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ABSTRACT In sub-Saharan Africa (SSA),cognitive screening is complicated by both cultural and educational factors, and the existing normative values may not be applicable. The Identification of Dementia in Elderly Africans (IDEA) cognitive screen is a low-literacy measure with good diagnostic accuracy for dementia. Objective: The aim of this study is to report normative values for IDEA and other simple measures [i.e., categorical verbal fluency, the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) 10-word list] in representative community-dwelling older adults in SSA. Methods: Individuals aged ≥60 years resident in 12 representative villages in Kilimanjaro, Tanzania and individuals aged ≥65 years resident within three communities in Akinyele Local Government Area, Oyo State, Nigeria underwent cognitive screening. The normative data were generated by the categories of age, sex, and education. Results: A total of 3,011 people in Tanzania (i.e., 57.3% females and 26.4% uneducated) and 1,117 in Nigeria (i.e., 60.3% females and 64.5% uneducated) were screened. Individuals with higher age, lower education, and female gender obtained lower scores. The 50th decile values for IDEA were 13 (60–64 years) vs. 8/9 (above 85 years), 10–11 uneducated vs. 13 primary educated, and 11/12 in females vs. 13 in males. The normative values for 10-word list delayed recall and categorical verbal fluency varied with education [i.e., delayed recall mean 2.8 [standard deviation (SD) 1.7] uneducated vs. 4.2 (SD 1.2) secondary educated; verbal fluency mean 9.2 (SD 4.8) uneducated vs. 12.2 (SD 4.3) secondary educated], substantially lower than published high-income country values. Conclusions: The cut-off values for commonly used cognitive screening items should be adjusted to suit local normative values, particularly where there are lower levels of education.

Background Tobacco use is an unambiguous health threat but the discourse on its effects and use predictors is more often focused on physical rather than psychological factors. The authors of this paper previously examined associations between domestic violence and tobacco use in women. In line with the MPOWER focus of monitoring tobacco use and predictors, we re-evaluate these relationships in the latest DHS survey of women in Nigeria. Methods Data from the 2013 DHS survey in Nigeria was analysed. The dataset examined tobacco use in a nationally representative sample of 38,740 women and violence experience in a subset of 27,634 women aged 15 - 49 years. Logistic regression models were fitted to derive adjusted odds of association between tobacco use and violence experience or perpetration in various domains, controlling for the effect of geographic location and womens' education. Results The prevalence of tobacco use among women was 0.4% (95% CI 0.3-0.6), a 55% reduction from 2008 values. 0.2% smoked cigarettes, 0.1% used snuff or chewing tobacco respectively. Tobacco use showed a consistent association with experience of severe physical violence in both the 2008 and 2013 surveys with a 60% increase in tobacco users violence odds. Experiencing sexual violence and perpetrating physical violence were not associated with tobacco use in 2013 counter to findings in 2008. Similarly experiencing emotional violence was a predictor of tobacco use in 2013 a change from 2008 findings Violence domains Adjusted odds (95% CI) 2008 Adjusted odds (95% CI) 2013 Experiencing severe physical violence 2.9 (2.2 - 3.9) 3.5 (1.8 - 7.2) Experiencing sexual violence 2.9 (2.0 - 4.1) 1.5 (0.3 - 4.4) Experiencing emotional violence 1.1 (0.5 - 2.1) 1.9 (1.1 - 3.3) Perpetrating physical violence 2.2 (1.3 - 3.8) 1.2 (0.3 - 4.3) [Table 1: Logistic odds of violence and tobacco use] Conclusions Despite the absolute reduction in tobacco use prevalence in this report, tobacco use and violence maintain a worrying co-occurrence in Nigerian women. Tobacco control efforts must identify vulnerable sub populations like women in domestic violence situations as priority for intervention. National programmes should explore opportunities for synergy between tobacco control and violence prevention programmes for women.

Background In recent times, the production of tobacco leaves has shifted from high-income countries to developing countries, especially those in Africa. In these countries, the governments support tobacco farming as a method of poverty alleviation. In addition, the Tobacco Industry (TI) actively promotes the alleged benefits of tobacco farming to the farmers and country, and these supposed benefits have been used to obstruct tobacco control policies. There is limited data regarding effects of tobacco farming from the view point of the growers themselves. This study set out to document the experience of tobacco farmers regarding the processes and profit gained through tobacco farming. Methods A cross sectional study using qualitative method of enquiry was carried out. Two agrarian communities with huge acreage ownership by the British American Tobacco Company Nigeria for tobacco farming were purposively selected for the study. Key informant interviews were conducted among the farmers and data obtained were transcribed and analysed though thematic analysis. Results Findings from the study show that although the tobacco farmers received support from the Industry to grow tobacco, they were often forced to sell their products with minimal margins of profit to the tobacco companies since it cannot be sold on open markets in Nigeria. Furthermore, there is a market monopoly as only one company buys the produce further reducing their bargaining power. Furthermore, the labour intensive nature of the tobacco farming process necessitates recruitment and of their children and other family members leading to hazardous exposure. Conclusions This study provides evidence which refutes claim by the Tobacco Industry about promises of prosperity to all involved in tobacco cultivation. Interactions with the farmers, did not indicate that tobacco farmers were wealthier than the non-tobacco farmers. This information will assist the drive for tobacco control policies.