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Evidence on access to medicines for chronic diseases from household surveys in five low- and middle-income countries.

ABSTRACT: The 2011 United Nations (UN) General Assembly Political Declaration on Prevention and Control of Non-Communicable Diseases (NCDs) brought NCDs to the global health agenda. Essential medicines are central to treating chronic diseases such as hypertension and diabetes. Our study aimed to quantify access to essential medicines for people with chronic conditions in five low- and middle-income countries and to evaluate how household socioeconomic status and perceptions about medicines availability and affordability influence access. We analysed data for 1867 individuals with chronic diseases from national surveys (Ghana, Jordan, Kenya, Philippines and Uganda) conducted in 2007-10 using a standard World Health Organization (WHO) methodology to measure medicines access and use. We defined individuals as having access to medicines if they reported regularly taking medicine for a diagnosed chronic disease and data collectors found a medicine indicated for that disease in their homes. We used logistic regression models accounting for the clustered survey design to investigate determinants of keeping medicines at home and predictors of access to medicines for chronic diseases. Less than half of individuals previously diagnosed with a chronic disease had access to medicines for their condition in every country, from 16% in Uganda to 49% in Jordan. Other than reporting a chronic disease, higher household socioeconomic level was the most significant predictor of having any medicines available at home. The likelihood of having access to medicines for chronic diseases was higher for those with medicines insurance coverage [highest adjusted odds ratio (OR) 3.12 (95% confidence intervals (CI): 1.38, 7.07)] and lower for those with past history of borrowing money to pay for medicines [lowest adjusted OR 0.56 (95% CI: 0.34, 0.92)]. Our study documents poor access to essential medicines for chronic conditions in five resource-constrained settings. It highlights the importance of financial risk protection and consumer education about generic medicines in global efforts towards improving treatment of chronic diseases.

SUBMITTER: Vialle-Valentin CE

PROVIDER: S-EPMC4654757 | biostudies-literature | 2015 Oct

REPOSITORIES: biostudies-literature

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Evidence on access to medicines for chronic diseases from household surveys in five low- and middle-income countries.

Vialle-Valentin Catherine E CE Serumaga Brian B Wagner Anita K AK Ross-Degnan Dennis D

Health policy and planning 20140924 8

The 2011 United Nations (UN) General Assembly Political Declaration on Prevention and Control of Non-Communicable Diseases (NCDs) brought NCDs to the global health agenda. Essential medicines are central to treating chronic diseases such as hypertension and diabetes. Our study aimed to quantify access to essential medicines for people with chronic conditions in five low- and middle-income countries and to evaluate how household socioeconomic status and perceptions about medicines availability an ...[more]

PMID: 25255920

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Project description:In most low- and middle-income countries (LMICs), household out-of-pocket (OOP) health spending constitutes a major source of healthcare financing. Household surveys are commonly used to monitor OOP health spending, but are prone to recall bias and unable to capture seasonal variation, and may underestimate expenditure-particularly among households with long-term chronic health conditions. Household expenditure diaries have been developed as an alternative to overcome the limitations of surveys, and pictorial diaries have been proposed where literacy levels may render traditional diary approaches inappropriate. This study compares estimates for general household and chronic healthcare expenditure in South Africa, Tanzania and Zimbabwe derived using survey and pictorial diary approaches. We selected a random sub-sample of 900 households across urban and rural communities participating in the Prospective Urban and Rural Epidemiology study. For a range of general and health-specific categories, OOP expenditure estimates use cross-sectional survey data collected via standardised questionnaire, and data from these same households collected via two-week pictorial diaries repeated four times over 2016-2019. In all countries, average monthly per capita expenditure on food, non-food/non-health items, health, and consequently, total household expenditure reported by pictorial diaries was consistently higher than that reported by surveys (each p<0.001). Differences were greatest for health expenditure. The share of total household expenditure allocated to health also differed by method, accounting for 2% in each country when using survey data, and from 8-20% when using diary data. Our findings suggest that the choice of data collection method may have significant implications for estimating OOP health spending and the burden it places on households. Despite several practical challenges to their implementation, pictorial diaries offer a method to assess potential bias in surveys or triangulate data from multiple sources. We offer some practical guidance when considering the use of pictorial diaries for estimating household expenditure.

