Distribution of cesarean delivery by Robson classification and predictors of postspinal anesthesia hypotension in Windhoek referral hospitals: A cross-sectional study

Background

There are concerns that high cesarean section (CS) rates are driven by nonmedical indications and unmitigated maternal hypotension following spinal anesthesia (SA) has materno fetal effects.

Aims

Our objective was to investigate CS rates using Robson classification, identify patient groups for focused intervention as well as assess the incidence and predictors of maternal hypotension following SA for cesarean delivery.

Subjects and Methods

A cross sectional design was employed over 3 months (February-April, 2019). Data about total deliveries (vaginal and operative) were obtained from the hospital medical records. For parturients who had CS, variables which covered maternal characteristics, conduct of anesthesia, and the index pregnancy according to Robson classification system were entered into a proforma designed for the study.

Results

The total deliveries were 3031, of which 556 were CSs, giving a CS rate of 18.3%. Twenty one nonconsenting parturients were excluded, so 535 responded. Robson groups 5, 10, and 1 combined contributed 75% [401/535] to the overall CS. Two or more previous CS, 29.7% [159/535], was the main indication for performing CS, followed by maternal request 12.9% [69/535]. The incidence of maternal hypotension was 62.6% (293/468); the independent predictors were elective CS and having comorbidities.

Conclusion

We found a low CS rate and Robson groups 5, 10, and 1 were the major contributors - previous CS (≥2) and maternal request were the predominant indications for performing CS. The independent predictors of SA induced hypotension were presence of comorbidities and elective CS.

An Assessment of Perceived Stigmatization of Patients Infected with COVID-19 in the Nation's Epicenter of the Pandemic: A Cross-Sectional Study of Residents of Agege, Lagos, Nigeria

BACKGROUND

In some parts of Africa, the patients and those who survived COVID-19 are stigmatized and this has impeded the response activities put in place to control the pandemic. In spite of this, most efforts in preventing COVID-19 were geared towards the use of non-pharmacologic measures without corresponding measures to dissipate stigmatization in the community. Therefore, this study assessed the factors associated with perceived stigmatization of patients with COVID-19 among residents of Agege local government, Lagos State, Nigeria.

METHODS

We conducted a cross-sectional survey among 333 consenting residents recruited from Agege local government area (LGA) using a multi-stage sampling technique. A semistructure, interviewer-administered questionnaire adapted from the People Living with Human Immunodefiency Virus (PLHIV) Stigma Index was used to collect data on socio-demographic characteristics, knowledge of COVID-19 and perceived stigmatization. Bivariate analysis was done using Chi-square and binary logistic regression was used to identify the determinants of perceived stigmatization at 5% level of significance.

RESULTS

The mean age of the respondents was 35.7 ± 13.6 years. Awareness about COVID-19 outbreak was 95.2%. Television (43.5%) and radio (36.9%) were the two major sources of information on COVID-19 infection and prevention. The proportions of the respondents who had poor knowledge and perceived stigmatization of COVID-19 patients were 50.0% and 47.7% respectively. A higher likelihood of perceived stigmatization was found among those aged 25 - 49 years (aOR= 3.1, 95% CI = 1.4 - 6.7), > 50 years (aOR= 2.1, 95% CI = 1.1 - 3.9) and married respondents (aOR= 1.8, 95% CI = 1.1 - 2.9).

CONCLUSION

The study highlights the poor knowledge about COVID-19 and a high level of stigmatization. Hence, targeted health educational interventions are urgently needed for the residents of Agege, most especially among married respondents as well as the adults.

An Assessment of Perceived Stigmatization of Patients Infected with COVID-19 in the Nation's Epicenter of the Pandemic: A Cross-Sectional Study of Residents of Agege, Lagos, Nigeria

BACKGROUND

In some parts of Africa, the patients and those who survived COVID-19 are stigmatized and this has impeded the response activities put in place to control the pandemic. Inspite of this, most efforts in preventing COVID-19 were geared towards the use of non-pharmacologic measures without corresponding measures to dissipate stigmatization in the community. Therefore, this study assessed the factors associated with perceived stigmatization of patients with COVID-19 among residents of Agege local government, Lagos State, Nigeria.

METHODS

We conducted a cross-sectional survey among 333 consenting residents recruited from Agege local government area (LGA) using a multi-stage sampling technique. A semistructure, interviewer-administered questionnaire adapted from the People Living with Human Immunodefiency Virus (PLHIV) Stigma Index was used to collect data on socio-demographic characteristics, knowledge of COVID-19 and perceived stigmatization. Bivariate analysis was done using Chi-square and binary logistic regression was used to identify the determinants of perceived stigmatization at 5% level of significance.

