Increase In Coverage Research Articles

Medicare Eligibility and Changes in Coverage, Access to Care, and Health by Sexual Orientation and Gender Identity

Medicare provides nearly universal insurance coverage at age 65 years. However, how Medicare eligibility affects disparities in health insurance coverage, access to care, and health status among individuals by sexual orientation and gender identity is poorly understood. To assess the association of Medicare eligibility with disparities in health insurance coverage, access to care, and self-reported health status among individuals by sexual orientation and by gender identity. This cross-sectional study used the age discontinuity for Medicare eligibility at age 65 years to isolate the association of Medicare with health insurance coverage, access to care, and self-reported health status, by their sexual orientation and by their gender identity. Data were collected from the Behavioral Risk Factor Surveillance System for respondents from 51 to 79 years old from 2014 to 2021. Data analysis was performed from September 2022 to April 2023. Medicare eligibility at age 65 years. Proportions of respondents with health insurance coverage, usual source of care, cost barriers to care, influenza vaccination, and self-reported health status. The study population included 927 952 individuals (mean [SD] age, 64.4 [7.7] years; 524 972 [56.6%] females and 402 670 [43.4%] males), of whom 28 077 (3.03%) identified as a sexual minority-lesbian, gay, bisexual, or another sexual minority identity (LGB+) and 3286 (0.35%) as transgender or gender diverse. Respondents who identified as heterosexual had greater improvements at age 65 years in insurance coverage (4.2 percentage points [pp]; 95% CI, 4.0-4.4 pp) than those who identified as LGB+ (3.6 pp; 95% CI, 2.3-4.8 pp), except when the analysis was limited to a subsample of married respondents. For access to care, improvements in usual source of care, cost barriers to care, and influenza vaccination were larger at age 65 years for heterosexual respondents compared with LGB+ respondents, although confidence intervals were overlapping and less precise for LGB+ individuals. For self-reported health status, the analyses found larger improvements at age 65 years for LGB+ respondents compared with heterosexual respondents. There was considerable heterogeneity by state in disparities by sexual orientation among individuals who were nearly eligible for Medicare (close to 65 years old), with the US South and Central states demonstrating the highest disparities. Among the top-10 highest-disparities states, Medicare eligibility was associated with greater increases in coverage (6.7 pp vs 5.0 pp) and access to a usual source of care (1.4 pp vs 0.6 pp) for LGB+ respondents compared with heterosexual respondents. The findings of this cross-sectional study indicate that Medicare eligibility was not associated with consistently greater improvements in health insurance coverage and access to care among LGBTQI+ individuals compared with heterosexual and/or cisgender individuals. However, among sexual minority individuals, Medicare may be associated with closing gaps in self-reported health status, and among states with the highest disparities, it may improve health insurance coverage, access to care, and self-reported health status.

Assessing the impact of COVID-19 on routine immunization in Sierra Leone

BackgroundThe COVID-19 pandemic had a profound impact on healthcare systems and services, including routine immunization (RI). To date, there is limited information on the effects of the COVID-19 pandemic on RI in West African countries such as Sierra Leone, which had already experienced public health emergencies that disrupted its healthcare system. Here, we describe the impact of the COVID-19 pandemic on the RI of key antigens in Sierra Leone.MethodsWe used vaccination data from the District Health Information System for BCG, measles-rubella 1 and 2, and pentavalent 1 and 3 antigens. We compared 2019, 2020, 2021, and 2022 annual coverage rates for the selected antigens at the national and district levels. We used the Pearson chi-square test to assess the difference between annual coverage rates between 2019 and 2020, 2020–2021, and 2021–2022.ResultsNational coverage rates for all antigens declined in 2019–2020, notably measles-rubella 1 and pentavalent 3 (-5.4% and − 4.9%). Between 2020 and 2021, there was an overall increase in coverage (+ 0.2% to + 2.5%), except for measles-rubella 2 (-1.8%). Measles-rubella antigens rebounded in 2021–2022, while others decreased between − 0.5 and − 1.9% in coverage. Overall, all district-level coverage rates in 2022 were lower than those in 2019. Most districts decreased between 2019 and 2022, though a few had a continuous increase; some had an increase/recovery between 2020 and 2021; some districts had recovered 2019 levels by 2022.ConclusionThe COVID-19 pandemic impacted Sierra Leone’s national BCG, measles-rubella, and pentavalent antigen immunization, which were not fully restored in 2022. Most districts experienced notable coverage declines during the pandemic, though a few reached or surpassed 2019 rates in 2022. Examining pandemic impact can benefit from a focus beyond the national level to identify vulnerable regions. Sierra Leone’s post-pandemic RI reestablishment needs targeted strategies and continual investments for equitable access and coverage, as well as to prevent vaccine-preventable diseases.

