Accuracy and Quality of Routine Immunisation Data Monitoring System in two South-Eastern Districts of Nigeria

Background To assess the accuracy and quality of immunisation data in Ogbaru (OGB) and Onitsha North (ONN) Local  Government Areas (LGAs) of Anambra State, Nigeria.Methods A validated methodology of immunisation Data Quality Audit was used. All the Health Facilities  (HFs) conducting immunisation in OGB (28) and ONN (20) as well as the two LGAs'  Immunisation Units (IUs) were visited. The records of the third dose of Diphtheria-pertussis-tetanus  (DPT3) and measles immunisation at the HFs from January to December 2009 was recounted and  compared with reported data at the LGA IUs for the same period. An Accuracy Ratio (AR), which  expresses the ratio of immunisation recounted at the HFs to that reported to the LGAs IUs was obtained.  AR of 0.95 to 1.05 indicates data accuracy. Immunisation Focal Persons (IFPs) in each HF were  interviewed using a validated tool that contained a 70-point knowledge scale and a 120-item quality score (QS) on the data monitoring system.Results The proportions of HFs with accurate data for DPT3 were 32.1% and 45.0% (p=0.39) in OGB and ONN respectively. The overall AR was 0.89 in OGB and 0.96 in ONN. The mean knowledge score   among IFPs in the LGAs was 44.1±8.0 and 46.2±6.9 (p<0.05), while the mean QS for HFs was   74.5±18.0 and 73.6±13.2 in OGB and ONN respectively (p<0.05). There was a fair correlation between   the overall QS and the overall knowledge score in the two LGAs, r=0.3 (p<0.05).Conclusion Auditing showed inaccurate and low quality of data reporting in the LGAs. Keywords Routine immunisation; Immunisation monitoring system; Data quality audit

The direct cost of care among surgical inpatients at a tertiary hospital in south west Nigeria

Introduction: This study was conducted to assess the direct cost of care and its determinants among surgical inpatients at university College Hospital, Ibadan. Methods: A retrospective review of records of 404 inpatients that had surgery from January to December, 2010 was conducted. Information was  extracted on socio-demographic variables, investigations, drugs, length of stay (LOS)and cost of  carewith a semi-structured proforma. Mean cost of care were compared using t-test and Analysis of  variance (ANOVA). Linear regression analysis was used to identify determinants of cost of care. Level of significance of 5% was used. In year 2010 $1 was equivalent to 150 naira ($1=₦ 150).Results: The median age of patients was 30 years with inter-quartile range of 13-42 years. Males were  257(63. 6%). The mean overall cost of care was ₦66,983 ± ₦31,985. Cost of surgery is about 50% of total cost of care. Patient first seen at the Accident and Emergency had a significantly higher mean cost of care of ß = ₦17,207(95% CI: ₦4,003 to ₦30,410). Neuro Surgery (ß=₦36,210), and Orthopaedic Surgery versus General Surgery(ß=₦10,258),and Blood transfusion (ß=₦18,493) all contributed to cost of care significantly. Increase of one day in LOS significantly increased cost of care by ₦2,372. 57. Conclusion: The evidence evaluated here shows that costs and LOS are interrelated. Attempt at reducing LOS will reduce the costs of care of surgical inpatient

National health insurance scheme: how protected are households in Oyo State, Nigeria from catastrophic health expenditure?

