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Background: A comprehensive summary of evidence about oral health in slum settings that could inform policy directions is lacking. Objective: To summarise the latest evidence regarding oral disease burden and their determinants, perceptions, practices, and service utilization in the slums and non-slum urban settings of LMICs. Design: Systematic review Data sources: Embase and MEDLINE (Ovid); PubMed; Scopus, Web of Science, CRD DARE Database; ELDIS; Essential Health Links; HINARI; African Index Medicus (AIM); and Bioline International, all searched from January 2000 to June 2023 using slum-related terms. Eligibility criteria: Empirical studies of all designs were eligible. Studies published in English with full-text available and reporting disease burden, perceptions, behaviours and service utilisation related to oral health of residents of slums or broader settings including slums in low and middle-income countries were included. Data extraction, quality assessment, synthesis and reporting: Studies were categorised and data were extracted and charted according to a preliminary conceptual framework refined by emerging findings. The Mixed Methods Assessment Tool (MMAT) was used to appraise the quality of empirical studies. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and (where applicable) the Synthesis Without Meta-analysis (SWiM) guideline were adopted for guiding synthesis and reporting. Results were tabulated and narratively summarised. Results: Full-text articles for 56 records were assessed for eligibility and 23 of the articles were included in this review. The majority (13 studies, 57%) were conducted in Asia, and nine studies (39%) in Africa. Six focused on slums (two examined slum and urban non-slum and four examined purely slum settings), two examined general urban settings, eight included both rural and urban areas in their settings, two examined disadvantaged/low socioeconomic, one assessed rural/urban/metropolis/municipal/district, three covered the national population or whole country, and one looked at high versus low socioeconomic regions. The commonest oral diseases reported were dental caries (prevalence: 13% - 76%), and periodontal diseases (prevalence: 23% - 99%). These were higher in slum settings and showed differences across age groups, gender, and socioeconomic classes. Most participants in the studies perceived their oral health status as satisfactory, a belief commoner among younger people, males, those in higher socio-economic classes, and employed. Mouth cleaning was mostly once daily, usually in the mornings. The use of toothpaste and brush was commonest. Other oral hygiene implements included toothpowder, chewing-stick, neem, charcoal, sand, snuff, salt, and the fingers. There was widespread engagement in home remedies for oral disease cure or prevention, while the use of professional dental care facilities was generally low and problem-driven. Conclusion: The systematic review identified a sparse body of literature on oral health surveys in slums and other urban settings in LMICs. Available data suggest a high oral disease burden, worse in slums, use of inappropriate mouth cleaning tools, self-care practices for pain relief, and few visits to care facilities. Systematic review registration: Systematic review registration with PROSPERO in February 2020, number CRD42020123613. [ABSTRACT FROM AUTHOR]

This study explores the enhancement of poly(lactic acid) (PLA) matrix using calcium hydroxyapatite (cHAP) and reduced graphene oxide (rGO) for developing composite scaffolds aimed at bone regeneration applications. The PLA composites were fabricated through solvent evaporation and melt extrusion and characterized by various techniques, including thermogravimetric analysis (TGA), differential scanning calorimetry (DSC), Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), and mechanical testing. The incorporation of cHAP and rGO significantly improved the thermal, mechanical, and morphological properties of the PLA matrix. Mechanical testing revealed that adding 10% cHAP and varying amounts of rGO (0.1%, 0.3%, 0.5%) enhanced tensile and compressive strengths, with the highest improvements observed at 0.5% rGO content. Thermal analysis showed increased thermal stability with higher degradation temperatures for the composites. Spectroscopic analyses confirmed the effective integration of cHAP and rGO into the PLA matrix with characteristic peaks of the fillers identified in the composite spectra. In vitro, degraded action tests in phosphate-buffered saline (PBS) at pH 7.4 over 12 months indicated that composites with higher rGO content exhibited lower mass loss and better mechanical stability. Furthermore, finite element analysis (FEA) simulations were performed to validate the experimental results, demonstrating a strong correlation between simulated and experimental compressive strengths. This novel approach demonstrates the potential of PLA/cHAP/rGO composites in creating effective and biocompatible scaffolds for tissue engineering, providing a comprehensive analysis of the synergistic effects of cHAP and rGO on the PLA matrix and offering a promising material for bone regeneration applications. [ABSTRACT FROM AUTHOR]

This research explores the enhancement of electrochemical performance in magnesium batteries by optimising magnesium alloy anodes, explicitly focusing on Mg-Al and Mg-Ag alloys. The study's objective was to determine the impact of alloy composition on anode voltage stability and overall battery efficiency, particularly under extended cycling conditions. The research assessed the anodes' voltage behaviour and internal resistance across magnesium bis(trifluoromethanesulfonyl)imide (Mg(TFSI)2) electrolyte formulations using a systematic setup involving cyclic voltammetry on the anode and electrochemical impedance spectroscopy. The Mg-Al alloy demonstrated superior performance, with minimal voltage drop and lower resistance increase than the Mg-Ag alloy. The results showed that the Mg-Al alloy maintained over 85% energy efficiency after 100 cycles, significantly outperforming the Mg-Ag alloy, which exhibited increased degradation and efficiency reduction to approximately 80%. These findings confirm that incorporating aluminium into magnesium anodes stabilises the anode voltage and enhances the overall battery efficiency by mitigating degradation mechanisms. Consequently, the Mg-Al alloy is identified as an up-and-coming candidate for use in advanced battery technologies, offering energy density and cycle life improvements. This study lays the groundwork for future research to refine magnesium alloy compositions further to boost battery performance. [ABSTRACT FROM AUTHOR]

This research aims to enhance the surface quality, mechanical properties, and biocompatibility of PEEK (polyether–ether–ketone) biomimetic dental implants through laser polishing. The objective is to improve osseointegration and implant durability by reducing surface roughness, increasing hydrophilicity, and enhancing mechanical strength. The methodology involved fabricating PEEK implants via FDM and applying laser polishing. The significant findings showed a 66.7% reduction in surface roughness, Ra reduced from 2.4 µm to 0.8 µm, and a 25.3% improvement in hydrophilicity, water contact angle decreased from 87° to 65°. Mechanical tests revealed a 6.3% increase in tensile strength (96 MPa to 102 MPa) and a 50% improvement in fatigue resistance (100,000 to 150,000 cycles). The strength analysis result showed a 10% increase in stiffness storage modulus from 1400 MPa to 1500 MPa. Error analysis showed a standard deviation of ±3% across all tests. In conclusion, laser polishing significantly improves the surface, mechanical, and biological performance of PEEK implants, making it a promising approach for advancing biomimetic dental implant technology. [ABSTRACT FROM AUTHOR]

This study explores the fabrication and characterisation of 3D-printed polylactic acid (PLA) scaffolds reinforced with calcium hydroxyapatite (cHAP) for bone tissue engineering applications. By varying the cHAP content, we aimed to enhance PLA scaffolds' mechanical and thermal properties, making them suitable for load-bearing biomedical applications. The results indicate that increasing cHAP content improves the tensile and compressive strength of the scaffolds, although it also increases brittleness. Notably, incorporating cHAP at 7.5% and 10% significantly enhances thermal stability and mechanical performance, with properties comparable to or exceeding those of human cancellous bone. Furthermore, this study integrates machine learning techniques to predict the mechanical properties of these composites, employing algorithms such as XGBoost and AdaBoost. The models demonstrated high predictive accuracy, with R2 scores of 0.9173 and 0.8772 for compressive and tensile strength, respectively. These findings highlight the potential of using data-driven approaches to optimise material properties autonomously, offering significant implications for developing custom-tailored scaffolds in bone tissue engineering and regenerative medicine. The study underscores the promise of PLA/cHAP composites as viable candidates for advanced biomedical applications, particularly in creating patient-specific implants with improved mechanical and thermal characteristics. [ABSTRACT FROM AUTHOR]

