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Besson ME, Pépin M, Metral PA. Lassa Fever: Critical Review and Prospects for Control. Trop Med Infect Dis 2024; 9:178. [PMID: 39195616 PMCID: PMC11359316 DOI: 10.3390/tropicalmed9080178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Revised: 08/10/2024] [Accepted: 08/12/2024] [Indexed: 08/29/2024] Open
Abstract
Lassa Fever is a deadly viral haemorrhagic disease, causing annually several hundreds of deaths in West Africa. This zoonotic disease is primarily transmitted to humans by rodents of the genus Mastomys, even though other rodents reportedly carry the Lassa virus, while secondary interhuman transmission accounts for approximately 20% of cases. Although this disease has been endemic in rural zones of Nigeria, Sierra Leone, Liberfia, and Guinea for hundreds of years, it is also characterised by epidemic outbreaks in the dry season, responsible for heavy death tolls. No licensed vaccine or satisfying treatment is currently available. Disease management is hindered by the incomplete knowledge of the epidemiology and distribution of the disease, resulting from an inadequate health and surveillance system. Additional scientific constraints such as the genetic diversity of the virus and the lack of understanding of the mechanisms of immune protection complexify the development of a vaccine. The intricate socio-economic context in the affected regions, and the lack of monetary incentive for drug development, allow the disease to persist in some of West Africa's poorest communities. The increase in the number of reported cases and in the fatality rate, the expansion of the endemic area, as well as the threat Lassa Fever represents internationally should urge the global community to work on the disease control and prevention. The disease control requires collaborative research for medical countermeasures and tailored public health policies. Lassa Fever, created by the interconnection between animals, humans, and ecosystems, and embedded in an intricate social context, should be addressed with a 'One Health' approach. This article provides an overview of Lassa Fever, focusing on Nigeria, and discusses the perspectives for the control of disease.
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Affiliation(s)
- Marianne E. Besson
- Department of Public Health, Royal Veterinary College, London NW1 0TU, UK
| | - Michel Pépin
- Department of Virology and Infectiology, VetAgro Sup Lyon University, 69280 Marcy L’Etoile, France;
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Aderinto N, Olatunji G, Kokori E, Abdulrahmon MA, Akinmeji A, Fatoye JO. Expanding surgical access in Africa through improved health insurance schemes: A review. Medicine (Baltimore) 2024; 103:e37488. [PMID: 38489736 PMCID: PMC10939550 DOI: 10.1097/md.0000000000037488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 03/17/2024] Open
Abstract
Surgical access remains a pressing public health concern in African nations, with a substantial portion of the population facing challenges in obtaining safe, timely, and affordable surgical care. This paper delves into the impact of health insurance schemes on surgical accessibility in Africa, exploring the barriers, challenges, and future directions. It highlights how high out-of-pocket costs, reliance on traditional healing practices, and inadequate surgical infrastructure hinder surgical utilization. Financing mechanisms often need to be more effective, and health insurance programs face resistance within the informal sector. Additionally, coverage of the poor remains a fundamental challenge, with geographical and accessibility barriers compounding the issue. Government policies, often marked by inconsistency and insufficient allocation of resources, create further obstacles. However, strategic purchasing and fund integration offer avenues for improving the efficiency of health insurance programs. The paper concludes by offering policy recommendations, emphasizing the importance of inclusive policies, streamlined financing mechanisms, coverage expansion, and enhanced strategic purchasing to bridge the surgical access gap in Africa. Decoupling entitlement from the payment of contributions, broadening the scope of coverage for outpatient medicines and related expenses, and enhancing safeguards against overall costs and charges, especially for individuals with lower incomes. Ultimately, by addressing these challenges and harnessing the potential of health insurance schemes, the continent can move closer to achieving universal surgical care and improving the well-being of its people.
