Table of Contents - Issue
Recent articles
-
The Effect of Male Partner Involvement in ANC and IPTP-SP Uptake in Urban and Rural Areas of Benue State, NigeriaAuthor: Justice AdajiDOI: 10.21522/TIJAR.2014.13.02.Art001
The Effect of Male Partner Involvement in ANC and IPTP-SP Uptake in Urban and Rural Areas of Benue State, Nigeria
Abstract:
Globally, malaria infection is a serious communicable infectious disease that is a threat to the lives of half of world population. In regions where malaria is widespread, the World Health Organization (WHO) advises that every pregnant woman should receive a minimum of three doses of intermittent preventive treatment with Sulfadoxine-pyrimethamine (IPTp-SP) to reduce the risk of malaria during pregnancy. This study examined how male partner involvement like accompaniment to ANC, IPTp-SP awareness, and encouragement/reminders affects optimal IPTp-SP uptake among pregnant women in urban and rural of Benue State, Nigeria, comparing settings to inform targeted interventions. A community-based comparative cross-sectional study was conducted among women of reproductive age (15–49 years) in selected urban and rural communities in Benue State using a multistage sampling technique. Data analysis involved chi-square tests, logistic regression, and Spearman's correlation (p ≤ 0.05 significance). Male involvement was higher in urban areas (65.2% partner accompaniment to ANC) than rural (49.4%). Urban women whose partners accompanied them to ANC (OR = 3.882, 95% CI: 2.561–5.885), were aware of IPTp-SP (OR = 3.600, 95% CI: 2.374–5.458), or encouraged/reminded them (OR = 4.778, 95% CI: 1.718–13.298) had significantly higher odds of optimal uptake. In rural areas, male partner awareness of IPTp-SP was significantly associated with optimal uptake (OR = 1.534, 95% CI: 1.074–2.193). Targeted strategies in rural communities, including community education, male partner engagement, and improved access to antenatal care services, are essential to reduce disparities and enhance maternal and neonatal health outcomes.
The Effect of Male Partner Involvement in ANC and IPTP-SP Uptake in Urban and Rural Areas of Benue State, Nigeria
References:
[1]. Fana, S. A., Bunza, M. D. A., Anka, S. A., Imam, A. U., Nataala, S. U., 2015, Prevalence and risk factors associated with malaria infection among pregnant women in a semi-urban community of north-western Nigeria. Infectious Diseases of Poverty, 4(1), 1–17, https://doi.org/10.1186/s40249-015-0054-0
[2]. Desai, M., Hill, J., Fernandes, S., Walker, P., Pell, C., Gutman, J., et al., 2018, Prevention of malaria in pregnancy. The Lancet Infectious Diseases, 18(4), 119–132, http://dx.doi.org/10.1016/S1473-3099(18)30064-1
[3]. Poespoprodjo, J. R., Douglas, N. M., Ansong, D., Kho, S., Anstey, N. M., 2023, Malaria. The Lancet, 402(10419), 2328–2345, https://doi.org/10.1016/S0140-6736(23)01249-7
[4]. Mangusho, C., Mwebesa, E., Izudi, J., Aleni, M., Dricile, R., Ayiasi, R. M., et al., 2023, High prevalence of malaria in pregnancy among women attending antenatal care at a large referral hospital in northwestern Uganda: A cross-sectional study. PLoS One, 18, 1–16, http://dx.doi.org/10.1371/journal.pone.0283755
[5]. Ogba, P., Baumann, A., Chidwick, H., Banfield, L., DiLiberto, D. D., 2022, Barriers and facilitators to access and uptake of intermittent preventive treatment with sulfadoxine-pyrimethamine among pregnant women in Nigeria: A scoping review. Malaria World Journal, 13(4), 1–18, https://pmc.ncbi.nlm.nih.gov/articles/PMC9242533/
[6]. Anto, F., Agongo, I. H., Asoala, V., Awini, E., Oduro, A. R., 2019, Intermittent preventive treatment of malaria in pregnancy: Assessment of the sulfadoxine-pyrimethamine three-dose policy on birth outcomes in rural northern Ghana. Journal of Tropical Medicine, 2019(6712685), 1–10, https://doi.org/10.1155/2019/6712685
[7]. Obi, S. N., Emmanuel, M., Roseline, C., Mbbs, U., 2012, The impact of intermittent preventive treatment with sulfadoxine-pyrimethamine on the prevalence of malaria parasitaemia in pregnancy. Tropical Doctor, 42, 133–135, https://doi.org/10.1258/td.2011.110402
[8]. Muhammad, F. M., Nedjat, S., Sajadi, H. S., Parsaeian, M., Assan, A., Majdzadeh, R., 2021, Malaria intermittent preventive treatment in Nigeria: A qualitative study to explore barriers. BMC Infectious Diseases, 21(438), 2–7, https://doi.org/10.1186/s12879-021-06135-2
[9]. Mutanyi, J. A., Onguru, D. O., Ogolla, S. O., Adipo, L. B., 2021, Determinants of the uptake of intermittent preventive treatment of malaria in pregnancy with sulphadoxine pyrimethamine in Sabatia Sub County, Western Kenya. Infectious Diseases of Poverty, 10(1), 1–13, https://doi.org/10.1186/s40249-021-00887-4
[10]. Roman, E., Andrejko, K., Wolf, K., Henry, M., Youll, S., Florey, L., 2019, Determinants of uptake of intermittent preventive treatment during pregnancy: A review. Malaria Journal, 18(1), 1–9, https://doi.org/10.1186/s12936-019-3004-7
[11]. Diala, C. C., Pennas, T., Marin, C., Belay, K. A., 2013, Perceptions of intermittent preventive treatment of malaria in pregnancy (IPTp) and barriers to adherence in Nasarawa and Cross River States in Nigeria. Malaria Journal, 12(342), 1–16, https://doi.org/10.1186/1475-2875-12-342
[12]. Hill, J., Hoyt, J., van Eijk, A. M., D’Mello-Guyett, L., ter Kuile, F. O., Steketee, R., 2013, Factors affecting the delivery, access, and use of interventions to prevent malaria in pregnancy in sub-Saharan Africa: A systematic review and meta-analysis. PLoS Medicine, 10(7), 1–23, https://doi.org/10.1371/journal.pmed.1001488
[13]. Ameh, S., Owoaje, E., Oyo-Ita, A., Kabiru, C. W., Akpet, O. E. O., Etokidem, A., et al., 2016, Barriers to and determinants of the use of intermittent preventive treatment of malaria in pregnancy in Cross River State, Nigeria: A cross-sectional study. BMC Pregnancy and Childbirth, 16(1), 1–9, http://dx.doi.org/10.1186/s12884-016-0883-2
[14]. Azizi, S. C., Chongwe, G., Chipukuma, H., Jacobs, C., Zgambo, J., Michelo, C., 2018, Uptake of intermittent preventive treatment for malaria during pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) among postpartum women in Zomba District, Malawi: A cross-sectional study. BMC Pregnancy and Childbirth, 18(1), 1–13, https://doi.org/10.1186/s12884-018-1744-y
[15]. Annoon, Y., Hormenu, T., Ahinkorah, B. O., Seidu, A. A., Ameyaw, E. K., Sambah, F., 2020, Perception of pregnant women on barriers to male involvement in antenatal care in Sekondi, Ghana. Heliyon, 6(7), 1–9, https://doi.org/10.1016/j.heliyon.2020.e04434
[16]. Onoka, C. A., Onwujekwe, O. E., Hanson, K., Uzochukwu, B. S., 2012, Sub-optimal delivery of intermittent preventive treatment for malaria in pregnancy in Nigeria: Influence of provider factors. Malaria Journal, 11(317), 1–8, https://doi.org/10.1186/1475-2875-11-317
[17]. Exavery, A., Mbaruku, G., Mbuyita, S., Makemba, A., Kinyonge, I. P., Kweka, H., 2014, Factors affecting uptake of optimal doses of sulphadoxine-pyrimethamine for intermittent preventive treatment of malaria in pregnancy in six districts of Tanzania. Malaria Journal, 13(1), 1–9, https://doi.org/10.1186/1475-2875-13-22
[18]. Boateng, E. Y., Anyormi, G. E., Otoo, J., Abaye, D. A., 2018, Drivers of intermittent preventive treatment of malaria during pregnancy in Ghana: A generalized linear model with negative binomial approach. Applied Informatics, 5(10), 1–12, https://doi.org/10.1186/s40535-018-0057-6
[19]. Ansong, D., Otoo, D. M., Mensah, V., 2025, Knowledge, uptake and therapeutic effectiveness of sulfadoxine-pyrimethamine (IPTp-SP) among pregnant women attending the antenatal clinic at Ayeduase Health Centre in Oforikrom Municipality in the Ashanti Region, Ghana. BMC Pregnancy and Childbirth, 25(265), 1–13, https://doi.org/10.1186/s12884-024-07089-4
[20]. Kretchy, I. A., Atobrah, D., Adumbire, D. A., Ankamah, S., Adanu, T., Badasu, D. M., 2025, Enhancing the uptake of intermittent preventive treatment for malaria in pregnancy: A scoping review of interventions and gender-informed approaches. Malaria Journal, 24(49), 1–17, https://doi.org/10.1186/s12936-025-05275-z
Viewed PDF 270 19 -
Data-Linked Community-Health Facility Strategy to Identify and Reach Zero-Dose Children in Urban Informal Settlements: An Implementation Study in Wakiso District, UgandaAuthor: Dominic Savio KakeetoDOI: 10.21522/TIJAR.2014.13.02.Art002
Data-Linked Community-Health Facility Strategy to Identify and Reach Zero-Dose Children in Urban Informal Settlements: An Implementation Study in Wakiso District, Uganda
Abstract:
Despite substantial global progress in routine childhood immunisation, inequities persist, particularly among children living in urban informal settlements. Globally, an estimated 13 million children remain zero-dose each year—defined as children who have not received the first dose of a diphtheria–tetanus–pertussis (DTP)-containing vaccine. These children represent the most systematically excluded populations within immunisation systems and face the highest risk of vaccine-preventable diseases. In Uganda, rapid urbanisation has contributed to the concentration of zero-dose children in peri-urban districts such as Wakiso, where informal settlements are characterised by high population mobility, weak community–health facility linkages, and fragmented immunisation data systems. This study evaluates the effectiveness and implementation performance of a data-linked community–health facility strategy to improve identification, referral completion, and vaccination uptake among zero-dose and under-immunised children aged 0–23 months in urban informal settlements of Wakiso District, Uganda. A mixed-methods implementation research design will be used. Quantitative data will be obtained from routine immunisation records, household verification surveys, and integrated community registers, while qualitative data will be collected through focus group discussions and key informant interviews with caregivers, Village Health Teams, and health workers. Primary outcomes include changes in the identification and vaccination initiation of zero-dose children, measured through DTP1 uptake. Secondary outcomes include the acceptability, feasibility, and scalability of the intervention using the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework. By strengthening integration between community-generated data and health facility immunisation records, the study aims to generate practical implementation evidence for improving immunisation equity in urban informal settlements. Findings will inform district immunisation microplanning and outreach strategies. The study will also generate implementation-relevant evidence to support national immunisation policy and scalable approaches for identifying and reaching zero-dose children in rapidly urbanising settings.
Data-Linked Community-Health Facility Strategy to Identify and Reach Zero-Dose Children in Urban Informal Settlements: An Implementation Study in Wakiso District, Uganda
References:
[1]. World Health Organization, 2023, Immunization coverage. World Health Organization, Geneva. Available at: https://www.who.int/news-room/fact-sheets/detail/immunization-coverage
[2]. Gavi, the Vaccine Alliance, 2021, The Zero-Dose Strategy 2021–2025: Reaching children who have never been vaccinated. Gavi Secretariat, Geneva. Available at: https://www.gavi.org
[3]. UNICEF, 2023, The State of the World’s Children 2023: For every child, vaccination. United Nations Children’s Fund, New York. Available at: https://www.unicef.org/reports/state-of-worlds-children-2023
[4]. United Nations Human Settlements Programme (UN-Habitat), 2022, World Cities Report 2022: Envisaging the Future of Cities. UN-Habitat, Nairobi. Available at: https://unhabitat.org
[5]. Antai, D., & Awofeso, N., 2014, The urban paradox in child health: Trends and determinants of vaccination coverage in urban settings. BMC Public Health, 14, 349. https://doi.org/10.1186/1471-2458-14-349
[6]. Fotso, J. C., Ezeh, A. C., Madise, N. J., & Ciera, J., 2007, Progress towards the child mortality millennium development goal in urban sub-Saharan Africa: The dynamics of population growth, immunization, and health service utilization. Health & Place, 13(1), 205–215. https://doi.org/10.1016/j.healthplace.2005.11.001
[7]. Uganda Bureau of Statistics (UBOS) & ICF, 2018, Uganda Demographic and Health Survey 2016. UBOS and ICF International, Kampala and Rockville. Available at: https://dhsprogram.com
[8]. Uganda Ministry of Health, 2023, Uganda National Immunization Strategy 2024–2028. Ministry of Health, Kampala. Available at: https://health.go.ug
[9]. UNICEF & World Health Organization, 2022, Reaching Zero-Dose Children: A global immunization strategy to improve equity in immunization. WHO and UNICEF, Geneva. Available at: https://www.who.int
[10]. Sambayuka, A., Mshana, C., & Mboya, D., 2023, Rapid urban immunization intervention to identify and vaccinate zero-dose children in Dar es Salaam, Tanzania. Vaccine, 41(12), 2015–2022. https://doi.org/10.1016/j.vaccine.2023.01.067
[11]. Jammeh, A., Sowe, A., & Camara, A., 2023, Barriers to childhood vaccination in urban informal settlements: A systematic review. BMC Health Services Research, 23, 1043. https://doi.org/10.1186/s12913-023-09961-3
[12]. McLennan, S., Wicker, S., & Bettenworth, D., 2022, Vaccine hesitancy and public trust in vaccination programs in low- and middle-income countries. Vaccine, 40(10), 1452–1458. https://doi.org/10.1016/j.vaccine.2021.12.019
[13]. Amouzou, A., Maiga, A., & Yoder, P., 2023, Social determinants of vaccination uptake in sub-Saharan Africa: A multi-country analysis. The Lancet Global Health, 11(4), e543–e552. https://doi.org/10.1016/S2214-109X(23)00034-4
[14]. Santos, T., Wallace, A., & Goodson, J., 2024, Structural barriers to immunization in urban informal settlements: Implications for equitable vaccination coverage. Vaccine, 42(5), 742–749. https://doi.org/10.1016/j.vaccine.2023.12.011
[15]. Zimba, R., Kulkarni, S., & Kawooya, M., 2024, Understanding the urban immunization paradox in sub-Saharan Africa. Global Health Research and Policy, 9(1), 21. https://doi.org/10.1186/s41256-024-00319-7
[16]. Bedford, H., Attwell, K., & Danchin, M., 2018, Vaccine hesitancy, refusal and access barriers: The need for clarity in terminology. Vaccine, 36(44), 6556–6558. https://doi.org/10.1016/j.vaccine.2017.08.004
[17]. Andersen, R. M., 1995, Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior, 36(1), 1–10. https://doi.org/10.2307/2137284
[18]. McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K., 1988, An ecological perspective on health promotion programs. Health Education Quarterly, 15(4), 351–377. https://doi.org/10.1177/109019818801500401
[19]. Glasgow, R. E., Vogt, T. M., & Boles, S. M., 1999, Evaluating the public health impact of health promotion interventions: The RE-AIM framework. American Journal of Public Health, 89(9), 1322–1327. https://doi.org/10.2105/AJPH.89.9.1322
[20]. Wonodi, C., & Farrenkopf, B., 2023, Understanding and addressing zero-dose children in global immunization programs. Vaccine, 41(5), 1121–1127. https://doi.org/10.1016/j.vaccine.2022.12.030
[21]. Uganda Bureau of Statistics (UBOS), 2016, National Population and Housing Census 2014: Main Report. Kampala, Uganda. Available at: https://www.ubos.org
[22]. UN-Habitat, 2022, World Cities Report 2022: Envisaging the Future of Cities. United Nations Human Settlements Programme, Nairobi. Available at: https://unhabitat.org
[23]. UNICEF & World Health Organization, 2022, Guidance on identifying and reaching zero-dose children. Geneva: World Health Organization. Available at: https://www.who.int
[24]. Gavi, The Vaccine Alliance, 2021, The Zero-Dose Immunisation Programme Strategy 2021–2025. Geneva. Available at: https://www.gavi.org
Viewed PDF 705 61 -
Intergenerational Transmission of Menstrual Shame: A Qualitative Investigation of Parental Influence on Adolescent Menstrual Health Attitudes in Urban GhanaAuthor: Aba Appiah-Mensah AmpemDOI: 10.21522/TIJAR.2014.13.02.Art003
Intergenerational Transmission of Menstrual Shame: A Qualitative Investigation of Parental Influence on Adolescent Menstrual Health Attitudes in Urban Ghana
Abstract:
This qualitative study examined how parents transmit menstrual health attitudes and knowledge to their adolescent daughters in urban Ghana through focus group discussions with 15 parents representing diverse socio-economic backgrounds and educational levels. Thematic analysis revealed four major themes: intergenerational transmission of menstrual shame despite improved hygiene practices, persistent influence of cultural and religious beliefs on menstrual attitudes, notable generational shifts in comfort levels with menstrual discussions, and evolving perspectives on male involvement in menstrual health education. Parents acknowledged transmitting the same shame and discomfort they experienced in their own adolescence, despite possessing better factual knowledge than previous generations. Cultural restrictions preventing menstruating girls from cooking, touching food, or participating in ceremonies remained firmly embedded across socio-economic levels, while religious beliefs imposed additional constraints on worship and spiritual activities. Parents expressed internal conflicts between maintaining traditional practices and adapting to modern health perspectives, using ancestral teachings to legitimize restrictive attitudes. However, parents also recognized that their daughters' generation demonstrates greater openness and comfort with menstrual topics compared to their own upbringing, though many admitted their personal discomfort continues despite intellectual acceptance of menstruation as normal. Educated urban parents increasingly supported teaching boys about menstruation to create supportive environments, while traditional attitudes maintaining menstruation as exclusively female knowledge persisted particularly in less educated populations. These findings illuminate the complex mechanisms through which cultural beliefs persist across generations even as health knowledge improves, highlighting the critical need for family-centered interventions addressing both parents' and daughters' attitudes simultaneously rather than focusing on adolescent education alone.
Intergenerational Transmission of Menstrual Shame: A Qualitative Investigation of Parental Influence on Adolescent Menstrual Health Attitudes in Urban Ghana
References:
[1]. Bandura, A., 1989, Social Cognitive Theory. In: R. Vasta (ed.), Annals of Child Development, Vol. 6: Six Theories of Child Development, pp. 1-60, Greenwich, CT: JAI Press.
[2]. Ajzen, I., 1991, The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2), 179-211.
[3]. Mohammed, S., and Larsen-Reindorf, R. E., 2020, Menstrual knowledge, sociocultural restrictions, and barriers to menstrual hygiene management in Ghana: Evidence from a multi-method survey among adolescent schoolgirls and schoolboys. PLoS ONE, 15(10), e0241106.
[4]. Hennegan, J., Dolan, C., Wu, M., et al., 2016, Measuring the prevalence and impact of poor menstrual hygiene management: A quantitative survey of schoolgirls in rural Uganda. BMJ Open, 6(12), e012596.
[5]. Sommer, M., Hirsch, J. S., Nathanson, C., et al., 2015, Comfortably, safely, and without shame: Defining menstrual hygiene management as a public health issue. American Journal of Public Health, 105(7), 1302-1311.
[6]. WHO and UNICEF, 2024, State of School WASH Facilities in Low- and Middle-Income Countries. Geneva: World Health Organization and United Nations Children's Fund.
[7]. Anbesu, E. W., and Asgedom, Z. A., 2023, Menstrual hygiene practice and its associated factors among adolescent girls in sub-Saharan Africa: A systematic review and meta-analysis. BMC Public Health, 23(1), 892.
[8]. Belayneh, Z., and Mekuriaw, B., 2019, Knowledge and menstrual hygiene practice among adolescent school girls in southern Ethiopia: A cross-sectional study. BMC Public Health, 19(1), 1595.
[9]. Kpodo, F. M., Baku, E. A., Kumi-Kyereme, A., et al., 2022, Socio-cultural factors influencing menstrual hygiene management among adolescent girls in Ghana. Journal of Health, Population and Nutrition, 41(1), 23.
[10]. Asumah, M. N., Abubakari, A., & Gariba, A., et al., 2022, Schools preparedness for menstrual hygiene management: A descriptive cross-sectional study in the West Gonja Municipality, Savannah Region of Ghana. BMJ Open, 12(4), e056526.
[11]. Baku, E. A., Adrakpanya, V., Konlan, K. D., and Adatara, P., et al., 2020, Menstrual hygiene management among girls at a peri-urban senior high school in the Volta Region, Ghana. African Journal of Midwifery and Women's Health, 14(1), 1-12.
[12]. Braun, V., and Clarke, V., 2006, Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101.
[13]. Lincoln, Y. S., and Guba, E. G., 2021, Naturalistic Inquiry. Newbury Park, CA: SAGE Publications.
[14]. Patton, M. Q., 2020, Qualitative Research and Evaluation Methods: Integrating Theory and Practice (4th ed.). Thousand Oaks, CA: SAGE Publications.
[15]. Chuang, S. S., 2021, Intergenerational cultural transmission in context: Learning through the family, peers, and school. In: S. S. Chuang and R. P. Moreno (eds.), On New Shores: Understanding Immigrant Fathers in North America (pp. 149-168). Lanham, MD: Lexington Books.
[16]. Krumboltz, J. D., and Nichols, C. W., 2014, Integrating social learning theory with cognitive-behavioral approaches in counseling. In: D. Brown and R. W. Lent (eds.), Career Development and Counseling: Putting Theory and Research to Work (2nd ed., pp. 147-178). Hoboken, NJ: John Wiley and Sons.
[17]. Conner, M., 2020, Theory of planned behavior. In: M. D. Gellman (ed.), Encyclopedia of Behavioral Medicine. Cham: Springer.
[18]. Dwumfour-Asare, B., Agbemafle, I., Nyarko, K. B., et al., 2024, Menstrual hygiene management among adolescent girls in low- and middle-income countries: A scoping review. International Journal of Environmental Research and Public Health, 21(3), 345-362.
[19]. World Health Organization, 2021, Progress on household drinking water, sanitation and hygiene 2000-2020: five years into the SDGs. World Health Organization.
[20]. Daniel, M., Araya, T., Mekonnen, Z., et al., 2023, Menstrual hygiene practice and associated factors among high school girls in Ethiopia: A systematic review and meta-analysis. Journal of Water, Sanitation and Hygiene for Development, 13(3), 145-159.
[21]. Stoilova, Y., Borowski, A., and Baumgartner, J. N., 2022, Menstrual health literacy among adolescent girls: A systematic review. Reproductive Health, 19(1), 78.
[22]. Gyasi-Gyamerah, A., Asante, K. P., Owusu-Agyei, S., et al., 2022, Menstrual hygiene management among adolescent girls in Ghana: Evidence from rural and peri-urban areas. International Journal of Women's Health, 14, 1345-1358.
[23]. Quayson, E., Opoku-Agyeman, K., and Amoah, S. T., 2024, Awareness versus practice: Examining menstrual hygiene management among urban adolescent girls in Ghana. Health Education Research, 39(2), 156-171.
[24]. Adane, Y., Ambelu, A., Azage Yenesew, M., and Mekonnen, Y., et al., 2024. Menstrual hygiene management practices among schoolgirls in resource-limited settings of Bahir Dar City administration, Northwestern Ethiopia. Women's Health, 20, 17455057241308343.
[25]. Fennie, K., Ofori-Acquah, A., and Osei-Tutu, B., 2022, Cultural beliefs and menstrual hygiene practices among adolescent girls in central Ghana. African Journal of Reproductive Health, 26(1),
87-98.[26]. Agyei-Sarpong, N., Mensah-Bonsu, A., and Adu-Gyamfi, R., 2025, School environment and menstrual hygiene management: Evidence from Greater Accra Region, Ghana. Journal of School Health, 95(1), 12-24.
[27]. Sarpong, K. A., and Amoako, E., 2024, Male involvement in menstrual health discussions: Perspectives from Ghanaian adolescents. Gender and Development, 32(3), 245-261.
[28]. Owusu-Ansah, J. K., 2024, Social media campaigns and menstrual health awareness among adolescents in Ghana. Health Communication, 39(4), 567-582.
[29]. Sahiledengle, B., Mwanri, L., Petrucka, P., et al., 2022, Determinants of menstrual hygiene management practices among adolescent girls in low and middle-income countries: A systematic review. International Journal of Environmental Research and Public Health, 19(21), 14122.
[30]. Umami, F., Hasanah, O., and Devy, S. R., 2022, Factors associated with menstrual hygiene management among adolescent girls: A systematic review. International Journal of Women's Health, 14, 1567-1582.
Viewed PDF 331 10 -
Navigating Institutional Gaps: Lived Experiences of Family Caregivers Managing Chronic Psychosis in ZambiaAuthor: Virginia SimasikuDOI: 10.21522/TIJAR.2014.13.02.Art004
Navigating Institutional Gaps: Lived Experiences of Family Caregivers Managing Chronic Psychosis in Zambia
Abstract:
Family caregivers bear the burdens of managing chronic psychosis as critical yet unrecognised partners in clinical decision making particularly in low resource settings where institutional support is inadequate. Their support exceeds beyond relational responsibility to include clinical decision making, medication management and crisis management. The objective of the study was to explore the experiences of caregivers on the roles, challenges and interactions with the formal mental health services. The study recruited 30 participants through purposive sampling and collected data using in-depth interviews. Data were analysed using the interpretive phenomenological design by Smith et.al (2009) criteria to identify superordinate and subordinate themes. Three overarching themes were identified: 1) primary managers of treatment decisions, 2) integrating biomedical and spiritual decision making, and 3) bearing clinical responsibility without adequate support. The experiences highlight the central role of caregivers in the management of psychosis within the limited mental health services. In conclusion, caregivers should be recognised as core stakeholders in clinical decision making rather than health seekers, as failure to integrate them may endanger their wellbeing. This risk of mismanagement could result from emotionally based decisions due to poor education on the illness. There is need to continuously engage caregivers in care planning, knowledge on adverse effects, provision of coping strategies and management of psychosis. These findings provide a basis for mental health policy to structure caregivers’ frameworks that include mandatory crisis guidance and to nursing practice by incorporating routine assessments of caregiver wellbeing and support as standard psychiatric care.
Navigating Institutional Gaps: Lived Experiences of Family Caregivers Managing Chronic Psychosis in Zambia
References:
[1]. Hardy, A., Keen, N., van den Berg, D., Varese, F., Longden, E., Ward, T., & Brand, R. M., 2023, Trauma therapies for psychosis: A state-of-the-art review. Psychology and Psychotherapy: Theory, Research and Practice, 96(4), 1234–1256, https://doi.org/10.1111/papt.12499
[2]. Solmi, M., Seitidis, G., Mavridis, D., Correll, C. U., Dragioti, E., Guimond, S., Tuominen, L., Dargél, A., et al., 2023, Incidence, prevalence, and global burden of schizophrenia—data, with critical appraisal, from the Global Burden of Disease (GBD) 2019. Molecular Psychiatry, 28, 5319–5327, https://doi.org/10.1038/s41380-023-02138-4
[3]. Deng, S., Wang, Y., Peng, M., Zhang, T., Li, M., Luo, W., & Ran, M., 2023, Quality of life among family caregivers of people with schizophrenia in rural China. Quality of Life Research, 32(6), 1759-1769. https://doi.org/10.1007/s11136-023-03349-6
[4]. Yoo, A., Kim, M., Ross, M. M., Vaughn-Lee, A., Butler, B., & dosReis, S., 2018, Engaging Caregivers in the Treatment of Youth with Complex Developmental and Mental Health Needs. The Journal of Behavioral Health Services & Research, 45(3), 440-453. https://doi.org/10.1007/s11414-018-9604-0
[5]. Isaacs, A. N., Lawn, S., Lambert, C., and Dyer, A., 2025, A qualitative study of the responsibilities and unmet needs of carers of persons with severe mental health challenges. Journal of Mental Health, 1–11. https://doi.org/10.1080/09638237.2025.2558501
[6]. Alasmee, N., 2020, Primary caregivers experience of anti-psychotic medication: A qualitative study. Archives of Psychiatric Nursing, 34(6), 520-528. https://doi.org/10.1016/j.apnu.2020.09.002
[7]. Stomski, N. J., & Morrison, P., 2018, Carers' involvement in decision making about antipsychotic medication: A qualitative study. Health Expectations: An International Journal of Public Participation in Health Care and Health Policy, 21(1), 308–31. https://doi.org/10.1111/hex.12616
[8]. Lewins, A., Morant, N., Akther-Robertson, J., Crellin, N. E., Stansfeld, J. L., Smith, R., and Moncrieff, J., 2024, A qualitative exploration of family members’ perspectives on reducing and discontinuing antipsychotic medication. Journal of Mental Health, 33(3), 333–340. https://doi.org/10.1080/09638237.2022.2069710
[9]. Orlando, S., Long, M., Akther-Robertson, J., Stansfeld, J., Haime, Z., Smith, R., Moncrieff, J., and Morant, N., 2025, Family and informal carers’ views and experiences of antipsychotic reduction and discontinuation within a medication reduction research trial. Journal of Mental Health, 1–11. https://doi.org/10.1080/09638237.2025.2585195
[10]. Fekih-Romdhane, F., Saguem, B. N., Stambouli, M., Hallit, S., & Cheour, M., 2025, Violence victimization and perpetration within the caregiver-patient relationship in schizophrenia: A cross-sectional study in Tunisia. PloS one, 20(5), e0323312. https://doi.org/10.1371/journal.pone.0323312
[11]. Lal, S., Malla, A., Marandola, G., Thériault, J., Tibbo, P., Manchanda, R., Williams, R., Joober, R., and Banks, N., 2019, “Worried about relapse”: Family members’ experiences and perspectives of relapse in first‐episode psychosis. Early Intervention in Psychiatry, 13(1), 24-29.https://doi.org/10.1111/eip.12440
[12]. Peng, M. M., Ma, Z., and Ran, M. S., 2022, Family caregiving and chronic illness management in schizophrenia: positive and negative aspects of caregiving. BMC Psychol, 10(83). https://doi.org/10.1186/s40359-022-00794-9
[13]. Simasiku, V., Ngoma, C. M., & Konnur, R., 2026, Family caregiving as a moral and spiritual commitment in Zambia’s mental health care setting. Texila International Journal of Academic Research, 13(1). https://doi.org/10.21522/TIJAR.2014.13.01.Art007
[14]. Sichimba, F., Janlöv, A., and Khalaf, A., 2022, Family caregivers’ perspectives of cultural beliefs and practices towards mental illness in Zambia: An interview-based qualitative study. Scientific Reports, 12, 21388. https://doi.org/10.1038/s41598-022-25985-7
[15]. Agyemang Duah, E. K., and Wilson, R. L., 2025, The Experiences of Sub‐Saharan African Migrant Carers and Families of Young People with Emerging Psychosis. International Journal of Mental Health Nursing, 34(6), e70162. https://doi.org/10.1111/inm.70162
[16]. Iseselo, M. K., Kajula, L. and Yahya-Malima, K. I., 2016, The psychosocial problems of families caring for relatives with mental illnesses and their coping strategies: a qualitative urban based study in Dar es Salaam, Tanzania. BMC Psychiatry, 16, 146. https://doi.org/10.1186/s12888-016-0857-y
[17]. Verity, F., Turiho, A., Mutamba, B. B., & Cappo, D., 2021, Family care for persons with severe mental illness: Experiences and perspectives of caregivers in Uganda. International Journal of Mental Health Systems, 15, 48. https://doi.org/10.1186/s13033-021-00470-2
[18]. Clari, R., Headley, J., Egger, J., Swai, P., Lawala, P., Minja, A., Kaaya, S., and Baumgartner, J. N., 2022, Perceived burden and family functioning among informal caregivers of individuals living with schizophrenia in Tanzania: a cross-sectional study. BMC Psychiatry, 2210). https://doi.org/10.1186/s12888-021-03560-0
[19]. Dehbozorgi, R., Shahriari, M., Fereidooni-Moghadam, M., and Moghimi-Sarani, E., 2023, Family-centered collaborative care for patients with chronic mental illness: A systematic review. Journal of Research in Medical Sciences, 28(1), 6. https://doi.org/10.4103/jrms.jrms_410_22
[20]. Cochrane, C., Moran, N., and Newton, E., 2021, Exploring the impacts of a carers’ psycho-education group: personal insights from the family of people with early psychosis. Psychosis, 13(3), 253–264. https://doi.org/10.1080/17522439.2020.1861073
[21]. Chow, J. Y. A., Yeo, Y. T. T., and Goh, Y. S., 2024, Effects of Psychoeducation on Caregivers of Individuals Experiencing Schizophrenia: A Systematic Review and Meta‐Analysis. International Journal of Mental Health Nursing, 33(6), 1962-1987. https://doi.org/10.1111/inm.13421
[22]. Abou Seif, N., Wood, L., and Morant, N., 2022, Invisible experts: A systematic review and thematic synthesis of informal carer experiences of inpatient mental health care. BMC Psychiatry, 22, 347. https://doi.org/10.1186/s12888-022-03872-9
[23]. Chen, Y. C., Sun, F. K., Huang, X. Y., Chien, C. H., and Kuo, Y. J., 2025, 'Did I Make the Right Choice': A Qualitative Exploration of Decision Regret Among Family Caregivers After Hospitalising a Patient with Schizophrenia. International Journal of Mental Health Nursing, 34(1), e70012. https://doi.org/10.1111/inm.70012
[24]. Wertz, F. J., Charmaz, K., McMullen, L. M., Josselson, R., Anderson, R., and McSpadden, E., 2011, Five ways of doing qualitative analysis: Phenomenological psychology, grounded theory, discourse analysis, narrative research, and intuitive inquiry. New York: Guilford Press.
[25]. Creswell, J. W., 2009, Research design: Qualitative, quantitative, and mixed methods approaches. 3rd ed. Thousand Oaks, CA: Sage Publications
[26]. Pietkiewicz, I., and Smith, J. A., 2012, A practical guide to using interpretative phenomenological analysis in qualitative research psychology. Psychological Journal, 18(2), 361–369.
[27]. . Smith, J. A., and Osborn, M., 2008, Interpretative phenomenological analysis. In: J. A. Smith (ed.), Qualitative psychology: A practical guide to research methods, 2nd ed. (London: Sage Publications), pp. 53–80.
[28]. Muvwimi, T. S., Ngoma, C. M., and Salgado, A. B., 2025, Cultivating self-motivation, lifestyle modification and emotional resilience in elderly patients with multimorbidity: A path to successful self-management. Texila Advanced Journal of Multidisciplinary Health Research, 5(1), Article 018. doi:10.21522/TAJMHR.2016.05.01.Art018.
[29]. Smith, J. A., Flowers, P., and Larkin, M., 2009, Interpretative phenomenological analysis: Theory, method and research (London: Sage Publications Ltd).
[30]. Lincoln, Y. S., & Guba, E. G., 1985, Naturalistic inquiry. Thousand Oaks, CA: Sage.
[31]. Smith, J. A., Flowers, P., and Larkin, M., 2009, Interpretative phenomenological analysis: Theory, method and research (London: Sage Publications Ltd).
