Emerging cancer disease burden in a rural sub-Saharan African population: northeast Nigeria in focus.

Introduction: Sub-Saharan Africa (SSA) is plagued by myriads of diseases, mostly infectious; but cancer disease burden is rising among non-communicable diseases. Nigeria has a high burden of cancer, however its remote underserved culturally-conserved populations have been understudied, a gap this study sought to fill. Methods: This was a cross-sectional multi-institutional descriptive study of histologically diagnosed cancers over a four-year period (January 2019-December 2022) archived in the Departments of Pathology and Cancer Registries of six tertiary hospitals in the northeast of Nigeria. Data obtained included age at diagnosis, gender, tumor site and available cancer care infrastructure. Population data of the study region and its demographics was obtained from the National Population Commission and used to calculate incident rates for the population studied. Results: A total of 4,681 incident cancer cases from 2,770 females and 1,911 males were identified. The median age at diagnosis for females was 45 years (range 1-95yrs), and 56 years (range 1-99yrs) for males. Observed age-specific incidence rates (ASR) increased steadily for both genders reaching peaks in the age group 80 years and above with the highest ASR seen among males (321/100,000 persons) compared to females (215.5/100,000 persons). Breast, cervical, prostatic, colorectal and skin cancers were the five most common incident cancers. In females, breast, cervical, skin, ovarian and colorectal cancers were the top five malignancies; while prostate, haematolymphoid, skin, colorectal and urinary bladder cancers predominated in men. Conclusion: Remote SSA communities are witnessing rising cancer disease burden. Proactive control programs inclusive of advocacy, vaccination, screening, and improved diagnostics are needed.

Epidemiological trends and treatment abandonment of paediatric solid tumours in a nigerian tertiary hospital: a seven-year review (2016-2022).

BACKGROUND: Paediatric solid tumours, both benign and malignant, present significant health challenges, particularly in Sub-Saharan Africa where comprehensive data is limited. This study aims to elucidate the prevalence, distribution, and treatment outcomes of paediatric solid neoplasms in a tertiary hospital in South-East Nigeria over a seven-year period. METHODS: A retrospective cohort study was conducted at Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Nigeria. Clinical details and histological slides of confirmed cases from January 2016 to December 2022 were reviewed. Data extraction focused on socio-demographic variables and treatment outcomes, analysed using statistical methods. RESULTS: The study included 293 children diagnosed with solid tumours (58.1% malignant, 41.9% benign), with a female predominance (61.8%). The median age at diagnosis was 12 years. Fibroadenoma was the most common benign tumour (61.8% of benign cases), while non-Hodgkin lymphoma was the predominant malignant tumour (18.2% of malignant cases). Treatment abandonment rates differed significantly between benign (13.8%) and malignant (51.2%) tumours. Significant associations were found between treatment outcomes and factors such as gender (p = 0.0001 for benign tumours), age category (p = 0.0001 for benign tumours), and specific diagnoses (p = 0.0001 for both benign and malignant tumours). CONCLUSION: This study underscores the substantial burden of paediatric solid tumours in South-East Nigeria and highlights the critical need for improved treatment adherence strategies, particularly for malignant cases. The findings emphasize the importance of tailored interventions based on tumour type, age, and gender. These insights can inform future research, policy formulation, and healthcare strategies aimed at enhancing the management and outcomes of paediatric solid neoplasms in resource-limited settings.

Colonoscopy findings in patients with haematochezia in Benin (South-South Nigeria): A 9-year prospective study.

