المؤلفون: Koku Sisay Tamirat, Zemenu Tadesse Tessema, Getayeneh Antehunegn Tesema, Achamyeleh Birhanu Teshale

المصدر: BMC Pregnancy and Childbirth, Vol 21, Iss 1, Pp 1-12 (2021)
BMC Pregnancy and Childbirth

مصطلحات موضوعية: Rural Population, medicine.medical_specialty, Epidemiologic Factors, Social Determinants of Health, The pooled prevalence, Reproductive medicine, lcsh:Gynecology and obstetrics, Health Services Accessibility, Recommended ANC utilization, Pregnancy, Environmental health, Health care, medicine, Humans, Childbirth, Maternal Health Services, SSA, Socioeconomic status, Africa South of the Sahara, Determinants, lcsh:RG1-991, Health Services Needs and Demand, business.industry, Obstetrics and Gynecology, Prenatal Care, Patient Acceptance of Health Care, medicine.disease, Quality Improvement, Birth order, Women's Health, Female, Residence, business, Live birth, Research Article

الوصف: BackgroundEvery day in 2017, approximately 810 women died from preventable causes related to pregnancy and childbirth, with 99% of these maternal deaths occurring in low and lower-middle-income countries. Sub-Saharan Africa (SSA) alone accounts for roughly 66%. If pregnant women gained recommended ANC (Antenatal Care), these maternal deaths could be prevented. Still, many women lack recommended ANC in sub-Saharan Africa. This study aimed at determining the pooled prevalence and determinants of recommended ANC utilization in SSA.MethodsWe used the most recent standard demographic and health survey data from the period of 2006 to 2018 for 36 SSA countries. A total of 260,572 women who had at least one live birth 5 years preceding the survey were included in this study. A meta-analysis of DHS data of the Sub-Saharan countries was conducted to generate pooled prevalence, and a forest plot was used to present it. A multilevel multivariable logistic regression model was fitted to identify determinants of recommended ANC utilization. The AOR (Adjusted Odds Ratio) with their 95% CI andp-value ≤0.05 was used to declare the recommended ANC utilization determinates.ResultsThe pooled prevalence of recommended antenatal care utilization in sub-Saharan Africa countries were 58.53% [95% CI: 58.35, 58.71], with the highest recommended ANC utilization in the Southern Region of Africa (78.86%) and the low recommended ANC utilization in Eastern Regions of Africa (53.39%). In the multilevel multivariable logistic regression model region, residence, literacy level, maternal education, husband education, maternal occupation, women health care decision autonomy, wealth index, media exposure, accessing health care, wanted pregnancy, contraceptive use, and birth order were determinants of recommended ANC utilization in Sub-Saharan Africa.ConclusionThe coverage of recommended ANC service utilization was with high disparities among the region. Being a rural residence, illiterate, low education level, had no occupation, low women autonomy, low socioeconomic status, not exposed to media, a big problem to access health care, unplanned pregnancy, not use of contraceptive were determinants of women that had no recommended ANC utilization in SSA. This study evidenced the existence of a wide gap between SSA regions and countries. Special attention is required to improve health accessibility, utilization, and quality of maternal health services.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::9788e0116a64f1d58c0c0698566f534dTest
https://doaj.org/article/50e363f28b314f46ac362fb9e9411d42Test

المؤلفون: Ahmadul Hasan Khan, Margo van Gurp, Sharat Chandra Verma, Christina Mergenthaler, Ente Rood, Pushpraj Joshi, Lucie Blok, Mirjam I. Bakker, Razia Fatima

المصدر: BMC Infectious Diseases, Vol 20, Iss 1, Pp 1-14 (2020)
BMC Infectious Diseases

