Risk of COVID-19 death for people with a pre-existing cancer diagnosis prior to COVID-19-vaccination: A systematic review and meta-analysis.

While previous reviews found a positive association between pre-existing cancer diagnosis and COVID-19-related death, most early studies did not distinguish long-term cancer survivors from those recently diagnosed/treated, nor adjust for important confounders including age. We aimed to consolidate higher-quality evidence on risk of COVID-19-related death for people with recent/active cancer (compared to people without) in the pre-COVID-19-vaccination period. We searched the WHO COVID-19 Global Research Database (20 December 2021), and Medline and Embase (10 May 2023). We included studies adjusting for age and sex, and providing details of cancer status. Risk-of-bias assessment was based on the Newcastle-Ottawa Scale. Pooled adjusted odds or risk ratios (aORs, aRRs) or hazard ratios (aHRs) and 95% confidence intervals (95% CIs) were calculated using generic inverse-variance random-effects models. Random-effects meta-regressions were used to assess associations between effect estimates and time since cancer diagnosis/treatment. Of 23 773 unique title/abstract records, 39 studies were eligible for inclusion (2 low, 17 moderate, 20 high risk of bias). Risk of COVID-19-related death was higher for people with active or recently diagnosed/treated cancer (general population: aOR = 1.48, 95% CI: 1.36-1.61, I2 = 0; people with COVID-19: aOR = 1.58, 95% CI: 1.41-1.77, I2 = 0.58; inpatients with COVID-19: aOR = 1.66, 95% CI: 1.34-2.06, I2 = 0.98). Risks were more elevated for lung (general population: aOR = 3.4, 95% CI: 2.4-4.7) and hematological cancers (general population: aOR = 2.13, 95% CI: 1.68-2.68, I2 = 0.43), and for metastatic cancers. Meta-regression suggested risk of COVID-19-related death decreased with time since diagnosis/treatment, for example, for any/solid cancers, fitted aOR = 1.55 (95% CI: 1.37-1.75) at 1 year and aOR = 0.98 (95% CI: 0.80-1.20) at 5 years post-cancer diagnosis/treatment. In conclusion, before COVID-19-vaccination, risk of COVID-19-related death was higher for people with recent cancer, with risk depending on cancer type and time since diagnosis/treatment.

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).

Health education to promote knowledge about sickle cell disease and newborn screening in pregnant women: a community-based pilot study using the healthy beginning initiative.

BACKGROUND: Pregnancy presents a critical period for any maternal and child health intervention that may impact the health of the newborn. With low antenatal care attendance by pregnant women in health facilities in Nigeria, community-based programs could enable increased reach for health education about sickle cell disease (SCD) and newborn screening (NBS) among pregnant women. This pilot study aimed to assess the effect of education on the knowledge about SCD and NBS among pregnant women using the Healthy Beginning Initiative, a community-based framework. METHODS: A pre-post study design was used to evaluate knowledge of SCD and NBS in a convenience sample of 89 consenting pregnant women from three communities. Participants were given surveys prior to and following completion of a health education session. McNemar's test was used to compare the proportion of participants with correct responses. The level of significance was taken as p < 0.05. RESULTS: Compared to pre-test values, post-test values showed that participants understood that SCD is hereditary (93.3% vs. 69.7%), both parents must have at least one gene for someone to have SCD (98.9% vs. 77.5) and blood test is the right way to know if one has SCD (98.8% vs. 78.7%). Also, a large proportion of participants (post-test ~ 89.9%; compared to pre-test ~ 23.6%) understood that the chance of conceiving a child with SCD was 25% for a couple with the sickle cell trait (SCT). Knowledge of the possibility of diagnosing SCD shortly after birth was highly increased in the post test phase of the study when compared to the pre-test phase (93.3% vs. 43.9%, respectively). Concerning the overall knowledge scores, those with high level of knowledge significantly increase from 12.6% pretest to 87.4% posttest (p = 0.015). CONCLUSION: The health education intervention was associated with significant improvement on almost all measures of SCD knowledge. Focused health education for pregnant women using community structures can improve knowledge of SCD and NBS.

