Stakeholders' perception of a total market approach to HIV self-testing (HIVST) for the private sector in Nigeria.

BACKGROUND: The continuous supply of affordable and quality HIV self-test (HIVST) is a key pillar toward achieving the global HIV 95-95-95 target in Nigeria. This was a descriptive qualitative study that explored private sector stakeholders' perceptions of the enablers and barriers of the HIVST market in Nigeria. METHODS: A total of 29 In-depth interviews (IDIs) were conducted with HIVST supply chain stakeholders and private sector providers (PPMVs and Community Pharmacies). Responses were analyzed using Nvivo software and we systematically developed a total market approach analysis for supply chain stakeholders and archetypes for community Pharmacies and PPMVs based on insights gathered from their journey map. RESULTS: Challenges to the supply side dynamics include forecasting, point of care service delivery, the availability of free and subsidized HIVST kits in the market, neglect of private sector providers (Community Pharmacists and PPMVs) in the healthcare delivery system, limited demand for HIVST, and regulatory bottlenecks influences the overall market dynamics. High cost of the HIVST kit, which triggers low availability, accessibility and affordability from the demand side, depicts the need to understand the market dynamics. Addressing the barriers and optimizing the enablers of the three-model pharmacist and PPMV's will change the market dynamic and service delivery to generate demand. CONCLUSION: To address challenges which already exist, the government need to revise the process guidelines for introducing new HIVST products in the Nigerian market, developing contingency plans to ensure the supply of HIVST remains sufficient when experiencing economic shocks, and create a sustainable roadmap toward optimizing the market for HIVST kits.

Editorial: The WHO Global Oral Health Action Plan 2023-2030.

Oral health is finally on the global agenda. The World Health Organisation Global Oral Health Action Plan (OHAP) 2023-2030 (WHO, 2022a) has been completed following a public consultation which took place during August and September 2022. As oral diseases are the most prevalent non-communicable diseases; it is good to see that the OHAP will co-exist alongside the Global Action Plan for the Prevention and Control of Non-communicable Diseases 2013-2030. This editorial summarises the OHAP and highlights the opportunities and challenges discussed during the September 2022 EADPH congress, held co-jointly with the Council of the European Chief Dental Officers (CECDO).

The WHO Action Plan for Oral Health - How Can the EADPH Contribute - Opportunities and Challenges.

This paper summarises the proceedings of a workshop organised by the European Association of Dental Public Health, held in Montpellier in September 2022. The full proceedings were transcribed and are available on the Community Dental Health website (https://www.cdhjournal.org/article/973). The WHO Action Plan for Oral Health provides a golden opportunity to help raise the profile of oral health, to put oral health on the global public health agenda and ultimately improve oral health. It is to be applauded. However, delivery will present a challenge. Those challenges and opportunities are detailed in this paper.

Implementation and Effectiveness Outcomes of a Quality Improvement Intervention to Strengthen the Application of the World Health Organization Surgical Safety Checklist Tool in a Limited-Resource Setting.

BACKGROUND: There is a disparity in the provision of quality and safe surgical care in Nigeria. The capacity to track surgical safety through the use of the surgical safety checklist tool is variable in this setting. This study aimed to assess the outcomes of training on this checklist and the results of its pilot implementation. SUBJECTS, MATERIALS AND METHODS: A mixed-methods research comprising of quantitative and qualitative study designs was conducted to evaluate these 23 weeks intervention in our centre. Implementation was conducted in two phases: training of the surgical team and pilot testing of the intervention. Using the RE-AIM framework, implementation outcomes evaluated included reach of training, adoption of checklist and implementation challenges, while effectiveness outcomes evaluated included change in the knowledge score after the training and self-reported impact of the training and pilot test. Quantitative and qualitative data were collected and analyzed. RESULTS: There was a 2.4-point significant increase in the knowledge score after the training. During the pilot testing phase, 843 patients had surgery. The weekly checklist utilization rate for elective surgery rose to 64% at project completion. Despite logistic and manpower-related implementation challenges, the training intervention facilitated the translation of participant knowledge into practice (81.5%) and the pilot phase had a high impact on the practice of checklist use (3.8 ± 0.9). CONCLUSION: The quality improvement programme enhanced knowledge of checklist use and led to improved behaviour and positive organizational change. However, barriers need to be addressed to strengthen the sustainable use of the checklist tool.

