Impact of using eHealth tools to extend health services to rural areas of Nigeria: protocol for a mixed-method, non-randomised cluster trial

Introduction: eHealth solutions that use internet and related technologies to deliver and enhance health services and information are emerging as novel approaches to support healthcare delivery in sub-Saharan Africa. Using digital technology in this way can support cost-effectiveness of care delivery and extend the reach of services to remote locations. Despite the burgeoning literature on eHealth approaches, little is known about the effectiveness of eHealth tools for improving the quality and efficiency of health systems functions or client outcomes in resource-limited countries. eHealth tools including satellite communications are currently being implemented at scale, to extend health services to rural areas of Nigeria, in Ondo and Kano States and the Federal Capital Territory. This paper shares the protocol for a 2-year project (‘EXTEND’) that aims to evaluate the impact of eHealth tools on health system functions and health outcomes. Methodology and analysis: This multisite, mixed-method evaluation includes a non-randomised, cluster trial design. The study comprises three phases—baseline, midline and endline evaluations—that involve: (1) process evaluation of video training and digitisation of health data interventions; (2) evaluation of contextual influences on the implementation of interventions; and (3) impact evaluation of results of the project. A convergent mixed-method model will be adopted to allow integration of quantitative and qualitative findings to achieve study objectives. Multiple quantitative and qualitative datasets will be repeatedly analysed and triangulated to facilitate better understanding of impact of eHealth tools on health worker knowledge, quality and efficiency of health systems and client outcomes. Ethics and dissemination: Ethics approvals were obtained from the University of Leeds and three States’ Ministries of Health in Nigeria. All data collected for this study will be anonymised and reports will not contain information that could identify respondents. Study findings will be presented to Ministries of Health at scientific conferences and published in peer-reviewed journals. Trial registration number: ISRCTN32105372; Pre-results

Strengthening community engagement in the fight against hepatitis B in two regions of Cameroon

Background: In Cameroon, the prevalence of hepatitis B in the general population is 10%, and the vaccination coverage is less than 15% among adults. Although 80% have heard about the disease, only 50% know the modes of transmission and prevention of hepatitis B virus (HBV). Aim: To assess the knowledge, attitude and practice (KAP), sensitise the population and identify new cases of hepatitis B. Setting: Rural and urban areas of the Centre and South West Regions in Cameroon. Methods: An observational cross-sectional study was carried out from 2021 to 2023 on the general population to determine the HBV, seroprevalence and assess awareness of hepatitis B. We used modified Bloom’s cutoff to define KAP categories. Results: Seven hundred and fifty-nine and 456 persons gave consent to participate in the KAP and sero-surveys, respectively. About 20.4% (n = 155/759) of participants had never heard of hepatitis B. Among the 604 participants who had heard, 52.2% (n = 315/604) did not know at least one transmission route. However, 56.8% (n = 343/604) knew the hepatitis B vaccine, yet the vaccination coverage was 5.1% (n = 39/759). Furthermore, 69.5% (n = 420/604) had been tested at least once, 71.0% (n = 429/604) had inadequate knowledge and 68.7% (n = 415/604) had unfavourable practices. An association was observed between knowledge and practice, with an odds ratio of 4.1. HBV seroprevalence was 8.3%. Conclusion: Poor knowledge and lack of access to reliable information enhance the spread of hepatitis B. This propagation could be mitigated through sensitisation, voluntary counselling and testing (VCT) to identify new cases. Contribution: Highlights community-engaging initiatives to sensitise, test, prevent and treat hepatitis B

Factors affecting the delivery, access, and use of interventions to prevent malaria in pregnancy in sub-Saharan Africa: a systematic review and meta-analysis.

BACKGROUND: Malaria in pregnancy has important consequences for mother and baby. Coverage with the World Health Organization-recommended prevention strategy for pregnant women in sub-Saharan Africa of intermittent preventive treatment in pregnancy (IPTp) and insecticide-treated nets (ITNs) is low. We conducted a systematic review to explore factors affecting delivery, access, and use of IPTp and ITNs among healthcare providers and women. METHODS AND RESULTS: We searched the Malaria in Pregnancy Library and Global Health Database from 1 January 1990 to 23 April 2013, without language restriction. Data extraction was performed by two investigators independently, and data was appraised for quality and content. Data on barriers and facilitators, and the effect of interventions, were explored using content analysis and narrative synthesis. We conducted a meta-analysis of determinants of IPTp and ITN uptake using random effects models, and performed subgroup analysis to evaluate consistency across interventions and study populations, countries, and enrolment sites. We did not perform a meta-ethnography of qualitative data. Ninety-eight articles were included, of which 20 were intervention studies. Key barriers to the provision of IPTp and ITNs were unclear policy and guidance on IPTp; general healthcare system issues, such as stockouts and user fees; health facility issues stemming from poor organisation, leading to poor quality of care; poor healthcare provider performance, including confusion over the timing of each IPTp dose; and women's poor antenatal attendance, affecting IPTp uptake. Key determinants of IPTp coverage were education, knowledge about malaria/IPTp, socio-economic status, parity, and number and timing of antenatal clinic visits. Key determinants of ITN coverage were employment status, education, knowledge about malaria/ITNs, age, and marital status. Predictors showed regional variations. CONCLUSIONS: Delivery of ITNs through antenatal clinics presents fewer problems than delivery of IPTp. Many obstacles to IPTp delivery are relatively simple barriers that could be resolved in the short term. Other barriers are more entrenched within the overall healthcare system or socio-economic/cultural contexts, and will require medium- to long-term strategies. Please see later in the article for the Editors' Summary

Brain Redox Imaging Using In Vivo Electron Paramagnetic Resonance Imaging and Nitroxide Imaging Probes

Reactive oxygen species (ROS) are produced by living organisms as a result of normal cellular metabolism. Under normal physiological conditions, oxidative damage is prevented by the regulation of ROS by the antioxidant network. However, increased ROS and decreased antioxidant defense may contribute to many brain disorders, such as stroke, Parkinson’s disease, and Alzheimer’s disease. Noninvasive assessment of brain redox status is necessary for monitoring the disease state and the oxidative damage. Continuous-wave electron paramagnetic resonance (CW-EPR) imaging using redox-sensitive imaging probes, such as nitroxides, is a powerful method for visualizing the redox status modulated by oxidative stress in vivo. For conventional CW-EPR imaging, however, poor signal-to-noise ratio, low acquisition efficiency, and lack of anatomic visualization limit its ability to achieve three-dimensional redox mapping of small rodent brains. In this review, we discuss the instrumentation and coregistration of EPR images to anatomical images and appropriate nitroxide imaging probes, all of which are needed for a sophisticated in vivo EPR imager for all rodents. Using new EPR imaging systems, site-specific distribution and kinetics of nitroxide imaging probes in rodent brains can be obtained more accurately, compared to previous EPR imaging systems. We also describe the redox imaging studies of animal models of brain disease using newly developed EPR imaging