Knowledge, attitudes, and barriers: Palliative Care services for women with HIV in resource-limited settings.

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.

In-hospital psychoeducation for family caregivers of Nigerian children with cancer (The RESCUE Study).

OBJECTIVES: High levels of caregiver burden (CB) are experienced by informal caregivers of pediatric patients with cancer. There is increasing evidence highlighting the extent of CB across sub-Saharan African countries, although there remains lack of interventions that target improvements in their experience. This study aimed to determine the impact of a structured psychoeducation program on caregivers' outcomes relating to preparedness to provide care, burden of caregiving, and quality of life (QoL). METHODS: This quasi-experimental (pre-and-posttest) design, involved family caregivers of children on admission for cancer treatment in 4 Nigerian tertiary hospitals. Eligible participants received 2 structured, psychoeducational training sessions delivered by a multidisciplinary oncology team, focusing on the management of patients' condition, spiritual care, self-care, and support. RESULTS: Subjects were mainly female (79.5%) and mostly mothers to children undergoing cancer treatment (74.7%). Commonest cancer type was acute lymphoblastic leukemia (23.9%) with evidence of metastatic disease found in 9.6% of children. Significant improvements were observed between pre- and posttest for unmet needs (z = -9.3; p < 0.001), preparedness for caregiving in palliative care (PCPC) (z = -7.0; p < 0.001), and overall QoL (z = -7.3; p < 0.001). A significant reduction in CB was also reported (z = -8.7; p < 0.001). SIGNIFICANCE OF RESULTS: This psychoeducational intervention (PEI) resulted in significant improvements in unmet needs, CB and significant improvements in PCPC. However, a reduction in QoL of the family caregivers was also observed. Findings from this study should encourage the use of well-crafted PEIs, delivered within hospital settings to promote improvements in outcomes for informal caregivers of hospitalized children suffering from cancer, in an African context. Further intervention development is required to better understand intervention components influencing changes in outcomes, while exploring feasibility testing and adaptation to similar settings in Nigeria and within Africa.

Digital psychiatry in Nigeria: A scoping review.

Background: Mental healthcare workforce shortage in Nigeria poses a major obstacle to mental health services scale-up. Digital psychiatry may provide a veritable platform to bridge treatment gaps. Aim: To provide an overview of quantity and range of peer-reviewed publications on digital psychiatry in Nigeria. Setting: A comprehensive literature search encompassed all original, peer-reviewed research articles on digital psychiatry in Nigeria. PubMed, Google Scholar, and a direct exploration of relevant journal article reference lists were utilised. Inclusion criteria covered peer-reviewed original articles conducted in Nigeria between January 2013 and January 2023, regardless of quality. Exclusions comprised case reports, reviews, dissertations, and abstracts. Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines were adhered to, while methodological framework of Arksey and O'Malley was used to describe the review. Results: Fourteen studies meeting inclusion criteria exhibited two primary research areas: implementation and intervention. Most studies focused on intervention strategies, showcasing efficacy of digital devices in enhancing outcomes in depression and clinic appointments. Implementation studies indicated favorable acceptance by both clients and healthcare practitioners. Conclusion: Digital technology seems acceptable to Nigerian patients and clinicians. Policies to operationalise provision of digital healthcare services will have positive impact in addressing unmet mental health needs. Finally, the quality of the evidence from majority of studies has to be enhanced, and additional studies are required to uncover gaps in some regions of the country. Contribution: This research demonstrates that, despite some drawbacks, digital methods of providing mental healthcare are practical in Nigeria.

Psychosocial aspects of adult cancer patients: A scoping review of sub-Saharan Africa.

OBJECTIVE: Psychosocial aspects of adult cancer patients in sub-Saharan Africa (SSA) have been described in silos of research articles. Integrative analysis of regional evidence is lacking. This review aimed to describe the scope of existing research on mental health problems, identify research gaps and make informed research, policy and practice recommendations. METHODS: Search was conducted for original peer-reviewed research articles, irrespective of their quality, on psychosocial aspects of cancer in all SSA countries using PubMed, Google Scholar, Google search, African Index Medicus and direct searches of reference list of pertinent journal articles. Publications in English or translated to English were included. Case reports, dissertations, abstracts, publications without primary focus on psychosocial issues, psychosocial issues in children and studies conducted with SSA populations living outside the sub-region were excluded. The methodological framework described by Arksey and O'Malley was used to synthesize and present the results. Inductive approach was used to arrive at the thematic areas. Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guideline was used to describe the review. RESULTS: Eighty-three studies conducted across 15 countries were identified. Six thematic areas emerged namely; psychosocial needs, psychiatric disorders, coping strategies, suicidality, psychometrics and psychosocial interventions. Fifteen of 46 countries had at least one study with the majority of articles emanating from Nigeria. Research articles on psychosocial needs, psychiatric morbidities and coping strategies appears adequate for systematic review in SSA region. Despite the overwhelming evidence of high unmet psychosocial needs, a huge gap exists regarding psychosocial interventions. CONCLUSION: Further research is needed into identified gaps in the region and quality of evidence of these studies need to be improved upon. Comprehensive policies and action plan development are sin qua non for addressing psychosocial problems of adults with cancer in SSA.

Illness perception and cardiovascular risk factors in patients with myocardial infarction undergoing percutaneous coronary intervention in Iran.

BACKGROUND: Knowing of perception of the illness, and cardiovascular risk factors in patients with myocardial infarction is crucial in engaging in effective secondary prevention. This study aimed to examine illness perception and cardiovascular risk factors in patients with myocardial infarction undergoing percutaneous coronary intervention. METHODS: The participants comprised 131 patients undergoing a first-time percutaneous coronary intervention at a metropolitan, tertiary referral hospital in Tabriz, Iran. The convenience sampling method was employed to select the research sample within a six-month period. The instruments used were as follows: (1) Demographic and health information form, (2) The Brief Illness Perception Questionnaire (3) The Health Risk Assessment framework developed by the Centers for Disease Control and Prevention. The design of the study was descriptive, cross sectional. The continuous variables were analyzed using Independent t-test and analysis of variance (ANOVA); and categorical variables were compared using the chi-square test. RESULTS: Most participants had a positive family history of cardiovascular disease (54.2%), with 66.4% of participants having at least one cardiovascular risk factor such as diabetes (36.6%) hypertension (32.8%) and dyslipidemia (16%). Most participants were physically inactive (78.6%), about 48.9% were overweight, 34.4% suffered from obesity and 26% were smokers. Illness perception in this study was seen to be high (6.21), with highest scores occurring in the illness control dimension (6.83) and lowest scores occurring in the understanding dimension (3.77). There was a significant relationship between illness perception and physical activity, nutrition, sleep and general health. Direct significant relationships between biometric values (cholesterol, glucose, blood pressure); psychological factors (depression, anxiety and stress) and illness perception were also found to exist. CONCLUSIONS: Low scores in two dimensions of illness perception may lead to psychological consequences such as stress, anxiety, and depression. The relationship between illness perception and some risk factors of cardiovascular disease such as physical activity, diet and biometric values, reveal the need for more attention to patient education and counselling.

Perspectives, perceived self-efficacy, and preparedness of newly qualified physicians' in practising palliative care-a qualitative study.