مصطلحات موضوعية: Male, medicine.medical_specialty, Tuberculosis, Vaccination Coverage, Social Determinants of Health, Case notification, 030231 tropical medicine, Population, Health Services Accessibility, lcsh:Infectious and parasitic diseases, 03 medical and health sciences, 0302 clinical medicine, Nepal, Environmental health, medicine, Humans, Pakistan, lcsh:RC109-216, 030212 general & internal medicine, Social determinants of health, Sex Ratio, Mortality, education, Disease Notification, Population Density, education.field_of_study, Bangladesh, Multivariable linear regression, business.industry, Spatial analysis, Access to healthcare, medicine.disease, GIS, Health indicator, Infectious Diseases, Treatment Outcome, Vaccination coverage, Tropical medicine, Spatial clustering, Female, business, Research Article

الوصف: BackgroundIn order to effectively combat Tuberculosis, resources to diagnose and treat TB should be allocated effectively to the areas and population that need them. Although a wealth of subnational data on TB is routinely collected to support local planning, it is often underutilized. Therefore, this study uses spatial analytical techniques and profiling to understand and identify factors underlying spatial variation in TB case notification rates (CNR) in Bangladesh, Nepal and Pakistan for better TB program planning.MethodsSpatial analytical techniques and profiling was used to identify subnational patterns of TB CNRs at the district level in Bangladesh (N = 64, 2015), Nepal (N = 75, 2014) and Pakistan (N = 142, 2015). A multivariable linear regression analysis was performed to assess the association between subnational CNR and demographic and health indicators associated with TB burden and indicators of TB programme efforts. To correct for spatial dependencies of the observations, the residuals of the multivariable models were tested for unexplained spatial autocorrelation. Spatial autocorrelation among the residuals was adjusted for by fitting a simultaneous autoregressive model (SAR).ResultsSpatial clustering of TB CNRs was observed in all three countries. In Bangladesh, TB CNR were found significantly associated with testing rate (0.06%,p p p p p p p p p p p p ConclusionSubnational TB CNRs are more likely reflective of TB programme efforts and access to healthcare than TB burden. TB CNRs are better used for monitoring and evaluation of TB control efforts than the TB epidemic. Using spatial analytical techniques and profiling can help identify areas where TB is underreported. Applying these techniques routinely in the surveillance facilitates the use of TB CNRs in program planning.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::9f1a49c50a905f6be56cd8a400ed07ecTest
http://link.springer.com/article/10.1186/s12879-020-05207-zTest

المؤلفون: Wu Zeng, Shelley Kirychuk, Emmanuel Dankwah, Cindy Feng, Marwa Farag

المصدر: Reproductive Health, Vol 16, Iss 1, Pp 1-10 (2019)
Reproductive Health

مصطلحات موضوعية: Adult, Rural Population, medicine.medical_specialty, Adolescent, Social Determinants of Health, Reproductive medicine, Psychological intervention, lcsh:Gynecology and obstetrics, Health Services Accessibility, 03 medical and health sciences, Indirect costs, Young Adult, 0302 clinical medicine, Health facility, Pregnancy, Environmental health, Health care, medicine, Humans, Maternal Health Services, 030212 general & internal medicine, Social determinants of health, Social determinants, lcsh:RG1-991, 030219 obstetrics & reproductive medicine, business.industry, Public health, Research, Obstetrics and Gynecology, Patient Acceptance of Health Care, Delivery, Obstetric, Reproductive Medicine, Socioeconomic Factors, Birth, Residence, Female, Health Facilities, Reproductive aged women, business, Delivery

