Management of genitourinary trauma - current evaluation from the Sub-Saharan region: A systematic review.

BACKGROUND: Trauma is a major cause of morbidity globally and the sixth leading cause of death, accounting for 10% of all mortalities. The genitourinary trauma is estimated for approximately 10% of all patients presenting with trauma, and the kidney is the most injured genitourinary organ globally. However, there is a paucity of data on genitourinary injury from the Sub-Saharan, and there may be variations from common genitourinary organs injured in developed nations. AIM: To provide insight on the epidemiology and management of genitourinary trauma in Sub-Saharan Africa with recommendations based on international guidelines. METHODS: A thorough literature search of genitourinary trauma was conducted using PubMed, Google Scholar and African Journal Online. RESULTS: A total of 30 studies from the Sub-Saharan region were eligible for the study and reviewed for epidemiology, biodata, types of injury, mechanisms of injury, treatment and follow-up. After evaluating 21904 patients presenting with urological emergencies, approximately 6.6% of cases were due to genitourinary trauma. The commonest injury was urethral 42.9% (22.2-62.2%) followed by injury to the external genitalia (penis, scrotum, testes) 25.1% (8.8-67.7%). CONCLUSION: Genitourinary injury in Sub-Saharan Africa is underreported, and the presence of more trauma registries, trained urologists and trauma facilities could improve the overall standard of care as well as providing data for research and development in the field.

Diagnostic and Therapeutic Challenges of Rare Urogenital Cancers: Urothelial Carcinoma of the Renal Pelvis, Ureters and Urethra.

Urothelial carcinoma (UC) is a neoplastic growth that affects the lining of the urinary tract from the renal pelvis to the distal urethra. Urothelial cancer occurs less commonly along the upper urinary tract (renal pelvis and ureter) accounting for 5-10% and even rarer along the urethra approximately less than 1%. The incidence of UC of the upper urinary tract and urethra has been reported in the United States and Europe by the Surveillance, Epidemiology, and End Results Program and the Rare Cancers in Europe project, respectively. Considering the rarity of upper tract urothelial carcinoma (UTUC) and primary urethral cancer (PUC), there is a paucity of data from Sub-Saharan Africa. Both the European Association of Urology guideline and the National Comprehensive Cancer Network guideline have provided some clinical updates on the management of UTUC and PUC. However, UTUC and PUC present mostly at a more advanced stage than UC of bladder. A high index of suspicion is necessary for diagnosis even more for UTUC. Organ-sparing surgery is possible for both localized UTUC and PUC but stringent follow-up with urine cytology, endoscopy and imaging is mandated for early detection of recurrence.

Management guidelines of penile cancer- a contemporary review of sub-Saharan Africa.

BACKGROUND: Penile cancer is a rare malignancy with prevalence higher in areas of high Human Papilloma Virus (HPV) such as Africa, Asia and South America. In middle- and low-income countries where circumcision is not routinely practiced, the rate of penile cancer could be ten times higher. MAIN BODY OF THE ABSTRACT: A literature review was conducted from 1992 to 2019 using PubMed, Google Scholar, African Journal Online and Google with inclusion of 27 publications with emphasis on the Sub-Saharan literature. Findings revealed that most men with penile cancer in Sub-Saharan Africa (SSA) present with locally advanced to advanced disease with devastating consequences. The option of penile sparing procedure is reduced with most treatment option directed to mutilating surgeries. The lack of appropriate chemotherapy and radiotherapy worsens the prognosis in the region. SHORT CONCLUSION: Human Papilloma Virus (HPV) vaccination may not be cost-effective for most regions in SSA. Therefore, early childhood circumcision might be the best advocated alternative for prevention.

Contributing Risk Factors for Substance Use Among Youth in Postconflict Liberia.

Substance use is prevalent among youth in postconflict African countries and is associated with a number of public health problems such as poverty, child homelessness, and school truancy. This qualitative study explores the risk factors associated with substance use among Liberian youth from the perspective of public-school students. Nine focus groups were conducted with 72 Liberian public-school students (35 female, 37 male). Multiple risk factors for substance use among Liberian youth were identified through qualitative analysis, including emotional instability, gender, fear of academic failure, accessibility to substances within the school and community, poverty, and unintentional drug use. These findings are important to public health campaigns and postconflict recovery in Liberia, and may also inform prevention programs for substance use among Liberian youth.

The impact of transactional sex with teachers on public school students in Monrovia, Liberia - a brief report.

Access to education has been shown to strongly influence adolescent health across the world, and strong relationships with teachers has been found to lead to better academic and psychosocial outcomes for students. In many low-income countries where adolescents have less access to education and are more likely to experience poor health outcomes, risky sexual behaviors can exacerbate these challenges by increasing the risk of unintended pregnancy and sexually transmitted infections. This study sought to examine risky behaviors, such as substance use and risky sexual practices, of in-school youth in Liberia, a country in West Africa. Nine focus groups were conducted with public school students in Monrovia, Liberia in April 2012 using a semi-structured guide. The sessions took place in three public schools with n = 72 participants aged 12-20 years old. Following thematic content analysis, a pattern emerged of transactional sex between female students and male teachers, which often led to contrived and coercive relationships for the students. Conversely, participants reported that educators were not disciplined for having sex with students. Interventions to reduce the prevalence of transactional sex within the academic environment would likely protect the well being of school-going youth, particularly female youth, and support students' academic pursuits in Liberia.

A Qualitative Analysis of Substance Use among Liberian Youth: Understanding Behaviors, Consequences, and Protective Factors Involving School Youth and the School Milieu.

OBJECTIVE: Substance use is a significant and common problem among school-aged youths throughout Africa. Like other countries on this continent, the West-African nation of Liberia is recovering from civil war. A well-educated population of young people is critical to the recovery efforts and long-term success of Liberia. Substance use by school-aged youths has important public health consequences that could undermine Liberia's post-conflict recovery efforts. We wanted to better understand the culturally significant themes and subthemes related to substance use among youths attending public schools in Monrovia, Liberia. METHODS: A qualitative research design was used to collect data from 72 students attending public school in Monrovia, Liberia. Nine focus groups of 6-8 students from three public schools were facilitated using a semi-structured format to guide discussions on substance use. Student narratives were translated and re-occurring themes and subthemes were coded and analyzed. RESULTS: Four emergent themes described in this study were: Behaviors associated with substance useConsequences associated with individual useConsequences of substance use that affected the school milieuSchool-related factors that were protective from substance use.Subthemes associated with substance use included concealment of substances, intoxication and disruption of the classroom environment, expulsion from school, school drop-out, and school as protective against substance use. CONCLUSION: Liberian school-aged youths described important themes and subthemes associated with substance use occurring within the school milieu. These data have germane public health ramifications, and could help inform larger epidemiologic study methods and public health interventions for Liberia and countries with similar profiles.