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Exploring individual and structural factors influencing healthcare seeking behavior in the context of the Senegal’s Universal Health Coverage program: a multilevel analysis from the ANRS-12399 Soignants Senegal study
No full textBackground: Although Senegal’s Universal Health Coverage (UHC) program has improved access to care, it has sometimes led to overuse of health services. Moreover, the program’s substantial financial debt to health facilities (HFs) has exposed them to organizational and financial problems, making it difficult to renew drug stocks and pay salaries on time. The multiple effects of the UHC program, both on individuals and on HFs, may discourage individuals from seeking for care in HFs. This study analyzed structural and individual factors associated with healthcare-seeking behavior in the context of Senegal’s UHC program.
Methods: We used data from six HFs in the mostly rural Fatick region that participated in two different two surveys: ANRS 12399 Soignants Sénégal and CMUtuelleS. We performed a multilevel logistic regression model to identify individual and structural factors influencing healthcare-seeking behavior.
Results: Among the 313 individuals included, 63.3% were female and median age was 52 years (IQR [41⎯63]). Half the participants (50.5%) sought health services after experiencing a health problem in the two months prior to the survey. HFs, which the National Agency managing the UHC program (33.3%) owed most to, were better equipped and staffed, but also the most negatively affected by UHC implementation. Despite this, individuals sought care in these facilities just as frequently as in others, suggesting that being better equipped and staffed helped them to be more resilient to the negative effects of the UHC program. Individuals were less likely to seek care in smaller HFs. Instead, they were more likely to seek care in HFs providing HIV and tuberculosis care. Voluntary (i.e., paying) members (vs. other members) of community-based health insurance organizations, and individuals with a chronic illness (vs. without), were more likely to seek care. Persons with a disability (vs. without) and those experiencing food insecurity (vs. no food insecurity) were less likely to seek care.
Conclusion: Both the financial support provided to individuals by the UHC program and structural characteristics of the healthcare system were associated with seeking healthcare. Taking greater account of these structural aspects when implementing UHC could enhance the program’s effectiveness and help achieve its objectives
L’Afrique sub-saharienne, moteur de la croissance démographique mondiale
No full textEn 1990, l’Afrique sub-saharienne comptait un demi-milliard d’habitants, soit 700 millions de moins qu’en Chine ; à cette époque, ce pays était donc 2,2 fois plus peuplé que l’ensemble des pays d’Afrique de l’Ouest, de l’Est, centrale et australe. Mais en 2023, avec 1,2 milliard d’habitants, la population d’Afrique sub-saharienne ne compte dorénavant plus que 200 millions de personnes de moins qu’en Chine. En une trentaine d’années, l’Afrique sub-saharienne est donc devenue un géant démographique. Elle devrait même rapidement devenir la première puissance démographique mondiale. Sa croissance démographique est en effet encore importante, portée par une population très jeune et une fécondité qui reste élevée. Les tendances actuelles ne laissent la place à aucun doute sur son futur démographique : la population de l’Afrique sub-saharienne devrait continuer de croître au cours des trente prochaines années et le nombre de ses habitants pourrait dépasser les deux milliards en 2050
Yoann Doignon, Isabelle Blöss-Widmer, Elena Ambrosetti, Sébastien Oliveau. 2023. Population Dynamics in the Mediterranean. A demographic convergence ? [Dynamique des populations en Méditerranée. Une convergence démographique ?]. Springer. 161 pages
No full textGaspard Lion. 2024. Vivre au camping : Un mal-logement des classes populaires. Seuil. 315 pages.
