Catastrophic Health Expenditure and Impoverishment from Non- Communicable Diseases: A comparison of Private and Public Health Facilities in Ekiti State, Southwest Nigeria

Background: Catastrophic health expenditure and impoverishment are the outcomes of poor financing mechanisms. Little is known about the  prevalence and predictors of these outcomes among non-communicable disease patients in private and public health facilities. Methods: A health facility-based comparative cross-sectional study was conducted among 360 patients with non-communicable diseases (180 per  group) selected through multistage sampling. Data were collected with a semi-structured, intervieweradministered questionnaire and analyzed with  IBM SPSS for Windows, Version 22.0. Two prevalences of catastrophic health expenditure were calculated utilizing both the World Bank (CHE1)  and the WHO (CHE2) methodological thresholds. Results: The prevalence of CHE1 (Private:42.2%, Public:21.7%, p<0.001) and CHE2 (Private:46.8%, Public:28.0%, p<0.001) were higher in private  health facilities. However, there was no significant difference between the proportion of impoverishment (Private:24.3%, Public:30.9%, p=0.170). The  identified predictors were occupation, number of complications and clinic visits for catastrophic health expenditure and socioeconomic status for  impoverishment in private health facilities. Level of education, occupation, socioeconomic status, number of complications and alcohol predicted  catastrophic health expenditure while the level of education, socioeconomic status and the number of admissions predicted impoverishment in  public health facilities. Conclusion: Catastrophic health expenditure and impoverishment were high among the patients, with the former more prevalent in private health  facilities. Therefore, we recommend expanding the coverage and scope of national health insurance among these patients to provide them with  financial risk protection. Identified predictors should be taken into account by the government and other stakeholders when designing policies to  limit catastrophic health expenditure and impoverishment among them.&nbsp

Uptake of immunization and associated factors among 0-11 months infants in a rural community of Ekiti State

Background: Immunization is one of the most effective public health  interventions, leading to reduced infant and childhood mortality caused by vaccine preventable diseases worldwide. Rates of vaccine preventable diseases have been observed to be decreasing in many parts of the world in the past few decades with many children still remain unvaccinated. Studies have shown that factors that are associated with immunization rates include; low family income, lack of health insurance, low level of parental education, religion, young age of parents, presence of other siblings in the household, lack of source of health care, distance to health facilities, place of delivery etc. The aim of this study is to determine the uptake of  immunization and its associated factors among infants of a rural community inEkiti State.Methods: A systematic random sampling techniques was used to select 360 respondents from the rural Local Government Area whose mothers or caregivers were interviewed and vaccination cards observed to gather information on their immunization status. An interviewer administered semi-structured questionnaire and observational check-list were used to collect needed information. Descriptive analysis of findings was done using SPSS version 16.Results: Uptake of immunization by 0-11months children is relatively high in rural communities of Ekiti State (88.9%). The immunization card retention rate is also high (90%) and this is very good for authentic data gathering on routine immunization. The high uptake rate was found to be significantly associated with level of education, marital status and  occupation. Healthcare workers and radio announcement still remain major sources of information on immunization; therefore attitude of health  workers to clients is an important factor for uptake. Unavailability of vaccines, attitude of health workers and having no faith in immunization are important reasons for non-immunization.Conclusion: Uptake of immunization by children less than one year is relatively high in rural communities of Ekiti State (88.9%). The immunization card retention rate is also high (90%) and this is very good for authentic data gathering on routine immunization. Recommendation: Government to ensure regular, uninterrupted supply of vaccines to all points of vaccination to curb stock out, expand vaccination sites and centres to improve access and provide incentives to mothers/caregivers/families who completed their childhood immunization.Keywords: Uptake, Immunization, Infants, Rural Community, Ekiti Stat

