Self-reported Morbidity Research Articles

Long-term air pollution exposure and self-reported morbidity: A longitudinal analysis from the Thai cohort study (TCS)

BackgroundSeveral studies have shown the health effects of air pollutants, especially in China, North American and Western European countries. But longitudinal cohort studies focused on health effects of long-term air pollution exposure are still limited in Southeast Asian countries where sources of air pollution, weather conditions, and demographic characteristics are different. The present study examined the association between long-term exposure to air pollution and self-reported morbidities in participants of the Thai cohort study (TCS) in Bangkok metropolitan region (BMR), Thailand. MethodsThis longitudinal cohort study was conducted for 9 years from 2005 to 2013. Self-reported morbidities in this study included high blood pressure, high blood cholesterol, and diabetes. Air pollution data were obtained from the Thai government Pollution Control Department (PCD). Particles with diameters ≤10 μm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), ozone (O3), and carbon monoxide (CO) exposures were estimated with ordinary kriging method using 22 background and 7 traffic monitoring stations in BMR during 2005–2013. Long-term exposure periods to air pollution for each subject was averaged as the same period of person-time. Cox proportional hazards models were used to examine the association between long-term air pollution exposure with self-reported high blood pressure, high blood cholesterol, diabetes. Results of self-reported morbidity were presented as hazard ratios (HRs) per interquartile range (IQR) increase in PM10, O3, NO2, SO2, and CO. ResultsAfter controlling for potential confounders, we found that an IQR increase in PM10 was significantly associated with self-reported high blood pressure (HR = 1.13, 95% CI: 1.04, 1.23) and high blood cholesterol (HR = 1.07, 95%CI: 1.02, 1.12), but not with diabetes (HR = 1.05, 95%CI: 0.91, 1.21). SO2 was also positively associated with self-reported high blood pressure (HR = 1.22, 95%CI: 1.08, 1.38), high blood cholesterol (HR = 1.20, 95%CI: 1.11, 1.30), and diabetes (HR = 1.21, 95%CI: 0.92, 1.60). Moreover, we observed a positive association between CO and self-reported high blood pressure (HR = 1.07, 95%CI: 1.00, 1.15), but not for other diseases. However, self-reported morbidities were not associated with O3 and NO2. ConclusionsLong-term exposure to air pollution, especially for PM10 and SO2 was associated with self-reported high blood pressure, high blood cholesterol, and diabetes in subjects of TCS. Our study supports that exposure to air pollution increases cardiovascular disease risk factors for younger population.

Self-Reported Morbidity and Self-Rated Health among the Elderly in India: Revisiting the Puzzles

Both self-reported morbidity (SRM) and self-rated health (SRH) have been questioned on the grounds of reliability and validity, particularly in the context of developing countries such as India. It has been argued that indicators of self-perceived health often do not move in tandem with objective indicators of health and are not reflective of socioeconomic inequalities. This paper attempts to systematically examine the validity of SRH and SRM, analysing data for the aged population from the last two health rounds of the Indian National Sample Survey. We consider two indicators of SRM: chronic and acute, and test their association with different positional parameters such as economic condition, educational attainment and availability of healthcare facilities, using multivariable logistic regressions. We also test the association of SRH with these parameters and SRM, using ordered probit regression. In an alternative specification, we replace the general indicators of acute and chronic morbidity with the presence of specific diseases and health conditions, and examine the validity of SRH. Though SRM is typically lower for people who are disadvantaged in terms of different socioeconomic parameters, the latter are more likely to report worse SRH. Self-reported presence of specific illnesses and health conditions also significantly increases the likelihood of giving worse ratings for SRH among the aged in India. Our findings suggest that while SRH is a valid health indicator among the aged in India, one cannot be entirely dismissive of SRM, particularly with regard to its predictive validity for SRH.

