Does Sterilization Policy Exert an Upward Pressure on Interest Rate as Dictated by Theory? A Nigerian Example

The implications of capital inflows on the economy and the fall out of the policy geared towards addressing these phenomena, especially the impact of the policy on interest rate motivated us in this study. Under the framework of ARDL and using monthly series over a period of 2010M1-2021M3, our findings showed that in the short-run, sterilization policy leads to rising interest rate in the current period. However, after a lag, sterilization policy depresses interest rate. We equally found that in the long-run, sterilization policy pushes interest rate up. In another direction, we observed a negative relationship between money supply and interest rate both in the short-run and in the long-run and the exogenous variables in the model influence interest rate significantly. We therefore recommend that different measures should be adopted to cushion the effect of unsustainable capital inflows to avoid repeated need for further sterilization and the increasing cost of sterilization in the long-run. It is also our advice that exogenous variables should be factored in when fashioning out a desirable interest rate in line with economic reality

Grand Challenges in global eye health: a global prioritisation process using Delphi method

Background We undertook a Grand Challenges in Global Eye Health prioritisation exercise to identify the key issues that must be addressed to improve eye health in the context of an ageing population, to eliminate persistent inequities in health-care access, and to mitigate widespread resource limitations. Methods Drawing on methods used in previous Grand Challenges studies, we used a multi-step recruitment strategy to assemble a diverse panel of individuals from a range of disciplines relevant to global eye health from all regions globally to participate in a three-round, online, Delphi-like, prioritisation process to nominate and rank challenges in global eye health. Through this process, we developed both global and regional priority lists. Findings Between Sept 1 and Dec 12, 2019, 470 individuals complete round 1 of the process, of whom 336 completed all three rounds (round 2 between Feb 26 and March 18, 2020, and round 3 between April 2 and April 25, 2020) 156 (46%) of 336 were women, 180 (54%) were men. The proportion of participants who worked in each region ranged from 104 (31%) in sub-Saharan Africa to 21 (6%) in central Europe, eastern Europe, and in central Asia. Of 85 unique challenges identified after round 1, 16 challenges were prioritised at the global level; six focused on detection and treatment of conditions (cataract, refractive error, glaucoma, diabetic retinopathy, services for children and screening for early detection), two focused on addressing shortages in human resource capacity, five on other health service and policy factors (including strengthening policies, integration, health information systems, and budget allocation), and three on improving access to care and promoting equity. Interpretation This list of Grand Challenges serves as a starting point for immediate action by funders to guide investment in research and innovation in eye health. It challenges researchers, clinicians, and policy makers to build collaborations to address specific challenge

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

FINANCING ENERGY DEVELOPMENT IN NIGERIA: Analysis of Impact on the Electricity Sector

ABSTRACT Funding provisions by policy makers are usually for two main purposes including poverty and inequalit

Awareness of health effects of exposure to secondhand smoke from cigarettes: A cross-sectional study of never-smoked adult primary care patients in Eastern Nigeria

Background: Cigarette smoking whether actively or passively is a growing public health problem. Despite the wealth of information on the hazards of active cigarette smoking, awareness of the health effects of passive smoking on human population is often neglected in Nigeria. Aim: The study was aimed at describing the awareness of health effects of exposure to secondhand smoke from cigarettes among never-smoked adult primary care patients in Eastern Nigeria. Materials and Methods: A hospital-based study carried out on a cross-section of 500 adult patients in a primary care clinic in Nigeria. Data were collected using pretested, structured, and interviewer-administered questionnaire. Exposure to secondhand smoke was defined as exposure to cigarette smoke in a never-smoked adult patient in the previous 1 year. Data were analyzed using Statistical Package for Social Sciences version 21 for the calculation of percentages for categorical variables. Bivariate analysis involving Chi-square test was used to test for significance of association between categorical variables at P < 0.05. Results: The age of the respondents ranged from 18 to 74 years, with a mean age of 36 ± 12.4 years. There were 180 (36.0%) males with 320 (64%) females, with a sex ratio of 1.8. Awareness of general health effects of secondhand smoke on adults, children, and pregnant women was 95.6%, 92.8%, and 65.2%, respectively. The most common specific health effects the respondents were aware for adults, children, and obstetric population were lung cancer (95.6%), precipitation of asthmatic condition (92.8%), and delivery of small babies (65.2%), respectively. The predominant source of awareness of information was radio (93.6%). Awareness of general health effects of exposure to secondhand smoke on adults (P = 0.041), children (P = 0.031), and obstetrics population (P = 0.02) was significantly associated with exposure status. Conclusion: The most common health effects of secondhand smoke the respondents had highest awareness were lung cancer, precipitation of asthmatic attacks, and delivery of small babies in adults, children, and obstetric population, respectively. Awareness of general health effects on adults, children, and obstetrics population was significantly associated with exposure status. The current level of awareness should be improved while effort should be intensified to address identified areas of low level of awareness

