Higher Education Institutions are expected to lead the paradigm shift in waste management by adopting strategies that will contribute to sustainable development in their operations. The impact of these innovations will expectedly diffuse to their surrounding communities. Waste composition studies in HEIs enables the identification of campus-specific opportunities for waste reduction and recycling. The aim of this study was to assess the quantity, composition of solid waste generated by the staff and students of the Lagos University Teaching Hospital and College of Medicine, University of Lagos (LUTH/CMUL) compound. The study was a descriptive cross-sectional study conducted in the LUTH/CMUL compound. Solid waste generated from the commercial, academic and research; administrative and residential areas were quantified and characterized during the study. Solid waste generated in the four activity areas collected were sorted, classified and weighed using a weighing balance. An estimated 14.775 tonnes of waste is generated daily from the compound with a waste generation rate of 0.29/kg/capita/day. Plastic and polythene bags made up majority (31.1%) of the total solid waste generated in the compound followed by organic waste (23%). In the commercial area, organic waste (57.21%) formed majority of the waste, plastics formed the majority (22.95%) of the waste in the residential areas and paper waste was mostly generated in the administrative area (41.22%) and, the academic and research areas (36.10%). The quantity and composition of the solid waste generated are affected by the activities ongoing in the different categorized areas. A solid waste management scheme hinged on a zero waste policy should be designed by the LUTH and CMUL authorities. This scheme should tackle reduction of waste at source, efficient waste collection from generation points, waste recovery, recycling and composting, proper training of stakeholders and provision of incentives. Les établissements d'enseignement supérieur sont censés jouer un rôle de premier plan dans le changement de paradigme en matière de gestion des déchets en adoptant des stratégies contribuant au développement durable dans leurs activités. L'impact de ces innovations devrait, à terme, se diffuser dans les communautés environnantes. Les études sur la composition des déchets dans les établissements d'enseignement supérieur permettent d'identifier les opportunités spécifiques à chaque campus pour la réduction et le recyclage des déchets. L'objectif de cette étude était d'évaluer la quantité et la composition des déchets solides générés par le personnel et les étudiants du complexe Lagos University Teaching Hospital et du College of Medicine, University of Lagos (LUTH/CMUL). Il s'agissait d'une étude descriptive transversale menée dans le complexe LUTH/CMUL. Les déchets solides provenant des zones commerciales, académiques et de recherche, administratives et résidentielles ont été quantifiés et caractérisés au cours de l'étude. Les déchets collectés dans ces quatre zones d'activité ont été triés, classés et pesés à l'aide d'une balance de précision. On estime que 14,775 tonnes de déchets sont générées quotidiennement dans le complexe, avec un taux de production de déchets de 0,29 kg par habitant et par jour. Les plastiques et les sacs en polyéthylène constituaient la majorité (31,1 %) des déchets solides produits, suivis des déchets organiques (23 %). Dans la zone commerciale, les déchets organiques (57,21 %) prédominaient, tandis que les plastiques représentaient la majorité (22,95 %) des déchets dans les zones résidentielles. Les papiers constituaient la plus grande proportion des déchets dans les zones administratives (41,22 %) et dans les zones académiques et de recherche (36,10 %). La quantité et la composition des déchets solides générés varient en fonction des activités menées dans les différentes zones étudiées. Les autorités du LUTH et du CMUL devraient concevoir un schéma de gestion des déchets solides fondé sur une politique de zéro déchet. Ce schéma devrait inclure la réduction des déchets à la source, la collecte efficace à partir des points de production, la récupération, le recyclage et le compostage des déchets, ainsi qu'une formation adéquate des parties prenantes et la mise en place de mesures incitatives. Déchets solides, Gestion des déchets solides, Caractérisation des déchets, Activités académiques et de recherche.
The African American population is disproportionately impacted by congestive heart failure (CHF). The impact includes a hospitalization rate that is 2.5 times higher and a hospital stay that is, on average, a quarter of a day longer compared with Caucasians. Notably, nursing care has been associated with nearly a 30% decrease in hospitalizations and readmissions. Previous studies have demonstrated that registered nurses (RNs), working in conjunction with electronic health record systems to conduct care tasks, may optimize length of stay in African Americans with CHF. This study aimed to identify the needs of RNs who performed sociotechnical tasks, the perceived importance of these sociotechnical tasks, and the perceived performance of these tasks by RNs, in relation to the length of stay of their African American patients with CHF. The study used an observational, cross-sectional survey design in RNs who were randomly selected from a total population of 3498 RNs who provided care to 22,703 African American patients with CHF within 113,543 heart failure hospitalizations between January 1, 2015, and January 1, 2024. The RNs were retrospectively stratified into 2 groups based on EHR data: those whose African American patients had a mean length of stay of 10 days or less (Group A) and those whose mean length of stay was greater than 10 days (Group B). Descriptive statistics, Cohen d, and a 2-sided unpaired t test were used to analyze the data. The total sample of 200 RNs responded to the survey (100% survey completion rate). Group A (100 RNs) reported the least important task as drawing conclusions about how to use the EHR to care for African American patients (mean 4.66, SD 1.82). The least important task in Group B (100 RNs) was reading published research on African American patients (mean 4.88, SD 1.70). Group A reported performing best in caring for African American patients (mean 5.61, SD 1.44). Group B reported performing best at caring for all patients (mean 5.86, SD 1.04). A total of 17 significant sociotechnical needs were identified among groups. In total, 2 sociotechnical needs were unique to group B: caring for patients (ie, the full scope of social and technological processes in nursing care; Cohen d=0.32, 95% CI 0.04-0.59; P=.04) and working with information related to a patient's CHF in the EHR (eg, laboratory results, discharge summaries, or radiographic images) to care for the patient (Cohen d=0.33, 95% CI 0.05-0.61; P=.03). Lengths of patient stay may be reduced by identifying and addressing sociotechnical needs through targeted training, nursing care interventions, and RN-led risk stratification guidelines for working with EHRs to reduce lengths of stay in those who are disproportionately impacted by CHF.
