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Maternal and perinatal mortality remain huge challenges globally, particularly in low- and middle-income countries (LMICs) where >98% of these deaths occur. Emergency obstetric care (EmOC) provided by skilled health personnel is an evidence-based package of interventions effective in reducing these deaths associated with pregnancy and childbirth. Until recently, pregnant women residing in urban areas have been considered to have good access to care, including EmOC. However, emerging evidence shows that due to rapid urbanization, this so called “urban advantage” is shrinking and in some LMIC settings, it is almost non-existent. This poses a complex challenge for structuring an effective health service delivery system, which tend to have poor spatial planning especially in LMIC settings. To optimize access to EmOC and ultimately reduce preventable maternal deaths within the context of urbanization, it is imperative to accurately locate areas and population groups that are geographically marginalized. Underpinning such assessments is accurately estimating travel time to health facilities that provide EmOC. In this perspective, we discuss strengths and weaknesses of approaches commonly used to estimate travel times to EmOC in LMICs, broadly grouped as reported and modeled approaches, while contextualizing our discussion in urban areas. We then introduce the novel OnTIME project, which seeks to address some of the key limitations in these commonly used approaches by leveraging big data. The perspective concludes with a discussion on anticipated outcomes and potential policy applications of the OnTIME project.

In this study, the influence of physical environmental factors (rainfall, temperature, water depth, turbidity, transparency and conductivity) on the temporal distribution, abundance and catch of C. nigrodigitatus from the Cross River was investigated. Fish catch and abundance were monitored fortnightly for 12 months. Surface water samples were collected twice monthly and analyzed using standard methods. Seasonal variations in rainfall, water depth, temperature, turbidity, transparency and conductivity were observed across the study period. Correlation analysis showed a positive and significant relationship between rainfall and fish catch (P0.05). On the other hand, water depth and turbidity were positively correlated with fish catch but again both relationships were not statistically significant (P>0.05). These findings suggest that rainfall, temperature, conductivity and other environmental variables play important role(s) in the distribution and abundance of Chrysichthys nigrodigitatus in the Cross River, with implication of climate change impact on the species reproductive ecology and population dynamics.

This paper investigated the effect of unripe plantain peel (UPP) nanoparticles reinforced Zn-MgO composite coating on the hardness, anti-corrosion and microstructure properties of mild steel. The anti-corrosion characteristics of the coatings were examined using the potentiodynamic polarization method, employing 3.65 % NaCl solution as the test medium. The hardness of the coatings was studied employing the Brinell hardness technique, while the microstructure characteristics were examined using XRD and SEM/EDS. The results of the study revealed that the as-received mild steel sample exhibited the corrosion rate and hardness value of 8.6272 mm year-1 and 136.8 kgf mm-2, respectively, while the Zn-MgO coated mild steel sample exhibited a corrosion rate and hardness value of 242.5 kgf mm-2 and 3.6362 mm year-1, respectively. The optimal performing Zn-MgO-UPP coated mild steel sample (sample coated with 20 g L-1 of MgO and 6 g L-1 of UPP) exhibited a corrosion rate and hardness value of 0.8317 mm year-1 and 245.8 kgf mm-2, respectively. The corrosion rate and hardness value of the Zn-20MgO-6UPP coated mild steel sample indicated that the UPP nanoparticles further improved the passivating and strengthening ability of Zn-MgO coating. Moreover, the XRD profile of the coatings possessed high intensities, which indi­cat­ed that the coatings exhibit microstructural and chemical homogeneity, high stability and good texture. It was observed on the SEM micrographs that the Zn-MgO-UPP coating exhi­bited a more refined microstructure compared to the Zn-MgO coating, indicating the grain refining tendency of the UPP nanoparticles. The EDS further indicated the presence of essential and dispersion strengthening elements in the coatings.

BackgroundArtificial intelligence simulates human intelligence in machines that have undergone programming to make them think like human beings and imitate their activities. Artificial intelligence has dominated the medical sector to perform various patient diagnosis activities and improve communication between professionals and patients. The main goal of this study is to perform a scoping review to evaluate the development of artificial intelligence in all forms of hernia surgery except the diaphragm and upside-down hernia.MethodsThe study used the Preferred Reporting Items for Systematic and Meta-analyses for Scoping Review (PRISMA-ScR) to guide the structuring of the manuscript and fulfill all the requirements of every subheading. The sources used to gather data are the PubMed, Cochrane, and EMBASE databases, IEEE and Google and Google Scholar search engines. AMSTAR tool is the most appropriate for assessing the methodological quality of the included studies.ResultsThe study exclusively included twenty articles, whereby seven focused on artificial intelligence in inguinal hernia surgery, six focused on abdominal hernia surgery, five on incisional hernia surgery, and two on AI in medical imaging and robotics in hernia surgery.ConclusionThe outcomes of this study reveal a significant literature gap on artificial intelligence in hernia surgery. The results also indicate that studies focus on inguinal hernia surgery more than any other types of hernia surgery since the articles addressing the topic are more. The study implies that more research is necessary for the field to develop and enjoy the benefits associated with AI. Thus, this situation will allow the integration of AI in activities like medical imaging and surgeon training.

Abstract Background Evidence linking homocysteine (Hcy) with cardiovascular diseases (CVD) or its risk factors are limited in a sub-Saharan black population. Objective We set out to evaluate the association between Hcy and hypertension and other CVD risk factors in a population of adult Nigerians. Methods Data of 156 adults aged 18–70 years was accessed from the North Central study site of the REmoving the MAsk on Hypertension (REMAH) study. Homocysteine, blood glucose and lipid profile in whole blood/serum were measured using standard laboratory methods. Hypertension was diagnosed if average of 5 consecutive blood pressure (BP) measurements obtained using a mercury sphygmomanometer was equal to or higher than 140 systolic and/or 90 mmHg diastolic or the individual is on antihypertensive medication. Hyperhomocysteinemia (HHcy) was defined as Hcy > 10 µmol/L. Results Of the 156 participants, 72 (43.5%) were hypertensive, of whom 18 had HHcy. Subjects with HHcy were significantly (p

Objectives: To determine the anthropometric indices, lipopolysaccharide-binding proteins (LBP), and lipid profile in patients with metabolic endotoxemia. Methods: The study comprised of 47 patients with metabolic endotoxemia (the metabolic endotoxemia group) and 43 controls (the control group). Patients in the metabolic endotoxemia group were categorized further into three subgroups including the normal weight group (n=8), the overweight group (n=12) and the obese group (n=27). Height, weight, waist, and hip circumference were measured, and waist-hip ratio (WHR) and body mass index (BMI) were calculated. LBP was determined by ELISA and total cholesterol, triglycerides, high density lipoprotein by the respective enzymatic colorimetric methods. In addition, low density lipoprotein and very low density lipoprotein were determined by Friedewald’s formula. Results: The mean waist circumference (WC), hip circumference (HC), BMI, total cholesterol, low density lipoprotein, and LBP of the metabolic endotoxemia group were significantly higher (P< 0.05) than those of the control group. WHR, TG, high density lipoprotein and very low density lipoprotein of the metabolic endotoxemia group were not significantly different (P>0.05) from those of the control group. The mean WC, HC, WHR, and BMI of the obese group with metabolic endotoxemia were significantly higher (P< 0.05) than those of the overweight group and the normal weight group with metabolic endotoxemia. Significant positive correlations were obtained between BMI and LBP (r=0.610, P=0.001), total cholesterol and LBP (r=0.385, P=0.007), TG and LBP (r=0.356, P=0.014) in patients with metabolic endotoxemia. Conclusions: Metabolic endotoxemia arising from increased circulating level of bacterial derive particles consequent to perturbation in the gut microbial community and the elevated serum level of LBP may precede the development of obesity, characterized by dyslipidemia, dysregulation of gut energy harvest, and metabolic energy imbalance.

Gastrointestinal histoplasmosis (GIH) is infrequently described in people without underlying HIV infection. We aimed to compare the clinical presentation of GIH in people with and without HIV infection. We conducted a literature search of published cases of GIH from 2001–2021 and found 212 cases. Of these, 142 (67.0%) were male, and 124 (58.5%) had HIV infection. Most cases were from North America (n = 88, 41.5%) and South America (n = 79, 37.3%). Of the 212 cases, 123 (58.0%) were included in both clinical and pathological analyses. The remainder were excluded as details about clinical and pathological findings were not available. Of the 123 cases, 41 had HIV infection while 82 were without HIV infection. The diagnosis was predominantly by histopathology (n = 109, 88.6%). A significant proportion of people with HIV infection had abdominal pain as the most predominant symptom of GIH compared to those without HIV infection (65.9% versus 41.9%, p < 0.05). The colon was the most affected site with a slightly higher proportion in those with HIV infection compared with cases without HIV infection (46.3% versus 42.7%). The commonest pathologic findings were caecal and ileal ulcers. Caecal ulcers were significantly more frequent in cases with HIV infection compared to those without HIV (32.1% versus 7.1%, p < 0.05). Despite being more common in people with HIV infection, GIH also affects people without HIV infection with similar clinical presentations.

