World Health Survey Questionnaire Research Articles

Has Iran achieved the goal of reducing the prevalence of households faced with catastrophic health expenditure to 1%?: A national survey.

One of the goals of the Islamic Republic of Iran is to reduce the prevalence of catastrophic health expenditures among Iranian households to 1% by the end of the sixth 5-year development plan (2016-2021). This study was conducted to evaluate the level of access to this goal in the final year of this program. A national cross-sectional study was conducted on 2000 Iranian households in five provinces of Iran in 2021. Data were collected through interviews using the World Health Survey questionnaire. Data from households whose health care costs were more than 40% of their capacity to pay were included in the group of households with catastrophic health expanditure (CHE). Determinants of CHE were identified using univariate and multivariate regression analysis. 8.3% of households had experienced CHE. The variables of being a female head of household (odd ratio [OR] = 2.7), use of inpatient (OR = 1.82), dental (OR = 3.09), and rehabilitation services (OR = 6.12), families with disabled members (OR = 2.03) and low economic status of the households (OR = 10.73) were significantly associated with increased odds of facing CHE (p < 0.05). In the final year of the sixth 5-year development plan, Iran has not yet achieved its goal of "reducing the percentage of households exposed to CHE to 1%." Policymakers should pay attention to factors increasing the odds of facing CHE in designing interventions.

Prevalence of Depressive Disorders and Associated Factors among Adult Population of Dubai 2019

Background: Globally, depressive disorders are one of the leading causes of ill mental health and disability affecting about 1 in 4 people at some point in their lives. Population-level data on depressive disorders in the region are sparse yet essential for health sectors. This is the first population estimate for the prevalence of depressive disorders and associated factors in Dubai. Objective: The aim of this study was to estimate the prevalence of depressive disorders and the associated factors among adults aged ≥18 years in the Emirate of Dubai 2019. Method: This is a complex-design cross-sectional population survey targeting Dubai residents aged ≥18 years. This study was part of the Dubai Household Survey 2019 (DHHS-2019). The total number of participants was 2,244, with a response rate of 91.6%. The design was a 2-stage stratified cluster sample. Trained investigators conducted computer-assisted face-to-face interviews using the World Health Survey questionnaire and Patient Health Questionnaire (PHQ-9) screening. Analysis was design-based adjusting for weight, primary sampling unit, and stratum. Results: The overall prevalence of depressive disorders was 2.3% (95% confidence interval [CI]: 1.6%–3.4%). Screening revealed 1.9% (95% CI: 1.2%–2.9%) of participants were positive for depressive disorders, with no prior diagnosis constituting approximately 74% of the depressed. Factors associated with depression were adjusted using logistic regression and revealed significantly higher odds of depressive disorders among the following: unmarried (single, divorced, and widowed) comparing to married (odds ratio [OR]: 2.7, 95% CI: 1.2–6.3) and smokers than nonsmokers (OR: 3.3, 95% CI: 1.4–8.0). Employment was found to be a protective factor and reduced the odds of having depressive disorders by 80% comparing to unemployed (OR: 0.2, 95% CI: 0.1–0.7). Moreover, those suffering from health conditions had higher odds for having depressive disorders, such as chest pain (OR: 20.2, 95% CI: 5.5–74.8), history of tuberculosis (TB) (OR: 12.6, 95% CI: 2.1–76.8), and history of stroke (OR: 22.5, 95% CI: 6.8–74.2). Conclusion: The prevalence of depressive disorders was relatively low in Dubai compared to most countries. However, approximately 74% of individuals with depression were undiagnosed, indicating the need for screening programs. The odds of having depressive disorders were significantly higher among unmarried, unemployed, smokers, and those with a history of TB and stroke.

