Reasons For Unmet Need Research Articles

Determinants of Dental Care Utilization, Unmet Dental Care Need, and Barriers among Women of Reproductive Age in the United States

Introduction: Dental care is integral to general health but is often isolated from the healthcare system nor discussed as part of overall health. The barriers to accessing needed dental care vary among socioeconomic and demographic groups. This study examined the disparities in dental care access and identified the socioeconomic and demographic factors associated with dental health needs among United States women. Methods: Using data from the 2017-2020 National Health and Nutrition Examination Surveys (NHANES), we conducted a Chi-square to assess the differences in the proportions of women who reported not getting their needed dental care and computed a weighted multivariate logistic regression to examine the factors associated with access to dental care use, unmet dental-care need, and reported reasons for unmet need. Results: Race, income, and education played a significant role in surveyed participants regarding dental care use and unmet dental care needs. Non-Hispanic Blacks and other minority racial-ethnic groups, including multi-racial groups, were likelier to have never used dental care than non-Hispanic Whites. Furthermore, non-Hispanic Whites with less than a high school education were likelier to have never used dental care than those with a high school education. Groups more likely to report an unmet need were women with PIR < 1.00. Moreover, between 1.00 and 1.99 compared to PIR ≥ 2.00 and women without health insurance compared to those with health insurance. Conclusion: Expanding insurance coverage for dental care and improving access for women with poor health may improve racial-ethnic and education-level disparities, specifically in African American women's unmet dental care needs.

A systematic review and meta-analysis of unmet needs for healthcare and long-term care among older people.

The absolute number of older individuals needing medical care and long-term care (LTC) is increasing globally due to the growing ageing population. However, it is uncertain who and what proportion of the population has access to care. Therefore, a systematic review and meta-analysis of the prevalence and reasons for unmet needs for healthcare and long-term care among older people, 65 years old and above, across countries was conducted. An information specialist performed a comprehensive search of four major databases (PubMed, EMBASE, Web of Science, and CINAHL) from inception to June 2020 without restrictions on language and date. We did random-effects meta-analysis to obtain pooled prevalence. We stratified the meta-analysis by reasons for unmet need categorized by barrier dimension (availability, accessibility, affordability, and acceptability), survey year, geographic location, and socio-demographic characteristics of the older individual. After screening 3912 articles, we included 101 studies published between 1996 and 2020. Of the 101 studies, 87 studies reported unmet healthcare needs and 14 studies reported unmet LTC needs. Overall, 10.4% (95% CI, 7.3-13.9) of the older population had unmet needs for healthcare. The common reasons for unmet healthcare needs were cost of treatment, lack of health facilities, lack of/conflicting time, health problem not viewed as serious, and mistrust/fear of provider. A significant variation in pooled prevalence of unmet healthcare needs due to cost was found by gender (male [10.9, 95% CI, 8.9-13.1] vs female [14.4, 95% CI, 11.8-17.3]), educational level (primary or less [13.3, 95% CI, 9.6-17.6] vs higher [7.5, 95% CI, 5.9-9.3]), self-reported health (poor [23.2, 95% CI, 18.8-27.8] vs good [4.4, 95% CI, 3.4-5.5]), insurance status (insured [9.0, 95% CI, 7.5-10.6] vs uninsured [27.7, 95% CI, 24.0-31.5]), and economic status of population (poorest [28.2, 95% CI, 14.1-44.9] vs richest [7.1, 95% CI, 3.8-11.3]). One in four (25.1, 95% CI, 17.1-34.2) older people had unmet needs in LTC. Rural residents had a higher prevalence of unmet needs in LTC compared to their urban counterparts. With the population ageing globally, it is necessary to improve access to health care and LTC for older people. Ensuring affordability of health services, reducing geographical barriers, and improving acceptability, will be critical in reducing unmet need. Unmet needs for healthcare were concentrated in population with no education, poor economic group, outpatient health facility user, and uninsured group. With education and economic-based inequalities at the forefront, all countries should focus on improving access to health services by reducing the burden related to healthcare costs.