Serological surveys provide an objective biological measure of population immunity, and tetanus serological surveys can also assess vaccination coverage. We undertook a national assessment of immunity to tetanus and diphtheria among Nigerian children aged p < 0.001). Full seroprotection (≥0.1 IU/mL) was the same for tetanus (42.2%) and diphtheria (41.7%), while long-term seroprotection (≥1 IU/mL) was 15.1% for tetanus and 6.0% for diphtheria. Full- and long-term seroprotection were higher in boys compared to girls (p < 0.001). Achieving high infant vaccination coverage by targeting specific geographic areas and socio-economic groups and introducing tetanus and diphtheria booster doses in childhood and adolescence are needed to achieve lifelong protection against tetanus and diphtheria and prevent maternal and neonatal tetanus.

Histiocytoses are a rare group of proliferative disorders with very similar clinical and histological pictures. We present a case report of two variants seen in an eight month old female and five month old male in a tertiary hospital in southern Nigeria. They both presented with painless neck swellings and fever, leucocytosis, neutrophilia and lymphopenia. Initial histologic examinations of the cervical lymph nodes biopsyposed a diagnostic conundrum. However, Immuno histochemical analysis done on both sample showed CD1a, positive S100 in keeping with Langerhans cell histiocytosis in the former. While, that of the latter showed strongly positive CD68, positive S 100 in 30% cells in keeping with Sinus histiocytosis with massive lympha- denopathy (SLMH) in the latter.Clinicians should have a high index of suspicion for histiocytosis in children presenting with generalised lymphadenopathy. Also, apart from the routine histology, immunohistochemistry analysis is recommended for all cases

Abstract Background Male partner involvement in antenatal care (ANC) is associated with positive maternal and neonatal outcomes. However, only a handful of men attend ANC with their partners. This study aimed to understand the underlying barriers and facilitators influencing men’s ANC attendance including HIV testing in Blantyre, Malawi. Methods Data were collected during a formative qualitative study of a cluster-randomised trial. Six focus group discussions (FGDs) with 42 men and women and 20 in-depth interviews (IDIs) were conducted at three primary health centres in urban Blantyre, Malawi. FGD participants were purposively sampled with IDI participants subsequently sampled after FGD participation. Thematic analysis was used to analyse the data. Results The economic requirement to provide for their families exerted pressure on men and often negatively affected their decision to attend ANC together with their pregnant partners despite obvious benefits. Peer pressure and the fear to be seen by peers queueing for services at ANC, an environment traditionally viewed as a space for women and children made men feel treated as trespassers and with some level of hostility rendering them feeling emasculated when they attend ANC. Health system problems associated with overall organization of the ANC services, which favours women created resistance among men to be involved. An association between ANC and HIV testing services discouraged men from attending ANC because of their fear of testing HIV-positive in the presence of their partners. The availability of a male friendly clinic offering a private, quick, supportive/sensitive and flexible service was considered to be an important incentive that would facilitate men’s ANC attendance. Men described compensation to cover transport and opportunity cost for attending the clinic as a motivator to attending ANC services and accepting an HIV test. Conclusion Peer and economic influences were the most influential barriers of men attending ANC and testing for HIV with their pregnant partners. Addressing these socio-economic barriers and having a male friendly clinic are promising interventions to promote male ANC attendance in this setting.

Abstract Introduction Coverage of palliative care in low and middle-income countries is very limited, and global projections suggest large increases in need. Novel approaches are needed to achieve the palliative care goals of Universal Health Coverage. This study aimed to identify stakeholders’ data and information needs and the role of digital technologies to improve access to and delivery of palliative care for people with advanced cancer in Nigeria, Uganda and Zimbabwe. Methods We conducted a multi-country cross-sectional qualitative study in sub-Saharan Africa. In-depth qualitative stakeholder interviews were conducted with N = 195 participants across Nigeria, Uganda and Zimbabwe (advanced cancer patients n = 62, informal caregivers n = 48, health care professionals n = 59, policymakers n = 26). Verbatim transcripts were subjected to deductive and inductive framework analysis to identify stakeholders needs and their preferences for digital technology in supporting the capture, transfer and use of patient-level data to improve delivery of palliative care. Results Our coding framework identified four main themes: i) acceptability of digital technology; ii) current context of technology use; iii) current vision for digital technology to support health and palliative care, and; iv) digital technologies for the generation, reporting and receipt of data. Digital heath is an acceptable approach, stakeholders support the use of secure data systems, and patients welcome improved communication with providers. There are varying preferences for how and when digital technologies should be utilised as part of palliative cancer care provision, including for increasing timely patient access to trained palliative care providers and the triaging of contact from patients. Conclusion We identified design and practical challenges to optimise potential for success in developing digital health approaches to improve access to and enhance the delivery of palliative cancer care in Nigeria, Uganda and Zimbabwe. Synthesis of findings identified 15 requirements to guide the development of digital health approaches that can support the attainment of global health palliative care policy goals.

The purpose of this paper is to analyze the potentials of soybean and sunflower feed rations on the growth parameters of broilers. The study was carried out at the Department of Agricultural Extension and Management, Federal College of forestry, Jos, Plateau state. One hundred (100) day old broiler chicks were purchased and divided into two (2) groups (A and B) with three (3) replicates in each group. Group A were fed with soybean feed ration, while Group B was fed with sunflower feed ration over a period of eight (8) weeks. Descriptive, proximate analysis and statistical ratios were used in analyzing data for the study. Feed A is composed of soybean meal (55%), groundnut cake (40%) and yellow maize (15%), while feed B is composed of sunflower (55%) groundnut cake (40%) and yellow maize (15%). The result of the proximate analysis indicated that each feed ingredients contained crude protein, crude fiber, ash and fat in significant quantities. The survival rate for the duration of the feeding trials for treatment B was significant at 97%. The estimate of daily weight gain was significant for treatment B from week 1 to week 4 and week 5 to week 8 with an index of 0.205 and 0.537 respectively. Also, the feed conversion ratio for treatment B was significant. While the Protein efficiency ratio was significant for treatment A. The implication of these findings suggests that sunflower was a very palatable poultry feed ration, with significant effects on the growth parameters of broilers.

Abstract Background Incidence of malaria and anaemia are of public health importance especially in pregnant women in endemic regions, due to the negative health consequences to the mother and fetus. This study aimed to assess the pattern of falciparum malaria infection and anaemia, based on malaria prevention methods practiced by participants. Methods A semi-structured tool was used to capture information on demographic, socio-economic and malaria prevention practices from 113 pregnant women attending antenatal clinics in 2 peri-urban health facilities in Lagos, southwest Nigeria. Malaria microscopy was conducted and haematocrit was measured. Logistic regression analysis was performed on the data collated from the survey. Results The prevalence of anaemia among pregnant women was 87.2%. The mean (± sd) packed cell volume (PCV) (%) of the 22 (19.5%) infected subjects (26.8 ± 6.6), was significantly lower (t = −2.60, P value = 0.007) than that of the 91 (80.5%) uninfected subjects (30.8 ± 6.0). The prevalence of infection was highest in the 3rd trimester (n = 40, 35.4%) at 27.5% (11/40) and among those in their first pregnancy (n = 32, 28.3%) at 25.0% (8/32). There was a significant difference (t = −2.23, P-value = 0.01) in the mean PCV % of pregnant women who consumed herbal teas in pregnancy (28.2 ± 5.2) compared to those who did not (30.8 ± 6.6). Regression analysis showed that first pregnancy, anti-malarial use and insecticide-treated nets use the night before study had increased odds of malaria infection in participants (OR = 1.35, P = 0.006, 95% CI 0.52−2.49; OR = 2.3, P = 0.005, 95% CI 0.14−0.41; OR = 1.92, P = 0.001, 95% CI 0.62−5.98) while intermittent preventive treatment (IPT) participation and formal education were strongly and significantly associated with lower risk of parasitaemia (OR = 0.95, P = 0.025, 95% CI 0.41−2.26; OR = 0.44, P = 0.005, 95% CI 0.34−10.50). Conclusion Interventions that will reduce malaria and moderate to severe anaemia, especially in a first pregnancy, should include education on the correct use of long-lasting insecticide-treated bed nets (LLIN), IPT and the dangers of herbal teas in pregnancy.

