Risk Factor Characterization of Ischemic Stroke Subtypes Among West Africans.

BACKGROUND AND PURPOSE: To identify the qualitative and quantitative contributions of conventional risk factors for occurrence of ischemic stroke and its key pathophysiologic subtypes among West Africans. METHODS: The SIREN (Stroke Investigative Research and Educational Network) is a multicenter, case-control study involving 15 sites in Ghana and Nigeria. Cases include adults aged ≥18 years with ischemic stroke who were etiologically subtyped using the A-S-C-O-D classification into atherosclerosis, small-vessel occlusion, cardiac pathology, other causes, and dissection. Controls were age- and gender-matched stroke-free adults. Detailed evaluations for vascular, lifestyle, and psychosocial factors were performed. We used conditional logistic regression to estimate adjusted odds ratios with 95% CI. RESULTS: There were 2431 ischemic stroke case and stroke-free control pairs with respective mean ages of 62.2±14.0 versus 60.9±13.7 years. There were 1024 (42.1%) small vessel occlusions, 427 (17.6%) large-artery atherosclerosis, 258 (10.6%) cardio-embolic, 3 (0.1%) carotid dissections, and 719 (29.6%) undetermined/other causes. The adjusted odds ratio (95% CI) for the 8 dominant risk factors for ischemic stroke were hypertension, 10.34 (6.91-15.45); dyslipidemia, 5.16 (3.78-7.03); diabetes, 3.44 (2.60-4.56); low green vegetable consumption, 1.89 (1.45-2.46); red meat consumption, 1.89 (1.45-2.46); cardiac disease, 1.88 (1.22-2.90); monthly income $100 or more, 1.72 (1.24-2.39); and psychosocial stress, 1.62 (1.18-2.21). Hypertension, dyslipidemia, diabetes were confluent factors shared by small-vessel, large-vessel and cardio-embolic subtypes. Stroke cases and stroke-free controls had a mean of 5.3±1.5 versus 3.2±1.0 adverse cardio-metabolic risk factors respectively (P<0.0001). CONCLUSIONS: Traditional vascular risk factors demonstrate important differential effect sizes with pathophysiologic, clinical and preventative implications on the occurrence of ischemic stroke among indigenous West Africans.

A qualitative focus group study concerning perceptions and experiences of Nigerian mothers on stillbirths.

OBJECTIVE: To explore the experiences and perceptions of stillbirth among mothers from a tertiary medical centre in Kano, Northern Nigeria. DESIGN: Qualitative, interpretative. SETTING: Tertiary healthcare facility, Murtala Muhammad Specialist Hospital (MMSH), Kano, Northern Nigeria. SAMPLE: Mothers who had given birth to a liveborn baby at the MMSH in the prior 6 months (n = 31). In order to capture the experiences and perception of stillbirth within this cohort we approached mothers who had in a previous pregnancy experienced a stillbirth. Of the 31 who attended 16 had a previous stillbirth. METHODS: Semi-structured Focus Group Discussions, consisting of open-ended questions about stillbirth, beliefs, experiences and influences were held in MMSH, conducted over 1 day. RESULTS: Our findings highlight that this is a resource-poor tertiary facility serving an ever-growing population, increasing strain on the hospital and healthcare workers. Many of the participants highlighted needing permission from certain family members before accessing healthcare or medical treatment. We identified that mothers generally have knowledge on self-care during pregnancy, yet certain societal factors prevented that from being their priority. Judgement and blame was a common theme, yet a complex area entwined with traditions, superstitions and the pressure to procreate with many mothers described being made to feel useless and worthless if they did not birth a live baby. CONCLUSIONS: As access to healthcare becomes easier, there are certain traditions, family and social dynamics and beliefs which conflict with scientific knowledge and act as a major barrier to uptake of healthcare services. The findings highlight the need for investment in maternity care, appropriate health education and public enlightenment; they will help inform appropriate interventions aimed at reducing stigma around stillbirth and aide in educating mothers about the importance of appropriate health seeking behaviour. Stillbirths are occurring in this area of the world unnecessarily, globally there has been extensive research conducted on stillbirth prevention. This research has highlighted some of the areas which can be tackled by modifying existing successful interventions to work towards reducing preventable stillbirths.

Whole-genome analysis of Nigerian patients with breast cancer reveals ethnic-driven somatic evolution and distinct genomic subtypes.