Hypoglycemia in a resource-poor Nigerian environment: A cross-sectional study of knowledge of symptoms, causes, and self-management practices among ambulatory type 2 diabetic patients in South-East Nigeria

Background: Hypoglycemic emergencies are potentially life-threatening complication of diabetes management that predisposes the patients to higher risk of disability and premature death. As the impetus for the prevention of diabetes-related hypoglycemic endpoints grows, emphasis should also be focused on patients' knowledge of symptoms, causes, and self-management practices for hypoglycemia. Aim: The study was aimed at describing the knowledge of symptoms, causes, and self-management practices for hypoglycemia among ambulatory type 2 diabetic patients in Eastern Nigeria. Materials and Methods: A cross-sectional descriptive study was carried out on 145 type 2 diabetic Nigerians at a primary care clinic in Eastern Nigeria. Data on knowledge of symptoms, causes, and self-management practices for hypoglycemia were collected using pretested, structured, and researcher-administered questionnaire. Results: The age of the type 2 diabetic patients ranged from 32 to 78 years with mean age of 44 ± 10.2 years. There were 59 (40.7%) male and 86 (59.3%) female. Thirty-six (24.8%), 22.8%, and 29.0% had adequate knowledge of symptoms, causes, and self-management practices for hypoglycemia with the most common symptom, cause, and self-management practice being dizziness (69.7%), overdose of antidiabetic medications (91.0%), and taking drink containing glucose (67.6%), respectively. Educational level was significantly associated with adequate knowledge of symptoms (P = 0.039), causes (P = 0.02), and self-management practices (P = 0.016) for hypoglycemia. Conclusion: Knowledge of causes, symptoms, and self-management practices for hypoglycemia was inadequate. The most common symptom, cause, and self-management practice for hypoglycemia were dizziness, overdose of medications, and taking of drink containing glucose, respectively. Adequate knowledge of causes, symptoms, and self-management practices for hypoglycemia was associated with educational level. There is a need for hypoglycemic-oriented diabetes education, especially in resource-poor environment

RISING EXTERNAL DEBT AND EXCHANGE RATE: EMPIRICAL EVIDENCE FROM NIGERIA

The fluctuating exchange rate and massive debt burden of Nigeria necessitates a thorough investigation of trends in her foreign debt levels, its underlying causes, and implications for economic growth. This study, therefore, investigated the impact of rising external debt on the exchange rate in Nigeria with annual data from 1980 to 2021. The motivation for this study was premised on inculcating government spending and inflation rate into the traditional analysis of exchange rate volatility in Nigeria using data sourced from CBN statistical bulletin (2020), DMO (2020), and WDI (2021). The data obtained were analyzed using the Augmented Dickey-Fuller (ADF) unit root test, Autoregressive Distributed Lag (ARDL) technique, and the stability and diagnostic test in the analysis. Based on the outcomes of the preliminary test analysis, the results show that external debt has a negative but insignificant effect on the exchange rate in Nigeria.&nbsp; Also, external debt has a positive and significant effect on the inflation rate in Nigeria. In light of these findings, the study concluded and recommended that the Nigerian government and/ or Central Bank of Nigeria should ensure that all borrowed funds are effectively channelled into viable projects that will yield returns to service the debts as well as pay up the debt at maturity, which puts pressure on the foreign exchange market in the short term and consequently results in exchange rate fluctuations in terms of the depreciation of the naira in the country. Keywords: External debt stock, Debt service payment, Inflation rate, Exchange rate, Nigeria. JEL Classifications:&nbsp;E31, 34, 43, F31

