Impact of mobile technologies on cervical cancer screening practices in Lagos, Nigeria (mHealth-Cervix): Protocol for a randomised controlled trial

Background: Incidence and mortality from cervical cancer have remained high due to many obstacles facing the implementation of organized screening programs in resource-constrained countries such as Nigeria. The application of mobile technologies (mHealth) to health services delivery has the potential to reduce inequalities, empower patients to control their health, and improve the cost-effectiveness of health care delivery. Aim: To assess the efficacy of mobile technology intervention on Pap test screening adherence compared to a control condition and also determine the factors affecting the uptake of Pap smear screening practices among women in Lagos. Methods: This is a multi-center randomized controlled trial that will involve women aged 25 to 65 years attending the General Outpatient clinics of the two tertiary health institutions in Lagos, Nigeria between April and December 2020. At baseline, a total of 200 National Health Insurance Scheme (NHIS) enrollees will be randomized to either a text message arm or usual care (control) arm. The primary outcome is the completion of a Pap smear within 6 months of enrolment in the study. The associations between any two groups of continuous variables will be tested using the independent sample t-test (normal distribution) or the Mann-Whitney U test (skewed data) and that of two groups of categorical variables with Chi-square X2or Fisher's exact test where appropriate. Using binary logistic regression model, we will adjust for age and other relevant sociodemographic and clinical variables and adherence to Pap test screening. Statistical significance will be defined as P-value less than 0.05. Discussion: The mHealth-Cervix study will evaluate the impact of mobile technologies on cervical cancer screening practices in Lagos, Nigeria as a way of contributing to the reduction in the wide disparities in cervical cancer incidence through early detection facilitated using health promotion to improve Pap smear screening adherence. Registration: PACTR202002753354517 13/02/202

The impact of economic recession on maternal and infant mortality: lessons from history

<p>Abstract</p> <p>Background</p> <p>The effect of the recent world recession on population health has featured heavily in recent international meetings. Maternal health is a particular concern given that many countries were already falling short of their MDG targets for 2015.</p> <p>Methods</p> <p>We utilise 20^thcentury time series data from 14 high and middle income countries to investigate associations between previous economic recession and boom periods on maternal and infant outcomes (1936 to 2005). A first difference logarithmic model is used to investigate the association between short run fluctuations in GDP per capita (individual incomes) and changes in health outcomes. Separate models are estimated for four separate time periods.</p> <p>Results</p> <p>The results suggest a modest but significant association between maternal and infant mortality and economic growth for early periods (1936 to 1965) but not more recent periods. Individual country data display markedly different patterns of response to economic changes. Japan and Canada were vulnerable to economic shocks in the post war period. In contrast, mortality rates in countries such as the UK and Italy and particularly the US appear little affected by economic fluctuations.</p> <p>Conclusions</p> <p>The data presented suggest that recessions do have a negative association with maternal and infant outcomes particularly in earlier stages of a country's development although the effects vary widely across different systems. Almost all of the 20 least wealthy countries have suffered a reduction of 10% or more in GDP per capita in at least one of the last five decades. The challenge for today's policy makers is the design and implementation of mechanisms that protect vulnerable populations from the effects of fluctuating national income.</p

Identifying patterns of alumni commitment in key strategic relationship programmes

Higher education institutions (HEIs) need to understand their alumni when drawing strategic relationship programmes. This paper aims to identify clusters of alumni based on their commitment relationship and to analyse factors influencing their intention to collaborate with the HEI. The study took place at a Portuguese university, considering a dataset of 1075 of alumni asserting intention to collaborate. First, a cluster analysis was conducted to identify patterns of commitment relationship. Secondly, a logistic regression was run to identify determinants of intention to collaborate. Both techniques revealed the decisive role of HEI commitment in the process. Relationship advantages and positive feelings towards the HEI were also pointed out as important. Alumni asserted recommendations, further training, sharing experiences and giving help as ways to collaborate with HEI. Regression results suggest that sociodemographic variables such as gender, marital status and volunteering are significantly associated with a probability to collaborate. Results also show that affiliation in sororities/fraternities and participation in extracurricular activities are significantly associated with that collaborative intention. The findings provide clues to support strategic relationship programmes based on consistent marketing campaigns, while bringing value to the literature in the European context, where alumni culture requires real insights to evolve.info:eu-repo/semantics/publishedVersio

Does trust play a role when it comes to donations? A comparison of Italian and US higher education institutions

Higher education institutions (HEIs) have experienced severe cutbacks in funding over the past few years, with universities examining options for alternative funding streams, such as alumni funding. Identifying the factors influencing their alumni's intentions to invest in their alma mater can be of significant importance when establishing a sustainable revenue stream. Within this context, empirical research on the potential role of trust is scarce. This paper aims to deepen the analysis of the relationship between alumni trust and engagement as well as three outcomes, namely support, commitment, and attitude toward donation. A structural equation model was tested on two samples of US (  = 318) and Italian (  = 314) alumni. Although both countries are affluent and developed countries, the USA has an established tradition of alumni donations, which is not such a developed practice in Italy. For both countries, results confirm that engagement is an antecedent of trust, which in turn leads to the three investigated outcomes (support, commitment, and attitude toward donations). In contrast, the effect of commitment on attitude toward donations is significant only for the USA universities. The paper has interesting theoretical and managerial implications. From a theoretical point of view, the study aims to address a gap concerning the role of trust in the HE context. Managerially, the study has significant implications for universities that want to change alumni attitude toward donations. [Abstract copyright: © Springer Nature B.V. 2020.