Black women across the African diaspora experience more aggressive breast cancer with higher mortality rates than white women of European ancestry. Although inter-ethnic germline variation is known, differential somatic evolution has not been investigated in detail. Analysis of deep whole genomes of 97 breast cancers, with RNA-seq in a subset, from women in Nigeria in comparison with The Cancer Genome Atlas (n = 76) reveal a higher rate of genomic instability and increased intra-tumoral heterogeneity as well as a unique genomic subtype defined by early clonal GATA3 mutations with a 10.5-year younger age at diagnosis. We also find non-coding mutations in bona fide drivers (ZNF217 and SYPL1) and a previously unreported INDEL signature strongly associated with African ancestry proportion, underscoring the need to expand inclusion of diverse populations in biomedical research. Finally, we demonstrate that characterizing tumors for homologous recombination deficiency has significant clinical relevance in stratifying patients for potentially life-saving therapies.

Spousal support during pregnancy in the Nigerian rural context: a mixed methods study.

BACKGROUND: Pregnancy constitutes a global health concern, thus the need for spousal support during this period cannot be overemphasized. This study examined the kinds of support pregnant women expected and received from their spouses as well as the effect of such supports during pregnancy, labour, and delivery. METHODS: The study adopted both quantitative and qualitative methods of data collection. The respondents were selected using multistage and simple random sampling techniques. RESULTS: Findings showed that respondents expected and received maximum support from their spouses during pregnancy, labour, and delivery. Spiritual support such as praying and fasting was top of the kinds of support pregnant women expected and received from their husbands during pregnancy and delivery. Others include helping in house chores, financial provision, taking care of other children, accompanying to labour room, and sexual support. More than three-quarters of the respondents stated that maximum support from their husbands made pregnancy, labour, and delivery easier. Cramer's V showed that the association between support and husbands' occupation was 0.233 and Pearson Chi-square showed that the association was statistically significant χ2(2) = 27.894,p < .001. CONCLUSION: The study concluded that spousal support during pregnancy was high among rural women in Southwestern Nigeria, and it impacted positively on their wife's period of pregnancy, labour, and delivery. A high level of spousal support should be sustained to promote family bonding and development as well as reduce maternal and child mortality.

Case Report: Atypical Cutaneous Presentation of Human T-cell Lymphotropic Virus Type 1-Related Adult T-cell Lymphoma.

Human T-cell lymphotropic virus type 1 (HTLV-1) is a retrovirus endemic in many parts of the world. Because of migration, cases of HTLV-1 in non-HTLV-1 endemic countries have been increasingly reported. Clinical presentation of HTLV-1 infection is highly variable, with a significant risk of diagnostic delays. Skin can be the first site affected by HTLV-1-related manifestations such as cutaneous involvement of adult T-cell leukemia/lymphoma (ATLL) and infective dermatitis associated with HTLV-1. A 32-year-old Nigerian man was admitted to the infectious disease department for high fever, asthenia, lymphocytosis, and vesicular bullous lesions on both hand palms and lower limbs. After clinical work-up was performed, bacterial superinfected herpes simplex viurs-2 ulcers were the presenting sign of HTLV-1-related chronic type ATLL. Standard treatment based on interferon-α plus zidovudine was started, but it was poorly tolerated; therefore, switching to an off-label dual antiretroviral regimen was attempted. The increasing prevalence of HTLV-1 in nonendemic areas may enhance the development of alternative treatments with better efficacy and tolerability profiles.

Infectious diseases screening approach among refugees: results from a single-center study.

INTRODUCTION: Our aim was to evaluate a screening program, with active case-finding and treatment for active tuberculosis (TB), latent tuberculosis infection (LTBI), blood-borne viruses (BBV), and sexually transmitted diseases (STDs) among refugees living in facility centers. METHODOLOGY: We collected data on refugees arriving to our attention in migrant centers in Sardinia, Italy. Socio-demographical data, anamnesis, and clinical features were collected. TST Mantoux was conducted, and X-ray chest (XRC) was performed if TST was positive. Blood-borne virus screening was proposed to all patients. Screening for STDs was offered according to guidelines, anamnesis, and physical examination. RESULTS: Eighty-one patients were included. Seventy (86.4%) were male, and the mean age was 24.8±5.7 years. Thirty-three (40.7%) had scabies. Overall, 40/81 (49.4%) had a positive TST Mantoux. One (2.5%) was hospitalized and died for multi-drug-resistant TB. One (2.5%) patient had intestinal-TB. 52/81 (64.2%) refused HIV screening, whereas no positivity was found among tested migrants. Sixty-two (76.5%) accepted HCV screening, and one (1.6%) had a positive test. Fifty-eight (71.6%%) accepted HBV testing, and 29 (50%) of them had positive serology. Ten (12.3%) patients had anal or genital lesions due to syphilis, Molluscum contagiosum, and HPV in 7 (70%), 2 (20%), and one (10%) case, respectively. CONCLUSIONS: Infectious diseases control and prevention are a key strategy among refugees. The stay in a migrant center is an extraordinary occasion for healthcare provision. This condition could allow a broad screening program in which quick BBV screening tests could be a good method to implement uptake. More information and educational programs would allow a higher understanding and acceptance of HIV screening.

