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Starnes JR, Rogers A, Wamae J, Okoth V, Mudhune SA, Omondi A, Were V, Baraza Awino D, Lefebvre CH, Yap S, Otieno Odhong T, Vill B, Were L, Wamai R. Childhood mortality and associated factors in Migori County, Kenya: evidence from a cross-sectional survey. BMJ Open 2023; 13:e074056. [PMID: 37607788 PMCID: PMC10445361 DOI: 10.1136/bmjopen-2023-074056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/08/2023] [Indexed: 08/24/2023] Open
Abstract
OBJECTIVES The under-five mortality (U5M) rate in Kenya (41 per 1000 live births) remains significantly above international goals (25 per 1000 live births). This is further exacerbated by regional inequalities in mortality. We aimed to describe U5M in Migori County, Kenya, and identify associated factors that can serve as programming targets. DESIGN Cross-sectional observational survey. SETTING Areas served by the Lwala Community Alliance and control areas in Migori County, Kenya. PARTICIPANTS This study included 15 199 children born to respondents during the 18 years preceding the survey. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was mortality in the first 5 years of life. The survey was powered to detect a 10% change in various health metrics over time with 80% power. RESULTS A total of 15 199 children were included in the primary analyses, and 230 (1.5%) were deceased before the fifth birthday. The U5M rate from 2016 to 2021 was 32.2 per 1000 live births. Factors associated with U5M included year of birth (HR 0.926, p<0.001), female sex (HR 0.702, p=0.01), parental marriage (HR 0.642, p=0.036), multiple gestation pregnancy (HR 2.776, p<0.001), birth spacing less than 18 months (HR 1.894, p=0.005), indoor smoke exposure (HR 1.916, p=0.027) and previous familial contribution to the National Hospital Insurance Fund (HR 0.553, p=0.009). The most common cause of death was malaria. CONCLUSIONS We describe factors associated with childhood mortality in a Kenyan community using survival analyses of complete birth histories. Mortality rates will serve as the baseline for future programme evaluation as a part of a 10-year study design. This provides both the hyperlocal information needed to improve programming and generalisable conclusions for other organisations working in similar environments.
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Affiliation(s)
- Joseph R Starnes
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Lwala Community Alliance, Rongo, Kenya
| | | | | | | | | | - Alyn Omondi
- Adaptive Model for Research and Empowerment of Communities in Africa, Kisumu, Kenya
| | - Vincent Were
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Christina Hope Lefebvre
- Department of Cultures, Societies, and Global Studies, Northeastern University, Boston, Massachusetts, USA
| | - Samantha Yap
- Department of Cultures, Societies, and Global Studies, Northeastern University, Boston, Massachusetts, USA
| | - Tom Otieno Odhong
- Department of Health Services, Migori County Government, Migori, Kenya
| | - Beffy Vill
- Department of Health Services, Migori County Government, Migori, Kenya
| | - Lawrence Were
- Department of Global Health, Boston University, Boston, Massachusetts, USA
| | - Richard Wamai
- Department of Cultures, Societies, and Global Studies, Northeastern University, Boston, Massachusetts, USA
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Ambalu R, Rashid S, Atwa S, Otira M, Ndolo L, Ojakaa D. Factors related to women's use of health insurance cover in Navakholo, Kakamega County, Kenya: sub-county level results based on community household register. BMC Public Health 2023; 23:576. [PMID: 36978061 PMCID: PMC10045922 DOI: 10.1186/s12889-023-15270-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/14/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND In concert with international commitments, the Government of Kenya identified Universal Health Coverage (UHC), mainly through the National Health Insurance Fund (NHIF), as one of its four priority agenda to enable its populations access health care without financial duress. Nevertheless, only about 19.5% of the Kenyan population is enrolled in any insurance health cover. Since 2016, Amref Health Africa and PharmAccess Foundation have been implementing the Innovative Partnership for Universal and Sustainable Healthcare (iPUSH) programme in Navakholo sub-county of Kakamega County. The main objective of this study is to examine use of health insurance cover among Women of Reproductive Age (WRA) in Navakholo sub-county, Kakamega County. METHODS We analysed data captured during household registration conducted in February 2021 which embraced a question on use of health insurance cover including NHIF. The dataset consisted 148,957 household members within 32,262 households, 310 villages, and 32 community health units. The data had been collected using mobile phones by trained Community Health Volunteers (CHVs) and transmitted using the Amref electronic data management platform and reposited in a server. Data were analysed through frequency distributions and logistic regression (descriptive and causal methods) using STATA software. RESULTS Insurance coverage, all providers included, in Navakholo sub-county stood at 11% among women aged 15-49 years. This is much lower than the national aggregate reported from sample surveys, but higher than the 7% found in the same survey for the region where Navakholo is situated. Social determinant variables - age, perceived condition of the household, and wealth ranking - are highly significant in the relationship with use of health insurance cover while measures of reproductive health and health vulnerability are not. CONCLUSION In Navakholo sub-county of Western Kenya, all-health-insurance coverage is lower than the national aggregate estimated from sample surveys. Age, perception of household condition, and wealth ranking are very significantly related to use of a health insurance cover. Frequent household registrations should be conducted to help monitor the trends and impact of health insurance campaigns. Training - upstream and downstream - on community household registration and data processing should be conducted to arrive at better quality data.
