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ALONG THE DNIEPER RIVER, Ukraine Fishing on a marbled expanse of frozen river, dressed head to toe in camouflage, Viktor Berkut looked very much the Soviet-born Everyman, and has the biography to match. He joined the Red Army in 1970 and spent three decades building air defense and rocket systems directed against Moscows ideological enemies in the West.

But the enemy has changed, and for that Mr. Berkut blames President Vladimir V. Putin of Russia. With roughly 130,000 Russian troops now threatening his native Ukraine, the 71-year-old pensioner says any connection he once felt to Russia is gone: Ukraine should join NATO, he said, and put up bloody resistance should Mr. Putin order an attack.

I never thought like this, Mr. Berkut said mournfully, as he plunked a Day-Glo lure through a hole in the ice of the Dnieper River near the city of Cherkasy. I lived all right in the Soviet Union. But now Ive begun to understand.

We need to oppose Russia, he added. We have chosen, not a Russian path, but a European one.

His sentiments underscore a profound shift that Ukrainians have undergone in the eight years since Russia first invaded and snatched away parts of their country. A people long divided by profound disputes over what language to speak, what church to follow and what historical heroes to revere has begun to stitch together a sense of common purpose in the face of a menacing foe.

Mr. Putin has made clear that he views Ukrainians and Russians as one people, divided by malign Western forces a historical injustice he says he is determined to fix. This has driven many Ukrainians to sometimes dramatic declarations of separation. People who grew up in Russian-speaking homes now choose to speak Ukrainian exclusively, and in some cases have refused to teach the language of their parents to their children.

Across the country, Lenin statues and hammer-and-sickle emblems of the Soviet past have been toppled, replaced by monuments to Ukrainians killed in a 2014 uprising that drove a Moscow-backed government from Kyiv. After four centuries of subservience to Moscow patriarchs, Ukraines Orthodox Church formally split with the Russian church in 2019.

Russia remains a dominating political and cultural force in Ukraine: its rappers and Tik-Tokers are popular even among young people who increasingly take their cultural cues from the West. In the Eastern provinces of Donetsk and Luhansk, where Ukraine is fighting Russian-backed separatists, many Ukrainians still feel a strong kinship with the Russians living just over the border. And across Ukraine, a raucous public reckoning over Russias place in the countrys past, and its future, is unresolved.

Amid warnings from the West that Russia could attack any day, the photographer Brendan Hoffman and I set off on a journey to explore what it means to be a Ukrainian at this moment of national peril. For 560 miles, we followed the Dnieper, a sickle-shaped river that stretches the length of Ukraine, physically separating the countrys western regions from the lands to the east, long considered to be more susceptible to Moscows gravitational pull.

Traveling along the river today, those divisions, while not gone completely, are less visible, outshone in many ways by a sense of common struggle.

We began our journey in Ukraines capital, Kyiv, where the Dnieper River flows past the golden domes of an 11th-century monastery and a 200-foot steel statue of a woman holding a sword and shield built to memorialize the Soviet victory in World War II.

But Kyivs most revered monument is of a much newer vintage. At the top of a hill, a short distance from Independence Square, or Maidan, sits a small memorial of black steel and granite plaques engraved with the spectral faces of protesters, known as the Heavenly Hundred, who were gunned down over several days in 2014 in an uprising Ukrainians call the Revolution of Dignity.

The revolt prompted Mr. Putin concerned that Ukraine was moving irrevocably toward the West to order the annexation of Crimea and instigate a separatist war in eastern Ukraine.

It also changed the way many Ukrainians see themselves. In a poll taken in 2001, only about half the country supported Ukraines declaration of independence from the Soviet Union a decade earlier. A 2021 poll found that number had risen to 80 percent, with nearly half the country in support of NATO membership.

Ukraine as a nation was born on Maidan in 2014, said Yevhen Hlibovytsky, a professor and public opinion pollster in Kyiv. Thats the point when the conflict became unbearable for Putin.

For many Ukrainians, the memorial to the Heavenly Hundred has become a site of pilgrimage. Parents of the dead visit it on their childrens birthdays and politicians come for photo ops.

Similar memorials can be found in almost every city and town. But Kyiv is where they died, many within sight of the memorial that now bears their likenesses.

About three hours downriver from Kyiv is the city of Cherkasy, scattered with memorials to veterans of a century of war. At the regional museum, in an exhibition on the 2014 uprising, is a photograph of a local photographer named Garry Efimov, his hair wet with blood after an encounter with riot police.

The experience was so traumatic, Mr. Efimov said, that he stopped speaking his native Russian and instead now speaks only in Ukrainian.

It is difficult actually, when you always read Russian books and literature, Bulgakov, Tolstoy, Dostoyevsky, he said in an interview at his art nouveau studio. But I succeeded, and now it is harder to speak in Russian than Ukrainian.

