Access To Health Care Research Articles

Older people’s challenges accessing health services in central Nepal: a qualitative study using the domain of access framework

BackgroundLow- and middle-income countries face rapid population aging. However, the health system has remained largely unprepared to deliver health services to an aging population. As the population is rapidly aging in Nepal, their challenges and experience should be the focus for health care providers to address these issues. There is a paucity of evidence on barriers and facilitators to accessing health care services among older people in Nepal. The aim of this study was to investigate the challenges that older people experience while accessing health services in central Nepal.MethodsThis qualitative study was conducted between April and June 2023. In-depth interviews were conducted among older people of a municipality in central Nepal, which were analysed thematically using a deductive-inductive approach based on the theory of access.ResultsHypertension and diabetes were the most common health problems among the participants. The affordability of health services was a major issue, although there is a health insurance scheme and a major focus on universal health coverage from the Government of Nepal. Other issues included poor acceptability, poor communication between older people and health staff, and poor accommodation due to a lack of elderly-friendly services, including long wait times in the clinic. Living with family was a major facilitator of access to health care services and was interrelated with multiple domains of access.ConclusionsThis study identified barriers to accessing health care services for older adults in Nepal. We found that the affordability of health services, poor acceptability, poor communication between older people and doctors, and a lack of elderly-friendly services are the key challenges experienced by older people. Older people felt that these barriers were easier to overcome when they had family support. Therefore, for those living with their children, family support was reported as the major facilitator.

Determinants of cervical cancer screening uptake among reproductive-age women in southwest Ethiopia: a case-control study.

Cervical cancer is a major global health issue, with 604,000 diagnoses and 342,000 deaths in 2020. Despite the importance of early detection, only 5% of eligible women in Ethiopia are screened. Therefore, this study aimed to assess the determinants of cervical cancer screening uptake among reproductive-age women at selected public hospitals in southwest Ethiopia. A case-control study involving 392 women (98 cases and 294 controls) aged 15-49 was conducted across three hospitals. Cases were women aged 15 to 49 who had cervical cancer screening, while controls were reproductive-age women seeking antenatal care or family planning but not screened. Data were collected via face-to-face interviews with pretested questionnaires and analyzed using SPSS 25. Bivariate analysis identified candidate variables with P-values < 0.25, and a multivariable logistic regression model determined factors with P-values < 0.05 as significant for cervical cancer screening uptake. Determinants of cervical cancer screening uptake included high knowledge of screening (AOR=6.23; 95%CI: 1.96, 19.79), a positive attitude toward screening (AOR=6.12; 95%CI: 2.40, 15.58), women aged 30-39 (AOR=3.94; 95%CI: 1.79, 8.63) and 40-49 (AOR=3.54; 95%CI: 1.52, 8.22), and those who reached health facilities within 60 minutes (AOR=2.32; 95%CI: 1.21, 4.45). The study pinpointed age, knowledge, attitude toward cervical cancer screening, and accessibility to health facilities within a 60-minute radius as pivotal factors impacting cervical cancer screening uptake among reproductive-age women. These findings highlight the importance of targeted education, promoting positive attitudes, and enhancing healthcare accessibility to improve screening uptake and reduce the burden of cervical cancer.

Redesigning telemedicine: preliminary findings from an innovative assisted telemedicine healthcare model

