The association between self-perceived health status and satisfaction with healthcare services: Evidence from Armenia.

BACKGROUND: Armenians very rarely seek healthcare services and, consequently experience more serious health conditions. With its ongoing reforms, Armenia is focusing on linking health system financing to the quality and volume of care provided. We examine the relationship between the perceived health status of the population and the satisfaction with healthcare services. METHODS: A pooled probit model is applied to analyse three datasets (2010, 2011 and 2012) from the Integrated Living Conditions Survey (ILCS). RESULTS: We find a strong association between self-perceived health and satisfaction with healthcare services but this association is not consistent across regions. CONCLUSIONS: The socioeconomic position of the household alone does not explain the perception of individual health status. The perceived dwelling condition and geography of residence emerged as important stressors on associations between the perceived health status of the population and the satisfaction with healthcare services. We have modelled the perceived health status and satisfaction with the healthcare services using demand side datasets. This study establishes the need to re-examine this association in a multidimensional construct.

The determinants of under-5 age children malnutrition and the differences in the distribution of stunting-A study from Armenia.

Stunting undermines economic growth by perpetuating the vicious cycle of poverty and labour market performance. Studies have captured the trend in stunting and present distributional evidence of policy effects in the country contexts. We identify the determinants of U5 (under 5 years of age) malnutrition for the poor and the Nonpoor and compare the distribution of stunting at four time points (2000, 2005, 2010 and 2015) over a 15-year period between different groups of population. Further, we decompose the gap in malnutrition into causes of differences in stunting between worse-off and better-off socioeconomic groups of the population and estimate the magnitude of distributional differences in stunting between two socioeconomic groups. We also present the inequality trend over time that provides insights into the dynamicity of the effect of different determinants on stunting at different time points. Using 35,490 observations from Armenian Demographic and Health Survey Data [four waves: Year2015,9533; Year2010,8644; Year2005,8919; Year2000,8334], we apply regression-based decomposition method and inequality measures to identify the determinants of malnutrition and distribution of stunting between and within socioeconomic groups. Although the proportional difference in prevalence of stunting between worse-off and better-off children of 13 months and above are reduced by 9.5% in 2015 compared to 2000, the association between socioeconomic position and stunting is statistically significant among children aged 13 months and above in 2000, as well as among children of 36 months and above in 2015. This study demonstrates that the less of socioeconomic distribution of the population, but rather more of the effect from in-country region and settlement of residence are significantly associated with stunting. The approach of our analysis is potentially also a useful tool to generate evidence for decision making towards achieving SDGs 2.2. We conclude that development in childhood is not independent from the distributional effect of region specific development initiatives. Understanding the regional characteristics and resources allocated for the maternal and child health is the necessity to address stunting.

Infant mortality in Armenia, 1992-2003.

Health system reforms have been taken in Armenia during a time of dramatic economic and fiscal distress. It is important to assess trends in health indicators and ascertain if the changes in socio-economic systems affected the health status of infants as the most vulnerable part of the population. We find that infant mortality has fallen during the period c. 1992-2003 in spite of the difficult economic circumstances because of health-care procedures that were introduced. Particular attention is paid to the underreporting of infants' death cases in the state registration system as well as to estimating the role of different factors influencing infant mortality in Armenia.

Infant mortality decline in Armenia: Why with uneven rates?

In this paper we analyse infant mortality in Armenia in terms of not only its socio-economic and geographic distribution but also changes in its age structure. Primary data on live births and infant deaths recorded in the official statistics and data of "Armenia Demographic and Health Survey 2005" are studied. We find that the socio-economically disadvantaged portion of the Armenian population is at a significantly increased risk of infant mortality; that geographically the mortality risk is unequally distributed, and is highest in the poorest region, Shirak; and that the recorded decline in infant mortality is due entirely to a decline in post-neonatal mortality, with neonatal deaths currently accounting for more than 75% of infant mortality as a whole. We conclude that efforts to reduce infant mortality in Armenia, and probably in the rest of this region of Commonwealth of Independent States, must involve policies and strategies that target infants' survival in at-risk populations, living in at-risk geographical regions, as well as addressing the issue of neonatal mortality among all Armenians.