Asian Journal of Medicine and Health

Factors Associated with Low Uptake of Voluntary HIV Testing and Counselling Services among Youths Aged 18–24 Years in Nakuru County, Kenya: A Systematic Review

Tue, 10 Nov 2026 00:00:00 +0000

Background: Voluntary HIV testing and counselling supports informed testing and linkage to prevention and care. Evidence specific to young adults in Nakuru County is dispersed across mixed-age studies and reports using different testing outcomes.

Objective: To identify factors associated with non-use or limited uptake of voluntary HIV testing and counselling among youths aged 18–24 years in Nakuru County and assess the directness and credibility of the available evidence.

Methods: A completed open-source verification search was conducted on 1 September 2026 for publications dated 1 January 2000–31 August 2026. Europe PMC exports, targeted institutional and publisher searches, and citation checking were used. Nakuru youth/student studies overlapping the target ages were retained as explicitly indirect evidence. Screening, extraction and JBI appraisal used a single reviewer workflow. Findings were synthesised without meta-analysis.

Results: After three duplicate removals, 248 records were screened; 38 reports were sought, eight were not retrieved, and 30 were assessed. Eleven reports representing seven studies were included. A subgroup labelled 18–24 years reported 87/226 (38.5%) using voluntary testing, although inconsistent age labels limited interpretation. Fear of a positive result, anticipated stigma, privacy concerns, low perceived need and service experiences recurred in descriptive evidence. Adjusted findings concerned broader ages, general testing or testing intention. Selection bias, inconsistent reporting, limited confounding control and cohort overlap prevented reliable ranking of determinants.

Conclusions: The verified literature supports attention to confidential, acceptable and accessible testing services, but does not establish current countywide uptake or independent determinants among 18–24-year-olds. Geographically and age-specific research with clearly defined voluntary-testing outcomes is required. The review was not registered; no funding was reported.

Factors Associated with Incomplete Childhood Immunisation among Children Attending Maternal and Child Health Clinics in Narok County: A Systematic Review

Tue, 10 Nov 2026 00:00:00 +0000

Background: Completion of childhood immunisation depends on timely return visits and reliable services. Evidence for children attending maternal and child health clinics in Narok County is dispersed across facility and community studies.

Objective: To synthesise factors associated with incomplete routine childhood immunisation in Narok County and assess their applicability to clinic attendees.

Methods: A completed open-source verification search, executed on 1 September 2026, covered publications from 1 January 2000 to 31 August 2026. Europe PMC, targeted publisher and institutional-repository searches, and reference checking were used. Screening, extraction and appraisal followed a single reviewer workflow. Revised JBI tools informed appraisal. Clinic evidence and supporting Narok community evidence were synthesised separately without meta-analysis.

Results: Of 210 captured records, 208 remained after deduplication; 27 reports were sought and 25 assessed. Seven reports representing five study groups were included. Two groups supplied clinic-linked evidence: a survey of 100 mother–child pairs and a registry analysis of 8,487 child records. Three community studies supplied contextual evidence. Reported associations concerned maternal education and employment, antenatal care, delivery setting, geographical access and failure to vaccinate during service contact. One household study reported adjusted odds ratios for full vaccination of 5.68 (95% confidence interval 2.44–13.21) for secondary versus primary education and 3.01 (1.37–6.64) for no previous facility failure to vaccinate. These estimates require caution because the composite outcome was inconsistently reported. Other reports contained conflicting models, age-ineligible completion classifications or unclear denominators. Confidence in factor magnitudes and their transfer to clinic attendees was very low.

Conclusions: Service continuity, caregiver resources and access warrant local attention, but the evidence does not establish a reliable causal ranking. Age-appropriate assessment at each contact and prospective evaluation of missed doses are priorities. No pooled estimate was calculated. The review was unregistered; no funding was declared.