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Affiliation(s)
- Rachel Ambalu
- Amref Health Africa (H.Q), P.O. Box 27691-00506, Nairobi, Kenya.
| | - Sadiq Rashid
- Amref Health Africa (H.Q), P.O. Box 27691-00506, Nairobi, Kenya
| | - Saul Atwa
- Amref Health Africa (H.Q), P.O. Box 27691-00506, Nairobi, Kenya
| | - Mariam Otira
- Amref Health Africa (H.Q), P.O. Box 27691-00506, Nairobi, Kenya
| | - Lucia Ndolo
- Amref Health Africa (H.Q), P.O. Box 27691-00506, Nairobi, Kenya
| | - David Ojakaa
- BRIM Research, P. O. Box 76100, 00508, Code, Yaya Towers, Nairobi, Kenya
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Larrea-Schiavon S, Vázquez-Quesada LM, Bartlett LR, Lam-Cervantes N, Sripad P, Vieitez I, Coutiño-Escamilla L. Interventions to Improve the Reproductive Health of Undocumented Female Migrants and Refugees in Protracted Situations: A Systematic Review. GLOBAL HEALTH, SCIENCE AND PRACTICE 2022; 10:e2100418. [PMID: 36562449 PMCID: PMC9771456 DOI: 10.9745/ghsp-d-21-00418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 11/08/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Limited evidence exists on interventions aimed at enabling reproductive health (RH) services access for undocumented female migrants and refugee women. We aimed to identify intervention characteristics and impacts on RH outcomes among migrants and refugee women in protracted situations. METHODS We conducted a systematic literature review of RH intervention studies that reported on migrants and refugee women in protracted situations. We applied 2 search strategies across 6 databases to identify peer-reviewed articles in English, Spanish, and Portuguese. Eligible studies were assessed for content and quality. RESULTS Of the 21,453 screened studies, we included 10 (all observational) for final data extraction. Interventions implemented among migrant and refugee women included financial support (n=2), health service delivery structure strengthening (n=4), and educational interventions (n=4). Financial support intervention studies showed that enabling women to obtain RH services for free or at a low cost promoted utilization (e.g., increased use of contraception). Interventions that established or strengthened health service delivery structures and linkage demonstrated increased prenatal visits, decreased maternal mortality, and facilitated access to safe abortion through referral services or access to medical abortion. Educational interventions indicated positive effects on RH knowledge and the importance of involving peers and meeting the unique needs of a mobile population. All intervention studies emphasized the need to accommodate migrant security concerns and cultural and linguistic needs. CONCLUSION Interventions in protracted situations reported positive outcomes when they were migrant or refugee-centered and complementary, culturally acceptable, geographically proximate, and cost-sensitive, as well as recognized the concerns around legality and involved opportunities for peer learning. Free or low-cost RH services and greater availability of basic and emergency maternal and neonatal care showed the most promise but required further community outreach, education, and stronger referral mechanisms. We recommend further participatory implementation research linked to policy and programming.
