Access To Health Care Services Research Articles

Exploring lack of trust and its impact on access and utilization of primary healthcare services among African immigrant women in the United States: a qualitative study of Ethiopian immigrant women

BackgroundLack of trust is a critical issue in healthcare that contributes to the growing disparities in access and utilization of health among minoritized and disadvantaged populations in the U.S. This study explored how lack of trust affects Ethiopian immigrant women’s (EIW) primary healthcare (PHC) experience and the personal and structural factors exacerbating the problem.MethodA qualitative cross-sectional design was used to collect data through in-depth interviews with EIW (N = 21) living in six states (MO, MD, VA, KS, MI and IN) and Washington DC using a pilot-tested semi-structured interview guide. A mix of purposive and snowball sampling was used to recruit participants who: (1) identify as an Ethiopian immigrant; (2) identify as a female; (3) be 18 years and older; (4) arrived in the U.S. within the last five years; and (5) speak Amharic or English languages. The interviews were recorded, transcribed verbatim, translated and cleaned for errors. An inductive thematic analysis was followed to analyze data using Nvivo12 software.ResultsThe findings showed that lack of trust is a significant concern among EIW negatively affecting their PHC experience and decisions in seeking care. The thematic analysis revealed five major factors contributing to the erosion of trust in PHC among EIW: (1) reliance on medication in U.S. healthcare system (2) preference for traditional homemade remedies over PHC recommendations and modern medicine (3) faith and its influence on trust and PHC decisions (4) lack of transparency in PHC, and (5) multilevel discrimination in PHC.ConclusionThe analysis suggested that PHC professionals provide understandable and contextualized health information, practice transparency, familiarize themselves with the healthcare system in immigrants’ countries of origin by asking their patients, and prioritize culturally competent care to gain trust. At structural and policy levels, reform is needed to dismantle systemic problems that enable and perpetuate discrimination, diversify the healthcare workforce, revise healthcare training curriculums and procedures to reflect immigrant needs, establish multi-sectoral collaboration between health, education, and immigration sectors to create conducive care environment for immigrants. Further research and conversation around alternative medicine is vital to expand evidence-based and inclusive PHC services for immigrants.

Availability and affordability of diabetes healthcare services associated with the frequency of diabetes-related complications

AimsUnderstanding the healthcare access challenges facing diabetic patients in low- and middle-income countries is very important. The present study investigated the association between availability (physical access) and affordability (economic access) to diabetes healthcare services and the frequency of diabetes-related complications.MethodsA cross-sectional survey study was conducted between February and May 2023 in Qazvin, Iran. Using convenience sampling, 373 type 2 diabetic patients (mean age = 57.99 years; SD = 11.71) referred to diabetic specialists’ clinics were surveyed. Demographic characteristics, physical access to diabetes healthcare services, economic access to diabetes healthcare services, and frequency of diabetes-related complications (FDRCs) were assessed. Data were assessed using linear regression analysis.ResultsThe mean total access score to healthcare services was 17.71 (out of 30; SD ± 4.21; range 6–30). Patients who had more access to healthcare services had less diabetes-related complications (p < 0.005). There was a significant negative correlation (p < 0.01) between FDRCs and (i) physical access to diabetes-related healthcare services (r = -0.166) and (ii) economic access to diabetes-related healthcare services (r = -0.153). Linear regression analysis showed that with each unit increase in participants’ economic, physical and total access to diabetes-related healthcare services, the FDRCs among participants decreased by 8.7%, 13.5%, and 8.8% respectively.ConclusionThe results indicate that increased physical accessibility (availability) and economic accessibility (affordability) of healthcare services are associated with fewer diabetes-related complications. Therefore, policymakers and healthcare managers need to reduce diabetes-related complications by implementing schemes to increase patient access to diabetes treatment services.

