Lack Of Health Insurance Coverage Research Articles

Modifiable risk factors for anemia among women of childbearing age in sub-saharan Africa (2015–2023)

BackgroundThe Sustainable Development Goals Target 2.2 aims to eliminate all forms of malnutrition, including anemia, while the World Health Assembly targets a 50% reduction in anemia among women of childbearing age by 2025. Despite these efforts, global anemia prevalence among women has only slightly decreased from 31% to 30% between 2000 and 2019. Therefore, identifying modifiable risk factors for anemia among women of childbearing age in Africa is crucial for developing evidence-based interventions and achieving these goals.MethodsWe conducted an analysis of the most recent Demographic and Health Surveys datasets from 21 Sub-Saharan Africa (SSA) countries, which were carried out between 2015 and 2023. Using multilevel multinomial regression models, we calculated the Adjusted Odds Ratio (AOR) with a 95% Confidence Interval, and subsequently estimated the Population Attributable Fraction (PAF) based on these AOR values.ResultsThe study consisted of 168,417 women of childbearing age [–] (15-49) from 21 SSA. The highest proportion of moderate to severe anemia was linked to the type of contraceptive method used (PAF = 53.11%). This was followed by the lack of health insurance coverage (PAF = 37.92%). Other significant factors included poverty (PAF = 11.50%), no formal education (PAF = 18.01%), high parity (PAF = 5.78%), and the use of unimproved drinking water sources (PAF = 3.88%). These 5 modifiable risk factors were associated with 80.60% (95%CI, 77.60-83.40%) moderate/severe anemia in SSA.ConclusionIn a cross-sectional study involving 21 SSA nations, we identified 5 modifiable risk factors associated with anemia among women of childbearing age in SSA. These factors should be a priority for policymakers when planning future interventions to address anemia in SSA’s women’s health.

Refugees' Human and Social Capital and Health Insurance Coverage.

The lack of health insurance coverage is one of the most serious challenges confronting refugees and an important public policy issue. This study examines how refugees' human and social capital is linked to their health insurance coverage. This study uses the 2020 Annual Survey of Refugees public use data file to test the relationship between refugees' human and social capital and their health insurance coverage. 770 refugees who entered the U.S. between 2015 and 2019 are included in the sample. Health insurance coverage is measured in three different levels: no coverage at all, coverage with a gap, and coverage all year long. This study employs an ordered probit regression. The findings show that refugees' human capital, regardless of whether it is from refugees' home country or the U.S., is not associated with health insurance coverage. However, refugees' social capital, in terms of their involvement in religious organizations and their informal bridging network with people from a different culture, is positively associated with coverage. The analysis also reveals a gap in coverage once the initial government assistance ends, and refugees' paid employment and household income are negatively associated with health insurance coverage. The findings suggest that refugees' social capital in the new country plays an important role in obtaining the necessary information for healthcare access while the positive impacts of human capital on healthcare access may not apply to the refugee population. Therefore, resettlement programs should place an emphasis on helping refugees build and enhance social connections with people of diverse cultural backgrounds.

The Dexcom Community Glucose Monitoring Project: 6-Month Results Using Continuous Glucose Monitoring in Type 2 Diabetes.

The Dexcom Community Glucose Monitoring Project is a collaborative, ongoing, primary care-driven public health initiative designed to provide continuous glucose monitoring (CGM) systems to adults with type 2 diabetes who lack health insurance coverage for CGM. After 6 months of program participation, mean A1C decreased by 2.4 ± 1.9% from baseline to 6-month follow-up (from 9.4 ± 1.7 to 7.1 ± 1.2%, P <0.001). There was a clinically meaningful and statistically significant improvement in CGM metrics as well. Greater CGM use in the primary care setting among people with type 2 diabetes may help patients successfully manage their diabetes.

Health insurance and transportation barriers impact access to epilepsy care in the United States

PurposeInconsistent access to healthcare for people with epilepsy results in reduced adherence to antiseizure medications, increased seizure frequency, and fewer appropriate referrals for epilepsy surgery. Identifying and addressing factors that impede access to care should consequently improve patient outcomes. We hypothesized that health insurance and transportation affect access to outpatient neurology care for adults living with epilepsy in the United States (US). MethodsWe conducted a retrospective cross-sectional study of US adults with active epilepsy surveyed via the National Health Interview Survey (NHIS) in 2015 and 2017. We established whether patients reported seeing a neurologist in the past year and used multiple logistic regression to determine whether health insurance status and transportation access were associated with this outcome. ResultsWe identified 735 respondents from 2015 and 2017, representing an estimated 2.98 million US adults with active epilepsy. After adjusting for socioeconomic and seizure-related co-variates, we found that a lack of health insurance coverage was associated with no epilepsy care in the past year (adjusted odds ratio [aOR] 0.22; 95 % confidence interval [CI]: 0.09 – 0.54). Delayed care due to inadequate transportation (aOR 0.42; 95 % CI: 0.19 – 0.93) also resulted in reduced patient access to a neurologist. ConclusionDue to the inherent nature of their condition, people with epilepsy are less likely to have employer-sponsored health insurance or consistent driving privileges. Yet, these factors also impact patient access to neurological care. We must address transportation and insurance barriers through long-term investment and partnership between community, healthcare, and government stakeholders.

Maxillofacial defects following road traffic accidents should be included in the disability spectrum.

In India, 21.20% of annual road traffic accidents (RTA) result in maxillofacial injuries, with most victims being young adults aged 18-45 years. Such RTAs cause personal losses to individuals and families and adversely impact the country's health system facilities. These losses result from the expenses for medical care, lost wages for individuals who are rendered unable to work, and lost productivity for family members who must miss work or school in order to care for the injured. Most nations lose 3% of their gross domestic product to road accidents. RTA injuries, often associated with severe morbidity, cause functional impairments and have immense psychological impact. Rehabilitating these patients and their future treatment needs constitute an economic burden to themselves and their families, more so in a developing country like India, where a majority of the population cannot afford the treatment costs and lack health insurance coverage. These injuries therefore, as defined by the International Classification of Functioning, Disability and Health 2001, fall within the ambit of impairment and disability. However, Indian law does not identify maxillofacial injuries and the ensuing trauma as disabilities. Addressing this could be an important step towards improvement in the care and compensation provided to survivors of such life changing accidents.

Perioperative capacity and contextual challenges in teaching hospitals of southern Ethiopia: explanatory sequential mixed-methods research

BackgroundPrevious Ethiopian literature on surgical capacity and challenges has focused on quantitative investigations, lacking contextual understanding. This explanatory sequential mixed-methods research (MMR) aimed to assess perioperative capacity and contextual challenges at three teaching hospitals in southern Ethiopia.MethodsA quantitative survey assessed workforce, infrastructure, service delivery, financing, and information systems. The survey findings were explained by qualitative semi-structured interviews of twenty perioperative providers. Descriptive statistics were integrated with qualitative thematic analysis findings using the narrative waving approach. Key findings from both datasets were linked using a joint display table.ResultsThe survey revealed shortages in the specialist workforce (with a ratio of 0.58 per 100,000 population), surgical volume (at 115 surgeries per 100,000 population), equipment, supplies, financing, and perioperative data tracking. Hospitals’ radiology services and blood products were only available 25–50% of the time, while anesthetic agents and essential laboratory services were often available 51–75% of the time. Perioperative management protocols were used rarely (1–25% of the time). Over 90% of patients lack health insurance coverage. Qualitative data also revealed scarcity of perioperative resources and equipment; unaffordable perioperative costs, lack of health insurance coverage, and unforeseen expenses; poor patient safety culture and communication barriers across the perioperative continuum of care; workforce shortages, job dissatisfaction, and concerns of competence; and weak national governance, and sociopolitical turmoil, and global market volatility exacerbating local challenges. These challenges are linked to risks in quality of care and patient safety, according to clinicians.ConclusionThe study identifies deficiencies in the health system and sociopolitical landscape affecting safe surgery conduct. It highlights the need for comprehensive health system strengthening to expand workforce, upgrade facilities, improve safety culture, resilience, and leadership to ensure timely access to essential surgery. Exploring external factors, such as the impact of national governance and sociopolitical stability on reform efforts is also essential.

