加纳儿童健康结局和服务利用相关因素的决定因素：2011 年进行的多指标类集调查。
Determinant of factors associated with child health outcomes and service utilization in Ghana: multiple indicator cluster survey conducted in 2011.
机构信息
Department of Biostatistics, School of Public Health University of Ghana, Legon, Ghana.
Department of Biological Environmental and Occupational Health Sciences, School of Public Health, University of Ghana, Legon, Ghana.
出版信息
Arch Public Health. 2014 Dec 1;72(1):42. doi: 10.1186/2049-3258-72-42. eCollection 2014.
BACKGROUND
The effects of National Health Insurance Scheme in Ghana and its impact on child health outcome and service utilization cannot be underestimated. Despite the tremendous improvement in child health care in Ghana, there are still some challenges in relation to how National health insurance membership, socioeconomic status and other demographic factors impacts on child health outcomes. The study seeks to determine the association between NHIS membership, socio-economic status, geographic location and other relevant background factors, on child health service utilization and outcomes.
METHODS
Secondary data from the Multiple Indicator Cluster Survey conducted in 2011 was used. Multivariate analysis based on Binary Logistic Regression Models and Multiple linear regression techniques was applied to determine factors associated with child health outcomes and service utilization. Collection of best models was based on Hosmer-Lemeshow Goodness-Of-Fit as one criterion of fit and the Akaike Information Criterion.
RESULTS
Controlling for confounding effect of socioeconomic status, age of the child, mothers education level and geographic location, the odds of a child developing anemia for children with National Health Insurance Scheme Membership is 65.2% [95% CI: 52.9-80.2] times less than children without National Health Insurance Scheme Membership. The odds of being fully immunized against common childhood illnesses for children with NHIS membership is 2.3[95% CI: 1.4-3.7] times higher than children without National Health Insurance Scheme Membership. There was no association between National Health Insurance Scheme Membership and stunted growth in children.
CONCLUSIONS
National Health Insurance Scheme Membership was found to be related to child health service utilization (full immunization) of children under five a child's anemia status. Children with NHIS are more likely to be fully immunized against common childhood diseases and are less likely to develop anemia. Stunted growth of children was not associated with National Health Insurance Scheme Membership. Health Education on the registration and the use of the National Health Insurance should be made a national priority to enable the Ministry of Health achieve routine Immunization targets and to reduce to the bearers minimum prevalence of anemia.
背景
加纳国家健康保险计划的实施效果及其对儿童健康结果和服务利用的影响不可低估。尽管加纳儿童保健工作取得了巨大进展，但在国家健康保险参保情况、社会经济地位和其他人口统计因素如何影响儿童健康结果方面仍存在一些挑战。本研究旨在确定 NHIS 参保情况、社会经济地位、地理位置和其他相关背景因素与儿童卫生服务利用和结果之间的关联。
方法
使用 2011 年进行的多指标类集调查的二级数据。应用基于二元逻辑回归模型和多元线性回归技术的多变量分析，确定与儿童健康结果和服务利用相关的因素。最佳模型的选择基于 Hosmer-Lemeshow 拟合优度，这是拟合的一个标准，以及赤池信息量准则。
结果
在控制社会经济地位、儿童年龄、母亲教育水平和地理位置等混杂因素的影响后，参加国家健康保险计划的儿童患贫血的几率是非参加者的 65.2%[95%CI：52.9-80.2]。参加国家健康保险计划的儿童完全接种常见儿童疾病疫苗的几率是非参加者的 2.3[95%CI：1.4-3.7]倍。国家健康保险计划的参加与儿童生长迟缓之间没有关联。
结论
国家健康保险计划的参加与五岁以下儿童的卫生服务利用（完全免疫）和儿童贫血状况有关。参加 NHIS 的儿童更有可能完全接种常见儿童疾病疫苗，并且不太可能患贫血。儿童生长迟缓与国家健康保险计划的参加无关。应将 NHIS 的注册和使用方面的健康教育作为国家重点，使卫生部能够实现常规免疫目标，并将贫血的发生率降到最低。
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