Background: Colonoscopy is an important armamentarium in the investigation of haematochezia. Patients with haematochezia are very anxious about the presence of blood in their faeces. They are usually referred for diagnostic colonoscopy based on the presence of blood in stool or anaemia. Aims/Objectives: To highlight the causes of haematochezia in patients over a 9-year prospective period in the Premier tertiary health centre in the South-South zone of Nigeria. Materials and Methods: All Consecutive patients seen in our surgical services (June 1, 2009, to May 30, 2018) requiring colonoscopy for haematochezia were entered into a proforma. The demographics, findings at colonoscopy, and outcome of colonoscopy were analysed. Results: Three hundred and sixty-five colonoscopies were done during the study period; of these, 44% (160 patients) had a colonoscopy for haematochezia. Mean age of patients was 54.7 years. Age range was 16-86 years. Cluster age group was fifth to seventh decade (62.5%). The male-to-female ratio was 2:1. Causes of haematochezia were Haemorrhoids 32.5%, large bowel cancer 23.8%, diverticular disease 10%, inflammatory disease of the bowel 6.3%, polyps 3.8%. About 15% of the patients had more than one colonic site of bleeding. The most common subsites for colon cancer were rectum and sigmoid colon (79.6%), in 11 patients (6.8%) was the tumour within reach of the examining finger. Repeat colonoscopy occurred in 3 patients (0.8%). The most common complication of colonoscopy was bleeding (0.8%). Two patients (0.5%) had colonic perforation. Conclusion: Forty-four percent (44%) of colonoscopy in Benin, South-South Nigeria has haematochezia as its indication. The cluster age group is the fifth to seventh decade. One in four patients had colon cancer and in 6.8% the tumour was within reach of the examining finger. It is the authors' opinion that colonoscopy should be routinely done in patients with haematochezia in South-South Nigeria.

Perception on hematology/oncology pharmacy practice and education needs in Nigeria: A national survey.

INTRODUCTION: Nigeria is a low-middle income country located in sub-Saharan Africa. Although cancer burden has continued to increase over time, there is a lack of pharmacists who specialize in oncology providing pharmaceutical care. The objectives of this study were to understand the perception of hematology/oncology pharmacy practice in Nigeria as well as the unmet education needs. METHOD: This is a cross-sectional survey conducted in December 2023. Pharmacists who were active members of various pharmacy organizations in Nigeria were invited to complete the survey. The survey focused on the perceptions of training needs in oncology pharmacy, current challenges and opportunities, as well as resources and support needed. Descriptive statistics were utilized for the data analysis. RESULTS: Of the 263 responders, the largest group fell between 25 and 34 years old (35%), over half received a Bachelor of Pharmacy as their highest degree (53%), and majority did not receive any oncology pharmacy training as part of their education (73%). Many respondents strongly agreed that pharmacists in Nigeria need specialized training to better serve cancer patients (79%). Cancer therapeutics and chemotherapy pharmacology were more prioritized compared to other training needs (mean (SD): 2.63(1.95) and 2.69(1.64), respectively). The main challenge that respondents faced was a lack of relevant skills and knowledge in oncology pharmacy (mean (SD): 2.23(1.53)). More than a fourth of the respondents were aware about the board certification process (28.8%), citing overcoming the cost barrier as the main obstacle for taking the board examination (mean (SD): 1.92 (1.38)). Respondents preferred online courses and onsite specialty training (75%) as the mode of training to address unmet needs. CONCLUSION: Despite the challenges and unmet education needs in hematology/oncology clinical practice, Nigerian pharmacists are very willing to expand their knowledge and improve their skills in patient care. The findings of this study can inform policy makers, healthcare administrators, and pharmacy educators in developing global partnerships among pharmacy organizations which employ targeted strategies like sponsorships to address such unmet needs.

Profile of Cataract Surgical Patients at the National Eye Centre, Kaduna, Nigeria.

Background: Cataract surgery has evolved over the years. This study aims to highlight the profile of the patients that underwent cataract surgery at a tertiary hospital with emphasis on patient demographics, surgical techniques performed, intraocular lens powers implanted, and the complications managed. Methodology: A retrospective cross-sectional descriptive study of all patients who had undergone cataract surgery within two years at the National Eye Centre, Kaduna, Nigeria. Data extracted from the electronic version of the manual cataract surgical records included the patient's age, sex, comorbidities, technique of cataract surgery performed, the intraocular lens powers implanted, and complications encountered. Intraoperative and postoperative complications up to the twelfth week were considered. All patients had biometry-guided intraocular lens implantation. Results: One thousand four hundred and seventy- two (1,472) patient records of all ages met the inclusion criteria with a male-female ratio of 1.4:1. The mean age was 51.4 ± 22.6 years. The difference in the mean age of the sexes was statistically significant (p=0.01) and 95% CI was 7.37- 10.40 years. Glaucoma was the commonest ocular comorbidity 142(9.65%) and only 5% (74) had systemic comorbidities. The mean intraocular lens (IOL) power was 19.25 ± 1.8Diopters (Range 10.5D to 26D). The commonest surgery performed was small incision cataract extraction with posterior chamber intraocular lens implant (SICS + PCIOL) 91.2% followed by Trabeculectomy with SICS + PCIOL (3.87%). Phacoemulsification accounted for 2.72% of surgeries. Intra-operative complications were posterior capsular rent in 7.1% (104) and vitreous loss in 4% (58). The commonest post-operative complications were corneal edema6.9% (103) and striae keratopathy 4.6% (68). Conclusion: Most cataract patients were male, above 50years of age and likely to be older than the females at surgery. The most performed surgical technique was small incision cataract surgery with posterior chamber intraocular lens implantation (SICS + PCIOL) while the mean intra-ocular lens power was 19.25 ± 1.8Dioptres. Globally accepted cataract surgical techniques utilizing recent technological advancements were employed with biometry-guided intraocular lens power calculation and implantation. Complications fell within the accepted global rates.

