Examining the association between exposure to mass media and health insurance enrolment in Ghana

Knowledge of mother-to-child transmission of HIV among women living with HIV in Malawi

OBJECTIVES

To reduce the incidence of mother-to-child transmission (MTCT) of HIV in Malawi, interventions have been created for women to be informed about the MTCT of HIV and for women living with HIV to be entered into the HIV care cascade to ensure safer deliveries. Our study aimed to examine the effectiveness of these strategies by exploring the determinants of adequate knowledge of MTCT of HIV among women living with HIV in Malawi.

METHODS

We used the 2015-16 Malawi Demographic and Health Survey data and applied logistics regression analysis to explore the determinants of adequate knowledge of MTCT of HIV among women living with HIV.

RESULTS

Our findings estimated that 75% of women living with HIV possessed adequate knowledge of MTCT of HIV. We also found that compared to those with no formal education, women with primary education (OR = 1.88, 95% CI = 1.04, 3.41) and secondary education or higher (OR = 2.61, 95% CI = 1.21, 5.62) were more likely to have adequate knowledge of MTCT of HIV. Furthermore, women who were resident in rural areas (OR = 2.97, 95% CI = 1.58, 5.57), were more likely to have adequate knowledge of MTCT of HIV relative to those in urban areas. Finally, women who had adequate HIV knowledge (OR = 1.85, 95% CI = 1.19, 2.89) and those who rejected the endorsement of HIV stigma and discrimination (OR = 2.30, 95% CI = 1.39, 3.81) were more likely to have adequate knowledge about the MTCT of HIV.

CONCLUSION

Based on our findings, there is an urgent need to offer women living with HIV in Malawi the opportunity to increase their knowledge of MTCT of HIV if the country is to make progress towards the elimination of MTCT of HIV as part of the overall strategy to contain new HIV infections in the country.

National health insurance enrolment among elderly ghanaians: the role of food security status

Older people with food insecurity in Ghana are often exposed to poor health conditions, highlighting the importance of the National health Insurance Scheme (NHIS) enrolment for ensuring they receive necessary medical attention through access to health care services. However, we know very little about the association between food insecurity and National Health Insurance Scheme enrolment among older people in Ghana. To address this void in the literature, this study uses a representative survey of adults aged 60 or older from three regions in Ghana (i.e., Upper West, Bono, and Greater Accra regions (n = 1,073)). We find that 77% of older adults reported not being enrolled into the NHIS. Results from logistic regression analysis show that older people who experienced severe household food insecurity were less likely to enroll in the National Health Insurance Scheme than those who did not experience any food insecurity (OR = 0.48 p < 0.001). Based on these findings, we argue that in addition to the traditional socioeconomic factors, addressing severe food insecurity may improve health insurance enrolment among older adults. Additionally, policymakers should also consider older people's socioeconomic circumstances when formulating policies for them to enrol in health insurance.

Factors associated with health insurance enrolment among ghanaian children under the five years. Analysis of secondary data from a national survey

Background

Health insurance enrolment provides financial access to health care and reduces the risk of catastrophic healthcare expenditure. Therefore, the objective of this study was to assess the prevalence and correlates of health insurance enrolment among Ghanaian children under five years.

Methods

We analysed secondary data from the 2017/18 Ghana Multiple Indicator Cluster Survey. The survey was a nationally representative weighted sample comprising 8,874 children under five years and employed Computer Assisted Personal Interviewing to collect data from the participants. In addition, Chi-square and Logistic Regression analyses were conducted to determine factors associated with health insurance enrolment.

Results

The results showed that a majority (58.4%) of the participants were insured. Health insurance enrollment was associated with child age, maternal educational status, wealth index, place of residence and geographical region (p < 0.05). Children born to mothers with higher educational status (AOR = 2.14; 95% CI: 1.39–3.30) and mothers in the richest wealth quintile (AOR = 2.82; 95% CI: 2.00–3.98) had a higher likelihood of being insured compared with their counterparts. Also, children residing in rural areas (AOR = 0.75; 95% CI: 0.61–0.91) were less likely to be insured than children in urban areas.

