scholarly journals Healthcare Utilization and Out-of-Pocket Expenditures Associated with Depression in Adults: A Cross-Sectional Analysis in Nepal

2020 ◽  
Author(s):  
Selina Rajan ◽  
Sujit D Rathod ◽  
Nagendra P Luitel ◽  
Adrianna Murphy ◽  
Tessa Roberts ◽  
...  
Keyword(s):  
Healthcare Utilization ◽  
Low Income ◽  
Negative Binomial ◽  
Service Providers ◽  
Outpatient Service ◽  
Healthcare Utilisation ◽  
Population Based ◽  
Low Income Countries ◽  
Cross Sectional ◽  
Probable Depression

Abstract Background: Despite attempts to improve universal healthcare coverage (UHC) in low income countries like Nepal, most healthcare utilization is still financed by out-of-pocket (OOP) payments, with detrimental effects on the poorest and most in need. Evidence from high income countries shows that depression is associated with increased healthcare utilization, which may lead to increased OOP expenditures, placing greater stress on families. To inform policies for integrating mental healthcare into UHC in LMIC, we must understand healthcare utilization and OOP expenditure patterns in people with depression. Aims: We examined associations between symptoms of depression and frequency and type of healthcare utilization and OOP expenditure among adults in Chitwan District, Nepal. Methods: We analysed data from a population-based survey of 2040 adults in 2013, who completed the PHQ-9 screening tool for depression and answered questions about healthcare utilization. We examined associations between increasing PHQ-9 score and healthcare utilization frequency and OOP expenditure using negative binomial regression. We also compared utilization of specific outpatient service providers and their related costs among adults with and without probable depression, determined by a PHQ-9 score of 10 or more. Results: We classified 80 (3.6%) participants with probable depression, 70.9% of whom used some form of healthcare in the past year compared to 43.9% of people without probable depression. Mean annual OOP healthcare expenditures were $118 USD in people with probable depression, compared to $110 USD in people without. With each unit increase in PHQ-9 score, there was a 14% increase in total healthcare visits (95% CI 7%-22%, p<0.0001) and $9 USD increase in OOP expenditures (95% CI $2-$17; p<0.0001). People with depression sought most healthcare from pharmacists (30.1%) but reported the greatest expenditure on specialist doctors ($36 USD). Conclusions: In this population-based sample from Central Nepal, we identified dose-dependent increases in healthcare utilization and OOP expenditure with increasing PHQ-9 scores. Future studies should evaluate whether provision of mental health services as an integrated component of UHC can improve overall health and reduce healthcare utilisation and expenditure, thereby alleviating financial pressures on families.

scholarly journals Healthcare Utilization and Out-of-Pocket Expenditures Associated with Depression in Adults: A Cross-Sectional Analysis in Nepal

2020 ◽  
Author(s):  
Selina Rajan ◽  
Sujit D Rathod ◽  
Nagendra P Luitel ◽  
Adrianna Murphy ◽  
Tessa Roberts ◽  
...  
Keyword(s):  
Healthcare Utilization ◽  
Low Income ◽  
Negative Binomial ◽  
Service Providers ◽  
Outpatient Service ◽  
Healthcare Utilisation ◽  
Population Based ◽  
Low Income Countries ◽  
Cross Sectional ◽  
Probable Depression

