Determinants of prostate specific antigen screening test uptake in an urban community in North-Central Nigeria

Background: Despite the increasing incidence of Prostate cancer, there has not been any focused screening policy or strategy in sub-Saharan Africa including Nigeria.Objectives: To assess the level of awareness and uptake of PSA screening test and their determinants in a Nigerian community.Methods: A cross-sectional population survey of men with no prior history of prostate cancer was carried out. Logistic re- gression analysis was used to determine the effect of identified variables in predicting awareness and uptake of prostate cancer screening.Results: Mean age was 51.5±9.8 years; a few men (31, 16.9%) had ever heard of the screening test and most got the information from health centers. A low proportion (8, 4.4%) had taken the screening test. Men with incomes above poverty line (OR = 11.7 2.8–50.1, p = .001) or those with health insurance (OR = 2.7 1.2–6.5, p = .023) were significantly more likely to be aware of the test. Only the men with higher incomes (OR = 25.6 5.8–114.2, p = .0001) were significantly more likely to have taken the test.Conclusion: Higher incomes and health insurance status impact screening awareness but only income status determines if men subsequently proceed to take the PSA screening test.Keywords: Prostate cancer; PSA screening; sub-Saharan Africa; Nigeria

Determinants of prostate specific antigen screening test uptake in an urban community in North-Central Nigeria

Background: Despite the increasing incidence of Prostate cancer, there has not been any focused screening policy or strategy in sub-Saharan Africa including Nigeria. Objectives: To assess the level of awareness and uptake of PSA screening test and their determinants in a Nigerian community. Methods: A cross-sectional population survey of men with no prior history of prostate cancer was carried out. Logistic regression analysis was used to determine the effect of identified variables in predicting awareness and uptake of prostate cancer screening. Results: Mean age was 51.5\ub19.8 years; a few men (31, 16.9%) had ever heard of the screening test and most got the information from health centers. A low proportion (8, 4.4%) had taken the screening test. Men with incomes above poverty line (OR = 11.7 2.8\u201350.1, p = .001) or those with health insurance (OR = 2.7 1.2\u20136.5, p = .023) were significantly more likely to be aware of the test. Only the men with higher incomes (OR = 25.6 5.8\u2013114.2, p = .0001) were significantly more likely to have taken the test. Conclusion: Higher incomes and health insurance status impact screening awareness but only income status determines if men subsequently proceed to take the PSA screening test. DOI: https://dx.doi.org/10.4314/ahs.v19i1.42 Cite as: Bello JO, Buhari T, Mohammed TO, Olanipekun HB, Egbuniwe AM, Fasiku OK, et al. Determinants of prostate specific antigen screening test uptake in an urban community in North-Central Nigeria. Afri Health Sci. 2019;19(1). 1665-1670. https://dx.doi.org/10.4314/ ahs. v19i1.4

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways