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Introduction: Access to credit and information and communication technology (ICT) plays a pivotal role in enhancing the practices of small-scale sugarcane farmers, impacting their financial, social, and economic wellbeing. However, many small-scale farmers need help accessing these resources, thereby affecting their ability to generate sustainable income. This study aimed to assess the factors influencing the adoption of ICT and access to credit and their subsequent impact on small-scale farmers' income. Methods: Employing a multistage sampling technique, 300 small-scale farmers were selected as participants in the study. The recursive bivariate probit regression model was used to assess the factors affecting adoption ICT and a selectivity-corrected ordinary least square regression model was utilized to estimate the synergistic effect of ICT adoption and access to credit on the income of small-scale sugarcane farmers. Results and discussion: The findings revealed that approximately 77% of small-scale farmers had access to credit, while more than 80% had adopted ICT. The results derived from the recursive bivariate probit (RBP) regression model indicated that access to credit, education, and extension support positively and significantly influenced the adoption of ICT. Conversely, marital status and non-farm income exhibited a negative and significant influence on the adoption of ICT. Gender and marital status were positively and significantly associated with access to credit, whereas age, education, and non-farm income showed a negative and significant relationship on access to credit. Subsequently, a selectivity-corrected ordinary least square regression model analysis revealed that factors such as gender, marital status, extension, government support, and transportation costs positively and significantly influenced farmer's income. In contrast, education, employment status, and non-farm income exhibited a negative and significant influence on income. Conclusion and recommendations: The study concludes that socio-demographic factors, such as gender, marital status, extension support, government support, and transportation costs, positively contribute to farmers' income. Small-scale sugarcane farmer involvement in other non-farm activities is associated with reduced farm income. This implies that farmers' livelihoods options are reduced as they can only focus on sugarcane development as a source of income. There is a pressing need to educate small-scale farmers on ICT and provide them with access to agricultural credit. Additionally, extension workers should offer advisory support to small-scale farmers requiring assistance in accessing agricultural credit. There is a need to train sugarcane farmers on different agricultural income generating activities to reduce their over-reliance on sugarcane development. By addressing the identified socio-demographic factors and implementing targeted policy interventions, stakeholders can foster an enabling environment for small-scale farmers to thrive, ultimately contributing to the sustainable development of the sugarcane sector and the broader agricultural landscape in South Africa.
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Addressing food security is one of the national priorities in South Africa, enshrined under the country's constitution, yet there is a growing percentage of households struggling to meet their food requirements. Food insecurity and malnutrition remain severe problems in rural communities and can be addressed through home gardening. This study aimed to assess the contributions of home gardens to food security in Limpopo Province. This study employed a quantitative research methodology. A total of 2043 rural households were selected using multistage stratified random sampling. The Household Food Insecurity Access Scale (HFIAS) was used to measure household food insecurity levels of home garden participants. Results showed that 46% of participants were food secure, 24% were severely food insecure, 17% were moderately food insecure and 13% were mildly food insecure. The results from the endogenous switching Poisson regression model showed that gender, household size, wage/salary, access to land, agriculture-related assistance and market distance had a positive influence on household food security of home garden participants. On the other hand, employment status and receiving any social relief had a negative association with household food security of home garden participants. The results also showed that employment status had a positive influence on the food security of home garden non-participants, while education, access to land, wage/salary and age had a negative influence. The results from average treatment effects (ATEs) showed that households that participated in home garden production had a negative and significant (p-value < 0.05) impact on household food insecurity. This study concludes that involvement in home gardening improves food security. Household food security can be enhanced through agricultural training and skills enhancement directed at increasing participation in home gardening in rural areas, thus addressing income and food security challenges. Agricultural education needs to be introduced and facilitated at school levels so that an understanding of food systems, nutrition and food security can be attained from younger age groups.