Historical Structural Racism in the Built Environment and Physical Health among Residents of Allegheny County, Pennsylvania.

Historical structural racism in the built environment contributes to health inequities, yet to date, research has almost exclusively focused on racist policy of redlining. We expand upon this conceptualization of historical structural racism by examining the potential associations of probable blockbusting, urban renewal, and proximity to displacement from freeway construction, along with redlining, to multiple contemporary health measures. Analyses linked historical structural racism, measured continuously at the census-tract level using archival data sources, to present-day residents' physical health measures drawn from publicly accessible records for Allegheny County, Pennsylvania. Outcome measures included average life expectancy and the percentage of residents reporting hypertension, stroke, coronary heart disease, smoking, insufficient sleep, sedentary behavior, and no health insurance coverage. Multiple regression analyses were conducted to examine separate and additive associations between structural racism and physical health measures. Redlining, probable blockbusting, and urban renewal were associated with shorter life expectancy and a higher prevalence of cardiovascular conditions, risky health behaviors, and residents lacking health insurance coverage. Probable blockbusting and urban renewal had the most consistent correlations with all 8 health measures, while freeway displacement was not reliably associated with health. Additive models explained a greater proportion of variance in health than any individual structural racism measure alone. Moreover, probable blockbusting and urban renewal accounted for relatively more variance in health compared to redlining, suggesting that research should consider these other measures in addition to redlining. These preliminary correlational findings underscore the importance of considering multiple aspects of historical structural racism in relation to current health inequities and serve as a starting point for additional research.

Risk factors of substance use treatment gaps among a nationally representative sample of black American adults in relation to sexual minority status and health insurance coverage

BackgroundLittle research has investigated predictors of specialty substance use treatment gaps among Black adults. This study examined differential odds of experiencing self-reported, past-year treatment gaps among Black adults with respect to sexual minority status and health insurance coverage, accounting for social cofactors.MethodThis cross-sectional study comprised 36,098 Black Americans aged 18 and older who completed the 2015–2019 National Survey on Drug Use and Health (NSDUH) and provided responses for all selected survey items. Design-based multivariable logistic regression models were used to examine predictors of drug and alcohol treatment gaps.ResultsSexual minority Black adults reported greater odds of experiencing treatment gaps to specialty treatment (i.e., inpatient hospital, inpatient/outpatient rehabilitation facility, or mental health center) compared to Black heterosexuals in adjusted models (Gay or lesbian: AOR = 2.01, 95% CI = 1.39–2.89; Bisexual: AOR = 2.35, 95% CI = 1.77–3.12), with bisexual Black women experiencing the greatest odds (AOR = 3.10, 95% CI = 2.33–4.14). Black adults with no health insurance were significantly more likely to report substance use treatment gaps relative to their peers with health insurance coverage (AOR = 50, 95% CI = 1.26–1.78).ConclusionThe results suggest a critical need for more investigations into patterns of specialty substance use treatment gaps within Black populations and for developing sexual identity-affirming mechanisms for closing the disparity gap, particularly for Black sexual minorities and those who lack health insurance coverage.

