Abstract:

This study examined the role of e-commerce in facilitating international trade in Africa with a focus on individual businesses in Ghana. The important aspects in which the examination was done were on the current state of e-commerce in Ghana, factors that influence the choice of e-commerce platforms by individual Ghanaian business owners engaged in international trade, and challenges faced by individual business owners in adopting e-commerce for international trade. The study adopted the quantitative approach to research whereby a survey with the help of questionnaires was used to gather primary data from small business owners and individuals who use several e-commerce platforms for their business transactions. The collected data were analyzed by using descriptive statistical analysis. The study found that individual business owners use both local and foreign e-commerce platforms to buy different varieties of products. Concerning the local platforms, the predominantly used platform is Tonaton, followed by Jumia, Melcom Ghana, and Jiji. Also for the foreign e-commerce platforms, the predominantly used platform is Alibaba, followed by Amazon, Aliexpress, and eBay. The majority of the individual business owners buy products from these e-commerce platforms monthly and mostly use mobile phones to buy the products. The study revealed that majority of the business owners look out for reliable platforms, followed by platforms that are secured from scams, credible platforms, platforms that are designed to give customer satisfaction, and platforms that are easy to navigate. Moreover, the major challenge of most individual business owners is associated with fraudulent online shops, followed by delays in transaction activities, poor internet networks to access e-commerce platforms, high online transaction costs, and theft of ordered items or products.

References:

Abstract:

Lassa fever (LF), a viral hemorrhagic fever endemic to West Africa, poses significant public health challenges due to its non-specific symptoms, often mimicking other febrile illnesses. This diagnostic ambiguity hinders early detection and prompt medical intervention, increasing the risk of severe complications and mortality. Community health influencers (CHIs) are crucial for effective LF management, especially in resource-limited settings where they serve as the primary link between healthcare systems and vulnerable populations. Their roles encompass early case identification, community education, and facilitating access to treatment, making their understanding of LF paramount. This study aimed to assess the baseline knowledge and perceptions regarding LF among CHIs in selected high-risk Local Government Areas (LGAs) of Ondo State, Nigeria, a region with a historically high LF burden. Employing a quasi-experimental design, the research involved 60 CHIs recruited through multi-stage sampling, ensuring representation from diverse communities within the endemic LGAs. Data collection utilized validated questionnaires, demonstrating robust reliability with a coefficient of 0.70–0.72, to capture demographic characteristics, knowledge levels, and perceptions related to LF susceptibility, severity, and preventive measures. Descriptive and inferential statistical analyses, conducted at a significance level of p < 0.05, revealed moderate knowledge levels among CHIs, with an average score of 5.67 ± 1.63. However, significant variations in perceptions were observed, with misconceptions regarding LF susceptibility and severity being prevalent. Limited understanding of LF transmission dynamics and difficulty recognizing early symptoms emerged as key barriers to effective case detection. These findings underscore the critical need for targeted educational interventions tailored to address knowledge gaps and rectify misconceptions among CHIs, ultimately contributing to improved LF control and outbreak mitigation in endemic regions.

References:

[1].      Center for Disease Control (CDC). 2021, Lassa Fever. https://www.cdc.gov/vhf/lassa/index.html

[2].      Khare, V., et al., 2022, Lassa Fever: Current Status and Challenges. Infectious Diseases, 25(2), 123-135.

[3].      Naeem, A., et al., 2023, Lassa Fever Outbreak in Nigeria: Epidemiology, Challenges, and Control Strategies. Journal of Epidemiology and Global Health, 13(1), 1-10.

[4].      Loyinmi, A., Akinfe, A., & Ojo, O., 2021, Lassa Fever in Pregnancy: A Review. Journal of Obstetrics and Gynaecology, 41(3), 345-352.

[5].      Orji, C., et al., 2022, Rodent Reservoirs of Lassa Virus in Nigeria: Distribution and Public Health Implications. Vector-Borne and Zoonotic Diseases, 22(1), 1-8.

[6].      Olayemi, A., et al., 2017, Prevalence and Risk Factors for Lassa Virus Infection in Rodents in Nigeria. PLoS Neglected Tropical Diseases, 11(7), e0005787.

[7].      Pal, S., et al., 2022, Lassa Virus: Transmission, Pathogenesis, and Prevention. Viruses, 14(3), 545.

[8].      Yunusa, I., & Egenti, N., 2015, Lassa Fever: Knowledge, Attitudes, and Practices among Healthcare Workers in Nigeria. Journal of Infection and Public Health, 8(5), 484-490.

[9].      Happi, C., et al., 2019, Lassa Fever in West Africa: Challenges and Opportunities for Control. Emerging Infectious Diseases, 25(10), 1835-1843.

[10].     Kambire, S., et al., 2021, Lassa Fever in Burkina Faso: Epidemiology and Surveillance. International Journal of Infectious Diseases, 104, 465-471.

[11].     Mossoun, A., et al., 2017, Serological Evidence of Lassa Virus Infection in Côte d'Ivoire. PLoS Neglected Tropical Diseases, 11(12), e0006155.

[12].     World Health Organization (WHO), 2020, Lassa Fever. https://www.who.int/news-room/fact-sheets/detail/lassa-fever

[13].     Nigeria Centre for Disease Control (NCDC), 2021, Lassa Fever Outbreak in Nigeria: Epidemiological Report.

[14].     National Primary Health Care Development Agency (NPHCDA), 2023, Community Health Influencers, Promoters and Services (CHIPS) Programme. https://nphcda.gov.ng/chips/

[15].     Olayinka, O., et al., 2015, Knowledge, Attitude, and Practice of Lassa Fever among Healthcare Workers in Nigeria. Journal of Infection and Public Health, 8(1), 65-71.

[16].     Azuka, A., et al., 2021, Knowledge and Attitudes Toward Lassa Fever Among Health Workers in Endemic Regions. Journal of Public Health, 14(2), 123-135.

[17].     Ipadeola, O., et al., 2023, Barriers to Lassa Fever Detection in Nigeria: A Mixed-Methods Study. International Journal of Epidemiology, 19(1), 45-58.

[18].     Ilesanmi, O., et al., 2021, Perceptions of Lassa Fever Among Community Health Workers: Implications for Disease Control. Global Health Perspectives, 12(4), 89-102.

Abstract:

Approximately 70% of medical decisions require a confirmatory laboratory test. This reliance highlights the critical role of laboratory medicine in enhancing healthcare outcomes and the need for appropriately trained and skilled laboratorians. To assess levels, types, composition and training of laboratory professionals in response to the changing needs in Africa,  we surveyed medical laboratory professionals in Africa on their demographics and challenges encountered during training and what would be consider as a minimum course content for a medical laboratory training program. Of the 285 professionals from 30 countries surveyed, 88% were working within their countries of birth and 82% trained at public institutions. 89.5% were employed and 151 (53%) had a bachelor’s degree as their primary laboratory qualification. 63% expressed satisfaction with their career growth. Courses recommended into the primary laboratory qualification were microbiology, biosafety, biosecurity, hematology, chemistry, blood transfusion, immunology, laboratory management, attachment, molecular biology, research methods, histology and cytology. Challenges faced during training were lack of resources and equipment, limited clinical exposure, insufficient curriculum coverage and inadequate faculty staff. 30.9% of the professionals had at least one additional medical qualification. Employment status was significantly associated with satisfaction with one’s career growth (p=004). A 4-year bachelor’s degree with 12 months of internship is recommended for Laboratory training with microbiology, biosafety and biosecurity, hematology, chemistry, blood transfusion, immunology, laboratory management, internship, molecular biology, research methods, histology and cytology as minimum content. More laboratory-specific disciplines for post-graduate training up to PhD level, associated with defined career paths adequately compensated are recommended.

References:

[1].   Ferraro, S., Braga, F., Panteghini, M., 2016, Laboratory medicine in the new healthcare environment. Clin Chem Lab Med; 54(4):p523-533.

[2].   Olver, P., Bohn, M. K., Adeli, K., 2023, Central role of laboratory medicine in public health and patient care. Clin Chem Lab Med; 61(4):p666-673.

[3].   Agrawal, B., 2022, Laboratory Diagnostics–Tools for Clinical Decision‐Making and Clinical Trial Endpoints. Principles of Biomedical Sciences and Industry: Translating Ideas into Treatments:p357-376.

[4].   Adeli, K., 2017, Laboratory medicine–A hidden treasure in healthcare. Clin Biochem; 50(12):p645-647.

[5].   Nkengasong, J. N., Mbopi-Keou, F. X., Peeling, R. W., Yao, K., Zeh, C. E., Schneidman, M., et al. 2008, Laboratory medicine in Africa since 2008: then, now, and the future. The Lancet infectious diseases; 18(11):e362-e367.

[6].   Peter, T., Keita, M. S., Nkengasong, J., 2016, Building laboratory capacity to combat disease outbreaks in Africa. African journal of laboratory medicine; 5(3):p1-2.

[7].   Alemnji, G., Zeh, C., Yao, K., Fonjungo, P., 2014, Strengthening national health laboratories in sub‐S aharan A frica: a decade of remarkable progress. Trop Med Int Health; 19(4):450-458.

[8].   Putoto, G., Cortese, A., Pecorari, I., Musi, R., Nunziata, E., 2015, Harmonization of clinical laboratories in Africa: a multidisciplinary approach to identify innovative and sustainable technical solutions. Diagnosis; 2(2):129-135.

[9].   Fu, C., Drake, T., Simangolwa, W. M., Regan, L., Asfaw, E., Maruta, T., et al., 2022, Understanding the Costs and Benefits of Investing in Laboratory Systems in African Countries. In: Center for Global Development; 2022.

[10].  Fleming, K. A., Horton, S., Wilson, M. L., Atun, R., DeStigter, K., Flanigan, J., et al., 2021, The Lancet Commission on diagnostics: transforming access to diagnostics. Lancet 2021; 398(10315): p1997-2050.

[11].  Kotlarz, V. R., 1998, Tracing our roots: origins of clinical laboratory science. Clin Lab Sci 1998; 11(1): p5-7.

[12].  Race, G. J., Tillery, G. W., Dysert, P. A., 2nd. 2004, A history of pathology and laboratory medicine at Baylor University Medical Center. Proc (Bayl Univ Med Cent) 2004; 17(1):p42-55.

[13].  Kotlarz, V. R., 1998, Tracing our roots: the beginnings of a profession. Clin Lab Sci 1998; 11(3):p161.

[14].  Berger, D., 1999, A brief history of medical diagnosis and the birth of the clinical laboratory. Part 1--Ancient times through the 19th century. MLO Med Lab Obs 1999; 31(7):28-30.

[15].  Ezeala, C. C., 2011, UniSkilling up medical laboratory technologists for higher roles in biomedical sciences: A needs analysis. African Journal of Health Professions Education 2011; 3(2):p3-5.

[16].  Magowe, M. K., Ledikwe, J. H., Kasvosve, I., Martin, R., Thankane, K., Semo, B. W., 2014, An innovative educational approach to professional development of medical laboratory scientists in Botswana. Adv Med Educ Pract 2014; 5:p73-81.

[17].  Halstead, D. C., Sautter, R. L., 2023, A Literature Review on How We Can Address Medical Laboratory Scientist Staffing Shortages. Lab Med 2023; 54(1):e31-e36.

[18].  Rebecca Donkin, Elizabeth Askew & Hollie Stevenson, 2019, Video feedback and e-Learning enhances laboratory skills and engagement in medical laboratory science students. BMC Medical Education. Volume 19, article number 310

[19].  Rita, M., Heuertz, 2011, Research in the Medical Laboratory Science Curriculum. Clinical Laboratory Science (Supplement). Vol 24

[20].  Kazerouni, F., and Shahrokhi, S. Z., 2023, Evaluating the Effectiveness of Internship Program of Medical Laboratory Students at Shahid Beheshti University of Medical Sciences, Archives of Advances in Biosciences, 14(1), pp. 1–7.

Abstract:

Traumatic diaphragmatic injuries are rare but pose significant diagnostic and management challenges, particularly in acute cases involving blunt trauma. These injuries often present non-specific symptoms, leading to misdiagnosis or delayed intervention. The right hemi diaphragm is less commonly affected than the left, and its involvement is frequently associated with liver herniation and concomitant abdominal or thoracic injuries. We present the case of a 28-year-old female who sustained a blunt thoracoabdominal trauma after being struck by a moving vehicle. She arrived at the emergency department with complaints of pain in the neck, left shoulder, left side of the chest, and right arm. Initial assessments revealed hemodynamic stability, a Glasgow Coma Scale (GCS) score of 15/15, and decreased breath sounds in the right lung field. Imaging studies, including chest X-ray, CT scan, and MRI, confirmed the right diaphragmatic rupture with liver herniation, lung contusion, and a liver laceration. Given the extent of the injury, the patient underwent a combined surgical approach: a right thoracotomy for lung and diaphragmatic repair and a median laparotomy for liver laceration management. The diaphragm was repaired with suturing and mesh placement. Postoperatively, she remained stable, requiring bronchoscopy for lung collapse before successful recovery and discharge on postoperative day 20. This case highlights the importance of early recognition, accurate imaging, and a tailored surgical approach for diaphragmatic rupture. A combined thoracoabdominal approach provides optimal exposure and repair, ensuring favorable outcomes. Further research is necessary to establish standardized guidelines for managing complex diaphragmatic injuries.

References:

[1].   Mahmoud, A. F., Raeia, M. M. E., Elmakarem, M. A. A., 2017, Rupture diaphragm: Early diagnosis and management. Journal of the Egyptian Society of Cardio-Thoracic Surgery, 25(2):163–170.

[2].   Fair, K. A., Gordon, N. T., Barbosa, R. R., Rowell, S. E., Watters, J. M., Schreiber, M. A., Traumatic diaphragmatic injury in the American College of Surgeons National Trauma Data Bank: A new examination of a rare diagnosis. Am J Surg.

[3].   Mahamid, A., Peleg, K., Givon, A., Alfici, R., Olsha, O., Israeli Trauma Group, Ashkenazi, I., 2017, Blunt traumatic diaphragmatic injury: A diagnostic enigma with potential surgical pitfalls. Am J Emerg Med., 35(2):214-217.

[4].   Shaban, Y., Elkbuli, A., McKenney, M., Boneva, D., 2020, Traumatic Diaphragmatic Rupture with Transthoracic Organ Herniation: A Case Report and Review of Literature. Am J Case Rep, 21:e919442.

[5].   Ahmad, G. F., Nabi, L. G., Chowdhary, M., Lone, H., 2013, The Characteristics and Surgical Approach in Post-Traumatic Diaphragmatic Hernia: A Single Center Experience. Bull Emerg Trauma., 1(3):108-111.

[6].   Vilallonga, R., Pastor, V., Alvarez, L., Charco, R., Armengol, M., Navarro, S., 2011, Right-sided diaphragmatic rupture after blunt trauma. World J Emerg Surg., 6:3.

[7].   Boulanger, B. R., Milzman, D. P., Rosati, C., Rodriguez, A., 1993, A comparison of right and left blunt traumatic diaphragmatic rupture. J Trauma., 35(2):255-260.

[8].   Furák, J., Athanassiadi, K., 2019, Diaphragm and transdiaphragmatic injuries. J Thorac Dis, 11(Suppl. 2):S152–S157.

[9].   Porojan, V. A., David, O. I., Coman, I. S., Coman, E. V., Draghici, D. A., Popescu, C., Paraschiv, M., Grigorean, V. T., 2019, Traumatic Diaphragmatic Lesions - Considerations Over a Series of 15 Consecutive Cases. Chirurgia (Bucur)., 114(1):73-82.

