Status and determinants of health services utilization among elderly migrants in China

Background:The household registration system in China places migrants in a vulnerable status regarding access to local public services,including limited access to health services.Most studies on migrants’health services utilization targeted on working-age migrants,and there has been a paucity of studies conducted among elderly migrants.This study aims to investigate the status of health services utilization and its influential factors among elderly migrants.Methods:Data(13,043 participants,52.4%male,mean age 66.22±6.20)were derived from the 2015 Migrant Dynamics Monitoring Survey.The outcome variable in the study was health services utilization,consisting of doctor visits,hospitalization and local inpatient care.The Behavioral Model of Health Service Use was applied to categorize the influential factors into three components,including predisposing,enabling and need factors.Multivariate logistic regression analysis was used to investigate the influential factors of the three components of health services utilization.Results:Of the total sample,45.5%would visit a doctor when they were ill,81.8%would prefer to be hospitalized when recommended by doctors,and 71.6%(those who were hospitalized)would choose to receive local inpatient care rather than going back to their hometown.Age,marital status,household income,years of residence,migration range,reasons for migration,size of friend network,health insurance type,local health insurance status and chronic disease status were significantly associated with health services utilization.Conclusion:A low level of local health services utilization was observed among elderly migrants.Enabling factors played important roles in promoting health services utilization among elderly migrants.Policy and decision makers may consider improving the capability for elderly migrants to access health services,such as increasing income and providing local health insurance.

Health Services Utilization and Health Status of Insured versus Uninsured Nigerian Children with Sickle Cell Disease

Introduction: Nigeria accounts for 150,000 infants born with the Sickle Cell Disease (SCD) every year. Children with SCD are affected by the deleterious effect of user fees which reduces affordability and utilization of health services. Evidences supported that institutionalized health insurance increases intensity of utilization. Methodology: The study was conducted at AKTH, Kano, and north-western, Nigeria. The study was retrospective comparative cross-sectional study. 100 patients were enrolled, 50 for each arm. Paediatric SCD clinic outpatients’ records and a specialty designed form containing the variables of interest were used. Data were analysed using Minitab 16. Proportions, percentages, tables, charts and chi squared test were used to compare the two groups. Result: The study found no association between the two groups in the likelihood of being insured based on age (χ2 = 1.478), gender (χ2 = 0.224) and dwellings (χ2 = 0.062). On health services utilization and insurance status, the study revealed that follow up clinic visits, unscheduled clinic visits and emergency room visits were more likely among the insured group compared to the uninsured group. While the health status and insurance status of the two groups over 12 months period showed a significant association with the insured more likely to have improved health status compared to uninsured (χ2 = 28.019, p = 0.0001). Similarly, health status and health services utilization were significantly associated with insurance status (χ2 = 12.191, p = 0.002). Conclusion: The insurance status of children with SCD is associated with their health services utilization and health status. However, age, gender and dwellings were not associated with insurance status of children with SCD. Therefore, when expanding insurance coverage (NHIS) among children with SCD considerations have to be given to increase health services utilization and resultant improvement in health status as these have the potential of reducing morbidity and mortality among children with SCD.

Utilization and Felt Need of Oral Health Care Services among Women in Chennai-Descriptive Cross-Sectional Study

Introduction： Oral health is window to overall health. There is a greatest burden of oral diseases on the underprivileged group. In developing countries like India the affordability to oral health care services is very limited thereby leading to poor oral wellness ＆ millions suffer intractable toothache and poor quality of living and end up with few dentition. Objective： To assess the utilization level of oral health services among women in Chennai. Material and methods： A cross-sectional questionnaire survey was conducted among 200 women in Teynampet Zone in Chennai District, Tamil Nadu. The women were chosen by simple random sampling and were interviewed using the semi-stzuctured questionnaire to assess their utilization level during the period of June to July 2016. The data were analyzed by SPSS Version 22. Result： Descriptive statistics and multivariate analysis--MANOVA were used to analyze the utilization level. Majority of the respondents were in the age group of 30-35years, most of the respondents had oral problem and almost everyone had visited dentist at least once within 3 years. Multivariate analysis--MANOVA also showed that the utilization levels were directly influenced by accessibility, availability and affordability and showed statistical significance （p value 〈 0.05） and also from MANOVA analysis it showed that the respondents who had poor oral hygiene did not utilize oral health care services as the affordability was a problem although accessibility and availability was adequate. Conclusion： Our fmdings suggest that people who had oral problem had visited dentist in previous 3 years and most of the people who visited dentist had a good oral hygiene. Cost of the treatment affected the dental visits. They believed that visiting the dentist is necessary only for pain relief.

