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SOCIALCONTEXT OFVESICOVAGINAL FISTULA IN EBONYI AND PLATEAU STATES, NIGERIA
Published 2023-06Subjects: “…Treatment Pathways…”
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ADOPTIONOFHEALTHINSURANCESCHEMEANDHEALTHSEEKINGBEHAVIOURAMOGEMPLOYEESOFPRIVATEORGANISATIONS IN ENUGU STATE, NIGERIA
Published 2023-08Subjects: “…Treatment pathways…”
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Page will reload when a filter is selected or excluded.- Health insurance 1 results 1
- Healthcare financing 1 results 1
- Marital Disruption 1 results 1
- Out-of-pocket health expenditure 1 results 1
- Private sector organisation employees in Nigeria 1 results 1
- The Health Insurance Scheme (HIS), a means of financing medical care among employees globally, is designed to subsidise medical costs. In Nigeria, HIS is inadequately implemented and this affects access to healthcare among employees, particularly in the private sector. Existing studies have mainly focused on biomedical aspects of HIS in the public sector with scant attention given to the social factors associated with its utilisation among employees of private organisations, including Enugu State, where the scheme has officially been adopted by private sector organisations. This study, therefore, examined the extent to which HIS is utilised; influence of its adoption on health-seeking behaviour; treatment pathways of enrollees; gender differentials in its utilisation; and the challenges reported by private sector employers that have enlisted in the scheme in Enugu State. The Structural Functionalist Theory and Health Belief Model served as framework, while the cross-sectional survey design was employed. The purposive sampling technique was used to select one organisation from each of the manufacturing and service industries that have adopted HIS. A sample of 457 respondents were drawn using Yamane’s formula. Simple random sampling was used to proportionately administer semi-structured questionnaire to employees in manufacturing (369) and service (88) industries. Twenty-four in-depth interviews were conducted with employees in manufacturing (14) and service (10) industries. Sixteen key informant interviews were conducted with management staff of manufacturing (5) and service (3) industries. Four healthcare providers from National Health Insurance Agency (NHIA) accredited hospitals, two managers of health maintenance organisations, and two NHIA executive officers. The quantitative data were analysed using descriptive statistics, Logistic regression and T-test at p≤0.05, while the qualitative data were content-analysed. The respondents’ age was 38±2.4 years; 77.4% had tertiary education and 70.8% were married. Forty-six percent partially utilised and 32.0% adequately utilised HIS. The extent to which HIS was adequately utilised was significantly associated with respondents’ aged ≥50 years (OR=4.87), tertiary education (OR=3.53) and those who were married (OR=2.57). Influence of HIS on health-seeking behaviour was significantly associated with senior staff (OR=1.57) and 100, 000 (OR=4.04) as monthly income. The treatment pathways for employees started with visit to HIS hospitals (61.2%), home therapy (23.2%), visit to hospitals without HIS (12.5%), faith/religious centres (2.9%) and traditional medical centre (0.2%). Some of those who did not visit HIS accredited hospitals at the onset of their ill-health resorted to visiting HIS accredited hospitals when their conditiondeteriorated.Femaleemployees(52.6%)were more likely to seek healthcare through HIS than their male counterparts (47.4%) after enrolling in HIS plan. Private sector employers’ challenges in the adoption of HIS included payment of premium, abuse oftheschemebysomeemployees,complexbureaucratic structure of the scheme and employees' inability to access certain treatments due to their organisations’ chosen HIS plan.Socio-organisational and individual factors influenced the adoption of health insurance scheme and the health seeking-behaviour of private sector employees in Enugu State, Nigeria. Health maintenance officials, Healthcare providers and other stakeholders should therefore increase awareness about the benefits of utilising health insurance scheme by private sector employees in order to reduce out-of-pocket health expenditure. 1 results 1
- Treatment Pathways 1 results 1
- Treatment pathways 1 results 1
- Vesicovaginal Fistula (VVF), an uncontrollable leakage of urine through the vaginal, is a global public health problem associated with maternal death. In Nigeria, it is a common gynaecological issue associated with marital disruption and social exclusion. Studies on VVF have mainly focused on its biomedical aspects with scant attention given to the social factors associated with the condition, especially in and stateshere there are availabiy of well-established VVF Centres for patient referrals. This studytherefore, examined the determinants, community perception, prevalence, treatment pathways and factors influencing care and support for VVF in Ebonyi and Plateau states. The Ecological Model of Health provided the framework. A mixed-methods approach comprising a comparative cross-sectional survey design was adopted. A sample of 695 respondents: Ebonyi (324) and Plateau (371) states were drawn using Cochran’s (1977) formula. A multi-stage sampling technique was used to administer semi-structured questionnaire to community members to elicit information on community perception and socio-economic consequences of VVF. Hospital Records (Ebonyi (136) and Plateau (381) states) were used to generate information on the prevalence and determinants of VVF. Key Informant interviews were conducted with four gynaecologists and four nurses. In-depth interviews (20 from each state) and case studies (4 from each state) were conducted with VVF patients to elicit information on treatment pathways, and care and support. Quantitative data were analysed using descriptive statistics, Chi-square and Logistic Regression at p≤0.05, while the qualitative data were content-analysed. The respondents’ age was 34.22±10.27 years; 78.6% were married and 40.7% attained secondary education. The major determinants of VVF included obstetrics complications (86.1%), congenital (1.0%) and prolonged labour (0.6%). Eight per cent had negative perception about VVF patients, but those in Plateau were six times (OR=5.56) more likely to hold negative perceptions of VVF patients than those in Ebonyi State. Prevalence of VVF was 12.2 (Ebonyi) and 23.7 (Plateau) per 100,000 women; and these were significantly related to age at child delivery (x2=20.19), parity (x2=27.02) and education (x2=102.34). The common treatment pathways for VVF among patients started from simple home remedies and herbs with few visiting modern healthcare facilities before referrals to VVF Centres. Ignorance and the belief that the traditional therapy was more effective were factors that influenced VVF patients’ decision to utilise home remedies and herbs at the beginning of the condition. Perceived severity of the condition and referrals made by the healthcare providers influenced the choice of subsequent treatment options. Delay to visit modern healthcare facilities aggravated the VVF condition. In Ebonyi State, care and support for VVF patients was influenced by marital status and level of spousal affection, while the number of times VVF repairs were done as well as relatives’ decisions influenced care and support for VVF patients in Plateau State. The burden of odour from VVF patients and the cost of treatment resulted in stigmatisation, divorce, job loss and economic disempowerment among these patients. Social and demographic factors influenced the determinants and treatment pathways for Vesicovaginal Fistula in Ebonyi and Plateau states, Nigeria. There is a need for government and healthcare providers to further sensitise women about the best practices leading to the prevention of thecondition. therefore, examined the determinants, community perception, prevalence, treatment pathways and factors influencing care and support for VVF in Ebonyi and Plateau states. 1 results 1
- Vesicovaginal Fistula Patients 1 results 1
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