Challenges facing seaborne cargo operations in Nigeria: a case study of Lagos Port Complex

This paper aims to look into the challenges confronting seaborne cargo operations in Nigeria, using Lagos Port Complex (LPC) as a case study. The research adopted expository research design. Lagos Port Complex was the sample frame, and 230 questionnaires was administered using purposive sampling technique. Descriptive statistics was used for the analysis. Tables and the centre tendency to ascertain the opinion of the respondents were used. The results shows that the challenges confronting the maritime operation in Nigeria include the fact that foreign vessels berth more in LPC; import cost are very high; lack of export makes ships to frequently sail back on ballast; and finally, foreign dominance in Nigeria territorial waters. The respondents seems more indifferent about the adequacy or inadequacy port infrastructures in handling the cargoes at the port, with regards to mechanized as well as port-system upgrade to international standard. Respondents were also indifferent about foreigners manning the ships (meaning that if the CABOTAGE Act had not failed in its essence that should not have been a problem that needs attention or be spoken about after fifteen years of enacting the Act). It can be said that the CABOTAGE Act have not actualize its essence. These challenges confronting the maritime operations in Nigeria should have been addressed through the CABOTAGE Act

Examination of On-Street Parking and Traffic Congestion Problems in Lokoja

Parking and traffic congestion is synonymous to each other because failure to meet parking demand of people in a city lead to on-street parking that results to traffic congestion. Traffic congestion is a condition on road networks that occurs as use increases, and is characterized by slower speeds, longer trip times, and increased vehicular queuing. The availability of less space in urban areas has increased demand for parking space especially in central business area. Inadequate off-street parking in most of our urban centres has metamorphosed to the problem of on-street parking coupled with inadequate traffic management commonly experienced today in most Nigerian cities. In view of the above, this research work examined the menace of on-street parking and traffic congestion problems in Lokoja, Nigeria. The study was conducted using questionnaires and field observation to collect the required data at the locations/corridors in the city where on-street parking and traffic congestion were prominent and also, adequate survey of the traffic devices in the locations of study was also conducted to determine it functionality. Four hundred and fifty one (451) questionnaires were administered to the shop-owners, one hundred and seventy four (174) to the parked vehicle-owners and one hundred and two (102) to the commuters, to make a total of seven hundred and twenty seven (727) research samples. Finding revealed that inadequate parking, infectiveness of traffic devices, absences of loading and offloading bays etc have caused on-street parking and traffic congestion in Lokoja. To reduce the menace, policy measures are recommended among which are; institution of enforcement of traffic rules and regulations by disciplined law enforcement agents, relocation of certain activities that caused on-street parking and introduction of intelligent transport system which make use of sustainable devices such as Bluetooth and other communication/mobile devices, traffic management improvement and provision of off-street parking facilities in the city plan. Key word: Transportation, on-street parking, traffic management, urban center, traffic congestion, Lokoj

Assessing Africa’s child survival gains and prospects for attaining SDG target on child mortality

This study assessed Africa’s child survival gains and prospects for attaining Sustainable Development Goals (SDG) target 3.2. We analysed multiple country-level secondary datasets of 54 African countries and presented spatial analysis. Results showed that only 8 out of the 54 African countries have achieved substantial reductions in under-5 mortality with an under-five mortality rate (U5MR) of 25 deaths per 1,000 live births or less. Many countries are far from achieving this target. Results of the predictions using supervised machine learning on the Bayesian network reveal that the probability of achieving the SDG target 3.2 (i.e., having U5MR of 25 deaths per 1000 live births or less) increases (from 21.6% to 100%) when the contraceptive prevalence increases from 49.8% to 78.5%; and the use of skilled birth attendants increases from 44.8% to 86.3%; and percentage of secondary school completion of female increases from 42.5 to 74.0%. Our results from Local indicator of spatial autocorrelation (LISA) cluster maps show that 7 countries (mainly in West/Central Africa) formed the high-high clusters (hotspots for U5M) and may not achieve the SDG target 3.2 unless urgent and appropriate investments are deployed. As 2030 approaches, there is a need to address the problem of limited access to quality health care, female illiteracy, limited access to safe water, and poor access to quality family planning services, particularly across many sub-Saharan African countries

Severe Aortic Stenosis and Coronary Artery Disease—Implications for Management in the Transcatheter Aortic Valve Replacement Era A Comprehensive Review

Management of coronary artery disease (CAD) in patients with severe aortic stenosis (AS) referred for transcatheter aortic valve replacement (TAVR) is posing challenges. Due to limited and heterogeneous data on the prevalence and clinical impact of CAD on the outcomes of TAVR and the management strategies for CAD in patients undergoing TAVR, we performed a comprehensive review of the literature. Significant CAD is present in 40% to 75% of patients undergoing TAVR. The impact of CAD on outcomes after TAVR remains understudied. Based on existing data, not all patients require revascularization before TAVR. Percutaneous coronary intervention (PCI) should be considered for severely stenotic lesions in proximal coronaries that subtend a large area of myocardium at risk. Ongoing studies randomizing patients to surgical or percutaneous management strategies for severe AS will help provide valuable data regarding the impact of CAD on TAVR outcomes, the role of PCI, and its timing in relation to TAVR

Adverse Events Related to SARS-Cov-2 Vaccination: A Systematic Review and Meta-Analysis

