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Health inequity on access to services in the ethnic minority regions of Northeastern Myanmar: a cross-sectional study.

ABSTRACT: To evaluate health inequity on access to services in the ethnic regions of Northeastern Myanmar from three points of analysis: geographic barrier, gender-based disparity and financial burden of health services.A multistage-stratified random cluster survey was conducted in Shan State Special Region 2 and Eastern Shan State Special Region 4 of Northeastern Myanmar in 2016, including a total number of 774 households.A total number of 4235 participants were recruited during the survey.Geographic distance, gender, household income and inpatient/outpatient service utilisation.The study results showed that residents living within 5?km of any form of healthcare facilities paid more outpatient visits (90.06 visits per thousand population) in the past 2?weeks, compared with those living 5-20?km and over 20?km (54.84 and 54.02 per thousand population, respectively) from healthcare facilities. A similar trend with little significant differences was found for inpatient service use. Regarding household income, adults with an annual household income of above US$720 were more likely to seek outpatient service (OR=1.43, 95%?CI 0.98 to 2.10) compared with those with an annual income of

SUBMITTER: Tang K

PROVIDER: S-EPMC5735411 | biostudies-literature | 2017 Dec

REPOSITORIES: biostudies-literature

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Health inequity on access to services in the ethnic minority regions of Northeastern Myanmar: a cross-sectional study.

Tang Kun K Zhao Yingxi Y Li Bolun B Zhang Siqiao S Lee Sung Hoon SH

BMJ open 20171214 12

<h4>Objectives</h4>To evaluate health inequity on access to services in the ethnic regions of Northeastern Myanmar from three points of analysis: geographic barrier, gender-based disparity and financial burden of health services.<h4>Setting</h4>A multistage-stratified random cluster survey was conducted in Shan State Special Region 2 and Eastern Shan State Special Region 4 of Northeastern Myanmar in 2016, including a total number of 774 households.<h4>Participants</h4>A total number of 4235 part ...[more]

PMID: 29247090

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Project description:Background/objectivesWhile it is acknowledged that minority ethnic (ME) groups across international settings face barriers to accessing care for dementia, it is not clear whether ME groups access services less frequently as a result. The objective of this review is to examine whether ME groups have longer delays before accessing dementia/memory services, higher use of acute care and crisis services and lower use of routine care services based on existing literature. We also examined whether ME groups had higher dementia severity or lower cognition when presenting to memory services.DesignSystematic review with narrative synthesis.SettingNonresidential medical, psychiatric, memory, and emergency services.ParticipantsTwenty studies totaling 94,431 older adults with dementia or mild cognitive impairment.MeasurementsWe searched Embase, Ovid MEDLINE, Global Health, and PsycINFO from inception to November 2018 for peer-reviewed observational studies which quantified ethnic minority differences in nonresidential health service use in people with dementia. Narrative synthesis was used to analyze findings.ResultsTwenty studies were included, mostly from the U.S. (n = 13), as well as the UK (n = 4), Australia (n = 1), Belgium (n = 1), and the Netherlands (n = 1). There was little evidence that ME groups in any country accessed routine care at different rates than comparison groups, although studies may have been underpowered. There was strong evidence that African American/Black groups had higher use of hospital inpatient services versus U.S. comparison groups. Primary care and emergency services were less well studied. Study quality was mixed, and there was a large amount of variability in the way ethnicity and service use outcomes were ascertained and defined.ConclusionThere is evidence that some ME groups, such as Black/African American groups in the U.S., may use more acute care services than comparison populations, but less evidence for differences in routine care use. Research is sparse, especially outside the U.S.

Project description:BackgroundLittle is known about the associations between healthy dietary patterns and metabolic dysfunction-associated fatty liver disease (MAFLD) in less-developed ethnic minority regions (LEMRs), where the prevalence of MAFLD is increasing rapidly and dietary habits are quite different from those in developed countries. Moreover, a significant subset of MAFLD individuals in LEMRs are nonobese, but the efficacy of dietary patterns on MAFLD individuals with different obese statuses is also unclear. We aimed to test the associations of two wildly recommended a priori dietary patterns-Alternate Mediterranean diet (AMED) and Dietary Approaches to Stop Hypertension (DASH)-with the risk of MAFLD in the total population, and further in nonobese and obese individuals.MethodsWe recruited 99,556 participants in the China Multi-Ethnic Cohort Study, an ongoing cohort study in less-developed southwest China. Using validated food frequency questionnaire, each participant was assigned an AMED score and a DASH score. MAFLD was ascertained as hepatic steatosis on ultrasound together with diabetes, overweight/obesity, or two other metabolic risk factors. We performed logistic regression with inverse probability of exposure weighting (IPEW) to examine associations between two dietary patterns and MAFLD, adjusting for potential confounders under the guidance of directed acyclic graphs. Further, analyses were stratified by body mass index.ResultsWe included 66,526 participants (age 49.5±11.0; 62.6% women), and the prevalence of MAFLD was 16.1%. Participants in the highest quintile of DASH score showed strong inverse associations with risks of MAFLD (OR = 0.85; 95% CI, 0.80-0.91; Ptrend < 0.001) compared with participants in the lowest quintile. The association between DASH and nonobese MAFLD (OR = 0.69; 95% CI, 0.61-0.78; Ptrend < 0.001) was stronger (I2 = 78.5 % ; Pheterogeneity = 0.001) than that with obese MAFLD (OR = 0.90; 95% CI, 0.83-0.98; Ptrend = 0.002). There was a null association between AMED and MAFLD risk.ConclusionsIn LEMRs, a DASH diet but not AMED was associated with MAFLD. The relationship appeared to be more pronounced in nonobese MAFLD individuals than in obese MAFLD individuals.

