ArticleInternational journal for equity in health2017
Changes in catastrophic health expenditure in post-conflict Sierra Leone: an Oaxaca-blinder decomposition analysis.
Article in International journal for equity in health, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 3 of them syntheses that pooled it.
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Who cites it
23 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Catastrophic health expenditure and associated factors in low-, lower-middle and upper-middle-income countries: systematic review and meta-analysis.Global health action · 2026Pooled it
- Catastrophic health expenditure in sub-Saharan Africa: systematic review and meta-analysis.Bulletin of the World Health Organization · 2022Pooled it
- Factors associated with catastrophic health expenditure in sub-Saharan Africa: A systematic review.PloS one · 2022Pooled it
- Non-operative versus operative management of uncomplicated acute appendicitis: a randomized controlled study in Sierra Leone.BMC surgery · 2026Trial
- Progress and inequalities in early initiation of breastfeeding among women in Sierra Leone, 2008-2019.International breastfeeding journal · 2025Article
- The Economic Burden of Healthcare Utilization: Findings from a Health and Well-Being Survey in Informal Settlements of Freetown, Sierra Leone.Journal of urban health : bulletin of the New York Academy of Medicine · 2025Article
- What influences the impact of health financing reforms? Using qualitative comparative analysis to identify patterns in health financing systems and their effects on financial protection.SSM - health systems · 2025Review
- Spatial variation, 20-year trends, and determinants of the double burden of wasting and stunting among under-five children in Ethiopia: a geo-spatial and multivariate decomposition analysis (2000-2019).Scientific reports · 2024Article
- Decomposing the inequalities in the catastrophic health expenditures on the hospitalization in India: empirical evidence from national sample survey data.Frontiers in public health · 2024Article
- All-cause mortality of hospitalised patients with suspected COVID-19 in Sierra Leone: a prospective cohort study.BMJ open · 2023Article
- Decomposing Disability Inequality in Unmet Healthcare Needs and Preventable Hospitalizations: An Analysis of the Korea Health Panel.International journal of public health · 2023Article
- A Sierra Leone 2021 Midwifery Clinical Training Needs Assessment: A Call to Action to Augment Clinical Precepting.Annals of global health · 2023Article
- Population health trends analysis and burden of disease profile observed in Sierra Leone from 1990 to 2017.BMC public health · 2022Article
- Financial risk protection from out-of-pocket health spending in low- and middle-income countries: a scoping review of the literature.Health research policy and systems · 2022Article
- [Social Determinants Affecting Changes in Mental Health of Rural-Urban Migrant Population in Chengdu: An Oaxaca-Blinder Decomposition Analysis].Sichuan da xue xue bao. Yi xue ban = Journal of Sichuan University. Medical science edition · 2022Article
- Inequalities in maternal healthcare use in Sierra Leone: Evidence from the 2008-2019 Demographic and Health Surveys.PloS one · 2022Article
- Inequalities in catastrophic health expenditures in conflict-affected areas and the Colombian peace agreement: an oaxaca-blinder change decomposition analysis.International journal for equity in health · 2021Article
- Catastrophic expenditure and impoverishment after caesarean section in Sierra Leone: An evaluation of the free health care initiative.PloS one · 2021Article
- The Basic vs. Ability-to-Pay Approach: Evidence From China's Critical Illness Insurance on Whether Different Measurements of Catastrophic Health Expenditure Matter.Frontiers in public health · 2021Article
- Understanding the Improvement in Full Childhood Vaccination Coverage in Ethiopia Using Oaxaca-Blinder Decomposition Analysis.Vaccines · 2020Article
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAt the end of the eleven-year conflict in Sierra Leone, a wide range of policies were implemented to address both demand- and supply-side constraints within the healthcare system, which had collapsed during the conflict. This study examines the extent to which households' exposure to financial risks associated with seeking healthcare evolved in post-conflict Sierra Leone.
methodThis study uses the 2003 and 2011 cross-sections of the Sierra Leone Integrated Household Survey to examine changes in catastrophic health expenditure between 2003 and 2011. An Oaxaca-Blinder decomposition approach is used to quantify the extent to which changes in catastrophic health expenditure are attributable to changes in the distribution of determinants (distributional effect) and to changes in the impact of these determinants on the probability of incurring catastrophic health expenditure (coefficient effect).
resultsThe incidence of catastrophic health expenditure decreased significantly by 18% from approximately 50% in 2003 t0 32% in 2011. The decomposition analysis shows that this decrease represents net effects attributable to the distributional and coefficient effects of three determinants of catastrophic health expenditure - ill-health, the region in which households reside and the type of health facility used. A decrease in the incidence of ill-health and changes in the regional location of households contributed to a decrease in catastrophic health expenditure. The distributional effect of health facility types observed as an increase in the use of public health facilities, and a decrease in the use of services in facilities owned by non-governmental organizations (NGOs) also contributed to a decrease in the incidence of catastrophic health expenditure. However, the coefficient effect of public health facilities and NGO-owned facilities suggests that substantial exposure to financial risk remained for households utilizing both types of health facilities in 2011.
conclusionThe findings support the need to continue expanding current demand-side policies in Sierra Leone to reduce the financial risk of exposure to ill health.
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