, Hospital Duran i Reynals, Gran via KM 2,7, 08907-Hospitalet, Barcelona, Spain
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Fang P, Dong S, Xiao J, Liu C, Feng X, Wang Y. Regional inequality in health and its determinants: evidence from China. Health Policy 2010; 94:14-25. [PMID: 19735959 DOI: 10.1016/j.healthpol.2009.08.002] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Revised: 07/25/2009] [Accepted: 08/02/2009] [Indexed: 11/23/2022]
Abstract
Health inequality is a problem with great political importance all over the world. Urban-rural inequality in health has attracted great attentions in recent years in China, but very few researches have been undertaken into regional discrepancies in health. This research aims at measuring the degree of regional health inequality in China and identifying its determinants. Indicators for health, socioeconomic status, health resources and health services delivery were selected through Delphi consultations from 18 experts. With cross-sectional data from 31 provinces, composite health indexes were generated. The regional inequality in health was described by Lorenz curve and measured by Gini coefficient. The determinants of health inequality were identified through canonical correlation analysis. The results showed that there existed distinct regional disparities in health in China, which were mainly reflected in "Maternal & Child Health" and "Infectious Diseases", not in the most commonly used health indicator average life expectancy. The regional health inequality in China was increasing with the rapid economic growth. The regional health inequality was associated with not only the distribution of wealth, but also the distribution of health resources and primary health care services. Policy makers need to be aware of three major challenges when they try to achieve and maintain equality in distribution of health: First, the most commonly used health indicators are not necessarily sensitive enough to detect health inequalities. Second, increase in health inequality is often accompanied with rapid economic growth and increase in life expectancy. Countries in transition are facing the greatest challenge in developing a fair and equitable health care system. Finally, investment in health resources does bring about differences in distribution of health. However, primary health care plays a more important role than hospital services in reducing regional disparities in health.
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Eslava-Schmalbach J, Alfonso H, Oliveros H, Gaitán H, Agudelo C. A new Inequity-in-Health Index based on Millennium Development Goals: methodology and validation. J Clin Epidemiol 2007; 61:142-50. [PMID: 18177787 DOI: 10.1016/j.jclinepi.2007.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2006] [Revised: 04/22/2007] [Accepted: 05/03/2007] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Developing a new Inequity-in-Health Index (IHI) assuming inequity as "inequality of health outcomes," based on Millennium Development Goals (MDG). STUDY DESIGN AND SETTING Ecological study. Countries from around the world were included from United Nations, the World Bank, and a nonprofit organization's databases. The reliability and validity of this bidimensional IHI was tested. Main factor analysis (promax rotation) and main component analysis were used. RESULTS Six variables were used for constructing the IHI was constructed with six variables: underweight children, child mortality, death from malaria in children aged 0-4, death from malaria at all ages, births attended by skilled health personnel, and immunization against measles. The IHI had high internal consistency (Cronbach's alpha=0.8504), was reliable (Spearman>0.9, P=0.0000), and had 0.3033pi around the world (range: 0pi-0.5984pi). IHI had high correlation with the human development and poverty indexes, health gap indicator, life expectancy at birth, probability of dying before 40 years of age, and Gini coefficients (Spearman>0.7, P=0.0000). IHI discriminated countries by income, region, indebtedness, and corruption level (Kruskal Wallis, P<0.01). IHI had sensitivity to change (P=0.0000). CONCLUSION IHI is a bidimensional, valid and reliable index to monitor MDG. A new reliable methodology for developing bidimensional indicators is shown, which could be used for constructing other ones with their corresponding scores and graphs.
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