International Journal of Public Health

, Volume 60, Issue 5, pp 589–597 | Cite as

How can we improve healthcare access and general self-rated health among orphans and vulnerable children? Findings from a Kenyan cross-sectional study

  • Michael L. Goodman
  • Sarah E. Seidel
  • Reegan Kaberia
  • Philip H. Keiser
Original Article

Abstract

Objectives

This study analyzes healthcare access and general self-rated health (GSRH) among orphan and vulnerable child (OVC) households enrolled in an empowerment program in Eastern Province, Kenya. Analyses investigate whether reported monthly income mediates the association between program participation and medical security. Predictors of GSRH are also investigated.

Methods

Cross-sectional survey data on families (n = 707) participating in a multisectoral empowerment program were collected in June 2012. Regression methods were used to investigate study aims.

Results

Monthly income mediated 14.3 % of the total effect of program participation on healthcare accessibility. Program participation was not significantly associated with higher GSRH.

Conclusions

Increased reported monthly income predicted improved healthcare access, but only explained a portion of improved healthcare access in the study population. Partnerships between community-based empowerment programs and clinical providers might successfully target multiple outcomes among OVC, including improved healthcare access, though further research on potential synergies is required. GSRH was associated with increased access to food, medical care, literacy, safe drinking water and household income. Further research on GSRH among OVC should target measurement validity, potential sources of disparity in GSRH between OVC and non-OVC, and targets for improving GSRH among OVC.