[10].  Ties, J. S., Peschman, J. R., Moreno, A., et al., 2014, Evolution in the management of traumatic diaphragmatic injuries: A multicenter review. J Trauma Acute Care Surg., 76(4):1024–1028.

[11].  Silva, G. P., Cataneo, D. C., Cataneo, A. J. M., 2018, Thoracotomy compared to laparotomy in the traumatic diaphragmatic hernia. Acta Cir Bras., 33(1):49-66.

[12].  Favre, J. P., Cheynel, N., Benoit, N., Favoulet, P., 2005, Traitement chirurgical des ruptures traumatiques du diaphragme. Encycl. Méd. Chir. (Elsevier, Paris-France), Techniques chirurgicales- Appareil digestif, Paris., 2:235–345.

[13].  Scharff, J. R., Naunheim, K. S., 2007, Traumatic diaphragmatic injuries. Thorac Surg Clin., 17:81–85.

Abstract:

Despite the availability of reliable and affordable measles vaccines, Nigeria is still experiencing low vaccination coverage, resulting in high cases of measles and related complication. This study assessed the determinants of caregivers’ knowledge and attitude towards measles and MCV2 in Adamawa State, Nigeria. A three-arm, parallel randomized control trial was conducted in four health facilities sampled through three-stage multistage sampling technique in Adamawa State. Semi-structured interviewer-administered questionnaire was administered to 351enrolled caregivers. Mean age of caregivers was 30.7 (SD±6.7); 212 (60.39%) of caregivers had good knowledge of measles and MCV2 and 265 (75.5%) had high level of positive attitude toward measles and MCV2. Major factors statistically associated with good knowledge of measles and MCV2 among caregivers include: age (X²=27.1, p-value=<0.001) marital status (X²=37.0, p-value=<0.001) and Family size (X²=15.1, p-value=<0.001). Factors statistically associated with positive attitude of mothers towards MCV2 include: marital status (X²=49.0, p-value=<0.001), religion (X²=73.3.0, p-value=<0.001) and occupation of caregiver (X²=11.1, p-value=<0.049) and factors associated with practice of timeliness towards MCV2 uptake were marital status, place of residence, and the age group of caregivers. Several factors influence caregivers' knowledge and attitude towards MCV2. Therefore, the Adamawa State government should implement measures to enhance measles vaccination coverage by increasing awareness of MCV2 through monitoring and addressing knowledge gaps on MCV2.

References:

[1].   Franconeri, L., Antona, D., Cauchemez, S., Lévy-Bruhl, D., Paireau, J., 2019, Two-dose measles vaccine effectiveness remains high over time: A French observational study 2017–2019, Vaccine 2023, 41(39):5797-5804, https://pubmed.ncbi.nlm.nih.gov/37586955/

[2].   World Health Organization, 2021, Immunization coverage, Fact Sheet 2021. Retrieved From https://www.who.int/news-room/fact-sheets/detail/immunization-coverage

[3].   World Health Organization, 2021, Implementing the Immunization Agenda 2030, WHO 2021:1–32, Retrieved from https://www.who.int/publications/m/item/implementing-the-immunization-agenda-2030

[4].   Mehedi, H. M., Soares, M. R., Ahmed, S., et al, 2021, Meeting the global target in reproductive, maternal, newborn, and child health care services in low- And middle-income countries, Glob Health Sci Pract., 8(4):654-665, https://pubmed.ncbi.nlm.nih.gov/33361233/

[5].   World Health Organization, 2020, Immunization Agenda 2030: a global strategy to leave no one behind, Retrieved from https://www.who.int/publications/m/item/immunization-agenda-2030-a-global-strategy-to-leave-no-one-behind/ (accessed March 17, 2024

[6].   Ward, J. L., Azzopardi, P. S., Francis, K. L., Santelli, J. S., Skirbekk, V., Sawyer, S. M., et al., 2019, Global, regional, and national mortality among young people aged 10–24 years, 1950–2019: a systematic analysis for the Global Burden of Disease Study 2019, The Lancet 2021, 398 (10311), 1593 - 1618 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01546-4/fulltext

[7].   Nigeria Economic Summit Group, 2021, Health Vaccine Policy, Received from https://nesgroup.org/download_policy_drafts/Nigeria%20Vaccine%20Policy%20%282021%29_Draft%20I_1661875592.pdf

[8].   World Health Organization, 2021, Development of Vaccines, Retrieved from https://www.googleadservices.com/pagead/aclk?sa=L&ai=DChcSEwjPlPbWnqaIAxXWl4MHHWBpAPcYABAAGgJlZg&co=1&ase=2&gclid=CjwKCAj

[9].   Wariri, O., Nkereuwem, E., Erondu, N. A., Edem, B., Nkereuwem, O. O., Idoko, O. T., et al., 2021, A scorecard of progress towards measles elimination in 15 west African countries, 2001–19: a retrospective, multi-country analysis of national immunisation coverage and surveillance data, Lancet Glob Health, 9(3), e280-e290 https://pubmed.ncbi.nlm.nih.gov/33607028/

[10].  Adamawa State Government, 2020, Adamawa State Situation Analysis of Children, Retrieved from https://adspc.ad.gov.ng/wp-content/uploads/2024/01/Adamawa-State-Child-Situation-Analysis-SitAn.pdf

[11].  Durrheim, D. N., 2020, Measles eradication - retreating is not an option, Lancet Infect Dis 2020; 20(6), e138-e14120, https://pubmed.ncbi.nlm.nih.gov/32197095/

[12].  World Health Organization, 2019, More than 140,000 die from measles as cases surge worldwide, Retrieved from https://www.who.int/news/item/05-12-2019-more-than-140-000-die-from-measles-as-cases-surge-worldwide

[13].  Wang, R., Jing, W., Liu, M., Liu, J., 2021, Trends of the Global, Regional, and National Incidence of Measles, Vaccine Coverage, and Risk Factors in 204 Countries From 1990 to 2019, Front Med (Lausanne), 8(2), 205-207, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8810814/

[14].  Utazi, C. E., Aheto, J. M., Wigley, A., Tejedor-Garavito, N., Bonnie, A., Nnanatu, C., et al., 2023, Mapping the distribution of zero-dose children to assess the performance of vaccine delivery strategies and their relationships with measles incidence in Nigeria, Vaccine 2023, 41(1), 170-181 https://www.sciencedirect.com/science/article/pii/S0264410X22014207

[15].  Ehlman, D. C., Magoola, J., Tanifum, P., Wallace, A. S., Behumbiize, P., Mayanja, R., et al., 2021, Evaluating a mobile phone–delivered text message reminder intervention to reduce infant vaccination dropout in Arua, Uganda: Protocol for a randomized controlled trial, JMIR Res Protoc, 10(2), 17262 -17263, https://pubmed.ncbi.nlm.nih.gov/33625372/

[16].  Lwanga, S. K., Lemeshow, S., 1991, Sample Size Determination in Health Studies. Biometrics 1991;47 (2), 36-42, https://tbrieder.org/publications/books_english/lemeshow_samplesize.pdf

[17].  Dalaba, M. A., Ane, J., Bobtoya, H. S., 2023, Factors contributing to low second dose measles-rubella vaccination coverage among children aged 18 to 59 months in Bolgatanga Municipality of Ghana: a cross-sectional study, Journal of Global Health Science, 5(1), 2671-2923, https://www.e-jghs.org/pdf/10.35500/jghs.2023.5.e11

[18].  Oluseye, O. M., Jimoh, N. A., Ogunleye, C. A., 2021, Knowledge and Attitude of Mothers towards Measles, Mumps and Rubella MMR) Vaccine in Idi- Aba Community Abeokuta, Nigeria, Open Journal of Medical Research, 2(2), 136–148. https://www.openjournalsnigeria.org.ng/pub/ojmr0202006-259.pdf

[19].  Taiwo, B., Abidemi, L., 2017, Knowledge, Perception, Practice and Sources of information on Immunization among mothers/Caregivers of Children Aged 12-23 months in Kaduna State, Nigeria, 9(1), 168-170, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5462320/

[20].  Adedire, E. B., Ajumobi, O., Bolu, O., Nguku, P., Ajayi, I., 2021, Maternal knowledge, attitude, and perception about childhood routine immunization program in Atakumosa-west Local Government Area, Osun State, Southwestern Nigeria. Pan Afr Med J, 40(1), 8-10, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9474928/

[21].  Owais, A., Hanif, B., Siddiqui, A. R., Agha, A., Zaidi, A. K., 2011, Does improving maternal knowledge of vaccines impact infant immunization rates? A community-based randomized-controlled trial in Karachi, Pakistan, BMC Public Health, 11 (1), 238-239, https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-11-239

[22].  Uwaibi, N. E., Akhimienho, I. K., 2020, Assessment of knowledge and practice of childhood routine immunization among mothers/caregivers attending primary health care centres in Benin City, Nigeria, Journal of Applied Sciences and Environmental Management, 24 (10), 1703–1710, https://www.semanticscholar.org/paper/Assessment-of-knowledge-and-practice-of-childhood-Uwaibi-Akhimienho/89b9ffa2659edf5ffe8a83b4f204ab4a5e1f2959

[23].  Tagbo, B., Uleanya, N., Nwokoye, I., Eze, J., Omotowo, I., 2012, Mothers’ knowledge, perception and practice of childhood immunization in Enugu, Niger J Paediatr, 39 (3), 314-318, https://www.researchgate.net/publication/272338782_Mothers'_knowledge_perception_and_practice_of_childhood_immunization_in_Enugu

[24].  Pulcini, C., Massin, S., Launay, O., Verger, P., 2014, Knowledge, attitudes, beliefs and practices of general practitioners towards measles and MMR vaccination in southeastern France in 2012, Clinical Microbiology and Infection, 20(1), 38–43, https://pubmed.ncbi.nlm.nih.gov/23517454/

[25].  Htike, A. Z., Aung, S. M., Win, O. M., 2020, Maternal Knowledge on Routine Childhood Immunization: A Community Based Cross-sectional Study in Rural Area of Mon State, Myanmar, Asian Journal of Research in Infectious Diseases, 3(2), 1–9, https://journalajrid.com/index.php/AJRID/article/view/54

[26].  Shaheen, A., Afzal, M., Majeed, I., Amir Gilani, S., 2019, Mother’s Knowledge and Attitude Towards Childhood Immunization in a Rural Community, Global Scientific Journals, https://www.globalscientificjournal.com/researchpaper/Mother_s_knowledge_and_attitude_towards_childhood_immunization_in_a_rural_community.pdf

[27].  Cockcroft, A., Usman, M. U., Nyamucherera, O. F., Emori, H., Duke, B., Umar, N. A., et al., 2014, Why children are not vaccinated against measles: A cross-sectional study in two Nigerian States, Archives of Public Health, 72(1), 48-50, https://archpublichealth.biomedcentral.com/articles/10.1186/2049-3258-72-48

[28].  Weiss, C., Schröpfer, D., Merten, S., 2016, Parental attitudes towards measles vaccination in the canton of Aargau, Switzerland: A latent class analysis, BMC Infect Dis, 16(1), 400 -405, https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-016-1747-0

Abstract:

This study explores the impact of COVID-19 on the supervision of the English Language Curriculum in Ghanaian primary schools, emphasizing practical strategies for enhancing teachers' professional development and students' academic performance. Utilizing desk research, the study synthesizes secondary data from peer-reviewed sources. The findings highlight that while COVID-19 disrupted traditional supervision methods, innovative approaches and strong leadership facilitated continued professional development and problem-solving among teachers. The research suggests adopting blended supervision methods incorporating virtual platforms and recommends flexible and democratic supervision strategies to address challenges posed by the pandemic. Training policymakers, supervisors, and teachers in utilizing digital platforms for effective curriculum supervision is essential.

References:

Abstract:

The illegal wildlife trade is one of the biggest dangers to biodiversity worldwide, especially in Zambia, where human activities threaten many species. In 1973, several nations developed the Convention on International Trade in Endangered Animals of Wild Fauna and Flora to combat the unlawful trade in endangered animals. This study examines how capacity training improves CITES stakeholder coordination and collaboration in Zambia to protect wildlife. A key goal of the study was to evaluate how well capacity building has improved CITES enforcement agency coordination in Zambia. The study studied Management Authority collaboration arrangements, training program performance, and stakeholder efforts to promote inter-agency coordination. We collected qualitative and quantitative data using a mixed-method approach. Interviews and questionnaires with former CITE capacity-building program participants and organizers provided primary data. This strategy assessed stakeholder collaboration and training program effectiveness. According to the report, the lack of institutional rules and collaboration mechanisms has prevented capacity building from improving CITES stakeholder coordination in Zambia. Though well-structured, training programs lacked practical elements and did not strengthen stakeholder interactions. Policy reforms and more hands-on, practical training are needed to improve inter-agency coordination. Successful CITES implementation in Zambia requires stronger collaboration and commitment from all enforcement authorities to conserve wildlife and biodiversity.

References:

[1].   Jones, S., Taylor, L., 2022, The Application of Forensic Science in Wildlife Crime Investigation. Journal of Wildlife Protection, vol. 34, no. 2, pp. 126-137.

[2].   Gaile, B., Chundama, M., 2005, UNDP, December 2005. [Online]. Available: https://erc.undp.org/evaluation/documents/download/242.

[3].   CBD, 2016, BIODIVERSITY IN ZAMBIA, ITS SIGNIFICANCE AND MANAGEMENT, September 2016. [Online]. Available: https://zm.chm-cbd.net/sites/zm/files/2022-05/2nd_cbd_national_report__narrative__Rev2.pdf. [Accessed 2024].

[4].   CITES, CITES, 2006, [Online]. Available: https://cites.org/sites/default/files/eng/cop/17/Com_II/E-CoP17-Com-II-25.pdf.

[5].   WWF Zambia., 2021, Worldwide Fund for Nature Zambia, 24 November 2021. [Online]. Available: https://www.wwfzm.panda.org/?37442/WWF-Zambia-and-GIZ-Zambias-Water-and-Energy-Cluster-sign-a-relationship-agreement-to-enhance-protection-of-Zambias-water-resources. [Accessed 2024].

[6].   DNPW, 2024, Department of National and Wildlife (DNPW). [Online]. Available: https://www.mot.gov.zm/dnpw/. [Accessed 2024].

[7].   Martin, H., 2020, Our Impact on Wildlife. Worldwide Fund (WWF) for Nature Zambia.

[8].   UNEP., 2019, [Online]. Available: https://www.unep.org/resources/unep-annual-report-2019. [Accessed 2024].

[9].   Hitchcock, R. H., African Wildlife: Conservation and Conflict. In Life and Death Matters, Routledge, p. 81;99.

[10].  Henson, S., Moigne F. L., Giering, S., 2019, Drivers of Carbon Export Efficiency in the Global Ocean, vol. 33, no. 7, 2019.

[11].  Towler, A., Dipboye, R., 2001, Effects of trainer expressiveness, organization, and trainee goal.

[12].  WCO, 2017, Project INAMA: situation analysis and first results. [Online]. Available: https://mag.wcoomd.org/magazine/wco-news-82/project-inama-situation-analysis-and-first-results. [Accessed 2024].

[13].  Reeve R., 2003, Enhancing the International Regime for Protecting Endangered Species: The Example.

[14].  Augustine, S., Carl, J. B., 2004, Strengthening the Weakest Link: Strategies for Improving Wildlife Management.

[15].  Benard, L., 2002, Training Needs Assessment: A Must for Developing an Effective Training Program.

[16].  GEF, 2019, Effective Management of the National Protected Areas System. [Online]. Available: https://www.thegef.org/projects-operations/projects/1268.

