RESUMO
Objectives: This study sought to assess the current impact of health insurance coverage on medication adherence and blood pressure control of patients being managed for hypertension in Ghana and Nigeria. Methods: The study was a prospective study among 109 patients with hypertension in two health facilities with similar population dynamics in Ghana and Nigeria. Patients were systematically selected, categorized as having health insurance coverage or not, and followed up monthly for 6 months. The outcome variables (medication adherence and blood pressure control) were then measured and compared at 6 months. Analysis was done using Stata with level of significance set at p ⩽ 0.05. Results: There was a 90% insurance coverage among participants from Ghana compared to 15% from Nigeria. National Health Insurance Authority enrolees in both countries had better blood pressure control and medication adherence compared to non-enrolees (adjusted odds ratio = 2.6 and 4.5, respectively). Conclusion: National Health Insurance Authority enrolment was found to be poor among respondents in Nigeria compared to Ghana. Enrolment into the National health financing schemes in both countries led to better blood pressure control and medication adherence among patients with hypertension at primary health facilities. There is therefore the need for system strengthening to improve their sustainability.
RESUMO
Background: Hypertension is a serious health problem and it is one of the diseases that impair health-related quality of life. The central tenet of care should be to improve health-related quality of life and overall well-being and not just be limited to improving clinical outcomes. This study assesses and compares health-related quality of life and its predictors among hypertensive patients in two government hospitals in Ekiti State, Nigeria. Methods: This was a comparative cross-sectional study involving 440 hypertensive patients (220 in each group), recruited using a systematic sampling technique within the hospitals. Data on socio-demographic, economic and clinical characteristics including the cost of care for hypertension were collected from the patients. The WHOQoL-BREF questionnaire was used to assess health-related quality of life. Data were entered and analyzed using IBM SPSS Statistics for Windows, Version 22.0. Results: All domains of health-related quality of life were better among patients in federal government teaching hospitals, however, only the physical (T = -7.932, p < 0.001) and overall (T = -2.783, p = 0.006) domains were of statistical significance. An inverse relationship between cost and health-related quality of life was found in the two hospitals (State: r = -0.224, p = 0.001; Federal: r = -0.378, p < 0.001). Identified predictors of health-related quality of life were age, locality of residence, income, number of complications, exercise and smoking in both hospitals. Other predictors were marital status, living arrangement, occupation, number of medications, and involvement in religious and spiritual activities among patients in the state government teaching hospital; household size, length of diagnosis, and indirect cost among patients in the federal government teaching hospital. Conclusion: There is a need to support hypertensive patients in the state government teaching hospitals to reduce the inequality of low health-related quality of life among them. Identified predictors should be taken into consideration when putting in place policies that will improve the health-related quality of life of these patients.