Keywords

Health care access General self-rated health OVC Kenya 

References

  1. Amuyunzu-Nyamongo M, Taffa N (2004) The triad of poverty, environment and child health in Nairobi informal settlements. J Health Popul Dev Ctries, [online]. http://www.jhpdc.unc.edu
  2. Andrews G, Skinner D, Zuma K (2006) Epidemiology of health and vulnerability among children orphaned and made vulnerable by HIV/AIDS in sub-Saharan Africa 1 Paper presented at the OVC roundtable at the 7th AIDS Impact Conference, Cape Town, April, 2005. AIDS care 18(3):269–276Google Scholar
  3. Awiti JO (2014) Poverty and health care demand in Kenya. BMC Health Serv Res 14(1):560PubMedCentralPubMedCrossRefGoogle Scholar
  4. Bailis DS, Segall A, Chipperfield JG (2003) Two views of self-rated general health status. Soc Sci Med 56(2):203–217PubMedCrossRefGoogle Scholar
  5. Bain R, Wright J, Yang H, Pedley S, Gundry S, Bartram J (2012) Improved but not necessarily safe: water access and the Millennium Development Goals [GWF Discussion Paper 1225]. Canberra: global water forum. http://www.globalwaterforum.org/wp-content/uploads/2012/07/Improved-but-not-necessarily-safe_Water-access-and-the-Millennium-Development-Goals_GWF1225.pdf. Accessed 12 Mar 2015
  6. Basu S, Andrews J, Kishore S, Panjabi R, Stuckler D (2012) Comparative performance of private and public health care systems in low-and middle-income countries: a systematic review. PLoS Med 9(6):e1001244PubMedCentralPubMedCrossRefGoogle Scholar
  7. Bryant JH (2009) Kenya’s cash transfer program: protecting the health and human rights of orphans and vulnerable children. Health Hum Rights 11(2):65–76PubMedGoogle Scholar
  8. Chandola T, Jenkinson C (2000) Validating self-rated health in different ethnic groups. Ethn Health 5(2):151–159PubMedCrossRefGoogle Scholar
  9. Chuma J, Maina T (2012) Catastrophic health care spending and impoverishment in Kenya. BMC Health Serv Res 12(1):413PubMedCentralPubMedCrossRefGoogle Scholar
  10. Chuma J, Gilson L, Molyneux C (2007) Treatment-seeking behaviour, cost burdens and coping strategies among rural and urban households in Coastal Kenya: an equity analysis. Trop Med Int Health 12:673–686PubMedCrossRefGoogle Scholar
  11. Cluver L, Gardner F, Operario D (2007) Psychological distress amongst AIDS-orphaned children in urban South Africa. J Child Psychol Psychiatry 48(8):755–763PubMedCrossRefGoogle Scholar
  12. DeSalvo KB, Bloser N, Reynolds K, He J, Muntner P (2006) Mortality prediction with a single general self-rated health question. J Gen Intern Med 21(3):267–275PubMedCentralPubMedCrossRefGoogle Scholar
  13. Goodman ML, Kaberia R, Morgan RO, Keiser, PH (2014) Health and livelihood outcomes associated with participation in a community-based empowerment program for orphan families in semirural Kenya: a cross-sectional study. Vulnerable Child Youth Stud 9(4):365–376. doi:10.1080/17450128.2014.938142
  14. Gulliford M, Figueroa-Munoz J, Morgan M, Hughes D, Gibson B, Beech R, Hudson M (2002) What does ‘access to healthcare’ mean? J Health Serv Res Pol 7(3):186–188CrossRefGoogle Scholar
  15. Hammond WP, Matthews MD, Corbie-Smith G (2010) Psychosocial factors associated with routine health examination scheduling and receipt among African American men. J Natl Med Assoc 102(4):276PubMedCentralPubMedGoogle Scholar
  16. Heck JE, Sell RL, Gorin SS (2006) Healthcare access among individuals involved in same-sex relationships. Am J Public Health 96(6):1111–1118PubMedCentralPubMedCrossRefGoogle Scholar
  17. Hosseinpoor AR, Victora CG, Bergen N, Barros A, Boerma T (2011) Towards universal health coverage: the role of within-country wealth-related inequality in 28 countries in sub-Saharan Africa. Bull World Health Organ 89(12):881–889. doi:10.1590/S0042-96862011001200011 PubMedCentralPubMedCrossRefGoogle Scholar
  18. Janevic T, Jankovic J, Bradley E (2012) Socioeconomic position, gender, and inequalities in self-rated health between Roma and non-Roma in Serbia. Int J Public Health 57(1):49–55PubMedCrossRefGoogle Scholar
  19. Jylhä M (2009) What is self-rated health and why does it predict mortality? Towards a unified conceptual model. Soc Sci Med 69(3):307–316PubMedCrossRefGoogle Scholar
  20. Larson K, Halfon N (2010) Family income gradients in the health and health care access of US children. Matern Child Health J 14(3):332–342PubMedCentralPubMedCrossRefGoogle Scholar
