Risk factors for hepatocellular carcinoma associated with hepatitis C genotype 3 infection: A systematic review.

BACKGROUND: Hepatitis C virus (HCV) is a blood-borne virus which globally affects around 79 million people and is associated with high morbidity and mortality. Chronic infection leads to cirrhosis in a large proportion of patients and often causes hepatocellular carcinoma (HCC) in people with cirrhosis. Of the 6 HCV genotypes (G1-G6), genotype-3 accounts for 17.9% of infections. HCV genotype-3 responds least well to directly-acting antivirals and patients with genotype-3 infection are at increased risk of HCC even if they do not have cirrhosis. AIM: To systematically review and critically appraise all risk factors for HCC secondary to HCV-G3 in all settings. Consequently, we studied possible risk factors for HCC due to HCV-G3 in the literature from 1946 to 2023. METHODS: This systematic review aimed to synthesise existing and published studies of risk factors for HCC secondary to HCV genotype-3 and evaluate their strengths and limitations. We searched Web of Science, Medline, EMBASE, and CENTRAL for publications reporting risk factors for HCC due to HCV genotype-3 in all settings, 1946-2023. RESULTS: Four thousand one hundred and forty-four records were identified from the four databases with 260 records removed as duplicates. Three thousand eight hundred and eighty-four records were screened with 3514 excluded. Three hundred and seventy-one full-texts were assessed for eligibility with seven studies included for analysis. Of the seven studies, three studies were retrospective case-control trials, two retrospective cohort studies, one a prospective cohort study and one a cross-sectional study design. All were based in hospital settings with four in Pakistan, two in South Korea and one in the United States. The total number of participants were 9621 of which 167 developed HCC (1.7%). All seven studies found cirrhosis to be a risk factor for HCC secondary to HCV genotype-3 followed by higher age (five-studies), with two studies each showing male sex, high alpha feto-protein, directly-acting antivirals treatment and achievement of sustained virologic response as risk factors for developing HCC. CONCLUSION: Although, studies have shown that HCV genotype-3 infection is an independent risk factor for end-stage liver disease, HCC, and liver-related death, there is a lack of evidence for specific risk factors for HCC secondary to HCV genotype-3. Only cirrhosis and age have demonstrated an association; however, the number of studies is very small, and more research is required to investigate risk factors for HCC secondary to HCV genotype-3.

Effectiveness of online training in improving primary care doctors' competency in brief tobacco interventions: A cluster-randomized controlled trial of WHO modules in Delta State, Nigeria.

BACKGROUND: The World Health Organization (WHO) strongly recommends that brief tobacco interventions should be routinely offered in primary care. However, medical doctors do not consistently and effectively intervene during their encounters with cigarette smokers. There is a paucity of studies assessing the effect of training on the tobacco intervention competency of primary care doctors in Nigeria. AIM: To evaluate the effectiveness of online training in improving competency in brief tobacco interventions among primary care doctors in Delta State, Nigeria. METHODS: A cluster-randomized controlled trial was conducted among eligible doctors working in government-owned facilities. The 22 eligible Local Government Areas (LGAs) served as clusters. The intervention group received a WHO six-hour online course on brief tobacco cessation intervention, delivered via Zoom. The control group received no intervention. A structured questionnaire was sent to participants via WhatsApp before and six months after the training. The primary outcome variables were scores for knowledge, attitude, self-efficacy, and practice. Differences in change of scores between intervention and control groups were assessed with t-test. To adjust for clustering, these inter-group differences were further analyzed using linear mixed-effects regression modeling with study condition modeled as a fixed effect, and LGA of practice entered as a random effect. RESULTS: The intervention group had a significantly higher mean of change in scores for knowledge (effect size 0.344) and confidence (effect size 0.52). CONCLUSION: The study shows that training, even online, positively affects clinician competency in brief tobacco intervention. This is important for primary care systems in developing countries. Mandatory in-service training and promotion of the WHO modules are recommended.

Sociodemographic predictors of non-communicable diseases risk-related knowledge and behaviours: a cross-sectional study of in-school adolescents in a southern Nigerian State.

