International Journal of Health Services, Oct 26, 2022
The prevalence of diabetes mellitus and hypertension is increasing yearly in many low- and middle... more The prevalence of diabetes mellitus and hypertension is increasing yearly in many low- and middle-income countries such as Nigeria. The increasing burden of these noncommunicable diseases has led to an increase in the overall cost of health care. This study aimed at determining the direct and indirect health care costs of diabetes mellitus and hypertension occurring both singly and in co-morbidity. The study was undertaken in the Enugu State University Teaching Hospital (a tertiary hospital) in Enugu State, Southeast Nigeria. Data were collected using a pre-tested questionnaire. Out of 817 patients interviewed, 37% had only diabetes mellitus, 35% had hypertension, and 28% had both diabetes mellitus and hypertension in co-morbidity. Direct costs of treating diabetes mellitus and hypertension in the month before the survey were $28.40 and $19.35, respectively, while the indirect costs of treatment in the month before the study were $7.36 and $5.51, respectively. Direct and indirect costs for diabetes mellitus and hypertension in co-morbidity were $37.00 and $4.62, respectively. A concentration index showed that diabetes mellitus and hypertension were more evident among the poor than the rich. The economic cost when compared with patients’ income revealed that >25% of their income is spent monthly on health care.
International Journal of Social Determinants of Health and Health Services
The prevalence of diabetes mellitus and hypertension is increasing yearly in many low- and middle... more The prevalence of diabetes mellitus and hypertension is increasing yearly in many low- and middle-income countries such as Nigeria. The increasing burden of these noncommunicable diseases has led to an increase in the overall cost of health care. This study aimed at determining the direct and indirect health care costs of diabetes mellitus and hypertension occurring both singly and in co-morbidity. The study was undertaken in the Enugu State University Teaching Hospital (a tertiary hospital) in Enugu State, Southeast Nigeria. Data were collected using a pre-tested questionnaire. Out of 817 patients interviewed, 37% had only diabetes mellitus, 35% had hypertension, and 28% had both diabetes mellitus and hypertension in co-morbidity. Direct costs of treating diabetes mellitus and hypertension in the month before the survey were $28.40 and $19.35, respectively, while the indirect costs of treatment in the month before the study were $7.36 and $5.51, respectively. Direct and indirect co...
OBJECTIVES Nigeria is one of the 30 high-burden countries for TB and currently, recurrent costs o... more OBJECTIVES Nigeria is one of the 30 high-burden countries for TB and currently, recurrent costs of TB treatment services are largely dependent on donor-funding, with government providing the health facilities. This study aims to assess the benefit incidence of TB treatment services so as to determine if the poor and rural dwellers preferentially benefit from such services that were subsidized by government and donors. METHODS A survey of patients (n=202) accessing TB treatment services was conducted between 2019 and 2020 in five purposively selected rural and urban health facilities in Enugu State. Socioeconomic status (SES) was estimated using household assets ownership. Benefits of TB services were measured by multiplying the unit cost of utilization of different services while the net benefit was calculated by subtracting out-of-pocket (OOP) payments incurred from the benefits. We estimated the benefit for one month and the benefit for the whole TB treatment course (6 months). Concentration index was used to determine the level of equity in spending across the socio-economic quintiles. RESULTS 56.4% of the respondents were from urban facilities. 100% had used TB drugs in the past months, 73% had undergone a Gene-Xpert test, and 67% had had a consultation. All patients received TB drugs without OOP payment, but 90% paid for X-ray. Urban respondents captured a disproportionally higher share of benefit from TB services. The concentration index was -0.025 for net benefit from TB services across different quintiles, indicating the pro-poor distribution of TB services in Nigeria. CONCLUSIONS The benefit from TB services had a pro-poor distribution, but urban respondents obtained a disproportionally higher share of gross and net benefit from TB services. Funding for TB services needs to be secured to promote the equitable access to TB services.
