title: Determinant of factors associated with child health outcomes and service utilization in Ghana: multiple indicator cluster survey conducted in 2011.
abstract: BACKGROUND
  The effects of National Health Insurance Scheme in Ghana and its impact on child health outcome and service utilization cannot be underestimated. Despite the tremendous improvement in child health care in Ghana, there are still some challenges in relation to how National health insurance membership, socioeconomic status and other demographic factors impacts on child health outcomes. The study seeks to determine the association between NHIS membership, socio-economic status, geographic location and other relevant background factors, on child health service utilization and outcomes.
  
  
  METHODS
  Secondary data from the Multiple Indicator Cluster Survey conducted in 2011 was used. Multivariate analysis based on Binary Logistic Regression Models and Multiple linear regression techniques was applied to determine factors associated with child health outcomes and service utilization. Collection of best models was based on Hosmer-Lemeshow Goodness-Of-Fit as one criterion of fit and the Akaike Information Criterion.
  
  
  RESULTS
  Controlling for confounding effect of socioeconomic status, age of the child, mothers education level and geographic location, the odds of a child developing anemia for children with National Health Insurance Scheme Membership is 65.2% [95% CI: 52.9-80.2] times less than children without National Health Insurance Scheme Membership. The odds of being fully immunized against common childhood illnesses for children with NHIS membership is 2.3[95% CI: 1.4-3.7] times higher than children without National Health Insurance Scheme Membership. There was no association between National Health Insurance Scheme Membership and stunted growth in children.
  
  
  CONCLUSIONS
  National Health Insurance Scheme Membership was found to be related to child health service utilization (full immunization) of children under five a child's anemia status. Children with NHIS are more likely to be fully immunized against common childhood diseases and are less likely to develop anemia. Stunted growth of children was not associated with National Health Insurance Scheme Membership. Health Education on the registration and the use of the National Health Insurance should be made a national priority to enable the Ministry of Health achieve routine Immunization targets and to reduce to the bearers minimum prevalence of anemia.
authors: Department of Biostatistics, School of Public Health University of Ghana, Legon, Ghana.
authors: Duah
authors: D
authors: Dwumoh
authors: Department of Biological Environmental and Occupational Health Sciences, School of Public Health, University of Ghana, Legon, Ghana.
authors: Edward Eyipe
authors: EE
authors: Essuman
authors: Department of Biostatistics, School of Public Health University of Ghana, Legon, Ghana.
authors: Seth Kwaku
authors: SK
authors: Afagbedzi
keywords: Akaike Information Criterion (AIC); Anemia; Binary Logistic Regression; Chi-square test statistic; Enumeration areas; Hierarchical backward selection; Hosmer-Lemeshow Goodness-Of-Fit (HL-GOF); Multivariate analysis; National health insurance; Stunted growth and full immunization; Taylor linearization estimation; Under five