Seroprevalence of Hepatitis B Virus Infection among Pregnant Women at the Antenatal Booking Clinic of a Tertiary Hospital in Lagos Nigeria

Objectives: The objectives were to determine the seroprevalence of hepatitis B virus (HBV) infection and assess the major risk factors among Nigerian pregnant women.Subjects and Methods: This was a cross‑sectional descriptive study carried out among pregnant women at the antenatal clinic of a Tertiary Hospital in Lagos, Nigeria. A total number of 150 consenting pregnant women were selected for the study. A structured pretested interviewer‑administered questionnaire was used for the data collection. Sera were collected and tested for hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg).Results: Of the150 women screened during the study, 11 (7.3%) were seropositive for HBsAg. Of these 11 women, 4 (36.4%) were also positive for HBeAg. There was no statistically significant difference in the mean ages of participants who were seropositive for HBsAg and those who were negative for the virus (P = 0.888). There were statistically significant differences in the seroprevalence of HBsAg recorded among respondents with previous surgery (odd ratio [OR] ‑ 2.97; 95% confidence interval [CI] ‑ 1.08‑16.67; P = 0.046), previously affected sibling or spouse (OR ‑ 5.03; 95% CI ‑ 1.11–25.27; P = 0.001) and those with two or more lifetime sexual partners (OR ‑ 4.11; 95% CI ‑ 2.85–9.22; P = 0.024).Conclusion: The sero‑prevalence rate of HBV infection and also its infectivity is high in Lagos, Nigeria. These findings thus support the need for a nationwide policy of routine and widespread HBV screening among pregnant women.Keywords: Hepatitis B Surface Antigen, Hepatitis B Virus, Infectivity, Lagos, Nigeria, Seroprevalenc

Impact of Mobile Technologies on Cervical Cancer Screening Practices in Lagos, Nigeria (mHealth-Cervix): A Randomized Controlled Trial

PURPOSE: We assessed the impact of mHealth on Pap test screening uptake and also determined the factors that affect screening uptake among women in Lagos, Nigeria. MATERIALS AND METHODS: A randomized controlled trial was carried out among women in two tertiary health institutions in Lagos, Nigeria, between July 2020 and March 2021. Participants were randomly assigned to either a text message (mHealth) intervention or usual care arm. The main study outcome was the uptake of Pap smear testing within 6 months of enrollment in the study. We tested the associations between two groups of continuous variables using the unpooled independent-sample t-test (normal distribution) and that of two groups of categorical variables with the chi-square (χ2) test. Using a multinomial logistic regression model, we adjusted for relevant sociodemographic and clinical predictors of uptake of Pap smear screening. Statistical significance was defined as P < .05. RESULTS: There was a significantly higher rate of uptake of Pap smear screening among women in the mHealth arm compared with those in the usual care arm (51.0% v 35.7%, P = .031). Following adjustment in the final multivariate model, level of income (odds ratio [OR] = 5.13, 95% CI, 1.55 to 16.95), awareness of Pap smear (OR = 16.26; 95% CI, 2.49 to 76.64), General Outpatient clinic attendance, and introduction of mHealth intervention during follow-up (OR = 4.36; 95% CI, 1.44 to 13.22) were the independent predictors of Pap smear uptake. CONCLUSION: The use of mHealth technologies intervention via short-text message services is a feasible solution for cervical cancer prevention in low- and middle-income countries, and thus, the widespread use of mHealth services by health care providers and policymakers could contribute to the implementation of cervical cancer prevention services in Nigeria and in the settings of other low- and middle-income countries

Can Baumol's model of unbalanced growth contribute to explaining the secular rise in health care expenditure? An alternative test

In a recent paper, I argued that Baumol's model of 'unbalanced growth' offers a ready explanation for the observed secular rise in Health Care Expenditure (HCE) in rich countries. Baumol's model implies that HCE is driven by wage increases in excess of productivity growth. I tested this hypothesis empirically, using data from a panel of 19 Organization for Economic Cooperation and Development (OECD) countries and found robust evidence in favour of Baumol's theory. An alternative way to test Baumol's theory is to check whether its implication that variations in the relative price of medical care contribute significantly to explaining variations in health expenditure in the same direction has an empirical grounding. Earlier studies, although mostly not in an explicit attempt to test Baumol's theory, have occasionally rejected this hypothesis. Despite poor data quality of the available medical price indices, I perform the alternative test using data for nine OECD countries. My findings suggest that the relative price of medical care is in fact a statistically significant explanatory variable for health expenditure, thus lending support to Baumol's theory.