Project description:BackgroundTransgender and gender diverse individuals often face structural barriers to health care because of their gender minority status. The aim of this study was to examine the association between gender minority stress and access to specific health care services among transgender women and transfeminine people in China.MethodsThis multicenter cross-sectional study recruited participants between January 1st and June 30th 2020. Eligible participants were 18 years or older, assigned male at birth, not currently identifying as male, and living in China. Gender minority stress was measured using 45 items adapted from validated subscales. We examined access to health care services and interventions relevant to transgender and gender diverse people, including gender affirming interventions (hormones, surgeries), human immunodeficiency virus (HIV) and sexually transmitted infections (STIs) testing, pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). Multivariable regression was used to measure correlations between gender minority stress and access to health care service.ResultsThree hundred and twenty-four people completed a survey and data from 277 (85.5%) people were analyzed. The mean age was 29 years old (standard deviation [SD] = 8). Participants used hormones (118/277, 42.6%), gender affirming surgery (26/277, 9.4%), HIV testing (220/277, 79.4%), STI testing (132/277, 47.7%), PrEP (24/276, 8.7%), and PEP (29/267, 10.9%). Using gender affirming hormones was associated with higher levels of discrimination (adjusted odds ratio [aOR] 1.41, 95% confidence interval [CI] 1.17-1.70) and internalized transphobia (aOR 1.06, 95%CI 1.00-1.12). STI testing was associated with lower levels of internalized transphobia (aOR 0.91, 95%CI 0.84-0.98).ConclusionsOur data suggest that gender minority stress is closely related to using health services. Stigma reduction interventions and gender-affirming medical support are needed to improve transgender health.

Project description:BACKGROUND:Most regions of Myanmar fall within the Indo-Burma Biodiversity Hotspot and are threatened with biodiversity loss. Development of a comprehensive framework for sustainable development is crucial. Figs are ecological keystone species within these regions and are also important for traditional spiritual food and health uses, which often have accompanying conservation practices. The traditional use and management of figs may offer clues to help guide the development of national policies for sustainable development. In this study, we showcase the rich ethnobotanical knowledge as well as the variety of collection and conservation practices of figs among five ethnic groups in Southern Shan State. METHODS:We performed both key informant and semi-structured interviews with 114 informants from five ethnic groups. Their uses for figs were categorized according to local practices and recipes. Informants were asked about trends in conservation status over the past 10?years and any conservation-related customs and practices. Data were analyzed quantitatively with common quantitative ethnobotany indices, the use report (UR) and use value (UV). RESULTS:Informants reported the uses of eight fig species (Ficus auricularta, F. concinna, F. geniculata, F. hispida, F. racemosa, F. religiosa, F. semicordata, and F. virens). F. geniculata and F. virens were most useful (UR?=?228) and were used by all five ethnic groups, corresponding to a high use value (UV?=?2). Treatments for 16 diseases were reported from seven species. Household consumption, economic and sacred uses were accompanied by sustainable practices of harvest and protection. Traditional taboos, in situ and ex situ conservation were common especially for highly demanded species (F. geniculata and F. virens) and the sacred fig F. religiosa. CONCLUSION:Findings suggest that figs are useful for food (all informants) and medicine (13.16% of the informants) in the study area. Traditional taboos, in situ and ex situ conservation practices help to maintain sustainable utilization of locally important figs. This is an early contribution to the traditional knowledge of edible figs. Although similar uses have been reported in neighboring countries for seven of the fig species, the ethnobotanical use of F. concinna is novel.

