Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2015

Open Access 01-12-2015 | Research

Determinants of access to healthcare by older persons in Uganda: a cross-sectional study

Authors: Stephen Ojiambo Wandera, Betty Kwagala, James Ntozi

Published in: International Journal for Equity in Health | Issue 1/2015

Login to get access

Abstract

Background

Older persons report poor health status and greater need for healthcare. However, there is limited research on older persons’ healthcare disparities in Uganda. Therefore, this paper aimed at investigating factors associated with older persons’ healthcare access in Uganda, using a nationally representative sample.

Methods

We conducted secondary analysis of data from a sample of 1602 older persons who reported being sick in the last 30 days preceding the Uganda National Household Survey. We used frequency distributions for descriptive data analysis and chi-square tests to identify initial associations. We fit generalized linear models (GLM) with the poisson family and the log link function, to obtain incidence risk ratios (RR) of accessing healthcare in the last 30 days, by older persons in Uganda.

Results

More than three quarters (76%) of the older persons accessed healthcare in the last 30 days. Access to healthcare in the last 30 days was reduced for older persons from poor households (RR = 0.91, 95% CI: 0.83-0.99); with some walking difficulty (RR = 0.90, 95% CI: 0.83-0.97); or with a lot of walking difficulty (RR = 0.84, 95% CI: 0.75-0.95). Conversely, accessing healthcare in the last 30 days for older persons increased for those who earned wages (RR = 1.08, 95% CI: 1.00-1.15) and missed work due to illness for 1–7 days (RR = 1.19, 95% CI: 1.10-1.30); and 8–14 days (RR = 1.19, 95% CI: 1.07-1.31). In addition, those who reported non-communicable diseases (NCDs) such as heart disease, hypertension or diabetes (RR = 1.09, 95% CI: 1.01-1.16); were more likely to access healthcare during the last 30 days.

