Factors Influencing Satisfaction with Service Delivery Among National Health Insurance Scheme Enrollees in Ibadan, Southwest Nigeria.

Perceived quality of care is a determinant of uptake of health services. This study aimed to assess the determinants of quality of care of enrollees in the National Health Insurance Scheme (NHIS) in Nigeria. The outcome was satisfaction with health care services, which was used as a proxy for quality. Findings will assist in the intervention to enhance enrollment in the scheme and for universal health coverage attainment. This was a descriptive cross-sectional study conducted among enrollees in selected NHIS facilities in Ibadan, Nigeria. Data on satisfaction with health care were collected among selected 432 enrollees with the aid of an adapted semi-structured WHO-USAID interviewer-administered questionnaire. Data were analyzed using chi-square and multiple logistic regression models (α = 0.05). Among predictors of satisfaction with health services were younger age (OR = 1.85, 95% CI = 1.05-3.25, p = .024), working in the private sector (OR = 1.84, 95% CI = 1.03-3.28, p = .022), and seeking information about quality of services prior enrollment (OR = 1.63, 95% CI = 1.04-2.53, p = .013). Targeted intervention based on the findings of this study should be implemented to improve satisfaction with the services offered

PRIVATIZATION OF PUBLIC ENTERPRISES: WHICH WAY NIGERIA?

Governments exist among others to implement policies for the enhancement of the living standard of citizens. To accomplish this goal, public enterprises are established to provide goods and services. With the use of secondary data, the paper examines privatization policy in Nigeria. It observed government interference, lack of transparency and accountability as the major hindrances to the successful implementation of the policy. The paper therefore recommends that for privatization to achieve its goals, government should stop interfering in the implementation of the policy and appoint people of credible character to manage the implementing agency of privatization in Nigeria

Geospatial distribution and bypassing health facilities among National Health Insurance Scheme enrollees: implications for universal health coverage in Nigeria.

BACKGROUND: This study was carried out to enable an assessment of geospatial distribution and access to healthcare facilities under the National Health Insurance Scheme (NHIS) of Nigeria. The findings will be useful for efficient planning and equitable distribution of healthcare resources. METHODS: Data, including the distribution of selected health facilities, were collected in Ibadan, Nigeria. The location of all facilities was recorded using Global Positioning System and was subsequently mapped using ArcGIS software to produce spider-web diagrams displaying the spatial distribution of all health facilities. RESULTS: The result of clustering analysis of health facilities shows that there is a statistically significant hotspot of health facility at 99% confidence located around the urban areas of Ibadan. The significant hotspot result is dominated by a feature with a high value and is surrounded by other features also with high values. Away from the urban built-up area of Ibadan, health facility clustering is not statistically significant. There was also a high level (94%) of bypassing of NHIS-accredited facilities among the enrollees. CONCLUSIONS: Lopsided distribution of health facilities in the study area should be corrected as this may result in inequity of access to available health services

Pharmacogenomics in Heart Failure: Where Are We Now and How Can We Reach Clinical Application?

Heart failure is becoming increasingly prevalent in the United States and is a significant cause of morbidity and mortality. Several therapies are currently available to treat this chronic illness; however, clinical response to these treatment options exhibit significant interpatient variation. It is now clearly understood that genetics is a key contributor to diversity in therapeutic response, and evidence that genetic polymorphisms alter the pharmacokinetics, pharmacodynamics, and clinical response of heart failure drugs continues to accumulate. This suggests that pharmacogenomics has the potential to help clinicians improve the management of heart failure by choosing the safest and most effective medications and doses. Unfortunately, despite much supportive data, pharmacogenetic optimization of heart failure treatment regimens is not yet a reality. In order to attenuate the rising burden of heart failure, particularly in the context of the recent paucity of new effective interventions, there is an urgent need to extend pharmacogenetic knowledge and leverage these associations in order to enhance the effectiveness of existing heart failure therapies. The present review focuses on the current state of pharmacogenomics in heart failure and provides a glimpse of the aforementioned future needs

