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1.
Lancet Haematol ; 11(4): e299-e308, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38432241

RESUMEN

Sickle cell disease has a growing global burden falling primarily on low-income countries (LICs) and lower-middle-income countries (LMICs) where comprehensive care is often insufficient, particularly in rural areas. Integrated care models might be beneficial for improving access to care in areas with human resource and infrastructure constraints. As part of the Centre for Integration Science's ongoing efforts to define, systematise, and implement integrated care delivery models for non-communicable diseases (NCDs), this Review explores models of care for sickle cell disease in LICs and LMICs. We identified 99 models from 136 studies, primarily done in tertiary, urban facilities in LMICs. Except for two models of integrated care for concurrent treatment of other conditions, sickle cell disease care was mostly provided in specialised clinics, which are low in number and accessibility. The scarcity of published evidence of models of care for sickle cell disease and integrated care in rural settings of LICs and LMICs shows a need to implement more integrated models to improve access, particularly in rural areas. PEN-Plus, a model of decentralised, integrated care for severe chronic non-communicable diseases, provides an approach to service integration that could fill gaps in access to comprehensive sickle cell disease care in LICs and LMICs.


Asunto(s)
Prestación Integrada de Atención de Salud , Enfermedades no Transmisibles , Humanos , Países en Desarrollo , Enfermedades no Transmisibles/terapia , Pobreza
2.
Creat Nurs ; 30(1): 65-73, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-38304931

RESUMEN

Holistic nursing practice requires an understanding of the constraints of poverty as one of the social determinants of health. Future nurses need to be change agents for social justice. A descriptive, qualitative study was conducted to explore students' experience of the Missouri Association for Community Action Poverty Simulation© (CAPS) and its impact on empathy and social justice awareness among a purposive sample of 56 sophomore baccalaureate nursing students at a public university in the Northeastern United States. Inductive thematic analysis was applied to data collected from a postparticipation reflection paper. Five themes emerged: (a) emotions, (b) personal history of poverty, (c) empathy, (d) rising advocacy, and (e) lessons learned. The results support that the CAPS simulation provides an experiential opportunity which impacts empathy and foundational attitudes to be a change agent for social justice. Recommendations include structured education about social determinants of health prior to the CAPS simulation, continued education throughout nursing curricula, and experiential opportunities to apply social justice skills before graduation.


Asunto(s)
Bachillerato en Enfermería , Estudiantes de Enfermería , Humanos , Empatía , Estudiantes de Enfermería/psicología , Actitud del Personal de Salud , Bachillerato en Enfermería/métodos , Pobreza/psicología , Justicia Social
3.
Asia Pac J Public Health ; 36(2-3): 246-248, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38294024

RESUMEN

The International Day of the World's Indigenous Peoples and the Tribal Pride Day hold significant importance in India, home to 106 million indigenous individuals. There are 705 recognized Scheduled Tribes (STs) in India that enrich the nation's cultural fabric but experience disproportionately high morbidity and mortality. Historical injustice, geographic isolation, and cultural diversity deeply influence ST health causing disparities between indigenous and non-indigenous health indicators. To meet Sustainable Development Goals, India established the Ministry of Tribal Affairs and implemented various health initiatives. However, climate change, deforestation, limited education and employment opportunities, poverty, and under-representation pose a challenge. Empowerment, inclusive policies, community-specific targets, resource allocation, technology utilization, and multi-sectoral collaboration are vital for indigenous health. Achieving health equity for indigenous communities is a global commitment and moral imperative. By addressing historical wrongs, and working holistically, we must ensure that indigenous communities in India and beyond enjoy improved health and well-being.


Asunto(s)
Pobreza , Humanos , Escolaridad , India
4.
J Natl Med Assoc ; 116(1): 83-92, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-38172041

RESUMEN

The COVID-19 pandemic halted many in-person programs of research and required researchers to pivot to technology-enhanced approaches. To date, there are no examples or guidelines on how to use technology to implement health promotion programs rooted in the community-based participatory research (CBPR) model among low-income older Black adults. The aims of this paper are (a) to describe and report on the health-related outcomes of an in-person CBPR model-based health promotion intervention program for older Black adults in a low-income community, and (b) to describe the process of adapting this program to a technology-enhanced and Zoom-delivered format and provide preliminary evidence on the health-related outcomes and acceptability of this program. This paper highlights the potential benefits of a technology-enhanced and Zoom-delivered health promotion program among low-income older Black adults and provides recommendations to optimize such efforts to foster these benefits. These recommendations are aligned with the four domains of the CBPR model (i.e., contexts, partnership processes, intervention and research, and outcomes). We conclude that CBPR model-based, technology implemented health promotion interventions for low-income older Black adults are acceptable to such adults and should attend to the values, perspectives, and preferences of these individuals. The information in this manuscript is relevant to health promotion specialists at this seemingly ongoing though post-pandemic era because technology-enhanced interventions are scalable and cost-effective and those anchored in CBPR are well-positioned to promote health equity.