Abstract Background: Despite attempts to improve universal healthcare coverage (UHC) in low income countries like Nepal, most healthcare utilization is still financed by out-of-pocket (OOP) payments, with detrimental effects on the poorest and most in need. Evidence from high income countries shows that depression is associated with increased healthcare utilization, which may lead to increased OOP expenditures, placing greater stress on families. To inform policies for integrating mental healthcare into UHC in LMIC, we must understand healthcare utilization and OOP expenditure patterns in people with depression.Aims: We examined associations between symptoms of depression and frequency and type of healthcare utilization and OOP expenditure among adults in Chitwan District, Nepal.Methods: We analysed data from a population-based survey of 2040 adults in 2013, who completed the PHQ-9 screening tool for depression and answered questions about healthcare utilization. We examined associations between increasing PHQ-9 score and healthcare utilization frequency and OOP expenditure using negative binomial regression. We also compared utilization of specific outpatient service providers and their related costs among adults with and without probable depression, determined by a PHQ-9 score of 10 or more.Results: We classified 80 (3.6%) participants with probable depression, 70.9% of whom used some form of healthcare in the past year compared to 43.9% of people without probable depression. Mean annual OOP healthcare expenditures were $118 USD in people with probable depression, compared to $110 USD in people without. With each unit increase in PHQ-9 score, there was a 14% increase in total healthcare visits (95% CI 7%-22%, p<0.0001) and $9 USD increase in OOP expenditures (95% CI $2-$17; p<0.0001). People with depression sought most healthcare from pharmacists (30.1%) but reported the greatest expenditure on specialist doctors ($36 USD).Conclusions: In this population-based sample from Central Nepal, we identified dose-dependent increases in healthcare utilization and OOP expenditure with increasing PHQ-9 scores. Future studies should evaluate whether provision of mental health services as an integrated component of UHC can improve overall health and reduce healthcare utilisation and expenditure, thereby alleviating financial pressures on families.

scholarly journals Healthcare Utilization and Out-of-Pocket Expenditures Associated with Depression in Adults: A Cross-Sectional Analysis in Nepal

2020 ◽  
Author(s):  
Selina Rajan ◽  
Sujit D Rathod ◽  
Nagendra P Luitel ◽  
Adrianna Murphy ◽  
Tessa Roberts ◽  
...  
Keyword(s):  
Healthcare Utilization ◽  
Low Income ◽  
Negative Binomial ◽  
Service Providers ◽  
Outpatient Service ◽  
Population Based ◽  
Low Income Countries ◽  
Health Coverage ◽  
Cross Sectional ◽  
Probable Depression

Abstract Background: Despite attempts to improve universal health coverage (UHC) in low income countries like Nepal, most healthcare utilization is still financed by out-of-pocket (OOP) payments, with detrimental effects on the poorest and most in need. Evidence from high income countries shows that depression is associated with increased healthcare utilization, which may lead to increased OOP expenditures, placing greater stress on families. To inform policies for integrating mental healthcare into UHC in LMIC, we must understand healthcare utilization and OOP expenditure patterns in people with depression. We examined associations between symptoms of depression and frequency and type of healthcare utilization and OOP expenditure among adults in Chitwan District, Nepal. Methods: We analysed data from a population-based survey of 2040 adults in 2013, who completed the PHQ-9 screening tool for depression and answered questions about healthcare utilization. We examined associations between increasing PHQ-9 score and healthcare utilization frequency and OOP expenditure using negative binomial regression. We also compared utilization of specific outpatient service providers and their related costs among adults with and without probable depression, determined by a PHQ-9 score of 10 or more. Results: We classified 80 (3.6%) participants with probable depression, 70.9% of whom used some form of healthcare in the past year compared to 43.9% of people without probable depression. Mean annual OOP healthcare expenditures were $118 USD in people with probable depression, compared to $110 USD in people without. With each unit increase in PHQ-9 score, there was a 14% increase in total healthcare visits (95% CI 7%-22%, p<0.0001) and $9 USD increase in OOP expenditures (95% CI $2-$17; p<0.0001). People with depression sought most healthcare from pharmacists (30.1%) but reported the greatest expenditure on specialist doctors ($36 USD). Conclusions: In this population-based sample from Central Nepal, we identified dose-dependent increases in healthcare utilization and OOP expenditure with increasing PHQ-9 scores. Future studies should evaluate whether provision of mental health services as an integrated component of UHC can improve overall health and reduce healthcare utilisation and expenditure, thereby alleviating financial pressures on families.

scholarly journals General Healthcare Utilization and Out-of-Pocket Expenditures Associated with Depression in Adults: A Cross-Sectional Analysis in Nepal

