Factors Associated with Unmet Needs of Chronic Diseases in Kenya: Multilevel Analysis of Kenya Household Health Expenditure and Utilization Survey 2018

  • Peter O. Mokaya University of Pécs
  • Mohammed Elmadani University of Pécs
  • István Ágoston, PhD University of Pécs
  • Gabriella Hideg, PhD University of Pécs
Keywords: Unmet Healthcare Needs, Chronic Diseases, Household Characteristics, Gender Disparities, Health Insurance
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This study investigates the factors that contribute to unmet healthcare demands among people with chronic illnesses. The 2018 Kenya Household Health Expenditure and Utilization Survey, conducted by the Kenya National Bureau of Statistics, provided the extensive national sample used in this study, which provides information about the state of the healthcare system. A two-stage sample approach was used in the survey to pick 1,500 clusters and then identify twenty-five households inside each cluster, producing a total coverage of 37,500 households. This cross-sectional study looks at how factors interact in Kenya's 47 counties, both at the household and communal levels. The results highlight the significant impact of household characteristics, which account for 81% of the explanation for unmet healthcare needs, while factors at the community or county level account for 19%. These findings are consistent with macroeconomists' and health experts' viewpoints that health is a shared family asset. Interesting gender discrepancies show that women are more vulnerable than men because of their complex healthcare needs. Contrary to popular belief, married people face more difficulties getting access to healthcare. Economic status highlights the differences even more, with the poorest households facing the biggest difficulties. In line with earlier studies, access to healthcare remains a major barrier for rural inhabitants. This emphasises how urgently needed specialised healthcare treatments are in rural areas, particularly for those suffering from chronic diseases. The study shows a decrease in the likelihood of unmet healthcare needs in households with health insurance. It is particularly important to economically and socially empower the household head to invest in and prioritise healthcare needs since chronic diseases are almost a sure bet in every household, especially in the later years of an individual's life


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Adeniji, F. I. P., Lawanson, A. O., & Osungbade, K. O. (2022). The microeconomic impact of out-of-pocket medical expenditure on the households of cardiovascular disease patients in general and specialised heart hospitals in Ibadan, Nigeria. PLoS One, 17(7), e0271568. https://doi.org/10.1371/journal.pone.0271568

Allin, S., Grignon, M., & Le Grand, J. (2010). Subjective unmet need and utilisation of health care services in Canada: what are the equity implications? Soc Sci Med, 70(3), 465-472. https://doi.org/10.1016/j.socscimed.2009.10.027

Azad, A. D., Charles, A. G., Ding, Q., Trickey, A. W., & Wren, S. M. (2020). The gender gap and healthcare: Associations between gender roles and factors affecting healthcare access in Central Malawi, June-August 2017. Arch Public Health, 78(1), 119. https://doi.org/10.1186/s13690-020-00497-w

Belay, D. G., Asratie, M. H., Aragaw, F. M., Tsega, N. T., Endalew, M., & Gashaw, M. (2022). Open defecation practice and its determinants among households in sub-Saharan Africa: pooled prevalence and multilevel analysis of 33 sub-Saharan Africa countries demographic and health survey. Trop Med Health, 50(1), 28. https://doi.org/10.1186/s41182-022-00416-5

Bernell, S., & Howard, S. W. (2016). Use Your Words Carefully: What Is a Chronic Disease? Front Public Health, 4, 159. https://doi.org/10.3389/fpubh.2016.00159

CDC. (2022). About Chronic Diseases. Centers for Disease Control and Prevention. https://www.cdc.gov/chronicdisease/about/index.htm

Chen, J., Rizzo, J. A., & Rodriguez, H. P. (2011). The health effects of cost-related treatment delays. Am J Med Qual, 26(4), 261-271. https://doi.org/10.1177/1062860610390352

Dawkins, B., Renwick, C., Ensor, T., Shinkins, B., Jayne, D. G., & Meads, D. M. (2021). What factors affect patients' ability to access healthcare? An overview of systematic reviews. Tropical Medicine & International Health, 26, 1177 - 1188.