RESULTS

The mean age of the respondents was 35.7 ± 13.6 years. Awareness about COVID-19 outbreak was 95.2%. Television (43.5%) and radio (36.9%) were the two major sources of information on COVID-19 infection and prevention. The proportions of the respondents who had poor knowledge and perceived stigmatization of COVID-19 patients were 50.0% and 47.7% respectively. A higher likelihood of perceived stigmatization was found among those aged 25 - 49 years (aOR= 3.1, 95% CI = 1.4 - 6.7), > 50 years (aOR= 2.1, 95% CI = 1.1 - 3.9) and married respondents (aOR= 1.8, 95% CI = 1.1 - 2.9).

CONCLUSION

The study highlights the poor knowledge about COVID-19 and a high level of stigmatization. Hence, targeted health educational interventions are urgently needed for the residents of Agege, most especially among married respondents as well as the adults.

Aflatoxin awareness and Aflasafe adoption potential of Nigerian smallholder maize farmers: OPEN ACCESS

Aflatoxin is a potent mycotoxin that can cause cancer and death and is associated with stunted growth. Prevalence of aflatoxin is widespread in Africa negatively impacting health and trade. Aflasafe is a biological control product that can be applied to maize or groundnut fields to reduce aflatoxin contamination. This study examines the levels of aflatoxin and Aflasafe awareness and understanding among smallholder maize farmers in Nigeria. In addition, the factors affecting Aflasafe purchase patterns and sustained usage over multiple growing seasons by farmers were evaluated. In-person surveys of 902 Nigerian smallholder farmers were conducted during October and November of 2016. This work contributes to the existing literature by documenting awareness levels of aflatoxin and use of Aflasafe as a control in Nigeria. Results suggest that the level of awareness of aflatoxin was very high in states where Aflasafe was promoted as an intervention for aflatoxin management. In Kaduna state, the region with the longest intervention, there was a consistent increase in the usage of Aflasafe since its introduction in 2010. Furthermore, farmers who purchase Aflasafe bundled (combined) with other inputs were more likely to persist in using the product. Education was found to significantly and positively impact continued usage of Aflasafe. Continued interventions, promotion and general education of the public are recommended for increased awareness, trial, and adoption of Aflasafe in Nigeria.

Biological control of aflatoxins in Africa: current status and potential challenges in the face of climate change

Aflatoxin contamination of crops is frequent in warm regions across the globe, including large areas in sub-Saharan Africa. Crop contamination with these dangerous toxins transcends health, food security, and trade sectors. It cuts across the value chain, affecting farmers, traders, markets, and finally consumers. Diverse fungi within Aspergillus section Flavi contaminate crops with aflatoxins. Within these Aspergillus communities, several genotypes are not capable of producing aflatoxins (atoxigenic). Carefully selected atoxigenic genotypes in biological control (biocontrol) formulations efficiently reduce aflatoxin contamination of crops when applied prior to flowering in the field. This safe and environmentally friendly, effective technology was pioneered in the US, where well over a million acres of susceptible crops are treated annually. The technology has been improved for use in sub-Saharan Africa, where efforts are under way to develop biocontrol products, under the trade name Aflasafe, for 11 African nations. The number of participating nations is expected to increase. In parallel, state of the art technology has been developed for large-scale inexpensive manufacture of Aflasafe products under the conditions present in many African nations. Results to date indicate that all Aflasafe products, registered and under experimental use, reduce aflatoxin concentrations in treated crops by >80% in comparison to untreated crops in both field and storage conditions. Benefits of aflatoxin biocontrol technologies are discussed along with potential challenges, including climate change, likely to be faced during the scaling-up of Aflasafe products. Lastly, we respond to several apprehensions expressed in the literature about the use of atoxigenic genotypes in biocontrol formulations. These responses relate to the following apprehensions: sorghum as carrier, distribution costs, aflatoxin-conscious markets, efficacy during drought, post-harvest benefits, risk of allergies and/or aspergillosis, influence of Aflasafe on other mycotoxins and on soil microenvironment, dynamics of Aspergillus genotypes, and recombination between atoxigenic and toxigenic genotypes in natural conditions.

Effects of the novel BK (KCa 1.1) channel opener GoSlo-SR-5-130 are dependent on the presence of BKβ subunits

BACKGROUND AND PURPOSE

GoSlo-SR compounds are efficacious BK (KCa 1.1) channel openers, but little is known about their mechanism of action or effect on bladder contractility. We examined the effects of two closely related compounds on BK currents and bladder contractions.

