Determinants of Access to Health Care Among Women in East African Countries: A Multilevel Analysis of Recent Demographic and Health Surveys from 2008 to 2017

Barriers to healthcare access among reproductive age women in extremely high and very high maternal mortality countries: Multilevel mixed effect analysis

BACKGROUND

It is widely recognized that maternal deaths in low-resource countries are attributed to deprived access to maternal health services. Therefore, the aim of this study was to assess barriers to healthcare access among reproductive age women in extremely high and very high maternal mortality countries.

METHODS

A community based cross sectional surveys were conducted among 181,472 reproductive age women. Stata version 17.0 was used to analyze the data. Mixed effect binary logistic regression model was analyzed. Odds ratio along with 95% CI was generated to identify factors associated with barriers to healthcare access. A p-value less than 0.05 was declared as statistical significance.

RESULTS

A total of 64.3% (95% CI: 64.06, 64.54) reproductive age women faced barriers to healthcare access. Young age, no formal education, poor wealth index, no media exposure, multiparty, no health insurance coverage, and rural residence were significantly associated with barriers to healthcare access.

CONCLUSION

More than six in ten reproductive age women had barriers to healthcare access in extremely high and very high maternal mortality countries. Increasing extensive health education, minimizing financial hardship by expanding health insurance may minimize barriers to healthcare access with attention to rural resident reproductive age women.

Knowledge and factors associated with active management of the third stage of labor in sub-Saharan Africa: A systematic review and meta-analysis

BACKGROUND

Postpartum hemorrhage (PPH) is one of the leading causes of maternal mortality in sub-Saharan Africa. Implementing active management in the third stage of labor has significantly reduced the incidence of PPH. Thus, understanding the level of healthcare providers' knowledge of active management in the third stage of labor can inform guidelines, policies, and practices for effectively preventing PPH.

OBJECTIVE

This review aimed to assess the level of healthcare providers' knowledge and associated factors of active management in the third stage of labor in sub-Saharan Africa.

SEARCH STRATEGY

We conducted a search using PubMed, Scopus, Web of Science, Google Scholar, Cochrane Library, and the African Journals online international databases.

SELECTION CRITERIA

The inclusion criteria were determined before the review of the articles and adhere to the criteria of population, intervention, comparison, and outcome.

DATA COLLECTION AND ANALYSIS

Statistical analysis was performed using STATA data analysis software version 14, while Microsoft Excel was utilized for data abstraction. We checked publication bias using a funnel plot and Egger and Begg regression tests. A P value less than 0.05 was considered statistically significant, suggesting the presence of presence publication bias. The I2 statistic was used to assess heterogeneity between studies. The study's overall effect was evaluated using the random effects model.

MAIN RESULT

The study included 20 studies to conduct a pooled prevalence analysis. The overall prevalence of healthcare providers' knowledge of active management of third-stage labor in sub-Saharan Africa was 47.975% (95% CI: 32.585, 63.365). Having pre- and in-service training (AOR: 2.25, 95% CI: 1.00, 5.08), having a higher degree (AOR: 1.98, 95% CI: 1.39, 2.82), and having good practices (AOR: 8.91, 95% CI: 4.58, 17.40) were significantly associated with healthcare provider's knowledge regarding active management third stage of labor.

CONCLUSIONS

The overall healthcare providers' knowledge of active management of the third stage of labor (AMTSL) was low in sub-Saharan Africa. Obstetric healthcare providers should undertake comprehensive training covering all AMTSL components through pre- and in-service diploma training programs.

Effect of women empowerment on treatment seeking practice for sexually transmitted infections among women in Ethiopia

BACKGROUND

Sexually transmitted infections (STI) are public health problems in Ethiopia. Women have a higher chance of acquiring STI. STI complications are more severe in women compared to men. Despite that, treatment seeking for STI among women is poor. Woman empowerment and gender related factors may be playing a role for treatment seeking practice for STI. However, there are no studies that assess the association between these factors and treatment seeking practice for STI among married reproductive age women in Ethiopia. Therefore, this analysis was designed to explore this association in Ethiopia.

