Health insurance and care-seeking behaviours of female migrants in Accra, Ghana

Does health insurance status influence healthcare-seeking behavior in rural communities? evidence from rural Ghana

Introduction

National health insurance programs are considered important mechanisms for ensuring equity in access to and utilization of healthcare services by removing financial barriers associated with seeking treatment in healthcare facilities. Although studies on health insurance schemes in many low-and-middle-income countries (LMICs) have demonstrated a significant relationship between health insurance status and healthcare-seeking behavior, data on the influence of this health financing policy on the decision to seek formal healthcare among rural inhabitants remains limited. Underpinned by the Andersen-Newman behavioral model of healthcare use, this study examined the influence of health insurance status on healthcare-seeking behavior among rural dwellers in Ghana.

Methods

A community-based cross-sectional study was conducted among 460 rural residents in Ghana from 8th September to 5th December 2022. Chi-square tests were used to study the significance level and association between healthcare-seeking behavior and selected independent variables. A multiple logistic regression model was fitted to test the association between health insurance status and healthcare-seeking behavior, introducing other selected explanatory variables as controls.

Results

The mean age of the respondents was 29.6 ± 6.8 years. A little above half (53.1 %) disclosed having insurance, whereas 46.1 % stated they were without coverage. Regarding healthcare-seeking behavior, the most commonly chosen treatment source was traditional healers (37.2 %), followed by the public healthcare system (28.3 %) and self-treatment (18.2 %). The private healthcare system was the least preferred, with only 16.3 % opting for it. While the bivariate analysis demonstrated a significant relationship between health insurance status and healthcare-seeking behavior (p-0.001), the logistic regression model results showed that health insurance status was not an independent predictor of healthcare-seeking behavior (p = 0.069).

Conclusion

It could, therefore, not be concluded that the respondents with health insurance coverage were more likely than the uninsured to use formal healthcare providers as their most frequent source of treatment during illness. This study provides vital information for policymakers aiming at increasing access to and utilization of facility-based formal care in rural and remote settings.

Prevalence of high-risk human papillomavirus infection and cervical lesions among female migrant head porters (kayayei) in Accra, Ghana: a pilot cross-sectional study

BACKGROUND

Little attention has been given to the risk of high-risk human papillomavirus (hr-HPV) infection and cervical precancerous lesions among female migrant head porters (kayayei) in Ghana, as a vulnerable group, and to promote cervical screening in these women. This pilot study aimed to determine the prevalence of hr-HPV infection and cervical lesions among kayayei in Accra, the capital of the Greater Accra Region of Ghana and to describe our approach to triaging and treating these women.

METHODS

This descriptive cross-sectional cohort study involved the screening of 63 kayayei aged ≥ 18 years at the Tema Station and Agbogbloshie markets in March 2022 and May 2022. Concurrent hr-HPV DNA testing (with the MA-6000 platform) and visual inspection with acetic acid (VIA) was performed. We present prevalence estimates for hr-HPV DNA positivity and VIA 'positivity' as rates, together with their 95% confidence intervals (CIs). We performed univariate and multivariable nominal logistic regression to explore factors associated with hr-HPV infection.

RESULTS

Gross vulvovaginal inspection revealed vulval warts in 3 (5.0%) and vaginal warts in 2 (3.3%) women. Overall, the rate of hr-HPV positivity was 33.3% (95% CI, 21.7-46.7), whereas the VIA 'positivity' rate was 8.3% (95% CI, 2.8-18.4). In the univariate logistic regression analysis, none of the sociodemographic and clinical variables assessed, including age, number of prior pregnancies, parity, past contraceptive use, or the presence of abnormal vaginal discharge showed statistically significant association with hr-HPV positivity. After controlling for age and past contraceptive use, only having fewer than two prior pregnancies (compared to having ≥ 2) was independently associated with reduced odds of hr-HPV infection (adjusted odds ratio, 0.11; 95% CI, 0.02-0.69).

CONCLUSION

In this relatively young cohort with a high hr-HPV positivity rate of 33.3% and 8.3% of women showing cervical lesions on visual inspection, we posit that kayayei may have an increased risk of developing cervical cancer if their accessibility to cervical precancer screening services is not increased.

A cost-effectiveness analysis of pre-pregnancy genetic screening for deafness: an empirical study in China

Objectives

This research aims to assess the effectiveness and cost-effectiveness of pre-pregnancy deafness screening policies.

Methods

Married couples from Shanghai, Beijing, and Suzhou in China were enrolled. We conducted high-throughput, pre-pregnancy genetic screenings for deafness in women and their partners. We compared the cost-effectiveness of deafness genetic screening with the status quo. The two-step screening (wife then partner) and following treatments and interventions were included in the decision tree model. We conducted a cost-effectiveness analysis based on the decrease in deaf newborns, healthy newborn births, and cost-utility analysis of pre-pregnancy deafness genetic screening separately. Cost, utility, and probability data used in the three models were collected from a survey combined with literature and expert consultants. A 5% discount rate and a series of one-way sensitivity analyses along with a Monte Carlo simulation were used to test the reliability of this research.