الوصف: Background Many women still deliver outside a health facility in Ghana, often under unhygienic conditions and without skilled birth attendants. This study aims to examine the social determinants influencing the use of health facility delivery among reproductive-aged women in Ghana. Methods Nationally representative data from the 2014 Ghana Demographic and Health Survey was used to fit univariable and multivariable logistic regression models to estimate the influence of the social determinants on health facility delivery. Andresen’s health care utilization model was used as the conceptual framework guiding this study.. Results Only 72% of deliveries take place at a health facility in Ghana. The results of the adjusted model indicate that place of residence, financial status, education, religion, parity and perceived need were significantly associated with health facility delivery. First, urban women had a higher likelihood of health facility delivery than rural women (Adjusted Odds ratio [AOR] =2.21; 95% Confidence interval [CI] = 1.53–3.19). Second, middle-class and rich women were 1.57 (95%CI = 1.18–2.08) times and 6.91 (95%CI = 4.12–11.59) times, respectively more likely to deliver at health facility compared to the poor. Third, women with either at least secondary education (AOR = 2.04; 95%CI = 1.57–2.64) or primary education (AOR = 1.39, 95%CI = 1.02–1.92) were more likely to deliver at health facility than women with no education. In terms of parity, first time mothers were 1.58 (95% CI = 1.18–2.12) times more likely to deliver at health facility than those who had given birth three or more times before. Finally, regarding perceived need, women who were aware of pregnancy complications were 1.32 (95%CI = 1.02–1.70) times more likely to use health facility delivery than those who were not informed about pregnancy complications. Conclusions First, in spite of Ghana’s free maternal health services policy, poorer women were much less likely to have a health facility delivery, which points to the need to understand the indirect costs and other financial barriers preventing women from delivering at a health facility. Second, many of the identified variables influence the demand and not just the supply for health care services, and highlight the importance of the social determinants of health and investments in interventions that extend beyond improving physical access.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::6ceee0c4fdc458b963e56d790405158cTest
http://link.springer.com/article/10.1186/s12978-019-0753-2Test

المؤلفون: Noel K. Joseph, Emelda A. Okiro, Kefa G. Wairoto, Peter M. Macharia

المصدر: BMC Health Services Research, Vol 20, Iss 1, Pp 1-12 (2020)
BMC Health Services Research

مصطلحات موضوعية: Adult, medicine.medical_specialty, Adolescent, 030231 tropical medicine, Psychological intervention, Sub-national, Antenatal care, Health Services Accessibility, Health administration, 03 medical and health sciences, 0302 clinical medicine, Health facility, Pregnancy, Environmental health, medicine, Humans, Maternal Health Services, 030212 general & internal medicine, Healthcare Disparities, Socioeconomic status, Determinants, 2. Zero hunger, Spatial Analysis, Age at first marriage, business.industry, Spatial variation, Health Policy, Public health, lcsh:Public aspects of medicine, 1. No poverty, Prenatal Care, lcsh:RA1-1270, Kenya, Birth order, Logistic Models, Socioeconomic Factors, Mapping, Health Care Surveys, Small-Area Analysis, Marital status, Female, Health Facilities, business, Research Article

الوصف: Background The spatial variation in antenatal care (ANC) utilisation is likely associated with disparities observed in maternal and neonatal deaths. Most maternal deaths are preventable through services offered during ANC; however, estimates of ANC coverage at lower decision-making units (sub-county) is mostly lacking. In this study, we aimed to estimate the coverage of at least four ANC (ANC4) visits at the sub-county level using the 2014 Kenya Demographic and Health Survey (KDHS 2014) and identify factors associated with ANC utilisation in Kenya. Methods Data from the KDHS 2014 was used to compute sub-county estimates of ANC4 using small area estimation (SAE) techniques which relied on spatial relatedness to yield precise and reliable estimates at each of the 295 sub-counties. Hierarchical mixed-effect logistic regression was used to identify factors influencing ANC4 utilisation. Sub-county estimates of factors significantly associated with ANC utilisation were produced using SAE techniques and mapped to visualise disparities. Results The coverage of ANC4 across sub-counties was heterogeneous, ranging from a low of 17% in Mandera West sub-county to over 77% in Nakuru Town West and Ruiru sub-counties. Thirty-one per cent of the 295 sub-counties had coverage of less than 50%. Maternal education, household wealth, place of delivery, marital status, age at first marriage, and birth order were all associated with ANC utilisation. The areas with low ANC4 utilisation rates corresponded to areas of low socioeconomic status, fewer educated women and a small number of health facility deliveries. Conclusion Suboptimal coverage of ANC4 and its heterogeneity at sub-county level calls for urgent, focused and localised approaches to improve access to antenatal care services. Policy formulation and resources allocation should rely on data-driven strategies to guide national and county governments achieve equity in access and utilisation of health interventions.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::5249f11413d8231e072a357c8cf4d13dTest
http://link.springer.com/article/10.1186/s12913-020-05531-9Test