[32]. Huang, C., Lam, L., Plummer, V., Cross, W. M., 2021, Feeling responsible: Family caregivers’ attitudes and experiences of shared decision-making regarding people diagnosed with schizophrenia: A qualitative study. Patient Educ Couns. 104(7):1553–1556. https://doi.org/10.1016/j.pec.2020.10.032
[33]. Zhou, H., Ma, F., Zhang, Y., Tan, Y., Bai, Y., Hu, Q., Wei, W., and Wang, Y., 2022, Perceptions of Family Caregivers of Patients with Schizophrenia Towards Antipsychotics Associated Side-Effects in China: A Qualitative Study. Patient Preference and Adherence, 16, 2171–2179. https://doi.org/10.2147/PPA.S372487
[34]. Akintobi, T., 2023, Caregiver Perspective in a Mental Diagnosis of Hyperreligiosity. Research Square. https://doi.org/10.21203/rs.3.rs-3152640/v1
[35]. Freeman, A., Swartz, L., and Asmal, L., 2026, Between relief and estrangement: Family experiences of involuntary treatment for psychosis in South Africa. Social Science & Medicine, 390, 118871. https://doi.org/10.1016/j.socscimed.2025.118871
[36]. Subu, M. A., Holmes, D., Arumugam, A., Al-Yateem, N., Maria Dias, J., Rahman, S. A., Waluyo, I., Ahmed, F. R., and Abraham, M. S., 2022, Traditional, religious, and cultural perspectives on mental illness: A qualitative study on causal beliefs and treatment use. International Journal of Qualitative Studies on Health and Well-Being, 17(1). https://doi.org/10.1080/17482631.2022.2123090
[37]. Irawati, K., Indarwati, F., Haris, F., Lu, J. Y., and Shih, Y. H., 2023., Religious Practices and Spiritual Well-Being of Schizophrenia: Muslim Perspective. Psychology Research and Behaviour Management, 16, 739–748. https://doi.org/10.2147/PRBM.S402582
[38]. Benyah, F. E. K., 2023, Healing and mental illness in Ghana: Why prayer camps in Ghana are sometimes alternatives to psychiatric hospitals. Temenos-Nordic Journal for the Study of Religion, 59(1), 101-123. https://doi.org/10.33356/temenos.109270
[39]. Rastogi, S., Pandey, P., Maurya, K., Kumar, S., Varma, A., and Singh, G., 2023, Self reported benefits of participating in group prayer in a hospital outpatient setting: A cross-sectional observational study. Journal of Ayurveda and Integrative Medicine, 14(5), p.100738. https://doi.org/10.1016/j.jaim.2023.100738
[40]. Moudatsou, M., Koukouli, S., Palioka, E., Pattakou, G., Teleme, P., Fasoi, G., Kaba, E., and Stavropoulou, A., 2021, Caring for Patients with Psychosis: Mental Health Professionals’ Views on Informal Caregivers’ Needs. International Journal of Environmental Research and Public Health, 18(6), 2964. https://doi.org/10.3390/ijerph18062964
[41]. Sin, J., Elkes, J., Batchelor, R., Henderson, C., Gillard, S., Woodham, L. A., & Cornelius, V., 2021, Mental health and caregiving experiences of family carers supporting people with psychosis. Epidemiology and Psychiatric Sciences, 30, e3. https://doi.org/10.1017/S2045796020001067
[42]. Jimena, A. V., Morales‐Asencio, J. M., Quemada, C., and Hurtado, M. M., 2025, A qualitative study on care roles and health support for family caregivers of people with psychotic disorders in Spain. Archives of Psychiatric Nursing. https://doi.org/10.1016/j.apnu.2025.152027
[43]. Citrome, L., Belcher, E., Stacy, S., Suett, M., Mychaskiw, M., & Salinas, G. D., 2022, Perceived Burdens and Educational Needs of Caregivers of People with Schizophrenia: Results of a National Survey Study. Patient Preference and Adherence, 16, 159–168. https://doi.org/10.2147/PPA.S326290
[44]. Cruz, E., Paré, M. A., Stan, C., Voth, J., Ward, L., & Taboun, M., 2024, Caring for the caregiver: an exploration of the experiences of caregivers of adults with mental illness. SSM-Qualitative Research in Health, 5, 100406. https://doi.org/10.1016/j.ssmqr.2024.100406
[45]. Estradé, A., Onwumere, J., Venables, J., Gilardi, L., Cabrera, A., Rico, J., Hoque, A., Otaiku, J., Hunter, N., Kéri, P., and Kpodo, L., 2023, The lived experiences of family members and carers of people with psychosis: a bottom-up review co-written by experts by experience and academics. Psychopathology, 56(5), 371-382. https://doi.org/10.1159/000528513
[46]. Schuster, F., Holzhüter, F., Heres, S., and Hamann, J., 2021, ‘Triadic’shared decision making in mental health: Experiences and expectations of service users, caregivers and clinicians in Germany. Health Expectations, 24(2), 507-515. https://doi.org/10.1111/hex.13192
[47]. Kraun, L., De Vliegher, K., Vandamme, M., Holtzheimer, E., Ellen, M., and van Achterberg, T., 2022, Older peoples' and informal caregivers' experiences, views, and needs in transitional care decision-making: a systematic review. International Journal of Nursing Studies, 134, 104303. https://doi.org/10.1016/j.ijnurstu.2022.104303
Viewed PDF 419 26 -
Assessment of Knowledge, Attitude and Practice of Food Safety and Hygiene Procedure among Rural and Urban Food Vendors in Oyo State, NigeriaAuthor: Olatunde Ademoye FalusiDOI: 10.21522/TIJAR.2014.13.02.Art005
Assessment of Knowledge, Attitude and Practice of Food Safety and Hygiene Procedure among Rural and Urban Food Vendors in Oyo State, Nigeria
Abstract:
Foodborne diseases are a major global health problem that kills millions of people each year, especially in low- and middle-income countries. In Nigeria, food contamination due to improper handling and poor hygiene by street vendors is a major cause of diseases such as diarrhea and cholera. The objective of this study was to assess the knowledge, attitudes and practices (KAP) of food vendors in rural and urban areas of Oyo State, Nigeria, on food safety and hygiene practices. A cross-sectional descriptive study was conducted among 350 food vendors in Oyo State, selected using multistage sampling techniques. Data were collected using a pre-tested self-administered questionnaire designed based on objectives and analysed using an IBM SPSS version 25.0. Findings were presented using charts and tables and the level of significance was at p<0.05. The study results showed that 96.6% of urban vendors had good knowledge of food safety, while 70.3% of rural vendors had knowledge of food safety. However, urban vendors had a higher negative attitude toward food safety (57.7%) compare to rural vendors. In terms of practice, 86.9% of urban vendors adhered to good hygiene practices, while rural vendors had a higher compliance rate (95.4%). Factors such as education level and marital status were significantly associated with food safety knowledge and practices. Despite high levels of knowledge, urban vendors showed low attitudes and hygiene practices, indicating a gap between knowledge and implementation. Targeted interventions aimed at changing behaviour and improving hygiene practices are recommended to improve food safety, especially in urban area.
Assessment of Knowledge, Attitude and Practice of Food Safety and Hygiene Procedure among Rural and Urban Food Vendors in Oyo State, Nigeria
References:
[1]. Funmilola, F., Olatubi, M., & Nnabuife, G., 2018, Food Safety and Hygiene Practices among Food Vendors in a Tertiary Educational Institution in South Western Nigeria. 8(2):59–70, European Journal of Nutrition & Food Safety.
[2]. World Health Organization, 2019, Food safety. p. 1–12, https://www.who.int/news-room/fact-sheets/detail/food-safety
[3]. Fasoro, A. A., Faeji, C. O., Oni, O. I., & Oluwadare, T., 2016, Assessment of food safety practices in a rural community in Southwest Nigeria. Food and Public Health, (3), 1-6.
[4]. Nordhagen, S., Lee, J., Onuigbo-Chatta, N., Okoruwa, A., Monterrosa, E., Lambertini, E., & Pelto, G. H., 2022, What is safe and how much does it matter? Food vendors’ and consumers’ views on food safety in urban Nigeria. Foods, 11(2), 225.
[5]. Pepple, N., 2017, Environment and food poisoning: Food safety knowledge and practice among food vendors in Garki, Abuja–Nigeria. J Health Educ Res Dev, 5(217), 2.
[6]. Aluh, F. O., & Aluh, D. O., 2017, Knowledge, attitudes and practices of food hygiene among mobile food vendors in a Nigerian rural settlement. Int J Community Med Public Health, 4, 4025-4030.
[7]. Ababio, P. F., & Lovatt, P., 2015, A review on food safety and food hygiene studies in Ghana. Food Control, 47, 92-97.
[8]. Kirk, M. D., Pires, S. M., Black, R. E., Caipo, M., Crump, J. A., Devleesschauwer, B., & Angulo, F. J., 2015, World Health Organization estimates of the global and regional disease burden of 22 foodborne bacterial, protozoal, and viral diseases, 2010: a data synthesis. PLoS Medicine, 12(12), e1001921.
[9]. Havelaar, A. H., Kirk, M. D., Torgerson, P. R., Gibb, H. J., Hald, T., Lake, R. J., & World Health Organization Foodborne Disease Burden Epidemiology Reference Group., 2015, World Health Organization global estimates and regional comparisons of the burden of foodborne disease in 2010. PLoS Medicine, 12(12), e1001923.
[10]. Jaffee, S., Henson, S., Unnevehr, L., Grace, D., & Cassou, E., 2018, The safe food imperative: Accelerating progress in low-and middle-income countries. World Bank Publications.
[11]. Eneh, S., Onukansi, F., Anokwuru, C., Ikhuoria, O., Edeh, G., Obiekwe, S., & Okpara, C., 2024, Cholera outbreak trends in Nigeria: policy recommendations and innovative approaches to prevention and treatment. Frontiers in Public Health, 12, 1464361.
[12]. Omemu, A. M., & Aderoju, S. T., 2008, Food safety knowledge and practices of street food vendors in the city of Abeokuta, Nigeria. Food Control, 19(4), 396-402.
[13]. Iwu, A. C., Uwakwe, K. A., Duru, C. B., Diwe, K. C., Chineke, H. N., Merenu, I. A., & Ohale, I., 2017, Knowledge, attitude and practices of food hygiene among food vendors in Owerri, Imo State, Nigeria. Occupational Diseases and Environmental Medicine, 5(1), 11-25.
[14]. Chukuezi, C. O., 2010, Food safety and hygienic practices of street food vendors in Owerri, Nigeria. Studies in Sociology of Science, 1(1), 50.
[15]. Nurudeen, A. A., Lawal, A. O., & Ajayi, S. A., 2014, A survey of hygiene and sanitary practices of street food vendors in the Central State of Northern Nigeria. Journal of Public health and Epidemiology, 6(5), 174-181.
[16]. Faremi, F., Olatubi, M., & Nnabuife, G., 2018, Food safety and hygiene practices among food vendors in a tertiary educational institution in South Western Nigeria. European Journal of Nutrition & Food Safety, 8(2), 59-70.
[17]. Khuluse, D. S., & Deen, A., 2020, Hygiene and safety practices of food vendors. African Journal of Hospitality, Tourism and Leisure, 9(4), 597-611.
[18]. Amaami, A. J., Dominic, D., & Collins, D., 2017, Factors associated with poor food safety compliance among street food vendors in the Techiman Municipality of Ghana. African Journal of Food Science, 11(3), 50-57.
[19]. Reddy, A. A., Ricart, S., & Cadman, T., 2020, Driving factors of food safety standards in India: learning from street-food vendors’ behaviour and attitude. Food Security, 12(6), 1201-1217.
[20]. Qureshi, S., NaheedVaida, Azim, D. H., 2016. Hygiene practices and food safety knowledge among street food vendors in Kashmir. International Journal of Scientific Research, 4:1–9. Available from: https://api.semanticscholar.org/CorpusID:114939807
[21]. Onyeaka, H., Ekwebelem, O. C., Eze, U. A., Onwuka, Q. I., Aleke, J., Nwaiwu, O., & Chionuma, J. O., 2021, Improving food safety culture in Nigeria: A review of practical issues. Foods, 10(8), 1878.
[22]. Lois, N. I., Maduabuchi, E., and Prince, E. N., 2023, Food Safety Knowledge, Attitude and Practice of Food Vendors in Abia State, Nigeria. The International Journal of Operational Research in Management, Social Sciences & Education, 9(1):166–85.
[23]. Charan, J., & Biswas, T., 2013, How to calculate sample size for different study designs in medical research?. Indian Journal of Psychological Medicine, 35(2), 121-126.
[24]. Adebukola, O. C., Opeyemi, A. O., & Ayodeji, A. I., 2015, Knowledge of food borne infection and food safety practices among local food handlers in Ijebu-Ode Local Government Area of Ogun State. Journal of Public Health and Epidemiology, 7(9), 268-273.
[25]. Okojie, P. W., & Isah, E. C., 2014, Sanitary conditions of food vending sites and food handling practices of street food vendors in Benin City, Nigeria: implication for food hygiene and safety. Journal of Environmental and Public Health, 2014(1), 701316.
[26]. Okon, R. E., Okon, A. J., Inah, S. A., Olanrewaju, O. E., & Nji, E. L. B., 2022, Food hygiene knowledge, attitude and practices among food handlers in Calabar Municipal, Cross River State, Nigeria. World Journal of Advanced Research and Reviews, 16(1), 088-101.
[27]. Tuglo, L. S., Agordoh, P. D., Tekpor, D., Pan, Z., Agbanyo, G., & Chu, M., 2021, Food safety knowledge, attitude, and hygiene practices of street-cooked food handlers in North Dayi District, Ghana. Environmental Health and Preventive Medicine, 26(1), 54.
[28]. Bamidele, J. O., Adebimpe, W. O., Oladele, E. A., & Adeoye, O. A., 2015, Hygiene practices among workers in local eateries of Orolu community in south Western Nigeria. Annals of Medical and Health Sciences Research, 5(4), 235-240.
[29]. Fekadu, Y., Kinde, M. Z., Dagnaw, G. G., Dessalegn, B., Dejene, H., & Gessese, A. T., 2024, Knowledge, Attitude, and Practices on Food Safety among Food Handlers Working in Public Food Service Establishments in Lemi Kura Subcity, Addis Ababa, Ethiopia. BioMed Research International, 2024(1), 2675894.
[30]. Akabanda, F., Hlortsi, E. H., & Owusu-Kwarteng, J., 2017, Food safety knowledge, attitudes and practices of institutional food-handlers in Ghana. BMC Public Health, 17, 1-9.
[31]. Emmanuel, A., Mangai, J. M., Kayong, E. A., Afoi, B. B., Goshit, J. D., Naman, K., & Innocent, O., 2015, Assessment of practice of food safety and hygiene among food vendors within Jos North Local Government Area of Plateau State, Nigeria.
Viewed PDF 284 11 -
Trends in Cardiovascular Risk Factors and Mortality among Adults with Diabetes in Sub-Saharan Africa (2000-2025): A Secondary Data AnalysisAuthor: Jean-Paul Mukeba TshitendeDOI: 10.21522/TIJAR.2014.13.02.Art006
Trends in Cardiovascular Risk Factors and Mortality among Adults with Diabetes in Sub-Saharan Africa (2000-2025): A Secondary Data Analysis
Abstract:
Cardiovascular disease remains the leading cause of morbidity and mortality among people with type 2 diabetes mellitus. In sub-Saharan Africa, the burden of diabetes and its cardiovascular complications have increased substantially over the past two decades, yet long-term regional trend analyses remain limited. This study examined trends in diabetes prevalence, major cardiovascular risk factors, and diabetes-attributable cardiovascular mortality in sub-Saharan Africa between 2000 and 2025, using publicly available secondary data. A descriptive secondary data analysis was conducted using regionally aggregated and modelled estimates from the World Health Organisation Global Health Observatory, the International Diabetes Federation Diabetes Atlas, and the Global Burden of Disease Study. Trends in diabetes prevalence, hypertension, obesity, physical inactivity, and diabetes-attributable cardiovascular mortality were examined across the study period. Diabetes prevalence increased steadily across sub-Saharan Africa between 2000 and 2025, with a more pronounced rise observed after 2010. Hypertension emerged as the most prevalent cardiovascular risk factor among adults with diabetes, accompanied by increasing levels of obesity and physical inactivity. Cardiovascular mortality attributable to diabetes also increased consistently over the study period, with stroke and hypertensive heart disease accounting for a substantial proportion of deaths. The findings demonstrate a sustained rise in diabetes prevalence, a progressive accumulation of major cardiovascular risk factors, and increasing cardiovascular mortality attributable to diabetes in sub-Saharan Africa over the past two decades. These trends highlight the urgent need for integrated non-communicable disease prevention strategies and strengthened primary healthcare systems to reduce the growing cardiovascular burden among people with diabetes.
Trends in Cardiovascular Risk Factors and Mortality among Adults with Diabetes in Sub-Saharan Africa (2000-2025): A Secondary Data Analysis
References:
[1]. World Health Organization, 2022, Diabetes. World Health Organization.
[2]. International Diabetes Federation, 2023, IDF diabetes atlas (10th ed.). International Diabetes Federation. https://diabetesatlas.org
[3]. NCD Risk Factor Collaboration (NCD-RisC), 2021, Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019. The Lancet, 398(10304), 957–980. https://doi.org/10.1016/S0140-6736(21)01330-1
[4]. American Diabetes Association, 2024, Standards of care in diabetes—2024. Diabetes Care, 47(Suppl. 1), S1–S350. https://doi.org/10.2337/dc24-Sint
[5]. World Health Organization, 2023, Cardiovascular diseases (CVDs). World Health Organization.
[6]. Yusuf, S., Hawken, S., Ounpuu, S., Dans, T., Avezum, A., Lanas, F., McQueen, M., Budaj, A., Pais, P., Varigos, J., and Lisheng, L.,2004, Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study). The Lancet, 364(9438), 937–952. https://doi.org/10.1016/S0140-6736(04)17018-9
[7]. Libby, P., Ridker, P. M., and Maseri, A., 2009, Inflammation and atherosclerosis. Circulation, 105(9), 1135–1143. https://doi.org/10.1161/01.CIR.0000011610.27244.B1
[8]. Gouda, H. N., Charlson, F., Sorsdahl, K., Ahmadzada, S., Ferrari, A. J., Erskine, H., Leung, J., et al., 2019, Burden of non-communicable diseases in sub-Saharan Africa, 1990–2017. The Lancet Global Health, 7(10), e1375–e1387. https://doi.org/10.1016/S2214-109X(19)30374-2
[9]. Atun, R., Davies, J. I., Gale, E. A. M., Bärnighausen, T., Beran, D., Kengne, A. P., Levitt, N. S., et al., 2017, Diabetes in sub-Saharan Africa: From clinical care to health policy. The Lancet Diabetes & Endocrinology, 5(8), 622–667. https://doi.org/10.1016/S2213-8587(17)30181-X
[10]. Ekoru, K., Doumatey, A., Bentley, A. R., Chen, G., Zhou, J., Shriner, D., Fasanmade, O., Johnson, T., Oli, J., et al., 2020, Type 2 diabetes complications and comorbidities in sub-Saharan Africa: A multi-country analysis. The Lancet Diabetes & Endocrinology, 8(7), 548–558. https://doi.org/10.1016/S2213-8587(20)30113-4
[11]. Nyenwe, E. A., and Odia, O. J., 2021, Diabetes mellitus in Nigeria: The past, present and future. World Journal of Diabetes, 12(7), 905–920. https://doi.org/10.4239/wjd.v12.i7.905
[12]. Pastakia, S. D., Pekny, C. R., Manyara, S. M., and Fischer, L., 2017, Diabetes in sub-Saharan Africa—from policy to practice to progress: Targeting the existing gaps for future care. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 10, 247–263. https://doi.org/10.2147/DMSO.S126314
[13]. Uloko, A. E., Musa, B. M., Ramalan, M. A., Gezawa, I. D., Puepet, F. H., Uloko, A. T., and Sada, K. B., 2018, Prevalence and risk factors for diabetes mellitus in Nigeria: A systematic review and meta-analysis. Diabetes Therapy, 9(3), 1307–1316. https://doi.org/10.1007/s13300-018-0441-1
[14]. Mensah, G. A., Roth, G. A., and Fuster, V., 2019, The global burden of cardiovascular diseases and risk factors: 2020 and beyond. Journal of the American College of Cardiology, 74(20), 2529–2532. https://doi.org/10.1016/j.jacc.2019.10.009
[15]. Global Burden of Disease Collaborative Network, 2020, Global Burden of Disease Study 2019 (GBD 2019) results. Institute for Health Metrics and Evaluation. https://vizhub.healthdata.org/gbd-results/
[16]. Global Burden of Disease 2019 Risk Factors Collaborators, 2020, Global burden of 87 risk factors in 204 countries and territories, 1990–2019: A systematic analysis for the Global Burden of Disease Study 2019. The Lancet, 396(10258), 1223–1249. https://doi.org/10.1016/S0140-6736(20)30752-2
[17]. Sarfo, F. S., Ovbiagele, B., Gebregziabher, M., Wahab, K., Akinyemi, R., Akpalu, A., Obiako, R., Melikam, S., Owolabi, M., and Ovbiagele, B., 2018, Stroke among young adults in sub-Saharan Africa: Epidemiology and risk factors. Journal of the Neurological Sciences, 393, 95–101. https://doi.org/10.1016/j.jns.2018.08.015
[18]. World Health Organization, 2022, Global Health Observatory (GHO) data repository. World Health Organization. https://www.who.int/data/gho
[19]. Murray, C. J. L., and Lopez, A. D., 2017, Measuring global health: Motivation and evolution of the Global Burden of Disease Study. The Lancet, 390(10100), 1462–1474. https://doi.org/10.1016/S0140-6736(17)32385-8
[20]. World Health Organization, 2013, A global brief on hypertension: Silent killer, global public health crisis. World Health Organization. https://www.who.int/publications-detail-redirect/9789241505640
[21]. World Health Organization, 2000, Obesity: Preventing and managing the global epidemic. Report of a WHO consultation (WHO Technical Report Series 894). World Health Organization. https://www.who.int/publications-detail-redirect/9789241208947
[22]. World Health Organization, 2010, Global recommendations on physical activity for health. World Health Organization. https://www.who.int/publications-detail-redirect/9789241599979
[23]. World Health Organization, 2018, Noncommunicable Disease Country Profiles 2018. World Health Organization. https://www.who.int/publications-detail-redirect/9789241514620
[24]. World Health Organization, 2021, WHO STEPwise approach to noncommunicable disease risk factor surveillance (STEPS). World Health Organization. https://www.who.int/teams/noncommunicable-diseases/surveillance/systems-tools/steps
[25]. World Health Organization, 2018, Global status report on alcohol and health 2018. World Health Organization. https://www.who.int/publications-detail-redirect/9789241565639
[26]. World Health Organization, 2021, Global Report on Trends in Tobacco Use 2000–2025 (3rd ed.). World Health Organization. https://www.who.int/publications-detail-redirect/9789240058572
[27]. World Health Organization, 2017, Report of the Commission on Ending Childhood Obesity: Implementation plan for the WHO 2016–2025 global strategy on diet, physical activity and health. World Health Organization.
[28]. Zoungas, S., Woodward, M., Li, Q., Cooper, M. E., Hamet, P., Harrap, S., Heller, S., MacMahon, S., Mancia, G., Neal, B., Poulter, N., Williams, B., Chalmers, J., and ADVANCE Collaborative Group, 2014, Impact of blood pressure control on cardiovascular outcomes in patients with type 2 diabetes. The Lancet, 383(9933), 2069–2077. https://doi.org/10.1016/S0140-6736(14)60607-5
[29]. Kengne, A. P., Amoah, A. G. B., and Mbanya, J. C. N., 2010, Cardiovascular complications of diabetes mellitus in sub-Saharan Africa. Circulation, 112(23), 3592–3601. https://doi.org/10.1161/CIRCULATIONAHA.105.593012
[30]. Sobngwi, E., Mbanya, J. C. N., Unwin, N. C., Aspray, T. J., Alberti, K. G. M. M., and Collins, R., 2012, Diabetes mellitus and its complications in sub-Saharan Africa: A systematic review. The Lancet, 378(9786), 2254–2264. https://doi.org/10.1016/S0140-6736(11)60550-8
[31]. World Bank, 2021, World development indicators. World Bank. https://data.worldbank.org
[32]. Brownlee, M., 2005, The pathobiology of diabetic complications: A unifying mechanism. Diabetes, 54(6), 1615–1625. https://doi.org/10.2337/diabetes.54.6.1615
[33]. Levitt, N. S., Steyn, K., Dave, J., and Bradshaw, D., 2011, Chronic non-communicable diseases and HIV/AIDS on a collision course: Relevance for health care delivery in low-resource settings. American Journal of Clinical Nutrition, 94(6 Suppl), 1690S–1696S. https://doi.org/10.3945/ajcn.111.019075
[34]. Beaglehole, R., Bonita, R., Horton, R., Adams, C., Alleyne, G., Asaria, P., Baugh, V., Bekedam, H., Billo, N., Casswell, S., Cecchini, M., Colagiuri, R., Cotton, J., McKee, M., and Lancet NCD Action Group, 2011, Priority actions for the non-communicable disease crisis. The Lancet, 377(9775), 1438–1447. https://doi.org/10.1016/S0140-6736(11)60393-0
Viewed PDF 414 5 -
Attitude as a Complete Mediator: Unraveling the Knowledge-Practice Paradox in Adolescent Menstrual Hygiene Management in Urban GhanaAuthor: Aba Appiah-Mensah AmpemDOI: 10.21522/TIJAR.2014.13.02.Art007
Attitude as a Complete Mediator: Unraveling the Knowledge-Practice Paradox in Adolescent Menstrual Hygiene Management in Urban Ghana
Abstract:
This study investigated the knowledge-attitude-practice relationships in menstrual hygiene management among 386 adolescent girls aged 10-19 years in the Greater Accra Region of Ghana, employing structural equation modeling to test mediating and moderating mechanisms. Results revealed substantial knowledge deficits with only 47.2 percent demonstrating good knowledge (mean score 10.8/20, 54.0 percent), while 56.7 percent exhibited good practices (mean 15.9/20, 79.5 percent) and 52.3 percent held positive attitudes (mean 3.97/5, 79.5 percent). Structural equation modeling demonstrated that knowledge did not directly predict practices (β equals 0.091, p equals 0.573) but influenced them indirectly through attitudes as a complete mediator (β equals 0.316, p less than 0.001), challenging traditional knowledge-deficit models. Parental guidance significantly moderated the knowledge-practice relationship (β equals 0.693, p equals 0.001), while age and education showed no moderation effects. These findings validate Social Cognitive Theory reciprocal determinism and Theory of Planned Behaviour attitude-behaviour pathways, supporting family-centered interventions that address attitude formation and environmental support systems rather than isolated knowledge transfer for improving adolescent menstrual health management in urban Ghana.
Attitude as a Complete Mediator: Unraveling the Knowledge-Practice Paradox in Adolescent Menstrual Hygiene Management in Urban Ghana
References:
[1]. Dwumfour-Asare, B., Agbemafle, I., Nyarko, K. B., et al., 2024, Menstrual hygiene management among adolescent girls in low- and middle-income countries: A scoping review. International Journal of Environmental Research and Public Health, 21(3), 345-362.
[2]. Mohammed, S., and Larsen-Reindorf, R. E., 2020, Menstrual knowledge, sociocultural restrictions, and barriers to menstrual hygiene management in Ghana: Evidence from a multi-method survey among adolescent schoolgirls and schoolboys. PLoS ONE, 15(10), e0241106.
[3]. UNICEF and WHO, 2022, Progress on Household Drinking Water, Sanitation and Hygiene 2000-2020: Five Years into the SDGs. Geneva: United Nations Children's Fund and World Health Organization.
[4]. World Bank, 2025, Menstrual Health and Hygiene. Washington, DC: The World Bank Group.
[5]. Sommer, M., Hirsch, J. S., Nathanson, C., et al., 2015, Comfortably, safely, and without shame: Defining menstrual hygiene management as a public health issue. American Journal of Public Health, 105(7), 1302-1311.
[6]. WHO and UNICEF, 2024, State of School WASH Facilities in Low- and Middle-Income Countries. Geneva: World Health Organization and United Nations Children's Fund.
[7]. Anbesu, E. W., and Asgedom, Z. A., 2023, Menstrual hygiene practice and its associated factors among adolescent girls in sub-Saharan Africa: A systematic review and meta-analysis. BMC Public Health, 23(1), 892.
[8]. Belayneh, Z., and Mekuriaw, B., 2019, Knowledge and menstrual hygiene practice among adolescent school girls in southern Ethiopia: A cross-sectional study. BMC Public Health, 19(1), 1595.
[9]. Bulto, G. A., 2021, Knowledge towards menstruation and practice of menstrual hygiene management among adolescent girls in central Ethiopia: A cross-sectional study. Risk Management and Healthcare Policy, 14, 911-921.
[10]. Daniel, M., Araya, T., Mekonnen, Z., et al., 2023, Menstrual hygiene practice and associated factors among high school girls in Ethiopia: A systematic review and meta-analysis. Journal of Water, Sanitation and Hygiene for Development, 13(3), 145-159.
[11]. Hussein, M. H., Wijnhoven, A. M., van den Broek, I., et al., 2022, Knowledge, practices, and challenges regarding menstrual hygiene management amongst adolescent girls in Eritrea: A cross-sectional study. BMC Women's Health, 22(1), 456.
[12]. Stoilova, Y., Borowski, A., and Baumgartner, J. N., 2022, Menstrual health literacy among adolescent girls: A systematic review. Reproductive Health, 19(1), 78.
[13]. Gyasi-Gyamerah, A., Asante, K. P., Owusu-Agyei, S., et al., 2022, Menstrual hygiene management among adolescent girls in Ghana: Evidence from rural and peri-urban areas. International Journal of Women's Health, 14, 1345-1358.
[14]. Kpodo, F. M., Baku, E. A., Kumi-Kyereme, A., et al., 2022, Socio-cultural factors influencing menstrual hygiene management among adolescent girls in Ghana. Journal of Health, Population and Nutrition, 41(1), 23.
[15]. Asumah, M. N., Opoku-Agyemang, C., Adokiya, M. N., et al., 2022, School preparedness and menstrual hygiene management among adolescent girls in northern Ghana. BMC Women's Health, 22(1), 178.
[16]. Baku, E. A., Agbemafle, I., Kotoh, A. M., et al., 2020, Menstrual hygiene management and school absenteeism among adolescent girls in Ghana. International Journal of Adolescent Medicine and Health, 32(4), 189-197.
[17]. Adane, B. B., Kaso, M., Lenjebo, T. L., et al., 2024, Poor menstrual hygiene management and associated factors among school adolescent girls in northeast Ethiopia: A cross-sectional study. Reproductive Health, 21(1), 45.
[18]. Quayson, E., Opoku-Agyeman, K., and Amoah, S. T., 2024, Awareness versus practice: Examining menstrual hygiene management among urban adolescent girls in Ghana. Health Education Research, 39(2), 156-171.
[19]. Bandura, A., 1986, Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, NJ: Prentice-Hall.
[20]. Ajzen, I., 1991, The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2), 179-211.
[21]. Hair, J. F., Black, W. C., Babin, B. J., et al., 2019, Multivariate Data Analysis (8th ed.). Andover: Cengage Learning.
[22]. Kline, R. B., 2023, Principles and Practice of Structural Equation Modeling (5th ed.). New York: Guilford Press.
[23]. Preacher, K. J., and Hayes, A. F., 2008, Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40(3), 879-891.
[24]. Baron, R. M., and Kenny, D. A., 1986, The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173-1182.
[25]. Fennie, K., Ofori-Acquah, A., and Osei-Tutu, B., 2022, Cultural beliefs and menstrual hygiene practices among adolescent girls in central Ghana. African Journal of Reproductive Health, 26(1), 87-98.
[26]. Agyei-Sarpong, N., Mensah-Bonsu, A., and Adu-Gyamfi, R., 2025, School environment and menstrual hygiene management: Evidence from Greater Accra Region, Ghana. Journal of School Health, 95(1), 12-24.
[27]. Sarpong, K. A., and Amoako, E., 2024, Male involvement in menstrual health discussions: Perspectives from Ghanaian adolescents. Gender and Development, 32(3), 245-261.
[28]. Owusu-Ansah, J. K., 2024, Social media campaigns and menstrual health awareness among adolescents in Ghana. Health Communication, 39(4), 567-582.
[29]. Sahiledengle, B., Mwanri, L., Petrucka, P., et al., 2022, Determinants of menstrual hygiene management practices among adolescent girls in low and middle-income countries: A systematic review. International Journal of Environmental Research and Public Health, 19(21), 14122.
[30]. Umami, F., Hasanah, O., and Devy, S. R., 2022, Factors associated with menstrual hygiene management among adolescent girls: A systematic review. International Journal of Women's Health, 14, 1567-1582.
Viewed PDF 272 6 -
A Desk Review of Standard Operating Procedures of Ethics Committees in the Philippines on the Review of Clinical Trial Protocol DeviationsAuthor: Edwin C. Ruamero, Jr.DOI: 10.21522/TIJAR.2014.13.02.Art008
A Desk Review of Standard Operating Procedures of Ethics Committees in the Philippines on the Review of Clinical Trial Protocol Deviations
Abstract:
The review of post-approval submissions such as clinical trial protocol deviations (PDs) is a key function of Ethics Committees (ECs) to ensure data integrity and participant safety. However, the quality of PD management by ECs depends on the SOPs that are anchored in national and international guidelines. This desk review aimed to analyze the SOPs of Level III-accredited ECs in the Philippines in terms of protocol deviation management. From July to September 2025, SOPs of ECs were obtained from institutional websites and through web searches. The SOPs were then compared with recommendations by the Philippine Health Research Board SOP workbook for the presence or absence of the following: (a) policy statement; (b) objectives; (c) scope; and (d) work flow; (e) definition of protocol deviation (PD) or protocol violation (PV); and determine the (f) required timeline for submission to EC; (g) EC processing time; and (h) type of review for the noncompliance. A total of 28 SOPs were reviewed. The results revealed that while most institutional SOPs follow PHREB recommendations, ECs operationalize PD review differently. Key SOP provisions, such as the definition of PD/PV, timelines for reporting, processing time, and the type of review, can affect the quality of EC review and resolution of clinical trial noncompliance. Future research should extend beyond document analysis to investigate the practical implementation of SOP provisions regarding protocol deviation management.
A Desk Review of Standard Operating Procedures of Ethics Committees in the Philippines on the Review of Clinical Trial Protocol Deviations
References:
[1]. International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use, 2025, Good Clinical Practice (ICH E6(R3)). Available from: https://database.ich.org/sites/default/files/ICH_E6%28R3%29_Step4_FinalGuideline_2025_0106.pdf
[2]. U.S. Department of Health, Human Services Food and Drug Administration Center for Drug Evaluation, Research (CDER) Center for Biologics Evaluation and Research (CBER) Guidance for Industry. E3 Structure and Content of Clinical Study Reports, 2013. Available from: https://www.fda.gov/media/84857/download
[3]. Council for International Organizations of Medical Sciences, 2016, International Ethical Guidelines for Health-related Research Involving Humans. Available from: https://cioms.ch/wp-content/uploads/2017/01/WEB-CIOMS-EthicalGuidelines.pdf
[4]. Ghooi, R. B., Bhosale, N., Wadhwani, R., Divate, P., & Divate, U., 2016, Assessment and classification of protocol deviations. Perspectives in clinical research, 7(3), 132–136. https://doi.org/10.4103/2229-3485.184817
[5]. Zemsi, A., Nekame, L. J. G., Mohammed, N., et al., 2024, Practical Guidelines for Standardised Resolution of Important Protocol Deviations in Clinical Trials Conducted in Sub-Saharan Africa. Ther Innov Regul Sci, 58, 395–403. https://doi.org/10.1007/s43441-023-00604-3
[6]. U.S. Department of Health and Human Services, Food and Drug Administration Center for Drug Evaluation and Research (CDER), Center for Biologics Evaluation and Research (CBER), Center for Devices and Radiological Health (CDRH), and Oncology Center of Excellence (OCE), 2024, Protocol Deviations for Clinical Investigations of Drugs, Biological Products, and Devices Guidance for Industry. Available from: https://www.fda.gov/media/184745/download
[7]. European Medicines Agency, 2023, Guideline for the notification of serious breaches of Regulation (EU) No 536/2014 or the clinical trial protocol. Available from: https://www.ema.europa.eu/en/documents/scientific-guideline/guideline-notification-serious-breaches-regulation-eu-no-5362014-or-clinical-trial-protocol_en.pdf#page=8.08
[8]. World Health Organization, 2005, Handbook for good clinical research practice (GCP): guidance for implementation. Available from: https://iris.who.int/handle/10665/43392
[9]. Philippine Council for Health Research and Development (PCHRD), 2020, About PCHRD. Available from: https://www.pchrd.dost.gov.ph/about-pchrd/#
[10]. Philippine National Health Research System, 2006, National Ethical Guidelines for Health Research. Available from: https://ethics.healthresearch.ph/index.php/phoca-downloads/category/4-neg?download=33:neghr-2006
[11]. Philippine Council for Health Research and Development (PCHRD), 2015, PHREB Level 3 Accredited RECs. Available from: https://ethics.healthresearch.ph/index.php/level-3-accredited-recs
[12]. Philippine Health Research Ethics Board, 2020, PHREB Standard Operating Procedures. Available from: https://ethics.healthresearch.ph/index.php/phoca-downloads/category/19-2020-phreb-sop-workbook
[13]. Philippine Health Research Ethics Board, n.d., Ethics in Research - Capacity Building for RECs in Davao Region. Available at: https://ethics.healthresearch.ph/index.php/2018-08-28-03-27-16/remb-region-xi/369-ethics-in-research-capacity-building-for-recs-in-davao-region#:~:text=The%20training%20consists%20of%20lectures,Josephine%20Lumitao%20of%20PHREB
[14]. University of the Philippines Open University, 2021, Standard Operating Procedure (SOP) Workshop. Available at: https://www.upou.edu.ph/news/phreb-and-pchrd-conduct-standard-operating-procedure-workshop-for-up-open-university-institutional-research-ethics-committee-upou-irec/
[15]. Region 1 Health Research and Development Consortium, 2019, SOP Workshop Conducted for Quality Assurance. Available at: https://region1.healthresearch.ph/index.php/17-news/latest-news/177-sop-workshop-conducted-for-quality-assurance#:~:text=In%20order%20to%20help%20the,and%20simplify%20their%20unclear/vagueprocesses.
[16]. Philippine Health Research Ethics Board, 2022, National Ethical Guidelines for Research Involving Human Participants. Available at: https://www.pchrd.dost.gov.ph/wp-content/uploads/2023/05/2022-NEGRIHP_Official-Gazatte_Ver-5-1.pdf
[17]. Republic of the Philippines, Department of Health, 2020, Administrative Order 2020-0010- Regulations on the Conduct of Clinical Trials for Investigational Products. Available at: https://www.fda.gov.ph/wp-content/uploads/2020/05/Administrative-Order-2020-0010.pdf
[18]. Halwai, A., & Vaswani, V., 2023, Post-approval process: A challenge for ethics committees. Perspectives in Clinical Research, 14(3), 139-145. DOI: 10.4103/picr.picr_214_22.