Catastrophic health expenditures for children with disabilities in Iran: A national survey

The aim of this study was to investigate thepercentage of households with disabled children aged 0-8years who had faced catastrophic health expenditures (CHEs) due to the health costs of these children in Iran. This cross-sectional study was carried out on 2000 households with disabled children aged 0-8years in five provinces of Iran in 2020. Data were collected using the World Health Survey questionnaire and face-to-face interview. Determinants of CHE were identified using logistic regression. 32.7% of households with disabled children had faced CHE. Head of household being female (Adjusted OR=18.89, 95%CI: 10.88-29.42), poor economic status of the household (Q1: Adjusted OR=20.26, 95% CI, 11.42-35.94; Q2: Adjusted OR=8.27, 95%CI, 4.45-15.36; Q3: Adjusted OR=13.88, 95%CI, 7.89-24.41), lack of supplementary insurance by a child with disabilities (Adjusted OR=6.13, 95%CI, 3.39-11.26), having a child with mental disability (Adjusted OR=2.71, 95%CI, 1.60-4.69), and type of basic health insurance (having Iranian Health Insurance: Adjusted OR=2.20, 95%CI, 1.38-3.49; having Social security insurance: Adjusted OR=1.66, 95%CI, 1.06-2.61) significantly increased the chances of facing CHE. A significant percentage of households with disabled children had faced CHE because of their disabled child's health costs. The key determinants of CHE should be considered by health policy-makers in order to more financial protection of these households.

The Study of Out-of-pocket Payment and the Exposure of Households with Catastrophic Health Expenditures Following the Health Transformation Plan in Iran.

IntroductionOne of the main objectives of health systems is providing financial protection against out-of-pocket (OOP) health expenditures. According to the 2011 report by the World Health Organization in the Eastern Mediterranean Regional Office (EMRO), a huge portion of health service in Iran is paid OOP, which is around 58% of the total health system expenditure. Furthermore, all over the world, around 25 million households (100 million people) are trapped in poverty as a result of paying health service costs. Therefore, this research was aimed at investigating the OOP and exposure of households with catastrophic health expenditures (CHE) following the implementation of a health transformation plan in Tabriz, Iran.MethodsA descriptive-analytic study was conducted on a cross-sectional basis. The sample included 400 households, who were interviewed using the World Health Survey questionnaire, and then OOP payment and exposure of households to CHE were estimated, and the effective factors on OOP payment and the determinants of CHE were analyzed using a regression model.ResultsAfter implementing the health transformation plan, the average share of households’ OOP payments, toward their ability to pay was 13.2%. In addition, 11.25% of the households were exposed to CHE in Tabriz. The key determinants of OOP were income, dental services, pharmaceuticals, radiology, and physiotherapy. The factors affecting CHE were income, insurance status, marital status, dental services, pharmacy, physiotherapy, and radiological services.ConclusionBased on the results of the current study and compared to similar research conducted prior to this plan, it is obvious that the transformation plan was able to achieve its goal in “reducing OOP payments”. However, health services such as dental, pharmacy, physiotherapy, and radiology would increase the likelihood of facing OOP payments. These variables should be considered by health policy-makers in order to review and revise the content of recent reform to provide financial protection against OOP for people.

Household financial contribution to the health system after Iran's Health Transformation Plan

Iran's Health Transformation Plan (HTP) was implemented in 2014 to decrease household expenditures. The present study seeks to measure the household financial contribution to healthcare expenditures in Sistan-Baluchistan Province after the implementation of HTP. A household survey was conducted in 2017 in Sistan-Baluchistan Province. The province is the most remote and poorest in the country and this poverty has extended to most of its main health indicators as well. About 2400 households were selected as the study samples using multistage sampling. Data were collected using the World Health Survey questionnaire. The questionnaire was designed by WHO in 2003 for assessing health system performance. Two main indicators of equity in health were measured: the percentage of households facing catastrophic health expenditure (CHE) and the Fair Financial Contribution Index (FFCI). The multiple adjusted logistic regression model was used to study the likelihood of facing CHE and to calculate the adjusted odds ratios (OR) using the model coefficients. Data were then analyzed the Statistical Package for the Social Sciences. The results showed that 484 (20.2%) of the households faced CHE after implementation of the HTP. The FFCI was approximately 0.7 across the province. Statistically significant relationships were observed between the chances of facing CHE and variables including place of residence (p=0.010), having members aged more than 65 years (p=0.005) and having members with disabilities and in need of care (p=0.001). There were statistically significant relationships between the chance of facing CHE and variables related to the use of health services, including the use of dental (OR=5.212), rehabilitation (OR=2.471), diagnostic and laboratory (OR=3.637), and inpatient (OR=2.511) services. Despite the implementation of HTP, a high percentage of the households faced CHE. The authorities should pay more attention to low-income and remote regions of the country; in addition, the HTP should financially cover outpatient healthcare services in an adequate manner.