المؤلفون: Mario Vianna Vettore, Guilherme Loureiro Werneck, Fernando José Herkrath

المصدر: BMC Public Health, Vol 20, Iss 1, Pp 1-13 (2020)
BMC Public Health

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Urban Population, Health surveys, Context (language use), Health Services Accessibility, Structural equation modeling, 03 medical and health sciences, 0302 clinical medicine, Environmental health, Tooth loss, Humans, Medicine, Theoretical models, 030212 general & internal medicine, Social determinants of health, Dental Health Services, Aged, Aged, 80 and over, business.industry, Public health, lcsh:Public aspects of medicine, Public Health, Environmental and Occupational Health, lcsh:RA1-1270, 030206 dentistry, Dental health services utilisation, Middle Aged, Patient Acceptance of Health Care, Crowding, Rural population, Female, Rural area, medicine.symptom, Biostatistics, business, Brazil, Research Article

الوصف: Background The utilisation of health services is determined by complex interactions. In this context, rural populations face greater barriers in accessing dental services than do urban populations, and they generally have poorer oral health status. The evaluation of the determinants of health services utilisation is important to support planning and management of dental services. The aim of this study was to evaluate the predictors of dental services utilisation of Brazilian adults living in rural and urban areas. Methods Data from 60,202 adults aged 18 years or older who took part in the Brazilian National Health Survey carried out in 2013 were analysed. Predisposing (age, sex, education, social networks), enabling financing (income, durable goods and household’s crowding), enabling organisation (health insurance, registration in primary health care [PHC]) and need variables (eating difficulties, self-perceived tooth loss and self-perceived oral health) were selected based upon the Andersen behavioural model. Multi-group structural equation modeling assessed the direct and indirect associations of independent variables with non-utilisation of dental services and the interval since the last dental visit for individuals living in rural and urban areas. Results Adults living in urban areas were more likely to use dental services than those living in rural areas. Lower enabling financing, lower perceived dental needs and lack of PHC registration were directly associated with lower utilisation of dental services (non-utilisation, β = − 0.36, β = − 0.16, β = − 0.03, respectively; and interval since last dental visit, β = 1.25, β = 0.82, β = − 0.12, respectively). The enabling financing (non-utilisation, βrural = − 0.02 [95%CI: − 0.03 to − 0.02], βurban = 0.00 [95%CI: − 0.01 to 0.00]) and PHC registration (non-utilisation, βrural = − 0.03 [95%CI: − 0.04 to − 0.02], βurban = − 0.01 [95%CI, − 0.01 to − 0.01]) non-standardised total effects were stronger in rural areas. Enabling organisation (β = 0.16) and social network (β = − 2.59) latent variables showed a direct effect on the interval since last dental visit in urban areas. Education and social networks influenced utilisation of dental services through different pathways. Males showed less use of dental services in both urban and rural areas (non-utilisation, βrural = − 0.07, βurban = − 0.04; interval since last dental visit, βrural = − 0.07, βurban = − 0.07) and older adults have used dental services longer than younger ones, mainly in rural areas (βrural = 0.26, βurban = 0.17). Conclusion Dental services utilisation was lower in rural areas in Brazil. The theoretical model was supported by empirical data and showed different relationships between the predictors in the two geographical contexts. In rural areas, financial aspects, education, primary care availability, sex and age were relevant factors for the utilisation of services.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::44861d1fb2b563fa0f07bdf06acfb291Test
http://link.springer.com/article/10.1186/s12889-020-09100-xTest

المؤلفون: Miguel San Sebastian, Enrique Teran, Edy Quizhpe, Anni-Maria Pulkki-Brännström