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Jamal MH, Abdul Aziz AF, Aizuddin AN, Aljunid SM. Successes and obstacles in implementing social health insurance in developing and middle-income countries: A scoping review of 5-year recent literatures. Front Public Health 2022; 10:918188. [PMID: 36388320 PMCID: PMC9648174 DOI: 10.3389/fpubh.2022.918188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/22/2022] [Indexed: 01/22/2023] Open
Abstract
Social health insurance (SHI) is a form of health finance mechanism that had been implemented in many countries to achieve universal health care (UHC). To emulate the successes of SHI in many developed countries, many developing and middle-income countries (MICs) have attempted to follow suit. However, the SHI implementation has problems and obstacles. Many more obstacles were observed despite some successes. This scoping review aimed to study the various developments of SHI globally in its uses, implementation, successes, and obstacles within the last 5 years from 2017 to 2021. Using three databases (i.e., PubMed, EBSCO, and Google Scholar), we reviewed all forms of articles on SHI, including gray literature. The PRISMA-ScR protocol was adapted as the guideline. We used the following search terms: social health insurance, national health insurance, and community health insurance. A total of 57,686 articles were screened, and subsequently, 46 articles were included in the final review. Results showed that the majority of SHI studies were in China and African countries, both of which were actively pursuing SHI programs to achieve UHC. China was still regarded as a developing country. There were also recent experiences from other Asian countries, but only a few from South America. Implementing SHI to achieve UHC was desirable but will need to consider several factors and issues. This was especially the case in developing and MICs. Eventually, full UHC would only be possible with a combination of general taxation and SHI.
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Affiliation(s)
- Mohammad Husni Jamal
- University of Cyberjaya, Cyberjaya, Malaysia,Academy of Family Physicians of Malaysia, Kuala Lumpur, Malaysia
| | - Aznida Firzah Abdul Aziz
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Malaysia
| | - Azimatun Noor Aizuddin
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Malaysia,International Centre for Casemix and Clinical Coding, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Cheras, Malaysia,*Correspondence: Azimatun Noor Aizuddin
| | - Syed Mohamed Aljunid
- Department of Health Policy and Management, College of Public Health, Kuwait University, Kuwait City, Kuwait
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Shirley H, Wamai R. A Narrative Review of Kenya's Surgical Capacity Using the Lancet Commission on Global Surgery's Indicator Framework. GLOBAL HEALTH, SCIENCE AND PRACTICE 2022; 10:e2100500. [PMID: 35294388 PMCID: PMC8885340 DOI: 10.9745/ghsp-d-21-00500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/12/2022] [Indexed: 11/15/2022]
Abstract
Surgery, anesthesia, and obstetric (SAO) care is quickly being recognized for its critical role in cost-effectively improving global morbidity and mortality. Six core indicators for SAO capacity were established in 2015 by the Lancet Commission on Global Surgery (LCoGS) and include: SAO provider density, population proximity to surgery-ready facilities, annual national operative volume, a system to track perioperative mortality rate, and protection from impoverishing and catastrophic expenditures. The surgical capacity of Kenya, a lower-middle-income country, has not been evaluated using this framework. Our goal was to review published literature on surgery in Kenya to assess the country's surgical capacity and system strength. A narrative review of the relevant literature provided estimates for each LCoGS indicator. While progress has been made in expanding access to care across the country, key steps remain in the effort to provide equitable, affordable, and timely care to Kenya's population through universal health coverage. Additional investment into training SAO providers, operative infrastructure, and accessibility are recommended through a national surgery, obstetric, and anesthesia plan.
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Affiliation(s)
| | - Richard Wamai
- Department of Cultures, Societies and Global Studies, Northeastern University, College of Social Sciences and Humanities, Integrated Initiative for Global Health, Boston, MA, USA
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Cesare N, Were LPO. A multi-step approach to managing missing data in time and patient variant electronic health records. BMC Res Notes 2022; 15:64. [PMID: 35177096 PMCID: PMC8851714 DOI: 10.1186/s13104-022-05911-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 01/21/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Electronic health records (EHR) hold promise for conducting large-scale analyses linking individual characteristics to health outcomes. However, these data often contain a large number of missing values at both the patient and visit level due to variation in data collection across facilities, providers, and clinical need. This study proposes a stepwise framework for imputing missing values within a visit-level EHR dataset that combines informative missingness and conditional imputation in a scalable manner that may be parallelized for efficiency. RESULTS For this study we use a subset of data from AMPATH representing information from 530,812 clinic visits from 16,316 Human Immunodeficiency Virus (HIV) positive women across Western Kenya who have given birth. We apply this process to a set of 84 clinical, social and economic variables and are able to impute values for 84.6% of variables with missing data with an average reduction in missing data of approximately 35.6%. We validate the use of this imputed dataset by predicting National Hospital Insurance Fund (NHIF) enrollment with 94.8% accuracy.