Asunto(s)
Promoción de la Salud , Pandemias , Humanos , Pandemias/prevención & control , Población Negra , Pobreza , Investigación Participativa Basada en la Comunidad , Negro o Afroamericano
5.
Fam Process ; 63(2): 749-767, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38258316

RESUMEN

How Black Americans in the United States (U.S.) make sense of a sociopolitical climate marked by racist imagery, tensions, and police violence is important to understand given the numerously documented detrimental effects of racism-related stress on the well-being of Black parents and children. Informed by Racism-Related Stress Theory, the current study employed a convergent parallel mixed methods design to better understand the ways racism-related stressors in the sociopolitical climate impacted the daily lives and mental health of a sample of Black families with low income. Seventy-eight Black American preadolescents (Mage = 11.0; 43.6% girls) and their parents (79% mothers; 76% living below the U.S. federal poverty level [FPL]) from the southwestern U.S. reported their symptoms of depression and how they had been affected by racial stressors in the sociopolitical climate between Fall 2018 and Summer 2019. A nested sample of 10 parents (80% mothers; 80% living below the FPL) from the quantitative sample also participated in a semi-structured interview. Meta-inferences across methods were drawn pertaining to the influence of child gender on parents' interpretation of effects for children, the toll racism-related stress in the sociopolitical climate takes on Black families, and the transferal of effects on parents to children through parenting and parental depressive symptoms. Findings spotlight the need for policies and family-centered programming that address the racism-related stress faced by many Black youth and their families. Providing families with opportunities and tools that can potentially mitigate harmful effects and foster empowerment could promote positive and lasting change.


Asunto(s)
Negro o Afroamericano , Racismo , Humanos , Femenino , Masculino , Negro o Afroamericano/psicología , Niño , Racismo/psicología , Adulto , Estrés Psicológico/psicología , Estrés Psicológico/etnología , Política , Padres/psicología , Depresión/etnología , Depresión/psicología , Pobreza/psicología , Estados Unidos , Sudoeste de Estados Unidos
6.
Curr Opin Pediatr ; 36(1): 10-16, 2024 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-37972976

RESUMEN

PURPOSE OF REVIEW: This review evaluates the current evidence for relationships of social factors with childhood obesity and for a role of social care in reduction of childhood obesity. RECENT FINDINGS: Most literature on the relationship between social factors and childhood obesity has examined food insecurity as a risk factor for obesity. Associations between food insecurity and excess weight in children are most consistent during infancy and among those with food insecurity at more than one time point. A few pilot food security interventions that link patients with produce or groceries show feasibility and potential promise for reducing childhood obesity risk factors. However, full-scale, randomized studies to examine interventions that reduce social needs and their effects on childhood obesity are lacking. Future research is needed to examine holistic social care approaches to effectively reduce childhood obesity risk factors. SUMMARY: Food insecurity acts as a barrier to childhood obesity prevention and treatment. Patient-centered, validated measures of social needs and effective interventions to address social needs are needed to equitably prevent and treat childhood obesity.


Asunto(s)
Obesidad Infantil , Humanos , Niño , Obesidad Infantil/prevención & control , Obesidad Infantil/etiología , Pobreza , Abastecimiento de Alimentos , Factores de Riesgo , Apoyo Social
7.
Am J Trop Med Hyg ; 110(2): 303-310, 2024 02 07.
Artículo en Inglés | MEDLINE | ID: mdl-38150738

