Daniel Chukwuemeka Ogbuabor

Background: Despite its impact on nurses’ well-being, hospital efficiency, and patients’ quality of care, published studies on workplace violence against nurses in sub-Saharan Africa are scarce. This study assessed the prevalence, characteristics, and determinants of workplace violence among nurses in public tertiary hospitals in Enugu State, Nigeria. Methods: The study was a cross-sectional survey among nurses in the four (4) public tertiary hospitals (n = 450) in Enugu State Nigeria. The nurses were selected from the hospitals using proportional stratified random sampling technique. Data were collected using a self-administered, workplace violence questionnaire for nurses. The outcome variable was nurses’ experiences of workplace violence in the past 12 months, scoring as yes or no. Workplace violence included verbal, physical, and sexual violence. Additionally, we collected socio-demographic and organizational characteristics of the nurses. Nurses’ socio-demographic factors, organizational characteristics and prevalence of workplace violence were summarized using descriptive statistics. We identified the predictors of workplace violence using bivariate analysis and binary regression. The significance level for all inferential analyses was p-value less than 0.05. Results: Overall, the prevalence of any workplace violence was 92.4%. The prevalence of verbal violence, physical violence, and sexual violence are 91.1%, 13.3%, and 2.0% correspondingly. Relatives of patients perpetrated most workplace violence among nurses in this study. Female nurses were more likely to experience verbal abuse than male nurses (COR = 2.84, 95%CI: 1.09–7.42, p = 0.002). Being a registered nurse (AOR = 2.06, 95%CI: 1.13–3.78, p = 0.019), direct contact with patients (AOR = 21.04, 95%CI: 3.17–139.82, p = 0.002), working in accident and emergency units (AOR = 6.91, 95%CI: 2.82–16.93, p < 0.001) increased the likelihood of physical violence against nurses. Direct contact with patients (AOR = 20.71, 95%CI: 3.54–121.12, p = 0.001) increased the likelihood of sexual violence. Conclusion: Workplace violence among nurses in public hospitals need to improve. Decision-makers and practitioners can incorporate these findings into safeguarding policies and strategies to improve nurses’ safety and monitor interventions to eliminate workplace violence against nurses in Nigeria.

Background Low-and middle-income countries face a significant dual burden of tuberculosis (TB) and cigarette smoking. Nevertheless, studies examining the prevalence and determinants of smoking status and frequency among people with TB (PWTB) are scarce in sub-Saharan Africa, including Lesotho. Therefore, this study evaluated the prevalence and determinants of smoking status and frequency among people with TB in Lesotho. Methods Data on people with TB from the 2023 Lesotho Demographic and Health Survey were used in this study (n = 224). The data were adjusted for sampling weight, stratification, and cluster sampling design. The outcome variables were smoking status and smoking frequency (daily smoking and occasional smoking). The predictor variables included socio-demographic factors, household characteristics, alcohol use, TB-related stigma, and mental health status. We evaluated the association between outcome and predictor variables using Pearson’s chi-squared test and complex sample logistics regression. Statistical significance was set at a p-value < 0.05. Results The prevalence of cigarette smoking among PWTB is 32.2%. The prevalence of daily and occasional smoking among PWTB is 24.9% and 7.3%, respectively. Being male (AOR=120.15, 95%CI:30.53-472.81, pConclusion The high prevalence of smoking among PWTB needs to improve in Lesotho. Policies and programs to reduce smoking among PWTB must target the male gender, improve media exposure to anti-tobacco campaigns, reduce alcohol consumption and improve mental health among people with TB.

Background: Significant gaps in scholarship on the cost-benefit analysis of haemodialysis exist in low-middle-income countries, including Nigeria. The study, therefore, assessed the cost-benefit of haemodialysis compared with comprehensive conservative care (CCC) to determine if haemodialysis is socially worthwhile and justifies public funding in Nigeria. Methods: The study setting is Abuja, Nigeria. The study used a mixed-method design involving primary data collection and analysis of secondary data from previous studies. We adopted an ingredient-based costing approach. The mean costs and benefits of haemodialysis were derived from previous studies. The mean costs and benefits of CCC were obtained from a primary cross-sectional survey. We estimated the benefit-cost ratios (BCR) and net benefits to determine the social value of the two interventions. Results: The net benefit of haemodialysis (2,251.30) was positive, while that of CCC was negative (-1,197.19). The benefit-cost ratio of haemodialysis was 1.09, while that of CCC was 0.66. The probabilistic and one-way sensitivity analyses results demonstrate that haemodialysis was more cost-beneficial than CCC, and the BCRs of haemodialysis remained above one in most scenarios, unlike CCC’s BCR. Conclusion: The benefit of haemodialysis outweighs its cost, making it cost-beneficial to society and justifying public funding. However, the National Health Insurance Authority requires additional studies, such as budget impact analysis, to establish the affordability of full coverage of haemodialysis.

