Implications of national tax policy on local pharmaceutical production in a southwestern state nigeria - qualitative research for the intersection of national pharmaceutical policy on health systems development.

BACKGROUND: Universal access to quality and affordable medicines is one of the targets of the Sustainable Development Goals (SDGs). Access to essential medicines is defined as the availability of medicine at an affordable price in public and private health institutions including retail pharmacies in the proximity of less than an hour from the home of the population. The dependence on importation to meet the drug needs of an expanding population has implications on the growth of the local pharmaceutical industry, availability, and affordability of essential medicines in the country. This study aims to understand the dynamics of tariffs and tax policy on local drug production in the pharmaceutical industry in Nigeria. METHODS: This was a qualitative study involving the use of Key Informant Interviews (KIIs). A total of 15 stakeholders were interviewed. Interviews conducted were analysed thematically. The data generated were analysed using Atlas.Ti version 8.2. RESULTS: Assessment of the pharmaceutical industry sub-sector underscores myriads of challenges facing the industry and explains why the pharmaceutical industries in Nigeria are performing sub-optimally. Key stakeholders in the sector expressed concern about the fact that substantial percentage of drugs consumed in Nigeria are imported. Local manufacturers are underperforming due to several factors. Some highlighted factors were unfriendly tax environment, high cost of production, infrastructural deficit, low patronage from the government, and lack of access to low-interest rate loans. However, tax incentives and tax cuts are proven strategies to encourage and facilitate the growth of entrepreneurs in the pharmaceutical industry. CONCLUSIONS: Stakeholders' perspective of implications of the tax environment on the pharmaceutical sector of Nigeria revealed the unfriendliness of the government policy to local manufacturers. Although the checklist for availability and prices of essential medicines in Osun state, Nigeria revealed that the pre-selected drugs were available in the facilities, the observed prices further affirmed the relative difficulty that is experienced by local manufacturers to compete with imported brands of the same drugs.

Socio-economic factors associated with antenatal care in Nigeria.

There is a dearth of knowledge on how much financial autonomy interacts with affordability and consequently access to ante-natal health care in Nigeria. This study evaluated the relationship between women's financial autonomy and utilization of antenatal care (ANC) services. ANC attendance during pregnancy and the financial autonomy of women aged 15-49 in 42,000 selected households across all 36 states and the FCT, was assessed using data from the 2018 NDHS. Descriptive statistics and bivariate and multivariate logistic regression analyses were carried out and significant predictors were tested at a 95% significance level. The proportion of women considered to have no financial, partial and full autonomies were 63.1%, 32.0% and 4.9% respectively. Living in an urban region was a statistically significant predictor of financial autonomy among women and the odds of financial autonomy increased with the level of education and wealth index. Type of residence and occupation type were also significant predictors of ANC utilization. Full financial autonomy to make financial decisions did not significantly improve the odds of antenatal health care services during pregnancy (OR = 1.03; 95% CI: 0.87 - 1.22). Other factors such as education, employment and wealth index of the women were more significantly associated with antenatal care attendance. A call for improved educational facilities and wealth creation schemes at national and sub-national levels of government is necessary to improve ante-natal care utilization in health care facilities.

Influence of Knowledge of Spousal Fertility Cycles on Male Reproductive Health Participation in Ibadan Metropolis, Nigeria.

