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1.
Ethn Dis ; 32(2): 113-122, 2022.
Article in English | MEDLINE | ID: mdl-35497398

ABSTRACT

Objective: To determine if race-ethnicity is correlated with case-fatality rates among low-income patients hospitalized for COVID-19. Research Design: Observational cohort study using electronic health record data. Patients: All patients assessed for COVID-19 from March 2020 to January 2021 at one safety net health system. Measures: Patient demographic and clinical characteristics, and hospital care processes and outcomes. Results: Among 25,253 patients assessed for COVID-19, 6,357 (25.2%) were COVID-19 positive: 1,480 (23.3%) hospitalized; 334 (22.6%) required intensive care; and 106 (7.3%) died. More Hispanic patients tested positive (51.8%) than non-Hispanic Black (31.4%) and White patients (16.7%, P<.001]. Hospitalized Hispanic patients were younger, more often uninsured, and less likely to have comorbid conditions. Non-Hispanic Black patients had significantly more diabetes, hypertension, obesity, chronic kidney disease, and asthma (P<.05). Non-Hispanic White patients were older and had more cigarette smoking history, COPD, and cancer. Non-Hispanic White patients were more likely to receive intensive care (29.6% vs 21.1% vs 20.8%, P=.007) and more likely to die (12% vs 7.3% vs 3.5%, P<.001) compared with non-Hispanic Black and Hispanic patients, respectively. Length of stay was similar for all groups. In logistic regression models, Medicaid insurance status independently correlated with hospitalization (OR 3.67, P<.001) while only age (OR 1.076, P<.001) and cerebrovascular disease independently correlated with in-hospital mortality (OR 2.887, P=.002). Conclusions: Observed COVID-19 in-hospital mortality rate was lower than most published rates. Age, but not race-ethnicity, was independently correlated with in-hospital mortality. Safety net health systems are foundational in the care of vulnerable patients suffering from COVID-19, including patients from under-represented and low-income groups.


Subject(s)
COVID-19 , Comorbidity , Government Programs , Humans , Poverty , United States
2.
Front Public Health ; 10: 890507, 2022.
Article in English | MEDLINE | ID: mdl-35493349

ABSTRACT

Financial inclusion, whereby all adults have effective access to financial products, including insurance, has increasingly become a global priority, particularly in low and middle income economies. This study matches the measured development level of inclusive insurance in Chinese provinces with China Family Panel Studies (CFPS) data and evaluates the impact of inclusive insurance on income distribution and inclusive growth. The findings support that inclusive insurance has a positive impact on income distribution and inclusive growth. The effect is more pronounced in eastern areas, rural areas and low-income households. The policy shocks and instrumental variables introduced prove the robustness of the results. PSM-DID test indicate that the inclusive insurance policy has a significant positive effect on income distribution. Alternative measure of inclusive insurance and GMM test with instrumental variables indicate that the results are robust. Additionally, we also find that there is a threshold effect on the impact of the inclusive insurance on income. When the universal insurance index exceeds the threshold value, the promoting effect on income is enhanced.


Subject(s)
Income , Insurance, Health , China , Family Characteristics , Poverty
3.
J Glob Health ; 12: 04032, 2022.
Article in English | MEDLINE | ID: mdl-35493778

ABSTRACT

Background: The global burden of cervical cancer is concentrated in low-and middle-income countries (LMICs), with the greatest burden in Africa. Targeting limited resources to populations with the greatest need to maximize impact is essential. The objectives of this study were to geocode cervical cancer data from a population-based cancer registry in Kampala, Uganda, to create high-resolution disease maps for cervical cancer prevention and control planning, and to share lessons learned to optimize efforts in other low-resource settings. Methods: Kampala Cancer Registry records for cervical cancer diagnoses between 2008 and 2015 were updated to include geographies of residence at diagnosis. Population data by age and sex for 2014 was obtained from the Uganda Bureau of Statistics. Indirectly age-standardized incidence ratios were calculated for sub-counties and estimated continuously across the study area using parish level data. Results: Overall, among 1873 records, 89.6% included a valid sub-county and 89.2% included a valid parish name. Maps revealed specific areas of high cervical cancer incidence in the region, with significant variation within sub-counties, highlighting the importance of high-resolution spatial detail. Conclusions: Population-based cancer registry data and geospatial mapping can be used in low-resource settings to support cancer prevention and control efforts, and to create the potential for research examining geographic factors that influence cancer outcomes. It is essential to support LMIC cancer registries to maximize the benefits from the use of limited cancer control resources.