Rubella is a leading cause of preventable congenital abnormalities. Paucity of data exists on the national morbidity burden of rubella infection, particularly among women of reproductive age in Nigeria. Added to this is the absent immunization policy on rubella vaccination in Nigeria. To determine the spatial and Euclidean distribution, correlates and predictors of rubella immunity among women of reproductive age in Ekiti state, southwest Nigeria. A community-based cross-sectional survey for rubella IgG antibodies among women of reproductive age selected using multi-stage sampling technique. Data was collected quantitatively using interviewer-administered semi-structured questionnaire. Blood sample was collected for qualitative assay of rubella IgG. Global Positioning System (GPS) co-ordinates of sampled households were recorded. Euclidean distance tool in the ArcGIS environment analyzed the proximity to established rubella IgG negative areas. Data entry and analysis was through the use of Statistical Product and Service Solutions (SPSS) 23 and level of statistical significance was set at p-value < 0.05. The mean age of the women was 30.5±7.9 years. A total of 482 (84.1%) had negative rubella IgG serology. There was wide spread immunity gap. Educated respondents (p=0.009), higher number of inhabitants in households (p=0.011), ever married (p<0.001) and prior vaccination history (p<0.001) were associated with rubella immunity. Secondary education (aOR=2.47; p=0.046) and urban location (aOR=0.45; p=0.003) were predictive of rubella immunity (p<0.05). The rubella immunity gap cuts across both rural and urban areas with a potential for disease spread in the Euclidean-determined proximal areas. To reduce the wide spread immunity gap, increase herd immunity, the Federal Government of Nigeria needs to introduce rubella vaccination in the National Immunization. KEYWORDS: Rubella Immunity, Spatial Distribution, Correlates, Predictors, Women, Nigeria. La rubéole est une cause majeure d'anomalies congénitales évitables. Il existe une rareté de données sur la charge nationale de morbidité liée à l'infection rubéoleuse, en particulier chez les femmes en âge de procréer au Nigéria. À cela s'ajoute l'absence de politique nationale de vaccination contre la rubéole. Déterminer la distribution spatiale et euclidienne, ainsi que les corrélats et prédicteurs de l'immunité contre la rubéole chez les femmes en âge de procréer dans l'État d'Ekiti, sud-ouest du Nigéria. Une enquête transversale communautaire a été menée pour la recherche d'anticorps IgG anti-rubéole chez des femmes en âge de procréer sélectionnées par une technique d'échantillonnage en plusieurs étapes. Les données ont été recueillies de manière quantitative à l'aide d'un questionnaire semi-structuré administré par un enquêteur. Un prélèvement sanguin a été effectué pour un test qualitatif des IgG anti-rubéole. Les coordonnées GPS des ménages échantillonnés ont été enregistrées. L'outil de distance euclidienne dans l'environnement ArcGIS a permis d'analyser la proximité des zones établies comme négatives aux IgG anti-rubéole. La saisie et l'analyse des données ont été réalisées avec le logiciel Statistical Product and Service Solutions (SPSS) version 23, et le seuil de signification statistique a été fixé à p < 0,05. L'âge moyen des femmes était de 30,5 ± 7,9 ans. Au total, 482 (84,1 %) présentaient une sérologie IgG anti-rubéole négative. Un large déficit d'immunité a été observé. Les répondantes instruites (p = 0,009), les ménages avec un nombre élevé d'habitants (p = 0,011), les femmes déjà mariées (p < 0,001) et celles ayant un antécédent de vaccination (p < 0,001) étaient associées à l'immunité contre la rubéole. Le niveau d'éducation secondaire (aOR = 2,47 ; p = 0,046) et la localisation urbaine (aOR = 0,45 ; p = 0,003) étaient prédictifs de l'immunité contre la rubéole (p < 0,05). Le déficit d'immunité contre la rubéole touche à la fois les zones rurales et urbaines, avec un potentiel de propagation de la maladie dans les zones proximales déterminées par l'analyse euclidienne. Pour réduire ce déficit d'immunité, accroître l'immunité collective, le gouvernement fédéral du Nigéria doit introduire la vaccination contre la rubéole dans le Programme national de vaccination. Immunité contre la rubéole, Distribution spatiale, Corrélats, Prédicteurs, Femmes, Nigéria.
Implicit bias can influence behavior and decision-making, such as treatment decisions in clinical settings. Given documented Black-White disparities in vascular care, the purpose of this study was to describe the prevalence and degree of implicit bias and recognition of bias among vascular surgeons. The sample included vascular surgeons in the Vascular Quality Initiative. Participants completed a survey of demographic questions, race implicit association test, and six bias recognition questions. Implicit bias was categorized as no preference, or slight, moderate, or strong pro-White or pro-Black. We stratified implicit and bias recognition findings by physician race/ethnicity, sex, years of experience, and region; and examined the relationship between implicit bias and bias recognition. The survey was completed by 304 participants. Most participants (71.6%) showed a pro-White bias with 73.0% of this group in moderate and strong categories. Bias magnitude varied based on physician race/ethnicity, years of experience, and region. Although 77.5% of respondents showed recognition of biases, of those whose results showed lack of recognition, 67.8% had moderate or strong bias. Women were more likely than men to report recognition of biases and of the potential impact of bias on decision-making. Most people have some level of implicit bias, developed from early life reinforcements, social stereotypes, and learned experiences. However, these are important findings in a profession that takes care of a high proportion of individuals from structurally vulnerable groups. Given the lack of association between implicit bias and recognition of biases, recognition may be an important first step to minimize documented disparities.
Lower respiratory infections (LRIs) remain the world's leading infectious cause of death. This analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 provides global, regional, and national estimates of LRI incidence, mortality, and disability-adjusted life-years (DALYs), with attribution to 26 pathogens, including 11 newly modelled pathogens, across 204 countries and territories from 1990 to 2023. With new data and revised modelling techniques, these estimates serve as an update and expansion to GBD 2021. Through these estimates, we also aimed to assess progress towards the 2025 Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) target for pneumonia mortality in children younger than 5 years. Mortality from LRIs, defined as physician-diagnosed pneumonia or bronchiolitis, was estimated using the Cause of Death Ensemble model with data from vital registration, verbal autopsy, surveillance, and minimally invasive tissue sampling. The Bayesian meta-regression tool DisMod-MR 2.1 was used to model overall morbidity due to LRIs. DALYs were calculated as the sum of years of life lost (YLLs) and years lived with disability (YLDs) for all locations, years, age groups, and sexes. We modelled pathogen-specific case-fatality ratios (CFRs) for each age group and location using splined binomial regression to create internally consistent estimates of incidence and mortality proportions attributable to viral, fungal, parasitic, and bacterial pathogens. Progress was assessed towards the GAPPD target of less than three deaths from pneumonia per 1000 livebirths, which is roughly equivalent to a mortality rate of less than 60 deaths per 100 000 children younger than 5 years. In 2023, LRIs were responsible for 2·50 million (95% uncertainty interval [UI] 2·24-2·81) deaths and 98·7 million (87·7-112) DALYs, with children younger than 5 years and adults aged 70 years and older carrying the highest burden. LRI mortality in children younger than 5 years fell by 33·4% (10·4-47·4) since 2010, with a global mortality rate of 94·8 (75·6-116·4) per 100 000 person-years in 2023. Among adults aged 70 years and older, the burden remained substantial with only marginal declines since 2010. A mortality rate of less than 60 deaths per 100 000 for children younger than 5 years was met by 129 of the 204 modelled countries in 2023. At a super-regional level, sub-Saharan Africa had an aggregate mortality rate in children younger than 5 years (hereafter referred to as under-5 mortality rate) furthest from the GAPPD target. Streptococcus pneumoniae continued to account for the largest number of LRI deaths globally (634 000 [95% UI 565 000-721 000] deaths or 25·3% [24·5-26·1] of all LRI deaths), followed by Staphylococcus aureus (271 000 [243 000-298 000] deaths or 10·9% [10·3-11·3]), and Klebsiella pneumoniae (228 000 [204 000-261 000] deaths or 9·1% [8·8-9·5]). Among pathogens newly modelled in this study, non-tuberculous mycobacteria (responsible for 177 000 [95% UI 155 000-201 000] deaths) and Aspergillus spp (responsible for 67 800 [59 900-75 900] deaths) emerged as important contributors. Altogether, the 11 newly modelled pathogens accounted for approximately 22% of LRI deaths. This comprehensive analysis underscores both the gains achieved through vaccination and the challenges that remain in controlling the LRI burden globally. Furthermore, it demonstrates persistent disparities in disease burden, with the highest mortality rates concentrated in countries in sub-Saharan Africa. Globally, as well as in these high-burden locations, the under-5 LRI mortality rate remains well above the GAPPD target. Progress towards this target requires equitable access to vaccines and preventive therapies-including newer interventions such as respiratory syncytial virus monoclonal antibodies-and health systems capable of early diagnosis and treatment. Expanding surveillance of emerging pathogens, strengthening adult immunisation programmes, and combating vaccine hesitancy are also crucial. As the global population ages, the dual challenge of sustaining gains in child survival while addressing the rising vulnerability in older adults will shape future pneumonia control strategies. Gates Foundation.
