Impact of using eHealth tools to extend health services to rural areas of Nigeria: protocol for a mixed-method, non-randomised cluster trial

Introduction: eHealth solutions that use internet and related technologies to deliver and enhance health services and information are emerging as novel approaches to support healthcare delivery in sub-Saharan Africa. Using digital technology in this way can support cost-effectiveness of care delivery and extend the reach of services to remote locations. Despite the burgeoning literature on eHealth approaches, little is known about the effectiveness of eHealth tools for improving the quality and efficiency of health systems functions or client outcomes in resource-limited countries. eHealth tools including satellite communications are currently being implemented at scale, to extend health services to rural areas of Nigeria, in Ondo and Kano States and the Federal Capital Territory. This paper shares the protocol for a 2-year project (‘EXTEND’) that aims to evaluate the impact of eHealth tools on health system functions and health outcomes. Methodology and analysis: This multisite, mixed-method evaluation includes a non-randomised, cluster trial design. The study comprises three phases—baseline, midline and endline evaluations—that involve: (1) process evaluation of video training and digitisation of health data interventions; (2) evaluation of contextual influences on the implementation of interventions; and (3) impact evaluation of results of the project. A convergent mixed-method model will be adopted to allow integration of quantitative and qualitative findings to achieve study objectives. Multiple quantitative and qualitative datasets will be repeatedly analysed and triangulated to facilitate better understanding of impact of eHealth tools on health worker knowledge, quality and efficiency of health systems and client outcomes. Ethics and dissemination: Ethics approvals were obtained from the University of Leeds and three States’ Ministries of Health in Nigeria. All data collected for this study will be anonymised and reports will not contain information that could identify respondents. Study findings will be presented to Ministries of Health at scientific conferences and published in peer-reviewed journals. Trial registration number: ISRCTN32105372; Pre-results

Genetic Variations and Haplotype Diversity of the UGT1 Gene Cluster in the Chinese Population

Vertebrates require tremendous molecular diversity to defend against numerous small hydrophobic chemicals. UDP-glucuronosyltransferases (UGTs) are a large family of detoxification enzymes that glucuronidate xenobiotics and endobiotics, facilitating their excretion from the body. The UGT1 gene cluster contains a tandem array of variable first exons, each preceded by a specific promoter, and a common set of downstream constant exons, similar to the genomic organization of the protocadherin (Pcdh), immunoglobulin, and T-cell receptor gene clusters. To assist pharmacogenomics studies in Chinese, we sequenced nine first exons, promoter and intronic regions, and five common exons of the UGT1 gene cluster in a population sample of 253 unrelated Chinese individuals. We identified 101 polymorphisms and found 15 novel SNPs. We then computed allele frequencies for each polymorphism and reconstructed their linkage disequilibrium (LD) map. The UGT1 cluster can be divided into five linkage blocks: Block 9 (UGT1A9), Block 9/7/6 (UGT1A9, UGT1A7, and UGT1A6), Block 5 (UGT1A5), Block 4/3 (UGT1A4 and UGT1A3), and Block 3′ UTR. Furthermore, we inferred haplotypes and selected their tagSNPs. Finally, comparing our data with those of three other populations of the HapMap project revealed ethnic specificity of the UGT1 genetic diversity in Chinese. These findings have important implications for future molecular genetic studies of the UGT1 gene cluster as well as for personalized medical therapies in Chinese

Plasma Sex Steroid Levels and Steroidogenesis in the Gonad of the Self-fertilizing Fish Rivulus marmoratus

The mangrove killifish, Rivulus marmoratus, is the only known self-fertilizing vertebrate. This species is sexually dimorphic; sexually mature individuals are either hermaphrodite or primary and secondary males. Although the mangrove killifish has a unique reproductive strategy, there has been no study on the reproductive endocrinology of this species. Thus we investigated plasma sex steroid hormone levels and steroidogenesis in the gonads of R. marmoratus by enzyme linked immunosorbent assay (ELISA). Plasma 17β-estradiol (E2) and 11-ketotestosterone (11-KT) were detected both in hermaphrodite and in primary male. Ovarian follicles (follicle-enclosed oocytes) from hermaphrodites, which were categorized into early yolk stage and late yolk stage, and testis tissue of primary males were cultured with different concentrations of 17α-hydroxyprogesterone (OHP) or testosterone (T) for 24 h. Production of T, E2, 11-KT and 17α-20 β-dihydroxy-4-pregnen-3-one (17α,20β-P) in the medium from tissue culture were measured by ELISA. Early and late ovarian follicles of hermaphrodites and testis pieces of primary males synchronously secreted E2, 11-KT, and 17α,20β-P following incubation with OHP or T. We conclude that both hermaphrodite and primary male of the mangrove killifish secrete estrogen, androgen, and progestin synchronously

Sanitation investments in Ghana: An ethnographic investigation of the role of tenure security, land ownership and livelihoods

