Supply-Side Barriers to the Use of Public Healthcare Facilities for Childhood Illness Care in Rural Zambia: A Cross-Sectional Study Linking Data from a Healthcare Facility Census to a Household Survey
Abstract
:1. Introduction
2. Materials and Methods
2.1. Source of Data
2.2. Participants
2.3. Variables and Measurements
2.4. Statistical Analyses
3. Results
3.1. Characteristics of the Study Children: Demand-Side Factors
3.2. Characteristics of Public Healthcare Facilities: Supply-Side Factors
3.3. Bivariate Analyses for Using Public Healthcare Facilities
3.4. Multivariate Analyses of the Association between Using a Public Healthcare Facility and Supply-Side Factors
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- United Nations Inter-Agency Group for Child Mortality Estimation (UN IGME). Levels & Trends in Child Mortality: Report 2020, Estimates Developed by the United Nations Inter-Agency Group for Child Mortality Estimation. Available online: https://www.unicef.org/media/79371/file/UN-IGME-child-mortality-report-2020.pdf.pdf (accessed on 14 March 2021).
- World Health Organization. Global Health Observatory Data Repository. Available online: https://apps.who.int/gho/data/node.main.65?lang=en (accessed on 14 March 2021).
- Jacobs, B.; Ir, P.; Bigdeli, M.; Annear, P.L.; Van Damme, W. Addressing Access Barriers to Health Services: An Analytical Framework for Selecting Appropriate Interventions in Low-Income Asian Countries. Health Policy Plan. 2012, 27, 288–300. [Google Scholar] [CrossRef] [PubMed]
- Geldsetzer, P.; Williams, T.C.; Kirolos, A.; Mitchell, S.; Ratcliffe, L.A.; Kohli-Lynch, M.K.; Bischoff, E.J.L.; Cameron, S.; Campbell, H. The Recognition of and Care Seeking Behaviour for Childhood Illness in Developing Countries: A Systematic Review. PLoS ONE 2014, 9, e93427. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Do, M.; Micah, A.; Brondi, L.; Campbell, H.; Marchant, T.; Eisele, T.; Munos, M. Linking Household and Facility Data for Better Coverage Measures in Reproductive, Maternal, Newborn, and Child Health Care: Systematic Review. J. Glob. Health 2016, 6, 020501. [Google Scholar] [CrossRef] [PubMed]
- Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2019 (GBD 2019) Results; Institute for Health Metrics and Evaluation (IHME): Seattle, WA, USA, 2020; Available online: http://ghdx.healthdata.org/gbd-results-tool (accessed on 7 May 2021).
- Jackson, K.D.; Higgins, C.R.; Laing, S.K.; Mwila, C.; Kobayashi, T.; Ippolito, M.M.; Sylvia, S.; Ozawa, S. Impact of Substandard and Falsified Antimalarials in Zambia: Application of the SAFARI Model. BMC Public Health 2020, 20, 1–11. [Google Scholar] [CrossRef] [PubMed]
- Ministry of Health. National Health Facility Census Analytical Report; Ministry of Health: Lusaka, Zambia, 2019; p. 10.
- Ministry of Health. National Integrated Management of Newborn and Childhood Illness (IMNCI) Strategic Plan 2019–2021; Ministry of Health: Lusaka, Zambia, 2019; p. 2.
- The Demographic and Health Surveys (DHS) Program. Zambia. Available online: https://dhsprogram.com/Countries/Country-List.cfm (accessed on 14 March 2021).
- Tanou, M.; Kamiya, Y. Assessing the Impact of Geographical Access to Health Facilities on Maternal Healthcare Utilization: Evidence from the Burkina Faso Demographic and Health Survey 2010. BMC Public Health 2019, 19, 838. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Gabrysch, S.; Cousens, S.; Cox, J.; Campbell, O.M.R. The Influence of Distance and Level of Care on Delivery Place in Rural Zambia: A Study of Linked National Data in a Geographic Information System. PLoS Med. 2011, 8, e1000394. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Lohela, T.J.; Campbell, O.M.R.; Gabrysch, S. Distance to Care, Facility Delivery and Early Neonatal Mortality in Malawi and Zambia. PLoS ONE 2012, 7, e52110. [Google Scholar] [CrossRef] [PubMed]
- Nesbitt, R.C.; Gabrysch, S.; Laub, A.; Soremekun, S.; Manu, A.; Kirkwood, B.R.; Amenga-Etego, S.; Wiru, K.; Höfle, B.; Grundy, C. Methods to Measure Potential Spatial Access to Delivery Care in Low- and Middle-Income Countries: A Case Study in Rural Ghana. Int. J. Health Geogr. 2014, 13, 25. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Ministry of Health. National Health Capital Investment Plan 2019–2021; Ministry of Health: Lusaka, Zambia, 2019; p. 6.