Results

Between Jan 1, 2019, and Dec 31, 2021, we recruited 6,200 females and 540 male spouses from community health service centers in Shanghai, Beijing, and Suzhou. The incremental cost-effectiveness ratio (ICER) for reducing deaf newborn births was USD 32,656 per case and USD 1,203,926 per case for increasing one healthy newborn birth. This gap exists because of the overall decrease of newborn births. From the perspective of the whole society, deafness genetic screening is not cost-effective for reducing the overall quality-adjusted life years (QALY) in the population.

Discussion

Pre-pregnancy genetic testing is effective in decreasing the occurrence of congenital deafness. It is a cost-saving measure when compared with the costs of future medical expenditure and income loss for the affected families. However, such screening and preventive avoidance of pregnancy will decrease the population size and QALY. Only post-screening ART with PGT was shown to increase the birth of healthy newborns. Focusing on key groups such as premature births or consanguineous couples may improve the societal effects of screening.

Health needs of migrant female head porters in Ghana: evidence from the Greater Accra and Greater Kumasi Metropolitan areas

BACKGROUND

In low-and middle-income countries, migrants are confronted with health needs which affect the promotion of their well-being and healthy lives. However, not much is known about the health needs of migrant female head porters (Kayayei) in Ghana. This study assesses the health needs of migrant female head porters in the Greater Kumasi Metropolitan Area (GKMA) and Greater Accra Metropolitan Area (GAMA).

METHODS

The study adopted a convergent mixed methods design where both qualitative and quantitative data were used. A representative sample size of 470 migrant female head porters was used for the study.

RESULTS

The study revealed that ante-natal care, post-natal care, treatment of malaria, treatment of diarrhoea diseases, mental health, sexual health, and cervical cancer were health needs of migrant female head porters. The findings showed that participants from the GAMA significantly have greater cervical cancer needs (71.6% vrs 67.1%, p = 0.001) compared to those from the GKMA. Kayeyei from the GKMA significantly have greater mental health needs than those from the GAMA (84.6% vrs 79.2%, p = 0.031). Also, Kayeyei from the GKMA significantly have higher attendance of post-natal care compared to those from the GAMA (99.4% vrs 96.2%, p = 0.013).

CONCLUSION

The findings underscore differential health needs across geographical localities. Based on the findings of the study, specific health needs such as ante-natal care and post-natal care should be included in any health programmes and policies that aim at addressing health needs of migrant female head porters in the two metropolitan areas of Ghana.

Access to Healthcare Services among Thai Immigrants in Japan: A Study of the Areas Surrounding Tokyo

Numerous undocumented and uninsured foreigners living in Japan have faced barriers when trying to obtain appropriate healthcare services, which have occasionally led to issues with unpaid medical bills to medical institutions. Although information on health and socioeconomic status is essential to tackle such issues, relevant data has been unavailable due to difficulties in contacting this population. This study involved a cross-sectional survey using questionnaires concerning the general demographic characteristics, socioeconomic status, health profiles, information access, and knowledge/attitude/practice of health insurance of Thai nationals living in Japan. The study participants included Thai nationals who lived in Tokyo and the surrounding prefectures. The survey was conducted mainly at public religious events from September 2022 to December 2022. Overall, the questionnaires were obtained from 84 participants, though 67 participants were included in the final analysis after excluding missing variables. There were participants with unspecified visa status (32.8%) and uninsured status (40.3%). Among them, 86.4% expressed positive attitudes towards health insurance. However, multivariate multivariable regression analyses revealed the low insurance practice status among the unspecified visa group (aOR, 0.02; 95% CI, 0.00-0.13). Overall, the results reveal limited access to healthcare services in subgroups of Thai immigrants in Japan.

Does the immediate reimbursement of medical insurance reduce the socioeconomic inequality in health among the floating population? Evidence from China

BACKGROUND

Enhancing health intervention for floating populations has become an essential aspect of public health around the world. China launched a policy reform aimed at implementing immediate reimbursement for trans-provincial inpatient treatments. The objective of this study was to investigate the effects of this policy change on socioeconomic inequality in health among the floating population.

METHODS

This study used two waves of individual-level data from the China Migrants Dynamic Survey (CMDS) collected in 2017 and 2018 as well as administrative hospital data at the city level. The sample included 122061 individuals and 262 cities. Under a quasi-experimental research design, we built up the framework to employ the generalized and multi-period difference-in-differences estimation strategy. We used the number of qualified hospitals that could provide immediate reimbursement to represent the degree and intensity of the implementation of this policy change. We also calculated the Wagstaff Index (WI) to measure socioeconomic inequality in health.