Fetal growth restriction in a cohort of migrants in Germany.

BACKGROUND: Migrant women may have an increased risk of adverse birth outcomes. This study analyses the occurrence of low birth weight, preterm birth and intrauterine growth restriction / fetal growth restriction (IUGR/FGR) in pregnant migrants. METHOD: Cross-sectional study of 82 mother-child pairs of pregnant migrants attending medical care in Germany. RESULTS: The Median age was 27 years, 49% of patients were of oriental-asian ethnicity and median year of migration was 2015. At least one previous pregnancy was reported in 76% of patients, in 40% the delivery mode was caesarian section. Median gestational age was 39.7 weeks. Preterm birth occurred in 6.1% of pregnancies. Median gestational age for preterm birth was 32.3 weeks. Low birth weight (< 2500 g) occurred in 6.1%. Birth weights below the 10th percentile of birth weight for gestational age were observed in 8.5% of the total cohort. CONCLUSIONS: Compared to German data no increased occurrence of low birth weight, preterm birth or IUGR/FGR was found. We note that the rate of caesarian section births was higher than in the general population for reasons yet to be identified. The authors propose stratification according to migration status for the national documentation of birth outcomes in Germany.

Bioactivity-directed evaluation of fruit of Kigelia africana (Lam.) benth. Used in treatment of malaria in Iwo, Nigeria.

ETHNOPHARMACOLOGICAL RELEVANCE: The ancient people of Iwo communities consisting of Ile-Ogbo, Olupona, Iwo and Ogbagba continue to engage in the traditional use of medicinal plants for the treatment and management of common diseases especially malaria. AIMS OF THIS STUDY: This study conducted an ethnomedicinal survey of plants used to treat malaria and feverish conditions by the people of Iwo, Nigeria. It also evaluated the antiplasmodial activity of the morphological parts of Kigelia africana (Lam.) Benth., and isolated, as well as characterised pure compounds from the semi-purified fractions of the fruit extract. MATERIALS AND METHODS: The ethnomedicinal survey was conducted using semi-structured questionnaires administered to only herb sellers in Iwo, Ile-Ogbo, Olupona, and Ogbagba areas of Osun State. Extracts of K. africana morphological parts; leaf, root, stem bark, and fruit were obtained by cold maceration in methanol, followed by assessment of acute toxicity (LD50) and antiplasmodial activity in Plasmodium berghei infected rats using the 4-day suppressive test model. The most active fruit extract was further subjected to activity-guided fractionation and purification using n-hexane, dichloromethane, ethyl acetate (EtOAc), n-butanol (n-BuOH), and methanol (MeOH) in gradients to obtain the semi-purified fractions and two pure isolated compounds using various chromatographic and spectroscopic techniques. RESULTS AND DISCUSSION: From the survey, thirty-one plant species were identified for treating malaria in Iwo area. Azadirachta indica leaf was the most frequently used (78.3% of the respondents) while Manihot esculenta leaf (3.33%) was the least. The identified plants are distributed among 24 families, with Anacardiaceae and Asteraceae (11.67% each) been the most occurring families. Kigelia africana (Bignoniaceae) ranked the 6th position with 60% frequency of occurrence. The LD50 values obtained for the extracts were greater than 5000 mg/kg (p.o). The chemo-suppression activity of the extracts at 125 mg/kg was in the order of stem bark (26.59%), leaf (41.75%), root (43.95%), and fruit (54.54%). The semi-purified methanol fraction of the fruit showed the most antiplasmodial activity with a percent chemo-suppression of 69.94 and yielded 4-(2,3-dihydroxypropoxy)-3,5-dihydroxy-5-methylfuran-2-one and sucrose. CONCLUSION: The use of herbs and medicinal plants either singly or in combination for the treatment of malaria among the people of Iwo community in Nigeria is still well practised. Lack of formal education among most of the respondents and use of same local name for different plants species or plant parts; which often lead to wrong plant collection were among the constrains encountered. Kigelia africana has antiplasmodial activity in the order of fruit > root > leaf > stem bark.

