Multi-criteria decision analysis method for differential diagnosis of tropical febrile diseases.

This paper employs the Analytical Hierarchy Process (AHP) to enhance the accuracy of differential diagnosis for febrile diseases, particularly prevalent in tropical regions where misdiagnosis may have severe consequences. The migration of health workers from developing countries has resulted in frontline health workers (FHWs) using inadequate protocols for the diagnosis of complex health conditions. The study introduces an innovative AHP-based Medical Decision Support System (MDSS) incorporating disease risk factors derived from physicians' experiential knowledge to address this challenge. The system's aggregate diagnostic factor index determines the likelihood of febrile illnesses. Compared to existing literature, AHP models with risk factors demonstrate superior prediction accuracy, closely aligning with physicians' suspected diagnoses. The model's accuracy ranges from 85.4% to 96.9% for various diseases, surpassing physicians' predictions for Lassa, Dengue, and Yellow Fevers. The MDSS is recommended for use by FHWs in communities lacking medical experts, facilitating timely and precise diagnoses, efficient application of diagnostic test kits, and reducing overhead expenses for administrators.

Heterogeneity in head and neck cancer incidence among black populations from Africa, the Caribbean and the USA: Analysis of cancer registry data by the AC3.

BACKGROUND: Africa and the Caribbean are projected to have greater increases in Head and neck cancer (HNC) burden in comparison to North America and Europe. The knowledge needed to reinforce prevention in these populations is limited. We compared for the first time, incidence rates of HNC in black populations from African, the Caribbean and USA. METHODS: Annual age-standardized incidence rates (IR) and 95% confidence intervals (95%CI) per 100,000 were calculated for 2013-2015 using population-based cancer registry data for 14,911 HNC cases from the Caribbean (Barbados, Guadeloupe, Trinidad & Tobago, N = 443), Africa (Kenya, Nigeria, N = 772) and the United States (SEER, Florida, N = 13,696). We compared rates by sub-sites and sex among countries using data from registries with high quality and completeness. RESULTS: In 2013-2015, compared to other countries, HNC incidence was highest among SEER states (IR: 18.2, 95%CI = 17.6-18.8) among men, and highest in Kenya (IR: 7.5, 95%CI = 6.3-8.7) among women. Nasopharyngeal cancer IR was higher in Kenya for men (IR: 3.1, 95%CI = 2.5-3.7) and women (IR: 1.5, 95%CI = 1.0-1.9). Female oral cavity cancer was also notably higher in Kenya (IR = 3.9, 95%CI = 3.0-4.9). Blacks from SEER states had higher incidence of laryngeal cancer (IR: 5.5, 95%CI = 5.2-5.8) compared to other countries and even Florida blacks (IR: 4.4, 95%CI = 3.9-5.0). CONCLUSION: We found heterogeneity in IRs for HNC among these diverse black populations; notably, Kenya which had distinctively higher incidence of nasopharyngeal and female oral cavity cancer. Targeted etiological investigations are warranted considering the low consumption of tobacco and alcohol among Kenyan women. Overall, our findings suggest that behavioral and environmental factors are more important determinants of HNC than race.

An Assessment of Antihypertensive Medication Adherence among Hypertensive Patients Attending the Outpatient Clinics in the University of Uyo Teaching Hospital, Uyo.

CONTEXT: Hypertension is a global cause of significant morbidity, ranking top as a cause of increased disability-adjusted life years. Patients who do not take their prescribed medication show almost a fourfold increase in the risk of dying from stroke by the second year after being prescribed treatment and a nearly threefold increased risk in the 10th year when compared to patients who take their prescribed medication. Medication adherence is a key factor in the control of high blood pressure. OBJECTIVE: The objective of the study was to assess the antihypertensive medication adherence rate of patients attending the outpatient clinics at the University of Uyo Teaching Hospital (UUTH) and to explore factors that affect their adherence to the medications. MATERIALS AND METHODS: This was a descriptive cross-sectional study of adult hypertensive patients attending the outpatient clinics at UUTH, from May to July 2018, who had been placed on antihypertensive medication(s) for at least 6 months. A standardized Morisky Medication Adherence 8 Questionnaire for assessing medication adherence was modified and used for the data collection. The questionnaires were administered by trained interviewers. Data were analyzed using SPSS 20.0. RESULTS: A total of 379 hypertensive patients took part in the study; 85.2% were adherent to antihypertensive medication(s), but only 14.2% showed good adherence. Four of the five dimensions considered in the Morisky Assessment greatly affected antihypertensive medication adherence. The mean age of the study participants was 60.8 ± 1.8 years, and 75% were male. CONCLUSION: Good adherence to antihypertensive medication was quite low in this study population, and it was affected by all dimensions of the Morisky Assessment; health-care providers should pay more attention to their patient's drug adherence, educate them on medication adherence, and get them involved in their care.

