International Journal for Equity in Health最新文献

{"title":"Communication dynamics in the care of preterm infants: a multi-level qualitative study from a high-burden district in Indonesia.","authors":"Mira Miraturrofi'ah, Qorinah Estiningtyas Sakilah Adnani, Dwi Agustian, Lisa McKenna, Dany Hilmanto","doi":"10.1186/s12939-026-02914-y","DOIUrl":"10.1186/s12939-026-02914-y","url":null,"abstract":"<p><strong>Background: </strong>Preterm birth remains a major contributor to infant mortality and long-term morbidity globally, with disproportionate burdens in low- and middle-income countries, including Indonesia. Global maternal and newborn health agendas increasingly promote continuity of care, family-centred approaches, and behaviour-informed communication across levels of service delivery. However, how globally endorsed principles are translated into routine communication during hospital-to-home transitions is shaped by local health systems, provider capacity, and household contexts, and remains insufficiently understood in high-burden settings. This study aimed to map communication dynamics in preterm infant care in a high-burden district in Indonesia using a multi-level qualitative approach.</p><p><strong>Methods: </strong>This exploratory multi-level qualitative study applied behavioural and communication frameworks to examine communication processes across clinical, household, and systemic levels in Bandung District, a high-burden area in West Java, involving referral hospitals and community health facilities. Purposive sampling included 59 participants, comprising mothers of preterm infants, hospital and primary health care providers, district and provincial health authorities, professional groups, and the national health insurance administrators. Data were gathered via in-depth interviews, focus group discussions, participant observations, and document analysis. Reflexive Thematic Analysis was conducted with NVivo 15, incorporating iterative coding, memoing, cluster analysis, and theme refinement. Rigour was maintained through triangulation, audit trails, and peer debriefing.</p><p><strong>Result: </strong>Four interconnected themes encapsulated the communication landscape: Communication Practices (channels, techniques, timing, message content, interprofessional handover); Household and Community Support (health literacy, practical skills, beliefs, motivation/self-efficacy, emotional coping, family and peer support); Worker Capacity and Resources (training deficiencies, workload/time constraints, educational materials, supervision, standard operating procedures); and System, Policy, and Access (policy, monitoring, financing, interagency coordination, referral pathways, infrastructure, geographic/economic accessibility). These themes collectively demonstrate how fragmented practices, inconsistent provider capability, and varying family preparedness produce inequitable continuity of care, hindering effective transitions from hospital to home.</p><p><strong>Conclusion: </strong>Communication in preterm infant care is influenced by interrelated interpersonal, household, workforce, and systemic factors. Strengthening continuity of care requires integrated, multi-tiered strategies that align communication practices across levels of service delivery to reduce inequities in post-discharge care and prevent avoidable neonatal risks in high-burd","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13459254/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148175686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Climate change, financial development, and health outcomes in sub Saharan Africa.","authors":"Lordina Amoah, Daniel Ofori-Sasu, John Amoah, Ebenezer Bugri Anarfo, Joshua Titus-Kwaku","doi":"10.1186/s12939-026-02894-z","DOIUrl":"10.1186/s12939-026-02894-z","url":null,"abstract":"<p><p>This study examines the relationship between climate change and health outcomes in Africa. It further explores the role of financial development in moderating the relationship between climate change and health outcomes. It applies the dynamic system of the generalized method of moments estimation to a panel dataset of 43 African countries over the period 2000-2023. The key findings confirm that higher CO₂ emissions significantly reduce life expectancy and increase mortality rates, whereas financial development has a positive effect on life expectancy but negatively affects mortality rates, indicating that an increase in financial development mitigates the negative impact of carbon emissions on health outcomes. This paper provides empirical evidence of the fundamental role of financial development in the nexus between climate change and health outcomes. While governments are encouraged to increase investments in climate-resilient healthcare infrastructure, clean water systems, sustainable energy, and disease monitoring, financial sector players are advised to prioritize the creation of innovative financial tools related to climate and health, such as climate risk insurance, weather-indexed insurance, and health insurance, which can help reduce the impact of health problems caused by climate change on people, governments and the economy as a whole.