Open Access Opinion Article

Nigeria National Health Insurance Scheme: A Highly Subsidized Health Care Program for a Privileged Few

David A. Adewole, Kayode O. Osungbade

International Journal of TROPICAL DISEASE & Health, Page 1-11
DOI: 10.9734/IJTDH/2016/27680

The National Health Insurance Scheme (NHIS) of Nigeria was established over a decade ago with the aim of achieving universal health coverage within ten years of inception. Currently the population coverage is less than 10%. Beneficiaries are primarily the formal sector employees. An assessment of the three dimensions of universal health coverage in the South West geo-political zone of Nigeria is essential to determine the gaps in these areas. These will be of assistance for policy makers in efforts to expand the scheme.

Methods: Secondary data on health indices such as life expectancy at birth, infant and under - 5 mortality rates, maternal mortality ratio and infectious diseases prevalence, were accessed from the World Bank website. The premium paid per enrollee was obtained from the Strategic Review of Nigeria’s National Health Insurance Scheme Population figures was obtained from the Nigerian population census from the National Population Commission website, while data on the number of enrollees, accredited facilities and the distribution of these by State in the South West geo-political zone was obtained from the NHIS South West Zonal Office in Ibadan, Oyo State Nigeria. The available data were manually analyzed with the aid of the MicroSoft – Excel. Appropriate tables to align with the study objectives were generated. Ethical approval to use some of the data was obtained from the NHIS southwest zonal office, Ibadan Nigeria.

Results: Poor health indices exemplified by low life expectancy at 54 years, high infant and under 5 mortality rates of 88 and 143 per 1000 live births respectively. Maternal mortality ratio was 630 per 100,000 live births. Estimated percentage of enrollees of the population was 1.7. At an annual growth rate of 2.7%, the estimated population of the southwest zone in 2016 is over 35 million people of which only 1.7% were enrollees under the scheme. Seventy-five per cent or above of enrollees in the zone were registered with just over 10% of all the accredited health facilities. Funding of the scheme was solely limited to contributions from the federal government while beneficiaries contribution was nil, with a resultant shortfall of about one-third of the expected total fund. The population coverage of the scheme in the southwest zone was poor, the, distribution of the enrollees across accredited health facilities was grossly skewed, and funding of the scheme was inadequate. These findings have negative implications on efficiency of service delivery, and equitable access to quality health care services. Stakeholders must address these gaps if universal health coverage is to be achieved.

Open Access Original Research Article

Women and Providers’ Perception, Attitude and Satisfaction with Focused Antenatal Care in Ondo State, Nigeria

O. A. Fatile, O. A. Akpor, F. A. Okanlawon, E. O. Fatile

International Journal of TROPICAL DISEASE & Health, Page 1-12
DOI: 10.9734/IJTDH/2016/27673

Aims: The overall objective of the study is to evaluate women and providers’ perception, attitude and satisfaction with antenatal care in Ondo State using the new Focused Antenatal care (FANC) model as this information will improve quality of ANC provided for women in Ondo state.

Study Design: A quantitative design was used.

Place and Duration of Study: This study was conducted in two selected hospitals in Ondo State, the State Specialist Hospital (SSH), Akure offering FANC as intervention site and Arakale Maternity Hospital (as comparison site), also located in Akure South Local Government Area of Ondo State Nigeria. The study was conducted between September and October 2011.

Methodology: A purposive sampling technique was used in the study. 200 women were selected using simple random sampling from the daily register and all the thirty nurses working in the maternal and child health clinics of the two hospitals participated.  The instruments used were self-administered questionnaire for the nurses and interviewer administered questionnaire for the women. Data was analysed using the Statistical Package for Social Sciences (SPSS).

Results: Findings from the study revealed that the majority of the women 104 (55.9%) were aged 25 – 34 years and majority of the respondents 110 (56.7%) of women, had 4-6 children. 120 (60%) pregnant women and 18 (60.7%) providers still preferred the traditional ANC. Hypothesis 1 revealed that there is a significant relationship between perception and attitude towards FANC among Nurses r = 0.59 P ≤ 0.01. Hypothesis 2 showed a significant difference in the perceived satisfaction among women in FANC and traditional ANC with t - 7.995, P ≤ 0.05 this shows that women in FANC are more satisfied.

Conclusion: The benefits of quality maternal health service especially antenatal care cannot be overemphasized. Focused antenatal care practice can be enhanced by establishing link between the community and the health facility in order to increase utilization of the services offered by the new WHO package. Therefore, there is need for the implementation of focused ante natal care at all levels of healthcare delivery system in Nigeria.

Open Access Original Research Article

Duffy Blood Group Distribution among Patients in a Malaria Endemic Region

I. Z. Isaac, R. T. John, F. P. Udomah, M. Imoru, O. Erhabor, A. Femi

International Journal of TROPICAL DISEASE & Health, Page 1-5
DOI: 10.9734/IJTDH/2016/29050

Background: It was noted since in the 1920s that Black Africans had some intrinsic resistance to infection with malaria. Duffy negative status is suggested to play a role in resistance to malaria infection and has been reported with higher frequencies in countries where there is a high incidence of Plasmodium vivax malaria. We carried out this study to find out the distribution of Duffy blood group among patients in a tertiary hospital.

Study Design: Two hundred and twenty nine hospitalized patients requiring a red cell transfusion with age range of between 1 year and 75 years and mean age of 27.3 years, were recruited for the study.

