1
|
Cheng SPS, Heo K, Joos E, Vervoort D, Joharifard S. Barriers to Accessing Congenital Heart Surgery in Low- and Middle-Income Countries: A Systematic Review. World J Pediatr Congenit Heart Surg 2024; 15:94-103. [PMID: 37915213 DOI: 10.1177/21501351231204328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
BACKGROUND Congenital heart disease (CHD) is the most common major congenital anomaly. Ninety percent of children with CHD are born in low- and middle-income countries (LMICs), where over 90% of patients lack access to necessary treatments. Reports on barriers to accessing CHD care are limited. Accordingly, it is difficult to design evidence-based interventions to increase access to congenital cardiac surgical care in LMICs. OBJECTIVE We performed a qualitative systematic review to understand barriers to accessing congenital cardiac surgical care in LMICs. METHODS We conducted a search of Ovid MEDLINE and CINAHL databases to identify relevant articles from January 2000 to May 2021. We then used a thematic analysis to summarize qualitative data into a framework of preoperative, perioperative, and postoperative barriers. RESULTS Our search yielded 1,585 articles, of which 67 satisfied the inclusion criteria. Notable preoperative barriers included delayed diagnosis, insufficient caregiver education, financial constraints, difficulty reaching treatment centers, sociocultural stigma of CHD, sex-based discrimination of patients with CHD, and Indigeneity. Perioperative barriers included lack of hospital resources and workforce, need for prolonged hospitalization, and strained physician-patient relationships. Many patients faced barriers postoperatively and into adulthood due to a shortage of critical care resources, inadequate caregiver counseling and patient education, lack of follow-up, and debt from hospital bills and missed work. CONCLUSION Reducing neonatal and childhood mortality begins with recognizing barriers to accessing health care. Our systematic review identifies and classifies challenges in accessing CHD in LMICs and suggests solutions to major barriers.
Collapse
Affiliation(s)
- Samuel P S Cheng
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kayoung Heo
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emilie Joos
- Division of General Surgery, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dominique Vervoort
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Shahrzad Joharifard
- Division of Pediatric Surgery, Department of Surgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
2
|
Quintana HK, Gutierrez F, Ibarra F, Ruiz A, Niño C, Velásquez IM, Motta J. Description of the National Mortality Register of Panama. JOURNAL OF REGISTRY MANAGEMENT 2023; 50:155-164. [PMID: 38504706 PMCID: PMC10945919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Introduction The National Mortality Register (NMR) of Panama is a key element in demographic analysis and in acquiring an updated picture of population health in Panama. The main objectives of this study are to characterize the NMR and to enumerate its strengths and weaknesses. Methods We describe the history, processes, and structure of the Vital Statistics Section of the National Institute of Statistics and Census (the curator of the NMR database). In addition, we discuss publication punctuality, underregistration of the data, the proportion of registered deaths certified by medical doctors, and the top 5 causes of death according to the 80 groups of the International Classification of Diseases, Tenth Revision. We also examine works derived from the register's data, from the first publication on its website (2002) until 2019. Results The NMR procedures were described. The web reports of the NMR were performed with a delay of between 1 to 2 years. The underregistration of deaths in 2002-2019 was 14.7%, and the national yearly proportion of deaths certified by medical doctors was always above 90%. Hard-to-reach areas had higher underregistration proportions and fewer deaths certified by medical doctors. Information extracted from the NMR supports several national and international reports, geographic information systems, and studies. The most common causes of death between 2002 and 2019 were noncommunicable diseases. Conclusions The NMR is a robust official information system. However, hard-to-reach areas require improvement in terms of the NMR. The NMR is used for publishing official reports, writing studies, and updating reports on the current health status of Panama in a timely fashion following international guidelines.