Though most Ukrainians speak or at least understand both Russian and Ukrainian, debates over the primacy of one language are among the most contentious within Ukraine and also between Ukraine and Russia. Last year, a new law took effect requiring anyone working in customer service, whether waiters or bank tellers, to start any interaction with Ukrainian.

There are also strict quotas on the amount of Russian-language programming permitted on Ukrainian TV and radio.

Mr. Putin has described efforts to limit Russian in Ukraine as genocide, and has justified Russias annexation of Crimea in part by asserting the need to protect Russian speakers there.

While there are hard-liners in Ukraine on both sides of the debate, many more are like Natalia Polishchuk and Aleksandr Yaryomenko, who own a store in Cherkasy selling traditional Ukrainian embroidered shirts called vyshyvanky.

Feb. 15, 2022, 5:59 p.m. ET

In the store we speak Ukrainian, but between us we speak Russian, said Ms. Polishchuk, who is 51. We lived in the Soviet Union, were of an age, you understand.

But that does not mean they are any less patriotic, said Mr. Yaryomenko, who is 60.

If someone took over your kitchen and started frying cutlets there they took Crimea and a piece of Donbas what would you do, pat them on the head? he said. We need to support our homeland, our Ukraine.

Even far from the front lines, it is difficult to avoid reminders of war. In Dnipro, a city of one million people five hours farther downriver, an entire square has been turned into a life-size diorama. It features armored personnel carriers, a tank turret and other artifacts from a fierce battle in the east in which a handful of Ukrainian soldiers, known as the Cyborgs, held off a siege by Russian-backed separatists that ended in early 2015 after 242 days.

Nearby, at a hospital for veterans, Aleksandr Segeda, a retired sergeant, who was born in Russia, but fought against the separatists in the east, needs no reminders of the war.

You greet someone in the morning, and by lunch you hear that hes no longer alive and hes 22 years old and has pregnant wife and a small child, Mr. Segeda said, drifting through a memory. Forgetting that is impossible. And so is forgiving.

Others are trying to look toward the future, even as the threat of a new war looms.

Economic ties between Ukraine and Russia were once so strong that when a state-of-the-art steel plant opened across the river in 2012, Valery Gergiev, the conductor of St. Petersburgs Mariinsky Theater and close friend of Mr. Putin, gave a concert to mark the occasion.

In the two years before war broke out, Russia accounted for nearly half the factorys sales of wheels for railroad cars and nearly a quarter of its sales of steel piping. Now the factory, Interpipe Steel, sells nothing to Russia.

The Kremlins position. President Vladimir V. Putin of Russia, who has increasingly portrayed NATOs eastward expansion as an existential threat to his country, said that Moscows growing military presence on the Ukrainian border was a response to Ukraines deepening partnership with the alliance.

Interpipe was forced to make huge investments to increase the quality of its products to meet the higher standards for export to Europe and North America, even while some of its employees left to join the fight in the east, said its spokeswoman, Svetlana Manko. Sales have not yet reached prewar levels, but theyre climbing steadily, she said.

I think this trauma has nudged all Ukrainian businesses to find ways to develop, she said.

A short drive further south through fallow gray-brown sunflower fields took us to Zaporizhzhya, the heartland of what was once an independent settlement of Cossacks.

At a drafty gym on the citys industrial outskirts, a group of young boys and girls dressed in baggy red Cossack pants were practicing fending off saber blows and body slamming one another, while one boy honed his technique with a whip. They were learning a Ukrainian form of martial arts called spas, a tradition that had largely fallen out of favor during the Soviet era, their teacher, Yaroslav Pavlenko, explained. In the years since the war began, he said, there has been a concerted effort to revive it.

Now that there is open aggression being committed against Ukraine, peoples minds are changing, Mr. Yaroslav said, adding that patriotism is now welcomed.

Even while learning to fight, Mr. Pavlenkos wife, Oksana, said, the children are shielded from news about the buildup of Russian troops. She avoids the news, herself, when she can.

The last time I watched the news I had two desires, she said. The first was to run out to the store and buy supplies of buckwheat and sugar. And the second was to grab all my documents and leave the country.

Of course, logically Im not prepared to do that, she added.

It was dark by the time we reached Kherson, the last large city along the Dnieper before it flows into the Black Sea. But the yellow facade of the Dormition Cathedral was brilliantly lit, and the sounds of a choir echoed from within.

Inside, a troika of priests in marigold-colored mantles intoned prayers in a deep baritone.

In 2019, the Ukrainian Orthodox church was granted independence after 400 years of subordination to the patriarch of Moscow.

For many Ukrainians it was another victory in the drive to separate fully from Moscows influence. Parishes across Ukraine rushed to change their allegiances, though not all.

The Dormition Cathedral in Kherson remains loyal to Moscow, and some of its parishioners view Russia as a more benign force than many of their compatriots.

For all of our existence dark forces have been trying to divide us, said Lyudmila Ivanovna, who would only give her name and patronymic.

