OpenUCT :: Browsing by Author "Ataguba, John"

Browsing by Author "Ataguba, John"

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Open Access
An Equity Analysis of the Burden from Alcohol Consumption in South Africa
(2020) Correia, Fontes Mayara; London, Leslie; Ataguba, John; Harker-Burnhams, Nadine
Background: Alcohol consumption remains one of the leading contributors to the risk of mortality worldwide. While literature sources are clear that alcohol consumption has a major negative impact on society and which is felt more severely amongst low-socioeconomic families, the literature on alcoholrelated harm on individuals and households in South Africa, especially from different socio-economic backgrounds, is very limited. This study represents an initial attempt to assess inequalities and inequity in alcohol consumption, at the household and individual levels, in South Africa using national household data. The objectives of this study are (1) to examine the usability of existing survey data in South Africa for assessing alcohol-related expenditure and impacts; (2) to provide a detailed description of alcohol consumption patterns in South Africa at the individual level using various equity stratifiers and (3) to assess the socioeconomic distribution of expenditure on alcoholic beverages at the household level in South Africa. Methods. For objective 1, all publicly available alcohol data sources for South African populations were scanned to examine their usability. A set of qualitative interviews with 10 key researchers in the alcohol policy and economics field in South Africa were undertaken to capture their experience and perceptions of alcohol data in South Africa. The analysis involved identifying databases known to key informants, exploring challenges in using the datasets for research and further analyzing any recommendations for how routine datasets could be better used to inform policy. For Objectives 2 and 3, this study used publicly available secondary data, including the National Income Dynamics Study (NIDS) and the Income Expenditure Survey (IES). The data have been anonymized and can be accessed from the DataFirst website. Results: There are differences in alcohol consumption patterns and alcohol expenditure among equity stratifiers. The findings show that the burden of alcohol consumption is heavier on the poor. Poorer households spend a significantly larger share of their total household consumption expenditure on alcoholic beverages than richer households—a case of regressivity in spending on alcoholic beverages. Spending on alcohol beverages became less regressive (i.e. a pro-poor ‘shift') between 1995 and 2000; and between 2005/06 and 2010/11. For alcohol consumption patterns, current drinkers are more prevalent among the rich; whereas binge drinkers are more prevalent among the poor. Binge drinking is a problem among the low-income, young individuals, male and African populations. The results also show that there are significant constraints limiting the quality and usefulness of alcohol data in South Africa. These constraints are related to (a) lack of accessibility of survey data, (b) lack of systematic and standardized measurement of alcohol consumption, (c) limited geographic coverage, (d) infrequent survey timing and (e) lack of public availability of industry data on price, production, distribution and consumption of alcohol. Conclusion: This study provides evidence that alcohol consumption in South Africa may be a reflection of genuine differences in consumption patterns among socioeconomic status, and the burden falls most heavily on poorer households and individuals. Based on the results, there is an opportunity to further reduce the regressivity of alcohol expenditure by implementing comprehensive alcohol harm-reduction policies. This study supports recommendations for the South African government to continue to push for evidence-based alcohol policies aiming to decrease alcohol consumption, especially for risky drinkers. However, limited data accessibility in South Africa could potentially impact on the implementation, monitoring and evaluation of relevant policy and interventions to address alcohol-related harms. Thus, for implementing evidence-based alcohol policy in South Africa to be successful, the government must have accessible, reliable and meaningful data for stakeholders and researchers to evaluate interventions and assess whether national alcohol policies aiming to decrease alcohol consumption have achieved their intended objectives.