Background: The prevalence of type 2 diabetes (t2dm) in Africa is increasing due to increase in associated risks factors such as unhealthy eating, obesity and physical inactivity. Diet monitoring is an important component in the management of t2dm to aid and prevent progression and complications. Research on dietary assessment in Africa is currently gaining interests and this paper aims to review the dietary assessment methods used with people living with t2dm. Methods: The Cochrane Library, MEDLINE, Global Health and Web of Science databases were searched using keywords to identify studies that assessed the diet of people living with type-2 diabetes in Africa. The keywords were those related to the concepts: t2dm, dietary assessment, Africa and nutrient intake. We excluded papers not written in English, studies without a quantitative dietary assessment and studying a specific food, studies done among Africans but in developed countries, studies done among children and studies that measured neither energy intake or body mass index. Result: Search yielded 132 papers after duplicates were removed. This reduced to 41 after the title and abstract screening and further to 10 after the full text screening. The included papers were based in six African countries: Algeria, Morocco, Uganda, Ghana, Cameroon and South Africa. The 24-hour dietary recall was the most common dietary assessment method used in 8 studies and two studies used the estimated food diaries. Five studies did not use a country-specific food composition table. Eight used a researcher-entered online dietary analysis software for nutrient intake estimation, out of which 7 contained the food database of a different country. Two studies estimated nutrient intake using a statistical tool and paper-and-pen. None of the dietary assessment methods used in the studies was validated in this patient group. Conclusion: Limited evidence was available on the measurement of diet in patients with t2dm in Africa. There is need to improve the dietary assessment methods in Africa to prevent the progression and complication of t2dm.

Objectives To describe changes in public risk perception and risky behaviours during the first wave (W1) and second wave (W2) of COVID-19 in Nigeria, associated factors and observed trend of the outbreak.Design A secondary data analysis of cross-sectional telephone-based surveys conducted during the W1 and W2 of COVID-19 in Nigeria.Setting Nigeria.Participants Data from participants randomly selected from all states in Nigeria.Primary outcome Risk perception for COVID-19 infection categorised as risk perceived and risk not perceived.Secondary outcome Compliance to public health and social measures (PHSMs) categorised as compliant; non-compliant and indifferent.Analysis Comparison of frequencies during both waves using χ2 statistic to test for associations. Univariate and multivariate logistic regression analyses helped estimate the unadjusted and adjusted odds of risk perception of oneself contracting COVID-19. Level of statistical significance was set at p

BackgroundThe COVID-19 pandemic commenced in China and has caused the death of numerous people globally. Despite the adverse effects, the outbreak has created room for job opportunities in healthcare, particularly the pharmaceutical domain. The main goal of this study is to examine how the current pandemic has triggered job creation in the healthcare domain and created a new economic market.MethodsThe study used the Preferred Reporting Items for Systematic and Meta-analyses for Scoping Review (PRISMA-ScR) to structure the manuscript and the subheadings to use. The source used to gather data is the PubMed database.ResultsThe study exclusively included fourteen articles, five of which focused on the pharmaceutical sector, three focused on vaccine sales, three on vaccination centers, and three on testing centers.ConclusionThe COVID-19 pandemic has created job opportunities in the healthcare sector. Most jobs are in the pharmaceutical sector, vaccination, and testing centers. However, more comprehensive research on the topic is necessary to gather conclusive outcomes on whether these jobs will be relevant after the pandemic.

The increasing global human population is projected to reach 9.7 billion people by 2050. This population growth is currently linked to the trends of world-wide urbanization, growth of megacities and shifting dietary patterns. While humankind faces the daunting challenge of feeding and providing healthy lives for its teeming populations, urban agriculture holds promise for improving the quality of life in cities. Fortunately, policymakers and planners are accepting the need to support peri-urban farmers to increase the resilience of food systems while efficiently managing already strained natural resources. We argue that for urban agriculture to significantly increase food yields, it is crucial to adopt a One Health approach to agriculture and environmental stewardship. Here, we propose six nature-based and climate-smart approaches to accelerate the transition toward more sustainable food systems. These approaches include reducing the reliance on synthetic agricultural inputs, increasing biodiversity through producing locally adapted crops and livestock breeds, using probiotics and postbiotics, and adopting portable digital decision-support systems. Such radical approaches to transforming food production will require cross-sectoral stakeholder engagement at international, national, and community levels to protect biodiversity and the environment whilst ensuring sustainable and nutritious diets that are culturally acceptable, accessible, and affordable for all.

BackgroundNigeria has one of the worst health and development profiles globally. A weak health system, poor infrastructure, and varied socio-cultural factors are cited as inhibitors to optimal health system performance and improved maternal and child health status. eHealth has become a major solution to closing these gaps in health care delivery in low- and middle-income countries (LMICs). This research reports the use of satellite communication (SatCom) technology and the existing 3G mobile network for providing video training (VTR) for health workers and improving the digitization of healthcare data.ObjectiveTo evaluate whether the expected project outcomes that were achieved at the end-line evaluation of 2019 were sustained 12 months after the project ended.MethodsFrom March 2017 to March 2019, digital innovations including VTR and data digitization interventions were delivered in 62 healthcare facilities in Ondo State, southwest Nigeria, most of which lacked access to a 3G mobile network. Data collection for the evaluation combined documents' review with quantitative data extracted from health facility registers, and 24 of the most significant change stories to assess the longevity of the outcomes and impacts of digital innovation in the four domains of healthcare: use of eHealth technology for data management, utilization of health facilities by patients, the standard of care, and staff attitude. Stories of the most significant changes were audio-recorded, transcribed for analysis, and categorized by the above domains to identify the most significant changes 12 months after the project closedown.ResultsFindings showed that four project outcomes which were achieved at end-line evaluation were sustained 12 months after project closedown namely: staff motivation and satisfaction; increased staff confidence to perform healthcare roles; improved standard of healthcare delivery; and increased adoption of eHealth innovations beyond the health sector. Conversely, an outcome that was reversed following the discontinuation of SatCom from health facilities is the availability of accurate and reliable data for decision-making.ConclusionDigital technology can have lasting impacts on health workers, patients, and the health system, through improving data management for decision-making, the standard of maternity service delivery, boosting attendance at health facilities, and utilization of services. Locally driven investment is essential for ensuring the long-term survival of eHealth projects to achieve sustainable development goals (SDGs) in LMICs.

Neste artigo, coloco os campos da terminologia e do integracionismo em discussão sobre a questão da indeterminação do signo. Emprego as lentes oferecidas por ambos os paradigmas para discutir dados sobre a indeterminação dos termos em um texto sobre processo legislativo. Eu defendo que os dados parecem confirmar várias noções integracionistas interrelacionadas, incluindo a construção do significado como contextualização idiossincrática e o princípio da reflexividade. Isso evidencia como o campo da terminologia pode alavancar a filosofia integracionista da linguagem para potencializar seu poder explicativo. No entanto, também argumento que os insights teóricos da terminologia baseada em texto podem servir como um corretivo para as percepções de indeterminação radical do signo no integracionismo.

Li-excess Mn-based disordered rock salt oxides (DRX) are promising Li-ion cathode materials owing to their cost-effectiveness and high theoretical capacities. It has recently been shown that Mn-rich DRX Li1+xMnyM1-x-yO2 (y ≥ 0.5, M are hypervalent ions such as Ti4+ and Nb5+) exhibit a gradual capacity increase during the first few charge-discharge cycles, which coincides with the emergence of spinel-like domains within the long-range DRX structure coined as δ phase. Here, we systematically study the structural evolution upon heating of Mn-based DRX at different levels of delithiation to gain insight into the structural rearrangements occurring during battery cycling and the mechanism behind δ phase formation. We find in all cases that the original DRX structure relaxes to a δ phase, which in turn leads to capacity enhancement. Synchrotron X-ray and neutron diffraction were employed to examine the structure of the δ phase, revealing that selective migration of Li and Mn/Ti cations to different crystallographic sites within the DRX structure leads to the observed structural rearrangements. Additionally, we show that both Mn-rich (y ≥ 0.5) and Mn-poor (y < 0.5) DRX can thermally relax into a δ phase after delithiation, but the relaxation processes in these distinct compositions lead to different domain structures. Thermochemical studies and in situ heating XRD experiments further indicate that the structural relaxation has a larger thermodynamic driving force and a lower activation energy for Mn-rich DRX, as compared to Mn-poor systems, which underpins why this structural evolution is only observed for Mn-rich systems during battery cycling.

