BackgroundHuman papilloma virus (HPV) vaccination in Nigeria will require substantial financing due to high cost of HPV vaccine and inexistence of structures to support adolescent vaccination. Alternative sources are needed to sustain the government funded HPV vaccination programme. This study assessed Nigerian mothers’ willingness-to-pay (WTP) for HPV vaccine. We also compared the difference between the average WTP and estimated costs of vaccinating a pre-adolescent girl (CVG).MethodsWe conducted a quantitative, cross-sectional, survey-based study in which 50 questionnaires were distributed to each of 10 secondary schools located in two rural and one urban city in Anambra state. The questionnaires were then randomly distributed to girls aged 9–12 years of age to give to their mothers. Contingent valuation approach using the payment card technique was used to estimate the average maximum WTP among the survey participants. Correlates of WTP for HPV vaccination were obtained using multivariate logistic regression. Estimated CVG was obtained by adapting cost of HPV vaccine delivery in Tanzania to the Nigerian setting.ResultsA total of 438 questionnaires (88 %) were returned. The average WTP was US$ 11.68. This is opposed to estimated delivery cost of US$ 18.16 and US$ 19.26 for urban and rural populations respectively at vaccine price offered by the Vaccine Alliance (Gavi) and US$ 35.16 and US$ 36.26 for urban and rural populations respectively at the lowest obtainable public sector vaccine price. Demand for HPV vaccine was deemed high (91.6 %) and was significantly associated with respondents previously diagnosed of HPV infection.ConclusionDemand for HPV vaccine was high although short of estimated CVG. High demand for vaccine should be capitalized upon to increase vaccine uptake. Education on cervical cancer and provider-initiated vaccination should be promoted to increase vaccine uptake. Co-payment could be a feasible financing strategy in the event of national HPV vaccination.

Background Studies reporting factors associated with exclusive breastfeeding are mostly quantitative. No study has performed a systematic qualitative summary to document the recurring constraints and facilitators to exclusive breastfeeding in sub-Saharan African countries from breastfeeding mothers’ perspective. This study systematically reviews the literature reporting barriers and facilitators to exclusive breastfeeding from the breastfeeding mothers’ perspective in sub-Saharan Africa to develop an educational intervention to optimize exclusive breastfeeding. Methods A systematic literature review of qualitative studies such as phenomenological studies, followed by a risk of bias and methodological assessment of the included studies’ quality using the Critical Appraisal Skills Programme (CASP) tool was conducted. MEDLINE and Google Scholar were searched from January 1990 to October 2019 to retrieve studies of breastfeeding mothers who had infants aged between 0 and 12 months. Two authors independently carried out the review process and resolved disagreements through consensus. We analyzed the data thematically. Results After reviewing 92 studies, 20 studies involving 836 participants from 11 countries were eligible. Of the 72 studies excluded, 39 were not conducted in sub-Saharan Africa, and 33 included other participants such as fathers. Three themes emerged as barriers to exclusive breastfeeding (EBF) and five additional themes were identified with facilitators of maternal-infant factors being the most significant in both cases. Maternal employment and knowledge of the benefits of EBF were the most common maternal-infant factors that served as a barrier and a facilitator, respectively. The study’s limitations were that the review involved only primary research among breastfeeding mothers living in sub-Saharan Africa and excluded studies not available in the English language. The information synthesized from this review could be used to develop communication strategies employed during individual and group patient education in the hospitals to improve breastfeeding mothers’ understanding, acceptance, and practice of exclusive breastfeeding. This review was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42020133761. Conclusions This review found that maternal-infant factors have the most significant influence over the practice of exclusive breastfeeding. Therefore, interventions targeted towards maternal-infant factors will improve and optimize exclusive breastfeeding significantly and, ultimately, improve maternal-child health outcomes.

Background: Selenium is a trace element essential for the normal functions of different human body systems and its deficiency has been associated with different disease states. In recent years, many systematic reviews of randomized clinical trials in humans have demonstrated various properties of selenium such as antioxidant, anti-inflammatory, increased immunity, blocking tumour invasion and metastasis in various pathological conditions. Therefore, there is need to summarize these recent findings in one single paper to facilitate the decision making of clinicians and policy makers regarding the inclusion of selenium supplementation in routine clinical practice, treatment guidelines and essential medicine list. This study would guide researchers towards future research and design of clinical trials. Objectives: The objective of this umbrella review is to assess the clinical outcomes of selenium supplementation in different disease states and to determine its therapeutic implications. Eligibility criteria: Only systematic reviews of randomized clinical trials reporting clinical outcomes after the use of selenium alone as a supplement in the management of diseases will be included. While primary studies, systematic reviews that involved the administration of selenium in combination with other trace elements for the prevention or treatment of diseases will be excluded. Methods: The following databases will be searched by three independent reviewers: MEDLINE, PUBMED, EMBASE, COCHRANE database of systematic reviews, CINAHL, JBI Evidence synthesis, EPISTEMONIKOS, SCOPUS, Web of Science and TRIP PRO. Unpublished reviews will be searched using ProQuest for dissertations and Theses, Canadian Agency for drugs and Technologies in Health (CADTH) database of Grey matters and GOOGLE scholar. Systematic reviews published in the last 10 years (2013 to 2023). There will be no language restriction. The services of a translator will be employed if studies in other languages were found. Selection of reviews and data extraction will be done by 3 independent reviewers. Summary of findings will be presented in tables accompanied by texts where necessary. Keywords: Selenium, clinical outcomes, systematic review, disease management, umbrella review Strengths and limitations of this study This is the first umbrella review on the use of selenium supplements for disease management. Secondly, the findings from this study would facilitate the decision making of clinicians and policy makers regarding the inclusion of selenium supplementation in routine clinical practice, treatment guidelines and essential medicine list. Nevertheless, a major limitation of this umbrella review would be a reduced scope of eligible studies because only systematic reviews/ or meta-analysis that included randomized clinical trials will be considered.

Introduction There is growing scientific evidence of mental and well-being issues that doctoral research students face as a result of not finishing their program on time. This study aims to explore the factors associated with the timely completion of doctoral research studies in the clinical pharmacy speciality. Methods This was a mixed-method study that combined surveys with in-depth interviews. Current doctoral research students and pharmacists who have recently completed their doctoral research program participated in the study. A validated questionnaire and an interview topic guide developed from the literature and pretesting were used to collect data. Data for this study were collected between February 2021 and September 2021. Quantitative data were analysed with the Statistical Package for Social Sciences (SPSS) V.25 while interview data were subjected to reflexive thematic analysis. Results 47 students who are currently pursuing their doctoral research program in clinical pharmacy participated in the survey, while 8 pharmacists who had recently completed their doctoral research program in clinical pharmacy participated in the in-depth interviews. Five themes were identified: factors contributing to delay in the program, factors contributing to the timely completion of the program, ways to improve the program, advice to current students and advice to prospective students. Having more than one supervisor, supervisors’ commitment to the research work and support from the department were identified as facilitators of timely completion of doctoral research programs in clinical pharmacy. Conclusion Our study provides an understanding of the barriers and facilitators of timely completion of doctoral research programs in the clinical pharmacy specialist, and how these can be used to improve the postgraduate study programs in Nigeria.