RESUMEN

Noma (cancrum oris) is an orofacial gangrene affecting young children living in extreme poverty. The acute morbidity is high, and survivors suffer from physical and social sequelae. When diagnosed early, noma can be cured. Noma is especially prevalent in sub-Saharan Africa, where traditional medicine is the norm. The aim of this work was to provide 1-day training to traditional healers in Burkina Faso and to evaluate change in knowledge of noma across time. A sample of 78 healers who attended the training were asked to complete the same questionnaire before, immediately after, and 8 months after the training. A total of 66 healers completed the entire study. Before training, more than 40% of the participants did not know any of its key messages. Most of the key messages were acquired and still present after 8 months by a large proportion of the participants. Systematic intraoral examination was practiced by 7 (9.0%) of the traditional healers before training, and 43 (65.2%) reported doing so 8 months after training. The key messages aiming to improve early diagnosis as well as rapid and adequate treatment (the recognition of facilitating factors and the need to perform a systematic oral examination and to advise hospital transfer) have been well integrated. The study suggests that organizing a self-managed training program is feasible when done within an association, as was the case here, and owing to the willingness to collaborate shown by the traditional healers who participated in our study.


Asunto(s)
Noma , Humanos , Niño , Preescolar , Noma/diagnóstico , Practicantes de la Medicina Tradicional , Burkina Faso/epidemiología , Medicina Tradicional , Pobreza
8.
J Ethnobiol Ethnomed ; 19(1): 65, 2023 Dec 19.
Artículo en Inglés | MEDLINE | ID: mdl-38115132

RESUMEN

In this debate article, we have tried to discuss Traditional Ecological Knowledge (TEK) and its close link to the available resources and lack of options in the indigenous communities. We came across the article of Hartel et al. where they initiated a discussion on this important but debatable topic of TEK and its merits and demirits for the environment. We believe that this discourse could continue to clarify both sides of the picture. Our research group is working on species facing extinction threats due to extensive utilization, leading to overexploitation of the taxa, which the TEK seldom cares for. We are of the opinion that the marginalized tribal communities living around the globe extensively use some of the species and natural resources for their food, fodder, fiber, shelter, energy, health and other benefits, irrespective of their conservation needs, and many other ecosystem services. They have to sustain their basic live's needs from the resources available for their livelihood. They collect economically important medicinal and other species in large quantities to gain higher earnings, rather than thinking of the issues faced by them. Hence, we believe that the continuity and utilization of TEK are driven by poverty and lack of choices rather than positive environmental values, historically. Nevertheless, those communities sometimes have their local system of protection which sometimes works very well or otherwise with the passage of time and the formation of government-driven regulations in the recent past, TEK itself has lost its real sense especially, related to conservation and management. Therefore, TEK could be linked with existing research-based policies and regulations for long-lasting benefits to the environment and its sustainable future. Such bridging can benifit all the stake hoders-the TEK holders, regulatory bodies, government agencies and many more. This debate can lead to a positive and critical discourse towards the clarification of the conundrum under consideration as well as creation of more questions hyptheses related to TEK.


Asunto(s)
Conservación de los Recursos Naturales , Ecosistema , Conocimiento , Alimentación Animal , Recursos Naturales , Pobreza , Humanos , Pueblos Indígenas
9.
Soc Sci Med ; 336: 116249, 2023 11.
Artículo en Inglés | MEDLINE | ID: mdl-37742541

RESUMEN

BACKGROUND: Community-level socioeconomic disparities have a significant impact on an individual's health and overall well-being. However, current estimates for poverty threshold, which are often used to assess community-level socioeconomic status, do not account for cost-of-living differences or geography variability. The goals of this study were to compare geographic county-level overlap and gaps in access to care for households within poverty and working poor designations. METHODS: Data were obtained for 21 continental United States (US) states from the United Way's Asset Limited, Income Constrained, Employed (ALICE) households for 2021. Raw data contained the percentage of households at the federal poverty level, the percentage of households at the ALICE designations (working poor), and the total households at the county level. Local Moran's I tests for spatial autocorrelation were performed to identify the clustering of poverty and ALICE households. These clusters were overlaid with a 30-min drive time from critical access hospitals' physical addresses. FINDINGS: County-level clusters of ALICE (working poor) households occurred in different areas than the clustering of poverty households. Of particular interest, the extent to which the 30-min drive time to critical care overlapped with clusters of ALICE or poverty changed depending on the state. Overall, clustering in ALICE and poverty overlapped with 30-min drive times to critical care between 46 and 90% of the time. However, the specific states where disparities in access to care were prominent differed between analyses focused on households in poverty versus the working poor. INTERPRETATIONS: Findings highlight a disparity in equitable inclusion of individuals across the spectrum of socioeconomic status. Furthermore, they suggest that current public health programming and benefits which support low socioeconomic populations may be missing a vulnerable sub-population of working families. Future studies are needed to better understand how to address the health disparities facing individuals who are above the poverty threshold but still struggle economically to meet based needs.