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The COVID-19 pandemic challenged health systems globally. Reverse transcription polymerase chain reaction (RT-PCR) is the gold standard for detecting the presence of SARS-CoV-2 in clinical samples. Rapid diagnostic test (RDT) kits for COVID-19 have been widely used in Nigeria. This has greatly improved test turnover rates and significantly decreased the high technical demands of RT-PCR. However, there is currently no nationally representative evaluation of the performance characteristics and reliability of these kits. This study assessed the sensitivity, specificity, and predictive values of ten RDT kits used for COVID-19 testing in Nigeria. This large multi-centred cross-sectional study was conducted across the 6 geo-political zones of Nigeria over four months. Ten antigen (Ag) and antibody (Ab) RDT kits were evaluated, and the results were compared with RT-PCR. One thousand, three hundred and ten (1,310) consenting adults comprising 767 (58.5%) males and 543 (41.5%) females participated in the study. The highest proportion, 757 (57.7%), were in the 20-39 years' age group. In terms of diagnostic performance, Lumira Dx (61.4, 95% CI: 52.4-69.9) had the highest sensitivity while MP SARS and Panbio (98.5, 95% CI: 96.6-99.5) had the highest specificity. For predictive values, Panbio (90.7, 95% CI: 79.7-96.9) and Lumira Dx (81.2, 95% CI: 75.9-85.7) recorded the highest PPV and NPV respectively. Ag-RDTs had better performance characteristics compared with Ab-RDTs; however, the sensitivities of all RDTs in this study were generally low. The relatively high specificity of Ag-RDTs makes them useful for the diagnosis of infection in COVID-19 suspected cases where positive RDT may not require confirmation by molecular testing. There is therefore the need to develop RDTs in-country that will take into consideration the unique environmental factors, interactions with other infectious agents, and strains of the virus circulating locally. This may enhance the precision of rapid and accurate diagnosis of COVID-19 in Nigeria.
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The high burden of anaemia during pregnancy underscores the urgent need to gain a comprehensive understanding of the factors contributing to its widespread occurrence. Our study assessed the prevalence and the trends of moderate-to-severe anaemia (MSA) in late pregnancy (28 to 36 weeks) and then investigated the key determinants driving this prevalence among women in Lagos, Nigeria. We conducted a secondary data analysis involving 1216 women enrolled in the Predict-PPH study between January and March 2023. We employed a multivariate binary logistic regression model with a backward stepwise selection approach to identify significant predictors of MSA. The study revealed a 14.5% prevalence of MSA during pregnancy. Independent predictors of MSA included having given birth to two or more children (adjusted odds ratio = 1.46, 95% confidence interval: 1.03-2.07), having a maternal body mass index (BMI) of 28 kg/m2 or higher (adjusted odds ratio = 1.84, 95% confidence interval: 1.29-2.61), having less than tertiary education (adjusted odds ratio = 1.51, 95% confidence interval: 1.08-2.11), and being unemployed (adjusted odds ratio = 1.97, 95% confidence interval: 1.19-3.26). It is crucial for pregnant women, particularly those with higher parities and elevated BMI, to be monitored regularly for anaemia and its consequences during their antenatal care. Additionally, addressing the link between low education, unemployment, and anaemia necessitates comprehensive strategies that empower women in terms of education and economic status to enhance the overall well-being of individuals and communities, ultimately reducing the prevalence of anaemia and associated health issues in pregnancy.
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Anemia , Pregnancy Complications, Hematologic , Pregnancy Trimester, Third , Humans , Female , Pregnancy , Nigeria/epidemiology , Anemia/epidemiology , Adult , Prevalence , Cross-Sectional Studies , Pregnancy Complications, Hematologic/epidemiology , Young Adult , Risk Factors , Body Mass IndexABSTRACT
BACKGROUND: Most previous clinical studies investigating the connection between prenatal anaemia and postpartum haemorrhage (PPH) have reported conflicting results. OBJECTIVES: We examined the association between maternal prenatal anaemia and the risk of PPH in a large cohort of healthy pregnant women in five health institutions in Lagos, Southwest Nigeria. METHODS: This was a prospective cohort analysis of data from the Predict-PPH study that was conducted between January and June 2023. The study enrolled n = 1222 healthy pregnant women giving birth in five hospitals in Lagos, Nigeria. The study outcome, WHO-defined PPH, is postpartum blood loss of at least 500 milliliters. We used a multivariable logistic regression model with a backward stepwise conditional approach to examine the association between prenatal anaemia of increasing severity and PPH while adjusting for confounding factors. RESULTS: Of the 1222 women recruited to the Predict-PPH study between January and June 2023, 1189 (97·3%) had complete outcome data. Up to 570 (46.6%) of the enrolled women had prenatal anaemia while 442 (37.2%) of those with complete follow-up data had WHO-defined PPH. After controlling for potential confounding factors, maternal prenatal anaemia was independently associated with PPH (adjusted odds ratio = 1.37, 95% confidence interval: 1.05-1.79). However, on the elimination of interaction effects of coexisting uterine fibroids and mode of delivery on this association, a sensitivity analysis yielded a lack of significant association between prenatal anaemia and PPH (adjusted odds ratio = 1.27, 95% confidence interval: 0.99-1.64). We also recorded no statistically significant difference in the median postpartum blood loss in women across the different categories of anaemia (P = 0.131). CONCLUSION: Our study revealed that prenatal anaemia was not significantly associated with PPH. These findings challenge the previously held belief of a suspected link between maternal anaemia and PPH. This unique evidence contrary to most previous studies suggests that other factors beyond prenatal anaemia may contribute more significantly to the occurrence of PPH. This highlights the importance of comprehensive assessment and consideration of various maternal health factors in predicting and preventing this life-threatening obstetric complication.