Tropical Medicine & International Health, 2020
ObjectiveTo determine the population groups that benefit from a Free Maternal and Child Health (F... more ObjectiveTo determine the population groups that benefit from a Free Maternal and Child Health (FMCH) programme in Enugu State, South‐east Nigeria, so as to understand the equity effects of the programme.MethodA community‐based survey was conducted in rural and urban local government areas (LGAs) to aid the benefit incidence analysis (BIA) of the FMCH. Data were elicited from 584 randomly selected women of childbearing age. Data on their level of utilisation of FMCH services and their out‐of‐pocket expenditures on various FMCH services that they utilised were elicited. Benefits of the FMCH were valued using the unit cost of providing services while the net benefit was calculated by subtracting OOP expenditures made for services from the value of benefits. Costs were calculated in local currency (Naira (₦)) and converted to US Dollars. The net benefits were disaggregated by urban–rural locations and socio‐economic status (SES). Concentration indices were computed to provide the level...
Community based health insurance (CBHI) is a not-for-profit type of health insurance that has bee... more Community based health insurance (CBHI) is a not-for-profit type of health insurance that has been used by poor people to protect themselves against the high costs of seeking medical care and treatment for illness. In CBHI schemes, members regularly pay small premiums into a collective fund which is then used to pay for health services that they require. Many CBHI schemes are designed for people that live and work in rural areas or the informal sector who are unable to get adequate public, private, or employer-sponsored health insurance.
Background In Nigeria, health maintenance organizations (HMOs) are the purchasers of health insur... more Background In Nigeria, health maintenance organizations (HMOs) are the purchasers of health insurance with a social National Health Insurance Scheme for civil servants. However the roles of HMOs in implementation of social health insurance are not clear. This study determined the roles of HMOs in implementation of the national social health insurance scheme in Enugu, Southeast Nigeria. Methods A partially mixed sequential dominant status design was employed in the study. Quantitative data were collected from 613 Federal Government employees that are registered with the National Health Insurance Scheme (NHIS) as part of the Formal Sector Social Health Insurance Program (FSSHIP) using an interviewer-administered questionnaire. Test for sampling adequacy was ensured (KMO, 0.701) and likewise the sphericity of the data using Bartlett’s test (Chi [1] 796.72, p-value < 0.001). For the qualitative study, there was document review and in-depth interviews. A total of 28 in-depth interview...
International Journal of Medicine and Health Development, 2019
Objective: The study investigated the level of awareness and extent of financial risk protection ... more Objective: The study investigated the level of awareness and extent of financial risk protection among the population in Enugu state, southeast Nigeria. Materials and Methods: A mixed-method approach involving cross-sectional quantitative and qualitative methods was adopted for data collection and analysis. The study was conducted in two purposively selected urban and rural local government settings in Enugu North and East senatorial zones, respectively. Results: The quantitative results show that most of the respondents (77.1%) were women and 80.2% were married. Slightly above a quarter of the respondents (25.6%) were self-employed, whereas 29.1% were main income earners. Out-of-pocket (OOP) dominates payment mechanisms (94.9%), whereas more than half (54.4%) of the respondents went to patent medicine dealers for treatment in the last one month. Logistic regression shows overall significance in use of prepayment mechanisms with χ2 = 56.57 and P = 0.001. More so, finding indicates that 55.9% of respondents have heard of prepayment mechanisms mainly from television (30.4%) and radio program (20.2%), while 89.5% has not used any prepayment mechanism in the State. Conclusion: OOP still dominates payment mechanism in Enugu state. Although over half of the respondents (55.9%) have heard of prepayment mechanisms, approximately 90% has not used any prepayment mechanism in the State. This calls for policy that will ensure moving away from OOP payment to prepayment mechanism through health system strengthening and awareness creation for the populace.
The aim of this study was to investigate the socio-economic status (SES) and geographic differenc... more The aim of this study was to investigate the socio-economic status (SES) and geographic differences in occurrence and burden of tropical endemic diseases, as well as the health seeking behaviours of individuals residing in Ebonyi State, Nigeria. The study was undertaken in three communities (urban, semi-urban and rural). A pre-tested structured interview schedule was used to collect data from randomly selected households. An asset-based SES index was used to examine the occurrence of socio-economic equity in burden of disease and health seeking behaviours, whilst comparisons between the three communities were used to explore geographic equity in the burden of disease and health seeking behaviours of households. The majority of the households reported occurrences of illness during the month preceding the survey. Malaria and diarrhoea were the most commonly reported illnesses. There were inequities in the burden of disease and treatment seeking behaviours amongst the study groups. The...
