Factors influencing the choice of facilities among enrolees of a prepayment scheme in Ibadan, Southwest Nigeria

Aims: Factors that influence the personal choice of a health care facility among health care consumers vary. Currently, what influences the choice of health facilities among enrollees under the National Health Insurance Scheme (NHIS) is not known. This study aimed to as-sess what influences the choice of facilities in the NHIS of Nigeria. Methods: This was a descriptive cross-sectional study conducted among enrollees in selected NHIS facilities in the 11 Local Government Areas (LGAs) of Ibadan, Nigeria. A total of 432 enrollees were selected and were interviewed. A WHO-USAID semi-structured interviewer-administered questionnaire was used to obtain relevant data. Data collection was between Oc-tober and December 2019. Data were analyzed using STATA version 12.0 (α =0.05).Results: At unadjusted OR, older respondents (OR 3.24, CI = 2.52-4.18, p = <0.0001), and those who had attained the tertiary level of education (OR 3.30, CI 2.57-4.23, p <0.0001) were more likely to make a personal choice of health care facilities. A similar pattern was ob-served among respondents who were in the high socioeconomic group (OR 4.10, CI 3.01-5.59, p = <0.0001). However, at Adjusted OR, only high socio-economic status was a predic-tor of personal choice of health care facility (OR 1.92, CI 1.21-3.05, p = 0.005). Conclusion: This study is suggestive that a need for and the ability to afford the cost of care influence the choice of health facilities. Policies that promote health literacy in the general populace will enhance the capability of individuals to make a personal choice of health facili-ties. Stakeholders should prioritize this for policy.Recommended citation: David A. Adewole, Temitope Ilori. Factors influencing the choice of facilities among enrolees of a prepayment scheme in Ibadan, Southwest Nigeria Acknowledgments: The authors wish to acknowledge study participants for permission to interview them in the course of the data collection of this study.Authors' contributions: David Adewole conceived and designed the study. Temitope Ilori did data collection and analysis. Both authors contributed equally to the manuscript write-up. The two authors also read through the manuscript draft the second time and agreed to the final manuscript. Conflict of interests: None declared

Factors influencing the choice of facilities among enrolees of a prepayment scheme in Ibadan, Southwest Nigeria

Aims: Factors that influence the personal choice of a health care facility among health care consumers vary. Currently, what influences the choice of health facilities among enrollees under the National Health Insurance Scheme (NHIS) is not known. This study aimed to as-sess what influences the choice of facilities in the NHIS of Nigeria. Methods: This was a descriptive cross-sectional study conducted among enrollees in selected NHIS facilities in the 11 Local Government Areas (LGAs) of Ibadan, Nigeria. A total of 432 enrollees were selected and were interviewed. A WHO-USAID semi-structured interviewer-administered questionnaire was used to obtain relevant data. Data collection was between Oc-tober and December 2019. Data were analyzed using STATA version 12.0 (α =0.05).Results: At unadjusted OR, older respondents (OR 3.24, CI = 2.52-4.18, p = <0.0001), and those who had attained the tertiary level of education (OR 3.30, CI 2.57-4.23, p <0.0001) were more likely to make a personal choice of health care facilities. A similar pattern was ob-served among respondents who were in the high socioeconomic group (OR 4.10, CI 3.01-5.59, p = <0.0001). However, at Adjusted OR, only high socio-economic status was a predic-tor of personal choice of health care facility (OR 1.92, CI 1.21-3.05, p = 0.005). Conclusion: This study is suggestive that a need for and the ability to afford the cost of care influence the choice of health facilities. Policies that promote health literacy in the general populace will enhance the capability of individuals to make a personal choice of health facili-ties. Stakeholders should prioritize this for policy.Recommended citation: David A. Adewole, Temitope Ilori. Factors influencing the choice of facilities among enrolees of a prepayment scheme in Ibadan, Southwest Nigeria Acknowledgments: The authors wish to acknowledge study participants for permission to interview them in the course of the data collection of this study.Authors' contributions: David Adewole conceived and designed the study. Temitope Ilori did data collection and analysis. Both authors contributed equally to the manuscript write-up. The two authors also read through the manuscript draft the second time and agreed to the final manuscript. Conflict of interests: None declared