EXPERIMENTAL APPROACH

A combination of electrophysiology, molecular biology and synthetic chemistry was used to examine the effects of two novel channel agonists on BK channels from bladder smooth muscle cells and in HEK cells expressing BKα alone or in combination with either β1 or β4 subunits.

KEY RESULTS

GoSlo-SR-5-6 shifted the voltage required for half maximal activation (V1/2 ) of BK channels approximately -100 mV, irrespective of the presence of regulatory β subunits. The deaminated derivative, GoSlo-SR-5-130, also shifted the activation V1/2 in smooth muscle cells by approximately -100 mV; however, this was reduced by ∼80% in HEK cells expressing only BKα subunits. When β1 or β4 subunits were co-expressed with BKα, efficacy was restored. GoSlo-SR-5-130 caused a concentration-dependent reduction in spontaneous bladder contraction amplitude and this was abolished by iberiotoxin, consistent with an effect on BK channels.

CONCLUSIONS AND IMPLICATIONS

GoSlo-SR-5-130 required β1 or β4 subunits to mediate its full effects, whereas GoSlo-SR-5-6 worked equally well in the absence or presence of β subunits. GoSlo-SR-5-130 inhibited spontaneous bladder contractions by activating BK channels. The novel BK channel opener, GoSlo-SR-5-130, is approximately fivefold more efficacious on BK channels with regulatory β subunits and may be a useful scaffold in the development of drugs to treat diseases such as overactive bladder.

Persistent current and Drude weight for the one-dimensional Hubbard model from current lattice density functional theory

The Bethe ansatz local density approximation (LDA) to lattice density functional theory (LDFT) for the one-dimensional repulsive Hubbard model is extended to current-LDFT (CLDFT). The transport properties of mesoscopic Hubbard rings threaded by a magnetic flux are then systematically investigated by this scheme. In particular we present calculations of ground state energies, persistent currents and Drude weights for both a repulsive homogeneous and a single impurity Hubbard model. Our results for the ground state energies in the metallic phase compare favorably well with those obtained with numerically accurate many-body techniques. Also the dependence of the persistent currents on the Coulomb and the impurity interaction strength, and on the ring size are all well captured by LDA-CLDFT. Our study demonstrates the value of CLDFT in describing the transport properties of one-dimensional correlated electron systems. As its computational overheads are rather modest, we propose this method as a tool for studying problems where both disorder and interaction are present.

Exchange parameters from approximate self-interaction correction scheme

The approximate atomic self-interaction correction (ASIC) method to density functional theory is put to the test by calculating the exchange interaction for a number of prototypical materials, critical to local exchange and correlation functionals. ASIC total energy calculations are mapped onto a Heisenberg pairwise interaction and the exchange constants J are compared to those obtained with other methods. In general the ASIC scheme drastically improves the band structure, which for almost all the cases investigated resemble closely available photoemission data. In contrast the results for the exchange parameters are less satisfactory. Although ASIC performs reasonably well for systems where the magnetism originates from half-filled bands, it suffers from similar problems than those of local density approximation for other situations. In particular, the exchange constants are still overestimated. This reflects a subtle interplay between exchange and correlation energy, not captured by the ASIC.

Beyond prejudice as simple antipathy: hostile and benevolent sexism across cultures

The authors argue that complementary hostile and benevolent components of sexism exist across cultures. Male dominance creates hostile sexism (HS), but men's dependence on women fosters benevolent sexism (BS)--subjectively positive attitudes that put women on a pedestal but reinforce their subordination. Research with 15,000 men and women in 19 nations showed that (a) HS and BS are coherent constructs that correlate positively across nations, but (b) HS predicts the ascription of negative and BS the ascription of positive traits to women, (c) relative to men, women are more likely to reject HS than BS, especially when overall levels of sexism in a culture are high, and (d) national averages on BS and HS predict gender inequality across nations. These results challenge prevailing notions of prejudice as an antipathy in that BS (an affectionate, patronizing ideology) reflects inequality and is a cross-culturally pervasive complement to HS.

Beyond prejudice as simple antipathy: hostile and benevolent sexism across cultures

The authors argue that complementary hostile and benevolent components of sexism exist across cultures. Male dominance creates hostile sexism (HS), but men's dependence on women fosters benevolent sexism (BS)--subjectively positive attitudes that put women on a pedestal but reinforce their subordination. Research with 15,000 men and women in 19 nations showed that (a) HS and BS are coherent constructs that correlate positively across nations, but (b) HS predicts the ascription of negative and BS the ascription of positive traits to women, (c) relative to men, women are more likely to reject HS than BS, especially when overall levels of sexism in a culture are high, and (d) national averages on BS and HS predict gender inequality across nations. These results challenge prevailing notions of prejudice as an antipathy in that BS (an affectionate, patronizing ideology) reflects inequality and is a cross-culturally pervasive complement to HS.