Aesthetic‐And patient‐related outcomes following root coverage procedures: A systematic review and network meta‐analysis

Aim of this systematic review (SR) of randomized controlled trials (RCTs) was to evaluate effect of different flap designs and graft materials for root coverage, in terms of aesthetics, patient satisfaction and self-reported morbidity (post-operative pain/discomfort). A comprehensive literature search was performed. A mixed-modelling approach to network meta-analysis was utilized to formulate direct and indirect comparisons among treatments for Root Coverage Esthetic Score (RES), with its individual components, and for subjective patient-reported satisfaction and post-operative pain/discomfort (visual analogue scale (VAS) of 100). Twenty-six RCTs with a total of 867 treated patients (1708 recessions) were included. Coronally Advanced Flap (CAF) + Connective Tissue Graft (CTG) (0.74 (95% CI [0.24, 1.26], p=.005)), Tunnel (TUN) + CTG (0.84 (95% CI [0.15, 1.53]), p=.01) and CAF+Graft substitutes (GS) (0.55 (95% CI [0.006, 1.094], p=.04)) were significantly associated with higher RES than CAF. No significant difference between CAF+CTG and TUN+CTG was detected (0.09 (95% CI [-0.54, 0.72], p=.77)). Addition of CTG resulted in less natural tissue texture (-0.21 (95% CI [-0.34, -0.08]), p=.003) and gingival colour (-0.06 (95% CI [-0.12, -0.03], p=.03)) than CAF. CTG techniques were associated with increased morbidity. Connective tissue graft procedures showed highest overall aesthetic performance for root coverage, although graft integration might impair soft tissue colour and appearance. Additionally, CTG-based techniques were also correlated with a greater patient satisfaction and morbidity.

Referred morbidity of an African descendant community in the eastern Amazonia

Abstract Background In the Amazon there are several quilombola communities, remnants of the enslaved peoples of African descendant. In Pará/Brazil (Eastern Amazonia) there are over 300 quilombola communities established in rural areas. The aim of this study is to investigate the living conditions and morbidity of individuals aged 18+ years who live in a quilombola community in the city of Ananindeua/Pará. Methods A cross-sectional study was done with 132 individuals (71.3% of the population). A household survey and a questionnaire evaluating socioeconomic, life habits and self-reported morbidity were conducted. Results Among the participants 90.2% belonged to the D/E economic class, 60.6% were women, the median age was 39.5 years (p = 0.343) and the per capita income was U$41.50/month with no difference between sexes (p = 0.266). 97.0% of the participants self-declared black or brown. Women had more education than men (7x5 years, p = 0.019). Most worked with agriculture and fishing (55.5%). 53.8% of men rated their health status as good while 41.0% of women rated their health as good (p = 0.002). 55.3% had never smoked cigarettes, 25.8% were ex-smokers, and 25.8% were smokers. More men (78.8%) used alcohol regularly than women (43.8%) (p = 0.000), among the users 32.5% reported weekly or daily use. The frequency of self-reported morbidity was as follows: Asthma 21.7%, Hypertension 10.6%, Diabetes 6.8%, Chronic infectious diseases 5.6%, Kidney disease 3.9%, Stroke 3.3%, Angina 3.1%, Liver disease 2.3%, Chronic heart failure 1.5%, with no difference between the sexes. Only 4.0% used medication for diabetes, and 7.6% for hypertension. Conclusions The study shows the social vulnerability of this quilombola community, which is similar to others in the region. The rural afro-derived Amazonian populations need to be empowered to help inform policy makers about their main health issues and healthcare needs. Key messages There are few studies about health of quilombola communities. This research shows the need for further investigations to produce sensible information and promote the empowerment of these populations. This study shows a high level of vulnerability of this community, similar to others in rural Amazon. Information about their health needs is fundamental to promotion of public policies in the region.

