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Article ; Online: Evaluating health systems' efficiency towards universal health coverage: A data envelopment analysis.

Eze, Paul / Idemili, Chidumebi Judith / Lawani, Lucky Osaheni

Inquiry : a journal of medical care organization, provision and financing

2024 Volume 61, Page(s) 469580241235759

Abstract: To estimate the technical efficiency of health systems toward achieving universal health coverage (UHC) in 191 countries. We applied an output-oriented data envelopment analysis approach to estimate the technical efficiency of the health systems, ... ...

Abstract	To estimate the technical efficiency of health systems toward achieving universal health coverage (UHC) in 191 countries. We applied an output-oriented data envelopment analysis approach to estimate the technical efficiency of the health systems, including the UHC index (a summary measure that captures both service coverage and financial protection) as the output variable and per capita health expenditure, doctors, nurses, and hospital bed density as input variables. We used a Tobit simple-censored regression with bootstrap analysis to observe the socioeconomic and environmental factors associated with efficiency estimates. The global UHC index improved from the 2019 estimates, ranged from 48.4 (Somalia) to 94.8 (Canada), with a mean of 76.9 (std. dev.: ±12.0). Approximately 78.5% (150 of 191) of the studied countries were inefficient (ϕ < 1.0) with respect to using health system resources toward achieving UHC. By improving health system efficiency, low-income, lower-middle-income, upper-middle-income, and high-income countries can improve their UHC indices by 4.6%, 5.5%, 6.8%, and 4.1%, respectively, by using their current resource levels. The percentage of health expenditure spent on primary health care (PHC), governance quality, and the passage of UHC legislation significantly influenced efficiency estimates. Our findings suggests health systems inefficiency toward achieving UHC persists across countries, regardless of their income classifications and WHO regions, as well as indicating that using current level of resources, most countries could boost their progress toward UHC by improving their health system efficiency by increasing investments in PHC, improving health system governance, and where applicable, enacting/implementing UHC legislation.
MeSH term(s)	Humans ; Universal Health Insurance ; Health Expenditures ; Global Health ; Health Resources ; Government Programs
Language	English
Publishing date	2024-03-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	42153-4
ISSN	1945-7243 ; 0046-9580
ISSN (online)	1945-7243
ISSN	0046-9580
DOI	10.1177/00469580241235759
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Article ; Online: Impact of community-based health insurance in low- and middle-income countries: A systematic review and meta-analysis.

Eze, Paul / Ilechukwu, Stanley / Lawani, Lucky Osaheni

PloS one

2023 Volume 18, Issue 6, Page(s) e0287600

Abstract: Background: To systematically evaluate the empirical evidence on the impact of community-based health insurance (CBHI) on healthcare utilization and financial risk protection in low- and middle-income countries (LMIC).: Methods: We searched PubMed, ... ...

Abstract	Background: To systematically evaluate the empirical evidence on the impact of community-based health insurance (CBHI) on healthcare utilization and financial risk protection in low- and middle-income countries (LMIC). Methods: We searched PubMed, CINAHL, Cochrane CENTRAL, CNKI, PsycINFO, Scopus, WHO Global Index Medicus, and Web of Science including grey literature, Google Scholar®, and citation tracking for randomized controlled trials (RCTs), non-RCTs, and quasi-experimental studies that evaluated the impact of CBHI schemes on healthcare utilization and financial risk protection in LMICs. We assessed the risk of bias using Cochrane's Risk of Bias 2.0 and Risk of Bias in Non-randomized Studies of Interventions tools for RCTs and quasi/non-RCTs, respectively. We also performed a narrative synthesis of all included studies and meta-analyses of comparable studies using random-effects models. We pre-registered our study protocol on PROSPERO: CRD42022362796. Results: We identified 61 articles: 49 peer-reviewed publications, 10 working papers, 1 preprint, and 1 graduate dissertation covering a total of 221,568 households (1,012,542 persons) across 20 LMICs. Overall, CBHI schemes in LMICs substantially improved healthcare utilization, especially outpatient services, and improved financial risk protection in 24 out of 43 studies. Pooled estimates showed that insured households had higher odds of healthcare utilization (AOR = 1.60, 95% CI: 1.04-2.47), use of outpatient health services (AOR = 1.58, 95% CI: 1.22-2.05), and health facility delivery (AOR = 2.21, 95% CI: 1.61-3.02), but insignificant increase in inpatient hospitalization (AOR = 1.53, 95% CI: 0.74-3.14). The insured households had lower out-of-pocket health expenditure (AOR = 0.94, 95% CI: 0.92-0.97), lower incidence of catastrophic health expenditure at 10% total household expenditure (AOR = 0.69, 95% CI: 0.54-0.88), and 40% non-food expenditure (AOR = 0.72, 95% CI: 0.54-0.96). The main limitations of our study are the limited data available for meta-analyses and high heterogeneity persisted in subgroup and sensitivity analyses. Conclusions: Our study shows that CBHI generally improves healthcare utilization but inconsistently delivers financial protection from health expenditure shocks. With pragmatic context-specific policies and operational modifications, CBHI could be a promising mechanism for achieving universal health coverage (UHC) in LMICs.
MeSH term(s)	Humans ; Developing Countries ; Community-Based Health Insurance ; Delivery of Health Care ; Health Expenditures ; Universal Health Insurance ; Insurance, Health
Language	English
Publishing date	2023-06-27
Publishing country	United States
Document type	Meta-Analysis ; Systematic Review ; Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0287600
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Impact of community-based health insurance in low- and middle-income countries

