An assessment of primary health care costs and resource requirements in Kaduna and Kano, Nigeria

Introduction

The availability of quality primary health care (PHC) services in Nigeria is limited. The PHC system faces significant challenges and the improvement and expansion of PHC services is constrained by low government spending on health, especially on PHC. Out-of-pocket (OOP) expenditures dominate health spending in Nigeria and the reliance on OOP payments leads to financial burdens on the poorest and most vulnerable populations. To address these challenges, the Nigerian government has implemented several legislative and policy reforms, including the National Health Insurance Authority (NHIA) Act enacted in 2022 to make health insurance mandatory for all Nigerian citizens and residents. Our study aimed to determine the costs of providing PHC services at public health facilities in Kaduna and Kano, Nigeria. We compared the actual PHC service delivery costs to the normative costs of delivering the Minimum Service Package (MSP) in the two states.

Methods

We collected primary data from 50 health facilities (25 per state), including PHC facilities-health posts, health clinics, health centers-and general hospitals. Data on facility-level recurrent costs were collected retrospectively for 2019 to estimate economic costs from the provider's perspective. Statewide actual costs were estimated by extrapolating the PHC cost estimates at sampled health facilities, while normative costs were derived using standard treatment protocols (STPs) and the populations requiring PHC services in each state.

Results

We found that average actual PHC costs per capita at PHC facilities-where most PHC services should be provided according to government guidelines-ranged from US$ 18.9 to US$ 28 in Kaduna and US$ 15.9 to US$ 20.4 in Kano, depending on the estimation methods used. When also considering the costs of PHC services provided at general hospitals-where approximately a third of PHC services are delivered in both states-the actual per capita costs of PHC services ranged from US$ 20 to US$ 30.6 in Kaduna and US$ 17.8 to US$ 22 in Kano. All estimates of actual PHC costs per capita were markedly lower than the normative per capita costs of delivering quality PHC services to all those who need them, projected at US$ 44.9 in Kaduna and US$ 49.5 in Kano.

Discussion

Bridging this resource gap would require significant increases in expenditures on PHC in both states. These results can provide useful information for ongoing discussions on the implementation of the NHIA Act including the refinement of provider payment strategies to ensure that PHC providers are remunerated fairly and that they are incentivized to provide quality PHC services.

Artificial dragonfly algorithm in the Hopfield neural network for optimal Exact Boolean k satisfiability representation

This study proposes a novel hybrid computational approach that integrates the artificial dragonfly algorithm (ADA) with the Hopfield neural network (HNN) to achieve an optimal representation of the Exact Boolean kSatisfiability (EBkSAT) logical rule. The primary objective is to investigate the effectiveness and robustness of the ADA algorithm in expediting the training phase of the HNN to attain an optimized EBkSAT logic representation. To assess the performance of the proposed hybrid computational model, a specific Exact Boolean kSatisfiability problem is constructed, and simulated data sets are generated. The evaluation metrics employed include the global minimum ratio (GmR), root mean square error (RMSE), mean absolute percentage error (MAPE), and network computational time (CT) for EBkSAT representation. Comparative analyses are conducted between the results obtained from the proposed model and existing models in the literature. The findings demonstrate that the proposed hybrid model, ADA-HNN-EBkSAT, surpasses existing models in terms of accuracy and computational time. This suggests that the ADA algorithm exhibits effective compatibility with the HNN for achieving an optimal representation of the EBkSAT logical rule. These outcomes carry significant implications for addressing intricate optimization problems across diverse domains, including computer science, engineering, and business.