She was sympathetic to Russias intervention in eastern Ukraine, which she said had historically been one of the richest regions in the Russian Empire. Why should she have to speak a new language or go to a new church, she asked, if we were all sent here by the same God.

As we parted after the evening service, she assured me that she had nothing against Ukrainians from the west, who might hold different views.

My husband is from western Ukraine, she said. Its true, we divorced, but never mind.

The rest is here:
Ukrainians Find Common Purpose in Opposing Russia - The New York Times

Ukrainian President Volodymyr Zelenskyy, right, speaks to German Chancellor Olaf Scholz during their meeting at The Mariinskyi Palace in Kyiv, Ukraine, on Monday. Scholz visited Ukraine as part of a flurry of Western diplomacy aimed at heading off a feared Russian invasion that some warn could be just days away. AP hide caption

Ukrainian President Volodymyr Zelenskyy, right, speaks to German Chancellor Olaf Scholz during their meeting at The Mariinskyi Palace in Kyiv, Ukraine, on Monday. Scholz visited Ukraine as part of a flurry of Western diplomacy aimed at heading off a feared Russian invasion that some warn could be just days away.

German Chancellor Olaf Scholz met with Ukraine's President Volodymyr Zelenskyy in Kyiv on Monday, pledging solidarity with that country amid fears of a Russian invasion.

Speaking at a news conference with his counterpart, Scholz said Ukraine's sovereignty is non-negotiable, adding that he expects Russia to take clear steps to deescalate tensions.

Scholz also issued a threat of "far-reaching sanctions" if Moscow sends troops over the border. However, he didn't provide specific details on what those might be.

But the German leader has refused Ukraine's repeated pleas to send military aid and weapons as the United States and Britain have done, saying Germany has a longstanding policy of not sending that type of help to conflict zones.

Instead, Scholz stressed Germany's role as the largest source of financial aid to Ukraine, making a new pledge to extend 150 million euros to Kyiv.

After the meeting, Zelenskyy said the two nations "share the common vision that the escalation on the Ukrainian-Russian border is an unprecedented challenge for Europe and the world."

And in a news conference alongside Scholz, Zelenskyy suggested the possibility of dropping Ukraine's goal of NATO membership an issue at the heart of the conflict with Russia. It is a major reversal for Zelenskyy, who as recently as Sunday said he would continue to pursue joining the international alliance, regardless of Russian threats and skepticism among western countries.

"Maybe the question of open doors is for us like a dream," Zelenskyy said on Monday.

He added: "How much should Ukraine go on that path? ... Who will support us?"

Zelenskyy also responded to U.S. reports that Russia could be planning to launch an attack on Wednesday, according to the BBC.

"We are being threatened with a big war and the date of the military invasion is set again," he said in a statement, according to the BBC.

The leader praised the strength of his own country and proclaimed "our state today is stronger than ever."

"We want peace and we want to resolve all issues exclusively through negotiations," Zelenskyy reportedly said, predicting that the violence in Donbas and Crimea would soon end. Both regions, he said, would return to Ukrainian control through diplomatic means.

Wednesday would not be a day of war but rather a day of unity, he added.

Meanwhile, Russia denies plans to invade its neighbor, despite massing 100,000 soldiers on Ukraine's borders and another 30,000 soldiers near the Belarus-Ukraine border. The explanation it has offered the world is that it is merely conducting military exercises.

The Kremlin last week said its forces along the Belarus border would eventually return back to home bases in Russia but officials did not provide a timeframe for the withdrawal.

The White House says the operation is yet another escalation of tensions along the Ukraine border.

U.S. President Joe Biden and other Western leaders, including European Commission President Ursula Von der Leyen, have warned Russia that if it sends its forces into Ukraine, as it did in 2014, they will prevent the Nord Stream 2 gas pipeline from coming online. That pipeline would transport gas from Russia to Germany Europe's longtime economic engine.

Scholz is planning on flying to Moscow to meet with Russian President Vladimir Putin on Tuesday.

The leader's attempts to diffuse tensions and find a peaceful resolution, comes as several nations, including Germany, Australia, Israel, Japan and South Korea, are telling their citizens to evacuate from Ukraine.

On Monday, the U.S. State Department announced it is in the process of temporarily relocating its embassy operations from Kyiv to Lviv "due to the dramatic acceleration in the buildup of Russian forces."

"The Embassy will remain engaged with the Ukrainian government, coordinating diplomatic engagement in Ukraine. We are also continuing our intensive diplomatic efforts to deescalate the crisis," officials said in a statement.

The families of embassy staff were ordered to leave Ukraine on Jan. 23. On Monday evening, the State Department also told all U.S. citizens to depart Belarus, in part over Russia's military buildup.

Following a call with Zelenskyy on Sunday, the White House issued a statement saying "President Biden made clear that the United States would respond swiftly and decisively, together with its Allies and partners, to any further Russian aggression against Ukraine."