المصدر: International Journal for Equity in Health
International Journal for Equity in Health, Vol 19, Iss 1, Pp 1-10 (2020)

مصطلحات موضوعية: Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi, Adult, medicine.medical_specialty, Adolescent, Standard of living, Health Services Accessibility, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Universal health coverage, Environmental health, Health care, medicine, Humans, 030212 general & internal medicine, Social determinants of health, Healthcare Disparities, Socioeconomic status, Health policy, Health inequality, 030505 public health, business.industry, lcsh:Public aspects of medicine, Research, Health Policy, Public health, Public Health, Environmental and Occupational Health, Health services research, lcsh:RA1-1270, Public Health, Global Health, Social Medicine and Epidemiology, Health Care Service and Management, Health Policy and Services and Health Economy, Middle Aged, Health equity, Health reform, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Socioeconomic Factors, Health Care Reform, Health Care Surveys, Female, Ecuador, Socioeconomic determinants, 0305 other medical science, Psychology, business

الوصف: Background Over the last 12 years, Ecuador has implemented comprehensive health sector reform to ensure equitable access to health care services according to need. While there have been important achievements in terms of health care coverage, the effects of these reforms on socioeconomic inequalities in health care have not been analysed. The present study assesses whether the health care reforms implemented in the decade between 2007 and 2017 have contributed to reducing the socioeconomic inequalities in women’s health care access. Methods The present study was based on two waves (2006 and 2014) of the Living Standards Measurement Survey conducted in Ecuador. Data from women of reproductive age (15 to 49 years) were analysed to evaluate health care coverage across three indicators: skilled birth attendance, cervical cancer screening, and the use of modern contraceptives. Absolute risk differences were calculated between the heath care indicators and the socioeconomic variables using binomial regression analysis for each time period. The Slope Index of Inequality (SII) was also calculated for each socioeconomic variable and period. A multiplicative interaction term between the socioeconomic variables and period was included to assess the changes in socioeconomic inequalities in health care over time. Results Access to health care increased in the three studied outcomes during the health sector reform. Significant reductions in inequality in skilled birth attendance were observed in all socioeconomic variables except in the occupational class. Cervical cancer screening inequalities increased according to education and occupation, but decreased by wealth. Only a poorer education was observed for modern contraceptive use. Conclusions While most socioeconomic inequalities in skilled birth attendance decreased during the reform period, this was not the case for inequalities in cervical cancer screening or the use of modern contraceptives. Further studies are needed to address the social determinants of these health inequalities.

وصف الملف: application/pdf

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::51b4de1e3f5b6f9208cbb108cf1b558cTest
https://doi.org/10.1186/s12939-020-01294-1Test

المؤلفون: Erica W. M. Janszen, Geerte C. den Hollander

المصدر: BMC Pregnancy and Childbirth
BMC Pregnancy and Childbirth, Vol 20, Iss 1, Pp 1-8 (2020)

مصطلحات موضوعية: Adult, medicine.medical_specialty, Adolescent, Social Determinants of Health, media_common.quotation_subject, MEDLINE, Reproductive medicine, Determinants of health, lcsh:Gynecology and obstetrics, Inequity, Health Services Accessibility, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Environmental health, medicine, Humans, Maternal Health Services, Uganda, 030212 general & internal medicine, Social determinants of health, Empowerment, Poverty, Socioeconomic status, lcsh:RG1-991, Health policy, Obstetric fistula, media_common, 030219 obstetrics & reproductive medicine, business.industry, Health Policy, Vaginal Fistula, Correction, Obstetrics and Gynecology, medicine.disease, Obstetric Labor Complications, Malnutrition, Female, Maternal health, business

