Summary Background Risk of mortality following surgery in patients across Africa is twice as high as the global average. Most of these deaths occur on hospital wards after the surgery itself. We aimed to assess whether enhanced postoperative surveillance of adult surgical patients at high risk of postoperative morbidity or mortality in Africa could reduce 30-day in-hospital mortality. Methods We did a two-arm, open-label, cluster-randomised trial of hospitals (clusters) across Africa. Hospitals were eligible if they provided surgery with an overnight postoperative admission. Hospitals were randomly assigned through minimisation in recruitment blocks (1:1) to provide patients with either a package of enhanced postoperative surveillance interventions (admitting the patient to higher care ward, increasing the frequency of postoperative nursing observations, assigning the patient to a bed in view of the nursing station, allowing family members to stay in the ward, and placing a postoperative surveillance guide at the bedside) for those at high risk (ie, with African Surgical Outcomes Study Surgical Risk Calculator scores ≥10) and usual care for those at low risk (intervention group), or for all patients to receive usual postoperative care (control group). Health-care providers and participants were not masked, but data assessors were. The primary outcome was 30-day in-hospital mortality of patients at low and high risk, measured at the participant level. All analyses were done as allocated (by cluster) in all patients with available data. This trial is registered with ClinicalTrials.gov , NCT03853824 . Findings Between May 3, 2019, and July 27, 2020, 594 eligible hospitals indicated a desire to participate across 33 African countries; 332 (56%) were able to recruit participants and were included in analyses. We allocated 160 hospitals (13 275 patients) to provide enhanced postoperative surveillance and 172 hospitals (15 617 patients) to provide standard care. The mean age of participants was 37·1 years (SD 15·5) and 20 039 (69·4%) of 28 892 patients were women. 30-day in-hospital mortality occurred in 169 (1·3%) of 12 970 patients with mortality data in the intervention group and in 193 (1·3%) of 15 242 patients with mortality data in the control group (relative risk 0·96, 95% CI 0·69–1·33; p=0·79). 45 (0·2%) of 22 031 patients at low risk and 309 (5·6%) of 5500 patients at high risk died. No harms associated with either intervention were reported. Interpretation This intervention package did not decrease 30-day in-hospital mortality among surgical patients in Africa at high risk of postoperative morbidity or mortality. Further research is needed to develop interventions that prevent death from surgical complications in resource-limited hospitals across Africa. Funding Bill & Melinda Gates Foundation and the World Federati...
Fish farming is among agricultural activities that are used to fight food and nutritional security in Nigeria. But, the aim of the Nigerian government is not only to make its citizen food and nutritional secure, but to provide a safe food for its populace as well. The mere isolation and characterization of potential food borne illness pathogens does not provide sufficient information for public health policy development. Hence, a cross-sectional study was conducted to assess the knowledge, attitudes and practices of fish handlers in Kaduna State, Nigeria. A structured face-to-face questionnaire was designed and administered to 37 street fish vendors between May-August, 2017. Results indicated that respondents had good level of knowledge and attitudes and poor practices toward food hygiene measures. Almost all of the food workers were aware of the role of hand washing before and after handling of fish as well as wearing protective clothing during work while majority lack knowledge about microbial hazards transmitted through fish in the (67-78%) study area. A significant positive correlation was observed between knowledge and attitude (rs = 0.60, P = 0.00), level of education (rs=0.5, P=0.000) and but negative correlation with years of business experience (rs=-0.3, P=0.03). A significance between knowledge and practices (rs = 0.2, P = 0.23) revealed that increased knowledge of food safety does not always result in positive change in fish handling behaviors.