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German chancellor warns of far-reaching sanctions if Russia moves on Ukraine - NPR

Study area

This study was conducted in Lagos State, South-West Nigeria. Though the smallest in area of Nigeria's 36 states, Lagos State is arguably the most economically important state of the country [22]. Lagos has a population estimated at 21 million in 2016, which makes it the most populous state in Nigeria and the largest city in Africa [23] Pap smear services are only available in a few public healthcare facilities in Lagos. Some private hospitals and diagnostic centres also offer pap smear services to clients.

There has been a rapid development of slums in Lagos as a result of rapid urbanization and ruralurban migration [24]. Lagos has 192 identified slum communities [25]. Urban slums are settlements, neighbourhoods, or city regions that cannot provide the basic living conditions necessary for its inhabitants, to live in a safe and healthy environment [26]. The United Nations Human Settlements Programme (UN-HABITAT) defines a slum settlement as one that cannot provide any of the following basic living characteristics: Durable housing of a permanent nature that protects against extreme climate conditions; Sufficient living space, which means no more than three people sharing the same room; Easy access to safe water in sufficient amounts at an affordable price; Access to adequate sanitation in the form of a private or public toilet shared by a reasonable number of people; Security of tenure that prevents forced evictions [26].

Ago-Egun Bariga is a slum settlement located in Bariga Local Council Development Agency in the city of Lagos. The inhabitants are mainly of the Egun tribe with a few people of the Yoruba tribe. Ago-Egun Bariga is overcrowded and is lacking in basic social amenities. There is no pipe-borne water or drainage system. Human faeces are deposited into the water near the residence. The majority of the houses are built with wooden planks on the water surfaces. Others are old buildings made of mud-plastered walls and dilapidated zinc roofing.

Otto-Ilogbo extension is under the administration of the Lagos Mainland Local Government area. It is located around a large refuse dump located in between the Otto community and Ilogbo community, hence its name, Otto-Ilogbo extension. Its inhabitants are mainly Yoruba and Igbo petty traders and artisans who live freely amongst each other. There is no form of town planning in Otto-Ilogbo extension and the houses are numerous. Most of the houses are made of wooden planks and dilapidated zinc. There is no drainage system or pipe-borne water in the community and community members mostly practice open defecation. Otto-Ilogbo extension is grossly overcrowded.

The distance between the study community and the control community is about 20km by road. Both communities are located within different local governments, which are not contiguous in location. The commercial activities of both slum communities are also not directly related. This minimizes the chances of interaction between control and intervention arms, as well as spill-over effects of the intervention.

This study is a quasi-experimental controlled study with pre and post design, aimed at determining the effect of social marketing intervention on the knowledge, attitude and uptake of pap smear among women residing in an urban slum.

The study population consisted of women aged 2165years who reside in the two selected urban slums in LagosAgo-Egun Bariga (Intervention community) and Oto-Ilogbo extension (Control community). The inclusion criteria for the study were women who had resided in the slum for at least 1year and women that had been married/cohabiting/sexually active. The exclusion criteria were women who were too sick to attend the health education sessions/cervical cancer screening, women who were pregnant during the course of the study.

The study was based on the hypothesis that at post-intervention, the intervention group would have at least 20% (0.20) improvement in the knowledge, attitude, and uptake of Pap smear screening for cervical cancer [10]. The sample size was determined using the formula for the comparison of proportions [27].

$${text{n }} = frac{{left[ {{text{Z}}_{alpha } + {text{Z}}_{beta } } right]^{{2}} left{ {left[ {{text{P}}_{{1}} left( {{1} - {text{P}}_{{1}} } right)} right] , + , left[ {{text{P}}_{{2}} left( {{1} - {text{P}}_{{2}} } right)} right]} right}}}{{left[ {{text{P}}_{{1}} {-}{text{ P}}_{{2}} } right]^{{2}} }}$$

Prevalence (P2) of women who had undergone cervical cancer screening in a previous study was 13.3% [28].

The expected prevalence (P1) after the intervention was 33.3%. The calculated minimum sample size was 66 for each group. Because multistage sampling was employed, design effect was taken into consideration and the minimum sample size was multiplied by 2. The sample size then came to 132. After compensating for attrition, with an attrition rate of 30%, the sample size calculated was 188 for each group.

A multistage sampling method was used in selecting study participants. In the first stage, two slums from the list of slums in Lagos State were selected using a computer-generated table of random numbers. The sampling frame included all the 192 identified slum communities in Lagos. The first slum selected-Ago-Egun Bariga- was the intervention community while the second selectedOtto-Ilogbo extensionwas the control community.

In the second stage, each community was divided into five clusters based on the arrangement of houses and forty houses were selected from each cluster. The "spin the bottle" EPI-derived technique (a technique derived by EPI research Inc for cluster sampling in household surveys) was used in selecting the houses in each cluster [29]. The index house in each cluster was selected by spinning a bottle in the middle of the cluster. The bottle was observed to see where its tip points; the house whose front door was closest to the tip was the index house. The next house chosen was the one whose front door was closest to the index one.

