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Public health in Nigeria

2011

Nigeria is the most populous black nation in the world with her population estimated to be about 140 million (2006 population census). In Nigeria, health care is provided through 53 tertiary health institutions; numerous secondary, primary, and private health care entities; and many private clinics and hospitals [1], yet there is no com-prehensive health insurance. This is unlike in the developed countries such as Europe and the US where health insurance is with a history of about 700 years [2, 3].The lack of a comprehensive health insurance has led to a high default rate in thyroid cancer management among other cancers, in Nigeria. Thyroid malignancy is an uncom-mon disease with a uniform world incidence of 40 per mil-lion and accounts for less than 1% or approximately 1% of all malignancies [4-6]. Although seen from childhood to old age, the peak incidence is the 6

Public Health in Nigeria Public Health in Nigeria To the Editor: Nigeria is the most populous black nation in the world with her population estimated to be about 140 million (2006 population census). In Nigeria, health care is provided through 53 tertiary health institutions; numerous secondary, primary, and private health care entities; and many private clinics and hospitals [1], yet there is no comprehensive health insurance. This is unlike in the developed countries such as Europe and the US where health insurance is with a history of about 700 years [2, 3]. The lack of a comprehensive health insurance has led to a high default rate in thyroid cancer management among other cancers, in Nigeria. Thyroid malignancy is an uncommon disease with a uniform world incidence of 40 per million and accounts for less than 1% or approximately 1% of all malignancies [4-6]. Although seen from childhood to old age, the peak incidence is the 6th decade in Europe and America and 4th decade in Africa and Asia [4]. This makes the disease a source of concern in Africa where the peak incidence is in the productive age group. Differentiated thyroid cancer which constitutes more than 85% of all thyroid malignancies is a potentially treatable disease especially if detected early and managed appropriately with patients’ survival rates reaching as high as 90% [7]. This potentially treatable disease however is still a burden to many Nigerian patients who cannot afford the cost of effective management. The average cost of treatment of thyroid cancer is $2500 (N375 000 00) in Nigeria. This average cost is beyond the reach of majority of indigent Nigerians whose average monthly income is about $67 (N10 000). We carried out a retrospective review of the 56 patients with thyroid malignancy managed since the inception of the department in April 2006 at the Department of Nuclear Medicine, University College Hospital Ibadan. In terms of affordability of treatment only 21 patients out of 56 (37.5 %) could afford the cost of diagnostic whole body iodine-131 (131I) scan while only 16 (28.6%) out 21 patients could afford 131I ablation treatment. The remaining 35 patients (62.5%) could not afford the cost of diagnostic whole body 131I scan or that of 131I treatment. Nigeria is the 37th country in the world in terms of Gross Domestic Product (GDP) as of 2007 [8] in which about 64.4% of the population live on less than $1.25 per day based on UN Human Development Report, 2009 [9]. In Nigeria, the burden of cost of treatment is on the patients; therefore, the standard management of thyroid cancer is still elusive to many patients. This situation induces a shorter overall survival of the population. www.nuclmed.gr View publication stats Authors declare that they have no conflicts of interest Bibliography 1. 2. 3. 4. 5. 6. 7. 8. 9. Alonge TA, Okoje VN. Perception of the Role of Nuclear Medicine in Clinical Practice in Nigeria. J Nucl Med 2008; 49 (3): 15N – 16N Saltman RB. Social Health Insurance in Perspective: The challenge of sustaining stability. In: Saltman RB, Busse R, Figueras J Eds. Social Health Insurance Systems in Western Europe. Open University Press, Mc-Graw Hill, England 2004; 3-20. Saltman RB, Dubois H.F.W. The Historical and Social Base of Social Health Insurance Systems. In: Saltman RB, Busse R, Figueras J Eds. Social Health Insurance Systems in Western Europe. Open University Press, Mc-Graw Hill, England 2004; 21-32. Badoe EA, Archampong EQ, Jaja MOA. Principles & Practice of Surgery 4th edn. Assemblies of God literature centre Ltd. Accra 2009; 363. Kraft O. Hepatic Metastases of Differentiated Thyroid Carcinoma. Nuc Med Rev 2005; 8 (1): 44-6. Das BK, Biswal BM, Bhavaraju VMK. Rational Management of Differentiated Thyroid Cancer. Malaysian Journal of Medical Science 2006; 13 (2): 45-51. Hundahl SA, Fleming ID, Fremgen AM, Menck HR. A National Cancer Data Base Report on 53, 856 cases of thyroid carcinoma treated in the U.S, 1985-1995. Cancer 1998; 83(12): 2638-48. Nigeria-Wikipedia. Accessed 10th February, 2011. Available at http://en.wikipedia.org/wiki/Nigeria List of countries by percentage of population living in poverty. Accessed 10th February, 2011. http://en.wikipedia.org/wiki/ List_of_countries_by_percentage_of_population_living_in_ poverty K. S. Adedapo MBBS, FWACP, MSc, Isaac O. Fadiji MBBS, Akin T. Orunmuyi MBBS, John E. Ejeh BSc, MSc, Bola O.A. Osifo MSc, PhD Department of Nuclear Medicine, University College Hospital, University of Ibadan, Ibadan Nigeria John E. Ejeh BSc, MSc Department of Nuclear Medicine, University College Hospital, P.M.B. 5116 Dugbe Post Office, Ibadan South West Nigeria E-mail: [email protected] Hell J Nucl Med 2011:14(1): 85 Hellenic Journal of Nuclear Medicine Published on line: 26 March 2011 January - April 2011