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Out-of-pocket (OOP) payments have severe consequences for health care access and utilisation and are especially catastrophic for the poor. Although women comprise the majority of the poor in Nigeria and globally, the implications of OOP payments for health care access from a gender perspective have received little attention. This study seeks to fill this gap by using a combination of quantitative and qualitative analysis to investigate the gendered impact of OOPs on healthcare utilisation in south-eastern Nigeria. 411 households were surveyed and six single-sex Focus Group Discussions conducted. This study confirmed the socioeconomic and demographic vulnerability of female-headed households (FHHs), which contributed to gender-based inter-household differences in healthcare access, cost burden, choices of healthcare providers, methods of funding healthcare and coping strategies. FHHs had higher cost burdens from seeking care and untreated morbidity than male-headed households (MHHs) with affordability as a reason for not seeking care. There is also a high utilisation of patent medicine vendors (PMVs) by both households (PMVs are drug vendors that are unregulated, likely to offer very low-quality treatment and do not have trained personnel). OOP payment was predominantly the means of healthcare payment for both households, and households spoke of the difficulties associated with repaying health-related debt with implications for the medical poverty trap. It is recommended that the removal of user fees, introduction of prepayment schemes, and regulating PMVs be considered to improve access and provide protection against debt for FHHs and MHHs. The vulnerability of widows is of special concern and efforts to improve their healthcare access and broader efforts to empower should be encouraged for them and other poor households.

Background Uptake of delivery and postnatal care remains low in Low and Middle-Income Countries (LMICs), where 99% of global maternal deaths take place. However, the potential impact of antenatal depression on use of institutional delivery and postnatal care has seldom been examined. This study aimed to examine whether antenatal depressive symptoms are associated with use of maternal health care services. Methods A population-based prospective study was conducted in Sodo District, Southern Ethiopia. Depressive symptoms were assessed during pregnancy with a locally validated, Amharic version of the Patient Health Questionnaire (PHQ-9). A cut off score of five or more indicated possible depression. A total of 1251 women were interviewed at a median of 8 weeks (4–12 weeks) after delivery. Postnatal outcome variables were: institutional delivery care utilization, type of delivery, i.e. spontaneous or assisted, and postnatal care utilization. Multivariate logistic regression was used to examine the association between antenatal depressive symptoms and the outcome variables. Results High levels of antenatal depressive symptoms (PHQ score 5 or higher) were found in 28.7% of participating women. Nearly two-thirds, 783 women (62.6%), delivered in healthcare institutions. After adjusting for potential confounders, women with antenatal depressive symptoms had increased odds of reporting institutional birth [adjusted Odds Ratio (aOR) =1.42, 95% Confidence Interval (CI): 1.06, 1.92] and increased odds of reporting having had an assisted delivery (aOR = 1.72, 95% CI: 1.10, 2.69) as compared to women without these symptoms. However, the increased odds of institutional delivery among women with antenatal depressive symptoms was associated with unplanned delivery care use mainly due to emergency reasons (aOR = 1.62, 95% CI: 1.09, 2.42) rather than planning to deliver in healthcare institutions. Conclusion Improved detection and treatment of antenatal depression has the potential to increase planned institutional delivery and reduce perinatal complications, thus contributing to a reduction in maternal morbidity and mortality.

Anxiety is highly prevalent in many populations; however, the burden of anxiety disorders amongst pregnant women in low-resource settings is not well documented. We investigated the prevalence and predictors of antenatal anxiety disorders amongst low-income women living with psychosocial adversity. Pregnant women were recruited from an urban, primary level clinic in Cape Town, South Africa. The Mini-International Neuropsychiatric Interview diagnostic interview assessed prevalence of anxiety disorders. Four self-report questionnaires measured psychosocial characteristics. Logistic regression models explored demographic and socioeconomic characteristics, psychosocial risk factors and psychiatric comorbidity as predictors for anxiety disorders. Amongst 376 participants, the prevalence of any anxiety disorder was 23%. Although 11% of all women had post-traumatic stress disorder, 18% of the total sample was diagnosed with other anxiety disorders. Multivariable analysis revealed several predictors for anxiety including a history of mental health problems (adjusted odds ratio [AOR] 4.11; 95% confidence interval (CI) 2.03–8.32), Major depressive episode (MDE) diagnosis (AOR 3.83; CI 1.99–7.31), multigravidity (AOR 2.87; CI 1.17–7.07), food insecurity (AOR 2.57; CI 1.48–4.46), unplanned and unwanted pregnancy (AOR 2.14; CI 1.11–4.15), pregnancy loss (AOR 2.10; CI 1.19–3.75) and experience of threatening life events (AOR 1.30; CI 1.04–1.57). Increased perceived social support appeared to reduce the risk for antenatal anxiety (AOR 0.95; CI 0.91–0.99). A range of antenatal anxiety disorders are prevalent amongst pregnant women living in low-resource settings. Women who experience psychosocial adversity may be exposed to multiple risk factors, which render them vulnerable to developing antenatal anxiety disorders.