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Affiliation(s)
- Nicholas Aderinto
- Department of Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Gbolahan Olatunji
- Department of Medicine and Surgery, University of Ilorin, Ilorin, Nigeria
| | - Emmanuel Kokori
- Department of Medicine and Surgery, University of Ilorin, Ilorin, Nigeria
| | | | - Ayodeji Akinmeji
- Department of Medicine, Olabisi Onabanjo University, Ogun, Nigeria
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Akokuwebe ME, Idemudia ES. Fraud within the Nigerian health system, a double threat for resilience of a health system and the response to the COVID-19 pandemic: a review. Pan Afr Med J 2023; 45:116. [PMID: 37745915 PMCID: PMC10516760 DOI: 10.11604/pamj.2023.45.116.36979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 06/08/2023] [Indexed: 09/26/2023] Open
Abstract
As Nigeria battles the COVID-19 pandemic, systemic fraud within the health system may undermine the efforts to halt the devastating effect of the disease and the fight against COVID-19. Fraud is a major concern worldwide, especially in developing countries such as Nigeria, where it is widespread within the health system. The vulnerability of the Nigerian health system despite several efforts from relevant stakeholders, has consistently been underscored before the pandemic arose, raising serious concerns. These concerns include fraud, embezzlement, and mismanagement of funds, exploitation, lack of transparency in policymaking, cutting corners in procurement processes, and taking advantage of the healthcare workforce for personal benefits. Also, other involvements in the vulnerability of the Nigerian health system that are worrisome include stakeholders using the pandemic to their advantage to increase their private benefits, a short supply of vital health resources, fraudulent recruitment of the health workforce, and ineffective crisis management. This study explores fraud within the Nigerian health system, its impact and implications for health-system resilience as well as its response to the COVID-19 pandemic. Guided by agency theory, causes and impacts of fraud in the health system and its implications on the response to COVID-19 were explained. Systematic review method was employed; out of 1462 articles identified and screened dated from 1991 to 2021, sixty articles were included in the analysis and interpretation. Specific fraud interventions should focus on a weak and vulnerable health system, service delivery, high-risk institutionalized health workforce, and addressing issues of fraud within and outside the health system in order to curb the dreaded COVID-19 and its variants in Nigeria.
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Nicholas A, Deji O. Invisible illness: The consequences of limited health insurance in Africa. Health Sci Rep 2023; 6:e1313. [PMID: 37275667 PMCID: PMC10234111 DOI: 10.1002/hsr2.1313] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/20/2023] [Accepted: 05/22/2023] [Indexed: 06/07/2023] Open
Abstract
Background Limited health insurance coverage in Africa poses a significant challenge, impeding access to quality healthcare for millions of individuals. Methods This paper synthesizes information from existing literature and research on the topic of limited health insurance coverage in Africa. The identified consequences and root causes are presented in a structured format. Results The consequences of limited health insurance coverage in Africa include increased financial burden on households, decreased access to health services, and inadequate coverage for essential health services. These consequences contribute to reduced utilization of healthcare services and negative health outcomes, including the deterioration of existing health conditions and the development of new health problems. The financial burden is particularly significant due to high poverty rates in Africa, forcing households to pay for healthcare services out of pocket and leading to considerable financial strain and even financial ruin. Additionally, limited health insurance coverage restricts access to necessary health services, resulting in delayed treatment, missed diagnoses, and poor health outcomes. Conclusion The root causes of limited health insurance coverage in Africa are multifaceted and include factors such as poverty, lack of government support, and limited private-sector involvement. These systemic issues contribute to the persistence of inadequate health insurance coverage and hinder efforts to improve access to quality healthcare for African populations.
