BackgroundOut-of-pocket spending (OOPS) is the major payment strategy for healthcare in Nigeria. Hence, the paper assessed the determinants socio-economic status (SES) of OOPS and strategies for coping with payments for healthcare in urban, semi-urban and rural areas of southeast Nigeria. This paper provides information that would be required to improve financial accessibility and equity in financing within the public health care system.MethodsThe study areas were three rural and three urban areas from Ebonyi and Enugu states in South-east Nigeria. Cross-sectional survey using interviewer-administered questionnaires to randomly selected householders was the study tool. A socio-economic status (SES) index that was developed using principal components analysis was used to examine levels of inequity in OOPS and regression analysis was used to examine the determinants of use of OOPS.ResultsAll the SES groups equally sought healthcare when they needed to. However, the poorest households were most likely to use low level and informal providers such as traditional healers, whilst the least poor households were more likely to use the services of higher level and formal providers such as health centres and hospitals. The better-off SES more than worse-off SES groups used OOPS to pay for healthcare. The use of own money was the commonest payment-coping mechanism in the three communities. The sales of movable household assets or land were not commonly used as payment-coping mechanisms. Decreasing SES was associated with increased sale of household assets to cope with payment for healthcare in one of the communities. Fee exemptions and subsidies were almost non-existent as coping mechanisms in this studyConclusionsThere is the need to reduce OOPS and channel and improve equity in healthcare financing by designing and implementing payment strategies that will assure financial risk protection of the poor such pre-payment mechanisms with government paying for the poor.

BackgroundAttention and interest in the use of Complementary and Alternative Medicine (CAM) has been reawakened globally. Evidence from studies carried out in different parts of the world has established that CAM use is very common and varies among populations. This study investigated the use of CAM among adults in Enugu urban, irrespective of their health status. It provided information on the prevalence of CAM use, forms of CAM remedies used and reasons for utilizing themMethodsThe study areas were three local government areas in Enugu urban of Enugu State. Cross-sectional survey using questionnaires were administered to randomly selected households. All consenting participants were used for the studyResults732 participants (37.2% males and 62.8% females) were used for the study. Ages ranged from 18 - 65 years. 620 (84.7%) of the adult population have used CAM ranging from one single type to twenty different types while 112 (15.3%) have not used any form of CAM. The most commonly used CAM product was the biological products, followed by prayer/faith healing. Major reasons for using CAM include their natural state and also for health promotion and maintenance.ConclusionThere is need for adequate policy formulation and regulation to ensure safety and efficacy of CAM products. Measures to ensure rational use of CAM should be instituted.

The use of complementary and alternative medicine (CAM) is now on the increase. Evidence from studies carried out globally has established that CAM use is very common and varies among populations. This study investigated patterns of CAM use, perceived benefits, and associated harm with CAM use among adults. A cross-sectional study was conducted in three local government areas of Enugu urban, Southeast Nigeria. An interviewer-administered questionnaire was used to collect data from all consenting adult participants aged between 18 and 65 years. Of the 732 participants interviewed, 62.8% were females while 37.2% were males. Majority (84.7%) of the participants had used CAM at one time or another. The most commonly used CAM product was the biological products, followed by spiritual therapy. The major route of administration for CAM products was oral and about 40% of the participants combined CAM with conventional medicine. Majority (78.6%) of CAM users benefited from CAM products after using them while a few complained of adverse reactions. As CAM is gaining widespread acceptance and use, there is need for clinical trial on the benefits and adverse effects associated with the use of CAM to facilitate proof of efficacy and safety of the products.

BackgroundDiabetes mellitus (DM) is a life-long illness that affects the quality of life, requiring close monitoring and control. Type 2 DM is preventable and controllable but increasing cost of care could hinder access to quality care because of inability to pay leading to high morbidity, mortality and productivity losses. The people living with diabetes mellitus (PLWD) in Nigeria have high risk for high economic burden and catastrophic expenditure not only because they make frequent visits to the health facilities, report late with complications but also pay out of pocket at the point of accessing care. The aim of this study was to assess the magnitude of economic burden borne and catastrophic costs incurred by PLWD in Nigeria.MethodsCross-sectional descriptive survey design was used to study a sample of 308 type2 PLWD managed at a tertiary health institution, South east Nigeria using semi-structured, prevalidated questionnaire. Data collection period was 2 months.ResultsThe major findings were economic burden of type 2 DM of N56,245 ($356). Catastrophic direct cost was 45 % at 30 % threshold (the determinant level for catastrophic spending set). All socio-economic status (SES) groups suffered catastrophic expenditure but the poorest quartile had the highest incidence.ConclusionsEconomic burden of DM was high for PLWD who also suffered high catastrophic costs due to the impact of out of pocket payment. PLWD need financial protection especially for the poorest since they buy from the same market and incur same costs. Policy decision making to assist the PLWD cope with cost of care is needful in Nigeria and nations with related problems.

Learning in the clinical environment is an integral part of nursing education programme. In tertiarybased nursing courses, students spend time learning in the clinical setting as they do in their classroombased studies. The purpose of this study was to explore teaching skills considered by undergraduate student nurses as effective in the clinical setting as well as qualities that make a clinical teacher effective. A descriptive design was employed using questionnaires to collect data. Respondents comprised year four undergraduate student nurses admitted through direct entry (DE) and university matriculation examination (UME) results. Using validated structured questionnaire, data were collected from 101 students who had completed their six months consolidated clinical experience on their perception of teaching skills and teacher qualities considered effective in the clinical setting. Data were analyzed using both descriptive and inferential statistics. Specifically, frequencies, percentage and standard deviation were used for descriptive analysis of scores while chi square and Mann-Whitney tests were used to test the mean differences in the teaching skills and to test whether there was a significant difference in their perception of teacher behaviours respectively at 0.05 level of significance. The result showed that having both clinical (professional) and teaching knowledge were the most important teaching skills for effective clinical teaching. Five qualities ranked by students as teacher behaviours important for effective teaching include being honest with students, motivation to teach, willingness to listen and using good communication skills, supervising students effectively and being positive role model. These factors could be considered when recruiting future clinical teachers and when planning in-service education programmes for clinical teachers to promote student learning.