Spatial distribution and associated factors of health insurance coverage in Ethiopia: further analysis of Ethiopia demographic and health survey, 2016.

Health insurance is one of the instruments to achieve universal health coverage. However, in Ethiopia, the coverage of health insurance is very low and varies from place to place as well. Therefore, exploring the spatial distribution of health insurance is important to prioritize and design targeted intervention programs in the country. A total of 16,583 reproductive age group women (15-49 years) were included in this study. The Bernoulli model was used by applying Kulldorff methods using the SaTScan software to analyse the purely spatial clusters of health insurance coverage. ArcGIS version 10.3 was used to visualize the distribution of health insurance coverage across the country. Mixed-effect logistic regression analysis was also used to identify predictors of health insurance coverage. Health insurance coverage among women aged 15-49 years had spatial variations across the country (Moran's I: 0.115, p < 0.001). Health insurance coverage in Amhara (p < 0.001) and Tigray (p < 0.001) National Regional States clustered spatially. Reading newspapers at least once a week (Adjusted Odds Ratio (AOR) = 1.78, 95% CI: (1.18-2.68))), 40-44 years of age (AOR = 2.14, 95% CI: (1.37-3.35)), clerical working mothers (AOR = 4.33, 95% CI: (2.50-7.49)), mothers' with secondary school education (AOR = 1.77; 95% CI: (1.21-2.58)), mothers' with higher school education (AOR = 2.62; 95% CI: (1.63-4.23)), having more than 5 family members (AOR = 1.25; 95% CI: (1.01-1.55)) and richest wealth quantile (AOR = 3.43, 95% CI: (1.96-6.01)) were predictors of health insurance coverage among reproductive age group women in Ethiopia. Health insurance coverage was very low in Ethiopia and had spatial variations across the country. The hot spot areas with low health insurance coverage need more coherent and harmonized action such as strengthening financial protection through national health packages, sharing experience from regions which have better health insurance coverage and using mass media to increase awareness and confidence of potentials in the systems, which may encourage them to enrol.

Kebede SA ，Liyew AM ，Tesema GA ，Agegnehu CD ，Teshale AB ，Alem AZ ，Yeshaw Y ... -  《-》

Spatial distribution and associated factors of community based health insurance coverage in Ethiopia: further analysis of Ethiopian demography and health survey, 2019.

Community-Based Health Insurance is an emerging concept for providing financial protection against the cost of illness and improving access to quality health services for low-income households excluded from formal insurance and taken as a soft option by many countries. Therefore, exploring the spatial distribution of health insurance is crucial to prioritizing and designing targeted intervention policies in the country. A total of 8,663 households aged 15-95 years old were included in this study. The Bernoulli model was used by applying Kulldorff methods using the SaTScan software to analyze the purely spatial clusters of community based health insurance. ArcGIS version 10.3 was used to visualize the distribution of community-based health insurance coverage across the country. Mixed-effect logistic regression analysis was also used to identify predictors of community-based health insurance coverage. Community based health insurance coverage among households had spatial variations across the country by regions (Moran's I: 0.252, p < 0.0001). Community based health insurance in Amhara (p < 0.0001) and Tigray (p < 0.0001) regions clustered spatially. Age from 15-29 and 30-39 years (Adjusted Odds Ratio 0.46(AOR = 0.46, CI: 0.36,0.60) and 0.77(AOR = 0.77, CI: 0.63,0.96), primary education level 1.57(AOR = 1.57, CI: 1.15,2.15), wealth index of middle and richer (1.71(AOR = 1.71, CI: 1.30,2.24) and 1.79(AOR = 1.79, CI: 1.34,2.41), family size > 5, 0.82(AOR = 0.82, CI: 0.69,0.96),respectively and regions Afar, Oromia, Somali, Benishangul Gumuz, SNNPR, Gambella, Harari, Addis Ababa and Dire Dawa was 0.002(AOR = 0.002, CI: 0.006,0.04), 0.11(AOR = 0.11, CI: 0.06,0.21) 0.02(AOR = 0.02, CI: 0.007,0.04), 0.04(AOR = 0.04, CI: 0.02,0.08), 0.09(AOR = 0.09, CI: 0.05,0.18),0.004(AOR = 0.004,CI:0.02,0.08),0.06(AOR = 0.06,CI:0.03,0.14), 0.07(AOR = 0.07, CI: 0.03,0.16) and 0.03(AOR = 0.03, CI: 0.02,0.07) times less likely utilize community based health insurance than the Amhara region respectively in Ethiopia. Community based health insurance coverage among households in Ethiopia was found very low still. The government needs to develop consistent financial and technical support and create awareness for regions with lower health insurance coverage.

Terefe B ，Alemu TG ，Techane MA ，Wubneh CA ，Assimamaw NT ，Belay GM ，Tamir TT ，Muhye AB ，Kassie DG ，Wondim A ，Tarekegn BT ，Ali MS ，Fentie B ，Gonete AT ，Tekeba B ，Kassa SF ，Desta BK ，Ayele AD ，Dessie MT ，Atalell KA ... -  《BMC PUBLIC HEALTH》

Geospatial variations and determinants of contraceptive utilization among married reproductive age women in Ethiopia: spatial and multilevel analysis of Ethiopian Demographic and Health Survey, 2019.

Terefe B ，Getnet M ，Akalu Y ，Belsti Y ，Diress M ，Gela YY ，Getahun AB ，Bitew DA ，Belay DG ... -  《-》

Effect of mass media on comprehensive knowledge of HIV/AIDS and its spatial distribution among reproductive-age women in Ethiopia: a spatial and multilevel analysis.

Agegnehu CD ，Tesema GA 《BMC PUBLIC HEALTH》

Spatial distribution and determinants of acute respiratory infection among under-five children in Ethiopia: Ethiopian Demographic Health Survey 2016.

Amsalu ET ，Akalu TY ，Gelaye KA 《PLoS One》