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Yew SQ, Trivedi D, Adanan NIH, Chew BH. Facilitators and barriers of digital health technologies implementation in hospital settings in lower-income and middle-income countries since the COVID-19 pandemic: a scoping review protocol. BMJ Open 2024; 14:e078508. [PMID: 38296272 PMCID: PMC10831434 DOI: 10.1136/bmjopen-2023-078508] [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: 08/03/2023] [Accepted: 01/17/2024] [Indexed: 02/03/2024] Open
Abstract
INTRODUCTION The implementation of digital health technologies (DHTs) in hospitals worldwide has been uneven since the COVID-19 pandemic. Ambiguity in defining the landscape of DHTs adds to the complexity of this process. To address these challenges, this scoping review aims to identify the facilitators and barriers of implementing DHTs in hospitals in lower-income and middle-income countries (LMIC) since COVID-19, describe the DHTs that have been adopted in hospital settings in LMIC during this period, and develop a comprehensive classification framework to define the landscape of DHTs implemented in LMIC. METHODS AND ANALYSIS We will conduct a systematic search in PubMed, Scopus, Web of Science and grey literature. Descriptive statistics will be used to report the characteristics of included studies. The facilitators and barriers to DHTs implementation, gathered from both quantitative and qualitative data, will be synthesised using a parallel-results convergent synthesis design. A thematic analysis, employing an inductive approach, will be conducted to categorise these facilitators and barriers into coherent themes. Additionally, we will identify and categorise all available DHTs based on their equipment types and methods of operation to develop an innovative classification framework. ETHICS AND DISSEMINATION Formal ethical approval is not required, as primary data collection is not involved in this study. The findings will be disseminated through peer-reviewed publications, conference presentations and meetings with key stakeholders and partners in the field of digital health.
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Affiliation(s)
- Sheng Qian Yew
- Department of Public Health Medicine, Universiti Kebangsaan Malaysia Fakulti Perubatan, Cheras, Federal Territory of Kual, Malaysia
| | - Daksha Trivedi
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hertfordshire, UK
| | | | - Boon How Chew
- Department of Family Medicine, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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Gala P, Kamano JH, Vazquez Sanchez M, Mugo R, Orango V, Pastakia S, Horowitz C, Hogan JW, Vedanthan R. Cross-sectional analysis of factors associated with medication adherence in western Kenya. BMJ Open 2023; 13:e072358. [PMID: 37669842 PMCID: PMC10481848 DOI: 10.1136/bmjopen-2023-072358] [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: 02/28/2023] [Accepted: 08/14/2023] [Indexed: 09/07/2023] Open
Abstract
OBJECTIVES Poor medication adherence in low-income and middle-income countries is a major cause of suboptimal hypertension and diabetes control. We aimed to identify key factors associated with medication adherence in western Kenya, with a focus on cost-related and economic wealth factors. SETTING We conducted a cross-sectional analysis of baseline data of participants enrolled in the Bridging Income Generation with Group Integrated Care study in western Kenya. PARTICIPANTS All participants were ≥35 years old with either diabetes or hypertension who had been prescribed medications in the past 3 months. PRIMARY AND SECONDARY OUTCOME MEASURES Baseline data included sociodemographic characteristics, wealth and economic status and medication adherence information. Predictors of medication adherence were separated into the five WHO dimensions of medication adherence: condition-related factors (comorbidities), patient-related factors (psychological factors, alcohol use), therapy-related factors (number of prescription medications), economic-related factors (monthly income, cost of transportation, monthly cost of medications) and health system-related factors (health insurance, time to travel to the health facility). A multivariable analysis, controlling for age and sex, was conducted to determine drivers of suboptimal medication adherence in each overarching category. RESULTS The analysis included 1496 participants (73.7% women) with a mean age of 60 years (range 35-97). The majority of participants had hypertension (69.2%), 8.8% had diabetes and 22.1% had both hypertension and diabetes. Suboptimal medication adherence was reported by 71.2% of participants. Economic factors were associated with medication adherence. In multivariable analysis that investigated specific subtypes of costs, transportation costs were found to be associated with worse medication adherence. In contrast, we found no evidence of association between monthly medication costs and medication adherence. CONCLUSION Suboptimal medication adherence is highly prevalent in Kenya, and primary-associated factors include costs, particularly indirect costs of transportation. Addressing all economic factors associated with medication adherence will be important to improve outcomes for non-communicable diseases. TRIAL REGISTRATION NUMBER NCT02501746.
