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Background: Bone fractures remain a significant global public health issue despite preventive measures, leading to substantial health and economic consequences. Effective treatment options are difficult to access in most sub-Saharan African countries, leading to reliance on unqualified practitioners and resulting in serious complications that worsen poverty. In Nigeria, the main challenge is the need for out-of-pocket payment for healthcare, which is the primary method of health financing. However, anecdotal evidence suggests that some patients find it easier to finance their fracture care than others. This study aimed to identify the factors that predict difficult fracture-care financing among patients treated operatively for long-bone fractures (LBFs) in southwestern Nigeria. Methods: The study collected socio-demographic and clinical data on 690 consecutive adult patients with LBFs treated with SIGN nails between July 2014 and June 2024 at a mission teaching hospital in southwestern Nigeria. A literature review and preliminary interviews were conducted with patients, caregivers, and hospital staff to understand potential risk factors for difficult fracture-care financing. The patients were divided into two cohorts – easy fracture-care financing (EF) and difficult fracture-care financing (DF) – based on their promptness in paying the in-patient care bills. Potential risk factors for DF identified in the initial univariate analysis were entered as covariates into a binary logistic regression to determine the significant predictors of DF. Results: The mean age of the patients was 45.1 years (SD = 17.52). The DF cohort comprised 321 (46.5%) patients. Significant predictors of DF included younger age (p = 0.018), male gender (p = 0.002), lack of formal education or low level of education (p < 0.001), residence in the hospital city (p < 0.001), absence of health insurance (p = 0.013), lack of extended family support (p < 0.001), previous traditional bone setting treatment (p = 0.005), concomitant injury (p = 0.017), and a post-operative hospital stay longer than one week (p = 0.036). Conclusions: The findings suggest that improving people's socioeconomic status through job creation, women's empowerment, reduction of gender inequality, higher education, comprehensive health insurance coverage, and stronger family bonds, as well as preventive strategies to reduce the occurrence and severity of injuries, can improve fracture-care financing in low-resource settings. [ABSTRACT FROM AUTHOR]

Background: In 2022, the U.S. Centers for Disease Control and Prevention collaborated with implementing partners, African Field Epidemiology Network and Sydani Group, to support COVID-19 vaccination efforts in Nigeria. To characterize the costs of COVID-19 vaccination, this study evaluated financial costs per dose for activities implemented to support the intensification campaign for COVID-19 vaccination. Methods: This retrospective evaluation collected secondary data from existing expenditure and programmatic records on resource utilization to roll out COVID-19 vaccination during 2022. The study included incremental financial costs of the activities implemented to support an intensification campaign for COVID-19 vaccination across nine states and six administrative levels in Nigeria from the perspective of the external donor (U.S. Government). Costs for vaccines and injection supplies, transport of vaccines, and any economic costs, including government in-kind contributions, were not included. All costs were converted from Nigerian Naira to 2022 U.S. Dollars (US$). Results: The estimated financial delivery cost of the COVID-19 vaccination intensification campaign was US$0.84 per dose (total expenditure of US$6.29 million to administer 7,461,971 doses). Most of the financial resources were used for fieldwork activities (86%), followed by monitoring and supervision activities (8%), coordination activities (5%), and training-related activities (1%). Labor (58%) and travel (37%) were the resource inputs that accounted for the majority of the cost, while shares of other resource inputs were marginal (1% for each). Most labor costs (79%) were spent on payments for mass vaccination campaign teams, including pay-for-performance incentives. By administrative level, the largest share of costs (46%) was for pay-for-performance incentives at the community, health facility, or campus levels combined, followed by local government area level (24%), community level only (15%), state level (9%), national level (3%), campus level only (1%), and health facility level only (< 1%). Conclusions: Findings from the evaluation can help to inform resources needed for vaccination activities to respond to future outbreaks and pandemics in resource-limited settings, particularly to reach new target populations not regularly included in routine childhood immunization delivery. [ABSTRACT FROM AUTHOR]

Background: The significant burden and adverse outcomes of Trichomonas vaginalis infection during pregnancy highlight the urgent need to understand the factors contributing to its widespread occurrence. Our study determined the prevalence of T. vaginalis infection among parturients using the novel Trichomonas rapid test, and then assessed associated factors among parturients in Lagos, Nigeria. Methods: This multicenter descriptive cross-sectional study enrolled n = 188 parturients in the labor ward of three hospitals in Lagos, Southwest Nigeria, from April 2021 to December 2021. We identified factors significantly associated with T. vaginalis infection using the multivariable binary logistic regression model with a backward stepwise selection approach. Results: The study revealed a 7.4% (95% confidence interval: 4.1–12.2) prevalence of T. vaginalis infection. The only factor independently associated with T. vaginalis infection was a history of term or preterm prelabor rupture of membranes (PROM) in the index pregnancy (adjusted odds ratio = 11.38, 95% confidence interval: 2.15–60.17). Conclusion: One in 13 parturient women in our study had T. vaginalis infection, with a notable association with preterm or term PROM. Our findings, however, underscore the need for further research with a larger sample size to understand the causal pathways and broader risk factors associated with T. vaginalis infection, informing more effective public health strategies. [ABSTRACT FROM AUTHOR]

Background: Women living with HIV (WLWH) in low- middle-income countries (LMICs) face increased mortality risks from comorbidities despite progress in antiretroviral therapy. Palliative care (PC) is vital for these patients, yet its integration in LMICs, such as Nigeria, is suboptimal due to unique challenges. Objective: This study investigated the knowledge, perceived barriers, and facilitators influencing PC integration into routine HIV care within healthcare (HC) settings. Methodology: A cross-sectional survey was conducted among WLWH in twelve HC facilities throughout Nigeria. Data collection involved surveys focused on PC knowledge, attitudes, facilitators, and barriers. Logistic regression analyses were employed to examine the data. Results: This study revealed significant gaps in knowledge and attitudes towards PC among HIV + women at NISA-MIRCs. Over 90% were unaware of PC services, but many saw its potential to offer hope (55%) and improve quality of life (56.5%). The key predictors of PC knowledge included education, occupation, religion, having fewer children, urban residence, type of residence, and having a high income (p <.05). Despite the willingness to access PC, barriers such as negative HC worker attitudes, perceived high cost, and limited decision autonomy could hinder integration. Facilitators included low-cost services, positive HCW attitudes, physician recommendations, and perceived necessity for personal well-being. Conclusion: Knowledge gaps, diverse attitudes, and significant barriers highlight the need for targeted PC interventions for WLWH. Tailoring educational programs, addressing cost barriers, and improving healthcare infrastructure are crucial to enhancing PC accessibility and quality. These findings can guide policymakers and HC practitioners toward more effective and inclusive care strategies. [ABSTRACT FROM AUTHOR]

Background: Dyslexia, a neurodevelopmental disorder affecting reading skills, poses significant challenges to children's academic performance and quality of life. Despite its rising prevalence and adverse effects, understanding of its relationship with vision anomalies remains limited, particularly in low-resource settings like Nigeria. This study aims to assess the prevalence of binocular vision anomalies (BVAs) among children with and without dyslexia in Kano, Nigeria. Methods: This is a hospital-based, cross-sectional, matched-paired, controlled study conducted at the Aminu Kano Teaching Hospital (AKTH) Eye Clinic in Northern Nigeria. The study included school children who visited the AKTH Eye Clinic from January 2018 to December 2022. Visual acuity tests, external eye examinations and accommodative, binocular vision and oculomotor skills tests were conducted. Descriptive statistics, independent t-tests, Mann–Whitney U tests and Fisher's exact tests were conducted, with a significance level set at p < 0.05. Results: Forty-four children aged 12 ± 2 years participated. Children with dyslexia reported higher rates of visual symptoms than those without dyslexia, Blurring vision, visual distortion and eye strain were the most prevalent (p < 0.05) BV symptoms. Accommodative insufficiency), was the most common visual abnormality, and was significantly higher in children with dyslexia than those without dyslexia (45.5% vs. 18.2%). However, other visual anomalies showed no significant difference between groups. There was a high prevalence of binocular vision anomalies in both groups. Binocular test findings showed dyslexic children had significantly lower distance positive fusional vergence recovery values (p = 0.005). All cases of convergence insufficiency alone were found in the non-dyslexic group. Conclusions: The study found that children with dyslexia residing in Northern Nigeria demonstrated higher rates of visual symptoms, more accommodative insufficiency and lower distance positive fusional vergence recovery values compared to their non-dyslexic counterparts. [ABSTRACT FROM AUTHOR]

