搜索结果：Annals of Ibadan postgraduate medicine

Timely and comprehensive analyses of causes of death stratified by age, sex, and location are essential for shaping effective health policies aimed at reducing global mortality. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 provides cause-specific mortality estimates measured in counts, rates, and years of life lost (YLLs). GBD 2023 aimed to enhance our understanding of the relationship between age and cause of death by quantifying the probability of dying before age 70 years (70q0) and the mean age at death by cause and sex. This study enables comparisons of the impact of causes of death over time, offering a deeper understanding of how these causes affect global populations. GBD 2023 produced estimates for 292 causes of death disaggregated by age-sex-location-year in 204 countries and territories and 660 subnational locations for each year from 1990 until 2023. We used a modelling tool developed for GBD, the Cause of Death Ensemble model (CODEm), to estimate cause-specific death rates for most causes. We computed YLLs as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. Probability of death was calculated as the chance of dying from a given cause in a specific age period, for a specific population. Mean age at death was calculated by first assigning the midpoint age of each age group for every death, followed by computing the mean of all midpoint ages across all deaths attributed to a given cause. We used GBD death estimates to calculate the observed mean age at death and to model the expected mean age across causes, sexes, years, and locations. The expected mean age reflects the expected mean age at death for individuals within a population, based on global mortality rates and the population's age structure. Comparatively, the observed mean age represents the actual mean age at death, influenced by all factors unique to a location-specific population, including its age structure. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 250-draw distribution for each metric. Findings are reported as counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2023 include a correction for the misclassification of deaths due to COVID-19, updates to the method used to estimate COVID-19, and updates to the CODEm modelling framework. This analysis used 55 761 data sources, including vital registration and verbal autopsy data as well as data from surveys, censuses, surveillance systems, and cancer registries, among others. For GBD 2023, there were 312 new country-years of vital registration cause-of-death data, 3 country-years of surveillance data, 51 country-years of verbal autopsy data, and 144 country-years of other data types that were added to those used in previous GBD rounds. The initial years of the COVID-19 pandemic caused shifts in long-standing rankings of the leading causes of global deaths: it ranked as the number one age-standardised cause of death at Level 3 of the GBD cause classification hierarchy in 2021. By 2023, COVID-19 dropped to the 20th place among the leading global causes, returning the rankings of the leading two causes to those typical across the time series (ie, ischaemic heart disease and stroke). While ischaemic heart disease and stroke persist as leading causes of death, there has been progress in reducing their age-standardised mortality rates globally. Four other leading causes have also shown large declines in global age-standardised mortality rates across the study period: diarrhoeal diseases, tuberculosis, stomach cancer, and measles. Other causes of death showed disparate patterns between sexes, notably for deaths from conflict and terrorism in some locations. A large reduction in age-standardised rates of YLLs occurred for neonatal disorders. Despite this, neonatal disorders remained the leading cause of global YLLs over the period studied, except in 2021, when COVID-19 was temporarily the leading cause. Compared to 1990, there has been a considerable reduction in total YLLs in many vaccine-preventable diseases, most notably diphtheria, pertussis, tetanus, and measles. In addition, this study quantified the mean age at death for all-cause mortality and cause-specific mortality and found noticeable variation by sex and location. The global all-cause mean age at death increased from 46·8 years (95% UI 46·6-47·0) in 1990 to 63·4 years (63·1-63·7) in 2023. For males, mean age increased from 45·4 years (45·1-45·7) to 61·2 years (60·7-61·6), and for females it increased from 48·5 years (48·1-48·8) to 65·9 years (65·5-66·3), from 1990 to 2023. The highest all-cause mean age at death in 2023 was found in the high-income super-region, where the mean age for females reached 80·9 years (80·9-81·0) and for males 74·8 years (74·8-74·9). By comparison, the lowest all-cause mean age at death occurred in sub-Saharan Africa, where it was 38·0 years (37·5-38·4) for females and 35·6 years (35·2-35·9) for males in 2023. Lastly, our study found that all-cause 70q0 decreased across each GBD super-region and region from 2000 to 2023, although with large variability between them. For females, we found that 70q0 notably increased from drug use disorders and conflict and terrorism. Leading causes that increased 70q0 for males also included drug use disorders, as well as diabetes. In sub-Saharan Africa, there was an increase in 70q0 for many non-communicable diseases (NCDs). Additionally, the mean age at death from NCDs was lower than the expected mean age at death for this super-region. By comparison, there was an increase in 70q0 for drug use disorders in the high-income super-region, which also had an observed mean age at death lower than the expected value. We examined global mortality patterns over the past three decades, highlighting-with enhanced estimation methods-the impacts of major events such as the COVID-19 pandemic, in addition to broader trends such as increasing NCDs in low-income regions that reflect ongoing shifts in the global epidemiological transition. This study also delves into premature mortality patterns, exploring the interplay between age and causes of death and deepening our understanding of where targeted resources could be applied to further reduce preventable sources of mortality. We provide essential insights into global and regional health disparities, identifying locations in need of targeted interventions to address both communicable and non-communicable diseases. There is an ever-present need for strengthened health-care systems that are resilient to future pandemics and the shifting burden of disease, particularly among ageing populations in regions with high mortality rates. Robust estimates of causes of death are increasingly essential to inform health priorities and guide efforts toward achieving global health equity. The need for global collaboration to reduce preventable mortality is more important than ever, as shifting burdens of disease are affecting all nations, albeit at different paces and scales. Gates Foundation.