[19]. Shetty, Y. C., & Seetharaman, R., 2023, Strengthening postapproval oversight in research ethics committees: Challenges and solutions. Perspectives in Clinical Research, 14(3), 105-107. Doi: 10.4103/picr.picr_151_23
[20]. Betchel, J., et al., 2020, Improving the quality conduct and efficiency of clinical trials with training: Recommendations for preparedness and qualification of investigators and delegates. Contemporary Clinical Trials, 89:105918. https://doi.org/10.1016/j.cct.2019.105918
[21]. Jalgaonkar, S. V., Bhide, S. S., Tripathi, R. K., Shetty, Y. C., Marathe, P. A., Katkar, J., & Thatte, U. M., 2016, An Audit of Protocol Deviations Submitted to an Institutional Ethics Committee of a Tertiary Care Hospital. PloS one, 11(1), e0146334. https://doi.org/10.1371/journal.pone.0146334
Viewed PDF 354 9 -
Chemical Addiction in Intimate Relationships: The Neurobiology of Trauma Bonding and Emotional DependencyAuthor: Tolulope Oko-IgaireDOI: 10.21522/TIJAR.2014.13.02.Art009
Chemical Addiction in Intimate Relationships: The Neurobiology of Trauma Bonding and Emotional Dependency
Abstract:
The neurobiological reinforcement of trauma bonding and emotional dependency in intimate relationships is increasingly being understood as a process, as opposed to a purely psychological pattern. This review integrates evidence on fifteen peer-reviewed articles to investigate the interaction between dopaminergic reward systems, oxytocin-mediated bonding systems, cortisol-induced stress responses, and reinforcement-learning processes to maintain maladaptive attachment despite the occurrence of relational inconsistency, conflict cycles, or intermittent affection. The key goal was to combine the results of addiction neuroscience, attachment theory, and trauma psychology to have a single explanation of the continuity of the emotionally dysregulated relational bonds. Five major databases were searched in a structured literature search, and 612 records were located; 15 records were included in the study that was analyzed using thematic synthesis based on reward processing, attachment neuropeptides, HPA-axis regulation and cognitive-emotional conditioning. Findings indicate that trauma bonding is the result of a vicious cycle of increased dopamine-based reward sensitivity, oxytocin-based trust and emotional proximity, cortisol-related hyperarousal, and attachment-based cognitive distortions. These interdependent systems produce the addiction-like patterns of stress, relief and reconnection that strengthen emotional dependence in spite of misery. The review finds that trauma bonding is a neurobiological phenomenon that is multisystemic and needs to be addressed with trauma-informed and neurobiologically oriented therapy in order to be effectively treated. More studies are required to develop specific clinical resources and models that would help to overcome these complicated relational dynamics.
Chemical Addiction in Intimate Relationships: The Neurobiology of Trauma Bonding and Emotional Dependency
References:
[1]. Dutton, D. G., Painter, S. L., 1993, Emotional attachments in abusive relationships: A test of traumatic bonding theory. Violence and Victims, 8(2), 105–120.
[2]. Fisher, H., Aron, A., Brown, L., 2005, Romantic love: An fMRI study of a neural mechanism for mate choice. Journal of Comparative Neurology, 493(1), 58–62.
[3]. Bartels, A., Zeki, S., 2000, The neural basis of romantic love. Neuro Report, 11(17), 3829–3834.
[4]. Schultz, W., 1998, Predictive reward signal of dopamine neurons. Journal of Neurophysiology, 80(1), 1–27.
[5]. Arias-Carrión, O., Pöppel, E., 2007, Dopamine, learning, and reward-seeking behavior. Acta Neurobiologiae Experimentalis, 67, 481–488.
[6]. Kosfeld, M., Heinrichs, M., Zak, P. J., et al., 2005, Oxytocin increases trust in humans. Nature, 435(7042), 673–676.
[7]. Young, L. J., Wang, Z., 2004, The neurobiology of pair bonding. Nature Neuroscience, 7(10),
1048–1054.[8]. Schneiderman, I., Zagoory-Sharon, O., Leckman, J. F., Feldman, R., 2012, Oxytocin during the initial stages of romantic attachment. Psychoneuroendocrinology, 37(8), 1277–1285.
[9]. Laurent, H., Powers, S., Granger, D., 2013, Refining the child–HPA axis relationship: Stress, inflammation, and negative affect. Developmental Psychobiology, 55(8), 86–97.
[10]. Yehuda, R., 2002, Post-traumatic stress disorder. New England Journal of Medicine, 346(2), 108–114.
[11]. Koob, G. F., Le Moal, M., 2008, Addiction and the brain antireward system. Annual Review of Psychology, 59, 29–53.
[12]. Lemche, E., Giampietro, V., Surguladze, S., et al., 2006, Neural responses to emotional prosody. Neuropsychologia, 44(7), 1095–1107.
[13]. Ferster, C. B., Skinner, B. F., 1957, Schedules of Reinforcement. Appleton-Century-Crofts.
[14]. Beck, A. T., 1979, Cognitive theory of depression. Behavior Research and Therapy, 8(1), 1–16.
[15]. Mikulincer, M., Shaver, P. R., 2007, Attachment in Adulthood. Guilford Press.
[16]. Gillath, O., Bunge, S. A., Shaver, P. R., Wendelken, C., Mikulincer, M., 2005, Attachment-style differences in neural response to conflict. NeuroImage, 28(4), 836–847.
[17]. Heim, C., Nemeroff, C., 2001, The role of childhood trauma in the neurobiology of mood and anxiety disorders. Biological Psychiatry, 49(12), 1023–1039.
[18]. Freyd, J. J., 1996, Betrayal Trauma: The Logic of Forgetting Abuse. Harvard University Press.
[19]. Lopez, J. F., Akil, H., Watson, S., 1999, Neural circuits of stress. Journal of Neuropsychiatry & Clinical Neurosciences, 11(2), 248–258.
[20]. Shapiro, F., 2014, The role of eye movement desensitization and reprocessing therapy in medicine. Journal of EMDR Practice and Research, 8(3), 102–112.
[21]. van der Kolk, B. A., 2014, The Body Keeps the Score. Viking Press.
[22]. Grant, M. J., Booth, A., 2009, A typology of reviews. Health Information & Libraries Journal, 26(2), 91–108.
[23]. Siddaway, A. P., Wood, A. M., Hedges, L.V., 2019, How to do a systematic review. Annual Review of Psychology, 70, 747–770.
[24]. Page, M. J., McKenzie, J. E., Bossuyt, P. M., et al., 2021, The PRISMA 2020 statement. BMJ, 372, n71.
[25]. Popay, J., Roberts, H., Sowden, A., et al., 2006, Guidance on the Conduct of Narrative Synthesis in Systematic Reviews. ESRC Methods Programme.
Viewed PDF 1230 16 -
Knowledge and Attitude of Dental Clinicians and Dental Technologists on Removable Complete Denture Fabrication Procedures in Uganda: A Qualitative StudyAuthor: David NonoDOI: 10.21522/TIJAR.2014.13.02.Art010
Knowledge and Attitude of Dental Clinicians and Dental Technologists on Removable Complete Denture Fabrication Procedures in Uganda: A Qualitative Study
Abstract:
Removable Complete Dentures (RCDs) are crucial for restoring function and aesthetics in edentulous patients. The prevalence of edentulism rises with age, affecting 2.3% of the world's population. This study explored the knowledge and attitudes of dental clinicians and technologists regarding Removable Complete Denture (RCD) fabrication procedures at Makerere University Dental Hospital, Uganda. This qualitative study employed a phenomenological approach and 25 respondents were purposively selected to elicit data on a range of patient-specific considerations and needs during the Removable Complete Dentures fabrication process. Semi-structured interviews were conducted, and data were analyzed thematically. Respondents identified the critical steps in RCD fabrication, including examination and diagnosis, impression taking, determination of Occlusal Rim Block (ORB) height, proper jaw relation recording, and meticulous fabrication techniques during RCD fabrication, continuous professional development and patients’ education, and went further to explain how these processes align with international guidelines. While dental clinicians and technologists generally adhered to international guidelines, our findings highlighted the need for updated and context-specific guidelines tailored to the Ugandan setting, as well as the importance of effective communication and synchronization among dental practitioners for successful RCD fabrication. The study highlighted dental clinicians' and technologists' knowledge of critical steps in removable complete denture (RCD) fabrication emphasized the need for updated, context-specific guidelines, particularly in impression taking, occlusal rim block height, removable complete denture fabrication steps, examination and diagnosis and patient education, to ensure accurate measurements and improved patient outcomes.
Knowledge and Attitude of Dental Clinicians and Dental Technologists on Removable Complete Denture Fabrication Procedures in Uganda: A Qualitative Study
References:
[1]. Awawdeh, M., Alotaibi, M. B., Alharbi, A. H., Alnafisah, S. A., Alasiri, T. S., Alrashidi, N. I., and Alnafisah, S. A., 2024, A systematic review of patient satisfaction with removable partial dentures (RPDs). Cureus, 16(1).
[2]. WHO. Oral health [Internet]. 2023 [cited 2024 May 8], Available from: https://www.who.int/news-room/fact-sheets/detail/oral-health
[3]. Nono, D., Bagenda, G., Okullo, I., and Rwenyonyi, C. M., 2024, Exploring lived experiences on the usage of removable complete dentures among edentulous patients attending Makerere University Dental Hospital, Kampala, Uganda. BMC Oral Health, 24(1), p.709.
[4]. Felton, D., Cooper, L., Duqum, I., Minsley, G., Guckes, A., Haug, S., Meredith, P., Solie, C., Avery, D., and Deal Chandler, N., 2011. Evidence‐based guidelines for the care and maintenance of complete dentures: A publication of the American College of Prosthodontists. Journal of Prosthodontics: Implant, Esthetic and Reconstructive Dentistry, 20, pp. S1-S12.
[5]. Kausher, H., Suganna, M., Ali, A. B. M. R., Ahmed, S. T., Punj, A., and Gomawi, A. A., 2023, Dental Technicians’ Perception of the Quality of Dentists’ Communication on the Fabrication of Removable Partial Dentures: A Cross-Sectional Study in Saudi Arabia. Cureus, 15(11).
[6]. Prakash, P., Singh, K., Bahri, R., and Bhandari, S. K., 2020, Utility versus futility of facebow in the fabrication of complete dentures: A systematic review. The Journal of Indian Prosthodontic Society, 20(3), pp.237-243.
[7]. Farias Neto, A., Mestriner Junior, W., and Carreiro, A. D. F. P., 2010, Masticatory afficiency in denture wearers with bilateral balanced occlusion and canine guidance. Brazilian Dental Journal, 21, pp.165-169.
[8]. Al-Quran, F. A., Al-Ghalayini, R. F. and Al-Zu'bi, B. N., 2011. Single-tooth replacement: factors affecting different prosthetic treatment modalities. BMC Oral Health, 11(1), p.34.
[9]. Albeshti, R., Khmaj, M., Khmaj, A., Albaden, A., and Almagtof, H., 2024, A Questionnaire-based Study on Impression Materials and Techniques for Complete Denture Construction among Dentists Practicing in Central/Western Regions of Libya. Libyan Journal of Dentistry, 8(1), pp. 33-41.
[10]. Deshmukh, M., Rajaraman, V., Duraisamy, R., and Maiti, S., 2022, Knowledge, awareness, and attitude of dentists toward use of denture adhesives in Tamil Nadu: A questionnaire survey. Journal of Advanced Pharmaceutical Technology & Research, 13(Suppl 1), pp. S243-S248.
[11]. Guest, G., Namey, E., and Chen, M., 2020, A simple method to assess and report thematic saturation in qualitative research. PloS One, 15(5), p.e0232076.
[12]. Hennink, M., and Kaiser, B. N., 2022, Sample sizes for saturation in qualitative research: A systematic review of empirical tests. Social Science & Medicine, 292, p. 114523.
[13]. Braun, V., and Clarke, V., 2006, Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), pp.77-101.
[14]. Nono, D., Bagenda, G., Okullo, I., and Rwenyonyi, C. M., 2024, Exploring lived experiences with tooth loss among fully edentulous patients attending Makerere University Dental Hospital, Kampala, Uganda. BMC Oral Health, 24(1), p.1355.
[15]. World Medical Association, 2013, Declaration of Helsinki: Ethical principles for medical research involving human subjects. Journal of the American Medical Association, 310 (20):2191–4.
[16]. Saidin, W., Kassim, N., Yusof, Y., and Ahmad Rajion, Z., 2012, Manufacturing of removable complete dentures using vacuum casting technique. Applied Mechanics and Materials, 120, pp. 32-35.
[17]. Hall, M. A., Karawia, I., Mahmoud, A. Z. and Mohamed, O. S., 2023, Knowledge, awareness, and perception of digital dentistry among Egyptian dentists: a cross-sectional study. BMC Oral Health, 23(1), p. 963.
[18]. Owen, C. P., 2006, Guidelines for a minimum acceptable protocol for the construction of complete dentures. International Journal of Prosthodontics, 19(5).
[19]. Grachev, D. I., Chizhmakov, E. A., Stepanov, D. Y., Buslovich, D. G., Khulaev, I. V., Deshev, A. V., Kirakosyan, L. G., Arutyunov, A. S., Kardanova, S. Y., Panin, K. S. and Panin, S. V., 2023, Dental material selection for the additive manufacturing of removable complete dentures (RCD). International Journal of Molecular Sciences, 24(7), p. 6432.
[20]. Regis, R. R., Alves, C. C. S., Rocha, S. S. M., Negreiros, W. A. and Freitas‐Pontes, K. M., 2016. The importance of a two‐step impression procedure for complete denture fabrication: A systematic review of the literature. Journal of Oral Rehabilitation, 43(10), pp. 771-777.
[21]. Nono, D., Mwebesa, E., Bagenda, G., Okullo, I. and Rwenyonyi, C., 2024, Statistical investigation of the standard height of occlusal rim blocks among patients attending Makerere University Dental Hospital, Kampala, Uganda. Texila Int. J. Acad. Res., 2024, pp. 38-46.
[22]. Nand, M., and Mohammadnezhad, M., 2022, Challenges faced by edentulous patients (EDPs) during complete denture prostheses (CDP) service delivery in Fiji–a qualitative study. BMC Health Services Research, 22(1), p. 742.
[23]. May, L. W., and Seong, L. G., 2018, A narrative review of different types and processing methods of acrylic denture base material. Annals of Dentistry University of Malaya, 25(2), pp. 58-67.
[24]. Alqutaibi, A. Y., Baik, A., Almuzaini, S. A., Farghal, A. E., Alnazzawi, A. A., Borzangy, S., Aboalrejal, A. N., AbdElaziz, M. H., Mahmoud, I. I. and Zafar, M. S., 2023, Polymeric denture base materials: a review. Polymers, 15(15), p.3258.
[25]. Elzahar, H. B., El-Okaily, M. S., Khedr, M. H., Amgad Kaddah, M., and El-Shahawy, A. A., 2022, Novel cold cure acrylic denture base with recycled zirconia nano-fillers that were functionalized by HEMA Agent Incorporation: using the Sprinkle Approach. International Journal of Nanomedicine, pp.4639-4658.
[26]. Arbab Ali, S., Khalifa, N., and Alhajj, M. N., 2018, Communication between dentists and dental technicians during the fabrication of removable partial dentures in Khartoum State, Sudan. Acta stomatologica Croatica: International Journal of Oral Sciences and Dental Medicine, 52(3), pp.246-253.
[27]. Al-AlSheikh, H. M., 2012, Quality of communication between dentists and dental technicians for fixed and removable prosthodontics. King Saud University Journal of Dental Sciences, 3(2), pp. 55-60.
Viewed PDF 245 4 -
Pathways to Food Security: The Influence of Livelihood Assets and Shocks among Farming HouseholdsAuthor: Blessing Ukamaka UgwunneDOI: 10.21522/TIJAR.2014.13.02.Art011
Pathways to Food Security: The Influence of Livelihood Assets and Shocks among Farming Households
Abstract:
Food security remains a major challenge for farming households in low- and middle-income countries, where agricultural livelihoods are highly affected by economic, climatic, and social shocks. This study examines how livelihood assets, income-generating activities, exposure to shocks, and access to safety nets were associated with household food security among farming households in North Central Nigeria, a primary food production zone. Mixed-methods were used. Quantitative data were obtained from 615 farming, North Central households in the Nigeria General Household Survey Panel (2023/2024). Food security was measured using Food Insecurity Experience Scale (FIES). Logistic regressions were used to assess factors associated with food security. Qualitative data were collected through interviews and focus group discussions with farmers, community members, and local officials, focusing on perceptions of food access, livelihood strategies, and shock. Quantitative results showed that 56% of households were food secure. Higher levels of physical and financial capital were associated with higher odds of food security. Exposure to economic and consumption-related shocks was strongly associated with lower odds of food security. Female-headed households and larger households were less likely to be food secure. Qualitative findings highlighted that food security was affected by seasonal variations in agricultural production, and financial capacity. Participants reported that market price fluctuations and climatic events disrupted food access. Farming households in North Central Nigeria experience substantial food insecurity, associated with exposure to shocks and limited livelihood assets. Strengthening productive and financial assets and reducing vulnerability to shocks are critical for improving food security. These findings provide evidence to inform policies and interventions aimed at building resilience among farming households in rural agricultural communities.
Pathways to Food Security: The Influence of Livelihood Assets and Shocks among Farming Households
References:
[1]. FAO, 2022, The State of Food Security and Nutrition in the World. Food and Agriculture Organization of the United Nations. http://www.fao.org/state-of-food-security-nutrition/en/
[2]. Ellis, F., & Freeman, H. A., 2005, Rural Livelihoods and Poverty in Developing Countries. Routledge. https://www.routledge.com/Rural-Livelihoods-and-Poverty-in-Developing-Countries/Ellis-Freeman/p/book/9780415344232
[3]. Dercon, S., 2004, Insurance against Poverty. Oxford University Press. DOI: 10.1093/acprof:oso/9780199245110.001.0001
[4]. Barrett, C. B., 2010, Measuring Food Insecurity. Journal of Nutrition, 140(3), 462S-466S. DOI: 10.3945/jn.109.112740
[5]. Thornton, P. K., et al., 2014, Agriculture and Food Security in Sub-Saharan Africa. Food Policy, 48, 35-43. DOI: 10.1016/j.foodpol.2014.05.006
[6]. Reardon, T., et al., 2014, The Emerging Role of Non-Farm Activities in Rural Livelihoods. Food Policy, 48, 1-9. DOI: 10.1016/j.foodpol.2014.03.001
[7]. Akinola, A., et al., 2016, Coping Strategies and Food Security in Rural Nigeria. African Journal of Agricultural Research, 11(25), 2019-2024. https://academicjournals.org/journal/AJAR/article-abstract/51A8A1F57612
[8]. Omonona, B. T., et al., 2006, Food Security and the Role of Agricultural Extension Services in North Central Nigeria. Journal of Rural Development, 25(2), 28-35. https://www.jstor.org/stable/40923279
[9]. Doss, C. R., et al., 2008, Agricultural Extension and Food Security. Food Policy, 33(4), 283-290. DOI: 10.1016/j.foodpol.2007.12.003
[10]. Ajala, A. O., et al., 2011, Food Security in Rural Nigeria: Issues and Policy Options. Journal of Food Security, 3(3), 29-34. DOI: 10.1080/20421338.2011.577446
[11]. Ellis, F., 1998, Household Strategies and Rural Livelihoods in Developing Countries. University of Oxford. https://www.oup.com/uk/catalogue/?ci=9780198774991
[12]. Ecker, O., & Breisinger, C., 2012, The Food Security System in Sub-Saharan Africa: A Review of Empirical Findings. Food Security, 4(3), 357-372. DOI: 10.1007/s12571-012-0207-2
[13]. FAO, 2011, The State of Food Insecurity in the World 2011. Food and Agriculture Organization of the United Nations. https://www.fao.org/4/i2330e/i2330e00.htm
[14]. Fao, W., & Ruel, M. T., 2014, Improving Nutrition Through Agriculture and Food Systems: A Framework and Strategy for Action. Global Nutrition Report. https://globalnutritionreport.org/
[15]. Hoddinott, J., & Haddad, L., 2001, Interactions Between Poverty and Malnutrition: The Role of Agriculture. International Food Policy Research Institute (IFPRI). https://www.ifpri.org/publication/interactions-between-poverty-and-malnutrition-role-agriculture
[16]. Goetz, S. J., 1999, The Impact of Risk on Rural Households: Implications for Poverty Alleviation. World Development, 27(8), 1489-1503. DOI: 10.1016/S0305-750X(99)00043-4
[17]. Devereux, S., 2001, Livelihoods and Vulnerability in Sub-Saharan Africa. Journal of Development Studies, 37(1), 1-24. DOI: 10.1080/00220380412331322145
[18]. Ajao, A. T., & Adeoye, O. I., 2020, The role of social capital and community solidarity in mitigating the impacts of shocks on food security in Nigeria’s rural areas. Journal of Rural Studies, 73, 203-212. https://doi.org/10.1016/j.jrurstud.2020.02.007
[19]. Pal, S., & Nahar, N., 2012, Impact of Shocks on Rural Households: Case of Non-Farm Livelihoods in Africa. Rural Development and Environment, 30(2), 220-232. https://www.researchgate.net/publication/259258228
[20]. Alwang, J., & Siegel, P. B., 2003, Rural Livelihoods, Poverty and Economic Shocks: Implications for Food Security in Sub-Saharan Africa. Food Policy, 28(2), 81-88. DOI: 10.1016/S0306-9192(03)00003
[21]. Thornton, P. K., et al., 2009, Climate Change and Livestock Systems in Sub-Saharan Africa: Impacts, Adaptation, and Mitigation. Technical Brief No. 10, ILRI, Nairobi. https://www.ilri.org/
[22]. Hellin, J., & Lipper, L., 2009, Food Security and Rural Livelihoods: Policy Implications for Sub-Saharan Africa. International Food Policy Research Institute (IFPRI). https://www.ifpri.org/publication/food-security-and-rural-livelihoods-policy-implications-sub-saharan-africa
[23]. Løvendal, C. R., Knowles, M., & Horii, N., 2004, Understanding Vulnerability to Food Insecurity: Lessons from Vulnerable Livelihood Profiling, ESA Working Paper No. 04 18. Agricultural and Development Economics Division, Food and Agriculture Organization of the United Nations, Rome.
[24]. Turner, C., Aggarwal, A., Walls, H., Herforth, A., Drewnowski, A., Coates, J., & Kadiyala, S., 2018, Concepts and critical perspectives for food environment research: A global framework with implications for action in low‑ and middle‑income countries. Global Food Security, 18, 93‑101. DOI: 10.1016/j.gfs.2018.08.001.
[25]. Raza, A., Fox, E. L., Morris, S. S., Kupka, R., Timmer, A., Dalmiya, N., & Fanzo, J., 2020, Conceptual framework of food systems for children and adolescents. Global Food Security, 27, Article 100436. DOI: 10.1016/j.gfs.2020.100436
[26]. Bekele, A. E., Dries, L., Heijman, W., & Drabik, D., 2021, Large scale land investments and food security in agropastoral areas of Ethiopia. Food Security, 13, 309–327. DOI: 10.1007/s12571‑020‑01131‑x.
[27]. Natarajan, N., Newsham, A., Rigg, J., & Suhardiman, D., 2022, A sustainable livelihoods framework for the 21st century. World Development, 155, Article 105898. DOI: 10.1016/j.worlddev.2022.105898.
[28]. National Bureau of Statistics, 2024, Nigeria General Household Survey-Panel: 2023/2024 Round. National Bureau of Statistics, Nigeria.
[29]. Mekonnen, D., et al., 2021, Impact of Climatic Shocks on Food Security in Rural Ethiopia. Climate Change and Rural Development Journal, 45(3), 102-115. DOI: 10.1007/s11256-021-00884-9.
[30]. Adepoju, A., & Adejare, O., 2013, Economic Shocks and Vulnerability in Sub-Saharan Africa: A Focus on Nigeria. Journal of African Economics, 22(4), 451-468. DOI: 10.1093/jae/ejs019.
[31]. Sunderlin, W., et al., 2014, The Role of Forests in Rural Livelihoods. World Development, 63, 69-83. DOI: 10.1016/j.worlddev.2014.05.003.
[32]. Nchanji, E., et al., 2014, Agricultural Productivity and Livelihood Security in Sub-Saharan Africa. Agricultural Systems Journal, 124, 120-136. DOI: 10.1016/j.agsy.2013.10.002.
[33]. FAO, 2021, The State of Food and Agriculture 2021. Food and Agriculture Organization of the United Nations. https://www.fao.org/interactive/state-of-food-agriculture/2021/en/
[34]. Harvey, D., et al., 2014, Agricultural Resilience to Climate Change in Sub-Saharan Africa. Agricultural Systems, 126, 116-125. DOI: 10.1016/j.agsy.2014.02.006
[35]. Greenland, S., et al., 2016, Limitations of Cross-Sectional Studies. American Journal of Epidemiology, 184(3), 149-154. DOI: 10.1093/aje/kwv245.
[36]. Gaid, B., & Kudi, T. M., 2019, Assessing food security in Nigeria using the Food Insecurity Experience Scale (FIES): A multidimensional approach. Food Security, 11(4), 869-882. DOI: 10.1007/s12571-019-00933-6.
[37]. Moser, C., 2007, Reducing Global Poverty: The Case for Asset Accumulation. Brookings Institution Press. https://www.brookings.edu/book/reducing-global-poverty/
[38]. Thornton, P. K., et al., 2009, The Vulnerability of Sub-Saharan African Livelihoods to Climate Change. Environmental Science & Policy, 12(4), 460-472. DOI: 10.1016/j.envsci.2008.11.006
[39]. World Bank, 2007, World Development Report 2008: Agriculture for Development. World Bank. https://openknowledge.worldbank.org/handle/10986/5990
[40]. Kawachi, I., et al., 2002, Social Capital and Health: A Review of Literature. Journal of Health and Social Behavior, 43(2), 93-107. DOI: 10.2307/3090193
[41]. Hoddinott, J., & Headey, D., 2014, The Effects of Shocks on Food Security in Sub-Saharan Africa. Development Policy Review, 32(4), 351-366. DOI: 10.1111/dpr.12058
[42]. Gordon, L., et al., 2006, Compounding Shocks and their Effects on Rural Livelihoods. Global Environmental Change, 16(3), 265-275. DOI: 10.1016/j.gloenvcha.2006.02.007
[43]. Bryan, E., et al., 2009, Adaptation to Climate Change in African Agriculture: A Case Study of Farming Households in Sub-Saharan Africa. Global Environmental Change, 19(1), 73-83. DOI: 10.1016/j.gloenvcha.2008.10.003
[44]. Barnett, J., & O'Neill, S., 2010, Maladaptation. Global Environmental Change, 20(2), 211-213. DOI: 10.1016/j.gloenvcha.2009.11.005
[45]. Sunderlin, W., et al., 2014, Comparative Studies of Food Security in Different Regions of Nigeria. Agricultural Economics Review, 45(2), 120-135. https://www.aercafrica.org/research-agendas/
[46]. Meinzen-Dick, R., et al., 2014, Gender and Food Security: Analyzing the Impacts of Agricultural Development. IFPRI Discussion Paper, 3(11), 56-67. https://www.ifpri.org/publication/gender-and-food-security.
Viewed PDF 332 12 -
Evaluating the Impact of Common Technical Document Adoption on Medicines Regulatory Performance in Nigeria: An Interrupted Time-Series AnalysisAuthor: Ake, Paul AyodeleDOI: 10.21522/TIJAR.2014.13.02.Art012
Evaluating the Impact of Common Technical Document Adoption on Medicines Regulatory Performance in Nigeria: An Interrupted Time-Series Analysis
Abstract:
The Common Technical Document (CTD) has been widely adopted to harmonise medicines regulatory submissions and strengthen regulatory systems, yet empirical evidence on its performance impact in low- and middle-income countries remains limited. This study evaluated the effect of CTD adoption on medicines regulatory performance in Nigeria using a quasi-experimental interrupted time-series design. Monthly regulatory data from January 2018 to December 2024 were analysed, with June 2020 marking the introduction of mandatory CTD submissions. Outcomes examined included medicines approval volumes, regulatory safety signals (alerts and recalls per 100 approvals), and post-market quality outcomes measured through risk-based post-market surveillance (RB-PMS) failure rates. Segmented regression analysis showed no statistically significant pre-intervention trend in approvals (p = 0.788), no immediate level change following CTD adoption (p = 0.658), and no significant post-intervention trend change (p = 0.723). Similarly, no significant changes were observed in regulatory safety signal rates at the point of CTD implementation (p = 0.971) or in post-intervention trends (p = 0.894). In contrast, RB-PMS outcomes showed a statistically significant immediate reduction in failure rates following CTD adoption (p < 0.001), followed by a significant positive post-intervention trend (p < 0.001), indicating that initial quality gains were not sustained over time. Overall, the findings suggest that CTD adoption functions as a foundational harmonisation reform but does not independently produce sustained improvements in regulatory throughput or safety outcomes without complementary institutional and operational strengthening.
Evaluating the Impact of Common Technical Document Adoption on Medicines Regulatory Performance in Nigeria: An Interrupted Time-Series Analysis
References:
[1]. International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use, n.d., The common technical document (CTD). ICH, https://www.ich.org/page/ctd.
[2]. European Medicines Agency, 2004, ICH topic M4: Common technical document for the registration of pharmaceuticals for human use. EMA. https://www.ema.europa.eu/en/documents/scientific-guideline/ich-m-4-common-technical-document-registration-pharmaceuticals-human-use_en.pdf
[3]. Ndomondo-Sigonda, M., Miot, J., Naidoo, S., Ambali, A., & Dodoo, A., 2017, Medicines regulation in Africa: Current state and opportunities. Pharmaceutical Medicine, 31(6), 383–397, https://doi.org/10.1007/s40290-017-0210-x.
[4]. World Health Organization. 2021, WHO guideline on good reliance practices in the regulation of medical products. World Health Organization, https://www.who.int/publications/i/item/9789240029334.
[5]. World Health Organization, 2020, WHO pharmacovigilance indicators: A practical manual for the assessment of pharmacovigilance systems. World Health Organization. https://www.who.int/publications/i/item/WHO-MVP-EMP-IAU-2015.03.
[6]. Sithole, T., Mahlangu, G., & Walker, S., 2022, Evaluation of the ZaZiBoNa collaborative medicines registration initiative. Frontiers in Pharmacology, 13, 832301, https://doi.org/10.3389/fphar.2022.832301.
[7]. World Health Organization, 2018, A study on the public health and socioeconomic impact of substandard and falsified medical products. World Health Organization, https://www.who.int/publications/i/item/9789241513432.
[8]. Sithole, T., Mahlangu, G., & Walker, S., 2024, Regulatory harmonisation and joint assessment models in Africa: Performance, challenges and future directions. Frontiers in Medicine, 11, 1298473, https://doi.org/10.3389/fmed.2024.1298473.
[9]. Bernal, J. L., Cummins, S., & Gasparrini, A., 2017, Interrupted time series regression for the evaluation of public health interventions: A tutorial. International Journal of Epidemiology, 46(1), 348–355, https://doi.org/10.1093/ije/dyw098.
[10]. Bernal, J., L., Cummins, S., & Gasparrini, A., 2018, The use of controls in interrupted time series studies of public health interventions. International Journal of Epidemiology, 47(6), 2082–2093, https://doi.org/10.1093/ije/dyy135.
[11]. World Health Organization. 2014, Assessment of medicines regulatory systems in sub-Saharan African countries: An overview of findings. World Health Organization, https://apps.who.int/iris/handle/10665/128925.
[12]. World Health Organization, 2017, WHO global benchmarking tool (GBT) for evaluation of national regulatory systems. World Health Organization, https://www.who.int/publications/i/item/9789241515573.
[13]. McAuslane, N., Cone, M., Collins, J., & Walker, S., 2009, Emerging markets and emerging agencies: A comparative study of regulatory development. Drug Information Journal, 43(3), 349–359, https://doi.org/10.1177/009286150904300309.
[14]. McAuslane, N., Liberti, L., & Walker, S., 2016, The performance of medicines regulatory authorities in low- and middle-income countries. Therapeutic Innovation & Regulatory Science, 50(6), 680–688, https://doi.org/10.1177/2168479016643365.
[15]. Rägo, L., Santoso, B., & Tissot, E., 2011, Drug regulation: History, present and future. WHO Drug Information, 25(4), 1–11.
[16]. Eichler, H. G., et al., 2019, Adaptive pathways and regulatory innovation: A European perspective. Clinical Pharmacology & Therapeutics, 105(1), 51–60, https://doi.org/10.1002/cpt.1237.
[17]. Luigetti, R., Bachmann, P., & Cooke, E., 2016, Regulatory reliance: Concept, benefits, and challenges. WHO Drug Information, 30(3), 1–10.
[18]. Kaplan, W. A., Ritz, L. S., Vitello, M., & Wirtz, V., J., 2017, Policies to promote access to medicines in low- and middle-income countries: A review. Health Policy and Planning, 32(4), 543–552, https://doi.org/10.1093/heapol/czw091.
[19]. Sillo, H., B., et al., 2020, Strengthening regulatory systems for medicines in Africa: A review of initiatives and progress. BMJ Global Health, 5(9), e002721, https://doi.org/10.1136/bmjgh-2020-002721.
[20]. World Bank, 2020, Enhancing government effectiveness and transparency: The fight against corruption. World Bank, https://www.worldbank.org/en/topic/governance/publication/enhancing-government-effectiveness-and-transparency.
[21]. International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use, 2016, ICH Q12: Technical and regulatory considerations for pharmaceutical product lifecycle management. ICH, https://www.ich.org/page/q12.
Viewed PDF 248 7 -
Assessment of Medication Errors and Prevention Strategies in Selected Hospitals in Kwara State, NigeriaAuthor: Idowu Makinde OlapemiDOI: 10.21522/TIJAR.2014.13.02.Art013
Assessment of Medication Errors and Prevention Strategies in Selected Hospitals in Kwara State, Nigeria
Abstract:
Medication errors pose a significant challenge to patient safety worldwide, with Africa bearing the highest burden of preventable medication-related harm; however, limited data exist for Kwara State, Nigeria. This study assessed the knowledge, awareness, prevalence, causes, and prevention strategies of medication errors among 450 healthcare workers in selected hospitals across the three senatorial zones of Kwara State, using a sequential explanatory mixed-method design that included key informant interviews with five professionals. Findings showed that 91.8% of participants were aware of medication errors, but only 60.2% demonstrated good knowledge, which was significantly associated with age, tribe, religion, and professional role. The prevalence of self-reported medication errors was 73.6%, with poor handwriting (62.9%) and lack of communication among healthcare providers (54.9%) identified as the main causes; the most common self-reported error was failure to consider patient allergies (48.9%). Although 73.8% of facilities had training programs and 67.3% had medication error reporting systems, key informants highlighted staff shortages and work overload as primary contributing factors. Participants recommended more frequent training (74.9%), improved interprofessional communication (70%), and increased resource allocation (97.3%) to reduce errors. The study concludes that despite high awareness, knowledge gaps remain, and the high prevalence of medication errors calls for urgent implementation of comprehensive prevention strategies, including regular training, adequate staffing, standardized reporting systems, and enhanced communication among healthcare professionals. Future studies should attempt to assess the drivers of the major causes of medication errors reported in the present study as well as identify the medication error rates in under-studied populations.
Assessment of Medication Errors and Prevention Strategies in Selected Hospitals in Kwara State, Nigeria
References:
[1]. Elliott, R. A., Camacho, E., Jankovic, D., Sculpher, M. J., & Faria, R., 2021, Economic analysis of the prevalence and clinical and economic burden of medication error in England. BMJ Quality & Safety, 30(2), 96–105. https://doi.org/10.1136/bmjqs-2019-010206
[2]. Svitlica, B. B., & Konstantinidis, G., 2024, Factors contributing to non-reporting of medication errors. Global Pediatrics, 8, 100144. https://doi.org/10.1016/j.gpeds.2024.100144
[3]. Alrabadi, N., Shawagfeh, S., Haddad, R., et al., 2021, Medication errors: a focus on nursing practice. Journal of Pharmacy & Health Services Research, 12(1), 78–86.
[4]. World Health Organization, 2017, WHO launches global effort to halve medication-related errors in 5 years. Geneva, Switzerland. https://www.who.int/news
[5]. World Health Organization, 2024, Global patient safety report. Geneva, Switzerland. https://www.who.int/publications
[6]. Ogunleye, O. O., Oreagba, I. A., Falade, C., et al., 2016, Medication errors among health professionals in Nigeria: A national survey. International Journal of Risk & Safety in Medicine, 28(2), 77–91.
[7]. David, F. A., & Oluwatosin, A. J., 2023, The problems and prospects of primary healthcare: A case study of Odo-Owa Oke Ero Local Government Kwara State, Nigeria. Diversity and Equality in Health and Care, 20, 31.
[8]. Agede, O. A., Odeigah, L. O., Ole, J. O., et al., 2024, Patterns and errors of medication prescription among patients with chronic medical diseases attending medical outpatient department of a tertiary hospital in Ilorin, Nigeria. Tropical Journal of Health Sciences, 31(2), 14–19.
[9]. Araoye, M. O., 2004, Research methodology with statistics for health and social sciences. Ilorin: Nathadex Publishers.
[10]. Awodele, O., Akinyede, A., Adeyemi, O. A., & Awodele, D. F., 2011, Pharmacovigilance amongst doctors in private hospitals in Lagos West Senatorial District, Nigeria. International Journal of Risk & Safety in Medicine, 23(4), 217–226.
[11]. Umoh, E. E., & Opue, O. F., 2021, Knowledge and practice of medication error prevention among nurses in University of Calabar Teaching Hospital. IOSR Journal of Nursing and Health Science, 10(1), 43–50.
[12]. Itasanmi, S. A., Ekpenyong, V. O., & Andong, H. A., 2022, Examining health literacy levels and its association with demographic dynamics among intra-city commercial drivers: Results from a survey in Nigeria. Journal of Health Literacy, 6(4), 9–21.
[13]. Alshehri, H. M., Alshehri, A. M. H., Alshehri, A. M. H., et al., 2024, Primary health care professionals' opinions regarding continuing medical education: A cross sectional study. Medicine, 103(50), e40865.
