Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
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Global health action
Integrating GIS and local knowledge for optimised medical supply prepositioning in flood-prone Nigeria: a strategic framework
BACKGROUND: Nigeria faces recurring flood disasters that severely disrupt its healthcare systems and delays medical relief efforts. Current medical supply prepositioning by the National Emergency Management Agency (NEMA) remains inadequate due to infrastructure limitations, funding constraints, and poor coordination. OBJECTIVE: To develop and validate a Strategic Medical Hub Locator Framework that integrates Geographic Information Systems (GIS) analysis with qualitative local knowledge to optimise medical supply prepositioning for flood emergencies in Nigeria. METHODS: We employed a mixed-methods approach, combining qualitative analysis of 22 GIS-based flood risk studies in Nigeria and structured expert survey responses from 34 professionals with flood response experience, including five with direct NEMA warehouse experience. The framework was grounded in Disaster Risk Reduction theory and supported by Protection Motivation Theory and Theory of Planned Behaviour. RESULTS: The framework identified eight strategic medical hub locations: six existing NEMA warehouses (Abuja, Lagos, Kano, Gombe, Maiduguri, Kaduna) with the strongest performance, and two new strategic sites (Akure and Uyo) to address service gaps in South-South and South-East regions. Abuja emerged as the highest-performing hub with a composite score reflecting good centrality, governance capacity, and operational readiness. The framework successfully bridged data silos between spatial flood risk patterns and operational constraints. CONCLUSIONS: Integration of GIS thematic analysis with qualitative local data provides a viable, replicable method for enhancing humanitarian medical logistics in flood-prone regions. The Strategic Medical Hub Locator Framework offers a structured decision-support tool that can inform evidence-based investment in Nigeria's disaster health infrastructure, while being adaptable to other Global South contexts. Key findings: Where primary geospatial data silos are present, GIS analysis can be enhanced by combining it with local qualitative insights, thereby bridging the gap between technical modelling and practitioner realities.Added knowledge: The paper offers a methodological contribution through the design of a Strategic Medical Hub Locator Framework that is replicable in contexts where primary data and complex modelling are not feasible.Global health impact for policy and action: This study provides policymakers and humanitarian actors with a proof-of-concept decision-support tool. The exploratory framework offers a scalable model that can be adapted to other flood-prone settings where primary data and practical knowledge are scattered, thereby strengthening disaster preparedness and health system resilience strategies.
27 May 2026
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A computational text analysis of recent African digital health strategies and their attention to vulnerable populations
BACKGROUND: Digital health offers opportunities to transform healthcare systems and improve access to care, particularly in low- and middle-income countries. However, there is concern that national digital health strategies may inadequately address the needs of vulnerable populations, risking the reinforcement of existing health inequalities. OBJECTIVE: This study investigates the extent to which recent African national digital health strategies consider and prioritize vulnerable populations particularly at risk of digital exclusion (women, children and the elderly). METHODS: We conducted a computational text analysis of 13 recent national digital health strategy documents from African countries to identify major topical priorities within the strategies and to systematically assess the frequency and context of references to vulnerable populations. RESULTS: Most strategies focus on broad goals such as health system strengthening, infrastructure development, and stakeholder coordination. While there are mentions of women and children, these references are often indirect and not accompanied by concrete plans or dedicated actions. References to the elderly are especially rare. Few strategies include specific measures to ensure digital inclusion or equity for these vulnerable populations. CONCLUSIONS: Recent African digital health strategies currently prioritize systemic and infrastructural development, but the needs of vulnerable populations are often overlooked or superficially addressed. To prevent the digital divide from widening, national strategies should embed explicit equity targets, actionable plans, and mechanisms for meaningful inclusion and participation of all population groups.
20 May 2026
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