Household Cost of Antenatal Care and Delivery Services in a Rural Community of Kaduna State; Northwestern Nigeria

Maternal mortality remains a leading cause of death among women of reproductive age. While Nigeria has only two percent of the global population; it contributes 10 to the global maternal mortality burden. Antenatal care (ANC) reduces the incidence of maternal mortality. However; financial capability affects access to antenatal care. Thus; the rural poor are at a higher risk of maternal mortality. Materials and Methods: A cross-sectional descriptive study involving 135 women (pregnant women and those who are 6 weeks postpartum). Structured interviewer-administered questionnaires were used for data collection. Data analysis was carried out using statistical package for social sciences software (version 17). Results: The average amount spent on booking and initial laboratory investigations were N77 (half a dollar) and N316 ($2); respectively. Per ANC visit; average amount spent on drugs and transportation were N229 ($1.5) and N139 ($0.9) respectively. For delivery; the average amount spent was N1500 ($9.6). On an average; ANC plus delivery cost about N3;365.00 ($22). There was a statistically significant association between husband's income and ANC attendance (X 2 = 2.451; df = 2; P = 0.048). Conclusion: Cost of Antenatal care and delivery services were not catastrophic but were a barrier to accessing antenatal care and facility-based delivery services in the study area. ANC attendance was associated with the income of household heads. Pro-poor policies and actions are needed to address this problem; as it will go a long way in reducing maternal mortality in this part of the country

An Evaluation of the Prevalence of HIV/AIDS on Selected Economies of Sub-Saharan Africa

Human immunodeficiency syndrome (HIV) whose full-blown period is called acquired immunity deficiency syndrome (AIDS) is today a terminal disease. While one weakens the body hormones; the other comes to claim the life with its accompanying opportunistic diseases. Several factors have been reviewed to be causing the infection and its prevalence as well as its socio-economic; scientific and cultural dimensions. The cost implication of this ailment is enormous when considered from individual; national or global perspective; especially when the cost of treatment and the cost of the disability adjusted life years (DALYs) lost to incapacitation from HIV/AIDS is considered. This study has investigated the financial implications of treatment and the DALYs lost to HIV/AIDS from the perspective of sub-Saharan Africa covering thirty-five countries. Infected population of age 15-49 years were considered; being the active life year age group. Applying Morrow's DALYs measurement; and Ainsworth's per capita general rule method of costing HIV/AIDS; it was found that the cost of treatment of HIV/AIDS in any country depends on her economic strength on the one hand and the size of the infected population on the other; to the extent that no country spends or loses less than 3 percent of her national income on treatment and to DALYs. To any country; the financial cost of the DALYs lost to HIV/AIDS is much more than the cost of treatment per episode; mostly huge enough to develop a sector of the country's economy. However; a single recommendation could be difficult as individual countries experience different effect; but different countries must pursue long-run anti-prevalence policies individually and as economic region or bloc

Further Potential Savings Attributable to Maximum Generic Substitution of Antidepressants in South Africa: a Retrospective Analysis of Medical Claims

The main objective of the study was to calculate potential cost savings that could have been generated by maximum generic substitution of antidepressants within the private health care sector of South Africa from 2004 to 2006. Data on computerized medicine claims of patients receiving one or more antidepressants during three consecutive years (i.e. 2004; 2005 and 2006) were elicited from a South African pharmaceutical benefit management company. The total study population consisted of 292 071 items (N = 5 982 869) on 273 673 prescriptions (N = 5 213 765) at a total cost of R56 183 697.91 (N = R1 346 210 929.00). A quantitative; retrospective drug utilization review was conducted; and data were analyzed using the Statistical Analysis Systemr programme. Potential cost savings were computed for criteria-eligible substances in the study population. Generic medicine constituted 58.7(N = 292 071) of all antidepressants claimed; at a total cost of 28.2(N = R1 346 210 929.00) of all incurred costs. With total substitution of the average price of all criteria-eligible innovators; a potential saving of 9.3(N = R56 183 697.91) of the actual antidepressant cost over the study period was calculated. In developing countries with limited health care resources; generic medicines can be cost-saving treatment alternatives

Potential Cost Savings from Generic Medicines - Protecting the Prescribed Minimum Benefits