Agreement between self-reported morbidity and pharmacy claims data for prescribed medications in an older community based population

BackgroundStudies have indicated variability around prevalence estimates of multimorbidity due to poor consensus regarding its definition and measurement. Medication-based measures of morbidity may be valuable resources in the primary-care setting where access to medical data can be limited. We compare the agreement between patient self-reported and medication-based morbidity; and examine potential patient-level predictors of discordance between these two measures of morbidity in an older (≥ 50 years) community-based population.MethodsA retrospective cohort study was performed using national pharmacy claims data linked to The Irish LongituDinal study on Ageing (TILDA). Morbidity was measured by patient self-report (TILDA) and two medication-based measures, the Rx-Risk (< 65 years) and Rx-Risk-V (≥65 years), which classify drug claims into chronic disease classes. The kappa statistic measured agreement between self-reported and medication-based morbidity at the individual patient-level. Multivariate logistic regression was used to examine patient-level characteristics associated with discordance between measures of morbidity.ResultsTwo thousand nine hundred twenty-five patients were included (< 65 years: N = 1095, 37.44%; and ≥ 65 years: N = 1830 62.56%). Hypertension and high cholesterol were the most prevalent self-reported morbidities in both age cohorts. Agreement was good or very good (κ = 0.61–0.81) for diabetes, osteoporosis and glaucoma; and moderate for high cholesterol, asthma, Parkinson’s and angina (κ = 0.44–0.56). All other conditions had fair or poor agreement. Age, gender, marital status, education, poor-delayed recall, depression and polypharmacy were significantly associated with discordance between morbidity measures.ConclusionsMost conditions achieved only moderate or fair agreement between self-reported and medication-based morbidity. In order to improve the accuracy in prevalence estimates of multimorbidity, multiple measures of multimorbidity may be necessary. Future research should update the current Rx-Risk algorithms in-line with current treatment guidelines, and re-assess the feasibility of using these indices alone, or in combination with other methods, to yield more accurate estimates of multimorbidity.

Chronic respiratory morbidity in the Bhopal gas disaster cohorts: a time-trend analysis of cross-sectional data (1986–2016)

ObjectivesIn 1984, nearly 500,000 inhabitants of Bhopal city, India, were exposed to toxic gases that leaked from a nearby pesticide manufacturing plant. In 1985, four cohorts were established to assess the long-term health impact of exposure, namely, mild, moderate, severely exposed and unexposed groups. The self-reported morbidity data of these cohorts were collected by follow-up cross-sectional surveys at regular intervals over the last 35 years. The present study aimed to analyse the long-term trend of chronic (duration of symptoms >3 months) respiratory morbidity in the four cohorts, stratified by age groups. Study designThe design of this study is a longitudinal analysis of cross-sectional respiratory morbidity data. MethodsChronic respiratory morbidity data within the cohorts were analysed at 5-year intervals (first recorded data from 1986). Based on age at the time of exposure, subjects were stratified into four age groups: children (aged <10 years), teenagers (aged ≥10 to <20 years), younger adults (aged ≥20 to <40 years) and older adults (aged ≥40 years). ResultsDuring the first decade, after exposure to the toxic gases, chronic respiratory morbidity in children and teenagers was high (up to 9.1%), which declined thereafter. Progressively increasing chronic respiratory morbidity was observed in both the younger and older adult age groups within all cohorts during the initial 5–10 years after exposure. Respiratory morbidity in both the younger and older adult age groups remained high for 15–20 years and thereafter recorded a declining trend. The highest respiratory morbidity observed during this study in the younger and older adult age groups was 38.6% and 59.5%, respectively; these values were both recorded in the severely exposed cohort. ConclusionsExposure to toxic gases released during the Bhopal gas disaster has resulted in chronic respiratory morbidity of the exposed population; this morbidity has continued over decades. The age of the individuals at the time of exposure and exposure severity were crucial determinants of the long-term trend of respiratory morbidity.

Health care utilization and out of pocket expenditure in a rural area of Kerala: a cross sectional study

