West Africa Journal of Medicine

EDITORIAL: Emerging Technologies in Health Care: Bridging the Promise and the Gaps

G. E. Erhabor — Mon, 30 Jun 2025 00:00:00 +0000

We are delighted to present this edition of the journal, featuring a diverse range of articles that address some of the most pressing health issues across the region. The papers in this issue reflect the growing breadth and depth of medical scholarship in Africa-encompassing innovative technologies, evolving clinical practices, and persistent systemic challenges. Together, they underscore the complexity of healthcare in our setting and the continuing efforts of researchers and practitioners to improve outcomes through evidence, creativity, and collaboration.

In the rapidly changing world of medicine, the boundary between human intelligence and machine precision continues to blur. The current issue of the West African Journal of Medicine presents three compelling papers that together invite reflection on Africa’s position in this evolving frontier. They span the spectrum-from the promise of artificial intelligence and robotics in healthcare delivery to the persistent challenges of financing chronic disease care. Collectively, they remind us that the continent’s future in health care will depend not only on its openness to innovation but also on its ability to ensure that such innovations are accessible, affordable, and equitable. The role of artificial intelligence within the field of medicine is becoming increasingly ubiquitous and critical. In addition to its application in medical education, artificial intelligence is transforming nearly every aspect of medicine-from enhancing diagnosis and imaging interpretation, to guiding surgical precision, personalizing treatment, monitoring patients in real time, streamlining health records, and accelerating drug discovery.^1-4

The review article by Akanbi and colleagues is both an exposition and a call to action. It highlights the transformative role of artificial intelligence (AI) in clinical practice and challenges African practitioners to move from spectators to contributors in this global revolution. Drawing on over seventy articles from multiple databases, the authors provide an instructive overview of AI concepts, terminologies, and applications across medicine-from image interpretation and predictive analytics to surgical guidance and drug development. They note that AI technologies are already enhancing diagnostic accuracy in radiology, ophthalmology, oncology, and cardiology, while enabling remote monitoring, decision support, and personalized treatment strategies. Yet, the authors also emphasize a glaring paradox: while AI is reshaping global health, many clinicians in sub-Saharan Africa remain unfamiliar with its principles and possibilities. This knowledge gap, compounded by infrastructural limitations and ethical concerns, risks widening the divide between technologically advanced and resource-constrained regions. The continent must build capacity, strengthen regulatory frameworks, and create local datasets that reflect its unique patient populations. Only then can Africa move from being a consumer of imported algorithms to a co-creator of context-relevant AI solutions.^6,8

In their work, Sanusi et al highlight the practical application of these emerging technologies in the rehabilitation of stroke survivors. Their study provides a rare insight into the realities of adopting high-tech innovations in a resource-limited setting. Using a qualitative design, the authors engaged 52 stroke survivors attending neurology clinics in two tertiary hospitals in Nigeria to explore their awareness, perceptions, and readiness to participate in a robotic rehabilitation programme. The findings were striking: more than half of respondents had no prior knowledge of robotic rehabilitation, and nearly half identified financial constraints, transportation difficulties, and distance to care as major barriers to participation. Facilitators, on the other hand, included increased awareness, patient education, and transportation support.

Beyond statistics, Sanusi et al. draw attention to deeper structural issues-from limited technological infrastructure and shortage of trained personnel to the absence of targeted health financing for rehabilitation services. While patients expressed optimism about trying robotic therapy if proven effective, the study underscores a broader challenge: the readiness of the health system to accommodate innovation. In essence, the study illustrates that technological breakthroughs alone are insufficient; their success depends on cultural acceptance, financial accessibility, and system preparedness. It reinforces the need for an ecosystem that supports innovation adoption — where policy, training, and patient engagement evolve alongside technology.^5–7

At the other end of the spectrum, Mariere and colleagues remind us of the enduring socioeconomic realities confronting patients in low- and middle-income countries. Their paper examined how individuals living with long-term conditions such as hypertension, diabetes, tuberculosis, and HIV navigate the costs of care in Bayelsa State, Nigeria. Involving patients across three specialist hospitals, the study paints a sobering picture: nearly four in five patients pay for care out-of-pocket, and even among those enrolled in health insurance schemes, many still resort to additional personal spending. Coping mechanisms were often economically distressing-missing clinic visits, forfeiting essential needs, or borrowing money from friends and cooperatives. The type of chronic disease influenced both the payment method and coping pattern, with patients managing non-communicable diseases being somewhat more likely to use health insurance than those with communicable diseases. This study vividly demonstrates the financial fragility of healthcare access in the subregion. Despite the introduction of state and national insurance schemes, coverage remains shallow, leaving many households exposed to catastrophic expenditures. These findings further underscore one of the major limitations to the potential integration of technological and therapeutic advances in medical care i.e. the barrier of access and affordability.

Together, these articles thus illuminate the intertwined challenges and opportunities confronting African health systems. The message is clear: technological progress must be matched by social preparedness and systemic reform. AI and robotics hold immense potential to revolutionize medical education, diagnostics, rehabilitation, and patient management. Yet, these innovations can only reach their full impact if our health systems are equipped-financially, ethically, and infrastructurally-to support them. The future of healthcare in West Africa depends on empowering healthcare workers to harness emerging technologies, strengthening systems through investment in infrastructure and local research, and ensuring that innovation reaches everyone, regardless of poverty, geography, or digital literacy. Only by aligning technological progress with equity and preparedness can the region build a truly resilient and inclusive health system. The challenge before us is to ensure that the digital transformation of healthcare becomes not a new source of inequity, but a catalyst for shared progress across the continent.