CONTEXTE: Il existe une disparité dans la fourniture de soins chirurgicaux sûrs et de qualité au Nigéria. La capacité de suivre la sécurité chirurgicale par l'utilisation de la liste de contrôle de sécurité chirurgicale est variable dans ce contexte. Cette étude visait à évaluer les résultats de la formation à cette liste de contrôle et les résultats de sa mise en œuvre pilote. SUJETS, MATÉRIEL ET MÉTHODES: Une recherche à méthodes mixtes comprenant des études quantitatives et qualitatives a été menée pour évaluer cette intervention de 23 semaines dans notre centre. La mise en œuvre s'est déroulée en deux phases : formation de l'équipe chirurgicale et essai pilote de l'intervention. En utilisant le cadre REAIM, les résultats de la mise en œuvre évalués comprenaient la portée de la formation, l'adoption de la liste de contrôle et les défis de la mise en œuvre, tandis que les résultats de l'efficacité évalués comprenaient le changement dans le score des connaissances après la formation et l'impact auto-déclaré de la formation et de l'essai pilote. Des données quantitatives et qualitatives ont été recueillies et analysées. RÉSULTATS: Une augmentation significative de 2,4 points du score de connaissances a été observée après la formation. Au cours de la phase de test pilote, 843 patients ont été opérés. Le taux d'utilisation de la liste de contrôle hebdomadaire pour les opérations non urgentes est passé à 64 % à la fin du projet. Malgré les difficultés de mise en œuvre liées à la logistique et à la main-d'œuvre, l'intervention de formation a facilité l'application des connaissances des participants dans la pratique (81,5 %) et la phase pilote a eu un impact élevé sur la pratique de l'utilisation de la liste de contrôle (3,8 ± 0,9). CONCLUSION: Le programme d'amélioration de la qualité a renforcé les connaissances sur l'utilisation des listes de contrôle et a conduit à une amélioration des comportements et à un changement organisationnel positif. Toutefois, des obstacles doivent être surmontés pour renforcer l'utilisation durable de l'outil de la liste de contrôle. Mots-clés: Liste de contrôle, Sécurité des patients, Amélioration de la qualité, Chirurgie, Organisation mondiale de la santé.

The impact of HPV vaccination on the prevention of oropharyngeal cancer: A scoping review.

INTRODUCTION: HPV-associated oropharyngeal cancer (OPC) has one of the most rapidly rising incidences of any cancer in high-income countries. HPV vaccination is being tested to prevent HPV-associated OPC. OBJECTIVE: To determine the effect of Human Papilloma Virus (HPV) vaccination on the prevention of OPC in adults worldwide. BASIC RESEARCH DESIGN: Scoping review conducted using PRISMA-ScR Checklist. METHOD: An electronic literature search identified relevant records. Titles and abstracts were screened to assess eligibility by two researchers, and data from relevant full-text articles were extracted and synthesised. RESULTS: Three-hundred-and-forty-three studies were identified, with eleven articles meeting the inclusion criteria. The most common study design was cross-sectional (n = 7), the most common location was the US (n = 6) and data collection periods spanned 2004 to 2020. One article found unvaccinated participants had a 19 times increased risk of developing OPC compared with those who had been vaccinated against HPV. The remaining papers showed that prevalence of HPV-vaccine-type oral infection was significantly lower in vaccinated participants than unvaccinated participants, with a reduction of oral HPV detection ranging from 72% to 93%. This reduction varied by sex. CONCLUSIONS: There is evidence to suggest that HPV vaccination reduces oral HPV infection and decreases the incidence of HPV-associated OPC. There is substantial need for further research which directly examines the relationship between HPV vaccination status and subsequent OPC development.

The Impact of Oral Health Training on the Early Year's Workforce Knowledge, Skills and Behaviours in Delivering Oral Health Advice: A Systematic Review.