Background: Out-of-pocket expenditure in health has substantial negative side effects. They may lead to impoverishment. The knowledge of pattern of health care utilization and out of pocket expenditure is imperative for policy making in health care. Objectives of this study were to study utilization pattern of health care services of the population in a rural area of Thrissur district and study of the self-reported chronic morbidity profile and out of pocket expenditure for chronic diseases among the population.Methods: A community based cross sectional study was conducted in Tholur panchayath area of Thrissur district of Kerala. The calculated sample size was 552 households. House hold was considered as primary sampling units. All family members of the house hold were included in the study. Cluster sampling method was adopted. Data was collected using a pre tested semi-structured questionnaire.Results: A total of 809 individuals from 583 households were found to have chronic diseases. Among them, 54.8% were utilizing private health facility for their treatment. Majority (86%) were following modern medicine system for treatment. Health insurance was availed by 26.6 % of the study participants. Most common reported morbidity was combination of hypertension, diabetes mellitus, and hypercholesterolemia. The total median out of pocket expenditure for chronic diseases was found to be 5000 Indian Rupees. It was found that 41.6% of the total income of study participants was spent for health care of chronic diseases which indicate catastrophic health expenditure.Conclusions: The burden of chronic disease is high and the private hospitals are approached more by the study population for treatment rather than government hospitals. Health insurance coverage is low, and social assistance availed for treatment is marginal. These factors lead to high out of pocket expenditure amounting to catastrophic health expenditure.

Self-perceived general health among community-dwelling Portuguese older adults: do men and women differ?

AbstractEvidence on how gender intersects with relevant social constructs in later phases of life is scarce. This investigation examined gender inequalities in perceived health status (self-perceived general health; SPGH) by Portuguese elderly community-dwellers while considering psycho-social and socio-demographic determinants. This study used data from a representative sample of community-dwellers aged ≥65 years (N = 920), who were enrolled in the Portuguese Elderly Nutritional Status Surveillance System (PEN-3S) project. Associations between SPGH and socio-demographic and psycho-social variables, functionality and self-reported morbidity were tested; indirect effects of relevant predictors on SPGH were also tested using a bootstrap method. Gender inequalities in health were found: women significantly rated their health worse than men; overall, participants rated their health as fair. Education, functional status, depression symptoms and self-reported morbidity significantly predicted SPGH among women, whereas only the latter two were associated with SPGH among men. For both genders, depression was the strongest predictor of SPGH. Mediation analyses detected indirect effects of cognitive function and loneliness feelings on SPGH among older adults. Results herein provide insights on the predictive role of psycho-social variables on SPGH and support the need for considering the context when addressing the correlates of SPGH among Portuguese older adults. Altogether, these findings might support cost-effective interventions targeting the most vulnerable groups of the population to inequalities in health and its predictors.

Self- Reported morbidity in adults: population survey in Rio Branco, Brazil, 2007 – 2008

Introduction: Epidemiological data allow to know the needs of the communities and can provide subsidies for planning and actions in the health services, hence, it is necessary to investigate illness and chronic non-communicable diseases in the population of interest.&#x0D; Objective: The objectives of this study are to describe and verify the association between the most prevalent self-reported morbidities in adults regarding the characteristics: socioeconomic, demographic and lifestyle. &#x0D; Methods: This is a population-based survey conducted with adults (?18 years of age), living in Rio Branco, Acre State, Brazil, during the period 2007/2008. The sample consisted of 1516 individuals, from a probabilistic sampling in two stages of a draw.&#x0D; Results: The most prevalent self-reported morbidity was spine/back disease with a percentage of 30.8%, followed by hypertension (28.3%), malaria (28.3%) and depression (18.7%). Regarding socioeconomic and demographic aspects, the most prevalent characteristics were: female gender and low level of formal education, with statistical significance. As for life habits, the most common characteristics with statistical significance were: smoking and physical inactivity.&#x0D; Conclusion: In view of the scarcity of studies of this nature in the North region of Brazil, and especially in the State of Acre, the results regarding the most prevalent self-reported morbidities in the adult population of Rio Branco are of fundamental importance, to alert researchers and health professionals. This contributes to a better adaptation and/or implementation of public strategies for promotion, protection and health assistance.