RESULTS

This policy change and income level had a negative joint impact on the health status of floating population (odds ratio = 0.955, P < 0.01), that is, the lower the income, the better the number of qualified hospitals' effect on health improvement. Furthermore, as the number of qualified tertiary hospitals increased, the health inequality would decrease significantly on average at the city level (P < 0.05). In addition, inpatient utilization as well as total expenditure and reimbursement significantly improved after the policy change, and the magnitude of increase was greater in the relatively lower-income group (P < 0.01). Finally, only inpatient spending could obtain immediate reimbursement in the early stage, thus, compared with primary care, these impacts were greater in tertiary care.

CONCLUSIONS

Our study revealed that after the implementation of immediate reimbursement, the floating population could obtain greater and more timely reimbursement, which significantly increased its inpatient utilization, promoted health, and reduced the health inequality caused by socioeconomic factors. These results suggest that a more accessible and friendly medical insurance scheme should be promoted for this group.

Health care access and migration experiences among Venezuelan female sex workers living in the Dominican Republic

Objective

To identify sexual risk behaviors and barriers to sexual and reproductive health care (SRH) among Venezuelan female sex workers living in the Dominican Republic.

Methods

This was a mixed-methods study using four focus group discussions (FGDs) and a cross-sectional quantitative survey with Venezuelan migrant female sex workers. The study was conducted from September through October 2021 in two urban areas (Santo Domingo and Puerto Plata) in the Dominican Republic. Information collected from the FGDs was analyzed using thematic content analysis, and quantitative data were analyzed using univariate descriptive statistics. Data analysis was conducted from 30 November 2021 to 20 February 2022.

Results

In all, 40 Venezuelan migrant female sex workers with a median (range) age of 33 (19-49) years participated in the FGDs and survey. The FDGs identified barriers to SRH services, including immigration status and its implications for formal employment and health access, mental wellbeing, quality-of-life in the Dominican Republic, navigating sex work, perceptions of sex work, SRH knowledge, and limited social support. Findings of the quantitative analysis indicated that most participants reported feeling depressed (78%), lonely/isolated (75%), and having difficulty sleeping (88%). Participants reported an average of 10 sexual partners in the past 30 days; 55% had engaged in sexual practices while under the influence of alcohol; and only 39% had used a condom when performing oral sex in the past 30 days. Regarding AIDS/HIV, 79% had taken an HIV test in the past 6 months, and 74% knew where to seek HIV services.

Conclusions

This mixed-methods study found that nationality and social exclusion have a multilayered influence on migrant female sex workers, sexual risk behaviors, and access to health care. Recommendations for effective evidence-based interventions to address sexual health knowledge need to be implemented to address risky sexual behaviors, improve access to SRH, and reduce affordability barriers.

Health service behaviors of migrants: A conceptual framework

Universal health coverage is vital to the World Health Organization's (WHO's) efforts to ensure access to health as a human right. However, it has been reported that migrants, including both international immigrants and internal migrants, underuse health services. Establishing a conceptual framework to facilitate research on the health service behaviors (HSB) of migrants is particularly important. Many theoretical frameworks explaining the general population's HSB have been published; however, most theoretical frameworks on migrants' HSB only focus on international immigrants without the inclusion of internal migrants. Of note, internal migrants are much more abundant than immigrants, and this group faces similar barriers to HSB as immigrants do. Based on theoretical frameworks of immigrants' HSB and Anderson's behavior model, the author proposes a new conceptual framework of migrants' HSB that includes both immigrants and internal migrants. The new conceptual framework divides the determinants into macro-structural or contextual factors, health delivery system characteristics, and characteristics of the population at risk and describes subgroup-specific factors. The author added some variables and reclassified variables in some dimensions, including characteristics of health delivery systems and access to healthcare. The characteristics of health delivery systems comprise the volume, organization, quality, and cost of the health delivery system, while the characteristics of access to healthcare include time accessibility, geographic accessibility, and information accessibility. The outcomes of HSB have been expanded, and relationships between them have been reported. The mediating effects of some variables have also been described. This conceptual framework can facilitate a deep and comprehensive understanding of the HSB determination process for migrants, including internal migrants.

Contraceptive use among female head porters: implications for health policy and programming in Ghana

Objective

Despite the growing literature on the barriers to contraceptives use among women, the perspective of female head porters has not been exhaustively researched. Using Bronfenbrenner's socio-ecological theory, we explore the factors that influence the contraceptive decision-making of migrant female head porters in the Kumasi Metropolis and the implications for health policy and planning.

Methodology

A case study of female head porters in the Kumasi Metropolis was conducted. We employed a qualitative approach in the collection and analysis of the data. A combination of cluster, purposive, and convenience sampling procedures was used to select 48 migrant female head porters to participate in semi-structured in-depth interviews. The data collected were analyzed using the thematic analytical framework.

Results

We found the main barriers to the uptake of contraception among the head porters to include high cost of contraceptives, perceived side effects associated with contraceptive use, and the disapproval of a male sexual partners.

