Geospatial barriers to healthcare access for breast cancer diagnosis in sub-Saharan African settings: The African Breast Cancer—Disparities in Outcomes Cohort Study

We examined the geospatial dimension of delays to diagnosis of breast cancer in a prospective study of 1541 women newly diagnosed in the African Breast Cancer—Disparities in Outcomes (ABC-DO) Study. Women were recruited at cancer treatment facilities in Namibia, Nigeria, Uganda and Zambia. The baseline interview included information used to generate the geospatial features: urban/rural residence, travel mode to treatment facility and straight-line distances from home to first-care provider and to diagnostic/treatment facility, categorized into country/ethnicity (population)-specific quartiles. These factors were investigated in relation to delay in diagnosis (≥3 months since first symptom) and late stage at diagnosis (TNM: III, IV) using logistic regression, adjusted for population group and sociodemographic characteristics. The median (interquartile range) distances to first provider and diagnostic and treatment facilities were 5 (1-37), 17 (3-105) and 62 (5-289) km, respectively. The majority had a delay in diagnosis (74%) and diagnosis at late stage (64%). Distance to first provider was not associated with delay in diagnosis or late stage at diagnosis. Rural residence was associated with delay, but the association did not persist after adjustment for sociodemographic characteristics. Distance to the diagnostic/treatment facility was associated with delay (highest vs lowest quartile: odds ratio (OR) = 1.56, 95% confidence interval (CI) = 1.08-2.27) and late stage (overall: OR = 1.47, CI = 1.05-2.06; without Nigerian hospitals where mostly local residents were treated: OR = 1.73, CI = 1.18-2.54). These findings underscore the need for measures addressing the geospatial barriers to early diagnosis in sub-Saharan African settings, including providing transport or travel allowance and decentralizing diagnostic services

Breast cancer survival and survival gap apportionment in sub-Saharan Africa (ABC-DO): a prospective cohort study

Background: Breast cancer is the second leading cause of death from cancer in women in sub-Saharan Africa, yet there are few well characterised large-scale survival studies with complete follow-up data. We aimed to provide robust survival estimates in women in this setting and apportion the survival gaps. Methods: The African Breast Cancer-Disparities in Outcomes (ABC-DO) prospective cohort study was done at eight hospitals across five sub-Saharan African countries (Namibia, Nigeria, South Africa, Uganda, and Zambia). We prospectively recruited women (aged ≥18 years) who attended these hospitals with suspected breast cancer. Women were actively followed up by use of a telephone call once every 3 months, and a mobile health application was used to keep a dynamic record of follow-up calls due. We collected detailed sociodemographic, clinical, and treatment data. The primary outcome was 3-year overall survival, analysed by use of flexible proportional mortality models, and we predicted survival under scenarios of modified distributions of risk factors. Findings: Between Sept 8, 2014, and Dec 31, 2017, 2313 women were recruited from these eight hospitals, of whom 85 did not have breast cancer. Of the remaining 2228 women with breast cancer, 58 women with previous treatment or recurrence, and 14 women from small racial groups (white and Asian women in South Africa), were excluded. Of the 2156 women analysed, 1840 (85%) were histologically confirmed, 129 (6%) were cytologically confirmed, and 187 (9%) were clinically confirmed to have breast cancer. 2156 (97%) women were followed up for up to 3 years or up to Jan 1, 2019, whichever was earlier. Up to this date, 879 (41%) of these women had died, 1118 (52%) were alive, and 159 (7%) were censored early. 3-year overall survival was 50% (95% CI 48–53), but we observed variations in 3-year survival between different races in Namibia (from 90% in white women to 56% in Black women) and in South Africa (from 76% in mixed-race women to 59% in Black women), and between different countries (44–47% in Uganda and Zambia vs 36% in Nigeria). 215 (10%) of all women had died within 6 months of diagnosis, but 3-year overall survival remained low in women who survived to this timepoint (58%). Among survival determinants, improvements in early diagnosis and treatment were predicted to contribute to the largest increases in survival, with a combined absolute increase in survival of up to 22% in Nigeria, Zambia, and Uganda, when compared with the contributions of other factors (such as HIV or aggressive subtypes). Interpretation: Large variations in breast cancer survival in sub-Saharan African countries indicate that improvements are possible. At least a third of the projected 416 000 breast cancer deaths that will occur in this region in the next decade could be prevented through achievable downstaging and improvements in treatment. Improving survival in socially disadvantaged women warrants special attention. Funding: Susan G Komen and the International Agency for Research on Cancer

Rapid epidemic expansion of the SARS-CoV-2 Omicron variant in southern Africa

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic in southern Africa has been characterised by three distinct waves. The first was associated with a mix of SARS-CoV-2 lineages, whilst the second and third waves were driven by the Beta and Delta variants, respectively1-3. In November 2021, genomic surveillance teams in South Africa and Botswana detected a new SARS-CoV-2 variant associated with a rapid resurgence of infections in Gauteng Province, South Africa. Within three days of the first genome being uploaded, it was designated a variant of concern (Omicron) by the World Health Organization and, within three weeks, had been identified in 87 countries. The Omicron variant is exceptional for carrying over 30 mutations in the spike glycoprotein, predicted to influence antibody neutralization and spike function4. Here, we describe the genomic profile and early transmission dynamics of Omicron, highlighting the rapid spread in regions with high levels of population immunity

PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK

Background Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. Methods All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. Results A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. Conclusion Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions

If not now, when? Time for the European Union to define a global health strategy

Speakman, E. M., McKee, M., & Coker, R. (2017). If not now, when? Time for the European Union to define a global health strategy. Lancet Global Health, 5(4), e392-e393. https://doi.org/10.1016/S2214-109X%2817%2930085-

The Criminal Justice System and Ordeal of Victims of Crime in Nigeria: A Preliminary Observation

Law is important and indeed indispensable for the continued existence of human society. The criminal justice system is entrusted with the responsibility of controlling criminal behaviour and punishing criminals or offenders. Compared to civil law, criminal law focuses more on the benefit of the state and political community than on victims of crime. Regrettably, a justice system which places more emphasis on criminals or offenders than victims of crime cannot be said to be wholly fair, equitable and just. It has placed victims in an unbearable but avoidable ordeal. Nevertheless, the system can be tinkered with to ensure a balance of justice in society. SOPHIA: An African Journal of Philosophy Vol. 8 (2) 2006: pp. 28-3

Curing, thermal resistance and bending behavior of laterised concrete containing ceramic wastes

Recent years have witnessed an increase in volume of construction and demolition wastes generated in some developed and developing countries, which mostly constitute environmental issues. Therefore, it is important to explore the potential of such waste materials, or when used with locally available materials for concrete production. Thus, this research effort aims at determining the effects of curing methods (polythene wrapping and water immersion), and exposure to high temperature, on strength characteristics of laterised concrete samples made with ceramic floor tiles wastes as aggregates. The study also explored the bending behavior of steel reinforced beam mixes comprising ceramics and laterite. From the obtained results, samples made with ceramic and laterite developed higher strengths when cured with polythene covering than the water cured samples. However, the reference concrete samples developed better strength in normal curing condition (immersion in water). In terms of thermal resistance, the laterised samples had better resistance at elevated temperatures than the reference concrete. Lastly, for the tested beams, the maximum mid span bending strength decreased with increasing laterite content. Overall, it can be considered that ceramic floor tiles wastes with minimal laterite content can be used for concrete production, and by so doing, the negative impact of these wastes on the environment can be controlled

Nutritive value and methane production potential of energy and protein rich feed stuffs fed to livestock in India

Four protein-rich (groundnut cake-GNC, mustard seed cake-MSC, cotton seed cake-CSC and coconut cake-CNC) and 8 energy-rich (wheat grain-WG, barley grain-BG, oat grain-OG, maize grain-MG, wheat bran A-WBA, wheat bran B-WBB, rice bran-RB, chickpea husk/chuni-GC) feedstuffs were evaluated for their carbohydrate and protein fractions, in vitro dry matter degradability, in vitro methane production and energy loss as methane. Crude protein (CP) and ether extract contents were higher in protein-rich feedstuffs than in energy feedstuffs. High lignin content was noted in CSC, GNC, MSC and RB. Degradable CP fractions of total CP ranged from 0.61 to 0.97 and were higher for protein-rich than energy-rich feedstuffs. On an average, protein-rich feedstuffs had more undegradable CP fraction than the grains or brans. Starch content was highest (P<0.001) in WBB and least in CSC with values of 369 and 37.3 g/kg DM, respectively. Rapidly degradable carbohydrate fraction (CA) was highest in WG, OG, MG (all energy-rich feedstuffs) and least in RB (6.7 g/kg DM). Similar to the observation made in the protein fractions, protein-rich feedstuffs had more unavailable CHO. Feedstuffs energy loss as methane was highest (P<0.001) from GC (1.90 Mj/kg DM) and least from MG (1.19 Mj/kg DM). Methane production of the feedstuffs could be predicted from the chemical composition, CP and CHO fractions. On an average, chemical composition and protein fractions were better predictors of CH4 production versus CHO fractions with mean R-2 values of 0.94 and 0.80, respectively. Data on relative methane emission from energy and protein rich feeds could be utilized to prepare diets that will lead to less methane production from ruminants