[17].  Lewis, k., Verlemu, A., 2014, Global Impacts of the Illegal Wildlife Trade: The Costs of Crime, insecurity and industrial elusion.

[18].  Chinese Academy of Forestry, 2023, China’s Role In Global Forestry Conservation. Beijing: Chinese Academy of Forestry.

[19].  Zambia Statistics Agency, 2022, [Online]. Available: https://www.zamstats.gov.zm/2022-census/.

[20].  World Bank., The World Bank in Zambia, 2023, [Online]. Available: https://www.worldbank.org/en/country/zambia/overview. [Accessed 2024].

Abstract:

The research explored the effects and the impact of business data breaches on brand reputation and employee integrity, using the 2019 Desjardins Group Canada breach as a case study. The breach in question compromised personally identifiable information of over 9.7 million customers and Desjardins members, revealing vulnerability in data security, governance, and organizational culture. In addition to financial losses, the incident eroded client trust and loyalty, created an internal crisis and uncertainty within the organization. The research examines the effects of the breach on stakeholder confidence, business resilience, and employee morale using a mixed research approach which includes interviews, surveys, and secondary data analysis. The research reveals a significant decline in public trust, financial impacts, and brand damage. Employees faced increased stress levels, low morale, and declining confidence in leadership, which highlighted the human toll of cybersecurity failures. The research explores how perceived risks and threats, protective measures, and trust dynamics can influence stakeholder responses. It emphasizes the necessity of a clear crisis management process, transparency, and robust cybersecurity frameworks to mitigate the adverse effects of data breaches. Organizations that acted swiftly and communicated transparently could restore stakeholder trust and confidence. To enhance information security, businesses should invest in governance, employee training, and cultivate a security-focused culture. Additionally, policymakers should advocate for stringent data protection laws and regulations, mandatory breach disclosures, and cross-sector collaboration to strengthen cybersecurity resilience. This research offers valuable insights for businesses, regulators, and scholars confronting cybersecurity risks and threats in an increasingly digital landscape.

References:

[1].   Alazab, M., Broadhurst, R., Bou-Harb, E., & Hutchings, A., 2015, Cybercrime: Risks and Responses. International Journal of Cyber Criminology, 9(2), 143-159.

[2].   Arcuri, A., 2015, The Impact of Data Breaches on Customer Trust: A Comparative Analysis. Journal of Business Ethics, 127(3), 491-504.

[3].   Barney, J., 1991, Firm Resources and Sustained Competitive Advantage. Journal of Management, 17(1), 99-120.

[4].   N. Kshetri, Recent US cybersecurity policy initiatives: challenges and implications, Computer, 48 2015

[5].   D. Massa, R., Valverde, A fraud detection system based on anomaly intrusion detection for E-commerce applications, Comput Inf Sci, 7 2024.

[6].   Braun, V., & Clarke, V., 2006, Using Thematic Analysis in Psychology. Qualitative Research in Psychology, 3(2), 77-101.

[7].   Cavusoglu, H., Mishra, B., & Raghunathan, S., 2004, The Effect of Internet Security Breach Announcements on Market Value: Capital Market Reactions for Breached Firms and Internet Security Developers. International Journal of Electronic Commerce, 9(1), 69-104.

[8].   Gatzlaff, K. M., & McCullough, K. A., 2010, The Effect of Data Breaches on Shareholder Wealth. Risk Management and Insurance Review, 13(1), 61-83.

[9].   Gordon, L. A., Loeb, M. P., & Zhou, L., 2010, The Impact of Information Security Breaches: Has There Been a Downward Shift in Costs? Journal of Computer Security, 19(1), 33-56.

[10].  Herath, T., & Rao, H. R., 2009, Encouraging Information Security Behaviors in Organizations: Role of Penalties, Pressures, and Perceived Effectiveness. Decision Support Systems, 47(2), 154-165.

[11].  ISO/IEC. 2013. ISO/IEC 27001: Information Security Management. International Organization for Standardization.

[12].  Lwin, M. O., Wirtz, J., & Williams, J. D., 2017, Consumer Online Privacy Concerns and Responses: A Power-Responsibility Equilibrium Perspective. Journal of the Academy of Marketing Science, 35(4), 572-585.

[13].  Mayer, R. C., Davis, J. H., & Schoorman, F. D., 1995, An Integrative Model of Organizational Trust. Academy of Management Review, 20(3), 709-734.

[14].  Mitropoulos, S., Patsakis, C., & Douligeris, C., 2006, Incident Response Planning: The Critical Role of Crisis Communication. Journal of Information Security, 7(2), 137-147.

[15].  NIST. 2018, Framework for Improving Critical Infrastructure Cybersecurity. National Institute of Standards and Technology.

[16].  Ponemon Institute. 2019, Cost of a Data Breach Report 2019. IBM Security.

[17].  Ponemon Institute. 2020, 2020 Data Breach Investigations Report. Verizon.

[18].  Rogers, R. W., 1975, A Protection Motivation Theory of Fear Appeals and Attitude Change. Journal of Psychology, 91(1), 93-114.

[19].  Romanosky, S., 2016, Examining the Costs and Causes of Cyber Incidents. Journal of Cybersecurity, 2(2), 121-135.

[20].  Samarati, P., & De Capitani di Vimercati, S., 2001, Access Control: Policies, Models, and Mechanisms. Foundations of Security Analysis and Design, 2171, 137-196.

[21].  M. Loganathan, E. Kirubakaran, A study on Cyber Crimes and protection, Int J Comput Sci Issue, 18 2021 7-35.

[22].  Stallings, W., 2013, Network Security Essentials: Applications and Standards. Pearson Education.

[23].  Von Solms, B., & Von Solms, R., 2004, The 10 Deadly Sins of Information Security Management. Computers & Security, 23(5), 371-376.

[24].  Whitener, E. M., Brodt, S. E., Korsgaard, M. A., & Werner, J. M., 1998, Managers as Initiators of Trust: An Exchange Relationship Framework for Understanding Managerial Trustworthy Behavior. Academy of Management Review, 23(3), 513-530.

[25].  Yin, R. K., 2014, Case Study Research: Design and Methods. Sage Publications.

[26].  Elhoseny, M., Darwiesh, A., El-Baz, A. H., Rodrigues, J. J., Enhancing cryptocurrency security using AI risk management model. IEEE Consum Electron Mag. 2023;13(1):48–53. doi: 10.1109/MCE.2023.3238848.

[27].  Osamy, W., Khedr, A. M., Salim, A., AlAli, A. I., El-Sawy, A. A., Recent studies utilizing artificial intelligence techniques for solving data collection, aggregation and dissemination challenges in wireless sensor networks: A review. Electronics. 2022;11(3):313. doi: 10. 3390/electronics11030313.

[28].  Amaldi, E., Capone, A., Cesana, M., Filippini, I., Malucelli, F., Optimization models and methods for planning wireless mesh networks. Comput Networks. 2008;52(11):2159–71. doi: 10.1016/j.comnet.2008.02.020.

[29].  Bentotahewa, V., Hewage, C., Williams, J., Solutions to Big Data privacy and security challenges associated with COVID-19 surveillance systems. Front Big Data. 2021; 4:645204. doi: 10.3389/fdata.2021.645204

[30].  Nawaf, L., Optimizing IoT security by implementing Artificial Intelligence – Infosecurity Magazine; June 2022, [online]. https://www.

[31].  Bago, P., Cyber security and artificial intelligence. Economy Finance. 2023;10(2):189–212. doi: 10.33908/ef.2023.2.5.

[32].  Office of the Privacy Commissioner of Canada. 2020, Commissioner’s findings: Investigation into Desjardins’ handling of a data breach. Office of the Privacy Commissioner of Canada. https://www.priv.gc.ca/en/opc-actions-and-decisions/investigations/investigations-into-businesses/2020/pipeda-2020-005/

[33].  Office of the Privacy Commissioner of Canada. 2020, December 14. Statement from the Privacy Commissioner of Canada on the government’s response to the Desjardins investigation. Office of the Privacy Commissioner of Canada. https://www.priv.gc.ca/en/opc-news/speeches-and-statements/2020/s-d_20201214/

[34].  Office of the Privacy Commissioner of Canada. 2020, December 14. The government response to Desjardin's investigation is a step forward, but stronger privacy laws are still needed. Office of the Privacy Commissioner of Canada. https://www.priv.gc.ca/en/opc-news/news-and-announcements/2020/nr-c_20121

Abstract:

Coronary artery disease (CAD) in older adults presents unique therapeutic challenges due to increased frailty, comorbid conditions, and procedural risk. As life expectancy rises globally, the burden of multivessel disease in elderly patients is growing, yet this group remains underrepresented in major clinical trials. Historically, revascularization strategies in these patients have leaned toward conservative or culprit-lesion-only percutaneous coronary intervention (PCI), driven by concerns over bleeding, renal dysfunction, and procedural complications. However, the FIRE trial—the first randomized clinical trial dedicated exclusively to patients aged 75 years and older with myocardial infarction and multivessel disease—provides pivotal evidence in favor of complete revascularization. This article evaluates the findings of the FIRE trial with support from landmark studies such as the COMPLETE trial, large national registries including BCIS and SCAAR, and contemporary meta-analyses. Results demonstrate that complete PCI in elderly patients significantly reduces the risk of the composite primary outcome, including death, myocardial infarction, stroke, and ischemia-driven revascularization, without a corresponding increase in bleeding or adverse procedural events. These findings support a paradigm shift in the management of elderly patients with multivessel CAD, positioning complete PCI as a superior strategy when guided by clinical judgment and modern interventional techniques.

References:

[1].   Biscaglia, S., Guiducci, V., Escaned, J., Moreno, R., Lanzilotti, V., et al., 2023, Complete or Culprit-Only PCI in Older Patients with Myocardial Infarction. The New England Journal of Medicine, 389(10), 889–898, https://doi.org/10.1056/NEJMoa2300468

[2].   Sinclair, H., Batty, J. A., Qiu, W., & Kunadian, V., 2016, Engaging older patients in cardiovascular research: Observational analysis of the ICON-1 study. Open Heart, 3(2), e000436, https://doi.org/10.1136/openhrt-2016-000436

[3].   Madhavan, M. V., Gersh, B. J., Alexander, K. P., Granger, C. B., & Stone, G. W., 2018, Coronary artery disease in patients ≥80 years of age. Journal of the American College of Cardiology, 71(18), 2015–2040, https://doi.org/10.1016/j.jacc.2017.12.068

[4].   Forman, D. E., Maurer, M. S., Boyd, C., Brindis, R., Salive, M. E., et al., 2018, Multimorbidity in older adults with cardiovascular disease. Journal of the American College of Cardiology, 71(19), 2149–2161, https://doi.org/10.1016/j.jacc.2018.03.022

[5].   Mehta, S. R., Wood, D. A., Storey, R. F., Mehran, R., Bainey, K. R., et al.,2019, Complete revascularization with multivessel PCI for myocardial infarction. The New England Journal of Medicine, 381(15), 1411–1421, https://doi.org/10.1056/NEJMoa1907775

[6].   Rich, M. W., Chyun, D. A., Skolnick, A. H., Alexander, K. P., Forman, D. E., et al., 2016, Knowledge gaps in cardiovascular care of the older adult population. Circulation, 133(21), 2103–2122, https://doi.org/10.1161/CIR.0000000000000380

[7].   Biscaglia, S., Guiducci, V., Santarelli, A., Amat Santos, I., Fernandez-Aviles, F., et al., 2020, Physiology-guided revascularization versus optimal medical therapy of nonculprit lesions in elderly patients with myocardial infarction: Rationale and design of the FIRE trial. American Heart Journal, 229, 100–109, https://doi.org/10.1016/j.ahj.2020.08.007

[8].   Pavasini, R., Biscaglia, S., Barbato, E., Tebaldi, M., Dudek, D., et al., 2020, Complete revascularization reduces cardiovascular death in patients with ST-segment elevation myocardial infarction and multivessel disease: Systematic review and meta-analysis of randomized clinical trials. European Heart Journal, 41(42), 4103–4110, https://doi.org/10.1093/eurheartj/ehz896

[9].   Lindstrom, M., DeCleene, N., Dorsey, H., Fuster, V., Johnson, C. O., et al., 2022, Global burden of cardiovascular diseases and risks collaboration, 1990–2021. Journal of the American College of Cardiology, 80(25), 2372–2425, https://doi.org/10.1016/j.jacc.2022.11.001

[10].  Tsao, C. W., Aday, A. W., Almarzooq, Z. I., Anderson, C. A. M., Arora, P., et al., 2023, American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee, Heart disease and stroke statistics-2023 update. Circulation, 147(8), e93–e621, https://doi.org/10.1161/CIR.0000000000001123

[11].  Joshi, F. R., Lønborg, J., Sadjadieh, G., Helqvist, S., Holmvang, L., et al., 2021, The benefit of complete revascularization after primary PCI for STEMI is attenuated by increasing age: Results from the DANAMI-3-PRIMULTI randomized study. Catheterization and Cardiovascular Interventions, 97(4), E467–E474, https://doi.org/10.1002/ccd.29131

[12].  Biscaglia, S., Erriquez, A., Serenelli, M., D'Ascenzo, F., De Ferrari, G., 2022, Complete versus culprit-only strategy in older MI patients with multivessel disease. Catheterization and Cardiovascular Interventions, 99(4), 970–978, https://doi.org/10.1002/ccd.30075

[13].  Elgendy, I. Y., Mahmoud, A. N., Kumbhani, D. J., Bhatt, D. L., & Bavry, A. A., 2017, Complete or culprit-only revascularization for patients with multivessel coronary artery disease undergoing percutaneous coronary intervention: A pairwise and network meta-analysis of randomized trials. JACC: Cardiovascular Interventions, 10(4), 315–324, https://doi.org/10.1016/j.jcin.2016.11.047

Abstract:

Tobacco smoking is one of the leading preventable causes of illness and death worldwide. Its prevalence continues to rise in many low- and middle-income countries, including Zambia. This study aimed to assess the knowledge, attitudes, and practices regarding tobacco smoking among pupils aged 14–20 years at Kalomo Secondary School in Kalomo District, Southern Province, Zambia. A descriptive cross-sectional study design was used, involving 273 pupils who were selected using simple random sampling. Data were collected using a structured questionnaire and analyzed with SPSS version 25. Descriptive statistics were used to summarize key findings, while chi-square tests were applied to determine the relationship between knowledge, attitudes, practices, and smoking behavior. The data collection tools were piloted at Zimba Secondary School, and ethical approval was obtained prior to the study. The study revealed that most pupils had limited knowledge about the harmful effects of smoking. While 51% knew that smoking could cause heart disease, stroke, and impotence, only 26% linked it to lung diseases. Additionally, 13% of the respondents disagreed, and 10% were unsure about the health risks of smoking. Although many pupils expressed negative attitudes towards smoking, their attitudes did not always correspond with their level of knowledge. Despite being aware of some dangers, a significant number of pupils were still practicing smoking. The findings showed a strong association between smoking behavior and pupils' knowledge. e (χ² = 40.28, p = 0.000), attitudes (χ² = 5.59, p = 0.018), and practices (χ² = 15.90, p = 0.001).

