National Integration and Peaceful Co-Existence in Nigeria: The Role of Inter-Ethnic/Inter-Religious Marriages

It is no longer news that Nigeria as one united political and geographical entity has continued to experience inter-religious and inter-ethnic sentiments bickering, misunderstanding, mistrust which have constantly snowballed into crisis of tremendous proportion. As a result, many innocent lives and properties worth billions of naira have been lost. This ugly situation has continued to threaten the corporate existence of Nigeria and retrogressively affected the socioeconomic development of Nigeria. However, when there is no genuine effort to bring about genuine national integration, peaceful coexistence will definitely be a mirage. One of the factors or strategies identified as capable of fostering national integration and  guaranteeing peaceful co-existence is inter-ethnic, inter-religious and even inter-communal marriages among the people of different ethnic groups and adherents of different religions in Nigeria. This paper clarifies concepts in the write-up and also points out how intermarriages can foster peace and unity. It also recommends that traditional and religious leaders should be encouraged to inspire those they watch over to embrace this type of mixed marriage in order to achieve sustainable national development and most importantly promote peaceful coexistence among different ethnic groups in Nigeri

A systematic review of blockchain in healthcare : frameworks, prototypes, and implementations

Blockchain, a form of distributed ledger technology has attracted the interests of stakeholders across several sectors including healthcare. Its' potential in the multi-stakeholder operated sector like health has been responsible for several investments, studies, and implementations. Electronic Health Records (EHR) systems traditionally used for the exchange of health information amongst healthcare stakeholders have been criticised for centralising power, failures and attack-points with exchange data custodians. EHRs have struggled in the face of multi-stakeholder and system requirements while adhering to security, privacy, ethical and other regulatory constraints. Blockchain is promising amongst others to address the many EHR challenges, primarily trustless and secure exchange of health information amongst stakeholders. Many blockchain-in-healthcare frameworks have been proposed; some prototyped and/or implemented. This study leveraged the PRISMA framework to systematically search and evaluate the different models proposed; prototyped and/or implemented. The bibliometric and functional distribution of all 143 articles from this study were presented. This study evaluated 61 articles that discussed either prototypes or pilot or implementations. The technical and architectural analysis of these 61 articles for privacy, security, cost, and performance were detailed. Blockchain was found to solve the trust, security and privacy constraints of traditional EHRs often at significant performance, storage and cost trade-offs.peer-reviewe

Scaling up a decentralized offline patient ID generation and matching algorithm to accelerate universal health coverage : insights from a literature review and health facility survey in Nigeria

Background: Quality of health service delivery data remains sub-optimal in many Low and middle-income countries (LMICs) despite over a decade of progress in digitization and Health Management Information Systems (HMIS) improvements. Identifying everyone residing in a country utilizing universal civil registration and/or national unique identification number systems especially for vulnerable patients seeking care within the care continuum is an essential part of pursuing universal health coverage (UHC). Many different strategies or candidate digital technologies exist for uniquely identifying and tracking patients within a health system, and the different strategies also have their advantages and trade-offs. The recent approval of Decentralized identifier (DID) core specification by World Wide Web Consortium (W3C) heralds the search for consensus on standard interoperable DID methods.Objective: This paper aims to: (1) assess how candidate Patient Identification Systems fit the digital Patient ID desirable attributes framework in literature; and (2) use insights from Nigeria to propose the scale-up of an offline, interoperable decentralized Patient ID generation and a matching model for addressing network reliability challenges of centralized electronic registries in LMICs.Methods: We combined: (i) systematic review of the literature to identify the characteristics of leading candidates for Patient ID systems, with (ii) review of policies and (iii) quantitative survey of 14 general hospitals in Nigeria's Federal Capital Territory to understand the model(s) of patient ID strategies currently implemented by public hospitals.Results: Evidence from the literature review and quantitative survey showed that no current Patient ID strategy in Nigeria simultaneously meets the six attributes of uniqueness, unchanging, uncontroversial, inexpensive, ubiquitous, and uncomplicated required for ensuring the reliability of unique patient identification systems and of the HMIS more generally.Conclusions: The findings are used to propose a model of algorithms for universal-offline Patient ID generation and matching models that is cost effective and can be easily scaled-up throughout Nigeria. The prototype has promise for generating and validating a universally unique Patient ID given a set of patient characteristics without a central rigid authority. The model can also help to fast-track the implementation of a Master Patient Index (MPI) and interoperability of existing digital health platforms in LMICs.peer-reviewe

