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Background: Health worker training is an essential component of epidemic control; rapid delivery of such training is possible in low-middle income countries with digital platforms. Methods: Based on prior experience with the Ebola outbreak, we developed and deployed a bespoke InStrat COVID-19 tutorial app, to deliver accurate and regularly updated information about COVID-19 to frontline health workers and epidemic response officers across 25 states of Nigeria. The potential effectiveness of this app in training frontline health workers was assessed through online pre- and post-tests and a survey. Results: A total of 1051 health workers from 25 states across Nigeria undertook the e-learning on the InStrat COVID-19 training app. Of these, 627 (57%) completed both the pre- and post-tests in addition to completing the training modules. Overall, there were statistically significant differences between pre- and post-tests knowledge scores (54 increasing to 74). There were also differences in the subcategories of sex, region and cadre. There were higher post-test scores in males compared with females, younger versus older and southern compared with northern Nigeria. A total of 65 (50%) of the participants reported that the app increased their understanding of COVID-19, while 69 (53%) stated that they had applied the knowledge and skills learnt at work. Overall, the functionality and usability of the app were satisfactory. Conclusion: Capacity building for epidemic control using e-health applications is potentially effective, can be delivered at minimal cost and service disruption and can serve as a tool for capacity building in similar contexts.

Background: Increasing access to maternal and child health (MCH) services is crucial to achieving universal health coverage (UHC) among pregnant women and children under-five (CU5). The Nigerian government between 2012 and 2015 implemented an innovative MCH programme to reduce maternal and CU5 mortality by reducing financial barriers of access to essential health services. The study explores how the implementation of a financial incentive through conditional cash transfer (CCT) influenced the uptake of MCH services in the programme.Methods: The study used a descriptive exploratory approach in Anambra state, southeast Nigeria. Data was collected through qualitative [in-depth interviews (IDIs), focus group discussions (FGDs)] and quantitative (service utilization data pre- and post-programme) methods. Twenty-six IDIs were conducted with respondents who were purposively selected to include frontline health workers (n = 13), National and State policymakers and programme managers (n = 13). A total of sixteen FGDs were conducted with service users and their family members, village health workers, and ward development committee members from four rural communities. We drew majorly upon Skinner's reinforcement theory which focuses on human behavior in our interpretation of the influence of CCT in the uptake of MCH services. Manual content analysis was used in data analysis to pull together core themes running through the entire data set.Results: The CCTs contributed to increasing facility attendance and utilization of MCH services by reducing the financial barrier to accessing healthcare among pregnant women. However, there were unintended consequences of CCT which included a reduction in birth spacing intervals, and a reduction of trust in the health system when the CCT was suddenly withdrawn by the government.Conclusion: CCT improved the utilization of MCH, but the sudden withdrawal of the CCT led to the opposite effect because people were discouraged due to lack of trust in government to keep using the MCH services. Understanding the intended and unintended outcomes of CCT will help to build sustainable structures in policy designs to mitigate sudden programme withdrawal and its subsequent effects on target beneficiaries and the health system at large.

This study reports the synthesis of ZnO nanoparticles using the aqueous solution of broccoli extract. The nanoparticles, represented as broc-ZnO (with broccoli extract) and nb-ZnO (without broccoli extract), were obtained after calcination. The nanoparticles were characterized using X-ray diffraction (XRD), Transmission electron microscopy (TEM), Fourier Transform infra-red (FTIR), Energy dispersive spectroscopy (EDX), UV-visible spectroscopy (UV) and Photoluminescence (PL). Hexagonal phases were identified for both nanoparticles, while average crystallite sizes of 14 and 17 nm for broc-ZnO and nb-ZnO, respectively, were obtained. UV studies indicated the bandgap of the broc-ZnO and nb-ZnO as 4.09 and 3.87 eV, respectively. A plausible mechanism for the synthesis of the nanoparticles was suggested. The photocatalytic efficiency of broc-ZnO, obtained via the broccoli extract, was evaluated by studying its photo-enhanced catalytic activity against methylene blue (MB) and phenol red (PR), under UV light irradiation and 74% and 71% degradation efficiency of the successive dyes were achieved.