Collapse
Affiliation(s)
- Hedley Knewjen Quintana
- Department of Research and Health Technology Assessment, Gorgas Memorial Institute for Health Studies, Panama City, Panama
- Department of Preventive and Social Medicine, Faculty of Medicine, University of Panama
| | - Fernando Gutierrez
- Vital Statistics Section, Instituto Nacional de Estadística y Censo, Contraloría General de la República de Panamá
| | - Fulvia Ibarra
- Vital Statistics Section, Instituto Nacional de Estadística y Censo, Contraloría General de la República de Panamá
| | - Andy Ruiz
- Vital Statistics Section, Instituto Nacional de Estadística y Censo, Contraloría General de la República de Panamá
| | - Cecilio Niño
- Department of Research and Health Technology Assessment, Gorgas Memorial Institute for Health Studies, Panama City, Panama
| | - Ilais Moreno Velásquez
- Department of Research and Health Technology Assessment, Gorgas Memorial Institute for Health Studies, Panama City, Panama
| | - Jorge Motta
- Department of Research and Health Technology Assessment, Gorgas Memorial Institute for Health Studies, Panama City, Panama
| |
Collapse
|
3
|
Del Rio AI, Moreno Velásquez I, Roa R, Montenegro Mendoza R, Motta J, Quintana HK. Prevalence of hypertension and possible risk factors of hypertension unawareness among individuals aged 30-75 years from two Panamanian provinces: Results from population-based cross-sectional studies, 2010 and 2019. PLoS One 2022; 17:e0276222. [PMID: 36441768 PMCID: PMC9704556 DOI: 10.1371/journal.pone.0276222] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 10/04/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Recent estimates of hypertension in Panama remain unknown. We aim to describe the variation in prevalence and unawareness of hypertension in two Panamanian provinces using two different cross-sectional population-based studies and to investigate risk factors associated with hypertension unawareness. METHODS Data were derived from a sub-national study conducted in the provinces of Panama and Colon (PREFREC-2010 [2,733 participants]) and from a nationally representative study (ENSPA-2019), in which we restricted our analyses to the same provinces (4,653 participants). Individuals aged 30-75 years who had (a) self-reported history of hypertension or (b) blood pressure (BP) ≥140/90mmHg or (c) a combination or both were classified as hypertensive. Participants with BP≥140/90mmHg who denied a history of hypertension were considered unaware of the condition. Multivariable logistic regression models were used to estimate the association between risk factors and unawareness, expressed as odds ratios (OR) and 95% confidence interval (CI). FINDINGS In 2010, the prevalence and unawareness of hypertension in men were 51.6% (95% CI: 45.7-57.5) and 32.3% (25.4-40.1), respectively, and in women 46.0% (42.1-49.9) and 16.1% (12.6-20.4), respectively. In 2019, the prevalence and unawareness of hypertension in men were 46.5% (42.1-51.0) and 52.3% (45.9-58.6), and in women 42.1% (39.6-44.7) and 33.3% (29.8-37.0). Men (2010 and 2019), age <50 years (2010 and 2019), having no/primary education (2010), and living in a non-urban region (2019) were positively associated with hypertension unawareness, whereas obesity (2010), physical inactivity (2010), family history of hypertension (2019), and BP assessment in the year before study enrollment (2010 and 2019) were inversely associated with hypertension unawareness. INTERPRETATION Benefits of a decrease in the prevalence of hypertension are being undermined by an increase in hypertension unawareness. Actions should be encouraged to strengthen the implementation of the existing healthcare program for cardiovascular risk factor control.