BackgroundTelemedicine holds immense potential to revolutionise healthcare delivery, particularly in resource-limited settings and for patients with chronic diseases. Despite proven benefits and policy reforms, the use of telemedicine remains low due to several patient, technology, and system-level barriers. Assisted telemedicine employs trained health professionals to connect patients with physicians, which can improve access and scope of telemedicine. The study aims to describe the design, service utilisation and chronic disease outcomes following the implementation of an assisted telemedicine initiative.MethodsThis is an observational implementation study. Barriers and potential solutions to the implementation of telemedicine were identified through interviews with key stakeholders. The assisted telemedicine solution using an interoperable platform integrating electronic health records, point-of-care diagnostics, and electronic clinical decision support systems was designed and piloted at three telemedicine clinics in Tamil Nadu, India. Nurses were trained in platform use and facilitation of tele-consultations. Health records of all patients from March 2021 to June 2023 were included in the analysis. Data were analysed to assess the utilisation of clinic services and improvements in health outcomes in patients with diabetes mellitus and hypertension.ResultsOver 2.4 years, 11,388 patients with a mean age of 45 (± 20) years and median age of 48 years, predominantly female (59.3%), accessed the clinics. The team completed 15,437 lab investigations and 26,998 consultations. Among 5542 (48.6%) patients that reported chronic conditions, diabetes mellitus (61%) and hypertension (45%) were the most frequent. In patients with diabetes mellitus and hypertension, 43% and 75.3% were newly diagnosed, respectively. Diabetes mellitus and hypertension patients had significant reductions in fasting blood sugar (-33.0 mg/dL (95% CI (-42.4, -23.7, P < 0.001)), and systolic (-9.6 mmHg (95% CI (-12.1, -7.0), P < 0.0001)) and diastolic blood pressure (-5.5 mmHg (95% CI (-7.0, -4.08), P < 0.0001)) at nine months from first visit, respectively.ConclusionsThe ‘Digisahayam’ model demonstrated feasibility in enhancing healthcare accessibility and quality by bridging healthcare gaps, diagnosing chronic conditions, and improving patient outcomes. The model presents a scalable and sustainable approach to revolutionising patient care and achieving digital health equity, with the potential for adaptation in similar settings worldwide.

Utilization of Artificial Intelligence to Improve Equitable Healthcare Access for Breast Implant Patients

Abstract The recently mandated US Food and Drug Administration (FDA) patient decision checklists were developed with the goal of improving the informed decision-making process for patients considering breast implants. Yet, prior research has demonstrated that these checklists are written at reading levels far in excess of that recommended by the National Institutes of Health and the American Medical Association. Patients considering breast implants are required to sign these forms prior to surgery, even if they have little to no comprehension of their contents. This study aims to improve the accessibility, and therefore the utility, of the mandated FDA patient literature using the assistance of artificial intelligence (AI). Patient decision checklists were obtained from the three most utilized breast implant manufacturers in the United States– Allergan, Mentor, and Sientra. AI was then asked to synthesize a novel patient decision checklist, written at the 6th grade reading level, using these checklists as source material. The AI-assisted checklist was edited by plastic surgeons for both formatting and content. Readability analysis of all documents was performed using the Flesch Reading-Ease Score, Flesch-Kincaid Grade Level, Gunning-Fog Index, Coleman-Liau Index, Simplified Measure of Gobbledygook, and Automated Readability Index. Textual analysis included sentence count, word count, number and percentage of complex words, average number of words per sentence, and average number of syllables per word. The overall readability of Allergan, Mentor, and Sientra patient checklists correlated with the college reading level. These documents were of a statistically significantly higher reading level the AI-assisted checklist, which was written at the recommended 6th grade level. Text composition analysis similarly demonstrated substantial differences between the AI-assisted and FDA mandated literature. The currently mandated breast implant patient checklists are written at a college reading level and are inaccessible to the average patient. We propose a new patient decision checklist, generated with the assistance of artificial intelligence, in order to improve healthcare access within plastic surgery. This simplified material can be used as an adjunct to the current checklists in order to improve shared decision making.

Spatial distribution and factors associated with HIV testing among adolescent girls and young women in Sierra Leone