Abstract Background The Nigerian government introduced and implemented a health programme to improve maternal and child health (MCH) called Subsidy Reinvestment and Empowerment programme for MCH (SURE-P/MCH). It ran from 2012 and ended abruptly in 2015 and was followed by increased advocacy for sustaining the MCH (antenatal, delivery, postnatal and immunization) services as a policy priority. Advocacy is important in allowing social voice, facilitating prioritization, and bringing different forces/actors together. Therefore, the study set out to understand how advocacy works - through understanding what effective advocacy implementation processes comprise and what mechanisms are triggered by which contexts to produce the intended outcomes. Methods The study used a Realist Evaluation design through a mixed quantitative and qualitative methods case study approach. The programme theory (PT) was developed from three substantive social theories (power politics, media influence communication theory, and the three-streams theory of agenda-setting), data and programme design documentation, and subsequently tested. We report information from 22 key informant interviews including national and State policy and law makers, policy implementers, CSOs, Development partners, NGOs, health professional groups, and media practitioners and review of relevant documents on advocacy events post-SURE-P. Results Key advocacy organizations and individuals including health professional groups, the media, civil society organizations, powerful individuals, and policymakers were involved in advocacy activities. The nature of their engagement included organizing workshops, symposiums, town hall meetings, individual meetings, press conferences, demonstrations, and engagements with media. Effective advocacy mechanism involved alliance brokering to increase influence, the media supporting and engaging in advocacy, and the use of champions, influencers, and spouses (Leadership and Elite Gendered Power Dynamics). The key contextual influences which determined the effectiveness of advocacy measures for MCH included the political cycle, availability of evidence on the issue, networking with powerful and interested champions, and alliance building in advocacy. All these enhanced the entrenchment of MCH on the political and financial agenda at the State and Federal levels. Conclusions Our result suggest that advocacy can be a useful tool to bring together different forces by allowing expression of voices and ensuring accountability of different actors including policymakers. In the context of poor health outcomes, interest from policymakers and politicians in MCH, combined with advocacy from key policy actors armed with evidence, can improve prioritization and sustained implementation of MCH services.

Abstract Background Maternal and Child Health is a global priority. Access and utilization of facility-based health services remain a challenge in low and middle-income countries. Evidence on barriers to providing and accessing services omits information on the role of security within facilities. This paper explores the role of security in the provision and use of maternal health services in primary healthcare facilities in Nigeria. Methods Study was carried out in Anambra state, Nigeria. Qualitative data were initially collected from 35 in-depth interviews and 24 focus groups with purposively identified key informants. Information gathered was used to build a programme theory that was tested with another round of interviews (17) and focus group (4) discussions. Data analysis and reporting were based on the Context-Mechanism-Outcome heuristic of Realist Evaluation methodology. Results The presence of a male security guard in the facility was the most important security factor that facilitated provision and uptake of services. Others include perimeter fencing, lighting and staff accommodation. Lack of these components constrained provision and use of services, by impacting on behaviour of staff and patients. Security concerns of facility staff who did not feel safe to let in people into unguarded facilities, mirrored those of pregnant women who did not utilize health facilities because of fear of not being let in and attended to by facility staff. Conclusion Health facility security should be key consideration in programme planning, to avert staff and women’s fear of crime which currently constrains provision and use of maternal healthcare at health facilities.

Software-Defined Networking (SDN) is a network paradigm introduced to overcome the inherent challenges of traditional networks. Its architecture is either deployed with a single controller or multiple controllers. While the first is not suitable for large-scale networks, the latter is confronted with a controller placement problem (CPP) in a large-scale network environment. CPP involves the challenge of deploying the optimal number of controllers within a network while meeting certain performance requirements considered conflicting in nature such as reliability, load balancing, latency, energy efficiency, and computation time. A single optimal or random placement may not be feasible in CPP and careful planning is of the essence to find an appropriate trade-off among the metrics. To achieve this, several CPP approaches have been proposed, developed, and deployed over the years, each having its unique objectives, strengths, and weaknesses. Therefore, this paper performed a comprehensive review of some of the existing approaches to identify the unique solutions offered, comprehend the different strategies and the challenges that exist as well as provide researchers with future directions aimed at improving the optimum location and allocation of controllers, in particular, for SDN application in wireless sensor network (WSN). The findings revealed several existing solutions and algorithms as well as several challenges such as the need for an efficient algorithm, attack-aware, cost-aware, and energy-aware CPP schemes while achieving a good quality of service.

The study presents a power-cooling organic Rankine cycle with an ejector system (ORCPCES). The objective is to determine the thermodynamic, economic and sustainability of the ORCPCES from the manufacturing, commissioning and decommissioning phases. Component-wise modelling was first performed based on the exergy concept. The system simulation was carried out using a developed source code in Engineering Equation Solver (EES). The refrigerant leakages and the material component impact on the environment were evaluated at all phases of the plant life cycle. The results indicate that the evaporator cooling rate (ECR) and the power-cooling efficiency (PCE) varied from 120.8 to 153 kW and 28.87 to 34.43 % across the refrigerants with the highest PCE and exergy efficiency obtained using R1234ze. The maximum power output was obtained using R1234ze. The overall environmental impact due to the components occurred at5.1×105mPts, 5.24×105mPts and 5.4×105mPts for R245fa, R1234yf, and R1234ze, respectively, while 4.01×105mPts 7.81×104mPts and9.33×105mPts was due to the working fluids in that order. The unit cost of electricity (UCOE) across the refrigerants varies from 0.181$/kWh to 0.2291$/kWh with the least UCOE, 0.181$/kWh obtained using R1234ze. The highest exergetic sustainability index of 0.56 was achieved using R1234ze.

Most of the reviews on histoplasmosis documented in literature have been in the adult population. Very few studies highlight the peculiarities associated with histoplasmosis in Africa especially in the pediatric population. This review addresses the above concerns with clinical summaries and diagnosis of some case reports of histoplasmosis in African children. We highlighted 44 case reports of histoplasmosis in African children (1950–2021) distributed across Western Africa (38.6%, n = 17), Eastern Africa (9.1%, n = 4), Southern Africa (9.1%, n = 4), and Central Africa (43.2%, n = 19). No case report was found from Northern Africa. The age range was 1–17 years, with a mean of 9.2. Of the 44 case reports, 8 cases (18.2%, 8/44) were caused by Histoplasma capsulatum var capsulatum , 33 cases (75%, 33/44) were caused by Histoplasma capsulatum var duboisii , and specie identification was not found in 3 cases. Only three (6.8%) cases were HIV positive; 56.8% (25/44) were disseminated histoplasmosis, pulmonary histoplasmosis accounted for just one case (2.3%, 1/44). Extrapulmonary presentation included skin lesions (ulcers, fistulas, nodules, patches, pigmentations, papules, and abscesses), bone lesions, osteoarthritis, and fractures. The commonest sites affected were skin ( n = 29, 65.9%), bones ( n = 20, 45.5%), and lymph nodes ( n = 15, 34.1%). Histopathology was the commonest diagnostic method ( n = 33, 75%). Amphotericin B was first-line therapy in 45.5% of the cases ( n = 20) followed by ketoconazole (20.5%, n = 9); 27 cases (61.4%) had favorable outcomes, 8 cases (18.2%) had fatal outcomes, while in 9 cases, the outcome was not revealed. This review revealed several cases of histoplasmosis misdiagnosed as other conditions including tuberculosis ( n = 3, 6.8%), pneumonia ( n = 1, 2.3%), cancers ( n = 4, 9.1%), nephritic syndrome ( n = 1, 2.3%), leishmaniasis ( n = 1, 2.3%), and hyperreactive malarial splenomegaly syndrome ( n = 1, 2.3%). In addition, histoplasmosis was not considered in some case reports even when symptoms were suggestive. Diagnosis of histoplasmosis was made at autopsy with postmortem findings suggestive of histoplasmosis ( n = 3, 6.8%). This report highlights the need for a paradigm shift on the part of pediatricians in Africa. They need to look beyond clinical conditions considered common in our environment for this age group and evaluate for other diseases including histoplasmosis.

Abstract Intramuscular myxoma (IM) is a rare mesenchymal neoplasm with the incidence of one per 1 000 000 people and is reported greater among women. Our case reports an IM of a deltoid muscle in a young man. Differential diagnosis with sarcoma is important. Surgery is the treatment of choice usually without recurrence.