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Affiliation(s)
- Pooja Gala
- Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | | | - Manuel Vazquez Sanchez
- Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Richard Mugo
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Vitalis Orango
- Medicine, Moi University, Eldoret, Kenya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Sonak Pastakia
- Center for Health Equity and Innovation, Purdue University College of Pharmacy Nursing and Health Sciences, West Lafayette, Indiana, USA
| | - Carol Horowitz
- Medicine and Population Health Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joseph W Hogan
- Biostatistics, Brown University, Providence, Rhode Island, USA
| | - Rajesh Vedanthan
- Medicine and Population Health, New York University Grossman School of Medicine, New York, New York, USA
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Coste M, Bousmah MAQ. Predicting health services utilization using a score of perceived barriers to medical care: evidence from rural Senegal. BMC Health Serv Res 2023; 23:263. [PMID: 36927564 PMCID: PMC10018867 DOI: 10.1186/s12913-023-09192-2] [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: 06/02/2022] [Accepted: 02/16/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Ensuring access to healthcare services is a key element to achieving the Sustainable Development Goal 3 of "promoting healthy lives and well-being for all" through Universal Health Coverage (UHC). However, in the context of low- and middle-income countries, most studies focused on financial protection measured through catastrophic health expenditures (CHE), or on health services utilization among specific populations exhibiting health needs (such as pregnancy or recent sickness). METHODS This study aims at building an individual score of perceived barriers to medical care (PBMC) in order to predict primary care utilization (or non-utilization). We estimate the score on six items: (1) knowing where to go, (2) getting permission, (3) having money, (4) distance to the facility, (5) finding transport, and (6) not wanting to go alone, using individual data from 1787 adult participants living in rural Senegal. We build the score via a stepwise descendent explanatory factor analysis (EFA), and assess its internal consistency. Finally, we assess the construct validity of the factor-based score by testing its association (univariate regressions) with a wide range of variables on determinants of healthcare-seeking, and evaluate its predictive validity for primary care utilization. RESULTS EFA yields a one-dimensional score combining four items with a 0.7 Cronbach's alpha indicating good internal consistency. The score is strongly associated-p-values significant at the 5% level-with determinants of healthcare-seeking (including, but not limited to, sex, education, marital status, poverty, and distance to the health facility). Additionally, the score can predict non-utilization of primary care at the household level, utilization and non-utilization of primary care following an individual's episode of illness, and utilization of primary care during pregnancy and birth. These results are robust to the use of a different dataset. CONCLUSION As a valid, sensitive, and easily documented individual-level indicator, the PBMC score can be a complement to regional or national level health services coverage to measure health services access and predict utilization. At the individual or household level, the PBMC score can also be combined with conventional metrics of financial risk protection such as CHE to comprehensively document deficits in, and progress towards UHC.