Empirical Relationship between Stock Exchange Transactions and Key Macroeconomic Variables in Nigeria

The study determined the influenced of some macroeconomic variables on the government stock, industrial/equities stock and total stock transactions in the Nigerian stock exchange market. Time series data were used in the study that covers the period 1970 to 2010. Unit root test (Augmented Dicker Fuller test) conducted on the data shows that some were stationary at levels and some were not. Double log multiple linear models were specify and estimated using ordinary least squares technique. The empirical results reveal that inflation; domestic savings, nominal exchange rate of N/$, value of total import and liberalization period are significant macroeconomic variables affecting the value of industrial/equities trading in the Nigerian stock exchange market. Also, external debt, nominal exchange rate, external reserves, and industrial capacity utilization rate are significant macroeconomic variables that affect the value of government stock transaction in the stock market. The study further reveals that the value of total stock transaction is significantly affected by inflation rate, domestic savings, oil revenues, and industrial capacity utilization rate. The result calls for a long term policy package that should focused on stabilization of real and monetary policy variables in the Nigerian economy. Also, institutional and operational reforms in the country's capital market are inevitable in a bit to increase the subsector's efficiency

Mobile health insurance system and associated costs : a cross-sectional survey of primary health centers in Abuja, Nigeria

Background: Nigeria contributes only 2% to the world’s population, accounts for 10% of the global maternal death burden. Health care at primary health centers, the lowest level of public health care, is far below optimal in quality and grossly inadequate in coverage. Private primary health facilities attempt to fill this gap but at additional costs to the client. More than 65% Nigerians still pay out of pocket for health services. Meanwhile, the use of mobile phones and related services has risen geometrically in recent years in Nigeria, and their adoption into health care is an enterprise worth exploring.Objective: The purpose of this study was to document costs associated with a mobile technology–supported, community-based health insurance scheme.Methods: This analytic cross-sectional survey used a hybrid of mixed methods stakeholder interviews coupled with prototype throw-away software development to gather data from 50 public primary health facilities and 50 private primary care centers in Abuja, Nigeria. Data gathered documents costs relevant for a reliable and sustainable mobile-supported health insurance system. Clients and health workers were interviewed using structured questionnaires on services provided and cost of those services. Trained interviewers conducted the structured interviews, and 1 client and 1 health worker were interviewed per health facility. Clinic expenditure was analyzed to include personnel, fixed equipment, medical consumables, and operation costs. Key informant interviews included a midmanagement staff of a health-management organization, an officer-level staff member of a mobile network operator, and a mobile money agent.Results: All the 200 respondents indicated willingness to use the proposed system. Differences in the cost of services between public and private facilities were analyzed at 95% confidence level (P<.001). This indicates that average out-of-pocket cost of services at private health care facilities is significantly higher than at public primary health care facilities. Key informant interviews with a health management organizations and a telecom operator revealed high investment interests. Cost documentation analysis of income versus expenditure for the major maternal and child health service areas—antenatal care, routine immunization, and birth attendance for 1 year—showed that primary health facilities would still profit if technology-supported, health insurance schemes were adopted.Conclusions: This study demonstrates a case for the implementation of enrolment, encounter management, treatment verification, claims management and reimbursement using mobile technology for health insurance in Abuja, Nigeria. Available data show that the introduction of an electronic job aid improved efficiency. Although it is difficult to make a concrete statement on profitability of this venture but the interest of the health maintenance organizations and telecom experts in this endeavor provides a positive lead.peer-reviewe

Standardizing primary health care referral data sets in Nigeria : practitioners' survey, form reviews, and profiling of Fast Healthcare Interoperability Resources (FHIR)