Relapsing–Remitting Multiple Sclerosis in a Nigerian Woman: Diagnostic and Therapeutic Challenges in a Low-Resource Setting

Tue, 13 Oct 2026 00:00:00 +0000

Background: Multiple sclerosis (MS) is a chronic immune-mediated demyelinating disorder of the central nervous system that is increasingly recognised in sub-Saharan Africa. Diagnostic and treatment delays remain common because of a low index of suspicion, limited access to neuroimaging, overlap with infectious and degenerative neurological disorders, and limited availability of medication.

Case Presentation: We report the case of a 43-year-old Nigerian woman who presented with a three-year history of recurrent lower limb paraesthesia and stiffness, followed by the subacute onset of visual blurring and right facial paraesthesia. Neurological examination was largely unremarkable. Magnetic resonance imaging (MRI) of the brain demonstrated multiple periventricular, deep white matter, pontine, and cerebellar peduncular T2/FLAIR hyperintense lesions with characteristic Dawson’s fingers. Cerebrospinal fluid analysis revealed positive oligoclonal bands (type 2). Whole-spine MRI showed extensive multilevel degenerative disc disease with spinal canal stenosis, as well as features consistent with demyelinating pathology. A diagnosis of relapsing–remitting multiple sclerosis was made based on the 2017 McDonald criteria. The patient showed significant clinical improvement following corticosteroid therapy. Although interferon beta-1a (Avonex) was advised as disease-modifying therapy, access was limited because of its unavailability.

Conclusion: This case highlights the diagnostic complexity of multiple sclerosis in low-resource settings, particularly when extensive degenerative spine disease coexists. Increased awareness and early utilisation of MRI and CSF analysis are important for prompt diagnosis of MS, while limited treatment resources may affect outcomes in Nigeria.

Gut Hormones and Hypothalamic Pituitary Integration in Linear Growth and Weight Regulation in Children and Adolescents

Fri, 06 Nov 2026 00:00:00 +0000

Background: Gut peptides coordinate food intake, nutrient handling and neuroendocrine responses during development. Their relevance to paediatric obesity is established more firmly than their contribution to attained height. Recent receptor genetics, incretin trials and nutritional interventions justify an integrated reassessment.

Objective: To examine relationships between gut hormones, hypothalamic–pituitary signalling, linear growth and weight trajectories, distinguish causal evidence from association, and identify diagnostic and therapeutic implications.
Methods: A structured, targeted narrative synthesis evaluated PubMed-indexed publications dated January 2001 to 10 September 2026. Bibliographic records and available abstracts were verified against PubMed-linked Europe PMC records. Paediatric systematic reviews and randomised trials received greatest weight, followed by cohorts, genetic and functional studies, and case reports. Adult and experimental findings were explicitly separated. Direct Scopus searching, exhaustive screening, independent duplicate selection and formal risk-of-bias grading were not performed.

Results: GLP-1 receptor agonists have the strongest paediatric interventional evidence for reducing excess weight gain and BMI. GHSR loss-of-function variants strengthen the biological link between ghrelin signalling and stature, including short stature with low IGF-I despite normal conventional stimulated GH responses. Circulating ghrelin does not consistently predict height velocity. Undernutrition can uncouple GH secretion from IGF-I production. GLP-2 treatment supports intestinal adaptation, although height responses are heterogeneous. Microbiota-directed nutrition offers encouraging growth evidence in young undernourished children, without establishing gut-hormone mediation. Long-term effects of incretin therapy on adult height and peak bone mass remain insufficiently characterised.

Conclusions: Gut signals influence both energy balance and the conditions permitting growth, but weight efficacy cannot establish linear-growth efficacy. Clinical interpretation requires attention to nutritional state, puberty, receptor function and the specific outcome measured.

Factors Associated with Immediate Complications after Mastectomy with Axillary Lymph Node Dissection for Breast Cancer: A Critical Review of Studies Published from 2016 to 2025

Mon, 09 Nov 2026 00:00:00 +0000

Immediate morbidity after mastectomy with axillary lymph node dissection (ALND) remains clinically consequential despite refinements in operative technique and perioperative care. This critical narrative review evaluates factors associated with complications arising during admission or approximately the first 30 postoperative days, with particular attention to seroma requiring intervention, surgical-site infection, haematoma, skin-flap necrosis and wound-healing problems. Peer-reviewed studies published between 2016 and 2025 were identified through targeted searches of accessible scholarly resources and citation tracing; studies reporting broader breast-surgery populations or longer follow-up were interpreted as indirect evidence. The strongest recurring associations concern excess body mass and the additional tissue and lymphatic disruption accompanying ALND, although effect estimates depend on the complication definition, operative case mix and adjustment for confounding. Diabetes, smoking, hypertension, older age, treatment sequencing and operative complexity have less uniform outcome-specific support. Randomised studies and syntheses generally favour mechanical dead-space closure for reducing clinically significant seroma, but individual trials differ, and improvement in infection, necrosis or patient-centred recovery is not established consistently. Evidence for cyanoacrylate sealants and tranexamic acid is conflicting, whereas prolonged prophylactic antibiotics have not demonstrated clear benefit in a dedicated multicentre trial. Major obstacles to inference include inconsistent definitions, variable drainage and aspiration protocols, mixing of mastectomy with breast-conserving surgery or reconstruction, inadequate separation of early from chronic complications, and sparse external validation of prediction tools. The available literature supports risk-aware perioperative planning and selective consideration of technically appropriate flap fixation rather than a universal complication-prevention package. Future multicentre studies should enrol clearly defined mastectomy–ALND cohorts, report standardised 30-day outcomes and assess both effectiveness and unintended consequences.

Ursodiol as Salvage Therapy in Steroid- and MMF-Refractory Cholestatic Immune Checkpoint Inhibitor Hepatitis with Concurrent Pneumonitis

Thu, 15 Oct 2026 00:00:00 +0000

Introduction: Immune checkpoint inhibitor hepatitis (ICIH) occurs in 0-30% of patients receiving PD-L1 and CTLA-4 inhibitors, while checkpoint inhibitor pneumonitis (CIP) affects 2-19% of patients. ICIH typically presents as steroid-responsive hepatocellular injury. Cholestatic and mixed patterns are rare and are more frequently steroid-refractory, requiring second-line immunosuppression. Concurrent ICIH and checkpoint inhibitor pneumonitis in a single patient is exceptionally rare. The combination of ICIs with other immunosuppressants may magnify hepatotoxicity and pneumonitis through overlapping immune dysregulation. Ursodiol shows promise for cholestatic drug-induced liver injury because of its choleretic, hepatoprotective, and immunomodulatory mechanisms, but it remains poorly studied in ICIH. We present a case of steroid-refractory cholestatic ICIH with concurrent recurrent pneumonitis that was associated with a marked biochemical response to ursodiol.

Case Presentation: A 63-year-old male with metastatic non-small cell lung carcinoma (NSCLC), initially diagnosed in 2017, developed recurrence in 2023. He received eight cycles of carboplatin/paclitaxel followed by pembrolizumab/osimertinib combination therapy. He presented with dyspnoea and was found to have a subsegmental pulmonary embolism, with diffuse bilateral ground-glass opacities on CT. Bronchoalveolar lavage (BAL) confirmed CIP. Simultaneously, cholestatic transaminitis developed (AST 166 U/L, ALT 168 U/L, ALP 336 U/L). The autoimmune workup was negative, and viral testing showed resolved hepatitis B. Despite high-dose corticosteroids for pneumonitis, liver enzymes progressively worsened over seven days, peaking at AST 388 U/L, ALT 410 U/L, ALP 337 U/L, and total bilirubin 3.4 mg/dL. Liver biopsy showed hepatitis and moderate portal inflammation consistent with ICIH. Pembrolizumab was permanently discontinued, but osimertinib was continued with high-dose corticosteroids. Because of steroid-refractory disease, mycophenolate mofetil (MMF) 500 mg twice daily was added, with an initial partial response. However, the patient developed rebound transaminitis (ALP 405 U/L, AST 227 U/L). He had recurrent episodes of severe pneumonitis that required escalating corticosteroid doses; therefore, MMF and osimertinib were held because of worsening infection risk and recurrent pneumonitis. Ursodiol 500 mg daily was initiated as adjunctive therapy for the cholestatic pattern. Liver function tests showed marked improvement on ursodiol monotherapy. Liver function tests had nearly normalised within three weeks of therapy: AST 19 U/L (95% reduction from peak), ALT 24 U/L (94% reduction), and ALP 147 U/L (56% reduction).