Background: The major objective of the National Health Insurance Scheme (NHIS) in Nigeria is to protect families from the financial hardship of large medical bills. Catastrophic Health Expenditure (CHE) is rampart in Nigeria despite the take-off of the NHIS. This study aimed to determine if households enrolled in the NHIS were protected from having CHE. Methods: The study took place among 714 households in urban communities of Oyo State. CHE was measured using a threshold of 40% of monthly non-food expenditure. Descriptive statistics were done, Principal Component Analysis was used to divide households into wealth quintiles. Chi-square test and binary logistic regression were done. Results: The mean age of household respondent was 33.5 years. The median household income was 43,500 naira (290 US dollars) and the range was 7,000–680,000 naira (46.7–4,533 US dollars) in 2012. The overall median household healthcare cost was 890 naira (5.9 US dollars) and the range was 10-17,700 naira (0.1–118 US dollars) in 2012. In all, 67 (9.4%) households were enrolled in NHIS scheme. Healthcare services was utilized by 637 (82.9%) and CHE occurred in 42 (6.6%) households. CHE occurred in 14 (10.9%) of the households in the lowest quintile compared to 3 (2.5%) in the highest wealth quintile ( P = 0.004). The odds of CHE among households in lowest wealth quintile is about 5 times. They had Crude OR (CI): 4.7 (1.3–16.8), P = 0.022. Non enrolled households were two times likely to have CHE, though not significant Conclusion: Households in the lowest wealth quintiles were at higher risk of CHE. Universal coverage of health insurance in Nigeria should be fast-tracked to give the expected financial risk protection and decreased incidence of CHE

Clients’ willingness to pay for immunization services in the urban and rural primary health centers of Enugu state, Nigeria

Our study aims at determining the pattern of willingness of clients to pay for childhood immunization services in urban and rural primary health centers of Enugu state, Nigeria. Using a cross-sectional design, 800 clients who presented with their children/wards to receive childhood immunization services were selected at the primary health center in rural and urban local government areas of the state. The mean age was 28.9±4.5 and 26.7±5.1 years in the urban and rural areas respectively. About 54.5% of clients in the urban and 55.3% in the rural area were willing to pay for immunization services. The clients willingness to pay was influenced by: non satisfaction with immunization services, (OR=0.3, 95%CI: 0.2- 0.5), younger age, (OR=1.4, 95%CI: 1.0-2.0) marital status (OR=2.8, 95%CI: 1.2-6.5), proximity to health centers (OR=0.6, 95%CI: 0.4- 0.8), and delivering in a private health facility (OR=0.4, 95%CI: 0.1-0.9). The study suggests that the economic value that clients give to immunization services was similar in the rural and urban areas, and this could be increased by improving the level of clients’ satisfaction for the services among others

National Health Insurance Scheme: How Protected Are Households in Oyo State, Nigeria from Catastrophic Health Expenditure?

Background The major objective of the National Health Insurance Scheme (NHIS) in Nigeria is to protect families from the financial hardship of large medical bills. Catastrophic Health Expenditure (CHE) is rampart in Nigeria despite the take-off of the NHIS. This study aimed to determine if households enrolled in the NHIS were protected from having CHE. Methods The study took place among 714 households in urban communities of Oyo State. CHE was measured using a threshold of 40% of monthly non-food expenditure. Descriptive statistics were done, Principal Component Analysis was used to divide households into wealth quintiles. Chi-square test and binary logistic regression were done. Results The mean age of household respondent was 33.5 years. The median household income was 43,500 naira (290 US dollars) and the range was 7,000–680,000 naira (46.7–4,533 US dollars) in 2012. The overall median household healthcare cost was 890 naira (5.9 US dollars) and the range was 10-17,700 naira (0.1–118 US dollars) in 2012. In all, 67 (9.4%) households were enrolled in NHIS scheme. Healthcare services was utilized by 637 (82.9%) and CHE occurred in 42 (6.6%) households. CHE occurred in 14 (10.9%) of the households in the lowest quintile compared to 3 (2.5%) in the highest wealth quintile (P= 0.004). The odds of CHE among households in lowest wealth quintile is about 5 times. They had Crude OR (CI): 4.7 (1.3–16.8), P= 0.022. Non enrolled households were two times likely to have CHE, though not significant Conclusion Households in the lowest wealth quintiles were at higher risk of CHE. Universal coverage of health insurance in Nigeria should be fast-tracked to give the expected financial risk protection and decreased incidence of CHE

Contribution of household health care expenditure to poverty in Oyo State, South West Nigeria: A rural and urban comparison