Materials and Methods: Three milliliters of whole blood was collected from each subject into an EDTA anticoagulated tubes. The red cell was typed for Duffy antigen using potent antisera from Lorne Laboratory UK according to the manufacturer’s instructions.

Results: This study reported that 19.2% were Duffy positive (Fya+b-, Fya-b+ and Fya+b+ with respective prevalence of 7.4%, 4.4% and 7.4%) while 80.8% (61.1% Females and 19.7% Males) of the patients were Duffy negative (Fy a-b-). The prevalence of Duffy negative was highest among age group 21-30 with 26.2%, followed by age group 31-40 with 17.5% and the least was age group 41 – 50 years with 3.5%. The prevalence of Duffy negative among the three ethnic groups of Hausa, Igbo and Yoruba was 180(78.6%), 2(0.9%) and 3(1.3%) respectively.

Conclusion: We concluded that we now have Duffy positive group in Nigeria a potential risk to P. vivax infection and recommend that the Nigeria government should carry out an epidemiological study on the prevalence of Plasmodium vivax and Plasmodium knowlesi.

Open Access Original Research Article

Effects of Childhood Malaria on the Biochemical and Haematological Profiles of Infected Children in Anambra State, Nigeria

Obiageli Panthe Okeke, Cyril Ali Imakwu, Joseph Effiong Eyo, Fabian C. Okafor

International Journal of TROPICAL DISEASE & Health, Page 1-14
DOI: 10.9734/IJTDH/2016/26619

Background: The present study was carried out to establish data on the effects of childhood malaria on plasma levels of some haematological and biochemical parameters in the pathology of malaria in Anambra state children.

Methods: The concentrations of   sodium ion (Na+), bilirubin, alkaline phosphatase (ALP), serum glutamate oxaloacetate transaminase (SGOT), serum glutamate pyruvate transaminase (SGPT), total iron concentration, Haemoglobin (Hb), packed cell volume (PCV) and white blood cell (WBC), in blood samples of malaria parasitaemic children and control were evaluated using standard methods. Chi- square, Fisher Least Significance Difference, t-test, analysis of variance (ANOVA) and multiple regressions were employed to test significant differences among the variables. For all determination, the significant difference was set at p<0.05.

Results: The female children infected with malaria parasites had a significant higher mean PCV than the male in the communities (31.73 ± 4.58 to 28.25 ± 3.75) and hospitals (31.12 ± 11.78 to 28.27 ± 5.56) surveyed respectively. Also the female infected children had significant higher WBC count than male. WBC count in malaria infection was gametocyte count dependent. Gametocyte count of 1 – 10 and 11 – 100 in communities and hospitals surveyed had significant different WBC count. In the age group comparison, malaria infected and uninfected children 0 – 4.9 years had significant higher bilirubin concentrations (0.55 ± 0.25 to.35 ± 0.14). Children aged 10 – 14.9 years old had significant higher Hb (10.30 ± 0.29 to 10.90 ± 0.26) than other age groups in the survey. Age comparison showed that PCV and Hb concentrations of malaria infected children aged 5 – 9.9 years were significantly lower than the control. Sex and age may be a determining factor for low PCV since male infected children had significant lower PCV in both community and hospital surveys. Hypernatraemia was generally observed in malaria infection amongst children in Anambra state. In hospital infections, there was significant elevation in the concentrations of liver enzyme (SGOT) in Plasmodium infected male more than their female counterpart.

Conclusion: Symptomatic and asymptomatic malaria are associated with anaemia and haemoglobinuria. WBC counts in childhood malaria are gametocyte count dependent. Sex and age are predisposing factor for low PCV since the infected male children had a significant lower PCV in both community and hospital surveys.

Open Access Review Article

Promoting Diabetes Self Management Education [DSME] through Community Based Care in Nigeria

Onyebigwa Onyemaechi Onyekachukwu

International Journal of TROPICAL DISEASE & Health, Page 1-15
DOI: 10.9734/IJTDH/2016/28781

Nigeria has the largest number of people living with diabetes mellitus in Africa and through a period of ten years, there was an over 50% increase in morbidity rates. There is also a twin burden of communicable and non-communicable diseases in Nigeria which influences the poor life expectancy rate of 54 years. Diabetes mellitus is a chronic disease and with the help of the chronic care model, functional and clinical outcomes are highly dependent on an informed, activated patient. In Nigeria, the organization of health care for diabetes has improved to the state of having country specific clinical management guidelines but our outcomes are still far below standards. At present, the care arrangement that is operational is the traditional hospital-based management as well as alternative/unorthodox health care practices. Self-management among people living with diabetes is still very poor and non-adherence to clinical regimen is rampant and greatly influenced by cultural beliefs. The chronic care model is fully functional in developed countries and underway in developing ones. However, there is a dearth of research into effective forms of care outside the clinical settings in Nigeria. In fact, diabetes self-management and education [DSME] in Nigeria, revolves around the secondary care level with few referrals in some states back to the primary health care level. Community based care for diabetes mellitus remains an untapped resource which can go a long way in promoting self-care behaviours especially when it is culturally sensitive and supportive. This review paper aims at exploring barriers and facilitators of community based care for DSME in Nigeria with the goal of producing informed, activated patients who can serves as peer models and can promote disease prevention habits among members of families and communities.