User innovation of medical technologies in a developing country setting – the case of lower limb prostheses in Malawi

As is well known, users can make significant contributions to innovations, including innovating themselves. However, much work on user innovation has focussed on developed countries. The question remains whether and how users innovate in a developing country setting. Bodies of literature that explicitly consider innovations in such settings emphasise the influence of limitations. This thesis therefore investigates how limitations shape the creation and sharing of innovations by users. This issue is analysed for medical technologies, because these can have different user groups, including patients, who have been little focussed on, even in developed countries. In this setting, a focus on innovation as defined relatively inclusively is most suitable, and therefore the term 'changes' is often used rather than 'innovations' to express this inclusiveness. By comparing the changes made to the same kind of technology by different groups of users in different settings with different limitations, the influence of these limitations can be analysed. Therefore, data were collected on changes made by patients as well as orthopaedic technicians to lower limb prostheses in two orthopaedic centres in Malawi. First, observations were conducted of the production process for prostheses, followed by semi-structured interviews with orthopaedic technicians and patients, and with additional experts to understand the broader context. It was found that patients and orthopaedic technicians did make many changes. Three kinds of limitations were identified, that influence these changes by users. Like users in developed countries, patients and orthopaedic technicians make these changes to fulfil their needs because available products and services are not satisfactory. Limitations both restrict what products and services are available to users, and also influence the characteristics of the creation and sharing of changes by users. Many users reported on efforts to share their changes with others despite the limitations, often due to a sense of professional collegiality and solidarity. In summary, limitations help to explain how changes by users occur in developing countries, but also how any accumulation of such changes users make is restricted. Improving this situation could help less developed countries in making better use of any user innovations that do occur, and thus contribute to their development more generally

EFFECT OF A PHARMACIST INTERVENTION ON SELF MANAGEMENT PRACTICES AMONG HYPERTENSIVE-DIABETIC PATIENTS RECEIVING CARE IN A NIGERIAN TERTIARY HOSPITAL

Objective: The objective of this study was to evaluate the effect of a pharmacist-led intervention on self-management practices among hypertensive-diabetic patients receiving care in a Nigeria tertiary hospital. Methods: The study adopted a prospective, longitudinal; single-blind, two-arm randomised controlled trial to implement a pharmacist-led educational intervention on hypertension management among patients in Federal Medical Centre Lokoja, Kogi State. All the patients who met the eligibility criteria and gave their written consent to participate in the study were recruited into the study randomized in the intervention group (IG) and Control (CG). Data was collected using Hypertension Self Care Activity Level Effects (H-SCALE) questionnaire. The retrieved questionnaires were first coded into Microsoft Excel (2014) for cleaning of errors, after which the data was exported into the Statistical Product and Services Solutions (SPSS for windows, Version 16.0. SPSS Inc. 2007, Chicago, USA) software. Descriptive statistics such as frequencies, percentages and mean scores were used to summarise the data. All responses were first presented as frequencies and percentages. Chi-square was used to determine the correlation between socio-demographic and patients’ clinical characteristics. Independent sample t-test and paired sample t-test were used to compare differences between and within groups. Results: At baseline, more patients in the control group were adherent to their medications 16 (11.5) and had low salt diets 47 (33.8) than patients in the intervention group. However, more patients in the intervention group were non-smokers 127 (88.8) and engaged more in physical activity 38 (26.6) than patients in the control group. However, more of the patients in the control group were adherent to weight management practices 38 (27.3) than patients in the intervention group 36 (25.2), at baseline. All the patients in both study groups reported to have taken alcohol in the past seven days. It can be seen that, patients in the intervention group at endpoint, differed positively from the control group at baseline in adherence to medication, physical activity, reducing alcohol consumption and smoking cessation. It can also be observed that the baseline intervention group differed positively from the endpoint in medication adherence (t=-26.045, p<0.001); physical activity (t=-15.081, p<0.001); weight management practices (t=-5.479, p<0.0010, and alcohol consumption 9t=-11.550, p<0.001). Conclusion: A pharmacist led educational intervention had a positive impact on the self-management practices of hypertensive-diabetes patients

Addressing Resistance to Antibiotics in Pluralist Health Systems

There is growing international concern about the threat to public health of the emergence and spread of bacteria resistant to existing antibiotics. An effective response must invest in both the development of new drugs and measures to slow the emergence of resistance. This paper addresses the former. It focuses on low and middle-income countries with pluralistic health systems, where people obtain much of their antibiotics in unorganised markets. There is evidence that these markets have enabled people to treat many infections and reduce mortality. However, they also encourage overuse of antibiotics and behaviour likely to encourage the emergence of resistance. The paper reviews a number of strategies for improving the use of antibiotics. It concludes that effective strategies need measures to ensure easy access to antibiotics, as well as those aimed at influencing providers and users of these drugs to use them appropriately.Funding for work on this paper was provided by a grant by the UK ESRC to the STEPS Centre and a grant by the UK Department for International Development to the Future Health Systems Consortium