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Affiliation(s)
- Marion Coste
- Aix Marseille University, CNRS, AMSE, Marseille, France. .,Aix Marseille University, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France.
| | - Marwân-Al-Qays Bousmah
- Aix Marseille University, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France.,Université Paris Cité, IRD, Inserm, Ceped, Paris, F-75006, France
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Bergen S, Murimi D, Gruer C, Munene G, Nyachieo A, Owiti M, Sommer M. Living with Endometriosis: A Narrative Analysis of the Experiences of Kenyan Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4125. [PMID: 36901136 PMCID: PMC10001793 DOI: 10.3390/ijerph20054125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
Despite the high global prevalence of endometriosis, little is known about the experiences of women living with the disease in low- and middle-income contexts, including in Kenya and other countries across sub-Saharan Africa. This study captures the perspectives and recommendations of Kenyan women living with endometriosis through written narratives about the impact of the disease on their daily lives and their journeys through diagnosis and treatment. Thirty-seven women between the ages of 22 and 48 were recruited from an endometriosis support group in Nairobi and Kiambu, Kenya (February-March of 2022) in partnership with the Endo Sisters East Africa Foundation. Narrative data (written anonymous stories submitted through Qualtrics) were analyzed using a deductive thematic analysis methodology. Their stories revealed three themes related to their shared experiences with endometriosis: (1) stigma and disruption to quality of life, (2) barriers to acceptable healthcare, and (3) reliance on self-efficacy and social support to cope with the disease. These findings demonstrate a clear need for improved social awareness of endometriosis in Kenya and the establishment of clear, effective, and supportive pathways, with trained, geographically and financially accessible health care providers, for endometriosis diagnosis and treatment.
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Affiliation(s)
- Sadie Bergen
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA
| | - Doris Murimi
- Endo Sisters East Africa Foundation, Laiboni Center, Off Lenana Rd., Nairobi P.O. Box 100798-00101, Kenya
| | - Caitlin Gruer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA
| | - Gibson Munene
- Endo Sisters East Africa Foundation, Laiboni Center, Off Lenana Rd., Nairobi P.O. Box 100798-00101, Kenya
| | - Atunga Nyachieo
- Institute of Primate Research, Karen, Nairobi P.O. Box 24481-00502, Kenya
| | - Maureen Owiti
- The Department of Obstetrics and Gynaecology, Kenyatta National Hospital, Nairobi P.O. Box 20723-00202, Kenya
| | - Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA
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Li J, Wu D, Li H, Chen J. Unmet healthcare needs predict frailty onset in the middle-aged and older population in China: A prospective cohort analysis. Front Public Health 2023; 11:1064846. [PMID: 36815170 PMCID: PMC9939901 DOI: 10.3389/fpubh.2023.1064846] [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: 10/08/2022] [Accepted: 01/13/2023] [Indexed: 02/09/2023] Open
Abstract
Objectives Older populations have a relatively high prevalence of unmet healthcare needs, which can result in poor health status. Moreover, in the coming century, frailty is expected to become one of the most serious global public health challenges. However, there is a lack of clear evidence proving an association between unmet healthcare needs and frailty. This study aimed to assess whether unmet healthcare needs predict the onset of frailty in China. Methods The association between frailty and unmet healthcare needs was explored by analyzing data from the China Health and Retirement Longitudinal Study (CHARLS) using random-effects logistic regression and Cox regression with time-varying exposure. Results At baseline, 7,719 respondents were included in the analysis. Random-effects logistic regression shows that unmet outpatient healthcare needs were associated with increased risk of both contemporaneous (adjusted OR [aOR], 1.17; 95% CI, 1.02-1.35) and lagged (aOR, 1.24; 95% CI, 1.05-1.45) frailty, as were unmet inpatient needs (contemporaneous: aOR, 1.28; 95% CI, 1.00-1.64; lagged: aOR, 1.55; 95% CI, 1.17-2.06). For respondents not classified as frail at baseline (n = 5,392), Cox regression with time-varying exposure shows significant associations of both unmet outpatient needs (adjusted HR, 1.23; 95% CI, 1.05-1.44) and unmet inpatient needs (adjusted HR, 1.48; 95% CI, 1.11-1.99) with increased risk of developing frailty. Conclusions Reducing unmet healthcare needs would be a valuable intervention to decrease frailty risk and promote healthy aging in middle-aged and older populations. It is urgent and essential that the equity and accessibility of the medical insurance and health delivery systems be strengthened.
