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They ‘don't cure old age’: older Ugandans’ delays to health-care access

Published online by Cambridge University Press:  15 June 2017

ENID SCHATZ*
Affiliation:
Department of Health Sciences, University of Missouri, Columbia, USA.
JANET SEELEY
Affiliation:
Department of Global Health & Development, London School of Hygiene & Tropical Medicine, UK. Medical Research Council/Uganda Virus Research Institute, Entebbe, Uganda.
JOEL NEGIN
Affiliation:
School of Public Health, University of Sydney, Australia.
JOSEPH MUGISHA
Affiliation:
Department of Health Sciences, University of Missouri, Columbia, USA. Medical Research Council/Uganda Virus Research Institute, Entebbe, Uganda.
*
Address for correspondence: Enid Schatz, 535 Clark Hall, Columbia, MO 65211, USAE-mail:[email protected]

Abstract

Uganda's population is ageing, which comes with increased and varied burdens of disease and health-care needs. At the same time, gerontological care in Uganda remains neglected. This paper examines the factors that cause older Ugandans to delay health-care access. We conduct a thematic analysis of data drawn from nine focus groups held with rural Ugandans aged 60-plus. Our analysis highlights the factors that delay older persons’ access to health care and how these align with the Three-Delay Model, which was originally developed to assess and improve obstetric care in low-resource settings. Our participants report delays in deciding to seek care related to mobility and financial limitations, disease aetiology, severity and stigma (Delay I); reaching care because of poor roads and limited transportation options (Delay II); and receiving appropriate care because of ageism among health-care workers, and poorly staffed and under-supplied facilities (Delay III). We find these delays to care are interrelated and impacted by factors at the individual, community and health-system levels. We conclude by arguing for multi-pronged interventions that will address these delays, improve access to care and ultimately enhance older Ugandans’ health and wellbeing.