Conclusion

This study revealed that more than half of the participants were insured. Health insurance enrolment was influenced by the child's age, mother's educational status, wealth index, residence, ethnicity and geographical region. Therefore, interventions aimed at increasing health insurance coverage among children should focus on children from low socio-economic backgrounds. Stakeholders can leverage these findings to help improve health insurance coverage among Ghanaian children under five years.

Knowledge of pregnancy complications and utilization of antenatal care services in Rwanda

BACKGROUND

While Rwanda's progress towards achieving the maternal health care targets of the Sustainable Development Goals is impressive, evidence of women's limited utilization of antenatal care (ANC) services in the context of an improved health care system provides an opportunity for exploring other essential but less highlighted factors that may shape ANC service utilization. In this study, we examined the association between women's knowledge of pregnancy complications and the utilization of maternal health services.

METHODS

We employed logistic regression analysis using the 2015 Rwanda Demographic and Health Survey data. Our analytical sample consisted of women (n = 5883) in their reproductive ages (15-49 years). Three maternal health care indicators, namely, timing of first ANC visit, number of ANC visits, and place of delivery, were explored. We controlled for the effects of socioeconomic and demographic characteristics, including marital status, place of residence and age.

RESULTS

The results show that women with no knowledge of pregnancy complications were less likely to utilize ANC services within the first trimester (odds ratio [OR] = 0.76, p < 0.01), achieve the WHO recommended minimum of eight visits (OR = 0.66, p < 0.01), and deliver at a health facility (OR = 0.77, p < 0.10).

CONCLUSION

Given these findings, we recommend restructuring existing maternal health care programs to include rigorous maternal health education.

Association Between Exposure to Mass Media Family Planning Messages and Utilization of Modern Contraceptive Among Urban and Rural Youth Women in Ethiopia

Background

Family planning helps to reduce poverty, increase gender equity, prevent the spread of sexually transmitted infections, and reduce maternal, infant, and childhood mortality. Hence, this study aimed to examine the association between exposure to mass media family planning messages and the utilization of modern contraceptives among urban and rural youth women in Ethiopia.

Methods

A comparative cross-sectional study using the 2016 Ethiopia Demographic and Health Survey (EDHS) data set was applied. The data were analyzed with SPSS version 20. Multivariate logistic regression analysis was performed to assess the association between exposure to mass media family planning messages and the utilization of modern contraceptives by controlling confounders. An adjusted odds ratio with a 95% confidence interval was considered to declare a statistically significant association.

Results

The total sample was comprised of 6401 women (4061 from rural and 2340 from the urban area). There was no association between women exposed to mass media family planning messages and the utilization of modern contraceptives in rural areas. Surprisingly, this study showed that women exposed to mass media family planning messages in an urban area were less likely to use modern contraception by 62% (AOR: 0.38; 95% CI: 0.21, 0.68).

Conclusion

The present study revealed that there was no significant association between women exposed to mass media family planning messages and utilization of modern contraceptives in rural areas. But, women exposed to mass media family planning messages in urban areas were less likely to use modern contraception. The study showed the role of inequalities in modern contraceptive utilization as shaped by structural and intermediary factors including religion, location, household wealth, education, and the number of children. This implies that the use of modern contraceptive use may be more impactful if cultural, geographical, and socioeconomic barriers are addressed.

Antenatal care utilization in the fragile and conflict-affected context of the Democratic Republic of the Congo