In spite of the established roles and influence of men on women's uptake and utilization of reproductive health care interventions, the degree of involvement with intimate issues within the household which could help to understand male involvement and support remains an under-researched topic. The aim of this study was to investigate the degree of involvement at the family level of men within sub-urban communities of Ibadan in South-West Nigeria. A cross sectional survey design was conducted among 380 men selected from sub-urban communities in Ibadan, Oyo State using multi-stage sampling. Data was obtained using pre-tested, semi-structured, interviewer administered questionnaires. Data were analysed using descriptive statistics, bivariate analysis and logistic regression with level of significance set at 5%. Mean age of respondents was 41.1 ± 7.6 years. Men who were knowledgeable of spouse's menstrual cycles and ovulation dates were significantly more likely to have supported some form of public health intervention before (p <0.001). Age over 30, above secondary education, and men aware of menstrual dates of spouse were significant predictors of reproductive health interventions. Men who were aware of menstrual cycles of spouse were 96.6% more likely to be supportive or involved in reproductive health matters compared to those who were not (OR =0.034; 95% CI = 0.02 - 0.07; p <0.001). Involvement of men at family level as demonstrated in this study serves to influence and explain the level of involvement with reproductive health. Further research investigating other proximal factors that influence male participation is recommended.

Nutritional status of school children in South-west Nigeria: Inferences from a national homegrown school feeding programme.

Background: The School Feeding Programme if properly executed has the capacity to improve the nutritional status of the school children. Objective: To assess the nutritional status of school children in Ondo State Nigeria given that the National Home-Grown School Feeding Programme (NHGSFP) has been operational in the state for over five years. Methods: This was a descriptive cross-sectional study. Results: A total of 234 subjects from public schools and 227 subjects from private schools were enrolled in the study. Their mean age was 8.23 ± 1.92 years. Wasting, overweight, obesity, underweight, and stunting were noted in 19.4%, 11.4%, 0.4%, 5.0%, and 20.7% of the children, respectively. The prevalence of stunting (30.3%) and wasting (23.9%) was more among subjects from the public schools. A significant association was found between Weight-for-Age Z-score, Height-for-Age Z-score, and BMI-for-Age Z-score and the children's school type (p < 0.005). Conclusion: Majority of the children showed normal growth, the rest were in both extremes of malnutrition, the subjects from private schools seem to present better nutritional status, although there is no baseline data to ratify this finding. A further study on this subject using the current finding as a baseline data is recommended.

Correction: Experiences of doctoral students enrolled in a research fellowship program to support doctoral training in Africa (2014 to 2018): The Consortium for Advanced Research Training in Africa odyssey.

[This corrects the article DOI: 10.1371/journal.pone.0252863.].

Response to Letter to the Editor.

The authors respond to the comments raised in the letter regarding Adeniji and Obembe's article on catastrophic health expenditures in sub-Saharan Africa.

Cardiovascular Disease and Its Implication for Higher Catastrophic Health Expenditures Among Households in Sub-Saharan Africa.

Background: Cardiovascular diseases (CVDs) impose an enormous and growing economic burden on households in sub-Saharan Africa (SSA). Like many chronic health conditions, CVD predisposes families to catastrophic health expenditure (CHE), especially in SSA due to the low health insurance coverage. This study assessed the impact of CVD on the risks of incurring higher CHE among households in Ghana and South Africa. Methods: The World Health Organization (WHO) Study on Global AGEing and Adult Health (WHO SAGE), Wave 1, implemented 2007-2010, was utilized. Following standard procedure, CHE was defined as the health expenditure above 5%, 10%, and 25% of total household expenditure. Similarly, a 40% threshold was applied to household total nonfood expenditure, also referred to as the capacity to pay. To compare the difference in mean CHE by household CVD status and the predictors of CHE, Student's t-test and logistic regression were utilized. Results: The share of medical expenditure in total household spending was higher among households with CVD in Ghana and South Africa. Households with CVD were more likely to experience greater CHE across all the thresholds in Ghana. Households who reported having CVD were twice as likely to incur CHE at 5% threshold (odds ratio [OR], 1.946; confidence interval [CI], 0.965-1.095), 3 times as likely at 10% threshold (OR, 2.710; CI, 1.401-5.239), and 4 times more likely to experience CHE at both 25% and 40% thresholds, (OR, 3.696; CI, 0.956-14.286) and (OR, 4.107; CI, 1.908-8.841), respectively. In South Africa, households with CVD experienced higher CHE across all the thresholds examined compared with households without CVDs. However, only household CVD status, household health insurance status, and the presence of other disease conditions apart from CVD were associated with incurring CHE. Households who reported having CVD were 3 times more likely to incur CHE compared with households without CVD (OR, 3.002; CI, 1.013-8.902). Conclusions: Our findings suggest that CVD predisposed households to risk of higher CHE. Equity in health financing presupposes that access to health insurance should be predicated on individual health needs. Thus, targeting and prioritizing the health needs of individuals with regard to healthcare financing interventions in SSA is needed.