Artificial Neural Network Logic-Based Reverse Analysis with Application to COVID-19 Surveillance Dataset

The Boolean Satisfiability Problem (BSAT) is one of the crucial decision problems in the fields of computing science, operation research, and mathematical logic that is resolved by deciding whether or not a solution to a Boolean formula exists. When there is a Boolean variable allocation that induces the Boolean formula to yield TRUE, then the SAT instance is satisfiable. The main purpose of this chapter is to utilize the optimization capacity of the Lyapunov energy function of Hopfield neural network (HNN) for optimal representation of the Random Satistibaility for COVID-19 Surveillance Data Set (CSDS) classification with the aim of extracting the relationship of dominant attributes that contribute to COVID-19 detections based on the COVID-19 Surveillance Data Set (CSDS). The logical mining task was carried based on the data mining technique of the energy minimization technique of HNN. The computational simulations have been carried using the different number of clauses in validating the efficiency of the proposed model in the training of COVID-19 Surveillance Data Set (CSDS) for classification. The findings reveals the effectiveness and robustness of k satisfiability reverse analysis with Hopfield neural network in extracting the dominant attributes toward COVID-19 Surveillance Data Set (CSDS) logic.

Determining staffing needs for improving primary health care service delivery in Kaduna State, Nigeria

Background: The equitable distribution of a skilled health workforce is critical to health service delivery. Kaduna state has taken significant steps to revamp the primary health care system to ensure access to health care for its populace. However, these investments are yet to yield the desired outcomes due to health workforce shortages and the inequitable distribution of those available. Methods: A Workload Indicator for Staffing Need (WISN) study was conducted at Kaduna state's primary health care level. The study focused on estimating staffing requirements; Nurses/Midwives and Community Health Worker practitioners, Community Health Officers, Community Health Extension Workers, and Junior Community Health Extension Workers in all government-prioritised primary health care facilities. A total of ten focal primary health care facilities in Kaduna North Local Government Area (LGA) were included in the study. Results: Findings from the study revealed a shortage of Nurses/Midwives and Community Health Workers across the study facilities. For the Nurse/Midwife staffing category, nine of the ten PHCs have a WISN ratio < 1, indicating that the number of staff in the Nurse/Midwife category is insufficient to cope with the workload. In two of the ten primary health care facilities, there is an excess in the number of CHWs available; a WISN ratio > 1 was calculated. Conclusion: The WISN study highlights staffing needs in Kaduna State's government-prioritised primary health care facilities. This evidence establishes the basis for applying an evidence-based approach to determining staffing needs across the primary health care sector in the State to guide workforce planning strategies and future investments in the health sector. The World Health Organisation (WHO) WISN tool is useful for estimating staffing needs required to cope with workload pressures, particularly in a resource-constrained environment like Kaduna State.

Simulation Study on Modified Weibull Distribution for Modelling of Investment Return

The Weibull distribution is one of the most popular statistical models extensively applied to lifetime data analysis such as survival data, reliability data, wind speed, and recently in financial data, due to itsts flexibility to adaptably imitate different families of statistical distributions. This study proposed a modified version of the two-parameter Weibull distribution by incorporating additional parameters in the internal rate of return and insurance claims data. The objective is to examine the behaviour of investment return on the assumption of the proposed model. The proposed and the existing Weibull distribution parameters have been estimated via a simulated annealing algorithm. Experimental simulations have been conducted mimicking the internal rate of return (IRR) data for both short time (small sample) and long-term investment periods (large samples). The performance of the proposed model has been compared with the existing two-parameter Weibull distribution model in terms of their R-square (R2), mean absolute error (MAE), root mean squared error (RMSE), Akaike’s information criterion (AIC), and the Kolmogorov-Smirnov test (KS). The numerical simulation revealed that the proposed model outperformed the existing two-parameter Weibull distribution model in terms of accuracy, robustness, and sensitivity. Therefore, it can be concluded that the proposed model is entirely suitable for the long-term investment period. The study will be extended using the internal rate of return real data set. Furthermore, a comparison of the various Weibull distribution parameter estimators such as metaheuristics or evolutionary algorithms based on the proposed model will be carried out.

P4727Comparing in-hospital outcomes of transcatheter mitral valve repair vs surgical mitral valve repair in patients with pulmonary hypertension

Background

The comparative outcomes of transcatheter mitral valve repair with Mitraclip (TMVR) versus surgical mitral valve repair (SMVR) in pulmonary hypertension (PH) patients are underexplored.