"Background: South Africa has followed a pro-generic policy since the introduction of the National Drug Policy in 1996. The selection processes in the public and private sectors have; however; remained largely disconnected; and at times contradictory. Medicines provided outside of hospitals accounted for 17of medical aid spend in 2006; up 8.8from the previous year. Of particular concern to funders has been the expenditure on the 27 chronic conditions listed as Prescribed Minimum Benefits. The Medical Schemes Act (No 131 of 1998) provides for the definition of Prescribed Minimum Benefits; which stipulate a package of services or care a medical scheme must provide for in its benefit design. There is pressure to reconsider these requirements in order to increase the affordability of medical scheme coverage. This study assessed the potential savings thatwould be achievable by substituting generics for brand name (originator) medicines listed in the chronic disease algorithms set out by the Council for Medical Schemes (CMS).Methods: All medicines listed in the 25 chronic diseases algorithms made available by the CMS were identified. Brand and generic versions were identified in the Monthly Index of Medical Specialties (MIMS; May 2006). Single exit prices inclusive of value added tax were obtained from the web site of the Pharmaceutical Blue Book and the cost per defined daily dose for one month was then calculated. Cost differentials; where available; were then identified for each medicine listed in the algorithms. Cost differentials for medicines within each algorithm were presented as the median of the difference between brand and generic medicines listed for that algorithm; and also as the median of differences between generic medicines for the same condition. Results: Three of the algorithms (diabetes insipidus; haemophilia and hypothyroidism) list medicines for which no generic equivalent was available at the time of the study. The median cost differential between brand and generic equivalents for the remaining 22 chronic conditions ranged from 19.5(for type 1 diabetes mellitus) to 97(for Addison's disease). Across the entire chronic disease algorithm set; 80 medicines with generic equivalents were listed for 22 conditions. The median cost differential between brand and generic versions of these 80 medicines was 49.9(interquartile range 32.0 to 78.5). Of all generic medicines identified; 67.5were more than 40cheaper; per defined daily dose (DDD) per month; than the branded version. In 16 medicines the cost differentials between generic versions were 1or less. Some correlation between the number of generics and the size of the cost differential was apparent (correlation coefficient 0.49). There were examples of high-cost differentials in highly competitive areas of the market. Conclusions: An argument could be made for more closely aligning the process of developing the National Essential Drugs List and the development of the CMS algorithms. By being more specific about which medicines should be covered; needless expenditure on ""me-too"" agents of doubtful additional benefit could be avoided. Where clinically warranted; appropriate choices could be provided. Finality in respect of the pricing of medicines needs to be achieved. This applies not only to the dispensing fee but also to the proposed benchmarking process and the proposed differentialbetween brand and generic medicines."

Newborn Screening for Classic Galactosemia and Primary Congenital Hypothyroidism in the Nkangala District of the Mpumalanga Province of South Africa

Objectives: The main objective of this work was to establish the newborn incidence of classic galactosemia and congenital hypothyroidism within the Nkangala district of Mpumalanga. In the process a cost effective protocol for newborn screening of both diseases was developed. Study design and setting : Blood spot specimens were collected from over 30of newborn infants in the Nkangala district of Mpumalanga Province in a six month period from June to November 2005. The specimens were subsequently screened for classic galactosemia and hypothyroidism using metabolite quantification assays. GALT (galactose-1-phosphate uridyltransferase) enzyme activity assays were also performed to confirm the reliability of the total galactose assays. Real-time PCR was used to detect commonly occurring mutations in the GALT gene that cause galactosemia. Subjects and outcome measures: Informed consent was obtained from the parents of the newborn infants prior to commencement of screening. Total galactose levels of above 0;9 mg/L and TSH concentrations of above 25;1 mU/L were considered to be indicative of galactosemia and hypothyroidism; respectively. A decrease in the total financial input on the screening protocol was evaluated for significance in cost reduction. Results: The incidence of hypothyroidism was found to be 0.1while none of the newborns presented with classic galactosemia. There was up to 20 reduction in direct input costs of screening when our protocol is applied. Conclusion: Cost effective newborn screening is possible when classic galactosemia and congenital hypothyroidism are screened; simultaneously. Cumulative disease frequency plots confirm the already established fact that hypothyroidism tends to prevail in higher frequencies than classic galactosemia