scholarly journals Determinants of Household Catastrophic Costs for Drug Sensitive Tuberculosis Patients in Kenya

2020 ◽  
Author(s):  
Beatrice Wangari Kirubi ◽  
Jane Ong’ang’o ◽  
Peter Nguhiu ◽  
Knut Lönnroth ◽  
Aiban Rono ◽  
...  
Keyword(s):  
Public Health ◽  
Sensitivity Analysis ◽  
Social Protection ◽  
Financial Burden ◽  
Public Health Facility ◽  
Household Expenditure ◽  
Delayed Treatment ◽  
Productivity Losses ◽  
National Patient ◽  
Nationally Representative

Abstract Background: Despite free diagnosis and treatment for Tuberculosis (TB), the costs during treatment impose a significant financial burden on patients and their households.Aim: The study sought to identify the determinants for catastrophic costs among patients with drug-sensitive TB (DSTB) and their households in Kenya.Methods: The data was collected during the 2017 Kenya national patient cost survey from a nationally representative sample (n=1071). Treatment related costs and productivity losses were estimated. Total costs exceeding 20% of household income were defined as catastrophic and used as the outcome. Multivariable Poisson regression analysis was performed to measure the association between selected individual, household and disease characteristics and occurrence of catastrophic costs. A deterministic sensitivity analysis was carried using different thresholds and the significant predictors were explored.Results: The proportion of catastrophic costs among DSTB patients was 27% (n=294). Patients with catastrophic costs had higher median productivity losses, 39 hours interquartile range (IQR) 20-104, and total median costs of USD 567 (IQR 299-1,144). The incidence of catastrophic costs had a dose response with household expenditure. The poorest quintile was 6.2 times (95% CI 4.0-9.7) more likely to incur catastrophic costs compared to the richest. The prevalence of catastrophic costs decreased with increasing household expenditure quintiles (proportion of catastrophic costs: 59.7%, 32.9%, 23.6%, 15.9%, and 9.5%) from the lowest quintile (Q1) to the highest quintile (Q5). Other determinants included hospitalization: PR=2.8, (95% CI 1.8-4.5) and delayed treatment: PR=1.5 (95% CI 1.3-1.7). Protective factors included receiving care at a public health facility: PR= 0.8 (95% CI 0.6-1.0), and a higher Body Mass Index (BMI): PR= 0.97 (95% CI 0.96-0.98). Pre TB expenditure, hospitalization and BMI were significant predictors in all sensitivity analysis scenarios.Conclusion: There are significant inequities in the occurrence of catastrophic costs. Social protection interventions in addition to existing medical and public health interventions are important to implement for patients most at risk of incurring catastrophic costs.

scholarly journals Determinants of household catastrophic costs for drug sensitive tuberculosis patients in Kenya

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Beatrice Kirubi ◽  
Jane Ong’ang’o ◽  
Peter Nguhiu ◽  
Knut Lönnroth ◽  
Aiban Rono ◽  
...  
Keyword(s):  
Public Health ◽  
Sensitivity Analysis ◽  
Social Protection ◽  
Financial Burden ◽  
Prevalence Ratio ◽  
Public Health Facility ◽  
Household Expenditure ◽  
Delayed Treatment ◽  
Productivity Losses ◽  
Nationally Representative

Abstract Background Despite free diagnosis and treatment for tuberculosis (TB), the costs during treatment impose a significant financial burden on patients and their households. The study sought to identify the determinants for catastrophic costs among patients with drug-sensitive TB (DSTB) and their households in Kenya. Methods The data was collected during the 2017 Kenya national patient cost survey from a nationally representative sample (n = 1071). Treatment related costs and productivity losses were estimated. Total costs exceeding 20% of household income were defined as catastrophic and used as the outcome. Multivariable Poisson regression analysis was performed to measure the association between selected individual, household and disease characteristics and occurrence of catastrophic costs. A deterministic sensitivity analysis was carried using different thresholds and the significant predictors were explored. Results The proportion of catastrophic costs among DSTB patients was 27% (n = 294). Patients with catastrophic costs had higher median productivity losses, 39 h [interquartile range (IQR): 20–104], and total median costs of USD 567 (IQR: 299–1144). The incidence of catastrophic costs had a dose response with household expenditure. The poorest quintile was 6.2 times [95% confidence intervals (CI): 4.0–9.7] more likely to incur catastrophic costs compared to the richest. The prevalence of catastrophic costs decreased with increasing household expenditure quintiles (proportion of catastrophic costs: 59.7%, 32.9%, 23.6%, 15.9%, and 9.5%) from the lowest quintile (Q1) to the highest quintile (Q5). Other determinants included hospitalization: prevalence ratio (PR) = 2.8 (95% CI: 1.8–4.5) and delayed treatment: PR = 1.5 (95% CI: 1.3–1.7). Protective factors included receiving care at a public health facility: PR = 0.8 (95% CI: 0.6–1.0), and a higher body mass index (BMI): PR = 0.97 (95% CI: 0.96–0.98). Pre TB expenditure, hospitalization and BMI were significant predictors in all sensitivity analysis scenarios. Conclusions There are significant inequities in the occurrence of catastrophic costs. Social protection interventions in addition to existing medical and public health interventions are important to implement for patients most at risk of incurring catastrophic costs. Graphic abstract

scholarly journals Household Expenditures And Direct Medical Costs Among Older Adults In Ghana: Evidence From Who-sage Wave 2

2020 ◽  
Author(s):  
Paa-Kwesi Blankson ◽  
Sandra Ama Hewlett ◽  
Thomas Akuetteh Ndanu ◽  
Gyaami Amoah ◽  
Matthew Owusu Boamah ◽  
...  
Keyword(s):  
Older Adults ◽  
Social Protection ◽  
Financial Burden ◽  
World Health ◽  
Household Expenditure ◽  
Adult Health ◽  
Health Coverage ◽  
Financial Risk Protection ◽  
Younger Adults ◽  
Household Expenditures

Abstract Background: The Ghanaian population aged 60 years and older will almost double to reach 10% of the total population by 2050. Ascertaining the pattern of health expenditures among this growing population group is important to inform policy makers about the targets for financial risk protection as part of achieving Universal Health Coverage (UHC) by 2030. This study aimed to estimate household expenditures among older adults and determine the direct medical costs.Methods : The World Health Organization's Study on global AGEing and adult health (SAGE) Wave 2 was conducted in China, Ghana, India, Mexico, Russian Federation, and South Africa between 2014 and 2015, as a follow-up to Wave 0 in 2003 to 2004 and Wave 1 in 2007 to 2010. Survey questions explored sources of income and total direct expenditures in the year preceding interview. SAGE Ghana was implemented using face-to-face interviews in a nationally representative sample of persons aged 50+ years with a comparison sample of younger adults aged 18–49 years.Findings : Analyses included a total of 4,735 participants, with 1,948 (41.1%) males and 2,787 (58.9%) females, of median and mean ages of 58 years and 57.6 (±16.7), respectively. The average annual household expenditures were US$ 1,893.44 (±3,501.14). Older adults had higher expenditure levels at US$ 1,902 (± 3,876), as compared to younger adults, US$ 1,867 (±1,937). Direct health-related costs and food expenditure accounted for 18% and 46% respectively of the total household expenditure of older Ghanaian adults. The prevalence of catastrophic health expenditure among older adults in Ghana was 4.5% (95% CI 3.5% to 5.8%)Conclusion: These updated estimates on household expenditure among older adults provide needed evidence to support the inclusion of social protection mechanisms in the national ageing agenda. The National Health Insurance as presently did not reduce the financial burden for households with older adults.

scholarly journals Barriers to uptake of reproductive information and contraceptives in rural Tanzania: an intersectionality informed qualitative enquiry

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e036600
Author(s):  
Allison Carroll ◽  
Anuj Kapilashrami
Keyword(s):  
Public Health ◽  
Unmet Need ◽  
Public Health Facility ◽  
Structural Factors ◽  
Snowball Sampling ◽  
Health Seeking ◽  
Reproductive Choices ◽  
Rural Tanzania ◽  
Home Based ◽  
Social Controls

ObjectivesAccess to reproductive information and contraception (RIC) continues to be a critical unmet need in Tanzania and impedes the realisation of reproductive health rights. This study examined key sources of RIC and the factors influencing their uptake by women in Mbeya region of Tanzania.SettingThis qualitative study was undertaken in a rural ward in a district in the south of the Mbeya regionParticipantsIn-depth interviews were undertaken with 48 women users and 2 nurses working in a public health facility, and focus group discussions with 16 home-based care workers in the district. Participants were recruited through a local non-governmental organisation (NGO) in the region, and via snowball sampling. All interactions were recorded, translated and transcribed and sought to identify the available resources and barriers in using them.ResultsParticipants reported six main sources of reproductive information and contraceptives: public health facilities, NGO mobile clinics, other women, Mganga wa Asili (witchdoctors/traditional doctors) and Duka la Dawa (pharmacy). Women users and healthcare workers identified a range of individual (age, marital status and geography) and health system-wide factors shaping women’s reproductive choices and preventing uptake of contraceptives. The study also revealed structural factors such as gender, ethnicity, indigeneity as key determinants of access and health seeking, placing women from Sukuma and Maasai communities is the most disadvantageous position. Historical social disadvantage, patriarchal social controls and the pressure to preserve sociocultural traditions that women experience in the Maasai and Sukuma tribes underpin their disconnect from mainstream services.ConclusionWomen’s reproductive choices and their uptake of contraceptives are shaped by the interaction of a range of individual, household, institutional and structural factors. An intersectional lens enables examination of the ways in which these factors interact and mutually constitute disadvantage and privilege.

scholarly journals Burden of foodborne disease in the Netherlands: from science to policy

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
L Mughini Gras
Keyword(s):  
Public Health ◽  
The Netherlands ◽  
Cost Of Illness ◽  
Disease Burden ◽  
Food Groups ◽  
Source Attribution ◽  
Productivity Losses ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Animal Contact

Abstract In the Netherlands, the Ministry of Health mandates the National Institute for Public Health and the Environment (RIVM) to provide annual updates of the number of illnesses, disease burden and cost-of-illness caused by an agreed-upon standard panel of 14 enteric pathogens. These pathogens are mainly transmitted by food, but also via direct contact with animals, environment-mediated and human-to-human transmission routes. The disease burden is expressed in DALYs (Disability Adjusted Life Years), a metric integrating morbidity and mortality into one unit. Furthermore, the cost-of-illness (COI) related to these 14 pathogens is estimated and expressed in euros. The COI estimates include healthcare costs, the costs for the patient and/or his family, such as travel expenses, as well as costs in other sectors, for example due to productivity losses. Moreover, using different approaches to source attribution, the estimated DALYs and associated COI estimates are attributed to five major transmission pathways (i.e. food, environment, direct animal contact, human-human transmission, and travel) and 11 food groups within the foodborne pathway itself. The most recent DALY and COI estimates referring to the year 2018 show that the 14 pathogens in question are cumulatively responsible for about 11,000 DALYs and €426 million costs for the Dutch population in 2018, with a share for foodborne transmission being estimated at 4,300 DALYs and €171 million costs, which is comparable to previous years. These estimates have been providing vital insights for policy making as to guide public health interventions and resource allocation for over two decades in the Netherlands. Herewith, the approach and outcomes of the burden of disease and COI estimates in the Netherlands will be presented, with a focus on how these estimates enable policy-makers and the scientific community to monitor trends, generate scientific hypotheses, and undertake public health actions.

scholarly journals Dementia Caregiving, Care Recipient Health, and Financial Burdens

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 56-56
Author(s):  
Rashmita Basu
Keyword(s):  
Physical Health ◽  
Healthcare Costs ◽  
Financial Burden ◽  
Care Recipient ◽  
Positive Feeling ◽  
Nationally Representative ◽  
Financial Burdens ◽  
Health Deterioration ◽  
Retirement Study

Abstract Objective: While about 75% of people with ADRD receive care informally by their family members, relatively little is known about the effect of the quality of caregiving on maintaining carerecipient’s health and financial burden of out-of-pocket (OOP) healthcare costs. The goal of this study is to examine the quality of caregiving on the out-of-pocket healthcare costs among ADRD patients and if caregiving prevents deterioration of physical health of carerecipients. Data and Sample: We used a nationally representative sample of people diagnosed with ADRD from the Aging Demographic and Memory Study, subsample of the Health and Retirement Study. The study sample includes carerecipients whose caregivers participated in the survey (N=261). Outcome measures: Primary outcomes were deterioration of carerecipients’ health (1=yes, 0=no) and annual OOP healthcare costs. The quality of caregiving is captured by if caregiving made them feel good, feel useful and fee closer to carerecipients. More than 70% caregivers reported that caregiving make them feel good or useful. About 60% of carerecipients’ physical health was maintained, and average out-of-pocket costs was $3,701/year ($0-$31,051). Multivariable logit for binary health outcome and OLS regression for OOP cost were estimated. Results: The likelihood of health deterioration was significantly lower for carerecipients whose caregivers reported that caregiving made them feel useful (AOR=5.1, 95% CI: 1.9- 14.5) and lower OOP remained significantly associated with presence of usefulness of caregiving (cost decrease, $3000 [95% CI: $6309-$918). Positive feeling of caregiving is independently associated with lower OOP cost and deterioration of physical health among ADRD patients.