Obesity and associated factors in young adults attending tertiary institutions in south-eastern Nigeria

Objective: To assess prevalence of overweight/obesity and associated factors in a group of university undergraduates in south-east Nigeria.Design: Cross-sectional survey.Setting: Five tertiary institutions in south-east Nigeria.Methods: A total of 1610 undergraduates were selected using multistage sampling. A validated questionnaire on sociodemographic, dietary and lifestyle factors was used. Variables studied included body mass index (BMI), waist:hip ratio (WHR) and blood pressure (BP). Descriptive statistics and Chi square test were used for data analyses.Results: Prevalence of obesity and overweight were 6.5% [4.2% males; 8.4% females (p < 0.05)] and 13.4% [8.4% males; 17.7% females (p < 0.05)], respectively. A higher prevalence of central obesity and abdominal obesity was found in the females (15.7% and 27.2%, respectively) compared to the males (1.1% and 2.4%, respectively) (p < 0.05). Consumption of unhealthy snack foods (X2 = 13.39), being a female (X2 = 47.91), first year student (X2 = 41.82), and having high systolic (X2 = 88.18) and diastolic (X2 = 10.17) BP were associated with obesity (p < 0.05).Conclusions: Prevalence of obesity was high in the studied population and, if left unchecked, portends deleterious consequences, especially with respect to the development of cardiovascular diseases.Keywords: association, obesity, overweight, socio-demographic factors, young adult

Prevalence and pattern of psychoactive substance use among government secondary school students in central Nigeria

Introduction: psychoactive substances are chemicals that affect the nervous system and alter the activity in the brain. Such substances include alcohol and other illicit drugs. This research study aimed to determine the prevalence and pattern of psychoactive substance use among students at a government secondary school in Ilorin, Kwara State, Nigeria. Methods: this study adopts a cross-sectional descriptive survey design. A simple random sampling technique was used to select 104 students for an invitation to fill a semi-structured questionnaire after consenting to the informed consent. Correlational analyses were performed between social characteristics and the knowledge of the effects and prevalence of substance use. Results: thirty-three point seven percent (33.7) of students reported to use psychoactive substances, with alcohol and tramadol being the most consumed. Those aged 15-19 years were found to have a higher prevalence of substances use than other ages. There was an important knowledge of the social perspective and health effects of using such substances, but they persisted in their consumption. Age and school level were observed to have a statistically significant correlation with the knowledge of the effects of drug use. Conclusion: our study shows that the prevalence and pattern of psychoactive substance use among the students are high considering their level and age. The majority of the students knew about psychoactive substance use and its social and health effects. We, therefore, recommend a multi-stakeholder effort within the community to curtail drug use among young people

Socio-environmental determinants of parasitic intestinal infections among children: a cross-sectional study in Nigeria

Background: Intestinal parasitic infections are a major public health problem among school-aged children, especially those residing in rural areas. These infections predispose the children to several other health problems. This study assesses intestinal parasitic infections among school children in a rural area in Nigeria and their socioenvironmental determinants. Methods: This cross-sectional study included 250 primary school-age children from three randomly selected schools in Elemere, a poor rural area in Kwara State, Nigeria. A semi-structured questionnaire was used to record the socio-demographic data, and stool samples were microscopically examined for intestinal parasites. Results: The overall prevalence of intestinal parasites was 23.6% (59/250). Of the infected children, the most common parasite was Ascaris lumbricoides 50.8% (30/59), followed by Giardia lamblia 28.8% (17/59), Entamoeba spp.16.9% (10/59) and Dipylidium caninum in 3.4% (2/59). Rural domicile was associated with parasitic infections (P= 0.036) compared to a semi-urban or urban residence. Compared to younger age groups, children in the higher age groups had 64% (95% confidence interval,0.15–0.90;P= 0.03) lesser parasitic infections. Conclusion: Intestinal parasitic infections are common in school children in the studied area, and may be associated with unclean water sources, poor hygiene, and economic conditions. General health education should emphasize cleanliness, personal hygiene and sanitation to prevent and control parasitic intestinal infections among schoolchildren in these communities

Knowledge of cervical cancer, risk factors, and barriers to screening among reproductive women in Nigeria