Multimorbidity, low income and unmet need for healthcare: a national study of 41,135 older adults

Abstract The aims of this study were: (1) to identify the determinants of unmet need for access to primary care in middle-aged and older adults; and (2) to examine the reasons for unmet need. We used data from the Canadian Longitudinal Study on Aging (CLSA), a nationally representative survey of adults aged 45 to 85 years. Respondents were asked if they ‘needed health care during the last 12 months but did not receive it’. For those who replied ‘Yes’, the survey asked for the reason(s) for not receiving the needed care. Out of 41,135 respondents, 3,468 had unmet need for healthcare in the last 12 months. Among respondents with 0, 1, 2 and ≥3 morbidities, the proportion reporting unmet need was 2.5%, 5.3%, 5.1% and 9.1% respectively. After adjusting for covariates, the odds ratios (ORs) for unmet need for 1, 2 and ≥3 morbidities (compared to no morbidity) were 1.25 (95% CI: 0.87 to 1.78; p = 0.23), 1.57 (95% CI: 1.13 to 2.17; p < 0.05) and 2.03 (95% CI: 1.51 to 2.73; p < 0.05), respectively. For income groups, the ORs for unmet need (compared to >$150,000/year) were 0.94 (95% CI: 0.79 to 1.12) for $100,000-$150,000, 1.02 (95% CI: 0.87 to 1.20;) for $50,000-$100,000, 1.30 (95% CI: 1.09 to 1.55) for $20,000-$50,000, and 1.39 (95% CI: 1.08 to 1.78) for < $20,000. Other statistically significant determinants of unmet need included age (older adults were less likely to have unmet need), sex (females were more likely), having a family physician (less likely) and perceived physical and mental health (poor health more likely to be associated with unmet need). The most common reasons for unmet need were: ‘long wait time’ (52.1%) and ‘doctor did not think it was necessary’ (16.7%). Multimorbidity and low-income are associated with higher odds of unmet need among older adults. This disparity is partly due to not having a regular family physician and long wait time to see a doctor. Reducing these barriers are critical to reducing inequalities in health outcomes.

8.H. Workshop: Health equity and Chronic diseases: Public health and Primary care roles

Abstract Publicly funded health systems are based on the principle of universal access to care. However, significant gaps still exist between services needed and services received (i.e. unmet need for healthcare), especially in chronic disease management and prevention, particularly affecting marginalized groups in the society. Public Health and Primary Care should be working in integrated systems, as they are crucial in addressing health needs in the community and population at large. Several international organizations and leading scholars in the field have been advocating for the integration or primary care and public health to improve population health as well as to tackle complex issues such as multimorbidity. However, these two sectors are still working in silos across several countries, with a significant negative impact in terms of efficiency of the services provided and health care costs. The aim of this workshop will be to provide a global perspective on the issue of health equity in chronic disease management and prevention, with focus on marginalized population subgroups, such as elderly, immigrants and people from low socioeconomic status. We will discuss as well the determinants of unmet health needs for access to primary care in middle-aged and older adults, and examine the reasons for unmet need. We will further discuss about the need and strategies for enhanced integration between public health and primary care in chronic disease management and prevention. Key messages • Public health systems are based on the principle of universal access to care. However, significant gaps still exist between services needed and services received (i.e. unmet need for healthcare). • Public Health and Primary Care should be working in integrated systems to tackle complex issues such as multimorbidity.

