Implementation of assistance for one pregnant woman one cadre (OPOC) in Banjarnegara District, Central Java Province, Indonesia

The high maternal mortality rate caused by late detection of risk factors for pregnant women is a major health problem in Banjarnegara District. One of the efforts made to overcome this problem is the implementation of assistance for one pregnant woman by one cadre (OPOC). The application of OPOC consists of four mentoring activities, namely reminders about antenatal care schedule, detecting risk factors, monitoring fetal movements, and carrying out delivery planning and handling complications.Therefore, this study aims to describe the implementation of OPOC as well as to evaluate cadres' performance in Banjarnegara District. A quantitative cross-sectional design was used, where a total of 200 cadres were selected as respondents using a representative purposive sampling method. The results showed that reminding mothers about their antenatal care schedule,detecting risk factors, monitoring of fetal health through movements, and making commitments for birth planning and complications prevention were carried out by 199 (99.49%), 129 (64.84%), 138 (69.05%), and 159 (79.42%) respondents, respectively. More than 92% of them know their duties and responsibilities as companions for pregnant women, but only 28% have knowledge about the benefits of assisting. Furthermore, 93% often carry out OPOC assistance. The knowledge of cadres about OPOC assistance was good, but some of them are not knowledgeable about its benefits. These findings show that they need guidance, training, and motivation from public health centers. (Afr J Reprod Health 2022; 26[7]: 83-89).

Assessment of Risk Factors for Advanced Open Angle Glaucoma Presentation among Patients Visiting Jimma University Medical Center, Jimma, Ethiopia

Glaucoma is the predominant cause of irreversible blindness, particularly the late presentation. The purpose of this study is to identify the risk factors associated with late presentation in Jimma University Medical Center METHODS: A case-control study was done among patients newly diagnosed to have open angle glaucoma (of any type) at Jimma University Medical Center from July 2014 ­ January 2019. Cases were patients/eyes diagnosed to have any type of open angle glaucoma with advanced glaucomatous disc features, whereas controls were patients diagnosed with early and moderate stages of glaucoma. RESULTS: There were 205 (116 cases and 89 controls) participants. The mean age of the participants at the time of diagnosis was 58.3±13.4yrs. Family history of blindness, presenting IOP, type of glaucoma and age were independently associated with late presentation. Patients with family history of blindness had late advanced glaucoma five times higher than those with no family history of blindness. The presence of late glaucoma among patients with presenting intra ocular pressure < 30mmHg is lower than those having ≥30mmHg (Adjusted Odds Ratio= 0.136). Primary open-angle glaucoma patients were less likely to present with advanced glaucoma than pseudo exfoliative glaucoma patients (Adjusted Odds Ratio=0.39). The chance of presenting with late glaucoma was increased by 3.4% for every one-year increment of age. CONCLUSIONS: Presence of family history of blindness, high presenting intraocular pressure, pseudo exfoliative glaucoma and old age are risk factors for late presentation of glaucoma

Audit of delayed presentation in breast cancer from a tertiary centre in the Niger Delta, Nigeria

Context: Breast cancer is the most common cause of cancer-related morbidity and mortality in women in developing countries, compounded by delayed presentation. Determining the contemporary reasons for delayed presentation in our environment, is necessary to properly guide enlightenment campaigns, enhance their effectiveness and improve patient survival. Subjects and Methods: A 1-year audit of consecutive histologically-confirmed breast cancer patients presenting to University of Benin Teaching Hospital was done. Socio-demographic data, time to presentation with reasons, stage at presentation were obtained in a proforma and analyzed. Results: 92% of patients had delayed presentation. 270 patients with complete records were included in the study. Mean age of patients was 47.6±11.0years, most were between 40 ­ 49 years (32.2%). Most patients in the study were married (75.6%), of lower class (52.2%) and had tertiary education (55.9%). Delay of 12 ­ 15months occurred most (54.8%) with advanced stage disease (Stages 3/4; 73%). Use of alternative medicine accounted for most of the delay (48.9%) while fear of mastectomy (30.4%), financial (6.7%) and referral problems (6.7%) were other common reasons. Conclusion: Delay in presentation is common in our breast cancer patients. Use of alternative medicine, fear of mastectomy, financial issues were common reasons for delay. There should be proper regulation of alternative medical practice to forestall bogus claims of cancer treatment. More affordable and accessible screening centres, insurance coverage of cancer care, alongside enlightenment about effect of delayed presentation and appropriate cancer care in religious houses, amongst traditional rulers and other custodians of cultural practices are required to help mitigate negative beliefs resulting in delayed presentation

Delay to diagnosis and breast cancer stage in an urban South African breast clinic

