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Healthcare
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Access and Healthcare for Disadvantaged Populations
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Access and Healthcare for Disadvantaged Populations

A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Health Assessments".

Deadline for manuscript submissions: closed (31 December 2022) | Viewed by 33146

Special Issue Editor

Dr. Khoa Truong

E-Mail Website
Guest Editor
Department of Public Health Sciences, 509 Edwards Hall, Clemson University South Carolina, Clemson, SC 29631, USA
Interests: access and healthcare for disadvantaged populations; insurance, utilization of healthcare services, and health outcomes; tobacco, alcohol, and illicit drug control policy; obesity, mental health, child health; built environment and health, global health; statistical modelling, GIS, and simulation
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This Special Issue of Healthcare seeks commentaries, original research, short reports, and reviews on exacerbated and new challenges in healthcare services in the era of Covid-19 for disadvantages populations including the uninsured, under-insured, and rural population. While the Covid pandemic has taken heavy toll on the entire world population, certain sociodemographic groups are less prepared and more vulnerable to problems associated with isolation and reduced services. This Special Issue aims to publish research from emerging opportunities such as new data, revised care protocol, collaborative partnerships, and novel service model to inform the debate and discussion on meaningful changes or necessary modification in practice and policy. While addressing disparities in healthcare services has been an important priority of any health systems, this task will become increasingly critical in the years to come as Covid-19 has a lasting impact and probably widened the gap of health-related disparity. Progress in improving healthcare services for the disadvantaged population made in recent years could have been eliminated. Rigorous analyses and effective solutions to improve quality and access while containing and lowing healthcare costs for the vulnerable population are critically needed. Studies published in this Special Issue are envisioned to aid health administrators, policy analysts, and government officials in developing their strategic planning and policy implementation.

Prof. Khoa Truong
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Covid-19
  • Uninsured, under-insured, rural population, vulnerable groups
  • Healthcare needs, healthcare services, access to healthcare services
  • Isolation, barriers, disparities

Published Papers (16 papers)

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Research

13 pages, 2245 KiB  
Article
A Pilot Feasibility Study to Establish Full Pulpotomy in Mature Permanent Teeth with Symptomatic Irreversible Pulpitis as a Routine Treatment in Mexican Public Healthcare Services
by Roberto Gustavo Sánchez-Lara y Tajonar, Jaime Vicente Vergara-Tinoco, Till Dammaschke and Rubén Abraham Domínguez-Pérez
Healthcare 2022, 10(12), 2350; https://doi.org/10.3390/healthcare10122350 - 23 Nov 2022
Cited by 2 | Viewed by 1448
Abstract
Symptomatic irreversible pulpitis is a common dental disease for which root canal treatment (RCT) has been the standard treatment. However, in many countries, RCT is considered a high-cost treatment that is not covered by public healthcare services; this forces patients to have dental [...] Read more.
Symptomatic irreversible pulpitis is a common dental disease for which root canal treatment (RCT) has been the standard treatment. However, in many countries, RCT is considered a high-cost treatment that is not covered by public healthcare services; this forces patients to have dental extraction as their only option to relieve pain. In the last decade, several investigations have provided evidence that an alternative treatment known as full pulpotomy (FP) could be an alternative for patients who could not afford the cost of an RCT. Nevertheless, evidence is lacking on the success rate that could be obtained if it is performed in a public dental care clinic (PDCC). The present investigation has two main objectives. To be the first approach of a multicentric feasibility study to find out whether an FP performed by a general practice dentist (GPD) in a PDCC could be suitable and establish its success rate and patient satisfaction. Patients attending a PDCC with symptoms of irreversible pulpitis were invited to participate. FP was performed and followed up at 1, 3, 6, 9, and 12 months. The treatment success was assessed by combining three variables, patient satisfaction, clinical, and radiographic outcomes. Forty-one patients from 17 to 78 years old received the intervention. In total, 97.5% were completely satisfied with the treatment and were considered successful since none of the clinical or radiographic variables were present in any of the follow-ups. An FP performed by a GPD in a PDCC could be suitable as a routine treatment for symptomatic irreversible pulpitis due to the excellent success rate and patient satisfaction. Full article
(This article belongs to the Special Issue Access and Healthcare for Disadvantaged Populations)
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8 pages, 237 KiB  
Article
The Alonissos Study: Cross-Sectional Study of the Community Respiratory Health Status in a Greek Healthcare Access Underprivileged Island
by Petros Kassas, Eudoxia Gogou, Charalampos Varsamas, Konstantinos Vogiatzidis, Aggeliki Psatha, Maria Pinaka, Dimitra Siachpazidou, Alexandra Sistou, Eleftherios D. Papazoglou, Despoina Kalousi, Konstantina Vatzia, Kyriaki Astara, Nikolaos Tsiouvakas, Sotirios G. Zarogiannis and Konstantinos I. Gourgoulianis
Healthcare 2022, 10(12), 2338; https://doi.org/10.3390/healthcare10122338 - 22 Nov 2022
Cited by 3 | Viewed by 1240
Abstract
In this study, we investigated the self-reported (questionnaire-based) prevalence of Obstructive Sleep Apnoea Syndrome (OSAS) and the prevalence of Chronic Obstructive Pulmonary Diseases (COPD) in the context of demographics and adherence to the Mediterranean diet in the general population of Alonissos, a non-profit [...] Read more.
