Service Brand Equity in Developing Economies: The Case of Egyptian Banking Sector

The brand equity concept is one of the most significant concepts for branding and marketing and its model and measurement have interested many academics and practitioners. Most of the research on brand equity has focused on physical goods, with a dearth of studies on the service sector in general and particularly in the banking sector. The dearth of research in this area appears paradox as branding could be argued to play a distinctive role particularly in the service sector. This is because strong brands increase consumers' trust of the imperceptible purchase and reduce their perceived monetary, social, or safety risk in buying services, which are difficult to evaluate prior to purchase and for which it sometimes takes a long time after purchase to confirm the brand promise. Consequently, many scholars have called for an investigation of brand equity in the service sector. In addition, most of the research on brand equity has focused on developed countries which would suggest a regional focus on developing countries. To sum up, despite the importance of brand equity in the service sector, there is lack of empirical evidence in the service sector in general and specifically in the banking sector, particularly for developing economies. Furthermore, there is lack of studies that examined and compared service brand equity across bank type (local public, local private and foreign banks) to provide a benchmark especially for foreign banks. Contributing to scholarly attempts to fill the gaps in the brand equity literature. this thesis examines consumer-based brand equity (CBBE) in the Egyptian banking sector in general and based on each bank type: public, private and foreign. In addition, the study aims to find out the similarities and differences on brand equity based on bank type. The regional context of the study is Egypt As the largest Arab country and the entry point for the Middle East and Africa Egypt appeared to be of high practical relevance and be a suitable regional research context. Unlike previous researches, a mixed method approach was employed to achieve the research aims. Qualitative data was used to triangulate the quantitative data and gaining a richer understanding of the quantitative findings. Four hundred and sixty-eight self-administered questionnaires were collected by offline and online modes, and 14 semi-structured face-to-face interviews provided details about how consumers perceived consumer-based brand equity in Egyptian banking. Data was analysed using SPSS19. Different types of statistical applications were used, such as descriptive analysis, factor analysis and multiple regressions. Content analysis using NVivo10 software was used to analyse the interview data. The main findings reveal that CBBE is applicable in the Egyptian banking sector. The results show that brand awareness, reliable staff, brand association and brand loyalty are the most effective variables on overall value of brand equity in the Egyptian banking sector, while within public banks, reliable staff, brand association and brand loyalty have the most influence on the overall value of brand equity. However, private and foreign banks share the same variables which affect the overall value of brand equity; these variables are brand awareness, brand loyalty and brand personality. The findings reveal that there is a significant difference between public banks and private and foreign banks; however, there is no significant difference between private and foreign banks. The qualitative findings support and add meaning to the quantitative results. The current research contributes to knowledge in the field of service brand equity research and extend our understanding in developing economics and adding to the debate on the area of brand equity.Furthermore, it contributes methodologically by using mixed methods and mixed modes (offline and online). In addition, the study overcomes the limitations of previous studies in three ways. Firstly, different types of brand association were incorporated and real consumers were approached rather than relying on students’ samples. Secondly, perceived quality was measured using the SERVPERF scale, providing a more comprehensive quality measure than many studies. Thirdly, the data were collected from Egypt, which as a developing country establishes an underresearched regional context. Therefore, as is the case in many developing countries, there were many challenges involved in the data collection process. Based on the results, the study provides a number of pratical contributions: It offers a manageable scale ‘‘tool kit'' for managers in the banking sector, regardless of type of bank, to create, maintain and improve their brand equity. It also provides guidelines that public, private and foreign banks could use to compare their performance with competitors. The study emphasizes the importance of building and developing brand awearness for private and foreign banks. As the service encounter is the “moment of truth” and is one of the most important determinants of brand equity, public banks should place more emphasis on their internal branding as well as on external consumers. Top management should invest in cultivating their brand values to their employees, particularly front-line employees, as they will deliver them to consumers through the service encounter. Another interesting finding with practical relevance was that although the majority of banks in Egypt has online banking services, most of the study respondents did not use them, therefore they might be well advised to collaborate with the Central Bank of Egypt (CBE) to organise a campaign to cultivate trust in the country’s online banking infrastructure and promote the advantages of using it. Online banking could be one of the solutions to overcrowding and long queues in public banks and improve the quality of the service provided which will lead to consumers’ satisfaction and increase the level of brand equity. Most consumers of public banks perceived their banks as the only secure banks guaranteed by the Egyptian government. Similarly to promoting the use of online banking, there is a need to develop a better public awareness of the role of the CBE in supervising all banks in Egypt regardless of their type. This will ensure fair and equal opportunities for all banks, which will foster real competition and hence is argued to affect the quality of the service provided. Despite the research achieved its planned objectives, as any social research, it has certain constraints and limitations. These limitations could offer opportunities for future research to address. Firstly, due the lack of detailed information about the study population, this research used a convenience sample of induvadul commercial bank consumers in the Greater Cairo. Future research could employ probability sampling if possible. Moreover, future studies could cover more cities in Egypt, not only the Greater Cairo area (even though the focus on this area has been discussed and justified in the thesis). Secondly, although the importance of CBBE has been analysed mainly from a consumer perspective it might be useful to examine service brand equity from the points of view of employees (managers and front-line) in banks in order to gain a better and comprehensive understanding from both perspectives. Thirdly, while this study examined and compared CBBE in diffrent bank types (public, private and foreign) in Egypt. It is suggested that a comparison could be made based on the top bank in each types, as this could give more specific recommendations for these banks. Fourthly, due to limitations of time and funds, future reseach could examine and compare CBBE in different services sectors and in different countries. Fifthly, this study focused on commercial banks in Egypt in general without distinguish between Islamic and conventional banks.Therefore, future research could carefully distinguish between Islamic and conventional banks and compare CBBE across them to gain a better understanding of the differences and similarities. Sixthly, it could be worth comparing the CBBE of foreign banks when they operate overseas (e.g., Barclays Bank and HSBC)