Asunto(s)
Salud Poblacional , Trabajadores Pobres , Humanos , Estados Unidos , Salud Pública , Planificación en Salud , Pobreza , Factores Socioeconómicos
10.
Cad Saude Publica ; 39(7): e00218022, 2023.
Artículo en Portugués | MEDLINE | ID: mdl-37585906

RESUMEN

Social and community networks constitute an important social determinant of health, especially in the poorer segments of civil society and in their struggles to guarantee the right to health care. This study sought to understand the social and community networks created by women living in a low-income community and their relationship with the development of health care in this social group. Semi-structured interviews were conducted with 11 women participating in a nongovernmental organization in the community, and the data were subjected to content analysis. The analysis highlighted four categories: the community as a large network, formed by multiple interconnected dynamic networks; the network of "aunts", women with an important role in the care of the community, treated as part of the family; the conversation circles, such as the rite of periodic meeting on the sidewalks, indicated as an important space that guarantees emotional stability and quality of life; and the benzedeiras with the use of medicinal plants, they are reference care within the community, providing disease prevention, health treatment, and referral to the health care unit when necessary. We concluded that the social and community networks created by the participants are important social determinants, and health facilities registered in the territory should value such networks.


As redes sociais e comunitárias constituem um importante determinante social de saúde, especialmente nos segmentos populares da sociedade civil e em suas lutas para garantir o direito à saúde. Esta pesquisa buscou compreender quais são as redes sociais e comunitárias constituídas por mulheres residentes em uma comunidade de baixa renda e sua relação com a produção da saúde nesse grupo social. Foram realizadas entrevistas semiestruturadas com 11 mulheres participantes de uma organização não governamental (ONG) da comunidade, e os dados foram submetidos à análise de conteúdo. A análise destacou quatro categorias: a comunidade como uma grande rede - formada por múltiplas redes dinâmicas interligadas; a rede das "tias" - mulheres com papel importante no cuidado da comunidade, tratadas como parte da família; as rodas de conversa - como o rito de encontro periódico nas calçadas, apontado como importante espaço garantidor de estabilidade emocional e qualidade de vida; e as benzedeiras e o uso de plantas medicinais - referências de cuidado na comunidade, que proporcionam prevenção/tratamento à saúde e encaminhamento para a unidade de saúde quando necessário. Conclui-se que as redes sociais e comunitárias formadas pelas participantes são determinantes sociais importantes. Assim, é necessária a valorização de tais redes pelos equipamentos de saúde inscritos no território.


Las redes sociales y comunitarias constituyen un importante determinante social de salud, especialmente en los segmentos populares de la sociedad civil y en sus luchas para garantizar el derecho a la salud. La presente investigación buscó comprender cuáles son las redes sociales y comunitarias tejidas por las mujeres residentes en una comunidad de bajos ingresos y su relación con la producción de la salud en este grupo social. Se realizaron entrevistas semiestructuradas con 11 mujeres participantes de una organización no gubernamental de la comunidad, y los datos se sometieron a análisis de contenido. El análisis destacó cuatro categorías: la comunidad como una gran red - formada por múltiples redes dinámicas interconectadas; la red de las "tías" - mujeres con papel importante en el cuidado de la comunidad, tratadas como parte de la familia; las ruedas de conversación - como el rito de encuentro periódico en las aceras, señalado como un espacio importante que garantiza la estabilidad emocional y la calidad de vida, y las curanderas y el uso de plantas medicinales - referencias de cuidado en la comunidad; que proporcionan prevención/tratamiento a la salud y el encaminamiento para la unidad de salud cuando sea necesario. Se concluye que las redes sociales y comunitarias tejidas por las participantes son determinantes sociales importantes, siendo necesaria la valorización de tales redes por los equipos de salud inscritos en el territorio.