In this study, we investigated the self-reported (questionnaire-based) prevalence of Obstructive Sleep Apnoea Syndrome (OSAS) and the prevalence of Chronic Obstructive Pulmonary Diseases (COPD) in the context of demographics and adherence to the Mediterranean diet in the general population of Alonissos, a non-profit line island in Greece (i.e., with scarce boat transportation to the mainland). In this cross-sectional study, 236 inhabitants of Alonissos participated (circa 10% of the island’s population), and 115 males and 121 females were evaluated with appropriate questionnaires for OSAS, COPD, and adherence to the Mediterranean diet and subsequently underwent spirometry testing to establish COPD diagnosis. The self-reported prevalence of OSAS and COPD was 9.44% and 18.8%, respectively. However, only 8.99% of the participants were diagnosed with COPD based on their spirometry testing. Adherence to the Mediterranean Diet was moderate. The high prevalence of COPD and OSAS in this underprivileged island in terms of healthcare access highlights the need for improvements in health promotion and primary healthcare provision in non-profit line Greek islands. Full article
(This article belongs to the Special Issue Access and Healthcare for Disadvantaged Populations)
7 pages, 1535 KiB  
Article
Impact of the Implementation of Laboratory Information System (WWDISA) on Timely Provision of HIV-1 Viral Load Results in a Rural Area, Inhambane, Mozambique
by Elda Muianga Anapakala, Patrina Chongo, Isis da Barca, Tomás Dimas, Nadia Sitoe, Ruben Sebastião, Francelino Chongola, Isabel Pinto, Osvaldo Loquiha, Solon Kidane, Ilesh Jani and Sofia Viegas
Healthcare 2022, 10(11), 2167; https://doi.org/10.3390/healthcare10112167 - 29 Oct 2022
Viewed by 1710
Abstract
WWDISA is an optional module of the DISA Laboratory Information system (LIS) that offers a web portal that allows access to test results over the internet for patient clinical management. This study aims to assess the applicability of using the WWDISA web application, [...] Read more.
WWDISA is an optional module of the DISA Laboratory Information system (LIS) that offers a web portal that allows access to test results over the internet for patient clinical management. This study aims to assess the applicability of using the WWDISA web application, and the lessons learned from its implementation in six health facilities in Mabote district, Inhambane province. Data from 2463 and 665 samples for HIV-viral load (HIVVL) tests, extracted from paper-based and WWDISA systems, respectively, were included, from January to December 2020. Data were simultaneously collected on a quarterly basis from both systems to allow comparison. The WWDISA turnaround time (TAT) from sample collection to results becoming available was found to be 10 (IQR: 8–12) days and significantly lower than the health unit manual logbook (p value < 0.001). Regarding the system efficiency, it was found that among 1978 search results, only 642 (32.5%) were found, and the main challenges according to the users were lack of connectivity (77%) and the website going down (62%). The WWDISA module has been shown to be effective in reducing the TAT, although a stable internet connection and accurate data entry are essential to make the system functional. Full article
(This article belongs to the Special Issue Access and Healthcare for Disadvantaged Populations)
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19 pages, 624 KiB  
Article
Experiences and Perceived Barriers of Asylum Seekers and People with Refugee Backgrounds in Accessing Healthcare Services in Romania
by Liliana Dumitrache, Mariana Nae, Alina Mareci, Anca Tudoricu, Alexandra Cioclu and Alexandra Velicu
Healthcare 2022, 10(11), 2162; https://doi.org/10.3390/healthcare10112162 - 29 Oct 2022
Cited by 6 | Viewed by 2364
Abstract
Traditionally a country of emigration, Romania recently experienced an increased migration influx, although it is more a country of transit than a destination for refugees and irregular migrants. Refugees often face difficulties when trying to meet their needs and access essential services. This [...] Read more.