Measuring Socio-Economic Inequality in Self-Reported Morbidity in India: Decomposition Analysis

This paper assesses socio-economic inequalities in self-reported morbidities (SRMs) among households in India. Particularly, we addressed two questions. Is socio-economic-related inequality in SRMs significantly pro-rich or pro-poor? What are the major socio-economic and regional determinants contributing to inequality? This study is based on National Sample Survey 71st round (2014). We calculated equity ratio and concentration index (CI) to assess socio-economic-related inequality. Further, we applied probit regression and decomposition of CI to identify the major factors contributing to inequality. The finding suggests that SRMs and hospital admission have significantly pro-rich distribution, and accessibility to healthcare is a constraint against poor households. After adjusting the inequality, the unjust inequality due to socio-economic gradient is still found to be significant. Overall, income and regional differences are observed to be inflating factors, while education and insurance are observed to be deflating factors in socio-economic inequality in SRMs. High out-of-pocket expenditure with high proportion of transportation cost indicates high burden of accessing healthcare, which acts as a deterrent for poor in seeking healthcare. The government targets of investing 2.5 per cent of the Gross Domestic Product in the healthcare sector and running an ambitious programme like Universal Health Coverage are necessary efforts in the presence of income and health inequalities.

The Dutch LATER physical outcomes set for self-reported data in survivors of childhood cancer

PurposesStudies investigating self-reported long-term morbidity in childhood cancer survivors (CCS) are using heterogeneous outcome definitions, which compromises comparability and include (un)treated asymptomatic and symptomatic outcomes. We generated a Dutch LATER core set of clinically relevant physical outcomes, based on self-reported data. Clinically relevant outcomes were defined as outcomes associated with clinical symptoms or requiring medical treatment.MethodsFirst, we generated a draft outcome set based on existing questionnaires embedded in the Childhood Cancer Survivor Study, British Childhood Cancer Survivor Study, and Dutch LATER study. We added specific outcomes reported by survivors in the Dutch LATER questionnaire. Second, we selected a list of clinical relevant outcomes by agreement among a Dutch LATER experts team. Third, we compared the proposed clinically relevant outcomes to the severity grading of the Common Terminology Criteria for Adverse Events (CTCAE).ResultsA core set of 74 self-reported long-term clinically relevant physical morbidity outcomes was established. Comparison to the CTCAE showed that 36% of these clinically relevant outcomes were missing in the CTCAE.Implications for Cancer SurvivorsThis proposed core outcome set of clinical relevant outcomes for self-reported data will be used to investigate the self-reported morbidity in the Dutch LATER study. Furthermore, this Dutch LATER outcome set can be used as a starting point for international harmonization for long-term outcomes in survivors of childhood cancer.

Assessing expanded community wide treatment for schistosomiasis: Baseline infection status and self-reported risk factors in three communities from the Greater Accra region, Ghana.

BackgroundThis paper reports on the baseline prevalence and associated risk factor findings of a pilot, longitudinal study exploring community-wide treatment of schistosomiasis and soil-transmitted helminthiasis, using albendazole plus praziquantel in the Greater Accra region of Ghana.MethodFrom three communities, at least, 658 individuals were enrolled into the study via random household selection. Prevalence and intensity of schistosomiasis and STH infection were determined from stool and urine samples with a questionnaire being administered in order to explore other morbidities and risk factors. Factor analysis of household demographic variables was undertaken to generate a socioeconomic score; this was then further categorised into tertiles. Proportional-odds cumulative logit generalised estimating equation (GEE) models were used to investigate categorical ordinal intensity of infection associations with morbidity. Separately, logistic GEE models were used to investigate risk factor associations with infection prevalence.ResultsBoth Schistosoma haematobium and S. mansoni were prevalent in the three communities, with the prevalence of S. haematobium ranging from 3.3% (24/679; 95% CI = 1.9–4.7) to 19% (114/632; 95% CI = 15.8–22.2) and S. mansoni ranging from 30% (202/679; 95% CI = 26.5–33.5) to 78.3% (409/536; 95% CI = 74.7–81.9). The total prevalence of STH across all three sites was negligible at 1.3% (24/1847; 95% CI = 0.8–1.9) comprising mainly hookworm (10/1847). Multivariable statistical models indicated males to be 2.3 (95% CI = 1.7–3.3) times more likely to have a high intensity S. mansoni infection and 1.5 (95% CI = 1.1–2) times more likely to have a high intensity of S. haematobium infection compared to females. There was no significant difference in the likelihood of infection with S. mansoni between adults and school age children (SAC), however S. haematobium infections were found to be 2.5 (95% CI = 1.8–3.5) times more likely to occur in school age children than in adults.Multivariable statistical models (adjusted for age and sex) indicated an association between schistosomiasis and a number of self-reported morbidity indicators (notably diarrhoea and blood in stool and urine). Low socio-economic status was also associated with SCH infection (OR: 2; 95% CI = 1.3–3.2).ConclusionThe communities targeted by this study showed a range of Schistosoma prevalence’s of infection, from hypo-endemic through to meso-endemic and hyper-endemic. The prevalence of SCH across the different age groups in the study locations highlights the large number of individuals currently being left out of the standard morbidity control method of annual treatment of the SAC.

