Quality in primary health care services in sub-Sahara Africa: right or privilege?

The Primary Health Care (PHC) system has been the foundation for the operation of the health system in most of Sub-Sahara Africa following the Alma Ata Declaration in 1978. Quality of care is an important determinant of health services utilization, and is a health outcome of public health importance. It is known that the perception of the users about the quality of service offered in a health facility is a determinant of patient's choice of provider and willingness to pay for the services. This paper discusses quality of primary health care services with focus on perspectives of the users and the need for a user driven and business minded delivery of PHC services in Sub-Sahara African nations.Keywords: Quality of care, Primary health care , PHC, Sub-Sahara, Afric

Quality of sexual and reproductive health services for adolescents and young people in public health facilities in Southwest Nigeria : a mystery client study

Background To support the policy drive for the promotion of sexual and reproductive health (SRH) of adolescents and young people (AYP), it is necessary to understand the characteristics of the existing SRH services available to them. Objective To assess the provision and experiences of care in SRH services for AYP in a Nigerian setting. Methods Twelve male and female mystery clients (MCs) conducted 144 visits at 27 selected primary and secondary health facilities in two Local Government Areas (LGA) in Ogun State, Nigeria. A 27-item adolescent quality of care (AHQOC) index with a Cronbach’s Alpha of 0.7 was used to obtain a quality-of-care score for each clinic visit. Linear panel-data random-effects regression models using the generalised least square estimator were used to assess quality associated factors. Sentiment analysis was done on the qualitative narrative summaries provided by MCs after each visit. Results There was an absence of the use of educational materials during the 60.4% of the visits. The MCs’ medical history (90.3%), social record (63.9%), sexual/reproductive history (53.5%), and contraceptive experience (66.0%) were not obtained in most of the visits. Female MC visits had a lower AHQOC index rating on average compared to males (β=-0.3, CI −1.6 – 1.0 p = 0.687), rural health facilities had a lower AHQOC index rating on average compared to urban (β=-2.7, CI −5.1 – −0.2, p = 0.031), and a higher ranking of the health worker on the scale of 1–10 corresponded to a higher AHQOC index of the MC visit (β = 1.9, CI 1.6–2.1, p < 0.001). There were more positive than negative sentiments about the clinic encounters. Conclusion This study found gaps in the competencies of the health workers, non-usage of educational materials in clinic encounters with young people, as well as the differential perception of quality of care by male and female AYP

Key informants’ perspectives on policy- and service-level challenges and opportunities for delivering adolescent and youth-friendly health services in public health facilities in a Nigerian setting

Background: Integrating the care of adolescents and young people into existing public health facilities requires deliberate efforts to address challenges related to policy and service provision. This study assessed key informants’ perspectives on policy- and service-level challenges, and opportunities, for implementing a strategic framework for adolescent and youth-friendly health services (AYFHS) in public health facilities in a Nigerian setting. Methods: Seventeen key informants were interviewed including members of the Adolescent sexual and reproductive health (ASRH) Technical Working Group (TWG), program managers of non-governmental organizations (NGO), State and local level health officials, and youth representatives, in Ogun State, Southwest Nigeria. Result: Findings from this study indicate that some health workers continue to have a negative attitude toward young people’s sexual and reproductive health. There was some level of inclusion of adolescents and young people living with disabilities in ASRH programming which is welcome and extremely important. Some of the challenges in ASRH service provision included insufficient coordination of activities of donors/partners working in the adolescent health space. Also found was the missed opportunity to strengthen policy implementation with research, and the need for increased focus on mental health, substance use, and other aspects of adolescent and young people’s health. There was noted the opportunity to explore the Basic Health Care Provisions Funds (BHCPF) as a new source of funding for health services for AYP in Nigeria. Conclusion: This study provided the context of the implementation of a strategic framework for adolescent reproductive health in a Nigerian setting from the perspectives of policy and service-level stakeholders. Opportunities for improving program delivery identified include ensuring research-based policy implementation and seeking program sustainability through tapping into new sources of funding

Economic Impact of COVID-19 Lockdown on households

Introduction:&nbsp;this study evaluated the economic impact of the COVID-19 lockdown on individuals and households. Methods:&nbsp;a cross-sectional online survey was used to collect data. Nigerian citizens who were domiciled or restricted from travelling abroad for no less than one month since the COVID-19 restrictions and lockdown were recruited into the study through focal persons purposively selected across the different states in Nigeria. Using WhatsApp® platform, the respondents completed the survey on household income and expenditure before and during the lockdown. Economic burden of COVID-19 lockdown on individuals and families was estimated using a prevalence-based cost of illness approach. Results:&nbsp;four hundred and four (male = 242; female = 162) individuals have participated in the study. The mean (SD) age of the respondents was 30.98 (10.92) years. Monthly income showed no statistically significant difference (p = 0.73) before and during lockdown. The overall household expenditure before and during the lockdown periods were USD 320 and USD 290. The total mean monthly costs for COVID-19 and non-COVID-19 health related problems were ₦11746.25 (USD30.79) and ₦11784.9 (USD 30.89), respectively. Household expenditure for hand sanitizers, facemasks, hand gloves, and disinfectants increased significantly during the COVID-19 restriction lockdown (p &lt; 0.05). However, expenditure on education, water, electricity, fuel, internet data, clothing and wears, toiletries decreased significantly during the lockdown period (p &lt; 0.05). Conclusion:&nbsp;this study suggests that the costs of continuing COVID-19 restrictions could have huge economic consequences on households and health system