Coverage Evaluation of Mass Drug Administration for Lymphatic Filariasis in Mahoba District of Uttar Pradesh

Background Lymphatic filariasis is a neglected tropical disease. In this disease patient has face hydroceale and lymphedema in leg. 863 million people had risk of lymphatic filariasis in 2020 who were belongs to 50 countries. The present study aimed to assess coverage and compliance of mass drug administration for lymphatic filariasis.MethodsFrom 300 households (1660 individuals) in rural area was covered in coverage evaluation survey by systematic selection of subunits using PPS. Data collected by trained team and data were collected using predesigned questionnaire. MS – Excel spreadsheet used for data compilation.ResultsOverall, estimated 37.8% drugs were swallowed in rural area of District Mahoba. 3.7% person in study population experienced adverse drug effect. In rural area, albendazole was swallowed more by females as compared to males but reverse in case of DEC. The most common reason for both albendazole and DEC not swallowed as reported by study population was not sick.Conclusions For filariasis elimination, need to increase coverage and also increase compliance for take drug. Coverage and compliance increase by perform information education and communication activities perform with different platform.

Grazing affects ecosystem traits by regulating plateau pika activities at the landscape scale

The mechanism underlying the effects of livestock grazing on grassland ecosystem traits has been greatly discussed. However, as a common small burrowing mammal on the Tibetan Plateau grasslands, the plateau pika's (Ochotona curzoniae) influence on alpine grassland ecosystem traits has rarely been investigated, especially beyond the plot scale. In this study, we flew an unmanned aerial vehicle (UAV) over a grassland landscape under grazing and nongrazing treatments. Mounted visible spectral remote sensing, in combination with field surveys, was utilized to explore how livestock and pika grazing modify grassland ecosystem traits at the landscape scale on the Tibetan Plateau (TP). Using object-oriented classification and partial least squares regression, we retrieved the pika burrow distribution and grassland ecosystem traits. Then, the relationships among livestock grazing, pika burrowing and ecosystem traits were evaluated. The results indicated that livestock grazing reduces the alpine meadow community height by 0.13 cm and the species number by 0.25 while increasing the vegetation coverage by 9.69 % and the aboveground biomass (AGB) by 10.07 g/m2. A lower statue grassland community with greater coverage caused by livestock grazing promotes pika burrowing. Pika burrow density increases 100/ha per 1.70 % increase in vegetation coverage, a 1.87 g/m2 increase in AGB or a 0.08 m decrease in community height. Under livestock grazing, both community structure and nutrients are more strongly associated with pika burrow density. The structural equation model demonstrated that livestock grazing regulates pika burrow density by moderating structural value and subsequently affecting nutritional value. Pika burrowing activity explains 40 % of the total variation in nutritional value. Our findings revealed an intrinsic linkage between mammal activities and alpine grassland ecosystems, which can provide guidelines for grassland management through pika population control by adjusting grazing intensity on the TP.

