Background and objectives: Namibia aims to improve population health and human development. As there is limited research to date exploring the sociodemographic patterns of disease and healthcare access in the country, this thesis aimed to assess the burden of infectious and non-communicable diseases, the coverage of public health interventions and barriers to healthcare access at the population level.
Methods: Using data collected from 9,849 households and 41,646 individuals in the 2013 Namibia Demographic and Health Survey, the prevalence and sociodemographic patterns of disease and healthcare barriers were explored. Specifically, this thesis investigated the prevalence and distribution of chronic diseases, the coverage of public health interventions and access to healthcare. The determinants of these outcomes were assessed in descriptive, multivariable and spatial analyses.
Results: In this DHS population, chronic disease prevalence was high (HIV: 13.9%; hypertension: 36.9% and hyperglycaemia: 5.4%). However, co-morbidity of these conditions was low. Malaria control intervention coverage was below government target levels in high transmission areas. In relation to healthcare access, almost half of women reported at least one barrier to healthcare, including distance to health facilities and getting money for treatment. Women who were less educated, less wealthy and lived in rural areas were more likely to report distance as a problem in accessing care. Spatial analyses indicated that distance and travel time to health facilities was highly variable in rural areas, with approximately 40% of the rural population having to travel for more than an hour to reach a facility. Multivariable analyses indicated that men, those who were less wealthy and lived in rural areas lived further away from health facilities. Health insurance was associated with health service utilisation but coverage of insurance was just 17.5%, with men, wealthier and more educated populations more likely to be insured.
Conclusions: The findings presented in this thesis suggest that urban-rural and socioeconomic differences are underlying determinants of population health and healthcare access in Namibia, with rural, less wealthy and less educated populations often disadvantaged. Further research is needed to better understand disease co-morbidity, to evaluate intervention programmes, and to more intricately understand the population-level barriers to healthcare in the country so as to inform strategies to improve population health and achieve human development in Namibia.This research was funded by the Biomedical Research Counci