Background: Sub-Saharan Africa bears the highest burden of sickle cell disease (SCD) globally with Nigeria, Democratic Republic of Congo, Tanzania, Uganda being the most affected countries. Uganda reports approximately 20,000 SCD births annually, constituting 6.67% of reported global SCD births. Despite this, there is a paucity of comprehensive data on SCD from the African continent. SCD registries offer a promising avenue for conducting prospective studies, elucidating disease severity patterns, and evaluating the intricate interplay of social, environmental, and genetic factors. This paper describes the establishment of the Sickle Pan Africa Research Consortium (SPARCo) Uganda registry, encompassing its design, development, data collection, and key insights learned, aligning with collaborative efforts in Nigeria, Tanzania, and Ghana SPARCo registries. Methods: The registry was created using pre-existing case report forms harmonized from the SPARCo data dictionary and ontology to fit Uganda clinical needs. The case report forms were developed with SCD data elements of interest including demographics, consent, baseline, clinical, laboratory and others. That data was then parsed into a customized REDCap database, configured to suit the optimized ontologies and support retrieval aggregations and analyses. Patients were enrolled from one national referral and three regional referral hospitals in Uganda. Results: A nationwide electronic patient-consented registry for SCD was established from four regional hospitals. A total of 5,655 patients were enrolled from Mulago National Referral Hospital (58%), Jinja Regional Referral (14.4%), Mbale Regional Referral (16.9%), and Lira Regional Referral (10.7%) hospitals between June 2022 and October 2023. Conclusion: Uganda has been able to develop a SCD registry consistent with data from Tanzania, Nigeria and Ghana. Our findings demonstrate that it's feasible to develop longitudinal SCD registries in sub-Saharan Africa. These registries will be crucial for facilitating a range of studies, including the analysis of SCD clinical phenotypes and patient outcomes, newborn screening, and evaluation of hydroxyurea use, among others. This initiative underscores the potential for developing comprehensive disease registries in resource-limited settings, fostering collaborative, data-driven research efforts aimed at addressing the multifaceted challenges of SCD in Africa. [ABSTRACT FROM AUTHOR]

Background: Despite the availability of effective vaccines, human papillomavirus (HPV) vaccine uptake remains low in most resource-limited settings including Nigeria. Mobile health technology (mHealth) has the potential to empower patients to manage their health, reduce health disparities, and enhance the uptake of HPV vaccination. Aim: The "mHealth-HPVac" study will assess the effects of mHealth using short text messages on the uptake of HPV vaccination among mothers of unvaccinated girls aged 9–14 years and also determine the factors influencing the uptake of HPV vaccination among these mothers. Methods: This protocol highlights a randomised controlled trial involving women aged 25–65 years who will be enrolled on attendance for routine care at the General Outpatient clinics of Lagos University Teaching Hospital, Lagos, Nigeria between July and December 2024. At baseline, n = 123 women will be randomised to either a short text message or usual care (control) arm. The primary outcome is vaccination of the participant's school-age girl(s) at any time during the 6 months of follow-up. The associations between any two groups of continuous variables will be assessed using the independent sample t-test for normally distributed data, or the Mann-Whitney U test for skewed data. For two groups of categorical variables, the Chi-square (X2) test or Fisher's exact test will be used, as appropriate. Using the multivariable binary logistic regression model, we will examine the effects of all relevant sociodemographic and clinical variables on HPV vaccination uptake among mothers of unvaccinated but vaccine-eligible school-age girls. Statistical significance will be reported as P < 0.05. Discussion: The mHealth-Cervix study will evaluate the impact of mobile technologies on HPV vaccination uptake among mothers of unvaccinated but vaccine-eligible school-age girls in Lagos, Nigeria as a way of contributing to the reduction in the wide disparities in cervical cancer incidence through primary prevention facilitated using health promotion to improve HPV vaccination uptake. Registration: PACTR202406727470443 (6th June 2024). [ABSTRACT FROM AUTHOR]

The provision of specialized spine care in Nigeria presents a pressing challenge amid limited resources and geographical disparities. This correspondence offers a comprehensive roadmap for improving spine surgery and care within the country. We examine the current state of spinal health infrastructure, highlighting barriers such as limited access to specialists and facilities, particularly in rural areas, and financial constraints for patients. Innovations in spinal treatment, including the adoption of minimally invasive techniques and advancements in surgical modalities, are discussed alongside persistent challenges such as disparities in access and equipment costs. Training and education of spine surgeons emerge as critical areas requiring attention, with a shortage of qualified professionals exacerbated by inadequate training programs and resource constraints. We advocate for fostering local and international collaborations to address these gaps, emphasizing the role of partnerships in capacity building and knowledge exchange. Additionally, we explore the potential of public-private partnerships and investments to enhance the Nigerian spine healthcare system, calling for strategic initiatives to modernize infrastructure and improve accessibility. Finally, we propose a strategic blueprint encompassing infrastructure enhancement, training programs, research initiatives, policy advocacy, and public awareness campaigns. Through concerted efforts from local stakeholders and international partners, we envision a future where spine care in Nigeria is comprehensive, accessible, and of high quality, leading to improved health outcomes and a higher quality of life for those affected by spinal conditions. [ABSTRACT FROM AUTHOR]

Background: A major challenge of either endoscopic or percutaneous approach to placing palliative biliary stents is the difficulty in traversing tight perihilar malignant obstructions. This can be overcome with a rendezvous approach (combined endoscopic retrograde cholangiopancreatography (ERCP)/percutaneous approach) or may require initial placement of an external drain and reattempting later. Interventional radiology for biliary obstruction is still in infant days in our locality. Herein, we describe two cases of perihilar malignant biliary obstruction (MBO) managed at a private facility in Lagos, Nigeria, in which we had to come up with a creative approach to crossing these tight junctions in the absence of ERCP facilities. This was done by securing percutaneous retrograde access into the common bile duct and combining it with the initially unsuccessful anterograde approach. In both cases, this combined percutaneous anterograde/retrograde approach resulted in successful traversal of the malignant obstruction and placement of internal biliary stents. Case presentation: We present the case of two elderly patients with tight malignant biliary obstruction (MBO), one from a suspected cholangiocarcinoma and the other from hepatic metastatic colorectal carcinoma. Both patients had successful traversal of the obstruction via a combined percutaneous anterograde/retrograde approach and biliary stenting. Conclusions: Our case reports demonstrate an unusual approach that should assist interventional radiologists in resource-limited setting who seek for a viable option to those presently available for traversing perihilar MBOs in the percutaneous placement of internal stents. [ABSTRACT FROM AUTHOR]

Purpose: To underline the feasibility of achieving early weight bearing in patients with distal end-segment femur fractures (AO/OTA 33) treated with retrograde intramedullary nailing and supplemental plate or lag screws in the absence of C-arm. Methods: 41 distal end-segment femur fractures (DFFs) included in the study were treated with SIGN nails with or without a side plate in a center that lacked intraoperative fluoroscopy and fracture table. A medial or lateral para-patellar incision was used for fracture reduction, nail insertion and side plate placement. Follow-ups were done at six weeks, 12 weeks, and six months post-operatively. Results: Distal end-segment fractures constituted 13.2% of all femur fractures treated. The patients' mean age and range were 49.6 and 23–83 years respectively. They were mostly injured in road traffic accidents. 27 were daily-income earners. By the 12th week post-operatively, 82.1% of them could flex their knee beyond 90°, all of them could bear weight fully, and 71.8% could squat & smile. Conclusion: The study highlighted the procedure for retrograde nailing of DFFs in a setting without the requisite facilities for minimally-invasive surgeries. The findings demonstrated the feasibility of achieving an expedited weight bearing for the predominantly daily-income-earning victims to ensure early return to work and poverty reduction. While the small sample size is a limitation, the study does provide information that could serve as a basis for future randomized controlled trials in low-resource settings. [ABSTRACT FROM AUTHOR]

Introduction:Telemedicine practice experiences during the COVID-19 pandemic have not been well documented in resource-constrained settings, such as Nigeria. We set out to assess knowledge, attitude, and factors associated with telemedicine practice during the COVID-19 lockdown, as well as physician experiences in Kano, Nigeria. Methods:We employed a mixed-methods approach, utilizing structured questionnaires administered to 246 physicians, followed by in-depth interviews with a purposive subsample of 20 individuals. The data were analyzed using logistic regression and the framework approach. Results:Overall, 65.0% of the respondents demonstrated moderate to good knowledge of telemedicine. Before COVID, only 47.6% (n = 117) reported practicing telemedicine, compared with 77.2% (n = 190) during the COVID lockdown (p < 0.05). Factors associated with telemedicine practice included having at least 5 years of work experience, working in pediatrics, undergoing senior residency training, receiving formal telemedicine training, possessing good knowledge of telemedicine, and having a positive attitude toward it. The odds of engaging in telemedicine practice were four times higher (adjusted odds ratio = 4.10, 95% confidence interval: 1.79–9.40) for those who practiced it before the pandemic. Challenges identified included knowledge and skill gaps, slow internet connectivity, unstable electricity, and inadequate equipment. Conclusion:To enhance telemedicine practice in resource-limited settings, it is important to focus on strengthening information and communication infrastructure, providing comprehensive clinician training, implementing careful patient selection processes, and improving practice guidelines. [ABSTRACT FROM AUTHOR]