Assessing the knowledge and practices of primary healthcare workers on malaria diagnosis and related challenges in view of COVID-19 outbreak in a Nigerian Southwestern metropolis.

The clinical features of COVID-19 and malaria are interrelated. Due to the similarity of symptoms between the two disease states, patients can be incorrectly diagnosed with the other ailment in areas with limited health resources. There is a dearth of knowledge of co-infection between COVID-19 and malaria from healthcare providers' perspective. Hence, this study assessed the ability of primary healthcare workers to diagnose malaria infection correctly from COVID-19 infection. A multistage sampling technique was used to select health care workers who were directly involved in malaria case management at 261 government-owned primary health facilities in Oyo State. Socio-demographic characteristics of respondents, knowledge and practices, COVID-19 differential diagnosis and challenges that healthcare workers face regarding malaria diagnosis were obtained using a standardized electronic structured questionnaire. Descriptive statistics, bivariate and multivariate analysis were conducted on data collected and significant results were interpreted at a 5% level of significance. A good percentage of the respondents (81.6%, 74.3%) had good knowledge about malaria and COVID-19. However, the knowledge gained did not translate to practice, as majority (86.2%) of respondents had poor malaria diagnosis practices. Practices relating to COVID-19 differential diagnosis in 69.7% of respondents were also poor. Most of the respondents attributed poor practices to the unavailability of Malaria Rapid Diagnostic Test (mRDT), inadequate training and continuous capacity improvement. Only 12.3% of the respondents have not had any form of training on malaria diagnosis and treatment in the last five years. Harmonization of regular trainings and continuous on-the job capacity building is essential to improve case identification, diagnosis and management of both ailments. Also, uninterrupted supplies of essential commodities such as mRDT in laboratories will reduce missed opportunities for malaria diagnosis.

Sexual autonomy and the use of modern contraceptives in Nigeria: Evidence from the 2018 demographic and health survey.

Objective: The objective of the study was to determine the prevalence and relationship between sexual autonomy and modern contraceptive use among Nigerian women. Methods: Secondary data analysis of the 2018 Nigerian Demographic and Health Survey was conducted among Nigerian women aged 15-49 years who were married or had a partner. Analysis was conducted using descriptive analysis and univariate and multivariate logistic regression. P < 0.05 was considered statistically significant. Results: Participants that had never heard or seen a family planning awareness message were 59.6%, whereas 55.9% were capable of deciding whether to refuse their husband/partner's sex or not. The prevalence of modern contraceptive use was 12%, and the likelihood of using modern contraceptives increased with the level of education, wealth status, and the number of living children. Sexual autonomy was also a significant predictor of modern contraceptive use (odds ratio = 1.35, 95% confidence interval: 1.25-1.46). Conclusion: There is a very low prevalence of modern contraceptive use among women in Nigeria. Sexual autonomy, poverty, education, and the number of living children play a major role. Thus, women empowerment and girl-child education are critical interventions needed for the best outcomes on contraceptive use in Africa. Male involvement in sexual autonomy is also key since they are major decisionmakers regarding women's issues.

