Adesina Stephen Adesope, Amole Isaac Olusayo, Adegoke Adepeju Olatayo, Akinwumi Akinsola Idowu, Adefokun Imri Goodness, Odekhiran Ehimen Oluwadamilare, Ekunnrin Olusola Tunde, Ojo Simeon Ayorinde, Durodola Adewumi Ojeniyi, Awotunde Olufemi Timothy, Ikem Innocent Chiedu, Eyesan Samuel Uwale
Bowen University Teaching Hospital, P. O. Box 15, Ogbomoso, Oyo, Nigeria.
Bowen University, P.M.B 284, Iwo, Osun, Nigeria.
BMC Public Health. 2024 Dec 18;24(1):3462. doi: 10.1186/s12889-024-20991-y.
Bone fractures remain a significant global public health issue despite preventive measures, leading to substantial health and economic consequences. Effective treatment options are difficult to access in most sub-Saharan African countries, leading to reliance on unqualified practitioners and resulting in serious complications that worsen poverty. In Nigeria, the main challenge is the need for out-of-pocket payment for healthcare, which is the primary method of health financing. However, anecdotal evidence suggests that some patients find it easier to finance their fracture care than others. This study aimed to identify the factors that predict difficult fracture-care financing among patients treated operatively for long-bone fractures (LBFs) in southwestern Nigeria.
The study collected socio-demographic and clinical data on 690 consecutive adult patients with LBFs treated with SIGN nails between July 2014 and June 2024 at a mission teaching hospital in southwestern Nigeria. A literature review and preliminary interviews were conducted with patients, caregivers, and hospital staff to understand potential risk factors for difficult fracture-care financing. The patients were divided into two cohorts - easy fracture-care financing (EF) and difficult fracture-care financing (DF) - based on their promptness in paying the in-patient care bills. Potential risk factors for DF identified in the initial univariate analysis were entered as covariates into a binary logistic regression to determine the significant predictors of DF.
The mean age of the patients was 45.1 years (SD = 17.52). The DF cohort comprised 321 (46.5%) patients. Significant predictors of DF included younger age (p = 0.018), male gender (p = 0.002), lack of formal education or low level of education (p < 0.001), residence in the hospital city (p < 0.001), absence of health insurance (p = 0.013), lack of extended family support (p < 0.001), previous traditional bone setting treatment (p = 0.005), concomitant injury (p = 0.017), and a post-operative hospital stay longer than one week (p = 0.036).
The findings suggest that improving people's socioeconomic status through job creation, women's empowerment, reduction of gender inequality, higher education, comprehensive health insurance coverage, and stronger family bonds, as well as preventive strategies to reduce the occurrence and severity of injuries, can improve fracture-care financing in low-resource settings.
尽管采取了预防措施，但骨折仍是一个重大的全球公共卫生问题，会导致严重的健康和经济后果。在撒哈拉以南非洲的大多数国家，难以获得有效的治疗方案，导致人们依赖不合格的从业者，进而引发严重并发症，加剧贫困。在尼日利亚，主要挑战在于医疗保健需要自掏腰包支付费用，这是卫生筹资的主要方式。然而，有传闻证据表明，一些患者发现为骨折护理筹集资金比其他患者更容易。本研究旨在确定在尼日利亚西南部接受长骨骨折（LBF）手术治疗的患者中，预测骨折护理筹资困难的因素。
该研究收集了2014年7月至2024年6月期间在尼日利亚西南部一家教会教学医院连续接受SIGN髓内钉治疗的690例成年LBF患者的社会人口统计学和临床数据。对患者、护理人员和医院工作人员进行了文献综述和初步访谈，以了解骨折护理筹资困难的潜在风险因素。根据患者支付住院费用的及时性，将患者分为两个队列——骨折护理筹资容易（EF）和骨折护理筹资困难（DF）。在初始单因素分析中确定的DF潜在风险因素作为协变量纳入二元逻辑回归，以确定DF的显著预测因素。
患者的平均年龄为45.1岁（标准差=17.52）。DF队列包括321例（46.5%）患者。DF的显著预测因素包括年龄较小（p=0.018）、男性（p=0.002）、缺乏正规教育或教育水平低（p<0.001）、居住在医院所在城市（p<0.001）、没有医疗保险（p=0.013）、缺乏大家庭支持（p<0.001）、以前接受过传统接骨治疗（p=0.005）、合并损伤（p=0.017）以及术后住院时间超过一周（p=0.036）。
研究结果表明，通过创造就业、增强妇女权能、减少性别不平等、提高教育水平、提供全面的医疗保险覆盖以及加强家庭纽带等方式提高人们的社会经济地位，以及采取预防策略减少伤害的发生和严重程度，可以改善资源匮乏地区的骨折护理筹资情况。