Assessment and predictors of blood glucose levels in hypertensives attending a secondary health centre: relationship with physical activity and diet quality

The aim: this study aims to assess the prevalence of hyperglycaemia, the association between diet quality, physical exercise and blood glucose levels among hypertensives attending a secondary health centre in Nigeria. There is a paucity of data concerning these issues and the study would contribute positively to future management of the patients. Methods: the study was a cross-sectional study of 354 hypertensives that was conducted at the State Hospital, Oyo, Nigeria. The systematic sampling technique was used to recruit patients, and the data were analysed using SPSS software version 23. Linear regression was done to determine the predictors of hyperglycaemia, and logistic regression was done to determine the predictors of diet quality. Results: the mean age of the respondents was 52.60(SD±8.26) years. The prevalence of undiagnosed diabetes in this cohort was 19.60 %. The association of glycated haemoglobin (HbAic) with High Density Lipoprotein (HDL) was negative, weak in strength and statistically significant (p-value=0.034). For every 1 unit decrease in High Density Lipoprotein (HDL), there was a statistically significant increase in HbAic by about 0.383 units (95 % C.I equals -0.737 to -0.029, p-value=0.034). For every 1 unit increase in total Cholesterol, there was a significant increase in HbAic by about 0.158 units (95 % CI equals 0.007 to 0.308, p-value=0.04). Age group <45 years were about 2 times less likely to have good diet quality than those of 55 years and above (OR=0.502; 95 % CI=0.270 – 0.932, p-value=0.029). Conclusions: the study has assisted to characterise this population of hypertensives in terms of serum glucose levels. The prevalence of hyperglycaemia was high among these hypertensives. The predictors of hyperglycaemia were HDL and Cholesterol. Also, the predictor of good diet quality was the age of the respondent

Pattern of population coverage of a social health insurance scheme in a Southwest Nigeria State: A 3-year post implementation evaluation

Aims: Social health insurance scheme is capable of minimizing inequity of access to health services, and thereby enhance an improvement in population health outcomes. Recently the National Health Insurance Scheme (NHIS) of Nigeria decentralized its management to the sub-national levels, thus the emergence of State Health Insurance Schemes (SHIS).  The SHIS of Oyo State Nigeria started operations about three years ago (June 2017). There is limited/sparse evidence on the performance of the scheme since its inception. Therefore, the aim of this study was to assess the scheme’s level of population coverage in the first three years of implementation. The findings will also provide an evidence base to inform the repositioning of the scheme for improved performance and enable it achieve the purpose of its establishment.  Methods: Service data from the server of Oyo SHIS were downloaded, collated and analyzed with excel software. Data extraction, cleaning and analysis covered a period of three months (September – October, 2020). Descriptive statistics were used to summarise the data. Population coverage distributions were expressed as frequency and percentages. Frequency tables and graphs were generated to disaggregate the findings. Conclusion: Stakeholders in the Oyo State SHIS need to re-strategize to reposition the scheme for an accelerated population coverage as a proxy for performance assessment. Acknowledgements: Authors wish to acknowledge Oyo State Health Insurance Agency for the permission to make use of the data and to submit the manuscript for publication. We authors would like to sincerely acknowledge the contributions of Prof. Charles Wiysonge and that of Dr. Chukwudi Nnaji for the comprehensive review and suggestions made on this manuscript. Many thanks.   Authors' contributions: David Adewole conceived and designed the study. Wuraola Ladepo and Temitope Ilori did data collection and analysis.  Adewole, Owolabi and Akande contributed equally to the manuscript write up. All authors read through the manuscript draft the second time. All authors agreed to the final manuscript.   Conflict of interests: None declared

Pattern of population coverage of a social health insurance scheme in a Southwest Nigeria State: A 3-year post implementation evaluation

