Background In the context of urban slum settings in Africa, there is limited knowledge about how food preparers make decisions as to the types of meals they serve in their households. Understanding what goes into food preparers' daily choices and the complexity of providing nutritious food in resource-scarce environments are crucial to addressing the challenges of food insecurity and malnutrition.Objective This study explored perspectives on what food is prepared in households, the factors influencing meal choices and how decisions are made about what to serve and when.Methods This qualitative study was conducted among persons living in two urban slums in Ibadan, Nigeria, who were most responsible for food preparation in their households. Trained research assistants conducted 30 in-depth semi-structured interviews in the local languages. Data collected were transcribed verbatim, then translated into English. The data were coded with NVivo software (Version 12) and analysed using thematic analysis.Results Of the 30 food preparers interviewed, 28 were women. Data analysis identified three major themes: what is eaten and how it is prepared; gendered decision-making and normative beliefs; and adapting food preparation to an environment of food scarcity. The food preferences described by all participants were similar, with most expressing a desire to make calorie-dense meals. Traditional "swallows", carbohydrate-rich dough-like dishes made from starchy roots, tubers or grains, were regarded as central to most meals, although it was highlighted that children often wanted processed foods, such as white rice and noodles. Decision-making over what to prepare was gendered, with men's preferences being favoured in addition to those of children. Food preparation was time-consuming and complicated by a lack of refrigeration and limited storage.Conclusion This study offers valuable insights into the resourcefulness and resilience of slum-dwelling women in planning and preparing diverse meals in the context of living in resource-limited environments and balancing traditional family hierarchies. The findings will contribute to the development of contextually relevant interventions to improve access to nutritious foods, enhance food security, and ultimately contribute to the nutritional well-being of urban slum dwellers.

Introduction Globally, stroke is a leading cause of mortality with higher incidence in low- and middle-income countries. However, stroke beliefs and knowledge among community partners are essential considerations for tailoring of interventions in West Africa.Purpose To describe differences in beliefs, attitudes, and practices related to stroke risks, prevention, and care delivery from alternative/complementary providers/healers, orthodox/modern medicine/health care providers, community members and leaders in Nigeria.Methods Six focus groups with community members and leaders (n = 57) and key informant interviews with health providers (n = 24) from alternative/complementary and orthodox/modern medicine providers were conducted to qualitatively explore beliefs, attitudes, practices, and recommendations related to stroke in urban (Ibadan) and rural (Ibarapa) communities in Nigeria. The Socio-Ecological Model guided selection of participants, and the Health Belief Model guided the development of questions for participants.Results Participants perceived stroke as disabling, though manageable, and having higher odds of repeat stroke for survivors. High blood pressure, stress, sleep issues, heredity, and lifestyle factors were some stroke risk factors perceived by participants from both sites although God, witchcraft/evil people were reported by rural participants. Hospital visits and consumption of herbal concoction, self-medication and visit to church for prayers were some actions taken to manage stroke by both urban and rural participants. Low literacy levels, limited funds, fear of and distance to hospitals, and absence of insurance were some barriers to uptake of recommendations from orthodox medicine practitioners which are drivers to unorthodox practitioners. To improve stroke care and prevention across communities, free risk factor screening, indigenous stroke awareness programs via print, audio-visual and electronic media were suggested by all participants.Conclusion Diverse beliefs and practices are related to stroke risk factors, prevention and care and barriers with obtaining care. There is need to work across systems to improve stroke prevention and care in communities.

The clinical profile of the disease in southern Nigeria is less reported. This study aims to describe the clinical characteristics and intra-hospital outcomes of PPCM in Ibadan, south-west Nigeria. We reviewed 69 cases of PPCM seen in Nigerian Women at the University College Hospital Ibadan between 2006 and 2021. The mean age at presentation was 30.5 ± 6.7 years (age range 18 – 46 years). The mean BMI was 23.5 kg/M2. Most were from the low socio-economic group (47/68.1

