Peer-reviewed article
Protective role of health insurance coverage in reducing under-five mortality in Ethiopia: Gompertz inverse-Gaussian shared frailty modelling.
Kase BF, Seifu BL, Mare KU, Shibeshi AH, Asebe HA et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study analysed data from 10,641 under-five children in Ethiopia to understand how health insurance affects child survival. The researchers found that children whose mothers had health insurance had significantly lower risk of dying before age five compared to those without coverage. However, only 3.5% of mothers in the study had health insurance, showing that coverage remains extremely low in Ethiopia. Other important factors affecting child survival included where the family lived, family size, and the spacing between births.
Key points
- Health insurance coverage was significantly associated with lower under-five mortality risk (adjusted hazard ratio 0.13)
- 96.46% of under-five children were born to uninsured mothers, indicating very low health insurance coverage
- Place of residence, family size, twin status, place of delivery, and birth interval were also significantly associated with under-five mortality
- The study used advanced statistical modelling (Gompertz inverse-Gaussian shared frailty model) on nationally representative survey data from 2016
- Authors call for urgent policies to expand health insurance coverage to reduce under-five mortality
Limitations
This is an observational study using survey data, so it cannot establish causation or account for unmeasured confounders that might explain why insured children have better survival. The extremely low insurance coverage (3.5%) limits the precision of estimates for the insured group.
Abstract
Objective To determine the association between health insurance coverage and under-five mortality in Ethiopia using data from the 2016 Ethiopia Demographic and Health Survey (EDHS). Methods The current study used a total of 10 641 under-five children from the 2016 EDHS. To identify the predictors, the Gompertz inverse-Gaussian shared frailty model was fitted. The theta value, Akaike Information Criteria and Bayesian Information Criteria were applied for model evaluation, and variables with p values less than 0.2 were included in the multivariable analysis. The strength and statistical significance of the associations were demonstrated by reporting the adjusted HR (AHR) with a 95% CI in the multivariable Gompertz inverse-Gaussian shared frailty model. Results According to the study's findings, 96.46% of the children were born to mothers not covered by health insurance. The study found that health insurance coverage was significantly associated with a lower risk of under-five mortality (not covered: AHR=0.13; 95% CI 0.02, 0.95). Other factors that showed significant associations with under-five mortality include place of residency, family size, twin status, place of delivery and preceding birth interval. Conclusion The findings indicate that health insurance coverage in Ethiopia is significantly associated with a lower risk of mortality among children under five. However, coverage remains low among mothers of these children, highlighting an urgent need for policies and interventions aimed at expanding health insurance coverage and addressing key determinants of child health to reduce under-five mortality and improve child survival outcomes. Addressing gaps in health insurance and other contributing factors is vital for creating effective strategies to lower under-five mortality rates.