scholarly journals (A231) Deficiencies in the Preparedness of Emergency Medical Services Providers for Terrorist Incidents Involving Children

2011 ◽  
Vol 26 (S1) ◽  
pp. s63-s63
Author(s):  
M. Reilly
Keyword(s):  
Public Health ◽  
United States ◽  
Emergency Medical Services ◽  
A Priori ◽  
The United States ◽  
Medical Services ◽  
Special Populations ◽  
Provider Education ◽  
Emergency Medical ◽  
Nationally Representative

IntroductionRecent studies have discussed major deficiencies in the preparedness of emergency medical services (EMS) providers to effectively respond to disasters, terrorism and other public health emergencies. Lack of funding, lack of national uniformity of systems and oversight, and lack of necessary education and training have all been cited as reasons for the inadequate emergency medical preparedness in the United States.MethodsA nationally representative sample of over 285,000 emergency medical technicians (EMTs) and Paramedics in the United States was surveyed to assess whether they had received training in pediatric considerations for blast and radiological incidents, as part of their initial provider education or in continuing medical education (CME) within the previous 24 months. Providers were also surveyed on their level of comfort in responding to and potentially treating pediatric victims of these events. Independent variables were entered into a multivariate model and those identified as statistically significant predictors of comfort were further analyzed.ResultsVery few variables in our model caused a statistically significant increase in comfort with events involving children in this sample. Pediatric considerations for blast or radiological events represented the lowest levels of comfort in all respondents. Greater than 70% of respondents reported no training as part of their initial provider education in considerations for pediatrics following blast events. Over 80% of respondents reported no training in considerations for pediatrics following events associated with radiation or radioactivity. 88% of respondents stated they were not comfortable with responding to or treating pediatric victims of a radiological incident.ConclusionsOut study validates our a priori hypothesis and several previous studies that suggest deficiencies in preparedness as they relate to special populations - specifically pediatrics. Increased education for EMS providers on the considerations of special populations during disasters and acts of terrorism, especially pediatrics, is essential in order to reduce pediatric-related morbidity and mortality following a disaster, act of terrorism or public health emergency.

scholarly journals Crises and Resilience at the Frontline—Public Health Facility Managers under Devolution in a Sub-County on the Kenyan Coast

PLoS ONE ◽  
2015 ◽  
Vol 10 (12) ◽  
pp. e0144768 ◽  
Author(s):  
Mary Nyikuri ◽  
Benjamin Tsofa ◽  
Edwine Barasa ◽  
Philip Okoth ◽  
Sassy Molyneux
Keyword(s):  
Public Health ◽  
Health Facility ◽  
Public Health Facility ◽  
Kenyan Coast

scholarly journals Equity of geographical access to public health facilities in Nepal

2021 ◽  
Vol 6 (10) ◽  
pp. e006786
Author(s):  
Wen-Rui Cao ◽  
Prabin Shakya ◽  
Biraj Karmacharya ◽  
Dong Roman Xu ◽  
Yuan-Tao Hao ◽  
...  
Keyword(s):  
Public Health ◽  
Travel Time ◽  
Weighted Average ◽  
Developed Countries ◽  
Public Health Facility ◽  
Health Facilities ◽  
Public Health Facilities ◽  
Geographical Access ◽  
Geographical Accessibility ◽  
New Facilities

IntroductionGeographical accessibility is important against health equity, particularly for less developed countries as Nepal. It is important to identify the disparities in geographical accessibility to the three levels of public health facilities across Nepal, which has not been available.MethodsBased on the up-to-date dataset of Nepal formal public health facilities in 2021, we measured the geographical accessibility by calculating the travel time to the nearest public health facility of three levels (ie, primary, secondary and tertiary) across Nepal at 1×1 km2 resolution under two travel modes: walking and motorised. Gini and Theil L index were used to assess the inequality. Potential locations of new facilities were identified for best improvement of geographical efficiency or equality.ResultsBoth geographical accessibility and its equality were better under the motorised mode compared with the walking mode. If motorised transportation is available to everyone, the population coverage within 5 min to any public health facilities would be improved by 62.13%. The population-weighted average travel time was 17.91 min, 39.88 min and 69.23 min and the Gini coefficients 0.03, 0.18 and 0.42 to the nearest primary, secondary and tertiary facilities, respectively, under motorised mode. For primary facilities, low accessibility was found in the northern mountain belt; for secondary facilities, the accessibility decreased with increased distance from the district centres; and for tertiary facilities, low accessibility was found in most areas except the developed areas like zonal centres. The potential locations of new facilities differed for the three levels of facilities. Besides, the majority of inequalities of geographical accessibility were from within-province.ConclusionThe high-resolution geographical accessibility maps and the assessment of inequality provide valuable information for health resource allocation and health-related planning in Nepal.

