Perceptions of patent and proprietary medicine vendors and communities of the tiered accreditation programme for family planning services in Lagos and Kaduna states, Nigeria.

This study evaluated the perception of patent and proprietary medicine vendors (PPMVs) of the accreditation programme to improve their capacity to provide family planning (FP) services in Lagos and Kaduna, Nigeria. A cross-sectional mixed-method approach among 224 PPMVs was used to investigate their perception, willingness to pay for and adhere to the programme, its benefits, and the community women's perception of the value of PPMVs. Chi-square analysis and structural equation modelling (SEM) were used to analyse survey data, while focus group discussions (FGDs) were analysed using the grounded theory. PPMVs were enthusiastic because of the benefits, including increased clientele, revenue, and improved service provision capacity. Approximately 97% of PPMVs found the programme acceptable and were willing to pay, with 56% and 71% willing to pay between N5000-N14900 ($12-36) and N25000-N35000 ($60-87), respectively. A significant relationship between educational attainment, location, and willingness to pay was revealed. Among community women, the fear of side effects, lack of partners' support, myths and misconceptions, and lack of access to modern contraceptives were factors affecting contraceptive uptake. The capacity of PPMVs to improve FP uptake is promising and can be leveraged to improve health outcomes in communities while strengthening their businesses.

Knowledge, Attitude, and Practice Toward Cervical Cancer Screening Among Female University Students in Ishaka Western Uganda.

Purpose: Cervical cancer (CC) is the leading cause of cancer-related death among women living in third-world countries. CC is preventable, with the possibility of complete treatment if detected early. The objective of the study was to assess the level of knowledge, attitude, and practice on CC screening (CCS) among female university students (FUS) in Ishaka, western Uganda. Methods: The study was a descriptive cross-sectional study among FUS (n = 407) in western Uganda conducted after the first nationwide lockdown in Uganda. Information was collected using a questionnaire and descriptively presented as frequency and percentages. Results: The majority of our respondents were medical students 283 (69.5%), below 25 years 339 (83.3%), with Anglican Christian religious background 150 (36.9%). Respondents above the age of 25 years (p = 0.0052) and those in the medical profession (p < 0.001) had more knowledge. More medical students had a better attitude (p = 0.0043) and favorable practices (0.0134) compared to their non-medical counterparts. There is a weak correlation between attitude (r = 0.206, p < 0.001) and practice (r = 0.181, p = 0.0003) with knowledge on CCS. Conclusion: Observation from the present study suggests the need for more efforts in the fight against cervical cancer and encouragement of positive attitude and practice towards cervical cancer screening and uptake of vaccination.

Meta-synthesis and science mapping analysis of HIV/HPV co-infection: a global perspective with emphasis on Africa.

BACKGROUND: Viral infections are emerging with diverse clinical relevance both in endemic environments and non-endemic regions of the world. Some of the viruses cause co-infections that are of public health importance. The progress of studies on human immunodeficiency virus / Human papillomavirus (HIV/HPV) co-infection is not well documented especially in Africa where cases are endemic. METHOD: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a global three-decade meta-synthesis and science mapping analysis on HIV/HPV co-infections. Assessment of progress, Author/Country productivity/trends, topic conceptual framework, and international collaborative networks were analyzed. RESULTS: We recovered 196 documents of 115 sources from the web of science database. The meta-synthesis revealed 1203 prolific authors containing nine solo authors, an annual growth rate of 8.09%, a significant average citation per article of 20.7%, and an average citation per year per document of 2.1. A significant high correlation between the mean/TC per article and the mean total citation (TC) per year showed 80.98% of the articles produced between 2005 and 2007 on HPV/HIV co-infection. The co-author per document index were 7.0 and the collaboration index was 6.4. The meta-analysis also revealed inadequate funding from individual or governmental organizations; among the 196 documents dataset, 114 (58.2%) were funded, and only 31 (15.8%) were funded in Africa where HIV/HPV co-infection cases are endemic. CONCLUSIONS: Authors' collaboration network, countries' collaboration, authors' citations and implementation of research-based finding in previous studies are yet to receive the relevant outcome, especially as various countries in the African continent have received poor funding with a repeated reporting of co-infection associated with HIV/HPV. African needs to re-awaken and stir up research-based interest in HPV/HIV co-infection studies to resolve indigenous public health concerns associated with the viral endemicity.

Exploring the Essential Stroke Care Structures in Tertiary Healthcare Facilities in Rivers State, Nigeria.

