Barriers and facilitators to the delivery of age-friendly health services in Primary Health Care centres in southwest, Nigeria: A qualitative study.

BACKGROUND: With the rapid growth of Nigeria's older population, it has become important to establish age-friendly healthcare systems that support care for older people. This study aimed to explore the barriers and facilitators to the delivery of age-friendly health services from the perspectives of primary healthcare managers in Lagos State, Nigeria. METHOD: We conducted 13 key informant interviews including medical officers of health, principal officers of the (Primary Health Care) PHC Board and board members at the state level. Using a grounded theory approach, qualitative data analysis was initially done by rapid thematic analysis followed by constant comparative analysis using Dedoose software to create a codebook. Three teams of two coders each blind-coded the interviews, resolved coding discrepancies, and reviewed excerpts by code to extract themes. RESULTS: The main barriers to the delivery of age-friendly services included the lack of recognition of older adults as a priority population group; absence of PHC policies targeted to serve older adults specifically; limited training in care of older adults; lack of dedicated funding for care services for older adults and data disaggregated by age to drive decision-making. Key facilitators included an acknowledged mission of the PHCs to provide services for all ages; opportunities for the enhancement of older adult care; availability of a new building template that supports facility design which is more age-friendly; access to basic health care funds; and a positive attitude towards capacity building for existing workforce. CONCLUSION: While we identified a number of challenges, these offer opportunities to strengthen and prioritize services for older adults in PHCs and build on existing facilitators. Work is needed to identify and test interventions to overcome these challenges and improve the responsiveness of the PHC system to older adults through the delivery of age-friendly health services in PHCs in Lagos, Nigeria.

Impact of training and case manager support for traditional birth attendants in the linkage of care among HIV-positive pregnant women in Southwest Nigeria: a 3-arm cluster randomized control trial.

BACKGROUND: Mother-to-child transmission (MTCT) accounts for 90% of all new paediatric HIV infections in Nigeria and for approximately 30% of the global burden. This study aimed to determine the effectiveness of a training model that incorporated case managers working closely with traditional birth attendants (TBAs) to ensure linkage to care for HIV-positive pregnant women. METHODS: This study was a 3-arm parallel design cluster randomized controlled trial in Ifo and Ado-Odo Ota, Ogun State, Nigeria. The study employed a random sampling technique to allocate three distinct TBA associations as clusters. Cluster 1 received training exclusively; Cluster 2 underwent training in addition to the utilization of case managers, and Cluster 3 served as a control group. In total, 240 TBAs were enrolled in the study, with 80 participants in each of the intervention and control groups. and were followed up for a duration of 6 months. We employed a one-way analysis of variance (ANOVA) statistical test to evaluate the differences between baseline and endline HIV knowledge scores and PMTCT practices. Additionally, bivariate analysis using the chi-square test was used to investigate linkage to care. Furthermore, logistic regression analysis was utilized to identify TBA characteristics associated with various PMTCT interventions, including the receipt of HIV test results and repeat testing at term for HIV-negative pregnant women. The data analysis was performed using Stata version 16.1.877, and we considered results statistically significant when p values were less than 0.05. RESULTS: At the end of this study, there were improvements in the TBAs' HIV and PMTCT-related knowledge within the intervention groups, however, it did not reach statistical significance (p > 0.05). The referral of pregnant clients for HIV testing was highest (93.5%) within cluster 2 TBAs, who received both PMTCT training and case manager support (p ≤ 0.001). The likelihood of HIV-negative pregnant women at term repeating an HIV test was approximately 4.1 times higher when referred by TBAs in cluster 1 (AOR = 4.14; 95% CI [2.82-5.99]) compared to those in the control group and 1.9 times in cluster 2 (AOR = 1.93; 95% CI [1.3-2.89]) compared to the control group. Additionally, older TBAs (OR = 1.62; 95% CI [1.26-2.1]) and TBAs with more years of experience in their practice (OR = 1.45; 95% CI [1.09-1.93]) were more likely to encourage retesting among HIV-negative women at term. CONCLUSIONS: The combination of case managers and PMTCT training was more effective than training alone for TBAs in facilitating the linkage to care of HIV-positive pregnant women, although this effect did not reach statistical significance. Larger-scale studies to further investigate the benefits of case manager support in facilitating the linkage to care for PMTCT of HIV are recommended. TRIAL REGISTRATION: The study was retrospectively registered in the Pan African Clinical Trial Registry, and it was assigned the unique identification number PACTR202206622552114.