Conclusion

The findings indicate that head porters' contraceptive decision-making is largely influenced by their social and economic circumstances. To address these, we recommend a carefully tailored approach, starting with a free National Health Insurance Scheme (NHIS) enrollment policy for all head porters in the country. There is also the need for the Ghana Health Service, and NGOs in health to work together to create effective awareness among female head porters on the benefits and misconceptions of contraception by incorporating culturally appropriate education that would facilitate the adoption of positive attitudes towards contraception. Additionally, NGOs in health in collaboration with the health facilities should initiate a process that encourages joint reproductive health decision-making among partners which recognises the added value of men's participation. We argue that men's active participation in contraception decision-making could potentially address their scepticism towards uptake.

The Health Experiences of Young Internal Migrants in Ghana-Identifying Priorities for Sustainable Health Promotion

The Sustainable Development Goals underscore the importance of migration to the achievement of health, and global migration presents both opportunities and challenges for the development of health promotion. Despite such recognition, very little work has focused on health promotion with young migrants, including how migration shapes opportunities for positive health. This paper reports findings from a qualitative study that sought to advance knowledge of the health experiences of young internal migrants in Ghana (n = 14) and considers ways to harness these perspectives in the development of sustainable health promotion solutions. Methods included community consultations, participatory workshops and interviews with young migrants aged 14-21 years. Findings highlighted how the social determinants of health affected young migrants' opportunities to support their health. Our analysis highlights how a lack of access to adequate food, shelter and health services often resulted in the adoption of alternative health practices, including the use of herbal remedies. Supporting positive livelihoods as part of tackling the social determinants of health is crucial to mitigate the impacts of poverty and inequalities on young migrants' health practices and outcomes. We conclude by considering how to advance relevant health promotion with young migrants living in contexts of vulnerability.

When the healthcare system neglects some people: Rural-Urban Migration, socio-cultural conditions, and health coping strategies in informal settlement, Madina, Ghana: An exploratory design

Migrants face several unmet health needs due to the inability of the healthcare system to address their healthcare challenges. As a result, they adopt coping strategies to overcome their healthcare needs. Consequences can include infrequent but severe adverse reactions, dangerous drug interactions, incorrect dosage etc. Little is known in Ghana about the role played by cultural and linguistic barriers in shaping migrants' access to formal healthcare and the coping mechanisms adopted by these migrants to overcome their healthcare challenges. Surprisingly, most of the studies that have been conducted have focused on financial barriers to care accessibility. This presents a loss opportunity for any health programme aimed at addressing this inequity. Thus, the purpose of this paper is to fill this gap by exploring the challenges of healthcare accessibility and coping strategies adopted by migrants to overcome their healthcare needs in the informal urban settlement of Madina, in the Greater Accra Region. The author employed a narrative type of qualitative research design. A purposive and then snowball sampling technique were used to select 20 participants to participate in the study after saturation was reached. Twelve in-depth interviews (IDIs) and six key informants' interviews (KIIs), as well as two focus group discussions (FGDs), were conducted. The study is consistent with the ecological model, which posits that health is determined by influences at multiple levels. The author found linguistic, cultural, stigmatisation and financial challenges as the main barriers to healthcare accessibility among the migrants. As a result, self-medication and the use of lay health personnel for addressing healthcare needs were more pronounced. The study also found other means of survival that posed a health risk to the migrants. Based on this, it was recommended that healthcare systems take into account the healthcare needs of migrants who are people with culturally and linguistically diverse backgrounds.

Does direct settlement of intra-province medical reimbursements improve financial protection among middle-aged and elderly population in China? Evidence based on CHARLS data

In low- and middle-income countries, social health insurance schemes are the main focus of efforts to achieve universal health coverage (UHC) by promoting access to health care and financial protection. Problems with financial protection in China are caused mainly by health insurance fragmentation and a rapid rise in medical expenditure. In this context, China implemented a policy of direct settlement of intra-provincial medical reimbursement in 2014. We evaluated the impact of the policy on financial protection with a population aged 45 and above based on the China Health and Retirement Longitudinal Study from 2011 to 2018. We estimated the policy effects using the difference-in-differences method, based on coarsened exact matching. We found that the policy significantly reduced the catastrophic health expenditures (CHEs) rate by approximately 10% in the population, whether middle-aged or elderly. Subgroup analyses indicated that middle-aged and elderly people living in western China and with lower household incomes received greater protection from the policy. The CHEs rate for the two age groups in western China was reduced by 16.26% and 20.12%, respectively. The CHEs rate was reduced by 24.51% and 17.32% for middle-aged individuals in the lowest and second household income quartiles, respectively, and by 21.31% for older adults in the second household income quartile. The new rural cooperative medical scheme exerted a smaller protective effect than urban medical insurance among the participants aged 60 and older. We found that in addition to optimizing health insurance schemes, more health care reform measures, such as adopting more efficient payment methods and rationalizing medical expenditures, should be combined to help reduce health inequities and accelerate progress toward achieving UHC and the Sustainable Development Goals.

Availability and Affordability of Primary Health Care Among Vulnerable Populations in Urban Kumasi Metropolis: Family Health Perspective

Purpose

Health-related expenditures pose a significant burden on vulnerable populations. This study assessed the availability and affordability of primary health care among disadvantaged populations in urban Kumasi Metropolis, Ghana.

