The key objective of this research was to estimate out of pocket expenditure (OOPE) incurred by the Indian households for the treatment of childhood infections. We estimated OOPE estimates on ...outpatient care and hospitalization by disease conditions and type of health facilities. In addition, we also estimated OOPE as a share of households' total consumption expenditure (TCE) by MPCE quintile groups to assess the quantum of the financial burden on the households. We analyzed the Social Consumption: Health (SCH) data from National Sample Survey Organization (NSSO) 75th round (2017-18). Outcome indicators were prevalence of selected infectious diseases in children aged less than 5 years, per episode of OOPE on outpatient care in the preceding 15 days, hospitalization in the preceding year and OOPE as a share of households' total consumption expenditure. Our analysis suggests that the most common childhood infection was 'fever with rash' followed by 'acute upper respiratory infection' and 'acute meningitis'. However, the highest OOPE for outpatient care and hospitalization was reported for 'viral hepatitis' and 'tuberculosis' episodes. Among the households reporting childhood infections, OOPE was 4.8% and 6.7% of households' total consumption expenditure (TCE) for outpatient care and hospitalization, respectively. Furthermore, OOPE as a share of TCE was disproportionately higher for the poorest MPCE quintiles (outpatient, 7.9%; hospitalization, 8.2%) in comparison to the richest MPCE quintiles (outpatient, 4.8%; hospitalization, 6.7%). This treatment and care-related OOPE has equity implications for Indian households as the poorest households bear a disproportionately higher burden of OOPE as a share of TCE. Ensuring financial risk protection and universal access to care for childhood illnesses is critical to addressing inequity in care.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Oral health is rarely a priority of health policy agendas,1-3 although the recent World Health Organization (WHO) Resolution on Oral Health (WHA74.5) highlighted that oral diseases affect over 3.5 ...billion people worldwide and are among the most expensive diseases to treat.3 Such diseases particularly affect poorer and marginalized groups and are a key driver of catastrophic health expenditures.2 For those without access to essential oral health care, oral diseases can result in reduced performance of essential daily functions, pain and discomfort, and systemic infections; they can also necessitate emergency hospital admission.1'2Scientists and WHO have repeatedly emphasized the need for oral health systems improvement.1-3 However, progress in oral health systems transformation has been slow. Concrete know-how for spurring evidence- and values-driven action has been lacking for multiple reasons.First, lack of clarity persists as to what constitutes - from citizens' perspectives - essential oral care and how it can be optimally governed, funded and delivered. Without comprehensive accountability for citizen values, divergent stakeholder interests complicate rather than address problems. Second, the oral health community remains disconnected from the broader health community. Although oral diseases and noncommunicable diseases share common risk factors and sequelae, oral health systems rarely benefit from innovations in other areas of health care.1 Third, a high level of provider influence exists within the oral health policy ecosystem. The traditional business models of organized dentistry often give precedence to private financing approaches, contributing to a culture of reluctance against public governance and delivery arrangements. Fourth, the level of idiosyncrasy is high within the dental research ecosystem. Traditionally anchored biomedical research targets clinical disease management rather than empowering citizens to maintain good oral health.1 Dental public health research has been successfully describing problems, but scaling up implementation research to improve oral health is needed.
World Health Organization, in 2018, announced the Declaration of Astana4 stating that “Primary Health Care is a cornerstone of sustainable health system for universal health coverage (UHC) and ...health-related Sustainable Development Goals.” In order to mainstream oral health in this vision of Ayushman Bharat, we will have to overcome the multifarious challenges that dentistry faces today, namely, serious shortages in diversity of trained personnel, irregular outreach to the poorest and underserved populations, high treatment costs, barriers such as transport and lack of appropriate technologies, isolation of oral health services from the broader health system, and limited adoption of prevention and oral health promotion strategies. Achievement of universal coverage for oral health in India requires the following: systems of oral health-care delivery that can absorb and integrate many now-fragmented services and provide accessible treatment and prevention universally to those in need, health financing schemes that cover the costs of oral health care without putting health consumers, governments, or providers at risk of bankruptcy or severe economic hardship, and a health-care workforce that displays a deeper range of skill mix and skills and that features greater attention to health management and community-based caregivers.
Abstract
Background:
Analgesic use needs to be regulated due to its adverse effects. This study aimed to analyse the change in prescription rates and patterns of the analgesics prescribed for various ...oral conditions and to analyse their trends across different age groups and gender to promote rational prescription of drugs and eventually influence regulatory policies.
Methods:
Secondary analysis was conducted on medical audit data collected from the private health sector in India. The prescription rate per 1000 persons per year was calculated from May 2013 to April 2016 using the mean projected population (PP) of India. Cross-tabulations were conducted to analyse the prescription rate and their changes across different age groups, gender and oral conditions.
