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Indonesia has experienced 246 tsunami events from 416 to 2018, according to the National Oceanic and Atmospheric Administration. The Central Sulawesi region has been notably impacted by natural disasters, including a magnitude 7.4 earthquake in Palu and Donggala, which triggered tsunamis and liquefaction, severely damaging 2,758 buildings, including schools and healthcare facilities. High tsunami vulnerability is predicted for the Minahasa Islands, northern Mongondow, and Gorontalo regions due to their proximity to earthquake epicenters and megathrust faults. This study assesses the risk to educational and healthcare facilities from tsunami hazards, incorporating hazard mapping, exposure quantification, and vulnerability assessment. Tsunami hazard scenarios, including predictive (based on potential maximum earthquake magnitudes) and historical (based on past events), are modeled to produce inundation maps. Vulnerability is assessed based on building design specifications, site selection, and material quality, focusing on compliance with disaster-resistant standards. Using the 2006 Pangandaran tsunami vulnerability curve, the damage and economic losses are estimated. The dominant building taxonomy is one-story MCF structures, with a total of 412 educational facilities and 9 healthcare facilities impacted. Economic losses are calculated based on damage indices, replacement cost values, and building area, amounting to 732.8 billion for educational facilities and 26.25 billion for healthcare facilities. These findings underscore the need for targeted mitigation strategies and policymaker engagement to enhance resilience in tsunami-prone areas.

Background Although evidence on healthcare utilization avoidance during COVID-19 pandemic is emerging, such knowledge is limited in rural settings. An effective policy to the COVID-19 shocks and stresses in rural settings require empirical evidence to inform the design of health policies and programmes. To help overcome this evidence gap and also contribute to policy decisions, this study aimed at examining COVID-19-induced healthcare utilization avoidance and associated factors in rural India. Methods This study used the third-round data from the COVID-19-Related Shocks in Rural India survey conducted between 20-24 September, 2020 across six states. The outcome variable considered in this study was COVID-19-induced healthcare utilization avoidance. Multivariable Binary Logistic Regression Model via Multiple Imputation was used to assess the factors influencing COVID-19-induced healthcare utilization avoidance. Results Data on 4,682 respondents were used in the study. Of this, the prevalence of COVID-19-induced healthcare utilization avoidance was 15.5% in rural India across the six states. After adjusting for relevant covariates, participants from the Bihar State have significantly higher likelihood of COVID-19-induced healthcare utilization avoidance compared to those from the Andhra Pradesh. Also, participants whose educational level exceeds high school, those who use government hospital/clinic, engage in daily wage labour in agriculture have significantly higher odds of COVID-19-induced healthcare utilization avoidance compared to their counterparts. Conclusion Our study revealed that state of residence, type of health facility used, primary work activity and educational level were associated with COVID-19-induced healthcare utilization avoidance in rural India. The findings suggest that policy makers and public health authorities need to formulate policies and design interventions that acknowledge socioeconomic and demographic factors that influence healthcare use avoidance.

Background This paper focuses on the period from 2019 to 2021 and investigates the factors associated with the high prevalence of C-section deliveries in South India. We also examine the nuanced patterns, socio-demographic associations, and spatial dynamics underlying C-section choices in this region. A cross-sectional study was conducted using large nationally representative survey data. Methods National Family Health Survey data (NFHS) from 2019 to 2021 have been used for the analysis. Bayesian Multilevel and Geospatial Analysis have been used as statistical methods. Results Our analysis reveals significant regional disparities in C-section utilization, indicating potential gaps in healthcare access and socio-economic influences. Maternal age at childbirth, educational attainment, healthcare facility type size of child at birth and ever pregnancy termination are identified as key determinants of method of C-section decisions. Wealth index and urban residence also play pivotal roles, reflecting financial considerations and access to healthcare resources. Bayesian multilevel analysis highlights the need for tailored interventions that consider individual household, primary sampling unit (PSU) and district-level factors. Additionally, spatial analysis identifies regions with varying C-section rates, allowing policymakers to develop targeted strategies to optimize maternal and neonatal health outcomes and address healthcare disparities. Spatial autocorrelation and hotspot analysis further elucidate localized influences and clustering patterns. Conclusion In conclusion, this research underscores the complexity of C-section choices and calls for evidence-based policies and interventions that promote equitable access to quality maternal care in South India. Stakeholders must recognize the multifaceted nature of healthcare decisions and work collaboratively to ensure more balanced and effective healthcare practices in the region.