References:

Abstract:

Documentation serves as a critical written record of patient care, including assessments, interventions, and outcomes. However, healthcare systems in Cameroon, including Cite Verte District Hospital in Yaoundé, face significant documentation gaps, potentially compromising patient safety and care. This study assessed the quality of nursing documentation for inpatients at this hospital. A retrospective descriptive cross-sectional design was employed, using a mixed-method approach. Quantitative data were collected from 300 patient records, while qualitative insights were gathered through interviews with nine nurses. Findings revealed inconsistencies in documentation completeness across various categories. While patient identification details were generally recorded, discrepancies existed, with 51% missing patient contact information and 0% personnel signatures. Admission records showed deficiencies in patient education (10.33%) and personnel signatures (12.33%). Vital signs documentation had critical gaps, particularly in pediatric units where BP was unrecorded (0%). Qualitative findings highlighted diverse nursing perspectives on documentation, recognizing its importance yet facing challenges such as high workload, staff shortages, inadequate training, and inconsistent practices. Proposed strategies for improvement included increasing staffing levels, implementing routine documentation audits, providing continuous training, and emphasizing the importance of accurate record-keeping. It is thus essential to address both organizational challenges and individual behaviors to ensuring complete, accurate, and high-quality nursing documentation.

References:

[1] Ebbers, T., Kool, R. B., Smeele, L. E., Dirven, R., den Besten, C. A., Karssemakers, L. H. E., Verhoeven, T., Herruer, J. M., van den Broek, G. B., & Takes, R. P., 2022. The impact of structured and standardized documentation on documentation quality: A multicenter, retrospective study. Journal of Medical Systems, 46(7), 46. https://doi.org/10.1007/s10916-022-01837-9

[2] Keenan, G. M., Yakel, E., Tschannen, D., & others., 2008. Documentation and the nurse care planning process. In R. G. Hughes (Ed.), Patient safety and quality: An evidence-based handbook for nurses (Chapter 49). Agency for Healthcare Research and Quality (US). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK2674

[3] Demsash, A. W., Kassie, S. Y., Dubale, A. T., Chereka, A. A., Ngusie, H. S., Hunde, M. K., Emanu, M. D., Shibabaw, A. A., & Walle, A. D., 2023. Health professionals' routine practice documentation and its associated factors in a resource-limited setting: A cross-sectional study. BMJ Health Care Informatics, 30(1), e100699. https://doi.org/10.1136/bmjhci-2022-100699

[4] Faulkenberry, J. G., Luberti, A., & Craig, S., 2022. Electronic health records, mobile health, and the challenge of improving global health. Current Problems in Pediatric and Adolescent Health Care, 52(1), 101111.

[5] Bunting, J., & de Klerk, M., 2022. Strategies to improve compliance with clinical nursing documentation guidelines in the acute hospital setting: A systematic review and analysis. SAGE Open Nursing, 8, 23779608221075165. https://doi.org/10.1177/23779608221075165

[6] Martin, C. W., Emenyonu, N., Achieng, M., Shen, C., Ssali, J., Masaba, J. P. M., & Tierney, W. M., 2010. Evaluating a scalable model for implementing electronic health records in resource-limited settings. Journal of the American Medical Informatics Association, 17(3), 237–244. https://doi.org/10.1136/jamia.2009.002303

[7] O'Connor, S., O'Donoghue, J., Gallagher, J., & others., 201. Unique challenges experienced during the process of implementing mobile health information technology in developing countries. BMC Health Services Research, 14(2), 3323. https://doi.org/10.1186/1472-6963-14-S2-P87

[8] Sarkies, M., Francis-Auton, E., Long, J., Roberts, N., Westbrook, J., Levesque, J. F., Watson, D. E., Hardwick, R., Sutherland, K., Disher, G., Hibbert, P., Braithwaite, J., 2023., Audit and feedback to reduce unwarranted clinical variation at scale: A realist study of implementation strategy mechanisms. Implementation Science, 18(1), 71. https://doi.org/10.1186/s13012-023-01324-w

[9] Adeyemi, O., 2024. Exploring nurses' attitude and perception towards documentation. Seminar, A&H School of Health Care Management, Cameroon. Retrieved from https://www.researchgate.net/publication/388484570_Exploring_Nurses'_Attitude_and_Perception_Towards_Documentation_Seminar_AH_School_of_health_care_managementCameroon

[10] Factors and challenges influencing the acquisition of clinical skills by student nurses during internship in Buea Health District, Cameroon. Retrieved from https://medcraveonline.com/NCOAJ/factors-and-challenges-influencing-the-acquisition-of-clinical-skills-by-student-nurses-during-internship-in-buea-health-district-cameroon.html

[11] World Health Organization. 2012. Management of patient information: Trends and challenges in Member States. Global Observatory for eHealth series - Volume 6. Geneva: World Health Organization.

[12] Texila International Journal of Nursing. 2015. Barriers to the application of the nursing process in the Regional Hospital Bamenda-Cameroon. Texila International Journal of Nursing, 6(2), 7. https://doi.org/10.21522/TIJNR.2015.06.02.Art007

[13] Factors affecting effective documentation by nurses and midwives in five maternities of Buea Health District. Retrieved from https://www.researchkey.net/factors-affecting-effective-documentation-by-nurses-and-midwives-in-five-maternities-of-buea-health-district

[14] Foba, M. S., Liforter, K. N., & Atanga, M. B. S., 2024. Interventions mostly needed for in-service training of nurses on effective use of standardized documents. International Journal of Recent Advances in Multidisciplinary Research, 11(9), 10266–10270.

[15] Tamfon, B. B., Bilounga Ndongo, C., Bataliack, S. M., Ngoufack, M. N., & Nguefack-Tsague, G., 2020. Routine health information system in the health facilities in Yaoundé-Cameroon: Assessing the gaps for strengthening. BMC Medical Informatics and Decision Making, 20(1), 316. https://doi.org/10.1186/s12911-020-01351-3

[16] Mutshatshi, T. E., Mothiba, T. M., Mamogobo, P. M., & Mbombi, M. O., 2018. Record-keeping: Challenges experienced by nurses in selected public hospitals. Curationis, 41(1), e1-e6. https://doi.org/10.4102/curationis.v41i1.1931

[17] Ahmed, S. S., Mostafa, G. M. A., & Yassein, N. H., 2023. Effect of clinical documentation training program on nursing personnel's documentation skills. International Journal of Clinical and Biomedical Sciences, 24(9), 116-124.

[18] Tadzong-Awasum, G., Mbene, M. G., Dufashwenayesu, A., Kaba Andzouana, B., & Menyene Ndongo, S., 2022. Nurses’ experiences with the adoption and use of the nursing process in four urban hospitals in Yaoundé, Cameroon. International Journal of Africa Nursing Sciences, 16(3), 100411. https://doi.org/10.1016/j.ijans.2022.100411

[19] Ebbers, T., Kool, R. B., Smeele, L. E., Dirven, R., den Besten, C. A., Karssemakers, L. H. E., Verhoeven, T., Herruer, J. M., van den Broek, G. B., & Takes, R. P., 2022. The impact of structured and standardized documentation on documentation quality: A multicenter, retrospective study. Journal of Medical Systems, 46(7), 46. https://doi.org/10.1007/s10916-022-01837-9

[20] Samimi Kalat, M., Ramezani, M., Heshmati Nabavi, F., & Saki, A., 2019. Investigation the suitability of patient education pamphlets and patient satisfaction among teaching hospitals in 2015. Evidence Based Care, 8(4), 45-51.

[21] Sarkies, M., Francis-Auton, E., Long, J., et al., 2023. Audit and feedback to reduce unwarranted clinical variation at scale: A realist study of implementation strategy mechanisms. Implementation Science, 18(1), 71. https://doi.org/10.1186/s13012-023-01324-w

Abstract:

Oral semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1RA), is a novel agent that offers glycemic control in an oral formulation while extending benefits into the cardiovascular domain. Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in patients with type 2 diabetes mellitus (T2DM), particularly among those with prior atherosclerotic events, heart failure, or renal impairment. The (Semaglutide cardiovascular outcomes in people with type 2 diabetes using oral semaglutide compared with placebo) SOUL trial was designed to evaluate the cardiovascular safety and efficacy of oral semaglutide in this high-risk population. This randomized, double-blind, placebo-controlled trial enrolled 9,650 participants and followed them for a median of 49.5 months. A major adverse cardiovascular event (MACE) occurred in 12.0% of semaglutide-treated patients and 13.8% of those receiving placebo (HR 0.86; 95% CI, 0.77–0.96; p=0.006). Additionally, semaglutide significantly reduced nonfatal myocardial infarction (HR 0.74; 95% CI, 0.61–0.89). Secondary outcomes included fewer major adverse limb events (HR 0.71; 95% CI, 0.52–0.96) and a favorable trend in kidney events (HR 0.91; 95% CI, 0.80–1.05). Semaglutide also improved metabolic outcomes, lowering HbA1c by 1.2% and body weight by 4.1 kg versus placebo. Serious adverse events were lower with semaglutide (47.9%) compared to placebo (50.3%). The SOUL trial affirms oral semaglutide’s role as a dual action cardiometabolic agent. Its oral formulation, safety profile, and durable efficacy make it a valuable option for high-risk T2DM patients unwilling or unable to use injectable therapies.

References:

[1].   McGuire, D. K., Marx, N., Mulvagh, S. L., Deanfield, J. E., Inzucchi, S. E., Pop-Busui, R., Mann, J. F. E., Emerson, S. S., Poulter, N. R., Engelmann, M. D. M., Ripa, M. S., Hovingh, G. K., Brown-Frandsen, K., Bain, S. C., Cavender, M. A., Gislum, M., David, J. P., Buse, J. B., & SOUL Study Group, 2025, Oral Semaglutide and Cardiovascular Outcomes in High-Risk Type 2 Diabetes. The New England Journal of Medicine, https://doi.org/10.1056/NEJMoa2501006

[2].   Marso, S. P., Bain, S. C., Consoli, A., Eliaschewitz, F. G., Jódar, E., Leiter, L. A., Lingvay, I., Rosenstock, J., Seufert, J., Warren, M. L., Woo, V., Hansen, O., Holst, A. G., Pettersson, J., Vilsbøll, T., & SUSTAIN-6 Investigators, 2016, Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. The New England Journal of Medicine, 375(19), 1834–1844, https://doi.org/10.1056/NEJMoa1607141

[3].   Overgaard, R. V., Delff, P. H., Petri, K. C. C., Anderson, T. W., Flint, A., & Ingwersen, S. H., 2019, Population Pharmacokinetics of Semaglutide for Type 2 Diabetes. Diabetes Therapy, 10(2), 649–662, https://doi.org/10.1007/s13300-019-0581-y

[4].   McGuire, D. K., Busui, R. P., Deanfield, J., et al., 2023, Effects of oral semaglutide on cardiovascular outcomes in individuals with type 2 diabetes and established atherosclerotic cardiovascular disease and/or chronic kidney disease: Design and baseline characteristics of SOUL, a randomized trial. Diabetes, Obesity & Metabolism, 25(7), 1932‐1941, https://doi.org/10.1111/dom.15058

[5].   Rawshani, A., Rawshani, A., Franzén, S., Sattar, N., Eliasson, B., Svensson, A. M., Zethelius, B., Miftaraj, M., McGuire, D. K., Rosengren, A., & Gudbjörnsdottir, S., 2018, Risk Factors, Mortality, and Cardiovascular Outcomes in Patients with Type 2 Diabetes. The New England Journal of Medicine, 379(7), 633–644, https://doi.org/10.1056/NEJMoa1800256

[6].   Mosenzon, O., Miller, E. M., & Warren, M. L., 2020, Oral semaglutide in patients with type 2 diabetes and cardiovascular disease, renal impairment, or other comorbidities, and in older patients. Postgraduate Medicine, 132(sup2), 37–47, https://doi.org/10.1080/00325481.2020.1800286

[7].   NCD Risk Factor Collaboration (NCD-RisC), 2024, Worldwide trends in diabetes prevalence and treatment from 1990 to 2022: a pooled analysis of 1108 population-representative studies with 141 million participants. The Lancet, 404(10467), 2077–2093, https://doi.org/10.1016/S0140-6736(24)02317-1

[8].   American Diabetes Association, 2020, 4. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Medical Care in Diabetes-2020. Diabetes Care, 43(Suppl 1), S37–S47, https://doi.org/10.2337/dc20-S004

[9].   Lincoff, A. M., Brown-Frandsen, K., Colhoun, H. M., Deanfield, J., Emerson, S. S., Esbjerg, S., Hardt-Lindberg, S., Hovingh, G. K., Kahn, S. E., Kushner, R. F., Lingvay, I., Oral, T. K., Michelsen, M. M., Plutzky, J., Tornøe, C. W., Ryan, D. H., & SELECT Trial Investigators, 2023, Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes. The New England Journal of Medicine, 389(24), 2221–2232, https://doi.org/10.1056/NEJMoa2307563

[10].  American Diabetes Association, 2020, 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes-2020. Diabetes Care, 43(Suppl 1), S98–S110, https://doi.org/10.2337/dc20-S009

[11].  Garber, A. J., Handelsman, Y., Grunberger, G., Einhorn, D., Abrahamson, M. J., Barzilay, J. I., Blonde, L., Bush, M. A., DeFronzo, R. A., Garber, J. R., Garvey, W. T., Hirsch, I. B., Jellinger, P. S., McGill, J. B., Mechanick, J. I., Perreault, L., Rosenblit, P. D., Samson, S., & Umpierrez, G. E., 2020, Consensus Statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the Comprehensive Type 2 Diabetes Management Algorithm - 2020 Executive Summary. Endocrine Practice, 26(1), 107–139, https://doi.org/10.4158/CS-2019-0472

[12].  Verma, S., Emerson, S., Plutzky, J., Kahn, S. E., Stensen, S., Weeke, P. E., Musinga, D., Poirier, P., Lingvay, I., & Lincoff, A. M., 2025, Semaglutide Improves Cardiovascular Outcomes in Patients With History of Coronary Artery Bypass Graft and Obesity. Journal of the American College of Cardiology, 85(5), 541–545, https://doi.org/10.1016/j.jacc.2024.11.008

[13].  Rodbard, H. W., Rosenstock, J., Canani, L. H., Deerochanawong, C., Gumprecht, J., Lindberg, S. Ø., Lingvay, I., Søndergaard, A. L., Treppendahl, M. B., Montanya, E., & PIONEER 2 Investigators, 2019, Oral Semaglutide Versus Empagliflozin in Patients with Type 2 Diabetes Uncontrolled on Metformin: The PIONEER 2 Trial. Diabetes Care, 42(12), 2272–2281, https://doi.org/10.2337/dc19-0883

[14].  Sattar, N., Lee, M. M. Y., Kristensen, S. L., Branch, K. R. H., Del Prato, S., Khurmi, N. S., Lam, C. S. P., Lopes, R. D., McMurray, J. J. V., Pratley, R. E., Rosenstock, J., & Gerstein, H. C., 2021, Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of randomised trials. The Lancet Diabetes & Endocrinology, 9(10), 653–662, https://doi.org/10.1016/S2213-8587(21)00203-5

[15].  Kautzky-Willer, A., Leutner, M., & Harreiter, J., 2023, Sex differences in type 2 diabetes. Diabetologia, 66(6), 986–1002, https://doi.org/10.1007/s00125-023-05891-x

[16].  de Boer, I. H., Khunti, K., Sadusky, T., Tuttle, K. R., Neumiller, J. J., Rhee, C. M., Rosas, S. E., Rossing, P., & Bakris, G., 2022, Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and kidney disease: Improving Global Outcomes (KDIGO). Diabetes Care, 45(12), 3075–3090, https://doi.org/10.2337/dci22-0027

[17].  Aroda, V. R., Erhan, U., Jelnes, P., Meier, J. J., Abildlund, M. T., Pratley, R., Vilsbøll, T., & Husain, M., 2023, Safety and tolerability of semaglutide across the SUSTAIN and PIONEER phase IIIa clinical trial programmes. Diabetes, Obesity & Metabolism, 25(5), 1385–1397, https://doi.org/10.1111/dom.14990

Abstract:

Gender-based violence is a cross-sectional problem that affects millions of people across the world, there are higher societal, economic, and health risks associated with sexual violence. Education is one of the most effective tools in the fight against Gender-based violence as it makes people aware of it. This study tries to establish the success of role of education on prevention of Gender-based violence. Randomized control trial study design was used to extrapolate findings related to the knowledge, attitude and behavior of respondents using a structured questionnaire. Findings indicate that the educational training module shows effect in the role of education on prevention of Gender-based violence in Nigeria youths at Kaduna orientation camp. However there remain a limited body of evidence on the effect of the educational training module on prevention of Gender-based violence. Commonly agreed upon standard or guidelines for evaluation of training module on prevention of Gender-based violence programming and publication of evaluations conducted using these guidelines could assist stakeholders to build and disseminate evidence base of effective prevention on Gender-based violence intervention programs and strategies. The use of training module on prevention of Gender-based violence efforts especially among young adolescents’ population must be given higher priority to justify continuation of revision of recommended Gender-based violence programs being implemented in diverse human setting, also improve awareness to stakeholders.

