Ghana has made significant stride towards universal health coverage (UHC) by implementing the National Health Insurance Scheme (NHIS) in 2003. This paper investigates the progress of UHC indicators in Ghana from 1995 to 2015 and makes future predictions up to 2030 to assess the probability of achieving UHC targets. National representative surveys of Ghana were used to assess health service coverage and financial risk protection. The analyses estimated the coverage of 13 prevention and four treatment service indicators at the national level and across wealth quintiles. In addition, we calculated catastrophic health payments and impoverishment to assess financial hardship and used a Bayesian regression model to estimate trends and future projections as well as the probabilities of achieving UHC targets by 2030. Wealth-based inequalities and regional disparities were also assessed. At the national level, 14 out of the 17 health service indicators are projected to reach the target of 80% coverage by 2030. Across wealth quintiles, inequalities were observed amongst most indicators with richer groups obtaining more coverage than their poorer counterparts. Subnational analysis revealed while all regions will achieve the 80% coverage target with high probabilities for the prevention services, the same cannot be applied to the treatment services. In 2015, the proportion of households that suffered catastrophic health payments and impoverishment at a threshold of 25% non-food expenditure were 1.9% (95%CrI: 0.9–3.5) and 0.4% (95%CrI: 0.2–0.8), respectively. These are projected to reduce to 0.4% (95% CrI: 0.1–1.3) and 0.2% (0.0–0.5) respectively by 2030. Inequality measures and subnational assessment revealed that catastrophic expenditure experienced by wealth quintiles and regions are not equal. Significant improvements were seen in both health service coverage and financial risk protection over the years. However, inequalities across wealth quintiles and regions continue to be cause of concerns. Further efforts are needed to narrow these gaps.
BackgroundBecause of the rapid increase of non-communicable diseases (NCDs) and high burden of healthcare-related financial issues in Bangladesh, there is a concern that out-of-pocket (OOP) payments related to illnesses may become a major burden on household. It is crucial to understand what are the major illnesses responsible for high OPP at the household level to help policymakers prioritize key areas of actions to protect the household from 100% financial hardship for seeking health care as part of universal health coverage. ObjectivesWe first estimated the costs of illnesses among a population in urban Bangladesh, and then assessed the household financial burden associated with these illnesses. MethodA cross-sectional survey of 1593 randomly selected households was carried out in Bangladesh (urban area of Rajshahi city), in 2011. Catastrophic expenditure was estimated at 40% threshold of household capacity to pay. We employed the Bayesian two-stage hurdle model and Bayesian logistic regression model to estimate age-adjusted average cost and the incidence of household financial catastrophe for each illness, respectively. ResultsOverall, approximately 45% of the population of Bangladesh had at least one episode of illness. The age-sex-adjusted average medical expenses and catastrophic health care expenditure among the households were TK 621 and 8%, respectively. Households spent the highest amount of money 7676.9 on paralysis followed by liver disease (TK 2695.4), injury
Context. Alternative pain management interventions involving caregivers may be valuable adjuncts to conventional pain management interventions.Objectives. Use systematic review methodology to examine caregiver-facilitated pain management interventions in a hospital setting and whether they improve patient, caregiver, provider, or health system outcomes.Methods. We searched MEDLINE, EMBASE, PsycINFO, CINAHL, and Scopus databases from inception to April 2020. Original research on caregiver-facilitated pain management interventions in hospitalized settings (i.e., any age) were included and categorized into three caregiver engagement strategies: inform (e.g., pain education), activate (e.g., prompt caregiver action), and collaborate (encourage caregiver's interaction with providers).Results. Of 61 included studies, most investigated premature (n ¼ 27 of 61; 44.3%) and full-term neonates (n ¼ 19 of 61; 31.1%). Interventions were classified as activate (n ¼ 46 of 61; 75.4%), inform-activate-collaborate (n ¼ 6 of 61; 9.8%), informactivate (n ¼ 5 of 61; 8.2%), activate-collaborate (n ¼ 3 of 61; 4.9%), or inform (n ¼ 1 of 61; 1.6%) caregiver engagement strategies. Interventions that included an activate engagement strategy improved pain outcomes in adults (18e64 years) (e.g., self-reported pain, n ¼ 4 of 5; 80%) and neonates (e.g., crying, n ¼ 32 of 41; 73.0%) but not children or older adults (65 years and older). Caregiver outcomes (e.g., pain knowledge) were improved by inform-activate engagement strategies (n ¼ 3 of 3). Interventions did not improve provider (e.g., satisfaction) or health system (e.g., hospital length of stay) outcomes. Most studies were of low (n ¼ 36 of 61; 59.0%) risk of bias.Conclusion. Caregiver-facilitated pain management interventions using an activate engagement strategy may be effective in reducing pain of hospitalized neonates. Caregiver-facilitated pain management interventions improved pain outcomes in most adult studies; however, the number of studies of adults is small warranting caution pending further studies. J Pain Symptom Manage 2020;60:1034e1046.
