Community-Based Health Insurance： An Evolutionary Approach to Achieving Universal Coverage in Low-Income Countries

The WHO World Health Assembly, and the most recent WHO World Health Report, have called for all health systems to move toward universal coverage. However, low-income countries have made little progress in this respect. We use existing evidence to describe the evolution of community-based health insurance in low-income countries through the three stages of basic model, enhanced model, and nationwide model. We have concluded that community-based health insurance development is a potential strategy to meet the urgent need for health financing in low-income countries. With careful planning and implementation, it is possible to adopt such evolutionary approach to achieve universal coverage by extending tax-based financing/social insurance characteristics to community-based health insurance schemes.

Associations of early-life factors and indoor environmental exposure with asthma among children:a case-control study in Chongqing,China

Background Childhood asthma has substantial effects on children’s health.It is important to identify influencing factors in early life in the development of childhood asthma.We aim to evaluate the effects of early-life factors and indoor environmental exposure on childhood asthma in Chongqing,China.Method We designed a case-control study to enrol children with asthma aged 3 to<14 years old and controls in Chongqing,China.The“Children’s Early Life and Indoor Environment Survey”was used to collect the early-life factors and indoor environmental exposure of foetuses in utero and of infants during the first 3 years of life.A multivariate logistic regression model was used to evaluate the association between independent variables and childhood asthma and the interaction of early-life factors and environmental exposure.Results A total of 160 asthma cases and 247 controls were included in this study.The mean ages of the cases and controls were 5.53±1.88 and 5.72±2.34 years,respectively(P=0.192).Early-life factors and indoor environmental exposure were independently associated with childhood asthma.Infectious diseases of the respiratory system in children under 3 years old[adjusted odds ratio(OR)=5.76,95%confidence interval(CI)2.49-13.30],bedroom air conditioner use(adjusted OR=4.61,95%CI 1.45-14.64),and bedroom dampness/mould(adjusted OR=2.98,95%CI 1.54-5.75)ranked as the three most significant exposures associated with the risk of childhood asthma.Other factors associated with an increased risk of childhood asthma included second-hand smoke exposure in early life(adjusted OR=1.93,95%CI 1.24-3.00),neonatal pneumonia(adjusted OR=1.90,95%CI 1.05-3.42)and maternal allergic diseases during pregnancy(adjusted OR=2.13,95%CI 1.10-4.10).The interaction effects of child second-hand smoke exposure with other covariates were not found to be statistically significant.Conclusions Early-life factors and indoor environmental exposure are closely related to childhood asthma in Chongqing,China.Further interventions and management in the early life of children should be considered to prevent and control childhood asthma in Chongqing and similar cities.

Increasing prevalence and influencing factors of childhood asthma: a cross-sectional study in Shanghai, China

Background Asthma has been a global problem,especially in children.We aim to evaluate the contemporary prevalence and influencing factors of asthma among children aged 3–7 years in Shanghai,China.Methods A random sample of preschool children was included in this study.The International Study of Asthma and Allergies in Childhood questionnaire was adopted to assess the childhood asthma.Multivariable logistic regression models were used to evaluate the associations between independent variables and childhood asthma.Results Of 6389 preschool children who were invited to take part in this study,6163(response rate:96.5%)completed the questionnaire and were included in the analysis.The overall prevalence of asthma was 14.6%which increased more than six folds from 2.1%in 1990.Being male,younger age,preterm delivery,being born in spring or autumn,being delivered by elective cesarean section without indication,miscarriage,high socioeconomic status,having allergy history,and exposure to passive smoking,latex paint,and dust were potential risk factors for childhood asthma.Spending more time outdoors(>30 min/day),having indoor plants,and cleaning rooms more frequently were potential protective factors.Conclusions The prevalence of childhood asthma in Shanghai has increased dramatically during the past three decades.The findings about risk and protective factors of childhood asthma could be used to develop appropriate strategies to prevent and control childhood asthma in Shanghai and in other similar metropolitan cities.