This study evaluated the essential stroke care structure available in the two Tertiary Health Facilities in Rives State, Nigeria. This was a descriptive survey involving the Stroke Care Survey and Assessment Tool (checklist/questionnaire) developed by the World Stroke Organisation to obtain information about the available essential stroke care structure (facilities, equipment, personnel and management protocol) at the two tertiary health facilities (RSUTH & UPTH). The study gathered relevant information, which was summarised into tables and graphs using Microsoft Excel 2016. From the results, although facilities had A and E departments, dedicated stroke units (fixed or mobile) were unavailable, and there was no locally developed protocol to support rapid triage of stroke patients. The facilities and equipment were either unavailable or insufficient. Only one health facility (RSUTH) provided 24 hrs/7 days laboratory services. The workforces were a mix between regular clinical staff and some specialists. Tissue plasminogen activator (tPA) use was non-existent, though specialists were trained on its administration. There was no locally developed or adopted stroke-specific clinical guidelines. In conclusion, the structural services available for stroke care within the studied tertiary health facilities were poor, unavailable or grossly insufficient. The state facility (RSUTH) suffered the most in terms of unavailable national support and staff development.

COVID-19-Related Mental Health Burdens: Impact of Educational Level and Relationship Status Among Low-Income Earners of Western Uganda.

Objective: The study aimed to investigate the relationship between mental health with the level of education, relationship status, and awareness on mental health among low-income earners in Western Uganda. Methods: This was a cross-sectional descriptive study carried out among 253 participants. Anxiety, anger, and depression were assessed using a modified generalized anxiety disorder (GAD-7), Spielberger's State-Trait Anger Expression Inventory-2, and Beck Depression Inventory item tools, respectively. Results: The majority of our respondents were male (n = 150/253, 59.3), had a secondary level of education (104/253, 41.1), and were single (137/253, 54.2). No formal education and primary education (r2 = 47.4% and 6.4%, respectively) had a negative correlation with awareness of mental health care. In addition, no formal education had a positive correlation with anger and depression (r2 = 1.9% and 0.3%, respectively). Singleness in this study had a negative correlation with awareness of mental health care, anger, and depression (r2 = 1.9, 0.8, and 0.3%, respectively), and a positive correlation with anxiety (r2 = 3.9%). Conclusion: It is evident that education and relationship status influenced awareness on mental health care and mental health state among low-income earners in Western Uganda during the first COVID-19 lockdown. Therefore, policymakers should strengthen social transformation through the proper engagement of low-income earners in this COVID-19 era.

Anxiety, Anger and Depression Amongst Low-Income Earners in Southwestern Uganda During the COVID-19 Total Lockdown.

Background: Low-income earners are particularly vulnerable to mental health, consequence of the coronavirus disease 2019 (COVID-19) lockdown restrictions, due to a temporary or permanent loss of income and livelihood, coupled with government-enforced measures of social distancing. This study evaluates the mental health status among low-income earners in southwestern Uganda during the first total COVID-19 lockdown in Uganda. Methods: A cross-sectional descriptive study was undertaken amongst earners whose income falls below the poverty threshold. Two hundred and fifty-three (n = 253) male and female low-income earners between the ages of 18 and 60 years of age were recruited to the study. Modified generalized anxiety disorder (GAD-7), Spielberger's State-Trait Anger Expression Inventory-2 (STAXI-2), and Beck Depression Inventory (BDI) tools as appropriate were used to assess anxiety, anger, and depression respectively among our respondents. Results: Severe anxiety (68.8%) followed by moderate depression (60.5%) and moderate anger (56.9%) were the most common mental health challenges experienced by low-income earners in Bushenyi district. Awareness of mental healthcare increased with the age of respondents in both males and females. A linear relationship was observed with age and depression (r = 0.154, P = 0.014) while positive correlations were observed between anxiety and anger (r = 0.254, P < 0.001); anxiety and depression (r = 0.153, P = 0.015) and anger and depression (r = 0.153, P = 0.015). Conclusion: The study shows the importance of mental health awareness in low resource settings during the current COVID-19 pandemic. Females were identified as persons at risk to mental depression, while anger was highest amongst young males.

Polycyclic Aromatic Hydrocarbon Levels in Wistar Rats Exposed to Ambient Air of Port Harcourt, Nigeria: An Indicator for Tissue Toxicity.