Research Output inOrthopaedics and Sports Medicine from Nigeria and Africa - A Bibliometric Analysis.

Background: Nigeria has a relatively large scientific community that produces an adequate research output among African countries. Not many studies have analysed the research output in orthopaedics and sports medicine from Nigeria and Africa. Hence, we aimed to analyze the research output in orthopaedics and sports medicine from Nigeria and Africa. Methodology: We used the SCOPUS data from the Scimago Journal & Country Rank website. It allows us to draw various journal metrics for research. Results: Between 1996 and 2022, Nigerian research publications in orthopaedics and sports medicine had grown from 4 in 1996 to 39 in 2022 (a 10-fold growth) but overall is 62nd in the world representing 0.07% of publications in the period. In the same period, Africa published 8297 papers in orthopaedics and sports medicine representing only 1.24% of the global publications in this field. Conclusion: There is low research output in Orthopaedics and Sports Medicine from Nigeria and, the whole African continent. However, there has been a growth in the publications from Africa.

Practice of Mammography in a Private Nigerian Cancer Foundation: Our Experience.

BACKGROUND: Despite the proven effectiveness of mammography in screening and early breast cancer detection, there is still a huge disparity in both access to breast care and the quality of services provided in Nigeria. Non-governmental organizations (NGOs) have attempted to bridge this gap through awareness campaigns and subsidized breast imaging services. OBJECTIVES: To document the mammographic findings of adult females in a private NGO and assess the benefits of mammography practice in our locality. MATERIAL AND METHODS: This was a retrospective evaluation of mammographic examinations carried out over a two-year period (January 2020- December 2021) in a private cancer foundation in Abuja, Nor t h Ce nt r al Nigeria. Demographic details, clinical and mammographic features were analyzed with a statistical level of significance set at p≤0.05. RESULT: The age range of 565 women evaluated in this study was 31-84 years with the majority (55.7%) of them in the 40-49 year range. More than half (52.7%) of the women had had at least one previous mammogram. Screening was the predominant indication for mammograms in 361 women (63.9%) while 204(36.1%) were symptomatic. Breast pain (59.6%) and breast lump (26.3%) were the most common clinical indications. The predominant breast density pattern was the American College of Radiologists Breast Imaging and Reporting Data System (ACR BIRADS) type B (Scattered fibroglandular densities) in 241 women (42.7%). Mammogram was normal in 206 women (34.7%) while 52 (8.8%) had intraparenchymal findings. The final assessment showed that most of the mammograms were BIRADS category 1(69.6%) and 2(13.8%) signifying normal and benign findings. Body mass index, parity, age at first pregnancy, menopausal status, and breast density had significant relationships with the final BIRADS category. CONCLUSION: Mammography is an invaluable part of breast care in our locality. Evaluation of mammographic services in our private NGO showed a predominance of screening mammography while a majority of the women with symptomatic breast diseases had normal and benign findings.

