Cost of treatment as a barrier to access and continuity of healthcare for patients with mental ill-health in Lagos, Nigeria

In Nigeria, there are several barriers to access to effective mental healthcare, e.g. cost, distance to the mental health facility, social stigma, cultural beliefs, attitudes and taboos. This study aimed at i) determining the cost of treatment of a random sample of psychiatric patients and to compare the sample with a matched group of patients from the internal medical department clinics; ii) assessing the impact of cost on access to care and maintenance treatment for the study group in the context of their exclusion from the Lagos State free health services and the National Health Insurance Scheme. Medical records of 100 patients currently attending the outpatients’ clinic of the Department of Psychiatry of the Lagos State University Teaching Hospital (Ikeja, Nigeria) were randomly selected and audited. A similar exercise was also conducted for patients attending the medical outpatients’ clinic in the same hospital. The monthly costs of prescribed medications were computed and compared. The monthly cost of treatment of patients from the Department of Psychiatry compared to patients with physical ailments from the medical outpatients’ clinic was found to be significant vis à vis the average income of average Nigerians. Contrary to expectations, the mean cost of drug treatment borne by medical outpatients was much higher (N=2549.07 vs N=1904.5) (P<0.05) than that of patients attending the psychiatric outpatients’ clinic. However, the expensive cost for the psychiatric patients far exceeded the expensive costs for the medical patients. The findings from this study showed that the average monthly cost of treatment of patients attending the psychiatric clinic was lower than patients from the medical outpatients’ clinic. However, the most expensive cost for psychiatric patients far exceeded the most expensive cost for medical patients. This study also revealed that there is no free health program covering psychiatric treatment anywhere in Nigeria and mental health drugs are funded from personal and family expenses. It is thereby suggested that policy makers should change policy regarding the coverage of Nigerians with mental illness. In doing so, the major barrier to assess and the treatment gap can be reduced

Analysis of the variability of airborne particulate matter with prevailing meteorological conditions across a semi-urban environment using a network of low-cost air quality sensors.

The concentrations of fine and coarse fractions of airborne particulate matter (PM) and meteorological variables (wind speed, wind direction, temperature and relative humidity) were measured at six selected locations in Ile Ife, a prominent university town in Nigeria using a network of low-cost air quality (AQ) sensor units. The objective of the deployment was to collate baseline air quality data and assess the impact of prevailing meteorological conditions on PM concentrations in selected residential communities downwind of an iron smelting facility. The raw data obtained from OPC-N2 of the AQ sensor units was corrected using the RH correction factor developed based k-Kohler theory. This PM (corrected) fast time resolution data (20 s) from the AQ sensor units were used to create daily averages. The overall mean mass concentrations for PM2.5 and PM10 were 213.3, 44.1, 23.8, 27.7, 20.2 and 41.5 μg/m3 and; 439.9, 107.1, 55.0, 72.4, 45.5 and 112.0 μg/m3 for Fasina (Iron-Steel Smelting Factory, ISSF), Modomo, Eleweran, Fire Service, O.A.U. staff quarters and Obafemi Awolowo University Teaching and Research Farm (OAUTRF), respectively. PM concentration and wind speed showed a negative exponential distribution curve with the lowest exponential fit coefficient of determination (R2) values of 0.08 for PM2.5 and 0.03 for PM10 during nighttime periods at Eleweran and Fire service sites, respectively. The relationship between PM concentration and temperature gave a decay curve indicating that higher PM concentrations were observed at lower temperatures. The exponential distribution curve for the relationship between PM concentration and relative humidity (RH) showed that PM concentrations do not vary for RH 80 % for both day and nighttime. The performances of the MLR model were slightly poor and as such not too reliable for predicting the concentration but useful for improving predictive model accuracy when other variables contributing to the variability of PM is considered. The study concluded that the anthropogenic and industrial activities at the smelting factory contribute significantly to the elevated PM mass concentration measured at the study locations

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

Spatiotemporal distribution of pollutants and impact of local meteorology on source influence on pollutants' level in a traffic air-shed in Lagos megacity, Nigeria.