Traditionally a country of emigration, Romania recently experienced an increased migration influx, although it is more a country of transit than a destination for refugees and irregular migrants. Refugees often face difficulties when trying to meet their needs and access essential services. This study aims to explore the experiences and barriers of asylum seekers and people with refugee backgrounds in accessing healthcare services in Romania. It is an exploratory study with a qualitative research design, which uses an inductive and deductive approach, with thematic analysis being applied in order to grasp the difficulties and barriers that asylum seekers and people with refugee backgrounds experience in accessing essential social services. The research was based on seven in-depth interviews with representatives of significant national or international non-governmental organisations assisting refugees and asylum seekers in Romania and 129 semi-structured interviews with different categories of people with refugee backgrounds from Southwest Asia, Eastern Africa and Ukraine. One of the most salient themes we identified relates to accessing the healthcare system. Participants talked about what information they needed to access medical services, where they looked for this information, and what barriers they faced in the process. Cultural, linguistic, structural, and financial barriers were perceived as the most significant. Improved public awareness, a better understanding of asylum issues, and stronger community support are essential to addressing inequalities experienced by this vulnerable population. Full article
(This article belongs to the Special Issue Access and Healthcare for Disadvantaged Populations)
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10 pages, 254 KiB  
Article
Cervical Cancer Screening among Female Refugees in Jordan: A Cross-Sectional Study
by Nadia Muhaidat, Mohammad A. Alshrouf, Roaa N. Alshajrawi, Zeina R. Miqdadi, Raghad Amro, Abedalaziz O. Rabab’ah, Serena A. Qatawneh, Alaa M. Albandi and Kamil Fram
Healthcare 2022, 10(7), 1343; https://doi.org/10.3390/healthcare10071343 - 20 Jul 2022
Cited by 1 | Viewed by 2720
Abstract
Background: Cervical cancer (CC) is mainly linked to infection with a high-risk oncogenic human papillomavirus (HPV), with 85% of deaths occurring in developing countries. Refugees are less likely to be aware of screening methods and to have routine gynecological examinations. Methods: This is [...] Read more.
Background: Cervical cancer (CC) is mainly linked to infection with a high-risk oncogenic human papillomavirus (HPV), with 85% of deaths occurring in developing countries. Refugees are less likely to be aware of screening methods and to have routine gynecological examinations. Methods: This is a cross-sectional study involving a total of 359 women aged 19–64 living in the Jerash camp in Jordan. Data were collected using a carefully developed and validated questionnaire. Results: A total of 359 participants were included in the study, with a mean age of 38.99 ± 10.53. Participants demonstrated fair knowledge of CC risk factors (4.77 ± 2.85 out of 11). Among the participants, 73.5% had heard of the cervical smear test; however, only 12.8% had actually undergone the test, with a mean total number of smear tests performed of 1.48 ± 0.79 and the mean age at the time of the first test was 32.5 ± 7.89. Conclusions: Refugee women have a fair level of knowledge of CC risk factors but are unmotivated to have a Pap smear test to screen for CC. Efforts should be made to raise awareness about the issue and promote testing for underrepresented women in refugee camps. Full article
(This article belongs to the Special Issue Access and Healthcare for Disadvantaged Populations)
18 pages, 303 KiB  
Article
Irregular Migrant Workers and Health: A Qualitative Study of Health Status and Access to Healthcare of the Filipino Domestic Workers in Mainland China
by Hui Chen, Quan Gao, Brenda S. A. Yeoh and Yungang Liu
Healthcare 2022, 10(7), 1204; https://doi.org/10.3390/healthcare10071204 - 27 Jun 2022
Cited by 1 | Viewed by 1781
Abstract
In public health research, the health issues of irregular and vulnerable migrant populations remain under-explored. In particular, while mainland China has become a new and popular job-seeking destination for Filipino domestic workers (FDWs), the health status of FDWs and their access to healthcare [...] Read more.
In public health research, the health issues of irregular and vulnerable migrant populations remain under-explored. In particular, while mainland China has become a new and popular job-seeking destination for Filipino domestic workers (FDWs), the health status of FDWs and their access to healthcare have been invisible to public and academic concerns. This paper fills this lacuna by conducting a qualitative study that investigates FDWs’ self-reported health status and their healthcare-seeking behaviors. The results show that: (1) respondents do not report significant abusive and exploitative experience because the scarcity of FDWs in China in relation to the high demand enables them a certain degree of agency in labour market; (2) while FDWs do report some health problems, they tend to resort to self-medication and food-healing; (3) the main factors influencing health-seeking behavior include the fear of deportation, language gaps, the lack of knowledge of the local healthcare system and dependence on co-ethnic networks which serves as a double-edged sword; (4) these factors also lead to hesitation in health-seeking choice between public and private hospitals, which sometimes result in delayed treatment. This paper contributes to revealing the health conditions of FDWs in mainland China and calls for more inclusive health policy to enroll foreign domestic workers into the local health system in China. Full article
(This article belongs to the Special Issue Access and Healthcare for Disadvantaged Populations)
20 pages, 1982 KiB  
Article
Readiness of Mozambique Health Facilities to Address Undernutrition and Diarrhea in Children under Five: Indicators from 2018 and 2021 Survey Data
by Júlia Sambo, Adilson Fernando Loforte Bauhofer, Simone S. Boene, Marlene Djedje, António Júnior, Adalgisa Pilale, Luzia Gonçalves, Nilsa de Deus and Sérgio Chicumbe
Healthcare 2022, 10(7), 1200; https://doi.org/10.3390/healthcare10071200 - 27 Jun 2022
Cited by 2 | Viewed by 2102
Abstract
The World Health Organization’s systems framework shows that service delivery is key to addressing pressing health needs. Inadequate healthcare and the lack of healthcare services are factors associated with undernutrition and diarrhea in children under five, two health conditions with high morbi-mortality rates [...] Read more.
The World Health Organization’s systems framework shows that service delivery is key to addressing pressing health needs. Inadequate healthcare and the lack of healthcare services are factors associated with undernutrition and diarrhea in children under five, two health conditions with high morbi-mortality rates in Mozambique. The aim of the analysis was to determine the readiness score of nutrition and diarrhea services for children under five and the influence of malaria and HIV (Human Immunodeficiency Virus) service readiness on the readiness of these two services. A total of 1644 public health facilities in Mozambique were included from the 2018 Service Availability and Readiness Assessment. Additionally, a cross-sectional study was conducted to determine the availability and readiness scores of nutrition services in 2021 in five referral health facilities. The availability of nutrition and diarrhea services for children is low in Mozambique, with both scoring below 75%. Major unavailability was observed for human resources, guidelines, and training dimensions. Diarrhea (median (IQ): 72.2% (66.7 to 83.3)) and nutrition service readiness (median (IQ): 57.1% (52.4 to 57.1)) scores were significantly different (p < 0.001), while it is desirable for both services to be comprehensively ready. Nutrition services are positively associated with diarrhea service readiness and both services are associated with malaria and HIV service readiness (p < 0.05). None of the health facilities had all tracer items available and none of the facilities were considered ready (100%). There is a persisting need to invest comprehensively in readiness dimensions, within and across child health services. Full article
(This article belongs to the Special Issue Access and Healthcare for Disadvantaged Populations)
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10 pages, 254 KiB  
Article
Healthcare Utilization and Smoking among South Carolina’s Long-Term Uninsured
by Caitlin Torrence, Khoa Truong and Laksika B. M. Sivaraj
Healthcare 2022, 10(6), 1079; https://doi.org/10.3390/healthcare10061079 - 10 Jun 2022
Cited by 1 | Viewed by 1263
Abstract
Cigarette smoking and tobacco-related health conditions have continued to rise among persons of low social economic status. This study explored the association between healthcare utilization and smoking among the long-term uninsured (LTU). The sample consisted of South Carolina residents who had been without [...] Read more.
Cigarette smoking and tobacco-related health conditions have continued to rise among persons of low social economic status. This study explored the association between healthcare utilization and smoking among the long-term uninsured (LTU). The sample consisted of South Carolina residents who had been without healthcare insurance for at least 24 months. Multivariable logistic regression was used to estimate differences in the likelihood of delaying healthcare due to cost and/or not filling a needed prescription between smokers and non-smokers. Among LTU, smoking was a significant predictor of delaying healthcare at the 10% level (AOR = 1.36, 95% CI = 0.99–1.86); the sensitivity analysis strengthened this association at the 5% level (AOR = 1.43, 95% CI = 1.06–1.93). Smoking was a significant predictor of not filling needed prescriptions (AOR = 1.44, 95% CI = 1.06–1.96). While neglected healthcare utilization was common among the LTU, this problem was more severe among smokers. The wider gap in access to healthcare services among the LTU, especially LTU who smoke, warrants further attention from the research community and policy makers. Full article
(This article belongs to the Special Issue Access and Healthcare for Disadvantaged Populations)
17 pages, 832 KiB  
Article
Factors Associated with Caesarean and Peripartum Complications at Southern Mozambique’s Rural Hospitals: A Cross-Sectional Analytical Study
by Sérgio Chicumbe, Group POEM and Maria do Rosário Oliveira Martins
Healthcare 2022, 10(6), 1013; https://doi.org/10.3390/healthcare10061013 - 31 May 2022
Cited by 1 | Viewed by 1381
Abstract
Information about factors underlying peripartum complications is needed to inform health programs in Mozambique. This retrospective study covered the period from January 2013 to December 2018 and was performed at three rural-district hospitals in southern Mozambique, aiming at assessing factors associated with caesarean [...] Read more.
