Health services utilization and costs of the insured and uninsured under the formal sector social health insurance scheme in Enugu metropolis South East Nigeria

Background: Health insurance is a social security system that aims to facilitate fair financing of health costs through pooling and judicious  utilization of financial resources, in order to provide financial risk  protections and cost burden sharing for people against high cost of  healthcare through various prepayment methods prior to falling ill. It is still unclear how the Federal Social Health insurance program for federal civil servants has affected the insured and uninsured civil servants in terms of health services cost and utilization in Enugu metropolis.Objectives: The aim of the study was to compare the health services  utilization and cost of insured with that of the non.insured federal civil servants with a view to generate information for policymaking on improving services of the National Health Insurance Scheme.Materials and Methods: A comparative, descriptive, cross.sectional survey  of both the insured and uninsured federal civil servants was conducted in Enugu metropolis. Respondents were purposively enrolled and were  grouped according to their insurance status after signing the informed consent form. Comparative analysis of health services utilization,satisfaction, and health services cost which include total cost, average cost, and catastrophic expenditures were done using SPSS version 17.0.Results: There were 809 respondents; this comprised 451 insured and 358 uninsured respondents. There were 420 males (51.9%) and 389 females (48.1%). It was found that 657 respondents had at least easy access to health; this comprised 369 (56.7%) insured and 288 (43.3%) non-insured respondents while 70 (46%) of the non-insured and 82 (54%) of the insured civil servant had difficult access to health care (P = 0.620).Conclusion: There are still federal civil servants yet to enroll into the formal sector social insurance program. The NHIS-insured civil servants have no appreciable advantage in terms of access to and cost of health services in Enugu metropolis.Key words: Health insurance, health services utilization, insure

Changing Pattern of Bacteriuria among Asymptomatic Secondary School Adolescents within Enugu South East Nigeria

Background: Urinary tract infection is one of the infections that could lead to chronic kidney disease. Most of the offending isolates are usually Gram-negative bacteria such as Escherichia coli. Adolescent age groups are a special group of individuals who indulge in some risk behavior that could predispose them to urinary tract infections with possible mixed flora.Aim: The aim was to determine the burden of Gram.positive significant bacteriuria among adolescents in Enugu.Subjects and Methods: A survey of 628 adolescents attending secondaryschools in Enugu was studied. Information on sociodemographic profile was obtained using a self-administered questionnaire. Clean-catch urine sample was collected using a sterile boric acid bottle, and this was cultured in both anaerobic and aerobic media. Significant isolates were Gram-stained in order to determine their characteristics. Data were analyzed using SPSS version 15.0.(Chicago Illinois USA). Results: There were 324 females and 304 males. Significant bacteria growth was identified in 61 samples giving a prevalence rate of 9.7% (61/628). Gram-positive bacteria were isolated in 77.1% (47/61) of samples, while Gram-negativebacteria were isolated in 22.9% (14/61) of samples. Staphylococcus saprophyticus was the most common Gram-positive organism isolated this consists 38.3% (18/47) while E. coli was the most common Gram.negative bacteria isolated comprising 64.2% (9/14). Other Gram-positive bacteria isolated were Staphylococcus auerus, Staphylococcus epididimis. All isolated bacteria were more common in females 44/61 (72.1%) than males 17/61 (27.9%).Conclusion: Gram-positive bacteriuria is prevalent among secondary school adolescents, and S. saprophyticus is the most common Gram-positive organism implicated. Further studies should be undertaken to determine the risk factors and possible sensitivity pattern among the age group.Keywords: Adolescents, Bacteriuria, Urinary tract infectio

Open heart surgery in Nigerian children the need for international and regional collaboration: The Bayelsa and Enugu experience

Background: Children with congenital heart diseases (CHD) often require palliative or definitive surgical heart interventions to restore cardiopulmonary function. Lack of early cardiac intervention contributes to large numbers of potentially preventable deaths and sufferings among children with such conditions. Objectives: The aim of this study was to highlight our experience and the importance of international and regional collaboration for open heart surgery in children with CHD and capacity building of local cardiac teams in Bayelsa and Enugu States. Methodology: In November 2016, a memorandum of understanding (MOU) was signed by the managements of FMC, Yenagoa, Bayelsa State, UNTH, Enugu and an Italian-based NGO- Pobic Open Heart International for collaboration in the area of free open heart surgery for children with CHDs and training of local cardiac teams from both institutions either in Nigeria or in Italy. Patients for the program were recruited from Bayelsa and Enugu States with referrals from all over the country with combined screening and selection done in UNTH. Selected patients were operated on and funded free of charge by the Italian NGO. Hands on training of the local cardiac teams and cardiac intervention was done twice yearly in Nigeria. Result: From inception of the program in November, 2016 to May, 2019 a total of 47 children (21 Males, 26 Females; age range 6 months to 14 years) with various types of congenital heart defects had free open heart surgery from the program with 41 surgeries done in UNTH & 6 in Italy (complex pathologies). Also, home cardiac teams from UNTH and FMC, Yenagoa gained from on-site capacity training & retraining from the Italian cardiac team both in Nigeria and in Italy. The Success rate was 95.7% (44) and Case Fatality rate was 4.3% (2). Conclusion: There is a great efficacy in early cardiac intervention. This is with respect to a high success rate and minimal Case Fatality seen in this study. This was achieved through Regional and international collaboration

Timing of cardiac surgery and other intervention among children with congenital heart disease: A review article

Background: Early diagnosis and improved facilities are necessary for determining the optimal timing of surgery and other interventions in children with congenital heart diseases in Nigeria. This is because late presentation, late diagnosis and delayed surgery can lead to mortality and affect the quality of life among these children. Objectives: This review article is aimed at enumerating the timing of cardiac surgeries and other interventions and to seek if there is any factor associated with the timing of cardiac surgery. Methods: A search on PubMed database, World Health Organization libraries, Google scholar, TRIP database, and reference lists of selected articles on timing of cardiac surgery in children was done. The Cochrane Database of Systematic Reviews was also searched. We noted few data from African setting. Key words such as timing of cardiac surgery; children, congenital heart defect were used. Conclusion: Appropriate timing for cardiac surgery in children with congenital heart disease is very important as late surgical intervention could result in several morbidities and mortality