Table 2. Results of mixed-effects regression models for the associations between individual and country-level factors and public hospital use for four primary care services in 56 low- and middle-income countries.
| Variable | Contraceptives |
Antenatal care |
Care for childhood diarrhoea |
Care for childhood fever or cough |
|||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| No. of respondents | No. (%) using hospitals | OR (95% CI) | No. of respondents | No. (%) using hospitals | OR (95% CI) | No. of respondents | No. (%) using hospitals | OR (95% CI) | No. of respondents | No. (%) using hospitals | OR (95% CI) | ||||
| Individual characteristics | |||||||||||||||
| Area | |||||||||||||||
| Urban | 31 106 | 8 857 (28.5) | 2.45 (2.34 to 2.56) | 100 715 | 44 319 (44.0) | 1.96 (1.92 to 2.00) | 8 549 | 3 938 (46.1) | 3.15 (2.91 to 3.40) | 14 750 | 6 574 (44.6) | 3.04 (2.87 to 3.23) | |||
| Rural | 59 174 | 7 207 (12.2) | Ref. | 226 892 | 60 146 (26.5) | Ref. | 21 364 | 4 902 (23.0) | Ref. | 35 791 | 7 923 (22.1) | Ref. | |||
| Wealth quintiles | |||||||||||||||
| Q1 poorest | 19 218 | 1 876 (9.8) | Ref. | 78 375 | 17 656 (22.5) | Ref. | 7 846 | 1 647 (21.0) | Ref. | 12 817 | 2 521 (19.7) | Ref. | |||
| Q2 | 19 937 | 2 462 (12.4) | 1.11 (1.03 to 1.19) | 75 056 | 20 984 (28.0) | 1.28 (1.25 to 1.32) | 6 998 | 1 754 (25.1) | 1.14 (1.04 to 1.25) | 12 018 | 2 925 (24.3) | 1.16 (1.08 to 1.24) | |||
| Q3 | 19 221 | 3 191 (16.6) | 1.34 (1.25 to 1.43) | 68 657 | 22 249 (32.4) | 1.52 (1.48 to 1.56) | 6 265 | 1 872 (29.9) | 1.34 (1.22 to 1.48) | 10 595 | 3 045 (28.7) | 1.29 (1.19 to 1.39) | |||
| Q4 | 17 631 | 4 045 (22.9) | 1.59 (1.48 to 1.71) | 60 216 | 22 876 (38.0) | 1.84 (1.79 to 1.90) | 5 284 | 1 894 (35.8) | 1.53 (1.38 to 1.70) | 8 999 | 3 243 (36.0) | 1.52 (1.40 to 1.65) | |||
| Q5 richest | 14 273 | 4 490 (31.5) | 1.84 (1.70 to 1.99) | 45 303 | 20 700 (45.7) | 2.45 (2.36 to 2.54) | 3 520 | 1 673 (47.5) | 2.01 (1.77 to 2.29) | 6 112 | 2 763 (45.2) | 1.97 (1.78 to 2.17) | |||
| Woman's age, years | |||||||||||||||
| 15–19 | 5 453 | 1 001 (18.4) | Ref. | 20 833 | 5 621 (27.0) | Ref. | 2 115 | 563 (26.6) | Ref. | 3 251 | 871 (26.8) | Ref. | |||
| 20–30 | 42 139 | 7 724 (18.3) | 0.95 (0.87 to 1.03) | 195 174 | 65 995 (33.8) | 1.02 (0.99 to 1.06) | 18 805 | 5 924 (31.5) | 1.06 (0.94 to 1.20) | 30 233 | 9 297 (30.8) | 1.02 (0.92 to 1.13) | |||
| 31–40 | 31 698 | 5 483 (17.3) | 0.96 (0.88 to 1.04) | 93 228 | 28 195 (30.2) | 1.06 (1.02 to 1.10) | 7 670 | 2 031 (26.5) | 1.00 (0.88 to 1.15) | 14 487 | 3 776 (26.1) | 1.01 (0.91 to 1.12) | |||
| 41–65 | 10 990 | 1 856 (16.9) | 1.06 (0.96 to 1.16) | 18 372 | 4 654 (25.3) | 1.10 (1.04 to 1.16) | 1 323 | 322 (24.3) | 1.01 (0.84 to 1.22) | 2 570 | 553 (21.5) | 0.98 (0.85 to 1.13) | |||