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Anemia , Postpartum Hemorrhage , Pregnancy , Humans , Female , Nigeria/epidemiology , Postpartum Hemorrhage/epidemiology , Prospective Studies , Anemia/epidemiology , Family , VitaminsABSTRACT
BACKGROUND: HIV self-testing (HIVST) among young people is an effective approach to enhance the uptake of HIV testing recommended by the World Health Organization. However, the COVID-19 pandemic disrupted conventional facility-based HIV testing services, necessitating the exploration of innovative strategies for the effective delivery of HIVST. OBJECTIVE: This study analyzed the outcomes of a digital World AIDS Day crowdsourcing open call, designed to elicit youth responses on innovative approaches to promote HIVST among young people (14-24 years) in Nigeria during COVID-19 restrictions. METHODS: From November 2 to 22, 2020, a World AIDS Day 2020 crowdsourcing open call was held digitally due to COVID-19 restrictions. The crowdsourcing open call followed World Health Organization standardized steps, providing a structured framework for participant engagement. Young people in Nigeria, aged 10-24 years, participated by submitting ideas digitally through Google Forms or email in response to this crowdsourcing open call prompt: "How will you promote HIV self-testing among young people during COVID-19 pandemic?" Data and responses from each submission were analyzed, and proposed ideas were closely examined to identify common themes. Four independent reviewers (AE, SM, AZM, and TG) judged each submission based on the desirability, feasibility, and impact on a 9-point scale (3-9, with 3 being the lowest and 9 being the highest). RESULTS: The crowdsourcing open call received 125 eligible entries, 44 from women and 65 from men. The median age of participants was 20 (IQR 24-20) years, with the majority having completed their highest level of education at the senior secondary school level. The majority of participants lived in the South-West region (n=61) and Lagos state (n=36). Of the 125 eligible entries, the top 20 submissions received an average total score of 7.5 (SD 2.73) or above. The panel of judges ultimately selected 3 finalists to receive a monetary award. Three prominent themes were identified from the 125 crowdsourcing open call submissions as specific ways that HIVST can adapt during the COVID-19 pandemic: (1) digital approaches (such as gamification, photoverification system, and digital media) to generate demand for HIVST and avoid risks associated with attending clinics, (2) awareness and sensitization through existing infrastructures (such as churches, schools, and health facilities), and (3) partnerships with influencers, role models, and leaders (such as religious and youth leaders and social influencers in businesses, churches, organizations, and schools) to build trust in HIVST services. CONCLUSIONS: The crowdsourcing open call effectively engaged a diverse number of young people who proposed a variety of ways to improve the uptake of HIVST during the COVID-19 pandemic. Findings contribute to the need for innovative HIVST strategies that close critical knowledge and practice gaps on ways to reach young people with HIVST during and beyond the pandemic. TRIAL REGISTRATION: ClinicalTrials.gov NCT04710784; https://clinicaltrials.gov/study/NCT04710784.