METHODS

This analysis used the 2016 Ethiopian demographic and health survey (EDHS) data. The 2016 EDHS collected data about STI treatment seeking practice for STI among other variables. Data was analyzed using STATA 17.0. Sampling weights were applied to improve the representativeness of the samples. Descriptive statistics were computed to describe the characteristics of the women. Binary and multivariable logistic regression models were fitted to identify the association between treatment seeking practice for STI and predictor variables. Multicollinearity was checked using variance inflation factors before running the multivariable logistic regression.

RESULTS

In this study, about 28% (95%CI: 20.87, 36.77) married reproductive age women with STI or STI symptoms sought treatment from the formal sector. Women whose husband attended secondary and higher education (AOR, 8.52; 95%CI 1.42, 51.21), and women with higher women empowerment scores (AOR 1.38, 95%CI 1.06, 1.81) had higher odds of treatment seeking for STI or STI symptoms. On the other hand, women who believe wife beating is justified had lower odds (AOR 0.32; 95%CI 0.15, 0.68) of treatment seeking for STI or STI symptoms.

CONCLUSIONS

Treatment seeking practice for STI among married reproductive age women in Ethiopia is low. The Ministry of Health and development partners shall conduct further research to identify barriers for treatment seeking practice. Gender variables (women empowerment and belief that wife beating is justified) were significantly associated with STI treatment seeking practice among married reproductive age women. STI prevention and control strategies shall include women empowerment and gender issues as essential component in STI prevention, treatment, and control activities.

Six in ten female youths in low-income East African countries had problems in accessing health care: a multilevel analysis of recent demographic and health surveys from 2016-2021

BACKGROUND

Access to health care services is a basic human right, and an individual's health and overall quality of life may suffer as a result of barriers to accessing health services. Access to comprehensive and quality health care is fundamental for promoting and maintaining health, preventing and treating diseases, and reducing premature deaths. However, only half of the African population has access to modern health services. Therefore, this study aimed to assess the health care access and associated factors among female youths in low-income East African countries.

METHODS

This study used secondary data from 2016 to 2021 demographic and health surveys of 7 low-income East African countries. A total weighted sample of 51,064 youths was included. A multilevel binary logistic regression was employed to identify the associated factors of access to health care since the data has a hierarchical structure. Adjusted Odds Ratio (AOR) with a 95% confidence interval (CI) at a p-value less than 0.05 was used to measure the association of variables whereas Intra-class correlation coefficient (ICC), Median Odds Ratio (MOR), and proportional change in variance (PCV) were used to measure random effects.

RESULT

The overall magnitude of access to healthcare among female youths in low-income East African countries was 38.84% (95% CI: 38.41, 39.26). Youth's educational level, rich wealth status, media exposure, and community level education were the positive while higher youth's age and rural residence were the negative predictors of access to healthcare among female youths. Besides, living in different countries compared to Burundi was also an associated factor for accessing healthcare in low-income East African countries.

CONCLUSION

About six in ten female youths were not accessing health care in low-income East African countries. Therefore, to increase healthcare access, health managers and policymakers needed to develop strategies to improve the poor household wealth index, and redistribution of health services for rural residents. The decision-makers and program planners should also work on increasing access to education and media exposure for youths. Further research including health system and quality of service-related factors for accessing healthcare should also be considered by researchers.

Knowledge, attitudes and practices of patients with chronic pharyngitis toward laryngopharyngeal reflux in Suzhou, China

BACKGROUND

This study aimed to investigate the knowledge, attitudes and practices (KAP) of patients with chronic pharyngitis in Suzhou, China toward laryngopharyngeal reflux (LPR).