Probiotics and related preparations, including synbiotics and postbiotics, are living and non-living microbial-based multi-components, which are now among the most popular bioactive agents. Such interests mainly arise from the wide range and numerous beneficial effects of their use for various hosts. The current minireview article attempts to provide an overview and discuss in a holistic way the concepts, methodologies, action mechanisms, and applications of probiotic-based multi-components in human, animal, plant, soil, and environment health. Probiotic-based multi-component preparations refer to a mixture of bioactive agents, containing probiotics or postbiotics as main functional ingredients, and prebiotics, protectants, stabilizers, encapsulating agents, and other compounds as additional constituents. Analyzing, characterizing, and monitoring over time the traceability, performance, and stability of such multi-component ingredients require relevant and sensitive analytical tools and methodologies. Two innovative profiling and monitoring methods, the thermophysical fingerprinting thermogravimetry–differential scanning calorimetry technique (TGA-DSC) of the whole multi-component powder preparations, and the Advanced Testing for Genetic Composition (ATGC) strain analysis up to the subspecies level, are presented, illustrated, and discussed in this review to respond to those requirements. Finally, the paper deals with some selected applications of probiotic-based multi-components to human, animal, plant, soil and environment health, while mentioning their possible action mechanisms.

The continuous search for eco-friendly corrosion inhibitors due to differences in corrosive media remains an important point in corrosion control. The experimental studies on the corrosion inhibition of urea on mild steel in automotive gas oil (AGO) was conducted using gasometric techniques and scanning electron microscope (SEM). The theoretical approach on the density functional theory (DFT) on the urea molecule was carried out using Gaussian 09 software. The adsorption behavior of urea molecules on the surface of the mild steel was analyzed using Frumkin and Flory-Huggins adsorption isotherms models and Gibb’s free energy, respectively. The result of the experimental study shows a poor corrosion inhibitory effect of urea on mild steel in automobile gas oil (AGO) medium as the inhibition efficiency decreased from 69.30% in week 1 to 12% in week 11 at 200 ppm of inhibitor. The adsorption of urea on the mild steel surface obeys Frumkin’s adsorption isotherm model. Gibb’s free energy of adsorption of urea molecules onto mild steel surface revealed a physisorption mechanism. SEM results showed the non-inhibitive nature of urea on the studied mild steel. Quantum chemical parameters such as HOMO, LUMO, electron affinity, electronegativity, and the fraction of electrons transferred to the metal surface were calculated and interpreted to compare the experimental and theoretical results. The theoretical findings in the current investigation were not in agreement with the experimental result, thereby creating a need for further study using the electrochemical method.

This paper documents, and reflects on key strengths and weaknesses of, existing patient feedback management systems at primary health care in Bangladesh and proposes key implications for future policy and practice. A mixed-method study was conducted in two Upazila (sub-district) Health Complexes (UHC) within one district in Bangladesh. It reports qualitative data from thematic analysis of in-depth interviews ( n = 15) with key stakeholders; non-participant observations of feedback environment at UHCs; document review; and a stakeholder workshop. Patient feedback data from publicly available web portals were also analyzed. Multiple parallel patient feedback systems exist at health facilities. Key strengths across all systems included common goals of ensuring accountability and patient voice and high-level commitment. Common weaknesses included lack of documented processes, limited awareness of available channels among patients and a lack of documented actions following feedback. The findings helped to provide a few implications for future policy and practice on patient feedback management.