Injuries Among Afghan Refugees: Review of Evidence

2004 ◽  
Vol 19 (2) ◽  
pp. 169-173 ◽  
Author(s):  
Khurram Nasir ◽  
Adnan A. Hyder ◽  
C. M. Shahbaz
Keyword(s):  
Public Health ◽  
Developing Countries ◽  
Web Search ◽  
Public Health Problem ◽  
Refugee Camps ◽  
Limited Information ◽  
Loss Of Life ◽  
War Injuries ◽  
Afghan Refugees ◽  
Productivity Losses

AbstractBackground:Injuries are a public health problem in developing countries resulting in major financial and productivity losses. Injuries in vulnerable populations, such as refugees, make an even greater impact on loss of life. Afghan refugees in Pakistan continue to form one of the world's largest refugee populations. This study systemically reviews the literature to estimate the magnitude and prevalence of intentional and unintentional injuries in Afghan refugees, and explores the implications of the findings for refugee healthcare policy and development of potential interventions specifically for Afghan refugees.Methods:Electronic databases of MEDLINE, POPLINE, Refworld, and Winspirs were searched. In addition, a web search was conducted and specific organizational websites were reviewed. The search in developing countries was limited to studies in English or with an English abstract for the years 1966–2001.Results:The literature review identified patients with reported war injuries who presented to hospitals. Injuries to extremities (45%) were more frequent than injuries to the head or neck (36%, p <0.001), and thorax/abdomen (14%, p <0.001) regions. A majority of the injuries were caused by explosives, which included landmines (32.5%), fragmentations, such as shrapnel (33%), and firearms (27%). The mean incidence of mortality in these studies was 11%.Conclusions:Despite such an extensive search, limited information was found pertinent to injuries in Afghan refugees residing in refugee camps. This dearth of literature on the prevalence of injuries, risk factors, and outcomes among this vulnerable group is a research and policy gap for public health. Specific quantitive and qualitative studies in this field are required to shape refugee healthcare policies and develop intervention programs.

Effects of Government-Implemented Cash Plus Model on Violence Experiences and Perpetration Among Adolescents in Tanzania, 2018‒2019

2021 ◽  
Vol 111 (12) ◽  
pp. 2227-2238
Author(s):  
Tia Palermo ◽  
Leah Prencipe ◽  
Lusajo Kajula ◽  
Keyword(s):  
Public Health ◽  
Social Protection ◽  
Physical Violence ◽  
Sexual Debut ◽  
Positive Impact ◽  
School Attendance ◽  
Controlled Trial ◽  
Scale Up ◽  
Cash Transfer ◽  
Percentage Points

Objectives. To examine the impacts of a government-implemented cash plus program on violence experiences and perpetration among Tanzanian adolescents. Methods. We used data from a cluster randomized controlled trial (n = 130 communities) conducted in the Mbeya and Iringa regions of Tanzania to isolate impacts of the “plus” components of the cash plus intervention. The panel sample comprised 904 adolescents aged 14 to 19 years living in households receiving a government cash transfer. We estimated intent-to-treat impacts on violence experiences, violence perpetration, and pathways of impact. Results. The plus intervention reduced female participants’ experiences of sexual violence by 5 percentage points and male participants’ perpetration of physical violence by 6 percentage points. There were no intervention impacts on emotional violence, physical violence, or help seeking. Examining pathways, we found positive impacts on self-esteem and participation in livestock tending and, among female participants, a positive impact on sexual debut delays and a negative effect on school attendance. Conclusions. By addressing poverty and multidimensional vulnerability, integrated social protection can reduce violence. Public Health Implications. There is high potential for scale-up and sustainability, and this program reaches some of the most vulnerable and marginalized adolescents. (Am J Public Health. 2021;111(12):2227–2238. https://doi.org/10.2105/AJPH.2021.306509 )

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