Efficacy of Single Dose Anthelminthic Treatment against Soil Transmitted Helminth Infections and Schistosomiasis Among School Children in Selected Rural Communities in South East Nigeria

Background: Soil-transmitted helminth infections and schistosomiasis constitute a major public health problem in developing countries. The objective of this study was to evaluate the efficacy of single dose anthelminthic treatment against soil-transmitted helminthic infections and schistosomiasis among school children in Ebonyi State. Subjects and Methods: A school-based chemotherapeutic intervention study was conducted from September 2007 to January 2008 among five hundred and seventy-six primary school children selected by multistage sampling technique. The study was carried out in three distinct stages: pre-chemotherapeutic, chemotherapeutic and post-chemotherapeutic intervention stages. Selected children diagnosed as infected with the helminths investigated were treated. The efficacy of anthelminthic treatment was determined by helminth egg count at four, eight and sixteen weeks post-treatment. Results: Up to 38.5% of the children had at least one helminth infection. Ascaris lumbricoides was the commonest STH encountered. The cure rate 4 weeks after the treatment of STH infection was lowest in Trichuris trichiura cases. At week 8 and week 16 there was a 100% cure rate for all the cases with STH infection. The egg reduction rate at weeks 8 and 16 was 100% for all the STH infection but ranged from 90.6% to 94.4% at week 16 for the S. haematobium infected cases. At week 16 following treatment, the cure rates for S. haematobium infection ranged from 70.8% to 74.0%. Conclusion: This study has shown the efficacy of single dose anthelminthic treatment against soil-transmitted helminth infections and schistosomiasis among school-age children. Journal of Community Medicine & Primary Health vol 23 (1-2) 201

Sustainable Health Care Financing for Low Income Communities in Sub-Saharan Africa: A Review of the Options and Opportunities

The purpose of health financing is to make funding available to ensure that all individuals have access to effective public health and personal health care. Private health care expenditures constitute a significant proportion of health care spending in most developing countries and are a major cause of impoverishment. Many communities in sub-Saharan Africa countries are low income countries with most of its people living below US $1 per day. This implies that people in such areas would find it difficult to maintain a good living standard including accessing basic health care services. Poor people use health care services far less than the well-off. Out of pocket payment for health care services; a widely used strategy to supplement governmental resources in sub-Saharan Africa, further aggravates the situation. Wherever access to health services is monetized, the poorest are excluded. Ensuring that people are not denied access to health care services because they cannot afford it has long been a cornerstone of modern health financing systems in many countries. The challenge facing governments in low income sub-Saharan African countries is to reduce the regressive burden of out-of-pocket expenditure on health by expanding pre-payment schemes which spread financial risk and reduce the spectre of catastrophic health care expenditures. This review, therefore intends to examine the options and opportunities for sustainable health care financing for low income communities in sub- Saharan Africa.Keywords: Low income communities, health financing, options, opportunities, Sub-Saharan Africa

Lifestyle Changes and the Risk of Colorectal Cancer among Immigrants in the United Kingdom: Reflections and Lessons for Sub-Saharan Africa

Colorectal cancer (CRC) is a public health challenge in developed countries and an emerging public health problem in developing countries. There is the established association between lifestyle and colorectal cancer globally. Scientific observations have shown low prevalence of this cancer in sub-Saharan Africa, Middle East, South Asia and the Caribbean. This is not so for Australasia, North America and Western Europe where the prevalence of colorectal cancer is high. Evidence have shown that migrant populations from low risk regions to countries in North America, Europe and Australasia have an increased risk of colorectal cancer (CRC) in their newly found environment as a result of lifestyle transitions as well as these populations contributing to the burden of the disease and public health challenges in their immigrant countries. More so over the past few decades, large transitions have occurred in lifestyle in the countries of origin of these migrants and these transitions reflect in epidemiological outcomes such as; changes in average stature, body composition and observed changes in disease patterns such that these developing countries that were saddled with burdens of communicable disease (CDs) are gradually acquiring non-communicable disease (NCDs) in high proportions particularly; diabetes, cancers etc; hence the double burden of disease. Importantly, as globalization and the proliferation of “Westernized” life style continues, it is becoming increasingly common to observe in these developing countries a battle with century old issues of CDs in addition to emerging health epidemics such as cancers. It is based on this that this paper through a review of literature, discusses the risk of CRC among migrants in the UK, its' impact on the health systems and lessons for sub-Saharan Africa.Keywords: Life style; Transitions; Colorectal Cance

