Effects of speculum lubrication on cervical smears for cervical cancer screening: A double blind randomized clinical trial.

BACKGROUND: Speculum lubrication may help to reduce the pain experienced during Pap-smear collection and hence increase uptake of cervical cancer screening and repeat testing, but there are fears of its interference with cytological results. AIM: To determine and compare the adequacy of cervical cytology smears and the mean pain scores of women undergoing cervical cancer screening with or without speculum lubrication. METHODS: This was a randomised controlled study of 132 women having cervical cancer screening at a tertiary hospital in Nigeria. Sixty-six participants were randomly assigned to the 'Gel' and 'No Gel' groups, respectively. Pap smears were collected from each participant with a lubricated speculum ('Gel group') or a non-lubricated speculum ('No Gel group'). The primary outcome measures were the proportion of women with unsatisfactory cervical cytology smears and the mean numeric rating scale pain scores, while the secondary outcome measures were the proportion of women who were willing to come for repeat testing and the cytological diagnosis of Pap-smear results. RESULTS: The baseline socio-demographic variables were similar in both groups. There was no significant difference in the proportion of unsatisfactory cervical smear results between the two groups (13.6% vs. 21.2%, p = 0.359). However, the mean pain scores were significantly lower in the gel group than in the no gel group (45.04 vs. 87.96; p<0.001). An equal proportion of the participants in each group (90.9% vs. 90.9%; p > 0.999) were willing to come for repeat cervical smears in the future. CONCLUSION: Speculum lubrication did not affect the adequacy of cervical smears but significantly reduced the pain experienced during pap smear collection. Also, it did not significantly affect the willingness to come for repeat cervical smears in the future. TRIAL REGISTRATION: The trial was registered with the Pan-African Clinical Trial Registry with a unique identification and registration number: PACTR2020077533364675.

The Political Economy of the Design of the Basic Health Care Provision Fund (BHCPF) in Nigeria: A Retrospective Analysis for Prospective Action.

Nigeria has instituted health financing reforms in the past, yet Universal Health Coverage (UHC) remains elusive and out-of-pocket spending accounts for over 70% of the country's total health expenditure. A current reform, the Basic Health Care Provision Fund (BHCPF), was established by the National Health Act of 2014 to increase the coverage of quality basic health services and promote UHC in Nigeria. However, there is limited knowledge of the political economy of health financing reforms in Nigeria and the impact on reform outcomes. This study applied the Political Economy Framework for Health Financing Reforms as described by Sparkes et al. in assessing the political economy of the BHCPF design. The study found that the BHCPF design was considerably influenced by the interplay of stakeholders' interests. The National Assembly was pivotal in ensuring the first BHCPF appropriation in 2018, and the Minister of Health, using donor-funded support, hastened the early BHCPF design. However, certain design elements were opposed by the legislature, bureaucratic and interest groups, which led to the suspension of the BHCPF and its subsequent redesign, led by bureaucratic groups. This produced changes in the BHCPF utilization, governance, pooling and counterpart funding arrangements, some of which increased the influence of bureaucratic groups and diminished the influence of the health ministry and external actors. These changes have implications for BHCPF implementation subsequently, including reduced accountability, potential stakeholders' conflicts, and fragmentation in external contributions. Understanding and managing these stakeholders' dynamics can create an accelerated consensus, minimize obstacles, and efficiently mobilize resources for achieving reform objectives.

Engaging stakeholders to identify gaps and develop strategies to inform evidence use for health policymaking in Nigeria.

Introduction: recent efforts to bridge the evidence-policy gap in low-and middle-income countries have seen growing interest from key audiences such as government, civil society, international organizations, private sector players, academia, and media. One of such engagement was a two-day virtual participant-driven conference (the convening) in Nigeria. The aim of the convening was to develop strategies for improving evidence use in health policy. The convening witnessed a participant blend of health policymakers, researchers, political policymakers, philanthropists, global health practitioners, program officers, students, and the media. Methods: in this study, we analyzed conversations at the convening with the aim to disseminate findings to key stakeholders in Nigeria. The recordings from the convening were transcribed and analyzed inductively to identify emerging themes, which were interpreted, and inferences are drawn. Results: a total of 630 people attended the convening. Participants joined from 13 countries. Participants identified poor collaboration between researchers and policymakers, poor community involvement in research and policy processes, poor funding for research, and inequalities as key factors inhibiting the use of evidence for policymaking in Nigeria. Strategies proposed to address these challenges include the use of participatory and embedded research methods, leveraging existing systems and networks, advocating for improved funding and ownership for research, and the use of context-sensitive knowledge translation strategies. Conclusion: overall, better interaction among the various stakeholders will improve the evidence generation, translation, and use in Nigeria. A road map for the dissemination of findings from this conference has been developed for implementation across the strata of the health system.