University of Nigeria Teaching Hospital

Hematopoietic stem cell transplantation (HSCT) is a critical treatment for non-Hodgkin lymphoma (NHL) but involves significant post-transplant risks. Frailty, measured by the Modified Frailty Index-11 (mFI-11), may influence outcomes. We analyzed NHL patients undergoing autologous or allogeneic HSCT from the Nationwide Inpatient Sample (2016–2020). Frailty was defined by mFI-11, and outcomes included in-hospital mortality, unfavorable discharge, prolonged length of stay (LOS), complications, and costs. Multivariable regression models with stratification by age and Charlson Comorbidity Index were applied. Of 2807 patients (ages 18–85), frail patients were older and had more comorbidities. In autologous HSCT, frailty was linked to higher mortality (2.02

Abstract Background Robotic-assisted spine surgery (RASS) represents a transformative advancement in spinal neurosurgery, offering superior precision, reduced complications, and improved clinical outcomes compared to conventional freehand or fluoroscopy-guided techniques. However, its implementation in Sub-Saharan Africa (SSA) faces significant challenges, including prohibitive costs, infrastructure limitations, and inconsistent maintenance capabilities. This meta-analysis aimed to evaluate the cost–benefit ratio of RASS versus conventional techniques in SSA, analyze clinical outcome differences relevant to regional needs, and propose feasible implementation models tailored to resource-constrained settings. Methods A systematic review and meta-analysis were conducted following PRISMA guidelines, incorporating nine key studies identified through a comprehensive search of PubMed, Embase, Cochrane Library, Scopus, and African Journals Online. The analysis focused on randomized controlled trials, prospective cohort studies, and high-quality retrospective comparisons. Outcomes included screw accuracy, complication rates, cost data, operative times, and hospital stays. Statistical analysis was performed using RevMan 5.4 and R software, with pooled odds ratios and weighted mean differences calculated for clinical and economic outcomes. Results RASS demonstrated significant advantages, including higher screw accuracy (94–98% vs. 85–91%), reduced neurological complications (1.9% vs. 4.3%), and lower revision rates (3.1% vs. 5.2%). However, upfront costs were 5–15 times higher ($500,000–$1.5 M per system), with per-case disposables costing 4–8 times more ($800–$1,200 vs. $100–$300). Operational challenges included longer setup times and infrastructure dependencies. Despite clinical benefits, the economic burden and logistical barriers render widespread RASS adoption impractical in most SSA settings without external funding or innovative financing models. Conclusion While RASS offers compelling clinical improvements for spinal surgery in SSA, its high costs and infrastructure demands currently limit feasibility. Wider adoption will depend on practical measures such as strategic partnerships, phased implementation, and strengthening of local technical and surgical capacity.

The shortage of well-trained personnel to deliver cancer care and conduct research remains a major obstacle to reducing disparities in cancer survival between high-income countries and low-income and middle-income countries (LMICs). This Commission set out to provide actionable guidance for strengthening the global cancer workforce with an emphasis on reducing these disparities. To better understand the extent of the rising global cancer burden and the resulting workforce needs, we modelled the current and future global landscape of 17 common cancers and 18 workforce personnel types. Among the modelled cancers, diagnosed incidence rates are projected to increase globally, especially in LMICs, driven by growing and ageing populations and changing risk factors. Crucially, we estimate that one in three cancers go undiagnosed worldwide, with more than 60% of cancers remaining undiagnosed in parts of Africa. We find that, among the diagnosed cancers in LMICs, late-stage presentation and a lack of essential treatments and qualified health professionals contribute to poor survival. According to our modelling, in 2050, 5-year net survival is projected to remain lowest in Africa (34%) and Asia (39%), while reaching beyond 60% in high-income settings. The global cancer workforce shortage is projected to reach about 100 million in 2050, with the largest shortages being for nurses (65 million) and diagnostic (radiology and pathology) specialists (16 million), especially in Africa and Asia. Comprehensive workforce scale-up of all personnel types is projected to avert 170 million cancer deaths and yield net economic benefits of US$120 trillion between 2030 and 2050, translating to a global return on investment of $4 per $1 invested. Focusing primarily on examples from sub-Saharan Africa and Latin America, we examine key obstacles to workforce development and retention in LMICs and propose pragmatic actions to address the workforce crisis. These actions include establishment of workforce and cancer registries; the creation of cross-sector and international partnerships to improve access to education and research training programmes as well as diagnostics, therapeutics, and equipment; and implementation of task-shifting, digital health, and artificial intelligence solutions, which could improve workforce productivity, further strengthening the case for investing in the cancer workforce. TRANSLATIONS: For the Spanish, Portuguese, French, Chinese (Mandarin), Arabic and Russian translations of the abstract see Supplementary Materials section.