The reciprocal relationship between openness and creativity: from neurobiology to multicultural environments.

The desire for novelty and variety in experiences, which may manifest in an inclination to engage with individuals from a diverse range of cultural backgrounds, collectively constitutes the personality dimension known as "Openness to Experience." Empirical research has identified a positive correlation between trait openness and various expressions of creativity, such as divergent ideation, innovative problem-solving strategies, and cumulative creative accomplishments. This nexus between openness to interpersonal diversity, as an aspect of the larger personality trait of openness, and creativity has precipitated considerable scholarly interest across the disciplines of personality, social and organizational psychology, and neuroscientific investigation. In this paper, we review the neurobehavioral properties, including the cognitive processes and neural mechanisms, that connect these two constructs. Further, we explore how culture influences levels of openness and creativity in individuals and consider how creativity predisposes individuals toward openness to a plethora of experiences, including those occurring in culturally diverse contexts. This reciprocal entanglement of creativity and openness has been shown to foster a reduction in biases, augment conflict resolution capabilities, and generally yield superior outcomes in multicultural environments.

The neurobiology of openness as a personality trait.

Openness is a multifaceted behavioral disposition that encompasses personal, interpersonal, and cultural dimensions. It has been suggested that the interindividual variability in openness as a personality trait is influenced by various environmental and genetic factors, as well as differences in brain functional and structural connectivity patterns along with their various associated cognitive processes. Alterations in degree of openness have been linked to several aspects of health and disease, being impacted by both physical and mental health, substance use, and neurologic conditions. This review aims to explore the current state of knowledge describing the neurobiological basis of openness and how individual differences in openness can manifest in brain health and disease.

Provider and facility readiness for age-friendly health services for older adults in primary health care centres in southwest, Nigeria.

There is a growing focus on interventions at the health system level to promote healthy aging and provide age-friendly health services (AFHS) in low- and middle-income countries where populations are aging. This study aimed to determine the provider and facility readiness for AFHS. We developed and implemented surveys to collect PHC facility capacity and readiness to deliver AFHS and a KAP survey for facility healthcare workers based on guidelines from the WHO age-friendly tool kit and questionnaires from other studies. Direct observation and structured interviews of facility heads were conducted in a stratified random sample of 15 out of the 57 comprehensive PHC facilities in Lagos, Nigeria. One hundred and twenty providers were conveniently sampled for the KAP survey. Statistical analysis was conducted using STATA version 15 (StataCorp, College Station, Texas, USA). For facility readiness, only 13.3% of PHCs sometimes offered hearing assessment and none of the PHCs offered colorectal cancer assessment. Few (20.0%) facilities offered home services and only 1 (0.7%) had dedicated funding for care of older people. Ramps were at the entrance in 60.0% of facilities and almost half (43.3%) of the PHCs had wheelchair accessible entrances to the public toilets. The majority of HCWs (81.7%) had heard about healthy aging but only 5.0% about AFHS, only 10.8% reported formal training. Around a third knew about specific conditions which affect people as they age, including; depression (37.5%), urinary incontinence (35.0%), and falls/immobility (33.3%). Over half of the providers (54.2%) screened for malnutrition in older patients, 25.8% screened for suspected elder abuse and much less (19.2%) for delirium. This study found some areas of strength but also gaps in facility readiness as well as knowledge and training needed to support AFHS care. We recommend identifying interventions to improve the availability and delivery of care for older adults.

Psychosocial Support and Cost Burden of Cancer Among Patients Attending Tertiary Oncology Clinics in Lagos State, Nigeria.