BackgroundSierra Leone faces a significant challenge in addressing HIV/AIDS, particularly among adolescent girls and young women. This age group is considered highly vulnerable due to biological factors and social inequalities. Understanding the prevalence of HIV testing in this demographic is crucial for designing effective prevention and treatment strategies. This study investigated the spatial distribution of HIV testing and its associated factors among adolescent girls and young women in Sierra Leone.MethodsData from the 2019 Sierra Leone Demographic and Health Survey was used for the study. The sample comprised 6,062 adolescent girls and young women between the ages of 15 and 24. Spatial autocorrelation and Moran’s I statistic were employed to analyze the spatial distribution of HIV testing. An analysis utilising mixed-effect multilevel binary logistic regression was performed to determine the factors associated with HIV testing. The findings were presented as adjusted odds ratios (aOR) and a 95% confidence interval (CI).ResultsThe national prevalence of HIV testing among adolescents and young women in Sierra Leone was 42.1% [40.3,43.9]. Kailahun, Kambia, Tonkolil, some parts of the Western rural area, and Bonthe districts were found to be statistically significant hotspot for HIV testing. Whereas, Karene, Falaba, Bo, kenema, and some parts of Pujuhun were statistically cold spot districts. Adolescent girls and young women aged 20–24 [aOR = 1.63, 95% CI = 1.29, 2.07] had higher odds of HIV testing than those aged 15–19. Those with secondary/higher education [aOR = 1.87, 95% CI = 1.40, 2.51] had higher odds of HIV testing than those with no education. The odds of HIV testing was higher among adolescent girls and young women who use the Internet [aOR = 1.75, 95% CI = 1.32, 2.33] than those who did not use internet. Adolescent girls and young women with one [aOR = 16.56, 95% CI = 12.31, 22.29] and two or more parity [aOR = 16.37, 95% CI = 10.86, 24.68] had higher odds of HIV testing than those with no parity. The likelihood of HIV testing was higher among adolescent girls and young women who had sex below 18 [aOR = 4.54, 95% CI = 3.25, 6.34] and those who had sex at 18+ [aOR = 5.70, 95% CI = 3.84, 8.45] compared to those who had never had sex. Adolescent girls and young women who visited health facilities in the past 12 months [aOR = 1.82, 95% CI = 1.46, 2.26] had higher odds of HIV testing than those who did not.ConclusionDespite some positive trends, HIV testing rates among adolescent girls and young women in Sierra Leone remain moderate. Spatial autocorrelation analysis consistently revealed hotspots and cold spots for HIV testing, with Kailahun, Kambia, Tonkolil, some parts of the Western rural area, and Bonthe districts remaining persistent hotspots. Age, education, internet use, sexual history, parity, and healthcare access are significant factors influencing testing behaviour. To improve testing rates, the government and policymakers should prioritize educational campaigns, expand internet access, integrate HIV testing into routine healthcare, and address stigma associated with HIV.

Teledentistry in the detection of oral potentially malignant disorders and oral cancer in the Latin American region: a review of literature with current possibilities

Teledentistry has emerged as a promising tool in bridging the gap in healthcare accessibility, particularly in regions like Latin America region, where resources for oral healthcare are often limited. Drawing upon a comprehensive review of literature, this overview assessed the applications and clinical outcomes of teledentistry in diagnosing oral potentially malignant disorders (OPMDs) and oral cancer, highlighting the challenges and opportunities specific to the Latin American context. Moreover, it examined the integration of artificial intelligence algorithms and teledentistry for enhancing diagnostic accuracy, thereby optimizing resource allocation and improving patient outcomes. By elucidating the current landscape and future prospects, this overview provided insights for policymakers, healthcare providers, and researchers, fostering advancements in oral healthcare delivery with the aim of reducing the burden of OPMDs and oral cancer in the Latin American region.

Medical imaging utilization in migrants compared with nonmigrants in a universal healthcare system: A population-based matched cohort study.

