Background: Hypertension is a leading risk factor for death in sub-Saharan Africa. Quality treatment is often not available nor affordable. We assessed the effect of a voluntary health insurance program, including quality improvement of healthcare facilities, on blood pressure (BP) in hypertensive adults in rural Nigeria. Methods: We compared changes in outcomes from baseline (2009) to midline (2011) and endline (2013) between non-pregnant hypertensive adults in the insurance program area (PA) and a control area (CA), through household surveys. The primary outcome was the difference between the PA and CA in change in BP, using difference-in-differences analysis. Results: Of 1500 eligible households, 1450 (96.7%) participated, including 559 (20.8%) hypertensive individuals, of which 332 (59.4%) had follow-up data. Insurance coverage increased from 0% at baseline to 41.8% at endline in the PA and remained under 1% in the CA. The PA showed a 4.97 mm Hg (95% CI: −0.76 to +10.71 mm Hg) greater decrease in systolic BP and a 1.81 mm Hg (−1.06 to +4.68 mm Hg) greater decrease in diastolic BP from baseline to endline compared to the CA. Respondents with stage 2 hypertension showed an 11.43 mm Hg (95% CI: 1.62 to 21.23 mm Hg) greater reduction in systolic BP and 3.15 mm Hg (−1.22 to +7.53 mm Hg) greater reduction in diastolic BP in the PA compared to the CA. Attrition did not affect the results. Conclusion: Access to improved quality healthcare through an insurance program in rural Nigeria was associated with a significant longer-term reduction in systolic BP in subjects with moderate or severe hypertension.

Access to improved quality healthcare through an insurance program in rural Nigeria was associated with a significant longer-term reduction in systolic BP in subjects with moderate or severe hypertension.

There is low awareness and poor perception of referral protocol in the health care system among the people of Ilorin. The higher the level of education, the more knowledge the respondents have about referral in the health system and the more likely they have correct perception of referral in health care. The Nigeria health care system policy on referral and appropriate hospital utilization could be more effective if public awareness is created about it via the media while making effort to improve the credibility of the PHC.

IntroductionMalaria has proven to be the most horrendous and intractable amongst the health problems confronting countries in the sub-Saharan Africa. This study aims to determine the ownership and utilisation of long lasting insecticide treated nets following free distribution campaign in a state in South West Nigeria.MethodsMulti-stage sampling technique was used to recruit 2560 households spread across the 16 LGAs of the state. Interviewer administered standardized questionnaire was used for the survey. Data analysis was done using Stata 10 software.ResultsSixty eight point six percent (68.6%) of the households had at least one under-five child living in the household while 32.6% had at least one pregnant woman living in the household. A total of 2440 (95.3%) households received LLIN during the campaign. Overall, the utilization rate for all respondents was 58.5%. Despite the fact that 2440 households received LLINs during the campaign, only 84.3% of them were seen to have hung theirs during the survey.ConclusionCoverage and ownership of LLINs increased significantly following the free distribution campaign. There was a discrepancy between net possession and net use with rate of use lower than possession. Post distribution educational campaign should be incorporated into future distribution campaigns to help increase net utilisation.

Background: Access to quality obstetric care is considered essential to reducing maternal and new-born mortality. We evaluated the effect of the introduction of a multifaceted voluntary health insurance programme on hospital deliveries in rural Nigeria. Methods: We used an interrupted time-series design, including a control group. The intervention consisted of providing voluntary health insurance covering primary and secondary healthcare, including antenatal and obstetric care, combined with improving the quality of healthcare facilities. We compared changes in hospital deliveries from 1 May 2005 to 30 April 2013 between the programme area and control area in a difference-in-differences analysis with multiple time periods, adjusting for observed confounders. Data were collected through household surveys. Eligible households (n = 1500) were selected from a stratified probability sample of enumeration areas. All deliveries during the 4-year baseline period (n = 460) and 4-year follow-up period (n = 380) were included. Findings: Insurance coverage increased from 0% before the insurance was introduced to 70.2% in April 2013 in the programme area. In the control area insurance coverage remained 0% between May 2005 and April 2013. Although hospital deliveries followed a common stable trend over the 4 pre-programme years (P = 0.89), the increase in hospital deliveries during the 4-year follow-up period in the programme area was 29.3 percentage points (95% CI: 16.1 to 42.6; P < 0.001) greater than the change in the control area (intention-to-treat impact), corresponding to a relative increase in hospital deliveries of 62%. Women who did not enroll in health insurance but who could make use of the upgraded care delivered significantly more often in a hospital during the follow-up period than women living in the control area (P = 0.04). Conclusions: Voluntary health insurance combined with quality healthcare services is highly effective in increasing hospital deliveries in rural Nigeria, by improving access to healthcare for insured and uninsured women in the programme area.