Background: The leading cause of cancer-related fatalities among women worldwide is cervical cancer. Lack of awareness and availability of screening services in Nigeria contribute to the high incidence and fatality rates of cervical cancer. This study assesses the knowledge of cervical cancer, risk factors, and barriers to screening among reproductive women in Nigeria. Methods: A cross-sectional study was conducted among women of reproductive age in Shao, Moro local government area of Kwara State, Nigeria, to determine their knowledge about cervical cancer, risk factors, and barriers to screening. The data were collected using a structured questionnaire and analyzed using descriptive statistics and inferential statistics. Results: A total of 326 women between the ages of 15–50 were included in the study, with the majority being married (56.1%) and having secondary school education (43.6%). Two-hundred seventy-one (83.1%) participants were aware of cervical cancer, but only 39.0% had good knowledge of the disease. Two hundred forty-three (74.5%) women were sexually active and 70% did not use condoms during sexual activity. Only 6.9% of the participants had ever been screened for cervical cancer, with 38.0% being unaware of the screening. The results showed that there was a statistically significant (P<0.001) association between the knowledge of the respondents and selected risk factors for cervical cancer such as sexual activity, previous sexually transmitted infection diagnosis, contraceptive usage, and abnormal bleeding. Conclusion: This study indicates poor knowledge of cervical cancer and that targeted health education campaigns are required to increase awareness and knowledge about cervical cancer among reproductive women in Nigeria. Efforts should also be made to improve access to cervical cancer screening services, especially in rural and underserved area

Moral expansiveness around the world:The role of societal factors across 36 countries

International audienceWhat are the things that we think matter morally, and how do societal factors influence this? To date, research has explored several individual-level and historical factors that influence the size of our ‘moral circles.' There has, however, been less attention focused on which societal factors play a role. We present the first multi-national exploration of moral expansiveness—that is, the size of people’s moral circles across countries. We found low generalized trust, greater perceptions of a breakdown in the social fabric of society, and greater perceived economic inequality were associated with smaller moral circles. Generalized trust also helped explain the effects of perceived inequality on lower levels of moral inclusiveness. Other inequality indicators (i.e., Gini coefficients) were, however, unrelated to moral expansiveness. These findings suggest that societal factors, especially those associated with generalized trust, may influence the size of our moral circles

Factors Influencing the Use of Fertilizer in Arable Crop Production Among Smallholder Farmers In Owerri Agricultural Zone of Imo State

Abstract: The study evaluated the factors influencing the use of fertilizer in arable crop production among smallholder farmers in Owerri Agricultural Zone of Imo State. The objectives determined factors influencing the use of fertilizer in arable crop production among smallholder farmers, and determined socio-economic characteristics of smallholder arable crop production farmers in the study area. A multistage random sampling technique was adopted in selecting six Local Government Areas (LGAs), two community from each selected LGA, two villages from each selected communities and five farmers from each selected village. Data were collected with the aid of a well-structured questionnaire from one hundred and twelve farmers. Data were analyzed using frequency distribution, and logistic regression analysis. Results of the analysis showed that output of crop, level of education, farm size and price of fertilizer were important factors influencing farmers&apos; use of fertilizer in arable crop production while gender, age and household size were not. The result further showed that the average age of the farmers were 54.3years, 52.7% of them were males. The farmers spent about 8.5years in school and 20.6 years was their average farming experience. They have an average farm size of 1.3ha and household size of 7persons. The number of extension contact per month was twice. [Academia Arena 2010;2(6):90-96]

Factors Influencing the Use of Fertilizer in Arable Crop Production Among Smallholder Farmers In Owerri Agricultural Zone of Imo State

Abstract: The study evaluated the factors influencing the use of fertilizer in arable crop production among smallholder farmers in Owerri Agricultural Zone of Imo State. The objectives determined factors influencing the use of fertilizer in arable crop production among smallholder farmers, and determined socio-economic characteristics of smallholder arable crop production farmers in the study area. A multistage random sampling technique was adopted in selecting six Local Government Areas (LGAs), two community from each selected LGA, two villages from each selected communities and five farmers from each selected village. Data were collected with the aid of a wellstructured questionnaire from one hundred and twelve farmers. Data were analyzed using frequency distribution, and logistic regression analysis. Results of the analysis showed that output of crop, level of education, farm size and price of fertilizer were important factors influencing farmers&apos; use of fertilizer in arable crop production while gender, age and household size were not. The result further showed that the average age of the farmers were 54.3years, 52.7% of them were males. The farmers spent about 8.5years in school and 20.6 years was their average farming experience. They have an average farm size of 1.3ha and household size of 7persons. The number of extension contact per month was twice. [Academia Arena, 2010;2(9):41-49]