Human behaviours have huge impact on disease prevention and how the attitudes and behaviour of security personnel in UMTH Maiduguri affect disease prevention during Covid-19 is the core of this study. To ascertain the knowledge, attitudes, behaviour and effects of disease preventive protocols of security personnel working within University of Maiduguri Teaching Hospital (UMTH) towards Covid-19. Methods: This is a cross-sectional descriptive study which took place from September 2020 to March 2021, approved by the Ethical Review Board of the Borno State Ministry of Health, carried out among security personnel selected through a simple random sampling technique. The data from this study was entered into Statistical Product and Service Solution (SPSS Statistics) soft version 29.0. The data was tested for normality; discreet variables were tested using Chi square while continuous variables were tested using either T-test or Analysis of Variance (ANOVA) for parametric data and their non-parametric equivalent for non-parametric data. P- Value of less than 0.05(P< 0.05) was set as statistically significant. Total of 64 people completed the survey, 57(89.9%) males and 7(10.1%) females. The mean age is 28.1yrs, range of 42yrs, and standard deviation of 9.3yrs. The Prevalence of physical distancing, use of face mask and hand washing before and after onset of Covid-19 pandemic 49(76.6%);53(82.8%), 45(70.3%);56(87.5%), 52(81.3%); 53(82.8%). Majority have one form of misconception or the other for their non-adherent to Covid-19 protocols, there was also statistical significant improvement in the use of face mask and physical distancing when we compared before and after Covid-19 pandemic declaration with P-values of 0.023 and 0.038 respectively but no significant difference in the frequency of hand washing (P-value 0.44) and there was no major change in the level of Covid-19 related signs and symptoms before and after declaration of Covid-19 pandemic in Maiduguri. The study showed a significant improvement in the attitude and behaviour of the security personnel towards Covid-19. There was still a high level of misconception of the security personnel towards Covid-19 as most respondents would rather pray over Covid-19 or visit the herbalist than seek medical care. Overall, there was some level of improvement in their preventive measures towards Covid-19.

For more than three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has provided a framework to quantify health loss due to diseases, injuries, and associated risk factors. This paper presents GBD 2023 findings on disease and injury burden and risk-attributable health loss, offering a global audit of the state of world health to inform public health priorities. This work captures the evolving landscape of health metrics across age groups, sexes, and locations, while reflecting on the remaining post-COVID-19 challenges to achieving our collective global health ambitions. The GBD 2023 combined analysis estimated years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 375 diseases and injuries, and risk-attributable burden associated with 88 modifiable risk factors. Of the more than 310&#x2008;000 total data sources used for all GBD 2023 (about 30% of which were new to this estimation round), more than 120&#x2008;000 sources were used for estimation of disease and injury burden and 59&#x2008;000 for risk factor estimation, and included vital registration systems, surveys, disease registries, and published scientific literature. Data were analysed using previously established modelling approaches, such as disease modelling meta-regression version 2.1 (DisMod-MR 2.1) and comparative risk assessment methods. Diseases and injuries were categorised into four levels on the basis of the established GBD cause hierarchy, as were risk factors using the GBD risk hierarchy. Estimates stratified by age, sex, location, and year from 1990 to 2023 were focused on disease-specific time trends over the 2010-23 period and presented as counts (to three significant figures) and age-standardised rates per 100&#x2008;000 person-years (to one decimal place). For each measure, 95% uncertainty intervals [UIs] were calculated with the 2&#xb7;5th and 97&#xb7;5th percentile ordered values from a 250-draw distribution. Total numbers of global DALYs grew 6&#xb7;1% (95% UI 4&#xb7;0-8&#xb7;1), from 2&#xb7;64 billion (2&#xb7;46-2&#xb7;86) in 2010 to 2&#xb7;80 billion (2&#xb7;57-3&#xb7;08) in 2023, but age-standardised DALY rates, which account for population growth and ageing, decreased by 12&#xb7;6% (11&#xb7;0-14&#xb7;1), revealing large long-term health improvements. Non-communicable diseases (NCDs) contributed 1&#xb7;45 billion (1&#xb7;31-1&#xb7;61) global DALYs in 2010, increasing to 1&#xb7;80 billion (1&#xb7;63-2&#xb7;03) in 2023, alongside a concurrent 4&#xb7;1% (1&#xb7;9-6&#xb7;3) reduction in age-standardised rates. Based on DALY counts, the leading level 3 NCDs in 2023 were ischaemic heart disease (193 million [176-209] DALYs), stroke (157 million [141-172]), and diabetes (90&#xb7;2 million [75&#xb7;2-107]), with the largest increases in age-standardised rates since 2010 occurring for anxiety disorders (62&#xb7;8% [34&#xb7;0-107&#xb7;5]), depressive disorders (26&#xb7;3% [11&#xb7;6-42&#xb7;9]), and diabetes (14&#xb7;9% [7&#xb7;5-25&#xb7;6]). Remarkable health gains were made for communicable, maternal, neonatal, and nutritional (CMNN) diseases, with DALYs falling from 874 million (837-917) in 2010 to 681 million (642-736) in 2023, and a 25&#xb7;8% (22&#xb7;6-28&#xb7;7) reduction in age-standardised DALY rates. During the COVID-19 pandemic, DALYs due to CMNN diseases rose but returned to pre-pandemic levels by 2023. From 2010 to 2023, decreases in age-standardised rates for CMNN diseases were led by rate decreases of 49&#xb7;1% (32&#xb7;7-61&#xb7;0) for diarrhoeal diseases, 42&#xb7;9% (38&#xb7;0-48&#xb7;0) for HIV/AIDS, and 42&#xb7;2% (23&#xb7;6-56&#xb7;6) for tuberculosis. Neonatal disorders and lower respiratory infections remained the leading level 3 CMNN causes globally in 2023, although both showed notable rate decreases from 2010, declining by 16&#xb7;5% (10&#xb7;6-22&#xb7;0) and 24&#xb7;8% (7&#xb7;4-36&#xb7;7), respectively. Injury-related age-standardised DALY rates decreased by 15&#xb7;6% (10&#xb7;7-19&#xb7;8) over the same period. Differences in burden due to NCDs, CMNN diseases, and injuries persisted across age, sex, time, and location. Based on our risk analysis, nearly 50% (1&#xb7;27 billion [1&#xb7;18-1&#xb7;38]) of the roughly 2&#xb7;80 billion total global DALYs in 2023 were attributable to the 88 risk factors analysed in GBD. Globally, the five level 3 risk factors contributing the highest proportion of risk-attributable DALYs were high systolic blood pressure (SBP), particulate matter pollution, high fasting plasma glucose (FPG), smoking, and low birthweight and short gestation-with high SBP accounting for 8&#xb7;4% (6&#xb7;9-10&#xb7;0) of total DALYs. Of the three overarching level 1 GBD risk factor categories-behavioural, metabolic, and environmental and occupational-risk-attributable DALYs rose between 2010 and 2023 only for metabolic risks, increasing by 30&#xb7;7% (24&#xb7;8-37&#xb7;3); however, age-standardised DALY rates attributable to metabolic risks decreased by 6&#xb7;7% (2&#xb7;0-11&#xb7;0) over the same period. For all but three of the 25 leading level 3 risk factors, age-standardised rates dropped between 2010 and 2023-eg, declining by 54&#xb7;4% (38&#xb7;7-65&#xb7;3) for unsafe sanitation, 50&#xb7;5% (33&#xb7;3-63&#xb7;1) for unsafe water source, and 45&#xb7;2% (25&#xb7;6-72&#xb7;0) for no access to handwashing facility, and by 44&#xb7;9% (37&#xb7;3-53&#xb7;5) for child growth failure. The three leading level 3 risk factors for which age-standardised attributable DALY rates rose were high BMI (10&#xb7;5% [0&#xb7;1 to 20&#xb7;9]), drug use (8&#xb7;4% [2&#xb7;6 to 15&#xb7;3]), and high FPG (6&#xb7;2% [-2&#xb7;7 to 15&#xb7;6]; non-significant). Our findings underscore the complex and dynamic nature of global health challenges. Since 2010, there have been large decreases in burden due to CMNN diseases and many environmental and behavioural risk factors, juxtaposed with sizeable increases in DALYs attributable to metabolic risk factors and NCDs in growing and ageing populations. This long-observed consequence of the global epidemiological transition was only temporarily interrupted by the COVID-19 pandemic. The substantially decreasing CMNN disease burden, despite the 2008 global financial crisis and pandemic-related disruptions, is one of the greatest collective public health successes known. However, these achievements are at risk of being reversed due to major cuts to development assistance for health globally, the effects of which will hit low-income countries with high burden the hardest. Without sustained investment in evidence-based interventions and policies, progress could stall or reverse, leading to widespread human costs and geopolitical instability. Moreover, the rising NCD burden necessitates intensified efforts to mitigate exposure to leading risk factors-eg, air pollution, smoking, and metabolic risks, such as high SBP, BMI, and FPG-including policies that promote food security, healthier diets, physical activity, and equitable and expanded access to potential treatments, such as GLP-1 receptor agonists. Decisive, coordinated action is needed to address long-standing yet growing health challenges, including depressive and anxiety disorders. Yet this can be only part of the solution. Our response to the NCD syndemic-the complex interaction of multiple health risks, social determinants, and systemic challenges-will define the future landscape of global health. To ensure human wellbeing, economic stability, and social equity, global action to sustain and advance health gains must prioritise reducing disparities by addressing socioeconomic and demographic determinants, ensuring equitable health-care access, tackling malnutrition, strengthening health systems, and improving vaccination coverage. We live in times of great opportunity. Gates Foundation and Bloomberg Philanthropies.