Background: Referral linkages are crucial for efficient functioning of primary health care (PHC) systems. Fast Healthcare Interoperability Resource (FHIR) is an open global standard that facilitates structuring of health information for coordinated exchange among stakeholders.Objective: The objective of this study is to design FHIR profiles and present methodology and the profiled FHIR resource for Maternal and Child Health referral use cases in Ebonyi state, Nigeria—a typical low- and middle-income country (LMIC) setting.Methods: Practicing doctors, midwives, and nurses were purposefully sampled and surveyed. Different referral forms were reviewed. The union of data sets from surveys and forms was aggregated and mapped to base patient FHIR resource elements, and extensions were created for data sets not in the core FHIR specification. This study also introduced FHIR and its relation to the World Health Organization’s (WHO’s) International Classification of Diseases.Results: We found many different data elements from the referral forms and survey responses even in urban settings. The resulting FHIR standard profile is published on GitHub for adaptation or adoption as necessary to aid alignment with WHO recommendations. Understanding data sets used in health care and clinical practice for information sharing is crucial in properly standardizing information sharing, particularly during the management of COVID-19 and other infectious diseases. Development organizations and governments can use this methodology and profile to fast-track FHIR standards adoption for paper and electronic information sharing at PHC systems in LMICs.Conclusions: We presented our methodology for profiling the referral resource crucial for the standardized exchange of new and expectant moms’ information. Using data from frontline providers and mapping to the FHIR profile helped contextualize the standardized profile.peer-reviewe

Electricity, computing hardware, and internet infrastructures in health facilities in Sierra Leone : field mapping study

Background: Years of health information system investment in many countries have facilitated service delivery, surveillance, reporting, and monitoring. Electricity, computing hardware, and internet networks are vital for health facility–based information systems. Availability of these infrastructures at health facilities is crucial for achieving national digital health visions.Objective: The aim of this study was to gain insight into the state of computing hardware, electricity, and connectivity infrastructure at health facilities in Sierra Leone using a representative sample.Methods: Stratified sampling of 72 (out of 1284) health facilities distributed in all districts of Sierra Leone was performed, factoring in the rural-urban divide, digital health activity, health facility type, and health facility ownership. Enumerators visited each health facility over a 2-week period.Results: Among the 72 surveyed health facilities, 59 (82%) do not have institutionally provided internet. Among the 15 Maternal and Child Health Posts, as a type of primary health care unit (PHU), 9 (60%) use solar energy as their only electricity source and the other 6 (40%) have no electricity source. Similarly, among the 13 hospitals, 5 (38%) use a generator as a primary electricity source. All hospitals have at least one functional computer, although only 7 of the 13 hospitals have four or more functional computers. Similarly, only 2 of the 59 (3%) PHUs have one computer each, and 37 (63%) of the PHUs have one tablet device each. We consider this health care computing infrastructure mapping to be representative with a 95% confidence level within an 11% margin of error. Two-thirds of the PHUs have only alternate solar electricity, only 10 of the 72 surveyed health facilities have functional official internet, and most use suboptimal computing hardware. Overall, 43% of the surveyed health facilities believe that inadequate electricity is the biggest threat to digitization. Similarly, 16 (22%) of the 72 respondents stated that device theft is a primary hindrance to digitization.Conclusions: Electricity provision for off-electricity-grid health facilities using alternative and renewable energy sources is emerging. The current trend where GSM (Global System for Mobile Communication) service providers provide the internet to all health facilities may change to other promising alternatives. This study provides evidence of the critical infrastructure gaps in health facilities in Sierra Leone.peer-reviewe

ECG abnormalities among HIV infected children placed on ART at Enugu, South East of Nigeria

Background: Cardiovascular abnormalities are not much reported among human immunodeficiency virus (HIV) infected children especially in Africa where there is high HIV disease. In addition, the use of highly active antiretroviral therapy (HAART) in such children may have a protective effect on the cardiovascular system. Methods: Cross-sectional study of randomly selected eighty HIV infected and 80 aged matched non- HIV-infected children were used. HIV-infected children were on HAART for more than 5years and had steadily received the treatment for 6 months prior to the time of the tests. Heights and weights were measured and body mass index calculated. Cardiac indices evaluated were heart rate (HR), PR interval, QRS duration, QT/QTC Interval, P/QRS/T Axis, RV5/SV1 voltage and RV5+SV1 voltage. Results: The average heart rate was significantly higher among HIV infected children on HAART than their non-infected counterparts (P= 0.019). At 0.05 significance level, their PR interval was significantly higher than those in the control group (P=0.050). The average QRS duration result also showed a significant difference between that of test and control subjects (P = 0.022) Conclusion: The HAART usage possibly improved the cardiovascular functioning in the infected children but the protective effects diminish with increase age and longer exposur