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Affiliation(s)
- Aderinto Nicholas
- Department of Medicine and SurgeryLadoke Akintola University of TechnologyOgbomoshoNigeria
| | - Olatunji Deji
- Department of Medicine and SurgeryUniversity of IlorinIlorinNigeria
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Akang EN, Opuwari CS, Enyioma-Alozie S, Moungala LW, Amatu TE, Wada I, Ogbeche RO, Ajayi OO, Aderonmu MM, Shote OB, Akinola LA, Ashiru OA, Henkel R. Trends in semen parameters of infertile men in South Africa and Nigeria. Sci Rep 2023; 13:6819. [PMID: 37100822 PMCID: PMC10133443 DOI: 10.1038/s41598-023-33648-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/17/2023] [Indexed: 04/28/2023] Open
Abstract
There are conflicting reports on trends of semen parameters from different parts of the globe. However, in recent times there is dearth of information on the trend in Sub-Saharan countries. Therefore, in this study we aimed at determining the trends in semen parameters in Nigeria and South Africa between 2010 and 2019. A retrospective study of semen analyses of 17,292 men attending fertility hospitals in Nigeria and South Africa in 2010, 2015 and 2019. Patients who had undergone vasectomy and those who had a pH less than 5 or greater than 10 were excluded from this study. The following variables were assessed: ejaculate volume, sperm concentration, progressive motility, total progressively motile sperm count (TPMSC), total sperm count, and normal sperm morphology. Between 2010 and 2019, significant trends of decreasing values were observed in normal sperm morphology (- 50%), and the ejaculatory volume (- 7.4%), indicating a progressive deterioration of the values in both countries. In Nigeria, there were significant decreases in progressive motility (- 87%), TPMSC (- 78%), and sperm morphology (- 55%) between 2010 and 2019 (P < 0.001). Spearman`s rank correlation revealed significant negative associations between age and morphology (ρ = - 0.24, P < 0.001), progressive motility (ρ = - 0.31. P < 0.001), and TPMSC (ρ = - 0.32, P < 0.001). Patients in South Africa were younger than those from Nigeria, with also a significantly higher sperm morphology, sperm concentration, progressive motility, total sperm count and TPMSC. Our findings provide a quantitative evidence of an alarming decreasing trend in semen parameters in Nigeria and South Africa from 2010 to 2019. It also proves that astheno- and teratozoospermia are the leading causes of male infertility in these regions. In addition to this, it also shows empirically that semen parameters decrease with advancement in age. These findings are the first report of temporal trends in semen parameters in Sub-Saharan countries, necessitating a thorough investigation on the underlying factors promoting this worrisome decline.
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Affiliation(s)
- Edidiong Nnamso Akang
- Department of Anatomy, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria.
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut, USA.
| | - Chinyerum Sylvia Opuwari
- Department of Medical Biosciences, Faculty of Natural Sciences, University of the Western Cape, Bellville, South Africa
| | | | | | | | | | | | | | | | | | - Lateef Adekunle Akinola
- Department of Obstetrics and Gynaecology, Medison Specialist Women's Hospital, Lagos, Nigeria
| | | | - Ralf Henkel
- Department of Medical Biosciences, Faculty of Natural Sciences, University of the Western Cape, Bellville, South Africa.
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
- LogixX Pharma, Theale, Berkshire, UK.
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Mhazo AT, Maponga CC, Mossialos E. Inequality and private health insurance in Zimbabwe: history, politics and performance. Int J Equity Health 2023; 22:54. [PMID: 36991454 PMCID: PMC10061904 DOI: 10.1186/s12939-023-01868-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 03/17/2023] [Indexed: 03/31/2023] Open
Abstract
INTRODUCTION Zimbabwe has one of the highest rates of private health insurance (PHI) expenditures as a share of total health expenditures in the world. The perfomamce of PHI, known as Medical Aid Societies in Zimbabwe, requires close monitoring since market failures and weaknesses in public policy and regulation can affect overall health system performance. Despite the considerable influence of politics (stakeholder interests) and history (past events) in shaping PHI design and implementation, these factors are frequently sidelined when analyzing PHI in Zimbabwe. This study considers the roles of history and politics in shaping PHI and determining its impact on health system performance in Zimbabwe. METHODS We reviewed 50 sources of information using Arksey & O'Malley's (2005) methodological framework. To frame our analysis, we used a conceptual framework that integrates economic theory with political and historical aspects developed by Thomson et al. (2020) to analyze PHI in diverse contexts. RESULTS We present a timeline of the history and politics of PHI in Zimbabwe from the 1930s to present. Zimbabwe's current PHI coverage is segmented along socio-economic lines due to a long history of elitist and exclusionary politics in coverage patterns. While PHI was considered to perform relatively well up to the mid-1990s, the economic crisis of the 2000s eroded trust among insurers, providers, and patients. That culminated in agency problems which severely lessened PHI coverage quality with concurrent deterioration in efficiency and equity-related performance dimensions. CONCLUSION The present design and performance of PHI in Zimbabwe is primarily a function of history and politics rather than informed choice. Currently, PHI in Zimbabwe does not meet the evaluative criteria of a well-performing health insurance system. Therefore, reform efforts to expand PHI coverage or improve PHI performance must explicitly consider the relevant historical, political and economic aspects for successful reformation.