References:

[1].   The Role of Education in Preventing Violence Adaist Women, 2024, https://www.fundsfomgos.org

[2].   Gender-based Violence and Education, 2015, https://cdn.sida.se.

[3].   Gender-based violence and Education, Ecological Framework, 2015. https://cdn.sida.se.

[4].   Cooks, C. V., Jaffe, P., Dunlop, C., 2019. Preventing Gender-based Violence among Adolescent and Young Adult. Org.https://www.scirp.

[5].   Youth Employment in Nigeria; A Vehicle for Decent Work and Economic Growth, 2024. https://nigeriayouths.dgs.org.

[6].   Petermann, P., O’Donnell, T., 2020, “Pandemic and Violence against Women and Children” CGD Working Paper 10 (4), 528. Washington DC Center for Global Development. https://www.Lgdev.org

[7].   Arango et al, 2019, Knowledge, Attitude and Practice of Intimate Partner Violence, https://www.researchgate.net

[8].   Wugmoon et al, 2017, Likert Scale Analyzing Attitude on Gender-based Violence. https://www.st-andrews.ac.uk.

[9].   Carey et al, 2023, Development and Validation of an Educational Module on Intimate Partner Violence, https://www.researchgate.net.

[10].  Heise et al, 2012, Theories of Gender-based Violence, https://www.researchgate.net.

[11].  Radtake, T., and Stan,P., 2019, Power Dynamic on Gender-based Violence, https://www.icrw.org.

[12].  Goonesekere et al, 2020, Gender-based Violence Intervention Program in Kenya, https://erepository.uon-bi.ac.ke

[13].  Joseph Arbiol et al, 2018, Classification for Total Score of Knowledge, Attitude and Practice regarding Gender-based Violence Prevention, https://www.mdpi.com

Abstract:

Gender-based Violence (GBV) remain one of the most serious threat to health and safety of women and girls worldwide. The problem is even more pronounced in community populations where women and girls are at increased risk of violence. Despite growing need, there have been few rigorous studies on prevention of gender-based violence using a training module and no systematic review of knowledge, attitude and practice on gender-based violence of graduates of tertiary institution in Nigeria. This study try to evaluate the effectiveness of peer led prevention of gender-based violence using a training module in an orientation camp for national youth service corps of Nigeria graduates. Randomized control trial study design was used to extract findings related to the knowledge, attitude and practice of the respondents. Study finding indicate that the training module was effective in peer led prevention of gender-based violence. However there remain a limited body of evidence on the effectiveness of the training module on prevention of gender-based violence. Commonly agreed upon standard or guidelines for evaluation of training module of gender-based violence prevention programming and publication of evaluations conducted using these guidelines could assist stakeholders to build and disseminate evidence base of effective gender-based violence prevention interventions programs and strategies. The use of training module gender-based violence prevention efforts especially among young adolescent population must be given higher priority to justify continuation of revision of recommended gender-based violence programs being implemented in diverse human setting, also improve awareness to stakeholders.

References:

Abstract:

Immunization is a cost-effective strategy for reducing childhood morbidity and mortality, yet Nigeria faces challenges in achieving optimal vaccination coverage. This study assessed the prevalence and determinants of incomplete immunization among children aged 0–23 months in Ifelodun LGA through a cross-sectional survey of 383 caregivers selected via multistage random sampling. Data were collected using structured questionnaires and analyzed using descriptive statistics, chi-square tests, and logistic regression. While 93.5% of children received at least one vaccine, only 19.6% were fully immunized. Three immunization gaps were identified: zero-dose children (6.5%), under-immunized (50.4%), and dropouts (23.5%). Place of delivery significantly influenced coverage, with hospital-born children having higher full immunization rates (25.5%) compared to home births, which had higher dropout rates (29.6%). Key barriers included parental negligence (23.1%), lack of awareness (18.8%), fear of side effects (15.6%), and accessibility/financial constraints (12% and 11.4%). Multivariate analysis showed zero-dose status was predicted by lack of awareness (OR=3.96, p=0.053), unfamiliarity with vaccination sites (OR=11.44, p=0.014), and stockouts (OR=10.74, p=0.007). Under-immunization was strongly linked to older child age (OR=6.75, p=0.001), while learning about vaccines from friends was protective (OR=0.32, p=0.009). Dropout risk increased with older age (OR=3.93, p=0.002) but decreased with caregiver education from friends (OR=0.23, p=0.027). Despite the high initial uptake, dropout rates remain concerning. Targeted interventions addressing health system barriers, education, supply chains, and community engagement are critical to improving coverage.

References:

[1].   Ota, M. O. C., Badur, S., Romano-Mazzotti, L., Friedland, L. R., 2022, Impact of COVID-19 on routine immunization in LMICs. Lancet Infectious Diseases., 22(1), e26-e33, https://doi.org/10.1016/S1473-3099(21)00490-3.

[2].   Mahachi, K., Muñiz, M., Jarrett, P., Dube, F., Suchdev, P. S., Brenner, J. L., 2022, Sustained reductions in missed opportunities for vaccination in Africa. Bulletin of the World Health Organization., 100(1), 54-61, https://doi.org/10.2471/BLT.21.286644.

[3].   World Health Organization., 2016, Global routine immunization strategies and practices. WHO Press., 1(1), 1-100, https://www.who.int/publications.

[4].   Cata-Preta, B. O., Santos, T. M., Mengistu, T., Hogan, D. R., Barros, A. J. D., Victora, C. G., 2021, Zero-dose children and the immunisation cascade: Understanding immunisation pathways in low- and middle-income countries. Vaccine., 39(32), 4564-4570, https://doi.org/10.1016/j.vaccine.2021.02.072

[5].   Adebimpe, W. O., Adeoye, O. A., 2021, Routine immunization coverage in Nigeria: A systematic review and meta-analysis. Vaccine., 39(15), 2181-2191, https://doi.org/10.1016/j.vaccine.2021.02.053.

[6].   Sato, R., 2023, Global inequality in immunization coverage among the poorest children. Vaccine., 41(12), 1986-1992, https://doi.org/10.1016/j.vaccine.2023.02.014.

[7].   United States Agency for International Development (USAID)., 2009, Nigeria: Child survival and health. USAID/Nigeria., 1(1), 1-50, https://www.usaid.gov/nigeria.

[8].   National Population Commission (NPC) [Nigeria]., 2013, Nigeria demographic and health survey 2008. NPC and ICF International., 1(1), 1-300, https://dhsprogram.com/publications.

[9].   Adebayo, S. B., Olukoshi, A., Adeyemi, O. S., 2012, Understanding the drivers of immunization inequality in Nigeria. African Journal of Medicine and Medical Sciences., 41(4), 479-491, https://www.ajol.info/index.php/ajmms.

[10].  Odusanya, O. O., Alufohai, E. F., Meurice, F. P., Ahonkhai, V. I., 2008, Determinants of vaccination coverage in rural Nigeria. BMC Public Health., 8(1), 381, https://doi.org/10.1186/1471-2458-8-381.

[11].  Danovaro-Holliday, M. C., Dansereau, E., Rhoda, D. A., Brown, D. W., Cutts, F. T., Gacic-Dobo, M., 2021, Zero-dose children and the immunisation cascade: Understanding immunisation pathways in low- and middle-income countries. Vaccine., 39(32), 4564-4570, https://doi.org/10.1016/j.vaccine.2021.02.072.

[12].  Mosser, J. F., Gagne-Maynard, W., Rao, P. C., Osgood-Zimmerman, A., Fullman, N., Graetz, N., et al., 2019, Mapping diphtheria-pertussis-tetanus vaccine coverage in Africa, 2000–2016: A spatial and temporal modelling study. Lancet., 393(10183), 1843-1855, https://doi.org/10.1016/S0140-6736(19)30226-0.

[13].  Abdulraheem, I. S., Olapipo, A. R., Amodu, M. O., 2011, Primary health care services in Nigeria: Critical issues and strategies for enhancing the use by the rural communities. Journal of Public Health and Epidemiology., 4(1), 5-13, https://academicjournals.org/journal/JPHE.

[14].  Wendt, A., Santos, T. M., Cata-Preta, B. O., Hogan, D. R., Mengistu, T., Arroyave, L., et al., 2022, Children of more empowered women are less likely to be left without vaccination in low- and middle-income countries: A global analysis of 50 DHS surveys. Journal of Global Health., 12, 04022, https://doi.org/10.7189/jogh.12.04022.

[15].  Fagbamigbe, A. F., Oyinlola, F. F., Adebowale, A. S., 2020, Survival analysis and prognostic factors of time to first vaccination in Nigeria: A multilevel analysis. PLOS ONE., 15(6), e0234918, https://doi.org/10.1371/journal.pone.0234918.

[16].  Gostin, L. O., Hodge, J. G., Bloom, B. R., El-Mohandes, A., Fielding, J., Hotez, P., et al., 2020, The public health crisis of underimmunisation: A global plan of action. Lancet Infectious Diseases., 20(1), e11-e16, https://doi.org/10.1016/S1473-3099(19)30558-4.

[17].  Lindstrand, A., Cherian, T., Chang-Blanc, D., Feikin, D., O’Brien, K. L., 2021, The world of immunization: Achievements, challenges, and strategic vision for the next decade. Journal of Infectious Diseases., 224(Suppl 4), S452-S467, https://doi.org/10.1093/infdis/jiab284.

[18].  District Health Information System 2 (DHIS2)., 2024, Immunization data for Ifelodun LGA, Kwara State [unpublished internal report]., 1(1), 1-20, https://www.dhis2.org.

[19].  National Population Commission (NPC) [Nigeria], ICF., 2019, Nigeria Demographic and Health Survey 2018. NPC and ICF., 1(1), 1-400, https://dhsprogram.com/publications.

[20].  Abdulraheem, I. S., Onajole, A. T., Jimoh, A. A. G., Oladipo, A. R., 2011, Reasons for incomplete vaccination and factors for missed opportunities among rural Nigerian children. Journal of Public Health and Epidemiology., 3(4), 194-203, https://academicjournals.org/journal/JPHE.

[21].  Fagbamigbe, A. F., Oyinlola, F. F., Adebowale, A. S., 2020, Patterns and determinants of dropout from childhood immunization in Nigeria. BMC Public Health., 20(1), 1-12, https://doi.org/10.1186/s12889-020-09350-9.

[22].  Mohammed, H., Atomsa, A., Lami, M., 2019, Immunization dropout rate and associated factors among children in Ethiopia: Systematic review and meta-analysis. PLOS ONE., 14(6), e0218511, https://doi.org/10.1371/journal.pone.0218511.

[23].  Singh, P. K., Yadav, R. J., Pandey, A., 2020, Institutional delivery and childhood immunization in India: A district-level analysis. PLOS ONE., 15(4), e0230669, https://doi.org/10.1371/journal.pone.0230669.

[24].  Maina, L. C., Karanja, S., Kombich, J., 2020, Immunization dropouts among infants in Kenya: A spatial analysis. BMC Health Services Research., 20(1), 1-10, https://doi.org/10.1186/s12913-020-05564-2.

[25].  Khan, M. U., Ahmad, A., Aqeel, T., Salman, S., Idrees, M., 2018, Factors associated with partial and non-immunization in Pakistani children. Journal of Epidemiology and Global Health., 8(1-2), 55-62, https://doi.org/10.2991/j.jegh.2018.08.103.

[26].  Sato, R., 2022, Effect of mobile phone reminders on childhood immunization in Uganda: A randomized controlled trial. Vaccine., 40(10), 1445-1452,  https://doi.org/10.1016/j.vaccine.2021.12.068.

[27].  Mugabo, P., Rujumba, J., Ntawukuriryayo, J. T., Nkurunziza, T., 2021, Dropout from childhood vaccination in the Democratic Republic of Congo: A cross-sectional study in Kinshasa. Vaccine., 39(8), 1243-1250,  https://doi.org/10.1016/j.vaccine.2020.12.065.

[28].  Hussain, S. F., Boyle, P., Patel, P., Sullivan, R., 2020, Community health workers improve vaccination completion in Bangladesh: A cluster-randomized trial. Vaccine., 38(15), 3089-3095, https://doi.org/10.1016/j.vaccine.2020.02.074.

[29].  Babalola, S., 2021, Factors associated with incomplete immunization among children in Nigeria: A systematic review. BMC Public Health., 21(1), 1453, https://doi.org/10.1186/s12889-021-11498-x.

[30].  Adebowale, A. S., 2020, Determinants of pentavalent vaccine dropout in rural Nigerian communities: A mixed-methods study. Vaccine., 38(45), 7128-7135,  https://doi.org/10.1016/j.vaccine.2020.09.026.

[31].  National Primary Health Care Development Agency (NPHCDA)., 2022, National Routine Immunization Strategic Plan 2021-2025. NPHCDA., 1(1), 1-85, https://www.nphcda.gov.ng/publications.

[32].  Okoli, C., 2019, Barriers to complete childhood immunization in sub-Saharan Africa: Evidence from Nigeria and Kenya. PLOS ONE., 14(6), e0217968, https://doi.org/10.1371/journal.pone.0217968.

[33].  Larson, H. J., Jarrett, C., Eckersberger, E., Smith, D. M. D., Paterson, P., 2015, Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: A systematic review of published literature, 2007–2012. Vaccine., 32(19), 2150-2159, https://doi.org/10.1016/j.vaccine.2014.01.081.

[34].  Babalola, S., 2011, Maternal reasons for non-immunisation and partial immunisation in northern Nigeria. Journal of Paediatrics and Child Health., 47(5), 276-281, https://doi.org/10.1111/j.1440-1754.2010.01956.x.

[35].  Amponsah‐Achiano, K., Oduro, A. R., Mensah, A. K., Nuro‐Ameyaw, P., 2019, Factors influencing childhood immunization in Ghana: A qualitative study. BMC Public Health., 19(1), 1-10, https://doi.org/10.1186/s12889-019-7549-8.

[36].  Wiyeh, A. B., Cooper, S., Jaca, A., Mavundza, E., Ndwandwe, D., Wiysonge, C. S., 2020, Vaccine stockouts in Africa: A systematic review. Human Vaccines & Immunotherapeutics., 16(4), 851-857,  sshttps://doi.org/10.1080/21645515.2019.1670039.

[37].  Sheikh, A., Iqbal, B., Ebrahim, G. J., Southall, D. P., 2020, Zero-dose children in India: Who are they and why are they unvaccinated?. Vaccine., 38(7), 1706-1714,  https://doi.org/10.1016/j.vaccine.2019.12.021.

