Epidemiological Transition in the Economic Community of West African States (ECOWAS): Evidence from the Global Burden of Disease 1990-2017.

INTRODUCTION: This study sought to explore the pattern of epidemiological transition in the Economic Community of West African States (ECOWAS). METHODS: We extracted data from the global burden of disease study. Countries were grouped using the Sociodemographic Index (SDI). The DisMod-MR 2.1, a Bayesian meta-regression tool, was used as the main method of estimating variations in epidemiologic data sources and other parameters. Examples of these included model predictions, as well as 95% corresponding uncertainty intervals for all death, Years of Life Lost, Years Lived with Disability, and DisabilityAdjusted Life Years (DALYs). RESULTS: The DALYs from Group 1 diseases were higher in all the countries in the region compared to those from non-communicable diseases (NCDs) and injuries, as well as total NCDs in 1990 and this was the same in the subregion in 2017, except in Cape Verde (with the highest SDI), where there were higher DALYs from NCDs/ injuries and the total NCDs than the Group 1 diseases. In 1990, deaths from Group 1 diseases were higher in all the countries in the region than those from the total NCDs except in Cape Verde, while in 2017, deaths from Group 1 diseases were higher than those from Total NCDs except in Cape Verde, the Gambia, Ghana, and Senegal. CONCLUSION: The overall pattern is that of concurrent communicable disease and increasing NCD burden with increasing SDI. Detailed understanding of these patterns and contextual factors are needed to help inform national and regional policies to address the epidemiological transition in the ECOWAS.

INTRODUCTION: Cette étude a cherché à explorer le modèle de transition épidémiologique dans la Communauté économique des États de l'Afrique de l'Ouest (CEDEAO). MÉTHODES: Nous avons extrait les données de l'étude sur la charge mondiale de morbidité. Les pays ont été regroupés à l'aide de l'indice sociodémographique (IDS). Le DisMod-MR 2.1, un outil de métarégression bayésienne, a été utilisé comme principale méthode d'estimation des variations des sources de données épidémiologiques et d'autres paramètres. Des exemples de ceux-ci comprenaient les prédictions du modèle, ainsi que les intervalles d'incertitude correspondants à 95 % pour tous les décès, les années de vie perdues, les années vécues avec une incapacité et les années de vie corrigées de l'incapacité (DALY). RÉSULTATS: Les DALY des maladies du groupe 1 étaient plus élevées dans tous les pays de la région par rapport à celles des maladies non transmissibles (MNT) et des traumatismes, ainsi que le total des MNT en 1990 et il en était de même dans la sous-région en 2017, sauf au Cap. Verde (avec le SDI le plus élevé), où il y avait des DALY des MNT/blessures plus élevées et le total des MNT que les maladies du groupe 1. En 1990, les décès dus aux maladies du groupe 1 étaient plus élevés dans tous les pays de la région que ceux du total des MNT sauf au Cap-Vert, tandis qu'en 2017, les décès dus aux maladies du groupe 1 étaient plus élevés que ceux du total des MNT sauf au CapVert, le Gambie, Ghana et Sénégal. CONCLUSION: Le schéma général est celui d'une maladie transmissible concomitante et d'un fardeau croissant des MNT avec l'augmentation du SDI. Une compréhension détaillée de ces modèles et facteurs contextuels est nécessaire pour aider à éclairer les politiques nationales et régionales pour faire face à la transition épidémiologique dans la CEDEAO. Mots clés: Transition épidémiologique, Afrique de l'Ouest, Maladie non transmissible, Maladie transmissible, Index sociodémographique.

NATIONAL HEALTH INSURANCE SCHEME: PERCEPTION AND PARTICIPATION OF FEDERAL CIVIL SERVANTS IN IBADAN.

Introduction: The National Health Insurance Scheme is a social health insurance programme designed by the Federal Government of Nigeria to complement sources of financing the health sector and to improve access to health care for the majority of Nigerians. Presently, the enrolment level on the Scheme is majorly among those in the formal sector and user experiences have been different. This study seeks to determine the perception and participation of Civil Servants regarding the National Health Insurance Scheme in Ibadan. Methods: A descriptive cross-sectional study was conducted among 273 civil servants working at the Federal Secretariat, Ikolaba, between October and November 2015. An interviewer-administered questionnaire was used to collect information on socio-demographic characteristics, awareness, and membership of the NHIS, perception of NHIS, and health-seeking behaviour. Participation was defined as the number of civil servants registered or enrolled under the scheme, in other words, members of the scheme. Information on perceptions was sought using a 3-point Likert scale. Descriptive statistics and chi-square tests were used for data analysis at a 5% level of significance. Results: About 60.1% of the respondents were males. The average age was 39.7±9.1 years, with 85.0% of the respondents being married. The majority (65.2%) of the respondents were mid-level cadre workers, 17.62% were working as senior-level workers and the remaining 17.6% were low cadre workers. The majority (88.9%) completed tertiary education, while just 11.1% completed basic education. The mean household size was 2.5±0.6. Awareness of the National Health Insurance Scheme was very high (95.2%) with 83.5% enrolled under the scheme. About (50%) of the respondents joined the scheme because it is cheap and affordable. There was a significant association between awareness, level of education, knowledge of NHIS, and registration into the scheme by respondents. The majority of the respondents (87.3%) claimed that NHIS is a better means of settling healthcare costs than Out-of-pocket-payment. The majority of the respondents thought that health insurance is a viable programme. Conclusion: The perception of health insurance among civil servants was varied while participation was high. Relevant intervention should be introduced to remove bottlenecks to accessing and operating the scheme.