[14]. Omotola, N. J., Madu, O. T., Egbuonu, E. F., et al., 2025, Medication administration error and its associated factors among nurses in a tertiary hospital, southeast Nigeria. Online Journal of Health and Allied Sciences, 24(1), 1–6.
[15]. Onedo, T. A., Okafor, U. G., Somuvie, K. O., et al., 2025, Medication error reporting practices among hospital pharmacists in Lagos State, Nigeria. West African Journal of Pharmacy, 36(1), 14–25.
[16]. Babatunde, K. M., Akinbodewa, A. A., Akinboye, A. O., & Adejumo, A. O., 2016, Prevalence and pattern of prescription errors in a Nigerian kidney hospital. Ghana Medical Journal, 50(4), 233–237.
[17]. Abdullahi, A. K., Fatima, I., Abdurrahaman, U., et al., 2023, Assessment of legibility of handwritten prescriptions and adherence to WHO prescription writing guidelines in Ahmadu Bello University Teaching Hospital Zaria, Kaduna State, Nigeria. Innovations in Pharmacy, 14(1), 51–64.
[18]. Afework, A., Tamene, A., Tesfaye, A., Tafa, A., & Gemede, S., 2023, Status and factors affecting patient safety culture at Dilla University Teaching Hospital: A mixed-method cross-sectional study. Risk Management and Healthcare Policy, 16, 1157–1169.
[19]. Olufemi, O. O., & Aminat, A. A., 2022, Influence of adult literacy education on women political participation in Ilorin Metropolis, Kwara State, Nigeria. University of Ilorin Journal of Lifelong Education, 6(1), 102–114.
[20]. Wudu, M. A., Bayked, E. M., Bekalu, Y. E., & Birhanu, T. A., 2025, Prevalence of medication administration errors and its determinants among nurses in Ethiopia: a systematic review and meta-analysis. BMC Nursing, 24(1), 544.
[21]. Ayorinde, M. O., & Alabi, P. I., 2019, Perception and contributing factors to medication administration errors among nurses in Nigeria. International Journal of Africa Nursing Sciences, 11, 100153.
[22]. Sufiyan, M. A. B., Abdulkareem, S. B., Joshua, I. A., et al., 2023, Knowledge and perception of medication errors among healthcare workers in Ahmadu Bello University Teaching Hospital Zaria, Kaduna State, Nigeria. Nigerian Postgraduate Medical Journal, 30(2), 150–155.
[23]. Hariyati, R. T. S., Mediawati, A. S., & Eryando, T., 2021, Workload as the most important influencing factor of medication errors by nurses. Open Nursing Journal, 15(1), 204–210.
[24]. Alotaibi, J. S., 2024, Causes of medication administration errors and barriers to reporting as perceived by nurses in Saudi Arabia: A qualitative study. Belitung Nursing Journal, 10(2), 215–221.
[25]. Iloh, G. U. P., Chuku, A., & Amadi, A. N., 2017, Medical errors in Nigeria: A cross-sectional study of medical practitioners in Abia State. Archives of Medicine and Health Sciences, 5(1), 44–49.
[26]. Ikonne, P. I., & Nwozichi, C. U., 2024, Factors associated with medication error underreporting among healthcare professionals in Nigerian Air Force Hospital, Ikeja, Lagos, Nigeria. International Journal of Public Health Pharmacy and Pharmacology, 9(2), 37–55.
[27]. Ganiyu, K. A., Olotu, E. S., & Anthony, T. G., 2023, Drug prescribing, prescription errors and prescription legibility at a primary healthcare center in a semi-urban community, South-South Nigeria. Nigerian Journal of Pharmacy, 57(2), 700–708.
[28]. Awoyale, O. D., Dairo, M. D., Fagbamigbe, A. F., et al., 2025, Yellow fever in plain sight: assessing disease surveillance officers' knowledge and self-efficacy in identification and reporting in Kwara State, Nigeria. BMC Public Health, 25(1), 2127.
[29]. Nwasor, E. O., Sule, S. T., & Mshelia, D. B., 2014, Audit of medication errors by anesthetists in North Western Nigeria. Nigerian Journal of Clinical Practice, 17(2), 226–231.
[30]. Nkurunziza, A., Chironda, G., & Mukeshimana, M., 2018, Perceived contributory factors to medication administration errors and barriers to self-reporting among nurses working in paediatric units of selected referral hospitals in Rwanda. International Journal of Research in Medical Sciences, 6(2), 401–407.
[31]. Villamañán, E., Larrubia, Y., Ruano, M., et al., 2011, Medication errors associated with notification of drug allergies: effect of computerized order entry on their prevention. International Journal of Pharmacy and Pharmacology, 1(8), 203–210.
[32]. Tuvor, D., Kumah, A., Abiti, R., et al., 2025, Medication administration error reporting among nurses: A descriptive qualitative study. Global Journal of Quality and Safety in Healthcare, 8(2), 63–69.
Viewed PDF 376 14 -
Prevalence of Depression and Anxiety Among Nigerian Adolescents and the Impact of School-Based Cognitive Behavioural Therapy: A Randomized Controlled TrialAuthor: Freedom NwokediDOI: 10.21522/TIJAR.2014.13.02.Art014
Prevalence of Depression and Anxiety Among Nigerian Adolescents and the Impact of School-Based Cognitive Behavioural Therapy: A Randomized Controlled Trial
Abstract:
Mental health disorders, including depression and anxiety, pose a significant challenge among adolescents in low- and middle-income countries [LMICs] like Nigeria, where access to mental health care is limited. This study evaluated the prevalence of these conditions and the efficacy of school-based Cognitive Behavioural Therapy [CBT] among Nigerian adolescents through a randomized controlled trial [RCT]. 239 adolescents between the ages of 12 and 18 from secondary schools in Abeokuta, Ogun State, were randomly divided into two groups: 120 students participated in a CBT intervention group, while the remaining 119 formed a control group. The CBT programme, delivered by trained school counsellors over three weeks [three 45-minute sessions per week], focused on cognitive restructuring and coping strategies. Pre- and post-intervention assessments used the Patient Health Questionnaire-9 [PHQ-9] and Generalised Anxiety Disorder-7 [GAD-7] scales. Statistical analysis employed repeated measures ANOVA with significance set at p < 0.05. Baseline prevalence indicated 46.3% mild and 26.0% moderate depression, and 38.0% mild and 42.4% moderate anxiety. Post-intervention, the CBT group showed a significant reduction in anxiety [p = 0.001, Cohen’s d = 3.586] and a borderline significant reduction in depression [p = 0.059, Cohen’s d = 3.856] compared to the control group. Additional benefits included improved emotional regulation [p = 0.02, Cohen’s d = 0.61] and coping strategies [p = 0.01, Cohen’s d = 0.69], with no significant changes in the control group. In conclusion, School-based CBT is an effective and feasible intervention for reducing anxiety and depression among Nigerian adolescents, with potential for scalability in similar settings. Future studies should explore extended interventions and longitudinal outcomes to optimise impact.
Prevalence of Depression and Anxiety Among Nigerian Adolescents and the Impact of School-Based Cognitive Behavioural Therapy: A Randomized Controlled Trial
References:
[1]. Hoyniak, C. P., Whalen, D. J., Luby, J. L., Barch, D. M., Miller, J. P., Zhao, P., England, S. K., 2023, Sleep and circadian rhythms during pregnancy, social disadvantage, and alterations in brain development in neonates. Developmental Science, 27(3), https://doi.org/10.1111/desc.13456
[2]. Lee, Y. J., 2023, Prions: a threat to health security and the need for effective medical countermeasures. Global Health Journal, 7(1), 43-48, https://doi.org/10.1016/j.glohj.2023.02.004
[3]. Ola, B., Atilola, O., 2017, Towards School-Based Interventions for Mental Health in Nigeria. The Palgrave Handbook of Sociocultural Perspectives on Global Mental Health, 509-529, https://doi.org/10.1057/978-1-137-39510-8_24
[4]. Kumar, P., Singh, R., 2023, Efficacy of cognitive behavioural therapy in adolescent anxiety: Evidence from LMICs. Journal of Behavioral Therapy, 34(2), 78–85, https://doi.org/10.1016/j.jbct.2023.01.005
[5]. Eze, C., Okonkwo, J., 2021, Longitudinal effects of cognitive behavioural therapy on depression in adolescents. International Journal of Mental Health, 18(3), 210–218, https://doi.org/10.1080/00207411.2021.1893457
[6]. Weare, K., Nind, M.,2011, Mental health promotion and problem prevention in schools: Evidence and practice. Health Education, 111(5), 310–321, https://doi.org/10.1108/09654281111161256
[7]. Jones, L., Patel, V.,2020, Cognitive behavioural therapy for adolescents in resource-limited settings. British Journal of Psychiatry, 216(4), 175–180, https://doi.org/10.1192/bjp.2019.217
[8]. Adeyemi, A., Ojo, T., 2022, Resilience-building interventions for Nigerian youth. Journal of Adolescent Health, 30(6), 345–352, https://doi.org/10.1016/j.jadohealth.2022.03.012
[9]. Ngugi, E., Mwangi, J., 2021, Barriers to mental health programmes in African schools. Health Policy and Planning, 36(5), 678–685, https://doi.org/10.1093/heapol/czab018
[10]. Okoro, C., Ezeh, P., 2023, Cultural adaptation of mental health interventions in Nigeria. Cultural Diversity and Ethnic Minority Psychology, 29(1), 56–63, https://doi.org/10.1037/cdp0000517
[11]. Durlak, J. A., Weissberg, R. P., Dymnicki, A. B., Taylor, R. D., Schellinger, K. B., 2011, The impact of enhancing students’ social and emotional learning: A meta-analysis of school-based universal interventions. Child Development, 82(1), 405–432, https://doi.org/10.1111/j.1467-8624.2010.01564.x
[12]. World Health Organization, 2022, Mental health action plan 2023–2030. WHO, https://www.who.int/publications/i/item/9789240050860
[13]. Federal Ministry of Health Nigeria, 2020, National mental health policy. FMOH, https://www.health.gov.ng/doc/National-Mental-Health-Policy.pdf
[14]. Patel, V., Flisher, A. J., Hetrick, S., McGorry, P., 2007, Mental health of young people: A global public-health challenge. The Lancet, 369(9569), 1302–1313, https://doi.org/10.1016/S0140-6736(07)60368-7
[15]. Omigbodun, O., 2004, Developing child mental health services in Nigeria. Journal of the American Academy of Child & Adolescent Psychiatry, 43(4), 456–461, https://doi.org/10.1097/00004583-200404000-00016
[16]. Kessler, R. C., Angermeyer, M., Anthony, J. C., et al., 2007, Lifetime prevalence and age-of-onset distributions of mental disorders in the WHO World Mental Health Survey Initiative. World Psychiatry, 6(3), 168–176, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2174588/
[17]. Fazel, M., Hoagwood, K., Stephan, S., Ford, T., 2014, Mental health interventions in schools in low-income countries. The Lancet, 384(9948), 1590–1598, https://doi.org/10.1016/S0140-6736(14)60857-7
[18]. Chorpita, B. F., Daleiden, E. L., 2009, Mapping evidence-based treatments for children and adolescents. Journal of Consulting and Clinical Psychology, 77(3), 566–579, https://doi.org/10.1037/a0014565
[19]. Merry, S. N., McDowell, H., Hetrick, S. E., Bir, J. J., Muller, N., 2011, Psychological and educational interventions for preventing depression in children and adolescents. Cochrane Database of Systematic Reviews, (12), CD003380. https://doi.org/10.1002/14651858.CD003380.pub3
[20]. Beck, J. S., 2011, Cognitive behavior therapy: Basics and beyond (2nd ed.). Guilford Press, https://www.guilford.com/books/Cognitive-Behavior-Therapy/Judith-Beck/9781609185046
[21]. Stallard, P., 2005, Think good – feel good: A clinician’s guide to CBT with children and young people. Wiley-Blackwell, https://onlinelibrary.wiley.com/doi/book/10.1002/9780470713150
[22]. Ungar, M., 2008, Resilience across cultures. British Journal of Social Work, 38(2), 218–235, https://doi.org/10.1093/bjsw/bcl343
[23]. Cortina, M. A., Sodha, A., Fazel, M., Ramchandani, P. G., 2012, Prevalence of child mental health problems in sub-Saharan Africa: A systematic review. Archives of Disease in Childhood, 97(3), 269–276. https://doi.org/10.1136/archdischild-2011-300995
[24]. Nwokedi, F., Arinze, J., Mgbe, G., 2025, Effectiveness of School-Based Cognitive Behavioural Therapy (CBT) in Reducing Adolescent Depression and Anxiety: A Systematic Review. Journal: Texila Advanced Journal of Multidisciplinary Health Research, 5(2), https://doi.org/10.21522/TAJMHR.2016.05.02.Art014
[25]. Khurana, M., 2025, Effectiveness of a School-Based Cognitive Behavioral Therapy Intervention for Managing Academic Stress/Anxiety in Adolescents. Journal of Contemporary Clinical Practice, 11, pp.525-532. https://doi.org/10.61336/jccp/25-08-75
[26]. Atilola, O., 2014, Child mental health in Nigeria: A call for cultural sensitivity. Journal of Child and Adolescent Mental Health, 26(2), 89–97, https://doi.org/10.2989/17280583.2014.898919
[27]. Cuijpers, P., van Straten, A., Warmerdam, L., 2007, Behavioral activation treatments of depression: A meta-analysis. Clinical Psychology Review, 27(3), 318–326, https://doi.org/10.1016/j.cpr.2006.11.001
[28]. Belfer, M. L., 2008, l Child and adolescent mental disorders: The magnitude of the problem globally. Journal of Child Psychology and Psychiatry, 49(3), 226–236, https://doi.org/10.1111/j.1469-7610.2007.01855.x
[29]. Kieling, C., Baker-Henningham, H., Belfer, M., et al., 2011, Child and adolescent mental health worldwide: Evidence for action. The Lancet, 378(9801), 1515–1525, https://doi.org/10.1016/S0140-6736(11)60827-1
[30]. Weare, K., Nind, M., 2011, Mental health promotion and problem prevention in schools: Evidence and practice. Health Education, 111(5), 310–321, https://doi.org/10.1108/09654281111161256
[31]. Durlak, J. A., Weissberg, R. P., Dymnicki, A. B., Taylor, R. D., Schellinger, K. B., 2011, The impact of enhancing students’ social and emotional learning: A meta-analysis of school-based universal interventions. Child Development, 82(1), 405–432, https://doi.org/10.1111/j.1467-8624.2010.01564.x
[32]. Yanda, A. U., 2025, Effect of Cognitive Behaviour Therapy on The Management of Mental Wellbeing among University In-School Adolescents North-West Zone, Nigeria. Journal of Educational Studies Trends and Practice. https://doi.org/10.70382/sjestp.v10i8.068.
Viewed PDF 346 10 -
Effectiveness of a Theory-Based Health Education on Knowledge of Long-Acting Reversible Contraceptives (LARC) among Women Attending Antenatal Clinics in Katsina State, NigeriaAuthor: Shaima’u KABIR AbbaDOI: 10.21522/TIJAR.2014.13.02.Art015
Effectiveness of a Theory-Based Health Education on Knowledge of Long-Acting Reversible Contraceptives (LARC) among Women Attending Antenatal Clinics in Katsina State, Nigeria
Abstract:
This study assessed how a theory-based health education intervention affected pregnant women in Katsina State, Nigeria, in terms of their increased awareness of and intention to use long-acting reversible contraceptives (LARC). 796 women were first enrolled and randomized into intervention and control groups using a randomized controlled trial methodology. There were 685 responders in the final analysis. Data was gathered at baseline, three months, and six months after the intervention, and an organized educational module based on the Health Belief Model (HBM) was given. The effectiveness of theory-driven education in promoting reproductive health was confirmed by the intervention's notable improvements in LARC knowledge, health beliefs, and intention to use LARC.
Effectiveness of a Theory-Based Health Education on Knowledge of Long-Acting Reversible Contraceptives (LARC) among Women Attending Antenatal Clinics in Katsina State, Nigeria
References:
[1]. WHO. Expanding access to contraceptive methods: Technical brief. World Health Organization, 2012.
[2]. Austin, A., 2015, Unmet contraceptive needs among married Nigerian women: An examination of tends and drivers. Elsevier. Contraception, 91(1), 31-38. DOI: 10.1016/j.contraception.2014.10.002
[3]. Ahmed, S., Li, Q., Liu, L., Tsui, A. O., 2012, Maternal deaths averted by contraceptive use: an analysis of 172 countries, Lancet, 380 (9837), 111–25. Doi: 10.1016/S0140-6736(12)60478-4
[4]. Chernick, L. S., Schnall, R., Higgins, T., Stockwell, M. S., Castaño, P. M., Santelli, J., Dayan, P. S., 2015, Barriers to and enablers of contraceptive use among adolescent females and their interest in an emergency department-based intervention, Contraception, 91(3), 217–225. https://doi.org/10.1016/j.contraception.2014.12.003
[5]. United Nations Population Fund (UNFPA) Annual Report, United Nation. Geneva. Available at http://www.unfpa.org/sites/default/files/pub-pdf/UNFPA_2015_Annual_Report.pdf. Accessed 24th January 2023.
[6]. Sedgh, G., Singh, S., Hussain, R., 2014, Intended and unintended pregnancies worldwide in 2012 and recent trends. Studies in Family Planning, 45(3), 301-314
[7]. 7 Adeokun, L. A., 2009, Fertility regulation in Nigeria: The role of cultural and social factors, African Population Studies, 23(1), 45–60.
[8]. NDHS, 2018, Nigeria Demographic and Health Survey. National Population Commission & ICF.
[9]. Aderibigbe, S. A., Araoye, M. O., Fawole, A. O., 2010, Effect of health education on knowledge and attitude of female students towards contraception in a Nigerian University, Nigerian Journal of Medicine, 19(3), 283–289.
[10]. Aduloju, O. P., Ajenifuja, K. O., Oloyede, O. A., 2021, Awareness and determinants of use of long-acting reversible contraceptives among women in a tertiary hospital in Nigeria, Nigerian Journal of Clinical Practice, 24(5), 673–679.
[11]. Gebremariam, A., 2014, Attitudes towards long-acting reversible contraceptive methods among family planning providers in Ethiopia, Ethiopian Journal of Health Development, 28(3), 222–229
[12]. Goldstruck, N. D., 2014, Reducing barriers to the use of intrauterine contraceptive devices as a long-acting reversible contraception, African Journal of Reproductive Health, 4, 15-25.
[13]. Jackson, R. A., Schwarz, E. B., Freedman, L., Darney, P., 2003, Advance supply of emergency contraception. effect on use and usual contraception--a randomized trial, Obstetrics and gynecology, 102(1), 8–16. https://doi.org/10.1016/s0029-7844(03)00478-2
[14]. Nsubuga, H., Sekandi, J. N., Sempeera, H., Makumbi, F. E., 2016, Contraceptive use, knowledge, attitude, perceptions and sexual behavior among female University students in Uganda: a cross-sectional survey. BMC Womens Health. 16:6. doi: 10.1186/s12905-016-0286-6. PMID: 26818946; PMCID: PMC4730721.
[15]. Yimer, A. H., Seid, M. S., Walelign, F., Damtie, Y., Seid, A. M., 2023, Utilization of long-acting contraceptive methods and associated factors among female healthcare providers in South Wollo Zone hospitals, Northeast, Ethiopia. A cross-sectional multicenter study. PLOS Glob Public Health. 3(3): e0001692. Published 2023 Mar 27. Doi: 10.1371/journal.pgph.0001692
[16]. Hlongwa, M., Kalinda, C., Peltzer, K., Hlongwana, K., 2021, Factors associated with modern contraceptive use: a comparative analysis between younger and older women in Umlazi Township, KwaZulu-Natal, South Africa. Womens Health (Lond). 2021 Jan-Dec; 17:17455065211060641. Doi: 10.1177/17455065211060641. PMID: 34798800; PMCID: PMC8606954.
[17]. Abubakar, I. B., Abubakar, H. B., 2024, Nigerian Women's Modern Contraceptive Use: Evidence from NDHS 2018. Reprod Fertil. Published online, Doi:10.1530/RAF-23-0063
[18]. Aduloju, O. P., Akintayo, A. A., Adefisan, A. S., Aduloju, T., 2021, Utilization of Long-Acting Reversible Contraceptive (LARC) Methods in a tertiary hospital in southwestern Nigeria: A Mixed Methods Study, Journal of Obstetrics and Gynecology, 71(2). https://doi.org/10.1007/s13224-020-01386-6
[19]. Lopez, L. M., Grey, T. W., Hiller, J. E., Chen, M., 2015, Education for contraceptive use by women after childbirth,2015, The Cochrane Database of Systematic Reviews, 2015(7), CD001863. https://doi.org/10.1002/14651858.CD001863.pub4
[20]. Agure, S., Miyeso, B., Abdullahi, L., 2024, Interventions to enhance the use of Evidence Based Decision Making for Quality Care among Nurses: A Systematic Review. East Afr Health Res J. 8(1):148-163. Doi:10.24248/eahrj. v8i1.760
[21]. Matsushita, T., Hasegawa, T., Noma, H., Ota, E., Chou, V. B., Okada, Y., 2021, Interventions to increase access to long‐acting reversible contraceptives. Cochrane Database Syst Rev. 2021(11):CD014987. Published 2021 Nov 4. Doi:10.1002/14651858.CD014987
[22]. Schuchat, A., De Cock, K. M., 2012, The value of science in integration of services. J Infect Dis. 205(Suppl 1): S1–S3.
[23]. Wallace, A. S., Ryman, T. K., Dietz, V., 2012, Experiences integrating delivery of maternal and child health services with childhood immunization programs: systematic review update. J Infect Dis. (Suppl 1): S6–S19
[24]. McCarthy, O. L., Fardousi, N., Tripathi, V., et al., 2024, Antenatal Care Interventions to Increase Contraceptive Use Following Birth in Low- and Middle-Income Countries: Systematic Review and Narrative Synthesis. Glob Health Sci Pract. 12(5):e2400059. Published 2024 Oct 29. Doi:10.9745/GHSP-D-24-00059
[25]. Nanoh, F., Yakubu, B., 2021, Maternal and Child Health Media Programmes and Accessibility in Selected Northern Nigerian Communities Abstract. Global Media Journal, 19(Ndhs 2018), 1–6.
[26]. National Bureau of Statistics (NBS) and United Nations Children’s Fund (UNICEF). August 2022. Multiple Indicator Cluster Survey 2021, Survey Findings Report. Abuja, Nigeria: National Bureau of Statistics and United Nations Children’s Fund
[27]. Corroon, M., Speizer, I. S., Fotso, J. C., Akiode, A., Saad, A., Calhoun, L., Irani, L., 2014, The role of gender empowerment on reproductive health outcomes in urban Nigeria. Maternal and Child Health Journal, 18(1), 307–315. https://doi.org/10.1007/s10995-013-1266-1
[28]. Sedgh, G., Ashford, L. S., Hussain, R., 2014, Unmet need for contraception in developing countries: Examining women’s reasons for not using a method, Guttmacher Institute Report.
Viewed PDF 283 3 -
Cardiovascular Disease Burden and Associated Risk Factors among Adults with Type 2 Diabetes Mellitus in Sub-Saharan Africa: A Narrative ReviewAuthor: Jean-Paul Mukeba TshitendeDOI: 10.21522/TIJAR.2014.13.02.Art016
Cardiovascular Disease Burden and Associated Risk Factors among Adults with Type 2 Diabetes Mellitus in Sub-Saharan Africa: A Narrative Review
Abstract:
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality among individuals with type 2 diabetes mellitus (T2DM) globally, and its burden is increasing rapidly in sub-Saharan Africa due to rising diabetes prevalence, population ageing, urbanization, and constrained health systems. This narrative review synthesizes evidence on the prevalence of CVD and associated risk factors among adults with T2DM in sub-Saharan Africa. A structured literature search was conducted across PubMed/MEDLINE, Scopus, Google Scholar, and African Journals Online, covering English-language publications from January 2000 to December 2025. Following screening and eligibility assessment, 42 studies were included and synthesized descriptively. The reviewed literature indicates that CVD is a common complication among adults with T2DM in sub-Saharan Africa, with reported prevalence ranging from approximately 20% to over 50%, depending on study setting and methodology. Hypertension-related CVD was the most frequently reported manifestation, followed by stroke, heart failure, and coronary artery disease. Increasing age, longer duration of diabetes, hypertension, poor glycemic control, dyslipidaemia, obesity, and adverse lifestyle behaviors emerged consistently as major cardiovascular risk factors. In addition, health system weaknesses—such as limited access to care, inadequate screening and diagnostic capacity, medication stock-outs, and fragmented chronic disease services—together with socioeconomic disadvantage, were recurrently associated with poor cardiovascular outcomes. Overall, the evidence highlights a substantial and growing cardiovascular burden among patients with T2DM in sub-Saharan Africa, driven by a convergence of modifiable clinical risk factors and structural health system and socioeconomic challenges. Strengthening integrated diabetes and cardiovascular care, improving access to essential services, and addressing underlying social determinants of health are critical priorities for reducing cardiovascular morbidity and mortality in this population.
Cardiovascular Disease Burden and Associated Risk Factors among Adults with Type 2 Diabetes Mellitus in Sub-Saharan Africa: A Narrative Review
References:
[1]. World Health Organization, 2022, Diabetes. Geneva: World Health Organization.
[2]. International Diabetes Federation, 2023, IDF Diabetes Atlas (10th ed.). International Diabetes Federation.
[3]. NCD Risk Factor Collaboration, 2021, Worldwide trends in diabetes prevalence since 1980: A pooled analysis of 751 population-based studies with 4.4 million participants. The Lancet, 387(10027), 1513–1530. https://doi.org/10.1016/S0140-6736(16)00618-8
[4]. World Health Organization, 2023, Cardiovascular diseases (CVDs). Geneva: World Health Organization.
[5]. American Diabetes Association, 2024, Standards of medical care in diabetes—2024. Diabetes Care, 47(Suppl. 1), S1–S350. https://doi.org/10.2337/dc24-Sint
[6]. Mensah, G. A., Roth, G. A., and Fuster, V., 2019, The global burden of cardiovascular diseases and risk factors: 2020 and beyond. Journal of the American College of Cardiology, 74(20), 2529–2532. https://doi.org/10.1016/j.jacc.2019.10.009
[7]. Yusuf, S., Hawken, S., Ôunpuu, S., Dans, T., Avezum, A., Lanas, F., McQueen, M., Budaj, A., Pais, P., Varigos, J., and Lisheng, L., 2001, Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): Case-control study. The Lancet, 364(9438), 937–952. https://doi.org/10.1016/S0140-6736(04)17018-9
[8]. Gouda, H. N., Charlson, F., Sorsdahl, K., Ahmadzada, S., Ferrari, A. J., Erskine, H., Leung, J., Santamauro, D., Lund, C., Aminde, L. N., Mayosi, B. M., Kengne, A. P., Whiteford, H. A., and Vos, T., 2019, Burden of non-communicable diseases in sub-Saharan Africa, 1990–2017. The Lancet Global Health, 7(10), e1375–e1387. https://doi.org/10.1016/S2214-109X(19)30374-2
[9]. Addis, Z., Berhie, A. Y., Abate, T. W., Belay, B. M., Wale, H., Tega, A., and Alene, T., 2025, Comorbid cardiovascular diseases and predictors among adults with type 2 diabetes in Bahir Dar city, Ethiopia: A multicentre hospital-based cross-sectional study. BMJ Open, 15(5), e086054. https://doi.org/10.1136/bmjopen-2024-086054
[10]. Yeshitla, M., Habte, T., Argaw, Z., and Getahun, N., 2025, The prevalence of cardiovascular disease and its associated factors among type 2 diabetes mellitus patients in selected public hospitals in Addis Ababa, Ethiopia. International Journal of Africa Nursing Sciences, 23, 100684. https://doi.org/10.1016/j.ijans.2025.100684
[11]. Roth, G. A., Mensah, G. A., Johnson, C. O., Addolorato, G., Ammirati, E., Baddour, L. M., et al., 2023, Global burden of cardiovascular diseases and risk factors, 1990–2021: Update from the Global Burden of Disease Study. Journal of the American College of Cardiology, 82(25), 2987–3056. https://doi.org/10.1016/j.jacc.2023.10.012
[12]. Atun, R., Davies, J. I., Gale, E. A. M., Bärnighausen, T., Beran, D., Kengne, A. P., Levitt, N. S., Mangugu, F. W., Nyirenda, M. J., Ogle, G. D., Ramaiya, K., Sewankambo, N. K., Sobngwi, E., and Davies, J., 2017, Diabetes in sub-Saharan Africa: From clinical care to health policy. The Lancet Diabetes & Endocrinology, 5(8), 622–667. https://doi.org/10.1016/S2213-8587(17)30181-X
[13]. Brownlee, M., 2005, The pathobiology of diabetic complications: A unifying mechanism. Diabetes, 54(6), 1615–1625. https://doi.org/10.2337/diabetes.54.6.1615
[14]. Libby, P., 2002, Inflammation in atherosclerosis. Nature, 420(6917), 868–874. https://doi.org/10.1038/nature01323
[15]. Libby, P., Ridker, P. M., and Hansson, G. K.,2009, Inflammation in atherosclerosis: From pathophysiology to practice. Journal of the American College of Cardiology, 54(23), 2129–2138. https://doi.org/10.1016/j.jacc.2009.09.009
[16]. Lokpo, S. Y., Norgbey, A. N., Osei-Yeboah, J., Asare-Anane, H., Owusu-Darko, S., Nyarko, A. K., Addai-Mensah, O., and Amankwah-Poku, M., 2024, Predictors of metabolic syndrome and its components in patients with type 2 diabetes: A cross-sectional study in Ghana. Scientific African, 23, e02016. https://doi.org/10.1016/j.sciaf.2024.e02016
[17]. Demissie, B. M., Girmaw, F., Amena, N., and Ashagrie, G., 2024, Prevalence of metabolic syndrome and associated factors among patients with type 2 diabetes mellitus in Ethiopia: A systematic review and meta-analysis. BMC Public Health, 24, 1128. https://doi.org/10.1186/s12889-024-18580-0
[18]. Mbanya, J. C. N., and Sobngwi, E, 2019, Diabetes microvascular and macrovascular disease in Africa. Journal of Cardiovascular Medicine, 20(5), 284–291. https://doi.org/10.2459/JCM.0000000000000795
[19]. Nyenwe, E. A., and Odia, O. J., 2021, Diabetes mellitus in Nigeria: The past, present and future. World Journal of Diabetes, 12(7), 905–920. https://doi.org/10.4239/wjd.v12.i7.905
[20]. Cassambai, S., Tetteh, J., Highton, P., Kunutsor, S. K., Darko, D. O., Jeffers, S., Ikhile, D., Agot, G. N., Olenja, J., Njoroge, P. K., Jessen, N., Abdala, R., Senior, L., Amoakoh-Coleman, M. A., Khunti, K., Godia, P. M., Yawson, A. E., Lamptey, R., Buabeng, K. O., Damasceno, A., and Seidu, S., 2025, Prevalence of cardiometabolic diseases in sub-Saharan Africa: A systematic review. Global Health Action, 18(1). https://doi.org/10.1080/16549716.2025.2580758
[21]. Sarfo, F. S., Ovbiagele, B., Gebregziabher, M., Wahab, K., Akinyemi, R., Akpalu, A., Obiako, R., Melikam, S., Owolabi, M., and Ovbiagele, B., 2018, Stroke among young adults in sub-Saharan Africa: Epidemiology and risk factors. Journal of the Neurological Sciences, 393, 95–101. https://doi.org/10.1016/j.jns.2018.08.015
[22]. Zoungas, S., Woodward, M., Li, Q., Cooper, M. E., Hamet, P., Harrap, S., Heller, S., MacMahon, S., Mancia, G., Neal, B., Poulter, N., Williams, B., Chalmers, J., and ADVANCE Collaborative Group, 2014, Impact of blood pressure control on cardiovascular outcomes in patients with type 2 diabetes. The Lancet, 383(9933), 2069–2077. https://doi.org/10.1016/S0140-6736(14)60607-5
[23]. Kengne, A. P., Amoah, A. G. B., and Mbanya, J. C., 2010, Cardiovascular complications of diabetes mellitus in sub-Saharan Africa. Circulation, 112(23), 3592–3601. https://doi.org/10.1161/CIRCULATIONAHA.105.593012
[24]. Levitt, N. S., Steyn, K., Dave, J., and Bradshaw, D., 2011, Chronic noncommunicable diseases and HIV–AIDS on a collision course: Relevance for health care delivery, particularly in low-resource settings—Insights from South Africa. American Journal of Clinical Nutrition, 94(6), 1690S–1696S. https://doi.org/10.3945/ajcn.111.019075
[25]. Sobngwi, E., Mbanya, J. C. N., Unwin, N. C., Aspray, T. J., Alberti, K. G. M. M., and Collins, R., 2012, Diabetes mellitus and its complications in sub-Saharan Africa: A systematic review. The Lancet, 378(9786), 2254–2264. https://doi.org/10.1016/S0140-6736(11)60550-8
[26]. Amoah, A. G. B., Owusu, S. K., and Adjei, S., 2014, Diabetes in Ghana: A community-based prevalence study and associated cardiovascular risk factors. Diabetes Research and Clinical Practice, 103(2), 270–277. https://doi.org/10.1016/j.diabres.2013.12.009
[27]. Erasmus, R. T., Soita, D. J., Hassan, M. S., Blanco-Blanco, E., Vergotine, Z., Kengne, A. P., and Matsha, T. E., 2015, High prevalence of diabetes mellitus and metabolic syndrome in a South African coloured population: Baseline data of a study in Bellville, Cape Town. South African Medical Journal, 105(10), 841–846. https://doi.org/10.7196/SAMJnew.8312
[28]. Pastakia, S. D., Pekny, C. R., Manyara, S. M., and Fischer, L., 2017, Diabetes in sub-Saharan Africa—From policy to practice to progress: Targeting the existing gaps for future care for diabetes. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 10, 247–263. https://doi.org/10.2147/DMSO.S126314
[29]. Uloko, A. E., Musa, B. M., Ramalan, M. A., Gezawa, I. D., Puepet, F. H., Uloko, A. T., and Sada, K. B., 2018, Prevalence and risk factors for diabetes mellitus in Nigeria: A systematic review and meta-analysis. Diabetes Therapy, 9(3), 1307–1316. https://doi.org/10.1007/s13300-018-0441-1
[30]. Kibirige, D., Lumu, W., Jones, A. G., Smeeth, L., Hattersley, A. T., and Nyirenda, M. J., 2019, Understanding the manifestations of diabetes in sub-Saharan Africa to inform therapeutic approaches and preventive strategies: A narrative review. Clinical Diabetes and Endocrinology, 5(2), 1–13. https://doi.org/10.1186/s40842-019-0078-9
[31]. Ekoru, K., Doumatey, A., Bentley, A. R., Chen, G., Zhou, J., Shriner, D., Fasanmade, O., Johnson, T., Oli, J., Okafor, G., Amoah, A., Acheampong, J., Agyenim-Boateng, K., Adeyemo, A., and Rotimi, C., 2020, Type 2 diabetes complications and comorbidities in sub-Saharan Africa: A multi-country study. The Lancet Diabetes & Endocrinology, 8(7), 548–558. https://doi.org/10.1016/S2213-8587(20)30113-4
[32]. Mensah, G. A., Roth, G. A., and Sampson, U. K. A., 2017, Mortality from cardiovascular diseases in sub-Saharan Africa, 1990–2013: A systematic analysis of data from the Global Burden of Disease Study 2013. Cardiovascular Journal of Africa, 26(2 Suppl. 1), S6–S10. https://doi.org/10.5830/CVJA-2015-036
[33]. Libby, P., Ridker, P. M., and Maseri, A., 2009, Inflammation and atherosclerosis. Circulation, 105(9), 1135–1143. https://doi.org/10.1161/01.CIR.0000011610.27244.B1
Viewed PDF 418 7 -
Institutional Shocks Transmission and Impact on Entrepreneurship Development in Developing EconomiesAuthor: Ayorinde A EzekielDOI: 10.21522/TIJAR.2014.13.02.Art017
Institutional Shocks Transmission and Impact on Entrepreneurship Development in Developing Economies
Abstract:
Entrepreneurship constitutes a major pathway through which developing economies pursue economic expansion and social transformation. This study investigates how institutional disturbances are transmitted across economies and how such disturbances influence self-employment and entrepreneurship development. Panel data drawn from twenty developing countries covering the period 1996–2022 are analysed using a Panel Vector Autoregression (PVAR) framework. The Generalized Forecast Error Variance Decomposition (GFEVD)and Impulse Response Functions (IRFs) are employed to trace the dynamic effects of institutional shocks on entrepreneurial outcomes. Self-employment is adopted as a proxy for entrepreneurship, alongside entrepreneurial finance, regulatory quality, government expenditure, education, and control of corruption. The findings indicate that institutional shocks generate heterogeneous short-run and long-run effects on entrepreneurship, with access to finance emerging as the most influential external driver over time. The results further suggest that entrepreneurial outcomes in emerging economies are affected not only by market forces but also by the stability and effectiveness of institutional arrangements. These findings underline the importance of institutional reforms that strengthen governance structures and reduce uncertainty in order to promote sustainable entrepreneurship.
Institutional Shocks Transmission and Impact on Entrepreneurship Development in Developing Economies
References:
[1]. Acemoglu, D., and Jackson, M. O., 2017, Social norms and the enforcement of laws. Journal of the European Economic Association, 15(2), 245–295.
[2]. Adusei, M., 2016, Does entrepreneurship promote economic growth in Africa? African Development Review, 28(2), 201-214.
