Symptoms, concerns, and experiences of women living with and beyond breast cancer in Africa: A mixed-methods systematic review.

OBJECTIVE: A mixed-methods systematic review to determine reported symptoms, concerns, and experiences of women living with and beyond breast cancer in Africa. METHODS: Literature searches were conducted in Medline, Embase, PsycINFO, Global Health, Web of Science, CINAHL, and the Cochrane Library. Quantitative and qualitative studies that comprised study populations of women with breast cancer from countries in Africa, detailing symptoms, concerns, and experiences of living with and beyond breast cancer were included. Inductive framework analysis was applied to organise existing literature with the Adversity, Restoration, and Compatibility framework and quality was assessed using the Mixed Methods Appraisal Tool. RESULTS: In total, 48 studies were included, comprising quantitative (n = 24), qualitative (n = 23) and mixed method (n = 1) studies. Women reported multiple complex and burdensome symptoms at all stages of the breast cancer disease trajectory. Multiple pervasive factors influencing participants' experiences included a lack of cancer knowledge, being removed from decision-making, religion, and the presence and use of traditional medicines. Literature relating to benefit finding, understanding identity for the future, and broader perspectives of well-being was absent. CONCLUSIONS: This review contributes insights and mapping of symptoms, concerns, and experiences of women with breast cancer in Africa. There is a great necessity to increase an understanding of the needs and experiences of women with breast cancer in Africa following cancer treatment, stages of remission, and longer-term monitoring and follow-up. This is required to ensure access to prompt and timely clinical and individualized supportive care for women with breast cancer in Africa.

Medication Adherence among Pulmonary Tuberculosis Patients in Treatment Centers in a Southern Nigerian Local Government Area: Question Mark on Performance of DOTS Services.

Background: Directly observed treatment short-course (DOTS) offers free, accessible and effective treatments with high treatment success rate and retention. Despite this, evidence from Rivers State suggest a downward trend in tuberculosis (TB) cure rate and a high burden of drug resistance among pulmonary tuberculosis (PTB) patients. Medication adherence appears to play a key role in TB evolution. Aim: to assess medication adherence and its determinants among pulmonary TB clients in DOTS centers. Methodology: A total of 225 adult PTB clients from eightactive DOTS centers in Obio/Akpor Local Government Area of Rivers State were selected. A validated questionnaire, Morisky Medication adherence Scale-8 was used to collect medication-taking behaviour of clients, dichotomised into adherent and non-adherent. Binary logistic regression was conducted to check crude association between medication adherence and client/treatment factors. Variables with p<0.2 were selected and subjected to multivariate logistic regression with alpha set at p<0.05. Results: Non-adherence to medication was 35.1% with forgetfulness and stress with medication plan as top reasons for non-adherence. Factors associated with non-adherence included persisting sputum production (aOR: 2.951(1.027-8.482);p=0.045), past treatment history (aOR: 5.422(1.93-15.228);p=0.001) and smoking (aOR: 7.779(1.58-38.305);p=0.012). Conclusion: Over one-thirds of PTB clients in DOTS centers in Obio/Akpor LGA were non-adherent to anti-TB medications. Factors associated with non-adherence included persisting sputum production, past treatment history and smoking. To attenuate these risk factors for non-adherence, training and retraining of DOTS center staff on counselling is a smart option that can be explored by the LGA, providers and managers of the DOTS programme.

Stroke survivors in Nigeria: A door-to-door prevalence survey from the Niger Delta region.

The burden of stroke has been projected to increase in low-and middle-income countries due to the ongoing epidemiological transition. However, community-based stroke prevalence studies are sparse in sub-Saharan Africa particularly in Nigeria. This study aimed to provide a comparative estimate of the prevalence of stroke survivors in the rural Niger Delta region. A three-phased door-to-door survey was conducted using WHO modified instruments. In the first-phase, 2028 adults (≥18years) participants randomly selected from two rural communities were screened by trained health research assistants for probable stroke. In the second phase, suspected cases were screened with stroke-specific tool. Positive cases were made to undergo complete neurological evaluation by two study neurologist in phase-three. Stroke diagnosis was based on clinical evaluation using WHO criteria. Overall, 27 (8 first-ever and 19 recurrent cases) stroke survivors with crude prevalence of 13.31/1000 (95% CI, 8.32-18.31) and a non-significant difference in prevalence between the two study communities were found, (P=0.393I). In addition, age-adjusted prevalence of stroke survivors was 14.6/1000 person, about 7-folds higher than previous estimates outside the Niger Delta region. The prevalence increases significantly with advancing in age, P<0·001. Among others, hypertension (92.59%) was the commonest risk factor and comorbidity found. Improved stroke surveillance and care, as well as better management of the underlying risk factors, primarily undetected or uncontrolled high blood pressure, remains a public health priority.