Open Access
Assessing socio-economic inequalities in the use of antenatal care in the Southern African Development community
(2019) Selebano, Keolebogile Mable; Ataguba, John
Introduction Despite the unprecedented efforts of national governments along with various NGOs to achieve the third SDG, which is to reduce global maternal mortality to less than 70 per 100 000 live births by 2030, developing countries seem to be lagging far behind in reaching this goal (UNDP, 2016). This paper focuses on socioeconomic inequalities in the use of ANC services as an important aspect of MHC in SADC countries. Methods The data used in this study are obtained from the Demographic and Health Survey (DHS). Three mutually exclusive variables were created to assess ANC inequality, namely, 1) No ANC visits 2) Less than four ANC visits and 3) At least four ANC visits. A fourth variable that assesses the actual number of ANC visits that a pregnant woman had received was created and called 'Intensity’. ANC and SES using the wealth index were used to construct the concentration curves and indices to determine whether health care utilization is concentrated among the poor or the rich. Results Over 70% of all who lived in rural areas had '0 ANC’, with Namibia and Tanzania as the only exception to this finding. In four of the eleven countries, over 58.36% of women were married and were likely to make an adequate number of ANC visits. Namibia and Lesotho are two of the eleven countries that had a great majority of women educated up to the secondary level, 65.61% and 49.90% of which attained at least 4 ANC visits, respectively. Women who worked in agricultural settings had the least likelihood of attaining any ANC visits. Discussions and conclusion ANC use was consistently lower in women with no education, doing agricultural work and those residing in rural areas in the SADC region. Overall, marriage is inconclusive in determining ANC use. Inequality in wealth makes ANC utilization more predominant among the rich. Saving mothers and babies is ultimately saving the population and knowledge of the patterns of maternal health usage is imperative to draw relevant policies that are evidence based.
Open Access
Assessment of technical and scale efficiency of public clinics in eSwatini
(2020) Kindandi, Kikanda; Ataguba, John
Developing countries, while working to achieve the WHO universal health coverage goal, have to constantly strike a balance, when allocating their already limited resources, between health and other sectors of their economies (agriculture, education, infrastructure, housing, security, defence etc..). As a result, there is always a limit on how much funding developing countries local governments are able to allocate to their health sector. Limited heath sector funding in the presence of significant health care needs may in turn have a negative impact on health systems outcomes. In addition to government health financing constraints, health systems outcomes in developing countries may also be jeopardized by the prevalence of inefficiencies within local health care delivery systems, especially within public health facilities. This study investigates the level of technical and scale efficiency of a nationally representative sample of 65 randomly selected public clinics in Eswatini using Data Envelopment Analysis. The DEA estimates indicate that 42 clinics (64.7%) were technically inefficient, with an average technical efficiency score of 80.4% (STD= 18.8%). Fifty-one (78.4%) clinics were scale inefficient with an average scale efficiency score of 90.4% (STD = 6.6%). The most prevalent scale inefficiency among public clinics was increasing return to scale with 92.2% (47/51) of scale inefficient clinics operating under increasing return to scale. All 42 inefficient clinics could have delivered the same level of output with 5,701,449.4, US $ less in government funding, 115.3 less clinical staff, 138.8 less support staff and 119.8 less consultation rooms The results reveal inefficiencies within the Health system in Eswatini. It seems possible to save significant amount of money if measures were put in place to mitigate resource wastages. Hence, policy interventions that help not only optimize inputs but also allow outputs expansion through improving the demand for health care would contribute to improving technical and scale efficiency of public clinics in the Kingdom of Eswatini.
Open Access
Does the distribution of health care benefits in Kenya meet the principles of universal coverage?
(BioMed Central Ltd, 2012) Chuma, Jane; Maina, Thomas; Ataguba, John
BACKGROUND:The 58th World Health Assembly called for all health systems to move towards universal coverage where everyone has access to key promotive, preventive, curative and rehabilitative health interventions at an affordable cost. Universal coverage involves ensuring that health care benefits are distributed on the basis of need for care and not on ability to pay. The distribution of health care benefits is therefore an important policy question, which health systems should address. The aim of this study is to assess the distribution of health care benefits in the Kenyan health system, compare changes over two time periods and demonstrate the extent to which the distribution meets the principles of universal coverage. METHODS: Two nationally representative cross-sectional households surveys conducted in 2003 and 2007 were the main sources of data. A comprehensive analysis of the entire health system is conducted including the public sector, private-not-for-profit and private-for-profit sectors. Standard benefit incidence analysis techniques were applied and adopted to allow application to private sector services. RESULTS: The three sectors recorded similar levels of pro-rich distribution in 2003, but in 2007, the private-not-for-profit sector was pro-poor, public sector benefits showed an equal distribution, while the private-for-profit sector remained pro-rich. Larger pro-rich disparities were recorded for inpatient compared to outpatient benefits at the hospital level, but primary health care services were pro-poor. Benefits were distributed on the basis of ability to pay and not on need for care. CONCLUSIONS: The principles of universal coverage require that all should benefit from health care according to need. The Kenyan health sector is clearly inequitable and benefits are not distributed on the basis of need. Deliberate efforts should be directed to restructuring the Kenyan health system to address access barriers and ensure that all Kenyans benefit from health care when they need it.