CONTEXTE: Malgré l'efficacité avérée de la mammographie dans le dépistage et la détection précoce du cancer du sein, il existe encore une énorme disparité tant dans l'accès aux soins du sein que dans la qualité des services fournis au Nigeria. Les organisations non gouvernementales (ONG) ont tenté de combler cette lacune grâce à des campagnes de sensibilisation et à des services d'imagerie mammaire subventionnés. OBJECTIFS: Documenter les résultats mammographiques des femmes adultes dans une ONG privée et évaluer les avantages de la pratique de la mammographie dans notre localité. MATÉRIEL ET MÉTHODES: Il s'agissait d'une évaluation rétrospective des examens mammographiques réalisés sur une période de deux ans (janvier 2020 - décembre 2021) dans une fondation de lutte contre le cancer privée à Abuja, au Nigeria. Les détails démographiques, les caractéristiques cliniques et mammographiques ont été analysés avec un niveau de signification statistique fixé à p ≤ 0,05. RÉSULTAT: La tranche d'âge des 565 femmes évaluées dans cette étude était de 31 à 84 ans, la majorité (55,7 %) d'entre elles se situant dans la tranche d'âge de 40 à 49 ans. Plus de la moitié (52,7 %) des femmes avaient déjà subi au moins une mammographie précédente. Le dépistage était l'indication prédominante pour les mammographies chez 361 femmes (63,9 %), tandis que 204 (36,1 %) étaient symptomatiques. Les douleurs mammaires (59,6 %) et les masses mammaires (26,3 %) étaient les indications cliniques les plus courantes. Le motif de densité mammaire prédominant était de type B du système de notation et de rapport d'imagerie mammaire du Collège Américain des Radiologues (ACR BIRADS) chez 241 femmes (42,7 %). La mammographie était normale chez 206 femmes ( 34, 7 %) , t andi s que 52 ( 8, 8 %) présent ai ent des anomal i es intraparenchymateuses. L'évaluation finale a montré que la plupart des mammographies étaient classées BIRADS catégorie 1 (69,6 %) et 2 (13,8 %), ce qui signifie des résultats normaux et bénins. L'indice de masse corporelle, la parité, l'âge à la première grossesse, le statut ménopausique et la densité mammaire avaient des relations significatives avec la catégorie BIRADS finale. CONCLUSION: La mammographie est un élément inestimable des soins du sein dans notre localité. L'évaluation des services mammographiques dans notre ONG privée a montré une prédominance de la mammographie de dépistage, tandis que la majorité des femmes atteintes de maladies mammaires symptomatiques présentaient des résultats normaux et bénins. MOTS-CLÉS: Mammographie, Femmes, Nigeria, Soins du sein, Imagerie mammaire, Organisation non gouvernementale.

Impact of a pharmacist-led intervention on prostate cancer illness perception.

DISCLAIMER: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: Illness perception (IP) significantly determines illness outcomes. This study determined the impact of a pharmacist educational intervention on IP in patients with prostate cancer (PCa) and predictors of IP. METHODS: Using a brief IP questionnaire, an interventional study of patients with PCa was conducted in all cancer reference hospitals in one Nigerian state. After a pre-post assessment of patients' IP, descriptive and inferential statistical analyses were performed. The impact of pharmacists' intervention on IP was determined by paired-sample statistics and correlation analysis at the 95% CI. Relationships and predictors of IP were determined using Kendall's tau-b (τb), likelihood ratio, and F tests of equality of means, respectively. P < 0.05 was considered statistically significant. RESULTS: Pharmacists' educational intervention significantly improved IP (SEM, 0.13; r = 0.875; P < 0.0001) among the 200 participants. The analyses also showed a significant paired sample difference (2.662; SEM, 0.06; 95%CI, 2.536-2.788; t = 41.69; df = 199; P < 0.0001). All subscales of patients' IP significantly improved except for illness consequences (P = 0.173) and identity (mean [SD], 4.40 [3.730] in both pre- and postintervention assessments). Pre- and postintervention assessments showed a significant negative relationship of IP with age (τb = -110 [P = 0.040] and τb = -14 [P = 0.021], respectively), Gleason score (τb = -0.125 [P = 0.021] and τb = -0.124 [P=0.012], respectively), and age at diagnosis (τb = -0.103 [P = 0.036] post intervention). IP was significantly dependent on the drug therapy (df = 8; mean square [M] = 6.292; F = 2.825; P = 0.006), alcohol intake (df = 1; M = 9.608; F = 4.082; P = 0.045) and Gleason score (df = 9; M = 6.706; F = 3.068; P = 0.002). CONCLUSION: Patients' IP significantly improved after pharmacists' educational intervention. Predictors of IP were drug therapies, alcohol use and Gleason score. Findings can be extrapolated in clinical settings to improve treatment outcomes.