Application of exposure bracketing to streamline the development of contraceptive products

Developing new long-acting products of well-characterized contraceptive drugs is one way to address some of the reasons for unmet need for modern methods of family planning among women in low- and middle-income countries. Development and approval of such products traditionally follow a conventional paradigm that includes large Phase 3 clinical trials to evaluate efficacy (pregnancy prevention) and safety of the investigational product. Exposure-bracketing is a concept that applies known pharmacokinetics and pharmacodynamics of a drug substance to inform its safe and efficacious use in humans. Several therapeutic areas have applied this concept by leveraging established drug concentration-response relationships for approved products to expedite development and shorten the timeline for the approval of an investigational product containing the same drug substance. Based on discussions at a workshop hosted by the Bill & Melinda Gates Foundation in December 2020, it appears feasible to apply exposure-bracketing to develop novel contraceptive products using well-characterized drugs.

Unmet healthcare needs among middle-aged and older adults in China.

Unmet healthcare needs have increasingly been recognised as an indicator of equity of healthcare access and utilisation, having the potential to capture frailty of health and social protection systems. This study aimed to estimate the prevalence of unmet healthcare needs and its correlates among middle-aged and older adults in China. This study is based on analyses of the China Health and Retirement Longitudinal Study carried out in 2011 among Chinese adults aged 45years and above. Multivariable logistic regression models were conducted to examine associated factors, stratified by rural or urban residence. Reasons for having unmet needs for inpatient and outpatient services were also analysed. Among 14,774 participants, the prevalence of unmet healthcare needs was 13.0% (95% confidence interval 12.3-13.8%) and was higher in rural areas. The most prevalent reasons for unmet need for inpatient and outpatient care were 'not enough money' and 'illness is not serious, don't need treatment', respectively. The respondents who were unmarried, employed, had poor self-reported health, needed help with activities of daily living, reported lower life satisfaction, multiple chronic conditions and depressive symptoms had increased odds of unmet healthcare needs. This study suggests that unmet healthcare needs are more concentrated among people living with multiple health conditions and mental health problems in China. If universal health coverage goals and sustainable development goal 3 are to be met, it is essential that effective mechanisms for addressing unmet healthcare needs are identified.

Annual prevalence of unmet healthcare need in Thailand: evidence from national household surveys between 2011 and 2019

BackgroundExtending Universal Health Coverage (UHC) requires identifying and addressing unmet healthcare need and its causes to improve access to essential health services. Unmet need is a useful monitoring indicator to verify if low incidence of catastrophic health spending is not a result of foregone services due to unmet needs. This study assesses the trend, between 2011 and 2019, of prevalence and reasons of unmet healthcare need and identifies population groups who had unmet needs.MethodThe unmet healthcare need module in the Health and Welfare Survey (HWS) 2011–2019 was used for analysis. HWS is a nationally representative household survey conducted by the National Statistical Office biennially. There are more than 60,000 respondents in each round of survey. The Organisation for Economic Co-operation and Development (OECD) standard questions on unmet need and reasons behind were applied for outpatient (OP), inpatient (IP) and dental services in the past 12 months. Data from samples were weighted to represent the Thai population. Univariate analysis was applied to assess unmet need across socioeconomic profiles.ResultsThe annual prevalence of unmet need between 2011 and 2019 was lower than 3%. The prevalence was 1.3–1.6% for outpatient services, 0.9% - 1.1% for dental services, and lower than 0.2% for inpatient care. A small increasing trend was observed on dental service unmet need, from 0.9% in 2011 to 1.1% in 2019. The poor, the elderly and people living in urban areas had higher unmet needs than their counterparts. Long waiting times was the main reason for unmet need, while cost of treatment was not an issue.ConclusionThe low level of unmet need at less than 3% was lower than OECD average (28%), and was the result of UHC since 2002. Regular monitoring using the national representative household survey to estimate annual prevalence and reasons for unmet need can guide policy to sustain and improve access by certain population groups.

1.I. Workshop: Capturing access challenges in health care: can the vignette methodology help?

