Determinants of health insurance ownership among women in Kenya: evidence from the 2008-09 Kenya demographic and health survey.

BACKGROUND: The Government of Kenya is making plans to implement a social health insurance program by transforming the National Hospital Insurance Fund (NHIF) into a universal health coverage program. The objective of this study was to examine the determinants associated with health insurance ownership among women in Kenya. METHODS: Data came from the 2008-09 Kenya Demographic and Health Survey, a nationally representative survey. The sample comprised 8,435 women aged 15-49 years. Descriptive statistics and multivariable logistic regression analysis were used to describe the characteristics of the sample and to identify factors associated with health insurance ownership. RESULTS: Being employed in the formal sector, being married, exposure to the mass media, having secondary education or higher, residing in households in the middle or rich wealth index categories and residing in a female-headed household were associated with having health insurance. However, region of residence was associated with a lower likelihood of having insurance coverage. Women residing in Central (OR = 0.4; p < 0.01) and North Eastern (OR = 0.1; p < 0.5) provinces were less likely to be insured compared to their counterparts in Nairobi province. CONCLUSIONS: As the Kenyan government transforms the NHIF into a universal health program, it is important to implement a program that will increase equity and access to health care services among the poor and vulnerable groups.

Marital status and risk of HIV infection in slum settlements of Nairobi, Kenya: results from a cross-sectional survey.

Kenya still faces major challenges due to the HIV/AIDS epidemic. This study examined the association between marital status and risk of HIV infection in urban slums of Nairobi. Data were derived from a cross-sectional population-based survey nested in an ongoing Demographic Surveillance System in two urban slums in Nairobi. Descriptive statistics and multivariate logistic regression analysis were used to describe the characteristics of the sample and to assess the association between marital status and risk of HIV infection. HIV prevalence among married men and women was 10.4% and 11.1% and among divorced/separated/widowed men and women was 14.9% and 27.9%. Multivariate results showed the risk of acquiring HIV was significantly associated with being married, divorced/separated/widowed, being in the older age groups and the Luo ethnic group. There is urgent need for appropriate HIV prevention interventions targeted at the urban poor to address the high risk of HIV infections in this population.

Delaying sexual debut as a strategy for reducing HIV epidemic in Kenya.

The study purpose was to determine the association between sexual debut and HIV sero-status, and factors contributing to a positive HIV sero-status. Retrospective cross-sectional data from the Kenya Demographic and Health Survey-2003 were used. Data on women aged 15-49 (n = 3,273) and men aged 15-54 (n = 2,917) accepting HIV testing were retained from three datasets. Stata version 10.1 was used for analyses, p < 0.05. Nine percent of women and 5% of men tested positive for HIV, of whom 46% and 49%, p < 0.001 were aged 16-21 respectively. After adjusting for confounding, women and men who had sexual debut aged 16-21 were 2.31 (95% CI: 1.52-3.51), p < 0.001 and 1.83 (95% CI: 1.07-3.13), p < 0.05 times more likely to test positive for HIV compared to those who never had sex respectively. Early sexual debut continues to be a major risk factor for acquiring HIV infection later in life, suggesting earlier interventions could have a major impact towards fighting the disease.

Determinants for participation in a public health insurance program among residents of urban slums in Nairobi, Kenya: results from a cross-sectional survey.

BACKGROUND: The government of Kenya is making plans to implement a social health insurance program by transforming the National Hospital Insurance Fund (NHIF) into a universal health coverage program. This paper examines the determinants associated with participation in the NHIF among residents of urban slums in Nairobi city. METHODS: The study used data from the Nairobi Urban Health and Demographic Surveillance System in two slums in Nairobi city, where a total of about 60,000 individuals living in approximately 23,000 households are under surveillance. Descriptive statistics and multivariate logistic regression analysis were used to describe the characteristics of the sample and to identify factors associated with participation in the NHIF program. RESULTS: Only 10% of the respondents were participating in the NHIF program, while less than 1% (0.8%) had private insurance coverage. The majority of the respondents (89%) did not have any type of insurance coverage. Females were more likely to participate in the NHIF program (OR = 2.4; p < 0.001), while respondents who were formerly in a union (OR = 0.5; p < 0.05) and who were never in a union (OR = 0.6; p < 0.05) were less likely to have public insurance coverage. Respondents working in the formal employment sector (OR = 4.1; p < 0.001) were more likely to be enrolled in the NHIF program compared to those in the informal sector. Membership in microfinance institutions such as savings and credit cooperative organizations (SACCOs) and community-based savings and credit groups were important determinants of access to health insurance. CONCLUSIONS: The proportion of slum residents without any type of insurance is high, which underscores the need for a social health insurance program to ensure equitable access to health care among the poor and vulnerable segments of the population. As the Kenyan government moves toward transforming the NHIF into a universal health program, it is important to harness the unique opportunities offered by both the formal and informal microfinance institutions in improving health care capacity by considering them as viable financing options within a comprehensive national health financing policy framework.

Determinants for HIV testing and counselling in Nairobi urban informal settlements.

BACKGROUND: Counselling and testing is important in HIV prevention and care. Majority of people in sub-Saharan Africa do not know their HIV status and are therefore unable to take steps to prevent infection or take up life prolonging anti-retroviral drugs in time if infected. This study aimed at exploring determinants of HIV testing and counselling in two Nairobi informal settlements. METHODS: Data are derived from a cross-sectional survey nested in an ongoing demographic surveillance system. A total of 3,162 individuals responded to the interview and out of these, 82% provided a blood sample which was tested using rapid test kits. The outcome of interest in this paper was HIV testing status in the past categorised as "never tested"; "client-initiated testing and counselling (CITC)" and provider-initiated testing and counselling (PITC). Multinomial logistic regression was used to identify determinants of HIV testing. RESULTS: Approximately 31% of all respondents had ever been tested for HIV through CITC, 22% through PITC and 42% had never been tested but indicated willingness to test. Overall, 62% of females and 38% of males had ever been tested for HIV. Males were less likely to have had CITC (OR = 0.47; p value < 0.001) and also less likely to have had PITC (OR = 0.16; p value < 0.001) compared to females. Individuals aged 20-24 years were more likely to have had either CITC or PITC compared to the other age groups. The divorced/separated/widowed were more likely (OR = 1.65; p value < 0.01) to have had CITC than their married counterparts, while the never married were less likely to have had either CITC or PITC. HIV positive individuals (OR = 1.60; p value < 0.01) and those who refused testing in the survey (OR = 1.39; p value < 0.05) were more likely to have had CITC compared to their HIV negative counterparts. CONCLUSION: Although the proportion of individuals ever tested in the informal settlements is similar to the national average, it remains low compared to that of Nairobi province especially among men. Key determinants of HIV testing and counselling include; gender, age, education level, HIV status and marital status. These factors need to be considered in efforts aimed at increasing participation in HIV testing.