A Systematic Literature Review of Substance-Use Prevention Programs Amongst Refugee Youth.

This paper aims at exploring existing literature on substance use prevention programs, focusing on refugee youth. A comprehensive search for relevant articles was conducted on Scopus, PubMed, and EBSCOhost Megafile databases including Academic Search Ultimate, APA PsycArticles, APA PsycInfo, CINAHL with Full Text, E-Journals, Humanities Source Ultimate, Psychology and Behavioural Sciences Collection, and Sociology Source Ultimate. Initially, a total of 485 studies were retrieved; nine papers were retained for quality assessment after removing duplicates. Of the nine studies that met the inclusion criteria, only three are found to partially addressed substance use prevention programs. The two substance use prevention programs that emerge from the study are Adelante Social and Marketing Campaign (ASMC), and Screening and Brief Intervention (SBI). Six others explored protective factors and strategies for preventing substance use. The study findings show that refugee youth held negative attitudes toward institutions that provide substance use prevention programs. This review concluded that refugee youth often experience persistent substance use as they are not aware of prevention programs that may reduce the prevalence and/or severity of such misuse.

Machine learning models for prediction of double and triple burdens of non-communicable diseases in Bangladesh.

Increasing prevalence of non-communicable diseases (NCDs) has become the leading cause of death and disability in Bangladesh. Therefore, this study aimed to measure the prevalence of and risk factors for double and triple burden of NCDs (DBNCDs and TBNCDs), considering diabetes, hypertension, and overweight and obesity as well as establish a machine learning approach for predicting DBNCDs and TBNCDs. A total of 12,151 respondents from the 2017 to 2018 Bangladesh Demographic and Health Survey were included in this analysis, where 10%, 27.4%, and 24.3% of respondents had diabetes, hypertension, and overweight and obesity, respectively. Chi-square test and multilevel logistic regression (LR) analysis were applied to select factors associated with DBNCDs and TBNCDs. Furthermore, six classifiers including decision tree (DT), LR, naïve Bayes (NB), k-nearest neighbour (KNN), random forest (RF), and extreme gradient boosting (XGBoost) with three cross-validation protocols (K2, K5, and K10) were adopted to predict the status of DBNCDs and TBNCDs. The classification accuracy (ACC) and area under the curve (AUC) were computed for each protocol and repeated 10 times to make them more robust, and then the average ACC and AUC were computed. The prevalence of DBNCDs and TBNCDs was 14.3% and 2.3%, respectively. The findings of this study revealed that DBNCDs and TBNCDs were significantly influenced by age, sex, marital status, wealth index, education and geographic region. Compared to other classifiers, the RF-based classifier provides the highest ACC and AUC for both DBNCDs (ACC = 81.06% and AUC = 0.93) and TBNCDs (ACC = 88.61% and AUC = 0.97) for the K10 protocol. A combination of considered two-step factor selections and RF-based classifier can better predict the burden of NCDs. The findings of this study suggested that decision-makers might adopt suitable decisions to control and prevent the burden of NCDs using RF classifiers.

Impact of prenatal maternal dietary exclusion on childhood obesity and overweight risk.

BACKGROUND: Child birthweight is a measure of fetal nutrition that is primarily determined by prenatal maternal (PM) diet. Child birthweight and child obesity/overweight risk are well established to be linked. Nevertheless, no studies have investigated the impact of PM dietary exclusion on child obesity/overweight risk or body mass index z-score (BMIz). OBJECTIVES: The study aimed to determine whether PM dietary exclusion affected the child's BMIz, obesity/overweight risk, whether child birthweight serves as a mediator of this, and whether PM use of dietary supplements can protect against this. METHODS: Waves within the years 2004-2019 from the Longitudinal Study of Australian Children, a population-based cohort study, were analyzed. The participants were aged 0 to 15 years during these waves of the study. Analysis was conducted using logistic and linear models. A total of 5,107 participants were involved in the first wave of the study. RESULTS: The PM exclusion of fish was associated with a higher risk of being underweight at age 14 or 15 years and mild-to-moderate obesity at age 6 or 7 years. The PM exclusion of egg was associated with a higher risk of being overweight at age 14 or 15 years. The exclusion of dairy was associated with more mixed effects. Mediation effects did not reach statistical significance. Moderation effects involving PM dietary supplement use, when they did occur, were associated with higher child BMIz and usually a higher risk of obesity/overweight. CONCLUSIONS: Fish and eggs are likely important parts of PM diets for preventing childhood obesity and overweight. Further studies will be needed to determine reasons for this and the apparent adverse effects of dietary supplements on overweight/obesity risk.