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13459213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148175719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social determinants of mental health in Germany: a systematic scoping review mapping the landscape of researched determinants, outcome measures, and explanatory concepts.","authors":"Martin S Lehe, Pauline Reiß, Vanessa C Jürgensen, Georg Halbeisen, Georgios Paslakis","doi":"10.1186/s12939-026-02877-0","DOIUrl":"10.1186/s12939-026-02877-0","url":null,"abstract":"<p><strong>Introduction: </strong>Social determinants play a critical role in shaping mental health (MH) outcomes. The World Health Organization emphasizes the importance of addressing such factors to reduce MH disparities. This scoping review aims to assess the landscape of research on social determinants of MH in Germany, focusing on frequently studied social determinants, MH outcomes, and underlying theoretical frameworks and explanatory mechanisms, particularly the consideration of the framework of intersectionality.</p><p><strong>Methods: </strong>Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines, a systematic literature search was conducted in PubMed and Web of Science. Studies that specifically addressed social determinants of MH in Germany were targeted, and data were charted to map key research trends.</p><p><strong>Results: </strong>A total of 73 studies were included in the data analysis and synthesis, and outcomes were grouped into eight social determinants of health domains. The most frequently examined domains were demographics (in 96.0% of included studies), interpersonal/community/cultural influences (89.3%), economic stability (72.0%), and education (57.3%). Less frequently addressed domains included neighborhood and built environment (25.3%), environmental events (16.0%), other health-related determinants (16.0%), and healthcare access and quality (5.3%). We observed substantial heterogeneity within and between domains. MH outcomes were more often studied in terms of mental illness than positively defined MH, with depression and anxiety being the most frequently assessed outcomes. Theoretical frameworks such as the biopsychosocial model, social-ecological perspectives, and resilience theory were commonly applied, while intersectionality was rarely explicitly analyzed.</p><p><strong>Discussion: </strong>This scoping review delineates the research landscape on social determinants of MH in Germany. The findings point towards a predominant focus on individual-level determinants, with comparatively limited attention to systemic and structural factors. Moreover, an emphasis on mental illness rather than MH, alongside substantial heterogeneity in measured constructs, may constrain the understanding of MH disparities. These gaps highlight the need for more comprehensive, intersectional approaches that account for the diversity of individuals, contexts, and outcomes.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13242142/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148163146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Alright, that's enough now, because it's not fair\": A qualitative study on realities of intersectional inequality among adolescents from Bogotá, Colombia.","authors":"Johanna Carolina Sánchez-Castro, Nelly Esther Caliz Romero, Laura Pilz González, Katherina Heinrichs, Christiane Stock","doi":"10.1186/s12939-026-02902-2","DOIUrl":"10.1186/s12939-026-02902-2","url":null,"abstract":"<p><strong>Background: </strong>Colombia is one of the most unequal countries in Latin America, with Bogotá exemplifying the urban concentration of structural and intersectional inequalities. Adolescents living in marginalised areas of the city face vulnerabilities due to overlapping systems of oppression, including classism, racism, sexism, and xenophobia. The COVID-19 pandemic further exacerbated these disparities, heightening socioeconomic stressors and influencing developmental processes. This study aimed to explore how adolescents in two socioeconomically disadvantaged neighbourhoods in Bogotá experience and engage with intersectional inequality in their everyday lives, particularly in the context of the pandemic.</p><p><strong>Methods: </strong>The study employed a qualitative design. Data were collected through problem-centred semi-structured interviews with adolescents and school counsellors, complemented by direct observation. Participants were recruited from two schools located in areas characterised by marginalisation and social exclusion. Interviews explored perceptions of social inequality, mental health, and the influence of COVID-19 measures. Data were analysed using thematic analysis, following a collaborative, iterative process involving multiple researchers to ensure reflexivity. National and international ethical guidelines were followed in the development of the research.