Promoting universal financial protection: a study assessing the effects of knowledge and perception towards enrolment in health insurance schemes among clienteles using tertiary health services

Objective: To assess the evidence of the effects of knowledge and perception of health insurance on the willingness to enrol and utilize health insurance among clienteles using tertiary health services.Method: This was a cross-sectional descriptive study. The instrument was a pre tested, semi-structured self administered questionnaire. Descriptive statistics as well as chi-square test and regression analysis were done to show statistically significant associations.Results: The findings reveal that majority of the respondents had heard about health insurance at 275(78.6%), a significant number at 265(75.7%) had the right understanding of what it is; with the electronic and print media accounting for the major source of knowledge of health insurance at 85(24.3%) and 117(33.4%) respectively. Notwithstanding, most of the respondents 202(57.7%) felt that their current knowledge of health insurance is still very limited of such scheme(s) and as such affects their interest in enrolling in a scheme. Statistically significant association between the level of knowledge and the willingness to enrol in an insurance scheme feeling that they need more information on health insurance and the willingness to enrol in a health insurance scheme was shown (X2= 6.689, df= 1, p-value= 0.01). Accordingly, most respondents were willing to enrol and utilize the benefits of different types of health insurance services.Conclusion: The findings from this study has brought to the fore the relationship(s) between knowledge and perception of clients using health services and the effect(s) on their desire and willingness to participate in health insurance schemes. Still, there are concerns that necessitate wide spread advocacy for health insurance.Keywords: Health insurance, Knowledge, Perception, Enrolment, Nigeri

The status of tuberculosis infection control measures in health care facilities rendering joint TB/ HIV services in “German Leprosy and Tuberculosis Relief Association” supported states in Nigeria

Objective: To assess the status of tuberculosis (TB) infection control practice in health care facilities implementing joint TB/HIV activities.Materials and Methods: A descriptive survey triangulating self-administered questionnaire (facility survey to Infection Control Officer, individual health worker to general health workers), review of facility case notes and participant observation techniques was carried out. Twelve health facilities from southern Nigeria were assessed.Results: (1) Administrative and work practice control measure: Only 1 (8.3%) facility had a documented TB Infection control policy; 2 (16.7%) facilities had Infection Control Committee; 5 (41.7%) facilities had Infection Control Officer; 2 (16.7%) asked questions at the health records about cough; 1 (8.3%) facility had health workers intermittently checking for patients with cough in the waiting hall; and 2 (16.7%) facilities had Infection Control Officers who have attended some training on infection control. No facility had Information, Education and Communication (IEC) materials reminding patients and health workers of the possibility of TB transmission in the health care setting. While 86.4% of TB patients were screened for HIV, only 54.7% of HIV patients were tested for TB. (2) Environmental control measures: All the waiting halls were well ventilated. Though 66.7% of the consulting rooms were well ventilated, 25% of them were over crowded; 58.3% of the facilities managed sputum smear positive TB patients in the same ward with HIV-positive and other vulnerable patients; no facility had air cleaners.Conclusion: Implementation of the different aspects of the administrative control and work practice component of TB infection control measure range from 8.3% to 41.7% of the facilities. Urgent measures should be taken to reverse this trend in the face of TB burden due to HIV

Research priority setting for health policy and health systems strengthening in Nigeria: The policymakers and stakeholders perspective and involvement

Introduction: Nigeria is one of the low and middle income countries (LMICs) facing severe resource constraint, making it impossible for  adequate resources to be allocated to the health sector. Priority setting becomes imperative because it guides investments in health care, health research and respects resource constraints. The objective of this study was to enhance the knowledge and understanding of policymakers on researchpriority setting and to conduct a research priority setting exercise. Methods: A one-day evidence-to-policy research priority setting meeting was held. The meeting participants included senior and middle level  policymakers and key decision makers/stakeholders in the health sector in Ebonyi State southeastern Nigeria. The priorities setting meeting involved a training session on priority setting process and conduction of priority setting exercise using the essential national health research (ENHR) approach. The focus was on the health systems building blocks (health workforce; health finance; leadership/governance; medical  products/technology; service delivery; and health information/evidence). Results: Of the total of 92 policymakers invited 90(97.8%) attended the meeting. It was the consensus of the policymakers that research should focus on the challenges of optimal access to health products and  technology; effective health service delivery and disease control under a  national emergency situation; the shortfalls in the supply of professional personnel; and the issues of governance in the health sector    management.Conclusion:Research priority setting exercise involving  policymakers is an example of demand driven strategy in the health  policymaking process capable of reversing inequities and strengthening the health systems in LMICs

