The spillover effect of midwife attrition from the Nigerian midwives service scheme

Abstract Background The Nigerian Midwives Service Scheme (MSS) increased use of antenatal services at rural public sector clinics. However, it is unclear if women who would not have otherwise sought care, or those who would have sought care in rural private sector clinics caused this change. Additionally, it is also unclear if the reported midwife attrition was associated with a spillover of the scheme’s effect on urban areas. We sought to answer these two questions using data from two nationally representative surveys. Methods We used an interrupted time series model to assess trends in the use of obstetric (i.e. antenatal and delivery) services among rural and urban respondents in the 2008 and 2013 Nigerian demographic and health surveys. Results We found that the MSS led to a 5-percentage point increase in the use of antenatal services at rural public sector clinics, corroborating findings from a previous study. This change was driven by women who would not have sought care otherwise. We also found that there was a 4-percentage point increase in the use of delivery services at urban public sector clinics, and a concurrent 4-percentage point decrease in urban home deliveries. These changes are most likely explained by midwives’ attrition and exemplify a spillover of the scheme’s effect. Conclusion Midwife attrition from the Nigerian MSS was associated with a spillover of the scheme’s effect on the use of delivery services, on urban areas

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children <18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p<0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p<0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p<0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer

Biomedical colonialism or local autonomy?: local healers in the fight against tuberculosis

Analiza el papel de los agentes médicos autóctonos y sus conocimientos en las campañas antituberculosas contemporáneas en el África subsahariana. Sitúa la medicina contemporánea, llevada a cabo en África en la herencia cultural de la medicina colonial, para comprender el marco histórico en el que se desarrollaron, a partir de los años setenta del siglo XX, las estrategias de la Organización Mundial de la Salud de promoción y desarrollo de las medicinas 'tradicionales'. En los proyectos sanitarios analizados, se evalúan las prácticas médicas locales y se entrenan a los agentes autóctonos para integrarlos en actividades estrictamente biomédicas: identificación de síntomas, remisión a hospitales o supervisión de tratamientos farmacológicos.The article explores the role played by indigenous medical agents, and their knowledge, within contemporary tuberculosis campaigns in sub-Saharan Africa. To understand the historical framework within which the World Health Organization devised its strategies to promote and develop traditional medicine as of the 1970s, the article contextualizes contemporary medicine as a cultural legacy of colonial medicine. Under the public healthcare projects analyzed in the article, local medical practices were assessed and indigenous agents trained so they could take part in strictly biomedical activities, like symptom identification, referrals to hospitals, or supervision of drug treatments.Trabajo realizado para la obtención del Diploma de Estudios Avanzados (DEA) en el programa de doctorado Salud: Antropología e Historia, bajo la dirección de la profesora Rosa María Medina Doménech

THE ROLE OF ORGANIZED LABOR IN THE POLITICAL DEVELOPMENT OF NIGERIA

Abstract not availabl

Analysis of the state of development of adult education in Nigeria : suggestions for future action

The purpose of this study was to analyze the state of development of adult education in Nigeria. The major objectives were to review the state of development of Nigerian adult education programs, assess the overall effectiveness of these programs, and utilize the findings to suggest action for future program improvement. A questionnaire was administered by mail to the Permanent Secretaries of the Ministry of Education in the States and to the heads of education departments of universities in Nigeria. The Kendall's Coefficient of Concordance (W) and the Kruskal-Wallis (H) Tests were used to test the null hypotheses. Differences were assessed at the .01 level of significance. From the findings of the study, the following conclusions were drawn: 1. Facilities, equipment, and other instructional materials in the Nigerian adult education program are perceived as inadequate. 2. The most important impact of adult education was to induce more children to attend school. 3. The Ministry of Education is perceived as the most influential agency for adult education in the country. Other ministries are perceived as having little influence in adult education. 4. The majority of the adult education teachers have no qualifications beyond the First School Leaving Certificate. Additionally, they have not been given the training needed for the efficient work with adult learners. 5. Religious institutions are perceived as most effective and influential, while the Red Cross, Y.M.C.A. and other similar agencies have limited influence and limited programs for adults. On the basis of the findings of the study, the following recommendations are suggested. It is recommended that: 1. This study be used as a pilot study and that more intensive research be done on the development of adult education in Nigeria. 2. The universities and other institutions of higher learning take a more active part in adult education. Training, research, counseling, extension services, and other essential services should be established for the advancement of adult education. 3. A coherent curriculum of adult education be developed that provides for the sequential development of the knowledge, understanding, skills, attitudes, and values required to maintain one's effectiveness in a changing Nigerian society. 4. More funds be provided for adult education. The government should play a major role in this. 5. More incentives be created for people who want to get involved with adult education. 6. All adult education plans and programs be periodically reviewed and evaluated. 7. Pre-service and in-service training be expanded for all of those employed in the adult education field. 8. All programs of adult education be required to clarify their program objectives and participate in the development of inter-agency working agreements to insure that the resources of adult education are used effectively in meeting the adult educational needs of individuals, institutions, and communities. 9. There be a national commitment to provide the resources and philosophical support necessary for the development of lifelong learning as an integral element of the Nigerian way of life. 10. The government ministries, universities and other agencies and organizations in the country should emulate the religious institutions who have demonstrated an effective approach to program development and delivery

Development of a fundamental model for pelleting efficiency of an innovative hybrid fish feed processing system

The development of a fundamental model for predicting pelleting efficiency at variable feed rates and number of orifices was central to optimizing the performance of an innovative hybrid fish feed processing system. The system was designed for simplicity, quality, and precision in fish feed production. Machine parameters, derived from comprehensive design and parametric analysis, were used to establish input variables for the pelleting efficiency model, including feed rate and number of orifices. With a constant driving force of 713.38 N from a 3 hp electric motor, the system demonstrated pelleting efficiencies of 55 %, 70 %, and 88 % for 15, 20, and 25 orifices, respectively. At a fixed die orifice, increasing the feed rate from 10 to 20 mm/rev at interval of 5 mm/rev resulted in efficiencies of 60 %, 80 %, and 110 %. Evaluation of the combined effect of the factors predicted an optimum efficiency of 86.9 % at optimal settings of 20mm/rev and 15 orifices. The model’s experimental validation, conducted under optimized conditions, showed that the 20-orifice die produced a higher pelleting efficiency (97%) but with reduced pellet floatability, whereas the 15-orifice die yielded an efficiency of 86.21 % and better floatability. The prediction error of 0.69% validated the model’s accuracy at 99 %. In addition, an introduction of cassava starch constituent improved pellet floatability and surface finish. This study therefore, highlights the potential of the developed model to enhance pelleting performance, balancing efficiency and pellet quality, and providing a robust foundation for optimizing fish feed production processes