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Research article
Access to primary healthcare services and associated factors in urban slums in Nairobi-Kenya
Peter O. Otieno
African Population and Health Research Center
Corresponding Author
ORCiD: https://orcid.org/0000-0001-6828-8301
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Public Health.
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 percent 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.
Keywords
Access to primary healthcare, Universal health coverage, Urban slums, Penchansky and Thomas’s model.
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CURRENT STATUS: Published
Version 4
Posted 13 Jun, 2020
No comments provided
Editorial decision: Minor revision
On 02 Jun, 2020
Reviewers invited
Invitations sent on 28 May, 2020
Reviewer #1 agreed
On 28 May, 2020
Review #1 received
Received 28 May, 2020
Editor assigned
On 26 May, 2020
Submission checks complete
On 25 May, 2020
Editor invited
On 25 May, 2020
Community comments: 1
Editorial decision: Major revision
On 15 Apr, 2020
Review #2 received
Received 15 Apr, 2020
Reviewer #2 agreed
On 25 Mar, 2020
Reviewers invited
Invitations sent on 20 Mar, 2020
Reviewer #1 agreed
On 20 Mar, 2020
Review #1 received
Received 20 Mar, 2020
Editor assigned
On 17 Feb, 2020
Submission checks complete
On 16 Feb, 2020
Editor invited
On 16 Feb, 2020
No comments provided
Editorial decision: Major revision
On 08 Jan, 2020
Review #2 received
Received 06 Jan, 2020
Review #3 received
Received 23 Dec, 2019
Review #1 received
Received 18 Dec, 2019
Reviewer #3 agreed
On 26 Nov, 2019
Reviewer #1 agreed
On 25 Nov, 2019
Reviewer #2 agreed
On 25 Nov, 2019
Reviewers invited
Invitations sent on 21 Nov, 2019
Editor invited
On 05 Nov, 2019
Editor assigned
On 05 Nov, 2019
Submission checks complete
On 04 Nov, 2019
First submitted
On 23 Oct, 2019
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Subject Areas
Health Policy
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This preprint is under consideration at BMC Public Health. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Access to primary healthcare services and associated factors in urban slums in Nairobi-Kenya
Peter O. Otieno
African Population and Health Research Center
Corresponding Author
ORCiD: https://orcid.org/0000-0001-6828-8301
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 4
Posted 13 Jun, 2020
No comments provided
Editorial decision: Minor revision
On 02 Jun, 2020
Reviewers invited
Invitations sent on 28 May, 2020
Reviewer #1 agreed
On 28 May, 2020
Review #1 received
Received 28 May, 2020
Editor assigned
On 26 May, 2020
Submission checks complete
On 25 May, 2020
Editor invited
On 25 May, 2020
Community comments: 1
Editorial decision: Major revision
On 15 Apr, 2020
Review #2 received
Received 15 Apr, 2020
Reviewer #2 agreed
On 25 Mar, 2020
Reviewers invited
Invitations sent on 20 Mar, 2020
Reviewer #1 agreed
On 20 Mar, 2020
Review #1 received
Received 20 Mar, 2020
Editor assigned
On 17 Feb, 2020
Submission checks complete
On 16 Feb, 2020
Editor invited
On 16 Feb, 2020
No comments provided
Editorial decision: Major revision
On 08 Jan, 2020
Review #2 received
Received 06 Jan, 2020
Review #3 received
Received 23 Dec, 2019
Review #1 received
Received 18 Dec, 2019
Reviewer #3 agreed
On 26 Nov, 2019
Reviewer #1 agreed
On 25 Nov, 2019
Reviewer #2 agreed
On 25 Nov, 2019
Reviewers invited
Invitations sent on 21 Nov, 2019
Editor invited
On 05 Nov, 2019
Editor assigned
On 05 Nov, 2019
Submission checks complete
On 04 Nov, 2019
First submitted
On 23 Oct, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Health Policy
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Public Health.
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 percent 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.