University College Hospital, Ibadan

The 4th UN General Assembly declaration on non-communicable diseases (NCDs) and mental health, adopted on Dec 15, 2025, was notable for its explicit inclusion of dementia, bringing dementia prevention into focus as an international public policy priority.1 A central question therefore becomes how dementia prevention will be prioritised, resourced, and implemented and how it will be integrated into existing NCD policies and health-system strategies (appendix).

Spirituality is deeply embedded in childbirth experiences among Nigerian women; yet, its integration into maternity care remains limited, especially at the primary health care (PHC) level. This study explored the barriers and facilitators to integrating spirituality in childbirth among PHC workers in Ogbomoso, Nigeria. An exploratory qualitative research design was used, involving semi-structured interviews with ten purposively selected female PHC workers from selected health centers. Participants were mostly aged 41-50years, predominantly Christian, and had 11-20years of professional experience. Thematic analysis generated six themes as barriers to integrating spirituality: safety concerns related to harmful or unsterile spiritual items; concerns about disturbance from loud prayers disrupting the ward environment; heavy workload limiting attention to non-clinical needs; lack of training on spiritual care beyond prayer; time constraints, particularly during emergencies; and personal beliefs of health workers which sometimes conflicted with patients' spiritual preferences. Facilitators to integrating spirituality generate four themes: strong rapport between patients and caregivers, a calm and organized clinical environment, allowing access to personal spiritual items like scriptures or prayer beads, and supportive management policies that enabled flexibility without compromising care. The findings suggest that while spirituality is valued, systemic, institutional, and individual-level factors influence its implementation. Integrating spiritual care into PHC will require targeted training, staffing improvements, clear policies, and culturally sensitive guidelines to ensure holistic and respectful maternal care.

Transient ischaemic attack (TIA) represents a critical window for stroke prevention, yet physician knowledge and system readiness vary across healthcare settings. Evidence describing national patterns of TIA management knowledge among physicians in low- and middle-income countries remains limited. This national cross-sectional survey aims to evaluate Nigerian physicians’ knowledge of TIA diagnosis and management, identify factors associated with adequate knowledge, and explore perceived barriers to optimal TIA care. A nationwide descriptive cross-sectional survey was conducted among licensed medical doctors practicing in Nigeria using a structured online questionnaire. Knowledge of TIA presentation, investigations, and management was assessed using a composite scoring system categorized as poor, fair, or good. Descriptive statistics summarized participant characteristics and knowledge patterns. Bivariate analyses and multinomial logistic regression were performed to identify independent predictors of knowledge level. A total of 404 physicians participated. Overall, 38.1% demonstrated good knowledge of TIA management, while 40.6% had fair knowledge and 21.3% had poor knowledge. Most respondents correctly identified the high early risk of stroke following TIA (79.0%) and recommended urgent brain imaging (80.2%) and vascular imaging (76.5%). However, only 30.2% had received formal TIA training within the previous five years, and fewer than one-third reported the presence of local referral pathways. The most frequently reported barriers included patient-related factors (71.0%), limited access to urgent neuroimaging (61.4%), and lack of guideline-based protocols (38.9%). Multinomial logistic regression analysis demonstrated significant regional variation in knowledge levels, with lower odds of good knowledge observed outside the South-West region. While Nigerian physicians demonstrate moderate awareness of key TIA management principles, important gaps remain in guideline-based practice and system-level readiness. Targeted educational initiatives, improved access to neuroimaging, and development of structured referral pathways may enhance early stroke prevention efforts.

Background: Understanding the patterns of documentation among endodontic caregivers, ranging from students and registrars to consultants, can provide valuable insights into systemic strengths and weaknesses within dental service delivery frameworks. Objective: This study evaluated the adequacy of radiographic documentation in endodontic treatment, assessing the frequency of preoperative, intraoperative, and postoperative radiographs, and determining factors associated with adequate reportage. Methods: A retrospective review was conducted on 357 patient records treated for endodontic conditions at a tertiary dental hospital. Data extracted included demographic variables, designation of the attending caregiver, radiographic documentation, diagnosis, and treatment type. Adequacy of radiographic reportage was defined by inclusion of the coronal surface, apical structures, periodontal ligament space, and canal patency in the recorded findings. Descriptive and inferential statistics, including chi-square tests, were performed at a 5% significance level. Results: Patients were predominantly aged 20–29 years (25.2%) and female (56.0%). Most treatments were rendered by registrars (88.2%). Although 96.9% of cases had preoperative radiographs, and 88.5% and 85.7% had master cone and obturation radiographs respectively, only 16.2% of records met the criteria for adequate documentation. Acute apical periodontitis (36.4%) was the most common diagnosis, and conventional root canal therapy accounted for 86.8% of treatments. The association between caregiver designation and adequacy of radiographic documentation was not statistically significant (p = 0.287). Conclusion: While radiographs were widely utilized in endodontic care, comprehensive documentation was suboptimal. Structured training and adherence to documentation protocols are essential to improve radiographic reporting standards and ensure medico-legal accountability in clinical practice.

