Healthcare without borders: A cross-sectional study of immigrant and nonimmigrant children admitted to a large public sector hospital in the Gauteng Province of South Africa

  • PLoS Medicine, Volume 18, No. 3, Year 2021

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Study Justification:
The study titled “Healthcare without borders: A cross-sectional study of immigrant and nonimmigrant children admitted to a large public sector hospital in the Gauteng Province of South Africa” aimed to address the gaps in healthcare provision for immigrant children in South Africa. With a significant proportion of children in public sector health facilities being immigrants, it was important to understand the characteristics and differences between immigrant and South African children accessing healthcare at Kalafong Provincial Tertiary Hospital (KPTH). This study aimed to provide valuable insights into the healthcare needs of immigrant children and inform policy and practice to ensure equitable healthcare access for all children.
Study Highlights:
1. The study included 508 children, divided into two groups: 271 general pediatric patients and 237 neonates.
2. Approximately 25% of children in the neonatal group and 22.5% in the general pediatric group were immigrants.
3. Immigrant parents/caregivers had lower educational levels, lower income, difficulty communicating in English, and were more likely to reside in informal settlements compared to South African parents/caregivers.
4. There were no significant differences between immigrant and South African children in terms of antenatal care visits, type of delivery, gestational age, birth weight, immunization coverage, and prevention of mother-to-child transmission of HIV.
5. However, the immigrant group had higher rates of malnutrition (wasting) compared to the South African group in the general pediatric group.
6. A significant proportion (10%) of neonates born to immigrant mothers were born outside a medical facility.
7. The study highlights the importance of viewing the immigrant population as a high-risk group and emphasizes the need for equal healthcare access and support for all children.
Recommendations for Lay Readers:
1. Ensure equal access to healthcare: Policy and practice should focus on providing equal healthcare access to both immigrant and South African children, regardless of their socioeconomic background or immigration status.
2. Address malnutrition: Efforts should be made to address the higher rates of malnutrition among immigrant children, particularly in the general pediatric group.
3. Improve communication: Healthcare providers should ensure effective communication with immigrant parents/caregivers who may have difficulty communicating in English.
4. Enhance support for immigrant mothers: Additional support should be provided to immigrant mothers, especially during pregnancy and childbirth, to reduce the proportion of neonates born outside medical facilities.
Recommendations for Policy Makers:
1. Develop inclusive healthcare policies: Policy makers should develop inclusive healthcare policies that prioritize equitable access to healthcare for all children, including immigrants.
2. Strengthen healthcare infrastructure: Investments should be made to strengthen healthcare infrastructure, particularly in areas with a high immigrant population, to ensure adequate facilities for childbirth and neonatal care.
3. Enhance cultural competency training: Healthcare providers should receive cultural competency training to better understand and address the unique healthcare needs of immigrant children and their families.
4. Collaborate with community organizations: Policy makers should collaborate with community organizations and stakeholders to promote tolerance, respect, and equal healthcare access for all children, regardless of their immigration status.
Key Role Players:
1. Policy makers and government officials responsible for healthcare policy and planning.
2. Healthcare providers, including doctors, nurses, and other healthcare professionals.
3. Community organizations working with immigrant populations.
4. Non-governmental organizations (NGOs) focusing on child health and immigrant rights.
5. Researchers and academics specializing in public health and immigration.
Cost Items for Planning Recommendations:
1. Healthcare infrastructure development and improvement.
2. Cultural competency training programs for healthcare providers.
3. Additional support services for immigrant mothers, such as prenatal and postnatal care.
4. Outreach programs and community engagement initiatives.
5. Research and data collection on immigrant health outcomes.
6. Advocacy campaigns promoting equal healthcare access for all children.
Please note that the cost items provided are general categories and not actual cost estimates. Actual budget planning would require a detailed analysis of specific needs and resources available.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study is a cross-sectional study conducted over a 4-month period, which provides a snapshot of the characteristics and differences between immigrant and SA children admitted to the hospital. The study includes a sample size of 508 children, which is relatively large. The study utilizes a structured questionnaire and health record review to gather information. However, the study does not mention the specific methods used for data analysis, which could affect the strength of the evidence. To improve the strength of the evidence, future studies could consider using a longer study period, including a larger sample size, and providing more details on the data analysis methods.

