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Background Infant mortality rates are reliable indices of the child and general population health status and health care delivery. The most critical factors affecting infant mortality are socioeconomic status and ethnicity. The aim of this study was to assess the association between socioeconomic disadvantage, ethnicity, and perinatal, neonatal, and infant mortality in Slovakia before and during the COVID-19 pandemic. Methods The associations between socioeconomic disadvantage (educational level, long-term unemployment rate), ethnicity (the proportion of the Roma population) and mortality (perinatal, neonatal, and infant) in the period 2017–2022 were explored, using linear regression models. Results The higher proportion of people with only elementary education and long-term unemployed, as well as the higher proportion of the Roma population, increases mortality rates. The proportion of the Roma population had the most significant impact on mortality in the selected period between 2017 and 2022, especially during the COVID-19 pandemic (2020–2022). Conclusions Life in segregated Roma settlements is connected with the accumulation of socioeconomic disadvantage. Persistent inequities between Roma and the majority population in Slovakia exposed by mortality rates in children point to the vulnerabilities and exposures which should be adequately addressed by health and social policies.

Objectives:This study aims to compare selected early childhood health risks and health outcomes of children from marginalized Roma communities (MRCs) in Slovakia with those of the majority.Methods:We obtained cross-sectional data from mother-child dyads from the majority (N = 109) and MRCs (N = 143) via questionnaires and from medical records. Socioeconomic status, health risks and health outcomes were compared using chi-square and Mann-Whitney U tests in SPSS.Results:Mothers from MRCs reported significantly worse socioeconomic status. Air quality in the households in MRCs was significantly worse, affected by heating with stoves, burning fresh wood and indoor smoking. The diet composition of children from MRCs was characterized by shorter breastfeeding and unhealthy diet composition less fresh fruits and vegetables, more processed meat products, and sweet and salty snacks. Children from MRCs more often suffered from respiratory and diarrheal diseases, used antibiotics and were hospitalized.Conclusion:The health and healthy development of children living in MRCs is endangered by various poverty-related factors. Persistent differences in exposures and health in early childhood should be a priority goal of the state’s social and health policies.

Objectives: This study aims to compare the early childhood mental health of children from marginalized Roma communities (MRCs) in Slovakia with that of the majority and explore possible mediating pathways of mothers’ perceived stress and harsh discipline practices.Methods: We used data from the first wave of the longitudinal RomaREACH study collected in 2021–2022. Two populations were included in the sample: 94 mother-child dyads from MRCs and 79 from the majority population (children aged 14–18 months). Data were analysed using linear regression, and mediation was tested using PROCESS Macro in SPSS.Results: Belonging to MRCs vs. the majority, perceived stress of mothers and harsh discipline were found to be associated with early mental health problems in children. Perceived stress of mothers partially mediates the relationship between belonging to MRCs vs. majority and harsh discipline and harsh discipline partially mediates the relationship between perceived stress of mothers and the mental health of children.Conclusion: Mothers from MRCs perceive more stress, which is associated with more frequent use of harsh discipline practices having a negative impact on the mental health of young children.

Background Emotional and behavioural problems (EBP) are the most common mental health issues during adolescence, and their incidence has increased in recent years. The system of care for adolescents with EBP is known to have several problems, making the provision of care less than optimal, and attention needs to be given to potential improvements. We, therefore, aimed to examine what needs to be done to improve the system of care for adolescents with EBP and to assess the urgency and feasibility of the proposed measures from the perspective of care providers. Methods We used Concept mapping, a participatory mixed-method research, based on qualitative data collection and quantitative data analysis. A total of 33 stakeholders from 17 institutions participated in our study, including psychologists, pedagogues for children with special needs, teachers, educational counsellors, social workers and child psychiatrists. Results Respondents identified 43 ideas for improving of the system of care for adolescents with EBP grouped into 5 clusters related to increasing the competencies of care providers, changes at schools and school systems, support for existing services, transparency of the care system in institutions and public administration, and the adjustment of legislative conditions. The most urgent and feasible proposals were related to the support of awareness-raising activities on the topic of EBP, the creation of effective screening tools for the identification of EBP in adolescents, strengthening the role of parents in the process of care, comprehensive work with the family, creation of multidisciplinary support teams and intersectoral cooperation. Conclusions Measures which are more accessible and responsive to the pitfalls of the care system, together with those strengthening the role of families and schools, have greater potential for improvements which are in favour of adolescents with EBP. Care providers should be invited more often and much more involved in the discussion and the co-creation of measures to improve the system of care for adolescents with EBP.

This study aimed to explore the effect of socioeconomic disadvantage accumulated in marginalised Roma communities (MRCs) on early childhood development and to assess the role of selected socioeconomic indicators in the association between belonging to MRCs vs. the majority and early childhood development. We obtained cross-sectional data from 232 mother–child dyads from MRCs and the majority population. The differences in early childhood development and background variables between the two groups were tested using chi-square and Mann–Whitney U tests. The moderated mediation was tested using PROCESS Macro in SPSS Model 14 on 5000 bootstrap samples. Statistically significant differences between children from MRCs and the majority were found in terms of maternal age, parental education, household equipment, as well as early childhood development. Household equipment moderated the indirect effect of being from MRCs vs. the majority on early childhood development through parental education. The indirect effect through parental education was high at a low household equipment level, reduced at an average level and non-significant at a high level of household equipment. Our study uncovered disparities in early childhood development between children from MRCs and the majority population. Parental education significantly influenced developmental outcomes, while household equipment mitigated its impact.

