The determinants and consequences of economic vulnerability among urban elderly Nigerians

In rapidly urbanising Sub-Saharan African contexts, not much is known about the economic vulnerability of elderly people and its consequences. Dominant international institutions have indicated that the economic situation of elderly people in developing countries is precarious, especially where high levels of poverty and minimal social safety nets are the norm. As a consequence, the impact of economic vulnerability can be quite punishing on disadvantaged households with an ageing elderly person. Yet, the case of urban elderly Nigerians has thus far remained largely unresearched. This thesis represents a quantitative investigation of economic vulnerability amongst urban elderly Nigerians and its health-related consequences, examined through a consumption allocation welfare measure. It draws on economic, gerontological, and sociological perspectives to undertake this task. The key drivers of economic vulnerability and resulting consequences are likely to be complex and varied. Urban Elderly Nigerians may be economically vulnerable because they possess certain pre-disposing characteristics. This study is concerned with investigating these associated determinants of economic vulnerability amongst urban elderly Nigerians using a recent nationally representative household survey—the Nigerian General Household Panel Survey (NGHPS), which was collected by the National Bureau of Statistics in 2010. The first part of the study examines the determinants of economic vulnerability, through the use of a consumption allocation model. The findings of this study reveal that the age of the household head, household size, household structure, and regional location, are key determinants of economic vulnerability amongst urban elderly households in Nigeria. As a consequence, does economic vulnerability (represented by consumption allocation) influence health status and spending amongst elderly Nigerian households? I extracted useful data from the NGHPS to address this pertinent question. This is the second part of the study. The findings suggest that economic vulnerability is strongly related to health status and health spending. This thesis highlights key methodological challenges in using a secondary data source to study economic vulnerability amongst elderly people in a developing country context. The study also offers some policy options to tackle economic vulnerability among elderly households in urban Nigeria, and its health-related consequences

The determinants and consequences of economic vulnerability among urban elderly Nigerians

In rapidly urbanising Sub-Saharan African contexts, not much is known about the economic vulnerability of elderly people and its consequences. Dominant international institutions have indicated that the economic situation of elderly people in developing countries is precarious, especially where high levels of poverty and minimal social safety nets are the norm. As a consequence, the impact of economic vulnerability can be quite punishing on disadvantaged households with an ageing elderly person. Yet, the case of urban elderly Nigerians has thus far remained largely unresearched. This thesis represents a quantitative investigation of economic vulnerability amongst urban elderly Nigerians and its health-related consequences, examined through a consumption allocation welfare measure. It draws on economic, gerontological, and sociological perspectives to undertake this task. The key drivers of economic vulnerability and resulting consequences are likely to be complex and varied. Urban Elderly Nigerians may be economically vulnerable because they possess certain pre-disposing characteristics. This study is concerned with investigating these associated determinants of economic vulnerability amongst urban elderly Nigerians using a recent nationally representative household survey—the Nigerian General Household Panel Survey (NGHPS), which was collected by the National Bureau of Statistics in 2010. The first part of the study examines the determinants of economic vulnerability, through the use of a consumption allocation model. The findings of this study reveal that the age of the household head, household size, household structure, and regional location, are key determinants of economic vulnerability amongst urban elderly households in Nigeria. As a consequence, does economic vulnerability (represented by consumption allocation) influence health status and spending amongst elderly Nigerian households? I extracted useful data from the NGHPS to address this pertinent question. This is the second part of the study. The findings suggest that economic vulnerability is strongly related to health status and health spending. This thesis highlights key methodological challenges in using a secondary data source to study economic vulnerability amongst elderly people in a developing country context. The study also offers some policy options to tackle economic vulnerability among elderly households in urban Nigeria, and its health-related consequences

Home Secretary - Open Letter: Hidden Harm Summit for Domestic Abuse 21 May 2020 COVID-19 Impact

Dear Home Secretary. We are writing to you to ask that your Government takes urgent steps to reduce the impact of the domestic abuse within Black, African, Asian and other Minority Ethnic heritage communities – during the Covid-19 lockdown and in the future. Additionally, to recognise the impact of ‘honour’ abuse, forced and child marriage, and female genital mutilation (FGM) in its agenda

‘Honour’ abuse, violence, and forced marriage in the UK. Police cases (incidents and charges) and specialised training: 2018 and 2019.

This report marks the 15th anniversary of the tragic and avoidable death of Banaz Mahmod. A young woman living in London, Banaz was the victim of Britain’s most notorious so-called ‘honour’ killing. The police handling of her case was fraught with incompetence, oversight, error, and lack of cultural awareness. Numerous times, in the months leading up to her murder, Banaz reported her abuse to the police, even warning them that she would be murdered. She went as far as writing down the names of her killers. 1 An investigation by the Independent Police Complaints Commission (IPCC) after her death found that two police forces had failed Banaz. This report presents the number of ‘honour’ based abuse and violence (HBA/V), including forced marriage cases, recorded by 38 police forces across the UK, and their engagement in specialised training, for 2018 and 2019