Abstract Background Each year, about 70,000 women die from bleeding after childbirth. Maternal anaemia increases the risk of postpartum bleeding. WHO recommends that treatment for postpartum haemorrhage should begin if there is blood loss ≥300 ml with abnormal haemodynamic signs (including elevated shock index) or blood loss ≥500 ml within 24 hours of birth. The prevalence of anaemia is highest in Sub-Saharan Africa and South Asia and these regions also have the highest maternal death rates. We examine the effect of severe anaemia (haemoglobin <70 g/L) compared to moderate anaemia (haemoglobin 70-99 g/L) on shock in 15066 women giving birth in Nigeria, Pakistan, Tanzania and Zambia. Methods We conducted a cohort analysis of data from the WOMAN-2 trial. We report mean and median estimated blood loss and the number of women with blood loss ≥1L, stratified by anaemia severity. We defined shock as post birth shock index >1.3. We define shock index as heart rate ÷ systolic blood pressure. We use multivariable logistic regression to calculate an odds ratio for the effect of severe anaemia on shock, adjusting for estimated blood loss, antepartum haemorrhage or placenta abnormalities, infection and hypertension. Results Mean (SD) estimated blood loss was 306 (177) ml in women with moderate anaemia compared to 339 (269) ml for severe anaemia. Median (IQR) estimated blood loss was 280 (200-350) ml for moderate anaemia versus 290 (200-360) ml for severe anaemia. Blood loss ≥1L occurred in 1.2% (156/12982) of women with moderate anaemia versus 2.9% (60/2076) with severe anaemia (OR=2.45 95%CI 1.81-3.31). Shock occurred in 0.8% (103/12,974) of women with moderate anaemia versus 2.3% (48/2,070) with severe anaemia. Severe anaemia tripled the odds of shock (OR=3.35, 95%CI 2.34-4.81). After adjusting for blood loss and other factors, severe anaemia more than doubled the odds of shock (aOR=2.39, 95%CI 1.59-3.58). Conclusions For any given blood loss, women with severe anaemia are more likely to become shocked. Preventing and treating anaemia in women of reproductive age must be a public health priority.

Background: Unintended pregnancy continues to be a huge public health problem in sub-Saharan Africa (SSA), including in Southern Africa, where adolescent girls and young women (AGYW) face higher risks. Therefore, this study aimed to determine the multilevel factors associated with unintended pregnancy among AGYW in Southern Africa. Methods: This study analysed a weighted sample of 20,748 AGYW (15–24 years) drawn from the most recent Demographic and Health Surveys (DHSs) in nine Southern African countries. We fitted multilevel logistic regression models to examine multilevel factors associated with unintended pregnancy at p < 0.05 statistical significance. Results: The pooled prevalence of unintended pregnancy among AGYW in Southern Africa was 39.1% (95% CI: 38.8–40.1). Higher odds of unintended pregnancy were observed among AGYW with secondary education (aOR=1.88, 95% CI: 1.65–2.13), those exposed to media (aOR=1.14, 95% CI: 1.06–1.22), contraceptive users (aOR=1.24, 95% CI: 1.16–1.33), and urban residents (aOR=1.19, 95% CI: 1.10–1.30). However, AGYW aged 20–24 years (aOR=0.64, 95% CI: 0.60–0.69), and those with a history of pregnancy loss (aOR=0.78, 95% CI: 0.69–0.89) were associated with lower odds of unintended pregnancy. Conclusion: This study found several multilevel factors associated with unintended pregnancy among AGYW. Governments and sexual and reproductive health (SRH) programmes in Southern Africa should priorities targeted youth‑friendly services, expand access to SRH services, and tailor interventions to national and local contexts to reduce unintended pregnancies among AGYW in the region.