BACKGROUND:Despite decades of control interventions in sub-Saharan Africa, morbidity associated with Onchocerca volvulus infection still exerts a substantial burden of disease, arising from cutaneous, ocular and neurological manifestations. METHODS:We developed and integrated a morbidity sub-model into our previously published individual-based, stochastic transmission model, EPIONCHO-IBM, including both reversible (severe itch, reactive skin disease (RSD)), and irreversible (skin atrophy, depigmentation, hanging groin) cutaneous sequelae, and eye disease (blindness, visual impairment). We modelled the relationship between onchocerciasis skin disease (OSD) and infection prevalence using pre-intervention data from northern Nigeria, and between onchocerciasis ocular disease (OOD) and infection intensity using data from the Onchocerciasis Control Programme in West Africa. We simulated the impact of ivermectin mass drug administration (MDA) upon OSD and OOD using data from Cameroon, Central African Republic, Nigeria, Sudan and Uganda. RESULTS:Modelled age-specific OSD and OOD prevalence at baseline align well with reported prevalence estimates across the simulated range of endemicity levels but underestimate irreversible OSD in older age groups. Under MDA, we capture trends in infection prevalence, severe itch and irreversible OSD but underestimate reductions in RSD and blindness prevalence. CONCLUSIONS:Integrating morbidity outcomes into transmission dynamics modelling will help improve estimates of onchocerciasis disease burden and inform the effectiveness and cost-effectiveness of current and alternative interventions.

OBJECTIVE:To explore Nigerian women's lived experiences of menopause and identify sociocultural, structural, and health-system factors shaping symptom recognition, care-seeking, and wellbeing, using in-depth qualitative inquiry. DESIGN:Qualitative interview study. SETTING:Urban, peri-urban, and rural communities across Nigeria. PARTICIPANTS:Post-menopausal women aged 40-66 years experiencing natural, surgical, or medical menopause. METHODS:As part of the Nigerian arm of the MARIE project, semi-structured qualitative interviews were conducted with purposively sampled post-menopausal women to capture diverse menopausal stages, socioeconomic positions, and geographic contexts. Interviews were analysed using thematic analysis informed by an equity-centred, intersectional framework. Multiple researchers independently coded transcripts, with iterative discussion and triangulation to enhance analytic rigour and validity. RESULTS:Three interrelated themes characterised menopausal experiences in Nigeria. First, structural health-system inequalities were evident, including limited anticipatory information, inadequate clinician training, fragmented care pathways, and restricted access to hormone replacement therapy and non-hormonal treatments. Second, sociocultural and gendered norms shaped symptom interpretation and disclosure, with menopause often framed as a natural or inevitable life stage requiring endurance rather than care, compounded by stigma and silencing within families and communities. Third, women demonstrated adaptive coping and resilience, relying on peer networks, faith-based practices, and self-management strategies in the absence of formal support. Urban participants reported comparatively better access to information and services, while rural women described pronounced neglect and dependence on informal care. CONCLUSIONS:This qualitative study provides the first in-depth, context-specific account of menopausal experiences among Nigerian women, revealing substantial inequities driven by sociocultural beliefs, economic constraints, and systemic gaps in healthcare provision. The findings underline the urgent need for culturally sensitive, equity-oriented menopause care in Nigeria, including integration into primary healthcare, improved professional training, affordable access to evidence-based treatments, and public health education to reduce stigma and unmet need.