This research uses advanced statistical methods to examine climate change mitigation policies' economic and environmental impacts. The primary objective is to assess the effectiveness of carbon pricing, renewable energy subsidies, emission trading schemes, and regulatory standards in reducing CO2 emissions, fostering economic growth, and promoting employment. A mixed-methods approach was employed, combining regression analysis, cost–benefit analysis (CBA), and computable general equilibrium (CGE) models. Data were collected from national and global databases, and sensitivity analyses were conducted to ensure the robustness of the findings. Key findings revealed a statistically significant reduction in CO2 emissions by 0.45% for each unit increase in carbon pricing (p < 0.01). Renewable energy subsidies were positively correlated with a 3.5% increase in employment in the green sector (p < 0.05). Emission trading schemes were projected to increase GDP by 1.2% over a decade (p < 0.05). However, chi-square tests indicated that carbon pricing disproportionately affects low-income households (p < 0.05), highlighting the need for compensatory policies. The study concluded that a balanced policy mix, tailored to national contexts, can optimise economic and environmental outcomes while addressing social equity concerns. Error margins in GDP projections remained below ±0.3%, confirming the models' reliability. [ABSTRACT FROM AUTHOR]

This research investigates the application of machine learning models to optimise renewable energy systems and contribute to achieving Net Zero emissions targets. The primary objective is to evaluate how machine learning can improve energy forecasting, grid management, and storage optimisation, thereby enhancing the reliability and efficiency of renewable energy sources. The methodology involved the application of various machine learning models, including Long Short-Term Memory (LSTM), Random Forest, Support Vector Machines (SVMs), and ARIMA, to predict energy generation and demand patterns. These models were evaluated using metrics such as Mean Absolute Error (MAE) and Root Mean Squared Error (RMSE). Key findings include a 15% improvement in grid efficiency after optimisation and a 10–20% increase in battery storage efficiency. Random Forest achieved the lowest MAE, reducing prediction error by approximately 8.5%. The study quantified CO2 emission reductions by energy source, with wind power accounting for a 15,000-ton annual reduction, followed by hydropower and solar reducing emissions by 10,000 and 7500 tons, respectively. The research concludes that machine learning can significantly enhance renewable energy system performance, with measurable reductions in errors and emissions. These improvements could help close the "ambition gap" by 20%, supporting global efforts to meet the 1.5 °C Paris Agreement targets. [ABSTRACT FROM AUTHOR]

Background: With 60% of Africa's population under the age of 25 years, investing in youth will accelerate progress towards achieving the Sustainable Development Goals (SDGs). The United Nations concept of 'Development Accelerators' is operationalized by examining factors associated with multiple SDGs among adolescents in Nigeria. Methodology: Through data collected on the health of 1800 adolescents in Southwest Nigeria (Ibadan), ten SDG targets were identified. Accelerator protective factors that could lead to the attainment of two or more SDG targets were identified. Associations were assessed using multivariable logistic regression adjusting for sociodemographic covariates and multiple testing. Cumulative effects were tested by marginal effects modelling. Results: Participants' mean age was 15.02 years (SD = 2.27). Family (parenting support), environmental (no survival work and food security) and school (safe schools) related factors emerged as development accelerators. For seven of the identified SDG-aligned targets, a combination of two or more accelerator factors showed cumulative positive associations, suggesting accelerator synergies with a combination of three accelerators showing the greatest increase. For instance, perceiving the school environment as safe, being food secure and having optimal mental health was associated with an 67% chance of not using psychoactive substances. While with safe school alone it was 39% (29%-51%), with food security alone it was 42% (31%-54%) and with optimal mental health alone it was 54% (42%-66%). Conclusion: Several development accelerators related to family, environmental and school factors can have additive effects on the attainment of the SDGs amongst adolescents in Nigeria. This has practical and policy utility in the fastest growing economy in Africa. [ABSTRACT FROM AUTHOR]

This research investigates using Polyether ether ketone (PEEK) in dental prosthetics, focusing on enhancing the mechanical properties, adhesion capabilities, and environmental sustainability through AI-driven data analysis and advanced surface treatments. The objectives include improving PEEK's adhesion to dental types of cement, assessing its biocompatibility, and evaluating its environmental impact compared to traditional materials. The methodologies employed involve surface treatments such as plasma treatment and chemical etching, mechanical testing under ASTM standards, biocompatibility assessments, and lifecycle analysis. AI models predict and optimize mechanical properties based on extensive data. Significant findings indicate that surface-treated PEEK exhibits superior adhesion properties, maintaining robust mechanical integrity with no cytotoxic effects and supporting its use in direct contact with human tissues. Lifecycle analysis suggests PEEK offers a reduced environmental footprint due to lower energy-intensive production processes and recyclability. AI-driven analysis further enhances the material's performance prediction and optimization, ensuring better clinical outcomes. The study concludes that with improved surface treatments and AI optimization, PEEK is a promising alternative to conventional dental materials, combining enhanced performance with environmental sustainability, paving the way for broader acceptance in dental applications. [ABSTRACT FROM AUTHOR]

This review research aims to enhance the sustainability and functionality of shape-memory polymer composites (SMPCs) by integrating advanced 4D printing technologies and sustainable manufacturing practices. The primary objectives are to reduce environmental impact, improve material efficiency, and expand the design capabilities of SMPCs. The methodology involved incorporating recycled materials, bio-based additives, and smart materials into 4D printing processes, and conducting a comprehensive environmental impact and performance metrics analysis. Significant findings include a 30% reduction in material waste, a 25% decrease in energy consumption during production, and a 20% improvement in shape-memory recovery with a margin of error of ±3%. Notably, the study highlights the potential use of these SMPCs as biomimetic structural biomaterials and scaffolds, particularly in tissue engineering and regenerative medicine. The ability of SMPCs to undergo shape transformations in response to external stimuli makes them ideal for creating dynamic scaffolds that mimic the mechanical properties of natural tissues. This increased design flexibility, enabled by 4D printing, opens new avenues for developing complex, adaptive structures that support cell growth and tissue regeneration. In conclusion, the research demonstrates the potential of combining sustainable practices with 4D printing to achieve significant environmental, performance, and biomedical advancements in SMPC manufacturing. [ABSTRACT FROM AUTHOR]

This research investigates the environmental sustainability and biomedical applications of shape memory polymers (SMPs), focusing on their integration into 4D printing technologies. The objectives include comparing the carbon footprint, embodied energy, and water consumption of SMPs with traditional materials such as metals and conventional polymers and evaluating their potential in medical implants, drug delivery systems, and tissue engineering. The methodology involves a comprehensive literature review and AI-driven data analysis to provide robust, scalable insights into the environmental and functional performance of SMPs. Thermomechanical modeling, phase transformation kinetics, and heat transfer analyses are employed to understand the behavior of SMPs under various conditions. Significant findings reveal that SMPs exhibit considerably lower environmental impacts than traditional materials, reducing greenhouse gas emissions by approximately 40%, water consumption by 30%, and embodied energy by 25%. These polymers also demonstrate superior functionality and adaptability in biomedical applications due to their ability to change shape in response to external stimuli. The study concludes that SMPs are promising sustainable alternatives for biomedical applications, offering enhanced patient outcomes and reduced environmental footprints. Integrating SMPs into 4D printing technologies is poised to revolutionize healthcare manufacturing processes and product life cycles, promoting sustainable and efficient medical practices. [ABSTRACT FROM AUTHOR]

