Social capital in the management of breast cancer in Lagos, Nigeria.

PURPOSE: Breast cancer is the most common cancer in women worldwide, necessitating substantial social support during diagnosis and treatment. This study examines the role of social capital in breast cancer management, focusing on the experiences of patients. OBJECTIVES: The objective of the study was to explore the role of social capital in breast cancer management among women living with breast cancer in Lagos, Nigeria. METHODS: Using a qualitative design, the study recruited 23 women with breast cancer receiving treatment at a teaching hospital in Lagos, Nigeria. Data were content analyzed to identify themes related to social capital. RESULTS: The study found that social capital, crucial for breast cancer patients' emotional and instrumental support, stems from various sources such as relatives, immediate family, spouses, places of worship, friends, and neighbors. Effective coping and management of the condition were facilitated through this support network. However, assistance from places of worship, friends, and neighbors was only accessible to those who openly acknowledged their health conditions and had established connections with these social groups. Relationships led to support only when there was a disclosure of the health condition. SIGNIFICANCE OF RESULTS: (1) This finding reinforces the importance of integrating social support mechanisms including family, friends, and community networks into breast cancer management programs. (2) The study identifies diverse sources of social capital, including relatives, family, spouses, places of worship, friends, and neighbors, stressing the need for tailored support networks. (3) Research reveals the link between health condition disclosure and support accessibility from groups like places of worship and friends, and it emphasizes creating stigma-free environments for patients to disclose health status comfortably. (4) The study highlights family involvement in breast cancer management as crucial for effective coping. Healthcare professionals should prioritize interventions strengthening family support systems. (5) Findings of stress community support for better breast cancer outcomes, advocating for initiatives like support groups and awareness campaigns to boost social capital and aid affected individuals. CONCLUSION: The study emphasizes the significance of involving family members in the breast cancer management process and highlights the need for support systems within families and communities to facilitate better outcomes for breast cancer patients.

Places Nigerians visited during COVID-19 government stay-home policy: evidence from secondary analysis of data collected during the lockdown.

Introduction: Compliance with the Government's lockdown policy is required to curtail community transmission of Covid-19 infection. The objective of this research was to identify places Nigerians visited during the lockdown to help prepare for a response towards future infectious diseases of public health importance similar to Covid-19. Methods: This was a secondary analysis of unconventional data collected using Google Forms and online social media platforms during the COVID-19 lockdown between April and June 2020 in Nigeria. Two datasets from: i) partnership for evidencebased response to COVID-19 (PERC) wave-1 and ii) College of Medicine, University of Lagos perception of and compliance with physical distancing survey (PCSH) were used. Data on places that people visited during the lockdown were extracted and compared with the sociodemographic characteristics of the respondents. Descriptive statistics were calculated for all independent variables and focused on frequencies and percentages. Chi-squared test was used to determine the significance between sociodemographic variables and places visited during the lockdown. Statistical significance was determined by P<0.05. All statistical analyses were carried out using SPSS version 22. Results: There were 1304 and 879 participants in the PERC wave-1 and PCSH datasets, respectively. The mean age of PERC wave-1 and PCSH survey respondents was 31.8 [standard deviation (SD)=8.5] and 33.1 (SD=8.3) years, respectively.In the PCSH survey, 55.9% and 44.1% of respondents lived in locations with partial and complete covid-19 lockdowns, respectively. Irrespective of the type of lockdown, the most common place visited during the lockdown was the market (shopping); reported by 73% of respondents in states with partial lockdown and by 68% of respondents in states with the complete lockdown. Visits to families and friends happened more in states with complete (16.1%) than in states with partial (8.4%) lockdowns. Conclusions: Markets (shopping) were the main places visited during the lockdown compared to visiting friends/family, places of worship, gyms, and workplaces. It is important in the future for the Government to plan how citizens can safely access markets and get other household items during lockdowns for better adherence to stay-at-home directives for future infectious disease epidemics.

Regional variations in child and mother's characteristics influencing the use of insecticide treated net in Nigeria.