Discussion: This case highlights synergistic drug toxicities and therapeutic challenges in managing overlapping immune-related adverse events. The concurrent use of pembrolizumab and osimertinib may amplify both hepatotoxicity and pneumonitis compared with monotherapy, requiring enhanced surveillance. Only 10-15% of ICIH cases fail corticosteroid therapy, and cholestatic-pattern ICIH is generally more treatment-refractory than hepatocellular patterns. Managing concurrent refractory hepatitis and pneumonitis limits conventional treatment options. Ursodiol has been proposed to have choleretic effects, hepatocyte membrane-stabilising activity, anti-apoptotic properties, and immunomodulatory effects through decreased MHC class I expression. Increased MHC class I expression has been reported in cholestatic-pattern injury. The patient's detailed longitudinal clinical course, including laboratory trends and therapeutic modifications, is provided in Supplementary Appendix 1.

Conclusions: This case illustrates the potential risk of severe, overlapping immune-related adverse events with combination ICI-TKI therapy and the particular challenge of cholestatic-pattern ICIH. Most notably, ursodiol was associated with substantial biochemical improvement as salvage therapy in steroid- and MMF-refractory disease, suggesting that it may warrant consideration early in cholestatic ICIH, particularly when infection risk precludes conventional immunosuppression. This case adds to the limited literature supporting the role of ursodiol and highlights the need for prospective trials. Clinicians should remain aware of the synergistic toxicities of immunotherapy and consider alternative therapeutic approaches for refractory cases.

Evidence for Harm Reduction Programming: Prevalence and Risk Factors of Tramadol Use among Adolescents in Juba, South Sudan

Mon, 12 Oct 2026 00:00:00 +0000

Background: Tramadol misuse among adolescents is an emerging public health concern in several African settings, facilitated by its accessibility and non-medical use. In Juba, South Sudan, empirical evidence on the prevalence and factors associated with tramadol use among adolescents remains limited.

Aim: This study assessed the prevalence and risk factors of tramadol use among adolescents in Juba, South Sudan.

Methods: A cross-sectional survey was conducted among 297 adolescents aged 12–17 years in Juba. A structured questionnaire gathered data on socio-demographic characteristics and tramadol use, which the researchers then entered using EpiData and analysed with SPSS version 27. Descriptive and inferential statistics, including chi-squared tests and Cramer's V, were computed with 95% confidence intervals (CIs). The study adhered to ethical standards.

Results: The sample was predominantly male (82.8%; 95% CI: 78.5–86.9) and aged 15–17 years (80.8%; 95% CI: 76.1–85.2). Most lived in low-income households (56.9%; 95% CI: 51.2–62.3), and 57.9% (95% CI: 51.9–63.6) engaged in paid work. The lifetime prevalence of tramadol use was 81.1% (95% CI: 76.8–85.9), past-12-month use was 72.1% (95% CI: 66.7–77.4), and past-30-day use was 62.6% (95% CI: 56.9–68.4). Initiation commonly occurred at ages 12–14 years (37.7%) and 15–17 years (43.1%). Regular use was notable, with 19.2% using tramadol several times per week and 13.5% using it daily or almost daily. Tramadol use was significantly associated with age (χ² = 39.73, p < .001, Cramer's V = 0.366), residential location (χ² = 60.91, p < .001, V = 0.453), household size (χ² = 22.78, p < .001), employment status (χ² = 29.31, p < .001), perceived family economic status (χ² = 12.22, p = 0.002), peer introduction (χ² = 120.67, p < .001, V = 0.637), peer pressure (68.5% vs. 57.1%; p = 0.043), and situational motives such as coping with stress (χ² = 125.91, p < .001, V = 0.651), among others.