Methods

This study was a descriptive cross-sectional study conducted among multi-level participants of vulnerable populations ≥18 years of age (n=710) constituting the older adults/aged, pregnant women, head porters, sex workers, and other vulnerable groups (people with disabilities and the homeless). Data were collected using a semistructured questionnaire. Poisson regression with robust variance was used to assess the association between vulnerability and access to health care.

Results

There were significant differences in the availability and adequacy of health care among the vulnerable groups studied. Distance to the source of care was >5 km for majority of the vulnerable groups and the average expenditure on a visit to the health facility was GH¢ 27.04 (∼US$ 5.55 as at January 2019). Challenges to health care among the vulnerable groups included monetary (37.9%), stigmatization (18.6%), and staff attitude (25.9%). Head porters and other vulnerable groups were less likely to view health care as affordable compared with older adults. The difference in the perception of health care affordability was, however, explained by sociodemographic characteristic and health care-related factors.

Conclusion

Despite the introduction of a National Health Insurance Scheme in Ghana, this study highlights challenges in health care access among vulnerable populations independent of the type of vulnerability. This suggests the need for stakeholders to adopt other innovative care strategies that may have broader applicability for all populations.

Inclusive partnership and community mobilization approaches to improve maternal health care access among internal migrants in nine Indian cities

Background

Disparities in healthcare access to internal migrants exist, and the gaps may widen further if appropriate steps are not taken. Innovative approaches are needed to better align the healthcare services with the migrants’ needs.

Aim

The aim was to develop and test a supportive strategy of healthcare, which would achieve the desired level of access and delivery of maternal healthcare services to internal migrants living in nine Indian cities.

Methods

This intervention with the quasi-experimental design was conducted with pre- vs post-intervention comparisons within the interventional groups and with the control group. The intervention was implemented with an inclusive partnership approach. Advocacy and community mobilization were the main intervention components.

Findings

An increased proportion of women sought antenatal care during the intervention. More women initiated seeking antenatal care in the first trimester. Due to intervention, health workers’ prenatal (41.7% in the post- against 14.7% in the pre-interventional phase) and postnatal home visits increased (11.6% to 34.7%) considerably.

Conclusions

Interventions with inclusive partnership would improve healthcare access to vulnerable communities such as migrants. Hence, efforts to strengthen the government healthcare system through novel strategies are crucial to provide better healthcare to migrants.

Emerging properties of malaria transmission and persistence in urban Accra, Ghana: evidence from a participatory system approach

Background

Several studies that aim to enhance the understanding of malaria transmission and persistence in urban settings failed to address its underlining complexity. This study aims at doing that by applying qualitative and participatory-based system analysis and mapping to elicit the system’s emergent properties.

Methods

In two experts’ workshops, the system was sketched and refined. This system was represented through a causal loop diagram, where the identification of leverage points was done using network analysis.

Results

45 determinants interplaying through 56 linkages, and three subsystems: urbanization-related transmission, infection-prone behaviour and healthcare efficiency, and Plasmodium resistance were identified. Apart from the number of breeding sites and malaria-positive cases, other determinants such as drug prescription and the awareness of householders were identified by the network analysis as leverage points and emergent properties of the system of transmission and persistence of malaria.

Conclusion

Based on the findings, the ongoing efforts to control malaria, such as the use of insecticide-treated bed nets and larvicide applications should continue, and new ones focusing on the public awareness and malaria literacy of city dwellers should be included. The participatory approach strengthened the legitimacy of the recommendations and the co-learning of participants.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12936-021-03851-7.

Breastfeeding knowledge and practices of working mothers in the informal economy in New Delhi: A formative study to explore new intervention pathways towards improved maternal and child health outcomes

This was a formative study to yield evidence on the conceptual and empirical pathways to improve maternal and child health (MCH) outcomes among informally working mothers while securing livelihoods, and for this, explores how informally working women navigate time sensitive childcare practices such as exclusive breastfeeding (EBF) with their work, and how do the conditions and nature of informal employment shape it. This study was conducted in February-May 2017 using non-probability sampling for cross-sectional semi structured interviews (n = 92) and focus group discussions (n = 56) with working mothers with a child under 2 and 5 years respectively, having regular and stable working history in the informal economy. The study team partnered with Self-Employed Women's Association for site selection and recruitment of study participants across 4 sectors of work in New Delhi, India: home-based work, pheri or barter work, street vending and domestic work. While 65% women report EBF for 6-months, checks with infant feeding recall reveal several disruptions from customary practices and working conditions, and successful EBF only in home-based work, the least paying of all. 59% women reported returning to work under 6-months, leading to early weaning. 90% women were aware of the importance of EBF in the standard language of public health messaging, however, checks with non-standard language queries reveal a drop to 55-80% exhibiting lack of effective knowledge that women could use. The findings emphasise that conditions and nature of informal employment shape MCH outcomes in cities of the global south, where such employment dominates. Furthermore, we use the findings to suggest the following responsive approaches for intervention: delaying mother's return to work, increasing proximity between mother and child, deeper and engaged knowledge of breastfeeding and early child development practices, improving problem solving capacity and agency of the mother, and enabling home and workplace conditions.