Exit and voice : diaspora population and national development in Nigeria

This article interrogates the role of the Nigerian Diaspora in contributing financial and intellectual remittances for national development. It does so because conventional diaspora studies have focused on how various diaspora populations adapt to the social, economic, and political realms in the countries of settlement even as they seek to maintain their own traditions and cultures. Recent developments indicate Diasporas have played prominent roles in the political, social, and economic development of their countries of origin. As a result, it becomes crucial to integrate the role of the Diaspora in contributing not just financial but also intellectual remittances to enhance national development. This is because intellectual remittances are critical for institution building and addressing leadership deficit which will in turn channel financial remittances into proper national development agenda. Yet, this is too often neglected in the extant literature. Relying on the diaspora option theory and Hirschman’s exit, voice and loyalty theory, with data gleaned from a structured questionnaire survey, interviews, institutional reports, and other secondary sources, this article explores how diaspora communities serve as critical bridges that facilitate national development through financial and intellectual remittances. The study revealed that whereas financial remittance is important for addressing development gaps, it becomes more forceful when combined with other forms of remittances such as intellectual and social remittances. IMPACT STATEMENT : The motivation for this study was to understand the contributions of the diaspora population who in spite of their physical exit from home continue to make their voices heard and felt by contributing both knowledge and financial resources towards the growth and development of Nigeria. Nigeria faces scary challenges of national development, and the quest for socio-economic transformation led the government to devise an engagement strategy to draw from the experiences and expertise of her citizens living outside the country known as the diaspora population. Incidentally, this segment of the population living outside the shores of their home country is sometimes forced by dire socio-economic circumstances to migrate and settle in other climes where they not only contribute to the growth of their host country but make monetary and knowledge contributions to families and communities back home. The study concludes that the diaspora contribution is crucial and pivotal to national development but it is not a magic wand or elixir that can fix all the challenges affecting the country.The Carnegie Corporation of New York (CCNY).https://www.tandfonline.com/loi/oass20hj2024Future AfricaSDG-01:No povert

A Recent HIV Diagnosis Is Associated with Non-Completion of Isoniazid Preventive Therapy in an HIV-Infected Cohort in Cape Town

Introduction: Despite high rates of successful treatment TB incidence in South Africa remains high, suggesting ongoing transmission and a large reservoir of latently infected persons. Isoniazid preventive therapy (IPT) is recommended as preventive therapy in HIV-infected persons. However, implementation has been slow, impeded by barriers and challenges including the fear of non-adherence. Objective and Methods: The aim was to evaluate predictors of IPT non-completion. One hundred and sixty four antiretroviral therapy (ART)-naïve HIV-infected patients with tuberculin skin test ≥5 mm were recruited from Khayelitsha day hospital and followed up monthly. A questionnaire was used to collect demographic information. Results: The overall completion rate was 69%. In multivariable analysis, there was a 29% decrease in risk of non-completion for every year after HIV diagnosis (OR 0.81; 95% C.I. 0.68–0.98). Self-reported alcohol drinkers (OR 4.05; 95% C.I. 1.89–9.06) also had a four-fold higher risk of non-completion, with a strong association between alcohol drinkers and smoking (χ2 27.08; p<0.001). Conclusion: We identify patients with a recent HIV diagnosis, in addition to self-reported drinkers and smokers as being at higher risk of non-completion of IPT. The period of time since HIV diagnosis should therefore be taken into account when initiating IPT. Our results also suggest that smokers and alcohol drinkers should be identified and targeted for adherence interventions when implementing IPT on a wider scale

Numerical Based Optimization for Natural Gas Dehydration and Glycol Regeneration

Exergy is a simultaneous measure of the quantity and quality of energy. This helps to identify the inefficiency of the process and allows engineers to determine the cause and magnitude of the loss for each operating unit. Natural gas dehydration via absorption using glycol is the most economically attractive approach, and this advantage can only stand if lower energy consuption relative to adsorption process can be obtained; thus, timely prediction and identification of energy consumption is vital. In this study, an energy utilization predictive model for natural gas dehydration unit energy consumption was developed. This numeric approach will increase accuracy and reduce the high simulation time often encountered in using other simulation software. To achieve this novel idea, a multilayer perceptron approach which is a deep learning neural network model built on python using Tensorflow was adopted. The model used for this study is implemented to further increase the accuracy of the output set variables which are matched with simulation result. Since we are dealing with a non-linear function, rectified linear unit (ReLU) function was used to activate the neurons in hidden layers so as to strengthen the model to be more flexible in finding relationships which are arbitrary in the input parameter. These input parameters are fed into the steady state model and sent to various branches of fully connected neural network models using a linear activation function. Each branch produces a result for each output parameter thereby fitting the model by reducing the mean squared error loss. The training data were not normalized but left in their original form. Results showed that the adopted double hidden layer with 5 branches are uniquely branched in such a way that it predicts values for a single output variable, which is an upgrade to the former work done with a single hidden layer in literature. The accuracy analysis showed that the proposed double hidden layer approach in this study out-performed the single hidden layer

Temperature Controls Crystalline Iron Oxide Utilization by Microbial Communities in Methanic Ferruginous Marine Sediment Incubations