Millions of children and young people (CYP) in low‐ and middle‐income countries (LMICs) have no access to mental health care. This huge treatment gap is primarily due to limited availability of trained mental health professionals. We propose task‐sharing as a scalable strategy to expand access to child and adolescent mental health (CAMH) interventions in LMICs. Task‐sharing involves using the few mental health specialists in LMICs to train and supervise nonspecialists to provided CAMH interventions. There is strong evidence of clinical and cost effectiveness of task‐shared mental health interventions for adults in LMICs and promising evidence for CYP. To succeed, task‐shared programmes need to be embedded in a balanced system‐wide care setting that includes stakeholder involvement. The existing mental health specialists may require additional training in leadership, supervision, mentoring, service design and evaluation in order to meet the additional expectations of managing task‐sharing programmes. The nonspecialists to be trained would need assurances about workload, ongoing supervision, clinical back up for cases that exceed their expertise, certification for their training and career progression. CAMH task‐sharing offers good promise for increasing CYP's access to mental health interventions in LMICs. However, planners need to be aware of the important practical, ethical and contextual considerations necessary for success and sustainability. [ABSTRACT FROM AUTHOR]

Background: Low birth weight (LBW) is a major public health problem in Ethiopia. Dietary diversity is a key indicator of maternal dietary adequacy that may affect birth weight but little is known about their relationship. Hence, this study aimed to assess the association of suboptimal maternal dietary diversity during pregnancy and low birth weight in Gurage Zone, Ethiopia. Methods: The prospective study was conducted among 1062 pregnant women enrolled consecutively in between 16 to 20 gestational weeks and followed until delivery. The baseline data were collected at recruitment and dietary diversity was assessed using the minimum dietary diversity score for women (MDD-W) tool in three different rounds. The average of three scores was considered to categorize women into optimal (consumed ≥ 5 food groups) and suboptimal (consumed < 5 food groups) dietary diversity groups. The risk of low birth weight among suboptimal dietary diversity was assessed using modified Poisson regression with robust standard error. Results: Of the 1062 pregnant women recruited, 959 (90.4%) women completed follow-up. Among them, 302 (31.5%) women are having optimal and the rest, 657 (68.5%) women are having suboptimal dietary diversity. The risk of low birth weight was significantly higher among women with sub-optimal dietary diversity than among those with optimal diversity (ARR = 1.89, 95% CI: 1.25, 2.84). Other factors such as rural residence (ARR = 1.61, 95% CI: 1.43, 1.87), age > = 35 years (AAR = 3.94, 95% CI: 2.41, 6.46), being underweight (ARR = 1.81, 95% CI: 1.14, 2.86), height < 150cm (ARR = 4.65, 95% CI: 2.52, 8.59), unwanted pregnancy (ARR = 3.35, 95% CI: 2.23, 5.02), preterm delivery (3.65, 95% CI: 2.27, 5.84) and lack of nutritional counseling (ARR = 1.69, 95% CI: 1.08, 2.67) significantly increased the risk of low birth weight. Conclusion: Suboptimal dietary diversity associated low birth weight. Promoting dietary diversity by strengthening nutritional education and avoiding unwanted pregnancy particularly among rural residents may help to reduce the incidence of low birth weight. [ABSTRACT FROM AUTHOR]

Investing in adolescents in Africa holds great promise for the development of the continent. The steps involved in identifying factors linked to interventions that may accelerate the attainment of multiple SDGs for adolescents in Nigeria are described. Data from a survey to investigate the well-being of 1800 adolescents aged 10–19 years in Southwest Nigeria was analysed. A four-step process was employed: 1) Mapping of variables deemed as suitable proxies for SDG targets; 2) Mapping hypothesised protective factors (accelerators) from the study instruments. Consequently, SDG targets related to elimination of hunger, good health, gender equality and peace; and seven accelerators (safe schools, parenting support, good mental health, no survival work, food security, stable childhood, and regular physical activity) were identified; 3) evaluating associations using bivariate analysis and multivariable logistic regression, 4) calculating adjusted probabilities. The mean age of the adolescents was 15.02 ± 2.27 years (48.6% female). Good mental health, not doing survival work, safe schools, stable childhood and parental support were significantly associated with at least two SDG targets. For example, food security was significantly associated with the highest number of SDG outcomes: one SDG target related to child survival (no substance use: x2 = 3.39, p = <0.001); three SDG targets related to educational outcomes (school progression: x2 = 5.68, p = 0.017, ability to concentrate in school: x2 = 26.92, p = <0.001, and school attendance: x2 = 25.89, p = <0.001); and four SDG targets related to child protection (no risky sexual behaviours: x2 = 16.14, p = <0.001, no perpetration of violence: x2 = 15.74, p = <0.001, no community violence: x2 = 39.06, p =<0.001, and no sexual abuse: x2 = 7.66, p = 0.006). Interventions centred around good mental health, not doing survival work, safe schools, small family size, stable childhood and parental support are potential accelerators for the attainment of SDG outcomes by adolescents living in Nigeria. [ABSTRACT FROM AUTHOR]

This paper describes a postgraduate training programme in child and adolescent mental health (CAMH) in Nigeria. It explains the background, curriculum development, teaching, evaluation and outcomes. By its 10th year the programme had trained 166 CAMH professionals from 14 African countries. Many of the graduates are running clinical CAMH services in their countries, mostly pioneered by them. They are also conducting CAMH training, including as faculty on the programme, and some are in international CAMH leadership roles. Key success elements of the programme that can be replicated in other low- and middle-income countries include international partnership, adopting a train-the-trainer approach, using a curriculum that covers clinical aspects of CAMH while also developing leadership and research skills, use of free-access training resources, and access to seed funding. [ABSTRACT FROM AUTHOR]

Much of the emerging evidence on the impact of COVID-19 on people with psychosocial disabilities comes from high-income countries. This study sought to explore the perceptions and experiences of youths living with psychosis during the COVID-19 pandemic in Nigeria. Using a co-produced research process, a facility-based study was conducted among youth with confirmed diagnosis of a psychotic disorder. In-depth interviews were conducted with 20 participants. Data was transcribed, double-coded and analysed with Atlas.ti using a thematic analysis approach. We found that participants were aware of good evidence-based information on the nature of the disease and the pandemic. Many of them described worsening mental health and disruptions to daily routines. Opportunities for deepening family relationships, skill building, helping others, and extended time for previously neglected self-development activities were described. This study benefitted from co-production with persons with lived experience, which could be harnessed for future research on psychosis. [ABSTRACT FROM AUTHOR]