Introduction: The African Rigorous Innovative Stroke Epidemiological Surveillance (ARISES) study is focused on developing an integrated mHealth community-based interactive Stroke Information and Surveillance System. This is the first paper to qualitatively investigate and contrast community beliefs, attitudes, and practices related to stroke prevention, risk factors and care from alternative/complementary medicine providers/healers, orthodox/modern medicine/health care providers, community members and leaders in Nigeria. Methods: Six focus groups with community members and leaders (n=57) and key informant interviews with health providers (n=24) from alternative/complementary medicine providers and orthodox/modern medicine providers were conducted to qualitatively explore beliefs, attitudes, practices, and recommendations related to stroke in urban (Ibadan) and rural (Ibarapa) communities in Nigeria. The Health Belief Model and Social Ecological Model guided the questions and thematic analysis of the qualitative data. Results: Participants perceived stroke as disabling though manageable but with odds of repeat stroke for survivors. High blood pressure, stress, sleep issues, heredity, and lifestyle factors were some stroke risk factors perceived by participants from both sites although God, witchcraft/evil people were reported by rural participants. Hospital visits and consumption of herbal concoction, self-medication and visit to church for prayers were some actions taken to manage stroke by both urban and rural participants. Low literacy levels, limited funds, fear of and distance to hospitals, and absence of insurance were some barriers to uptake of recommendations from orthodox medicine practitioners which are drivers to unorthodox practitioners. To improve stroke care and prevention across communities, free risk factor screening, indigenous stroke awareness programs via print, audio-visual and electronic media were suggested by all participants. Conclusion: Diverse beliefs and practices are related to stroke risk factors, prevention and care and barriers with obtaining care. There is need to work across systems to improve stroke prevention and care in communities.

The Tertiary Institutions Social Health Insurance Program (TISHIP) was created by the National Health Insurance Authority (NHIA) to enhance health insurance coverage among students in tertiary institutions in Nigeria. Despite being in existence for many years, a significant number of eligible students remain uncovered by the program. It is unclear whether the intended users are sufficiently aware of the program’s existence and benefits. Therefore, this study assessed the level of knowledge about the TISHIP program and related factors among students enrolled in selected tertiary institutions in Southwest Nigeria. Using a descriptive cross-sectional study design, 430 students were surveyed using a multi-stage random sampling technique from the University of Ibadan, Ibadan, Nigeria and the Federal College of Agriculture, Ibadan. Data were collected using a structured self-administered questionnaire of twenty-one questions using both a 4-point Likert scale questions and other questions not on a Likert scale to comprehensively assess the students’ knowledge and perceptions. Responses to the Likert scale were reversed, so that “Strongly disagree” had a score of “1”, and “Strongly agree” was assigned a score of “4”. Overall, six questions were used to determine the knowledge of TISHIP, and the highest score was therefore “24”. Persons with scores corresponding to the mean value and above (≥12 points) were categorized to have “Good knowledge of TISHIP”, while those with lower score (<12) were said to have “Poor knowledge of TISHIP”. One question “What is your view about TISHIP” was used to determine respondent’s perception of TISHIP. Responses were arranged as follows: “Good”, “Poor”, and “Not sure”. “Good” and “Not sure” were merged as “Poor”. Chi-square tests were conducted to determine the association between knowledge and utilization of TISHIP with sociodemographic characteristics of the respondents. The level of significance was set at p < 0.05. The mean age of the respondents was 21.2 ± 2.9 years. More than half of the respondents (52.1%) were males, and 76.0% were university students. Overall, 46.0% of the students had good knowledge of TISHIP, and 173 (73.0%) had a good perception of the program. Being male (Chi-square = 0.043, p = 0.836) was associated with having a good knowledge of TISHIP. University students were approximately 3 times more likely to have good knowledge of TISHIP compared to college students (AOR = 2.616, 95%CI = 1.209 – 5.658, p = 0.015). Postgraduate students were three times more likely to have a good perception of TISHIP (AOR = 3.257, 95%CI = 0.622 – 17.051, p = 0.162) than undergraduate students. Knowledge of TISHIP was low while perception of the program was promising among students in tertiary institutions. Increased efforts to effectively communicate existence and benefits of TISHIP will be critical to the success of the program.

Background Hypertension is a leading cause of cardiovascular morbidity globally, particularly in Africa. Despite clinic attendance and treatment, many hypertensive patients experience suboptimal blood pressure (BP) control. In Nigeria, hypertension is associated with high rates of multi-organ complications. Understanding the profiles of patients with uncontrolled hypertension is crucial for optimizing management strategies. Objective To describe the socio-demographic and clinical profile of hypertensive outpatients with uncontrolled blood pressure despite regular follow-up and instituted treatment. Methods A consecutive sampling of 78 registered hypertensive patients was conducted. Inclusion criteria were: Diagnosed with hypertension ≥6 months prior to recruitment Clinic BP ≥140/90 mmHg on at least two consecutive visits Participants were recruited as part of an ongoing interventional study. Data were collected using a semi-structured questionnaire that incorporated the Hillbone Compliance to High Blood Pressure Scale. Sociodemographic and clinical variables were analyzed. Results Gender distribution: 66.7% female (n = 52), 33.3% male (n = 26) Mean age: 54.3 ± 11.48 years Education: 62.3% had post-secondary education, 6.5% had no formal education Marital status: 80% married Income: Most earned above the Nigerian minimum wage Mean initial BP: 143.92/89.21 mmHg (SBP range: 93–185, DBP range: 61.5–136) Obesity: 40.3% of respondents Lifestyle: Low prevalence of alcohol and tobacco use Medication adherence: 71.4% adherent A significant positive correlation was observed between poorer medication adherence and higher diastolic blood pressure (R = 2.57, p = 0.024). Conclusion Even patients with good medication adherence may exhibit suboptimal BP control. Physicians should recognize the patterns of uncontrolled hypertension regardless of favorable sociodemographic or clinical profiles and implement appropriate interventions to optimize management.