Medical imaging is an integral part of healthcare. Globalization has resulted in increased mobilization of migrants to new host nations. The association between migration status and utilization of medical imaging is unknown. A retrospective population-based matched cohort study was conducted in Ontario, Canada from April 1, 1995 to December 31, 2016. A total of 1,848,222 migrants were matched 1:1 to nonmigrants in the year of migration on age, sex, and geography. Utilization of computed tomography (CT), magnetic resonance imaging (MRI), radiography, and ultrasonography was determined. Rate differences per 1,000 person-years comparing migrants to nonmigrants were calculated. Relative rates were calculated using a recurrent event framework, adjusting for age, sex, and time-varying socioeconomic status, comorbidity score, and access to a primary care provider. Estimates were stratified by migration age: children and adolescents (≤19 years), young adults (20 to 39), adults (40 to 59), and older adults (≥60). Utilization rates of CT, MRI, and radiography were lower for migrants across all age groups compared with Ontario nonmigrants. Increasing age at migration was associated with larger differences in utilization rates. Older adult migrants had the largest gap in imaging utilization. The longer the time since migration, the larger the gap in medical imaging use. In multivariable analysis, the relative rate of imaging was approximately 20% to 30% lower for migrants: ranging from 0.77 to 0.88 for CT and 0.72 to 0.80 for MRI imaging across age groups. Radiography relative rates ranged from 0.84 to 0.90. All migrant age groups, except older adults, had higher rates of ultrasonography. The indication for imaging was not captured, thus it was not possible to determine if the imaging was necessary. Migrants utilized less CT, MRI, and radiography but more ultrasonography. Older adult migrants used the least amount of imaging compared with nonmigrants. Future research should evaluate whether lower utilization is due to barriers in healthcare access or health-seeking behaviors within a universal healthcare system.

Differences in setting of initial dementia diagnosis among fee-for-service Medicare beneficiaries.

Accurate and timely diagnosis of dementia is necessary to allow affected individuals to make informed decisions and access appropriate resources. When dementia goes undetected until a hospitalization or nursing home stay, this could reflect delayed diagnosis or misdiagnosis, and may reflect underlying disparities in healthcare access. In this retrospective cohort study, we used 2012-2020 Medicare claims and other administrative data to examine variation in setting of dementia diagnosis among fee-for-service Medicare beneficiaries with an initial claims-based dementia diagnosis in 2016. We used multinomial logistic regression to evaluate the association of person and geographic factors with diagnosis location, and Cox proportional hazards regression to examine 4-year survival relative to diagnosis location. Among 754,204 Medicare beneficiaries newly diagnosed with dementia in 2016, 60.3% were diagnosed in the community, 17.2% in hospitals, and 22.5% in nursing homes. Adjusted 4-year survival rates were significantly lower among those diagnosed in hospitals [-16.1 percentage points (95% CI: -17.0, -15.1)] and nursing homes [-16.8 percentage points (95% CI: -17.7, -15.9)], compared to those diagnosed in the community. Community-diagnosed beneficiaries were more often female, younger, Asian or Pacific Islander, Native American or Alaskan Native, Hispanic, had fewer baseline hospitalizations and higher homecare use, and resided in wealthier ZIP codes. Rural beneficiaries were more likely to be diagnosed in hospitals. Many older adults are diagnosed with dementia in a hospital or nursing home. These individuals have significantly lower survival than those diagnosed in the community, which may indicate diagnosis during an acute illness or care transition, or at a later disease stage, all of which are suboptimal. These results highlight the need for improved dementia screening in the general population, particularly for individuals in rural areas and communities with higher social deprivation.

Utilization Postnatal Care Services in Hyolmo Community

Postnatal care (PNC) utilization among the Hyolmo community highlights significant gaps in existing literature and underscores the critical need for targeted healthcare interventions in remote and ethnically distinct populations. This study reveals that, while considerable attention is given to urban and accessible rural populations, remote communities face unique challenges that can impede access to essential maternal health services. The results demonstrate that age, education, and socio-economic factors significantly influence PNC uptake, suggesting disparities that are compounded in remote areas like the Helambu Rural Municipality of Sindhupalchowk District. This study shows that younger mothers, often less aware or hindered by accessibility barriers, are less likely to utilize PNC services compared to their older counterparts. This disparity highlights the necessity for community-specific educational programs that can enhance understanding and encourage the use of PNC services among younger women. Additionally, the influence of education and socio-economic status on PNC utilization points to the broader implications of systemic inequities in healthcare access. Moreover, the study brings to light the role of cultural practices and beliefs in shaping healthseeking behaviors, which varies significantly across different communities. In the traditional beliefs may conflict with modern healthcare practices, there is a clear need for culturally sensitive health interventions that respect and integrate local customs and practices. This research not only contributes to a deeper understanding of the factors affecting PNC service uptake in a specific Nepalese community but also calls for comprehensive policy responses. By addressing the multifaceted challenges faced by the Hyolmo community ranging from geographic isolation to cultural and educational barriers the study advocates for a holistic approach to healthcare. This should include the development of policies that ensure equitable access to health services, enhance community health education, and promote cultural competence among healthcare providers. Ultimately, such efforts are essential for improving maternal and infant health outcomes in remote communities, ensuring that every individual, regardless of their socio-economic or cultural background, has access to the necessary postnatal care.