Background Human migration is a worldwide phenomenon that receives considerable attention from the media and healthcare authorities alike. A significant proportion of children seen at public sector health facilities in South Africa (SA) are immigrants, and gaps have previously been noted in their healthcare provision. The objective of the study was to describe the characteristics and differences between the immigrant and SA children admitted to Kalafong Provincial Tertiary Hospital (KPTH), a large public sector hospital in the urban Gauteng Province of SA. Methods and findings A cross-sectional study was conducted over a 4-month period during 2016 to 2017. Information was obtained through a structured questionnaire and health record review. The enrolled study participants included 508 children divided into 2 groups, namely 271 general paediatric patients and 237 neonates. Twenty-five percent of children in the neonatal group and 22.5% in the general paediatric group were immigrants. The parents/caregivers of the immigrant group had a lower educational level (p < 0.0001 neonatal and paediatric), lower income (neonatal p < 0.001; paediatric p = 0.024), difficulty communicating in English (p < 0.001 neonatal and paediatric), and were more likely residing in informal settlements (neonatal p = 0.001; paediatric p = 0.007) compared to the SA group. In the neonatal group, there was no difference in the number of antenatal care (ANC) visits, type of delivery, gestational age, and birth weight. In the general paediatric group, there was no difference in immunisation and vitamin A supplementation coverage, but when comparing growth, the immigrant group had more malnutrition compared to the SA group (p = 0.029 for wasting). There was no difference in the prevalence of maternal human immunodeficiency virus (HIV) infection, with equally good prevention of mother-to-child transmission (PMTCT) coverage. There was also no difference in reported difficulties by immigrants in terms of access to healthcare (neonatal p = 0.379; paediatric p = 0.246), although a large proportion (10%) of the neonates of immigrant mothers were born outside a medical facility. Conclusions Although there were health-related differences between immigrant and SA children accessing in-hospital care, these were fewer than expected. Differences were found in parental educational level and socioeconomic factors, but these did not significantly affect ANC attendance, delivery outcomes, immunisation coverage, HIV prevalence, or PMTCT coverage. The immigrant population should be viewed as a high-risk group, with potential problems including suboptimal child growth. Health workers should advocate for all children in the community they are serving and promote tolerance, respect, and equal healthcare access.

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Based on the provided information, here are some potential innovations that can be used to improve access to maternal health:

1. Multilingual Communication Tools: Develop and implement multilingual communication tools, such as translated educational materials and interpreter services, to overcome language barriers faced by immigrant parents/caregivers who have difficulty communicating in English. This can help ensure that they receive important information about maternal health and can effectively communicate with healthcare providers.

2. Culturally Sensitive Maternal Health Programs: Design and implement culturally sensitive maternal health programs that take into account the unique needs and challenges faced by immigrant populations. These programs can provide targeted support and resources to address specific issues related to maternal health, such as nutrition, prenatal care, and breastfeeding.

3. Mobile Health (mHealth) Solutions: Utilize mobile health technologies, such as smartphone applications and text messaging services, to provide accessible and convenient maternal health information and reminders to both immigrant and nonimmigrant populations. These technologies can help bridge the gap in healthcare access by delivering important health messages directly to individuals’ mobile devices.

4. Community Health Workers: Train and deploy community health workers who are familiar with the immigrant population and can serve as trusted sources of information and support for maternal health. These workers can provide culturally appropriate guidance, assist with navigating the healthcare system, and connect individuals to necessary resources and services.

5. Collaborative Partnerships: Foster collaborations between healthcare providers, community organizations, and immigrant support networks to improve access to maternal health. By working together, these stakeholders can identify and address barriers, share resources, and develop innovative solutions that meet the specific needs of immigrant populations.

It’s important to note that these recommendations are based on the information provided and may need to be tailored to the specific context and challenges faced in the Gauteng Province of South Africa.
AI Innovations Description
Based on the provided study, here is a recommendation that can be developed into an innovation to improve access to maternal health:

1. Implement culturally sensitive and language-appropriate healthcare services: Develop and implement programs that cater to the specific needs of immigrant mothers, including providing interpreters or translators, and ensuring that healthcare providers are trained in cultural competency. This will help bridge the communication gap and ensure that immigrant mothers can effectively communicate their healthcare needs.