Background: Evidence of willingness to pay for kidney replacement therapy is scarce in low-middle-income countries, including Nigeria’s Formal Sector Social Health Insurance Programme. The study, therefore, assessed the willingness to pay for haemodialysis among chronic kidney disease patients in Abuja, Nigeria.Methods: The study adopted a cross-sectional survey design. We used the contingent valuation method to estimate the maximum stated willingness to pay (WTP) for haemodialysis among end-stage kidney disease (ESKD) patients. We obtained informed written consent from respondents before data collection. The socio-demographic characteristics and willingness to pay data were summarized using descriptive statistics. We evaluated the mean differences in respondents’ WTP using Mann-Whitney and Kruskal-Wallis tests. All variables that hadp < 0.25 in the bivariate analysis were included in the Generalized Linear Model (gamma with link function) to determine the predictors of the WTP for one’s and another’s haemodialysis. The level of significance in the final model was ρ < 0.05.Results: About 88.3% and 64.8% of ESKD patients were willing to pay for personal and altruistic haemodialysis, correspondingly. The mean annual WTP for haemodialysis for one’s and altruistic haemodialysis was USD25,999.06 and USD 1539.89, respectively. Private hospital patients were likelier to pay for their haemodialysis (β = 0.39, 95%CI: 0.21 to 0.57,p < 0.001). Patients attending public-private partnership hospitals were less likely to pay for altruistic haemodialysis than those attending public hospitals (β = -1.65, 95%CI: -2.51 to -0.79,p < 0.001).Conclusions: The willingness to pay for haemodialysis for themselves and others was high. The type of facility ESKD patients attended influenced their willingness to pay for haemodialysis. The findings highlight the need for policies to enhance affordable and equitable access to haemodialysis in Nigeria through pre-payment mechanisms and altruistic financing strategies.

Background Managing end-stage renal disease (ESRD) is cost-intensive and unaffordable for most people in low and middle-income countries such as Nigeria. Nonetheless, the benefit package of health insurance schemes excludes chronic kidney disease in Nigeria. This study aimed to determine the cost-effectiveness of haemodialysis compared to comprehensive conservative care (CCC) in managing ESRD patients in Nigeria. Methods Using direct costs, we conducted a cost-utility analysis of haemodialysis versus CCC from the provider and patient perspectives. The effectiveness of the two alternatives was determined using Disability-Adjusted Life Years (DALYs) averted. We discounted DALYs at 3%, but not costs, because costs were cross-sectional data collected within a year. We used average and incremental cost-effectiveness ratios to compare the cost-effectiveness of the two alternatives. We used one-way sensitivity analysis to assess the robustness of the results. Results The unit costs of providing haemodialysis and CCC were $152.21 and $72.44, respectively. The discounted mean DALYs averted per person were $151.7 and $111.1 per DALY averted for haemodialysis and CCC patients, respectively. The average cost-effectiveness ratios were $1.00 and $0.65 per DALY averted for haemodialysis and CCC patients, respectively. Compared to CCC, the incremental cost-effectiveness ratio (ICER) of haemodialysis is $1.97 per DALY averted. Conclusion Haemodialysis is substantially more effective and highly cost-effective than CCC for managing ESRD in Nigeria. The findings endorse increasing the coverage of haemodialysis in Nigeria's universal health coverage schemes to make haemodialysis more accessible for ESRD patients needing sustainable kidney care.

BackgroundEvidence of willingness to pay for renal replacement therapy is scarce in low-middle-income countries, including Nigeria's Formal Sector Social Health Insurance Programme. The study, therefore, assessed the willingness to pay for haemodialysis among chronic kidney disease patients in Abuja, Nigeria.MethodsThe study adopted a cross-sectional survey design. We used the contingent valuation method to estimate the maximum stated willingness to pay (WTP) for haemodialysis among end-stage renal disease (ESRD) patients. The socio-demographic characteristics and willingness to pay data were summarized using descriptive statistics. We evaluated the mean differences in respondents' WTP using Mann-Whitney and Kruskal-Wallis tests. All variables that had p < 0.25 in the bivariate analysis were included in the Generalized Linear Model (gamma with link function) to determine the predictors of the WTP for one's and another's haemodialysis. The level of significance in the final model was ρ < 0.05.ResultsAbout 88.3% and 64.8% of patients receiving haemodialysis were willing to pay for their haemodialysis and others, correspondingly. The mean annual WTP for haemodialysis for one’s and altruistic haemodialysis was USD25,999.06 and USD 1539.89, respectively. Private hospital patients were likelier to pay for their haemodialysis (β = 0.39, 95%CI: 0.21 to 0.57, p < 0.001). Patients attending public-private partnership hospitals were less likely to pay for altruistic haemodialysis than those attending public hospitals (β = -1.65, 95%CI: -2.51 to -0.79, p < 0.001).ConclusionsThe findings highlight the need for policies to promote affordable access to haemodialysis for all socioeconomic groups. Pre-payment mechanisms should be explored rather than out-of-pocket payments which pose financial hardships. The potential for altruistic financing strategies should also inform the redesign of funding policies to enhance equitable access.

Although the treatment for end-stage renal disease (ESRD) under Nigeria’s National Health Insurance Authority is haemodialysis (HD), the cost of managing ESRD is understudied in Nigeria. Therefore, this study estimated the provider and patient direct costs of haemodialysis and managing ESRD in Abuja, Nigeria. The study was a cross-sectional survey from both healthcare provider and consumer perspectives. We collected data from public and private tertiary hospitals (n = 6) and ESRD patients (n = 230) receiving haemodialysis in the selected hospitals. We estimated the direct providers’ costs using fixed and variable costs. Patients’ direct costs included drugs, laboratory services, transportation, feeding, and comorbidities. Additionally, data on the sociodemographic and clinical characteristics of patients were collected. The costs were summarized in descriptive statistics using means and percentages. A generalized linear model (gamma with log link) was used to predict the patient characteristics associated with patients’ cost of haemodialysis. The mean direct cost of haemodialysis was $152.20 per session (providers: $123.69; and patients: $28.51) and $23,742.96 annually (providers: $19,295.64; and patients: $4,447.32). Additionally, patients spent an average of $2,968.23 managing comorbidities. The drivers of providers’ haemodialysis costs were personnel and supplies. Residing in other towns (HD:β = 0.55, ρ = 0.001; ESRD:β = 0.59, ρ = 0.004), lacking health insurance (HD:β = 0.24, ρ = 0.038), attending private health facility (HD:β = 0.46, ρ < 0.001; ESRD: β = 0.75, ρ < 0.001), and greater than six haemodialysis sessions per month (HD:β = 0.79, ρ < 0.001; ESRD: β = 0.99, ρ < 0.001) significantly increased the patient’s out-of-pocket spending on haemodialysis and ESRD. The costs of haemodialysis and managing ESRD patients are high. Providing public subsidies for dialysis and expanding social health insurance coverage for ESRD patients might reduce the costs.

Background Food security is crucial to improve maternal nutrition during pregnancy. However, evidence of the magnitude and social determinants of food insecurity among pregnant women is scarce in Nigeria. Therefore, this study used nationally representative data to assess the prevalence and determinants of food insecurity among pregnant women in Nigeria. Methods The study setting was Nigeria. The study is a secondary analysis of data from the Nigeria Demographic and Health Survey 2018 using a cross-sectional household survey design. We adjusted the data for sampling weight, stratification, and cluster sampling design. The dependent variable was food security status: food security (dietary diversity) and food insecurity (no dietary diversity). The independent variables included women's socio-demographic and household characteristics. We cross-tabulated food security status and pregnant women's characteristics to measure the association using the Chi-square statistics. We included all significant variables from the bivariate analysis in a complex sample logistic regression model to determine the adjusted effect of each independent variable on food insecurity. We set the statistical significance for all inferential analyses at p Results The prevalence of food insecurity among pregnant women in Nigeria is 45%. Residing in the North-East (AOR:1.70, 95%CI:1.26-2.29, pConclusions The proportion of food-insecure pregnant women needs to improve in Nigeria. The government and its partners must address the cost of healthy diets, abate conflicts, and strengthen the implementation of food and nutrition policies. It is imperative to incorporate the social determinants of food insecurity identified in this study into policies and plans to improve food security among pregnant women in Nigeria.

Background: Smoking is a leading cause of avoidable deaths and attributable disability-adjusted life years globally. Yet, the determinants of smoking practices among women are understudied. This study assessed the determinants of smoking and smoking frequency among women of reproductive age in Nigeria. Methods and materials: Data from the 2018 Nigeria Demographic and Health Survey (NDHS) were used in this study (n = 41,821). The data were adjusted for sampling weight, stratification, and cluster sampling design. The outcome variables were smoking status and smoking frequency (daily smoking and occasional smoking). The predictor variables included women’s socio-demographic and household characteristics. Pearson’s chi-squared test was used to evaluate the association between outcome and predictor variables. All variables significant in bivariate analyses were further analysed using complex sample logistics regression. Statistical significance was set at a p-value < 0.05. Results: The prevalence of smoking among women of reproductive age is 0.3%. The prevalence of smoking frequency is 0.1% (daily) and 0.2% (occasionally). Overall, women aged 25-34 (AOR = 2.13, 95%CI: 1.06-4.29, ρ = 0.034), residing in the South-south region (AOR = 9.45, 95%CI: 2.04-43.72, ρ ρ = 0.004), in female-headed households (AOR = 2.56, 95%CI: 1.29-5.08, ρ = 0.007) and owning mobile phones (AOR = 2.10, 95%CI: 1.13-3.90, ρ = 0.020) were more likely to smoke. Whereas female-headed households (AOR = 4.34, 95%CI: 1.37-13.77, ρ = 0.013) and being formerly married (AOR = 6.37, 95%CI: 1.67-24.24, ρ = 0.007) predisposed to daily smoking, age 15-24 (AOR = 0.11, 95%CI: 0.02-0.64, ρ = 0.014) was protective of daily smoking among women. Owning mobile phones (AOR = 2.43, 95%CI: 1.17-5.06, ρ = 0.018) increased the odds of occasional smoking among women. Conclusions: The prevalence rates of smoking and smoking frequency are low among women of reproductive age in Nigeria. Women-centred approaches to tobacco prevention and cessation must become evidence-informed by incorporating these determinants into interventions targeting women of reproductive age in Nigeria.

Background: Countries in sub-Saharan Africa, including Nigeria, continue to depend on donor funding to achieve their national HIV response goals. The Government of Nigeria has made limited progress in translating political commitment to reduce donor dependency into increased domestic investment to ensure the sustainable impact of the HIV response. We explored the context-specific factors affecting the financial sustainability of the HIV response in Nigeria. Methods: Between November 2021 and March 2022, we conducted document reviews (n=13) and semistructured interviews with purposively selected national and subnational stakeholders (n=35). Data were analyzed thematically using the framework of health financing functions comprising revenue generation, pooling, and purchasing. Results: Stakeholders reported that there is a low level of government funding for the HIV response, which has been compounded by the weak engagement of Ministry of Finance officials and the unpredictable and untimely release of budgeted funds. Opportunities for domestic funding include philanthropy and an HIV Trust Fund led by the private sector. Integration of HIV treatment services into social health insurance schemes has been slow. Commodity purchasing has been inefficient due to ineffective coordination. Government stakeholders have been reluctant to support one-stop-shop facilities that target key and priority populations. Conclusion: Opportunities exist in the government and private sectors for improving domestic health financing to support transitioning from donor support and ensuring the financial sustainability of the HIV response in Nigeria. To ensure that domestic financing for the HIV response is stable and predictable, the amount of domestic funding needs to increase and a framework that incorporates donor transition milestones must be developed, implemented, and monitored. Key Findings The financial sustainability of the HIV response in Nigeria faces a variety of challenges, including heavy reliance on donor funding that is declining, a low level of domestic funding, and a low level of private-sector financing. In an effort to improve financing sustainability, integrating HIV testing and treatment services into social health insurance schemes has been slow due to concerns over the high cost of antiretroviral drugs. Purchasing of HIV treatment and prevention commodities has been inefficient because of the lack of an integrated procurement and supply chain management process. Despite the high costs associated with providing HIV treatment in hospitals, decentralizing treatment to primary health care centers and shifting tasks to less specialized staff has been slow. Key Implications Decision-makers and donors can use these findings to develop and implement a plan to increase domestic resource mobilization. The findings can help guide the implementation of a country-owned sustainable HIV response framework that incorporates donor transition milestones, ensures evidence-informed integration of HIV services into universal coverage schemes, initiates policy change to enable public financing of the community-led response, prioritizes HIV care and treatment, and addresses inequalities in future resource allocation decisions.