Résumé Objectif: L'objectif de l'étude était de déterminer la prévalence et la relation entre l'autonomie sexuelle et l'utilisation de méthodes contraceptives modernes chez les femmes nigériennes. Méthodes: L'analyse des données secondaires de l'enquête démographique et sanitaire nigérienne de l'année 2018 a été menée auprès de femmes nigérienne âgées de 15 à 49 ans mariées ou en couple. L'analyse a été effectuée à l'aide d'une analyse descriptive et d'une régression logistique univariée et multivariée. P < 0,05 était considéré comme statistiquement significatif. Résultats: Les participants qui n'avaient jamais entendu ou vu un message de sensibilisation à la planification familiale étaient 59,6 %, tandis que 55,9 % étaient capables de décider ou refuser les rapports sexuelles avec leur mari/partenaire. La prévalence de l'utilisation de méthodes contraceptives modernes était de 12 % et la probabilité d'utiliser des contraceptifs modernes augmentait avec le niveau d'éducation, la richesse et le nombre d'enfants. L'autonomie sexuelle était également un prédicteur significatif de l'utilisation de méthode contraceptives modernes (rapport des chances = 1,35, intervalle de confiance à 95 % : 1,25-1,46). Conclusion: Il y a une très faible prévalence de l'utilisation de méthodes contraceptives modernes chez les femmes nigériennes. L'autonomie sexuelle, la pauvreté, l'éducation et le nombre d'enfants jouent un rôle majeur. Ainsi, l'autonomisation des femmes et l'éducation des filles sont des interventions essentielles nécessaires pour obtenir les meilleurs résultats en matière d'utilisation des méthodes contraception en Afrique. L'implication des hommes dans l'autonomie sexuelle est également essentielle car ils jouent un rôle important dans les décisions concernant la vie de couple. Mots-clés: Utilization méthodes contraceptives, Enquête démographique et sanitaire, planification familiale, autonomie sexuelle, autonomisation des femmes.

Knowledge of school teachers and the associating factors in the effective delivery of the school health programme in Nigeria.

Introduction: the important position that teachers occupy in school settings make them indispensable in the effective delivery of the School Health Programme (SHP). This study assessed the SHP knowledge of primary school teachers and the perception of their roles in the successful delivery of the programme in Ondo State, Nigeria. Methods: this was a cross-sectional descriptive study. A multi-stage sampling technique was used to select 400 teachers from 42 primary schools, from the study population. A semi-structured self-administered questionnaire was used to collect data. Each respondent´s aggregate score was classified as being poor knowledge, if it was < 50% of the maximum obtainable score and good knowledge, if it was equal or more than 50% of the maximum obtainable score. Results: the majority of the teachers (76%) demonstrated poor knowledge of the programme. Yet, a good number of them, believe they have a part to play in the implementation of the SHP. Academic qualification was found to be statistically associated with SHP knowledge (p < 0.01). Length of time in teaching service (p= 0.035; OR=1.033; 95%CI = 1.002- 1.065) was found to be a predictor of adequate SHP knowledge. Conclusion: the SHP knowledge of the teachers was found to be inadequate. Although, most of the teachers agreed that they had roles to play in the SHP delivery, a sizeable number of them could not state what those roles entailed. It is recommended, therefore, that government and all stakeholders in education and health sectors should conduct trainings on SHP, focusing on teachers´ roles in the school community.

Development and evaluation of a package to improve hypertension control in Nigeria [DEPIHCON]: a cluster-randomized controlled trial.