Open Access
Explaining the socio-economic inequalities in child immunisation coverage in Zimbabwe
(University of Cape Town, 2020) Chigwenah, Tariro; Ataguba, John
Socioeconomic inequalities in health have received significant attention globally because of the well-known association between wealth and health. A lot of studies show that poor people are more prone to sickness than their counterparts. Immunisation has been a key antidote to avert deaths for children under the age of 5. This study represents an initial attempt to assess specific variables that contribute to socioeconomic inequalities in immunisation coverage in Zimbabwe. Data were obtained from the 2015 Zimbabwe Demographic Health Survey, a nationally representative survey. Immunisation coverage was measured using four categories: full immunisation (a child who will have received 10 doses of vaccines), partial immunisation (a child who will have received at least one but not all vaccines), no immunisation (a child who will not have received any immunisation dose from birth) and immunisation intensity (a proportion of doses received to total doses that they should have received). Inequalities in immunisation coverage in Zimbabwe were assessed using concentration curves and indices. A positive (negative) concentration index indicates immunisation coverage concentrated among the rich (poor). The concentration index was decomposed to identify how different variables contribute to the socioeconomic inequality in immunisation coverage in Zimbabwe. Results indicate that immunisation intensity and full immunisation concentration indices were (0.0154) and (0.0250) respectively, indicating that children from lower socio-economic status are less likely to receive all doses of vaccines. No immunisation and partial immunisation concentration indices were (-0.0778) and (-0.0878) indicating that children from higher socioeconomic status are more likely to have their children immunised opposed to their poor counterparts. The main contributors to socioeconomic inequality in immunisation coverage are the mother's education, socioeconomic status and place of residence (rural/urban and province). While immunisation services are free of charge in the public health sector in Zimbabwe, coverage rates are higher among the wealthy, which shows that there may be barriers to utilising these services that may not be the direct cost of vaccination. There have to be measures by the government to reach people in areas that are not easily accessible. Also, more needs to be done to reduce socioeconomic inequalities in Zimbabwe.
Open Access
Factors that affect uptake of community-based health insurance in low- and middle- income countries: a systematic review
(2014) Adebayo, Esther; Wiysonge, Charles; Ataguba, John
Includes abstract. Includes bibliographical references.
Open Access
Financial health protection in Swaziland: an assessment of financial catastrophe and impoverishment from out-of-pocket payments
(2016) Ngcamphalala, Cebisile; Ataguba, John
As the drive towards universal coverage is gaining momentum globally, the need for assessing levels of financial health protection in countries, particularity the developing world, has increasingly become important. Swaziland's health financing system performance in terms of ensuring financial health protection is not clearly understood. This paper assesses financial catastrophe and impoverishment from out - of - pocket payments and associated factors that predict them in Swaziland. The Swaziland Household Income and Expenditure Survey (SHIES) for 2009/2010 was used for the analyses. Financial catastrophe was assessed using a variable threshold. Impoverishment was assessed using both a national and $1.25/day international poverty line. Logistic regression models were used to assess factors that predict household vulnerability to financial catastrophe and impoverishment. It emerged that about 9.6 per cent of the Swazi households experienced financial catastrophe while about 1.1 per cent were pushed below the poverty line as a result of out - of - pocket payments. Factors associated with households' vulnerability include; education of the household - head, household size, location, age and household socio - economic status. The findings indicate that financial health protection is not adequate in Swaziland. Thus, there is a need for financing mechanisms that do not place undue hardships on the poor and vulnerable.
Open Access
Financial protection in Uganda's health system catastrophic and impoverishment effects of out-of-pocket health care payments
(2012) Kwesiga, Brendan; Ataguba, John
This study assesses the impact of out-of-pocket payments for health care on the welfare of households in Uganda. Using data from the nationally representative Uganda National Household Survey 2009/10, the study assesses the extent and intensity of catastrophic out-of-pocket health care payments using a threshold that varies with household's socio-economic status. The study also assesses the impact of out-of-pocket payments on the poverty status of the population.