Subject(s)
Uterine Cervical Neoplasms , Female , Humans , Incidence , Poverty , Spatial Analysis , Uganda/epidemiology , Uterine Cervical Neoplasms/epidemiology , Uterine Cervical Neoplasms/prevention & control
4.
J Med Internet Res ; 24(5): e33591, 2022 May 04.
Article in English | MEDLINE | ID: mdl-35507397

ABSTRACT

BACKGROUND: Although well recognized for its scientific value, data sharing from clinical trials remains limited. Steps toward harmonization and standardization are increasing in various pockets of the global scientific community. This issue has gained salience during the COVID-19 pandemic. Even for agencies willing to share data, data exclusivity practices complicate matters; strict regulations by funders affect this even further. Finally, many low- and middle-income countries (LMICs) have weaker institutional mechanisms. This complex of factors hampers research and rapid response during public health emergencies. This drew our attention to the need for a review of the regulatory landscape governing clinical trial data sharing. OBJECTIVE: This review seeks to identify regulatory frameworks and policies that govern clinical trial data sharing and explore key elements of data-sharing mechanisms as outlined in existing regulatory documents. Following from, and based on, this empirical analysis of gaps in existing policy frameworks, we aimed to suggest focal areas for policy interventions on a systematic basis to facilitate clinical trial data sharing. METHODS: We followed the JBI scoping review approach. Our review covered electronic databases and relevant gray literature through a targeted web search. We included records (all publication types, except for conference abstracts) available in English that describe clinical trial data-sharing policies, guidelines, or standard operating procedures. Data extraction was performed independently by 2 authors, and findings were summarized using a narrative synthesis approach. RESULTS: We identified 4 articles and 13 policy documents; none originated from LMICs. Most (11/17, 65%) of the clinical trial agencies mandated a data-sharing agreement; 47% (8/17) of these policies required informed consent by trial participants; and 71% (12/17) outlined requirements for a data-sharing proposal review committee. Data-sharing policies have, a priori, milestone-based timelines when clinical trial data can be shared. We classify clinical trial agencies as following either controlled- or open-access data-sharing models. Incentives to promote data sharing and distinctions between mandated requirements and supportive requirements for informed consent during the data-sharing process remain gray areas, needing explication. To augment participant privacy and confidentiality, a neutral institutional mechanism to oversee dissemination of information from the appropriate data sets and more policy interventions led by LMICs to facilitate data sharing are strongly recommended. CONCLUSIONS: Our review outlines the immediate need for developing a pragmatic data-sharing mechanism that aims to improve research and innovations as well as facilitate cross-border collaborations. Although a one-policy-fits-all approach would not account for regional and subnational legislation, we suggest that a focus on key elements of data-sharing mechanisms can be used to inform the development of flexible yet comprehensive data-sharing policies so that institutional mechanisms rather than disparate efforts guide data generation, which is the foundation of all scientific endeavor.


Subject(s)
COVID-19 , Pandemics , Humans , Information Dissemination , Informed Consent , Poverty
5.
BMJ ; 377: o1108, 2022 05 03.
Article in English | MEDLINE | ID: mdl-35504653

Subject(s)
Poverty , Students , Humans
6.
Health Aff (Millwood) ; 41(5): 722-731, 2022 May.
Article in English | MEDLINE | ID: mdl-35500181

ABSTRACT

The South Korean National Health Insurance scheme has lacked sufficient coverage scope (services covered) and depth (costs covered) since it achieved national coverage in 1989. The government implemented two separate welfare plans (2004-08 and 2009-12) to improve the financial protection of National Health Insurance by mainly focusing on costs covered. The third plan (initiated in 2013) was the most comprehensive, addressing both scope and depth. We evaluated the impact of this benefit expansion policy for four categories of major disease (cancer, cardiac disease, cerebrovascular disease, and rare diseases) on catastrophic health expenditures, impoverishment, and unmet need. Using 2012-17 Korean Health Panel Survey data, we performed difference-in-differences analyses and triple-difference analyses to examine the differential impact of policy across income groups. The policy reduced catastrophic health expenditures among beneficiary households across almost all postpolicy years. However, there was no average effect on reducing household impoverishment or unmet need. The policy had mixed effects by income but did not generally favor low-income households. To provide stronger financial protection, the policy must address issues beyond expanding coverage, such as provider payment structure. In addition, special policy measures for low-income households need to be adopted.