</p><p><strong>Results: </strong>The synthesis of 95 h of observation notes, 42 participating adolescents (aged 12-18, 57% girls), and six professionals (mainly psychologists) revealed three overarching themes: (a) perceiving inequality, wherein adolescents experience multiple, intersecting forms of social inequality, intensified by the pandemic; (b) feeling inequality, which highlights how the structural disadvantages were linked to emotional distress, reduced future expectations, and strained family dynamics; (c) becoming a social agent of change. The data showed that despite these adversities, many participants demonstrated agency by using peer support networks and creative expression to cope with social injustice.</p><p><strong>Conclusions: </strong>The findings highlight the importance of addressing adolescent life experiences, feelings and behavioural performance through an intersectional lens, particularly in urban contexts marked by structural disadvantage. Interventions must consider the interconnected nature of social inequalities and prioritise the voices of young people in policy and programme development. Future research should deepen the understanding of adolescent experiences of inequality and promote inclusive strategies for psychosocial support.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"25 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13235179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148163018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Escaping the metric-driven governance trap in global health: how DALYs and coverage indicators mislead policymakers in LMICs.","authors":"Yusuf Hared Abdi, Sharmake Gaiye Bashir, Yakub Burhan Abdullahi, Yusuff Adebayo Adebisi, Don Eliseo Iii Lucero-Prisno","doi":"10.1186/s12939-026-02909-9","DOIUrl":"10.1186/s12939-026-02909-9","url":null,"abstract":"<p><p>Every year, billions of dollars in global health financing are allocated on the basis of a single number a disability-adjusted life year, a coverage rate, or a composite index generated thousands of miles from the communities that will bear the consequences of those decisions. The structural disconnect between the production of global health metrics and their application in low- and middle-income countries (LMICs) is not merely a technical inconvenience; it is a defining feature of an unequal international order. As LMIC governments face mounting pressure to demonstrate accountability to donors and multilateral institutions, the metrics that ostensibly measure their progress have come to shape not only what is measured but what is funded, prioritized, and ultimately valued. We argue that the dominant tools of global health measurement disability-adjusted life years (DALYs), quality-adjusted life years (QALYs), coverage indicators, and composite indices systematically misrepresent health realities in LMICs, distort policy priorities, and actively undermine the health system strengthening. Our argument is not that coverage indicators are without value measuring whether people access life-saving interventions remains vital but that their deployment as the primary grammar of global health governance, uncoupled from system-level and equity dimensions, actively distorts decision-making. This is not simply a technical problem of imperfect indicators; it is a metric-driven governance trap that locks LMICs into externally defined priorities and distorts the politics of health decision-making. We argue that escaping this trap requires a fundamental reorientation of the global health measurement enterprise: one that redirects investment from international modelling to national data systems, subjects the normative assumptions embedded in global metrics to genuinely participatory revision, and institutionalises locally driven measurement frameworks co-designed with LMIC governments, civil society, and communities. Only by moving methodological authority and analytical sovereignty closer to where illness is actually lived can global health metrics become tools of accountability rather than instruments of abstraction.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"25 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13238035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148163001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding barriers to healthcare services utilization among women in Mauritania: a socio-anthropological analysis.","authors":"Clairanne Bost, Miguel Bennasar-Veny, Maria Jesus Girona Magraner, Aina Maria Yáñez Juan","doi":"10.1186/s12939-026-02912-0","DOIUrl":"10.1186/s12939-026-02912-0","url":null,"abstract":"<p><strong>Background: </strong>Persistent health inequities affecting women are exacerbated in contexts where weak institutional, sociopolitical, and health system responses intersect with structural barriers that limit the availability and accessibility of healthcare services. In Mauritania, gender discrimination remains pervasive and contributes to women's non-utilization or discontinuation of healthcare. This study examines the sociocultural barriers limiting healthcare utilization among Mauritanian women, particularly in relation to gender-based violence (GBV) and sexual and reproductive health (SRH), with attention to reliance on informal or alternative pathways, and discontinuation of formal care.