Investigating determinants of out-of-pocket spending and strategies for coping with payments for healthcare in southeast Nigeria

<p>Abstract</p> <p>Background</p> <p>Out-of-pocket spending (OOPS) is the major payment strategy for healthcare in Nigeria. Hence, the paper assessed the determinants socio-economic status (SES) of OOPS and strategies for coping with payments for healthcare in urban, semi-urban and rural areas of southeast Nigeria. This paper provides information that would be required to improve financial accessibility and equity in financing within the public health care system.</p> <p>Methods</p> <p>The study areas were three rural and three urban areas from Ebonyi and Enugu states in South-east Nigeria. Cross-sectional survey using interviewer-administered questionnaires to randomly selected householders was the study tool. A socio-economic status (SES) index that was developed using principal components analysis was used to examine levels of inequity in OOPS and regression analysis was used to examine the determinants of use of OOPS.</p> <p>Results</p> <p>All the SES groups equally sought healthcare when they needed to. However, the poorest households were most likely to use low level and informal providers such as traditional healers, whilst the least poor households were more likely to use the services of higher level and formal providers such as health centres and hospitals. The better-off SES more than worse-off SES groups used OOPS to pay for healthcare. The use of own money was the commonest payment-coping mechanism in the three communities. The sales of movable household assets or land were not commonly used as payment-coping mechanisms. Decreasing SES was associated with increased sale of household assets to cope with payment for healthcare in one of the communities. Fee exemptions and subsidies were almost non-existent as coping mechanisms in this study</p> <p>Conclusions</p> <p>There is the need to reduce OOPS and channel and improve equity in healthcare financing by designing and implementing payment strategies that will assure financial risk protection of the poor such pre-payment mechanisms with government paying for the poor.</p

Lack of observational evidence for quantum structure of space-time at Plank scales

It has been noted (Lieu & Hillmann, 2002) that the cumulative affect of Planck-scale phenomenology, or the structure of space-time at extremely small scales, can be lead to the loss of phase of radiation emitted at large distances from the observer. We elaborate on such an approach and demonstrate that such an effect would lead to an apparent blurring of distant point-sources. Evidence of the diffraction pattern from the HST observations of SN 1994D and the unresolved appearance of a Hubble Deep Field galaxy at z=5.34 lead us to put stringent limits on the effects of Planck-scale phenomenology.Comment: 12 pages, 3 figures, accepter for ApJ

Health risk behaviours among adolescents in the English-speaking Caribbean: a review

<p>Abstract</p> <p>Background</p> <p>The aim of this paper was to review and summarize research on prevalence of health risk behaviours, their outcomes as well as risk and protective factors among adolescents in the English-speaking Caribbean.</p> <p>Methods</p> <p>Searching of online databases and the World Wide Web as well as hand searching of the <it>West Indian Medical Journal </it>were conducted. Papers on research done on adolescents aged 10 – 19 years old and published during the period 1980 – 2005 were included.</p> <p>Results</p> <p>Ninety-five relevant papers were located. Five papers were published in the 1980s, 47 in the 1990s, and from 2000–2005, 43 papers. Health risk behaviours and outcomes were divided into seven themes. Prevalence data obtained for these, included lifetime prevalence of <b>substance use</b>: cigarettes-24% and marijuana-17%; <b>high risk sexual behaviour</b>: initiation of sexual activity ≤ 10 years old-19% and those having more than six partners-19%; <b>teenage pregnancy</b>: teens account for 15–20% of all pregnancies and one-fifth of these teens were in their second pregnancy; <b>Sexually-Transmitted Infections (STIs)</b>: population prevalence of gonorrhoea and/or chlamydia in 18–21 year-olds was 26%; <b>mental health</b>: severe depression in the adolescent age group was 9%, and attempted suicide-12%; <b>violence and juvenile delinquency</b>: carrying a weapon to school in the last 30 days-10% and almost always wanting to kill or injure someone-5%; <b>eating disorders and obesity</b>: overweight-11%, and obesity-7%. Many of the risk behaviours in adolescents were shown to be related to the adolescent's family of origin, home environment and parent-child relationships. Also, the protective effects of family and school connectedness as well as increased religiosity noted in studies from the United States were also applicable in the Caribbean.</p> <p>Conclusion</p> <p>There is a substantial body of literature on Caribbean adolescents documenting prevalence and correlates of health risk behaviours. Future research should emphasize the designing and testing of interventions to alleviate this burden.</p