The application of principles for the implementation, management, and maintenance of point-of-care (POC) testing system service is unclear in tertiary healthcare settings in Nigeria. Hence, the study assessed these principles through the perceptions of healthcare professionals (HCPs). The cross-sectional study was conducted among 300 HCPs in the University of Uyo Teaching Hospital (UUTH), southern Nigeria, using a pre-tested self-administered questionnaire that assessed the major principles for POC system service. The questionnaires assessed the implementation principles (determination of healthcare need, presence of POC Organizing and implementation committee, POC testing policy/ accountability protocols, direct involvement of Health care Professionals (HCPs) and the training and certification of operators), the management principles (establishment of quality assurance and audit policies, establishment of maintenance and inventory control policies, establishment of documentary protocols) and the maintenance principles (accreditation and/or regulation of POC testing systems/devices and the central laboratory's involvement in effecting all the principles). Categorical data were summarized in frequency and percentages and presented in tables and figures. Regarding implementation principles, most respondents affirmed not having determined the healthcare need, clinical/operational/ economic benefits, performance requirements, clinical risks, and costs before deployment (63.3%), not having any POC organizing/ implementation coordinating committee (83.3%), no POC testing policy/ accountability protocols (96.7%), and no training/certification of operators for POC systems/devices in the hospital and/or their departments/units (91.7%) (p<0.001). On the management principles, most respondents affirmed negatively to having established quality assurance/ audit policies (83.3%), maintenance/inventory control policies (91.7%), and documentary protocols for POC systems/devices in the hospital and/ or their department/unit (96.7%) (p<0.001). Concerning the maintenance principles, most respondents affirmed to no accreditation/regulation policy (73.3%) and involvement of the central laboratory regarding the POCT systems/devices within the hospital and/or their departments/ units (78.4%) (p<0.001). The level of application of POC principles is low within UUTH based on current findings. This highlights a critical gap in current operational practices, posing potential risks to the quality of patient diagnostic data. Immediate development/implementation of targeted programs and enhanced compliance protocols to address these deficiencies is recommended.