- Noor, A.M.; Zurovac, D.; Hay, S.I.; Ochola, S.A.; Snow, R.W. Defining Equity in Physical Access to Clinical Services Using Geographical Information Systems as Part of Malaria Planning and Monitoring in Kenya. Trop. Med. Int. Health 2003, 8, 917–926. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Ministry of Health. Zambia National Health Strategic Plan 2017–2021. Available online: https://www.moh.gov.zm/?wpfb_dl=68 (accessed on 14 March 2021).
- Tlebere, P.; Jackson, D.; Loveday, M.; Matizirofa, L.; Mbombo, N.; Doherty, T.; Wigton, A.; Treger, L.; Chopra, M. Community-Based Situation Analysis of Maternal and Neonatal Care in South Africa to Explore Factors That Impact Utilization of Maternal Health Services. J. Midwifery Womens Health 2007, 52, 342–350. [Google Scholar] [CrossRef] [PubMed]
- Noor, A.M.; Amin, A.A.; Gething, P.W.; Atkinson, P.M.; Hay, S.I.; Snow, R.W. Modelling Distances Travelled to Government Health Services in Kenya. Trop. Med. Int. Health 2006, 11, 188–196. [Google Scholar] [CrossRef] [PubMed]
- Ministry of Health. Zambia Malaria Indicator Survey 2018; Ministry of Health: Lusaka, Zambia, 2019; p. 62.
- Christopher, J.B.; Le May, A.; Lewin, S.; Ross, D.A. Thirty Years after Alma-Ata: A Systematic Review of the Impact of Community Health Workers Delivering Curative Interventions against Malaria, Pneumonia and Diarrhoea on Child Mortality and Morbidity in Sub-Saharan Africa. Hum. Resour. Health 2011, 9, 1–11. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Rutebemberwa, E.; Pariyo, G.; Peterson, S.; Tomson, G.; Kallander, K. Utilization of Public or Private Health Care Providers by Febrile Children after User Fee Removal in Uganda. Malar. J. 2009, 8, 45. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Baume, C.; Helitzer, D.; Kachur, S.P. Patterns of Care for Childhood Malaria in Zambia. Soc. Sci. Med. 2000, 51, 1491–1503. [Google Scholar] [CrossRef]
- Zambia National Malaria Elimination Centre. Guidelines for the Diagnosis and Treatment of Malaria in Zambia: Fifth Edition. Available online: https://static1.squarespace.com/static/58d002f017bffcf99fe21889/t/5cb9738a42ffca0001aaedbc/1555657626933/NationalMalariaTreatmentGuidelines2017_Final20170917+%281%29.pdf (accessed on 14 March 2021).
- The Demographic and Health Surveys (DHS) Program. Methodology. Available online: https://dhsprogram.com/Methodology/GPS-Data-Collection.cfm (accessed on 14 March 2021).
- Carter, E.D.; Ndhlovu, M.; Eisele, T.P.; Nkhama, E.; Katz, J.; Munos, M. Evaluation of Methods for Linking Household and Health Care Provider Data to Estimate Effective Coverage of Management of Child Illness: Results of a Pilot Study in Southern Province, Zambia. J. Glob. Health 2018, 8, 010607. [Google Scholar] [CrossRef] [PubMed]
- Masiye, F.; Kaonga, O.; Banda, C.M. Informal Payments for Primary Health Services in Zambia: Evidence from a Health Facility Patient Exit Survey. Health Policy OPEN 2020, 1, 100020. [Google Scholar] [CrossRef]
Characteristic | Fever (n = 854) | Diarrhea (n = 813) | ||
---|---|---|---|---|
n | % | n | % | |
Age in months, median (interquartile range) | 23 | 12–35 | 18 | 11–28 |
Sex | ||||
Male | 413 | 48.4 | 398 | 49.0 |
Female | 441 | 51.6 | 415 | 51.0 |
Mother’s educational level | ||||
No formal education | 118 | 13.8 | 112 | 13.8 |
Primary | 550 | 64.4 | 501 | 61.6 |
Secondary | 181 | 21.2 | 198 | 24.4 |
Higher | 5 | 0.6 | 2 | 0.2 |
Household’s wealth quintile | ||||
