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Exploring the Theory-Practice Gap in Nursing Education among Nursing Students in Zambia: A Mixed Study MethodAuthor: Sarah Banda ADOI: 10.21522/TIJAR.2014.13.03.Art001
Exploring the Theory-Practice Gap in Nursing Education among Nursing Students in Zambia: A Mixed Study Method
Abstract:
Nursing is both a science and an art, grounded in theory and centred on practical skills. Training in nursing education aims to build students’ cognitive and psychomotor abilities so they acquire strong theoretical knowledge and practical competence. The goal is to prepare competent nurses who can deliver safe, and high-quality care to individuals, families, and communities. Nursing education also promotes continuous learning, encouraging students to remain curious and adaptable in response to evolving trends in healthcare. Clinical exposure plays a crucial role in helping students adjust to the norms and culture of the profession. Learning in real clinical environments enables students to develop essential competencies for effective patient care. This study explored the theory-practice gap in nursing education among nursing students in Zambia. An exploratory sequential mixed-methods design was used, starting with qualitative focus group discussions to capture students’ experiences and perceptions of mismatches between classroom teaching and clinical practice. Insights from this phase guided the development of a structured questionnaire for the quantitative phase. Findings revealed a persistent theory-practice gap influenced by inadequate clinical supervision, limited resources, and inconsistencies in clinical procedures across facilities. Logistic regression analysis showed that students’ training level, clinical exposure, and access to mentorship significantly shaped their perceptions of the gap. The study underscores the importance of aligning theoretical instruction with clinical practice through stronger supervision, availability of clinical materials, and improved collaboration between training schools and clinical sites. Bridging these gaps can enhance student competence and contribute to quality nursing care in Zambia.
Exploring the Theory-Practice Gap in Nursing Education among Nursing Students in Zambia: A Mixed Study Method
References:
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[3]. Banda S, Mweemba C, Musonda P. Exploring the theory-practice gap in nursing education in Zambia. Int J Nurs Educ. 2016;10(3):45-50.
[4]. Benner P, Stephen KA, Leonard M, Day L. Educating nurses: a call for radical transformation. San Francisco (CA): Jossey-Bass; 2018.
[5]. Budgen C, Gamroth L. Bridging the theory-practice gap with simulation in nursing education. J Nurs Educ. 2022;61(1):45-50.
[6]. Chan EA. Integrating theory and practice: the role of simulation in nursing education. J Clin Nurs. 2022;31(5-6):789-97.
[7]. Dale AE. The theory-practice gap in nursing: the role of the nurse teacher. J Adv Nurs. 2011;20(3):521-5.
[8]. Dunn SV, Hansford B. Undergraduate nursing students' perceptions of their clinical learning environment. J Adv Nurs. 2020;25(6):1299-306.
[9]. Fairbrother P, Jones A, Rivas K. Development and evaluation of a clinical teaching model for nursing practice. Nurse Educ Pract. 2016;16(1):31-5.
[10]. Hatlevik IKR. The theory-practice relationship: reflective skills and theoretical knowledge as key factors in bridging the gap in initial nursing education. Nurse Educ Today. 2012;32(7):646-50.
[11]. Houghton CE, Casey D, Shaw D, Murphy K. Staff and students' perceptions and experiences of teaching and assessment in clinical practice: a qualitative study. Nurse Educ Today. 2013;33(8):841-6.
[12]. Landers MG. The theory-practice gap in nursing: the role of the nurse teacher. J Adv Nurs. 2014;32(6):1550-6.
[13]. Maimbolwa M, Chirwa E, Mbewe C. Bridging the theory-practice gap in nursing education in Zambia: a qualitative study. BMC Nurs. 2017;16:25.
[14]. Makhathini B, Mthembu TG, Mkhize S. Exploring the theory-practice gap in nursing education in South Africa. Curationis. 2021;44(1):a2140.
[15]. McCaugherty D. The theory-practice gap in nursing education: a review of the literature. Nurse Educ Today. 2015;35(5):e1-7.
[16]. McKenna L, McCall L, Wray N. Clinical placements and the theory-practice gap: a longitudinal study. Nurse Educ Today. 2022;105:105043.
[17]. Melnyk BM, Fineout-Overholt E. Evidence-based practice in nursing & health care: a guide to best practice. 4th ed. Philadelphia: Wolters Kluwer; 2019.
[18]. Mntambo L. The theory-practice gap in nursing education: a study of undergraduate nursing students in Lusaka, Zambia. Lusaka: University of Zambia Press; 2021.
[19]. Nabolsi M, Zumot A, Wardam L, Abu-Moghli F. The theory-practice gap in nursing education: a qualitative study. Nurse Educ Pract. 2022;65:103464.
[20]. Newton JM, Billett S, Ockerby CM. Journeying through clinical placements: an examination of pre-service nursing students' learning experiences. Nurse Educ Today. 2009;29(6):630-4.
[21]. Norman D. Developing clinical reasoning and decision making. New York: Routledge; 2018.
[22]. Rolfe G. The theory-practice gap in nursing: from research-based practice to practitioner-based research. J Adv Nurs. 2014;28(3):672-9.
[23]. Saifan A, AbuRuz ME, Masa'Deh R. Theory-practice gaps in nursing education: a qualitative perspective. J Soc Sci. 2015;11(1):20-9.
[24]. Scully NJ. The theory-practice gap and skill acquisition: an issue for nursing education. Collegian. 2011;18(2):93-8.
[25]. Sharif F, Masoumi S. Solutions to bridge the theory-practice gap in nursing education in the UAE: a qualitative study. BMC Med Educ. 2021;21:219.
[26]. Upton D. Bridging the theory-practice gap in nursing education: a review of strategies. Nurse Educ Today. 2024;114:105432.
[27]. World Health Organization. State of the World's Nursing 2020: Investing in Education, Jobs and Leadership. Geneva: World Health Organization; 2020.
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Association between Rainfall, Temperature, and Dengue Fever Incidence in Selected Regions of Guyana, 2020–2022: A Hydrometeorological Correlation AnalysisAuthor: S Allison PetersDOI: 10.21522/TIJAR.2014.13.03.Art002
Association between Rainfall, Temperature, and Dengue Fever Incidence in Selected Regions of Guyana, 2020–2022: A Hydrometeorological Correlation Analysis
Abstract:
Characterizing the meteorological determinants of dengue transmission is critical for developing anticipatory surveillance frameworks in tropical settings like Guyana, where precipitation and temperature fluctuations are intrinsically linked to the reproductive ecology of Aedes aegypti. This study examined the association between monthly and annual hydrometeorological parameters, rainfall (mm), daytime temperature (℃), and nighttime temperature (℃), and confirmed dengue fever case counts in Guyana's administrative Regions 5, 6, and 9 from 2020 to 2022. Data were obtained from the Guyana Ministry of Health national disease notification system and the Guyana Hydrometeorological Service. Descriptive and correlation analyses revealed that the highest annual rainfall year (2021) corresponded with peak dengue case burden nationally (4,384 cases), while Region 6, which recorded both the highest cumulative rainfall (3,348.6 mm in 2021) and the second-greatest case burden, demonstrated the strongest apparent positive association between precipitation and case counts. Daytime temperatures remained relatively stable across the three years (30.6–31.9℃), suggesting limited temperature variability as an independent driver within this range, though nighttime temperatures showed modest co-variation with case trends. These findings provide empirical support for rainfall as a key correlate of dengue incidence in Guyana and lay the foundation for prospective distributed lag non-linear modeling and the development of an early warning system.
Association between Rainfall, Temperature, and Dengue Fever Incidence in Selected Regions of Guyana, 2020–2022: A Hydrometeorological Correlation Analysis
References:
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[9]. Yasanayake CN, Zaitchik BF, Gnanadesikan A, Gardner LM, Shet A. Mechanistic modeling of Aedes aegypti mosquito habitats for climate-informed dengue forecasting. GeoHealth. 2025;9(9).
[10]. Hii YL, Zhu H, Ng N, Ng LC, Rocklöv J. Forecast of dengue incidence using temperature and rainfall. PLoS Negl Trop Dis. 2012;6(11):e1908.
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[13]. Medina E, Cogollo MR, González-Parra G. Prescriptive temporal modeling approach using climate variables to forecast dengue incidence in Córdoba, Colombia. Math Biosci Eng. 2024;21(12):7760-82.
[14]. Geraldini B, Johansen IC, Justus M. Influence of temperature and precipitation on dengue incidence in Campinas, São Paulo State, Brazil (2013-2022). Rev Soc Bras Med Trop. 2024;57.
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[20]. Pan American Health Organization. Epidemiological update: dengue in the Americas. Washington (DC): Pan American Health Organization; 2024.
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[22]. Colón-González FJ, Lake IR, Bentham G. Climate variability and dengue fever in warm and humid Mexico. Am J Trop Med Hyg. 2013;88(5):849-57.
[23]. Méndez-Lázaro P, Muller-Karger F, Otis D, McCarthy M, Peña-Orellana M. Assessing climate variability effects on dengue incidence in San Juan, Puerto Rico. Int J Environ Res Public Health. 2014;11(9):9409-28.
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[25]. Tello MPC, Rosales CGC, Baculima RDP. Dengue en Ecuador, su relación con el cambio climático y la dinámica del Aedes aegypti. Mediciencias UTA. 2025;9(3):39-47.
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Healthcare Professionals Satisfaction to Multichannel Market in Tanzania: A Case Study of Webinar in Dar es salaamAuthor: Mbeya BDOI: 10.21522/TIJAR.2014.13.03.Art003
Healthcare Professionals Satisfaction to Multichannel Market in Tanzania: A Case Study of Webinar in Dar es salaam
Abstract:
This study aimed to understand the satisfaction of Healthcare Professionals (HCPs) with a multichannel market (webinar) in Dar es Salaam, Tanzania. The study population consisted of healthcare professionals who regularly attend webinars. A sample of 250 HCPs was selected from a simple random sampling and were involved in a survey from which data were collected through questionnaires. The majority of the HCPs were male 78% and female 22%. Among the HCPs, 87.2% were doctors, 9.6% pharmacists, and 3.2% nurses. Data validity and reliability were tested, and data analysis was done using SPSS. The study findings revealed that 63.2% of the HCPs were not satisfied with the audio, 88% were satisfied with the knowledge obtained through the webinar, and 80% were satisfied with the communication style of the presenter through the webinar. Regression analysis results showed a significant relationship between satisfaction with sound quality (p = 0.02) and knowledge (p = 0.05), while there was no significant relationship with communication style, with a p-value > 0.05.ANOVA showed a significant difference in mean among the groups with a p-value <0.01. The study recommends conduction of dry run to ensure that the webinar is tested before the actual webinar to avoid audio problems. The use of a recorded webinar allows the avoidance of audio problems and ensures a good internet connection to avoid buffering and facilitate good sound quality. This study has implications for all stakeholders involved in webinars. The theoretical and practical implications provide benefits of the study to the government, business organizations, and NGO.
Healthcare Professionals Satisfaction to Multichannel Market in Tanzania: A Case Study of Webinar in Dar es salaam
References:
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[10]. Maatta S. The service experience of webinars: a case study of Opinahjo. 2015.
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Knowledge and Utilization of Malaria Preventive Measure among Pregnant Women in University of Nigeria Teaching Hospital (UNTH), Enugu State, NigeriaAuthor: Ikeonwueme Peace ObikaDOI: 10.21522/TIJAR.2014.13.03.Art004
Knowledge and Utilization of Malaria Preventive Measure among Pregnant Women in University of Nigeria Teaching Hospital (UNTH), Enugu State, Nigeria
Abstract:
Malaria remains a major public health challenge in Sub-Saharan Africa, especially among pregnant women, who are at high risk for severe malaria and adverse maternal and neonatal outcomes. Malaria prevention through the use of Insecticide treated nets (ITNs) Intermittent preventive treatment (IPT), and other measures is recommended. This study aimed to assess the knowledge and utilization of malaria preventive measures among pregnant women attending antenatal care at University of Nigeria teaching hospital (UNTH) Enugu. A Cross-Sectional Study was conducted among pregnant women attending antenatal clinics at UNTH Enugu. Data were collected through structured questionnaires and information on demographic characteristics, knowledge, and utilization of malaria preventive measures were obtained. Descriptive and inferential statistics were used to analyze the data. The study included 200 pregnant women, with a mean age of 28.4 years. A significant proportion (70%) of participants demonstrated good knowledge of malaria and its preventive measures. However, only 55% of them reported regular use of ITNs, and 40% adhered to IPT protocols. Factors such as age, education level, and marital status were significantly associated with the utilization of preventive measures. While knowledge of malaria prevention among pregnant women in UNTH is high, the utilization of preventive measures is suboptimal. There is a need for targeted interventions to improve adherence to malaria prevention strategies.
Knowledge and Utilization of Malaria Preventive Measure among Pregnant Women in University of Nigeria Teaching Hospital (UNTH), Enugu State, Nigeria
References:
[1]. World Health Organization. Guidelines for malaria in pregnancy. Geneva: World Health Organization; 2021.
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Factors Contributing to the Use of Traditional-Based Oxytocic Products for Labor Induction and Pregnancy Termination in Rural Settings of Kavango Region, NamibiaAuthor: Sebastien Njila TshipambaDOI: 10.21522/TIJAR.2014.13.03.Art005
Factors Contributing to the Use of Traditional-Based Oxytocic Products for Labor Induction and Pregnancy Termination in Rural Settings of Kavango Region, Namibia
Abstract:
The use of traditional oxytocic substances remains widespread in many rural African communities for labor induction and pregnancy termination, despite increasing availability of modern obstetric services. In the Kavango region of Namibia, these practices continue to be commonly utilized and may contribute to adverse maternal health outcomes. A cross-sectional mixed-methods study was conducted among 250 women of reproductive age in rural Kavango. Quantitative data were collected using structured questionnaires and analyzed using SPSS version 26, applying descriptive statistics, chi-square tests, and multivariate logistic regression to identify associated factors. Qualitative data were obtained through focus group discussions and analyzed using thematic analysis. The prevalence of traditional oxytocic use was 62.0% (95% CI: 55.8–68.0). Significant predictors included strong cultural beliefs (AOR = 2.8, p = 0.001), residence more than 10 km from a health facility (AOR = 2.3, p = 0.004), low educational attainment (AOR = 1.9, p = 0.012), and influence of traditional birth attendants (AOR = 3.1, p < 0.001). Reported complications included excessive bleeding (18%), infection (12%), and uterine-related complications (6%). Qualitative findings revealed persistent trust in traditional practices, perceived effectiveness, and concerns about stigma within formal healthcare settings. The study concludes that traditional oxytocic use remains prevalent in rural Kavango and is influenced by socio-cultural dynamics and health system limitations. Interventions should focus on improving healthcare access, strengthening community health education, and fostering collaboration between formal healthcare providers and traditional birth attendants.