Validation of the Yoruba Version of the Pain Self-Efficacy Questionnaire in Patients with Chronic Low Back Pain.

STUDY DESIGN: Cultural adaptation and psychometric analysis. OBJECTIVE: This study determined the test-retest reliability, acceptability, internal consistency, divergent validity of the Yoruba pain self-efficacy questionnaire (PSEQ-Y). It also examined the ceiling and floor effects and the small detectable change (SDC) of the PSEQ-Y among patients with chronic low back pain (LBP). SUMMARY OF BACKGROUND DATA: There are various indigenous language translations of the PSEQ and none adapted to African language. However, translations of the PSEQ into Nigerian languages are not readily available. METHODS: The validity testing phase of the study involved 131 patients with LBP, while 83 patients with LBP took part in the reliability phase. Following the Beaton recommendation for cultural adaptation of instruments, the PSEQ was adapted into the Yoruba language. The psychometric properties of the PSEQ-Y determined comprised: internal consistency, divergent validity, test-retest reliability, and SDC. RESULTS: The mean age of the participants was 52.96 ±â€Š17.3 years. The PSEQ-Y did not correlate with the Yoruba version of Visual Analogue Scale (VAS-Y) scores (r = -0.05; P = 0.59). The values for the internal consistency and the test-retest reliability of the PSEQ-Y were 0.79 and 0.86, with the 95% confidence interval of the test-retest reliability ranging between 0.82 and 0.90. The standard error of measurement (SEM) and the SDC of the PSEQ-Y were 1.2 and 3.3, respectively. The PSEQ-Y had no floor or ceiling effect, as none of the respondents scored either the minimal or maximal scores. CONCLUSION: This is the first study in Nigeria to culturally adapt PSEQ. The PSEQ-Y showed adequate psychometric properties similar to existing versions. Therefore, the tool can be used to assess pain self-efficacy in clinical and research settings and help to improve the health outcomes of patients chronic LBP.Level of Evidence: 3.

Exploração qualitativa do itinerário terapêutico de crianças com deficiência física na Nigéria usando análise de conteúdo temática / Exploración cualitativa del itinerario terapéutico de niños con discapacidades físicas en Nigeria utilizando análisis de contenido temático / Qualitative exploration into therapeutic itinerary of children with physical disabilities in Nigeria using thematic content analysis

Resumo Objetivo Explorar o itinerário terapêutico na busca de cuidados para crianças com deficiências físicas pelos cuidadores. Métodos Um plano qualitativo descritivo que recrutou nove cuidadores de crianças com deficiência física, com consentimento, que frequentavam um Hospital Universitário Nigeriano. Foi utilizado um guia de entrevista semi-estruturado para coletar dados sobre o itinerário terapêutico, que foi definido como os caminhos percorridos pelos indivíduos para resolver o seu problema de saúde. As entrevistas foram gravadas em áudio e transcritas literalmente. Os dados foram analisados utilizando a análise do conteúdo temático. Resultados os temas emergentes revelaram que os cuidadores iniciaram o itinerário terapêutico para os respetivos filhos após a observação de quaisquer deficiências que vão para além de doenças casuais. A falta de capacidade dos hospitais privados, que servem como ponto inicial de entrada na busca de cuidados, encorajou a procura por cuidados nos hospitais públicos, lares espirituais, e clínicas tradicionais. A entrada na fisioterapia dependia de auto-referências, referências por parentes e médicos. Cuidar de crianças com deficiência física prejudicou de modo significativo a vida social, as finanças, o trabalho do cuidador; e expectativas não alcançadas de que a criança melhorasse o mais cedo possível encorajaram um pluralismo contínuo. Conclusão e implicações para a prática O fato de ter crianças com deficiências e de ter havido atraso nos progressos levou os cuidadores a práticas múltiplas e complexas na busca de cuidados de saúde.

