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Abugu JO, Chukwu AM, Onyeso OK, Alumona CJ, Adandom II, Chukwu OAD, Awosoga OA. Determinants of the managerial staff's disposition towards e-payment platforms in public tertiary hospitals in Enugu, Nigeria: a cross-sectional study. BMC Health Serv Res 2023; 23:1240. [PMID: 37951924 PMCID: PMC10638801 DOI: 10.1186/s12913-023-10302-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/08/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Many Nigerians pay out-of-pocket for their health care, and some hospitals have started utilising e-payment systems to increase transactional efficiency. The study investigated the type and usage of e-payment platforms in public hospitals and the factors that may influence the managerial staff's disposition towards using the e-payment system. METHODS We conducted a cross-sectional survey of 300 managerial staff within the four public tertiary hospitals in Enugu, Nigeria, through proportionate quota sampling. The survey obtained participants' demographic characteristics, types of e-payment platforms, managerial staff's technophobia, perception of credibility, and disposition towards e-payment. Data were analysed using descriptive statistics, Spearman correlation, and hierarchical linear regression. RESULTS The majority of the respondents (n = 278, 92.7% completion rate) aged 43.4 ± 7.6 years were females (59.0%) with a bachelor's degree (54.7%). Their disposition (80.0%±17.9%), perceptions of the usefulness (85.7 ± 13.9%), and user-friendliness (80.5 ± 18.1%) of e-payment in the hospital were positive, credibility (72.6 ± 20.1%) and technophobia (68.0 ± 20.7%) were moderate. There was a negative correlation between technophobia and disposition toward the use of e-payment (ρ = -0.50, P < 0.001). Significant multivariate predictors of managerial disposition towards e-payment were; being a woman (β = 0.12, P = 0.033), married (β = 0.18, P = 0.003), positive perception of usefulness (β = 0.14, P = 0.025), and credibility (β = 0.15, P = 0.032). CONCLUSION Most participants had a positive disposition towards e-payment in public hospitals. However, managers with technophobia, a negative perception of e-payment usefulness, and credibility had a lesser disposition to its use. To ensure the universal implementation of e-payment in Nigerian hospitals, the service providers should make the e-payment platforms more secure and user-friendly to health services consumers and providers.
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Affiliation(s)
- James Okechukwu Abugu
- Department of Marketing, Faculty of Business Administration, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Amaechi Marcellus Chukwu
- Department of Marketing, Faculty of Business Administration, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Ogochukwu Kelechi Onyeso
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB, Canada
| | - Chiedozie James Alumona
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria.
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB, Canada.
| | | | - Ogo-Amaechi D Chukwu
- Department of Computer Science, Faculty of Physical Sciences, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
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Manyazewal T, Ali MK, Kebede T, Magee MJ, Getinet T, Patel SA, Hailemariam D, Escoffery C, Woldeamanuel Y, Makonnen N, Solomon S, Amogne W, Marconi VC, Fekadu A. Mapping digital health ecosystems in Africa in the context of endemic infectious and non-communicable diseases. NPJ Digit Med 2023; 6:97. [PMID: 37237022 PMCID: PMC10213589 DOI: 10.1038/s41746-023-00839-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
Investments in digital health technologies such as artificial intelligence, wearable devices, and telemedicine may support Africa achieve United Nations (UN) Sustainable Development Goal for Health by 2030. We aimed to characterize and map digital health ecosystems of all 54 countries in Africa in the context of endemic infectious and non-communicable diseases (ID and NCD). We performed a cross-national ecological analysis of digital health ecosystems using 20-year data from the World Bank, UN Economic Commission for Africa, World Health Organization, and Joint UN Programme on HIV/AIDS. Spearman's rank correlation coefficients were used to characterize ecological correlations between exposure (technology characteristics) and outcome (IDs and NCDs incidence/mortality) variables. Weighted linear combination model was used as the decision rule, combining disease burden, technology access, and economy, to explain, rank, and map digital health ecosystems of a given country. The perspective of our analysis was to support government decision-making. The 20-year trend showed that technology characteristics have been steadily growing in Africa, including internet access, mobile cellular and fixed broadband subscriptions, high-technology manufacturing, GDP per capita, and adult literacy, while many countries have been overwhelmed by a double burden of IDs and NCDs. Inverse correlations exist between technology characteristics and ID burdens, such as fixed broadband subscription and incidence of tuberculosis and malaria, or GDP per capita and incidence of tuberculosis and malaria. Based on our models, countries that should prioritize digital health investments were South Africa, Nigeria, and Tanzania for HIV; Nigeria, South Africa, and Democratic Republic of the Congo (DROC) for tuberculosis; DROC, Nigeria, and Uganda for malaria; and Egypt, Nigeria, and Ethiopia for endemic NCDs including diabetes, cardiovascular disease, respiratory diseases, and malignancies. Countries such as Kenya, Ethiopia, Zambia, Zimbabwe, Angola, and Mozambique were also highly affected by endemic IDs. By mapping digital health ecosystems in Africa, this study provides strategic guidance about where governments should prioritize digital health technology investments that require preliminary analysis of country-specific contexts to bring about sustainable health and economic returns. Building digital infrastructure should be a key part of economic development programs in countries with high disease burdens to ensure more equitable health outcomes. Though infrastructure developments alongside digital health technologies are the responsibility of governments, global health initiatives can cultivate digital health interventions substantially by bridging knowledge and investment gaps, both through technology transfer for local production and negotiation of prices for large-scale deployment of the most impactful digital health technologies.