Violence against women and against children are human rights violations with lasting harms to survivors and societies at large. Intimate partner violence (IPV) and sexual violence against children (SVAC) are two major forms of such abuse. Despite their wide-reaching effects on individual and community health, these risk factors have not been adequately prioritised as key drivers of global health burden. Comprehensive x§and reliable estimates of the comparative health burden of IPV and SVAC are urgently needed to inform investments in prevention and support for survivors at both national and global levels. We estimated the prevalence and attributable burden of IPV among females and SVAC among males and females for 204 countries and territories, by age and sex, from 1990 to 2023, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2023. We searched several global databases for data on self-reported exposure to IPV and SVAC and undertook a systematic review to identify the health outcomes associated with each of these risk factors. We modelled IPV and SVAC prevalence using spatiotemporal Gaussian process regression, applying data adjustments to account for measurement heterogeneity. We employed burden-of-proof methodology to estimate relative risks for outcomes associated with IPV and SVAC. These estimates informed the calculation of population attributable fractions, which were then used to quantify disability-adjusted life-years (DALYs) attributable to each risk factor. Globally, in 2023, we estimated that 608 million (95% uncertainty interval 518-724) females aged 15 years and older had ever been exposed to IPV, and 1·01 billion (0·764-1·48) individuals aged 15 years and older had experienced sexual violence during childhood. 18·5 million (8·74-30·0) DALYs were attributed to IPV among females and 32·2 million (16·4-52·5) DALYs were attributed to SVAC among males and females in 2023. IPV and SVAC were among the top contributors to the global disease burden in 2023, particularly among females aged 15-49 years, ranking as the fourth and fifth leading risk factors, respectively, for DALYs in this group. Among the eight health outcomes found to be associated with IPV, anxiety disorders and major depressive disorder were the leading causes of IPV-attributed DALYs, accounting for 5·43 million (-1·25 to 14·6) and 3·96 million (1·71 to 6·92) DALYs in 2023, respectively. SVAC was associated with 14 health outcomes, including mental health disorder, substance use disorder, and chronic and infectious disease outcomes. Self-harm and schizophrenia were the leading causes of SVAC-attributed burden, with SVAC accounting for 6·71 million (2·00 to 12·7) DALYs due to self-harm and 4·15 million (-1·92 to 13·1) DALYs due to schizophrenia in 2023. IPV and SVAC are substantial contributors to global health burden, and their health consequences span a variety of individual health outcomes. Importantly, mental health disorders account for the greatest share of disease burden among survivors. Investing in prevention of these avoidable risk factors has the potential to avert millions of DALYs and considerable premature mortality each year. Our findings represent strong evidence for global and national leaders to elevate IPV and SVAC among public health priorities. Sustained investments are needed to prevent IPV and SVAC and to implement interventions focused on supporting the complex social and health needs of survivors. Gates Foundation.
There is a scarcity of data reporting on the burden of sickle cell disease across many African settings, particularly among children, who have the highest risk of preventable morbidity and mortality in the absence of early diagnosis and care. We aimed to estimate the prevalence of sickle cell disease and the absolute number of paediatric cases in sub-Saharan Africa to inform policy and service responses. For this systematic review and modelling analysis, we searched MEDLINE, Embase, Global Health (CABI), and African Journals Online (AJOL) for studies published from Jan 1, 2000, to Sept 10, 2025, that reported the prevalence of sickle cell disease among children and adolescents younger than 15 years in sub-Saharan Africa. We pooled crude prevalence using random-effects meta-analysis. We then fitted a mixed-effects meta-regression for age band (infants [aged 0 to <12 months], children aged <5 years, children and adolescents aged <15 years), sickle cell disease phenotype (total sickle cell diseases, haemoglobin SS [HbSS], haemoglobin SC [HbSC], and other compound heterozygous variants), Socio-demographic Index (SDI), World Bank income group, and geographical coordinates (latitude, longitude, interaction), plus a country random intercept. Absolute cases for 2023 were derived with the UN World Population Prospects. 40 studies contributed 71 prevalence datapoints from 22 countries across all four subregions of sub-Saharan Africa. Estimated prevalence for all sickle cell diseases was 1·54% (95% CI 0·34-7·49) in infants, 1·51% (0·35-6·72) in children younger than 5 years, and 1·78% (0·21-12·09) in children and adolescents younger than 15 years. By haemoglobin phenotype, the prevalence of HbSS was 0·70% (0·15-3·44) in infants, 0·69% (0·17-2·80) in children younger than 5 years, and 0·80% (0·09-5·11) in children and adolescents younger than 15 years, while that of HbSC was 0·29% (0·06-1·46), 0·28% (0·05-1·50), and 0·33% (0·04-2·43) across the same age groups, respectively. Using UN 2023 population denominators, we estimated 1 165 800 (95% CI 260 600-5 662 100) cases in infants, 2 752 200 (632 700-12 253 200) cases in children younger than 5 years, and 8 854 800 (1 068 900-60 148 700) cases in children and adolescents younger than 15 years living with sickle cell disease in sub-Saharan Africa in 2023. Regional prevalence (children aged <5 years, all sickle cell diseases) was highest in central Africa (2·07% [95% CI 0·30-12·76]), followed by west, southern, and east Africa. The burden was concentrated in populous countries, particularly Nigeria, Ethiopia, and the Democratic Republic of the Congo. Study quality was moderate overall and heterogeneity was substantial. Despite data gaps in many countries, the burden of sickle cell disease, especially in west and central Africa, underscores the urgent need to scale up newborn and early childhood screening, prophylaxis, vaccination, and comprehensive care within child health platforms, alongside strengthened surveillance to close evidence gaps and guide sustainable policy reforms. None.
Breast cancer is a leading cause of mortality and morbidity among females worldwide. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, we provided an updated comprehensive assessment of the epidemiological trends, disease burden, and risk factors associated with breast cancer globally, regionally, and nationally from 1990 to 2023. Breast cancer incidence, mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) were estimated by age and sex for 204 countries and territories from 1990 to 2023. Mortality estimates were generated using GBD Cause of Death Ensemble models, leveraging data from population-based cancer registration systems, vital registration systems, and verbal autopsies. Mortality-to-incidence ratios were calculated to derive both mortality and incidence estimates. Prevalence was calculated by combining incidence and modelled survival estimates. YLLs were established by multiplying age-specific deaths with the GBD standard life expectancy at the age of death. YLDs were estimated by applying disability weights to prevalence estimates. The sum of YLLs and YLDs equalled the number of DALYs. Breast cancer burden attributable to seven risk factors was examined through the comparative risk assessment framework. The GBD forecasting framework was used to forecast breast cancer incidence and mortality from 2024 to 2050. Age-standardised rates were calculated for each metric using the GBD 2023 world standard population. In 2023, there were an estimated 2·30 million (95% uncertainty interval [UI] 2·01 to 2·61) breast cancer incident cases, 764 000 deaths (672 000 to 854 000), and 24·1 million (21·3 to 27·5) DALYs among females globally. In the World Bank low-income group, where a low age-standardised incidence rate (ASIR) was estimated (44·2 per 100 000 person-years [31·2 to 58·4]), the age-standardised mortality rate (ASMR) was the highest (24·1 per 100 000 [16·8 to 31·9]). The highest ASIR was in the high-income group (75·7 per 100 000 [67·1 to 84·0]), and the lowest ASMR was in the upper-middle-income group (11·2 per 100 000 [10·2 to 12·3]). Between 1990 and 2023, the ASIR in the low-income group increased by 147·2% (38·1 to 271·7), compared with a 1·2% (-11·5 to 17·2) change in the high-income group. The ASMR decreased in the high-income group, changing by -29·9% (-33·6 to -25·9), but increased by 99·3% (12·5 to 202·9) in the low-income group. The increase in age-standardised DALY rates followed that of ASMRs. Risk factors such as dietary risks, tobacco use, and high fasting plasma glucose contributed to 28·3% (16·6 to 38·9) of breast cancer DALYs in 2023. The risk factors with a decrease in attributable DALYs between 1990 and 2023 were high alcohol use and tobacco. By 2050, the global incident cases of breast cancer among females were forecast to reach 3·56 million (2·29 to 4·83), with 1·37 million (0·841 to 2·02) deaths. The stable incidence and declining mortality rates of female breast cancer in high-income nations reflect success in screening, diagnosis, and treatment. In contrast, the concurrent rise in incidence and mortality in other regions signals health system deficits. Without effective interventions, many countries will fall short of the WHO Global Breast Cancer Initiative's ambitious target of achieving an annual reduction of 2·5% in age-standardised mortality rates by 2040. The mounting breast cancer burden, disproportionately affecting some of the world's most vulnerable populations, will further exacerbate health inequalities across the globe without decisive immediate action. Gates Foundation, St Jude Children's Research Hospital.