Aims: Social health insurance scheme is capable of minimizing inequity of access to health services, and thereby enhance an improvement in population health outcomes. Recently the National Health Insurance Scheme (NHIS) of Nigeria decentralized its management to the sub-national levels, thus the emergence of State Health Insurance Schemes (SHIS).  The SHIS of Oyo State Nigeria started operations about three years ago (June 2017). There is limited/sparse evidence on the performance of the scheme since its inception. Therefore, the aim of this study was to assess the scheme’s level of population coverage in the first three years of implementation. The findings will also provide an evidence base to inform the repositioning of the scheme for improved performance and enable it achieve the purpose of its establishment.  Methods: Service data from the server of Oyo SHIS were downloaded, collated and analyzed with excel software. Data extraction, cleaning and analysis covered a period of three months (September – October, 2020). Descriptive statistics were used to summarise the data. Population coverage distributions were expressed as frequency and percentages. Frequency tables and graphs were generated to disaggregate the findings. Conclusion: Stakeholders in the Oyo State SHIS need to re-strategize to reposition the scheme for an accelerated population coverage as a proxy for performance assessment. Acknowledgements: Authors wish to acknowledge Oyo State Health Insurance Agency for the permission to make use of the data and to submit the manuscript for publication. We authors would like to sincerely acknowledge the contributions of Prof. Charles Wiysonge and that of Dr. Chukwudi Nnaji for the comprehensive review and suggestions made on this manuscript. Many thanks.   Authors' contributions: David Adewole conceived and designed the study. Wuraola Ladepo and Temitope Ilori did data collection and analysis.  Adewole, Owolabi and Akande contributed equally to the manuscript write up. All authors read through the manuscript draft the second time. All authors agreed to the final manuscript.   Conflict of interests: None declared

Development of a video-observation method for examining doctors’ clinical and interpersonal skills in a hospital outpatient clinic in Ibadan, Oyo State, Nigeria

Background: Improving the quality of primary healthcare provision is a key goal in low-and middle-income countries (LMICs). However, to develop effective quality improvement interventions, we first need to be able to accurately measure the quality of care. The methods most commonly used to measure the technical quality of care all have some key limitations in LMICs settings. Video-observation is appealing but has not yet been used in this context. We examine preliminary feasibility and acceptability of video-observation for assessing physician quality in a hospital outpatients’ department in Nigeria. We also develop measurement procedures and examine measurement characteristics. Methods Cross-sectional study at a large tertiary care hospital in Ibadan, Nigeria. Consecutive physician-patient consultations with adults and children under five seeking outpatient care were video-recorded. We also conducted brief interviews with participating physicians to gain feedback on our approach. Video-recordings were double-coded by two medically trained researchers, independent of the study team and each other, using an explicit checklist of key processes of care that we developed, from which we derived a process quality score. We also elicited a global quality rating from reviewers. Results: We analysed 142 physician-patient consultations. The median process score given by both coders was 100 %. The modal overall rating category was ‘above standard’ (or 4 on a scale of 1–5). Coders agreed on which rating to assign only 44 % of the time (weighted Cohen’s kappa = 0.26). We found in three-level hierarchical modelling that the majority of variance in process scores was explained by coder disagreement. A very high correlation of 0.90 was found between the global quality rating and process quality score across all encounters. Participating physicians liked our approach, despite initial reservations about being observed. Conclusions: Video-observation is feasible and acceptable in this setting, and the quality of consultations was high. However, we found that rater agreement is low but comparable to other modalities that involve expert clinician judgements about quality of care including in-person direct observation and case note review. We suggest ways to improve scoring consistency including careful rater selection and improved design of the measurement procedure for the process score

Haemoparasite Prevalence, Genetic Diversity of TLR2B Gene and Relationship with Haematological Parameters in Chicken