OBJECTIVES: To determine the effectiveness of training the early year's workforce on their knowledge, skills and/or behaviours in delivering oral health advice. METHODS: Four databases: PubMed, Web of Science, Embase and Scopus were searched to evaluate the effectiveness of oral health training on knowledge, skills and behaviour of the early year's workforce with a minimum of one-month follow-up. Randomised or quasi-randomised trials and before and after studies were included. RESULTS: All six included studies showed improved knowledge and one of the five studies showed significant changes in behaviours of participants post oral health training. None of the included studies addressed changes in skills as an outcome. CONCLUSION: This systematic review found evidence that oral health training of the early year's workforce is effective in improving their knowledge but not necessarily their behaviours delivering oral health advice. Although training of the wider workforce on oral health is recommended, high quality research is required with longitudinal follow-up to assess changes in behaviours and ultimately impacts on oral health.

Associations of macro and micronutrients and antioxidants intakes with preeclampsia: A case-control study in Jordanian pregnant women.

BACKGROUND AND OBJECTIVES: A study was conducted to evaluate whether preeclampsia in pregnant women is associated with dietary factors and antioxidant intake (vitamin C, vitamin E, vitamin A, and selenium). METHODS AND RESULTS: In this case-control study, a group of 79 pregnant Jordanian women (36 preeclamptic pregnant women and 43 healthy pregnant women aged 18-45 years with a gestational age ≥20th week of pregnancy) were recruited from the obstetrics and gynecology clinics at Royal Medical Services, King Hussein Medical Center, Amman, Jordan. Information about socio-demographics, anthropometric measurements, biochemical measurements, nutritional intake, and dietary habits was collected through a structured interview. Three 24-hour dietary records were also made. Data were analyzed using Statistical Package for the Social Sciences (SPSS), and dietary intake was analyzed using ESHA software. Prepregnancy BMI, age, multiple pregnancies, energy intake, beta-carotene, vitamin C, and sodium showed significant difference between preeclamptic pregnant women and healthy pregnant women. The odds ratio (OR) and the corresponding 95% confidence interval (CI) show that a strong association with preeclampsia exists for the intake of fat (OR = 6.40, 95% CI: 1.85-22.17) and saturated fat (OR = 3.35, 95% CI: 1.0-11.54). Inverse associations with preeclampsia were found for fruit intake (OR = 0.16, 95% CI: 0.47-0.55) and olive oil intake (OR = 0.20, 95% CI: 0.05-0.78). CONCLUSION: In this case-control study in Jordanian pregnant women, preeclampsia was associated with a high intake of fat, saturated fat, and sodium and a low intake of fruits, fiber, vitamin C, B-carotene, and olive oil.

Enhanced Point-of-Care Ultrasound Applications by Integrating Automated Feature-Learning Systems Using Deep Learning.

Recent applications of artificial intelligence (AI) and deep learning (DL) in health care include enhanced diagnostic imaging modalities to support clinical decisions and improve patients' outcomes. Focused on using automated DL-based systems to improve point-of-care ultrasound (POCUS), we look at DL-based automation as a key field in expanding and improving POCUS applications in various clinical settings. A promising additional value would be the ability to automate training model selections for teaching POCUS to medical trainees and novice sonologists. The diversity of POCUS applications and ultrasound equipment, each requiring specialized AI models and domain expertise, limits the use of DL as a generic solution. In this article, we highlight the most advanced potential applications of AI in POCUS tailored to high-yield models in automated image interpretations, with the premise of improving the accuracy and efficacy of POCUS scans.

Health Insurance Knowledge, Attitude and the Uptake of Community-Based Health Insurance Scheme among Residents of a Suburb in Lagos, Nigeria.

BACKGROUND: Out of pocket payment for health services in the midst of financial hardship is a major contributor to poor access to healthcare in Nigeria with the resultant poor health indices. Towards the goal of Universal Health Coverage, Community Based Health Insurance (CBHI) was introduced in addition to the National Health Insurance Scheme but with minimal impact and utilization. OBJECTIVE: The objective of this study was to assess health insurance-related knowledge and attitudes and to examine the uptake of CBHI. METHODS: This was a descriptive cross-sectional study. A multi-stage sampling method was used to select 419 respondents from the Ajeromi-Ifelodun community. A semi-structured interviewer-administered questionnaire was used to collect data for the study. Data analysis was done using Microsoft Excel and Epi-Info 7.1. RESULTS: Most of the respondents (80.2%) had not heard of Community-Based Health Insurance and only about 9% of respondents had good knowledge about it. However, most (62.5%) of the respondents had a positive attitude towards health insurance generally. Only 4.5% of the respondents were enrolled in the CBHI scheme and had paid their premium up to date. There was a significant association between the respondents' knowledge and their uptake of the scheme (<0.001), and also between their attitudes and uptake (p = 0.002). CONCLUSION: This study suggests that for CBHI to be successful, certain strategies must be implemented towards increasing awareness and knowledge about CBHI. This will in turn increase the uptake of the scheme, a necessary requirement for achieving the goal of Universal Health Coverage.