De-Graft Aikins, A., Unwin, N., Agyemang, C., Allotey, P., Campbell, C., & Arhinful, D. (2010). Tackling Africa's chronic disease burden: from the local to the global. Globalisation and Health, 6(1), 5. https://doi.org/10.1186/1744-8603-6-5

Doğan, İ., & Doğan, N. (2015). Usage of the Intraclass Correlation Coefficient As a Measure of Dependence in Dyadic Data: Review. Turkiye Klinikleri Journal of Biostatistics, 7, 119-125.

Dotse-Gborgbortsi, W., Tatem, A. J., Matthews, Z., Alegana, V. A., Ofosu, A., & Wright, J. A. (2023). Quality of maternal healthcare and travel time influence birthing service utilisation in Ghanaian health facilities: a geographical analysis of routine health data. BMJ Open, 13(1), e066792. https://doi.org/10.1136/bmjopen-2022-066792

Fjær, E. L., Stornes, P., Borisova, L. V., McNamara, C. L., & Eikemo, T. A. (2017). Subjective perceptions of unmet need for health care in Europe among social groups: Findings from the European social survey (2014) special module on the social determinants of health. European Journal of Public Health, 27, 82–89.

Goodman, A. C., Stano, M., & Tilford, J. M. (1999). Household Production of Health Investment: Analysis and Applications. Southern Economic Journal, 65(4), 791-806. https://doi.org/https://doi.org/10.1002/j.2325-8012.1999.tb00200.x

Hughes, M. E., & Waite, L. J. (2002). Health in household context: living arrangements and health in late middle age. J Health Soc Behav, 43(1), 1-21.

Jacobs, B., Ir, P., Bigdeli, M., Annear, P. L., & Van Damme, W. (2012). Addressing access barriers to health services: an analytical framework for selecting appropriate interventions in low-income Asian countries. Health Policy Plan, 27(4), 288-300. https://doi.org/10.1093/heapol/czr038

Jenkins, J. M., Rasbash, J., & O'Connor, T. G. (2003). The role of the shared family context in differential parenting. Developmental psychology, 39 1, 99-113.

KeNADA, K. N. D. A. (2018). Kenya household and health expenditure and utilization survey (khheus) 2018. Department of policy planning and health financing. Retrieved 27 June from https://statistics.knbs.or.ke/nada/index.php/catalog/95

Liyew, A. M., & Teshale, A. B. (2020). Individual and community level factors associated with anemia among lactating mothers in Ethiopia using data from Ethiopian demographic and health survey, 2016; a multilevel analysis. BMC Public Health, 20.

Merlo, J., Chaix, B., Ohlsson, H., Beckman, A., Johnell, K., Hjerpe, P., Råstam, L., & Larsen, K. (2006). A brief conceptual tutorial of multilevel analysis in social epidemiology: using measures of clustering in multilevel logistic regression to investigate contextual phenomena. J Epidemiol Community Health, 60(4), 290-297. https://doi.org/10.1136/jech.2004.029454

Njagi, P., Arsenijevic, J., & Groot, W. (2020). Cost-related unmet need for healthcare services in Kenya. BMC Health Serv Res, 20(1), 322. https://doi.org/10.1186/s12913-020-05189-3

O'Donnell, O. (2007). Access to health care in developing countries: breaking down demand side barriers. Cad Saude Publica, 23(12), 2820-2834. https://doi.org/10.1590/s0102-311x2007001200003

OECD. (2009). Multilevel Analyses, in PISA Data Analysis Manual: SPSS, Second Edition. OECO Publishing. https://doi.org/https://doi.org/10.1787/9789264056275-16-en

OECD. (2011). "Introduction", in Health at a Glance 2011: OECD Indicators. OECD Publishing. https://www.oecd-ilibrary.org/content/component/health_glance-2011-3-en