Asunto(s)
Redes Comunitarias , Calidad de Vida , Humanos , Femenino , Apoyo Social , Brasil , Pobreza
11.
MCN Am J Matern Child Nurs ; 48(6): 326-333, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37589952

RESUMEN

PURPOSE: To evaluate the predictors of postpartum depression and to examine the effects of maternal racial identity on postpartum depression among women with low incomes in the United States. STUDY DESIGN AND METHODS: We conducted a secondary data analysis using baseline data from the Baby's First Years study, including postpartum women living below the federal poverty line who were recruited from four diverse communities in the United States. Postpartum depression symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D). Logistic regressions were performed to identify associations between pre-identified postpartum depression risk factors and postpartum depression among participants, followed by predictive margins analyses to elaborate on probability of postpartum depression across different racial identity groups in the sample. RESULTS: The sample included 1,051 postpartum women. Almost one-half of participants identified as Black (45.9%), followed by White (20.7%), American Indian (1.8%), and Asian (1.3%). Prevalence of postpartum depression in the sample was 24%. Financial insecurity and alcohol use were positively associated with postpartum depression, whereas level of education and reported physical health were negatively associated with postpartum depression. Mothers who identified as Black had an 8.3% higher probability of postpartum depression than that of White mothers in the sample. CLINICAL IMPLICATIONS: Nurses working with populations with low income should assess social determinants of health to provide holistic mental health care. Women with low incomes should be referred to resources which account for their financial burden. Racial disparities exist in perinatal care, and birth and postpartum mental health outcomes. It is crucial to address the systemic racism faced by Black mothers experiencing postpartum depression.


Asunto(s)
Depresión Posparto , Embarazo , Femenino , Estados Unidos/epidemiología , Humanos , Depresión Posparto/epidemiología , Pobreza , Madres/psicología , Periodo Posparto , Factores de Riesgo , Depresión
12.
Am J Health Promot ; 37(8): 1141-1146, 2023 11.
Artículo en Inglés | MEDLINE | ID: mdl-37489060

RESUMEN

PURPOSE: To describe the prevalence of food insecurity among pregnant and parenting women with opioid use disorder (OUD), its association with psychosocial health, and their experience with the Special Supplemental Nutrition Program for Women Infant Child (WIC) program. DESIGN: This cross-sectional study collected survey data through REDCAP. SETTING: The study was conducted at a single, urban, opioid treatment program. SUBJECTS: A total of 91 female participants (≥18 years of age and receiving OUD treatment services) were approached about the study and all consented. MEASURES: Measures included: US Household Short Form Food Security Survey, Patient Health Questionnaire 4(PHQ4), Perceived Stress Scale (PSS), and a demographics and food behavior survey. ANALYSIS: Descriptive analyses (frequency, means) described data and Chi-Square, Fischer's exact, t-tests were used to compare data between food security groups. RESULTS: Participants were on average 34 years old, Caucasian (68%), and non-Hispanic (87%). Most reported low (32%) to very low (33%) food security. Pearson correlation analyses indicate a strong positive linear relationship between Food Security Score and PHQ4 Total (P = .0002), PHQ4 Depression (P = .0003), PHQ4 Anxiety (P = .0009), and PSS Total (P < .0001). Only 38% felt the foods available in WIC supported their breastfeeding. Limitations include a single site and recall bias. CONCLUSIONS: Significant nutritional inequity in families affected by maternal substance use exists, with potential for adverse maternal and child development related implications.


Asunto(s)
Asistencia Alimentaria , Trastornos Relacionados con Opioides , Distrés Psicológico , Lactante , Niño , Embarazo , Humanos , Femenino , Adulto , Analgésicos Opioides , Responsabilidad Parental , Estudios Transversales , Pobreza , Abastecimiento de Alimentos , Inseguridad Alimentaria , Trastornos Relacionados con Opioides/epidemiología
13.
Prim Health Care Res Dev ; 24: e48, 2023 07 24.
Artículo en Inglés | MEDLINE | ID: mdl-37486286