Background: Vaccination has been adopted as a key public health strategy for combating the COVID-19 pandemic. The accelerated SARS-CoV-2 vaccines’ development had limited time for extensive investigation of the adverse events. The study aimed to assess the average adverse events rates in published COVID-19 vaccination studies. Subjects and Method: The study used systematic review and meta-analysis involving studies that reported adverse events following administration of any of the approved COVID-19 vaccines in humans. A highly specific search strategy was developed and implemented in PubMed. The core search string was “(COVID-19 OR COVID OR "coronavirus disease") AND vaccin* AND (side-effects OR "adverse events")”. Titles and abstracts were screened, and full texts of potentially relevant articles were retrieved. Data extracted included general study background, adverse events, and frequency of occurrence. Meta-analyses were conducted for adverse events reported by at least 5 studies. Meta-analysis of proportions was carried out using logit transformation with the generalized linear mixed model estimation method. Results: A total of 108 adverse events were reported in 15 studies observing 735,515 participants from 10 countries. The highest pooled prevalence rates were pain at injection site (67.2%; 95% CI= 46.49 to 82.86; I2= 99.9%, 11 studies, 670,557 participants), weakness/fatigue (41.88%; 95% CI= 26.82 to 58.61, I2= 99.9%, 13 studies, 671,045 participants), muscle/joint pain (28.95%; 95% CI= 16.95 to 44.86, I2= 99.9%, 13 studies, 672,791 participants), and headache (27.78%; 95% CI= 17.59 to 40.95, I2= 99.9%, 14 studies, 672,883 participants). Four cases of death were reported by two papers enrolling 711 patients with cancer or multiple sclerosis, three due to comorbid disease progression, and one case due to COVID-19. Forty-three cases of anaphylaxis were reported in three studies enrolling 68,218 participants. Conclusion: The most prevalent adverse events among recipient of SARS-CoV-2 vaccines were local and general systemic reactions. Keywords: COVID-19, SARS-CoV-2 vaccine, adverse events, meta-analysis, systematic review Correspondence: Segun Bello. Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Nigeria. Email: [email protected]

Adverse Events Related to SARS-Cov-2 Vaccination: A Systematic Review and Meta-Analysis

Background: Vaccination has been adopted as a key public health strategy for combating the COVID-19 pandemic. The accelerated SARS-CoV-2 vaccines’ development had limited time for extensive investigation of the adverse events. The study aimed to assess the average adverse events rates in published COVID-19 vaccination studies. Subjects and Method: The study used systematic review and meta-analysis involving studies that reported adverse events following administration of any of the approved COVID-19 vaccines in humans. A highly specific search strategy was developed and implemented in PubMed. The core search string was “(COVID-19 OR COVID OR "coronavirus disease") AND vaccin* AND (side-effects OR "adverse events")”. Titles and abstracts were screened, and full texts of potentially relevant articles were retrieved. Data extracted included general study background, adverse events, and frequency of occurrence. Meta-analyses were conducted for adverse events reported by at least 5 studies. Meta-analysis of proportions was carried out using logit transformation with the generalized linear mixed model estimation method. Results: A total of 108 adverse events were reported in 15 studies observing 735,515 participants from 10 countries. The highest pooled prevalence rates were pain at injection site (67.2%; 95% CI= 46.49 to 82.86; I2= 99.9%, 11 studies, 670,557 participants), weakness/fatigue (41.88%; 95% CI= 26.82 to 58.61, I2= 99.9%, 13 studies, 671,045 participants), muscle/joint pain (28.95%; 95% CI= 16.95 to 44.86, I2= 99.9%, 13 studies, 672,791 participants), and headache (27.78%; 95% CI= 17.59 to 40.95, I2= 99.9%, 14 studies, 672,883 participants). Four cases of death were reported by two papers enrolling 711 patients with cancer or multiple sclerosis, three due to comorbid disease progression, and one case due to COVID-19. Forty-three cases of anaphylaxis were reported in three studies enrolling 68,218 participants. Conclusion: The most prevalent adverse events among recipient of SARS-CoV-2 vaccines were local and general systemic reactions. Keywords: COVID-19, SARS-CoV-2 vaccine, adverse events, meta-analysis, systematic review Correspondence: Segun Bello. Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Nigeria. Email: [email protected]

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Coronavirus disease 2019 (COVID-19) pandemic across Africa : current status of vaccinations and implications for the future

The introduction of effective vaccines in December 2020 marked a significant step forward in the global response to COVID-19. Given concerns with access, acceptability, and hesitancy across Africa, there is a need to describe the current status of vaccine uptake in the continent. An exploratory study was undertaken to investigate these aspects, current challenges, and lessons learnt across Africa to provide future direction. Senior personnel across 14 African countries completed a self-administered questionnaire, with a descriptive analysis of the data. Vaccine roll-out commenced in March 2021 in most countries. COVID-19 vaccination coverage varied from low in Cameroon and Tanzania and up to 39.85% full coverage in Botswana at the end of 2021; that is, all doses advocated by initial protocols versus the total population, with rates increasing to 58.4% in Botswana by the end of June 2022. The greatest increase in people being fully vaccinated was observed in Uganda (20.4% increase), Botswana (18.5% increase), and Zambia (17.9% increase). Most vaccines were obtained through WHO-COVAX agreements. Initially, vaccination was prioritised for healthcare workers (HCWs), the elderly, adults with co-morbidities, and other at-risk groups, with countries now commencing vaccination among children and administering booster doses. Challenges included irregular supply and considerable hesitancy arising from misinformation fuelled by social media activities. Overall, there was fair to reasonable access to vaccination across countries, enhanced by government initiatives. Vaccine hesitancy must be addressed with context-specific interventions, including proactive programmes among HCWs, medical journalists, and the public

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