This study investigated the PAH levels in Wistar rats exposed to ambient air of the Port Harcourt metropolis. Twenty Wistar rats imported from a nonpolluted city (Enugu) were exposed to both indoor and outdoor air. Following the IACUC regulation, baseline data were obtained from 4 randomly selected rats, while the remaining 16 rats (8 each for indoor and outdoor) were left till day 90. Blood samples were obtained by cardiac puncture, and the PAH levels were determined using Gas Chromatography Flame-Ionization Detector (GC-FID). GraphPad Prism (version 8.0.2) Sidak's (for multiple data set) and unpaired t-tests (for two data sets) were used to evaluate the differences in group means. Seven of the PAHs found in indoor and outdoor rats were absent in baseline rats. The mean concentrations of PAH in indoor and outdoor animals were higher than those of baseline animals, except for Benzo(a)pyrene, which was found in baseline animals but absent in other animal groups. Additionally, Dibenz(a,h)anthracene, Indeno(1,2,3-c,d)pyrene, Pyrene, 2-methyl, and other carcinogenic PAHs were all significantly higher (p < 0.05) in outdoor groups. The vulnerable groups in Port Harcourt are at the greatest risk of such pollution. Therefore, urgent environmental and public health measures are necessary to mitigate the looming danger.

A Descriptive-Multivariate Analysis of Community Knowledge, Confidence, and Trust in COVID-19 Clinical Trials among Healthcare Workers in Uganda.

Background-misinformation and mistrust often undermines community vaccine uptake, yet information in rural communities, especially of developing countries, is scarce. This study aimed to identify major challenges associated with coronavirus disease 2019 (COVID-19) vaccine clinical trials among healthcare workers and staff in Uganda. Methods-a rapid exploratory survey was conducted over 5 weeks among 260 respondents (66% male) from healthcare centers across the country using an online questionnaire. Twenty-seven questions assessed knowledge, confidence, and trust scores on COVID-19 vaccine clinical trials from participants in 46 districts in Uganda. Results-we found low levels of knowledge (i.e., confusing COVID-19 with Ebola) with males being more informed than females (OR = 1.5, 95% CI: 0.7-3.0), and mistrust associated with policy decisions to promote herbal treatments in Uganda and the rushed international clinical trials, highlighting challenges for the upcoming Oxford-AstraZeneca vaccinations. Knowledge, confidence and trust scores were higher among the least educated (certificate vs. bachelor degree holders). We also found a high level of skepticism and possible community resistance to DNA recombinant vaccines, such as the Oxford-AstraZeneca vaccine. Preference for herbal treatments (38/260; 14.6%, 95% CI: 10.7-19.3) currently being promoted by the Ugandan government raises major policy concerns. High fear and mistrust for COVID-19 vaccine clinical trials was more common among wealthier participants and more affluent regions of the country. Conclusion-our study found that knowledge, confidence, and trust in COVID-19 vaccines was low among healthcare workers in Uganda, especially those with higher wealth and educational status. There is a need to increase transparency and inclusive participation to address these issues before new trials of COVID-19 vaccines are initiated.

Substance Use, Highly Active Antiretroviral Therapy, and Liver Enzymes: Evidence From a Cross-Sectional Study of HIV-Infected Adult Patients Without Comorbidities on HAART in the University of Port Harcourt Teaching Hospital.

This study applied a structural equation modeling (SEM) to evaluate the role of substance use (alcohol, smoking, and trado-medicine use) to changes in the liver enzymes (AST, ALT, and ALP) levels in HIV-infected adult patients on a highly active antiretroviral treatment (HAART) for not <1 year. The study was a cross-sectional, part of a randomized comparative trial (Ref: UPH/CEREMAD/REC/19), involving 129 (46 males and 83 females) HIV-infected adult patients. Liver enzyme levels were determined from analyzed blood samples using the Clinical Chemistry Analyser (VS10) manufactured by Vitro Scient, while the study determined substance use using a reliable (Cronbach alpha = 0.805) rapid-exploratory survey questionnaire. Liver enzyme values were further categorized into: normal or abnormal using normal reference ranges (ALT = 7-55 U/L, AST = 8-48 U/L, and ALP = 40-129 U/L). STATGRAPHICS V16.1.11 (StatPoint Tech., Inc.) and SPSS (IBM® Amos V21.0.0, USA) were used to analyze the data. Among the HIV-HAART patients, 27.9% were alcohol users, 20.9% smokers, and 20.1% trado-medicine users. In addition, ALP (71.3%) abnormality was higher than ALT (34.9%) and AST (28.7%). The result from the SEM provided only a partial support for our hypotheses of direct substance use effects on the liver enzyme levels and abnormalities; with a direct association of alcohol with an elevated AST (b = 0.170, p = 0.05) and smoking with a higher AST (b = 0.484, p < 0.01) and ALT (b = 0.423, p < 0.01) values. Trado-medicine use was not directly associated with enzyme elevation and abnormality. In conclusion, ALP abnormality was the most common, and there is a close association between an elevated ALT and AST, with or without an elevated ALP. The study found that HIV-HAART patients who drink or smoke will have at least one or more abnormal transaminases. The possible explanation to the increased risk among HIV-HAART patients could be associated with the metabolic pressures and supra-additive effects on the livers.

