Lagos University Teaching Hospital (LUTH) is a tertiary hospital established in 1961 and is located in Idi-Araba, Surulere, Lagos State, the administrative division of Nigeria. The teaching hospital affiliated with the University of Lagos College of Medicine established in 1962. The University of Lagos College of Medicine educates students and LUTH provides them with experience through placement and work experience.
Background Low- and middle-income countries (LMICs), particularly Sub-Saharan Africa, experience a high burden of surgical disease and a disproportionately high postoperative morbidity and mortality. Although machine learning based pediatric surgical risk calculators (SRCs) have been developed to support clinical decision making, most are derived from high-income settings and may not generalize well to LMIC populations. We previously developed a pediatric surgical risk calculator using multinational LMIC data; however, its performance in independent African cohorts remains unknown. Methods We conducted an external validation study of a previously developed pediatric surgical risk calculator using prospective data from children undergoing surgery at four tertiary referral hospitals in Ethiopia and Nigeria between July 2024 and February 2025. Model performance was assessed by evaluating discrimination (area under the receiver operating characteristic curve) and calibration (slope and intercept). Predicted risk was stratified into low, intermediate, and high-risk categories to enhance clinical applicability. Model recalibration was performed to optimize performance in the external cohort. Results A total of 1670 pediatric surgical patients were included from the four hospitals. In-hospital mortality was 6.8%. Mortality varied significantly by site, age, weight, sex, prematurity, preoperative sepsis, transfusion, supplemental oxygen use, antibiotic use, ASA class, type of surgery (emergent vs elective), need of ICU postoperatively and reoperation. The risk prediction model had good discrimination overall with an area under the curve (AUC) of 0.84, outperforming ASA classification alone (AUC = 0.77). Discrimination remained high for general pediatric surgery cases (AUC = 0.83) and was highest for emergency cases (AUC = 0.89), but was low in neonates (AUC = 0.64). The model demonstrated systematic miscalibration, which improved following logistic calibration. Patients were stratified into meaningful risk categories, which reliably distinguishes between low-and-hgih risk patients (LR = 0.1 and LR = 5.4 respectively). However, 66.5% fall in the intermediate risk group which is not useful in decision making (LR = 1.0). Conclusion The pediatric surgical risk calculator demonstrated good performance in the African context, with improved clinical utility following recalibration and risk stratification. Reduced performance in neonates suggests the need to incorporate additional risk factors and potentially separate models for this subgroup. Future efforts should focus on supporting the use of the SRC in risk communication, clinical decision making, and resource prioritization.
BACKGROUND:Type III female genital mutilation (FGM) is corrected by the scar tissue removal of the vaginal opening, known as deinfibulation. OBJECTIVES:To determine the current evidence on whether deinfibulation leads to improved obstetric, neonatal, gynecologic, and sexual health outcomes. SEARCH STRATEGY:The following databases were searched from inception to May 18, 2023: CINAHL Plus (EBSCOhost), MEDLINE (Ovid), PsycINFO (EBSCOhost), SCOPUS, and Web of Science. SELECTION CRITERIA:Two review authors independently screened the titles and abstracts, extracted data, and performed the risk of bias assessment. DATA COLLECTION AND ANALYSIS:Meta-analysis was conducted with RevMan, and the quality of evidence was assessed using the GRADE approach. MAIN RESULTS:Eight studies with serious risk of bias involving 3166 women were included. Very low-certainty evidence indicates that deinfibulation for women with type III FGM reduced the odds of an emergency cesarean birth (odds ratio [OR] 0.16, 95% confidence interval [CI] 0.06-0.42) and genital tract lacerations (OR 0.48, 95% CI 0.29-0.79) when compared to women with type III FGM without deinfibulation. Reduced odds of an emergency cesarean birth apply when compared to women without FGM (OR 0.59, 95% CI 0.37-0.93). Antepartum deinfibulation, compared to intrapartum deinfibulation, may lead to a reduction in the duration of labor, with little or no difference in the risk of prolonged labor (low-certainty evidence). Antepartum deinfibulation may increase the likelihood of postpartum hemorrhage and cesarean births in pregnant women with type III FGM (low-certainty evidence). We found no studies for inclusion on gynecologic, urologic, and sexual health outcomes for this update. CONCLUSIONS:The evidence of deinfibulation for women with type III FGM is available only for obstetrics outcomes. Larger observational studies in settings where type III FGM is predominantly practiced are required to improve the certainty of the evidence in these findings.
Background:Automated brain tumor segmentation on multi-parametric magnetic resonance imaging (mpMRI) is crucial in assessing patient outcomes and remains a challenge across Sub-Saharan Africa (SSA). Since 2012, the Brain Tumor Segmentation (BraTS) Challenge has evaluated state-of-the-art artificial intelligence (AI) methods to detect, characterize, and classify tumors. However, it is unclear if these methods can generalize, and hence be widely implemented, in SSA populations. To address this, the BraTS-Africa challenge was conducted in 2023 and 2024 to evaluate population-specific AI models for automated segmentation of brain tumors on mpMRI from the region. Methods:Preoperative T1-weighted, T1-contrast enhanced, T2-weighted, and T2-FLAIR brain MRI scans of 115 patients diagnosed with adult diffuse glioma were curated, annotated, and utilized for the Challenge. Participants were invited to develop and validate their methods. The participating teams were evaluated using weighted Dice Score Coefficient (DSC) and 95% Hausdorff Distance (HD95). Results:In the 2023 challenge a total of 9 teams with participants from 12 countries met the submission criteria and were ranked. The 2024 challenge featured 6 teams from 7 countries. Compared to 2023, the six top ranked methods from 2024 had higher DSC (9.4%) and lower HD95 (57.21%). Conclusions:Together, the 2023 and 2024 challenges provided a unique opportunity to include brain mpMRI glioma cases from SSA in global efforts to develop and evaluate AI methods for the detection of glioma boundaries and their quantification, where the potential of AI solutions to transform healthcare into resource-limited settings is more likely.