Invasive fungal diseases (IFDs) are of huge concern in resource-limited settings, particularly in Africa, due to the unavailability of diagnostic armamentarium for IFDs, thus making definitive diagnosis challenging. IFDs have non-specific systemic manifestations overlapping with more frequent illnesses, such as tuberculosis, HIV, and HIV-related opportunistic infections and malignancies. Consequently, IFDs are often undiagnosed or misdiagnosed. We critically reviewed the available literature on IFDs in Africa to provide a better understanding of their epidemiology, disease burden to guide future research and interventions. Cryptococcosis is the most encountered IFD in Africa, accounting for most of the HIV-related deaths in sub-Saharan Africa. Invasive aspergillosis, though somewhat underdiagnosed and/or misdiagnosed as tuberculosis, is increasingly being reported with a similar predilection towards people living with HIV. More cases of histoplasmosis are also being reported with recent epidemiological studies, particularly from Western Africa, showing high prevalence rates amongst presumptive tuberculosis patients and patients living with HIV. The burden of pneumocystis pneumonia has reduced significantly probably due to increased uptake of anti-retroviral therapy among people living with HIV both in Africa, and globally. Mucormycosis, talaromycosis, emergomycosis, blastomycosis, and coccidiomycosis have also been reported but with very few studies from the literature. The emergence of resistance to most of the available antifungal drugs in Africa is yet of huge concern as reported in other regions. IFDs in Africa is much more common than it appears and contributes significantly to morbidity and mortality. Huge investment is needed to drive awareness and fungi related research especially in diagnostics and antifungal therapy.

Tatumella ptyseos septicaemia in humans is yet to be reported in Nigeria with very few cases reported worldwide. This case report describes the clinical and distinctive biochemical characteristics of Tatumella ptyseos, its antibiotic sensitivity pattern and risk factors associated with Tatumella ptyseos septicaemia. Our case is a 2 months old ex-premature female from Calabar, admitted in the month of May, 2018 into the Children´s Emergency Room, of the University of Calabar Teaching Hospital, Nigeria. She presented with cough of one month and fever of three weeks, and was found to be acutely ill looking, febrile with temperature of 38.6°C, mildly pale, dyspnoeic and tachypnoeic with SPO2 of 80% in room air, tender hepatomegaly of 6cm and a splenomegaly of 6cm. Blood culture yielded Gram negative rods identified as Tatumella ptyseos by OXOID MICROBACT™ GNB identification kit.

Objectives Retinopathy of prematurity (ROP) will become a major cause of blindness in Nigerian children unless screening and treatment services expand. This article aims to describe the collaborative activities undertaken to improve services for ROP between 2017 and 2020 as well as the outcome of these activities in Nigeria.Design Descriptive case study.Setting Neonatal intensive care units in Nigeria.Participants Staff providing services for ROP, and 723 preterm infants screened for ROP who fulfilled screening criteria (gestational age

BackgroundThe in-service training of frontline health workers (FHWs) in primary health care facilities plays an important role in improving the standard of health care delivery. However, it is often expensive and requires FHWs to leave their posts in rural areas to attend courses in urban centers. This study reports the implementation of a digital health tool for providing video training (VTR) on maternal, newborn, and child health (MNCH) care to provide in-service training at scale without interrupting health services. The VTR intervention was supported by satellite communications technology and existing 3G mobile networks. ObjectiveThis study aims to determine the feasibility and acceptability of these digital health tools and their potential effectiveness in improving clinical knowledge, attitudes, and practices related to MNCH care. MethodsA mixed methods design, including an uncontrolled pre- and postquantitative evaluation, was adopted. From October 2017 to May 2018, a VTR mobile intervention was delivered to FHWs in 3 states of Nigeria. We examined changes in workers’ knowledge and confidence in delivering MNCH services through a pre- and posttest survey. Stakeholders’ experiences with the intervention were explored through semistructured interviews that drew on the technology acceptance model to frame contextual factors that shaped the intervention’s acceptability and usability in the work environment. ResultsIn total, 328 FHWs completed both pre- and posttests. FHWs achieved a mean pretest score of 51% (95% CI 48%-54%) and mean posttest score of 69% (95% CI 66%-72%), reflecting, after adjusting for key covariates, a mean increase between the pre- and posttest of 17 percentage points (95% CI 15-19; P

Introduction As childhood mortality from infectious diseases falls across sub-Saharan Africa (SSA), the burden of disease attributed to surgical conditions is increasing. However, limited data exist on paediatric surgical outcomes in SSA. We compared the outcomes of five common paediatric surgical conditions in SSA with published benchmark data from high-income countries (HICs).Methods A multicentre, international, prospective cohort study was undertaken in hospitals providing paediatric surgical care across SSA. Data were collected on consecutive children (birth to 16 years), presenting with gastroschisis, anorectal malformation, intussusception, appendicitis or inguinal hernia, over a minimum of 1 month, between October 2016 and April 2017. Participating hospitals completed a survey on their resources available for paediatric surgery.The primary outcome was all-cause in-hospital mortality. Mortality in SSA was compared with published benchmark mortality in HICs using χ2 analysis. Generalised linear mixed models were used to identify patient-level and hospital-level factors affecting mortality. A p

The effects of the different combined manner of ultrasound and covalent reaction between polyphenol and myofibrillar protein (MP) from chicken were studied. More so, antioxidant activities, digestive properties, and potential mechanism of ultrasound-assisted oxidation system of hydrophilic ((−)-Epicatechin gallate, ECG) and hydrophobic (Baicalein, BN) polyphenols was also analyzed in this study. Among all the combined treatments, surface hydrophobicity (SUH), active sulfhydryl contents (ASC), and specific surface area (SSA) of ultrasonic assisted ECG oxidation group (T6) was relatively apparent, indicating that a more unfolding MP structure was obtained. Furthermore, ultrasonic assisted ECG oxidation group showed the highest antioxidant activities compared with other combined treatments on the basis of the results of DPPH free radical scavenging activities, metal ion chelating activities, and hydroxyl radicals (OH·) scavenging activities. The results of simulated digestion system and kinetic analysis also verified that ultrasonic assisted ECG oxidation had higher MP bio-accessibility than the control group. In contrast, a lower digestibility was displayed in ultrasonic assisted BN oxidation group. In summary, the ultrasound-assisted covalent reaction of MP and ECG might be a desirable approach for industrial production of MP from chicken with better antioxidant activities and digestive properties.

Background: Health worker training is an essential component of epidemic control; rapid delivery of such training is possible in low-middle income countries with digital platforms. Methods: Based on prior experience with the Ebola outbreak, we developed and deployed a bespoke InStrat COVID-19 tutorial app, to deliver accurate and regularly updated information about COVID-19 to frontline health workers and epidemic response officers across 25 states of Nigeria. The potential effectiveness of this app in training frontline health workers was assessed through online pre- and post-tests and a survey. Results: A total of 1051 health workers from 25 states across Nigeria undertook the e-learning on the InStrat COVID-19 training app. Of these, 627 (57%) completed both the pre- and post-tests in addition to completing the training modules. Overall, there were statistically significant differences between pre- and post-tests knowledge scores (54 increasing to 74). There were also differences in the subcategories of sex, region and cadre. There were higher post-test scores in males compared with females, younger versus older and southern compared with northern Nigeria. A total of 65 (50%) of the participants reported that the app increased their understanding of COVID-19, while 69 (53%) stated that they had applied the knowledge and skills learnt at work. Overall, the functionality and usability of the app were satisfactory. Conclusion: Capacity building for epidemic control using e-health applications is potentially effective, can be delivered at minimal cost and service disruption and can serve as a tool for capacity building in similar contexts.