PHYSICIANS’ PERCEPTION AND ADHERENCE TO CLINICAL GUIDELINES FOR THE MANAGEMENT OF ACUTE CORONARY SYNDROME IN VIETNAMESE HOSPITALS

Introduction: Understanding guideline acceptance related factors and barriers to guideline adoption may help improve guideline implementation. We aimed to investigate physicians’ perception and adherence to ACS guidelines in Vietnamese hospitals. Methods: This was a cross-sectional study. Physicians’ perception was collected through interviews, using a validated questionnaire. Physicians’ adherence to ACS guidelines was determined through medical records of ACS patients treated by interviewed doctors, using prescribing indicators. Data were analyzed using SPSS 20.0, with significant level of p &lt; 0.05. Results: There were 33 cardiologists completed the interview (mean age 36.4, male 57.6%). Majority of physicians perceived that ACS guidelines were useful, reliable, and available. They definitely understood, would keep updating, and implementing those guidelines. About a third of physicians supposed that guideline adherence did not save treatment costs. Major barrier was lack of health insurance coverage. A total of 342 medical records of ACS patients (mean age 65.3, male 59.1%) was reviewed for physicians’ adherence. Patients with unstable angina/non-ST-elevation myocardial infarction accounted for the largest proportion. Statins were predominantly indicated (in 96.4% of patients), followed by aspirin (89.9%), ACEIs/ARBs (86.3%), P2Y12 inhibitors (84.7%), and beta-blockers (59.5%). Ultimately, 52.2% of patients were prescribed all four recommended medications. No differences in physicians’ characteristics, perception and barriers to guideline between high- and low-adherence doctors were found. Conclusions: Majority of physicians had positive perception towards ACS guidelines, but there were still certain barriers. Physicians’ prescribing practice was highly consistent with the guidelines, but the indication of beta-blockers and all four recommended medications were limited.

Burden of undiagnosed depression among older adults in India: a population based study.

The study explored the levels and associated factors of undiagnosed depression among community-dwelling older Indian adults. It also identified the socio-demographic predictors of undiagnosed depression among the study population at national and state levels. The study employed data from the Longitudinal Ageing Study in India wave-I, 2017-18. Based on the data on depression from interviewee's self-reporting and measurement on Composite International Diagnostic Interview- Short Form (CIDI-SF) and Centre for Epidemiological Studies- Depression scale (CES-D) scales, we estimated undiagnosed depression among older adults (age 60+). We estimated multivariable binary logistic regressions to examine the socio-demographic and health-related predictors of undiagnosed depression among older adults. 8% (95% CI: 7.8-8.4) of the total older adults had undiagnosed depression on CIDI-SF scale and 5% (95% CI: 4.8-5.3) on the combined CIDI-SF and CES-D. Undiagnosed depression was higher among those who were widowed, worked in the past and currently not working, scheduled castes, higher educated and the richest. Lack of health insurance coverage, presence of any other physical or mental impairment, family history of Alzheimer's/Parkinson's disease/ psychotic disorder, lower self-rated health and poor life satisfaction were significant predictors of undiagnosed depression on both CIDI-SF and combined scales. To improve the health of older adults in India, targeted policy efforts integrating mental health screening, awareness campaigns and decentralization of mental healthcare to primary level is needed. Further research could explore the causal factors behind different levels of undiagnosed depression.

Precarious Work and Housing for Michigan Farmworkers During the COVID-19 Pandemic and Beyond