Conclusion: Tramadol use is highly prevalent among adolescents in Juba, begins in early adolescence, and frequently occurs at regular or daily intervals. Use is shaped by an interplay of demographic, socioeconomic, peer, and psychosocial factors, with peer-related influences and situational motives showing the strongest associations. The findings indicate an urgent need for school-based prevention, regulation of tramadol access, and family-level interventions targeting young people in Juba as part of harm-reduction programming.

Nutritional Knowledge and Adherence to Folic Acid Intake among Women Attending Antenatal Clinic at Ibrahim Taiwo Primary Health Centre, Ogbomoso, Oyo State, Nigeria

Mon, 26 Oct 2026 00:00:00 +0000

Background: Adequate folic acid intake before and during pregnancy is important for maternal and foetal health. However, nutritional knowledge may not consistently translate into adherence to supplementation. This study assessed nutritional knowledge and adherence to folic acid intake among women attending the antenatal clinic at Ibrahim Taiwo Primary Health Centre, Ogbomoso, Oyo State, Nigeria.

Methods: A descriptive cross-sectional study involved 240 antenatal clinic attendees recruited through convenience sampling. Data were collected using a semi-structured questionnaire covering sociodemographic and pregnancy-related characteristics, nutritional knowledge, adherence and perceived influencing factors. Descriptive statistics and Pearson's chi-square test were used for analysis, with statistical significance assessed at the 5% level.

Results: Overall, 197 respondents (82.1%) demonstrated good nutritional knowledge, whereas 116 (48.3%) were classified as adherent and 124 (51.7%) as non-adherent. Although 126 respondents (52.5%) reported knowing the recommended dosage, 102 (42.5%) identified 400 µg daily. Agreement concerning pregnancy-related health beliefs ranged from 59.6% to 78.4%, with perceived benefits receiving the highest agreement. Nutritional knowledge was not significantly associated with adherence (χ² = 0.879, p = .35).

Conclusion: Good nutritional knowledge was common, but fewer than half of the respondents met the study's adherence criterion. The findings suggest that antenatal counselling should address reported knowledge gaps alongside behavioural and contextual factors relevant to regular folic acid intake.

Factors and Management Strategies in Patients with Delayed Recovery after Anesthesia: A Prospective Observational Study

Hayder Hasan Khudhiar, Alaa Alsafi — Fri, 30 Oct 2026 00:00:00 +0000

Background: Delayed recovery after anaesthesia is a common postoperative complication that can increase patient morbidity and prolong hospital stay. Multiple factors, including age, anaesthesia type, drug effects, and metabolic disturbances, have been reported to influence recovery time.

Objective: This study aimed to assess the factors associated with delayed recovery after anaesthesia and evaluate management strategies in patients undergoing surgery at Al-Almani Hospital from 8 December 2025 to 3 January 2026.

Methods: A total of 35 patients were included in this observational study. Data were collected on age, sex, weight, type of anaesthesia (general or regional), body temperature, random blood sugar (RBS), recovery time, smoking status, reasons for delayed recovery, and management strategies used, including reversal agents. General anaesthesia involved intravenous induction followed by inhalational maintenance, while regional anaesthesia included spinal and other regional techniques. Statistical analysis was performed using SPSS version 28, and descriptive and inferential statistics were applied to evaluate associations.

Results: The mean age of patients was 52.06 ± 14.95 years, and the mean weight was 82.46 ± 24.79 kg. Delayed recovery was observed in 24 patients (68.6%), with prolonged anaesthesia, opioid overdose, residual neuromuscular blockade, hyperglycaemia, hypoglycaemia, electrolyte imbalance, hypothermia, and delayed metabolism recorded as potential contributing factors. Delayed recovery occurred in 87.5% of patients receiving general anaesthesia compared with 52.6% of those receiving regional anaesthesia, and this association was statistically significant (Fisher’s exact test, p = 0.035). Management strategies included supportive care, reversal agents (naloxone, neostigmine + atropine), active warming, insulin therapy, and electrolyte correction.

