Health insurance coverage and access to skilled birth attendance in Togo

Mati, Komi; Adegoke, Korede K.; Michael-Asalu, Abimbola; Salihu, Hamisu M.

doi:10.1002/ijgo.12449

Cited by 8 publications

(8 citation statements)

References 22 publications

(48 reference statements)

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“…These findings are consistent with analysis conducted using data from KDHS 2008-9, which highlighted that 7% of women who possessed insurance at that time were 23 percentage points more likely to deliver in a health facility (18). Coverage by insurance remains a critical influencer of accessing health services (19). It is commendable that a 5% increase in insurance coverage was observed between the 2008-9 and 2014 demographic surveys.…”

Section: Social Environmentsupporting

confidence: 82%

Choice between home and health institutional births in the era of Kenya’s maternity subsidy

Musau¹,

Ng'ang'a²

2020

Preprint

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Background Adverse maternal and neonatal outcomes disproportionately afflict low and middle-income countries, which experience high-unmet need for safe and skilled attendance at birth. This study sought to investigate how choices for place of birth were made in Kenya during the era of a national maternal subsidy. Methods The study employed data from the Kenya Demographic Health Survey 2014 and involved data from women who experienced a birth around the time when the maternity subsidy was in place. After testing for multi-collinearity of variables and addressing endogenous endogeneity using two-stage residual inclusion, probit regression models were estimated. The choice for place of birth was employed as a binary outcome variable. Results Overall, data from 4,772 women were included in the analysis. The women’s mean age was 27.7 years and majority (83.8%) were married or staying with their sexual partners. Among these women, 2748 (57.5%) had elected institutional births. Regression analysis illustrated that woman’s age, the woman and partner’s education, economic empowerment, low parity, low county poverty headcount rate and access to medical insurance. Further, access to complementary reproductive services such as antenatal care and family planning and the existence of the maternity subsidy were associated with increased likelihood to choose deliveries in health facilities. Conclusions The existence of the maternal subsidy confers women increased potential to elect health institutions as a preferred place for birth, although this was influenced by other factors. These findings imply that investments, which prevent teen pregnancies, reduce domestic and national poverty, increase education attainment, expand autonomy of women in decision making and promote access to the continuum of reproductive health services can optimize choice making during the existence of the maternity subsidy favoring access to safe institutional births.

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Section: Social Environmentsupporting

confidence: 82%

Choice between home and health institutional births in the era of Kenya’s maternity subsidy

Musau¹,

Ng'ang'a²

2020

Preprint

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“…This was lower than studies conducted in Namibia 80.3% [ 28 ]. The finding was much higher than studies conducted in Cambodia 19.8% [ 17 ], Bangladesh 35.9% [ 22 ], sub-Saharan African countries 53% [ 15 ], Ethiopia 28.6% [ 29 ], Togo 66.67% [ 19 ], and Nepal 48% [ 30 ]. The discrepancy might be due to differences in the study period that is Namibia study use DHS 2006/07 while this study 2008\2017.…”

Section: Discussionmentioning

confidence: 64%

“…This study evidenced that likelihood of obtaining skilled birth attendance at birth was higher among women of middle and rich wealth status as compared to poor women. This finding was supported by studies conducted in Vietnam [11], Togo [19], Bangladesh [13,22], Ethiopia [29]. The possible justification might be due to women with medium and rich household wealth index were more likely to be able to pay for care-seeking costs such as transportation, medications, and any associated costs and also can get easily information about the benefit of obtaining skilled birth attendance at birth [28].…”

Section: Discussionmentioning

confidence: 70%

“…Other scholars from Ethiopia evidenced that place residence, maternal education, distance to a health facility, the decision on place of delivery, and knowledge on obstetric danger signs after delivery was associated with SBA [ 10 ]. Educational status [ 10 – 14 ], antenatal care visit [ 15 – 18 ], age group [ 19 ], previous pregnancy complication [ 10 , 14 , 20 ], decision of place of delivery [ 14 ], parity [ 20 ], husband education [ 12 ], wealth index [ 11 , 19 , 21 , 22 ], accessing health care [ 18 ], sex of provider [ 23 ], residence [ 22 ], and maternal occupation [ 20 ] were identified as significant factors associated with SBA.…”

Section: Introductionmentioning

confidence: 99%

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Pooled prevalence and determinants of skilled birth attendant delivery in East Africa countries: a multilevel analysis of Demographic and Health Surveys

Tessema

Tesema

2020

Ital J Pediatr

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Introduction Skilled health professional assisted delivery is an effective strategy to reduce maternal and newborn mortality. Skilled assistant delivery can prevent about 16–33% of maternal and newborn mortality. Despite the commitments of the government to assure home free delivery, majority of the births in Sub-Saharan Africa are attended by traditional birth attendants. As to our search of the literature, there is limited evidence on the prevalence and determinants of skilled delivery in East African countries. Therefore, this study aimed to estimate the pooled prevalence and determinants of skilled birth attendant delivery in East Africa Countries. Methods Pooled analysis was done based on Demographic and Health Surveys conducted in the 12 East African countries from 2008 to 2017. A total weighted sample of 141,483 women who gave birth during the study period was included in the study. The pooled prevalence of skilled birth attendance was estimated using STATA version 14. Intra-class Correlation Coefficient, Median Odds Ratio, Proportional Change in Variance, and deviance were used for model fitness and comparison. The multilevel multivariable logistic regression model was fitted to identify determinants of skilled birth attendance in the region. Adjusted Odds Ratio with its 95% Confidence Interval was used to declare significant determinants of skilled birth attendants. Results The pooled prevalence of skilled birth attendant in East African countries were 67.18% (95% CI:66.98, 67.38) with highest skilled birth attendant in Rwanda (90.68%) and the lowest skilled birth attendant in Tanzania (11.91%). In the Multilevel multivariable logistic regression model; age 15–24 (Adjusted Odds Ratio (AOR) = 1.14, 95%CI:1.09, 1.18), age 25–49(AOR = 1.16, 95%CI:1.10,1.23), primary women education (AOR = 1.57, 95%CI:1.51,1.63), secondary and above women education (AOR = 2.85, 95%CI:1.73,3.01), primary husband education (AOR = 1.11, 95%CI = 1.07,1.15), secondary and above husband education (AOR = 1.46, 95%CI = 1.40,1.53), middle wealth index (AOR = 1.43, 95%CI = 1.38,1.49),rich wealth index (AOR = 2.38, 95%CI = 2.28,2.48), had ANC visit (AOR = 1.68, 95%CI = 1.62,1.73),multiple gestation (AOR = 2.06, 95%CI = 1.90,2.25), parity 2–4(AOR = 0.65, 95%CI = 0.61,0.69), parity 5 + (AOR = 0.44, 95%CI = 0.41,0.47), accessing health care not big problem (AOR = 1.32, 95%CI = 1.28,1.36), residence (AOR = 0.43, 95%CI = 0.41,0.45) and being Burundi resident (AOR = 0.77, 95%CI = 0.70,0.85) were significantly associated with skilled assisted delivery. Conclusion Skilled birth attendance at birth in the East Africa countries was low. Maternal age, women and husband education, wealth index, antenatal care visit, multiple gestations, parity, accessing health care, residence, and living countries were major determinants of skilled attendant delivery. Strategies to increase the accessibility and availability of healthcare services, and financial support that targets mothers from poor households and rural residents to use health services will be beneficial. Health education targeting mothers and their partner with no education are vital to increasing their awareness about the importance of skilled birth attendance at birth.

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“…Education level and income are highly correlated and people who are educated not only have higher odds of better income but also can have access to health education messages, internalize them and act on them. Moreover, income has also been associated with access to health services through increased ability to pay in areas with low coverage of health insurance like Tanzania [28–30]. Though, 48% of men were found to be aware of the diseases, the utilization of screening was considerably low (8%).…”

Section: Discussionmentioning

confidence: 99%

Knowledge, Perceived Risk and Utilization of Prostate Cancer Screening Services among Men in Dar Es Salaam, Tanzania

et al. 2019

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Background Late diagnosis of prostate cancer is common in low and middle income countries and contributes to high morbidity and mortality of the disease. Utilization of prostate cancer screening services plays a major role in prevention of adverse outcomes. However, there is limited information on the knowledge about, the perceived risk of, and the utilization of prostate cancer screening in Tanzania. Objective To determine knowledge and perceived risk of prostate cancer, and the utilization of prostate cancer screening services, and associated factors, among men in Dar es Salaam, Tanzania. Design A population-based cross-sectional study involving men aged 40 years and above living in Dar es Salaam was conducted between May and August, 2018. Methodology Participants were recruited through multistage random sampling and took part in structured face-to-face interviews. Categorical variables were summarized using proportions while continuous variables were summarized as medians and inter-quarterly range (IQR). Chi square test was used to compare differences between proportions, and logistic regression modelling was used to determine factors associated with utilization of prostate cancer screening. Both crude and adjusted odds ratios (OR), with corresponding 95% confidence intervals, are reported. All analyses were two-tailed and the significance level set at 5%. Results A total of 388 men with a median age of 53 years (IQR 44–55) participated. Half (52.1%) had poor knowledge about prostate cancer and prostate cancer screening. A third (32.3%, n = 125) perceived the risk of prostate cancer to be low. Only 30 respondents (7.7%) had ever been screened for prostate cancer. Utilization of prostate cancer screening services was independently associated with age above 60 years [AOR = 21.46, 95% CI: 6.23, 73.93], monthly income above 305 US Dollars [AOR = 15.68, 95% CI: 4.60, 53.48], the perceived risk of prostate cancer [AOR = 16.34, 95% CI: 7.82, 14.92] and knowledge about prostate cancer [AOR = 67.71, 95% CI: 8.20, 559.57]. Conclusions Knowledge about prostate cancer and prostate cancer screening services was low among men in Dar es Salaam with a third perceiving themselves to be at no risk for the disease. Utilization of screening services was low and associated with low income, younger age, low perceived risk of prostate cancer and low knowledge about the disease. Intervention measures aiming to increase knowledge about prostate cancer and screening services, and affordable provision of services, are urgently called for.

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Health insurance coverage and access to skilled birth attendance in Togo

Cited by 8 publications

References 22 publications

Choice between home and health institutional births in the era of Kenya’s maternity subsidy

Choice between home and health institutional births in the era of Kenya’s maternity subsidy

Pooled prevalence and determinants of skilled birth attendant delivery in East Africa countries: a multilevel analysis of Demographic and Health Surveys

Knowledge, Perceived Risk and Utilization of Prostate Cancer Screening Services among Men in Dar Es Salaam, Tanzania

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