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Research article
Determinants of Orthopaedic Service Utilisation among Young People Aged 5-24 Years Old in Zambia
Queen Elizabeth Seketi
The University of Zambia School of Public Health
Corresponding Author
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Background
Musculoskeletal conditions and/or disorders (MSDs), which affect muscles, tendons and ligaments, are the main causes of disability in many patients even though such disorders can be addressed through orthopaedic care. Little was known on the determinants of Orthopaedic services utilisation among young people between the ages of 5-24 in Zambia.
Methods
An embedded mixed methods design was used to conduct a hospital based cross sectional study that focused on high and low level of orthopaedic services utilisation. Stratified random sampling was used to draw a sample of 162 children and young people (5-24) from the hospital registers. Purposive sampling was used for eight service providers and convenient sampling for 10 parents and six young people. A data extraction checklist and self-administered questionnaires were for service providers. In-depth interviews with parents and a focus group discussion with six clients aged 15 to 24. Quantitative data was analysed using STATA version 14. Statistical tests included chi square, univariate and investigator led stepwise multiple logistic regression. Content and thematic analysis were done for qualitative data.
Results
41 percent of clients had high level of service utilisation. Physiotherapy clients were 84 percent significantly less likely to use services compared to clients from prosthetic and orthotics workshops [AOR 0.16; 95% CI 0.05, 0.59; P=0.01]. Clients living in low density residential areas were 86 percent times less likely to use Orthopaedic services compared to those in high density residential areas [AOR 0.14; 95% CI 0.05, 0.43; P<0.0001]. Participants without Insurance were 83 percent less likely to use Orthopaedic services compared to those with Insurance [AOR 0.17; 95% CI 0.05, 0.55; P=0.003]. At service level, barriers were inadequate financial and human resources. For care givers,key barriers included inadequate information about practices and other essential health actions to manage MSDs at home; costs of transport and fear of marital discord to discuss matters at length.
Conclusion The type of service used, area of residence and Health Insurance are significant determinants of Orthopaedic services utilisation. It is highly recommended that such services be decentralised to address key family barriers. Inadequate resources for orthopaedic service provision also need to be adequately addressed.
Keywords
Orthopaedic, Utilisation, level, Determinants, Disability
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This is a preprint. It has not completed peer review.
Research article
Determinants of Orthopaedic Service Utilisation among Young People Aged 5-24 Years Old in Zambia
Queen Elizabeth Seketi
The University of Zambia School of Public Health
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 15 Jan, 2020
No community comments so far
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Orthopedics
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Musculoskeletal conditions and/or disorders (MSDs), which affect muscles, tendons and ligaments, are the main causes of disability in many patients even though such disorders can be addressed through orthopaedic care. Little was known on the determinants of Orthopaedic services utilisation among young people between the ages of 5-24 in Zambia.
Methods
An embedded mixed methods design was used to conduct a hospital based cross sectional study that focused on high and low level of orthopaedic services utilisation. Stratified random sampling was used to draw a sample of 162 children and young people (5-24) from the hospital registers. Purposive sampling was used for eight service providers and convenient sampling for 10 parents and six young people. A data extraction checklist and self-administered questionnaires were for service providers. In-depth interviews with parents and a focus group discussion with six clients aged 15 to 24. Quantitative data was analysed using STATA version 14. Statistical tests included chi square, univariate and investigator led stepwise multiple logistic regression. Content and thematic analysis were done for qualitative data.
Results
41 percent of clients had high level of service utilisation. Physiotherapy clients were 84 percent significantly less likely to use services compared to clients from prosthetic and orthotics workshops [AOR 0.16; 95% CI 0.05, 0.59; P=0.01]. Clients living in low density residential areas were 86 percent times less likely to use Orthopaedic services compared to those in high density residential areas [AOR 0.14; 95% CI 0.05, 0.43; P<0.0001]. Participants without Insurance were 83 percent less likely to use Orthopaedic services compared to those with Insurance [AOR 0.17; 95% CI 0.05, 0.55; P=0.003]. At service level, barriers were inadequate financial and human resources. For care givers,key barriers included inadequate information about practices and other essential health actions to manage MSDs at home; costs of transport and fear of marital discord to discuss matters at length.
Conclusion The type of service used, area of residence and Health Insurance are significant determinants of Orthopaedic services utilisation. It is highly recommended that such services be decentralised to address key family barriers. Inadequate resources for orthopaedic service provision also need to be adequately addressed.
Figure 1
Figure 2