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OBJECTIVES: There is currently a limited ability to accurately identify women at risk of postpartum hemorrhage (PPH). We conducted the "Predict-PPH" study to develop and evaluate an antepartum prediction model and its derived risk-scoring system. METHODS: This was a prospective cohort study of healthy pregnant women who registered and gave birth in five hospitals in Lagos, Nigeria, from January to June 2023. Maternal antepartum characteristics were compared between women with and without PPH. A predictive multivariable model was estimated using binary logistic regression with a backward stepwise approach eliminating variables when P was greater than 0.10. Statistically significant associations in the final model were reported when P was less than 0.05. RESULTS: The prevalence of PPH in the enrolled cohort was 37.1%. Independent predictors of PPH such as maternal obesity (adjusted odds ratio [aOR] 3.25, 95% confidence interval [CI] 2.47-4.26), maternal anemia (aOR 1.32, 95% CI 1.02-1.72), previous history of cesarean delivery (aOR 4.24, 95% CI 3.13-5.73), and previous PPH (aOR 2.65, 95% CI 1.07-6.56) were incorporated to develop a risk-scoring system. The area under the receiver operating characteristic curve (AUROC) for the prediction model and risk scoring system was 0.72 (95% CI 0.69-0.75). CONCLUSION: We recorded a relatively high prevalence of PPH. Our model performance was satisfactory in identifying women at risk of PPH. Therefore, the derived risk-scoring system could be a useful tool to screen and identify pregnant women at risk of PPH during their routine antenatal assessment for birth preparedness and complication readiness.
Subject(s)
Postpartum Hemorrhage , Humans , Female , Postpartum Hemorrhage/epidemiology , Nigeria/epidemiology , Pregnancy , Prospective Studies , Adult , Risk Assessment , Risk Factors , Prevalence , Young Adult , Logistic Models , ROC Curve , Cohort StudiesABSTRACT
Gender differences in productivity are one of the major obstacles impeding the development of agriculture in Africa and Nigerian particularly. With the Oaxaca-Blinder (OB) and exogenous switching treatment regression (ESTER) models, this study investigates the causes of the productivity differences among 360 sampled rice farmers in Nigeria as well as gender inequality in agricultural productivity. The findings showed that there is an inequalities between men and women, which contributes to a gender productivity gap of almost 29 % in favour of men. As a result, plots managed by women are 29 % less productive than plots handled by men. The analysis of the factors influencing gender variations in production reveals that the endowment component, which accounts for 15 % of the productivity gap, is significantly influenced by marital status, education, farm size, and access to market information. Similarly, the ESTER results show that the rice yield of FHHs would have decreased by 25.41 kg/ha (a 1.02 % reduction) if they had been assigned the same returns to the observed features of MHHs. This difference is significant at the 1 % level. Thus, the findings imply that the FHHs are not at a yield disadvantage when compared to the MHHs. Therefore, it can be said that there are gender productivity disparities in the Nigerian agricultural industry. As such, policy interventions aimed at empowering women must take these disparities into consideration as well as the causes that contribute to them. Overall, the results demonstrate that although policymakers and their development partners can use improved technologies to increase MHH and FHH yields, reducing the difference in market linkages is necessary to close the gender gap in rice productivity and provide FHHs with equal access to the market.
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Objectives: This study developed an Air Quality Health Index (AQHI) based on global scientific evidence and applied it to data from Cape Town, South Africa. Methods: Effect estimates from two global systematic reviews and meta-analyses were used to derive the excess risk (ER) for PM2.5, PM10, NO2, SO2 and O3. Single pollutant AQHIs were developed and scaled using the ERs at the WHO 2021 long-term Air Quality Guideline (AQG) values to define the upper level of the "low risk" range. An overall daily AQHI was defined as weighted average of the single AQHIs. Results: Between 2006 and 2015, 87% of the days posed "moderate to high risk" to Cape Town's population, mainly due to PM10 and NO2 levels. The seasonal pattern of air quality shows "high risk" occurring mostly during the colder months of July-September. Conclusion: The AQHI, with its reference to the WHO 2021 long-term AQG provides a global application and can assist countries in communicating risks in relation to their daily air quality.