Subject(s)
Health Expenditures , Insurance, Health , Humans , Income , Poverty , Republic of Korea
7.
Pediatrics ; 149(Suppl 5)2022 May 01.
Article in English | MEDLINE | ID: mdl-35503329

ABSTRACT

CONTEXT: Previous reviews of mental health interventions have focused on adolescents (10-19 years), with a paucity of comprehensive evidence syntheses on preventive interventions for school-aged children (5-10 years). OBJECTIVE: To summarize and synthesize the available evidence from systematic reviews of mental health and positive development interventions for children aged 5-14.9 years in both high-income (HIC) and low- and middle-income countries (LMIC), with a focus on preventive and promotive strategies. DATA SOURCES: This overview includes all relevant reviews from OVID Medline, The Cochrane Library, and Campbell Systematic Reviews through December 2020. STUDY SELECTION: We included systematic reviews that synthesized empirical studies using experimental or quasi-experimental designs to evaluate the effectiveness of interventions in children aged 5-14.9 years. DATA EXTRACTION: Data extraction and quality assessment were completed independently and in duplicate by two review authors. The AMSTAR2 tool was used to assess methodological quality. RESULTS: We included 162 reviews. The greatest evidence was found in support of school-based universal and anti-bullying interventions in predominantly HIC. Moderate evidence was found for the use of substance abuse prevention, and early learning and positive development interventions in mixed settings. In LMIC-only contexts, the most promising evidence was found for positive youth development programs. LIMITATIONS: The review was primarily limited by paucity of high-quality research due to methodological issues and high heterogeneity. CONCLUSIONS: This overview of reviews highlights the need for further research to consolidate findings and understand the specific criteria involved in creating positive mental health and development outcomes from the various interventions considered.


Subject(s)
Income , Mental Health , Adolescent , Child , Humans , Poverty , Schools , Systematic Reviews as Topic
8.
JAMA Netw Open ; 5(5): e2210480, 2022 May 02.
Article in English | MEDLINE | ID: mdl-35511177

ABSTRACT

Importance: Implemented in 2012, the Healthy, Hunger-Free Kids Act of 2010 (HHFKA) increased nutritional requirements of the National School Lunch Program (NSLP) to reverse the potential role of the NSLP in childhood obesity. Objective: To evaluate whether associations between the free or reduced-price NSLP and body mass growth differed after implementation of the HHFKA. Design, Setting, and Participants: This cohort study used data from 2 nationally representative cohorts of US kindergarteners sampled in 1998 to 1999 and 2010 to 2011 and followed up for 6 years, through grade 5, in the Early Childhood Longitudinal Study Kindergarten Class of 1998-1999 (ECLS-K:1999, in 2003-2004) and Kindergarten Class of 2010-2011 (ECLS-K:2011, in 2015-2016). In total, 5958 children were selected for analysis from low-income families eligible for the free or reduced-price NSLP (household income <185% of the federal poverty level) who attended public schools and had no missing data on free or reduced-price NSLP participation or on body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) at kindergarten or grades 1 and 5. Data were analyzed from January 1 to September 7, 2021. Exposures: Cross-cohort comparison of before vs after implementation of the HHFKA for free or reduced-price NSLP participation at kindergarten and grades 1 and 5. Main Outcomes and Measures: Body mass index difference (BMID) from obesity threshold was the difference in BMI units from the age- and sex-specific obesity thresholds (95th percentile) and is sensitive to change at high BMI. Multigroup models by cohort included weights to balance the distribution of the 2 cohorts across a wide range of covariates. A Wald test was used to assess whether associations differed between the cohorts. Results: In the final analysis, 3388 children in ECLS-K:1999 (1696 girls [50.1%]; mean [SD] age at baseline, 74.6 [4.3] months) and 2570 children in ECLS-K:2011 (1348 males [52.5%]; mean [SD] age at baseline, 73.6 [4.2] months) were included. The best fitting model for BMID change by free or reduced-price NSLP participation across the cohorts included fixed and time-varying associations. Before HHFKA implementation, grade 5 free or reduced-price NSLP participants had higher BMID, adjusted for their prior BMID trajectory, than nonparticipants (ß = 0.54; 95% CI, 0.27-0.81). After HHFKA implementation, this association was attenuated (ß = -0.07; 95% CI, -0.58 to 0.45), and grade 5 associations were different across cohorts (χ21 = 4.29, P = .04). Conclusions and Relevance: In this cohort study using cross-cohort comparisons, children from low-income families who participated in the free or reduced-price NSLP had a higher likelihood of progression to high BMI that was no longer observed after HHFKA implementation. This finding suggests that the HHFKA may have attenuated the previous association of the NSLP with child obesity disparities.