| Any secondary education | |||||||||||||||
| Yes | 39 963 | 8 482 (21.2) | 1.13 (1.08 to 1.18) | 130 398 | 54 824 (42.0) | 1.25 (1.22 to 1.27) | 9 541 | 3 688 (38.7) | 1.16 (1.07 to 1.25) | 18 512 | 7 010 (37.9) | 1.20 (1.14 to 1.27) | |||
| No | 50 317 | 7 582 (15.1) | Ref. | 197 209 | 49 641 (25.2) | Ref. | 20 372 | 5 152 (25.3) | Ref. | 32 029 | 7 487 (23.4) | Ref. | |||
| Media exposurea | |||||||||||||||
| Yes | 60 070 | 11 562 (19.2) | 1.00 (0.95 to 1.05) | 190 526 | 70 264 (36.9) | 1.11 (1.09 to 1.13) | 16 904 | 5 728 (33.9) | 1.01 (0.95 to 1.09) | 29 854 | 9 797 (32.8) | 1.00 (0.95 to 1.06) | |||
| No | 30 210 | 4 502 (14.9) | Ref. | 137 081 | 34 201 (24.9) | Ref. | 13 009 | 3 112 (23.9) | Ref. | 20 687 | 4 700 (22.7) | Ref. | |||
| Country characteristics | |||||||||||||||
| Surveyed post-2015 | |||||||||||||||
| Yes | 51 548 | 8 664 (16.8) | 0.65 (0.38 to 1.09) | 219 075 | 75 892 (34.6) | 0.67 (0.35 to 1.27) | 19 198 | 5 725 (29.8) | 0.40 (0.20 to 0.79) | 28 940 | 8 578 (29.6) | 0.34 (0.17 to 0.66) | |||
| No | 38 732 | 7 400 (19.1) | Ref. | 108 532 | 28 573 (26.3) | Ref. | 10 715 | 3 115 (29.1) | Ref. | 21 601 | 5 919 (27.4) | Ref. | |||
| Land area, millions km2 | 90 280 | NA | 1.03 (0.66 to 1.59) | 327 607 | NA | 0.74 (0.43 to 1.28) | 29 913 | NA | 1.14 (0.64 to 2.03) | 50 541 | NA | 1.05 (0.59 to 1.86) | |||
| Government effectiveness indexb | 90 280 | NA | 0.36 (0.18 to 0.70) | 327 607 | NA | 0.71 (0.30 to 1.67) | 29 913 | NA | 0.82 (0.34 to 2.02) | 50 541 | NA | 0.83 (0.33 to 2.05) | |||
| Total health expenditure per capita, hundreds int. $c | 90 280 | NA | 1.17 (1.02 to 1.34) | 327 607 | NA | 1.31 (1.11 to 1.55) | 29 913 | NA | 1.10 (0.92 to 1.32) | 50 541 | NA | 1.06 (0.89 to 1.26) | |||
| Share of out-of-pocket expenditure on health, % | 90 280 | NA | 0.95 (0.81 to 1.11) | 327 607 | NA | 1.05 (0.86 to 1.27) | 29 913 | NA | 0.97 (0.79 to 1.19) | 50 541 | NA | 0.99 (0.81 to 1.21) | |||
| Regiond | |||||||||||||||
| East African | 26 020 | 4 218 (16.2) | Ref. | 65 321 | 13 287 (20.3) | Ref. | 8 340 | 1 708 (20.5) | Ref. | 14 251 | 2 924 (20.5) | Ref. | |||
| Eastern Mediterranean | 7 338 | 1 751 (23.9) | 1.64 (0.55 to 4.89) | 14 658 | 8 537 (58.2) | 3.48 (0.90 to 13.55) | 3 566 | 1 750 (49.1) | 4.51 (1.09 to 18.69) | 3 112 | 1 508 (48.5) | 3.59 (0.87 to 14.84) | |||
| European | 529 | 59 (11.2) | 1.06 (0.28 to 3.93) | 8 899 | 2 246 (25.2) | 0.41 (0.08 to 2.05) | 587 | 144 (24.5) | 1.44 (0.27 to 7.83) | 534 | 139 (26.0) | 1.05 (0.20 to 5.64) | |||
| Middle African | 1 988 | 1 098 (55.2) | 4.63 (1.69 to 12.69) | 31 789 | 11 549 (36.3) | 2.10 (0.60 to 7.42) | 2 826 | 1 025 (36.3) | 1.45 (0.39 to 5.45) | 5 048 | 1 744 (34.6) | 1.18 (0.32 to 4.38) | |||