Factors Contributing to the Use of Traditional-Based Oxytocic Products for Labor Induction and Pregnancy Termination in Rural Settings of Kavango Region, Namibia
References:
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Artificial Intelligence in Regulatory Medical Writing: Opportunities, Challenges, and Implications for Clinical Trial DocumentationAuthor: Padmakala MunjampallyDOI: 10.21522/TIJAR.2014.13.03.Art006
Artificial Intelligence in Regulatory Medical Writing: Opportunities, Challenges, and Implications for Clinical Trial Documentation
Abstract:
Artificial intelligence (AI) is increasingly being explored in healthcare communication and scientific documentation, including applications in regulatory medical writing. Regulatory medical writing plays a critical role in the preparation of clinical trial documentation required for regulatory submissions, including clinical study reports, study protocols, investigator brochures, and safety reports. The integration of AI technologies, particularly natural language processing and machine learning, has created opportunities to improve efficiency, consistency, and workflow management in documentation-related activities. However, concerns remain regarding accuracy, transparency, ethical considerations, and regulatory compliance associated with AI-assisted documentation. This article explores the current and potential applications of artificial intelligence in regulatory medical writing and evaluates its implications for clinical trial documentation. A qualitative narrative review approach was adopted using published literature, regulatory guidance documents, and policy papers related to AI in healthcare, scientific communication, and regulatory science. The review identifies major opportunities associated with AI-assisted documentation, including automated drafting, content summarization, workflow optimization, and consistency in document preparation. At the same time, important limitations and challenges were identified, including reliability concerns, hallucination risks, lack of transparency, ethical considerations, data privacy issues, and uncertainties regarding regulatory acceptance. The review further discusses the evolving role of medical writers in an AI-assisted environment and highlights the importance of human oversight in maintaining documentation quality, scientific accuracy, and compliance with regulatory expectations. The findings suggest that while AI has significant potential to support regulatory medical writing, responsible integration requires robust governance frameworks, ethical oversight, and clear regulatory guidance.
Artificial Intelligence in Regulatory Medical Writing: Opportunities, Challenges, and Implications for Clinical Trial Documentation
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A Comparative Study of Synthesized Berberine-Iron Oxide Nanoparticles and Cisplatin: Characterization and Biological ApplicationsAuthor: Devarajan NaliniDOI: 10.21522/TIJAR.2014.13.03.Art007
A Comparative Study of Synthesized Berberine-Iron Oxide Nanoparticles and Cisplatin: Characterization and Biological Applications
Abstract:
Non-small cell lung cancer (NSCLC) remains one of the leading causes of cancer-related deaths worldwide due to its high incidence, aggressive progression, and limited treatment options. Although cisplatin-based chemotherapy is a standard treatment for NSCLC, its clinical use is hindered by severe side effects and drug resistance. To address these challenges, the present study focused on the green synthesis of berberine-loaded iron oxide nanoparticles (BBR-FeONPs) using Phyllanthus amarus as a natural reducing and stabilizing agent. The formation of BBR-FeONPs was indicated by a visible color change and confirmed through characterization techniques, including UV-visible spectroscopy, FTIR, XRD, SEM, TEM, and zeta potential analysis. UV-vis spectroscopy showed a surface plasmon resonance peak at 335-342 nm, while FTIR identified functional groups involved in nanoparticle stabilization. XRD confirmed their crystalline structure, and SEM/TEM analyses revealed spherical and oval-shaped particles with an average size of 52 ± 2 nm. Zeta potential analysis (-8.50 mV) indicated moderate colloidal stability. Antimicrobial assays showed dose-dependent inhibition zones against S. aureus (13.0 mm), E. coli (14.3 mm), and P. aeruginosa (15.0 mm). In vitro cytotoxicity studies demonstrated enhanced anticancer activity of BBR-FeONPs against H460 NSCLC cells (IC₅₀=34.27 ± 2 μg/mL) compared to BBR, FeONPs, and cisplatin, with lower toxicity toward HEK-293 normal cells. Wound healing assays showed significant anti-migratory activity (6.14% at 200 μg/mL). These findings suggest that BBR-FeONPs are a promising and safer alternative for NSCLC treatment. Further studies are needed to explore their molecular mechanisms, assess in vivo toxicity, and evaluate biodistribution profiles.
A Comparative Study of Synthesized Berberine-Iron Oxide Nanoparticles and Cisplatin: Characterization and Biological Applications
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Leveraging Syndromic Surveillance of Surgical Site Infections to Improve Infection Prevention and Control in Tanzania: A Quasi Experimental StudyAuthor: Joseph C. HokororoDOI: 10.21522/TIJAR.2014.13.03.Art008
Leveraging Syndromic Surveillance of Surgical Site Infections to Improve Infection Prevention and Control in Tanzania: A Quasi Experimental Study
Abstract:
Surveillance of surgical site infection (SSI) is key for improving Infection Prevention and Control (IPC). In Tanzania, it is unclear how primary health facilities (PHFs) that perform syndromic surveillance of SSI differ from those that do not. This quasi-experimental study, conducted from September to November 2024, evaluated how PHFs implementing syndromic surveillance differ in IPC adherence from those that do not. The quantitative sample included 905 surgical patients from surveillance conducting PHFs and 600 from non-conducting facilities. Results demonstrated that facilities practicing syndromic surveillance achieved significantly higher IPC adherence scores, with a mean of 400.1 (SD 138.9) compared to 263.1 (SD 99.88) in the control group. This marked difference of 137 points proved statistically significant (SE 54.12; CI 23.29–250.71; unpaired t = 2.5313; P < 0.0209). For the qualitative, researchers interviewed 49 Quality Improvement Team (QIT) members to triangulate the quantitative data. These sessions were transcribed verbatim on the same day and analyzed using NVivo version 20.2, utilizing a hybrid deductive and inductive coding approach. Reported via consolidated criteria for reporting qualitative research, the analysis generated four core themes. Participants reported that syndromic surveillance is a highly valuable tool for identifying operational gaps, understanding the true infection burden, and actively strengthening facility wide IPC measures. Ultimately, these findings provide suggestive evidence that syndromic surveillance directly aids in reducing surgical site infections. Because establishing surveillance systems improves care quality, the authors recommend that all healthcare facilities should monitor for healthcare-associated infections, including SSIs, to protect patient safety.
Leveraging Syndromic Surveillance of Surgical Site Infections to Improve Infection Prevention and Control in Tanzania: A Quasi Experimental Study
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[24]. Puro V, Coppola N, Frasca A, Gentile I, Luzzaro F, Peghetti A, et al. Pillars for prevention and control of healthcare-associated infections: an Italian expert opinion statement. Antimicrob Resist Infect Control. 2022;11(1):87. doi:10.1186/s13756-022-01125-8.
[25]. Shenoy ES, Branch-Elliman W. Automating surveillance for healthcare-associated infections: rationale and current realities (Part I/III). Antimicrob Steward Healthc Epidemiol. 2023;3(1):e25. doi:10.1017/ash.2022.312.
[26]. Abubakar U, Amir O, Rodríguez-Baño J. Healthcare-associated infections in Africa: a systematic review and meta-analysis of point prevalence studies. J Pharm Policy Pract. 2022;15:99. https://doi.org/10.1186/s40545-022-00500-5
[27]. Abbas MEA, de Kraker MEA, Aghayev E, Astagneau P, Aupee M, Behnke M, et al. Impact of participation in a surgical site infection surveillance network: results from a large international cohort study. J Hosp Infect. 2019;102(3):267-76. https://doi.org/10.1016/j.jhin.2018.12.003
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[29]. Allegranzi B, Donaldson LJ, Kilpatrick C, Syed S, Twyman A, Kelley E, et al. Infection prevention: laying an essential foundation for quality universal health coverage. Lancet Glob Health. 2019;7(6):e698-700. doi:10.1016/S2214-109X(19)30174-3.
[30]. Allegranzi B, Kilpatrick C, Storr J, Kelley E, Park BJ, Donaldson L. Global infection prevention and control priorities 2018-22: a call for action. Lancet Glob Health. 2017;5(12):e1178-80. doi:10.1016/S2214-109X(17)30427-8.
[31]. Ariyo P, Zayed B, Riese V, Anton B, Latif A, Kilpatrick C, et al. Implementation strategies to reduce surgical site infections: a systematic review. Infect Control Hosp Epidemiol. 2019;40(3):287-300. doi:10.1017/ice.2018.355.
[32]. Tartari E, Muthukumaran P, Peters A, Allegranzi B, Pittet D. Monitoring your institution: the WHO Hand Hygiene Self-Assessment Framework—is it worth it? Clin Microbiol Infect. 2019;25(8):925-8. doi:10.1016/j.cmi.2019.04.009.
[33]. Mwanja H, Waswa JP, Kiggundu R, Mackline H, Bulwadda D, Byonanebye DM, et al. Utility of syndromic surveillance for the surveillance of healthcare-associated infections in resource-limited settings: a narrative review. Front Microbiol. 2024;15:1493511. doi:10.3389/fmicb.2024.1493511.
[34]. Meckawy R, Stuckler D, Mehta A, et al. Effectiveness of early warning systems in the detection of infectious disease outbreaks: a systematic review. BMC Public Health. 2022;22:2216. https://doi.org/10.1186/s12889-022-14625-4
[35]. Hughes E, Edeghere O, O'Brien J, et al. Emergency department syndromic surveillance systems: a systematic review. BMC Public Health. 2020;20:1891. https://doi.org/10.1186/s12889-020-09949-y
[36]. Horan D, Delahunt E, Roe M, Hägglund M, Blake C, Kelly S. "More than likely the men come first. That's just very frustrating." A qualitative exploration of contextual factors affecting the implementation of injury prevention initiatives and the provision of effective injury management in elite-level women's club. Br J Sports Med. 2023. https://doi.org/10.1136/bjsports-2022-106548
[37]. Allegranzi B, Bagheri S, Combescure C, Graafmans W, Attar H, Donaldson L, et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet. 2011;377(9761):228-41. doi:10.1016/S0140-6736(10)61458-4.
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Multifaceted Interventions and HIV Risky Sexual Behaviours among Adolescent Girls and Young Women: A Case Study of the DREAMS Partnership in Mubende Region, UgandaAuthor: Moses IsangaDOI: 10.21522/TIJAR.2014.13.03.Art009
Multifaceted Interventions and HIV Risky Sexual Behaviours among Adolescent Girls and Young Women: A Case Study of the DREAMS Partnership in Mubende Region, Uganda
Abstract:
Risky sexual behaviour among Adolescent Girls and Young Women (AGYW) is a global health challenge resulting in new cases of HIV infection, sexually transmitted Infections (STIs), unwanted pregnancies and unsafe abortions. This study aimed at examining the effectiveness of multifaceted interventions on reduction of risky sexual behaviours (RSBs) among AGYW in Mubende region, Uganda. The study adopted a descriptive cross-sectional design for both qualitative and quantitative data collection and analysis. Quantitative data was gathered through pre-tested structured questionnaires from 385 randomly selected participants, while qualitative data was collected via focus group discussions and key Informant interviews with purposively selected respondents. Quantitative data was analyzed using STATA 18.0 software, while qualitative data was transcribed verbatim and analyzed using NVIVO software. The findings revealed that 92.5% of the target population was reached by DREAMS interventions. Marital status (AOR = 0.17, 95% CI: 0.04–0.64, p = 0.01), Education status (AOR = 0.001,95% CI: 0.00-0.00, p<0.001 ), Age at enrollment (AOR = 49.52,95% CI:1.24-1981.93, p= 0.038), Journeys plus (AOR=22.75, 95% CI: 1.26-409.98, p= 0.034), employment after graduation (AOR=14.57, 95% CI: 1.15-184.00, p=0.038), marriage after graduation (AOR=15.95, 95% CI: 1.11-229.21, p=0.042) and starting own business after graduation (AOR=15.32, 95% CI: 1.66-141.33, p=0.016), were the independent variables significantly associated with RSBs. HIV prevention and sexual health, economic empowerment, behaviour change, employment opportunity, reduced unintended pregnancies, retention in school and asset building were identified as the major outcomes achieved by the program. Education status, Marital status, age enrollment, Journeys plus curriculum, employment, marriage and starting own business after graduation positively influenced RSBs.
Multifaceted Interventions and HIV Risky Sexual Behaviours among Adolescent Girls and Young Women: A Case Study of the DREAMS Partnership in Mubende Region, Uganda
References:
[1]. Keto T, Tilahun A, Mamo A. Knowledge, attitude and practice towards risky sexual behaviors among secondary and preparatory students of Metu town, southwestern Ethiopia. BMC Public Health. 2020;20:1186. https://doi.org/10.1186/s12889-020-09371-4
[2]. Centers for Disease Control and Prevention. Sexual risk behaviors: reducing health risks among youth. Available from: https://www.cdc.gov/youth-behavior/risk-behaviors/sexual-risk-behaviors.html
[3]. World Health Organization. Report on global sexually transmitted infection surveillance 2018. South Med J. 2018;70:1-58.
[4]. Cassim N, Coetzee LM, da Silva MP, Glencross DK, Stevens WS. Assessing very advanced HIV disease in adolescent girls and young women. SAHARA J. 2023;24. https://doi.org/10.4102/sajhivmed.v24i1.1501
[5]. UNAIDS. HIV and adolescent girls and young women: thematic briefing note. 2024 Global AIDS Update. Geneva: UNAIDS; 2024.
[6]. UNAIDS. In danger: UNAIDS Global AIDS Update 2022. Geneva: UNAIDS; 2022.
[7]. Ewemooje OS. Risky sexual behaviour among adolescent girls and young women in Nigeria: persistent driver of HIV infections. J Interv Epidemiol Public Health. 2023;6. https://doi.org/10.37432/jieph.2023.6.4.91
[8]. Madiba S, Ngwenya N. Cultural practices, gender inequality and inconsistent condom use increase vulnerability to HIV infection: narratives from married and cohabiting women in rural communities in Mpumalanga Province, South Africa. Glob Health Action. 2017;10(1):1341597. https://doi.org/10.1080/16549716.2017.1341597
[9]. Petroni S. Advancing the evidence base on child marriage and HIV. 2019.
[10]. Matovu JKB, Bukenya JN, Kasozi D, Kisaka S, Kisa R, Nyabigambo A, et al. Sexual-risk behaviours and HIV and syphilis prevalence among in- and out-of-school adolescent girls and young women in Uganda: a cross-sectional study. PLoS One. 2021;16(9):e0257321. https://doi.org/10.1371/journal.pone.0257321
[11]. Uganda AIDS Commission. The Uganda HIV and AIDS Country Progress Report. Kampala: Uganda AIDS Commission; 2015.
