Perceptions and beliefs of community gatekeepers about genomic risk information in African cleft research.

BACKGROUND: A fundamental ethical issue in African genomics research is how socio-cultural factors impact perspectives, acceptance, and utility of genomic information, especially in stigmatizing conditions like orofacial clefts (OFCs). Previous research has shown that gatekeepers (e.g., religious, political, family or community leaders) wield considerable influence on the decision-making capabilities of their members, including health issues. Thus, their perspectives can inform the design of engagement strategies and increase exposure to the benefits of genomics testing/research. This is especially important for Africans underrepresented in genomic research. Our study aims to investigate the perspectives of gatekeepers concerning genomic risk information (GRI) in the presence of OFCs in a sub-Saharan African cohort. METHODS: Twenty-five focus group discussions (FGDs) consisting of 214 gatekeepers (religious, community, ethnic leaders, and traditional birth attendants) in Lagos, Nigeria, explored the opinions of participants on genomic risk information (GRI), OFC experience, and the possibility of involvement in collaborative decision-making in Lagos, Nigeria. Transcripts generated from audio recordings were coded and analyzed in NVivo using thematic analysis. RESULTS: Three main themes-knowledge, beliefs, and willingness to act-emerged from exploring the perspective of gatekeepers about GRI in this group. We observed mixed opinions regarding the acceptance of GRI. Many participants believed their role is to guide and support members when they receive results; this is based on the level of trust their members have in them. However, participants felt they would need to be trained by medical experts to do this. Also, religious and cultural beliefs were crucial to determining participants' understanding of OFCs and the acceptance and utilization of GRI. CONCLUSIONS: Incorporating cultural sensitivity into public engagement could help develop appropriate strategies to manage conflicting ideologies surrounding genomic information in African communities. This will allow for more widespread access to the advances in genomics research in underrepresented populations. We also recommend a synergistic relationship between community health specialists/scientists, and community leaders, including spiritual providers to better understand and utilize GRI.

Exploring church members' perceptions towards physical activity, fruits and vegetables consumption, and church's role in health promotion: implications for the development of church-based health interventions.

Background: The study explored the perceptions of church members towards physical activity (PA), the consumption of fruits and vegetables (FV), and the church's role in health promotion prior to the development of a church-based intervention for physical activity and fruit and vegetable consumption in Lagos, Nigeria. Method: Sixteen focus group discussions (FGD) and eleven key Informant Interviews (KII) were conducted. Eight FGDs among adults and four among the youth and the elderly church members. Key informant interviews were held among church leaders and members of the church medical advisory. Study findings were categorized under thematic headings. Based on the data analysis, several key themes were identified: the knowledge of the concept of health and common health problems, opinions of physical activity, opinions of healthy eating and fruit and vegetable consumption, types and attitudes towards existing church-based health programs and the role of the church in health promotion and church-based health programs. Within each theme, several childthemes were noted such as the challenges with fruit and vegetable consumption, biblical support for physical activity and fruit & vegetable consumption, the role of the church leaders, program sustainability and barriers to participation. Results: The participants perceived health not only as the absence of disease but as general well-being of the body and soul. Health was also related to the ability to perform religious activities. Common health problems included a mix of communicable and non-communicable diseases. They are aware that physical activity, fruits and vegetables are essential for healthy living. The youth saw it as a means of improving their physical appearance however the elderly expressed concerns about the possibility of associated trips and falls. Overall, they viewed fruits and vegetables as healthy foods while processed western foods were perceived as unhealthy. Fruits and vegetables were seen as beneficial primarily to aid food digestion, boost immunity, improve youthfulness, aid weight control and to prevent chronic disease. The study participants agreed that the church, as an institution, has a significant role to play in promoting the health of her members. Instituted health committees embedded within existing church structures often lead church-based health-promoting activities and are imperative for sustainability. Types of health programs included health talks, screening programs for common NCDs, sport competitions, distributions of FV during church ceremonies such as harvests, Lenten seasons, Love feasts and church bazaars. Health outreaches were seen as a means of evangelism, and it was unanimously agreed that the Bible supports PA and healthy eating. Generally, the respondents had positive attitudes towards church-based health programs and they advised that future programs include the use of technology and should be integrated into existing church activities to improve participation. The participants also noted that the opinion of the church leaders influences the behaviours of church members and their support is critical in the development and implementation of church-based health programs. Conclusion: Church members are aware that physical activity and the consumption of fruits and vegetables are important for healthy living and expressed support for church-based health programs. They believe that the Bible supports the promotion of PA and FV consumption as healthy behaviours. Program integration, the use of technology and support of church leaders and existing church medical advisory groups are imperative for developing and sustaining church-based health programs.

The prevalence of drug use and illicit trafficking: A descriptive cross sectional study of irregular migrant returnees in Nigeria.

The study assessed the prevalence of drug use and drug trafficking among Nigerian returned migrants from Libyan detention centers in the transit or destination along the Mediterranean irregular migration route. This is a descriptive cross sectional study. The study population was restricted to migrants who returned from May 2017 and April 2018. A total of 382 (238 male and 144 female) were contacted and provided information for this study. These participants were recruited using judgemental and snowballing techniques. Both quantitative and qualitative methods of data collection were used. Results showed that 61.3% of the respondents used drugs during their migration. Drug use was predominant among those in the younger age group (26-30) accounting for 24.9%. The study revealed reasons for respondents' drug use which were as a result of migration frustration and trauma, or compulsion. The findings on drug trafficking revealed that 15.7% of the respondents engaged in drug trafficking during their migration, and 28% of the respondents that trafficked drugs had previous experience of arrest or detention by law enforcement agent (in Libya). Findings from this study showed high prevalence of drug use among irregular migrants. Experience of migration frustration and trauma were among the factors that contribute to drug use among the migrant population. The study also discovered that some of the migrants who got into illicit drug trafficking were to raise money for survival while some were compelled into the business. The high prevalence of drug use among irregular migrants from findings draw attention to the important implications for public health and social security, while drug trafficking in existence among migrants calls for need of social reintegration.

Human rights abuses experienced by people who use drugs: a Nigeria-focused review

Drug abuse is a global health issue. Even though people use drugs for different reasons, some-times drugs become central to their lives and they believe that they cannot live without them. Such people are dependent on the drugs they use. The social stigma of alcohol, and other drugs, use remains in society. People who use or abuse drugs are highly stigmatized, which often pre-vents them from being included and accepted within society and their communities. People see them as irresponsible and a threat to the environment. Some families cannot acknowledge that a family member uses drugs, or provide them with proper treatment in hospitals or rehabilitation centers because of the accompanying stigma, which the family may not like to be associated with. Many people who use drugs are jobless and poor, and have been disengaged from their families, education and training. They may resort to self-medication when they need medical attention. Some of them cannot afford expensive medical services and may die as a result of treatable illnesses. In some cases, medical service providers can be reluctant to admit people who use drugs to their facilities and, thus, they face compounding rejection. This paper descri-bes human rights abuses occurring among drug users, and also reviews the available literature on human rights violations experienced by people who use drugs with focus in the Nigerian socio-cultural environment.