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Affiliation(s)
- Tsegahun Manyazewal
- Addis Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia.
| | - Mohammed K Ali
- Emory University, Rollins School of Public Health, Hubert Department of Global Health, Atlanta, GA, USA
- Emory University, School of Medicine, Department of Family and Preventive Medicine, Atlanta, GA, USA
| | - Tedla Kebede
- Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
| | - Matthew J Magee
- Emory University, Rollins School of Public Health, Hubert Department of Global Health, Atlanta, GA, USA
| | - Tewodros Getinet
- St. Paul's Hospital Millennium Medical College, School of Public Health, Addis Ababa, Ethiopia
| | - Shivani A Patel
- Emory University, Rollins School of Public Health, Hubert Department of Global Health, Atlanta, GA, USA
| | - Damen Hailemariam
- Addis Ababa University, College of Health Sciences, School of Public Health, Addis Ababa, Ethiopia
| | - Cam Escoffery
- Emory University, Rollins School of Public Health, Department of Behavioral, Social, and Health Education Sciences, Atlanta, GA, USA
| | - Yimtubezinash Woldeamanuel
- Addis Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia
| | - Nardos Makonnen
- University of Virginia, School of Medicine, Department of Emergency Medicine, Charlottesville, VA, USA
| | - Samrawit Solomon
- St. Paul's Hospital Millennium Medical College, School of Public Health, Addis Ababa, Ethiopia
| | - Wondwossen Amogne
- Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | - Vincent C Marconi
- Emory University School of Medicine and Rollins School of Public Health, Atlanta, GA, USA
| | - Abebaw Fekadu
- Addis Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia
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Ordóñez CE, Marconi VC, Manderson L. Addressing coloniality of power to improve HIV care in South Africa and other LMIC. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1116813. [PMID: 37064826 PMCID: PMC10090665 DOI: 10.3389/frph.2023.1116813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/24/2023] [Indexed: 03/31/2023] Open
Abstract
We describe the appropriateness and potential for effectiveness of three strategic approaches for improving HIV care in South Africa: community-based primary healthcare, local/community-based stakeholder engagement, and community-engaged research. At their core, these approaches are related to overcoming health inequity and inequality resulting from coloniality of power's heterogenous structural processes impacting health care in many low- and middle-income countries (LMIC). We turn to South Africa, a middle-income country, as an example. There the HIV epidemic began in the 1980s and its ending is as elusive as achieving universal healthcare. Despite impressive achievements such as the antiretroviral treatment program (the largest in the world) and the country's outstanding cadre of HIV experts, healthcare workers and leaders, disadvantaged South Africans continue to experience disproportionate rates of HIV transmission. Innovation in global public health must prioritize overcoming the coloniality of power in LMIC, effected through the imposition of development and healthcare models conceived in high-income countries (HIC) and insufficient investment to address social determinants of health. We advocate for a paradigm shift in global health structures and financing to effectively respond to the HIV pandemic in LMIC. We propose ethically responsive, local/community-based stakeholder engagement as a key conceptual approach and strategy to improve HIV care in South Africa and elsewhere. We join in solidarity with local/community-based stakeholders' longstanding efforts and call upon others to change the current status quo characterized by global public health power concentrated in HIC.
