ABSTRACT
Catastrophic health expenditure and impoverishment are the outcomes of poor financing mechanisms. Little is known about the prevalence and predictors of these outcomes among non-communicable disease patients in private and public health facilities. METHODS: A health facility-based comparative cross-sectional study was conducted among 360 patients with non-communicable diseases (180 per group) selected through multistage sampling. Data were collected with a semi-structured, interviewer administered questionnaire and analyzed with IBM SPSS for Windows, Version 22.0. Two prevalences of catastrophic health expenditure were calculated utilizing both the World Bank (CHE1) and the WHO (CHE2) methodological thresholds. RESULTS: The prevalence of CHE1 (Private:42.2%, Public:21.7%, p<0.001) and CHE2 (Private:46.8%, Public:28.0%, p<0.001) were higher in private health facilities. However, there was no significant difference between the proportion of impoverishment (Private: 24.3%, Public:30.9%, p=0.170). The identified predictors were occupation, number of complications and clinic visits for catastrophic health expenditure and socioeconomic status for impoverishment in private health facilities. Level of education, occupation, socioeconomic status, number of complications and alcohol predicted catastrophic health expenditure while the level of education, socioeconomic status andthe number of admissions predicted impoverishment in public health facilities. CONCLUSION: Catastrophic health expenditure and impoverishment were high among the patients, with the former more prevalent in private health facilities. Therefore, we recommend expanding the coverage and scope of national health insurance among these patients to provide them with financial risk protection. Identified predictors should be taken into account by the government and other stakeholders when designing policies to limit catastrophic health expenditure and impoverishment among them
Subject(s)
Poverty , Noncommunicable Diseases , Catastrophic Health Expenditure , Health Facilities , Patients , NigeriaABSTRACT
Background: Laparoscopic ovarian drilling (LOD) is one-off treatment modality for clomiphene citrate (CC)-resistant polycystic ovarian syndrome (PCOS) avoiding the need of medical therapy and its attendant complications. Aims and Objectives: This study aimed at determining the efficacy of LOD in women with anovulatory infertility secondary to CC-resistant PCOS and factors influencing reproductive outcomes. Materials and Methods: A cross-sectional study of infertile women who underwent LOD on account of CC-resistant PCOS between January 2012 and December 2015 at a tertiary institution. Results: Patients aged 2438 years (29.7 ± 3.6 years) and their body mass index (BMI) ranges from 20 to 35 (26.3 ± 4.3). The majority (90.5%) were nulliparous. Most (61.3%) had primary infertility. Their duration of infertility ranges from 1 to 13 years (4.3 ± 2.7) and ovarian volume ranges from 10 to 24 cm3 (mean, right ovary = 15.2 ± 3.2; left ovary = 16.3 ± 3.2). The number of drills per ovary ranged from 4 to 14 (mean, right ovary = 7.4 ± 2.1; left ovary = 7.3 ± 2.1) and the luteinizing hormone/follicle stimulating hormone (LH)/FSH ratio ranges from 2 to 6 (3.2 ± 1.4). All achieved spontaneous resumption of menses and ovulation with mean durations of 4.0 ± 1.8 days and 5.3 ± 3.2 weeks, respectively. Eighty-three (60.6%) clinical pregnancies were recorded, of which 68 (49.6%) resulted to live births (61 singletons and 7 twin births) and 14 (10.2%) early first trimester miscarriages. The mean time interval from LOD to pregnancy was 4.4 ± 1.1 months. There was a significant association between BMI, duration of infertility, FSH/LH ratio, and pregnancy outcomes (P < 0.05). Conclusion: LOD is the most preferred treatment modality for CC-resistant PCOS as it resulted in higher pregnancy rate