Background: Changing global health and development trends have resulted in a need for continued professional development (CPD) within the health and development sectors. In low-resource settings, where the need for training and CPD may be highest, there are significant challenges for disseminating information and skills. There is a need to improve mental health literacy and reduce levels of stigma about maternal mental illness. The Bettercare series of distance learning books provides a peer-based format for CPD. We aimed to evaluate the Bettercare Maternal Mental Health book as a format for CPD. Aim: The aim of this study was to determine whether the Bettercare Maternal Mental Health book significantly improves knowledge and decreases stigma around mental health for care providers from the health and social development sectors. Setting: One hundred and forty-one participants (social workers, nursing students and health professionals) were provided with the Bettercare Maternal Mental Health book to study. Methods: Before and after studying the book, the same multiple-choice knowledge test and the Mental Illness Clinicians’ Attitude Scale were used to assess cognitive knowledge and mental health stigma, respectively. Results: Participants’ knowledge showed a statistically significant (p < 0.001) improvement between the pre- and post-test results, for all six chapters of the book. However, participants’ attitudes towards mental illness did not show a statistically significant change between the pre- and post-test results. Conclusion: We found that this method of learning elicited significant improvement in mental health knowledge for care providers. Continued professional development policy planners and curriculum developers may be interested in these findings.

There is mixed evidence on the cost-effectiveness of cash transfers, along with food supplements and behaviour change communication interventions in improving child nutrition outcomes. To add to existing literature, we examined the cost-effectiveness of medium-quantity lipid-based nutrient supplement (LNS) and social and behaviour change communication (SBCC) messaging, separately and combined, compared to an existing unconditional cash transfers (UCT) programme in children 6-23 months of age in the district Rahim Yar Khan, Pakistan. This was a four-arm, community-based cluster randomised controlled trial. The UCT provided a quarterly sum of USD 32, the medium-quantity LNS contained a daily ration of 50 g of LNS, and the SBCC included monthly and quarterly messaging on nutrition, health, and hygiene to eligible households. Cost data were collected from a provider perspective through the review of procurement invoices and budgets, as well as interviews with stakeholders. We examined cost-effectiveness via statistically significant differences between the intervention and control arms, and estimated as cost per case of stunting, and disability-adjusted life years (DALYs) averted at six and 18 months of intervention. Costs were higher for SBCC intervention combinations (UCT + SBCC and UCT + LNS + SBCC) due to high training costs for lady health workers. UCT + LNS achieved a reduction in stunting at a per-case cost of USDS 278.74 at six months and USD 897.15 at 18 months. UCT + LNS + SBCC achieved a reduction in stunting at per case cost of USD 846.48 at six months and USD 2324.58 at 18 months. The cost per DALYs averted for preventing stunting was USD 234 to USD 557.42 at six months, and USD 787.73 to USD 1537 at 18 months without discounting and age-weights. Although the affordability of such interventions is arguable, combining UCTs with LNS appears to be very cost-effective for reducing undernutrition and averting DALYs, while combining cash transfers with LNS and SBCC showed limited cost-effectiveness when targeting stunting. Clinicaltrials.gov: NCT03299218.

Background: Over the years, the Kyrgyz Republic has implemented health reforms that target health financing with the aim of removing financial barriers to healthcare including out-of-pocket health payments (OOPPs). This study examines the trends in OOPPs and the incidence of catastrophic health expenditure (CHE) post the “Manas Taalimi” and “Den Sooluk” health reforms. Methods: We used data from the Kyrgyzstan Integrated Household Surveys (2012 – 2018). Population-weighted descriptive statistics were used to examine the trends in OOPPs and CHE at three thresholds; 10 percent of total household consumption expenditure (Cata10), 25 percent of total household consumption expenditure (Cata25) and 40 percent of total household non-food consumption expenditure (Cata40). Panel and cross-sectional logistic regression with marginal effects were used to examine the predictors of Cata10 and Cata40. Findings: Between 2012 and 2018, OOPPs increased by about US$6 and inpatient costs placed the highest cost burden on users (US $ 13.6), followed by self-treatment (US$10.7), and outpatient costs (US $ 9). Medication continues to predominantly drive inpatient, outpatient, and self-treatment OOPPs. About 0.378 to 2.084 million people (6 – 33 percent) of the population incurred catastrophic health expenditure at the three thresholds between 2012 and 2018. Residing in households headed by a widowed or single head, or residing in rural regions, increases the likelihood of incurring catastrophic health expenditure. Conclusions: The initial gains in the reduction of OOPPs and catastrophic health expenditure appear to gradually erode since costs continue to increase after an initial decline and catastrophic health expenditure continues to rise unabated. This implies that households are increasingly incurring economic hardship from seeking healthcare. Considering that this could result to forgone expenditure on essential items including food and education, efforts should target the sustainability of these health reforms to sustain the reduction of catastrophic health payments and its dire consequences.

