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Abstract Background The goal of Universal Health Coverage (UHC) is to ensure that everyone is able to obtain the health services they need without suffering financial hardship. UHC remains a mirage if government health expenditure is not improved. Health priority refers to general government health expenditure as a percentage of general government expenditure. It indicates the priority of the government to spend on healthcare from its domestic public resources. Our study aimed to assess health priorities in the Economic Community of West African States (ECOWAS) using the health priority index from the WHO’s Global Health Expenditure Database. Method We extracted and analysed data on health priority in the WHO’s Global Health Expenditure Database across the 15 members of the ECOWAS (Benin, Burkina Faso, Cabo Verde, Cote d'Ivoire, The Gambia, Ghana, Guinea, Guinea-Bissau, Liberia, Mali, Niger, Nigeria, Senegal, Sierra Leone, and Togo) from 2010 to 2018 to assess how these countries prioritize health. The data are presented using descriptive statistics. Results Our findings revealed that no West African country beats the cutoff of a minimum of 15% health priority index. Ghana (8.43%), Carbo Verde (8.29%), and Burkina Faso (7.60%) were the top three countries with the highest average health priority index, while Guinea (3.05%), Liberia (3.46%), and Guinea-Bissau (3.56%) had the lowest average health priority in the West African region within the period of our analysis (2010 to 2018). Conclusion Our study reiterates the need for West African governments and other relevant stakeholders to prioritize health in their political agenda towards achieving UHC.

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

Background: Delivery by caesarean section has been reported as the single most important risk factor for maternal infection. Post caesarean wound infection continues to be a source of maternal morbidity and mortality in developing countries despite the recent advances in aseptic techniques. Wound infection is not only a leading cause of prolonged hospital stay, but also a major cause of widespread aversion to caesarean delivery in developing countries. In order to control and prevent post caesarean wound infection in our environment, there was a need to evaluate the relative contribution of each aetiological factor and the microbiological pattern as these will help to ensure better management of the patient. Objectives: The study determined the incidence of and predisposing factors to wound infection in elective versus emergency caesarean sections, and the associated micro-organisms. Design: This was a prospective comparative cohort study Setting: The study was carried out at the ward 4 obsterics, ward 4 extension and Microbiology department of the Federal Medical Centre, Owerri between February and April 2015. Methodology: A total of 276 patients who underwent caesarean sections (138 elective and 138 emergency) and who met the inclusion criteria were recruited longitudinally for the study. Swabs taken from infected wounds were subjected to gram staining and culture and results were analysed using the computer Software Package for Social Sciences (SPSS) version 20. Results: The outcome of the study showed that the incidence of post caesarean section wound infection in elective and emergency caesarean section was 9.4% and 17.4% respectively, giving an overall incidence of 13.4%. Additionally, only 3 risk factors out of the seventeen (17) risk factors studied were found to be independent variables for post caesarean wound infection. Conclusion: The study showed conclusively that prolonged rupture of membranes, post-operative anaemia and a midline sub-umbilical incision were independent risk factors contributing directly to a higher incidence of post-caesarean wound infection with Staphylococcus aureus being the single most common organism implicated.

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

Background: Booking in pregnancy has been found to significantly influence the maternal and perinatal outcome of pregnancy. Unbooked pregnancies contribute to adverse maternal and perinatal outcomes. Some paturients in Owerri, South eastern Nigeria and environs have the erroneous idea that booking was not important for safe motherhood. Objectives: The study was to determine the maternal and perinatal outcomes of unbooked versus booked pregnancies.The maternal outcomes examined included normal deliveries, instrumental vaginal deliveries, caesarean sections and maternal mortality. The perinatal outcomes included an evaluation of Apgar scores and perinatal mortality. Design: It was a retrospective comparative study Setting: The study was carried out at the Federal Medical Center,Owerri South-eastern Nigeria between January, 2010 and December, 2011. Methodology: The labour ward records of all deliveries in the Centre between January 2010 and December 2011were examined and data collected from the theatre and Special care baby unit to determine the maternal and perinatal outcomes. Paturients who registered their pregnancies and received antenatal care in the Centre were termed booked, while those seen in labour for the first time irrespective of whether they registered elsewhere or not, were termed unbooked. Data was analysed using standard electronic calculators. Results: There were a total of Six thousand, six hundred and seventy five (6675) deliveries within the period under review with a total of 680 unbooked pregnancies giving an overall incidence of 10.2%. The incidence was10.12% for 2010 and 10.24% for 2011respectively. In all the indices used to assess maternal and perinatal outcome, there was a more favourable outcome in the booked parturients compared to those who were unbooked. Conclusion: The study goes on to re- emphasize the contribution of the unbooked mother to bad obstetric indices. The unbooked mother increases the risk of operative deliveries, maternal mortality, birth asphyxia and perinatal mortality.

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

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

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

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

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

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

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

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

Objective: To investigate the prevalence of life-threatening complications related to pregnancies with abortive outcome and the associated health service events and performance in Nigerian public tertiary hospitals., Design: Secondary analysis of a nationwide cross-sectional study., Setting: Forty-two tertiary hospitals., Population: Women admitted for pregnancy-related complications., Methods: All cases of severe maternal outcomes (SMO: maternal near-miss or death) due to abortive pregnancy complications (defined as spontaneous or induced abortion, and ectopic pregnancy) were prospectively identified over 1 year using uniform identification criteria., Main Outcome Measures: Prevalence of SMO, mortality index (% maternal death/SMO), case fatality rate, time until death after admission, and health service performance., Results: Of 5779 women admitted with abortive pregnancy complications, 444 (7.9%) experienced an SMO: 366 maternal near-misses and 78 maternal deaths. Intra-hospital maternal mortality ratio from complicated abortive pregnancy outcome was 85/100 000 live births. Case fatality rate was worst for abortion-related infections (19.1%). A quarter of maternal deaths occurred on the same day of admission; however, the peak time of occurrence of death was 3-7 days of admission. Women experiencing cardiovascular, renal or coagulation organ dysfunction were less likely to survive. Higher level of maternal education and closer residence to a health facility improved chance of maternal survival., Conclusions: Abortive outcome remains a major contributor to SMO in Nigeria. Although early hospital presentation by women is critical to surviving abortive pregnancy complications, improved, appropriate, and timely management is essential to enhance maternal survival., Tweetable Abstract: 78 maternal deaths and 366 near-misses occurred from abortions and ectopic pregnancies in 42 Nigerian referral hospitals in 1 year., (© 2019 World Health Organization; licensed by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.)

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