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Affiliation(s)
- Claudia E. Ordóñez
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
- Correspondence: Claudia E. Ordóñez
| | - Vincent C. Marconi
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
- School of Medicine, Emory University, Atlanta, GA, United States
| | - Lenore Manderson
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Montano MA. Emerging Life Sciences Series: Q&A with the Editor. Adv Biol (Weinh) 2023; 7:e2200328. [PMID: 36653962 DOI: 10.1002/adbi.202200328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 11/23/2022] [Indexed: 01/20/2023]
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Liu C, Wang Z, Hui Q, Chiang Y, Chen J, Brijkumar J, Edwards JA, Ordonez CE, Dudgeon MR, Sunpath H, Pillay S, Moodley P, Kuritzkes DR, Moosa MYS, Jones DP, Marconi VC, Sun YV. Crosstalk between Host Genome and Metabolome among People with HIV in South Africa. Metabolites 2022; 12:metabo12070624. [PMID: 35888748 PMCID: PMC9316179 DOI: 10.3390/metabo12070624] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/16/2022] [Accepted: 07/01/2022] [Indexed: 02/01/2023] Open
Abstract
Genome-wide association studies (GWAS) of circulating metabolites have revealed the role of genetic regulation on the human metabolome. Most previous investigations focused on European ancestry, and few studies have been conducted among populations of African descent living in Africa, where the infectious disease burden is high (e.g., human immunodeficiency virus (HIV)). It is important to understand the genetic associations of the metabolome in diverse at-risk populations including people with HIV (PWH) living in Africa. After a thorough literature review, the reported significant gene−metabolite associations were tested among 490 PWH in South Africa. Linear regression was used to test associations between the candidate metabolites and genetic variants. GWAS of 154 plasma metabolites were performed to identify novel genetic associations. Among the 29 gene−metabolite associations identified in the literature, we replicated 10 in South Africans with HIV. The UGT1A cluster was associated with plasma levels of biliverdin and bilirubin; SLC16A9 and CPS1 were associated with carnitine and creatine, respectively. We also identified 22 genetic associations with metabolites using a genome-wide significance threshold (p-value < 5 × 10−8). In a GWAS of plasma metabolites in South African PWH, we replicated reported genetic associations across ancestries, and identified novel genetic associations using a metabolomics approach.
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Affiliation(s)
- Chang Liu
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; (C.L.); (Q.H.); (Y.C.); (J.C.)
| | - Zicheng Wang
- College of Arts and Sciences, Emory University, Atlanta, GA 30322, USA;
| | - Qin Hui
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; (C.L.); (Q.H.); (Y.C.); (J.C.)
| | - Yiyun Chiang
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; (C.L.); (Q.H.); (Y.C.); (J.C.)
| | - Junyu Chen
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; (C.L.); (Q.H.); (Y.C.); (J.C.)
| | - Jaysingh Brijkumar
- Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban 4041, South Africa; (J.B.); (H.S.); (S.P.); (M.Y.S.M.)
| | - Johnathan A. Edwards
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA;
- School of Medicine, Emory University, Atlanta, GA 30322, USA; (M.R.D.); (D.P.J.); (V.C.M.)
- Lincoln International Institute for Rural Health, School of Health and Social Care, University of Lincoln, Lincoln LN6 7TS, UK
| | - Claudia E. Ordonez
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA;
| | - Mathew R. Dudgeon
- School of Medicine, Emory University, Atlanta, GA 30322, USA; (M.R.D.); (D.P.J.); (V.C.M.)
| | - Henry Sunpath
- Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban 4041, South Africa; (J.B.); (H.S.); (S.P.); (M.Y.S.M.)
| | - Selvan Pillay
- Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban 4041, South Africa; (J.B.); (H.S.); (S.P.); (M.Y.S.M.)
| | - Pravi Moodley
- National Health Laboratory Service, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban 4011, South Africa;
| | - Daniel R. Kuritzkes
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Mohamed Y. S. Moosa
- Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban 4041, South Africa; (J.B.); (H.S.); (S.P.); (M.Y.S.M.)
| | - Dean P. Jones
- School of Medicine, Emory University, Atlanta, GA 30322, USA; (M.R.D.); (D.P.J.); (V.C.M.)
| | - Vincent C. Marconi
- School of Medicine, Emory University, Atlanta, GA 30322, USA; (M.R.D.); (D.P.J.); (V.C.M.)
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA;
- Emory Vaccine Center, Atlanta, GA 30322, USA
| | - Yan V. Sun
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; (C.L.); (Q.H.); (Y.C.); (J.C.)
- Correspondence: ; Tel.: +1-404-727-9090
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The challenges of implementing low-dose computed tomography for lung cancer screening in low- and middle-income countries. NATURE CANCER 2020; 1:1140-1152. [PMID: 35121933 DOI: 10.1038/s43018-020-00142-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/09/2020] [Indexed: 12/12/2022]
Abstract
Lung cancer accounts for an alarming human and economic burden in low- and middle-income countries (LMICs). Recent landmark trials from high-income countries (HICs) by demonstrating that low-dose computed tomography (LDCT) screening effectively reduces lung cancer mortality have engendered enthusiasm for this approach. Here we examine the effectiveness and affordability of LDCT screening from the viewpoint of LMICs. We consider resource-restricted perspectives and discuss implementation challenges and strategies to enhance the feasibility and cost-effectiveness of LDCT screening in LMICs.
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