A multicultural study of stereotyping in English-speaking countries

Citizens of 9 different English-speaking countries (N = 619) evaluated the average, or typical, citizen of 5 English-speaking countries (Great Britain, Canada, Nigeria, United States, Australia) on 9 pairs of bipolar adjectives. Participants were drawn from Australia, Botswana, Canada, Kenya, Nigeria, South Africa, the United States, Zambia, and Zimbabwe. There were statistically significant similarities in the rankings of the 5 stimulus countries on 8 of the 9 adjective dimensions and a strong convergence of autostereotypes and heterostereotypes on many traits. The results relate to previous stereotyping research and traditional methods of assessing the accuracy of national stereotypes.

Depression and suicidal preoccupation in South African students

Xhosa, Zulu, and colored students in South Africa did not differ on depression scores, but there was some evidence that the pattern of the symptoms of depression differed among the three groups.

Cross-cultural aspects of fears in African children and adolescents

The purpose of this study was to compare level and type of fears in Nigerian and Kenyan children using the Fear Survey Schedule for Children, Revised (FSSC-R; [Ollendick, T.H. (1983). Reliability and validity of the Revised Fear Survey Schedule for Children (FSSC-R). Behaviour Research and Therapy, 21, 685-692]). A total of 852 males and females between the ages of 8 and 17 were surveyed. Results indicated that Nigerian children reported significantly higher total fear than Kenyan children and that scores from both countries were higher than those found in the United States, Australia and China. This suggests that the cultures of Kenya and Nigeria may share a common variable that makes reporting of fears greater than that reported by children of other world cultures. In addition, Christian children in both countries reported higher levels of fear on several factors than Muslim children, indicating that Islamic beliefs may encourage children to report less fear or to deal with their fears better than Christian beliefs. Finally, children between the ages of 8 and 12 reported greater fear of the unknown than children between 13 and 17 years of age. Overall, these findings suggest that important cultural, religious and age differences exist for levels of childhood fears reported in Nigeria and Kenya.

Attitudes about suicide in Zambian and Nigerian students

215 Zambian Lozi-speaking students viewed suicide as more normal and acceptable than did 203 Nigerian Yoruban students, also as more serious, and more often as having clear motives.

Australian and South African undergraduates' HIV-related knowledge, attitudes, and behaviors

To understand safe sex behavior in two countries which have been differentially affected by the HIV/AIDS epidemic, the present study compared the AIDS-related knowledge, attitudes, and behaviors of 920 heterosexual undergraduate students in Australia and 228 heterosexual undergraduate students in South Africa. South African students were found to have significantly less knowledge about HIV/AIDS, and significantly less favorable attitudes toward safe sex behavior than their Australian counterparts. They were also more likely to report that they have avoided various groups of people for fear of contracting AIDS. Experience from Australia over the period 1986-1995 suggests that significant improvements in the AIDS-related knowledge, attitudes, and behaviors of South African undergraduates are achievable.

HIV/AIDS-related social anxieties in adolescents in three African countries

This study examines the social anxieties associated with HIV prevention in adolescents in three African countries (Nigeria, Kenya, and Zimbabwe). The subjects used in this study were black Africans in form 2 or grade 10 in public high schools (Nigeria, n = 387; Kenya, n = 274; Zimbabwe n = 313). Subjects responded to the 33 item AIDS Social Assertiveness Scale (ASAS). Data indicated similar factor structures for each of the three countries and included five factors. The combined sample factor intercorrelations were modestly but significantly correlated. The mean scores for each factor were compared, and ANOVA of the factors by country, by gender, and by interaction between country and gender were performed. The factor structures were very similar between countries, each including five factors that had similar themes: condom interactions, refusal of risk, confiding in significant others, contact with people with HIV/AIDS, and general assertiveness. These factor structures were also very similar to one found in previous studies of Australian adolescents on the ASAS. The Kenyan means for four of the five factors were significantly lower than those for Nigeria, and were also significantly lower than the Zimbabwean means for two of the five factors, suggesting that Kenyan students are less anxious about social situations related to HIV/AIDS than others. Significant variance was found for several factors due to gender, country, and the interaction between gender and country. These results have important implications for designing education programs. The similarities of anxieties regarding HIV/AIDS social situations suggest that these clusters of social barriers to reduction of HIV infection risk might form the basis of educational interventions, and that dimensions of HIV social anxieties are similar across countries.