Increase of catastrophic health expenditure while it does not have socio-economic anymore; finding from a district on Tehran after recent extensive health sector reform

BackgroundEnsuring financial protection of the community against health care expenditures is one of the fundamental goals of the health system. Catastrophic health expenditures (CHE) occurs when out-of-pocket health expenditures due to health care expenses considerably affect family life. The main purpose of this study was to analyze CHE trend over time and to determine its determinants.MethodsThe last round of a three part study over time was conducted in June to September 2015 on 600 households in a non-affluent area of Tehran. The World Health Survey questionnaire was used to collect information. Health expenditure was considered to be catastrophic when OOP health expenditures exceed 40% of household’s capacity to paysubsistence expenditures. After calculating the amount of households’ exposure to CHE, determinants resulting in CHE using logistic regression and the amount of economic inequality in the exposure of households to CHE using the concentration index were calculated. Then, performing a decomposition analysis, the contribution of each of the studied variables to the observed economic inequality was determined. All the findings were compared with the results of studies carried out in the years 2003 and 2008.ResultsIn the year 2015, 29.9% of households incurred CHE. This amount was 12.6 and 11.8% in the 2003 and 2008 studies, respectively. The concentration index was - 0.017(confidence interval; − 0.086 to 0.051), which, unlike the CI calculated in the years 2003 and 2008, was not significant. The most important determinant affecting the exposure to CHE was inpatient service utilization (OR = 1.64).ConclusionComparing to the whole national wide findings in sum, in 2015, the amount of the exposure of the studied households to CHE was significant, and it in comparison with the results of the previous studies was increased. However, there was no significant economic inequality and the observed levels of inequalityin comparison with the results of the previous studies conducted in 2003 and 2008 were decreased.

Catastrophic health expenditure and its determinants in households with gastrointestinal cancer patients: evidence from new health system reform in Iran

PurposeThe right to health for all people means that everyone should have access to the needed healthcare services without suffering from severe financial hardship. The purpose of this paper is to investigate the prevalence as well as the effective factors on facing catastrophic health expenditures (CHE) among gastrointestinal cancer patients and families in Kurdistan province in west of Iran after the implementation of Health Transformation Plan (HTP).Design/methodology/approachA cross-sectional study was carried out on 189 households with gastrointestinal cancer patients in Kurdistan province in 2018. Data were collected using World Health Survey questionnaire. A method developed by World Health Organization with the threshold of 40 percent household’s capacity to pay was used in order to measure the proportion of households facing CHE. Also, logistic regression was applied for identifying the effective factors on household’s exposure to CHE. Data were analyzed using STATA version 13.FindingsAlmost 73 percent (72.7 percent) of the households (n=117) faced the CHE. Not having supplementary health insurance (adjusted odds ratio (AOR): 3.8; 95% confidence interval: 1.3–10.8 (and having low socio-economic status (AOR: 7.1; 95% CI: 1.8–28.1) were the significant factors affecting the households’ exposure to CHE. In total, 57 and 1 percent of the studied households reported that having a gastrointestinal cancer patient at home had a significant effect on refraining from using health services by other family members.Originality/valueThe proportion of the studied households facing CHE was very high. This may indicate the weakness of health system as well as health insurance or the weakness of HTP in financial protection of fragile population.

Catastrophic Health Expenditure in Households with Severe Mental Disorders Patients: Evidence After Iran's Health Transformation Plan

Background: The high cost of mental health services can be a great barrier to accessing healthcare for patients with mental disorders. Objectives: The present study aimed to measure the catastrophic health expenditure (CHE) for households with severe mental disorders (SMDs) patients. Methods: A cross-sectional study was conducted among 400 households with SMDs patients who referred to four psychiatric university centers located in Tehran for outpatient services from July 2017 to March 2018. We consecutively selected 100 participants from each hospital. Data were collected using the World Health Survey questionnaire through interviews. The method considered by the WHO was used to measure the CHE and a forced-entry logistic regression technique was applied to assess factors affecting the CHE using STATA version 14.0 software. Results: The results showed that 25.75% of the households with SMDs patients faced CHE. There was also a significant relationship between households facing CHE and variables including the age of the household head (40 - 59 years; OR: 0.283, P value = 0.049), education status of the household head (university; OR: 0.075, P value = 0.002), utilization of dental (OR: 12.38, P value = 0.000), rehabilitation (OR: 6.99, P value = 0.012), and medication (OR: 3.17, P value = 0.049) services, and the household expenditures quintile (the fifth quintile; OR: 0.111 P value = 0.000). Conclusions: It is suggested that the Health Transformation Plan financially covers outpatient healthcare services more sufficiently, especially for mental disorders.