Lowest | 406 | 47.5 | 377 | 46.4 |
Second | 260 | 30.4 | 250 | 30.8 |
Middle | 136 | 15.9 | 136 | 16.7 |
Fourth | 35 | 4.1 | 39 | 4.8 |
Highest | 17 | 2.0 | 11 | 1.4 |
Source of advice or treatment 1 | ||||
Government health center | 466 | 54.6 | 418 | 51.4 |
Government health post | 159 | 18.6 | 145 | 17.8 |
Mission hospital/clinic | 26 | 3.0 | 17 | 2.1 |
Traditional practitioner | 2 | 0.2 | 4 | 0.5 |
No treatment | 204 | 23.9 | 233 | 28.7 |
Characteristic | Fever (n = 245) | Diarrhea (n = 253) | ||
---|---|---|---|---|
n | % | n | % | |
Distance between cluster and health facility (km), median (interquartile range) | 4.5 | 2.3–7.6 | 4.6 | 2.3–7.6 |
Deployment of health workers | ||||
Qualified health personnel unavailable | 10 | 4.1 | 9 | 3.6 |
At least one qualified health worker available | 189 | 77.1 | 195 | 77.1 |
All four cadres for the standard health post 1 available | 6 | 2.4 | 7 | 2.8 |
All four cadres for the standard rural health center 2 available | 40 | 16.3 | 42 | 16.6 |
Allocation of equipment | ||||
Neither | 149 | 60.8 | 148 | 58.5 |
Only a microscope | 15 | 6.1 | 17 | 6.7 |
Only a hemoglobin meter | 52 | 21.2 | 57 | 22.5 |
Both | 29 | 11.8 | 31 | 12.3 |
Characteristic | Fever (n = 854) | Diarrhea (n = 813) | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
Not Used | Used | p-Value 4 | Not Used | Used | p-Value 3 | |||||
n | % | n | % | n | % | n | % | |||
Supply-side factors | ||||||||||
Distance to the nearest healthcare facility | ||||||||||
<5 km | 92 | 19.8 | 373 | 80.2 | <0.001 | 100 | 23.3 | 329 | 76.7 | <0.001 |
5–10 km | 69 | 25.0 | 207 | 75.0 | 69 | 28.8 | 171 | 71.3 | ||
>10 km | 44 | 38.9 | 69 | 61.1 | 67 | 46.5 | 77 | 53.5 | ||
Availability of health workers at the nearest healthcare facility | ||||||||||
Qualified health personnel unavailable | 8 | 29.6 | 19 | 70.4 | 0.756 | 12 | 46.2 | 14 | 53.8 | 0.270 |
At least one qualified health worker available | 162 | 23.9 | 516 | 76.1 | 185 | 28.5 | 463 | 71.5 | ||
All four cadres for the standard health post 1 available | 4 | 33.3 | 8 | 66.7 | 5 | 31.3 | 11 | 68.8 | ||
All four cadres for the standard rural health center 2 available | 31 | 22.6 | 106 | 77.4 | 34 | 27.6 | 89 | 72.4 | ||
Availability of equipment at the nearest healthcare facility | ||||||||||
Neither | 135 | 26.9 | 366 | 73.1 | 0.121 | 155 | 31.1 | 343 | 68.9 | 0.270 |
Only a microscope | 14 | 20.9 | 53 | 79.1 | 18 | 31.6 | 39 | 68.4 | ||
Only a hemoglobin meter | 37 | 19.4 | 154 | 80.6 | 40 | 24.1 | 126 | 75.9 | ||
Both | 19 | 20.0 | 76 | 80.0 | 23 | 25.0 | 69 | 75.0 | ||
Demand-side factors | ||||||||||
Age in months | ||||||||||
<6 | 15 | 23.4 | 49 | 76.6 | 0.851 | 25 | 42.4 | 34 | 57.6 | 0.017 |
6–11 | 29 | 21.0 | 109 | 79.0 | 46 | 27.4 | 122 | 72.6 | ||
12–23 | 61 | 25.4 | 179 | 74.6 | 80 | 25.5 | 234 | 74.5 | ||
24–35 | 44 | 22.1 | 155 | 77.9 | 47 | 29.0 | 115 | 71.0 | ||
36–47 | 30 | 26.8 | 82 | 73.2 | 28 | 42.4 | 38 | 57.6 | ||
48–59 | 26 | 25.7 | 75 | 74.3 | 10 | 22.7 | 34 | 77.3 | ||
Sex | ||||||||||
Male | 93 | 22.5 | 320 | 77.5 | 0.325 | 123 | 30.9 | 275 | 69.1 | 0.248 |
Female | 112 | 25.4 | 329 | 74.6 | 113 | 27.2 | 302 | 72.8 | ||
Mother’s education | ||||||||||
No formal education | 30 | 25.4 | 88 | 74.6 | 0.049 | 43 | 38.4 | 69 | 61.6 | 0.063 |
Primary | 143 | 26.0 | 407 | 74.0 | 138 | 27.5 | 363 | 72.5 | ||
Secondary or higher | 32 | 17.2 | 154 | 82.8 | 55 | 27.5 | 145 | 72.5 | ||
Household’s wealth quintile | ||||||||||