Health Behavioural Status of Gender Differences in Older People

Aging is a universal phenomenon with no single definition, varying across cultures, time, and space. The health and well-being of older adults are significantly influenced by their behaviors, which often vary by gender. These differences can impact physical health, mental health, and overall quality of life. This study explores the health behavioral status of older adults, focusing on gender differences and how these disparities affect their health indicators. Such changes impact the health status of older people, making it harder for them to manage daily tasks and access healthcare. Conducted in Dhangadhi Sub-Metropolitan City, Kailali District, Nepal, this study aims to understand the socio-economic and health status of older people. Objectives include examining gender differences in health behavior among the elderly in this region. Gender differences in health behaviors among older adults significantly impact their health. Women engage more in preventive behaviors and seek healthcare services, while men engage in riskier behaviors and underutilize services. Understanding these differences is crucial for developing effective, gender-specific interventions to improve older adults' health and well-being. Gender differences were significant, with males showing a higher percentage of better health compared to females, and females showing slightly higher rates of bad health compared to males. Vision problems were prevalent, with a majority reporting no issues, some reporting minor problems, and a smaller portion having normal vision. Significant vision problems were reported by a notable fraction of respondents. Respiratory diseases were more prevalent among males than females, indicating a significant gender association. Gout or knee pain was more common in females than males, also showing a significant gender difference. Diabetes affected a larger portion of males compared to females, indicating a significant gender association. Blood pressure issues were slightly more prevalent in males compared to females, showing a significant gender association. Emotional health conditions such as grief, depression, and sadness showed significant gender differences, with females more likely to experience these issues.

Digital health tools and technologies dimensions for equitable access to health, including Universal Health Coverage in developing economies

This study sought to investigate digital health tools and technologies dimensions for equitable access to health, including Universal Health Coverage in developing economies. Universal Health Coverage (UHC) is a promise of accessible and high-quality healthcare, which addresses coverage of essential health services and catastrophic health spending, in line with goal 3 of the United Nations Sustainable Development Goals (SDGs). However, the problem of inequitable access to health, including UHC, continues to plague the entire endeavour, even with notable technological advancements among the population and within the health sector. This study uses a narrative literature review methodology to investigate the dimensions of digital health tools and technologies for equitable access to health, including UHC. The findings from this study identify internet access, availability of internet, availability of a smart device, and device access to digital content as key dimensions for equitable access to health, including UHC in developing economies, and in line with digital health tools and technologies. Considering these dimensions will ensure that developed and deployed interventions are available and accessible to the majority of the population. Ultimately promoting digital health and equitable access to health, as well as ensuring that key dimensions of digital health tools and technologies are not assumed.

High-cost users still came to hospitals during the COVID-19 pandemic during first wave data in Thailand: secondary data analysis

