Health insurance and the financial implications of sickle cell disease among parents of affected children attending a tertiary facility in Lagos, south-west Nigeria.

INTRODUCTION: there is a paucity of data on the financial implications of sickle cell disease on households of affected children and their use of health insurance in Nigeria. This study assessed the awareness of health insurance, patterns of health service utilization and financial implications of sickle cell disease among children seeking care at a tertiary facility in Nigeria. METHODS: a structured questionnaire was administered to parents of 314 children with sickle cell disease attending the pediatric hematology unit of the Lagos University Teaching Hospital between May and December 2019. RESULTS: mean age of the children was 91.5 ± 43.1 months. M: F was 1.17: 1. 45.5% of households earned above NGN 150,000 (USD 417) monthly. 71.3% of the parents had heard of health insurance but only 20.7% were enrolled in a health insurance scheme. Awareness of health insurance was significantly associated with social class (p=0.000) and monthly household income (p=0.000). 60.8% of the parents preferred pre-facility treatment. Social class (p=0.01) and monthly household income (p=0.001) were significantly associated with home treatment. Time on admission ranged from 2-18 days with an average of 4.31 days. Average cost of hospitalization was USD 148 ± USD 14.2 and total cost of care incurred was USD 20,787. Neither age of child (p=0.857), estimated household income (p=0.863) nor social class (p=0.397) was associated with cost of care. CONCLUSION: a high cost of care was observed in our study population underscoring the need for increased awareness and access to health insurance for households of children with sickle cell disease.

Pediatric Oncology in Nigeria: A Panoramic View.

PURPOSE: A large number of children still die as a result of cancer in low- to middle-income countries, and factors such has poor infrastructure, inadequate human resources, and poorly developed health insurance are responsible for most of these deaths. Nigeria is a country with a young population and a struggling health system. We aimed to survey pediatric oncologists in Nigeria using an online survey instrument. METHODS: We surveyed the national group of pediatric oncologists using an instrument designed to assess manpower availability, infrastructural support, support services, and presence of radiotherapy and medications. RESULTS: A total of 14 institutions responded, represented by 24 oncologists of the 42 oncologists on the platform, with a response rate of 57.1%. Most of the oncologists had practiced for more than 10 years, but only two institutions had a dedicated pediatric oncology ward. There was no population-based pediatric oncology tumor registry. Molecular diagnostic capability was not available, nor was a structurally efficient radiotherapy support service. The centers also struggled with inadequate blood and blood product provision. CONCLUSION: Pediatric oncology services in Nigeria are still grappling with weak human capital, poorly developed infrastructure, weak regional and national referral systems, and poor support services.

Prevalence and risk factors of asymptomatic bacteriuria among children living with HIV in Lagos, Nigeria.

INTRODUCTION: HIV/AIDS has gradually become a chronic disorder following the success of combination chemotherapy. As a result of the persisting immune deficiency, certain risk factors predispose affected individuals to infections. The aim of the study was to determine the prevalence and identify risk factors of asymptomatic bacteriuria among HIV infected children. METHODS: this was a case control study conducted at the Lagos University Teaching Hospital from July 2010 to June 2011.Eighty-five children living with HIV were consecutively selected from the HIV clinic of the Lagos University Teaching Hospital and compared with 85 age and sex matched HIV negative controls for the occurrence of asymptomatic bacteriuria. Mid-stream urine samples were obtained from the participants and the samples were analyzed for microscopy, culture and sensitivity. Demographic and clinical data was obtained from the caregivers and clinical notes respectively. Data were analyzed utilizing SPSS version 17. RESULTS: the prevalence of asymptomatic bacteriuria was 24.7% among children living with HIV and 8.2% among un-infected children (p value 0.004). The stage of the disease, CD4 count, sex as well as age were risk factors for asymptomatic bacteriuria among children living with HIV. CONCLUSION: asymptomatic bacteriuria is a prevalent problem among children living with HIV infection and urinary screening should be routine in the work up of febrile children living with HIV.