Awareness and perception toward referral in health care: A study of adult residents in Ilorin, Nigeria

Background and Objective: The Nigeria Health System operates three levels of health care, which correspond to the tiers of government and interacts through a referral system. The national health policy recommends the Primary Health Care (PHC) as the entry point to health care system. However, these facilities are poorly managed leading to underutilization. Therefore, people usually attend any facility that will meet their needs, not considering the appropriateness of the level of care. This study is to determine the awareness and perception of adult residents in Ilorin toward referral in health care. Methods: A cross-sectional descriptive survey was conducted among 366 adult residents in Ilorin, selected by multi-stage sampling technique. Data were obtained using a semi-structured questionnaire, appropriately scored and analyzed with Epi-Info 2005 computer software. Results: Only 22 (6.0%) respondents knew that PHC is supposed to be the fi rst point of call when ill and 25 (6.8%) were aware that referral hospitals have the right to reject patients without referral. More than two third, 256 (69.9%) of the respondents felt it will be unreasonable for any hospital to reject patients on the basis of not being referred. The level of education was signifi cantly associated with the knowledge and perception of referral in the health care. Conclusion: There is low awareness and poor perception of referral protocol in the health care system among the people of Ilorin. The higher the level of education, the more knowledge the respondents have about referral in the health system and the more likely they have correct perception of referral in health care. The Nigeria health care system policy on referral and appropriate hospital utilization could be more effective if public awareness is created about it via the media while making effort to improve the credibility of the PHC.Arri\ue8re-plan et objectif: Le syst\ue8me de sant\ue9 du Nigeria exploite trois niveaux de soins de sant\ue9, qui correspondent \ue0 la les niveaux de gouvernement et interagit gr\ue2ce \ue0 un syst\ue8me de renvoi. La politique nationale de sant\ue9 recommande le principal. Soins de sant\ue9 (HCP) comme entr\ue9e point au syst\ue8me de soins de sant\ue9. Toutefois, ces installations sont mal g\ue9r\ue9es menant \ue0 la sous-utilisation. Par cons\ue9quent, personnes assistent g\ue9n\ue9ralement \ue0 toute installation qui r\ue9pondra \ue0 leurs besoins, ne pas consid\ue9rer la pertinence du niveau de soins. Cette \ue9tude vise \ue0 d\ue9terminer la sensibilisation et la perception des adultes r\ue9sidents dans Ilorin vers le renvoi dans les soins de sant\ue9. M\ue9thodes: Une enqu\ueate descriptive transversale a \ue9t\ue9 r\ue9alis\ue9e entre r\ue9sidents adultes 366 Ilorin, s\ue9lectionn\ue9 par \ue9chantillonnage multi\ue9tape technique. Donn\ue9es ont \ue9t\ue9 obtenues \ue0 l\u2019aide d\u2019un questionnaire semi-structur\ue9, convenablement notation et analys\ue9es avec Epi-info 2005 logiciels. R\ue9sultats: Les r\ue9pondants seulement 22 (6,0 %) savaient que PHC est cens\ue9 pour \ueatre le point de premi\ue8re fi d\u2019appel lorsqu\u2019il est malade et 25 (6,8 %) savaient que les h\uf4pitaux de recours ont le droit de rejeter les patients sans renvoi. 256 Tiers, plus de deux (% 69.9) le feutre de r\ue9pondants il sera d\ue9raisonnable pour n\u2019importe quel h\uf4pital de rejeter les patients sur la base des n\u2019\ue9tant ne pas vis\ue9s. Le niveau d\u2019\ue9ducation \ue9tait important consid\ue9rablement associ\ue9 \ue0 la connaissance et la perception de renvoi dans les soins de sant\ue9. Conclusion: Il est faible sensibilisation et une mauvaise perception de protocole de renvoi dans le syst\ue8me de soins de sant\ue9 parmi les gens de Ilorin. Plus le niveau d\u2019\ue9ducation, de la connaissance plus les r\ue9pondants ont sur renvoi dans le syst\ue8me de sant\ue9 et les plus susceptibles d\u2019avoir une perception correcte de renvoi dans les soins de sant\ue9. Les soins de sant\ue9 du Nigeria syst\ue8me politique sur le renvoi et l\u2019utilisation appropri\ue9e d\u2019h\uf4pital pourrait \ueatre plus efficace si la sensibilisation du public est cr\ue9\ue9e. sujet via les m\ue9dias tout en faisant des efforts visant \ue0 am\ue9liorer la cr\ue9dibilit\ue9 de la HCP

Awareness and perception toward referral in health care: A study of adult residents in Ilorin, Nigeria

