International Journal for Equity in Health最新文献

{"title":"Access to eye health services among older people with disabilities in Karamoja, Uganda: a qualitative exploration of successful care seeking.","authors":"Emma Jolley, Stevens Bechange, Gladys Atto, Lillian Namukasa, Beatrice Guzu, Sandra Flight, Juliet Sentongo, Hannah Kuper, Jane Wilbur","doi":"10.1186/s12939-025-02650-9","DOIUrl":"https://doi.org/10.1186/s12939-025-02650-9","url":null,"abstract":"<p><strong>Background: </strong>Older people with disabilities frequently have high healthcare needs, but little is known about how they access health services or effective strategies to improve their access. The aim of this study was to explore journeys to access eye health services of older people with diverse disabilities in two districts in Karamoja, Uganda, and to identify the resources they drew on to access care. This study provides evidence about how older people with diverse disabilities in Uganda access eye health services and provides insights into how access can be expanded across this group.</p><p><strong>Methods: </strong>We used a positive deviance approach focussed on successful care seekers to identify strategies that may help improve access among this group. We purposively selected 20 older men and women with different disabilities from two districts of Karamoja, who had successfully accessed eye care services. We generated data through in-depth interviews and analysed it using Levesque's conceptual framework of access to health care to situate and describe the findings.</p><p><strong>Results: </strong>Participants narrated their eye health seeking journeys and described a wide range of factors that supported and hindered them across different domains described in the Levesque framework. For example, people's ability to perceive their eye healthcare need could be hindered by the similarity of symptoms with their existing disability, or by understanding them as a normal part of aging. Some individuals were known to healthcare workers because of their disability and were visited regularly to check on their well-being and provide information about services. People with children, spouses and other close social connections got information and advice about eye health that was not available to individuals who were socially isolated due to mobility issues or disability-related stigma.</p><p><strong>Conclusions: </strong>Older people with disabilities in Karamoja face a range of disability-specific challenges in their abilities to perceive, seek, reach and engage with health care. This study adds useful context to the population-based survey conducted in Karamoja in 2023 and demonstrates how the positive deviance approach can be helpful in identifying strategies to improve access where little or no evidence currently exists.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"269"},"PeriodicalIF":4.1,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145292015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare gaps and inequities following hospitalisation for COVID-19 in Brazil's universal healthcare system: a patient-engaged survey of Long COVID healthcare needs, use and barriers.","authors":"Margareth Crisóstomo Portela, Claudia Caminha Escosteguy, Sheyla Maria Lemos Lima, Michelle Bernardino, Bárbara do Nascimento Caldas, Letícia Soares, Maurício Teixeira Leite de Vasconcellos, Mônica Martins, Carla Lourenço Tavares de Andrade, Natalie Perez Baginski, Gabriela Góes, Brenda Sabaine, Marta Cavalcanti, Danielle Furtado, Elisabeth Stelson, Flora Cornish, Emma-Louise Aveling","doi":"10.1186/s12939-025-02635-8","DOIUrl":"https://doi.org/10.1186/s12939-025-02635-8","url":null,"abstract":"<p><strong>Background: </strong>Long COVID (LC) is an infection-associated chronic condition (IACC) that tends to be neglected by healthcare systems. Studies of post-COVID healthcare utilisation find elevated levels of use but have mainly been conducted in high-income settings. In the context of Brazil's universal health system (SUS), our patient-engaged study aimed to map healthcare needs, use, and access barriers related to LC up to 24 months following COVID-19 hospitalisation, in the interest of informing health system planning for an equitable LC response.</p><p><strong>Methods: </strong>A cohort survey included a probabilistic sample of hospitalised COVID-19-confirmed individuals aged ≥ 18, who had been discharged from public hospitals in Rio de Janeiro between December 2020 and November 2022. Socio-demographic and clinical data were collected, including self-reported LC symptoms, self-reported LC, healthcare needs, use, and access barriers.