In resource-limited settings, the standard of care prescribed in developed countries for either operative or nonoperative management of traumatic intracranial hematomas (TICHs) frequently has to be adapted to the economic and infrastructural realities. This study aims to present the outcome of selected cases of TICHs managed nonoperatively without routine intensive care unit admission, repeated cranial computed tomography (CT) scan or intracranial pressure monitoring at a rural neurosurgical service in a developing country. This was a retrospective analysis of a cohort of our patients with cranial CT-confirmed TICHs selected for nonoperative treatment from our prospective head injury (HI) register over a 42-month period. There were 67 patients (51 males) in this study with a mean age of 38.6 (standard deviation, 17.6) years, having mild HI in >half, (55.2%, 37/67) and anisocoria in 22.4% (15/67). Road traffic accident was the most common (50/67, 74.7%) trauma etiology. Isolated acute-subdural hematoma, intracerebral hemorrhage, and epidural hematoma occurred in 29.9%, 25.4%, and 22.4% of the patients respectively. Only 2 of 8 patients in whom intensive care unit admission was deemed necessary could afford admission. Repeat cranial CT scan was requested in 8 patients (8/67, 11.9%); only 5 of these could afford the investigation. The outcome of care was good in 82.1% patients (55/67). Increasing severity of the HI (P < 0.01) and presence of pupillary abnormality (P = 0.03) were significant predictors of poor outcome. In a Nigerian rural neurosurgery practice, nonoperative management of a well-selected cohort of TICHs was attended by acceptable level of favorable outcome. [ABSTRACT FROM AUTHOR]

Background: High HIV prevalence, and lack of organized screening for the indigent population receiving care and treatment within HIV clinics in low-resource settings increases cervical cancer incidence. We sought to determine predictors of cervical precancer in women living with HIV and receiving cervical cancer screening in Jos, Nigeria. Methods: A cross-sectional study of women living with HIV and receiving care and treatment in adult HIV/AIDS clinics in Jos-Metropolis, Nigeria between June 2020 and April 2023. Ethical approvals were obtained from the ethics committee in Jos, Nigeria and Northwestern University IRB, USA. Informed consent was obtained from eligible participants, and data on socio-demographics, cancer risk factors, and cytology reports were collected. The outcome variables were cervical precancer lesions. The independent variables were prior Pap smear status, socio-demographics, income, educational, and other reproductive health factors. Descriptive statistics was done to obtain means ± sd, frequencies, and percentages for the variables. Univariate and bivariate analyses were done to determine predictors of cervical dysplasia. Analyses were performed using R software. Results: Of 957 women screened, 570 were living with HIV and 566 women had cytology report and were included in the final analysis. The mean age was 45.08 ± 8.89 years and 81.6% had no prior evidence of Pap test (under-screened). Prevalence of cervical dysplasia was 24% (mild and severe dysplasia were 12.9% and 11.1%, respectively). Age above 45 years (aOR = 3.48, p = 0.009), postmenopausal status (aOR = 7.69, p = 0.000), and women with no history of prior IUCD use (aOR = 5.94, p = 0.0001), were predictors for severe dysplasia. Women who had history of STI (aOR = 0.17, p = 0.000), prior use of IUCD (aOR = 0.32, p = 0.004), prior use of condom (aOR = 2.50, p = 0.003) and had co-morbidities (aOR = 0.46, p = 0.009) were more likely to have had a Pap test in the past. Conclusions: The majority of indigent women receiving care at HIV clinics had their first Pap test screening, and lack of organized screening among older and post-menopausal women with HIV, puts women at a higher risk of developing severe cervical precancer lesions. [ABSTRACT FROM AUTHOR]

Background: Psychosocial factors such as pain catastrophising (PC), kinesiophobia, and pain self-efficacy (PSE) complicate disease burden among people with chronic pain and disability. Purpose: To investigate the psychosocial correlates of neck pain intensity and disability among Nigerians with non-specific neck pain (NSNP). Methods: We conducted a cross-sectional study of Nigerians with NSNP through hospitals-based consecutive sampling. Numeric Pain Rating Scale and the Neck Disability Index questionnaire were used to assess participants' pain intensity (PI) and neck disability (ND), respectively. Kinesiophobia, PC, and PSE were assessed using Tampa Scale for Kinesiophobia (TSK), Pain Catastrophising Scale, and Pain Self-efficacy Questionnaire, respectively. Data analyses were completed using descriptive statistics, independent samples t-test, Pearson's correlation coefficient, and multiple linear regression at p0.05. Results: Participants were (24 males, 48 females) aged 51.56 ± 14.31 years. The average PI (5.28 ± 1.80) and ND (35.03 ± 17.85) were moderate. There were significant correlations between PC and PI (r=0.350, p=0.003), and ND (r=0.339, p=0.004); kinesiophobia and ND (r=0.314, p=0.007); and PSE and ND (r 0.561, p<0.001). Multiple linear regression analysis showed that PC (b=0.270, p=0.026) and ND (b=0.494, p=0.001) significantly predicts PI, while age (b=0.197, p=0.038), PI (b=0.344, p=0.001), and PSE (b=0.474, p<0.001) predicts ND. There were no statistically significant gender differences in PC, kinesiophobia and PSE. Conclusion: Non-specific neck pain and ND correlates with psychosocial factors such as PC and PSE, respectively. There were no gendered differences in psychosocial responses to NSNP, however, older individuals tend to have more severe ND. Assessment of age and psychosocial factors should be included in management of NSNP. [ABSTRACT FROM AUTHOR]

We investigated the knowledge of COVID-19 pathogenesis and prevention, attitude, and adherence to safe clinical practices among radiographers during the pandemic and made some informed policy recommendations. The study was an online cross-sectional survey. The questionnaire captured data on respondents' demographics, knowledge of COVID-19, attitudes, practices, and standard precaution adherence during the pandemic. Data were analysed using descriptive statistics, Pearson's correlation and one-way ANOVA tests. Of the 255 respondents, 17.3% were actively involved in the management of COVID-19 cases. Participants had high scores regarding their knowledge of COVID-19 pathology (82.46 ± 8.67%), prevention (93.43 ± 7.11%) and attitude (74.11 ± 11.61%), but low compliance to safety precautions (56.08 ± 18.56%). Knowledge about COVID-19 prevention strategies differed significantly across educational qualifications, F(3, 251) = 4.62, p =.004. Similarly, levels of compliance with safety precautions differed across educational qualification (F[3, 251] = 4.53, p =.004) and years-in-practice (F[4, 250] = 4.17, p =.003). Participants' adherence to standard COVID-19 precautions was low. The level of professional qualification influenced participants' knowledge and safe practices during the pandemic. Upgrading the aseptic techniques and amenities in practice settings and broadening the infectious diseases modules in the entry-level and continuous professional education may improve radiographers' response to COVID-19 and future pandemics. Radiographers whose qualifications were lower than a bachelor's degree had significantly less knowledge of COVID-19 prevention. Generally, radiographers had a positive attitude towards safe practices during the pandemic, but inadequate education, standard operational guidelines and resources affected their level of adherence. Apart from the shortage of personal protective equipment, poor infrastructural design and inadequate hygienic facilities such as handwashing stations, running water and non-contact hand sanitizer dispensers hampered adherence to COVID-19 precautions in low-resource settings. [ABSTRACT FROM AUTHOR]

Introduction: Cervical cancer is the fourth most diagnosed cancer among women globally, with much of the burden being carried by women in limited-resource settings often worsened by the high prevalence of HIV. Furthermore, the COVID-19 pandemic disrupted organized screening efforts and HIV management regimens worldwide, and the impact of these disruptions have not been examined in these settings. The purpose of this paper is to describe whether uptake of cervical cancer screening and HIV management changed before, during, and since the COVID-19 pandemic in North-Central Nigeria. Methods: Longitudinal healthcare administration data for women who obtained care between January 2018 and December 2021 were abstracted from the AIDS Prevention Initiative Nigeria (APIN) clinic at Jos University Teaching Hospital. Patient demographics, pap smear outcomes, and HIV management indicators such as viral load and treatment regimen were abstracted and assessed using descriptive and regression analyses. All analyses were conducted comparing two years prior to the COVID-19 pandemic, the four quarters in 2020, and the year following COVID-19 restrictions. Results: We included 2304 women in the study, most of whom were between 44 and 47 years of age, were married, and had completed secondary education. About 85% of women were treated with first line highly active retroviral therapy (HAART). Additionally, 84% of women screened using pap smear had normal results. The average age of women who sought care at APIN was significantly lower in Quarter 3, 2020 (p = 0.015) compared to the other periods examined in this study. Conversely, the average viral load for women who sought care during that period was significantly higher in adjusted models (p < 0.0001). Finally, we determined that the average viral load at each clinic visit was significantly associated with the period in which women sought care. Conclusions: Overall, we found that COVID-19 pandemic mitigation efforts significantly influenced women's ability to obtain cervical cancer screening and routine HIV management at APIN clinic. This study buttresses the challenges in accessing routine and preventive care during the COVID-19 pandemic, especially in low-resource settings. Further research is needed to determine how these disruptions to care may influence long-term health in this and similar at-risk populations. [ABSTRACT FROM AUTHOR]