</p><p><strong>Methods: </strong>A qualitative study was conducted in Nouakchott, Mauritania, between August and October 2023, using a feminist, socio-anthropological approach. Thirty-three adult women participated, including 28 recruited through stratified purposive sampling to capture diversity in age, cultural background, and socioeconomic status. Data were collected through six participatory experiential workshops and five semi-structured individual interviews with key informants. A thematic analysis was conducted to examine how sociocultural norms and structural inequalities shape women's trajectories of access to GBV and SRH services.</p><p><strong>Results: </strong>Women's engagement with the healthcare system was constrained by entrenched social and cultural norms that normalize silence and endurance. GBV-related barriers included fear of disclosure, risk of social exclusion, and fear of legal repercussions, rooted in patriarchal expectations and internalized stigma. SRH-related barriers reflected shame and limited sexual health information sustained across the life course. Disengagement from the formal health system was further driven by institutional mistrust, discriminatory and racist practices against minority and migrant women, and procedural requirements such as police authorization for GBV care. Many women consequently relied on traditional practitioners or discontinued formal healthcare following negative experiences.</p><p><strong>Conclusions: </strong>The convergence of systemic violence against women, restrictive sociocultural norms, and institutional failures undermines the utilization of essential healthcare services in Mauritania. These barriers intersect with racism and poverty, reinforcing structural exclusion and contributing to long-term adverse health outcomes. Addressing these interconnected barriers requires integrated legal and social protection measures, alongside rights-based health policies and culturally sensitive service delivery models that prioritize women's needs and voices.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13267192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148163152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nipah virus destroyed my personal, family, and social life: stories of the hardship faced by Nipah survivors in Bangladesh.","authors":"Utpal K Mondal, Dewan Imtiaz Rahman, Wasik Rahman Aquib, Arifur Rahman Bablu, Mohammad Ariful Islam, S M Zafor Shafique, Muhammad Rashedul Alam, Kamal Ibne Amin Chowdhury, Michael Selorm Avumegah, John D Klena, Mohammed Ziaur Rahman, Mustafizur Rahman, Stephen P Luby, Joel M Montgomery, Sayera Banu, Syed Moinuddin Satter","doi":"10.1186/s12939-026-02893-0","DOIUrl":"10.1186/s12939-026-02893-0","url":null,"abstract":"<p><strong>Background: </strong>Nipah virus (NiV) causes recurrent outbreaks in Bangladesh with high mortality and persistent health consequences among survivors. As outbreak detection and clinical management improve, the number of survivors is likely to increase, creating an urgent need for long-term clinical, psychosocial, and rehabilitation support.</p><p><strong>Objective: </strong>To explore the lived experience of NiV survivors in Bangladesh and how physical, psychological, social, and economic challenges shape life after acute illness.</p><p><strong>Methods: </strong>We conducted a qualitative study with a phenomenological orientation among 27 adult NiV survivors in Bangladesh. Survivors were purposively selected to capture variation in sex, age, exposure route, years since illness, and severity of acute disease. Where survivors had substantial communication difficulties or limited recall of the acute illness, caregivers provided supplementary contextual information on illness and recovery. In-person, semi-structured interviews were conducted in May 2022. Data were analysed inductively using reflexive thematic analysis with analyst triangulation to enhance credibility.</p><p><strong>Results: </strong>Participants were interviewed between 2 and 21 years after illness. Survivors described persistent functional limitations, including fatigue, mobility and balance problems, headaches, and visual changes, as well as cognitive and emotional difficulties, including memory problems, irritability, sleep disturbance, and anxiety. These challenges altered daily routines, self-perception, and expectations for the future. Survivors also described stigma and fear of contagion in healthcare and community settings, which restricted social participation, education, and marriage prospects. Households experienced substantial economic hardship through income loss, borrowing, mortgaging land, and sale of assets to pay for treatment and recovery. Coping responses included practical adjustments and reliance on family support and religious faith, although many participants reported ongoing uncertainty about health, livelihoods, and the future.