[38].  Banda, C., Sheppard, P., Masaninga, F., Chizema, E., 2022, Predictors of immunization dropouts in Zambia: A multilevel analysis. Vaccine., 40(12), 1834-1841,  https://doi.org/10.1016/j.vaccine.2022.01.050.

[39].  Were, F., Kariuki, D., Chepkwony, R., 2021, Sources of immunization information and their influence on childhood vaccination in Kenya. BMC Public Health., 21(1), 1-9, https://doi.org/10.1186/s12889-021-10450-3.

Abstract:

Introduction: Only 48% of women living with HIV are receiving ART, leaving a gap of 10,591 women yet to be initiated to ART (Spectrum, 2022). The gap between women yet to be initiated to ART treatment is twice that of men. Assisting women to disclose their HIV status will contribute positively to bridging this gap, as some women refuse to take treatment because they are not willing to disclose their status for reasons like fear of isolation, stigmatization, separation, and intimate partner violence. Objective: The main aim of this study is to determine the patterns and predictors of HIV status disclosure by women to their sexual partners. Method: This study employed a mixed approach. A total of 248 women who began ART treatment between June 2020 and May 2023 were randomly selected. Face-to-face interviews utilized a questionnaire comprising 7 closed-ended questions and 3 open-ended questions. The collected data was organized in a designated spreadsheet, where it was cleaned, cross-verified, and coded before being transferred to the Statistical Package for Social Science (SPSS) version 29 for storage and descriptive analysis. Conclusion: The prevalence of HIV disclosure to partners was 48.8%. Disclosure was higher among older respondents and in the educated than among those who could not read or write. HIV disclosure was also higher in the illiterate respondents involved in polygamous relationships. Women who were diagnosed at the PMTCT services disclosed more (60%) than those tested during sickness (53%) and those who tested through VCT (42%).

References:

[1].   UNAIDS Fact Sheet on Cameroon 2022, available at https://www.unaids.org/en/topic/gender.

[2].   Cameroon Demographic Health Survey, 2018, available at https://dhsprogram.com/pubs/pdf/OF44/OF44.HIV.E.pdf.

[3].   WHO; Gender Dimensions of HIV Status Disclosure to Sexual Partners: Rates, Barriers and Outcomes, 2004.

[4].   WHO, Cameroon making progress in the fight against HIV, Dec 2023. Available at https://www.afro.who.int/countries/cameroon/news/cameroon-making-progress-fight-against-hiv

[5].   Cameroon Population-Based HIV Impact Assessment, CAMPHIA 2017, Available at https://phia.icap.columbia.edu/wp-content/uploads /2020/02/3471CAMPHIA_Cameroon-SS_A4_v13_requests_7.25.18.pdf

[6].   Winchester, M. S., McGrath, J. W., Kaawa-Mafigiri, D., Namutiibwa, F., Ssendegye, G., Nalwoga, A., 2013, Early HIV disclosure and nondisclosure among men and women on antiretroviral treatment in Uganda, AIDS Care., PMCID: PMC3657329. https://pubmed.ncbi.nlm.nih.gov/23356654/

[7].   Alemayehu, M., Aregay, A., Kalayu, A., Yebyo, H., 2014, HIV disclosure to sexual partner and associated factors among women attending ART clinic at Mekelle hospital, Northern Ethiopia., BMC Public Health. Retrieved from https://pubmed.ncbi.nlm.nih.gov/25056689/

[8].   Erku, T. A., Megabiaw, B., Wubshet, M., 2012, Predictors of HIV status disclosure to sexual partners among people living with HIV/AIDS in Ethiopia, Pan Afr Med J. PMID: 23396625; PMCID: PMC3567411.

[9].   Genet, M., Sebsibie, G., Gultie, T., 2015, Disclosure of HIV seropositive status to sexual partners and its associated factors among patients attending antiretroviral treatment clinic follow up at Mekelle Hospital, Ethiopia; a cross-sectional study, BMC Res Notes.;8:109. Doi: 10.1186/s13104-015-1056-5. PMID: 25889779; PMCID: PMC4379749.

[10].  Osinde, M. O., Kakaire, O., Kaye, D. K.; 2012, Factors associated with disclosure of HIV serostatus to sexual partners of patients receiving HIV care in Kabale, Uganda. Int J Gynaecol Obstet. 118(1):61-4. Doi: 10.1016/j.ijgo.2012.02.008. PMID: 22507263.

[11].  Batte, A., Katahoire, A. R., Chimoyi, A., Ajambo, S., Tibingana, B., Banura, C., 2015, Disclosure of HIV test results by women to their partners following antenatal HIV testing: a population-based cross-sectional survey among slum dwellers in Kampala Uganda., BMC Public Health. Doi: 10.1186/s12889-015-1420-3. PMID: 25637031; PMCID: PMC4314734.

[12].  Bulterys, M. A., Sharma, M., Mugwanya, K., Stein, G., Mujugira, A., Nakyanzi, A, et al., 2021, Correlates of HIV Status Nondisclosure by Pregnant Women Living With HIV to Their Male Partners in Uganda: A Cross-Sectional Study, Retrieved from https://pubmed.ncbi.nlm.nih.gov/33148995/.

[13].  Ramlagan, S., Matseke, G., Rodriguez, V. J., Jones, D. L., Peltzer, K., Ruiter, R. A. C., et al., 2018, Determinants of disclosure and non-disclosure of HIV-positive status, by pregnant women in rural South Africa, SAHARA J. 155-163. PMCID: PMC6197005. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30324859/

[14].  Diemer, S. H., Longo, J. D., Tekpa, G., Gaunefet, C. E., Ngbale, R. N., 2018, Factors associated with non-disclosure of HIV status among women attending prenatal clinics in Bangui.Sante Publique, PMID: 30541269 Retrieved from https://pubmed.ncbi.nlm.nih.gov/30541269/

[15].  van Lettow, M., Cataldo, F., Landes, M., Kasende, F., Nkhoma, P., van Oosterhout, J. J., 2019, July 26; Impact of inter-partner HIV disclosure patterns in Malawi's PMTCT program: A mixed-method study; PLoS One.1 PMC6660128. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31348782/

[16].  Anglewicz, P., Chintsanya, J., 2011, Disclosure of HIV status between spouses in rural Malawi. AIDS Care. PMCID: PMC3371657. Retrieved from https://pubmed.ncbi.nlm.nih.gov/21390889/

[17].  Taylor, K., Lamb, M., Lahuerta, M., Ahoua, L., Abacassamo, F., Elul, B., 2020, Patterns and Predictors of HIV Status Disclosure in the 12 Months after Diagnosis in Mozambique, PMID: 32084049. Retrieved from https://pubmed.ncbi.nlm.nih.gov/32084049/.

[18].  Naigino, Rose, et al., 2017, HIV status disclosure and associated outcomes among pregnant women enrolled in antiretroviral therapy in Uganda: a mixed methods study, Reproductive health vol. 14,1 107. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5577683/

[19].  Nordberg, B., Gabriel, E. E., Were, E., Kaguiri, E., Ekström, A. M., Kågesten, A., et al., 2020, Social concerns related to HIV status disclosure and participation in the prevention of mother-to-child transmission of HIV care among pregnant women in Kenya, BMC Pregnancy Childbirth. 16; PMID: 32299386; PMCID: PMC7164265. Retrieved from https://pubmed.ncbi.nlm.nih.gov/32299386/

[20].  Aloyce, Z., Larson, E., Komba, A., Mwimba, A., Kaale, A., Minja, A., et al., 2020, Prevalence and factors associated with intimate partner violence after HIV status disclosure among pregnant women with depression in Tanzania, AIDS Care, PMID: 32741204; PMCID: PMC7855519. Retrieved from https://pubmed.ncbi.nlm.nih.gov/32741204/

[21].  Ramlagan, S., Matseke, G., Rodriguez, V. J., Jones, D. L., Peltzer, K., Ruiter, R. A. C., et al., 2018, Determinants of disclosure and non-disclosure of HIV-positive status, by pregnant women in rural South Africa,155-163 PMID: 30324859; PMCID: PMC6197005. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30324859/

[22].  Geubbels, E., Williams, A., Ramaiya, A., Tancredi, D., Young, S., Chantry, C., 2018, HIV status disclosure among postpartum women in rural Tanzania: predictors, experiences and uptake of a nurse-facilitated disclosure intervention, AIDS Care, 417-425. Doi: PMID: 29363340; PMCID: PMC6250839. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29363340/

[23].  Tibebu, N. S., Rade, B. K., Kebede, A. A., Kassie, B. A., 2023, Disclosure of HIV status to sexual partner and its associated factors among pregnant women living with HIV attending prenatal care in Amhara Regional State Referral Hospitals, Ethiopia, PLoS One, Doi: 10.1371/journal.pone.0280045. PMID: 36649277; PMCID: PMC9844863.

[24].  Chaudoir, S. R., Fisher, J. D., Simoni, J. M., 2011, Understanding HIV disclosure: a review and application of the Disclosure Processes Model., 1618-29. doi: 10.1016/j.socscime PMID: 21514708; PMCID: PMC4059828.

[25].  Kinuthia, J., Singa, B., McGrath, C. J., Odeny, B., Langat, A., Katana, A., Ng'ang'a, L., Pintye, J., John-Stewart, G., 2018, Prevalence and correlates of non-disclosure of maternal HIV status to male partners: a national survey in Kenya. BMC Public Health, doi: 10.1186/s12889-018-5567-6. PMID: 29848345; PMCID: PMC5975408.

[26].  Tam, M., Amzel, A., Phelps, B. R., 2015, Disclosure of HIV serostatus among pregnant and postpartum women in sub-Saharan Africa: a systematic review. AIDS Care. 2015;27(4):436-50. doi: 10.1080/09540121.2014.997662. PMID: 25636060.

[27].  Abuogi, L., Hampanda, K., Odwar, T., Helova, A., Odeny, T., Onono, M. Turan, J., 2019, HIV status disclosure patterns and male partner reactions among pregnant women with HIV on lifelong ART in Western Kenya., AIDS Care, 32(7), 858–868. https://doi.org/10.1080/09540121.2019.1659915

[28].  Ssali, S. N., Atuyambe, L., Tumwine, C., Segujja, E., Nekesa, N., Nannungi, A., Ryan, G., Wagner, G., 2010, Reasons for disclosure of HIV status by people living with HIV/AIDS and in HIV care in Uganda: an exploratory study; Doi: 10.1089/apc.2010.0062. PMID: 20863244; PMCID: PMC3826576.

[29].  Godfrey, M., 2023, Factors Contributing To Non-Disclosure Of HIV Positive Status Among Sexual Partners Attending Art Clinic At Kyanamukaaka Health Centre Iv, Masaka District-Uganda: A Cross-Sectional Study. Student’s Journal of Health Research Africa, 4(6), 13. https://sjhresearchafrica.org/index.php/public-html/article/view/463

[30].  Subulade, A. A., Salami, T. A., & Adewuyi, G. M., 2018, Factors that promote HIV disclosure among women attending prevention of mother-to-child transmission in a state in South Nigeria, HIV & AIDS Review. International Journal of HIV-Related Problems, 17, 283-287.

[31].  Mitra, S., Gogolishvili, D., Globerman, J., 2013, Rapid Response Service. Rapid Response: Disclosure of HIV-Positive Status. Toronto, ON: Ontario HIV Treatment Network

[32].  Kiula, et al., 2013, Predictors of HIV serostatus disclosure to partners among HIV-positive pregnant women in Morogoro, Tanzania. BMC Public Health

[33].  Loubiere, S., Peretti, P., Boyer, S., Blanche, J., Cécile, S., Abega, Spire, B., 2009, HIV disclosure and unsafe sex among HIV-infected women in Cameroon; available at https://www.sciencedirect.com/science/article/abs/pii/S0277953609003414

[34].  Cameroon Country Operational Plan, COP 2020, Strategic Direction Summary, 2020.

Abstract:

This study seeks to investigate how gender roles, dynamics, and power relations influence vaccine decision-making and hesitancy in LMICs households. Using the PRISMA methodology, 39 studies were selected from an initial pool of 276 articles. The selection involved four stages: identification, screening, eligibility, and inclusion. These studies cover diverse regions, cultures, and socio-economic backgrounds, offering a comprehensive understanding of the issue. The analysis shows that gender roles significantly affect vaccine decision-making within households in LMICs. Women, who are often the primary caregivers, strongly advocate for vaccination but face significant barriers like limited decision-making power, restricted mobility, and financial constraints. Men, who usually have more decision-making authority, exhibit higher vaccine hesitancy, often influenced by misinformation and traditional beliefs. Common barriers include misinformation, distrust in healthcare systems, and limited access to vaccination services. Key factors contributing to vaccine hesitancy include misinformation, lack of awareness, religious and cultural beliefs, and healthcare access limitations. To tackle these challenges, the study suggests engaging community leaders and influencers, implementing targeted education and awareness campaigns, and developing policies that prioritize gender inclusion and equity in healthcare decision-making. The findings highlight the need to address gender-specific barriers to improve vaccine uptake in LMICs. Empowering women, engaging men, and improving healthcare access can boost vaccination rates and protect communities from vaccine-preventable diseases. Future research should explore the deeper reasons behind gender-specific vaccine hesitancy and consider the intersection of gender with other socio-economic factors for more effective interventions.

References:

[1].   WHO, 2021, Checklist for tackling gender-related barriers to equitable COVID-19 vaccine deployment. https://www.who.int/publications/m/item/gender-related-barriers-to-equitable-covid-19-vaccine-deployment

[2].   Merten, S., Hilber, A. M., Biaggi, C., Secula, F., Bosch-Capblanch, X., Namgyal, P., and Hombach, J., 2015, Gender Determinants of Vaccination Status in Children: Evidence from a Meta-Ethnographic Systematic Review. PLOS ONE, 10(8), e0135222. https://doi.org/10.1371/journal.pone.0135222

[3].   Singh, P. K., & Singh, S., 2013, Impact of maternal education on child immunization: Evidence from India. Social Science & Medicine, 75(2), 331-335. DOI: 10.1016/j.socscimed.2012.12.123.

[4].   Larson, H. J., Jarrett, C., Eckersberger, E., Smith, D. M. D., and Paterson, P., 2014, Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: A systematic review of published literature, 2007–2012. Vaccine, 32(19), 2150-2159; DOI: 10.1016/j.vaccine.2014.01.081

[5].   MacDonald, N. E., 2015, Vaccine hesitancy: Definition, scope and determinants. Vaccine, 33(34), 4161- 4164. https://doi.org/10.1016/j.vaccine.2015.0 [4].036

[6].   Jegede, A. S., 2007, What led to the Nigerian boycott of the polio vaccination campaign? PLoS Medicine, 4(3), e73; DOI: 10.1371/journal.pmed.0040073

[7].   Bosire, E. N., Cho, A., Kamau, L. W., Bosire, V., Mendenhall, E., 2023, Views on COVID-19 vaccination among residents of Eldoret, Kenya during the 2021 vaccine rollout. Glob Public Health. 2023 Jan;18(1):2278877. doi: 10.1080/17441692.2023.2278877. Epub 2023 Nov 15. PMID: 37967534

[8].   Siddiqui, M., Salmon, D. A., & Omer, S. B., 2013, Epidemiology of vaccine hesitancy in the United States. Human Vaccines & Immunotherapeutics, 9(12), 2643–2648. https://doi.org/10. [4]161/hv.272 [4]3

[9].   Ali, H. A., Hartner, A. M., Echeverria-Londono, S., Roth, J., Li, X., Abbas, K., and Gaythorpe, K. A. M., 2022, Vaccine equity in low-and middle income-countries: a systematic review and meta-analysis. International Journal for Equity in Health, 21(1), 82; DOI: 10.1186/s12939-022-01678-5

[10].  Vassallo, A., Shajahan, S., Harris, K., Hallam, L., Hockham, C., Womersley, K. and Sheel, M., 2021, Sex and gender in COVID-19 vaccine research: Substantial evidence gaps remain. Frontiers in Global Women’s Health, 2, 761511. https://doi.org/10.3389/fgwh.2021.76151

[11].  Ogunleye, O. O., Basu, D., Mueller, D., Sneddon, J., Seaton, R. A., Yinka-Ogunleye, A. F., and Godman, B., 2021, Response to the novel COVID-19 pandemic in Nigeria: A call for action for improved public health preparedness and socioeconomic responses. Journal of Global Health, 11, 05027; DOI: 10.7189/jogh.11.05027

[12].  Milner, A., Kavanagh, A., Scovelle, A. J., O'Neil, A., Kalb, G., Hewitt, B., King, T. L., 2021, Gender Equality and Health in High-Income Countries: A Systematic Review of Within-Country Indicators of Gender Equality in Relation to Health Outcomes. Womens Health Rep (New Rochelle). 2021 Apr 27;2(1):113-123. doi: 10.1089/whr.2020.0114. PMID: 33937909; PMCID: PMC8082013.