Circumstantial evidence suggests that a high proportion of cases of epilepsy in countries across sub-Saharan Africa (SSA) remain undiagnosed. The magnitude of the burden is unknown. Screening tools offer promise for early detection and prevalence estimation that will enable evidence-informed management of epilepsy in SSA. This review will systematically assess the accuracy and reliability of screening tools for detecting epilepsy in communities and primary care settings in SSA. Relevant databases, non-database sources and grey literature will be searched for studies on epilepsy screening tools. PubMed, LILACS, CINAHL, PsycINFO and Google Scholar, from inception to 31 May 2026, will be searched for studies on screening tools (questionnaires) administered by non-expert physicians to populations or hospital/clinic-based cohorts with no language restrictions. The following search terms will be used: screening tool, screening questionnaire, screening test, screening instrument, diagnostic tool, diagnostic accuracy, epilepsy, sensitivity, specificity, true positive, false positive, true negative and false negative and SSA. All countries in SSA will be included as search terms. Cochrane databases, African Journals Online, African Index Medicus, HINARI and Preprint and Thesis repositories will also be searched. Reference lists of potentially relevant studies will be reviewed, and experts will be contacted to identify additional studies missed in our searches. Study selection (using a pretested study selection flow chart), data extraction (using a validated data extraction form) and risk-of-bias assessment (using the revised Quality Assessment of Diagnostic Accuracy Studies-2) will be performed independently by at least two reviewers, and any discrepancies will be resolved through discussion. The pooled sensitivity, specificity and diagnostic odds ratio (DOR) will be estimated from 2-by-2 tables of true positives, false positives, true negatives and false negatives. Possible causes of heterogeneity between studies will be assessed through pre-specified subgroup analyses. A meta-analysis will be conducted using a bivariate random-effects model to summarise sensitivity, specificity and DOR per patient. A summary receiver operating characteristic curve will be plotted to determine the overall diagnostic performance of the index tests. Sensitivity analyses will be conducted to test the robustness of pooled estimates of screening accuracy, and all estimates will be presented with their 95% CIs. This study will synthesise empirical evidence from publicly available published and unpublished studies, and hence no ethical approval is required. An eligible study with serious ethical issues will be excluded from the analysis and the reasons for exclusion will be documented. The review findings will be shared with all relevant stakeholders, including healthcare providers, patient advocate groups, agencies involved in implementing epilepsy care and policies, civil society, social services providers and researchers. The review findings will be shared widely at scientific symposia and conferences, and the final report will be published in a high-impact-factor peer-reviewed journal. CRD42024566976.
Malaria remains a major public health concern in Sub-Saharan Africa, where prevention efforts such as insecticide-treated nets (ITNs) play a critical role in reducing transmission. However, malaria prevalence varies across geographic areas and household contexts, including differences in mosquito bed net utilization (treated, untreated, or absent), as well as other environmental and socioeconomic determinants. Understanding the spatial distribution of malaria and how it varies across households with different bed net utilization patterns can provide descriptive insights to support malaria control programs. This study aimed to describe and map the spatial distribution of malaria among households with different mosquito bed net utilization categories (no net, treated net, and untreated net) across 19 sub-Saharan African countries. A community-based cross-sectional study was conducted using the most recent Demographic and Health Survey (DHS) data from 19 sub-Saharan African countries. The analysis included 126,424 individuals who underwent malaria rapid diagnostic testing across 11,594 survey clusters. Malaria infection status was measured at the individual level, while spatial analyses were conducted at the cluster (enumeration area) level, the primary sampling unit used in DHS surveys. Data were cleaned, weighted, and analyzed using Stata version 17, accounting for the DHS complex sampling design (sampling weights, clustering, and stratification). Malaria prevalence and corresponding 95% confidence intervals were estimated. Spatial patterns of malaria distribution were explored using ArcGIS version 10.7 and SaTScan™ version 10.0.2. The pooled malaria prevalence across 19 sub-Saharan African countries was 24.0% (95% CI 18-30%), with regional variation observed: Central Africa recorded the highest prevalence at 26% (95% CI 18-34%), followed by West Africa at 25% (95% CI 15-35%), and East Africa at 20% (95% CI 10-31%). Regarding bed net usage, 49.17% (95% CI 48.89-49.45%) reported no bed net, 48.06% (95% CI 47.78-48.34%) used insecticide-treated nets (ITNs), and 2.77% (95% CI 2.68-2.86%) used untreated bed nets. Malaria prevalence was highest among no bed net users with 32.75%, followed by 28.91% among untreated bed net users and 13.23% among ITN users. Spatial analysis indicated significant spatial clustering of malaria cases (Global Moran's I = 0.159, Z-score = 239.06, p ≤ 0.001). Hotspot areas identified by the Getis-Ord Gi* statistic included Benin, Burkina Faso, Togo, Uganda, Rwanda, and parts of Republic of the Congo and Mozambique. SaTScan analysis detected 34 significant malaria clusters overall, with 23 clusters among no bed net users, 25 among ITN users, and 12 among untreated bed net users. Despite ongoing malaria control efforts, malaria prevalence remains substantial across sub-Saharan Africa, with notable regional and spatial disparities observed across areas with different bed net utilization patterns. These descriptive spatial findings highlight geographic heterogeneity in malaria burden and may help inform geographically targeted malaria control strategies. Strengthening access to insecticide-treated nets, improving community awareness, and prioritizing identified hotspot areas may contribute to strengthening malaria control efforts toward achieving global malaria reduction targets by 2030.
Diphtheria, a re-emerging public health threat, is a vaccine-preventable acute respiratory infection caused by toxigenic strains of Corynebacterium diphtheriae. Caregivers of this most vulnerable group must be knowledgeable of the disease, its risk factors, and preventive measures to curb its spread. To determine the knowledge, risk perception and prevention against diphtheria among caregivers of under fives. A cross-sectional descriptive study was conducted in January 2024. A total of 288 caregivers of children under five years of age were selected using a multi-stage sampling technique, and data were collected using an interviewer-administered questionnaire. The data were analyzed using SPSS version 27, and results were presented in tables. The chi-square test was used to test for association between the socio-demographic variables and dependent variables, and the level of statistical significance was set at a p-value of <0.05. The median age of the respondents was 32 ± IQR 10.8 years. About half (51.7%) of the respondents had good knowledge of diphtheria, positive perception of the risk of the disease was reported in 77.1% of the respondents and 75.6% had good practice of the preventive measures against the disease. A quarter (26.8%) of the respondent's children took the complete 3 doses of the pentavalent vaccine. Despite positive diphtheria prevention behaviors, the identified gap in pentavalent vaccination coverage indicates a significant need for community immunization programs. Investigating the factors contributing to this low coverage is crucial for developing effective strategies to strengthen immunization programs. La diphtérie, une menace réémergente pour la santé publique, est une infection respiratoire aiguë évitable par la vaccination, causée par des souches toxinogènes de Corynebacterium diphtheriae. Les aidants de ce groupe le plus vulnérable doivent être informés de la maladie, de ses facteurs de risque et des mesures préventives pour freiner sa propagation. Déterminer les connaissances, la perception du risque et les pratiques de prévention contre la diphtérie chez les aidants d'enfants de moins de cinq ans. Une étude descriptive transversale a été menée en janvier 2024. Un total de 288 aidants d'enfants de moins de cinq ans a été sélectionné à l'aide d'une technique d'échantillonnage en plusieurs étapes, et les données ont été recueillies à l'aide d'un questionnaire administré par un enquêteur. Les données ont été analysées avec SPSS version 27, et les résultats ont été présentés sous forme de tableaux. Le test du chi carré a été utilisé pour évaluer l'association entre les variables sociodémographiques et les variables dépendantes, avec un seuil de signification statistique fixé à p < 0,05. L'âge médian des répondants était de 32 ± IQR 10,8 ans. Environ la moitié (51,7 %) des répondants avaient une bonne connaissance de la diphtérie, 77,1 % avaient une perception positive du risque de la maladie, et 75,6 % pratiquaient correctement les mesures préventives. Un quart (26,8 %) des enfants des répondants avaient reçu les trois doses complètes du vaccin pentavalent. Malgré des comportements positifs en matière de prévention de la diphtérie, l'écart observé dans la couverture vaccinale pentavalente souligne un besoin important de programmes communautaires de vaccination. Il est essentiel d'examiner les facteurs contribuant à cette faible couverture afin de développer des stratégies efficaces pour renforcer les programmes de vaccination. Diphtérie, Connaissances, Perception du risque, Prévention, Chikun LGA.