Chronic kidney diseases among homeless and slum dwellers in Accra, Ghana

Introduction

chronic kidney disease is an important risk factor for cardiovascular-related morbidity and death. In Ghana, relatively little is known about the prevalence of chronic kidney disease (CKD) in homeless and slum dwellers in the major cities of the country. This study aimed at determining the prevalence of CKD among homeless people in Nima and Agbogbloshie, Accra, Ghana, and to evaluate the association between socio demographic characteristics and CKD.

Methods

we recorded information on individuals' socio-demographic characteristics and anthropometric indices, and took blood samples from a total of 512 homeless participants for serum creatinine measurement. Renal function was estimated according to the 4-variable Modification of Diet in Renal Disease (MDRD) and Cockcroft–Gault (C-G) equations.

Results

participants with normal serum creatinine (SCr), made up of 232 males and 280 females totaling 512 took part in the study. Those with normal glomerular filtration rate (GFR) were 86% and 84.6% by means of the C-G and MDRD equations respectively. According to the C-G formula, kidney damage and mild to severe renal insufficiency was found in 13.2% of the participants and 4 participants (0.8%) had renal failure. On the other hand, 15.4% of the participants were found to have some kidney damage and mild to severe renal insufficiency according to the MDRD formula with no participant suffering from kidney failure.

Conclusion

the prevalence of CKD among the homeless Ghanaians was significant, especially among those with hypertension, diabetes and human immunodeficiency syndrome virus (HIV) infection.

Challenges and facilitators to the provision of sexual, reproductive health and rights services in Ghana

Expanding access to sexual and reproductive health (SRH) services is one of the key targets of the Sustainable Development Goals. The extent to which sexual and reproductive health and rights (SRHR) targets will be achieved largely depends on how well they are integrated within Universal Health Coverage (UHC) initiatives. This paper examines challenges and facilitators to the effective provision of three SRHR services (maternal health, gender-based violence (GBV) and safe abortion/post-abortion care) in Ghana. The analysis triangulates evidence from document review with in-depth qualitative stakeholder interviews and adopts the Donabedian framework in evaluating provision of these services. Critical among the challenges identified are inadequate funding, non-inclusion of some SRHR services including family planning and abortion/post-abortion services within the health benefits package and hidden charges for maternal services. Other issues are poor supervision, maldistribution of logistics and health personnel, fragmentation of support services for GBV victims across agencies, and socio-cultural and religious beliefs and practices affecting service delivery and utilisation. Facilitators that hold promise for effective SRH service delivery include stakeholder collaboration and support, health system structure that supports continuum of care, availability of data for monitoring progress and setting priorities, and an effective process for sharing lessons and accountability through frequent review meetings. We propose the development of a national master plan for SRHR integration within UHC initiatives in the country. Addressing the financial, logistical and health worker shortages and maldistribution will go a long way to propel Ghana's efforts to expand population coverage, service coverage and financial risk protection in accessing essential SRH services.

Narratives of internal migration experiences, health/well-being issues among females working as head-porters (Kayayei) in Ghana

Purpose

This study aims to explore the internal migration experiences and health/well-being issues of 38 girls and women working as Kayayei (head-porters) in Accra, Ghana.

Design/methodology/approach

Data were collected from seven focus group interview sessions, and thematic analysis was used to analyse the data.

Findings

The results revealed the geographic, structural and family issues that promote increased migration of females to the cities. The findings betray the potential negative effects of migration on the participants’ quality of life, including accessing health services. They also suggest that the Kayayei phenomenon is a significant child protection, health/well-being concern yet to be given adequate attention in ways that consider the implications of such large internal migration of females on the overall human resource development capacities of rural communities.

Originality/value

This is an original study with data collected to explore internal rural to urban migration and its effect on health and well-being of young girls and women.

Employment based health financing does not support gender equity in universal health coverage

Health financing and entitlement systems linked to employment can disadvantage women, argue Lavanya Vijayasingham and colleagues

Effect of socioeconomic status on the healthcare-seeking behavior of migrant workers in China