Onyango, E. M., & Onyango, B. M. (2018). The Rise of Noncommunicable Diseases in Kenya: An Examination of the Time Trends and Contribution of the Changes in Diet and Physical Inactivity. J Epidemiol Glob Health, 8(1-2), 1-7. https://doi.org/10.2991/j.jegh.2017.11.004

Otieno, P. O., Kiroro, F., Runyenje, C., & Kamau, P. (2021). Unmet need for primary healthcare and associated individual and household-level factors in Kenya: results from a national survey. BMJ Open, 11(5), e041032. https://doi.org/10.1136/bmjopen-2020-041032

Park, Y. S., Kim, H., Yun, I., Park, E. C., & Jang, S. Y. (2023). Association between caregiver type and catastrophic health expenditure among households using inpatient medical services: using Korean health panel. BMC Health Serv Res, 23(1), 721. https://doi.org/10.1186/s12913-023-09703-1

Powell-Wiley, T. M., Poirier, P., Burke, L. E., Després, J. P., Gordon-Larsen, P., Lavie, C. J., Lear, S. A., Ndumele, C. E., Neeland, I. J., Sanders, P., & St-Onge, M. P. (2021). Obesity and Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation, 143(21), e984-e1010. https://doi.org/10.1161/cir.0000000000000973

Rodríguez, G., & Elo, I. (2003). Intra-class Correlation in Random-effects Models for Binary Data. The Stata Journal, 3(1), 32-46.

Seyoum, T. F., Andualem, Z., & Yalew, H. F. (2023). Insecticide-treated bed net use and associated factors among households having under-five children in East Africa: a multilevel binary logistic regression analysis. Malar J, 22(1), 10. https://doi.org/10.1186/s12936-022-04416-y

Suchman, L., Hashim, C. V., Adu, J., & Mwachandi, R. (2020). Seeking care in the context of social health insurance in Kenya and Ghana. BMC Public Health, 20(1), 614. https://doi.org/10.1186/s12889-020-08742-1

Tadiri, C. P., Gisinger, T., Kautzky-Willer, A., Kublickiene, K., Herrero, M. T., Norris, C. M., Raparelli, V., & Pilote, L. (2021). Determinants of perceived health and unmet healthcare needs in universal healthcare systems with high gender equality. BMC Public Health, 21(1), 1488. https://doi.org/10.1186/s12889-021-11531-z

Too, W., Lelei, F., Adam, M., & Halestrap, P. (2023). Preparedness, resilience and unmet needs of informal caregivers of advanced cancer patients in a Regional Mission Hospital in Kenya: Qualitative Study. BMC Palliat Care, 22(1), 16. https://doi.org/10.1186/s12904-022-01048-6

Vlassoff, C. (2007). Gender differences in determinants and consequences of health and illness. J Health Popul Nutr, 25(1), 47-61.

Warshaw, G. A. (2006). Introduction: Advances and Challenges in Care of Older People with Chronic Illness.

WHO. (2002). Innovative care for chronic conditions : building blocks for actions : global report. In. Geneva: World Health Organization.

WHO, & World Bank. (2017). Tracking universal health coverage: 2017 global monitoring report. World Health Organization. https://apps.who.int/iris/handle/10665/259817

Zarei, L., Moradi, N., Peiravian, F., Hatami-Mazinani, N., Mahi-Birjand, M., Arabloo, J., & Babar, Z. U. (2022). Catastrophic pharmaceutical expenditure in patients with type 2 diabetes in Iran. Int J Equity Health, 21(1), 188. https://doi.org/10.1186/s12939-022-01791-5

31 August, 2023
How to Cite
Mokaya, P., Elmadani, M., Ágoston, I., & Hideg, G. (2023). Factors Associated with Unmet Needs of Chronic Diseases in Kenya: Multilevel Analysis of Kenya Household Health Expenditure and Utilization Survey 2018. East African Journal of Health and Science, 6(1), 355-367. https://doi.org/10.37284/eajhs.6.1.1402