2019 ◽  
Author(s):  
Selina Rajan ◽  
Sujit D Rathod ◽  
Nagendra P Luitel ◽  
Adrianna Murphy ◽  
Tessa Roberts ◽  
...  
Keyword(s):  
Healthcare Utilization ◽  
Low Income ◽  
Negative Binomial ◽  
Mental Healthcare ◽  
Negative Binomial Regression ◽  
Population Based ◽  
Low Income Countries ◽  
Cross Sectional ◽  
Universal Healthcare ◽  
Probable Depression

Abstract Background: Despite attempts to improve universal healthcare coverage (UHC) in low income countries like Nepal, most healthcare utilization is still financed by out-of-pocket (OOP) payments, with detrimental effects on the poorest and most in need. Evidence from high income countries shows that depression is associated with increased healthcare utilization, which may lead to increased OOP expenditures, placing greater stress on families. To inform policies for integrating mental healthcare into UHC in LMIC, we must understand general healthcare utilization and OOP expenditure patterns in people with depression. Aims: We examined associations between symptoms of depression and frequency and type of general healthcare utilization and OOP expenditure among adults in Chitwan District, Nepal. Methods: We analysed data from a population-based survey of 2040 adults in 2013, who completed the PHQ-9 screening tool for depression and answered questions about general healthcare utilization. We modelled associations between increasing PHQ-9 score and healthcare utilization frequency and OOP expenditure using negative binomial regression. We also compared sector-specific utilization of outpatient healthcare and their related costs among adults with and without probable depression, determined by a PHQ-9 score of 10 or more. Results: We classified 80 (3.6%) participants with probable depression, 70.9% of whom used some form of general healthcare in the past year compared to 43.9% of people without probable depression. Mean annual OOP healthcare expenditures were $118 USD in people with probable depression, compared to $110 USD in people without. With each unit increase in PHQ-9 score, there was a 14% increase in total healthcare visits (95% CI 7%-22%, p<0.0001) and $9 USD increase in OOP expenditures (95% CI $2-$17; p<0.0001). People with depression sought most general healthcare from pharmacists (30.1%) but reported the greatest expenditure on specialist doctors ($36 USD). Conclusions: In this population-based sample from Central Nepal, we identified dose-dependent increases in healthcare utilization and OOP expenditure with increasing PHQ-9 scores. Strengthening UHC to include early detection and treatment for people affected by depression as an integrated component of general healthcare should lead to a reduction in financial pressures on families, which is likely to reduce the incidence of depression in Nepal.

scholarly journals Healthcare Utilization and Out-of-Pocket Expenditures Associated with Depression in Adults: A Cross-Sectional Analysis in Nepal

2019 ◽  
Author(s):  
Selina Rajan ◽  
Sujit D Rathod ◽  
Nagendra P Luitel ◽  
Adrianna Murphy ◽  
Tessa Roberts ◽  
...  
Keyword(s):  
Healthcare Utilization ◽  
Low Income ◽  
Negative Binomial ◽  
Mental Healthcare ◽  
Negative Binomial Regression ◽  
Population Based ◽  
Low Income Countries ◽  
Cross Sectional ◽  
Universal Healthcare ◽  
Probable Depression