BACKGROUND: Cancer management brings about changes in patients' paths of life, in their daily activities, work, relationships, and family roles, and it is associated with a high level of patient psychological stress and financial toxicity. The objective of this study was to assess the psychosocial support and financial burden of cancer patients and determine socioeconomic factors that impact them. Methodology and Methods: This was a descriptive cross-sectional study among 240 cancer patients in Lagos University Teaching Hospital (LUTH) and Lagos State University Teaching Hospital (LASUTH) in Nigeria. The respondents were recruited consecutively and data was collected using structured, adapted, interviewer administered questionnaires. The data was analyzed using epi info software version 7.1 with chi-square used to test for associations and the level of significance was set at p<0.05. RESULTS: Overall, 74.6% of respondents had perceived psychosocial support scores higher than 50 out of 100. The family was the most common source of support across the emotional, financial and tangible support dimension's (91.7%, 83.8% and 85.4%) while healthcare professionals (60%) were the commonest for informational support. Overall, 69.6% had COST scores less than 50% indicating worse financial toxicity. Statistical associations were found between cost burden and cancer type (p=0.01), age (p<0.0001) and financial support (p<0.0001). Older patients, those who had financial support, and those with gynecological cancers had a decreased financial burden For psychosocial support associations were seen with employment status (p=0.02), and treatment (p<0.0001). Higher psychosocial support for patients who were employed and had begun treatment. CONCLUSION: The majority of respondents experienced high levels of financial toxicity but adequate psychosocial support. More research is needed, as well as the inclusion of support groups into clinics and the availability of loans to help with the initial costs.

Perceptions and uptake of COVID-19 vaccines amongst undergraduate students in a tertiary institution in Lagos State.

Background: COVID-19 pandemic has ravaged the world, causing deaths in different countries. Fortunately, production of its vaccine has brought some tranquillity, and Nigeria was not left behind. This study aimed to determine the role of knowledge and perception towards the uptake of COVID-19 vaccine amidst undergraduate students of the University of Lagos, Lagos, Nigeria. Methods: This descriptive cross-sectional study was carried out amongst 170 students at the University of Lagos using a multi-stage sampling method. Self-administered questionnaires were used to collect information on demography, knowledge, perception, acceptance and uptake of COVID-19 vaccine. Data were analysed utilising SPSS Version 26. The level of significance was at P < 0.05. Results: Majority of respondents 125 (73.5%) had good knowledge of COVID-19 vaccine and 87 (51.2%) respondents attributed source of information to social media. Although many 99 (58.2%) respondents had positive perceptions of the vaccine, few 16 (9.4%) had taken the vaccine. Less than quarter 24 (22.1%) planned to receive COVID-19 vaccine while majority 120 (77.9%) had no plans to, cite safety concerns. There was a statistically significant association between age (P = 0.001), level of training (P = 0.034) and uptake of COVID-19 vaccine. Conclusion and Recommendations: The level of uptake of COVID-19 vaccine was poor amongst undergraduate students in tertiary institutions in Lagos. Age and level of training of respondents were factors associated with poor uptake. It is recommended that the section of university responsible for sharing of information amongst students organises risk communication activities targeted at specific areas about COVID-19 vaccine to improve vaccine uptake amongst students.

Role of traditional beliefs in the knowledge and perceptions of mental health and illness amongst rural-dwelling women in western Nigeria.

BACKGROUND: Globally, the public health importance of mental health has gained significant attention in recent years. In Africa, many traditional belief systems impact the perceptions, attitude and management of mental illness. Women are usually the primary caregivers of mentally ill persons, but they have lower mental health literacy. AIM: To assess rural women's knowledge, perceptions and attitudes regarding mental illnesses and the role of traditional beliefs in their management. SETTING: Epe Local Government Area of Lagos State, Nigeria. METHODS: This was a cross-sectional study with a total of 295 rural women recruited through a multistage sampling method. A pretested interviewer-administered questionnaire was used to collect data. Summary and inferential statistics were measured using Epi Info version 7. The level of significance was predetermined at 5%. RESULTS: A total of 253 questionnaires were adequately filled and analysed. Overall, just over one-third (35%) of respondents had good knowledge and only 26% had positive attitudes towards mental health and illness. About 45% reported that mental illness should first be treated in 'the traditional way', whilst 47% felt that there was no need for collaboration between orthodox and unorthodox healthcare for mental illness. Sociodemographic variables were significantly associated with knowledge (educational level p = 0.001) and attitude (marital status p = 0.001 and ethnicity p = 0.001). CONCLUSION: Respondents had poor knowledge of and attitude towards mental health, and traditional beliefs played a role in their perception and management of mental illness. We recommend community-based health education programmes to improve knowledge and help-seeking for mental illness amongst rural women.

