Search

Objective : This study reviews the craniofacial clefts that presented at a Nigerian tertiary health facility, highlighting our experience with the pattern of presentation and surgical care of these patients. Design : A retrospective review of the smile train database and medical records of all individuals who had been diagnosed with any of the Tessier craniofacial clefts and managed between 1st January 2007 and 31st December 2020 was done. The data were presented as numbers and percentages of cases. Setting : The cleft clinic of a tertiary health facility and a major cleft referral center in South-West Nigeria. Results : Forty-five patients with craniofacial clefts were managed over the study period. 15.6% had associated syndromes, 2.2% had a family history of similar craniofacial cleft and 11% had a history of a possible teratogen. There were 21 (46.7%) middle clefts, 14(31.1%) lateral clefts and 10(22.2%) oblique clefts. The most common type of cleft was Tessier 0 while the Tessier 6 was the least common type. The median age at surgery was 10 months for male and 5months for female subjects, 15.3% complication rate was found in this study. Four patients had revision surgeries to correct residual deformities in this study. Conclusion : The diverse presentations and occurrence of the rare craniofacial clefts present complex aesthetic and functional problems that require individualized often multidisciplinary care. The execution of a properly planned treatment will reduce complications and the need for revision surgeries. [ABSTRACT FROM AUTHOR]

The Niger Delta region in South-South Nigeria, on Africa's West Coast, is densely populated. The region, which contains a substantial stock of crude oil and natural gas, has been nicknamed "the engine room" for Nigeria's economic development and progress. It is responsible for up to 90% of the country's economic growth (or gross domestic product/GDP). The region has multiple ecosystems, such as the aquatic environment, that are critical to the survival of the area's various habitats and living species. However, the same region has witnessed unjustifiable environmental pollution arising from oil activities over the years of exploration and production which has orchestrated negative consequences on the Niger Delta ecosystem. This has led to extended negative consequences on natural resources, which also have detrimental repercussions psychologically, ecologically, socially, economically, and physically which, in turn, impacts the overall health of the affected individuals. This write-up provides an overview of the major drivers of the oil leakage in Nigeria's Niger Delta ecosystem as well as the major impacts on the environment. It will also analyze numerous means of remediation in use and extend such for a more inclusive and productive option. Moreover, this review offers key measures that may help to maintain long-term policies for reducing adverse implications and increasing the living standard for the Niger Delta area's affected communities. [ABSTRACT FROM AUTHOR]

Objective: To investigate the burden and health service events surrounding severe maternal outcomes (SMO) related to life-threatening postpartum haemorrhage (PPH) in Nigerian public tertiary hospitals.Design: Secondary analysis of a nationwide cross-sectional study.Setting: Forty-two tertiary hospitals.Population: Women admitted for pregnancy, childbirth or puerperal complications.Methods: All cases of SMO [maternal near miss (MNM) or maternal death (MD)] due to PPH were prospectively identified using WHO criteria over a 1-year period.Main Outcome Measures: Incidence of SMO, health service events, case fatality rate (CFR) and mortality index (MI: % of death/SMO).Results: Postpartum haemorrhage occurred in 2087 (2.2%) of the 94 835 deliveries recorded during the study period. A total of 354 (0.3%) women had an SMO (103 MD; 251 MNM). It was the most frequent obstetric haemorrhagic complication across hospitals. PPH had the highest maternal mortality ratio (112/100 000 live births) and the recorded MI (29.1%) and CFR (4.9%) were second only to that of ruptured uterus. About 83% of women with SMO were admitted in a critical condition with over 50% being referred. MD was more likely when PPH led to neurological (80.8%), renal (73.5%) or respiratory (58.7%) organ dysfunction. Although the timing of life-saving interventions was not statistically different between the cases of MD and MNM, close to one-quarter of women who died received critical intervention at least 4 hours after diagnosis of life-threatening PPH.Conclusions: Postpartum haemorrhage was a significant contributor to obstetric haemorrhage and SMO in Nigerian hospitals. Emergency obstetric services should be enhanced at the lower levels of healthcare delivery to reduce avoidable deaths from PPH.Funding: The original research that generated the data for this secondary analysis, and the publication of this secondary analysis, was funded by the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research Development and Research Training in Human Reproduction (HRP), a cosponsored programme executed by the World Health Organization. We have no other funding issue to declare for our study.Tweetable Abstract: One hundred and three maternal deaths and 251 near-misses resulted from PPH in 42 Nigerian tertiary facilities in 1 year. [ABSTRACT FROM AUTHOR]

Introduction: Prelacteal feeding practice contravenes the recommendation of World Health Organisation that breastfeeding be initiated within an hour of childbirth. Consequently, the health, social, emotional and economic benefits of optimal breastfeeding are limited. Therefore, to break this vicious cycle of prelacteal feeding and suboptimal breastfeeding, factors associated with the practice must be identified. Objective: To assess prelacteal feeding practices and its associated factors in a rural community with the view to generate data for community-level interventions that will promote optimal breastfeeding. Methods: Data was collected during a community-based surveillance for maternal, newborn and child health project in Tsibiri, a rural community in north-western Nigeria. The survey questionnaire was uploaded into mobile devices running on an android operating system. Trained female interviewers collected the data over a period of one week in 2011. Results: A total of 270 out of 309 interviewed women had experienced childbirth and were included in the analysis. Majority (85.2%) of respondents utilised prelacteal feeds for their newborns. Plain water was the most common prelacteal feed (44.7%). Prelacteal feeding was associated with births assisted by unskilled birth attendants (AOR 5.322, 95%CI 1.634-17.333); while operative delivery reduced the likelihood of the practice (AOR 0.168, 95%CI 0.060-0.470). No statistically significant association was found between use of prelacteal feed and women’s age, education or access to income. Conclusion: The predominance of prelacteal feeding practices underscores the need for innovative strategies that create awareness among mothers and health care providers, with emphasis on health facility deliveries, advantages of breastfeeding and risks of prelacteal feeding. [ABSTRACT FROM AUTHOR]

The Opa Reservoir, established for water supply to the Obafemi Awolowo University community, over the years has received direct linkage to township drains as a result of the widening and dredging of its river channels. The current study aimed at documenting monthly heavy metal loads at its riverine, transition and lacustrine zones in 2012–2013. Most of the heavy metals, analysed using an atomic absorption spectrophotometer, occurred within wide ranges, with coefficients of variation ranging from 60% to 300%, although the differences in heavy metal loads between the different zones were statistically insignificant at both the surface and bottom levels. The overall order of dominance of the metals was Ni > Cu > Fe > Zn > Cd = Cr > Pb, with nickel concentration being very high throughout. Heavy metal total mean concentration was higher during the rainy season (1.889 mg l−1) than the dry season (1.503 mg l−1) irrespective of sampling sites, having highly significant seasonal differences (p< 0.001) in Ni, Cd, Fe and Cu concentrations. The mean concentrations of Zn (0.074 mg l−1), Fe (0.176 mg l−1), Cu (0.507 mg l−1) and Pb (0.004 mg l−1) were within the WHO acceptable limit. However, the recorded levels of toxic elements Cd (0.031 mg l−1) and Ni (0.905 mg l−1) pose potential health risk to water consumers. [ABSTRACT FROM PUBLISHER]

Thirty-nine morphometric and five meristic comparisons were carried out on 12-month-old interspecific and intergeneric hybrids of the African clariid catfishesHeterobranchus longifilis,Clarias gariepinusandClarias anguillarisfrom experimental earthen ponds in Nigeria. Canonical discriminant analysis accounted for 89.4% of the variations, with eigenvalues of 151.69 and 9.06, respectively, the highest loading in the two axes coming from only 12 variables. A re-analysis based on those 12 variables revealed four major groups among the nine genetic combinations from a plot of axes 1 and 2, which accounted for 95.2% of the variations. The Mahalanobis square distance (D2) between the offspring of the various mating combinations also revealed the varying levels of relationship between them based on their morphometric and meristic characters. The interspecific hybrids showed some level of heterosis only in the inheritance of the length of the frontal fontanelles compared to that of the putativeClariasspecies. The study shows the level of similarities in many of the morphometric and merisitic features, especially among the hybrids, and the distinguishing features that can be used to identify the hybrids from their putative parents. [ABSTRACT FROM AUTHOR]

This study reviewed retrospectively the cases of obstructed labour as seen at the specialist Gombe Hospital (SHG), Gombe State, over a period of 5 years. The incidence of obstructed labour was 4.0%. There was a progressive decline in the time trend over the study period. About 80.3% of the patients were unbooked emergencies and 99.5% of them had been in labour elsewhere before presenting at the hospital. The leading cause of obstructed labour was cephalopelvic disproportion (83.0%). Caesarean section (72.2%) was the most common method of delivery. Puerperal sepsis was the most frequent morbidity. However, the longest duration of hospital stay was as a result of a bedsore. The maternal mortality for cases of obstructed labour was 7605/ 100 000 and the perinatal mortality was 628/1000 births. The study aims to reinstate public interest in this health problem and offers suggestions on how to curb this human tragedy. [ABSTRACT FROM AUTHOR]