Maternal mortality represents one of the widest gaps between developed and developing countries. Ninety-nine percent of maternal deaths occur in developing countries, with over half occurring in sub-Saharan Africa. This health indicator became a global priority when the United Nations' Sustainable Development Goal 3.1 set out to decrease the global maternal mortality rate to less than 70 per 100 000 births by 2030. In the Democratic Republic of the Congo (DRC), 473 of every 100 000 women who give birth die due to pregnancy-related complications. These deaths could be prevented through enhanced access and utilization of antenatal care services and skilled birth attendants. However, amid prolonged conflict, violence, and authoritarian governments, the Democratic Republic of the Congo has been classified as a fragile and conflict-affected situation and women are prone to face difficulties accessing maternal health services. This study examined the utilization of antenatal care and skilled birth attendants in the Democratic Republic of Congo using logistic regressions. Our findings show that women living in regions with extremely high levels of prolonged conflict were significantly less likely than those in regions with moderate levels of conflict to have their first antenatal care visit within the first trimester (OR = 0.29, p < 0.01), and to have four visits (OR = 0.46, p < 0.01). Overall, women in regions with extremely high levels of conflict (OR = 0.41, p < 0.01) were less likely to meet the World Health Organization's antenatal care recommendations compared to those in regions with moderate levels of conflict. The findings suggest that conflict-affected countries, such as the Democratic Republic of the Congo, require context-specific interventions if progress is to be made towards achieving Sustainable Development Goal 3.1.

Reducing HIV misconceptions among females and males in Malawi: are we making progress?

Policy response to endemic HIV prevalence rates in Malawi has prioritised reducing HIV misconceptions through dissemination of factual information about HIV transmission. Yet, over three decades after the implementation of these strategies, we know little about how effective they have been in dispelling misconceptions that may be associated with new HIV infections. Using the 2004, 2010 and 2015/16 Malawi Demographic and Health Surveys and applying multivariate logistic regression, this study examined how endorsement of HIV misconceptions among males and females have changed over time. For women, we found at the bivariate level that the odds of endorsing misconception about HIV transmission were higher in 2004 (OR = 1.38, p < 0.001) but lower in 2015-16 (OR = 0.92, p < 0.001) compared to 2010. We also observed that the difference between 2015-16 and 2010 in misconception endorsement was largely supressed by socioeconomic characteristics (OR = 1.06, p < 0.01). It is also found at the bivariate level that, compared to men in 2010, men in 2004 (OR = 1.23, p < 0.05) were more likely to endorse misconception about HIV transmission although those in 2015-16 (OR = 0.92, p < 0.05) were less likely to do so. Once we accounted for behavioural variables, the significant impact for 2015-16 (OR = 0.98, p > 0.05), compared to 2010, was fully attenuated. Based on our findings, we recommend increasing efforts at reaching women and men with HIV information. It is also crucial to improve women's socioeconomic status to ensure a substantial reduction in their endorsement of HIV misconceptions in Malawi.

Examining purchasing reforms towards universal health coverage by the National Hospital Insurance Fund in Kenya

BACKGROUND

Kenya has prioritized the attainment of universal health coverage (UHC) through the expansion of health insurance coverage by the National Hospital Insurance Fund (NHIF). In 2015, the NHIF introduced reforms in premium contribution rates, benefit packages, and provider payment methods. We examined the influence of these reforms on NHIF's purchasing practices and their implications for strategic purchasing and health system goals of equity, efficiency and quality.

METHODS

We conducted an embedded case study with the NHIF as the case and the reforms as embedded units of analysis. We collected data at the national level and in two purposively selected counties through 41 in-depth interviews with health financing stakeholders, facility managers and frontline providers; 4 focus group discussions with 51 NHIF members; and, document reviews. We analysed the data using a Framework approach.

RESULTS

The new NHIF reforms were characterized by weak purchasing actions. Firstly, the new premium contribution rates were inadequately communicated and unaffordable for certain citizen groups. Secondly, while the new benefit packages were reported to be based on service needs, preferences and values of the population, they were inadequately communicated and unequally distributed across different citizen groups. In addition, the presence of service delivery infrastructure gaps in public healthcare facilities and the pro-urban and pro-private distribution of contracted health facilities compromised delivery of, and access to, these new services. Lastly, the new provider payment methods and rates were considered inadequate, with delayed payments and weak links to financial accountability mechanisms which compromised their ability to incentivize equity, efficiency and quality of healthcare delivery.