Abstract Access to health care is a key performance dimension for health systems. Around 3% of the EU27 population experienced unmet need for health services in 2019 (Eurostat 2021). However, this average hides significant differences across and within countries, between income groups, levels of education and socio-economic categories. While some of the reasons for unmet need are more personal (no time, fear of doctor, etc.), the most common factors are health system-related. Although self-reported unmet need and other existing indicators, including catastrophic spending and impoverishing out-of-pocket spending, provide a general picture of the state of accessibility in EU Member States in relation to factors such as age, income or education, they do not necessarily reveal specific gaps in access or coverage that are linked to other characteristics or specific services. This workshop discusses a new method to measure access to health care, which was developed by the Observatory on Health Systems and Policies to support the European Commission's DG SANTE and the Expert Group on Health Performance Assessment (HSPA) in developing their work on more refined performance measures for health care system access across Europe. The work builds on the findings of a 2019 survey by the Observatory and its Health System and Policy Monitor (HSPM) network on “Gaps in Coverage and Access in the European Union”, which identified a range of vulnerable groups facing access hurdles. The overall goal is to provide a ‘proof of concept' to see whether a vignette approach could add to existing indicators, particularly regarding the differentiation between population coverage and realised access to care. A vignette is a short case study of an individual designed to simulate key features of a real-world scenario, which is then presented to relevant professionals to solicit their hypothetical response. Our workshop first discusses the vignette method developed for this purpose (presentation 1) before sharing the interpretation of results of two of the four vignette pilots that were carried out, that is, the vignette on stroke (presentation 2) and the vignette on palliative care for cancer patients (Presentation 3). The workshop will conclude with a moderated audience discussion about the pros and cons of the vignette method as opportunities to scale up the vignette approach. Key messages The vignette approach can identify gaps in coverage and access as well as differences in treatment and quality not identified by other indicators. The vignette approach can help explain how access contributed to suboptimal health outcomes, enabling the formulation of targeted policies.

Providers\u2019 perspectives of socio-cultural and health service challenges related to postpartum family planning in Alexandria, Egypt

BackgroundPostpartum family planning (PPFP) focuses on prevention of unintended pregnancy and closely spaced pregnancies through the first 12 months following childbirth. Adoption of family planning during the postpartum period in Egypt faces unique challenges. This study aimed to explore the socio-cultural and health service challenges related to PPFP in Alexandria, Egypt, from perspectives of family planning providers working in public settings.MethodsThree focus group discussions were conducted in the period from May to July 2017. It included 32 family planning physicians working in the family health centers and maternal and child health centers in Alexandria for 3 years or more. A discussion guide was prepared. Analysis of data was done using thematic data analysis using a deductive approach.ResultsThe working experience of participants ranged from 3 to 30 years. The most frequently reported reasons for unmet need for PPFP were cultural norms about the contraceptive effects of lactation and inaccurate knowledge of women about the conditions for appropriate use of the lactation amenorrhea as a contraceptive method. The most commonly cited challenge related to the quality of service was the inadequate health education services about PPFP. Lack of training and supervision of community health workers was one of the underlying causes of the perceived inadequacy of the service.ConclusionsMass media campaigns advocating for family planning are urgently needed with full support from the government. Improvement of health education services is a must. Redistribution of family planning providers with an increase in the staff members is highly recommended.

'Be nice to us, we're still learning': an online survey of young people in Hawkes Bay, New Zealand, about unmet need for sexual health care and improving access to services.