Streptococcus mutans has been strongly associated with dental caries. The mother, the primary caregiver in the first year of life is the most significant source of the bacteria. The presence of S. mutans in infants from birth to 6 weeks of life was assessed. Prospective study of 24 women enrolled during their third trimester. Socio-demographic characteristics, oral hygiene, dietary practices and obstetric characteristics obtained using investigator-administered questionnaire. Saliva samples collection from neonates at birth and six weeks, investigated by cultural microbial analysis and polymerase chain reaction to detect S. mutans specific species genes. Total of 24 mother-child pairs assessed. Mothers mean age; 31.29 (+/- 4.6) years. Neonates' mean gestational age; 38.79 (+/-1.4) weeks, with 14 (58.3%) females and 10 (41.7) males. Microbiological culture analysis of the saliva sample of the neonates showed that 25% of the neonates had S. mutans at birth and 25% had it at 6 weeks post-delivery. Approximately 25% of salivary samples from the neonates showed S. mutans upon cultural analysis and correlated with the presence of the bacteria in 41.7% of the samples using Polymerase chain reaction. Streptococcus mutans detected at birth in 60% of neonates were identical to that of the mothers. Maternal transmission is the primary source of S. mutans acquisition. Culture analysis of oral fluid revealed presence of viable and cultivable S. mutans in neonates asserting the acquisition of these species at birth and their presence before tooth eruption. Streptococcus mutans est fortement associé aux caries dentaires. La mère, en tant que principale personne en charge durant la première année de vie, constitue la source la plus significative de cette bactérie. Cette étude a évalué la présence de S. mutans chez les nourrissons, de la naissance jusqu'à six semaines de vie. Étude prospective menée auprès de 24 femmes recrutés au cours du troisième trimestre de grossesse. Les caractéristiques sociodémographiques, l'hygiène bucco-dentaire, les habitudes alimentaires et les antécédents obstétricaux ont été recueillis via un questionnaire administré par l'enquêteur. Des échantillons de salive ont été prélevés chez les nouveau-nés à la naissance et à six semaines, puis analysés par culture microbienne et réaction en chaîne par polymérase (PCR) pour détecter les gènes spécifiques de S. mutans. Un total de 24 paires mère-enfant ont été évaluées. L'âge moyen des mères était de 31,29 ans (+/- 4,6). L'âge gestationnel moyen des nouveau-nés était de 38,79 semaines (+/- 1,4), avec 14 filles (58,3 %) et 10 garçons (41,7 %). L'analyse microbiologique des échantillons de salive a révélé que 25 % des nouveau-nés présentaient Streptococcus mutans à la naissance, et 25 % à six semaines après l'accouchement. Environ 25 % des échantillons salivaires ont montré la présence de S. mutans par culture, et cette présence était confirmée dans 41,7 % des échantillons par PCR. Chez 60 % des nouveau-nés ayant Streptococcus mutans à la naissance, les souches étaient identiques à celles de leurs mères. La transmission maternelle constitue la principale source d'acquisition de Streptococcus mutans. L'analyse de la salive a révélé la présence de S. mutans viable et cultivable chez les nouveau-nés, confirmant une acquisition dès la naissance, avant même l'apparition des dents. WAJM 2025; 42 (7): 531-541. Streptococcus mutans, Salive, Acquisition initiale, Mères, Nourrissons.
The links between periodontal disease and a number of systemic diseases including respiratory diseases have been widely reported in the literature. The burden and prevalence of periodontal disease and chronic obstructive pulmonary disease (COPD) is increasing globally. Periodontitis is now recognised as an independent risk factor for COPD. In addition, these two chronic diseases have similar pathogenic mechanisms. Despite these facts, the role of prevention of periodontitis in the management of COPD had not been fully explored. The aim of the study was to look at the effect of non-surgical periodontal therapy on the control of symptoms of Chronic Obstructive Pulmonary Disease (COPD) in our resource-limited settings. Sixty-nine COPD patients with concurrent periodontitis, who were at least 40 years old, were recruited from the Chest clinic of a tertiary institution in Ile Ife, Osun State, Nigeria between July 2021 and January 2023. Using GraphPad software, the participants were randomly categorised into two groups (control and intervention). The intervention group received non-surgical periodontal therapy (NSPT) and oral hygiene instructions (OHI) while the control group received oral hygiene instruction (OHI) only after the initial determination of the aMMP-8 assay and oral examinations. However, they had their non-surgical periodontal therapy after the three months follow-up. Clinical parameters such as COPD Assessment Test (CAT) scores, probing pocket depths (PPD), clinical attachment level (CAL) and a biomarker active matrix metalloproteinase-8 (aMMP-8) were recorded at baseline and after 3 months. Independent t-test was used for normally distributed variables for the two groups while Mann-Whitney U test was used for non-normally distributed variables. Paired t-test was used for the intra-group comparisons of the mean values and p value set at <0.05. A total of 69 participants comprising 35 participants in the intervention group and 34 participants in the control group were enrolled in this study. The intervention group demonstrated statistically significant improvements in the CAT scores from 18.66 to 15.06 (p<0.04), aMMP-8 from 26.28ng/ml to 18.66ng/ml (p<0.001), mean PPD from 2.78mm to 2.64mm (p<0.05) and mean CAL from 4.64mm to 4.50mm (p<0.001) in comparison to the control group ( CAT scores from 18.91 to 17.59 p=0.07, aMMP-8 from 30.80ng/ml to 27.11ng/ml p=0.11, mean PPD from 2.82mm to 2.84mm p=0.37, and mean CAL from 4.88mm to 4.89mm p=0.69). The results of this study emphasize the possible advantages of incorporating periodontal care into strategies for managing COPD. Les liens entre les maladies parodontales et un certain nombre de maladies systémiques, y compris les maladies respiratoires, ont été largement rapportés dans la littérature. Le fardeau et la prévalence des maladies parodontales ainsi que de la bronchopneumopathie chronique obstructive (BPCO) augmentent à l'échelle mondiale. La parodontite est désormais reconnue comme un facteur de risque indépendant de la BPCO. En outre, ces deux maladies chroniques présentent des mécanismes pathogéniques similaires. Malgré ces faits, le rôle de la prévention de la parodontite dans la prise en charge de la BPCO n'a pas été pleinement exploré. L'objectif de cette étude était d'évaluer l'effet de la thérapie parodontale non chirurgicale sur le contrôle des symptômes de la BPCO dans un contexte à ressources limitées. Soixante-neuf patients atteints de BPCO avec une parodontite concomitante, âgés d'au moins 40 ans, ont été recrutés à la clinique de pneumologie d'un établissement tertiaire à Ile-Ife, dans l'État d'Osun, au Nigeria, entre juillet 2021 et janvier 2023. À l'aide du logiciel GraphPad, les participants ont été répartis aléatoirement en deux groupes (témoin et intervention). Le groupe d'intervention a reçu une thérapie parodontale non chirurgicale (NSPT) ainsi que des instructions d'hygiène bucco-dentaire (OHI), tandis que le groupe témoin a reçu uniquement des instructions d'hygiène bucco-dentaire après la détermination initiale du test aMMP-8 et les examens buccaux. Toutefois, ce groupe a bénéficié de la thérapie parodontale non chirurgicale après le suivi de trois mois. Les paramètres cliniques tels que les scores du test d'évaluation de la BPCO (CAT), la profondeur de sondage des poches (PPD), le niveau d'attache clinique (CAL) et le biomarqueur métalloprotéinase matricielle-8 active (aMMP-8) ont été enregistrés au départ et après 3 mois. Le test t indépendant a été utilisé pour les variables normalement distribuées entre les deux groupes, tandis que le test de Mann-Whitney U a été utilisé pour les variables non normalement distribuées. Le test t apparié a été utilisé pour les comparaisons intra-groupes des valeurs moyennes, avec un seuil de significativité fixé à p < 0,05. Un total de 69 participants, dont 35 dans le groupe d'intervention et 34 dans le groupe témoin, ont été inclus dans cette étude. Le groupe d'intervention a montré des améliorations statistiquement significatives des scores CAT (de 18,66 à 15,06 ; p < 0,04), des niveaux de aMMP-8 (de 26,28 ng/ml à 18,66 ng/ml ; p < 0,001), de la PPD moyenne (de 2,78 mm à 2,64 mm ; p < 0,05) et du CAL moyen (de 4,64 mm à 4,50 mm ; p < 0,001) comparativement au groupe témoin (scores CAT de 18,91 à 17,59 ; p = 0,07, aMMP-8 de 30,80 ng/ml à 27,11 ng/ml ; p = 0,11, PPD moyenne de 2,82 mm à 2,84 mm ; p = 0,37, et CAL moyen de 4,88 mm à 4,89 mm ; p = 0,69). Les résultats de cette étude soulignent les avantages potentiels de l'intégration des soins parodontaux dans les stratégies de prise en charge de la BPCO. Maladie parodontale, score du test d'évaluation de la BPCO (CAT), contrôle de la BPCO, aMMP-8.