Despite the rise in the burden of heart failure (HF), there seems to be poor level of awareness concerning the syndrome particularly in the lowand middle-income countries. This study sought to determine the level of awareness of HF among patients attending cardiology clinic in a big tertiary institution in South Western Nigeria. Patients attending the Cardiology clinic at University College Hospital, Ibadan were recruited. A structured questionnaire was used to assess their level of awareness of HF. Normally distributed continuous variables were summarised as means and standard deviations. Categorical variables were expressed as frequencies and percentages. The statistical analysis was done using SPSS, Windows version 23.0 (Armonk, NY: IBM Corp). Majority of the participants were females (55.2%) with mean age of 56.4years. Most patients (54.0%) were educated to tertiary level, lived in urban area (96.4%) and had hypertension (88.0%). The overall knowledge of the course of HF was not optimal, however, most patients have heard about HF before the study and are aware of common aetiologies and symptoms of HF. There was mixed performance with the knowledge of treatment of HF with many misconceptions. The most preferred source for information was the clinic (99.4%). Others included the internet (83.0%), and patient guides (67.6%). This study highlighted the gap and the need for educational interventions to address misconceptions and improve patients & knowledge about HF.

Until recently, little was known about the emerging problem of non-communicable forms of heart failure supplementing traditional pathways to the syndrome in sub-Saharan Africa due to infections and infestations. Contemporary studies have built on historical reports to demonstrate that the aetiology and indeed case profile of heart failure (i.e., more women and younger individuals affected in the prime of their lives) is different from that of high-income countries. This study will assess the long-term outcomes, risk factors, clinical phenotypes, and genomics of heart failure in Ibadan, Nigeria, estimate the healthcare cost associated with heart failure and how it affects evidence-based care, and understand the cultural and social conceptions of heart failure in the city and, by extension, in Nigeria. Data from each subject shall be obtained using a uniform and standardized case report form. A detailed clinical documentation on cases of heart failure will be undertaken. The following data shall be obtained: study identification number, centre code, demographic data, date of diagnosis of HF, and pre-admission history (previous heart failurerelated admissions). Others include New York Heart Association functional class, symptoms, signs, self-reported cardiovascular risk factors, aetiology of heart failure, comorbidities, blood investigations, point-of-care biomarker, Chest X-ray, 12-lead ECG, echocardiography, medications, barriers to care, quality of life data, etc. Blood samples will be obtained during enrollment for analysis of biochemical biomarkers. The primary outcome of the study will be mortality by any cause. Secondary outcomes will include non-fatal major events (both resulting in and not resulting in admission). The project will provide data on the contemporary aetiology, clinical profile management and outcomes of heart failure in Ibadan, which may be extrapolated to other parts of the country.

Comprehensive, comparable, and timely estimates of demographic metrics-including life expectancy and age-specific mortality-are essential for evaluating, understanding, and addressing trends in population health. The COVID-19 pandemic highlighted the importance of timely and all-cause mortality estimates for being able to respond to changing trends in health outcomes, showing a strong need for demographic analysis tools that can produce all-cause mortality estimates more rapidly with more readily available all-age vital registration (VR) data. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) is an ongoing research effort that quantifies human health by estimating a range of epidemiological quantities of interest across time, age, sex, location, cause, and risk. This study-part of the latest GBD release, GBD 2023-aims to provide new and updated estimates of all-cause mortality and life expectancy for 1950 to 2023 using a novel statistical model that accounts for complex correlation structures in demographic data across age and time. We used 24&#x2008;025 data sources from VR, sample registration, surveys, censuses, and other sources to estimate all-cause mortality for males, females, and all sexes combined across 25 age groups in 204 countries and territories as well as 660 subnational units in 20 countries and territories, for the years 1950-2023. For the first time, we used complete birth history data for ages 5-14 years, age-specific sibling history data for ages 15-49 years, and age-specific mortality data from Health and Demographic Surveillance Systems. We developed a single statistical model that incorporates both parametric and non-parametric methods, referred to as OneMod, to produce estimates of all-cause mortality for each age-sex-location group. OneMod includes two main steps: a detailed regression analysis with a generalised linear modelling tool that accounts for age-specific covariate effects such as the Socio-demographic Index (SDI) and a population attributable fraction (PAF) for all risk factors combined; and a non-parametric analysis of residuals using a multivariate kernel regression model that smooths across age and time to adaptably follow trends in the data without overfitting. We calibrated asymptotic uncertainty estimates using Pearson residuals to produce 95% uncertainty intervals (UIs) and corresponding 1000 draws. Life expectancy was calculated from age-specific mortality rates with standard demographic methods. For each measure, 95% UIs were calculated with the 25th and 975th ordered values from a 1000-draw posterior distribution. In 2023, 60&#xb7;1 million (95% UI 59&#xb7;0-61&#xb7;1) deaths occurred globally, of which 4&#xb7;67 million (4&#xb7;59-4&#xb7;75) were in children younger than 5 years. Due to considerable population growth and ageing since 1950, the number of annual deaths globally increased by 35&#xb7;2% (32&#xb7;2-38&#xb7;4) over the 1950-2023 study period, during which the global age-standardised all-cause mortality rate declined by 66&#xb7;6% (65&#xb7;8-67&#xb7;3). Trends in age-specific mortality rates between 2011 and 2023 varied by age group and location, with the largest decline in under-5 mortality occurring in east Asia (67&#xb7;7% decrease); the largest increases in mortality for those aged 5-14 years, 25-29 years, and 30-39 years occurring in high-income North America (11&#xb7;5%, 31&#xb7;7%, and 49&#xb7;9%, respectively); and the largest increases in mortality for those aged 15-19 years and 20-24 years occurring in Eastern Europe (53&#xb7;9% and 40&#xb7;1%, respectively). We also identified higher than previously estimated mortality rates in sub-Saharan Africa for all sexes combined aged 5-14 years (87&#xb7;3% higher in GBD 2023 than GBD 2021 on average across countries and territories over the 1950-2021 period) and for females aged 15-29 years (61&#xb7;2% higher), as well as lower than previously estimated mortality rates in sub-Saharan Africa for all sexes combined aged 50 years and older (13&#xb7;2% lower), reflecting advances in our modelling approach. Global life expectancy followed three distinct trends over the study period. First, between 1950 and 2019, there were considerable improvements, from 51&#xb7;2 (50&#xb7;6-51&#xb7;7) years for females and 47&#xb7;9 (47&#xb7;4-48&#xb7;4) years for males in 1950 to 76&#xb7;3 (76&#xb7;2-76&#xb7;4) years for females and 71&#xb7;4 (71&#xb7;3-71&#xb7;5) years for males in 2019. Second, this period was followed by a decrease in life expectancy during the COVID-19 pandemic, to 74&#xb7;7 (74&#xb7;6-74&#xb7;8) years for females and 69&#xb7;3 (69&#xb7;2-69&#xb7;4) years for males in 2021. Finally, the world experienced a period of post-pandemic recovery in 2022 and 2023, wherein life expectancy generally returned to pre-pandemic (2019) levels in 2023 (76&#xb7;3 [76&#xb7;0-76&#xb7;6] years for females and 71&#xb7;5 [71&#xb7;2-71&#xb7;8] years for males). 194 (95&#xb7;1%) of 204 countries and territories experienced at least partial post-pandemic recovery in age-standardised mortality rates by 2023, with 61&#xb7;8% (126 of 204) recovering to or falling below pre-pandemic levels. There were several mortality trajectories during and following the pandemic across countries and territories. Long-term mortality trends also varied considerably between age groups and locations, demonstrating the diverse landscape of health outcomes globally. This analysis identified several key differences in mortality trends from previous estimates, including higher rates of adolescent mortality, higher rates of young adult mortality in females, and lower rates of mortality in older age groups in much of sub-Saharan Africa. The findings also highlight stark differences across countries and territories in the timing and scale of changes in all-cause mortality trends during and following the COVID-19 pandemic (2020-23). Our estimates of evolving trends in mortality and life expectancy across locations, ages, sexes, and SDI levels in recent years as well as over the entire 1950-2023 study period provide crucial information for governments, policy makers, and the public to ensure that health-care systems, economies, and societies are prepared to address the world's health needs, particularly in populations with higher rates of mortality than previously known. The estimates from this study provide a robust framework for GBD and a valuable foundation for policy development, implementation, and evaluation around the world. Gates Foundation.