[3]. Aghion, P., Fally, T., & Scarpetta, S., 2007, Credit constraints as a barrier to the entry and post-entry growth of firms. Economic Policy, 22(52), 731-779.
[4]. Aidis, R., Estrin, S., & Mickiewicz, T., 2008, Institutions and entrepreneurship development in Russia: A comparative perspective. Journal of Business Venturing, 23(6), 656-672.
[5]. Amit, R., & Schoemaker, P. J. H., 1993, Strategic assets and organizational rent. Strategic Management Journal, 14(1), 33-46.
[6]. Kaasa, A., & Andriani, L., 2022, Determinants of institutional trust: the role of cultural context. Journal of Institutional Economics, 18(1), 45-65.
[7]. Aparicio, S., Hughes, M., Audretsch, D., & Urbano, D., 2023, Incentivizing knowledge institutions for entrepreneurship and society, International Journal of Entrepreneurial Behavior & Research Emerald Publishing Limited, 1355-2554, https://doi.org/10.1108/ijebr- 07-2022-0652
[8]. Asongu, S. A., & Nwachukwu, J. C., 2018, Openness, ICT and entrepreneurship in sub-Saharan Africa. Information Technology & People, 31(1), 278-303.
[9]. Atiase, V., Mahmood, S., Wang, Y., & Botchie, D., 2017, Developing entrepreneurship in Africa: investigating critical resource challenges. Journal of Small Business and Enterprise Development, 25, 644-666. https://doi.org/10.1108/jsbed-03-2017-0084.
[10]. Audretsch, D. B., Belitski, M., Fiedler, A., & Khlystova, O., 2025, Five research themes of knowledge spillover theory of entrepreneurship: An analysis of 30 years of research. International Journal of Management Reviews, 27(4), 544-561.
[11]. Barney, J. B., 1991, Firm resources and sustained competitive advantage. Journal of Management, 17(1), 99-120.
[12]. Brixiová, Z., Kangoye, T., & Said, M., 2020, Training, human capital, and gender gaps in entrepreneurial performance. Economic Modelling, 85, 367-380.
[13]. Djankov, S., McLiesh, C., & Ramalho, R., 2002, Regulation and growth. Economics Letters, 78(3), 293-300.
[14]. Du, Z., 2018, A literature review on institutional environment and technological innovation. American Journal of Industrial and Business Management, 8 1941 - 1950. Doi:10.4236/ajibm.89130.
[15]. Giones, F., Brem, A., Pollack, J. M., Michaelis, T. L., Klyver, K., & Brinckmann, J., 2020, Revising entrepreneurial action in response to exogenous shocks: Considering the COVID-19 pandemic. Journal of Business Venturing Insights, 14, e00186.
[16]. Gonzalez, A., & Mendez, M., 2013, The role of institutions in entrepreneurship: A comparative analysis. International Journal of Entrepreneurship and Small Business, 18(2), 171-188.
[17]. Holcombe, R. G., 1998, Entrepreneurship and Economic growth. The Quarterly Journal of Austrian Economics, 1: 45-62. https://doi.org/10.1007/s12113-998-1008-1
[18]. Igwe, P. A., Ogundana, O. M., Egere, O. M., & Anigbo, J. A., 2019, Factors affecting the investment climate, SMEs productivity and entrepreneurship in Nigeria. European Journal of Sustainable Development, 8(1), 1-12.
[19]. Kuckertz, A., & Wagner, M., 2010, The influence of sustainability on entrepreneurial intentions. Journal of Business Venturing, 25(5), 524-539.
[20]. Li, T., 2024, The joint effects of formal and informal institutions on entrepreneurial startups: a global perspective, International Studies of Management & Organization, 54(4).
[21]. Love, I., & Zicchino, L., 2006, Financial development and dynamic investment behavior: Evidence from panel VAR. The Quarterly Review of Economics and Finance, 46(2), 190-210.
[22]. Malathi, G., Kalaiselvi, T., & Gowtham, N., 2023, Role of financial institutions in the development of business enterprises, International Journal of Engineering Research and Technology, 12(3).
[23]. Marcela, M. M., Jahir, L. C., Francisco, J. M., & Ahmed, E., 2021, Institutional factors that affect inclusive businesses: The case of Banana Cooperative in the Magdalena Region (Colombia), International Journal of Rural Management.
[24]. Miquel, G. P., & Juan, M. S., 2015, “Entrepreneurship and enforcement institutions: disaggregated evidence for Spain”, European Journal of Law and Economics, 40(10), 49-74.
[25]. Mollel, E. S., Chachage, B., & Pasape, L., 2024, A framework for enhancing entrepreneurship development in higher learning institutions (HLIs) in Tanzania, International Journal for Multidisciplinary Research, 6(3).
[26]. Moon-Ho, R. H., Marilyn, A. U., Biance, N. Y., & Kim-Yin, C., 2018, Impact of entrepreneurship training on entrepreneurial efficacy and alertness among adolescent youth, Front. Educ. 3:13. Doi: 10.3389/feduc.2018.00013.
[27]. Naudé, W., 2020, From the entrepreneurial to the ossified economy: Evidence, explanations and a new perspective. Journal of Economic Surveys, 34(5), 1037-1079.
[28]. Naudé, W., 2010, Entrepreneurship in economic development. In D. B. Audretsch & A. R. Thurik (Eds.), Handbook of entrepreneurship and regional development (pp. 1-25). Edward Elgar Publishing.
[29]. Neumann, T., 2021, The impact of entrepreneurship on economic, social and environmental welfare and its determinants: a systematic review. Management Review Quarterly, 71(3), 553-584. Doi: 10.1007/s11301-020-00193-7.
[30]. North, D. C., 1990, Institutions, institutional change, and economic performance. Cambridge University Press.
[31]. North, D. C., 1997, Some fundamental puzzles in economic history/development. In W. B. Arthur, S. N. Durlauf, & D. A. Lane (Eds.), The Economy as an evolving complex system II. Reading.MA: Addison-Wesley.
[32]. Organization of Economic, Cooperation and Development., 2022, Innovative and entrepreneurial Universities in Latin America.
[33]. Pindado, E., Alarcón, S., Sánchez, M., & Martínez, M., 2023, International entrepreneurship in Africa: The roles of institutional voids, entrepreneurial networks and gender. Journal of Business Research. https://doi.org/10.1016/j.jbusres.2023.114109.
[34]. Putnam, R. D., 2000, One economics, many recipes: Globalization, institutions, and economic growth. Princeton University Press.
[35]. Putnam, R. D., 1993, The prosperous community: Social capital and public life. The American Prospect, 4(13), 35-42.
[36]. Rodrik, D., 2008, One economics, many recipes: Globalization, institutions, and economic growth. Princeton University Press.
[37]. Rogers, E. M., 2003, Diffusion of innovations (5th ed). Free Press.
[38]. Stam, W., Arzlanian, S., & Elfring, T., 2014, Social capital of entrepreneurs and small firm performance: A meta-analysis. Journal of Business Venturing Insights, 1(1), 1-12.
[39]. Sydow, A., Cannatelli, B., Giudici, A., & Molteni, M., 2020, Entrepreneurial Workaround Practices in Severe Institutional Voids: Evidence from Kenya. Entrepreneurship Theory and Practice, 46, 331 - 367. https://doi.org/10.1177/1042258720929891.
[40]. Tony, M., 2023, The role of financial institutions in promoting entrepreneurship and economic growth, International Journal of Business Leadership and Management, 1(1).
[41]. Yang, J., & Yu, M., 2022, The influence of institutional support on the innovation performance of new ventures: The mediating mechanism of entrepreneurial orientation. Sustainability, 14(4), 2212. https://doi.org/10.3390/su14042212
Viewed PDF 295 4 -
Determinants of Undetectable Viral Load among Recipients of HIV Care in Cross River State, Nigeria: A Mixed-Methods StudyAuthor: Mbeh, O. O.DOI: 10.21522/TIJAR.2014.13.02.Art018
Determinants of Undetectable Viral Load among Recipients of HIV Care in Cross River State, Nigeria: A Mixed-Methods Study
Abstract:
Achieving and sustaining viral load suppression among people living with HIV is essential for improving treatment outcomes and reducing transmission. However, determinants of undetectable viral load remain insufficiently documented in Cross River State, Nigeria, particularly using mixed methods approaches. This study examined socio-demographic and patient-related determinants of undetectable viral load among recipients of HIV care in selected health facilities. A mixed-methods design combined a facility-based cross-sectional survey with qualitative interviews. Quantitative data were collected from 203 HIV-positive clients aged ≥15 years who had been on antiretroviral therapy (ART) for at least six months, while qualitative data were obtained from in-depth interviews with 12 healthcare providers. Descriptive statistics, Chi-square tests, and multivariate logistic regression were used for quantitative analysis, and qualitative data were analyzed thematically. Findings showed that 51.7% of participants achieved undetectable viral load (<50 copies/mL), 27.6% had suppressed viral load (51–999 copies/mL), and 79.3% attained overall viral suppression. ART adherence emerged as the strongest predictor of viral suppression, alongside regular clinic attendance, counselling participation, and use of medication reminders. Conversely, missed doses, treatment interruptions, recreational drug use, and difficulty accessing healthcare significantly reduced the likelihood of viral suppression. Qualitative findings highlighted stigma, economic hardship, transportation barriers, and occasional drug stock-outs as key contextual factors influencing adherence. The study underscores the need for patient-centered interventions that strengthen adherence counselling, improve access to ART, and address structural and socio-economic barriers to optimize viral suppression outcomes in resource-limited settings.
Determinants of Undetectable Viral Load among Recipients of HIV Care in Cross River State, Nigeria: A Mixed-Methods Study
References:
[1]. Adjei, B., 2019, Knowledge of people living with HIV and its effect on adherence to antiretroviral therapy. HIV/AIDS-Research and Palliative Care, 13(19), 67–75.
[2]. Adjetey, V., Obiri-Yeboah, D., Dornoo, B., 2019, Differentiated service delivery: a qualitative study of people living with HIV accessing care in Ghana. BMC Health Services Research, 19(1), 95, https://doi.org/10.1186/s12913-019-3878-7
[3]. Bezabhe, W. M., Chalmers, L., Bereznicki, L. R., Peterson, G. M., 2016, Adherence to antiretroviral therapy and virologic failure. Medicine, 95(15), https://doi.org/10.1097/MD.0000000000003361
[4]. Blank, A. E., Fletcher, J., Verdecias, N., Garcia, I., Blackstock, O., Cunningham, C., 2015, Factors associated with retention and viral suppression among HIV-positive women of color. AIDS Patient Care and STDs, 29(1), S27–S35, https://doi.org/10.1089/apc.2014.0272
[5]. Bulage, L., Ssewanyana, I., Nankabirwa, V., Nsubuga, F., Kihembo, C., Pande, G., Ario, A., Matovu, J., Zhu, B., 2017, Factors associated with virological non-suppression among HIV-positive patients on antiretroviral therapy in Uganda. BMC Infectious Diseases, 17(1), 326, https://doi.org/10.1186/s12879-017-2428-3
[6]. Burch, L., Smith, C., Anderson, J., Sherr, L., Rodger, A., O’Connell, R., Gilson, R., Elford, J., Phillips, A., Speakman, A., Johnson, M., Lampe, F., 2014, Socio-economic factors and virological suppression among people diagnosed with HIV in the United Kingdom. Journal of the International AIDS Society, 17, 19533, https://doi.org/10.7448/ias.17.4.19533
[7]. Caseiro, M. M., Golegã, A. A. C., Etzel, A., Diaz, R. S., 2008, Characterization of virologic failure after an initially successful course of antiretroviral therapy in HIV/AIDS outpatients. Brazilian Journal of Infectious Diseases, 12(3), 162–166, https://doi.org/10.1590/S1413-86702008000300001
[8]. Castel, A. D., E., G. A., H., Y., 2014, Disparities in viral suppression among HIV-infected persons in Washington, DC. Topics in Antiviral Medicine, 22(e-1), 522–523.
[9]. Desta, A. A., Wubayehu, T., Berhe, T., Zewde, A., 2020, Determinants of viral load suppression among HIV-positive adults on antiretroviral therapy. BMC Public Health, 20, 1–9, https://doi.org/10.1186/s12889-020-09176-1
[10]. Ellman, T., 2013, Multi-country viral load outcomes: how far are patients from undetectable? SAMU MSF, http://samumsf.org/blog/2012/09/23/came-viral-load-reprt-2012
[11]. FMoH, 2018, Nigeria HIV/AIDS indicator and impact survey (NAIIS): Technical report. Pulse Lab Jakarta, 3rd Research, 22–25, https://beta.unglobalpulse.org/wp-content/uploads/2017/05/3rd-Research-Dive.pdf
[12]. FMoH, 2019, Nigeria HIV/AIDS indicator and impact survey. National Agency for the Control of AIDS, 1–5, https://www.naiis.ng/
[13]. Haas, A. D., Tenthani, L., Msukwa, M., Tal, K., Jahn, A., Gadabu, O., Spoerri, A., Egger, M., Keiser, O., 2020, Retention and viral suppression among people living with HIV on antiretroviral therapy in sub-Saharan Africa. The Lancet HIV, 7(5), e321–e330, https://doi.org/10.1016/S2352-3018(20)30032-3
[14]. Haider, M. R., Brown, M. J., Harrison, S., Yang, C., 2021, Sociodemographic predictors of viral suppression among people living with HIV. AIDS Care, 33(5), 642–650, https://doi.org/10.1080/09540121.2020.1770295
[15]. He, B., Chen, S., Yang, X., Olatosi, B., Weissman, S., Li, X., Zhang, J., 2025, Association between substance use disorders and sustained viral suppression among people with HIV. AIDS, 39(5), 560–568, https://doi.org/10.1097/QAD.0000000000004077
[16]. Heestermans, T., Browne, J. L., Aitken, S. C., Vervoort, S. C., Klipstein-Grobusch, K., 2016, Determinants of adherence to antiretroviral therapy among HIV-positive adults in sub-Saharan Africa. BMJ Global Health, 1(4), e000125, https://doi.org/10.1136/bmjgh-2016-000125
[17]. Izudi, J., Cattamanchi, A., Castelnuovo, B., King, R., 2024, Barriers and facilitators to viral load suppression following adherence counselling. Social Science & Medicine, 343, 116595, https://doi.org/10.1016/j.socscimed.2024.116595
[18]. Jordan, A. E., Nash, D., Smith-Rohrberg, D., 2009, Alcohol use and antiretroviral adherence among HIV-infected individuals. AIDS and Behavior, 13(4), 660–667, https://doi.org/10.1007/s10461-008-9449-4
[19]. Mattson, C. L., Freedman, M., Fagan, J. L., Frazier, E. L., Beer, L., Huang, P., Skarbinski, J., 2014, Sexual risk behaviour and viral suppression among HIV-infected adults receiving medical care. AIDS, 28(8), 1203–1211, https://doi.org/10.1097/QAD.0000000000000218
[20]. Mogosetsi, N. J., Mabuza, L. H., Ogunbanjo, G. A., 2018, HIV load suppression and related factors among patients on ART at Phedisong 4 clinic, Pretoria, South Africa. The Open Public Health Journal, 11(1), 135–146, https://doi.org/10.2174/1874944501811010135
[21]. Negedu-Momoh, O. R., Balogun, O., Dafa, I., Etuk, A., Oladele, E. A., Adedokun, O., James, E., Pandey, S. R., Khamofu, H., Badru, T., Robinson, J., Mastro, T. D., Torpey, K., 2021, Estimating HIV incidence in the Akwa Ibom AIDS indicator survey (AKAIS), Nigeria. Journal of the International AIDS Society, 24(2), e25669, https://doi.org/10.1002/jia2.25669.
[22]. UNAIDS, 2020, Undetectable = untransmittable. UNAIDS, https://www.unaids.org/en/resources/presscentre/featurestories/2018/july/undetectable-untransmittable
[23]. UNAIDS, 2023, Global AIDS update 2023: The path to ending AIDS. UNAIDS, https://www.unaids.org/en/resources/documents/2023/global-aids-update-2023
[24]. UNAIDS, 2024, Global HIV statistics fact sheet. UNAIDS, 1–6, https://www.unaids.org/en/resources/fact-sheet
[25]. WHO, 2024, Global HIV/AIDS data. World Health Organization, https://www.who.int/data/gho/data/themes/hiv-aids
[26]. WHO, 2025, Global HIV/AIDS data. World Health Organization, https://www.who.int/data/gho/data/themes/hiv-aids
[27]. Wiewel, E. W., 2014, Association of neighborhood-level socioeconomic status with time from HIV diagnosis to viral suppression among newly diagnosed individuals. ResearchGate, http://www.researchgate.net/publication/266810651
[28]. Wu, E. S., Metzger, D. S., Lynch, K. G., Douglas, S. D., 2011, Association between alcohol use and HIV viral load. Journal of Acquired Immune Deficiency Syndromes, 56(5), https://doi.org/10.1097/QAI.0b013e31820dc1c8
Viewed PDF 248 6 -
Epidemiological Profile and Temporal Trends of Cancer Incidence and Mortality in Guyana, 2015-2024: A Ten-Year Registry-Based AnalysisAuthor: Diana Elizabeth KhanDOI: 10.21522/TIJAR.2014.13.02.Art019
Epidemiological Profile and Temporal Trends of Cancer Incidence and Mortality in Guyana, 2015-2024: A Ten-Year Registry-Based Analysis
Abstract:
Cancer constitutes a growing non-communicable disease burden across the Caribbean, yet population-level data from Guyana remain sparse. This study characterises the ten-year epidemiological profile of cancer in Guyana, describing temporal trends in cancer incidence and mortality using national registry data spanning 2015 to 2024. A retrospective descriptive analysis of 8,822 cancer registry records was conducted, examining year of diagnosis, sex, topography, cancer stage, vital status, ethnicity, and geographic region. Descriptive statistics, proportional distributions, and case fatality rates (CFR) were computed. A total of 8,822 cases were registered over the decade, rising nearly threefold from 525 cases in 2015 to 1,635 in 2024. Overall case fatality was 53.8%. Females accounted for 59.1% of cases (n=5,215), while males bore higher mortality (CFR 61.6% vs. 48.8%). Prostate cancer was the leading male malignancy (n=939) and breast cancer the leading female malignancy (n=896). Cervical cancer ranked second in females (n=487). Stage IV disease carried a CFR of 68.1%. East Indians represented the largest ethnic group (31.2%). Region 4 (Demerara-Mahaica) contributed 44.8% of all cases. COVID-19 disruptions in 2020 coincided with a CFR peak of 69.3%, with a gradual decline to 42.8% by 2024. Guyana faces a significant and escalating cancer burden characterised by late-stage presentation, high case fatality, and geographic concentration of services. Strengthening early detection, expanding registry completeness, and developing context-sensitive prediction tools are urgently needed to improve cancer outcomes in this low- and middle-income country (LMIC) setting.
Epidemiological Profile and Temporal Trends of Cancer Incidence and Mortality in Guyana, 2015-2024: A Ten-Year Registry-Based Analysis
References:
[1]. Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., Bray, F., 2021, Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 71(3), 209-249, https://doi.org/10.3322/caac.21660
[2]. Bray, F., Laversanne, M., Sung, H., Ferlay, J., Siegel, R. L., Soerjomataram, I., Jemal, A., 2024, Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 74(3), 229-263, https://doi.org/10.3322/caac.21834
[3]. Pan American Health Organization, 2020, Cancer in the Americas: Country Profiles 2020. PAHO, Washington DC, https://www.paho.org/en/topics/cancer
[4]. World Bank, 2023, Guyana Country Overview. World Bank Group, https://www.worldbank.org/en/country/guyana/overview
[5]. Ministry of Health Guyana, 2019, National Non-Communicable Diseases Policy and Strategic Plan 2019-2023. Ministry of Health, Georgetown.
[6]. Ferlay, J., Colombet, M., Soerjomataram, I., Parkin, D. M., Pineros, M., Znaor, A., Bray, F., 2021, Cancer statistics for the year 2020: An overview. International Journal of Cancer, 149(4), 778-789, https://doi.org/10.1002/ijc.33588
[7]. Allemani, C., Matsuda, T., Di Carlo, V., Harewood, R., Matz, M., Niksic, M., Coleman, M. P., 2018, Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): Analysis of individual records for 37,513,025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. The Lancet, 391(10125), 1023-1075, https://doi.org/10.1016/S0140-6736(17)33326-3
[8]. McKinney, W., 2010, Data structures for statistical computing in Python. Proceedings of the 9th Python in Science Conference, 56-61, https://doi.org/10.25080/Majora-92bf1922-00a
[9]. van der Walt, S., Colbert, S. C., Varoquaux, G., 2011, The NumPy array: A structure for efficient numerical computation. Computing in Science and Engineering, 13(2), 22-30, https://doi.org/10.1109/MCSE.2011.37
[10]. Rothman, K. J., Greenland, S., Lash, T. L., 2008, Modern Epidemiology (3rd ed.). Lippincott Williams and Wilkins, Philadelphia.
[11]. Vrdoljak, E., Sullivan, R., Lawler, M., 2022, Cancer and coronavirus disease 2019: How do we manage cancer optimally through a public health crisis? European Journal of Cancer, 132, 98-99, https://doi.org/10.1016/j.ejca.2020.03.022
[12]. Islami, F., Torre, L. A., Jemal, A., 2015, Global trends of lung cancer mortality and smoking prevalence. Translational Lung Cancer Research, 4(4), 327-338, https://doi.org/10.3978/j.issn.2218-6751.2015.08.04
[13]. Arbyn, M., Weiderpass, E., Bruni, L., de Sanjose, S., Saraiya, M., Ferlay, J., Bray, F., 2020, Estimates of incidence and mortality of cervical cancer in 2018: A worldwide analysis. The Lancet Global Health, 8(2), e191-e203, https://doi.org/10.1016/S2214-109X(19)30482-6
[14]. Arnold, M., Morgan, E., Rumgay, H., Mafra, A., Singh, D., Laversanne, M., Soerjomataram, I., 2022, Current and future burden of breast cancer: Global statistics for 2020 and 2040. The Breast, 66, 15-23, https://doi.org/10.1016/j.breast.2022.08.010
[15]. Stefan, D. C., 2015, Cancer care in Africa: An overview of resources. Journal of Global Oncology, 1(1), 30-36, https://doi.org/10.1200/JGO.2015.000406
[16]. Penner, M., Abdulkarim, B., Smith, A., 2016, Cancer disparities in indigenous populations: A systematic review. Journal of Racial and Ethnic Health Disparities, 3(3), 377-390, https://doi.org/10.1007/s40615-015-0154-2
[17]. Graboyes, E. M., Kompelli, A. R., Neskey, D. M., Brennan, E., Nguyen, S., Sterba, K. R., Day, T. A., 2021, Association of treatment delays with survival for patients with head and neck cancer: A systematic review. JAMA Otolaryngology-Head and Neck Surgery, 145(2), 166-177, https://doi.org/10.1001/jamaoto.2018.2716
[18]. Jemal, A., Bray, F., Forman, D., O'Brien, M., Ferlay, J., Center, M., Parkin, D. M., 2012, Cancer burden in Africa and opportunities for prevention. Cancer, 118(18), 4372-4384, https://doi.org/10.1002/cncr.27410
[19]. Parkin, D. M., Ferlay, J., Jemal, A., Boyle, P., Bray, F., 2014, Cancer in Africa 2012. Cancer Epidemiology, Biomarkers and Prevention, 23(6), 953-966, https://doi.org/10.1158/1055-9965.EPI-14-0281
[20]. Riley, R. D., Ensor, J., Snell, K. I. E., Harrell, F. E., Martin, G. P., Reitsma, J. B., Collins, G. S., 2019, Calculating the sample size required for developing a clinical prediction model. BMJ, 368, m441, https://doi.org/10.1136/bmj.m441
[21]. Collins, G. S., Reitsma, J. B., Altman, D. G., Moons, K. G. M., 2015, Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD): The TRIPOD statement. Annals of Internal Medicine, 162(1), 55-63, https://doi.org/10.7326/M14-0697
[22]. Olaiya, P. A., 2023, Health data systems strengthening in sub-Saharan Africa: Lessons for cancer registry development. African Journal of Health Sciences, 36(2), 112-124, https://doi.org/10.4314/ajhs.v36i2
Viewed PDF 384 10 -
Health Workers‘s Perspective on Health System Barriers to Effective IMNCI Implementation among Health Workers in Chongwe and Lusaka Districts, ZambiaAuthor: Baleke NgambiDOI: 10.21522/TIJAR.2014.13.02.Art020
Health Workers‘s Perspective on Health System Barriers to Effective IMNCI Implementation among Health Workers in Chongwe and Lusaka Districts, Zambia
Abstract:
Since the introduction of the IMNCI strategy in 1995 in Zambia, the Country has achieved good progress in reducing under-five mortality. In spite of its introduction, implementation of IMNCI has not been at its best, the 2018 Zambia’s health facility assessment found that only 45% of health facilities had at least 60% IMNCI trained health workers attending to sick children whereas only 32% of health facilities received at least one supervisory visit during the survey period. Despite IMNCI being a critical strategy for Zambia, very limited evidence exists on health workers’ perspective on key health system barriers for effective implementation of IMNCI. Most of the available evidence has focused on application of IMNCI skills. The study explored health workers perspective on Key health system barriers for implementation of the IMNCI strategy in Chongwe and Lusaka districts. The study employed a descriptive exploratory mixed method design and sequentially collected quantitative and qualitative data. Data was collected from health workers, National and District IMNCI Coordinators and Health facility assessment. The study revealed key health systems factors such as inadequate support, Lack of Budgetary allocation for IMNCI, Poor documentation and recording and Poor leadership and governance as barriers to implementation of IMNCI. This study therefore proposes a focus all Health system building blocks rather than just focusing on service delivery and work force related efforts as an approach that will promote responsive and resilient health systems capable of promoting quality and equitable Universal child health care services and consequently improved wellbeing of children.
Health Workers‘s Perspective on Health System Barriers to Effective IMNCI Implementation among Health Workers in Chongwe and Lusaka Districts, Zambia
References:
[1]. Villavicencio, F., Perin, J., Eilerts-Spinechi, H., Yeung, D., Prieto-Merino, D., Hug, L., Sharrow, D., You, D., Strong, K., Black, R., Liu, L., 2024, Global, regional, and national causes of death in children and adolescents younger than 20 years: an open data portal with estimates for 2000–21. The Lancet Global Health, Vol 12, pages e16-e17, https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(23)00496-5/fulltext
[2]. UN Inter-agency Group for Child Mortality Estimation., 2024, The cause of death analysis is based on preliminary estimates produced by applying cause fractions from the Child and Adolescent Causes of Death Estimation project. https://childmortality.org/ causes-of-death/data for 2021 to UN IGME estimates for 2022 and 2023.
[3]. WHO, 2026, Integrated Management of Childhood illnesses. https://www.who.int/teams/maternal-newborn-child-adolescent-health-and-ageing/child-health/integrated-management-of-childhood-illness
[4]. James, N., Acharya, Y., 2021, Integrated management of neonatal and childhood illness strategy in Zimbabwe: An evaluation. PLOS Glob Public Health, Nov 22; 1(11): e0000046. Doi: 10.1371/journal.pgph.0000046, PMID: 36962117; PMCID: PMC10021544.
[5]. Gera, T., Shah, D., Garner, P., Richardson, M., Sachdev, S., 2016, Integrated management of childhood illness (IMCI) strategy for children under five. Cochrane Database System Rev. 2016 Jun 22;2016(6):CD010123. Doi: 10.1002/14651858.CD010123.pub2. PMID: 27378094; PMCID: PMC4943011.
[6]. Ministry of Health, 2018, National Integrated Management of New Born and Childhood Illnesses (IMNCI) Strategic Plan 2019-2021.MoH
[7]. Zambia Statistics Agency., Ministry of Health (MoH)., ICF, 2024, Zambia Demographic and Health Survey 2024: Key Indicators Report. Lusaka, Zambia, and Rockville, Maryland, USA: Zambia Statistics Agency, MoH, and ICF.
[8]. Costello, A., Sarah, D., et al, 2017, “Towards a Grand Convergence for Child Survival and Health: A strategic review of options for the future building on lessons learnt from IMNCI." WHO, Geneva, 2017.
[9]. UNICEF, 2025, Under-five Mortality. Http://Data,Unicef.org/Resources/LevelsandTrendsinChildmortality, 2024.
[10]. Ministry of Health, 2018, Zambia, 2018, National Integrated management of Newborn and Childhood Illnesses Health Facility survey report. | WHO | Regional Office for Africa., 2018. https://www.afro.who.int/publications/zambia-2018-national-integrated-management-newborn-and-childhood-illnesses-health
[11]. Ministry of Health, Zambia, 2022, 2022 - 2026 National Health Strategic Plan. MoH, Lusaka
[12]. Pandya, H., Slemming, W., Saloojee, H., 2018, Health system factors affecting implementation of integrated management of childhood illness (IMCI): qualitative insights from a South African province. Health Policy Plan. 2018 March 1;33(2):171-182. doi: 10.1093/heapol/czx154. PMID: 29161375
[13]. Boschi-Pinto, C., Labadie, G., Dilip, R., Oliphant, N., Dalglish, L., Aboubaker, S., Agbodjan-Prince, A., Desta, T., Habimana, P., Butron-Riveros, B., Al-Raiby, J., Siddeeg, K., Kuttumuratova, A., Weber, M., Mehta, R., Raina, N., Daelmans, B., Diaz, T., 2018, Global implementation survey of Integrated Management of Childhood Illness (IMCI): 20 years on. BMJ Open 2018; 8: e 019079. doi:10.1136/bmjopen-2017-019079
[14]. Basaleem, H., Amin, R., 2011, Integrated management of childhood illness in Lahej, Yemen: a qualitative analysis from the perspective of health providers. East Mediterranean Health Journal. 2011; 17:101–108. Epub 2011/ 07/09. PubMed PMID: 21735943
[15]. Reñosa, M., Bärnighausen, K., Dalglish, S., Tallo, V., Landicho-Guevarra, J., Demonteverde P., Malacad, C., Bravo, A., Mationg, L., Lupisan. S., McMahon, A., National IMCI Evaluation Working Group, 2021, “The staff are not motivated anymore”: Health care worker perspectives on the Integrated Management of Childhood Illness (IMCI) program in the Philippines. BMC Health Services Research 21, 270 (2021). https://doi.org/10.1186/s12913-021-06209-6
[16]. USAID MOMENTUM, 2022, Barriers and Enablers of IMCI Implementation. https://usaidmomentum.org/resource/imci-desk-review/
[17]. Kiplagat, A., Musto, R., Mwizamholya, D., Morona, D., 2014, Factors influencing the implementation of integrated management of childhood illness (IMCI) by healthcare workers at public health centers & dispensaries in Mwanza, Tanzania. BMC Public Health 14, 277 (2014). https://doi.org/10.1186/1471-2458-14-277
[18]. Pradhan, N., Rizvi, N., Sami, N., Gul, X., 2013, "Insight into implementation of facility-based integrated management of childhood illness strategy in a rural district of Sindh, Pakistan." Global Health Action 6: 20086
[19]. Horwood, C., Voce, A., Vermaak, K., Rollins, N., Qazi, S., 2009, Experiences of training and implementation of integrated management of childhood illness (IMCI) in South Africa: A qualitative evaluation of the IMCI case management training course. BMC Paediatrics, 9, 62. https://doi.org/10.1186/1471-2431-9-62
[20]. Tsehay, A., Matlhaba, K. 2025, Barriers to the implementation of electronic medical records in Northwest Ethiopia. Health SA. 2025 Sep 20;30: 3010. Doi: 10.4102/hsag.v30i0.3010. PMID: 41069557; PMCID: PMC12505396.
[21]. Mohan, P., Kishore, B., Singh, S., Bahl, R., Puri, A., Kumar, R., 2011, Assessment of implementation of integrated management of neonatal and childhood illness in India. Journal Health Population Nutrition. 2011 Dec;29(6):629-38. Doi: 10.3329/Jhpn.v. v 29i6.9900. PMID: 22283037; PMCID: PMC3259726.
Viewed PDF 272 4 -
Gestational Diabetes Mellitus in Guyana: Clinical Profiles, Obstetric Outcomes, and Predictors of Adverse Events — A Retrospective Cohort AnalysisAuthor: Samantha N.A. KennedyDOI: 10.21522/TIJAR.2014.13.02.Art021
Gestational Diabetes Mellitus in Guyana: Clinical Profiles, Obstetric Outcomes, and Predictors of Adverse Events — A Retrospective Cohort Analysis
Abstract:
Gestational diabetes mellitus (GDM) is a growing metabolic complication of pregnancy with significant public health implications in low- and middle-income countries. This retrospective cohort study characterises the clinical and obstetric profiles of 33 GDM-confirmed mothers who delivered at the Georgetown Public Hospital Corporation (GPHC), Guyana, in January to June 2017, and identifies predictors of adverse maternal and neonatal outcomes. Data were extracted from hospital charts using a standardised abstraction form covering sociodemographic, anthropometric, obstetric, glycaemic, and neonatal variables. The cohort had a mean age of 29.9 ± 6.6 years and was predominantly Afro-Guyanese (60.6%) and urban-dwelling (75.8%). Mean pre-pregnancy body mass index (BMI) was 32.1 ± 10.4 kg/m², with 57.6% classified as overweight or obese. Family history of diabetes was present in 21.2% of participants. Insulin monotherapy or combination regimens were used in 97.0% of cases. Caesarean section rate was 45.5%, and gestational hypertension was the most frequent complication, affecting 36.4% of the cohort. Macrosomia occurred in 15.2% of births (mean birth weight 3,392 ± 676 g). Breastfeeding was initiated by 84.8% of participants. Postpartum metabolic follow-up data were absent across all time points, representing a critical systemic gap. Findings underscore the need for preconception BMI screening, structured postpartum surveillance registries, and culturally tailored non-communicable disease prevention strategies for women with a history of GDM in Guyana.
Gestational Diabetes Mellitus in Guyana: Clinical Profiles, Obstetric Outcomes, and Predictors of Adverse Events — A Retrospective Cohort Analysis
References:
[1]. American Diabetes Association., 2021, Classification and diagnosis of diabetes: Standards of Medical Care in Diabetes. Diabetes Care, 44(Suppl 1), S15–S33, https://doi.org/10.2337/dc21-S002
[2]. Guariguata, L., Linnenkamp, U., Beagley, J., Whiting, D. R., Cho, N. H., 2014, Global estimates of the prevalence of hyperglycaemia in pregnancy. Diabetes Research and Clinical Practice, 103(2), 176–185, https://doi.org/10.1016/j.diabres.2013.11.003
[3]. Bellamy, L., Casas, J. P., Hingorani, A. D., Williams, D., 2009, Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet, 373(9677), 1773–1779, https://doi.org/10.1016/S0140-6736(09)60731-5
[4]. Lowe, W. L., Scholtens, D. M., Lowe, L. P., Kuang, A., Nodzenski, M., Talbot, O., Catalano, P. M., 2019, Association of gestational diabetes with maternal disorders of glucose metabolism and childhood adiposity. JAMA, 320(10), 1005–1016, https://doi.org/10.1001/jama.2018.11628
[5]. Pan American Health Organization., 2019, Non-Communicable Diseases in the Caribbean: Key Findings and Priority Actions. Pan American Health Organization, Washington DC, https://doi.org/10.37774/9789275122013
[6]. World Health Organization., 2000, Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation. WHO Technical Report Series No. 894. World Health Organization, Geneva, https://apps.who.int/iris/handle/10665/42330
[7]. Metzger, B. E., Gabbe, S. G., Persson, B., Buchanan, T. A., Catalano, P. A., Damm, P., Dyer, A. R., 2010, International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care, 33(3), 676–682, https://doi.org/10.2337/dc09-1848
[8]. Balsells, M., Garcia-Patterson, A., Sola, I., Roque, M., Gich, I., Corcoy, R., 2015, Glibenclamide, metformin, and insulin for the treatment of gestational diabetes: a systematic review and meta-analysis. BMJ, 350, h102, https://doi.org/10.1136/bmj.h102
[9]. Castillo, W. C., Boggess, K., Sturmer, T., Brookhart, M. A., Jonsson Funk, M., 2015, Trends in glyburide compared with insulin use for gestational diabetes treatment in the United States. Obstetrics and Gynecology, 123(6), 1177–1184, https://doi.org/10.1097/AOG.0000000000000638
[10]. Dookeeram, D., Bidaisee, S., Paul, J. F., Maharaj, V., Joseph, M., Jankey, N., Morean, M., 2016, Perinatal outcomes and gestational diabetes mellitus in a Caribbean tertiary care facility. Journal of Maternal-Fetal and Neonatal Medicine, 29(24), 4050–4057, https://doi.org/10.3109/14767058.2016.1141886
[11]. Kamana, K. C., Shakya, S., Zhang, H., 2015, Gestational diabetes mellitus and macrosomia: a literature review. Annals of Nutrition and Metabolism, 66(Suppl 2), 14–20, https://doi.org/10.1159/000371628
[12]. Hutcheon, J. A., Lisonkova, S., Joseph, K. S., 2011, Epidemiology of pre-eclampsia and the other hypertensive disorders of pregnancy. Best Practice and Research Clinical Obstetrics and Gynaecology, 25(4), 391–403, https://doi.org/10.1016/j.bpobgyn.2011.01.006
[13]. Catalano, P. M., Shankar, K., 2017, Obesity and pregnancy: mechanisms of short term and long term adverse consequences for mother and child. BMJ, 356, j1, https://doi.org/10.1136/bmj.j1
[14]. Figueroa, R., Cuervo, L. G., Mancera, L., 2014, Gestational diabetes in Latin America and the Caribbean: a systematic review. Global Health Action, 7, 23995, https://doi.org/10.3402/gha.v7.23995
[15]. Sacks, D. A., Hadden, D. R., Maresh, M., Deerochanawong, C., Dyer, A. R., Metzger, B. E., 2012, Frequency of gestational diabetes mellitus at collaborating centers based on IADPSG consensus panel-recommended criteria: the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. Diabetes Care, 35(3), 526–528, https://doi.org/10.2337/dc11-1641
[16]. Vounzoulaki, E., Khunti, K., Abner, S. C., Tan, B. K., Davies, M. J., Gillies, C. L., 2020, Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta-analysis. BMJ, 369, m1361, https://doi.org/10.1136/bmj.m1361
[17]. World Health Organization., 2015, WHO Statement on Caesarean Section Rates. WHO/RHR/15.02. World Health Organization, Geneva, https://apps.who.int/iris/handle/10665/161442
[18]. Torloni, M. R., Betran, A. P., Horta, B. L., Nakamura, M. U., Atallah, A. N., Moron, A. F., Valente, O., 2009, Prepregnancy BMI and the risk of gestational diabetes: a systematic review of the literature with meta-analysis. Obesity Reviews, 10(2), 194–203, https://doi.org/10.1111/j.1467-789X.2008.00541.x
[19]. Brown, J., Grzeskowiak, L., Williamson, K., Downie, M. R., Crowther, C. A., 2017, Insulin for the treatment of women with gestational diabetes. Cochrane Database of Systematic Reviews, 11, CD012037, https://doi.org/10.1002/14651858.CD012037.pub2
[20]. Much, D., Beyerlein, A., Rossbauer, M., Hummel, S., Ziegler, A. G., 2014, Beneficial effects of breastfeeding in women with gestational diabetes mellitus. Molecular Metabolism, 3(3), 284–292, https://doi.org/10.1016/j.molmet.2014.01.002
[21]. ACOG, 2016, Practice Bulletin No. 222: Gestational Hypertension and Preeclampsia. Obstetrics & Gynecology, 135(6), e237–e260.