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Project description:BACKGROUND:Mass deworming against soil-transmitted helminthiasis, which affects 1 billion of the poorest people globally, is one of the largest public health programmes for neglected tropical diseases, and is intended to be equitable. However, the extent to which treatment programmes for deworming achieve equitable coverage across wealth class and sex is unclear and the public health metric of national deworming coverage does not include representation of equity. This study aims to measure both coverage and equity in global, national, and subnational deworming to guide future programmatic evaluation, investment, and metric design. METHODS:We used nationally representative, geospatial, household data from Demographic and Health Surveys that measured mother-reported deworming in children of preschool age (12-59 months). Deworming was defined as children having received drugs for intestinal parasites in the previous 6 months before the survey. We estimated deworming coverage disaggregated by geography, wealth quintile, and sex, and computed an equity index. We examined trends in coverage and equity index across countries, within countries, and over time. We used a regression model to compute the household correlates of deworming and ecological correlates of equitable deworming. FINDINGS:Our study included 820 883 children living in 50 countries from Africa, the Americas, Asia, and Europe that are endemic for soil-transmitted helminthiasis using 77 Demographic and Health Surveys from December, 2003, to October, 2017. In these countries, the mean deworming coverage in preschool children was estimated at 33·0% (95% CI 32·9-33·1). The subnational coverage ranged from 0·5% to 87·5%, and within-country variation was greater than between-country variation. Of the 31 countries reporting that they reached the WHO goal of more than 75% national coverage, 30 had inequity in deworming, with treatment concentrated in wealthier populations. We did not detect systematic differences in deworming equity by sex. INTERPRETATION:Substantial inequities in mass deworming programmes are common as wealthier populations have consistently higher coverage than that of the poor, including in countries reporting to have reached the WHO goal of more than 75% national coverage. These inequities seem to be geographically heterogeneous, modestly improving over time, with no evidence of sex differences in inequity. Future reporting of deworming coverage should consider disaggregation by geography, wealth, and sex with incorporation of an equity index to complement the conventional public health metric of national deworming coverage. FUNDING:Bill & Melinda Gates Foundation, Stanford University Medical Scientist Training Program.

Project description:Gestational weight gain (GWG) estimates enable the identification of populations of women at risk for adverse outcomes. We described GWG distribution in low- and middle-income countries (LMICs). Demographic and Health Surveys and other national surveys were used to calculate the average GWG by regressing the weight of pregnant women (15-49 years) at the time of the interview on their gestational age, adjusting for sociodemographic factors. A mixed-effects hierarchical model was built with survey-specific GWG as the dependent variable and restricted cubic splines for survey year, super-region, and country-level covariates (total fertility rate, gross domestic product, and average female body mass index) to predict the national, regional, and income level average GWG in 2020. Uncertainty ranges (UR) were obtained using bootstrap. Estimates were compared with the Institute of Medicine's GWG recommendations for women with normal weight (11.5kg) and underweight (12.5kg). Survey data were available for 70 LMICs (234 data points, 1991-2022). Predicted country-specific GWG for 2020 ranged from 2.6 to 13.5kg. Ten countries presented estimates above the recommendation for women with underweight; nine of which were from Central Europe, Eastern Europe, and Central Asia; apart from one, these were upper-middle income. Regional GWG was estimated at 5.4kg (95%UR 3.1,7.7) in Sub-Saharan Africa; 6.2kg (95%UR 3.4,9.0) in North Africa and the Middle East; 8.6kg (95%UR 6.0,11.3) in South Asia; 9.3kg (95%UR 6.2,12.3) in Southeast Asia, East Asia, and Oceania; 10.0kg (95%UR 7.1,12.9) in Latin America and the Caribbean; and 13.0kg (95%UR 9.0,16.9) in Central and Eastern Europe, and Central Asia. A gradient was observed across income: 5.3kg (95%UR 2.7,7.9) for low-income, 7.6kg (95%UR 5.2,10.1) for lower-middle-income, and 9.8kg (95%UR 7.1,12.5) for upper-middle-income countries. No income group achieved the minimum recommended weight gain. GWG was estimated to be insufficient in almost all LMICs. Improved data and monitoring are crucial for impactful interventions.

Dataset Information

Evidence on access to medicines for chronic diseases from household surveys in five low- and middle-income countries.

Publications

Evidence on access to medicines for chronic diseases from household surveys in five low- and middle-income countries.

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