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Purpose: To examine the association between benign breast disease (BBD) and breast cancer (BC) in a heterogeneous population of African women. Methods: BC cases and controls were enrolled in three sub-Saharan African countries, Nigeria, Cameroon, and Uganda, between 1998 and 2018. Multivariable logistic regression was used to test the association between BBD and BC. Risk factors dually associated with BBD and BC were selected. Using a parametric mediation analysis model, we assessed if selected BC risk factors were mediated by BBD. Results: Of 6,274 participants, 55.6% (3,478) were breast cancer cases. 360 (5.7%) self-reported BBD. Fibroadenoma (46.8%) was the most commonly reported BBD. Women with a self-reported history of BBD had greater odds of developing BC than those without (adjusted odds ratio [aOR] 1.47, 95% CI 1.13–1.91). Biopsy-confirmed BBD was associated with BC (aOR 2.25, 95% CI 1.26–4.02). BBD did not significantly mediate the effects of any of the selected BC risk factors. Conclusions: In this study, BBD was associated with BC and did not significantly mediate the effects of selected BC risk factors. [ABSTRACT FROM AUTHOR]

Unhealthy diet and physical inactivity are modifiable risk factors for non-communicable diseases. Policies formulated in line with international guidelines are required for the implementation of population-level interventions to reduce the risks. This study describes the utilization of multisectoral approach (MSA) for the formulation of nutrition and physical activity policies and the extent to which they align with the WHO 'Best Buy Interventions'. The research utilized a descriptive case study design and the theoretical model guiding the study was the Walt and Gilson framework for policy analysis. Data were obtained through the interview of 44 key informants using pre-tested guides and document review of 17 policies and articles obtained from government institutions or through the search of electronic databases. Data were integrated and analysed using thematic analysis. Between 2000 and 2016, Nigeria had formulated 10 nutrition-related policies and 5 guidelines with actions to promote physical activity. Only three nutrition and two physical activity policies adopted a high level of MSA. In line with the WHO best buy interventions, educational interventions for the general population are proposed to reduce sugar and salt intake and replace transfat with polyunsaturated fats but there are no legal regulatory acts to support these actions. Policy documents with actions to reduce physical inactivity do not include the WHO best buys. The country should adopt a wider range of actors to formulate and review policies, integrate all the WHO best buy interventions and develop effective legislation to regulate the salt and sugar content of processed foods. [ABSTRACT FROM AUTHOR]

Background: Harmful alcohol use is a modifiable risk factor contributing to the increasing burden of non-communicable diseases and deaths and the implementation of policies focused on primary prevention is pivotal to address this challenge. Policies with actions targeting the harmful use of alcohol have been developed in Nigeria. This study is an in-depth analysis of alcohol-related policies in Nigeria and the utilization of WHO Best Buy interventions (BBIs) and multi-sectoral action (MSA) in the formulation of these policies.Methods: A descriptive case study design and the Walt and Gilson framework of policy analysis was utilized for the research. Components of the study included a scoping review consisting of electronic search of Google and three online databases (Google Scholar, Science Direct and PubMed) to identify articles and policy documents with no language and date restrictions. Government institution provided documents which were not online. Thirteen policy documents, reports or articles relevant to the policy formulation process were identified. Other components of the study included interviews with 44 key informants (Bureaucrats and Policy Makers) using a pretested guide. The qualitative data were coded and analyzed using thematic analysis.Results: Findings revealed that policy actions to address harmful alcohol use are proposed in the 2007 Federal Road Safety Act, the Non-communicable Diseases Prevention and Control Policy and the Strategic Plan of Action. Only one of the best buy interventions, (restricted access to alcohol) is proposed in these policies. Multi-sectoral action for the formulation of alcohol-related policy was low and several relevant sectors with critical roles in policy implementation were not involved in the formulation process. Overall, alcohol currently has no holistic, health-sector led policy document to regulate the marketing, promotion of alcohol and accessibility. A major barrier is the low government budgetary allocation to support the process.Conclusions: Nigeria has few alcohol-related policies with weak multi-sectoral action. Funding constraint remains a major threat to the implementation and enforcement of proposed policy actions. [ABSTRACT FROM AUTHOR]

Background: The increasing burden of non-communicable diseases (NCDs) in sub-Saharan Africa is causing further burden to the health care systems that are least equipped to deal with the challenge. Countries are developing policies to address major NCD risk factors including tobacco use, unhealthy diets, harmful alcohol consumption and physical inactivity. This paper describes NCD prevention policy development process in five African countries (Kenya, South Africa, Cameroon, Nigeria, Malawi), including the extent to which WHO "best buy" interventions for NCD prevention have been implemented.Methods: The study applied a multiple case study design, with each country as a separate case study. Data were collected through document reviews and key informant interviews with national-level decision-makers in various sectors. Data were coded and analyzed thematically, guided by Walt and Gilson policy analysis framework that examines the context, content, processes and actors in policy development.Results: Country-level policy process has been relatively slow and uneven. Policy process for tobacco has moved faster, especially in South Africa but was delayed in others. Alcohol policy process has been slow in Nigeria and Malawi. Existing tobacco and alcohol policies address the WHO "best buy" interventions to some extent. Food-security and nutrition policies exist in almost all the countries, but the "best buy" interventions for unhealthy diet have not received adequate attention in all countries except South Africa. Physical activity policies are not well developed in any study countries. All have recently developed NCD strategic plans consistent with WHO global NCD Action Plan but these policies have not been adequately implemented due to inadequate political commitment, inadequate resources and technical capacity as well as industry influence.Conclusion: NCD prevention policy process in many African countries has been influenced both by global and local factors. Countries have the will to develop NCD prevention policies but they face implementation gaps and need enhanced country-level commitment to support policy NCD prevention policy development for all risk factors and establish mechanisms to attain better policy outcomes while considering other local contextual factors that may influence policy implementation such as political support, resource allocation and availability of local data for monitoring impacts. [ABSTRACT FROM AUTHOR]