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Introduction: Postpartum hemorrhage (PPH) remains the leading cause of maternal mortality. A new clinical intervention (E-MOTIVE) holds the potential to improve early PPH detection and management. We aimed to develop and pilot implementation strategies to support uptake of this intervention in Kenya, Nigeria, South Africa, and Tanzania., Methods: Implementation strategy development: We triangulated findings from qualitative interviews, surveys and a qualitative evidence synthesis to identify current PPH care practices and influences on future intervention implementation. We mapped influences using implementation science frameworks to identify candidate implementation strategies before presenting these at stakeholder consultation and design workshops to discuss feasibility, acceptability, and local adaptations. Piloting: The intervention and implementation strategies were piloted in 12 health facilities (3 per country) over 3 months. Interviews (n=58), case report forms (n=1,269), and direct observations (18 vaginal births, 7 PPHs) were used to assess feasibility, acceptability, and fidelity., Results: Implementation strategy development: Key influences included shortages of drugs, supplies, and staff, limited in-service training, and perceived benefits of the intervention (e.g., more accurate PPH detection and reduced PPH mortality). Proposed implementation strategies included a PPH trolley, on-site simulation-based training, champions, and audit and feedback. Country-specific adaptations included merging the E-MOTIVE intervention with national maternal health trainings, adapting local PPH protocols, and PPH trollies depending on staff needs. Piloting: Intervention and implementation strategy fidelity differed within and across countries. Calibrated drapes resulted in earlier and more accurate PPH detection but were not consistently used at the start. Implementation strategies were feasible to deliver; however, some instances of limited use were observed (e.g., PPH trolley and skills practice after training)., Conclusion: Systematic intervention development, piloting, and process evaluation helped identify initial challenges related to intervention fidelity, which were addressed ahead of a larger-scale effectiveness evaluation. This has helped maximize the internal validity of the trial., (© Forbes et al.)

Introduction: Human Papillomavirus (HPV) infection is a risk factor for cervical cancer, the fourth most common cancer among women globally. Its burden is the highest in sub-Saharan Africa, with over 90% mortality. Interventions may fail without evidence-based data on stratified prevalence and risk factors among most at-risk women across Nigeria., Methods: A cross-sectional comparative study, with participants recruited from the Nigerian Institute of Medical Research's Clinics, NGO outreaches, a cancer screening centre and a university teaching hospital. Questionnaires were self-administered. Trained medics performed sampling at healthcare facilities, and self-sampling was used at outreaches., Results: Nine hundred eighty-five study participants were recruited. About 37% and 27% of the women knew about HPV and its vaccines, respectively, but only 6% confirmed vaccination with HPV vaccines. HPV prevalence was highest among women with unknown marital status (35.9%), single women (33.8%), widowed/divorced/separated women (30.3%), and married/cohabiting women (19.6%). HPV infection was significantly higher among women who take alcohol (odds=1.7 [95% CI: 1.2-2.4]) and women who smoke (odds=2.6 [95% CI: 1.4 - 4.6]. HPV strains detected included HPV16 (1.3%), HPV18 (1.5%), Low Risk (0.2%) and Other High-Risk groups (19.7%)., Conclusion: The inverse relationship between prevalence and education suggests interventions improving awareness and prevention would be impactful. Such interventions could also target HIV-positive women, women presenting with sexually-transmitted infections, who smoke and frequently drink alcohol., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Onwuamah, Feng, Momoh, Uwandu, Ahmed, Idigbe, Vincent, Ogbu, Okonkwo, Sokei, Abimbola, Ojopagogo, Okoli, Adesina, Ezemelue, Sowunmi, Okwuzu, Labo−Popoola, Shaibu, Ohihoin, Nzeribe, David, Olaleye, Ofotokun, Dong and Ezechi.)

Background: Africa is unlikely to end hunger and all forms of malnutrition by 2030 due to public health problems such as the double burden of malnutrition (DBM). Thus, the aim of this study is to determine the prevalence of DBM and degree of socio-economic inequality in double burden of malnutrition among children under 5 years in sub-Saharan Africa., Methods: This study used multi-country data collected by the Demographic and Health Surveys (DHS) Program. Data for this analysis were drawn from the DHS women's questionnaire focusing on children under 5 years. The outcome variable for this study was the double burden of malnutrition (DBM). This variable was computed from four indicators: stunting, wasting, underweight and overweight. Inequalities in DBM among children under 5 years were measured using concentration indices (CI)., Results: The total number of children included in this analysis was 55,285. DBM was highest in Burundi (26.74%) and lowest in Senegal (8.80%). The computed adjusted Erreygers Concentration Indices showed pro-poor socio-economic child health inequalities relative to the double burden of malnutrition. The DBM pro-poor inequalities were most intense in Zimbabwe (-0.0294) and least intense in Burundi (-0.2206)., Conclusions: This study has shown that across SSA, among under-five children, the poor suffer more from the DBM relative to the wealthy. If we are not to leave any child behind, we must address these socio-economic inequalities in sub-Saharan Africa.