Subject(s)
Food Services , Pediatric Obesity , Child , Child, Preschool , Cohort Studies , Female , Humans , Longitudinal Studies , Male , Pediatric Obesity/epidemiology , Pediatric Obesity/prevention & control , Poverty
9.
PLoS One ; 17(5): e0267665, 2022.
Article in English | MEDLINE | ID: mdl-35511788

ABSTRACT

AIM: This study aimed to examine the prevalence of delays and borderline impaired performance for Brazilian girls and boys and the differences in the motor trajectories (locomotor and ball skills) of girls and boys (3- to 10-years-old) across WEIRD (Western, Educated, Industrial, Rich, and Democratic) countries and Brazil-a low- and middle-income country (LMIC). METHODS: We assessed 1000 children (524 girls; 476 boys), 3- to 10.9-year-old (M = 6.9, SD = 2.1; Girls M = 6.9, SD = 2.0; Boys M = 6.9, SD = 2.1), using the Test of Gross Motor Development-3. Using systematic search, original studies investigating FMS in children using the TGMD-3 were eligible; 5 studies were eligible to have the results compared to the Brazilian sample. One sample t-test to run the secondary data from Irish, American, Finnish, and German children (i.e., mean, standard deviation). RESULTS: The prevalence of delays and borderline impaired performance was high among Brazilian girls (28.3% and 27.5%) and boys (10.6% and 22.7%). The cross-countries comparisons showed significant (p values from .048 and < .001) overall lower locomotor and ball skills scores for Brazilian children; the only exceptions were skipping, catching, and kicking. We observed stability in performance, across countries, after 8-years-old, and no ceiling effects were found in the samples. CONCLUSIONS: The Brazilian sample emphasized the need for national strategies to foster children's motor proficiency. Differences in motor opportunities may explain the differences in motor trajectories between children in WEIRD and LMIC countries.


Subject(s)
Motor Skills , Musculoskeletal Physiological Phenomena , Child , Child, Preschool , Cross-Cultural Comparison , Developing Countries , Female , Humans , Male , Poverty
10.
BMC Public Health ; 22(1): 897, 2022 May 05.
Article in English | MEDLINE | ID: mdl-35513842

ABSTRACT

BACKGROUND: Policy debates over anti-poverty programs are often marked by pernicious stereotypes suggesting that direct cash transfers to people residing in poverty encourage health-risking behaviors such as smoking, drinking, and other substance use. Causal evidence on this issue is limited in the U.S. Given the prominent role of child allowances and other forms of cash assistance in the 2021 American Rescue Plan and proposed Build Back Better legislation, evidence on the extent to which a monthly unconditional cash gift changes substance use patterns among low-income mothers with infants warrants attention, particularly in the context of economic supports that can help improve early environments of children. METHOD: We employ a multi-site, parallel-group, randomized control trial in which 1,000 low-income mothers in the U.S. with newborns were recruited from hospitals shortly after the infant's birth and randomly assigned to receive either a substantial ($333) or a nominal ($20) monthly cash gift during the early years of the infant's life. We estimate the effect of the unconditional cash transfer on self-report measures of maternal substance use (i.e., alcohol, cigarette, or opioid use) and household expenditures on alcohol and cigarettes after one year of cash gifts. RESULTS: The cash gift difference of $313 per month had small and statistically nonsignificant impacts on group differences in maternal reports of substance use and household expenditures on alcohol or cigarettes. Effect sizes ranged between - 0.067 standard deviations and + 0.072 standard deviations. The estimated share of the $313 group difference spent on alcohol and tobacco was less than 1%. CONCLUSIONS: Our randomized control trial of monthly cash gifts to mothers with newborn infants finds that a cash gift difference of $313 per month did not significantly change maternal use of alcohol, cigarettes, or opioids or household expenditures on alcohol or cigarettes. Although the structure of our cash gifts differs somewhat from that of a government-provided child allowance, our null effect findings suggest that unconditional cash transfers aimed at families living in poverty are unlikely to induce large changes in substance use and expenditures by recipients. TRIAL REGISTRATION: Registered on Clinical Trials.gov NCT03593356 in July of 2018.