BackgroundThe phenomenon of high-cost users (HCUs) in health care occurs when a small proportion of patients account for a large proportion of health care expenditures. By understanding this phenomenon during the COVID-19 pandemic, tailored interventions can be provided to ensure that patients receive the care they need and reduce the burden on the health system.ObjectivesThis study aimed to determine (1) whether the HCUs phenomenon occurred during the pandemic in Thailand by exploring the pattern of inpatient health expenditures over time from 2016 to 2021; (2) the patient characteristics of HCUs; (3) the top 5 primary diagnoses of HCUs; and (4) the potential predictors associated with being an HCU.MethodsThe secondary data analysis was conducted via inpatient department (IPD) e-Claim data from the National Health Security Office for the Universal Coverage Scheme, which provides health care to ~ 80% of the Thai population. Health care expenditure over time was calculated, and the characteristics of the population were examined via descriptive analysis. Multinomial logistic regression was applied to explore the potential predictors associated with being an HCU.ResultsThe characteristics of HCUs remained relatively the same from 2016 to 2021. In terms of the proportion of male (55%) to female patients (45%), the age ranged from 55 to 57 years, with an estimated 8-day length of hospital stay and 7 admissions per year, and the average health care cost per patient was ≥ USD 2,860 (100,000 THB). The low-cost users (LCUs) group (the bottom 50% of the population), had more female patients (55%), a younger age ranging from 27 to 33 years, a 3-day length of stay, 1‒2 admissions per year, and a lower average health care cost per patient, which was less than USD 315 (≤ 11,000 THB).ConclusionThe HCUs phenomenon still existed even with limited health care accessibility or lockdown measures implemented during the COVID-19 pandemic. This finding could indicate the uniqueness of the need for health services by HCUs, which differ from those of other population groups. By understanding the trends of health care utilization and expenditure, along with potential predictors associated with being an HCU, policies can be introduced to ensure the appropriate allocation of health resources to the right people in need of the right care during future pandemics.

Simulated GP clinic closure: effects on patient access in the Irish Mid-West.

Rural communities can experience more barriers to accessing health care than their urban counterparts, largely due to fewer healthcare staff and services, and geographical isolation. The purpose of this study is to examine the availability of GP practices in rural communities across the Mid-West of Ireland and the potential impact of practice closure on patient access. GP clinic locations were identified in Ireland's Mid-West, specifically counties Limerick and Clare. Administrative subdivisions of both counties, Small Areas (SAs), were identified and their XY geographic centre coordinates recorded. SAs were indexed into six levels of rurality according to Irish Central Statistics Office urban/rural classifications (1, cities; 2, satellite urban towns; 3, independent urban towns; 4, rural areas with high urban influence; 5, rural areas with moderate urban influence; 6, highly rural/remote areas). The direct linear distance from the centre of each SA to its respective closest GP clinic was calculated. Simulated closure of each GP clinic was assessed programmatically by removing practices from the overall dataset and calculating the new direct linear distance from each SA to the next closest GP clinic. The majority of the SAs in County Clare (63%) and County Limerick (66%) are classified as rural (rurality index &ge;4), with the exception of Limerick City, where all SAs were defined as urban. Rural SAs have longer travel distances to GP clinics than their urban counterparts, and these distances are greater with increasing rurality of a population. Simulated closure of GP clinics revealed increasing travel distances to the next closest clinic with increasing level of rurality in a stepwise fashion (r2=0.31). Rural community dwellers across the Mid-West of Ireland face longer travel distances to GP clinics than their urban counterparts. Thus rural communities will be, on average, more adversely affected should their local GP clinic close. While these findings are unsurprising, our methodology calculates a discrete number that can be used to rank vulnerability of local communities. Rural areas are particularly vulnerable to GP clinic closure, and maintaining a solid foundation of primary care in these areas will require careful service and workforce planning.

Contextual success and pitfalls of mHealth service for maternal and child health in Africa: An Intervention, Context, Actors, Mechanism, and Outcome (ICAMO) framework guided systematic review of qualitative evidence

