Technical quality of delivery care in private- and public-sector health facilities in Enugu and Lagos States, Nigeria.

Private-sector providers are increasingly being recognized as important contributors to the delivery of healthcare. Countries with high disease burdens and limited public-sector resources are considering using the private sector to achieve universal health coverage. However, evidence for the technical quality of private-sector care is lacking. This study assesses the technical quality of maternal healthcare during delivery in public- and private-sector facilities in resource-limited settings, from a systems and programmatic perspective. A summary index (the skilled attendance index, SAI), was used. Two-staged cluster sampling with stratification was used to select representative samples of case records in public- and private-sector facilities in Enugu and Lagos States, Nigeria. Information to assess criteria was extracted, and the SAI calculated. Linear regression models examined the relationship between SAI and the private and public sectors, controlling for confounders. The median SAI was 54.8% in Enugu and 85.7% in Lagos. The private for-profit sector's SAI was lower than and the private not-for-profit sector's SAI was higher than the public sector in Enugu [coefficient = -3.6 (P = 0.018) and 12.6 (P < 0.001), respectively]. In Lagos, the private for-profit sector's SAI was higher and the private not-for-profit sector's SAI was lower than the public sector [3.71 (P = 0.005) and -3.92 (P < 0.001)]. Results indicate that the technical quality of private for-profit providers' care was poorer than public providers where the public provision of care was weak, while private for-profit facilities provided better technical quality care than public facilities where the public sector was strong and there was a relatively strong regulatory body. Our findings raise important considerations relating to the quality of maternity care, the public-private mix and needs for regulation in global efforts to achieve universal healthcare.

Pattern of substance use among senior students of command secondary schools in Ibadan, Nigeria.

BACKGROUND: The aim of this study was to assess the pattern of drug use among senior secondary school students within military locations in Ibadan, Nigeria. METHODS: A cross-sectional survey was carried out in 2006. RESULTS: Five hundred ten students participated with a mean age of 15.0 +/- 1.2 years. The prevalence of lifetime use of any substance was 15.3%. Alcohol (33.9%), solvents (17.3%), and tobacco (10.6%) were the most commonly used substances. Only gender and age were associated with the lifetime use of tobacco and solvents (p < 0.05). CONCLUSION: The information provided a useful baseline on which subsequent interventions could be based and evaluated.

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.