Background This study examined the wealth-related inequality in women healthcare seeking behaviour for under-five children illness in Afghanistan and its determinants. Methods Data of 32409 mothers/caregivers of children under-five were extracted from Afghanistan Multiple Indicator Cluster Survey conducted in 2022. Wealth-related inequalities in women healthcare seeking behaviour for under-five children illness was investigated using Erreygers and Wagstaff concentration indices and curve. Contributions of selected factors to the total inequality were estimated using the Erreygers decomposition technique. Results The Erreygers and Wagstaff normalized concentration indices for women healthcare seeking behaviour for under-five children illness was 0.040; p  < 0.000 and 0.042; p  < 0.000 respectively. Hence, women healthcare seeking behaviour for children under-five illness was heavily concentrated among women from richer households and disfavoured women from poorer households. The decomposition findings revealed that household wealth (265%), residency in rural areas (-125%), access to mobile phone (-83%), access to internet (67%) and mothers’ education (26%) were the major determinants of pro-rich inequalities. Conclusion Policy makers, the private and development actors in Afghanistan should promote inclusive income generation interventions and healthcare awareness programmes, including women from poor households to eliminate wealth-related inequalities in women healthcare seeking behaviour. There is need for decentralizing health facilities in both rural and urban areas to improve equitable access to healthcare services. There is scope for disseminating health education through mobile phones and internet, reaching out to all areas to improve knowledge on children’s illnesses and subsequently reduce inequalities in women health seeking behaviours.

Background Tuberculosis (TB) is a serious health concern, particularly in developing countries. Various delays, such as patient delay (PD) and healthcare system delay (HSD) in the TB process, are exacerbating the disease burden and increasing the rates of transmission and mortality in various global communities. Therefore, the aim of this study is to identify risk factors associated with PD and HSD in TB patients in Tabriz, Iran. Methods A cross-sectional study was conducted on 173 TB patients in Tabriz, Iran from 2012 to 2014. Patients were interviewed with a semi-structured questionnaire. Frequencies and percentages were reported for patient categories of sex, age, and education. The median and interquartile range (IQR) were reported for the time intervals of delays. Univariate and multivariate logistic regressions of delay in respect to socio-demographic and clinical variables were performed. Statistical significance was set at p  < 0.05. Results The median values for delays were 53 days for HSD (IQR = 73) and 13 days for PD (IQR = 57). Odds ratios (OR) associated with PD were: employed vs. unemployed (OR = 5.86, 95% CI: 1.59 to 21.64); public hospitals vs. private hospitals (OR = 2.64, 95% CI: 1.01 to 6.85); ≥ 3 vs. < 3 visits to health facilities before correct diagnosis (OR = 2.35, 95% CI: 1.08 to 5.11); and male vs. female (OR = 2.28, 95% CI: 1.29 to 4.39). The OR associated with HSD were: ≥ 3 vs. < 3 visits to health facilities before correct diagnosis (OR = 9.44, 95% CI: 4.50 to 19.82), without vs. with access to TB diagnostic services (OR = 3.56, 95% CI: 1.85 to 6.83), and misdiagnosis as cold or viral infection vs. not (OR = 2.62, 95% CI: 1.40 to 4.91). Conclusions The results provide for an important understanding of the risk factors associated with PD and HSD. One of the major recommendations is to provide more TB diagnostic knowledge and tools to primary health providers and correct diagnoses for patients during their initial visit to the health care facilities. The knowledge generated from this study will be helpful for prioritizing and developing strategies for minimizing delays, initiating early treatment to TB patients, and improving TB-related training programs and healthcare systems in Tabriz, Iran.

As societies grow more complex andpeople are increasingly bombarded withhealth information and misinformation health literacy becomes essential. Peoplewith strong health literacy skills enjoybetter health and well-being while thosewith weaker skills tend to engage in riskierbehaviour and have poorer health. With evidence from the recent EuropeanHealth Literacy Survey this report identifiespractical and effective ways public healthand other sector authorities and advocatescan strengthen health literacy in a varietyof settings including educational settings workplaces marketplaces health systems new and traditional media and politicalarenas. The report can be used as a tool forspreading awareness stimulating debateand research and above all for informingpolicy development and action.

Background In 2017, about 20% of the world’s children under 1 year of age with incomplete DPT vaccination lived in Nigeria. Fully-immunised child coverage (FIC), which is the percentage of children aged 12–23 months who received all doses of routine infant vaccines in their first year of life in Nigeria is low. We explored the associations between child, household, community and health system level factors and FIC, in particular focussing on urban formal and slum, and rural residence, using representative Nigeria Demographic Health Survey (NDHS) data from 2003, 2008 and 2013. Method Multilevel logistic regression models were applied for quantitative analyses of NDHS 2003, 2008 and 2013 data, singly, pooled overall and stratified by rural/urban, and within urban by formal and slum. We also quantify Population Attributable Risk (PAR) of FIC. Results FIC for rural, urban formal and slum rose from 7.4, 25.6 and 24.9% respectively in 2003 to 15.8, 45.5 and 38.5% in 2013, and varied across sociodemographics. In pooled NDHS analysis, overall and stratified, final FIC adjusted odds (aOR) were: 1. Total population - delivery place (health facility vs home, aOR = 1.13, 95% CI = 0.73–1.73), maternal education (higher vs no education, aOR = 3.92, 95% CI = 1.79–8.59) and place of residence (urban vs rural, aOR = 1.69, 95% CI = 0.89–3.22). 2. Rural, urban formal and slum stratified: A .Rural – delivery place (aOR = 1.47, 95% CI = 1.12–1.94), maternal education (aOR = 4.99, 95% CI = 2.48–10.06). B .Urban formal - delivery place (aOR = 2.62, 95% CI = 1.43–4.79), maternal education level (aOR = 9.18, 95% CI = 3.05–27.64). C .Slums - delivery place (aOR = 5.39, 95% CI = 2.18–13.33), maternal education (aOR = 5.03, 95% CI = 1.52–16.65). The PAR revealed the highest percentage point increase in FIC would be achieved in all places of residence by maternal higher education: rural-38.15, urban formal-22.88 and slum 23.76, while non-attendance of antenatal care was estimated to lead to the largest reduction in FIC. Conclusion Although low FIC in rural areas may be largely due to lack of health facilities and immunisation education, the intra-urban disparity is mostly unexplained, and requires further qualitative and interventional research. We show the FIC point increase that can be achieved if specific sociodemographic variable (risk) are addressed in the various communities, thus informing prioritisation of interventions.