Background: High-quality neonatal care requires sufficient functional medical devices, furniture, fixtures, and use by trained healthcare workers, however there is lack of publicly available tools for quantification and costing. This paper describes development and use of a planning and costing tool regarding furniture, fixtures and devices to support scale-up of WHO level-2 neonatal care, for national and global newborn survival targets. Methods: We followed a systematic process. First, we reviewed planning and costing tools of relevance. Second, we co-designed a new tool to estimate furniture and device set-up costs for a default 40-bed level-2 neonatal unit, incorporating input from multi-disciplinary experts and newborn care guidelines. Furniture and device lists were based off WHO guidelines/norms, UNICEF and national manuals/guides. Due to lack of evidence-based quantification, ratios were based on operational manuals, multi-country facility assessment data, and expert opinion. Default unit costs were from government procurement agency costs in Kenya, Nigeria, and Tanzania. Third, we refined the tool by national use in Tanzania. Results: The tool adapts activity-based costing (ABC) to estimate quantities and costs to equip a level-2 neonatal unit based on three components: (1) furniture/fixtures (18 default but editable items); (2) neonatal medical devices (16 product categories with minimum specifications for use in low-resource settings); (3) user training at device installation. The tool was used in Tanzania to generate procurement lists and cost estimates for level-2 scale-up in 171 hospitals (146 District and 25 Regional Referral). Total incremental cost of all new furniture and equipment acquisition, installation, and user training were US$93,000 per District hospital (level-2 care) and US$346,000 per Regional Referral hospital. Estimated cost per capita for whole-country district coverage was US$0.23, representing 0.57% increase in government health expenditure per capita and additional 0.35% for all Regional Referral hospitals. Conclusion: Given 2.3 million neonatal deaths and potential impact of level-2 newborn care, rational and efficient planning of devices linked to systems change is foundational. In future iterations, we aim to include consumables, spare parts, and maintenance cost options. More rigorous implementation research data are crucial to formulating evidence-based ratios for devices numbers per baby. Use of this tool could help overcome gaps in devices numbers, advance efficiency and quality of neonatal care. [ABSTRACT FROM AUTHOR]

Background: This study presents the clinical pattern of presentation and survival rate of retinoblastoma, which is the most prevalent form of pediatric intraocular cancer. The aim of this study is to provide baseline information about the clinical presentation and management of retinoblastoma at ECWA Eye Hospital. Additionally, the study identifies priority areas for enhancing medical care for children diagnosed with this cancer. ECWA Eye Hospital, situated in Kano State, Nigeria, is a specialized eye center located in the North-Western region of the country. Methods: A prospective study spanning five years was conducted at ECWA Eye Hospital to investigate clinically diagnosed cases of retinoblastoma. The study took place from January 2018 to December 2022. The patients received standardized pre-medication and chemotherapy protocols for retinoblastoma. Subsequently, a five-year follow-up was conducted to monitor the patients' progress. The collected data was analyzed, descriptive statistics were generated, and the survival rate was calculated. Results: During the five-year study period, a total of 35 cases of retinoblastoma were diagnosed. The patients had an average age of 3.21 ± 1.32 years. The most common presentation patterns observed were fungating ocular mass and proptosis. Among the cases, there were 10 instances of bilateral proptosis and 25 instances of unilateral proptosis. While no patients exhibited bilateral leukocoria, eight cases of unilateral leukocoria with anterior segment seedlings were identified. The additional patterns of presentation are proptosis, leukocoria, fungating orbital mass, redness and loss of vision. The mortality rate was 80% (28 cases), while the survival rate was 20% (7 cases). Notably, all the survivors had unilateral retinoblastoma. Conclusion: The majority of cases observed at ECWA Eye Hospital involve advanced retinoblastoma. In low-resource settings where alternative treatment options are limited, chemotherapy is considered a viable treatment option. Early presentation of retinoblastoma in patients may lead to a higher survival rate when chemotherapy is administered. [ABSTRACT FROM AUTHOR]

The birth of babies sharing body part(s) and surviving independently is indeed a scientific marvel. Conjoined twinning is a rare phenomenon with various presentations, having an estimated incidence of 1 per 200,000 live births. The successes recorded by experts in developed countries in the separation of conjoined twins in recent times, especially among those with complex unions are indeed fascinating. The management of conjoined twins presents a great challenge to medical and surgical teams in tropical African countries such as ours where we are faced with challenges of limited resources and facilities, even amidst the presence of well-trained experts. The incidence of conjoined twins is difficult to report in our practice because of failures that accompanied previous cases that were managed and not reported. This is the first successful separation after two previous failed attempts at our center. We report a case of successful surgical separation of thoraco-omphalopagus conjoined twins who were undiagnosed prenatally and delivered by emergency cesarean section following prolonged labor by a primiparous woman. Babies were joined from the lower chest and the upper abdomen and they shared a single umbilicus and omphalocele sac. No internal viscus was shared apart from the torso wall. They were cared for from 12 h of live until 127 days of live when they were successfully separated by a team of medical and surgical experts. This is a report of a successful separation of conjoined twins at the University of Ilorin Teaching Hospital in North Central Nigeria. Careful interdisciplinary conduct of expert activities will ensure the survival of rare congenital malformations such as conjoined twinning even in underdeveloped climes. [ABSTRACT FROM AUTHOR]

The U.S. Centers for Disease Control and Prevention in collaboration with the National Malaria Elimination Program and the African Field Epidemiology Network established the Malaria Frontline Project to provide innovative approaches to improve the malaria program implementation in Kano and Zamfara States, Nigeria. Innovative approaches such as malaria bulletin, malaria monitoring wall chart, conduct of ward level data validation meetings and malaria dashboard have helped improve the use of data for decision making at all levels. Innovative approaches deployed during the project implementation facilitated data analysis and a better understanding of malaria program performance and data utilization for decision making at all levels. These innovative approaches may improve malaria control program performance in Nigeria and other resource limited countries. [ABSTRACT FROM AUTHOR]

Background: Pregnancy-related acute kidney injury (PRAKI) is a common cause of AKI globally. The incidence and burden of PRAKI are still high in low and middle-income countries (LMICs) especially in Africa due to limited access to optimal obstetric care, late diagnosis, and referral. The study aimed to determine the incidence and aetiologies of PRAKI among women in the peripartum period in two government hospitals in Nigeria. Methodology: This was a prospective study where serum creatinine was measured among pregnant women presenting in labour at 0-hour, 6 hour, 12 hour, 24 hour, 48 hour and 7 days post-delivery. AKI was defined using the Kidney Disease Improving Global Outcome criteria. Binary logistic regression was used to determine predictors of PRAKI. Results: The mean age of the 162 pregnant women who completed the study was 30.05±1.28 years. The incidence of AKI use was 22.2%. The aetiologies of PRAKI were obstetric haemorrhage (66.7%), eclampsia (19.4%), and sepsis (13.9%). Seventeen (47.2%) patients had Stage 1 PRAKI, 12 (33.3%) had Stage 2 PRAKI, while seven (19.4%) had Stage 3 PRAKI. Factors significantly associated with PRAKI were parity (p=<0.001), caesarean section (p=<0.001), excess blood loss (p=<0.001), and prolonged duration of labour (p=0.002). Conclusion: PRAKI occurred in 1 out 5 pregnant women in the peripartum period. Obstetric haemorrhage, sepsis, and eclampsia which are preventable or treatable are common major aetiologies of PRAKI. PRAKI is more associated with multi-parity, caesarean delivery, haemorrhage, and prolonged duration of labour. Optimal ante-natal care, health education, and prompt diagnosis and management of obstetric complications will reduce the incidence in Nigeria. [ABSTRACT FROM AUTHOR]

Background: Postpartum contraception is a simple measure that can potentially impact positively on quality of life of mothers and their families, and reduce overall maternal mortality and morbidity, especially in low resource settings. Aims: To determine factors affecting acceptance of contraception in the immediate post-partum period. Methodology: This was a cross sectional study carried out between January 2019 to December 2021. A convenient sample of women in the immediate postpartum period had exit interviews, using a semi-structured interviewer administered questionnaire and information was obtained on sociodemographic and reproductive characteristics, pregnancy and delivery history, and reasons for accepting or refusing contraception. Data analysis was done using simple descriptive and inferential statistics. A p-value of < 0.05 was considered statistically significant. Results: A total of 455 women participated in the study. The mean age of respondents was 29.32 ± 6.31 years, and most women were parous with 1-4 children (313, 68.8%). Only 199 women (43.7%) accepted immediate postpartum contraception, mostly implants (166 women) and intra-uterine devices (18 women). Reasons for accepting contraception was to rest, heal and regain strength while reasons for refusing were husband-related factors and the perception that it was too early to initiate contraception. Several factors were significantly associated with uptake of contraception (P- value < 0.05) including age, ethnicity, duration of marriage, parity, number and sex of children alive, desire for more children, previous unplanned pregnancy, accoucheur, time and mode of delivery, outcome of index pregnancy, previous use of contraception and timing of contraceptive counselling. Conclusion: Acceptance of immediate postpartum can be increased by educating women about their need and safety, greater male involvement and creating opportunities for multiple counselling sessions antenatally. [ABSTRACT FROM AUTHOR]