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Affiliation(s)
- Jun Li
- Tongji Medical College, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Huazhong University of Science and Technology, Wuhan, China
| | - Di Wu
- Tongji Medical College, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Huazhong University of Science and Technology, Wuhan, China
| | - Haomiao Li
- School of Political Science and Public Administration, Wuhan University, Wuhan, China,*Correspondence: Haomiao Li ✉
| | - Jiangyun Chen
- School of Health Management, Southern Medical University, Guangzhou, China
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Kirtland J, Tremoleda JL, Trivedy C. Traumatic injury patterns in humans from large feline predators: A systematic review and descriptive analysis. TRAUMA-ENGLAND 2022. [DOI: 10.1177/14604086221123307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Traumatic attacks from large feline predators cause a small yet significant burden of disease in rural populations, are increasing in frequency, cause complex injuries and worsen human–wildlife conflicts. Data on the traumatic injury pattern found in victims of these animals is sparse, and this study aimed to collate and synthesise patterns of injury to inform the care and management of these patients. Methods A multi-ethnographic literature search (PubMed, Embase, Web of Science, Google Scholar, and other sources) was performed on 12/1/21 to capture all available data describing anatomical injury and the mechanism of injury sustained by humans from attacks by lions, leopards and tigers. Quality and bias assessment was performed using the Joanna Briggs Critical Evaluation tools. Results Of 5110 studies identified, 42 were included in this review totalling 84 individual patient cases. A total of 85% of fatal injuries were due to exsanguination combined with neuroaxis injury of the neck. All wounds were susceptible to tissue loss, infection and long-term neuro-vascular complications. Leopards injured anterior-midline structures of the neck more often than did lions and tigers, while the latter caused high-energy fractures. Time lag to treatment for survivors of wild attacks extended to multiple days, and occult injury was common. Conclusion In addition to the primary finding of complex neck injury, this study generated specific patterns of injury seen from the included species and highlighted occult injury and healthcare disparity as challenges in providing patient care.
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Affiliation(s)
- Jack Kirtland
- Blizard Institute, Queen Mary University of London, UK
| | - Jordi L. Tremoleda
- Blizard Institute, Queen Mary University of London, UK
- QMUL University Veterinarian and Senior Lecturer in Trauma, Animal Science and Welfare, London, UK
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Rahman T, Gasbarro D, Alam K. Financial risk protection from out-of-pocket health spending in low- and middle-income countries: a scoping review of the literature. Health Res Policy Syst 2022; 20:83. [PMID: 35906591 PMCID: PMC9336110 DOI: 10.1186/s12961-022-00886-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 07/05/2022] [Indexed: 11/26/2022] Open
Abstract
Background Financial risk protection (FRP), defined as households’ access to needed healthcare services without experiencing undue financial hardship, is a critical health systems target, particularly in low- and middle-income countries (LMICs). Given the remarkable growth in FRP literature in recent times, we conducted a scoping review of the literature on FRP from out-of-pocket (OOP) health spending in LMICs. The objective was to review current knowledge, identify evidence gaps and propose future research directions. Methods We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines to conduct this scoping review. We systematically searched PubMed, Scopus, ProQuest and Web of Science in July 2021 for literature published since 1 January 2015. We included empirical studies that used nationally representative data from household surveys to measure the incidence of at least one of the following indicators: catastrophic health expenditure (CHE), impoverishment, adoption of strategies to cope with OOP expenses, and forgone care for financial reasons. Our review covered 155 studies and analysed the geographical focus, data sources, methods and analytical rigour of the studies. We also examined the level of FRP by disease categories (all diseases, chronic illnesses, communicable diseases) and the effect of health insurance on FRP. Results The extant literature primarily focused on India and China as research settings. Notably, no FRP study was available on chronic illness in any low-income country (LIC) or on communicable diseases in an upper-middle-income country (UMIC). Only one study comprehensively measured FRP by examining all four indicators. Most studies assessed (lack of) FRP as CHE incidence alone (37.4%) or as CHE and impoverishment incidence (39.4%). However, the LMIC literature did not incorporate the recent methodological advances to measure CHE and impoverishment that address the limitations of conventional methods. There were also gaps in utilizing available panel data to determine the length of the lack of FRP (e.g. duration of poverty caused by OOP expenses). The current estimates of FRP varied substantially among the LMICs, with some of the poorest countries in the world experiencing similar or even lower rates of CHE and impoverishment compared with the UMICs. Also, health insurance in LMICs did not consistently offer a higher degree of FRP. Conclusion The literature to date is unable to provide a reliable representation of the actual level of protection enjoyed by the LMIC population because of the lack of comprehensive measurement of FRP indicators coupled with the use of dated methodologies. Future research in LMICs should address the shortcomings identified in this review. Supplementary Information The online version contains supplementary material available at 10.1186/s12961-022-00886-3.