This study aimed to assess the knowledge and perception of Nigerian paediatricians regarding paediatric sleep disorders and their management. It also assessed the state of their current practice with screening, evaluating and treating sleep disorders in children and the perceived barriers and facilitators to the provision of quality care for sleep disorders for Nigerian children. This descriptive cross-sectional study was conducted among 153 Paediatricians who practice in Nigeria and attended the Annual Scientific Meeting of the Paediatrics Association of Nigeria (PAN) held in January 2023 at Akure, Ondo state, Nigeria. We utilized a pilot-tested, semi-structured questionnaire adapted from the Paediatrics sleep survey questionnaire. Data was analysed with the IBM SPSS software, version 20. The 153 respondents were from the six geopolitical zones in Nigeria. More than two-thirds (66.7%) had a poor knowledge score (<6). The majority of the respondents rated their confidence in diagnosing sleep disorders as fair (63.4%), while 22.2% rated it as poor. Almost all (98.7%) reported the lack of sleep laboratory in their centre of practice. Also, about two-thirds (68.0%) had no paediatric sleep clinic. The main barriers to the management of paediatric sleep disorders were lack of training (119; 77.3%) and lack of sleep laboratory (102; 66.7%). Having a sleep laboratory in the centre of practice was significantly associated with the knowledge of the paediatricians (p = 0.044). There is a need for interventions to improve the knowledge of Nigerian paediatricians on sleep medicine and the provision of Paediatric sleep laboratory facilities in Nigeria. Cette étude visait à évaluer les connaissances et la perception des pédiatres nigérians concernant les troubles du sommeil pédiatriques et leur prise en charge. Elle a également examiné l'état de leur pratique actuelle en matière de dépistage, d'évaluation et de traitement des troubles du sommeil chez les enfants, ainsi que les obstacles et facilitateurs perçus pour la fourniture de soins de qualité aux enfants nigérians souffrant de troubles du sommeil. Cette étude descriptive transversale a été menée auprès de 153 pédiatres exerçant au Nigeria et ayant participé à la Réunion Scientifique Annuelle de l'Association Nigériane de Pédiatrie (PAN) tenue en janvier 2023 à Akure, État d'Ondo, Nigeria. Nous avons utilisé un questionnaire semi-structuré, testé au préalable, adapté du questionnaire sur le sommeil pédiatrique. Les données ont été analysées avec le logiciel IBM SPSS, version 20. Les 153 répondants provenaient des six zones géopolitiques du Nigeria. Plus des deux tiers (66,7 %) avaient un score de connaissances faible (<6). La majorité des répondants ont évalué leur confiance dans le diagnostic des troubles du sommeil comme moyenne (63,4 %), tandis que 22,2 % l'ont jugée faible. Presque tous (98,7 %) ont signalé l'absence de laboratoire du sommeil dans leur centre de pratique. De plus, environ deux tiers (68,0 %) n'avaient pas de clinique du sommeil pédiatrique. Les principaux obstacles à la prise en charge des troubles du sommeil pédiatriques étaient le manque de formation (119 ; 77,3 %) et l'absence de laboratoire du sommeil (102 ; 66,7 %). La présence d'un laboratoire du sommeil dans le centre de pratique était significativement associée aux connaissances des pédiatres (p = 0,044). Il est nécessaire de mettre en place des interventions pour améliorer les connaissances des pédiatres nigérians en médecine du sommeil et pour fournir des infrastructures de laboratoires du sommeil pédiatrique au Nigeria. Connaissances sur le sommeil pédiatrique, Pratique du sommeil pédiatrique, Laboratoires du sommeil pédiatrique, Promoteurs et facilitateurs, Nigeria.
Studies have demonstrated lower odds of survival from out-of-hospital cardiac arrest (OHCA) during nighttime hours, but this has not been studied in North America since 2013, and it is unclear what factors might explain this survival difference. To identify whether OHCA survival during nighttime hours remains lower than during daytime hours using contemporary data and whether it can be explained by variable patient physiology or emergency care factors. This cohort study included adults (aged ≥18 years) with OHCA in the Cardiac Arrest Registry for Enhanced Survival from 2013 to 2024. Daytime was defined as 7:00 am to 10:59 pm, and nighttime was defined as 11:00 pm to 6:59 am. Primary outcomes were sustained return of spontaneous circulation (ROSC) and neurologically favorable survival (Cerebral Performance Category score of 2 or more). A multilevel mixed-effects logistic regression model with prehospital agency as a random effect and patient or treatment characteristics as fixed effects was used. A similar analysis of postresuscitation survival was performed among patients with sustained ROSC, adjusting for the time-to-cardiopulmonary resuscitation interval and defibrillation status. A mediation analysis was performed to identify whether the prehospital response interval mediates the association. Of 1 151 845 patients in the registry, 874 415 were eligible and included in the analysis, and the median (IQR) age in the cohort was 64 (52-75) years with 557 515 males (63.8%) and 181 878 Black or African American patients (20.8%), 146 352 Hispanic or Latino patients (16.7%), and 447 646 White patients (51.2%). A minority of OHCA responses occurred at nighttime (241 967 [27.7%]), and the odds of sustained ROSC and neurologically favorable survival were lower at nighttime than daytime (sustained ROSC: 62 548 [25.8%] vs 193 486 [30.6%]; adjusted odds ratio [aOR], 0.85; 95% CI, 0.84-0.86; neurologically favorable survival: 16 234 [6.7%] vs 58 542 [9.3%]; aOR, 0.84; 95% CI, 0.82-0.86). Among those with sustained ROSC, the odds of postresuscitation survival at nighttime were also lower than daytime (aOR, 0.93; 95% CI, 0.90-0.95). The prehospital response interval partially mediated the nighttime survival disadvantage, with approximately 12.6% of the total effect mediated by the response interval. In this cohort study of OHCA, nighttime response was associated with lower adjusted odds of sustained ROSC, neurologically favorable survival, and postresuscitation survival. Emergency care factors accounted for only a portion of the decreased odds of survival at nighttime.