Cancer is a leading cause of death globally. Accurate cancer burden information is crucial for policy planning, but many countries do not have up-to-date cancer surveillance data. To inform global cancer-control efforts, we used the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 framework to generate and analyse estimates of cancer burden for 47 cancer types or groupings by age, sex, and 204 countries and territories from 1990 to 2023, cancer burden attributable to selected risk factors from 1990 to 2023, and forecasted cancer burden up to 2050. Cancer estimation in GBD 2023 used data from population-based cancer registration systems, vital registration systems, and verbal autopsies. Cancer mortality was estimated using ensemble models, with incidence informed by mortality estimates and mortality-to-incidence ratios (MIRs). Prevalence estimates were generated from modelled survival estimates, then multiplied by disability weights to estimate years lived with disability (YLDs). Years of life lost (YLLs) were estimated by multiplying age-specific cancer deaths by the GBD standard life expectancy at the age of death. Disability-adjusted life-years (DALYs) were calculated as the sum of YLLs and YLDs. We used the GBD 2023 comparative risk assessment framework to estimate cancer burden attributable to 44 behavioural, environmental and occupational, and metabolic risk factors. To forecast cancer burden from 2024 to 2050, we used the GBD 2023 forecasting framework, which included forecasts of relevant risk factor exposures and used Socio-demographic Index as a covariate for forecasting the proportion of each cancer not affected by these risk factors. Progress towards the UN Sustainable Development Goal (SDG) target 3.4 aim to reduce non-communicable disease mortality by a third between 2015 and 2030 was estimated for cancer. In 2023, excluding non-melanoma skin cancers, there were 18&#xb7;5 million (95% uncertainty interval 16&#xb7;4 to 20&#xb7;7) incident cases of cancer and 10&#xb7;4 million (9&#xb7;65 to 10&#xb7;9) deaths, contributing to 271 million (255 to 285) DALYs globally. Of these, 57&#xb7;9% (56&#xb7;1 to 59&#xb7;8) of incident cases and 65&#xb7;8% (64&#xb7;3 to 67&#xb7;6) of cancer deaths occurred in low-income to upper-middle-income countries based on World Bank income group classifications. Cancer was the second leading cause of deaths globally in 2023 after cardiovascular diseases. There were 4&#xb7;33 million (3&#xb7;85 to 4&#xb7;78) risk-attributable cancer deaths globally in 2023, comprising 41&#xb7;7% (37&#xb7;8 to 45&#xb7;4) of all cancer deaths. Risk-attributable cancer deaths increased by 72&#xb7;3% (57&#xb7;1 to 86&#xb7;8) from 1990 to 2023, whereas overall global cancer deaths increased by 74&#xb7;3% (62&#xb7;2 to 86&#xb7;2) over the same period. The reference forecasts (the most likely future) estimate that in 2050 there will be 30&#xb7;5 million (22&#xb7;9 to 38&#xb7;9) cases and 18&#xb7;6 million (15&#xb7;6 to 21&#xb7;5) deaths from cancer globally, 60&#xb7;7% (41&#xb7;9 to 80&#xb7;6) and 74&#xb7;5% (50&#xb7;1 to 104&#xb7;2) increases from 2024, respectively. These forecasted increases in deaths are greater in low-income and middle-income countries (90&#xb7;6% [61&#xb7;0 to 127&#xb7;0]) compared with high-income countries (42&#xb7;8% [28&#xb7;3 to 58&#xb7;6]). Most of these increases are likely due to demographic changes, as age-standardised death rates are forecast to change by -5&#xb7;6% (-12&#xb7;8 to 4&#xb7;6) between 2024 and 2050 globally. Between 2015 and 2030, the probability of dying due to cancer between the ages of 30 years and 70 years was forecasted to have a relative decrease of 6&#xb7;5% (3&#xb7;2 to 10&#xb7;3). Cancer is a major contributor to global disease burden, with increasing numbers of cases and deaths forecasted up to 2050 and a disproportionate growth in burden in countries with scarce resources. The decline in age-standardised mortality rates from cancer is encouraging but insufficient to meet the SDG target set for 2030. Effectively and sustainably addressing cancer burden globally will require comprehensive national and international efforts that consider health systems and context in the development and implementation of cancer-control strategies across the continuum of prevention, diagnosis, and treatment. Gates Foundation, St Jude Children's Research Hospital, and St Baldrick's Foundation.

