Multi-criteria decision analysis method for differential diagnosis of tropical febrile diseases.

This paper employs the Analytical Hierarchy Process (AHP) to enhance the accuracy of differential diagnosis for febrile diseases, particularly prevalent in tropical regions where misdiagnosis may have severe consequences. The migration of health workers from developing countries has resulted in frontline health workers (FHWs) using inadequate protocols for the diagnosis of complex health conditions. The study introduces an innovative AHP-based Medical Decision Support System (MDSS) incorporating disease risk factors derived from physicians' experiential knowledge to address this challenge. The system's aggregate diagnostic factor index determines the likelihood of febrile illnesses. Compared to existing literature, AHP models with risk factors demonstrate superior prediction accuracy, closely aligning with physicians' suspected diagnoses. The model's accuracy ranges from 85.4% to 96.9% for various diseases, surpassing physicians' predictions for Lassa, Dengue, and Yellow Fevers. The MDSS is recommended for use by FHWs in communities lacking medical experts, facilitating timely and precise diagnoses, efficient application of diagnostic test kits, and reducing overhead expenses for administrators.

Lessons learned on data collection for a digital health intervention-insights and challenges from Nigeria.

Objectives: This article delves into the challenges of medical data collection during the COVID-19 pandemic in developing countries, using Nigeria as a case study. It emphasizes how data collection impacts research quality, reliability, and validity. Methods: Qualitative research utilizing purposive sampling was employed to explore experiences in designing a diagnostic tool for febrile diseases in Nigeria. A questionnaire with selectable and open-ended questions was utilized for data collection, and 23 respondents participated. Results: Among 74 potential participants, 23 valid responses were gathered, revealing significant themes related to experiences and challenges in medical data collection. A multidisciplinary team approach proved beneficial, fostering collaboration, enhancing knowledge, and promoting positive experiences. Despite challenges with paper questionnaires, most participants preferred them for ease of use. Connectivity issues hindered timely data uploading and disrupted virtual meetings. Conclusion: Innovative and flexible strategies, such as a blended data collection approach and well-coordinated teams, were vital in overcoming challenges. Electronic data collection tools, reminders, and effective communication played key roles, leading to positive outcomes. This study provides valuable insights for researchers and practitioners involved in data collection, particularly in developing countries like Nigeria.

Modelling Differential Diagnosis of Febrile Diseases with Fuzzy Cognitive Map.

The report of the World Health Organization (WHO) about the poor accessibility of people living in low-to-middle-income countries to medical facilities and personnel has been a concern to both professionals and nonprofessionals in healthcare. This poor accessibility has led to high morbidity and mortality rates in tropical regions, especially when such a disease presents itself with confusable symptoms that are not easily differentiable by inexperienced doctors, such as those found in febrile diseases. This prompted the development of the fuzzy cognitive map (FCM) model to serve as a decision-support tool for medical health workers in the diagnosis of febrile diseases. With 2465 datasets gathered from four states in the febrile diseases-prone regions in Nigeria with the aid of 60 medical doctors, 10 of those doctors helped in weighting and fuzzifying the symptoms, which were used to generate the FCM model. Results obtained from computations to predict diagnosis results for the 2465 patients, and those diagnosed by the physicians on the field, showed an average of 87% accuracy for the 11 febrile diseases used in the study. The number of comorbidities of diseases with varying degrees of severity for most patients in the study also covary strongly with those found by the physicians in the field.

Changes in preterm birth and stillbirth during COVID-19 lockdowns in 26 countries.

Preterm birth (PTB) is the leading cause of infant mortality worldwide. Changes in PTB rates, ranging from -90% to +30%, were reported in many countries following early COVID-19 pandemic response measures ('lockdowns'). It is unclear whether this variation reflects real differences in lockdown impacts, or perhaps differences in stillbirth rates and/or study designs. Here we present interrupted time series and meta-analyses using harmonized data from 52 million births in 26 countries, 18 of which had representative population-based data, with overall PTB rates ranging from 6% to 12% and stillbirth ranging from 2.5 to 10.5 per 1,000 births. We show small reductions in PTB in the first (odds ratio 0.96, 95% confidence interval 0.95-0.98, P value <0.0001), second (0.96, 0.92-0.99, 0.03) and third (0.97, 0.94-1.00, 0.09) months of lockdown, but not in the fourth month of lockdown (0.99, 0.96-1.01, 0.34), although there were some between-country differences after the first month. For high-income countries in this study, we did not observe an association between lockdown and stillbirths in the second (1.00, 0.88-1.14, 0.98), third (0.99, 0.88-1.12, 0.89) and fourth (1.01, 0.87-1.18, 0.86) months of lockdown, although we have imprecise estimates due to stillbirths being a relatively rare event. We did, however, find evidence of increased risk of stillbirth in the first month of lockdown in high-income countries (1.14, 1.02-1.29, 0.02) and, in Brazil, we found evidence for an association between lockdown and stillbirth in the second (1.09, 1.03-1.15, 0.002), third (1.10, 1.03-1.17, 0.003) and fourth (1.12, 1.05-1.19, <0.001) months of lockdown. With an estimated 14.8 million PTB annually worldwide, the modest reductions observed during early pandemic lockdowns translate into large numbers of PTB averted globally and warrant further research into causal pathways.