The effect of treatment time on the efficacy of trypanocides in rats experimentally infected with Trypanosoma brucei brucei was assessed. The thirty albino rats utilized in this study were divided into six groups, each with five rats. Group 1 rats were uninfected while those in groups 2 - 6 were inoculated intraperitoneally with 106 trypanosomes. Group 2 rats were left untreated while groups 3 - 6 rats were treated respectively on days 5, 8, 11 and 14 post infection (PI) with 1.0 mg/kg Securidium® (brand of isometamidium chloride) intraperitoneally. Level of parasitaemia, rectal temperature, clinical signs, haematological indices (packed cell volume and total leucocyte count) and survivability were used to evaluate the treatment time on the efficacy of Securidium®. Pre-patent period was 4 - 5 days. On days 4, 5, and 11 following the treatments (PT), the parasites were eliminated in the treated groups 3 - 6 respectively. Also, two rats relapsed in group 3 from 37 days PT with 20% mortality, whereas groups 4 - 6 rats relapsed from days 19, 16 and 21 PT respectively. Groups 4 - 6 rats had 40%, 60% and 80% mortalities respectively. The mean PCV and TLC showed a striking drop (p<0.05) PI, however, group 3 had a better result PT compared to other infected-treated groups. In conclusion, it is safe to say that treatment time is a significant determinant of therapeutic efficacy in trypanosomosis, as early treatment group had better overall indices of therapeutic efficacy than the late treatment groups.

Coccidiosis is a major economic burden in poultry farming worldwide. In Nigeria, herbal anticoccidials are widely used, yet their efficacy compared to orthodox drugs remains unclear. This study evaluates their comparative effects in broilers experimentally infected with mixed Eimeria species. 70 five-week-old broiler birds were employed in this study. The infective dose of the field strain of mixed Eimeria species was determined following standard procedures. Forty-two birds were randomly assigned to six groups (seven birds per group) to compare the anticoccidial effects of herbal and orthodox drugs. Groups A–E were infected with 10 5 sporulated mixed Eimeria tenella and E. maxima oocysts while group F was the uninfected control. Groups A-D were treated with Cocci00® (branded herbal drug), unbranded herbal preparation (UHP), Amprolium, and Diclazuril respectively, following the manufacturer's recommended dosage. Group E remained untreated. Clinical signs, body weight changes, oocyst output, feed conversion ratio (FCR), lesion score, survivability/mortality and haematological parameters of the birds were assessed. Among treated groups, birds in the UHP group had significantly higher ( p <  0.05) oocyst counts, mortality rates, and FCR, along with lower ( p <  0.05) weight gain. Conversely, groups A, C, and D demonstrated comparable mortality rates, survival times, oocyst counts, FCR and lesion scores. However, these values were slightly better in the Diclazuril-treated group D birds. In conclusion, both Cocci00® (branded herbal) and orthodox drugs showed similar anticoccidial effects, but Diclazuril was the most effective. The UHP had the lowest efficacy.

Genetic programming (GP) of four levels of complexity, including artificial neural networks of the hyper-tanh activation function (ANN-Hyper-Tanh), artificial neural networks of the sigmoid activation function (ANN-Sigmoid), evolutionary polynomial regression (optimized with genetic algorithm) (EPR), and intelligent techniques have been used to predict the erodibility of lateritic soil collected from an erosion site and treated with hybrid cement. Southeastern Nigeria and specifically Abia State is being destroyed by gully erosion, the solution of which demands continuous laboratory examinations to determine the parameters needed to design sustainable solutions. Furthermore, complicated equipment setups are required to achieve reliable results. To overcome constant laboratory works and equipment needs, intelligent prediction becomes necessary. This present research work adopted four different metaheuristic techniques to predict the erodibility of the soil; classified as A-7-6, weak, unsaturated, highly plastic, high swelling and high clay content treated with HC utilized in the proportions of 0.1–12% at the rate of 0.1%. The results of the geotechnics aspect of the work shows that the HC, which is a cementitious composite formulated from blending nanotextured quarry fines (NQF) and hydrated lime activated nanotextured rice husk ash (HANRHA), improves the erodibility of the treated soil substantially and consistently. The outcome of the prediction models shows that EPR with SSE of 1.6% and R2 of 0.996 outclassed the other techniques, though all four techniques showed their robustness and ability to predict the target (Er) with high performance accuracy.