AUTHOR=Oyando Robinson , Barasa Edwine , Ataguba John E. 

TITLE=Socioeconomic Inequity in the Screening and Treatment of Hypertension in Kenya: Evidence From a National Survey

JOURNAL=Frontiers in Health Services

VOLUME=Volume 2 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/health-services/articles/10.3389/frhs.2022.786098

DOI=10.3389/frhs.2022.786098

ISSN=2813-0146

ABSTRACT=Background: Non-communicable diseases (NCDs) account for 50% of hospitalisations and 55% of inpatient deaths. Hypertension is one of the major NCDs in Kenya. Equitable access and utilisation of screening and treatment interventions are critical for reducing the burden of hypertension. This study assessed horizontal equity (equal treatment for equal need) in the screening and treatment for hypertension.  It also decomposed socioeconomic inequalities in care use in Kenya.
Methods: Cross-sectional data from the 2015 NCDs risk factors STEPwise survey, covering 4,500 adults aged 18-69 years were analysed. Horizontal inequity (HI) index (measures inequity), concentration curves, and concentration indices (CI) (measures inequality) were computed. A positive (negative) HI or CI values suggests that the outcome of interest is pro-rich (pro-poor). Contributions of need (age, sex, and body mass index (BMI)) and non-need (wealth status, education, exposure to media, employment, and area of residence) factors to the observed inequality were evaluated using a standard decomposition method  .

Results: The need for hypertension screening was higher among poorer than wealthier socioeconomic groups (CI = -0.077; p < o.05). However, wealthier groups needed hypertension treatment more than poorer groups (CI = 0.293; p<0.001). Inequity in the use of hypertension screening (HI = 0.185; p<0.001) and treatment (HI = 0.095; p<0.001) were significantly pro-rich. Need factors such as sex and BMI were the largest contributors to inequalities   in the use of screening services. By contrast, non-need factors like the area of residence, wealth, employment status mainly contributed to inequalities in utilisation of treatment services.

Conclusion: Among other things, the use of hypertension screening and treatment services in Kenya should be according to need to realise the Sustainable Development Goals for NCDs. Specifically, efforts to attain equity in healthcare use for hypertension services should be multi-sectoral and focused on crucial inequity drivers such as regional disparities in care use, poverty and educational attainment. Also, concerted awareness campaigns are needed to increase the uptake of screening services for hypertension.