Pattern of Skin Cancers in a Tertiary Medical Center in Southwest Nigeria

Background: Skin cancers are the most common malignancies in the western world, and their incidence is increasing globally. However, the data about the pattern in sub-Saharan Africa are limited. This study evaluates the pattern of primary skin malignancies in a tertiary medical center located in a sub-urban area. Methods: The histo-pathological records of patients managed for malignancies from January 2012 to December 2020 were retrieved from the pathology department of a tertiary medical center in Ekiti State, Southwest Nigeria. All primary skin cancers seen within this study period were extracted from the records and then reviewed retrospectively. Results: The male-to-female ratio of primary skin malignancies was 1:1.06, and the mean age of patients was 57.2 ± 17years. All patients were black Africans who were mainly of the Yoruba ethnicity (97.2%). Squamous cell cancer had the highest frequency (34.7%), followed by melanoma (27.8%), dermatofibrosarcoma (12.5%), and basal cell carcinoma (11.1%). The most commonly affected anatomic region is the lower limbs (50.6%). Conclusion: The pattern of primary skin cancers seen in black Africans differ from that of Caucasians: however, larger community-based studies in our environment is recommended to provide more conclusive information about the pattern of skin cancers

Knowledge of COVID‑19 and Practice of Preventive Measures among Adult Residents during the Ease of Lockdown in Nigeria

Background: The governments of many countries have taken steps to avert the spread of COVID 19. The  gradual relaxation of the lockdown in Nigeria might be counter‑productive if not properly managed. The best means to reduce and stop transmission is for the public to be adequately informed about the disease and its preventive measures. This research assessed the knowledge of COVID‑19 and practice of preventive measuresalong with its predictors among Nigerian residents during the ease of the lockdown. Methodology: A cross‑sectional study was conducted among 1421 adult residents of Nigeria. Data were  collected between 6th and 20th September, 2020, using a semi-structured online questionnaire adapted from previous studies. IBM SPSS version 26 was used for data analysis. Pearson’s Chi‑square and logistic regression were used to determine the predictors of preventive practices. Results: The mean age of the respondents was 27.5 ± 9.1 years. Avery large proportion (98.8%) of the respondents had a good knowledge of the disease (score of ≥4 out of 6 variables) and the internet (70.1%) was the major source of their information. However, only 57.6% of them had good practice of preventive measures of the disease (score of ≥3 out of 4). Predictor of good practice of preventive measure included female sex (adjusted odds ratio [AOR] = 2.626; 95% confidence interval [CI] = 2.078–3.319), being married (AOR = 2.177; 95% CI = 1.568–3.023), and possessing tertiary and postgraduate level of education (AOR = 1.813; 95% CI = 1.082–3.036 and AOR = 2.102; 95% CI = 1.206–3.664, respectively). However, residents in local government headquarters and other villages as well as towns (AOR = 0.541; 95% CI = 0.388–0.756 and AOR = 0.587; 95% CI = 0.350–0.983, respectively) have less likelihood of engaging in good practice of preventive measures. Conclusion: Majority of the research participants had good knowledge of the disease, while about half take part in good preventive practices measures. Predictors of the practice measures included sex, level of education, place of residence, as well as marital status. Therefore, targeted interventions should be directed to the males, those who reside outside the Federal Capital Territory and state capitals, and other high‑risk groups as found by this study to reduce the risk of disease contraction during this period

Awareness and Practice of Proper Health Seeking Behaviour and Determinant of Self-Medication among Physicians and Nurses in a Tertiary Hospital in Southwest Nigeria

There is generally a lack of good health-seeking practices among health professionals due to a variety of factors, including the intensity of the medical practice itself. Doctors and nurses are perceived to have a good knowledge of ideal health-seeking behaviors and as such, it is important to determine the level of their awareness and estimate whether this knowledge is put into practice. This study, therefore, aimed to determine the level of awareness and practices of proper health-seeking behavior and to identify the factors responsible for self-medication among doctors and nurses in a tertiary hospital in Nigeria. Methodology: A cross-sectional descriptive study was conducted between April and may 2018 among 106 doctors and 164 nurses in a tertiary health facility in Ido-Ekiti, Ekiti State, Southwestern Nigeria. A simple random sampling technique by balloting was performed from the list of doctors and nurses in the hospital to select doctors and nurses that participated in the study. A pretested semi-structured self-administered questionnaire was designed and used to collect data. The data were entered into the computer software and analyzed using SPSS version 20. P ≤ 0.05 was taken as significant. Result: Out of 106 doctors and 164 nurses recruited, only 102 doctors and 143 nurses filled the questionnaire completely and returned for analysis. One hundred and four respondents (42.4%) fall within the ages of 31 - 40 years with a male to female ratio of 1:1.23. Awareness of proper health seeking behavior among both doctors and nurses was high among the two groups with no statistically significant difference between them. Twenty-nine (28.0%) doctors compared with thirty-four (23.8%) nurses go for a regular medical check-up with no statistically significant difference between the two groups (p = 0.411). Out of these, 5 (17.2%) doctors and 7 (23.8%) nurses visit at an interval of less than 6 month (p = 0.736). There is a statistically significant difference in the number of doctors (60.8%) compared with nurses (41.3%) that have consulted a doctor in the last one year (p = 0.003). More than half (51.6%) of this consultation among doctors was over the phone whereas 64.4% of such among nurses were via clinic appointment (p = 0.008). More doctors (90.2%) comply with their treatment prescription from physicians compared with nurses (77.6%) (p = 0.010). More nurses compared with doctors self-medicate when ill [Doctor 61.8% (63), Nurses 78.3% (112)] (p = 0.005) and had also self-medicated in the last one year [Doctor 34.3% (35), Nurses 42.7% (61)] (p = 0.187). Decreasing age, decreasing years of experience, increasing working hours, lack of health insurance, fear of confidentiality and lack of satisfaction with health services are factors that significantly increased the likelihood of self-medication among doctors and nurses within the last one year. Conclusion: Awareness of proper health seeking behavior was high but this did not translate into proper health-seeking practices among doctors and nurses. There is apathy for regular medical check-up and self-medication was also high among this group of health workers. Decreasing age and years of experience, increasing working hours, lack of health insurance, fear of confidentiality and lack of satisfaction with health services were factors were identified to significantly increase the likelihood of self-medication

CryptoImperforate Hymen with a Huge Abdominal Mass and Massive Hematocolpometra in a 15-Year-Old Girlmenorrhea with a Huge Abdominal Mass and Massive Hematocolpometra in a 15-Year-Old Girl

Background: Imperforate hymen is one of the commonest embryological defects of the lower genital tract which occurs due to failure of canalization of the sinovaginal bulb. Its incidence is 1 in 2000 girls. Case Presentation: This case is of a 15-year-old nullipara who presented on account of a 2-month history of recurrent abdominal pain, hesitancy, and primary amenorrhea. Her physical examination reveals a huge abdominopelvic mass about the size of a 26 weeks intra-uterine gestation, and a vagina examination revealed an imperforate hymen. A pelvic ultrasound confirmed a massive hematometra and hemaltocolpos leading to a diagnosis of imperforate hymen. She had a hymenotomy with a cruciate incision to drain the menstrum. Conclusion: Pediatricians and gynaecologists need a high index of suspicion to diagnose this defect for earlier treatment and reduced morbidity due to late diagnosis

Financial cost of hypertension in urban and rural tertiary health facilities in Southwest, Nigeria: A comparative cross-sectional study

Background: The financial cost of hypertension could result in serious economic hardship for patients, their households, and the community. To assess and compare the direct and indirect cost of care for hypertension in urban and rural tertiary health facilities. Material and Methods: A comparative cross-sectional study was carried out in two tertiary health facilities which are located in urban and rural communities of the southwest, Nigeria. Four hundred and six (204 urban, 202 rural) hypertensive patients were selected from the health facilities using a systematic sampling technique. A pretested semi-structured, interviewer-administered questionnaire adapted from that used in a previous study was used for data collection. Information on biodata, and direct and indirect costs was collected. Data entry and analysis were done using IBM SPSS Statistics for Windows, Version 22.0. Results: More than half of the respondents were females (urban, 54.4%; rural, 53.5%) and in their middle age (45-64 years) (urban, 50.5%; rural, 51.0%). The monthly cost of care for hypertension was significantly higher in urban than in rural tertiary health facilities (urban, ₦19,703.26 [$54.73]; rural, ₦18,448.58 [$51.25]) (P < 0.001). There was a significant difference in the direct cost (urban, ₦15,835.54 [$43.99]; rural, ₦14,531.68 [$40.37]) (P < 0.001), although the indirect cost (urban, ₦3,867.72 [$10.74]; rural, ₦3,916.91 [$10.88]) (P = 0.540) did not show much difference between the groups. The cost of drugs/consumables and investigations contributed more than half (urban, 56.8%; rural, 58.8%) of the cost in both health facilities. Conclusion: The financial cost of hypertension was higher in the urban tertiary health facility; therefore, more government support is needed in this health facility to close the financial gap

