{
  "abstract": "Background: In Nigeria, neurosurgical care is primarily financed by out-of-pocket (OOP) payments due to minimal health insurance coverage, leading to high rates of financial distress, limited access, and delayed care. This study aimed to quantify patient-level OOP costs, evaluate the risk of catastrophic and impoverishing expenditures, and assess the socioeconomic impacts of neurosurgical hospitalization.\n\nMethods: We conducted a prospective cohort study of neurosurgical patients at the University College Hospital, Ibadan, from January to August 2024. Structured questionnaires were administered at admission, discharge, and 2–4 weeks post-discharge to capture direct medical, direct non-medical, and indirect costs of care. Catastrophic health expenditure (CHE) was assessed using two established thresholds: out-of-pocket health expenditure exceeding 10% of total household income, consistent with the SDG 3.8.2 framework, and expenditure ≥40% of household capacity to pay, using the WHO approach. Impoverishment was assessed against the World Bank poverty line for Nigeria. Ethical approvals were obtained from the University of Ibadan/University College Hospital Ibadan and Duke Health Institutional Review Boards.\n\nResults: We enrolled 99 neurosurgical patients (median age 33, 75% male). Traumatic brain injury was the most common diagnosis (48%). The median length of stay was 14 days. Most patients (92%) relied on household savings, and 52% borrowed money to cover their cost of care. Only 12% had any health insurance, which covered a median of 30% of expenses. The median direct medical cost per patient was ₦969,000 ($633), non-medical cost ₦202,000 ($132), and indirect cost ₦141,639 ($93). The median total OOP expenditure was ₦1,410,787 ($922; IQR: ₦815,951–₦2,442,176). Among households with sufficient baseline economic data, 97.0% were already below the specified poverty threshold before healthcare payments. Both households initially above the threshold crossed below it, following OOP expenditure, while the mean daily per-capita poverty gap increased from ₦3,296 to ₦30,350.\n\nConclusion: These findings underscore the inadequacy of current financial protection mechanisms. To improve access and equity, urgent policy action is needed to expand pooled health financing, increase public investment in neurosurgical services, and provide targeted subsidies for high-cost surgical care. Strengthening public neurosurgical services and decentralizing care (to reduce travel and indirect costs) will also help shield vulnerable households. These measures are critical as Nigeria advances toward universal health coverage.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Surgery, College of Medicine, University of Ibadan",
    "Department of Neurological Surgery, University College Hospital",
    "Duke Global Neurosurgery and Neurology",
    "Duke Global Health Institute",
    "Georgetown University School of Medicine",
    "Department of Neurosurgery, Duke University Health System",
    "University of Chicago Pritzker School of Medicine",
    "Duke University School of Medicine",
    "University of Maryland School of Medicine",
    "Department of Sociology (Medical Sociology), University of Ibadan",
    "Institute of Child Health, College of Medicine, University of Ibadan and University College Hospital"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 16,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Amos O. Adeleye"
    },
    {
      "affs": [
        2,
        3
      ],
      "name": "Allan Bakesiga"
    },
    {
      "affs": [
        1
      ],
      "name": "Oluseyi O. Agboola"
    },
    {
      "affs": [
        4
      ],
      "name": "Claudia Fernandez Perez"
    },
    {
      "affs": [
        5
      ],
      "name": "Prince Antwi"
    },
    {
      "affs": [
        2
      ],
      "name": "Benjamin Mukumbya"
    },
    {
      "affs": [
        6
      ],
      "name": "Chibueze Agwu"
    },
    {
      "affs": [
        2
      ],
      "name": "Ifeanyichukwu Ozobu"
    },
    {
      "affs": [
        7
      ],
      "name": "Mohamed-Yahia Monawar"
    },
    {
      "affs": [
        7
      ],
      "name": "C. Maxwell Beck"
    },
    {
      "affs": [
        8
      ],
      "name": "Madison Evans"
    },
    {
      "affs": [
        9
      ],
      "name": "Kabiru K. Salami"
    },
    {
      "affs": [
        10
      ],
      "name": "Adebola E. Orimadegun"
    },
    {
      "affs": [
        3
      ],
      "name": "Osondu Ogbuoji"
    },
    {
      "affs": [
        2,
        3,
        5
      ],
      "name": "Michael M. Haglund"
    },
    {
      "affs": [
        2,
        3,
        5
      ],
      "name": "Alvan-Emeka K. Ukachukwu"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/42qqym96mnr6q.bib",
  "cited_by": 0,
  "doi": "10.3389/fneur.2026.1897423",
  "fulltext_url": "https://www.frontiersin.org/articles/10.3389/fneur.2026.1897423/full",
  "id": "42qqym96mnr6q",
  "issns": [
    "1664-2295"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fneur.2026.1897423/full",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
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      "lcc",
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      "openalex",
      "2003|Healthcare Systems and Reforms"
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  "pdf_url": "https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2026.1897423/pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-23",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/42qqym96mnr6q.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:16Z",
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  "subjects": [
    {
      "field": "medicine",
      "origin": "lcc:RC346-429",
      "subfield": "neurology"
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  ],
  "title": "Socioeconomic analysis of the in-hospital neurosurgical continuum of care for patients in Nigeria",
  "title_text": "Socioeconomic analysis of the in-hospital neurosurgical continuum of care for patients in Nigeria",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T13:43:11Z",
  "url": "https://research.draconitic.com/paper/42qqym96mnr6q",
  "venue": "Frontiers in Neurology",
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}