Investigating the Place of Population Increase and Level of Income Earning in Food Security A Study of Yam Supply in Awka Urban, Anambra State of Nigeria

This research was carried out to present yam supply and food security situation in Awka urban, Anambra State. Data used were collected through questionnaires and oral interview, using the simple random sampling to select the respondents. The Pearson Product Moment Correlation was employed in testing the hypotheses formulated. It was found out that there is a significant relationship between population increase and yam supply and that there is a significant relationship between the income of the consumers and yam consumption. The increase in the population in Awka urban has led to a decrease in food production causing the people to look outward for food supply. This can be averted if agricultural productivity is increased and more jobs are provided for the people to earn income to purchase food

Meta-analysis of factors affecting prevalence estimates of HIV-associated neurocognitive disorder in sub-Saharan Africa

Successful treatment of HIV with anti-retroviral therapy (ART) is resulting in more people living with HIV-associated neurocognitive disorder (HAND). In sub-Saharan Africa, this calls for strategic planning and judicious allocation of scarce resources, which requires an accurate estimate of the prevalence of HAND. Estimates of the prevalence of HAND in sub-Saharan Africa vary greatly, between 18.8% and 88.3%. This variability may be explained by factors such as different diagnostic approach, neuromedical examination, ART status, sampling method, substance abuse, assessors’ qualification, depression and outcome measure. Different methods of diagnosing HAND, different outcome measures and non-random sampling techniques make it almost impossible to accurately estimate the prevalence of HAND in subSaharan Africa, often resulting in overestimation of the burden of disease. Consumers of health research should consider certain study characteristics and exercise appropriate caution when interpreting burden of disease in sub-Saharan Africa, especially when pursuing policy shift. Underestimating the prevalence of HAND will certainly affect the capacity and speed of containment, while overestimating will draw unnecessary attention and result in the misallocation of scarce resources. Significance: • The high prevalence of HAND in sub-Saharan Africa as estimated in this review calls for further research on the impact of HAND on activities of daily living and putative therapeutic modalities. • We highlight which study characteristics should be critically checked when using prevalence estimates for the purpose of health policy and distribution of scarce resources in sub-Saharan Africa. • By favouring certain factors, this review will guide HIV health researchers in which techniques should be used to estimate the burden of HAND. These factors may also apply to estimating the burden of other diseases in sub-Saharan Africa.University of Pretoria.https://sajs.co.zaPhysiotherap

A qualitative study exploring healthcare workers’ lived experiences of the impacts of COVID-19 policies and guidelines on maternal and reproductive healthcare services in the United Kingdom

INTRODUCTION During the COVID-19 pandemic, pregnant women were regarded as vulnerable to poor health outcomes if infected with the SARS-CoV-2 (COVID-19) virus. To protect the United Kingdom’s (UK) National Health Service (NHS) and pregnant patients, strict infection control policies and regulations were implemented. This study aimed to understand the impact of the COVID-19 policies and guidelines on maternal and reproductive health services during the pandemic from the experiences of healthcare workers (HCWs) caring for these patients. METHODS This qualitative study involved HCWs from the United Kingdom Research study into Ethnicity and COVID-19 outcomes in Healthcare workers (UK-REACH) project. Semi-structured interviews and focus groups were conducted online or by telephone with 44 diverse HCWs. Transcripts were thematically analyzed following Braun and Clarke’s principles of qualitative analysis. RESULTS Three key themes were identified during analysis. First, infection control policies impacted appointment availability, resulting in many cancellations and delays to treatment. Telemedicine was also used extensively to reduce risks from face-to-face consultations, disadvantaging patients from minoritized ethnicities. Secondly, staff shortages and redeployments reduced availability of consultations, appointments, and sonography scans. Finally, staff and patients reported challenges accessing timely, reliable and accurate information and guidance. CONCLUSIONS COVID-19 demonstrated how a global health crisis can impact maternal and reproductive health services, leading to reduced service quality and surgical delays due to staff redeployment policies. Our findings underscore the implications of policy and future health crises preparedness. This includes tailored infection control policies, addressing elective surgery backlogs early and improved dissemination of relevant vaccine information

Cost-Effectiveness of Alternative Models of Community Health Workers for promotion of Maternal, Newborn and Child Health in Northern Nigeria