ABSTRACT Objectives Farmworkers in Michigan face precarious and exploitative labor conditions that affect their access to affordable, fair, and quality housing, which are key social determinants of health. We sought to assess the health, working conditions, and housing access, affordability, and quality of farmworkers living in and outside of employer-provided housing during the COVID-19 pandemic. Methods We conducted a mixed methods cross-sectional study in collaboration with community partners from the Michigan Farmworker Project and the Michigan Department of Civil Rights. We assessed housing, labor conditions, and general health through in-depth phone interviews with seasonal, migrant, and H-2A farmworkers (n = 63) during the height of the COVID-19 pandemic (2020–2021) in Michigan. Descriptive analyses of these data included comparisons by type of farmworker and type of housing (employer-provided or other). Results The majority of farmworkers interviewed were women and seasonal farmworkers and spoke primarily Spanish. A significant share of farmworker participants reported living in poverty (38.3%) and had low or very low food security (27.0%). Nearly half of farmworkers (47.6%) rated their health as “fair” or “poor” during the year prior to the interview, and more than a third reported 3 or more chronic conditions (39.6%) and lack of health insurance coverage (38.7%). Among the 43 workers tested, 25.6% reported testing positive for COVID-19. Farmworkers reported experiences of objectification and dehumanization. Three-quarters of workers reported feeling that they were treated as less than human by supervisors and one-third reported verbal abuse. Farmworkers also experienced challenges exacerbated by their social vulnerability that impeded them from finding affordable, quality housing. Regarding housing quality, the majority of workers (80.6%) reported one or more environmental hazards around their residence, and about a third reported not having air conditioning (33.%) and lacking a functioning washing machine (33.9%). Concerns about the quality of drinking water accessible to workers and exposure to chemicals were shared by participants. Conclusion This study adds valuable knowledge to the understanding of the systemic barriers to housing and work conditions for female and male seasonal, migrant, and H-2A farmworkers in Michigan. Shortcomings in the regulatory and policy environment result in precarious housing and work conditions, including exploitative labor practices. These conditions negate equality, fairness, and health equity, important tenants for public health.

IJCM_228A: Awareness &amp; possession of health insurance scheme and its impact on health care utilization amongst people seeking services in tertiary care hospitals of coastal Karnataka: A cross-sectional study

Background: Healthcare is a fundamental human right, and various insurance schemes in India strive to make healthcare inexpensive and accessible to everyone. The government’s Ayushman Bharat and PMJAY programmes aim to guarantee universal health coverage and financial risk protection for households within the country. According to the NITI Ayog, more than 40 crore people lack health insurance coverage in the country. This lack of awareness limits access to healthcare services, especially for the marginalized population. The focus of this study is to assess the impact of availing health insurance on healthcare utilization. Objective: To assess the level of awareness and proportion of patients who are availing health insurance scheme and its impact on healthcare utilisation. Methodology: This cross-sectional study was carried out at teaching hospitals affiliated with Kasturba Medical College, Mangalore. The sample size was estimated to be 118, which included the adult patients admitted to the wards of respective hospitals who gave informed consent. The study participants received an internally verified questionnaire with four sections in Kannada and English. Results: Out of 118 participants, 89% are literate, and two-thirds are holders of BPL card. 84% of study participants are aware of a certain health insurance scheme, among which 90% being aware of the services offered and 82% considering it may be a worthwhile investment. 60% of total respondents possessed any kind of insurance scheme, with three quarters of them utilizing government schemes. Among the insurance holders, 82% receive full reimbursement for their medical condition and 58.5% agree that owning health insurance enables them greater access to health-care services. Paying medical expenses out of pocket drives uninsured people to reconsider obtaining an insurance. Conclusion: Public awareness and financial assistance programs should be tailored with culturally competent communication and simplified enrolment processes to enhance the coverage of health insurance services.

Structural Racism-Related State Laws and Healthcare Access Among Black, Latine, and White U.S. Adults.

Racialized healthcare inequities in the USA remain glaring, yet root causes are understudied. To address this gap, we created a state-level structural racism legal index (SRLI) using the Structural Racism-Related State Law Database and analyzed its association with racialized inequities in four outcomes (lacking health insurance coverage, lacking a personal doctor, avoiding care due to cost, lacking a routine check-up) from the 2013 Behavioral Risk Factor Surveillance System (N = 454,834). To obtain predicted probabilities by SRLI quartiles (Q1 = less structural racism, Q4 = more structural racism) and racialized group, we fit survey-weighted multilevel logistic models adjusted for individual- and state-level covariates. We found substantial healthcare access inequities across racialized groups within SRLI quartiles and less pronounced, but still meaningful, inequities within racialized groups across SRLI quartiles. For example, the predicted probabilities of lacking health insurance coverage across SRLI quartiles ranged from 13 to 20% among Black adults, 31 to 41% among Latine adults, and 8 to 11% among White adults. Across racialized groups in Q4 states, predicted probabilities ranged from 11% among White adults to 41% among Latine adults. Similar patterns were observed for lacking a personal doctor and avoiding care due to cost. Findings underscore the need to address structural racism in laws and policies to mitigate these inequities.