Introduction: The financial burden of health care costs in Nigeria is borne almost entirely by the individuals and household members as health care financing is still mostly from out of pocket (OOP) payments. OOP payments can lead households into poverty. This study aimed to estimate the contribution of household health care expenditure to poverty in rural and urban communities in Oyo state, Nigeria. Method: This is a comparative cross-sectional study using a tested and adapted version of the Living Standard Survey questionnaire to collect data on 5,696 household members from 1,434 household representatives. Representatives were selected using a multistage sampling method. Information was collected from 714(49.8%) and 720(50.2%) households in the urban and rural Local Government Area (LGA), respectively. International poverty line of $1.25 per day was used. Poverty level was measured with and without household health expenditure. An exact McNemar’s test was used to determine the difference in the proportion of poor, gross and net payment for health care services. SPSS software was used for data analysis. Results: Health care was utilised by 1,006 (70.2%) of the 1,434 households studied. Of urban and rural households, 637(89.2%) and 369(51.3%) utilized health care services, respectively. Only 513(29.8%) were poor while 1519(88.2%) were poor after considering the cost of utilising health care. Increase in poverty of 66.2% occurred because of health care utilisation (p<0.001). Conclusion: Health care expenditure increased the proportion of household members living below poverty line. To protect against poverty free basic health care services is required in Nigeria

Cost-effectiveness of screening methods for urinary schistosomiasis in a school-based control programme in Ibadan, Nigeria

Objective To carry out a comparative cost-effectiveness analysis of screening methods for urinary schistosomiasis; terminal haematuria, unqualified haematuria, dysuria, visual urine examination and chemical reagent strip technique, in a school-based control programme.Design Estimation of costs and determination of cost-effect ratios of the screening methods applied in a school-based screening and treatment programme, from the perspective of a programme manager.Setting A junior secondary school in Ibadan, Nigeria.Main outcome measures Cost per number of cases correctly diagnosed.Results Unqualified haematuria was found to be the most cost-effective method costing N51.06 (US$2.16) to diagnose a case correctly, followed by terminal haematuria N58.91 (US$ 2.50) and dysuria N84.24 (US$3.57). Despite the relatively high input costs of chemical reagent strip technique over visual urine examination (N22.12 (US$ 0.94) per student vs. N6.44 (US$0.27) per student), it was found to be more cost effective costing N304.56 (US$ 12.91) to diagnose a case correctly than visual examination of urine cost of N317.58 (US$ 13.46) per correct case diagnosed.Conclusion From the viewpoint of a programme manager, interview method of screening by asking for blood in the urine remains the most efficient means of screening for urinary schistosomiasis in school-based control programmes in our environment.Cost-effectiveness Schistosomiasis Screening methods School-based programme

Pattern of the meningococcal meningitis outbreak in Northern Nigeria, 2009

Objectives: Despite the availability of vaccines, children are the people most often affected by epidemic meningococcal meningitis. The pattern of the epidemic meningococcal meningitis outbreak in Northern Nigeria in 2009 and the Neisseria meningitidis strains responsible for this epidemic are described here. Methods: A retrospective cross-sectional study was conducted in 16 states, involving 48 local government areas (LGAs), 91 health facilities, and 96 communities. Data collection involved in-depth interviews with key informants from the federal to the community level, a review of records, and a solution-oriented national workshop with participants from all states of the Federation. Cerebrospinal fluid (CSF) samples were collected from some of the suspected cases at the start of the outbreak and were tested using the rapid Pastorex latex agglutination kit. Results: Kastina (11153, 20.4%), Jigawa (8643, 15.8%), Bauchi (8463, 15.5%), Kano (6811, 12.4%), and Gombe (6110, 11.2%) were the states with the highest prevalence of meningitis. The states of Nasarawa (11.0%), Adamawa (8.0%), and Borno (7.6%) recorded the highest percentage of deaths, while the Shongom (Gombe State 12.5%), Illela (Sokoto State 9.8%), and Ikara (Kaduna State 9.1%) LGAs recorded the most deaths amongst cases seen. Conclusions: The testing of CSF samples during meningitis outbreaks is recommended in order to monitor the occurrence of the multiple meningitis serotypes during these outbreaks and to direct serotype-specific vaccination response activities