Vision-related quality of life and visual function in a 70-year-old Swedish population.

To investigate vision-related quality of life (VRQoL), visual function and predictors of poor vision in a population of 70-year-olds. Self-reported ocular morbidity and responses to the National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25) in a cross-sectional population study (N=1203) in Gothenburg, Sweden, were compared with results from ophthalmic examination (N=560). The most common self-reported ophthalmic morbidities were cataract (23.4%), age-related macular degeneration (AMD; 4.7%), glaucoma (4.3%) and diabetic retinopathy (1.4%). Cataract was more prevalent in women (p=0.001). The composite score from NEI VFQ-25 for the entire cohort was 91.4 (standard deviation: 27.5). When comparing composite score for different eye diseases, persons with cataract or AMD exhibited lower scores (p=0.029 and 0.018, respectively). Best-corrected visual acuity (BCVA) was normal (≥0.5 decimal) in 98.9%; two individuals had low vision (<0.3). Men exhibited better BCVA (median: -0.08 logMAR) than women (-0.06; p=0.005). Visual field defects were observed in 16.3% and uncorrected refractive errors in 61.5%. Poor vision was reported by 7.4% of participants with presenting visual acuity (PVA) ≥0.5 (decimal), while 66.7% with PVA <0.5 reported good vision. Of 27 individuals with PVA <0.5, 55.6% obtained a BCVA of ≥1.0 with the right correction. Low contrast sensitivity was a significant predictor of experiencing poor vision (p=0.008), while PVA and visual field defects were not. Low contrast sensitivity is a predictor of experiencing poor vision. There is a discrepancy between subjective/objective visual function and a high prevalence of uncorrected refractive errors. Women have more cataract, and men demonstrate slightly better visual acuity.

Levels and Correlates of Self-reported Maternal Morbidity in Women in a Community outreach area of a Teaching Hospital in Bihar

Levels and Correlates of Self-reported Maternal Morbidity in Women in a Community outreach area of a Teaching Hospital in Bihar

Self-reported morbidity profile among geriatric population in ICMR-model rural health research unit, Kallur, Tirunelveli

Background: The Model Rural Health Research Unit at Kallur, Tirunelveli, established by the Department of Health Research, Government of India, is linked to Tirunelveli Medical College. It is mentored by the ICMR-National Institute of Epidemiology, Chennai. The key objective was to develop area-specific models to undertake field health research depending on the disease profile, topography, morbidity patterns, and better health-care services. As a part of the ongoing activity, we constructed a cohort of 36,289 people and analyzed the self-reported information on morbidities experienced by the registered population from different aspects. In this communication, we report some of the findings extracted from the data sets as descriptive epidemiology on the self-reported magnitude of illness and their utilization of health services in the rural cohort of a primary health center among the geriatric population 60 years or more. Methods: A demographic health database of 11,006 households (HH) with 36,289 individuals was constructed in the study area under the Primary Health Centre, Nadu Kallur, Tirunelveli. This database consists of self-reported morbidity data collected at baseline, pertaining to the cohort members with age 60 years or more and analyzed it. Results: The study area's total geriatric population with 60 years of age or more was 4891 (13.5%). In this cohort, the gender ratio was 824 males for every 1000 females, with an average of 0.4 geriatric persons per HH, and 37% of them were illiterates. About 38% of the study population were either widowed or separated. Nearly 65% of the people in the cohort lived in the same house for more than 10 years. Around 10% were pensioners, and almost 36% had to work for their daily living. Only 27% had health insurance or were covered by a health scheme. About 52% (2564) of the individuals reported about their one or more ailments. The total number of different types of ailments reported was 3704. Among them, 402 (11%) were not treated. For the remaining (3302 ailments) one or more treatments were taken, i.e., in all 4705 instances, treatment was taken either consulting a physician or self-treatment. Hypertension (25%) and diabetes mellitus (21%) were the major cause of morbidity among the elderly in this cohort. Conclusion: The above rural baseline survey portrays the commonly reported morbidities and their treatment-seeking behavior of a cohort of elderly people living in the area under Government Primary Health Centre, Nadu Kallur, South India. The findings indicate that the commonly reported morbidity and their treatment-seeking behavior remain unchanged even after rapid strides in India's health-care delivery. This study's data strengthen the need to increase the services for the geriatric population to improve their quality of life.