Abstract Background: Despite attempts to improve universal healthcare coverage (UHC) in low income countries like Nepal, most healthcare utilization is still financed by out-of-pocket (OOP) payments, with detrimental effects on the poorest and most in need. Evidence from high income countries shows that depression is associated with increased healthcare utilization, which may lead to increased OOP expenditures, placing greater stress on families. To inform policies for integrating mental healthcare into UHC in LMIC, we must understand healthcare utilization and OOP expenditure patterns in people with depression. Aims: We examined associations between symptoms of depression and frequency and type of healthcare utilization and OOP expenditure among adults in Chitwan District, Nepal. Methods: We analysed data from a population-based survey of 2040 adults in 2013, who completed the PHQ-9 screening tool for depression and answered questions about healthcare utilization. We modelled associations between increasing PHQ-9 score and healthcare utilization frequency and OOP expenditure using negative binomial regression. We also compared sector-specific utilization of outpatient healthcare and their related costs among adults with and without probable depression, determined by a PHQ-9 score of 10 or more. Results: We classified 80 (3.6%) participants with probable depression, 70.9% of whom used some form of healthcare in the past year compared to 43.9% of people without probable depression. Mean annual OOP healthcare expenditures were $118 USD in people with probable depression, compared to $110 USD in people without. With each unit increase in PHQ-9 score, there was a 14% increase in total healthcare visits (95% CI 7%-22%, p<0.0001) and $9 USD increase in OOP expenditures (95% CI $2-$17; p<0.0001). People with depression sought most healthcare from pharmacists (30.1%) but reported the greatest expenditure on specialist doctors ($36 USD). Conclusions: In this population-based sample from Central Nepal, we identified dose-dependent increases in healthcare utilization and OOP expenditure with increasing PHQ-9 scores. Strengthening UHC to include early detection and treatment for people affected by depression as an integrated component of healthcare should lead to a reduction in financial pressures on families, which is likely to reduce the incidence of depression in Nepal.

scholarly journals Improving access to healthcare for women in Tanzania by addressing socioeconomic determinants and health insurance: a population-based cross-sectional survey

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e023013 ◽  
Author(s):  
Deogratius Bintabara ◽  
Keiko Nakamura ◽  
Kaoruko Seino
Keyword(s):  
Health Insurance ◽  
Low Income ◽  
Formal Education ◽  
Wealth Index ◽  
Population Based ◽  
Reproductive Age ◽  
Low Income Countries ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Low Income Country

ObjectiveThis study was performed to explore the factors associated with accumulation of multiple problems in accessing healthcare among women in Tanzania as an example of a low-income country.DesignPopulation-based cross-sectional survey.SettingNationwide representative data for women of reproductive age obtained from the 2015–2016 Tanzania Demographic and Health Survey were analysed.Primary outcome measuresA composite variable, ‘problems in accessing healthcare’, with five (1-5) categories was created based on the number of problems reported: obtaining permission to go to the doctor, obtaining money to pay for advice or treatment, distance to a health facility and not wanting to go alone. Respondents who reported fewer or more problems placed in lower and higher categories, respectively.ResultsA total of 13 266 women aged 15–49 years, with a median age (IQR) of 27 (20–36) years were interviewed and included in the analysis. About two-thirds (65.53%) of the respondents reported at least one of the four major problems in accessing healthcare. Furthermore, after controlling for other variables included in the final model, women without any type of health insurance, those belonging to the poorest class according to the wealth index, those who had not attended any type of formal education, those who were not employed for cash, each year of increasing age and those who were divorced, separated or widowed were associated with greater problems in accessing healthcare.ConclusionThis study indicated the additive effects of barriers to healthcare in low-income countries such as Tanzania. Based on these results, improving uptake of health insurance and addressing social determinants of health are the first steps towards reducing women’s problems associated with accessing healthcare.

Epidemiology of hypertension in low-income countries: a cross-sectional population-based survey in rural Uganda

2011 ◽  
Vol 29 (6) ◽  
pp. 1061-1068 ◽  
Author(s):  
Dermot Maher ◽  
Laban Waswa ◽  
Kathy Baisley ◽  
Alex Karabarinde ◽  
Nigel Unwin
Keyword(s):  
Low Income ◽  
Population Based ◽  
Low Income Countries ◽  
Cross Sectional ◽  
Population Based Survey

scholarly journals Epidemiology of multimorbidity in conditions of extreme poverty: a population-based study of older adults in rural Burkina Faso

2020 ◽  
Vol 5 (3) ◽  
pp. e002096
Author(s):  
Maria Lisa Odland ◽  
Collin Payne ◽  
Miles D Witham ◽  
Mark J Siedner ◽  
Till Bärnighausen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Burkina Faso ◽  
Physical Performance ◽  
Low Income ◽  
Household Survey ◽  
Population Based ◽  
Low Income Countries ◽  
Cross Sectional ◽  
Management Interventions