• Approximately 13% of the study participants have received at least one dose of the COVID-19 vaccine. • Nearly six in ten unvaccinated participants were hesitant to accept the COVID-19 vaccine. • Age ≥50 years, unemployment, and past ART adverse reaction are associated with lower odds of hesitancy. • Females and those attending ART clinics located in the states' capitals have higher odds of hesitancy. • Major reasons for COVID-19 vaccine hesitancy included fear of adverse effects and doubts about the vaccine's efficacy. Hesitancy to COVID-19 vaccine may worsen the burden of COVID-19 among people living with HIV (PLHIV), who are at a higher risk of COVID-19-related hospitalization and death, compared to HIV non-infected individuals. Therefore, we evaluate the predictors and reasons for COVID-19 vaccine hesitancy among unvaccinated PLHIV in six antiretroviral therapy (ART) clinics across northern Nigeria. In this cross-sectional study, conducted between October 2021 and February 2022 in six hospitals across two geopolitical regions of Nigeria, we utilized interviewer-administered questionnaires to assess COVID-19 vaccine hesitancy among a convenience sample of 790 eligible adult PLHIV. Hesitancy was defined as answering 'no' or 'maybe' to a question asking participants their willingness to accept the COVID-19 vaccine. A multivariate logistic regression model was used to estimate the adjusted odds ratio (aOR) and 95% confidence interval (CI) of the factors associated with COVID-19 vaccine hesitancy among PLHIV. Of the total 660 unvaccinated participants included in the analysis (61.82% female, mean age [SD] of 39.76 [10.75]), 381 (57.72%) were hesitant to COVID-19 vaccine. Being 50 years and older (aOR: 0.43; 95% CI: 0.21–0.89), being unemployed (aOR: 0.57; 95% CI: 0.34–0.95), experiencing the adverse effects of ART (aOR: 0.36; 95% CI: 0.15–0.86), and perception of being at high risk of contracting COVID-19 (aOR: 0.22; 95% CI: 0.13–0.37) were associated with significantly lower odds of hesitancy. Conversely, being female (aOR: 1.64; 95% CI: 1.02–2.61) and attending ART clinics at state administrative capital cities (IIDH Kano [aOR: 2.40; 95% CI: 1.10–5.25], MMSH Kano [aOR: 5.59; 95% CI: 1.97–10.66], YSSH Damaturu [aOR: 9.88; 95% CI: 4.02–24.29] vs. GH Gashua) were associated with significantly higher odds of hesitancy. The most common reasons for hesitancy include fear of potential adverse effects, skepticism about vaccine efficacy, the rapid development of the COVID-19 vaccine, and the perceived lack of effort to develop a cure or vaccine for HIV/AIDS. Interventions aimed at combating misperceptions and misinformation regarding the COVID-19 vaccination program may reduce the prevalence of COVID-19 vaccine hesitancy among unvaccinated PLHIV. [ABSTRACT FROM AUTHOR]

Background: Poor maternal, newborn and child health outcomes remain a major public health challenge in Nigeria. Mobile health (mHealth) interventions such as patient-held smart cards have been proposed as effective solutions to improve maternal health outcomes. Our objectives were to assess the acceptability and experiences of pregnant women with the use of a patient-held smartcard for antenatal services in Nigeria. Methods: Using focus group discussions, qualitative data were obtained from 35 pregnant women attending antenatal services in four Local Government Areas (LGAs) in Benue State, Nigeria. The audio-recorded data were transcribed and analyzed using framework analysis techniques such as the PEN-3 cultural model as a guide. Results: The participants were 18–44 years of age (median age: 24 years), all were married and the majority were farmers. Most of the participants had accepted and used the smartcards for antenatal services. The most common positive perceptions about the smartcards were their ability to be used across multiple health facilities, the preference for storage of the women's medical information on the smartcards compared to the usual paper-based system, and shorter waiting times at the clinics. Notable facilitators to using the smartcards were its provision at the "Baby showers" which were already acceptable to the women, access to free medical screenings, and ease of storage and retrieval of health records from the cards. Costs associated with health services was reported as a major barrier to using the smartcards. Support from health workers, program staff and family members, particularly spouses, encouraged the participants to use the smartcards. Conclusion: These findings revealed that patient-held smart card for maternal health care services is acceptable by women utilizing antenatal services in Nigeria. Understanding perceptions, barriers, facilitators, and supportive systems that enhance the use of these smart cards may facilitate the development of lifesaving mobile health platforms that have the potential to achieve antenatal, delivery, and postnatal targets in a resource-limited setting. [ABSTRACT FROM AUTHOR]

The World Health Organization recommends parasite-based diagnosis of malaria before the administration of artemisininbased combination therapy (ACT). Trained community medicine distributors (CMDs) constitute a credible option in healthcare delivery in resource-limited and hard-to-reach settings. This study evaluated the performance of mRDT, microscopy and PCR in the diagnosis of malaria among febrile under-5 children in rural South-western Nigeria. One thousand and forty-three (1,043) febrile children aged 3 – 59 months were enrolled on this study as part of a larger one. The CMDs collected finger prick blood samples and performed mRDT, prepared thick blood smears for malaria microscopy and blood spots on filter paper for PCR assays. Malaria was detected in 78.7%, 69.2% and 55% by mRDT, PCR and microscopy, respectively. The sensitivity of mRDT was 88.2% versus 92.5% while specificity was 42.2% versus 38.2% against PCR and microscopy, respectively. The PPV, NPV and diagnostic accuracy were 88.2% versus 64.8, 61.7% versus 80.6% and 74.0% versus 68.1% respectively. Levels of agreement with PCR and microscopy were fair (κ-value = 0.336 versus 0.322). PCR detected 97.8% P. falciparum, 4.4% P. malariae and 2.5% P. ovale. Trained community medicine distributors can effectively performed malaria rapid diagnostic tests to guide appropriate home management of malaria in resource-limited settings. [ABSTRACT FROM AUTHOR]

Objectives: Individualized care has the potential to significantly improve health outcomes in patients with chronic conditions. This study was aimed at evaluating the quality of individualized care and its impact on clinical outcomes in patients with the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) receiving treatment in a resource-limited setting. Materials and Methods: The study was a cross-sectional prospective study carried out in the HIV/AIDS clinic of the University of Uyo Teaching Hospital, Nigeria. Data on the demographic and clinical details of the patients were obtained from patient's case notes using a suitably designed, pre-piloted data collection instrument. Data on patients' assessment of the quality of individualized care were obtained using a "Patient Assessment of Quality of Individualized Care for Chronic Illness Scale." Quantitative data were analyzed using the IBM Statistical Product and Service Solutions version 25.0 computer package. Descriptive statistics was used to summarize data, whereas inferential statistics was used where applicable with statistical significance set at P < 0.05. Results: The overall mean patients' satisfaction with individualized care score was 3.54 (standard deviation = ±0.86; max. = 5). The majority of the patients (271) had a documented viral load of <50 copies/mL, whereas 27% (109) of the patients had a recently documented CD4 count that was >500 cells/mm³. Bivariate analysis showed that the quality of individualized care was positively correlated with the patients' CD4 count (r = 0.036; P = 0.657). A negative correlation between the quality of individualized care and the patients' viral load (r = -0.103; P = 0.177) was also found. Conclusion: Provision of individualized care to patients with HIV/AIDS may improve clinical outcomes. In making therapeutic decisions, clinicians should take into cognizance individual patients' preferences and needs. [ABSTRACT FROM AUTHOR]

Background: In resource-poor settings, perinatal infections contribute significantly to maternal and neonatal deaths, and the use of clean delivery kits (CDKs) has been proposed as a tool to reduce the risk of infection-related deaths. This study aims to assess the acceptability and effectiveness of CDKs in preventing infections in deliveries attended by traditional birth attendants (TBAs) in Abeokuta, Nigeria. Methods: The study was a cluster-randomized trial with 67 birth centres/clusters, 453 births/mothers, and 457 babies randomized to intervention or control arms; intervention involved supplementation of delivery with JANMA CDKs. Interviews were conducted at the birth homes, and the primary outcomes were neonatal infection and puerperal fever. The association between infection and perinatal risk factors was tested using the Chi-square and Fisher's exact tests. Results: CDKs were well accepted by TBAs. The incidence of puerperal fever and neonatal infection was 1.1% and 11.2%, respectively. Concurrent infection was found in 1 (0.22%) of the mother-neonate pair. There was no significant association between any of the sociodemographic factors and infection for both mothers and neonates. PROM and prolonged labour were significantly associated with puerperal infection. All mothers with puerperal fever were from the control group. Compared to the control group, the relative risk of puerperal infection and neonatal infection in the intervention group was 0.08 (0.004 –1.35, p = 0.079) and 0.64 (0.37 to 1.1, p = 0.10), respectively. Conclusion: CDKs hold promising results in attenuating maternal infections in resource-poor settings. Larger studies with greater statistical power are required to establish statistically reliable information. [ABSTRACT FROM AUTHOR]

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.)