الوصف: Background The uneven global and national distribution of obstetric fistulas suggests a complex network of determinants contributing to fistula development. This study aims to create an understanding of the determinants of obstetric fistula in Uganda and to give a framework for health policy improvement. Methods A scoping review of existing literature was performed, searching the PubMed/MEDLINE database, Ugandan Demographic and Health Surveys, and official sources of Ugandan statistics. Data was analysed using the model for the determinants of health by Dahlgren and Whitehead. Results Obstetric fistulas are associated with different personal lifestyle factors, certain social and community networks, as well as poor working and living conditions. Malnutrition, early childbearing, limited female empowerment, lack of awareness of childbearing risks, low socioeconomic status, and long distances to emergency obstetric care play a part. Certain regions of Uganda are in particular associated with obstetric fistula, where an accumulation of determinants is notable. Conclusion Analysis using the model of Dahlgren and Whitehead shows that obstetric fistulas are associated with determinants at different levels of society. Poverty and low education link these in a web that is disproportionately hard to escape from for the poorest women. This inequity asks for co-operation between ministries to dismantle the environment for obstetric fistula.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::fe1f17bb2ce33bf313867bc52d3302e2Test
https://doi.org/10.1186/s12884-020-02951-7Test

المؤلفون: Patricia Akweongo, Genevieve Cecilia Aryeetey, John Azaare, Duah Dwomoh

المصدر: Reproductive Health
Reproductive Health, Vol 17, Iss 1, Pp 1-17 (2020)

مصطلحات موضوعية: Delayed reimbursement, Adult, medicine.medical_specialty, Effet de traitement, Évaluation de l’impact, Impact evaluation, Perinatal Death, Context (language use), Population health, Mort-né, lcsh:Gynecology and obstetrics, Ghana, Health Services Accessibility, Cohort Studies, Study Protocol, Pregnancy, Environmental health, Health care, Rembourcement retardé, medicine, Humans, Maternal Health Services, Social determinants of health, lcsh:RG1-991, Perinatal Mortality, business.industry, Public health, Health Policy, Treatment effect, Infant, Newborn, Obstetrics and Gynecology, Stillbirth, Patient Acceptance of Health Care, Delivery, Obstetric, Kenya, Reproductive Medicine, Propensity score matching, Female, Business, Qualitative research

الوصف: Résumé Arrière-Plan Le Ghana a introduit ce que nous appelons aujourd’hui Politique de Soins Médicaux Maternels ‘Gratuits’ (Free Maternal Health Policy (FMHCP)) en 2008 à travers l’inscriptions des femmes enceintes au projet national d’assurance santé afin de leur permettre d’avoir accès aux services médicaux ‘gratuits’. Selon ce projet, chaque femme enceinte au Ghana doit bénéficier d’une manière complète des services médicaux maternels. Objectif Cette étude a pour objectif, d’évaluer la contribution de la Politique de Services Médicaux Maternels ‘Gratuits’, aux services de consultations prénatales et les accouchements à l’hôpital ainsi que déterminer l’impact de la politique sur l’enfant mort-né, périnatal et les décès néonatals en employant des interventions quasi-expérimentales. L’étude contextualisera également les résultats en tenant compte des contraintes de financement et les difficultés d’opération du projet qui portent sur le fonctionnement du projet dans la Région de Haut-Est. Méthodologies de recherche Cette étude suit un plan de méthodologie variée afin d’évaluer l’efficacité du traitement en employant des variables produites à partir des données historiques du Ghana et des données démographiques de santé du Kenya(DHS) de 2008/2014, comme traitement et la comparaison des groupes, respectivement. Le DHS emploie un plan complexe, des données différentes seront évaluées afin de s’occuper des groupes divers et aux stratifications à tous les niveaux de l’analyse en mettant les données en STATA et préfixer les commandes du Stata avec ‘svy’. Ainsi, l’impact du projet sera évalué en utilisant des plans quasi-expérimentaux, la mise des scores dans le bon endroit, et la différenciation de méthode, la prédominance, la différence dans les moyennes et le test d’association entre le résultat final et les divergences dans les résultats seront tous obtenus en utilisant le Rao Scot Chi-square. Les variables déconcertantes seront ajustées après avoir employé Poisson et multiples modèles de régression logistiques. Les résultats obtenus sous forme de compte rendu statistiques seront présentés en pourcentages, en coefficients régressifs et en proportion de risques. Cette étude emploie, donc, la technique d’étude de cas intrinsèques afin d’explorer les opérations courantes du Projet ‘gratuit’ au Ghana en utilisant des méthodes qualitatives afin de produire des données primaires dans la Région du Haut-Est. Pour une analyse approfondie. Discussions L’étude révèlera les contributions du Projet aux services médicaux maternels et sa performance en ce qui concerne l’élimination du phénomène des enfants mort-nés, périnatals et les résultats de services médicaux maternels et néonatals. Les discussions se concentreront sur le plan du projet et sa réalisation tout en tenant compte des contraintes de ressources en montrant si l’Objectif de Développement Durable (Objectif 3) sera atteint ou non. L’efficacité du Projet ainsi que ses succès en ce qui concerne l’assurance santé sociale dans le contexte de la santé publique et les difficultés économiques seront également discutées. Approbation protocolaire Cette étude a été approuvée pour mise en exécution par le Comité de Vérification Ethique du Service de la santé publique du Ghana: GHS-ERC 002/04/19.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::3b26b126122a6a085b65691747109fb2Test
http://europepmc.org/articles/PMC7597017Test

