Effect of Wealth on Health Care Seeking Behavior And Out of Pocket Health Expenditure in Malawi

Thesis (Master's)--University of Washington, 2016-06

Background: Under-five mortality continues to be a source of concern globally, particularly in Sub-Saharan Africa. Exploring the association between wealth, health seeking behavior and out-of-pocket expenditure is necessary in order to pinpoint the areas to which resources should be channeled so as to make maximum inpact in reduction of under-five mortality. Methods: This study aims to highlight the disparity in seeking for healthcare and personal spending for healthcare across the different socioeconomic levels in Malawi. We performed a cross sectional population-based household survey in 2015. The survey contained data for children 2-59 months with a reported history of symptoms of non-severe pneumonia, malaria and diarrhea in the two weeks prior to the survey. A principal component analysis (PCA) was used to construct a wealth index (the predictor of interest) into quintiles. We carried out a bivariate and multivariate logistic regression of the predictor of interest, wealth index, and the outcome variables, health seeking behavior and out-of-pocket expenditure (OOP). Results: The sample included 1,150 children between the ages of 2-59 months whose parents reported cough, diarrhea or fever in the past two weeks. In the unadjusted bivariate analysis and multivariate analysis adjusting for education, age of caregiver, area of residence and number of people in the household, there was no observed trend in seeking for treatment across the wealth quintiles. In the unadjusted bivariate analysis, the odds of seeking for care in government facilities among participants in the lowest wealth quintile was 26% less when compared to those in the highest wealth quintile (OR = 0.74, 95% CI: 0.39, 1.39). There were no observed trends when comparing the odds of incurring OOP expenditure among participants across the different wealth quintiles. Comparing dollar amount spent among participants who incurred OOP, participants in the highest wealth quintile were likely to spend 2.28 times more money when compared to those in the lowest wealth quintile, with statistical significance. Conclusion: In a population with marginal differences in socioeconomic status, the concept of wealth may be inconsequential to their health seeking behavior or out-of-pocket expenditure. Ensuring a constant supply of medications and enforcing the non-payment of service fees in government health facilities may be a solution to improving health seeking behavior and reducing under-five mortality in Malawi.