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Affiliation(s)
- Alison T Mhazo
- Ministry of Health, Community Health Sciences Unit (CHSU), Private Bag 65, Area 3, Lilongwe, Malawi.
| | - Charles C Maponga
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, P.O. Box A178, Avondale, Harare, Zimbabwe
| | - Elias Mossialos
- The London School of Economics and Political Science, Department of Health Policy, LSE Health, London, UK
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Ambalu R, Rashid S, Atwa S, Otira M, Ndolo L, Ojakaa D. Factors related to women's use of health insurance cover in Navakholo, Kakamega County, Kenya: sub-county level results based on community household register. BMC Public Health 2023; 23:576. [PMID: 36978061 PMCID: PMC10045922 DOI: 10.1186/s12889-023-15270-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/14/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND In concert with international commitments, the Government of Kenya identified Universal Health Coverage (UHC), mainly through the National Health Insurance Fund (NHIF), as one of its four priority agenda to enable its populations access health care without financial duress. Nevertheless, only about 19.5% of the Kenyan population is enrolled in any insurance health cover. Since 2016, Amref Health Africa and PharmAccess Foundation have been implementing the Innovative Partnership for Universal and Sustainable Healthcare (iPUSH) programme in Navakholo sub-county of Kakamega County. The main objective of this study is to examine use of health insurance cover among Women of Reproductive Age (WRA) in Navakholo sub-county, Kakamega County. METHODS We analysed data captured during household registration conducted in February 2021 which embraced a question on use of health insurance cover including NHIF. The dataset consisted 148,957 household members within 32,262 households, 310 villages, and 32 community health units. The data had been collected using mobile phones by trained Community Health Volunteers (CHVs) and transmitted using the Amref electronic data management platform and reposited in a server. Data were analysed through frequency distributions and logistic regression (descriptive and causal methods) using STATA software. RESULTS Insurance coverage, all providers included, in Navakholo sub-county stood at 11% among women aged 15-49 years. This is much lower than the national aggregate reported from sample surveys, but higher than the 7% found in the same survey for the region where Navakholo is situated. Social determinant variables - age, perceived condition of the household, and wealth ranking - are highly significant in the relationship with use of health insurance cover while measures of reproductive health and health vulnerability are not. CONCLUSION In Navakholo sub-county of Western Kenya, all-health-insurance coverage is lower than the national aggregate estimated from sample surveys. Age, perception of household condition, and wealth ranking are very significantly related to use of a health insurance cover. Frequent household registrations should be conducted to help monitor the trends and impact of health insurance campaigns. Training - upstream and downstream - on community household registration and data processing should be conducted to arrive at better quality data.
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Affiliation(s)
- Rachel Ambalu
- Amref Health Africa (H.Q), P.O. Box 27691-00506, Nairobi, Kenya.