Background: People living with HIV or AIDS in resource-limited settings are faced with challenges in their nutrition and micronutrient levels. This study aimed to determine the effect of nutrition education on the nutrition status and serum zinc level of HIV and AIDS clients, and its implication for HIV care in resource-limited settings. Methods: This intervention study was conducted among HIV clients at the University of Nigeria Teaching Hospital and Enugu State University Teaching Hospital, which served as the intervention and control groups respectively. A nutrition education programme was delivered to the intervention group. In both groups, before and after the intervention, the body mass index of participants was calculated using their height (m2) and weight (kg) while their serum zinc levels were analysed using spectrophotometry. Chi-square and McNemar chi-square tests were used in the analysis. Results: A total of 185 respondents was studied in each group, with the majority in the 30–39 and 40–49 age groups, respectively (65.4% of the study group and 64.4% of the control group). Larger proportions of respondents in both groups were females (72.4% vs 75.1% respectively). Three months after the intervention, the proportion of respondents with normal serum zinc levels improved significantly from 20.5% to 51.9% in the intervention group (χ2McNemar, p < 0.001), whereas the control group had no appreciable improvement (16.8% vs 22.7%) (χ2McNemar, p < 0.117). Furthermore, the post-intervention serum zinc level difference between the intervention and control groups was statistically significant (χ2 = 33.699; p < 0.001). No statistically significant difference existed in the nutritional status between the groups (χ2 = 3.469; p = 0.325). Conclusion: Nutrition education had a positive effect on the serum zinc levels of HIV clients. Integrating nutrition education programmes as a key component of HIV care in resource-limited settings will help improve the serum zinc level of people living with HIV, which ultimately improves their immune status and life expectancy. [ABSTRACT FROM AUTHOR]

Healthcare waste (HCW) is generated from hospitals or healthcare related facilities and is considered a major source of environmental contamination because it is made up of potentially harmful substances. In developing countries, especially Nigeria, management of HCW is becoming an issue of concern. The main objective of this study was to assess the current HCW management practices at two hospitals in Abuja, Nigeria. This cross-sectional study was conducted from June to July 2018 among randomly selected healthcare workers (HWs) practising at two hospitals in Abuja, Nigeria, using an electronic interviewer-administered questionnaire installed on a smartphone via an open data tool kit. We evaluated the waste segregation practices and assessed the knowledge of HWs regarding HCW in one public secondary and one private tertiary health facility. The status of waste management practice in the health facilities was carried out using the following criteria: waste management (responsibility, segregation, storage and packaging); waste transport; waste recycling and reuse; waste treatment and final disposal. Data gathered were analysed by performing descriptive statistics. Of the 105 health workers interviewed, 69 (65.7%) were females and mostly (44.8%) were within the age group 31-40 years. The proportion of respondents who had received specific training in the management of HCW was 17.1% (18/105). The level of HCW management practices in both facilities was found to be level 2: operating in a manner with some aspects that are considered sustainable. HCW management (HCWM) in Abuja is worth sustainable, especially in resource-limited settings. Hospital Management Board needs to ensure that measures needed to improve the HCWM at hospitals are provided. [ABSTRACT FROM AUTHOR]

Malaria is a major public health problem in the tropics, especially in resource-limited settings where presumptive malaria treatment is well practised. Prompt malaria diagnosis is essential in ensuring definitive antimalarial therapy. Malaria rapid diagnostic tests (mRDTs) are a suitable option in resource-limited settings. The study evaluated and compared the diagnostic performance of BinaxNOW™ mRDT, microscopy and quantitative polymerase chain reaction (qPCR) in suspected malaria cases in Lagos, south-western Nigeria. The cross-sectional study was conducted in four Primary Health Centres and Ikorodu General Hospital in Lagos. A total of 146 suspected malaria patients aged 2 to 67years were screened between August 2013 and November 2013. Venous blood samples were collected after informed consent was obtained from participants or guardians for mRDT, thick blood film for microscopy and dried blood spots on filter paper for PCR assays. Sociodemographic information of each patient was collected with a structured case report form. The sensitivity, specificity, positive and negative predictive values, diagnostic accuracy, and kappa's level of agreement were analysed. The level of statistical significance was set at ρ ≤ 0.05. Falciparum malaria positive rate and prevalence were temperature (56.8%) and age-dependent (42.5%). The sensitivity and specificity of mRDT and microscopy were 94.7%, 91.7% and 85.4%, 96.5% respectively. While the positive predictive value (PPV) and negative predictive (NPV) were 79.9%, 94.2% and 96.4%, 95.0%. The diagnostic accuracy and kappa's level of agreement for mRDT and microscopy were 89.0%, 94.5% and 0.78 and 0.89, respectively. The performance of BinaxNOW™ malaria RDT was comparable with microscopy and can be used to guide malaria treatment in resource-limited settings to enhance parasite-based treatment of all suspected malaria cases when microscopy is unavailable. [ABSTRACT FROM AUTHOR]

Helicobacter pylori and intestinal parasites cause gastrointestinal diseases with a high prevalence in children in resource limited developing countries. There is paucity of information in Nigeria on co-infection of H. pylori and intestinal parasites. The study was conducted to determine the prevalence of H. pylori and parasite co-infection in children from selected low-income communities in Lagos, Nigeria. Fecal samples were collected from 151 healthy children aged ≤11 years across six low-income communities in Lagos. H. pylori was detected using stool antigen test and conventional PCR assay, intestinal parasites were detected using formol-ether concentration and nested PCR assay. Structured questionnaires were administered to parents and legal guardians of the children by an interviewer to collect relevant data on demographic and lifestyle factors. The prevalence of H. pylori was 31.79% (48), with a higher prevalence in children aged 2–3 years. The prevalence of intestinal parasites was 21.19% (32) with the lowest frequency found in children aged 8–9 years. The parasites detected include: A. lumbricoides (10.6%), G. intestinalis (7.3%), hookworm (1.99%), E. histolytica (0.66%), S. mansoni (0.66%). There was co-infection prevalence of 10.6% (16) which was associated with the parasites: G. intestinalis (7.3%) and A. lumbricoides (3.97%). Polyparasitism with G. intestinalis and A. lumbricoides was reported in 2 children infected with H. pylori. This study which is the first reported in Lagos established a low prevalence of H. pylori and intestinal parasite co-infection in children and provides better understanding of the epidemiology of H. pylori infection associated with intestinal parasites in Nigeria. [Display omitted] • This is the first study on H. pylori and parasite co-infection in children in Lagos. • H. pylori co-infection more with Giardia intestinalis and Ascaris lumbricoides. • Polyparasitism (G. intestinalis and A. lumbricoides) with H. pylori was found. [ABSTRACT FROM AUTHOR]

BACKGROUND: Laparoscopic myomectomy for removal of uterine fibroid in resource-limited settings is cost prohibitive. Open abdominal myomectomy is unarguably more affordable, despite the drawbacks. OBJECTIVE: The study aimed to determine fertility and obstetric outcomes after an open abdominal myomectomy. MATERIALS AND METHODS: A retrospective descriptive study that involved the retrieval of medical records, and analysis of the data of women who had open abdominal myomectomy due to uterine fibroid and unexplained infertility, in a private health facility in Abraka, Delta State, Nigeria, from 1 February 2014 to 31 January 2021. The age, duration of infertility, location of fibroid masses within the uterus, history of previous pregnancy, pregnancy after myomectomy, pregnancy outcome and amongst other variables were captured and analysed using IBM SPSS version 23. RESULTS: The data for 69 (88.5%) out of the 78 patients who had myomectomy was available for analysis. The mean age of patients was 33.3 ± 4.7 years; about 2/3 (65.5%) of the patients were <30 years. The pregnancy rate after myomectomy was 55.1% (38/69), most (44.9%) of the pregnancies occurred in the 1st year after myomectomy and about half (46.4%) of the patients were delivered by caesarean section. Patient's age, shorter duration of infertility and fewer fibroid masses were significantly associated with favourable fertility outcomes (P < 0.001, P < 0.001 and P < 0.05, respectively). Age ≤ 30 years was most predictive of pregnancy after myomectomy, P < 0.017. CONCLUSION: The study showed that women with uterine fibroid and unexplained causes of infertility at age ≤ 30 years have good fertility and obstetric outcome after open abdominal myomectomy. [ABSTRACT FROM AUTHOR]