Lowest | 108 | 26.6 | 298 | 73.4 | 0.009 | 112 | 29.7 | 265 | 70.3 | 0.950 |
Second | 56 | 21.5 | 204 | 78.5 | 69 | 27.6 | 181 | 72.4 | ||
Middle | 24 | 17.6 | 112 | 82.4 | 39 | 28.7 | 97 | 71.3 | ||
Fourth | 15 | 42.9 | 20 | 57.1 | 13 | 33.3 | 26 | 66.7 | ||
Highest | 2 | 11.8 | 15 | 88.2 | 3 | 27.3 | 8 | 72.7 |
Characteristic | Fever (n = 854) | Diarrhea (n = 813) | ||
---|---|---|---|---|
AOR | 95% CI | AOR | 95% CI | |
Supply-side factors | ||||
Distance to the nearest healthcare facility | ||||
<5 km | 1.00 | Reference | 1.00 | Reference |
5–10 km | 0.74 | 0.46-1.18 | 0.73 | 0.47–1.14 |
>10 km | 0.36 | 0.20–0.66 | 0.30 | 0.18–0.51 |
Availability of health workers at the nearest healthcare facility | ||||
Qualified health personnel unavailable | 1.00 | Reference | 1.00 | Reference |
At least one qualified health worker available | 1.39 | 0.47–4.12 | 2.58 | 0.95–7.03 |
All four cadres for the standard health post 1 available | 0.81 | 0.13–5.09 | 2.02 | 0.41–9.85 |
All four cadres for the standard rural health center 2 available | 1.29 | 0.37–4.54 | 2.96 | 0.95–9.24 |
Availability of equipment at the nearest healthcare facility | ||||
Neither | 1.00 | Reference | 1.00 | Reference |
Only a microscope | 1.08 | 0.45–2.55 | 0.67 | 0.31–1.48 |
Only a hemoglobin meter | 1.29 | 0.75–2.21 | 1.21 | 0.73–2.00 |
Both | 1.36 | 0.62–3.01 | 1.32 | 0.67–2.59 |
Demand-side factors | ||||
Age in months | ||||
<6 | 1.00 | Reference | 1.00 | Reference |
6–11 | 1.24 | 0.55–2.76 | 1.98 | 0.99–3.97 |
12–23 | 0.91 | 0.44–1.90 | 2.10 | 1.10–4.00 |
24–35 | 1.13 | 0.53–2.41 | 1.95 | 0.97–3.92 |
36–47 | 0.69 | 0.31–1.54 | 0.90 | 0.40–2.02 |
48–59 | 0.71 | 0.31–1.63 | 2.57 | 0.98–6.78 |
Sex | ||||
Male | 1.00 | Reference | 1.00 | Reference |
Female | 0.88 | 0.62–1.27 | 1.15 | 0.81–1.63 |
Mother’s education | ||||
No formal education | 1.00 | Reference | 1.00 | Reference |
Primary | 0.84 | 0.49–1.43 | 1.47 | 0.89–2.43 |
Secondary or higher | 1.36 | 0.68–2.71 | 1.40 | 0.76–2.59 |
Household’s wealth quintile | ||||
Lowest | 1.00 | Reference | 1.00 | Reference |
Second | 1.31 | 0.85–2.01 | 0.88 | 0.58–1.34 |
Middle | 1.56 | 0.88–2.78 | 0.83 | 0.49–1.41 |
Fourth | 0.30 | 0.13–0.73 | 0.61 | 0.26–1.44 |
Highest | 2.25 | 0.42–12.24 | 0.92 | 0.20–4.35 |
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Mochida, K.; Nonaka, D.; Wamulume, J.; Kobayashi, J. Supply-Side Barriers to the Use of Public Healthcare Facilities for Childhood Illness Care in Rural Zambia: A Cross-Sectional Study Linking Data from a Healthcare Facility Census to a Household Survey. Int. J. Environ. Res. Public Health 2021, 18, 5409. https://doi.org/10.3390/ijerph18105409
Mochida K, Nonaka D, Wamulume J, Kobayashi J. Supply-Side Barriers to the Use of Public Healthcare Facilities for Childhood Illness Care in Rural Zambia: A Cross-Sectional Study Linking Data from a Healthcare Facility Census to a Household Survey. International Journal of Environmental Research and Public Health. 2021; 18(10):5409. https://doi.org/10.3390/ijerph18105409
Chicago/Turabian StyleMochida, Keiji, Daisuke Nonaka, Jason Wamulume, and Jun Kobayashi. 2021. "Supply-Side Barriers to the Use of Public Healthcare Facilities for Childhood Illness Care in Rural Zambia: A Cross-Sectional Study Linking Data from a Healthcare Facility Census to a Household Survey" International Journal of Environmental Research and Public Health 18, no. 10: 5409. https://doi.org/10.3390/ijerph18105409