Ectopic pregnancy is a common gynaecological emergency in Nigeria, West Africa. Here we present a case that brings to light some of the problems facing the health sector in reducing the high maternal mortality rate. [ABSTRACT FROM PUBLISHER]

Abstract: Objective: To compare the pattern of jaundice resolution among children with severe malaria treated with quinine and artemether. Methods: Thirty two children who fulfilled the inclusion criteria were recruited for the study from two hospitals with intensive care facilities. They were divided into two groups; ‘Q’ and ‘A’, receiving quinine and artemether, respectively. Jaundice was assessed by clinical examination. Results: Sixteen out of 32 children recruited (representing 50%) presented with jaundice on the day of recruitment. The mean age was (7.00±2.56) years. On day 3, four patients in ‘A’ and six patients in ‘Q’ had jaundice. By day 7, no child had jaundice. Conclusion: The study has shown that both drugs resolve jaundice although artemether relatively resolves it faster by the third day. [Copyright &y& Elsevier]

Abstract: Objective: To assess the potential of lotion made from honey and propolis in the treatment of septic wounds in order to determine its effectiveness. Methods: The study area was Osun State, Southwest Nigeria. Fifty patients with septic wounds, aged from 20-60 years, were treated with lotion made from honey and propolis harvested from the Centre for Apicultural Research, Training and Honey Production (CARTHOP) Farm of College of Agriculture, Osun State University, Ejigbo. Honey and powdered propolis were mixed in a ratio of seven to three. The lotion was applied to the wounds three times a day. Results: The wounds of the 80% of the patients showed remarkable signs of improvement at the end of the 4th day; 60% had their wounds completely healed at the end of the 10th day; the remaining 40% healed completely at the end of the 15th day. All healed wounds were without scars or blisters. Conclusions: It can be concluded that the lotion from the honey and propolis has great potential for the treatment and healing of septic wounds. It is recommended that it should be incorporated in the treatment plans of septic wounds and other gangrenous wounds by hospitals in Nigeria. [Copyright &y& Elsevier]

Background: Cardiovascular diseases (CVD) are among the most prevalent and preventable chronic diseases in the 21st century The global burden of disease: 2004 update. The Report in Sections. A person's risk of developing CVD can be reduced by adopting healthy lifestyles, spiritual and religious practices The American Heart Association Life's Simple 7 in African Americans of the Jackson Heart Study. Fasting as a spiritual practice is not exempted from these benefits. Most world's religions recommend a period of fasting. The obligatory Ramadan fasting in Islam may provide an interesting opportunity to reduce food intake and increase physical activity. The main objective of this study is to investigate the effect of Ramadan fasting on cardiovascular risk factors on healthy adult Muslims., Method: The study was pre/post-test single arm intervention conducted at the staff clinic of Family Medicine department, AKTH, and Northwest, Nigeria. Kano. The study recruited healthy adults 18yrs and above not on any medications that can affect metabolic profiles consecutively from two weeks before Ramadan fasting of 2018 and the last week of Ramadan of the same year. The questionnaire included information on sociodemographic, clinical parameters and Lifestyle pattern., Result: Thirty healthy volunteers were included in this study, 25 males (83.3%) and 5 females (16.7%). The mean age was 38.23 ± 6.35(SD). Twenty-five participants were married (83.3%) with 4 singles (13.3%) and 1 divorcee (3.3%). During Ramadan fasting, weight reduced (67.90 ± 11.61 versus 66.53 ± 12.13 4th week of Ramadan p-value < 0.002) Body Mass Index (22.89 ± 3.63 versus 4th week of Ramadan 22.38 ± 3.64 p-value < 0.002) and systolic blood pressure (120.33 ± 19.91versus 4th week of Ramadan 115.33 ± 14.32 p-value 0.003) reduced significantly compared to baseline. The waist circumference, pulse rate, fasting blood sugar and cholesterol were reduced but were not statistically significant., Conclusion: The result from this study suggested that Ramadan fasting may be a useful means of reducing burden of cardiovascular diseases, as the improved cardiovascular risk factors associated with fasting may translate into a significant health benefit., Competing Interests: Declarations Ethical approval Ethical approval was obtained from AKTH Research and Ethics Committee. Reference (NHREC/21/08/2008/AKTH/EC/2224). All participants signed informed consent for the study. Consent for publication Not applicable. Clinical trial number Not applicable since no drugs were introduced. The intervention was religious practice fasting during Ramadan. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Soil-transmitted helminthiases (STH) and schistosomiasis are parasitic neglected tropical diseases (NTDs) of significant public health importance globally, including Nigeria. Urogenital schistosomiasis is highly endemic in Apojola, a rural community in Ogun State, southwest Nigeria, but data on STH and intestinal schistosomiasis in the neglected community are lacking., Objectives: To determine the prevalence and intensity of STH and intestinal schistosomiasis and the risk factors associated with the infections in Apojola., Methods: The study was community-based and cross-sectional. A structured questionnaire was used to obtain information on socio-demographic, personal, and household WASH characteristics of the study population. Stool samples were collected and processed for parasitological examination using the triplicate Kato-Katz (K-K) smears., Results: A total of 283 individuals (males, 50.2%; females, 49.8%) aged 3 to 65 years (mean age ± S.D.: 19.6 ± 14.8 years) participated in the study. No case of intestinal schistosomiasis was recorded in the study, while the overall prevalence of any STH was 38.2%: A. lumbricoides (24.0%) and hookworms (25.8%). Prevalence of infection was not significantly different between males and females for any STH (40.1% vs. 36.2%, χ 2  = 0.473, p = 0.492); A. lumbricoides (23.2% vs. 22.7%, χ 2  = 0.012, p = 0.913); or hookworms (28.2% vs. 23.4%; p = 0.360; χ 2  = 0.839), but significantly varied with age for any STH (χ 2  = 22.225, p = 0.002); A. lumbricoides (χ 2  = 16.354, p = 0.022); or hookworms (χ 2  = 20.001, p = 0.006). The intensity of infection was neither associated with gender nor age and was mostly light. Walking barefoot, toilet type (absent/bush), and irregular washing of fruits and/or vegetables before consumption were significantly associated with STH., Conclusion: Our data indicate that intestinal schistosomiasis is not prevalent in Apojola and that the community is a moderate-risk area for STH. Hence, the current annual preventive chemotherapy for STH (PC STH) with albendazole or mebendazole in school-aged children (SAC) through the school-based delivery programme should be extended to non-enrolled SAC and pre-SAC using other delivery platforms. This should be complemented with regular and effective health education campaigns as well as water, sanitation, and hygiene (WASH)-related interventions., Competing Interests: Declarations Ethics approval and consent to participate Ethical approvals for the study were granted by the Health Research Ethics Committees of the College of Medicine, University of Lagos (Ref: CMUL/HREC/01/20/713) and the Ogun State Ministry of Health, Abeokuta (Ref: HPRS/381/337).Following full disclosure of the objectives, procedures and benefits of the study, written informed consent was obtained from each subject (parent or legal guardian in the case of a minor) before participation in the study. They were also informed of their rights to refuse participation in the study and to withdraw at any time during the study without affecting their rights of access to any intervention. Participants’ confidentiality was ensured through a coding process. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Celiac disease (CD) affects the small intestine and can hinder nutrient absorption. It is found worldwide and common in certain groups of people including individuals with Type 1 Diabetes Mellitus (T1DM). However, the prevalence of CD in the West African region is not documented. This study aimed to investigate the prevalence and pattern of CD autoimmunity in Nigerian children and adolescents diagnosed with T1DM., Methods: This was a cross-sectional descriptive study of children and adolescents with T1DM at the Paediatric Endocrinology Clinic of seven selected tertiary health facilities in Nigeria. Information was collected on socio-demographics, clinical characteristics and anthropometrics. The subjects were screened for markers of CD autoimmunity using anti-tissue transglutaminase antibody (tTG) and anti-endomysial antibody (EMA). Endoscopy and duodenal biopsy were recommended for participants with elevated CD-specific antibodies., Results: The study recruited a total of 104 children and adolescents with TIDM, out of which six participants (5.8%) had CD autoimmunity. All six participants were females, aged between 3 and 12 years, with a mean age of 9.2 ± 3.7 years. Participants with CD autoimmunity were more likely to have DM diagnosed before the age of 10 years compared to those without CD autoimmunity (83.3% vs. 37.7%, p = 0.149). Except for two participants, all individuals with CD autoimmunity experienced gastrointestinal symptoms such as nausea, vomiting, diarrhoea, and bloating., Conclusion: This study highlights the occurrence of CD autoimmunity in Nigerian children and adolescents with TIDM. Healthcare providers should consider screening for celiac disease in children and adolescents with T1DM, particularly in females and when gastrointestinal symptoms are present. Additionally, the findings from this study suggest that there is a high probability of a significant burden of CD, even within the general population in Nigeria. Therefore, it's important to maintain a high level of suspicion and to actively screen at-risk groups in clinical settings to ensure early diagnosis of CD., Competing Interests: Declarations Ethics approval and consent to participate Ethical approval was obtained from the ethics committees of all the involved hospitals – Health Research and Ethics Committee of LASUTH (LREC/06/10/1121); Health Research and Ethics Committee of LUTH (ADM/DCST/HREC/2682); Ethics and Research Committee of OAUTHC (ERC/2019/07/05); Health Research Ethics Committee of OOUTH (OOUTH/HREC/377/2020AP); Research Ethics Committee of AKUTH (AKTH/MAC/SUB/12A/P-3/VI/2108); Research and Ethics Committee of ATBUTH (ATBUTH/ADM/42/VOL.1) and Research Ethics Committee of UI/UCH (UI/EC/24/0362). Written informed consent was obtained from all parents or guardians and assent from all subjects. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Maternal mortality remains a significant challenge in Nigeria, where 28.5% of global maternal deaths occur. Barriers such as weak policy environments and lack of product availability hinder the implementation of life-saving interventions. This research aims to establish a cross-country network of experts and champions to promote the adoption of evidence-based MNCNH interventions at scale., Methods: The AIM-MNCNH partnership involving the African Centre for Excellence in Population Health and Policy, Pathfinder, Centre for Communication and Social Impact, and the Medical Women's Association of Nigeria (MWAN) will engage national and subnational platforms, healthcare providers, policymakers, and community advocates in 16 states. Key interventions include strengthening policy environments, building technical capacity for advocacy, and promoting the availability of innovative maternal health interventions for postpartum haemorrhage (PPH) treatment., Results: This approach is expected to establish a national network of MNCNH experts, drive high-level political advocacy, and strengthen the policy environment for implementing MNCNH innovations. Preliminary engagements with the National Primary Healthcare Development Agency and governments of the 16 states have yielded results. Key indicators for success will include the number of healthcare workers trained, the coverage of new PPH interventions, and reductions in maternal mortality., Conclusion: This project provides a strategic approach to scaling evidence-based MNCNH innovations. Successful implementation will contribute to achieving Sustainable Development Goal 3 (SDG 3) and significantly reduce maternal mortality in Nigeria., Competing Interests: The Authors declare that no competing interest exists, (Copyright © 2024 by West African Journal of Medicine.)