Haemoparasite constitute a major challenge in native chicken production in Africa. This study determines the genetic diversity and the effect of TLR2B gene polymorphism on haemoparasite and haematology of the chickens based on genotype and sex. 600 chickens of 25 weeks old consisting of Naked neck (NN), Normal feather (NF), and the Frizzle feather (FF) reared in battery cage-system were sampled for blood and analyzed for haematology, parasite occurrence and load, polymerase chain reaction, and gene sequencing. Polymorphisms were detected and their effect on haematology was determined. Results showed the occurrence of Plasmodium gallinacieum, Trypanosoma brucei, and Leucocytozoon schoutedeni with NF having the highest occurrence followed by NN and FF chicken genotype. There was a significant (P <0.05) effect of genotype and sex on haematology. Seven of the eight polymorphism detected were singleton and found only in NF while parsimonious 656GA was detected in all the chicken genotypes with no relationship with haematology and haemoparasite. NF had the highest nucleotide (0.00114) and haplotype diversity (0.584). The study revealed the occurrence of genetic variation in TLR2B gene, haematology, and haemoparasite in FUNAAB Alpha chickens which could provide baseline information in future breeding programmes of the chicken for the tropical environment

Drug Prescription Pattern in a Primary Care Clinic, Southwest, Nigeria

Background: Rational drug use is of the utmost importance in a region such as West Africa, where the prevalence of drug resistance is increasing due to inappropriate use of medications.&nbsp; Objective: This study aimed to assess the pattern of prescription drug use at the General Outpatient Clinic of the University College Hospital, Ibadan. This study also assessed the knowledge and attitude toward rational drug use among prescribing physicians in the Clinic.&nbsp; Design: The study was a retrospective cross-sectional review of patients' records over&nbsp;three years.&nbsp;The medical records were selected by systematic random sampling and subjected to the WHO&nbsp;core drug use&nbsp;indicators. Prescribers&nbsp;at the study site had their knowledge, attitude, and practice (KAP) of rational drug use assessed with a self-administered questionnaire.&nbsp; Results: A total of 795 medical records were&nbsp;analyzed&nbsp;for drug use indicators. The mean number of drugs per encounter was 2.64 ±1.23. The percentage of encounters in which an antibiotic was prescribed was 20.4%, while 71.6% of all drugs prescribed were in the generic form.&nbsp;From the KAP&nbsp;survey, 64% of physicians routinely prescribed both generic and brand names, and 68% admitted they needed further education on rational drug use.&nbsp; Conclusion: Using the WHO&nbsp;core drug use&nbsp;indicators, this study identified some degree&nbsp;of&nbsp;polypharmacy&nbsp;and&nbsp;poor adherence to the generic&nbsp;prescription of drugs. Continuing Medical Education for health workers is encouraged to stem the irrational prescription of medications in the African sub-region.&nbsp; Keywords:&nbsp;Prescription Drugs Use, Rational Use of Medicines, Physician's knowledge, Nigeri

Targeting women with free cervical cancer screening: challenges and lessons learnt from Osun state, southwest Nigeria

Introduction: the study was conducted to determine the challenges and suggest solutions to conducting free cervical cancer screening among Nigerian women. Methods: awareness was created among women groups and mass media in Osun State for women to undergo free cervical cancer screening programme. Consenting women had their sociodemographic characteristics, awareness and uptake of HPV vaccine documented and papanicolaou smear procedure done with adequate referral for treatment given where necessary. Results: a total of 287 women had cervical cancer screening. Mean (SD) age was 51.6 (14.3) years. Most participants were urban based (87.1%), married (63.1%), had secondary education (39%) and were traders (79.1%). None of the women were aware of the preventive HPV vaccine or had been vaccinated against HPV. About 6% were pre-invasive while 0.7% had invasive cervical cancer. The highest proportions of respondents affected were young, married and had lower education. Challenges identified included poor attendance, low risk perception and logistic issues. Conclusion: most participants were urban based. There is need to decentralize cancer of cervix screening through mobile clinics and establishment of screening centres in the rural areas. Neighbour to neighbour sensitization is essential. Also, HPV vaccine should be available and affordable to all girls before sexual maturity.The Pan African Medical Journal 2016;2