Payment methods for patients on Haemodialysis procedures at Muhimbili national hospital and its impact on adherence to dialysis sessions and routine laboratory testing

Abstract

ABSTRACT Background: Haemodialysis (HD) is the primary treatment for end-stage renal disease (ESRD), usually conducted three times a week, with each session lasting four hours. In Tanzania, patients rely on government subsidy, health insurance or out-of-pocket to finance this service. Enhancing the quality of life, patients with end-stage renal diseases need to focus on treatment adherence. Objective: This study aims to assess how payment methods influence the adherence of ESRD patients to dialysis sessions and routine laboratory testing at Muhimbili National Hospital Materials and Methods: This was a cross-sectional analytical study designed, conducted among patients undergoing hemodialysis treatment for over a month by May-June 2024 at Muhimbili National Hospital Upanga and Mloganzila units. A total of 221 haemodialysis patients during the data collection period were accessed. Data was collected through structured questionnnaires. Analysis was performed using Stata version 18.0. Descriptive statistics summarized numerical variables using mean and standard deviation, while categorical data were presented as frequency and percentage. Bivariate and multivariate logistic regression models were employed to determine associations between variables. Results: Among 221 respondents, the mean age was 47 with a standard deviation of 16 years. The majority (60.6%) were male. Regarding occupation, the majority 63.80% were informally employed. Additionally, more than half of respondents 65.60% had health insurance. Furthermore, 68.3% of participants reported having at least one other chronic disease. Most 91% of respondents know the importance of laboratory tests, at least once a month 84.62% of respondents do required tests. Patients with no insurance were less likely to adhere to dialysis sessions (AOR=0.1, 95% CI= 0.002-0.49) compared to patients with insurance. Patients with no health insurance were less likely to adhere to laboratory tests (OR=0.439, 95% CI= O.2-0.4) compared to those with health insurance who were more likely to adhere. v Conclusion: In conclusion, there is a clear need for enhanced insurance coverage and targeted interventions that address both financial challenges and adherence issues. Addressing these factors can contribute to more consistent care and better management of ESRD. The study sheds light on the significant role of health insurance coverage in promoting adherence to dialysis sessions and routine laboratory testing.