Comparative Cost of Early Infant Male Circumcision by Nurse-Midwives and Doctors in Zimbabwe

BACKGROUND: The 14 countries that are scaling up voluntary male medical circumcision (VMMC) for HIV prevention are also considering early infant male circumcision (EIMC) to ensure longer-term reductions in HIV incidence. The cost of implementing EIMC is an important factor in scale-up decisions. We conducted a comparative cost analysis of EIMC performed by nurse-midwives and doctors using the AccuCirc device in Zimbabwe. METHODS: Between August 2013 and July 2014, nurse-midwives performed EIMC on 500 male infants using AccuCirc in a field trial. We analyzed the overall unit cost and identified key cost drivers of EIMC performed by nurse-midwives and compared these with costing data previously collected during a randomized noninferiority comparison trial of 2 devices (AccuCirc and the Mogen clamp) in which doctors performed EIMC. We assessed direct costs (consumable and nonconsumable supplies, device, personnel, associated staff training, and waste management costs) and indirect costs (capital and support personnel costs). We performed one-way sensitivity analyses to assess cost changes when we varied key component costs. RESULTS: The unit costs of EIMC performed by nurse-midwives and doctors in vertical programs were US$38.87 and US$49.77, respectively. Key cost drivers of EIMC were consumable supplies, personnel costs, and the device price. In this cost analysis, major cost drivers that explained the differences between EIMC performed by nurse-midwives and doctors were personnel and training costs, both of which were lower for nurse-midwives. CONCLUSIONS: EIMC unit costs were lower when performed by nurse-midwives compared with doctors. To minimize costs, countries planning to scale up EIMC should consider using nurse-midwives, who are in greater supply than doctors and are the main providers at the primary health care level, where most infants are born

Positive attitudes to pediatric HIV testing: findings from a nationally representative survey from Zimbabwe.

Early HIV testing and diagnosis are paramount for increasing treatment initiation among children, necessary for their survival and improved health. However, uptake of pediatric HIV testing is low in high-prevalence areas. We present data on attitudes towards pediatric testing from a nationally representative survey in Zimbabwe

Wound botulism in injectors of drugs: upsurge in cases in England during 2004.

Wound infections due to Clostridium botulinum were not recognised in the UK and Republic of Ireland before 2000. C. botulinum produces a potent neurotoxin which can cause paralysis and death. In 2000 and 2001, ten cases were clinically recognised, with a further 23 in 2002, 15 in 2003 and 40 cases in 2004. All cases occurred in heroin injectors. Seventy cases occurred in England; the remainder occurred in Scotland (12 cases), Wales (2 cases) and the Republic of Ireland (4 cases). Overall, 40 (45%) of the 88 cases were laboratory confirmed by the detection of botulinum neurotoxin in serum, or by the isolation of C. botulinum from wounds. Of the 40 cases in 2004, 36 occurred in England, and of the 12 that were laboratory confirmed, 10 were due to type A. There was some geographical clustering of the cases during 2004, with most cases occurring in London and in the Yorkshire and Humberside region of northeast England

Beyond the Marrakesh VIP Treaty: Typology of copyright access-enabling provisions for persons with disabilities

This paper builds upon the evidence drawn from a scoping study on access to copyright works by persons with disabilities. It identifies and discusses specific access‐enabling technologies for persons with aural, cognitive, physical, and visual disabilities and how they are affected by the exercise of exclusive rights. It shows how, and the extent to which states\u27 ratification of the Marrakesh Treaty to Facilitate Access to Published Works for Persons Who Are Blind, Visually Impaired, or Otherwise Print Disabled (Marrakesh Treaty) has enabled the making of accessible format of copyright works for persons with disabilities. To this end, the paper examines patterns and trends of accessible format enabling provisions in the copyright laws of World Intellectual Property Organization (WIPO) member states

Beyond the Marrakesh VIP Treaty: Typology of copyright access-enabling provisions for persons with disabilities

This paper builds upon the evidence drawn from a scoping study on access to copyright works by persons with disabilities. It identifies and discusses specific access‐enabling technologies for persons with aural, cognitive, physical, and visual disabilities and how they are affected by the exercise of exclusive rights. It shows how, and the extent to which states\u27 ratification of the Marrakesh Treaty to Facilitate Access to Published Works for Persons Who Are Blind, Visually Impaired, or Otherwise Print Disabled (Marrakesh Treaty) has enabled the making of accessible format of copyright works for persons with disabilities. To this end, the paper examines patterns and trends of accessible format enabling provisions in the copyright laws of World Intellectual Property Organization (WIPO) member states

