Planning for health equity in the Americas: an analysis of national health plans

Factors Affecting Age of Initial Specialty Clinic Evaluation Among Infants with Sickle Cell Disease in Kingston, Jamaica

OBJECTIVES

To evaluate the effectiveness of newborn screening for sickle cell disease in eastern Jamaica by determining what proportion of screen-positive infants were registered with the Sickle Cell Unit (SCU) by two months (60 days) of age and identifying parents' perceptions of facilitators and barriers impacting age at registration.

STUDY DESIGN

This cross-sectional study used a mixed method approach. Ages at diagnosis confirmation and first clinic visit were recorded for screen-positive infants born between February 1, 2015, and November 15, 2017. All parents were invited to complete the survey and early and late attendees were invited to participate in the qualitative aspect of the study. A researcher-designed questionnaire and an interview guide based on the Capability, Opportunity, Motivation, Behavior (COM-B), and Health Belief Models examined factors that may affect time to registration. Quantitative data were analyzed to yield descriptive statistics using Stata®v14. All interview data were coded. Similar codes were grouped together into themes.

RESULTS

Most (97.7%) of the 133 screen-positive infants had their diagnosis confirmed. Only 40% had their first clinic visit by age 60 days. Denial of the diagnosis, poor communication, and the costs of treatment and transportation were perceived barriers to registration, whereas family support was a facilitator.

CONCLUSIONS

Diagnosis confirmation was almost universal, but most infants did not attend clinic by two months of age. In-depth interviews have identified several facilitators and barriers that can be targeted to improve early registration.

Ethnic-Regional Differences in the Allocation of High Complexity Spending in Brazil: Time Analysis 2010-2019

The following paper presents as a research problem the ethnic-regional differences in the allocation of high complexity spending in Brazil in an analysis from 2010 to 2019. This is a descriptive research in which a generalized linear model (GLM) was developed to analyze these hospital expenditures with high complexity procedures. The total spending on high complexity procedures in Brazil has increased over the past decade. The study shows that the lowest average expenditures are found in the North and Northeast regions. When comparing the spending between different ethnicities, it was observed that the only decrease between the years 2010 and 2019 was in the amount spent on procedures in indigenous people. The spending on male patients was significantly higher compared to female patients. The highest expenditures, on the other hand, are concentrated in the regions of state capitals favoring the strengthening of hub municipalities. Geographic inequalities in access still persist, even with most states already offering almost all procedures. The Brazilian territory is very heterogeneous and needs to organize its health system by regions, therefore integrated public policies and economic and social development are urgently needed.