Rural‒urban disparities in household catastrophic health expenditure in Bangladesh: a multivariate decomposition analysis.

BACKGROUND: Rural‒urban disparity in catastrophic healthcare expenditure (CHE) is a well-documented challenge in low- and middle-income countries, including Bangladesh, limiting financial protection and hindering the achievement of the Universal Health Coverage target of the United Nations Sustainable Development Goals. However, the factors driving this divide remain poorly understood. Therefore, this study aims to identify the key determinants of the rural‒urban disparity in CHE incidence in Bangladesh and their changes over time. METHODS: We used nationally representative data from the latest three rounds of the Bangladesh Household Income and Expenditure Survey (2005, 2010, and 2016). CHE incidence among households seeking healthcare was measured using the normative food, housing, and utilities method. To quantify covariate contributions to the rural‒urban CHE gap, we employed the Oaxaca-Blinder multivariate decomposition approach, adapted by Powers et al. for nonlinear response models. RESULTS: CHE incidence among rural households increased persistently during the study period (2005: 24.85%, 2010: 25.74%, 2016: 27.91%) along with a significant (p-value ≤ 0.01) rural‒urban gap (2005: 9.74%-points, 2010: 13.94%-points, 2016: 12.90%-points). Despite declining over time, substantial proportions of CHE disparities (2005: 87.93%, 2010: 60.44%, 2016: 61.33%) are significantly (p-value ≤ 0.01) attributable to endowment differences between rural and urban households. The leading (three) covariate categories consistently contributing significantly (p-value ≤ 0.01) to the CHE gaps were composition disparities in the lowest consumption quintile (2005: 49.82%, 2010: 36.16%, 2016: 33.61%), highest consumption quintile (2005: 32.35%, 2010: 15.32%, 2016: 18.39%), and exclusive reliance on informal healthcare sources (2005: -36.46%, 2010: -10.17%, 2016: -12.58%). Distinctively, the presence of chronic illnesses in households emerged as a significant factor in 2016 (9.14%, p-value ≤ 0.01), superseding the contributions of composition differences in household heads with no education (4.40%, p-value ≤ 0.01) and secondary or higher education (7.44%, p-value ≤ 0.01), which were the fourth and fifth significant contributors in 2005 and 2010. CONCLUSIONS: Rural‒urban differences in household economic status, educational attainment of household heads, and healthcare sources were the key contributors to the rural‒urban CHE disparity between 2005 and 2016 in Bangladesh, with chronic illness emerging as a significant factor in the latest period. Closing the rural‒urban CHE gap necessitates strategies that carefully address rural‒urban variations in the characteristics identified above.

Multimorbidity and health-related quality of life amongst Indigenous Australians: A longitudinal analysis.

