Socioeconomic inequalities and inequities in the screening and treatment of diabetes and hypertension in Kenya

Omondi, Robinson Oyando

Socioeconomic inequalities and inequities in the screening and treatment of diabetes and hypertension in Kenya

Master Thesis

2021

Abstract

The burden of non-communicable diseases (NCDs) is on a disproportionate rise in low-and middleincome countries (LMICs). Equity in the utilisation of screening and treatment services for NCDs is important in reducing associated disease burden. For instance, the 2030 Sustainable Development Goal 3.4 that aims to reduce by one-third premature NCDs mortality, has adopted prevention and treatment as critical interventions for achieving this target. However, little is known about equity in the use of screening and treatment services for major NCDs like diabetes and hypertension in Kenya. This dissertation assesses horizontal equity (i.e. equal treatment for equal need) in the screening and treatment for diabetes and hypertension. Further, it examines factors contributing to inequality. Data from the 2015 STEPwise cross-sectional survey on NCDs risk factors were used in the analysis. Concentration curves, concentration indices and horizontal inequity index were used to assess socioeconomic inequality and inequity in the screening and treatment for diabetes and hypertension. The Wagstaff decomposition approach was used to examine factors contributing to socioeconomic inequality in screening and treatment. For a granular presentation of inequity and inequality findings, analyses were conducted across the wealth and regional divides in Kenya. Overall, the rich benefited disproportionately more in the utilisation of screening and treatment services, given their population share of need. Of note, inequalities in the use of screening and treatment interventions for diabetes and hypertension were observed in the geographic regions. In general, non-need factors such as educational attainment, area of residence, exposure to media, employment, and wealth status were the largest contributors to inequality in both screening and treatment. By contrast, need factors like sex also significantly contributed to inequality in diabetes and hypertension screening. After controlling for need, a statistically significant pro-rich inequity in the use of diabetes and hypertension screening was observed. Both the use of diabetes and hypertension treatment were pro-rich though a statistically significant result was only seen for the former. For equity in the screening and treatment for diabetes and hypertension in Kenya, demand enhancing mechanisms such as health education through the mass media and free NCD screening in the public sector should be implemented. Also, given the interplay of factors beyond the health sector that affect utilisation of healthcare services, there is a need for multi-sectoral approaches at various levels to address drivers of social inequality with a critical focus in rural and marginalised areas.

Keywords

economics

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