Collapse
Affiliation(s)
- Angela Isabel Del Rio
- Gorgas Memorial Institute for Health Studies, Panama City, Panama
- Ministry of Health, Panama City, Panama
- * E-mail:
| | - Ilais Moreno Velásquez
- Gorgas Memorial Institute for Health Studies, Panama City, Panama
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Berlin, Germany
| | - Reina Roa
- Gorgas Memorial Institute for Health Studies, Panama City, Panama
- Ministry of Health, Panama City, Panama
| | | | - Jorge Motta
- Gorgas Memorial Institute for Health Studies, Panama City, Panama
| | | |
Collapse
|
4
|
Tran R, Forman R, Mossialos E, Nasir K, Kulkarni A. Social Determinants of Disparities in Mortality Outcomes in Congenital Heart Disease: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 9:829902. [PMID: 35369346 PMCID: PMC8970097 DOI: 10.3389/fcvm.2022.829902] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundSocial determinants of health (SDoH) affect congenital heart disease (CHD) mortality across all forms and age groups. We sought to evaluate risk of mortality from specific SDoH stratified across CHD to guide interventions to alleviate this risk.MethodsWe searched electronic databases between January 1980 and June 2019 and included studies that evaluated occurrence of CHD deaths and SDoH in English articles. Meta-analysis was performed if SDoH data were available in >3 studies. We included race/ethnicity, deprivation, insurance status, maternal age, maternal education, single/multiple pregnancy, hospital volume, and geographic location of patients as SDoH. Data were pooled using random-effects model and outcome was reported as odds ratio (OR) with 95% confidence interval (CI).ResultsOf 17,716 citations reviewed, 65 met inclusion criteria. Sixty-three were observational retrospective studies and two prospective. Of 546,981 patients, 34,080 died. Black patients with non-critical CHD in the first year of life (Odds Ratio 1.62 [95% confidence interval 1.47–1.79], I2 = 7.1%), with critical CHD as neonates (OR 1.27 [CI 1.05-1.55], I2 = 0%) and in the first year (OR 1.68, [1.45-1.95], I2 = 0.3%) had increased mortality. Deprived patients, multiple pregnancies, patients born to mothers <18 years and with education <12 years, and patients on public insurance with critical CHD have greater likelihood of death after the neonatal period.ConclusionThis systematic review and meta-analysis found that Black patients with CHD are particularly vulnerable for mortality. Numerous SDoH that affect mortality were identified for specific time points in CHD course that may guide interventions, future research and policy.Systematic Review Registration[https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42019139466&ID=CRD42019139466], identifier [CRD42019139466].
Collapse
Affiliation(s)
- Richard Tran
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
- *Correspondence: Richard Tran,
| | - Rebecca Forman
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Elias Mossialos
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Khurram Nasir
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Institute, Houston Methodist Hospital, Houston, TX, United States
| | - Aparna Kulkarni
- Cohen Children’s Medical Center, Donald and Barbara Zucker School of Medicine, New Hyde Park, NY, United States
| |
Collapse
|
5
|
Simas C, Larson HJ, Paterson P. ''Those who do not vaccinate don't love themselves, or anyone else'': a qualitative study of views and attitudes of urban pregnant women towards maternal immunisation in Panama. BMJ Open 2021; 11:e044903. [PMID: 34417210 PMCID: PMC8381308 DOI: 10.1136/bmjopen-2020-044903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES To identify pregnant women's views and attitudes towards maternal immunisation in Panama based on in-depth interviews and focus groups. SETTING Two main urban centres in Panama (San Miguelito and Panama City). PARTICIPANTS Fifty-six pregnant women from Panama City (n=29) and San Miguelito (n=27). METHODS In-depth interviews and focus groups were conducted, audio-recorded, transcribed verbatim and analysed using a deductive-inductive approach. RESULTS Our findings suggest that this population perceives vaccination as a key component of maternal healthcare, not an elective part of it. The pregnant women interviewed disclosed a heightened perception of vulnerability to infectious diseases. For this reason, safety and effectiveness of maternal vaccines were closely associated for many participants (a vaccine was perceived as safe if it was effective against disease). Refusal of maternal vaccination was strongly associated with parental negligence. Participants reported the participation of husbands and partners in the decision-making around their health. Most participants reported high information-seeking behaviour, particularly online; many interviewees confirmed any information obtained online with their healthcare professionals (HCPs). Vaccine recommendations from HCPs appeared to be one of the main predictors of maternal immunisations among the sample interviewed. While acceptability of maternal vaccines was high in this sample, some pregnant women expressed concerns and doubts (e.g., that maternal vaccines could cause miscarriages) which require attention. Finally, many participants reported difficulties in accessing maternal vaccination, pointing to financial and physical barriers. CONCLUSIONS The acceptability of maternal immunisation was high among the interviewed women. The pregnant women's receptiveness to maternal vaccinations, even when information provided was limited, is suggestive of high levels of trust in HCPs. Even so, HCPs and health officials should remain alert to apprehensions expressed by pregnant women. Many participants reported struggles in accessing maternal vaccination, pointing to issues that merit further examination.