Conclusion: Delayed recovery after anaesthesia was associated with multiple perioperative factors in this study. Anaesthesia type showed a statistically significant association with recovery outcome, whereas age was not significantly associated with delayed recovery. Given the relatively small sample size and observational design, these findings should be interpreted with caution. Timely recognition and appropriate management of potentially reversible factors may support improved postoperative recovery.

Twice-Daily Topical Honey versus Povidone-Iodine for Wound Care after Mastectomy with Axillary Lymph Node Dissection for Breast Cancer: A Randomized Controlled Trial at Bogodogo University Hospital, Ouagadougou, Burkina Faso

Sat, 31 Oct 2026 00:00:00 +0000

Background: Wound complications can complicate recovery after mastectomy with axillary lymph node dissection. Evidence comparing twice-daily topical honey with povidone-iodine in this setting remains limited.

Aims: To compare twice-daily topical honey with povidone-iodine for the care of the surgical wound after mastectomy with axillary lymph node dissection for breast cancer.

Study Design: Single-centre, open-label, two-arm, parallel-group randomised controlled trial with blinded assessment of the primary outcome.

Place and Duration of Study: Department of Gynaecology-Obstetrics and Reproductive Medicine, Bogodogo University Teaching Hospital, Ouagadougou, Burkina Faso, from 1 October 2024 to 30 September 2026.

Methodology: Women aged 18 years or older undergoing mastectomy or breast-conserving surgery with axillary dissection for histologically proven breast cancer were randomised 1:1, with stratification by neoadjuvant chemotherapy. After removal of the initial dressing on day 1–2, the honey arm received twice-daily application of honey and the control arm twice-daily application of 10% dermal povidone-iodine on the incision until complete healing. The primary outcome was time to complete healing, assessed on standardised photographs by an independent assessor blinded to allocation. Secondary outcomes were 30-day surgical site infection (SSI, CDC criteria), seroma, skin necrosis, dehiscence, pain during wound care, skin reactions and length of stay.

Results: Of 176 randomised women (88 per arm), 174 (98.9%) completed 30-day follow-up. Baseline characteristics were comparable; 78.2% had stage III–IV disease and 94.8% had received neoadjuvant chemotherapy. Complete healing before day 14 occurred in 26.1% of the honey arm versus 4.7% of the povidone-iodine arm (relative risk, RR 5.62; 95% CI 2.03–15.57; p < 0.001), and by day 21 in 93.2% versus 82.6% (p = 0.037). SSI occurred in 1.1% versus 7.0% (RR 0.16; 95% CI 0.02–1.32; p = 0.063). Seroma (8.0% vs 22.1%; RR 0.36; 95% CI 0.16–0.81; p = 0.011), pain during wound care on day 7 (11.4% vs 48.8%; p < 0.001) and skin reactions (2.3% vs 16.3%; p = 0.001) were less frequent with honey. Length of stay did not differ.

Conclusion: Compared with povidone-iodine, twice-daily topical honey after mastectomy with axillary dissection accelerated wound healing and reduced seroma, pain during wound care and skin reactions. The lower SSI rate did not reach statistical significance. Honey is an affordable and well-tolerated alternative that warrants confirmation in a larger multicentre trial.

Risk Factors for Postoperative Pulmonary Complications in Patients Undergoing Colorectal Surgery for Malignancy at Dhaka Medical College Hospital: A Prospective Observational Study

Humayra Ahmed Ukti — Sat, 31 Oct 2026 00:00:00 +0000

Background: Postoperative pulmonary complications (PPCs) are important causes of morbidity after major abdominal surgery. Patients undergoing colorectal surgery for malignancy may be particularly vulnerable owing to advanced age, smoking, respiratory disease, comorbidities, poor nutritional status, and open surgical approaches.

Aim: This study evaluated the incidence and risk factors for PPCs among patients undergoing colorectal surgery for malignancy at Dhaka Medical College Hospital (DMCH).

