Search

The study analysed the knowledge, attitude and practice (KAP) of inclusive extension service among agricultural extension workers in southwestern Nigeria. All the extension workers (268) in Agricultural Development Programmes (ADPs) in five states randomly selected within southwestern Nigeria were interviewed for the study via a structured and pre-tested questionnaire. The collected data were presented using descriptive and inferential statistics. The mean age, formal education and job experience of the extension workers were 43.3±8.4, 17.0±2.6 and 14.1±8.4 years, respectively. The majority of the respondents were male (74.3%) and married (77.8%). Furthermore, most of them have encountered farmers with special needs such as albinism (81.7%), hearing impairment (87.3%), visual impairment (85.2%) and mental disability (81.7%) among others. The majority of the respondents (60.0%) had high capacity for inclusive extension service. The extension workers differed significantly across the states in terms of their practice scores, but not in their knowledge and attitude scores. The findings revealed that at p

Introduction: To improve surgical quality and safety, health systems must prioritise equitable care for surgical patients. Racialised patients experience worse postoperative outcomes when compared with non-racialised surgical patients in settler colonial nation-states. Identifying preventable adverse outcomes for equity-deserving patient populations is an important starting point to begin to address these gaps in care. To derive literature-based estimates of the outcome gap for racialised surgical patients, we will systematically review and meta-analyse rates of adverse postoperative events associated with common and/or high-risk operations performed in Canada and the USA., Methods and Analysis: An electronic search of Medline, Embase, Web of Science, Cochrane Central, CINAHL and Scopus will be conducted to identify studies reviewing complication rates of racialised compared with non-racialised patients from inception to December 2023. We will include publications from the USA and Canada comparing surgical outcomes of racialised and non-racialised patients. The procedures of interest will be the four most common (hip arthroplasty, knee arthroplasty, appendectomy and cholecystectomy), and the five highest risk (oesophagectomy, abdominal aortic aneurysm, aortic valve replacement, coronary artery bypass graft and pancreatectomy) surgical procedures performed in these countries. The outcomes will be mortality, length of stay in hospital, readmission, reoperation, wound dehiscence, surgical site infection, pulmonary embolism, sepsis or septic shock, pneumonia, blood transfusion, stroke, myocardial infarction and bile duct injury. Summary estimates of cumulative incidence, prevalence, incidence rate and occurrence rate of complications using DerSimonian and Laird random effects models will be calculated for the systematic review and meta-analysis. Heterogeneity in these estimates will be examined using subgroup analyses and meta-regression., Ethics and Dissemination: This study uses secondary data and, therefore, does not require ethics approval. This study will be communicated through presentations at international conferences and published in peer-reviewed literature. The results from this study will inform the development of future surgical equity tools and quality improvement programmes and provide benchmarks on the impact of racism on surgical outcomes., Prospero Registration Number: CRD42024491439., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background: Because tertiary centres are generally situated at urban sites, it is unclear whether patients in rural areas have the same access to surgical services that patients in urban areas do. We sought to map the North American evidence landscape of how rurality affects access to medically indicated surgeries and identify system-, patient-, and provider-level barriers that preclude urban-comparable care., Methods: We carried out a systematic search adhering to PRISMA for Scoping Reviews methodology across PubMed, MEDLINE, Scopus, and Web of Science, encompassing literature from the last 26 years (January 2023). Search terms included "rural population," "health care access," "surgical procedures," and "health disparities." We synthesized our findings using a narrative approach., Results: Of 13 897 identified studies, we included 71 publications, spanning a wide spectrum of surgical disciplines. Of these, 83% reported diminished and 17% reported accelerated access to surgery, and 30% reported an interaction between rurality with other social determinants of health, particularly age, sex and gender, and race and ethnicity. Of the studies that reported diminished access, top cited reasons included primary and specialist provider density, differences in patients' socioeconomic profiles, and provision of comparable counselling during surgical decisionmaking. Strikingly, a key driver of enhanced surgical access was an absence of specialized medical interventions leading to an overreliance on surgical alternatives., Conclusion: Whether surgical access was diminished or accelerated, the net impact of rurality was a deviation from guideline-concordant care. A key implication of these findings is that reliance on surgical wait times alone can skew perception of surgical access, advocating for adoption of integrated quality-of-care metrics that better reflect access to comprehensive medical and surgical treatment programs., Contexte: Étant donné que les centres de soins tertiaires se trouvent généralement en milieu urbain, on peut se demander si l'accès aux services chirurgicaux est le même en région rurale qu'en milieu urbain. Nous avons voulu cartographier, preuve à l'appui, l'impact de la ruralité sur l'accès à des chirurgies médicalement indiquées en Amérique du Nord et identifier les obstacles, propres au système, à la patientèle et aux équipes soignantes, qui nuisent à la prestation des soins équivalents à ceux des milieux urbains. MÉTHODES: Nous avons procédé à une interrogation systématique (conforme à la Norme de réalisation de revue systématique de la littérature PRISMA) des bases de données PubMed, MEDLINE, Scopus et Web of Science regroupant la littérature des 26 dernières années (janvier 2023). Les mots clés de langue anglaise utilisés incluaient : « rural population », « health care access », « surgical procedures » et « health disparities ». Nous avons synthétisé nos observations au moyen d'une approche narrative. RÉSULTATS: Des 13 897 études recensées, nous avons retenu 71 publications abordant un vaste éventail de disciplines chirurgicales. Parmi ces publications, 83 % faisaient état d'un accès diminué, 17 % d'un accès plus rapide à la chirurgie, et 30 % d'un lien entre la ruralité et d'autres déterminants sociaux de la santé, notamment l'âge, le sexe et le genre, ainsi que la race et l'ethnicité. Selon les études ayant fait état d'un accès diminué, les principales raisons incluaient la densité des effectifs en médecine primaire et de spécialité, les différences de profils socioéconomiques de la patientèle et l'offre d'un counselling comparable lors du processus décisionnel concernant la chirurgie. À noter, l'un des principaux facteurs d'amélioration de l'accès aux soins chirurgicaux était l'absence d'interventions médicales spécialisées associées à une dépendance indue à l'endroit des solutions chirurgicales., Conclusion: Que l'accès à la chirurgie ait été diminué ou accéléré, l'impact net de la ruralité a pris la forme d'un écart par rapport aux soins préconisés par les lignes directrices. Ces observations indiquent principalement que la dépendance à l'égard des temps d'attente en chirurgie seule peut fausser la perception quant à l'accès aux soins chirurgicaux, ce qui milite en faveur de l'adoption de paramètres de qualité de soins intégrés qui reflèteraient plus fidèlement l'accès à des programmes de traitements médicaux et chirurgicaux complets., Competing Interests: Competing interests:: Alisha Ebrahim, Sarthak Sinha, Ifeoluwa Adedipe, and Abeer Ahmad acknowledge the support of the Department of Distributed Learning and Rural Initiatives, Cumming School of Medicine, University of Calgary (not paid to authors). Aaron Johnston reports receiving travel support from the College of Family Physicians of Canada (CFPC). Dr. Johnston also holds volunteer roles with CFPC and the Association of Faculties of Medicine of Canada. No other competing interests were declared., (© 2025 CMA Impact Inc. or its licensors.)