Conclusion

In the Ugandan context, health need factors (self-reported NCDs, severity of illness and mobility limitations) and enabling factors (household wealth status and earning wages in particular) were the most important determinants of accessing healthcare in the last 30 days among older persons.
Appendix
Available only for authorised users
Literature
1.
Ameh S, Gómez-Olivé FX, Kahn K, Tollman SM, Klipstein-Grobusch K. Predictors of health care use by adults 50 years and over in a rural South African setting. Global Health Action. 2014;7:24771.CrossRefPubMed
2.
UNFPA, HAI. Ageing in the twenty-first century: a celebration and a challenge. London: United Nations Population Fund (UNFPA), New York, and HelpAge International; 2012.
3.
4.
Aboderin I, Ferreira M. Linking ageing to development agendas in Sub-Saharan Africa: challenges and approaches. Population Ageing. 2008;1:51–73.CrossRef
5.
UBOS. Uganda national household survey 2009–2010. Socio-economic module. Abridged report. Kampala, Uganda: Uganda Bureau of Statistics; 2010.
6.
7.
AU. Africa health strategy: 2007–2015. Addis Ababa: African Union; 2007.
8.
MoGLSD. National Policy for Older Persons: Ageing with Security and Dignity. Kampala, Uganda: Ministry of Gender, Labour and Social Development; 2009.
9.
Kyobutungi C, Ezeh A, Zulu E, Falkingham J. HIV/AIDS and the health of older people in the slums of Nairobi, Kenya: results from a cross sectional survey. BMC Public Health. 2009;9:153.CrossRefPubMedCentralPubMed
10.
Ezeh A, Chepngeno-Langat G, Abdhalah Z, Woubalem Z. The situation of older people in poor urban settings: the case of Nairobi, Kenya. In: Cohen B, Menken J, editors. Aging in Sub-Saharan Africa: recommendations for furthering research. Washington, US: The National Academies Press; 2006. p. 7–45.
11.
MRC, UVRI. Direct and indirect effects of HIV/AIDS and anti-retroviral treatment on the health and wellbeing of older people. In: WHO’s Study on global AGEing and adult health (SAGE). Kampala: Uganda Virus Research Institute & Medical Research Council; 2011.
12.
Gómez-Olivé FX, Thorogood M, Clark B, Kahn K, Tollman S. Self-reported health and health care use in an ageing population in the Agincourt sub-district of rural South Africa. 2013.
13.
Aboderin I. Understanding and advancing the health of older populations in sub-Saharan Africa: policy perspectives and evidence needs. Public Health Rev. 2010;32:357–76.
14.
UN. Madrid International Plan of Action on Ageing (MIPAA). New York (NY): United Nations; 2002.
15.
Mulumba M, Nantaba J, Brolan C, Ruano A, Brooker K, Hammonds R. Perceptions and experiences of access to public healthcare by people with disabilities and older people in Uganda. Int J Equity Health. 2014;13:76.CrossRefPubMedCentral
16.
Debpuur CY, Welaga P, Wak G, Hodgson A. Self-reported health and functional limitations among older people in the Kassena-Nankana District, Ghana. 2010.
17.
Gómez-Olivé FX, Thorogood M, Clark B, Kahn K, Tollman S. Assessing health and well-being among older people in rural South Africa. Global Health Action. 2010;2:23–35.
18.
Kowal P, Kahn K, Ng N, Naidoo N, Adbullah S, Bawah A, et al. Ageing and adult health status in eight lower-income countries: the INDEPTH WHO-SAGE collaboration. 2010.
19.
Kyobutungi C, Egondi T, Ezeh A. The health and well-being of older people in Nairobi’s slums. Global Health Action. 2010;3:45–53.CrossRef
20.
Mwanyangala MA, Mayombana C, Urassa H, Charles J, Mahutanga C, Abdullah S, et al. Health status and quality of life among older adults in rural Tanzania. 2010.
21.
Minh HV, Byass P, Chuc NTK, Wall S. Patterns of health status and quality of life among older people in rural Viet Nam. 2010.
22.
Scholten F, Mugisha J, Seeley J, Kinyanda E, Nakubukwa S, Kowal P, et al. Health and functional status among older people with HIV/AIDS in Uganda. BMC Public Health. 2011;11:886.CrossRefPubMedCentralPubMed
23.
Ng N, Hakimi M, Byass P, Wilopo S, Wall S. Health and quality of life among older rural people in Purworejo District, Indonesia. 2010.
24.