[12]. Saul J, Bachman G, Allen S, Toiv NF, Cooney C, Beamon T. The DREAMS core package of interventions: a comprehensive approach to preventing HIV among adolescent girls and young women. PLoS One. 2018;13(12):e0208167. https://doi.org/10.1371/journal.pone.0208167
[13]. Uganda Bureau of Statistics. Statistical Abstract 2013. Kampala: Uganda Bureau of Statistics; 2013.
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[15]. Murewanhema G, Musuka G, Moyo P, Moyo E, Dzinamarira T. HIV and adolescent girls and young women in sub-Saharan Africa: a call for expedited action to reduce new infections. IJID Reg. 2022;5:30-2. https://doi.org/10.1016/j.ijregi.2022.08.009
[16]. Komuhangi A, Muhumuza A, Kasozi W. Prevalence of risky sexual behavior and its associated factors among adolescent girls and young women in Moroto District, Karamoja Region, Uganda. Texila Int J Public Health. 2025;13. https://www.texilajournal.com/v2/thumbs/article/38_TJ3120.pdf
[17]. Namukasa S. Factors that contribute to teenage pregnancy during COVID-19 in Uganda: a study of Bugiri Municipal Council in Bugiri District. 2021.
[18]. Mohapi BJ, Pitsoane EM. Life skills as a behaviour change strategy in the prevention of HIV and AIDS: perceptions of students in an open and distance learning institution. SAHARA J. 2017;14(1):77-84. https://doi.org/10.1080/17290376.2017.1374878
[19]. Nkhoma DE, Lin CP, Katengeza HL, Soko CJ, Estinfort W, Wang YC, et al. Girls' empowerment and adolescent pregnancy: a systematic review. Int J Environ Res Public Health. 2020;17(5):1664. https://doi.org/10.3390/ijerph17051664
[20]. Gangaramany A, Balvanz P, Gichane MW, Goetschius S, Sharma S, Sharma K, et al. Developing a framework for cash transfer programs that foster sustained economic empowerment to reduce sexual risk among adolescent girls and young women: a qualitative study. BMC Public Health. 2021;21(1):122. https://doi.org/10.1186/s12889-020-10130-8
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[22]. Omona K, Bwire GW, Mugisa G, Tolit Akullu J. Drivers of risky sexual behaviours among adolescents in Nebbi Municipality, Uganda: analytical cross-sectional study. Crit Public Health. 2026;36. https://doi.org/10.1080/09581596.2025.2604882
[23]. Misinde C, Nansubuga E, Nankinga O. Out-of-school female adolescent employment status and sexually transmitted infections risk in Uganda: is it a plausible relationship? BMC Public Health. 2018;18(1):1173. https://doi.org/10.1186/s12889-018-6094-1
[24]. Bradley JE, Bhattacharjee P, Ramesh BM, Girish M, Das AK. Evaluation of Stepping Stones as a tool for changing knowledge, attitudes and behaviours associated with gender, relationships and HIV risk in Karnataka, India. BMC Public Health. 2011;11:496. https://doi.org/10.1186/1471-2458-11-496
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Blockchain-Enabled Smart Contract Monitoring and Universal Health Coverage Efficiency for Neglected Tropical Diseases in NigeriaAuthor: Yilchini Yilben IshakuDOI: 10.21522/TIJAR.2014.13.03.Art010
Blockchain-Enabled Smart Contract Monitoring and Universal Health Coverage Efficiency for Neglected Tropical Diseases in Nigeria
Abstract:
This study examines the role of blockchain-enabled monitoring systems in enhancing the efficiency of Universal Health Coverage (UHC) for Neglected Tropical Diseases (NTDs) in Nigeria. Despite ongoing policy efforts, UHC delivery remains constrained by fragmented governance structures, weak financial transparency, and limited real-time performance monitoring. Blockchain technology, operationalized through smart contract–based mechanisms, offers a pathway to strengthen accountability, improve resource tracking, and optimize system efficiency. A quantitative cross-sectional design was employed using data from 314 health system stakeholders across three expert groups: UHC and NTD specialists, Healthcare 4.0 and IT experts, and international digital health professionals. Data were analyzed using Principal Components Analysis (PCA), reliability testing, Confirmatory Factor Analysis (CFA), and Structural Equation Modeling (SEM). The model demonstrated strong fit (RMSEA = 0.028; SRMR = 0.043; CFI = 0.99). Findings show that blockchain-enabled monitoring systems significantly influence UHC efficiency, with Blockchain systems (HBC) (β = 0.40) and fund utilization monitoring (β = 0.39) as the strongest drivers. Big data (β = 0.33), fog computing (β = 0.36), socio-cultural acceptance (β = 0.36), and economic readiness (β = 0.39) also showed significant effects. Efficiency gains are driven by integrated monitoring architectures that align governance mechanisms, data infrastructure, and contextual readiness conditions. These findings provide policy-relevant evidence for strengthening transparent and efficient UHC systems for NTD control in resource-constrained settings.
Blockchain-Enabled Smart Contract Monitoring and Universal Health Coverage Efficiency for Neglected Tropical Diseases in Nigeria
References:
[1]. World Health Organization. Global Health Observatory: Universal Health Coverage Index. Geneva: World Health Organization; 2024.
[2]. Badamasi HS. Coverage: measure of achieving universal health coverage in Nigeria. In: IntechOpen; 2022. p. 1-6.
[3]. Kumar R, et al. Blockchain applications in healthcare. J Med Syst. 2020;44(9):1-8.
[4]. Popov V, et al. Blockchain in Healthcare 4.0: a systematic review. J Biomed Inform. 2022;131:104103.
[5]. Akash SS, Ferdous MS. A blockchain-based system for healthcare digital twin. IEEE Access. 2022;10:50523-47.
[6]. National Information Technology Development Agency. National blockchain policy for Nigeria. Abuja: NITDA; 2023.
[7]. Edo OC, et al. Why do healthcare workers adopt digital health technologies? Int J Inf Manag Data Insights. 2023;3(1):100186.
[8]. Hair JF, Black WC, Babin BJ, Anderson RE. Multivariate Data Analysis. 8th ed. Andover: Cengage; 2019.
[9]. Ogundeji Y, et al. Universal health coverage in Nigeria: gaps, opportunities, and recommendations. BMC Health Serv Res. 2023;23(1):1-14.
[10]. Dhingra S, Raut R, Naik K, Muduli K. Blockchain technology applications in healthcare supply chains. IEEE Access. 2024;12:11230-57.
[11]. Ifeagwu SC, et al. Health financing for universal health coverage in sub-Saharan Africa. Glob Health Res Policy. 2021;6(1):8.
[12]. Adebisi YA, et al. Assessment of health budgetary allocation in Nigeria. Int J Health Life Sci. 2020;6(2):e102552.
[13]. Ahmed I, Abdullah S, Ahmed A. IoT-fog-based healthcare 4.0 system using blockchain technology. J Supercomput. 2023;79:3999-4020.
[14]. Ntuen C, et al. Digital health adoption in Nigeria: a qualitative review. J Health Inform Afr. 2021;8(1):1-12.
[15]. Kuo TT, Kim HE, Ohno-Machado L. Blockchain distributed ledger technologies for biomedical and healthcare applications. J Am Med Inform Assoc. 2017;24(6):1211-20.
[16]. World Health Organization. Global strategy on digital health 2020-2025. Geneva: World Health Organization; 2021.
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[19]. Labrique AB, et al. Best practices in scaling digital health in low- and middle-income countries. Glob Health Sci Pract. 2018;6(Suppl 1):S1-9.
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An Assessment of Mental Health Help-Seeking Behaviours of Adolescents and Young People in Bauchi State, Nigeria: A Cross-sectional StudyAuthor: Comfort Runyi Oyom EffiomDOI: 10.21522/TIJAR.2014.13.03.Art011
An Assessment of Mental Health Help-Seeking Behaviours of Adolescents and Young People in Bauchi State, Nigeria: A Cross-sectional Study
Abstract:
Adolescence and young adulthood are critical developmental phases often marked by a high prevalence of mental health issues, including in Nigeria. This study evaluated the prevalence of depression and mental health help-seeking behaviours of adolescents and young people in Bauchi State, Nigeria. A cross-sectional community-based survey was conducted in May 2026 among adolescents and young people aged 15 to 24 years in Bauchi Local Government Area, Bauchi State, Nigeria, using a multistage sampling technique. Quantitative data were collected from 390 participants using a three-part questionnaire that included descriptive statistics, the Patient Health Questionnaire-9 (PHQ-9) to measure depressive symptoms, and the General Help-Seeking Questionnaire (GHSQ, V15) to assess the likelihood of seeking support from various sources. Data were analyzed using SPSS version 26.0, employing descriptive statistics, t-tests, chi-square tests, and ANOVA, with significance set at p<0.05. The mean age of respondents was 18.84± 2.59 years. Prevalence of depression using PHQ-9 was 19.2% mild, 58.7% moderate, 15.6% moderately severe, and 2.6% severe. Overall, the mean PHQ-9 score was 11.65±3.6, indicating moderate depression. Young people (20 to 24 years) exhibited significantly higher mean depression scores (12.3±3.6) compared to adolescents (11.2±3.5, p=0.004). Overall, adolescents and young people in Bauchi State sought help mostly from their parents/guardians (x̄=5.58, SD=1.076), siblings/close relatives (x̄=5.31, SD=0.940), religious leaders (x̄=5.28, SD=1.160), and close friends (x̄=5.01, SD=1.123). There was no significant difference in help-seeking behaviours by gender and age group (p>0.05); however, the study found that more females sought help from online resources than males (t=-2.202, p=0.028), and that more males would not seek help (x̄=4.16, SD=1.302) as often as females (x̄=3.87, SD=1.490; t=2.099, p=0.036). While help-seeking behaviours tended to decrease with increasing depression severity, this was not found to be statistically significant (p=0.0060). The findings reveal a high burden of depression, with a preference for seeking help from informal sources and religious leaders. Mental health interventions in Nigeria should be decentralized into community and religious structures, while policy efforts should improve community-level identification of depression and strengthen referral pathways for specialized care.
An Assessment of Mental Health Help-Seeking Behaviours of Adolescents and Young People in Bauchi State, Nigeria: A Cross-sectional Study
References:
[1]. UNFPA. World Population Dashboard. New York: UNFPA; 2022. Available from: https://www.unfpa.org/data/world-population-dashboard
[2]. World Health Organization. Mental health of adolescents [Fact sheet]. Geneva: WHO; 2025. Available from: https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health
[3]. Thapar A, Eyre O, Patel V, Brent D. Depression in young people. Lancet. 2022;400(10352):617-31.
[4]. Asaolu O, Alawode GO, Ajike S, Ogunsami OO, Ibitoye SE, Bello M, et al. Effect of text-messaging on treatment adherence practices among young people living with HIV in Niger State, Nigeria. J AIDS HIV Res. 2023;15(1):41-7.
[5]. National Population Commission (Nigeria), ICF. Nigeria Demographic and Health Survey 2018. Abuja (Nigeria); Rockville (MD): NPC, ICF; 2022.
[6]. Aguirre Velasco A, Cruz ISS, Billings J, Jiménez M, Rowe S. What are the barriers, facilitators, and interventions targeting help-seeking behaviours for common mental health problems in adolescents? A systematic review. BMC Psychiatry. 2020;20(1):293.
[7]. Cavioni V, Grazzani I, Ornaghi V, Agliati A, Pepe A. Adolescents' mental health at school: the mediating role of life satisfaction. Front Psychol. 2021;12:720628.
[8]. Ogbonna PN, Iheanacho PN, Ogbonnaya NP, et al. Prevalence of mental illness among adolescents (15-18 years) treated at Federal Neuropsychiatric Hospital, Enugu, Nigeria, from 2004 to 2013. Arch Psychiatr Nurs. 2020;34:7-13.
[9]. Mohammed A, Mohammed N, Rasaki A, Oyedun R, Gadzama BN, Okoh EO. Pattern of anxiety, depression, and suicidality among in-school adolescents in Bauchi, North-East Nigeria. Int J Community Med Public Health. 2024;11(9):3342-7.
[10]. Hayes D, Mansfield R, Mason C, Santos J, Moore A, Boehnke J, et al. The impact of universal, school-based interventions on help-seeking in children and young people: a systematic literature review. Eur Child Adolesc Psychiatry. 2024;33:2911-28.
[11]. Telesia L, Kaushik A, Kyriakopoulos M. The role of stigma in children and adolescents with mental health difficulties. Curr Opin Psychiatry. 2020;33(6):571-6.
[12]. Radez J, Reardon T, Creswell C, Lawrence PJ, Evdoka-Burton G, Waite P. Why do children and adolescents (not) seek and access professional help for their mental health problems? A systematic review of quantitative and qualitative studies. Eur Child Adolesc Psychiatry. 2021;30(2):183-211. doi:10.1007/s00787-019-01469-4.
[13]. Almanasef M. Mental health literacy and help-seeking behaviours among undergraduate pharmacy students in Abha, Saudi Arabia. Risk Manag Healthc Policy. 2021;14:1281-6. doi:10.2147/RMHP.S289211.
[14]. Abugu LI, Ugwu DI, Chukwuelobe IJ, Anike AI. Mental health help-seeking behaviour of in-school adolescents in Nsukka LGA. Int J Stud Educ. 2025;21(2):255-63.
[15]. Adaramoye TO, Adedini SA, Sunmola AM. Help-seeking behaviour among young women with experience with intimate partner violence in Nigeria. BMC Womens Health. 2025;25:388.
[16]. Heerde JA, Hemphill SA. Examination of associations between informal help-seeking behaviour, social support, and adolescent psychosocial outcomes: a meta-analysis. Dev Rev. 2017. doi:10.1016/j.dr.2017.10.001.
[17]. Aluh DO, Okonta MJ, Odili VU. Cross-sectional survey of mental health literacy among undergraduate students of the University of Nigeria. BMJ Open. 2019;9(9):e028913.
[18]. Africa Polling Institute, EpiAFRIC. Mental Health in Nigeria Survey. Abuja: Africa Polling Institute; 2019.
[19]. Labinjo T, Serrant L, Ashmore R, Turner J. Perceptions, attitudes, and cultural understandings of mental health in Nigeria: a scoping review of published literature. Ment Health Relig Cult. 2020;23(7):606-24.
[20]. Barrow E, Thomas G. Exploring perceived barriers and facilitators to mental health help-seeking in adolescents: a systematic literature review. Educ Psychol Pract. 2022;38(2):173-93. https://doi.org/10.1080/02667363.2022.2051441.