BACKGROUND: Dealing with life-limiting illnesses, death, dying and grief, is uncharted territory for medical graduates. It is a field that is heavily influenced by cultural, religio-spiritual and social factors. This adds complexity to palliative and end-of-life-care, which challenges newly qualified physicians and requires the formation of appropriate knowledge, skills, and attitudes in junior doctors. This study aimed to obtain insight into the perspectives, perceived self-efficacy, and preparedness of newly qualified Nigerian physicians in practising palliative care and identify potential variables influencing them. METHODS: The study was a cross-sectional, multi-centre survey of newly qualified Nigerian physicians, using semi-structured, in-depth qualitative interviews. The data were analysed by applying content-structuring qualitative content analysis. RESULTS: Forty semi-structured interviews were conducted with medical house officers at two tertiary institutions in Nigeria. The perceived self-efficacy and preparedness of newly qualified Nigerian physicians in practising palliative care were reported to be higher in areas of family involvement, and pain and symptom management than in areas of breaking bad news, prognosis, and diagnosing dying. Major influences on the young physicians' perceived self-efficacy and preparedness in practising palliative care were socio-economic circumstances of a resource-limited setting and cultural-religious considerations. In addition, the perceived impact of palliative care education and experience was documented. CONCLUSIONS: This study offers valuable insights into the perceived self-efficacy and preparedness of newly qualified physicians and reveals the influence of socio-cultural and socio-economic variables in Nigeria. Evidence of the social, cultural, and religio-spiritual dimensions of palliative care is indispensable for culturally sensitive care. These results could aid in the development of appropriate knowledge, skills, and attitudes in newly qualified physicians through culturally and contextually appropriate palliative care training measures. The results may be applicable to other sub-Saharan African settings and may be used to improve future palliative care education, training, and practice.

Impact of integrated teaching-learning method on oncology clinical decision-making ability and cognitive learning of nursing students.

BACKGROUND: Innovative and student-centered teaching methods are required to improve critical thinking and clinical reasoning skills. The objective of this study was to determine the impact of an oncology internship training on learning outcomes of nursing students using an integrated teaching-learning method. METHODS: A pre- and post-test quasi-experimental study was conducted among 107 undergraduate nursing students in fourth year who were allocated to two groups (intervention group = 51 and control group = 55) to receive an integrated teaching-learning method and routine method respectively. Data was collected using the Clinical Decision Making in Nursing Scale (CDMNS) and the students' cognitive learning test. RESULTS: Difference in mean scores of cognitive learning test post-intervention was significant between the two groups (p < 0.001). Total CDMNS scores and its dimensions increased significantly for the intervention group post-intervention (p < 0.001). Analysis of covariance (ANCOVA) showed that when the effect of confounding variables, such as the student's Grade Point Average (GPA) and the pre-test scores of cognitive learning and decision-making scale were held constant, the effect of the independent variable (group) on students' cognitive learning test (p = 0.002) and CDMNS (p = 0.004) was significant. CONCLUSIONS: Nursing students' cognitive learning and clinical decision-making scores were improved as a result of the integrated teaching-learning method. Nursing educators can use this method in clinical education to improve students' cognitive and meta-cognitive skills, thereby improving nursing care quality.

Disrupted mothering in Iranian mothers with breast cancer: a hybrid concept analysis.