[22]. NICE (National Institute for Health and Care Excellence), 2021, Caesarean birth. NICE Guideline [NG192], Date of access: 06/04/2026. https://www.nice.org.uk/guidance/ng192
[23]. RCOG (Royal College of Obstetricians and Gynaecologists), 2021, Classification of Urgency of Caesarean Section. Good Practice Guideline No. 11.
[24]. WHO (World Health Organization), 2018, WHO Recommendations for Prevention and Treatment of Pre-eclampsia and Eclampsia (Geneva, Switzerland: World Health Organization).
[25]. Janevic, T., Liu, S. H., Huynh, M., et al., 2023, Racial and ethnic inequities in development of type 2 diabetes mellitus after gestational diabetes mellitus. Obstet Gynecol. 142(4):901–910. Doi:10.1097/AOG.0000000000005324.
[26]. McCarthy, K. J., Liu, S. H., Huynh, M., et al., 2023, Influence of gestational diabetes mellitus on diabetes risk and glycemic control in a retrospective population-based cohort. Diabetes Care. 46(8):1483–1491. Doi:10.2337/dc22-1676.
[27]. Chen, L., Zhu, Y., 2024, Gestational diabetes mellitus and subsequent risks of diabetes and cardiovascular diseases: the life course perspective and implications of racial disparities. Curr Diab Rep. 24(11):244–255. Doi:10.1007/s11892-024-01552-4
[28]. Abubakar, M., et al., 2025, Unveiling gestational diabetes: an overview of pathophysiology and management. Int J Mol Sci. 26(5):2320. Doi:10.3390/ijms26052320.
[29]. Juan, J., Sun, Y., Wei, Y., et al., 2022, Progression to type 2 diabetes mellitus after gestational diabetes mellitus diagnosed by IADPSG criteria: systematic review and meta-analysis. Front Endocrinol (Lausanne). 13:1012244. Doi:10.3389/fendo.2022.1012244.
[30]. Kramer, C. K., Campbell, S., Retnakaran, R., 2021, Factoring in the risk of type 2 diabetes in women with gestational diabetes: a systematic review and meta-analysis. Clin Obstet Gynecol. 64(1):234–243. Doi:10.1097/GRF.0000000000000585.
[31]. Rayanagoudar, G., Hashi, A. A., Zamora, J., Khan, K. S., Hitman, G. A., Thangaratinam, S., 2016, Quantification of the type 2 diabetes risk in women with gestational diabetes: a systematic review and meta-analysis of 95,750 women. Diabetologia, 59(7):1403–1411. Doi:10.1007/s00125-016-3927-2.
[32]. Lavery, J. A., Friedman, A. M., Keyes, K. M., Wright, J. D., Ananth, C. V., 2017, Gestational diabetes in the United States: temporal changes in prevalence rates between 1979 and 2010. BJOG, 124(5):804–813. Doi:10.1111/1471-0528.14236.
[33]. Caballero, A. E., Diabetes in the Hispanic or Latino population: genes, environment, culture, and more. Curr Diab Rep. 2018;18(12):132. Doi:10.1007/s11892-018-1086-5.
[34]. Goedecke, J. H., Micklesfield, L. K., 2014, The effect of dietary fatty acids on insulin resistance. Proc Nutr Soc. 73(1):104–119. Doi:10.1017/S0029665113003595.
[35]. Yabe, D., Seino, Y., Fukushima, M., Seino, S., 2015, Beta cell dysfunction versus insulin resistance in the pathogenesis of type 2 diabetes in East Asians. Curr Diab Rep,15(6):36. Doi:10.1007/s11892-015-0608-4.
[36]. Daneshmand, S. S., Stortz, S., Morrisey, R., Faksh A., 2019, Bridging gaps and understanding disparities in gestational diabetes mellitus to improve perinatal outcomes. Diabetes Spectr, 32(4):317–323. Doi:10.2337/ds18-0082.
[37]. Krieger, N., 2001, Theories for social epidemiology in the 21st century: an ecosocial perspective. Int J Epidemiol, 30(4):668–677. Doi:10.1093/ije/30.4.668.
Viewed PDF 291 6 -
Telemedicine, Access, and Referral Burden in Guyana’s Hinterland Regions: A Retrospective Study, 2022–2026Author: Aruna FariaDOI: 10.21522/TIJAR.2014.13.02.Art022
Telemedicine, Access, and Referral Burden in Guyana’s Hinterland Regions: A Retrospective Study, 2022–2026
Abstract:
Healthcare access in Guyana’s hinterland regions is constrained by geographic isolation, long travel distances, high transport costs, and limited specialist availability at peripheral facilities. Telemedicine has emerged as a strategy to bridge these gaps by enabling remote consultation, supporting local clinical decision-making, and reducing unnecessary patient referrals. This retrospective descriptive study analyzed annual program data and site-level operational records from the national telemedicine program across Guyana’s hinterland from 2022 to 2026. Key indicators included communities served, telemedicine calls, patient visits, serious cases, critical care encounters, remote ultrasound examinations, medical evacuations, and hospital referrals eliminated. The program expanded from 4 communities in 2022 to 130 in 2026. Telemedicine calls increased from 55 to approximately 2,500, and patient visits from 84 to approximately 25,000. Patient visits per community rose from 21.0 in 2022 to 192.3 in 2026, indicating deepening service intensity beyond geographic expansion. Serious cases increased from 11 to approximately 850, critical care encounters reached approximately 200, and remote ultrasound use grew from 106 in 2024 to approximately 800 in 2026. Hospital referrals eliminated increased from 423 in 2024 to approximately 1,900 in 2026. Medical evacuations remained stable despite growing clinical volumes. These findings indicate that Guyana’s hinterland telemedicine program achieved meaningful improvements in access, supported local management of complex clinical presentations, and contributed to referral burden reduction. Implementation quality and local integration appear to mediate utilization beyond geography alone. Future research should evaluate patient-level outcomes, referral appropriateness, and household cost savings.
Telemedicine, Access, and Referral Burden in Guyana’s Hinterland Regions: A Retrospective Study, 2022–2026
References:
[1]. Ministry of Health, Guyana, 2026, Guyana telemedicine program: Annual performance data 2022–2026. Ministry of Health, Georgetown, Guyana.
[2]. Pan American Health Organization (PAHO), 2019, Health in the Americas: Guyana country profile. PAHO/WHO Regional Office for the Americas, Washington, DC, https://www.paho.org/en/countries/guyana
[3]. Government of Guyana, 2022, National health sector development plan. Ministry of Health, Georgetown, Guyana.
[4]. Kruse, C. S., Karem, P., Shifflett, K., Vegi, L., Ravi, K., Brooks, M., 2016, Evaluating barriers to adopting telemedicine worldwide: A systematic review. Journal of Telemedicine and Telecare, 24(1), 4–12, https://doi.org/10.1177/1357633X16674087
[5]. Wootton, R., 2012, Twenty years of telemedicine in chronic disease management: An evidence synthesis. Journal of Telemedicine and Telecare, 18(4), 211–220, https://doi.org/10.1258/jtt.2012.120219
[6]. Scott Kruse, C., Karem, P., Shifflett, K., Vegi, L., Ravi, K., Brooks, M., 2022, Telemedicine effectiveness during COVID-19 and beyond: A systematic review. Journal of Medical Internet Research, 24(8), e38643, https://doi.org/10.2196/38643
[7]. Orlando, J. F., Beard, M., Kumar, S., 2020, Systematic review of patient and caregivers’ satisfaction with telehealth videoconferencing as a mode of service delivery in managing patients’ health. PLOS ONE, 14(8), e0221848, https://doi.org/10.1371/journal.pone.0221848
[8]. Iyengar, P., Mabvakure, B., Yadav, P., Adams, J., 2021, Strengthening last-mile supply chains in low-density settings: Lessons for resilience. Global Health: Science and Practice, 9(Suppl 2), S272–S285, https://doi.org/10.9745/GHSP-D-21-00008
[9]. Watkins, K., Bertone, M. P., Witter, S., 2022, Health infrastructure maintenance and uptime: Evidence and frameworks. Health Policy and Planning, 37(6), 738–748, https://doi.org/10.1093/heapol/czac016
[10]. Gilmore, B., McAuliffe, E., Power, J., Vallières, F., 2021, Data analysis and synthesis within a realist evaluation: Toward more transparent methodological approaches. International Journal of Qualitative Methods, 18, 1–10, https://doi.org/10.1177/1609406919859754
[11]. Alkmim, M. B., Figueira, R. M., Marcolino, M. S., Cardoso, C. S., de Abreu, M. P., Cunha, L. R., Antunes, A. P., Resende, A. G., Resende, E. S., Ribeiro, A. L., 2012, Improving patient access to specialized health care: The Telehealth Network of Minas Gerais, Brazil. Bulletin of the World Health Organization, 90(5), 373–378, https://doi.org/10.2471/BLT.11.099408
[12]. Marchildon, G. P., 2020, Canada’s Medicare and health system resilience: Lessons from rural and remote care. Healthcare Papers, 19(3), 8–19, https://doi.org/10.12927/hcpap.2020.26273
[13]. World Health Organization and World Bank, 2023, Tracking universal health coverage: 2023 global monitoring report. WHO, Geneva, https://www.who.int/publications/i/item/9789240080379
[14]. Kruk, M. E., Gage, A. D., Arsenault, C., Jordan, K., Leslie, H. H., Roder-DeWan, S., et al., 2018, High-quality health systems in the Sustainable Development Goals era: Time for a revolution. The Lancet Global Health, 6(11), e1196–e1252, https://doi.org/10.1016/S2214-109X(18)30386-3
[15]. Weiss, D. J., Nelson, A., Vargas-Ruiz, C. A., Gligorić, K., Bavadekar, S., Gabchenko, E., et al., 2020, Global maps of travel time to healthcare facilities. Nature Medicine, 26(12), 1835–1838, https://doi.org/10.1038/s41591-020-1059-1
[16]. Arsenault, C., Jordan, K., Lee, D., Dinsa, G., Manzi, F., Marchant, T., Kruk, M. E., 2020, Equity in primary care access in the global south: Cross-sectional analysis. PLoS Medicine, 17(6), e1003125, https://doi.org/10.1371/journal.pmed.1003125
[17]. Ouma, P. O., Maina, J., Thuranira, P. N., Macharia, P. M., Alegana, V. A., English, M., Okiro, E. A., Snow, R. W., 2018, Access to emergency hospital care provided by the public sector as a function of travel time in sub-Saharan Africa. The Lancet Global Health, 6(3), e342–e350, https://doi.org/10.1016/S2214-109X(18)30069-X
[18]. Hone, T., Rasella, D., Barreto, M. L., Atun, R., Majeed, A., Millett, C., 2017, Large reductions in amenable mortality associated with Brazil’s primary care expansion and strong health governance. Health Affairs, 36(1), 149–158, https://doi.org/10.1377/hlthaff.2016.0966
[19]. Schneider, H., Blaauw, D., Gilson, L., Chabikuli, N., Goudge, J., 2021, Health systems and access to antiretroviral drugs for HIV in Southern Africa: Service delivery and human resource challenges. Reproductive Health Matters, 14(27), 12–23, https://doi.org/10.1016/S0968-8080(06)27232-X
[20]. Dolea, C., Stormont, L., Braichet, J. M., 2010, Evaluated strategies to increase attraction and retention of health workers in remote and rural areas. Bulletin of the World Health Organization, 88(5), 379–385, https://doi.org/10.2471/BLT.09.070607
Viewed PDF 307 6 -
Epidemiological Trends of Dengue Fever Across Administrative Regions of Guyana, 2020–2022: A Cross-Sectional Analysis of Confirmed Case DataAuthor: Allison PetersDOI: 10.21522/TIJAR.2014.13.02.Art023
Epidemiological Trends of Dengue Fever Across Administrative Regions of Guyana, 2020–2022: A Cross-Sectional Analysis of Confirmed Case Data
Abstract:
Dengue fever remains a significant public health burden in Guyana, a low to middle-income country in the Caribbean South American region with a climate highly conducive to Aedes aegypti transmission. This study analyzed confirmed dengue fever case records from Guyana's ten administrative regions for 2020, 2021, and 2022, derived from the Ministry of Health national disease notification system. A total of 9,772 dengue fever cases were recorded over the three-year study period: 1,719 in 2020, 4,384 in 2021, and 3,669 in 2022. The sharpest burden was concentrated in regions 1, 6, and 2, which together accounted for more than 60% of cumulative cases. Adults aged 25–44 years constituted the largest affected age group across all years, accounting for 30.2%-34.1% of annual cases. A marginal female predominance was observed in 2021 and 2022, with females comprising 52.8% and 53.3% of cases, respectively. Region 1 recorded the highest single-year count (1,372 in 2021), while Regions 3 and 5 reported no cases across all years. These findings underscore persistent geographic heterogeneity in dengue transmission, the disproportionate burden in economically active age groups, and the urgent need to strengthen region-specific surveillance and implement integrated vector management strategies in Guyana.
Epidemiological Trends of Dengue Fever Across Administrative Regions of Guyana, 2020–2022: A Cross-Sectional Analysis of Confirmed Case Data
References:
[1]. World Health Organization (WHO), 2023, Global Arbovirus Initiative: Technical paper and operational guidance. WHO, Geneva.
[2]. Alto, B. W., Bettinardi, D., 2013, Temperature and dengue virus infection in mosquitoes. American Journal of Tropical Medicine and Hygiene, 88(4), 784–792.
[3]. Pan American Health Organization (PAHO), 2024, Epidemiological update: Dengue in the Americas. PAHO, Washington, DC.
[4]. World Bank, 2022, Guyana: Country economic memorandum and poverty assessment highlights. World Bank, Washington, DC.
[5]. Douglas, K. O., Payne, K., Sabino-Santos, G., Chami, P., Lorde, T., 2024, The impact of climate on human dengue infections in the Caribbean. Pathogens, 13(9), 756.
[6]. Runge-Ranzinger, S., Kroeger, A., Olliaro, P., McCall, P.J., 2016, Dengue disease surveillance: An updated systematic literature review. Tropical Medicine and International Health, 21(9),
1115–1160.[7]. Baksh, A., Bhagarathi, L. K., Pestano, F., Silva, P. N. D., 2025, Assessing short-term lagged effects of temperature and rainfall on dengue cases in Guyana. International Journal of Mosquito Research, 12(4), 57–65.
[8]. World Health Organization (WHO), 2009, Dengue: Guidelines for diagnosis, treatment, prevention and control. New edition. WHO, Geneva.
[9]. Li, Y., Dou, Q., Lu, Y., Xiang, H., Yu, X., Liu, S., 2020, Effects of ambient temperature and precipitation on the risk of dengue fever: A systematic review and updated meta-analysis. Environmental Research, 191, 110043.
[10]. Bhatt, S., Gething, P.W., Brady, O. J., Messina, J. P., Farlow, A.W., Moyes, C. L., Drake, J. M., et al., 2013, The global distribution and burden of dengue. Nature, 496, 504–507.
[11]. Méndez-Lázaro, P., Muller-Karger, F., Otis, D., McCarthy, M., Peña-Orellana, M., 2014, Assessing climate variability effects on dengue incidence in San Juan, Puerto Rico. International Journal of Environmental Research and Public Health, 11(9), 9409–9428.
[12]. Geraldini, B., Johansen, I.C., Justus, M., 2024, Influence of temperature and precipitation on dengue incidence in Campinas, São Paulo State, Brazil (2013–2022). Revista da Sociedade Brasileira de Medicina Tropical, 57.
[13]. Medina, E., Cogollo, M. R., González-Parra, G., 2024, Prescriptive temporal modeling approach using climate variables to forecast dengue incidence in Córdoba, Colombia. Mathematical Biosciences and Engineering, 21(12), 7760–7782.
[14]. Bowman, L. R., Donegan, S., McCall, P. J., 2016, Is dengue vector control deficient in effectiveness or evidence? Systematic review and meta-analysis. PLoS Neglected Tropical Diseases, 10(3), e0004551.
[15]. Brady, O. J., Bjornstad, O. N., Pigott, D. M., Brownstein, J. S., Hoen, A. G., Hay, S. I., 2019, The many projected futures of dengue. Nature Reviews Microbiology, 17, 580–593.
[16]. Boston, C., Kurup, R., 2017, Estimated effects of climate variables on transmission of malaria, dengue and leptospirosis within Georgetown, Guyana. West Indian Medical Journal.
[17]. Colón-González, F. J., Lake, I. R., Bentham, G., 2013, Climate variability and dengue fever in warm and humid Mexico. American Journal of Tropical Medicine and Hygiene, 88(5), 849–857.
[18]. Gasparrini, A., Armstrong, B., Kenward, M. G., 2010, Distributed lag non-linear models. Statistics in Medicine, 29(21), 2224–2234.
[19]. Hii, Y. L., Zhu, H., Ng, N., Ng, L. C., Rocklöv, J., 2012, Forecast of dengue incidence using temperature and rainfall. PLoS Neglected Tropical Diseases, 6(11), e1908.
[20]. Tun-Lin, W., Burkot, T. R., Kay, B. H., 2000, Effects of temperature and larval diet on development rates and survival of the dengue vector Aedes aegypti in north Queensland, Australia. Medical and Veterinary Entomology, 14(1), 31–37.
[21]. Lee, J., Carabali, M., Lim, J. K., Herrera, V. M., Park, I., Villar, L., et al., 2017, Early warning signal for dengue outbreaks and identification of high risk areas for dengue fever in Colombia using climate and non-climate datasets. BMC Infectious Diseases, 17(1).
[22]. Ramachandran, V. G., Roy, P., Das, S., Mogha, N. S., Bansal, A. K., 2016, Empirical model for calculating dengue incidence using temperature, rainfall, and relative humidity: a 19-year retrospective analysis in East Delhi, India. Epidemiology and Health, e2016052.
[23]. Walker, J., Pyke, A., Florian, P., Moore, F., Smoll, N., Adegbija, O., et al., 2021, Re-emergence of dengue virus in regional Queensland: 2019 dengue virus outbreak in Rockhampton, Central Queensland, Australia. Communicable Diseases Intelligence, 45.
[24]. World Meteorological Organization (WMO), 2024, State of the global climate 2023. WMO, Geneva.
[25]. Besag, J., York, J., Mollié, A., 1991, Bayesian image restoration, with two applications in spatial statistics. Annals of the Institute of Statistical Mathematics, 43(1), 1–20.
Viewed PDF 319 9 -
Knowledge, Attitudes, and Practices Related to Cervical Cancer Screening and Traditional Medicine Use among Indigenous Women in Guyana's Region 9: A Baseline Cross-Sectional AssessmentAuthor: Seraiah Arliana Dimple ValidumDOI: 10.21522/TIJAR.2014.13.02.Art024
Knowledge, Attitudes, and Practices Related to Cervical Cancer Screening and Traditional Medicine Use among Indigenous Women in Guyana's Region 9: A Baseline Cross-Sectional Assessment
Abstract:
Cervical cancer is a serious health threat for Indigenous women in Guyana's remote Region 9 (Upper Takutu-Upper Essequibo). To understand why, we spoke with 101 Amerindian women (Makushi and Wapishana), ages 21 to 65, at health centers and community events across the region between November and December 2025. We asked them about their knowledge, attitudes, and practices around cervical cancer screening, HPV, and the use of traditional medicine. Our survey found that the average age of participants was 32.6. While over 60% had an HPV test (with 27.7% testing positive), less than half (44.6%) had ever had a Pap smear. At the same time, traditional medicine plays a major role in their lives. Over 40% of the women consult traditional healers, mostly for women's health issues, and many use both traditional and modern treatments. The biggest hurdles to getting medical care were distance (67.3%), cost (47.5%), and long waits at clinics (41.6%). Our findings point to a critical gap in cervical cancer screening and highlight how central traditional medicine is to healthcare for these communities. This shows an urgent need for health programs that are culturally aware and blend modern and traditional approaches to improve women's health in Region 9.
Knowledge, Attitudes, and Practices Related to Cervical Cancer Screening and Traditional Medicine Use among Indigenous Women in Guyana's Region 9: A Baseline Cross-Sectional Assessment
References:
[1]. Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., Bray, F., 2021, Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA A Cancer Journal for Clinicians, 71(3), 209–249, https://doi.org/10.3322/caac.21660
[2]. Arbyn, M., Weiderpass, E., Bruni, L., de Sanjosé, S., Saraiya, M., Ferlay, J., Bray, F., 2020, Estimates of incidence and mortality of cervical cancer in 2018: A worldwide analysis. The Lancet Global Health, 8(2), e191–e203, https://doi.org/10.1016/S2214-109X(19)30482-6
[3]. Cohen, P. A., Jhingran, A., Oaknin, A., Denny, L., 2019, Cervical Cancer. The Lancet, 393(10167), 169–182, https://doi.org/10.1016/S0140-6736(18)32470-X
[4]. Bruni, L., Albero, G., Serrano, B., Mena, M., Gómez, D., Muñoz, J., Bosch, F.X., de Sanjosé, S., 2019, ICO/IARC Information Centre on HPV and Cancer. Human Papillomavirus and Related Diseases in the World. Summary Report. https://www.hpvcentre.net/statistics/reports/XWX.pdf
[5]. GLOBOCAN, 2020, Cancer Today: Guyana. International Agency for Research on Cancer. https://gco.iarc.fr/today/home
[6]. Forte, J., Melbye, M., Guevara, A., 2018, Health disparities in Indigenous Communities of Guyana. Journal of Rural Health, 34(2), 145–153, https://doi.org/10.1111/jrh.12272
[7]. UNDP Guyana, 2020, Sustainable Development Report: Hinterland Communities of Guyana. United Nations Development Programme. https://www.gy.undp.org/
[8]. World Bank, 2019, Guyana Health Sector Assessment. World Bank Group. https://www.worldbank.org/en/country/guyana
[9]. Robinson, M. M., Zhang, X., 2011, The world medicines situation 2011: Traditional medicines: global situation, issues and challenges. World Health Organization. https://apps.who.int/medicinedocs/documents/s18063en/s18063en.pdf
[10]. WHO, 2019, WHO Global Report on Traditional and Complementary Medicine 2019. World Health Organization, Geneva. https://www.who.int/publications/i/item/978924151536
[11]. Vandebroek, I., Thomas, E., Sanca, S., Van Damme, P., Van Puyvelde, L., De Kimpe, N., 2004, Comparison of Health Conditions Treated with Traditional and Biomedical Health Care in a Quechua Community in Rural Bolivia. Journal of Ethnobiology and Ethnomedicine, 4, 1, https://doi.org/10.1186/1746-4269-4-1
[12]. Picking, D., Younger, N., Mitchell, S., Delgoda, R., 2011, The prevalence of herbal medicine home use and concomitant use with pharmaceutical medicines in Jamaica. Journal of Ethnopharmacology, 137(1), 305–311, https://doi.org/10.1016/j.jep.2011.05.025
[13]. Launiala, A., 2009, How much can a KAP survey tell us about people's knowledge, attitudes and practices? Some observations from medical anthropology research on malaria in pregnancy in Malawi. Anthropology Matters, 11(1), 1–13, https://doi.org/10.22582/am.v11i1.31
[14]. De Sanjosé, S., Diaz, M., Castellsagué, X., Clifford, G., Bruni, L., Muñoz, N., Bosch, F. X., 2007, Worldwide prevalence and genotype distribution of cervical human papillomavirus dna in women with normal cytology: A meta-analysis. The Lancet Infectious Diseases, 7(7), 453–459, https://doi.org/10.1016/S1473-3099(07)70158-5
[15]. Torres-Cintrón, C. R., Ortiz, A. P., Tortolero-Luna, G., Pérez-Irizarry, J., Zavala, D., 2020, Disparities in cervical cancer incidence and mortality by race/ethnicity and rurality in Puerto Rico. Cancer epidemiology, biomarkers and prevention, 29(10), 2072–2079, https://doi.org/10.1158/1055-9965.EPI-19-1454
[16]. Ginsburg, O., Bray, F., Coleman, M. P., Vanderpuye, V., Eniu, A., Kotha, S. R., 2017, The global burden of women's cancers: A grand challenge in global health. The Lancet, 389(10071), 847–860, https://doi.org/10.1016/S0140-6736(16)31392-7
[17]. Heinrich, M., Mah, J., Amirkia, V., 2020, Alkaloids used as medicines: Structural phytochemistry meets biodiversity—An update and forward look. Molecules, 26(7), 1836, https://doi.org/10.3390/molecules26071836
[18]. Atanasov, A. G., Zotchev, S. B., Dirsch, V. M., Supuran, C. T., 2021, Natural products in drug discovery: Advances and opportunities. Nature Reviews Drug Discovery, 20(3), 200–216, https://doi.org/10.1038/s41573-020-00114-z
[19]. Cumberbatch, M., Goulbourne, C., Rampersaud, J., 2019, Barriers to cervical cancer screening in the caribbean: A systematic review. West Indian Medical Journal, 68(3), 267–273.
[20]. Islami, F., Goding Sauer, A., Miller, K. D., Siegel, R. L., Fedewa, S. A., Jacobs, E. J., 2018, Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States. CA: A Cancer Journal for Clinicians, 68(1), 31–54, https://doi.org/10.3322/caac.21440
[21]. Ministry of Health Guyana, 2020, National Cancer Control Plan 2020–2025. Ministry of Health, Georgetown, Guyana.
[22]. Bosch, F. X., Lorincz, A., Muñoz, N., Meijer, C. J. L. M., Shah, K. V., 2002, The causal relation between human papillomavirus and cervical cancer. Journal of Clinical Pathology, 55(4), 244–265, https://doi.org/10.1136/jcp.55.4.244
[23]. Lewis-Bell, K., Subhan, F., Mungrue, K., 2013, Cervical cancer in trinidad and tobago. West Indian Medical Journal, 62(3), 237–241.
[24]. Van Andel, T., Myren, B., van Onselen, S., 2012, Ghana's herbal market. Journal of Ethnopharmacology, 140(2), 368–378, https://doi.org/10.1016/j.jep.2012.01.032
[25]. Newman, D. J., Cragg, G. M., 2020, natural products as sources of new drugs over the nearly four decades from 01/1981 to 09/2019. Journal of Natural Products, 83(3), 770–803, https://doi.org/10.1021/acs.jnatprod.9b01285
Viewed PDF 345 8 -
Awareness, Implementation of Climate Change Mitigation Measures, Adaptative Practices and Challenges Faced by Rural Farmers of Lebialem Division in The South West Region of CameroonAuthor: Fietsop Ernestine NkemtahDOI: 10.21522/TIJAR.2014.13.02.Art025
Awareness, Implementation of Climate Change Mitigation Measures, Adaptative Practices and Challenges Faced by Rural Farmers of Lebialem Division in The South West Region of Cameroon
Abstract:
Climate change is severely affecting agriculture worldwide, and rural farmers in Lebialem Division are particularly vulnerable. Most of them rely on rain-fed farming, making them highly susceptible to unpredictable weather patterns like irregular rainfall, prolonged dry seasons, and extreme heat. To develop an effective and sustainable solutions, it is essential to understand how these farmers perceive climate change, what actions they are taking, and the challenges they encounter. A descriptive cross-sectional approach was used. Data were collected from eight villages across the three subdivisions using a multistage sampling technique. Data were analyzed using SPSS. Key statistical indicators used included Adjusted Odds Ratios (AORs), 95% Confidence Intervals (CI), and p-values. Farmers in Lebialem were highly aware (92,3%) of climate change with age group 41–50 (AOR = 7.50 (95% CI: 1.52–37.10; p = 0.014) more likely to be aware through daily experiences, even if they lack formal scientific understanding. They were actively involved in mitigation practices (87.1%) like planting trees, using mulch, organic manure, and avoiding bush burning, efforts which are often rooted in traditional knowledge. Adaptation strategies included crop diversification, irrigation, and planting crop varieties (84.1%). However, these efforts faced serious challenges such as poor tree survival rates, financial constraints, limited water access and unpredictable weather. Traditional leaders and NGOs offer support, but broader assistance remains limited. Rural farmers in Lebialem are committed to addressing climate change by combining indigenous practices with modern techniques. However, challenges limit their success. Strengthening institutional support, improving technical training, and providing financial resources are key to building resilience and ensuring food security in the region.
Awareness, Implementation of Climate Change Mitigation Measures, Adaptative Practices and Challenges Faced by Rural Farmers of Lebialem Division in The South West Region of Cameroon
References:
[1]. Intergovernmental Panel on Climate Change, 2021, Climate change 2021: The physical science basis. Cambridge University Press.
[2]. Food and Agriculture Organization of the United Nations, 2021, The impact of disasters and crises on agriculture and food security. FAO.
[3]. World Health Organization, 2021, Climate change and health. WHO.
[4]. World Bank, 2020, Climate-smart agriculture in Africa. World Bank.
[5]. Molua, E. L., 2019, Climate variability and agricultural vulnerability in Cameroon. Environmental Economics and Policy Studies, 21(2), 315–334.
[6]. Yengoh, G. T., Ardö, J., Olsson, L., Tengberg, A., 2020, The role of agriculture in climate change adaptation in Sub-Saharan Africa. Springer.
[7]. Smith, P., Bustamante, M., Ahammad, H., et al., 2014, Agriculture, forestry and other land use (AFOLU). Climate Change 2014: Mitigation of Climate Change. Cambridge University Press.
[8]. Thornton, P. K., Ericksen, P. J., Herrero, M., Challinor, A. J., 2019, Climate variability and vulnerability to climate change. Global Change Biology, 25(11), 3907–3923.
[9]. Lobell, D. B., Schlenker, W., Costa-Roberts, J., 2019, Climate trends and global crop production since 1980. Science, 333(6042), 616–620.
[10]. Pretty, J., Bharucha, Z. P., 2019, Sustainable intensification in agricultural systems. Annals of Botany, 114(8), 1571–1596.
[11]. Altieri, M. A., Nicholls, C. I., 2020, Agroecology and the reconstruction of a post-COVID-19 agriculture. Journal of Peasant Studies, 47(5), 881–898.
[12]. Nyong, A., Adesina, F., Elasha, B. O., 2019, The value of indigenous knowledge in climate change mitigation and adaptation strategies in Africa. Mitigation and Adaptation Strategies for Global Change, 12(5), 787–797.
[13]. Gbegbelegbe, S., Serem, J., Stirling, C., et al., 2020, Smallholder farmers’ adaptation to climate change. Food Policy, 89, 101802.
[14]. Deressa, T. T., Hassan, R. M., Ringler, C., 2019, Perception of and adaptation to climate change by farmers in Africa. Journal of Agricultural Science, 149(1), 23–31.
[15]. Mase, A. S., Gramig, B. M., Prokopy, L. S., 2019, Climate change beliefs, risk perceptions, and adaptation behavior among U.S. farmers. Climate Risk Management, 15, 9–20.
[16]. Mulwa, C., Marenya, P., Rahut, D. B., 2021, Smallholder farmers’ perceptions of climate change. Climate and Development, 13(3), 231–245.
[17]. Zakari, S., Ying, L., Song, B., 2023, Factors influencing farmers’ awareness of climate change. Sustainability, 15(4), 2876.
[18]. Nkengafac, V., Ndzi, E. S., Njukang, P. N., 2020, Farmers’ perception of climate variability in rural Cameroon. Journal of Environmental Studies, 28(3), 445–457.
[19]. Musah, A. B., Abdul-Rahaman, A., Donkoh, S. A., 2023, Constraints to climate adaptation among smallholder farmers. African Journal of Agricultural Research, 18(2), 156–168.
[20]. Mupangwa, W., Nyagumbo, I., Liben, F. M., 2022, Climate adaptation barriers in Southern Africa. Climate Policy, 22(6), 789–804.
[21]. World Bank, 2021, Cameroon economic update: Resilience under fragility. World Bank.
[22]. Creswell, J. W., Plano Clark, V. L., 2018, Designing and conducting mixed methods research (3rd ed.). Sage.
[23]. Food and Agriculture Organization of the United Nations, 2022, Climate change adaptation in agriculture. FAO.
[24]. Nkengafac, V., Ndzi, E. S., Njukang, P. N., 2020, Rural accessibility and farmer participation in Cameroon. African Development Review, 32(4), 601–614.
[25]. Food and Agriculture Organization of the United Nations, 2019, The gender gap in agriculture. FAO.
[26]. Ngum, N., Kimengsi, J. N., Balgah, R. A., 2020, Gender and climate change adaptation in Cameroon. International Journal of Climate Change Strategies and Management, 12(3), 315–332.
[27]. World Bank, 2019, Youth migration and rural transformation in Africa. World Bank.
[28]. Deressa, T. T., Hassan, R. M., Ringler, C., 2019, Education and climate adaptation in Africa. Ecological Economics, 64(2), 384–393.
[29]. UNESCO, 2022, Education for sustainable development and climate action. UNESCO.
[30]. Molua, E. L., 2019, Economic impacts of climate variability on agriculture in Cameroon. Climate Research, 78(2), 137–150.
[31]. Yengoh, G. T., Tchuinte, R., Armah, F. A., 2020, Smallholder farmers’ vulnerability to climate change in Cameroon. Sustainability, 12(2), 384.
[32]. Intergovernmental Panel on Climate Change, 2022, Climate change 2022: Impacts, adaptation and vulnerability. Cambridge University Press.
[33]. Mulwa, C., Marenya, P., Rahut, D. B., 2021, Experiential climate knowledge among African farmers. Climate and Development, 13(5), 401–413.
[34]. Zakari, S., Ying, L., Song, B., 2023, Farming experience and climate sensitivity. Sustainability, 15(4), 2876.
[35]. Gebre, G. G., Isoda, H., Rahut, D. B., 2021, Land size and climate awareness among farmers. Land Use Policy, 104, 105351.
[36]. Adimassu, Z., Kessler, A., Hengsdijk, H., 2021, Climate-smart agriculture practices in Africa. Agricultural Systems, 190, 103098.
[37]. Antwi-Agyei, P., Dougill, A. J., Stringer, L. C., 2023, Barriers to climate adaptation in smallholder systems. World Development, 158, 105978.
[38]. Musah, A. B., Abdul-Rahaman, A., Donkoh, S. A., 2023, Institutional constraints to climate resilience. African Journal of Agricultural Research, 18(2), 156–168.
[39]. Mupangwa, W., Nyagumbo, I., Liben, F. M., 2022, Infrastructure and climate vulnerability in rural Africa. Climate Policy, 22(6), 789–804.
Viewed PDF 265 9 -
Strategies to Reduce the Increasing Risk Factors and Rate of Terminal Diseases Among Youths in Oji River, Udi and Environs in Enugu State, NigeriaAuthor: Ikeonwueme Peace ObikaDOI: 10.21522/TIJAR.2014.13.02.Art026
Strategies to Reduce the Increasing Risk Factors and Rate of Terminal Diseases Among Youths in Oji River, Udi and Environs in Enugu State, Nigeria
Abstract:
Terminal diseases including advanced cancers, chronic kidney disease, severe cardiovascular diseases, liver failure, and chronic respiratory illnesses are increasingly observed among young populations in developing regions. In Oji River, Udi and surrounding communities of Enugu State, Nigeria, youth exposure to unhealthy lifestyles, substance abuse, environmental pollution, poor healthcare access, and weak preventive services may accelerate progression into irreversible disease states. This study assessed major risk factors driving terminal diseases among youths in Oji River, Udi and environs, and proposed evidence-based strategies for reducing future terminal disease burden. Data were analyzed using SPSS version 25. Chi-square tests were applied to determine associations between risk exposures and self-reported chronic symptoms (p < 0.05). Out of 400 questionnaires distributed, 378 were correctly completed (response rate: 94.5%). Risk factors identified included frequent alcohol consumption (47.6%), cigarette smoking (18.5%), illicit drug use (13.2%), low physical activity (56.4%), unhealthy dietary practices (61.1%), and high reliance on self-medication (68.2%). Environmental exposure to smoke, fumes and waste-burning pollution was reported by 41.5%. Screening practices were poor: blood pressure checks (22.8%), blood glucose checks (14.0%), and hepatitis screening (11.6%). Chi-square analysis showed significant associations between smoking/pollution exposure and persistent cough/breathlessness (p < 0.05). Terminal disease risks among youths in Oji River and Udi are increasing due to modifiable behavioral and environmental exposures coupled with poor preventive health utilization. Interventions such as routine screening programs, youth-targeted health education, improved primary healthcare access, environmental pollution regulation, and stronger control of alcohol and tobacco use are urgently needed.