Improving Demand for Health Services with the Involvement of Community Health Workers: A Case Study of Community Dynamics at Mosango Rural Health Zone in the Democratic Republic of Congo

Introduction: DRC is one of Sub-Saharan Africa country with high infant and maternal mortality. The major problem is the underuse of health services because of inaccessibility on all fronts and also the population under-information to the health and development problems. Community participation is one of the basic requirements and basic principles of the Primary Health Care to solve this problem. That is why we choose Mosango RHZ to assess the improvement of demand for health services with the involvement of community health workers. Methods: We conduct a cross-sectional study carried out in Mosango RHZ in 2019. The study combined a mixed method (quantitative and qualitative) based on the realist evaluation approach which takes into account the Context-Mechanisms-Effects explained in the conceptual framework model. Results: Four predictive factors determine the improvement of health indicators with the involvement of CHWS in activities of the Mosango RHZ: Having attended school (p = 0.000;OR = 0.150);Having sufficient theoretical knowledge on malaria, diarrhoea, pneumonia, malnutrition, availability of inputs to treat these diseases (p = 0.004;OR = 0.192);Having taken the training as CHWS and Having undergone more than one training as CHW (p = 0.013;OR = 0.074). This result corroborated with other studies carried in low- and middle-income countries like DRC. Conclusion: The involvement of CHWs on improving demand for health services is effective in Mosango RHZ. The improvement of health service indicators and the effectiveness of this community intervention were conditioned by capacity building of the CHWs, the availability of inputs and the involvement of the community in the activities of the health zone through the Community Action Cells.

Impact of the New Cooperative Medical Scheme on Health Care Service Utilization in Rural China

Using the 2000, 2004, and 2006 CHNS longitudinal survey data and econometric methods （random-effect probit regression model and DID methods）, this study conducted an empirical analysis to estimate the impact of NCMS. The major conclusions are as follows. First, predisposing factors, enabling factors, health care need factors, and lifestyle factors affect health care utilization. Second, results using DID methods indicate that NCMS did not affect health care service utilization （outpatient and inpatient） of individuals when ill, but it might increase the possibility of getting a health examination. Third, there is no difference in health care service utilization （both outpatient and inpatient） between the NCMS enrollment group and the non-enrollment group in both working age group （15-59） and the elderly group （60 and over）. Therefore, it can be said that NCMS did not affect the health care utilization in both the group. However, NCMS positively affects disease prevention behavior （visiting the hospital to receive a health examination） in the working age group, but the effect did not appear in the elderly group.

Barriers and facilitators to healthcare facility utilization by non-Ebola patients during the 2018-2020 Ebola outbreak in the Democratic Republic of Congo

Background An Ebola Virus Disease(EVD)outbreak occurred in North Kivu between 2018 and 2020.This eastern province of the Democratic Republic of Congo was also grappling with insecurity caused by several armed groups.This study aimed to explore the barriers and facilitators to utilizing Healthcare Facilities(HCFs)by non-Ebola patients during the crisis.Methods A qualitative case study was conducted in Beni and Butembo with 24 relatives of 15 deceased non-EVD patients,47 key informants from healthcare workers(HCWs),as well as community leaders.Semi-structured interviews were conducted to explore three key areas:(i)the participants’illness history,care pathway,care,and social support;(ii)their perceptions of how EVD affected the care outcome;and(iii)their opinions on the preparedness,supply,use,and quality of healthcare before and during the outbreak.All interviews were recorded,transcribed verbatim,and the-matically analysed using Atlas-ti 8.0.Results Nine of the 15 deaths were female and their ages ranged from 7 to 79 years.The causes of death were non-communicable(13)or infectious(2)diseases.Conspiracy theories,failure to establish security,and the concept of the"Ebola business"were associated with misinformation and lower levels of trust in government and HCFs.The negative perceptions,fear of being identified as an Ebola case,apprehension about the triage unit,and inadequacy of personal protective equipment resulted in a preference for private or informal HCFs.For half of the deceased’s relatives,the Ebola outbreak hastened their death.Conversely,community involvement,employing familiar,neutral,and credible HCWs,and implementing a free care policy increased the number of visits.These results were observable despite a lack of funds,overstretched HCWs,and long waiting time.Conclusions Our findings can inform policies before and during future outbreaks to enhance the resilience of rou-tine HCFs by maintaining dialogue between HCWs and patients,and rebuilding confidence in HCFs.Quantitative studies including context analysis are essential to identify the determinants of care-seeking during such a crisis.

The Effect of PHC Digital Innovations and Performance-Based Incentives on Uptake of Maternal and Child Health Services in Selected Pilot Sites in Kenya

Background: While global efforts have led to a decline in maternal and neonatal mortality, Sub-Saharan Africa continues to face disproportionately high rates, remaining far above the Sustainable Development Goal (SDG) targets. In Kenya, as the 2030 SDG deadline approaches, the gap in maternal, neonatal, and child health services remains significant. Addressing these challenges is critical to improving Maternal, Neonatal, and Child Health (MNCH) outcomes. Objective: This study explores how integration of digital health innovations into the MNCH chain of service delivery affects the quality of MNCH care within the selected PHC settings in Kajiado, Kisii and Migori Counties in Kenya. Methodology: This Quasi-experimental study was conducted 1-year post-intervention targeting a total of 482 pregnant women from intervention and control sites in Kisii, Kajiado and Migori Counties, Kenya. Data was analysed using Chi-Square test comparing frequencies between intervention and control groups when both variables are categorical. Results: Pre-intervention data revealed an increase in first ANC coverage within first trimester, from 167 to 278 post-intervention (p Linda mama social health insurance registrations increased from 1008 to 1135. At the intervention sites, 938 pregnant women got screened by midwives using portable mobile Obstetric Point-of-Care Ultrasound (OPOCUS) technology compared to the 27 cases that accessed ultrasound services in the noncontiguous control sites. The pilot sites midwives earned themselves an incentive income totaling Ksh 400,000 while the Community Health Promoters (CHPs) who created demand for OPOCUS earned an incentive income totaling Ksh 327,195 from their IGAs that were project supported. There was a significant increase in mobile health application usage and e-resources access for health information in the intervention group (p services and improved adherence to referrals. Conclusion: The success of digital health interventions in improving health-seeking behaviour, knowledge, and service uptake highlights the potential of such innovations to strengthen health systems and achieve universal health coverage. We recommend the intervention for a scale-up in other PHC settings in Kenya.

Equity of health service utilization of urban residents： data from a western Chinese city

Background Getting medical treatment is still difficult and expensive in western China. Improving the equity of basic health services is one of the tasks of the new healthcare reform in China. This study aimed to analyze the parallel and vertical equity of health service utilization of urban residents and then find its influencing factors. Methods In August 2011, a household survey was conducted at 18 communities of Baoji City by multi-stage stratified random sampling. Based on the survey data, we calculated a concentration index of health service utilization for different income residents and a difference index of different ages. We then investigated the influencing factors of health service utilization by employing the Logistic regression model and log-linear regression model. Results The two-week morbidity rate of sampled residents was 19.43%, the morbidity rate of chronic diseases was 21.68%, and the required hospitalization rate after medical diagnosis was 11.36%. Among out-patient service utilization, the two-week out-patient rate, number of two-week out-patients, and out-patient expense had good parallel and vertical equity, while out-patient compensation expense had poor parallel and vertical equity. The inpatient service utilization, hospitalization rate, number of inpatients, days stayed in the hospital, and inpatient expense had good parallel equity, while inpatient compensation expense had poor parallel equity. While the hospitalization rate and number of inpatients had vertical equity, the days stayed in hospital, inpatient expense, and inpatient compensation expense had vertical inequity. Conclusions Urban residents＇ health was at a low level and there was not good health service utilization. There existed rather poor equity of out-patient compensation expense. The equity of inpatient service utilization was quite poor. Income difference and the type of medical insurance had great effects on the equity of health service utilization.