Beyond illness: Understanding the social determinants in the life of a middle-aged Pakistani woman

Background: Poverty is both a cause and a consequence of poor health, and the scarcity of resources limits access to essential health care services. Aim: To highlight the implications on health of the often-neglected social determinants. Methods: We examined the experiences of Shahida Parveen, a middle-aged, unmarried woman, living in a resource-poor setting in Rawalpindi, Pakistan, and the interplay of the social determinants and inadequate safety nets on her health and wellbeing. Results: Shahida's narrative unveiled a poignant journey marked by health challenges early in her lifetime, her profound losses and the systemic barriers to accessing healthcare. Poverty, limited social support, and healthcare disparities emerged as central factors in shaping her health outcomes. Conclusion: This case report highlights the need for a more just and more inclusive healthcare system that guarantees comprehensive social safety nets and accessible health care services for vulnerable populations.

Challenges in accessing health care services for women and girls with disabilities using a humanitarian physical rehabilitation program in Lebanon: a mixed method study

BackgroundAchieving equitable healthcare access for persons with disabilities is vital, as they often face various barriers that impact their health and well-being. Recognizing the importance of gender equity, this study aims to explore the specific barriers faced by women and girls with disabilities in accessing quality healthcare services in Lebanon.MethodsA mixed-method sequential explanatory approach was employed. Initially, a retrospective descriptive study analyzed data from the International Committee of the Red Cross (ICRC)-supported physical rehabilitation programme (PRP) database. Subsequently, in-depth interviews were conducted to delve into factors influencing gender-disproportionate service users and to uncover barriers to accessing healthcare. Levesque et al.‘s ‘Conceptual framework on healthcare access’ was used to organize and map the results.ResultsThe quantitative analysis of service utilization at ICRC PRP centers from 2015 to 2022 revealed significant gender disparities, with males comprising 66.6% of service users compared to 33.4% females. This trend was consistent across age categories, nationalities, and clinical conditions. Healthcare access for women and girls with disabilities was found to be inadequate across all five dimensions of the Levesque framework: adequacy, accessibility, affordability, appropriateness, and availability, as well as their corresponding abilities. While certain challenges such as transportation, financial constraints, inadequate infrastructure, and limited information on available services were common to both genders, gender-specific barriers primarily included societal norms, safety concerns during unaccompanied visits to healthcare facilities, limited access to societal information, economic disparities, preferences for female healthcare providers, and the need for privacy during consultations.ConclusionThis study underscores key barriers hindering healthcare access for women and girls with disabilities in Lebanon, necessitating tailored interventions. Gender-specific challenges, including societal norms and safety concerns, require targeted solutions for improved access and outcomes. This study serves as a call to action for stakeholders at various levels to collaborate and implement concrete measures to bridge the gap in healthcare access and ensure that no one is left behind.

Factors associated with access to health services among people with long COVID in the Brazilian Amazon

BackgroundAccess to healthcare services for the population with long COVID is a challenge, as healthcare systems have been tasked with responding effectively to the extensive clinical heterogeneity of this disease.ObjectiveTo analyze the factors associated with access to health services among people with long COVID in the Brazilian Amazon.MethodsThis is a cross-sectional study using a quantitative method, conducted through an online survey between May 2023 and January 2024. The study included participants aged 18 years or older, residing in the northern region of Brazil, with a confirmed diagnosis of COVID-19 and who experienced long COVID. Participants completed an adapted version of the questionnaire on the Research Electronic Data Capture platform. Data were analyzed by multiple logistic regression.ResultsA total of 364 people with long COVID participated in the study, of which only 167 (45.88%) had access to healthcare to treat the symptoms of this clinical condition. In the final multiple logistic regression model, only factors related to the need for services were associated with healthcare access. Participants with symptoms of dermatological alterations (AOR = 2.57; p = 0.01), a pre-COVID-19 diagnosis of chronic disease (AOR = 5.62; p = 0.04), those who treated their most severe COVID-19 infection with the assistance of a healthcare professional (AOR = 4.97; p = 0.01), and those who used antibiotics during their most severe COVID-19 infection (AOR = 3.24; p = 0.01) were more likely to access healthcare services for treating long COVID.ConclusionFactors related to the need for services were the only ones associated in this population. It is important to know these aspects to identify the most affected populations and propose measures.