Completion of multidose vaccine series in early childhood: current challenges and opportunities.

Completion of all doses in multidose vaccine series provides optimal protection against preventable infectious diseases. In this review, we describe clinical and public health implications of multidose vaccine series noncompletion, including current challenges to ensuring children receive all recommended vaccinations. We then highlight actionable steps toward achieving early childhood immunization goals. Although coverage levels are high for most early childhood vaccinations, rates of completion are lower for vaccinations that require multiple doses. Recent research has shown that lower family socioeconomic status, a lack of health insurance coverage, having multiple children in the household, and moving across state lines are associated with children failing to complete multidose vaccine series. These findings provide contextual evidence to support that practical challenges to accessing immunization services are impediments to completion of multidose series. Strategies, including reminder/recall, use of centralized immunization information systems, and clinician prompts, have been shown to increase immunization rates. Re-investing in these effective interventions and modernizing the public health infrastructure can facilitate multidose vaccine series completion. Completion of multidose vaccine series is a challenge for immunization service delivery. Increased efforts are needed to address remaining barriers and improve vaccination coverage in the United States.

Reciprocal Association Between Chronic Pain and Health Insurance Type in a Population-based Longitudinal Cohort Study

Chronic pain is a widespread condition limiting adults’ daily activities and labor force participation. In the United States, withdrawal from the workforce could be associated with loss of health insurance coverage, while lack of health insurance coverage can limit access to diagnosis and management of chronic health conditions. We used a longitudinal cohort study of middle-aged adults to investigate whether chronic pain is reciprocally associated with coverage by any insurance and type of insurance coverage over a 2-year period (2018 and 2020). Among 5,137 participants (median age of 57 years in 2018), 29% reported chronic pain in either year, while 9 to 10% were uninsured each year. Using multivariable cross-lagged logistic regression analysis, chronic pain in 2018 was not associated with having any insurance coverage in 2020, and lack of coverage in 2018 was not associated with chronic pain in 2020. In further analysis, we determined that public coverage, other (non-private) coverage, or no coverage in 2018 were associated with an increased risk of chronic pain in 2020; while chronic pain in 2018 increased the risk of coverage by public rather than private insurance 2 years later, as well as the risk of coverage by other (non-private) payors. The reciprocal association of non-private insurance coverage and chronic pain may be related to insufficient access to chronic pain treatment among publicly insured adults, or qualification for public insurance based on disability among adults with chronic pain. These results demonstrate that accounting for the type of health insurance coverage is critical when predicting chronic pain in US populations. PerspectiveIn a longitudinal cohort study of middle-aged US adults, the use of public and other non-private insurance predicts future experience of chronic pain, while past experience of chronic pain predicts future use of public and other non-private insurance.

Access to healthcare and depression severity in vulnerable groups the US: NHANES 2013–2018

BackgroundAccess to healthcare is essential for managing chronic diseases, yet it often poses a barrier, contributing to a significant burden of conditions like depression. This study aimed to investigate the association between healthcare access and depression severity in contemporary free-living adults in the US, with a focus on identifying vulnerable populations. MethodData from the National Health and Nutrition Examination Survey cycles 2013–2018 were utilized, involving 13,689 participants aged 20 years or older. Multivariable multinomial logistic regression models were conducted, adjusting for various confounding variables. ResultsApproximately 17 % of US adults lacked access to healthcare, while 24 % experienced varying levels of depression severity, with 8 % having moderate-to-severe depression. More males faced challenges accessing healthcare, while more females reported diverse levels of depression. Both healthcare access and depression severity were associated with low educational attainment, low familial income, lacking spousal support, lacking health insurance coverage, and worse self-reported overall health. We found a higher vulnerability to moderate-to-severe depression among females (OR (95 % CI): 1.20 (0.91, 1.59)), individuals identifying as the Other ethnic group (1.69 (1.02, 2.79)), and those living without a spouse (1.57 (1.10, 2.26)). LimitationsOur cross-sectional study cannot establish causality, and potential biases related to self-reported data exist. ConclusionsAccess to healthcare emerged as a crucial predictor of moderate-to-severe depression among females, individuals of the Other ethnic group, and those without a spouse. Longitudinal research is needed to confirm and enhance our understanding of factors that shape the relationship between healthcare access and depression in free-living US adults.