Using metaphors to assess anticipatory perceptions of personal death

The Revised Death Fantasy Scale (RDFS) is an 18-item measure based on metaphors of personal death. It was constructed to assess psychological aspects of contemplating personal death, at levels of awareness less conscious than those tapped by conventional self-report measures. It contains two subscales: Positive Metaphors and Negative Metaphors. In several studies the RDFS has shown evidence of reliability and validity. The scale may be potentially useful in health-related research and in the training and support of individuals whose work is related to death and dying.

Fears in American, Australian, Chinese, and Nigerian children and adolescents: a cross-cultural study

The fears of childhood and adolescence may differ from one cultural context to another. We explored this possibility in 1200 American, Australian, Chinese, and Nigerian children and adolescents between 7 and 17 years of age. Responses to a standard fear survey schedule revealed significant differences in the number, content, pattern, and level of fears. Nigerian children and adolescents endorsed fears at higher levels than American, Australian, or Chinese youth who did not differ from one another. However, differences in the pattern and content of fears for boys and girls of different ages were noted across the countries. Results were interpreted within a cultural context, which suggested that cultures which favor inhibition, compliance, and obedience serve to increase levels of fear. Alternative interpretations are offered and limitations of cross-cultural research are explored.

Depression in Nigerian and American students

112 college students in America and 180 Muslim Yoruban students in Nigeria obtained similar scores on the Beck Depression Inventory. Although they differed in their response to seven of the 21 items, no clear general pattern of differences emerged.

Gender and depression in undergraduates: a comment

Gender differences in responses of 376 students to the Beck Depression Inventory for American and Nigerian students did not replicate 1994 results reported by Nolan and Willson.

Fears of AIDS in Nigerian students: dimensions of the fear of AIDS Scale (FAIDSS) in west Africa

A study based on a sample of 2500 individuals aged 18 years and over in six west African cities was undertaken for the purpose of determining the cross-cultural consistency and replicability of fears about AIDS. A factor analysis of the data obtained confirmed a similar factor structure to that reported in Australia. Implications for the prevention of HIV transmission in Nigeria and other west African countries is discussed. Our findings showed that the fear of AIDS Scale (FAIDSS) is a reliable index of fear of aids and is readily scaleable. Other implications for health education are considered.

Death anxiety and death denial: Nigerian and Australian students' metaphors of personal death

Ninety-two Nigerian students and 114 Australian students completed Templer's (1970) Death Anxiety Scale (DAS) and Feifel and Nagy's (1981) death fantasy measure of positive and negative death metaphors. They were each also asked to write his or her own metaphor of personal death. Results of the DAS showed that the two groups did not differ significantly on the level of conscious death anxiety, but Nigerian students' scores were significantly higher on both positive and negative personal death metaphors scales. Also, significantly more Nigerian students wrote personal metaphors of their own and more often used a neutral metaphor to describe their personal death. Australian students more often used a positive or a negative metaphor. The Nigerian students thus evidenced less death denial than the Australian students did.

Sex differences in preferences for ideal female body shape

The investigator aimed to replicate on an African sample Fallon and Rozin's (1985); Huon, Morris, and Brown's (1990); and Tiggemann and Pennington's (1990) findings of sex differences in female body preferences. Males and females were asked to identify their ideal female body shape and the one they believed men and women in general would prefer. A simple analysis of variance and t test demonstrated a discrepancy between women's actual and preferred body sizes, while the males knew the females' preferred size. These findings support the previous studies. The female undergraduates' and adult women's consistently negative evaluations of their own body compared with their ideal or preferred body are explored and found to result from being subjected to implicit pressures toward thinness not suffered by their male counterparts. Recommendations for future research are made.

Perception of visual illusions in a sample of Nigerian children

This study examined the effects of cultural factors on perception of 15 boys and 21 girls in Nigeria. The five geometric illusions of Segall, Campbell, and Herskovitz were shown in booklets. Previously tested Afghan boys gave evidence of greater illusion than the Nigerian children. The findings also supported previous research on perception of illusion.

Influence of urban-rural upbringing on Nigerian students' test anxiety

To examine the effects of urban and rural upbringing on test anxiety 221 Nigerian high school students completed measures of test anxiety and environment/academic performance. Analysis showed that younger urban groups scored better than older rural groups in academic performance, rural students having high scores in environment/academic performance scales. The findings corroborate earlier work on urban and rural upbringing and text anxiety. Suggestions for cross-cultural research which incorporates test anxiety and the construct of concentration are detailed.