Background. Breast cancer is the most common cancer in women in many low- and middle-income countries, and often presents at an advanced stage that affects prognosis irrespective of the care available. Although patient-related delay is commonly cited, the reasons for delay and the relationship of delay to stage are still poorly documented, especially in Africa. Objectives. To identify where patient-related socioeconomic delays occur and how these relate to stage at presentation. Methods. Consecutive women with a new breast cancer diagnosis were prospectively invited to complete a questionnaire on their socioeconomic characteristics and ability to access care. Clinical stage at presentation was documented. Results. Over 14 months, 252 women completed the questionnaire (response rate 71.6%). Their median age was 55 years (interquartile range 44 - 65), with 26.5% aged <45 years. Stage at presentation was stage 1 in 15.5% of patients, stage 2 in 28.5% and stage 3 in 56.0%. Almost a third of the patients (30.4%) presented with a T4 tumour (6.1% inflammatory). Total delay in presenting to the breast clinic was significantly associated with locally advanced stage at presentation (p=0.021). Average delay differed between early stage (1.5 months) and locally advanced (2.5 months), and most delay occurred between acknowledging a breast symptom and seeking care. The least delay was between attending a health service and presenting at the open-access breast clinic, with 75.0% presenting within 1 month. Factors associated with delay were difficulties with transport, low level of education and fear of missing appointments due to work. Conclusions. Most women delayed in seeking breast care. Facilitating direct access to specialist breast clinics may reduce delays in presentation and improve time to diagnosis and care

A Prospective Study on the Impact of Waiting Times for Radiotherapy for Cervical Cancer at Charlotte Maxeke Johannesburg Academic Hospital

Background. Radiotherapy plays a vital role in the management of cervical cancer. However; due to high patient load and limited resources; waiting lists are unacceptably long. This is a highly curable malignancy that often occurs in economically active; relatively young women. Thus; the impact of treatment delays on society is disproportionately large when compared to many other malignancies. Delays also impact negatively on the health care system and places further stress on an already burdened department. This prospective study aimed to evaluate the potential impact of radiotherapy delays Patients and methods. Eighty-one patients requiring radical radiotherapy for cervical cancer were selected. Patients were re-evaluated every four weeks while waiting; and again at simulation.Results. Median delay from first consultation to simulation was 55 days. Longer delays were not statistically correlated to tumour progression. Most of the upstaging occurred around 40 to 65 days. One in four patients received blood transfusions and required hospital admission. Four patients needed haemostatic brachytherapy for bleeding. Conclusion. A relationship between time waited and disease progression could not be proven. However; numbers were small and statistical tests were likely underpowered. The study does; however; highlight unacceptably long delays for radiotherapy and a wait of less than 40 days is recommended

Excess of non-verbal cases of autism spectrum disorders (ASDs) presenting to orthodox clinical practice in Africa - a trend possibly resulting from late diagnosis and intervention

Objectives. Characteristics of children with autism spectrum disorders (ASDs) in Africa are not known because of unavailability of large-scale epidemiological studies in this region. This review explored the age at first presentation to orthodox clinical practice of African children with ASDs and their expressive language ability at presentation. Methods. A literature search of case series and case reports of ASDs from Africa was done through PubMed/MEDLINE, Google Scholar, African Journals Online (AJOL), and archives of the Nigerian Journal of Psychiatry. Six articles included content relating to age of the child at first presentation to orthodox clinical practice and symptoms at presentation related to expressive language ability and therefore fulfilled the inclusion criteria. Suggestions are made to explain the observations emanating from the review. Results. An excess of non-verbal over verbal cases of ASDs have been presenting to orthodox clinical practice and there is a common denominator of late presentation/diagnosis and in turn late intervention, with most cases presenting for the first time well above 8 years of age. Attempts to explain these observations included low levels of knowledge and awareness about ASDs in Africa, problems with help-seeking behaviour, and lack of mental healthcare facilities and trained personnel. nclusions. Enhancement of processes directed at ensuring early diagnosis and interventions, especially interventions aimed at improving speech and language development well and sufficiently early, may bring about a shift in the trend of excess non-verbal cases of ASDs over verbal cases presenting to orthodox clinical practice

Delays in Presentation and Treatment of Breast Cancer in Enugu; Nigeria

To assess the delays and define the causes of delay in presentation and treatment of breast cancer patients inEnugu;Nigeria. Across-sectional survey of breast cancer patients using a semi structured questionnaire. SurgicalOncology unit;University ofNigeriaTeachingHospitalEnugu; (UNTH-E);Nigeria. 164 consecutively presenting breast cancer patients seen between June 1999 andMay 2005. Most of the patients (82.3) reported for initial evaluation at a modern health facility while 17.5reported first toAlternative practitioners. Forty six patients (26.4) presented within a month of noticing the symptoms while 72 (45.3) delayed more than 3 months. In contrast; 18 (17) were seen at the site of definitive treatment within one month of seeking help at the initial hospital while 73.4had a delay of more than 3months after the initial hospital contact. Institutional or physician induced delayswere present in 46.2of the caseswhile patient related delayswere present in 79.2of cases.Only use of alternative practitioners for initial treatmentwas significantly related to delays ofmore than threemonths before presentation (p= 0.017). For breast cancer prevention programs in Nigeria to succeed; they must in addition to breast awareness and screening programs; address the institutional bottlenecks; the dearth of knowledge among primary care physicians and improve referrals fromalternative practitioners and prayer houses