Advancing the care of individuals with cancer through innovation & technology: Proceedings from the cardiology oncology innovation summit 2020 and 2021

As cancer therapies increase in effectiveness and patients' life expectancies improve, balancing oncologic efficacy while reducing acute and long-term cardiovascular toxicities has become of paramount importance. To address this pressing need, the Cardiology Oncology Innovation Network (COIN) was formed to bring together domain experts with the overarching goal of collaboratively investigating, applying, and educating widely on various forms of innovation to improve the quality of life and cardiovascular healthcare of patients undergoing and surviving cancer therapies. The COIN mission pillars of innovation, collaboration, and education have been implemented with cross-collaboration among academic institutions, private and public establishments, and industry and technology companies. In this report, we summarize proceedings from the first two annual COIN summits (inaugural in 2020 and subsequent in 2021) including educational sessions on technological innovations for establishing best practices and aligning resources. Herein, we highlight emerging areas for innovation and defining unmet needs to further improve the outcome for cancer patients and survivors of all ages. Additionally, we provide actionable suggestions for advancing innovation, collaboration, and education in cardio-oncology in the digital era.

Treatment of uncomplicated malaria at public health facilities and medicine retailers in south-eastern Nigeria

Background

At primary care facilities in Nigeria, national treatment guidelines state that malaria should be symptomatically diagnosed and treated with artemisinin-based combination therapy (ACT). Evidence from households and health care providers indicates that many patients do not receive the recommended treatment. This study sought to determine the extent of the problem by collecting data as patients and caregivers leave health facilities, and determine what influences the treatment received.

Methods

A cross-sectional cluster survey of 2,039 respondents exiting public health centres, pharmacies and patent medicine dealers was undertaken in urban and rural settings in Enugu State, south-eastern Nigeria.

Results

Although 79% of febrile patients received an anti-malarial, only 23% received an ACT. Many patients (38%) received sulphadoxine-pyrimethamine (SP). A further 13% of patients received an artemisinin-derivative as a monotherapy. An estimated 66% of ACT dispensed was in the correct dose. The odds of a patient receiving an ACT was highly associated with consumer demand (OR: 55.5, p < 0.001).

Conclusion

Few febrile patients attending public health facilities, pharmacies and patent medicine dealers received an ACT, and the use of artemisinin-monotherapy and less effective anti-malarials is concerning. The results emphasize the importance of addressing both demand and supply-side influences on malaria treatment and the need for interventions that target consumer preferences as well as seek to improve health service provision.

Geographic inequities in provision and utilization of malaria treatment services in southeast Nigeria: diagnosis, providers and drugs

OBJECTIVES

To examine the levels of geographic inequities in households' choice of providers, mode of diagnosis and drugs for the treatment of malaria.

METHODS

Interviewer-administered questionnaire was used to collect information from 2250 randomly selected respondents from six malaria-endemic communities in southeast Nigeria. A comparison of data between urban and rural areas was used to examine geographic inequities in treatment seeking.

FINDINGS

There were geographic inequities in the use of different providers and drugs for the treatment of malaria. The urbanites used more of private hospitals/clinics and specialist hospital, while the rural dwellers used more of drug sellers (patent medicine dealers (PMD) and pharmacy shops (PS)). The rural dwellers were prescribed the cheaper drugs whilst the urbanites were prescribed the more costly drugs.

CONCLUSION

The geographic inequities in malaria treatment are skewed against the rural people. Everybody is seeking care from the private sector for treatment of malaria but the rural dwellers are using mostly the informal healthcare providers.

Informal payments for healthcare: differences in expenditures from consumers and providers perspectives for treatment of malaria in Nigeria

OBJECTIVES

To examine differences in malaria treatment expenditures from the perspectives of consumers and providers in southeast Nigeria.

METHODS

The study was conducted using household surveys, provider surveys and exit poll interviews. The amount of money that the providers claimed to charge their patients for malaria treatment services was compared with the expenditures that the respondents actually incurred for malaria treatment services from the same providers.

RESULTS

The average expenditure for malaria treatment from the consumers as elicited from both the household survey and exit poll interviews was $6.30, while it was $2.20 for the providers from information from the provider survey. The widest gaps between expenditures for consumers and amounts purportedly charged by providers were found in public healthcare facilities. All socio-economic status groups and residents of urban and rural areas were exposed to informal payments.

CONCLUSION

The differences in malaria treatment expenditures from consumers' and providers' perspectives point to high levels of informal payments, which worsen the economic burden of the disease and may predispose to catastrophic health spending. The informal payments are personal gains to the individual providers but represent a loss to the society, in terms of higher healthcare costs. Such payments should be addressed by policy makers so as to make treatment of malaria less costly to patients.