In the third stage, where there was more than one eligible female in a house, the respondent was selected by simple random sampling by balloting. In the event that there was no eligible female in a selected house, it was excluded and the next house was selected.

Data was collected using interviewer-administered questionnaires. The questionnaire was adapted from previous studies. [12, 30,31,32] It contained questions on the socio-demographic characteristics of respondents, knowledge of cervical cancer (which include; ever heard of cervical cancer, symptoms and risk factors of cervical cancer, prevention of cervical cancerscreening and HPV vaccination), knowledge of pap smear (which include; ever heard of pap smear, how frequently the test should be done, women eligible for testing), attitude towards cervical cancer (which include Likert statements on perceived susceptibility to cervical cancer, perceived severity of cervical cancer and perception of screening), and uptake of pap smear. The questionnaires were pretested in another slum not used for the study and adjustments were made. Four trained female research assistants with post-secondary degrees collected data.

Focused group discussions (FGD) were conducted among women age 2165 in Ago Egun Barigathe intervention community prior to the commencement of the intervention. Homogenous groups of 810 women of similar age were used. The focused group discussion was aimed at gaining a deeper understanding of the womens perceptions about cervical cancer screening, barriers and recommendations, in order to aid the design and implementation of the social marketing intervention.

Findings from the qualitative survey guided the social marketing intervention. The respondents wanted the test to be free or largely subsidized and wanted female providers. Many said they will require the consent of their husbands to undergo the test. Also, the majority of the discussants wanted the test to be carried out in their community. The women suggested the use of a megaphone, SMS and health education sessions to promote the intervention.

Eight benchmarks describe the key concepts and principles of social marketing and include Customer orientation, Behavioural focus, Exchange, Developing insight, Competition analysis, Theory, Segmentation, and Methods Mix [33]. Customer orientation involves seeing things through the customers eyes. It involves understanding where the customer is starting from, their knowledge, attitudes and beliefs, and their social context [34]. Prior to the intervention, these were assessed using interviewer-administered questionnaires and focus group discussions. Behavioural focus implies that the intervention is focused on influencing specific behaviours, not just knowledge, attitudes, and beliefs [35]. In this regard, our study aimed to increase the uptake of pap smear, and not just increase knowledge and improve attitudes.

Exchange considers benefits and costs of adopting and maintaining a new behaviour; maximizes the benefits and minimizes the costs to create an attractive offer [35]. In this study, we provided pap smear services and explained the benefits of pap smear to the participants. We also reduced the costs by providing the pap smears free and making it easily accessible within the community. Spouses of the participants were also educated to reduce husbands disapproval (an intangible cost). Developing insight involves developing a deeper understanding of what is or is not likely to engage a target audience or motivate them in relation to a particular behaviour [33]. In our study, focus group discussions conducted before the intervention helped to understand potential enabling factors and barriers to change.

Competition analysis in social marketing leads to the identification of countervailing forces and the systematic development of strategies to reduce the impact of these external and internal competitive forces [33]. Some of the external countervailing forces we identified in our study were spouses disapproval, cost of the test, and distance to the testing site. These were addressed in the intervention. Internal countervailing forces included poor knowledge and attitudes towards cervical cancer screening and we addressed these by providing health education.

Theory involves using behavioural theories to understand target behaviour and inform the intervention [36]. The health belief model guided our intervention [37]. During the health education sessions, women received adequate information on the risk factors of cervical cancer so they can understand that all sexually active women are at risk of the disease and thus develop healthy perceptions of personal susceptibility (Perceived Susceptibility) [37]. The health education also provided information on the seriousness and consequences of cervical cancer in terms of symptoms and complications, ill-health and suffering, time lost from work, and economic difficulties (Perceived Severity) [37]. Our intervention also addressed the benefits of pap smear in detecting precancerous changes early, before cancerous changes manifest (Perceived Benefits).

We assessed barriers to cervical cancer screening using questionnaires and focus group discussions and addressed them. The perceived barriers identified included religious and cultural barriers, spouses disapproval, feeling embarrassed, and cost. The support of religious leaders, husbands, and traditional leaders was sought. The religious and traditional leaders helped promote the pap smear services by speaking at our health education sessions. The barrier of cost was addressed by making the pap smears free. Feelings of embarrassment were minimized by using only female service providers (Perceived Barriers). The cues provided in this study included SMS to remind the women about the date and time of the pap smears, and banners displayed strategically in the community in English, Yoruba, and Egun languages (Cues to Action). Undergoing pap smear does not require much effort from the client and we provided information on how to prepare for a pap smear test and what to expect in the health education sessions (Self-efficacy).