Subject(s)
Mothers , Substance-Related Disorders , Child , Family Characteristics , Female , Financial Statements , Humans , Infant , Infant, Newborn , Poverty , Substance-Related Disorders/epidemiology , Substance-Related Disorders/prevention & control
11.
Pan Afr Med J ; 41: 140, 2022.
Article in English | MEDLINE | ID: mdl-35519173

ABSTRACT

Multimorbidity is defined as the co-existence of multiple health conditions in one person. However, its use in research has been predominantly applied to non-communicable diseases, because research was conducted almost exclusively in developed countries. More recently, infectious diseases of long duration, such as human immunodeficiency virus (HIV), have also been included in the conceptualization of multimorbidity. While multimorbidity is a growing area of research globally; much less is known about the phenomenon in low and middle-income countries (LMICs) where disease burdens are heavily impacted by HIV. Health systems and services tend to be constrained in LMICs and information on disease patterns are important to better prioritize services. This commentary aims to describe the changing conceptualization of multimorbidity, the dearth of research into multimorbidity in LMICs and how the knowledge generated by research in LMICs can contribute to the global understanding of multimorbidity. LMICs can play a key role in the implementation of integration research.


Subject(s)
Multimorbidity , Noncommunicable Diseases , Cross-Sectional Studies , Developing Countries , Humans , Noncommunicable Diseases/epidemiology , Poverty
12.
Infect Dis Poverty ; 11(1): 48, 2022 May 03.
Article in English | MEDLINE | ID: mdl-35505361

ABSTRACT

BACKGROUND: The One Health (OH) concept has been promoted widely around the globe. OH framework is expected to be applied as an integrated approach to support addressing zoonotic diseases as a significant global health issue and to improve the efficiency and effectiveness of zoonosis prevention and control. This review is intended to overview the social impact of the implementation of OH on zoonosis prevention and control. METHODS: A scoping review of studies in the past 10 years was performed to overview the integration feature of OH in zoonosis prevention and control and the social impacts of OH. PubMed and Web of Science were searched for studies published in English between January 2011 and June 2021. The included studies were selected based on predefined criteria. RESULTS: Thirty-two studies were included in this review, and most of them adopted qualitative and semi-qualitative methods. More than 50% of the studies focused on zoonosis prevention and control. Most studies were conducted in low- and middle-income countries in Africa and Asia. Applying OH approach in diseases control integrates policymakers, stakeholders, and academics from various backgrounds. The impact of OH on economic is estimated that it may alleviate the burden of diseases and poverty in the long term, even though more financial support might be needed at the initial stage of OH implementation. OH implementation considers social and ecological factors related to zoonosis transmission and provides comprehensive strategies to assess and address related risks in different communities according to regions and customs. CONCLUSIONS: Based on reviewed literature, although there seems to be a lack of guidelines for assessing and visualizing the outcomes of OH implementation, which may limit the large-scale adoption of it, evidence on the contributions of implementing OH concepts on zoonosis prevention and control indicates long-term benefits to society, including a better integration of politics, stakeholders and academics to improve their cooperation, a potential to address economic issues caused by zoonosis, and a comprehensive consideration on social determinants of health during zoonosis prevention and control.


Subject(s)
One Health , Animals , Global Health , Income , Poverty , Zoonoses/prevention & control
13.
PLoS One ; 17(5): e0267244, 2022.
Article in English | MEDLINE | ID: mdl-35507557