National health accounts: Structure, trends and sustainability of health expenditure in Nigeria

No Abstract

Financial linkage and development in sub-Saharan Africa The informal financial sector in Nigeria

SIGLEAvailable from British Library Document Supply Centre-DSC:9349.834(90) / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Financial linkage and development in Sub-Saharan Africa The role of formal financial institutions in Nigeria

SIGLEAvailable from British Library Document Supply Centre-DSC:9349.834(ODI-WP--88) / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Characteristics, Complications and Outcome of Patients Treated with Automated Peritoneal Dialysis at the Peritoneal Dialysis Unit, University Hospital of the West Indies

Objective: To characterize and evaluate complications and outcomes of the patients treated with automated peritoneal dialysis (PD) at the University Hospital of the West Indies (UHWI), Jamaica. Method: Retrospective data were collected from peritoneal dialysis patients’ case files retrieved from the medical records department of UHWI. Demographic data (age, gender, address, marital status), year of dialysis commencement, cause of end stage renal disease (ESRD), haemoglobin, serum electrolytes, serology, blood pressure readings, medications used, blood transfusion and erythropoietin use were collated. Complications such as infections (pneumonia, catheter-related infections), cardiac related disorders (congestive cardiac failure, acute coronary syndrome, pericarditis/pericardial effusion), cerebrovascular diseases, renal osteodystrophy, complications of the procedure and of end stage renal disease (ESRD), outcome and cause of death were retrieved from patients’ case files for analysis. Results: There were 202 patients receiving peritoneal dialysis between September, 1999 and December, 2008. Data on 190 were analysed. The case files of 12 patients were not included because of incomplete data. The ages of the studied PD patients ranged between 33 and 65 years. The mean haemoglobin was 7.4 g/dL, serum calcium of 2.1 mmol/L, serum phosphate of 1.9 mmol/L and calcium/phosphate product of 4.1mmol2/L2. The serum albumin was 32 g/L and serum total cholesterol/HDL ratio of 5.3. Most patients were from Kingston and St Andrew (56.8%), St Catherine (18.9%) and Clarendon (7.4%). Hypertension (27.9%), chronic glomerulonephritis (17.9%) and diabetes mellitus (17.4%) were the commonest causes of ESRD. There were 70.5% unmarried persons and 81.6% of patients were unemployed. HIV, Hepatitis B and Hepatitis C seropositivity were discovered in 4.1%, 1.1 and 0.5% of patients respectively. Only 20% of the patients used erythropoietin and of this 92% used it less than 50% of the prescribed frequency. Infections (43.2%) such as pneumonia, peritonitis, catheter tunnel infection, exit site infection and cardiac related complications (37.4%) such as congestive cardiac failure, acute coronary syndrome, pericarditis/pericardial effusion were the most frequently encountered complications. Forty-one per cent of patients were transferred to haemodialysis mainly on account of inadequate dialysis clearance. Sepsis (42%) such as pneumonia, urinary tract infection, peritonitis and cardiac related causes (31%) such as congestive cardiac failure and acute coronary syndrome were the two major causes of death. Of those who died of sepsis, 45.2% had pneumonia. Only 9.5% (4/42) of patients had confirmed peritonitis during their illness. Conclusion: Infection and cardiovascular disease were common complications observed in this study. Therefore intensive management of risk factors (hypertension, diabetes and dyslipidaemia) and prompt recognition of infection is hereby recommended. Early recognition and appropriate management of sepsis in peritoneal dialysis patients should be initially based on standard protocol. The use of erythropoietin in peritoneal dialysis patients will enhance better management of anaemia and improve quality of life. Keywords: Complications, outcome, peritoneal