Type
Article
Copyright
Copyright © Cambridge University Press 2017 

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References

Albanese, E., Liu, Z., Acosta, D., Guerra, M., Huang, Y., Jacob, K., Jimenez-Velazquez, I., Llibre Rodriguez, J., Salas, A., Sosa, A., Uwakwe, R., Williams, J., Borges, G. Jotheeswaran, A., Klibanski, M., McCrone, P., Ferri, C. and Prince, M. 2011. Equity in the delivery of community healthcare to older people: findings from 10/66 Dementia Research Group cross-sectional surveys in Latin America, China, India and Nigeria. BMC Health Services Research, 11, 153.Google Scholar
Ameh, S., Gómez-Olivé, F. X., Kahn, K., Tollman, S. M. and Klipstein-Grobusch, K. 2014. Predictors of health care use by adults 50 years and over in a rural South African setting. Global Health Action, 7, doi: 10.3402/gha.v7.24771.Google Scholar
Ashforth, A. 2002. An epidemic of witchcraft? The implications of AIDS for the post-apartheid state. African Studies, 61, 1, 121–43.Google Scholar
Asiki, G., Murphy, G., Nakiyingi-Miiro, J., Seeley, J., Nsubuga, R. N., Karabarinde, A., Waswa, L., Biraro, S., Kasamba, I., Pomilla, C., Maher, D., Young, E., Kamali, A. and Sandhu, M. 2013. The general population cohort in rural south-western Uganda: a platform for communicable and non-communicable disease studies. International Journal of Epidemiology, 42, 1, 129–41.Google Scholar
Bovet, P., Gervasoni, J.-P., Mkamba, M., Balampama, M., Lengeler, C. and Paccaud, F. 2008. Low utilization of health care services following screening for hypertension in Dar es Salaam (Tanzania): a prospective population-based study. BMC Public Health, 8, 1, 407.Google Scholar
Braun, V. and Clarke, V. 2006. Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 2, 77101.Google Scholar
Braun, V. and Clarke, V. 2013. Successful Qualitative Research: A Practical Guide for Beginners. Sage, Thousand Oaks, California.Google Scholar
Brinda, E. M., Kowal, P., Attermann, J. and Enemark, U. 2015. Health service use, out-of-pocket payments and catastrophic health expenditure among older people in India: the WHO Study on global AGEing and adult health (SAGE). Journal of Epidemiology and Community Health, 69, 5, 489–94.Google Scholar
Buregyeya, E., Kulane, A., Colebunders, R., Wajja, A., Kiguli, J., Mayanja, H., Musoke, P., Pariyo, G. and Mitchell, E. 2011. Tuberculosis knowledge, attitudes and health-seeking behaviour in rural Uganda. International Journal of Tuberculosis and Lung Disease, 15, 7, 938–42.Google Scholar
Calvello, E. J., Skog, A. P., Tenner, A. G., Wallis, L. A., Calvello, E. J., Skog, A. P., Tenner, A. G. and Wallis, L. A. 2015. Applying the lessons of maternal mortality reduction to global emergency health. Bulletin of the World Health Organization, 93, 6, 417–23.Google Scholar
Clausen, F., Sandberg, E., Ingstad, B. and Hjortdahl, P. 2000. Morbidity and health care utilisation among elderly people in Mmankgodi village, Botswana. Journal of Epidemiology and Community Health, 54, 1, 5863.Google Scholar
Cohen, R. L., Li, Y., Giese, R. and Mancuso, J. D. 2013. An evaluation of the Presidentʼs emergency plan for AIDS relief effect on health systems strengthening in sub-Saharan Africa. JAIDS: Journal of Acquired Immune Deficiency Syndromes, 62, 4, 471–9.Google Scholar
Coovadia, H., Jewkes, R., Barron, P., Sanders, D. and McIntyre, D. 2009. The health and health system of South Africa: historical roots of current public health challenges. The Lancet, 374, 9692, 817–34.Google Scholar
Droti, B. 2014. Availability of health care for older persons in primary care facilities in Uganda. PhD thesis, London School of Hygiene & Tropical Medicine, University of London, London.Google Scholar
Epping-Jordan, J. E., Pruitt, S. D., Bengoa, R. and Wagner, E. H. 2004. Improving the quality of health care for chronic conditions. Quality and Safety in Health Care, 13, 4, 299305.Google Scholar
Gómez-Olivé, F. X., Thorogood, M., Clark, B., Kahn, K. and Tollman, S. 2013. Self-reported health and health care use in an ageing population in the Agincourt sub-district of rural South Africa. Global Health Action, 6, 1, 19305, doi: 10.3402/gha.v6i0.19305.Google Scholar
Goudge, J., Gilson, L., Russell, S., Gumede, T. and Mills, A. 2009. Affordability, availability and acceptability barriers to health care for the chronically ill: longitudinal case studies from South Africa. BMC Health Services Research, 9, 75.Google Scholar
Kuteesa, M. O., Seeley, J., Cumming, R. G. and Negin, J. 2012. Older people living with HIV in Uganda: understanding their experience and needs. African Journal of AIDS Research, 11, 4, 295305.Google Scholar
Lalonde, A. B., Okong, P., Mugasa, A. and Perron, L. 2003. The FIGO Save the Mothers Initiative: the Uganda–Canada collaboration. International Journal of Gynecology & Obstetrics, 80, 2, 204–12.Google Scholar
Lloyd-Sherlock, P. 2000. Population ageing in developed and developing regions: implications for health policy. Social Science & Medicine, 51, 6, 887–95.Google Scholar
Mahy, M., Autenrieth, C. S., Stanecki, K. and Wynd, S. 2014. Increasing trends in HIV prevalence among people aged 50 years and older: evidence from estimates and survey data. AIDS, 28, S4539.Google Scholar
Mathers, C., Fat, D. M. and Boerma, J. T. 2008. The Global Burden of Disease: 2004 Update. World Health Organization. Available online at http://www.who.int/healthinfo/global_burden_disease/2004_report_update/en/. Accessed on December 17, 2015.Google Scholar
