Catastrophic Health Expenditure and Impoverishment from NonCommunicable Diseases: A comparison of Private and Public Health Facilities in Ekiti State, Southwest Nigeria

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

Knowledge of COVID-19 and practice of preventive measures among adult residents during the ease of lockdown in Nigeria

Background: The governments of many countries have taken steps to avert the spread of COVID 19. The gradual relaxation of the lockdown in Nigeria might be counter-productive if not properly managed. The best means to reduce and stop transmission is for the public to be adequately informed about the disease and its preventive measures. This research assessed the knowledge of COVID-19 and practice of preventive measures along with its predictors among Nigerian residents during the ease of the lockdown. Methodology: A cross-sectional study was conducted among 1421 adult residents of Nigeria. Data were collected between 6th and 20th September, 2020, using a semi-structured online questionnaire adapted from previous studies. IBM SPSS version 26 was used for data analysis. Pearson's Chi-square and logistic regression were used to determine the predictors of preventive practices. Results: The mean age of the respondents was 27.5 ± 9.1 years. A very large proportion (98.8%) of the respondents had a good knowledge of the disease (score of ≥4 out of 6 variables) and the internet (70.1%) was the major source of their information. However, only 57.6% of them had good practice of preventive measures of the disease (score of ≥3 out of 4). Predictor of good practice of preventive measure included female sex (adjusted odds ratio [AOR] = 2.626; 95% confidence interval [CI] = 2.078­3.319), being married (AOR = 2.177; 95% CI = 1.568­3.023), and possessing tertiary and postgraduate level of education (AOR = 1.813; 95% CI = 1.082­3.036 and AOR = 2.102; 95% CI = 1.206­3.664, respectively). However, residents in local government headquarters and other villages as well as towns (AOR = 0.541; 95% CI = 0.388­0.756 and AOR = 0.587; 95% CI = 0.350­0.983, respectively) have less likelihood of engaging in good practice of preventive measures. Conclusion: Majority of the research participants had good knowledge of the disease, while about half take part in good preventive practices measures. Predictors of the practice measures included sex, level of education, place of residence, as well as marital status. Therefore, targeted interventions should be directed to the males, those who reside outside the Federal Capital Territory and state capitals, and other high-risk groups as found by this study to reduce the risk of disease contraction during this period.