Objective: To evaluate the feasibility and performance of self-collected vaginal swab samples for HPV screening among women in Lagos, Nigeria., Methods: A cross-sectional study was implemented from March to August 2020 among sexually active women. Study participants provided same-day paired vaginal swab samples. Medic-sampling and poster-directed self-sampling methods were used to collect the two samples per participant. A real-time PCR assay detected HPV 16, HPV 18, other-high-risk (OHR) HPV, and the human β-globin gene. The self-collected samples' sensitivity, specificity, and accuracy were determined against the medic-collected samples using the MedCalc Online Diagnostic Calculator., Results: Of the 213 women aged 16 ~ 63-year-old recruited, 187 (88%) participants had concordant results, while 26 (12%) participants had discordant results. Among the 187 concordant results, 35 (19%) were HPV positive, 150 (80%) participants were HPV negative, and two (1%) were invalid. 18 (69%) out of the 26 discordant samples were invalid. The self-collected sample was invalid for 14 (54%) participants. Two (8%) medic-collected samples were invalid. Compared to the medic-collected sample, the self-collected sample was 89.80% (95% CI: 77.77 ~ 96.60%) sensitive and 98.21% (95% CI: 94.87 ~ 99.63%) specific, with an accuracy of 96.31% (95% CI: 92.87 ~ 98.40%). The mean age for HPV positive and negative participants were 39 and 40, respectively, with an ANOVA p-value of 0.3932. The stratification of HPV infection by the age group was not statistically significant (P > 0.05)., Conclusions: With high accuracy of 96%, self-collected sampling is adequate when tested with real-time PCR and may increase the uptake of HPV testing. Though more self-collected samples were invalid than medic-collected samples, most likely due to poor collection, they could be identified for repeat testing. Future implementation can avoid this error with improved guidance and awareness., (© 2022. The Author(s).)

Background: The WHO in collaboration with the Nigeria Federal Ministry of Health, established a nationwide electronic data platform across referral-level hospitals. We report the burden of maternal, foetal and neonatal complications and quality and outcomes of care during the first year., Methods: Data were analysed from 76,563 women who were admitted for delivery or on account of complications within 42 days of delivery or termination of pregnancy from September 2019 to August 2020 across the 54 hospitals included in the Maternal and Perinatal Database for Quality, Equity and Dignity programme., Findings: Participating hospitals reported 69,055 live births, 4,498 stillbirths and 1,090 early neonatal deaths. 44,614 women (58·3%) had at least one pregnancy complication, out of which 6,618 women (8·6%) met our criteria for potentially life-threatening complications, and 940 women (1·2%) died. Leading causes of maternal death were eclampsia ( n  = 187,20·6%), postpartum haemorrhage (PPH) ( n  = 103,11·4%), and sepsis ( n  = 99,10·8%). Antepartum hypoxia ( n  = 1455,31·1%) and acute intrapartum events ( n  = 913,19·6%) were the leading causes of perinatal death. Predictors of maternal and perinatal death were similar: low maternal education, lack of antenatal care, referral from other facility, previous caesarean section, latent-phase labour admission, operative vaginal birth, non-use of a labour monitoring tool, no labour companion, and non-use of uterotonic for PPH prevention., Interpretation: This nationwide programme for routine data aggregation shows that maternal and perinatal mortality reduction strategies in Nigeria require a multisectoral approach. Several lives could be saved in the short term by addressing key predictors of death, including gaps in the coverage of internationally recommended interventions such as companionship in labour and use of labour monitoring tool., Funding: This work was funded by MSD for Mothers; and UNDP/UNFPA/ UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a co-sponsored programme executed by the World Health Organization (WHO)., Competing Interests: The authors declare no competing interests., (© 2022 World Health Organization.)

Objective: Ovarian cancer in Black women is common in many West African countries but is relatively rare in North America. Black women have worse survival outcomes when compared to White women. Ovarian cancer histotype, diagnosis, and age at presentation are known prognostic factors for outcome. We sought to conduct a preliminary comparative assessment of these factors across the African diaspora., Methods: Patients diagnosed with ovarian cancer (all histologies) between June 2016-December 2019 in Departments of Pathology at 25 participating sites in Nigeria were identified. Comparative population-based data, inclusive of Caribbean-born Blacks (CBB) and US-born Blacks (USB), were additionally captured from the International Agency for Research on Cancer and Florida Cancer Data Systems. Histology, country of birth, and age at diagnosis data were collected and evaluated across the three subgroups: USB, CBB and Nigerians. Statistical analyses were done using chi-square and student's t-test with significance set at p<0.05., Results: Nigerians had the highest proportion of germ cell tumor (GCT, 11.5%) and sex-cord stromal (SCST, 16.2%) ovarian cancers relative to CBB and USB (p=0.001). CBB (79.4%) and USB (77.3%) women were diagnosed with a larger proportion of serous ovarian cancer than Nigerians (60.4%) (p<0.0001). Nigerians were diagnosed with epithelial ovarian cancers at the youngest age (51.7± 12.8 years) relative to USB (58.9 ± 15.0) and CBB (59.0± 13.0,p<0.001). Black women [CBB (25.2 ± 15.0), Nigerians (29.5 ± 15.1), and USB (33.9 ± 17.9)] were diagnosed with GCT younger than White women (35.4 ± 20.5, p=0.011). Black women [Nigerians (47.5 ± 15.9), USB (50.9 ± 18.3) and CBB (50.9 ± 18.3)] were also diagnosed with SCST younger than White women (55.6 ± 16.5, p<0.01)., Conclusion: There is significant variation in age of diagnosis and distribution of ovarian cancer histotype/diagnosis across the African diaspora. The etiology of these findings requires further investigation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 George, Omotoso, Pinto, Mustapha, Sanchez-Covarrubias, Umar, Umar, Oluwasola, Okolo, Anthony, Ukekwe, Bakari, Dahiru, Abdullahi, Abimiku, Abdurrahman, Usman, Ahmed, Usman, Kabir, Eleje, Chiemeka, Nzeribe, Nweke, Kadas, Suleiman, Ekanem, Uche, Paul, Agwu, Edegbe, Anorlu, Banjo, Ajenifuja, Fawole, Kazeem, Magaji, Silas, Athanasius, Tamunomie, Bassey, Abudu, Ango, Abdullahi, Lawal, Kabir, Ekanem, Ezeanochie, Yahaya, Castillo, Bahall, Chatrani, Brambury, Bowe, Halliday, Bruney, Butler, Ragin, Odedina, Chamala, Schlumbrecht and Audu.)