Segmentation involves assigning people to groups that exhibit similar characteristics, beliefs values, and behaviours in order to, develop specifically targeted interventions, designed to help them change behaviour [33]. In this study, we tried to identify segments of the population with similar characteristics. Using the socio-demographic characteristics, most of the women were married, of the Egun tribe, were of the Christian religion, had no formal education, and had low incomes. Hence they could not be segmented along these lines. Also, almost all the women had poor knowledge, poor attitude and all had not had cervical cancer screening in the past. The participants also had similar motivational factors e.g. cost, distance, and spousal support. The women were more similar in characteristics than different.

Product The providers were trained and supervised to be warm and receptive. They were trained to be courteous and to re-assure the women about the procedure and also to minimize discomfort during the procedure. Only female providers were recruited to provide pap smears as this was a recommendation from the focus group discussion. Bureaucracy, which is often the case in government hospitals where pap smear is provided was limited (Fig.1).

Social marketing framework

Price Pap smear services were offered free of charge. The clients did not need to pay for transportation, as the location of the services was within the community. This study had sensitization meetings for husbands to enable the spouses to understand the importance of pap smears and hence reduce disapproval (Fig.1).

Place Services were made available within the community (Fig.1). The place used was suitable and comfortable for the women and the procedure. Adequate privacy was ensured. Also, responses from the FGD had suggested a location within the community. The venue used was the clinic of a traditional birth attendant in the community, who is certified and registered with the State government ministry of health. The centre was re-painted to make it more appealing for the intervention.

Promotion Six health education sessions were organized for the women with each woman attending one health education session. A meeting was also carried out to educate their husbands on cervical cancer and pap smear. The health belief model guided the content of the health education sessions and information education communication (IEC) materialshandbills and banners. Contents of the health education included: a description of cervical cancer, its burden, risk factors, symptoms, complications, and prevention. The health education also included details on the Pap smear test, its importance, how frequently it should be done, and who should have it done. A brief description was also given of what to expect during the test (Fig.1).

As part of the promotion, community mobilization was carried out and three community mobilizes were sought amongst key people in the community who understood the local dialect. Religious clerics and community leaders also publicly showed support for the intervention through speeches. Information, Education, and communication (IEC) materials in form of handbills and banners were used and reminder SMSs were sent out periodically. The positioning statement for the social marketing intervention was Cervical Cancer Is Real, Get a Pap Smear Test Today. This was written in English, Egun, and Yoruba Languages and was boldly displayed on all banners, handbills, and t-shirts.

After the intervention, the same respondents who were interviewed at the beginning of the study were interviewed again using the same questionnaire to assess their knowledge, attitude, and uptake of Pap smear. The interviews were conducted for both the intervention group and the control group. Women in the control group had health education sessions on cervical cancer and free pap smears after the study, for ethical reasons.

The study duration was 7months from pre-intervention data collection to post-intervention data collection. The Health education sessions lasted for 6weeks and afterwards, pap smears were made available in the community for a period of 3months. There was a period of 4months between the health education sessions, and the post-intervention data collection.

Data entry and cleaning were done using Microsoft Excel 2010. Data was then imported and analysed using IBM SPSS Version 20.0 (Armonk, NY: IBM Corp). Stata Version 16 (College Station, TX: Stata Corp LLC) was used for difference in difference analysis. Categorical data were summarized using frequencies and proportions. Numerical data were summarized using means and standard deviations, median and interquartile range. Observations with incomplete data were excluded from analysis.

A scoring method was developed to quantify the respondents knowledge of cervical cancer and pap smear and also their attitude towards cervical cancer and pap smear. For the knowledge scoring, ten knowledge questions were scored. Knowledge questions scored include; ever heard of cervical cancer, symptoms of cervical cancer known, risk factors of cervical cancer known, if cervical cancer can be prevented, cervical cancer prevention measures known, ever heard of tests that detect cervical cancer early, does detecting cervical cancer early improve treatment outcome, type of cervical cancer screening tests known, ever heard of pap smear, and how often pap smear tests should be done. Correct responses were awarded a point each and incorrect responses no point. Some questions allowed multiple correct responses. The maximum attainable score was 32 while the lowest attainable score was 0. The mean knowledge score was calculated.

There were nine questions assessing attitudes of women towards cervical cancer and pap smear on a Likert scale. The questions were; Cervical cancer is a severe disease, I could be susceptible to cervical cancer, I cannot have cervical cancer because I dont have multiple sexual partners, I cannot have cervical cancer because I believe I am spiritually protected, Cervical cancer is a death sentence, Chances of curing cervical cancer are better when the disease is discovered at an early stage, Cervical cancer can be prevented from occurring, Cervical cancer screening is important, and I am comfortable with having a cervical cancer screening test. The highest score for each question was 5 while the lowest score was 1. The possible range of scores was 545. The mean attitude score was calculated.