Paul Eze / Stanley Ilechukwu / Lucky Osaheni Lawani

PLoS ONE, Vol 18, Iss

A systematic review and meta-analysis

2023 Volume 6

Abstract: Background To systematically evaluate the empirical evidence on the impact of community-based health insurance (CBHI) on healthcare utilization and financial risk protection in low- and middle-income countries (LMIC). Methods We searched PubMed, CINAHL, ... ...

Abstract	Background To systematically evaluate the empirical evidence on the impact of community-based health insurance (CBHI) on healthcare utilization and financial risk protection in low- and middle-income countries (LMIC). Methods We searched PubMed, CINAHL, Cochrane CENTRAL, CNKI, PsycINFO, Scopus, WHO Global Index Medicus, and Web of Science including grey literature, Google Scholar®, and citation tracking for randomized controlled trials (RCTs), non-RCTs, and quasi-experimental studies that evaluated the impact of CBHI schemes on healthcare utilization and financial risk protection in LMICs. We assessed the risk of bias using Cochrane’s Risk of Bias 2.0 and Risk of Bias in Non-randomized Studies of Interventions tools for RCTs and quasi/non-RCTs, respectively. We also performed a narrative synthesis of all included studies and meta-analyses of comparable studies using random-effects models. We pre-registered our study protocol on PROSPERO: CRD42022362796. Results We identified 61 articles: 49 peer-reviewed publications, 10 working papers, 1 preprint, and 1 graduate dissertation covering a total of 221,568 households (1,012,542 persons) across 20 LMICs. Overall, CBHI schemes in LMICs substantially improved healthcare utilization, especially outpatient services, and improved financial risk protection in 24 out of 43 studies. Pooled estimates showed that insured households had higher odds of healthcare utilization (AOR = 1.60, 95% CI: 1.04–2.47), use of outpatient health services (AOR = 1.58, 95% CI: 1.22–2.05), and health facility delivery (AOR = 2.21, 95% CI: 1.61–3.02), but insignificant increase in inpatient hospitalization (AOR = 1.53, 95% CI: 0.74–3.14). The insured households had lower out-of-pocket health expenditure (AOR = 0.94, 95% CI: 0.92–0.97), lower incidence of catastrophic health expenditure at 10% total household expenditure (AOR = 0.69, 95% CI: 0.54–0.88), and 40% non-food expenditure (AOR = 0.72, 95% CI: 0.54–0.96). The main limitations of our study are the limited data available for meta-analyses ...
Keywords	Medicine ; R ; Science ; Q
Subject code	306
Language	English
Publishing date	2023-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Catastrophic health expenditure in sub-Saharan Africa: systematic review and meta-analysis.

Eze, Paul / Lawani, Lucky Osaheni / Agu, Ujunwa Justina / Acharya, Yubraj

Bulletin of the World Health Organization

2022 Volume 100, Issue 5, Page(s) 337–351J

Abstract: Objective: To estimate the incidence of, and trends in, catastrophic health expenditure in sub-Saharan Africa.: Methods: We systematically reviewed the scientific and grey literature to identify population-based studies on catastrophic health ... ...