Morton's Toe: Prevalence and Inheritance Pattern among Nigerians.

BACKGROUND: Anatomical variations have been genetically linked and the difference in the length of the big toe relative to the second toe (Morton's toe) is not an exception; however, its prevalence and inheritance pattern has been a scientific debate. Therefore, this study investigated the prevalence and inheritance pattern of Morton's toe among Nigerians in Rivers State. MATERIALS AND METHODS: A total of 101 families comprising of 101 parents (fathers and mothers) and 135 offspring were conveniently sampled for this study. The observed big toe pattern was described as "LBT" and "SBT" representing big toe longer than the second toe and big toe shorter or equal to the second toe, respectively. The offspring trait was tabulated alongside the parental combination patterns (i.e., when both parents had LBT, both parents SBTand a combination of LBTand SBT). XLSTAT 2012 (version 4.2.2) Chi-square analysis tested the association between sex and Morton's toe. Mendelian Chi-square gene distribution model evaluated the conformance to simple dominance-recessive pattern, while the Hardy-Weinberg (H-W) equation for allele frequency compared the parental allele frequency to that of the offspring. RESULTS: LBT(218; 64.7%) was more in the studied population than SBT(119; 35.3%); with males (63; 18.7%) having slightly higher proportion of SBT (Morton's toe) than females (56; 16.6%), which was without sexual preference (χ2 = 0.141, P > 0.932). The test of offspring gene distribution in conformance to Mendelian simple dominant-recessive monohybrid cross had rather weak result. The H-W equation showed a deviation of offspring allele distribution (1:3:2.5 [2:6:5]) from the parents (1:3:2). CONCLUSION: Morton's toe could be said to be genetically linked, however, its inheritance pattern does not conform to the simple dominant-recessive model, but a more complex pattern. It should be noted that the large frequency of a trait in a population does not make it dominant.

Evaluation of sexual dimorphism by discriminant function analysis of toe length (1T-5T) of adult Igbo populace in Nigeria.

BACKGROUND: Sex determination is an important and one of the foremost criteria in establishing the identity of an individual, and this is achieved by investigating various anatomical structures to establish sex discriminatory features. The present study conducted baseline data for the toe with a view of finding discriminatory sex characteristics. MATERIALS AND METHODS: A total of 420 subjects were studied by direct linear measurements of the toe length (big toe [1T] to the fifth toes [5T]) of both feet using a digital Vernier caliper with accuracy of 0.01 mm. Statistical Package for Social Sciences  (IBM, version 23, Armonk, New York, USA), Levene's ANOVA outcome informed the use of t-tests to compare mean differences. Discriminant function analysis (DFA) was used to evaluate the possibility of sex categorization. The significance level was set at 95%. RESULTS: The mean ± standard deviation values of the right (R) toes for the males were 49.63 ± 4.43 mm (1T), 36.92 ± 5.14 mm (2T), 30.35 ± 4.95 mm (3T), 25.55 ± 3.97 mm (4T) and 22.21 ± 2.94 mm (5T), whereas the female values were 45.73 ± 4.07 mm (1T), 33.31 ± 4.66 mm (2T), 26.63 ± 4.02 mm (3T), 22.89 ± 3.43 mm (4T), and 19.77 ± 2.70 mm (5T). The left male values were 49.16 ± 4.32 mm (1T), 36.82 ± 5.16 mm (2T), 30.88 ± 4.91 mm (3T), 26.13 ± 3.99 mm (4T), and 22.46 ± 3.24 mm (5T), whereas the female values were 45.33 ± 4.05 mm (1T), 33.05 ± 4.70 mm (2T), 27.27 ± 4.29 mm (3T), 23.10 ± 3.36 mm (4T), 19.81 ± 2.59 mm (5T). From the results, males displayed significantly higher mean values than females in all measured parameters (t = 2.405, P = 0.018) with no asymmetry (P > 0.05); although T3 and T4 were larger on the left foot. The DFA model when tested with the present data derived a significant F likelihood ratio test (P < 0.001), a Wilks' lambda predictability value of 0.759 having a model accuracy of 69.5% with a better prediction for female (70%) than males (69%). CONCLUSION: The use of toe length alone may not be effective for sex differentiation; however, it can serve as an adjunct in forensic investigation involving sex identification.