Determinants of health insurance ownership in Jordan: a cross-sectional study of population and family health survey 2017-2018

OBJECTIVES

With about one-third of the population living below the poverty line, Jordan faces major healthcare, social and national development issues. Low insurance coverage among the poor and high out-of-pocket expenditure worsens the financial insecurity especially for the marginalised population. The Government of Jordan aims to achieve universal coverage of health insurance-a bold plan that requires research evidence for successful implementation. In this study, we aimed to assess the proportion of the population covered by any health insurance, and the determinants owing a health insurance.

DESIGN

A population-based prospective cohort study.

SETTING

Jordan.

METHODS

Data for this study were derived from the Jordan Population and Family Health Survey, which was implemented by the Department of Statistics from early October 2017 to January 2018. Sample characteristics were described as percentages with 95% CIs. Binary logistic regression models were used to estimate OR of health insurance ownership. Parsimonious model was employed to assess the sex and geographical differences.

RESULTS

Data revealed that in 2017-2018, 73.13% of the 12 992 men and women had health insurance. There was no indication of age of sex difference in health insurance ownership; however, marital status and socioeconomic factors such as wealth and education as well as internet access and geographical location appeared to be the important predictors of non-use of health insurance. The associations differed by sex and urbanicity for certain variables. Addressing these inequities may help achieve universal coverage in health insurance ownership in the population.

CONCLUSIONS

More than one-quarter of the population in Jordan were not insured. Efforts to decrease disparities in insurance coverage should focus on minimising socioeconomic and geographical disparities to promote equity in terms of healthcare services.

Barriers to Prenatal Care Among Food-Insufficient Women: Findings from the Pregnancy Risk Assessment Monitoring System

Background: This study examines the relationship among food insufficiency, adequacy of prenatal care, and barriers to prenatal care. Materials and Methods: Using data from the Pregnancy Risk Assessment Monitoring System (PRAMS), 2009-2016, negative binomial and logistic regression models were used to assess the association among food insufficiency during pregnancy, late onset of prenatal care, the number of prental care visits, as well as barriers to prenatal care. Results: Findings indicate that food insufficiency is associated with not initiating prenatal care during the first trimester and having fewer overall visits. In addition, food insufficiency is associated with more overall barriers to prenatal care, and this association operates through several specific barriers, including not having enough money, lacking transportation to get to the clinic or doctor's office, not being able to get time off work, not having a Medicaid card, having too many other things going on, and having no one to take care of children. Conclusion: Considering the adverse consequences of both food insufficiency and a lack of sufficient prenatal care for maternal and child health, study findings suggest a need to develop targeted interventions that expand access and remove barriers to prenatal care among food-insufficient women.

Food Insecurity Associated with Attendance to Antenatal Care Among Pregnant Women: Findings from a Community-Based Cross-Sectional Study in Southern Ethiopia

Purpose

Enrollment to antenatal care (ANC) is still not universal in Ethiopia. This study examines whether household food insecurity affects antenatal care attendance or not, as well as other factors associated with antenatal care. As optimal antenatal care is vital for the improvement of maternal and child health, the study will contribute to the efforts in improving maternal and child health.

Patients and Methods

A community-based cross-sectional study was conducted among 707 pregnant women at or above 3 months of self-reported pregnancy in Southern Ethiopia. Multi-stage sampling was employed to obtain the study units. Data were collected using an interviewer-administered structured questionnaire. Logistic regression analysis was conducted to identify the independent factors associated with study outcome.

Results

Out of a total of 707 study subjects, the majority (71%) of the study women visited a health facility for ANC service. The odds of ANC use was lower for women who were not in marital union (adjusted odds ratio (AOR)=0.39, 95% confidence interval (CI)=0.16-0.97), and those from food insecure households (AOR=0.50, 95% CI=0.32-0.79). ANC attendance was higher for women from high socio-economic status (AOR=2.62, 95% CI=1.29-5.29), with planned pregnancy (AOR=1.82, 95% CI=1.16-2.85) and a perceived risk from danger signs (AOR=4.32, 95% CI=1.60-11.67).

Conclusion

While the overall ANC use was high, women experiencing food insecurity and those with unplanned pregnancy were having lower odds of ANC attendance among others. Interventions targeting at enhancing women's attendance to ANC service might be realized through commitment from the agriculture, economic, as well as health sectors by increasing productivity and providing special attention to women in the pre-pregnancy and pregnancy period. Moreover, educating women so that they can recognize that every pregnancy is risky and promotion of family planning to reduce unplanned pregnancy could improve attendance to the ANC service.

Nutrition Interventions Integrated into an Existing Maternal, Neonatal, and Child Health Program Reduce Food Insecurity Among Recently Delivered and Pregnant Women in Bangladesh

Background

Antenatal care may be a means to reduce food insecurity in pregnancy and postpartum periods.

Objective

With the use of a cluster-randomized design, we tested whether participation in nutrition-focused antenatal care intending to improve household knowledge about the importance of nutrition for pregnant and lactating women and encourage allocation of household resources to ensure sufficient quality and quantity of foods, without providing food assistance, would reduce household food insecurity.

Methods

Alive & Thrive integrated nutrition interventions into an existing Maternal, Neonatal, and Child Health (MNCH) program in Bangladesh. The nutrition-focused MNCH package was delivered in 10 subdistricts through antenatal care visits with the use of interpersonal communication, community mobilization, and monitoring of weight gain, aiming to improve maternal diet quality, quantity, and micronutrient intake during pregnancy and breastfeeding. The package included components that could reduce food insecurity, measured using the Household Food Insecurity Access Scale. To examine the impact of the nutrition-focused MNCH package compared with the standard MNCH package, we used linear and multinomial logit regression models, adjusted for subdistrict clustering, to test differences at endline in items, domains, and categories of food insecurity, after first confirming no differences at baseline.

Results

At baseline, nearly half of households were food insecure. At endline, the groups differed in food insecurity, whether expressed as items, domains, or categories, with food insecurity in the nutrition-focused MNCH group 22 percentage points lower than in the standard MNCH group and 20 percentage points lower than at baseline.

Conclusions

Participation in nutrition-focused antenatal care reduced household food insecurity among recently delivered and pregnant women. Integration of social and behavioral nutrition interventions into antenatal care with components that promote food security provides a potentially effective means to reduce food insecurity, without incurring high costs of providing supplemental food, in populations where limited resources can be directed towards accessing adequate and appropriate foods. Registered at clinicaltrials.gov as NCT02745249.