2. Strengthen antenatal care (ANC) services: Focus on improving ANC attendance among immigrant mothers by providing targeted education and outreach programs. This can include community-based initiatives, such as mobile clinics or home visits, to reach immigrant mothers who may face barriers in accessing traditional healthcare facilities.

3. Enhance nutrition support: Develop nutrition programs specifically tailored to address the higher prevalence of malnutrition among immigrant children. This can include providing nutritional counseling, access to affordable and culturally appropriate food options, and promoting breastfeeding practices.

4. Improve access to healthcare facilities for immigrant mothers: Address the issue of a significant proportion of immigrant neonates being born outside of medical facilities by improving access to healthcare facilities. This can be achieved by establishing satellite clinics or mobile healthcare units in areas with high immigrant populations, ensuring that immigrant mothers have access to safe and hygienic birthing facilities.

5. Strengthen collaboration and coordination: Foster partnerships between healthcare providers, community organizations, and immigrant support groups to improve coordination and collaboration in delivering maternal healthcare services. This can include joint initiatives to raise awareness, share resources, and advocate for the rights and healthcare needs of immigrant mothers.

By implementing these recommendations, healthcare systems can work towards improving access to maternal health for immigrant populations, ultimately leading to better health outcomes for both mothers and their children.
AI Innovations Methodology
Based on the provided description, here are some potential recommendations to improve access to maternal health:

1. Multilingual healthcare services: Implementing language interpretation services or hiring multilingual healthcare professionals can help overcome the language barrier faced by immigrant parents/caregivers, making it easier for them to communicate their healthcare needs and understand medical information.

2. Culturally sensitive healthcare practices: Developing culturally sensitive healthcare practices can help create a welcoming and inclusive environment for immigrant parents/caregivers. This can include training healthcare providers on cultural competency and understanding the unique needs and beliefs of immigrant populations.

3. Community outreach programs: Establishing community outreach programs can help raise awareness about maternal health services and provide information on available resources. These programs can be tailored to the specific needs and challenges faced by immigrant communities, addressing cultural, linguistic, and socioeconomic barriers.

4. Improved access to antenatal care: Ensuring that immigrant women have equal access to antenatal care services is crucial for promoting healthy pregnancies and reducing maternal and neonatal complications. This can be achieved by providing information on available services, facilitating transportation, and addressing financial barriers.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Data collection: Gather data on the current state of maternal health access for immigrant populations in the target area. This can include information on healthcare utilization, barriers faced, and health outcomes.

2. Define indicators: Identify key indicators that reflect access to maternal health, such as the number of antenatal care visits, immunization coverage, birth outcomes, and maternal health outcomes.

3. Baseline assessment: Establish a baseline assessment of the current situation by analyzing the collected data and calculating the indicators for the immigrant population.

4. Intervention implementation: Implement the recommended interventions, such as multilingual healthcare services, culturally sensitive practices, community outreach programs, and improved access to antenatal care.

5. Monitoring and evaluation: Continuously monitor the implementation of the interventions and collect data on the selected indicators. Compare the post-intervention data with the baseline assessment to measure the impact of the recommendations on improving access to maternal health.

6. Analysis and interpretation: Analyze the collected data to assess the effectiveness of the interventions. This can involve statistical analysis, comparing pre- and post-intervention data, and identifying any significant changes or improvements in access to maternal health for immigrant populations.

7. Reporting and dissemination: Summarize the findings and communicate the results to relevant stakeholders, including healthcare providers, policymakers, and community organizations. This can help inform future decision-making and guide efforts to further improve access to maternal health for immigrant populations.

Statistics:
Citations: 2
Authors: 5
Identifiers:
DOI: 10.1371/JOURNAL.PMED.1003565
ISSN: 15491277
Research Areas:
Community Interventions, Disparities, Food Security, Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Social Determinants
Study Countries:
South Africa
Study Design:
Cross Sectional Study
Study Approach:
Quantitative
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