The first COVID-19 case in Sudan was announced on March 13th, 2020. 1835 deaths were recorded as of February 7th, 2021. 800,000 doses of the Oxford-AstraZeneca vaccine were allocated to Sudan through COVAX in March 2021. However, multiple challenges exist in vaccinating the Sudanese population, ranging from an inadequate cold chain system to low acceptance rates of COVID-19 vaccination among the Sudanese population. Economic crises, high inflation rates and long-standing economic sanctions have also negatively impacted the healthcare system in Sudan as a result of deprivation of access to research and development funding., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Authors.)

COVID-19 being a public health emergency of international concern has emerged in most African countries including Niger. Niger, a landlocked country, is tasked with controlling the pandemic. However, of the big challenges the country faced is the fragility of healthcare system which posed limitations to the fight against the virus. The virus overwhelmed the fragile healthcare system which led to inaccessibility of quality healthcare to the citizens coupled with issues of flooding and economic recession that happened during the pandemic. The healthcare sectored has further been crippled by exposure and infection of the already insufficient healthcare workers. In addition to this, there was the burden of NTDs and other communicable and non-communicable diseases that subverted the country in the depths of difficulties. As per the predictions of World Bank, the poverty curve is likely to escalate due to the outrageous impacts of COVID-19. Adding on to this, the occurrence of natural disasters such as flooding has further stretched the country. It's no coincidence that the country would confront plethora of challenges amidst the second wave. Therefore, timely decision and necessary interventions are needed to strengthen the country's fight against the pandemic. However, this is only feasible when Nigerien government, international allies and other wealthy nations work closely to ensure that the challenges faced by the healthcare system are tackled., (© 2021 The Authors.)

Background: Despite the global efforts made to eradicate malaria, it continues to be a significant cause of morbidity and mortality in both neonates and the parturients. This study was done to determine the relationship between placental parasitemia, average neonatal birth weight and the relationship between the use of malaria preventive measures and the occurrence of placental parasitemia with the aim to improving maternal and neonatal outcome. Patients and Methods: This cross-sectional study was done at the labor ward unit of the Federal Medical Center, Owerri, from December 2013 to May 2014. It involved one hundred and eighty primigravidae and baby pairs recruited consecutively. Thick and thin blood films were made from maternal peripheral blood and placenta. The babies were examined and weighed immediately after delivery. Results: Most of the participants had only one dose of intermittent preventive therapy (75%) with statistically significant higher level of fever episodes (P < 0.0001). Forty participants (58.0%) did not use any form of malaria preventive measure in pregnancy (P < 0.0001) and had a significantly higher placental parasitemia when compared with their counterparts. Average birth weight of neonates with placental parasitemia in mothers who used intermittent presumptive therapy (IPT) only (t = 2.22, P = 0.005), and IPT + insecticide-treated net (ITN) (t = 7.91, P ≤ 0.000) was significantly higher than those who did not use any form of malaria prevention in pregnancy (t = 4.69, P ≤ 0.0001). Conclusion: Primigravidae with placental or maternal peripheral parasitemia who failed to use malaria preventive measures delivered babies with reduced average birth weight. A scheme aimed at making ITN readily available, and improving the girl child education is highly recommended. [ABSTRACT FROM AUTHOR]

The article offers information on gestational diabetes mellitus (GDM), a diabetes which occurs mainly during pregnancy and serves as a medical challenge in Africa. It mentions that diet and exercise are the primary treatment options for GDM. Moreover, glyburide, was found to be a suitable alternative to insulin for GDM treatment.

Context: In Nigeria, abortion is permitted only to save the life of a woman. Unsafe abortion is common and is a major cause of maternal mortality, yet policymakers have done little to address the problem., Methods: In-depth interviews were conducted in 2008 with 49 Nigerian politicians and officials to assess their awareness of unsafe abortion and its role in maternal mortality, and to determine their perceptions of the policies and actions needed to address these problems., Results: Participants had poor knowledge of Nigeria's abortion law and the number of abortions and abortion-related deaths, though many knew of women who had died or nearly died from unsafe abortion. Policymakers were guided by moral and religious considerations rather than by evidence-based approaches. About one-third of informants felt that abortion should not be legal under any circumstances, one-fifth supported liberalization on medical grounds and a similar proportion believed that abortion should be legal in cases of rape and incest. Strategies recommended by respondents to reduce maternal mortality included facilitating access to contraceptives, providing sexuality education, improving the health care system, empowering women and providing free pregnancy care., Conclusions: Intense public health education and advocacy targeting policymakers is needed to increase political will for reducing abortion-related maternal deaths in Nigeria. Presenting statistics on unsafe abortion together with compelling personal stories will likely resonate with policymakers and contribute to an informed public debate on abortion law reform.

Introduction: A humanitarian crisis means any event or series of events that are harmful to the health or security of the general population. The Niger Republic is currently facing a serious crisis amid the military coup of July 26, 2023. We fear that if nothing is done about it quickly, there could be a civil war in Niger and other neighboring countries. Aim: This present article aims to provide comprehensive knowledge about the ongoing humanitarian crisis in Niger, highlighting the factors that caused it and providing possible solutions for them. Methodology: A literature search was conducted on the recent humanitarian crisis caused by the military coup in Niger Republic using databases such as PubMed, ResearchGate, Google Scholar, World Health Organization, United Nations, online newspapers, and reports from 2013 to 2023. Result: We found that the humanitarian crisis amid the military coup in Niger Republic has further amplified the vulnerability of millions of Nigeriens to more problems in the Niger Republic. The number of Nigeriens in need of humanitarian assistance has reportedly increased by 65%, from 2.3 million in 2019 to 3.8 million in 2021. More than two million children in Niger have been impacted by the crisis in the country and need humanitarian assistance. Furthermore, other causes of the humanitarian crisis in the Niger Republic include sociodemographic factors, climate change, and other natural disasters. Conclusion: The humanitarian crisis in Niger, caused by different factors such as socioeconomic stagnation, environmental causes, food insecurity, terrorist activities, and internal displacement, is an alarming situation that requires an urgent solution and a response from the international community. There is a need to analyze all the underlying causes of humanitarian crises and find long‐lasting solutions for them. Key points: Niger is a landlocked country in West Africa that has been facing a humanitarian crisis for ages.The number of Nigeriens in need of humanitarian assistance has reportedly increased by 65% from 2.3 million in 2019 to 3.8 million in 2021, with a probability of geometric increase to date.There are quite a lot of direct and indirect consequences that could result from the humanitarian crisis, especially amid the military coup in Niger.To tackle this complicated situation in Niger, a more humanitarian approach is required. [ABSTRACT FROM AUTHOR]