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[26]. Rod N, Davies M, de Vries T, et al. Young adulthood: a transitional period with lifelong implications for health and wellbeing. BMC Glob Public Health. 2025;3:25. https://doi.org/10.1186/s44263-025-00148-8
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Beyond Attendance: Drivers of Delayed and Discontinued Antenatal Care in Karisimbi Health Zone, Eastern DRC; a Triangulated Qualitative StudyAuthor: David Munganga KasekeDOI: 10.21522/TIJAR.2014.13.03.Art012
Beyond Attendance: Drivers of Delayed and Discontinued Antenatal Care in Karisimbi Health Zone, Eastern DRC; a Triangulated Qualitative Study
Abstract:
In unstable urban environments such as Karisimbi in the eastern of the Democratic Republic of Congo (DRC), timely access and completion of antenatal care (ANC) remains challenging. To explore how women, community leaders, and health providers in Karisimbi Health Zone understand the delayed and incomplete ANC use. We conducted a triangulated qualitative study. 64 participants were purposively enrolled: 51 women delivered in the previous 12 months, 7 healthcare providers, 5 religious leaders, and 1 community leader. Data was collected through focal group discussion and in-depth interviews in Swahili and French depending on the preference of the participants. Data was recording, transcribed, translated in English and imported in Nvivo15 for thematic framework analysis and triangulation. Six themes were identified: ANC as a valued but not always urgent service, cumulative cost of seeking care, livelihood and waiting time, social judgment, service experience, and household and community support. Delayed and incomplete ANC use was shaped by interacting with financial, social, and health-system constraints, including care-related costs and income loss; low perceived need without symptoms; fear of social judgment, provider reception, and trust; and limited household or community support. Improving uptake requires integrated action on affordability, quality of care, trust, and community support.
Beyond Attendance: Drivers of Delayed and Discontinued Antenatal Care in Karisimbi Health Zone, Eastern DRC; a Triangulated Qualitative Study
References:
[1]. Tunçalp Ö, Pena-Rosas JP, Lawrie T, Bucagu M, Oladapo O, Portela A, et al. WHO recommendations on antenatal care for a positive pregnancy experience—going beyond survival. BJOG. 2017;124(6):860-2. https://doi.org/10.1111/1471-0528.14599
[2]. World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience. Geneva: World Health Organization; 2016. Available from: https://iris.who.int/handle/10665/250796
[3]. Abdiwali SA, Adesina OA, Fekadu GA, Geta TG. Barriers and facilitators to antenatal care services utilisation in Somaliland: a qualitative study. BMJ Open. 2024;14(11):e085073. https://doi.org/10.1136/bmjopen-2024-085073
[4]. Gage A, Conrad M, Knight M, Banke-Thomas A, Bintz C, Bienhoff K, et al. Measuring antenatal care timing and content across 131 low-income and middle-income countries, 1995-2023: a systematic analysis of trends. Lancet Glob Health. 2026;14(5):e702-13. https://doi.org/10.1016/S2214-109X(26)00010-0
[5]. World Health Organization. Trends in maternal mortality 2000 to 2023: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division. Geneva: World Health Organization; 2025. Available from: https://www.who.int/publications/i/item/9789240108462
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Acceptance Without Adherence: Health System Bottlenecks and Residual Vaccine Hesitancy in Maternal and Child Healthcare Utilisation in Kwara State, NigeriaAuthor: Eyitayo Ebenezer EmmanuelDOI: 10.21522/TIJAR.2014.13.03.Art013
Acceptance Without Adherence: Health System Bottlenecks and Residual Vaccine Hesitancy in Maternal and Child Healthcare Utilisation in Kwara State, Nigeria
Abstract:
Caregiver acceptance of routine immunisation in Kwara State, Nigeria, is generally high, yet persistent missed doses and incomplete continuity of maternal–child care signal significant coverage bottlenecks. This study examined utilisation patterns, knowledge, attitudes, and residual hesitancy among 1,173 caregivers of children aged 0–23 months across six Local Government Areas to identify independent predictors of zero-dose status, missed immunisation visits, and suboptimal antenatal care attendance. Data were analysed using SPSS v28. While ANC attendance reached 87.4% and facility delivery 80.4%, only 47.3% of ANC attendees completed at least four visits, and 13.9% reached the eight-contact standard. Despite high vaccine safety perceptions (96.6%), 9.7% of children were zero-dose for Penta-1, and 9.1% of caregivers reported missed immunisation visits. In adjusted models, the strongest protective factor against zero-dose status was receiving immunisation reminders, underscoring the critical role of systematic patient tracking in overcoming service-side barriers. Community rumours discouraging immunisation significantly increased the odds of zero-dose status and missed visits, while urban/peri-urban residence was strongly protective against missed visits. These findings demonstrate that in Kwara State, acceptance is not the binding constraint. Closing the immunisation gap requires reliable system performance, structured reminders, and risk communication that actively engages residual safety concerns through trusted interpersonal channels.
Acceptance Without Adherence: Health System Bottlenecks and Residual Vaccine Hesitancy in Maternal and Child Healthcare Utilisation in Kwara State, Nigeria
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Determinants of Health Communication Quality in Diabetes Management in Bamenda Health District CameroonAuthor: Eyong Manyiyong QueentaDOI: 10.21522/TIJAR.2014.13.03.Art014
Determinants of Health Communication Quality in Diabetes Management in Bamenda Health District Cameroon
Abstract:
Effective communication is essential in diabetes care because it improves patients’ understanding of their condition, treatment adherence, and satisfaction with care. This study assessed communication practices, provider–patient interaction, and barriers affecting perceived communication quality among diabetic patients in the Bamenda Health District, Cameroon. A cross-sectional study involving 149 diabetic patients was conducted using structured questionnaires. Data were analyzed using descriptive statistics, Pearson’s correlation, one-way ANOVA, and multivariate regression techniques. Findings showed that 86% of participants reported that healthcare providers frequently used simple and understandable language (p < 0.001), while only 15% experienced the explain-back method (p = 0.007). Although 57% perceived providers as empathetic (p < 0.001), only 35.6% reported active involvement in decision-making. Significant positive relationships existed between perceived communication quality and receiving regular updates (r = 0.407, p < 0.001), consideration of patient emotions (r = 0.344, p < 0.001), opportunities to ask questions (r = 0.295, p < 0.001), use of visual aids (r = 0.240, p = 0.003), and encouragement of self-care practices (r = 0.262, p = 0.001). One-way ANOVA revealed significant effects of provider–patient interaction factors such as consultation time, active listening, and compassion (p < 0.001). Multivariate analysis identified the use of visual aids (β = 0.050, p = 0.030) and adequate consultation time (β = 0.087, p = 0.014) as positive predictors of communication quality, whereas time constraints negatively affected communication (β = -0.081, p = 0.009).
Determinants of Health Communication Quality in Diabetes Management in Bamenda Health District Cameroon
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Assessing Knowledge and Awareness of HIV Pre-exposure Prophylaxis (PrEP) Among University Students in Nkurenkuru Town, NamibiaAuthor: Sebastien Tshipamba NjilaDOI: 10.21522/TIJAR.2014.13.03.Art015
Assessing Knowledge and Awareness of HIV Pre-exposure Prophylaxis (PrEP) Among University Students in Nkurenkuru Town, Namibia
Abstract:
Pre-exposure prophylaxis (PrEP) is an effective biomedical strategy for preventing HIV transmission; however, its impact depends on adequate awareness, understanding, and willingness to use it, particularly among vulnerable groups such as university students. Evidence on PrEP awareness in semi-rural settings like Nkurenkuru Town, Namibia, remains limited. This cross-sectional study, conducted from January to December 2023 among 200 university students, used a structured self-administered questionnaire, with data analyzed using descriptive statistics and chi-square tests. Findings revealed low awareness, with only 25% of participants having heard of PrEP and just 10% demonstrating adequate knowledge of its use. Digital platforms (38.5%) and healthcare workers (30.5%) were the main information sources. Despite limited awareness, 72.5% of students expressed willingness to use PrEP if recommended by a healthcare professional. A significant association was found between prior awareness and willingness to use PrEP, with higher acceptance among those aware of it (90.0%) compared to those unaware (66.7%) (χ²=13.67, p=0.008). Although better knowledge was associated with greater willingness (90.0% vs. 70.6%), this was not statistically significant (χ²=3.41, p=0.065). Overall, while willingness to use PrEP is high, awareness and knowledge remain insufficient, highlighting the need for targeted educational interventions and increased involvement of healthcare providers to improve uptake among university students.
Assessing Knowledge and Awareness of HIV Pre-exposure Prophylaxis (PrEP) Among University Students in Nkurenkuru Town, Namibia
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Effectiveness of Community-based Distribution Methods of HIV Self-Test Kits among Female Sex Workers (FSWs) in Lagos State, NigeriaAuthor: John-Dada, IDOI: 10.21522/TIJAR.2014.13.03.Art016
Effectiveness of Community-based Distribution Methods of HIV Self-Test Kits among Female Sex Workers (FSWs) in Lagos State, Nigeria
Abstract:
Community-based distribution method of HIV self–test kits is one of the distribution methods for HIV self -test uptake among Female Sex Workers (FSWs) in Nigeria. Yet it seems that understanding of its effectiveness and uptake has been on the margins among key populations (KPs) such as FSWs. To fill this gap, a cross-sectional comparative design with 375 FSWs, comprising 143 urban and 232 semi-urban residents in Lagos State, was measured and compared between the two groups to ascertain the effectiveness of the community-based distribution method of HV Self Testing (HIVST) uptake and how it could promote and sustain a long-term health care system in the context of HIVST uptake. Data for this study were collected using a structured questionnaire and analyzed using SPSS. The key finding showed that overall, 86% of both urban and semi-urban participants affirmed the effectiveness of community-based distribution methods of HIVST. The main reasons included non-stigmatization, lack of discrimination, regard for FSWs, confidentiality, and cost-effective uptake. Statistical analysis revealed significant differences between community-based and other distribution models (p < 0.05). However, minimal awareness of community-based distribution was identified. In the alternative, the study shows that intervention to redress this challenge can promote and sustain the effectiveness of community-based HIVST distribution, contribute valuable information to the field of HIV prevention and care, offer insights that can inform targeted approaches to enhance HIV testing uptake, meet the health needs of FSWs living with HIV, thereby mitigating the spread of the disease and contributing to improved health conditions.
Effectiveness of Community-based Distribution Methods of HIV Self-Test Kits among Female Sex Workers (FSWs) in Lagos State, Nigeria
References:
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[9]. National Agency for the Control of AIDS (NACA). New survey results indicate that Nigeria has an HIV prevalence of 1.3% [Internet]. 2025. Available from: https://naca.gov.ng/Nigeria-prevalence-rate/
[10]. World Health Organization. HIV Self-Testing: Key Questions, Answers, and Messages for Community Organizations. Geneva: WHO; 2023. Available from: https://iris.who.int/bitstream/handle/10665/273771/WHO_CDS-HIV_18.23-eng.pdf
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Factors Influencing the Management of Type 2 Diabetes among Patients at the Nylon District Hospital in Douala, CameroonAuthor: Fankep Dihewou Alphonse BertinDOI: 10.21522/TIJAR.2014.13.03.Art017
Factors Influencing the Management of Type 2 Diabetes among Patients at the Nylon District Hospital in Douala, Cameroon
Abstract:
Type 2 diabetes mellitus (T2DM) is one of the leading chronic non-communicable diseases worldwide and constitutes a major public health problem in low- and middle-income countries. Poor therapeutic adherence, inadequate nutritional practices, limited communication, and socioeconomic constraints significantly affect the management of this condition. This study aimed to identify the factors influencing the management of type 2 diabetes among patients attending the Nylon District Hospital in Douala, Cameroon. A descriptive cross-sectional study was conducted from November 2024 to July 2025 among 200 patients diagnosed with T2DM. Data were collected using a structured questionnaire after informed consent and analyzed using Microsoft Excel, Epi Info, and RStudio software. Results revealed that males represented 62% of participants while patients aged above 60 years constituted 63% of respondents. About 34% of respondents regularly consumed alcohol, while 19% had never participated in any diabetes education program. Furthermore, 63% perceived healthcare personnel as inaccessible or aggressive, and 81% had previously interrupted treatment. Financial constraints, inadequate communication on diabetes, and poor adherence to dietary recommendations were among the major barriers identified. The findings suggest that improving therapeutic education, strengthening communication strategies, and facilitating access to medication could significantly improve the outcomes of diabetes management.
Factors Influencing the Management of Type 2 Diabetes among Patients at the Nylon District Hospital in Douala, Cameroon
References:
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Consumption of Food Groups During Pregnancy and Adverse Pregnancy Outcomes among Women Attending Public Hospitals in Gambella Town, Southwest EthiopiaAuthor: Gatjiek Tut WieDOI: 10.21522/TIJAR.2014.13.03.Art018
Consumption of Food Groups During Pregnancy and Adverse Pregnancy Outcomes among Women Attending Public Hospitals in Gambella Town, Southwest Ethiopia
Abstract:
Diets with limited food groups during pregnancy remain a significant predictor of maternal anemia, hypertensive disorders in pregnancy (HDP), preterm delivery (PTD), and low birth weight (LBW). Unbalanced dietary practices remain persistent in low- and middle-income countries, including Ethiopia. This study aimed to compare the risks of adverse pregnancy outcomes between pregnant women who consumed and did not consume specific food groups among women attending public hospitals in Gambella Town, Southwest Ethiopia. An institution-based prospective cohort study was conducted among 254 pregnant women enrolled and followed from July 25, 2024, to March 10, 2025, at public hospitals. Data were collected using a structured questionnaire administered by an interviewer. Food group consumption was assessed twice using a 24-hour dietary recall. Modified Poisson regression models were used to estimate risk ratios and 95% confidence intervals. Of the 254 enrolled women, 232 completed the follow-up (response rate: 91.3%). Lack of consumption of the other vitamin A-rich vegetables, fruit, roots, and tubers was significantly associated with a higher risk of low maternal hemoglobin (ARR = 1.959; 95% CI = 1.073–3.575, P = 0.006). However, HDP, PTD, and LBW were not associated with the consumption of any food groups. Lack of consumption of other vitamin A-rich vegetables, fruits, roots, and tubers was associated with a higher risk of low maternal hemoglobin. Improving antenatal nutrition counseling and education on consuming a variety of food groups, as well as addressing the social determinants that affect intake of food groups, is essential for enhancing pregnancy outcomes.