Abstract Background The containment of poliovirus infectious/potentially infectious materials in all biomedical facilities in Nigeria remain crucial to maintaining gains recorded towards polio eradication. Activities involved in the Nigerian Poliovirus type 2-laboratory containment survey in line with the 3rd Global Action Plan III (GAP III) for poliovirus containment are documented in this study. Through these activities, the overall preparedness for poliovirus eradication in Nigeria is assessed. Method A cross-sectional survey was conducted from 19th September-31st October 2016 using structured Laboratory survey and inventory (LSI) questionnaires uploaded onto the SPSS software package in 560 biomedical facilities classified either as high risk or medium risk facilities across the 6 zones in Nigeria. Results In total, 560 biomedical facilities were surveyed in Nigeria in conformity with the GAP III. In total, 86% of the facilities surveyed were with laboratories while 14% were without laboratories. Twelve laboratories with poliovirus potentially infectious materials were identified in this exercise. In total, 50% of the 12 laboratories were under the ministry of education for research purposes. While 33% were among those laboratories surveyed in the phase 1a exercise without any recorded inventory, but have acquired some since the phase 1a survey. A total of 13,484 poliovirus infectious materials were found in the 12 laboratories. Only 8% of the materials were immediately destroyed while the remaining materials (62%) were found in Oyo and Borno states scheduled for destruction within 3–4 months according to WHO protocol for destruction of poliovirus infectious materials. Conclusion This study has revealed the successful containment of all poliovirus infectious materials in the laboratories surveyed. It has also revealed some surveillance gaps. We recommend that the surveillance system be improved to maintain the gains from the containment exercise and avoid reintroduction of infectious materials into biomedical facilities. This reduces the chances of viral reintroduction to the population in general.

Abstract Background The year 2014 was a turning point for polio eradication in Nigeria. Confronted with the challenges of increased numbers of polio cases detected in rural, hard-to-reach (HTR), and security-compromised areas of northern Nigeria, the Nigeria polio program introduced the HTR project in four northern states to provide immunization and maternal and child health services in these communities. The project was set up to improve population immunity, increase oral polio vaccine (OPV) and other immunization uptake, and to support Nigeria’s efforts to interrupt polio transmission by 2015. Furthermore, the project also aimed to create demand for these services which were often unavailable in the HTR areas. To this end, the program developed a community engagement (CE) strategy to create awareness about the services being provided by the project. The term HTR is operationally defined as geographically difficult terrain, with any of the following criteria: having inter-ward/inter-Local Government Area/interstate borders, scattered households, nomadic population, or waterlogged/riverine area, with no easy to access to healthcare facilities and insecurity. Methods We evaluated the outcome of CE activities in Kano, Bauchi, Borno, and Yobe states to examine the methods and processes that helped to increase OPV and third pentavalent (penta3) immunization coverage in areas of implementation. We also assessed the number of community engagers who mobilized caregivers to vaccination posts and the service satisfaction for the performance of the community engagers. Results Penta3 coverage was at 22% in the first quarter of project implementation and increased to 62% by the fourth quarter of project implementation. OPV coverage also increased from 54% in the first quarter to 76% in the last quarter of the 1-year project implementation. Conclusions The systematic implementation of a CE strategy that focused on planning and working with community structures and community engagers in immunization activities assisted in increasing OPV and penta3 immunization coverage.

The traditional Long-Range Wide-Area Network (LoRaWAN) uses an Advanced Encryption Standard (AES) 128 bit symmetric key to secure entities and data against several attacks. However, due to the existence of heterogeneous applications, designing a globally accepted and resilient LoRaWAN security model is challenging. Although several security models to maximize the security efficiency in LoRaWAN exist using the trusted key server to securely manage the keys, designing an optimum LoRaWAN security model is yet to be fully realized. Therefore, in this paper, we proposed two LoRaWAN security algorithms, A and B, for a trusted key management server (TKMS) to securely manage and distribute the keys amongst the entities. Algorithm B is an enhanced version of Algorithm A, which utilizes the security shortcomings of Algorithm A. We employed two formal analysis methods in the modelling, results analysis, and verification. The Scyther security verification tool was used for algorithm modelling and analysis against all possible attacks, while BAN logic was used to prove the logical correctness of the proposed algorithms. The results indicate that BAN logic feasibly proves the model logic correctness and the security claims employed in Scyther are reliable metrics for assessing the algorithms’ security efficiency. The security claims proved that the security algorithm is more secure and reliable as no attacks were detected across all entities in the enhanced-Algorithm B, unlike in Algorithm A. Moreover, the application of hashing minimizes computation cost and time for authentication and message integrity as compared to symmetric and asymmetric encryption. However, the proposed algorithm is yet to be verified as completely lightweight.

Low-Power Wide-Area Network (LPWAN) is a wireless WAN technology that connects low-powered and low-bandwidth devices with low bit rates atop Long Ranges (LoRa). It is characterized by improved scalability, wide area coverage, and low power consumption, which are beneficial to resource-constrained devices on the Internet of Things (IoT) for effective communication and security. Security in Long-Range Wide-Area Networks (LoRaWAN) widely employs Advanced Encryption Standard (AES) 128-bit symmetric encryption as the accepted security standard for a key generation that secures communication and entities. However, designing an efficient key manifestation and management model is still a challenge as different designs are based on different research objectives. To date, there is no global and well-accepted LoRaWAN security model for all applications. Thus, there is a need to continually improve the LoRaWAN security model. This paper, therefore, performed an in-depth analysis of some existing LoRaWAN key security models to identify security challenges affecting these security models and assess the strengths and weaknesses of the proposed solutions. The goal is to improve some of the existing LoRaWAN security models by analysing and bringing together several challenges that affect them. Several relevant studies were collected and analysed; the analysis shows that though there are few research works in this area, several existing LoRaWAN security models are not immune to attacks. Symmetry encryption is found to be the most used approach to manage key security due to its less computational operations. Moreover, it is possible to improve existing key security models in LPWAN with consideration of the resource constrained. Again, trusted third parties for key management were also widely used to defend against possible attacks and minimize operational complexities. We, therefore, recommend the design of lightweight and less complex LPWAN security models to sustain the lifespan of LPWAN devices.

Probiotics and related preparations, including synbiotics and postbiotics, are living and non-living microbial-based multi-components, which are now among the most popular bioactive agents. Such interests mainly arise from the wide range and numerous beneficial effects of their use for various hosts. The current minireview article attempts to provide an overview and discuss in a holistic way the concepts, methodologies, action mechanisms, and applications of probiotic-based multi-components in human, animal, plant, soil, and environment health. Probiotic-based multi-component preparations refer to a mixture of bioactive agents, containing probiotics or postbiotics as main functional ingredients, and prebiotics, protectants, stabilizers, encapsulating agents, and other compounds as additional constituents. Analyzing, characterizing, and monitoring over time the traceability, performance, and stability of such multi-component ingredients require relevant and sensitive analytical tools and methodologies. Two innovative profiling and monitoring methods, the thermophysical fingerprinting thermogravimetry–differential scanning calorimetry technique (TGA-DSC) of the whole multi-component powder preparations, and the Advanced Testing for Genetic Composition (ATGC) strain analysis up to the subspecies level, are presented, illustrated, and discussed in this review to respond to those requirements. Finally, the paper deals with some selected applications of probiotic-based multi-components to human, animal, plant, soil and environment health, while mentioning their possible action mechanisms.

Currently, cholecystectomy is performed laparoscopically. While the conventional approach (CA) with four access ports persists, other methods seek to reduce trauma or to optimize cosmetic results. In this study, the safety and cosmetic outcome of a suprapubic approach (SA) were evaluated. Between 2015 and 2016, patients undergoing elective cholecystectomy either by CA or by a suprapubic approach (SA) at our institution were included. The cosmetic outcome, postoperative morbidity, operative time and length of stay were evaluated. Pictures of the site of intervention were taken 6–12 months postoperatively and rated on a scale from 1 (unsatisfying aesthetic result) to 5 (excellent aesthetic result). Five “non-medical” and five “medical” raters as well as one board-certified plastic surgeon performed the ratings. A total of 70 patients were included (n = 28 SA, n = 42 CA). The two groups did not differ in baseline characteristics (age, gender, BMI). The SA group showed a significantly better aesthetic outcome compared to the CA group 4.8 (4.8–4.9) vs. 4.2 (3.8–4.4), (p > 0.001). Medical raters: 4.0 (3.8–4.2) vs. 4.8 (4.6–5.0), (p < 0.001); non-medical raters: 4.2 (3.8–4.6) vs. 5.0 (4.8–5.0), (p < 0.001); plastic surgeon: 4.0 (4.0–4.0) vs. 5.0 (5.0–5.0), (p < 0.001). Fair interrater consistency was demonstrated with an ICC of 0.47 (95% CI = 0.38–0.57). No significant difference in the complication rate (1 (3.5%) in SA vs. 6 (14%) in CA, (p = 0.3)), or the operating time 66 (50–86) vs. 70 (65–82) min, (p = 0.3), were observed. Patients stayed for a median of three (3–3) days in the SA group and 3 (3–4) days in the CA group (p = 0.08). This study demonstrated that the suprapubic approach is an appropriate alternative to conventional laparoscopic cholecystectomy, presenting a better cosmetic outcome with a similar complication rate.

