Fostered children's perception of their health care and illness treatment in Ekiti Yoruba households, Nigeria

This paper reports the findings from both quantitative and qualitative fieldwork conducted in six Ekiti Yoruba communities of southwestern Nigeria on the treatment of child illness within households. Relying heavily on data from focus group discussions, it shows how fostered children use local proverbs and day-to-day common sayings to describe their perception of the responses to and treatment of their illnesses in a very different way from that of the foster parents. Parents’ responses and treatment of fostered and non-fostered children’s illnesses were compared. Both the qualitative and quantitative evidence from the study showed that treatments were delayed for foster-children in comparison to own children, and foster-parents were found to be less sensitive to foster-child illness, which they often suspected was used to avoid housework. The different responses to, and treatment of, foster-children’s illnesses are important for the understanding of the probable effects on differential morbidity, and possibly mortality, between fostered and nonfostered children

Qualitative exploration of intra-household variations in treatment of child illness in polygynous Yoruba families: the use of local expressions

The drastic cut in government expenditure on health with the extension of the 'user pays' principle to health care utilization in Nigeria following the adoption of the Structural Adjustment Program is probably having its greatest effect on the family. Contrary to what happened in the past, when the cost of treatment was usually borne by the mother of a sick child, the role of the father is becoming increasingly significant. Before the introduction of the 'user pays' principle to health care, treatment in many government hospitals was free. Intra-household variations in response to and treatment of child illness, especially in polygynous Yoruba households in Nigeria, occurred for a number of other reasons. Probably because the mother and her children usually form a social unit within a polygynous union, meeting the cost of treatment and some other minor daily needs of the child has always been the responsibility of the mother, although the economic independence of most senior wives seems to have waned as a result of current economic difficulties. In the past, a woman's ability to meet the cost of treatment of her children was partly explained by her separate income from that of her husband, but with the persistent rise in cost of treatment, many mothers now have to look to their husbands or other sources for assistance in paying for treatment of their children. This paper examines treatment behaviour under the present circumstances and explores how common expressions of the Yoruba can be used to explain differences in a polygynous husband’s responses to the treatment of illness of his wives' children. Such treatment poses a great risk of child morbidity and mortality now that the role of the father has become important in meeting the current high cost of treatment in many Yoruba families

Health transition research in Nigeria in the era of the structural adjustment program

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Sexual networking in Freetown against the background of the AIDS epidemic

West Africa, since the discovery of the HIV virus, has remained relatively unperturbed by the attendant AIDS epidemic sweeping through the other portions of the continent south of Sahara. The low level, of both the reported and the diagnosed cases of the epidemic at the onset, seem to explain the initial lukewarm and sometimes cynical attitude on the part of both the government and the populace. In recent times, however, emerging revelations from research on sexual behaviour in the region seem to be generating greater concerns about the possibility of continued containment of this scourge. So in many West African countries efforts are being made to generate baseline data to help in assessing the risk of this epidemic, given the background knowledge of the sexual behavioural correlates of AIDS gained elsewhere. However, not all the strategic points in this region have had such an inventory carried out or reported. Not only does Freetown, the capital of Sierra Leone, fall into this category, it is also confronted with certain challenges at the regional level, as well as some internal peculiarities which underscore the need for the present inventory

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Inhibition and mechanism of Terminalia catappa on mild-steel corrosion in sulphuric-acid environment

Mild-steel samples were immersed in 0.5 M H2SO4 having different concentrations of Terminalia catappa leaf-extract for investigating inhibition and mechanism of the leaf-extract on mild-steel corrosion in the testenvironment. Corrosion-rate measurements were obtained by potentiodynamic polarisation and gravimetric techniques and analysed for detailing sustainable corrosion-protection by the natural-plant in the test-environment. Results indicate potentiodynamic corrosion-rate correlated excellently (R = 99.25%, Nash-Sutcliffe efficiency (NSE) = 98.52%, ANOVA p-value = 0.0222) with function of the gravimetric corrosion-rate and the leaf-extract concentration. By the experimental and correlated results, inhibition effectiveness on mild-steel corrosion increased with increasing leaf-extract concentration up to the 8 g/L Terminalia catappa leaf-extract, which exhibited optimal inhibition efficiency, η = 99.99% (experimental model) or η = 95.45% (correlation prediction). Correlation prediction, potentiodynamic and gravimetric data followed the Langmuir and the Flory-Huggins adsorption isotherms with agreements of favourable adsorption/prevalent physisorption mechanism for the leaf-extract corrosion-protection of mild-steel in the test-environment

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways