http://www.equityhealthj.com The latest research articles published by International Journal for Equity in Health 2012-02-02T00:00:00Z IntroductionBrazil and Colombia have pursued extensive reforms of their health care systems in the last couple of decades. The purported goals of such reforms were to improve access, increase efficiency and reduce health inequities. Notwithstanding their common goals, each country sought a very different pathway to achieve them. While Brazil attempted to reestablish a greater level of State control through a public national health system, Colombia embraced market competition under an employer-based social insurance scheme. This work thus aims to shed some light onto why they pursued divergent strategies and what that has meant in terms of health outcomes. Methods: A critical review of the literature concerning equity frameworks, as well as the health care reforms in Brazil and Colombia was conducted. Then, the shortfall inequality values of crude mortality rate, infant mortality rate, under-five mortality rate, and life expectancy for the period 1960-2005 were calculated for both countries. Subsequently, bivariate and multivariate linear regression analyses were performed and controlled for possibly confounding factors. Results: When controlling for the underlying historical time trend, both countries appear to have experienced a deceleration of the pace of improvements in the years following the reform, for all the variables analyzed. In the case of Colombia, some of the previous gains in under-five mortality rate and crude mortality rate were, in fact, reversed. Conclusions: Neither reform seems to have had a decisive positive impact on the health outcomes analyzed for the defined time period of this research. This, in turn, may be a consequence of both internal characteristics of the respective reforms and external factors beyond the direct control of health reformers. Among the internal characteristics: underfunding, unbridled decentralization and inequitable access to care seem to have been the main constraints. Conversely, international economic adversities, high levels of rural and urban violence, along with entrenched income inequalities seem to have accounted for the highest burden among external factors. http://www.equityhealthj.com/content/11/1/6 Roberto Esteves International Journal for Equity in Health 2012, null:6 2012-02-02T00:00:00Z doi:10.1186/1475-9276-11-6 /content/figures/1475-9276-11-6-toc.gif International Journal for Equity in Health 1475-9276 ${item.volume} 6 2012-02-02T00:00:00Z PDF Background: An understanding of the febrile illness experience of Nigerian nomadic Fulani is necessary for developing an appropriate strategy for extending malaria intervention services to them. An exploratory study of their malaria illness experience was carried out in Northern Nige-ria preparatory to promoting malaria intervention among them. Methods: Ethnographic tools including interviews, group discussions, informal conversations and living-in-camp observations were used for collecting information on local knowledge, perceived cause, severity and health seeking behaviour of nomadic Fulani in their dry season camps at the Gongola-Benue valley in Northeastern Nigeria. Results: Nomadic Fulani regarded pabboje (a type of "fever" that is distinct from other fevers because it "comes today, goes tomorrow, returns the next") as their commonest health prob-lem. Pabboje is associated it with early rains, ripening corn and brightly coloured flora. Pabboje is inherent in all nomadic Fulani for which treatment is therefore unnecessary de-spite its interference with performance of duty such as herding. Traditional medicines are used to reduce the severity, and rituals carried out to make it permanently inactive or divert its recurrence. Although modern antimalaria may make the severity of subsequent pabboje episodes worse, nomads seek treatment in private health facilities against fevers that are persistent using antimalarial medicines. The consent of the household head was essential for a sick child to be treated outside the camp. The most important issues in health service utilisaitonutilization amondamong nomads are belief that fever is a Fulani illness that needs no cure until a particular period, preference for private medicine vendors and avoidance of public health service facilities. Conclusions: Understanding nomadic Fulani beliefs about pabboje is useful for planning an acceptable community participatory fever management among them. http://www.equityhealthj.com/content/11/1/5 Oladele Akogun Minnakur Gundiri Jacqueline Badaki Sani Njobdi Adedoyin Adesina Olumide Ogundahunsi International Journal for Equity in Health 2012, null:5 2012-01-31T00:00:00Z doi:10.1186/1475-9276-11-5 /content/figures/1475-9276-11-5-toc.gif International Journal for Equity in Health 1475-9276 ${item.volume} 5 2012-01-31T00:00:00Z PDF Background In this paper, we create an index of economic exclusion based on validated questionnaires of economic hardship and material deprivation, and examine its association with health in Canada. The main study objective is to determine the extent to which income and this index of economic exclusion index are overlapping measurements of the same concept. Methods: We used the Canadian Household Panel Survey Pilot and performed multilevel analysis using a sample of 1588 individuals aged 25 to 64, nested within 975 households. Results: While economic exclusion is inversely correlated with both individual and household income, these are not perfectly overlapping constructs. Indeed, not only these indicators weakly correlated, but they also point to slightly different sociodemographic groups at risk of low income and economic exclusion. Furthermore, the respective associations with health are of comparable magnitude, but when these income and economic exclusion indicators are included together in the same model, they point to independent and cumulative, not redundant effects. Conclusions: We explicitly distinguish, both conceptually and empirically, between income and economic exclusion, one of the main dimensions of social exclusion. Our results suggest that the economic exclusion index we use measures additional aspects of material deprivation that are not captured by income, such as the effective hardship or level of economic 'well-being'. http://www.equityhealthj.com/content/11/1/4 Emilie Renahy Beatriz Alvarado Llano Maria Koh Amelie Quesnel-Vallee International Journal for Equity in Health 2012, null:4 2012-01-27T00:00:00Z doi:10.1186/1475-9276-11-4 /content/figures/1475-9276-11-4-toc.gif International Journal for Equity in Health 1475-9276 ${item.volume} 4 2012-01-27T00:00:00Z PDF Background: This study aims to resolve two limitations of previous studies. First, as only a few studies examining social capital have been conducted in non-western countries, it is inconclusive that the concept, which has been developed in Western societies, applies similarly to an Asian context. Second, this study considers social capital at the individual-level, area-level and cross-levels of interaction and examines its associations with health while simultaneously controlling for various confounders at both the individual-level and area-level, whereas previous studies only considered one of the two levels. The purpose of this study is therefore to examine the associations between social capital and health by using multilevel analysis after controlling for various confounders both at the individual and area-levels (i.e., concentrated disadvantage) in non-western countries. Methods: We conducted a cross-sectional survey from December 2010 to April 2011 in Seoul, South Korea. The target population included respondents aged 25 years and older who have resided in the same administrative area since 2008. The final sample for this study consisted of 4,730 respondents within all 25 of Seoul's administrative areas. Results: In our final model, individual-level social capital, including network sources (OR=1.23; 95% CI=1.11-1.37) and organizational participation (OR=2.55; 95% CI=2.11-3.08) was positively associated with good/very good health. Interestingly, the individual x area organizational participation cross-level interaction was negatively associated with good/very good health (OR=0.40; 95% CI=0.32-0.50), indicating that in areas with higher organizational participation, individuals with high organizational participation were less likely to report good/very good health when compared to low organizational participation individuals. Conclusion: Our study provides evidence that individual-level social capital is associated with self-reported health, even after controlling for both individual and area-level confounders. Although this study did not find significant relationships between area-level organizational participation and self-reported health, this study found the cross-level interaction for social capital. Hence, in areas with lower organizational participation, the probability of reporting good/very good health is higher for individuals with high organizational participation than individuals with low organizational participation. This study, albeit tentatively, suggests that policy makers should focus upon social capital when making policies which aim to enhance one's health. http://www.equityhealthj.com/content/11/1/3 Sehee Han Heaseung Kim Hee-Sun Lee International Journal for Equity in Health 2012, null:3 2012-01-26T00:00:00Z doi:10.1186/1475-9276-11-3 /content/figures/1475-9276-11-3-toc.gif International Journal for Equity in Health 1475-9276 ${item.volume} 3 2012-01-26T00:00:00Z PDF China is a country with vast regional differences and uneven economic development, which have led to widening gaps between the rich and poor in terms of access to healthcare, quality of care, and health outcomes. China's healthcare reform efforts must be tailored to the needs and resources of each region and community. Building and strengthening primary care within the Chinese health care system is one way to effectively address health challenges. This paper begins by outlining the concept of primary care, including key definitions and measurements. Next, results from a number of studies will demonstrate that primary care characteristics are associated with savings in medical costs, improvements in health outcomes and reductions in health disparities. This paper concludes with recommendations for China on successfully incorporating a primary care model into its national health policy, including bolstering the primary care workforce, addressing medical financing structures, recognizing the importance of evidence-based medicine, and looking to case studies from countries that have successfully implemented health reform. http://www.equityhealthj.com/content/11/1/2 Li-Mei Hung Sarika Rane Jenna Tsai Leiyu Shi International Journal for Equity in Health 2012, null:2 2012-01-20T00:00:00Z doi:10.1186/1475-9276-11-2 /content/figures/1475-9276-11-2-toc.gif International Journal for Equity in Health 1475-9276 ${item.volume} 2 2012-01-20T00:00:00Z PDF IntroductionGendered practices of working life create gender inequalities through horizontal and vertical gender segregation in work, which may lead to inequalities in health between women and men. Gender equality could therefore be a key element of health equity in working life. Our aim was to analyze what gender (in)equality means for the employees at a woman-dominated workplace and discuss possible implications for health experiences. Methods: All caregiving staff at two workplaces in elder care within a municipality