Background Sleep deprivation is widely recognized as a potential contributor to childhood obesity. However, few studies have addressed this issue in low-income settings. The aim of this study was to determine the association of both sleep duration and sleep quality with overweight/obesity among adolescents of Bangladesh. Methods A cross-sectional study was conducted in four randomly selected schools in Gazipur, Bangladesh, from May to August 2019. Using a self-administered semi-structured questionnaire, data on sleep duration and sleep quality were collected from 1,044 adolescents between 13 and 17 years of age. The body mass indices of the study participants were evaluated using their objectively-assessed anthropometric measurements (weight and height). Multilevel logistic regression was used for data analysis. Results The prevalence of underweight, overweight and obesity in adolescents in this study were 14.9, 18 and 7.1%, respectively. More than 15% of the students reported sleep disturbance and poor sleep quality. After adjusting for confounders, reduced (<7 h/day) total sleep duration (OR=1.73, 95% CI=1.21-2.47), weekend sleep duration (OR=1.46, 95% CI=1.00-2.12), and night sleep duration (OR=1.55, 95% CI=1.06-2.28) were found to be significantly associated with overweight or obesity in Bangladeshi adolescents. Similarly, significant positive associations were evident between short duration of total sleep (OR=0.33, 95% CI=0.20-0.54), weekday sleep (OR=0.55, 95% CI=0.35-0.84), weekend sleep (OR=0.53, 95% CI=0.31-0.89), and night sleep (OR=0.56, 95% CI=0.36-0.87), and underweight in study participants. Adolescents with short sleep duration were found less likely to be underweight and more likely to be overweight/obese. Conclusions Study findings denoted short sleep duration to be associated with overweight/obesity and underweight among adolescents of Bangladesh. Adequate sleep may therefore serve as an effective obesity prevention strategy in the growing stages.
Objectives: To validate the two-factor structure (i.e., cognitive and somatic) of the Health and Behaviour Inventory (HBI), a widely used post-concussive symptom (PCS) rating scale, through factor analyses using bifactor and correlated factor models and by examining measurement invariance (MI). Methods: PCS ratings were obtained from children aged 8–16.99 years, who presented to the emergency department with concussion (n = 565) or orthopedic injury (OI) (n = 289), and their parents, at 10-days, 3-months, and 6-months post-injury. Item-level HBI ratings were analyzed separately for parents and children using exploratory and confirmatory factor analyses (CFAs). Bifactor and correlated models were compared using various fit indices and tested for MI across time post-injury, raters (parent vs. child), and groups (concussion vs. OI). Results: CFAs showed good fit for both a three-factor bifactor model, consisting of a general factor with two subfactors (i.e., cognitive and somatic), and a correlated two-factor model with cognitive and somatic factors, at all time points for both raters. Some results suggested the possibility of a third factor involving fatigue. All models demonstrated strict invariance across raters and time. Group comparisons showed at least strong or strict invariance. Conclusions: The findings support the two symptom dimensions measured by the HBI. The three-factor bifactor model showed the best fit, suggesting that ratings on the HBI also can be captured by a general factor. Both correlated and bifactor models showed substantial MI. The results provide further validation of the HBI, supporting its use in childhood concussion research and clinical practice.
20 Ghana has made significant stride towards universal health coverage (UHC) by implementing the 21 National Health Insurance Scheme (NHIS) in 2003. This paper investigates the progress of UHC 22 indicators in Ghana from 1995 to 2030 and makes future predictions up to 2030 to assess the 23 probability of achieving UHC targets. National representative surveys of Ghana were used to 24 assess health service coverage and financial risk protection. The analysis estimated the coverage 25 of 13 prevention and four treatment service indicators at the national level and across wealth 26 quintiles. In addition, this analysis calculated catastrophic health payments and impoverishment 27 to assess financial hardship and used a Bayesian regression model to estimate trends and future 28 projections as well as the probabilities of achieving UHC targets by 2030. Wealth-based 29 inequalities and regional disparities were also assessed. At the national level, 14 out of the 17 30 health service indicators are projected to reach the target of 80% coverage by 2030. Across 31 wealth quintiles, inequalities were observed amongst most indicators with richer groups 32 obtaining more coverage than their poorer counterparts. Subnational analysis revealed while all 33 regions will achieve the 80% coverage target with high probabilities for prevention services, the 34 same cannot be applied to treatment services. In 2015, the proportion of households that suffered 35 catastrophic health payments and impoverishment at a threshold of 25% non-food expenditure 36 were 1.9% (95%CrI: 0.9-3.5) and 0.4% (95%CrI: 0.2-0.8), respectively. These are projected to 37 reduce to less than 0.5% by 2030. Inequality measures and subnational assessment revealed that 38 catastrophic expenditure experienced by wealth quintiles and regions are not equal. Significant 39 improvements were seen in both health service coverage and financial risk protection as a result 40 of NHIS. However, inequalities across wealth quintiles and at the subnational level continue to 41 be cause of concerns. Further efforts are needed to narrow these inequality gaps. 42 Introduction 43 Universal Health Coverage (UHC) is a concept in which all people receive the quality, essential 44 services they need without experiencing financial hardship [1,2]. The First Global Monitoring 45 Report formulated by World Health Organizations (WHO) and World Bank identified three 46 dimensions: population, health services, and financing through risk pooling mechanism to track 47 UHC progress [1]. Since its integration into the recently adopted Sustainable Development Goal 48 (SDG) 3, member countries of the United Nations (UN) have committed to achieve UHC by 49 2030 [3]. This commitment consists of two targets: a minimum of 80% essential health service 50 coverage for all people, regardless of socioeconomic status, and 100% financial risk protection 51 from out-of-pocket (OOP) payments for health care [1]. UHC is a key mechanism to ensure 52 affordability and equity as well as to guarantee resilient hea...
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