Microorganisms can use crystalline iron minerals for iron reduction linked to organic matter degradation or as conduits for direct interspecies electron transfer (mDIET) to syntrophic partners, e.g., methanogens. The environmental conditions that lead either to reduction or conduit use are so far unknown. We investigated microbial community shifts and interactions with crystalline iron minerals (hematite and magnetite) in methanic ferruginous marine sediment incubations during organic matter (glucose) degradation at varying temperatures. Iron reduction rates increased with decreasing temperature from 30°C to 4°C. Both hematite and magnetite facilitated iron reduction at 4°C, demonstrating that microorganisms in the methanic zone of marine sediments can reduce crystalline iron oxides under psychrophilic conditions. Methanogenesis occurred, however, at higher rates with increasing temperature. At 30°C, both hematite and magnetite accelerated methanogenesis onset and maximum process rates. At lower temperatures (10°C and 4°C), hematite could still facilitate methanogenesis but magnetite served more as an electron acceptor for iron reduction than as a conduit. Different temperatures selected for different key microorganisms: at 30°C, members of genus Orenia, Halobacteroidaceae, at 10°C, Photobacterium and the order Clostridiales, and at 4°C Photobacterium and Psychromonas were enriched. Members of the order Desulfuromonadales harboring known dissimilatory iron reducers were also enriched at all temperatures. Our results show that crystalline iron oxides predominant in some natural environments can facilitate electron transfer between microbial communities at psychrophilic temperatures. Furthermore, temperature has a critical role in determining the pathway of crystalline iron oxide utilization in marine sediment shifting from conduction at 30°C to predominantly iron reduction at lower temperatures

The Influence of HIV on the Evolution of Mycobacterium tuberculosis.

HIV significantly affects the immunological environment during tuberculosis coinfection, and therefore may influence the selective landscape upon which M. tuberculosis evolves. To test this hypothesis whole genome sequences were determined for 169 South African M. tuberculosis strains from HIV-1 coinfected and uninfected individuals and analyzed using two Bayesian codon-model based selection analysis approaches: FUBAR which was used to detect persistent positive and negative selection (selection respectively favoring and disfavoring nonsynonymous substitutions); and MEDS which was used to detect episodic directional selection specifically favoring nonsynonymous substitutions within HIV-1 infected individuals. Among the 25,251 polymorphic codon sites analyzed, FUBAR revealed that 189-fold more were detectably evolving under persistent negative selection than were evolving under persistent positive selection. Three specific codon sites within the genes celA2b, katG, and cyp138 were identified by MEDS as displaying significant evidence of evolving under directional selection influenced by HIV-1 coinfection. All three genes encode proteins that may indirectly interact with human proteins that, in turn, interact functionally with HIV proteins. Unexpectedly, epitope encoding regions were enriched for sites displaying weak evidence of directional selection influenced by HIV-1. Although the low degree of genetic diversity observed in our M. tuberculosis data set means that these results should be interpreted carefully, the effects of HIV-1 on epitope evolution in M. tuberculosis may have implications for the design of M. tuberculosis vaccines that are intended for use in populations with high HIV-1 infection rates

Temperature controls crystalline iron oxide utilization by microbial communities in methanic ferruginous marine sediment incubations

Microorganisms can use crystalline iron minerals for iron reduction linked to organic matter degradation or as conduits for direct interspecies electron transfer (mDIET) to syntrophic partners, e.g., methanogens. The environmental conditions that lead either to reduction or conduit use are so far unknown. We investigated microbial community shifts and interactions with crystalline iron minerals (hematite and magnetite) in methanic ferruginous marine sediment incubations during organic matter (glucose) degradation at varying temperatures. Iron reduction rates increased with decreasing temperature from 30 degrees C to 4 degrees C. Both hematite and magnetite facilitated iron reduction at 4 degrees C, demonstrating that microorganisms in the methanic zone of marine sediments can reduce crystalline iron oxides under psychrophilic conditions. Methanogenesis occurred, however, at higher rates with increasing temperature. At 30 degrees C, both hematite and magnetite accelerated methanogenesis onset and maximum process rates. At lower temperatures (10 degrees C and 4 degrees C), hematite could still facilitate methanogenesis but magnetite served more as an electron acceptor for iron reduction than as a conduit. Different temperatures selected for different key microorganisms: at 30 degrees C, members of genus Orenia, Halobacteroidaceae, at 10 degrees C, Photobacterium and the order Clostridiales, and at 4 degrees C Photobacterium and Psychromonas were enriched. Members of the order Desulfuromonadales harboring known dissimilatory iron reducers were also enriched at all temperatures. Our results show that crystalline iron oxides predominant in some natural environments can facilitate electron transfer between microbial communities at psychrophilic temperatures. Furthermore, temperature has a critical role in determining the pathway of crystalline iron oxide utilization in marine sediment shifting from conduction at 30 degrees C to predominantly iron reduction at lower temperatures