Introduction: visual inspection is a low-cost screening strategy that can be used to prevent cervical cancer in women. These techniques can improve screening health outcomes for internally displaced women (IDW) who have poor sexual and reproductive health and rights' behaviors and outcomes. This study aimed to determine the prevalence of precancerous lesions and other clinical features using a visual inspection with acetic acid (VIA) technique during a cervical cancer screening campaign in two internally displaced people (IDP) camps in Benue State, Nigeria. Methods: this was a cross-sectional study of 166 IDW who voluntarily participated in the study during a VIA cervical cancer screening campaign in two IDP camps in Benue State, Nigeria the screening was done by a group of qualified and trained healthcare workers and data was collected using a structured, pretested questionnaire. Results: a total of 99(60%) of the women had a first sexual experience at 16 years, while 78(47%) had more than 5 full-term pregnancies. Although only 72(43.4%) of the women acknowledged having more than one sexual partner, over 70% of the women stated that their sexual partner had another sexual partner. The prevalence of precancerous lesions among women was 10.8%. Smoking(p=0.003), age at menarche (p= 0.001) and sexual behaviors (p=0.009, p=0.004) were factors that had a statistically significant relationship with the presence of a precancerous lesion among the IDW. The study also highlights the high rate (95%) of cervicitis among the women and the relatively high rate (5.4%) of leukoplakia. Conclusion: the majority of IDW had sociodemographic and lifestyle characteristics that predisposed them to developing cervical cancer More targeted interventions aimed at improving the sociodemographic and lifestyle characteristics of IDW are recommended. In addition, there is a need to create awareness about cervical cancer among IDW and make screening available in camp facilities for early detection and management. [ABSTRACT FROM AUTHOR]

Background: Benign prostatic hyperplasia (BPH) is a major health concern associated with lower urinary tract symptoms and sexual dysfunction in men. Recurrent inflammation, decreased apoptotic rate and oxidative stress are some of the theories that explain the pathophysiology of BPH. Common salt, a food additive, is known to cause systemic inflammation and redox imbalance, and may serve as a potential risk factor for BPH development or progression. This study examined the effect of common salt intake on the pathology of testosterone-induced BPH. Methods: Forty male Wistar rats were randomly divided into four equal groups of 10: a control and three salt diet groups-low-salt diet (LSD), standard-salt diet (SSD) and high-salt diet (HSD). The rats were castrated, allowed to recuperate and placed on salt-free diet (control), 0.25% salt diet (LSD), 0.5% salt diet (SSD) and 1.25% salt diet (HSD) for 60 days ad libitum. On day 33, BPH was induced in all the rats with daily injections of testosterone propionate-Testost® (3 mg/kg body weight) for 28 days. The rats had overnight fast (12 h) on day 60 and were euthanized the following day in order to collect blood and prostate samples for biochemical, molecular and immunohistochemistry (IHC) analyses. Mean ± SD values were calculated for each group and compared for significant difference with ANOVA followed by post hoc test (Tukey HSD) at p < 0.05. Results: This study recorded a substantially higher level of IL-6, IL-8 and COX-2 in salt diet groups and moderate IHC staining of COX-2 in HSD group. The prostatic level of IL-17, IL-1β, PGE2, relative prostate weight and serum PSA levels were not statistically different. The concentrations of IGF-1, TGF-β were similar in all the groups but there were multiple fold increase in Bcl-2 expression in salt diet groups-LSD (13.2), SSD (9.5) and HSD (7.9) and multiple fold decrease in VEGF expression in LSD (-6.3), SSD (-5.1) and HSD (-14.1) compared to control. Activity of superoxide dismutase (SOD) and concentration of nitric oxide rose in LSD and SSD groups, and SSD and HSD groups respectively. Activities of glutathione peroxidase and catalase, and concentration of NADPH and hydrogen peroxide were not significantly different. IHC showed positive immunostaining for iNOS expression in all the groups while histopathology revealed moderate to severe prostatic hyperplasia in salt diet groups. Conclusions: These findings suggest that low, standard and high salt diets aggravated the pathology of testosterone-induced BPH in Wistar rats by promoting inflammation, oxidative stress, while suppressing apoptosis and angiogenesis. [ABSTRACT FROM AUTHOR]

Background: HIV seroprevalence in Nigeria is increasing among men who have sex with men (MSM) from 14% to 2007 to 23% in 2014, threatening progress towards ending the epidemic in the country. Expanding access to HIV testing and linkage to care for key populations, like young MSM (YMSM), is critical to end the HIV epidemic in Nigeria. The Intensive Combination Approach to Roll Back the Epidemic in Nigerian Adolescents (iCARE Nigeria) pilot intervention successfully implemented a combination of evidence-based interventions utilizing peer navigators and popular social media apps and platforms to reach young men at risk for HIV exposure, including YMSM. We conducted sequential mixed methods explanatory implementation research to expand on the previously reported effectiveness and implementation outcomes and to explore the determinants and strategies which contributed to primary study results. Methods: We conducted key informant interviews and focus group discussions with 2 peer navigators and 3 study staff at the end of the pilot. We used directed content analysis to understand the quantitative results from the pilot. Using the Implementation Research Logic Model, we were able to identify and map strategies through mechanisms of action from barriers addressed to the reported implementation outcomes including feasibility, acceptability fidelity and adoption. Results: We found that iCARE Nigeria's pilot intervention implementers reported high feasibility, acceptability fidelity and adoption were associated with implementation of strategies which addressed many challenging contextual factors, including social stigma, online social networking, legal barriers surrounding MSM behavior, and the COVID-19 pandemic. These strategies included integration of stakeholders' interests, selection of experienced peer navigators including from the targeted population, training and supportive supervision using an implementation guide, ensuring safety (COVID and legal) and identification of clinics serving the targeted population. Conclusion: Mixed methods using implementation research frameworks provided insights into the strategies and barriers and facilitators they addressed which may explain the success of the pilot. These results can inform strategies needed to scale-up the intervention to youth including YMSM in other areas in Nigeria and the region. Trial registration ISRCTN: ISRCTN94590823, https://doi.org/10.1186/ISRCTN94590823 [ABSTRACT FROM AUTHOR]

Background/introduction: One of the key recommendations for the new WHO global strategy for oral health is inclusion of disadvantaged populations and their engagement in policy dialogues such that their needs and views are addressed in policy decisions. Objectives: This study explored oral health perceptions, practices and care-seeking experiences of slum residents in Ibadan, Nigeria. Method: Focus group discussions (FGD) were conducted with family health-decision makers in an urban slum site. Oral health perceptions, practices, and care-seeking experiences were discussed. FGDs were recorded, transcribed, and translated. ATLAS.ti qualitative research software was deployed for analysis using thematic analysis. Results: Six FGD sessions, divided by gender and age, were conducted between September–October 2019, (N = total 58 participants, aged 25 to 59 years). Common dental ailments mentioned were dental pain, tooth sensitivity, bleeding gums, tooth decay, mouth odor, gum disease, and tooth fracture. Perceived causes of dental conditions included poor dental hygiene and habits, sugary diets, ignorance, and supernatural forces. Mouth cleaning was mostly done once daily using toothbrush and paste. Other cleaning tools were ground glass, wood ash, charcoal, "epa Ijebu" (a dentrifice), and "orin ata" (a type of chewing stick). Remedies for relieving dental pain included over-the-counter medicines, warm salted water, gin, tobacco (snuff/powdered), cow urine/dung, battery fluid, and various mixtures/ concoctions. Visits to the dentists were mentioned by a few but this was usually as last resort. Main barriers to accessing care from dental care facilities were unaffordability of service charges and fear of extreme treatment measures (extraction). Suggested measures to improve timely access to dental health care included reducing/subsidizing costs of treatments and medications, offering non-extraction treatment options, and oral health education programmes. Conclusion: The slum residents experience various forms of dental ailments mostly pain-related. The residents perceived formal dental clinics as unaffordable, thereby engaging in self‐care remedies and harmful oral health practices before seeking professional help. Policymakers and decision-makers may leverage this empirical evidence for the people's education on early dental care and address challenges to affordable, available, and acceptable oral healthcare services among slum residents to improve access to care facilities. [ABSTRACT FROM AUTHOR]