The aromaticity and CDFT properties of naphthalene and its aza-derivatives were theoretically investigated using density functional theory (DFT) electronic structure method. The reactivity and chemistry of Azanaphthalene (1-AN), 1, 2-diazanaphthalene (1, 2-DAN), 1, 3-diazanaphthalene (1, 3-DAN), 1, 4-diazanaphthalene (1,4-DAN), 1, 5-diazanaphthalene (1, 5-DAN), 1, 6-diazanaphthalene (1, 6-DAN), 1, 7-diazanaphthalene (1,7-DAN) and 1, 8-diazanaphthalene (1, 8-DAN) were thoroughly explored and predicted focusing more on the fuzzy atomic space analysis, quantum chemical descriptors (CDFT), natural bond orbital (NBO), and structural electronic properties. The CDFT is focused on predicting the condensed Fukui function and dual descriptors along with condensed local electrophilicity and nucleophilicity investigation. From the aromaticity computational study, 1,7-DAN gave PDI, FLU, FLU-π, PLR, HOMA, BIRD and LOLIPOP values of approximately one (1) was found to be the most aromatic in the group, and strongest π-stacking ability. The aromaticity follows the trend: 1, 7-DAN > 1, 8-DAN > 1, 5-DAN > 1, 6-DAN > 1, 4-DAN > 1, 2-DAN > 1-AN > naphthalene. The second order perturbation energy NBO analysis revealed that the 3 highest stabilization energies in the molecules are C6–Na to C3–C4 (π∗−π∗ 236.90 kcal/mol) of 1, 6-DAN, C3–C4 to C1–C2 (π∗−π∗236.37 kcal/mol) of 1-AN and C7–N10 to C2–C4 (π∗−π∗235 kcal/mol) of 1, 3-DAN.

Background: Schistosomiasis is a Neglected Tropical Disease (NTD) that constitutes a public health problem in Sub-Saharan Africa (SSA), including Nigeria. There is need for updated information on the extent of the disease burden at community level to facilitate effective prioritization and monitoring of the disease. Methods: A cross-sectional study was conducted among school-aged children in Obudu Local Government Area (LGA), one of the 18 LGAs in Cross River State, Southern Nigeria. Seven schools from seven communities were randomly selected for this study. A total of 1,113 urine samples obtained from school-aged children were screened for Schistosoma haematobium (S. haematobium) eggs using standard parasitological method of diagnosis. Proteinuria and hematuria were evaluated using reagent test strips. Results: In this study, 153 (13.7%) children were infected with S. haematobium. More males (86 or 14.7%) were infected than females (67 or 12.7%); the differences were not statistically significant. The overall geometric mean intensity of infection was 13.3 eggs/10ml of urine. Females (13.69 eggs/10ml of urine) had the highest intensity of infection than males (12.91eggs/10ml of urine). Prevalence of hematuria was 152 (13.7%) (95% C.I. = 10.649 – 18.751%) while the prevalence of proteinuria was 172 (15.5%) (95% C.I. = 5.162 – 38.712%). Prevalence of infection significantly (p

Background: Increasing access to maternal and child health (MCH) services is crucial to achieving universal health coverage (UHC) among pregnant women and children under-five (CU5). The Nigerian government between 2012 and 2015 implemented an innovative MCH programme to reduce maternal and CU5 mortality by reducing financial barriers of access to essential health services. The study explores how the implementation of a financial incentive through conditional cash transfer (CCT) influenced the uptake of MCH services in the programme.Methods: The study used a descriptive exploratory approach in Anambra state, southeast Nigeria. Data was collected through qualitative [in-depth interviews (IDIs), focus group discussions (FGDs)] and quantitative (service utilization data pre- and post-programme) methods. Twenty-six IDIs were conducted with respondents who were purposively selected to include frontline health workers (n = 13), National and State policymakers and programme managers (n = 13). A total of sixteen FGDs were conducted with service users and their family members, village health workers, and ward development committee members from four rural communities. We drew majorly upon Skinner's reinforcement theory which focuses on human behavior in our interpretation of the influence of CCT in the uptake of MCH services. Manual content analysis was used in data analysis to pull together core themes running through the entire data set.Results: The CCTs contributed to increasing facility attendance and utilization of MCH services by reducing the financial barrier to accessing healthcare among pregnant women. However, there were unintended consequences of CCT which included a reduction in birth spacing intervals, and a reduction of trust in the health system when the CCT was suddenly withdrawn by the government.Conclusion: CCT improved the utilization of MCH, but the sudden withdrawal of the CCT led to the opposite effect because people were discouraged due to lack of trust in government to keep using the MCH services. Understanding the intended and unintended outcomes of CCT will help to build sustainable structures in policy designs to mitigate sudden programme withdrawal and its subsequent effects on target beneficiaries and the health system at large.

Background: Health insurance is seen as a pathway to achieving Universal health coverage in low- and middle-income countries. The Nigeria Government has mandated states to set up social health insurance as a mechanism to offer financial protection to her citizens. However, the design of these schemes has been left to individual states. In preparation for the set-up of a contributory social health insurance scheme in Akwa Ibom State, Nigeria. This study assesses the willingness-to-pay for a social health insurance among rural residents in the state.Methods: The study was conducted in three local government areas in Akwa Ibom State, South south Nigeria. It was a cross-sectional study with multi-stage data collection using a demand questionnaire. Interviews were conducted with 286 household heads who were bread winners. Contingent valuation using iterative bidding with double bounded dichotomous technique was used to elicit the WTP for health insurance. Multiple regression using least square method was used to create a model for predicting WTP.Findings: About 82% of the household heads were willing to pay insurance premiums for their households. The median WTP for insurance premium was 11,142 Naira ($29), 95% CI: 9,599–12,684 Naira ($25–$33) per annum. The respondents were predominantly middle-aged (46.8%), Ibibio men (71.7%) with an average household size of five persons and bread winners who had secondary education (43.0%) and were mainly pentecostals (51.5%). The mean age of respondents was 46.4 ± 14.5 yrs. The two significant predictors of WTP for insurance premium amongst these rural residents were income of breadwinner (accounts for 79%) and size of household (2%). The regression coefficients for predicting WTP for insurance premium are intercept of 2,419, a slope of 0.1763 for Bread winner income and a slope of 741.5 household size, all values in Naira and kobo.Conclusion: Majority of rural residents in Akwa Ibom State were willing to pay for social health insurance. The amount they were willing to pay was significantly determined by the income of the breadwinner of the household and the size of the family. These findings are relevant to designing a contributory social health insurance scheme that is affordable and sustainable in order to ensure universal health coverage for the citizens.

This paper documents, and reflects on key strengths and weaknesses of, existing patient feedback management systems at primary health care in Bangladesh and proposes key implications for future policy and practice. A mixed-method study was conducted in two Upazila (sub-district) Health Complexes (UHC) within one district in Bangladesh. It reports qualitative data from thematic analysis of in-depth interviews ( n = 15) with key stakeholders; non-participant observations of feedback environment at UHCs; document review; and a stakeholder workshop. Patient feedback data from publicly available web portals were also analyzed. Multiple parallel patient feedback systems exist at health facilities. Key strengths across all systems included common goals of ensuring accountability and patient voice and high-level commitment. Common weaknesses included lack of documented processes, limited awareness of available channels among patients and a lack of documented actions following feedback. The findings helped to provide a few implications for future policy and practice on patient feedback management.

Background: Strengthening health systems to improve access to maternity services remains challenging for Nigeria due partly to weak and irregular in-service training and deficient data management. This paper reports the implementation of digital health tools for video training (VTR) of health workers and digitization of health data at scale, supported by satellite communications (SatCom) technology and existing 3G mobile networks.Objective: To understand whether, and under what circumstances using digital interventions to extend maternal, newborn and child health (MNCH) services to remote areas of Nigeria improved standards of healthcare delivery.Methods: From March 2017 to March 2019, VTR and data digitization interventions were delivered in 126 facilities across three states of Nigeria. Data collection combined documents review with 294 semi-structured interviews of stakeholders across four phases (baseline, midline, endline, and 12-months post-project closedown) to assess acceptability and impacts of digital interventions. Data was analyzed using a framework approach, drawing on a modified Technology Acceptance Model to identify factors that shaped technology adoption and use.Results: Analysis of documents and interview transcripts revealed that a supportive policy environment, and track record of private-public partnerships facilitated adoption of technology. The determinants of technology acceptance among health workers included ease of use, perceived usefulness, and prior familiarity with technology. Perceptions of impact suggested that at the micro (individual) level, repeated engagement with clinical videos increased staff knowledge, motivation and confidence to perform healthcare roles. At meso (organizational) level, better-trained staff felt supported and empowered to provide respectful healthcare and improved management of obstetric complications, triggering increased use of MNCH services. The macro level saw greater use of reliable and accurate data for policymaking.Conclusions: Simultaneous and sustained implementation of VTR and data digitization at scale enabled through SatCom and 3G mobile networks are feasible approaches for supporting improvements in staff confidence and motivation and reported MNCH practices. By identifying mechanisms of impact of digital interventions on micro, meso, and macro levels of the health system, the study extends the evidence base for effectiveness of digital health and theoretical underpinnings to guide further technology use for improving MNCH services in low resource settings.Trial Registration: ISRCTN32105372.