Introduction: Adequate nutrition plays a major role in delaying disease progression and improving quality of life of people living with human immunodeficiency virus (PLHIV). Therefore, it is important to assess their nutrition knowledge and practice of dietary diversity, especially in resource-limited settings, where most HIV infections occur. Aim of the study was to assess the nutrition knowledge and dietary diversity practice of PLHIV in a resource-limited setting. Material and methods: This was a health facility-based cross-sectional analytical study conducted at two tertiary HIV clinics in Enugu, Nigeria. Using a systematic random sampling technique, 370 adult HIV patients were recruited. Bivariate and multivariate logistic regression analyses were performed to identify factors associated with good nutrition knowledge and high dietary diversity among respondents. P-value < 0.05 was considered statistically significant. Results: Good nutrition knowledge was observed in 69.7% of the respondents, while 60.0% had high dietary diversity. In multivariate analysis, secondary educational level (AOR: 0.54; 95% CI: 0.29-0.97; p = 0.040) and earning a family monthly income of 31,000-60,000 (AOR: 2.12; 95% CI: 1.11-4.06; p = 0.024) were predictors of good nutrition knowledge. Number of children in a household (AOR: 2.09; 95% CI: 1.19-3.67) was predictive of high dietary diversity. Conclusions: Educational level and family monthly income are predictors of nutrition knowledge, while number of children in a household is a predictor of dietary diversity. Nutrition education should be incorporated into HIV care program targeting those with low educational levels and low family monthly incomes for improvement of their nutrition knowledge. [ABSTRACT FROM AUTHOR]

Background An omphalocele is a congenital defect of the anterior abdominal wall, characterized by herniation of midline abdominal content through an extraembryonic part of the umbilical cord. Management of this condition is challenging, particularly in resource-limited settings. Methods Using a standardized data collection instrument, we retrospectively reviewed the medical records of all patients who underwent surgical omphalocele management over a 10-year period at a tertiary care hospital in Ibadan, Nigeria. The review included documentation of perioperative complications, anaesthetic and surgical techniques, and patient outcomes. Results From January 2008 through December 2017, 57 neonates underwent surgical omphalocele repair (59.6% boys; mean age, 2.7 days; mean birth weight, 3.06 kg). In total, 33 neonates (57.9%) had major omphaloceles, and 24 (42.1%) had minor omphaloceles. At the time of surgery, about 77.2% of patients were categorized as class 1 or 2 according to the American Society of Anesthesiologists Physical Status Classification System. In total, 15 patients (26.3%) had comorbidities, including sepsis (n=10, 17.5%), anaemia (n=3, 5.3%), jaundice (n=2, 3.5%), and congenital anomalies (n=6, 10.5%). General anaesthesia with a relaxant technique was administered to all neonates, and primary closure was conducted on 52 patients (91.2%). Intraoperative complications included difficult intubation (n=5, 8.8%), hypothermia (n=7, 12.3%), tachycardia (n=37, 64.9%), and bradycardia (n=3, 5.3%). Postoperatively, 15 neonates (26.3%) required mechanical ventilation and intensive care management, and 14 (24.6%) died. Conclusions At this tertiary care centre in Nigeria, an appreciable number of patients with omphaloceles were surgically managed, primarily using primary wound closure. Poor postoperative outcomes, including mechanical ventilation and mortality, were common. [ABSTRACT FROM AUTHOR]

Objectives: Quality of life assessment is considered an important measure of outcome in long-term illness and management. Patient satisfaction surveys are essential in obtaining a comprehensive understanding of the patient's needs and their opinion of the service received. The purpose of this study was to determine the healthrelated quality of life (HRQOL) and satisfaction with pharmaceutical care services among patients with type II diabetes mellitus (DM) receiving care in Nigeria. Materials and Methods: A cross-sectional prospective study was conducted among 120 patients with type II DM receiving treatment at General Hospital Ikot Ekpene in Akwa Ibom state, Nigeria. Patients who met the eligibility criteria and attended clinic appointments at the medical outpatient clinic as well as those admitted into the medical wards of the hospital during the period of the study were recruited. Data on the extent of patients' satisfaction with pharmaceutical care as well as their quality of life in diabetes were obtained using the patient satisfaction with pharmaceutical care questionnaire, and the patient quality of life based on diabetes related complaints questionnaire. The duration of the study was 7 months. Data obtained were analyzed using the Statistical Program and Service Solutions version 25.0 computer package with statistical significance set at P < 0.05. Results: The quality of life of the patients based on diabetes-related complaints was poor. Fatigue was the most frequently reported complaint (n = 116; 96.6%), followed by polyuria (n = 106; 88.33%). The overall mean scores of patient satisfaction with pharmacists' friendly explanation and management of therapy were 4.03 (±0.52) and 3.53 (±0.44), respectively. There was a statistically significant relationship between patients' satisfaction with pharmacists' friendly explanations and patient complaints of weight changes (r = 0.219; P < 0.05), decreased energy levels (r = 0.205; P < 0.05), and numbness (r = 0.270; P < 0.01). Furthermore, there was a statistically significant relationship between patients' satisfaction with pharmacists' therapy management and patients' complaint of fatigue (r = 0.187; P < 0.05), numbness (r = 0.189; P = 0.05), and blurred vision (r = 0.204; P < 0.05). Conclusion: The HRQOL of the patients was poor as the majority of the patients had diabetes-related complaints. Patients' satisfaction with the pharmaceutical care services offered was good. Periodic evaluation of the quality of life and satisfaction with health-care services among patients with DM is recommended. [ABSTRACT FROM AUTHOR]

In this review, the ethical issues peculiar to the COVID-19 pandemics and the role of healthcare workers, especially those in resource-limited settings are x-rayed. We contend that there is a pressing ethical issue that needs urgent clarification on the rights and responsibilities of healthcare workers, especially in the current context of CO VID-19 pandemic preparedness and responsiveness. We searched MEDLINE, Web of Science, EMBASE, Google Scholar, PUBMED related articles, newspaper articles, and online news sources for relevant information. The various professional codes of conduct (World Medical Association, Medical and Dental Council of Nigeria) were also consulted. The ethical principles of equitable distribution of healthcare resources, confidentiality with associated stigmatization, issues relating to duty to care by the healthcare workers and those pertaining to conduct of clinical trials and access to approved therapies or vaccines were highlighted in this study. We agree with the submission that healthcare workers only have a moral duty to treat patients with COVID-19 if the necessary protective equipment and adequate compensation are not provided. We argue that the duty of physicians and other healthcare workers to care for patients during pandemics such as C0V1D-19 is obligatory in the absence of required protective equipment and other forms of compensation. There is a need for the government and other stakeholders to put in place a National Pandemic /Epidemic Ethical Framework to address these identified ethical challenges. [ABSTRACT FROM AUTHOR]

Objective of the study: The study was aimed to determine barriers to modern contraceptive use among pregnant women attending antenatal care at Enugu State University Teaching Hospital from 1st March to 31st May 2014. Materials and Methods: Using a semi-structured questionnaire, relevant data were extracted. Data were entered and analyzed using Epi InfoTM statistical software version 7. p value<0.05 was considered statistically significant. Results: A total of 432 women participated in the study. Their mean age was 28.6±4.4 years. The majority were married (93.06%), multiparous (59%) and mainly Igbos (93.06%). Although the level of awareness of modern contraceptive among the respondents was high (91.8%), only about 35% of them (n=151/432) had ever used modern contraceptives in the past. Over one-third (36.3%, n=144/397) of the respondents who were aware of modern contraceptive do not intend to ever use modern contraceptive in future. The self-reported barriers to the use of modern contraceptive were; religious barrier (53.9%), fear of side effect (24%), husband's disapproval (17.8%) and cost. Conclusions: Addressing these identified barriers hopefully will promote the use of modern contraceptive for family planning thus preventing unintended pregnancy in our sub region. [ABSTRACT FROM AUTHOR]