Background: Community health workers (CHWs) have proven to be successful in mobilizing rural populations to utilize primary health services where they can be supported by skilled health workers. This study assessed the cost-effectiveness of three CHW models implemented in northern Nigeria. Method: Using a quasi-experimental design, we compare the costs and health outcomes for communities where CHW models were implemented versus those where no CHW models were implemented. The three CHW models were Community Volunteer (CV), Nigeria Subsidy Reinvestment and Empowerment Programme for Maternal and Child Health Village Health Worker (VHW), and the Junior Community Health Extension Worker providing community based service delivery (JCHEW-CBSD). The unit costs, consultation patterns, benefit-cost ratios, and cost-effectiveness ratios were calculated for the three CHW models. Results: Compared to the CVs, the VHWs and the JCHEW-CBSDs had the highest levels of interactions in the community, each helping to educate 120-130 pregnant women each year. JCHEW-CBSDs made the most referrals for antenatal care (220) and facility births (122); however, women who interacted with the VHWs increased their antenatal care visits the most, with 92% of the women having made at least one and 70% having made 4+ ANC visits. The unit cost of the CVs was lowest, compared to the other two models, at $127 versus$3176 for the VHW model and $4443 for the JCHEWCBSD model. The outcomes per unit cost ratios were highest for the VHW model. For every$1000 invested in the VHW, there were 54 ANC 4+ visits and 95.9 deliveries attended by a skilled birth attendant. The Incremental Cost-Effectiveness Ratios for the VHW model were also lower than for the JCHEW-CBSD model, ranging from a low of an additional $25 per incremental ANC visits to$152 for increments in attended deliveries, the latter amount three times lower than for the JCHEW-CBSD model. Conclusion: This cost-effectiveness study of CHW models in Northern Nigeria shows that the SURE-P VHW model was most cost-effective. The VHW model, an enhanced volunteer model, promises the greatest return on investment if scaled up in northern Nigeria and settings with similar health care delivery contexts

Setting priorities for ageing research in Africa: a systematic mapping review of 512 studies from sub-Saharan Africa

BACKGROUND: In 2040, the older population's growth rate in sub-Saharan Africa (SSA) will be faster than those experienced by developed nations since 1950. In preparation for this growth, the National Institute on Aging commissioned the National Academies' Committee on Population to organize a workshop on advancing aging research in Africa. This meeting provided a platform for discussing some areas requiring improvement in aging research in SSA regions. We believed that conducting a systematic review of peer-reviewed articles to set priorities for aging research in SSA is warranted. Therefore, this article is the first in a Four-Part series that summaries the types and trends of peer-reviewed studies in SSA. METHODS: This systematic mapping review followed the Search-Appraisal-Synthesis-Analysis Framework. We systematically searched multiple databases from inception till February 2021 and included peer-reviewed articles conducted with/for older adults residing in SSA. Conventional content analysis was employed to categorize studies into subject-related areas. RESULTS: We included 512 studies (quantitative = 426, qualitative = 71 and mixed-method = 15). Studies were conducted in 32 countries. Quantitative studies included were observational studies: cross-sectional (n = 250, 59%), longitudinal (n = 126, 30%), and case-control (n = 12, 3%); and experimental studies: pre-post design (n = 4, 1%), randomized control trial (RCT, n = 12, 3%); and not reported (n = 21, 5%). Fifteen qualitative studies did not state their study design; where stated, study design ranged from descriptive (n = 14, 20%), ethnography (n = 12, 17%), grounded theory (n = 7, 10%), narrative (n = 5, 7%), phenomenology (n = 10, 14%), interpretative exploratory (n = 4, 6%), case studies (n = 4, 6%). Of the 15 mixed-method studies, seven did not state their mixed-method design. Where stated, design includes concurrent (n = 1), convergent (n = 1), cross-sectional (n = 3), informative (n = 1), sequential exploratory (n = 1) and retrospective (n = 2). Studies were classified into 30 (for quantitative studies) and seven (for qualitative and mixed-method) subject-related areas. HIV/AIDs-related and non-communicable diseases-related studies were the most predominant subject-related areas. No studies explored the transdisciplinary co-production of interventions. CONCLUSIONS: There are glaring gaps in ageing research in SSA, especially mixed-methods and RCTs. A large number of studies focused on HIV/AIDs and non-communicable disease-related studies. National and international funding agencies should set up priority funding competitions for transdisciplinary collaborations in ageing research

Hunger, waiting time and transport costs: Time to confront challenges to ART adherence in Africa