ABSTRACT

The Affordable Care Act's Medicaid expansion to individuals with adults under 138 percent of the federal poverty level led to insurance coverage for millions of Americans in participating states. This study investigates Medicaid expansion's potential spillover participation in the Supplemental Nutrition Assistance Program (SNAP; formerly the Food Stamp Program). In addition to providing public insurance, the policy connects individuals to SNAP, affecting social determinants of health such as hunger. We use difference-in-differences regression to estimate the effect of the Medicaid expansion on SNAP participation among approximately 414,000 individuals from across the United States. The Current Population Survey is used to answer the main research question, and the SNAP Quality Control Database allows for supplemental analyses. Medicaid expansion produces a 2.9 percentage point increase (p = 0.002) in SNAP participation among individuals under 138 percent of federal poverty. Subgroup analyses find a larger 5.0 percentage point increase (p = 0.002) in households under 75 percent of federal poverty without children. Able-Bodied Adults Without Dependents (ABAWDs) are a category of individuals with limited access to SNAP. Although they are a subset of adults without children, we found no spillover effect for ABAWDs. We find an increase in SNAP households with $0 income, supporting the finding that spillover was strongest for very-low-income individuals. Joint processing of Medicaid and SNAP applications helps facilitate the connection between Medicaid expansion and SNAP. Our findings contribute to a growing body of evidence that Medicaid expansion does more than improve access to health care by connecting eligible individuals to supports like SNAP. SNAP recipients have increased access to food, an important social determinant of health. Our study supports reducing administrative burdens to help connect individuals to safety net programs. Finally, we note that ABAWDs are a vulnerable group that need targeted program outreach.


Subject(s)
Food Assistance , Patient Protection and Affordable Care Act , Adult , Child , Humans , Insurance Coverage , Medicaid , Poverty , United States
14.
Nat Commun ; 13(1): 2456, 2022 May 04.
Article in English | MEDLINE | ID: mdl-35508551

ABSTRACT

Income-based energy poverty metrics ignore people's behavior patterns, particularly reducing energy consumption to limit financial stress. We investigate energy-limiting behavior in low-income households using a residential electricity consumption dataset. We first determine the outdoor temperature at which households start using cooling systems, the inflection temperature. Our relative energy poverty metric, the energy equity gap, is defined as the difference in the inflection temperatures between low and high-income groups. In our study region, we estimate the energy equity gap to be between 4.7-7.5 °F (2.6-4.2 °C). Within a sample of 4577 households, we found 86 energy-poor and 214 energy-insecure households. In contrast, the income-based energy poverty metric, energy burden (10% threshold), identified 141 households as energy-insecure. Only three households overlap between our energy equity gap and the income-based measure. Thus, the energy equity gap reveals a hidden but complementary aspect of energy poverty and insecurity.


Subject(s)
Income , Poverty , Family Characteristics , Food Supply , Humans
15.
BMC Public Health ; 22(1): 870, 2022 05 02.
Article in English | MEDLINE | ID: mdl-35501740

ABSTRACT

BACKGROUND: The COVID-19 pandemic has disproportionately impacted economically-disadvantaged populations in the United States (US). Precarious employment conditions may contribute to these disparities by impeding workers in such conditions from adopting COVID-19 mitigation measures to reduce infection risk. This study investigated the relationship between employment and economic conditions and the adoption of COVID-19 protective behaviors among US workers during the initial phase of the COVID-19 pandemic. METHODS: Employing a social media advertisement campaign, an online, self-administered survey was used to collect data from 2,845 working adults in April 2020. Hierarchical generalized linear models were performed to assess the differences in engagement with recommended protective behaviors based on employment and economic conditions, while controlling for knowledge and perceived threat of COVID-19, as would be predicted by the Health Belief Model (HBM). RESULTS: Essential workers had more precarious employment and economic conditions than non-essential workers: 67% had variable income; 30% did not have paid sick leave; 42% had lost income due to COVID-19, and 15% were food insecure. The adoption of protective behaviors was high in the sample: 77% of participants avoided leaving home, and 93% increased hand hygiene. Consistent with the HBM, COVID-19 knowledge scores and perceived threat were positively associated with engaging in all protective behaviors. However, after controlling for these, essential workers were 60% and 70% less likely than non-essential workers, who by the nature of their jobs cannot stay at home, to stay at home and increase hand hygiene, respectively. Similarly, participants who could not afford to quarantine were 50% less likely to avoid leaving home (AOR: 0.5; 95% CI: 0.4, 0.6) than those who could, whereas there were no significant differences concerning hand hygiene. CONCLUSIONS: Our findings are consistent with the accumulating evidence that the employment conditions of essential workers and other low-income earners are precarious, that they have experienced disproportionately higher rates of income loss during the initial phase of the COVID-19 pandemic and face significant barriers to adopting protective measures. Our findings underscore the importance and need of policy responses focusing on expanding social protection and benefits to prevent the further deepening of existing health disparities in the US.