Background and Objective: The Nigeria Health System operates three levels of health care, which correspond to the tiers of government and interacts through a referral system. The national health policy recommends the Primary Health Care (PHC) as the entry point to health care system. However, these facilities are poorly managed leading to underutilization. Therefore, people usually attend any facility that will meet their needs, not considering the appropriateness of the level of care. This study is to determine the awareness and perception of adult residents in Ilorin toward referral in health care. Methods: A cross-sectional descriptive survey was conducted among 366 adult residents in Ilorin, selected by multi-stage sampling technique. Data were obtained using a semi-structured questionnaire, appropriately scored and analyzed with Epi-Info 2005 computer software. Results: Only 22 (6.0%) respondents knew that PHC is supposed to be the fi rst point of call when ill and 25 (6.8%) were aware that referral hospitals have the right to reject patients without referral. More than two third, 256 (69.9%) of the respondents felt it will be unreasonable for any hospital to reject patients on the basis of not being referred. The level of education was signifi cantly associated with the knowledge and perception of referral in the health care. Conclusion: There is low awareness and poor perception of referral protocol in the health care system among the people of Ilorin. The higher the level of education, the more knowledge the respondents have about referral in the health system and the more likely they have correct perception of referral in health care. The Nigeria health care system policy on referral and appropriate hospital utilization could be more effective if public awareness is created about it via the media while making effort to improve the credibility of the PHC.Arrière-plan et objectif: Le système de santé du Nigeria exploite trois niveaux de soins de santé, qui correspondent à la les niveaux de gouvernement et interagit grâce à un système de renvoi. La politique nationale de santé recommande le principal. Soins de santé (HCP) comme entrée point au système de soins de santé. Toutefois, ces installations sont mal gérées menant à la sous-utilisation. Par conséquent, personnes assistent généralement à toute installation qui répondra à leurs besoins, ne pas considérer la pertinence du niveau de soins. Cette étude vise à déterminer la sensibilisation et la perception des adultes résidents dans Ilorin vers le renvoi dans les soins de santé. Méthodes: Une enquête descriptive transversale a été réalisée entre résidents adultes 366 Ilorin, sélectionné par échantillonnage multiétape technique. Données ont été obtenues à l’aide d’un questionnaire semi-structuré, convenablement notation et analysées avec Epi-info 2005 logiciels. Résultats: Les répondants seulement 22 (6,0 %) savaient que PHC est censé pour être le point de première fi d’appel lorsqu’il est malade et 25 (6,8 %) savaient que les hôpitaux de recours ont le droit de rejeter les patients sans renvoi. 256 Tiers, plus de deux (% 69.9) le feutre de répondants il sera déraisonnable pour n’importe quel hôpital de rejeter les patients sur la base des n’étant ne pas visés. Le niveau d’éducation était important considérablement associé à la connaissance et la perception de renvoi dans les soins de santé. Conclusion: Il est faible sensibilisation et une mauvaise perception de protocole de renvoi dans le système de soins de santé parmi les gens de Ilorin. Plus le niveau d’éducation, de la connaissance plus les répondants ont sur renvoi dans le système de santé et les plus susceptibles d’avoir une perception correcte de renvoi dans les soins de santé. Les soins de santé du Nigeria système politique sur le renvoi et l’utilisation appropriée d’hôpital pourrait être plus efficace si la sensibilisation du public est créée. sujet via les médias tout en faisant des efforts visant à améliorer la crédibilité de la HCP

Perception and practice of contraception among male soldiers in Sobi barracks, Ilorin, Nigeria

Background: There is a popular belief among the general population that Nigerian soldiers tend to have large families but this has not been substantiated with evidence-based research. The Nigerian military health authority implements female targeted contraception strategies, with less focus on their husbands; who are the dominant fertility determinants. Objective: To determine the perception and practice of contraception among male soldiers of Sobi Cantonment, Ilorin,Nigeria, with a view to instituting male-targeted contraceptive/family planning strategies. Methodology: A cross-sectional survey of 334 male soldiers using multistage sampling technique and pre-tested interviewer administered questionnaires. Results: The respondents’ approval of contraception (73.6%) and willingness to discuss it with their spouses/partners(71.6%) were high. Fear of wives/partner’s sexual promiscuity (55.7%), cultural and religious beliefs (43.2%), fear of the side effects of contraceptives (29.5%) and the desire for more children (21.6%) were reported reasons for the non-approval of contraception. The prevalence of contraceptive use among the respondents was low (12.3%). There was a significant relationship between the respondents’ educational level and contraceptive use (p< 0.05). Conclusion: The study revealed a high approval and willingness to discuss contraception with their spouses/partners but low contraceptive use

Sustained effect of health insurance and facility quality improvement on blood pressure in adults with hypertension in Nigeria: A population-based study

Hypertension is a leading risk factor for death in sub-Saharan Africa. Quality treatment is often not available nor affordable. We assessed the effect of a voluntary health insurance program, including quality improvement of healthcare facilities, on blood pressure (BP) in hypertensive adults in rural Nigeria. We compared changes in outcomes from baseline (2009) to midline (2011) and endline (2013) between non-pregnant hypertensive adults in the insurance program area (PA) and a control area (CA), through household surveys. The primary outcome was the difference between the PA and CA in change in BP, using difference-in-differences analysis. Of 1500 eligible households, 1450 (96.7%) participated, including 559 (20.8%) hypertensive individuals, of which 332 (59.4%) had follow-up data. Insurance coverage increased from 0% at baseline to 41.8% at endline in the PA and remained under 1% in the CA. The PA showed a 4.97 mm Hg (95% CI: -0.76 to +10.71 mm Hg) greater decrease in systolic BP and a 1.81 mm Hg (-1.06 to +4.68 mm Hg) greater decrease in diastolic BP from baseline to endline compared to the CA. Respondents with stage 2 hypertension showed an 11.43 mm Hg (95% CI: 1.62 to 21.23 mm Hg) greater reduction in systolic BP and 3.15 mm Hg (-1.22 to +7.53 mm Hg) greater reduction in diastolic BP in the PA compared to the CA. Attrition did not affect the results. Access to improved quality healthcare through an insurance program in rural Nigeria was associated with a significant longer-term reduction in systolic BP in subjects with moderate or severe hypertensio