Determinants of orthopaedic service utilisation among young people aged 5-24 years old in Zambia
Date
2019
Authors
Seketi, Elizabeth Queen
Journal Title
Journal ISSN
Volume Title
Publisher
The University of Zambia
Abstract
Musculoskeletal conditions and/or disorders (MSDs) are the main causes of
disability in many patients even though such disorders can be addressed through
orthopaedic care. Some of the known factors that influence the utilisation of
Orthopaedic services utilisation include: geographical coverage, availability of
human resources, client socioeconomic and demographic characteristics among
others. However, the actual levels of Orthopaedic services utilisation with their
associated factors in Zambia remain unknown to a larger extent. Most research in
orthopaedics in Zambia has focussed mainly on pure clinical research yielding little
information on determinants of Orthopaedic services utilisation. This study
examined, with a conceptual based multidimensional model, the determinants of
Orthopaedic service utilisation among young patients (5-24) at the University
Teaching Hospital and the St John Paul II Orthopaedic Mission Hospital in Lusaka,
Zambia. An embedded mixed methods design was used to conduct a hospital based
cross sectional study that focused on high and low level of orthopaedic services
utilisation. Stratified random sampling was used to draw a sample of 162 children
and young people (5-24) from the hospital registers. Purposive sampling was used
for eight Service providers and 10 parents. Quantitative data was collected using a
data extraction checklist and self-administered questionnaires for service providers.
These contained questions on service attributes and client characteristics.
Qualitative data was collected using a semi structured interview guide for
interviews with parents. A focus group discussion guide was used to hold one focus
group discussion with six clients aged 15 to 24. Quantitative data was analysed
using STATA Version 14. Statistical tests included chi square, univariate and
multiple logistic regression. Thematic and content analysis was done for qualitative
data.
The study found that the proportion for high level of use was 41%. The determinants
included type of service, where clients from physiotherapy less likely to use
services compared to clients from prosthetic and orthotics workshops [AOR 0.16,
95% CI 0.05, 0.59; P=0.01]; Area of residence, where clients aged 5-24 living in
low density residential areas were less likely to use Orthopaedic services compared
to those in high density residential areas [AOR 0.14, 95% CI 0.05, 0.43; P=0.0001].
Health Insurance was another determinant in which those without Insurance were
less likely to use Orthopaedic services compared to those with Insurance[ AOR
0.17 95% CI 0.05, 0.55; P=0.003]. At service level, limited financial and human
resources hindered the hospitals from achieving all their objectives. There are
referrals /consultations within the hospitals. However, there is little or no
coordination in form of a referral network. Most parents did not understand the
cause of their child’s MSDs and a few were hopeful that better outcomes would
ensue. Key barriers cited by most mothers included lack of information about
practices and other essential health actions to manage MSDs at home; cultural
beliefs; distance to health facility and costs of transport and fear of marital discord
if they discussed matters at length with their husbands.
In conclusion, the study established that those living in low density residential areas
and not having some level of Health Insurance were less likely to use Orthopaedic
services. Inadequate resources are major barriers to orthopaedic service provision
and need to be adequately addressed.
Description
Thesis
Keywords
Orthopedic services--Children--Zambia , Orthopedic--musculoskeletal