Information about factors underlying peripartum complications is needed to inform health programs in Mozambique. This retrospective study covered the period from January 2013 to December 2018 and was performed at three rural-district hospitals in southern Mozambique, aiming at assessing factors associated with caesarean and peripartum complications. Data were extracted by clinical criteria-based audits on randomly select clients’ files. Logistical regression was used to identify factors associated with peripartum complications. Amongst 5068 audited files, women mean age was 25 years (Standard Deviation (SD) = 7), gestational age was 38 weeks (SD = 2), 25% had “high obstetric-risk” and 19% delivered by caesarean. Factors significantly associated with caesarean included being transferred [Adjusted Odds Ratio (aOR) =1.8; 95% Confidence Interval (95%CI) = 1.3–2.6], preeclampsia [aOR (95%CI) = 2.0 (1.2–3.3)], age [aOR (95%CI) = 0.96 (0.93–0.99)] and “high obstetric-risk” [aOR (95%CI) = 0.54 (0.37–0.78)]. Factors significantly associated with neonatal complication included mother being transferred [aOR (95%CI) = 2.1 (1.8–2.6)], “high obstetric-risk” [aOR (95%CI) = 1.6 (1.3–1.96)], preeclampsia [aOR (95%CI) = 1.5 (1.2–1.8), mother’s age [aOR (95%CI) = −2% (−3%, −0.1%)] and gestational age [aOR (95%CI) = −8% (−13%, −6%)] increment. This study identified amendable factors associated with peripartum complications in rural referral health settings. Strengthening hospitals’ performance assurance is critical to address the identified factors and improve peripartum outcomes for mothers-neonate dyads. Full article
(This article belongs to the Special Issue Access and Healthcare for Disadvantaged Populations)
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12 pages, 2464 KiB  
Article
Predicting Areas with High Concentration of the Long-Term Uninsured and Their Association with Emergency Department Usage by Uninsured Patients in South Carolina
by Khoa Truong, Julie Summey Bedi, Lingling Zhang, Brooke Draghi and Lu Shi
Healthcare 2022, 10(5), 771; https://doi.org/10.3390/healthcare10050771 - 21 Apr 2022
Viewed by 1327
Abstract
Background: To predict areas with a high concentration of long-term uninsured (LTU) and Emergency Department (ED) usage by uninsured patients in South Carolina. Methods: American Community Survey data was used to predict the concentration of LTU at the ZIP Code Tabulation Area (ZCTA) [...] Read more.
Background: To predict areas with a high concentration of long-term uninsured (LTU) and Emergency Department (ED) usage by uninsured patients in South Carolina. Methods: American Community Survey data was used to predict the concentration of LTU at the ZIP Code Tabulation Area (ZCTA) level. In a multivariate regression model, the LTU concentration was then modeled to predict ED visits by uninsured patients. ED data came from the restricted South Carolina Patient Encounter data with patients’ billing zip codes. A simulation was conducted to predict changes in the ED visit numbers and rates by uninsured patients if the LTU concentration was reduced to a lower level. Results: Overall, there was a positive relationship between ED visit rates by the uninsured patients and areas with higher concentrations of LTU. Our simulation model predicted that if the LTU concentration for each ZCTA was reduced to the lowest quintile, the ED visit rates by the uninsured would decrease significantly. The greatest reduction in the number of ED visits by the uninsured over a two-year period was for the following primary diagnoses: abdominal pain (15,751 visits), cellulitis and abscess (11,260 visits) and diseases for the teeth and supporting structures (10,525 visits). Conclusions: The provision of primary healthcare services to the LTU could help cut back inappropriate uses of ED resources and healthcare costs. Full article
(This article belongs to the Special Issue Access and Healthcare for Disadvantaged Populations)
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12 pages, 835 KiB  
Article
Health Seeking Behaviour and Healthcare Utilization in a Rural Cohort of North India
by Rajaram Yadav, Kamran Zaman, Ayush Mishra, Mahendra M. Reddy, Prem Shankar, Priyanka Yadav, Kaushik Kumar and Rajni Kant
Healthcare 2022, 10(5), 757; https://doi.org/10.3390/healthcare10050757 - 19 Apr 2022
Cited by 6 | Viewed by 3904
Abstract
Background: The healthcare infrastructure of a country determines the health-seeking behaviour of the population. In developing countries such as India, there is a great disparity in the distribution of healthcare institutions across urban and rural areas with disadvantages for people living in rural [...] Read more.