Abstract Background Ghana’s low investment in household sanitation is evident from the low rates of improved sanitation. This study analysed how land ownership, tenancy security and livelihood patterns are related to sanitation investments in three adjacent rural and peri-urban communities in a district close to Accra, Ghana’s capital. Methods Qualitative data was gathered for this comparative ethnographic study over seven months, (June, 2011-January, 2012) using an average of 43 (bi-weekly) participant observation per community and 56 in-depth interviews. Detailed observational data from study communities were triangulated with multiple interview material and contextual knowledge on social structures, history of settlement, land use, livelihoods, and access to and perceptions about sanitation. Results This study shows that the history of settlement and land ownership issues are highly correlated with people’s willingness and ability to invest in household sanitation across all communities. The status of being a stranger i.e. migrant in the area left some populations without rights over the land they occupied and with low incentives to invest in sanitation, while indigenous communities were challenged by the increasing appropriation of their land for commercial enterprises and for governmental development projects. Interview responses suggest that increasing migrant population and the high demand for housing in the face of limited available space has resulted in general unwillingness and inability to establish private sanitation facilities in the communities. The increasing population has also created high demand for cheap accommodation, pushing tenants to accept informal tenancy agreements that provided for poor sanitation facilities. In addition, poor knowledge of tenancy rights leaves tenants in no position to demand sanitation improvements and therefore landlords feel no obligation or motivation to provide and maintain domestic sanitation facilities. Conclusions The study states that poor land rights, the history of settlements, in-migration and insecure tenancy are key components that are associated with local livelihoods and investments in private sanitation in rapidly changing rural and peri-urban communities of Ghana. Sanitation policy makers and programme managers must acknowledge that these profound local, ethnic and economic forces are shaping people’s abilities and motivations for sanitation investments

Investigation of the Potentials of Oil Palm Frond Fibre for Thermal Insulation of Food Flasks

Natural fibers obtained from oil palm fronds at Offa, Nigeria were investigated for reinforcement of heat-resistant lining for hot food flasks. Frond fibre was subjected to 5% NaOH chemical treatment to impose better surface property and used to reinforce polypropylene matrix as composites with 10%, 20%, 30% and 40% fibre loading. Treated frond fibre, polypylene matrix and samples of fabricated composites were subjected to standard chemical, mechanical and physical tests including density/hardness, impact/tensile strengths and thermogravimetric/thermal conductivity analyses following standard procedures. The test  equipment included injection molding machine, Instron tensile tester, Tinius impact tester, Rockwell hardness tester, Perkin Elmer instrument and Lees disc apparatus; accessed in workshops/laboratories of Kaduna Polytechnic, Ahmadu Bello University, Zaria, Engineering Materials Development Institute, Akure and Federal University of Technology, Minna. The characterization result showed the composite was nontoxic to humans if it contacted food in the flask. The physical, mechanical and thermal properties showed that only 20%-40% fibre loading was beneficial after which performance declined. Mechanical properties of frond reinforced composites (density, hardness, impact and tensile strength) were adequate for required service condition. The decomposition temperature of the composites was about 4800C which was above 3500C-4350C for most conventional domestic insulators, 2900C for pure treated frond fibre and 4350C for polypropylene matrix. Thermal conductivity reduced from 0.0035Wm-1K-1 to 0.0025Wm-1K-1 for 20%-40% 10mm thick fibre loaded composites. For 50mm thick conventional domestic insulators, it was 0.11- 0.23Wm-1K-1 for polypropylene matrix, 0.066Wm-1K-1 for rock wool, 0.036Wm-1K-1 for glass fibre and 0.03Wm-1K-1 for polystyrene, confirming the superiority of the frond reinforced composites as minimized thermal conductivity is the most critical determinant of material suitable for thermal insulation

Evaluation of the Suitability of Oil Palm Fruit Bunch Stalk Fibre for Lagging of Hot Food Containers

Oil palm fruit bunch stalk fibres obtained after the harvest from a plantation located at Offa, Nigeria. These fibers were treatedwith 5% NaOH aqueous solution, used to reinforce polypropylene polymer and investigated for thermal insulation of hot foodcarrying flasks. Treated fibres were loaded in concentrations by weights of 10%, 20%, 30% and 40% as filler into polypropylenematrix, fabricated into composites with an injection moulding machine with specimen of each formulation analysed for chemical,physical, mechanical and thermal properties including density, hardness, impact/tensile strengths, thermo-gravimetric and thermal conductivity using standard test equipment to ascertain the suitability for heat resisting application. Test equipmentincluded Lee’s disc apparatus, Perkin Elmer instrument, Instron tensile, Tinius impact and Rockwell hardness testers accessed inworkshops and laboratories in Nigeria. The characterization result showed the composite as nontoxic to humans if it contactedfood in the flask. The physical, mechanical and thermal properties showed that only 20%-40% fibre loading was beneficial afterwhich performance declined. Mechanical properties of bunch stalk reinforced composites (density, hardness, impact and tensilestrength) were adequate for the service conditions. The decomposition temperature of composites was about 4800C which wasabove 3500C-4350C for most conventional domestic insulators, 2810C for pure treated bunch stalk fibre and 4350C for polypropylene matrix. Thermal conductivity reduced from 0.11- 0.23Wm-1K-1for polypropylene matrix to 0.0025Wm-1K-1 for40% 10mm thick fibre loaded composite while it was 0.066Wm-1K-1 for 50mm thick rock wool, 0.036Wm-1K-1 for glass fibre and0.03Wm-1K-1 for polystyrene used as conventional domestic insulators. This confirmed superiority of the fruit bunch stalkreinforced composites as for thermal insulation application over common domestic insulator