BACKGROUND: Nigeria's healthcare system capacity to stem the increasing trend in hypertension is limited in coverage, scope and manpower. Use of trained community-based care providers demonstrated to be an effective complement in improving access to, and supporting healthcare delivery has not been adequately examined for hypertension care in Nigeria. This study is proposed to evaluate the effectiveness of using trained community-oriented resource persons (CORPs) to improve hypertension control in Nigeria. METHODS: An intervention study will be conducted in three states using a mixed method design. First is a baseline survey using a semi-structured pre-tested questionnaire to collect information on demographics, clinical data, knowledge, occurrence and risk factors of hypertension among 1704 adults ≥18 years. Focus group discussions (FGD) and key informant interviews (KII) will be conducted to explore a community's experience of hypertension, challenges with hypertension management and support required to improve control in 10 selected communities in each state. The second is a cluster-randomized controlled trial to evaluate effect of a package on reduction of blood pressure (BP) and prevention of cardiovascular (CVD) risk factors among 200 hypertensive patients to be followed up in intervention and control arms over a 6-month period in each state. The package will include trained CORPs conducting community-based screening of BP and referral, diagnosis confirmation and initial treatment in the health facility, followed by monthly home-based follow-up care and provision of health education on hypertension control and healthy lifestyle enhanced by phone voice message reminders. In the control arm, the usual care (diagnosis, treatment and follow-up care in hospital of a patient's choice) will continue. Third, an endline survey will be conducted in both intervention and control communities to evaluate changes in mean BP, control, knowledge and proportion of other CVD risk factors. In addition, FGD and KII will be used to assess participants' perceived quality and acceptability of the interventions as delivered by CORPs. DISCUSSION: This research is expected to create awareness, improve knowledge, perception, behaviours, attitude and practices that will reduce hypertension in Nigeria. Advocacy for buy-in and scale up of using CORPs in hypertension care by the government is key if found to be effective. TRIAL REGISTRATION: PACTR Registry PACTR202107530985857 . Registered on 26 July 2021.

Prevalence and factors associated with catastrophic health expenditure among slum and non-slum dwellers undergoing emergency surgery in a metropolitan area of South Western Nigeria.

BACKGROUND: Out of Pocket (OOP) payment continues to persist as the major mode of payment for healthcare in Nigeria despite the introduction of the National Health Insurance Scheme (NHIS). Although the burden of health expenditure has been examined in some populations, the impact of OOP among slum dwellers in Nigeria when undergoing emergencies, is under-researched. This study sought to examine the prevalence, factors and predictors of catastrophic health expenditure amongst selected slum and non-slum communities undergoing emergency surgery in Southwestern Nigeria. METHODS: The study utilised a descriptive cross-sectional survey design to recruit 450 households through a multistage sampling technique. Data were collected using pre-tested semi-structured questionnaires in 2017. Factors considered for analysis relating to the payer were age, sex, relationship of payer to patient, educational status, marital status, ethnicity, occupation, income and health insurance coverage. Variables factored into analysis for the patient were indication for surgery, grade of hospital, and type of hospital. Households were classified as incurring catastrophic health expenditure (CHE), if their OOP expenditure exceeded 5% of payers' household budget. Analysis of the data took into account the multistage sampling design. RESULTS: Overall, 65.6% (95% CI: 55.6-74.5) of the total population that were admitted for emergency surgery, experienced catastrophic expenditure. The prevalence of catastrophic expenditure at 5% threshold, among the population scheduled for emergency surgeries, was significantly higher for slum dwellers (74.1%) than for non-slum dwellers (47.7%) (F = 8.59; p = 0.019). Multiple logistic regression models revealed the significant independent factors of catastrophic expenditure at the 5% CHE threshold to include setting of the payer (whether slum or non-slum dweller) (p = 0.019), and health insurance coverage of the payer (p = 0.012). Other variables were nonetheless significant in the bivariate analysis were age of the payer (p = 0.017), income (p<0.001) and marital status of the payer (p = 0.022). CONCLUSION: Although catastrophic health expenditure was higher among the slum dwellers, substantial proportions of respondents incurred catastrophic health expenditure irrespective of whether they were slum or non-slum dwellers. Concerted efforts are required to implement protective measures against catastrophic health expenditure in Nigeria that also cater to slum dwellers.

Experiences of doctoral students enrolled in a research fellowship program to support doctoral training in Africa (2014 to 2018): The Consortium for Advanced Research Training in Africa odyssey.