Methods

The Nationwide Inpatient Sample (NIS) database was queried from 2009 to 2015 and those who underwent TMVR or SMVR with PH were identified. International Classification of Diseases (ICD) codes were used to identify the target population, primary and secondary outcomes. Propensity scores (PS) were calculated for each patient. A standardized morbidity ratio (SMR) weight was then calculated for each patient in both groups. Absolute standardized differences (ASD) were used to compare the baseline characteristics.

Results

We identified a total of 341 and 4,665 cases from NIS who underwent TMVR and SMVR, respectively, over the study period. The mean age of patients was 67 yrs. Patients who underwent TMVR were older (75 vs. 66, ASD =0.32). Women comprised 47.8% of TMVR admission while 42.16% of SMVR admissions were females. Patients who underwent TMVR had a significantly higher Elixhauser comorbidity score >4 (43.4% vs 34.2%, ASD =0.3). TMVR group had higher rates of previous myocardial infarctions (16.7% vs. 7.1%, ASD = 0.30), congestive heart failure (80% vs. 6.2%, ASD = 0.44), percutaneous intervention (PCI) (15.6% vs. 5.9%, ASD = 0.32), coronary artery bypass grafting (CABG) (22.8% vs. 2.7%, ASD = 0.63), cerebrovascular disease (13.5% vs. 5.5%, ASD = 0.27), chronic obstructive pulmonary disease (30.8% vs. 21.1%, ASD = 0.22)and chronic renal failure (43.1% vs. 18.9%, ASD = 0.54). Inpatient mortality was similar between the 2 groups (3.6% vs 6.2%, p=0.573). TMVR patients had less hemorrhage requiring transfusion (8.1% vs 21.1, p<0.001), acute kidney injury (22.2% vs 33.6%, p<0.001), pacemaker placement (1.20% vs 6.89%, p<0.001), cardiogenic shock (4.5% vs 11.5%, p=0.0012) and mechanical circulatory device need (3.9% vs 9.7%, p=0.003). The TMVR group had lower median hospital cost ($53,824 vs $68,311, p<0.001) and LOS (7.5 days vs 13.1 days, p<0.001).

Conclusions

While in-hospital mortality in PH patients after TMVR compared to SMVR, TMVR was associated with significantly lower periprocedural complications.

Study of hepatic functions and prevalence of hepatitis B surface antigenaemia in Nigerian children with human immunodeficiency virus infection

BACKGROUND

HIV and hepatitis B virus (HBV) co-infected patients have a significantly increased risk of dying from liver disease especially after starting treatment with highly active antiretroviral therapy. We aim to determine the prevalence of hepatitis B surface antigenaemia in HIV-infected children and their significance in relation to hepatic functions.

METHOD

Two hundred and eighty four HIV-infected children aged between 4 mouths to 15 years attending the Paediatric infectious disease clinic of University of Maiduguri Teaching Hospital (UMTH) Maiduguri, Nigeria from September 2007 to December 2007 were the subject for this study. Two hundred and seventy six HIV-negative children with served as age and sex-matched controls. They underwent investigations to evaluate the liver function (serum alanine transferase (ALT), alkaline phosphotase (ALP) and bilirubin) and the prevalence of hepatitis B surface antigen (HBsAg) using ELISA technique.

RESULTS

Prevalence of HBsAg of 19% and 9.4% was observed among HIV-infected children controls (p = 0.004). Serum ALT and bilirubin concentrations were significantly higher in the HIV-infected group compared to the controls, (p < 0.05). HIV-infected children with HBs antigenaemia had significantly higher ALT and ALP concentrations compared to those without HBs antigenaemia (p < 0.05).

CONCLUSION

These findings point to the high risk of HBV infection and continual paranchymal damage in HIV-infected children before commencing ART. Vaccination against HBV should eliminate this risk. Ideally HBV serology should be evaluated before starting ART to help guide therapeutic decision-making.