Healthcare Service Payment Methods and Coping Strategies of Nomads and Labor Migrants in Oyo State, Nigeria.

Nomads and labor migrants constitute a vulnerable group beset with high healthcare costs due to lack of health insurance coverage. Their inability to pay for health care constitutes a threat to their well-being and health risk to the host community as they have higher morbidity from diseases and serve as a reservoir of infective agents. This study investigated how nomads and labor migrants pay and cope with necessary healthcare costs. A cross-sectional study was carried out among 323 migrants in four local government areas of Oyo State, which were selected purposively. A pretested semi-structured questionnaire that sought information on respondents' sociodemographics, healthcare payment methods and coping strategies were employed. Data were analyzed using descriptive statistics and chi-square test to test the association between categorical variables at P ≤ 0.05. The mean age of the respondents was 34.4 ± 1.4 years and 53.2% were farmers. Of the 200 respondents who had used the formal healthcare system, 13 (6.5%) obtained free services via the National Health Insurance Scheme (NHIS) and 187 (93.2%) paid out of pocket for service. Coping with health bills, 115 (62.2%) paid from savings, 34 (18.4%) borrowed money, and 58 (31.4%) sold property. Those with formal education were more likely to pay through NHIS (χ2 = 9.7, P = 0.002). Nomads/migrants in this study have demonstrated the inability to cope with payment of health bills, suggesting the need to look into the policy on healthcare funding/support to migrants and educationally disadvantaged persons. The creation of prepaid pooled payment systems such as social and community health insurance schemes is suggested.

MODELLING THE MORBIDITY PATTERN OF TUBERCULOSIS AND ITS ASSOCIATED FACTORS IN OYO STATE, NIGERIA.

BACKGROUND: With the advent of HIV, the risk of Tuberculosis (TB) has increased. The trend in the number of cases of TB in Oyo State over the past five years has not been documented. Hence, this study reviewed the number of cases of TB and determined some of its associated factors. MATERIALS AND METHODS: A retrospective analysis was conducted on TB surveillance data reported between January 1st 2011 and December 31st 2014. Data were obtained from the integrated disease surveillance and response (IDSR) of Oyo State Ministry of Health, Nigeria. Number of TB cases, age, local government areas (LGA), month and year of reporting was extracted. Data were analyzed using descriptive statistics, negative binomial and the Poisson regression models. Model fit was assessed using the AIC and the -2LogL. RESULTS: The incidence of TB was highest in 2013 (23 per 10000 population) in Ibarapa East LGA. The risk of Tuberculosis was 62.8% higher in 2014 (IRR = 1.628; 95%CI = 1.281, 2.068) and also 17% higher in 2012 (IRR = 1.170; 95%CI = 1.010, 1.356). Also, the risk of TB was highest in Ibarapa East LGA (IRR = 2.576; 95%CI = 1.945, 3.412) and lowest in Ogbomoso South LGA (IRR = 0.229; 95%CI = 0.069, 0.764). Adolescents and adults also had higher risk of TB compared to children. CONCLUSION: The frequency of Tuberculosis declined overtime and older adults had a higher risk. The low frequency of TB in the state may be an indication and good evidence of concerted control measures. Efforts should be put in place to further bring down the number of cases especially in the identified hotspots.