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Client satisfaction with health service provision within the health insurance schemes are crucial to guide policy and decision making. Further on, the achievement of universal health coverage within the health insurance scheme in Nigeria requires evaluating the extent to which the expectations of those who have utilized health-care services, are met. This study was designed to assess NHIS-enrollees' satisfaction and the responsiveness of outpatient health care services provided under the NHIS at UNTH, Enugu. This cross sectional descriptive study was carried out between July and September 2018. Data on enrollee's satisfaction was collected using the standardized Patient Satisfaction Questionnaire, and data on responsiveness was collected using the questionnaire from a responsiveness survey designed by the WHO. The results show that of the 368 NHIS-enrollees in the survey, 269 (73.1%) were satisfied with the services they received and 190 (51.6%) respondents considered the services to be responsive to their needs, with 'choice of provider' and 'autonomy' ranking the least in domain of service. The factors independently associated with dissatisfaction with the NHIS services at UNTH (at p<0.05) include: having a family size of ≤4, having worked for 10-19 years in the civil service, and having >4 dependents. The factors independently associated were: male gender, rural residence, having attended the UNTH twice or thrice, and having worked in the civil service for <10 years or for 10-20 years. This study concludes that a high proportion of NHIS-enrollees were satisfied with outpatient services within the NHIS; however, NHIS outpatient services were responsive to the needs of only half of the enrollees. It is recommended that poorly performing domains of services are strengthened, especially 'choice of provider' and 'autonomy'; and that factors associated with non-satisfaction and non-responsiveness of outpatient services offered within the NHIS be addressed by orientation, training and local policy solutions.

Background: Potable water, good sanitary conditions, and good hygienic practices are essential for the survival and development of children. Objective: The study aimed to determine the demographic and socioeconomic effect of water, sanitation, and hygiene (WASH) in the occurrence of diarrheal disease among pediatric age group in Aba, Abia State. Materials and Methods: The study adopted a descriptive cross-sectional survey design to assess the environmental sanitation in the selected study areas. The survey was designed with the use of questionnaire which was administered to a sample size of 360 participants. The collected data were entered into computer software called Statistical Package for the Social Sciences (SPSS) Version 20.0 and analyzed using descriptive statistical analysis. Results: The results were displayed in frequency tables and charts. The relation between variables was determined with Fisher’s exact test and the findings showed that 267 (74.1%) of the participants reported with 1–5 times episodes of diarrhea/year and 204 (56.7%) participants had available water supply and the major source of water supply was borehole in 227 (63.1%) participants. In terms of water treatment, 255 (70.8%) reported of not boiling water before use; 100 (27.7%) did not wash hands after defecation, 225 (62.5%) did not wash hands after touching pet animals, and only 32 (8.8%) reported of not washing fruits/vegetables before eating or cooking. A total of 264 (73.3%) had the knowledge of treating children with diarrhea at health center. Conclusion: WASH had impact in the occurrence of diarrheal disease among pediatric age group in relation to demographic and socioeconomic factors. However, the available and functional sanitary facilities do not meet the required standards. Therefore, awareness should be generated on the importance of WASH practices in all local governments in Abia State.

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