Methods: A prospective observational study included 200 adult patients undergoing colorectal surgery for malignancy at DMCH from January 2024 to December 2025. Demographic, clinical, laboratory, anaesthetic, and operative variables were recorded prospectively. PPCs included pneumonia, treated atelectasis, respiratory failure, pleural effusion requiring intervention, treated bronchospasm, or unplanned postoperative mechanical ventilation. Univariate associations were assessed using appropriate statistical tests. Variables with P<0.10 were entered into multivariable binary logistic regression. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated, and ROC analysis assessed model discrimination.

Results: Among 200 patients, 32 (16.0%) developed PPCs. Pneumonia occurred in 15 (7.5%), atelectasis in 12 (6.0%), and respiratory failure in 7 (3.5%). PPCs were associated with older age, smoking, chronic respiratory disease, ASA physical status ≥III, hypoalbuminaemia, and open surgery. Multivariable analysis identified age ≥65 years (aOR 2.74, 95% CI 1.17–6.42; P=0.020), smoking (aOR 2.31, 95% CI 1.01–5.30; P=0.047), chronic respiratory disease (aOR 3.21, 95% CI 1.19–8.65; P=0.021), ASA ≥III (aOR 2.86, 95% CI 1.25–6.53; P=0.012), and open surgery (aOR 2.68, 95% CI 1.15–6.24; P=0.022) as independent risk factors.

Conclusion: PPCs affected approximately one-sixth of patients. Advanced age, smoking, chronic respiratory disease, higher ASA physical status, and open surgery were independently associated with PPCs. Early risk identification may support targeted respiratory optimization and closer postoperative surveillance.

A 5-Year Experience of Placental Abruption in Two Tertiary Health Facilities in Southern Nigeria

Sat, 31 Oct 2026 00:00:00 +0000

Background: Abruptio placentae is an obstetric emergency associated with severe maternal and perinatal morbidity and mortality, particularly in developing countries. Antenatal care, prompt diagnosis and timely delivery, when indicated, are important aspects of clinical management.

Objectives: To determine the prevalence and fetomaternal outcomes of abruptio placentae.

Method: This retrospective study examined the maternal and fetal outcomes of 208 cases of abruptio placentae managed at delta state university teaching hospital, oghara, and central hospital, warri, nigeria, between 1 january 2017 and 31 december 2022. Details of the patients were obtained from hospital records and entered into a data collection proforma. Data were analysed using the statistical package for the social sciences (spss), version 22.

Results: There were 22,108 deliveries and 208 cases of abruptio placentae during the study period, corresponding to an incidence of 0.94%. Women aged 31 years and above accounted for 60.1% of cases. Most patients (66.3%) had a parity of 1–4, while 59.6% were booked. Hypertension in pregnancy was recorded in 56.7% of cases. Fourteen early neonatal deaths (6.7% of the 208 cases) were reported.

Conclusion: Placental abruption was associated with maternal and perinatal complications in the two facilities. These findings support the importance of antenatal care, timely presentation and prompt obstetric assessment.

National Health Insurance Scheme Awareness and Benefit-statement Endorsement among Urban- and Rural-classified Respondents in a Ghanaian Household Survey

Tue, 03 Nov 2026 00:00:00 +0000

Aims: To describe self-reported awareness of Ghana's National Health insurance scheme (NHIS), affirmative responses to broad benefit statements and their distribution across recorded urban and rural groups.

Study Design: A descriptive cross-sectional household survey with exploratory comparisons by recorded settlement classification.

Place and Duration of Study: Four districts in the present Northern Region of Ghana constituted the intended sampling frame; interviews took place from March 2025 to February 2026.

Methodology: A four-stage household selection procedure was specified. Fourteen positively phrased benefit statements were administered; one for which 80.0% of responses were missing was excluded, leaving a 13-item endorsement count (0–13). The three descriptive score bands were 11–13, 8–10 and 0–7. Statistical intervals and tests did not account for clusters or sampling weights.