Adoption of electronic medical records in developing countries-A multi-state study of the Nigerian healthcare system.

Electronic medical records (EMR) are extensively used in developed countries to manage patient records and facilitate consultations and follow-up of treatment. This has resulted in centralised databases where different services and clinicians can quickly access patient data to support healthcare delivery. However, adoption and usage of EMR in developing countries is not common and, in most cases, non-existent. Clinicians are dependent on patients keeping their own records manually with no centralised database to manage and control the patient medical history. The key objective of this study was to investigate the propensity of clinicians and senior management personnel in healthcare facilities to adopt EMR and evaluate the contextual factors that impact or impede adoption. Using Davis's technology adoption model extended with other factors, this study determined if contextual or situational factors are associated with barriers that impede adoption of EMRs in developing countries. Using a cross-sectional quantitative research approach, a questionnaire was designed to collect data across four states in the Niger Delta region of Nigeria. Stratified random sampling was used to select healthcare facilities that participated in the survey and selection of respondents from each healthcare facility. Data was collected by trained research assistants and a total of 1,177 valid responses were received and analysed using factor analysis and multiple regression analysis. The results from the analysis show that usefulness, critical success factors, awareness and relative advantage significantly influence clinicians' intention to adopt EMRs. Surprisingly, infrastructure availability was not statistically significant. Meanwhile, risk and data security both negatively influence adoption, indicating that user perception of risk and safety of their data decreases their propensity to adopt EMRs. The results from this study suggests that usefulness and anticipated success factors in facilitating operations within healthcare facilities have a great influence on user adoption of EMRs. Awareness, training and education of users on the effectiveness of EMRs and their usefulness will increase adoption. The results will be beneficial in helping government and healthcare leaders formulate policies that will guide and support adoption of EMR. Other policy recommendations and suggestions for future research were also proffered.

Perception and practices towards Covid-19 amongst residents in Southern Nigeria.

BACKGROUND: Within a short duration, coronavirus disease 2019 (COVID-19) spread globally, affecting all facets of life and causing widespread panic. This study set out to assess the perception and practices towards COVID-19 of urban and rural residents in Akwa Ibom State, Nigeria. MATERIALS AND METHODS: A cross-sectional study design and multistaged sampling technique were used. Data were collected using an interviewer-administered questionnaire between October and December 2020. Scores assessing perception and practices were allocated and graded based on specific stratified demarcations. P < 0.05 was considered statistically significant. RESULTS: A total of 822 individuals from the selected households were interviewed (urban: 401, 48.8%; rural: 421, 51.2%). Majority of respondents urban (99.8%) and rural (97.9%) were aware of COVID-19. Most respondents had low risk-perception of COVID-19 (62.4%), with significantly more rural respondents having low-risk perception (70.6% rural vs. 54.0% urban). The general perception of COVID-19 amongst the respondents was good (79.2%) with no statistically significant difference between urban and rural residents. Most of the participants had good practices towards COVID-19, with significantly higher proportion of urban respondents having good practice (93.8%) compared to their rural counterparts (83.1%). Amongst rural residents, high-risk perception was associated with higher proportion of good practice (93.4%) compared to 84.5% of low-risk perception (P = 0.015). CONCLUSIONS: The participants had high level of awareness, low risk perception, good general perception and good practices toward COVID-19. However, urban respondents showed better practices towards COVID-19. More attention should be directed towards improving COVID-19 perception and practices particularly amongst rural residents.

Willingness to Pay for a Contributory Social Health Insurance Scheme: A Survey of Rural Residents in Akwa Ibom State, Nigeria.

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.

Assessment of Resources for Primary Health Care: Implications for the Revitalization of Primary Health Care in Akwa Ibom, Nigeria.