Digital health solutions and state of interoperability : landscape analysis of Sierra Leone

Background: The government and partners have invested heavily in the health information system (HIS) for service delivery, surveillance, reporting, and monitoring. Sierra Leone’s government launched its first digital health strategy in 2018. In 2019, a broader national innovation and digital strategy was launched. The health pillar direction will use big data and artificial intelligence (AI) to improve health care in general and maternal and child health in particular. Understanding the number, distribution, and interoperability of digital health solutions is crucial for successful implementation strategies.Objective: This paper presents the state of digital health solutions in Sierra Leone and how these solutions currently interoperate. This study further presents opportunities for big data and AI applications.Methods: All the district health management teams, all digital health implementing organizations, and a stratified sample of 72 (out of 1284) health facilities were purposefully selected from all health districts and surveyed.Results: The National Health Management Information System’s (NHMIS’s) aggregate reporting solution populated by health facility forms HF1 to HF9 was, by far, the most used tool. A health facility–based weekly aggregate electronic integrated disease surveillance and response solution was also widely used. Half of the health facilities had more than 2 digital health solutions in use. The different digital health software solutions do not share data among one another, though aggregate reporting data were sent as necessary. None of the respondents use any of the health care registries for patient, provider, health facility, or terminology identification.Conclusions: Many digital health solutions are currently used at health facilities in Sierra Leone. The government can leverage current investment in HIS from surveillance and reporting for using big data and AI for care. The vision of using big data for health care is achievable if stakeholders prioritize individualized and longitudinal patient data exchange using agreed use cases from national strategies. This study has shown evidence of distribution, types, and scale of digital health solutions in health facilities and opportunities for leveraging big data to fill critical gaps necessary to achieve the national digital health vision.peer-reviewe

Formative study of mobile phone use for family planning among young people in Sierra Leone : global systematic survey

Background: Teenage pregnancy remains high with low contraceptive prevalence among adolescents (aged 15-19 years) in Sierra Leone. Stakeholders leverage multiple strategies to address the challenge. Mobile technology is pervasive and presents an opportunity to reach young people with critical sexual reproductive health and family planning messages.Objective: The objectives of this research study are to understand how mobile health (mHealth) is used for family planning, understand phone use habits among young people in Sierra Leone, and recommend strategies for mobile-enabled dissemination of family planning information at scale.Methods: This formative research study was conducted using a systematic literature review and focus group discussions (FGDs). The literature survey assessed similar but existing interventions through a systematic search of 6 scholarly databases. Cross-sections of young people of both sexes and their support groups were engaged in 9 FGDs in an urban and a rural district in Sierra Leone. The FGD data were qualitatively analyzed using MAXQDA software (VERBI Software GmbH) to determine appropriate technology channels, content, and format for different user segments.Results: Our systematic search results were categorized using Grading of Recommended Assessment and Evaluation (GRADE) into communication channels, audiovisual messaging format, purpose of the intervention, and message direction. The majority of reviewed articles report on SMS-based interventions. At the same time, most intervention purposes are for awareness and as helpful resources. Our survey did not find documented use of custom mHealth apps for family planning information dissemination. From the FGDs, more young people in Sierra Leone own basic mobile phones than those that have feature capablilities or are smartphone. Young people with smartphones use them mostly for WhatsApp and Facebook. Young people widely subscribe to the social media–only internet bundle, with the cost ranging from 1000 leones (US $0.11) to 1500 leones (US$0.16) daily. Pupils in both districts top-up their voice call and SMS credit every day between 1000 leones (US $0.11) and 5000 leones (US$0.52).Conclusions: mHealth has facilitated family planning information dissemination for demand creation around the world. Despite the widespread use of social and new media, SMS is the scalable channel to reach literate and semiliterate young people. We have cataloged mHealth for contraceptive research to show SMS followed by call center as widely used channels. Jingles are popular for audiovisual message formats, mostly delivered as either push or pull only message directions (not both). Interactive voice response and automated calls are best suited to reach nonliterate young people at scale.peer-reviewe