Catastrophic health expenditure among ex-Gazan families in Jerash camp, Jordan.

OBJECTIVES: This study investigated the magnitude of catastrophic health expenditure (CHE) among ex-Gazan households in Jerash camp in Jordan. STUDY DESIGN: This retrospective survey used a systematic sample. METHODS: A systematic sample was used wherein every fifth house in Jerash camp was invited to participate in the study. The camp represents the largest community of ex-Gazan refugees in Jerash camp. Of the 1038 households who were invited, 976 households agreed to participate (response rate = 94%) and filled the pilot-structured questionnaire with information related to their socio-economic characteristics, health status, and their healthcare and total household expenditures. van Doorslaer's method was used to calculate the frequency of CHE, wherein the expenditure on health care was considered catastrophic if it exceeded 10% of a household's total expenditure. RESULTS: Of the sample, 41.8% suffered from CHE. Moreover, we calculated the frequency of CHE using 15%, 20%, 30%, and 40% as threshold values, and the total rates were 14.7, 6.3, 1, and 0.3%, respectively. In addition, the statistical analysis of the results showed higher frequencies of CHE in households with larger number of dependents, those headed by widowed women, and those with history of hospitalizations. CONCLUSIONS: The study shows that the rate of CHE in Jerash camp is very high and mainly due to the cost of hospitalization. Special attention should be paid for the residents of that area.

"We need good nutrition but we have no money to buy food": sociocultural context, care experiences, and newborn health in two UNHCR-supported camps in South Sudan.

BACKGROUND: Determinants of newborn health and survival exist across the reproductive life cycle, with many sociocultural and contextual factors influencing outcomes beyond the availability of, and access to, quality health services. In order to better understand key needs and opportunities to improve newborn health in refugee camp settings, we conducted a multi-methods qualitative study of the status of maternal and newborn health in refugee camps in Upper Nile state, South Sudan. METHODS: In 2016, we conducted 18 key informant interviews with health service managers and front-line providers and 13 focus group discussions in two Sudanese refugee camps in Maban County, South Sudan. Our focus group discussions comprised 147 refugee participants including groups of mothers, fathers, grandmothers, traditional birth attendants, community health workers, and midwives. We analysed our data for content and themes using inductive and deductive techniques. RESULTS: We found both positive practices and barriers to newborn health in the camps throughout the reproductive lifecycle. Environmental and contextual factors such as poor nutrition, lack of livelihood opportunities, and insecurity presented barriers to both general health and self-care during pregnancy. We found that the receipt of material incentives is one of the leading drivers of utilization of antenatal care and facility-based childbirth services. Barriers to facility-based childbirth included poor transportation specifically during the night; insecurity; being accustomed to home delivery; and fears of an unfamiliar birth environment, caesarean section, and encountering male health care providers during childbirth. Use of potentially harmful traditional practices with the newborn are commonplace including mixed feeding, use of herbal infusions to treat newborn illnesses, and the application of ash and oil to the newborn's umbilicus. CONCLUSIONS: Numerous sociocultural and contextual factors impact newborn health in this setting. Improving nutritional support during pregnancy, strengthening community-based transportation for women in labour, allowing a birth companion to be present during delivery, addressing harmful home-based newborn care practices such as mixed feeding and application of foreign substances to the umbilicus, and optimizing the networks of community health workers and traditional birth attendants are potential ways to improve newborn health outcomes.