Moderate acute malnutrition (MAM) is a persistent public health problem in Tanzania. The current approach for its management is nutrition counselling. However, there has been no commercial production of ready‐to‐use supplementary foods for the management of MAM in the country but rather imported from companies outside the country. The objective of the study was to determine the ability of a ready‐to‐use food supplementation versus corn soya blend (CSB+) to manage MAM. The randomised controlled trial employed three parallel arm approach. The first arm received CSB+ and infant and young child feeding (IYCF) counselling, the second arm received ready‐to‐use food (RUF) and IYCF counselling and the third arm, a control group, received IYCF as standard care for three consecutive months. Results indicated that the overall proportion of children who recovered from MAM was 65.6%. There was a significant difference (p < 0.001) in the proportion of children who recovered from MAM between the three arms (CSB+, RUF and standard care). Results revealed further a high recovery rate of 83.7% in the RUF arm, followed by 71.9% in the CSB+ arm and 41% in the standard care arm. The risk differences for RUF compared with CSB+ and standard care were 11.8% and 42.7%, respectively. RUFs can be used as an alternative supplement to conventional CSB+ for the management of MAM in children and, thus, has the potential to scale up its use to address the problem of MAM among 6 to 59 months' children. Key messages: Moderate acute malnutrition can progress to the severe form, which is a life‐threatening condition if not well managed.Chronic undernutrition, in turn, can have an impact on the nutritional status of future generations, tending to result in 'intergenerational growth failure', a cycle of poor diet that continues throughout generations with lifelong implications.Supplementary foods can be formulated from locally available ingredients that are accessible, cheap and can deliver the required amounts of nutrients essential for the effective recovery of children with MAM.Supplementation of RUFs is more effective in treating MAM when compared to other conventional supplementation methods. [ABSTRACT FROM AUTHOR]

Background: The double burden of malnutrition (DBM) is rising globally, particularly in sub-Saharan Africa. In Sierra Leone, the incidence of overweight, obesity (OWOB), and overnutrition among women has sharply increased. This finding accompanies the high incidence of undernutrition, which has been prevalent for decades. This study aimed to determine the prevalence of different malnutrition categories (underweight, overweight, obesity, and overnutrition) and associated factors among women of reproductive age (15–49 years) in Sierra Leone using secondary data analysis of the Sierra Leone Demographic Health Survey of 2019 (SLDHS-2019). Methods: We conducted secondary data analysis of the SLDHS-2019 of 7,514 women aged 15–49 years. We excluded pregnant, post-natal, lactating, and post-menopausal women. Data was collected using validated questionnaires, and respondents were selected through a multistage stratified sampling approach. A multivariable logistic regression analysis was used to determine factors associated with malnutrition among 15–49-year-old women in Sierra Leone. Results: Among 15–49-year-old women in Sierra Leone, the prevalence of underweight was 6.7% (95%CI: 4.5-8.9%); overweight at 19.7% (95%CI: 17.7-21.7%); obesity was 7.4% (95% CI: 5.2-9.6%); and overnutrition, 27.1% (95%CI: 25.2-29.0%). Women aged 25–34 years were more likely to be underweight (adjusted Odds Ratios, aOR = 1.670, 95%CI: 1.254–2.224; p < 0.001) than those aged 15–24 years; women who were not married were less likely to be underweight (aOR = 0.594, 95%CI: 0.467–0.755; p < 0.001) than married women. Women from the North were less likely to be underweight (aOR = 0.734, 95%CI: 0.559–0.963; p = 0.026) than the East, and those who did not listen to the radio were less likely to be underweight (aOR = 0.673; 95%CI: 0.549–0.826; p < 0.001) than those who did. Overweight was less likely among 25–34 years (aOR = 0.609, 95%CI: 0.514–0.722; p < 0.001) and 35–49 years (aOR = 0.480, 95%CI: 0.403–0.571; p < 0.001) age-groups than 15–24 years; more likely among not married women (aOR = 1.470, 95%CI:1.249–1.730; p < 0.001) than married; less likely among working-class (aOR = 0.840, 95%CI: 0.720–0.980; p = 0.026) than not working-class; most likely in women from the North (aOR = 1.325, 95%CI:1.096–1.602; p = 0.004), and less likely among women from the South (aOR = 0.755, 95%CI: 0.631–0.903; p = 0.002) than the East; less likely among women of middle-wealth-index (aOR = 0.656, 95%CI: 0.535–0.804; p < 0.001), richer-wealth-index (aOR = 0.400, 95%CI: 0.309–0.517; p < 0.001), and richest-wealth-index (aOR = 0.317, 95%CI: 0.234–0.431; p < 0.001) than the poorest-wealth-index; and more likely among women who did not listen to radios (aOR = 1.149; 95%CI:1.002–1.317; p = 0.047) than those who did. The predictors of overweight among women 15–49 years are the same as obesity and overnutrition, except overnutrition and obesity were less likely in female-headed households (aOR = 0.717,95%CI: 0.578–0.889; p < 0.001). Conclusion: The prevalence of all categories of malnutrition among women of reproductive age in Sierra Leone is high, affirming a double burden of malnutrition in this study population. Underweight was more likely among the 25–34-year age group than 15–24-year. The predictors of overweight, obesity, and overnutrition were being unmarried/single, residing in the North, and not listening to the radio. There is an urgent need for policymakers in Sierra Leone to design comprehensive educational programs for women of reproductive age on healthy lifestyles and the dangers of being underweight or over-nourished. [ABSTRACT FROM AUTHOR]

