The DOI matches its Crossref record; 28 of the 29 references it cites were found in a registry or an index.
Examining Inequities in Incidence of Catastrophic Health Expenditures on Different Healthcare Services and Health Facilities in Nigeria
Open accessAbstract
OBJECTIVE: There is limited evidence about levels of socio-economic and other differences in catastrophic health spending in Nigeria and in many sub-Saharan African countries. The study estimated the level of catastrophic healthcare expenditures for different healthcare services and facilities and their distribution across socioeconomic status (SES) groups. METHODS: The study took place in four Local Government Areas in southeast Nigeria. Data were collected using interviewer-administered questionnaires administered to 4873 households. Catastrophic health expenditures (CHE) were measured using a threshold of 40% of monthly non-food expenditure. We examined both total monthly health expenditure and disaggregated expenditure by source and type of care. RESULTS: The average total household health expenditure per month was 2354 Naira ($19.6). For outpatient services, average monthly expenditure was 1809 Naira ($15.1), whilst for inpatient services it was 610 Naira ($5.1). Higher health expenditures were incurred by urban residents and the better-off SES groups. Overall, 27% of households incurred CHE, higher for poorer socioeconomic groups and for rural residents. Only 1.0% of households had a member that was enrolled in a health insurance scheme. CONCLUSION: The worse-off households (the poorest SES and rural dwellers) experienced the highest burden of health expenditure. There was almost a complete lack of financial risk protection. Health reform mechanisms are needed to ensure universal coverage with financial risk protection mechanisms.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“In southeast Nigeria (where Imo State is located), 27% of households incur catastrophic health expenditures, and this rate was higher for rural regions and for people with a mental illness (factoring in both direct and indirect costs of the illness) [65–67].”
From Integrating mental health into primary care: evaluation of the Health Action for Psychiatric Problems In Nigeria including Epilepsy and SubstanceS (HAPPINESS) pilot project (2022) · cites this paper as [65]
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
Filmer, D. P., & Pritchett, L. H. (2001) · Demography · doi:10.2307/3088292 · Cited by 5,963
Household catastrophic health expenditure: a multicountry analysis
Xu, K., EVANS, D. B., Kawabata, K., Zeramdini, R., Klavus, J., & Murray, C. J. L. (2003) · The Lancet · doi:10.1016/s0140-6736(03)13861-5 · Cited by 2,322
Nigeria Demographic and Health Survey 2008
Macro, I. (2009) · Cited by 2,131
Macroeconomics and health: investing in health for economic development
Sachs, J. D. (2002) · Revista Panamericana de Salud Pública · doi:10.1590/s1020-49892002000800017 · Cited by 1,844
Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993–1998
Wagstaff, A. R., & van Doorslaer, E. K. A. (2003) · Health Economics · doi:10.1002/hec.776 · Cited by 1,228
Sachs, J. D. (2001) · World Health Organization eBooks · Cited by 800
World Development Indicators 2003
Bank, W. (2003) · World Bank, Washington, DC eBooks · doi:10.1596/0-8213-5422-1 · Cited by 434
Ranson, M. K. (2002) · PubMed · Cited by 378
World Development Indicators 2005
Bank, W. (2005) · World Bank, Washington, DC eBooks · doi:10.1596/0-8213-6071-x · Cited by 329
Insured yet vulnerable: out-of-pocket payments and India's poor
Shahrawat, R., & Rao, K. D. (2011) · Health Policy and Planning · doi:10.1093/heapol/czr029 · Cited by 288
Flagged first, then by citations
1 of the 29 references couldn’t be matched to a known paper.
Research works printed but not linked: 2
- 2011, Key issues from the 2011 AfHEA conference: Toward universal health coverage in Africa.