Collapse
Affiliation(s)
- Clarissa Simas
- Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Heidi J Larson
- Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Department of Health Metrics Sciences, University of Washington, Seattle, Washington, USA
| | - Pauline Paterson
- Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- National Institute for Health Research Health Protection Research Unit (NIHR-HPRU) in Immunisation, London School of Hygiene and Tropical Medicine in partnership with Public Health England, London, UK
| |
Collapse
|
6
|
Castro F, Benavides Lara A, Garcés A, Moreno-Velásquez I, Odell C, Pérez W, Ortiz-Panozo E. Under-5 Mortality in Central America: 1990-2016. Pediatrics 2021; 147:peds.2020-003442. [PMID: 33361357 DOI: 10.1542/peds.2020-003442] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We aimed to calculate the change in under-5 mortality rates (U5MRs) (1990-2016), to assess countries' status regarding Sustainable Development Goal (SDG) 3.2.1 (reducing the U5MR to ≤25 deaths per 1000 live births by 2030), to list the most important causes of death (1990, 2016), and to examine the association between selected SDG indicators and U5MRs using a linear mixed-effects regression. METHODS Ecological study in which we used estimates from the Global Burden of Disease Study 2016 for Central American countries. Results were expressed as U5MRs (deaths per 1000 live births), cause-specific mortality rates (deaths per 100 000 population <5 years of age), and regression coefficients with 95% confidence intervals. RESULTS U5MRs decreased 65% (1990-2016), and in 2016, all countries but Guatemala had met SDG 3.2.1. The main causes of death were diarrheal diseases (1990; 311.1 per 100 000) and lower respiratory infections (LRIs) (2016; 78.1 per 100 000). When disaggregated by country (2016), congenital birth defects were the most important cause of death in all countries except for in Honduras (neonatal preterm birth) and Guatemala (LRIs). Nutritional status; availability of water, sanitation, and hygiene services; coverage of vaccines; and coverage of contraception were associated with a reduction in U5MRs. CONCLUSIONS Central America has achieved a large reduction in U5MRs. Countries must address both the high mortality caused by LRIs and the rising mortality caused by noncommunicable causes of death through an improvement of SDG indicators that guarantees equitable progress in child survival in the region.
Collapse
Affiliation(s)
- Franz Castro
- Gorgas Memorial Institute for Health Studies, Panama City, Panama.,Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Adriana Benavides Lara
- Costa Rican Institute of Research and Teaching in Nutrition and Health, Cartago, Costa Rica
| | - Ana Garcés
- Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | | | - Chris Odell
- Institute for Health Metrics and Evaluation, Seattle, Washington; and
| | - Wilton Pérez
- Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Eduardo Ortiz-Panozo
- Center for Population Health Research, National Institute of Public Health of Mexico, Cuernavaca, Mexico
| |
Collapse
|
7
|
Best KE, Vieira R, Glinianaia SV, Rankin J. Socio-economic inequalities in mortality in children with congenital heart disease: A systematic review and meta-analysis. Paediatr Perinat Epidemiol 2019; 33:291-309. [PMID: 31347722 DOI: 10.1111/ppe.12564] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/02/2019] [Accepted: 05/27/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND The impact of socio-economic status (SES) on congenital heart disease (CHD)-related mortality in children is not well established. OBJECTIVES We aimed to systematically review and appraise the existing evidence on the association between SES (including poverty, parental education, health insurance, and income) and mortality among children with CHD. DATA SOURCES Seven electronic databases (Medline, Embase, Scopus, PsycINFO, CINAHL, ProQuest Natural, and Biological Science Collections), reference lists, citations, and key journals were searched. STUDY SELECTION AND DATA EXTRACTION We included articles reporting original research on the association between SES and mortality in children with CHD if they were full papers published in the English language and regardless of (a) timing of mortality; (b) individual or area-based measures of SES; (c) CHD subtype; (d) age at ascertainment; (e) study period examined. Screening for eligibility, data extraction, and quality appraisal were performed in duplicate. SYNTHESIS Meta-analyses were performed to estimate pooled ORs for in-hospital mortality according to health insurance status. RESULTS Of 1388 identified articles, 28 met the inclusion criteria. Increased area-based poverty was associated with increased odds/risk of postoperative (n = 1), neonatal (n = 1), post-discharge (n = 1), infant (n = 1), and long-term mortality (n = 2). Higher parental education was associated with decreased odds/risk of neonatal (n = 1) and infant mortality (n = 5), but not with long-term mortality (n = 1). A meta-analysis of four US articles showed increased unadjusted odds of in-hospital mortality in those with government/public versus private health insurance (OR 1.40, 95% CI 1.24, 1.56). The association between area-based income and CHD-related mortality was conflicting, with three of eight articles reporting significant associations. CONCLUSION This systematic review provides evidence that children of lower SES are at increased risk of CHD-related mortality. As these children are over-represented in the CHD population, interventions targeting socio-economic inequalities could have a large impact on improving CHD survival.
