Khurshid Alam

Background
Urban-rural inequality in accessing quality antenatal care (ANC) is a well-documented challenge in low- and middle-income countries like Bangladesh and Pakistan, hindering maternal healthcare utilization and progress towards the Sustainable Development Goals. This study explores the key factors contributing to this inequality in Bangladesh and Pakistan and highlights inter-country differences.

Methods
We analyzed data from Demographic Health Surveys (2017–2018) of Bangladesh and Pakistan for women aged 15–49 who had at least one live birth in the three years preceding the survey. To identify the extent and sources of inequality, we decomposed urban-rural differences in quality ANC utilization into explained (attributable to variations in socioeconomic and demographic characteristics) and unexplained (reflecting differences in the effects of these characteristics) components using Blinder-Oaxaca type models adapted for nonlinear response variables.

Results
Urban women were significantly more likely to receive quality ANC than rural women in both Bangladesh and Pakistan, with disparities of about 20%-25% points. Most of the inequality was explained by differences in socioeconomic and educational characteristics rather than behavioral factors. Wealth status was the dominant contributor, explaining nearly 58% of the inequality in Bangladesh and 46% in Pakistan, followed by women’s and husbands’ education, media exposure, and women’s autonomy. The pattern of predictors was broadly consistent across both countries, though education contributed more in Pakistan, while media exposure and husband’s education played a larger role in Bangladesh.

Conclusion
Significant urban-rural inequality exists in Bangladesh and Pakistan, which is more pronounced in Pakistan. Among the common significant predictors for both countries, wealth disparity has the highest contribution percentage. In Pakistan, women’s education is the second largest contributor to inequality, whereas in Bangladesh, both media exposure and husband’s education played notable roles. Reducing urban-rural inequality in quality ANC requires targeted policies addressing wealth and educational disparities, along with interventions that promote media access and women’s autonomy to ensure equitable maternal healthcare utilization.

Background
The coronavirus disease (COVID-19) pandemic and mobility-restricting policies (MRPs) have created substantial barriers to healthcare access globally. This study quantified the causal impact of government-imposed MRPs and perceived COVID-19 risk on household unmet medical needs in Nigeria, examining the differential effects for vulnerable populations.

Methods
We conducted difference-in-differences analyses using nationally representative household panel data from the pre-pandemic period (January-February 2019, n = 1,596 households) and the early pandemic period (April-August 2020). Unmet needs were measured as self-reported forgone medical care at the household level. We employed two approaches to disentangle voluntary from policy-driven restrictions: comparing states with total versus partial lockdown, and comparing states with below- versus above-median mobility reductions (Google Mobility data). We estimated COVID-19 risk effects across four state-level case burden categories during and after the lockdown.

Results
Households in total lockdown states experienced 13.0% points (95%CI: 3.0–23.0) (doubling baseline rate) higher unmet needs compared to households in partial lockdown states. This converges with mobility approach showing 15.0% points (95%CI: 6.0–25.0) higher unmet needs among individuals with below-median mobility. During lockdown, the COVID-19 case burden had no significant differential impact. However, during the post-lockdown period (June-August 2020), households in Lagos (the epicentre, with more than 10,000 cases) experienced 24.0% points (95%CI: 2.0–46.0) higher unmet needs compared to low-risk states. Persons with disabilities faced disproportionate barriers during lockdown, with a 40.0% point (95% CI: 6.0–74.0) higher rate in high-risk states and a 74.0% point (95%CI: 22.0-126.0) higher rate in the epicentre. No differential impacts were observed for poverty or chronic disease status.

Conclusion
Considering the detrimental effects of unmet medical needs, this study suggests that policymakers should evaluate the risks of COVID-19 in relation to the implementation of MRPs to protect households and vulnerable groups during future pandemics in Nigeria.

Mental health conditions impose substantial economic burdens on healthcare systems globally, with growing evidence indicating disproportionate impacts on household-level out-of-pocket (OOP) expenditures. Despite Australia's universal healthcare system, the financial burden of mental health conditions on households remains underexplored.
To examine the longitudinal relationship between mental health status and OOP healthcare expenditures among Australian adults, and assess how education and income moderate this relationship.
We analyzed 17 waves (2006-2022) of the Household, Income and Labour Dynamics in Australia (HILDA) survey, encompassing 57,647 person-year observations from 3,391 unique individuals. Mental health was measured using the Mental Health Inventory-5 (MHI-5) scale and newly proposed expanded MHI-9 scales. We employed fixed-effects panel regression models and instrumental variable analysis to address unobserved heterogeneity.
A one-unit decrease in MHI-5 score is associated with 0.18-0.25% increase in inflation-adjusted OOP healthcare expenditure, equivalent to AU$2.10-$3.00 per unit decline, with a 10-point decline in MHI-5 costing households an additional AU$21-$30. Instrumental variable estimates revealed larger causal effects of 0.80-1.00%. Individuals with good mental health and higher education demonstrated expenditure patterns consistent with Grossman's health capital theory, while those with poor mental health showed disrupted relationships between education and healthcare spending. Urban residents faced 11.00% higher inflation-adjusted OOP costs than the rural residents.
Mental health deterioration significantly increases household healthcare expenditure burdens in Australia. Traditional health economics theories apply primarily to individuals with good mental health, indicating the need for targeted rather than universal policy approaches.

Data on dementia epidemiology in the Middle East and North Africa (MENA) region is limited. This systematic review and meta-analysis examined dementia prevalence across MENA. Databases were searched up to October 2024. Analyses were stratified by country and sex. Pooled prevalence was estimated using a random-effects model with a 95% confidence interval (CI). Fifty-two studies on the selected countries met inclusion criteria, covering 87,219 individuals with dementia from a total population of 1,045,908. The pooled prevalence was 12.16% (95% CI: 9.61–14.96) for the region and the Israel had the highest prevalence (17.00%), followed by Iran (13.20%), Turkey (11.40%), Saudi Arabia (8.34%), and Egypt (6.86%). Dementia was more common in women than men (13.84% vs. 8.69%). Dementia is prevalent in MENA, with significant variation across countries. The region's aging population highlights the need for ongoing monitoring of dementia trends.

Chronic respiratory diseases, including chronic obstructive pulmonary disease (COPD), asthma, pneumoconiosis, interstitial lung disease (ILD) and pulmonary sarcoidosis, are major global causes of mortality and morbidity. Although the COVID-19 pandemic has influenced acute respiratory health, its impact on chronic respiratory conditions remains unclear. We estimated the global, regional and national burden of chronic respiratory diseases from 1990 to 2023, including risk factors, and evaluated how these burdens have shifted during the COVID-19 pandemic using the Global Burden of Disease Study 2023. In 2023, chronic respiratory diseases accounted for 569.2 million (95% uncertainty interval (UI), 508.8-639.8) cases and 4.2 million (3.6-5.1) deaths. The age-standardized death rate declined by 25.7% globally from 1990 to 2023 despite an increase in ILD and pulmonary sarcoidosis. Mortality declined in younger males, especially for asthma, whereas older adults experienced a rise in ILD and pulmonary sarcoidosis. Smoking was the primary risk factor for COPD, whereas high body mass index and silica exposure were key risk factors for asthma and pneumoconiosis. During the pandemic, the incidence of chronic respiratory diseases increased modestly, but the decline in mortality rates became more pronounced, highlighting the need for sustained global attention and action to address their long-term burden.