Pollution from vehicular emissions is a major cause of poor air quality observed in many urban and semi-urban towns and cities. As such, this study was conducted to assess air quality and the spatiotemporal distribution of vehicular and traffic-related pollutants in several air sheds of Lagos megacity, the economic nerve centre of Nigeria. A setup of low-cost air quality sensors comprising five (5) units was deployed between November 2018 and February 2019 within traffic corridors in the heart of the city. Diurnal variation of pollutants indicated that carbon dioxide (CO2) peaked during the early hours of the day, total oxide (Ox = NO2+O3) peaked at mid-day while carbon monoxide (CO) had two distinct peaks which correspond to morning and evening rush hours. Nitrogen dioxide (NO2) concentration peaked during evening hours. Average concentrations are NO2 (97.1 ± 9.7) ppb, Ox (78.6 ± 27.2) ppb, CO2 (450.1 ± 31.2) ppm, and CO (2285.63 ± 743.7) ppb. Average concentrations of pollutants were above thresholds set by the World Health Organization (WHO) except for NO2 which was within the range permissible limits. The implication of this is that the atmosphere is polluted due to elevated concentrations of airborne pollutants, an indication which is of both health and environmental concern. The air quality index (AQI) indicates that the quality of ambient air varies from good to very unhealthy for Ox, and unhealthy to very unhealthy for CO, while AQI for PM2.5 and PM10 showed hazardous at all the sampling locations except at UNILAG where it is unhealthy for the sensitive group. For all of the sampling sites, conditional bivariate probability function (CBPF) plots show a significant agreement with the location of known pollution sources

Strategies for optimising early detection and obstetric first response management of postpartum haemorrhage at caesarean birth:a modified Delphi-based international expert consensus

Objective: There are no globally agreed on strategies on early detection and first response management of postpartum haemorrhage (PPH) during and after caesarean birth. Our study aimed to develop an international expert’s consensus on evidence-based approaches for early detection and obstetric first response management of PPH intraoperatively and postoperatively in caesarean birth. Design: Systematic review and three-stage modified Delphi expert consensus. Setting: International. Population: Panel of 22 global experts in PPH with diverse backgrounds, and gender, professional and geographic balance. Outcome measures: Agreement or disagreement on strategies for early detection and first response management of PPH at caesarean birth. Results: Experts agreed that the same PPH definition should apply to both vaginal and caesarean birth. For the intraoperative phase, the experts agreed that early detection should be accomplished via quantitative blood loss measurement, complemented by monitoring the woman’s haemodynamic status; and that first response should be triggered once the woman loses at least 500 mL of blood with continued bleeding or when she exhibits clinical signs of haemodynamic instability, whichever occurs first. For the first response, experts agreed on immediate administration of uterotonics and tranexamic acid, examination to determine aetiology and rapid initiation of cause-specific responses. In the postoperative phase, the experts agreed that caesarean birth-related PPH should be detected primarily via frequently monitoring the woman’s haemodynamic status and clinical signs and symptoms of internal bleeding, supplemented by cumulative blood loss assessment performed quantitatively or by visual estimation. Postoperative first response was determined to require an individualised approach. Conclusion: These agreed on proposed approaches could help improve the detection of PPH in the intraoperative and postoperative phases of caesarean birth and the first response management of intraoperative PPH. Determining how best to implement these strategies is a critical next step

Strategies for optimising early detection and obstetric first response management of postpartum haemorrhage at caesarean birth: a modified Delphi-based international expert consensus.

ObjectiveThere are no globally agreed on strategies on early detection and first response management of postpartum haemorrhage (PPH) during and after caesarean birth. Our study aimed to develop an international expert's consensus on evidence-based approaches for early detection and obstetric first response management of PPH intraoperatively and postoperatively in caesarean birth.DesignSystematic review and three-stage modified Delphi expert consensus.SettingInternational.PopulationPanel of 22 global experts in PPH with diverse backgrounds, and gender, professional and geographic balance.Outcome measuresAgreement or disagreement on strategies for early detection and first response management of PPH at caesarean birth.ResultsExperts agreed that the same PPH definition should apply to both vaginal and caesarean birth. For the intraoperative phase, the experts agreed that early detection should be accomplished via quantitative blood loss measurement, complemented by monitoring the woman's haemodynamic status; and that first response should be triggered once the woman loses at least 500 mL of blood with continued bleeding or when she exhibits clinical signs of haemodynamic instability, whichever occurs first. For the first response, experts agreed on immediate administration of uterotonics and tranexamic acid, examination to determine aetiology and rapid initiation of cause-specific responses. In the postoperative phase, the experts agreed that caesarean birth-related PPH should be detected primarily via frequently monitoring the woman's haemodynamic status and clinical signs and symptoms of internal bleeding, supplemented by cumulative blood loss assessment performed quantitatively or by visual estimation. Postoperative first response was determined to require an individualised approach.ConclusionThese agreed on proposed approaches could help improve the detection of PPH in the intraoperative and postoperative phases of caesarean birth and the first response management of intraoperative PPH. Determining how best to implement these strategies is a critical next step