International audienceAdherence levels in Africa have been found to be better than those in the US. However around one out of four ART users fail to achieve optimal adherence, risking drug resistance and negative treatment outcomes. A high demand for 2nd line treatments (currently ten times more expensive than 1st line ART) undermines the sustainability of African ART programs. There is an urgent need to identify context-specific constraints to adherence and implement interventions to address them. We used rapid appraisals (involving mainly qualitative methods) to find out why and when people do not adhere to ART in Uganda, Tanzania and Botswana. Multidisciplinary teams of researchers and local health professionals conducted the studies, involving a total of 54 semi-structured interviews with health workers, 73 semi-structured interviews with ART users and other key informants, 34 focus group discussions, and 218 exit interviews with ART users. All the facilities studied in Botswana, Tanzania and Uganda provide ARVs free of charge, but ART users report other related costs (e.g. transport expenditures, registration and user fees at the private health facilities, and lost wages due to long waiting times) as main obstacles to optimal adherence. Side effects and hunger in the initial treatment phase are an added concern. We further found that ART users find it hard to take their drugs when they are among people to whom they have not disclosed their HIV status, such as co-workers and friends. The research teams recommend that (i) health care workers inform patients better about adverse effects; (ii) ART programmes provide transport and food support to patients who are too poor to pay; (iii) recurrent costs to users be reduced by providing three-months, rather than the one-month refills once optimal adherence levels have been achieved; and (iv) pharmacists play an important role in this follow-up care

The prevalence and long-term health effects of Long Covid among hospitalised and non-hospitalised populations: A systematic review and meta-analysis

BACKGROUND: The aim of this study was to systematically synthesise the global evidence on the prevalence of persistent symptoms in a general post COVID-19 population. METHODS: A systematic literature search was conducted using multiple electronic databases (MEDLINE and The Cochrane Library, Scopus, CINAHL, and medRxiv) until January 2022. Studies with at least 100 people with confirmed or self-reported COVID-19 symptoms at ≥28 days following infection onset were included. Patient-reported outcome measures and clinical investigations were both assessed. Results were analysed descriptively, and meta-analyses were conducted to derive prevalence estimates. This study was pre-registered (PROSPERO-ID: CRD42021238247). FINDINGS: 194 studies totalling 735,006 participants were included, with five studies conducted in those <18 years of age. Most studies were conducted in Europe (n = 106) or Asia (n = 49), and the time to follow-up ranged from ≥28 days to 387 days. 122 studies reported data on hospitalised patients, 18 on non-hospitalised, and 54 on hospitalised and non-hospitalised combined (mixed). On average, at least 45% of COVID-19 survivors, regardless of hospitalisation status, went on to experience at least one unresolved symptom (mean follow-up 126 days). Fatigue was frequently reported across hospitalised (28.4%; 95% CI 24.7%-32.5%), non-hospitalised (34.8%; 95% CI 17.6%-57.2%), and mixed (25.2%; 95% CI 17.7%-34.6%) cohorts. Amongst the hospitalised cohort, abnormal CT patterns/x-rays were frequently reported (45.3%; 95% CI 35.3%-55.7%), alongside ground glass opacification (41.1%; 95% CI 25.7%-58.5%), and impaired diffusion capacity for carbon monoxide (31.7%; 95% CI 25.8%-3.2%). INTERPRETATION: Our work shows that 45% of COVID-19 survivors, regardless of hospitalisation status, were experiencing a range of unresolved symptoms at ∼ 4 months. Current understanding is limited by heterogeneous study design, follow-up durations, and measurement methods. Definition of subtypes of Long Covid is unclear, subsequently hampering effective treatment/management strategies. FUNDING: No funding

Exploring the influence of health management processes on health outcomes among internally displaced persons (IDPs)