Mayosi, B. M., Flisher, A. J., Lalloo, U. G., Sitas, F., Tollman, S. M. and Bradshaw, D. 2009. The burden of non-communicable diseases in South Africa. The Lancet, 374, 9693, 934–47.Google Scholar
McCarthy, R., Byrne-Davis, L., Hart, J., Yuill, G., Slattery, H., Jackson, M. and Byrne, G. J. 2015. A feasible, acceptable and effective way to teach health care workers in low- and middle-income countries a method to manage acutely ill obstetric women. Midwifery, 31, 1, 1924.Google Scholar
Mills, E. J., Bärnighausen, T. and Negin, J. 2012. HIV and aging – preparing for the challenges ahead. New England Journal of Medicine, 366, 14, 1270–3.Google Scholar
Moreira, E., Brock, G., Glasser, D., Nicolosi, A., Laumann, E., Paik, A., Paik, A., Wang, T. and Gingell, C., for the GSSAB Investigators’ Group 2005. Help-seeking behaviour for sexual problems: the Global Study of Sexual Attitudes and Behaviors. International Journal of Clinical Practice, 59, 1, 616.Google Scholar
Mulumba, M., Nantaba, J., Brolan, C. E., Ruano, A. L., Brooker, K. and Hammonds, R. 2014. Perceptions and experiences of access to public healthcare by people with disabilities and older people in Uganda. International Journal for Equity in Health, 13, 1, 76.Google Scholar
Murray, C., Vos, T., Lozano, R., Naghavi, M., Flaxman, A., Michaud, C., Ezzati, M., Shibuya, K., Salomon, J., et al. 2012. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 380, 9859, 2197–223.Google Scholar
Negin, J., Bärnighausen, T., Lundgren, J. D. and Mills, E. J. 2012. Aging with HIV in Africa: the challenges of living longer. AIDS, 26, S15.Google Scholar
Negin, J. and Cumming, R. G. 2010. HIV infection in older adults in sub-Saharan Africa: extrapolating prevalence from existing data. Bulletin of the World Health Organization, 88, 11, 847–53.Google Scholar
Negin, J., Nyirenda, M., Seeley, J. and Mutevedzi, P. 2013. Inequality in health status among older adults in Africa: the surprising impact of anti-retroviral treatment. Journal of Cross-cultural Gerontology, 28, 4, 491–3.Google Scholar
Negin, J., Rozea, A. and Martiniuk, A. L. 2014. HIV behavioural interventions targeted towards older adults: a systematic review. BMC Public Health, 14, 1, 507.Google Scholar
Nnko, S., Bukenya, D., Kavishe, B. B., Biraro, S., Peck, R., Kapiga, S., Grosskurth, H. and Seeley, J. 2015. Chronic diseases in North-West Tanzania and Southern Uganda. Public perceptions of terminologies, aetiologies, symptoms and preferred management. PLOS ONE, 10, 11, e0142194.Google Scholar
Obrist, B., Iteba, N., Lengeler, C., Makemba, A., Mshana, C., Nathan, R., Alba, S., Dillip, A., Hetzel, M., Mayumana, I., Schulze, A. and Mshinda, H. 2007. Access to health care in contexts of livelihood insecurity: a framework for analysis and action. PLOS Medicine, 4, 10, 1584–1588 (e308).Google Scholar
Peltzer, K., Williams, J. S., Kowal, P., Negin, J., Snodgrass, J. J., Yawson, A., Minicuci, N., Thiele, L., Phaswana-Mafuya, N., Biritwum, R., Naidoo, N. and Chatterji, S. 2014. Universal health coverage in emerging economies: findings on health care utilization by older adults in China, Ghana, India, Mexico, the Russian Federation, and South Africa. Global Health Action, 7, doi: 10.3402/gha.v7.25314.Google Scholar
Rabkin, M., Kruk, M. E. and El-Sadr, W. M. 2012. HIV, aging and continuity care: strengthening health systems to support services for noncommunicable diseases in low-income countries. AIDS, 26, S7783.Google Scholar
Scholten, F., Mugisha, J., Seeley, J., Kinyanda, E., Nakubukwa, S., Kowal, P., Naidoo, N., Boerma, T., Chatterji, S. and Grosskurth, H. 2011. Health and functional status among older people with HIV/AIDS in Uganda. BMC Public Health, 11, 1, 886.Google Scholar
Scholten, F., Seeley, J., Mugisha, J., Zalwango, F. and Wright, S. 2011. Uganda Well-being of Older People Study: Study of Global AGEing and Adult Health (SAGE) Sub-study. Medical Research Council/Uganda Virus Research Unit, Research Unit on AIDS, Entebbe, Uganda and World Health Organization, Geneva. Available online at http://www.who.int/healthinfo/sage/hiv_studies/en/. Accessed on October 28, 2014.Google Scholar
Stewart, F., Dall'Olio, A. M., Eberhard, A., Borg, A. H., Bronchi, C., Sebudde, R. K., Morisset, J., Coll-Black, S., Magezi, B., Nguessa Nganou, J.-P. and Kibirige, M. 2014. Reducing Old Age and Economic Vulnerabilities: Why Uganda Should Improve its Pension System. Number 88683, The World Bank, 1–80. Available online at http://documents.worldbank.org/curated/en/2014/06/19705558/reducing-old-age-economic-vulnerabilities-uganda-improve-pension-system. Accessed on October 25, 2014.Google Scholar
The Republic of Uganda, Ministry of Health. N.D. Health Sector Strategic Plan II, 2005/06-2009/2010. http://siteresources.worldbank.org/INTPRS1/Resources/383606-1201883571938/Uganda_HSSP_2.pdf. Accessed on May 8, 2017.Google Scholar
Thaddeus, S. and Maine, D. 1994. Too far to walk: maternal mortality in context. Social Science & Medicine, 38, 8, 1091–110.Google Scholar
Vela, C., Samson, E., Zunzunegui, M. V., Haddad, S., Aubin, M.-J. and Freeman, E. E. 2012. Eye care utilization by older adults in low, middle, and high income countries. BMC Ophthalmology, 12, 5.Google Scholar
Wandera, S. O., Kwagala, B. and Ntozi, J. 2015. Determinants of access to healthcare by older persons in Uganda: a cross-sectional study. International Journal for Equity in Health, 14, 1, 26.Google Scholar
Wong, R. and Díaz, J. J. 2007. Health care utilization among older Mexicans: health and socioeconomic inequalities. Salud Pública De México, 49, supplement 4, S505-14.Google Scholar