in the north of Sweden were invited to participate in the study. Forty-five employees participated, 38 women and 7 men. Seven focus group discussions were performed and led by a moderator. Qualitative content analysis was used to analyze the focus groups. Results: We identified two themes. "Advocating gender equality in principle" showed how gender (in)equality was seen as a structural issue not connected to the individual health experiences. "Justifying inequality with individualism" showed how the caregivers focused on personalities and interests as a justification of gender inequalities in work division. The justification of gender inequality resulted in a gendered work division which may be related to health inequalities between women and men. Gender inequalities in work division were primarily understood in terms of personality and interests and not in terms of gender. Conclusion: The health experience of the participants was affected by gender (in)equality in terms of a gendered work division. However, the participants did not see the gendered work division as a gender equality issue. Gender perspectives are needed to improve the health of the employees at the workplaces through shifting from individual to structural solutions. A healthy-setting approach considering gender relations is needed to achieve gender equality and fairness in health status between women and men. http://www.equityhealthj.com/content/11/1/1 Sofia Elwer Lena Alex Anne Hammarstrom International Journal for Equity in Health 2012, null:1 2012-01-04T00:00:00Z doi:10.1186/1475-9276-11-1 /content/figures/1475-9276-11-1-toc.gif International Journal for Equity in Health 1475-9276 ${item.volume} 1 2012-01-04T00:00:00Z PDF Progress towards the first Millennium Development Goal (MDG1) to end poverty and hunger has lagged behind attainment of other MDGs due to chronic poverty and worldwide inequity in access to adequate health care, food, clean water, and sanitation. Despite ongoing challenges, Rwanda has experienced economic progress and the expansion of the national public health system during the past 20 years. However, protein-energy malnutrition in children under five is still a major concern for physicians and government officials in Rwanda. Approximately 45% of children under the age of five in Rwanda suffer from chronic malnutrition, and one in four is undernourished. For years, health facilities in Rwanda have used incorrect growth references for measuring nutritional status of children despite the adoption of new standards by the World Health Organization in 2006. Under incorrect growth references used in Rwanda, a number of children under five who were severely underweight were not identified, and therefore were not treated for malnutrition, thus potentially contributing to the under five mortality rate. Given that one in ten children suffer from malnutrition worldwide, it is imperative that all countries with a burden of malnutrition adopt the most up-to-date international standards for measuring malnutrition, and that the problem is brought to the forefront of international public health initiatives. For low income countries in the process of improving economic conditions, as Rwanda is, increasing the identification and treatment of malnutrition can promote the advancement of MDG1 as well as physical and cognitive development in children, which is imperative for advancing future economic progress. http://www.equityhealthj.com/content/10/1/61 Agnes Binagwaho Mawuena Agbonyitor Alphonse Rukundo Niloo Ratnayake Fidel Ngabo Josephine Kayumba Bridget Dowdle Elena Chopyak Mary Smith Fawzi International Journal for Equity in Health 2011, null:61 2011-12-29T00:00:00Z doi:10.1186/1475-9276-10-61 /content/figures/1475-9276-10-61-toc.gif International Journal for Equity in Health 1475-9276 ${item.volume} 61 2011-12-29T00:00:00Z XML IntroductionThe importance of gender in understanding health practices and illness experiences is increasingly recognized and key to this work is a better understanding of the application of gender relations. The influence of masculinities and femininities, and the interplay within and between them manifests within relations and interactions among couples, family members and peers to influence health behaviours and outcomes. Methods: To explore how conceptualizations of gender relations have been integrated in health research a scoping review of the existing literature was conducted. The key terms gender relations, gender interactions, relations gender, partner communication, femininities and masculinities were used to search online databases. Results: Through analysis of this literature we identified two main ways gender relations were integrated in health research: a) as emergent findings; and b) as a basis for research design. In the latter, gender relations are included in conceptual frameworks, and used to guide data collection and direct data analysis. Conclusions: Current uses of gender relations are typically positioned within intimate heterosexual couples whereby single narratives (i.e., either men or women) are used to explore the influence and /or impact of intimate partner gender relations on health and illness issues. Recommendations for advancing gender relations and health research are discussed. This research has the potential to reduce gender inequities in health. http://www.equityhealthj.com/content/10/1/60 Joan Bottorff John Oliffe Carole Robinson Joanne Carey International Journal for Equity in Health 2011, null:60 2011-12-13T00:00:00Z doi:10.1186/1475-9276-10-60 /content/figures/1475-9276-10-60-toc.gif International Journal for Equity in Health 1475-9276 ${item.volume} 60 2011-12-13T00:00:00Z PDF Background: Improving maternal health is one of the eight Millennium Development Goals. It is widely accepted that the