Introduction: the adolescence period is a significant phase in development of non-communicable diseases. Public health interventions that reduce risky behaviors among adolescents are beneficial across the life course. This study assessed the level of non-communicable diseases (NCDs´) risk-related knowledge, the prevalence of NCDs´ risk behavior, and the sociodemographic predictors of NCDs´ risk-related knowledge and behaviors among in-school adolescents in a Southern Nigerian State. Methods: a cross-sectional study design was employed to assess the NCDs´ risk-related knowledge and behaviors among a random multistage sample of 607 students age between 10 and 19 years. Data were collected using an interviewer-administered semi-structured questionnaire adapted from the WHO STEPS questionnaire. Descriptive and inferential analyses of data collected were carried out using the IBM SPSS version 22 software. Results: the mean age of the students was 14.7 (SD=1.52) years, 57.2% (n=347) of which were females, and 42.8% (n=260) were males. The proportion of students with good overall NCDs risk-related knowledge was 22.7% (n=138). Age, place of residence, family's socioeconomic status, and mother's level of education were significant sociodemographic predictors of good overall NCD risk-related knowledge. Among the students, 66.2% (n=402) self-report inadequate physical activity, 65.7% (n=399) self-report consumption of unhealthy diets, 29.2% (n=177) self-report current alcohol use, and 3.3% (n=20) self-report they were current cigarette smokers. Conclusion: a significant proportion of the surveyed students had poor overall NCDs risk-related knowledge and engaged in NCDs risk behaviors. The relevant stakeholders concern with prevention of NCDs in government and non-governmental organizations should target adolescents in NCD control strategies in the study setting.

Family planning service availability and readiness assessment of primary health care facilities in Delta State, Nigeria: a mixed methods survey.

BACKGROUND: The availability of contraceptives, family planning guidelines, and Information, Education, and Communication (IEC) materials can increase access to family planning services. This study assessed the availability of commodities and readiness of primary health care (PHC) facilities in Delta State to offer family planning services. METHODS: A cross-sectional design with an explanatory mixed-method approach was used i.e., the authors first collected the quantitative data, and after preliminary analysis of quantitative information, the qualitative approach was utilised to gather data on the perspectives of 32 PHC facility managers and 6 reproductive health supervisors on factors affecting family planning service availability and readiness. RESULTS: Twenty-one (65.6%) of the PHC facilities surveyed offered at least five modern methods of family planning. Stock-outs of emergency contraceptives, implants, intra-uterine contraceptive device (IUCD), oral contraceptive pills (OCP), condoms, and injectables were observed in 31 (96.9%), 17 (53.1%), 13 (40.6%), 4 (12.5%), 2 (6.3%), and 1 (3.1%) of the facilities respectively. Eleven (34.4%) and 8 (25.0%) of the facilities had IEC materials and family planning guidelines, and contraceptive commodity checklists respectively. Seventeen (53.1%) of the facilities did not have complete records of family planning activities. CONCLUSION: This study shows that a significant proportion of PHC facilities had stock-outs of contraceptive commodities, no complete records of contraceptive activities, no IEC materials and no family planning checklists. Continuous training of health providers and increased government commitment can help to improve contraceptive services.

Prevalence and Predictors of Hypocalcaemia among Adolescent Girls in Rural Public Secondary Schools in South-South Nigeria.

Background: Adolescent girls are at risk of developing skeletal inadequacy due to an imbalance between calcium intake and high requirements of calcium during this period of increased modeling and skeletal consolidation. This study assessed the prevalence and predictors of hypocalcaemia among adolescent girls in rural public secondary schools in south-south Nigeria. Methods: This was a cross-sectional study conducted to assess the prevalence and predictors of hypocalcaemia among 238 adolescent girls selected by a multi-stage sampling technique. Data was collected using a semi-structured questionnaire which was interviewer-administered. Descriptive and inferential analysis of data collected was carried out using the IBM SPSS version 22 software. Results: Over half (53.3%) and 75.2% of the participants were in their late adolescence period (17-19 years) and belonged to the lower social class level. Over one-quarter (30.7%) of the participants had hypocalcaemia. Participants who were in their mid-adolescence period (14-16 years) (OR= 2.38; 95% CI: 1.23-4.57), who skipped lunch (OR= 2.92; 95% CI: 1.35-6.34), who skipped breakfast (OR= 3.60; 95% CI: 1.65-7.83) and were in senior secondary 1 class (OR= 4.76; 95% CI: 1.21-18.75) had 2, 3, 4, and 5 times higher likelihood respectively of having hypocalcaemia. Participants who consume milk daily, who consume milk weekly and who had normal weight had 81.0%, 60.0% and 72.0% decreased odds respectively of having hypocalcaemia. Conclusion: The study brings to the fore a high prevalence of hypocalcaemia among the participants. Educational interventions targeted at parents to support adolescent girls to take calcium-supplements and calcium-rich meals should be implemented.

A cross-sectional analysis of respiratory ill-health among charcoal workers and its implications for strengthening occupational health services in southern Nigeria.