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Affiliation(s)
- Nina Cesare
- Boston University School of Public Health, Biostatistics and Epidemiology Data Analytics Center, Boston, MA, USA.
| | - Lawrence P O Were
- Department of Health Sciences & School of Public Health, Department of Global Health, Boston University Sargent College, Boston, MA, USA
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Setiawan E, Nurjannah N, Komaryani K, Nugraha RR, Thabrany H, Purwaningrum F, Sarnianto P. Utilization patterns of healthcare facility and estimated expenditure of PLHIV care under the Indonesian National Health Insurance Scheme in 2018. BMC Health Serv Res 2022; 22:97. [PMID: 35065632 PMCID: PMC8783989 DOI: 10.1186/s12913-021-07434-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 12/15/2021] [Indexed: 11/10/2022] Open
Abstract
Background This study analyzed current patterns of service use, referral, and expenditure regarding HIV care under the National Health Insurance Scheme (JKN) to identify opportunities to improve HIV treatment coverage. As of September 2020, an estimated 543,100 people in Indonesia were living with HIV, but only 352,670 (65%) were aware of their status, and only 139,585 (26%) were on treatment. Furthermore, only 27,917 (4.5%) viral load (VL) tests were performed. Indonesia seeks to broaden its HIV response. In doing so, it intends to replace declining donor-funding through better coverage of HIV/AIDS services by its JKN. Thus, this study aims to assess the current situation about HIV service coverage and expenditure under a domestic health-insurance funded scheme in Indonesia. Methods This study employs a quantitative method by way of a cross-sectional approach. The 2018 JKN claims data, drawn from a 1% sample that JKN annually produces, were analyzed. Nine hundred forty-five HIV patients out of 1,971,744 members were identified in the data sample and their claims record data at primary care and hospital levels were analyzed. Using ICD (International Statistical Classification of Diseases and Related Health Problems), 10 codes (i.e., B20, B21, B22, B23, and B24) that fall within the categories of HIV-related disease. For each level, patterns of service utilization by patient-health status, discharge status, severity level, and total cost per claim were analyzed. Results Most HIV patients (81%) who first seek care at the primary-care level are referred to hospitals. 72.5% of the HIV patients receive antiretroviral treatment (ART) through JKN; 22% at the primary care level; and 78% at hospitals. The referral rate from public primary-care facilities was almost double (45%) that of private providers (24%). The most common referral destination was higher-level hospitals: Class B 48%, and Class C 25%, followed by the lowest Class A at 3%. Because JKN pays hospitals for each inpatient admission, it was possible to estimate the cost of hospital care. Extrapolating the sample of hospital cases to the national level using the available weight score, it was estimated that JKN paid IDR 444 billion a year for HIV hospital services and a portion of capitation payment. Conclusion There was an underrepresentation of PLHIV (People Living with HIV) who had been covered by JKN as 25% of the total PLHIV on ART were able to attain access through other schemes. This study finding is principally aligned with other local research findings regarding a portion of PLHIV access and the preferred delivery channel. Moreover, the issue behind the underutilization of National Health Insurance services in Indonesia among PLHIV is similar to what was experienced in Vietnam in 2015. The 2015 Vietnam study showed that negative perception, the experience of using social health insurance as well as inaccurate information, may lead to the underutilization problem (Vietnam-Administration-HIV/AIDSControl, Social health insurance and people living with HIV in Vietnam: an assessment of enrollment in and use of social health insurance for the care and treatment of people living with HIV, 2015). Furthermore, the current research finding shows that 99% of the total estimated HIV expenditure occurred at the hospital. This indicates a potential inefficiency in the service delivery scheme that needs to be decentralized to a primary-care facility.