المؤلفون: Wim Groot, Milena Pavlova, Oluwasegun Jko Ogundele

المساهمون: Health Services Research, RS: CAPHRI - R2 - Creating Value-Based Health Care, Maastricht Graduate School of Governance, RS: FSE TA-TIER, RS: GSBE MGSoG

المصدر: BMC Public Health, 20(1):549. BioMed Central Ltd
BMC Public Health
BMC Public Health, Vol 20, Iss 1, Pp 1-12 (2020)

مصطلحات موضوعية: Adult, Rural Population, COUNTRIES, medicine.medical_specialty, Urban Population, Population, Psychological intervention, Nigeria, DETERMINANTS, Ghana, Health Services Accessibility, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Environmental health, Health care, parasitic diseases, Cluster Analysis, Humans, Medicine, Maternal Health Services, 030212 general & internal medicine, Healthcare Disparities, Family planning, education, Multinomial logistic regression, Reproductive health, education.field_of_study, 030219 obstetrics & reproductive medicine, business.industry, lcsh:Public aspects of medicine, Public health, DELIVERY CARE, Public Health, Environmental and Occupational Health, lcsh:RA1-1270, Reproductive services, Health Surveys, Access, Social Class, Socioeconomic Factors, Family Planning Services, Needs assessment, Female, Reproductive Health Services, Maternal care, business, Research Article

الوصف: Background Inequalities in access to health care result in systematic health differences between social groups. Interventions to improve health do not always consider these inequalities. To examine access to reproductive health care services in Ghana and Nigeria, the patterns of use of family planning and maternal care by women in these countries are explored. Methods We used population-level data from the Ghana and Nigeria Demographic Health Surveys of 2014 and 2013 respectively. We applied a two-step cluster analysis followed by multinomial logistic regression analysis. Results The initial two-step cluster analyses related to family planning identified three clusters of women in Ghana and Nigeria: women with high, medium and poor access to family planning services. The subsequent two-step cluster analyses related to maternal care identified five distinct clusters: higher, high, medium, low and poor access to maternal health services in Ghana and Nigeria. Multinomial logistic regression showed that compared to women with secondary/higher education, women without education have higher odds of poor access to family planning services in Nigeria (OR = 2.54, 95% CI: 1.90–3.39) and in Ghana (OR = 1.257, 95% CI: 0.77–2.03). Compared to white-collar workers, women who are not working have increased odds of poor access to maternal health services in Nigeria (OR = 1.579, 95% CI: 1.081–2.307, p ≤ 0.01). This association is not observed for Ghana. Household wealth is strongly associated with access to family planning services and maternal health care services in Nigeria. Not having insurance in Ghana is associated with low access to family planning services, while this is not the case in Nigeria. In both countries, the absence of insurance is associated with poor access to maternal health services. Conclusions These differences confirm the importance of a focused context-specific approach towards reproductive health services, particularly to reduce inequality in access resulting from socio-economic status. Interventions should be focused on the categorization of services and population groups into priority classes based on needs assessment. In this way, they can help expand coverage of quality services bottom up to improve access among these vulnerable groups.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::502fd04b9d5c72aaa70537fb41202d4fTest
https://doi.org/10.21203/rs.2.17114/v3Test