Assessing potential benefits of visits to neighborhoods with higher tree canopy coverage using mobility data: Associations with cardiovascular health outcomes in twenty US metropolitan areas

BackgroundResearch on health benefits due to exposure to green space, such as tree canopy coverage, has predominantly focused on canopy coverage in home neighborhoods. Yet exposures to tree canopy coverage in other spaces visited during the week or on weekends outside the home neighborhoods remains largely unexplored. ObjectivesWe examined whether differences in coverage levels of tree canopy in neighborhoods visited compared to home neighborhoods was associated with lower prevalence of coronary heart disease (CHD) and stroke, adjusting for exposure to home canopy coverage. We further investigated if the associations varied across levels of home canopy coverage, and if they were more pronounced on weekdays or weekends. MethodsWe used 2018 mobile phone data from the twenty largest U.S. Metropolitan Statistical Areas (MSAs). For each home census tract, we derived a weighted tree canopy coverage exposure from all visited tracts based on the proportion of visits to other tracts by home tract residents. We subtracted home canopy coverage from the weighted canopy coverage in each of the visited tracts to calculate tract-specific differences. We evaluated associations between differences in tree canopy coverage and prevalence of CHD and stroke via spatial error models, adjusting for tract-level home canopy coverage, MSA, socioeconomic and built environment characteristics. ResultsFor every ten-percentage-point increase in tree canopy coverage in visited tracts relative to home tracts, there was a 0.32–0.34% decrease in stroke prevalence. Association with CHD prevalence was not observed after adjusting for spatial autocorrelation. Variations between weekdays and weekends were minimal. The difference in tree canopy coverage was associated with CHD prevalence only for home tracts with low tree canopy coverage, while the difference was associated with stroke prevalence across home tracts with low, moderate, and high tree canopy coverage, with diminishing effect size. DiscussionThis study identified that greater tree canopy coverage in visited neighborhoods relative to home neighborhoods was associated with lower stroke prevalence, and associations varied across home neighborhoods with different tree canopy coverage levels. It emphasized the need to factor in the neighborhood mobility networks in urban planning initiatives to promote cardiovascular health.

Hydration mechanism of molybdenite affected by surface oxidation: New insights from DFT and MD simulations

The oxidation and hydration of molybdenite surfaces cannot be avoided during the crushing and flotation processes in industry, which adversely affects its clean separation and extraction. In this study, the hydration mechanism under the influence of molybdenite surface oxidation was investigated using density functional theory (DFT) and molecular dynamics (MD) simulations. The results showed that the adsorption energy of a single water molecule on the molybdenite (0 0 1) surface changed from −0.33 kcal/mol to −2.07 kcal/mol after oxidation. Dissociated O acted as a bridging link on the molybdenite (0 0 1) surface, inducing hybridization of the Hw 1 s orbitals with the Os 2p orbitals, thereby enhancing the adsorption of water molecules. The adsorption energy of a single water molecule on the molybdenite (1 1 0) surface changed from −33.97 kcal/mol to −3.37 kcal/mol after oxidation. The dissociated O hindered the hybridization of the Mo 4d and Ow 2p orbitals, thus preventing the adsorption of water molecules on the (1 1 0) surface. After oxidation, the interfacial interaction between the molybdenite (0 0 1) surface and water molecules was enhanced, while the interfacial interaction between the molybdenite (1 1 0) surface and water molecules was weakened. The water molecules near the surface of molybdenite are adsorbed through hydrogen bonding and gradually form a hydrated film consisting of three layers of water molecules with a thickness of 8–9 Å as the water coverage increases.

Predicting the coupling effects of grass and shrub with biological crust on splash and sheet erosion

Vegetation plays an important role in preventing soil erosion in arid and semi-arid regions. However, the current research on soil erosion under vegetation conditions neglected the role of biological crusts (BSC). The impact of different combinations of grass and shrub vegetation with BSC on the soil erosion process were investigated in this study through indoor simulated rainfall experiments and field experiments. Additionally, the calculation formula for the splash and sheet erodibility coefficients (KSS) in the Rangeland Hydrology and Erosion Model (RHEM) model was revised and validated. The results showed that the ability of BSC to reduce erosion was gradually enhanced with an increase in BSC coverage. The significant erosion reduction effect of BSC under different vegetation coverages was found. As the BSC coverage increased to 40 %, the soil erosion process changed from transport-limited to detach-limited. When grass and shrub was combined with BSC, the average flow velocity was smaller than that of the individual vegetation treatments. Moreover, the proportion of BSC resistance was the highest among the various vegetation combinations consistently. When the coverage of the combined BSC exceeded that of the vegetation, the BSC dominated the soil erosion process through its direct physical protection and indirect alteration of soil properties. When the BSC coverage was incorporated into KSS, the determination coefficients of the revised KSS were all above 0.8. This study deepened the understanding of the coupling effects of grass and shrub with BSC on slope erosion processes, and improved the predictive accuracy of the RHEM model.

Mitigation of urban heat island in China (2000–2020) through vegetation-induced cooling

City afforestation serves as a robust strategy for thermal mitigation. Employing multisource satellite data, we explored the impact of vegetation cover on temperature dynamics across urban and rural sectors in Chinese cities. Our analysis reveals that a 1 % increase in vegetation coverage corresponds to a reduction in surface temperature by 0.099 °C to 0.102 °C in urban environments. However, the cooling effect diminishes from urban to rural areas, where increased vegetation occasionally results in warming. Further, the temperature reduction tends to stabilize at higher vegetation levels, as demonstrated in grid-based evaluations. Significantly, variations in urban population density substantially modulate these cooling effects. Over the period 2000–2020, afforestation increased vegetation coverage by 4.35 % in urban areas, which led to cooling in 67.43 % of the analyzed cities, with an average surface temperature decline of 0.58 °C. Additionally, our findings document a notable attenuation of the urban heat island (UHI) effect over time, with an average decrease of 0.56 ± 0.35 °C. This reduction primarily results from the thermoregulatory effects of changes in vegetation coverage, which cool urban areas and may warm rural ones. Our study underscores the critical role of afforestation in urban climate management and its efficacy in attenuating urban heat waves and UHI effects.

Coverage of Indoor Smoking and Vaping Restrictions in the U.S., 1990–2021

Secondhand smoke exposure increases the risk of premature death and disease in children and non-smoking adults. As a result, many US states and local jurisdictions have enacted comprehensive indoor smoking restrictions (ISR). Indoor vaping restrictions (IVR) have also been adopted to protect against exposure to secondhand e-cigarette aerosol. This study aimed to quantify state and national US coverage of policies restricting indoor cigarette and e-cigarette use over time. Data from the American Nonsmokers Rights' Foundation on US ISR from 1990 to 2021 and IVR from 2006 to 2021 were analyzed. Combining these data with 2015 US Census population estimates, the percentage of state and national residents covered by partial and comprehensive restrictions in bars, restaurants, and workplaces, were calculated (analysis in 2023-2024) over time. Between 1990-2021, national coverage of comprehensive ISR increased for bars (0% to 67.3%), restaurants (0% to 78.2%), and workplaces (0% to 77.5%). Partial ISR coverage decreased for bars (14.8% to 13.9%), restaurants (40.2% to 15.4%) and workplaces (40.2% to 22.5%). From 2006 to 2021, comprehensive IVR coverage increased for bars (0% to 43.5%), restaurants (0% to 51.5%), and workplaces (0% to 53.2%). Despite these increases in coverage, by the end of 2021, <50% of the population was protected by comprehensive ISR for bars, restaurants, and workplaces in 19, 12, and 14 states, respectively. The percentage of the US population protected by ISR and IVR has increased over time. However, gaps in coverage remain, which may contribute to disparities in tobacco-related disease and death.

Increasing fluctuations in the Arctic summer sea ice cover are expected with future global warming

The loss of Arctic sea ice (ASI) represents a major transformation in the Arctic region, impacting regional and global climate, ecosystems, and socio-economic structures. Observational and reanalysis data have consistently shown a notable shift in polar environmental conditions over recent decades, marked by a substantial reduction in the ASI area and a rise in the variability in its coverage and distribution. Utilizing data from the latest Coupled Model Intercomparison Project phase, our study reveals a consistent pattern highlighting a fundamental shift in ASI dynamics preceding total loss. We observe increasing fluctuations in the September ASI area as the threshold for an ice-free Arctic is approached across various scenarios and models. This pattern is particularly concentrated in the Central Arctic (CA) sub-region. Spatial analyses reveal increasing variance along the CA’s northern coastlines, accompanied by a substantial increase in open water coverage, underscoring the shift from stable to highly variable ice conditions in this region. Additionally, our findings suggest a potential link between increased ASI fluctuations and variability in surface wind speeds. These specific results underscore the urgency of multidisciplinary approaches in addressing the challenges posed by ASI variability, with implications for marine ecosystems, Indigenous communities, and navigational safety.

Fire season matters for midstory hardwood control: Impacts of fire season and firing technique on plant communities

In the southeastern USA, lack of historical fire regimes often leads to hardwood encroachment into early successional plant communities and managed pine stands, reducing wildlife value and timber yields. Land managers lack information on how firing technique interacts with fire season to influence plant communities. We designed an experiment to quantify these interactions in east-central Mississippi with pairs of 4 m × 8 m plots randomly assigned a backing and heading fire in each of three seasons: February (Feb), May–June (May/Jun), and September–October (Sep/Oct). We used thermocouples to monitor fire temperature and tagged midstory trees to monitor response. We lit heading fires with an 18–25 kph wind generated by a backpack blower and backing fires into the ambient wind. Despite backing fires producing longer residence times than heading fires and raising temperature above the lethal threshold of 60 °C an average of 54 s longer, firing technique did not influence midstory response one growing season post-fire. Backing and heading fires produced similar maximum temperatures. For both firing techniques, May/Jun resulted in the highest midstory mortality rates which were 3-fold greater than Sep/Oct and 4-fold greater than Feb. Among all three fire seasons, trees with a 2.5 cm diameter at breast height (DBH) had approximately a 75% chance of top-kill which decreased to <20% as trees approached 6.5 cm DBH. We found no effects of fire season on fire temperature, rate of spread, flame height, or percent crown scorch. We found no significant interactions between fire season and firing technique. Understory analysis revealed Sep/Oct produced the greatest increase in forb coverage, May/Jun resulted in the most grass coverage, and Feb produced the most brambles (Rubus spp.). On sites with similar species, weather, and fuel conditions to ours, land managers should emphasize fire season over firing technique for midstory control and understory manipulation. Where midstory hardwood control with fire is a priority, fire return intervals should be frequent enough to prevent trees from exceeding 2.5 cm DBH to avoid trees escaping fire's reach. These data can help managers reduce midstory competition with crop trees and promote understory development for wildlife.

DFT Atomic‐Scale Insight into Pt/Cu Single Atom Alloy Clusters Supported on γ‐Al2O3: The Effect of Hydrogen Environment

Single atom alloy (SAA) clusters formed by anchoring single atoms in small supported host clusters are emerging as catalysts with high performance. In this work, density functional theory (DFT) calculations and ab‐initio molecular dynamics (AIMD) simulations are performed to study the stability and the structure evolution of γ‐alumina‐supported platinum/copper SAA clusters of sub‐nanometer size in hydrogen environment. Due to the strong dynamic nature of both Cu cluster and anchored Pt single atom and their evolving interaction with the support, different isomers with different geometric and energetic properties are predicted. Extensive sampling through AIMD simulations reveals strong effect of hydrogen on the location of Pt single atom and strong variation of the cluster shape, evolving from 3D to concave and planar shapes wetting the alumina support. Interfacial site location of Pt single atom is found to be hydrogen coverage dependent. When the hydrogen coverage increases, the Pt single atom located preferentially at the interfacial site is pulled up by hydrogen atoms toward the upper surface Cu layers. The interaction of Pt/Cu cluster with alumina is predicted to decrease with increasing hydrogen coverage. Finally, electronic structure analysis reveals dramatic effect of hydrogen on the metallic nature of the catalysts.

