Cost-utility of burns management in Nigeria: a case study of the National Orthopaedic Hospital, Enugu.

A major problem of burns is the high cost of management, as well as the discrimination and disability they can cause to patients. Maximising resource utilisation is of key importance for lower-middle-income countries (LMICs) like Nigeria. There is a need to know if Nigerian patients who were victims of burns get the best value for money. This study aimed to evaluate the average cost of managing burns in Nigeria, and determine if the treatment approach is cost-effective. The study was a cost-utility analysis from the perspective of health service providers in Nigeria, a case study of the National Orthopaedic Hospital Enugu (NOHE) using 2013 Microsoft excel. Data on the cost of burn management were obtained from a retrospective study conducted in NOHE in 2012 on 285 patients. Costs were adjusted to reflect the future (2015) value using a real interest rate of 3%. These costs were presented in 2015 US dollars, and a discount rate of 3% was used for both cost and outcome. Health outcome was presented in disability adjusted life years (DALYs). Based on a cost-effectiveness threshold of $2,758.4 (i.e. representing Nigerian GDP/capita), burn management is cost-effective in Nigeria ($526.68/DALY averted). The result also showed that the cost of managing burns in Nigeria is $7,123.28 per patient, which is more than the average income. Burn management in Nigeria is cost-effective but too expensive for most Nigerians to afford.

Un des problèmes de la prise en charge des brûlés est son coût, ainsi que la discrimination et le handicap que la brûlure peut entraîner. L'optimisation des ressources financières est d'une importance cruciale dans les pays en développement comme le Nigeria et il est nécessaire de savoir si les finances engagées se révèlent utiles. Cette étude a pour but d'évaluer le coût de prise en charge des brûlés au Nigeria, et d'évaluer l'efficacité du traitement, à partir des données de l'Hôpital Orthopédique National (HON) d'Enugu. Les données des 285 patients hospitalisés dans l'HON pour brûlures en 2012 ont été analysées. Les chiffres de 2012 ont été extrapolés à 2015 en tenant compte d'une inflation de 3%. L'état de santé après traitement a été chiffré en Espérance de Vie Corrigée de l'Incapacité (EVCI). Le coût de traitement d'une brûlure est de 7 123,28$ soit 526,68$ par année d'ECVI gagnée et la prise en charge des brûlés apparaît donc utile, en termes médico-économiques. Ce coût est cependant à rapporter au PIB per capita du Nigeria, qui est de 2 758,40$. La prise en charge des brûlés au Nigeria, bien que trop chère pour la plupart des nigérians, est efficace financièrement.

Situational analysis of orphans and vulnerable children in urban and rural communities of Plateau State.

BACKGROUND: Orphans and Vulnerable Children (OVC) are children affected by HIV and AIDS by virtue of, among others, living in a household where one or more people are ill, dying or deceased, or which fosters orphans, and children whose care givers are too ill or old to continue to care for them. They often have more health needs than their peers. This study was carried out to obtain baseline information on the needs of OVC in North-Central Nigeria as a basis for provision of relief services. METHODS: A house to house cross-sectional survey of OVC recruited via a multistage sampling technique was carried out in four LGAs of Plateau State, Nigeria. The Child Status Index (CSI) tool was used to obtain information from the respondents and/or their caregivers. Vulnerability of the children was assessed using a Vulnerability Index (VI) scoring which ranged from 1-21, with 1-9 being vulnerable, 10-14 more vulnerable, and 15-21 being most vulnerable. RESULTS: A total of 825 OVC ages ranging from 0-17 years and mean age of 9.8 ± 4.5 years were studied. 432 were males (52.4%) and 393 females (47.6%). 64.8% lived in households headed by women out of which 77.6% were widows. Six hundred and one (72.8%) household heads were farmers. Paternal orphans made up 59.8% of the respondents and 12.1% had lost both parents. Prevalence of abuse/exploitation was 17.7% and 66.7% experienced household food insecurity. Four hundred and seventy-eight (57.9%) OVC lived in households with no source of income. One hundred and fifty-one (18.3%) children (54.9% boys and 45.1% girls) had never been to school. 55.0% had minimal health problems. Majority of them (60.3%) lived in dilapidated shelter and 3.3% were living on the street. CONCLUSION: This survey revealed the various needs of OVC. Efforts to care, support and protect vulnerable children should not only focus on their immediate survival needs such as education, shelter and clothing, but also on long-term developmental needs that reduce children's vulnerability such as life skills, child protection, vocational training, food security and household economic strengthening.