Antecedents For the Adoption of Telemedicine in India: Scale development and validation

Background: Telemedicine is increasingly recognized as a promising solution to healthcare challenges in India, particularly in remote areas. However, the country's vast population and geographic diversity present significant obstacles to providing accessible and high-quality healthcare services to all citizens. By leveraging technology, telemedicine has the potential to bridge this gap and enable remote delivery of medical services. Objective: This study aims to develop and validate a scale that assesses the factors influencing the adoption of telemedicine in the Indian context. Understanding these factors is crucial for identifying key drivers and barriers to telemedicine adoption in India. Design: Quantitative methods were employed for scale development. The instrument development process involved several stages: factor identification, item generation, pre-testing, pilot testing, and scale validation. A structured questionnaire was administered to healthcare professionals, industry experts, and patients who have used or intend to use telemedicine. Setting: Confirmatory factor analysis and subsequent tests, such as reliability and validity tests were conducted to establish the internal consistency of the scales. These statistical analyses aimed to identify underlying factors and ensure accurate measurement of latent variables that affect the adoption of telemedicine. Results: The study established a robust scale to assess the five key factors, which are the vital explanatory variables in telemedicine adoption in India. These meticulously validated scales, encompassing technology, government policy, user attitudes, societal demand, and healthcare professional perspectives, demonstrate high reliability and validity in understanding the adoption dynamics of telemedicine in the context of India. Conclusion: This research offers a validated scale for assessing telemedicine adoption in India, crucial for healthcare service providers, policy makers, and researchers in this field. It enables informed decisions in implementing telemedicine, addressing unique challenges and opportunities, and significantly contributing to optimizing healthcare delivery across India's diverse socio-economic and geographical landscape.

Smartphone Adoption and Healthcare Usage Among Older Adults in India

ABSTRACT The growing aging population globally requires accessible digital healthcare services to maintain a healthy lifestyle. Smartphones have the potential to connect individuals with digital healthcare services. However, whether older adults perceive smartphones as a convenient means of accessing these services remains uncertain. This study aimed to investigate the perspectives of older Indian adults regarding smartphone adoption and its usage in healthcare services. For this, a mixed-methods approach combining quantitative and qualitative methods was employed. A total of 59 older adults participated in the study, of whom 54 completed survey questionnaires, 15 engaged in semi-structured interviews, and 10 participated in both studies. The findings reveal that older adults have adopted smartphones for various purposes after initially facing hindrances, often with assistance from family members. However, the use of smartphone-based healthcare applications remains minimal. These findings suggest that addressing the challenges older adults face with user interface design will enhance their use of healthcare applications. Thus, healthcare applications must feature a user-friendly interface specifically tailored for older adults. Additionally, familiar and popular application-inspired interfaces, social and family support, co-designing, digital health awareness, and training programmes can further promote the adoption of smartphone-based healthcare applications among older adults.

“When in Rome…”: structural determinants impacting healthcare access, health outcomes, and well-being of South Asian older adults in Ontario using a multilingual qualitative approach

With the increase in international migration, the need for an equitable healthcare system in Canada is increasing. The current biomedical model of healthcare is constructed largely in the Eurocentric tradition of medicine, which often disregards the diverse health perspectives of Canada’s racialized immigrant older adults. As a result, current healthcare approaches (adopted in the US and Canada) fall short in addressing the health needs of a considerable segment of the population, impeding their ability to access healthcare services. This study aimed to identify and understand the structural and systemic factors that influence healthcare experiences and well-being among South Asian older adults in Ontario, addressing a significant gap in empirical and theoretical knowledge in the Canadian context. We conducted in-depth individual and dyadic interviews (n = 28) utilizing a descriptive multilingual cross-cultural qualitative approach. Through this research, participants expressed that their understanding of well-being does not align with that of their healthcare providers, resulting in unmet health needs. Our study uses an intersectional lens to demonstrate participants’ perceptions of virtual access to care and systemic factors, such as mandatory assimilation and whiteness as a taken-for-granted norm impacting the health and well-being of South Asian older adults. The findings of this research can offer valuable insights to healthcare providers and policymakers in developing culturally competent practices, guidelines, and training policies that effectively address the healthcare needs of the South Asian population in Canada.