Exclusive breastfeeding (EBF) remains a key public health strategy for improving infant and maternal outcomes. In Nigeria, despite policy commitments, EBF practice rates remain inconsistent and highly context-dependent. This integrative review assesses the prevalence and patterns of EBF in Nigeria, examines the socio-demographic and systemic factors influencing practice, identifies barriers and enablers, and evaluates existing interventions to promote EBF. Nineteen peer-reviewed primary studies, published between 2013 and 2024, were systematically identified across six geopolitical zones. Data were extracted from PubMed, ScienceDirect, and the University of Hull library database using a PRISMA search strategy, and synthesis followed a deductive coding framework, drawing on qualitative and quantitative findings. The theoretical frameworks for this review were the Socio-Ecological Model (SEM) and the Health Belief Model (HBM), which provide insights into the influence of individual, interpersonal, community, and societal factors on exclusive breastfeeding practices in Nigeria. Analysis of 19 studies in Nigeria revealed that the percentage of women that exclusively breastfed their infant from birth to six months averaged 46.4% (range 12.5%–73.8%), while early initiation within one hour of delivery averaged 57.3%. Despite high awareness, a significant “knowledge-practice gap” exists due to complex socio-contextual and maternal factors. Higher EBF rates correlate with maternal age (31+), tertiary education, and hospital deliveries. Conversely, employment in the formal sector often hinders EBF due to short maternity leave. Primary barriers include cultural myths (viewing colostrum as “dirty” or breastmilk as “insufficient” without water) and lack of spousal/family support. Facilitators include healthcare engagement (ANC/PNC) and high maternal self-efficacy. The review also identified gaps in research, including the limited inclusion of fathers, informal caregivers, and mothers in displaced or rural communities. This review advances the literature by offering a context-sensitive, multi-dimensional interpretation of EBF practices in Nigeria. It highlights the need for equity-focused policies and interventions that move beyond individual awareness to address structural enablers of maternal capabilities.

Teenage pregnancy in Nigeria hinders girls’ educational attainment and is often influenced by cultural norms that restrict discussions about sex and access to health information. Guided by Bronfenbrenner’s Ecological Systems Theory, this study explored how cultural values affect sexual health knowledge and its relationship with academic achievement among pregnant adolescents. A cross-sectional survey was conducted with 400 pregnant teenagers aged 15–19 across three Nigerian states (Niger, Lagos, and Port Harcourt). Participants were selected through a purposive snowball sampling. Data were analysed using SPSS Version 23, applying descriptive statistics and inferential analyses through Structural Equation Modelling (SEM). Cultural values were significantly negatively associated with sexual health knowledge (β = − 0.414, p < 0.001). Sexual health knowledge positively predicted academic achievement (β = 0.392, p < 0.001) and significantly mediated the relationship between cultural values and academic outcomes (βₐb = − 0.136, p < 0.001). Cultural beliefs at the macrosystem level limit sexual health literacy, which in turn affects the academic outcomes of pregnant teenagers. Enhancing comprehensive sexuality education, addressing cultural taboos, and fostering supportive school environments are crucial to improving both reproductive health awareness and academic performance among this vulnerable population.

Underdiagnosis of cardiometabolic risk factors (CMRFs) may represent an unrecognised biological pathway contributing to dementia risk; yet remains poorly characterised in African and African diaspora populations. We quantified the prevalence and determinants of underdiagnosed hypertension and abnormal glycaemia across four cohorts comprising up to 7,000 adults aged ≥ 40 years from Nigeria, Kenya, and The United States: Indianapolis, and North Texas. Underdiagnosis was defined as absence of self-reported diagnosis despite elevated systolic blood pressure (≥ 130 mmHg) or fasting blood glucose (≥ 100 mg/dL). Cohort-stratified analyses examined demographic, socioeconomic, cognitive, Alzheimer’s genetic, and blood-based biomarker correlates. Underdiagnosis was pervasive in African cohorts. Elevated fasting glucose was associated with cognitive impairment in Kenya and North Texas, while severe hypertension and diabetes were linked to Alzheimer’s disease-related biomarkers [pTau217/181, NFL and Aβ42/40] in North Texas (all p ≤ 0.05). These findings identify context-specific diagnostic gaps in populations at high dementia risk and highlight cardiometabolic detection as a mechanistic target for prevention.