No full textDifferent vaccines, different trust issues? Disentangling the effect of trust in various institutions using dominance analysis
No full textVaccination campaigns involve a wide variety of institutional actors whether as producers of expertise, as decision-makers or as organizers and vaccinators. In this paper, we aim to compare the role of trust in a variety of institutions and actors on attitudes to vaccines in France, with a particular focus on the role of trust in scientific and political actors. We draw on a survey conducted in the summer of 2023 among a large sample of the French adult population (n = 4303, quota sampling with post-stratification weighting procedure). The survey combines a rich set of questions pertaining to vaccination (vaccination in general and vaccination against Covid-19, Measles, HPV, Hepatitis B and the Flu) as well as a set of items pertaining to trust in 13 institutions and actors (the CEVIPOF Trust Barometer). We use dominance analysis to compare the influence of distrust in each institution and actor on attitudes to a diversity vaccines and vaccination in general. We also compare them to other determinants of vaccine hesitancy such as sociodemographic status, political identities and scientific literacy. We find that, overall, trust in science tends to be an important determinant of attitudes to all vaccines. But we also found that trust in government agencies, and pharmaceutical companies are also crucial. We also found that the importance of trust in science varies depending on the vaccine: it bears particularly heavily on attitudes to vaccination in general and to vaccination against measles while trust in more political actors and political dispositions bear more heavily on attitudes to Covid-19 vaccination. Our study underlines the importance of tayloring interventions to the specificities faced by each vaccine as well as emphasizing how institutional decision-making processes guarantee the evidence-based nature of vaccination policies
The evolution of the child penality and gender-related inequality in the Netherlands, 1989-2022
No full textWe study the evolution of the child penalty and gender-related inequality in the Netherlands. We use administrative panel data from 1989 to 2022 in an extension of the event study approach used in Kleven et al. (2019b). We document a substantial decline in child penalties (in earnings) for first-time mothers from 60% in the early 1990s to 35% in the 2010s. This decline is much larger than in the handful of other countries documented so far. However, looking at subperiods, we also find that the decline in the child penalty in the Netherlands has stalled in the mid 2000s, despite a steep rise in spending on formal childcare. Next, we decompose the gender-related inequality for parents into inequality related to children, education, migration background and a residual. We find that overall gender-related inequality and child-related gender inequality decline in parallel over time. The role of education and migration background is small and becomes less important over time. Hence, a substantial residual remains, and cannot be attributed to the aforementioned factors. We also show that the event-time window used is crucial for the contribution of the child penalty to the evolution of gender inequality
Sociologie de Grenoble
No full textGrenoble a tout d'une grande ville, avec ses importants centres de recherche, ses entreprises de haute technologie, sa forte concentration de cadres et d'ingénieurs. Elle semble en partager aussi les problèmes : pollution, délinquance, inégalités... Nichée au creux des massifs alpins, à l'ombre de Lyon et aux portes de la Suisse et de l'Italie, Grenoble n'en reste pas moins une ville moyenne par sa démographie et son rayonnement. Elle s'est toutefois distinguée par la rencontre entre des mondes politique, scientifique et industriel qui ont construit le récit d'un laboratoire d'innovations technologiques, urbaines, culturelles et sociales. Ce livre en brosse un portrait contrasté : celui d'une ville tiraillée entre attractivité et répulsion, qui offre un cadre de vie marqué par de fortes hiérarchies sociospatiales et des recompositions économiques favorisant certains secteurs au détriment d'autres. Ni Silicon Valley française, ni Chicago alpine, Grenoble mérite qu'on s'y intéresse pour ce qu'elle est vraiment, en montrant la diversité des modes de vie de l'ensemble de sa population, et non uniquement de ses élites ou de ses marges
On the Use of Kannisto Model for Mortality Trajectory Modelling at Very Old Ages
No full textThe Kannisto model is one of the most widely used parametric models for old-age mortality estimation. The model finds extensive use in life tables calculations, such as in the Human Mortality Database for old-age mortality smoothing, and in pension and annuity policy planning. However, recent concerns have arisen regarding the accuracy of this model for modeling mortality patterns at advanced ages Feehan (2018). We explore the question further using thorough age-validated mortality data for France, Belgium and Quebec (Canada), where a large number of extinct birth cohorts were followed up to age 115. Our comparison of the Kannisto model's performance with other frequently used mathematical mortality models showed a systematic underestimation of death rates for the Kannisto model, which becomes apparent as early as circa age 100 in all populations studied, for both males and females. This systematic underestimation in mortality would translate in a systematic overestimation of life expectancy that becomes noticeable after age 100. Caution is thereby advised when using the Kannisto model to estimate mortality at very old ages
Adoption of HIV preexposure prophylaxis (PrEP) among female sex workers (FSWs) in Côte d’Ivoire: complex trajectories and early adopters
No full textBACKGROUND: The ANRS 12381 PRINCESSE project (11/2019-06/2023) enrolled 489 FSWs and implemented community-based sexual and reproductive health care, including PrEP, delivered through mobile clinics at prostitution sites in the San Pedro region. This presentation aims to describe PrEP trajectories and the factors associated with its use, focusing on “early adopters”.
METHODS: This analysis included 400 FSWs eligible for PrEP (HIV-negative, HBsAg-negative) enrolled up to December 2022 (>6 months of follow-up). Clinical records were analyzed to describe PrEP cascade, follow-up, and PrEP trajectories. A multivariable logistic regression identified factors associated with PrEP early adopters.