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Air Pollutants , Air Pollution , Humans , Air Pollutants/analysis , Nitrogen Dioxide/analysis , South Africa , Air Pollution/analysis , World Health Organization , Particulate Matter/analysisABSTRACT
Introduction: Mother-to-child transmission remains an important mode of transmission of hepatitis B infection particularly in endemic areas. The knowledge and practices of pregnant women about mother-to-child transmission (MTCT) of hepatitis B virus (HBV) may influence the uptake of strategies to reduce mother-to-child transmission of infection. Objectives: This study assessed the knowledge and willingness to uptake hepatitis B virus infection preventive services among pregnant women in Ado-Ekiti, Nigeria. Methods: This was a cross-sectional study that involved 373 pregnant women at the Ekiti State University Teaching Hospital (EKSUTH) and Maternal Child Specialist Clinics, Ado-Ekiti, Nigeria. A structured questionnaire was used to assess their knowledge, practices, and perceptions about MTCT of hepatitis B infection. Results: Only 52.5% (196) of the respondents had good knowledge, although the majority 290 (77.7%) had heard of hepatitis B infection prior to the survey. Only 147 (39.4%) of the respondents had ever had hepatitis B screening. More persons with professional jobs had good knowledge about hepatitis B infection compared with other occupations (p < 0.001). However, more respondents aged 30-34 years had poor knowledge about hepatitis B infection compared with other age groups (p = 0.045). Respondents with good knowledge about hepatitis B infection were willing to uptake hepatitis B infection prevention services (p < 0.001). Conclusion: This study showed that respondents with professional jobs had good knowledge about hepatitis B infection and those who had good knowledge about the infection were willing to utilize hepatitis B preventive measures. Awareness of MTCT of HBV did not translate into good practice as only few respondents had screened for hepatitis B. There is a need to intensify education about modes of transmission of hepatitis B infection with an emphasis on promoting good preventive practices.
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Background and Aims: Qigong and Tai Chi (QTC) are mind-body exercises involving a sequence of graceful movements, which promote self-healing, meditation, and self-cultivation. There is growing evidence that Qigong and/or Tai Chi therapy may improve the physical and psychological health among adults with multiple health conditions including joint movement. This systematic review aims to synthesize the available evidence on the type and effectiveness of QTC therapies used in the management of temporomandibular joint (TMJ) dysfunction. Methods: This systematic review followed the AMSTAR-2 guideline, and it was reported based on guidelines in the PRISMA checklist. The review involved a systematic search of nine electronic databases. After deduplication and screening of the literature retrieved from the search, only one article was included based on the review's inclusion criteria. Data was extracted from this article and synthesized. Results: The only included article was on a non-randomized control trial which investigated the role of Tai Chi Qigong (a form of Qigong) therapy in improving joint mobility and alleviating trismus among 52 survivors of nasopharyngeal carcinoma who had TMJ disorders. The study reported, at different time intervals (at pretest; at mid-intervention; at posttest; and at follow-up posttest), that no significant difference (p > 0.05) was observed concerning mouth opening capacity between the intervention group and the control group. However, over time, less severe deterioration in mouth-opening was noted among the participants in the intervention group (p = 0.181) as compared to the control group (p < 0.001). Conclusion: The role of QTC therapies in improving joint mobility and alleviating trismus is not yet fully understood, but it seems promising. The available evidence is inadequate to categorically conclude on the efficacy of these therapies. Further studies will be required to fully assess the effectiveness of QTC therapies in the management of TMJ dysfunction.
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BACKGROUND: Limited human resource for health may impede the attainment of health-related sustainable development goals in low-income countries. This study aims to identify migration factors among final-year students of health-related disciplines at a Nigerian university, reflecting trends in Nigeria and sub-Saharan African countries. METHODS: A cross-sectional study was conducted using a semi-structured, self-administered questionnaire to collect data from 402 final-year students of Medicine/Dentistry, Nursing, Pharmacy and Occupational therapy Physiotherapy at Obafemi Awolowo University, Ile Ife. Univariate, bivariate and multivariate data analysis were conducted and a p-value < 0.05 was taken as statistically significant. RESULTS: The mean age of the respondents was 24.3 ± 2.3 years. Most (326; 81.1%) respondents had intentions to migrate and majority (216; 53.7%) of respondents had an unfavourable attitude towards practising in Nigeria. Students of Nursing constitute the highest proportion (68; 91.9%) of those willing to migrate (p = 0.009). The common preferred destinations for those who intend to migrate were the United Kingdom (84; 25.8%), Canada (81; 24.8%), and the United States of America (68; 20.9%). Respondents who had favourable attitude towards practicing abroad (AO.R: 2.9; 95% C.I 1.6-5.2; p = 0.001) were three times more likely to have migration intentions compared with those who had an unfavourable attitude towards practicing abroad, while the odds for those who had favourable attitude towards practicing in Nigeria (AO.R: 0.4; 95% C.I 0.2-0.7; p = 0.002) was two times less than those who had an unfavourable attitude towards practice in Nigeria. Respondents who desire specialist training (AO.R: 3.0; 95% C.I 1.7-5.4; p < 0.001) were three times more likely to have intention to migrate abroad when compared to those who were undecided or had no desire to pursue specialist training. CONCLUSION: Most respondents had the intention to migrate abroad after graduation and this could be attributed to the desire for specialist training and their attitude towards practising in Nigeria. Interventions aimed at improving specialist training in Nigeria and incentivizing health care practice may reduce migration trends among Nigeria's health professionals in training.