Teachers' prompt and proper first aid management of avulsed teeth in schools is crucial for a favorable prognosis. This study assessed the knowledge, attitudes, and practices (KAP) of primary school teachers in Ibadan, Nigeria, regarding the first aid management of avulsed teeth and their relationship with the participants' sociodemographic factors. A cross-sectional study was conducted among primary school teachers from randomly selected local government areas in Ibadan, Nigeria, from October to December 2023. Data collection was done using a pretested self-administered questionnaire. The sociodemographic characteristics and KAP scores were summarized using descriptive statistics. Chi-square tests and binary logistic regression were used to identify the association between sociodemographic factors and KAP scores. A total of 251 teachers participated in the study, with median (Interquartile Range (IQR)) age and teaching experience of 47 years (37- 54) and 19 years (10-24), respectively. About twenty-four percent of them had adequate knowledge, and 37.4% demonstrated a positive attitude toward the emergency management of avulsed teeth. One hundred and seventeen teachers had witnessed avulsion injuries before, and out of them, 49 (41.8%) did nothing. Teachers with prior information were more likely to have adequate knowledge. [aOR = 2.66, 95% CI (1.28; 5.52), p = 0.008]. This study revealed that a high proportion of primary school teachers had inadequate knowledge, poor attitude, and sub-optimal practices of first aid management of dental avulsion. This highlights a critical need for targeted educational interventions among teachers to increase the prognosis of dental avulsion in school children.

Left ventricular hypertrophy (LVH) is an increase in left ventricular mass due to an increase in cardiomyocyte size. It is said to be a strong predictor of cardiovascular diseases. Detection of LVH is important as early diagnosis and initiation of measures can reduce/halt progression or even cause regression, resulting in prevention or delay of unfavourable cardiovascular outcomes. There is limited data on the frequency of electrocardiographic LVH in hospital population (in-patient and out-patient) in Nigeria. Therefore, the study aimed to estimate the frequency of ECG-diagnosed LVH in hospital patients in Ibadan. The study was conducted at the cardiology unit of UCH, Ibadan. 12-Lead ECGs done between 01/01/2023 to 30/06/2023 for adult men and women 18 years and above were studied. Diagnosis of LVH was based on either Sokolow- Lyon or Cornell voltage criteria. A total of 1678 tracings were analyzed (male - 701, female - 977). LVH was present in 399 tracings (23.8%, 238 cases per thousand), and was significantly more frequent in males than females (28.8% vs. 20.16%). Frequency increased with increasing age. LVH was noted to be significantly associated with incident atrial fibrillation (AF), other arrhythmias, and left atrial enlargement with odds ratios of 3.29 (95% CI: 1.60-6.80), 1.74 (95% CI: 1.17-2.58) and 3.35 (95% CI: 2.52-4.46) respectively. The frequency of ECG-detected LVH was 23.8% in UCH. It was predominantly seen in males and significantly associated with AF, other arrhythmias and left atrial enlargement.

Pentalogy of Cantrell (POC) is a collection of five congenital malformations involving the heart, pericardium, diaphragm, sternum, and anterior abdominal wall. This is a spectrum, and could be incomplete or complete; naked or covered cordis or can be classified based on the location of the heart, and in this index patient-thoraco-abdominal ectopia cordis. We aim to highlight this finding of covered incomplete pentalogy of Cantrell and the peculiarities of management in our sub-region that relies solely on out of pocket payment. A 30-hour old female admitted with history and clinical examination findings in keeping with a covered pentalogy of Cantrell (Thoraco-abdominal ectopia cordis) in a term neonate. Attached is a video link at presentation https://youtu.be/0vQuzq14G9Q. Pentalogy of Cantrell is a complex anomaly. The constraints we encountered in the initial management of this neonate is not uncommon in surgical practice within Nigeria, and other resource constrained countries especially amongst carers of paediatric patients. Other factors at play in our sub-region are ignorance, high rate of illiteracy, superstitious beliefs, and varied cultural practices, and this partly hindered further evaluation of this vulnerable neonate in our sub-region.

