The catastrophic cost of motorcycle road traffic injuries: Experience from a major reference centre in a lower-middle income country.

BACKGROUND: Motorcycle crashes are an increasing public health problem in low- and middle-income countries (LMICs). An accurate estimation of the economic burden of these crashes could be complex owing to a prevalent system of out-of-pocket (OOP) payment for health care services in these countries. Our study aims to objectively evaluate the cost implication of motorcycle Road Traffic Injuries (RTIs) among road crash victims managed at a major trauma reference hospital in Nigeria. Two economic evaluation methods were used to accurately reflect the cost-of-care (C-o-C) of each victim as well as for cross-validation. METHOD: This is a prospective cohort study conducted between August 2020 and May 2021. All patients involved in motorcycle road traffic crashes presenting to the Emergency Department of the University College Hospital, Ibadan, Nigeria, were included in the study. For each patient, all medical expenses from the time of injury (T0) to 30 days after injury (T30) or Time to death (TD) - whichever occurred first, were valued in costs, and added (Activity-based costing or ABC), while also estimating overall cost-of-care (C-o-C) at T30 or TD, using the willingness-to-pay (WTP) method. Following the WHO definition, catastrophic expenditure was defined as expenditure > 25% of the patient's estimated annual household income. RESULTS: Of the 150 consecutively managed motorcycle crashes victims during the study period, 112 had complete data. The median monthly household income for the cohort was $121 with 75% of them earning less than $180. The median cost-of-care (C-o-C), by ABC, was $242 ($143 - 828). For individual care items, expenditure on surgical intervention(s) was the highest followed by prosthesis and implant procurement, and radiological investigations. On the other hand, the estimated medical cost was $2356 (IQR $938 - 6475) by WTP. Only 14% had health insurance coverage. The overall expenditure was catastrophic for 46% of the patients. Monthly household income of < $180 (AOR=9.2; 95% CI=2.6-32.8; p < 0.001), absence of health insurance coverage (AOR=10.7; 95% CI=1.1-101.6; p = 0.040), and prolonged hospital stay above 14 days (AOR=25.1; 95% CI=5.5 -115.1; p = 0.001) were predictors of catastrophic expenditure. There was a weak positive correlation between actual cost-of-care using the ABC method and WTP (r = 0.247; p = 0.102). CONCLUSION: The aggregate cost of motorcycle RTIs is catastrophic for nearly half of the victims attending the University College Hospital, Ibadan. The willingness-to-pay method, though less tedious is often less reliable in these settings owing to a prevalent OOP payment system. This study identified the need to implement effective financial protection mechanisms against the high OOP expenditure faced by motorcycle crash victims in LMICs.

The complications seen from the treatment by traditional bonesetters.

Traditional bone setters are rampant in the West African subregion but the atrocities committed by them have never been reported hence the need for this article that deals with the menace caused by them. All patients referred to the University College Hospital between 1996 and 2001 were included in this study. Only a few number of the patients have been selected just to illustrate the menace caused by the traditional bonesetters in so many African societies. The deformities, financial loss and amputations resulting from the management by traditional bonesetters have been highlighted. Suggestions are made on how to improve awareness in the way of adequate communications through televisions, radio and the press. Much need to be done in the society as it was found in the study that poverty or lack of education alone is not the major cause of the society seeking the help of the traditional healers, but probably the culture and traditional beliefs of the society.