Using a mHealth tutorial application to change knowledge and attitude of frontline health workers to Ebola virus disease in Nigeria: a before-and-after study

Background: The Ebola epidemic exposed the weak state of health systems in West Africa and their devastating effect on frontline health workers and the health of populations. Fortunately, recent reviews of mobile technology demonstrate that mHealth innovations can help alleviate some health system constraints such as balancing multiple priorities, lack of appropriate tools to provide services and collect data, and limited access to training in health fields such as mother and child health, HIV/AIDS and sexual and reproductive health. However, there is little empirical evidence of mHealth improving health system functions during the Ebola epidemic in West Africa. Methods: We conducted quantitative cross-sectional surveys in 14 health facilities in Ondo State, Nigeria, to assess the effect of using a tablet computer tutorial application for changing the knowledge and attitude of health workers regarding Ebola virus disease. Results: Of 203 participants who completed pre- and post-intervention surveys, 185 people (or 91%) were female, 94 participants (or 46.3%) were community health officers, 26 people (13 %) were nurses/midwives, 8 people (or 4%) were laboratory scientists and 75 people (37%) belonged to a group called others. Regarding knowledge of Ebola: 178 participants (or 87.7%) had foreknowledge of Ebola before the study. Further analysis showed an 11% improvement in average knowledge levels between pre- and post-intervention scores with statistically significant differences (P < 0.05) recorded for questions concerning the transmission of the Ebola virus among humans, common symptoms of Ebola fever and whether Ebola fever was preventable. Additionally, there was reinforcement of positive attitudes of avoiding the following: contact with Ebola patients, eating bush meat and risky burial practices as indicated by increases between pre- and post-intervention scores from 83 to 92%, 57 to 64% and 67 to 79%, respectively. Moreover, more participants (from 95 to 97%) reported a willingness to practice frequent hand washing and disinfecting surfaces and equipment following the intervention, and more health workers were willing (from 94 to 97%) to use personal protective equipment to prevent the transmission of Ebola. Conclusions: The modest improvements in knowledge and reported attitudinal change toward Ebola virus disease suggests mHealth tutorial applications could hold promise for training health workers and building resilient health systems to respond to epidemics in West Africa

conditions for re deployment and energy development

Irrespective of technical abundancy, RE potential per se does not imply a structural and inclusive expansion of energy access and an overall sustainable energy development of EA. Proper technological, economic, institutional, and policy considerations must be made to assess which are the best ways and most apt policies to sustain the exploitation of such potential in the regional context in relation to other energy sources, as well as which roadblocks and challenges are faced. A first meaningful consideration in this sense is that EA is characterised by a strong rural-urban imbalance: the majority of the population lives in poorly interconnected rural communities away from the electricity grid, which serves predominantly densely populated urban centres. While plans to tackle the imbalance are in place in virtually every country (both Kenya and South Africa have achieved notable results in this sense), the issue is not going to be structurally overcome rapidly. Thus, as highlighted by the least-cost electrification scenarios in Chap. 4, when discussing the case for renewables to increase and improve access, a distinction must be made between national grid expansion to reach additional shares of the population, and specific decentralised solutions