Bridging the distance: understanding access to healthcare through stories from Gwich’in medical travellers in Northwest Territories

ABSTRACT In northern Canada, medical travel – the movement of patients to a larger centre to access healthcare services outside their home community – is a dominant feature of the healthcare system. This qualitative study explored the medical travel experiences of Gwich’in living above the Arctic Circle in the Gwich’in Settlement Area in Northwest Territories (NT). Data collection in 2020 comprised storytelling sessions with 10 Gwich’in medical travellers (6 female, 4 male). Using inductive and deductive methods with continual critical reflexivity, and guided by Gwich’in values, concerns about access to healthcare were found to be at the heart of each story. A broad conceptualisation of access was applied to understand and interpret the results according to six dimensions: accessibility, availability, affordability, adequacy, acceptability, and awareness. Situated within a context of colonialism, structural inequities and other factors relevant across the Circumpolar North, the results suggest that the NT medical travel policy framework provides only partial access to care. This article illustrates a need for healthcare and other government systems to think about policy and programmes in a more wholistic, equitable and relationship-centred way, which would help not only to bridge distances across geography, but also between peoples.

Examining health determinants and outcomes of older adults across Ghana's North-South divide.

Healthcare services and outcomes are often not evenly distributed across geographic regions. This study used the harmonized data from the Research on Early Life and Trends and Effects (RELATE) to compare the health outcomes of older adults across the North-South divide of Ghana and identify the factors underlying these differences. Although the literature indicates that the South has more health resources and better health indicators, the current study revealed that, for older adults, health outcome in the North was comparatively better than that in the South. The optimal health index scores show that older adults in the North are living at 86% of their optimal health compared with 82% in the South. Work-related physical activity and age substantially influenced optimal health in both regions. Additionally, healthcare use and gender were influential, particularly in the South. The results of the current study suggest that healthcare service availability can impact health outcomes, but so can behavioral and sociodemographic factors.

PERCEPTIONS AND THEIR CORRELATION WITH ENROLLMENT IN THE INDONESIAN NATIONAL HEALTH INSURANCE SCHEME

Background: Health insurance serves as a key mechanism in facilitating wider and more equitable availability of healthcare services, ensuring that every individual can access the services they need. Aims: This research aims to examine the correlation between community perceptions and enrollment in the National Health Insurance (JKN) in the Musi Rawas Utara District, Indonesia. Methods: This research applied a cross-sectional study by collecting data from 384 respondents. Logistic regression analysis was used to assess the correlation between perceptions and JKN enrollment. Results: The results showed that 68.49% of respondents were not enrolled in the JKN. Factors associated with JKN enrollment include perceptions regarding JKN, income, and the history of illness. People with favorable perceptions have a 1.90 times higher chance to join the JKN membership. People with income ≥ provincial minimum wage (UMR) have an opportunity of 0.50 times higher than people with income &lt; UMR to join the JKN membership. The history of illness is likely to enhance JKN enrollment by 7.86 times. Conclusion: In the Musi Rawas Utara District, the rate of enrollment in the JKN program remains low. Strategic policy reforms, accompanied by targeted advocacy and health education promotion, have the potential to significantly increase JKN enrollment and contribute to the realization and sustainability of universal health coverage (UHC) goals. Keywords: Perception, Enrollment, National Health Insurance

Exploring sexual and reproductive health needs, barriers, and coping strategies of internally displaced women of reproductive ages in north-central Nigeria: A qualitative analysis.

Women and girls form a substantial proportion of the population of internally displaced people (IDP) in Nigeria, these vulnerable populations are at risk of sexual and reproductive health (SRH) rights violations and greater risk of unsafe abortion and high maternal deaths. IDP women's living conditions are often precarious, exposing them to health risks, challenges are often faced due to lack of finance and other related factors to access health care services leading to them improvising health care services which is considered dangerous to their health. There is a gap in the study regarding the SRH needs of the IDP women and the alternative they opt for in meeting their sexual needs. This study explores the SRH needs, barriers and coping strategies of women of reproductive age in North Central IDP camps. A qualitative study was conducted between January 8th and February 28th, 2024, in 4 internally displaced camps in Abuja and Benue among women of reproductive age. Using a well-structured interview guide for an in-depth interview, 14 respondents were purposively selected for the study. The women were interviewed to provide insight into the SRH needs, coping strategies and barriers to utilizing SRH services in the selected camps. Data analysis was conducted using Nvivo version 11. The study revealed the SRH needs for specific family planning methods, free SRH services and antenatal facilities in the camp and the need for toilets. Without the SRH services women cope using herbs and concoctions, they also patronize traditional birth attendants and some of the barriers include finance, husbands' approval and distance to health facilities. In conclusion, women in the IDP camp have SRH needs that need to be met as their coping strategies are not adequate but could complicate their sexual health. It therefore recommended the government should provide adequate medical personnel in the camp for easy access to SRH services.

