Cost-effectiveness of screening methods for urinary schistosomiasis in a school-based control programme in Ibadan, Nigeria.

OBJECTIVE: To carry out a comparative cost-effectiveness analysis of screening methods for urinary schistosomiasis; terminal haematuria, unqualified haematuria, dysuria, visual urine examination and chemical reagent strip technique, in a school-based control programme. DESIGN: Estimation of costs and determination of cost-effect ratios of the screening methods applied in a school-based screening and treatment programme, from the perspective of a programme manager. SETTING: A junior secondary school in Ibadan, Nigeria. MAIN OUTCOME MEASURES: Cost per number of cases correctly diagnosed. RESULTS: Unqualified haematuria was found to be the most cost-effective method costing N51.06 (US$ 2.16) to diagnose a case correctly, followed by terminal haematuria N58.91 (US$ 2.50) and dysuria N84.24 (US$ 3.57). Despite the relatively high input costs of chemical reagent strip technique over visual urine examination (N22.12 (US$ 0.94) per student vs. N6.44 (US$ 0.27) per student), it was found to be more cost effective costing N304.56 (US$ 12.91) to diagnose a case correctly than visual examination of urine cost of N317.58 (US$ 13.46) per correct case diagnosed. CONCLUSION: From the viewpoint of a programme manager, interview method of screening by asking for blood in the urine remains the most efficient means of screening for urinary schistosomiasis in school-based control programmes in our environment.

Utilization and costs of medical services at military health facilities in Ibadan, Nigeria.

The Nigerian Army introduced user charges in its health care services in 1994. This study attempts to assess possible impact of user charges on the utilization of army health services in Ibadan, Nigeria. This is a descriptive, retrospective study and it involved the review of hospital records from 1992 to 1996 in military health facilities in Ibadan. Yearly consultation rate increased from 339 per 1,000 population in 1992 to 581 per 1,000 population in 1996. While cost of care significantly increased over the years in the army health facilities, services were offered at lower costs when compared with the cost of similar services from non-military medical centers. Utilization of health services is not deterred in spite of the introduction of user charges. Further study was suggested to assess impact.