Review of cancer control policy in Nigeria and comparison with selected African countries: implications for future policy making

Context: The public health importance of cancers in Nigeria is emerging. Robust cancer control policies are needed at all levels of government, especially the state. Objective: To review cancer control policies in Nigeria, especially regarding breast and cervical cancers, with emphasis on policy development process, scope and policy implementation. Also to compare Nigerian cancer control policy with selected African countries and suggest ways through which Nigerian states, such as Abia, can develop evidence-informed, patient-centered cancer control policy. Methods: A structured literature search was done using relevant subject headings and keywords. Boolean operators 'and'/'or' were used to refine the search. Databases searched were Pubmed/Medline, Embase, PsychInfo, Cinahl, Global Health and ERIC. The search included articles published between 2008 and 2018. Data was also collected from the International Cancer Control Plan portal as well as focused Google search. Results: Of the 194 abstracts retrieved, only 29 were included in this review. The 2018 Nigerian National Cancer Control plan (NCCP) showed significant improvement over the 2008 version, in terms of scope and policy development process. Literature search did not reveal any state-level comprehensive cancer control policy. The Nigerian policy lacked specific guidelines for breast cancer compared with the Ghanaian policy. Ghana allocated 12% of total budget to cancer research compared to 0.4% in Nigeria. The South African Breast Cancer policy was developed using more findings from local research and had the most encompassing, multiple perspectives approach. Conclusion: Review shows the content, process, pearls and pitfalls of cancer control policy from Nigeria and five other African countries. Findings will inform the strategy for developing cancer control framework states in Nigeria and other countries. As more Nigerian states work towards developing state cancer control plans, it is important to address the shortfalls identified in the current NCCP, especially regarding the use of multiple perspectives analysis

Use of Electronic Nicotine Delivery Systems (ENDS) by pregnant women I: Risk of small-for-gestational-age birth.

INTRODUCTION: The 2016 US Surgeon General's Report suggests that the use of electronic nicotine delivery systems (ENDS) is a fetal risk factor. However, no previous study has estimated their effect on adverse pregnancy outcomes. We assessed the prevalence of current ENDS use in pregnant women and explored the effect on birth weight and smallness-for-gestational-age (SGA), correcting for misclassification from nondisclosure of smoking status. METHODS: We conducted a cohort study with 248 pregnant women using questionnaire data and biomarkers (salivary cotinine, exhaled carbon monoxide, and hair nicotine). We evaluated the association between birth weight and the risk of SGA by applying multivariate linear and log-binomial regression to reproductive outcome data for 232 participants. Participants who did not disclose their smoking status were excluded from the referent group. Sensitivity analysis corrected for misclassification of smoking/ENDS use status. RESULTS: The prevalence of current ENDS use among pregnant women was 6.8% (95% CI: 4.4-10.2%); most of these (75%) were concurrent smokers. Using self-reports, the estimated risk ratio of SGA for ENDS users was nearly two times the risk in the unexposed (RR=1.9, 95% CI: 0.6-5.5), and over three times that for ENDS-only users versus the unexposed (RR=3.1, 95% CI: 0.8-11.7). Excluding from the referent group smokers who did not disclose their smoking status, the risk of SGA for ENDS-only use was 5 times the risk in the unexposed (RR=5.1, 95% CI: 1.1- 22.2), and almost four times for all types of ENDS users (RR=3.8, 95% CI: 1.3-11.2). SGA risk ratios for ENDS users, corrected for misclassification due to self-report, were 6.5-8.5 times that of the unexposed. CONCLUSIONS: Our data suggest that ENDS use is associated with an increased risk of SGA.