Background: Gestational weight gain (GWG) is a risk factor for adverse pregnancy outcomes, future obesity and chronic diseases among women. However, has not received much attention in many low and middle-income countries such as Nigeria. We investigated the pattern, associated factors and pregnancy outcomes of GWG in Ibadan, Nigeria, using the Ibadan Pregnancy Cohort Study (IbPCS). Methodology: The IbPCS is a multicentre prospective cohort study conducted among 1745 pregnant women recruited from four health facilities in Ibadan, Nigeria. GWG, the primary outcome, was categorised according to the Institute of Medicine's classification into insufficient, adequate and excessive weight gain. Pregnancy outcomes were the secondary outcome variables. Logistic regression analysis (Adjusted odds ratios and 95% confidence interval CI) was used to examine associations, and Poisson regression analyses were used to investigate associations with outcomes. Results: Only 16.9% of women had optimal GWG, 56.8% had excessive GWG, and 26.9% had insufficient GWG. Excessive GWG was associated with high income '> #20,000-' (AOR: 1.64, 95% CI: 1.25–2.17), being overweight (AOR: 2.12, 95% CI: 1.52–2.95) and obese (AOR: 1.47, 95% CI: 1.02–2.13) after adjusting for confounders. In contrast, increased odds of insufficient GWG have associated women with depression (AOR: 1.70, 95% CI 1.17–2.47). There was no significant association between inappropriate GWG and pregnancy outcomes However, there was an increased odds for postpartum haemorrhage (AOR: 2.44, 95% CI 1.14–5.22) among women with obesity and excessive GWG. Conclusions: Excessive GWG was the most typical form of GWG among our study participants and was associated with high maternal income, and being overweight or obese. GWG needs to be monitored during antenatal care, and interventions that promote appropriate GWG should be implemented among pregnant women in Nigeria. [ABSTRACT FROM AUTHOR]

Background: Nigeria is one of six countries with half the global burden of youth living with HIV. Interventions to date have been inadequate as AIDS-related deaths in Nigeria's youth have remained unchanged in recent years. The iCARE Nigeria HIV treatment support intervention, a combination of peer navigation and SMS text message medication reminders to promote viral suppression, demonstrated initial efficacy and feasibility in a pilot trial among youth living with HIV in Nigeria. This paper describes the study protocol for the large-scale trial of the intervention. Methods: The iCARE Nigeria-Treatment study is a randomized stepped wedge trial of a combination (peer navigation and text message reminder) intervention, delivered to youth over a period of 48 weeks to promote viral suppression. Youth receiving HIV treatment at six clinical sites in the North Central and South Western regions of Nigeria were recruited for participation. Eligibility criteria included registration as a patient at participating clinics, aged 15–24 years, on antiretroviral therapy for at least three months, ability to understand and read English, Hausa, Pidgin English, or Yoruba, and intent to remain a patient at the study site during the study period. The six clinic sites were divided into three clusters and randomized to a sequence of control and intervention periods for comparison. The primary outcome is plasma HIV-1 viral load suppression, defined as viral load ≤ 200 copies/mL, in the intervention period versus the control period at 48 weeks of intervention. Discussion: Evidence-based interventions to promote viral load suppression among youth in Nigeria are needed. This study will determine efficacy of a combination intervention (peer navigation and text message reminder) and collect data on potential implementation barriers and facilitators to inform scale-up if efficacy is confirmed. Trial registration: ClinicalTrials.gov number, NCT 04950153, retrospectively registered July 6, 2021, https://clinicaltrials.gov/. [ABSTRACT FROM AUTHOR]

Accurate characterization of microcalcifications (MCs) in 2D digital mammography is a necessary step toward reducing the diagnostic uncertainty associated with the callback of indeterminate MCs. Quantitative analysis of MCs can better identify MCs with a higher likelihood of ductal carcinoma in situ or invasive cancer. However, automated identification and segmentation of MCs remain challenging with high false positive rates. We present a two-stage multiscale approach to MC segmentation in 2D full-field digital mammograms (FFDMs) and diagnostic magnification views. Candidate objects are first delineated using blob detection and Hessian analysis. A regression convolutional network, trained to output a function with a higher response near MCs, chooses the objects which constitute actual MCs. The method was trained and validated on 435 screening and diagnostic FFDMs from two separate datasets. We then used our approach to segment MCs on magnification views of 248 cases with amorphous MCs. We modeled the extracted features using gradient tree boosting to classify each case as benign or malignant. Compared to state-of-the-art comparison methods, our approach achieved superior mean intersection over the union (0.670 ± 0.121 per image versus 0.524 ± 0.034 per image), intersection over the union per MC object (0.607 ± 0.250 versus 0.363 ± 0.278) and true positive rate of 0.744 versus 0.581 at 0.4 false positive detections per square centimeter. Features generated using our approach outperformed the comparison method (0.763 versus 0.710 AUC) in distinguishing amorphous calcifications as benign or malignant. [ABSTRACT FROM AUTHOR]

Background: Child marriage hinders progress toward population health and development goals. Cost effective interventions that address the root causes of child marriage are needed to speed progress toward ending the practice. Nigeria is home to the largest number of married girls in Africa and many of these girls are members of the Hausa ethnic group, making efforts to tackle this issue particularly urgent among this population. Methods: Radio programs have the potential to inform large numbers of people about the harms of child marriage and change their support for the practice at low cost. We will develop a series of radio programs that address gender inequitable attitudes that motivate child marriage among Hausa communities in Ibadan, Nigeria. The content of the series will be based on input from the Hausa community. A baseline survey that measures knowledge of and support for child marriage will be conducted among randomly selected samples of Hausa adults in two cities: Ibadan, which will serve as the intervention site, and Akure, the control site. The radio programs will then air on Hausa-language stations in Ibadan over a three-month period, with the aim of informing persons of the potential harms of child marriage and reducing their support for the practice. A follow-up survey with the same individuals surveyed at baseline will be conducted in both cities. We will measure the impact of this intervention by comparing changes in these outcomes over time in the intervention site (Ibadan) with changes in the same outcomes in the control site (Akure). Conclusion: This study will investigate whether a series of targeted radio programs can reduce support for child marriage. The intervention is readily scalable and cost-effective and, if it effectively shifts attitudes toward child marriage, could represent a promising way of addressing child marriage in Nigeria. [ABSTRACT FROM AUTHOR]