Nigeria accounts for a quarter of malaria cases worldwide, which can be prevented with the use of insecticide treated nets (ITN). While studies have documented mother-related characteristics influencing use of ITN, regional variations in the influence of those factors are not well known. This study investigated nine factors (age, place of residence, education, religion, wealth, number of children in the household, sex of child, age of child and previous experience of child mortality) as possible predictors of use of ITN for children and how the associations vary across northern and southern parts of the country. The study utilised the 2015 Nigeria Malaria Indicator Survey, which comprised 6524 mothers (4009 from the north and 2151 from the south) aged 15-49. Bivariate and multivariate logistic regression models were fitted. It was found that, less than half (47.9%) of the respondents reported no access to a mosquito net in the north compared to 70.8% in the south. More than half (51.4%) of the northern respondents used insecticide treated net (ITN) for the child compared to 27.1% of southern mothers. When the variables are fitted together in the same model, place of residence, mother's age, mother's education, wealth, religion, number of children in the household and previous experience of child mortality were associated with the use of ITN. Regional variations exist in the influence of mother's age, number of children in the household and previous experience of child mortality. It was submitted that mother's characteristics are more important than the child's factors in the use of ITN, and that, contrary to the theory of poor utilisation of health-related facilities in the north compared to the south, residents in the former have access to and use ITN more than their counterparts from the latter.

The use of and need for data and information by health professionals supporting the delivery of palliative cancer care services in sub-Saharan Africa: A qualitative study.

PURPOSE: The ability to develop and evaluate approaches to the management of advanced cancer in sub-Saharan Africa is limited by the lack of local, reliable and valid data to ensure that practice is evidence-based, replicable and reflects the needs of the population served. METHODS: A secondary qualitative analysis of in-depth interviews with 59 health professionals delivering palliative cancer care in Nigeria, Uganda and Zimbabwe were conducted to determine the use and needs for data and information for patient care and service delivery. Framework analysis was used, informed by a conceptual model for data use in low and middle-income countries. RESULTS: Three meta-themes include: (1) Current practice in data gathering and use; (2) Gaps for capturing, storing information and supporting communication, and; (3) Needs and opportunities for data use. Deficits in current data access and use were identified, alongside targets for improving the quality, accessibility and utility of data to inform the development of palliative cancer care. CONCLUSIONS: The availability and use of relevant and reliable data relating to the current provision of palliative cancer care are requisite for the contextually appropriate and effective development of health services. The requirements and constraints articulated by participants can guide future development and optimisation of digital health approaches for palliative cancer care in the participating countries, with relevance to the wider sub-Saharan Africa region.

"From the Time You Start With them Until the Lord Calls You": A Qualitative Study on the Experiences and Expectations of People Living with Advanced Cancer Interacting With Palliative Care Services in Uganda, Nigeria and Zimbabwe.

CONTEXT: A challenge facing the provision of palliative care in sub-Saharan Africa is a means of increasing coverage of services whilst maintaining quality. Developing an evidence base that reflects patients' experiences and expectations of palliative care services, the context within which services are provided, and the approaches adopted by services in caring for patients, could facilitate and inform the planning and development of patient-centered and responsive services. OBJECTIVES: To explore the experiences and expectations of palliative care for people living with advanced cancer in Nigeria, Uganda, and Zimbabwe. METHODS: A secondary qualitative analysis of in-depth interviews with 62 people with advanced cancer in Nigeria, Uganda, and Zimbabwe. Framework approach to thematic analysis of transcripts was adopted, focusing on patients' experiences and expectations when interacting with palliative care services, aligning reporting with the COnsolidated criteria for REporting Qualitative research (COREQ). RESULTS: Four main themes were generated from the analysis: 1) Condition and community as drivers of a multidimensional burden when living with advanced cancer; 2) The expectations and endeavors of palliative care to ameliorate the impact of cancer on physical, psychological and basic needs; 3) Processes and preferences for interacting and communicating with palliative care services, and; 4) Restoration of hope in the context of limited resources. CONCLUSION: Wide-ranging physical, psychological, social and financial impacts on participants were outlined. These concerns were largely met with compassionate and responsive care in the context of constrained resources. Study findings can inform evolving notions of patient-centred care for serious illnesses in the participating countries.

We love orthodox medicine but still use our 'Elewe omo': Utilization of traditional healers among women in an urban community in Nigeria.

Background: Traditional Medicine refers to knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures. Women have been reported to utilize orthodox health care facilities more hence this study in an urban center. Objective: To determine the utilization of traditional healers, preference of healthcare and co-utilization of traditional and orthodox medicine among women in an urban community in Lagos, Nigeria. Method: A cross sectional design using a multistage sampling to select 270 women in Mosan Okunola, Lagos, Nigeria in 2019. A pretested semi-structured intervieweradministered questionnaire and an in-depth interview were used to obtain data from participants. Utilization of traditional healers was referenced within the last 12 months. Result: Sixty three percent (63.2%) of the study population utilized traditional healers and 80.6% of respondents that accessed healthcare utilized traditional healers. The Traditional Medicine ingredient dealer was the most patronized (74.6% of respondents). Eighty three percent (83.3%) of study participants indicated preference for orthodox medicine and 53.1% of the study respondents co-utilized both traditional healers and orthodox medicine. Concurrent use of both traditional and orthodox medicine was not a common practice among the women. Level of education, monthly income and means of payment for treatment had a statistical significant association (P < 0.05) with utilization of traditional healers but means of payment for treatment was the singular predictive factor of utilization of traditional healers. Conclusion: Utilization of traditional healers among women in this community was high with majority indicating a preference for orthodox medicine. It is recommended that an in-depth history of remedies used by patients should be delved into by orthodox health practitioners.

Does where mothers live matter? Regional variations in factors influencing place of child delivery in Nigeria.

Utilization of health care facilities for child delivery is associated with improved maternal and neonatal outcomes, but less than half of mothers use these for child delivery in Nigeria. This study investigated the factors associated with facility delivery in Nigeria, and their variation between the Northern and Southern parts of the country - two regions with distinct socio-cultural make-ups. The study included 33,924 mothers aged 15-49 who had given birth in the last 5 years preceding the 2018 Nigeria Demographic and Health Survey. Overall, higher age, being educated, being a Christian, being an urban resident, being exposed to mass media, making joint decisions with partner on health care, beginning antenatal visits in the first trimester and attending antenatal clinics frequently were found to be associated with improved use of a health care facility for child delivery. An average mother in Northern Nigeria had a 38% chance of having a facility-based delivery, whereas the likelihood in the South was 76%. When other factors were adjusted for, age and listening to the radio were significant predictors of facility-based delivery in the South but not in the North. In the North, Christians were more likely than Muslims to have a facility-based delivery, but the reverse was true in the South. Rural women in the South had a 16% greater chance of having a facility-based delivery than urban women in the North. The study results suggest that there is inequality in access to health care facilities in Nigeria, and the differences in the socio-cultural make-up of the two regions suggest that uniform intervention programmes may not yield similar results across the regions. The findings give credence to, and expand on, the Cosmopolitan-Success and Conservative-Failure Hypothesis.

The COVID-19 pandemic: Stay Home policy and exposure to risks of infection among Nigerians.

The global threat which continues to accompany SARS-CoV-2 has led to a global response which adopts lockdown and stays home policy as means of curtailing its spread. This study investigates compliance with the Stay Home policy and exposure to COVID-19 in Nigeria. A survey was conducted from April 4 to May 8, 2020 using a cross-sectional mixed-methods approach to elicit responses from 879 participants across six geopolitical zones of Nigeria. Descriptive, χ 2, and multiple regression tests were used to analyze survey data using SPSS, whereas NVivo v12 was used for thematic analysis of qualitative data. States with complete lockdown had 72.4% of respondents complying fully with the policy compared with 44.2% of respondents in zones with the partial lockdown. Market places, classified as high-risk zones, were the most visited (n = 505; 71.0%). Though compliance was influenced by the nature of lockdown enforced (χ 2 = 70.385, df = 2; p < 0.05), being a female, a widow, and unemployed were associated with increased compliance. Exposure to COVID-19 was associated with being married, unemployed, and having no income. Fear, anxiety, and misperception play major roles in compliance. The authors conclude that compliance is not uniform and a more nuanced and targeted approach is required as the government continues to respond to the COVID-19 global pandemic.

Stakeholder perspectives and requirements to guide the development of digital technology for palliative cancer services: a multi-country, cross-sectional, qualitative study in Nigeria, Uganda and Zimbabwe.

INTRODUCTION: Coverage of palliative care in low and middle-income countries is very limited, and global projections suggest large increases in need. Novel approaches are needed to achieve the palliative care goals of Universal Health Coverage. This study aimed to identify stakeholders' data and information needs and the role of digital technologies to improve access to and delivery of palliative care for people with advanced cancer in Nigeria, Uganda and Zimbabwe. METHODS: We conducted a multi-country cross-sectional qualitative study in sub-Saharan Africa. In-depth qualitative stakeholder interviews were conducted with N = 195 participants across Nigeria, Uganda and Zimbabwe (advanced cancer patients n = 62, informal caregivers n = 48, health care professionals n = 59, policymakers n = 26). Verbatim transcripts were subjected to deductive and inductive framework analysis to identify stakeholders needs and their preferences for digital technology in supporting the capture, transfer and use of patient-level data to improve delivery of palliative care. RESULTS: Our coding framework identified four main themes: i) acceptability of digital technology; ii) current context of technology use; iii) current vision for digital technology to support health and palliative care, and; iv) digital technologies for the generation, reporting and receipt of data. Digital heath is an acceptable approach, stakeholders support the use of secure data systems, and patients welcome improved communication with providers. There are varying preferences for how and when digital technologies should be utilised as part of palliative cancer care provision, including for increasing timely patient access to trained palliative care providers and the triaging of contact from patients. CONCLUSION: We identified design and practical challenges to optimise potential for success in developing digital health approaches to improve access to and enhance the delivery of palliative cancer care in Nigeria, Uganda and Zimbabwe. Synthesis of findings identified 15 requirements to guide the development of digital health approaches that can support the attainment of global health palliative care policy goals.

Patients' experiences of family members' reactions to diagnosis of breast cancer and support in the management of breast cancer in Lagos, Nigeria.

OBJECTIVE: The objectives of this study are to describe patients' experiences of family members' reactions to diagnosis of breast cancer and investigate the role of family support in the management of breast cancer. METHOD: The study used the descriptive qualitative method in data collection and analysis. Fifteen participants, who were undergoing either radiotherapy or chemotherapy treatment at a private hospital, consented and participated in the study. Data were content analyzed under two specific themes on family members' reactions and family support received. FINDINGS: The findings show that some participants reported negative reactions of some family members, and this affected them negatively. While some participants received support from their families, others did not. SIGNIFICANCE OF FINDINGS: The findings of our study show the critical role of family support in the management of breast cancer; therefore, family members should be encouraged to give breast cancer patient the necessary support to help them manage their sick role behavior since their illness has no cure.

The role, impact, and support of informal caregivers in the delivery of palliative care for patients with advanced cancer: A multi-country qualitative study.