Consumption of Food Groups During Pregnancy and Adverse Pregnancy Outcomes among Women Attending Public Hospitals in Gambella Town, Southwest Ethiopia
References:
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[27]. Wang W, Xie X, Yuan T, Wang Y, Zhao F, Zhou Z, et al. Epidemiological trends of maternal hypertensive disorders of pregnancy at the global, regional, and national levels: a population-based study. BMC Pregnancy Childbirth. 2021;21:364. https://doi.org/10.1186/s12884-021-03809-2
[28]. Datta BK, Husain MJ, Kostova D. Hypertension in women: the role of adolescent childbearing. BMC Public Health. 2021;21(1):1-14. https://doi.org/10.1186/s12889-021-11488-z
[29]. Meazaw MW, Chojenta C, Muluneh MD, Loxton D. Factors associated with hypertensive disorders of pregnancy in sub-Saharan Africa: a systematic review and meta-analysis. PLoS One. 2020;15(8):e0237476. https://doi.org/10.1371/journal.pone.0237476
[30]. Fite MB, Tura AK, Yadeta TA, Oljira L, Wilfong T, Mamme NY, et al. Co-occurrence of iron, folate, and vitamin A deficiency among pregnant women in eastern Ethiopia: a community-based study. BMC Nutr. 2023;9:72. https://doi.org/10.1186/s40795-023-00724-x
[31]. Jugha VT, Anchang JA, Sofeu-Feugaing DD, Taiwe GS, Kimbi HK, Anchang-Kimbi JK. Dietary micronutrient intake and its effect on haemoglobin levels of pregnant women for clinic visit in the Mount Cameroon health area: a cross-sectional study. Front Nutr. 2024;11:1341625. https://doi.org/10.3389/fnut.2024.1341625
[32]. Mulugeta SS. Geographical disparities and determinants of adherence to iron folate supplementation among pregnant women in Ethiopia: spatial and multilevel analysis of the Ethiopian Mini Demographic and Health Survey of 2019. BMJ Open. 2022;12(9):e061900. https://doi.org/10.1136/bmjopen-2022-061900
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[37]. Nisak SK, Nadhiroh SR. Relationship of mid-upper arm circumference measure (MUAC) in pregnant women to the incidence of low birth weight (LBW): systematic review. Media Gizi Kesmas. 2024;13(1):512-20. https://doi.org/10.20473/mgk.v13i1.2024.512-520
[38]. Ambreen S, Yazdani N, Alvi AS, Qazi MF, Hoodbhoy Z. Association of maternal nutritional status and small for gestational age neonates in peri-urban communities of Karachi, Pakistan: findings from the PRISMA study. BMC Pregnancy Childbirth. 2024;24(1):1-8. https://doi.org/10.1186/s12884-024-06420-3
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The Influence of Multi-stakeholder Health Promotion Interventions on Maternal and Infant Mortality Outcomes in Lagos State, NigeriaAuthor: Bolajoko Esther OgunwaleDOI: 10.21522/TIJAR.2014.13.03.Art019
The Influence of Multi-stakeholder Health Promotion Interventions on Maternal and Infant Mortality Outcomes in Lagos State, Nigeria
Abstract:
Maternal and infant mortality rates in peri-urban Lagos State, Nigeria, persist at critically elevated levels despite improvements in health infrastructure. In the Epe and Ibeju Lekki Local Government Areas (LGAs), a trust deficit rooted in sociocultural disconnection between formal health systems and community governance structures drives high rates of unbooked deliveries and late-stage obstetric emergencies. This study evaluates the influence of a structured Multi-Stakeholder Health Promotion Intervention (MSHPI) on maternal health service utilization, emphasizing the roles of traditional leaders, religious authorities, male household decision-makers, and narrative media in driving behavioural change. A convergent parallel mixed-methods design was employed. A structured questionnaire was administered to 500 women of reproductive age (15 to 49 years) across Epe and Ibeju Lekki LGAs using multi-stage stratified sampling, with data analyzed via logistic regression and Chi-square tests. Qualitative data from 25 Key Informant Interviews and 4 Focus Group Discussions were analyzed through thematic content analysis. Results revealed that women receiving antenatal care (ANC) counselling endorsed by traditional rulers were 3.42 times more likely to book care in the first trimester (OR = 3.42; 95% CI: 2.15, 5.43; p < 0.001). Husband's approval was the strongest individual predictor of skilled birth attendance (OR = 4.42; p < 0.001). Exposure to the 'Man of the House' edutainment intervention produced a 68.4% increase in facility-based deliveries (p = 0.004). Postnatal care uptake remained critically low at 29.6%. Integrating traditional, religious, and male stakeholders into a coordinated advocacy framework significantly improves health-seeking behaviour, highlighting the value of institutionalizing Community Health Advocacy Councils.
The Influence of Multi-stakeholder Health Promotion Interventions on Maternal and Infant Mortality Outcomes in Lagos State, Nigeria
References:
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[8]. Lagos State Health Service Commission. Strategic guidelines for community health promotion in Lagos State. Lagos: LSHSC; 2024.
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[12]. Okonofua FE, Ntoimo LFC, Ogungbangbe J, Anjorin S, Imongan W, Yaya S. Predictors of men's attitude to women's use of skilled pregnancy care in rural Nigeria. BMC Pregnancy Childbirth. 2018;18(1):64.
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[15]. Olamijulo JA, Olorunfemi G, Tijani M. Trends and causes of maternal mortality at the Lagos University Teaching Hospital. BMC Pregnancy Childbirth. 2022;22(1):215.
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Barriers to Early Detection of Chronic Diseases among University Students in Nigeria: Evidence from a Cross-Sectional SurveyAuthor: Taiwo AkhigbeDOI: 10.21522/TIJAR.2014.13.03.Art020
Barriers to Early Detection of Chronic Diseases among University Students in Nigeria: Evidence from a Cross-Sectional Survey
Abstract:
Chronic diseases are more than ever affecting young adults in developing countries and countries in the middle and low-income regions. Although early screening is vital for detecting such diseases, the participation rate among Nigerian university students in this screening is low. This study aimed to identify challenges in the early detection of chronic diseases among tertiary school students. A cross-sectional survey was conducted among 500 undergraduate students at a college in Nigeria. Data collection utilised structured, self-administered questionnaires that collected information on socio-demographic characteristics, awareness of conditions, risk perception, and barriers to screening. The analysis used descriptive statistics and chi-square tests at the 5% significance level. Of those who answered: 88.6% known about chronic diseases; only 40.2% understood enough; only 35.8% believed they were at risk. Key barriers included low susceptibility perception (64%), financial constraint (58.4%), fear of being diagnosed (55.2%), lack of screening services provided (52.6%), and lack of awareness of these services (49.8%). Institutional barriers, including long waiting time (46.2%) and limited on-campus health service (44%), were also observed. While many university students are aware of various chronic diseases, perceptions of risk with several structural issues are insufficient to allow for early detection. Enhancements of health education initiatives, improved availability of screening services, and supportive policy measures are all urgent issues. Chronic diseases, early detection, screening barriers, university students, Nigeria.
Barriers to Early Detection of Chronic Diseases among University Students in Nigeria: Evidence from a Cross-Sectional Survey
References:
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[16]. Coker OS, Akyala AI, Coker RB. Cardiovascular disease knowledge, risk perception, and lifestyle behaviors among university students in North-Central Nigeria: a cross-sectional study. BMC Public Health. 2025. https://doi.org/10.1186/s12889-025-26071-z
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Assessment of Knowledge, Attitude and Practice toward Medical Waste Management among Healthcare Workers in Wau, Western Bahr El Ghazal State, South Sudan: Evidence for ActionAuthor: Emmanuel Aban NyilekDOI: 10.21522/TIJAR.2014.13.03.Art021
Assessment of Knowledge, Attitude and Practice toward Medical Waste Management among Healthcare Workers in Wau, Western Bahr El Ghazal State, South Sudan: Evidence for Action
Abstract:
Medical waste contains potentially harmful materials is a public health problem worldwide. This study describes knowledge, attitudes, and practices towards medical waste management among healthcare workers from selected healthcare facilities in Wau. A cross-sectional, descriptive, and mixed-approach study was conducted among 135 healthcare workers randomly selected from 14 healthcare facilities. A pre-tested, structured questionnaire, key informant interviews, and observation checklist were used to collect the intended data. Descriptive and thematic analyses were performed. Findings were presented using tables, graphs, pie charts, and quotes.Of 135 respondents, 55% (n=74) were females and 45% (n=61) were males. The majority, 91% (n=123), had good knowledge about medical waste management. Healthcare workers at primary healthcare and government facilities had slightly better knowledge compared to those at hospitals or private facilities. 74% (n=100) had a positive attitude and perceived medical waste management as a priority. Regarding practices 47% were unvaccinated against work-related illnesses, used gloves (58.5%) and overalls (24.4%) as personal protective equipment. Healthcare workers were found having good knowledge, positive attitudes, and fair practices. Thus, continuous training on medical waste management, awareness, vaccination, provision of adequate personal protective equipment, and supply of waste management facilities are required to improve the health and wellbeing of both patients and healthcare workers.
Assessment of Knowledge, Attitude and Practice toward Medical Waste Management among Healthcare Workers in Wau, Western Bahr El Ghazal State, South Sudan: Evidence for Action
References:
[1]. Rahman Shabur M, Siddique AB. Solid waste management in an urban community of a developing country: An overview of 5 Rs strategies. World Dev Sustain. 2025;7:100254. Available from: https://doi.org/10.1016/j.wds.2025.100254
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[3]. Kmentt L, Cronk R, Tidwell JB, Rogers E. Water, sanitation, and hygiene (WASH) in healthcare facilities of 14 low- and middle-income countries: To what extent is WASH implemented and what are the drivers of improvement in their service levels? H2Open J. 2021;4(1):130. doi:10.2166/h2oj.2021.095. Accessed May 2026.
[4]. World Health Organization. WHO handed over first-ever medical waste management to South Sudan's Ministry of Health. Available from: https://www.afro.who.int/countries/south-sudan/news/who-handed-over-first-ever-medical-waste-management-south-sudans-ministry-health. Accessed September 3, 2023.
[5]. Babanyara Y, Ibrahim D, Garba T, Bogoro A, Abubakar M. Poor medical waste management (MWM) practices and its risks to human health and the environment: A literature review. World Acad Sci Eng Technol Int J Environ Ecol Geol Geophys Eng. 2013;7(11).
[6]. United Nations Environment Programme. Health and Safety Guidelines for Waste Pickers in South Sudan. 2013. Available from: https://wedocs.unep.org/handle/20.500.11822/19536
[7]. Asomugha AU, Benjamin N, Kiss I. Knowledge, attitude and practice of healthcare workers towards medical waste management: A comparative study of two geographical areas. J Waste Manag Dispos. 2022;5(1):101.
[8]. Namutebia I, Nanyunja Z. Knowledge, attitudes and practices towards medical waste management among health workers at Mityana District Hospital, Mityana District: A cross-sectional descriptive survey. Student's J Health Res. 2016.
[9]. Mugabi B, Hattingh S, Chima SC. Assessing knowledge, attitudes, and practices of healthcare workers regarding medical waste management at a tertiary hospital in Botswana: A cross-sectional quantitative study. Niger J Clin Pract. 2018.
[10]. Abah SO, Ohimain EI. Healthcare waste management in Nigeria: A case study. J Public Health Epidemiol. 2011;3(3):99-110.
[11]. Suram S, Rudra VG, Miryala RK, Parin NR. Knowledge, attitude, and practices toward biomedical waste management among healthcare workers. Asian J Water Environ Pollut. 2025;22(5):204-213. doi:10.36922/AJWEP025090058.
[12]. Mane V, Nimbannavar SM, Yuvaraj BY. Knowledge, attitude and practice of biomedical waste and its management among healthcare workers at a tertiary care hospital, Karnataka, India. Int J Community Med Public Health. 2016;3:2953-2957.
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[14]. Bouzid M, Cumming O, Hunter PR. What is the impact of water sanitation and hygiene in healthcare facilities on care seeking behaviour and patient satisfaction? A systematic review of the evidence from low-income and middle-income countries. BMJ Glob Health. 2018;3:e000648.
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[17]. Olaniyi F, Ogola J, Tshitangano T. Challenges of effective management of medical waste in low-resource settings: Perception of healthcare workers in Vhembe district healthcare facilities, South Africa. Trans R Soc S Afr. 2021;76(1):81-88. Available from: https://doi.org/10.1080/0035919X.2021.1900949
[18]. Buxton H, Flynn E, Oluyinka O, Cumming O, Esteves Mills J, Shiras T, et al. Barriers and opportunities experienced by staff when implementing infection prevention and control guidelines during labour and delivery in healthcare facilities in Nigeria. J Hosp Infect. 2019;103(4):428-434.
[19]. Maina M, Tosas-Auguet O, McKnight J, Zosi M, Kimemia G, Mwaniki P, et al. Extending the use of the World Health Organization's Water Sanitation and Hygiene Assessment Tool for surveys in hospitals: From WASH-FIT to WASH-FAST. PLoS One. 2019;14(12):e0226548.
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Impact of a Mobile Application-Based Intervention on Mental Health and Stress Coping Strategies among Nurses: A Randomized Controlled TrialAuthor: Shyna NoronhaDOI: 10.21522/TIJAR.2014.13.03.Art022
Impact of a Mobile Application-Based Intervention on Mental Health and Stress Coping Strategies among Nurses: A Randomized Controlled Trial
Abstract:
Health is wealth. Nurses serve as the backbone of the healthcare system. Yet, the demanding nature of clinical practice - including extended working hours, rotational shifts, low payrolls, emotional strain, and continuous exposure to occupational stressors - significantly affects their mental well-being and professional efficiency. This study aimed to evaluate the effectiveness of a mobile application-based intervention in enhancing mental health and reducing stress among nurses employed in tertiary care hospitals. A pre-test and post-test parallel-group design was adopted among 36 registered nurses selected through simple random sampling in Mangalore, Karnataka, India. Participants were allocated into intervention and control groups, with the intervention group receiving the wellness-focused mobile application for one month while the control group received standard information. Data were collected using validated instruments, including the WHO-5 Well-Being Index, Perceived Stress Scale (PSS-4), and Brief COPE Inventory. Statistical analysis incorporated descriptive and inferential measures such as paired t-tests, independent t-tests, and chi-square tests. Between-group comparisons at post-test showed that the intervention group had significantly lower stress scores and significantly higher coping scores than the control group, while mental health scores improved significantly within the intervention group over time but did not differ significantly from the control group at post-test, likely reflecting the modest sample size. These findings indicate that digital mental health strategies can meaningfully reduce stress and strengthen coping abilities among nurses, supporting further investigation of their potential to improve broader psychological well-being. This research study concludes that mobile application-based interventions offer an innovative, accessible, and cost-effective solution to enhancing mental health, stress management, and emotional well-being among nurses in healthcare settings.
