Browsing by Author "Wilm Quentin"

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    Association between self-reported genderbased discrimination and maternal mortality rates: results of an ecological multi-level analysis across nine countries in Sub-Saharan Africa
    (BMC Public Health, 2025-10-21) Clara, Orduhan; Ruth Waitzberg; Manuela De Allegri; Bona Chitah; Jean-Paul Dossou; Charlestine Bob Elwange; Adama Faye; Sharon Fonn; Christabel Kambala; Shafiu Mohammed; Hamidou Niangaly; Chenjerai Sisimayi; Wilm Quentin
    Background Sub-Saharan Africa suffers from the highest maternal mortality ratio (MMR) in the world, with 542 deaths per 100,000 live births in 2017, relative to a global ratio of 211. Reducing gender-based discrimination (GBD) and increasing the empowerment of women and girls have recently been recognized as prerequisites for improving maternal health. Previous studies have shown GBD to result in low utilization of maternal health services and poorer quality of care. However, limited research is available on the relationship between GBD and maternal mortality in Sub-Saharan Africa (SSA). Therefore, the objective of this study was to assess whether GBD is associated with maternal mortality in SSA. Methods We investigated the association between self-reported GBD and maternal mortality in an ecological study. We used data from two surveys: the Demographic and Health Surveys (DHS) and the Afrobarometer. Data refer to 78 sub-national regions, located in nine Sub-Saharan African countries (Benin, Malawi, Mali, Nigeria, Senegal, South Africa, Uganda, Zambia, and Zimbabwe). Data were analyzed using a two-level linear regression model with random intercept. The regression controlled for covariates at region- and country-level. Results The proportion of women who reported experiencing GBD varied between 0% in several regions in Benin, Mali, Senegal, South Africa, and Zimbabwe and 24·7% in Atacora, Benin. We identified a positive association between the proportion of women who reported experiencing GBD in a region in the past year and MMR (β 0.88, CI [0.65; 1.12]). A 1% increase in the proportion of women experiencing GBD resulted in an increase of the MMR by nearly two, meaning, an additional two more maternal deaths per 100,000 live births. This association was even more pronounced after adjusting for region-level covariates, but did not change with the inclusion of country-level covariates (β 1.95, CI [1.71; 2.19]). Conclusions The study’s findings show that the rate of self-reported GBD is associated with maternal mortality in a region, even after controlling for other factors that are known to influence maternal deaths. However, our model does not rule out endogeneity. Further research is needed to unravel causal pathways between GBD and maternal mortality.
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    Examining the potential of mobile money-based health insurance for people living with HIV and hypertension or diabetes in Uganda
    (Frontiers in Health Services, 2026-03-17) Zakumumpa, Henry; Ssempala Richard; Jepchirchir Kiplagat; Japheth Kwiringira; Wilm Quentin; Verena Struckmann
    Background: Digital technologies are increasingly promoted as alternative pathways for financing universal health coverage (UHC) in sub-Saharan Africa, yet evidence on their acceptability among informal-sector populations remains limited. This study explored the acceptability of mobile money–based private health insurance among people living with HIV (PWH) with comorbid hypertension or diabetes in Uganda. Methods: We conducted an exploratory qualitative study in Fort Portal City, midwestern Uganda. Data were collected through four focus group discussions with PWH (n = 48) and 18 key informant interviews with representatives of telecom companies, private health insurers, regulators, and health providers. Data were analyzed thematically using an established analytical framework on facilitators and barriers to mobile health technologies. Results: PWH reported rising out-of-pocket expenditures for managing hypertension and diabetes compared to HIV care, which remains largely donor-funded. Facilitators to uptake included high mobile phone ownership, widespread use of mobile money, perceived affordability of monthly premiums (USD 1.35–8.20), prior experience with mobile money insurance, and convenience of digital payments. Barriers included limited understanding of insurance principles, mistrust of private insurers, fears of mobile money fraud, high internet data costs, intermittent electricity supply, and widespread poverty. Conclusion: Mobile money–based health insurance was perceived as affordable and acceptable among PWH with NCD comorbidities. However, low insurance literacy and mistrust of insurers remain major obstacles. Mobile money–based health insurance warrants further research as a complementary pathway for expanding health insurance coverage in Uganda and similar settings.