Background Young people need equitable access to high-quality sexual and reproductive health care to enjoy good sexual health. Methods This online survey of people aged 15-24years in a defined region of New Zealand asked about unmet need for sexual health care and sought views on improving access to sexual health care. Results Fivehundred participants took part in the study between August and October 2020, of whom 60% were female, 25% were of Māori (indigenous) ethnicity, and 21.4% were gender and/or sexuality diverse. Sixty percent had ever received sexual health care (300/500), and 74.3% received it from a general practice clinic (223/300). Overall, 41% (204/500) reported they needed, but had not received sexual health care in the past ('unmet need'). Reasons for unmet need included being shy, embarrassed or ashamed (74.5%, 152/204), fear of judgment by clinic staff (42.6%, 87/204), cost (32.8%, 67/204), concerns about confidentiality (28.9%, 59/204), and not knowing where to go (24%, 49/204). Māori participants were more likely to report not knowing where to go (32.1% vs 20%, P=0.04). Participants identified the need to reduce stigma, normalise sexual health care, improve convenience, affordability and awareness of services as key to improving access. Reassurance about confidentiality and being treated with kindness, empathy and respect were deemed critical to service acceptability. Conclusions Action is urgently needed at policy, funding and practice levels to improve access to services by: reducing societal stigma, normalising discussions around sexual health, improving affordability and raising awareness of services. Quality improvement is also needed in general practice to ensure young people can routinely access youth-friendly sexual and reproductive health care.

Unmet Need For Contraception: An Overview From A District In West Bengal

Objectives: To address the social correlates of unmet need for contraception among currently married women of reproductive age group. Methods: This community based cross sectional study was conducted in urban and rural areas of Howrah district of West Bengal during April to Sept 09. Multistage stratified random sampling was followed. Results: Out of total 2000 respondents, 1400 (70%) belonged to nuclear family; more than half (57.2%) were below 30 years of age. About 1/3rd (33.3%) of the respondents had no institutional education. The overall unmet need for contraception in this study was 8.7%. Unmet need was higher among the rural, Muslim, illiterate and lower age group. The main reasons for unmet need were lack of information (39%), fear of adverse effect (21.3%), and opposition from husband (11.5%), hindrance from elder family members (10.4%), inconvenient time (8%), and religious barrier (3.5%). Conclusion: To minimize the unmet need BCC programme to be strengthened

A cross sectional study of contraceptive use and reasons for unmet needs among mothers attending immunisation clinic at tertiary care centre of central India

Background: Unmet need of contraception remains a national problem. The study was conducted among the mothers attending immuno-prophylaxis clinic (IPC) at tertiary care centre of central India to determine the use of different types of contraception and assess the unmet need for contraception along with the reasons associated with the unmet needs of contraception. Aim and objective was to study the contraceptive use, reasons for unmet needs amongst the mothers attending IPC and some related factors.Methods: This was a cross-sectional study conducted during the period from February-April 2016 at IPC in tertiary care setting. In this study 280 mothers attending IPC for Measles and DPT 1st booster of their child were enrolled. The sample population was selected by simple random sampling method. A pre-tested structured questionnaire was used to collect data from the respondents with written informed consent.Results: This study shows that, 65% of mother told they were practicing any type of family planning method. Unmet need for contraception was 37.14 per cent. Among those having unmet need (n=104), fear of side effects (41.35%), infrequent sex (25%) were the common reasons for unmet need. Religion, age of marriage, age at 1st pregnancy, education, socioeconomic status, occupation of husband, counselling about contraceptives during ANC/PNC visits and resumption of menses were significantly associated with the use of contraceptives.Conclusions: The unmet need for contraception was quite high. Most of the study subjects were not using contraception due to fear of side effects and lack of knowledge.

