Inequities in incidence, morbidity and expenditures on prevention and treatment of malaria in southeast Nigeria

Abstract

BackgroundMalaria places a great burden on households, but the extent to which this is tilted against the poor is unclear. However, the knowledge of the level of the burden of malaria amongst different population groups is vital for ensuring equitable control of malaria. This paper examined the inequities in occurrence, economic burden, prevention and treatment of malaria.MethodsThe study was undertaken in four malaria endemic villages in Enugu state, southeast Nigeria. Data was collected using interviewer-administered questionnaires. An asset-based index was used to categorize the households into socio-economic status (SES) quartiles: least poor; poor; very poor; and most poor. Chi-square analysis was used to determine the statistical significance of the SES differences in incidence, length of illness, ownership of treated nets, expenditures on treatment and prevention.ResultsAll the SES quartiles had equal exposure to malaria. The pattern of health seeking for all the SES groups was almost similar, but in one of the villages the most poor, very poor and poor significantly used the services of patent medicine vendors and the least poor visited hospitals. The cost of treating malaria was similar across the SES quartiles. The average expenditure to treat an episode of malaria ranged from as low as 131 Naira ($1.09) to as high as 348 Naira ($2.9), while the transportation expenditure to receive treatment ranged from 26 Naira to 46 Naira (both less than $1). The level of expenditure to prevent malaria was low in the four villages, with less than 5% owning untreated nets and 10.4% with insecticide treated nets.ConclusionMalaria constitutes a burden to all SES groups, though the poorer socio-economic groups were more affected, because a greater proportion of their financial resources compared to their income are spent on treating the disease. The expenditures to treat malaria by the poorest households could lead to catastrophic health expenditures. Effective pro-payment health financing and health delivery methods for the treatment and prevention of malaria are needed to decrease the burden of the disease to the most-poor people.

Healthcare financing in Nigeria: A systematic review assessing the evidence of the impact of health insurance on primary health care delivery

“…Almost all the studies revealed that insurance schemes enhanced financial access to quality care for primary health care needs in provider centres. [20][21][22][23][24][25][26][27][28][29][30][31][32]34] This corroborates the objective of the health insurance policy in Nigeria which explicitly seeks to provide a prepayment system that will improve access to quality healthcare by widening membership and thereby creating adequate pooling of risk. [13] While our findings suggests a march towards achievement of this objective of the NHIS, regrettably, evidence also reveals that wide gaps still exist in achieving the objectives of health insurance programme in the country.…”

“…However, six studies did not meet the inclusion criteria and were excluded. [21][22][23][24][25][26] Figure 1: Flow chart of search results of studies from searching and screening…”

“…Almost all the studies revealed that insurance schemes enhanced financial access to quality care for primary health care needs in provider centres. [20][21][22][23][24][25][26][27][28][29][30][31][32]34] For instance, antenatal care (ANC) and deliveries increased significantly following one year of commencement of a CB-HIs in Anambra state, one of the states in eastern Nigeria;…”

Evaluation of SMS reminder messages for altering treatment adherence and health seeking perceptions among malaria care-seekers in Nigeria

“…Drug retailers are particularly important for increasing access (Beyeler et al 2015) as 77% of fever episodes among children (NPC and ICF International 2013) and 35–55% of adults seeking malaria treatment (Uguru et al 2009; Onwujekwe et al 2011) first seek care at these types of shops. However, demand for diagnosis is also low as very few individuals seek testing before purchasing anti-malaria drugs (Isiguzo et al 2014; Liu et al 2015; Prach et al 2015).…”

Constraints to universal coverage: inequities in health service use and expenditures for different health conditions and providers

“…However, there are other factors related to poverty, geographic inaccessibility and lack of knowledge [11,15]. The 2008 NDHS in Nigeria showed the most important barrier that women faced in accessing healthcare was getting money for treatment [4].…”