Introduction/background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. The AF Atrial Fibrillation Registry, which commenced in June 2023, was designed to provide clinical epidemiological data on patients with AF in the country., Objective(s): The objective is to describe the rationale, design, and early findings from the registry., Materials/methods: This is a prospective clinical registry of adult patients aged 18 years and above with AF., Results: The registry so far included 276 patients who met the eligibility criteria. There were 146(52.8%) males (mean age-63.3(14.13) years) and 130 (47.1%) females (mean age-59.3(17.58) years) Cardiovascular risk profile of the patients with AF was cigarette smoking (current/previous 2(38 %), hypertension 203(74%), diabetes 28(10.3%), and family history of CVD 56(20.6%). The median CHADVASC score is 3(IQR - 2,4). Rate control was the most frequent management strategy. Eighty-seven (87) have completed 6 months of follow-up, 10(11%) were re-hospitalized, and 9(10.3%) died., Conclusions: Compared to developed countries, our patients with AF are relatively young and have lower rates of diabetes mellitus but higher rates of hypertension. Rate control is the main strategy used for managing AF. Mortality is high at one year but lags behind re-hospitalization. This may provide an opportunity for intervention., Competing Interests: The Authors declare that no competing interest exists, (Copyright © 2024 by West African Journal of Medicine.)

Introduction: Viral hepatitis C (HCV) is a global public health problem, and its management could impose substantial financial burdens on households, especially in sub-Saharan Africa, which has limited health coverage. This study assessed the economic impact of managing HCV patients in households in a resource-limited setting., Methods: This was a facility-based cross-sectional survey involving a two-stage sampling method to select 90 hepatitis C patients at various stages of the disease. The data were analyzed using the Statistical Package for Social Sciences version 26, and the results are presented in tables., Results: The mean cost of managing hepatitis C for three months was N549,754 ($1,447). Up to 93.5% of hepatitis C patients pay out-of-pocket for health care. Only 3.3% of the patients had health insurance coverage, and the rest were covered by employers. The proportion of households that experienced catastrophic health expenditures because of care for hepatitis C was 70.5%. Before health payments, 3.2% of the households were already in poverty, and 1.1% were in extreme poverty. After healthcare payments, 17.9% more households were tipped into poverty and 18.9% into extreme poverty because of payment for their treatment., Conclusion: Payment for the management of hepatitis C patients is predominantly out-of-pocket, and a significant proportion of households suffer financial catastrophe because of the cost of managing HCV. Coordinated efforts by stakeholders are required to implement prepayment schemes and direct subsidies to enhance financial protection for patients managed for HCV infection., Competing Interests: The Authors declare that no competing interest exists, (Copyright © 2024 by West African Journal of Medicine.)

Introduction: Thrombospondin-1 (TSP-1) is a key protein product of activated platelets which is significantly increased in sickle cell vaso-occlusive crisis (VOC) and other inflammatory conditions. This study aims to determine TSP-1 levels and their relationship with platelet indices and inflammation., Objective: To evaluate TSP-1 levels in sickle cell anaemia (SCA) patients and assess their relationship with platelet indices and inflammation., Methods: This hospital-based cross-sectional comparative study was conducted in North Western Nigeria from July to December 2022. The study included 120 participants: 80 adults with SCA (40 in VOC) and 40 in steady state (SS)), matched with 40 healthy controls (HbAA). TSP-1 levels were measured using ELISA and haematological parameters were obtained from an automated analyzer. Analysis of variance was used to compare groups and determinants of TSP-1 variability were analyzed using multiple logistic regression. Statistical significance was at p ≤0.05., Results: The mean TSP-1 level was significantly higher in VOC patients (406.0 ± 164.6 ng/mL) compared to SS patients (312.4 ± 145.6 ng/mL) and HbAA controls (192.3 ± 121.2 ng/mL) (p < 0.001). In the SS group, TSP-1 negatively correlated with mean platelet volume (MPV; r = -0.38, p = 0.02) and platelet-large cell ratio (P-LCR; r = -0.36, p = 0.02). White blood cell count (WBC) was the only predictor of TSP-1 variability (β = 10.301, t = 3.843, p < 0.001)., Conclusion: Elevation of TSP-1 during VOC indicates its potential as a biomarker for crisis episodes. In SS patients, TSP-1 is associated with platelet indices, suggesting its role in platelet activation. WBC is a key predictor of TSP-1 variability, emphasizing the influence of inflammation., Competing Interests: The Authors declare that no competing interest exists, (Copyright © 2024 by West African Journal of Medicine.)

Introduction/background: Chronic heart failure (CHF) has important gender-specific aspects, which are worthy of note, as they influence the haemodynamic state of patients the choice of therapy, aetiology, and clinical outcomes. Women are less frequently represented in CHF studies and clinical trials than males. While some published data are conflictive, more studies tailored to this critical discourse are necessary to inform patient care and improve outcomes in patients with CHF., Objectives: The study aims to describe the rationale, design and clinical presentations, profile, and 1-year outcomes of the first 1290 CHF in the Ibadan CHF project., Materials/methods: We analyzed the differences between the genders regarding the aetiology of heart disease, comorbidities, triggers, left ventricle functional state, treatment, and all cause-mortality at 1 year., Results: A total of 1290 patients (55.8% men) were included. The men were older than the women (p<.001) and had a higher prevalence of alcohol and cigarette use, comorbidities, and worse cardiac structural abnormalities (p<.001). The are also gender differences in the pattern of aetiology of HF. HHF, DCM, and pericardial diseases are more common in men. Women have higher rates of rheumatic heart disease. Mortality rates at 6- and 12 months were higher in men., Conclusions: There is a gender difference in clinical profile and outcomes of CHF in this cohort. Males appear to have a worse clinical profile, structural cardiac abnormalities as well as worse one-year outcomes., Competing Interests: The Authors declare that no competing interest exists, (Copyright © 2024 by West African Journal of Medicine.)

In October 2023, Nigeria integrated the single-dose human papillomavirus (HPV) vaccine into its routine immunization program, aiming to protect 7.7 million girls aged 9 to 14 years. This milestone in the fight against HPV-related cancers, especially cervical cancer, faces significant challenges due to high vaccine rejection rates driven by misinformation and cultural barriers. Despite the vaccine's proven safety and efficacy, uptake remains low. This communication highlights the urgent need for a comprehensive public health education campaign to address these barriers. Proposed strategies include leveraging digital health technologies, integrating HPV education into school curricula, training community health workers, engaging religious and cultural leaders, and launching media campaigns featuring personal narratives. Implementing these evidence-based interventions is crucial for dispelling myths, misconceptions, and skepticism surrounding HPV vaccines. This will enhance acceptance and uptake, ultimately reducing cervical cancer mortality in Nigeria., (©2024 American Association for Cancer Research.)

