Determinants of access to healthcare by older persons in Uganda: a cross-sectional study

International Journal for Equity in Health

James Ntozi¹  Betty Kwagala¹  Stephen Ojiambo Wandera² 

[1] Department of Population Studies, School of Statistics and Planning, College of Business and Management Sciences, Makerere University, Kampala, Uganda;Consortium for Advanced Research Training in Africa (CARTA cohort 2) Fellow at the African Population and Health Research Centre (APHRC), Nairobi, Kenya

关键词: Elderly;    Health services;    Health care;    Utilization;    Uganda;    Africa;   

Others  :  1137679
DOI  :  10.1186/s12939-015-0157-z

 received in 2014-10-24, accepted in 2015-02-24,  发布年份 2015

【 摘 要 】

Background

Older persons report poor health status and greater need for healthcare. However, there is limited research on older persons’ healthcare disparities in Uganda. Therefore, this paper aimed at investigating factors associated with older persons’ healthcare access in Uganda, using a nationally representative sample.

Methods

We conducted secondary analysis of data from a sample of 1602 older persons who reported being sick in the last 30 days preceding the Uganda National Household Survey. We used frequency distributions for descriptive data analysis and chi-square tests to identify initial associations. We fit generalized linear models (GLM) with the poisson family and the log link function, to obtain incidence risk ratios (RR) of accessing healthcare in the last 30 days, by older persons in Uganda.

Results

More than three quarters (76%) of the older persons accessed healthcare in the last 30 days. Access to healthcare in the last 30 days was reduced for older persons from poor households (RR = 0.91, 95% CI: 0.83-0.99); with some walking difficulty (RR = 0.90, 95% CI: 0.83-0.97); or with a lot of walking difficulty (RR = 0.84, 95% CI: 0.75-0.95). Conversely, accessing healthcare in the last 30 days for older persons increased for those who earned wages (RR = 1.08, 95% CI: 1.00-1.15) and missed work due to illness for 1–7 days (RR = 1.19, 95% CI: 1.10-1.30); and 8–14 days (RR = 1.19, 95% CI: 1.07-1.31). In addition, those who reported non-communicable diseases (NCDs) such as heart disease, hypertension or diabetes (RR = 1.09, 95% CI: 1.01-1.16); were more likely to access healthcare during the last 30 days.

Conclusion

In the Ugandan context, health need factors (self-reported NCDs, severity of illness and mobility limitations) and enabling factors (household wealth status and earning wages in particular) were the most important determinants of accessing healthcare in the last 30 days among older persons.