The improper disposal of unused and expired medications (UEMs) poses significant public health and environmental risks. Healthcare practitioners are pivotal in promoting safe disposal practices, yet their behaviours and educational roles remain underexplored. This study assessed UEM disposal practices among healthcare practitioners in Ibadan, Nigeria, and their engagement in patient education on safe disposal methods. A cross-sectional survey using validated questionnaire was conducted from September 2023 to February 2024 among 255 healthcare practitioners (65 physicians, 64 hospital pharmacists, and 126 community pharmacists) in Ibadan, Nigeria. Data were analyzed using IBM SPSS version 26.0, with associations tested via Pearson’s Chi-square (p < 0.05). Most practitioners reported possessing UEMs at home (81.5

Introduction: Reduction in salt intake improves blood pressure control and reduces the risk of hypertension and other noncommunicable diseases (NCDs). However, salt intake remains high among Nigerians. This study aimed to identify barriers and facilitators to salt reduction among hypertensive patients attending a family medicine clinic in southern Nigeria. Methodology: A focussed group discussion (FGD) exploring patients’ perceptions of the barriers and facilitators to salt reduction was conducted with 8 groups of purposefully selected 74 hypertensives who consumed excess dietary salt, stratified by age and sex, using an FGD guide. Thematic analysis was then performed using Nvivo ® version 12 pro. Ethical approval was obtained from Irrua Specialist Teaching Hospital (ISTH), and written informed consent was obtained from the patients before the FGD. Results: Respondents had a mean age of 51.96 ± 8.98 years. The majority were females (47, 63.5%) and had uncontrolled blood pressure (66, 89.2%). Five major themes were identified, from which several minor themes emerged. Respondents rated their overall health as good but expressed concerns about their poor blood pressure control. Identified barriers to salt reduction included family pressure, ignorance, ready availability and affordability of salt and lack of affordable alternatives. Facilitators of salt reduction were measuring the amount of cooking salt, removing salt from the dining table and providing substitutes. Respondents, however, expressed willingness to reduce their salt consumption. Conclusion: The study identified barriers and facilitators to salt reduction. There is a need to create awareness of the safe amount of salt to be consumed and provide safe and readily available alternatives.

Abstract Background Hypertension is the number one risk factor for cardiovascular death worldwide and its prevalence has been on the increase in LMICs including Nigeria. There is an increasing awareness and recognition of the contributions of the community health workers (CHWs) in the healthcare system. This study assessed their current role in the management of hypertension and patient satisfaction with the care received. Methods A mixed method study (cross-sectional study of 381 CHWs and key informant interview of 14 patients with hypertension selected using multi-stage and purposive sampling respectively) was conducted across five states in different geopolitical zones of Nigeria to assess the role of CHWs in hypertension management and the patients’ level of satisfaction with services of CHWs. Chi-square test was used to assess relationship between categorical variables. A p-value ≤ 0.05 was considered statistically significant. Thematic analysis of the text data from the KII was done using Nvivo® version 12 pro. Results A total of 381 CHWs completed the study. They were predominantly males (63%) with mean age of 40.96 ± 12.51 years. Only about one-third of the CHWs (31%) could correctly diagnose hypertension while only 15% knew the base-line investigations to be requested. Being female (FE = 9.205, p = 0.008) and resident in northwest geopolitical region (χ2 = 20.920, p < 0.001) had statistically significant associations with appropriate diagnostic skills for hypertension. Being supervised by doctors was associated with appropriate knowledge of baseline investigations for hypertension (χ2 = 5.534, p = 0.019). Mostly, hypertensive patients reported positive experiences and satisfaction with the services provided by the CHWs. Conclusions Community health workers currently have critical contributions in the management of hypertension in Nigeria. Hypertensive patients generally reported satisfactory experience with CHWs managing them. The services rendered by CHWs can be improved upon by adequate supervision and training.