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Intention , Students, Medical , Humans , Young Adult , Adult , Nigeria , Cross-Sectional Studies , Health Personnel , Surveys and QuestionnairesABSTRACT
Introduction: High crop productivity has the potential to improve the food and nutrition security status of not only smallholder farmers but also households in general. However, smallholder farmers operate in a dynamic environment whereby their crop production is affected by various factors that hinder it from lessening food insecurity and malnutrition in rural areas. The study investigated the determinants of crop productivity and its effect on household food and nutrition security status in South Africa. Methods: This study employed a quantitative research method. A total of 1520 households were selected using the multi-stage stratified random sampling technique. Out of the total sample size of 1520, 386 were crop producers, 176 producers were from Mpumalanga province, and 210 producers were from the Limpopo province. Results and discussion: Most of the smallholder farmers do not have access to the irrigation system, mechanization, and agricultural inputs. The Household Food Insecurity Access Scale showed that most smallholder farmers were food insecure, with 78% of the farmers in each province found to be food insecure. The results from Household Dietary Diversity Score (HDDS) showed that in the overall sampled population, 50% of smallholder farmers had highly diverse diets. Only 50% of the smallholder farmers had high dietary diversity in each province. Irrigation systems and involvement in crop production had a positive influence on the crop productivity of smallholder farmers. The results from the Conditional Mixed Process (CMP) model showed that ownership of livestock, harvest, and disability in the family negatively impacted smallholder farmers' food security status while household size had a positive effect on the food security of smallholder farmers. The results also showed that social grants, agricultural assistance, and harvest had a negative impact on the nutrition status of smallholder farmers. While household size had a positive impact on the nutrition status of smallholder farmers. Conclusion and recommendations: Factors such as irrigation systems and involvement in crop production influenced crop productivity. Household size influenced the nutritional status of smallholder farmers while harvest size affected the food security status. There is a need to encourage more households to get involved in farming. Government and nongovernmental organizations need to support smallholder farmers with agricultural productive resources like irrigation systems to improve their crop productivity.
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Background: Anaemia in pregnancy remains a severe public health problem in sub-Saharan African countries including Nigeria. Objectives: To assess factors associated with anaemia in pregnancy among Nigerian women. Methods: A secondary analysis of the 2018 Nigeria demographic health survey was conducted to determine the predictors of anaemia among Nigerian pregnant women (N=1522). SAS 9.4 was used for the analysis. Results: The prevalence of anaemia in pregnancy was 61.1%. On multivariable logistic regression analysis, women in the North-central (AOR=2.52, CI=1.46-4.35) and South-south (AOR=2.21, CI=1.06-4.59) had increased odds of anaemia in pregnancy, compared to those in the Northwest. Women with no education (AOR=2.38, CI=1.28-4.44), primary education (AOR=3.06, CI=1.58-5.96) and secondary education (AOR=1.75, CI=1.04-2.94) had increased odds of anaemia in pregnancy compared to women with teriary education. Also, women not in marital union had increased odds of anaemia in pregnancy compared to women in a union (AOR=2.56, CI=1.15-5.72). Women in the second (AOR=2.42, CI=1.79-3.29) and third trimesters of pregnancy (AOR=2.83, CI=2.07-3.89) had increased odds of anaemia. Conclusion: These findings are important for the control of anemia among pregnant Nigerian women. Women in the Northcentral and Southsouth zones are particularly at risk for anaemia in pregnancy and should receive special attention during antenatal care.
Subject(s)
Anemia , Pregnancy Complications, Hematologic , Pregnancy , Female , Humans , Pregnancy Complications, Hematologic/epidemiology , Anemia/epidemiology , Prenatal Care , Pregnant Women , Educational Status , PrevalenceABSTRACT
BACKGROUND: We evaluated cervical cancer program for women living with HIV (WLHIV) to determine program screening rate, primary case finder screening accuracy and treatment and post-treatment screening rate among screen-positive patients. METHODS: A ten-month review of cervical cancer program data among WLHIV aged 15-49 years on HIV care across forty-one comprehensive ART sites, supported by APIN (a PEPFAR implementing partner) for cervical cancer screening and treatment in Nigeria, was conducted from October 2020 to July 2021. Initial screening was done using visual inspection with acetic acid (VIA) followed by a gynaecologist expert review through a program-designed software named AVIVA, as a confirmatory test. Associations were measured between the primary case finder screening accuracy and study covariates at p-value of 0.05. RESULTS: About 10,289 asymptomatic women aged 15-49 years living with HIV were screened for cervical cancer by primary case finders using VIA-based screening test. About 732 (7.1%) had a positive screening test suggestive of precancerous lesions or cervical cancer. Three hundred and fifteen (43.0%) of VIA positive women had treatment using thermal ablation and less than one-third (21.6%) of those treated came back for post-treatment screening test. Primary case finder screening sensitivity, specificity, positive predictive and negative predictive accuracy using gynaecologist review as confirmatory test were 60.8%, 71.5%, 41.7% and 84.5% respectively. Overall screening accuracy was 68.8%. CONCLUSION AND RECOMMENDATIONS: This innovative approach to cervical cancer screening among WLHIV yielded modest results in preventing program error and wastages. Wider deployment of expert-based reviews of VIA though AVIVA software might be a veritable approach to improve screening accuracy in low resource settings.
Subject(s)
HIV Infections , Uterine Cervical Neoplasms , Humans , Female , Early Detection of Cancer , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/therapy , Nigeria , Acetic Acid , HIV Infections/complications , HIV Infections/diagnosisABSTRACT
In South Africa, the population at risk of malaria is 10% (around six million inhabitants) and concern only three provinces of which Limpopo Province is the most affected, particularly in Vhembe District. As the elimination approaches, a finer scale analysis is needed to accelerate the results. Therefore, in the process of refining local malaria control and elimination strategies, the aim of this study was to identify and describe malaria incidence patterns at the locality scale in the Vhembe District, Limpopo Province, South Africa. The study area comprised 474 localities in Vhembe District for which smoothed malaria incidence curve were fitted with functional data method based on their weekly observed malaria incidence from July 2015 to June 2018. Then, hierarchical clustering algorithm was carried out considering different distances to classify the 474 smoothed malaria incidence curves. Thereafter, validity indices were used to determine the number of malaria incidence patterns. The cumulative malaria incidence of the study area was 4.1 cases/1000 person-years. Four distinct patterns of malaria incidence were identified: high, intermediate, low and very low with varying characteristics. Malaria incidence increased across transmission seasons and patterns. The localities in the two highest incidence patterns were mainly located around farms, and along the rivers. Some unusual malaria phenomena in Vhembe District were also highlighted as resurgence. Four distinct malaria incidence patterns were found in Vhembe District with varying characteristics. Findings show also unusual malaria phenomena in Vhembe District that hinder malaria elimination in South Africa. Assessing the factors associated with these unusual malaria phenome would be helpful on building innovative strategies that lead South Africa on malaria elimination.
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Malaria , Humans , South Africa/epidemiology , Incidence , Seasons , Malaria/epidemiology , Malaria/prevention & control , AlgorithmsABSTRACT
The war in Syria, which started over 11 years ago, has devastated the country's water sources, healthcare system, and other vital facilities for healthy living. The country is vulnerable to outbreaks, especially epidemic-prone ones like cholera, due to its fragile health system. Syria experienced its last hit of cholera in 2009, which led to the deaths of several Syrian children and affected about 1,000 people. The current cholera resurgence in Syria calls for public concern. Considering the poor access to clean water, the forced relocation of people, and other destruction caused by the war, these factors have exposed Syrian children to infectious diseases like cholera. We argued for more efforts toward the implementation of Water, Sanitation and Hygiene (WASH) in the country. We also pointed out the need for proper education and sensitization campaigns using all available resources to educate the populace, mass chlorination of wells, mapping vulnerable areas, and implementing WASH while encouraging vaccination coverage for cholera as a strategy to reduce its incidence. Improving the national surveillance systems will aid in the timely and appropriate reporting of any outbreak. Again, more negotiations should be done to seek a lasting solution to ending the war and restoring peace and serenity in the country.