Is there a role for low intensity pulsed ultrasound (LIPUS) in delayed or nonunion following arthrodesis in foot and ankle surgery?

BACKGROUND: Delayed union and nonunion following foot and ankle arthrodesis is a disabling complication for patients. There are no clinical studies looking at whether there is a role for use of low-intensity pulsed ultrasound (LIPUS) following this. The aim of this study is to investigate the efficacy of LIPUS in this cohort of patients in our centre. METHODS: This was a retrospective observational study reviewing the use of LIPUS in patients who had arthrodesis of a number of different foot and ankle joints diagnosed with delayed or non-union. RESULTS: Over a 5year period, 18 patients (71st MTPJ fusion, 2 subtalar joints, 2 triple fusion, 4 ankle fusions and 3 isolated midfoot joint) with radiologically confirmed delayed union, were treated with a standardised LIPUS therapy. Twelve patients (67%) were treated successfully with full radiological union confirmed. 4 patients required further surgical revision surgery while 2 were treated conservatively. Isolated small foot joints demonstrated a higher incidence of fusion (9/10; 90%) after LIPUS in comparison to larger or multiple joint arthrodesis (3/8; 38%). CONCLUSIONS: There may be a role for the use of LIPUS as a treatment option in delayed union of isolated, small foot joint arthrodesis. However, we would not recommend its use in large or multiple F&A joint arthrodesis. Large multicentre series are required to confirm our findings.

Research participation among state and local public health emergency preparedness and response programs.

OBJECTIVES: The objective of our study was to assess whether state and local health staff participated in public health emergency preparedness research activities and what partner organizations they collaborated with on research. STUDY DESIGN: This is a cross-sectional study. METHODS: Data were derived from a 2014 web-based survey of state, territorial, and local health departments conducted by the Centers for Disease Control and Prevention and NORC at the University of Chicago as part of a larger project to assess the public health emergency preparedness and response research priorities of state and local health departments. RESULTS: Overall, 30% of survey respondents indicated that health department staff were involved in public health preparedness and response research-related activities. Thirty-four percent indicated that they were extremely or moderately familiar with emergency preparedness research and literature. Approximately 67% of respondents reported interest in receiving additional information and/or training related to the preparedness research and literature. The most frequently reported partners for collaboration in preparedness research-related activities were schools of public health (34%). CONCLUSIONS: Our findings suggest that there is health department interest in learning more about preparedness and response science and that additional efforts are needed to increase health department participation in public health emergency preparedness and response research-related activities.

Second to fourth digit ratio, sex differences and antropometric measuments: their relationship in children.

BACKGROUND: The aim of this study was to determine the effect of socio-demographic factors and anthropometric measurements on 2/4 digit ratio in the school aged children. METHODS: This cross-sectional study was completed in primary and secondary schools in the city center of Canakkale, Turkey. The students were seated at a table by the responsible doctor, and were asked to extend the palm of the right and left hand in the schools. Using a Vernier Caliper the 2/4 fingers were measured from the palm twice, and the results were noted together with socio-demographic information. Weight, length, waist and hip measurements were taken while students were behind a folding screen. RESULTS: A total of 1860 students from 5-14 years were included in the study. The right hand 2/4 digit ratio was 0.9765±0.035 and the left hand ratio was 0.9716±0.036 for girls. For the boys the ratios were 0.9688±0.035 for right hand and 0.9653±0.033 for left hand. The digit ratios of girls were significantly higher than boys and the right hand ratio was even greater. The 2/4 digit measurements of both hands of students were positively correlated with each other. In regression model left hand 2/4 ratio is dependent hip circumference, monthly income and gender as adjusted r2 0.051. The right hand 2/4 ratio was dependent gender, monthly income, hip circumference and birthweight as adjusted r2 0.041. CONCLUSIONS: The 2/4 digit ratio of school-aged in Turkish children differed based on gender. Digit ratios depend on the hip circumference, gender (girls have higher ratio), birthweight, gestation week and monthly income. Further research, especially the effect of monthly income, is needed.