| | - Sadiq Rashid
- Amref Health Africa (H.Q), P.O. Box 27691-00506, Nairobi, Kenya
| | - Saul Atwa
- Amref Health Africa (H.Q), P.O. Box 27691-00506, Nairobi, Kenya
| | - Mariam Otira
- Amref Health Africa (H.Q), P.O. Box 27691-00506, Nairobi, Kenya
| | - Lucia Ndolo
- Amref Health Africa (H.Q), P.O. Box 27691-00506, Nairobi, Kenya
| | - David Ojakaa
- BRIM Research, P. O. Box 76100, 00508, Code, Yaya Towers, Nairobi, Kenya
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Adeniji FIP, Obembe TA. Cardiovascular Disease and Its Implication for Higher Catastrophic Health Expenditures Among Households in Sub-Saharan Africa. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2023; 10:59-67. [PMID: 36945240 PMCID: PMC10024946 DOI: 10.36469/001c.70252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 02/07/2023] [Indexed: 06/18/2023]
Abstract
Background: Cardiovascular diseases (CVDs) impose an enormous and growing economic burden on households in sub-Saharan Africa (SSA). Like many chronic health conditions, CVD predisposes families to catastrophic health expenditure (CHE), especially in SSA due to the low health insurance coverage. This study assessed the impact of CVD on the risks of incurring higher CHE among households in Ghana and South Africa. Methods: The World Health Organization (WHO) Study on Global AGEing and Adult Health (WHO SAGE), Wave 1, implemented 2007-2010, was utilized. Following standard procedure, CHE was defined as the health expenditure above 5%, 10%, and 25% of total household expenditure. Similarly, a 40% threshold was applied to household total nonfood expenditure, also referred to as the capacity to pay. To compare the difference in mean CHE by household CVD status and the predictors of CHE, Student's t-test and logistic regression were utilized. Results: The share of medical expenditure in total household spending was higher among households with CVD in Ghana and South Africa. Households with CVD were more likely to experience greater CHE across all the thresholds in Ghana. Households who reported having CVD were twice as likely to incur CHE at 5% threshold (odds ratio [OR], 1.946; confidence interval [CI], 0.965-1.095), 3 times as likely at 10% threshold (OR, 2.710; CI, 1.401-5.239), and 4 times more likely to experience CHE at both 25% and 40% thresholds, (OR, 3.696; CI, 0.956-14.286) and (OR, 4.107; CI, 1.908-8.841), respectively. In South Africa, households with CVD experienced higher CHE across all the thresholds examined compared with households without CVDs. However, only household CVD status, household health insurance status, and the presence of other disease conditions apart from CVD were associated with incurring CHE. Households who reported having CVD were 3 times more likely to incur CHE compared with households without CVD (OR, 3.002; CI, 1.013-8.902). Conclusions: Our findings suggest that CVD predisposed households to risk of higher CHE. Equity in health financing presupposes that access to health insurance should be predicated on individual health needs. Thus, targeting and prioritizing the health needs of individuals with regard to healthcare financing interventions in SSA is needed.
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Affiliation(s)
- Folashayo Ikenna Peter Adeniji
- Department of Health Policy & Management, Faculty of Public Health, College of Medicine University of Ibadan, Ibadan, Nigeria
| | - Taiwo Akinyode Obembe
- Department of Health Policy & Management, Faculty of Public Health, College of Medicine University of Ibadan, Ibadan, Nigeria
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Osei Afriyie D, Masiye F, Tediosi F, Fink G. Confidence in the health system and health insurance enrollment among the informal sector population in Lusaka, Zambia. Soc Sci Med 2023; 321:115750. [PMID: 36801748 DOI: 10.1016/j.socscimed.2023.115750] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/29/2022] [Accepted: 01/27/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND To improve equitable access to quality essential services and reduce financial hardship, low-and-middle-income countries are increasingly relying on prepayment strategies such as health insurance schemes. Among the informal sector population, confidence in the health system to provide effective treatment and trust in institutions can play an important role in health insurance enrollment. The objective of this study was to examine the extent to which confidence and trust affect enrollment into the recently introduced Zambia National Health insurance. METHODS We conducted a regionally representative cross-sectional household survey in Lusaka, Zambia collecting information on demographics, health expenditure, ratings of last health facility visit, health insurance status and confidence in the health system. We used multivariable logistic regression to assess the association between enrollment and confidence in the private and public health sector as well as trust in the government in general. RESULTS Of the 620 respondents interviewed, 70% were enrolled or planning to enroll in the health insurance. Only about one-fifth of respondents were very confident that they would receive effective care in the public health sector 'if they became sick tomorrow' while 48% were very confident in the private health sector. While confidence in the public system was only weakly associated with enrollment, confidence in the private health sector was strongly associated with enrollment (Adjusted odds ratio (AOR) 3.40 95% CI 1.73 - 6.68). No association was found between enrollment and trust in government or perceived government performance. CONCLUSIONS Our results suggest that confidence in the health system, particularly in the private health sector, is strongly associated with health insurance enrollment. Focusing on achieving high quality of care across all levels of the health system may be an effective strategy to increase enrollment in health insurance.