The study aimed to compare the quality of life (QoL) in two communities with different exposures to conflict and investigate the inter-relationship between posttraumatic stress disorder (PTSD), social support, and QoL. This is a cross-sectional with 413 participants. Study instruments included the PTSD module of the Composite International Diagnostic Interview (CIDI), the World Health Organization Quality of Life BREF (WHOQoL-BREF), and the Multidimensional Scale of Perceived Social Support (MSPSS). The family domain of social support was protective of both PTSD and QoL. Except for the relationship between community's location and the physical subscale of the QoL, a hierarchical regression analysis showed that all the independent variables were significantly associated with the QoL domains. Direct exposure to crises impaired QoL more than areas indirectly exposed. PTSD and the family domain of social support play a significant role in the QoL outcome. This suggests that therapeutic intervention to improve QoL should target these key variables., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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.)

Background: In Nigeria, COVID-19 vaccines were delivered through outreach activities, as well as integrated within routine immunisation. However, evaluations of integrated approaches for novel vaccines are scarce. We aimed to understand the perceived benefits and challenges of integrating the COVID-19 vaccine within routine immunisation in Nigeria, and identify ways to strengthen this approach., Methods: We conducted 30 semi-structured interviews with community members and healthcare workers in primary healthcare facilities (PHCs) in Jigawa (n = 16) and Oyo (n = 14) states, Nigeria from 08 August to 13 September 2022. Participants were selected purposively from PHCs. We obtained information on participants' perception about routine immunisation, and perceived benefits and challenges associated with integrated COVID-19 vaccine delivery. Healthcare worker and community interviews were analysed separately following a thematic analysis approach., Results: We identified four themes that describe the community and healthcare workers' responses, perceived impact, and the health system adaptions to the challenges associated with the integrated vaccine delivery approach. Community members expressed concern that children might be given COVID-19 vaccines instead of routine immunisations, while others appreciated the integrated approach due to their trust in the efficacy of COVID-19 vaccines, government, and healthcare providers. Healthcare providers perceived the integrated approach as improving vaccination coverage and awareness but noted additional problems of increased workload, vaccine scarcity, and prolonged clinic visits. Insufficient resources were subsisting barriers to effective integration in both states, but the provider's gender was also a challenge in Jigawa state. Additionally, the use of incentives to generate demand had ambiguous effects in Jigawa state., Conclusion: Taking an integrated approach to deliver COVID-19 vaccines was acceptable by healthcare providers but community members expressed concerns. Given existing vaccination programmes have persistent challenges, it is pertinent to address these barriers to enhance effectiveness of an integrated approach., (© 2024. The Author(s).)

Background: Viral hepatitis B and C (HBV and HCV) pose significant public health concern in Nigeria, where access to healthcare and treatment affordability are limited. This study investigated sociodemographic and clinical predictors of health insurance coverage and access to care among patients with HBV and HCV in Nasarawa State, Nigeria. Methods: A cross-sectional facility-based study was conducted at two secondary hospitals in Nasarawa State, Nigeria. Participants included patients diagnosed with HBV, HCV, or both who were ≥18 years old. Data were collected using a structured questionnaire covering sociodemographic and clinical information, health insurance details, and economic impact. Binary logistic regression was used to analyze the relationship between sociodemographic/clinical factors and health insurance status. Results: Out of 303 participants, 68% had health insurance, which mostly covered hepatitis screening and vaccination. Significant predictors of health insurance coverage included being aged 36-40 years (adjusted odds ratio [aOR]: 11.01, 95% confidence interval [CI]: 2.38-50.89, p = 0.002), having post-secondary education (aOR: 25.2, 95% CI: 9.67-65.68, p < 0.001), being employed (aOR: 27.83, 95% CI: 8.85-87.58, p < 0.001), and being HIV-positive (aOR: 4.06, 95% CI: 1.55-10.61, p = 0.004). Nearly all those insured (99%) faced restrictions in insurance coverage for viral hepatitis services. Conclusions: This study reveals that while health insurance coverage is relatively high among viral hepatitis patients in Nasarawa State, significant restrictions hinder access to comprehensive services, especially for vulnerable groups like younger adults, the unemployed, and PLHIV. Key factors influencing coverage include age, education, employment, and HIV status. Expanding benefit packages to include viral hepatitis diagnosis and treatment, raising awareness about viral hepatitis as part of insurance strategy, improving access for underserved populations, and integrating hepatitis services into existing HIV programs with strong policy implementation monitoring frameworks are crucial to advancing universal health coverage and meeting the WHO's 2030 elimination goals.

Background: The undergraduate medical training programme is demanding and rigorous. This underlines the importance of a peer mentorship strategy to improve the well-being, self-determination, school connectedness, and performance of struggling medical and nursing students. This study is aimed at identifying struggling medical and nursing students using two cumulative continuous assessment test (CAT) scores, assess their subjective vitality and school engagement and evaluate the impact of the peer mentorship intervention on them., Methods: The study will adopt a mixed-methods approach and will be conducted in the medical colleges of Nnamdi Azikiwe University, Awka, Nigeria, and the University of Rwanda. Three instruments will be used: The subjective Vitality Scale (SVS), the University Student Engagement Inventory (USEI), and the academic records of the students before and after the commencement of the intervention programme. The consenting least-performing medical and nursing students identified by their low CAT scores (below 45%) in basic medical sciences will be selected for study in each institution. The outcome measures will include students' CAT scores, subjective vitality, and school engagement scores. The data will be analysed both quantitatively and qualitatively. Thematic content analysis will be adopted in the analysis of the responses generated from the focus group discussion. The mean ± standard deviation or median and interquartile range statistic will be adopted for the quantitative data., Discussion: Given the paucity of data on struggling medical and nursing students in Nigeria and Rwanda, this research was designed to help in exploring evidence-based interventions to improve and prevent poor subjective well-being of struggling students. The study is expected to fill these knowledge gaps., Trial Registration: Pan African Clinical Trial registry, PACTR202405546896613, registration date: 27 th May, 2024. This proposal has been supported by grant 1R25TW011217 from the US National Institutes of Health (NIH)/Fogarty International Center (FIC) which also includes co-funds from the U.S. Department of State's Office of the U.S. Global AIDS Coordinator and Health Diplomacy (S/GAC) and the President's Emergency Plan for AIDS Relief (PEPFAR) to the African Forum for Research and Education in Health (AFREhealth). The Grant Principal Investigators are Profs. Nelson K.Sewankambo (contact PI), Prisca Adejumo, Jean Bisimwa Nachega, Fatima Suleman., (© 2024. The Author(s).)

Background: Household-level food safety practices may have a long-term outcome on the nutrition and health status of under-five children. This study explores the relationships between caregivers' self-reported food safety knowledge, behavior, perception of food safety control, and their young child's (< 5 years) nutrition status., Methods: In a cross-sectional study design, 664 caregivers from five Local Government Areas (LGAs) in Ibadan, Nigeria were surveyed using an interviewer-administered questionnaire on their food safety knowledge, behavior and perceived food safety control. Anthropometric measurements of the household's index child (aged 6-59 months) were also taken. Variables for food safety knowledge and behavior score were selected using principal component analyses. The nutritional status of the children (Z-scores for weight-for-height (WAZ), height-for-age (HAZ), and weight-for-age (WHZ)) were calculated. Description statistics were run on all variables and logistic regression models examined associations between the three food safety constructs and the children's nutritional status. Covariates such as LGAs, caregiver's age, household size, wealth index, child's gender, and age were adjusted., Results: High-level of food safety knowledge, behavior and lots of perceived control on food safety issues were reported by 77.7%, 76.7%, and 81.1% of the caregivers. Using WAZ, HAZ and WHZ that are ≤ -2, acute malnutrition (6.0%), chronic malnutrition (42.5%), and underweight (22.0%), respectively were prevalent among the children. Perceived food safety control was the only food safety construct associated with acute malnutrition. Wealth index, caregivers' age, number of under 5 at home, child age, and gender were associated with acute malnutrition. Caregiver's age, child's age, and gender were associated with chronic malnutrition. Furthermore, caregiver's age, education and child's age were associated with a child being underweight. The significance level was at P < 0.05., Conclusion: Factors associated with food safety and children's nutritional outcomes are multi-faceted in nature. Future studies should explore access to resources and other intermediate factors that may explain the linkage between childhood malnutrition and caregivers' food safety awareness, knowledge, and behavior. Public health and food safety initiatives to bridge the gap between perceived food safety control and actual food safety behavior/practices., (© 2024. The Author(s).)

