Assessment of the knowledge, practice, and barriers of physicians in Lagos about respiratory diseases preventable vaccines

Objectives: Immunizations are indicated in a wide range of clinical situations. There are gaps in the implementation of the acceptable recommended guidelines on adult immunization in Nigeria. This study aims to evaluate the perceptions, practices, and barriers of physicians in recommending adult vaccines. Materials and Methods: A descriptive cross-sectional study was conducted using an anonymous, self-administered survey to understand the perceptions, practice, and barriers to adult vaccine recommendations among adult physicians in Lagos. Results: Ninety-seven physicians completed the questionnaire with male-to-female ratio of 1:1.3. The mean age of the responders was 39.54 ± 6.2. The proportion with overall good knowledge was 40 (41.2%). The vaccines routinely recommended include: Pneumococcal conjugate vaccine 73 (81.1%), COVID-19 vaccine 70 (77.8%), and influenza vaccine 57 (63.3%), respectively. The common barriers for vaccine recommendation include: Unavailability 53 (54.6%), poor reminder systems, 43 (44.3%), inadequate insurance coverage 33 (34%), and vaccine shortage 31 (32%). There was a significant association between the knowledge of physicians and sociodemographics, including age (χ2 = 6.548, P = 0.038), duration of practice (χ2 = 7.761, P = 0.039), type of specialist training (χ2 = 3.860, P = 0.049), as well as specialty (χ2 = 11.282, P = 0.004). Conclusion: This study suggests that the knowledge of physicians regarding adult vaccinnations is below average. Most recommended adult respiratory disease preventable vaccines are pneumococcal conjugate, influenza, and COVID-19 vaccines. The major barriers to vaccination include availability and cost. The implication of this finding is the need to increase awareness about vaccine utilization as well as access among physicians in Lagos and Nigeria at large if the narrative must change

Examining Motivation and Perception of Visitors at Lekki Conservation Centre (LCC) in Nigeria

People are driven to take up various actions due to motivation. The study examined the motivation and perception of visitors as well as examining the future behavioural intentions of the visitors at Lekki Conservation Centre (LCC), Lagos state, Nigeria. The study employed self-administered questionnaire to obtain information from the visitors. Random sampling method was used to select a total of 200 visitors involved in the survey. Data obtained were analyzed using Statistical Package for Social Sciences (SPSS 21) and results were presented descriptively and inferentially. Results obtained indicated that attractions such as canopy walkway, games served as pullattractions for the visitors to the site while adventure, sightseeing, relaxation and rest were highly ranked as push-motivations for the visitors to the site. The visitors also perceived the site experience as a satisfactory one while affirming they would revisit and recommend the site to other. Chi square analysis revealed a significant relationship between visitors’ motivation and perception (p=0.000). The site posed minimal challenges for visitation and as such is a good place to visit as it affords visitors an entertaining and satisfactory experience. Motivation study is important for tourist sites to improve their competitiveness in the market as it facilitates improvement of visitors’ satisfaction

Anatomy and Specific Gravity of Wood Samples from Six Nigerian Tree Species in Relation to their Diagnostic X-ray Shielding Capabilities

The basic principle of protection against nuclear radiation is to keep radiation exposure as  much as possible below the maximum permissible dose equivalent (MPD). In order to redress the dependence on costly shielding materials such as lead, steel, glass and gypsum, cheaper and readily available  materials  such as wood have been brought under focus as potential resources for shielding hazardous radiations. Making use of the relative transmission of 60 kVp X-rays by the wood of six Nigerian tree species as reference data, this study examined the wood anatomy of the tree  species (i.e Syzygium guinense (Willd.) DC., Tectona grandis L., Afzelia pachyloba Harms., A.  africana Pers., Gmelina arborea Roxb. and Daniellia oliveri (Rolfe) Hutch. & Dalziel with a view to providing information on the wood anatomical basis for their X-ray shielding capabilities. T. grandis and G. arborea were  the two most fibrous of  the six species studied, with their fibre-to-non-fibrous tissue ratios (F/NF) being 1.24 and 1.01 respectively. Incidentally, these two species transmitted  the least amounts of radiation at an average wood thickness of 5 cm.   Tyloses were observed in the wood of all but G. arborea and D. oliveri, and the % of vessels with tylose ranged  from 20.64 to 50.36.  At  0.05 level of probability, the reference data on relative X-ray transmission showed significant positive correlation  with % axial parenchyma content (r = 0.754), but significant negative correlations with % fibre content (-0.734), %  of vessels with tylose (-0.864), vessel diameter (-0.757), vessel lumen width (-0.753) and F/NF (-0.742). The diagnostic X-ray attenuation capability of the  wood samples examined can therefore be anatomically explained by these six  parameters, and their evaluation in prospective wood samples for shielding hazardous radiations can be useful. Key words: Gmelina arborea, hardwood, hazardous radiation, Tectona grandis, tylose,  wood anatomy, X-ray

Evaluation of patients with suspected obstructive sleep apnea in a low-middle income country: Lagos experience

Obstructive sleep apnea (OSA) is a common chronic disorder that decreases the quality of life of patients. It is an underdiagnosed medical condition in Nigeria. This study aimed to describe the clinical presentations and validate the sleep apnea screening questionnaires with a home sleep study for the diagnosis of patients with suspected OSA seen in Lagos. This was a descriptive cross sectional study carried out on adult patients with suspicion of OSA referred to the Respiratory Clinic of Lagos State University Teaching Hospital. A proforma was used to obtain information and also data from home polysomnography was obtained for each patient. We selected 22 patients. The commonest presentations include snoring (20 or 90.9%), daytime somnolence (16 or 72.7%) and choking while sleeping (12 or 54.5%). The commonest comorbidities were hypertension (16 or 72.7%) and obesity (6 or 27.3%). The STOP-Bang  score identified more patients with a high clinical probability for OSA than the Epworth score (20 and 12 patients respectively). Polysomnography showed evidence of sleep apnea in most suspected patients with severity ranging from mild, to moderate to severe disease (3 or 13.6%, 3 or 13.6%, and 10 or 45.5% respectively). The use of combined Epworth and STOP-Bang questionnaires combination is great tool in identifying patients with suspected cases of OSA based on clinical presentations that will eventually benefit in a resource-limited environment like Lagos. There should be increased awareness of the use of this readily available and cheap questionnaire among physicians in Lagos for ease of OSAS diagnosis for many patients

Stakeholder perspectives on the demand and supply factors driving substandard and falsified blood pressure lowering medications in Nigeria: A qualitative study

OBJECTIVES: Although substandard and falsified (SF) blood pressure (BP) lowering medications are a global problem, qualitative research exploring factors driving this in Nigeria has not been reported. This study provides information on factors driving demand for and supply of low-quality BP lowering medications in Nigeria and potential strategies to address these factors. METHODS: This was a cross-sectional qualitative study. Between August 2020 and September 2020, we conducted 11 in-depth interviews and 7 focus group discussions with administrators of health facilities, major manufacturers and distributors of BP lowering medications, pharmacists, drug regulators, patients and primary care physicians purposively sampled from the Federal Capital Territory, Nigeria. Data were analysed using directed content analysis, with the aid of Dedoose. RESULTS: We found that demand for SF BP lowering medications in Nigeria was driven by high out-of-pocket expenditure and stockouts of quality-assured BP lowering medications. Supply of low-quality BP lowering medications was driven by limited in-country manufacturing capacity, non-adherence to good manufacturing and distribution practices, under-resourced drug regulatory systems, ineffective healthcare facility operations, poor distribution practices, limited number of trained pharmacists and the COVID-19 pandemic which led to stockouts. Central medicine store procurement procedures, active pharmaceutical ingredient quality check and availability of trained pharmacists were existing strategies perceived to lower the risk of supply and demand of SF BP lowering medications. CONCLUSION: Our findings suggest that demand for and supply of SF BP lowering medications in Nigeria are driven by multi-level, interrelated factors. Multi-pronged strategies need to target stakeholders and systems involved in drug production, distribution, prescription, consumption, regulation and pricing

Clinical characteristics and treatment patterns of pregnant women with hypertension in primary care in the Federal Capital Territory of Nigeria: Cross-sectional results from the Hypertension Treatment in Nigeria Program