【 授权许可】

   
2015 Wandera et al.; licensee BioMed Central.

【 参考文献 】

• [1]Ameh S, Gómez-Olivé FX, Kahn K, Tollman SM, Klipstein-Grobusch K: Predictors of health care use by adults 50 years and over in a rural South African setting. Global Health Action 2014, 7:24771.
• [2]UNFPA, HAI: Ageing in the twenty-first century: a celebration and a challenge. United Nations Population Fund (UNFPA), New York, and HelpAge International, London; 2012.
• [3]World Population Prospects: The 2012 Revision. [http://esa.un.org/wpp/unpp/panel_population.htm]
• [4]Aboderin I, Ferreira M: Linking ageing to development agendas in Sub-Saharan Africa: challenges and approaches. Population Ageing 2008, 1:51-73.
• [5]UBOS: Uganda national household survey 2009–2010. Socio-economic module. Abridged report. Uganda Bureau of Statistics, Kampala, Uganda; 2010.
• [6]Definition of an older or elderly person: Proposed Working Definition of an Older Person in Africa for the MDS Project [http://www.who.int/healthinfo/survey/ageingdefnolder/en/]
• [7]AU: Africa health strategy: 2007–2015. African Union, Addis Ababa; 2007.
• [8]MoGLSD: National Policy for Older Persons: Ageing with Security and Dignity. Ministry of Gender, Labour and Social Development, Kampala, Uganda; 2009.
• [9]Kyobutungi C, Ezeh A, Zulu E, Falkingham J: HIV/AIDS and the health of older people in the slums of Nairobi, Kenya: results from a cross sectional survey. BMC Public Health 2009, 9:153. BioMed Central Full Text
• [10]Ezeh A, Chepngeno-Langat G, Abdhalah Z, Woubalem Z: The situation of older people in poor urban settings: the case of Nairobi, Kenya. In Aging in Sub-Saharan Africa: recommendations for furthering research. Edited by Cohen B, Menken J. The National Academies Press, Washington, US; 2006:7-45.
• [11]MRC, UVRI: Direct and indirect effects of HIV/AIDS and anti-retroviral treatment on the health and wellbeing of older people In WHO’s Study on global AGEing and adult health (SAGE). Uganda Virus Research Institute & Medical Research Council, Kampala; 2011.
• [12]Gómez-Olivé FX, Thorogood M, Clark B, Kahn K, Tollman S: Self-reported health and health care use in an ageing population in the Agincourt sub-district of rural South Africa. 2013.
• [13]Aboderin I: Understanding and advancing the health of older populations in sub-Saharan Africa: policy perspectives and evidence needs. Public Health Rev 2010, 32:357-376.
• [14]UN: Madrid International Plan of Action on Ageing (MIPAA). United Nations, New York (NY); 2002.
• [15]Mulumba M, Nantaba J, Brolan C, Ruano A, Brooker K, Hammonds R: Perceptions and experiences of access to public healthcare by people with disabilities and older people in Uganda. Int J Equity Health 2014, 13:76. BioMed Central Full Text
• [16]Debpuur CY, Welaga P, Wak G, Hodgson A: Self-reported health and functional limitations among older people in the Kassena-Nankana District, Ghana. 2010.
• [17]Gómez-Olivé FX, Thorogood M, Clark B, Kahn K, Tollman S: Assessing health and well-being among older people in rural South Africa. Global Health Action 2010, 2:23-35.
• [18]Kowal P, Kahn K, Ng N, Naidoo N, Adbullah S, Bawah A, et al.: Ageing and adult health status in eight lower-income countries: the INDEPTH WHO-SAGE collaboration. 2010.
• [19]Kyobutungi C, Egondi T, Ezeh A: The health and well-being of older people in Nairobi’s slums. Global Health Action 2010, 3:45-53.
• [20]Mwanyangala MA, Mayombana C, Urassa H, Charles J, Mahutanga C, Abdullah S, et al.: Health status and quality of life among older adults in rural Tanzania. 2010.
• [21]Minh HV, Byass P, Chuc NTK, Wall S: Patterns of health status and quality of life among older people in rural Viet Nam. 2010.
• [22]Scholten F, Mugisha J, Seeley J, Kinyanda E, Nakubukwa S, Kowal P, et al.: Health and functional status among older people with HIV/AIDS in Uganda. BMC Public Health 2011, 11:886. BioMed Central Full Text
• [23]Ng N, Hakimi M, Byass P, Wilopo S, Wall S: Health and quality of life among older rural people in Purworejo District, Indonesia. 2010.
• [24]Razzaque A, Nahar L, Khanam MA, Streatfield PK: Socio-demographic differentials of adult health indicators in Matlab, Bangladesh: self-rated health, health state, quality of life and disability level. 2010.
• [25]Nankwanga A, Phillips J, Neema S: Exploring and curbing the effects of HIV/AIDS on elderly people in Uganda. J Comm Health Sci 2009, 4:19-30.
• [26]Ntozi JPM, Nakayiwa S: AIDS in Uganda: how has the household coped with the epidemic. Cont Afr HIV/AIDS Epidemic 1999, 2:155-181.
• [27]Seeley J, Kabunga E, Tumwekwase G, Wolff B, Grosskurth H: The Impact of the AIDS Epidemic on the Lives of Older People in Rural Uganda. DEV Working Paper 04; 2008.
• [28]Seeley J, Wolff B, Kabunga E, Tumwekwase G, Grosskurth H: ‘This is where we buried our sons’: people of advanced old age coping with the impact of the AIDS epidemic in a resource-poor setting in rural Uganda. Ageing Soc 2009, 29:115.
• [29]Golaz V, Rutaremwa G: The vulnerability of older adults: what do census data say? An application to Uganda. Afr Popul Stud 2011, 26:605-622.
• [30]Ssengooba F, Rahman S, Hongoro C, Rutebemberwa E, Mustafa A, Kielmann T, et al.: Health sector reforms and human resources for health in Uganda and Bangladesh: mechanisms of effect. Hum Resour Health 2007, 5:3. BioMed Central Full Text
• [31]Hjelm K, Atwine F: Health-care seeking behaviour among persons with diabetes in Uganda: an interview study. BMC International Health and Human Rights 2011, 11.
