Early detection of breast, cervical, ovarian and endometrial cancers in low resource countries: an integrated approach

The incidence of breast and gynecological cancers continues to increase in low and middle resource countries [LRC'S and MRC's] with a disproportionately higher mortality rate compared to that in high resource countries. This has been attributed to factors such as an increased life span due to better control of communicable diseases and improved nutrition, as well as lifestyle and reproductive changes. A lack of public awareness and understanding of these cancers, absence of an organized screening program and a lack of accessible and effective treatment options, is responsible for the higher mortality rate. A practical approach of a combined program of integrating a well woman examination with screening for breast and cervical cancer and diagnostic evaluation for Ovarian and Endometrial cancer in symptomatic women is proposed in this article which can serve as a model to be studied for efficacy in low resource countries

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Maternal demand for cesarean section: perception and willingness to request by Nigerian antenatal clients

Ngozi S Okonkwo1, Oladosu A Ojengbede2, Imran O Morhason-Bello1, Babatunde O Adedokun31Department of Obstetrics and Gynecology, University College Hospital; 2Center for Population and Reproductive Health, College of Medicine, University of Ibadan, Ibadan; 3Department of Epidemiology, Medical Statistics, and Environmental Health, College of Medicine, Ibadan, Oyo State, NigeriaBackground: Contrary to the widely reported aversion to cesarean section in the West African subregion, maternal demand for cesarean section (MDCS) seems to be on the increase, and there is little evidence to explain this trend. The purpose of this study was to determine the perception and attitudes of Nigerian antenatal clients towards MDCS, their willingness to request MDCS, and the relationship between willingness to request MDCS and sociodemographic characteristics.Methods: A cross-sectional survey was undertaken among 843 antenatal clients at Agbongbon/Orayan primary health care centers (PHCs), Adeoyo Maternity Hospital (SHC), and UCH Ibadan (THC), representing the three different levels of health care in Nigeria, ie, primary, secondary, and tertiary.Results: The proportion of women aware of MDCS was 39.6%. Predictors of awareness were education and type of health facility. Women from THC and those with tertiary education and above were more likely to be aware of MDCS than others (P = 0.001). Doctors were major sources of information on MDCS (30.8%) as well as friends (24.3%). Common reasons reported for MDCS were fear of labor pains (68.9%), and fear of poor labor outcome (60.1%), and fear of fecal (20.2%) and urinary incontinence (16.8%). More women from the THC than other facilities believed that requests for MDCS should be granted (P < 0.001). However, willingness to request MDCS was low (6.6%). More than 50% of those willing to request MDCS would likely be criticized, mainly by their husbands. On multiple logistic regression, respondents at the THC were significantly more likely than those at the SHC or the PHCs to request cesarean section and to favor a woman’s right of autonomy to choose her mode of delivery.Conclusion: The decision for MDCS is a difficult one, because willingness is low and criticism by partners of those who choose MDCS is high. Provision of epidural anesthesia and improved safety of vaginal delivery is recommended. This may prevent Nigerian women from making a difficult choice for MDCS based on fear of pain and poor labor outcome. The role of the male partner should be taken into consideration in order to make sustainable policies or guidelines for MDCS in developing countries.Keywords: maternal demand cesarean section, perception, antenatal, clients, Nigeri

Help-seeking behavior among women currently leaking urine in Nigeria: is it any different from the rest of the world?

Babatunde O Adedokun,1 Imran O Morhason-Bello,2 Oladosu A Ojengbede,2 Ngozi S Okonkwo,1 Charles Kolade21Department of Epidemiology, Medical Statistics, and Environmental Health, College of Medicine, University of Ibadan, Oyo state, Nigeria; 2Department of Obstetrics and Gynecology, College of Medicine/University College Hospital, University of Ibadan, Ibadan, Oyo state, NigeriaObjective: We examined help-seeking behaviors and factors influencing their choice of hospital care in women currently leaking urine.Materials and methods: This study was part of a multistage community survey conducted among 5001 women in Nigeria who participated in the Ibadan Urinary Incontinence Household Survey. Help-seeking behavior was analyzed among 139 respondents currently leaking urine within the population surveyed.Results: The mean age of those currently leaking urine was 35.7 years (standard deviation = 15.8). Only 18 (12.9%) had ever sought help, of which 15 had received hospital care. Logistic regression analysis showed that the odds of seeking hospital care was higher among less educated women (odds ratio [OR] = 4.05, 95% confidence interval [CI]: 1.17–13.89) and among those with severe incontinence (OR = 4.20, 95% CI: 1.24–14.29). Reasons mentioned for not seeking hospital care include a belief that the condition is not life-threatening (51.2%), do not believe there is treatment (18.2%), lack of funds (1.7%), too shy to disclose (2.5%), afraid of complications (1.7%), other (2.5%), and no reason (22.3%).Conclusion: This study shows that very few women, currently experiencing urinary incontinence have sought medical care (approximately 1 in 10); and that the barriers identified are similar to those identified in previous studies, except that these women lack the necessary funds to seek care.Keywords: urinary incontinence, help (health)-seeking behavior, women, Nigeri

Giving to family versus giving to the community within and across generations

Family transfers, Community institutions, Role model effect, O12, J13, D10,