BACKGROUND: The Consortium for Advanced Research Training in Africa (CARTA) aims to transform higher education in Africa. One of its main thrusts is supporting promising university faculty (fellows) to obtain high quality doctoral training. CARTA offers fellows robust support which includes funding of their attendance at Joint Advanced Seminars (JASes) throughout the doctoral training period. An evaluation is critical in improving program outcomes. In this study; we, CARTA fellows who attended the fourth JAS in 2018, appraised the CARTA program from our perspective, specifically focusing on the organization of the program and its influence on the fellows' individual and institutional development. METHODS: Exploratory Qualitative Study Design was used and data was obtained from three focus group discussions among the fellows in March 2018. The data were analyzed using thematic approach within the framework of good practice elements in doctoral training-Formal Research Training, Activities Driven by Doctoral Candidates, Career Development as well as Concepts and Structures. RESULTS: In all, 21 fellows from six African countries participated and all had been in the CARTA program for at least three years. The fellowship has increased fellows research skills and expanded our research capacities. This tremendously improved the quality of our doctoral research and it was also evident in our research outputs, including the number of peer-reviewed publications. The CARTA experience inculcated a multidisciplinary approach to our research and enabled significant improvement in our organizational, teaching, and leadership skills. All these were achieved through the well-organized structures of CARTA and these have transformed us to change agents who are already taking on research and administrative responsibilities in our various home institutions. Unfortunately, during the long break between the second and the third JAS, there was a gap in communication between CARTA and her fellows, which resulted in some transient loss of focus by a few fellows. CONCLUSION: The CARTA model which builds the research capacity of doctoral fellows through robust support, including intermittent strategic Joint Advanced Seminars has had effective and transformative impacts on our doctoral odyssey. However, there is a need to maintain the momentum through continuous communication between CARTA and the fellows all through this journey.

Affording unavoidable emergency surgical care - The lived experiences and payment coping strategies of households in Ibadan metropolis, Southwestern Nigeria.

BACKGROUND: Pre-payment and risk pooling schemes, central to the idea of universal health coverage, should protect households from catastrophic health expenditure and impoverishment; particularly when emergency care is required. Inadequate financial protection consequent on surgical emergencies occurs despite the existence of risk-pooling schemes. This study documented the experiences and coping strategies of slum and non-slum dwellers in a southwestern metropolis of Nigeria who had undergone emergency surgery. METHODS: In-depth interviews were conducted with 31 participants (13 slums dwellers, 18 non-slum dwellers) who had recently paid for emergency surgical care in Ibadan. Patients who had experienced catastrophic health expenditure from the use of emergency surgical care were identified and people who paid for the care were purposively selected for the interviews. Using an in-depth interview guide, information on the experiences and overall coping strategies during and after the hospitalization was collected. Data were analyzed inductively using the thematic approach. RESULTS: The mean age of the 31 participants (consisting of 7 men and 24 women) was 31 ± 5.6years. Apathy to savings limited the preparation for unplanned healthcare needs. Choice of hospital was determined by word of mouth, perceptions of good quality or prompt care and availability of staff. Social networks were relied on widely as a coping mechanism before and during the admission. Patients that were unable to pay experienced poor and humiliating treatment (in severe cases, incarceration). Inability to afford care was exacerbated by double billing and extraneous charges. It was opined that health care should be more affordable for all and that the current National Health Insurance Scheme, that was operating sub-optimally, should be strengthened appropriately for all to benefit. CONCLUSION: The study highlights households' poor attitude to health-related savings and pre-payment into a social solidarity fund to cover the costs of emergency surgical care. It also highlights the factors influencing costs of emergency surgical care and the role of social networks in mitigating the high costs of care. Improving financial protection from emergency surgical care would entail promoting a positive attitude to health-related savings, social solidarity and extending the benefits of social health insurance.

Association between household environmental conditions and nutritional status of women of childbearing age in Nigeria.