Open defecation is a harmful and unsafe practice that contributes to environmental pollution and disproportionately affects developing nations, particularly those in Sub-Saharan Africa. According to the World Health Organization (WHO) and the United Nations International Children's Emergency Fund (UNICEF) Joint Monitoring Programme (JMP), Sub-Saharan Africa is home to 46% of the global population still practising open defecation. Socio-economic factors, cultural norms, and individual attitudes play crucial roles in shaping sanitation behaviours and influencing open defecation practices. Therefore, this study aims to determine the prevalence, spatial distribution, and geographic inequalities of open defecation in Sub-Saharan Africa. A community-based cross-sectional survey was conducted, including 20,130 clusters and 496,957 households from 34 Sub-Saharan African countries. The Demographic and Health Survey (DHS) data were weighted, cleaned, and analyzed using Microsoft Excel, Stata version 17, ArcGIS version 10.7, and SaTScan™ version 10.1. Spatial analyses were performed using ArcGIS version 10.7 and Kulldorff's SaTScan™ version 10.1, while Geographically Weighted Regression (GWR) analyses were conducted using ArcGIS version 10.7. The prevalence of open defecation among households in Sub-Saharan Africa was 23.24% (95% CI: 23.12-23.35). The practice was clustered across enumeration areas (Global Moran's I = 0.25, Z-score = 366.12, P-value ≤ 0.001). The Getis-Ord Gi* statistic identified hotspots of open defecation primarily in East Africa, Central Africa, and West Africa. Anselin Local Moran's I detected both high and low clusters of open defecation, while SaTScan cluster analysis identified 146 windows containing significant clusters of households practising open defecation across Sub-Saharan Africa. Geographically Weighted Regression (GWR) analysis revealed that several factors were positively associated with open defecation, including lack of educational attainment, unimproved drinking water sources, lack of basic access to water, younger household heads, and extreme poverty. Additionally, household size greater than four, the richest households and urban and rural residency were negatively associated with open defecation practices. This study reveals a high prevalence of open defecation (23.24%) in Sub-Saharan Africa with significant geographic clustering, particularly in East, Central, and West Africa. This estimate is higher than the 18% reported by the 2021 WHO/UNICEF Joint Monitoring Programme (JMP). Novel spatial and GWR analyses uncovered associations with poverty, lack of education, water access, age of household heads, and wealth status. These findings underscore the need for geographically targeted, multi-sectoral sanitation interventions that address underlying socio-demographic disparities. Future research should explore the effectiveness of spatially tailored programs and integrate behavioral insights to accelerate progress toward Sustainable Development Goal 6.
One of the complications of Diabetes Mellitus (DM) - both type 1(T1DM) and type 2 (T2DM) is Tropical diabetic hand syndrome (TDHS). The initiating event ranges from trivial trauma to overt injury to the hand in the presence of hyperglycaemia, usually aggravated by poorly treated wounds, superimposed infection and peripheral neuropathy. This case series aims to highlight the different forms of presentation of TDHS and their outcomes. This is a case series that reviewed four cases of TDHS managed at the Endocrine Unit of Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, over an 11 months period from August 2023 to June 2024. Out of seven identified cases, four with complete treatment records were included. Case 1: A 24-year-old female single lady with a 2-week history of a stick injury to the left hand presented with a random blood sugar (RBS) of 22.2 mmol/L, swelling, ulcers, and pus discharge. Staphylococcus spp. was cultured from the wound. She was treated with antibiotics and underwent debridement. Case 2: A 20-year-old female trader presented with a 2-weeks history of spontaneous blisters on the right hand with an RBS of 22.5mmol/L, she exhibited similar symptoms as case 1. Staphylococcus spp. was also cultured. She had antibiotics and debridement. Case 3: A 44-year-old male butcher presented with a 3-weeks history of a knife injury to the left hand, along with swelling, ulcers, pus, and gangrene with an RBS of 18.5mmol/L. He required debridement and subsequent amputation. Case 4: A 49 year-old widow, a known T2DM, and Hypertensive heart failure patient who presented with left hand swelling and ulceration from the cannula site. She eventually died from multiple organ failure. TDHS remains a serious and preventable complication among diabetic patients in tropical regions. This case series underscores the importance of educating patients on hand care in addition to other forms of diabetic education to prevent severe outcomes such as gangrene and amputation. L'une des complications du diabète sucré (DM), qu'il soit de type 1 (DT1) ou de type 2 (DT2), est le syndrome de la main diabétique tropicale (SMDT). L'événement déclencheur varie d'un traumatisme mineur à une lésion franche de la main en présence d'hyperglycémie, généralement aggravée par une mauvaise prise en charge des plaies, une infection surajoutée et une neuropathie périphérique. Cette série de cas vise à mettre en évidence les différentes formes de présentation du SMDT ainsi que leurs issues. Il s'agit d'une série de cas portant sur quatre patients atteints de SMDT pris en charge à l'unité d'endocrinologie de l'Hôpital Universitaire Ahmadu Bello (ABUTH), à Zaria, sur une période de 11 mois allant d'août 2023 à juin 2024. Sur sept cas identifiés, quatre disposant de dossiers thérapeutiques complets ont été inclus. Cas 1: Une femme célibataire de 24 ans présentant un antécédent de traumatisme par bâton à la main gauche datant de deux semaines, avec une glycémie aléatoire de 22,2 mmol/L, un œdème, des ulcérations et un écoulement purulent. Staphylococcus spp. a été isolé de la plaie. Elle a été traitée par antibiothérapie et a bénéficié d'un débridement. Cas 2: Une commerçante de 20 ans présentant depuis deux semaines des bulles spontanées à la main droite avec une glycémie aléatoire de 22,5 mmol/L, avec des symptômes similaires au cas 1. Staphylococcus spp. a également été isolé. Elle a reçu des antibiotiques et un débridement. Cas 3: Un boucher de 44 ans présentant un traumatisme par couteau à la main gauche datant de trois semaines, associé à un œdème, des ulcérations, du pus et une gangrène, avec une glycémie aléatoire de 18,5 mmol/L. Il a nécessité un débridement suivi d'une amputation. Cas 4: Une veuve de 49 ans, connue pour un DT2 et une insuffisance cardiaque hypertensive, présentant un œdème et une ulcération de la main gauche au site de pose de la canule. Elle est finalement décédée d'une défaillance multiviscérale. Le SMDT demeure une complication grave mais évitable chez les patients diabétiques des régions tropicales. Cette série de cas souligne l'importance de l'éducation des patients sur les soins des mains, en complément des autres aspects de l'éducation diabétique, afin de prévenir des issues graves telles que la gangrène et l'amputation. Syndrome de la main diabétique tropicale, Traumatisme, Chirurgie, Éducation.
The purpose of this study is to analyze trends and disparities in the place of death of older adults with heart failure (HF) across the United States (US) from 1999 to 2022. We used the US multiple cause-of-death files from CDC Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) to access HF-related deaths among individuals aged ≥ 65 from 1999 to 2022. Deaths were categorized at home/hospice facilities, medical facilities, and nursing homes, and stratified into different demographic and geographic groups. Statistically significant trends in mortality over time were identified using Joinpoint regression model. From 1999 to 2022, there were 6,767,325 HF-related deaths. Of these, 2,124,398 (30.04 %) deaths occurred in home/hospice facilities, 2,627,426 (37.15 %) deaths occurred in medical facilities, and 2,015,501 (28.50 %) deaths occurred in nursing homes. The proportion of HF deaths increased in home/hospice facilities (AAPC 3.93*, CI: 3.76 - 4.14) while decreasing in medical facilities (AAPC -1.70*, CI: -1.79 to -1.61) and nursing homes (AAPC -2.07*, CI: -2.33 to -1.88) in all race/ethnic groups, US census regions and rural-urban areas. Hispanics had the highest proportion of deaths in home/hospice, while NH African Americans had the lowest. West and South regions continued to have high mortality in home/hospice, while the Midwest continued to have the highest mortality in nursing homes. A significant shift was seen in the place of death amongst older adults with HF, with an increase in the proportion of HF deaths occurring in home/hospice facilities and a decrease at medical facilities and nursing homes.