BACKGROUND: Defining the disrupted mothering would contribute to developing strategies to support mothers with breast cancer. The aim of this study was to analyze the concept of mothering disruption using a hybrid model. METHODS: The Hybrid method for concept analysis was implemented consisting of three phases: theoretical, fieldwork, and final analysis. In the theoretical phase, the literature was searched using electronic databases including PubMed, ScienceDirect, Scopus, ProQuest, Google Scholar, CINAHL, Wiley, Ovid, Magiran, and SID from 2000 to 2020. Any quantitative or qualitative studies published in English or Persian, which were focused on mothering disruption in mothers with breast cancer were included in the study. In the phase of fieldwork, 20 mothers were interviewed to explore the aspects of mothering disruption. The interviews were transcribed and analyzed with conventional content analysis. In the final phase, an overall analysis of the two previous phases was performed. RESULTS: In the theoretical phase, the following attributes were determined: "disturbance in maternal identity and roles", "maternal insensitivity and unresponsiveness: disconnection physically and psychologically", "the career disruption process" and "biographical disruption". The fieldwork phase explored three themes including "the unbalance between multiple roles", "role failure", and "reduced maternal sensitivity". The final synthesis yielded that the main integrated elements of mothering disruption are "disease as threating maternal role and identity", "inability to interpret and respond to child behaviors and needs", and "support for transitioning from being patient toward maternal competency". CONCLUSION: With a deeper understanding of the term 'disrupted mothering' or 'mothering disruption', healthcare providers will have a foundation to improve cancer care, deliver effective communication and help such mothers cross this disruption and achieve restoration of their mothering role. Future research is needed to validate this concept and explore connections with health outcomes.

Functional status of women after cancer and its related factors: A study based on Roy adaptation model.

BACKGROUND: The role strain is still high for women within Iranian families. This can be further compounded by diseases such as cancer. The aim of this study was to investigate the functional status of women with cancer and its relationship with symptoms experienced by women during the period of the disease. METHODS: This cross-sectional study was carried out with 150 women with the cancer diagnosis who were referred to the Cancer Clinic of Shahid Ghazi Tabatabai Hospital in Tabriz, Iran. The Comprehensive Inventory of Functioning (CIF-CA) was used to evaluate their functional status. RESULT: The mean total performance of participants was 3.06(± 0.51), and the range of mean variation scores was between 1.83 and 5. Regarding the housework dimension, women reported less function in all of activities while in the social dimension, participation in social and religious activities waned. In the dimension of personal activities, majority of women reported rest and sleep during the day. CONCLUSION: Clinicians should explore the use of rehabilitation programmes to ensure that a holistic approach to care for women with cancer is given priority in order to improve the quality of life of these women and subsequently their roles in family and society.

Barriers to the Provision and Utilization of Palliative Care in Africa: A Rapid Scoping Review.

Palliative care (PC) has continued to be less available, underutilized, and unintegrated in many of the healthcare systems, especially in Africa. This scoping review synthesized existing published papers on adult PC in Africa, to report the barriers to PC and to assess the methodologies used in these studies. Eight electronic databases and Google Scholar were searched to identify relevant studies published between 2005 and 2018. Overall, 42 publications (34 empirical studies and 9 reviews) that reported issues related to barriers to adult PC were selected. Three themes identified were individual-level, system-level, and relational barriers. The studies reviewed predominantly utilized cross-sectional and retrospective study design, underscoring the need for more studies employing qualitative design. Findings highlight the need for health education, training opportunities, more funding, communication, and timely referral. Future works could focus on underlying factors to these barriers and ethno-religious perspectives to PC in Africa.

Patient-centred communication for women with breast cancer: Relation to body image perception.

AIMS AND OBJECTIVES: This study aimed to determine the predictive values of patient-centred communication (PCC) and patient's characteristics on the body image (BI) perception in postmastectomy patients. BACKGROUND: Patient-centred communication has been touted as a means of addressing BI issues, especially for postmastectomy patients. DESIGN AND METHODS: This predictive correlational study was conducted on 275 surgically treated breast cancer patients admitted to the Oncology Departments of two hospitals in Tabriz, Iran. These patients were selected using a convenience sampling method. The Body Image after Breast Cancer Questionnaire (BIBCQ) and patient-centred communication questionnaire (PCCQ) were used for collecting the data. Descriptive and inferential statistics were applied to the data. Reporting was in accordance with the STROBE guideline. RESULTS: A multivariable model significantly predicted BI perception in participants using surgery type and time elapsed following surgery. Participants' limitations were significantly affected by surgery type and participants' perception of the nurses' PCC skills. Arm concern was significantly affected by surgery type and nurses' PCC skills. CONCLUSION: Patient-centred skills in nurse-patient communication are critical for resolving BI difficulties such as arm concerns and limitations regarding the disease and its treatment. RELEVANCE TO CLINICAL PRACTICE: Patient-centred communication skills can be taught nurses in the clinical setting to help alleviate patients' BI problems.