Background: The novel coronavirus (COVID-19) pandemic is disproportionately impacting the health of people with disability. Resilience has remained an important health promoting characteristic during periods of social distancing restrictions. Factors promoting resilience for people with disability under the context of the pandemic remains poorly understood. Studies have yet to investigate evidence-based factors that promote resilience over multiple periods of restrictions for people with disability. Methods: A longitudinal study developed via a collaborative partnership between peer-support workers with lived experience of spinal cord injury (SCI) and university researchers was undertaken to fill knowledge gaps around factors promoting resilience for people with SCI during two periods of stringent social distancing restrictions within Victoria, Australia. Over 12-months, participants with SCI completed two surveys, towards the end of two lockdown periods. Evidence-based factors associated with resilience were measured. The Impact on Participation and Autonomy Questionnaire, the International SCI Quality of Life scale, and the 10-item Conor Davidson Resilience Scale, respectively measured autonomy and participation limitations, life satisfaction and psychological health, and resilience. A structural equation modelling (SEM) approach established factors directly and indirectly associated with resilience. Results: A model with excellent fit was produced. During two extended lockdowns over the 12-month period, increased family role limitations and favourable psychological health were respectively, negatively (Lockdown 1 [n = 127]: β = -.251, p <.01, Lockdown 2: β = -.400, p <.01) and positively (Lockdown 1: β =.601, p <.01, Lockdown 2 [n = 65]: β =.430, p <.01) associated with resilience. Indirect negative associations between resilience and increased outdoor autonomy limitations (Lockdown 1: β = -.195, p <.01, Lockdown 2: β = -.255, p <.01) and social life limitations (Lockdown 1: β = -.217, p <.01, Lockdown 2: β = -.142, p <.05) existed, and these relationships were moderated by psychological health. Conclusions: Psychological health, and participation and autonomy are determinants of resilience during periods of crisis. Health and social care providers and public health departments should prioritise programs promoting these domains, to counter the negative impact of social distancing. [ABSTRACT FROM AUTHOR]

Background: Abortion-related complications are one of the five main causes of maternal mortality. However, research about abortion is very limited in fragile and conflict-affected settings. Our study aims to describe the magnitude and severity of abortion-related complications in two referral hospitals supported by Médecins Sans Frontières and located in such settings in northern Nigeria and Central African Republic (CAR). Methods: We used a methodology similar to the World Health Organization (WHO) near-miss approach adapted in the WHO multi-country study on abortion (WHO-MCS-A). We conducted a cross-sectional study in the two hospitals providing comprehensive emergency obstetric care. We used prospective medical records' reviews of women presenting with abortion-related complications between November 2019 and July 2021. We used descriptive analysis and categorized complications into four mutually exclusive categories of increasing severity. Results: We analyzed data from 520 and 548 women respectively in Nigerian and CAR hospitals. Abortion complications represented 4.2% (Nigerian hospital) and 19.9% (CAR hospital) of all pregnancy-related admissions. The severity of abortion complications was high: 103 (19.8%) and 34 (6.2%) women were classified as having severe maternal outcomes (near-miss cases and deaths), 245 (47.1%) and 244 (44.5%) potentially life-threatening, 39 (7.5%) and 93 (17.0%) moderate, and 133 (25.6%) and 177 (32.3%) mild complications, respectively in Nigerian and CAR hospitals. Severe bleeding/hemorrhage was the main type of complication in both settings (71.9% in the Nigerian hospital, 57.8% in the CAR hospital), followed by infection (18.7% in the Nigerian hospital, 27.0% in the CAR hospital). Among the 146 women (Nigerian hospital) and 231 women (CAR hospital) who did not report severe bleeding or hemorrhage before or during admission, anemia was more frequent in the Nigerian hospital (66.7%) compared to the CAR hospital (37.6%). Conclusion: Our data suggests high severity of abortion-related complications in these two referral facilities of fragile and conflict-affected settings. Factors that could contribute to this high severity in these contexts include greater delays in accessing post-abortion care, decreased access to contraceptive and safe abortion care that result in increased unsafe abortions; as well as increased food insecurity leading to iron-deficiencies and chronic anaemia. The results highlight the need for better access to safe abortion care, contraception, and high quality postabortion care to prevent and manage complications of abortion in fragile and conflict-affected settings. [ABSTRACT FROM AUTHOR]