Subject(s)
COVID-19 , Adult , COVID-19/prevention & control , Employment , Humans , Income , Pandemics/prevention & control , Poverty , United States/epidemiology
16.
Int J Equity Health ; 21(1): 62, 2022 May 08.
Article in English | MEDLINE | ID: mdl-35527274

ABSTRACT

INTRODUCTION: While it is recognized that there are costs associated with postoperative patient follow-up, risk assessments of catastrophic health expenditures (CHEs) due to surgery in sub-Saharan Africa rarely include expenses after discharge. We describe patient-level costs for cesarean section (c-section) and follow-up care up to postoperative day (POD) 30 and evaluate the contribution of follow-up to CHEs in rural Rwanda. METHODS: We interviewed women who delivered via c-section at Kirehe District Hospital between September 2019 and February 2020. Expenditure details were captured on an adapted surgical indicator financial survey tool and extracted from the hospital billing system. CHE was defined as health expenditure of ≥ 10% of annual household expenditure. We report the cost of c-section up to 30 days after discharge, the rate of CHE among c-section patients stratified by in-hospital costs and post-discharge follow-up costs, and the main contributors to c-section follow-up costs. We performed a multivariate logistic regression using a backward stepwise process to determine independent predictors of CHE at POD30 at α ≤ 0.05. RESULTS: Of the 479 participants in this study, 90% were classified as impoverished before surgery and an additional 6.4% were impoverished by the c-section. The median out-of-pocket costs up to POD30 was US$122.16 (IQR: $102.94, $148.11); 63% of these expenditures were attributed to post-discharge expenses or lost opportunity costs (US$77.50; IQR: $67.70, $95.60). To afford c-section care, 64.4% borrowed money and 18.4% sold possessions. The CHE rate was 27% when only considering direct and indirect costs up to the time of discharge and 77% when including the reported expenses up to POD30. Transportation and lost household wages were the largest contributors to post-discharge costs. Further, CHE at POD30 was independently predicted by membership in community-based health insurance (aOR = 3.40, 95% CI: 1.21,9.60), being a farmer (aOR = 2.25, 95% CI:1.00,3.03), primary school education (aOR = 2.35, 95% CI:1.91,4.66), and small household sizes had 0.22 lower odds of experiencing CHE compared to large households (aOR = 0.78, 95% CI:0.66,0.91). CONCLUSION: Costs associated with surgical follow-up are often neglected in financial risk calculations but contribute significantly to the risk of CHE in rural Rwanda. Insurance coverage for direct medical costs is insufficient to protect against CHE. Innovative follow-up solutions to reduce costs of patient transport and compensate for household lost wages need to be considered.


Subject(s)
Aftercare , Health Expenditures , Catastrophic Illness , Cesarean Section , Female , Humans , Patient Discharge , Poverty , Pregnancy , Rwanda
17.
J Health Popul Nutr ; 41(1): 16, 2022 05 03.
Article in English | MEDLINE | ID: mdl-35505386

ABSTRACT

BACKGROUND: The purpose of the project was to improve newborn health in neonatal care units in a low resource area with high neonatal mortality, predominantly by better nutrition and educational exchange of health care workers. METHOD: A fourfold program to make human milk production and distribution feasible and desirable. 1 Education to enlighten health care workers and parents to the excellence of human milk. 2 Lactation counselling to address the various challenges of breastfeeding. 3 Improving infants´ general condition. 4 Infrastructure alterations in the hospital. A collaboration between hospitals in India and Norway. RESULTS: The number of infants receiving human milk increased pronouncedly. Systematic, professional lactation counselling, the establishment of a milk bank, and empowerment of nurses was perceived as the most important factors. CONCLUSIONS: It is possible to greatly improve nutrition and the quality of newborn care in low/middle income settings by optimising human resources. Viable improvements can be obtained by long-term health partnership, by involving all hierarchal levels and applying locally developed customized methods.


