ObjectiveThe Social Health Insurance Program (SHIP) shares a major portion of social security, and is also key to Universal Health Coverage (UHC) and health equity. The Government of Nepal launched SHIP in the Fiscal Year 2015/16 for the first phase in three districts, on the principle of financial risk protection through prepayment and risk pooling in health care. Furthermore, the adoption of the program depends on the stakeholders' behaviors, mainly, the beneficiaries and the providers. Therefore, we aimed to explore and assess their perception and experiences regarding various factors acting on SHIP enrollment and adherence.MethodsA cross-sectional, facility-based, concurrent mixed-methods study was carried out in seven health facilities in the Kailali, Baglung, and Ilam districts of Nepal. A total of 822 beneficiaries, sampled using probability proportional to size (PPS), attending health care institutions, were interviewed using a structured questionnaire for quantitative data. A total of seven focus group discussions (FGDs) and 12 in-depth interviews (IDIs), taken purposefully, were conducted with beneficiaries and service providers, using guidelines, respectively. Quantitative data were entered into Epi-data and analyzed with SPSS, MS-Excel, and Epitools, an online statistical calculator. Manual thematic analysis with predefined themes was carried out for qualitative data. Percentage, frequency, mean, and median were used to describe the variables, and the Chi-square test and binary logistic regression were used to infer the findings. We then combined the qualitative data from beneficiaries' and providers' perceptions, and experiences to explore different aspects of health insurance programs as well as to justify the quantitative findings.Results and prospectsOf a total of 822 respondents (insured-404, uninsured-418), 370 (45%) were men. Families' median income was USD $65.96 (8.30–290.43). The perception of insurance premiums did not differ between the insured and uninsured groups (p = 0.53). Similarly, service utilization (OR = 220.4; 95% CI, 123.3–393.9) and accessibility (OR = 74.4; 95% CI, 42.5–130.6) were found to have high odds among the insured as compared to the uninsured respondents. Qualitative findings showed that the coverage and service quality were poor. Enrollment was gaining momentum despite nearly a one-tenth (9.1%) dropout rate. Moreover, different aspects, including provider-beneficiary communication, benefit packages, barriers, and ways to go, are discussed. Additionally, we also argue for some alternative health insurance schemes and strategies that may have possible implications in our contexts.ConclusionAlthough enrollment is encouraging, adherence is weak, with a considerable dropout rate and poor renewal. Patient management strategies and insurance education are recommended urgently. Furthermore, some alternate schemes and strategies may be considered.
Background Oral health problems are highly prevalent among school children in Nepal. Poor oral health condition may be influenced by various factors. However, little is known about the sociodemographic and awareness related factors on oral health problems among school children in Nepal. Therefore, this study aimed to assess the association of gender and knowledge on DMFT index among school children. Methods A cross-sectional study was conducted among school children of Grade Seven in 12 schools of Kaski district in Nepal. Schools were randomly selected from the urban and semi-urban areas in the district. Data were collected covering oral health knowledge, socio-demographic characteristics, oral health condition and practices. The factors of poor oral health condition and practices were examined using t-test, one-way ANOVA, and multiple linear regression. Results Of the total participants (n = 669), 54.9% were females and their mean DMFT score was 1.82 (SD = 1.07). Total decayed score was higher among those who did not have knowledge that fluoride prevents decay compared to those who had knowledge about it (Being aware of fluoride prevents decay: Mean = 1.21 (SD = 1.54) versus not being aware of that: mean = 2.13 (SD = 2.13); p = 0.029). Females were more likely to have higher DMFT scores compared to males (β-coefficient = 0.43, 95% CI 0.13, 0.73, p = 0.005). In addition, higher knowledge score was negatively associated with higher DMFT score (β-coefficient = − 0.09, 95% CI − 0.20, -0.01, p = 0.047). Conclusion Being female students and those having lower level of knowledge on oral health attributed to higher DMFT index. Periodic dental check-up coupled with oral health education on regular brushing, use of fluoridated paste, tongue cleaning and care of gum diseases are recommended in schools.
IntroductionSchool children have a high prevalence of oral health problems in Nepal. Socio-demographic factors such as gender, parents’ socioeconomic status, and individual awareness of oral health may have an influence on the occurrence of oral health problems. However, little evidence is available about the oral health problems and their associated factors among school children. Therefore, this study aimed to assess the factors associated with oral health problems among school children in Nepal.MethodologyA cross-sectional study was conducted among school children of grade 7 in 12 schools of Kaski district, Gandaki Province, Nepal. The schools were randomly chosen from urban and semi-urban areas in the district. A total of 669 students participated in the study. Data were collected using a set of questionnaires covering dental health knowledge, socio-demographic characteristics, oral health condition and practices. The factors of poor oral health condition and practices were examined using t-test, one-way Anova, and multiple linear regression.ResultsSchool children who visited health institutions for oral health services and those with parents having higher level education had higher dental health knowledge scores. Total decayed score was higher among those who did not have knowledge that fluoride prevents decay compared to those who had knowledge about it (Have knowledge about fluoride prevents decay: Mean=1.21 (SD=1.54) Vs No knowledge: mean=2.13 (SD=2.13). Females were more likely to have higher DMFT score compared to males (β-coefficient=0.43, 95% CI=0.13, 0.73, P value=0.005) and increase in knowledge score was associated a with a decrease in DMFT score (β-coefficient=-0.09, 95% CI= -0.20, -0.10, P value=0.047).ConclusionThis study found that gender, knowledge score, and parent’s socioeconomic status were the major factors contributing to higher DMFT scores. School children should be provided with regular oral health counseling and promotion activities in schools and oral health screening in schools.
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