use of maternal health services helps in reducing maternal morbidity and mortality. The utilization of maternal health services is a complex phenomenon and it is influenced by several factors. Therefore, the factors at different levels affecting the use of these services need to be clearly understood. The objective of this study was to estimate the effects of individual, community and district level characteristics on the utilisation of maternal health services with special reference to antenatal care (ANC), skilled attendance at delivery and postnatal care (PNC). Methods: This study was designed as a cross sectional study. Data from 15,782 ever married women aged 15-49 years residing in Madhya Pradesh state of India who participated in the District Level Household and Facility Survey (DLHS-3) 2007-08 were used for this study. Multilevel logistic regression analysis was performed accounting for individual, community and district level factors associated with the use of maternal health services. Type of residence at community level and ratio of primary health center to population and percent of tribal population in the district were included as district level variables. Results: The results of this study showed that 61.7% of the respondents used ANC at least once during their most recent pregnancy whereas only 37.4% women received PNC within two weeks of delivery. In the last delivery, 49.8% mothers were assisted by skilled personnel. There was considerable amount of variation in the use of maternal health services at community and district levels. About 40% and 14% of the total variance in the use of ANC, 29% and 8% of the total variance in the use of skilled attendance at delivery and 28% and 8.5% of the total variance in the use of PNC was attributable to differences across communities and districts, respectively. When controlled for individual, community and district level factors, the variances in the use of skilled attendance at delivery attributable to the differences across communities and districts were reduced to 15% and 4.3% respectively. There were only marginal reductions observed in the variance at community and district level for ANC and PNC use. The household socio-economic status and mother's education were the most important factors associated with the use of ANC and skilled attendance at delivery. The community level variable was only significant for ANC and skilled attendance at delivery but not for PNC. None of the district level variables used in this study were found to be influential factors for the use of maternal health services. Conclusions: We found sufficient amount of variations at community and district of residence on each of the three indicators of the use of maternal health services. For increasing the utilisation of these services in the state, in addition to individual-level, there is a strong need to identify and focus on community and district-level interventions. http://www.equityhealthj.com/content/10/1/59 Tej Ram Jat Nawi Ng Miguel San Sebastian International Journal for Equity in Health 2011, null:59 2011-12-05T00:00:00Z doi:10.1186/1475-9276-10-59 /content/figures/1475-9276-10-59-toc.gif International Journal for Equity in Health 1475-9276 ${item.volume} 59 2011-12-05T00:00:00Z PDF Background: Although the Republic of Vanuatu has improved maternal indicators, more needs to be done to improve equity among the poorest in the use of reproductive health services to expedite the progress towards the Millennium Development Goal 5(MDG 5) target. While large developing country studies provide evidence of a rich-poor gap in reproductive health services utilization, not much is written in terms of Pacific Islands. Thus, this study aims to examine the degree of inequality in utilization of reproductive health services in a nationally representative sample of Vanuatu households. Methods: This paper used data from the 2007 Vanuatu Multiple Indicator Cluster Survey (MICS). The analyses were based on responses from 615 ever married women, living with at least one child below two years of age. Outcomes included antenatal care (ANC) and use of birth attendants at delivery, place of delivery, and counseling and testing for HIV/AIDS. Descriptive statistics and multivariate logistic regression methods were employed in the analysis. Results: Findings revealed that the economic well-being status of the household to which women belong, played a crucial role in explaining the variation in service utilization. Inequality in utilization was found to be more pronounced between the poorest and richest groups within the wealth quintiles. In adjusted models, mothers in the richest bands of wealth were 5.50 (95% confidence interval [CI]: 1.34-22.47), 2.12 (95% CI : 1.02-3.42), 4.0 (95% CI 1.58-10.10), and 2.0 (95% CI 1.02-5.88) times more likely to have assisted delivery from medically trained personnel, have institutional deliveries, and have counseling and testing for HIV/AIDS. Conclusions: Association between household wealth inequality and utilization of ANC and delivery assistance from medically trained personnel, institutional delivery, and counseling and testing for HIV/AIDS suggest that higher utilization of reproductive health care services in Vanuatu poor-rich inequalities need to be addressed. Reducing poverty and making services more available and accessible to the poor may be essential for improving overall reproductive health care utilization rate in Vanuatu. http://www.equityhealthj.com/content/10/1/58 Mosiur Rahman Syed Haque Md. Mostofa Len TarivondA Muhammad Shuaib International Journal for Equity in Health 2011, null:58 2011-12-02T00:00:00Z doi:10.1186/1475-9276-10-58 /content/figures/1475-9276-10-58-toc.gif International Journal for Equity in Health 1475-9276 ${item.volume} 58 2011-12-02T00:00:00Z PDF