Intergroup comparisons (intervention and control group comparisons) were made at baseline. Within-group comparison of the intervention group and the control group, before and after intervention was also done. Comparison of proportions between two groups was done using Pearsons chi-squared test or Fishers exact test as appropriate. For numerical data, independent sample T-test was used to compare across the two groups while paired T-test was used to compare each group before and after. Repeated measures analysis was also used to assess within and between group changes.

Difference-in-difference (DID) analysis was used to estimate intervention effects, adjusting for biases that could be the result from permanent differences between the groups (pre-existing differences), as well as biases from comparisons over time in the intervention group that could be the result of trends due to other causes of the outcome (time trends) [38]. The difference-in-difference is an early quasi-experimental strategy for estimating causal effects [39]. Difference-in-difference is a useful technique to use when randomization on the individual level is not possible [38]. The DID estimate is defined as the difference in the average outcome in the intervention group before and after the intervention minus the difference in the average outcome in the control group before and after the intervention [39]. DID analysis was done using linear random-effects regression with an interaction term between study arm and study period. [39]

The level of significance was set at 5%. Associations or differences were considered statistically significant if p values were less than or equal to 0.05.

Approval for this study was obtained from the health research and ethics committee of the Lagos University Teaching Hospital with approval number: ADM/DCST/HREC/APP/2028. Written informed consent was obtained. All methods were carried out in accordance with the relevant guidelines and regulations. e.g., the Declaration of Helsinki.

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Effect of social marketing on the knowledge, attitude, and uptake of pap smear among women residing in an urban slum in Lagos, Nigeria - BMC Women's...

A young woman walks past a Bitcoin symbol in the window of a company that offers blockchain application services.

Sean Gallup | Getty Images News | Getty Images

Cryptocurrencies rose Tuesday with U.S. equities as tensions between Ukraine and Russia appeared to be easing.

Bitcoin climbed 4.6% to $44,177.34, while ether rose 7.6% to $3,114.09, according to data from Coin Metrics. Almost the entire crypto market was higher Tuesday.

The moves are likely a "natural market surge" after it had been "resolutely neutral" for much of the past week, said Clara Medalie, research lead at crypto market data provider Kaiko. She added that both bitcoin and ether have broken through previous resistance and are headed for one-month highs.

"The past month has been bearish for nearly all crypto assets following a prolonged bout of low liquidity and macro-induced volatility," she said. "It remains to be seen whether this upside break has conviction, with bitcoin still trading nearly $20,000 below previous all time highs."

Tuesday's upward moves follow an announcement from Moscow that the Russian Defense Ministry has begun returning some troops to deployment bases after training exercises near the Ukraine border.

Bitcoin traded choppily on Monday as the conflict had appeared to escalate, while stocks ended the day lower. The cryptocurrency has been trading like more traditional risk assets for several months as its investor base becomes increasingly institutionalized.

Although the bounce is welcome, it also shows the correlation between traditional and digital markets is "as strong as ever," Valkyrie Investments CEO Leah Wald said.

"Going forward, we believe the expected rate hikes are priced in and will not have much effect on prices," she added. "Additionally, fundamentals including active wallet addresses, total transactions, and multiple crypto asset apps ascending to the top of app store download charts after the Super Bowl shows there is still strong interest in and demand for bitcoin and altcoins. We remain firmly bullish and stand behind our belief that the second half of this year is likely to see a strong rally in digital assets including bitcoin."

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Bitcoin and ether rise as Ukraine-Russia tensions appear to ease - CNBC

Moscow, Russia Fyodor, a middle-aged Russian man, pulls out his phone from his pocket and scrolls through photos of himself and several others in camouflage fatigues.

They are holding up assault rifles and machineguns next to the white, blue and red of a Russian flag decorated with the emblem of their unit, a sword-and-shield with an Orthodox cross.

Our group was called the Russian Orthodox Army, even though Im an atheist and we had both Christians and Muslims, he told this reporter in a Moscow cafe, before swiping to the next photo.

This guy on the left, he was a local guy. He was a Muslim, and he was my friend. He died.

Fyodor, or Fedya for short, does not want to be known by his real name.

In 2014, after watching the Ukraine conflict from afar, he says he was wary of propaganda and decided to travel to the Donbas to see for himself. He ended up joining the Russia-backed separatist movement in eastern Ukraine, taking up arms with local rebels.

They were fighting a war with the central government in Kyiv, which they saw as having taken power in an ultranationalist coup during the Euromaidan revolution.

Once, eight of us were out on patrol through a field when we came under mortar fire, he recalled. I dont know how we survived. There was debris flying all around me, I hurt my shoulder, and I still had to carry another guy who injured his legs. Im not a believer at all but it was a real miracle all of us got out of there alive.

Fyodor saw how the war brought out the worst in people, and the grim realities of the rebels own brand of justice. He claims he once came across a 12-year-old girl who had been raped.

The man that did this, lets just say hes not around any more, he said ominously. I would have him brought to trial, personally, but I understand the people that put him up against the wall.