METHODS

This cross-sectional study was conducted in patients with chronic pharyngitis in Suzhou, China at the otolaryngology outpatient clinic of the First Affiliated Hospital of Soochow University between November, 2022, and May, 2023. Data was collected through a self-designed online questionnaire encompassing the sociodemographic characteristics and three dimensions of KAP. The questionnaire was administered using SoJump, and data were exported from this platform. Subsequently, statistical analysis, including Structural Equation Modeling, was performed using SPSS 22 software to evaluate the KAP scores.

RESULTS

A total of 487 valid questionnaires were collected, with 275 (56.35%) female patients. The mean score of KAP were 4.76 ± 2.93 (possible range: 0-11), 33.10 ± 4.46 (possible range: 8-40), 31.29 ± 6.04 (possible range: 8-40), respectively. Pearson's correlation analysis showed significant positive correlations between knowledge and attitude dimensions (r = 0.413, P < 0.001), knowledge and practice dimensions (r = 0.355, P < 0.001), and attitude and practice dimensions (r = 0.481, P < 0.001). Structural equation modeling revealed that education exhibited positive effect on knowledge (β = 0.476, P < 0.001) and attitude (β = 0.600, P < 0.001), and having family history of chronic pharyngitis showed positive effect on knowledge (β = 0.580, P = 0.047), experienced with reflux symptoms showed positive effect on knowledge (β = 0.838, P = 0.001) and attitude (β = 0.631, P = 0.085). Moreover, knowledge showed positive effect on attitude (β = 0.555, P < 0.001) and practice (β = 0.351, P < 0.001). Attitude, in turn, showed positive effect on practice (β = 0.511, P < 0.001).

CONCLUSION

Patients with chronic pharyngitis had inadequate knowledge, positive attitudes and suboptimal practices toward LPR. Education, family history of chronic pharyngitis, experienced with reflux symptoms might have effect on their KAP.

Spatial distribution and determinants of barriers of health care access among female youths in Ethiopia, a mixed effect and spatial analysis

Access to healthcare services is a fundamental human right for every citizen, and it is the responsibility of the nation to guarantee that these services are acceptable, easily accessible, and timely. Barriers to accessing health services may have a detrimental effect on an individual's physical, and mental health, and overall quality of life. However, access to health care services is a common problem in developing countries. Therefore, this study aimed to investigate spatial distribution and determinants of barriers to healthcare access among female youths in Ethiopia. Secondary data analysis was conducted based on the Demographic and Health Surveys data conducted in Ethiopia. A total weighted sample of 6143 female youths aged 15-24 years old was included in this study. A mixed-effect analysis was employed to identify factors contributing to barriers to healthcare access among youths in Ethiopia. Adjusted Odds Ratio with 95% CI was used to declare the strength and significance of the association. The concentration index was used to assess wealth-related inequalities, while spatial analysis was used to explore the spatial distribution and significant windows of barriers to healthcare access. This study revealed that the magnitude of barriers to healthcare access among female youth was 61.3% with 95%CI (60.1 to 62.5) to at least one or more of the four reasons. Age 15-19 years old (AOR = 0.80, 95%CI 0.68 to 0.95), no formal education (AOR = 2.26, CI 1.61, 3.18), primary education (AOR = 2.21, CI 1.66, 2.95), marital status (AOR = 1.43, 95% CI 1.21, 1.70), poor household wealth (AOR = 1.63, 95% CI 1.31, 2.05), no Media exposure (AOR = 1.67, 95%CI 1.41-1.98), reside in rural areas (AOR = 1.63, 95%CI 1.05 to 2.54), and low community media exposure (AOR = 1.45, 95%CI 1.01-2.08) were significantly associated with barriers of health care service. Barriers to healthcare access were significantly and disproportionately concentrated in poor households. A non-random Barrier to healthcare access was observed in Ethiopia. Among the 9 regions, primary clusters were identified in only 4 regions (North Ormiya, Benishangul Gumuz, Gambella, and South Nation Nationality and Peoples regions. A significant proportion of female youths faced barriers to health care access Age, educational status, marital status, rural residency, low economic status, and media exposure were factors associated with barriers to health care access. Therefore, program planners and decision-makers should work on improving the country's economy to a higher economic level to improve the wealth status of the population, promote media exposure, and increase access to education.

