Background: Health insurance enrolment provides financial access to health care and reduces the risk of catastrophic healthcare expenditure. Therefore, the objective of this study was to assess the prevalence and correlates of health insurance enrolment among Ghanaian children under five years. Methods: We analysed secondary data from the 2017/18 Ghana Multiple Indicator Cluster Survey. The survey was a nationally representative weighted sample comprising 8,874 children under five years and employed Computer Assisted Personal Interviewing to collect data from the participants. In addition, Chi-square and Logistic Regression analyses were conducted to determine factors associated with health insurance enrolment. Results: The results showed that a majority (58.4%) of the participants were insured. Health insurance enrollment was associated with child age, maternal educational status, wealth index, place of residence and geographical region (p < 0.05). Children born to mothers with higher educational status (AOR = 2.14; 95% CI: 1.39–3.30) and mothers in the richest wealth quintile (AOR = 2.82; 95% CI: 2.00–3.98) had a higher likelihood of being insured compared with their counterparts. Also, children residing in rural areas (AOR = 0.75; 95% CI: 0.61–0.91) were less likely to be insured than children in urban areas. Conclusion: This study revealed that more than half of the participants were insured. Health insurance enrolment was influenced by the child's age, mother's educational status, wealth index, residence, ethnicity and geographical region. Therefore, interventions aimed at increasing health insurance coverage among children should focus on children from low socio-economic backgrounds. Stakeholders can leverage these findings to help improve health insurance coverage among Ghanaian children under five years.
In this study, we analysed the 2017/2018 Ghana MICS [27]. The 2017/18 MICS collected demographic and health data across Ghana, including rural and urban settings. The sampling of participants was done in two phases. The first phase involved selecting 660 enumeration areas from 20 strata, proportional to size. The second involved the selection of 13,202 households within the selected enumeration areas. The weighted sample size of children under five years was 8,874. Ghana had ten administrative regions divided into 20 strata, of which ten are rural and ten are urban. Participants were selected across all the regions and strata. The inclusion criteria were under five children in the selected households or those who passed the night before the survey in the selected households. Data were collected using Computer Assisted Personal Interviewing (CAPI). The under five questionnaire was administered to caregivers of children below five years. Trained field officers and supervisors collected the data between October 2017 and September 2018. Details about the 2017/18 MICS are provided elsewhere [28]. The dependent variable in this study was health insurance status (i.e. is [name] covered by any health insurance?) coded as 1 = Yes and 0 = No. The independent variables identified in the literature included child and maternal characteristics. These include child’s age, maternal educational status, wealth index, ethnicity, geographic region and place of residence. Details about the coding are provided in Table 1. The complex nature of the survey was accounted for by employing the ‘svy’ STATA command. STATA/SE version 16 (StataCorp, College Station, Texas, USA) was used to analyse that data. Descriptive statistics were computed for participants’ characteristics and summarized in a table. The Chi-square test was employed to examine the association between participant characteristics and health insurance status at the bivariate level. Binary Logistic Regression was employed to identify significant predictors of health insurance enrolment among under five children. The results were reported at a 95% confidence level. Socio-demographic characteristics of children, mothers and health insurance status in Ghana, 2017/18 Male Female 4369 4505 49.2 50.8 0–11 12–23 24–35 36–47 48–59 1700 1694 1750 1928 1802 19.2 19.1 19.7 21.7 20.3 Pre-primary/none Primary Junior High School Senior High School Higher 2428 1790 3259 954 443 27.3 20.2 36.7 10.8 5 Poorest Second Middle Fourth Richest 1966 1834 1769 1676 1630 22.2 20.7 19.9 18.8 18.4 Urban Rural 3821 5053 43.1 56.9 Western Central Greater Accra Volta Eastern Ashanti Brong- Ahafo Northern Upper East Upper West 931 926 862 710 953 2111 833 1055 282 211 10.5 10.4 9.7 8 10.7 23.8 9.4 11.9 3.2 2.4 Akan Mole Dagbani Others (Ewe, Gruma etc.) 4091 1503 3280 46.1 16.9 37 Insured Non-insured 5186 3689 58.4 41.6
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