Background: Occupational injuries are a growing public health problem. Approximately 1,000 workers die daily from occupational injuries globally. Artisans working in the informal sector of the construction industry in many low/middle income countries like Nigeria have a higher injury predisposition. This study will assess the determinants of occupational injuries and design a safety intervention for informal sector artisans in the Nigerian construction industry., Methods: A sequential mixed-methods design will be employed to study 840 bricklayers and carpenters (420 per artisan group) in Osun State, Nigeria. Quantitative data will be collected first while qualitative data will be collected thereafter. Thirdly, a modified Delphi-technique will be employed to co-design a safety education intervention. For the quantitative study, artisans will be recruited via multi-stage sampling and a semi-structured questionnaire will be administered to obtain information on artisans' socio-demographics, work-patterns and occupational injuries. A multivariable regression model will be used to determine the association between injury occurrence and independent variables. Twelve to sixteen focus group discussion (FGD) sessions will be conducted for artisans to obtain group perspectives about injuries and preferred safety training topics. From the FGD and quantitative study findings, a list of items for the safety training module will be compiled for the modified-Delphi process. Thereafter, the content validation index (CVI) will be derived and items with CVI of ≥0.80 will be included in the final safety training module., Conclusion: This paper describes the process required to assess the determinants of occupational injuries among artisans in the informal sector of the construction industry in Nigeria and further proposes the design of a context-relevant safety training intervention. The information from this study will be essential in promoting safe working environments for construction artisans., 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 © 2024 Ojo, Onayade and Naicker.)

Background: The World Health Organization prioritizes Mother's Own Milk (MOM) or donor human milk (DHM) when MOM is unavailable or insufficient. It is also important for healthcare workers (HCWs) to provide adequate support, information, and education to mothers to help improve their milk production and breastfeeding experience. DHM is scarce in developing countries, prompting a need for understanding health workers' perspectives., Methods: This cross-sectional study, conducted in 2021 in Ekiti State, Nigeria, examined the knowledge and attitudes of HCWs regarding human milk banking. A sample of 321 participants from government-owned hospitals completed a self-administered questionnaire., Results: Of the 321 participants (84.7% response rate), the majority were females (69.2%), aged 30-39 (32.1%), Christian (91.9%), and employed in tertiary hospitals (91.9%). About 65% of the HCWs believe that HMB is a safe practice and 42% believe that the DHM has the same quantity of immunological factors as fresh human milk. While 80.4% displayed good DHM knowledge, attitudes varied. The HCWs profession influenced their attitudes and a higher proportion of all female HCWs (71%), except for health assistants (65.4%), expressed willingness to donate their breast milk if needed. Among males HCWs, the majority of those who were doctors (82.8%) and pharmacists (62.5%) expressed willingness to support their spouses to donate breast milk, and they also had higher acceptance of DHM for their infants. In all, more than 80% of the HCWs will encourage mothers to donate their milk and feed babies under their care with DHM, but only 47% would accept DHM to feed their own children. Health assistants had less favourable views, and negative perceptions were linked to the internet and media sources., Conclusions: The study highlights health workers' awareness of DHM but indicates a reluctance to fully embrace it, especially among health assistants. The need for targeted education programs, to address knowledge gaps and negative perceptions, is crucial for the successful implementation of human milk banks in Nigeria. Overcoming challenges, such as safety concerns and sociocultural influences, requires focused efforts from policymakers and healthcare institutions., (© 2024. The Author(s).)

Background: Short-stay thyroid surgery is still nascent in developing nations like Nigeria. With the increasing cost of healthcare, there is consistently the need to reduce healthcare delivery costs. Short-stay services in selected cases meet this goal, in addition to other benefits of short hospital stays. This study aimed to highlight the feasibility of the practice of short-stay thyroidectomy in a rural tertiary hospital in Nigeria., Methods: The study is a retrospective review of all patients who had short-stay thyroidectomy in a rural tertiary hospital in Nigeria from January 2017 to December 2021., Results: The study reviewed 73 patients admitted for thyroidectomy on a short-stay basis within the study period. There were 70 (95.9%) females and three (4.1%) males, giving a ratio of 23:1 and a mean age of 39.8 years. Sixty-eight (93.2%) patients had no complications, and the others had minor complications that did not otherwise prolong their hospitalisation. Seventy-one (97.3%) patients were discharged within 24 hours of surgery, while two (2.7%) were discharged within 48 hours. There were no readmissions, and no mortality was recorded., Conclusion: Short-stay hospitalisation for thyroid surgery is feasible and a viable alternative to the conventional 72-hour postoperative hospital stay in our setting., (Copyright© Authors.)

Background: Despite the increasing burden of breast cancer in the developing world, there is a misunderstanding of the complex and multifaceted relationship between culture and cancer, particularly breast cancer. Hence, a dichotomy of illness narratives exists due to differential meaning making concerning breast cancer. While clinicians always recommend biomedical treatment, women with breast cancer often seek alternative treatment pathways., Aims: To explore the experiences of women with breast cancer and clinicians in Nigeria on the dichotomy in the illness narratives., Methods: This qualitative study used in-depth interviews and focus group discussion to explore the experiences of 22 women with breast cancer and 7 clinicians in Nigeria on the dichotomy in the illness narratives using grounded theory method analysis., Results: This study revealed that many women living with breast cancer (WLBC) hold health beliefs that are contradictory to the biomedical norm. They mostly sought treatment based on the perceived aetiology of breast cancer. The treatment pathway follows faith and traditional healing as alternatives or sometimes in combination with biomedicine. WLBC reported a constant fear of biomedical treatment, perceived to be harmful to women's sexuality, fertility and body image. Hence, after perceived treatment failure from alternative care, biomedical care becomes the last resort, usually at an advanced stage of breast cancer, often responsible for poor prognosis., Conclusion: There is a dichotomy of illness construction between sufferers and health practitioners. To guide women with breast cancer on the path of care, modern care practitioners should consider some cultural norms and practices without compromising professional ethos., (© 2024 The Author(s). Psycho‐Oncology published by John Wiley & Sons Ltd.)

Despite the globalization of health information, collaborations between high-income countries (HICs) and low/middle-income countries (LMICs), while present, could still increase. This study builds on previous research highlighting LMIC underrepresentation in neurosurgery literature. We conducted a comprehensive bibliometric analysis using the Scopus database to investigate collaborative neurosurgical research between HIC institutions and those in low-income country (LIC)/LMICs. Articles published between 2018 and 2020 were examined. Articles were categorized into 3 groups: guidelines, conferences, and consensus statements; articles related to training and collaborations; and other articles. We categorized articles and authors by country, role, and specific subtopic. We included 238 reports from 34 neurosurgical journals for analysis. Geographic distribution indicated that India led LIC/LMIC contributions (25.21%). Among HICs, the United States had the highest contribution (47.76%). In collaborative studies, Uganda, Cameroon, Tanzania, Indonesia, and Nigeria made significant contributions. LICs and LMICs accounted for 446 authors, while HICs contributed with 592. India has presented the highest number of authors in significant positions. In HICs, significant positions are recognized in USA articles. When scoring authors' position in collaborative papers, still HICs had a clear prevalence. The highest number of collaborations between HICs and LICs/LMICs has been observed in articles related to training and collaborations. Kenya matched India's contributions in training and collaborations. Global guidelines and consensus papers can enhance patient care, but LMICs' involvement remains limited. Further attention to training and collaboration initiatives is needed. This study emphasizes the importance of promoting collaboration and training between countries with varying resources to advance neurosurgical care globally., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Congress of Neurological Surgeons.)

Nigeria has the highest reported incidence of peripartum cardiomyopathy worldwide. This open-label, pragmatic clinical trial randomized pregnant and postpartum women to usual care or artificial intelligence (AI)-guided screening to assess its impact on the diagnosis left ventricular systolic dysfunction (LVSD) in the perinatal period. The study intervention included digital stethoscope recordings with point of-care AI predictions and a 12-lead electrocardiogram with asynchronous AI predictions for LVSD. The primary end point was identification of LVSD during the study period. In the intervention arm, the primary end point was defined as the number of identified participants with LVSD as determined by a positive AI screen, confirmed by echocardiography. In the control arm, this was the number of participants with clinical recognition and documentation of LVSD on echocardiography in keeping with current standard of care. Participants in the intervention arm had a confirmatory echocardiogram at baseline for AI model validation. A total of 1,232 (616 in each arm) participants were randomized and 1,195 participants (587 intervention arm and 608 control arm) completed the baseline visit at 6 hospitals in Nigeria between August 2022 and September 2023 with follow-up through May 2024. Using the AI-enabled digital stethoscope, the primary study end point was met with detection of 24 out of 587 (4.1%) versus 12 out of 608 (2.0%) patients with LVSD (intervention versus control odds ratio 2.12, 95% CI 1.05-4.27; P = 0.032). With the 12-lead AI-electrocardiogram model, the primary end point was detected in 20 out of 587 (3.4%) versus 12 out of 608 (2.0%) patients (odds ratio 1.75, 95% CI 0.85-3.62; P = 0.125). A similar direction of effect was observed in prespecified subgroup analysis. There were no serious adverse events related to study participation. In pregnant and postpartum women, AI-guided screening using a digital stethoscope improved the diagnosis of pregnancy-related cardiomyopathy. ClinicalTrials.gov registration: NCT05438576., (© 2024. The Author(s).)