BACKGROUND: The burden of multimorbidity has been observed worldwide and it has significant consequences on health outcomes. In Australia, health-related quality of life (HRQoL) is comparatively low amongst Aboriginal and/or Torres Strait Islanders, yet no studies have examined the effect of multimorbidity on HRQoL within this at-risk population. This study seeks to fill that gap by employing a longitudinal research design. METHODS: Longitudinal data were derived from three waves (9, 13, and 17) of the household, income and labour dynamics in Australia (HILDA) Survey. A total of 1007 person-year observations from 592 Aboriginal and/or Torres Strait Islander individuals aged 15 years and above were included. HRQoL was captured using the 36-item Short-Form Health Survey (SF-36), and multimorbidity was defined using self-reports of having been diagnosed with two or more chronic health conditions. Symmetric fixed-effects linear regression models were used to assess how intraindividual changes in multimorbidity were associated with intraindividual changes in HRQoL. RESULTS: Approximately 21% of Indigenous Australians were classified as experiencing multimorbidity. Respondents had statistically significantly lower HRQoL on the SF-36 sub-scales, summary measures, and health-utility index in those observations in which they experienced multimorbidity. Among others, multimorbidity was associated with lower scores on the SF-36 physical-component scale (ß = - 6.527; Standard Error [SE] = 1.579), mental-component scale (ß = - 3.765; SE = 1.590) and short-form six-dimension utility index (ß = - 0.075; SE = 0.017). CONCLUSION: This study demonstrates that having multiple chronic conditions is statistically significantly associated with lower HRQoL amongst Indigenous Australians. These findings suggest that comprehensive and culturally sensitive health strategies addressing the complex needs of individuals with multimorbidity should be implemented to improve the HRQoL of Indigenous Australians.

Evaluating the roles of energy innovation, fossil fuel costs and environmental compliance towards energy transition in advanced industrial economies.

Given the dire state of climate change, investigating key elements that impact the energy transition process and help monitor progress in greenhouse gas emissions to achieve environmental sustainability is of critical importance. The current study explores the association between energy transition, compliance with environmental agreements, fossil fuels costs, environmental technologies, economic growth, and environmental degradation in G20 economies from 1995 to 2019. Our findings from extensive econometric analysis reveal that economic growth, environmental innovation, renewable energy, and environmental compliance facilitate while fossil fuels and environmental degradation hinder the energy transition process. Our findings conclude that developed countries must focus on alternate energy resources to overcome environmental challenges and subsidize renewable energy and environmental technologies to replace fossil fuels with green energy resources methodologically. Further, policy measures have been discussed in detail in the study.

Gastroesophageal reflux disease following laparoscopic vertical sleeve gastrectomy and laparoscopic roux-en-Y gastric bypass: meta-analysis and systematic review of 5-year data.

To compare 5-year gastroesophageal reflux outcomes following Laparoscopic Vertical Sleeve Gastrectomy (LVSG) and Laparoscopic Roux-en-Y gastric bypass (LRYGB) based on high quality randomized controlled trials (RCTs). We conducted a sub-analysis of our systematic review and meta-analysis of RCTs of primary LVSG and LRYGB procedures in adults for 5-year post-operative complications (PROSPERO CRD42018112054). Electronic databases were searched from January 2015 to July 2021 for publications meeting inclusion criteria. The Hartung-Knapp-Sidik-Jonkman random effects model was utilized to estimate weighted mean differences where meta-analysis was possible. Bias and certainty of evidence was assessed using the Cochrane Risk of Bias Tool 2 and GRADE. Four RCTs were included (LVSG n = 266, LRYGB n = 259). An increase in adverse GERD outcomes were observed at 5 years postoperatively in LVSG compared to LRYGB in all outcomes considered: Overall worsened GERD, including the development de novo GERD, occurred more commonly following LVSG compared to LRYGB (OR 5.34, 95% CI 1.67 to 17.05; p = 0.02; I2 = 0%; (Moderate level of certainty); Reoperations to treat severe GERD (OR 7.22, 95% CI 0.82 to 63.63; p = 0.06; I2 = 0%; High level of certainty) and non-surgical management for worsened GERD (OR 3.42, 95% CI 1.16 to 10.05; p = 0.04; I2 = 0%; Low level of certainty) was more common in LVSG patients. LVSG is associated with the development and worsening of GERD symptoms compared to LRYGB at 5 years postoperatively leading to either introduction/increased pharmacological requirement or further surgical treatment. Appropriate patient/surgical selection is critical to minimize these postoperative risks.

Correction: The burden of chronic diseases among Australian cancer patients: Evidence from a longitudinal exploration, 2007-2017.

[This corrects the article DOI: 10.1371/journal.pone.0228744.].

Correction: The cost-effectiveness of controlling cervical cancer using a new 9-valent human papillomavirus vaccine among school-aged girls in Australia.