Out-of-pocket payment for health services: constraints and implications for government employees in Abakaliki, Ebonyi state, South east Nigeria

Background: Each year, 100 million people are impoverished globally as a result of expenditure on health. Objective: To assess the constraints and implications of out-of-pocket payment for health services among government employees in Abakaliki, Ebonyi State, south east Nigeria. Method: This was a cross-sectional descriptive study. The study instrument was a pre-tested, semi-structured self administered questionnaire. Results: Over half of the respondents (62.8 %) reported a history of illness in their household in the preceding four weeks before the study. Sixty-nine percent of these respondents relied on out-of-pocket payment in order to pay for health services at the moment of seeking medical treatment for themselves or their dependants; while 28.4 % and 2.6 % relied on a prepayment package (National Health Insurance Scheme) and borrowed money respectively to pay for health services at the moment of seeking medical treatment for themselves or their dependants. The vast majority of respondents (63.6 %) who relied on out-of-pocket payment reported their difficulties in accessing quality health care services as a result of financial hardship at the moment of seeking medical treatment. Most of them (47.7 %) resolved to self medication, while 28.4 %, 17.1 % and 6.8 % of them delayed seeking health care, patronized herbalists and ignored their illness respectively. Conclusion: This study brings to the fore the fact that most government employees and their dependants in Abakaliki have difficulties in accessing quality health care services via paying for them out-of-pocket.Keywords: Health services, payment, constraints, government employeesAfrican Health Sciences 2011; 11(3): 481 - 48

Out-of-pocket payment for health services: constraints and implications for government employees in Abakaliki, Ebonyi state, South east Nigeria

Background: Each year, 100 million people are impoverished globally as a result of expenditure on health. Objective: To assess the constraints and implications of out-of-pocket payment for health services among government employees in Abakaliki, Ebonyi State, south east Nigeria. Method: This was a cross-sectional descriptive study. The study instrument was a pre-tested, semi-structured self administered questionnaire. Results: Over half of the respondents (62.8 %) reported a history of illness in their household in the preceding four weeks before the study. Sixty-nine percent of these respondents relied on out-of-pocket payment in order to pay for health services at the moment of seeking medical treatment for themselves or their dependants; while 28.4 % and 2.6 % relied on a prepayment package (National Health Insurance Scheme) and borrowed money respectively to pay for health services at the moment of seeking medical treatment for themselves or their dependants. The vast majority of respondents (63.6 %) who relied on out-of-pocket payment reported their difficulties in accessing quality health care services as a result of financial hardship at the moment of seeking medical treatment. Most of them (47.7 %) resolved to self medication, while 28.4 %, 17.1 % and 6.8 % of them delayed seeking health care, patronized herbalists and ignored their illness respectively. Conclusion: This study brings to the fore the fact that most government employees and their dependants in Abakaliki have difficulties in accessing quality health care services via paying for them out-of-pocket.Keywords: Health services, payment, constraints, government employeesAfrican Health Sciences 2011; 11(3): 481 - 48

Donor support for HIV/AIDS control in sub-Saharan Africa: review of its contribution towards health system strengthening

Background: Consequent to the signing of the MDGs in year 2000, a platform was created for the ''injection'' of donor funds into countries with great need. This was to accelerate the achievement of the goals by the year 2015. This systematic review assesses the evidence of how international developmental assistance has impacted upon development outcomes in health systems, focusing specifically on donor support for HIV/AIDS.Methods: Via broad criteria the authors made the review as inclusive as possible and online search engines and databases including Embase, Google Scholar and Pubmed were searched over a period of eight months. Key words used to generate articles that fit the review topic included donor support, health systems, health outcomes, HIV/AIDs and Sub-Saharan Africa.Results: The review identified discernible evidence of the impact of international developmental support for health services concerned with HIV/AIDS, with concerns for health systems strengthening.Conclusion: Beyond the MDGs, the region needs a post-2015 development framework that will ensure sustainability for health system strengthening besides donor assistance. Donor support is only a part of the development picture. Economic growth and social progress as well as sustainable and workable policies for healthcare financing is needful, without which these countries which are over reliant on humanitarian actors will continue to cripple their ability to be self-sufficient and self reliant, and should these agencies cease to continue or run out of funding the consequences for the region will be dire.Keywords: sub-Saharan Africa, donor support, HIV/AIDS, health systems strengthening