Validity of asthma disease direction, bother, and risk as self-reported asthma morbidity measures in urban teens

Validity of asthma disease direction, bother, and risk as self-reported asthma morbidity measures in urban teens

Long-term effects of public health insurance on the health of children in Mexico: a retrospective study

On Dec 1, 2006, Mexico's public health-care insurance scheme, Seguro Popular, implemented the Medical Insurance Century XXI (SMSXXI) programme, to provide insurance to children younger than 5 years without social security. SMSXXI aims to increase access to health services, decrease out-of-pocket health expenses (OOPHE), and reduce health inequities. SMSXXI covers uninsured, primarily low-income, populations who might be most at risk of the financial and health consequences of costly medical interventions. We assessed the effects of SMSXXI on health outcomes and financial protection for Mexico's children using multiple nationally representative surveys and administrative data sources spanning 2001-16. The identification of effects relied on detailed hospital-level affiliation data mapping the geographical expansion of SMSXXI's coverage across the country over time. The units of analysis included hospitals, households, and children. Primary outcomes were neonatal and infant mortality, self-reported morbidity (health status, influenza, and diarrhoea), and child's height. Secondary outcomes were OOPHE, hospital discharges, and quality of service provision. Effects controlled for fixed and time-variant confounders using double-difference and triple-difference estimation strategies. Where feasible, we also estimated effects using exogenous variation in programme eligibility rules that limited enrolment in SMSXXI to children born after Dec 1, 2006. SMSXXI was not associated with early (<1 week) neonatal mortality, but was associated with a reduction in late (<28 days) neonatal mortality by 0·139 deaths per 1000 livebirths (95% CI 0·032-0·246), or 7% (2-12) relative to the comparison base of 1·98 deaths per 1000 livebirths in 2006. SMSXI was associated with a reduction in infant mortality from conditions covered by the programme by 0·147 deaths per 1000 livebirths (0·023-0·271), or 5% (1-10) relative to the comparison base of 2·73 deaths per 1000 livebirths. The effects were largest in high baseline mortality areas. Long-term health effects, 8 years after the onset of SMSXXI, were reflected in a 0·434 cm (0·404-0·459) height increase for birth cohorts exposed to the programme and an average effect on height of 0·879 cm (0·821-0·932) for low-income populations. About 3-6 years after SMSXXI started, children reported having better health status and lower incidence of influenza and diarrhoea. The programme led to a 14% reduction (7-28) in OOPHE, primarily from hospital-related expenses. No effects were detected on hospital discharges, suggesting that SMSXXI might not have increased use. SMSXXI promoted access to covered interventions and encouraged better primary care. The programme also promoted increased supply and quality of care by improving human and physical resources sensitive to unmet needs. Increased resource availability and improved supply of health care, rather than increased use, contributed to reduce infant mortality and improved long-term health as proxied by self-reported morbidity and child height. Consistent with the programme's focus on uninsured and low-income populations, the effects on mortality, long-term health status, and OOPHE were concentrated in vulnerable groups. Inter-American Development Bank.

Self-reported maternal morbidity: Results from the community level interventions for pre-eclampsia (CLIP) baseline survey in Sindh, Pakistan.