Open Access
Impact of National Health Insurance on health seeking behavior in the Kassena-Nankana district of Northern Ghana
(2009) Dalaba, Maxwell Ayindenaba; Ataguba, John
The National Health Insurance Scheme (NHIS) was introduced in Ghana in 2003 with the aim of mobilizing additional funds for health care, promoting equal access to reasonable health care, pool health risks, prevent impoverishment, and improve the efficiency and quality of health care. The success of the NHIS in improving access to health care since its implementation and the extent to which it has impacted on health seeking behaviour has not been extensively investigated. This study examines health-seeking behaviours of insured and uninsured households on the mutual health insurance scheme on health care access in the Kassena-Nankana District (KND) of northern Ghana and to determine the factors that influence household decision to enrol into the NHIS. The study is a cross sectional survey of 422 household heads randomly selected to represent rural, peri-urban and urban zones of KND. Data was analysed using STATA version 8.0. A binary logit model was used to determine factors that predict household enrolment into the NHIS. The choice of a particular type of provider with multiple outcomes was analysed using a multinomial logit model. Results showed that 72% of household heads were males and the average age was 51 years. Out of the 422 respondents, 64% were insured. Household heads of age 40 years and above, being a female household head, being married, and economic wealth positively influenced enrolment into the national health insurance scheme. Seventy four percent (74%) of the ill among the insured and 48% among uninsured sought care from public facilities while 14% among the insured and 8% among uninsured sought care from private facility. Also, self treatment among the insured was 13% and 44% among uninsured households. Results also showed that being a member of NHIS and being moderately or severely ill were associated with public health facility utilization. Household heads of 60 years or older was negatively associated with use of public health facilities. Similarly, a household that was insured, being a Muslim and the severity of illness of household member were positively associated with the use of private health care. The findings showed that the insured were more likely to use formal care providers than the uninsured. This implies that the NHI in the KND has improved the health seeking behaviour from the hitherto use of informal providers and self treatment to preferred use of formal providers.
Open Access
The impact of smoking on individual health expenditures: a case study of Namibia
(2017) Chisha, Zunda; Ataguba, John
Background: The increased smoking prevalence in some parts of the world, particularly in Low and Middle Income Countries (LMICs) is a major concern among tobacco control advocates and governments. The higher smoking-related disease prevalence associated with this is expected to fall among the sub-populations least able to pay for healthcare services in LMICs. This, in turn, will perpetuate the vicious cycle of poverty and disease. The current study contributes to developing an understanding of the socioeconomic disparities in smoking in Namibia and their potential association with per capita health-related expenditures. Method: Data from the Namibia 2013 Demographic and Health Survey, a nationally representative survey, are used in the study. Three main variables for healthcare costs are constructed, namely out-patient disease (OPD) costs, inpatient disease (IPD) costs and total out of pocket (OOP) payments. Concentration curves and indices are estimated for all three variables as well as for smoking intensity and smoking prevalence. Further, three Tobit regression models are run to examine the associations of the different healthcare costs with smoking intensity. Results: The concentration index of smoking prevalence is estimated at -0.05 compared to -0.18 for smoking intensity. Thus, both smoking prevalence and smoking intensity, in relation to their socioeconomic status, are concentrated among the poor. In contrast, the concentration index of OPD healthcare costs is calculated at 0.34 compared to 0.65 for IPD healthcare costs reflecting disproportionately higher healthcare costs among the rich. The concentration index of the overall total annual OOP payments is 0.55. Tobit regression analysis, however, does not find any statistically significant relationship between the smoking intensity and the amount spent on health care costs, regardless of whether these were IPD, OPD healthcare costs or total OOP payments. Conclusion: Namibia's current policies on demand reducing tobacco control policies can be strengthened by these findings. Smoking is an important determinant of several non-communicable diseases and has the potential to exacerbate health care costs across socioeconomic strata. Understanding the socioeconomic disparities in smoking is imperative for developing appropriate interventions against smoking.
Open Access
Investigating the relationship between social capital and self-rated health in South Africa
(2014) Lau, Yan Kwan; Ataguba, John
Much research has examined the relationship between social capital and self-rated health in developed countries. Few studies, however, have investigated this important relationship in developing countries. This study examined this research gap using data from the National Income Dynamics Study (NIDS), the first nationally representative panel study in South Africa. Information regarding social capital - norms of reciprocity, association activity, trust and group membership - was assessed in NIDS. Self-rated health was collected at Wave 1 in 2008, and Wave 2 in 2010 - 2011. The final sample consisted of 8866 respondents. Mixed effects models were fitted to predict self-rated health in Wave 2, using lagged covariates (from Wave 1). The results indicated that individual personalised trust, individual community service group membership and neighbourhood personalised trust were beneficial to self-rated health. Reciprocity, associational activity and other types of group memberships were not found to be significantly associated with self-rated health. Results indicate that both individual- and contextual-level social capital are associated with self-rated health. Policy makers in South Africa may want to consider social capital, in addition to other well-known social determinants of health, when implementing policies to improve the health of its population.