RESUMEN

AIM: This article draws on the poverty and access to health care framework to explore the barriers to access and utilization of primary health care among aged indigents under the Livelihood Empowerment Against Poverty Programme (LEAP) in Ghana. BACKGROUND: Although many developing countries have made progress in extending primary health care to their populations following the Alma-Ata Declaration of 1978, the establishment of the Millennium Development Goals, and the Sustainable Development Goals (SDGs), barriers remain pervasive, particularly among vulnerable population groups. Previous studies have hardly paid in-depth attention to this important indicator for measuring progress toward achieving SDG 3. METHODOLOGY: To this end, we conducted a case study of access to health care services and utilization among aged indigents enrolled on the LEAP programme in the Daffiama Bussie Issa District of the Upper West. We collected and analyzed qualitative data from indigents aged 65 years and above, health care providers, and staff of the LEAP and the National Health Insurance Scheme (NHIS). FINDINGS: Our analysis found geographic inaccessibility of health care, high costs of drugs and related services, exclusion of essential services from NHIS benefits package, and irregular transfer of cash to negatively influence access and utilization of health care among aged LEAP beneficiaries in the district. In addition to the need to strengthen the economy, provide health infrastructure and human resources for health in rural areas, the government needs to review the beneficiaries' bimonthly stipends to reflect the daily minimum wage, eliminate the delay in payments, and review the benefits package of the NHIS to include essential services and medical devices commonly used by aged people. Yet implementing these recommendations has affordability implications that require innovation to mobilize additional resources and create the desired fiscal space and institutions that can sustainably implement universal coverage programmes such as the LEAP.


Asunto(s)
Accesibilidad a los Servicios de Salud , Pobreza , Humanos , Ghana/epidemiología , Personal de Salud , Servicios de Salud , Programas Nacionales de Salud , Anciano
14.
Arch Dis Child ; 108(9): 709-714, 2023 09.
Artículo en Inglés | MEDLINE | ID: mdl-37474280

RESUMEN

In the year July 2022 to June 2023 there were 501 publications from randomised controlled trials (RCTs) in child and adolescent health in developing countries identified through a standardised search strategy that has been going for 20 years. This year, trials addressed the widest range of diseases and conditions that affect the health, development and well-being of children, newborns, adolescents and mothers. RCTs reflected old, neglected and new problems, the changing epidemiology of child health, social and economic circumstances in many countries, local and global priorities of low-income and middle-income countries, environmental causes of poor child health, and inequities. The RCTs tested new and refined treatments, diagnostics, vaccines, holistic management, and prevention approaches, and explored many outcomes, including mortality, nutrition, psychosocial measures, and neurodevelopment. The studies were conducted in numerous hospitals and healthcare clinics, schools, and communities, including among some of the world's most disadvantaged populations in humanitarian and refugee emergencies. Some studies are of the highest quality, and others fall short. Many RCTs will influence guidelines, practice and policies for years to come.


Asunto(s)
Salud del Adolescente , Pobreza , Femenino , Adolescente , Recién Nacido , Niño , Humanos , Madres , Salud Infantil , Ensayos Clínicos Controlados Aleatorios como Asunto
15.
Arch Dis Child ; 108(8): 622-631, 2023 08.
Artículo en Inglés | MEDLINE | ID: mdl-37142335

RESUMEN

BACKGROUND: Maternal nutrition in preconception and early pregnancy influences fetal growth. Evidence for effects of prenatal maternal nutrition on early child development (ECD) in low-income and middle-income countries is limited. OBJECTIVES: To examine impact of maternal nutrition supplementation initiated prior to or during pregnancy on ECD, and to examine potential association of postnatal growth with ECD domains. DESIGN: Secondary analysis regarding the offspring of participants of a maternal multicountry, individually randomised trial. SETTING: Rural Democratic Republic of the Congo, Guatemala, India and Pakistan. PARTICIPANTS: 667 offspring of Women First trial participants, aged 24 months. INTERVENTION: Maternal lipid-based nutrient supplement initiated preconceptionally (arm 1, n=217), 12 weeks gestation (arm 2, n=230) or not (arm 3, n=220); intervention stopped at delivery. MAIN OUTCOME MEASURES: The INTERGROWTH-21st Neurodevelopment Assessment (INTER-NDA) cognitive, language, gross motor, fine motor, positive and negative behaviour scores; visual acuity and contrast sensitivity scores and auditory evoked response potentials (ERP). Anthropometric z-scores, family care indicators (FCI) and sociodemographic variables were examined as covariates. RESULTS: No significant differences were detected among the intervention arms for any INTER-NDA scores across domains, vision scores or ERP potentials. After adjusting for covariates, length-for-age z-score at 24 months (LAZ24), socio-economic status, maternal education and FCI significantly predicted vision and INTER-NDA scores (R2=0.11-0.38, p<0.01). CONCLUSIONS: Prenatal maternal nutrition supplementation was not associated with any neurodevelopmental outcomes at age 2 years. Maternal education, family environment and LAZ24 predicted ECD. Interventions addressing multiple components of the nurturing care model may offer greatest impact on children's developmental potential. TRIAL REGISTRATION NUMBER: NCT01883193.