Maternal undernutrition remains a leading cause of morbidity and mortality in Nigeria. Yet, most interventional programmes are focused on infant and child nutrition outcomes and not on maternal nutrition-related outcomes. Evidence suggests that the integration of household environmental interventions into nutrition actions can make a difference in reducing the burden of maternal undernutrition. This study examined the influence of household environmental conditions (HHEC) on the nutritional status of women of childbearing age in Nigeria using secondary data from the 2013 Nigeria Demographic and Health Survey. The original sample of 38,948 women age 15-49 years was selected using multi-stage probability sampling. The sample for the current analysis was 23,344 after exclusion of women due to health status or provision of incomplete information. The dependent and main independent variables were undernutrition (defined as Body Mass Index below 18.5) and HHEC (generated from cooking fuel, toilet type, source of drinking water, and housing materials) respectively. Data were analysed using descriptive statistics, Chi-square, and logistic regression model at 5% level of significance. The prevalence of undernutrition among women living in houses with unimproved and improved HHEC was 17.2% and 7.2% respectively. The adjusted odds of undernutrition was significantly higher among women who lived in houses with unimproved HHEC (aOR = 2.02, C.I = 1.37-2.97, p <0.001). The odds of undernutrition are greater in young women (aOR = 2.38, C.I. = 1.88-3.00, p <0.001) compared to older, and those of lower wealth status (aOR = 2.14, CI = 1.69-2.71, p <0.001) compared to higher. Other predictors of undernutrition in women of reproductive age in Nigeria include the level of education, marital status, and working status. Living in a house with unimproved environmental conditions is a predictor of undernutrition in women. The integration of environmental and nutrition programmes could assist in addressing this burden in Nigeria.

Healthcare Service Payment Methods and Coping Strategies of Nomads and Labor Migrants in Oyo State, Nigeria.

Nomads and labor migrants constitute a vulnerable group beset with high healthcare costs due to lack of health insurance coverage. Their inability to pay for health care constitutes a threat to their well-being and health risk to the host community as they have higher morbidity from diseases and serve as a reservoir of infective agents. This study investigated how nomads and labor migrants pay and cope with necessary healthcare costs. A cross-sectional study was carried out among 323 migrants in four local government areas of Oyo State, which were selected purposively. A pretested semi-structured questionnaire that sought information on respondents' sociodemographics, healthcare payment methods and coping strategies were employed. Data were analyzed using descriptive statistics and chi-square test to test the association between categorical variables at P ≤ 0.05. The mean age of the respondents was 34.4 ± 1.4 years and 53.2% were farmers. Of the 200 respondents who had used the formal healthcare system, 13 (6.5%) obtained free services via the National Health Insurance Scheme (NHIS) and 187 (93.2%) paid out of pocket for service. Coping with health bills, 115 (62.2%) paid from savings, 34 (18.4%) borrowed money, and 58 (31.4%) sold property. Those with formal education were more likely to pay through NHIS (χ2 = 9.7, P = 0.002). Nomads/migrants in this study have demonstrated the inability to cope with payment of health bills, suggesting the need to look into the policy on healthcare funding/support to migrants and educationally disadvantaged persons. The creation of prepaid pooled payment systems such as social and community health insurance schemes is suggested.

Parental educational homogamy and under-five mortality in sub-Saharan Africa: Clarifying the association's intricacy.