Impact of a Mobile Application-Based Intervention on Mental Health and Stress Coping Strategies among Nurses: A Randomized Controlled Trial
References:
[1]. Shivesprasad AH. Work-related stress among nurses. J Psychiatr Nurs. 2013;2(3):85-9.
[2]. Sharma P, et al. Occupational stress among staff nurses: controlling the risk to health. Indian J Occup Environ Med. 2014;18(2):52-6.
[3]. Adriaenssens J, De Gucht V, Maes S. Determinants and prevalence of burnout in emergency nurses: a systematic review of 25 years of research. Int J Nurs Stud. 2015;52(2):649-61.
[4]. Proudfoot J. The future is in our hands: the role of mobile phones in the prevention and management of mental disorders. Aust N Z J Psychiatry. 2013;47(2):111-3.
[5]. Watanabe K, et al. Effectiveness of a smartphone-based stress management program for depression in hospital nurses during COVID-19 in Vietnam and Thailand: 2-arm parallel-group randomized controlled trial. J Med Internet Res. 2024;26:e50071.
[6]. Linardon J, et al. Efficacy of mental health smartphone apps on stress levels: a meta-analysis of randomised controlled trials. Health Psychol Rev. 2024;18(4):839-52.
[7]. Firth J, et al. The efficacy of smartphone-based mental health interventions for depressive symptoms: a meta-analysis of randomized controlled trials. World Psychiatry. 2017;16(3):287-98.
[8]. Pai Vernekar S, Shah H. A study of work-related stress among nurses in a tertiary care hospital in Goa. Int J Community Med Public Health. 2018;5(2):657-61.
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[10]. Jordan TR, Khubchandani J, Wiblishauser M. The impact of perceived stress and coping adequacy on the health of nurses: a pilot investigation. Nurs Res Pract. 2016;2016:5843256.
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[12]. Kumar CN, Manjunatha N, Math SB. A multi-state digital initiative in India aimed at improving primary mental healthcare through planning, execution, and gathering insights. Indian J Psychol Med. 2025;48(1 Suppl):02537176251393490.
[13]. Tamminga SJ, et al. Individual-level interventions for reducing occupational stress in healthcare workers. Cochrane Database Syst Rev. 2023;(5).
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[15]. Babapour AR, Gahassab-Mozaffari N, Fathnezhad-Kazemi A. Nurses' job stress and its impact on quality of life and caring behaviors: a cross-sectional study. BMC Nurs. 2022;21(1):75.
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Household, Faith, and Community Support as Enablers of Antenatal Care Completion in a Fragile Urban Setting of Eastern Democratic Republic of CongoAuthor: David Munganga KasekeDOI: 10.21522/TIJAR.2014.13.03.Art023
Household, Faith, and Community Support as Enablers of Antenatal Care Completion in a Fragile Urban Setting of Eastern Democratic Republic of Congo
Abstract:
Antenatal care (ANC) completion is influenced by health-service factors as well as household and community support systems. This study examined whether partner encouragement, faith-leader messages, religious activities and participation in women’s or community groups were associated with ANC completion among host community women in Karisimbi. A cross-sectional analysis was conducted using data from 715 eligible women who had given birth in the past 12 months and were selected through multistage household sampling. The main outcome were completion of at least four ANC contacts (ANC4+) and a minimum of eight ANC contacts (ANC8+). Key explanatory variables included partner encouragement, exposure to faith-leader messages promoting ANC, frequency of religious activities and participation in women’s or community groups. Multivariable logistic regression models were used, adjusting for maternal age, education, household assets, and access-related barriers. ANC4+ completion was 65.8%, while ANC8+ completion was 6.0%. In adjusted models, partner encouragement was associated with higher odds of ANC4+ completion (AOR 3.66; 95% CI 2.32-5.77), as was exposure to faith-leader ANC messages (AOR 2.03; 95% CI 1.13-3.63). Women/community group participation was positively but not significantly associated with ANC8+ completion (AOR 2.27; 95% CI 0.71-7.28). Partner encouragement and faith-leader communication may serve as practical entry points for improving ANC continuity in Karisimbi. Maternal health interventions in fragile urban settings should strengthen household and faith-community engagement to support sustained ANC attendance.
Household, Faith, and Community Support as Enablers of Antenatal Care Completion in a Fragile Urban Setting of Eastern Democratic Republic of Congo
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Clinical Profile and Predictors of Childhood Overweight Following In-Utero Exposure to Gestational Diabetes Mellitus: A Retrospective Cohort Study in GuyanaAuthor: Samantha N.A. KennedyDOI: 10.21522/TIJAR.2014.13.03.Art024
Clinical Profile and Predictors of Childhood Overweight Following In-Utero Exposure to Gestational Diabetes Mellitus: A Retrospective Cohort Study in Guyana
Abstract:
Children exposed to gestational diabetes mellitus (GDM) in utero are at increased long-term risk of obesity and dysglycaemia, yet Caribbean data remain scarce. This retrospective cohort analysis characterised the clinical profile and examined predictors of abnormal body mass index (BMI) among GDM-exposed children in Guyana. Perinatal data were extracted from the records of 33 mothers diagnosed with GDM during the index pregnancy (January–June 2017); informed consent was then obtained and structured maternal telephone interviews ascertained current child parameters. Anthropometric status was classified using the United States Centers for Disease Control and Prevention (CDC) BMI-for-age reference. Associations with overweight/obesity were assessed using Fisher’s exact test (with unadjusted odds ratios [OR] and 95% confidence intervals [CI]), the Mann–Whitney U test and the Spearman rank correlation. Overall, 13 children (39.4%, 95% CI 24.7–56.3) were overweight or obese and 5 (15.2%) were obese, while 8 (24.2%) had been macrosomic at birth. No factor was a statistically significant independent predictor of overweight/obesity. The strongest, non-significant signals were a higher number of daily meals (OR 5.62, 95% CI 0.89–35.39; p = 0.084) and lower birth weight (OR 3.43, 95% CI 0.73–16.09; p = 0.139); girls had a higher median BMI than boys (17.9 vs 16.6 kg/m²; p = 0.169). Birth weight was not positively correlated with current BMI (ρ = −0.18; p = 0.33). This exploratory, underpowered analysis supports routine longitudinal surveillance of GDM-exposed children and adequately powered comparative studies to inform maternal and child health policy in Guyana.
Clinical Profile and Predictors of Childhood Overweight Following In-Utero Exposure to Gestational Diabetes Mellitus: A Retrospective Cohort Study in Guyana
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Governance Quality, Institutional Stability, and Child Stunting in Sub-Saharan Africa: A Multi-Country Analysis of SDG 16 Pathways, 2015–2024Author: Eveline NgwenyiDOI: 10.21522/TIJAR.2014.13.03.Art025
Governance Quality, Institutional Stability, and Child Stunting in Sub-Saharan Africa: A Multi-Country Analysis of SDG 16 Pathways, 2015–2024
Abstract:
Child stunting affects over 66 million children in sub-Saharan Africa (SSA), representing 60% of the global burden. While food insecurity, poverty, and climate shocks explain part of this burden, the governance mechanisms linking institutional quality to malnutrition outcomes remain poorly quantified. This study examines whether and through which pathways governance quality and institutional stability (SDG 16) influence child stunting prevalence across 49 SSA countries over the period 2015–2024. Using an unbalanced cross-sectional dataset combining UNICEF/WHO/World Bank Joint Malnutrition Estimates, World Bank Worldwide Governance Indicators (WGI), and 20+ SDG proxy indicators, we employed a series of six nested ordinary least squares (OLS) regression models with progressive covariate adjustment, complemented by principal component analysis (PCA) for governance index construction and k-means clustering for country typology. Results indicate that the composite governance index (ICOMP_GOV_ACP) explains 46.5% of stunting variance in baseline models (M1: R²adj=0.465, F=21.870, p<0.001), but this effect is fully mediated in the parsimonious model (M5: R²adj=0.643, F=21.283, p<0.001) by three proximal determinants: skilled birth attendance (SBA_LAST, β=−0.414, p=0.002), food insecurity (FIES_LAST, β=+0.325, p=0.091), and electricity access (ELEC_LAST, β=−0.327, p=0.116). These findings establish governance as a distal determinant operating through service-delivery pathways, with implications for integrated SDG 16–2–3–7 policy strategies. We accordingly recommend that governance investments be systematically paired with targeted food security programmes and expansion of skilled birth attendance coverage to achieve meaningful reductions in stunting prevalence across sub-Saharan Africa.
Governance Quality, Institutional Stability, and Child Stunting in Sub-Saharan Africa: A Multi-Country Analysis of SDG 16 Pathways, 2015–2024
References:
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Health Consequences and Intimate Partner Relationships of Women with Genital Mutilation Experiences: A Cross-Sectional Comparative Study in South-East NigeriaAuthor: Chioma OliverDOI: 10.21522/TIJAR.2014.13.03.Art026
Health Consequences and Intimate Partner Relationships of Women with Genital Mutilation Experiences: A Cross-Sectional Comparative Study in South-East Nigeria
Abstract:
Female genital mutilation (FGM) remains a deeply rooted cultural practice with severe physical and psychological consequences. Despite global eradication efforts, it persists in parts of Nigeria where sociocultural norms override legal and health frameworks. This study explores the lived experiences of women in Eastern Nigeria who have undergone FGM, emphasizing their physical and psychological health outcomes. A comparative mixed-methods design was adopted, involving 300 women aged 18–69 years across six local government areas in Imo and Ebonyi States. Quantitative data were collected using validated instruments PHQ-9, GAD-7, EIS, and PCL-5, and analyzed with descriptive statistics, chi-square tests, and logistic regression. Qualitative insights were derived from seven key informant interviews and two focus group discussions, analyzed through inductive thematic coding using NVivo 12. Women who had undergone FGM reported significantly higher rates of immediate complications such as bleeding, pain, and infection, and long-term sequelae including dyspareunia, menstrual pain, and reduced sexual satisfaction (p < 0.001). Psychological outcomes revealed elevated depressive and anxiety symptoms, with mean PHQ-9 and GAD-7 scores of 17.2 ± 5.1 and 14.9 ± 4.8, respectively, compared to 11.3 ± 4.6 and 9.8 ± 4.2 among women without FGM. Qualitative themes underscored trauma, shame, emotional withdrawal, and relational disconnection, illustrating the interdependence of physical and psychological suffering. FGM continues to impose multidimensional harm on women’s health in Eastern Nigeria. Findings highlight the need for trauma-informed interventions that integrate clinical care, psychosocial support, and community re-education to mitigate both physical and emotional aftermaths. A holistic response combining medical rehabilitation and culturally sensitive counseling is imperative for survivor-centered healing and sustainable eradication efforts.
Health Consequences and Intimate Partner Relationships of Women with Genital Mutilation Experiences: A Cross-Sectional Comparative Study in South-East Nigeria
References:
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Prevalence and Severity of Dyspepsia with its Impact on the Quality of Life among Medical Outpatients in a Tertiary HospitalAuthor: Kanu Joseph EDOI: 10.21522/TIJAR.2014.13.03.Art027
Prevalence and Severity of Dyspepsia with its Impact on the Quality of Life among Medical Outpatients in a Tertiary Hospital
Abstract:
Dyspepsia is a constellation of symptoms in which epigastric pain is the main presentation with a global prevalence of 7% to 45%.The aim of this study was to determine the prevalence and severity of dyspepsia and its effect on the quality of life among medical out-patients at the 34-military hospital. A systematic sampling was conducted to recruit 401 patients; a standard questionnaire used to collect information on patients’ socio-demographic, clinical details, and risk factors of dyspepsia. A Short-form of the Leeds Dyspepsia Questionnaire (SF-LDQ) was used to assess symptoms and severity of dyspepsia. The Short Form Nepean Dyspepsia Index (SF-NDI) was used to assess the impact of dyspepsia on participants’ quality of life. The prevalence of dyspepsia among medical outpatients at the 34 Military Hospital using the Leeds Dyspepsia Questionnaire SF-LDQ was 266(66.3%). Among patients with dyspepsia, 119(44.7%) had severe dyspepsia, 103(38.7%) had moderate dyspepsia, 42(15.8%) had mild dyspepsia, and 2(0.8%) very mild dyspepsia. In multiple linear regression models, dyspepsia as well as dyspepsia severity were significantly associated with patients’ low quality of life QoL(P<0.001).This study revealed a high burden of dyspepsia among medical outpatients as well as an association between dyspepsia, dyspepsia severity and patient QoL. We recommend screening for dyspepsia as well as widening the scope of investigation among a larger patients’ population.
Prevalence and Severity of Dyspepsia with its Impact on the Quality of Life among Medical Outpatients in a Tertiary Hospital
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Modeling Healthcare 4.0 Pathways to Effective and Efficient Universal Health Coverage for Neglected Tropical Diseases in NigeriaAuthor: Yilchini Yilben IshakuDOI: 10.21522/TIJAR.2014.13.03.Art028
Modeling Healthcare 4.0 Pathways to Effective and Efficient Universal Health Coverage for Neglected Tropical Diseases in Nigeria
Abstract:
Healthcare 4.0 technologies are increasingly recognized for their potential to strengthen Universal Health Coverage (UHC), yet the mechanisms through which they influence UHC performance for Neglected Tropical Diseases (NTDs) in resource-constrained settings remain insufficiently modeled. This study develops and empirically tests a socio-technical framework linking Healthcare 4.0 enablers, contextual conditions, and two key UHC performance dimensions, effectiveness and efficiency, in Nigeria. Primary data were collected from 314 experts across NTD, UHC, and digital health domains. A sequential analytical approach was implemented, including Principal Components Analysis, Confirmatory Factor Analysis, and Structural Equation Modeling. The final model demonstrated strong fit (RMSEA = 0.028; SRMR = 0.043; CFI = 0.99; NNFI = 0.99; χ²/df = 1.24), with all structural paths statistically significant (p < 0.001). Two distinct but complementary pathways were identified. Technologies that enable continuous data exchange, ongoing monitoring, and enhanced clinical care, such as cloud computing and the Internet of Things, show stronger associations with effectiveness. In contrast, governance-oriented and computational infrastructures, including blockchain systems and big data analytics, are more closely linked to efficiency. The strength of these relationships varies depending on institutional readiness and broader system alignment. Collectively, the findings position Healthcare 4.0 as an integrated system driver whose effects are pathway-specific and context-dependent. The study provides an empirically grounded basis for designing coordinated digital health strategies aimed at strengthening UHC for NTDs in resource-constrained settings.