Exploring Organizational Culture Regarding Provision and Utilization of Palliative Care in a Nigerian Context: An Interpretive Descriptive Study.

BACKGROUND: Palliative care (PC) continues to be underutilized in Nigeria, but there is a lack of studies that explore organizational cultural dynamics regarding PC in Nigeria. The study aimed to understand the organizational culture in order to identify organizational enablers and inhibitors of the provision and utilization of PC in a Nigerian context. METHODS: Identification of the organizational culture was developed using a qualitative interpretive descriptive design. Cultural enablers and inhibitors were mapped out using semi-structured interviews with 38 participants, consisting of medical staff, patients, and their relatives. Thematic analysis was used to identify and analyze patterns within the collected data. RESULTS: Three themes were identified: cross-departmental collaborative practice, financial support practice, and continuity of care. The findings suggest that fundamental cultural changes, such as a policy for intradepartmental referral practices, telemedicine, and a welfare support system, are typically required as remedies for the failure to use PC in Nigeria and other similar contexts. CONCLUSIONS: This study offered a new understanding that not revealing deeper shared assumptions, and a shared way of thinking that underpins the PC practice within an organization, will have a negative bearing on organizational PC outcomes.

Construction of meanings during life-limiting illnesses and its impacts on palliative care: Ethnographic study in an African context.

OBJECTIVE: Knowledge about how people make meaning in cancer, palliative, and end-of-life care is particularly lacking in Africa, yet it can provide insights into strategies for improving palliative care (PC). This study explored ways in which cancer patients, their families, and health care professionals (HCPs) construct meaning of their life-limiting illnesses and how this impact on provision and use of PC in a Nigerian hospital. METHODS: This ethnographic study utilised participant observation, informal conversations during observation, and interviews to gather data from 39 participants, comprising service users and HCPs in a Nigerian hospital. Data were analysed using Spradley's framework for ethnographic data analysis. RESULTS: Meaning-making in life-limiting illness was predominantly rooted in belief systems. Most patients and their families, including some HCPs, perceived that cancer was caused by the devil, mystical, or supernatural beings. They professed that these agents manifested in the form of either spiritual attacks or that wicked people in society used either poison or acted as witches/wizards to inflict cancer on someone. These beliefs contributed to either nonacceptance of, or late presentation for, PC by most of patients and their families, while some professionals depended on supernatural powers for divine intervention and tacitly supporting religious practices to achieve healing/cure. CONCLUSIONS: Findings revealed that cultural and religious world views about life-limiting illnesses were used in decision-making process for PC. This, therefore, provided evidence that could improve the clinicians' cultural competence when providing PC to individuals of African descent, especially Nigerians, both in Nigerian societies and in foreign countries.

The effect of an oral care protocol and honey mouthwash on mucositis in acute myeloid leukemia patients undergoing chemotherapy: a single-blind clinical trial.