Background: The healthcare infrastructure of a country determines the health-seeking behaviour of the population. In developing countries such as India, there is a great disparity in the distribution of healthcare institutions across urban and rural areas with disadvantages for people living in rural areas. Objectives: Our objectives were to study the health-seeking behavior and factors associated with the use of formal healthcare among the Gorakhpur Health and Demographic Surveillance System (GHDSS) cohort of North India. Methods: The study was conducted in 28 villages from two rural blocks in the Gorakhpur district of eastern Uttar Pradesh, North India. Structured questionnaires were used to collect the data with regard to demographics, health-seeking behaviour and healthcare utilization. An adjusted odds ratio with 95% confidence interval was used to report the factors associated with the utilization of healthcare. Results: Out of 120,306 individuals surveyed, 19,240 (16%) individuals reported having any health problem in the last 15 days. Of them, 90% sought healthcare for their health needs. The formal healthcare utilization was 79%. The use of public health facilities was very low (37%) with most of the people seeking treatment from private healthcare (63%). Females, people with a higher level of education (graduate and above), and those belonging to rich and middle tercile were more likely to use formal healthcare services. Among different ailments, respiratory problems, gastrointestinal problems, and musculoskeletal problems were associated with decreased use of formal healthcare. Conclusion: About four in five individuals surveyed who had health problems sought treatments from formal healthcare with three in five preferring private institutions to public healthcare facilities due to a perceived higher level of treatment quality and nearby availability. There is an urgent need to re-establish community trust among public healthcare facilities with a focus on delivering on-site health care and enhancing the quality of services offered by public healthcare institutions. Full article
(This article belongs to the Special Issue Access and Healthcare for Disadvantaged Populations)
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11 pages, 593 KiB  
Article
HIV Viral Suppression among People Living with HIV on Antiretroviral Therapy in Haut-Katanga and Kinshasa Provinces of Democratic Republic of Congo
by Gulzar H. Shah, Lievain Maluantesa, Gina D. Etheredge, Kristie C. Waterfield, Osaremhen Ikhile, Roger Beni, Elodie Engetele and Astrid Mulenga
Healthcare 2022, 10(1), 69; https://doi.org/10.3390/healthcare10010069 - 31 Dec 2021
Cited by 1 | Viewed by 2204
Abstract
Human immunodeficiency virus (HIV) infections and less-than-optimal care of people living with HIV (PLHIV) continue to challenge public health and clinical care organizations in the communities that are most impacted by HIV. In the era of evidence-based public health, it is imperative to [...] Read more.
Human immunodeficiency virus (HIV) infections and less-than-optimal care of people living with HIV (PLHIV) continue to challenge public health and clinical care organizations in the communities that are most impacted by HIV. In the era of evidence-based public health, it is imperative to monitor viral load (VL) in PLHIV according to global and national guidelines and assess the factors associated with variation in VL levels. Purpose: This study had two objectives—(a) to describe the levels of HIV VL in persons on antiretroviral therapy (ART), and (b) to analyze the significance of variation in VL by patients’ demographic and clinical characteristics, outcomes of HIV care, and geographic characteristics of HIV care facilities. Methods: The study population for this quantitative study was 49,460 PLHIV in the Democratic Republic of Congo (DRC) receiving ART from 241 CDC-funded HIV/AIDS clinics in the Haut-Katanga and Kinshasa provinces of the DRC. Analysis of variance (ANOVA) was performed, including Tamhane’s T2 test for pairwise comparisons using de-identified data on all patients enrolled in the system by the time the data were extracted for this study by the HIV programs in May 2019. Results: The VL was undetectable (<40 copies/mL) for 56.4% of the patients and 24.7% had VL between 40 copies/mL and less than 1000 copies per mL, indicating that overall, 81% had VL < 1000 and were virologically suppressed. The remaining 19% had a VL of 1000 copies/mL or higher. The mean VL was significantly (p < 0.001) higher for males than for females (32,446 copies/mL vs. 20,786, respectively), persons <15 years of age compared to persons of ages ≥ 15 years at the time of starting ART (45,753 vs. 21,457, respectively), patients who died (125,086 vs. 22,090), those who were lost to follow-up (LTFU) (69,882 vs. 20,018), those with tuberculosis (TB) co-infection (64,383 vs. 24,090), and those who received care from urban clinics (mean VL = 25,236) compared to rural (mean VL = 3291) or semi-rural (mean VL = 26,180) clinics compared to urban. WHO clinical stages and duration on ART were not statistically significant at p ≤ 0.05 in this cohort. Conclusions: The VL was >1000 copies/mL for 19% of PLHIV receiving ART, indicating that these CDC-funded clinics and programs in the Haut-Katanga and Kinshasa provinces of DRC have more work to do. Strategically designed innovations in services are desirable, with customized approaches targeting PLHIV who are younger, male, those LTFU, with HIV/TB co-infection, and those receiving care from urban clinics. Full article
(This article belongs to the Special Issue Access and Healthcare for Disadvantaged Populations)
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14 pages, 1312 KiB  
Article
Developing an International Occupational Therapy Service: Perspectives and Implications
by Estíbaliz Jiménez-Arberas, Luis-Javier Márquez-Álvarez, Isabel Fernández-Méndez and María-Luisa Ruiz-Fernández
Healthcare 2021, 9(11), 1466; https://doi.org/10.3390/healthcare9111466 - 29 Oct 2021
Cited by 3 | Viewed by 1700
Abstract
Mali is one of the poorest countries in sub-Saharan Africa. Limited infrastructure renders access to health care difficult. There is a need to establish functional ways to improve Malian people’s health and treat disability. From this point of view, our project aims to [...] Read more.