[This corrects the article DOI: 10.1371/journal.pone.0223658.].

Correction: Cost-effectiveness evaluations of the 9-Valent human papillomavirus (HPV) vaccine: Evidence from a systematic review.

[This corrects the article DOI: 10.1371/journal.pone.0233499.].

Correction: Changes in inequality of childhood morbidity in Bangladesh 1993-2014: A decomposition analysis.

[This corrects the article DOI: 10.1371/journal.pone.0218515.].

Circular economy, environmental quality and tourism receipts in Europe: A time series data analysis.

The study examines how progress towards a circular economy (CE), patents related to recycling and secondary raw materials as a proxy for innovation, affect tourism receipts. The study uses Autoregressive Distributed Lag (ARDL) and Error Correction Method (ECM) to analyse time series data from EU countries from 2000 to 2020. Our estimates show that there exist long-run and short-run equilibrium relationships. In sum, evidence shows that promoting circular innovative practices, including recycling and using secondary raw materials in tourist destinations, could improve environmental quality and positively impact tourism receipts. The study concludes with policy and practical suggestions for circular economy innovation towards green tourism, destination management, and sustainable tourism.

Exploration of key drug target proteins highlighting their related regulatory molecules, functional pathways and drug candidates associated with delirium: evidence from meta-data analyses.

BACKGROUND: Delirium is a prevalent neuropsychiatric medical phenomenon that causes serious emergency outcomes, including mortality and morbidity. It also increases the suffering and the economic burden for families and carers. Unfortunately, the pathophysiology of delirium is still unknown, which is a major obstacle to therapeutic development. The modern network-based system biology and multi-omics analysis approach has been widely used to recover the key drug target biomolecules and signaling pathways associated with disease pathophysiology. This study aimed to identify the major drug target hub-proteins associated with delirium, their regulatory molecules with functional pathways, and repurposable drug candidates for delirium treatment. METHODS: We used a comprehensive proteomic seed dataset derived from a systematic literature review and the Comparative Toxicogenomics Database (CTD). An integrated multi-omics network-based bioinformatics approach was utilized in this study. The STRING database was used to construct the protein-protein interaction (PPI) network. The gene set enrichment and signaling pathways analysis, the regulatory transcription factors and microRNAs were conducted using delirium-associated genes. Finally, hub-proteins associated repurposable drugs were retrieved from CMap database. RESULTS: We have distinguished 11 drug targeted hub-proteins (MAPK1, MAPK3, TP53, JUN, STAT3, SRC, RELA, AKT1, MAPK14, HSP90AA1 and DLG4), 5 transcription factors (FOXC1, GATA2, YY1, TFAP2A and SREBF1) and 6 microRNA (miR-375, miR-17-5, miR-17-5p, miR-106a-5p, miR-125b-5p, and miR-125a-5p) associated with delirium. The functional enrichment and pathway analysis revealed the cytokines, inflammation, postoperative pain, oxidative stress-associated pathways, developmental biology, shigellosis and cellular senescence which are closely connected with delirium development and the hallmarks of aging. The hub-proteins associated computationally identified repurposable drugs were retrieved from database. The predicted drug molecules including aspirin, irbesartan, ephedrine-(racemic), nedocromil, and guanidine were characterized as anti-inflammatory, stimulating the central nervous system, neuroprotective medication based on the existing literatures. The drug molecules may play an important role for therapeutic development against delirium if they are investigated more extensively through clinical trials and various wet lab experiments. CONCLUSION: This study could possibly help future research on investigating the delirium-associated therapeutic target biomarker hub-proteins and repurposed drug compounds. These results will also aid understanding of the molecular mechanisms that underlie the pathophysiology of delirium onset and molecular function.

Maternal Healthcare Services Utilisation and Its Associated Risk Factors: A Pooled Study of 37 Low- and Middle-Income Countries.

Objectives: The utilisation of maternal healthcare services (MHS) can play an essential role in reducing maternal deaths. Thus, this study examines the prevalence and factors associated with MHS utilisation in 37 low-and-middle-income countries (LMICs). Methods: A total of 264,123 women were obtained from the Demographic and Health Surveys of 37 LMICs. Multivariate logistic regression was performed to identify the factors associated with maternal healthcare services utilisation. Results: Around one-third (33.7%) of the respondents properly utilise MHS among women of childbearing age. In the pooled sample, the odds of MHS utilisation were significantly higher with the increase in wealth index, women's age, age at the first birth, and husband/partner's education. Urban residence (AOR [adjusted odds ratio] = 1.56; 95% CI [confidence interval]: 1.49-1.64), women's autonomy in healthcare decision-making (AOR = 1.19; 95% CI: 1.15-1.24) and media exposure (AOR = 1.70; 95% CI: 1.58-1.83) were found to be the strongest positive factors associated with utilisation of MHS. In contrast, larger family (AOR = 0.93; 95% CI: 0.91-0.96), and families with 7 or more children (AOR = 0.72; 95% CI: 0.68-0.77) were significantly negatively associated with MHS utilisation. Conclusion: The utilisation of MHS highly varied in LMICs and the associated factors. Expanding the wealth status, education, age at first birth, mothers' autonomy in healthcare decisions, and media exposure could be essential strategies for increasing the utilisation of MHS; however, country-specific programs should be considered in national policy discussions. There is a need to formulate policies and design maternal health services programs that target socially marginalised women.

Changes in the prevalence of dementia in Australia and its association with geographic remoteness.

BACKGROUND: The exact prevalence of dementia in Australia is ambiguous. Australia is a vast continent with a small population, and 80% of the population live in five cities. This study explores recent changes in the prevalence of dementia. It also investigates geographic remoteness as a potential risk factor for developing dementia. METHODS: Survey of Disability, Ageing and Carers (SDAC), a nationally representative database, was used to conduct this study. A total of 74,862 and 65,487 individuals from 2015 and 2018, respectively, were considered for this study. A multivariable logistic regression model was used to evaluate the association between dementia and geographic remoteness for older adults aged 65 years and over. RESULTS: The results reveal that from 2015 to 2018, the prevalence of dementia among adults aged 65 years and older was higher in 2018 (5,229 per 100,000) than in 2015 (5,099 per 100,000). Significant geographical differences in the prevalence of dementia are observed among Australian adults, and this trend appears to be increasing. Furthermore, the unadjusted model revealed that, in 2015, older adults living in major cities had 1.29 (AOR: 1.29, 95% CI: 1.17-1.41) times higher odds of having dementia compared with their counterparts from outer regional and remote areas. In 2018, the adjusted model found that older adults living in major cities had 1.12 (AOR: 1.12, 95% CI: 1.01-1.25) times elevated odds of having dementia than their peers living in outer regional and remote areas. CONCLUSION: There is a rising prevalence of dementia in Australia. Further investigation is required to identify the causes of this increase. Increased public health initiatives should concentrate on behavioural characteristics and contextual environmental factors to ameliorate this trend.

Sleep duration, sleep quality and the risk of being obese: Evidence from the Australian panel survey.

BACKGROUND: Sleep difficulty is an unmet public health concern affecting a vast proportion of the world's population. Poor sleep duration (short or long sleep length) and quality affect more than half of older people. Sleep difficulty is associated with negative health outcomes such as obesity and reduced longevity. We aimed to assess whether poor sleep duration and quality are significant risk factors for obesity in adults aged 15 and over in Australia by examining a nationally representative panel data. METHODS: We used three waves (waves 13, 17, and 21) of the nationally representative Household, Income and Labour Dynamics in Australia (HILDA) survey data. The study applied generalized estimating equations (GEE) logistic regression model to assess the relationship between sleep duration and quality with obesity. RESULTS: The study found that the odds of being obese was significantly higher amongst the study participants with poor sleep duration (adjusted odds ratio [aOR]: 1.24, 95% confidence interval [CI]: 1.16-1.32) and poor sleep quality (aOR: 1.29, 95% CI: 1.02-1.38) compared with their counterparts who had good sleep duration and quality, respectively. CONCLUSION: Having short or long sleep at night and poor sleep quality are associated with an increased risk of obesity. Obesity poses a significant threat to the health of Australian adults. Enacting policies that raise public awareness of the significance of good sleep hygiene and encouraging healthy sleeping habits should be considered to address the alarming rise in the obesity rate.

Drug-Resistant Tuberculosis Stigma Among HealthCare Workers Toward the Development of a Stigma-Reduction Strategy: A Scoping Review.

Drug-resistant tuberculosis (DRTB) is a growing concern worldwide. The poor rate of service delivery exacerbates the severity, leading to an increase in community transmission, which is further amplified by stigma. Health care workers (HCWs) are at the forefront lines of service delivery; their efforts are suspected of resulting in stigmatization, negatively impacting patient-centered care. However, little is known about DRTB-related stigma among these HCWs, and interventions are limited. Our scoping review is significant because it provides an overview of the DRTB stigma confronting HCWs and informs subsequent stigma-reduction initiatives. Utilizing Arksey and O'Malley framework, we exhaustively searched electronic databases for relevant English-language studies published from 2010 to 2022, identifying the drivers and facilitators of DRTB-related stigma among HCWs from high-TB and -DRTB burden countries, and compiling recommendations that could reduce DRTB stigma. From 443 de-duplicated papers, 11 articles on HCWs' DRTB-related stigma were reviewed and synthesized. Fear was mentioned across included articles as a stigma driver. Other reported stigma drivers identified included feelings of discrimination, isolation, danger, lack of support, shame, and stress. Poor infection control (IC) was the leading stigma facilitator. Other stigma facilitators identified were differing IC interpretations, workforce culture, and workplace inequality facilitating to stigmatization of HCWs. Three key recommendations identified were addressing infection control issues; increase the competence of healthcare workers; and provide psychosocial assistance, emphasizing HCW safety during DRTB activities. DRTB stigma among HCWs is multifaceted, largely driven by fear and facilitated by varying implementation or interpretations of policies within the workplace. Making HCWs feel safe while conducting DRTB activities is a priority issue that should be addressed by improving IC, training and psychosocial support. More studies investigating country-specific and multilevel DRTB-related stigma among HCWs are required to inform the development of an effective stigma intervention strategy.

A latent class analysis of the socio-demographic factors and associations with mental and behavioral disorders among Australian children and adolescents.

BACKGROUND: Previous studies have shown a relationship between socio-demographic variables and the mental health of children and adolescents. However, no research has been found on a model-based cluster analysis of socio-demographic characteristics with mental health. This study aimed to identify the cluster of the items representing the socio-demographic characteristics of Australian children and adolescents aged 11-17 years by using latent class analysis (LCA) and examining the associations with their mental health. METHODS: Children and adolescents aged 11-17 years (n = 3152) were considered from the 2013-2014 Young Minds Matter: The Second Australian Child and Adolescent Survey of Mental Health and Wellbeing. LCA was performed based on relevant socio-demographic factors from three levels. Due to the high prevalence of mental and behavioral disorders, the generalized linear model with log-link binomial family (log-binomial regression model) was used to examine the associations between identified classes, and the mental and behavioral disorders of children and adolescents. RESULTS: This study identified five classes based on various model selection criteria. Classes 1 and 4 presented the vulnerable class carrying the characteristics of "lowest socio-economic status and non-intact family structure" and "good socio-economic status and non-intact family structure" respectively. By contrast, class 5 indicated the most privileged class carrying the characteristics of "highest socio-economic status and intact family structure". Results from the log-binomial regression model (unadjusted and adjusted models) showed that children and adolescents belonging to classes 1 and 4 were about 1.60 and 1.35 times more prevalent to be suffering from mental and behavioral disorders compared to their class 5 counterparts (95% CI of PR [prevalence ratio]: 1.41-1.82 for class 1; 95% CI of PR [prevalence ratio]: 1.16-1.57 for class 4). Although children and adolescents from class 4 belong to a socio-economically advantaged group and shared the lowest class membership (only 12.7%), the class had a greater prevalence (44.1%) of mental and behavioral disorders than did class 2 ("worst education and occupational attainment and intact family structure") (35.2%) and class 3 ("average socio-economic status and intact family structure") (32.9%). CONCLUSIONS: Among the five latent classes, children and adolescents from classes 1 and 4 have a higher risk of developing mental and behavioral disorders. The findings suggest that health promotion and prevention as well as combating poverty are needed to improve mental health in particular among children and adolescents living in non-intact families and in families with a low socio-economic status.