Monkey Selfie and Authorship in Copyright Law: The Nigerian and South African Perspectives

A photograph taken by a monkey is in the centre of a copyright claim in the famous monkey selfie case in the United States of America. Suing as next friend of the monkey, named Naruto, the People for the Ethical Treatment of Animals contended that copyright in the photograph belongs to the monkey as author of the photograph since the monkey created the photograph unaided by any person. On the motion of the defendants, the case was dismissed by the US district court on the ground that the concept of authorship under US Copyright Act cannot be defined to include non-human animals. The dismissal order was confirmed by a three-judge panel of the US Court of Appeal of Ninth Circuit a request for an appeal before a panel of eleven judges of the appellate court was denied. This paper reviews the case in the light of the concept of authorship and ownership, with specific focus on the authorship of photographs, under the Nigerian Copyright Act and South African Copyright Act. In so doing, it examines and relies on Ginsburg's six principles for testing authorship to test the authorship of photographs under the Acts. It also relies on the concepts of subjective rights and legal personality to explain the implication of conferring copyright ownership on non-human animals. It argues that for authorship of and ownership of the copyright in a photograph to be established under the Nigerian Copyright Act and South African Copyright Act, a legal person must have created the photograph. Consequently, for the purposes of argument, the paper proceeds on the assumption that the monkey selfie case originated from Nigeria or South Africa. After analysing relevant statutory provisions and case law, the paper finds that the Nigerian Copyright Act and the South African Copyright Act do not envisage the conferral of authorship in particular, and copyright protection in general, to a non-human animal. It then concludes that the courts in both countries would not reach a different conclusion from the one made by the US courts.   &nbsp

GADSA: Persuasive Gamified Antimicrobial Stewardship Decision Support App for Antibiotics Prescribing Behaviour Change in Nigeria

Antimicrobial Resistance (AMR) is a prominent global threat. The spread of AMR is further accelerated by the inappropriate use of antibiotics. While misuse and overuse of antibiotics are particular global challenges regardless of resources and settings, there is evidence these are amplified in low-to-middle income countries (LMIC) such as Nigeria. While successful antimicrobial stewardship (AMS) programmes have been implemented in LMIC, more research is required to better understand how to overcome some of the underlying reasons and behaviour obstacles, such as lack of training, limited resources, culture and inadequate infection prevention and control practice. This is of particular importance for prophylactic antibiotic prescribing to prevent surgical site infections (SSI). Evidence-based guidelines published by the World Health Organization (WHO) and other public health agencies advise on best practice for prescribing and administering prophylactic surgical antibiotics. However, compliance with such guidelines amongst surgical teams is often limited. The development of engaging decision support tools, accessible at the point of care, at low cost for use in LMICs, is required to help surgeons apply AMS guidelines to their daily practice. Serious mobile games, developed with an educational or training purpose rather than for entertainment, are a powerful tool for persuasive behaviour change but little interest has been given to research for AMR to change prescription behaviour in LMIC. In this research we present the co-development of a decision support tool for the 'Gamified Antimicrobial Stewardship Decision Support App' (GADSA) in Nigeria with surgeons from three participating hospital sites. GADSA is the first gamified decision support app using persuasive games techniques for prescribing behaviour change demonstrated to deliver a prescription behaviour change increasing compliance with SSI guidelines at the point of care. GADSA is also is novel at providing decision support for surgical antibiotic prescribing through gamified features such instruction of mentor, visual and textual immediate feedback system, persuasive messaging and positive and negative reinforcement

GADSA: Decision Support App for Antibiotics Prescribing in Nigeria

GADSA (Gamified Antimicrobial Stewardship Decision Support App) is a decision support tool to improve evidence-based prescribing, designed to be used at the point-of-care to help clinicians comply with guidelines in their everyday practice. The app represents a novel cross-platform, mobile decision support tool, integrating principles from serious games and gamification, to improve compliance with prescription guidelines of Surgical Antibiotic Prophylaxis (SAP) in Nigeria. This paper focuses on the decision support component of the mobile application, integrating the World Health Organisation and Sanford guidelines for SAP prescriptions