</p><p><strong>Results: </strong>In a sample of 556 participants, corresponding to an estimated population of 11,328 individuals, 50.0% (95%CI 44.3-55.6%) reported healthcare needs in the six months prior, due to new-onset or worsened conditions after COVID-19. Almost 45.0% did not complete high school, while 26.5% lived below the poverty line (~ US$6.85 per day), indicating a high proportion of socially vulnerable individuals. High prevalence of LC symptoms, self-reported LC, and new diagnoses were observed. Healthcare needs were associated with acute disease severity, number of LC symptoms, and new post-COVID diagnoses, including cardiovascular and kidney diseases, and endocrine and musculoskeletal disorders. Significant gaps existed between need and access to services, and part of the access to services involved substantial out-of-pocket expenditure. These gaps were particularly pronounced for specialised medical services, scans/imaging, post-COVID rehabilitation services, and mental healthcare. Despite a universal health system, those with higher monthly incomes (above R$1,500 or ~ US$250) were more likely to have accessed specialised medical care.</p><p><strong>Conclusions: </strong>The SUS is not meeting the high need for LC healthcare, raising concerns about deepening health inequities. In Brazil, as elsewhere, LC joins other IACCs in becoming an invisibilised epidemic, with LC patients, especially those unable to pay for care, neglected amid general healthcare backlogs. A comprehensive pandemic response must include dedicated efforts to surveil and treat the long-term impacts of infection.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"275"},"PeriodicalIF":4.1,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145292045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Equity by design principles for digital health interventions.","authors":"Laura Bitomsky, Marcia Nißen, Tobias Kowatsch","doi":"10.1186/s12939-025-02645-6","DOIUrl":"https://doi.org/10.1186/s12939-025-02645-6","url":null,"abstract":"<p><strong>Background: </strong>Despite significant progress in the past decade, health disparities persist. Digital health interventions (DHIs) offer a transformative opportunity to advance health equity but may also exacerbate the digital divide if equity considerations are not embedded from the onset. While there is broad consensus on the importance of equity-centered design, a critical gap re-mains in the form of actionable guidance for both research and practice. Thus, this study aims to develop equity by design principles for DHIs.</p><p><strong>Methods: </strong>We first synthesized existing scientific knowledge by assessing 42 articles/guidelines and formulated an initial set of 26 actionable, evidence-based design principles for DHIs (July through October 2024). We then conducted three semi-structured expert interviews to refine these principles (November 2024 through January 2025). We finally facilitated end-user workshops with two DHI providers to assess and finalize the design principles with respect to practical relevance and applicability (January through March 2025).</p><p><strong>Results: </strong>We identified 25 equity by design principles, 15 targeting DHIs, and 10 the organizational context in which DHIs are developed. The DHI-specific principles were categorized according to key process stages: needs assessment, design and development, implementation, and evaluation and dissemination. The organizational context principles were grouped into four domains: strategy, people, processes and structures, and partnerships and advocacy. We further challenged the principles real-world applicability, identifying three overarching challenges that hinder their successful implementation.</p><p><strong>Conclusions: </strong>The study underscores the necessity of moving beyond DHI-specific design considerations to address health inequities in digital health. By adopting these design principles, digital health companies can embed equity as a core strategic priority, actively contribute to reducing health disparities, and foster a more inclusive healthcare ecosystem.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"271"},"PeriodicalIF":4.1,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145292018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dollars and dilemmas: lenacapavir's pricing, patents, and the path to affordability.","authors":"Victor Abiola Adepoju, Abdulrakib Abdulrahim","doi":"10.1186/s12939-025-02610-3","DOIUrl":"https://doi.org/10.1186/s12939-025-02610-3","url":null,"abstract":"<p><p>Lenacapavir (Yeztugo), the world's first twice-yearly human immunodeficiency virus (HIV) prevention injection, offers transformative potential but faces a critical challenge: affordability. While its production cost is estimated at just $25 per person annually, projections place its market price at over $25,000 in high-income settings, a 1000-fold markup that could restrict access in low- and middle-income countries (LMICs). Gilead's licensing agreements with six generic manufacturers, covering 120 low-income countries, mark a step forward. However, upper middle-income countries with significant HIV burdens remain excluded. Four of these excluded countries namely Argentina, Brazil, Mexico, and Peru that hosted the pivotal PURPOSE-2 trial, due to ongoing high HIV transmission among sexual and gender minorities (SGM) and their historical underrepresentation in HIV clinical trials. This raises serious concerns about post-trial access. Moreover, the licensing terms limit flexibility, restrict generic sales outside designated territories, and omit price caps. Without broader coverage or concrete affordability commitments, millions may be left behind. Patent filings and the absence of a Medicines Patent Pool (MPP) partnership also amplify structural barriers. To meet global HIV targets, lenacapavir's rollout must be guided by equity, not monopoly. The coming year will be decisive and will determine whether this breakthrough becomes a global game-changer or another symbol of structural health inequity.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"270"},"PeriodicalIF":4.1,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145292051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond disease burden: the urgent need to address maternal health disparities among Indigenous populations in Latin America.","authors":"Edson Serván-Mori, Sergio Meneses-Navarro","doi":"10.1186/s12939-025-02600-5","DOIUrl":"https://doi.org/10.1186/s12939-025-02600-5","url":null,"abstract":"<p><strong>Background: </strong>Despite significant advances in documenting health disparities among Indigenous populations in Latin America, maternal health inequities remain underexplored. Indigenous women in the region face disproportionately high maternal mortality rates, obstetric complications, and inadequate access to maternal health services, exacerbated by systemic barriers such as poverty, geographical isolation, and institutional racism.</p><p><strong>Methods: </strong>This commentary critically examines the recent review, which provides a comprehensive overview of health disparities affecting Indigenous populations but neglects maternal health. By synthesizing evidence from recent studies, the commentary underscores the urgent need to address maternal health disparities as a key area of health system reform.</p><p><strong>Findings: </strong>Emerging evidence highlights that maternal health disparities among Indigenous women are not only pervasive but also indicative of broader structural discrimination embedded in health systems. Discrimination related to ethnicity, gender, and socioeconomic status compounds maternal health inequities, leading to preventable maternal mortality and morbidity. These patterns persist despite the relatively low cost of essential maternal health services, such as antenatal care, skilled birth attendance, and emergency obstetric care.</p><p><strong>Conclusions: </strong>Addressing maternal health disparities among Indigenous populations in Latin America is crucial for advancing UHC. Integrating equity-oriented policies and targeted interventions that dismantle structural discrimination could substantially reduce preventable maternal deaths and morbidity. Future reviews and regional assessments must prioritize maternal health to provide a more comprehensive understanding of health inequities in the region, aligning with global health equity frameworks and UHC goals.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"276"},"PeriodicalIF":4.1,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145292042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of poverty on child malnutrition and health in Lebanon: the need for multisectoral interventions.","authors":"Nicolai Petry, Omar Obeid, James P Wirth, Carla El-Mallah, Mira El Mokdad, Joelle Najjar, Gloria Safadi, Nour El Houda Ezzeddine, Layal Jaafar, Yasmine Ibrahim, Valeria Galetti, Fabian Rohner, Diana Kobayter, Mirella Abi Zeid Daou, Farah Asfahani, Firass Abiad, Amirhossein Yarparvar","doi":"10.1186/s12939-025-02652-7","DOIUrl":"https://doi.org/10.1186/s12939-025-02652-7","url":null,"abstract":"<p><strong>Background/objectives: </strong>Poverty and child malnutrition are deeply interconnected. Socioeconomic disparities limit access to adequate nutrition, healthcare, and education, and can lead to long-term developmental and economic consequences. This study examines the relationship between poverty and nutritional status, micronutrient deficiencies, and recent illnesses in children in Lebanon.