Use of electronic nicotine delivery systems by pregnant women II: Hair biomarkers for exposures to nicotine and tobacco-specific nitrosamines.

INTRODUCTION: Public awareness of electronic nicotine delivery systems (ENDS) has increased over time, and the perception that ENDS offer a safer alternative to cigarettes may lead some pregnant women to use them to reduce cigarette smoking during pregnancy. No previous studies have used metabolite levels in hair to measure nicotine exposure for ENDS users during pregnancy. We aimed to measure and compare levels of nicotine, cotinine, and tobacco-specific nitrosamines (TSNAs) in hair samples from pregnant women who were current ENDS users, current smokers, and current non-smokers. We also aimed to estimate the association between ENDS use/smoking and smallness for gestational age (SGA). METHODS: We used hair specimens from pregnant women who were dual users (ENDS and cigarettes), smokers, and non-smokers from a prospective cohort study to estimate exposure to nicotine, cotinine, and TSNAs. The exposure biomarkers and self-reports of smoking and ENDS use were used in log-binomial regression models to estimate risk ratios (RRs) for SGA among offspring. RESULTS: Nicotine concentrations for pregnant dual users were not significantly different from those for smokers (11.0 and 10.6 ng/mg hair, respectively; p=0.58). Similarly, levels of cotinine, and TSNAs for pregnant dual users were not lower than those for smokers. The RR for SGA was similar for dual users and smokers relative to nonsmokers, (RR=3.5, 95% CI: 0.8-14.8) and (RR=3.3, 95% CI: 0.9-11.6), respectively. Using self-reports confirmed by hair nicotine, the RR values for dual ENDS users and smokers were 8.3 (95% CI: 1.0-69.1) and 7.3 (95% CI:1.0-59.0), respectively. CONCLUSIONS: We did not observe lower levels of nicotine, cotinine, and TSNAs for current dual users compared to smokers during pregnancy. The risk of SGA for offspring of pregnant dual users was similar to that for offspring of pregnant smokers. Future studies are needed to further estimate the magnitude of the association between ENDS use and smallness for gestational age.

Electronic Nicotine Delivery Systems and Smoking Cessation in Arkansas, 2014.

OBJECTIVES: As of October 2015, evidence needed to make a recommendation about the use of electronic nicotine delivery systems (ENDS) for smoking cessation was limited. We used the 2014 Arkansas Behavioral Risk Factor Surveillance System with additional state-specific questions to determine the prevalence of ENDS use, the impact of ENDS use on smoking cessation, and beliefs about ENDS use in Arkansas. Our objectives were to determine if (1) ENDS use was associated with lower odds of quitting smoking, (2) ENDS users believed that ENDS use was not harmful to their health, and (3) ENDS users believed that switching to ENDS reduced their tobacco-related health risks. METHODS: We conducted a cross-sectional study of 4465 respondents to the Arkansas Behavioral Risk Factor Surveillance System and used weighted analyses to account for the complex survey design. We used a subset of records formed by (1) formers smokers who quitted smoking in the last 5 years and (2) current smokers to assess the odds of quitting. RESULTS: In 2014, 6.1% (95% confidence interval [CI], 5.0%-7.4%) of Arkansas adults were currently using ENDS. Of the 1083 participants who were current smokers or had quit smoking within the past 5 years, 515 (54.1%) had used ENDS. Of the 515 ENDS users, 404 (80.3%) had continued smoking. ENDS use was significantly associated with reduced odds of quitting smoking (weighted odds ratio = 0.53; 95% CI, 0.34-0.83). Although 2437 of 3808 participants (62.5%) believed that it was harmful for nonsmokers to start using ENDS and 1793 of 3658 participants (47.0%) believed that switching to ENDS did not reduce tobacco-related health risks, only 80 of 165 (41.3%) and 50 of 168 (33.9%) ENDS users shared these same respective beliefs. CONCLUSIONS: Most smokers who indicated smoking in the past 5 years and who tried ENDS did not stop smoking. ENDS use was inversely associated with smoking cessation. Tobacco cessation programs should tell cigarette smokers that ENDS use may not help them quit smoking.

Long-Term Nonmalignant Disease Mortality in Subjects Exposed to Transmissible Agents Present in Animals Used for Food.

OBJECTIVE: To study mortality from nonmalignant diseases in subjects with high exposure to transmissible agents present in animals used for food, and in their raw or inadequately cooked products. METHODS: Mortality was compared in a cohort of meat handlers in slaughtering and processing plants with that of the U.S. general population. RESULTS: Excess mortality was observed for conditions known to be associated with infections-these include, septicemia, chronic nephritis, diseases of the kidney and ureter, diseases of the pancreas, cirrhosis of the liver, acute and subacute endocarditis, acute rheumatic fever, functional diseases of the heart, aortic aneurysm, intracranial and intraspinous abscess, and meningitis. Excess mortality was also observed for ischemic heart disease and diabetes, conditions without an established infectious etiology, but which have been linked with infections. CONCLUSIONS: If transmissible agents present in food animals and their raw products cause long-term diseases and mortality in humans, this study importantly points to the likely diseases, many of which are already known to be associated with infections. The excess mortality observed for ischemic heart disease and diabetes is consistent with existing evidence linking these conditions with infections, and gives rise to the novel hypothesis that microbial agents present in food animals and their products may be candidates for an infective role in the occurrence of these conditions, and therefore needs further investigation.

Overweight and obesity profiles in Niger Delta Region, Nigeria.

INTRODUCTION: Overweight and obesity are global public health problems because of their effect on individuals, families and communities. The objective of this study was to describe the profile of overweight and obesity amongst adult out patients in Uyo in the Niger Delta region of Nigeria. METHOD: This was a cross-sectional descriptive study done between October 2011 and March 2012. Using a systematic sampling technique, 584 subjects aged 18-65 years were recruited; data were collected with a structured questionnaire. Subjects were measured for height, weight, waist and hip circumferences. Body mass index (BMI) and waist-hip ratio (WHR) were calculated. Subjects with a BMI of 25.0 kg/m2 - 29.9 kg/m2 were regarded as being overweight whilst a BMI of > 30.0 kg/m2 was regarded as obese. Subjects with a WHR of > 0.90 for men or > 0.85 for women were regarded as having abnormal WHR. RESULTS: Of the 584 subjects, 196 (36.6%) were men and 388 (66.4%) women. The mean age for men and women was 43.3 ± 17.8 years and 50.2 ± 13.6 years, respectively. The prevalence of overweight amongst men was 39.8% versus 31.7% for women; obesity in men was 28.0% versus 52.0% in women. Overweight and obesity were more prevalent in subjects aged 25-54 years and amongst married subjects. There was a significant relationship between obesity and television viewing (p = 0.003). Hypertension (p = 0.008) and osteoarthropathies (p = 0.043) were more prevalent amongst the obese than the non-obese subjects. CONCLUSION: Overweight and obesity are now common in our environment. There is therefore a need for more public education about the health consequences of big body size.

Awareness, use and main source of information on preventive health examinations: a survey of childbearing women in Uyo, Nigeria.

The study determined awareness, use and the main source of information about preventive health examinations among 387 childbearing women attending three health facilities in Uyo, Nigeria. Respondents were consenting women aged 15-49 years who had a live birth in the two months preceding the survey. Respondents were interviewed using structured questionnaires during child welfare clinic visits at each facility. Awareness about pap smears and breast self examination was 14.2% and 35.3% respectively. Testing rates were highest for blood pressure checks, HIV and blood sugar and lowest for Pap smears and mammograms. Health workers were the main informants on preventive tests. Awareness and secondary education enhanced women's uptake of screening services across levels of health care. Secondary education as a minimum and intensified awareness creation about preventive health examinations through media, school based programs, durbars and public health campaigns are vital to the health and well being of women and children.