Resumen Objetivo Explorar el itinerario terapéutico para la búsqueda de cuidado de niños con discapacidad física por parte de los cuidadores. Métodos Un diseño cualitativo descriptivo que recluta a nueve cuidadores de niños con discapacidades físicas que asisten a un hospital universitario de Nigeria. Se utilizó una guía de entrevista semiestructurada para recopilar datos sobre el itinerario terapéutico que se definió como los caminos que recorren los individuos para abordar su problema de salud. Las entrevistas fueron grabadas en audio y transcritas textualmente. Los datos se analizaron mediante análisis de contenido temático. Resultados Los temas emergentes revelaron que los cuidadores iniciaron un itinerario terapéutico para sus hijos al observar cualquier impedimento que vaya más allá de las enfermedades casuales. La falta de capacidad en los hospitales privados, que sirve como punto inicial de entrada en la búsqueda de atención, fomenta la vacilación en los hospitales públicos, hogares espirituales y clínicas tradicionales. La entrada en fisioterapia dependía de las autorremisiones, las derivaciones de familiares y médicos. El cuidado de niños con discapacidad física afectó significativamente la vida social, las finanzas y el trabajo del cuidador; y las expectativas no satisfechas de que un niño se recupere lo antes posible fomentaron el pluralismo continuo. Conclusión e implicaciones para la práctica El hecho de que los niños presentaran discapacidades e hitos retrasados condujo a múltiples prácticas complejas de búsqueda de atención médica entre los cuidadores. Por lo tanto, estos cuidadores se vuelven médicos pluralistas y encubiertamente no se adhieren a las prescripciones de tratamiento hospitalario.

Abstract Objective To explore the therapeutic itinerary for seeking care for children with physical disabilities by caregivers. Methods A descriptive qualitative design recruiting nine consenting caregivers of children with physical disabilities attending a Nigerian Teaching Hospital. A semi-structured interview guide was used to collect data on therapeutic itinerary which was defined as the paths taken by individuals to address their health problem. Interviews were audio-recorded and transcribed verbatim. Data was analyzed using thematic content analysis. Results Emerging themes revealed that caregivers commenced therapeutic itinerary for their children upon observation of any impairments that go beyond casual illnesses. Lack of capacity in private hospitals, which serves as initial point of entry into care seeking, encourage vacillation into public hospitals, spiritual homes, and traditional clinics. Entry into physiotherapy was dependent on self-referrals, referrals by relatives, and physicians. Caring for children with physical disability significantly affected caregiver's social life, finances, work; and unmet expectations for a child to get well as soon as possible encouraged continuous pluralism. Conclusion and implications for the practice Having children presenting with impairments and delayed milestones led to complex multiple health care seeking practices among caregivers. Thus, these caregivers become medical pluralists and covertly non-adherent to hospital treatment prescriptions.

Assessment of public hospital drug supply financing through the public-private partnership: pharmacists' perspectives

In Nigeria, drug financing by the public has been challenged by financial constraints through public fund due to a limited fund available to the government to meet all its demands. The objectives of this study were to determine the variability of the hospital patient prices of same drugs under the PublicPrivate Partnership (PPP) and in Private Retail Community Pharmacy (PRCP), and to investigate the perceived efficiency and effectiveness of the PPP by comparing it with the Drug Revolving Fund (DRF) model in drug supply financing. This study was conducted in Nigeria utilizing a mixed method. Mann-Whitney U test analysis was used to compare the median drug price of the two facilities. The majority (76.19%) of the drugs were sold at a cheaper rate in the hospital than what was obtained in the PRCP with no significance difference (p > 0.05). Dominant responses from the focused group discussions supported the PPP model. This study shows that the median patient price of the basket of matched pairs of same drugs in the hospital under the PPP and in the PRCP was identical. Overall, the participants were of the opinion that the PPP model was more efficient and effective than DRFin the financing drug supply

Psychosocial Experiences of HIV-Positive Women of African Descent in the Cultural Context of Infant Feeding: A Three-Country Comparative Analyses.