</p><p><strong>Methods: </strong>Data was collected as part of a national stratified cross-sectional household-based survey conducted in 2023. A total of 1,594 children aged 0-59 months were included in the analysis. Principal component analysis was used to create a household-level poverty index using indicators related to household-level ownership of durable goods, dwelling characteristics, food security status, and relevant livelihood coping strategies. Bivariate analyses were used to estimate the associations between poverty status and nutritional status indicators (i.e., stunting, underweight, wasting, anemia, iron deficiency, and vitamin A deficiency), multiple nutritional deficiencies, and recent illnesses indicators (i.e., diarrhea, fever, and lower-respiratory infection). Multivariable logistic regressions were used to estimate the association between poverty and nutrition and illness indicators and were further evaluated using Concentration Index Curves (CIC).</p><p><strong>Results: </strong>Multivariate analyses revealed significantly higher odds of stunting (OR: 5.27, 95% CI: 2.60, 10.66), underweight (OR: 5.46, 95% CI: 1.52, 19.56), vitamin A deficiency (OR: 2.65, 95% CI: 1.1, 6.33), diarrhea (OR: 1.99, 95% CI: 1.2, 3.3), fever (OR: 2.39, 95% CI: 1.52, 3.77) and lower respiratory infection (LRI, OR: 4.85, CI: 1.36, 17.26) for children from the poorest households compared to those from the wealthiest households. CIC showed that children from poor households were disproportionally affected by anemia, iron deficiency and wasting. Further, children with lower socioeconomic status were disproportionally affected by multiple deficiencies: 57.1% of children who suffered from 2 deficiencies were located in the lowest two poverty quintiles and 57.6% of those with three or more deficiencies were from the poorest households.</p><p><strong>Conclusion: </strong>Our findings underscore the profound impact of poverty on child malnutrition and infections. To effectively and sustainably address these challenges, a holistic, multisectoral approach is needed, combining targeted nutritional programs, social protection programs, WASH initiatives and educational interventions to break the cycle of poverty and malnutrition.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"267"},"PeriodicalIF":4.1,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145292047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing urban-rural inequality in the primary healthcare system readiness to provide postpartum care for mothers and newborns in Burkina Faso: a Gini index decomposition analysis.","authors":"Kadari Cisse, Danielle Yugbaré Belemsaga, Siaka Lougue, Adama Baguiya, Aristide Romaric Bado, Soumaila Traore, Henri Gautier Ouedraogo, Seni Kouanda","doi":"10.1186/s12939-025-02595-z","DOIUrl":"https://doi.org/10.1186/s12939-025-02595-z","url":null,"abstract":"<p><strong>Background: </strong>Maternal and neonatal mortality have declined significantly in sub-Saharan Africa (SSA). Postpartum care is one of the most neglected components of healthcare. It still drives maternal and neonatal mortality in SSA. Studies have shown a gap between urban and rural areas in terms of maternal and newborn healthcare (MNHC) services, including postpartum care utilization. However, little is known about the gap in postpartum care provision. Our study aimed to assess urban‒rural inequalities in healthcare system preparedness to provide postpartum care for mothers and newborns in Burkina Faso.</p><p><strong>Methods: </strong>We analyzed data from the National Harmonized Health Facilities Assessment (HHFA) survey conducted in all health facilities (HFs) in 2020 in Burkina Faso. Only health facilities of primary level of healthcare were included. The availability of and readiness for postpartum care for mothers and newborns were analyzed using the World Health Organization (WHO) HHFA guidelines. The Gini index was used to assess urban-rural inequalities. It was decomposed in overall Gini index which measures the inequality based on the all the primary healthcare facilities and within-group Gini index which quantifies the inequality within each subgroup (urban and rural areas).</p><p><strong>Results: </strong>Out of 2115 HFs, 387 were in urban areas (18.3%). All postpartum services for mothers and newborns were available in 58.4% of the HFs in urban areas versus 83.9% in rural areas (p < 0.001). The overall readiness score was 58.4% (52.1% in urban areas compared with 59.8% in rural areas; p < 0.001). The urban‒rural differences in readiness were primary driven by difference in staff and guidelines domain (36.3% and 42.3%, p < 0.001) and the medicines and products domain (55.2% and 70.6%, p < 0.001). The differences were also significant for the first point of contact with the healthcare system (health centers: 52.9% and 59.8%, p < 0.001). The overall Gini index was 0.167 (95% CI: [0.161-0.172]), with a higher inequality index for private HFs and hospitals. The within-group Gini index was higher in urban areas (0.204 [95% CI: 0.190-0.219]) than rural areas (0.145 [95% CI: 0.139-0.150]).