Geospatial Assessment of Healthcare Accessibility and Equity in Qatar in Preparation for the 2022 FIFA World Cup

Accessibility to healthcare is one of the significant components of social determinants of public healthcare and is integral to societies’ overall well-being and economic prosperity. This study intends to assess changes in spatial distributions and accessibility of healthcare services within Qatar for 2010–2020, specifically concerning preparation for the 2022 FIFA World Cup. Assessment of the healthcare infrastructure is made using various techniques within a Geographic Information Systems (GIS) framework, like kernel density estimation, network analysis, and proximity analysis. The results show that access to healthcare has significantly improved, especially in urban centers such as Doha, besides a significant reduction in the length one travels to access healthcare facilities. However, despite improvements, many areas outside Doha still lag, requiring further investment in strategic planning. This study underscores how effective the health policies in Qatar and the Qatar National Master Plan (QNMP) have been in furthering principles of equity in access to healthcare services. The policy implications are that healthcare service planning should be integrated with urban development and transport networks for sustainable improvement in healthcare access. Thus, investment in infrastructure, strategic planning of locations, and addressing residual disparities are crucial for the long-term healthcare equity and system resilience of Qatar’s healthcare system.

Comprehensive Review of Specialized Nursing Roles in Advancing Healthcare Delivery

Nursing's place in healthcare is changing from a more traditional and static position as healthcare has increasingly focused on specialization in modern times. Advanced nursing roles, including NPs, CNSs, certified registered nurse anesthetists, and clinical nurse educators, have gained growing importance in advancing patient and population health to further increase the accessibility of quality healthcare services as new care challenges arise. This appraisal aims to review the literature on the aspects in which these specialized nursing roles have enhanced the delivery of healthcare. Analyzing the literature and case studies incorporated in the paper reveals these roles' effects on patient outcomes, workforce productivity, and encompassing healthcare organization stability. It also presents the problems associated with employing specialized nurses based on specific regulatory, educational, and financial issues and suggestions about how these professionals can be utilized most effectively in health care.

Controversies in implementing the exemption policy for the elderly healthcare services in Tanzania: experiences from the priority setting process in two selected districts

BackgroundHealth financing system in Tanzania changed in the early 1990s as a result of the introduction of cost-sharing policies by the 1990s health sector reforms. The reforms brought about user fees which has led to inequity in access to health care services and catastrophic health expenditure among the elderly. In efforts to reduce the inequity gap among vulnerable groups, in 1994, the government introduced an exemption and waiver policy. More than three decades later, inequity in health care services access has persisted with the elderly population being more affected. The latter poses questions on the implementation efficiency of the exemption policy. We aimed to assess the implementation of the exemption policy on access to health services among the elderly in Tanzania by learning from the experiences of the priority setting process in two districts of western Tanzania.MethodsAn exploratory qualitative case study adopting Key informant interviews (KIIs) was used to collect data in Nzega and Igunga districts. The key informants involved the representatives of the planning team and decision makers from the community, health facility and district level. Information saturation was attained after the 24th interview and thus data collection ended. The content analysis approach was used to analyse the data.FindingsAlthough there is a designated office that deals with exemptions for the elderly in health facilities, there are challenges in accessing health services. The challenges include insufficient drugs, some laboratory tests not covered by the exemption, a lengthy process to access service, poor financial mechanisms for exempted services, inadequate information and clarity of the exemption categories, and limited to no involvement of different stakeholders in the exemption process.ConclusionThe exemption policy was introduced to help disadvantaged groups, including the elderly. However, its implementation encountered challenges which burden both the elderly and the health facilities. Its implementation has thus become a controversy to its initial aim that was to relieve the elderly from high healthcare costs. Revisiting the policy through a thorough stakeholders’ engagement and establishing alternative financing of the exemption policy are recommended.

Satisfaction of Mothers on Accessibility to Basic Health Units in Rawalpindi: A Descriptive study

Objective: To evaluate the satisfaction of mothers with Accessibility to Basic health units of Rawalpindi. Methodology: A descriptive study was conducted at the basic health units of Rawalpindi over a period of six months, and participants were selected using multi-stage sampling to assess the mother's expectations, experiences, and satisfaction regarding accessibility to primary health care centers. The eligibility criteria included mothers who had been residing in the area for at least six months and visiting BHUs for maternal or child health care. A total 275 mothers participated, a structured questionnaire was by Johns Hopkins School of Medicine, focusing on key factors demographics, distance to BHUs, clinic timings, waiting time, availability of healthcare services, staff behavior, and quality of care. Responses were analyzed descriptively, with percentages summarizing the distribution of answers related to distance, working hours, waiting times, and access to medical care using SPSS version 23. Results: The study revealed significant dissatisfaction among mothers regarding accessibility to Basic Health Units (BHUs). Only 2.18% strongly agreed that the distance to the health center was acceptable, while 52.00% disagreed. Similarly, just 1.09% found clinic working hours suitable, with 57.45% disagreeing. A majority, 55.64%, felt that waiting times were too long, and 38.55% disagreed that they had adequate access to medical care when needed. Overall, the dissatisfaction score for accessibility was 46%, highlighting critical areas for improvement in service delivery. Conclusions: The findings indicate that mothers experience significant barriers to accessing healthcare services at Basic Health Units (BHUs). The low levels of satisfaction related to distance, clinic hours, and waiting times suggest that these factors adversely affect their overall healthcare experience.

Telemedicine Platform with AI and Cloud Technology

The rising demand for accessible and efficient healthcare services has hastened the adoption of telemedicine solutions. This paper presents Telemedicines, an overarching platform that integrates virtual medical consultations with expedited delivery of medicines. In this way, the system addresses the most significant gaps in healthcare: permits patients to consult certified healthcare providers, receive digital prescriptions, and ensure the delivery of medications within hours. The proposition currently uses the same technologies to optimize logistics and ensure patient information. Data management, Telemedicines is going to change healthcare accessibility and responsiveness. This paper presents the goals, architecture, workflow, and potential impact on society of the telemedicines platform

Reproductive decision-making experiences of Australian adults with neurofibromatosis type 1 and schwannomatosis.

Individuals with neurofibromatosis type 1 and schwannomatosis (NF) often face difficult reproductive choices when family planning; however, their experiences and the barriers and enablers to reproductive decision-making are poorly understood. The purpose of this study was to explore the opinions and experiences of individuals with NF in Australia and inform the development of practice recommendations and resources. Focus groups with adults with NF were conducted using a semi-structured interview schedule developed by the research team. Partners were also invited. The focus groups were recorded, de-identified, transcribed, and analyzed using codebook thematic analysis. Three focus groups were conducted with 17 participants (12 = NF1, 4 = NF2-related schwannomatosis [NF2-SWN] and one partner). Three themes were identified: (1) Barriers and enablers; (2) Contemplating the options; and (3) Education and support needs. Barriers to reproductive decision-making included: difficulty accessing healthcare services to discuss reproductive planning; a lack of access to reliable information sources and support; and, in some cases, the financial cost of assistive reproductive technology. Conversely, positive healthcare experiences and support systems enabled reproductive choices. Participants reported many factors that contributed to their reproductive decisions, including: their personal experience of their condition; concern about their future health and that of an affected child; the impact of pregnancy on their health; and the opinion of healthcare providers, family, and friends. Many participants reported mental health difficulties related to their condition and additional stressors related to the reproductive journey. Participants' recommendations included increased access to healthcare services to discuss reproductive options, the development of comprehensive information resources, and improved psychological and peer support for individuals with NF considering family planning and, where relevant, their partners. In conclusion, people with NF and their partners identify a need for improved awareness of NF among healthcare professionals and increased access to appropriate services, information, and support to facilitate informed reproductive decision-making.