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Soil Erosion Estimation Using Remote Sensing Techniques in Wadi Yalamlam Basin, Saudi Arabia

Soil erosion is one of the major environmental problems in terms of soil degradation in Saudi Arabia. Soil erosion leads to significant on- and off-site impacts such as significant decrease in the productive capacity of the land and sedimentation. The key aspects influencing the quantity of soil erosion mainly rely on the vegetation cover, topography, soil type, and climate. This research studies the quantification of soil erosion under different levels of data availability in Wadi Yalamlam. Remote Sensing (RS) and Geographic Information Systems (GIS) techniques have been implemented for the assessment of the data, applying the Revised Universal Soil Loss Equation (RUSLE) for the calculation of the risk of erosion. Thirty-four soil samples were randomly selected for the calculation of the erodibility factor, based on calculating the K-factor values derived from soil property surfaces after interpolating soil sampling points. Soil erosion risk map was reclassified into five erosion risk classes and 19.3% of the Wadi Yalamlam is under very severe risk (37,740 ha). GIS and RS proved to be powerful instruments for mapping soil erosion risk, providing sufficient tools for the analytical part of this research. The mapping results certified the role of RUSLE as a decision support tool

Phytoestrogen <i>β</i>-Sitosterol Exhibits Potent In Vitro Antiviral Activity against Influenza A Viruses

Influenza is a contagious infection in humans that is caused frequently by low pathogenic seasonal influenza viruses and occasionally by pathogenic avian influenza viruses (AIV) of H5, H7, and H9 subtypes. Recently, the clinical sector in poultry and humans has been confronted with many challenges, including the limited number of antiviral drugs and the rapid evolution of drug-resistant variants. Herein, the anti-influenza activities of various plant-derived phytochemicals were investigated against highly pathogenic avian influenza A/H5N1 virus (HPAIV H5N1) and seasonal low pathogenic human influenza A/H1N1 virus (LPHIV H1N1). Out of the 22 tested phytochemicals, the steroid compounds β-sitosterol and β-sitosterol-O-glucoside have very potent activity against the predefined influenza A viruses (IAV). Both steroids could induce such activity by affecting multiple stages during IAV replication cycles, including viral adsorption and replication with a major and significant impact on the virus directly in a cell-free status “viricidal effect”. On a molecular level, several molecular docking studies suggested that β-sitosterol and β-sitosterol-O-glucoside exhibited viricidal effects through blocking active binding sites of the hemagglutinin surface protein, as well as showing inhibitory effects against replication through the binding with influenza neuraminidase activity and blocking the active sites of the M2 proton channel activity. The phytoestrogen β-sitosterol has structural similarity with the active form of the female sex hormone estradiol, and this similarity is likely one of the molecular determinants that enables the phytoestrogen β-sitosterol and its derivative to control IAV infection in vitro. This promising anti-influenza activity of β-sitosterol and its O-glycoside derivative, according to both in vitro and cheminformatics studies, recommend both phytochemicals for further studies going through preclinical and clinical phases as efficient anti-influenza drug candidates