Stroke is a major public health problem globally, and surviving patients have very high risks of recurrence. Age, sex, ethnicity, transient ischaemic attack(TIA), and hereditary characteristics are non-modifiable risk factors while the major modifiable risk factors for stroke are hypertension, diabetes, lack of physical exercise, alcohol and drug abuse, cholesterol, diet management and cardiac diseases. The aim of this narrative review was to discuss the current management and prevention of stroke. In this review, the databases of Medline (PubMed), Scopus, Web of Science and Google Scholar were used for literature search. The MESH terms used included "Diagnosis of Stroke", "Epidemiology of Stroke", "Management of Stroke" and "Prevention of Stroke". The other terms were "Stroke Mimicks" and "Biomarkers of Stroke". Studies that evaluated the current management of stroke in adult patients were included. This article is guided by the Scale for the Assessment of Narrative Review Articles (SANRA). A total of 800 studies were found. After excluding duplicate papers and applying the inclusion and exclusion criteria, 72 studies were included for review. The included studies were published between 2010 and 2025. These studies included 9 Randomised Controlled Ttrials, a cohort study and other studies. Computed tomography (CT) scan of the brain is the most common form of clinical imaging procedure used in the treatment of stroke and Non-contrast CT Scans are usually the first step in imaging process. Diffusion-weighted magnetic resonance imaging (MRI) is the most sensitive imaging technique, it shows ischaemic changes very early and is effective in the evaluation of cerebral changes in ischaemic stroke. Magnetic resonance imaging is more precise in excluding intracranial hemorrhage and MRI with DWI is more accurate in the revealing acute ischemic stroke. Stroke treatment mainly focuses on restoring blood flow to the brain and treating stroke-induced neurological injury.

Atrial Fibrillation (AF) is the most common form of sustained arrhythmia observed in clinical practice, and the incidence is rising in both developing and developed countries. It has been noted to contribute a major quota to the disability and death associated with cardiovascular diseases worldwide. Studies have shown that the pathophysiology of AF broadly revolves around electrical remodeling of the cardiac musculature, structural remodeling, calcium ion handling abnormalities, and autonomic nerve activation/remodeling. However, newer entities like inflammatory markers are emerging. The paper aims to review the current epidemiology of AF and the role of inflammatory markers in the pathogenesis of the condition. This is a narrative review of the literature. We reviewed the contemporary epidemiology, pathophysiology, with a focus on the role of inflammatory markers such as interleukin-2, interleukin-6, C-reactive protein, and tumor necrosis factor. Atrial fibrillation affects about 52.55 million individuals worldwide; prevalence and incidence increased by 137% and 124% between 1990 and 2021. The role of inflammation in the pathogenesis of AF and atrial flutter is increasingly being recognised. Elevated CRP predicts an increased risk of developing AF. TNF is associated with the pathogenesis of chronic AF, and levels in the plasma and left atrial tissue have a positive correlation with left atrial diameter. On the other hand, low IL-2 levels are associated with reduced incidence of postoperative AF. Interleukin 6 is associated with the generation and perpetuation of AF, and high levels correlate with the presence and duration of AF, as well as associated with the occurrence of AF post coronary artery bypass graft. Inflammatory markers are associated with increased incidence and prevalence of AF. Targeting this may offer novel insights into the prevention and treatment, thereby potentially reducing complications and improving patient outcomes in diverse settings.

Adherence to medications in chronic medical conditions such as systemic hypertension has been a major challenge globally. A number of factors responsible for this have been documented, but there are only few researches that explore the role spirituality can play in medication adherence. To determine the relationship between spirituality and medication adherence in patients with hypertension. This was a hospital-based cross-sectional study. Data collection was done using interviewer-administered questionnaires. Patients' spirituality levels and medication adherence were assessed using validated questionnaires. The relationship between participants' medication adherence and related variables was obtained while logistic regression was used to determine the independent predictors of poor medication adherence of respondents. A total of 376 patients were interviewed with 62.8% being female. Two-thirds of the participants (65.7%) had low medication adherence while the remaining one-third (34.3%) had high medication adherence. More than half of the participants (61.2%) had low levels of spirituality, 123 of them (32.7%) had moderate levels of spirituality while just 6.1% had high spirituality levels. The higher the level of spirituality, the lower the medication adherence (p=0.001). There is both poor medication adherence and low level of spirituality among the respondents. Spirituality was found to have an inverse relationship with medication adherence.

Access to safe surgery and anaesthesia remains a challenge, particularly in low-middle income countries. Lack of anaesthetic and surgical safety causes significant burdens on the healthcare systems, leading to high morbidity and mortality. To address these issues, the WHO introduced the Surgical Safety Checklist (SSC) in 2009. This study aims to investigate the knowledge, attitude, and availability of the SSC to members of the surgical team in Africa. A cross-sectional study design was used to sample members of the surgical team across tertiary hospitals in 6 African countries. A p-value less than 0.05 was considered significant for associations between dependent and independent variables. Of the 227 respondents, 55% are male and 45% are female. Students (Medical and Nursing) accounted for 30% while the remaining 70% comprised other professionals in the surgical team. Overall, 74% of the participants were aware of the WHO SSC with Anaesthetists and Surgeons having the highest awareness and medical and nursing students reporting the least awareness. Of the respondents aware, 93% had good knowledge and 88% had a positive attitude towards the WHO SSC. Of those who primarily use the WHO SSC, 82% said it was readily available. Awareness, Knowledge, Attitude and Availability of the WHO SSC were all associated with the university hospital of the respondents. The result of the study calls for increased training and education on the WHO SSC should be provided to all members of the surgical team, regardless of their professional roles and training levels.