BACKGROUND: Hypertensive disorders of pregnancy, including hypertension, are a leading cause of maternal mortality in Nigeria. However, there is a paucity of data on pregnant women with hypertension who receive care in primary health care facilities. This study presents the results from a cross-sectional analysis of pregnant women enrolled in the Hypertension Treatment in Nigeria Program which is aimed at integrating and strengthening hypertension care in primary health care centres. METHODS: A descriptive analysis of the baseline results from the Hypertension Treatment in Nigeria Program was performed. Baseline blood pressures, treatment and control rates of pregnant women were analysed and compared to other adult women of reproductive age. A complete case analysis was performed, and a two-sided p value \u3c 0.05 was considered statistically significant. RESULTS: Between January 2020 to October 2022, 5972 women of reproductive age were enrolled in the 60 primary healthcare centres participating in the Hypertension Treatment in Nigeria Program and 112 (2%) were pregnant. Overall mean age (SD) was 39.6 years (6.3). Co-morbidities were rare in both groups, and blood pressures were similar amongst pregnant and non-pregnant women (overall mean (SD) first systolic and diastolic blood pressures were 157.4 (20.6)/100.7 (13.6) mm Hg and overall mean (SD) second systolic and diastolic blood pressures were 151.7 (20.1)/98.4 (13.5) mm Hg). However, compared to non-pregnant women, pregnant women had a higher rate of newly diagnosed hypertension (65.2% versus 54.4% p = 0.02) and lower baseline walk-in treatment (32.1% versus 42.1%, p = 0.03). The control rate was numerically lower among pregnant patients (6.3% versus 10.2%, p = 0.17), but was not statistically significant. Some pregnant patients (8.3%) were on medications contraindicated in pregnancy, and none of the pregnant women were on aspirin for primary prevention of preeclampsia. CONCLUSIONS: These findings indicate significant gaps in care and important areas for future studies to improve the quality of care and outcomes for pregnant women with hypertension in Nigeria, a country with the highest burden of maternal mortality globally

MasakhaNEWS: News Topic Classification for African languages

African languages are severely under-represented in NLP research due to lack of datasets covering several NLP tasks. While there are individual language specific datasets that are being expanded to different tasks, only a handful of NLP tasks (e.g. named entity recognition and machine translation) have standardized benchmark datasets covering several geographical and typologically-diverse African languages. In this paper, we develop MasakhaNEWS -- a new benchmark dataset for news topic classification covering 16 languages widely spoken in Africa. We provide an evaluation of baseline models by training classical machine learning models and fine-tuning several language models. Furthermore, we explore several alternatives to full fine-tuning of language models that are better suited for zero-shot and few-shot learning such as cross-lingual parameter-efficient fine-tuning (like MAD-X), pattern exploiting training (PET), prompting language models (like ChatGPT), and prompt-free sentence transformer fine-tuning (SetFit and Cohere Embedding API). Our evaluation in zero-shot setting shows the potential of prompting ChatGPT for news topic classification in low-resource African languages, achieving an average performance of 70 F1 points without leveraging additional supervision like MAD-X. In few-shot setting, we show that with as little as 10 examples per label, we achieved more than 90\% (i.e. 86.0 F1 points) of the performance of full supervised training (92.6 F1 points) leveraging the PET approach.Comment: Accepted to IJCNLP-AACL 2023 (main conference

MasakhaNEWS:News Topic Classification for African languages

African languages are severely under-represented in NLP research due to lack of datasets covering several NLP tasks. While there are individual language specific datasets that are being expanded to different tasks, only a handful of NLP tasks (e.g. named entity recognition and machine translation) have standardized benchmark datasets covering several geographical and typologically-diverse African languages. In this paper, we develop MasakhaNEWS -- a new benchmark dataset for news topic classification covering 16 languages widely spoken in Africa. We provide an evaluation of baseline models by training classical machine learning models and fine-tuning several language models. Furthermore, we explore several alternatives to full fine-tuning of language models that are better suited for zero-shot and few-shot learning such as cross-lingual parameter-efficient fine-tuning (like MAD-X), pattern exploiting training (PET), prompting language models (like ChatGPT), and prompt-free sentence transformer fine-tuning (SetFit and Cohere Embedding API). Our evaluation in zero-shot setting shows the potential of prompting ChatGPT for news topic classification in low-resource African languages, achieving an average performance of 70 F1 points without leveraging additional supervision like MAD-X. In few-shot setting, we show that with as little as 10 examples per label, we achieved more than 90\% (i.e. 86.0 F1 points) of the performance of full supervised training (92.6 F1 points) leveraging the PET approach

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries