Preparing medical students to recognize and respond to gender based violence in Nigeria

Background: Medical practitioners are ideally positioned to mitigate the impact of gender based violence (GBV) on the health of victims. However, there is a lack of information on students\u2019 ability and willingness to do so. Objective: To identify factors which impact on students\u2019 attainment of the knowledge and perceived ability to manage victims. Methods: A cross-sectional survey was conducted on 388 (91.5%) final year medical students from three medical schools in South West, Nigeria. Results: Students were knowledgeable on sexual (63.7%) and physical (54.6%) forms of GBV and unfamiliar with other forms. The mean scores for knowledge (7.1 \ub1 2.5 out of 11); attitude (52.6 \ub1 10.3 out of 80); personal comfort (44.1 \ub1 10.0 out of 65) and skills (3.1 \ub1 2.6 out of 7) were calculated. Younger respondents, females and married students reported less skill to manage victims. The location of school, previous training and personal comfort remained significant determinants of students\u2019 self reported skills on GBV. Respondents with prior training on GBV and comfortable with managing patients, were four times more likely to perceive they were more skilled than their peers [AOR = 4.33, 95% CI: 2.37 \u2013 7.90 and AOR 3.53; 95% CI 2.16- 5.78 respectively]. Conclusion: Formalised skills training on GBV is a necessity, especially for young, female students and training cannot be left to serendipity. The medical curriculum should be reviewed. DOI: https://dx.doi.org/10.4314/ahs.v19i1.22 Cite as: Fawole OI, M. van Wyk J, Balogun BO, Akinsola OJ, A A. Preparing medical students to recognize and respond to gender based violence in Nigeria. Afri Health Sci. 2019;19(1). 1486-1498. https:// dx.doi. org/10.4314/ ahs. v19i1.2

Impact of mobile technologies on cervical cancer screening practices in Lagos, Nigeria (mHealth-Cervix): Protocol for a randomised controlled trial

Background: Incidence and mortality from cervical cancer have remained high due to many obstacles facing the implementation of organized screening programs in resource-constrained countries such as Nigeria. The application of mobile technologies (mHealth) to health services delivery has the potential to reduce inequalities, empower patients to control their health, and improve the cost-effectiveness of health care delivery. Aim: To assess the efficacy of mobile technology intervention on Pap test screening adherence compared to a control condition and also determine the factors affecting the uptake of Pap smear screening practices among women in Lagos. Methods: This is a multi-center randomized controlled trial that will involve women aged 25 to 65 years attending the General Outpatient clinics of the two tertiary health institutions in Lagos, Nigeria between April and December 2020. At baseline, a total of 200 National Health Insurance Scheme (NHIS) enrollees will be randomized to either a text message arm or usual care (control) arm. The primary outcome is the completion of a Pap smear within 6 months of enrolment in the study. The associations between any two groups of continuous variables will be tested using the independent sample t-test (normal distribution) or the Mann-Whitney U test (skewed data) and that of two groups of categorical variables with Chi-square X2or Fisher's exact test where appropriate. Using binary logistic regression model, we will adjust for age and other relevant sociodemographic and clinical variables and adherence to Pap test screening. Statistical significance will be defined as P-value less than 0.05. Discussion: The mHealth-Cervix study will evaluate the impact of mobile technologies on cervical cancer screening practices in Lagos, Nigeria as a way of contributing to the reduction in the wide disparities in cervical cancer incidence through early detection facilitated using health promotion to improve Pap smear screening adherence. Registration: PACTR202002753354517 13/02/202

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Plasma Homocysteine and Haematological Changes in Infertile Women in Lagos, Nigeria

Hyperhomocysteinemia has been described as a risk factor for infertility and adverse pregnancy outcomes such as recurrent/early pregnancy loss, pre-eclampsia and intrauterine growth restriction. Although Nigeria has a high prevalence of infertility, the contribution of homocysteine to female infertility is yet to be studied. This study aim to find possible relationship between elevated plasma homocysteine level and infertility. This descriptive cross-sectional study was carried out among eligible infertile and fertile women seeking care at the Lagos University Teaching Hospital. The subjects were 100 infertile women randomly selected from the fertility clinic, and the controls were 50 fertile women that have given birth in the last one year. Fasting plasma levels of homocysteine were estimated using enzyme immunoassay technique, while anticoagulated whole blood sample was used to evaluate haematological parameters (Hb, WBC, MCV, MCH, MCHC, RDW %), using the HMX haematology autoanalyser by Beckman Coulter. Statistical analysis was performed using the Chi-square and simple logistic regression model for associations and Student t-test for mean differences. Statistical significance was set at p-value &lt;0.05. Among infertile women, 34.0% (n=34) complained of primary infertility while 66.0% (n=66) had secondary infertility. Mean plasma homocysteine level of subjects and controls were 9.50 ± 1.88μmol/L and 9.44 ± 1.85μmol/L respectively. In the control group, the 95th percentile for homocysteine level was 12.0μmol/L. Differences in mean plasma homocysteine levels between the subjects and controls were not statistically significant (p=0.952).Mean values of haematological parameters did not vary significantly in both groups except for a marginal increase in WBC count of infertile women. Hyperhomocysteinemia may not be a major factor in female infertility in our environment.Key words: Plasma homocysteine, Female infertility, Haematological parameter