IntroductionMultimorbidity is a health issue of increasing importance worldwide, and is likely to become particularly problematic in low-income countries (LICs) as they undergo economic, demographic and epidemiological transitions. Knowledge of the burden and consequences of multimorbidity in LICs is needed to inform appropriate interventions.MethodsA cross-sectional household survey collected data on morbidities and frailty, disability, quality of life and physical performance on individuals aged over 40 years of age living in the Nouna Health and Demographic Surveillance System area in northwestern Burkina Faso. We defined multimorbidity as the occurrence of two or more conditions, and evaluated the prevalence of and whether this was concordant (conditions in the same morbidity domain of communicable, non-communicable diseases (NCDs) or mental health (MH)) or discordant (conditions in different morbidity domains) multimorbidity. Finally, we fitted multivariable regression models to determine associated factors and consequences of multimorbidity.ResultsMultimorbidity was present in 22.8 (95% CI, 21.4 to 24.2) of the study population; it was more common in females, those who are older, single, more educated, and wealthier. We found a similar prevalence of discordant 11.1 (95% CI, 10.1 to 12.2) and concordant multimorbidity 11.7 (95% CI, 10.6 to 12.8). After controlling for age, sex, marital status, education, and wealth, an increasing number of conditions was strongly associated with frailty, disability, low quality of life, and poor physical performance. We found no difference in the association between concordant and discordant multimorbidity and outcomes, however people who were multimorbid with NCDs alone had better outcomes than those with multimorbidity with NCDs and MH disorders or MH multimorbidity alone.ConclusionsMultimorbidity is prevalent in this poor, rural population and is associated with markers of decreased physical performance and quality of life. Preventative and management interventions are needed to ensure that health systems can deal with increasing multimorbidity and its downstream consequences.

scholarly journals Knowledge, Attitude and Practice of Healthcare Workers Towards Availability of Antiretroviral Pre-Exposure Prohylaxis in Nigeria

2018 ◽  
Vol 3 (3) ◽  
pp. 46-59
Author(s):  
Abayomi Joseph Afe ◽  
Adefunke Adetula ◽  
Olugbemiga Peter ◽  
Oluwalusi Ebenezer ◽  
Omolola Olonisakin
Keyword(s):  
Hiv Infection ◽  
Low Income ◽  
Healthcare Workers ◽  
Service Providers ◽  
Health Workers ◽  
Continuous Treatment ◽  
Low Income Countries ◽  
Fixed Dose ◽  
Cross Sectional ◽  
The World

