Differences in COVID-19 Preventive Behavior and Food Insecurity by HIV Status in Nigeria

AIDS and Behavior - The aim of the study was to assess if there were significant differences in the adoption of COVID-19 risk preventive behaviors and experience of food insecurity by people living...     

Socio-economic and geographic differentials in costs and payment strategies for primary healthcare services in Southeast Nigeria

The study explored socio-economic and geographic inequalities that exist in healthcare seeking, expenditures and methods of paying for healthcare. The study was conducted in two communities (one rural and urban) in Southeast Nigeria. A pre-tested questionnaire was administered to household heads or their representatives by trained interviewers. A socio-economic status (SES) index, together with urban-rural comparisons was used to examine the inequalities. The expenditures on healthcare and the proportions of respondents that used the different payment strategies were compared across SES quartiles and between the urban and rural areas. There were varying degrees of socio-economic and geographic inequalities in treatment expenditures, providers seen and payment modalities that were used. User fee without reimbursement was the commonest type of payment strategy, followed distantly by instalment payment. The two poorest quartiles were less likely to have used user fee and they mostly used instalment payment in the rural area. Logistic regression analysis showed that location was significantly and positively related to user fee but not to instalment payment. In conclusion, the poorest SES group and rural dwellers are the major sufferers of inequality and this could be mitigated through improved provision of primary healthcare services in rural areas and initiation of exemptions, vouchers and other pro-poor payment strategies for the poorest SES groups.     

Early postoperative hepatic sonography as a predictor of vascular and biliary complications in adult orthotopic liver transplant patients

OBJECTIVE: Our objective was to quantitatively assess the value of early posttransplantation hepatic artery resistive indexes in predicting vascular and nonvascular complications in adult orthotopic liver transplant (OLT) patients. MATERIALS AND METHODS: Between 1999 and 2001, 110 consecutive adults received grafts. Doppler sonographic graft evaluations measured main, right, and left resistive indexes within 24 to 48 hr after surgery (normal resistive index cutoff, 0.6). Clinical, operative, procedural, and radiologic reports were reviewed for vascular and biliary complications. Frequency, Student's t test, logistic, and regression statistical analyses were performed. RESULTS: even patients (6.4%) had vascular complications, including two (1.8%) hepatic artery and two (1.8%) hepatic vein stenoses, one (0.9%) hepatic vein thrombosis, two (1.8%) portal vein thromboses, and one (0.9%) thrombosis and two (1.8%) stenoses of the inferior vena cava (IVC). In 19 patients (17.3%), biliary complications included anastomotic strictures and leaks 1 week to 18 months after transplantation. In 11 patients (10%), sonographically large hematomas required surgical evacuation. In grafts with vascular complications or large hematomas, the mean early posttransplant main, right, and left indexes were significantly lower (< or = 0.6) than without these complications (p < 0.01). In grafts with and without biliary complications, mean early posttransplant main, right, and left indexes did not differ significantly. CONCLUSION: In adult OLT patients, low early posttransplant hepatic artery resistive indexes were sensitive (100%) and specific (80%) predictors for vascular complications (e.g., hepatic artery, portal vein, hepatic vein, and IVC) but not for biliary complications. All patients with indexes less than 0.6 within 24-48 hr after surgery should be monitored closely for vascular complications.     

How do health workers and community members perceive and practice community participation in the Bamako Initiative programme in Nigeria? A case study of Oji River local government area

The objective of this study was to assess the perceptions and practices of health workers and households in relation to community participation in the Bamako Initiative programme (BI). The study was conducted in Oji River local government area of South-East Nigeria where the BI program has been operational since 1993. A pre-tested questionnaire was used to collect information from 20 health workers charged with operating the BI in 20 health centres. In addition, focus group discussions were conducted with members of the district and village health committees. Community participation from both health worker and community perspectives seem to have been enhanced by the introduction of BI, despite some constraints. However, the communities were not involved in core areas of community participation, and the health workers seem to be resisting their participation fully. It is concluded the community participation in BI could be improved if expectations were made explicit. This improvement should take into consideration the desires and priorities of the communities and issues impeding participation should be addressed.     

Preferences for benefit packages for community-based health insurance: an exploratory study in Nigeria

Background  

It is important that community-based health insurance (CBHI) schemes are designed in such a way as to ensure the relevance of the benefit packages to potential clients. Hence, this paper provides an understanding of the preferred benefit packages by different economic status groups as well as urban and rural dwellers for CBHI in Southeast Nigeria.     

Clear cell carcinoma of the base of the tongue: MR imaging findings

Clear cell carcinoma of the base of the tongue is a rare minor salivary gland neoplasm, and to our knowledge, the MR imaging appearance of this entity has not been described. We present the MR imaging findings in such a case and review the differential diagnosis for tongue base masses in an adult.     

Inequities in valuation of benefits, choice of drugs, and mode of payment for malaria treatment services provided by community health workers in Nigeria

This study determined inequities of using community health workers (CHWs) for timely and appropriate treatment of malaria in terms of: 1) valuation of benefits; 2) actual purchase of drugs; and 3) payment modality in southeast Nigeria. Socioeconomic status (SES) influenced the valuation of benefits. Also, the poorest households consumed more of the cheaper drug and less of the more expensive drug (P < 0.05). The least poor households mostly paid in full, whereas the poorest households paid mostly through installments (P < 0.05). The use of CHWs improved overall geographic but not socioeconomic equity to the drugs. Hence, interventions for timely and appropriate treatment of malaria should be accompanied by drug delivery and payment strategies that would ensure SES equity in consumption of appropriate malaria treatment services.     

Is combination therapy for malaria based on user-fees worthwhile and equitable to consumers? Assessment of costs and willingness to pay in Southeast Nigeria

OBJECTIVES: To examine the equity implications of the costs of an episode of malaria, the benefit/cost ratios of using two artemisinin-based combination therapy (CT) from the consumers' view and inequities in willingness to pay (WTP) for CT. METHODS: A cross-sectional survey was conducted in Southeast Nigeria, where there is a moderate to high level of malaria resistance to chloroquine and sulfadoxine-pyrimethamine formulations. WTP was elicited from respondents using the bidding game (BG) and the structured haggling technique (SH). A socio-economic status (SES) index was used to examine the level of inequity in the key variables. In the benefit/cost ratios, the average cost of CT in Nigeria and price of Coartem were, respectively, used as the cost inputs while the mean WTP was the measure of benefit. Multiple regression analyses were used to determine the validity of the WTP estimates. RESULTS: More than 90% of the respondents were willing to pay for CT. The mean WTP in the BG was 301.1 Naira while it was 438.0 Naira in the SH. People in the highest SES quartile (Q4) were more willing to pay for CT than the lowest SES quartile (Q1). In the regression models, the SES quartiles were significantly related to levels of WTP. The benefit/cost ratios were higher in the SH group, and the ratio was only more than 1 using Coartem in only the SH group. The Q1 groups had the least benefit cost-ratios but the trend of SES differentials in benefit/cost ratios were not statistically significant in the BG group but was in the SH group. CONCLUSION: CT based on user-fees may not be worthwhile and equitable because there are economic and equity constraints to its wide-scale use. Benefit/cost ratios depend on the type of questions that were used to elicit WTP. Governments and donors should be willing to commit funds to make CT affordable to the poor consumers for the intervention to be used to significantly reduce the burden of malaria.