  21. Lee VC, Muriithi P, Gilbert-Nandra U, Kim AA, Schmitz ME, Odek J, Mokava R, Galbraith JS (2014) Orphans and vulnerable children in Kenya: results from a Nationally Representative Population-Based Survey. J Acquir Immune Defic Syndr 66:S89–S97PubMedCrossRefGoogle Scholar
  22. Link BG, Phelan JC (2006) Stigma and its public health implications. Lancet 367(9509):528–529PubMedCrossRefGoogle Scholar
  23. Macha J, Harris B, Garshong B, Ataguba JE, Akazili J, Kuwawenaruwa A, Borghi J (2012) Factors influencing the burden of health care financing and the distribution of health care benefits in Ghana, Tanzania and South Africa. Health Policy Plann 27(suppl 1):i46–i54CrossRefGoogle Scholar
  24. Mishra V, Bignami-Van Assche S (2008) Orphans and vulnerable children in high HIV prevalence countries in sub-Saharan Africa. Calverton, Maryland: Macro International. http://www.measuredhs.com/pubs/pdf/AS15/AS15.pdf. Accessed 2 Jan 2015
  25. Mishra V, Arnold F, Otieno F, Cross A, Hong R (2007) Education and nutritional status of orphans and children of HIV-infected parents in Kenya. AIDS Educ Prev 19(5):383–395PubMedCrossRefGoogle Scholar
  26. Mohseni M, Lindstrom M (2007) Social capital, trust in the health-care system and self-rated health: the role of access to health care in a population-based study. Soc Sci Med 64(7):1373–1383PubMedCrossRefGoogle Scholar
  27. Nyambedha EO, Wandibba S, Aagaard-Hansen J (2001) Policy implications of the inadequate support systems for orphans in western Kenya. Health Pol 58(1):83–96CrossRefGoogle Scholar
  28. Ogundari K, Abdulai A (2014) Determinants of household’s education and healthcare spending in Nigeria: evidence from survey data. Afr Dev Rev 26:1–14CrossRefGoogle Scholar
  29. Onadja Y, Bignami S, Rossier C et al (2013) The components of self-rated health among adults in Ouagadougou, Burkina Faso. Pop Health Met 11(1):15CrossRefGoogle Scholar
  30. Reidpath DD, Chan KY, Gifford SM, Allotey P (2005) ‘He hath the French pox’: stigma, social value and social exclusion. Soc Health Ill 27(4):468–489CrossRefGoogle Scholar
  31. Richardson LD, Norris M (2010) Access to health and health care: how race and ethnicity matter. Mt Sinai J Med 77(2):166–177PubMedCrossRefGoogle Scholar
  32. Shi L, Starfield B (2000) Primary care, income inequality, and self-rated health in the United States: a mixed-level analysis. Int J Health Serv 30(3):541–556PubMedCrossRefGoogle Scholar
  33. Skinner D, Tsheko N, Mtero-Munvati S et al (2006) Towards a definition of orphaned and vulnerable children. AIDS Behav 10(6):619–626PubMedCrossRefGoogle Scholar
  34. Skinner D, Sharp C, Jooste S et al (2013) A study of descriptive data for orphans and non-orphans on key criteria of economic vulnerability in two municipalities in South Africa. Curationis 36(1):1–8CrossRefGoogle Scholar
  35. Smith-Greenaway E (2014) Are literacy skills associated with young adults’ health in Africa? Evidence from Malawi. Soc Sci Med. doi:10.1016/j.socscimed.2014.07.036 PubMedGoogle Scholar
  36. Ssewamala FM, Han CK, Neilands TB (2009) Asset ownership and health and mental health functioning among AIDS-orphaned adolescents: findings from a randomized clinical trial in rural Uganda. Soc Sci Med 69(2):191–198Google Scholar
  37. Taffa N, Chepngeno G, Amuyunzu-Nyamongo M (2005) Child morbidity and healthcare utilization in the slums of Nairobi, Kenya. J Trop Pediatr 51:279–284PubMedCrossRefGoogle Scholar
  38. The Kenya CT-OVC Evaluation Team (2012) The impact of the Kenya Cash Transfer Program for orphans and vulnerable children on household spending. J Dev Effectiveness 4(1):9–37CrossRefGoogle Scholar
  39. Verhaeghe PP, Tampubolon G (2012) Individual social capital, neighbourhood deprivation, and self-rated health in England. Soc Sci Med 75(2):349–357PubMedCrossRefGoogle Scholar
  40. Watts H, Gregson S, Saito S et al (2007) Poorer health and nutritional outcomes in orphans and vulnerable young children not explained by greater exposure to extreme poverty in Zimbabwe. Trop Med Int Health 12(5):584–593PubMedCrossRefGoogle Scholar

Copyright information

© Swiss School of Public Health 2015

Authors and Affiliations

  • Michael L. Goodman
    • 1
    • 2
  • Sarah E. Seidel
    • 1
    • 2
  • Reegan Kaberia
    • 3
  • Philip H. Keiser
    • 4
  1. 1.Sodzo InternationalHoustonUSA
  2. 2.University of Texas School of Public HealthHoustonUSA
  3. 3.Zoe Orphan EmpowermentMauaKenya
  4. 4.University of Texas Medical BranchGalvestonUSA

Personalised recommendations