A geographical analysis of ethnic distribution of jaw ameloblastoma in Nigerians

Introduction: Ameloblastoma is the most common odontogenic tumour in Nigeria. A definite geographic variation has been observed in the frequency of odontogenic tumors from different parts of the world. However, there is no study on the regional variations in Nigeria. Hence, this study was designed to document the ethnic and geographical distribution of jaw ameloblastoma in Nigeria.Methods: Archival data on ameloblastoma from 10 health facilities were obtained. Global Moran’s I detected geographic clustering in its distribution while Local Getis Ord indicated the location of ameloblastoma clusters. Chi-square tested associations between variables at 0.05 level of significance.Results: A total of 1,246 ameloblastoma cases were recorded in Nigeria. Besides substantial state variations, a South-North gradient was noticed in its distribution. Significant positive spatial autocorrelation was observed in the three major groups while ameloblas- toma hotspots were found in the SouthWestern and Northwestern Nigeria. The Igbos had a higher prevalence of ameloblastoma outside their home region than within.Conclusion: The study hypothesized that the geographical distribution of ameloblastoma in Nigeria is the result of all or one of the following:  the country’s tropical climate, migration patterns and health seeking behavior. Hopefully, these claims should lead to further enquiry on the underlying causes.Keywords: Ameloblastoma, ethnicity, spatial analysis, Nigeria

Exposure to anti-malarial drugs and monitoring of adverse drug reactions using toll-free mobile phone calls in private retail sector in Sagamu, Nigeria: implications for pharmacovigilance

<p>Abstract</p> <p>Background</p> <p>Adverse drug reactions (ADRs) contribute to ill-health or life-threatening outcomes of therapy during management of infectious diseases. The exposure to anti-malarial and use of mobile phone technology to report ADRs following drug exposures were investigated in Sagamu - a peri-urban community in Southwest Nigeria.</p> <p>Methods</p> <p>Purchase of medicines was actively monitored for 28 days in three Community Pharmacies (CP) and four Patent and Proprietary Medicine Stores (PPMS) in the community. Information on experience of ADRs was obtained by telephone from 100 volunteers who purchased anti-malarials during the 28-day period.</p> <p>Results and Discussion</p> <p>A total of 12,093 purchases were recorded during the period. Antibiotics, analgesics, vitamins and anti-malarials were the most frequently purchased medicines. A total of 1,500 complete courses of anti-malarials were purchased (12.4% of total purchases); of this number, purchases of sulphadoxine-pyrimethamine (SP) and chloroquine (CQ) were highest (39.3 and 25.2% respectiuvely). Other anti-malarials purchased were artesunate monotherapy (AS) - 16.1%, artemether-lumefantrine (AL) 10.0%, amodiaquine (AQ) - 6.6%, quinine (QNN) - 1.9%, halofantrine (HF) - 0.2% and proguanil (PR) - 0.2%. CQ was the cheapest (USD 0.3) and halofantrine the most expensive (USD 7.7). AL was 15.6 times ($4.68) more expensive than CQ. The response to mobile phone monitoring of ADRs was 57% in the first 24 hours (day 1) after purchase and decreased to 33% by day 4. Participants in this monitoring exercise were mostly with low level of education (54%).</p> <p>Conclusion</p> <p>The findings from this study indicate that ineffective anti-malaria medicines including monotherapies remain widely available and are frequently purchased in the study area. Cost may be a factor in the continued use of ineffective monotherapies. Availability of a toll-free telephone line may facilitate pharmacovigilance and follow up of response to medicines in a resource-poor setting.</p

A geographical analysis of ethnic distribution of jaw ameloblastoma in Nigerians

Introduction: Ameloblastoma is the most common odontogenic tumour in Nigeria. A definite geographic variation has been observed in the frequency of odontogenic tumors from different parts of the world. However, there is no study on the regional variations in Nigeria. Hence, this study was designed to document the ethnic and geographical distribution of jaw ameloblastoma in Nigeria. Methods: Archival data on ameloblastoma from 10 health facilities were obtained. Global Moran\u2019s I detected geographic clustering in its distribution while Local Getis Ord indicated the location of ameloblastoma clusters. Chi-square tested associations between variables at 0.05 level of significance. Results: A total of 1,246 ameloblastoma cases were recorded in Nigeria. Besides substantial state variations, a South-North gradient was noticed in its distribution. Significant positive spatial autocorrelation was observed in the three major groups while ameloblastoma hotspots were found in the SouthWestern and Northwestern Nigeria. The Igbos had a higher prevalence of ameloblastoma outside their home region than within. Conclusion: The study hypothesized that the geographical distribution of ameloblastoma in Nigeria is the result of all or one of the following: the country\u2019s tropical climate, migration patterns and health seeking behavior. Hopefully, these claims should lead to further enquiry on the underlying causes. DOI: https://dx.doi.org/10.4314/ahs.v19i1.44 Cite as: Adisa AO, Osayomi T, Effiom OA, Kolude B, Lawal AO, Soyele OO, et al. A geographical analysis of ethnic distribution of jaw ameloblastoma in Nigerians. Afri Health Sci. 2019;19(1). 1677-1686. https://dx.doi.org/10.4314/ ahs. v19i1.4

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