OBJECTIVES: This study was conducted to assess the concentration of air pollutants at charcoal sites, the dose-response relationship between site-based exposure levels to air pollutants and prevalence of respiratory symptoms among charcoal workers, and the measures these workers employ to safeguard their health. DESIGN: Cross-sectional but comparative design SETTING: Charcoal production kiln sites in Sapele, Delta State, Nigeria. PARTICIPANTS: Overall 296 charcoal workers and age-matched, sex-matched and height-matched non-exposed traders (comparison group). PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was the prevalence of respiratory symptoms among charcoal workers while secondary outcomes included lung function indices as well as hazard control practices among charcoal workers. RESULTS: Majority (83.3%) of the sites had PM10 and PM2.5 values five times higher than the WHO standard. Charcoal workers were more likely to have respiratory symptoms; wheeze was statistically significant after adjusting for confounders, (OR 4.22; CI 1.37 to 12.99). The dose-response relationship between site-based exposure levels to air pollutants and the prevalence of respiratory symptoms among charcoal workers was statistically significant for all symptoms except chest tightness (p=0.167). Mean forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) were considerably lower among workers with differences of -0.22 (-0.42 to -0.05) L and -0.52 (-0.76 to -0.29) L, respectively, whereas FEV1/FVC ratio and peak expiratory flow rate were higher among workers with mean differences of 5.68 (3.59-8.82)% and 0.31 (-23.70 to 24.43) L/min, respectively; but the mean difference was significant only for the FEV1/FVC ratio. Charcoal workers had poor hazard control practices; only 3.4% reportedly used personal protective equipment. CONCLUSION: Air pollutants at kiln sites were higher than WHO standards. Despite the significantly higher prevalence of wheeze, chest tightness and chronic cough among charcoal workers, their hazard control practices were inadequate. Charcoal workers should adopt appropriate hazard control practices, and use improved devices which emit minimal pollutants.

Promotion of hand hygiene strengthening initiative in a Nigerian teaching hospital: implication for improved patient safety in low-income health facilities

Background: Health care-associated infection remains a significant hazard for hospitalized patients. Hand hygiene is a fundamental action for ensuring patient safety. Objective: To promote adoption of World Health Organization Hand Hygiene Guidelines to enhance compliance among doctors and nurses and improve patient safety. Methods: The study design was a cross sectional intervention in a Federal Teaching Hospital South-eastern Nigeria. Interventions involved training/education; introduction of hand rub; and hand hygiene reminders. The impact of interventions and hand hygiene compliance were evaluated using World Health Organization direct observation technique. Results: The post-intervention hand hygiene compliance rate was 65.3%. Hand hygiene indications showed highest compliance rate ‘after body fluid exposure' (75.3%) and ‘after touching a patient' (73.6%) while the least compliance rate was recorded ‘before touching a patient' (58.0%). Hand hygiene compliance rate was significantly higher among nurses (72.9%) compared to doctors (59.7%) (χ2 = 23.8, p < 0.05). Hand hygiene indication with significantly higher compliance rate was “before clean/aseptic procedure” (84.4%) (χ2 = 80.74, p < 0.05). Out of the 815 hand hygiene practices recorded 550 (67.5%) were hand rub action. Conclusions: hand hygiene campaigns using the World Health Organization tools and methodology can be successfully executed in a tertiary health facility of a low-income setting with far reaching improvements in compliance. .

Promotion of hand hygiene strengthening initiative in a Nigerian teaching hospital: implication for improved patient safety in low-income health facilities.

BACKGROUND: Health care-associated infection remains a significant hazard for hospitalized patients. Hand hygiene is a fundamental action for ensuring patient safety. OBJECTIVE: To promote adoption of World Health Organization Hand Hygiene Guidelines to enhance compliance among doctors and nurses and improve patient safety. METHODS: The study design was a cross sectional intervention in a Federal Teaching Hospital South-eastern Nigeria. Interventions involved training/education; introduction of hand rub; and hand hygiene reminders. The impact of interventions and hand hygiene compliance were evaluated using World Health Organization direct observation technique. RESULTS: The post-intervention hand hygiene compliance rate was 65.3%. Hand hygiene indications showed highest compliance rate 'after body fluid exposure' (75.3%) and 'after touching a patient' (73.6%) while the least compliance rate was recorded 'before touching a patient' (58.0%). Hand hygiene compliance rate was significantly higher among nurses (72.9%) compared to doctors (59.7%) (χ(2)=23.8, p<0.05). Hand hygiene indication with significantly higher compliance rate was "before clean/aseptic procedure" (84.4%) (χ(2)=80.74, p<0.05). Out of the 815 hand hygiene practices recorded 550 (67.5%) were hand rub action. CONCLUSIONS: hand hygiene campaigns using the World Health Organization tools and methodology can be successfully executed in a tertiary health facility of a low-income setting with far reaching improvements in compliance.

