Factors influencing the choice of facilities among enrolees of a prepayment scheme in Ibadan, Southwest Nigeria

Aims: Factors that influence the personal choice of a health care facility among health care consumers vary. Currently, what influences the choice of health facilities among enrollees under the National Health Insurance Scheme (NHIS) is not known. This study aimed to as-sess what influences the choice of facilities in the NHIS of Nigeria. Methods: This was a descriptive cross-sectional study conducted among enrollees in selected NHIS facilities in the 11 Local Government Areas (LGAs) of Ibadan, Nigeria. A total of 432 enrollees were selected and were interviewed. A WHO-USAID semi-structured interviewer-administered questionnaire was used to obtain relevant data. Data collection was between Oc-tober and December 2019. Data were analyzed using STATA version 12.0 (α =0.05).Results: At unadjusted OR, older respondents (OR 3.24, CI = 2.52-4.18, p = <0.0001), and those who had attained the tertiary level of education (OR 3.30, CI 2.57-4.23, p <0.0001) were more likely to make a personal choice of health care facilities. A similar pattern was ob-served among respondents who were in the high socioeconomic group (OR 4.10, CI 3.01-5.59, p = <0.0001). However, at Adjusted OR, only high socio-economic status was a predic-tor of personal choice of health care facility (OR 1.92, CI 1.21-3.05, p = 0.005). Conclusion: This study is suggestive that a need for and the ability to afford the cost of care influence the choice of health facilities. Policies that promote health literacy in the general populace will enhance the capability of individuals to make a personal choice of health facili-ties. Stakeholders should prioritize this for policy.Recommended citation: David A. Adewole, Temitope Ilori. Factors influencing the choice of facilities among enrolees of a prepayment scheme in Ibadan, Southwest Nigeria Acknowledgments: The authors wish to acknowledge study participants for permission to interview them in the course of the data collection of this study.Authors' contributions: David Adewole conceived and designed the study. Temitope Ilori did data collection and analysis. Both authors contributed equally to the manuscript write-up. The two authors also read through the manuscript draft the second time and agreed to the final manuscript. Conflict of interests: None declared

Factors influencing the choice of facilities among enrolees of a prepayment scheme in Ibadan, Southwest Nigeria

Aims: Factors that influence the personal choice of a health care facility among health care consumers vary. Currently, what influences the choice of health facilities among enrollees under the National Health Insurance Scheme (NHIS) is not known. This study aimed to as-sess what influences the choice of facilities in the NHIS of Nigeria. Methods: This was a descriptive cross-sectional study conducted among enrollees in selected NHIS facilities in the 11 Local Government Areas (LGAs) of Ibadan, Nigeria. A total of 432 enrollees were selected and were interviewed. A WHO-USAID semi-structured interviewer-administered questionnaire was used to obtain relevant data. Data collection was between Oc-tober and December 2019. Data were analyzed using STATA version 12.0 (α =0.05).Results: At unadjusted OR, older respondents (OR 3.24, CI = 2.52-4.18, p = <0.0001), and those who had attained the tertiary level of education (OR 3.30, CI 2.57-4.23, p <0.0001) were more likely to make a personal choice of health care facilities. A similar pattern was ob-served among respondents who were in the high socioeconomic group (OR 4.10, CI 3.01-5.59, p = <0.0001). However, at Adjusted OR, only high socio-economic status was a predic-tor of personal choice of health care facility (OR 1.92, CI 1.21-3.05, p = 0.005). Conclusion: This study is suggestive that a need for and the ability to afford the cost of care influence the choice of health facilities. Policies that promote health literacy in the general populace will enhance the capability of individuals to make a personal choice of health facili-ties. Stakeholders should prioritize this for policy.Recommended citation: David A. Adewole, Temitope Ilori. Factors influencing the choice of facilities among enrolees of a prepayment scheme in Ibadan, Southwest Nigeria Acknowledgments: The authors wish to acknowledge study participants for permission to interview them in the course of the data collection of this study.Authors' contributions: David Adewole conceived and designed the study. Temitope Ilori did data collection and analysis. Both authors contributed equally to the manuscript write-up. The two authors also read through the manuscript draft the second time and agreed to the final manuscript. Conflict of interests: None declared