Background: The increase of vaccination rates means that fewer children will be vulnerable to vaccine preventable diseases such as measles, which will invariably result in a drop in the infant mortality and morbidity rates. Objective: To assess the impact of the implementation of measles reduction strategies from 2006 to 2008 using the quarterly national program for immunization (NPI) in Akwa Ibom state, Nigeria. Method: Following informed consent, individuals presenting with febrile rash illnesses were routinely bled and tested for measles specific IgM using commercially available ELISA kit-MV-ELISA (Enzygnost; Behring Diagnostics, Marburg, Germany) in accordance with the manufacturer’s instructions. Results: A total of four hundred and four individuals comprising of 216 vaccinated and 188 unvaccinated, presenting with febrile rash illness were screened for measles specific IgM antibodies as indication of active infection between January 2006 and December 2008 out of which 122 (30.2%) had detectable levels of measles antibodies. Among the vaccinated and unvaccinated groups, 32 (14.8%) and 90 (47.9%) respectively were detected with measles IgM antibodies. The highest and lowest antibody levels were detected in 2006 (vaccinated: 54.7%; unvaccinated: 78.4%) and 2008 (vaccinated: 1.2%; unvaccinated: 12%) respectively. The distribution of measles burden by year show an overall decline in prevalence from 70% in 2006, 8.9% in 2007 to 3.7% in 2008. While, children under the age of 5 similarly had a decline in measles incidence of 73.3%, 10.7% and 3.3% respectively. Sex distribution of infection within the 3-year period shows that more females (37.4%) than males (21.2%) expressed measles IgM antibodies, and active infection was detected more in the rural (31.4%) than urban area (27.7%). However, findings indicate a tremendous decline in active infection in the rural areas from 67% in 2006 to 0% in 2008, and in the urban areas from 78% in 2006 to 9.3% in 2008 among both vaccinated and unvaccinated groups. A highly significant reduction in measles infection was observed more among males than females (P=0.009). Infection distribution by location did not show any significant difference (P=0.65) even though more individuals in the rural areas were noted with active infection. Conclusion: The study shows a highly significant reduction in measles burden among vaccinated individuals (P=0.0001) and invariably increases protective coverage of measles vaccination most especially among children under 5 years of age (P=0.0066) in the state. Findings justify effort by government and WHO in carrying immunization campaigns in children, 5-years and below irrespective of vaccination status and experience.

Schistosomiasis and soil-transmitted helminthiasis (STH) are neglected tropical diseases (NTDs) that cause chronic infections and ill health. The study was carried out to determine the current infection status and risk factors associated with Schistosoma haematobium and soil-transmitted helminth (STH) coinfection among school children in Biase Local Government Area (LGA), Cross River State, Nigeria. A cross-sectional study was carried out. Urine and fecal samples were randomly collected from 630 school children in six villages of Biase LGA. Urine sedimentation and Kato-Katz techniques were used to diagnose urogenital schistosomiasis and STHs, respectively. A structured questionnaire was used to collect demographic information and risk factors. The prevalence of S. haematobium in Biase LGA was 6.03%, with males (27 pupils, 9.00%) significantly more (χ2=8.903, p value = 0.003, C.I.=−82.650–120.650) infected than the females (11 pupils, 3.33%), while the prevalence of STH infection was 11.27% with no significant difference (χ2=0.002, p value = 0.962, C.I.=−16.441–54.559) in prevalence between males (34 pupils, 11.33%) and females (37 pupils, 11.21%). Prevalence of S. haematobium and STHs ranged from 1.82 to 19.13% and from 4.55 to 19.05% within the communities, respectively, with Abini (22 pupils, 19.13%) and Adim (20 pupils, 19.05%) communities having the highest prevalence for S. haematobium and STHs, respectively. The most infected age group was 11–13 years (21 pupils, 9.68%) for S. haematobium and 14–16 years (5 pupils, 21.74%) for STHs. Ascaris lumbricoides, hookworms, and Trichuris trichiura had prevalence of 5.56%, 3.02%, and 2.70%, respectively. An overall prevalence of 7.14% and 8.41% was observed for haematuria and proteinuria, respectively. Prevalence of coinfection among the parasites was 4.76%. Male pupils (OR=2.868, C.I.: 1.397–5.889), pupils of the age group of 11–13 years (OR=2.496, C.I.: 1.287–4.838), school children that swim (OR=1.527, C.I.: 0.784–2.974), those that cross streams to farm (OR=25.286, C.I.: 4.091–156.283), those that visit stream or river severally (OR=3.077, C.I.: 1.204–7.863), and those whose home is 1 km (OR=3.116, C.I.: 1.292–7.518) from the stream are at higher odds of infection with S. haematobium. For STHs, male pupils (OR=1.012, C.I.: 0.617–1.659), pupils of the age group of 11–13 years (OR=2.609, C.I.: 1.582–4.302), pupils that walk barefoot (OR=18.746, C.I.: 6.786–51.783), those that do not wash fruits and vegetables before eating (OR=2.334, C.I.: 1.400–3.892), those that do not wash hands after using the toilet (OR=1.200, C.I.: 0.730–1.973), those that eat soils (OR=2.741, C.I.: 1.533–4.902), those that drink water from streams or rivers (OR=189.509, C.I.: 24.807–1447.740), and those that use pit latrine (OR=2.920, C.I.: 1.746–4.885) and/or open defecation (OR=2.552, C.I.: 1.454–4.479) are at high odds of being infected with STHs. Urogenital schistosomiasis and soil-transmitted helminthiasis are still endemic diseases in Biase LGA. Although the degree of infection is quite low or moderate, there is a need to intensify and sustain control measures such as provision of sustainable clean water supply, health education intervention, and chemotherapy.

Background: Risk factors that are associated with HIV infection are also associated with HBV and HCV infections in sub-Saharan Africa. The HIV-infected pregnant cohort represents a unique population and infection with the hepatitis virus is considered a public health problem worldwide. Objective: The purpose of this study was to evaluate the prevalence of Human Immunodeficiency Virus, Hepatitis B and C virus parallel and overlapping infections among pregnant women attending antenatal clinics in Federal Capital Territory (FCT), Abuja. Method: Five hundred (500) blood samples were collected from three district hospitals in the FCT and tested at Wuse General Hospital, Abuja for the presence of antibodies to HIV and Hepatitis C virus, and HBsAg by ELISA technique in accordance with the manufacturer’s instructions. HIV seropositive sera were confirmed by Western blot. Result: Of the 500 pregnant women, those detected with HIV antibodies, HBsAg and anti-HCV antibodies were 42 (8.4%), 19 (3.8%) and 8 (1.6%) respectively. The overall seroprevalence of HIV and HBV or HCV co-infection was 9.5% while 7.1% and 2.4% HIV positive pregnant women were specifically co-infected with HBV and HCV respectively. Those within the age bracket of 15-20 years had the highest prevalence of HIV (13.4%), HBV (5.1%) and HCV (1.9%) infections. Among the occupation characteristics of the women, those of them involved in trading recorded the highest prevalence of HIV (60.6%), HBV (30.3) and HCV (6.1%). HIV was higher among the married women than the singles ((8.6% vs 6.5%); with HBV infection the reverse was the case (3.0% vs 9.8%) while HCV was same for both groups. History of blood transfusion did not reflect a higher rate of HIV and HBV (1.4% vs 9.6%; 2.8% vs 4.0% respectively) unlike HCV infection with 0.5% recorded only among those that had transfusion experience. Conclusion: When monitoring the risk of hepatotoxicity to antiretroviral drugs among these group of patients caution should be maintained. Moreover, evidence of parallel and overlapping HIV, HBsAg and HCV infections among this cohort should motivate inclusion of HBV and HCV among the diseases of surveillance in the national sentinel survey in order to ascertain the bigger picture of these infections in Nigeria.