CONCLUSION

While NHIF sought to expand population and service coverage and reduce out-of-pocket payments with the new reforms, weaknesses in the reforms' design and implementation limited NHIF's purchasing actions with negative implications for the health system goals of equity, efficiency and quality. For the reforms to accelerate the country's progress towards UHC, policy makers at the NHIF and, national and county government should make deliberate efforts to align the design and implementation of such reforms with strategic purchasing actions that are aimed at improving health system goals.

Examining purchasing reforms towards universal health coverage by the National Hospital Insurance Fund in Kenya

BACKGROUND

Kenya has prioritized the attainment of universal health coverage (UHC) through the expansion of health insurance coverage by the National Hospital Insurance Fund (NHIF). In 2015, the NHIF introduced reforms in premium contribution rates, benefit packages, and provider payment methods. We examined the influence of these reforms on NHIF's purchasing practices and their implications for strategic purchasing and health system goals of equity, efficiency and quality.

METHODS

We conducted an embedded case study with the NHIF as the case and the reforms as embedded units of analysis. We collected data at the national level and in two purposively selected counties through 41 in-depth interviews with health financing stakeholders, facility managers and frontline providers; 4 focus group discussions with 51 NHIF members; and, document reviews. We analysed the data using a Framework approach.

RESULTS

The new NHIF reforms were characterized by weak purchasing actions. Firstly, the new premium contribution rates were inadequately communicated and unaffordable for certain citizen groups. Secondly, while the new benefit packages were reported to be based on service needs, preferences and values of the population, they were inadequately communicated and unequally distributed across different citizen groups. In addition, the presence of service delivery infrastructure gaps in public healthcare facilities and the pro-urban and pro-private distribution of contracted health facilities compromised delivery of, and access to, these new services. Lastly, the new provider payment methods and rates were considered inadequate, with delayed payments and weak links to financial accountability mechanisms which compromised their ability to incentivize equity, efficiency and quality of healthcare delivery.

CONCLUSION

While NHIF sought to expand population and service coverage and reduce out-of-pocket payments with the new reforms, weaknesses in the reforms' design and implementation limited NHIF's purchasing actions with negative implications for the health system goals of equity, efficiency and quality. For the reforms to accelerate the country's progress towards UHC, policy makers at the NHIF and, national and county government should make deliberate efforts to align the design and implementation of such reforms with strategic purchasing actions that are aimed at improving health system goals.

Determinants of Enrolment and Renewing of Community-Based Health Insurance in Households With Under-5 Children in Rural South-Western Uganda

BACKGROUND

The desire for universal health coverage in developing countries has brought attention to communitybased health insurance (CBHI) schemes in developing countries. The government of Uganda is currently debating policy for the national health insurance programme, targeting the integration of existing CBHI schemes into a larger national risk pool. However, while enrolment has been largely studied in other countries, it remains a generally under-covered issue from a Ugandan perspective. Using a large CBHI scheme, this study, therefore, aims at shedding more light on the determinants of households' decisions to enrol and renew membership in these schemes.

METHODS

We collected household data from 464 households in 14 villages served by a large CBHI scheme in southwestern Uganda. We then estimated logistic and zero-inflated negative binomial (ZINB) regressions to understand the determinants of enrolment and renewing membership in CBHI, respectively.

RESULTS

Results revealed that household's socioeconomic status, husband's employment in rural casual work (odds ratio [OR]: 2.581, CI: 1.104-6.032) and knowledge of health insurance premiums (OR: 17.072, CI: 7.027-41.477) were significant predictors of enrolment. Social capital and connectivity, assessed by the number of voluntary groups a household belonged to, was also positively associated with CBHI participation (OR: 5.664, CI: 2.927-10.963). More positive perceptions on insurance (OR: 2.991, CI: 1.273-7.029), access to information were also associated with enrolment and renewing among others. Burial group size and number of burial groups in a village, were all significantly associated with increased the likelihood of renewing CBHI.

CONCLUSION

While socioeconomic factors remain important predictors of participation in insurance, mechanisms to promote inclusion should be devised. Improving the participation of communities can enhance trust in insurance and eventual coverage. Moreover, for households already insured, access to correct information and strengthening their social network information pathways enhances their chances of renewing.

Population-level impact of information sources on HIV testing uptake in South Africa: gender and age disparities

In South Africa, mass media and interpersonal communication sources have been used extensively to increase awareness of human immunodeficiency virus (HIV)/AIDS. A sub-population of 10,565 black Africans who participated in the 2011–2012 household survey was analysed. Overall compared to men, a higher proportion of women had ever been tested for HIV (76% versus 60%). In age-specific analysis, men and women aged 25–49 years were more likely to be ever been tested compared to the youngest (<25 years) and the oldest age groups (50+ years). More than 80% of the study population was exposed to mass media tools, while exposure to interpersonal information sources was less common (16–72%). Among adolescents, 37% (men) and 41% (women) of the HIV tests were collectively associated with exposure to interpersonal programmes, while mass media tools had substantial contributions on HIV testing rates among the older individuals. Information sources to promote HIV/AIDS awareness should be tailored to reduce age–gender disparities.

Exposure to mass media family planning messages among post-delivery women in Nigeria: testing the structural influence model of health communication

OBJECTIVES

While media campaigns are documented to be useful for increasing the uptake of family planning, very little is known about the population prevalence and correlates of exposure to mass media family planning messages among post-delivery women in Nigeria. We aimed to address this void by exploring the underlying factors that explain disparities in exposure to mass media family planning messages among post-delivery women in Nigeria.

METHODS

Our study was a secondary analysis of the Nigeria Demographic and Health Survey, a nationally representative dataset of men and women. Using logistic regression techniques and drawing on the structural influence model of health communication, we explored post-delivery women's (N = 13,889) exposure to mass media family planning messages in Nigeria.

RESULTS

We found that 32% of post-delivery women were exposed to family planning messages on mass media in Nigeria. At the bivariate level, Muslim women were less likely to be exposed to mass media family planning messages compared with Christian women (odds ratio [OR] 0.39; 95% confidence interval [CI] 0.36, 0.41); however, the OR became positive once we controlled for structural determinants such as household wealth and education (OR 1.22; 95% CI 1.07, 1.40). In the multivariate analysis, we found that traditionalist women (OR 0.29; 95% CI 0.14, 0.58) and women from rural areas (OR 0.69; 95% CI 0.62, 0.76) were less likely to be exposed to such messages. Moreover, richer, better educated, and employed women were more likely to be exposed to mass media family planning messages compared with their poorer, less educated and unemployed counterparts. Similarly, living in the South West region was positively associated with higher odds of being exposed to such messages.

CONCLUSION

Findings were largely consistent with the structural influence model of health communication, as highlighted by inequalities in exposure to mass media messages. Based on these findings, we provide several policy recommendations.

Sociodemographic patterns of health insurance coverage in Namibia

INTRODUCTION

Health insurance has been found to increase healthcare utilisation and reduce catastrophic health expenditures in a number of countries; however, coverage is often unequally distributed among populations. The sociodemographic patterns of health insurance in Namibia are not fully understood. We aimed to assess the prevalence of health insurance, the relation between health insurance and health service utilisation and to explore the sociodemographic factors associated with health insurance in Namibia. Such findings may help to inform health policy to improve financial access to healthcare in the country.

METHODS

Using data on 14,443 individuals, aged 15 to 64 years, from the 2013 Namibia Demographic and Health Survey, the association between health insurance and health service utilisation was investigated using multivariable mixed effects Poisson regression analyses, adjusted for sociodemographic covariates and regional, enumeration area and household clustering. Multivariable mixed effects Poisson regression analyses were also conducted to explore the association between key sociodemographic factors and health insurance, adjusted for covariates and clustering. Effect modification by sex, education level and wealth quintile was also explored.

RESULTS

Just 17.5% of this population were insured (men: 20.2%; women: 16.2%). In fully-adjusted analyses, education was significantly positively associated with health insurance, independent of other sociodemographic factors (higher education RR: 3.98; 95% CI: 3.11-5.10; p < 0.001). Female sex (RR: 0.83; 95% CI: 0.74-0.94; p = 0.003) and wealth (highest wealth quintile RR: 13.47; 95% CI: 9.06-20.04; p < 0.001) were also independently associated with insurance. There was a complex interaction between sex, education and wealth in the context of health insurance. With increasing education level, women were more likely to be insured (p for interaction < 0.001), and education had a greater impact on the likelihood of health insurance in lower wealth quintiles.

CONCLUSIONS

In this population, health insurance was associated with health service utilisation but insurance coverage was low, and was independently associated with sex, education and wealth. Education may play a key role in health insurance coverage, especially for women and the less wealthy. These findings may help to inform the targeting of strategies to improve financial protection from healthcare-associated costs in Namibia.

Modern or traditional health care? Understanding the role of insurance in health-seeking behaviours among older Ghanaians

Aim:

This paper examined the association between wealth and health insurance status and the use of traditional medicine (TM) among older persons in Ghana.

Background:

There have been considerable efforts by sub-Saharan African countries to improve access to primary health care services, partly through the implementation of risk-pooling community or national health insurance schemes. The use of TM, which is often not covered under these insurance schemes, remains common in many countries, including Ghana. Understanding how health insurance and wealth influence the use of TM, or otherwise, is essential to the development of equitable health care policies.

Methods:

The study used data from the first wave of the World Health Organisation’s Study of Global Ageing and Adult Health conducted in Ghana in 2008. Descriptive statistics and negative loglog regression models were fitted to the data to examine the influence of insurance and wealth status on the use of TM, controlling for theoretically relevant factors.

Findings:

Seniors who had health insurance coverage were also 17% less likely to frequently seek treatment from a TM healer relative to the uninsured. For older persons in the poorest income quintile, the odds of frequently seeking treatment from TM increased by 61% when compared to those in the richest quintile. This figure was 46%, 62% and 40% for older persons in poorer, middle and richer income quintiles, respectively, compared to their counterparts in the richest income quintile.

Conclusion:

The findings indicate that TM was primarily used by the poor and persons who were not enrolled in the National Health Insurance Scheme. TM continues to be a vital health care resource for the poor and uninsured older adults in Ghana.

Examining the unresolved conundrum of Traditional Birth Attendants' involvement in maternal and child health care delivery in Ghana

Traditional Birth Attendants (TBAs) have been a critical human resource in maternal health care delivery in Ghana. However, following the World Health Organization's directive for countries to discontinue using TBAs, the government of Ghana has since emphasized the use of skilled birth attendants. This policy shift created tensions between TBAs and Community Health Nurses. We examine this conundrum in this paper. We find that despite the ban, TBAs still attend a significant number of births - a situation which has produced intense contestations and continuous jostling for "functioning space" and clients between TBAs and nurses. We recommend a consensus-based partnership approach that promotes cultural competence and is sensitive to contextual cultural practices that underpin pregnancy and childbirth.

The influence of the Community-based Health Planning and Services (CHPS) program on community health sustainability in the Upper West Region of Ghana

Ghana introduced Community-based Health Planning and Services (CHPS) to improve primary health care in rural areas. The extension of health care services to rural areas has the potential to increase sustainability of community health. Drawing on the capitals framework, this study aims to understand the contribution of CHPS to the sustainability of community health in the Upper West Region of Ghana-the poorest region in the country. We conducted in-depth interviews with community members (n = 25), key informant interviews with health officials (n = 8), and focus group discussions (n = 12: made up of six to eight participants per group) in six communities from two districts. Findings show that through their mandate of primary health care provision, CHPS contributed directly to improvement in community health (eg, access to family planning services) and indirectly through strengthening social, human, and economic capital and thereby improving social cohesion, awareness of health care needs, and willingness to take action at the community level. Despite the current contributions of CHPS in improving the sustainability of community health, there are several challenges, based on which we recommend, that government should increase staffing and infrastructure in order to strengthen and maintain the functionality of CHPS.