Worldwide, under-five mortality (U5M) rate is highest in sub-Saharan Africa (SSA). There exists a gap in knowledge on the pathway through which Parental Educational Homogamy (PEH) influences U5M in SSA. In this study, we tested the research hypothesis' PEH is not associated with under-five children's survival probability in SSA. Demographic and health survey datasets for 21 SSA countries were analyzed. Cross-sectional design and multi-stage cluster sampling technique were used for sample selection in each of the countries under investigation. The dependent variable was the survival status of a newborn to age 59 months while the main independent variable was PEH generated from information on wife's and husband's level of education. Data were analyzed using Chi-square test, Cox-proportional hazard model and Brass-adjusted model (α=0.05). Under-five mortality rate ranges from 56/1,000 live born in South Africa to 190/1,000 live born in Sierra-Leone. Across countries, U5M rate was higher among the children of parents with at most primary education than that of parents who had at least secondary education. This pattern of U5M rate was also observed for children of parents where husbands were more educated than their wives. Maternal age at birth, sex of the child, toilet facility, type of cooking fuel, tetanus injection during pregnancy, and birth weight were significantly associated with U5M in 14, 11, 8, 7, 11, 14 and 20 countries respectively. A significant relationship was established between PEH and U5M in 11 of the 21 studied countries but was identified as a predictor of U5M in Congo Democratic Republic, Gambia and Zimbabwe. Parental educational homogamy exhibits a pattern of relationship with U5M in SSA. Ensuring that individuals particularly women have at least secondary education before childbearing will facilitate an U5M reduction in SSA.

Relationship between household wealth and childhood immunization in core-North Nigeria.

BACKGROUND: Childhood immunization rate is lowest in the core-North Nigeria. We examined the relationship between inequality in household wealth and complete childhood immunization in that part of the country. METHODS: A cross-sectional survey was conducted among 4079 mothers with children 12-23 months of age. Children were considered 'fully-immunized' if they received all the vaccines included in the immunization schedule. Data were analyzed using descriptive statistics and logistic regression models (α=5.0%). RESULTS: About 39% and 5.0% children of the rich and poor received complete immunization respectively. Also, 64.2% and 49.6% children of the rich women received BCG and DPT 3 compared to 15.9% and 8.7% observed among the children of the poor. Higher proportion of children from poor households (40.6%) received no immunization than 20.8% found from the rich households. The likelihood of receiving complete immunization was 1.95(C.I=1.35-2.80, p<0.001) times higher among the children of the rich than the poor. Other important predictors of childhood immunization were age, religion, media access, working status, husband's education, prenatal attendants and delivery place. CONCLUSION: Disparities existed in childhood immunization between the poor and rich in the core-North part of Nigeria. Policy makers should institute effective interventions that will assist children from poor households to improve their immunization access.

Determinants of wasting among schoolchildren in a Southwestern state of Nigeria: Implications to strengthen the nutritional component of primary health-care model.

BACKGROUND: Wasting is linked to about one-third of mortality among school-age children. More studies have centered on stunting among under-five children, with few documented studies exploring comparability and determinants of wasting among school pupils in southwestern Nigeria. This study aimed to investigate the comparability and determinants of wasting among schoolchildren in rural and urban communities of Obafemi-Owode local government area, Ogun State, Nigeria. METHODS: A cross-sectional study utilizing a quantitative approach was carried out among children both in rural and urban primary schools. Data were collected through interviewer-administered questionnaires. EPI-INFO version 6.03 was used, children were classified as wasted if weight-for-height Z-scores were <2 standard deviations below the National Center for Health Statistics/World Health Organization median. Associations were tested using t-tests and Chi-square test, while predictors were examined with logistic regression at 95% level of significance. RESULTS: Male gender was predominant (54.6%). Significantly more pupils from rural areas lived with grandparents and other guardians (60.3%) compared to their urban counterparts (39.7% P = 0.005). Pupils from rural schools were four times more likely to be wasted compared to those located in urban regions (odds ratio [OR]: 4.2; 95 confidence interval [CI] = 2.24-7.69). Male pupils were twice likely to be wasted compared to the female pupils (OR: 2.08; 95 CI = 1.22-3.55). CONCLUSION: Conclusively, the study revealed that the prevalence of wasting was higher among children from rural schools than in urban schools. There is an urgent need to implement viable interventions and policies that address nutritional deficiencies in primary school pupils, particularly in rural areas.