Affordability of health services and associated factors among patients with diabetes mellitus under regular follow-up at Dessie Comprehensive Specialized Hospital, Northeast Ethiopia

BackgroundThe burden of chronic illnesses, including cardiovascular disease and diabetes, is increasing in low- and middle-income countries. However, health systems often struggle to meet the needs of chronically ill patients. Affordability is crucial in ensuring access to quality healthcare for patients with diabetes mellitus (DM) and evaluating healthcare costs. Therefore, this study aimed to assess the affordability of health services and identify associated factors among DM patients receiving regular follow-ups at Dessie Comprehensive Specialized Hospital in Northeast Ethiopia, 2023.MethodsA cross-sectional study was conducted among 392 DM patients at Dessie Comprehensive Specialized Hospital (DCSH) from July 1 to 30, 2023. Data was collected using a structured questionnaire and chart review checklist. Systematic random sampling was employed, and the data were analyzed using EPI INFO version 7 and SPSS version 26. The outcome variable, affordability of health services, was measured by five items using a structured questionnaire. Logistic regression analysis was performed to identify significant factors associated at 95% confidence interval using odds ratio.ResultsMost participants were married (74.2%), and 55.9% were male. Among the DM patients, 211 (53.83%) found the health services affordable, with an interval of 48.85–58.72% at a 95% confidence interval with a p-value less than 0.05. Factors significantly associated with healthcare affordability included marital status, family size, average monthly income, and brand prescription.ConclusionThe study revealed that healthcare services were affordable for approximately half of the DM patients. However, this level of affordability falls short of the ideal standard. Improving the affordability and accessibility of healthcare services for DM patients, particularly those from low-income backgrounds, is crucial to ensuring better health outcomes.

IMPACTO DA PNEUMONIA NA MORTALIDADE INFANTIL: ANÁLISE HOSPITALAR NO ESTADO DA BAHIA

Introduction: Pneumonia is a severe respiratory infection, often caused by bacteria, viruses, or fungi, that primarily affects the lungs and can impair gas exchange, leading to respiratory difficulties. In Brazil, pneumonia presents a significant public health challenge, with a particular impact on children under five years of age. This issue is especially evident in the state of Bahia, where the infant mortality rate due to pneumonia is one of the highest in the country. The causes of this high mortality are linked to a combination of factors such as lack of access to adequate medical care, low vaccination coverage, poor living conditions, overcrowded homes, and insufficient air quality. Objectives: The main objective of this study is to analyze the impact of pneumonia on infant mortality in the state of Bahia, focusing on hospital data analysis between 2020 and 2024. The research aims to identify the epidemiological trends of the disease, understand the associated risk factors, and encourage the implementation of public policies to reduce infant mortality caused by pneumonia. Justification: This research is relevant to public health because it highlights the persistent high rates of infant mortality due to pneumonia, a critical issue in socially vulnerable areas. The study contributes to understanding the social, economic, and healthcare access factors affecting the child population in Bahia, providing essential data for more effective public health policies. Methodology: The study is of an epidemiological nature, using a quantitative approach. Data were collected from records of pediatric pneumonia cases provided by the Health Department of the State of Bahia (SESAB) and DATASUS, covering the period from 2020 to 2024. Data on incidence, mortality, demographic characteristics (age, sex, race/ethnicity), and regional conditions were analyzed. The analysis was performed using descriptive statistics and techniques such as calculating mortality rates and identifying risk factors. Results and Discussion: The data revealed that between January 2020 and September 2024, there were 295 deaths due to pneumonia in children in Bahia. The highest mortality was observed in the age groups under 1 year (33.6%) and 1 to 4 years (37.3%), indicating extreme vulnerability of these age groups to the disease. Additionally, pneumonia mortality was higher among children of mixed-race (parda) background (76.3%), reflecting socioeconomic and healthcare access inequalities, particularly in peripheral and rural areas. A slight predominance of deaths among girls was also observed, though the gender difference was small (2.37%). Conclusion: This study highlights the social and regional inequalities contributing to high infant mortality from pneumonia in Bahia, emphasizing the difficulties in accessing healthcare services in more vulnerable areas. The analysis revealed that children under 5 years of age, especially those under 1 year old, are the most affected. To reduce these rates, it is urgent to implement public policies focused on improving healthcare access, expanding vaccination coverage, and strengthening living conditions in the most underserved areas of Bahia.