Background: Despite global action and policy initiatives, internally displaced persons (IDPs) experience poor living conditions and lack healthcare access compared to refugees. This study sought to understand the relationship between health management processes and health outcomes among camp-dwelling IDPs in northern Nigeria. Method: 73 individuals participated in either a focus group (n = 49) or one-to-one interview (n = 24), comprising IDPs (n = 49), camp managers (n = 9), health workers (n = 7) and government administrative authorities (n = 8). Interviews explored IDP health management processes, partners and perceptions around camp management. Data were analysed using an inductive thematic approach. Results: Four main themes were identified: opinions about healthcare organisation and management, service availability, interventions and information management, and IDP health outcomes. Though many stakeholders, partnerships, and national and international government agencies were involved in the provision of healthcare services, respondents described efforts as disjointed. Reports suggested that the coordination and management of health services and resources were not tailored to the needs of those living in all camps. And because so many national and international agencies were involved, but under weak coordination, access to services was less than optimal and adequate management of critical public health interventions was lacking. Varied allocation of resources such as funding, medication and medically trained staff were viewed as key factors in the availability and the ability to access what was considered as essential healthcare services. Conclusion: The health of IDPs in camp-like settings was compromised by uncoordinated management, treatment, and control of communicable and non-communicable diseases. Government authorities need to be aware and consider the complexity of the multiagency involvement in the management and provision of IDP healthcare services. Introducing systems to streamline, monitor and support IDP healthcare management could be cost-effective strategies for achieving optimal health care

MORPHOMETRIC STUDY OF THE JUGULAR FORAMEN IN DRY NIGERIAN SKULLS. Estudio morfométrico del foramen yugular en cráneos nigerianos secos

Jugular foramen is a hiatus in the posterior cranial fossa that transmits the internal jugular vein among other structures. The knowledge of the jugular foramen is important in neurosurgical procedures. The objective of the study was to characterize the morphology and the dimensions of jugular foramen in dry Nigerian skulls. One hundred and seventy jugular foramens from 85 dry adult skulls of unknown sex were studied. Morphology was studied by observation and measurements were taken with Venier caliper. The parameters that were studied included the shape, septation, medio-lateral diameter, antero-posterior diameter of jugular foramen, and the dome, width and depth of jugular fossa. Oval shaped foramen (77%) was more prevalent than round shaped foramen (23%). Complete septation was found in 19.4% of skulls, while incomplete septation was found in 41.2% of skulls. Absence of septation was found in 39,4% of skulls. Dome over the jugular fossa was present in 67,6% and absent in 32,4% of the skulls. The antero-posterior diameter (right - 13,20mm±2.8, left - 11,72±2.8) and medio-lateral diameter (right – 18.73mm±3.5, left – 17,33mm±3.1) were significantly higher on the right side than on the left side. The depth of jugular fossa was significantly higher on the right side (12.38mm±2.4) than on the left side (10.95mm±2.8). The width of jugular fossa was higher on the right (12.06mm±3.6) than on the left (11.80mm±3.3) but the difference was not significant. The present study demonstrated right sided dominance in the metric parameters of the jugular foramen in our environment.   El foramen yugular es un hiato en la fosa craneal posterior que transmite la vena yugular interna entre otras estructuras. El conocimiento del foramen yugular es importante en procedimientos neuro-quirúrgicos. El objetivo del estudio era caracterizar la morfología y las dimensiones del foramen yugular en cráneos nige-rianos secos. Cientos y setenta forámenes yugulares a partir de 85 cráneos secos del adulto de sexo desconocido fueron estudiados. La morfología fue estudiada por la observación y las medidas fueron tomadas con el calibrador de Vernier. Los parámetros que fueron estudiados incluyeron la forma, la tabicación, el diámetro medio-lateral, el diámetro anteroposterior del foramen yugular, y la bóveda, la anchura y la profundidad de la fosa yugular. El agujero de forma oval (el 77%) era más frecuente que el agujero de forma redonda (23%). La tabicación completa fue encontrada en 19,4% de cráneos, mientras que la tabicación incompleta fue encontrada en 41,2% de cráneos. La ausencia de tabicación fue encontrada en 39,4% de cráneos. La bóveda sobre la fosa yugular estaba presente en 67,6% y ausente en 32,4% de los cráneos. El diámetro anteroposterior (derecho: 13,20 mm±2,8, izquierdo: 11,72±2,8) y el diámetro medio-lateral (derecho: 18,73mm ±3,5, izquierdo: 17,33mm±3,1) eran perceptiblemente más altos en el derecho que en el lado izquierdo. La profundidad de la fosa yugular era perceptiblemente más alta en el derecho (12,38mm±2,4) que en el lado izquierdo (10,95mm±2,8). La anchura de la fosa yugular era más alta en la derecha (12,06mm±3,6) que a la izquierda (11,80mm±3,3) pero la diferencia no era significativa. El actual estudio demostró la dominación del lado derecho en los parámetros métricos del foramen yugular en nuestro medio