Optimization of the emergency obstetric and neonatal care network in Benin through expert-based sub-national prioritizations.

To reduce maternal mortality by 2030, Benin needs to implement strategies for improving access to high quality emergency obstetric and neonatal care (EmONC). This study applies an expert-based approach using sub-national travel specificities to identify and prioritize a network of EmONC maternities that maximizes both population coverage and functionality. We conducted a series of workshops involving international, national, and department experts in maternal health to prioritize a set of EmONC facilities that meet international standards. Geographical accessibility modeling was used together with EmONC availability to inform the process. For women in need of EmONC, experts provided insights into travel characteristics (i.e., modes and speeds of travel) specific to each department, enabling more realistic travel times estimates modelled with the AccessMod software. The prioritization approach resulted in the selection of 109 EmONC maternities from an initial group of 125 designated maternities. The national coverage of the population living within an hour's drive of the nearest EmONC maternity increased slightly from 92.6% to 94.1% after prioritization. This increase in coverage was achieved by selecting maternities with sufficient obstetrical activities to be upgraded to EmONC maternities in the Plateau and Atlantique departments. The prioritization approach enabled Benin to achieve the minimum EmONC availability, while ensuring very good geographical accessibility to the prioritized network. Limited human and financial resources can now be targetted towards a smaller number of EmONC facilities to make them fully functioning in the medium-term. By implementing this strategy, Benin aims to reduce maternal mortality rates and deliver effective, high-quality obstetric and neonatal care, especially during emergencies.

Antenatal care coverage and early childhood mortality in Zimbabwe: new interpretations from nationally representative household surveys.

Zimbabwe has implemented universal antenatal care (ANC) policies since 1980 that have significantly contributed to improvements in ANC access and early childhood mortality rates. However, Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS), two of Zimbabwe's main sources of health data and evidence, often provide seemingly different estimates of ANC coverage and under-five mortality rates. This creates confusion that can result in disparate policies and practices, with potential negative impacts on mother and child health in Zimbabwe. We conducted a comparability analysis of multiple DHS and MICS datasets to enhance the understanding of point estimates, temporal changes, rural-urban differences and reliability of estimates of ANC coverage and neonatal, infant and under-five mortality rates (NMR, IMR and U5MR, separately) from 2009 to 2019 in Zimbabwe. Our two samples z-tests revealed that both DHS and MICS indicated significant increases in ANC coverage and declines in IMR and U5MR but only from 2009 to 2015. NMR neither increased nor declined from 2009 to 2019. Rural-urban differences were significant for ANC coverage (2009-15 only) but not for NMR, IMR and U5MR. We found that there is a need for more precise DHS and MICS estimates of urban ANC coverage and all estimates of NMR, IMR and U5MR, and that shorter recall periods provide more reliable estimates of ANC coverage in Zimbabwe. Our findings represent new interpretations and clearer insights into progress and gaps around ANC coverage and under-five mortality rates that can inform the development, implementation, monitoring and evaluation of policy and practice responses and further research in Zimbabwe.

High-resolution mapping of essential maternal and child health service coverage in Nigeria: a machine learning approach

BackgroundNational-level coverage estimates of maternal and child health (MCH) services mask district-level and community-level geographical inequities. The purpose of this study is to estimate grid-level coverage of essential MCH services...