International Journal of Health Services, Oct 26, 2022
The prevalence of diabetes mellitus and hypertension is increasing yearly in many low- and middle... more The prevalence of diabetes mellitus and hypertension is increasing yearly in many low- and middle-income countries such as Nigeria. The increasing burden of these noncommunicable diseases has led to an increase in the overall cost of health care. This study aimed at determining the direct and indirect health care costs of diabetes mellitus and hypertension occurring both singly and in co-morbidity. The study was undertaken in the Enugu State University Teaching Hospital (a tertiary hospital) in Enugu State, Southeast Nigeria. Data were collected using a pre-tested questionnaire. Out of 817 patients interviewed, 37% had only diabetes mellitus, 35% had hypertension, and 28% had both diabetes mellitus and hypertension in co-morbidity. Direct costs of treating diabetes mellitus and hypertension in the month before the survey were $28.40 and $19.35, respectively, while the indirect costs of treatment in the month before the study were $7.36 and $5.51, respectively. Direct and indirect costs for diabetes mellitus and hypertension in co-morbidity were $37.00 and $4.62, respectively. A concentration index showed that diabetes mellitus and hypertension were more evident among the poor than the rich. The economic cost when compared with patients’ income revealed that &gt;25% of their income is spent monthly on health care.
International Journal of Social Determinants of Health and Health Services
The prevalence of diabetes mellitus and hypertension is increasing yearly in many low- and middle... more The prevalence of diabetes mellitus and hypertension is increasing yearly in many low- and middle-income countries such as Nigeria. The increasing burden of these noncommunicable diseases has led to an increase in the overall cost of health care. This study aimed at determining the direct and indirect health care costs of diabetes mellitus and hypertension occurring both singly and in co-morbidity. The study was undertaken in the Enugu State University Teaching Hospital (a tertiary hospital) in Enugu State, Southeast Nigeria. Data were collected using a pre-tested questionnaire. Out of 817 patients interviewed, 37% had only diabetes mellitus, 35% had hypertension, and 28% had both diabetes mellitus and hypertension in co-morbidity. Direct costs of treating diabetes mellitus and hypertension in the month before the survey were $28.40 and $19.35, respectively, while the indirect costs of treatment in the month before the study were $7.36 and $5.51, respectively. Direct and indirect co...
OBJECTIVES Nigeria is one of the 30 high-burden countries for TB and currently, recurrent costs o... more OBJECTIVES Nigeria is one of the 30 high-burden countries for TB and currently, recurrent costs of TB treatment services are largely dependent on donor-funding, with government providing the health facilities. This study aims to assess the benefit incidence of TB treatment services so as to determine if the poor and rural dwellers preferentially benefit from such services that were subsidized by government and donors. METHODS A survey of patients (n=202) accessing TB treatment services was conducted between 2019 and 2020 in five purposively selected rural and urban health facilities in Enugu State. Socioeconomic status (SES) was estimated using household assets ownership. Benefits of TB services were measured by multiplying the unit cost of utilization of different services while the net benefit was calculated by subtracting out-of-pocket (OOP) payments incurred from the benefits. We estimated the benefit for one month and the benefit for the whole TB treatment course (6 months). Concentration index was used to determine the level of equity in spending across the socio-economic quintiles. RESULTS 56.4% of the respondents were from urban facilities. 100% had used TB drugs in the past months, 73% had undergone a Gene-Xpert test, and 67% had had a consultation. All patients received TB drugs without OOP payment, but 90% paid for X-ray. Urban respondents captured a disproportionally higher share of benefit from TB services. The concentration index was -0.025 for net benefit from TB services across different quintiles, indicating the pro-poor distribution of TB services in Nigeria. CONCLUSIONS The benefit from TB services had a pro-poor distribution, but urban respondents obtained a disproportionally higher share of gross and net benefit from TB services. Funding for TB services needs to be secured to promote the equitable access to TB services.