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Affiliation(s)
- Taslima Rahman
- Murdoch Business School, Murdoch University, Perth, WA, 6150, Australia. .,Institute of Health Economics, University of Dhaka, Dhaka, 1000, Bangladesh.
| | - Dominic Gasbarro
- Murdoch Business School, Murdoch University, Perth, WA, 6150, Australia
| | - Khurshid Alam
- Murdoch Business School, Murdoch University, Perth, WA, 6150, Australia
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Sheng P, Yang T, Zhang T. The Unmet Medical Demand among China's Urban Residents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111708. [PMID: 34770221 PMCID: PMC8583618 DOI: 10.3390/ijerph182111708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 10/31/2021] [Accepted: 11/01/2021] [Indexed: 11/16/2022]
Abstract
Our work aimed to build a reasonable proxy for unmet medical demands of China's urban residents. We combined health demand modeling and stochastic frontier analysis to produce a frontier medical demand function, which allowed us to disentangle unmet medical demands from the unobservable effects. We estimated unmet medical demands by using China's provincial dataset that covered 2005-2018. Our estimates showed that unmet medical demand at the national level was 12.6% in 2018, and regions with high medical prices confronted more unmet medical demands than regions with moderate or low medical prices during 2005-2018. Furthermore, medical prices and education were the main factors that affected unmet medical demand; therefore, policy making should pay more attention to reducing medical costs and promoting health education.
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Affiliation(s)
- Pengfei Sheng
- School of Economics, Henan University, Kaifeng 475002, China;
- Correspondence:
| | - Tingting Yang
- School of Economics, Henan University, Kaifeng 475002, China;
| | - Tengfei Zhang
- School of Public Finance and Taxation, Southwestern University of Finance and Economics, Chengdu 611130, China;
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Njagi P, Groot W, Arsenijevic J. Impact of household shocks on access to healthcare services in Kenya: a propensity score matching analysis. BMJ Open 2021; 11:e048189. [PMID: 34561259 PMCID: PMC8475159 DOI: 10.1136/bmjopen-2020-048189] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 09/13/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study examines the effects of household shocks on access to healthcare services in Kenya. Shocks are adverse events that lead to loss of household income and/or assets. DESIGN AND SETTING The study used data from the Kenya Integrated Household Budget Survey 2015/2016, a nationally representative cross-sectional survey. A propensity score matching approach was applied for the analysis. PARTICIPANTS The study sample included 16 297 individuals from households that had experienced shocks (intervention) and those that had not experienced shocks (control) within the last 12 months preceding the survey. OUTCOME MEASURES The outcome of interest was access to healthcare services based on an individual's perceived need for health intervention. RESULTS The results indicate that shocks reduce access to healthcare services when household members are confronted with an illness. We observed that multiple shocks in a household exacerbate the risk of not accessing healthcare services. Asset shocks had a significant negative effect on access to healthcare services, whereas the effect of income shocks was not statistically significant. This is presumably due to the smoothing out of income shocks through the sale of assets or borrowing. However, considering the time when the shock occurred, we observed mixed results that varied according to the type of shock. CONCLUSIONS The findings suggest that shocks can limit the capacity of households to invest in healthcare services, emphasising their vulnerability to risks and inability to cope with the consequences. These results provoke a debate on the causal pathway of household economic shocks and health-seeking behaviour. The results suggest a need for social protection programmes to integrate mechanisms that enable households to build resilience to shocks. A more viable approach would be to expedite universal health insurance to cushion households from forgoing needed healthcare when confronted with unanticipated risks.