Assessing mangrove cover change in Madagascar (1972–2019): Widespread mangrove deforestation is slowing down

Between the 1970s and early 2000s, Madagascar witnessed significant mangrove extent and condition declines due to deforestation and degradation. Data on mangrove extent prior to the early 1990s is scarce, contributing to uncertainties in long-term trend analyses. Recent estimates (since 2010) have reported widely varying mangrove extents from 2000 km² to 3400 km², indicating large uncertainties in current trends. Leveraging five decades of Landsat satellite data, this study offers a methodologically consistent approach to classify Madagascar's mangrove extent, providing a comprehensive dataset from 1972, 1989, 1999, 2009, to 2019. Our findings reveal an overall decrease of 8 % from 2935 km² in 1972–2699 km² in 2019, with loss rates decelerating from 0.4 % per year in the initial period to 0.2 % per year post-1999. This decline primarily reflects anthropogenic pressures, notably in the northern regions. Conversely, the last decade has witnessed a 5 % increase in mangrove coverage, primarily in the central and southern regions, thanks to concerted conservation and reforestation efforts, highlighting a positive shift in mangrove management and protection strategies. This study's long-term perspective is crucial for understanding the dynamics of mangrove coverage and guiding effective intervention strategies in Madagascar.

Analyzing Media Coverage Trends on Undocumented Migrant Children in South Korea

Objectives: This study examined the impact of media coverage on the public perceptions of undocumented migrant children in South Korea, highlighting their societal exclusion due to their undocumented status. Thise research explores how media shapes the awareness of these vulnerable minors, which is crucial for both their development and societal progress.Methods: We analyzed 302 articles from BIGKinds, a news service of the Korea Press Foundation, published from 1990 to 2023. These articles contained terms related to ‘undocumented migrant children,’ totaling 69,278 keywords. The analysis was conducted using R 4.3.1 with packages such as wordcloud2 and ggplot2 to assess keyword frequency and trends over the decades.Results: From the analysis, 69,240 keywords were identified, with the most common being “children, arrest, parents, foreigner, illegal, resident, rights, protection, birth, offspring, support, school”. Media trends have evolved, with an overall increase in coverage, particularly during significant societal events.Conclusion: Media portrayals have shifted from viewing these children merely as dependents of foreign workers to recognizing them as individuals. Residency remained a persistent theme, highlighting it as an unresolved issue. This study highlights the critical role of the media in informing the public about marginalized individuals and influencing societal engagement and perceptions.

The role of mobile broadband in poverty alleviation: a comparison of the effects of 3G and 4G network expansion in underdeveloped regions of Indonesia

ABSTRACT Alleviating poverty remains a significant global challenge necessitating effective interventions. While Information and Communications Technology (ICT) is widely acknowledged as a contemporary solution for addressing socioeconomic issues, the impact of supply-side factors, notably mobile broadband expansion, remains uncertain. Our study bridges this gap by analyzing the effects of 3G and 4G coverage on poverty rates and gaps in 109 underdeveloped regions in Indonesia from 2017–2021. Through quantitative analysis and map charts, we ascertain that increased 3G and 4G coverage is associated with decreased poverty rates and gaps. Specifically, a 1 percent rise in 3G coverage corresponds to a 0.019 percent decrease in poverty rates and a 0.011 point reduction in the poverty gap. Similarly, a 1 percent increase in 4G coverage reduces poverty rates by 0.009 percent and the poverty gap by 0.004 points. These findings offer valuable theoretical and practical insights to inform future research and policy initiatives.

Evaluation of knowledge, attitude, practices and effectiveness of menstrual hygiene interventions in rural schools from Lilongwe, Malawi