• [32]Pariyo G, Ekirapa-Kiracho E, Okui O, Rahman M, Peterson S, Bishai D, et al.: Changes in utilization of health services among poor and rural residents in Uganda: are reforms benefitting the poor? Int J Equity Health 2009, 8:39. BioMed Central Full Text
• [33]Andersen RM: Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav 1995, 36(March):1-10.
• [34]Andersen RM: National health surveys and the behavioral model of health services Use. Med Care 2008, 46:647-653.
• [35]Barros AJ, Hirakata VN: Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol 2003, 3:21. BioMed Central Full Text
• [36]Coutinho LM, Scazufca M, Menezes PR: Methods for estimating prevalence ratios in cross-sectional studies. Rev Saude Publica 2008, 42:992-998.
• [37]Lee J, Tan CS, Chia KS: A practical guide for multivariate analysis of dichotomous outcomes. Ann Acad Med Singapore 2009, 38:714-719.
• [38]Wanyenze R, Kyaddondo D, Kinsman J, Makumbi F, Colebunders R, Hardon A: Client-provider interactions in provider-initiated and voluntary HIV counseling and testing services in Uganda. BMC Health Serv Res 2013, 13:423. BioMed Central Full Text
• [39]Burström B: Increasing inequalities in health care utilisation across income groups in Sweden during the 1990s? Health Policy 2002, 62:117-129.
• [40]Morris S, Sutton M, Gravelle H: Inequity and inequality in the use of health care in England: an empirical investigation. Soc Sci Med 2005, 60:1251-1266.
• [41]van Doorslaer E, Masseria C, Koolman X: Group ftOHER: Inequalities in access to medical care by income in developed countries. Can Med Assoc J 2006, 174:177-183.
• [42]Hoeck S, Francois G, Van der Heyden J, Geerts J, Van Hal G: Healthcare utilisation among the Belgian elderly in relation to their socio-economic status. Health Policy 2011, 99:174-182.
• [43]Lima-Costa MF, Barreto S, Giatti L, Uchoa E: [Socioeconomic circumstances and health among the brazilian elderly: a study using data from a National Household Survey]. Cad Saude Publica 2003, 19:745-757.
• [44]Sato A: Does socio-economic status explain use of modern and traditional health care services? Soc Sci Med 2012, 75:1450-1459.
• [45]Channon AA, Andrade MV, Noronha K, Leone T, Dilip TR: Inpatient care of the elderly in Brazil and India: Assessing social inequalities. Soc Sci Med 2012, 75:2394-2402.
• [46]Yam H-K, Mercer SW, Wong L-Y, Chan W-K, Yeoh E-K: Public and private healthcare services utilization by non-institutional elderly in Hong Kong: Is the inverse care law operating? Health Policy 2009, 91:229-238.
• [47]Luo J, Zhang X, Jin C, Wang D: Inequality of access to health care among the urban elderly in northwestern China. Health Policy 2009, 93:111-117.
• [48]Corrieri S, Heider D, Matschinger H, Lehnert T, Raum E, Konig H-H: Income-, education- and gender-related inequalities in out-of-pocket health-care payments for 65+ patients - a systematic review. Int J Equity Health 2010, 9:20. BioMed Central Full Text
• [49]Manski RJ, Moeller JF, Chen H, Schimmel J, St Clair PA, Pepper JV: Patterns of older Americans’ health care utilization over time. Am J Public Health 2013, 103:1314-1324.
• [50]George P, Heng B, De Castro MJ, Wong L, Wei Lin N, Cheah JT: Self-reported chronic diseases and health status and health service utilization - Results from a community health survey in Singapore. Int J Equity Health 2012, 11:44. BioMed Central Full Text
• [51]Gómez-Olivé FX, Thorogood M, Clark B, Kahn K, Tollman S: Self-reported health and health care use in an ageing population in the Agincourt sub-district of rural South Africa. Global Health Action 2013, 6:19305.
• [52]Wong R, Diaz JJ: Health care utilization among older Mexicans: health and socioeconomic inequalities. Salud Publica Mex 2007, 49(Suppl 4):S505-514.
• [53]Redondo-Sendino Á, Guallar-Castillón P, Ramón Banegas J, Rodríguez-Artalejo F: Gender differences in the utilization of health-care services among the older adult population of Spain. BMC Public Health 2006, 6:155. BioMed Central Full Text
• [54]Wang H, Chen K, Pan Y, Jing F, Liu H: Associations and impact factors between living arrangements and functional disability among older Chinese adults. PLoS One 2013, 8:e53879.
• [55]Drainoni M-L, Lee-Hood E, Tobias C, Bachman SS, Andrew J, Maisels L: Cross-disability experiences of barriers to health-care access: consumer perspectives. J Disabil Policy Stud 2006, 17:101-115.
• [56]Wamala S, Merlo J, Bostrom G, Hogstedt C: Perceived discrimination, socioeconomic disadvantage and refraining from seeking medical treatment in Sweden. J Epidemiol Community Health 2007, 61:409-415.
• [57]Horner-Johnson W, Dobbertin K, Lee JC, Andresen EM: Disparities in chronic conditions and health status by type of disability. Disabil Health J 2013, 6:280-286.
• [58]Lezzoni LI, Frakt AB, Pizer SD: Uninsured persons with disability confront substantial barriers to health care services. Disabil Health J 2011, 4:238-244.
• [59]Smith DL: Disparities in healthcare access for older adults with disabilities. Topics Geriatric Rehabilitation 2008, 24:192-203.
• [60]Freitas MC, Ribeiro LC, Vieira Mde T, Teixeira MT, Bastos RR, Leite IC: Factors associated with the use of the Papanicolaou smear screening among older women in the interior of Brazil. Rev Bras Ginecol Obstet 2012, 34:432-437.
• [61]Wolf JH, Breslau N, Ford AB, Ziegler HD, Ward A: Access of the black urban elderly to medical care. J Natl Med Assoc 1983, 75:41-46.
• [62]Iezzoni LI, McCarthy EP, Davis RB, Siebens H: Mobility impairments and use of screening and preventive services. Am J Public Health 2000, 90:955-961.