Results: Among 595 analysed records (194 urban; 401 rural), 591 (99.3%) reported NHIS awareness. The endorsement bands contained 49 (8.2%), 290 (48.7%) and 256 (43.0%) respondents, respectively. Affirmative responses were least frequent for physiotherapy (27.9%), specialist consultation (39.8%), general surgery (40.2%) and basic dental care (40.5%). The highest-band proportion was 10.8% in the urban group and 7.0% in the rural group (unadjusted difference 3.8 percentage points; 95% CI −0.8 to 9.4; nominal P = .11); the three-band comparison yielded nominal P = .26. Internal consistency of the 13-item index was low (KR-20 = 0.35). Geographic fields recorded districts outside the intended four for 46 records and other regions for 15 records.

Conclusion: General NHIS awareness was frequently reported, whereas endorsements of individual benefit statements varied considerably. The unvalidated, low-reliability score, conditional benefit entitlements, discrepancies in geographic fields and lack of design-based analysis prevent conclusions about regional prevalence, validated literacy or urban–rural equivalence.

Spatial Distribution of Mental Health Facilities in Kaduna State, Nigeria: A GIS-based Analysis

Njoku Maureen Chioma, Daful Mwanret Gideon, B. J. Ajibuah, A. Dadan-Garba — Wed, 04 Nov 2026 00:00:00 +0000

The geographical distribution of mental health facilities is important for equitable mental healthcare planning. This study examined the spatial distribution of orthodox and non-orthodox mental health facilities in Kaduna State, Nigeria, using Geographic Information Systems (GIS). Fieldwork-based facility locations were analysed using Kernel Density Estimation, Average Nearest Neighbour (ANN), distance buffers of 10, 20, 30 and 50 km, and facility-to-population ratios across the state's three senatorial zones. Chapter Four reports 45 facilities in its ownership and facility-to-population analyses, although its type classification elsewhere reports 43; this discrepancy must be reconciled before submission. ANN analysis indicated statistically significant clustering (nearest-neighbour ratio = 0.262896; z = −9.353755; p < 0.001). Kernel density mapping showed a pronounced concentration around Kaduna metropolis, particularly Kaduna North and Kaduna South LGAs in Kaduna Central Senatorial Zone, and a secondary concentration around the Zaria–Sabon Gari axis. Buffer analysis indicated that geographical coverage increased as the distance threshold widened, but gaps remained in peripheral LGAs including Birnin Gwari, Kubau, Kauru, Kagarko and Sanga. The facility-to-population analysis also showed an uneven distribution, with the largest reported number of facilities in Kaduna Central Senatorial Zone. The findings indicate that mental health facilities are spatially clustered rather than evenly distributed across Kaduna State. GIS-informed planning, improved facility data management and targeted assessment of underserved areas are recommended.

Self-Regulation of Social Media Use among College Students: A Survey-informed Qualitative Inquiry

Thu, 05 Nov 2026 00:00:00 +0000

Background: Students use social media for communication, information, and leisure while also describing difficulties disengaging from applications during academic activities. Objective: To explore the experiences, challenges, and self-regulation strategies of college students selected from opposite ends of a social media self-regulation screening score distribution.

Methods: A survey-informed qualitative inquiry was conducted at a private college in Iloilo City, Philippines, during the first semester of the academic year 2026–2027. From an enrolled population of 7,907 students across 10 colleges, 367 students participated in a survey including the researcher-developed, 16-item Social Media Self-Regulation Inventory. Ten students, five from the lowest-scoring group and five from the highest-scoring group, subsequently participated in semi-structured interviews. Their accounts were organised using thematic analysis.

Results: Five themes were identified: influences on social media use; challenges in behavioural control; cognitive and biopsychosocial consequences; mitigation strategies and environmental controls; and awareness and personal regulation. Participants described entertainment, communication, boredom, stress relief, notification-triggered checking, displaced study time, guilt, disrupted sleep, and efforts to manage applications and devices. Accounts of difficulty occurred in both screening groups.

Conclusion: The interviews illustrate context-specific variation in how students recognise and manage social media distractions. These findings concern reported experiences and do not establish prevalence, causal effects, or the effectiveness of any self-regulation intervention.