Community-based data regarding maternal and perinatal morbidity and mortality are scarce in less-developed countries. The aim of the study was to collect representative community-level demographic health information to provide socio-demographic and health outcome data. A retrospective household survey of women of reproductive age (15-49 years) living in two districts of Sindh Province, Pakistan was conducted. Pregnancy incidence over the past 12 months and during each woman's lifetime; maternal, fetal, infant and child deaths in the past 12 months; and rates of hypertension and seizures in pregnancy were calculated. From June to September 2013, 88,410 households were surveyed with 1.2 (±0.6) women of reproductive age per household. 19,584 women (11.9%) reported pregnancies in the preceding 12 months; 83.0% had live births, 3.5% resulting in stillbirths and 13.6% in miscarriages. 34.2% of deliveries occurred at home. Out of all women who reported a pregnancy in past 12 months, 62.1% reported high blood pressure and 11.9% reported seizures complicating her most recent pregnancy. Blood pressure was not measured during survey to confirm hypertension. The perinatal, neonatal and maternal mortality ratios were 64.7/1000, 39/1000 and 166/100,000 livebirths, respectively. This study estimated population-level mortality ratios that can be used for the planning of health interventions in these regions. Self-reported pregnancy hypertension and seizures was inaccurate, reflecting limited community understanding of these disorders. Mortality estimates are comparable to those reported by the World Health Organization for maternal mortality ratio and neonatal mortality rate of 170/100,000 and 36/1000 live births, respectively.

Progress towards universal health coverage in the context of rheumatic diseases in India.

This study aims to measure current situation with regard to access and financial protection towards healthcare for rheumatic diseases (RDs) in India. The first part of this study is quantitative, and uses the data generated by the 71st Round of National Sample Survey 2014, which measured self-reported morbidity, choice of provider and utilization of services and out of pocket expenditure (OOPE) incurred on healthcare services in a sample of 65932 households and 333104 individuals from all across India. The second qualitative part of the study was done in one sample district to understand the barriers to access and financial protection. 3.5% of all hospitalizations in the preceding one year and 9.9% of all ambulatory care in the preceding 15days of this study period were due to RDs. Cost of care for RDs was three times higher in private sector. Cost on medicines comprised the largest share in both sectors. 54% of the households faced catastrophic health expenditure at 10% threshold (CHE-10) and this was nine times higher in private provisioning (OR: 8.8, CI: 6.8-11.4). 24% of the households had to borrow or sell household assets to meet the hospitalization expenditure. Insurance had marginal impact and it did not help in preventing household from facing CHE-10 for the lowermost three economic quintiles. There was significant unmet health care needs and lack of continuity of care of RDs in India. Addressing the gaps in access and financial protection for patients with RDs need greater emphasis in policy as well as implementation, if the country has to achieve Universal Health Coverage.

Changes in levels of morbidity and hospitalisation in Kerala: A district level analysis (1995–2014)

BackgroundThe objective of paper is to provide background information about the morbidity and hospitalization pattern in districts Kerala based on secondary data. MethodsUsing data from three rounds (52nd, 60th, and 71st) of National Sample Survey Organization (NSSO), the trend and pattern of self-reported morbidity were analysed across districts of Kerala. Descriptive analysis was carried out to understand the prevalence of self-reported morbidity variation over a period of two decades (1995–2014) and multivariate analysis was performed to identify the significant determinants of various types of self-reported morbidities and hospitalization. ResultsThe results indicate that while infectious diseases and NCDs increased by six times, CVDs increased by nearly nine times, and disability increased by five times from 1995 to 2014. Age, sex and location emerged as significant determinant of morbidity, with the elderly, female and urban areas depicting higher levels. Levels of morbidity and hospitalization were higher in the Southern part of Kerala than in Northern Kerala. ConclusionsThe emerging pattern of high morbidity in Kerala warrants treatment and constant medical attention in primary and community level, especially among elderly person. There is a need for widened and sustained public health care system with affordable average cost of treatment for NCDs and CVDs at the primary level.