Gender inequities in health care utilisation for common infections children under-5 in India

Common infectious diseases like pneumonia, diarrhoea and malaria, are the leading causes of mortality in young children aged below 5 years, especially in low and middle-income countries (LMICs). Globally, India is the country with the largest number of children under five years old (U5) and the largest number of deaths in this age group and where diarrhoea is the second biggest killer of children. Immunisations, medical treatment and hospital care are some of the available life-saving interventions for children affected by these three common infectious diseases. Nonetheless, not all children benefit equally from these interventions. In South Asia and in India, gender-based discrimination leads to differences in health outcomes and healthcare access, especially among young children. The estimated excess mortality of young girls (compared to young boys) in India reaches an average of 239,000 excess deaths every year. However, the current body of evidence showing gender-based inequities affecting health care utilisation in the region is less compelling. Furthermore, there is a scarcity of empirical research using nationally representative data and taking into account the theoretical basis of determinants of health care seeking behaviours for children. This thesis aimed to estimate the effect of gender and other determinants on health care seeking for common infections in young children in India, especially in the case of diarrhoea. A systematic review of the literature was conducted looking at gender inequalities in hospital admissions and care seeking for common infections in children from South Asia. The results showed that for acute lower respiratory infections - ALRI (predominantly pneumonia) - most of the studies reported significantly higher rates of hospital admissions for boys compared to girls. Although a much smaller number of studies for diarrhoea were selected, the studies from South Asia also reported a higher incidence rate ratio of admissions for boys compared to girls. Of the three studies, which reported in-hospital case fatality ratios for diarrhoea, girls were almost twice as likely to die when compared to boys (pooled Odds Ratio 1.81 (95% CI 1.55-2.11)). For care seeking behaviours, most studies reported a lower likelihood of girls receiving treatment for common infections compared to boys. Similarly, nearly all of the studies on nutrition and immunisation reported better nutrition outcomes and vaccination coverage for boys compared to girls. Building on the results from this literature review, and drawing on theoretical concepts from the social sciences, a conceptual framework was developed. An interdisciplinary approach integrating intersectional, ecosocial and epidemiological perspectives was used to allow for the improvement of interpretation of findings. A quantitative analysis of care seeking behaviours for young children with diarrhoea was conducted, using data from the two recent rounds of large-scale demographic health surveys in India - National Family Health Survey (NFHS-3 and NFHS-4). In the analysis of the NFHS-3 (2005-06), the combined effect of gender and wealth on care seeking for diarrhoea was assessed using a multivariable logistic regression model adjusting for other potential effect modifiers. A lower prevalence of care seeking outside the home for diarrhoea was significantly associated with being a girl (Adjusted Odds Ratio, 0.84 (95% CI, 0.72-0.99)), or belonging to a poorer family (P values varying from 0.024 richer versus richest to <0.001 poorest vs. richest). A further analysis using a heuristic model informed by intersectionality, combined sex and economic class into ten different categories. The results of this further analysis suggest that, in terms of care seeking, boys tend to be less affected by the lower economic status of the household when compared to girls. Subsequently, data from NFHS-4 (2015-16) were analysed and nine different types of care seeking behaviours for diarrhoea were explored, including type of treatment, place where care was sought, delay in seeking care and level and cost of care sought. Coverage for all of these care seeking behaviours for girls and boys were estimated and compared. For most of these care seeking behaviours, carers were more likely to pursue care and treatment for diarrhoea for boys than girls. Apart from gender, the other potential determinants of care seeking behaviours analysed were age, place of residence(rural/urban), number of siblings, social class (i.e. wealth quintile), mother’s education level, religion, belonging to a scheduled caste or tribe & backward class, region of residence and distance to nearest health care facility. A bivariate logistic regression analysis was conducted looking at sex and other determinants and the use of the costliest type of care available for diarrhoea (i.e., outpatient consultation in a private hospital/doctor/clinic). When compared to other types of care available, boys more often than girls received the costliest type of care. The adjusted results showed that girls in India are on average 16% less likely to receive the costliest type of care for diarrhoea when compared to boys (Odds Ratio 0.86 (95%CI 0.78–0.94)). Infants (children younger than 1-year-old), were also more likely to receive the costliest type of care available (Adjusted OR 0.78 (95%CI 0.71–0.86)). Other important and statistically significant determinants of the use of costly care were wealth index, with children in the poorest quintile being the ones less likely to get costly care (OR 0.33 ((95%CI 0.23 (0.18–0.30)) and the mother’s level of education. Similarly, the analysis revealed a clear regional pattern with a contrast between the group of four most populous High Focus States (i.e., Bihar, Madhya Pradesh, Rajasthan, Uttar Pradesh.), and other states in India. For example, the effect of gender and mothers’ level of education on use of the costliest type of care for diarrhoea remains significant when the four states of Bihar, Madhya Pradesh, Rajasthan, Uttar Pradesh are analysed as a separate group. However, the analysis of the remaining states did not show the same effects of gender and mothers’ level of education on care seeking. This study reveals important differences in care seeking behaviours for diarrhoea among children in India. These differences were largely driven by gender, age, socio economic class, mothers’ level of education and region. The results highlight the importance of gender and its relationship with social class and geography in child health in India. It also reveals a regional pattern in the determinants of child health care seeking. Policy initiatives targeting equity in access to health care should utilize intersectionality-informed analysis, considering the combined impact of gender with other axes of marginalisation and systems of social oppression, operating at different levels. Clarifying the pathways in which gender affects girl’s health in South Asia, as a whole, and India in particular, is a crucial step in the efforts to promote equity in health for all children

