ArticleBMC public health2020
Effects of social health insurance on access and utilization of obstetric health services: results from HIV+ pregnant women in Kenya.
Article in BMC public health, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
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Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it, 16 citations in OpenAlex.
- Interventions to Improve the Reproductive Health of Undocumented Female Migrants and Refugees in Protracted Situations: A Systematic Review.Global health, science and practice · 2022Pooled it
- Health insurance enrollment and maternal health service utilization using Ghana Demographic and Health Survey, 2022.PloS one · 2025Article
- Childhood mortality and associated factors in Migori County, Kenya: evidence from a cross-sectional survey.BMJ open · 2023Observational
- Factors related to women's use of health insurance cover in Navakholo, Kakamega County, Kenya: sub-county level results based on community household register.BMC public health · 2023Article
- A Narrative Review of Kenya's Surgical Capacity Using the Lancet Commission on Global Surgery's Indicator Framework.Global health, science and practice · 2022Review
- A multi-step approach to managing missing data in time and patient variant electronic health records.BMC research notes · 2022Article
- Utilization patterns of healthcare facility and estimated expenditure of PLHIV care under the Indonesian National Health Insurance Scheme in 2018.BMC health services research · 2022Article
- Strengthening the Health System as a Strategy to Achieving a Universal Health Coverage in Underprivileged Communities in Africa: A Scoping Review.International journal of environmental research and public health · 2022Article
- Successes and obstacles in implementing social health insurance in developing and middle-income countries: A scoping review of 5-year recent literatures.Frontiers in public health · 2022Article
- Examining gender differentials and determinants of private health insurance coverage in Zambia.BMC health services research · 2021Article
- Genital Chlamydia Trachomatis Infection: Prevalence, Risk Factors and Adverse Pregnancy and Birth Outcomes in Children and Women in sub-Saharan Africa.International journal of MCH and AIDS · 2021Article
- Integrated screening and treatment services for HIV, hypertension and diabetes in Kenya: assessing the epidemiological impact and cost-effectiveness from a national and regional perspective.Journal of the International AIDS Society · 2020Article
- Predictors of Health Insurance Enrollment among HIV Positive Pregnant Women in Kenya: Potential for Adverse Selection and Implications for HIV Treatment and Prevention.International journal of environmental research and public health · 2020Article
Corrections and comments
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Authors and funding
5 authors at 4 institutions in 2 countries.
Funding
Abstract
backgroundReducing maternal morbidity and mortality remains a top global health agenda especially in high HIV/AIDS endemic locations where there is increased likelihood of mother to child transmission (MTCT) of HIV. Social health insurance (SHI) has emerged as a viable option to improve population access to health services, while improving outcomes for disenfranchised populations, particularly HIV+ women. However, the effect of SHI on healthcare access for HIV+ persons in limited resource settings is yet to undergo rigorous empirical evaluation. This study analyzes the effect of health insurance on obstetric healthcare access including institutional delivery and skilled birth attendants for HIV+ pregnant women in Kenya.
methodsWe analyzed cross-sectional data from HIV+ pregnant women (ages 15-49 years) who had a delivery (full term, preterm, miscarriage) between 2008 and 2013 with their insurance enrollment status available in the electronic medical records database of a HIV healthcare system in Kenya. We estimated linear and logistic regression models and implemented matching and inverse probability weighting (IPW) to improve balance on observable individual characteristics. Additionally, we estimated heterogeneous effects stratified by HIV disease severity (CD4 < 350 as "Severe HIV disease", and CD4 > 350 otherwise).
findingsHealth Insurance enrollment is associated with improved obstetric health services utilization among HIV+ pregnant women in Kenya. Specifically, HIV+ pregnant women covered by NHIF have greater access to institutional delivery (12.5-percentage points difference) and skilled birth attendants (19-percentage points difference) compared to uninsured. Notably, the effect of NHIF on obstetric health service use is much greater for those who are sicker (CD4 < 350) - 20 percentage points difference.
conclusionThis study confirms conceptual and practical considerations around health insurance and healthcare access for HIV+ persons. Further, it helps to inform relevant policy development for health insurance and HIV financing and delivery in Kenya and in similar countries in sub-Saharan Africa in the universal health coverage (UHC) era.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.