Modeling Healthcare 4.0 Pathways to Effective and Efficient Universal Health Coverage for Neglected Tropical Diseases in Nigeria
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Critical Appraisal of Articles on Cross-Border Infrastructure Development in AfricaAuthor: Afolabi O. M.DOI: 10.21522/TIJAR.2014.13.03.Art029
Critical Appraisal of Articles on Cross-Border Infrastructure Development in Africa
Abstract:
Cross-border infrastructure development has become increasingly central to Africa’s regional integration and economic transformation agenda, particularly under frameworks such as the African Continental Free Trade Area (AfCFTA), Agenda 2063, and the Program for Infrastructure Development in Africa (PIDA). This narrative review critically appraised existing literature on cross-border infrastructure development across Africa, focusing on transport corridors, energy networks, trade facilitation systems, financing models, governance structures, and socio-economic implications. The review revealed a broad consensus in the literature that regional infrastructure connectivity can reduce trade costs, improve market accessibility, stimulate industrialization, and strengthen intra-African cooperation. However, the literature remains fragmented across disciplines, regions, and methodological approaches. Existing studies are heavily concentrated in selected countries and sub-regions, while several parts of Central and West Africa remain underexplored. The review further identified an overemphasis on physical infrastructure development with comparatively limited attention given to soft infrastructure components such as institutional coordination, customs harmonization, border governance, and regulatory integration. Significant methodological weaknesses, theoretical inconsistencies, and limited post-implementation evaluations were also observed. In addition, emerging concerns regarding environmental sustainability, climate resilience, community displacement, and uneven socio-economic benefits remain insufficiently addressed in the current literature. Ultimately, the review demonstrates that while Africa has made considerable progress in expanding regional infrastructure networks, the translation of these investments into sustainable and inclusive outcomes of regional integration remains constrained by governance deficiencies, financing challenges, institutional fragmentation, and weak policy coordination. The study highlights the need for more interdisciplinary, context-sensitive, and empirically grounded research to address the complex realities of cross-border infrastructure development in Africa.
Critical Appraisal of Articles on Cross-Border Infrastructure Development in Africa
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[26]. Zimano FR, Ruffin F. Palpable linkage of supply chain performance to hard and soft infrastructure marriage: The case of SADC road entry point management systems. Int J Logist Syst Manag. 2018;30(3):349-365. Available from: https://doi.org/10.1504/IJLSM.2018.092614 (inderscience.com)
[27]. Maurel M, Lapeyronie H, Meunier B. Impact of hard and soft infrastructure: Evidence from the EU partners, North Africa and CEECs. Working Paper P148. FERDI; 2016.
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[30]. Besaiso H, Abualqumboz M, Cheng X. Review of studies on sustainability of public-private partnership projects: A bibliometric analysis. Sustain Dev. 2025;33(S1):1551-1575. Available from: https://doi.org/10.1002/sd.70025
[31]. Quah E, Tan JR, Nursultan I. A comparative analysis of the Belt and Road Initiative with other global and regional infrastructure initiatives: Prospects and challenges. J Risk Financ Manag. 2025;18(6):338. Available from: https://doi.org/10.3390/jrfm18060338
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[35]. Akram KT. Belt and Road Initiative as a catalyst for international cooperation. Hong Kong Rev Belt Road Stud. 2024;2:33-49. Available from: https://doi.org/10.63596/oborjournal.2.2024.33-49
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Navigating the Localization Dilemma: Institutional and Capacity Constraints within South Sudanese Non-Governmental Organizations and Private EnterprisesAuthor: Angelo Lubang Paterno JadaDOI: 10.21522/TIJAR.2014.13.03.Art030
Navigating the Localization Dilemma: Institutional and Capacity Constraints within South Sudanese Non-Governmental Organizations and Private Enterprises
Abstract:
The debate over localization who leads humanitarian work, and on whose terms has grown more contentious even as its rhetoric has grown more consensual. In South Sudan, where decades of armed conflict have left the state unable to deliver basic services and where international agencies control the bulk of humanitarian funding, the localization agenda collides daily with hard institutional realities. This paper examines those collisions directly, treating localization not as a settled good whose implementation merely requires political will, but as a contested process shaped by funding asymmetries, governance gaps, and the legitimate yet often competing interests of local organizations, international NGOs, and the communities they both claim to serve. The study draws on case evidence from Juba, Wau, Bor, Pibor, Malakal, and Bentiu to trace how localization actually unfolds on the ground where it works, where it stalls, and why. The central argument is straightforward: localization in South Sudan will not advance through declarations or Grand Bargain commitments alone. It demands structural changes in the funding architecture, a reduction in the compliance burdens that keep local organizations dependent on international intermediaries, and deliberate investment in local institutional capacity measured in years, not project cycles.
Navigating the Localization Dilemma: Institutional and Capacity Constraints within South Sudanese Non-Governmental Organizations and Private Enterprises
References:
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[4]. Ensor MO. The meaningful participation of women in solving our common crises: Gendered perspectives on climate change and the humanitarian-development-peace nexus. J Peacebuild Dev. 2022;17(3):289-303. Available from: https://doi.org/10.1177/15423166221128178
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Community-Based Support Systems and Health System Gaps Affecting Viral Load Follow-up in Pmtct Programs in Cameroon: A Narrative ReviewAuthor: Egbe Derick AgborDOI: 10.21522/TIJAR.2014.13.03.Art031
Community-Based Support Systems and Health System Gaps Affecting Viral Load Follow-up in Pmtct Programs in Cameroon: A Narrative Review
Abstract:
Viral load monitoring remains an essential component of Prevention of Mother-to-Child Transmission (PMTCT) programs because it supports treatment monitoring, promotes viral suppression, and reduces the risk of HIV transmission from mother to child. However, continuity of viral load follow-up among pregnant and breastfeeding women living with HIV continues to face several challenges in Cameroon. This narrative review examined community-based support systems and health system gaps affecting viral load follow-up within PMTCT programs in Cameroon. A narrative review approach was used to synthesize evidence from quantitative studies, qualitative studies, mixed-method research, technical reports, and policy documents published between 2010 and 2026. Electronic databases including PubMed, Google Scholar, Scopus, African Journals Online, and Web of Science were searched alongside reports from the World Health Organization, UNAIDS, and the Cameroon National AIDS Control Committee. The review identified delayed laboratory result turnaround time, shortage of healthcare personnel, weak patient tracking systems, stigma, transportation difficulties, poor male partner involvement, and insecurity in conflict-affected regions as barriers affecting continuity of viral load monitoring. Community-based interventions such as mentor mother programs, peer support groups, community health worker follow-up, adherence counseling, and mobile phone reminders were found to improve retention in care, adherence to antiretroviral therapy, and continuity of PMTCT follow-up services. The review concludes that strengthening healthcare systems alongside expansion of community-based support interventions may improve viral load follow-up and PMTCT outcomes in Cameroon. Further implementation research is needed to evaluate context-specific approaches for improving continuity of HIV care among pregnant and breastfeeding women.
Community-Based Support Systems and Health System Gaps Affecting Viral Load Follow-up in Pmtct Programs in Cameroon: A Narrative Review
References:
[1]. Joint United Nations Programme on HIV/AIDS. Global AIDS update 2023. Geneva: UNAIDS; 2023. Available from: https://www.unaids.org/en/resources/documents/2023/global-aids-update-2023
[2]. World Health Organization. Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach. Geneva: WHO; 2021. Available from: https://www.who.int/publications/i/item/9789240031593
[3]. Cameroon National AIDS Control Committee. Cameroon HIV strategic information report. Yaoundé: Ministry of Public Health; 2023.
[4]. Fokam J, Takou D, Teto G, et al. Delayed viral load result return and treatment monitoring challenges in Cameroon. PLoS One. 2022;17(4):e0265857.
[5]. World Bank. The socio-economic impact of conflict in Cameroon’s North West and South West regions. Washington (DC): World Bank Group; 2022. Available from: https://www.worldbank.org
[6]. Ndzi ES, Ndziessi G, Fokam J, et al. HIV-related stigma and adherence challenges among women enrolled in PMTCT services in Cameroon. BMC Womens Health. 2019;19(1):145.
[7]. Cataldo F, Sam-Agudu NA, Phiri S, et al. The roles of expert mothers engaged in prevention of mother-to-child transmission programs in sub-Saharan Africa. J Int AIDS Soc. 2017;20(Suppl 6):21685.
[8]. Tchendjou P, Ndziessi G, Same Ekobo A, et al. Retention in PMTCT services and viral suppression among pregnant women living with HIV in Cameroon. Pan Afr Med J. 2021;39:112.
[9]. Penda IC, Moukoko CE, Ndzi ES, et al. Access barriers to PMTCT services in Cameroon. BMC Health Serv Res. 2020;20(1):987. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7643120/
[10]. Nguefack-Tsague G, Tchouangueu TF, Nwobegahay J, et al. Social support and adherence among HIV-positive mothers in Cameroon. BMC Public Health. 2018;18(1):5303.
[11]. Tita AT, Halle-Ekane GE, Mbuagbaw L, et al. Health service barriers affecting HIV care utilization in Cameroon. BMC Public Health. 2020;20(1):8321.
[12]. Waweru LM, Otieno CF, Oti SO, Mbanya JC. Challenges in continuity of HIV and chronic disease care in resource-limited settings. Pan Afr Med J. 2018;29:31.
[13]. Omonaiye O, Kusljic S, Nicholson P, et al. Male partner involvement in prevention of mother-to-child transmission programs in sub-Saharan Africa: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2021;21(1):63.
[14]. Ndziessi G, Cohen CR, Mukamba N, et al. Conflict and continuity of HIV care among pregnant and breastfeeding women in sub-Saharan Africa. AIDS Care. 2022;34(9):1101-9.
[15]. Sama CB, Feteh VF, Tindong M, et al. Cultural beliefs and adherence to HIV care in Cameroon. BMC Health Serv Res. 2021;21(1):84.
[16]. Phiri S, Tweya H, van Lettow M, et al. Impact of mentor mothers on retention in prevention of mother-to-child transmission programs in Malawi. J Int AIDS Soc. 2017;20(1):21692.
[17]. Thomson KA, Cheti EO, Reid T, et al. Health worker shortages and PMTCT service delivery in resource-limited settings. BMC Health Serv Res. 2018;18(1):2879.
[18]. Knettel BA, Cichowitz C, Ngocho JS, et al. Retention in HIV care during pregnancy and the postpartum period in sub-Saharan Africa. J Acquir Immune Defic Syndr. 2018;77(5):427-38.
[19]. Adeniyi OV, Ajayi AI, Ter Goon D, et al. Factors affecting adherence to antiretroviral therapy among pregnant women in South Africa. BMC Infect Dis. 2018;18(1):175.
[20]. Gourlay A, Birdthistle I, Mburu G, et al. Barriers and facilitating factors to the uptake of antiretroviral drugs for prevention of mother-to-child transmission of HIV in sub-Saharan Africa: a systematic review. J Int AIDS Soc. 2013;16(1):18588.
[21]. Nasuuna E, Kigozi J, Babirye L, et al. Challenges affecting viral load monitoring and retention in PMTCT care among pregnant women living with HIV in Uganda. AIDS Res Ther. 2018;15(1):22.
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[27]. Kalisa I, Musabwasoni SMG, Collins A, et al. Male partner involvement and adherence to PMTCT services among women living with HIV in Rwanda. BMC Pregnancy Childbirth. 2021;21(1):321.
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From Black Box to Boardroom: The Significance of Explainable AI (XAI) in Reducing Algorithmic Risk and Rebuilding Confidence in Digital Payment SystemsAuthor: Temitope OnibaniyiDOI: 10.21522/TIJAR.2014.13.03.Art032
From Black Box to Boardroom: The Significance of Explainable AI (XAI) in Reducing Algorithmic Risk and Rebuilding Confidence in Digital Payment Systems
Abstract:
The wide implementation of advanced Machine Learning (ML) models in digital payment systems, especially for fraud detection and credit risk assessment, has substantially improved operational efficiency and transaction security. The inherent opacity, often referred to as the black box character, of these high-performing algorithms poses considerable and mounting issues related to algorithmic fairness, stakeholder trust, and compliance with regulations. This article analyzes the growing strategic significance of Explainable Artificial Intelligence (XAI) as an important governance tool for mitigating algorithmic risk in financial services. The paper exposes how XAI, informed by Agency Theory and Institutional Theory, is not just a technical requirement but an essential institutional mechanism for ensuring regulatory accountability within frameworks like the EU AI Act, restoring public trust and identifying and alleviating systemic algorithmic bias in credit scoring and fraud risk assessment. A conceptual framework is introduced and it illustrates how XAI; using post-hoc interpretation methods such as SHAP (SHapley Additive exPlanations) and LIME (Local Interpretable Model-agnostic Explanations)- bridges the knowledge disparity between intricate AI models and various human stakeholders, including customers, fraud analysts, and regulators. This transformation shifts AI from a hypothetical institutional liability to a responsible, auditable, and governable asset within the digital payment ecosystem. The report concluded by describing key areas for forthcoming empirical research on the organizational problems associated with XAI implementation across various regulatory jurisdictions.
From Black Box to Boardroom: The Significance of Explainable AI (XAI) in Reducing Algorithmic Risk and Rebuilding Confidence in Digital Payment Systems
References:
[1]. Russell SJ, Norvig P. Artificial Intelligence: A Modern Approach. 4th ed. New Jersey: Pearson Education; 2021.
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[3]. Samek W, Wiegand T, Muller KR. Explainable artificial intelligence: Understanding, visualizing and interpreting deep learning models. ITU J ICT Discov. 2017;Special Issue 1:39-48.
[4]. Davis M, Park H. Adoption of AI-augmented payment systems by consumers: Behavioral factors and implications for user experience. Rev Consum Technol. 2023;25(1):34-56.
[5]. Garcia R, Thompson A. A comparative examination of the regulatory frameworks governing artificial intelligence within the financial services industry. Financ Regul Q. 2024;31(2):112-34.
[6]. Mehrabi N, Morstatter F, Saxena N, Lerman K, Galstyan A. A survey on bias and fairness in machine learning. ACM Comput Surv. 2021;54(6):1-35. Available from: https://doi.org/10.1145/3457607
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[8]. Wilson J, Garcia M. Ethical considerations and methodological adjustments concerning access limitations in private technology research. Technol Res Ethics. 2023;5(4):167-84.
[9]. Anderson J, Kumar S. A multi-dimensional investigation of stakeholders perspectives on the application of artificial intelligence in financial services. Int J Bank Finance. 2023;41(2):123-45.