The Households Health Spending and Impoverishment: A Study After Iran's Health Transformation Plan

Background: Iran’s Health Transformation Plan (HTP) was implemented to decrease households’ out of pocket and protect them from facing catastrophic health expenditure and impoverishment from 2014. It is needed to assess the effect of HTP; therefore, the study aimed to examine the households’ impoverishment due to health expenditure after HTP. Methods: A household survey was carried out in 2017 in Sistan and Baluchestan province in southeast Iran. About 2400 households were selected as the study sample using a multi-stage sampling technique. The household section of the World Health Survey questionnaire was used to collect data. Independent variables contained households’ characteristics, household income, chronic illness status, the use of health services, and health spending. The dependent variable was whether the household was faced with health spending impoverishment. Mixed effects logistic regression was used to assess the effect of the independent variables on the impoverishment using SPSS software 21. Results: About 7.5% of the households had no basic insurance and 757 (31.6) heads’ of the households were unemployment. The results showed that about 5.4% of the households impoverished due to health expenditure. The households in the furthest region were forced with impoverishment more than other regions (23.0%). Living in a rural area, unemployment, economic status, and inpatients and outpatient costs were the main determinates on impoverishment (P < 0.05). In addition, having supplementary insurance was a protective factor in facing impoverishment (P = 0.05). Conclusions: In general, despite the implementation of HTP, healthcare expenditures leading to impoverishment of high percent of the households and Iranian development goals have not been fulfilled in this region. Economic poverty of the people may also be an important factor in this regard. It is recommended that outpatient services are covered by health insurances.

Catastrophic health expenditure among households with members with special diseases: A case study in Kurdistan.

Background: One of the main goals of health systems is to protect people against financial risks associated with diseases that can be catastrophic for patients. In 2014, Health Sector Evolution Plan (HSEP) was implemented in Iran; one of the objectives of HSEP was to reduce out-of-pocket payments and provide more financial protection for people. Therefore, the present study aimed at exploring the likelihood of facing catastrophic health expenditures (CHE) among households with members suffering from dialysis, kidney transplant, or multiple sclerosis (MS) after the implementation of HSEP. Methods: A total number of 385 households were selected using stratified random sampling and were asked to complete the World Health Survey questionnaire through telephone conversations. As outlined by the World Health Organization (WHO), when household out-of-pocket expense for health services is ≥40% of its capacity to pay, then that household is considered to be facing CHE. Furthermore, determinants of CHE were identified using logistic regression. Results: The percentage of facing catastrophic health care expenditures for households with a MS, dialysis, and kidney transplant patient was 20.6%, 18.7%, and 13.8%, respectively. Results of logistic regression analysis revealed that patient’s economic status, level of education, supplementary insurance status, type of disease, multiple members with special diseases in the household, rural residence, use of inpatient, dental, and rehabilitation services were effective factors for determining the likelihood of facing CHE. Conclusion: Despite the implementation of HSEP, the percentage of CHE is still high for households that have members who suffer from special diseases. However, basic health insurance packages should be amended and more cost-sharing exemptions should be granted to provide more financial protection for the vulnerable households.

Measuring Financial Protection in Hospitalized Patients after the Health Sector Evolution Plan in Iran

Background: Protecting people from catastrophic health payments is widely recognized as an integral component of health systems and universal health coverage. Objectives: This study aimed to measure the financial protection against catastrophic health expenditure among hospitalized patients in Kermanshah, western Iran, after the implementation of the health sector evolution plan of Iran. Methods: This was a cross-sectional study. A total of 544 patients were selected using the proportional allocation to population size technique. A translated version of the world health survey questionnaire was used to collect data. Catastrophic health expenditure was calculated using WHO recommended methodology. Data were analyzed using STATA v.13. The statistical test performed included descriptive statistics and logistic regression. Results: About 4.8% of households with hospitalized patients were faced with catastrophic health expenditures. The total mean out-of-pocket (OOP) medical expenditures of being hospitalized was 819,220 Rials per patient. Mean OOP in patients with catastrophic payment was 2,220,500 Rial. Major determinants of catastrophic payment were associated with surgical cost (OR: 8.09 P Value = 0.000), chronic disease (OR: 2.78 P Value = 0.025), household size (> 6) (OR: 6.70 P Value < 0.036), and economic status of households (Quintile 5; OR: 0.005 P Value = 0.000). Conclusions: The Health Sector Evolution Plan should target and extend aids especially for chronically ill patients, those who need surgery, and those at poorest quintile due to the fact that they are more vulnerable to catastrophic health expenditure. These groups should be the priorities in the health sector evolution plan revision to achieve a more desired outcome.

Quality of perinatal care services from the user\u2019s perspective: a Dutch study applies the World Health Organization\u2019s responsiveness concept

BackgroundThe concept of responsiveness was introduced by the World Health Organization (WHO) to address non-clinical aspects of service quality in an internationally comparable way. Responsiveness is defined as aspects of the way individuals are treated and the environment in which they are treated during health system interactions.The aim of this study is to assess responsiveness outcomes, their importance and factors influencing responsiveness outcomes during the antenatal and delivery phases of perinatal care.MethodThe Responsiveness in Perinatal and Obstetric Health Care Questionnaire was developed in 2009/10 based on the eight-domain WHO concept and the World Health Survey questionnaire. After ethical approval, a total of 171 women, who were 2 weeks postpartum, were recruited from three primary care midwifery practices in Rotterdam, the Netherlands, using face-to-face interviews. We dichotomized the original five ordinal response categories for responsiveness attainment as ‘poor’ and good responsiveness and analyzed the ranking of the domain performance and importance according to frequency scores. We used a series of independent variables related to health services and users’ personal background characteristics in multiple logistic regression analyses to explain responsiveness.ResultsPoor responsiveness outcomes ranged from 5.9% to 31.7% for the antenatal phase and from 9.7% to 27.1% for the delivery phase. Overall for both phases, ‘respect for persons’ (Autonomy, Dignity, Communication and Confidentiality) domains performed better and were judged to be more important than ‘client orientation’ domains (Choice and Continuity, Prompt Attention, Quality of Basic Amenities, Social Consideration). On the whole, responsiveness was explained more by health-care and health related issues than personal characteristics.ConclusionTo improve responsiveness outcomes caregivers should focus on domains in the category ‘client orientation’.

Catastrophic Health Expenditure After the Implementation of Health Sector Evolution Plan: A Case Study in the West of Iran.

One of the main objectives of health systems is the financial protection against out-of-pocket (OOP) health expenditures. OOP health expenditures can lead to catastrophic payments, impoverishment or poverty among households. In Iran, health sector evolution plan (HSEP) has been implemented since 2014 in order to achieve universal health coverage and reduce the OOP health expenditures as a percentage of total health expenditures. This study aimed to explore the percentage of households facing catastrophic health expenditures (CHE) after the implementation of HSEP and the factors that determine CHE. A total of 663 households were selected through a cluster sampling based on the census framework of Sanandaj Health Center in July 2015. Data were gathered using face-to-face interviews based on the household section of the World Health Survey questionnaire. In this study, according to the World Health Organization (WHO) definition, if household health expenditures were equal to or more than 40% of the household capacity to pay, household was considered to be facing CHE. The determinants of CHE were analyzed using logistic regression model. The rates of households facing CHE were 4.8%. The key determinants of CHE were household economic status, presence of elderly or disabled members in the household and utilization of inpatient or rehabilitation services. The comparison of our findings and those of other studies carried out using a methodology comparable with ours in different parts of Iran before the implementation of HSEP suggests that the implementation of recent reforms has reduced CHE at the household level. Utilization of inpatient and rehabilitation services, the presence of elderly or disabled members in the household and the low economic status of the household would increase the likelihood of facing CHE. These variables should be considered by health policy-makers in order to review and revise content of recent reform, thus financially protecting public against CHE.