Surgical treatment of perineal giant condylomata acuminata (Buschke Lowenstein tumor): Case series from a developing country.

INTRODUCTION: Giant condylomata acuminatum (GCA) also referred to as Buschke-Lowenstein tumor (BLT) is a rare tumor primarily associated with low-risk HPV 6 and 11, which is believed to be a slow growing intermediate tumor with low potential to transform into invasive cancer. CASE PRESENTATION: We presented our experience with three cases of BLT (one woman and two men). CLINICAL DISCUSSION: The three patients had surgical excision and two of them had reconstruction of the surgical defect with good clinical outcome. CONCLUSION: We highlighted the importance of early identification of symptoms, treatment options and risk of recurrence as well as primary preventive strategies.

Optimizing Trichiasis Case Finding to Attain the Elimination of Trachoma as a Public Health Problem.

BACKGROUND: As national trachoma programmes increase efforts to reduce the burden of trachomatous trichiasis (TT), TT case finding and referral are critical public health programme components. Our research aimed to explore the most effective and efficient approaches to finding, referring, and managing TT cases. METHODS: This was a prospective descriptive study, utilizing both routine programme data and primary data collection. This study compared four different approaches to finding TT cases across three different local government areas (LGAs) in Kano State, Nigeria. Each of the study LGAs was divided into four sub-units to accommodate the four different approaches. RESULTS: The number of outreach attendees was 4795 across the four case finding approaches, and this varied hugely, with the smallest number and proportion (403, 0.26%) in settings only employing house-to-house case finding and the largest number and proportion (1901, 0.99%) when town criers were used. That said, the proportion of TT cases among people presenting at outreach was highest (32.5%) when house-to-house case finding was used and lowest (10.3%) when town criers were used. More female TT patients were found (53-70%) and had surgery (79-85%) compared to male cases, across all approaches. The average project expenditure for finding one TT case was similar for approaches that included house-to-house case finding (USD 5.4-6.3), while it was 3.5 times higher (USD 21.5 per TT case found) when town criers were used. DISCUSSION: This study found that the house-to-house TT case finding approaches were the most efficient method with the highest yield of TT cases. Including other eye condition and/or vision testing yielded similar results but required more personnel and cost.

Pattern, Clinical Characteristics, and Impact of Family History on Prostate-Specific Antigen in Prostate Cancer: A Multicenter Study.

Prostate cancer (PCa) is a major cause of illness and death in men of Sub-Sahara African origin. The study assessed the pattern of PCa, the effect of family history on PSA at diagnosis, and clinical characteristics of PCa in Nigeria. A cross-sectional survey of 200 participants was performed within a 12-month period in Nigeria. Data were collected through patients' interview and hospital records and analyzed using SPSS version 25. Descriptive and inferential statistics were performed. P values <.05 were significant. Mean age of 68.5 years was observed among the 200 study participants. Only 64 (32.0%) had a positive immediate family history of PCa, and 61 (30.5%) were not aware of their family cancer history. Most patients 140 (70.0%) had lower urinary tract symptom (LUTS)/lower back pain/leg pain, and the average Gleason score was 7.55 (±0.876). Symptoms of LUTS/lower back pain mostly occurred in patients between 58 and 79 years, while LUTS/leg pain was more common in persons between 60 and 84. Average PSA differed among participants; persons with no family cancer history (M = 143.989; 95% confidence interval [CI] = 114.849-173.129), family history of PCa (M = 165.463; 95% CI = 131.435), family history of cervical cancer (M = 133.456; 95% CI = 49.335-217.576), and persons with no knowledge of their family cancer history (M = 121.546; 95% CI = 89.234-153.857). Univariate one-way (F-Tests) showed that family history of cancer had no significant impact on patients' PSA (R2 = 0.017; adjusted R2 = 0.002; df = 3; F = 1.154; p = .329) at diagnosis. PCa mostly occurred in men within 60 to 70 years of age, and family history of cancer did not predict PSA at diagnosis. Patients presented to health facilities at advanced or metastatic stages. These findings highlight the need for policies and strategies that encourage early PCa screening.