</p><p><strong>Conclusions: </strong>Survivorship after Nipah virus infection in Bangladesh involves continuing functional, cognitive, psychosocial, and economic hardship that extends well beyond acute recovery. Priority actions include survivor-centred rehabilitation, brief mental health support, and counselling for caregivers on safe care practices. Stigma-sensitive risk communication and targeted financial support should also be integrated into existing Nipah surveillance and response systems.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13450552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148156379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frailty among older adults in Germany: regional variation across NAKO study centers.","authors":"Maximilian König, Stefan Rach, Rafael Mikolajczyk, Ben Schöttker, Ute Mons, Manuel Amthor, Henry Völzke, Claudia Meinke-Franze, Volker Harth, Nadia Obi, Matthias B Schulze, Barbara Thorand, Karin Halina Greiser, Michael Leitzmann, Anne Herrmann, Wolfgang Lieb, Jasmin Kiekert, Thomas Keil, Lilian Krist, Börge Schmidt, Jana-Kristin Heise, Katharina Nimptsch, Tobias Pischon, Till Ittermann","doi":"10.1186/s12939-026-02879-y","DOIUrl":"10.1186/s12939-026-02879-y","url":null,"abstract":"<p><strong>Background: </strong>Frailty is a geriatric syndrome associated with increased morbidity, disability, and mortality. While its prevalence has been studied extensively in individual cohorts and patient populations, national prevalence data are scarce and regional variations within Germany remain largely unexplored. This study examined the frequency of frailty and its regional variation across the 18 NAKO (German National Cohort) study centers using a uniform frailty index.</p><p><strong>Methods: </strong>We analysed baseline data collected between 2014 and 2019 from 39,248 participants aged 61-75 years enrolled in the NAKO study, a large population-based cohort recruited across 18 study centers in Germany. Frailty was measured using a 40-item Frailty Index (FI), with FI ≥ 0.25 indicating frailty. Regional variations in frailty were first examined using crude frequencies and subsequently analysed with logistic regression, adjusting for key confounders, including age, sex, and sociodemographic and socioeconomic factors, to account for compositional differences across centers.</p><p><strong>Results: </strong>The crude frequency of frailty in the total sample was 7.7% (95% CI: 7.5-8.0), while 34.1% were prefrail. Frailty frequencies showed a nearly twofold spread (5.4%-10.2%) across study sites, being highest in Essen, Düsseldorf, Regensburg, Saarbrücken, and Berlin, and lowest in Freiburg, Münster, and northern German centers. Higher age, lower socioeconomic status and weaker social networks were all independently associated with frailty status. However, while these compositional factors contributed to the variability observed across centers, they did not fully account for it.</p><p><strong>Conclusion: </strong>Notable regional differences in frailty are evident across NAKO study centers in Germany, even after accounting for population composition (age, sex, and socioeconomic factors). This residual heterogeneity suggests that contextual factors - such as regional healthcare access, environmental exposures, or structural policies - contribute to frailty development beyond individual risk factors.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"25 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13231660/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148156377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Explaining rural-urban disparities in child stunting in African least developed countries: a multi-country cross-sectional analysis.","authors":"Zhixin Liu, Dongsheng Zhao, Junkai Lin, Xiali Chen","doi":"10.1186/s12939-026-02898-9","DOIUrl":"10.1186/s12939-026-02898-9","url":null,"abstract":"<p><strong>Background: </strong>Rural-urban disparities in child stunting persist in African least developed countries (LDCs), undermining progress towards Sustainable Development Goal 2.2. However, multi-country evidence remains limited on which underlying factors account for these disparities. This study examined rural-urban differences in child stunting across 18 African LDCs and assessed the relative contributions of distal socioeconomic resources and proximal household environmental, healthcare-access, and dietary conditions.