A qualitative analysis of health information-sharing networks in the Indonesian poultry sector.

Animal production systems are developing into increasingly complex value chains involving a large diversity of actors with multiple and dynamic linkages, concurrently creating many opportunities for disease spread. Access to timely and good-quality animal health information is vital for designing effective disease management strategies. However, several factors may hamper information flows along those chains. Understanding the structure and dynamics of information networks is essential to develop effective and acceptable health information systems. We applied a qualitative network approach to understand how information about poultry health is generated, disseminated and used for decision-making along the poultry value chain in Indonesia. Maps of the value chain and information networks were generated based on data from key informant interviews to illustrate the linkages and information-sharing patterns between stakeholders. Four types of farm business models were identified: company-owned, contract, partnership and independent. Although companies and most independent farmers collected health and production data routinely, their systems were strongly siloed and still relied on a mix of digital and paper-based methods, which impaired their analytical capacity. Technical service providers from the upstream sector and industry associations were identified as key intermediaries in the information-sharing network with the ability to create informal bridges between separate business networks and public actors. These actors can play a strategic role in the development of integrated information systems to improve stakeholders' capacity to monitor, anticipate and manage disease threats at all levels of the value chain. This study contributes to fill an important knowledge gap regarding the layer sector and may help decision-makers to design effective policies and interventions tailored to the type of business model.

Enablers and barriers to effective HIV self-testing in the private sector among sexually active youths in Nigeria: A qualitative study using journey map methodology.

BACKGROUND: HIV is a public health burden in Nigeria. HIV self-testing is one of the approaches to testing, which is the first of the 95:95:95 cascade of a coherent response to the epidemic. The ability to self-test HIV is influenced by various factors that can either serve as enablers or barriers. Exploring these enablers and barriers to the uptake of HIVST will help achieve optimal HIV self-testing and provide a deeper understanding of the HIVST kits users' journey. OBJECTIVE: The purpose of the study was to identify enablers and barriers to the uptake of HIV self-testing among sexually active youth in Nigeria using journey map methodology. METHODS: We conducted a qualitative exploratory study between January 2021 to October 2021 to understand the journey map for taking up and using HIVST in the private health delivery systems which include the pharmacies and PPMVs. 80 youths in Lagos, Anambra and Kano states were interviewed using IDIs and in-person FGDs. Their responses were audio-recorded, transcribed and analyzed using a qualitative software package (Nvivo software). RESULTS: A journey map for taking up and effectively using HIVST using the private sector among sexually active youths using key enablers and barriers at the attract, purchase, use, confirmation, linkage, and reporting stage was developed. The major enablers among participants were privacy and confidentiality, bundling purchases with other health products, easy-to-use instructions, and past experience with other self-testing kits. The major barriers were fear of discrimination, big packaging, high price, lack of confidence from user error and fear of status disclosure. CONCLUSIONS: Sexually active young people's perspectives enhance our understanding of the barriers and enablers of using HIVST through the private sector. Optimizing the enablers such as improved confidentiality that may be seen in e-pharmacy, reducing barriers and factoring sexually young people's perspectives will enhance the market and the uptake of HIVST towards ensuring sustainability and accelerating progress towards the 95-95-95 targets.

Operationalizing strategies for expanding UHC for the vulnerable population in Nigeria.

People living in vulnerable conditions have often been neglected or have a low coverage in health insurance which exacerbate poverty, vulnerability and social exclusion. This necessitates building and implementing insurance coverage that fully integrates social protection systems and community-based social care that prioritise the needs of the most vulnerable. To that end, we propose a decentralized system of sustainable financing and management of the vulnerable group fund that is performance driven with multi-stakeholder accountability systems premised on integrated data management. Integrating these elements will ensure that some of the existing gaps in the basic healthcare provision fund implementation in Nigeria are addressed with the following fundamental building blocks for the vulnerable group fund. These recommendations will help governments, resource partners and relevant stakeholders to consider in formulating strategies for operationalizing the vulnerable group funds and decreasing health inequalities among the population. In addition to implementation of this to accelerate universal health coverage and social protection, this will help to mitigate the currents challenges that exacerbate the inequality gaps, and build more resilient health and social protection systems, including the systems within humanitarian crises settings.