Asunto(s)
Desarrollo Infantil , Suplementos Dietéticos , Embarazo , Niño , Humanos , Femenino , Lactante , Preescolar , Edad Gestacional , Antropometría , Pobreza
16.
Soc Sci Med ; 326: 115929, 2023 06.
Artículo en Inglés | MEDLINE | ID: mdl-37137200

RESUMEN

This study aims to investigate the evolution of financial protection of households against OOP in South Korea, where subsequent policies of expanding benefit coverage have been implemented primarily focusing on several severe diseases, by measuring catastrophic healthcare expenditure (CHE) and the characteristics of households vulnerable to CHE. Using the Korea Health Panel 2011-2018, this study analyzed CHE trends by the targeted severe diseases and other health problems and household income and examined the determinants of CHE using binary logistic regression. Our findings showed that CHE decreased in households with the targeted severe diseases but increased in households experiencing hospitalization that were not related to the targeted diseases, which appeared to have a significantly higher likelihood of CHE in 2018 than households with the targeted severe diseases. In addition, CHE was more prevalent and increased or remained stagnant among households whose heads had health problems than others. Inequalities in CHE also increased, showing increased Concentration Index (CI) and increased incidences of CHE in the lower income quartile during the study period. These results suggest that the current policies are insufficient to achieve its financial protection goals against healthcare expenditure in South Korea. In particular, benefit expansions targeting a specific disease may cause inequitable distribution of resources and may not enhance protection against households' financial burden.


Asunto(s)
Composición Familiar , Pobreza , Humanos , Objetivos , Enfermedad Catastrófica , Gastos en Salud , Programas Nacionales de Salud , República de Corea , Seguro de Salud
17.
BMC Pregnancy Childbirth ; 23(1): 364, 2023 May 19.
Artículo en Inglés | MEDLINE | ID: mdl-37208642

RESUMEN

BACKGROUND: Birthweight is an important indicator of maternal and fetal health globally. The multifactorial origins of birthweight suggest holistic programs that target biological and social risk factors have great potential to improve birthweight. In this study, we examine the dose-response association of exposure to an unconditional cash transfer program before delivery with birthweight and explore the potential mediators of the association. METHODS: Data for this study come from the Livelihood Empowerment Against Poverty (LEAP) 1000 impact evaluation conducted between 2015 and 2017 among a panel sample of 2,331 pregnant and lactating women living in rural households of Northern Ghana. The LEAP 1000 program provided bi-monthly cash transfers and premium fee waivers to enroll in the National Health Insurance Scheme (NHIS). We used adjusted and unadjusted linear and logistic regression models to estimate the associations of months of LEAP 1000 exposure before delivery with birthweight and low birthweight, respectively. We used covariate-adjusted structural equation models (SEM) to examine mediation of the LEAP 1000 dose-response association with birthweight by household food insecurity and maternal-level (agency, NHIS enrollment, and antenatal care) factors. RESULTS: Our study included a sample of 1,439 infants with complete information on birthweight and date of birth. Nine percent of infants (N = 129) were exposed to LEAP 1000 before delivery. A 1-month increase in exposure to LEAP 1000 before delivery was associated with a 9-gram increase in birthweight and 7% reduced odds of low birthweight, on average, in adjusted models. We found no mediation effect by household food insecurity, NHIS enrollment, women's agency, or antenatal care visits. CONCLUSIONS: LEAP 1000 cash transfer exposure before delivery was positively associated with birthweight, though we did not find any mediation by household- or maternal-level factors. The results of our mediation analyses may serve to inform program operations and improve targeting and programming to optimize health and well-being among this population. TRIAL REGISTRATION: The evaluation is registered in the International Initiative for Impact Evaluation's (3ie) Registry for International Development Impact Evaluations (RIDIESTUDY- ID-55942496d53af) and in the Pan African Clinical Trial Registry (PACTR202110669615387).