Infant feeding among mothers of African descent living with Human Immunodeficiency Virus (HIV) is a critical practice that is influenced by policies, cultural expectations, and the resultant psychosocial state of the mother. Hence, this paper draws insights from a broader infant feeding study. It provides insights into how guidelines on infant feeding practices, cultural expectations, migration, or geographic status intersect to influence the psychosocial experiences of mothers living with HIV. We compared psychosocial experiences of Black mothers of African descent living with HIV in Nigeria versus those in high-income countries (Canada and USA), in the context of contrasting national infant feeding guidelines, cultural beliefs about breastfeeding, and geographic locations. Survey was conducted in venue-based convenience samples in two comparative groups: (Ottawa, Canada and Miami-FL, USA combined [n = 290]), and (Port Harcourt, Nigeria [n = 400]). Using independent samples t-statistics, we compared the means and distributions of six psychosocial attributes between Black mothers in two distinct: Infant feeding groups (IFGs), cultural, and geographical contexts at p < 0.05. Psychosocial attributes, such as discrimination and stigma, were greater in women who exclusively formula feed (EFF) than in women who exclusively breastfeed (EBF) at p < 0.01. Heightened vigilance, discrimination, and stigma scores were greater in women whose infant feeding practices were informed by cultural beliefs (CBs) compared to those not informed by CBs at p < 0.001. Discrimination and stigma scores were greater among mothers in Canada and the USA than in Nigeria at p < 0.001. Heightened vigilance and perceived stress scores were less among women in Canada and the USA than in Nigeria at p < 0.001. The guidelines on infant feeding practices for mothers with HIV should consider cultural expectations and migration/locational status of mothers.

Determinants of Refugee and Migrant Health Status in 10 European Countries: The Mig-HealthCare Project.

In this study, we collect and synthesize information on the health status of the refugee/migrant population in ten European countries in order to map refugee/migrant health needs. With this information, we identify areas of intervention and healthcare system strengthening to provide the basis for future health planning and effective healthcare provision to migrants, asylum-seekers and refugees in the European Union (EU). METHODS: 1407 migrants in ten European Union countries (consortium members of the Mig-HealthCare project) were surveyed on general health, mental health, and specific diseases using an interviewer-administered questionnaire. Descriptive statistics and multivariable linear regression analyses were conducted to investigate the risk factors on general quality of life for migrants and refugees in the EU. RESULTS: Mean age was 31.9 (±11.05) years and 889 (63.1%) participants were males. The majority came from Syria, Afghanistan, Iraq, Nigeria, and Iran. Having a mental health disorder or a chronic disease such as a heart or respiratory disease was associated with worse general health. On the other hand, having permission to stay in the country of interview and being interviewed in the country of final destination was associated with better general health. Access to health care services was fragmented or unavailable for some interviewees because of linguistic, cultural, or administrative barriers. CONCLUSIONS: The management of chronic diseases and mental health conditions in European migrants and refugees is a key priority for health service provision. Further efforts should be made to guarantee healthcare access for migrant and refugee populations.

Diagnosis of leprosy in a Nigerian migrant: implementation of surveillance measures in the current migration context.

BACKGROUND: In Italy, leprosy diagnosis is reported in immigrants from endemic countries or Italians who have stayed in endemic areas. We report the first leprosy case to be observed in a migrant from Nigeria in the Rimini district (Emilia-Romagna, Northern Italy). METHODS: After describing the tasks of the various health Institutions in the Italian integrated system for diagnosis, treatment, and surveillance of leprosy, we describe the management and outcomes of the leprosy case and of the patient's contacts. RESULTS: In April 2017, Multibacillary Lepromatose Leprosy was diagnosed in a 29-year-old Nigerian man who arrived in Rimini in July 2014 after a 2-year stay in Libya. The local Public Health Service implemented the epidemiological investigation and identified the patient's close contacts. The management of the case and the surveillance of the 13 identified contacts, 7 Italians and 6 migrants, highlighted some critical issues. The late diagnosis of the case, due to the lack of knowledge of exotic diseases by general practitioners and other health and social professionals, and the loss at follow up of the close contacts (5 out of 6 migrants), represented important obstacles to the full success of surveillance measures. CONCLUSIONS: Although in Italy there is a well codified system of notification and surveillance of leprosy, the recognising of cases and the tracing and follow up of contacts are made difficult by the particular conditions of the involved people. This represents a new challenge for the Italian Public Health Authorities which, in the current context of immigration, often uncontrolled, must know how to respond to the new needs, in close collaboration with the State Institutions responsible for registering migrants and those health and social professionals who could facilitate the access of foreign people to health services.

The prevalence and determinants of complementary medicine use for nigerian children in the Turkish Republic of Northern Cyprus.