المؤلفون: Wim Groot, Jelena Arsenijevic, Purity Njagi

المساهمون: Health Services Research, Maastricht Graduate School of Governance, RS: FSE TA-TIER, RS: GSBE MGSoG, RS: CAPHRI - R2 - Creating Value-Based Health Care

المصدر: BMC Health Services Research
BMC Health Services Research, 20(1):322. BioMed Central Ltd
BMC Health Services Research, Vol 20, Iss 1, Pp 1-12 (2020)

مصطلحات موضوعية: health care delivery, poverty, DETERMINANTS, Health informatics, Health Services Accessibility, Health administration, 0302 clinical medicine, Universal Health Insurance, Health care, Medicine, Healthcare Financing, 030212 general & internal medicine, Cost-related, health service, outpatient care, health care economics and organizations, education, education.field_of_study, Family Characteristics, lcsh:Public aspects of medicine, 030503 health policy & services, Nursing research, Health Policy, Healthcare, article, health care cost, Equity, hospital patient, health care policy, Analysis of Health Care Markets, Regression Analysis, Female, ACCESS, 0305 other medical science, scale up, BEHAVIOR, Research Article, Unmet need, COUNTRIES, Adult, medicine.medical_specialty, Population, health care financing, Multilevel analysis, 03 medical and health sciences, Young Adult, Environmental health, cross-sectional study, Humans, human, i11 - Analysis of Health Care Markets, correlation coefficient, Health Services Needs and Demand, Poverty, business.industry, Public health, Equity (finance), family size, lcsh:RA1-1270, economics, Kenya, household, Cross-Sectional Studies, money, Self Report, Health Expenditures, business

الوصف: Background The assessment of unmet need is one way to gauge inequities in access to healthcare services. While there are multiple reasons for unmet need, financial barriers are a major reason particularly in low- and middle-income countries where healthcare systems do not offer financial protection. Moreover, accessibility and affordability are paramount in achieving universal health coverage. This study examines the extent of unmet need in Kenya due to financial barriers, the associated determinants, and the influence of regional variations. Methods We use data from the 2013 Kenya household health expenditure and utilization (KHHEUS) cross sectional survey. Self-reported unmet need due to lack of money and high costs of care is used to compute the outcome of interest. A multilevel regression model is employed to assess the determinants of cost-related unmet need, confounding for the effect of variations at the regional level. Results Cost-related barriers are the main cause of unmet need for outpatient and inpatient services, with wide variations across the counties. A positive association between county poverty rates and cost-related unmet is noted. Results reveal a higher intraclass correlation coefficient (ICC) of 0.359(35.9%) for inpatient services relative to 0.091(9.1%) for outpatient services. Overall, differences between counties accounted for 9.4% (ICC ~ 0.094) of the total variance in cost-related unmet need. Factors that positively influence cost-related unmet need include older household heads, inpatient services, and urban residence. Education of household head, good self-rated health, larger household size, insured households, and higher wealth quintiles are negatively associated with cost-related unmet need. Conclusion The findings underscore the important role of cost in enabling access to healthcare services. The county level is seen to have a significant influence on cost-related unmet need. The variations noted in cost-related unmet need across the counties signify the existence of wide disparities within and between counties. Scaling up of health financing mechanisms would fundamentally require a multi-layered approach with a focus on the relatively poor counties to address the variations in access. Further segmentation of the population for better targeting of health financing policies is paramount, to address equity in access for the most vulnerable and marginalized populations.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::d79f063c0248801698b167d77b6e6b10Test
http://europepmc.org/articles/PMC7164162Test