Socioeconomic analysis of the in-hospital neurosurgical continuum of care for patients in Nigeria
11 affiliations
- 1Department of Surgery, College of Medicine, University of Ibadan
- 2Department of Neurological Surgery, University College Hospital
- 3Duke Global Neurosurgery and Neurology
- 4Duke Global Health Institute
- 5Georgetown University School of Medicine
- 6Department of Neurosurgery, Duke University Health System
- 7University of Chicago Pritzker School of Medicine
- 8Duke University School of Medicine
- 9University of Maryland School of Medicine
- 10Department of Sociology (Medical Sociology), University of Ibadan
- 11Institute of Child Health, College of Medicine, University of Ibadan and University College Hospital
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.
Methods: 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.
Results: 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.
Conclusion: 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.
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BibTeX
@article{adeleye2026socioeconomic,
title = {{Socioeconomic analysis of the in-hospital neurosurgical continuum of care for patients in Nigeria}},
author = {Amos O. Adeleye and Allan Bakesiga and Oluseyi O. Agboola and Claudia Fernandez Perez and Prince Antwi and Benjamin Mukumbya and Chibueze Agwu and Ifeanyichukwu Ozobu and Mohamed-Yahia Monawar and C. Maxwell Beck and Madison Evans and Kabiru K. Salami and Adebola E. Orimadegun and Osondu Ogbuoji and Michael M. Haglund and Alvan-Emeka K. Ukachukwu},
journal = {Frontiers in Neurology},
year = {2026},
month = oct,
doi = {10.3389/fneur.2026.1897423},
url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1897423/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Socioeconomic analysis of the in-hospital neurosurgical continuum of care for patients in Nigeria
AU - Amos O. Adeleye
AU - Allan Bakesiga
AU - Oluseyi O. Agboola
AU - Claudia Fernandez Perez
AU - Prince Antwi
AU - Benjamin Mukumbya
AU - Chibueze Agwu
AU - Ifeanyichukwu Ozobu
AU - Mohamed-Yahia Monawar
AU - C. Maxwell Beck
AU - Madison Evans
AU - Kabiru K. Salami
AU - Adebola E. Orimadegun
AU - Osondu Ogbuoji
AU - Michael M. Haglund
AU - Alvan-Emeka K. Ukachukwu
PY - 2026
DA - 2026/10/23
JO - Frontiers in Neurology
DO - 10.3389/fneur.2026.1897423
UR - https://www.frontiersin.org/articles/10.3389/fneur.2026.1897423/full
AB - 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. Methods: 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. Results: 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. Conclusion: 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.
SN - 1664-2295
ER -