Abstract	Objective: To estimate the incidence of, and trends in, catastrophic health expenditure in sub-Saharan Africa. Methods: We systematically reviewed the scientific and grey literature to identify population-based studies on catastrophic health expenditure in sub-Saharan Africa published between 2000 and 2021. We performed a meta-analysis using two definitions of catastrophic health expenditure: 10% of total household expenditure and 40% of household non-food expenditure. The results of individual studies were pooled by pairwise meta-analysis using the random-effects model. Findings: We identified 111 publications covering a total of 1 040 620 households across 31 sub-Saharan African countries. Overall, the pooled annual incidence of catastrophic health expenditure was 16.5% (95% confidence interval, CI: 12.9-20.4; 50 datapoints; 462 151 households; Conclusion: Although data on catastrophic health expenditure for some countries were sparse, the data available suggest that a non-negligible share of households in sub-Saharan Africa experienced catastrophic expenditure when accessing health-care services. Stronger financial protection measures are needed.
MeSH term(s)	Africa South of the Sahara/epidemiology ; Catastrophic Illness/epidemiology ; Family Characteristics ; Health Expenditures ; Health Services ; Humans ; Incidence
Language	English
Publishing date	2022-04-04
Publishing country	Switzerland
Document type	Journal Article ; Meta-Analysis ; Review ; Systematic Review
ZDB-ID	80213-x
ISSN	1564-0604 ; 0042-9686 ; 0366-4996 ; 0510-8659
ISSN (online)	1564-0604
ISSN	0042-9686 ; 0366-4996 ; 0510-8659
DOI	10.2471/BLT.21.287673
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Short message service (SMS) reminders for childhood immunisation in low-income and middle-income countries: a systematic review and meta-analysis.

Eze, Paul / Lawani, Lucky Osaheni / Acharya, Yubraj

BMJ global health

2021 Volume 6, Issue 7

Abstract: Introduction: Childhood vaccine delivery services in the low- and middle-income countries (LMIC) are struggling to reach every child with lifesaving vaccines. Short message service (SMS) reminders have demonstrated positive impact on a number of ... ...

Abstract	Introduction: Childhood vaccine delivery services in the low- and middle-income countries (LMIC) are struggling to reach every child with lifesaving vaccines. Short message service (SMS) reminders have demonstrated positive impact on a number of attrition-prone healthcare delivery services. We aimed to evaluate the effectiveness of SMS reminders in improving immunisation coverage and timeliness in LMICs. Methods: PubMed, Embase, Scopus, Cochrane CENTRAL, CINAHL, CNKI, PsycINFO and Web of Science including grey literatures and Google Scholar were systematically searched for randomised controlled trials (RCTs) and non-RCTs that evaluated the effect of SMS reminders on childhood immunisation and timeliness in LMICs. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 assessment tool for RCTs and Cochrane Risk of Bias in Non-randomised Studies of Interventions tool for non-RCTs. Meta-analysis was conducted using random-effects models to generate pooled estimates of risk ratio (RR). Results: 18 studies, 13 RCTs and 5 non-RCTs involving 32 712 infants (17 135 in intervention groups and 15 577 in control groups) from 11 LMICs met inclusion criteria. Pooled estimates showed that SMS reminders significantly improved childhood immunisation coverage (RR=1.16; 95% CI: 1.10 to 1.21; I Conclusion: Current evidence from LMICs, although with significant heterogeneity, suggests that SMS reminders can contribute to achieving high and timely childhood immunisation coverage. Prospero registration number: CRD42021225843.
MeSH term(s)	Child ; Developing Countries ; Humans ; Immunization ; Infant ; Poverty ; Reminder Systems ; Text Messaging
Language	English
Publishing date	2021-07-21
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ISSN	2059-7908
ISSN	2059-7908
DOI	10.1136/bmjgh-2021-005035
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Article ; Online: Using i-tree canopy vegetation cover subtype classification to predict peri-domestic tick presence.

Omodior, Oghenekaro / Eze, Paul / Anderson, Kristina R

Ticks and tick-borne diseases

2021 Volume 12, Issue 3, Page(s) 101684

Abstract: While extant literature has generally indicated significant associations between vegetation cover and tick activity, no study has demonstrated the relative association between peri-domestic area vegetation cover subtypes and tick presence. In this study, ...