Subject(s)
Breast Feeding , Infant Health , Female , Hospitals , Humans , Income , Infant , Infant, Newborn , Poverty
19.
Article in English | MEDLINE | ID: mdl-35523456

ABSTRACT

OBJECTIVE: Understanding the side effects and acceptability of thermal ablation (TA) is necessary before large-scale application in screen-and-treat programmes can be justified in low-income and middle-income countries (LMICs). DESIGN: Articles were selected for inclusion by two independent reviewers. Risk of bias was assessed using the Downs and Black's criteria. Summary data were extracted, and authors contacted for data when necessary. Proportions of interest and 95% CIs were estimated using a random effects model. Subgroup analysis was performed based on place of treatment and timing of post-treatment follow-up. Heterogeneity was estimated using the I2. ELIGIBILITY CRITERIA: Studies that reported one or more side effects or patient acceptability measures after treatment of the cervix using TA in women living in LMICs who completed a cervical cancer screening test. Included articles were clinical trials or observational studies available in English and published before 18 December 2020. INFORMATION SOURCES: Ovid MEDLINE, EMBASE, CINAHL, CAB Global Health and WHO Global Index Medicus were searched for this systematic review and meta-synthesis. RESULTS: A total of 1590 abstracts were screened, 84 full text papers reviewed and 15 papers selected for inclusion in the qualitative review, 10 for meta-synthesis (N=2039). Significant heterogeneity was found in screening tests used to identify women eligible for TA and in methods to ascertain side effects. The most commonly reported side effect during treatment was pain (70%, 95% CI 52% to 85%; I2=98.01%) (8 studies; n=1454). No women discontinued treatment due to pain. At treatment follow-up, common side effects included vaginal discharge (72%, 95% CI 18% to 100%; I2=99.55%) (5 studies; n=771) and bleeding (38%, 95% CI 15% to 64%; I2=98.14%) (4 studies; n=856). Satisfaction with treatment was high in 99% (95% CI 98% to 100%; I2=0.00%) of women (3 studies; n=679). CONCLUSIONS: TA results in a number of common side effects, though acceptability remains high among women treated in LMICs. Standardised side effect and acceptability reporting are needed as TA becomes more readily available. PROSPERO REGISTRATION NUMBER: CRD42020197605.


Subject(s)
Drug-Related Side Effects and Adverse Reactions , Uterine Cervical Neoplasms , Developing Countries , Early Detection of Cancer , Female , Humans , Male , Pain , Poverty , Uterine Cervical Neoplasms/surgery
20.
Trials ; 23(1): 374, 2022 May 07.
Article in English | MEDLINE | ID: mdl-35526046

ABSTRACT

There is stark global inequity in health research in terms of where studies happen, who leads the research and the ultimate beneficiaries of the results generated. Despite significant efforts made, limited research ideas are conceptualised and implemented in low-resource settings to tackle diseases of poverty, and this is especially true in sub-Saharan Africa. There is strong evidence to show that the barriers to locally led research do not vary largely between disease, study type and location and can be largely solved by addressing these common gaps. The European & Developing Countries Clinical Trials Partnership (EDCTP) was established in 2003 as a European response to the global health crisis caused by the three main poverty-related diseases HIV, tuberculosis and malaria. EDCTP has established a model of long-term sustainable capacity development integrated into clinical trials which addresses this lack of locally led research in sub-Saharan Africa, supporting the development of individual and institutional capacity and research outputs that change the management, prevention and treatment of poverty-related and neglected infectious diseases across Africa. In recognition of emergent data on what the barriers and enablers are to long-term, sustainable capabilities to run studies, EDCTP formed a new collaboration with The Global Health Network (TGHN) in September 2017, with the aim to make a set of cross-cutting tools and resources to support the planning, writing and delivery of high-quality clinical trials available to research staff wherever they are in the world, especially those in low- and middle-income countries (LMICs) via TGHN platform. These new resources developed on the 'EDCTP Knowledge Hub' are those identified in the mixed method study described in this commentary as being key to addressing the gaps that the research community report as the most limiting elements in their ability to design and implement studies. The Knowledge Hub aims to make these tools freely available to any potential health research team in need of support and guidance in designing and running their own studies, particularly in low-resource settings. The purpose is to provide open access to the specific guidance, information and tools these teams cannot otherwise access freely. Ultimately, this will enable them to design and lead their own high-quality studies addressing local priorities with global alignment, generating new data that can change health outcomes in their communities.


Subject(s)
Malaria , Tuberculosis , Africa South of the Sahara , Developing Countries , Humans , Malaria/diagnosis , Malaria/prevention & control , Poverty , Tuberculosis/diagnosis , Tuberculosis/therapy
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