Background: The process of mass immunization against COVID-19 may be impacted by vaccine reluctance despite intense and ongoing efforts to boost vaccine coverage. The COVID-19 vaccine is a crucial component for controlling the pandemic. To the best of our knowledge, we did not come across any study presenting the post-vaccination side-effect profile among the Sudanese population. Developing strategies to improve the vaccine acceptability and uptake necessitate evidence-based reports about vaccine's side effects and acceptance. In this regard, this study aimed at estimating the prevalence of COVID-19 vaccine side-effects among the general population in Sudan. Methodology: A cross-sectional web-based quantitative study was conducted among the general population aged ≥18 years and residing in the Khartoum state of Sudan. A 30-item survey tool recorded the demographics, chronic diseases, allergy to other vaccines and COVID-19 vaccine side-effects after the first, second and booster doses. The data on the onset and duration of side-effects after each dose were also recorded. The distribution of side-effect scores after each dose of COVID-19 vaccine was compared using appropriate statistical methods. Results: A total of 626 participants were approached for this study. There was a preponderance of females (57.7%), and 19% of respondents had chronic diseases. The vaccination rate against COVID-19 was 55.8% (n = 349/626). The prevalence of side-effects after the first, second and booster doses were 79.7, 48 and 69.4%, respectively. Pain at the injection site, headache, fatigue, exhaustion and fever were the common side-effects after the first and second doses, while pain at the injection site, fatigue, headache and muscle pain were frequently reported after the booster dose. Most of these side-effects appeared within 6 h and resolved within one or two days following the administration of the vaccine dose. The average side-effects scores were 4.1 ± 4.4 (n = 349), 2.2 ± 3.6 (n = 202) and 3.5 ± 4.1 (n = 36) after the first, second and booster doses, respectively. The female gender had significantly higher side-effects after primary and booster doses. The age group 18-24 years indicated higher side-effects after the first dose compared to participants with ages ranging from 31 to 40 years (p = 0.014). Patients with chronic disease indicated significantly higher (p = 0.043) side-effects compared to those without any comorbid illness. Conclusions: This study showed a high prevalence of transient COVID-19 vaccine-related side-effects after primary and booster doses. However, these side-effects waned within 48 h. Pain at the injection site was the most common local side-effect, while fatigue, fever, headache and muscle pain were frequently reported systemic side-effects. The frequency of side-effects was more profound among females, young adults and those with comorbid conditions. These findings indicate that COVID-19 vaccines are safe and have side-effects as reported in the clinical trials of the vaccines. These results aid in addressing the ongoing challenges of vaccine hesitancy in the Sudanese population that is nurtured by widespread concerns over the safety profile. [ABSTRACT FROM AUTHOR]

Introduction: Existing studies have acknowledged the underutilization of skilled maternal healthcare services among women in rural Nigeria. Consequently, women in rural areas face a disproportionate risk of poor health outcomes including maternal morbidity and mortality. Addressing the challenge of non-use of skilled maternal healthcare in rural areas necessitates the involvement of multi-stakeholders across different sectors who have vital roles to play in improving maternal health. This study explores the factors contributing to the non-use of maternal healthcare services in rural areas of Edo, Nigeria from the perspectives of community elders and policymakers. Methods: In this qualitative study, data were collected through 10 community conversations (group discussions) with community elders each consisting of 12 to 21 participants, and six key informant interviews with policymakers in rural areas of Edo State, Nigeria. Participants were purposefully selected. Conversations and interviews occurred in English, Pidgin English and the local language; lasted for an average of 9 minutes; were audio-recorded and transcribed to English. Data were manually coded, and data analysis followed the analytical strategies for qualitative description including an iterative process of inductive and deductive approaches. Results: Policymakers and community elders attributed the non-use of maternal health services to poor quality of care. Notions of poor quality of care included shortages in skilled healthcare workers, apathy and abusive behaviours from healthcare providers, lack of life-saving equipment, and lack of safe skilled pregnancy care. Non-use was also attributed to women's complex utilization patterns which involved a combination of different types of healthcare services, including traditional care. Participants also identified affordability and accessibility factors as deterrents to women's use of skilled maternal healthcare. Conclusion: The emerging findings on pregnant women's combined use of different types of care highlight the need to improve the quality, availability, accessibility, and affordability of skilled maternal care for rural women in Nigeria. [ABSTRACT FROM AUTHOR]

The insurgence of COVID‐19 has received all attention at the detriment of research on most diseases. Procedures and protocols devised to curb the pandemic continues to affect lives and work. As most countries prepare to tune back to normalcy, working conditions undoubtedly will not be the same as the World Health Organization still urges nations to scale up procedures and strategies against the pandemic. As research groups and projects across the globe and especially in Ghana begins work, these protocols must be fashioned into their study protocol before approval will be granted by ethical institutions. This has led to increase in research cost, with additional responsibilities aside their normal research activities. This perspective clearly points out the impact of the pandemic on research, especially fieldwork. [ABSTRACT FROM AUTHOR]

Background: Postpartum haemorrhage (PPH) is a major cause of maternal morbidity and mortality and its incidence is increasing in many countries despite management guidelines. A national quality improvement programme called the Obstetric Bleeding Strategy for Wales (OBS Cymru) was introduced in all obstetric units in Wales. The aim was to reduce moderate PPH (1000 mL) progressing to massive PPH (> 2500 mL) and the need for red cell transfusion.Methods: A PPH care bundle was introduced into all 12 obstetric units in Wales included all women giving birth in 2017 and 2018 (n = 61,094). The care bundle prompted: universal risk assessment, quantitative measurement of blood loss after all deliveries (as opposed to visual estimation), structured escalation to senior clinicians and point-of-care viscoelastometric-guided early fibrinogen replacement. Data were submitted by each obstetric unit to a national database. Outcome measures were incidence of massive PPH (> 2500 mL) and red cell transfusion. Analysis was performed using linear regression of the all Wales monthly data.Results: Uptake of the intervention was good: quantitative blood loss measurement and risk assessment increased to 98.1 and 64.5% of all PPH > 1000 mL, whilst ROTEM use for PPH > 1500 mL increased to 68.2%. Massive PPH decreased by 1.10 (95% CI 0.28 to 1.92) per 1000 maternities per year (P = 0.011). Fewer women progressed from moderate to massive PPH in the last 6 months, 74/1490 (5.0%), than in the first 6 months, 97/1386 (7.0%), (P = 0.021). Units of red cells transfused decreased by 7.4 (95% CI 1.6 to 13.2) per 1000 maternities per year (P = 0.015). Red cells were transfused to 350/15204 (2.3%) and 268/15150 (1.8%) (P = 0.001) in the first and last 6 months, respectively. There was no increase in the number of women with lowest haemoglobin below 80 g/L during this time period. Infusions of fresh frozen plasma fell and there was no increase in the number of women with haemostatic impairment.Conclusions: The OBS Cymru care bundle was feasible to implement and associated with progressive, clinically significant improvements in outcomes for PPH across Wales. It is applicable across obstetric units of widely varying size, complexity and staff mixes. [ABSTRACT FROM AUTHOR]