Razzaque A, Nahar L, Khanam MA, Streatfield PK. Socio-demographic differentials of adult health indicators in Matlab, Bangladesh: self-rated health, health state, quality of life and disability level. 2010.
25.
Nankwanga A, Phillips J, Neema S. Exploring and curbing the effects of HIV/AIDS on elderly people in Uganda. J Comm Health Sci. 2009;4:19–30.
26.
Ntozi JPM, Nakayiwa S. AIDS in Uganda: how has the household coped with the epidemic. Cont Afr HIV/AIDS Epidemic. 1999;2:155–81.
27.
Seeley J, Kabunga E, Tumwekwase G, Wolff B, Grosskurth H: The Impact of the AIDS Epidemic on the Lives of Older People in Rural Uganda. DEV Working Paper 04; 2008.
28.
Seeley J, Wolff B, Kabunga E, Tumwekwase G, Grosskurth H. ‘This is where we buried our sons’: people of advanced old age coping with the impact of the AIDS epidemic in a resource-poor setting in rural Uganda. Ageing Soc. 2009;29:115.CrossRef
29.
Golaz V, Rutaremwa G. The vulnerability of older adults: what do census data say? An application to Uganda. Afr Popul Stud. 2011;26:605–22.
30.
Ssengooba F, Rahman S, Hongoro C, Rutebemberwa E, Mustafa A, Kielmann T, et al. Health sector reforms and human resources for health in Uganda and Bangladesh: mechanisms of effect. Hum Resour Health. 2007;5:3.CrossRefPubMedCentralPubMed
31.
Hjelm K, Atwine F: Health-care seeking behaviour among persons with diabetes in Uganda: an interview study. BMC International Health and Human Rights 2011, 11.
32.
Pariyo G, Ekirapa-Kiracho E, Okui O, Rahman M, Peterson S, Bishai D, et al. Changes in utilization of health services among poor and rural residents in Uganda: are reforms benefitting the poor? Int J Equity Health. 2009;8:39.CrossRefPubMedCentralPubMed
33.
Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36(March):1–10.CrossRefPubMed
34.
Andersen RM. National health surveys and the behavioral model of health services Use. Med Care. 2008;46:647–53.CrossRefPubMed
35.
Barros AJ, Hirakata VN. Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol. 2003;3:21.CrossRefPubMedCentralPubMed
36.
Coutinho LM, Scazufca M, Menezes PR. Methods for estimating prevalence ratios in cross-sectional studies. Rev Saude Publica. 2008;42:992–8.CrossRefPubMed
37.
Lee J, Tan CS, Chia KS. A practical guide for multivariate analysis of dichotomous outcomes. Ann Acad Med Singapore. 2009;38:714–9.PubMed
38.
Wanyenze R, Kyaddondo D, Kinsman J, Makumbi F, Colebunders R, Hardon A. Client-provider interactions in provider-initiated and voluntary HIV counseling and testing services in Uganda. BMC Health Serv Res. 2013;13:423.CrossRefPubMedCentralPubMed
39.
Burström B. Increasing inequalities in health care utilisation across income groups in Sweden during the 1990s? Health Policy. 2002;62:117–29.CrossRefPubMed
40.
Morris S, Sutton M, Gravelle H. Inequity and inequality in the use of health care in England: an empirical investigation. Soc Sci Med. 2005;60:1251–66.CrossRefPubMed
41.
van Doorslaer E, Masseria C, Koolman X, Group ftOHER. Inequalities in access to medical care by income in developed countries. Can Med Assoc J. 2006;174:177–83.CrossRef
42.
Hoeck S, Francois G, Van der Heyden J, Geerts J, Van Hal G. Healthcare utilisation among the Belgian elderly in relation to their socio-economic status. Health Policy. 2011;99:174–82.CrossRefPubMed
43.
Lima-Costa MF, Barreto S, Giatti L, Uchoa E. [Socioeconomic circumstances and health among the brazilian elderly: a study using data from a National Household Survey]. Cad Saude Publica. 2003;19:745–57.CrossRefPubMed
44.
Sato A. Does socio-economic status explain use of modern and traditional health care services? Soc Sci Med. 2012;75:1450–9.CrossRefPubMed
45.
Channon AA, Andrade MV, Noronha K, Leone T, Dilip TR. Inpatient care of the elderly in Brazil and India: Assessing social inequalities. Soc Sci Med. 2012;75:2394–402.CrossRefPubMedCentralPubMed
46.
Yam H-K, Mercer SW, Wong L-Y, Chan W-K, Yeoh E-K. Public and private healthcare services utilization by non-institutional elderly in Hong Kong: Is the inverse care law operating? Health Policy. 2009;91:229–38.CrossRefPubMed
47.
Luo J, Zhang X, Jin C, Wang D. Inequality of access to health care among the urban elderly in northwestern China. Health Policy. 2009;93:111–7.CrossRefPubMed
