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Access to primary healthcare services and associated factors in urban slums in Nairobi-Kenya

机译：内罗毕肯尼亚城市贫民窟的主要医疗服务和相关因素

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BACKGROUND:Access to primary healthcare is crucial for the delivery of Kenya's universal health coverage policy. However, disparities in healthcare have proved to be the biggest challenge for implementing primary care in poor-urban resource settings. In this study, we assessed the level of access to primary healthcare services and associated factors in urban slums in Nairobi-Kenya.METHODS:The data were drawn from the Lown scholars' study of 300 randomly selected households in Viwandani slums (Nairobi, Kenya), between June and July 2018. Access to primary care was measured using Penchansky and Thomas' model. Access index was constructed using principal component analysis and recorded into tertiles with categories labeled as poor, moderate, and highest. Generalized ordinal logistic regression analysis was used to determine the factors associated with access to primary care. The adjusted odds ratios (AOR) and 95% confidence intervals were used to interpret the strength of associations.RESULTS:The odds of being in the highest access tertile versus the combined categories of lowest and moderate access tertile were three times higher for males than female-headed households (AOR 3.05 [95% CI 1.47-6.37]; p??.05). Households with an average quarterly out-of-pocket healthcare expenditure of ≥USD 30 had significantly lower odds of being in the highest versus combined categories of lowest and moderate access tertile compared to those spending ≤ USD 5 (AOR 0.36 [95% CI 0.18-0.74]; p??.05). Households that sought primary care from private facilities had significantly higher odds of being in the highest versus combined categories of lowest and moderate access tertiles compared to those who sought care from public facilities (AOR 6.64 [95% CI 3.67-12.01]; p??.001).CONCLUSION:In Nairobi slums in Kenya, living in a female-headed household, seeking care from a public facility, and paying out-of-pocket for healthcare are significantly associated with low access to primary care. Therefore, the design of the UHC program in this setting should prioritize quality improvement in public health facilities and focus on policies that encourage economic empowerment of female-headed households to improve access to primary healthcare.
机译：背景：获取初级医疗保健对于交付肯尼亚的普遍健康保险政策至关重要。然而，医疗保健的差异已被证明是在城市资源环境中实施初级保健的最大挑战。在这项研究中，我们评估了内罗毕肯尼亚的城市贫民窟初级医疗服务和相关因素的进入水平：从viwandani贫民窟的300名随机选择的家庭的leown学者的研究中汲取了数据（内罗毕，肯尼亚） ，2018年6月至7月期间。使用Penchansky和Thomas的模型测量初级保健的访问。使用主成分分析构建访问索引，并记录到与标记为差，中等和最高的类别的Tertiles。广义序数逻辑回归分析用于确定与初级保健获取相关的因素。调整后的赔率比（AOR）和95％的置信区间用于解释关联的强度。结果：在最高通道的比率与最低和中等接入特性的组合类别比女性比女性更高三倍-howed户（AOR 3.05 [95％CI 1.47-6.37]; p？<〜05）。与花费≤USD5相比，具有≥USD30的平均零售保健支出的家庭≥USD30的≥USD30的最低和中等接入型截图的差异显着较低（AOR 0.36 [95％CI 0.18- 0.74]; p？<？05）。与那些寻求公共设施的人相比，私人设施初级护理的家庭从私人设施中获取私人保险的初级保险的几率明显较高，而且适度的接入泰姬剂（AOR 6.64 [95％CI 3.67-12.01]; P？< ？.001）.Conclusion：在肯尼亚的内罗毕贫民窟，生活在一个女性户主的家庭中，寻求从公共设施的护理，并支付医疗保健的口袋与低获取初级保健有关。因此，该环境中的UHC计划的设计应优先考虑公共卫生设施的质量改善，并专注于鼓励经济赋权的政策，以改善原发性医疗保健的获取。

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