BACKGROUND: Complementary and alternative medicine (CAM) is extensively used in the pediatric population. Environments and the nature of diseases have an impact on the type of CAM therapies used in children. AIMS: This study aims to determine the prevalence and determinants of CAM use among Nigerian children living in the Turkish Republic of Northern Cyprus (TRNC). SUBJECTS AND METHODS: A quantitative, descriptive and cross-sectional study was conducted among 50 parents living in the TRNC. The parents were selected by the snowball sampling technique. Data were collected using a self-administered, NAFKAM International-CAM-Questionnaire (I-CAM-Q). The data were analyzed using SPSS version 20. Chi-square test was used to analyze the associations of CAM use with values of P < 0.05 considered statistically significant. RESULTS: The mean ages of the parents and children were 30 ± 5.56 years and 3 ± 2.17 years, respectively. It was discovered that 34 (68%) out of 50 children had used CAM in the previous 12 months. The most commonly used CAM products were vitamins/minerals (82.4%) and herbs/herbal products (55.9%). While praying for health (61.8%) and relaxation techniques (50.0%) were the most used CAM practices. A majority of the parents perceived that CAM use was beneficial (85.3%). Approximately 10% of the children were prescribed CAM recommendation/treatment by physicians. The most used sources of information were relatives (36%) and friends (14.7%). Parents (58%) indicated that they did not disclose their use of CAMs for their children to a physician/nurse. CONCLUSIONS: CAM is used prevalently in this population and the use of CAM is primarily focused on improving well-being. CAM usage for children increases with parental use. Further qualitative research is needed to understand the parental belief in the use of CAMs for children.

Dynamics of anti-malarial antibodies in non-immune patients during and after a first and unique Plasmodium falciparum malaria episode.

BACKGROUND: Malaria is a major travel medicine issue. Retrospective confirmation of a malaria episode diagnosed in an endemic area can have relevant implications in transfusional medicine in Europe, where blood donors are excluded from donation on the basis of positive malaria serology. However, there is scarce evidence on the dynamics of anti-malarial antibodies after a first malaria episode in non-immune individuals. The first aim of this study was to describe the dynamics of anti-malarial antibodies in a first malaria episode in non-immune travellers. Secondary objectives were to assess the sensitivity of serology for a retrospective diagnosis in non-immune travellers diagnosed while abroad and to discuss the implications in transfusional medicine. METHODS: Retrospective analysis of the results of an indirect fluorescence antibody test (IFAT) for malaria available for patients with a first malaria episode by Plasmodium falciparum and admitted at the IRCCS Sacro Cuore Don Calabria hospital in a 14-year period. The antibody titres were collected at baseline and during further follow up visits. Epidemiological, demographic and laboratory test results (including full blood count and malaria parasite density) were anonymously recorded in a study specific electronic Case Report Form created with OpenClinica software. Statistical analysis was performed with SAS software version 9.4. RESULTS: Thirty-six patients were included. Among them, all but two were Europeans (one African and one American). Median length of fever before diagnosis was 2 days (IQR 1-3). Thirty-five patients had seroconversion between day 1 and day 4 from admission, and the titre showed a sharply rising titre, often to a very high level in a few days. Only a single patient remained negative in the first 5 days from admission, after which he was no more tested. Six patients were followed up for at least 2 months, and they all showed a decline in IFAT titre, tending to seroreversion (confirmed in one patient with the longest follow up, almost 4 years). CONCLUSIONS: Serology demonstrated reliable for retrospective diagnosis in non-immune travellers. The decline in the anti-malarial titre might be included in the screening algorithms of blood donors, but further studies are needed.

Rethinking parenthood within assisted reproductive technology: The need for regulation in Nigeria.

In Nigeria, reproduction is highly valued, with many people desiring to produce a child 'in their own image and likeness'. Previously, aspiring parents often resorted to adoption. Today, the availability of assisted reproductive technologies (ARTs) has provided options other than adoption for those desiring to procreate. Through ARTs, aspirations for a family may be attained through an exchange of reproductive goods and services, and not necessarily through traditional heterosexual relationships. ARTs have altered the perception of parenthood as it exists in Nigeria, and courts face a difficult task in defining parenthood within Nigerian jurisprudence, as they can only adjudicate based on extant law. Although ARTs provide greater individual choices for fulfilling the desire to procreate, they raise a number of ethical and legal issues that evolving legal systems, such as that in Nigeria, are ill-equipped to manage. This paper describes the traditional assignment of parenthood under indigenous laws and other sources of law within the Nigerian jurisprudence. We carried out an in-depth study of the Nigerian legislative framework and found that there are no laws directly regulating parenthood, procreation and ARTs in Nigeria. We also found that the extant laws are only tangentially related and do not answer the relevant questions sufficiently well, especially concerning succession, nationality and assignment of responsibility in collaborative reproduction. We conclude by highlighting the need for and recommending a regulatory framework on ARTs with a particular focus on providing a definition for parenthood achieved through ARTs in Nigeria.