CONTEXT: Primary health care (PHC) is the cornerstone of the Nigerian National Health Policy. The national policy on PHC under one roof is undergoing implementation nationwide as a means of strengthening the PHC system. Akwa Ibom State (AKS) is set to commence full implementation of the policy. AIMS: The aim of the study was to assess the existing human resource and infrastructure in PHC facilities in AKS. SETTINGS AND DESIGN: A descriptive cross-sectional study was carried out in 18 facilities selected from the three senatorial zones of AKS, Nigeria. SUBJECTS AND METHODS: A rapid assessment of selected PHC facilities based on a checklist adapted from the minimum standards for PHC as provided by the National PHC Development Agency. The results were analyzed using Excel and presented in tables. RESULTS: A total of 18 health facilities were included in the study. Human resources available were 276 full time core health workers, of which 48 (17.4%) were volunteer workers. There was inequitable distribution in district and facility type as 122(44.2%) work in Ikot Ekpene Senatorial district and 242 (87.7%) of them work in the Operational Base. Basic lifesaving equipment such as resuscitation sets was unavailable in more than 50% of the health facilities. CONCLUSIONS: There are absolute deficit and inequitable distribution of available human resources in AKS PHCs. Basic-lifesaving equipment is grossly inadequate. There is an urgent need for more health workers to be employed and provision of basic equipment for the PHCs.

Cervical cancer screening: barriers to access and potential solutions for Nigeria

In developed countries, giant strides have been made in reducing mortality due to cervical cancer. The success recorded has been largely attributed to effective screening programmes. In contrast, the burden and mortality due to this disease is rising in developing countries. Access to screening services remains a major challenge for the majority of the population at risk. This paper reviews the current demand-side barriers to cervical cancer screening in Nigeria and identifies potential solutions. Using academic databases and grey literature, a review was carried out to identify current screening modalities, barriers to access, and potential solutions. The current innovative method for control is early detection and treatment using “See and Treat” which involves visual inspection of the cervix with acetic acid (VIA) and cryotherapy. Lack of awareness, cost, and availability were identified as major barriers to access. Potential solutions feasible in the Nigerian context were categorized as financial and non-financial. The potential financial interventions include voucher schemes, conditional cash transfers, health equity, community loan funds, and prepayment mechanisms. Potential non-financial interventions that would be useful include raising awareness via health education and counseling, community participation, community based interventions, and pre-payment mechanisms...

Pregnancy and after: what women want from their partners - listening to women in Uyo, Nigeria.

BACKGROUND: A qualitative survey was conducted among childbearing women at three public health facilities in Uyo, Nigeria. We aimed to determine (i) women's expectations of partner support during pregnancy and the postpartum period; (ii) predictors of partner presence during childbirth. METHODS: From May to mid-July 2011, 387 eligible women were recruited serially during visits to the child welfare clinic at each facility. Interviews were conducted using semistructured questionnaires. Responses were extracted and categorized into eight distinct themes with corresponding examples. RESULTS AND DISCUSSION: The most desired form of partner support was assistance with domestic chores during and after pregnancy; followed by financial support during pregnancy and providing/caring for the baby in the postpartum period. Partner support during pregnancy was high 98.0% (351). While 73% of respondents expected partner presence during childbirth, 69.4% reported actual partner presence. Women with no experience of pregnancy before marriage, a husband in formal employment, and regular assistance at home had a two- to three-fold likelihood of expecting partner presence at childbirth compared to those without these attributes. Expecting partner presence increased the likelihood of partner presence at childbirth. Results suggest that women have specific expectations of partner involvement during and after pregnancy.

Awareness, use and main source of information on preventive health examinations: a survey of childbearing women in Uyo, Nigeria.

The study determined awareness, use and the main source of information about preventive health examinations among 387 childbearing women attending three health facilities in Uyo, Nigeria. Respondents were consenting women aged 15-49 years who had a live birth in the two months preceding the survey. Respondents were interviewed using structured questionnaires during child welfare clinic visits at each facility. Awareness about pap smears and breast self examination was 14.2% and 35.3% respectively. Testing rates were highest for blood pressure checks, HIV and blood sugar and lowest for Pap smears and mammograms. Health workers were the main informants on preventive tests. Awareness and secondary education enhanced women's uptake of screening services across levels of health care. Secondary education as a minimum and intensified awareness creation about preventive health examinations through media, school based programs, durbars and public health campaigns are vital to the health and well being of women and children.