Subject(s)
Cholera , Epidemics , Child , Humans , Cholera/epidemiology , Syria/epidemiology , Disease Outbreaks , WaterABSTRACT
This study compared neurological complications among a national sample of United States children with or without sickle cell disease (SCD) and evaluated health status, healthcare and special education utilization patterns, barriers to care, and association of SCD status and demographics/socioeconomic status (SES) on comorbidities and healthcare utilization. Data was acquired from the National Health Interview Survey (NHIS) Sample Child Core questionnaire 2007-2018 dataset that included 133,542 children. An affirmation from the guardian of the child determined the presence of SCD. Regression analysis was used to compare the associations between SCD and demographics/SES on neurological conditions at p < 0.05. Furthermore, adjusted odds ratios (AORs) were estimated for having various neurological conditions. Of the 133,481 children included in the NHIS, the mean age was 8.5 years (SD: 0.02) and 215 had SCD. Of the children with SCD, the sample composition included male (n = 110), and Black (n = 82%). The SCD sample had higher odds of having neuro-developmental conditions (p < 0.1). Families of Black children (55% weighted) reported household incomes < 100% of federal poverty level. Black children were more likely to experience longer wait times to see the doctor (AOR, 0.3; CI 0.1-1.1). Compared to children without SCD, those with SCD had a greater chance of seeing a medical specialist within 12 months (AOR 2.3; CI 1.5-3.7). This representative sample of US children with SCD shows higher odds of developing neurological complications, increased healthcare and special education services utilization, with Black children experiencing a disproportionate burden. This creates the urgency to address the health burden for children with SCD by implementing interventions in healthcare and increasing education assistance programs to combat neurocognitive impairments, especially among Black children.
Subject(s)
Anemia, Sickle Cell , Nervous System Diseases , Child , Humans , Male , Anemia, Sickle Cell/complications , Anemia, Sickle Cell/epidemiology , Anemia, Sickle Cell/ethnology , Black People/statistics & numerical data , Delivery of Health Care , Health Status , Nervous System Diseases/epidemiology , Nervous System Diseases/etiology , Surveys and Questionnaires , United States/epidemiology , Facilities and Services Utilization/statistics & numerical data , Health Services Accessibility , Social Determinants of Health/ethnology , Social Determinants of Health/statistics & numerical data , Female , Cost of Illness , Neurocognitive Disorders/epidemiology , Neurocognitive Disorders/ethnology , Neurocognitive Disorders/etiologyABSTRACT
Food insecurity continues to be a burden for many South Africans. The production and consumption of fruits and vegetables have a potential role in improving household food security and are considered one of the critical pathways for reducing food insecurity and malnutrition levels in the country. This paper set out to determine the effect of fruits and vegetables on the food security status of rural households in the Limpopo province. Data (secondary) for this study were collected from 2043 respondents who were selected through stratified random selection based on the population size of the district municipalities in Limpopo. This study used a quantitative research approach, and data were analyzed using a descriptive analysis, the household food insecurity access scale (HFIAS), and a Poisson regression model with an endogenous treatment model. The findings revealed that gender and involvement in agricultural production had a positive significant relationship with the consumption of fruits and vegetables, while disability grants had a negative impact. Age, household size, and receiving a disability grant had a positive significant impact on determining the household food insecurity status; however, gender had a negative significant relationship. This study concluded that the consumption of fruits and vegetables considerably influenced the food security status of the household. There is a need for government officials and local leaders to provide food security interventions that prioritize women and elders. These may include promoting household production and consumption of diversified fruits and vegetables.
Subject(s)
Fruit , Vegetables , Humans , Female , Aged , Food Supply , Rural Population , Food SecurityABSTRACT
The COVID-19 pandemic has further aggravated the burden of mental health and presents an opportunity for public health research to focus on evidence-based interventions appropriate for populations residing in resource-constrained, post-conflict settings. Post-conflict settings have a higher service gap in mental health and fewer protective factors, such as economic and domestic security. Post-conflict settings are defined as locations where open warfare has ended but resulting challenges have remained for years. A strong emphasis on the engagement of diverse stakeholders is needed to arrive at sustainable and scalable solutions to mental health service delivery. This review discusses mental health service delivery gaps in post-conflict settings, highlights the urgency of the matter in the context of the COVID-19 pandemic, and provides recommendations for service gaps from evidence-based case study exemplars with an implementation science lens using the Consolidated Framework for Implementation Research (CFIR) as guide to improving adaptation and uptake.