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Jaca A, Malinga T, Iwu-Jaja CJ, Nnaji CA, Okeibunor JC, Kamuya D, Wiysonge CS. Strengthening the Health System as a Strategy to Achieving a Universal Health Coverage in Underprivileged Communities in Africa: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:587. [PMID: 35010844 PMCID: PMC8744844 DOI: 10.3390/ijerph19010587] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 12/13/2022]
Abstract
Universal health coverage (UHC) is defined as people having access to quality healthcare services (e.g., treatment, rehabilitation, and palliative care) they need, irrespective of their financial status. Access to quality healthcare services continues to be a challenge for many people in low- and middle-income countries (LMICs). The aim of this study was to conduct a scoping review to map out the health system strengthening strategies that can be used to attain universal health coverage in Africa. We conducted a scoping review and qualitatively synthesized existing evidence from studies carried out in Africa. We included studies that reported interventions to strengthen the health system, e.g., financial support, increasing work force, improving leadership capacity in health facilities, and developing and upgrading infrastructure of primary healthcare facilities. Outcome measures included health facility infrastructures, access to medicines, and sources of financial support. A total of 34 studies conducted met our inclusion criteria. Health financing and developing health infrastructure were the most reported interventions toward achieving UHC. Our results suggest that strengthening the health system, namely, through health financing, developing, and improving the health infrastructure, can play an important role in reaching UHC in the African context.
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Affiliation(s)
- Anelisa Jaca
- Cochrane South Africa, South African Medical Research Council, Cape Town 8000, South Africa; (T.M.); (C.A.N.); (C.S.W.)
| | - Thobile Malinga
- Cochrane South Africa, South African Medical Research Council, Cape Town 8000, South Africa; (T.M.); (C.A.N.); (C.S.W.)
| | - Chinwe Juliana Iwu-Jaja
- Department of Nursing and Midwifery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 8000, South Africa;
| | - Chukwudi Arnest Nnaji
- Cochrane South Africa, South African Medical Research Council, Cape Town 8000, South Africa; (T.M.); (C.A.N.); (C.S.W.)
- School of Public Health and Family Medicine, University of Cape Town, Cape Town 8000, South Africa
| | | | - Dorcas Kamuya
- Department of Health Systems and Research Ethics, KEMRI-Wellcome Trust Research Programme, Nairobi 43640-00100, Kenya;
| | - Charles Shey Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town 8000, South Africa; (T.M.); (C.A.N.); (C.S.W.)
- School of Public Health and Family Medicine, University of Cape Town, Cape Town 8000, South Africa
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 8000, South Africa
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Mulenga J, Mulenga MC, Musonda KMC, Phiri C. Examining gender differentials and determinants of private health insurance coverage in Zambia. BMC Health Serv Res 2021; 21:1212. [PMID: 34753465 PMCID: PMC8576989 DOI: 10.1186/s12913-021-07253-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 10/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health insurance is an essential aspect of healthcare. This is because it enables the insured to acquire timely and essential healthcare services, besides offering financial protection from catastrophic treatment costs. This paper seeks to establish gender differentials and determinants of health insurance coverage in Zambia. METHODS The data used in this study was obtained from the 2018 Zambia Demographic and Health Survey. Data were analyzed using STATA 13.0 software and focused on descriptive and Probit regression analyses. RESULTS The study reveals that for women and men, age, wealth category, education, and professional occupation are positively associated with health insurance while being self-employed in the agricultural sector negatively influences health insurance coverage for both sexes. Other variables have gender-specific effects. For instance, being in marital union and having a clerical occupation increases the probability of having health insurance for women while being in the services, skilled, and unskilled manual occupations increases the probability of having health insurance for men. Further, residing in rural areas reduces the probability of having health insurance for men. CONCLUSION The study concludes that there are differences in factors that influence health insurance between women and men. Hence, this study highlights the need to enhance health insurance coverage by addressing the different factors that influence health insurance coverage among men and women. These factors include enhancing education, job creation, diversifying insurance schemes, and gender consideration in the design of National Health Insurance Scheme.