Background Reducing child mortality and morbidity is a public health concern globally. Like many other developing countries, Bangladesh is struggling to improve child health status as the use of medical treatment is still not at a satisfactory level. Hence, the objective of this study is to identify the contributing factors for inequalities in the use of medical treatment for common childhood illnesses in Bangladesh. Methods The study used data from the latest Bangladesh Demographic and Health Survey (BDHS)-2014. Children who had diarrhea, fever and cough in the 2 weeks preceding the survey were included in this study. Bivariate and multivariate analyses were conducted to unearth the influential factors for medical treatment use among under-five children with childhood illnesses. In the multivariate logistic regression, adjusted odds ratios with p values less than 0.05 were considered for determining significant predictors. Results This study found that only 37% of children suffering from fever/cough sought medical treatment while this figure was approximately 36% for diarrhea. Age of children, household wealth status, father’s education level, region of residence, number of children in the household, access to electronic media were identified as factors contributing to inequality in health care utilization for common childhood illnesses in Bangladesh. Conclusions Various socio-economic factors substantially influence the utilization of medical treatment for childhood illnesses. Therefore, to enhance equitable access to health care for children, interventions should be designed targeting children from households with low socio-economic status. Various awareness-raising health education programs, poverty alleviation programs especially for rural areas can contribute in this regard.

Early cancer diagnosis is crucial to improving disease prognosis. Although several studies have investigated the relationship between socioeconomic position (SEP) and stage at diagnosis, there is limited evidence from contexts with highly fragmented health systems and pronounced socioeconomic inequalities. This study analyzed the association between SEP and stage of cancer diagnosis. Data were obtained from the EquityCancer-LA baseline study. The sample included patients aged 18 or older with a confirmed cancer diagnosis within the 12 months prior to participation. Cancer stage was determined by the oncology committees of participating healthcare centers and logistic regression models were used to assess the association between SEP and cancer stage at diagnosis. A total of 343 individuals participated in the study, 39.1% of whom were diagnosed at a late stage. Two SEP indicators were associated with this outcome. After adjusting for covariates, participants without formal income had higher odds of late-stage diagnosis (OR = 2.14; 95% CI 1.02–4.53), and those who were non-head of household (OR = 1.83; 95% CI 1.11–3.02). When adjusting for all SEP variables, only non–head of household condition remained significantly associated (OR = 1.77; 95% CI 1.07–2.96). These results show that disadvantaged SEP was associated with higher odds of late-stage cancer diagnosis. The findings suggest the need for strategies that promote early diagnosis and address the socioeconomic inequities identified in this study.

Background Over the past two decades, child health indicators in Nepal have improved significantly at the national level. Yet, this progress hasn’t been uniform across various population subsets. This study identified the determinants associated with childhood full vaccination, assessed wealth-related inequalities, and delved into the key factors driving this inequality. Methods Data for this study were taken from the most recent nationally representative Nepal Demographic and Health Survey 2022. A total of 959 children aged 12–23 months who had received routine childhood basic antigens as per the national immunisation program were considered for analysis. Binary logistic regression models were conducted to identify the associated factors with outcome variable (uptake of full vaccination). The concentration curve and Erreygers normalized concentration index were used to assess inequality in full vaccination. Household wealth quintile index scores were used to measure wealth-related inequality and decomposition analysis was conducted to identify determinants explaining wealth-related inequality in the uptake of childhood vaccination. Results The coverage of full vaccination among children was 79.8% at national level. Several factors, including maternal health service utilisation variables (e.g., antenatal care, institutional delivery), financial challenges related to visiting health facilities, and mothers’ awareness of health mother group meetings within their ward, were associated with the uptake of full vaccination coverage among children. The concentration curve was below the line of equality, and the relative Erreygers normalized concentration index was 0.090, indicating that full vaccination was disproportionately higher among children from wealthy groups. The decomposition analysis identified institutional delivery (20.21%), the money needed to visit health facilities (14.25%), maternal education (16.79%), maternal age (8.53%), and caste (3.03%) were important contributors to wealth related inequalities in childhood full vaccination uptake. Conclusions There was notable wealth-related inequality in full vaccine uptake among children in Nepal. Multisectoral actions involving responsible stakeholders are pivotal in reducing the inequalities, including promoting access to maternal health services and improving educational attainment among mothers from socioeconomically disadvantaged communities.