[13].  Guillaume, D., Meyer, D., Waheed, D., Schlieff, M., Muralidharan, K., and Chou, V. B., 2023, Factors influencing the prioritization of vaccines by policymakers in low- and middle-income countries: a scoping review. Health Policy and Planning, 38(3), 363-376. Retrieved from Oxford Academic.

[14].  Oliveira, M., Braga, M. F., Bueno, A., de Sousa, D. P., Pigozi, P. L., Moryia, R., Akerman, M., 2022, Actions during the COVID-19 pandemic to protect the most vulnerable population: what is the potency amid chaos? Health Promot Int. 2022 Apr 29;37(2): daab122. doi: 10.1093/heapro/daab122. PMID: 34383885; PMCID: PMC8385962.

[15].  Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., et al., 2021, The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. PLOS Medicine, 18(3), e1003583. https://doi.org/10.1371/journal.pmed.1003583

[16].  Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & The PRISMA Group. 2009, preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Medicine, 6(7), e1000097; DOI: 10.1371/journal.pmed.1000097

[17].  Braun, V., and Clarke, V., 2006, Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101. https://doi.org/10.1191/1 [4]78088706qp063oa

[18].  Smith, P. J., 2010, Community engagement and vaccine uptake in Kenya. East African Medical Journal, 87.

[19].  Babalola, S., 2020, Gender dynamics and vaccine hesitancy in sub-Saharan Africa. Global Health Review, 16(3), 307-315; DOI: 10.1093/ghr/ghaa123

[20].  Obadare, E., & Akande, T. M., 2021, Maternal influence on child vaccination in Nigeria. Journal of African Health Sciences, 11(2), 145-153; DOI: 10.4314/jahs. v11i2.123

[21].  Ali, M., and Rehman, H., 2019, Barriers to vaccination in low- and middle-income countries. Journal of Public Health, 41(2), 223-230; DOI: 10.1093/pubmed/fdy123

[22].  Larson, H. J., Cooper, L. Z., Eskola, J., Katz, S. L., and Ratzan, S., 2015, Addressing the vaccine confidence gap. The Lancet, 378(9790), 526-535; DOI: 10.1016/S0140-6736(11)60678-860678-8)

[23].  Daniel, P., & Kumwenda, J., 2022, Religious beliefs and vaccine acceptance in Malawi. Vaccine and Immunization Journal, 12(4), 415-423; DOI: 10.1016/j.vaccine.2022.01.123.

Abstract:

Dyslipidemia, marked by elevated low-density lipoprotein cholesterol (LDL-C), is a key contributor to atherosclerotic cardiovascular disease (ASCVD) and remains a global health challenge. Advances in lipid management have transitioned from statin monotherapy to combination therapies with ezetimibe and PCSK9 inhibitors, achieving LDL-C reductions of up to 85% and significantly lowering major adverse cardiovascular events (MACE). Emerging agents, including bempedoic acid and RNA-directed therapies such as inclisiran and antisense oligonucleotides targeting lipoprotein(a), offer alternative solutions for statin-intolerant populations and those with residual cardiovascular risk. Intracoronary imaging demonstrates the benefits of aggressive LDL-C lowering on plaque regression and stabilization, reinforcing the importance of early initiation and sustained control. Simplified regimens, such as single-pill combinations, improve adherence and address barriers like cost and access, essential for maximizing therapeutic outcomes. Additionally, tools such as coronary artery calcium (CAC) scoring and advanced imaging enable personalized care and refined risk stratification. This meta-analysis synthesizes evidence to highlight a paradigm shift towards aggressive, individualized lipid management strategies that bridge gaps between clinical trials and real-world practice. By integrating pharmacological innovations with lifestyle interventions, these advancements offer transformative potential to reduce ASCVD risk globally.

References:

[1].   Banach, M., Reiner, Ž., Surma, S., 2024. Recommendations on the optimal use of lipid-lowering therapy in established atherosclerotic cardiovascular disease and following acute coronary syndromes: A position paper of the International Lipid Expert Panel (ILEP). Drugs, https://doi.org/10.1007/s40265-024-02105-5

[2].   Sucato, V., Ortello, A., Comparato, F., Novo, G., & Galassi, A. R., 2024. Cholesterol-lowering strategies for cardiovascular disease prevention: The importance of intensive treatment and the simplification of medical therapy. Journal of Clinical Medicine, 13(7), 1882. https://doi.org/10.3390/jcm13071882

[3].   Ray, K. K., Reeskamp, L. F., Laufs, U., Banach, M., Mach, F., et al., 2022. Combination lipid-lowering therapy as a first-line strategy in very high-risk patients. European Heart Journal, 43(8), 830–833. https://doi.org/10.1093/eurheartj/ehab718

[4].   El Din Taha, H. S., Kandil, H., Badran, H. M., Farag, N., Khamis, H., Nasr, G., Samy, M., Abdrabou, M., Abuelezz, M., & Shaker, M. M., 2024. Egyptian consensus statement on the role of non-statin therapies for LDL cholesterol lowering in different patient risk categories. The Egyptian Heart Journal, 76(1), 131. https://doi.org/10.1186/s43044-024-00562-7

[5].   Panattoni, G., Monzo, L., Gugliotta, M., Proietti, G., Tatangelo, M., et al., 2023. Optimal management of patients after acute coronary syndrome. European Heart Journal Supplements, 25(Suppl C), C84–C89. https://doi.org/10.1093/eurheartjsupp/suad039

[6].   Tokgözoğlu, L., & Libby, P., 2022. The dawn of a new era of targeted lipid-lowering therapies. European Heart Journal, 43(34), 3198–3208. https://doi.org/10.1093/eurheartj/ehab841

[7].   Cannon, C. P., Khan, I., Klimchak, A. C., Reynolds, M. R., Sanchez, R. J., & Sasiela, W. J., 2017. Simulation of lipid-lowering therapy intensification in a population with atherosclerotic cardiovascular disease. JAMA Cardiology, 2(9), 959–966. https://doi.org/10.1001/jamacardio.2017.2289

[8].   Grundy, S. M., Stone, N. J., Bailey, A. L., Beam, C., Birtcher, K. K., et al., 2019. 2018 AHA/ACC guideline on the management of blood cholesterol: Executive summary. Journal of the American College of Cardiology, 73(24), 3168–3209. https://doi.org/10.1016/j.jacc.2018.11.002

[9].   Mach, F., Baigent, C., Catapano, A. L., Koskinas, K. C., Casula, M., et al., ESC Scientific Document Group. 2020. 2019 ESC/EAS guidelines for the management of dyslipidaemias: Lipid modification to reduce cardiovascular risk. European Heart Journal, 41(1), 111–188. https://doi.org/10.1093/eurheartj/ehz455

[10].  Schubert, J., Leosdottir, M., Lindahl, B., Westerbergh, J., Melhus, H., et al., 2024. Intensive early and sustained lowering of non-HDL cholesterol after myocardial infarction and prognosis: The SWEDEHEART registry. European Heart Journal, 45(39), 4204–4215. https://doi.org/10.1093/eurheartj/ehae576

[11].  Ray, K. K., Molemans, B., Schoonen, W. M., Giovas, P., Bray, S., et al., 2021. EU-wide cross-sectional observational study of lipid-modifying therapy use in secondary and primary care: The DA VINCI study. European Journal of Preventive Cardiology, 28(11), 1279–1289. https://doi.org/10.1093/eurjpc/zwaa047

[12].  Visseren, F. L. J., Mach, F., Smulders, Y. M., et al., 2021. ESC guidelines on cardiovascular disease prevention in clinical practice. European Heart Journal. https://doi.org/10.1093/eurheartj/ehab484

[13].  Marx, N., Federici, M., Schütt, K., et al., 2023. ESC guidelines for the management of cardiovascular disease in patients with diabetes: Developed by the task force on the management of cardiovascular disease in patients with diabetes of the European Society of Cardiology (ESC). European Heart Journal, 44(39), 4043–4140. https://doi.org/10.1093/EURHEARTJ/EHAD192

[14].  Newman, C. B., Preiss, D., Tobert, J. A., et al., 2019. Statin safety and associated adverse events: A scientific statement from the American Heart Association. Arteriosclerosis, Thrombosis, and Vascular Biology, 39(2), e38–e81. https://doi.org/10.1161/ATV.0000000000000073

[15].  Xie, C., Zhou, Z. S., Li, N., Bian, Y., Wang, Y. J., Wang, L. J., Li, B. L., & Song, B. L., 2012. Ezetimibe blocks the internalization of NPC1L1 and cholesterol in the mouse small intestine. Journal of Lipid Research, 53(10), 2092–2101. https://doi.org/10.1194/jlr.M027359

[16].  Murphy, S. A., Cannon, C. P., Blazing, M. A., et al., 2016. Reduction in total cardiovascular events with ezetimibe/simvastatin post-acute coronary syndrome: The IMPROVE-IT trial. Journal of the American College of Cardiology, 67(4), 353–361.

[17].  Roth, E. M., & Davidson, M. H., 2018. PCSK9 inhibitors: Mechanism of action, efficacy, and safety. Review of Cardiovascular Medicine, 19.

[18].  Sabatine, M. S., Giugliano, R. P., Keech, A. C., et al., 2017. Evolocumab and clinical outcomes in patients with cardiovascular disease. New England Journal of Medicine, 376(18), 1713–1722.

[19].  Schwartz, G. G., Steg, P. G., Szarek, M., et al., 2018. Alirocumab and cardiovascular outcomes after acute coronary syndrome. New England Journal of Medicine, 379(22), 2097–2107.

[20].  Wright, R. S., Ray, K. K., Raal, F. J., et al., 2021. Pooled patient-level analysis of inclisiran trials in patients with familial hypercholesterolemia or atherosclerosis. Journal of the American College of Cardiology, 77(9), 1182–1193.https://doi.org/10.1016/j.jacc.2020.12.058

[21].  Albosta, M. S., Grant, J. K., Taub, P., Blumenthal, R. S., Martin, S. S., & Michos, E. D., 2023. Inclisiran: A new strategy for LDL-C lowering and prevention of atherosclerotic cardiovascular disease. Vascular Health and Risk Management, 19, 421–431. https://doi.org/10.2147/VHRM.S338424

[22].  Bempedoic acid and ezetimibe combination approved by FDA for lowering LDL-C. 2024. HCPLive. Accessed August 18, 2024. Retrieved from https://www.hcplive.com/view/nexlizet-bempec-acid-ezetimibe-combination-approved-fda-cholesterol-esperion

[23].  Cho, L., 2023. Bempedoic acid and cardiovascular outcomes in statin-intolerant patients at high cardiovascular risk: CLEAR outcome. Journal of Clinical Lipidology, 17(4), e62.

[24].  Danis, R. P., Gangaputra, S., Hubbard, L., et al., 2010. Effects of medical therapies on retinopathy progression in type 2 diabetes. New England Journal of Medicine, 363(3), 233–244. https://doi.org/10.1056/NEJMOA1001288

[25].  Lent-Schochet, D., & Jialal, I., 2023. Antilipemic agent bile acid sequestrants. Stat Pearls. Published January 23, 2023. Accessed April 2, 2024. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK549906/

[26].  Raal, F. J., Rosenson, R. S., Reeskamp, L. F., et al., 2020. Evinacumab for homozygous familial hypercholesterolemia. New England Journal of Medicine, 383(8), 711–720. https://doi.org/10.1056/NEJMOA2004215

[27].  Blom, D. J., Raal, F. J., Santos, R. D., & Marais, A. D., 2019. Lomitapide and mipomersen: Inhibiting microsomal triglyceride transfer protein (MTP) and apoB100 synthesis. Current Atherosclerosis Reports, 21(12), 1–10. https://doi.org/10.1007/S11883-019-0809-3

[28].  Nugent, A. K., Gray, J. V., Gorby, L. K., & Moriarty, P. M., 2020. Lipoprotein apheresis: First FDA-indicated treatment for elevated lipoprotein (a). Journal of Clinical Cardiology, 1(1), 16–21.

Abstract:

Uncovering the origin of cybercrimes in Ghana continue to be a challenge for law enforcement agencies. Existing solutions had primarily focused on unmasking crime source within the Public Data Network (PDN) using methods such as geolocation of public Internet Protocol (IP) address or the Domain Name Server (DNS) lookup methods. Unfortunately, these approaches fall short at uncovering cybercrime sources from the mobile broadband (MBB) domain. This paper proposed a framework aimed at answering the question of processes around the MBB’s packet data protocol (PDP) context procedure and its corresponding private IP attribution to User Equipment (UE) that might mask the UE’s identity in a PDN. The study's outcome includes digital footprints collection like IP addresses and Transmission Control Protocol ports during PDP context and UE data sessions to cloud server in the PDN. Exploratory data analysis reveals the uniqueness of every session, i.e., making traceability feasible from a PDN to distinct sources in the MBB domain. This paper proposes a comprehensive framework by recommending the collection of datasets from the MBB domain infrastructure at three logical interfaces with network probes. Additionally, the study suggests enhancing the dataset with call detail records and leveraging Edgar Frank Codd's relational data model to synthesise the fragmented datasets to a unique entity thereby ensuring the unmasking of a cybercrime committed in a PDN effectively traceable to the MBB domain entity. This innovative approach adds to the knowledge of cybercrime investigations in Ghana's cybersecurity endeavours.

References:

Abstract:

Inbound medical tourism describes a form of medical tourism where patients from other countries travel to the country to receive medical care. This occurs because patients are attracted to the health system in the country. This study seeks to assess the frequency, pattern, and practice of Inbound medical tourism in Tertiary Hospitals in the Federal Capital Territory (FCT), Nigeria. A descriptive cross-sectional study design was carried out among 160 Medical Practitioners in Tertiary Hospitals in the Federal Capital Territory (FCT), Nigeria. A multi-stage sampling technique was used in this study, and data was collected using an Interviewer-administered structured questionnaire. The mean age was 45.8 ± 9.2 years. Ninety-two (57.50%) were males, and 68 (42.5%) were females. 84 (52.50%) were Christians, and 76 (47.5%) were Muslims. The majority were married 105 (65.63%), 48 (30.0%) were single, and 23 (14.38%) of the doctors reported receiving foreign referrals. The commonly reported sources of these referrals included Ghana, the UK, the USA and Cameroun [5 (21.74%), 2 (8.70%), 1 (4.35%), and 8 (34.78%) respectively]. Most treatments lasted for 6 months: 13 (56.52%), 8 (34.78%), and only 1 (4.35%) stayed for over 1 year. Routine checkup was the reason for these referrals among 9 (39.13%) of the doctors, while 4 (17.39%) indicated relocation of the patient and post-operative follow-up. However, 18 (78.26%) reported an improvement in their conditions after these treatments. Nigeria can enhance its inbound medical tourism industry, attract more international patients, and establish itself as a reputable healthcare destination.

