Adult medical male circumcision (MC) is safe: global notifiable adverse event (AE) rates average below 2.0%. With Zimbabwe’s shortage of health care workers (HCWs) compounded by COVID-19 constraints, two-way text-based (2wT) MC follow-up may be advantageous over routinely scheduled in-person reviews. A 2019 randomized control trial (RCT) found 2wT to be safe and efficient for MC follow-up. As few digital health interventions successfully transition from RCT to scale, we detail the 2wT scale-up approach from RCT to routine MC practice comparing MC safety and efficiency outcomes. After the RCT, 2wT transitioned from a site-based (centralized) system to hub-and-spoke model for scale-up where one nurse triaged all 2wT patients, referring patients in need to their local clinic. No post-operative visits were required with 2wT. Routine patients were expected to attend at least one post-operative review. We compare 1) AEs and in-person visits between 2wT men from RCT and routine MC service delivery; and 2) 2wT-based and routine follow-up among adults during the 2wT scale-up period, January to October 2021. During scale-up period, 5084 of 17417 adult MC patients (29%) opted into 2wT. Of the 5084, 0.08% (95% CI: 0.03, 2.0) had an AE and 71.0% (95% CI: 69.7, 72.2) responded to ≥1 daily SMS, a significant decrease from the 1.9% AE rate (95% CI: 0.7, 3.6; p<0.001) and 92.5% response rate (95% CI: 89.0, 94.6; p<0.001) from 2wT RCT men. During scale-up, AE rates did not differ between routine (0.03%; 95% CI: 0.02, 0.08) and 2wT (p = 0.248) groups. Of 5084 2wT men, 630 (12.4%) received telehealth reassurance, wound care reminders, and hygiene advice via 2wT; 64 (19.7%) were referred for care of which 50% had visits. Similar to RCT outcomes, routine 2wT was safe and provided clear efficiency advantages over in-person follow-up. 2wT reduced unnecessary patient-provider contact for COVID-19 infection prevention. Rural network coverage, provider hesitancy, and the slow pace of MC guideline changes slowed 2wT expansion. However, immediate 2wT benefits for MC programs and potential benefits of 2wT-based telehealth for other health contexts outweigh limitations.

No abstract

Context: Software measurement is crucial to stay competitive and deliver quality software products. Problem: While much research has been done on measurement in large companies in developed countries, there is limited research on measurement in start-ups. So far there are no studies on whether these results apply to nascent ecosystems, such as those in East Africa. Goal: The aim of this study is to understand the use and perceived benefits of measurement in software start-ups in East Africa. Method: We performed a multi-case study on 19 software start-ups in hubs in Uganda and Kenya, through conducting semi-structured interviews. We transcribed and analyzed them using the content analysis technique. Results: We identified that start-ups are using a number of business and product-oriented metrics. Furthermore, we found no evidence on the use of design-oriented metrics. Nonetheless, start-ups have considerable expectations on the benefits of measuring. Finally, metrics found in this study partially differ from metrics used in start-ups in developed countries. Conclusion: There is a need to create a more inclusive characterization for measurement as early start-ups in East Africa cannot yet be represented with known models.

PurposeThe purpose of this paper is to report on podcasting experience by faculty and students in a South African higher education institution (HEI), identify issues, limitations and discuss implications for the design of future tools.Design/methodology/approachThis work consisted of two parts: semi‐structured interviews with lecturers, content/curriculum developers and a student survey.FindingsRogers's diffusion of innovations theory provided the framework for this research including determining how new innovations are disseminated, their rate of adoption, the five‐stage decision‐making process for adoption and the characteristics an innovation must possess to be attractive to adopters. The methodology used relied heavily on descriptive and qualitative data analyses in order to determine the current podcasting practices and experiences. Results reveal that by assuming some of the respondents are “innovators” or “early adopters”, they are still in the early stages of the decision‐making process.Research limitations/implicationsSome instructors who are identified as “early adopters” are experimenting with podcasting as an add‐on to existing lecture resources. However, innovations and their subsequent adoption require an understanding of lecturers' and students' perceptions, opportunities and challenges.Originality/valuePodcasting in developing HEIs and the tools therein to support the process has not been given much attention. The context of this study is the first kind of empirical research in this area. The findings from this exploratory research will be valuable for podcasting users.

No abstract