Mali is one of the poorest countries in sub-Saharan Africa. Limited infrastructure renders access to health care difficult. There is a need to establish functional ways to improve Malian people’s health and treat disability. From this point of view, our project aims to implement a remote occupational therapy service for the beneficiaries of the Kalana clinic in Mali through international cooperation. Using a spiral iterative model, a proposal for a remote occupational therapy service was developed and refined for a multidisciplinary context. The International Classification of Functioning, Disability, and Health (ICF) was used as a means to work from a multidisciplinary approach to treat all needs. The results are exemplified with a case report and qualitative impressions of the services. Full article
(This article belongs to the Special Issue Access and Healthcare for Disadvantaged Populations)
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13 pages, 385 KiB  
Article
Access to Healthcare for Minors: An Ethical Analysis of Judgments of the European Court of Human Rights
by Fabian-Alexander Tietze, Marcin Orzechowski, Marianne Nowak and Florian Steger
Healthcare 2021, 9(10), 1361; https://doi.org/10.3390/healthcare9101361 - 13 Oct 2021
Cited by 1 | Viewed by 1725
Abstract
The right to non-discriminatory access to healthcare is anchored in the European Convention on Human Rights and other international treaties or guidelines. Since its ratification, the European Convention on Human Rights was made binding in all Member States of the Council of Europe [...] Read more.
The right to non-discriminatory access to healthcare is anchored in the European Convention on Human Rights and other international treaties or guidelines. Since its ratification, the European Convention on Human Rights was made binding in all Member States of the Council of Europe and is interpreted by the European Court of Human Rights (ECtHR). Despite its legal recognition, discrimination in healthcare provision has repeatedly been an issue of medicoethical and political consideration. In this context, minors are particularly in danger of being deprived of this fundamental right. The aim of this study is to analyze the current state of the ECtHR jurisdiction on challenges in accessing healthcare for minor patients. We conducted a systematic search of judgments by the ECtHR using the keywords “healthcare” and “child”. We performed descriptive statistics and qualitative thematic analysis. Our search resulted in n = 66 judgments, which were all screened. Access to healthcare for minors played a role in n = 21 judgments, which involved applications against n = 13 countries. We formed five, partially overlapping categories, which represent recurring themes regarding the research topic. These themes are governance failure (n = 11), the status of refugee, asylum seeker or migrant (n = 5), parental home (n = 5), maternity and birth (n = 4) and others (n = 2). The normative framework of the ECtHR’s jurisprudence illustrates intersections between social, legal and medicoethical aspects of minors’ discrimination in the healthcare system. It emphasizes the particular vulnerability of children, who require exceptional protection. Inadequate access to healthcare manifests itself in specific situations, such as in the context of migration or staying in public institutions. Healthcare professionals need to be sensitized for such discrimination mechanisms, as they are often at the forefront of encountering structural discrimination in the healthcare system. Full article
(This article belongs to the Special Issue Access and Healthcare for Disadvantaged Populations)
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10 pages, 252 KiB  
Article
Racial and Ethnic Disparities in Preoperative Surgical Wait Time and Renal Cell Carcinoma Tumor Characteristics
by Eduardo Quinonez-Zanabria, Celina I. Valencia, Waheed Asif, Jiping Zeng, Ava C. Wong, Alejandro Cruz, Juan Chipollini, Benjamin R. Lee, Francine C. Gachupin, Chiu-Hsieh Hsu and Ken Batai
Healthcare 2021, 9(9), 1183; https://doi.org/10.3390/healthcare9091183 - 8 Sep 2021
Cited by 3 | Viewed by 1781
Abstract
Racial/ethnic minority groups have a disproportionate burden of kidney cancer. The objective of this study was to assess if race/ethnicity was associated with a longer surgical wait time (SWT) and upstaging in the pre-COVID-19 pandemic time with a special focus on Hispanic Americans [...] Read more.