Impact of mobile health technologies on human papillomavirus vaccination uptake among mothers of unvaccinated girls aged 9-14 years in Lagos, Nigeria (mHealth-HPVac): Study protocol of a randomised controlled trial.

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) may empower patients to control their health, reduce inequalities, and improve 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=224 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 tested using the independent sample t-test (normal distribution) or the Mann-Whitney U test (skewed data) and that of two groups of categorical variables with Chi-square (X2) or Fisher's exact test where 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 defined as A 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).

Navigating the Challenges in Setting Up a Sustainable Open-Heart Surgery Unit in a Resource-Constrained Environment in Northern Nigeria: Model and Strategies.

INTRODUCTION: Cardiac surgery requiring cardiopulmonary bypass had been unavailable in Northern Nigeria and the federal capital territory of Nigeria regularly. Several attempts in the past at setting up this service in a self-sustaining manner in Northern Nigeria had failed. This paper is a contrasting response to an earlier publication that emphasized the less-than-desirable role played by international cardiac surgery missions in the evolution of a sustainable open-heart surgery program in Nigeria. METHODS: The cardiothoracic unit of Federal Medical Centre, Abuja, was established on March 1, 2021, but could not conduct safe open-heart surgery. The model and strategies employed in commencing open-heart surgeries, including the choice of personnel training within the country and focused collaboration with foreign missions, are discussed. We also report the first seven patients to undergo cardiac surgery under cardiopulmonary bypass in our government-run hospital as well as the transition from foreign missions to local team operations. RESULTS: Seven patients were operated on within the first six months of setting up with high levels of skill transfer and local team participation, culminating in one of the operations entirely carried out by the local team of personnel. All outcomes were good at an average of one-year follow-up. CONCLUSION: In resource-constrained government-run hospitals, a functional, safe cardiac surgery unit can be set up by implementing well-planned strategies to mitigate encountered peculiar challenges. Furthermore, with properly harnessed foreign missions, a prior-trained local team of personnel can achieve independence and become a self-sustaining cardiac surgery unit within the shortest possible time.

Implementation fidelity of intravenous ferric carboxymaltose administration for iron deficiency anaemia in pregnancy: a mixed-methods study nested in a clinical trial in Nigeria.

BACKGROUND: Iron deficiency anaemia is common among pregnant women in Nigeria. The standard treatment is oral iron therapy, which can be sub-optimal due to side effects. Intravenous ferric carboxymaltose (FCM) is an evidenced-based alternative treatment with a more favourable side effect profile requiring administration according to a standardized protocol. In this study, we assessed the fidelity of administering a single dose of FCM according to protocol and identified factors influencing implementation fidelity. METHODS: We used a mixed-method approach with a sequential explanatory design nested in a clinical trial across 11 facilities in Lagos and Kano States, Nigeria. Guided by a conceptual framework of implementation fidelity, we quantitatively assessed adherence to protocol by directly observing every alternate FCM administration, using an intervention procedure checklist, and compared median adherence by facility and state. Qualitative fidelity assessment was conducted via in-depth interviews with 14 skilled health personnel (SHP) from nine purposively selected health facilities, using a semi-structured interview guide. We analyzed quantitative data using descriptive and inferential statistics in Stata and used thematic analysis to analyze the transcribed interviews in NVivo. RESULTS: A total of 254 FCM administrations were observed across the 11 study sites, with the majority in secondary (63%), followed by primary healthcare facilities (PHCs) (30%). Overall, adherence to FCM administration as per protocol was moderate (63%) and varied depending on facility level. The lowest level of adherence was observed in PHCs (36%). Median, adherence level showed significant differences by facility level (p = 0.001) but not by state (p = 0.889). Teamwork and availability of protocols are facilitation strategies that contributed to high fidelity. However, institutional/ logistical barriers are contextual factors that influenced the varied fidelity levels observed in some facilities. CONCLUSIONS: Collaborative teams and access to operating protocols resulted in high fidelity in some facilities. However, in some PHCs, fidelity to FCM was low due to contextual factors and intervention complexities, thereby influencing the quality of delivery. In Nigeria, scale-up of FCM will require attention to staff strength, teamwork and availability of administration protocols, in order to optimize its impact on anaemia in pregnancy.

Maternal morbidity and death associated with pregnancy loss before 28 weeks in Nigeria.