The aim of this work is to measure and determine the awareness on abortion and its legality amongst youths in Nigerian Universities. The undergraduate students of some selected universities in Nigeria constituted the study population. These were male and female undergraduate students across the faculties and departments of the schools. The study made use of questionnaire as the source of data collection. A total of 587 questionnaires were administered and analysed. Findings from this study supported literature on the knowledge of undergraduates on abortion. It further revealed that awareness of legal provisions guiding abortion in Nigeria was low, as only 28.3% of the respondents were aware of the criminal and penal code laws relating to abortion. It is recommended that the schools should include education of legal stance on abortion in the curriculum. Also, the undergraduate students should be educated on mortality resulting from abortion to boost the development rate of the country. [ABSTRACT FROM AUTHOR]

Background: Abortion draws varied emotions based on individual and societal beliefs. Often, women known to have sought or those seeking abortion services experience stigma and social exclusion within their communities. Understanding community perception of abortion is critical in informing the design and delivery of interventions that reduce the gaps in access to safe abortion for women. Objective: We explored community perceptions and beliefs relating to abortion, clients of abortion services, and abortifacients in Kenya. Methods: We conducted focus group discussions (FGDs) and in-depth interviews (IDIs) in Kisumu and Nairobi counties in Kenya among a mix of adult men and women, pharmacists, nurses, and community health volunteers. Results: Community perspectives around abortion were heterogeneous, reflecting a myriad of opinions ranging from total anti-abortion to more pro-choice positions, and with rural-urban differences. Notably, negative views on abortion became more nuanced and tempered, especially among young women in urban areas, as details of factors that motivate women to seek abortion became apparent. Participants were mostly aware of the pathways through which women and girls access abortion services. Whereas abortion is commonplace, multiple structural and socioeconomic barriers, as well as stigma, are prevalent, thus impeding access to safe and quality services. Conclusion: Community perceptions on abortion are heterogeneous, varying by gender, occupation, level of education, residence, and position in society. Stigma and the hostile abortion environment limit access to safe abortion services, with several negative consequences. There is urgent need to strengthen community-based approaches to mitigate predisposing and enabling factors for unsafe abortions. [ABSTRACT FROM AUTHOR]

Background: Underutilization of formal maternal care services and accredited health attendants is a major contributor to the high maternal mortality rates in rural communities in Nigeria. Perceptions of a poor quality of care and inaccessible services in health facilities strongly influence the low use of formal maternal care services. There is therefore a need to understand local perceptions about maternal health services utilization and maternal death. This study thereby aims to explore perceptions and beliefs about the underutilization of formal care and causes of maternal death, as well as to identify potential solutions to improve use and reduce maternal mortality in rural Nigeria. Methods: Data were collected through 9 community conversations, which were conducted with 158 community elders in 9 rural communities in Edo State, Nigeria. Data from transcripts were analyzed through inductive thematic analysis using NVivo 12 software. Results: Perceived reasons for the underutilization of formal maternal care included poor qualities of care, physical inaccessibility, financial inaccessibility, and lack of community knowledge. Perceived reasons for maternal death were related to medical causes, maternal healthcare services deficiencies, uptake of native maternal care, and poor community awareness and negligence. Elders identified increased access to adequate maternal care, health promotion and education, community support, and supernatural assistance from a deity as solutions for increasing use of formal maternal care and reducing maternal mortality rates. Conclusion: Study results revealed that multifaceted approaches that consider community contexts, challenges, and needs are required to develop acceptable, effective and long-lasting positive changes. Interventions aiming to increase use of formal care services and curb maternal mortality rates must target improvements to the technical and interpersonal qualities of care, ease of access, community awareness and knowledge, and allow community members to actively engage in implementation phases. [ABSTRACT FROM AUTHOR]

The effects of feed moisture, sugar and temperature on extrusion of fermented maize-soybean blend was investigated. Fermentation caused a reduction in sectional expansion index from 1.342 to 1.244, bulk density from 0.5005 to 0.5002 g/cm3 and water absorption index (WAI) from 5.9 to 5.2 but increased specific volume from 7.13 to 7.15 cm3/g and water solubility index (WSI) from 1.2 to 1.7. Increase in feed moisture (20-35 %) reduced sectional expansion index, specific volume, bulk density and water solubility index but increased the water absorption index. An increase in concentration of the sugar reduced extrudate sectional expansion index, specific volume and water absorption index but increased bulk density and water solubility index. Increasing the barrel temperature exhibited a predominant effect on the bulk density of the extruded products. Proximate composition of the samples revealed that the extrudate was high in protein content (between 19.2 and 23.0 %), low in fat and ash contents. [ABSTRACT FROM AUTHOR]

While laws in Uganda surrounding abortion remain contradictory, a frequent interpretation of the law is that abortion is only allowed to save the woman’s life. Nevertheless abortion occurs frequently under unsafe conditions at a rate of 54 abortions per 1000 women of reproductive age annually, taking a large toll on women’s health. There are an estimated 148,500 women in Uganda who experience abortion complications annually. Understanding opinion leaders’ knowledge and perceptions about unsafe abortion is critical to identifying ways to address this public health issue. We conducted in-depth, semi-structured interviews with 41 policy-makers, cultural leaders, local politicians and leaders within the health care sector in 2009–10 at the national as well as district (Bushenyi, Kamuli and Lira) level to explore their knowledge and perceptions of unsafe abortion and the potential for policy to address this issue. Only half of the sample knew the current law regulating abortion in Uganda. Respondents understood that the result of the current abortion restrictions included long-term health complications, unwanted children and maternal death. Perceived consequences of increasing access to safe abortion included improved health as well as overuse of abortion, marital conflict and less reliance on preventive behaviour. Opinion leaders expressed the most support for legalization of abortion in cases of rape when the perpetrator was unknown. Understanding opinion leaders’ perspectives on this politically sensitive topic provides insight into the policy context of abortion laws, drivers behind maintaining the status quo, and ways to improve provision under the law: increase education among providers and opinion leaders. [ABSTRACT FROM PUBLISHER]