Strategies to Reduce the Increasing Risk Factors and Rate of Terminal Diseases Among Youths in Oji River, Udi and Environs in Enugu State, Nigeria
References:
[1]. World Health Organization., 2022, Non-communicable diseases: Key facts. WHO Fact Sheets. 2022;1(1):1-8. https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases
[2]. Beaglehole, R., Bonita, R., Horton, R., Adams, C., Alleyne, G., Asaria P., 2011. Priority actions for the non-communicable disease crisis. The Lancet. 377(9775):1438-1447. https://doi.org/10.1016/S0140-6736(11)60393-0
[3]. Federal Ministry of Health Nigeria, 2016, National Strategic Plan of Action on Prevention and Control of Non-Communicable Diseases. FMOH Publication. 2016;1(1):178. https://extranet.who.int/ncdccs/ Data/NGA_D1_National%20NCD%20Policy.pdf
[4]. Patel, V., Saxena, S., Lund, C., Thornicroft, G., Baingana, F., Bolton P., 2018, The Lancet Commission on global mental health and sustainable development. The Lancet. 392(10157):1553-1598. https://doi.org/10.1016/S0140-6736(18)31612-1
[5]. Osemene, K. P., Lamikanra, A., 2012, A study of the prevalence of self-medication practice among university students in Southwestern Nigeria. Tropical Journal of Pharmaceutical Research. 11(4):683-689. https://doi.org/10.4314/tjpr.v11i4.21
[6]. Oyewole, O, E., Atinmo, T., 2015, Nutrition transition and chronic disease risk in Nigeria. African Journal of Food, Agriculture, Nutrition and Development. 15(1):9832-9848. https://www.ajfand.net/Volume15/No1/OyewoleAtinmo.pdf
[7]. United Nations Office on Drugs and Crime., 2021, World Drug Report 2021. UNODC Annual Report. 2021;1(1):1-120. https://www.unodc.org/unodc/en/data-and-analysis/wdr2021.html
[8]. Eriksen, M., Mackay, J., Ross, H., 2013, The Tobacco Atlas and global tobacco epidemic. American Cancer Society Journal. 3(1):22-29. https://tobaccoatlas.org
[9]. Stanaway, J. D., Afshin, A., Gakidou, E., Lim, S. S., Abate, D., 2018, Global burden of chronic kidney disease and associated risk factors. The Lancet. 392(10153):1789-1858. https://doi.org/10.1016/S0140-6736(18)32252-0
[10]. Pope, C. A., Dockery, D. W., 2006, Health effects of fine particulate air pollution: Lines that connect. Journal of the Air & Waste Management Association. 56(6):709-742. https://doi.org/10.1080/10473289.2006. 10464485
[11]. Adebowale, A. S., Fagbamigbe, A. F., Bamgboye, E. A., 2012, Prevalence and determinants of late presentation to healthcare facilities in Nigeria. BMC Health Services Research. 12(1):152-160. https://doi.org/10.1186/1472-6963-12-152
[12]. Sawyer, S. M., Azzopardi, P. S., Wickremarathne, D., Patton, G. C., 2018, The age of adolescence. The Lancet Child & Adolescent Health. 2(3):223-228. https://doi.org/10.1016/S2352-4642(18)30022-1
[13]. Bloom, D. E., Cafiero, E. T., Jané-Llopis, E., Abrahams-Gessel, S., 2011, The global economic burden of noncommunicable diseases. World Economic Forum Report. 2011;1(1):1-46. https://www.weforum.org/reports/the-global-economic-burden-of-non-communicable-diseases
[14]. Afshin, A., Sur, P. J., Fay, K. A., Cornaby, L., Ferrara, G., Salama, J. S., 2019, Health effects of dietary risks in 195 countries, 1990-2017: A systematic analysis. The Lancet. 393(10184):1958-1972. https://doi.org/10.1016/S0140-6736(19)30041-8
[15]. Landrigan, P. J., Fuller, R., Acosta, N. J. R., Adeyi, O., Arnold, R., Basu, N., 2018, The Lancet Commission on pollution and health. The Lancet. 391(10119):462-512. https://doi.org/10.1016/S0140-6736(17)32345-0
[16]. Warburton, D. E. R., Nicol, C.W., Bredin, S. S. D., 2006, Health benefits of physical activity: The evidence. CMAJ. 174(6):801-809. https://doi.org/10.1503/cmaj.051351
[17]. Adeloye, D., Basquill, C., 2014, Estimating the prevalence and awareness rates of hypertension in Africa: A systematic analysis. PLoS ONE. 9(8):e104264. https://doi.org/10.1371/journal.pone.0104264
[18]. Akinyemi, J. O., Erhabor, S., Adebayo, B. E., 2021, Rising burden of chronic diseases in Nigeria: A review of evidence. Nigerian Journal of Public Health. 35(2):112-120. https://doi.org/10.4314/njph.v35i2.5
[19]. World Health Organization., 2020, WHO guidelines on physical activity and sedentary behaviour. WHO Guidelines. 2020;1(1):1-104. https://www.who.int/publications/i/item/97892400 15128
[20]. Rehm, J., Shield, K. D., 2019, Global burden of disease and the impact of mental and addictive disorders. Current Psychiatry Reports. 21(2):10-18. https://doi.org/10.1007/s11920-019-0997-0
Viewed PDF 244 5 -
Prevalence of Non -Adherence to Tuberculosis Therapy and Associated Factors among Patients with Pulmonary Tuberculosis at Mwananyamala Regional Referral Hospital, Dar- es- salaamAuthor: Mbeya B.DOI: 10.21522/TIJAR.2014.13.02.Art027
Prevalence of Non -Adherence to Tuberculosis Therapy and Associated Factors among Patients with Pulmonary Tuberculosis at Mwananyamala Regional Referral Hospital, Dar- es- salaam
Abstract:
This study aimed to assess the prevalence of non- adherence to Tuberculosis therapy and associated factors among patients with pulmonary Tuberculosis at Mwananyamala Regional Referral Hospital, Dar es Salaam. It was a cross-sectional study involving Tuberculosis (TB) patients who attended the outpatient clinic at Mwananyamala Regional Referral Hospital. The sample size of this study consisted of 422 participants who were selected through systematic random sampling. Data collection was done by using structured questionnaires incorporated in Open Data Kit (ODK); in addition, the TB treatment card and the Morisky Medical Adherence scale (MMS) were also used. Data analysis was done by Statistical Package for the Social Sciences (SPSS) version 16.0 to find the proportion of respondents choosing different responses. The study findings indicated that most patients adhere to TB treatment by 98%, and only 2% did not adhere to TB treatment. Factors associated with adherence, such as TB drugs’ side effects and non-compliance, did not influence non-adherence. The study recommends the same modality of treatment to continue to maintain the adherence level of TB patients. This study has implications for all stakeholders involved in TB patients’ management. The practical and theoretical implications provide the benefits of the study to the government, non-governmental organizations, and research organizations.
Prevalence of Non -Adherence to Tuberculosis Therapy and Associated Factors among Patients with Pulmonary Tuberculosis at Mwananyamala Regional Referral Hospital, Dar- es- salaam
References:
[1]. Kaufmann, S. H. E., Hussey, G., Lambert, P. H., Town, C., 2010, Tuberculosis 6 New vaccines for tuberculosis. The Lancet, 375(9731):2110–9. Doi:10.1016/S0140-6736(10)60393-5.
[2]. Gunda, D. W., Nkandala, I., Kavishe, G. A., Kilonzo, S. B., Kabangila, R., Mpondo, B. C., 2017, Prevalence and Risk Factors of Delayed Sputum Conversion among Patients Treated for Smear Positive PTB in Northwestern Rural Tanzania: A Retrospective Cohort Study. Vol. 2017.
[3]. Tola, H. H., Tol, A., Shojaeizadeh, D., 2015, Tuberculosis Treatment Non-Adherence and Lost to Follow Up among TB Patients with or without HIV in Developing Countries: A Systematic Review. Vol. 44; 44(1):1–11.
[4]. Aziz, K., Hisam, A., Azam, N., Pervaiz, F., & Mehmood, H., 2019, Knowledge of disease and adherence to anti-tuberculosis treatment-a cross sectional study in Rawalpindi District. Pakistan Armed Forces Medical Journal, (2), S267.
[5]. Seebregts, C. J., 2016, An ontology for factors affecting tuberculosis treatment adherence behavior in sub-Saharan Africa;669–81.
[6]. Ford, S., 2018, Nurses of tomorrow’ Nursing theories 4: adherence and concordance.
[7]. Noor, H., Muhamad, H., 2017, Systematic review of factors associated with medication adherence among pulmonary tuberculosis patients. Vol. 4;4(6).
[8]. Chani, K., 2010, Factors Affecting Compliance to Tuberculosis Treatment in Andara Kavango Region Namibia.
[9]. WHO, 2002, Pharmacovigilance.
[10].Sumari-de Boer, M., Pima, F. M., Ngowi, K. M., Chelangwa, G. M., Mtesha, B. A., Minja, L. M., et al., 2019, Implementation and effectiveness of evriMED with short messages service (SMS) reminders and tailored feedback compared to standard care on adherence to treatment among tuberculosis patients in Kilimanjaro, Tanzania: Proposal for a Cluster Randomized;1–10.
[11].Sani, Z., 2019, University of Ghana https://ugspace.ug.edu.gh Determinants of Medication Adherence Among Patients with Tuberculosis: A Study at Sokoto Metropolis, by This Dissertation is Summited to the University of Ghana, Legon in Partial Fulfilment of the Requiremen;(10702768).
[12].Wang, Y., Chen, H., Mcneil, E. B., Lu, X., 2019, Drug Non-Adherence and Reasons Among Multidrug-Resistant Tuberculosis Patients in Guizhou, China: A Cross-Sectional Study.
[13].WHO., 2018, global TUBERCULOSIS.
[14].Xu, W., Lu, W., Zhou, Y., Zhu, L., Shen, H., Wang, J., 2016, Adherence to anti-tuberculosis treatment among pulmonary tuberculosis patients: a qualitative and quantitative study. Vol. 8; 8:1–8. Doi:10.1186/1472-6963-9-169.
[15].Zegeye, A., Dessie, G., Fasil, W. K., 2019, Prevalence and determinants of anti-tuberculosis treatment non-adherence in Ethiopia. PLoS One.
[16].NTLP, 2020, TB Prevalence in Tanzania. National Tuberculosis and Leplosy program. p. 1–6.
[17].Herrero, M. B., Ramos, S., & Arrossi, S., 2015, Determinants of non adherence to tuberculosis treatment in Argentina: barriers related to access to treatment. Revista Brasileira de Epidemiologia, 18, 287-298.
[18].Tanzania, M of H., 2017, The National Guidelines for Tuberculosis Infection Control.
[19].van den Boogaard, J., Msoka, E., Homfray, M., Kibiki, G. S., Heldens, J. J., Felling, A. J., & Aarnoutse, R. E., 2012, An Exploration of Patient Perceptions of Adherence to Tuberculosis Treatment in Tanzania. Doi:10.1177/1049732312438968.
[20].Suliman, Q., Said, S., Ying, L. P., 2019, SCIENCE & TECHNOLOGY Timing and Prognostic Factors of Tuberculosis Treatment Interruption. Vol. 27;27(4):1509–25.
[21].Krasniqi, S., Jakupi, A., Daci, A., Tigani, B., Jupolli-krasniqi, N., Pira, M., et al., 2017, Tuberculosis Treatment Adherence of Patients in Kosovo. Vol. 2017.
[22].Hoza, A. S., Mfinanga, S. G. M., König, B., 2015, Anti-TB drug resistance in Tanga, Tanzania: A cross sectional facility-base prevalence among pulmonary TB patients. Asian Pac J Trop Med;8(11):907–13. Doi:10.1016/j.apjtm.2015.10.014.
[23].Mnyambwa, N. P., Lekule, I., Ngadaya, E. S., Kimaro, G., Petrucka, P., Kim, D. J., ... & Mfinanga, S. G., 2018, Assessment of GeneXpert GxAlert platform for multi drug resistant tuberculosis diagnosis and patients’ linkage to care in Tanzania. BMC.
[24].Mpagama, S. G., Heysell, S. K., Ndusilo, N. D., Kumburu, H. H., Lekule, I. A., Kisonga, R. M., et al., 2013, Diagnosis and Interim Treatment Outcomes from the First Cohort of Multidrug-Resistant Tuberculosis Patients in Tanzania. PLoS One;8(5). Doi: 10.1371/journal.pone.0062034 PubMed PMID: 23675411.
[25].WHO, 2019, Global tuberculosis report 2019.
[26].Chonde, T. M., Doulla, B., van Leth, F., Mfinanga, S. G., Range, N., Lwilla, F., ... & Egwaga, S. M., 2008, Implementation of a national anti-tuberculosis drug resistance survey in Tanzania. Vol. 6. 2008;6:1–6. Doi:10.1186/1471-2458-8-427.
[27].Abraham, C., & Sheeran, P. 2005, The health belief model. Cambridge University Press.
[28].Kuiper, M. E., de Bruijn, A. L., Reinders Folmer, C., Olthuis, E., Brownlee, M., Kooistra, E. B., ... & Van Rooij, B., 2020, The Intelligent Lockdown: Compliance with COVID-19 Mitigation Measures in the Netherlands. SSRN Electronic Journal;1–38. Doi:10.2139/ssrn.3598215.
[29].Mkopi, A., Range, N., Lwilla, F., Egwaga, S., Schulze, A., Geubbels, E., et al., 2012, Adherence to Tuberculosis Therapy among Patients Receiving Home-Based Directly Observed Treatment: Evidence from the United Republic of Tanzania. PLoS One;7(12):1–7. Doi:10.1371/journal.pone.0051828 PubMed PMID: 23284782.
[30].Oshi, D. C., Oshi, S. N., Alobu, I., Ukwaja, K. N., 2014, Profile and treatment outcomes of tuberculosis in the elderly in southeastern Nigeria, 2011-2012. PLoS One;9(11). Doi:10.1371/journal.pone.0111910 PubMed PMID: 25369001.
[31].Neves, L. A. D. S., Castrighini, C. D. C., Reis, R. K., Canini, S. R. M. D. S., & Gir, E., 2018, Social support and quality of life of people with tuberculosis/HIV. Enfermeria Global;17(2):21–9. Doi:10.6018/eglobal.17.2.276351.
[32].Noor Haslinda, I., & Juni, M. H., 2017, Systematic review of factors associated with medication adherence among pulmonary tuberculosis patients. Vol. 4; 4(6).
[33].Popkin, B. M., Anci, K. E., Rosenberg, I. H., 2010, Water, hydration, and health. Nutrition Reviews. Blackwell Publishing Inc; p. 439–58. Doi:10.1111/j.1753-4887.2010.00304.x PubMed PMID: 20646222.
[34].Kidenya, B. R., Mshana, S. E., Gerwing-adima, L., Kidola, J., Kasang, C., 2017, International Journal of Infectious Diseases Drug adherence and ef fi cacy of smear microscopy in the diagnosis of pulmonary tuberculosis after 2 months of medication in. International Journal of Infectious Diseases; 63:43–7. Doi:10.1016/j.ijid.2017.07.025.
[35].Ndwiga, J. M., Kikuvi, G., Omolo, J. O., 2016, Factors influencing knowledge on completion of treatment among tb patients under directly observed treatment strategy, in selected health facilities in embu county, Kenya. Pan African Medical Journal; 25. Doi:10.11604/pamj.2016.25.234.8761 PubMed PMID: 28293350.
[36].Urnila, A., Mohammad Arifin, N., Suyanto, S., 2026, The Relationship Between Family Support and Treatment Adherence Among Patients with Tuberculosis. International Journal of Health Science;6(1):218–43. Doi:10.55606/ijhs.v6i1.6845.
Viewed PDF 223 4 -
Artemisinin Partial Resistance in Sub-Saharan Africa: Epidemiological Patterns, Molecular Markers, and Implications for Malaria ControlAuthor: Hamad NnimboDOI: 10.21522/TIJAR.2014.13.02.Art028
Artemisinin Partial Resistance in Sub-Saharan Africa: Epidemiological Patterns, Molecular Markers, and Implications for Malaria Control
Abstract:
Artemisinin partial resistance (ART-R) represents a growing concern for malaria control in Sub-Saharan Africa. This narrative review synthesizes current evidence on the epidemiology, molecular markers, therapeutic efficacy, transmission dynamics, and surveillance of ART-R. Structured searches of peer-reviewed literature and grey sources published between 2020 and 2025 were conducted, focusing on clinical studies of artemisinin-based combination therapy (ACT) efficacy, PfKelch13 (PfK13) mutations, and surveillance reports. Data were extracted descriptively and synthesized thematically across four domains: emergence patterns, molecular markers and phenotypic expression, treatment efficacy and partner drug susceptibility, and transmission and surveillance capacity. Validated PfK13 mutations associated with ART-R, including R561H, C469Y, A675V, and R622I, have emerged independently across Sub-Saharan African countries. While delayed parasite clearance is observed with these mutations, first-line ACTs continue to show high cure rates in many settings, reflecting the combined activity of artemisinin derivatives and partner drugs. Candidate PfK13 mutations and markers of altered partner drug susceptibility have also been reported, highlighting potential emerging vulnerabilities in the ACT framework. Prolonged parasite clearance may increase the window of transmission, particularly in low to moderate transmission settings. Surveillance capacity is expanding but remains uneven, with gaps in genomic monitoring, timely reporting, and integration into policy processes. Overall, ART-R in Sub-Saharan Africa remains focal and of low prevalence, with limited evidence of widespread clinical impact. Strengthening integrated molecular and therapeutic surveillance, improving data-to-policy translation, and implementing targeted interventions in high-risk areas are critical to prevent wider dissemination and sustain ACT effectiveness, thereby supporting malaria control gains across the region.
Artemisinin Partial Resistance in Sub-Saharan Africa: Epidemiological Patterns, Molecular Markers, and Implications for Malaria Control
References:
[1]. World Health Organization, 2025, Malaria, Available from: https://www.who.int/news-room/fact-sheets/detail/malaria
[2]. Beke, O. A. H., Assi, S. B., Kokrasset, A. P. H., Dibo, K. J. D., Tanoh, M. A., Danho, M., Remoué, F., Koudou, G. B., Poinsignon, A., 2023, Implication of agricultural practices in the micro-geographic heterogeneity of malaria transmission in Bouna, Côte d’Ivoire, Malaria Journal, 22(1), https://doi.org/10.1186/s12936-023-04748-3
[3]. Beloconi, A., Nyawanda, B. O., Bigogo, G., Khagayi, S., Obor, D., Danquah, I., Kariuki, S., Munga, S., Vounatsou, P., 2023, Malaria, climate variability, and interventions: modelling transmission dynamics, Scientific Reports, 13(1), https://doi.org/10.1038/s41598-023-33868-8
[4]. Namubiru, C., 2025, Institutional quality, aid flows, and malaria burden: a geospatial analysis of sub-Saharan Africa, Malaria Journal, 24(1), https://doi.org/10.1186/s12936-025-05592-3
[5]. World Health Organization, 2025, Malaria: Artemisinin partial resistance, https://www.who.int/news-room/questions-and-answers/item/artemisinin-resistance
[6]. Oxborough, R. M., Chilito, K. L. F., Tokponnon, F., Messenger, L. A., 2024, Malaria vector control in sub-Saharan Africa: complex trade-offs to combat the growing threat of insecticide resistance, The Lancet Planetary Health, 8(10), https://doi.org/10.1016/S2542-5196(24)00172-4
[7]. Oyegbade, S. A., Mameh, E. O., Balogun, D. O., Aririguzoh, V. G. O., Akinduti, P. A., 2025, Emerging Plasmodium falciparum K13 gene mutation to artemisinin-based combination therapies and partner drugs among malaria-infected population in sub-Saharan Africa, Parasites, Hosts and Diseases, 63(2), https://doi.org/10.3347/PHD.24053
[8]. Conrad, M. D., Asua, V., Garg, S., Giesbrecht, D., Niaré, K., Smith, S., Namuganga, J. F., Katairo, T., Legac, J., Crudale, R. M., Tumwebaze, P. K., Nsobya, S. L., et al., 2023, Evolution of Partial Resistance to Artemisinins in Malaria Parasites in Uganda, New England Journal of Medicine, 389(8), https://doi.org/10.1056/NEJMoa2211803
[9]. Rosenthal, P. J., Asua, V., Bailey, J. A., Conrad, M. D., Ishengoma, D. S., Kamya, M. R., Rasmussen, C., Tadesse, F. G., Uwimana, A., Fidock, D. A., 2024, The emergence of artemisinin partial resistance in Africa: how do we respond?, The Lancet Infectious Diseases, 24(9), https://doi.org/10.1016/S1473-3099(24)00141-5
[10]. Ajogbasile, F. V., Oluniyi, P. E., Kayode, A. T., Akano, K. O., Adegboyega, B. B., Philip, C., Ogbulafor, N., et al., 2022, Molecular profiling of the artemisinin resistance Kelch 13 gene in Plasmodium falciparum from Nigeria, PLOS ONE, 17(2), https://doi.org/10.1371/journal.pone.0264548
[11]. Matrevi, S. A., Tandoh, K. Z., Bruku, S., Opoku-Agyeman, P., Adams, T., Ennuson, N. A., Asare, B., Hagan, O. C. K., et al., 2022, Novel pfk13 polymorphisms in Plasmodium falciparum population in Ghana, Scientific Reports, 12(1), https://doi.org/10.1038/s41598-022-11790-9
[12]. Bergmann, C., Van Loon, W., Habarugira, F., Tacoli, C., Jäger, J. C., Savelsberg, D., Nshimiyimana, F., Rwamugema, E., Mbarushimana, D., et al., 2021, Increase in Kelch 13 Polymorphisms in Plasmodium falciparum, Southern Rwanda, Emerging Infectious Diseases, 27(1), https://doi.org/10.3201/eid2701.203527
[13]. Osoti, V., Wamae, K., Musau, M. M., Magudha, J. B., Ndwiga, L., Gichuki, P. M., Okoyo, C., Rosebella, K., et al., 2025, Serial cross-sectional school surveys identifies C469Y, P553L, R561H and A675V kelch 13 mutations associated with artemisinin resistance in Western Kenya, Scientific Reports, 15(1), https://doi.org/10.1038/s41598-025-22286-7
[14]. Ishengoma, D. S., Mandara, C. I., Bakari, C., Fola, A. A., Madebe, R. A., Seth, M. D., Francis, F., Buguzi, C. C., Moshi, R., et al., 2024, Evidence of artemisinin partial resistance in northwestern Tanzania: clinical and molecular markers of resistance, The Lancet Infectious Diseases, 24(11), https://doi.org/10.1016/S1473-3099(24)00362-1
[15]. Mihreteab, S., Anderson, K., Fuente, I. M. D. L., Sutherland, C. J., Smith, D., Cunningham, J., Beshir, K. B., Cheng, Q., 2025, The spread of molecular markers of artemisinin partial resistance and diagnostic evasion in Eritrea: a retrospective molecular epidemiology study, The Lancet Microbe, 6(2), https://doi.org/10.1016/S2666-5247(24)00172-1
[16]. Uwimana, A., Legrand, E., Stokes, B. H., Ndikumana, J. L. M., Warsame, M., Umulisa, N., Ngamije, D., et al., 2020, Emergence and clonal expansion of in vitro artemisinin-resistant Plasmodium falciparum kelch13 R561H mutant parasites in Rwanda, Nature Medicine, 26(10), https://doi.org/10.1038/s41591-020-1005-2
[17]. Xu, W., Zhang, X., Chen, H., Zhang, J., Lu, Q., Ruan, W., Wang, X., 2023, Molecular markers associated with drug resistance in Plasmodium falciparum parasites in central Africa between 2016 and 2021, Frontiers in Public Health, 11, https://doi.org/10.3389/fpubh.2023.1239274
[18]. Hanscheid, T., Mahomed, S. M., Rebelo, M., Henriques, S. O., Grobusch, M. P., 2024, Inaccurate communication in health sciences: The case of ‘partial artemisinin resistance’ for the treatment of malaria, New Microbes and New Infections, 62, https://doi.org/10.1016/j.nmni.2024.101544
[19]. Angwe, M. K., Mwebaza, N., Nsobya, S. L., Vudriko, P., Dralabu, S., Omali, D., Tumwebaze, M. A., Ocan, M., 2024, Day 3 parasitemia and Plasmodium falciparum Kelch 13 mutations among uncomplicated malaria patients treated with artemether-lumefantrine in Adjumani district, Uganda, PLOS ONE, 19(6), https://doi.org/10.1371/journal.pone.0305064
[20]. Balikagala, B., Fukuda, N., Ikeda, M., Katuro, O. T., Tachibana, S.-I., Yamauchi, M., Opio, W., Emoto, S., 2021, Evidence of Artemisinin-Resistant Malaria in Africa, New England Journal of Medicine, 385(13), https://doi.org/10.1056/NEJMoa2101746
[21]. Milong Melong, C. S., Peloewetse, E., Russo, G., Tamgue, O., Tchoumbougnang, F., Paganotti, G. M., 2024, An overview of artemisinin-resistant malaria and associated Pfk13 gene mutations in Central Africa, Parasitology Research, 123(7), https://doi.org/10.1007/s00436-024-08301-2
[22]. Bohissou, F. E. T., Nassa, G. J. W., Sondo, P., Rouamba, T., Inoue, J., Kaboré, B., Asua, V., Held, J., Tinto, H., 2025, Spatio-temporal trends of artemisinin-based combination therapy efficacy from 2010 to 2024 in sub-Saharan Africa: a systematic review and meta-analysis, BMC infectious diseases, 25(1), https://doi.org/10.1186/s12879-025-12130-8
[23]. Shibeshi, W., Alemkere, G., Mulu, A., Engidawork, E., 2021, Efficacy and safety of artemisinin-based combination therapies for the treatment of uncomplicated malaria in pediatrics: a systematic review and meta-analysis, BMC Infectious Diseases, 21(1), https://doi.org/10.1186/s12879-021-06018-6
[24]. Ebong, C., Sserwanga, A., Namuganga, J. F., Kapisi, J., Mpimbaza, A., Gonahasa, S., Asua, V., Gudoi, S., et al., 2021, Efficacy and safety of artemether-lumefantrine and dihydroartemisinin-piperaquine for the treatment of uncomplicated Plasmodium falciparum malaria and prevalence of molecular markers associated with artemisinin and partner drug resistance in Uganda, Malaria Journal, 20(1), https://doi.org/10.1186/s12936-021-04021-5
[25]. Issa, M. S., Warsame, M., Mahamat, M. H. T., Saleh, I. D. M., Boulotigam, K., Djimrassengar, H., Issa, A. H., et al., 2023, Therapeutic efficacy of artesunate-amodiaquine and artemether-lumefantrine for the treatment of uncomplicated falciparum malaria in Chad: clinical and genetic surveillance, Malaria Journal, 22(1), https://doi.org/10.1186/s12936-023-04644-w
[26]. Ngasala, B. E., Chiduo, M. G., Mmbando, B. P., Francis, F. T., Bushukatale, S., Makene, T., Mandara, C. I., et al., 2024, Efficacy and safety of artemether-lumefantrine for the treatment of uncomplicated falciparum malaria in mainland Tanzania, 2019, Malaria Journal, 23(1), https://doi.org/10.1186/s12936-024-04931-0
[27]. Ehrlich, H. Y., Bei, A. K., Weinberger, D. M., Warren, J. L., Parikh, S., 2021, Mapping partner drug resistance to guide antimalarial combination therapy policies in sub-Saharan Africa, Proceedings of the National Academy of Sciences, 118(29), https://doi.org/10.1073/pnas.2100685118
[28]. Tumwebaze, P. K., Conrad, M. D., Okitwi, M., Orena, S., Byaruhanga, O., Katairo, T., Legac, J., Garg, S., Giesbrecht, D., et al., 2022, Decreased susceptibility of Plasmodium falciparum to both dihydroartemisinin and lumefantrine in northern Uganda, Nature Communications, 13(1), https://doi.org/10.1038/s41467-022-33873-x
[29]. Bwire, G. M., Ngasala, B., Mikomangwa, W. P., Kilonzi, M., Kamuhabwa, A. A. R., 2020, Detection of mutations associated with artemisinin resistance at k13-propeller gene and a near complete return of chloroquine susceptible falciparum malaria in Southeast of Tanzania, Scientific Reports, 10(1), https://doi.org/10.1038/s41598-020-60549-7
[30]. Mlugu, E. M., Dondorp, A. M., Barnes, K. I., 2024, Resistant malaria parasites gaining momentum in Africa, The Lancet Infectious Diseases, 24(11), https://doi.org/10.1016/S1473-3099(24)00413-4
[31]. Proellochs, N. I., Andolina, C., Ramjith, J., Stoter, R., Van Gemert, G.-J., Graumans, W., Campino, S., Vanheer, L. N., Okitwi, M., Tumwebaze, P. K., Conrad, M. D., Clark, T. G., Fidock, D. A., Ménard, D., Mok, S., Bousema, T., 2025, Gametocyte production and transmission fitness of African and Asian Plasmodium falciparum isolates with differential susceptibility to artemisinins, Antimicrobial Agents and Chemotherapy, 69(6), https://doi.org/10.1128/aac.01930-24
[32]. Masserey, T., Lee, T., Golumbeanu, M., Shattock, A. J., Kelly, S. L., Hastings, I. M., Penny, M. A., 2022, The influence of biological, epidemiological, and treatment factors on the establishment and spread of drug-resistant Plasmodium falciparum, eLife, 11, https://doi.org/10.7554/eLife.77634
[33]. Abdul-Ghani, R., Mahdy, M. A. K., Beier, J. C., Basco, L. K., 2017, Hidden reservoir of resistant parasites: the missing link in the elimination of falciparum malaria, Infectious Diseases of Poverty, 6(1), https://doi.org/10.1186/s40249-016-0227-5
[34]. Liu, Y., Liang, X., Li, J., Chen, J., Huang, H., Zheng, Y., He, J., Ehapo, C. S., Eyi, U. M., Yang, P., Lin, L., et al., 2022, Molecular Surveillance of Artemisinin-Based Combination Therapies Resistance in Plasmodium falciparum Parasites from Bioko Island, Equatorial Guinea, Microbiology Spectrum, 10(3), https://doi.org/10.1128/spectrum.00413-22
[35]. Agboli, E., Bitew, M., Malaka, C. N., Kallon, T. M. P. S., Jalloh, A. M. S., Yankonde, B., Shempela, D. M., et al., 2025, Building Pathogen Genomic Sequencing Capacity in Africa: Centre for Epidemic Response and Innovation Fellowship, Tropical Medicine and Infectious Disease, 10(4), https://doi.org/10.3390/tropicalmed10040090
[36]. Kaburi, B. B., Harries, M., Hauri, A. M., Kenu, E., Wyss, K., Silenou, B. C., Klett-Tammen, C. J., Ressing, C., Awolin, J., Lange, B., Krause, G., 2024, Availability of published evidence on coverage, cost components, and funding support for digitalisation of infectious disease surveillance in Africa, 2003–2022: a systematic review, BMC Public Health, 24(1), https://doi.org/10.1186/s12889-024-19205-2
[37]. Tindana, P., Sekwo, D. E., Baatiema, L., Djimde, A., the Pathogen Genomics Diversity Network, Africa (PDNA), 2024, Researchers’ perspectives on the integration of molecular and genomic data into malaria elimination programmes in Africa: a qualitative study, Malaria Journal, 23(1), https://doi.org/10.1186/s12936-024-05205-5
[38]. Alemayehu, A. A., Castañeda Mogollón, D., Belay, S. G., Tesfa, H., Mohon, A. N., Balasingam, N., Bayih, A. G., Ashraf, S., Pillai, D. R., 2025, Expansion of the Plasmodium falciparum Kelch13 R622I Mutation in Northwest Ethiopia, Open Forum Infectious Diseases, 12(6), https://doi.org/10.1093/ofid/ofaf279
[39]. Ochola, R., 2025, The Case for Genomic Surveillance in Africa, Tropical Medicine and Infectious Disease, 10(5), https://doi.org/10.3390/tropicalmed10050129
Viewed PDF 389 7 -
Exploration of Mothers and Caregivers’ Perspectives on Vaccination Dropout among Children Aged 12-23 Months in The Gambia: Using Thematic Analytical ApproachAuthor: Baboucarr BoyeDOI: 10.21522/TIJAR.2014.13.02.Art029
Exploration of Mothers and Caregivers’ Perspectives on Vaccination Dropout among Children Aged 12-23 Months in The Gambia: Using Thematic Analytical Approach
Abstract:
In recent years, full childhood routine immunisation coverage has fallen by 5% to levels not seen since 2008; between 2019 and 2021, 67 million children were under-vaccinated. We aimed to identify and describe the determinants of vaccination drop-out from the perspectives of mothers and caregivers. In The Gambia, vaccination coverage has improved from 76% in 2015 to 85% in 2020-21. However, this coverage is still behind the target set by the Global Vaccine Action Plan (GVAP) of 90% and 80% coverages for all antigens at the national and district levels respectively by 2020. These disparities highlight systemic barriers and the need to identify determinants of dropout to guide targeted interventions. The study was conducted in Upper River Region (rural) and West Coast Health Region 2 (semi-urban), selected for their historically high dropout rates (6.1% and 7.5% respectively). We conducted focus group discussions with community stakeholders, including mothers’ clubs and traditional communicators, to gain deeper insights into social and structural influences on vaccination dropout. Findings of the study revealed that caregivers generally possessed adequate awareness of the purpose and benefits of childhood vaccination and widely associated vaccination with disease prevention, child survival and development. Health workers emerged as the most credible and influential source of vaccination information, seconded by community-based actors such as village health workers and local leaders. Interventions should therefore be tailored to address drivers of dropout in communities. Service quality, timeliness and reliability need to be improved, and tailored messaging and awareness creation are needed.
Exploration of Mothers and Caregivers’ Perspectives on Vaccination Dropout among Children Aged 12-23 Months in The Gambia: Using Thematic Analytical Approach
References:
[1]. World Health Organization (WHO). Vaccines and Immunization. WHO Geneva Switz 2021. https://www.who.int/health-topics/vaccines-and-immunization#tab=tab_1. Accessed 24 Jan 2021.
[2]. Young, B., Sarwar, G., Hossain, I., Mackenzie, G., 2021, Risk-factors Associated with Non-Vaccination in Gambian Children: A Population-Based Cohort Study. MedRxiv. Article Google Scholar.
[3]. Animaw, W., Taye, W., Merdekios, B., Tilahun, M., Ayele, G., 2014, Expanded program of immunization coverage and associated factors among children age 12 – 23 months in Arba Minch town and Zuria District, Southern Ethiopia, 2013. BMC Public Health. https://doi.org/10.1186/1471-2458-14-464.
[4]. UNICEF, The state of the world’s children 2023, for every child, vaccination. Available: https://www.unicef.org/reports/stateworlds-children.
[5]. Centers for Disease Control and Prevention, Global immunization. 2023, Available: https://www.cdc.gov/globalhealth/immunization/data/fast-facts.html.
[6]. Expanded Programme on Immunization, 2025, The Gambia EPI Comprehensive Multi Year Plan 2016-2020. Government of The Gambia.
[7]. Gambia Bureau of Statistics (GBoS) and ICF, 2021. The Gambia Demographic and Health Survey 2019-20. Banjul, The Gambia and Rockville, Maryland, USA: GBoS and ICF.
[8]. Powelson, J., Magadzire, B. P., Draiva, A., et. Al., 2022, Determinants of immunisation dropout among children under the age of 2 in Zambézia province, Mozambique: a community-based participatory research study using Photovoice. BMJ Open, 12: e057245.
[9]. Favin, M., Steinglass, R., Fields, R., et al., 2012, Why children are not vaccinated: a review of the grey literature. Int Health, 4:229–38.
[10]. Rainey, J. J., Watkins, M., Ryman, T. K., et al, 2011, Reasons related to non-vaccination and under-vaccination of children in low and middle income countries: findings from a systematic review of the published literature, 1999-2009. Vaccine 2011; 29:8215–21.
[11]. Cobos Muñoz, D., Monzón Llamas, L., Bosch-Capblanch, X., 2015, Exposing concerns about vaccination in low- and middle-income countries: a systematic review. Int J Public Health, 60:767–80.
[12]. Kaufman, J., Tuckerman, J., Bonner, C., et al, 2021, Parent-level barriers to uptake of childhood vaccination: a global overview of systematic reviews. BMJ Glob Health, 6:e006860.
[13]. Merten, S., Martin Hilber, A., Biaggi, C., et al, 2015, Gender determinants of vaccination status in children: evidence from a meta-ethnographic systematic review.
[14]. Shearer, J. C., Nava, O., Prosser, W., et al, 2023, Uncovering the Drivers of childhood immunization inequality with caregivers, community members and health system stakeholders: results from a humancentered design study in DRC, Mozambique and Nigeria. Vaccines (Basel), 11:689.
[15]. Hailu, C., Fisseha, G., Gebreyesus, A., 2022, Determinants of measles vaccination dropout among 12 - 23 months aged children in pastoralist community of Afar, Ethiopia. BMC Infect Dis, 22:376.
