Knowledge and Practice of the Referral System under the National Health Insurance Scheme among Medical and Dental Practitioners of A Large-Accredited Facility in Kano, Nigeria.

BACKGROUND: Studies on healthcare professionals' knowledge about the National Health Insurance Scheme (NHIS) are scarce. Therefore, we assessed the knowledge and practice of the NHIS referral system among Medical and Dental practitioners in a tertiary hospital in Northwest Nigeria. METHODS: This cross-sectional study involved 242 medical and dental practitioners randomly selected from nine departments for over 6-weeks. A structured self-administered questionnaire was used to collect data. Data were analyzed using descriptive and inferential statistics. RESULTS: The respondents' mean age was 35.7±6.0 years; they were predominantly males (64.9%). Their mean overall knowledge score was 58.9±23.0%, with 66.9% of respondents having inadequate overall knowledge of the NHIS referral system. Practice department (Fishers 2 exact, P=0.0019), perceived knowledge of the referral system (ꭓ =8.169, P=0.004), and having been referred as an enrolee (ꭓ2 = 6.358, P=0.012) were associated with overall-knowledge. Obstetrics-and-Gynaecology (odds ratio[OR]=0.29, 95% confident interval [CI] [0.88-0.98]), Dental and-Maxillofacial-Surgery (OR=0.08, 95%CI[0.01-0.98]), and Otorhinolaryngology (OR=0.18, 95%CI[0.04-0.80]) respondents were less likely to have adequate overall-knowledge.Although 56.2%, 50.4%, 20.7%, and 89.7% were enrolees, had received treatment as enrolees, had been referred as enrolees and treated other enrolees, respectively, an unimpressive proportion had sighted a referral letter (64.9%) or authorization code on the letter (25.2%), referred an enrolee from their department previously (51.2%) or used the NHIS referral form to write referrals (38.8%). CONCLUSION: The overall knowledge of the NHIS referral system was inadequate. The practice of the referral system was below expectation. Therefore, training medical and dental practitioners on the NHIS referral system is necessary. Training should target those who are least likely to have adequate overall knowledge.

CONTEXTE: Les études sur les connaissances des professionnels de la santé concernant le Régime d'assurance maladie national (NHIS) sont rares. Nous avons donc évalué les connaissances et la pratique du système de référence du NHIS parmi les médecins et dentistes d'un hôpital tertiaire du Nord-Ouest du Nigeria. MÉTHODES: Cette étude transversale a impliqué 242 médecins et dentistes sélectionnés de manière aléatoire dans neuf départements pendant plus de 6 semaines. Un questionnaire structuré auto-administré a été utilisé pour recueillir des données. Les données ont été analysées à l'aide de statistiques descriptives et inférentielles. RÉSULTATS: L'âge moyen des répondants était de 35,7 ± 6,0 ans ; ils étaient principalement des hommes (64,9 %). Leur score moyen global de connaissances était de 58,9 ± 23,0 %, avec 66,9 % des répondants ayant une connaissance globale insuffisante du système de référence du NHIS. Le département de pratique (test exact de Fisher, P=0,0019), la connaissance perçue du système de référence (ꭓ 2 =8,169, P=0,004) et avoir été référé en tant qu'adhérent (ꭓ 2 = 6,358, P=0,012) étaient associés à la connaissance globale. Les répondants en obstétrique-gynécologie (rapport des cotes [OR]=0,29, intervalle de confiance à 95 % [IC] [0,88-0,98]), en chirurgie dentaire et maxillo-faciale (OR=0,08, IC à 95 % [0,01-0,98]), et en oto-rhino-laryngologie (OR=0,18, IC à 95 % [0,04-0,80]) étaient moins susceptibles d'avoir une connaissance globale adéquate. Bien que 56,2 %, 50,4 %, 20,7 % et 89,7 % étaient adhérents, avaient reçu un traitement en tant qu'adhérents, avaient été référés en tant qu'adhérents et avaient traité d'autres adhérents, respectivement, une proportion peu impressionnante avait vu une lettre de référence (64,9 %) ou un code d'autorisation sur la lettre (25,2 %), avait référé un adhérent de leur département précédemment (51,2 %) ou avait utilisé le formulaire de référence du NHIS pour écrire des références (38,8 %). CONCLUSION: La connaissance globale du système de référence du NHIS était insuffisante. La pratique du système de référence était en deçà des attentes. Par conséquent, la formation des médecins et dentistes sur le système de référence du NHIS est nécessaire. La formation devrait cibler ceux qui sont moins susceptibles d'avoir une connaissance globale adéquate. MOTS-CLÉS: Connaissances et Pratiques, Professionnels de la santé, Régime national d'assurance maladie, Nigeria, Renvoi.

A survey of weight perception and social desirability of obesity among adults in Kano Metropolis, Northern Nigeria.