</p><p><strong>Conclusion: </strong>Our findings suggest an overall lower readiness score for the postpartum care, with a low overall and within urban and rural areas inequality. Even low, reducing these inequalities might help to provide high-quality postpartum care for all mothers and newborns regardless of their place of residence.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"274"},"PeriodicalIF":4.1,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145292102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A scoping review of equity toolkits for international academic partnerships.","authors":"Chelsea E Modlin, Prakriti Shrestha, Larry W Chang, Joseph Ali, Nelson K Sewankambo, Chizoba Wonodi","doi":"10.1186/s12939-025-02632-x","DOIUrl":"https://doi.org/10.1186/s12939-025-02632-x","url":null,"abstract":"<p><strong>Introduction: </strong>When there are frank asymmetries in power, resources, and capacity efforts to advance academic collaboration are essential for the conduct of ethical partnership-based health research, education, and policymaking. Numerous toolkits are available that provide structured templates for academic partnerships and other key stakeholders to systematically evaluate and reflect on how their practices enhance or inhibit equity. However, there is no comparative analysis available to examine similarities and differences between the multitude of toolkits available.</p><p><strong>Method: </strong>We conducted a comprehensive scoping review of international partnership equity toolkits across the domains of global health research, education, and practice in four academic databases (PubMed, Scopus, Web of Science, and WHO Regional Indexes) and grey literature. The search took place June through August 2023. A primary search used broad keyword combinations followed by a secondary search of toolkit titles identified during the primary search. PRISMA extension for scoping reviews was followed. Key themes, motivations, development processes, application practices, and uses of these toolkits were examined by a combination of (1) templated extraction of data and (2) applying an inductive and iterative coding approach by two independent reviewers.</p><p><strong>Results: </strong>Within the academic databases, 7580 abstracts were screened (7580 primary, 198 secondary), 120 documents underwent full-text review (112 primary, 8 secondary) and 27 articles (26 primary, 1 secondary) met inclusion criteria. Within the grey literature, 104 articles and webpages (40 primary, 64 secondary) met inclusion criteria. Seventeen toolkits were identified. The majority were geared toward evaluating research (n = 15) rather than education (n = 2) or practice (n = 0) partnerships. Toolkits covered a broad range of objectives, development methods, and target audiences. Twenty-three countries were represented in the creation of the toolkits; however, less than half (8/17, 47%) of toolkits had representation from low- or low/middle-income countries. We identified six broad categories within the toolkits - oversight, partnership dynamics, ethical foundation, contextual factors, partnership procedures and activities, and capacity. Under these, themes such as stakeholder engagement, communication, partnership outputs, clarification of roles and responsibilities, funding, and management of data or other products generated by the partnership were common.</p><p><strong>Conclusion: </strong>There was variability in the development, intended audience, and application methods of the toolkits, yet there was also substantial thematic content overlap. Limited information on the application or use of toolkits is available. To date, there is no data on whether these toolkits resulted in equity-oriented changes in partnership practices or policy.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"268"},"PeriodicalIF":4.1,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145292012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of a pilot urban primary healthcare model on the use of medically trained healthcare providers among the low-income slum populations in Bangladesh: findings from an implementation research study.","authors":"Md Golam Rabbani, Zakir Hossain, Khadija Islam Tisha, Kamrun Nahar, Zillur Rahman Sakin, Towhida Nasrin, Mohammad Wahid Ahmed, Md Zahid Hasan, Chandrasegarar Soloman, Margub Aref Jahangir, Maya Vandenent, Shehrin Shaila Mahmood","doi":"10.1186/s12939-025-02622-z","DOIUrl":"https://doi.org/10.1186/s12939-025-02622-z","url":null,"abstract":"<p><strong>Background: </strong>Delivering quality primary healthcare to the urban population has been challenging in many developing countries including Bangladesh. With a fragmented and pluralistic urban health system, the country experiences major hurdles in the provision of primary healthcare to its urban dwellers. Since 2021, an urban primary healthcare model called 'Aalo Clinic' is being piloted to serve the low-income urban population in Bangladesh. With an aim to ensure universal health coverage for the urban population, the model delivers an essential package of health services. We aimed to assess the implementation effect of this pilot model on the utilization of healthcare from medically trained providers (MTPs) for the management of acute illness.</p><p><strong>Methods: </strong>Following a cross-sectional study design, an implementation research study was conducted between October 2021 and August 2023 in the Korail, Mirpur, Shyampur, Dhalpur, and Tongi-Ershadnagar slums. Cross-sectional household surveys were conducted at baseline and end-line, involving over 2000 households in each round. Descriptive analysis and Chi-squared test were performed to assess the changes in healthcare utilization from MTPs, and logistic regression models were applied to assess the effectiveness of the model on healthcare utilization from MTPs while controlling for other covariates.</p><p><strong>Results: </strong>The utilization of healthcare from MTPs was significantly higher in the end-line (9.81% from Aalo Clinic and 18.6% from non-Aalo Clinic MTPs) compared to the baseline (0.64% from Aalo Clinic and 17.68% from non-Aalo Clinic MTPs). Healthcare utilization from local drug stores declined from 80.56% at baseline to 67.19% at end-line. Multivariate logistic regression showed respondents were 12.43 times more likely (95% CI: 7.49-20.63) to use Aalo Clinic services at end-line, indicating increased uptake of medically trained providers following the model's implementation.</p><p><strong>Conclusions: </strong>The Aalo Clinic Model was effective in influencing healthcare-seeking pattern of the slum populations and enhancing the utilization of qualified care from MTPs. The study supports replicating the model within existing healthcare structures and scaling it nationwide to advance universal health coverage in urban Bangladesh, contingent on sustained government funding for its operations.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"273"},"PeriodicalIF":4.1,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145292040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethnic inequalities and contraception in Latin America and the Caribbean: a scoping review.","authors":"Paulina Ríos-Quituizaca, Jesus Endara-Mina, Sergio Ramos-Avasola, Alisson Yánez, Nancy Armenta-Paulino","doi":"10.1186/s12939-025-02501-7","DOIUrl":"https://doi.org/10.1186/s12939-025-02501-7","url":null,"abstract":"<p><strong>Background: </strong>One of the Sustainable Development Goals (SDGs) is SDG 3.7. Ensuring universal access to sexual and reproductive health. The COVID-19 pandemic exacerbated pre-existing inequalities, disproportionately impacting ethnic groups in Latin America and the Caribbean (LAC). This review examines 23 years of evidence on contraceptive inequalities among these populations.</p><p><strong>Methods: </strong>A comprehensive literature review was conducted covering the period from 2000 to 2023 across seven databases. A combination of natural language and MESH/DECS terms was used, focusing on ethnicity and contraception in LAC countries. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Extension for Scoping Reviews (PRISMA-ScR), 856 studies were identified. After title and abstract screening, 92 full texts were reviewed, and 33 studies were included that analyzed or compared contraceptive coverage based on ethnicity.</p><p><strong>Results: </strong>The countries with the highest output on this topic are Guatemala, Mexico, and Ecuador. More than half (22) relied on national representative surveys, with most focusing on women of reproductive age, while only five included adolescents. Eight studies analyzed Afro-descendant populations, and 27 studies included indigenous populations. Although some studies reported increases in contraceptive coverage over time, 85% identified lower usage rates or probabilities among ethnic minorities, with persistent gaps.</p><p><strong>Conclusion: </strong>This review highlights contraceptive coverage gaps related to ethnicity in LAC, revealing enduring inequalities. As post-pandemic efforts aim to reduce disparities, countries with significant indigenous populations must prioritize evidence generation. Further research is needed in countries showing progress and among subgroups, such as adolescents or intra-country ethnic groups, to understand underlying causes and enhance contraceptive Access.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"272"},"PeriodicalIF":4.1,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145292105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}