BACKGROUND: Cancer is increasing in its prevalence in sub-Saharan Africa. Informal caregivers are key to supporting engagement and interaction with palliative care services, but limited literature on their role impedes development of supportive interventions. AIM: We aimed to understand the role, impact, and support of informal caregivers of patients with advanced cancer when interacting with palliative care services in Nigeria, Uganda, and Zimbabwe. DESIGN: Secondary analysis of qualitative interview transcripts. The dataset was assessed for fit and relevance and framework approach was used. SETTING/PARTICIPANTS: Interview transcripts of informal caregivers included participants aged over 18 years of age recruited from palliative care services across participating countries. RESULTS: A total of 48 transcripts were analyzed. Mean age was 37 (range 19-75) with equal numbers of men and women. Five themes emerged from the data: (1) caregivers are coordinators of emotional, practical, and health service matters; (2) caregiving comes at a personal social and financial cost; (3) practical and emotional support received and required; (4) experience of interacting and liaising with palliative care services; and (5) barriers and recommendations relating to the involvement of palliative care. CONCLUSIONS: The role of informal caregivers is multi-faceted, with participants reporting taking care of the majority of medical, physical, financial, and emotional needs of the care recipient, often in the face of sacrifices relating to employment, finances, and their own health and social life. Efforts to develop comprehensive cancer control plans in sub-Saharan Africa must take account of the increasing evidence of informal caregiver needs.

Predictors and consequences of early sexual debut among students in tertiary institutions in Lagos metropolis, Nigeria.

This study investigated the factors associated with early sexual debut, consensual sexual debut and multiple sexual partners in tertiary institutions in Lagos Metropolis, Nigeria. The study adopted a cross-sectional survey design with a proportional sampling method. Structured questionnaire was used to elicit information from respondents. Four hundred and thirty-three questionnaires were deemed eligible for data analysis. Chi-square, t-test and binary logistic regression were utilised to analyse the data. It was found that respondents who attended private secondary schools were more likely to have early sexual debut (X2= 3.076; p <0.05). There was no significant difference in the age at sexual debut for respondents from nuclear and extended families (M.D = - 0.377). Females were less likely to experience consensual sexual debut than their male counterparts (OR=0.469; p <0.01). Also, early sexual debut influenced exposure to multiple sexual partners- those who delayed sex till age 22 were the least likely to be exposed (OR= 0.056; p <0.001). Adequate sex education of young people-beginning at early years- before their sexual debut is important for improved sexual health.

Social and Bio-Medical Predictors of Exclusive Breastfeeding Among Nursing Mothers in Lagos and Taraba States, Nigeria.

PURPOSE: Although exclusive breastfeeding (EBF) is known to have positive consequences for mothers and infants, EBF rate in Nigeria is <25%. This study investigated if social factors were stronger predictors of EBF than bio-medical factors in the metropolitan areas of Lagos and Taraba States. Social factors included mother's education, infant sex, place of birth, and nature of mother's employment, while bio-medical factors included nature of birth (whether vaginal or caesarean section), problems with breast/nipple, breast milk insufficiency, and mother's age. DESIGN AND METHODS: The study adopted a cross-sectional survey design and mixed method of data collection. From the two states, 500 mothers with babies between 7 and 12 months of age completed a structured questionnaire. Twenty respondents from each state were interviewed using an in-depth interview guide. RESULTS: Education (ß = 1.743; p < 0.001), infant sex (ß = -0.454; p < 0.05), and place of delivery (ß = -1.552; p < 0.001) were significant social predictors. Breast milk insufficiency (ß = -1.851; p < 0.001) and mother's age (ß = 0.064; p < 0.001) were significant bio-medical predictors. When all the eight factors were considered, only two of the three social factors, namely, education and infants' sex, remained significant, while three bio-medical factors, namely, breast milk insufficiency, mother's age, and nature of delivery, were significant. CONCLUSIONS: Social and bio-medical factors co-determine the practice of EBF and must not be considered dichotomous. PRACTICAL IMPLICATIONS: Interventions to encourage EBF among Nigerian mothers must focus on education regarding its benefits and correction of misconceptions that breast milk alone is insufficient as an infant's diet.

Rehabilitation of drug abusers: the roles of perceptions, relationships and family supports.