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Affiliation(s)
- Purity Njagi
- Maastricht Graduate School of Governance, UNU-MERIT, Maastricht, The Netherlands
| | - Wim Groot
- Maastricht Graduate School of Governance, UNU-MERIT, Maastricht, The Netherlands
- Department of Health Services Research, Maastricht University Faculty of Health Medicine and Life Sciences, Maastricht, The Netherlands
| | - Jelena Arsenijevic
- School of Governance, Utrecht University Faculty of Law, Economics and Governance, Utrecht, The Netherlands
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Njagi P, Arsenijevic J, Groot W. Decomposition of changes in socioeconomic inequalities in catastrophic health expenditure in Kenya. PLoS One 2020; 15:e0244428. [PMID: 33373401 PMCID: PMC7771691 DOI: 10.1371/journal.pone.0244428] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 12/09/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Catastrophic health expenditure (CHE) is frequently used as an indicator of financial protection. CHE exists when health expenditure exceeds a certain threshold of household consumption. Although CHE is reported to have declined in Kenya, it is still unacceptably high and disproportionately affects the poor. This study examines the socioeconomic factors that contribute to inequalities in CHE as well as the change in these inequalities over time in Kenya. METHODS We used data from the Kenya household health expenditure and utilisation (KHHEUS) surveys in 2007 and 2013. The concertation index was used to measure the socioeconomic inequalities in CHE. Using the Wagstaff (2003) approach, we decomposed the concentration index of CHE to assess the relative contribution of its determinants. We applied Oaxaca-type decomposition to assess the change in CHE inequalities over time and the factors that explain it. RESULTS The findings show that while there was a decline in the incidence of CHE, inequalities in CHE increased from -0.271 to -0.376 and was disproportionately concentrated amongst the less well-off. Higher wealth quintiles and employed household heads positively contributed to the inequalities in CHE, suggesting that they disadvantaged the poor. The rise in CHE inequalities overtime was explained mainly by the changes in the elasticities of the household wealth status. CONCLUSION Inequalities in CHE are persistent in Kenya and are largely driven by the socioeconomic status of the households. This implies that the existing financial risk protection mechanisms have not been sufficient in cushioning the most vulnerable from the financial burden of healthcare payments. Understanding the factors that sustain inequalities in CHE is, therefore, paramount in shaping pro-poor interventions that not only protect the poor from financial hardship but also reduce overall socioeconomic inequalities. This underscores the fundamental need for a multi-sectoral approach to broadly address existing socioeconomic inequalities.
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Affiliation(s)
- Purity Njagi
- United Nations University-MERIT, Maastricht Graduate School of Governance, Maastricht University, Maastricht, Netherlands
| | - Jelena Arsenijevic
- Faculty of Law, Economics and Governance, School of Governance, Utrecht University, Utrecht, Netherlands
| | - Wim Groot
- United Nations University-MERIT, Maastricht Graduate School of Governance, Maastricht University, Maastricht, Netherlands
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, Maastricht University, Maastricht, Netherlands
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Clowse MEB. Learning to listen: how empathetic engagement with patients can help overcome reproductive injustice. Lupus Sci Med 2020; 7:7/1/e000455. [PMID: 33229364 PMCID: PMC7684822 DOI: 10.1136/lupus-2020-000455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 11/03/2022]
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