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Social Health Insurance in Ethiopia: A Synthesis of Evidence on Willingness to Enroll, Institutional Preparedness, Fiscal Space, and Service Readiness as a Platform for Policy ActionAuthor: Wudalew Meselu TesfayeDOI: 10.21522/TIJAR.2014.13.03.Art033
Social Health Insurance in Ethiopia: A Synthesis of Evidence on Willingness to Enroll, Institutional Preparedness, Fiscal Space, and Service Readiness as a Platform for Policy Action
Abstract:
Ethiopia enacted Proclamation No. 690/2010 establishing a Social Health Insurance (SHI) scheme for formal sector employees, yet the program has remained non-operational for over fourteen years. With the government renewing its resolve to launch SHI and the National Health Compact (2025) projecting a doubling of the government health financing share by 2030, a consolidated review of current evidence is urgently needed. This narrative review synthesizes published evidence on four dimensions critical to SHI implementation: willingness to join and pay (WTJ/WTP), institutional preparedness, fiscal space, and health service availability and readiness. Searches were conducted across PubMed/MEDLINE, Google Scholar, Scopus, and Hinari, supplemented by grey literature from the World Bank, WHO, ILO, UNICEF, and the Ethiopian Ministry of Health, covering January 2010 to April 2025. Pooled WTP for SHI among the formal sector workforce was 42.25% for the broader formal sector in a 2023 meta-analysis (19 studies) and 49.62% for public civil servants in a 2024 meta-analysis, the divergence reflecting the populations pooled; average WTP stood at 1.6% of gross monthly income, well below the proposed 3% premium. Willingness to join ranged from 47.5% to 74% across settings, moderated by income, knowledge, quality perceptions, and provider network scope. Institutional readiness is constrained by gaps in EHIS claims management, ICT infrastructure, and strategic purchasing capacity. Fiscal space is restricted by a tax-to-GDP ratio of only 6.8% and persistent high inflation, although the National Health Compact signals new financing ambition. Service readiness in public facilities is critically low, with basic amenities available in only 39% and diagnostics in 40% of facilities. The four domains are deeply interconnected, and a launch that addresses WTP concerns without resolving service quality deficits will reproduce the same impasse that has persisted since 2010. Coordinated, evidence-informed reform across all four domains is a prerequisite for a viable and equitable SHI program in Ethiopia.
Social Health Insurance in Ethiopia: A Synthesis of Evidence on Willingness to Enroll, Institutional Preparedness, Fiscal Space, and Service Readiness as a Platform for Policy Action
References:
[1]. Mebratie AD, Shamebo D, Alemu G, Shigute Z, Bedi AS. Willingness of urban formal sector workers to support a community-based health insurance scheme in Ethiopia. Clinicoecon Outcomes Res. 2025;17. Available from: https://doi.org/10.2147/CEOR.S533996
[2]. Federal Democratic Republic of Ethiopia. Social Health Insurance Proclamation No. 690/2010. Addis Ababa: Federal Negarit Gazeta; 2010.
[3]. Zarepour Z, Mebratie A, Shamebo D, Shigute Z, Alemu G, Bedi AS. Social health insurance and healthcare seeking behavior in urban Ethiopia. Ann Glob Health. 2023;89(1). Available from: https://doi.org/10.5334/aogh.4240
[4]. World Bank, Government of Ethiopia. National Health Compact: Ethiopia [Internet]. World Bank; 2025. Available from: https://thedocs.worldbank.org/en/doc/0273f33ab6ee48c5d842108b9b55c789-0140022025/original/National-Health-Compact-Ethiopia.pdf
[5]. Baethge C, Goldbeck-Wood S, Mertens S. SANRA-a scale for the quality assessment of narrative review articles. Res Integr Peer Rev. 2019;4:5. Available from: https://doi.org/10.1186/s41073-019-0064-8
[6]. Setegn A, Andargie G, Amare G, Debie A. Willingness to pay for social health insurance among teachers at governmental schools in Gondar Town, Northwest Ethiopia. Risk Manag Healthc Policy. 2021;14:861-868. Available from: https://doi.org/10.2147/RMHP.S299119
[7]. Girma S, Abebe G, Tamire A, Fekredin H, Taye B. Teachers' willingness to pay for social health insurance and its determinant factors at Harar Region, Ethiopia, 2021. Clinicoecon Outcomes Res. 2023;15:181-193. Available from: https://doi.org/10.2147/CEOR.S397766
[8]. Regassa Z, Negera E, Silashi T, Kaba Z, Mosisa G. Willingness to join and pay social health insurance and associated factors among public sector workers in Didu Woreda, South West Ethiopia, 2018. SAGE Open Med. 2022;10. Available from: https://doi.org/10.1177/22799036221123957
[9]. Kaso AW, Obsie GW, Debela BG, Tololu AK, Mohammed E, Hareru HE, et al. Willingness to pay for social health insurance and associated factors among public civil servants in Ethiopia: A systematic review and meta-analysis. PLoS One. 2024;19(2). Available from: https://doi.org/10.1371/journal.pone.0293513
[10]. Bayked EM, Toleha HN, Chekole BB, Workneh BD, Kahissay MH. Willingness to pay for social health insurance in Ethiopia: A systematic review and meta-analysis. Front Public Health. 2023;11. Available from: https://doi.org/10.3389/fpubh.2023.1089019
[11]. Federal Ministry of Health, Ethiopia. Health Sector Transformation Plan II (HSTP II): 2020/21-2024/25. Addis Ababa: FMoH; 2020.
[12]. International Labour Organization (ILO). ILO trains social health protection actors in Ethiopia [Internet]. ILO PROSPECTS Programme; 2024. Available from: https://www.ilo.org/resource/news/ilo-trains-social-health-protection-actors-ethiopia
[13]. P4H Network. Strengthening health financing and HTA institutionalization: WHO mission to Ethiopia [Internet]. P4H Network; 2024. Available from: https://p4h.world/en/news/strengthening-health-financing-and-hta-institutionalization/
[14]. m4health AG. Digitalising Ethiopia's health insurance systems [Internet]. m4health AG; 2024. Available from: https://m4health.pro/project/digitalisation-of-health-insurance-services-in-ethiopia/
[15]. London School of Hygiene and Tropical Medicine, Results for Development. Financing primary healthcare in Ethiopia: Overview of briefs. London: LSHTM; 2022.
[16]. Results for Development (R4D). Three challenges affecting community-based health insurance in Ethiopia [Internet]. R4D; 2024. Available from: https://r4d.org/blog/3-challenges-affecting-community-based-health-insurance-in-ethiopia/
[17]. Heller PS. The prospects of creating fiscal space for the health sector. Health Policy Plan. 2006;21(2). Available from: https://doi.org/10.1093/heapol/czj013
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Knowledge-Practice Gaps in Antimicrobial Prescribing among Nigerian Healthcare Providers: A Systematic Review and Meta-AnalysisAuthor: Mawo Philip BenuDOI: 10.21522/TIJAR.2014.13.03.Art034
Knowledge-Practice Gaps in Antimicrobial Prescribing among Nigerian Healthcare Providers: A Systematic Review and Meta-Analysis
Abstract:
Antimicrobial resistance (AMR) remains a major public health challenge globally, with low- and middle-income countries such as Nigeria carrying a substantial burden because of irrational antibiotic use, weak antimicrobial stewardship (AMS) systems, and limited diagnostic capacity. This systematic review and meta-analysis synthesized evidence on AMR knowledge, AMS awareness, and antibiotic prescribing practices among healthcare workers in Nigeria. A comprehensive search of PubMed, Scopus, and Web of Science identified 136 records, of which 17 studies met the eligibility criteria for qualitative synthesis and 15 were included in quantitative meta-analysis. Quantitative synthesis was conducted using a random-effects model. The pooled proportion of healthcare workers demonstrating good AMR knowledge was 64.8% (95% CI: 58.1%–71.2%), while AMS awareness was lower at 49.3% (95% CI: 41.2%–57.5%). Poor or inappropriate antibiotic prescribing practices remained common, with a pooled prevalence of 61.7% (95% CI: 53.4%–69.6%), whereas empirical antibiotic prescribing reached 72.9% (95% CI: 65.1%–79.8%). Recent AMS training exposure was also limited at 38.6% (95% CI: 30.4%–47.5%). Narrative synthesis revealed persistent gaps in stewardship implementation, diagnostic limitations, weak institutional support, pharmaceutical influence, and inadequate continuous professional education across healthcare settings. The findings demonstrate that moderate awareness of AMR among Nigerian healthcare workers has not translated into rational antimicrobial prescribing practices. Strengthening institutional AMS programs, improving diagnostic infrastructure, expanding stewardship training, and implementing behavior-focused interventions are urgently needed to reduce irrational antimicrobial use and curb the growing burden of AMR in Nigeria.
Knowledge-Practice Gaps in Antimicrobial Prescribing among Nigerian Healthcare Providers: A Systematic Review and Meta-Analysis
References:
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[22]. Akhigbe ME, Saka SA, Ighodaro O, Ghouse MA, Emekolom ON, Okoro OV. Doctors' knowledge, attitudes and prescription practices on antibiotic use: A study in a suburban tertiary hospital in Nigeria. BMC Health Serv Res. 2025;25(1):1-8.
[23]. Davwar P, Bitrus N, Nyam D, Ioramo K, Zawaya K, Agboghoroma O. Knowledge, attitudes, and practice of doctors in Nigeria regarding antimicrobial resistance. Niger Med J. 2023;64(4):492-502.
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[26]. Akande-Sholabi W, Oyesiji E, Adebisi YA. Antimicrobial stewardship: Community pharmacists' antibiotic dispensing practices, knowledge, and perception regarding antibiotics and antibiotic resistance. J Pharm Health Serv Res. 2023;14(4):383-91.
[27]. Obasanya JO, Ogunbode O, Landu-Adams V. An appraisal of the contextual drivers of successful antimicrobial stewardship implementation in Nigerian health care facilities. J Glob Antimicrob Resist. 2022;31:141-8.
[28]. Olugbake OA, Ayeni FA, Onwuchuluba EE, Ogbo PU, Ashamu KO. Knowledge and perception of antimicrobial stewardship amongst healthcare professionals in two secondary healthcare facilities in Lagos, Nigeria. Discover Public Health. 2025;22(1):1-11.
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Medical Management of Oral Submucous Fibrosis - A Narrative ReviewAuthor: Vidya Gurram ShankarDOI: 10.21522/TIJAR.2014.13.03.Art035
Medical Management of Oral Submucous Fibrosis - A Narrative Review
Abstract:
Oral submucous fibrosis, an oral potentially malignant disorder is a prevalent condition especially in the Asian subcontinent. Medical management is an integral part in the treatment of OSF. Evidence based practice with efficient protocol and treatment plan to address the patients concern is the current strategy applied. Though several factors play a crucial role in choosing the appropriate drug, lifestyle change, and habit cessation are the preliminary steps towards the methodological and systematic approach in management of OSF. So far none of the reported studies have examined the beneficial role of therapies in preventing malignant transformation in OSF patients. Understanding the importance of medical management in OSF vital as it remains a dilemma for oral medicine practitioners. Literature is abundant with variety of Anti-inflammatory drugs, Immunomodulators, Proteolytic/fibrolytic drugs, Antioxidants, Vitamins and micronutrients, Novel therapies for treatment of OSF. Therefore, we provide a working classification of drugs in OSF along with their mechanism of action, formulation, administration, bioavailability, safety profile, treatment outcomes and adverse effects of the drugs.
Medical Management of Oral Submucous Fibrosis - A Narrative Review
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Railway Infrastructure Development and Regional Economic Integration in Africa: Progress, Challenges and Future ProspectsAuthor: Afolabi O. M.DOI: 10.21522/TIJAR.2014.13.03.Art036
Railway Infrastructure Development and Regional Economic Integration in Africa: Progress, Challenges and Future Prospects
Abstract:
Regional economic integration remains a critical priority for Africa as the continent seeks to expand intra-African trade, strengthen regional value chains, and achieve sustainable economic development. Despite significant progress in policy initiatives such as the African Continental Free Trade Area (AfCFTA) and the Programme for Infrastructure Development in Africa (PIDA), inadequate transport infrastructure continues to restrict economic cooperation and market integration. Among transport modes, railway infrastructure offers considerable potential to reduce trade costs, improve connectivity, and facilitate the movement of goods and people across borders. This review explores the evolution of railway infrastructure development in Africa and its contribution to regional economic integration. Inferring on evidence from historical analyses, empirical studies, policy reports, and corridor-based case studies, the review explores the transformation of African railways from colonial-era extraction networks to contemporary infrastructure investments aimed at supporting regional development. Findings indicate that railway connectivity contributes positively to trade expansion, foreign direct investment attraction, market access, and cross-border economic cooperation. Major railway corridors, including the Lobito, Maputo, and emerging transcontinental corridors, demonstrate the capacity of rail infrastructure to stimulate regional integration through improved logistics efficiency and value chain development. However, the realization of these benefits remains constrained by infrastructure deficits, inadequate financing, fragmented technical standards, governance challenges, and limited technology adoption. The review concludes that railway infrastructure development is an essential enabler of Africa’s integration agenda and that coordinated regional planning, infrastructure modernization, policy harmonization, and sustained investment are necessary to maximize its economic and developmental impacts. Strengthening railway networks will be critical to unlocking the full potential of AfCFTA and fostering a more interconnected and competitive African economy.
Railway Infrastructure Development and Regional Economic Integration in Africa: Progress, Challenges and Future Prospects
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The Role of Soft Skills and Short Courses in Enhancing Career Improvement and Job Readiness among University Graduates in SomalilandAuthor: Mumin OmarDOI: 10.21522/TIJAR.2014.13.03.Art037
The Role of Soft Skills and Short Courses in Enhancing Career Improvement and Job Readiness among University Graduates in Somaliland
Abstract:
The transition from university to employment remains a critical challenge for graduates in developing nations, particularly in post-conflict contexts such as Somaliland. While technical competencies are emphasised in higher education, soft skills development and participation in short professional courses are often neglected. This study investigated the role of soft skills and short courses in enhancing career improvement and job readiness among graduates from three universities in Hargeisa, Somaliland. A descriptive research design with a mixed-methods approach was employed. A sample of 150 graduates (50 from each university) from the Class of 2025 was selected using convenience sampling. Data were collected through a structured questionnaire and semi-structured interviews and analysed using SPSS version 26. Graduates demonstrated low overall soft skills (M = 2.28 on a 5-point scale), with leadership (M = 1.95) and critical thinking (M = 2.08) the lowest. A significant positive correlation was found between soft skills and job readiness (r = 0.682, p < 0.01). While 36.7% had not attended short courses, participants reported better employment outcomes (44.2% vs. 16.4%). A moderate positive correlation was found between short course participation and career improvement (r = 0.548, p < 0.01). The majority (68.0%) were unemployed, with 78.7% attributing this to insufficient soft skills. Soft skills and short courses significantly enhance graduate employability. Higher education institutions must integrate soft skills training into curricula, and coordinated interventions are needed to address the employability crisis.
The Role of Soft Skills and Short Courses in Enhancing Career Improvement and Job Readiness among University Graduates in Somaliland
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