Gaps in health coverage for racialized im/migrant sex workers in metro Vancouver: Findings of a community-based cohort study (2014–2021)

BackgroundSex workers face substantial health inequities related to sexual health and gender-based violence, many of which are amplified for the large proportion of workers who are racialized im/migrants. While criminalization and stigma are known barriers to health care for this population, we know little about health insurance coverage, and in particular how this relates to im/migration experience and racialization. We examined associations between im/migration status, duration, and racialization on gaps in health insurance coverage in a cohort of women sex workers. MethodsAnalyses used data from a prospective, community-based cohort of women sex workers in Vancouver, BC (Sept 2014-August 2021). Interviewer-administered questionnaires were by experiential (current/former sex workers) and community-based staff. We developed multivariable logistic regression confounder models with generalized estimating equations (GEE) to examine associations between migration and racialization exposures of interest and health insurance coverage. ResultsOf 644 sex workers, 411 (63.8%) reported lacking health insurance coverage for services needed during the 7-year study. In multivariable GEE analysis, precarious im/migration status (adjusted odds ratio (AOR) 2.37, 95% confidence interval (CI) 1.56 – 3.60), recent (AOR 4.22, 95% CI 2.42 – 7.35) and long-term (AOR 2.13, 95% CI 1.54 – 2.96) migration, and being a racialized Asian im/migrant (AOR 3.06, 95% CI 2.14 – 4.39) were associated with recent lack of health insurance coverage. ConclusionPolicy and program reforms are needed to decouple health insurance access from immigration status, remove mandatory waiting periods for health insurance coverage, and ensure that provincial insurance provides sufficient coverage for marginalized women's healthcare needs.

Perception and reasons for the choice of informal provider among women receiving antenatal care services from traditional birth attendants in rural communities of Lagos state, Nigeria.

Unskilled delivery, particularly the use of traditional birth attendants, is a major threat to reducing maternal mortality in Africa. Despite the associated risks, there is insufficient evidence on the major reasons why pregnant women in Nigeria continue to use traditional birth attendant (TBA) services, especially in rural areas. This study, therefore, assessed the perception, reasons for use, and utilization of only TBA services in current pregnancy among rural-dwelling pregnant women in Lagos, Nigeria. A descriptive cross-sectional study was conducted among 347 pregnant women recruited from traditional birth attendant facilities at Ikorodu Local Government Area, Lagos. Data were collected with an interviewer-administered questionnaire and analyzed using SPSS version 25. Bivariate and multivariate analyses were conducted with a significance level set at p<0.05. The outcome measures included perception, utilization of only TBA services in current pregnancy, and reasons for use. Positive perception refers to positive thought, belief, or opinion held by the participants towards the TBA. All the respondents had a positive perception of TBAs, majority (70.3%) utilized TBA only while 29.7% combined TBA and healthcare facilities services in the current pregnancy. Recommendations from previous users (81.6%), welcoming and hospitable staff (77.2%), perceived spiritual protection (75.2%), and past use (68.6%), were some of the reasons cited by the respondents for utilizing only TBA services. Predictors of utilizing only TBA services were respondents' level of education, those with secondary (aOR = 0.261; 95% CI; 0.108-0.629) and tertiary (aOR = 0.352; 95% CI; 0.162-0.769) had lower utilization while the lack of health insurance coverage (aOR = 3.017; 95% CI; 1.476-6.166) were associated with higher utilization of TBAs. Respondents in this study had a positive perception of TBA services. Continuous training and an effective monitoring system of TBAs by the government and other healthcare stakeholders to improve women's birthing experiences is recommended.