Collapse
Affiliation(s)
- Kate E Best
- Institute of Health & Society, Newcastle University, Newcastle Upon Tyne, UK
| | - Rute Vieira
- Institute of Health & Society, Newcastle University, Newcastle Upon Tyne, UK.,The Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Judith Rankin
- Institute of Health & Society, Newcastle University, Newcastle Upon Tyne, UK
| |
Collapse
|
8
|
Armstrong ADC, Ladeia AMT, Marques J, Armstrong DMFDO, Silva AMLD, Morais Junior JCD, Barral A, Correia LCL, Barral-Netto M, Lima JAC. Urbanization is Associated with Increased Trends in Cardiovascular Mortality Among Indigenous Populations: the PAI Study. Arq Bras Cardiol 2018; 110:240-245. [PMID: 29466492 PMCID: PMC5898773 DOI: 10.5935/abc.20180026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 09/22/2017] [Indexed: 12/19/2022] Open
Abstract
Background The cardiovascular risk burden among diverse indigenous populations is not
totally known and may be influenced by lifestyle changes related to the
urbanization process. Objectives To investigate the cardiovascular (CV) mortality profile of indigenous
populations during a rapid urbanization process largely influenced by
governmental infrastructure interventions in Northeast Brazil. Methods We assessed the mortality of indigenous populations (≥ 30 y/o) from
2007 to 2011 in Northeast Brazil (Bahia and Pernambuco states).
Cardiovascular mortality was considered if the cause of death was in the
ICD-10 CV disease group or if registered as sudden death. The indigenous
populations were then divided into two groups according to the degree of
urbanization based on anthropological criteria:9,10
Group 1 - less urbanized tribes (Funi-ô, Pankararu, Kiriri, and
Pankararé); and Group 2 - more urbanized tribes (Tuxá,
Truká, and Tumbalalá). Mortality rates of highly urbanized
cities (Petrolina and Juazeiro) in the proximity of indigenous areas were
also evaluated. The analysis explored trends in the percentage of CV
mortality for each studied population. Statistical significance was
established for p value < 0.05. Results There were 1,333 indigenous deaths in tribes of Bahia and Pernambuco
(2007-2011): 281 in Group 1 (1.8% of the 2012 group population) and 73 in
Group 2 (3.7% of the 2012 group population), CV mortality of 24% and 37%,
respectively (p = 0.02). In 2007-2009, there were 133 deaths in Group 1 and
44 in Group 2, CV mortality of 23% and 34%, respectively. In 2009-2010,
there were 148 deaths in Group 1 and 29 in Group 2, CV mortality of 25% and
41%, respectively. Conclusions Urbanization appears to influence increases in CV mortality of indigenous
peoples living in traditional tribes. Lifestyle and environmental changes
due to urbanization added to suboptimal health care may increase CV risk in
this population.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Aldina Barral
- Centro de Pesquisas Gonçalo Moniz, Centro de Pesquisas Gonçalo Moniz da Fundação Oswaldo Cruz, Salvador, BA, Brazil
| | | | - Manoel Barral-Netto
- Centro de Pesquisas Gonçalo Moniz, Centro de Pesquisas Gonçalo Moniz da Fundação Oswaldo Cruz, Salvador, BA, Brazil
| | | |
Collapse
|