BackgroundMenstrual hygiene management (MHM) is associated with the menstrual process in women and adolescent girls who face cultural and financial challenges in rural areas of many developing countries. As part of the pilot study, we assessed the sustainability and effectiveness of the approaches and lessons learned from the MHM project intervention in rural areas of Lilongwe, Malawi.MethodsRural primary schools (n = 4) were purposively selected where an MHM intervention was implemented in Lilongwe, Malawi. The study employed a mixed-method research design. Assessments and data collection were performed through surveys of learners, literature reviews, key informant interviews (KIIs) (n = 90), and 20 focus group discussions (FGDs). The study participants included boys and adolescent girls (n = 100, 11–19 years; grades 5–8), teachers, mother groups, and community leaders from the selected schools.ResultsAll the schools had water sanitation and hygiene facilities and latrines (45% improved, 54% ventilated improved pit latrines – VIPs) that promoted menstrual hygiene for adolescent girls. However, two of the schools studied (50%, n = 4) did not have separate washrooms for changing sanitary materials. There was a slight increase in latrine coverage in Kabuthu zone communities (90% at baseline versus 93.4% at midterm). However, the coverage dropped to 85.7% at the final evaluation, which was attributed to too much rain received in the area that damaged most of the latrines. There was a significant reduction (p < 0.05) in the number of girls failing to attend classes due to menstruation (70% at baseline versus 14% at final evaluation). Furthermore, the project resulted in the majority of girls (94.4%) having access to school. There was a strong uptake and adoption of sanitary products (reusable pads and menstrual cups) among adolescent girls of all age groups. The study has demonstrated that the inclusion of key stakeholders such as health workers, parents, mother groups and community leaders promoted the uptake and sustainability of reusable pads and menstrual cups and MHM interventions and programs.ConclusionThe MHM project implementation improved adolescent girls’ education in the area. The inclusion of boys and other key stakeholders in the health education talks addressed issues of stigma and discrimination. The study, therefore, calls for comprehensive training on MHM and hygiene education to remove discrimination and harmful cultural practices.

Approaches for delivery of refractive and optical care services in community and primary care settings.

Uncorrected refractive error is a leading cause of vision impairment which, in most cases, can be managed with the appropriate spectacle correction. In 2021, the World Health Assembly endorsed a global target of a 40-percentage-point increase in effective coverage of refractive error by 2030. To achieve this global target, equitable access to refractive and optical services within community and primary care settings needs to be strengthened. This review will inform the development of technical guidance to support improvements in the testing and correction of refractive error among World Health Organization (WHO) member states. To determine the range of approaches for delivery of refractive and optical care services in community and primary care settings, and the methods employed for their evaluation. We searched CENTRAL, MEDLINE, Embase and Global Health databases, grey literature, and annual reports and websites of relevant organizations involved in eye-care delivery from January 2002 to November 2022 to identify approaches for refractive and optical service delivery. We included observational and interventional studies, reviews, and reports from relevant organizations related to delivering refractive services and optical services for preschool and school-aged children and adults in community and primary care settings published between January 2002 and November 2022. We searched for studies and reports published within the last 20 years because vision impairment due to uncorrected refractive error has only recently become a public health and eye health priority, therefore we did not expect to find much relevant literature until after 2002. Two review authors screened titles, abstracts and full texts, and extracted data. We resolved any discrepancies through discussion. We synthesized data, and presented results as tables, figures, and case studies. This project was led by the World Health Organization (WHO) Vision and Eye Care Programme. We identified 175 studies from searches of databases and grey literature, 146 records from company reports, and 81 records from website searches of relevant organizations that matched our inclusion criteria. Delivery approaches for refractive and optical services in community care included school-based, pharmacy, and outreach models, whereas primary care approaches comprised vision centre, health centre, and a combination of vision or health centre and door-to-door delivery. In community care, school-based and outreach approaches were predominant, while in primary care, a vision-centre approach was mainly used. In the WHO African region, the school-based and outreach approaches were mainly reported while, in the Americas, the outreach approach was mostly used. Very few approaches for service delivery were reported in the WHO Eastern Mediterranean region. Prominent gaps exist in the evaluation of the approaches, and few studies attempted to evaluate the approaches for delivery of refractive and optical care services. We comprehensively describe a range of approaches for delivery of refractive and optical services in community and primary care. Further evaluation of their effectiveness will better inform the application of these service-delivery approaches. The study outcomes will help guide WHO member states in strengthening refractive and optical services at community and primary care levels. This scoping review was supported by the Vision and Eye care Programme, World Health Organization and ATscale Global Partnership. The protocol of this scoping review was published in the Open Source Framework.