Abstract	While extant literature has generally indicated significant associations between vegetation cover and tick activity, no study has demonstrated the relative association between peri-domestic area vegetation cover subtypes and tick presence. In this study, we seek to determine whether neighborhood wood index and residential tick control practices confound or modify the effect of peri-domestic vegetation cover subtypes on tick presence. We conducted an ecological inventory of vegetation cover distribution using i-Tree Canopy on 210 private residential/peri-domestic properties in Indiana, USA. Results were paired with field obtained tick presence/absence data for each property together with online survey data provided by primary occupant of the property. Amblyomma americanum was the predominant tick species in peri-domestic areas. Higher proportion of vegetation cover in the peri-domestic area was significantly associated with tick presence. Of the four vegetation cover subtypes, (grass, shrubs, understory, and canopy), canopy was the most prevalent vegetation in peri-domestic areas of Indiana, USA. It was also the most significant predictor of tick presence. Among residential tick control processes, frequent leaf litter removal was significantly associated with reduced likelihood of peri-domestic tick presence. Neighborhood Wood Index (NWI) confounded the relationship between canopy and peri-domestic tick presence, while leaf-litter removal confounded the effect of understory vegetation subtype on peri-domestic tick presence. Compared to peri-domestic areas in neighborhoods with sparse NWI, those in neighborhoods with heavy/dense NWI had a 3.5x odd of peri-domestic tick presence (AOR = 3.46; 95 % CI: 1.23-9.65). Compared to peri-domestic areas in the central region, those in the southern region of Indiana were 8.7x more likely to have peri-domestic tick presence. Canopy as a vegetation cover subtype and frequent leaf litter removal represent particularly key peri-domestic variables that have significant implications for peri-domestic tick presence. Beyond parcel-scale landscape features, neighborhood wood index also plays an important role in peri-domestic tick presence. Additionally, i-Tree Canopy represents a promising methodological tool for identifying landscape features that predict tick presence.
MeSH term(s)	Animal Distribution ; Animals ; Ecology/methods ; Ecosystem ; Entomology/methods ; Indiana ; Ixodidae/physiology ; Parasitology/methods ; Trees/growth & development
Language	English
Publishing date	2021-02-09
Publishing country	Netherlands
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2541872-5
ISSN	1877-9603 ; 1877-959X
ISSN (online)	1877-9603
ISSN	1877-959X
DOI	10.1016/j.ttbdis.2021.101684
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Article ; Online: Functional properties of some varieties of new rice for Africa (NERICA) relevant to its processing

Chukwuka Eze Paul / Ikechukwu Oluka Sylvester / Nkechi Eze Chikodili

Journal on Processing and Energy in Agriculture, Vol 25, Iss 3, Pp 114-

2021 Volume 118

Abstract: Flour from rice can be applicable to several types of food or be used directly as a food substitute, and this can have an impact on the final quality of the product. This aimed to determine the functional properties of some selected NERICA varieties, ... ...

Abstract	Flour from rice can be applicable to several types of food or be used directly as a food substitute, and this can have an impact on the final quality of the product. This aimed to determine the functional properties of some selected NERICA varieties, namely, FARO 44, FARO 52, FARO 57, FARO 60 and FARO 61. Results obtained showed that the functional properties, such as the water absorption capacity (WAC), swelling power, water solubility index (WSI), bulk density, oil absorption capacity (OAC), and the foaming capacity, ranged from 251.74 to 298.51 (%); 7.42 to 8.41 (g/g); 10.01 to 12.27 (%); 0.92 to 1.00 (%); 0.45 to 1.36 (%); and 7.29 to 11.76 (%) respectively. All recorded samples were significantly different (p < 0.05). FARO 61 recorded the highest point of 298.51 (%), and 1.36 (%), in WAC and OAC respectively. While FARO 57 recorded the highest swelling power of 8.41 (g/g). These determined results of the functional properties of NERICA flour samples will be useful in determining their suitability in food and other relevant industries because the flour samples showed a high-quality range of functional properties that make them favourable for such activities.
Keywords	nerica ; functional properties ; rice ; food industry ; rice centre ; Agriculture ; S
Language	English
Publishing date	2021-01-01T00:00:00Z
Publisher	National Society of Processing and Energy in Agriculture, Novi Sad
Document type	Article ; Online
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Article: Validity of maternal recall for estimating childhood vaccination coverage – Evidence from Nigeria

Eze, Paul / Aniebo, Chioma Lynda / Agu, Ujunwa Justina / Agu, Sergius Alex / Acharya, Yubraj

Vaccine. 2022 Jan. 03, v. 40, no. 1

2022

Abstract: Vaccination coverage surveys in low- and middle-income countries typically estimate vaccination coverage using data from vaccination cards, parental recall, or a combination of the two. However, these surveys are often complicated by the pervasive ... ...