Racial/ethnic minority groups have a disproportionate burden of kidney cancer. The objective of this study was to assess if race/ethnicity was associated with a longer surgical wait time (SWT) and upstaging in the pre-COVID-19 pandemic time with a special focus on Hispanic Americans (HAs) and American Indian/Alaska Natives (AIs/ANs). Medical records of renal cell carcinoma (RCC) patients who underwent nephrectomy between 2010 and 2020 were retrospectively reviewed (n = 489). Patients with a prior cancer diagnosis were excluded. SWT was defined as the date of diagnostic imaging examination to date of nephrectomy. Out of a total of 363 patients included, 34.2% were HAs and 8.3% were AIs/ANs. While 49.2% of HA patients experienced a longer SWT (≥90 days), 36.1% of Non-Hispanic White (NHW) patients experienced a longer SWT. Longer SWT had no statistically significant impact on tumor characteristics. Patients with public insurance coverage had increased odds of longer SWT (OR 2.89, 95% CI: 1.53–5.45). Public insurance coverage represented 66.1% HA and 70.0% AIs/ANs compared to 56.7% in NHWs. Compared to NHWs, HAs had higher odds for longer SWT in patients with early-stage RCC (OR, 2.38; 95% CI: 1.25–4.53). HAs (OR 2.24, 95% CI: 1.07–4.66) and AIs/ANs (OR 3.79, 95% CI: 1.32–10.88) had greater odds of upstaging compared to NHWs. While a delay in surgical care for early-stage RCC is safe in a general population, it may negatively impact high-risk populations, such as HAs who have a prolonged SWT or choose active surveillance. Full article
(This article belongs to the Special Issue Access and Healthcare for Disadvantaged Populations)
10 pages, 253 KiB  
Article
Older Seniors during the COVID-19 Pandemic—Social Support and Oral Health-Related Quality of Life
by Sophia Weber, Sebastian Hahnel, Ina Nitschke, Oliver Schierz and Angelika Rauch
Healthcare 2021, 9(9), 1177; https://doi.org/10.3390/healthcare9091177 - 7 Sep 2021
Cited by 6 | Viewed by 2622
Abstract
The coronavirus disease (COVID-19) has greatly affected all parts of private life and led to social distancing and self-isolation. Limited social support for older or frail people might have led to decreased oral health and its related quality of life. The current study [...] Read more.
The coronavirus disease (COVID-19) has greatly affected all parts of private life and led to social distancing and self-isolation. Limited social support for older or frail people might have led to decreased oral health and its related quality of life. The current study aimed to investigate the social support of older seniors and self-perceived oral health-related quality of life (OHRQoL) over the course of the COVID-19 pandemic. Questionnaires were sent to all patients of the Dental Clinic of the University of Leipzig (Germany) aged 75, 80, or 85 years (n = 1228) at the end of February 2021. Besides demographic characteristics and care level, an adapted German version of the ENRICHD Social Support Inventory (ESSI-D) and the German Oral Health Impact Profile-14 (OHIP-14) were included. The response rate was 35.7% (n = 439). Twelve replies were not included in the data analysis as participants had either no interest, were cognitively impaired, or did not match the required age group. Analysis of ESSI-D revealed low social support for 13.2% (n = 53/403) of the seniors. No statistically significant impact of assigned care level on low social support was identified. Seniors with an assigned care level (CLyes) presented higher OHIP-14 sum scores (CLno/CLyes 6.43/10.12; p < 0.001). This was also true for six of the seven OHIP-14 domains, except for functional limitation. Regarding seniors with an assigned care level, a weak positive correlation was identified for sum scores of the ESSI-D and the OHIP-14 (r = 0.29). Despite the COVID-19 pandemic, older seniors reported high self-perceived social support. As seniors with an assigned care level revealed more impaired OHRQoL and a correlation with lower social support, special attention should be given to this vulnerable and frail group in times of a pandemic. When restrictions may minimize access to dental treatment and might negatively influence the oral health of older seniors, health care programs should offer more individual options for dental/medical appointments. Full article
(This article belongs to the Special Issue Access and Healthcare for Disadvantaged Populations)
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