Assessment of factors affecting self-rated health among elderly people in Southwest Nigeria.

CONTEXT: Self-rated health (SRH) is a subjective measure of health considered valid to predict mortality among the elderly. With the rapid increase of older people living in Nigeria and the lack of adequate social security, it is important to identify factors affecting their SRH. Social support has also taken on added importance among the elderly in view of scarce resources. OBJECTIVE: To determine the level of satisfaction with the forms of social support received by the elderly and the factors associated with their SRH. SETTINGS AND DESIGN: The study was a descriptive cross-sectional study design among the elderly in Southwest Nigeria. SUBJECTS AND METHODS: A multistage sampling technique was employed to select 360 elderly respondents for the study. A standardised questionnaire, Short Form Health Survey-36 was interviewer administered. The data were analysed using Statistical Package for the Social Sciences version 20. Significant associations between categorical variables were evaluated using Chi-square (χ2) test. Multiple regression test and adjusted odds ratios (ORs) were employed to assess the relationship of the various predictors of SRH. The level of significance was set at P < 0.05. RESULTS: The mean age of the 360 elderly respondents was 73 ± 9.3 years, 60.3% were female and 43.9% were widowed. Almost all (91.9%) the respondents received emotional while domestic support was the least in 50.3%. About 30.0% of the elderly self-rated their health as poor. The predictors of good SRH after multiple logistic regression included being married (OR = 1.84, 95% confidence interval [CI]: 1.01-3.33, P = 0.04); engagement in work (OR = 2.27, 95% CI: 1.11-4.63, P = 0.02); the absence of morbid conditions (OR = 12.6, 95% CI: 2.86-55.4, P = 0.001) and higher levels of education (OR = 0.41, 95% CI: 0.19-0.91, P = 0.03). CONCLUSIONS: About one-third of the elderly had poor SRH. Targeted interventions such as creating employment fit for the elderly and improving healthcare access is recommended.

Knowledge, Attitude, and Practice of Breastfeeding: A Comparative Study of Mothers in Urban and Rural Communities of Lagos, Southwest Nigeria.

BACKGROUND: Breastfeeding is a child survival intervention, which is effective in reducing child mortality. This study compared the knowledge, attitude, and practice of breastfeeding among mothers of under-five children in rural and urban communities of Lagos, Southwest Nigeria. METHODS: This comparative cross-sectional study was conducted in Ikeja and Ikorodu, an urban and a rural local government area (LGA) of Lagos state, respectively. A total of 248 mothers of children under 5 years were selected from both areas using multistage sampling technique and subsequently interviewed. Data were analyzed using the Statistical Package for the Social Sciences version 20. Chi-squared test was used for urban and rural comparisons. RESULTS: The respondents with good level of knowledge of breastfeeding in the urban and rural areas were 84.7% and 89.5%, respectively (P = 0.256). The overall positive attitude was 52.4% and 57.3% among the urban and rural respondents, respectively (P = 0.444). More than three-quarters (75.8%) of the respondents in the rural LGA and 43.5% of the urban respondents initiated breastfeeding immediately after birth (P < 0.001). Most of the rural respondents who had babies aged 0-24 months (46.8%) were currently breastfeeding their babies compared to 25.9% of their urban counterparts (P = 0.001). Furthermore, 79.8% of the rural respondents had practiced or were currently practicing exclusive breastfeeding (EBF) compared to 29.0% of the urban respondents (P < 0.001), with more urban women citing work resumption as reason for nonpractice of EBF (P = 0.010). The overall good practice was 16.1% and 69.4% among the urban and rural respondents, respectively (P < 0.001). CONCLUSION: Respondents' knowledge about breastfeeding was good, while their attitude was fair. The practice of breastfeeding among urban respondents was however low. Government and nongovernmental agencies should focus on programs that improve the attitude and breastfeeding practice of urban women.