This study examined ten heavy metals in five species: Macrobrachium vollenhovenii, Penaeus monodon, P. notialis, Chloroscombrus chrysurus, and Pseudotolithus typus, from Makoko floating slum, Lagos Lagoon to discern their bioaccumulation potentials, sources of origin, and health implications. The concentrations were in this order: Fe (4.172-10.176) > Zn (1.310-5.754) > Mn (0.475-2.330) > Cu (0.238-1.735) > Pb (0.121-0.391) > Cd (0.055-0.283) > Co (0.056-0.144) > Ni (0.039-0.121) > Cr (0.022-0.095) > As (0.003-0.031) mg/kg. The MPDI denotes "low toxicity," and the BAF/BSAF revealed that benthic species had higher bioconcentration potentials. Multivariate analyses revealed that heavy metals exhibited mutual relationships during chemical transport, and their sources were both geogenic and human-induced. The HI values were below 1, and the TCR values were below the threshold of 1 × 10 -4 . This suggests that the probabilities of noncancer and carcinogenic risks in human populations due to long-term consumption of the evaluated species are unlikely., Competing Interests: Declaration of competing interest 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., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Introduction: Antenatal care (ANC) services play a crucial role in safeguarding the health of pregnant women during their reproductive years. This study aimed to evaluate the primary factors influencing the utilization of ANC among women of childbearing age in Isari town, Jigawa State., Methods: We conducted a cross-sectional study among 400 mothers of childbearing age, selecting them using a simple random sampling method. Data were collected using interviewer-administered questionnaires. The statistical analyses performed were descriptive analysis, Pearson's chi-square test, and binary logistic regression analysis., Results: The majority of respondents (92.5%) indicated awareness of ANC, with a significant proportion expressing the necessity of ANC services (85.7%). 57.8% of the respondents indicated attending ANC services at least four times during pregnancy. Furthermore, the number of visits has a significant relationship with age ( P < 0.001), educational level ( P = 0.003), occupation ( P = 0.043), mother's knowledge of pregnancy danger signs ( P = 0.001), and husband's support for ANC ( P < 0.001)., Conclusion: Enhancing ANC utilization will necessitate focusing on women residing in rural areas and those with limited educational attainment., Competing Interests: The authors declare that they do not have any conflicts of interest., (Copyright © 2024 Sabo, Alzoubi, Saidu, Usman, Saulawa, Al-Mugheed, Farghaly Abdelaliem and Saeed Alabdullah.)

Background: Sexual violence among higher education students is a global public health problem. Identifying the characteristics of students who report victimization can serve as basis for programmes that target vulnerable students., Methods: The study was conducted among 30,114 Nigerian higher education students. They were selected from 18 institutions comprising universities, polytechnics, and colleges of education. The purpose of the study was to assess the characteristics of students who reported sexual violence (rape, attempted rape and sexual harassment) and to determine the association between reporting and their characteristics., Results: Our findings showed that 37% of the students reported experiencing sexual violence. Regression analysis showed that the odds of reporting among female students were two times greater than that of the male students (CI = 1.58-1.78; P < 0.001). The students who were traditionalists (aOR = 2.65, p < 0.001) or from other religious groups (aOR = 3.28, p < 0.001) had higher odds of reporting than those who were Christians. All the age groups represented in the study had significantly higher odds of reporting except those between 25 and 29 years (aOR = 1.03; p = 0.616). Non-final year students had significantly 7% lower odds of reporting (p = 0.037) than the first-year students. The students in the arts and humanities-related programmes significantly had higher odds of reporting than those in the science-related programs (aOR = 1.08; p = 0043). In addition, polytechnic and colleges of education students were two times more likely to report sexual violence than university students (p < 0.001). Also, the students from other regions were two times more likely to report sexual violence than those from Southwest region., Conclusion: The study concluded that sexual violence reporting by higher education students differ by their types of schools, sex, religion, level of education and geographical location., (© 2024. The Author(s).)

Achromobacter xylosoxidans is one of the nitrogen-fixing bacteria associated with cowpea rhizosphere across Africa. Although its role in improving soil fertility and inducing systemic resistance in plants against pathogens has been documented, there is limited information on its complete genomic characteristics from cowpea roots. Here, we report the complete genome sequence of A. xylosoxidans strain DDA01 isolated from the topsoil of a field where cowpea plants tolerant to cucumber mosaic virus (CMV) were grown in Ibadan, Nigeria. The genome of DDA01 was sequenced via Illumina MiSeq and contained 6,930,067 nucleotides with 67.55% G + C content, 73 RNAs, 59 tRNAs, and 6421 protein-coding genes, including those associated with nitrogen fixation, phosphate solubilization, Indole3-acetic acid production, and siderophore activity. Eleven genetic clusters for secondary metabolites, including alcaligin, were identified. The potential of DDA01 as a plant growth-promoting bacteria with genetic capabilities to enhance soil fertility for resilience against CMV infection in cowpea is discussed. To our knowledge, this is the first complete genome of diazotrophic bacteria obtained from cowpea rhizosphere in sub-Saharan Africa, with potential implications for improved soil fertility, plant disease resistance, and food security., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

As people living with HIV experience increased life expectancy, there is a growing concern about the burden of comorbid non-communicable diseases, particularly hypertension. This brief describes the current policy landscape on the management of HIV and hypertension in Akwa Ibom State, Nigeria, stakeholder engagement meetings, and the resulting five policy recommendations rooted in an ongoing research study designed to integrate hypertension management into HIV care across primary health centers in the State. In order to identify the current gaps in integrated care, discussion sessions with three stakeholder groups (i.e., healthcare providers, patient advocacy groups, and policy makers) were held separately in November 2022. The discussions were purposed to brainstorm policy-level solutions for integrating hypertension into HIV treatment. After all the sessions were concluded, there were five recommendations provided by the stakeholders for integrating HIV and hypertension care in the Akwa Ibom State. Stakeholders unanimously agreed with the need to integrate hypertension care for HIV impacted communities in the State. Specifically, stakeholders recommended to: (1) engage retired community health nurses as mentors; (2) actively link communities to integrated care in clinics; (3) integrate hypertension management with HIV education; (4) expand health insurance accessibility; and (5) formally integrate hypertension management into primary healthcare centers in Akwa Ibom State., (© 2024. The Author(s).)

There have been increasing reports of Klebsiella pneumoniae resistant to β-lactam antibiotics. This study aimed to determine the prevalence of some selected carbapenemase genes among clinical isolates of Klebsiella pneumoniae recovered from patients attending a private tertiary hospital in Southwestern Nigeria. The study was conducted over two months (February-March 2024). A total of 50 clinical isolates of Klebsiella pneumoniae from different clinical specimens were obtained from the Medical Microbiology Department, Babcock University Teaching Hospital (BUTH). The clinical isolates were then characterized using standard microbiological procedures and were tested for susceptibility to meropenem and other classes of antibiotics according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Polymerase Chain Reaction (PCR) detection for OXA-48 and NDM-1 carbapenemase genes was performed on the 50 clinical isolates. PCR analysis showed that 9 (18%) clinical isolates were positive for the OXA-48 gene, 22 (44%) were positive for the NDM-1 gene, 4 (8%) possessed both the OXA-48 and NDM-1 genes, and 23 (46%) possessed neither the OXA-48 nor NDM-1 genes. Antibiotic Susceptibility Testing (AST) revealed that all the clinical isolates were resistant to meropenem. In conclusion, this study demonstrates the presence of OXA-48 and NDM-1 genes in clinical isolates of Klebsiella pneumoniae recovered from patients attending a private tertiary hospital in Southwestern Nigeria, highlighting the role of ESBL (extended-spectrum beta-lactamase) as a major resistance mechanism alongside other mechanisms. Population-based surveillance programs should be implemented to monitor the prevalence and epidemiology of Klebsiella pneumoniae infections at the community level, facilitating early detection of outbreaks and identification of emerging antimicrobial resistance patterns. CORE TIP: This study highlights the significant prevalence of NDM-1 and OXA-48 carbapenemase genes among Klebsiella pneumoniae clinical isolates in a private tertiary hospital in Southwestern Nigeria, with 44% and 18% of isolates harboring these genes, respectively. Notably, 46% of isolates were resistant to carbapenems despite lacking these genes, suggesting alternative resistance mechanisms. The findings underscore the urgent need for enhanced surveillance, infection control measures, and antibiotic stewardship programs to combat the spread of multidrug-resistant Klebsiella pneumoniae in healthcare settings., (© 2024. The Author(s).)

Introduction: Diarrhoea is a major public health concern in developing countries, usually exacerbated by poor water, sanitation and hygiene but its aetiology is under-studied, particularly away from capital cities. We identified diarrhoeagenic Escherichia coli (DEC) from stools collected in Ile-Ife and Ilesa, Osun state, Nigeria and determined their antibiotic resistance profiles., Methods: Stool samples from 167 children with diarrhoea and 334 controls under the age of 5 years were cultured for Escherichia coli and Salmonella. Bacterial isolates were identified biochemically and DEC were identified by PCR. Antimicrobial susceptibility testing was by modified Kirby-Bauer disc diffusion method in accordance with the CLSI guidelines. Data were analyzed using Chi-square and Fisher's exact tests., Result: Diarrhoea infection is significantly high among children under 12 months (p = 0.002), caregivers without at least primary school education (p = 0.006), breastfeeding for under 6 months (p˂0.001), and caregivers who were siblings (p = 0.004). DEC was detected in 69(41.3%) cases but only 86(25.7%) controls (p < 0.001) and more commonly recovered during the wet season (p < 0.001). Enterotoxigenic E. coli (p = 0.031), enteropathogenic E. coli (p = 0.031) and Shiga-toxin-producing E. coli (p = 0.044) were recovered more commonly from cases than controls. DEC from patients with diarrhoea were commonly resistant to sulphonamides (91.3%), trimethoprim (82.6%), and ampicillin (78.3%) but were largely susceptible to quinolones and carbapenems (97.1%)., Conclusion: Enteropathogenic, enterotoxigenic and Shiga toxin-producing E. coli are associated with diarrhoea in our setting, and show considerable resistance to first-line antimicrobials. Risk factors for DEC diarrhoea include infancy, inadequate breastfeeding and caregivers with education below primary school., (© 2024. The Author(s).)

Background: Breast cancer is the most prevalent cancer for women in Nigeria, representing 25% of all cancers in women. How do women self-identify with the new realities of living with breast cancer before, during and after treatment?, Aims: This study aims to examine the self-identities of 22 women with breast cancer in Nigeria., Methods: The paper relies on grounded theory research method to collect data, analyse and capture the processes of self-identity formation., Results: The qualitative data analysis reveals the basic social process within symbolic interactionism that describes how breast cancer survivors perceive their agency and how new self-identities emerged from the new normal of living with breast cancer. A framework of three self-identities emerged from the data: (1) valued self-identity before breast cancer, (2) dependent and determined self-identities during treatment and (3) devalued self-identity post-treatment., Conclusion: This study should help caregivers understand the profound perpetual psycho-emotional impact that breast cancer has on sufferers and survivors., (© 2024 The Author(s). Cancer Reports published by Wiley Periodicals LLC.)

Nigeria's neurosurgical field faces profound challenges, including a critically low neurosurgeon-to-patient ratio and significant migration of medical professionals to developed countries. High costs, low socioeconomic status, and the urban-centric location of neurosurgical centers impede access to care. Key barriers to service delivery include lack of manpower, insufficient emergency care, limited imaging modalities, inadequate operative equipment, and ineffective political and administrative policies. Neurotrauma is the primary reason for neurosurgical intervention but is poorly managed due to delayed access and insufficient guidelines. The neurosurgical education system is strained by limited training capacity and the absence of subspecializations, restricting specialized care. Research output is low, hindered by limited infrastructure, lack of databases, insufficient funding, and minimal international collaboration. To address these issues, it is critical to enhance the imaging capabilities, ensure the availability of operative equipment, and establish effective policies for task sharing and communication at different levels of care. Other approaches include expanding training capacity, particularly in rural areas, implementing a uniform match system for residency, addressing gender disparities, and utilizing dual practice to ensure adequate compensation for neurosurgeons. Furthermore, stakeholders should develop subspecialization programs in areas such as neurovascular, neuro-oncology, pediatric neurosurgery, and minimally invasive neurosurgery to expand service scope. To transform the neurosurgical research landscape, efforts should be made to establish electronic medical databases, foster international collaborations to ensure funding, and make research mandatory for accreditation renewal to ensure continuous academic contribution., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The benefit of the delivery of the right form of cancer care, tailored to the right patient, at the right time is increasingly being recognized in the global oncology community. Information on the role and feasible potential of precision oncology during the management of genitourinary cancer in Nigeria, the most populous country in Africa, is limited. This article, therefore, describes the present application of personalized medicine in Nigeria and its barriers and facilitators. It provided granular details on manpower distribution and epidemiological disparities. It also explored the use of clinical and biological markers for screening and early diagnosis, the application of team science to support genomic profiling, cost-effective approaches for image-based phenotypic precision oncology, the emerging role of molecular imaging, access to clinical trials; and their potential to support data driven diagnosis, treatment decision and care availability in order to address gaps in genitourinary cancer management in the country., Competing Interests: Declaration of competing interest 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., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The novel coronavirus has significantly impacted healthcare systems worldwide, exposing healthcare professionals (HCPs) to work-related stressors to prevent the spread of SARS-CoV-2. This study aimed to assess the occupational stress of HCPs in Lagos State, Nigeria, using a qualitative approach. The study involved nine HCPs from various departments, including doctors, nurses, and medical laboratory technicians. The main causes of stress were workload, policy changes, and extended use of personal protective gear. The study found high levels of occupational stress among HCPs, with workload being the main cause. The impact of the disease outbreak crisis on HCPs' lives and work demands was observed, with occupational demands categorized into safety risk at work and public perceptions. Employers and unions must respond to HCPs' needs for workplace protection and appropriate help to address stressors., Competing Interests: The Authors declared no conflict of interest, (African Journal of Reproductive Health © 2024.)

Background: Diabetes is a multifactorial disease state that requires adequate patient monitoring for improved health outcomes. Diabetes knowledge and attitude, and associated factors such as medication adherence, medication discrepancy, health literacy, and glycemic control were evaluated in this study. The selected factors were also compared with diabetes knowledge and attitude., Methods: A cross-sectional study was carried out among ambulatory diabetes patients in three tertiary healthcare facilities in Nigeria. An interviewer-administered semi-structured questionnaire was utilized for data collection. Data was analysed using descriptive and inferential statistics with the level of significance set at p < 0.05., Results: A total of 188 diabetes patients participated in the study; 51 (27.1%) at the Federal Medical Center, Abeokuta, 69 (36.7%) at the University College Hospital, Ibadan, and 68 (36.2%) at the University of Ilorin Teaching Hospital, Ilorin. One hundred and twelve (59.6%) female patients participated in the study and patients' average age was 58.69 ± 13.68 years. Medication discrepancy was observed among 101 (53.7%) patients. One hundred and three (54.8%), 47 (25.0%) and 38 (20.2%) had high, medium, and low medication adherence, respectively. Ninety-one (48.4%) had high health literacy. Mean diabetes knowledge score was 14.64 ± 2.55 points out of a maximum obtainable score of 18 points. Mean diabetes attitude of patients was 62.50 ± 6.86 points out of a maximum obtainable score of 70 points. Significant positive association was observed between diabetes knowledge and health literacy (Beta = 0.021, p = 0.029). Diabetes knowledge was higher in patients with higher level of formal education (p = 0.046), higher diabetes attitude (p < 0.001) and high health literacy (p = 0.002). Patients' diabetes attitude was higher in individuals older than 60 years of age (p = 0.029), and those with high health literacy (p = 0.005)., Conclusions: The diabetes patients displayed good disease knowledge, attitude and medication adherence. Average levels of health literacy and medication discrepancy was observed among the patients. Significant differences were observed between patients' diabetes knowledge and level of formal education, diabetes attitude, health literacy and age. Patients' health literacy was significantly associated with diabetes knowledge., (© 2024. The Author(s).)

Background: Evaluating health workers' knowledge and practice of adverse drug reaction (ADR) reporting is an important step in identifying gaps in quality ADR reporting during public health interventions like the seasonal malaria chemoprevention (SMC) campaign. Pharmacovigilance (PV) monitoring is vital in SMC due to the number of children exposed to malaria medicines for a period of 4 or 5 months during the campaign. In Nigeria more than 10 million children are exposed to SMC medicines every year. The scale of this intervention emphasised the need for efficient and effective safety monitoring during the campaign. Thus, the objective of this study was to evaluate healthcare workers' (HCW) awareness, knowledge, attitude and practice (KAP) of ADR reporting in health facilities participating in SMC campaign to identify pharmacovigilance gaps which may suggest possible ways to ensure safety during the campaign., Methods: World Health Organization's service availability and readiness assessment (SARA) recommendations were used to sample 2,598 out of 5,195 used as supervising health facilities (HFs) during the 2022 SMC campaign across nine states of the country. Out of the sampled HFs, 2,144 eligible and consented health facility workers (HFWs) were assessed for awareness, and KAP of ADR using the validated 45-item self-administered questionnaire. The data was analysed using descriptive statistics and correlation analysis at p < 0.05., Results: The majority of the respondents are males (n = 1,333, 62.2%). The HFWs showed good awareness (n = 2,037, 95.0%) of pharmacovigilance (PV). However, only 809 (37.7%) of them had good knowledge scores. The mean ADR reporting attitude score (85.0 ± 15.3%) was good with many of the respondents (n = 1,548, 72.2%) having a good score. However, the respondents' ADR practice was suboptimal, only 1,356 (63.2%) of them had encounters with ADR, and a lot of negative perceived barriers to ADR reporting were identified in the study. For example, 493 (23%) believed that ADRs were not reported because they were not serious and life-threatening while 248 (11.6%) reported a fear of liability. Correlation analysis revealed female gender (r = 0.163, p < 0.001), older age (r = 0.207, p < 0.001) and years of practice (r = 0.050, p = 0.021) as factors significantly associated with ADR knowledge and attitude scores., Conclusion: The study indicated that HCWs across health facilities participating in SMC campaigns have ADR reporting knowledge and practice gaps. The study suggest training alone may not be effective in addressing gaps in ADR reporting. In addition to PV training, implementers can include continuous mentoring of health care workers or other similar interventions as part of strategy to improve ADR reporting. Also, context specific strategies to improve ADR reporting among health care worker needs to be implemented to address under-reporting of ADRs during SMC campaigns and other malaria public health interventions., (© 2024. The Author(s).)