Characterization of genetic polymorphisms in Nigerians residing in Guangzhou using massively parallel sequencing.

African populations exhibit extensive linguistic and cultural diversity but are less studied from a population genetic standpoint. Although much genetic data on admixed African individuals, such as African Americans, have been published, genetic polymorphism data, especially that based on sequence-based typing, are still insufficient in indigenous Africans. In this study, we examined the genetic diversity of 85 Nigerians residing in Guangzhou, China. Forensically relevant genetic markers, including autosomal short tandem repeats (A-STRs), X-chromosomal STRs (X-STRs), Y-chromosomal STRs (Y-STRs), and identity-informative single nucleotide polymorphisms (iiSNPs) were genotyped to uncover the genetic polymorphisms of this population. Sequence-based allelic variations were observed in 22 A-STRs, ten Y-STRs, and four X-STRs. Using massively parallel sequencing (MPS), the allele number increased from 475 length-based alleles to 683 sequence-based alleles. Compared to other populations, the overall observed heterozygosity of the 27 A-STRs was the highest in Nigerians, which reflected the higher genetic diversity of this population. The combined match probability of the 27 A-STRs was low at 9.06 × 10-38. When both A-STRs and iiSNPs were considered, the cumulative discrimination power, and combined power of exclusion for duo and trio paternity testing was 1-2.97 × 10-57, 1-2.20 × 10-10 and 1-4.61 × 10-17, respectively, which demonstrated that the STRs and SNPs analyzed here can be applied to forensic investigations. In summary, this study uncovers the genetic features of the Nigerian population and provides valuable frequency data for forensic applications.

Intersection of Migration and Access to Health Care: Experiences and Perceptions of Female Economic Migrants in Canada.

More people are migrating than ever before. There are an estimated 1 billion migrants globally-of whom, 258 million are international migrants and 763 million are internal migrants. Almost half of these migrants are women, and most are of reproductive age. Female migration has increased. The socioeconomic contexts of women migrants need investigation to better understand how migration intersects with accessing health care. We employed a focused ethnography design. We recruited 29 women from three African countries: Ghana, Nigeria, and South Africa. We used purposive and convenient sampling techniques and collected data using face-to-face interviews. Interviews were audio-recorded and transcribed verbatim. Data were analyzed with the support of ATLAS.ti 8 Windows (ATLAS.ti Scientific Software Development GmbH), a computer-based qualitative software for data management. We interviewed 10 women from both South Africa and Ghana and nine women from Nigeria. Their ages ranged between 24 and 64 years. The four themes that developed included social connectedness to navigate access to care, the influence of place of origin on access to care, experiences of financial accessibility, and historical and cultural orientation to accessing health care. It was clear that theses factors affected economic migrant women's access to health care after migration. Canada has a universal health care system but multiple research studies have documented that migrants have significant barriers to accessing health care. Most migrants indeed arrive in Canada from a health care system that is very different than their country of origin. Access to health care is one of the most important social determinants of health.

Experiences, views and needs of first-time fathers in pregnancy-related care: a qualitative study in south-East Nigeria.

BACKGROUND: Given the relevance of paternal involvement in maternal care, there is a need to prepare first-time fathers to participate in pregnancy and childbirth actively. This study explores the experiences and needs of first-time fathers; and how these influences their involvement during pregnancy and childbirth in Nigeria. METHODS: A descriptive qualitative study was conducted. Semi-structured interviews with 50 men recruited from rural and urban workplaces, hospitals, and markets, generated data used to explore the experiences, views and needs of first-time fathers' in pregnancy-related care in south-east Nigeria. All data were transcribed and analysed using thematic analysis. RESULTS: Six major themes were identified: gender roles, antenatal involvement, care costs and delivery choices, need to be informed, dealing with emotions, and dealing with the delivery day. The key finding reveals that inexperience and perceptions of gender roles greatly influenced the support provided by first-time fathers to their spouses and the support they received from their social support networks. Two primary needs were identified: need to be informed and the need to know about the cost of care in health settings. First-time fathers acknowledged the role of information on their decision making and final choices. CONCLUSION: Findings reveal the influence of gender norms, beliefs, and social support on first-time fathers' involvement in pregnancy and childbirth. This study also highlights the urgent need to provide informational support for first-time fathers and presents insights into what hospitals can do to achieve this need.