title: Socioeconomic inequities and payment coping mechanisms used in the treatment of type 2 diabetes mellitus in Nigeria.
abstract: OBJECTIVE
  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).
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Health Administration and Management; Department of Nursing Sciences, University of Nigeria, Enugu Campus, Enugu State, Umuahia, Abia State, Nigeria.
authors.forename: I L
authors.initials: IL
authors.lastname: Okoronkwo
authors.forename: J N
authors.initials: JN
authors.lastname: Ekpemiro
authors.forename: O E
authors.initials: OE
authors.lastname: Onwujekwe
authors.forename: A C
authors.initials: AC
authors.lastname: Nwaneri
authors.forename: P N
authors.initials: PN
authors.lastname: Iheanacho
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D017281:Cost of Illness; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D005191:Family Characteristics; D005260:Female; D005382:Financing, Personal; D017048:Health Care Costs; D019538:Health Care Surveys; D005102:Health Expenditures; D006801:Humans; D007348:Insurance, Health; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009549:Nigeria / Q000453:epidemiology; D012923:Social Class; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D019472:Universal Health Insurance