Distributed Conditional GAN (discGAN) For Synthetic Healthcare Data Generation

In this paper, we propose a distributed Generative Adversarial Networks (discGANs) to generate synthetic tabular data specific to the healthcare domain. While using GANs to generate images has been well studied, little to no attention has been given to generation of tabular data. Modeling distributions of discrete and continuous tabular data is a non-trivial task with high utility. We applied discGAN to model non-Gaussian multi-modal healthcare data. We generated 249,000 synthetic records from original 2,027 eICU dataset. We evaluated the performance of the model using machine learning efficacy, the Kolmogorov-Smirnov (KS) test for continuous variables and chi-squared test for discrete variables. Our results show that discGAN was able to generate data with distributions similar to the real data

Post-Secondary Schooling Quality and Manufacturing Capacity in Africa

Quality investment in post-secondary schooling could facilitate structural transformation of African economies presently dominated by small-scale agricultural activities. To probe the causal relationship between human capital quality and manufacturing capacity, we build a new database of schooling quality. The country-level average test score of students in the GMAT examinations between 1984 and 2006 is used as the main measure of post-secondary schooling quality. Our OLS results suggest a strong and positive relationship between schooling quality and manufacturing capacity. Our results are robust to the addition of a fairly large number of relevant variables, corrections for influential observations and check for self-selection related biases. Furthermore, we use 2SLS technique to correct for possible endogeneity, omitted variable bias and measurement error of the schooling quality indicator. Our instrument passed the tests of exogeneity, although the maximum likelihood technique is used due to weak instrument proble

Understanding the concept of health insurance: An innovative social marketing tool

Health insurance scheme is relatively new in many low to middle income countries. Awareness about and knowledge of the scheme is poor among potential beneficiaries. There are some misconceptions associated with health insurance, which contributes to its low acceptance in affected nations. The aim of this work is to present an information-education and communication concept that will serve as a social marketing tool that could enhance peoples’ understanding of the modus operandi of health insurance scheme, and as well as to demystify superstitious belief associated with it. This will contribute to a better understanding of the scheme among the people and enhance its uptake

Preferred Approach to Clinical Performance Improvement among Physicians at the University College Hospital, Ibadan Nigeria

Background: Training needs assessment involves the identification and prioritization of training requirements. The medical practice regulatory authority in Nigeria recommends continuing medical education for physicians. The courses are preplanned and often do not take into consideration the training needs and the preferred method for performance improvement. This study aimed to assess the preferred method for performance improvement among physicians at a tertiary health facility in Southwest Nigeria. Methods: This is a descriptive cross‑sectional survey carried out among 355 doctors employed in the University College Hospital, Ibadan. Sampling was conducted using stratified random sampling with a proportionate allocation to size across different cadres of doctors in various departments/units. The World Health Organization Hennessy‑Hicks Training Needs Analysis Questionnaire was adopted for this study. The self‑administered questionnaire consisted of 33 items (assignments) grouped into five subcategories: clinical assignments, communication/teamwork, research/audit, management/supervisory assignments, and administration. Participants were requested to rate each of the 33 items/assignments along with seven‑point scales (one = not at all important and seven = very important). The  Hennessy‑Hicks training manual quadrant chart was adopted for the interpretation of the training needs gap. Results: Three hundred and three (85.4%) of 355 participants responded to the survey. The mean age ± standard deviation of participants was 37.62 ± 6.7 years. About four‑fifths of the participants were resident doctors. Regarding the most important rating, the clinical assignment subcategory was rated (6.3) as the most important to participants’ job, out of the five subcategories. Participants, however, rated their performance best in the communication/teamwork subcategory. The training needs gap was highest (0.82) in the  research/audit subcategory and lowest (0.48) in the communication/teamwork category. All subcategories reported a similar score (5.8) on participants’ perception of the organization’s development as a method to bridge the gap in training needs. Participants also rated the training course method as a better method to improve performance in all five subcategories. Conclusion: The research/audit subcategory reported training needs gap that requires close monitoring and possible intervention. This could be done by organizing and sponsorship physicians for training courses. Keywords: Health resources, Nigeria, physicians, training needs assessment

A Syntactic Analysis of President Bola Ahmed Tinubu’s Inaugural Speech

The aim of this research was to carry out a syntactic analysis of President Bola Ahmed Tinubu’s inaugural speech, with a view to examining the syntactic devices employed, discussing how the syntactic devices help in the interpretation of the speech and explaining the devices in relation to the context of the speech. The inaugural speech of President Bola Ahmed Tinubu served as the data for the study. A combination of qualitative and quantitative approach was adopted in the study. The analysis of the data was done using frequency-based approach, with insights drawn from Halliday’s Systemic Functional grammar. The findings revealed the predominance of simple sentences for clarity and easy understanding as well as the strategic use of ellipsis, appositions, and substitutions to avoid unnecessary repetitions and for the purpose of emphasis. Adverbial phrases and syntactic parallelism were also employed to create unity and rhythm in the speech. The study concluded that President Bola Ahmed Tinubu’s language choices reinforce his political ideology, policy priorities and vision for Nigeria’s future

Gastric bypass and banding equally improve insulin sensitivity and β cell function

Bariatric surgery in obese patients is a highly effective method of preventing or resolving type 2 diabetes mellitus (T2DM); however, the remission rate is not the same among different surgical procedures. We compared the effects of 20% weight loss induced by laparoscopic adjustable gastric banding (LAGB) or Roux-en-Y gastric bypass (RYGB) surgery on the metabolic response to a mixed meal, insulin sensitivity, and \u3b2 cell function in nondiabetic obese adults. The metabolic response to meal ingestion was markedly different after RYGB than after LAGB surgery, manifested by rapid delivery of ingested glucose into the systemic circulation, by an increase in the dynamic insulin secretion rate, and by large, early postprandial increases in plasma glucose, insulin, and glucagon-like peptide-1 concentrations in the RYGB group. However, the improvement in oral glucose tolerance, insulin sensitivity, and overall \u3b2 cell function after weight loss were not different between surgical groups. Additionally, both surgical procedures resulted in a similar decrease in adipose tissue markers of inflammation. We conclude that marked weight loss itself is primarily responsible for the therapeutic effects of RYGB and LAGB on insulin sensitivity, \u3b2 cell function, and oral glucose tolerance in nondiabetic obese adults

Self‑reported Training Needs among Physicians in a Tertiary Institution, Southwest, Nigeria: An Application of Hennessy‑Hicks Training Needs Assessment Tool

Background: To keep pace with existing as well as emerging public and population health challenges, continuing in‑service professionaldevelopment (CPD) of physicians is paramount. This study assessed the training needs of physicians in a tertiary hospital in Ibadan, South‑West,Nigeria. Methods: This study utilized a descriptive cross‑sectional design. Three hundred and fifty‑five physicians were randomly selected. Data were collected with the aid of the Hennessy‑Hicks Training Needs Assessment tool. The instrument has five broad sub‑sections: Research/audit, communication/teamwork, clinical tasks, administration, and management/supervisory tasks. In all, these subsections are made up of 30 items with their roles/tasks and were used to assess the training needs of individual study respondents. Charts and proportions were utilized to present the CPD training needs reported by physicians. Mann–Whitney U test was used to examine the difference in training needs between consultants and resident doctors.  Results: A larger proportion of the study respondents were middle‑aged adults. Respondents’ ages were fairly distributed across the varying age brackets. Respondents within the age bracket 35–39 were the highest (30.36%), followed by those within ages 30–34 years (24.09%). With regard to training needs and capacity development, research/audit skills had the highest need (0.83). Furthermore, training that enhances   managerial/supervisory skills had a rating of 0.68. Clinical tasks and administration tasks have the same rating (0.63), whereas   communication/teamwork had the lowest rating. Consultants expressed higher training needs compared with resident doctors across all task domains. Conclusion: Quest for skills in research had the topmost priority among physicians, and thus, majority were likely to be receptive to training and acquisition of new skills. Future CPD training should reflect the critical needs for performance improvement, as indicated in this study. Keywords: Continuing Professional Development, Health-care, Hennessy‑Hicks Training Needs Assessment, Physicians, Nigeri