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Affiliation(s)
- James Mulenga
- Department of Economics, School of Social Science, Mulungushi University, Kabwe, Zambia.
| | - Mulenga C Mulenga
- Department of Economics, School of Social Science, Mulungushi University, Kabwe, Zambia
| | - Katongo M C Musonda
- National Authorizing Office of the European Development Fund, Ministry of Finance, Lusaka, Zambia
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Kasaie P, Weir B, Schnure M, Dun C, Pennington J, Teng Y, Wamai R, Mutai K, Dowdy D, Beyrer C. Integrated screening and treatment services for HIV, hypertension and diabetes in Kenya: assessing the epidemiological impact and cost-effectiveness from a national and regional perspective. J Int AIDS Soc 2021; 23 Suppl 1:e25499. [PMID: 32562353 PMCID: PMC7305418 DOI: 10.1002/jia2.25499] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 02/28/2020] [Accepted: 04/03/2020] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION As people with HIV age, prevention and management of other communicable and non-communicable diseases (NCDs) will become increasingly important. Integration of screening and treatment for HIV and NCDs is a promising approach for addressing the dual burden of these diseases. The aim of this study was to assess the epidemiological impact and cost-effectiveness of a community-wide integrated programme for screening and treatment of HIV, hypertension and diabetes in Kenya. METHODS Coupling a microsimulation of cardiovascular diseases (CVDs) with a population-based model of HIV dynamics (the Spectrum), we created a hybrid HIV/CVD model. Interventions were modelled from year 2019 (baseline) to 2023, and population was followed to 2033. Analyses were carried at a national level and for three selected regions (Nairobi, Coast and Central). RESULTS At a national level, the model projected 7.62 million individuals living with untreated hypertension, 692,000 with untreated diabetes and 592,000 individuals in need of ART in year 2018. Improving ART coverage from 68% at baseline to 88% in 2033 reduced HIV incidence by an estimated 64%. Providing NCD treatment to 50% of diagnosed cases from 2019 to 2023 and maintaining them on treatment afterwards could avert 116,000 CVD events and 43,600 CVD deaths in Kenya over the next 15 years. At a regional level, the estimated impact of expanded HIV services was highest in Nairobi region (averting 42,100 HIV infections compared to baseline) while Central region experienced the highest impact of expanded NCD treatment (with a reduction of 22,200 CVD events). The integrated HIV/NCD intervention could avert 7.76 million disability-adjusted-life-years (DALYs) over 15 years at an estimated cost of $6.68 billion ($445.27 million per year), or $860.30 per DALY averted. At a cost-effectiveness threshold of $2,010 per DALY averted, the probability of cost-effectiveness was 0.92, ranging from 0.71 in Central to 0.92 in Nairobi region. CONCLUSIONS Integrated screening and treatment of HIV and NCDs can be a cost-effective and impactful approach to save lives of people with HIV in Kenya, although important variation exists at the regional level. Containing the substantial costs required for scale-up will be critical for management of HIV and NCDs on a national scale.
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Affiliation(s)
- Parastu Kasaie
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Brian Weir
- Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Melissa Schnure
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Chen Dun
- Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jeff Pennington
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yu Teng
- Avenir Health, Glastonbury, CT, USA
| | - Richard Wamai
- Department of Cultures, Societies and Global Studies, Integrated Initiative for Global Health, Northeastern University, Boston, MA, USA
| | | | - David Dowdy
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Chris Beyrer
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Armstrong-Mensah E, Ebiringa DP, Whitfield K, Coldiron J. Genital Chlamydia Trachomatis Infection: Prevalence, Risk Factors and Adverse Pregnancy and Birth Outcomes in Children and Women in sub-Saharan Africa. Int J MCH AIDS 2021; 10:251-257. [PMID: 34900393 PMCID: PMC8647192 DOI: 10.21106/ijma.523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Genital Chlamydia trachomatis (CT) has adverse health outcomes for women and children. In pregnant women, the infection causes adverse obstetric outcomes including pelvic inflammation, ectopic pregnancy, and miscarriage. In children, it causes adverse birth outcomes such as skin rash, lesions, limb abnormalities, conjunctivitis, neurological damage, and even death. This article discusses genital CT prevalence, risk factors, and adverse pregnancy and birth outcomes among women and children in sub-Saharan Africa as well as challenges associated with the mitigation of the disease. A comprehensive search of databases including PubMed, ResearchGate, and Google Scholar was conducted using keywords such as genital chlamydia trachomatis, adverse pregnancy outcomes, adverse birth outcomes, and sub-Saharan African. We found that genital CT prevalence rates in some sub-Saharan Africa countries were higher than others and that risk factors such as the lack of condom use, having multiple sexual partners, and low educational levels contribute to the transmission of the infection. We also found that negative cultural practices, illiteracy among women, and the lack of access to screening services during pregnancy are some of the challenges associated with CT mitigation in sub-Saharan Africa. To reduce genital CT transmission in sub-Saharan Africa, efforts must be made by country governments to eliminate negative cultural practices, promote female literacy, and provide access to screening services for pregnant women.