Project description:Background: Mothers and their newborns are vulnerable to threats to their health and survival during the postnatal period. Full postnatal care (PNC) uptake decreases maternal deaths and is also essential for first 1,000 days of newborn's life, but PNC usage is usually inadequate in rural areas. Little is known about the full PNC utilization among rural Myanmar women. This study, therefore, aimed to study the situation of the utilization of full PNC and examine its determinants. Methods: This community-based cross-sectional study was conducted in selected villages of the Magway Region, Myanmar. A total of 500 married women who had children aged under 2 years were selected using multistage cluster sampling and interviewed with semi-structured questionnaires. The determinants of full PNC usage were identified by generalized estimating equation (GEE) under a logistic regression framework. Results: Among 500 rural women, around a quarter (25.20%; 95% confidence interval (CI), 21.58-29.21%) utilized full PNC. Multivariable analysis revealed that factors associated with full PNC usage included mothers attaining educational level of secondary or higher (adjusted odds ratio (AOR), 2.16; 95% CI, 1.18-3.94), belonging to higher income level (AOR, 2.02; 95% CI, 1.11-3.68), having male involvement (AOR, 2.19; 95% CI, 1.02-4.69), being of low birth order (i.e. the first birth) (AOR, 3.26; 95% CI, 1.80-5.91), and having awareness of postnatal danger signs (AOR, 2.10; 95% CI, 1.15-3.83). Moreover, the presence of misconceptions on postnatal practice was identified as a strong barrier to adequate PNC usage (AOR, 0.12; 95% CI, 0.04-0.36). Conclusion: Most of the rural women practiced inadequate PNC in Myanmar. Maternal healthcare services at rural areas should be intensively promoted, particularly among women who had high birth order (greater number of births). Health education regarding perinatal misconceptions and danger signs, and benefits of full PNC services usage should be emphasized and urgently extended.

Project description:As populations age, the numbers of carers overall and numbers of carers from minority ethnic groups in particular are rising. Evidence suggests that carers from all sections of the community and particularly carers from minority groups often fail to access care services. This may relate to barriers in accessing services and service dissatisfaction. The aim of this systematic review was to identify and summarise minority ethnic carers' perceptions of barriers to accessing community social care services and their satisfaction with these services if accessed. The following databases were searched from their start until July 2013: Social Care Online, Social Policy and Research, Scopus, PsychINFO, HMIC, ASSIA, MEDLINE, Embase, CINAHL Plus and AMED. Thirteen studies met the inclusion criteria. Most investigated either barriers to access or satisfaction levels, although three explored both. Only 4 studies investigated minority ethnic carers' satisfaction with social care, although 12 studies reported perceived barriers to accessing services. Few studies compared minority ethnic carers' perceptions with majority ethnic groups, making it difficult to identify issues specific to minority groups. Most barriers described were potentially relevant to all carers, irrespective of ethnic group. They included attitudinal barriers such as not wanting to involve outsiders or not seeing the need for services and practical barriers such as low awareness of services and service availability. Issues specific to minority ethnic groups included language barriers and concerns about services' cultural or religious appropriateness. Studies investigating satisfaction with services reported a mixture of satisfaction and dissatisfaction. Barriers common to all groups should not be underestimated and a better understanding of the relationship between perceived barriers to accessing services and dissatisfaction with services is needed before the experiences of all carers can be improved.

Project description:IntroductionHusbands can play a crucial role in pregnancy and childbirth, especially in patriarchal societies of developing countries. In Myanmar, despite the critical influence of husbands on the health of mothers and newborns, their roles in maternal health have not been well explored. Therefore, the aim of this study was to identify the factors associated with husbands' involvement in maternal health in Myanmar. This study also examined the associations between husbands' involvement and their spouses' utilization of maternal care services during antenatal, delivery and postnatal periods.MethodsA community-based, cross sectional study was conducted with 426 husbands in Thingangyun Township, Yangon, Myanmar. Participants were husbands aged 18 years or older who had at least one child within two years at the time of interview. Face to face interviews were conducted using a pretested structured questionnaire. Factors associated with the characteristics of husband's involvement as well as their spouses' utilization of maternal care services were analyzed by multivariable logistic regression models.ResultsOf 426 husbands, 64.8% accompanied their spouses for an antenatal visit more than once while 51.6% accompanied them for a postnatal visit. Husbands were major financial supporters for both antenatal (95.8%) and postnatal care (68.5%). Overall, 69.7% were involved in decision making about the place of delivery. Regarding birth preparedness, the majority of husbands prepared for skilled birth attendance (91.1%), delivery place (83.6%), and money saving (81.7%) before their spouses gave birth. In contrast, fewer planned for a potential blood donor (15.5%) and a safe delivery kit (21.1%). In the context of maternal health, predictors of husband's involvement were parity, educational level, type of marriage, decision making level in family, exposure to maternal health education and perception of risk during pregnancy and childbirth. Increased utilization of maternal health services was found among spouses of husbands who accompanied them to antenatal visits (AOR 5.82, 95% CI, 3.34-10.15) and those who had a well birth plan (AOR 2.42, 95% CI, 1.34-4.39 for antenatal visit and AOR 2.88, 95% CI, 1.52-5.47 for postnatal visit).ConclusionThe majority of husbands supported their spouses' maternal care services use financially; however, they were less involved in birth preparedness and postnatal care. Exposure to maternal health education and their maternal health knowledge were main predictors of their involvement. Women were more likely to use maternal care services when their husbands company them for ANC visits and had a well-birth plan in advance.

Dataset Information

Health inequity on access to services in the ethnic minority regions of Northeastern Myanmar: a cross-sectional study.

Publications

Health inequity on access to services in the ethnic minority regions of Northeastern Myanmar: a cross-sectional study.

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