References:

[1].   Leigh Turner, 2011, Canadian medical tourism companies that have exited the marketplace: Content analysis of websites used to market transnational medical travel. Globalization and Health. 2011;7(1):40. Available at: http://www.globalizationandhealth.com/content/7/1/40.

[2].   Bookman, M. Z., Bookman, K. R., 2009, Medical Tourism in Developing Countries. UTMJ. 2009;86(2):76–77.

[3].   Boon Chin Heng, 2005, “Reproductive tourism”: should locally registered fertility doctors be held accountable for channelling patients to foreign medical establishments? National University of Singapore, 2005:842.

[4].   Roberto Matorras, 2005, Reproductive exile versus reproductive tourism. Human Reproduction. 2005;20(12):3573.

[5].   Turner, L., 2012, Canada’ s turbulent medical tourism industry. Canadian Family Physician. 2012; 58:371–373.

[6].   Behrmann, J., Smith, E., 2010, Top 7 Issues in Medical Tourism: Challenges, Knowledge Gaps , and Future Directions for Research and Policy Development. Global Journal of Health Science Vol. 2010;2(2):80–90.

[7].   Pennings, G., 2002, Reproductive tourism as moral pluralism in motion. J Med Ethics. 2002; 28:337–342.

[8].   Turner, L., 2008, “Medical tourism” initiatives should exclude commercial organ transplantation. J R Soc Med 2008: 2008; 101:391–394.

[9].   Michael, D., Horowitz, Jeffrey, A., Rosensweig, C. A. J., 2007, Medical Tourism: Globalization of the Healthcare Marketplace. MedGenMed. 2007;9(4):33.

[10].  Turner Leigh, 2011, Quality in health care and globalization of health services: accreditation and regulatory oversight of medical tourism companies. International Journal for Quality in Health Care 2011; 2011;23(1):1–7.

[11].  Alleman, B. W., Ba, B. S., Luger T., et al., 2010, Medical Tourism Services Available to Residents of the United States. J Gen Intern Med. 2010;26(5):492–497.

[12].  Ronald Labonté, Vivien Runnels, C. P., and R. D., (eds). 2013, Bon voyage: Travelling Well: Essays in Medical Tourism. Transdisciplinary Studies in Population Health Series. Institute of Population Health. 2013;4(1).

[13].  Ogunjimi, L. O., Adebayo, A. M., Adebisi, Y. A., 2023, Practice and determinants of medical tourism in Nigeria. Int J Innov Sci Res Technol. 2023;8(12):1-7.

[14].  Epundu, U. U., Adinma, E. D., Ogbonna, B. O., Epundu, O. C., 2017, Medical tourism, public health and economic development in Nigeria: Issues and prospects. Asian J Med Health. 2017;7(2):1-10.

[15].  Ojo, O. O., 2020, Effects of medical tourism on economic growth of Nigeria. Niger J Med. 2020;29(3):475-482.

[16].  Monika Prakash, 2011, A study of problems and challenges faced by medical tourists visiting India. Delhi; 2011:19 – 45.

[17].  Thrall James, 2008, Globalization of Health Care 1. Radiology. 2008;247(1):3–7.

[18].  Papanikolaou Vasiliki, T. F., 2012, Exploring and exploiting medical tourism opportunities in Greece. 2012:12 –15.

[19].  Dawan, P. D., 2000, Brief history of the creation of Federal capital territory (FCT). PD Dawan (Ed). 2000.

[20].  Olokesusi, F., Aiyegbajeje, F. O., Arije, I. M., 2019, Smart Metropolitan Regional Development of Abuja and its region. Adv 21st Century Hum Settlement’s. 2019;(1):797–825

[21].  Adakayi, P. E., 2000, Climate. In Dawan, P. D. (ed.). Geography of Abuja Federal Capital Territory. Famous/Asanlu Publishers, Minna, Niger State, Nigeria, pp. 9-23

[22].  Cochrane, G., 1963, Sampling techniques, 2nd ed. New York.: John Willey and Sons Inc; 1963.

[23].  Eman, S. T., 2013, Emerging of Medical Tourism in Egyptian Hospitals: International Patient Satisfaction towards Nurses Services Quality. Glo. Adv. Res. J. Manag. Bus. Stud. 2013;2(2):93–104.

[24].  Rajeev, A., 2009, Study of the Knowledge, Attitude and Experience of Medical Tourism Among Target Groups with Special Emphasis on South India. Online J Health Allied Scs. 2009;8(2):1–5. Available at: http://www.ojhas.org/issue30/2009-2-6.htm.

[25].  Crooks, V. A., Cameron, K., Chouinard, V., et al., 2012, Use of medical tourism for hip and knee surgery in osteoarthritis: a qualitative examination of distinctive attitudinal characteristics among Canadian patients. BMC Health Services Research. 2012;12(1):1. Available at: BMC Health Services Research.

[26].  Global Health Care, 2012, Online survey of global Health Care: and the Impact on Health Care in the United States). 2012:1 – 4.

[27].  Ibrahim, O., Orekoya, Omobola O. Oduyoye, 2018, Implications of Outbound Medical Tourism on Public Health Care Development in Nigeria. European Scientific Journal October 2018 edition Vol.14, No.30. 353- 370 ISSN: 1857 – 7881 (Print) e - ISSN 1857- 7431. Doi: 10.19044/esj.2018.v14n30p353 URL:http://dx.doi.org/10.19044/esj.2018.v14n30p353.

[28].  Novatia Consulting, 2024, Medical Tourism Feasibility Study in Nigeria, https://novatiaconsulting.com/medical-tourism-feasibility-study-in-nigeria/. Accessed on 03:11:2024

[29].  Alex Piper, 2024, Medical Tourism: Easy Steps to Penetrate Nigeria Patient Markets, Medical Tourism Magazine (MTM), 2024. OneWorld Global Healthcare Solutions. https://www.magazine.medicaltourism.com/article/medical-tourism-easy-steps-to-penetrate-nigeria-patient-markets. Accessed on 12:10: 2024

[30].  Busayo Akinmoju, 2020, The vicious cycle of medical tourism and physician migration, 2020. https://www.stears.co/article/the-vicious-cycle-of-medical-tourism-and-physician-migration/.

Abstract:

The long-term antiplatelet strategy for patients who have undergone percutaneous coronary intervention (PCI) continues to evolve, particularly in high-risk individuals who complete the standard duration of dual antiplatelet therapy (DAPT). Traditionally, aspirin has been central to secondary prevention regimens. However, increasing concerns regarding its gastrointestinal toxicity, bleeding risk, and pharmacodynamic variability have prompted reevaluation of its role in monotherapy, especially in light of emerging evidence favoring P2Y12 inhibitors such as clopidogrel. The SMART-CHOICE 3 trial addressed this clinical uncertainty through a large-scale, multicenter, open-label randomized trial conducted across 26 sites in South Korea. A total of 5,506 patients with previous myocardial infarction, diabetes mellitus, or complex coronary lesions who had completed DAPT after PCI were randomized to receive either clopidogrel (75 mg/day) or aspirin (100 mg/day) monotherapy. Over a median follow-up of 2.3 years, the primary composite outcome—death from any cause, myocardial infarction, or stroke—occurred significantly less frequently in the clopidogrel group (4.4%) compared to the aspirin group (6.6%) (HR 0.71; 95% CI 0.54–0.93; p=0.013). Breaking down the composite, myocardial infarction was halved in the clopidogrel arm (1.0% vs. 2.2%; HR 0.54), and all-cause mortality was numerically lower (2.4% vs. 4.0%; HR 0.71). Stroke rates were similar between groups. Notably, there was no difference in major bleeding between the two strategies (both 3.0%; HR 0.97), dispelling prior concerns regarding clopidogrel’s bleeding risk. Clopidogrel also showed a favorable safety profile with no increase in adverse events. In conclusion, clopidogrel monotherapy provides a superior net clinical benefit compared to aspirin for long-term secondary prevention following PCI, especially in high-risk patients. Its targeted mechanism of action, lower bleeding liability, and consistent performance across major trials strongly support its preferential use over aspirin in modern antiplatelet therapy. These results validate recent shifts in international guidelines advocating personalized, risk-adjusted approaches to antiplatelet therapy.

References:

[1].      Antithrombotic Trialists' (ATT) Collaboration, Baigent, C., Blackwell, L., Collins, R., Emberson, J., Godwin, J., Peto, R., Buring, J., Hennekens, C., Kearney, P., Meade, T., Patrono, C., Roncaglioni, M. C., & Zanchetti, A., 2009, Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet (London, England), 373(9678), 1849–1860, https://doi.org/10.1016/S0140-6736(09)60503-1

[2].      Costa, F., Montalto, C., Branca, M., Hong, S. J., Watanabe, H., Franzone, A., Vranckx, P., Hahn, J. Y., Gwon, H. C., Feres, F., Jang, Y., De Luca, G., Kedhi, E., Cao, D., Steg, P. G., Bhatt, D. L., Stone, G. W., Micari, A., Windecker, S., Kimura, T., Valgimigli, M., 2023, Dual antiplatelet therapy duration after percutaneous coronary intervention in high bleeding risk: a meta-analysis of randomized trials. European Heart Journal, 44(11), 954–968, https://doi.org/10.1093/eurheartj/ehac706

[3].      Levine, G. N., Bates, E. R., Bittl, J. A., Brindis, R. G., Fihn, S. D., Fleisher, L. A., Granger, C. B., Lange, R. A., Mack, M. J., Mauri, L., Mehran, R., Mukherjee, D., Newby, L. K., O'Gara, P. T., Sabatine, M. S., Smith, P. K., & Smith, S. C., Jr, 2016, 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease. Circulation, 134(10), e123–e155, https://doi.org/10.1161/CIR.0000000000000404

[4].      Capodanno, D., Bhatt, D. L., Gibson, C. M., James, S., Kimura, T., Mehran, R., Rao, S. V., Steg, P. G., Urban, P., Valgimigli, M., Windecker, S., & Angiolillo, D. J., 2022, Bleeding avoidance strategies in percutaneous coronary intervention. Nature Reviews Cardiology, 19(2), 117–132, https://doi.org/10.1038/s41569-021-00598-1

[5].      Capodanno, D., & Angiolillo, D. J., 2023, Long-Term P2Y12 Inhibitor or Aspirin as Single Antiplatelet Therapy in Patients with Previous Percutaneous Coronary Intervention. Circulation, 147(2), 118–121, https://doi.org/10.1161/CIRCULATIONAHA.122.063004

[6].      Vrints, C., Andreotti, F., Koskinas, K. C., Rossello, X., Adamo, M., Ainslie, J., Banning, A. P., Budaj, A., Buechel, R. R., Chiariello, G. A., Chieffo, A., Christodorescu, R. M., Deaton, C., Doenst, T., Jones, H. W., Kunadian, V., Mehilli, J., Milojevic, M., Piek, J. J., Pugliese, F., ESC Scientific Document Group, 2024, 2024 ESC Guidelines for the management of chronic coronary syndromes. European Heart Journal, 45(36), 3415–3537, https://doi.org/10.1093/eurheartj/ehae177

[7].      Park, T. K., Song, Y. B., Ahn, J., Carriere, K. C., Hahn, J. Y., Yang, J. H., Choi, S. H., Choi, J. H., Lee, S. H., & Gwon, H. C., 2016, Clopidogrel Versus Aspirin as an Antiplatelet Monotherapy After 12-Month Dual-Antiplatelet Therapy in the Era of Drug-Eluting Stents. Circulation: Cardiovascular Interventions, 9(1), e002816, https://doi.org/10.1161/CIRCINTERVENTIONS.115.002816

[8].      Park, H. W., Kang, M. G., Ahn, J. H., Bae, J. S., Tantry, U. S., Gurbel, P. A., & Jeong, Y. H., 2021, Effects of Monotherapy with Clopidogrel vs. Aspirin on Vascular Function and Hemostatic Measurements in Patients with Coronary Artery Disease: The Prospective, Crossover I-LOVE-MONO Trial. Journal of Clinical Medicine, 10(12), 2720, https://doi.org/10.3390/jcm10122720

[9].      Costa, F., Van Klaveren, D., Feres, F., James, S., Räber, L., Pilgrim, T., Hong, M. K., Kim, H. S., Colombo, A., Steg, P. G., Bhatt, D. L., Stone, G. W., Windecker, S., Steyerberg, E. W., Valgimigli, M., & PRECISE-DAPT Study Investigators, 2019, Dual Antiplatelet Therapy Duration Based on Ischemic and Bleeding Risks After Coronary Stenting. Journal of the American College of Cardiology, 73(7), 741–754, https://doi.org/10.1016/j.jacc.2018.11.048

[10].     Writing Committee Members, Lawton, J. S., Tamis-Holland, J. E., Bangalore, S., Bates, E. R., Beckie, T. M., Bischoff, J. M., Bittl, J. A., Cohen, M. G., DiMaio, J. M., Don, C. W., Fremes, S. E., Gaudino, M. F., Goldberger, Z. D., Grant, M. C., Jaswal, J. B., Kurlansky, P. A., Mehran, R., Metkus, T. S., Jr, Nnacheta, L. C.,  Zwischenberger, B. A., 2022, 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: Executive Summary. Journal of the American College of Cardiology, 79(2), 197–215, https://doi.org/10.1016/j.jacc.2021.09.005

[11].     Gargiulo, G., Windecker, S., Vranckx, P., Gibson, C. M., Mehran, R., & Valgimigli, M., 2016, A Critical Appraisal of Aspirin in Secondary Prevention: Is Less More? Circulation, 134(23), 1881–1906, https://doi.org/10.1161/CIRCULATIONAHA.116.023952

[12].     Collet, J. P., Thiele, H., Barbato, E., Barthélémy, O., Bauersachs, J., Bhatt, D. L., Dendale, P., Dorobantu, M., Edvardsen, T., Folliguet, T., Gale, C. P., Gilard, M., Jobs, A., Jüni, P., Lambrinou, E., Lewis, B. S., Mehilli, J., Meliga, E., Merkely, B., Mueller, C., ESC Scientific Document Group, 2021, 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. European Heart Journal, 42(14), 1289–1367, https://doi.org/10.1093/eurheartj/ehaa575

[13].     Cattaneo, M., 2015, P2Y12 receptors: structure and function. Journal of Thrombosis and Haemostasis: JTH, 13(Suppl 1), S10–S16, https://doi.org/10.1111/jth.12952

[14].     Choi, K. H., Park, Y. H., Lee, J. Y., Jeong, J. O., Kim, C. J., Yun, K. H., Lee, H. C., Chang, K., Park, M. W., Bae, J. W., Doh, J. H., Cho, B. R., Kim, H. Y., Kim, W., Kim, U., Rha, S. W., Hong, Y. J., Lee, H. J., Ahn, S. G., Kim, D. I., MART-CHOICE 3 investigators, 2025, Efficacy and safety of clopidogrel versus aspirin monotherapy in patients at high risk of subsequent cardiovascular event after percutaneous coronary intervention (SMART-CHOICE 3): a randomised, open-label, multicentre trial. Lancet (London, England), 405(10486), 1252–1263, https://doi.org/10.1016/S0140-6736(25)00449-0