Background: Strengthening health systems to improve access to maternity services remains challenging for Nigeria due partly to weak and irregular in-service training and deficient data management. This paper reports the implementation of digital health tools for video training (VTR) of health workers and digitization of health data at scale, supported by satellite communications (SatCom) technology and existing 3G mobile networks.Objective: To understand whether, and under what circumstances using digital interventions to extend maternal, newborn and child health (MNCH) services to remote areas of Nigeria improved standards of healthcare delivery.Methods: From March 2017 to March 2019, VTR and data digitization interventions were delivered in 126 facilities across three states of Nigeria. Data collection combined documents review with 294 semi-structured interviews of stakeholders across four phases (baseline, midline, endline, and 12-months post-project closedown) to assess acceptability and impacts of digital interventions. Data was analyzed using a framework approach, drawing on a modified Technology Acceptance Model to identify factors that shaped technology adoption and use.Results: Analysis of documents and interview transcripts revealed that a supportive policy environment, and track record of private-public partnerships facilitated adoption of technology. The determinants of technology acceptance among health workers included ease of use, perceived usefulness, and prior familiarity with technology. Perceptions of impact suggested that at the micro (individual) level, repeated engagement with clinical videos increased staff knowledge, motivation and confidence to perform healthcare roles. At meso (organizational) level, better-trained staff felt supported and empowered to provide respectful healthcare and improved management of obstetric complications, triggering increased use of MNCH services. The macro level saw greater use of reliable and accurate data for policymaking.Conclusions: Simultaneous and sustained implementation of VTR and data digitization at scale enabled through SatCom and 3G mobile networks are feasible approaches for supporting improvements in staff confidence and motivation and reported MNCH practices. By identifying mechanisms of impact of digital interventions on micro, meso, and macro levels of the health system, the study extends the evidence base for effectiveness of digital health and theoretical underpinnings to guide further technology use for improving MNCH services in low resource settings.Trial Registration: ISRCTN32105372.

Abstract Molecularly imprinted polymers (MIPs) have been widely used for the modification of electrodes because of their native specificity for the intrinsic template molecules. The importance of catecholamines in the neurological and general well‐being of every individual cannot be overemphasized. Disorders associated with the imbalance in catecholamine levels can be diagnosed with electrochemical sensors capable of their determination in the presence of other biological interferents in extracellular fluids. MIPs based sensors have been designed for selective and simultaneous determination of these catecholamines in the past decade. Efforts in this regard and details on the components and preparation of these MIPs were presented in this review.

Mobile health (mhealth) tools delivered through wireless technology are emerging as effective strategies for delivering quality training, ensuring rapid clinical decision making, and monitoring implementation of simple and effective interventions in under-resourced settings. We share our early experience of developing and deploying the InStrat COVID-19 health worker training application (App) in Ogun State, Western Nigeria where the country's first COVID-19 case was reported. This App was designed to directly provide frontline health workers with accurate and up-to-date information about COVID-19; enable them to quickly identify, screen and manage COVID-19 suspects; provide guidance on specimen collection techniques and safety measures to observe within wards and quarantine centers dealing with COVID-19. The App was deployed in 271 primary health care facilities in Ogun state and a total of 311 health workers were trained to use it. Of the 123 health workers who completed knowledge pre- and post-tests, their average test score improved from 47.5 (±9.4) to 73.1(±10.0) %, P < 0.0001 after using the tutorial. Rapid adoption and uptake were driven largely by public-private sector involvement as well as certification of health workers with reported satisfaction levels of over 95% among those who completed pre- and post-test surveys. Challenges encountered included a lack of universal availability of android phones for frontline health workers, lack of internet access in remote areas and a need to incentivize the workers. The timely deployment of this App targeting primary health care workers, mostly in hard-to-reach areas, obviated the need for conventional didactic training with potential of savings in training costs and time and could be applied to similar contexts.

Background Well-functioning patient feedback systems can contribute to improved quality of healthcare and systems accountability. We used realist evaluation to examine patient feedback systems at health facilities in Bangladesh, informed by theories of citizenship and principal–agent relationships.Methods We collected and analysed data in two stages, using: document review; secondary analysis of data from publicly available web-portals; in-depth interviews with patients, health workers and managers; non-participant observations of feedback environments; and stakeholder workshops. Stage 1 focused on identifying and articulating the initial programme theory (PT) of patient feedback systems. In stage 2, we iteratively tested and refined this initial theory, through analysing data and grounding emerging findings within substantive theories and empirical literature, to arrive at a refined PT.Results Multiple patient feedback systems operate in Bangladesh, essentially comprising stages of collection, analysis and actions on feedback. Key contextual enablers include political commitment to accountability, whereas key constraints include limited patient awareness of feedback channels, lack of guidelines and documented processes, local political dynamics and priorities, institutional hierarchies and accountability relationships. Findings highlight that relational trust may be important for many people to exercise citizenship and providing feedback, and that appropriate policy and regulatory frameworks with clear lines of accountability are critical for ensuring effective patient feedback management within frontline healthcare facilities.Conclusion Theories of citizenship and principal–agent relationships can help understand how feedback systems work through spotlighting the citizenship identity and agency, shared or competing interests, and information asymmetries. We extend the understanding of these theories by highlighting how patients, health workers and managers act as both principals and agents, and how information asymmetry and possible agency loss can be addressed. We highlight the importance of awareness raising and non-threatening environment to provide feedback, adequate support to staff to document and analyse feedback and timely actions on the information.