Rheumatic and musculoskeletal diseases (RMDs) are important causes of morbidity, disability, and mortality worldwide, including in sub-Saharan Africa. However, the spectrum of RMDs in this region has not been well documented due to a lack of data. This is particularly true since many of the diseases observed were previously considered rare among Africans. This study aims to identify the various RMDs seen in a private rheumatology facility in Lagos, Nigeria. The case records of the first 5,000 consecutive patients diagnosed with RMDs between January 2004 and May 2022 were reviewed. Diagnoses were made using standard rheumatology guidelines/consensus, societal guidelines, or clinical evaluation. Data analysis was performed using the Statistical Package for Social Sciences (SPSS) version 26. The mean ± SD age of the 5,000 patients was 52.33 ± 16.15 years, with a female-to-male ratio of 1.7:1. The frequency of the common RMDs were degenerative joint diseases (54.16%), followed by inflammatory arthritis (14.52%), soft tissue rheumatism (13.28%) and connective tissue diseases (10.32%). Females were more commonly affected in all categories except crystal arthropathies and spondyloarthropathy. Septic arthritis, metabolic bone diseases, and orphan diseases were rarely seen, at 0.26%, 0.28%, and 0.82% of the total, respectively. This study, which includes arguably the largest cohort of RMD patients in sub-Saharan Africa, revealed a wide spectrum of RMDs, contrary to previous assumptions that RMDs are rare among Africans. As this is a hospital-based study, large population-based studies are recommended to determine the burden of RMDs in the community to guide policy implementation and resource allocation. Les maladies rhumatismales et musculosquelettiques (MRM) sont des causes importantes de morbidité, d'invalidité et de mortalité dans le monde, y compris en Afrique subsaharienne. Cependant, le spectre des MRM dans cette région n'a pas été bien documenté en raison du manque de données. Cela est particulièrement vrai puisque nombre de ces maladies étaient auparavant considérées comme rares chez les Africains. Cette étude vise à identifier les différentes MRM observées dans une clinique privée de rhumatologie à Lagos, Nigeria. Les dossiers des 5 000 premiers patients consécutifs diagnostiqués avec des MRM entre janvier 2004 et mai 2022 ont été examinés. Les diagnostics ont été établis selon les directives/consensus standards en rhumatologie, les recommandations des sociétés savantes ou l'évaluation clinique. L'analyse des données a été réalisée à l'aide du logiciel Statistical Package for Social Sciences (SPSS) version 26. L'âge moyen ± écart-type des 5 000 patients était de 52,33 ± 16,15 ans, avec un ratio femme/homme de 1,7:1. Les fréquences des MRM les plus courantes étaient les maladies articulaires dégénératives (54,16 %), suivies par les arthrites inflammatoires (14,52 %), les rhumatismes des tissus mous (13,28 %) et les maladies du tissu conjonctif (10,32 %). Les femmes étaient plus fréquemment touchées dans toutes les catégories, sauf pour les arthropathies microcristallines et les spondyloarthropathies. L'arthrite septique, les maladies osseuses métaboliques et les maladies orphelines étaient rarement observées, représentant respectivement 0,26 %, 0,28 % et 0,82 % du total. Cette étude, qui inclut probablement la plus grande cohorte de patients atteints de MRM en Afrique subsaharienne, a révélé un large spectre de ces maladies, contrairement aux hypothèses antérieures selon lesquelles elles seraient rares chez les Africains. Étant donné qu'il s'agit d'une étude hospitalière, de vastes études populationnelles sont recommandées afin de déterminer la charge des MRM dans la communauté et d'orienter la mise en œuvre des politiques ainsi que l'allocation des ressources. Spectre, Rhumatismal, Musculosquelettique, Nigeria.
Ischemic heart disease (IHD) and type 2 diabetes mellitus (T2DM) are leading causes of disability-adjusted life years globally among adults aged 55 years and older. Although both diseases share common risk factors and pathophysiological pathways, previous research has predominantly addressed these conditions in isolation. The co-occurrence patterns and regional variations of IHD and T2DM burden remain poorly understood. We aimed to characterize the global co-occurrence patterns of IHD and T2DM from a spatial perspective and to identify the corresponding risk factors distinguishing different burden regions. Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 database, we extracted age-standardized disability-adjusted life year (DALY) rates for IHD and T2DM among individuals aged 55 years and older from 204 countries and territories. Based on quartile distributions of global DALY rates for both diseases, we classified countries into four distinct burden regions: Low-Burden Regions (56 countries), T2DM-Dominant Regions (46 countries), IHD-Dominant Regions (46 countries), and Dual-Burden Regions (56 countries). We examined temporal trends from 1990-2021, computed population attributable fractions for major risk factors, and used machine learning-based SHAP (Shapley Additive Explanations) analysis to screen and quantify the effects of corresponding risk factors distinguishing regional classifications. Dual-Burden Regions were distributed across multiple geographic areas including the Caribbean and Central America, Persian Gulf states, Balkan Peninsula, Southeast Asia, West Africa, Eastern Mediterranean, and Northern Europe. The spatial distribution revealed distinct geographic clustering, with higher IHD rates in Eastern Europe and Central Asia, and elevated T2DM rates in Pacific Island nations and parts of the Middle East. Countries and territories with the highest burden for both diseases included North African countries (eg, Morocco: IHD 25,193.1/100,000 and T2DM 32,197.24/100,000) and Pacific Island nations such as Fiji exhibiting IHD burden of 24,758.17 per 100,000 and T2DM burden of 32,197.24 per 100,000. Marshall Islands showed IHD burden of 25,107.72/100,000 and T2DM burden of 22,122.46/100,000, while Nauru demonstrated the highest IHD burden (39,483.92/100,000). High systolic blood pressure contributed most to IHD burden globally (49.79%), while high body-mass index dominated T2DM burden (51.89%). Environmental factors demonstrated clear regional gradients, with household air pollution ranging from 4·58% in Low-Burden to 14.43% in Dual-Burden Regions for IHD. High body-mass index contributed 51.89% to T2DM burden globally, with regional variation from 40.61% in IHD-Dominant to 51.36% in Low-Burden Regions. SHAP analysis identified sociodemographic index (SDI2021) as the primary factor distinguishing Low-Burden from Dual-Burden Regions for both IHD (mean |SHAP| = 1.245) and T2DM (mean |SHAP| = 1.317). Diet high in processed meat consistently showed strong discriminatory power across multiple regional comparisons for T2DM (SHAP values 0.923-1.721), while secondhand smoke emerged as a critical differentiator with SHAP values exceeding 1.0 across various regional distinctions. Diet low in vegetables served as a primary differentiator between Low-Burden and T2DM-Dominant Regions (mean |SHAP| = 1.188). The co-occurrence of IHD and T2DM exhibits pronounced global heterogeneity, with Pacific Island nations and multiple geographic regions including Gulf states, North Africa, and other areas bearing disproportionate dual-burden. Socioeconomic development level fundamentally characterizes dual-burden status, while dietary and environmental factors serve as key regional differentiators. Intervening in modifiable risk factors, particularly processed meat consumption, vegetable intake, and environmental exposures, can fundamentally reduce the global burden of these co-occurring diseases.