IntroductionMobile health (mHealth) interventions have shown potential to improve maternal and child health outcomes in Africa, but their effectiveness depends on specific interventions, context, and implementation quality. Challenges such as limited infrastructure, low digital literacy, and sustainability need to be addressed. Further evaluation studies are essential to summarize the impact of mHealth interventions. Thus, this synthesis focuses on qualitative evidence of the impact of mHealth on maternal and child health in Africa to summarize such evidence to help policy decisions.MethodsA qualitative systematic review guided by the concepts of Intervention, Context, Mechanism, and Outcome (ICAMO) was employed in this study. The GRADE CERQual assessment and methodological constraints tools were utilized in the review to ascertain the level of confidence in the evidence and to examine the methodological limitations. The JBI checklist for qualitative research appraisal was also consulted during the review.ResultsThe current review contains 32 eligible studies from databases such as CINAHL, EMBASE, MEDLINE, Scopus, Web of Science, HINARI, and Cochrane Library. The review demonstrated substantial improvements in the HCP-woman relationship, communication system, maternal and child healthcare uptake, health-seeking behavior, and HCP skills. Economic capacities, maternal education, and the low quality of existing services challenged participants.ConclusionmHealth significantly improves maternal and child health outcomes in Africa. This review showed it can improve healthcare access, empower women, and contribute to the region's goal of universal health coverage. However, the challenges such as low partner support, high costs for services, and poor quality of current care as narrated by women need commitment from health authorities in the continent. The evidence from this review suggests that mHealth can be implemented to improve maternal and child health in Africa.Trial registrationPROSPERO: CRD42023461425.

Study of the Association Between Socioeconomic Determinants and Pregnancy Follow-Up Indicators of Mothers of Low-Birth-Weight Infants: Insights for Achieving Sustainable Development Goals

Aims: This study investigates the association between socioeconomic determinants and pregnancy follow-up among 200 mothers of low-birth-weight newborns. By identifying factors influencing maternal care and birth outcomes, the study contributes to achieving Sustainable Development Goals (SDG) 3, 8, and 10, focusing on improving maternal and child health, reducing socioeconomic disparities, and ensuring equitable healthcare access. Methods: A prospective descriptive study was conducted over 12 months (June 2020–July 2021) at the neonatology and nutrition reference center of Rabat Children's Hospital. The study recruited 206 mother-child pairs, focusing on those with low-birth-weight infants. Results: Among the 200 mothers, 92% followed their pregnancies. Distribution of prenatal consultations was as follows: 0.54% had one visit, 5.98% two visits, 33.7% three, 41.85% four, and 17.93% more than four. Analysis revealed significant associations between pregnancy follow-up and socioeconomic factors. Maternal age (p &lt; 0.001), education level (p &lt; 0.001), and place of residence significantly influenced pregnancy monitoring, with urban mothers more likely to receive follow-up care. Single mothers had a 100% non-tracking rate, while married mothers predominantly monitored their pregnancies. Conclusions: This study demonstrates the strong influence of sociodemographic factors on antenatal care use, aligning with findings from other contexts. It contributes new insights into the specific characteristics of our study population and has practical implications for shaping maternal and child health policies, addressing the unique needs of diverse sub-populations. Achieving SDG 3 (Good Health and Well-being), SDG 8 (Decent Work and Economic Growth), and SDG 10 (Reduced Inequalities) requires targeted interventions that improve equitable access to quality maternal care.

Estimating the economic impact of restricting reproductive healthcare access in Ohio.

This study analyzes the economic impacts of Ohio's Senate Bill 23, which would ban abortion care after fetal cardiac activity is detected. Leveraging previous research and publicly available datasets, a unique set of calculations were developed to determine abortion outcomes, individual costs, and public costs in three scenarios in which abortion care is banned in Ohio. Scenario 1 assumes that all abortion care is sought out-of-state. Scenario 2 assumes that all pregnancies result in a birth. Scenario 3 assumes that pregnancies either result in receiving out-of-state abortion care or result in a birth. The total additional economic impact of restricted abortion access in Ohio likely ranges between $98.8 million and $118.4 million, but could be up to $551.4 million per year. Regardless of the three scenarios analyzed, restrictions to accessing abortion care result in negative economic impacts for both individuals and the state. Several policy recommendations are proposed for consideration by policymakers and communities.

