ABSTRACT
Myanmar has a high proportion of out-of-pocket (OOP) health care expenditures with limited cost-sharing mechanisms. In Myanmar, there were limited data on the frequency of catastrophic health expenditure (CHE) due to OOP payments, as well as on the factors associated with CHE. This study aimed to investigate health care expenditure, the frequency of CHE, and the factors influencing CHE among households in Magway, Myanmar. A cross-sectional household survey was conducted in 2012 for 700 households (350 in urban areas and 350 in rural areas) in Magway. CHE was defined as a condition wherein the total amount of household health care expenditure was 40% or more of non-food expenditure in the past year. Multiple logistic regression analysis was applied to estimate odds ratios (ORs) and 95% confident intervals (CIs) of CHE. In the previous year, 28.3% of 350 urban households and 51.4% of 350 rural households utilized outpatient services. Households with at least one member admitted to a medical facility were 10.0% and 12.9%, respectively. Those with CHE were 25.2% in the urban areas and 22.7% in the rural areas. The adjusted OR of CHE was 7.79 (95% CI 3.73-16.26) for hospitalization and 1.08 (95% CI 0.36-3.23) for outpatient care, relative to no services used. These findings indicated that nearly one fourth of households in Magway faced CHE due to inpatient care. A safety-net mechanism to protect households from CHE in Myanmar seems essential.
ABSTRACT
Hypertension is one of the most important preventable causes of premature morbidity and mortality in the world. Many people with hypertension both in developing and developed countries have no adequate control of their blood pressure (BP). Hypertension-related knowledge and practice of patients play an important role in controlling hypertension and in preventing its long-term complications. The objective here was to study hypertension-related knowledge, practice and drug adherence of inpatients, and to examine an association between the knowledge regarding hypertension with BP control status and drug adherence. We studied hypertension-related knowledge, practice and drug adherence of patients in a hospital setting. A cross-sectional study was conducted among 209 patients with the diagnosis of primary hypertension at the Samarkand State Medical Institute. The study was conducted from June to September 2012. Drug adherence was studied using the Morisky 4-item self-report measure of medication-taking behavior. The reasons for drug non-adherence were assessed using a self-administered questionnaire. Odds ratio (OR) and 95% confidence interval (CI) were estimated by a logistic model. The BP control rate and drug adherence of the patients were suboptimal (24.4% and 36.8%, respectively). Overall, 64.6% of patients had good or adequate and 35.5% had inadequate knowledge about hypertension. Good knowledge of patients was significantly associated with controlled BP (OR=5.4, 95% CI, 1.7-16.2) and drug adherence (OR=3.8, 95% CI, 1.4-10.8). In conclusion, the inpatients of the secondary hospital had sufficient general knowledge about hypertension, but they had inadequate knowledge about specific issues such as treatment for and symptoms of hypertension. Both drug adherence and BP control rate were suboptimal and significantly associated with hypertension knowledge. This study specifies potential areas of hypertension education that could be improved by patients' knowledge of hypertension.