Open Access
Investigating the relationship between social capital and self-rated health in South Africa
(2014) Lau, Yan Kwan; Ataguba, John
Much research has examined the relationship between social capital and self-rated health in developed countries. Few studies, however, have investigated this important relationship in developing countries. This study examined this research gap using data from the National Income Dynamics Study (NIDS), the first nationally representative panel study in South Africa. Information regarding social capital - norms of reciprocity, association activity, trust and group membership - was assessed in NIDS. Self-rated health was collected at Wave 1 in 2008, and Wave 2 in 2010 - 2011. The final sample consisted of 8866 respondents. Mixed effects models were fitted to predict self-rated health in Wave 2, using lagged covariates (from Wave 1). The results indicated that individual personalised trust, individual community service group membership and neighbourhood personalised trust were beneficial to self-rated health. Reciprocity, associational activity and other types of group memberships were not found to be significantly associated with self-rated health. Results indicate that both individual- and contextual-level social capital are associated with self-rated health. Policy makers in South Africa may want to consider social capital, in addition to other well-known social determinants of health, when implementing policies to improve the health of its population.
Open Access
Malaria treatment seeking behaviour and access to artemisinin combination therapy : a case of Mushin, Lagos, Nigeria
(2010) Okwundu, Charles I; Ataguba, John
ACTs have been shown to be effective in treating malaria and are currently recommended as first-line drugs for the treatment of uncomplicated malaria in Nigeria because of resistance of malaria to chloroquine (CQ) and sulphadoxine pyrimethamine (SP). However, very little is known about malaria and treatment-seeking patterns and the use of ACTs since the adoption of the treatment policy more than 6 years ago in Nigeria.
Open Access
Sensitivity of measuring the progress in financial risk protection to varied survey instruments: A case study of Ghana
(2021) Sumboh, Jemima Ambamaah Catherine; Ataguba, John; Obse, Amarech
Valid and reliable data on household health expenditure and other household consumption expenditure are important for monitoring the progress towards Universal Health Coverage (UHC). However, the difficulty in obtaining reliable estimates of private expenditure on health often undermine the credibility of health accounts, limit the tracking of financial resources, and make international comparisons extremely difficult. This study assessed the sensitivity of estimates of out-of-pocket health payments and catastrophic health expenditure to the choice of survey instruments. The study used a household budget survey dataset collected in Ghana, in 2017/2018 by the Navrongo Health Research Center. The health expenditure questions were disaggregated into three different levels: Versions I, II and III containing 11, 44 and 56 health expenditure items, respectively. The number of non-health items and recall periods, however, were held constant across versions. Catastrophic health expenditure was measured as out-of-pocket health expenditure that exceeded a certain fraction of household non-food expenditure, depending on the socioeconomic group. Concentration indices were also used to determine the concentration of catastrophic health expenditure. The mean and median household out-of-pocket health expenditure per annum ranged from US$74.11 to USD$106.49, and US$13.69 to US$20.33, respectively depending on the type of survey instrument used. Also, between 7.98% and 12.68% of households incurred catastrophic out-of-pocket health payments, depending on the survey instrument used. The findings show that estimates of out-of-pocket health spending and financial catastrophe are sensitive to the level of disaggregation of out-of-pocket health spending questions in survey instruments. The concentration indices for catastrophic headcount and overshoot were all negative across all catastrophic threshold levels and data versions implying that catastrophic health payments are concentrated among poor households. Further research is needed, preferably validation studies, to enhance the reliability and comparability of estimates of OOP health expenditure and catastrophic health expenditure.