OBJECTIVE: To determine the prevalence of maternal morbidity and death from pregnancy loss before 28 weeks in referral-level hospitals in Nigeria. DESIGN: Secondary analysis of a nationwide cross-sectional study. SETTING: Fifty-four referral-level hospitals. POPULATION: Women admitted for complications arising from pregnancy loss before 28 weeks between 1 September 2019 to 31 August 2020. METHODS: Frequency and type of pregnancy loss were calculated using the extracted data. Multilevel logistic regression was used to determine sociodemographic and clinical factors associated with early pregnancy loss. Factors contributing to death were also analysed. MAIN OUTCOME MEASURES: Prevalence and outcome of pregnancy loss at <28 weeks; sociodemographic and clinical predictors of morbidity after early pregnancy loss; contributory factors to death. RESULTS: Of the 4798 women who had pregnancy loss at <28 weeks of pregnancy, spontaneous abortion accounted for 49.2%, followed by missed abortion (26.9%) and ectopic pregnancy (15%). Seven hundred women (14.6%) had a complication following pregnancy loss and 99 women died (2.1%). Most complications (26%) and deaths (7%) occurred after induced abortion. Haemorrhage was the most frequent complication in all types of pregnancy loss with 11.5% in molar pregnancy and 6.9% following induced abortion. Predictors of complication or death were low maternal education, husband who was not gainfully employed, grand-multipara, pre-existing chronic medical condition and referral from another facility or informal setting. CONCLUSION: Pregnancy loss before 28 weeks is a significant contributor to high maternal morbidity and mortality in Nigeria. Socio-economic factors and delays in referral to higher levels of care contribute significantly to poor outcomes for women.

Academic Neurosurgery in Nigeria- Past, Present, and Future: A Review.

Nigeria's neurosurgical field faces profound challenges, including a critically low neurosurgeon-to-patient ratio and significant migration of medical professionals to developed countries. High costs, low socioeconomic status, and the urban-centric location of neurosurgical centers impede access to care. Key barriers to service delivery include lack of manpower, insufficient emergency care, limited imaging modalities, inadequate operative equipment, and ineffective political and administrative policies. Neurotrauma is the primary reason for neurosurgical intervention but is poorly managed due to delayed access and insufficient guidelines. The neurosurgical education system is strained by limited training capacity and the absence of subspecializations, restricting specialized care. Research output is low, hindered by limited infrastructure, lack of databases, insufficient funding, and minimal international collaboration. To address these issues, it is critical to enhance the imaging capabilities, ensure the availability of operative equipment, and establish effective policies for task sharing and communication at different levels of care. Other approaches include expanding training capacity, particularly in rural areas, implementing a uniform match system for residency, addressing gender disparities, and utilizing dual practice to ensure adequate compensation for neurosurgeons. Furthermore, stakeholders should develop subspecialization programs in areas such as neurovascular, neuro-oncology, pediatric neurosurgery, and minimally invasive neurosurgery to expand service scope. To transform the neurosurgical research landscape, efforts should be made to establish electronic medical databases, foster international collaborations to ensure funding, and make research mandatory for accreditation renewal to ensure continuous academic contribution.

A designathon to co-create HPV screening and vaccination approaches for mothers and daughters in Nigeria: findings from a community-led participatory event.