BACKGROUND:Migration in Africa is increasing and driven by a variety of inter-related socio-economic, conflict and climate-related causes. Primary healthcare (PHC) migration on PHC service will be in the forefront of responding to the associated health issues. AIM:This study aimed to review the literature on the effect of migration on PHC service delivery in Africa and the challenges facing migrants in accessing PHC. METHOD:A systematic approach (Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews) was applied across six databases and grey literature from African universities (2010 to 2021). Data were extracted and analysed quantitatively and qualitatively. RESULTS:A total of 3628 studies were identified and 50 were included. Most studies were descriptive or used mixed methods. Publications came from 25 countries, with 52% of studies from South Africa, Uganda and Kenya. Most migrants originated from Zimbabwe, the Democratic Republic of Congo and Somalia. Population health management for migrant communities was challenging. Migration impacted PHC services through an increase in infectious diseases, mental health disorders, reproductive health issues and malnutrition. Primary healthcare services were poorly prepared for handling displaced populations in disaster situations. Access to PHC services was compromised by factors related to migrants, health services and healthcare workers. CONCLUSION:Several countries in Africa need to better prepare their PHC services and providers to handle the increasing number of migrants in the African context.Contribution: The review points to the need for a focus on policy, reducing barriers to access and upskilling primary care providers to handle diversity and complexity.

Background: Triple-negative breast cancer (TNBC) is an immunohistochemical type of breast cancer that lacks estrogen and progesterone receptors and HER2 protein expression. It occurs most frequently in young women under the age of 50 years and is seen relatively more often in women of African descent. It is characterized by an aggressive clinicopathologic course with a predilection for visceral metastasis, especially brain metastasis, and a lack of targeted therapies. Methods: A longitudinal cohort study of patients managed for TNBC and followed up in a single tertiary hospital from January 2014 to December 2017 was conducted. Epidemiological, clinicopathologic, therapeutic, and outcome data were analyzed. Overall survival (OS) and disease-free survival (DFS) were estimated using the Kaplan-Meier analysis. Results: A total of 137 patients aged 31-84 years with a median (interquartile range) age of 47.0 (43-57) years were recruited for the study. Slightly more than half (53.3%) were postmenopausal, and the majority (81; 59%) were under the age of 50 years. The predominant presentations were Stage II (46; 33.6%) and Stage III (42; 30.7%); 16 (11.7%) presented with Stage IV. The overall 2-year survival and DFS were 18.5 months and 38.7%, respectively, and 13.2 months and 18.9%, respectively. Conclusion: The analysis of the TNBC cohort has indicated a significant proportion of patients diagnosed with advanced TNBC in comparison to those in other cohorts. The patient's comorbidity and tumor grade were found to be significant determinants of the 2-year DFS and OS.

Background Diabetes mellitus is a noncommunicable chronic disease that is becoming prevalent among the youthful population. Aim This study assessed diabetic awareness, knowledge, attitude, and practices among undergraduates of a Nigerian university. Methods Descriptive cross-sectional study was conducted among 310 consenting undergraduates that completed a self-administered questionnaire on diabetes and diabetic self-care. Data collected were analyzed using descriptive and inferential statistics. Results The undergraduate age ranged from 16 to 30 years with the majority less than 20 years (55.5%), females 53.8%, Yoruba (87.4%), and second-year students (34.2%). Although a majority (85%) was aware of diabetes mellitus, 53% had poor knowledge, 70% had a negative attitude, and 60% had poor practices toward diabetes mellitus and diabetic self-care. Significant predictor of poor knowledge was being female (adjusted odds ratio 4.56; 95% confidence interval 2.79–7.45; p = 0.0001). Conclusion Despite high diabetes awareness, the knowledge, attitude, and practices were poor among undergraduates. There should be continuous education program on diabetes and diabetic self-care among the students.

Abstract Context: Hypertension causes cardiovascular morbidities globally, particularly in Africa. Hypertension is a disease that is difficult to manage, and there are reports of suboptimal control in hypertensive patients despite clinic attendance. This study sought to characterize the profile of outpatients with uncontrolled hypertension while on treatment. Materials and Methods: There was a purposive consecutive sampling of 78 registered hypertensive patients diagnosed at least six months before recruitment and having clinic blood pressures at ≥ 140/90 mmHg in at least two previous consecutive clinic visits in an outpatient clinic. Their sociodemographic and clinical variables were collected using a semi-structured questionnaire, which incorporated the Hillbone Compliance to High Blood Pressure Scale. Results: There were 52 (66.7%) females and 26 (33.3%) males. The mean age was 54.3 years ± 11.48. The mean blood Pressure (BP) at initial contact was 143.92/89 mmHg. About 40.3% of participants were obese. Most 71.4% of the patients were adherent to prescribed medications. There were no significant socio-demographic factors associated with uncontrolled hypertension after multiple linear regression analysis. There was a significant positive linear correlation between poorer medication adherence and higher diastolic blood pressure r = 2.57, P = 0.024. Conclusion: Physicians ought to recognize the pattern of uncontrolled blood pressure in patients despite treatment and institute an appropriate intervention.