Background Half of the people living in social exclusion in the Czech Republic are of Roma origin. The worse health of Roma could be partly explained by numerous barriers to accessing health care. Therefore, our study aimed to explore the perceptions of various stakeholders and experts who may have an impact on the inclusion of Roma and/or their access to health care on how to improve health care access for Roma living in social exclusion in the Czech Republic. Methods We conducted a concept mapping study and obtained data from 32 participants from health and social services, policymakers and others who were involved in different study phases (brainstorming, sorting, rating, interpretation). Results Out of 64 proposed measures sorted into six distinct clusters, 20 were rated as the most urgent and the most feasible and should be implemented with a priority to improve access to health care for Roma living in social exclusion. The proposed measures covered various topics, such as education and awareness of the target group as well as education and supervision of helping professionals, strengthening capacities and streamlining the health care system, health promotion and associated services and increasing the local and financial accessibility of health care. Overall, measures concerning the education and supervision of helping professionals were rated as both the most urgent and the most feasible. Individual priority measures targeted, for example, the health needs assessment of Roma living in social exclusion to set up interventions or to include topics such as participation, empowerment, cultural competence and communication training in the curricula of health care and helping professionals in postgraduate and continuing studies. Conclusions Stakeholders proposed a set of relevant and acceptable measures that may help improve access to health care for Roma living in social exclusion. The way they rated the proposed measures reflects both the current unfavourable mainstream and public discourse concerning Roma living in social exclusion and the most acute policy issues identified by several European and national bodies.

Background This study aims to assess which measures could improve the healthy early childhood development of children from marginalized Roma communities and to identify priority measures. Methods Concept mapping approach was used, using mixed methods. In total 54 professionals, including social workers, educators, health care providers, municipality representatives, and project managers participated in our study. Results Four distinct clusters of measures targeting living conditions, public resources, healthcare and community interventions, and 27 individual priority measures of highest urgency and feasibility were identified. The cluster ‘Targeting living conditions’, was rated as the most urgent but least feasible, whereas the cluster ‘Targeting health care’, was considered least urgent but most feasible. Among the 27 priority measures, ‘Planning parenthood’ and ‘Scaling up existing projects’ had the highest priority. Conclusion Our results reflect the public and political discourse and indicate significant barriers to implementation. Reducing inequalities in early childhood needs to be addressed through coordinated efforts.

Background Marginalized Roma communities (MRCs) in Slovakia experience longstanding exclusion from essential services, including healthcare. Roma women, in particular, face compounded vulnerabilities that contribute to unequal access and poorer health outcomes. Despite increasing attention to these issues, a deeper understanding of the lived experiences that shape healthcare access in MRCs remains necessary. Methods A qualitative study was conducted using semi-structured interviews with 13 Roma mothers living in MRCs and 13 professionals working in healthcare, public health, or policy, including six of Roma origin. Data were analyzed using consensual qualitative research and thematic analysis to identify significant access barriers. Results Roma women face multiple, often interconnected barriers to accessing healthcare, many of which are rooted in longstanding structural inequalities. These include distrust of the health system stemming from prior discrimination, difficulties in understanding health-related information and navigating the system, and financial hardship. On the side of healthcare providers, barriers involve shortages in the healthcare workforce, poor care coordination, and discriminatory attitudes. Conclusions Improving access to healthcare for Roma women requires a comprehensive, multi-level strategy. Efforts should focus on building trust, improving communication, addressing financial and systemic obstacles, and investing in culturally sensitive primary care. Health promotion assistants play a crucial role in bridging the gaps between communities and healthcare providers. Culturally sensitive healthcare interventions and inclusive policies are essential to reducing health disparities and promoting equitable access.

Toxocariasis is a parasitic infection that poses significant health risks to children, particularly in marginalised populations with limited access to sanitation and healthcare. This study aimed to compare the occurrence of toxocariasis in early childhood between a group of children from the Slovak majority population and from marginalised Roma communities (MRCs), explore potential risk and protective factors and the association with mental health difficulties in early childhood. Cross-sectional data were obtained from mothers, and blood samples of their children aged 14–21 months were collected during the first wave of the longitudinal RomaREACH study. A total of 88 blood samples from children were analysed: 49 children from the Slovak Majority population and 39 from MRCs. Anti- Toxocara canis IgG antibodies were detected in serum samples using an enzyme-linked immunosorbent assay (ELISA). Though it was not statistically significant, seropositivity for Toxocara canis was more often observed in children from MRCs (35.9%) than in the majority population (20.4%). The absence of running water in households significantly increases the risk of Toxocara infection in children, whereas a longer duration of breastfeeding decreases it. Children seropositive for Toxocara canis showed higher levels of early mental health difficulties even when controlled for MRC residence. These results indicate the need for integrated public health interventions targeting parasitic infections in susceptible populations. Improving access to sanitation, promoting breastfeeding, and strengthening the preventive and educational role of early childhood health services are critical strategies to reduce the risk of exposure to Toxocara spp. eggs and mitigate its potential impact on child health and development.

ObjectivesLarge socioeconomic inequalities in health are still present in the Central Europe. The aim was to explore socioeconomic inequalities in mortality in Visegrad countries—the Czech Republic, Hungary, Poland and Slovakia (V4), by three different socioeconomic indicators (unemployment, risk of poverty/social exclusion, education). The study was conducted within the H2020 Euro-Healthy project.MethodsThe associations between selected socioeconomic indicators and the standardised mortality rates by four main causes (mortality related to cancer, circulatory, respiratory and digestive system) in the economically active population aged 20–64 years in the 35 NUTS 2 level regions of the V4 in the period 2011–2013 were explored, using linear regression models.ResultsLower education level was the most significant predictor of mortality in the V4. The lowest mortality rates by all causes of death were found in the regions of the Czech Republic, the highest in regions of Hungary.ConclusionsDespite the common origin, the pathways of the V4 countries in employment, poverty and education seem to be different, also having impact on health equity. Therefore, where you live in the V4 can significantly influence your health.