The Unspotted Impact of Global Inflation and Economic Crisis on The Nigerian Healthcare System

Inflation, the rise in prices of goods and services, has been on an exponential rise over the past few years globally. The excess inflation and the devaluation of the Nigerian currency has aggravated the problem of poor healthcare funding in the country. The overlooked influences that global inflation has had on the Nigerian healthcare system were highlighted in this work. Some of the influences included increased healthcare costs leading to demand-related problems, increased morbidity, reduced quality of healthcare delivery despite the increased cost, understaffing, the inefficiency of healthcare workers, medical brain drain as well as dwindling of research activities. In line with these consequences, it has become imperative for the government to take action to curb the growing menace of inflation and its impacts, through policy development and implementation as well as increasing resource allocation to the health sector

Health-seeking behavioural practices of the elderly in rural community of Ekiti State, Southwestern Nigeria

Background: The aging process increases the risks of contracting a disease among elderly people. Health-seeking behaviour is poor among the aged in sub-Saharan countries like Nigeria, escalating the burden of noncommunicable diseases and the cost of health care which further impact the utilisation of orthodox medicine. Aim: This study aims to assess the health-care-seeking behavioural practices and associated factors among elderly people in Ido-Ekiti. Materials and Methods: A descriptive cross-sectional study was conducted among 420 elderly respondents in Ido-Ekiti. An interviewer-administered semi-structured questionnaire was used to collect information. The data collected were analyzed using SPSS version 25 and results were presented in the form of tables and bar charts. Chi-square tests were used to test for associations. All data analysis was done at a 5% level of significance. Results: The age range of respondents was between 65 and 95 years, with a mean age of 73.88 ± 6.84 years and 64.0% within the age range of 65–75 years. About 63.3% of the respondents have had an episode of illness in the last year preceding the study and only 35.3% consulted a doctor for treatment (good health-seeking behaviour); however, 57.9% of the respondents admitted utilising any of the following: self-medication, consult spiritualist, and use of herbal medicine (poor health-seeking behaviour). The factors statistically significantly associated with respondents' health-seeking behavioural practices are employment status (P < 0.001), educational level (P < 0.002), cost of health care, access to the health facility, length of time before consultation, beliefs, and lack of support from relations (P < 001). Conclusion: This study shows that the majority of the elderly had poor health-seeking behaviour due to educational and economic factors. Making the free or subsidized cost of health care for the elderly in rural communities and the provision of monthly financial support to the aged by the government will promote and encourage good health-seeking behaviour of old people

Perception and willingness to the uptake of covid-19 vaccine among household-heads in a rural community of south-western Nigeria

Background: The COVID-19 pandemic and its vaccine have been met with varying perceptions that may have both negative and positive effects on the willingness to uptake the COVID-19 vaccine. The study is set to determine the perception and willingness of the household heads to the uptake of COVID-19 vaccine in a rural community in Southwestern, Nigeria. Materials and Methods: A cross-sectional study was carried out among 409 household heads selected through a multistage sampling technique. The instrument of data collection was a semi-structured interviewer-administered questionnaire using the Health Belief model constructs. Data were analyzed with IBM SPSS version 21.0 and Pearson's Chi-square test was used to determine the association between perception and willingness to uptake vaccine. P<0.05 was taken as significant at 95% confidence interval. Results: The majority of the unvaccinated respondents in the study were not willing to take the COVID-19 vaccine (60.1%). There was a poor perception of the susceptibility/severity of unvaccinated respondents to COVID-19 infection and a poor perception of the benefit/barrier to the uptake of the COVID-19 vaccine. Perception of susceptibility and severity of COVID-19 infection were statistically related to the willingness to uptake the COVID-19 vaccine. Conclusion: There should be an increase in awareness campaigns to change the perception of people positively to COVID-19 infection and uptake of the COVID-19 vaccine