Assessment of organizational capacity for evidence-based health systems operations in Nigeria.

In Nigeria, health outcomes are unacceptably low largely due to the inability of the health system to function optimally. As part of a strategy to strengthen the health system, an assessment of institutional capacity for use of evidence for health system operations was conducted. The health system operations in terms of stewardship, health administration, service delivery, and access to essential medical products/technologies were fairly adequate. In terms of generation/strategic use of information, health financing, and health workforce, the operations were generally inadequate. There is need to evolve strategies that will guarantee equitable and sustained improvements across health services and health outcomes.

Research priority setting for health policy and health systems strengthening in Nigeria: the policymakers and stakeholders perspective and involvement.

INTRODUCTION: Nigeria is one of the low and middle income countries (LMICs) facing severe resource constraint, making it impossible for adequate resources to be allocated to the health sector. Priority setting becomes imperative because it guides investments in health care, health research and respects resource constraints. The objective of this study was to enhance the knowledge and understanding of policymakers on research priority setting and to conduct a research priority setting exercise. METHODS: A one-day evidence-to-policy research priority setting meeting was held. The meeting participants included senior and middle level policymakers and key decision makers/stakeholders in the health sector in Ebonyi State southeastern Nigeria. The priorities setting meeting involved a training session on priority setting process and conduction of priority setting exercise using the essential national health research (ENHR) approach. The focus was on the health systems building blocks (health workforce; health finance; leadership/governance; medical products/technology; service delivery; and health information/evidence). RESULTS: Of the total of 92 policymakers invited 90(97.8%) attended the meeting. It was the consensus of the policymakers that research should focus on the challenges of optimal access to health products and technology; effective health service delivery and disease control under a national emergency situation; the shortfalls in the supply of professional personnel; and the issues of governance in the health sector management. CONCLUSION: Research priority setting exercise involving policymakers is an example of demand driven strategy in the health policymaking process capable of reversing inequities and strengthening the health systems in LMICs.

Promotion of evidence-informed health policymaking in Nigeria: bridging the gap between researchers and policymakers.

In Nigeria, the lack of adequate understanding of the complex nature of translating research into policy and the incompatibility existing between researchers and policymakers constitute a great challenge to evidence-informed policymaking. To address these challenges a one-day evidence-to-policy training workshop was organised for policymakers, researchers and other major stakeholders in the health sector in southeastern Nigeria. Of the 104 individuals invited to the workshop 87 (83.6%) attended. The workshop training sessions focused on capacity development for evidence-informed health policy-making and building effective linkages/partnerships. The post-workshop assessment indicated significant improvements in participants' knowledge, their understanding of the health policymaking process and the use of evidence compared to their pre-workshop status. Using a focus group discussion, major strategies identified by participants that can bridge the gap between health policymakers and researchers included: involving both parties in planning and execution of health research and health programmes; promoting dialogue between researchers and policymakers; institutionalising research grants and commissioning research in health ministries; and ensuring that researchers are made to focus on the core needs of policymakers. There is need for further discussion and debate on the researchers and policymakers partnership concept in low income settings.

Enhancing leadership and governance competencies to strengthen health systems in Nigeria: assessment of organizational human resources development.

The lack of effective leadership and governance in the health sector has remained a major challenge in Nigeria and contributes to the failure of health systems and poor development of human resources. In this cross-sectional intervention study, leadership and governance competencies of policy makers were enhanced through a training workshop, and an assessment was conducted of organizational activities designed to promote evidence-informed leadership and governance to improve human resources for health (HRH). The training workshop increased the understanding of policy makers with regard to leadership and governance factors that ensure the functionality of health systems and improve human resources development, including policy guidance, intelligence and oversight, collaboration and coalition building, regulation, system design and accountability. Findings indicated that systems for human resources development exist in all participants' organizations, but the functionality of these systems was suboptimal. More systematic and standardized processes are required to improve competencies of leadership and governance for better human resources development in low-income settings.