RESULTS: Although 98% of eligible FSWs were interested in PrEP, only 62% initiated PrEP, and 39% renewed it at least once. Follow-up was very short (12 months with a gap of 6 months between two visits) for 31%, and regular (>12 months with no gap) for 6%. PrEP initiation was high among FSWs with regular (96%), seasonal (83%), or short (80%) follow-up, vs. 39% for those with very short follow-up. Among those who initiated, only 88% (regular), 70% (seasonal), 74% (short), and 35% (very short) renewed PrEP. Among 148 FSWs with regular/seasonal follow-up, four PrEP trajectories were identified (cf. figure showing individual trajectories): 15% “never initiated” PrEP, 39% “initiated and were later not interested anymore”, 18% “re-initiated after non-interest”, and 28% “initiated and never expressed non-interest”, the last two groups being considered as “early adopters”. Factors associated with early PrEP adoption included the usual price of intercourse with clients <1500 FCFA (aOR=2.4 [1.2-4.8]) and working in brothels (aOR=3.2 [1.6-6.6]). Figures presenting individual PrEP trajectories of FSWs enrolled in the PRINCESSE project
CONCLUSIONS: In PRINCESSE, loss-to-follow-up and seasonality of risks limited PrEP adoption. FSWs who were more precarious and less mobile became early adopters of this new prevention tool and could serve as potential ambassadors for promoting its uptake
P-725 Social inequalities in (recurrent) miscarriage risk among Finnish mothers
No full textAre socioeconomic position or migrant status associated with the risk of ever experiencing a miscarriage (ever miscarriage) or experiencing multiple miscarriages (recurrent miscarriage) among mothers?Education and income are negatively associated with ever miscarriage and recurrent miscarriage, whereas migrant status increases the risk of recurrent miscarriage but not ever miscarriage.Miscarriage risk likely has a social gradient, because social disadvantage (socioeconomic or belonging to a minority group) is associated with many risk factors of miscarriage including poor health, obesity, and stress (see e.g. Quenby et al. 2021). Disadvantaged groups may thus be disproportionally likely to experience a miscarriage. In the US, while singular miscarriage risk was consistent across social groups, low income and education were associated with a higher risk for recurrent miscarriage (Price 2006). Higher parental age, however, is a risk factor more common among socially advantaged groups making it important to study miscarriages within the life course context.This is an observational study in which we analyse Finnish population registers between years 1998 and 2021. Our dataset includes data about miscarriages recorded in hospitals and specialist healthcare (1998-2021), primary healthcare (2011-2021), and antenatal care visits (1998-2021) linked with socio-demographic information such as year of birth, education, household income, and country of birth (Finland or abroad). Our analytical sample includes all women born in 1979-83 and 1993-97 who had at least one child (N = 142,367).We compare different sources of miscarriage data (self-reported at antenatal visits vs. health-records) to ensure robustness of results as both administrative records and self-reports likely miss some miscarriages. We include the two cohorts mentioned above to match start of their reproductive lives with the availability of different miscarriage data (see above). We first test risk of ever miscarriage and recurrent miscarriage using logistic regression and will conduct longitudinal analyses to better account for lifecourse trajectories.More miscarriages were declared at antenatal visits than in administrative records, so these results are based on antenatal visits (results for administrative records were similar).22% of parous women declared previous miscarriages (16.4% one, 5.8% multiple). Crosstabulations revealed no differences in miscarriage risk by education, unlike for household income: e.g., among the lowest quintile 16.4% experienced one and 6.7% recurrent miscarriages; among the highest 14.9% and 5.1%, respectively (p < 0.001)). Those born abroad declared more recurrent miscarriages (6.7%) than those in Finland (5.8%) (p = 0.053).We ran four logistic regressions controlling for country of birth, parity, birth year, and age at the most recent antenatal visit where the number of miscarriages was declared. We examined the risk of ever miscarriage (N = 142,253) firstly including education and secondly income as the main explanatory variable and then explored the risk of recurrent miscarriage among those who ever had one (N = 31,596). Education and income were both negatively associated with the risk of ever miscarriage (e.g. OR(postgrad vs. basic)=0.62; OR(highest20% vs. lowest20%)=0.82) and recurrent miscarriage (e.g. OR(postgrad vs. basic)=0.73; OR(highest20% vs. lowest20%)=0.88), whereas being born abroad only increased the risk of recurrent miscarriage (OR = 1.17).Next, longitudinal models will analyse how these effects change over the lifecourse.Research in the US shows self-reported miscarriages may be underreported (Lindberg & Scott 2018), which could affect our results. However, relatively many women declared miscarriages (22%) indicating the problem might not be substantial here. While an observational study cannot prove causality, we cannot examine social inequalities in miscarriage risk otherwise.A better understanding of the social inequalities in miscarriage risk can inform policy makers on who to target with interventions. Reducing such inequalities reduces disadvantaged women being disproportionally affected by the negative mental and physical health consequences of miscarriages, which in turn reduces the overall population health gaps