In recent years, China has made great efforts to resolve the health inequality caused by household registration restrictions, and the unequal allotment of health services faced by migrant workers has been effectively alleviated. However, inequality in health services may exist not only between migrant workers and local citizens but also among migrant workers. Thus, the unbalanced utilization of health services among migrant workers deserves attention. Using data from the 2017 China Migrants Dynamic Survey (CMDS), we examined the relationship between socioeconomic status (SES) and healthcare-seeking behavior through multivariate regression analysis. Then, from the perspective of SES, this study divided migrant workers into different groups to explore the characteristics of healthcare-seeking behavior in different groups. The results showed that SES had a significant relationship with healthcare-seeking behavior. Those with high SES were more likely to use high-quality health services. By subdividing the category of migrant workers, we found that the utilization of health services among migrant workers was unbalanced. Education and income had significant gradients in multiple measures of healthcare-seeking behavior, while occupation had no significant difference in the behavior. Migrant workers with higher income and education were more likely to use high-quality health services. Especially for migrant workers who had high incomes (above 15,000 CNY) or whose educational backgrounds were graduate level or above, their utilization of health resources was significantly higher than that of other groups. When designing particular policies to improve the healthcare-seeking behavior of different SES migrant workers, we should pay attention to the low-education groups and low-income groups. Policymakers can reduce the current health inequality of migrant workers by strengthening health education and increasing medical subsidies to achieve health equality among migrant workers and between migrant workers and local citizens.

Differences in injury and trauma management between migrant workers and citizens

In Taiwan, legal migrant workers and almost all citizens are covered under the National Health Insurance program. Work-related injuries and various traumatic events constitute 2 major reasons for seeking medical care among migrant workers. Therefore, we conducted this retrospective study to delineate the clinical features of migrant workers with trauma and determine differences in trauma management between migrant workers and citizens under the current medical care and insurance system.We retrospectively reviewed the data of all patients with trauma who were discharged from adult wards between January 1, 2015 and December 31, 2016. We identified 5854 citizens and 110 migrant workers during the chart review. Data related to the prehospital period, emergency department, hospital course, and prognosis were collected and compared between migrant workers and citizens.More than half of the traumatic events among migrant workers occurred at factory, farm, or mine locations (migrant workers vs all citizens: 57.3% vs 11.5%), whereas most traumatic events among citizens occurred at street and home or dormitory locations (street: migrant workers vs all citizens: 17.3% vs 52.5%; home or dormitory: migrant workers vs all citizens: 0.9% vs 14.3%). Compared with citizens, migrant workers had lower scores in injury severity scores and new injury severity scores, but higher scores in revised trauma score and trauma and injury severity scores. The hospital course and prognosis were similar between migrant workers and citizens.Compared with citizens, migrant workers had a higher incidence of work-related injury and sustained less severe injuries. Under the coverage of the current health care and insurance system in Taiwan, migrant workers with trauma and work-related injuries receive comparable medical care and prognoses to citizens.

Trends in access to health services, financial protection and satisfaction between 2010 and 2016: Has China achieved the goals of its health system reform?

Guided by the principle of universal health coverage, China began its complex health system reform in 2009. Using data from the China Family Panel Studies (CFPS), this study assesses trends in healthcare utilization, financial protection, and satisfaction between 2010 and 2016. We use difference-in-means tests and regression analysis to evaluate overall trends and compare subsample results by urban/rural residence and income quartiles to examine changes in inequity. Our results show that China has achieved substantial improvements in access to healthcare services and financial protection since the health system reform in 2009. First, China has experienced a substantial increase in both inpatient and outpatient care utilization between 2010 and 2016. Second, people receive better financial protection by measures of health insurance coverage, inpatient reimbursement rate, the likelihood of incurring catastrophic health expenditure, and the likelihood of medical impoverishment. Third, inequity in financial protection by income quartiles has significantly decreased, though poorer groups remain more vulnerable. However, we do not observe a concurrent increase in satisfaction towards the health system. We also find that people are more willing to seek medical services in hospitals rather than primary care institutions. All these results suggest that China's ongoing health system reform should pay more attention to establishing a tiered health delivery system, strengthening financial protection for the poor, and increasing responsiveness to rising expectations.

China's New Cooperative Medical Scheme's Impact on the Medical Expenses of Elderly Rural Migrants

Background: With rapid urbanization in China, the scale of elderly migrants from rural areas to urban cities has increased rapidly from 5.03 million in 2000 to 13.4 million people in 2015. Methods: Based on the unbalanced panel data obtained from the Chinese Longitudinal Healthy Longevity Survey, this study investigates the impact of changes to the New Cooperative Medical Scheme (NCMS) on the medical expenditure of Chinese elderly rural migrants by using seemingly unrelated regression models. Results: NCMS coverage for elderly rural migrants rose from 11.83% in 2005 to 87.33% in 2014. The effective reimbursement rate increased significantly from 4.53% in 2005 to 36.44% in 2014, and out-of-pocket/income fell by 50% between 2005 and 2014. The NCMS significantly increased the effective reimbursement rate by 12.4% and out-of-pocket medical expenditure/income by 7.5% during this decade but played an insignificant role in reducing out-of-pocket payments. Conclusions: Policy makers need to promote a two-pronged strategy, which involves controlling the excessive growth of urban medical expenses and continuing to reform NCMS reimbursements for medical treatment, so non-urban resident elderly rural migrants can fully enjoy the welfare benefits of migration and urbanization.