48.
Corrieri S, Heider D, Matschinger H, Lehnert T, Raum E, Konig H-H. Income-, education- and gender-related inequalities in out-of-pocket health-care payments for 65+ patients - a systematic review. Int J Equity Health. 2010;9:20.CrossRefPubMedCentralPubMed
49.
Manski RJ, Moeller JF, Chen H, Schimmel J, St Clair PA, Pepper JV. Patterns of older Americans’ health care utilization over time. Am J Public Health. 2013;103:1314–24.CrossRefPubMedCentralPubMed
50.
George P, Heng B, De Castro MJ, Wong L, Wei Lin N, Cheah JT. Self-reported chronic diseases and health status and health service utilization - Results from a community health survey in Singapore. Int J Equity Health. 2012;11:44.CrossRefPubMedCentralPubMed
51.
Gómez-Olivé FX, Thorogood M, Clark B, Kahn K, Tollman S. Self-reported health and health care use in an ageing population in the Agincourt sub-district of rural South Africa. Global Health Action. 2013;6:19305.CrossRefPubMed
52.
Wong R, Diaz JJ. Health care utilization among older Mexicans: health and socioeconomic inequalities. Salud Publica Mex. 2007;49 Suppl 4:S505–514.PubMed
53.
Redondo-Sendino Á, Guallar-Castillón P, Ramón Banegas J, Rodríguez-Artalejo F. Gender differences in the utilization of health-care services among the older adult population of Spain. BMC Public Health. 2006;6:155.CrossRefPubMedCentralPubMed
54.
Wang H, Chen K, Pan Y, Jing F, Liu H. Associations and impact factors between living arrangements and functional disability among older Chinese adults. PLoS One. 2013;8:e53879.CrossRefPubMedCentralPubMed
55.
Drainoni M-L, Lee-Hood E, Tobias C, Bachman SS, Andrew J, Maisels L. Cross-disability experiences of barriers to health-care access: consumer perspectives. J Disabil Policy Stud. 2006;17:101–15.CrossRef
56.
Wamala S, Merlo J, Bostrom G, Hogstedt C. Perceived discrimination, socioeconomic disadvantage and refraining from seeking medical treatment in Sweden. J Epidemiol Community Health. 2007;61:409–15.CrossRefPubMedCentralPubMed
57.
Horner-Johnson W, Dobbertin K, Lee JC, Andresen EM. Disparities in chronic conditions and health status by type of disability. Disabil Health J. 2013;6:280–6.CrossRefPubMedCentralPubMed
58.
Lezzoni LI, Frakt AB, Pizer SD. Uninsured persons with disability confront substantial barriers to health care services. Disabil Health J. 2011;4:238–44.CrossRef
59.
Smith DL. Disparities in healthcare access for older adults with disabilities. Topics Geriatric Rehabilitation. 2008;24:192–203.CrossRef
60.
Freitas MC, Ribeiro LC, Vieira Mde T, Teixeira MT, Bastos RR, Leite IC. Factors associated with the use of the Papanicolaou smear screening among older women in the interior of Brazil. Rev Bras Ginecol Obstet. 2012;34:432–7.CrossRefPubMed
61.
Wolf JH, Breslau N, Ford AB, Ziegler HD, Ward A. Access of the black urban elderly to medical care. J Natl Med Assoc. 1983;75:41–6.PubMedCentralPubMed
62.
Metadata
Title
Determinants of access to healthcare by older persons in Uganda: a cross-sectional study
Authors
Stephen Ojiambo Wandera
Betty Kwagala
James Ntozi
Publication date
01-12-2015
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2015
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-015-0157-z

Other articles of this Issue 1/2015

International Journal for Equity in Health 1/2015 Go to the issue

Research Article

Client/patient perceptions of achieving equity in primary health care: a mixed methods study

Research

A cross-sectional study of socio-demographic factors associated with patient access to primary care in Slovenia

Research

A tale of two epidemics: gender differences in socio-demographic characteristics and sexual behaviors among HIV positive individuals in Mexico City

Research

Cameroon public health sector: shortage and inequalities in geographic distribution of health personnel

Study protocol

EQUIP Healthcare: An overview of a multi-component intervention to enhance equity-oriented care in primary health care settings

Research

Integrating spatial technology into studying the generational differences of migrants’ health protection status in urban China