Arthur Kleinman's 2009 Lancet commentary described global mental health as a "moral failure of humanity", asserting that priorities should be based not on the epidemiological and utilitarian economic arguments that tend to favour common mental health conditions like mild to moderate depression and anxiety, but rather on the human rights of those in the most vulnerable situations and the suffering that they experience. Yet more than a decade later, people with severe mental health conditions like psychoses are still being left behind. Here, we add to Kleinman's appeal a critical review of the literature on psychoses in sub-Saharan Africa, highlighting contradictions between local evidence and global narratives surrounding the burden of disease, the outcomes of schizophrenia, and the economic costs of mental health conditions. We identify numerous instances where the lack of regionally representative data and other methodological shortcomings undermine the conclusions of international research carried out to inform decision-making. Our findings point to the need not only for more research on psychoses in sub-Saharan Africa, but also for more representation and leadership in the conduct of research and in international priority-setting more broadly—especially by people with lived experience from diverse backgrounds. This paper aims to encourage debate about how this chronically under-resourced field, as part of wider conversations in global mental health, can be reprioritised. [ABSTRACT FROM AUTHOR]

Background: It is often difficult for clinicians in African low- and middle-income countries middle-income countries to access useful aggregated data to identify areas for quality improvement. The aim of this Delphi study was to develop a standardised perioperative dataset for use in a registry. Methods: A Delphi method was followed to achieve consensus on the data points to include in a minimum perioperative dataset. The study consisted of two electronic surveys, followed by an online discussion and a final electronic survey (four Rounds). Results: Forty-one members of the African Perioperative Research Group participated in the process. Forty data points were deemed important and feasible to include in a minimum dataset for electronic capturing during the perioperative workflow by clinicians. A smaller dataset consisting of eight variables to define risk-adjusted perioperative mortality rate was also described. Conclusions: The minimum perioperative dataset can be used in a collaborative effort to establish a resource accessible to African clinicians in improving quality of care. [ABSTRACT FROM AUTHOR]

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Since the adoption of the sustainable development goals (SDGs) by the United Nations (UN), the search has been on to identify interventions that have effects on multiple SDG-targets simultaneously. Like other developing countries, Ghana has a youthful population and would require creative, urgent, youth-focused interventions to be able to attain the SDGs by 2030. This paper describes the application of the accelerator model on data from a sample of Ghanaian adolescents to identify potential accelerators towards selected SDG targets involving youth. The data for 944 adolescents, 10–19 years (mean age 12.31 ± 3.51 years), extracted from two cross-sectional surveys on children and adolescents aged 6–19 years in Kumasi, Ghana, were analysed in this paper. Variables considered suitable proxies for SDG targets and potential accelerators were identified from the study instruments. Consequently, four aligned SDG targets (good mental health, access to ICT, school completion and no open defaecation) and five accelerators (cognitive stimulation, no relative poverty, low student–teacher ratio, high caregiver education and safe water) were extracted. Associations between accelerators and SDG targets were assessed using multivariable logistic regression adjusting for sociodemographic covariates and multiple testing. Cumulative effects were tested by marginal effects modelling. The three hypothesised accelerators identified were cognitive stimulation, low student–teacher ratio, and no relative poverty. A combination of all three accelerators was associated with a higher likelihood of adolescents having access to Information and Communication Technology (ICT) by +73% (CI 0.72–0.74), no open defecation by +44% (CI 0.43–0.46), school completion by +27% (CI 0.26–0.27) and good mental health by +9% (CI 0.08–0.10). Three hypothesized accelerators showed association across all four SDG aligned targets. The accelerator model has been further validated in this dataset from Ghana. Robust interventions designed around these accelerators may represent an opportunity for achieving the SDGs in Ghana. [ABSTRACT FROM AUTHOR]

Background: In Ethiopia limited information is available regarding the prevalence and predictors of anemia in pregnancy. This systematic review and meta-analysis estimated the pooled prevalence of anemia among pregnant women in Ethiopia and also identified its predictors. Materials and methods: The published primary studies were searched in the following electronic databases; PubMed/Medline, Google scholars, AJOL, and EMBASE. All primary studies published from 01/01/2010 to 30/05/2020 and written in English language were included without restriction on study setting and design. Critical appraisal of all available articles was done and extracted data was analyzed using STATA software version 14. The pooled prevalence of anemia was presented using a forest plot. The I2 statistical test for heterogeneity, and the Egger's and Begg's tests for publication bias were used. The relative risk was used to assess the association of predictor variables with anemia. Result: After screening 274 articles, sixty studies were included in the analysis. The pooled prevalence of anemia among pregnant women was 26.4(95% CI: 23.1, 29.6). Sub-group analysis showed higher pooled prevalence from community-based studies than institutional-based studies. Factors that were protective against maternal anemia included urban residence, formal education and smaller family size. Short birth interval and not having antenatal care (ANC) are associated with a higher risk of maternal anemia. Women with low dietary diversity [RR: 2.61(95% CI, 1.85, 3.68)], mid-upper arm circumference (MUAC) less than 23 cm [RR: 2.35(95% CI, 1.53, 3.68)] and those not taking iron-folic acid [RR: 1.53(95% CI: 1.30, 1.81)] also had a higher risk of anemia. Conclusion: Almost one in four pregnant women in Ethiopia had anemia. Being literate, living in urban areas with small family size and adequate birth spacing, as well as good dietary diversity are associated with a lower risk of anemia in pregnancy. Registration number: (ID: CRD42020211054). [ABSTRACT FROM AUTHOR]

District health managers (DHMs) lead and manage Ministry of Health programmes and system performance. We report on the acceptability and feasibility of inter-related activities to increase the agency of DHMs in Kenya, Nigeria, South Africa and Uganda using a cross-sectional rapid appraisal with 372 DHMs employing structured questionnaires. We found differences and similarities between the countries, in particular, who becomes a DHM. The opportunity to provide leadership and effect change and being part of a team were reported as rewarding aspects of DHMs' work. Demotivating factors included limited resources, bureaucracy, staff shortages, lack of support from leadership and inadequate delegation of authority. District managers ranked the acceptability of the inter-related activities similarly despite differences between contexts. Activities highly ranked by DHMs were to employ someone to support primary care staff to compile and analyse district-level data; to undertake study tours to well-functioning districts; and joining an African Regional DHM Association. DHMs rated these activities as feasible to implement. This study confirms that DHMs are in support of a process to promote bottom-up, data-driven, context-specific actions that can promote self-actualisation, recognises the roles DHMs play, provides opportunities for peer learning and can potentially improve quality of care. [ABSTRACT FROM AUTHOR]

Sickle cell disorder (SCD) is a serious blood disorder that affects millions of people worldwide. It is particularly prevalent in Africa. The condition can be associated with physical and psychological difficulties. There are no studies of psychological interventions for people affected by SCD in Africa where the majority of affected persons live. Eighteen students with SCD aged 16–24 years at University of Ibadan, Nigeria received five sessions of manualised group-based CBT. The sessions included psycho-education about SCD, strategies for managing negative thoughts and feelings, activity scheduling, relaxation techniques, and attention diversion. The outcome measures: Hospital Anxiety and Depression Scale (HADS), Coping Skills Questionnaire modified for sickle cell disease-adult version (CSQ-SCD), and Short-Form health survey (SF-36), were administered at baseline and repeated 1 week after the intervention. Post-intervention, there were significant reductions in anxiety and depressive symptoms (p = 0.001 and 0.02, respectively), increase in active and passive coping skills (p = 0.04 for both), and increase in social functioning (p = 0.001). Students' satisfaction with the intervention was very high. The study suggests that group-based CBT intervention is feasible, acceptable and appears helpful in reducing anxiety and depressive symptoms, improving adaptive coping skills, and social functioning of Nigerian University students affected by SCD. [ABSTRACT FROM AUTHOR]

