Prevalence of non-communicable diseases and use of health services in the Gaza Strip: an analysis of a household survey

Abstract

BackgroundThere is a growing need for and interest in targeting non-communicable diseases (NCDs) in Gaza Strip. However, little is known about their distribution among different population groups and about the use of health services by patients with NCDs. We aimed to identify the differences in prevalence of NCDs and use of health-care services among different groups of patients with NCDs in the Gaza Strip. MethodsWe interviewed 760 households in the Gaza Strip in July, 2013, about the characteristics of household members, including occurrence of NCDs, and their use of and expenditures on health services. We analysed data according to the frequency distribution of variables and used χ2 testing to assess the statistical difference between grouped variables. Findings661 (12·7%) of the 5192 individuals had at least one NCD. Prevalence of NCDs was higher among refugees than non-refugees (485 [13.4%] of 3618 vs 176 [10·5%] of 1574; odds ratio [OR] 1·23, 95% CI 1·023–1·477; p=0·027) and was associated with increasing age (Cramer's V=0·545): at least one NCD was reported in 78 (2·9%) of 2699 individuals aged less than 20 years, 110 (7·5%) of 1470 aged 20–39 years (OR 4·237, 95% CI 3·19–5·628), 248 (35·4%) of 701 aged 40–59 years (28·679, 21·091–38·995), and 225 (69·9%) of 322 aged 60 years or older (77·944, 56·165–108·169; p<0·0001). 545 (82·5%) of the 661 patients with NCDs regularly accessed health services at least once every 3 months. The choice of health provider for regular care for NCDs differed by refugee status; 327 (85·8%) of 381 refugee patients compared with 121 (73·8%) of 164 non-refugee patients chose public providers for the regular care of their NCDs (OR 2·152, 95% CI 1·37–3·38; p=0·001). InterpretationThe prevalence of NCDs is positively associated with increasing age. Entitlement to health care in the Gaza Strip through refugee status contributed to increasing the detection of NCDs and refugee status influenced the choice of health-care provider for NCDs. There is a need to expand entitlement to health services to achieve universal access to health care in order to respond to the increasing challenge of NCDs in the Gaza Strip. FundingWHO 2013 special grant for Priority Areas in Public Health in the Eastern Mediterranean Region.