Predictors of enrollment in a health protection scheme among informal sector workers in Kumasi Metropolis of Ghana

Objective

Informal sector workers are exposed to occupational hazards which could escalate their healthcare expenditures. Thus, enrollment in a health protection scheme among informal sector workers is useful for reducing their catastrophic healthcare expenditures. However, there is scant information on factors predicting their enrollment in the National Health Insurance Scheme (NHIS) in Ghana, a gap this quantitative study aims to fill. A sample of 350 informal sector workers was involved in a cross-sectional survey.

Results

Approximately 17% of the participants were enrolled in NHIS. Respondents who had worked between 5 and 7 years were significantly more likely to enroll in NHIS compared with those who had worked below 2 years (AOR = 13.159, CI 1.135–152.596, p = 0.039). The study further found that apprentices (AOR = 0.72, CI 0.353–1.056, p = 0.005) were less likely to enroll in NHIS compared with their masters. Participants who were exposed to electrical hazards (AOR = 2.93, CI 1.56–5.10, p = 0.013) and suffered from occupational diseases (AOR = 2.75, CI 1.743–5.17, p = 0.001) were significantly more likely to enroll in NHIS. Also, respondents who were non-Christians were significantly less likely to enroll in NHIS compared with their respective counterparts (AOR = 0.726, CI 0.067–2.503, p = 0.011). The findings are useful for increasing the NHIS enrollment rate among informal sector workers in Ghana.

Prevalence of diabetes among homeless and slum dwellers in Accra, Ghana: a survey study

OBJECTIVE

This study aimed at determining diabetes status of homeless people in Nima and Agbogbloshie, Accra, Ghana and to evaluate the association between socio-demographic characteristics and diabetes prevalence.

RESULTS

A total of 130 homeless and slum dwellers took part in the study out of which 7 (5.4%) participants were diagnosed with diabetes while 13 (10%) were considered as having prediabetes. This is slightly lower than what had been reported two decades ago but similar to overall estimates of diabetes prevalence in Africa (5.7%). Diagnosis of normoglycemia, prediabetes and diabetes was based on individual's hemoglobin A1c (HbA1c) level: ≤ 5.9%, 6.4-6.0%, and ≥ 6.5%, respectively. There was no significant association between prevalence of diabetes or prediabetes and the socio-demographic characteristics of the participants. The slightly lower diabetes prevalence among the homeless and slum dwellers compared to the general population may be due to constant movement of these people in the streets, a practice that could serve as a form of exercise for them. Intensive social support aimed at preventing and managing diabetes is crucial if we are to further reduce the incidence of diabetes in homeless people.

Latent and active tuberculosis infections in migrants and travellers: A retrospective analysis from the Spanish +REDIVI collaborative network

BACKGROUND

Tuberculosis (TB) is the leading cause of infectious disease mortality worldwide. We analysed active and latent TB infections (LTBI) from the Spanish Network for the Study of Imported Infectious Diseases by Travellers and Immigrants (+REDIVI).

METHODS

Observational, retrospective, multicentre study of TB and LTBI registered in the +REDIVI network from October 2009 to December 2016.

RESULTS

Of 1008 cases of LTBI, 884 (87.7%) were immigrants; 93 (4.5%), immigrants visiting friends and relatives (VFR); 2 (0.9%), VFR-travellers; and 29 (1.1%), travellers. Absolute (N = 157 vs. N = 75) and relative (12.5% vs. 5.9%) frequency decreased over the study period (p = 0.003). Median time to diagnosis was 24.6 months (females 50.3 vs males 11.9; p < 0.001). Of 448 TB cases, 405 (90.4%) were in immigrants; 30 (6.7%), VFR-immigrants; 6 (1.3%), VFR-travellers; and 7 (1.6%), travellers. Median time to diagnosis was 62.5 months (females 86.6 vs males 70.1; p = 0.0075). There were 8 multidrug resistant TB cases and 1 extensively drug resistant case of TB, all in immigrants.

CONCLUSION

TB was frequently diagnosed more than 5 years after arrival in Spain. Screening programmes for TB and LTBI in immigrants should be considered beyond this time point. Women showed a higher diagnostic delay for both latent and active TB.

Priorities and Challenges Accessing Health Care Among Female Migrants

Women’s ability to access health care requires access to and control of resources as well as the ability to make personal health decisions. Female migrants may experience additional challenges in accessing health care due to marginalization and vulnerability resulting from both their gender and their migrant status. Rural-to-urban migrant women working in the informal sector, such as Ghana’s head porters (kayayei), experience exclusion from the health system, risk of being uninsured, and poor health outcomes. Kayayei’s survival needs (eg, food, water) and a need to provide for their families can mean that migrant kayayei avoid health care expenses for illnesses or injuries. To ensure equal access to health care for migrant and non-migrant populations, health insurance is crucial. Yet, improving access to health care and service uptake requires more than health insurance. Incorporating culturally appropriate care into the provision of health services, or even developing specific migrant-friendly health services, could improve health service uptake and health awareness among migrants. Public health systems should also take account of migrants’ financial situations and priorities in the design and delivery of health services.