Longer lives and fertility far below the replacement level of 2.1 births per woman are leading to rapid population aging in many countries. Many observers are concerned that aging will adversely affect public finances and standards of living. Analysis of newly available National Transfer Accounts data for 40 countries shows that fertility well above replacement would typically be most beneficial for government budgets. However, fertility near replacement would be most beneficial for standards of living when the analysis includes the effects of age structure on families as well as governments. And fertility below replacement would maximize per capita consumption when the cost of providing capital for a growing labor force is taken into account. While low fertility will indeed challenge government programs and very low fertility undermines living standards, we find that moderately low fertility and population decline favor the broader material standard of living

Background: We conducted the first-of-its kind randomized stroke trial in Africa to test whether a THRIVES (Tailored Hospital-based Risk reduction to Impede Vascular Events after Stroke) intervention improved blood pressure (BP) control among patients with stroke. Methods and Results: Intervention comprised a patient global risk factor control report card, personalized phone text-messaging, and educational video. Four hundred patients recruited from 4 distinct medical facilities in Nigeria, aged ≥18 years with stroke-onset within one-year, were randomized to THRIVES intervention and control group. The control group also received text messages, and both groups received modest financial incentives. The primary outcome was mean change in systolic BP (SBP) at 12 months. There were 36.5% females, 72.3% with ischemic stroke; mean age was 57.2±11.7 years; 93.5% had hypertension and mean SBP was 138.33 (23.64) mm Hg. At 12 months, there was no significant difference in SBP reduction from baseline in the THRIVES versus control group (2.32 versus 2.01 mm Hg, P =0.82). In an exploratory analysis of subjects with baseline BP >140/90 mm Hg (n=168), THRIVES showed a significant mean SBP (diastolic BP) decrease of 11.7 (7.0) mm Hg while control group showed a significant mean SBP (diastolic BP) decrease of 11.2 (7.9) mm Hg at 12 months. Conclusions: THRIVES intervention did not significantly reduce SBP compared with controls. However, there was similar significant decrease in mean BP in both treatment arms in the subgroup with baseline hypertension. As text-messaging and a modest financial incentive were the common elements between both treatment arms, further research is required to establish whether these measures alone can improve BP control among stroke survivors. Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT01900756.

Accurate epidemiological surveillance of the burden of stroke is direly needed to facilitate the development and evaluation of effective interventions in Africa. The authors therefore conducted a systematic review of the methodology of stroke epidemiological studies conducted in Africa from 1970 to 2017 using gold standard criteria obtained from landmark epidemiological publications. Of 1330 articles extracted, only 50 articles were eligible for review grouped under incidence, prevalence, case-fatality, health-related quality of life, and disability-adjusted life-years studies. Because of various challenges, no study fulfilled the criteria for an excellent stroke incidence study.The relatively few stroke epidemiology studies in Africa have significant methodological flaws. Innovative approaches leveraging available information and communication technology infrastructure are recommended to facilitate rigorous epidemiological studies for accurate stroke surveillance in Africa.

Purpose The purpose of this paper is to examine the determinants of health expenditure at the household level in Nigeria with specific focus on the household and individual unique characteristics. It presents some stylised facts about the Nigerian health system and its financing options. It went further to show that household is the major financial organ of healthcare in Nigeria. The study aims to expand the domain of household health expenditure by analysing at national, urban and rural levels. Design/methodology/approach It adopted Engel curve approach, which was estimated using ordinary least squares technique. The model was structured to take care of life-cycle implications by examining effects of age in years and age groups (0-9, 10-19, 20-39, 40-59 and 60+) on healthcare spending. Data were drawn from the 2010 Harmonised Nigeria Living Standards Survey (HNLSS) conducted by the National Bureau of Statistics and analyses were conducted nationally, for urban and rural locations. Findings The result shows that individual characteristics like age, religion, education and household characteristics like income, size and headship commonly influence healthcare expenditure in Nigeria significantly. The household-level variables possess stronger significant effects among the rural households while marital status and employment had differential effects in both urban and rural locations. It also confirmed that Nigeria engages in intergenerational transfer of healthcare by the working population to the young and older generations. Research limitations/implications HNLSS was only limited to those who were sick or injured in the last two weeks preceding the survey, leaving out those whose sickness preceded the two weeks before the survey. Also, the scope of health expenditure is limited to curative care spending that exclude expenses on preventive care, rehabilitative care as well as other cost-saving services. Originality/value This paper fulfils an identified need to examine the determinants of household health expenditure at the national, urban and rural locations.