Maternal obesity is a neglected public health challenge in Nigeria, even though it's associated with adverse metabolic, pregnancy, postpartum outcomes and future risk of non-communicable diseases. The Ibadan Pregnancy Cohort Study (IbPCS) investigates maternal obesity, lifestyle factors and the associated pregnancy and postpartum outcomes in Ibadan, Nigeria. IbPCS is an ongoing prospective cohort study that enrolled 1745 pregnant women at = 20 weeks gestation at their first antenatal visit from four health facilities in Ibadan. Maternal body mass index (BMI) and lifestyle characteristics (Physical Activity - PA and Dietary Pattern) were assessed during enrollment using the pregnancy physical activity questionnaire and a qualitative food frequency questionnaire. The follow-up of participants was at 24 -28 weeks, third trimester, delivery and the postpartum period. Biomarkers (blood glucose and lipids) were assessed during the Oral Glucose Tolerance Test conducted between 24 - 28 weeks' gestation after an overnight fast. Baseline characteristics were: age (29.8±5.3 years), BMI (26.2±7.1kg/m2), primigravida (32.4%), married (94.2%), and tertiary level education (68.3%). This study will provide the preventive tools and lifestyle modification strategies required to mitigate the adverse effect of maternal obesity on maternal and child health and a future epidemic of cardiometabolic diseases in Nigeria. [ABSTRACT FROM AUTHOR]

This paper explores the SERVICOM reform, which was instituted in 2004 to fight the corruption and inefficiency considered to plague the Nigerian Civil Service. Using the method of 'following the policy', the paper demonstrates the meaning of SERVICOM for its various stakeholders: United Kingdom Department for International Development (DFID) officers, Nigerian bureaucrats, SERVICOM officers and citizens. The paper also shows how SERVICOM is made in the indeterminate bodily movements and social interactions of street-level bureaucrats rather than in the policy models crafted by experts. Not only has SERVICOM been incoherently implemented, it has also has been characterised by excessive rhetoric, which has constructed the idea of a good-willed technocratic state, eliciting ambivalence and catharsis in public discourse. Further, DFID officers have construed the reform as a success. This research provides an ethnographic perspective on how transnational 'good governance' initiatives in Africa are translated on the ground. [ABSTRACT FROM AUTHOR]

Purpose: Dietary diversity is a key proxy indicator of nutrient adequacy; however, limited studies have been done on it among pregnant women in Ethiopia. The study aimed to examine the prevalence of sub-optimal dietary diversity and its associated factors among pregnant women in Gurage zone, South Central Ethiopia. Materials and Methods: A mixed-method approach, a longitudinal study complemented with an exploratory qualitative study, was conducted. In the longitudinal study, a consecutively included sample of 668 pregnant women was followed in three rounds of survey. Dietary diversity was assessed using the minimum dietary diversity score for women (MDD-W) tool. The average of three dietary diversity scores was used to define overall diversity. Consuming less than 5 of 10 standard food groups was considered as suboptimal dietary diversity. Multivariable logistic regression analysis was used to identify predictors of suboptimal dietary diversity. Qualitative data were analysed using the thematic analysis method. Results: During the 16 to 20, 28 to 29 and 36 to 37 weeks of gestation surveys, 75.0, 78.7 and 76.5% of the women had sub-optimal dietary diversity. In aggregate, 84.4% (95% CI: 81.6, 87.3) of the women had sub-optimal dietary diversity. Rural residents (AOR: 1.91, 95% CI: 1.01, 3.62), women with no formal education (AOR: 5.51, 95% CI: 1.96, 15.53) and from food insecure households (AOR: 2.44, 95% CI: 1.07, 5.59) had higher odds of suboptimal dietary diversity. Women with higher nutritional knowledge (AOR: 0.92, 95% CI: 0.87, 0.98) were less likely to have suboptimal dietary diversity. Food taboos, poor nutritional literacy and pregnancy complications were also reported as factors affecting dietary diversity. Conclusion: Majority of pregnant women in the area had sub-optimal dietary diversity. Improving the socio-economic status and promoting nutrition knowledge may improve women's dietary diversity. [ABSTRACT FROM AUTHOR]

Evidence about psychological experiences surrounding female genital mutilation/cutting (FGM/C) remains weak and inconclusive. This article is the first of a series that deploys qualitative methods to ascertain the psychological experiences associated with FGM/C through the lifecycle of women. Using the free listing method, 103 girls and women, aged 12 to 68 years from rural and urban Izzi communities in Southeastern Nigeria, produced narratives to articulate their perceptions of FGM/C. Sixty-one of them had undergone FGM/C while 42 had not. Data was analysed using thematic analysis and the emerging themes were related to experiences and disabilities in the psychological, physical, and social health domains. While physical experiences were mostly negative, psychological experiences emerged as both positive and negative. Positive experiences such as happiness, hopefulness, and improved self-esteem were commonly described in response to a rise in social status following FGM/C and relief from the stigma of not having undergone FGM/C. Less commonly reported were negative psychological experiences, e.g., shame when not cut, anxiety in anticipation of the procedure, and regret, sadness, and anger when complications arose from FGM/C. Some participants listed disruption of daily activities, chronic pain, and sleep and sexual difficulties occurring in the aftermath of FGM/C. Most participants did not list FGM/C as having a significant effect on their daily living activities. In light of the association of FGM/C with both positive and negative psychological experiences in the Izzi community, more in-depth study is required to enable policy makers and those campaigning for its complete eradication to rethink strategies and improve interventions. [ABSTRACT FROM AUTHOR]