Cost\u2013related unmet need for healthcare services in Kenya

BackgroundThe assessment of unmet need is one way to gauge inequities in access to healthcare services. While there are multiple reasons for unmet need, financial barriers are a major reason particularly in low- and middle-income countries where healthcare systems do not offer financial protection. Moreover, accessibility and affordability are paramount in achieving universal health coverage. This study examines the extent of unmet need in Kenya due to financial barriers, the associated determinants, and the influence of regional variations.MethodsWe use data from the 2013 Kenya household health expenditure and utilization (KHHEUS) cross sectional survey. Self-reported unmet need due to lack of money and high costs of care is used to compute the outcome of interest. A multilevel regression model is employed to assess the determinants of cost-related unmet need, confounding for the effect of variations at the regional level.ResultsCost-related barriers are the main cause of unmet need for outpatient and inpatient services, with wide variations across the counties. A positive association between county poverty rates and cost-related unmet is noted. Results reveal a higher intraclass correlation coefficient (ICC) of 0.359(35.9%) for inpatient services relative to 0.091(9.1%) for outpatient services. Overall, differences between counties accounted for 9.4% (ICC ~ 0.094) of the total variance in cost-related unmet need. Factors that positively influence cost-related unmet need include older household heads, inpatient services, and urban residence. Education of household head, good self-rated health, larger household size, insured households, and higher wealth quintiles are negatively associated with cost-related unmet need.ConclusionThe findings underscore the important role of cost in enabling access to healthcare services. The county level is seen to have a significant influence on cost-related unmet need. The variations noted in cost-related unmet need across the counties signify the existence of wide disparities within and between counties. Scaling up of health financing mechanisms would fundamentally require a multi-layered approach with a focus on the relatively poor counties to address the variations in access. Further segmentation of the population for better targeting of health financing policies is paramount, to address equity in access for the most vulnerable and marginalized populations.

Education Relations, Number of Children and Acceptance of KB Information with Pregnancy Due to Unmet Need KB in Pregnant Mother in Binjai Health Center City In 2019

Pregnancy control and regulation is one of the ways to suppress the population in Indonesia through the family planning (KB) program. However, family planning programs in Indonesia still have problems, one of which is the high number of unmet need for family planning in Indonesia. 5 sub-districts in the City of Binjai showed that the District of Binjai Kota which had the highest number of unmet need for family planning was 18.27%. The purpose of this study was to analyze the Relationship of Education, Number of Children and Acceptance of Family Planning Information with Pregnancy Due to Unmet Need for KB in Pregnant Women in Binjai City Health Center in 2019. The method of this study used a cross sectional sample of 113 pregnant women in December 2018 - August 2019 at the Binjai City Health Center. Data were collected by interview using a questionnaire. Based on the results of the study note that out of 113 pregnant women there were 57 people (50.4%) who became pregnant as a result of Unmet Need KB. Variables related to Pregnancy Due to Unmet Need for KB are the number of children (p = 0.024) and the receipt of KB information (p = 0.001). The results of multiple logistic regression showed that respondents who had 1-2 children and did not receive family planning information had a probability of suffering from pregnancy due to unmet need for birth control by 57.8%. The suggestion for this research is that health workers pay more attention to those who have 1-2 children who are motivated to participate in the family planning program and ask pregnant women to ask health workers before using family planning tools as clearly as possible so that they are expected to be able to reduce the reasons for unmet need for family planning.

Demographic, socioeconomic, and health correlates of unmet need for mental health treatment in the United States, 2002\u201316: evidence from the national surveys on drug use and health

BackgroundUnmet need for mental health services remains high in the United States and is disproportionately concentrated in some groups. The scale and nature of these disparities have not been fully elucidated and bear further scrutiny. As such, in this study, we examine the demographic, socioeconomic, and health correlates of unmet need for mental health treatment as well as the reasons for unmet need.MethodsWe draw upon the National Survey for Drug Use and Health (NSDUH) from 2002 to 16 for adults aged 18 and over in the United States (n = 579,017). Using multivariable logistic regression, we simultaneously model the demographic, socioeconomic, and health correlates of unmet need for mental health treatment from 2002 to 16. We also analyse the reasons for unmet need expressed by these populations, reasons which include cost, perceived stigma, minimisation of symptoms, low perceived effectiveness of treatment, and structural barriers.ResultsMajor characteristics associated with increased odds of unmet need include past year substance abuse or dependence (other than hallucinogens and sedatives), fair, poor, or very poor health, being female, and an educational attainment of college or higher. With respect to reasons for unmet need, cost was most often cited, followed by perceived stigma, structural barriers, and minimisation. Characteristics associated with increased odds of indicating cost as a reason for unmet need include: being uninsured or aged 26–35. Minimisation and low perceived effectiveness are mentioned by high-income persons as reasons for unmet need. College-educated persons and women had higher odds of citing structural barriers as a reason for unmet need.ConclusionsThe correlates and causes of unmet need highlight the intersectionality of individual health needs with implications on addressing inequities in mental health policy and practice.