ObjectivesTo review and synthesize the existing evidence on bereavement care, within the United Kingdom (UK), for ethnic minority communities in terms of barriers and facilitators to access; models of care; outcomes from, and satisfaction with, service provision.DesignA systematic review adopting a framework synthesis approach was conducted. An electronic search of the literature was undertaken in MEDLINE, Embase, PsycINFO, Social Work Abstract and CINAHL via EBSCO, Global Health, Cochrane library, the Trip database and ProQuest between 1995 and 2020. Search terms included bereavement care, ethnic minority populations and the UK setting.ResultsFrom 3,185 initial records, following screening for eligibility, and full-text review of 164 articles, seven studies were identified. There was no research literature outlining the role of family, friends and existing networks; and a real absence of evidence about outcomes and levels of satisfaction for those from an ethnic minority background who receive bereavement care. From the limited literature, the overarching theme for barriers to bereavement care was 'unfamiliarity and irregularities'. Four identified subthemes were 'lack of awareness'; 'variability in support'; 'type and format of support'; and 'culturally specific beliefs'. The overarching theme for facilitators for bereavement care was 'accessibility' with the two subthemes being 'readily available information' and 'inclusive approaches'. Three studies reported on examples of different models of care provision.ConclusionsThis review reveals a stark lack of evidence about bereavement care for ethnic minority populations. In particular, understanding more about the role of family, friends and existing support systems, alongside outcomes and satisfaction will begin to develop the evidence base underpinning current provision. Direct user-representation through proactive engagement and co-design approaches may begin to determine the most appropriate models and format of bereavement care for ethnic minority communities to inform service design and delivery.

This study explored macro, meso and micro-level influences on the role of evidence in the development of six health policies in India and Nigeria. Macro-level influences included adoption of international agreements, movement towards evidence-informed policymaking, committed country leadership and resource environment. At meso level, national actors drove policy processes with support from the international actors. Micro-level influences included individual values, interests and evidence preferences. Factors at three levels are interrelated. Greater understanding of contextual influences can provide a platform for adapting to, or managing, these influences to improve the evidence-informed nature of health policymaking.

Background: Incidence and mortality from cervical cancer have remained high due to many obstacles facing the implementation of organized screening programs in resource-constrained countries such as Nigeria. The application of mobile technologies (mHealth) to health services delivery has the potential to reduce inequalities, empower patients to control their health, and improve the cost-effectiveness of health care delivery. Aim: To assess the efficacy of mobile technology intervention on Pap test screening adherence compared to a control condition and also determine the factors affecting the uptake of Pap smear screening practices among women in Lagos. Methods: This is a multi-center randomized controlled trial that will involve women aged 25 to 65 years attending the General Outpatient clinics of the two tertiary health institutions in Lagos, Nigeria between April and December 2020. At baseline, a total of 200 National Health Insurance Scheme (NHIS) enrollees will be randomized to either a text message arm or usual care (control) arm. The primary outcome is the completion of a Pap smear within 6 months of enrolment in the study. The associations between any two groups of continuous variables will be tested using the independent sample t-test (normal distribution) or the Mann-Whitney U test (skewed data) and that of two groups of categorical variables with Chi-square X 2 or Fisher's exact test where appropriate. Using binary logistic regression model, we will adjust for age and other relevant sociodemographic and clinical variables and adherence to Pap test screening. Statistical significance will be defined as P-value less than 0.05. Discussion: The mHealth-Cervix study will evaluate the impact of mobile technologies on cervical cancer screening practices in Lagos, Nigeria as a way of contributing to the reduction in the wide disparities in cervical cancer incidence through early detection facilitated using health promotion to improve Pap smear screening adherence. Registration: PACTR202002753354517 13/02/2020