Diabetic foot ulcers (DFUs) are a main factor leading to morbidity, hospitalizations, amputations, disability, and death of people with diabetes. However, the epidemiology and outcomes of DFUs in Nigeria are not well documented. This study (systematic review and meta-analysis) aimed to evaluate the prevalence, amputation rates, and clinical outcomes of DFU patients across various regions in Nigeria. The search was comprehensively conducted through electronic databases: African Journal Online (AJOL), PubMed, SCOPUS, and Google Scholar, for studies published in English between 2005 and July 15, 2024. Eligible studies reporting on the prevalence and outcomes of DFUs in Nigerian populations were included. Some of the search terms used are (“diabetes” OR “diabetic”) AND (“foot” OR “lower extremity” OR “limb” or “leg”) AND (“amputation” OR “amputations” OR “infection” OR “gangrene” OR “necrosis” OR “ulcer” OR “ulcers” OR “wound” OR “wounds”). Two investigators independently assessed the methodological quality using the Newcastle–Ottawa Scale, and key data were extracted using Microsoft Excel. Meta-regression and meta-analysis were performed using Stata version 16, employing a random effects model to estimate pooled prevalence and outcomes. Heterogeneity among studies was assessed using the I² statistic. Eighteen full studies were included, encompassing 2,616 patients with DFU across the studies. The mean age was 56.43 years, with average diabetes duration of 10.62 years and ulcer duration of 46.65 days. The pooled prevalence of DFUs was 16.69
Abstract Background: Pediatric osteosarcoma remains a major cause of cancer-related morbidity and mortality among children and adolescents in sub-Saharan Africa, where late presentation, limited diagnostic resources, and restricted access to multimodal therapy significantly affect outcomes. There is a lack of region-specific data describing the epidemiology, clinical characteristics, and treatment patterns of this disease in low-resource settings. Methods: We conducted a retrospective descriptive study of pediatric patients (≤21 years) diagnosed with osteosarcoma at a sub-Saharan African cancer centre between September 2019 and May 2025. Data were extracted from medical records and institutional databases. The Cox proportional hazards model and Kaplan-Meier survival analysis were used to predict survival. Results: 45 pediatric patients were identified. The median age at diagnosis was 15 years (range: 5-21), with a male predominance (55.6%). The majority of patients presented with advanced (66.7% ≥ stage III) or metastatic disease (51%), most commonly involving the lungs (82.6%). The long bones of the lower extremity (62.2%), particularly the distal femur (28.9%) and proximal tibia (22.2%), were the most frequently affected primary sites. Delayed presentation was common, with prolonged symptom duration prior to diagnosis (average 290 days). Surgery was performed in 31.1% (n=14). Chemotherapy formed the backbone of management, with 34 (75.6%) patients receiving systemic therapy in neoadjuvant (21, 46.7%), adjuvant (12, 26.7%), or concurrent chemotherapy (11, 24.4%) settings. Radiotherapy (RT) was administered to 27 patients (60%), functioning mostly as a curative modality in 71.1% (20/27), mainly with 3DCRT in 55.6% and IMRT in 44.4%. RT treatment completion was achieved in 26 patients (96.3%). The 1-year survival rate was 58.2%. The mean and median overall survival (OS) were 52.8 months (95% CI: 33.6-72.0) and 16.6 months (95% CI: 11.8-21.4), respectively. Survival did not differ significantly by age, sex, laterality, stage, or treatment type. Conclusion: Pediatric osteosarcoma in this cohort was characterized by prolonged diagnostic intervals, advanced-stage disease, and high metastatic burden at presentation, reflecting persistent systemic gaps in timely cancer diagnosis and access to comprehensive sarcoma care. High radiotherapy completion rates and the delivery of multimodal treatment in a proportion of patients, however, demonstrate the feasibility of structured oncologic care within resource-limited settings. These findings re-emphasize the impact of system-level constraints and the need for strengthened early diagnosis and referral pathways, diagnostic capacity, and access to multidisciplinary treatment in order to improve survival for pediatric osteosarcoma across sub-Saharan Africa. Citation Format: Adedayo Joseph, Adeseye M. Akinsete, Adewunmi Alabi, Ayodeji O. Ojetunde, Asepeoreoluwa Adeyemi. Pediatric osteosarcoma in a resource-limited setting: Data from a sub-Saharan African centre in Nigeria [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Bridging Discovery and Clinical Impact in Pediatric Cancer; 2026 Sep 22-25; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2026;86(18_Suppl_1):Abstract nr B028.