Tropical Medicine & International Health, 2020
ObjectiveTo determine the population groups that benefit from a Free Maternal and Child Health (F... more ObjectiveTo determine the population groups that benefit from a Free Maternal and Child Health (FMCH) programme in Enugu State, South‐east Nigeria, so as to understand the equity effects of the programme.MethodA community‐based survey was conducted in rural and urban local government areas (LGAs) to aid the benefit incidence analysis (BIA) of the FMCH. Data were elicited from 584 randomly selected women of childbearing age. Data on their level of utilisation of FMCH services and their out‐of‐pocket expenditures on various FMCH services that they utilised were elicited. Benefits of the FMCH were valued using the unit cost of providing services while the net benefit was calculated by subtracting OOP expenditures made for services from the value of benefits. Costs were calculated in local currency (Naira (₦)) and converted to US Dollars. The net benefits were disaggregated by urban–rural locations and socio‐economic status (SES). Concentration indices were computed to provide the level...
Community based health insurance (CBHI) is a not-for-profit type of health insurance that has bee... more Community based health insurance (CBHI) is a not-for-profit type of health insurance that has been used by poor people to protect themselves against the high costs of seeking medical care and treatment for illness. In CBHI schemes, members regularly pay small premiums into a collective fund which is then used to pay for health services that they require. Many CBHI schemes are designed for people that live and work in rural areas or the informal sector who are unable to get adequate public, private, or employer-sponsored health insurance.
Background In Nigeria, health maintenance organizations (HMOs) are the purchasers of health insur... more Background In Nigeria, health maintenance organizations (HMOs) are the purchasers of health insurance with a social National Health Insurance Scheme for civil servants. However the roles of HMOs in implementation of social health insurance are not clear. This study determined the roles of HMOs in implementation of the national social health insurance scheme in Enugu, Southeast Nigeria. Methods A partially mixed sequential dominant status design was employed in the study. Quantitative data were collected from 613 Federal Government employees that are registered with the National Health Insurance Scheme (NHIS) as part of the Formal Sector Social Health Insurance Program (FSSHIP) using an interviewer-administered questionnaire. Test for sampling adequacy was ensured (KMO, 0.701) and likewise the sphericity of the data using Bartlett’s test (Chi [1] 796.72, p-value < 0.001). For the qualitative study, there was document review and in-depth interviews. A total of 28 in-depth interview...
International Journal of Medicine and Health Development, 2019
Objective: The study investigated the level of awareness and extent of financial risk protection ... more Objective: The study investigated the level of awareness and extent of financial risk protection among the population in Enugu state, southeast Nigeria. Materials and Methods: A mixed-method approach involving cross-sectional quantitative and qualitative methods was adopted for data collection and analysis. The study was conducted in two purposively selected urban and rural local government settings in Enugu North and East senatorial zones, respectively. Results: The quantitative results show that most of the respondents (77.1%) were women and 80.2% were married. Slightly above a quarter of the respondents (25.6%) were self-employed, whereas 29.1% were main income earners. Out-of-pocket (OOP) dominates payment mechanisms (94.9%), whereas more than half (54.4%) of the respondents went to patent medicine dealers for treatment in the last one month. Logistic regression shows overall significance in use of prepayment mechanisms with χ2 = 56.57 and P = 0.001. More so, finding indicates that 55.9% of respondents have heard of prepayment mechanisms mainly from television (30.4%) and radio program (20.2%), while 89.5% has not used any prepayment mechanism in the State. Conclusion: OOP still dominates payment mechanism in Enugu state. Although over half of the respondents (55.9%) have heard of prepayment mechanisms, approximately 90% has not used any prepayment mechanism in the State. This calls for policy that will ensure moving away from OOP payment to prepayment mechanism through health system strengthening and awareness creation for the populace.
The aim of this study was to investigate the socio-economic status (SES) and geographic differenc... more The aim of this study was to investigate the socio-economic status (SES) and geographic differences in occurrence and burden of tropical endemic diseases, as well as the health seeking behaviours of individuals residing in Ebonyi State, Nigeria. The study was undertaken in three communities (urban, semi-urban and rural). A pre-tested structured interview schedule was used to collect data from randomly selected households. An asset-based SES index was used to examine the occurrence of socio-economic equity in burden of disease and health seeking behaviours, whilst comparisons between the three communities were used to explore geographic equity in the burden of disease and health seeking behaviours of households. The majority of the households reported occurrences of illness during the month preceding the survey. Malaria and diarrhoea were the most commonly reported illnesses. There were inequities in the burden of disease and treatment seeking behaviours amongst the study groups. The...
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Papers by Eric Obikeze