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Keesara S.R.,University of California at San Francisco | Juma P.A.,African Population Health Research Center | Harper C.C.,University of California at San Francisco
BMC Health Services Research | Year: 2015

Background: Nearly 40 % of women in developing countries seek contraceptives services from the private sector. However, the reasons that contraceptive clients choose private or public providers are not well studied. Methods: We conducted six focus groups discussions and 51 in-depth interviews with postpartum women (n=61) to explore decision-making about contraceptive use after delivery, including facility choice. Results: When seeking contraceptive services, women in this study preferred private over public facilities due to convenience and timeliness of services. Women avoided public facilities due to long waits and disrespectful providers. Study participants reported, however, that they felt more confident about the technical medical quality in public facilities than in private, and believed that private providers prioritized profit over safe medical practice. Women reported that public facilities offered comprehensive counseling and chose these facilities when they needed contraceptive decision-support. Provision of comprehensive counseling and screening, including side effects counseling and management, determined perception of quality. Conclusion: Women believed private providers offered the advantages of convenience, efficiency and privacy, though they did not consistently offer high-quality care. Quality-improvement of contraceptive care at private facilities could include technical standardization and accreditation. Development of support and training for side effect management may be an important intervention to improve perceived quality of care. © 2015 Keesara et al. Source

Buigut S.,American University in Dubai | Ettarh R.,African Population Health Research Center | Amendah D.D.,African Population Health Research Center
International Journal for Equity in Health | Year: 2015

Background: In Kenya, where 60 to 80% of the urban residents live in informal settlements (frequently referred to as slums), out-of-pocket (OOP) payments account for more than a third of national health expenditures. However, little is known on the extent to which these OOP payments are associated with personal or household financial catastrophe in the slums. This paper seeks to examine the incidence and determinants of catastrophic health expenditure among urban slum communities in Kenya. Methods: We use a unique dataset on informal settlement residents in Kenya and various approaches that relate households OOP payments for healthcare to total expenditures adjusted for subsistence, or income. We classified households whose OOP was in excess of a predefined threshold as facing catastrophic health expenditures (CHE), and identified the determinants of CHE using multivariate logistic regression analysis. Results: The results indicate that the proportion of households facing CHE varies widely between 1.52% and 28.38% depending on the method and the threshold used. A core set of variables were found to be key determinants of CHE. The number of working adults in a household and membership in a social safety net appear to reduce the risk of catastrophic expenditure. Conversely, seeking care in a public or private hospital increases the risk of CHE. Conclusion: This study suggests that a substantial proportion of residents of informal settlements in Kenya face CHE and would likely forgo health care they need but cannot afford. Mechanisms that pool risk and cost (insurance) are needed to protect slum residents from CHE and improve equity in health care access and payment. © 2015 Buigut et al.; licensee BioMed Central. Source

Church K.,London School of Hygiene and Tropical Medicine | Kiweewa F.,Makerere University | Dasgupta A.,London School of Hygiene and Tropical Medicine | Mwangome M.,Ifakara Health Institute | And 14 more authors.
Bulletin of the World Health Organization | Year: 2015

Objective To compare national human immunodeficiency virus (HIV) policies infuencing access to HIV testing and treatment services in six sub-Saharan African countries. Methods We reviewed HIV policies as part of a multi-country study on adult mortality in sub-Saharan Africa. A policy extraction tool was developed and used to review national HIV policy documents and guidelines published in Kenya, Malawi, South Africa, Uganda, the United Republic of Tanzania and Zimbabwe between 2003 and 2013. Key informant interviews helped to fll gaps in findings. National policies were categorized according to whether they explicitly or implicitly adhered to 54 policy indicators, identifed through literature and expert reviews. We also compared the national policies with World Health Organization (WHO) guidance. Findings There was wide variation in policies between countries; each country was progressive in some areas and not in others. Malawi was particularly advanced in promoting rapid initiation of antiretroviral therapy. However, no country had a consistently enabling policy context expected to increase access to care and prevent attrition. Countries went beyond WHO guidance in certain areas and key informants reported that practice often surpassed policy. Conclusion Evaluating the impact of policy diferences on access to care and health outcomes among people living with HIV is challenging. Certain policies will exert more infuence than others and official policies are not always implemented. Future research should assess the extent of policy implementation and link these findings with HIV outcomes. © 2015, World Health Organization. All rights reserved. Source

Faye O.,African Population Health Research Center | Faye O.,Center Detudes Of Populations | Baschieri A.,London School of Hygiene and Tropical Medicine | Falkingham J.,University of Southampton | Muindi K.,African Population Health Research Center
Journal of Urban Health | Year: 2011

Although linked to poverty as conditions reflecting inadequate access to resources to obtain food, issues such as hunger and food insecurity have seldom been recognized as important in urban settings. Overall, little is known about the prevalence and magnitude of hunger and food insecurity in most cities. Yet, in sub-Saharan Africa where the majority of urban dwellers live on less than one dollar a day, it is obvious that a large proportion of the urban population must be satisfied with just one meal a day. This paper suggests using the one- and two-parameter item response theory models to infer a reliable and valid measure of hunger and food insecurity relevant to low-income urban settings, drawing evidence from the Nairobi Urban Health and Demographic Surveillance System. The reliability and accuracy of the items are tested using both the Mokken scale analysis and the Cronbach test. The validity of the inferred household food insecurity measure is assessed by examining how it is associated with households' economic status. Results show that food insecurity is pervasive amongst slum dwellers in Nairobi. Only one household in five is food-secure, and nearly half of all households are categorized as "food-insecure with both adult and child hunger." Moreover, in line with what is known about household allocation of resources, evidence indicates that parents often forego food in order to prioritize their children. © 2011 The New York Academy of Medicine. Source

Amendah D.D.,African Population Health Research Center | Mukamah G.,Kenya Medical Research Institute | Komba A.,Kenya Medical Research Institute | Ndila C.,Kenya Medical Research Institute | And 3 more authors.
PLoS ONE | Year: 2013

Background: More than 70% of children with sickle cell disease (SCD) are born in sub-Saharan Africa where the prevalence at birth of this disease reaches 2% or higher in some selected areas. There is a dearth of knowledge on comprehensive care received by children with SCD in sub-Saharan Africa and its associated cost. Such knowledge is important for setting prevention and treatment priorities at national and international levels. This study focuses on routine care for children with SCD in an outpatient clinic of the Kilifi District Hospital, located in a rural area on the coast of Kenya. Objective: To estimate the per-patient costs for routine SCD outpatient care at a rural Kenyan hospital. Methods: We collected routine administrative and primary cost data from the SCD outpatient clinic and supporting departments at Kilifi District Hospital, Kenya. Costs were estimated by evaluating inputs - equipment, medication, supplies, building use, utility, and personnel - to reflect the cost of offering this service within an existing healthcare facility. Annual economic costs were similarly calculated based on input costs, prorated lifetime of equipment and appropriate discount rate. Sensitivity analyses evaluated these costs under different pay scales and different discount rate. Results: We estimated that the annual economic cost per patient attending the SCD clinic was USD 138 in 2010 with a range of USD 94 to USD 229. Conclusion: This study supplies the first published estimate of the cost of routine outpatient care for children born with SCD in sub-Saharan Africa. Our study provides policy makers with an indication of the potential future costs of maintaining specialist outpatient clinics for children living with SCD in similar contexts. © 2013 Amendah et al. Source

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