Asunto(s)
Lactancia , Pobreza , Recién Nacido , Lactante , Humanos , Femenino , Embarazo , Peso al Nacer , Análisis de Clases Latentes , Recién Nacido de Bajo Peso
18.
Front Public Health ; 11: 1106166, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-36992886

RESUMEN

Background: Many countries and regions worldwide are improving their healthcare systems through the integration and unification of health insurance programs covering different groups of people. In China, the past 10 years has been the time when Chinese government promote the Urban and Rural Residents Basic Medical Insurance (URRBMI) by integrating the Urban Residents' Basic Medical Insurance (URBMI) and New Rural Cooperative Medical Scheme (NRCMS). Objectives: To evaluate the impact of the URRBMI on equity in relation to health services. Methods: The quantitative data used in this study were obtained from the CFPS 2014-2020 database, and all respondents with health insurance type UEBMI, URBMI, and NRCMS were included. UEBMI respondents were set as the control group and URBMI or NRCMS as the intervention group, and a DID method model was used to analyze the impact of integrating health insurance on health service utilization, costs and health status. Heterogeneity analysis was also conducted after stratifying the sample according to income level and chronic disease status. This was done to investigate whether there were differences in the effects of the integrated health insurance program across different social groups. Results: The implementation of URRBMI is found to be associated with a significant increase in inpatient service utilization (OR = 1.51, P < 0.01) among rural Chinese residents. Regression results by income stratum show that the utilization of inpatient services increased in rural areas for high-, middle- and low-income groups, with the fastest increase (OR = 1.78, P < 0.05) emerging for low-income groups. Analysis by chronic disease status shows that rural residents with chronic disease are associated with a higher increase in hospitalization rates (OR = 1.64, P < 0.01). Conclusion: The implementation of URRBMI is found to have improved health insurance's ability to withstand risks and effectively improve access to health services for rural residents. In this regard, it can be considered as playing a positive role in bridging the gap in health service utilization between rural and urban areas and in improving regional equity.


Asunto(s)
Equidad en Salud , Seguro de Salud , Humanos , Servicios de Salud , Pobreza , China
19.
PLoS One ; 18(3): e0282319, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-36989275

RESUMEN

Previous studies examining the impact of heritage tourism have focused on specific ecological, economic, political, or cultural impacts. Research focused on the extent to which heritage tourism fosters host communities' participation and enhances their capacity to flourish and support long-term health and wellbeing is lacking. This systematic review assessed the impact of heritage tourism on sustainable community development, as well as the health and wellbeing of local communities. Studies were included if they: (i) were conducted in English; (ii) were published between January 2000 and March 2021; (iii) used qualitative and/or quantitative methods; (iv) analysed the impact of heritage tourism on sustainable community development and/or the health and wellbeing of local host communities; and (v) had a full-text copy available. The search identified 5292 articles, of which 102 articles met the inclusion criteria. The included studies covering six WHO regions (Western Pacific, African, Americas, South-East Asia, European, Eastern Mediterranean, and multiple regions). These studies show that heritage tourism had positive and negative impacts on social determinants of health. Positive impacts included economic gains, rejuvenation of culture, infrastructure development, and improved social services. However, heritage tourism also had deleterious effects on health, such as restrictions placed on local community participation and access to land, loss of livelihood, relocation and/or fragmentation of communities, increased outmigration, increases in crime, and erosion of culture. Thus, while heritage tourism may be a poverty-reducing strategy, its success depends on the inclusion of host communities in heritage tourism governance, decision-making processes, and access to resources and programs. Future policymakers are encouraged to adopt a holistic view of benefits along with detriments to sustainable heritage tourism development. Additional research should consider the health and wellbeing of local community groups engaged in heritage tourism. Protocol PROSPERO registration number: CRD42018114681.


Asunto(s)
Desarrollo Sostenible , Turismo , Pobreza , Salud Pública
20.
Indian J Med Ethics ; VIII(2): 95-102, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-36880475

RESUMEN

This paper aims to address the concern that quantitative public health studies do not integrate theoretical considerations. This qualitative study uses content analysis to explore the application of theory in Indian public health articles listed on PubMed. Social determinants such as poverty, income, social class, education, gender, caste, socioeconomic position, socioeconomic status, immigrant status, and wealth were the keywords used to identify the articles analysed in this study. From a selection of 91 public health articles, we identified potential theoretical frameworks based on the pathways/recommendations/explanations mentioned. Additionally, using the case of tuberculosis in India, we highlight how theoretical perspectives play a critical role in providing a holistic view of major health challenges. Finally, by emphasising the need to adopt a theoretical perspective in empirical quantitative research on public health in India, we hope to motivate scholars to include a theory or theoretical paradigm in their future research.


Asunto(s)
Salud Pública , Clase Social , Humanos , Pobreza , India
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