| Americas | 11 596 | 1 642 (14.2) | 0.82 (0.29 to 2.34) | 22 349 | 4 832 (21.6) | 1.15 (0.30 to 4.39) | 2 041 | 394 (19.3) | 0.99 (0.24 to 4.03) | 4 298 | 736 (17.1) | 0.89 (0.22 to 3.59) | |||
| Southern African | 7 845 | 1 498 (19.1) | 0.98 (0.23 to 4.21) | 7 430 | 1 742 (23.5) | 0.25 (0.04 to 1.43) | 655 | 151 (23.0) | 0.42 (0.07 to 2.63) | 1 089 | 242 (22.2) | 0.35 (0.06 to 2.11) | |||
| South East Asia | 20 520 | 3 508 (17.1) | 0.80 (0.30 to 2.12) | 91 325 | 45 083 (49.4) | 1.45 (0.43 to 4.88) | 5 005 | 2 476 (49.5) | 1.50 (0.42 to 5.44) | 10 290 | 4 959 (48.2) | 1.49 (0.41 to 5.39) | |||
| Western African | 9 423 | 1 900 (20.2) | 1.27 (0.57 to 2.84) | 70 854 | 14 739 (20.8) | 0.67 (0.25 to 1.81) | 6 014 | 964 (16.0) | 0.56 (0.20 to 1.60) | 10 254 | 1 891 (18.4) | 0.53 (0.19 to 1.49) | |||
| Western Pacific | 5 021 | 390 (7.8) | 0.56 (0.18 to 1.77) | 14 982 | 2 450 (16.4) | 0.53 (0.12 to 2.34) | 879 | 228 (25.9) | 1.03 (0.22 to 4.90) | 1 665 | 354 (21.3) | 1.06 (0.23 to 4.96) | |||
| Analysis | |||||||||||||||
| Intercept | NA | NA | 0.04 (0.02 to 0.10) | NA | NA | 0.07 (0.02 to 0.23) | NA | NA | 0.16 (0.05 to 0.51) | NA | NA | 0.19 (0.06 to 0.64) | |||
| Variance estimate, null model | NA | NA | 1.53 (−0.90 to 3.95) | NA | NA | 1.81 (−0.83 to 4.45) | NA | NA | 1.71 (−0.85 to 4.28) | NA | NA | 1.64 (−0.87 to 4.14) | |||
| Variance estimate, full model | NA | NA | 0.80 (−0.95 to 2.55) | NA | NA | 1.27 (−0.94 to 3.47) | NA | NA | 1.38 (−0.92 to 3.68) | NA | NA | 1.35 (−0.93 to 3.62) | |||
CI: confidence interval; Int. $: international dollar; NA: not applicable; OR: odds ratio; Ref.: reference category.
a Women were categorized as being exposed to the media if they reported doing at least one of the following every week: reading newspapers or magazines, listening to the radio or watching television.
b Government effectiveness index is estimated by the World Bank’s worldwide governance indicators project16 and is expressed in units of a standard normal distribution with a mean of zero and a standard deviation of one with higher values corresponding to better effectiveness.
c Total health expenditures per capita were obtained from the World Bank’s world development indicators database15 and are expressed in hundreds of international $.
d World regions were based on World Health Organization classifications and the African Region was divided into four sub-regions based on the United Nations Statistics Division classification.26
Notes: For each health service, we first calculated a null model with no covariates and only a country-specific random effect to model between-country variation in public hospital use.