When he took the girl to hospital, he saw how locals in Donetsk perceived the conflict.

The staff took him aside and asked whether Russian President Vladimir Putin would wish them a Happy New Year in his annual, televised address to the nation.

Unlike Crimea, separatist Donetsk Peoples Republic (DPR) and Luhansk Peoples Republic (LPR) were never absorbed into the Russian Federation. Neither were they recognised by any member states of the United Nations, including Russia.

You can see that they really wanted to be part of Russia, but that never happened, even though most of them have Russian passports now, he said, referring to Russias policy that has seen many in the rebel-controlled areas handed citizenship in recent years.

I cant speak for all of them, of course, but if you tell someone from Donetsk they are Ukrainian, theyll take that as an insult. I kind of feel bad for them, like we let them down.

Fyodor believes there is a distinct possibility of the current standoff escalating, but says he would not return to the front.

Sooner or later, I think, this conflict will turn hot. The guys at the front lines are under strict orders not to shoot, but you understand it only takes one shot from the other side and some hot-headed lads will return fire.

If a war does break out, I hope at least we will get to Kharkov, he said, using the Russian name for Ukraines second-largest city.

To Ukrainians, the northeastern metropolis is Kharkiv, a former industrial centre in the Soviet era.

Ninety-nine of the population there supports us anyway, claimed Fyodor, who is happy to watch the tensions from afar these days, as he works in advertising.

I wouldnt go back to war now, even though some of the lads are talking about it and theyre trying to draw me back in. Id only return to deliver humanitarian supplies. My shoulder still hurts sometimes from that mortar blast.

Yuri Tikhonov is another veteran, originally from Pskov in western Russia.

Like Fyodor, he was in his 30s when he travelled to the Donbas in November 2014 after watching events unfold on news channels.

Having spent his compulsory military service doing tech support, his only experience with firearms had been, to that point, firing three shots out of a rifle. He was understandably anxious.

Id taken part in re-enactments, but its one thing running around with a sword and another charging the battle lines with an assault rifle, Tikhonov, now in Saint Petersburg and working in construction, told Al Jazeera by phone.

I didnt have any romantic notions of war: my parents were veterans and knew what it was really like. But I had my mind set and I knew if I didnt go, Id never respect myself.

Im ashamed I didnt head there sooner because the closer to the start of the conflict, the more important each step. Another 15-20 men could decide the outcome of one battle.

When he arrived, Tikhonov was sent near the town of Debaltseve, where he handled communications and radio intel.

He was grateful not to be assigned to any assault divisions since he is as large as an elephant and cannot shoot.

His duties included listening in to the Ukrainian army, which transmitted their artillery coordinates openly over the air.

We listened in to the chatter from the Ukrainian army, who at the time were very poor at hiding their signals. We knew exactly where they were firing. It was very satisfying hearing: Fire! No, stop, stop! They can hear us! Theyre driving away! he said.

Even though he was not on the front line, Tikhonov still had a couple of close calls.

Luckily, no one ever fired on me directly, but looking back, I can see how I was so young and nave and I wasnt really scared of anything, he said. I was installing an antenna on a roof when suddenly we came under mortar fire. I figured I didnt have time to run and take cover. So I just stood there and clung on I was more scared of dropping the antenna.

In January and February 2015, Tikhonov took part in the battle of Debaltseve.

Id go outside for a smoke while artillery rounds are whizzing over my head, like a passing train but much faster, while mortar rounds whistled as they flew past, he said.

But we managed to defend Debaltsevo until February, when we handed it over to the LPR.

After that, Tikhonov and his team did not take part in any more battles and by April, it was time to go home.

War is very interesting. If you have good people around you, its remarkable. Id go down to the cellar to eat dinner with the other volunteers, sat down and listened to their stories of how they ended up there, and youre proud to stand side-by-side with them, he said.

I was assigned to the communist volunteers detachment, and even though Im far from a communist, we were all united.

They love their people and are willing to sacrifice their lives for them, so matter what their politics are, youre always on the level with them.

However, he was ashamed of all the looting he saw, particularly from his own side.

The LPR practically robbed entire cities, he said. They told [people] they were about to come under fire so everyone hid in the basement, while their apartments were ransacked.

Yuri does not think there will be another war, since taking over territory not to mention ruling it is an expensive undertaking for which the Russian government does not have the capacity.

Sure, it would be nice if all the Russian-speaking peoples lived together as one, but the government doesnt need Ukraine as another part of Russia, he said.

Ive heard theyre being real careful now and not letting just any new volunteers to the front line. For these sort of escalations, you need completely controllable people that wont try to storm Mariupol by themselves, because if you hit them too hard and the Ukrainians retreat, then well have to capture more territory. No one wants this.

The Russian army simply doesnt have the resources for such an expansive operation, he added. We might reach Kharkov, and thats it.

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Ex-Russian separatists on whether another Ukraine war is possible - Al Jazeera English