Open Access
Socioeconomic differentials in child stunting in rural and urban areas in Zambia
(2019) Mushinge, Douglas; Ataguba, John; Wilkinson, Thomas
Child stunting remains one of the biggest public health concerns in Zambia and other low and middle-income countries (LMICs). A formidable challenge faced in improving child health outcomes in LMICs includes persistent socioeconomic and residential disparities. Despite achieving an overall decline in the prevalence of child stunting over the past decades, children residing in rural areas and less-privileged households continue to fall behind their peers from urban areas and wealthier households in Zambia and other LMICs. Notably, studies have shown that children residing in rural areas and less privileged households have a higher risk and burden of stunted growth in sub-Saharan Africa (SSA). However, basic rural-urban differentiation in child stunting can potentially conceal wealth differentials that exist within rural and urban areas. Specifically, cross country analyses have revealed that wealth differentials were higher in urban areas compared to rural areas; and higher than the overall urban-rural odds of stunting among children under five years of age. Using data from the 2013/14 Zambia Demographic Health Survey (ZDHS), differences in the relationship between socioeconomic status and child stunting in urban and rural areas of Zambia were assessed in this study. Furthermore, the study examines the effect of socioeconomic status and residence type in predicting child stunting prevalence in Zambia. To achieve these, the thesis used chi-square tests and logistic regression analysis. To the best of my knowledge, this is the first single-country analysis primarily focused on Zambia that has disaggregated the effect of predictors of child stunting by residence type. It is anticipated that the results of this dissertation will broaden the knowledge-base on wealth and residential differentials in child nutritional outcomes in Africa and thereby provide useful information to policymakers and technocrats in Zambia. Overall, the findings indicate that children under five years who reside in urban areas and poorer households have a higher likelihood of becoming stunted compared to their peers in rural and wealthier households. However, the relationship between child stunting and household wealth (SES) differs slightly after segregating by residence type. In both rural and urban areas, there is a consistent inverse relationship between the odds of stunted growth among under-fives and SES. Furthermore, these findings indicate that socioeconomic differentials are wider in rural areas compared to urban areas and much wider than the overall rural-urban odds ratios in Zambia. These findings could possibly be because of socioeconomic inequalities in child stunting that are higher in rural areas than urban areas. However, there is a need for further research to examine the causes of differentials in child stunting that may exist in rural and urban locations of Zambia.
Open Access
Socioeconomic inequalities and inequities in the screening and treatment of diabetes and hypertension in Kenya
(2021) Omondi, Robinson Oyando; Ataguba, John; Barasa, Edwine
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.
Open Access
Socioeconomic inequalities in non-communicable diseases in South Africa
(2019) Zulu, Tryphine; Ataguba, John
Non-communicable diseases (NCDs) have reached epidemic proportions globally and in South Africa. This thesis is situated within the health equity framework. The aim is to assess the extent of wealth related inequalities in NCDs and to assess the impact of the social determinants of health in mediating these inequalities. Data from the first South African National Health and Examination Survey (SANHANES-1) and wave 4 of the South African National Income Dynamics Study (NIDS) were used. The methods used include the concentration curve, concentration index and decomposition analysis to assess the drivers of socioeconomic inequality in NCDs and some causes of NCDs including smoking, obesity, high blood pressure; use of screening services and effective coverage for hypertension management. The prevalence of smokers is 18.7%, the population average BMI is 26.38 kg/m2, and the prevalence of hypertension is 29.7%. The distribution of these risk factors is pro-wealthy with concentration indices ranging from 0.048 for hypertension, 0.057 for smoking prevalence to 0.115 for obesity. While these risk factors are prevalent amongst the wealthy, the outcomes are worse amongst the poor. The concentration index for expenditure on cigarettes is strongly pro-poor, (-0.130) compared to the prowealthy smoking prevalence. The hypertensive poor suffer more severe hypertension with a concentration index of -0.054 for depth and -0.079 for severity, respectively. Obesity affects the wealthiest the most. However, the overweight adults who are poor tend to suffer more severe obesity as shown by a relatively smaller concentration index of depth (0.015) and severity (0.033) respectively. The overall utilisation of screening services is below 50% for eligible respondents. The two wealthiest quintiles benefit disproportionately more than they should, given their share of the population. This is particularly true for diabetes and cholesterol with a concentration index of 0.27 for cholesterol, 0.129 for diabetes and 0.052 for hypertension. Adults that do not take up screening services are predominantly the black race group, poor, rural, male, unemployed and uninsured. Only 23% of those with hypertension are diagnosed, on treatment and are controlled. Wealth-related variables such as education, wealth, health insurance coverage and province of residence drive most of the observed pro-wealthy inequalities in this thesis. Wealthier adults benefit to a larger extent from the care cascade, compared to the poor. Therefore, until there is a substantial increase in early diagnosis and effective treatment, high levels of mortality from NCDs will persist in South Africa. And until the poor are prioritised through radical policy change in all economic sectors, the observed inequalities will continue.