Economic Impact of COVID-19 Lockdown on Households in Nigeria

Background: This study evaluated the economic impact of the COVID-19 lockdown on individuals and households in Nigeria. Methods: A cross-sectional online survey was used to collect data. Nigerian citizens who were domiciled or restricted from travelling abroad for no less than one month since the COVID-19 restrictions and lockdown were recruited into the study through focal persons purposively selected across the different states in Nigeria. Using WhatsApp® platform, the respondents completed the survey on household income and expenditure before and during the lockdown. Economic burden of COVID-19 lockdown on individuals and families was estimated using a prevalence-based cost of illness approach. Results: Four hundred and four (Male = 242; Female = 162) individuals have participated in the study. The mean (SD) age of the respondents was 30.98 (10.92) years. There was difference in mean (SD) monthly income before and during the lockdown (₦263389.27 (USD690.4) (SD ₦2589649.2)) vs. (₦207704.9 (USD544.4) (SD ₦1846806.84)). The overall household expenditure before and during the lockdown periods were USD 320 and USD 290. The total mean monthly costs for COVID-19 and non-COVID-19 health related problems were ₦11746.25 (USD30.79) and ₦11784.9 (USD 30.89). Household expenditure for hand sanitizers, facemasks, hand gloves, and disinfectants increased significantly during the COVID-19 restriction lockdown (p < 0.05). However, expenditure on education, water, electricity, fuel, internet data, clothing and wears, toiletries decreased significantly during the lockdown period (p < 0.05). Conclusion: This study suggest that the costs of continuing COVID-19 restrictions could have huge economic consequences on households and health system

Gender Differences in Students-Staff Violence in Urban and Rural Secondary Schools of Osun State, South Western Nigeria

Background: School violence is of public health importance. One important but often overlooked dimension is student-staff violence. The aim of the study was to assess the gender differences in the pattern of students-staff violence in urban and rural areas of Osun state with the hypothesis that male students and staff perpetrate violence more than female students and staff respectively. Methodology: A cross sectional study conducted among 800 secondary school students from JSS 2 to SSS 3 (400 in urban and 400 in rural areas) selected by multi-stage sampling technique. Results: The mean age for all the respondents was 14.3 years ±2.0, with the mean age for males as 14.2±2.0 and females as 14.3±2.0. Male respondents were 51.5% in urban schools and 51% in rural schools. Males were the main perpetrators in both urban and rural areas but more females in the rural areas perpetrated violence than their urban counterparts. Out of those who verbally abused school staff in urban areas, males constituted 61.5% compared to 38.5% of females. Respondents also experienced violence in the hands of academic staff (male and female). Conclusion: All forms of violence were perpetrated against school staff with prevalence higher in rural than urban areas. Males perpetrated most forms of violence than females in both urban and rural schools, though this was marked in urban schools. Female respondents in rural areas experienced significantly higher perpetration of most forms of school-related violence than urban females.Journal of Community Medicine &amp; Primary Health vol 23 (1-2) 2011

Economic Impact of COVID-19 Lockdown on Households

Introduction: this study evaluated the economic impact of the COVID-19 lockdown on individuals and households. Methods: a cross-sectional online survey was used to collect data. Nigerian citizens who were domiciled or restricted from travelling abroad for no less than one month since the COVID-19 restrictions and lockdown were recruited into the study through focal persons purposively selected across the different states in Nigeria. Using WhatsApp® platform, the respondents completed the survey on household income and expenditure before and during the lockdown. Economic burden of COVID-19 lockdown on individuals and families was estimated using a prevalence-based cost of illness approach. Results: four hundred and four (male = 242; female = 162) individuals have participated in the study. The mean (SD) age of the respondents was 30.98 (10.92) years. Monthly income showed no statistically significant difference (p = 0.73) before and during lockdown. The overall household expenditure before and during the lockdown periods were USD 320 and USD 290. The total mean monthly costs for COVID-19 and non-COVID-19 health related problems were ₦11746.25 (USD30.79) and ₦11784.9 (USD 30.89), respectively. Household expenditure for hand sanitizers, facemasks, hand gloves, and disinfectants increased significantly during the COVID-19 restriction lockdown (p < 0.05). However, expenditure on education, water, electricity, fuel, internet data, clothing and wears, toiletries decreased significantly during the lockdown period (p < 0.05). Conclusion: this study suggests that the costs of continuing COVID-19 restrictions could have huge economic consequences on households and health system

Validation of the Adolescent Health Quality of Care (AHQOC) index for mystery client studies.