- HE Ichoku, 2009, Incidence and intensity of catastrophic healthcare financing and impoverishment due to out-of-pocket payments in southeast Nigeria., Journal of Insurance and Risk Management, 4(4), 47
Cited by
Sorted by citations
Items 101–117 of 117
Labaeka, A. A. (2020) · Science Journal of Clinical Medicine · doi:10.11648/j.sjcm.20200904.12
Amodu, O. C. (2020) · ERA: Education and Research Archive (University of Alberta) · doi:10.7939/r3-v52s-6h63
Catastrophic Health Expenditures and Its Inequality in Rural Poor Households in ChinaPreprint
Wang, Y., Zhang, C., & Guo, M. (2021) · Research Square · doi:10.21203/rs.3.rs-627647/v1
Akuirene, O. A. (2020) · Clinical Medical Reviews and Reports · doi:10.31579/2690-8794/037
Catastrophic Health Expenditures and its Inequality in Rural Poor Households in ChinaPreprint
Wang, Y., Zhang, C., & Guo, M. (2021) · Research Square · doi:10.21203/rs.3.rs-627647/v2
Willingness to Pay (WTP) for Community-based Health Insurance Scheme (CBHIS) in a Nigerian State
Idoko, C. A., & Obienu, C. (2022) · International Journal of Medicine and Health Development · doi:10.4103/ijmh.ijmh_42_21
Onyia, J. A., Onwuka, E., Metu, A. G., Ezenekwe, U. R., Asogwa, H. T., & Ukwueze, E. R. (2022) · Journal of Economics and Sustainable Development · doi:10.7176/jesd/13-20-03
Yahaya, A. M., Kolawole, B., & Oyeleke, B. S. (2023) · Gusau Journal of Accounting and Finance · doi:10.57233/gujaf.v4i1.203
Alabi, A. O., Ainsworth, V., Lawal, A. O., Kizub, D., Chin, J., Woodmark, C., Omidiji, O. A. T., Adegboyega, B. C., Sowunmi, A. C., Ogunyemi, A. O., et al. (2025) · Frontiers in Oncology · doi:10.3389/fonc.2025.1418649
Investigating the development of local government research within a decade: a bibliometric analysis
Nguyen, T. T., Tran, H., & Tran, H. T. T. (2025) · International Review of Public Administration · doi:10.1080/12294659.2025.2504177
Makena, W., Nwankwo, M., Idris, A., Ayuba, J. T., Archibong, V. B., Ogbe, A. E., Ahumuza, R., Doris, E. A., Muhammed, A. O., Ishaku, B., et al. (2026) · Frontiers in Oncology · doi:10.3389/fonc.2026.1780152
Perspectives on Digital Health and Financial Inclusion in Africa
Agbo, S. O. (2026) · IGI Global eBooks · doi:10.4018/979-8-3373-3341-0.ch004
Akinlade, A., Bala, M., Abubakar, M. K., Omeje, K. U., & Mayana, S. A. (2026) · Journal of Public Health and Primary Care · doi:10.4103/jphpc.jphpc_40_25
Mukhtar, R. A., Abdulkadir, Z., Olawumi, A. L., & Yahya, A.-A. H. (2026) · Research Square · doi:10.21203/rs.3.rs-10914337/v1
Abraham, S. E., & Adebayo, A. M. (2026) · Research Square · doi:10.21203/rs.3.rs-10757646/v1
Odediji, S. A., Busari, L. O., Amoo, K. O., Olawuyi, A. O., Amoo-Adeboye, B. O., Surakat, O. A., & Adeleke, M. A. (2026) · BMJ Global Health · doi:10.1136/bmjgh-2025-023280
Metadata
- Authors
- Onwujekwe, O., Hanson, K., & Uzochukwu, B.
- Affiliations
- University of Nigeria (NG)
- London School of Hygiene & Tropical Medicine (GB)
- Corresponding author
- Onwujekwe, Obinna
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2012-07-16
- Volume
- 7
- Issue
- 7
- Pages
- e40811
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC3397929
- OpenAlex
- W2085315204
- Cited by
- 116
- References
- 29
- Citations by year
- 2026: 8 · 2025: 7 · 2024: 2 · 2023: 5 · 2022: 14 · 2021: 15 · 2020: 16 · 2019: 16 · 2018: 6 · 2017: 4 · 2016: 8 · 2015: 6 · 2014: 5 · 2013: 4
- FWCI
- 7.97
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Department for International Development
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Systems and Reforms
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Economic and Financial Impacts of Cancer
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Global Health Care Issues
- Keywords
- catastrophic health expenditure, socioeconomic disparities, household health expenditure, outpatient care, inpatient services, urban-rural differences, health insurance coverage, financial protection, universal health coverage, Nigeria
- MeSH terms
- Adult, Health Expenditures, Family Characteristics, Female, Health Facilities, Health Services, Humans, Insurance, Health, Male, Nigeria, Patient Acceptance of Health Care, Risk, Socioeconomic Factors, Incidence
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