Should all Status 1A patients be prioritized over high MELD patients? Concept of Risk Stratification in Extremely Ill Liver Transplant Recipients

BACKGROUND: Status 1A patients are prioritized over liver disease patients regardless of model for end-stage liver disease (MELD) score. We aimed to identify groups with high waitlist mortality in Status 1A and MELD\u3e/=40 patients to determine who would most benefit from transplantation. METHODS: Data on patients listed as Status 1A (n=4447) and MELD\u3e/=40 (n=3663) over 15 years (2002 to 2017) obtained from UNOS/OPTN registry. They were divided into two; derivation and validation groups. Risk factors associated with 28-day waitlist mortality were identified in derivation group and provided risk scores to divide patients into risk groups. Score system was applied to validation group to check its applicability. RESULTS: Risk factors for waitlist mortality in Status 1A included life support, performance status, severe coagulopathy, severe hypo or hypernatremia, and grade 3-4 encephalopathy. Risk factors in MELD\u3e/=40 included higher MELD scores (\u3e/=45), age, sex, race, life support, and encephalopathy. On comparing 7-day and 28-day mortality, both were higher in Status 1A and MELD\u3e/=40 high-risk groups compared to low-risk groups in the derivation group (p\u3c0.001). Probability of transplantation was lowest for high-risk MELD\u3e/=40 patients compared to all other groups (p\u3c0.001). These findings were reproduced in the validation set. Our proposed risk stratification system also showed acceptable 1 year graft and patient survival in high-risk groups. CONCLUSIONS: Our risk scoring system for extremely ill liver transplant candidates successfully stratified risk of waitlist mortality. Waitlist outcomes might be improved by modifications involving categorization of patients based on presence/absence of risk factors

Liver transplant patients with MELD\u3e50 at listing have poor waitlist outcomes and similar post transplant survival to status 1a patients

Background: Allocation of liver allografts is prioritized to Status 1A patients over end-stage liver disease patients. We aimed to analyze waitlist and transplant outcomes of Status 1A and extremely ill patients with MELD\u3e40 patients. Methods: Using United Network for Organ Sharing registry data, we retrospectively evaluated LT waitlist mortality, probability of LT and survival after LT between adults in the United States with Status 1A or ESLD with MELD \u3e40 listed for LT from July 1st 2013 to March 31st 2017. Competing waitlist outcomes such as death, transplant and removal from list were evaluated using Gray test. Transplant outcomes were analyzed using Kaplan-Meier method and log rank test. Results: During this time period, 611 patients were listed as Status 1A, 1140 were listed with a MELD between 40 to 50 and 62 with MELD\u3e50. Probability of transplant within 7 days was highest in Status 1A compared to MELD 40-50 and MELD\u3e50 (71.0% Vs 55.1% & 54.1%, p\u3c0.001). Death on waitlist within 7 days was highest in MELD\u3e50 compared to MELD 40-50 and Status 1A (22.9% Vs 13.8% & 16.4%, p=0.035). Probability of removal from waitlist within 7 days due to recovery was highest in Status 1A compared to MELD 40-50 and MELD\u3e50 (6.9% Vs 0.1% & 0%, p\u3c0.001). After transplant, no instantaneous 1 year risk of graft loss was observed between MELD\u3e50 and Status 1A (HR 1.8, CI 0.82-4.00, p=0.14) as well as MELD 40-50 and Status 1A (HR 1.07, CI 0.75-1.52, p=0.71). Instantaneous 1 year mortality showed a similar finding (HR 1.82, CI 0.77-4.3, p=0.16 & HR 1.13, CI 0.77-1.65, p=0.53). Conclusion: MELD\u3e50 have higher probability of death within 7 days on waitlist and similar graft and patient survival compared to MELD 40-50 and Status 1A patients. Hence MELD\u3e50 may be considered ahead of Status 1A in the allocation of liver grafts