The gender gap in outpatient care for non-communicable diseases in Mexico between 2006 and 2022

Background Equitable health service utilization is key to health systems’optimal performance and universal health coverage.The evidence shows that men and women use health services differently.However,current analyses have failed to explore these differences in depth and investigate how such gender disparities vary by service type.This study examined the gender gap in the use of outpatient health services by Mexican adults with non-communicable diseases(NCDs)from 2006 to 2022.Methods A cross-sectional population-based analysis of data drawn from National Health and Nutrition Surveys of 2006,2011–12,2020,2021,and 2022 was performed.Information was gathered from 300,878 Mexican adults aged 20 years and older who either had some form of public health insurance or were uninsured.We assessed the use of outpatient health services provided by qualified personnel for adults who reported having experienced an NCD and seeking outpatient care in the 2 weeks before the survey.Outpatient service utilization was disaggregated into four categories:non-use,use of public health services from providers not corresponding to the user’s health insurance,use of public health services from providers not corresponding to the user’s health insurance,and use of private services.This study reported the mean percentages(with 95%confidence intervals[95%CIs])for each sociodemographic covariate associated with service utilization,disaggregated by gender.The percentages were reported for each survey year,the entire study period,the types of service use,and the reasons for non-use,according to the type of health problem.The gender gap in health service utilization was calculated using predictive margins by gender,type of disease,and survey year,and adjusted through a multinomial logistic regression model.Results Overall,we found that women were less likely to fall within the“non-use”category than men dur-ing the entire study period(21.8%vs.27.8%,P<0.001).However,when taking into account the estimated gender gap measured by incremental probability and comparing health needs caused by NCDs against other conditions,com-pared with women,men had a 7.4%lower incremental likelihood of falling within the non-use category(P<0.001),were 10.8%more likely to use services from providers corresponding to their health insurance(P<0.001),and showed a 12%lower incremental probability of using private services(P<0.001).Except for the gap in private service utiliza-tion,which tended to shrink,the others remained stable throughout the period analyzed.Conclusion Over 16 years of outpatient service utilization by Mexican adults requiring care for NCDs has been char-acterized by the existence of gender inequalities.Women are more likely either not to receive care or resort to using private outpatient services,often resulting in catastrophic out-of-pocket expenses for them and their families.Such inequalities are exacerbated by the segmented structure of the Mexican health system,which provides health insur-ance conditional on formal employment participation.These findings should be considered as a key factor in reorient-ing NCD health policies and programs from a gender perspective.

Elimination of schistosomiasis requires multifactorial diagnostics: evidence from high- and low-prevalence areas in the Nile Delta, Egypt

Background:Schistosomiasis is one of the neglected tropical diseases(NTDs)selected for worldwide elimination in the near future.Egypt has made strong progress against its two endemic species of Schistosoma mansoni and S.haematobium.The former is prevalent in the Nile Delta with the latter dominating in the Nile south of Cairo.Innovative efforts are needed to reach the goal as further reduction of the prevalence has stalled due to ongoing transmission.In this study we aimed to explore the difference between low and high prevalence villages with regard to knowledge attitude and practice about schistosomiasis,utilization of health services,infection and transmission indices.Methods:A hybrid cross-sectional longitudinal study was conducted with three annual follow-ups conducted during 1994-1996.We used a representative systematic random sampling technique investigating 993 individuals from the high prevalence village and 614 from the low prevalence village.Data were analyzed using SPSS,comparing proportions with the Chi square test and means with the Student t test,and ANOVA.Results:Compliance of faecal sampling and chemotherapy was above 70%in both villages over the whole study period.Selective praziquantel treatment resulted in a significant reduction of prevalence and intensity of infection in both villages,dropping from 35.8%prevalence to 20.6%,in the low-prevalence village,and from 69.5 to 45.9%in the high-prevalence one.Intensity of infection at the base line was 30 eggs per gram(EPG)of stool in the low-prevalence village versus 105 EPG in the high-prevalence village.However,after the second round,reinfection rebounded by 22%in the high-prevalence village,while a slight improvement of the infection indices was demonstrated in the low-prevalence one.The level of knowledge was modest in both villages:people knew about self-protection and treatment,but not much about the role of human excreta for schistosomiasis transmission.While all participants maintained that using the water from the canals was inevitable,inhabitants in the high-prevalence village showed significantly lower scores reflecting higher water contact compared to the low-prevalence one.Many of them(67%)did not utilize the health centre at all compared to 26%of the people in the low-prevalence village.Interestingly,private clinics were seen as the primary source of health care by both villages,but more frequently so in the high-prevalence village(used by 87.2%of the inhabitants)compared to the low-prevalence one(59.8%).Conclusions:Even if chemotherapy works well as reflected by the observed downregulation of intensity of infection in both villages,reinfection continued due to difficulties to avoid water contact.Efforts must be made to make people understand the role of human excreta for transmission.There is also a need to make people better trust the medical services available.