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Objective To analyse and improve the Namibian maternity care system by implementing maternal near-miss surveillance during 1 October 2018 and 31 March 2019, and identifying the challenges and benefits of such data collection. Methods From the results of an initial feasibility study, we adapted the World Health Organization's criteria defining a maternal near miss to the Namibian health-care system. We visited most (27 out of 35) participating facilities before implementation and provided training on maternal near-miss identification and data collection. We visited all facilities at the end of the surveillance period to verify recorded data and to give staff the opportunity to provide feedback. Findings During the 6-month period, we recorded 37 106 live births, 298 maternal near misses (8.0 per 1000 live births) and 23 maternal deaths (62.0 per 100 000 live births). We observed that obstetric haemorrhage and hypertensive disorders were the most common causes of maternal near misses (each 92/298; 30.9%). Of the 49 maternal near misses due to pregnancies with abortive outcomes, ectopic pregnancy was the most common cause (36/298; 12.1%). Fetal or neonatal outcomes were poor; only 50.3% (157/312) of the infants born to maternal near-miss mothers went home with their mother. Conclusion Maternal near-miss surveillance is a useful intervention to identify within-country challenges, such as lack of access to caesarean section or hysterectomy. Knowledge of these challenges can be used by policy-makers and programme managers in the development of locally tailored targeted interventions to improve maternal outcome in their setting. [phrase omitted] [phrase omitted] Objectif Analyser et ameliorer le systeme de soins obstetricaux namlblen en instaurant une surveillance des deces maternels evites de justesse durant la periode comprise entre le 1er octobre 2018 et le 31 mars 2019. Cerner les defis et avantages que represente une telle collecte de donnees. Methodes En nous fondant sur les resultats d'une etude de faisabilite initiale, nous avons adapte les criteres employes par l'Organisation mondiale de la Sante pour definir les deces maternels evites de justesse et les avons appliques au systeme de sante namibien. Nous sommes alles dans la plupart (27 sur 35) des etablissements participants avant la mise en auvre, et avons organise des formations consacrees a (identification des deces maternels evites de justesse et a la collecte de donnees. Nous avons egalement rendu visite a l'ensemble des etablissements a l'issue de la periode de surveillance afin de verifier les donnees recueillies et de donner au personnel soignant l'occasion d'exprimer son avis. Resultats Durant cette periode de 6 mois, nous avons enregistre 37 106 naissances vivantes, 298 deces maternels evites de justesse (8,0 pour 1000 naissances vivantes) et 23 deces maternels (62,0 pour 100 000 naissances vivantes). Nous avons constate que les causes les plus frequentes de deces maternels evites de justesse etaient les hemorragies obstetricales et les problemes d'hypertension (92/298 pour l'une comme pour l'autre; 30,9%). Sur les 49 deces maternels evites de justesse lies a des grossesses infructueuses, la cause la plus repandue etait la grossesse extra-uterine (36/298; 12,1%). Le nombre d'issues fatales ou neonatales etait faible; a peine 50,3% (157/312) des bebes nes de femmes ayant evite un deces de justesse sont rentres avec leur mere a la sortie de l'hopital. Conclusion La surveillance des deces maternels evites de justesse est une intervention utile pour identifier les defis auxquels est confronte le pays, comme le manque d'acces aux cesariennes ou aux hysterectomies. S'ils sont conscients de ces defis, les legislateurs et responsables de programmes peuvent developper des actions ciblees et adaptees aux specificites locales afin d'ameliorer la sante maternelle dans leur region. [phrase omitted] Objetivo Analizar y mejorar el sistema de atencion de maternidad de Namibia al implementar la vigilancia de la morbilidad materna extrema durante el 1 de octubre de 2018 y el 31 de marzo de 2019, e identificar los retos y los beneficios de esa recopilacion de datos. Metodos A partir de los resultados de un estudio inicial de viabilidad, se adaptaron los criterios de la Organizacion Mundial de la Salud que definen la morbilidad materna extrema al sistema de atencion sanitaria de Namibia. Se visitaron la mayoria (27 de 35) de los centros participantes antes de la implementacion y se impartio capacitacion sobre la identificacion de los casos de morbilidad materna extrema y la recopilacion de datos. Se visitaron todos los centros al final del periodo de vigilancia para verificar los datos registrados y dar al personal la oportunidad de proporcionar informacion. Resultados Durante el periodo de 6 meses, se registraron 37 106 nacimientos vivos, 298 casos de morbilidad materna extrema (8,0 por cada 1000 nacimientos vivos) y 23 muertes maternas (62,0 por cada 100 000 nacimientos vivos). Se observo que las hemorragias obstetricas y los trastornos hipertensivos fueron las causas mas comunes de las morbilidades maternas extremas (cada una de ellas 92/298; 30,9 %). De los 49 casos de morbilidad materna extrema por embarazos cuyo resultado fue un aborto, el embarazo ectopico fue la causa mas comun (36/298; 12,1 %). Los resultados fetales o neonatales fueron deficientes; solo el 50,3 % (157/312) de los infantes nacidos de madres con morbilidad materna extrema regresaron a casa junto con sus madres quienes habian sido dadas de alta. Conclusion La vigilancia de la morbilidad materna extrema es una intervencion de gran utilidad para identificar las dificultades que existen dentro del pais, como la falta de acceso a la intervencion de cesarea o la histerectomia. Los responsables de formular las politicas y los gestores de los programas pueden utilizar el conocimiento de estas dificultades en la elaboracion de iniciativas focalizadas y adaptadas a las necesidades locales para mejorar los resultados de la maternidad en su entorno., Introduction A target within the third sustainable development goal (SDG 3: ensure healthy lives and promote well-being for all at all ages) (1) is to reduce the maternal mortality ratio [...]