Introduction: When medically indicated, caesarean section (CS) can be a life-saving intervention for mothers and their newborns. This study assesses the prevalence of CS and its associated factors, focussing on inequalities between rural and urban areas in Nigeria., Methods: We disaggregated the Nigeria Demographic and Health Survey 2018 and performed analyses separately for Nigeria's overall, rural, and urban residences. We summarised data using frequency tabulations and identified factors associated with CS through multivariable logistic regression analysis., Results: CS prevalence was 2.7% in Nigeria (overall), 5.2% in urban and 1.2% in rural areas. The North-West region had the lowest prevalence of 0.7%, 1.5% and 0.4% for the overall, urban and rural areas, respectively. Mothers with higher education demonstrated a greater CS prevalence of 14.0% overall, 15.3% in urban and 9.7% in rural residences. Frequent internet use increased CS prevalence nationally (14.3%) and in urban (15.1%) and rural (10.1%) residences. The southern regions showed higher CS prevalence, with the South-West leading overall (7.0%) and in rural areas (3.3%), and the South-South highest in urban areas (8.5%). Across all residences, rich wealth index, maternal age ≥ 35, lower birth order, and ≥ eight antenatal (ANC) contacts increased the odds of a CS. In rural Nigeria, husbands' education, spouses' joint healthcare decisions, birth size, and unplanned pregnancy increased CS odds. In urban Nigeria, multiple births, Christianity, frequent internet use, and ease of getting permission to visit healthcare facilities were associated with higher likelihood of CS., Conclusion: CS utilisation remains low in Nigeria and varies across rural-urban, regional, and socioeconomic divides. Targeted interventions are imperative for uneducated and socioeconomically disadvantaged mothers across all regions, as well as for mothers in urban areas who adhere to Islam, traditional, or 'other' religions. Comprehensive intervention measures should prioritise educational opportunities and resources, especially for rural areas, awareness campaigns on the benefits of medically indicated CS, and engagement with community and religious leaders to promote acceptance using culturally and religiously sensitive approaches. Other practical strategies include promoting optimal ANC contacts, expanding internet access and digital literacy, especially for rural women (e.g., through community Wi-Fi programs), improving healthcare infrastructure and accessibility in regions with low CS prevalence, particularly in the North-West, and implementing socioeconomic empowerment programs, especially for women in rural areas., (© 2024. The Author(s).)

Background: Macrophomina phaseolina is a pathogen that causes an opportunistic disease that spreads by soil and seeds and affects more than 500 different plant species, like fruits, trees, and row crops. Mycotoxins, such as phaseolinic acid, and phaseolinone, are produced by M. phaseolina isolates in previous investigations; however, the production of these mycotoxins seems to vary depending on the host and the region., Methods and Results: In this study, Macrophomina phaseolina strain 3 A was isolated from rotten cassava tuber and identified using the analysis of the sequences of the internal transcribed spacer region. The isolate was inoculated on a fresh healthy cassava tuber at 25 °C and tuber-rotting potential was monitored for 4 weeks. Virulence genes MPH&#95;06603, MPH&#95;06955, and MPH&#95;01521 were determined with designed primers, and secondary metabolites were characterized by FTIR and GCMS. The rotten tuber effect was observed from the 2nd week of the experiment with severe tuber rot and weight reduction. The PCR showed the presence of MPH&#95;06603 virulence gene. The GCMS showed N-Methylpivalamide (115.0 m/z), Butane, 1,4-dimethoxy- (119.0 m/z), and 5-Hydroxymethylfurfural (126.0 m/z) were the predominant metabolites produced by the pathogen. The compounds in the metabolites inhibit CYP3A4 enzymes, cause eye irritation, and Human Ether-a-go-go-related gene inhibition., Conclusion: This study revealed that M. phaseolina was responsible for the cassava tuber rot which leads to a lower yield of farm produce. The metabolites produced are toxic and unsafe for human consumption. It is suggested that farmers should destroy any cassava affected by this pathogen to prevent its toxic effects on humans and animals., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

This study hypothesizes that depression mediates the association between exposure to stigma and medication non-adherence in people living with HIV (PLHIV). We recruited 372 PLHIV from the Stigma, health-related Quality of life, antiretroviral Adherence, and Depression among people living with HIV (SQuAD-HIV) project, a multicenter cross-sectional study conducted between October 2021 and February 2022 among PLHIV attending six ART clinics in two geopolitical regions of northern Nigeria. A structural equation modeling (SEM) framework, utilizing the full information maximum likelihood estimator, was used to elucidate the pathways linking stigma, depression, and ART medication adherence, adjusting for sociodemographic characteristics. The total number of eligible participants analyzed (353) included 32.7% male PLHIV with a mean age (SD) of 39.42 (10.14). Being female was positively associated with adherence (β, 95% CI 0.335, 0.163-0.523, p-value < 0.001) but negatively associated with stigma (β, 95% CI - 0.334, - 0.561 to - 0.142, p-value = 0.001), while urban residence was negatively associated with stigma (β, 95% CI - 0.564, - 0.804 to - 0.340, p-value < 0.001). Our analysis also indicated that a higher level of experienced stigma was associated with decreased medication adherence. This association was partially mediated by depression (indirect effect = (0.256) (- 0.541) =  - 0.139; p-value < 0.01). The proportion of the association between stigma and medication adherence explained through mediation by depression was 35.6%. These findings underscore the need for targeted interventions aimed at lowering exposure to stigma among PLHIV to improve medication adherence., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: To describe the outcomes and quality of care for women and their babies after caesarean section (CS) in Nigerian referral-level hospitals., Design: Secondary analysis of a nationwide cross-sectional study., Setting: Fifty-four referral-level hospitals., Population: All women giving birth in the participating facilities between 1 September 2019 and 31 August 2020., Methods: Data for the women were extracted, including sociodemographic data, clinical information, mode of birth, and maternal and perinatal outcomes. A conceptual hierarchical framework was employed to explore the sociodemographic and clinical factors associated with maternal and perinatal death in women who had an emergency CS., Main Outcome Measures: Overall CS rate, outcomes for women who had CS, and factors associated with maternal and perinatal mortality., Results: The overall CS rate was 33.3% (22 838/68 640). The majority of CS deliveries were emergency cases (62.8%) and 8.1% of CS deliveries had complications after delivery, which were more common after an emergency CS. There were 179 (0.8%) maternal deaths in women who had a CS and 29.6% resulted from complications of hypertensive disorders of pregnancy. The overall maternal mortality rate in women who delivered by CS was 778 per 100 000 live births, whereas the perinatal mortality at birth was 51 per 1000 live births. Factors associated with maternal mortality in women who had an emergency CS were being <20 or >35 years of age, having a lower level of education and being referred from another facility or informal setting., Conclusions: One-third of births were delivered via CS (mostly emergency), with almost one in ten women experiencing a complication after a CS. To improve outcomes, hospitals should invest in care and remove obstacles to accessible quality CS services., (© 2024 John Wiley & Sons Ltd.)

Objective: To determine the frequency, demography, aetiology and mechanisms of ocular injuries associated with childhood traumatic cataract in Nigeria., Methods: A retrospective multicentre study conducted across ten child eye health tertiary facilities in Nigeria between January 2017 and December 2021. Clinic records of all children aged 0-17 years who had been diagnosed with cataract at the various participating centres were reviewed. Information collected include: biodata, mechanism of injury; laterality, place of injury; object responsible; person responsible; duration before presentation and surgical intervention., Results: A total of 636 out of 1656 children (38.4%) had traumatic cataracts during the study period. Their mean age was 109.4 ± 45.2 months with a male-to-female ratio of 2:1. Most injuries were unilateral, two (0.3%) children had bilateral involvement. Only 78 (15.3%) children presented within 4 weeks of the injury. Closed globe injuries were responsible for the traumatic cataract in 475 (74.7%) children, while open globe injuries were more likely to present within 24 h (P < 0.001). The commonest objects of injury were cane, sticks, plant, wood and play materials. Self-inflicted injuries occurred in about 82 (13%) children while 407 (64.0%) were caused by close relatives and contacts. The location where trauma occurred was home in 375 (59.8%) and school in 107 (16.8%) children., Conclusion: This multicentre study demonstrates that more than one-third of all childhood cataracts in Nigeria are trauma-related and majority are due to closed globe injuries. Public health interventions to reduce the occurrence of ocular trauma and to encourage early presentation after trauma are advocated., (© 2023. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)