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Affiliation(s)
- Doris Osei Afriyie
- Swiss Tropical and Public Health Institute, Department of Epidemiology and Public Health, Allschwil, Switzerland; University of Basel, Basel, Switzerland.
| | - Felix Masiye
- University of Zambia, Department of Economics, Lusaka, Zambia.
| | - Fabrizio Tediosi
- Swiss Tropical and Public Health Institute, Department of Epidemiology and Public Health, Allschwil, Switzerland; University of Basel, Basel, Switzerland.
| | - Günther Fink
- Swiss Tropical and Public Health Institute, Department of Epidemiology and Public Health, Allschwil, Switzerland; University of Basel, Basel, Switzerland.
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Taiwo AB, Fatunla OA, Ogundare OE, Oluwayemi OI, Babatola AO, Ajite AB, Ajibola AE, Olajuyin A, Sola-Oniyide B, Olatunya OS. Households Health Care Financing Methods: Social Status Differences, Economic Implications and Clinical Outcomes Among Patients Admitted in a Pediatric Emergency Unit of a Tertiary Hospital in South West Nigeria. Glob Pediatr Health 2023; 10:2333794X231159792. [PMID: 36922939 PMCID: PMC10009042 DOI: 10.1177/2333794x231159792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/08/2023] [Indexed: 03/13/2023] Open
Abstract
Background. The affordability of health care services by households within a country is determined by the health care financing methods used by her citizens. In accordance with World Health Organization (WHO), health services must be delivered equitably and without imposing financial hardship on the citizens. Aim. This study aimed to determine the pattern of households health care financing method and relate it to the social-background, economic implication and clinical outcome of care in pediatric emergency situations. Method: It is a cross-sectional descriptive study. Result. 210 children from different households were recruited. Majority (75.9%) of the children were aged 0 to 5 years, males (61.2%) and belonged to the low socio-economic status (95.7%). The overall median (IQR) cost of care, income and percentage of income spent on care were ₦10 700 (₦7580-₦19 700), ₦ 65000(₦38000-₦110 000) and 17.6% (7.1%-39.7%) respectively. Though 70 (34.8%) of the respondents were aware of health insurance scheme, only 12.8% were enrolled. There were significant differences in the households' health care financing methods with respect to the socioeconomic status (P = .010), paternal level of education (P < .001), maternal occupation (P = .020), paternal occupation (P = .030) and distribution of income (P < .001). Catastrophic spending was experienced by 67.4% of the household, all of whom paid via out-of-pocket payment (OOPP) (P < .001), catastrophic health spending (CHS) was significantly associated with death and discharge against medical advice (DAMA) (P = .023). All cases of mortality and 93% cases of DAMA occurred with paying out of pocket (OOP) (P = .168). Conclusion. health care services were majorly paid for OOP among households in this study and CHS are high among these households. Clinical and financial outcomes were worse when health care services were paid through OOP.
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Affiliation(s)
- Adekunle Bamidele Taiwo
- Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria.,Zankli Medical Services, Utako, Abuja, Nigeria
| | - Odunayo Adebukola Fatunla
- Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria.,Afe-babalola University, Ado Ekiti, Nigeria
| | - Olatunde Ezra Ogundare
- Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria.,Ekiti State University, Ado Ekiti, Nigeria
| | - Oludare Isaac Oluwayemi
- Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria.,Ekiti State University, Ado Ekiti, Nigeria
| | - Adefunke Olarinre Babatola
- Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria.,Ekiti State University, Ado Ekiti, Nigeria
| | - Adebukola Bidemi Ajite
- Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria.,Ekiti State University, Ado Ekiti, Nigeria
| | | | | | | | - Oladele Simeon Olatunya
- Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria.,Zankli Medical Services, Utako, Abuja, Nigeria
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