Introduction: Many urban residents in low- and middle-income countries live in unfavorable conditions with few healthcare facilities, calling to question the long-held view of urban advantage in health, healthcare access and utilization. We explore the patterns of healthcare utilization in these deprived neighborhoods by studying three such settlements in Nigeria. Methods: The study was conducted in three slums in Southwestern Nigeria, categorized as migrant, indigenous or cosmopolitan, based on their characteristics. Using observational data of those who needed healthcare and used in-patient or out-patient services in the 12 months preceding the survey, frequencies, percentages and odds-ratios were used to show the study participants' environmental and population characteristics, relative to their patterns of healthcare use. Results: A total of 1,634 residents from the three slums participated, distributed as 763 (migrant), 459 (indigenous) and 412 (cosmopolitan). Residents from the migrant (OR = 0.70, 95%CI: 0.51 to 0.97) and indigenous (OR = 0.65, 95%CI: 0.45 to 0.93) slums were less likely to have used formal healthcare facilities than those from the cosmopolitan slum. Slum residents were more likely to use formal healthcare facilities for maternal and perinatal conditions, and generalized pains, than for communicable (OR = 0.50, 95%CI: 0.34 to 0.72) and non-communicable diseases (OR = 0.61, 95%CI: 0.41 to 0.91). The unemployed had higher odds (OR = 1.45, 95%CI: 1.08 to 1.93) of using formal healthcare facilities than those currently employed. Conclusion: The cosmopolitan slum, situated in a major financial center and national economic hub, had a higher proportion of formal healthcare facility usage than the migrant and indigenous slums where about half of families were classified as poor. The urban advantage premise and Anderson behavioral model remain a practical explanatory framework, although they may not explain healthcare use in all possible slum types in Africa. A context-within-context approach is important for addressing healthcare utilization challenges in slums in sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Background: Nigeria has the second highest number of people living with HIV (PLWH) globally, and evidence-based approaches are needed to achieve national goals to identify, treat, and reduce new infections. Youth between the ages of 15–24, including young men who have sex with men (YMSM), are disproportionately impacted by the Nigerian HIV epidemic. The purpose of this study was to inform adaptation of evidence-based peer navigation and mHealth approaches (social media outreach to promote HIV testing; short messaging service text message reminders to promote HIV treatment engagement) to the local context within iCARE Nigeria, a multi-phase study designed to investigate combination interventions to promote HIV testing and care engagement among youth in Nigeria. Methods: To elicit expert and community perspectives, a local group of advisors from academia, community, and governmental sectors provided feedback on intervention adaptation, which then informed a series of focus groups with stakeholders in Ibadan, Nigeria. Focus group data were collected over a period of three days in December of 2018. Participants in focus groups included YMSM and HIV-positive youth in care ages 16–24, and HIV service providers from local AIDS service organizations (ASO). Groups were stratified by HIV serostatus, gender, and stakeholder type. Focus group sessions were conducted using a semi-structured interview guide, audio-recorded, transcribed verbatim, and analyzed using a content analysis approach. Results: Local experts recommended intervention adaptations specific to the status of peer navigators as volunteers, peer characteristics (slightly older age, high maturity level, HIV/YMSM status), and intervention characteristics and resources (low navigator to peer ratio; flexible matching by demographic and social characteristics; social media platforms and content). Five focus group discussions with stakeholders, including 27 participants were conducted to elicit feedback on these and other potential adaptations. Youth participants (n = 21) were mean age 20 years (range = 16–24); 76% HIV-positive, 76% men and 48% MSM. Service providers (n = 6) represented both HIV prevention and care services. Participants across stratified subgroups reported largely positive perceptions and high perceived acceptability of both mHealth and peer navigation strategies, and echoed the recommendations of the advisory group for volunteer-based navigators to promote altruism, with a low navigator-peer ratio (1:5). Participants emphasized the need to incorporate minimal mobile data use strategies and popular social media platforms among YMSM (e.g., Facebook, Grindr) for widespread access and reach of the interventions. Conclusions: In Ibadan, Nigeria, stakeholders support the adaptation of combined mHealth and peer navigation strategies to promote HIV testing and care engagement among high-risk youth. Recommended adaptations for the local context reflect concerns about the feasibility and sustainability of the intervention and are expected to improve accessibility and acceptability. [ABSTRACT FROM AUTHOR]

Background: Sleep difficulties are highly prevalent among adolescents, and are associated with significant impairments. The effectiveness and acceptability of Cognitive Behavioural Therapy-based (CBT-based) treatment for insomnia in adolescents is established for High Income Countries, but unknown for African settings. Thus, the aim of this study was to assess the effect of CBT-based intervention among in-school adolescents with sleep difficulties in Southern Nigeria. Methods: This was a pilot controlled trial involving 50 adolescents with highest ranked scores on the Insomnia Severity Index (ISI) recruited from four schools (two government and two privately owned). Balloting was used to assign two schools (public and private) with 25 participants to the intervention group, and the other two schools (public and private) with 25 participants as waiting-list controls. The two groups were dyad-matched for baseline ISI scores, gender, and type of school to reduce baseline differences. The treatment group received weekly group-based manualised CBT-based intervention over 5 weeks. Primary outcome was ISI score at 6th week. Secondary outcomes were sleep onset latency (SOL), Total sleep duration (TSD), depressive symptoms, sleep hygiene, and knowledge about sleep. Results: Participants were aged 13–17 years (M = 14.9, SD = 1.16) and consisted of 18 males and 32 females. Controlling for baseline scores, the intervention group showed significantly lower post-intervention insomnia scores compared with the control group {F (1, 34) = 1.10, p = 0.0001, (ηp2 = 0.59}, shorter SOL {F (1, 33) = 1.41, p = 0.0001, ηp2 = 0.39}, longer TSD {F (1, 33) = 1.03, p = 0.0001, ηp2 = 0.47}, lower depressive symptoms {F (1, 31) = 1.32, p = 0.002 (ηp2 = 0.34}, higher knowledge of sleep {F (1, 34) = 1.02, p = 0.001, ηp2 = 0.36}, but no significant change in sleep hygiene {F (1, 32) = 1.08, p = 0.08, ηp2 = 0.15}. All participants in the intervention group rated the programme as good or excellent. Conclusion: This pilot CBT-based intervention for adolescents with insomnia was feasible, well received and showed promising efficacy in this setting. Larger controlled trials are recommended to establish the generalisability of these findings in this region. Trial registration Pan African Clinical Trial Registry (Registration Number PACTR202001710494962) [ABSTRACT FROM AUTHOR]

Steroid hormones are one of the presumed modulators of Lactobacillus abundance in the vaginal epithelium. We set out to characterize the vaginal microbiome (VMB) and also provide an in-depth understanding of the relative contribution of estradiol (E2) and progesterone (P1) in shaping the vaginal microbiome of Nigerian women (n = 38) who experienced both uncomplicated term delivery and preterm delivery using samples longitudinally collected during pregnancy (17–21, 27–31, 36–41 weeks gestation) and 6 weeks postpartum. Vaginal swabs and blood samples were aseptically collected. Vaginal swabs were used for microbiome assessment using 16S ribosomal RNA (rRNA) gene sequencing. Blood samples were used for hormonal measurement using a competitive-based enzyme-linked immunosorbent assay (ELISA). Across several maternal covariates, maternal age, pregnancy status and delivery mode were not significantly associated with the vaginal microbiota whereas maternal E2 level (pE2 = 0.006, Omnibus), and P1 level (pP1 = 0.001, Omnibus) were significantly associated with the vaginal microbiome. E2 and P1 concentrations increased throughout pregnancy commensurately with increasing proportions of L. crispatus (pE2 = 0.036, pP1 = 0.034, Linear Mixed Model). An increasing trend of α-diversity was also observed as pregnancy progressed (pobserved ASV = 0.006, LMM). A compositional microbiome shift from Lactobacillus profile to non-Lactobacillus profile was observed in most postnatal women (pCST IV < 0.001, LMM). Analysis of our data shows a species-specific link between pregnancy steroid hormone concentration and L. crispatus abundance. [ABSTRACT FROM AUTHOR]

Problem: Poor knowledge and stigmatizing attitudes of healthcare professionals constitute a significant barrier to child and adolescent mental health care worldwide. This study aimed to determine the effect of a training intervention on the knowledge and attitudes of pediatric nurses to child mental health problems at a Nigerian tertiary hospital. Methods: A two group pretest–posttest study design was undertaken. A total of 156 pediatric nurses were recruited, and participants in the intervention group received a brief child mental health training based on the World Health Organization's mhGAP training manual. Knowledge and attitudes to child mental health problems were obtained at baseline, and post intervention. Findings: There were no differences in knowledge or attitudes across the two groups at baseline. Post intervention, there was a significant increase in the mean post knowledge scores of the intervention group compared with the control group (t = 3.8, p <.001). The effect size of the intervention was 0.62. There were no significant differences in mean post attitude scores across groups. Conclusion: Incorporating children and adolescents mental health competencies into the training of nurses had a modest effect on their knowledge, but limited effect on their attitudes. [ABSTRACT FROM AUTHOR]