Patterns and determinants of formal healthcare utilisation among individuals with and without proxy-identified mental health need in Tanzania: A cross-sectional analysis of the National Panel Survey
- 1Department of Business Management, Mbeya University of Science and Technology, Mbeya, Tanzania
- 2Department of Economics, University of Dodoma, Dodoma, Tanzania
Abstract
Formal healthcare utilisation remains persistently low across sub-Saharan Africa, yet utilisation patterns among individuals with mental health needs are poorly understood in low- and middle-income country contexts. Using data from the fifth wave of the Tanzania National Panel Survey (2020/21), this study examined patterns and determinants of formal healthcare utilisation among individuals aged 15 years and above with and without proxy-identified mental health need. A nationally representative cross-sectional sample of 11,891 individuals with non-missing outcome data was analysed. Proxy-identified mental health need was determined using the Washington Group Short Set item on difficulty remembering or concentrating at the severe threshold, a proxy associated with common mental disorders. The outcome was any formal provider visit in the four weeks prior to the interview, regardless of reason. Survey-weighted logistic regression estimated odds ratios and predicted probabilities within the Andersen Behavioural Model. Missing outcome data affected 505 individuals in a Missing Not At Random pattern; extreme bounds sensitivity analysis assessed implications for subgroup estimates. Overall weighted formal healthcare utilisation was 19.2%. Proxy-identified mental health need was observed in 54 individuals (weighted prevalence 0.45%). Female sex, older age (55 and above), and Southern Highlands zone residence were independently associated with higher utilisation. Household wealth showed a strong dose-response gradient: individuals in the richest quintile had 2.71 times higher adjusted odds than those in the poorest. Proxy-identified mental health need was not significantly associated with utilisation (adjusted odds ratio 1.27; 95% confidence interval: 0.53–3.04; p = 0.588). Extreme bounds analysis indicated that true utilisation could range from 2.0% to 92.7%, confirming subgroup findings are exploratory. Formal healthcare utilisation in Tanzania is strongly patterned by household wealth, sex, age, and geographic zone. Addressing wealth-related barriers and strengthening service availability in lower-utilisation zones should be the priorities for advancing equitable healthcare utilisation in Tanzania.
Related
- Metabolic determinants of cancer immunotherapy outcomes identified by plasma profiling
- Insights from a mobile healthcare clinic in Madagascar: Diversity and dynamics of viruses from febrile individuals in rural subsistence communities
- Economic burden of pertussis, its influencing factors, and hospitalization determinants among older adults (≥ 60 years) in Zhejiang, China: a cross-sectional study (2024–2025)
- Determinants of the continuum of maternal healthcare service utilization in Nigeria: Evidence from the 2024 Nigeria Demographic and Health Survey
- Association of calcium phosphate crystals with pain and inflammation among individuals with advanced knee osteoarthritis: A cross-sectional study.
BibTeX
@article{mlenge2026patterns,
title = {{Patterns and determinants of formal healthcare utilisation among individuals with and without proxy-identified mental health need in Tanzania: A cross-sectional analysis of the National Panel Survey}},
author = {Gallen Mlenge and Odass Bilame and Lutengano Mwinuka},
journal = {PLOS Mental Health},
year = {2026},
month = sep,
doi = {10.1371/journal.pmen.0000644},
url = {https://journals.plos.org/mentalhealth/article?id=10.1371/journal.pmen.0000644},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Patterns and determinants of formal healthcare utilisation among individuals with and without proxy-identified mental health need in Tanzania: A cross-sectional analysis of the National Panel Survey
AU - Gallen Mlenge
AU - Odass Bilame
AU - Lutengano Mwinuka
PY - 2026
DA - 2026/09/17
JO - PLOS Mental Health
DO - 10.1371/journal.pmen.0000644
UR - https://journals.plos.org/mentalhealth/article?id=10.1371/journal.pmen.0000644
AB - Formal healthcare utilisation remains persistently low across sub-Saharan Africa, yet utilisation patterns among individuals with mental health needs are poorly understood in low- and middle-income country contexts. Using data from the fifth wave of the Tanzania National Panel Survey (2020/21), this study examined patterns and determinants of formal healthcare utilisation among individuals aged 15 years and above with and without proxy-identified mental health need. A nationally representative cross-sectional sample of 11,891 individuals with non-missing outcome data was analysed. Proxy-identified mental health need was determined using the Washington Group Short Set item on difficulty remembering or concentrating at the severe threshold, a proxy associated with common mental disorders. The outcome was any formal provider visit in the four weeks prior to the interview, regardless of reason. Survey-weighted logistic regression estimated odds ratios and predicted probabilities within the Andersen Behavioural Model. Missing outcome data affected 505 individuals in a Missing Not At Random pattern; extreme bounds sensitivity analysis assessed implications for subgroup estimates. Overall weighted formal healthcare utilisation was 19.2%. Proxy-identified mental health need was observed in 54 individuals (weighted prevalence 0.45%). Female sex, older age (55 and above), and Southern Highlands zone residence were independently associated with higher utilisation. Household wealth showed a strong dose-response gradient: individuals in the richest quintile had 2.71 times higher adjusted odds than those in the poorest. Proxy-identified mental health need was not significantly associated with utilisation (adjusted odds ratio 1.27; 95% confidence interval: 0.53–3.04; p = 0.588). Extreme bounds analysis indicated that true utilisation could range from 2.0% to 92.7%, confirming subgroup findings are exploratory. Formal healthcare utilisation in Tanzania is strongly patterned by household wealth, sex, age, and geographic zone. Addressing wealth-related barriers and strengthening service availability in lower-utilisation zones should be the priorities for advancing equitable healthcare utilisation in Tanzania.
SN - 2837-8156
ER -