The paper examined Local Government and its development capabilities in Nassarawa Local Government Area of Kano State. The theoretical framework for this paper is anchored on Amartya Sen's capability approach. The first clarification that needs to be made is to ask whether the capability approach is a well-defined theory, or something broader, like a paradigm. In its most broad form, the capability approach can indeed be considered to be a paradigm. However, not everyone uses it as such. It could help to distinguish between three different levels at which the capability approach is operating: first, as a framework of thought for the evaluation of individual advantage and social arrangements. Second, as a critique of other approaches to the evaluation of well-being and justice. Third, as a formula or algorithm to make interpersonal comparisons of welfare or well-being. The capability approach is primarily and mainly a framework of thought, a mode of thinking about normative issues, henceloosely defineda paradigm. Sen has stressed that the capability approach can be used for a wide range of purposes (Sen, 1993). What does it mean to see the capability approach as a general framework of thought for the assessment of individual advantage and social arrangements? The capability approach focuses on the information that we need to make judgments about individual well-being, social policies, and so forth, and consequently rejects alternative approaches that it considers normatively inadequate, for example when an evaluation is done exclusively in monetary terms. The paper utilized primary data collected from a sample of 267 respondents using self-administered questionnaire, descriptive statistical technique using simple percentage presented in form of table and chart was employed to analyze the data collected. The paper revealed that Nassarawa Local Government has the capability to act and commit, that Nassarawa Local Government deliver on development projects; that Nassarawa Local Government has the capability to relate with external stakeholders, and that Nassarawa Local Government adapt and self-renew. The paper, therefore recommends; that the Nassarawa Local Government should improve on her capability to act and commit by ensuring that it effectively able to make decisions and commitments on viable policies that will improve the development capabilities of the Local Government, that the Nassarawa Local Government should improve on her capability to deliver on development projects by ensuring that the local government have sufficient and capable staff; clear organizational responsibilities; adequate financial resources; and effective administrative mechanisms in place, that the Nassarawa Local Government should improve on its capability to adapt and self-renew by regularly monitoring and evaluating the progress made on its development objectives, and encourage internal learning and reflection, that the Nassarawa Local Government should improve on her capability to relate with external stakeholders by adopting the poli...
Even though empirical evidence has shown that naturally endowed countries growth slower than their less naturally endowed counterparts, the scenario tagged as “resource curse hypothesis”, but it seems there are exceptions. Therefore, this study examines the confirmation or disputation of resource curse hypothesis among the West African Institutes for Financial and Economic Management (WAIFEM) member countries during the period 1986-2016. The study applied seemingly unrelated regression (SUR) and unraveled the strengthened effect of natural resources on output growth in Gambia, Ghana, and Sierra Leone. But, the study revealed a negative and statistically significant effect on economic growth in Liberia and Nigeria, thereby upholding the presence of resource curse hypothesis only in Liberia and Nigeria. Therefore, an overall “umbrella” policy recommendation inappropriate, but individually designed strategy that would help in managing the resources rents effectively in order to boost economic growth particularly in Liberia and Nigeria where their resource endowment serve as a curse rather than a blessing is recommended.
IntroductionSex workers are heightened risk of HIV/AIDS because of their risky sexual behaviour. In Nigeria, the number of sex workers living with HIV is eight times higher than the general population. HIV counselling and testing (HCT) is important in reducing spread of HIV and serves as an entry point to care. The study aimed at understanding the factors that influences sex workers patronage of HCT services in the study area.MethodsThe study was conducted in October 2016 among 150 brothel-based Female Sex Workers (FSWs) purposively selected across three randomly selected local government areas representing the three senatorial districts in Lagos, Nigeria. The result was processed through SPSS 16.0. A binary logistic regression model was used in understanding the predictors of HIV testing among the sex workers.ResultsThe mean age of sex workers was 28 years. Findings showed a high prevalence of risky behaviour with about two-third (65.3%) consumed alcohol and 42% sometimes engaged in unprotected sex. Majority (86%) had gone for HIV testing prior to the survey but only seven in every ten went for HCT within six months prior to the study. Results from the binary logistic regression showed that sex workers education and length of practicing sex work exert a statistical significance on the patronage of HIV testing (p<0.05). Sex workers that do not engage in unprotected sex are less likely to patronise HCT (OR 0.53) than those that sometimes have unprotected sex while sex workers that are not aware of HCT centres are less likely (OR 0.85) to patronise HCT services.ConclusionFindings demonstrate high risky sexual behaviour that exposes the FSWs to HIV infection. While a significant number of the sex workers have accessed HCT services at some point, many did not patronise within six months to the study. Though many attested to regular visit of NGOs involved in HCT testing in their brothels, there is still need for these NGOs to work with brothel managers. There is also an imperative for sexuality education to reduce high risky behaviour such as unprotected sex.
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