Infectious diseases transmitted by animals beyond symptoms, how socioeconomic and environmental conditions can influence them

Vector-borne diseases, such as dengue, chikungunya, zika, and leishmaniasis, represent a global public health challenge. This study aimed to understand the impact of socioeconomic, environmental, and healthcare access variables on the incidence of infectious diseases from 2012 to 2021, investigating patterns and correlations. Variables analyzed included the number of healthcare facilities, average income, population size, Gross Domestic Product (GDP), and accumulated deforestation. Multiple linear regression and correlations were used, with data from the Notifiable Diseases Information System (SINAN) and the National Institute for Space Research (INPE). Dengue showed a strong correlation with GDP, the number of healthcare facilities, and deforestation. Chikungunya was associated with population, GDP, and deforestation. Zika showed correlations with population growth and deforestation. Leptospirosis was negatively influenced by healthcare facilities and GDP, while hantavirus infection was inversely related to population growth and healthcare facilities. Leishmaniasis had positive correlations with GDP, healthcare facilities, and deforestation. This study reveals complex interactions between socioeconomic, environmental, and health variables in the incidence of infectious diseases. Understanding these patterns is crucial for formulating effective public policies, highlighting the need for integrated and holistic strategies in the control and prevention of these diseases.

Experiences and challenges of refugees from Ukraine in accessing healthcare and social services during their integration in Lithuania.

The influx of Ukrainian refugees to Lithuania due to the ongoing conflict has created substantial challenges in healthcare and social services. To identify the key challenges faced by Ukrainian refugees in accessing healthcare and social services in Lithuania. A qualitative study was conducted using semi-structured interviews with 22 Russian-speaking female Ukrainian refugees residing in various regions of Lithuania. Data were collected between July and October 2022 and analyzed using inductive qualitative content analysis to identify key themes related to healthcare access, social services, and integration. Refugees reported significant barriers, including language difficulties, long waiting times for healthcare services, and inconsistent access to social services, particularly in smaller municipalities. Despite access to free healthcare, the quality and timeliness of services were often inadequate, exacerbating challenges for those with pre-existing health conditions. Psychological support services were underutilized, and language barriers impeded access to both healthcare and employment opportunities. Coordination between social and healthcare services was lacking, creating further difficulties for refugees in navigating essential services. While Lithuanian authorities have provided critical support, significant gaps remain in healthcare access and social service coordination. Urgent improvements are needed in language support, psychological care, and healthcare accessibility, particularly in smaller municipalities. These findings highlight the need for targeted policies to address these challenges and ensure equitable access to services for all refugees. Future research should include more diverse refugee populations to guide comprehensive policy development.

Functional disability, health care access, and mental health in Ukrainians displaced by the 2022 Russian invasion

Armed conflict has negative mental health impacts on internally displaced people and refugees, however, much less is known of its effects on the mental health of displaced people and refugees with disabilities. We use pan-European data (N = 9,676), collected via an internet health needs survey across April-July 2022, to examine the mental health impacts of the 2022 Russian invasion of Ukraine on the mental health of displaced people with disabilities during the first months of the war. Regression models separately examined associations between functional impairment (vision, walking, existing mental health condition), access to healthcare, welfare payments, and anxiety and sleep quality, controlling for sociodemographic variables. The presence of pre-existing mental health conditions, mobility and vision impairment were each associated with higher levels of anxiety and poorer sleep quality. The ability to access health services and social security payments was also associated with better sleep and lower levels of anxiety. Humanitarian and local authorities must ensure Ukrainian refugees and IDPs are reviewed for their mental health needs, with particular attention to those with known disabilities.

Accessing medical care in the era of the digital revolution: arguing the case for the "digitally marginalised".

This article explores the intersection of healthcare accessibility and digitalisation from a rights perspective. Drawing from two illustrative cases presented to a filariasis management clinic in Puducherry, where the authors are affiliated, the article argues that despite the multiple benefits that digital health poses, there are individuals and sections of society that experience marginalisation in healthcare owing to digitalisation. Collating the data generated through the observations of the authors and the narratives of the patients, the article illustrates that such marginalisation can originate even from a relatively simple ICT adaptation like text message-based appointments, inducing health inequities. The impact of such digital marginalisation disproportionately affects vulnerable sections like older adults and the rural population in an intersectional pattern where disadvantages compound to produce larger health inequities for the affected. The study advocates for bridging the digital divide through efforts including digital literacy-when possible-and alternative solutions like dedicated helpdesks, training healthcare staff and involving NGOs and voluntary organisations to ensure health equity for the digitally marginalised.