Fistula Fortnight: innovative partnership brings mass treatment and public awareness towards ending obstetric fistula.

OBJECTIVE: As part of the global Campaign to End Fistula, the Fistula Fortnight, a 2-week mass obstetric fistula treatment project, was organized in northern Nigeria to contribute to reducing the backlog of untreated fistulas and raise awareness regarding obstetric fistulas and safe motherhood. METHODS: An array of partners joined forces to provide free surgical treatment, strengthen the capacity of existing facilities to manage obstetric fistulas, and utilize media strategies to raise awareness. RESULTS: The Fistula Fortnight took place from February 21 to March 6, 2005, at 4 established fistula repair centers in the northern Nigeria states of Kano, Katsina, Kebbi, and Sokoto. A total of 569 women received treatment, with an 87.8% rate of successful closures. The highly publicized event also raised awareness on the issue of obstetric fistula and helped put a face to maternal deaths. CONCLUSION: The Fortnight, which required extensive and thoughtful planning involving many persons cognizant of health system and quality of care issues, was effective in drawing attention to the vast fistula problem and contributed to reducing the backlog of patients.

Prevalence of malnutrition using Z-scores and absolute values in children under five years of age in Utan village, Jos, Plateau State, Nigeria.

OBJECTIVE: To compare the use of Z scores and absolute measurements in determining the prevalence of malnutrition among under-five children in the Plateau State, Nigeria. DESIGN: A community based, cross sectional study of under-five children. SETTING: An urban slum, Utan village, Jos, Plateau State, Nigeria. POPULATION: The village has a projected population of 3,000 people; 15% of whom are under-fives. STUDY POPULATION: Four hundred and twenty six under-five children. MAIN OUTCOME MEASURES: Absolute measures of weight for age, weight for height and height for age; and Z scores for the same indicators. INTERVENTION: Mass chemotherapy (antihelminths) and nutrition education were carried out after the study was done in 1993. RESULTS: Based on absolute measurements, 23.7% of the children had low weight for age; 34.9% of the under-fives were stunted (height for age), while 11.1% had low weight for height. Using Z-scores, 25.3% of the under-fives were malnourished based on weight for age, 37% were stunted (height for age), while 8.7% had low weight for height. CONCLUSION: Stunting is still prevalent in the under-five children surveyed in spite of the siting of the PHC clinic which offers promotive, preventive and curative services. Small scale industry could be set up to empower the women economically so that they can provide enough food for their households. A credit/loan scheme would also be beneficial. Emphasis should be placed on growth monitoring to help the women discover when the weight of their children is faltering. The use of oral rehydration therapy against diarrhoeal diseases and immunisation against the common childhood diseases that also affect the nutritional status of the children is important. Nutrition education and family planning programmes should be effectively organised for mothers.

Incidence and treatment seeking patterns for venereal diseases in Jos metropolis.

This is a cross-sectional survey in Jos metropolis of a sample of hospitals, clinics and other types of western drug dispensing facilities reported to have been patronised by patients seen at the sexually transmitted disease (STD) clinics in Nigeria. Its purpose was to obtain a better picture of the burden of STDs in the towns and villages in the different cultural areas of Nigeria. The results show that all the centres, from patent medicine store keepers upwards, treated STDs. A few of the non-physician manned centres denied treating STD patients. The estimated annual crude incidence rate of STDs in this town, from this study, was 6.8%, similar to the 7.4% estimated for Maiduguri town in an earlier study. Only 0.7% of the cases (compared with 0.8% in Maiduguri) were seen at the specialised STD clinic in the town. The implications of findings for the effective control of STDs in Nigeria are discussed.