The burden of chronic diseases, disease-stratified exploration and gender-differentiated healthcare utilisation among patients in Bangladesh.

BACKGROUND: Chronic diseases are considered one of the major causes of illness, disability, and death worldwide. Chronic illness leads to a huge health and economic burden, especially in low- and middle-income countries. This study examined disease-stratified healthcare utilisation (HCU) among Bangladesh patients with chronic diseases from a gender perspective. METHODS: Data from the nationally representative Household Income and Expenditure Survey 2016-2017 consisting of 12,005 patients with diagnosed chronic diseases was used. Gender differentiated chronic disease stratified-analytical exploration was performed to identify the potential factors to higher or lower utilisation of healthcare services. Logistic regression with step-by-step adjustment for independent confounding factors was the method used. RESULTS: The five most prevalent chronic diseases among patients were gastric/ulcer (Male/Female, M/F: 16.77%/16.40%), arthritis/rheumatism (M/F: 13.70%/ 13.86%), respiratory diseases/asthma/bronchitis (M/F: 12.09% / 12.55%), chronic heart disease (M/F: 8.30% / 7.41%), and blood pressure (M/F: 8.20% / 8.87%). Eighty-six percent of patients with chronic diseases utilised health care services during the previous 30 days. Although most patients received outpatient healthcare services, a substantial difference in HCU among employed male (53%) and female (8%) patients were observed. Chronic heart disease patients were more likely to utilise health care than other disease types, which held true for both genders while the magnitude of HCU was significantly higher in males (OR = 2.22; 95% CI:1.51-3.26) than their female counterparts (OR = 1.44; 1.02-2.04). A similar association was observed among patients with diabetes and respiratory diseases. CONCLUSION: A burden of chronic diseases was observed in Bangladesh. Patients with chronic heart disease utilised more healthcare services than patients experiencing other chronic diseases. The distribution of HCU varied by patient's gender as well as their employment status. Risk-pooling mechanisms and access to free or low-cost healthcare services among the most disadvantaged people in society might enhance reaching universal health coverage.

Informal employment and catastrophic health expenditures: Evidence from Pakistan.

Workers in informal employment suffered significant out-of-pocket healthcare expenditures (OOPHEs) due to their low earnings and a lack of a social safety net or health insurance. There is little or no evidence of impoverishment caused by OOPHEs in the context of labor market categorization. Therefore, this study examines the economic burden of OOPHEs and its associated consequences on households, whose members are in informal employment. This study estimates the incidence of catastrophic health expenditures (CHEs) and impoverishment across the households in formal and informal employment and their key determinants in Pakistan by employing the data from the two rounds of the Household Integrated Economic Survey (2015-16, 2018-19). For measuring CHEs and impoverishment, the budget share and capacity-to-pay approaches are applied. Various thresholds are used to demonstrate the sensitivity of catastrophic measures. We found a higher incidence of catastrophic healthcare payments among the informal workers, that is, 4.03% and 7.11% for 2015-16 and 2018-19, respectively, at a 10% threshold, while at a 40% threshold, the incidence of CHEs is found to be 0.40% and 2.34% for 2015-16 and 2018-19, respectively. These OOPHEs caused 1.53% and 3.66% of households who are in informal employment to become impoverished, compared with their formal counterparts. The study demonstrates that the probability of incurring CHEs and becoming impoverished is high among informal workers, compared with their formal counterparts. This result has clear policy implications, in which to protect the informal workers, it is necessary to expand the insurance coverage, particularly during the COVID-19 response and recovery efforts.