A multi-level analysis of prevalence and factors associated with caesarean section in Nigeria.

The choice of caesarean section (CS) plays a significant role in maternal and neonatal health. However, suboptimal CS uptake suggests unmet obstetric care leading to adverse maternal and neonatal health. Considering that maternal health problems in Nigeria remain a public health problem, this present study aims to assess the prevalence and multilevel factors associated with caesarean section among women of reproductive age in Nigeria. Data from the 2018 Nigeria Demographic and Health Survey were analysed. Our analyses included 19,964 women of reproductive age, with their last birth within five years preceding the survey. Multilevel logistic regression analysis was carried out to examine the predictors of the caesarean section in Nigeria. The prevalence of CS among women of reproductive age in Nigeria was 3.11%. Women from the Yoruba ethnic group [aOR = 0.52; 95%(CI = (0.32-0.84)], with two children [aOR = 0.67; 95%(CI = 0.52-0.88)], three children [aOR = 0.49; 95%(CI = 0.36-0.66)], four children and above [aOR = 0.34; 95%(CI = 0.26-0.46)], those who practised Islam [aOR = 0.74; 95%(CI = (0.56-0.99)], and those that had a normal weighted baby [aOR = 0.73; 95%(CI = 0.60-0.99)] were less likely to report having a CS in Nigeria compared to those from Hausa/Fulani ethnic group, those who had one child, those who practised Christianity, and those who had a high weighted baby. Also, women residing in rural areas [aOR = 0.79; 95% (CI = (0.63-0.99)] and the South-South [aOR = 0.65; 95%(CI = (0.46-0.92)] were less likely to have CS compared to those residing in urban areas and North Central. The study concluded that several individual and community-level factors, such as religious belief, number of children, ethnicity, place of residence, and region of residence, were associated with CS utilisation in Nigeria. Our study highlights the need for different regional, local, and cultural contexts for evidence-based policy and programmatic efforts to facilitate equitable access to a caesarean section in Nigeria.

The Colours of Octopus: Using Spectral Data to Measure Octopus Camouflage.

No animal can so effectively camouflage in such a wide range of environments as the octopus. Thanks to their highly malleable skin, they are capable of adapting their body patterns to the brightness and texture of their immediate environment, and they often seemingly match the colour of background objects. However, octopuses are colour-blind as their eyes have only one type of visual pigment. Therefore, chromatophores in their skin are likely to respond to changes in brightness, not chromaticity. To determine whether octopuses actually match background colours, we used a SpectraScan® PR-655 spectroradiometer to measure the reflectance spectra of Octopus tetricus skin in captivity. The spectra were compared with those of green algae, brown algae, and sponges-all of these being colourful objects commonly found in the octopus's natural environment. Even though we show that octopuses change both lightness and chromaticity, allowing them to potentially camouflage in a wide range of backgrounds in an effective manner, the overall octopus colours did not reach the same level of saturation compared to some background objects. Spectra were then modelled under the visual systems of four potential octopus predators: one dichromatic fish (Heller's barracuda), two trichromatic fish (blue-spotted stingray and two-spotted red snapper), and one tetrachromatic bird (wedge-tailed shearwater). We show that octopuses are able to match certain background colours for some visual systems. How a colour-blind animal is capable of colour-matching is still unknown.

Child refugees and asylum seekers: oral health and its place in the UK system.

Introduction The aim of this article is to provide a summary of the oral health status of child refugees and asylum seekers, and to describe their access to health services in the UK.Methods and analysis A review of the asylum process in the UK, the oral health status of child asylum seekers and the challenges in accessing dental services has been conducted.Conclusion There is limited data on the oral health status of child asylum seekers. Further research is required to estimate the burden of dental diseases and related conditions among this vulnerable population. Dental professionals can contribute to the holistic care of children with a sensitive and informed approach.