Acupuncture In Brazil Unified Health System; An Analysis Based On Different Health Management Tools

A inserção de Práticas Integrativas e Complementares nos sistemas públicos de saúde tem sido muito discutida nacional e internacionalmente. No Brasil a Política Nacional de Práticas Integrativas e Complementares norteia a inclusão da acupuntura no Sistema Único de Saúde. Este artigo analisou a implantação da acupuntura no SUS de 26 municípios do Departamento Regional de Saúde XIII/São Paulo, entre 2001 e 2011, a partir dos Planos Municipais de Saúde, Relatórios Anuais de Gestão e Sistemas de Informação. Os registros referentes à acupuntura foram analisados nas categorias contexto, atores, conteúdo e processo de implantação da prática. Os resultados mostraram um contexto favorável no âmbito legislativo e desfavorável no financiamento; somente atores institucionais; o conteúdo continha incoerências na estrutura dos documentos e nos registros da acupuntura; o processo mostrou que a política auxiliou a descrever a organização para a oferta da acupuntura. Conclui-se que a acupuntura e os instrumentos de gestão e planejamento em saúde têm incorporação incipiente nos 26 municípios, o que obsta o monitoramento e mantém essas práticas na periferia do sistema.22130131

A forum on the Zika virus

Luciana Brondi – ORCID: 0000-0001-6221-4440 https://orcid.org/0000-0001-6221-4440Item not available in this repository.http://somatosphere.net/2016/a-forum-on-the-zika-virus.html

Acupuntura No Sistema à nico De Saúde â Uma Análise Nos Diferentes Instrumentos De Gestão

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)The integration of Integrative and Complementary Practices into public health systems has been the subject of national and international debate. In Brazil, the National Policy on Integrative and Complementary Practices guides the integration of acupuncture into the Unified Health System (UHS). This article explored the availability and/or accessibility of acupuncture in the UHS in 26 municipalities in the XIII Health Region of the State of Sao Paulo between 2001 and 2011, based on the analysis of Municipal Health Plans, Annual Management Reports and complementary data obtained from Information Systems. The data was analyzed using a framework for policy analysis based on: context, process, content and actors. Results show that the legislative framework provides a favorable environment; however public funding for these activities is particularly limited. Only government actors participated in the decision-making processes; the plans and reports contained inconsistencies both in structure and in the references made to acupuncture; the process showed that the policy helped to describe the organization of the provision of acupuncture services. The study concludes that the integration of acupuncture and use of health management and planning tools is limited in the 26 municipalities and that this precludes monitoring and maintains these practices on the periphery of the system.221301310Coordination for the Improvement of Higher Education Personnel (Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior - CAPES)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Zika vírus in the Americas: Time to stop ignoring neglected tropical diseases

Luciana Brondi – ORCID: 0000-0001-6221-4440 https://orcid.org/0000-0001-6221-4440Item not available in this repository.https://www.ed.ac.uk/sites/default/files/atoms/files/global_health_academy_zika.pd

“We will pay the extra rupee to treat our son” - a conceptual framework explaining gender inequity in child health care utilization in South Asia [Oral Presentation]

Luciana Brondi – ORCID: 0000-0001-6221-4440 https://orcid.org/0000-0001-6221-4440Item not available in this repository

COVID-19 Antibody Survey of education Staff (CASS) survey results [Report]

Luciana Brondi - ORCID: 0000-0001-6221-4440 https://orcid.org/0000-0001-6221-4440Item not available in this repository.COVID-19 Antibody Survey of education Staff (CASS) uses blood tests to monitor the number of people working in education in Scotland who have coronavirus antibodies, and how this changes over the school year 2020/21.https://doi.org/10.52487/5865pubpu

Why are girls still dying unnecessarily? The need to address gender inequity in child health in the post–2015 development agenda

Luciana Brondi – ORCID: 0000-0001-6221-4440 https://orcid.org/0000-0001-6221-4440Item not available in this repository.The 40–year anniversary of the United Nations ‘International Women’s Day,’ was celebrated on 8 March 2015. As we approach the end of the Millennium Development Goals (MDGs), we reflect on the gender debate that has arose amidst tackling MDG4 and highlight the need for greater gender equality in measuring child health outcomes in the post–MDG era in line with MDG 3https://doi.org/10.7189/jogh.05.0203035pubpub

Integrated Community Case Management (iCCM): Evidence Review Symposium [Meeting Report]

Luciana Brondi – ORCID: 0000-0001-6221-4440 https://orcid.org/0000-0001-6221-4440Item not available in this repository.http://ccmcentral.com/wp-content/uploads/2014/07/iCCM-Symposium-Final-Report-17.07.2014.pd

The rule of law in times of health crises [Report]

Luciana Brondi - ORCID: 0000-0001-6221-4440 https://orcid.org/0000-0001-6221-4440Item not available in this repository.Run by A4ID, the Rule of Law Expertise (ROLE UK) Programme is funded by the Department for International Development (DFID).https://www.roleuk.org.uk/resources/rule-law-times-health-crisespubpu