Using intersectionality to study gender and antimicrobial resistance in low- and middle-income countries

Different sexes and genders experience differentiated risks of acquiring infections, including drug-resistant infections, and of becoming ill. Different genders also have different health-seeking behaviours that shape their likelihood of having access to and appropriately using and administering antimicrobials. Consequently, they are distinctly affected by antimicrobial resistance (AMR). As such, it is crucial to incorporate perspectives on sex and gender in the study of both AMR and antimicrobial use in order to present a full picture of AMR's drivers and impact. An intersectional approach to understanding gender and AMR can display how gender and other components 'intersect' to shape the experiences of individuals and groups affected by AMR. However, there are insufficient data on the burden of AMR disaggregated by gender and other socio-economic characteristics, and where available, it is fragmented. For example, to date, the best estimate of the global burden of bacterial AMR published in The Lancet does not consider gender or other social stratifiers in its analysis. To address this evidence gap, we undertook a scoping review to examine how sex and gender compounded by other axes of marginalization influence one's vulnerability and exposure to AMR as well as one's access to and use of antimicrobials. We undertook a gendered analysis of AMR, using intersectionality as a concept to help us understand the multiple and overlapping ways in which different people experience exposure vulnerability to AMR. This approach is crucial in informing a more nuanced view of the burden and drivers of AMR. The intersectional gender lens should be taken into account in AMR surveillance, antimicrobial stewardship, infection prevention and control and public and professional awareness efforts, both donor and government funded, as well as national and international policies and programmes tackling AMR such as through national action plans.

Problems with accessing healthcare and associated factors among reproductive-aged women in the Gambia using Gambia Demographic and Health Survey 2019/2020: a cross-sectional study

OBJECTIVES

To assess problems with accessing healthcare and its associated factors among reproductived-age women in the Gambia using the Gambia Demographic and Health Survey 2019/2020.

DESIGN

A community-based cross-sectional study.

SETTING

This study was based on a large, community-based cross-sectional survey, conducted from 2019 to 2020 in the Gambia. The survey employed a stratified two-stage cluster sampling technique to recruit study participants. Descriptive statistics and logistic regression models were used to summarise descriptive data and identify factors associated with problems of accessing healthcare, respectively. A p value of less than 0.05 and 95% CI were used to determine statistical significance.

PARTICIPANTS

A total of 11 865 reproductive-aged women (15-49 years) were included in the study. The mean age of the women was 28.21 with an SD of 9.33 and ranges 15-49 years. Regarding marital status, 7526 (63.43%) were married.

RESULTS

The magnitude of problems with accessing healthcare among reproductive-aged women in the Gambia was 45.5% (95% CI: 44.6%, 46.4%). Age (adjusted OR (AOR)=1.48, 95% CI: 1.12, 1.95), being from rural residence (AOR=1.28, 95% CI: 1.07, 1.53), parity (AOR=1.07, 95% CI: 1.03, 1.12), middle (AOR=0.54, 95% CI: 0.46, 0.64) and greater wealth (AOR=0.30, 95% CI: 0.25, 0.37), giving birth at health institutions (AOR=0.69, 95% CI: 0.58, 0.80), currently working (AOR=0.77, 95% CI: 0.68, 0.86) and geographical region were significantly associated with problems of accessing healthcare.

CONCLUSION

Problems of accessing healthcare among women of reproductive age were high in the Gambia. Age, region, working status, parity, residence, wealth and place of delivery were the identified factors associated with problems of accessing healthcare. Policymakers and public health experts should consider those factors while designing maternal healthcare programmes. Affordable healthcare service programmes should be designed to increase healthcare access in the Gambia.