Findings:
The mean analgesic prescription rate was highest among the 20-40 age group, and the highest increase was noted in ‘non-steroidal anti-inflammatory drug (NSAID) combinations’ (3.56 per 1000 persons per year) from May 2013 to April 2016. The ‘NSAID combinations’ group was also the most prescribed medication across all the oral conditions, with ‘diseases of hard tissues’ having the highest prescription rate (41.4 and 45.6 per 1000 persons per year, respectively, for 2013–14 and 2015–16).
Interpretation:
The results indicate an overall increase in the analgesic prescription rate, especially ‘NSAID combinations’ for each dental disease and age group, a finding that is hard to explain. Due to the lack of prescription guidelines in India, it is difficult to assess whether these analgesics were prescribed rationally or not.
To assess socioeconomic inequalities in traumatic dental injuries (TDIs) in adolescents in New Delhi and examine the role of material, psychosocial and behavioural factors in explaining these ...inequalities.
We conducted a cross sectional study of 1386 adolescents aged between 12-15 years residing in three diverse areas of New Delhi. A non-invasive clinical examination was used to estimate the prevalence of TDIs, and an interviewer-administered questionnaire was used to gather relevant behavioural and socio-demographic data. Multiple logistic regression models were used to assess the association between area based socioeconomic position and TDIs.
The overall prevalence of TDIs was 10.9%. Social inequalities in the prevalence of TDIs were observed across the adolescent population according to their area of residence. Socio-economic group differences in the prevalence of TDIs remained statistically significant after adjusting for demographic factors, material resources, social capital, social support and health affecting behaviours (OR 3.36, 95% CI 1.75-6.46 and OR 3.99, 95% CI 1.86-8.56 for adolescents from resettlement areas and urban slums respectively in comparison to middle class adolescents). Different psychosocial, material and socio-demographic variables did not attenuate the estimates for the relationship between area socioeconomic position and TDIs.
Area of residence was a strong predictor of TDIs in adolescents with a higher prevalence in more deprived areas. Social inequalities in TDIs were not explained by psychosocial and behavioural variables. Health promoting policies aimed at improving the physical environment in which adolescents reside might be instrumental in reducing the prevalence of TDIs and associated inequalities.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background: Sugar-sweetened beverages (SSBs) are associated with obesity, and various other noncommunicable diseases (NCDs). The aim of the study was to study the patterns of consumption of SSBs and ...association of SSB consumption with various socioeconomic factors and fried food consumption. Methodology: We used data of the 4th round of National Family Health Survey. We used multiple logistic regression to estimate the extent of the relationship between consumption of aerated drinks and various predictors. Furthermore, generalized structural equation modeling (GSEM) was used to derive a path diagram that showed a significant linkage between aerated drinks and observed variables. Results: Our study showed a clear association between consumption of aerated drinks with socioeconomic variables age, sex, marital status, and wealth index. The consumption of aerated drinks was also significantly associated with watching television and eating fried foods. Conclusion: Aerated drinks are a popular source of added sugar in the Indian diet. Limiting such factors can prove to be beneficial in reducing their consumption and further help in reducing the burden of NCDs.
Objective: To understand perceptions, attitudes and experiences of school-going adolescents, their parents, teachers and school management towards sugar-sweetened beverages (SSBs). Design: An ...exploratory qualitative study was undertaken. Setting: The study was conducted in selected, mixed, unaided schools in the state of Delhi. Subjects: Students of classes 8 to 12th, principals of schools, teachers, parents and school canteen owners. Results: SSBs formed an integral part of the diet of adolescents due to its taste and role as a thirst quencher. Respondents had a fair knowledge of health effects of SSBs. However, they were not aware of the range of drinks that constitute SSBs. Respondents associated SSBs with positivity and happiness. Promotion of SSBs by sports and film stars was cited as a major driver influencing consumption of SSBs by young people. Conclusions: SSBs were readily available even though schools had put in measures to restrict their availability in the premises. Peer pressure emerged as a key factor that drove the consumption of SSBs. Advertisements for SSBs involved individuals who were considered role models and these focused on themes that were important for young people such as belongingness, machismo and friendship among others. On the contrary, health promotion messages around obesity or the consumption of SSBs hardly had any brand ambassador or the visibility of campaigns that promoted SSBs.
According to me, there are two attributable reasons for this. Along with asking information on reproducibility and validity of results, reputed Indian journals like Indian Journal of Dental Research ...should ask all the submitting authors to write a short note on what is new in their study, what is the addition to body of evidence and what are the policy implications (if any).
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