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5. Reduction in perforated appendicitis incidence between rural and urban populations after introducing social health insurance in Vietnam: A population‐based study.

Author

Nguyen, Tran‐Nguyen, Chou, Yiing‐Jenq, and Huang, Nicole

Abstract

Background: Over the years, Vietnam has expanded its social health insurance (SHI) coverage to reduce health disparities. In this population‐based study, we examined the differences in incidences of perforated appendix between rural and urban populations in Vietnam since the expansion of SHI coverage in 2015. We also identified risk factors for perforated appendix in these populations. Method: The 2015–2019 SHI inpatient claims data from the Social Security Agency of Dong Thap Province were used to elaborate the final sample of 6863 patients aged 18 years or above who underwent an appendectomy. Multivariable probit and logistic regression model were employed to obtain adjusted estimates. Results: An overall rate of 22.9% for perforated appendix among adults in Dong Thap was revealed. After the expansion of SHI, rural residents consistently had lower rates of perforated appendix than urban residents, but the differences between rural and urban residents were small and decreased over time, that is from 4.4% in 2015 to 3.4% in 2019. Older, male, and poor residents were at a higher risk of perforated appendix in both urban and rural areas. In rural areas, patients with comorbidities, patients who resided in remote communes bordering Cambodia, and patients who had district hospitals or commune facilities as their primary assigned providers were significantly more likely to develop perforated appendix. Conclusion: Under the SHI in Vietnam, no significant difference was observed in perforated appendicitis incidence between urban and rural residents. Additional efforts are required to reduce poorer outcomes among other high‐risk residents. [ABSTRACT FROM AUTHOR]

Published
2024
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22. Prescribing antibiotics for children with dengue infection in Taiwan: who are at risk and who are high prescribers?

Author

Shen, Yi-Jung, Lien, Chia-En, Chou, Yiing-Jenq, Tsai, Theodore, and Huang, Nicole

Abstract

Inappropriate antibiotic use contributes to antimicrobial resistance, a global public health threat. The non-specific manifestations of dengue, itself a growing public health threat, lead to avoidable empiric antibiotic prescription, particularly in children. In this national pooled population-based cross-sectional study, we evaluated child and physician characteristics associated with antibiotics prescription in confirmed dengue cases in Taiwan. Linking national health care insurance claims and reports of confirmed dengue cases from 2008 to 2015, there were 7086 children with confirmed dengue with 21 744 outpatient visits and 2520 inpatient admissions. We assessed the presence of antibiotic prescription in outpatient and inpatient settings separately a week before or after the confirmation date. Logistic regression models with generalized estimating equations were applied to identify patient, practitioner, and other factors associated with antibiotic prescription. A total of 29.4% of children <18 years old with dengue who did not have a concomitant bacterial infection were prescribed antibiotics during the 14-day assessment period. Antibiotics prescription was reduced from 13.5% to 6.3% and from 43.2% to 19.3% in outpatient and inpatient settings, respectively, after dengue was confirmed. Young children were more likely to receive antibiotics. Significant variations in antibiotic prescribing across physicians were observed only in outpatient settings: physicians ≥60 years old and physicians practicing at clinics and in non-urban facilities were more likely to prescribe antibiotics. Antibiotics were less likely to be prescribed during an exceptional 2-year epidemic than in other years. Antibiotic prescribing for dengue, an arboviral infection affecting half of the global population, was shown to occur in 29% of paediatric cases in Taiwan. That potentially avoidable antibiotic consumption could be reduced by improving antibiotic stewardship, informed by understanding the conditions under which antibiotics are prescribed and the availability of prevention strategies for viral diseases, including dengue. We identified a number of such factors in this national population-based study. [ABSTRACT FROM AUTHOR]

Published
2024
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