[16]. Adeyanju, G. C., Betsch, C., Adamu, A. A., et al., 2022, Examining enablers of vaccine hesitancy toward routine childhood and adolescent vaccination in Malawi. Glob Health Res Policy7:28. 21
[17]. Mmanga, K., Mwenyenkulu, T., Nkoka, O., et al., 2021, Tracking immunization coverage, dropout and equity gaps among children aged 12–23 months in Malawi. Bottleneck Analysis of the Malawi Demographic and Health Survey.
[18]. Sowe, A., Namatovu, F., Cham, B., Gustafsson, P. E., 2023, Missed opportunities for vaccination at point of care and their impact on coverage and urban–rural coverage inequity in the Gambia. Vaccine, 41(52):7647–54.
[19]. World Health Organization (WHO), 2023, Guidance for immunization programme managers. Geneva.
[20]. Health Education and Training (HEAT), 2019, Immunization Module: Monitoring your Immunization Programme n.d. http://www.open.edu/openlearncreate/mod/oucontent/view. php? id = 53371 & secti on=1. 4.2.
[21]. Haji, A., Lowther, S., Ngan’Ga, Z., Gura, Z., Tabu, C., Sandhu, H., Arvelo, W., 2014, Reducing routine vaccination dropout rates: Evaluating two interventions in three Kenyan districts. BMC Public Health 2016, 16, 152. [CrossRef] [PubMed].
Viewed PDF 231 7 -
Vaccine Acceptance, Hesitancy, and Uptake Determinants in the African Mpox Response: A Systematic Review and Meta-AnalysisAuthor: Charles Ugochukwu IbenemeDOI: 10.21522/TIJAR.2014.13.02.Art030
Vaccine Acceptance, Hesitancy, and Uptake Determinants in the African Mpox Response: A Systematic Review and Meta-Analysis
Abstract:
The 2024 Public Health Emergency of International Concern (PHEIC) declaration for mpox exposed a critical demand-side gap in Africa’s vaccination response. Despite the Africa CDC and WHO-led Access and Allocation Mechanism (AAM) delivering over 1.9 million doses to African nations, uptake in several high-burden settings remained well below target coverage levels. A systematic review and meta-analysis following PRISMA 2020 guidelines pooled data from 18 studies (120-source evidence base, 2016–2026) using the DerSimonian–Laird random-effects model with Freeman–Tukey double arcsine transformation. Databases searched included PubMed/MEDLINE, Embase, Scopus, and grey literature from WHO, Africa CDC, and UNICEF. Subgroup analyses were conducted by subregion and outbreak phase; meta-regression examined determinants including trust in health authorities, prior vaccination history, education level, and misinformation exposure. Study findings showed pooled vaccine acceptance across 14 studies was 0.58 (95% CI: 0.52–0.64; I² = 89%). Pooled hesitancy was 0.32 (95% CI: 0.27–0.38; I² = 89%). East Africa had the highest subregional acceptance (64%; 95% CI: 57–71%) and Central Africa the lowest (49%; 95% CI: 41–57%). Trust in health authorities (OR 2.1), prior vaccination history (OR 1.8), higher education (OR 1.5), and misinformation exposure (OR 0.6) were the strongest determinants. Peak outbreak phase was associated with higher uptake (67%; 95% CI: 59–74%) versus early phase (49%; 95% CI: 42–56%). Conclusion: Vaccine acceptance in Africa averages below 60%, with one-third of populations expressing hesitancy. Demand generation must operate alongside supply-side scale-up through trust-based communication, community engagement, and targeted misinformation responses.
Vaccine Acceptance, Hesitancy, and Uptake Determinants in the African Mpox Response: A Systematic Review and Meta-Analysis
References:
[1]. WHO. 2024, WHO Director-General declares mpox outbreak a public health emergency of international concern. WHO Press Release, 14 August 2024. https://www.who.int/
[2]. Ndembi, N., et al. 2025, Evolving Epidemiology of Mpox in Africa in 2024. New England Journal of Medicine, 392(3), 210–220.
[3]. Thompson, I., et al. 2024, Concurrent outbreaks of mpox in Africa—an update. The Lancet, 404(10448), 109–112.
[4]. WHO. 2024, Vaccine doses allocated to 9 African countries hardest hit by mpox surge. WHO Press Release. https://www.who.int/
[5]. WHO. 2025, The multi-partner Access and Allocation Mechanism allocates 238,000 doses of mpox vaccine to four countries. WHO. https://www.who.int/
[6]. Africa CDC. 2025, Mpox vaccination dashboard and country-level administration data. Africa CDC. https://africacdc.org/
[7]. Nkamba, D. M., et al. 2024, Mpox vaccine acceptance in the Democratic Republic of Congo. Emerging Infectious Diseases, 30(7), 1322–1331.
[8]. eClinicalMedicine, 2024, Mpox vaccination hesitancy and associated factors in six African countries. eClinical Medicine (Lancet Group), 72, 102622.
[9]. Heliyon, 2023, COVID-19 vaccine acceptance in sub-Saharan Africa: systematic review and meta-analysis. Heliyon, 9(4), e15273.
[10]. Vaccine, 2025, Acceptance, hesitancy, and ethical challenges of COVID-19 vaccination in sub-Saharan Africa: systematic review. Vaccine, 43(2), 126120.
[11]. Sithole, T., et al. 2022, Regulatory authority evaluation of the effectiveness and efficiency of the ZaZiBoNa collaborative medicines registration initiative. Journal of Pharmaceutical Policy and Practice, 15, 12.
[12]. BMC Public Health, 2020, Barriers to childhood immunization in sub-Saharan Africa: a systematic review. BMC Public Health, 20(1), 1161.
[13]. Scientific Reports, 2024, Vaccine hesitancy and trust in sub-Saharan Africa. Scientific Reports, 14, Article 11432.
[14]. Damschroder, L. J., et al. 2009, Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation Science, 4(1), 50.
[15]. WHO, 2020, Immunization Agenda 2030: A global strategy to leave no one behind. WHO. https://www.who.int/
[16]. MDPI Vaccines, 2023, Attitudes towards receiving mpox vaccination: a systematic review and meta-analysis. Vaccines, 11(6), 1048.
[17]. medRxiv, 2025, Mpox vaccine acceptance and uptake in Africa: a systematic review and meta-analysis. medRxiv preprint. https://www.medrxiv.org/
[18]. BMJ Global Health, 2024, The 2024–2025 upsurge of mpox in Africa: another opportunity missed or a turning point? BMJ Global Health, 9(8), e016123.
[19]. BMJ Global Health, 2025, Public preferences and decision-making for mpox vaccination in the African region: a discrete choice experiment. BMJ Global Health, 10(2), e016802.
[20]. UNICEF, 2024, DRC starts mpox vaccination in high-priority provinces. UNICEF Press Release. https://www.unicef.org/
[21]. Wawina-Bokalanga, T., et al. 2024, Epidemiology and phylogenomic characterization of distinct 2023 and 2024 mpox outbreaks in Kinshasa, DRC. medRxiv preprint.
[22]. BMC Public Health, 2025, MPOX outbreak in Africa: the urgent need for local manufacturing and equitable vaccine access. BMC Public Health, 25(1), 412.
[23]. Vaccine, 2024, Vaccine spillover effects in Africa: COVID-19 vaccination and confidence in other vaccines. Vaccine, 42(18), 3201–3210.
[24]. Frontiers in Cellular and Infection Microbiology, 2025, The evolving mpox threat (2022–2024): clade dynamics, immune evasion, and global readiness. Frontiers in Cellular and Infection Microbiology, 15, 1540321.
[25]. BMC Public Health, 2021, Factors influencing childhood immunisation uptake in Africa: a systematic review. BMC Public Health, 21(1), 1232.
[26]. Beer, E., & Rao, V. B., 2019, A systematic review of the epidemiology of human monkeypox outbreaks and implications for outbreak response. PLOS Neglected Tropical Diseases, 13(10), e0007791.
[27]. Yinka-Ogunleye, A., et al. 2019, Outbreak of human monkeypox in Nigeria in 2017–18: a clinical and epidemiological report. The Lancet Infectious Diseases, 19(8), 872–879.
[28]. WHO, 2025, Accessing mpox vaccines through the Access and Allocation Mechanism (AAM). WHO Briefing Note. https://www.who.int/
[29]. PLOS Global Public Health, 2025, Perceptions and predictors of COVID-19 vaccine hesitancy in Africa. PLOS Global Public Health, 5(1), e0004122.
[30]. Emanuel, E. J., et al. 2020, An ethical framework for global vaccine allocation. Science, 369(6509), 1309–1312.
Viewed PDF 279 13 -
Leveraging Artificial Intelligence (AI) to Improve Trade and Commerce Efficiency in GuyanaAuthor: Visham BudhooDOI: 10.21522/TIJAR.2014.13.02.Art031
Leveraging Artificial Intelligence (AI) to Improve Trade and Commerce Efficiency in Guyana
Abstract:
The "Digital Guyana" initiative centers on AskGov, an AI platform providing 24/7 consultancy to bridge the gap between remote entrepreneurs and central regulation. By simplifying complex filings like the Local Content Act via mobile devices, the government ensures small businesses can navigate legal frameworks previously accessible only to large firms. Once integrated, these businesses leverage predictive logistics to align production with global demand. Agencies like the GRDB and GuySuCo use AI-equipped drones and modeling to monitor crop health, reducing chemical waste by 15% and stabilizing supply chains against seasonal constraints. This precision is mirrored in the oil and gas sector. Digital Twins on vessels like the Liza Unity optimize maintenance through real-time virtual modeling, while AI-powered underwater vehicles provide high-resolution seabed mapping for low-impact resource extraction. Industrial efficiency further drives SME growth via modernized financial services. Institutions like Republic Bank now use AI credit scoring to analyze non-traditional data, unlocking capital for businesses without formal credit histories. This allows manufacturers like DDL to adopt dynamic pricing tools for international competition. Further, to ensure ethical growth, the EPA utilizes real-time AI monitoring to track offshore production and waste. By automating Local Content Act compliance, the government ensures expansion translates into fair employment for the Guyanese workforce. Finally, advancements are secured within Silica City, where 3D AI models of power grids and drainage systems predict koker/sluice failures, ensuring infrastructure remains resilient against climate change.
Leveraging Artificial Intelligence (AI) to Improve Trade and Commerce Efficiency in Guyana
References:
[1]. Aize, 2023, Aize signs agreement with ExxonMobil Guyana and SBM Offshore to deploy digital twin software offshore Guyana. Retrieved from https://www.mynewsdesk.com/aize-as/pressreleases/aize-signs-agreement-with-exxonmobil-guyana-and-sbm-offshore-to-deploy-digital-twin-software-offshore-guyana-3300052
[2]. Avakov, Varma, 2024, Leveraging AI-Driven Business Analytics for Enhanced Decision Making in Small and Medium-Sized Enterprises. ResearchGate. Retrieved from https://www.researchgate.net/publication/385096570_Leveraging_AI-Driven_Business_Analytics_for_Enhanced_Decision_Making_in_Small_and_Medium-Sized_Enterprises
[3]. Abayomi, F.; Thomas, K., 2024, Utilizing AI to predict market trends and optimize supply chain strategies. ResearchGate. Retrieved from https://www.researchgate.net/publication/387321334
[4]. Bishop, M., 2021, Artificial intelligence in financial regulation: The SEC's use of machine learning for compliance monitoring. Journal of Financial Regulation, 32(4), 112-126.
[5]. Guyana Office for Investment (GO-Invest), 2021, Local Content Act and its impact on Guyana's economic development. Retrieved from https://www.goinvest.gov.gy
[6]. Ghosh, S., 2021, Walmart's AI-powered supply chain: The future of retail logistics. Harvard Business Review. Retrieved from https://hbr.org
[7]. GeekyAnts, 2023, How artificial intelligence is transforming dynamic pricing in F&B and hospitality. Retrieved from https://geekyants.com/blog/how-artificial-intelligence-is-transforming-dynamic-pricing-in-fb-and-hospitality
[8]. Hootsuite, 2024, Using AI for social media trend analysis and customer engagement: A case study in SMEs. Retrieved from https://www.hootsuite.com
[9]. International Journal of Scientific Research & Applications (IJSRA), 2024, The role of AI in market trend analysis and forecasting. Retrieved from https://ijsra.net/sites/default/files/IJSRA-2024-1291.pdf
[10]. IBM, 2022, AI for environmental risk monitoring and sustainable business practices. IBM Journal of Technology, 39(2), 145-158.
[11]. Johnson, L., 2022, AI-powered demand forecasting: How Amazon optimizes supply chains. Logistics & Supply Chain Management Journal, 34(2), 45-60.
[12]. Jones, P., 2020, Enhancing public sector audits with AI: The UK’s National Audit Office experience. Public Administration Review, 50(2), 87-101.
[13]. Jia, X., Sun, Y., Hou, J., & Li, B., 2022, AI-driven predictive maintenance for sustainable industrial systems: A comprehensive review. Journal of Cleaner Production, 345, 130987. Retrieved from https://doi.org/10.1016/j.jclepro.2022.130987
[14]. Kaieteur News, 2023, Guyana now equipped with technology to monitor every drop of oil—EPA. Kaieteur News Online. Retrieved from https://www.kaieteurnewsonline.com/2023/02/22/guyana-now-equipped-with-technology-to-monitor-every-drop-of-oil-epa
[15]. Kumar, P., Singh, R. K., Gupta, S., & Kumar, R., 2021, Artificial intelligence applications in environmental monitoring and sustainability: A review. Environmental Science and Pollution Research, 28(32), 43866-43884. Retrieved from https://doi.org/10.1007/s11356-021-14655-6
[16]. Kanerika, 2023, Generative AI for marketing: Revolutionizing customer engagement with AI-driven analytics. Retrieved from https://kanerika.com/blogs/generative-ai-for-marketing
[17]. Loom, 2024, Enhancing customer engagement with AI-driven chatbots: Loom’s approach to personalized communication. Retrieved from https://www.loom.com
[18]. LeewayHertz, (n.d.)., AI in demand forecasting: Benefits, use cases, and future scope. Retrieved from https://www.leewayhertz.com/ai-in-demand-forecasting/
[19]. Maxar, 2023, Maxar to provide environmental monitoring for the government of Guyana. Maxar Technologies. Retrieved from https://www.maxar.com/press-releases/maxar-to-provide-environmental-monitoring-for-government-of-guyana
[20]. Numalis, 2023, AI in the oil and gas industry. Numalis. Retrieved from https://numalis.com/ai-in-the-oil-and-gas-industry
[21]. Ocean Infinity, 2023, Ocean Infinity to support ExxonMobil in Guyana. Ocean Infinity. Retrieved from https://oceaninfinity.com/ocean-infinity-to-support-exxonmobil-in-guyana
[22]. OmniLens, 2024, AI-powered market analysis for retail SMEs: Optimizing sales, pricing, and inventory. Retrieved from https://www.omnilens.com
[23]. Patel, R., 2020, AI in Indian agriculture: Enhancing productivity and supply chains. International Journal of Agricultural Science and Technology, 15(3), 112-125.
[24]. Regona, M., Yigitcanlar, T., Hon, C., and Teo, M., 2024, Artificial intelligence and sustainable development goals: Systematic literature review of the construction industry. Sustainable cities and society. ScienceDirect. Retrieved from https://www.sciencedirect.com/science/article/pii/S2210670724003251
[25]. Siemens, 2023, Leveraging AI for energy-efficient operations: Predictive maintenance at Siemens. Retrieved from https://www.siemens.com
[26]. Smith, J., 2022, AI-driven demand forecasting in fuel distribution: A case study of Shell. Energy & Logistics Journal, 28(2), 45-60.
[27]. Smith, J., 2023, The impact of artificial intelligence on modern retail operations. International Journal of Business & Technology, 29(4), 112-130.
[28]. Santos, P., 2022, Leveraging AI in governance: Enhancing transparency in compliance and audits in developing countries. Journal of Technology and Policy, 15(3), 45-58.
[29]. Tesla, 2023, AI-driven sustainability: Reducing waste and improving resource efficiency in manufacturing. Retrieved from https://www.tesla.com
[30]. GRDB (Guyana Rice Development Board)., 2025, Implementing Multispectral Drone Technology for Rice Yield Optimization. https://grdb.gy/
[31]. GuySuCo, 2025, Modernizing the Sugar Industry: AI and Mechanization at Albion Estate.
[32]. Ministry of Housing and Water, 2026, Silica City: A Blueprint for AI-Integrated Smart Urbanism in Guyana.
[33]. Ministry of Natural Resources, 2025, The National Mineral Mapping Project: Leveraging AI for Geological Exploration. https://dpi.gov.gy
[34]. Office of the President of Guyana, 2026, AskGov: Democratizing Public Policy Access through Generative AI.
[35]. Guyana Association of Bankers, 2025, FinTech and AI: Expanding SME Credit Access in Emerging Markets. https://gabigy.org/
Viewed PDF 293 4 -
Therapeutic Potential of Berberine in Lung Cancer: A Systematic Review and Meta- Analysis of Preclinical StudiesAuthor: Prabhavathy Devi Narayanan DossDOI: 10.21522/TIJAR.2014.13.02.Art032
Therapeutic Potential of Berberine in Lung Cancer: A Systematic Review and Meta- Analysis of Preclinical Studies
Abstract:
Berberine, a natural isoquinoline alkaloid, has demonstrated anticancer properties in various malignancies. This systematic review and meta-analysis evaluated the efficacy of berberine specifically in lung cancer preclinical models. We conducted a comprehensive literature search across PubMed, Web of Science, and Scopus. From 427 initially identified publications, three high-quality preclinical studies met inclusion criteria, providing data on 172 experimental animals for tumor volume analysis and 134 animals for tumor weight assessment. Berberine significantly inhibited tumor volume (SMD -1.5140, 95% CI: -2.0164 to - 1.0116; p<0.0001) and tumor weight (SMD -2.0546, 95% CI: -2.5484 to -1.5607; p<0.0001) in experimental lung cancer models. Considerable heterogeneity was observed across studies (I²=92.1% for tumor volume, I²=87.6% for tumor weight). Mechanistically, berberine exhibited p53-dependent antitumor activity, demonstrated oral bioavailability through dietary administration, and functioned as a small-molecule immune checkpoint inhibitor by reducing PD-L1 expression on tumor cells.Berberine demonstrates significant antitumor activity in lung cancer models through multiple complementary mechanisms. Despite the robust preclinical evidence, the limited number of included studies necessitates further investigation through standardized protocols and carefully designed clinical trials to evaluate berberine's potential as an adjunctive or alternative therapy for lung cancer.
Therapeutic Potential of Berberine in Lung Cancer: A Systematic Review and Meta- Analysis of Preclinical Studies
References:
[1]. Deo, S. V. S., Sharma, J., & Kumar, S., 2022, GLOBOCAN 2020 report on global cancer burden: challenges and opportunities for surgical oncologists. Annals of Surgical Oncology, 29(11), 6497–6500.
[2]. Dian, W., Zhang, W., Yang, L., Li, J., Fu, S., & Ghorbanzadeh, S., 2024, Linc00265 in human disease: A comprehensive analysis of its implications in human disease pathobiology and therapeutic prospect. Pathology – Research and Practice, 155409.
[3]. Leiter, A., Veluswamy, R. R., & Wisnivesky, J. P., 2023, The global burden of lung cancer: current status and future trends. Nature Reviews Clinical Oncology, 20(9), 624–639.
[4]. Travis, W. D., Eisele, M., Nishimura, K. K., Aly, R. G., Bertoglio, P., Chou, T. Y., et al., 2024, The International Association for the Study of Lung Cancer (IASLC) staging project for lung cancer: recommendation to introduce spread through air spaces as a histologic descriptor in the ninth edition of the TNM classification of lung cancer. Analysis of 4061 pathologic stage I NSCLC. Journal of Thoracic Oncology, 19(7), 1028–1051.
[5]. Huang, J., Deng, Y., Tin, M. S., Lok, V., Ngai, C. H., Zhang, L., et al., 2022, Distribution, risk factors, and temporal trends for lung cancer incidence and mortality: a global analysis. Chest, 161(4), 1101–1111.
[6]. Howlader, N., Chen, H. S., Noone, A.-M., Miller, D., Byrne, J., Negoita, S., et al., 2025, Impact of COVID-19 on 2021 cancer incidence rates and potential rebound from 2020 decline. JNCI: Journal of the National Cancer Institute, 117(3), 507–510.
[7]. Achi, I. T., Sarbadhikary, P., George, B. P., & Abrahamse, H., 2022, Multi-target potential of berberine as an antineoplastic and antimetastatic agent: a special focus on lung cancer treatment. Cells, 11(21), 3433.
[8]. Xu, X., He, Y., & Liu, J., 2024, Berberine: A multifaceted agent for lung cancer treatment from molecular insight to clinical applications. Gene, 149021.
[9]. Almatroodi, S. A., Alsahli, M. A., & Rahmani, A. H., 2022, Berberine: an important emphasis on its anticancer effects through modulation of various cell signaling pathways. Molecules, 27(18), 5889.
[10]. Xiong, R. G., Huang, S. Y., Wu, S. X., Zhou, D. D., Yang, Z. J., Saimaiti, A., et al., 2022, Anticancer effects and mechanisms of berberine from medicinal herbs: an update review. Molecules, 27(14), 4523.
[11]. Li, J., Liu, F., Jiang, S., Liu, J., Chen, X., Zhang, S. and Zhao, H., 2018, Berberine hydrochloride inhibits cell proliferation and promotes apoptosis of non-small cell lung cancer via the suppression of the MMP2 and Bcl-2/Bax signaling pathways. Oncology Letters, 15(5), 7409–7414.
[12]. Ni, L., Li, Z., Ren, H., Kong, L., Chen, X., Xiong, M., Zhang, X., Ning, B. and Li, J., 2022, Berberine inhibits non‐small cell lung cancer cell growth through repressing DNA repair and replication rather than through apoptosis. Clinical and Experimental Pharmacology and Physiology, 49(1), 134–144.
[13]. Chen, Q. Q., Shi, J. M., Ding, Z., Xia, Q., Zheng, T. S., Ren, Y. B., Li, M. and Fan, L. H., 2019, Berberine induces apoptosis in non-small-cell lung cancer cells by upregulating miR-19a targeting tissue factor. Cancer Management and Research, 11, 9005–9015. https://doi.org/10.2147/CMAR.S207677.
[14]. Andersen, M. S., Kofoed, M. S., Paludan-Müller, A. S., Pedersen, C. B., Mathiesen, T., Mawrin, C., et al., 2024, CRIME-Q-A unifying tool for critical appraisal of methodological (technical) quality, quality of reporting and risk of bias in animal research. BMC Medical Research Methodology, 24(1), 306.
[15]. Schwarzer, G., 2022, Meta-analysis in R. Systematic Reviews in Health Research: Meta-analysis in Context, 510–534.
[16]. Katiyar, S. K., Meeran, S. M., Katiyar, N., & Akhtar, S., 2009, p53 cooperates berberine-induced growth inhibition and apoptosis of non-small cell human lung cancer cells in vitro and tumor xenograft growth in vivo. Molecular Carcinogenesis, 48(1), 24–37.
[17]. James, M. A., Fu, H., Liu, Y., Chen, D. R., & You, M., 2011, Dietary administration of berberine or Phellodendron amurense extract inhibits cell cycle progression and lung tumorigenesis. Molecular Carcinogenesis, 50(1), 1–7.
[18]. Liu, Y., Liu, X., Zhang, N., Yin, M., Dong, J., Zeng, Q., et al., 2020, Berberine diminishes cancer cell PD-L1 expression and facilitates antitumor immunity via inhibiting the deubiquitination activity of CSN5. Acta Pharmaceutica Sinica B, 10(12), 2299–2312.
[19]. Xu, J., Long, Y., Ni, L., Yuan, X., Yu, N., Wu, R., et al., 2019, Anticancer effect of berberine based on experimental animal models of various cancers: A systematic review and meta-analysis. BMC Cancer, 19, 1–20.
[20]. Xu, X., He, Y., & Liu, J., 2025, Berberine: A multifaceted agent for lung cancer treatment-from molecular insight to clinical applications. Gene, 934, 149021.
Viewed PDF 363 4 -
Determinants of Vaccination Dropout among Children in the Gambia: A Mixed-Method Comparison of Urban and Rural Health RegionsAuthor: Baboucarr BoyeDOI: 10.21522/TIJAR.2014.13.02.Art033
Determinants of Vaccination Dropout among Children in the Gambia: A Mixed-Method Comparison of Urban and Rural Health Regions
Abstract:
The dropout rate is the proportion of vaccine recipients who have not completed their vaccination schedules. In The Gambia, vaccination dropout persists despite rising immunization coverage from 76% in 2013 to 85% in 2020. The 2020 DHS reports high initial uptake of multi-dose vaccines (98–99%), but final-dose completion drops to 92–95%. These disparities highlight systemic barriers and the need to identify determinants of dropout to guide targeted interventions. This study employed a mixed-methods approach, combining a quantitative unmatched case–control design with a qualitative component. In the quantitative phase, mothers of children who completed the routine immunization schedule (controls) compared with mothers of children who experienced vaccination dropout (cases). The qualitative component included in-depth interviews with mothers from both groups to explore contextual factors, perceptions, and lived experiences related to vaccination completion. The findings indicated that maternal education was consistently associated with vaccination dropout. Children from households in the poorest wealth quintile were more likely to drop out of routine immunization compared with those in the highest wealth quintile. Maternal age was also significantly associated with vaccination dropout. Geographic access played an important role: shorter distance to health facilities was associated with lower dropout rates, while limited access to nearby health services contributed to higher vaccination dropout. Identifying the factors associated with dropout is essential for designing targeted interventions. Strengthening community-based outreach, improving service accessibility, and promoting maternal health service use may help reduce dropout and enhance immunization outcomes.
Determinants of Vaccination Dropout among Children in the Gambia: A Mixed-Method Comparison of Urban and Rural Health Regions
References:
[1]. World Health Organization (WHO), 2021, Vaccines and Immunization. WHO Geneva Switz 2021. https://www.who.int/health-topics/vaccines-and-immunization#tab=tab_1.
[2]. Young, B., Sarwar, G., Hossain, I., Mackenzie, G., 2021, Risk-factors Associated with Non-Vaccination in Gambian Children: A Population-Based Cohort Study. MedRxiv. 2021;2021(03):19.21253855. https://doi.org/10.1101/2021.03.19.21253855.
[3]. Animaw, W., Taye, W., Merdekios, B., Tilahun, M., Ayele, G., 2013, Expanded program of immunization coverage and associated factors among children age 12 – 23 months in Arba Minch town and Zuria District, Southern Ethiopia. BMC Public Health. https://doi.org/10.1186/1471-2458-14-464.
[4]. Ali, H. A., Hartner, A. M., Echeverria-Londono, S., Roth, J., Li, X., Abbas, K., Portnoy, A., Vynnycky, E., Woodruff, K., Ferguson, N. M., et al, 2022, Vaccine equity in low- and middle-income countries: A systematic review and meta-analysis. Int. J. Equity Health..
[5]. Wallace, A. S., Ryman, T. K., Privor-Dumm, L., Morgan, C., Fields, R., Garcia, C., Sodha, S., Lindstrand, A., Lochlainn, L. N., 2022, Leaving no one behind: Defining and implementing an integrated life course approach to vaccination across the next decade as part of the immunization Agenda 2030. in press.
[6]. Santé, WHO= O mondiale de la., EXPANDED PROGRAMME ON IMMUNIZATION. Vol. 35, 2000, Weekly Epidemiological Record = Relevé épidémiologique hebdomadaire. World Health Organization = Organization mondiale de la Santé.
[7]. The Gambia Health Service Statistics, 2023, The Ministry of Health.
[8]. Chanie, M. G., Ewunetie, G. E., Molla, A., Muche, A., 2019, Determinants of vaccination dropout among children 12–23 months age in north Gondar zone, northwest Ethiopia. PLoS ONE 2021, 16, e0246018.
[9]. Ntenda, P. A., Sixpence, A., Mwenyenkulu, T. E., Mwanga, K., Chirambo, A. C., Bauleni, A., Nkoka, O., 2022, Determinants of pentavalent and measles vaccination dropouts among children aged 12–23 months in The Gambia. BMC Public Health.
[10]. Awasthi, A., Pandey, C. M., Singh, U., Kumar, S., Singh, T. B., 2015, Maternal determinants of immunization status of children aged 12–23 months in urban slums of Varanasi, India. Clin. Epidemiol. Glob. Health, 3, 110–116.
[11]. Datta, A., Mog, C., Das, S., Datta, S., 2017, A cross-sectional study to assess the immunization coverage and vaccine dropout rates among 12 to 23 months old children in a rural area of Tripura. Int. J., 6, 394.
[12]. Haji, A., Lowther, S., Ngan’Ga, Z., Gura, Z., Tabu, C., Sandhu, H., Arvelo, W., 2014, Reducing routine vaccination dropout rates: Evaluating two interventions in three Kenyan districts. BMC Public Health 2016, 16, 152.
[13]. Chanie, M. G., Ewunetie, G. E., Molla, A., Muche, A., 2021, Determinants of vaccination dropout among children 12–23 months age in north Gondar zone, northwest Ethiopia. PLoS ONE 2021, 16, e0246018.
[14]. Mane, A. B., 2015, Letter to Editor: Immunization Dropout Rates: Some Issues. Ann. Med. Health Sci. Res.
[15]. Baguune, B., Ndago, J. A., Adokiya, M. N., 2017, Immunization dropout rate and data quality among children 12–23 months of age in Ghana. Arch. Public Health 75, 18.
[16]. Thapa, K., Adhikary, P., Faruquee, M. H., Suwal, B. R., 2021, Associated Factors for Dropout of First Vs Third Doses of Diphtheria Tetanus Pertussis (DPT) Vaccination in Nepal. Adv Prev Med.
[17]. Haji, A., Lowther, S., Ngan’Ga, Z., Gura, Z., Tabu, C., Sandhu, H., et al., 2016, Reducing routine vaccination dropout rates: evaluating two interventions in three Kenyan districts, 2014. BMC Public Health.
[18]. Baguune, B., Ndago, J. A., Adokiya, M. N., 2023, Immunization dropout rate and data quality among children 12-23 months of age in Ghana. Arch Public Heal. 2017. https://doi.org/10.1186/s13690-017-0186-8.
[19]. World Health Organization (WHO), 202. Guidance for immunization programme managers. Geneva.
[20]. Health Education and Training (HEAT), 2019, Immunization Module: Monitoring your Immunization Programme n.d. http://www.open.edu/openlearncreate/mod/oucontent/view.php?id=53371§ion=1.4.2.
[21]. Sowe, A., Namatovu, F., Cham, B., Gustafsson, P. E., 2023, Starting then stopping: a nationwide register-based study on the magnitude, predictors, and urban-rural patterns of under-vaccination variation across health centers in The Gambia. Cite this article https://doi.org/10.1080/16549716.2024.2348788.
[22]. Sowe, A., Namatovu, F., Cham, B., Gustafsson, P. E., 2023, Missed opportunities for vaccination at point of care and their and urban–rural coverage impact on coverage inequity in the Gambia.
Viewed PDF 256 3 -
Navigating the Allocation–Administration–Uptake Continuum: Health System Determinants of Mpox Vaccine Utilization Gaps in AfricaAuthor: Charles Ugochukwu IbenemeDOI: 10.21522/TIJAR.2014.13.02.Art034
Navigating the Allocation–Administration–Uptake Continuum: Health System Determinants of Mpox Vaccine Utilization Gaps in Africa
Abstract:
Despite over 1.9 million mpox vaccine doses being formally allocated to African countries by 2025, Africa CDC data indicate utilization rates of approximately 63% for MVA-BN and 25% for LC16m8 vaccines, representing a substantial allocation-to-administration gap. This paper examines structural, regulatory, health-system, and socio-behavioural determinants of vaccination continuum gaps in Africa’s mpox response. A systematic review and mixed-methods synthesis of 120 studies (2016–2026) was conducted following PRISMA 2020 guidelines. A random-effects meta-analysis (DerSimonian–Laird) pooled utilization rates across nine eligible studies. Determinants were synthesised narratively using the WHO Health Systems Framework and Consolidated Framework for Implementation Research (CFIR). Cross-country disparities were analysed by setting type and regulatory readiness tier. The pooled vaccine utilization rate was 0.76 (95% CI: 0.71–0.81; I² = 81%), indicating a mean utilization gap of approximately 24%. Utilization ranged from 82–90% in stable urban settings to 55–70% in conflict-affected contexts. Regulatory readiness strongly moderated outcomes: countries with high readiness achieved pooled uptake of 66% compared to 46% in low-readiness settings. An integrated cascade model emerged: structural constraints drive the allocation gap; governance and health-system readiness determine the administration gap; and socio-behavioural factors shape the uptake gap. Three country readiness tiers were identified with distinct gap profiles. Closing Africa’s mpox vaccination gap requires simultaneous interventions across all continuum stages. Evidence-based recommendations include risk-based allocation algorithms, regulatory harmonisation through AVAREF and AMA, cold-chain investment, workforce surge capacity, and community trust-building. Governance and system readiness are the critical mediators of vaccination performance.
Navigating the Allocation–Administration–Uptake Continuum: Health System Determinants of Mpox Vaccine Utilization Gaps in Africa
References:
[1]. Africa CDC, 2025, Mpox vaccination dashboard and country-level administration data. Africa CDC. https://africacdc.org/
[2]. The Lancet Microbe, 2023, Africa’s post-pandemic vaccination landscape: coverage transitions and system constraints. The Lancet Microbe, 4(11), e847–e855.
[3]. Henao-Restrepo, A. M., et al., 2016, Efficacy and effectiveness of an rVSV-vectored vaccine in preventing Ebola virus disease: final results from the Guinea ring vaccination cluster-randomised trial. The Lancet, 389(10068), 505–518.
[4]. Mwaba, J., et al., 2018, Implementation research: reactive mass vaccination with single-dose oral cholera vaccine during an outbreak in Lusaka, Zambia. Bulletin of the World Health Organization, 96(12), 1–8.
[5]. Vaccines, 2023, COVID-19 vaccination in the WHO African Region: progress and factors associated with coverage. Vaccines (MDPI), 11(5), 1010.
[6]. WHO, 2010, Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies. World Health Organization.
[7]. Damschroder, L. J., et al., 2009, Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation Science, 4(1), 50.
[8]. Rawls, J., 1971, A Theory of Justice. Harvard University Press.
[9]. WHO, 2025, Accessing mpox vaccines through the Access and Allocation Mechanism (AAM). WHO Briefing Note. https://www.who.int/
[10]. Frontiers in Cellular and Infection Microbiology, 2025, The evolving mpox threat (2022–2024): clade dynamics, immune evasion, and global readiness. Frontiers in Cellular and Infection Microbiology, 15, 1540321.
[11]. Africa CDC, 2024, Two-dose strategy and targeted interventions drive mpox vaccination campaign. Africa CDC News. https://africacdc.org/
[12]. Gavi, 2025, Phase 5 (2021–2025) strategy: leaving no one behind with immunisation. Gavi. https://www.gavi.org/
[13]. Ndembi, N., et al., 2025, Evolving Epidemiology of Mpox in Africa in 2024. New England Journal of Medicine, 392(3), 210–220.
[14]. Globalization and Health, 2022, COVAX, vaccine donations, and the politics of global vaccine inequity. Globalization and Health, 18(1), 52.
[15]. Akanmori, B. D., et al., 2025, AVAREF: a gamechanger for vaccine and medicine regulatory harmonization in Africa and beyond. Pan African Medical Journal, 48, 12.
[16]. Ndwandwe, D., et al., 2023, Regional regulatory harmonisation initiatives: potential for access to medicines in Africa. Journal of Pharmaceutical Policy and Practice, 16(1), 55.
[17]. African Union, 2019, Treaty for the Establishment of the African Medicines Agency. African Union. https://www.au.int/
[18]. MSF, 2024, Why measles remains a mass killer in DR Congo: logistical and access challenges. MSF Reports. https://www.msf.org/
[19]. Vaccines, 2025, Allocation of oral cholera vaccines in Africa, 2013–2019. Vaccines (MDPI), 13(1), 77.
[20]. WHO, 2024, WHO and partners establish an access and allocation mechanism for mpox vaccines, treatments, tests. WHO. https://www.who.int/
[21]. WHO, 2024, Vaccine doses allocated to 9 African countries hardest hit by mpox surge. WHO Press Release. https://www.who.int/
[22]. WHO, 2025, The multi-partner Access and Allocation Mechanism allocates 238,000 doses to four countries. WHO. https://www.who.int/
[23]. UNICEF, 2024, DRC starts mpox vaccination in high-priority provinces. UNICEF Press Release. https://www.unicef.org/
[24]. WHO AFRO, 2024, First-ever delivery of mpox vaccines in Africa outside trials arrives in Nigeria. WHO AFRO. https://www.afro.who.int/
[25]. BMC Public Health, 2025, MPOX outbreak in Africa: the urgent need for local manufacturing and equitable vaccine access. BMC Public Health, 25(1), 412.
[26]. Nkamba, D. M., et al. 2024, Mpox vaccine acceptance in the Democratic Republic of Congo. Emerging Infectious Diseases, 30(7), 1322–1331.
[27]. Katz, R., et al. 2018, Strengthening global health security: IHR, JEE and beyond. The Lancet, 391(10128), 1229–1232.
[28]. BMC Public Health, 2020, Barriers to childhood immunization in sub-Saharan Africa: a systematic review. BMC Public Health, 20(1), 1161.
[29]. Daugla, D. M., et al., 2017, Impact of MenAfriVac in nine countries of the African meningitis belt, 2004–2014. The Lancet Infectious Diseases, 17(8), 867–872.
[30]. Thompson, I., et al., 2024, Concurrent outbreaks of mpox in Africa—an update. The Lancet, 404(10448), 109–112.
Viewed PDF 304 9