Background: Expanded access to combination antiretroviral therapy (cART) throughout sub-Saharan Africa over the last decade has remarkably improved the prognosis of persons living with HIV (PLWH). However, some PLWH experience virologic rebound after a period of viral suppression, usually followed by selection of drug resistant virus. Determining factors associated with drug resistance can inform patient management and healthcare policies, particularly in resource-limited settings where drug resistance testing is not routine. Methods: A case–control study was conducted using data captured from an electronic medical record in a large treatment program in Nigeria. Cases PLWH receiving cART who developed acquired drug resistance (ADR) and controls were those without ADR between 2004 and 2011. Each case was matched to up to 2 controls by sex, age, and education. Logistic regression was used estimate odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with ADR. Results: We evaluated 159 cases with ADR and 299 controls without ADR. In a multivariate model, factors associated with ADR included older age (OR = 2.35 [age 30–40 years 95% CI 1.29, 4.27], age 41 + years OR = 2.31 [95% CI 1.11, 4.84], compared to age 17–30), higher education level (secondary OR 2.14 [95% CI 1.1.11–4.13]), compared to primary and tertiary), non-adherence to care (OR = 2.48 [95% CI 1.50–4.00]), longer treatment duration (OR = 1.80 [95% CI 1.37–2.35]), lower CD4 count((OR = 0.95 [95% CI 0.95–0.97]) and higher viral load (OR = 1.97 [95% CI 1.44–2.54]). Conclusions: Understanding these predictors may guide programs in developing interventions to identify patients at risk of developing ADR and implementing prevention strategies. [ABSTRACT FROM AUTHOR]

Background: Preterm birth is a major contributor to neonatal and under-five mortality, and births at lower gestational ages (GA) contribute more to these statistics. Most developed countries have succeeded in improving survival at extremes of GA, while most developing countries like Nigeria still lag behind. The objective of this retrospective study was to document the survival rates among extremely preterm neonates and factors associated with mortality in a tertiary center in Nigeria. Methods: The labor ward delivery and neonatal unit admission records were reviewed from January 2010 to December 2017. The GA, gender, mode of delivery, birth weight, duration of admission, and outcomes for babies delivered at 24 to 27 weeks + 6 days of gestation were recorded. The survival rates and factors associated with mortality were analyzed. Results: During this period, there were 11,607 live births with 1,685 (14.5%) preterm deliveries. There were 4,523 admissions to the neonatal unit; overall, 736 (16.3%) cases were preterm neonates out of which 152 (3.4%) subjects were extremely preterm. The overall survival rate was 24.3%, and the survival rate increased with increasing GA and birth weight (BW). Most deaths occurred in the first week of life. The means of BW and GA were significantly lower in babies that died, compared to those who survived. The median duration of admission was also lower for those that died, compared to those that survived. The most common causes of death were respiratory distress, sepsis, and intracranial hemorrhage. Conclusion: The survival rate of extremely preterm neonates is low in this study. Facilities to improve care, especially for respiratory support should be put in place to reduce mortality. [ABSTRACT FROM AUTHOR]

Spontaneous intracerebral hemorrhage (ICH) is associated with a high case fatality rate in resource-limited settings. The independent predictors of poor outcome after ICH in sub-Saharan Africa remains to be characterized in large epidemiological studies. We aimed to determine factors associated with 30-day fatality among West African patients with ICH. The Stroke Investigative Research and Educational Network (SIREN) study is a multicentre, case-control study conducted at 15 sites in Nigeria and Ghana. Adults aged ≥18 years with spontaneous ICH confirmed with neuroimaging. Demographic, cardiovascular risk factors, clinical features and neuroimaging markers of severity were assessed. The independent risk factors for 30-day mortality were determined using a multivariate logistic regression analysis with an adjusted odds ratio (OR) and 95% confidence interval (CI). Among 964 patients with ICH, 590 (61.2%) were males with a mean age (SD) of 54.3(13.6) years and a case fatality of 34.3%. Factors associated with 30-day mortality among ICH patients include: Elevated mean National Institute of Health Stroke Scale(mNIHSS);(OR 1.06; 95% CI 1.02–1.11), aspiration pneumonitis; (OR 7.17; 95% CI 2.82–18.24), ICH volume > 30mls; OR 2.68; 95% CI 1.02–7.00)) low consumption of leafy vegetables (OR 0.36; 95% CI 0.15–0.85). This study identified risk and protective factors associated with 30-day mortality among West Africans with spontaneous ICH. These factors should be further investigated in other populations in Africa to enable the development of ICH mortality predictions models among indigenous Africans. • A prospective multicentre, case-control study in patients with spontaneous intracerebral hemorrhage in Nigeria and Ghana. • Intracerebral hemorrhage is associated with high case fatality. • Low GCS, large hematoma volume, and aspiration pneumonitis are associated with 30-day mortality. • Cardiac disease, intraventricular hemorrhage, pyrexia and origin of the hemorrhage were not associated with mortality. [ABSTRACT FROM AUTHOR]

Objective: HIV care delivery in resource-limited settings (RLS) may serve as a paradigm for chronic disease care, but comprehensive measurement frameworks are lacking. Our objective was to adapt the patient-centered medical home (PCMH) framework for use in RLS, and evaluate the performance of HIV treatment programs within this framework.Design and Setting: Cross-sectional survey administered within the AIDS Prevention Initiative in Nigeria (APIN) network.Participants: Medical directors at APIN clinics.Main Outcome Measures: We adapted the 2011 US National Committee on Quality Assurance's PCMH standard to develop a survey measuring five domains of HIV care: (i) enhancing access and continuity, (ii) identifying and managing patient populations, (iii) planning and managing care, (iv) promoting self-care and support and (v) measuring and improving performance.Results: Thirty-three of 36 clinics completed the survey. Most were public (73%) and urban/semi-urban (64%); 52% had >500 patients in care. On a 0-100 scale, clinics scored highest in self-care and support, 91% (63-100%); managing patient populations, 80% (72-81%) and improving performance, 72% (44-78%). Clinics scored lowest with the most variability in planning/managing care, 65% (22-89%), and access and continuity, 61% (33-80%). Average score across all domains was 72% (58-81%).Conclusions: Our findings suggest that the modified PCMH tool is feasible, and likely has sufficient performance variation to discriminate among clinics. Consistent with extant literature, clinics showed greatest room for improvement on access and continuity, supporting the tool's face validity. The modified PCMH tool may provide a powerful framework for evaluating chronic HIV care in RLS. [ABSTRACT FROM AUTHOR]

To investigate the perceptions of parents towards universal new-born screening for hearing loss in Nigeria. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) system. A comprehensive search was undertaken using multiple databases (National Library of Medicine, PubMed, Cochrane Library, Scopus, Google Scholar, and MEDLINE) published in English between 2009 and 2018. The sample size of 10 studies were retrieved by using a predefined inclusion and exclusion criteria, keywords, and Boolean operator search patterns. Data extraction and analysis and quality appraisal of the selected articles was carried out. 80% of the identified studies indicated negative perceptions of Nigerian parents towards new-born hearing loss screening programmes. Possible reasons behind such negative perceptions were categorised into demographic factors, psychological factors, behavioural factors, and service-related factors. Specifically, barriers included low income, misconceptions, mode of delivery, fear of associated risk with screening procedure, preference for traditional medicines, inappropriately designed screening programmes, cost of screening programmes, resource-limited settings, lack of awareness about risk factors and their effects. The research concluded that it is necessary to focus on the range of underlying factors (including awareness and education) contributing in shaping the above mentioned negative perceptions among Nigerian parents. The findings have great implications for the theoretical researchers for developing future research path as well as practical suggestion for authorities in policymaking in the healthcare sector in Nigeria. [ABSTRACT FROM AUTHOR]

Background: Evidence for the impact of organized stroke multidisciplinary teams (MDTs) on outcomes in Africa is sparse., Aim: To compare stroke outcomes, before and after the establishment (September 16, 2016) of a pioneer MDT at a tertiary hospital in southern Nigeria., Methods: Using a retrospective, observational study design, the in-patient record of all stroke patients admitted between September 2014 to September 2018 was retrieved and rigorously reviewed. 155 patients seen 2 years before the MDT were compared with 169 stroke patients seen 2 years after the MDT. Stroke severity at admission and functioning at discharge were assessed using the Stroke Levity Scale (SLS) and the modified Rankin scale (mRS)., Results: Mean ages (in years) were 60 pre-MDT vs 59.57 post MDT (p = 0.754). There were more males, 51% pre-MDT vs 54.2% post MDT (p = 0.565). SLS and mRS were not significantly different; severe SLS and mRS pre-MDT, 52.9% vs post-MDT, 49.4% (p = 0.727) and pre-MDT 19.4% vs post-MDT 19.5% (p = 0.685) respectively. More post-MDT patients were discharged alive, pre-MDT,56.8% vs 79.2% post MDT (p < 0.001); had swallow tests, pre-MDT 9.23% vs post-MDT 33.5% (p < 0.001); on secondary prevention, pre-MDT 67.7% vs post-MDT 78.9% (p = 0.023); had more clinic visits, pre-MDT,0.7% vs post-MDT 38.3% (p < 0.001). MDT was independently associated with lower in-hospital mortality on multivariable regression, adjusted odds ratio (OR) (95% Confidence interval CI) 0.17 (0.09-0.32)., Conclusion: Our results suggest that an organized MDT may improve acute outcomes and reduce mortality in resource constrained settings where there may be no stroke units. These findings need further prospective validation., 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 © 2023 Elsevier Inc. All rights reserved.)