The Burden of Hypertension in an Oil- and Gas-Polluted Environment: A Comparative Cross-Sectional Study.

BACKGROUND: Evidence of positive association between traffic-related air pollution and elevated blood pressure has been published widely. However, the risk of hypertension and prolonged exposure to crude oil pollution and gas flares remains unexplored. METHODS: We recruited 2,028 residents (aged 18-80) in a cross-sectional survey of both oil/gas polluted and nonpolluted communities in the Niger Delta region of Nigeria. Prevalence and risk of hypertension, anthropometric indices, lifestyle and sociodemographic factors, and cardiovascular comorbidities were examined and compared between the 2 groups. Hypertension was defined as blood pressure ≥140/90mm Hg or on antihypertensive medication. Both univariate and multivariate logistic regression models were used to examine factors associated with hypertension. Model fits statistics were used to assess the parsimonious model and predictive power. RESULTS: More than one-third of participants were hypertensive (37.4%). Half of the participants were from oil-polluted areas (51%). Only 15% of participants reported family history of hypertension. In the adjusted model, participants living in oil-polluted areas were almost 5 times as likely to have developed hypertension (adjusted odds ratio (aOR) = 4.85, 95% confidence interval (CI): 1.84-12.82) compared to participants in unpolluted areas. Age modifies the association between pollution status and risk of hypertension. For every 10 years increase in the age of the participants, the odds of developing hypertension increased by 108% (aOR = 2.08, 95% CI: 1.77-2.43). CONCLUSION: The results suggested that exposure to oil/gas pollution may be associated with an increased risk of hypertension. Our findings need to be further investigated in longitudinal studies.

Utilization of intermittent preventive treatment of malaria by pregnant women in rivers state, Nigeria.

BACKGROUND: This study was conducted to assess the level of intermittent preventive treatment of malaria in pregnancy (IPTp) in Rivers State, Nigeria, to identify obstacles prohibiting utilization in order to make recommendations for improved uptake and malaria control in general. METHODS: A cross-sectional study was carried out in November 2008 among 339 pregnant women and those who had delivered children in the last 1 year, using a multistage sampling method. Data were analyzed using the Epi-Info version 6.04d statistical software package and hypothesis tests were conducted to compare summary statistics at 95% significance level. RESULTS: Most of the respondents (76.4%) had knowledge that malaria was caused by mosquitoes and was harmful in pregnancy. Although majority of the pregnant women (80.8%) attended antenatal care clinics, knowledge of the correct use of SP was low (32.6%) and only 62.8% took malaria preventive treatment. Of these, 58.4% took SP, while nearly a third, 31.8%, took chloroquine. Only 16.4% took their SP at the health facility directly observed by health workers according to the national guidelines. The commonest reason for not preventing malaria was that they were not sick during the period of pregnancy. CONCLUSIONS: Misconceptions about IPTp persist among women known to have attended antenatal care clinics, resulting in only a minority of pregnant women receiving IPTp as recommended by national guidelines. Efforts directed at awareness creation on the new malaria prevention and treatment policy are therefore necessary to enhance the uptake of IPT in pregnancy in Rivers State. Further studies are however, needed to evaluate the knowledge and practices of health care workers on the new malaria treatment policy.

Pattern of risky sexual behavior and associated factors among undergraduate students of the University of Port Harcourt, Rivers State, Nigeria.

INTRODUCTION: Age at sexual debut had decreased in the developing countries recently. Few documented studies have looked into the pattern of risky sexual behaviour and associated factors among undergraduate students in Rivers state of recent. This study examined the pattern of sexual risky behaviour of undergraduate in University of Port-Harcourt, Rivers State, Nigeria. METHODS: A descriptive cross sectional survey was adopted and three hundred students were purposively recruited. Data were collected by a self -administered semi-structured questionnaire and analysed using descriptive and chi-square statistics at 0.05 significant level. RESULTS: The mean age of respondents was 21.3 ± 2.8 years; more than half (57.4%) were females. Almost a quarter (24.5%) was each in 200 and 300 level of study respectively and more than a quarter (26.7%) lives alone. Sixty-one percent of the respondents had ever taken alcohol beverage with 36.1% of them were current users. More than half (52.0%) the respondents had either boy/girlfriend and a total of 144 (52.0%) had ever had sexual intercourse; of these 13% reportedly had only one sexual partner in their lifetime; girl/boy friend topped the list of their sexual partner; 48.6% respondents were currently sexually active and 32% used a form of protection during their last sexual activity. The mean age at sexual debut was 17.0 ± 4.5 years. Few (13.4%) have had sex in exchange for gifts and 5.1% of these was with a friend. Higher proportions of respondents who reported lifetime use of alcohol were sexually active (p<0.005). CONCLUSION: Respondents exhibits risky sexual behavior as more had sex without any form of protection. Public enlightenment programmes and targeted behavioral change interventions are therefore recommended.