The increase in the use, abuse and misuse of psychoactive substances is not just of concern to national government of different countries but poses a big problem to the international community as well as of a global public health challenge. The study explored the perceived influence of perceptions, relationships and family support on rehabilitation of drug abusers undergoing rehabilitation in a rehabilitation centre. The non-experimental study design was used. The study population was that of drug abuse patients undergoing rehabilitation in the Neuropsychiatric Hospital in Lagos. Purposive sampling technique was used to select the respondents. Forty drug abusers who were met the criteria of not being a psychotic, had undergone detoxification, in the last stages of rehabilitation and consented to voluntarily participate were interviewed using In-depth Interview Guide to collect qualitative data based on the objectives of the study. The data were manually content analysed. The drug abusers viewed their condition as a mental disorder, an illness, a bad and dangerous habit that can be treated. They viewed their relationship with their rehabilitation officers as professional and cordial, which is essential for the rehabilitation process. Financial, material and moral supports given by the family were identified as important catalysts for quick rehabilitation. Rehabilitation officers and policy makers should consider on improving on the role of professional relationships and family support in the rehabilitation process of drug abusers undergoing rehabilitation.

Maternal Health: a Qualitative Study of Male Partners' Participation in Lagos, Nigeria.

PURPOSE: Male involvement in maternal healthcare has been described as a key factor to reducing maternal mortality globally. Hence, this study investigated the choice of facility to be used during pregnancy and examined factors that influence male participation in maternal healthcare issues of their spouses as these factors may sometimes influence the choice of health care services for pregnant women. METHOD: The study was cross-sectional in design; the setting was at Badagry, Lagos, Nigeria. Thirty married men with at least the experience of birth of baby, who consented to participate, were purposively recruited for the study. Data were transcribed and content analysed using free narrative. RESULT: The results show that orthodox health care, traditional birth attendance (TBA), and faith healing were utilised by the respondents. The majority of the participants identified cost of health care services, economic recession, and their job demand as the reasons for their non-active participation in accompanying their spouses for antenatal clinic visit. CONCLUSION: However, to increase the level of men's participation in maternal healthcare, especially visiting antenatal clinic with spouses, antenatal services should be free of any monetary charges so as to encourage men to be involved and not look for excuses of financial needs. Utilisation of skilled birth attendance should be reinvigorated.

Managing Breast Cancer: Echoes from Patients in Lagos, Nigeria.

Breast cancer is ranked second as the cause of cancer death among women. Of importance to the management of breast cancer is the interaction processes between the patients and their professional caregivers or healthcare providers. Against this background, this study explores the experiences of Nigerian women as breast cancer patients and their interaction with their caregivers in the management of their condition. The study was cross-sectional in design. Twenty diagnosed breast cancer patients participated in the study and were purposively selected using convenience and snow balling sampling technique. Patients affirmed that they were initially afraid when diagnosed but overcame their fear based on caregivers' supports. Physical interactions and the use of mobile phones were common means of communication while the fear of death and financial burden of the disease were of major concerns to the patients. The majority of the patients were satisfied with the quality of care and treatment received in the private hospitals as they were encouraged and supported. It was discovered that professional caregivers are germane to patients' survival from shock and adequate information on how to manage their condition and live a normal life.

Living with cancer: a qualitative report of the experiences of leukaemia patients in Lagos, Nigeria.

The study examined the qualitative, cognitive and psychosocial experiences of those living with leukaemia undergoing treatment at a teaching hospital. Twenty respondents who consented to participate were purposively selected from the cancer patients with leukaemia receiving treatment in the said teaching hospital. The in-depth interview method was used to collect data. The data was analysed using manual content analysis. Data showed that patients lack basic knowledge about leukaemia and had no beliefs regarding leukaemia. Some patients believed in God and a medical breakthrough for a cure, while for some, the hope of living was not certain. The ill-health condition had brought about financial predicament to both patients and family members and has limited their productivity in terms of income-generating activities. Good interpersonal relationships and support from their care providers aided their compliance to treatment regime and provided hope for living positively with their condition. The study concludes that there is a need to educate the patients on the causes of their condition. Financial supports should be rendered to those living with leukaemia, while health care providers should be encouraged to continue to maintain good interpersonal relationships with their patients.