Knowledge, Practice and Willingness to Participate in Community Health Insurance Scheme among Households in Nigerian Capital City

Background: Health insurance is a social security system that guarantees the provision of needed health services to persons on the payment of token contributions at regular intervals. The objective of the survey was to determine knowledge, practice and willingness of households in Nigerian Capital City to pay and participate in Community Health Insurance Scheme.Materials and Methods: This descriptive and analytical cross-sectional study was carried out using the multistage cluster sampling technique to obtain data from 300 selected household heads or main financial decision makers. The data was analyzed using EPI-INFO software package. Statistical significance of p < 0.05 and confidence limit of 95% was used.Results: The major findings showed that the level of awareness (13%) concerning Community Health Insurance (CHI) was found to be very low among the respondents. The general principles of CHI were also poorly understood by the respondents. Attitude to the programme was positive as many showed interest in participating and enrolling themselves (97.0%), some family members (96.3%) and entire family members (90.3%).  Borrowing money to settle medical bills in this study has occurred in 30% of instances. Majority of respondents were willing to pay premiums ranging from N450 (96.6%) to N1200 (72.5%) for simple packages that do not include surgery and hospitalization.Conclusions: The community members were willing to participate and enrol if the programme is brought to them. There is a need to adequately subsidize the premiums that respondents were willing to pay in order to meet up with the cost of treatment.Key Words: Willingness, Participate, Community Health Insurance

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Providing antiretroviral therapy outside the hospital in a low-resource setting: a pilot study

Background: For nearly three decades, hospitals have been the only source of antiretroviral therapy (ART) for many people living with HIV. Yet, developing countries with the largest burden of HIV commonly lack the hospitals and health-care workers to care for these patients. In 2013, WHO recommended the use of structures outside hospitals for management of HIV. We piloted a community pharmacy ART model in communities with high HIV prevalence in Nigeria. The purpose was to develop a treatment model that could be expanded into an overarching comprehensive response to HIV management, especially in resource-limited settings with weak health systems. Methods: Registered community pharmacies linked to participating hospitals were recruited between February 2016 and May 2017. Patients with stable viral loads (≤20 copies/mL) who were willing to have their care devolved to a community pharmacy were referred by trained contact persons at the hospitals. Registered pharmacists at the community pharmacies counselled referred patients and refilled their prescriptions. Biodemographic and clinical data were collected from Feb 25, 2016, to May 31, 2017. The outcome measures were percentage of patients retained in care and adherence to therapy. Mean difference in the viral load at the baseline (≤20 copies/mL) and after 6 months was assessed using a paired sample t-test. Findings: 26 community pharmacies and 14 hospitals were included in the pilot. 375 patients (median baseline viral load 19 copies/mL [IQR 19–32]; median CD4 count 460 cells/mL [277–648]) had their care devolved to the community pharmacies. After 12 months, almost all the patients (374 [99·7%] of 375) were retained in care and adherence to medication (measured by prescription refill) was 100%. After 6 months of follow-up, 19 patients received results of their second viral load test, showing no significant difference in the mean viral load between baseline and after 6 months (p<0·46). Interpretation: We show that patients can conveniently access ART in community pharmacies linked to hospitals, with no adverse effects on adherence or viral load. The model will be rolled-out to other regions in Nigeria, and could potentially be applied elsewhere. Funding: PEPFAR

Developing new plantain varieties for Africa

Les bananiers plantain (Musa spp. AAB) sont d'importantes sources alimentaires dans les pays sud sahariens. La Sigatoka noire est l'une des contraintes majeures qui limitent la production de bananes. Le contrôle chimique existe mais il n'est pas approprié pour les petites fermes agricoles, les risques sur l'environnement sont incertains. L'IITA a développé un programme de recherche variétale sur les bananiers résistants à la Sigatoka. Ce programme innovant intègre l'amélioration génétique par des hybridations et les techniques de culture in vitro tout en garantissant le rendement et la qualité des fruits. En coopération avec le NARES (National Agricultural Research and Extension Systems), des variétés ont été testées ou créées. Cette association a permis également d'étudier les relations hôte-parasite, la stabilité des rendements et l'acceptabilité des nouvelles variétés par les consommateur

An Assessment of Ovarian Cancer Histotypes Across the African Diaspora

ObjectiveOvarian cancer in Black women is common in many West African countries but is relatively rare in North America. Black women have worse survival outcomes when compared to White women. Ovarian cancer histotype, diagnosis, and age at presentation are known prognostic factors for outcome. We sought to conduct a preliminary comparative assessment of these factors across the African diaspora. MethodsPatients diagnosed with ovarian cancer (all histologies) between June 2016-December 2019 in Departments of Pathology at 25 participating sites in Nigeria were identified. Comparative population-based data, inclusive of Caribbean-born Blacks (CBB) and US-born Blacks (USB), were additionally captured from the International Agency for Research on Cancer and Florida Cancer Data Systems. Histology, country of birth, and age at diagnosis data were collected and evaluated across the three subgroups: USB, CBB and Nigerians. Statistical analyses were done using chi-square and student's t-test with significance set at pResultsNigerians had the highest proportion of germ cell tumor (GCT, 11.5%) and sex-cord stromal (SCST, 16.2%) ovarian cancers relative to CBB and USB (p=0.001). CBB (79.4%) and USB (77.3%) women were diagnosed with a larger proportion of serous ovarian cancer than Nigerians (60.4%) (p<0.0001). Nigerians were diagnosed with epithelial ovarian cancers at the youngest age (51.7 +/- 12.8 years) relative to USB (58.9 +/- 15.0) and CBB (59.0 +/- 13.0,p<0.001). Black women [CBB (25.2 +/- 15.0), Nigerians (29.5 +/- 15.1), and USB (33.9 +/- 17.9)] were diagnosed with GCT younger than White women (35.4 +/- 20.5, p=0.011). Black women [Nigerians (47.5 +/- 15.9), USB (50.9 +/- 18.3) and CBB (50.9 +/- 18.3)] were also diagnosed with SCST younger than White women (55.6 +/- 16.5, p<0.01). ConclusionThere is significant variation in age of diagnosis and distribution of ovarian cancer histotype/diagnosis across the African diaspora. The etiology of these findings requires further investigation