Socioeconomic inequities and payment coping mechanisms used in the treatment of type 2 diabetes mellitus in Nigeria
IL Okoronkwo1, JN Ekpemiro2, OE Onwujekwe3, AC Nwaneri4, PN Iheanacho4
1 Department of Health Administration and Management; Department of Nursing Sciences, University of Nigeria, Enugu Campus, Enugu State, Umuahia, Abia State, Nigeria
2 Department of Nursing Sciences, University of Nigeria, Enugu Campus, Enugu State, Federal Medical Centre, Umuahia, Abia State, Nigeria
3 Department of Health Administration and Management, University of Nigeria, Umuahia, Abia State, Nigeria
4 Department of Nursing Sciences, University of Nigeria, Enugu Campus, Enugu State, Nigeria
I L Okoronkwo
Department of Health Administration and Management, University of Nigeria, Enugu Campus, Enugu State
Source of Support: None, Conflict of Interest: None
Aim: Given the enormous economic burden of diabetes in Nigeria and in sub-Saharan Africa, the study was designed to determine how different population groups cope with payment for type 2 diabetes mellitus (DM).
Materials and Methods: A total of 292 exit interviews were conducted with patients who attended the outpatient diabetic clinic in a specialist public health facility in southeast Nigeria. The monthly expenditures and strategies that were used to cope with payments for diabetic treatment were determined. A socioeconomic status (SES) index was used to divide the respondents into SES quartiles (Q1 (poorest), Q2, Q3, Q4 (least poor)). The coping mechanisms were disaggregated by SES.
Results: The mean monthly expenditure for the treatment of diabetes was ₦56,245.11 ($356). Expenditures were mostly incurred through out-of-pocket payments. The most common coping strategy utilized was household savings (99.0%) followed by support from family members (85.3%). All SES groups used more than one payment coping method. Borrowing, skipping of appointments, and stopping children education were significantly significant (P < 0.05).
Conclusion: The mean monthly direct cost in the treatment of type 2 diabetes among the study group was high. There were SES inequities in the use of coping mechanisms, with the poorest SES group (Q1) being worse off than other groups. The financial risk protection mechanisms such as health insurance that will reduce the economic burden of type 2 diabetes on households and provide universal health coverage to people suffering from DM more especially to the disadvantaged group should be developed and implemented.