Abstract Background Rapid urbanisation without concomitant infrastructure development has led to the creation of urban slums throughout sub-Saharan Africa. People living in urban slums are particularly vulnerable to food insecurity due to the lack of physical and economic accessibility to food. Hence, it is important to explore how vulnerable groups living in slums interact with the food environment. This study assessed the relationships between food insecurity, including restrictive coping strategies, food purchasing patterns and perceptions about the food environment among dwellers of selected urban slums in Ibadan, Nigeria. Methods This community-based cross-sectional study was conducted with people responsible for food procurement from 590 randomly selected households in two urban slums in Ibadan. Food insecurity and restrictive coping strategies were assessed using the Household Food Insecurity Access Scale and the Coping Strategy Index, respectively. We examined purchasing patterns of participants by assessing the procurement of household foodstuffs in different categories, as well as by vendor type. Participants’ perceptions of the food environment were derived through a five-item composite score measuring food availability, affordability and quality. Chi-square tests and logistic regression models analysed associations between food insecurity, purchasing patterns and perceptions of the food environment. Results The prevalence of food insecurity in the sample was 88%, with 40.2% of the households experiencing severe food insecurity. Nearly a third (32.5%) of the households used restrictive coping strategies such as limiting the size of food portions at mealtimes, while 28.8% reduced the frequency of their daily meals. Participants purchased food multiple times a week, primarily from formal and informal food markets rather than from wholesalers and supermarkets. Only a few households grew food or had livestock (3.2%). Food insecure households had a lower perceived access to the food environment, with an approximate 10% increase in access score per one-unit decrease in food insecurity (AOR = 0.90, 95% CI: 0.84, 0.96). The most procured foods among all households were fish (72.5%), bread (60.3%), rice (56.3%), yam and cassava flours (50.2%). Food-secure households procured fruit, dairy and vegetable proteins more frequently. Conclusion Food insecurity remains a serious public health challenge in the urban slums of Ibadan. Perceptions of greater access to the food environment was associated with increasing food security. Interventions should focus on creating more robust social and financial protections, with efforts to improve livelihoods to ensure food security among urban slum-dwellers.

BACKGROUND:The financial and educational status of individuals living with sickle-cell anaemia contributes to their general well-being. It is widely known that education is closely linked with positive health-seeking behaviors i.e., the more educated a person is, the better the person is likely to seek medical attention when needed, and take care of themselves before the crisis. It is considered that a relatively well-educated person with a means of livelihood would purchase the required drugs for prophylactic use. In most African countries where poverty is acute, it becomes a problem when the resource for education and finance needed for the treatment is not available. This study assessed the socioeconomic parameters (financial and educational status) of individuals living with the disorder within the Ibadan metropolis, southwest Nigeria.METHODS:This study is a descriptive cross-sectional study using quantitative methods that assessed individuals' financial and educational status with sickle cell anaemia. Respondents were recruited from federal and state hospitals, non-governmental foundations, worship centers, and schools. The individuals' educational and financial statuses were accessed using standardized data collection and assessment tools, while the data were analyzed using SPSS (v22). Presentation of inferential statistics was done at a 5% level of significance.RESULTS:The study recruited 253 participants, of which more than half (58.1%) were females. Those between 12-28 years were 64.4%, and the mean age was approximately 27.7±10.3 years. Also, 67.2% had tertiary education, 74.7% were neither engaged nor married at the time of this study, 88.5% were Yoruba, 73.5% of the participants were from a monogamous family, and 73.1% were Christians. A significant directly proportional association was found between financial status, educational status, and general well-being.CONCLUSION:Sociodemographic, as well as educational factors, contributed to the general well-being of the individual participants. Thus, finance, level of exposure, and the environment were found to contribute significantly to well-being. More than half of the participants had tertiary education or are currently in school compared to those without tertiary education. There is an association between those with tertiary education and the number of hospital visits in the selected participants. While no association exists between those with buoyant financial status compared to those without a stable source of income.