Stroke characteristics and outcomes in urban Tanzania: Data from the Prospective Lake Zone Stroke Registry.

Stroke is a second leading cause of death globally, with an estimated one in four adults suffering a stroke in their lifetime. We aimed to describe the clinical characteristics, quality of care, and outcomes in adults with stroke in urban Northwestern Tanzania. We analyzed de-identified data from a prospective stroke registry from Bugando Medical Centre in Mwanza, the second largest city in Tanzania, between March 2020 and October 2022. This registry included all adults ⩾18 years admitted to our hospital who met the World Health Organization clinical definition of stroke. Information collected included demographics, risk factors, stroke severity using the National Institutes of Health Stroke Scale, brain imaging, indicators for quality of care, discharge modified Rankin Scale, and in-hospital mortality. We examined independent factors associated with mortality using logistic regression. The cohort included 566 adults, of which 52% (294) were female with a mean age of 65 ± 15 years. The majority had a first-ever stroke 88% (498). Premorbid hypertension was present in 86% (488) but only 41% (200) were taking antihypertensive medications before hospital admission; 6% (32) had HIV infection. Ischemic strokes accounted for 66% (371) but only 6% (22) arriving within 4.5 h of symptom onset. In-hospital mortality was 29% (127). Independent factors associated with mortality were severe stroke (adjusted odds ratio (aOR) = 1.81, 95% confidence interval (CI) = 1.47-2.24, p < 0.001), moderate to severe stroke (aOR = 1.49, 95% CI = 1.22-1.84, p < 0.001), moderate stroke (aOR = 1.80, 95% CI = 1.52-2.14, p < 0.001), leukocytosis (aOR = 1.19, 95% CI = 1.03-1.38, p = 0.022), lack of health insurance coverage (aOR = 1.15, 95% CI = 1.02-1.29, p = 0.025), and not receiving any form of venous thromboembolism prophylaxis (aOR = 1.18, 95% CI = 1.02-1.37, p = 0.027). We report a stroke cohort with poor in-hospital outcomes in urban Northwestern Tanzania. Early diagnosis and treatment of hypertension could prevent stroke in this region. More work is needed to raise awareness about stroke symptoms and to ensure that people with stroke receive guidelines-directed therapy.

Health disparities among illegal immigrants and homeless people in the USA: a struggle within

Undocumented immigrants in the United States face significant barriers in accessing healthcare services, which contribute to health disparities. This population is often affected by homelessness due to limited access to affordable housing, limited employment opportunities, language barriers, fear of deportation, and lack of social support. Homelessness and the fear of deportation can lead to stress, anxiety, and physical illness among undocumented immigrants, highlighting the need for healthcare services tailored to their unique needs. Access to healthcare is further hindered by a lack of health insurance coverage, financial constraints, language and cultural barriers, and the ineligibility for public health insurance schemes. Undocumented immigrants who are homeless encounter additional challenges, including difficulties in accessing resources, navigating the healthcare system, and facing societal discrimination. This article focuses on the barriers faced by undocumented migrants in the United States regarding healthcare access and proposes feasible solutions to promote health equity and advance universal health coverage in the country. The absence of health coverage for undocumented migrants undermines the concept of universal healthcare in the USA, as it excludes a significant portion of the population from accessing essential healthcare services. Hence, there is a need for comprehensive immigration reform and policies that ensure impartial access to healthcare. Practical solutions include establishing culturally competent care, implementing mobile clinics or street medicine programs, fostering collaborative relationships with nonprofit organizations, advocating for policies safeguarding the rights of undocumented immigrants, and enhancing data collection techniques.