The Adolescent Health Quality of Care (AHQOC) index is a tool designed to evaluate the quality of facility-based adolescent sexual and reproductive health (ASRH) services. This descriptive cross-sectional study aimed to validate the AHQOC index in 27 primary and secondary public health facilities located in a rural and an urban local government area (LGA) of Ogun State, Nigeria. To conduct the study, 12 mystery clients (MCs) were recruited and performed 144 visits to the health facilities. The MCs were young males and females who were seeking information on premarital sex, pregnancy prevention, sexually transmitted infections (STIs), and contraception. The validity, and reliability of the AHQOC index were evaluated using exploratory factor analysis, Cronbach's Alpha, and intra-class correlation coefficient tests. The Kaiser-Meyer-Olkin test result for the initial 37-item pool was 0.7169, and the final tool retained 27 items with a Cronbach's Alpha of 0.80. Two subscales of the index had Cronbach's Alpha of 0.76 and 0.85. The intra-rater consistency assessed by the intra-class correlation coefficient was 0.66 (0.10-0.92) p = 0.001 for the urban LGA and 0.72 (0.37-0.91) p = 0.001 for the rural LGA. Positive and statistically significant relationships were observed between the full scales and subscales and the validity item (MC ranking of health worker on proficiency from 1 to 10). The results of this study demonstrate that the validated AHQOC index is a valuable tool for assessing the quality of ASRH services in public health facilities

Does social vulnerability for caries predict caries status of children in sub-urban Nigeria?

mportant to identify groups of people vulnerable to a disease condition. Aim: To determine the association between social vulnerability to caries and caries status of children in Ile-Ife, Nigeria. Methods: A composite vulnerability index for caries was developed using data generated for 992 children. Wilks Lambda test to verify relationship between vulnerability and its variables. Logistic regression analysis was conducted to determine if the social vulnerability for caries index was a good predictor for caries status. Results: The social vulnerability to caries index could not predict caries status. The study found that sex, age and number of siblings were the significant predictors of caries status in the study population. Females (AOR: 1.63; 95%CI: 1.08 2.46; p=0.02) and children with more than two siblings had higher odds of having caries (AOR: 2.61; 95%CI: 1.61 4.24; p<0.001) while children below 5 years had lower odds of having caries (AOR: 0.62; 95%CI: 0.39 1.00; p=0.05) Conclusions: The social vulnerability index for caries could not predict the caries status of children in the study population. Sensitive tools to identify children with caries in the study population should be developed

Attributes development for a discrete choice experiment on preferences in sexual and reproductive health services for adolescents and young people in Nigeria

Abstract Background A major component of the validity of the discrete choice experiment (DCE) research design lies in the correct specification of attributes and levels relevant to the research focus. In this paper, we set out the validation steps we took in designing the tool for a DCE on preferences in sexual and reproductive health (SRH) services for adolescents and young people. Methodology This study was carried out among adolescents and young people (AYP) in Ogun State, Southwest Nigeria. We used a three-step mixed-methods process in developing the attributes and attribute-levels for our DCE tool. The first was to conduct a series of 16 focus group discussions (FGD) with AYP ensuring maximal variation (by age group, sex, marital status, and location). The FGD included a priority listing process in which participants were asked to list and rank the most important characteristics of optimal SRH services for AYP. The lists were harmonized and items were scored. The main (highest scoring) themes emerging from the harmonized priority list were converted into an initial set of attributes and the subthemes as level. These initial attributes and levels were presented to a panel of methods and content experts in a virtual modified Delphi process. This was for deciding on the importance of the attributes in providing optimum sexual and reproductive health services for young people, and the appropriateness of the levels. The same set of attributes was presented to another set of AYP in a series of four FGD to clarify meanings, and test whether the wordings were well understood. We applied some decision rules for including and excluding attributes and levels in the different phases of the development process. Results We extracted an initial set of nine attributes with 2-4 levels each from the first FGD sessions. These were revised to a final set of seven attributes with 2-4 levels each based on findings from the expert review and final validation FGDs with AYP. The final attributes were: the type of staff, physical environment, health worker attitude, cost, waiting time, contraceptive availability, and opening hours. Conclusion The final set of attributes covered those relating to the services provided, the health workers providing the services, and the AYP. Our three-step process which included both quantitative and qualitative approaches ensured a rigorous process that produced a reliable combination of attributes and levels. Although we had to trade off some competing attributes to come to a final list, our decision rules helped us to conduct a transparent and reproducible process