9 research outputs found
Decomposition of socioeconomic inequalities in cigarette smoking: the case of Namibia
Background
Namibia has one of the highest levels of income inequality in the world. Increased smoking prevalence, especially among the youth, may leave the country facing the spectre of higher smoking-related disease prevalence in the years to come. This study examines socioeconomic inequalities in smoking in Namibia and explores the drivers of this inequality.
Methods
Data are obtained from the Namibia 2013 Demographic and Health Survey, a nationally representative survey. Concentration curves and indices are calculated for cigarette smoking prevalence and intensity to assess the respective inequalities. Smoking intensity is defined as the number of cigarette sticks smoked within the last 24 h before the survey. We use a decomposition technique to identify the contribution of various covariates to socioeconomic inequalities in smoking prevalence and intensity.
Results
The concentration indices for socioeconomic inequality in cigarette smoking prevalence and smoking intensity are estimated at 0.021 and 0.135, respectively. This suggests that cigarette smoking is more prevalent among the wealthy and that they smoke more frequently compared to less wealthy Namibians. For smoking intensity, the biggest statistically significant contributors to inequality are marital status, wealth and region dummy variables while for smoking prevalence, education and place of dwelling (urban vs rural) are the main contributors.
Conclusion
While overall inequality in smoking prevalence and intensity is focused among the wealthy, the contribution of region of residence and education warrant some attention from policy makers. Based on our results, we suggest an assessment of compliance and enforcement of the Tobacco Products Control Act, that initially focuses on regions with reportedly low education statistics followed by an appropriate implementation strategy to address the challenges identified in implementing effective tobacco control interventions
A qualitative review of implementer perceptions of the national community-level malaria surveillance system in Southern Province, Zambia
BACKGROUND: Parts of Zambia with very low malaria parasite prevalence and high coverage of vector control interventions are targeted for malaria elimination through a series of interventions including reactive case detection (RCD) at community level. When a symptomatic individual presenting to a community health worker (CHW) or government clinic is diagnostically confirmed as an incident malaria case an RCD response is initiated. This consists of a CHW screening the community around the incident case with rapid diagnostic tests (RDT) and treating positive cases with artemether-lumefantrine (AL, Coartem™) in accordance with national policy. Since its inception in 2011, Zambia’s RCD programme has relied on anecdotal feedback from staff to identify issues and possible solutions. In 2014, a systematic qualitative programme review was conducted to determine perceptions around malaria rates, incentives, operational challenges and solutions according to CHWs, their supervisors and district-level managers. METHODS: A criterion-based sampling framework based on training regime and performance level was used to select nine rural health posts in four districts of Southern Province. Twenty-two staff interviews were completed to produce English or bilingual (CiTonga or Silozi + English) verbatim transcripts, which were then analysed using thematic framework analysis. RESULTS: CHWs, their supervisors and district-level managers strongly credited the system with improving access to malaria services and significantly reducing the number of cases in their area. The main implementation barriers included access (e.g., lack of rain gear, broken bicycles), insufficient number of CHWs for programme coverage, communication (e.g. difficulties maintaining cell phones and “talk time” to transmit data by phone), and inconsistent supply chain (e.g., inadequate numbers of RDT kits and anti-malarial drugs to test and treat uncomplicated cases). CONCLUSIONS: This review highlights the importance of a community surveillance system like RCD in shaping Zambia’s malaria elimination campaign by identifying community-based infections that might otherwise remain undetected. At this stage the system must ensure it can meet growing public demand by providing CHWs the tools and materials they need to consistently carry out their work and expand programme reach to more isolated communities. Results from this review will be used to plan programme scale-up into other parts of Zambia
The impact of smoking on individual health expenditures: a case study of Namibia
Background: The increased smoking prevalence in some parts of the world, particularly in Low and Middle Income Countries (LMICs) is a major concern among tobacco control advocates and governments. The higher smoking-related disease prevalence associated with this is expected to fall among the sub-populations least able to pay for healthcare services in LMICs. This, in turn, will perpetuate the vicious cycle of poverty and disease. The current study contributes to developing an understanding of the socioeconomic disparities in smoking in Namibia and their potential association with per capita health-related expenditures. Method: Data from the Namibia 2013 Demographic and Health Survey, a nationally representative survey, are used in the study. Three main variables for healthcare costs are constructed, namely out-patient disease (OPD) costs, inpatient disease (IPD) costs and total out of pocket (OOP) payments. Concentration curves and indices are estimated for all three variables as well as for smoking intensity and smoking prevalence. Further, three Tobit regression models are run to examine the associations of the different healthcare costs with smoking intensity. Results: The concentration index of smoking prevalence is estimated at -0.05 compared to -0.18 for smoking intensity. Thus, both smoking prevalence and smoking intensity, in relation to their socioeconomic status, are concentrated among the poor. In contrast, the concentration index of OPD healthcare costs is calculated at 0.34 compared to 0.65 for IPD healthcare costs reflecting disproportionately higher healthcare costs among the rich. The concentration index of the overall total annual OOP payments is 0.55. Tobit regression analysis, however, does not find any statistically significant relationship between the smoking intensity and the amount spent on health care costs, regardless of whether these were IPD, OPD healthcare costs or total OOP payments. Conclusion: Namibia's current policies on demand reducing tobacco control policies can be strengthened by these findings. Smoking is an important determinant of several non-communicable diseases and has the potential to exacerbate health care costs across socioeconomic strata. Understanding the socioeconomic disparities in smoking is imperative for developing appropriate interventions against smoking
Smoking inequality and health expenditures: a case study of Namibia
Background
Many
parts of the world, specifically Low and Middle Income Countries (LMICs), have
experienced increased smoking prevalence. This portends higher future smoking-related
disease prevalence. Because the largest burden of smoking-related diseases is
likely to fall among the sub-populations least able to pay for healthcare
services, this poses a serious threat to the fight against poverty in LMICs. This
study contributes to developing an understanding of the socioeconomic
disparities in smoking prevalence and intensity in Namibia, a middle income
country in Africa, and the potential association with per capita health-related
expenditures.
Methods
Data
come from the 2013 Namibia Demographic and Health Survey. The study focuses on out-patient
disease (OPD) costs, inpatient disease (IPD) costs and total out-of-pocket
(OOP) payments. Concentration curves and indices are estimated for all three
variables as well as for smoking intensity and smoking prevalence. Further,
three Tobit regression models are run to examine the associations of the
different healthcare costs with smoking intensity.
Results
The
concentration index of smoking prevalence is estimated at -0.05 compared to
-0.18 for smoking intensity. In contrast, the concentration index of OPD
healthcare costs is estimated at 0.34 compared to 0.65 for IPD healthcare costs
reflecting disproportionately higher healthcare costs among the rich. The
concentration index of the overall total annual OOP payments is 0.55. Tobit
regression analysis, however, does not find any statistically significant
relationship between the smoking intensity and the amount spent on healthcare.
Conclusions
The
study finds that both smoking prevalence and intensity are only slightly higher
among the poor compared to the rich. This will likely exacerbate the overall
disease burden among the poor. Healthcare expenditures, in contrast, are more
reflective of the country's income inequality. It is conceivable that as the
country's economy grows and income inequality reduces, cigarettes may become
affordable which may increase consumption across the wealth quintiles