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Affiliation(s)
| | | | - Kaleb Whitfield
- Georgia State University, School of Public Health, Atlanta, Georgia 30303, USA
| | - Jake Coldiron
- Georgia State University, School of Public Health, Atlanta, Georgia 30303, USA
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Were LP, Hogan JW, Galárraga O, Wamai R. Predictors of Health Insurance Enrollment among HIV Positive Pregnant Women in Kenya: Potential for Adverse Selection and Implications for HIV Treatment and Prevention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2892. [PMID: 32331351 PMCID: PMC7216063 DOI: 10.3390/ijerph17082892] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 11/17/2022]
Abstract
Background: The global push to achieve the 90-90-90 targets designed to end the HIV epidemic has called for the removing of policy barriers to prevention and treatment, and ensuring financial sustainability of HIV programs. Universal health insurance is one tool that can be used to this end. In sub-Saharan Africa, where HIV prevalence and incidence remain high, the use of health insurance to provide comprehensive HIV care is limited. This study looked at the factors that best predict social health insurance enrollment among HIV positive pregnant women using data from the Academic Model Providing Access to Healthcare (AMPATH) in western Kenya. Methods: Cross-sectional clinical encounter data were extracted from the electronic medical records (EMR) at AMPATH. We used univariate and multivariate logistic regressions to estimate the predictors of health insurance enrollment among HIV positive pregnant women. The analysis was further stratified by HIV disease severity (based on CD4 cell count <350 and 350>) to test the possibility of differential enrollment given HIV disease state. Results: Approximately 7% of HIV infected women delivering at a healthcare facility had health insurance. HIV positive pregnant women who deliver at a health facility had twice the odds of enrolling in insurance [2.46 Adjusted Odds Ratio (AOR), Confidence Interval (CI) 1.24-4.87]. They were 10 times more likely to have insurance if they were lost to follow-up to HIV care during pregnancy [9.90 AOR; CI 3.42-28.67], and three times more likely to enroll if they sought care at an urban clinic [2.50 AOR; 95% CI 1.53-4.12]. Being on HIV treatment was negatively associated with health insurance enrollment [0.22 AOR; CI 0.10-0.49]. Stratifying the analysis by HIV disease severity while statistically significant did not change these results. Conclusions: The findings indicated that health insurance enrollment among HIV positive pregnant women was low mirroring national levels. Additionally, structural factors, such as access to institutional delivery and location of healthcare facilities, increased the likelihood of health insurance enrollment within this population. However, behavioral aspects, such as being lost to follow-up to HIV care during pregnancy and being on HIV treatment, had an ambiguous effect on insurance enrollment. This may potentially be because of adverse selection and information asymmetries. Further understanding of the relationship between insurance and HIV is needed if health insurance is to be utilized for HIV treatment and prevention in limited resource settings.
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Affiliation(s)
- Lawrence P.O. Were
- Department of Health Sciences, Boston University’s College of Health and Rehabilitation Sciences: Sargent College & Department of Global Health, Boston University School of Public Health, Boston, MA 02215, USA
| | - Joseph W Hogan
- School of Public Health, Brown University, Providence, RI 02912, USA; (J.W.H.); (O.G.)
| | - Omar Galárraga
- School of Public Health, Brown University, Providence, RI 02912, USA; (J.W.H.); (O.G.)
| | - Richard Wamai
- Department of Cultures, Societies and Global Studies, Northeastern University, Boston, MA 02115, USA;
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