Even though there has been significant success in reducing maternal mortality worldwide, Nigeria alone still accounted for about 28% of the global maternal deaths in the year 2020. Hence, we aim to assess the relationship between maternal health literacy and quality of care for pregnant women attending antenatal care (ANC) services in Primary Health. We conducted a cross-sectional study among 570 women attending ANCs in Primary Healthcare centers, Private hospitals and homes of Traditional Birth Attendants (TBA) in Ikorodu LGA of Lagos state. We included 8 PHCs, 2 private hospitals and 15 TBAs. We excluded facilities that did not offer both ANC and delivery services. We described respondents? sociodemographic characteristics using summary statistics. The maternal literacy tool had 14 items with a 3 points likert scale and it was adapted from a past study on maternal literacy. We calculated the mean score as 37.0. Quality of care received was measured using 13 services to be provided during ANC visits based on guidelines from WHO and other literature. Using the raw scores, we conducted linear regression to check for association between maternal health literacy and ANC service quality. More than half (64.2%) of the respondents were aged 25 to 34 years, with a mean age of 27.9, and about three-quarter (76.7%) of them were Yorubas. Three hundred and fifty (61.4%) of the women scored equal or higher than the mean maternal literacy score (37.0) and 350 (61.4%) received at least 9 out of the 13 expected services. The mean ANC service score received by women was 9.8 &#xb1; (3.6) and was higher in PHCs (10.5 &#xb1; 3.0) compared with private (9.7 &#xb1; 3.6) and TBA (7.3 &#xb1; 4.2) facilities (p<0.001). Maternal literacy was positively associated with quality of care. Similarly, women residing in urban settlement had higher odds to receive higher quality of care compared to those residing in rural areas. Our study shows that the type of healthcare facility a woman attended was a determining factor to the quality of ANC services received. The likelihood of receiving higher quality ANC service is greater in primary health centres than in private hospitals or homes managed by TBAs. The government, therefore, must adopt a multidimensional approach that includes interventions targeting individuals, households, communities, and other facility types in other to improve maternal and child health outcomes.

Intimate Partner Violence (IPV) are sexual, psychological, financial and physically coercive acts used against individuals who are at increased risk and constitute a vulnerable group. Women with gynaecologic health challenges may be at increased risk. To assess the prevalence of IPV, its pattern, predisposing factors and its impact on the health seeking behaviour among women with gynaecological diseases attending the gynaecologic clinic of the University College Hospital, Ibadan. A descriptive cross-sectional study was conducted among women with intimate partners who attended the gynaecologic clinic at the University College Hospital, Ibadan. A pretested semi-structured intervieweradministered questionnaire was used for data collection. Information obtained included sociodemographic characteristics, gynaecologic diagnosis and structured questions to assess their exposure to the different forms of IPV- psychological, physical, sexual, verbal and financial abuse from their intimate partners. Data was analysed using IBM SPSS version 25. Chi square test and multiple logistic regression were used to assess the association between sociodemographic characteristics of the women and their partners and the occurrence of IPV. The level of significance was set at p <0.05. A total of 231 respondents participated in the study. Among the respondents, 141 (61%) had experienced at least a form of IPV. About a half (49.8%) of the women suffered psychological abuse. About two-thirds (60.3%) of the victims reported the abuse to their relatives and/or friends, while none reported to a formal authority. About a quarter of IPV victims (26.8%) were less than 5 years in their relationship, and IPV decreased with increased duration of the union. Identified predisposing factors of statistical significance were low socio-economic status (p=0.019), polygamous family setting (p=0.019), being divorced/separated (p=0.001) and partner's alcohol/cigarette use (p=0.031). Women attending gynaecologic clinic suffer various forms of IPV. Healthcare providers should actively screen women during medical evaluation in the clinics. Concerted efforts must be made to prevent it, encourage prompt reporting through formal channels when it occurs and decisively address it.

The "Child health card" (CHC) is integral to monitoring a child's growth and assessing development to support the early detection of malnutrition and prompt intervention. CHC is also valuable in keeping track of a child's vaccinations. There are limited studies on knowledge and utilization of CHC in Oyo state, Nigeria. We therefore aimed to assess caregiver's knowledge, retention, and utilization of child health cards in Ibadan, Oyo State, Nigeria. A community-based mixed-method study using a parallel convergent design was employed. Quantitative data were collected from 617 caregivers at their compounds in the selected communities using an interviewer-administered questionnaire. Qualitative data were collected by interviewing caregivers and healthcare workers at health facilities. Bivariate analysis of quantitative indicators and thematic analysis of qualitative interviews were conducted. Caregiver knowledge of the CHC, including the contents of the CHC and growth charts, was poor, but retention was relatively high (69.6%). Retention of the CHC was higher among caregivers whose index child was <12 months (p=0.011) and among those with good knowledge of the CHC (p<0.001). Being employed (p=0.016), having tertiary education (p=0.027), having good knowledge (p<0.001), and good perception of the CHC (p=0.001) were positively associated with the utilization of CHC. We found that when caregivers failed to present the card at immunization clinics, they often faced verbal reprimands from healthcare workers, and in some cases, their child's vaccination was denied. CHC retention was high despite low utilization by caregivers. Therefore, interventions designed to improve community awareness of the CHC could provide an opportunity to improve the use of child health cards in this setting.

Globally, leprosy is one of the most stigmatized diseases and this affects the quality of life of people living with the disease, yet research on this issue in Nigeria is scarce. To understand the relationship between stigma and quality of life among people living with leprosy in Nigeria. A cross-sectional study conducted among 53 persons living with leprosy in Oke-Igbala and Ago-Ireti leprosy settlements in July, 2024 using a semi-structured tool to measure sociodemographic information, quality of life using the WHOQOL-BREF, and stigma using the SARI Stigma Scale. Descriptive statistics, chi-square tests and logistic regression were used to examine the data; p<0.05 was considered significant. The quality of life or general well-being was very poor for 94.3% of the respondents. The prevalence of stigma was 60.4%. Significant associations were found between source of income and quality of life (p=0.036), occupation and stigma (p=0.010). No statistical association was found between stigma and quality of life (p=0.239). Addressing the source of income and livelihood options of people living with leprosy may improve their quality of life. Future qualitative research to gain a deeper understanding of their experiences may be beneficial to reduce stigma.