Abstract	Vaccination coverage surveys in low- and middle-income countries typically estimate vaccination coverage using data from vaccination cards, parental recall, or a combination of the two. However, these surveys are often complicated by the pervasive absence of vaccination cards, forcing researchers to rely on parental recall. We assessed the validity of mothers’ recall against home-based vaccination cards using data from a community-based household survey in Nigeria.A cross-sectional survey of 1,254 mothers of children aged 12–23 months was performed in Enugu State, Nigeria in July 2020. Data on vaccination status for BCG, OPV, DPT, Measles, Yellow fever, and Vitamin A supplement were collected using two data sources: home-based vaccination cards and mothers’ recall. We evaluated the level of agreement between the two data sources; estimated the sensitivity and specificity of mothers’ recalls; and computed multivariable regression models to identify socio-demographic factors associated with mothers’ recall bias.Out of 1,254 mothers interviewed, 578 (46.1%) mothers with vaccination cards were included in this analysis. Vaccination coverage levels were generally similar across data sources, though recall-based data generally underestimated the coverage. The level of agreement between the two data sources was high (≥91.0% for all vaccine types) with recall bias due to under-reporting generally higher than recall bias due to over-reporting. The sensitivity of parental recalls was high for all vaccine types, while the specificity was low across vaccine types. Across all vaccines, mothers recall bias was significantly associated with the rural residence and not receiving postnatal care.In the absence of vaccination cards, mothers’ recall of their children’ vaccination status for BCG, OPV, DPT, Measles, Yellow fever and Vitamin A is a valid instrument for estimating childhood vaccination coverage in this setting in Nigeria. However, additional research is needed to confirm these findings at higher sub-national and national levels.
Keywords	childhood ; cross-sectional studies ; household surveys ; measles ; vaccination ; vaccines ; vitamin A ; yellow fever ; Nigeria
Language	English
Dates of publication	2022-0103
Size	p. 28-36.
Publishing place	Elsevier Ltd
Document type	Article
ZDB-ID	605674-x
ISSN	1873-2518 ; 0264-410X
ISSN (online)	1873-2518
ISSN	0264-410X
DOI	10.1016/j.vaccine.2021.11.060
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: Acceptability of mobile-phone reminders for routine childhood vaccination appointments in Nigeria - a systematic review and meta-analysis.

Eze, Paul / Agu, Sergius Alex / Agu, Ujunwa Justina / Acharya, Yubraj

BMC health services research

2021 Volume 21, Issue 1, Page(s) 1276

Abstract: Background: Mobile-phone reminders have gained traction among policymakers as a way to improve childhood vaccination coverage and timeliness. However, there is limited evidence on the acceptability of mobile-phone reminders among patients and caregivers. ...

Abstract	Background: Mobile-phone reminders have gained traction among policymakers as a way to improve childhood vaccination coverage and timeliness. However, there is limited evidence on the acceptability of mobile-phone reminders among patients and caregivers. This systematic review and meta-analysis aimed to evaluate the ownership of mobile-phone device and the willingness to receive mobile-phone reminders among mothers/caregivers utilizing routine childhood immunization services in Nigeria. Method: MEDLINE, Scopus, CINAHL, CNKI, AJOL (African Journal Online), and Web of Science were systematically searched for studies on the acceptability of mobile-phone reminders for routine immunization appointments among mothers/caregivers in Nigeria. Studies were assessed for methodological quality using the Newcastle Ottawa Scale and JBI critical appraisal checklists. Meta-analysis was conducted using random-effects model to generate pooled estimates (proportion) of mothers who owned at least one mobile phone and proportion of mothers willing to receive mobile-phone reminders. Results: Sixteen studies (13 cross-sectional and three interventional) involving a total of 9923 mothers across 15 states and the Federal Capital Territory Abuja met inclusion criteria. Pooled estimates showed that the proportion of mothers who owned at least one mobile phone was 96.4% (95% CI = 94.1-98.2%; I Conclusion: Current evidence suggests a high acceptability for mobile-phone reminder interventions to improve routine childhood immunization coverage and timeliness. Further studies, however, are needed to better understand unique regional preferences and assess the operational costs, long-term effects, and risks of this intervention. Systematic review protocol registration: PROSPERO CRD42021234183.
MeSH term(s)	Cell Phone ; Cross-Sectional Studies ; Female ; Humans ; Immunization ; Nigeria ; Reminder Systems ; Text Messaging ; Vaccination
Language	English
Publishing date	2021-11-26
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	2050434-2
ISSN	1472-6963 ; 1472-6963
ISSN (online)	1472-6963
ISSN	1472-6963
DOI	10.1186/s12913-021-07296-1
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Journal ; Article ; Online: Catastrophic health expenditure in sub-Saharan Africa

Eze, Paul / Lawani, Lucky Osaheni / Agu, Ujunwa Justina / Acharya, Yubraj

systematic review and meta-analysis

2022

Abstract: ... 337 ... ...

Abstract	337 351J
Keywords	Systematic Reviews
Language	English
Publisher	World Health Organization
Document type	Journal ; Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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