Open Access
Socioeconomic inequalities in skilled birth attendance in Zimbabwe: a comparative analysis
(2020) Lukwa, Akim Tafadzwa; Ataguba, John
This dissertation assessed socioeconomic inequalities in skilled birth attendance in Zimbabwe. High maternal mortality in low-income countries is a cause of concern globally. Skilled birth attendance prevents a substantial number of maternal deaths and it is critical for ensuring overall maternal health. However, sub-Saharan Africa is characterized by challenges in accessing skilled birth attendance. The existence of health inequalities has been demonstrated when simple comparisons are made by residence (rural-urban), education and wealth (poorrich) in developing nations. The study used data from the Zimbabwe Demographic and Health Surveys (ZDHS) of 2010/11 and 2015. The analysis focused on women of child-bearing age (15-49 years). Skilled birth attendance was determined by women assisted by health personnel with midwife training. Health personnel was defined as a nurse, midwife or doctor. A binary logistic regression model was computed to understand the relationship between skilled birth attendance, demographic attributes and some explanatory variables. Standard concentration curves and Wagstaff normalized concentration indices were used to assess whether skilled birth attendance was dominant among the poor or rich in Zimbabwe. Overall skilled birth attendance prevalence increased for the periods under review. Regression results showed that antenatal care visits, residence status, place of delivery, women level of education, employment status and marital status are statistically significant predictors of skilled birth attendance. Wagstaff normalized concentration indices of aggregated use of skilled birth personnel reflected that wealthy women were more likely to receive skilled birth attendance. The concentration curves for aggregated skilled birth attendance showed minimal existence of health inequalities, as the concentration curves almost coincided with the line of equality. However, a disaggregated analysis by health personnel revealed the existence of health inequalities. In summary, minimal socioeconomic inequalities exist if skilled birth attendance aggregated, but when assessed by different health personnel categories, widening socioeconomic inequalities are observed.
Open Access
Socioeconomic inequalities in Zambia's public health care delivery system
(2013) Phiri, Jane; Ataguba, John
In this thesis, equality is considered as the absence of differences in utilization among individuals of different socioeconomic status while equity is taken to mean that individuals in equal need of health care should use the same amount of care, irrespective of their socioeconomic status. Using the above definitions, this thesis, examines equity/inequality in the utilization of public health care in Zambia. Concentration curves, concentration indices and horizontal equity indices were used for this purpose. This thesis focuses specifically on public health care that is subsidized by the Government. It is anticipated that the findings of this thesis will broaden the knowledge base on health care utilization inequities in Africa.
Open Access
Socioeconomic-related health inequality in South Africa: evidence from General Household Surveys
(BioMed Central Ltd, 2011) Ataguba, John; Akazili, James; McIntyre, Di
BACKGROUND:Inequalities in health have received considerable attention from health scientists and economists. In South Africa, inequalities exist in socio-economic status (SES) and in access to basic social services and are exacerbated by inequalities in health. While health systems, together with the wider social determinants of health, are relevant in seeking to improve health status and health inequalities, those that need good quality health care too seldom get it. Studies on the burden of ill-health in South Africa have shown consistently that, relative to the wealthy, the poor suffer more from more disease and violence. However, these studies are based on selected disease conditions and only consider a single point in time. Trend analyses have yet to be produced. This paper specifically investigates socio-economic related health inequality in South Africa and seeks to understand how the burden of self-reported illness and disability is distributed and whether this has changed since the early 2000s. METHODS: Several rounds (2002, 2004, 2006, and 2008) of the South African General Household Surveys (GHS) data were used, with standardized and normalized self-reported illness and disability concentration indices to assess the distribution of illness and disability across socio-economic groups. Composite indices of socio-economic status were created using a set of common assets and household characteristics. RESULTS: This study demonstrates the existence of socio-economic gradients in self-reported ill-health in South Africa. The burden of the major categories of ill-health and disability is greater among lower than higher socio-economic groups. Even non-communicable diseases, which are frequently seen as diseases of affluence, are increasingly being reported by lower socio-economic groups. For instance, the concentration index of flu (and diabetes) declined from about 0.17 (0.10) in 2002 to 0.05 (0.01) in 2008. These results have also been confirmed internationally. CONCLUSION: The current burden and distribution of ill-health indicates how critical it is for the South African health system to strive for access to and use of health services that is in line with need for such care. Concerted government efforts, within both the health sector and other social and economic sectors are therefore needed to address the significant health inequalities in South Africa.