dialysis "Características, Complicaciones y Resultados Clínicos de los Pacientes Tratados con Diálisis Peritoneal Automatizada en la Unidad de Diálisis Peritoneal del Hospital Universitario de West Indies" RESUMEN Objetivo: Caracterizar y evaluar las complicaciones y resultados clínicos de los pacientes tratados con diálisis peritoneal automatizada (DP) en el Hospital Universitario de West Indies (HUWI), Jamaica. Método: Los datos retrospectivos fueron recopilados de pacientes de diálisis peritoneal tomados del departamento de historias clínicas del HUWI. Se recopilaron datos demográficos (edad, género, dirección, estado civil), año de comienzo de la diálisis, causa de la enfermedad renal en fase terminal (ERFT), hemoglobina, electrólitos del suero, serología, lecturas de la presión arterial, medicamentos usados, transfusión de sangre y uso de la eritropoyetina. Asimismo, a partir de las historias de casos de pacientes, se recogió para su análisis, información sobre complicaciones tales como infecciones (neumonía, infecciones por catéter), trastornos cardíacos (insuficiencia cardíaca congestiva, síndrome coronario agudo, pericarditis/derrame pericárdico), enfermedades cerebrovasculares, osteodistrofia renal, complicaciones de procedimiento y enfermedad renal en fase terminal (ERFT), así como resultado clínico y causa de muerte. Resultados: Entre septiembre de 1999 y diciembre de 2008, un total de 202 pacientes se encontraban recibiendo diálisis peritoneal. Los datos de 190 pacientes fueron analizados. Las historias clínicas de 12 casos, no fueron incluidas debido a que los datos estaban incompletos. Las edades de los pacientes de DP estudiados tenían edades entre 33 y 65 años. La hemoglobina media fue 7.4 g/dL, el calcio sérico 2.1 mmol/L, el fosfato sérico 1.9 mmol/L y el producto calcio/fosfato 4.1mmol²/L². La albúmina sérica fue 32g/L y la proporción colesterol total sérico/HDL fue 5.3. La mayoría de los pacientes eran de Kingston y Saint Andrew (56.8%), Saint Catherine (18.9%) y Clarendon (7.4%). La hipertensión (27.9%), la glomerulonefritis crónica (17.9%) y la diabetes mellitus (17.4%) fueron las causas más comunes de ERFT. Había un 70.5% de personas solteras y un 81.6% de pacientes eran desempleados. Se descubrió seropositividad para el VIH, la hepatitis B y la hepatitis C en 4.1%, 1.1% y 0.5% de los pacientes respectivamente. Sólo el 20% de los pacientes usaban eritropoyetina y de estos 92% lo usaban menos del 50% de la frecuencia prescrita. Las infecciones (43.2%) como la neumonía, la peritonitis, la infección del túnel del catéter, la infección del sitio de salida y las complicaciones cardíacas relacionadas (37.4%) tales como la insuficiencia cardíaca congestiva, el síndrome coronario agudo, y la pericarditis/derrame pericárdico, fueron las complicaciones encontradas con más frecuencia. Cuarenta y uno por ciento de los pacientes fueron transferidos a hemodiálisis debido principalmente a depuración inadecuada de la diálisis. Sepsis (42%) como la neumonía, la infección de las vías urinarias, peritonitis y causas cardíacas relacionadas (31%) tales como la insuficiencia cardíaca congestiva y el síndrome coronario agudo, fueron las dos causas principales de muerte. De los fallecidos por sepsis, 45.2% tenían neumonía. Sólo 9.5% (4/42) de los pacientes había confirmado peritonitis durante su enfermedad. Conclusión: La infección y la enfermedad cardiovascular constituyeron complicaciones comunes observadas en este estudio. Por lo tanto, se recomienda aquí el tratamiento intensivo de los factores de riesgo (hipertensión, diabetes y dislipidemia) y el pronto reconocimiento de la infección. La detección precoz y el tratamiento adecuado de la sepsis en los pacientes de diálisis peritoneal, deben basarse inicialmente en el protocolo estándar. El uso de la eritropoyetina en los pacientes de diálisis peritoneal proporcionará un mejor tratamiento de la anemia y conducirá a mejorar la calidad de vida. Palabras claves: complicaciones, resultado, diálisis peritonea