OBJECTIVES: The purpose of the study is to evaluate and compare the effectiveness of honey mouthwash and an oral care protocol on mucositis and weight loss in patients with acute myeloid leukemia receiving chemotherapy. MATERIALS AND METHODS: In this single-blind clinical trial, 53 acute myeloid leukemia (AML) patients receiving chemotherapy were randomly assigned into three groups: honey mouthwash (n = 17), oral care (n = 17), and control (n = 19). The severity of mucositis and weights was examined blindly at the baseline and 4-week follow-up. RESULTS: The prevalence of grades of mucositis in the study groups was significant at the end of the third (p = 0.002) and fourth (p < 0.001) weeks. The mucositis severity decreased at the end of the third and fourth weeks in the honey mouthwash group (p < 0.05), whereas it increased in the control group (p < 0.001). The difference in the weight was significant between the honey mouthwash and the control groups (p < 0.05, MD = 1.95) at the end of the third week, and between the honey mouthwash group with the control (p < 0.01, MD = 2.92) and oral care groups (p < 0.05, MD = 1.95) at the end of the fourth week. CONCLUSIONS: Honey mouthwash is effective in preventing and reducing the severity of mucositis, and weight loss and can be recommended for patients undergoing chemotherapy. CLINICAL RELEVANCE: The results of this study suggest that honey mouthwash can reduce the incidence and severity of mucositis in patients, reduce or eliminate the possibility of weight loss in them, as well as encourage some weight gain. Compared to routine oral care, honey mouthwash is also easier to use and handle. TRIAL REGISTRATION: IRCT2015121419919N7.

Understanding the Organization of Hospital-Based Palliative Care in a Nigerian Hospital: An Ethnographic Study.

CONTEXT: Organization and delivery of palliative care (PC) services vary from one country to another. In Nigeria, PC has continued to develop, yet the organization and scope of PC is not widely known by most clinicians and the public. OBJECTIVES: The aim of the study is to identify PC services available in a Nigerian Hospital and how they are organized. METHODS: This ethnographic study, utilized documentary analysis, participant observation, and ethnographic interviews (causal chat during observation and individual interviews) to gather data from members of PC team comprising doctors (n = 10), nurses (n = 4), medical social workers (n = 2), a physiotherapist, and a pharmacist, as well nurses from the oncology department (n = 3). Data were analyzed using Spradley's framework for ethnographic data analysis. RESULTS: PC was found to be largely adult patient-centered. A hospital-based care delivery model, in the forms of family meetings, in- and out-patients' consultation services, and a home-based delivery model which is primarily home visits conducted once in a week, were the two models of care available in the studied hospital. The members of the PC team operated two shift patterns from 7:00 am to 2.00 pm and a late shift from 2:00 pm to 7:00 pm instead of 24 h service provision. CONCLUSIONS: Although PC in this hospital has made significant developmental progress, the organization and scope of services are suggestive of the need for more development, especially in manpower and collaborative care. This study provided knowledge that could be used to improve the clinical practice of PC in various cross-cultural Nigerian societies and other African context, as well as revealing areas for PC development.

Pain research in Africa: a ten-year bibliometric survey.

PURPOSE: Over the years, a trend for very low numbers of scientific publications from Africa has emerged. There has been no evaluation of pain research publications from this region. This study was conducted to determine the African pain research spectrum over the last 10 years, to identify trends in the number of publications from different countries, to identify currently underexplored areas of pain research, and to stimulate renewed interest in quality pain research in Nigeria and Africa. METHODS: The English- and non-English-language medical literature on pain from July 2002 to May 2012 was studied using Medline, the Ovid database, and by performing hand searches of relevant references using Google. Publications on pain by Africans and/or non-Africans conducted in Africa on Africans living in Africa within the study period were included. The total number of articles per country, publication types, and impact factors of the respective journals were tabulated to determine the quantity and quality of research in this field. RESULTS: Two hundred twenty-eight (228) articles from 25 African countries that were published in 129 different journals were identified. The majority were epidemiological studies (43.9 %), experimental studies (20.2 %), randomized controlled trials (2.2 %), and systematic reviews (1.8 %). Nigeria, South Africa, and Uganda topped the list of the most-published articles, with 76 (33.3 %), 71 (31.1 %), and 12 (5.3 %), respectively. The total number of journals with impact factors was 81, of which 29 were high-impact-factor journals. CONCLUSION: Pain research publications from Africa should be encouraged. Given the underexplored frontiers of pain research, there is a need to engage in rigorous research in this field to enhance the contribution of the African continent ("the African Voice") to worldwide advances in this respect.