The Household Health Spending and Impoverishment: Findings from the Households Survey in Shiraz, Iran

The present study aimed to investigate the households' impoverishment due to the healthcare costs in Shiraz in 2012. In this household's survey, 800 households were studied in Shiraz. The study sample was selected using stratified and cluster sampling in the urban and rural areas, respectively. The information was collected using the household section of the World Health Survey questionnaire. In order to determine impoverishment due to health spending, at first, the households' food-based poverty line (subsistence expenditure) was measured. Then, households' health expenditure was subtracted from their total expenditure and if the obtained value was lower than the households' food-based poverty line, the households was considered to be impoverished due to health expenditures. The collected data were entered into the SPSS (version 16) statistical software and analyzed using descriptive statistic, Chi-square test, and logistic regression in backward method. The study results showed that 7.1% of the households (CI: 0.071 ± 0.018) were impoverished because of healthcare expenditures. Besides, the households in the first quintile were more likely to be faced with poverty compared to those in the other quintiles (p < 0.05). Being covered by health insurance did not affect the protection from poverty due to health costs. Moreover, the participants living in rural areas were faced with poverty more than those living in urban areas (p < 0.05). It seems that health expenditure can be an economic shock for household in Shiraz and through spending on health a household may fall into poverty. As insurance had no effect on impoverishment, it implies that change in health insurance plans and ways of health financing is necessary.

Stigma Associated with Tuberculosis Disease in Republic of Macedonia – Results from a Cross-Sectional Study

BACKGROUND: Stigma and discrimination are interrelated and are breaking the fundamental human rights. Both are associated with tuberculosis (TB) disease since ever and have negative influence on activities aimed at TB prevention, treatment and control, both at individual, community and societal level.AIM: To determine the magnitude of TB stigma in Republic of Macedonia, identify root causes and detect main determinants associated with it.MATERIAL AND METHODS: Cross-sectional study was performed on 315 TB patients registered in the period Jul, 2012-Jun, 2013, using selected module from World Health Survey questionnaire. Self-reported data is collected through face to face interview conducted by trained directly observed treatment (DOT) nurses in the patients’ home.RESULTS: 16.7% TB patients have not received any assistance when diagnosed with TB and 8.4% were treated badly by a member of the family or close friends because of the disease, consequences ranging from living the patient completely, refusal to talk or telling other people that the person is infected. An odd for such behavior were higher if the patient is male, married, have no formal education or have completed only primary school, is unemployed and lives in rural area.CONCLUSION: Understanding the origins of TB stigma is integral to reducing its impact on health. Our survey has provided a baseline on the magnitude of existent stigma associated with TB disease and has identified main determinants that trigger stigmatizing behavior.

Stigma Associated with Tuberculosis Disease in Republic of Macedonia – Results from a Cross-Sectional Study

BACKGROUND: Stigma and discrimination are interrelated and are breaking the fundamental human rights. Both are associated with tuberculosis (TB) disease since ever and have negative influence on activities aimed at TB prevention, treatment and control, both at individual, community and societal level.AIM: To determine the magnitude of TB stigma in Republic of Macedonia, identify root causes and detect main determinants associated with it.MATERIAL AND METHODS: Cross-sectional study was performed on 315 TB patients registered in the period Jul, 2012-Jun, 2013, using selected module from World Health Survey questionnaire. Self-reported data is collected through face to face interview conducted by trained directly observed treatment (DOT) nurses in the patients’ home.RESULTS: 16.7% TB patients have not received any assistance when diagnosed with TB and 8.4% were treated badly by a member of the family or close friends because of the disease, consequences ranging from living the patient completely, refusal to talk or telling other people that the person is infected. An odd for such behavior were higher if the patient is male, married, have no formal education or have completed only primary school, is unemployed and lives in rural area.CONCLUSION: Understanding the origins of TB stigma is integral to reducing its impact on health. Our survey has provided a baseline on the magnitude of existent stigma associated with TB disease and has identified main determinants that trigger stigmatizing behavior.

Social determinants of equity in access to healthcare for tuberculosis patients in Republic of Macedonia - results from a case-control study.

Health is a complex phenomenon and equity as a basic human right an integral part of constitutions in almost all countries in the world. In Republic of Macedonia (RM), Tuberculosis (TB) is clustered regionally and in certain ethnic groups. The main objective of this study was to analyze Social Determinants of Health (SDH) and equity in access to healthcare services for TB patients in RM, aimed at complex analysis of factors that cause inequities. Case-control study was conducted in the period March-December, 2013; "cases" are households of TB patients registered in the period July, 2012-June, 2013 and controls are households with no TB patients in their immediate vicinity. World Health Organization (WHO) World Health Survey questionnaire was used to collect data. Analysis of SDH of TB patients shows that patients are mostly males, of lower socio-economic status, are less educated, unemployed and TB is clustered in certain ethnic groups. Analysis of access has identified these determinants as important barriers in access to health services. The study has documented the basic SDH of TB patients in RM, as well as barriers in access to healthcare, providing useful baseline information to facilitate determination where to concentrate future efforts.

Inequality in household catastrophic health care expenditure in a low-income society of Iran

We assessed change in household catastrophic health care expenditures (CHE) and inequality in facing such expenditures in south-west Tehran. A cluster-sampled survey was conducted in 2003 using the World Health Survey questionnaire. We repeated the survey on the same sample in 2008 (635 and 603 households, respectively). We estimated the proportion of households facing CHE using the 'household's capacity to pay'. We identified the determinants of the household CHE using regression analysis and used the concentration index to measure socio-economic inequality and decompose it into its determinants factors. Findings showed that the proportion of household facing CHE had no significant change in this period (12.6% in 2003 vs 11.8% in 2008). The key determinants of CHE for both years were health care utilization and health care insurance status. Socio-economic status was the main contributor to inequality in CHE, while unequal utilization of dentistry and outpatient services had reduced the inequality in CHE between socio-economic groups. We observed no significant change in the CHE proportion despite policy interventions aimed at reducing such expenditures. Any solution to the problem of CHE should include interventions aimed at the determinants of CHE. It is essential to increase the depth of social insurance coverage by expanding the basic benefit package and reducing co-payments.

Self-Reported Visual Impairment and Impact on Vision-Related Activities in an Elderly Nigerian Population: Report from the Ibadan Study of Ageing

Background: Studies have shown an association between visual impairment and poor overall function. Studies from Africa and developing countries show high prevalence of visual impairment. More information is needed on the community prevalence and impact of visual impairment among elderly Africans. Methods: A multi-stage stratified sampling of households was implemented to select persons aged 65 years and over in the south-western and north-central parts of Nigeria. Impairments of distant and near vision were based on subjective self-reports obtained with the use of items derived from the World Health Organization multi-country World Health Survey questionnaire. Impairment was defined as reporting much difficulty to questions on distant and near vision. Disabilities in activities of daily living (ADL) and instrumental activities of daily living (IADL) were evaluated by interview, using standardized scales. Results: A total of 2054 subjects 957 (46.6%) males and 1097 (53.4) females responded to the questions on vision. 22% (n = 453) of the respondents reported distant vision impairment, and 18% (n = 377) reported near vision impairment (not mutually exclusive). Fifteen percent (n = 312), however, reported impairment for both far and near vision. Impairment of distant vision increased progressively with age (P < 0.01). Persons with self-reported near vision impairment had elevated risk of functional disability in several IADLs and ADLs than those with out. Distant vision impairment was less associated with role limitations in both ADLs and IADLs. Conclusion: The prevalence of self-reported distant visual impairment was high but that for near visual impairment was less than expected in this elderly African population. Impairment of near vision was found to carry with it a higher burden of functional disability than that of distant vision.

Perception of health state and the use of vignettes to calibrate for socioeconomic status: results of the World Health Survey in Brazil, 2003

As part of the World Health Organization (WHO) project focused on assessing the performance of national health systems, the World Health Survey (WHS) was carried out in many member countries. In order to enable comparison of self-rated health between different cultures of the same country or between different nations, the WHS questionnaire included vignettes of sample cases, that is, hypothetical stories that describe the health problems of third parties. The objective of the present study is to evaluate the possibility of using vignette ratings to implement a socioeconomic calibration scale for self-rated health in Brazil. Using Brazilian WHS data, perceptions of state of health, measured through two different strategies (self-rating and vignette-rating), were compared. The effects of socioeconomic status (educational level and number of household assets) on health domain ratings were estimated via multiple regression models, controlled for age and sex. The effects of socioeconomic status were significant for the majority of health domains in the case of self-perception, but statistically null in the case of third party ratings. It is concluded that the WHO vignettes are not appropriate for calibrating self-rated health measures in Brazil.