Cost-effectiveness of antivenoms for snakebite envenoming in 16 countries in West Africa

Background Snakebite poisoning is a significant medical problem in agricultural societies in Sub Saharan Africa. Antivenom (AV) is the standard treatment, and we assessed the cost-effectiveness of making it available in 16 countries in West Africa. Methods We determined the cost-effectiveness of AV based on a decision-tree model from a public payer perspective. Specific AVs included in the model were Antivipmyn, FAV Afrique, Echi-Tab-G and EchiTab-Plus. We derived inputs from the literature which included: type of snakes causing bites (carpet viper (Echis species)/non-carpet viper), AV effectiveness against death, mortality without AV, probability of Early Adverse Reactions (EAR), likelihood of death from EAR, average age at envenomation in years, anticipated remaining life span and likelihood of amputation. Costs incurred by the victims include: costs of confirming and evaluating envenomation, AV acquisition, routine care, AV transportation logistics, hospital admission and related transportation costs, management of AV EAR compared to the alternative of free snakebite care with ineffective or no AV. Incremental Cost Effectiveness Ratios (ICERs) were assessed as the cost per death averted and the cost per Disability-Adjusted-Life-Years (DALY) averted. Probabilistic Sensitivity Analyses (PSA) using Monte Carlo simulations were used to obtain 95% Confidence Intervals of ICERs. Results The cost/death averted for the 16 countries of interest ranged from $1,997 in Guinea Bissau to$6,205 for Liberia and Sierra Leone. The cost/DALY averted ranged from $83 (95$36-$240) for Benin Republic to$281 ($159-457) for Sierra-Leone. In all cases, the base-case cost/DALY averted estimate fell below the commonly accepted threshold of one time per capita GDP, suggesting that AV is highly cost-effective for the treatment of snakebite in all 16 WA countries. The findings were consistent even with variations of inputs in 1-way sensitivity analyses. In addition, the PSA showed that in the majority of iterations ranging from 97.3% in Liberia to 100% in Cameroun, Guinea Bissau, Mali, Nigeria and Senegal, our model results yielded an ICER that fell below the threshold of one time per capita GDP, thus, indicating a high degree of confidence in our results. Conclusions Therapy for SBE with AV in countries of WA is highly cost-effective at commonly accepted thresholds. Broadening access to effective AVs in rural communities in West Africa is a priority

Impact of dietary patterns, individual and workplace characteristics on blood pressure status among civil servants in Bida and Wushishi communities of Niger State, Nigeria

The global burden estimate of hypertension is alarming and results in several million deaths annually. A high incidence of sudden deaths from cardiovascular diseases in the civil workforce in Nigeria is often reported. However, the associations between Dietary Patterns (DPs), individual, and workplace characteristics of hypertension among this workforce have not been fully explored. This study aimed to identify DP in the Bida and Wushishi Communities of Niger State and establish its relationship with hypertension along with other individual and workplace characteristics. Factor analysis was used to establish DP, Chi-square test to identify their relationships with hypertension, and logistic regression to determine the predictor risk factors. The prevalence of hypertension was 43.7%; mean weight, height, and body fat were: 72.8±15 kg, 166±8.9 mm and 30.4%, respectively. Three DPs: “Efficient Diet,” “Local diet,” and “Energy Boost Diet” were identified. The factor loading scores for these factors were divided into quintiles Q1–Q5; none of them had a significant effect on hypertension status. Conversely, increase in age, the Ministry, Department, and Agency (MDA) of employment, frequency of eating in restaurants, and obesity were identified as significant risk factors. After adjusting for confounders (age, body mass index, MDA, and eating habits), a high score (Q5) in “efficient diet pattern” was significantly related to a lower likelihood of hypertension than a low score (Q1). The prevalence of hypertension among the participants was relatively very high. An increase in age and working in educational sector were risk factors associated with hypertension. Therefore, it is recommended that civil servants engage in frequent exercise and undergo regular medical checkups, especially as they get older. These findings highlight the need for large-scale assessment of the impact of variables considered in this study on hypertension, among the civil workforce across Niger state and Nigeria

Flying to Quality: Cultural Influences on Online Reviews

Customers increasingly consult opinions expressed online before making their final decisions. However, inherent factors such as culture may moderate the criteria and the weights individuals use to form their expectations and evaluations. Therefore, not all opinions expressed online match customers’ personal preferences, neither can firms use this information to deduce general conclusions. Our study explores this issue in the context of airline services using Hofstede’s framework as a theoretical anchor. We gauge the effect of each dimension as well as that of cultural distance between the passenger and the airline on the overall satisfaction with the flight as well as specific service factors. Using topic modeling, we also capture the effect of culture on review text and identify factors that are not captured by conventional rating scales. Our results provide significant insights for airline managers about service factors that affect more passengers from specific cultures leading to higher satisfaction/dissatisfaction

Effects of demographic factors on bank customers' attitudes and intention toward Internet banking adoption in a major developing African country

This study provides an African perspective to the global research and literature on retail customer adoption of Internet banking (IB). It empirically examines the influence of seven demographic variables – age, gender, level of education, marital status, employment status, income level and area of residence – on retail banking customers' behaviours toward IB adoption in a major developing African country – Nigeria. A sample of 500 customers was surveyed, and ANOVA and multiple regression analyses were used in testing the association of the variables with customer attitude and intention toward IB adoption. Although all seven variables were correlated with attitude and intention, only gender, level of education, and employment status showed significant ability to influence Nigerian customers' attitude and intention toward IB adoption. The study therefore concludes that gender, level of education, and employment status are the major demographic affecters of Nigerian banking customers' attitudes to IB adoption