Murdoch Business School, Murdoch University, Perth, Western Australia.
Hospitals' Management Board, Alagbaka Estate, Akure, Ondo State, Nigeria.
PLoS One. 2024 Apr 2;19(4):e0296301. doi: 10.1371/journal.pone.0296301. eCollection 2024.
Apart from the morbidity and mortality, the Coronavirus disease 2019 (COVID-19) pandemic has increased the predisposition of households in Nigeria to forgone care, thereby increasing their vulnerability to adverse health consequences. Since there is no previous study in Nigeria on the evolution of pandemic-related forgone care and its drivers, our study assess the evolution of the problem using descriptive and nationally representative panel data analyses. We found about a 30% prevalence of forgone care during the lockdown, which declined progressively afterwards, dropping by 69.50 percentage points between April 2020 and April 2022. This decline produced a surge in households needing care from about 35.00% in the early pandemic to greater than 50%, beginning in early 2021. The forgone care was primarily due to financial hindrances, movement restrictions, and supply-side disruptions. Household socioeconomic factors such as income loss had 2.74 [95%CI: 1.45-5.17] times higher odds of forgone care, job loss, food insecurity, and poverty were 87% (OR: 1.87 [95%CI: 1.25-2.79]), 60% (OR: 1.60 [95%CI: 1.12-2.31]) and 76% (OR: 1.76 [95%CI: 1.12-2.75]) more likely to predispose households to forgone care, respectively. Also, geographical location, such as the South-South zone, induced 1.98 [95%CI: 1.09-3.58] times higher odds of forgone care than North-Central. A married female household head increased the odds by 6.07 [95%CI: 1.72-21.47] times compared with an unmarried female head. However, having a married household head, social assistance, and North-East or North-West zone compared with North-Central increased the chance of accessing care by 69% (OR 0.31 [95%CI: 0.16-0.59]), 59%,(OR 0.41 [95%CI: 0.21-0.77]), 72% (OR 0.28 [95%CI: 0.15-0.53]) and 64% (OR 0.36 [95%CI: 0.20-0.65]), respectively. Non-communicable diseases, disability, old age, large household size and rural-urban location did not affect the forgone care. Our study highlights the need to strengthen Nigeria's health system, create policies to promote healthcare accessibility and prepare the country for future pandemic challenges.
除了发病率和死亡率，2019 年冠状病毒病（COVID-19）大流行增加了尼日利亚家庭放弃护理的倾向，从而使他们更容易受到不良健康后果的影响。由于尼日利亚以前没有关于与大流行相关的放弃护理及其驱动因素的研究，我们的研究使用描述性和全国代表性面板数据分析来评估该问题的演变。我们发现，在封锁期间，放弃护理的比例约为 30%，此后逐渐下降，在 2020 年 4 月至 2022 年 4 月期间下降了 69.50 个百分点。这种下降导致需要护理的家庭数量从大流行早期的约 35.00%飙升至 2021 年初的 50%以上。放弃护理主要是由于财务障碍、流动限制和供应方中断。家庭的社会经济因素，如收入损失，有 2.74 倍（95%CI：1.45-5.17）的可能性放弃护理，失业、粮食不安全和贫困分别使家庭放弃护理的可能性增加 87%（OR：1.87 [95%CI：1.25-2.79]）、60%（OR：1.60 [95%CI：1.12-2.31]）和 76%（OR：1.76 [95%CI：1.12-2.75]）。此外，地理位置，如南部地区，比中北部地区导致放弃护理的可能性高 1.98 倍（95%CI：1.09-3.58）。与未婚女性相比，已婚女性家庭户主使放弃护理的可能性增加了 6.07 倍（95%CI：1.72-21.47）。然而，与中北部地区相比，有已婚家庭户主、社会援助和东北部或西北部地区增加了获得护理的机会 69%（OR 0.31 [95%CI：0.16-0.59]）、59%（OR 0.41 [95%CI：0.21-0.77]）、72%（OR 0.28 [95%CI：0.15-0.53]）和 64%（OR 0.36 [95%CI：0.20-0.65]）。非传染性疾病、残疾、老年、大家庭规模和城乡位置并没有影响放弃护理。我们的研究强调需要加强尼日利亚的卫生系统，制定促进医疗保健可及性的政策，并为该国未来的大流行挑战做好准备。