Do education and living standard matter in breaking barriers to healthcare access among women in Bangladesh?

BACKGROUND

Barriers to healthcare access for women have a substantial influence on maternal and child health. By removing barriers to accessing healthcare, several sustainable development goals can be achieved. The goal of this study, based on the dominance analysis, was to examine how living standards and spousal education play role in removing barriers to healthcare access for women in Bangladesh.

METHODS

The study used the nationally representative Bangladesh Demographic and Health Survey (BDHS), 2017-18 data. A binary logistic regression model was applied for analyzing different types of health access barriers in the study. Additionally, a dominance analysis was conducted to identify the most responsible factors for removing barriers.

RESULTS

In Bangladesh, 66% of women faced at least one barrier in accessing healthcare. The results obtained from logistic regression and dominance analysis revealed that women's standard of living and spousal education explained the highest variation of having at least one barrier in accessing healthcare. Specifically, a high standard of living explained 24% of the total explained variation (OR 0.56, 95% CI 0.52-0.62), while both spousal education accounted for 27% (OR 0.49, 95% CI 0.45-0.54) of the total explained variation. The regression results also showed that women with higher standards of living as well as educated women having educated partners had lower odds of facing barriers in getting permission (OR 0.87, 95% CI 0.76-1.00 and OR 0.66, 95% CI 0.58-0.75) to go for advice/treatment, obtaining money (OR 0.43, 95% CI 0.39-0.47 and OR 0.37, 95% CI 0.34-0.40), distance to a health facility (OR 0.60, 95% CI 0.55-0.66 and OR 0.70, 95% CI 0.65-0.76), and not wanting to go alone (OR 0.72, 95% CI 0.66-0.89 and OR 0.75, 95% CI 0.69-0.81) for getting medical advice/treatment.

CONCLUSION

The findings of the study suggest paying extra attention to the spousal education and living standard of women to strengthen and reform the existing strategies and develop beneficial interventions to enhance unhindered accessibility to healthcare facilities for women.

Survival of children and youth with type 1 diabetes mellitus in Tanzania

INTRODUCTION

Survival from type 1 diabetes Mellitus is low in lower-income countries with underdeveloped health systems. Support programs from partners like life for a child (LFAC) and changing diabetes in children (CDiC) were implemented in Tanzania in 2005 to provide diabetes care to children and youth. No evaluation of survival has been done since their implementation.

OBJECTIVE

To assess the survival of children and youth living with diabetes mellitus (CYLDM) in Tanzania.

METHODS

A retrospective data collection from 39 clinics of CYLDM was done by extracting data from the diabetes registry between 1991 and 2019. Three cohort were analyzed (1) Cohort 1991-2004 (pre-implementation), (2) Cohort 2005-2010 (during implementation), and (3) 2011-2019 (after the implementation of LFAC/CDiC). Data were analyzed using STATA-version 14.

RESULTS

A total of 3822 data of CYLDM were extracted, mean age at diagnosis was 13.8 (±5) years. Approximately fifty-one percent (50.8%) were male. The total observation time was 28 years, and the Median duration of diabetes of 5 (IQR2, 8) years. Total death was 95 (3%), with a mean age at death of 17.7 (SD 4.7) years. The last cohort (2011-2019) had more diagnosis 2353 (72.7%), as compared to the <2005 cohort with only 163(5%). The survival improved from 59% before 2005 to 69% in the last cohort (2011-2019).

CONCLUSION

The implemented programs have facilitated the diagnosis and retention of CYLDM in the health care system. In doing so, it has also increased the survival probability in Tanzania compared to the early 90s.

Women empowerment and health insurance utilisation in Rwanda: a nationwide cross-sectional survey

Background

Health insurance coverage is one of the several measures being implemented to reduce the inequity in access to quality health services among vulnerable groups. Although women’s empowerment has been viewed as a cost-effective strategy for the reduction of maternal and child morbidity and mortality, as it enables women to tackle the barriers to accessing healthcare, its association with health insurance usage has been barely investigated. Our study aims at examining the prevalence of health insurance utilisation and its association with women empowerment as well as other socio-demographic factors among Rwandan women.

Methods

We used Rwanda Demographic and Health Survey (RDHS) 2020 data of 14,634 women aged 15–49 years, who were selected using multistage sampling. Health insurance utilisation, the outcome variable was a binary response (yes/no), while women empowerment was assessed by four composite indicators; exposure to mass media, decision making, economic and sexual empowerment. We conducted multivariable logistic regression to explore its association with socio-demographic factors, using SPSS (version 25).

Results

Out of the 14,634 women, 12,095 (82.6%) (95% CI 82.0–83.2) had health insurance, and the majority (77.2%) were covered by mutual/community organization insurance. Women empowerment indicators had a negative association with health insurance utilisation; low (AOR = 0.85, 95% CI 0.73–0.98) and high (AOR = 0.66, 95% CI 0.52–0.85) exposure to mass media, high decision making (AOR = 0.78, 95% CI 0.68–0.91) and high economic empowerment (AOR = 0.63, 95% CI 0.51–0.78). Other socio-demographic factors found significant include; educational level, wealth index, and household size which had a negative association, but residence and region with a positive association.

Conclusions

A high proportion of Rwandan women had health insurance, but it was negatively associated with women’s empowerment. Therefore, tailoring mass-media material considering the specific knowledge gaps to addressing misinformation, as well as addressing regional imbalance by improving women’s access to health facilities/services are key in increasing coverage of health insurance among women in Rwanda.

Sexually transmitted infections related care-seeking behavior and associated factors among reproductive age women in East Africa: a multilevel analysis of demographic and health surveys

Background

Sexually transmitted infections are serious global public health issue, and their consequences contribute significantly to population morbidity and mortality, especially in Sub-Saharan Africa. However, there is limited information about the sexually transmitted infections related care-seeking behavior in East Africa. Therefore, this study aimed to assess the pooled prevalence of sexually transmitted infections related care-seeking behavior, and associated factors among reproductive-age women in East Africa using the recent Demographic and Health Survey.

Methods

This study was based on recent Demographic and Health Survey of 8 East African countries from 2008/09 to 2018/2019. A total weighted sample of 12,004 reproductive-age women who reported sexually transmitted infections or symptoms of sexually transmitted infections in the last 12 months wereincluded. A multi-level mixed-effect logistic regression model was used and a P-value of < 0.05 was considered a statistically significant level for identification of individual and community level factors and AOR with a 95% l CI was computed.

Result

The overall prevalence of sexually transmitted infections related care-seeking behavior among reproductive-age women in East African countries was 54.14% [95% CI: 53.25%, 55.03%]. In multilevel analysis: being age 25–34 [AOR = 1.27 95%CI: 1.15–1.41], 35–49 [AOR = 1.26 95%CI: 1.13–1.41], women who attained secondary or above education [AOR = 1.27, 95% CI: 1.09, 1.47], being in rich household [AOR = 1.27, 95% CI 1.14, 1.41], women who were currently pregnant [AOR = 1.29, 95% CI 1.13, 1.47], who had been tested for HIV [AOR = 1.99, 95% CI 1.70, 2.33], women who had one and more than one sexual partner [AOR = 1.18, 95% CI 1.05, 1.34], women who lived in urban area [AOR = 1.16, 95% CI: 1.03, 1.31] and who perceived distance from the health facility was not a big problem was [AOR = 1.13, 95% CI 1.04, 1.23] were significantly associated with sexually transmitted infections related care-seeking behavior.