Introduction: The introduction of preexposure prophylaxis (PrEP) against incident HIV infection has changed the epidemiology of disease as continuous treatment with tenofovir and emtricitabine among high risk groups can reduce the relative risk for incident HIV infection by over 90%.However,despite the approved use of TDF+FTC, as a fixed dose combination of emtricitabine 200 mg and tenofovir disoproxil fumarate 300 mg, for oral PrEP since 2012 , it does not appear to have become widely accepted and in use among healthcare workers especially those in low income countries. Researches are therefore needed to consider the awareness and practice of health workers towards the availability of PrEP services in this part of the world. Healthcare workers are expected to be promoters of the use of PrEP services. Method: A cross sectional questionnaire-based study conducted in southern Nigerian over a 6 months period. Data were collected from 250 healthcare workers using interviewer-administered questionnaires. The data analysis was done using statistical package for the social sciences (SPSS) for windows version 20.0 software (SPSS Inc; Chicago, IL, USA). Frequency counts were generated for all variables and statistical test of significance was performed with chi-square test. Significance was fixed at P < 0.05 and highly significance if P < 0.01. Results: A high proportion of the respondents(>60%) were highly educated healthcare workers(majorly Nurses and medical doctors) and about half (55%) having at least 10yrs working experience in the health sector with most especially on the HIV program(>90%), majority (94%) of the health workers were aware about ARV pre-exposure prophylaxis but very few ( 6% )could give the standard definition for PrEP as the use of ARV drugs by HIV negative persons to prevent the acquisition of HIV.Most(67%) of them gave wrong definition for PrEP and worse still about one fifth (20%) had no idea what PrEP was all about. Most (70%) could not correctly identify all the ARV drugs in a standard PrEP regimen while about 35% had no idea at all of the approved ARVs used for PrEP. Though PrEP services was not available at any of the facilities where the respondents were working ,the approved drugs(TDF+FTC) for PrEP were available at about 40% of the health facilities(public and private) and 15% community pharmacies in the vicinity of the respondents . Only 60% of the respondents were willing to access PrEP service for themselves if indicated while 35% would not use such services even if it is indicated for reasons which include concern about adverse effects and safety.Awareness of PrEP was significantly associated with the ability of the healthcare workers to identify the correct ARV regimen, ARV dosages and also correct indication for PrEP. Awareness was also associated with the knowledge of the correct proven efficacy for PrEP(>95%) and high likelihood of seeing a patient placed on PrEP and willingness to use PrEP based on personal indication Conclusion: The level of awareness of PrEP among healthcare workers was very high at about 90% yet many(60%) could not give correct standard definitions of PrEP, PrEP ARV regimen, dosages and level of efficacy of PrEP. Also none of the respondent had PrEP services available either at their center or any known referral centers. This is unacceptable in a country with second highest HIV burden in the world and has adopted PrEP in her national HIV guideline with ongoing PrEP demonstration studies. The few healthcare workers who were able to mentioned this information were more likely to have seen a patient placed on PrEP and were more willing to use PrEP based on personal indication. Recommendations: There is need to deepen the and knowledge of PrEP among healthcare workers especially those in poor resource settings by engaging them through update courses outreach, educational resources, campaigns/seminars and workshops and various job aids. All healthcare service providers should be very comfortable to carry out HIV risk assessment of their clients and provide PrEP to those indicated directly or indirectly through referral

Assessment of knowledge and practice of vaccination of dogs against rabies by dog owners in Makurdi, Benue State, Nigeria

2020 ◽  
Vol 1 ◽  
pp. 5
Author(s):  
Audu Onyemocho ◽  
Agwa Moses ◽  
Aboh Kisani ◽  
Omole Namben Victoria ◽  
Anejo-Okopi Joseph
Keyword(s):  
Low Income ◽  
Life Time ◽  
Knowledge Score ◽  
Educational Status ◽  
Low Income Countries ◽  
Bivariate Analysis ◽  
Cross Sectional ◽  
Knowledge And Practice ◽  
Dog Owners ◽  
The Relationship

Objective: Rabies, one of the oldest and fatal infectious diseases known to human race, is transmitted by infected dogs. The global target of zero dog-mediated rabies human deaths has been set for 2030; however, the realization of this goal poses challenges in most low-income countries where rabies is endemic due to weak surveillance. Dogs have been increasingly deployed for domestic uses over the years, especially for security purposes. This study assessed the assessment of knowledge and practice of vaccination of dogs against rabies by dog owners. Materials and Methods: A cross-sectional community-based study was employed to study 400 dog owners in Makurdi metropolis through multistage sampling techniques. Sighting of valid dog vaccination card was used as criteria for current vaccination. Bivariate analysis was carried out to establish the relationship between the respondent knowledge of rabies and dog vaccination with significant value set at P < 0.05. Results: The mean age of the respondents was 31 (Â ± 0.8) years, majority of them had tertiary and secondary education (40.0% and 39.0%, respectively), 26.0% were traders, and 50.0% were married. Overall, 73.0% of the respondents had good knowledge score, 61.0% had seen at least a rabid dog in their life time, and 74.0% have a history of dog vaccination, but evidence of up to date vaccination of dogs by owners was seen in only 18.0% of all the vaccination cards sighted. The relationship between the educational status of the respondents, their knowledge score, and their dog vaccination was statistically significant (P < 0.05). Conclusion: Knowledge of rabies among dog owners in Makurdi was good, but the practice of dog vaccination was poor. Educational status was a good predictor of practice. Awareness campaign on dog vaccination should be strengthened and adequate measures should be put in place at the veterinary hospitals in Makurdi for vaccination of dogs.

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