Funds squeezed and stretched: the predicament of health care.

Funding for health in Ogun State, Nigeria is reviewed in relation to the health-for-all targets. The author examines the ways in which money is spent, with particular reference to the impact of wages, salaries and allowances on budgeting in a manpower-intensive sector.

PIP: Nigeria's national health policy promotes primary health care as the means to achieve health for all. Local governments, state governments, and the federal government are responsible for primary, secondary, and tertiary levels of care, respectively. All government levels are receiving fewer and fewer public funds. For example, the federal health budget for 1988 was just 25% of that for 1981 in real terms. Expenditure on always-needed items (e.g,, maintenance, medical supplies, and drugs) is still decreasing, while personnel costs either stay the same or increase. Ogun State has 15 local government areas and 448 health care facilities. Its total fertility and maternal, infant, and child mortality rates are 6.2, 15/1000 births, 90-120/1000 live births, and about 25%, respectively. Malaria, diarrhea, respiratory and other infections, and accidents account for most deaths. In 1988 and 1989, the local governments spent 11% and 10% (range = 4-23%), respectively, on the health sector. Per capita health expenditure ranges were US$0.30-0.80 and US$0.16-0.80, respectively. In the five newly created local government areas, the inferior health funding goes mainly to infrastructural development. In 1988 and 1989, the health sector of the local governments in Ogun State secured just 60% and 54%, respectively, of promised funds. Wages, salaries, and allowances made up 56% and 61% of expenditures; yet, 48% and 49% were proposed. The mean capital expenditures was just 18.5% of total health expenditure. When one looks at real value, however, the money expended on human resources was less than proposed. Thus, if the governments had achieved funding targets, there would have been more funds for nonpersonnel and capital costs. Ogun State needs to control personnel costs. The author hopes that this review sparks other states to conduct similar studies and leads to a national reexamination of financing policy.

Socio-psychological factors affecting emergency obstetric deliveries at the University College Hospital, Ibadan, Nigeria.

PIP: This study was designed to determine the influence of socio- psychological characteristics on reproductive outcomes among emergency cases admitted into the Labor Ward of the University College Hospital in Ibadan City, Nigeria. The study took place between May 1, 1984 and February 28, 1985 and included all emergency cases admitted (EA) into the hospital. 144 matched pairs of patients (emergency and booked cases) were admitted into the study making a total of 228 patients. Results of the study showed no observed differences in the educational or occupational status of the spouses of booked patients compared with EA. However, there were more uneducated women among the EA than the booked. IN both groups younger patients (15-34) had format education compared with the older patients (35+), strengthening the hypothesis that education is the most influential factor in patient's acceptance of modern maternity care. Polygamy and Islam were more prevalent among the EA than the booked. It is believed that the economic affects of polygamy exercise more direct adverse effects on reproduction than religion. The purdah system, practiced by Moslems confines women to their homes, interfering with their ability to get pre-natal care. Fewer number of EA lived with their spouses compared with booked patients. Lower social class is associated with larger numbers of adverse factors in reproductive outcomes such as increased rates of low birth weight babies, multiple pregnancies and fetal abnormalities. (Author's modified).^ieng

Clinical observations of malignant trophoblastic disease.

We studied the clinical records of 64 women with malignant trophoblastic disease. Fifty-five patients (68%) were aged 25-50 years. The current pregnancy was preceded by abortion in 24 cases, by molar pregnancy in 23 cases and by normal pregnancy in 17 cases. The most common presenting symptoms were vaginal bleeding, abdominal mass and abdominal pain. Pulmonary lesions were mostly silent, but hemoptysis occurred in seven patients. Metastases were found in 39 patients. Treatment was mainly chemotherapy. Remission for over 12 months occurred in 40 patients, and 21 patients died.

Cesarean section for twin pregnancy in Ibadan, Nigeria.

During an 11-year period, 23,524 deliveries were conducted at the University College Hospital, Ibadan; 4,360 (18.5%) were delivered by cesarean section, 49 of which were associated with twin pregnancy. The main indications for this operation in twin pregnancy were prolapsed umbilical cord, previous cesarean section scar and malpresentation of the second twin with the membranes already ruptured. The perinatal mortality of 18.2% was mainly attributable to prematurity. Obstetricians in this community have adopted a conservative attitude towards cesarean section because of the general aversion to this operation by our patients and the risk of subsequent rupture of the uterine scar in women who wish to deliver themselves at home in subsequent pregnancies. Cesarean section is therefore performed in twin pregnancy for the same absolute indications as for single pregnancy.