Conclusion

sexually transmitted infections related care-seeking behavior is relatively low as compared with other studies.. This study revealed that individual-level variables such as women's age, educational status, household wealth index, pregnancy status, ever been tested for HIV, number of sexual partners, and community-level variables such as residence and distance from a health facility were associated with sexually transmitted infections related care-seeking behavior. Therefore, public health interventions targeting uneducated women, poor households, and adolescents, as well as improving counseling and awareness creation during HIV/AIDS testing and Antenatal care visits, are vital to improving sexually transmitted infections care seeking behavior.

Determinants of accessing healthcare in Sub-Saharan Africa: a mixed-effect analysis of recent Demographic and Health Surveys from 36 countries

OBJECTIVE

This study aimed to assess the determinants of accessing healthcare among reproductive-age women in Sub-Saharan Africa (SSA).

DESIGN, SETTING AND ANALYSIS

Cross-sectional data were sourced from recent Demographic and Health Surveys in 36 SSA countries. We employed mixed-effect analysis to identify the determinants of accessing healthcare in SSA. OR and its 95% CI were reported for determinants associated with accessing healthcare.

OUTCOME

The outcome for this study was whether accessing healthcare was a 'big problem' or 'not a big problem'. Responses to these questions were categorised as a big problem and not a big problem.

PARTICIPANTS

A total weighted sample of 500 439 reproductive-age (15-49 years) women from each country's recent Demographic and Health Surveys from 2006 to 2018 were included in this study.

RESULTS

The pooled prevalence of healthcare access among reproductive-age women in SSA was 42.56% (95% CI 42.43% to 42.69%). The results of the mixed-effect analysis revealed that the determinants of accessing healthcare were urban residence (adjusted OR (AOR)=1.25, 95% CI 1.34 to 1.73), ability to read and write (AOR=1.15, 95% CI 1.22 to 1.28), primary education (AOR=1.08, 95% CI 1.07 to 1.12), secondary education and above (AOR=1.12, 95% CI 1.10 to 1.14), husband with primary education (AOR=1.06, 95% CI 1.07 to 1.1.12), husband with secondary education and above (AOR=1.22, 95% CI 1.18 to 1.27), middle wealth index (AOR=1.43, 95% CI 1.40 to 1.47), rich wealth index (AOR=2.19, 95% CI 2.13 to 2.24) and wanted pregnancy (AOR=1.27, 95% CI 1.19 to 1.29).

CONCLUSION

Healthcare access in SSA was found at 42.56%, which is very low even if Sustainable Development Goal 3.8 targeted universal health coverage for everyone so they can obtain the health services they need. The major determinants of healthcare access among reproductive-age women in SSA were urban residence, higher educational level, higher wealth index and wanted pregnancy. The findings of this study suggest and recommend strengthening and improving healthcare access for women who reside in the countryside, women with low level of education and women of low socioeconomic status.

Gender Differences in Informal Payments for Healthcare: Evidence from 36 African Countries

Informal payments are widespread in many healthcare systems and can impede access to healthcare and thwart progress to achieving Universal Health Coverage, a major element of the health-related Sustainable Development Goals. Gender may be an important driver in determining who pays informally for care, but few studies have examined this, particularly in low- and middle-income countries. Our study aimed to examine gender disparities in paying informally for healthcare in Africa. We used Afrobarometer Round 7 survey data collected between September 2016 and August 2018 from 34 African countries. The final sample was 44 715 adults. We used multiple logistic regression to evaluate associations between gender and paying informally to obtain healthcare. Our results show that 12% of women and 14% of men reported paying informally for healthcare. Men were more likely to pay informally for healthcare than women in African countries (OR 1.22 [95% CI 1.13-1.31]), irrespective of age, residential location, educational attainment, employment status, occupation, and indicators of poverty. To make meaningful progress towards improving Universal Healthcare Coverage in African countries, we must improve our understanding of the gendered aspects of informal payments in healthcare, which can act as both a barrier to accessing care and a determinant of poor health.