Le manque de leadership et de gouvernance efficaces dans le secteur de la santé demeure un défi de taille au Nigeria et contribue à l'échec des systèmes de santé et au faible développement des ressources humaines. Cette étude transversale sur le terrain s'est penchée sur le renforcement, grâce à un atelier de formation, des compétences de leadership et de gouvernance chez les responsables de politiques ainsi que sur l'évaluation des activités organisationnelles conçues pour favoriser le leadership et la gouvernance fondés sur les données probantes afin d'améliorer les ressources humaines en santé. L'atelier de formation a permis aux responsables de politiques de mieux comprendre les facteurs du leadership et de la gouvernance qui permettent d'assurer la fonctionnalité des systèmes de santé et d'améliorer le développement des ressources humaines, notamment l'orientation des politiques, le renseignement et la surveillance, la mise en place de collaborations et de coalitions, la réglementation, la conception des systèmes et l'obligation de rendre compte. Les résultats indiquent la présence de systèmes pour le développement des ressources humaines dans toutes les organisations des participants, mais leur fonctionnalité reste sous-optimale. Des processus plus systématiques et normalisés sont nécessaires pour améliorer les compétences de leadership et de gouvernance afin d'assurer un meilleur développement des ressources humaines dans les établissements à faible revenu.

Assessment of the risk status of pregnant women presenting for antenatal care in a rural health facility in Ebonyi State, South Eastern Nigeria.

BACKGROUND: Nigeria has one of the worst maternal and child health indices globally. AIMS: The objective of this study was to assess the risk status of pregnant women presenting for antenatal care in a rural health facility in Ebonyi State, South East Nigeria. SUBJECTS AND METHOD: This was a cross-sectional descriptive study of pregnant women selected by systematic random sampling. The study instrument was a pre-tested semi-structured interviewer-administered questionnaire. RESULT: The age range of the women in the study was 16-43 years. The mean age was 25.3 ± 1.3 years. According to the scoring system used, about one-fourth of the women (26%) had a high risk pregnancy while about a tenth (9.1%) had very high risk pregnancy. The vast majority of the women with at-risk pregnancies registered for antenatal care late: 58.9 % registered for antenatal care in the second trimester and 37.0 % registered for antenatal care in the third trimester of pregnancy. Of the women with an at-risk pregnancy, 79.5% had their last delivery at home and 67.1 % of them preferred to deliver at home in their current pregnancies. CONCLUSION: This study revealed that a substantial proportion of rural women with at-risk pregnancies go through their pregnancy period without significant modern antenatal care. The local government health department should intensify efforts through health enlightenment campaigns to educate rural pregnant women of the benefits of utilizing modern antenatal care services.

Bacterial contamination of stethoscopes used by health workers: public health implications.

BACKGROUND: This study was designed to assess both the potential for bacterial transmission by stethoscopes used by health-care workers in Nigeria and the implications for patient safety and control of hospital-acquired infections. METHODOLOGY: A structured questionnaire was administered to health workers and the surface of the diaphragm of their stethoscopes swabbed for bacteriological analysis using standard techniques. RESULTS AND CONCLUSIONS: Of the 107 stethoscopes surveyed, 84 (79%) were contaminated with bacteria; 59 (81%) of the contaminated stethoscopes belonged to physicians and 25 (74%) were from other health workers. Isolates included Staphylococcus aureus (54%), Pseudomonas aeruginosa (19%), Enterococcus faecalis (14%), and Escherichia coli (13%). All stethoscopes that had never been cleaned were contaminated while lower levels of contamination were found on those cleaned one week or less before the survey (chi(2) = 22.4, P < .05). Contamination was significantly higher on stethoscopes cleaned with only water (100%) compared to those cleaned with alcohol (49%) (chi(2) = 30.17, P < .05). Significantly fewer (9%) stethoscopes from health workers who washed their hands after seeing each patient were contaminated when compared with the instruments (86%) of those who did not practice hand washing (chi(2) = 23.79, P < .05). E. coli showed the highest antibiotic resistance, while S. aureus showed the highest antibiotic susceptibility. Strict adherence to stethoscope disinfection practices by health workers can minimize cross-contamination and ensure improved patient safety in hospital environments.

Development of health policy and systems research in Nigeria: lessons for developing countries' evidence-based health policy making process and practice.

Health policy and systems research (HPSR), which aims to produce reliable and rigorous evidence to inform the many critical decisions that must be made about health systems, is a new concept in Nigeria. In this study, policy makers and other stakeholders in the health sector identified the challenges and the potential intervention strategies to HPSR evidence use in policy making in Nigeria. The major challenges identified included capacity constraints at individual and organizational levels, communication gaps and poor networking between policy makers and researchers, and the non-involvement of healthcare recipients in identifying and planning care delivery needs. The main solutions suggested included promotion of strategies to encourage partnership between researchers and policy makers, improvement of staff incentives and facilities for research activities, improved budgetary provision for research, and sustainable institutional capacity development. These strategies have been shown to improve evidence-based policy making in developed countries and are likely to produce better outcomes in the developing world.