Mental health care among blacks in America: Confronting racism and constructing solutions.

To describe reasons for unmet need for mental health care among blacks, identify factors associated with causes of unmet need, examine racism as a context of unmet need, and construct ways to improve service use. Data from the 2011-2015 National Survey on Drug Use and Health were pooled to create an analytic sample of black adults with unmet mental health need (N=1237). Qualitative data came from focus groups (N=30) recruited through purposive sampling. Using sequential mixed methods, reasons for unmet need were regressed on sociodemographic, economic, and health characteristics of respondents. Findings were further explored in focus groups. Higher education was associated with greater odds of reporting stigma and minimization of symptoms as reasons for unmet need. The fear of discrimination based on race and on mental illness was exacerbated among college-educated blacks. Racism causes mistrust in mental health service systems. Participants expressed the importance of anti-racism education and community-driven practice in reducing unmet need. Mental health systems should confront racism and engage the historical and contemporary racial contexts within which black people experience mental health problems. Critical self-reflection at the individual level and racial equity analysis at the organizational level are critical.

Contraceptive behavior among ever-married reproductive age women in the estate sector in the district of Ratnapura, Sri Lanka

Background: Modern family planning (FP) methods remain the most effective means of reducing unmet need and its consequences including unplanned pregnancies. Objective: The objective of this study was to determine the contraceptive practice and unmet need for FP among 15–49-year-old ever-married women in estate sector in Ratnapura district. Materials and Methods: A community-based descriptive cross-sectional study was conducted using interviewer-administered questionnaire to assess contraceptive behavior among 15–49-year-old ever-married women in estate sector. Results: Contraceptive prevalence for the study group (n = 818) was 67.7% (95% confidence interval [CI]: 64.5–71.5) with the prevalence of 65.4% (95% CI: 62.0–68.7) for modern methods and 2.3% (95% CI: 1.5–3.4) for natural and traditional methods. The prevalence individual methods were 22.75% for female sterilization, 14.91% for injectables, 14.06% for oral contraceptives, 6.36% for intrauterine devices, 5.38% for subdermal implants, 1.85% for condoms, and 0.01% male sterilization. The prevalence of unmet need for FP was 16.3% (95% CI: 13.8–18.7) (n = 133) while that for spacing was 6.6% (95% CI: 5.4–7.8) (n = 53) and for limiting was 9.7 (95% CI: 8.2–11.2) (n = 80). Unmet need for modern methods was 18.8% (95% CI: 15.9–21.3) (n = 152). Reasons for unmet need were infrequent sex (21.5%), fear of side effects (18.6%), and low perceived risk of pregnancy (16.6%). Conclusions: Although contraceptive prevalence is high in estates, existence of high level of unmet need with reasons related to lack of awareness indicates the need of intervention studies to reduce unmet need and its consequences.

English

The proportion of women who have an unmet need for modern contraception is highest (24%) in Sub-Saharan Africa, which is double the world average of 12% in 2015. This unmet need leads to unintended pregnancies, unsafe abortions and limitation of women’s ability to achieve educational, employment and economic goals. This study aims to assess the unmet needs of contraception and the reasons for contraceptive non-use among female undergraduate students in Benin City. A descriptive cross-sectional study was conducted on female undergraduate students in Benin City, Edo State from January to June, 2017. The respondents were selected using multistage sampling technique. Data was collected using pre-tested structured self- administered questionnaires and data analysis was by IBM SPSS version 21.0. The level of significance was set at p < 0.05. Results revealed that a total of 400 respondents with mean age (SD) of 21.3 (2.5) years participated in this study. One hundred and sixty-one (40.2%) respondents were sexually active and of these, 128 (79.5%) had ever used contraceptives. However, only 97 (76.4%) of those who had sexual exposure within the past 1 month were currently using contraceptives. The unmet need of contraception was 18.6%. Reasons for unmet need included partner’s disapproval 24 (80.0%), fear of side effects 12 (40.0%) and religious beliefs 8 (20.0%). Thus, unmet need of contraception was high among the study group. Concerted efforts of relevant stakeholders will ensure universal access to sexual and reproductive health care services. Key words: Benin City, contraception, undergraduate, unmet needs

Understanding reasons for unmet health care needs in Korea: what are health policy implications?

BackgroundTo ensure equal access to necessary care regardless of an individual’s socioeconomic status, it is crucial to understand the factors that act as barriers. Unmet health care needs can arise for a variety of complex reasons, including personal choice, financial barriers, or lack of services, and each of these reasons requires a different policy approach. Researchers have advocated for a more granular measure of unmet health care need for better policy implication. This study aimed to assess various factors associated with different types of unmet health care needs in Korea.MethodsThe Korean National Health and Nutrition Examination Survey (KNHANES) 2010–2012 was used to analyze responses from 17,610 individuals over age 19. To measure the unmet needs of this population, self-reported experience in the past 1 year was used, and individual’s reasons for unmet need were sorted into three distinct categories – availability, acceptability, accessibility. Four different logistic regression models stratified by gender were used to examine the relationship between socioeconomic factors and unmet needs.ResultsWhile income was not a significant factor for men, women with lower incomes showed a higher likelihood of experiencing unmet need. In addition, women with lower incomes showed higher odds of having acceptability-related unmet needs during the past 1 year compared to men. Education and income levels were associated with accessibility-related unmet needs for both women and men.ConclusionAs unmet health care needs are considered to be a critical indicator of a country’s health care system, it is crucial to identify and eliminate any obstacles that prevent access to health care services. Under the current universal health care system in Korea, women, particularly those of lower income and lower educational levels, have limited access to necessary health care services. A gender-specific health care plan is recommended to reduce the higher rate of unmet needs experienced by this group. To reduce accessibility-related unmet needs, increasing available services for younger age groups, reflecting their needs of health services, needs to be considered.

Therapy access among children with autism spectrum disorder, cerebral palsy, and attention-deficit-hyperactivity disorder: a population-based study.

This study examined cross-sectional population-based rates in reported need and unmet need for occupational, physical, and speech therapy services in children with autism spectrum disorder (ASD) compared with children with attention-deficit-hyperactivity disorder (ADHD) and cerebral palsy (CP). The 2005-2006 and 2009-2010 (USA) National Survey of Children with Special Health Care data sets were used to compare therapy need and unmet need among children younger than 18 years with ASD (n=5178), ADHD (n=20 566), and CP (n=1183). Bivariate approaches and multivariate logistic regression using imputed data were used to identify associations between child and family characteristics, and access to therapy services. After adjusting for other variables, children with ASD had a significantly greater likelihood of having an unmet therapy need compared with children with ADHD (odds ratio [OR] 1.66, 95% confidence interval [CI] 1.36-2.03), but a similar unmet need as children with CP (OR 1.30, 95% CI 0.97-1.74). Factors associated with unmet need included survey year, younger child age, no health insurance, and increased functional and behavioral difficulties. Children in our sample had greater unmet therapy needs in 2009 than in 2005. Caregiver-reported reasons for unmet need included cost and school resources. Research examining future trends in therapy access are warranted for children with ASD and CP. Children with complex diagnoses of autism spectrum disorder and cerebral palsy had reported unmet need for therapy services. High costs of therapy were the primary reported reason contributing to reduced access among children.