BACKGROUND: Oncogenic types of human Papillomavirus (HPV) infection cause substantial morbidity and mortality in Nigeria. Nigeria has low cervical cancer screening and vaccination rates, suggesting the need for community engagement to enhance reach and uptake. We organised a designathon to identify community-led, innovative approaches to promote HPV screening and vaccination for women and girls, respectively, in Nigeria. A designathon is a three-phase participatory process informed by design thinking that includes the preparation phase that includes soliciting innovative ideas from end-users, an intensive collaborative event to co-create intervention components, and follow-up activities. METHODS: We organised a three-phase designathon for women (30-65yrs) and girls (11-26yrs) in Nigeria. First, we launched a national crowdsourcing open call for ideas on community-driven strategies to support HPV screening among women and vaccination among girls. The open call was promoted widely on social media and at in-person gatherings. All eligible entries were graded by judges and 16 exceptional teams (with 4-6members each). All six geo-political zones of Nigeria were invited to join an in-person event held over three days in Lagos to refine their ideas and present them to a panel of expert judges. The ideas from teams were reviewed and scored based on relevance, feasibility, innovation, potential impact, and mother-daughter team dynamics. We present quantitative data on people who submitted and themes from the textual submissions. RESULTS: We received a total of 612 submissions to the open call from mother-daughter dyads. Participants submitted ideas via a website designated for the contest (n = 392), in-person (n = 99), email (n = 31), or via an instant messaging application (n = 92). Overall, 470 were eligible for judging after initial screening. The average age of participants for daughters was 19 years and 39 years for mothers. Themes from the top 16 proposals included leveraging local leaders (5/16), faith-based networks (4/16), educational systems (4/16), and other community networks (7/16) to promote awareness of cervical cancer prevention services. After an in-person collaborative event, eight teams were selected to join an innovation training boot camp, for capacity building to implement ideas. CONCLUSIONS: Innovative strategies are needed to promote HPV screening for mothers and vaccination for girls in Nigeria. Our designathon was able to facilitate Nigerian mother-daughter teams to develop cervical cancer prevention strategies. Implementation research is needed to assess the effectiveness of these strategies.

Impact of mobile health technologies on human papillomavirus vaccination uptake among mothers of unvaccinated girls aged 9-14 years in Lagos, Nigeria (mHealth-HPVac): study protocol of a randomised controlled trial.

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).

Assessing nutrition-related knowledge, attitudes, and practices towards breast cancer prevention among female students at the Federal University of Oye-Ekiti, Nigeria.

BACKGROUND: Breast cancer remains a complex disease and leading cause of cancer-related death in Nigerian women. Recently, the role of nutrition has been highlighted in the etiology of breast cancer. METHODS: The aim of this research was to evaluate the nutrition-related knowledge, attitude, and practices of female university students. We also investigated the correlation between their demographic characteristics and their knowledge and attitudes of the survey participants. A descriptive cross-sectional study was carried out among female students at the Federal University of Oye (FUOYE), Nigeria. Participants completed self-administered questionnaires designed to assess their knowledge, attitude, and practices concerning cancer prevention. Statistical analysis was performed using SPSS 20, and significance was set at p < 0.05. RESULTS: Out of the 402 students who received the questionnaire, 300 completed it. The average age of the participants was 21.26 years with a standard deviation of 2.68. There was generally limited knowledge regarding breast cancer risk factors, with 45% of participants citing family history as the most recognized risk factor. Overall, knowledge level was influenced by the participants' permanent place of residence and course of study. Attitudes towards the impact of maternal and paternal nutrition on breast cancer prevention were notably low. Additionally, less than half of the participants demonstrated good dietary practices. CONCLUSION: This study revealed low levels of nutrition-related knowledge concerning cancer prevention, accompanied by poor dietary habits among the participants. These results suggest a possible link between inadequate knowledge about breast cancer prevention and the observed poor dietary practices among the participants. The frequent consumption of unhealthy foods among the participants may be a pointer to higher risk of breast cancer in the future, emphasizing a need for health education targeted at this group.

A review of factors influencing the uptake of prostate cancer treatment in Nigeria.

BACKGROUND: The uptake of prostate cancer (PCa) treatment determines the disease course, but is influenced by several factors. This review assessed the factors that influence the uptake of PCa treatments in Nigeria, with a view to providing evidence for policies and other interventional approaches that enhance treatment uptake and PCa outcomes. METHODS: A review of relevant articles retrieved from electronic databases of Web of science, PubMed, Google scholar, African Journals online and Hinari was performed using relevant keywords. Relevant studies were also extracted from the bibliographic references of the identified studies. Peer-reviewed published articles that reported any associated factor to the uptake or utilisation of PCa treatment options from 2000 to 2023 were considered eligible, and the most pertinent reports were extracted and incorporated into this review. RESULTS: The uptake of PCa treatment options was observed to be dependent on several factors which could be grouped as economic, system-related and patient-related factors. Among these were the availability of treatment options and targeted therapies, cost and financial constraints, system-related barriers, funding gaps and lack of insurance coverage, patients' beliefs and perceptions, access to radiotherapy services and access to PCa screening. CONCLUSION: Several influencing factors posed barriers to the timely uptake of PCa treatment. Policies and strategies aimed at reducing or preventing these barriers are solicited from relevant stakeholders.