Are people most in need utilising health facilities in post-conflict settings? A cross-sectional study from South Kivu, eastern DR Congo
Background: The disruptive effect of protracted socio-political instability and conflict on the health systems is likely to exacerbate inequities in health service utilisation in conflict-recovering contexts. Objective: To examine whether the level of healthcare need is associated with health facili...
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doaj-c207b6a4899441b3859fe218de8c832a2021-09-20T13:59:57ZengTaylor & Francis GroupGlobal Health Action1654-98802020-12-0113110.1080/16549716.2020.17404191740419Are people most in need utilising health facilities in post-conflict settings? A cross-sectional study from South Kivu, eastern DR CongoEspoir Bwenge Malembaka0Hermès Karemere1Ghislain Bisimwa Balaluka2Chiara Altare3Magdalene Akos Odikro4Samuel Makali Lwamushi5Rosine Bigirinama Nshobole6Jean Macq7Université Catholique de BukavuUniversité Catholique de BukavuUniversité Catholique de BukavuJohns Hopkins Bloomberg School of Public HealthUniversity of GhanaUniversité Catholique de BukavuUniversité Catholique de BukavuUniversité Catholique de LouvainBackground: The disruptive effect of protracted socio-political instability and conflict on the health systems is likely to exacerbate inequities in health service utilisation in conflict-recovering contexts. Objective: To examine whether the level of healthcare need is associated with health facility utilisation in post-conflict settings. Methods: We conducted a cross-sectional study among adults with diabetes, hypertension, mothers of infants with acute malnutrition, informal caregivers (of participants with diabetes and hypertension) and helpers of mothers of children acutely malnourished, and randomly selected neighbours in South Kivu province, eastern DR Congo. Healthcare need levels were derived from a combination, summary and categorisation of the World Health Organisation Disability Assessment Schedule 2.0. Health facility utilisation was defined as having utilised in the first resort a health post, a health centre or a hospital as opposed to self-medication, traditional herbs or prayer homes during illness in the past 30 days. We used mixed-effects Poisson regression models with robust variance to identify the factors associated with health facility utilisation. Results: Overall, 82% (n = 413) of the participants (N = 504) utilised modern health facilities. Health facility utilisation likelihood was higher by 27% [adjusted prevalence ratio (aPR): 1.27; 95% CI: 1.13–1.43; p < 0.001] and 18% (aPR: 1.18; 95% CI: 1.06–1.30; p = 0.002) among participants with middle and higher health needs, respectively, compared to those with low healthcare needs. Using the lowest health need cluster as a reference, participants in the middle healthcare need cluster tended to have a higher hospital utilisation level. Conclusion: Greater reported healthcare need was significantly associated with health facility utilisation. Primary healthcare facilities were the first resort for a vast majority of respondents. Improving the availability and quality of health service packages at the primary healthcare level is necessary to ensure the universal health coverage goal advocating quality health for all can be achieved in post-conflict settings.http://dx.doi.org/10.1080/16549716.2020.1740419health facilityutilisationhealth needpost-conflictsouth kivudr congowhodas |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Espoir Bwenge Malembaka Hermès Karemere Ghislain Bisimwa Balaluka Chiara Altare Magdalene Akos Odikro Samuel Makali Lwamushi Rosine Bigirinama Nshobole Jean Macq |
spellingShingle |
Espoir Bwenge Malembaka Hermès Karemere Ghislain Bisimwa Balaluka Chiara Altare Magdalene Akos Odikro Samuel Makali Lwamushi Rosine Bigirinama Nshobole Jean Macq Are people most in need utilising health facilities in post-conflict settings? A cross-sectional study from South Kivu, eastern DR Congo Global Health Action health facility utilisation health need post-conflict south kivu dr congo whodas |
author_facet |
Espoir Bwenge Malembaka Hermès Karemere Ghislain Bisimwa Balaluka Chiara Altare Magdalene Akos Odikro Samuel Makali Lwamushi Rosine Bigirinama Nshobole Jean Macq |
author_sort |
Espoir Bwenge Malembaka |
title |
Are people most in need utilising health facilities in post-conflict settings? A cross-sectional study from South Kivu, eastern DR Congo |
title_short |
Are people most in need utilising health facilities in post-conflict settings? A cross-sectional study from South Kivu, eastern DR Congo |
title_full |
Are people most in need utilising health facilities in post-conflict settings? A cross-sectional study from South Kivu, eastern DR Congo |
title_fullStr |
Are people most in need utilising health facilities in post-conflict settings? A cross-sectional study from South Kivu, eastern DR Congo |
title_full_unstemmed |
Are people most in need utilising health facilities in post-conflict settings? A cross-sectional study from South Kivu, eastern DR Congo |
title_sort |
are people most in need utilising health facilities in post-conflict settings? a cross-sectional study from south kivu, eastern dr congo |
publisher |
Taylor & Francis Group |
series |
Global Health Action |
issn |
1654-9880 |
publishDate |
2020-12-01 |
description |
Background: The disruptive effect of protracted socio-political instability and conflict on the health systems is likely to exacerbate inequities in health service utilisation in conflict-recovering contexts. Objective: To examine whether the level of healthcare need is associated with health facility utilisation in post-conflict settings. Methods: We conducted a cross-sectional study among adults with diabetes, hypertension, mothers of infants with acute malnutrition, informal caregivers (of participants with diabetes and hypertension) and helpers of mothers of children acutely malnourished, and randomly selected neighbours in South Kivu province, eastern DR Congo. Healthcare need levels were derived from a combination, summary and categorisation of the World Health Organisation Disability Assessment Schedule 2.0. Health facility utilisation was defined as having utilised in the first resort a health post, a health centre or a hospital as opposed to self-medication, traditional herbs or prayer homes during illness in the past 30 days. We used mixed-effects Poisson regression models with robust variance to identify the factors associated with health facility utilisation. Results: Overall, 82% (n = 413) of the participants (N = 504) utilised modern health facilities. Health facility utilisation likelihood was higher by 27% [adjusted prevalence ratio (aPR): 1.27; 95% CI: 1.13–1.43; p < 0.001] and 18% (aPR: 1.18; 95% CI: 1.06–1.30; p = 0.002) among participants with middle and higher health needs, respectively, compared to those with low healthcare needs. Using the lowest health need cluster as a reference, participants in the middle healthcare need cluster tended to have a higher hospital utilisation level. Conclusion: Greater reported healthcare need was significantly associated with health facility utilisation. Primary healthcare facilities were the first resort for a vast majority of respondents. Improving the availability and quality of health service packages at the primary healthcare level is necessary to ensure the universal health coverage goal advocating quality health for all can be achieved in post-conflict settings. |
topic |
health facility utilisation health need post-conflict south kivu dr congo whodas |
url |
http://dx.doi.org/10.1080/16549716.2020.1740419 |
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