</p><p><strong>Methods: </strong>We used the most recent Demographic and Health Surveys conducted between 2015 and 2024 in 18 African LDCs. The analytic sample included 88,625 children aged 6-59 months. Child stunting was defined as length/height-for-age z-scores below - 2 standard deviations from the WHO Child Growth Standards median. Explanatory factors included household wealth, maternal education, maternal digital access, water, sanitation and hygiene (WASH) conditions, healthcare access, and dietary diversity. Logistic regression and Karlson-Holm-Breen decomposition models were fitted separately within each country to estimate the rural-urban association in child stunting and the extent to which explanatory factors accounted for this association. Log odds ratios and decomposition estimates were then pooled across countries using random-effects meta-analysis.</p><p><strong>Results: </strong>Stunting prevalence was higher among rural than urban children in all 18 African LDCs, with rural-urban differences ranging from 4.2 to 33.1 percentage points across countries. In the KHB decomposition analysis, the pooled total odds ratio for child stunting associated with rural residence was 1.904 (95% CI: 1.644-2.205). All explanatory factors jointly accounted for 70.2% of the pooled rural-urban association. Household wealth made the largest contribution, accounting for 29.7% of the total association, followed by maternal digital access (23.6%) and maternal education (9.2%). WASH conditions accounted for 5.7%, whereas healthcare access and dietary diversity made limited contributions.</p><p><strong>Conclusion: </strong>Rural-urban inequalities in child stunting remain widespread across African LDCs. These inequalities were largely accounted for by unequal socioeconomic resources, especially household wealth, maternal digital access, and maternal education, while proximal household environmental, healthcare-access, and dietary factors made smaller or limited contributions. Narrowing this gap requires multisectoral strategies that address socioeconomic disadvantage, digital exclusion, and basic infrastructure deficits.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13321889/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148156362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ambient PM₂.₅, residential greenspace, and household healthcare expenditure in Shandong, China.","authors":"Siyuan Wang, Zhiwei Xu, Gian Luca Di Tanna, Raksha Pandya-Wood, Mingsheng Chen, Laura Downey, Stephen Jan, Lei Si","doi":"10.1186/s12939-026-02911-1","DOIUrl":"10.1186/s12939-026-02911-1","url":null,"abstract":"<p><strong>Background: </strong>Environmental factors such as air pollution and access to greenspace are increasingly recognised as important determinants of population health and healthcare expenditure. This study examined the relationship between ambient PM₂.₅, urban greenspace, and household healthcare expenditure in China, and assessed how healthcare expenditure was concentrated across these gradients of environmental exposure.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis using data from the 6th Health Services Survey in Shandong Province, linking household healthcare expenditure to residential greenspace (NDVI) and ambient PM₂.₅ at the village level. We used Generalised Linear Mixed Models with village-level random effects to estimate the relationship between household healthcare expenditure and environmental exposures. To examine inequalities in healthcare expenditure, we calculated concentration indices (CIs), quantifying the distribution of healthcare expenditure across levels of greenspace and air pollution.</p><p><strong>Results: </strong>A total of 27,603 individuals were included in the analysis. Higher NDVI exposure was associated with lower household healthcare expenditure (Q2: β = -0.21, P < 0.01; Q3: β = -0.21, P < 0.01; Q4: β = -0.26, P < 0.01), whereas higher ambient PM₂.₅ concentrations were linked to increased expenditure (Q2: β = 0.13, P < 0.01; Q3: β = 0.17, P < 0.01; Q4: β = 0.30, P < 0.01). In both models, older age (45-65 and ≥ 65 years) and underweight status were associated with higher healthcare expenditure (NDVI: β = 0.13-0.32, P < 0.01; PM₂.₅: β = 0.15-0.35, P < 0.01), as were households earning above 60% of median income (NDVI: β = 0.10, P < 0.01; PM₂.₅: β = 0.11, P < 0.01). Health insurance was linked to lower expenditure in the NDVI model (β = -0.10, P < 0.001) but not in the PM₂.₅ model. Inequality analyses indicated that household healthcare expenditure was disproportionately concentrated among residents with lower greenspace (NDVI: PCI = - 0.04, 95% CI: -0.05 to - 0.03) and higher PM₂.₅ exposure (PCI = 0.06, 95% CI: 0.05 to 0.07).</p><p><strong>Conclusion: </strong>Our findings highlight the importance of integrating environmental equity into public health and policy interventions to reduce healthcare expenditure and inequalities.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13455470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148156367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}