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Kamudoni P, Kiige L, Ortenzi F, Beal T, Nordhagen S, Kirogo V, Arimi C, Zvandaziva C, Garg A, Codjia P, Rudert C. Identifying and understanding barriers to optimal complementary feeding in Kenya. MATERNAL & CHILD NUTRITION 2024; 20 Suppl 3:e13617. [PMID: 38180165 PMCID: PMC10782142 DOI: 10.1111/mcn.13617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/07/2023] [Accepted: 12/09/2023] [Indexed: 01/06/2024]
Abstract
Optimal complementary feeding between the ages of 6 and 23 months provides children with the required range of nutritious and safe foods while continuing to be breastfed to meet their needs for essential nutrients and develop their full physical and cognitive potential. The rates of exclusive breastfeeding in the first 6 months of life have increased from 32% in 2008 to 60% in 2022 in Kenya. However, the proportion of children between 6 and 23 months receiving a minimum acceptable diet remains low and has declined from 39% in 2008 to 31% in 2023. The Kenyan Ministry of Health, GAIN and UNICEF collaborated to understand the drivers of complementary feeding practices, particularly proximal determinants, which can be directly addressed and acted upon. A secondary analysis of household surveys and food composition data was conducted to outline children's dietary patterns within the different regions of Kenya and the extent to which the affordability of animal-source foods could be improved. Ethnographic data were analyzed to identify socio-cultural barriers to optimal complementary feeding. Furthermore, we outlined the critical steps for developing user-friendly and low-cost complementary feeding recipes. The results of all the analyses are presented in five of the six papers of this Special Issue with this additional paper introducing the Kenyan context and some of the critical findings. The Special Issue has highlighted multidimensional barriers surrounding the use and availability of animal-source foods. Furthermore, it emphasizes the need for a multi-sectoral approach in enacting policies and programmes that address these barriers.
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Affiliation(s)
| | | | | | - Ty Beal
- Global Alliance for Improved Nutrition (GAIN)WashingtonDCUSA
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Odipo E, Jarhyan P, Nzinga J, Prabhakaran D, Aryal A, Clarke-Deelder E, Mohan S, Mosa M, Eshetu MK, Lewis TP, Kapoor NR, Kruk ME, Fink G, Okiro EA. The path to universal health coverage in five African and Asian countries: examining the association between insurance status and health-care use. Lancet Glob Health 2024; 12:e123-e133. [PMID: 38096884 PMCID: PMC10716621 DOI: 10.1016/s2214-109x(23)00510-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 10/19/2023] [Accepted: 10/25/2023] [Indexed: 12/17/2023]
Abstract
Despite major efforts to achieve universal health coverage (UHC), progress has lagged in many African and Asian countries. A key strategy pursued by many countries is the use of health insurance to increase access and affordability. However, evidence on insurance coverage and on the association between insurance and UHC is mixed. We analysed nationally representative cross-sectional data collected between 2022 and 2023 in Ethiopia, Kenya, South Africa, India, and Laos. We described public and private insurance coverage by sociodemographic factors and used logistic regression to examine the associations between insurance status and seven health-care use outcomes. Health insurance coverage ranged from 25% in India to 100% in Laos. The share of private insurance ranged from 1% in Ethiopia to 13% in South Africa. Relative to the population with private insurance, the uninsured population had reduced odds of health-care use (adjusted odds ratio 0·68, 95% CI 0·50-0·94), cardiovascular examinations (0·63, 0·47-0·85), eye and dental examinations (0·54, 0·42-0·70), and ability to get or afford care (0·64, 0·48-0·86); private insurance was not associated with unmet need, mental health care, and cancer screening. Relative to private insurance, public insurance was associated with reduced odds of health-care use (0·60, 0·43-0·82), mental health care (0·50, 0·31-0·80), cardiovascular examinations (0·62, 0·46-0·84), and eye and dental examinations (0·50, 0·38-0·65). Results were highly heterogeneous across countries. Public health insurance appears to be only weakly associated with access to health services in the countries studied. Further research is needed to improve understanding of these associations and to identify the most effective financing strategies to achieve UHC.
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Affiliation(s)
- Emily Odipo
- Population and Health Impact Surveillance Group, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | | | - Jacinta Nzinga
- Health Economics Research Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | | | - Amit Aryal
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Emma Clarke-Deelder
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | | | | | | | - Todd P Lewis
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Neena R Kapoor
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Günther Fink
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
| | - Emelda A Okiro
- Population and Health Impact Surveillance Group, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Kowal P, Corso B, Anindya K, Andrade FCD, Giang TL, Guitierrez MTC, Pothisiri W, Quashie NT, Reina HAR, Rosenberg M, Towers A, Vicerra PMM, Minicuci N, Ng N, Byles J. Prevalence of unmet health care need in older adults in 83 countries: measuring progressing towards universal health coverage in the context of global population ageing. Popul Health Metr 2023; 21:15. [PMID: 37715182 PMCID: PMC10503154 DOI: 10.1186/s12963-023-00308-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 07/09/2023] [Indexed: 09/17/2023] Open
Abstract
Current measures for monitoring progress towards universal health coverage (UHC) do not adequately account for populations that do not have the same level of access to quality care services and/or financial protection to cover health expenses for when care is accessed. This gap in accounting for unmet health care needs may contribute to underutilization of needed services or widening inequalities. Asking people whether or not their needs for health care have been met, as part of a household survey, is a pragmatic way of capturing this information. This analysis examined responses to self-reported questions about unmet need asked as part of 17 health, social and economic surveys conducted between 2001 and 2019, representing 83 low-, middle- and high-income countries. Noting the large variation in questions and response categories, the results point to low levels (less than 2%) of unmet need reported in adults aged 60+ years in countries like Andorra, Qatar, Republic of Korea, Slovenia, Thailand and Viet Nam to rates of over 50% in Georgia, Haiti, Morocco, Rwanda, and Zimbabwe. While unique, these estimates are likely underestimates, and do not begin to address issues of poor quality of care as a barrier or contributing to unmet need in those who were able to access care. Monitoring progress towards UHC will need to incorporate estimates of unmet need if we are to reach universality and reduce health inequalities in older populations.
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Affiliation(s)
- Paul Kowal
- International Health Transitions, Canberra, Australia.
- Health Data Analytics Team, The Australian National University, Canberra, Australia.
| | - Barbara Corso
- Neuroscience Institute, National Research Council (CNR), Padua, Italy
| | - Kanya Anindya
- School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Flavia C D Andrade
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana-Champaign, USA
| | - Thanh Long Giang
- Faculty of Economics, National Economics University, Hanoi, Viet Nam
| | | | - Wiraporn Pothisiri
- College of Population Studies, Chulalongkorn University, Bangkok, Thailand
| | - Nekehia T Quashie
- Department of Health Studies, University of Rhode Island, Kingston, USA
| | | | | | - Andy Towers
- School of Health Sciences, Massey University, Palmerston North, New Zealand
| | | | - Nadia Minicuci
- Neuroscience Institute, National Research Council (CNR), Padua, Italy
| | - Nawi Ng
- Department of Public Health and Community Medicine, University of Gothenberg, Gothenburg, Sweden
| | - Julie Byles
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
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