BACKGROUND: Obesity and its complications are emergent health challenges in developing countries including Nigeria. We determined the concordance of perceived with measured weight and assessed the social desirability of obesity among adults in Kano metropolis in northern Nigeria. METHODS: A cross sectional descriptive study was conducted among 400 adults using structured interview questionnaires. RESULTS: Among 386 respondents, 58 (84.1%) of underweight adults, 106 (46.2%) of healthy weight adults, 46 (66.7%) of overweight adults and 16 (84.2%) of obese adults incorrectly perceived their weight category. Sixty (15.5%) participants considered obesity as socially desirable and a sign of good living and affluence. Older respondents (> or = 40 years) (P = 0.0001), Igbo or Yoruba ethnicity (P = 0.0035) and non-formal or primary education (P < 0.0001) were significantly associated with positive view of obesity. However, only ethnicity; Yoruba-Adjusted Odds Ratio (aOR) = 1.60, 95% Confidence Interval (95% CI) (1.20-2.86), P = 0.018, Igbo (aOR = 3.22, 95% CI (1.64-6.3), P =0.005 and educational status; non-formal (aOR = 4.61, 95% CI 1.62-16.9), P = 0.01; primary (aOR = 4.95, 95% CI (1.4-17.8), P = 0.015 remained significant predictors after adjusting for confounding. CONCLUSION: The discordance between perceived and measured weight is worrisome but the low social desirability of obesity should be encouraged. Weight control using periodic weight measurements, nutritional education and physical exercise are paramount.

Patterns and predictors of cigarette smoking among HIV-infected patients in northern Nigeria.

The smoking behaviour of persons living with HIV/AIDS in sub-Saharan Africa is poorly documented. We employed a cross-sectional study design to assess the prevalence and predictors of tobacco smoking among HIV-infected patients in northern Nigeria (n = 296). Approximately one quarter of respondents were either current (7.8%) or ex-smokers (17.9%). Smoking rates among HIV-infected women were extremely low. HIV-infected men were at least three times as likely to smoke as their female counterparts living with HIV: adjusted odds ratio (AOR) 3.16, 95% confidence interval (95% CI) 2.17-7.32. Patients with tertiary education were at least twice as likely to smoke compared with their counterparts without formal education (AOR 2.63, 95% CI 1.08-6.67). The preponderance of cigarette smoking among educated HIV-infected men in northern Nigeria offers a unique opportunity for targeted smoking cessation programmes.

Malaria among antenatal clients attending primary health care facilities in Kano state, Nigeria.

BACKGROUND: Malaria in pregnancy remains a major public health problem especially in sub-Saharan Africa. However, the prevalence of clinical and asymptomatic infection among antenatal client (ANC) attendees is largely unknown, especially at primary health care (PHC) level in northern Nigeria. This study assessed the prevalence of fever, malarial parasitemia and anemia among pregnant women attending PHC facilities in Kano, northern Nigeria. METHODS: A cross-sectional descriptive study was conducted among 360 ANCs attending PHC facilities in two Local Government Areas (LGAs) in Kano state. Data were collected using a pre-tested semi-structured interviewer administered questionnaire. Blood samples were also obtained for thin blood smear for malaria parasite using Giemsa staining technique. Hemoglobin was estimated from the Packed Cell Volume (PCV) determined using hematocrit. RESULTS: Age of the subjects ranged from 15 to 42 years with a mean +/- SD of 24.0 +/- 6.0. Up to 39.2% (n = 141) (95% Confidence Interval = 34.1-44.4%) of the subjects were found to have malarial parasitemia. Exactly 36.2% (n = 51) of those with parasitemia had fever (temperature >or= 37.5 degrees C) while 63.8% (n = 90) of them were asymptomatic. Anemia, (hemoglobin of

Patients' satisfaction with services obtained from Aminu Kano Teaching Hospital, Northern Nigeria.

OBJECTIVE: Periodic patient satisfaction surveys provide feedback to hospital management and staff regarding the quality of services rendered. These surveys have become routine as part of total quality management in developed countries. We assessed patient satisfaction with services provided in a teaching hospital in northern Nigeria. METHOD: Structured questionnaires were administered on a cross-section of 201 patients and two focus group discussions were held with patient relatives at Aminu Kano Teaching Hospital. RESULTS: Overall, 83% of the patients were satisfied with the services received from Aminu Kano Teaching Hospital, while the remaining 17% were dissatisfied. Specifically, 88%, 88%, 87% and 84% of the patients were satisfied with patient provider relationship, in-patient services, hospital facilities and access to care. However, 30% and 27% of the patients were dissatisfied with waiting time and cost of treatment respectively. Patients and their relatives complained about delayed appointments, missing folders, missing laboratory results and long appointments for ultrasound and other radiological investigations. CONCLUSION: The high patient satisfaction notwithstanding, health workers need to consider patients as customers by being friendly and reducing waiting time for consultation and investigations. Widespread implementation of the National Health Insurance Scheme will also reduce the cost of services and drugs to patients.