As we reflect on the contributions in this issue, we are reminded that the advancement of medicine in our region depends on continuous inquiry, innovation, and collaboration. Each study featured here adds to the growing body of knowledge that informs practice and policy across West Africa. We encourage researchers, clinicians, and scholars to continue sharing their experiences and findings through this platform, so that together we can strengthen the evidence base for improving health outcomes in our communities. The West African Journal of Medicine remains committed to promoting rigorous scientific discourse and welcomes submissions that contribute to the pursuit of excellence in healthcare across the subregion.

Prof G.E Erhabor

Editor-in-Chief

REFERENCES

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Zarei M, Mamaghani HE, Abbasi A, Hosseini MS. Application of artificial intelligence in medical education: A review of benefits, challenges, and solutions. Medicina Clínica Práctica. 2024;7(2):100422.
Mirbabaie M, Stieglitz S, Frick NR. Artificial intelligence in disease diagnostics: A critical review and classification on the current state of research guiding future direction. Health and Technology. 2021;11(4):693-731.
Zhang K, Yang X, Wang Y, Yu Y, Huang N, Li G, et al. Artificial intelligence in drug development. Nature medicine. 2025;31(1):45-59.
Randhawa K, Vanhaverbeke W, Ritala P. Legitimizing digital technologies in open innovation ecosystems: Overcoming adoption barriers in Healthcare. California Management Review. 2024;67(1):45-68.
Agbeyangi AO, Lukose JM. Telemedicine adoption and prospects in sub-Saharan Africa: a systematic review with a focus on South Africa, Kenya, and Nigeria. Healthcare (Basel). 2025;13(7):762.
Olajubu AO, Fajemilehin BR, Olajubu TO, Afolabi BS. Effectiveness of a mobile health intervention on uptake of recommended postnatal care services in Nigeria. Plos one. 2020;15(9):e0238911.
Setia D, Monga S. AI, Development, and Diplomacy: India-Africa Cooperation in the Age of Technology. Indian Journal of African Studies. 2025;26(1-2):177-98.

ORIGINAL: Serial C-reactive Protein and Blood Culture in the Diagnosis of Neonatal Sepsis among Babies with Risk Factors for Sepsis at Uniosun Teaching Hospital, Osogbo, Nigeria

A. O. Omoboyeje , O. J. Adebami, O. A. Oyedeji, A. Ademisoye, V. O. Kayode — Mon, 30 Jun 2025 00:00:00 +0000

Background: Neonatal sepsis (NNS) contributes significantly to morbidity and mortality among newborns, especially in developing countries. Early identification of risk factors is crucial for prompt diagnosis and treatment. This study aimed to investigate utility of serial C-reactive protein (CRP) and blood culture in the diagnosis of neonatal sepsis (NNS) among babies with risk factors for sepsis.

Methodology: All consecutive term babies with maternal and/or neonatal risk factors for sepsis with or without initial symptoms were studied. Blood culture was done for all the participants. The CRP I was done at admission, CRP II at 48 hours and CRP III at 72 hours (a total of 3 samples). The value of CRP ≥10mg/l was considered abnormal.

Results: Of 106 participants, 35 (33%) had positive blood cultures, with Staphylococcus aureus being the prevalent organism. The sensitivity of CRP at the cut off ≥10mg/l was 60%, 69.7%, and 66.7% for CRP I, CRP II and CRP III, with negative predictive value (NPV) of 73.6%,72.2% and 73.8%, respectively. Abnormal temperature, respiratory distress and convulsion at presentation were significantly associated with positive blood culture (p= 0.002, 0.014 and 0.009, respectively). Logistic regression identified abnormal temperature and delivery outside the hospital facility as being significantly related to elevated CRP values (p= 0.027, 0.016).

Conclusion: These findings highlight the importance of utilization of serial CRP tests in the early detection of sepsis in neonates with risk factors.

ORIGINAL: Pattern of Morbidities, Mortality and Healthcare Financing of Hospitalised Medical Patients (MOHOPA): The Study Protocol

Mon, 30 Jun 2025 00:00:00 +0000

MOHOPA (Pattern of Morbidities, Mortality and Healthcare Financing of Hospitalised Medical Patients) Study aimed to determine the pattern of morbidities among patients admitted to the medical wards of 7 Teaching and Specialised Hospitals across Nigeria, the short-term outcomes of admissions and their determinants, challenges of managing the patients, and the pattern of healthcare financing for their care. The primary study outcomes were all-cause mortality (in-hospital and at 12 weeks post-discharge), duration of hospitalisation and rehospitalisation rate. 705 patients were recruited consecutively between May 2023 and March 2024, from Aminu Kano Teaching Hospital, University of Maiduguri Teaching Hospital, Federal Medical Centre Lokoja, University College Hospital, Ibadan, University of Nigeria, Ituku-Ozalla Campus, Enugu, Delta State University Teaching Hospital, Oghara, and University of Abuja Teaching Hospital. Each patient was followed up for 12 weeks or until his/her demise or referral to another facility. We hereby present the detailed study protocol.

ORIGINAL: Burnout Without Borders: Exploring Burnout and the Validity of the Maslach Burnout Inventory Among Medical Students Across Four Countries in Africa

Mon, 30 Jun 2025 00:00:00 +0000

Background: There has been little or no cross-cultural validation study of the Maslach Burnout Inventory (MBI) from sub-Saharan Africa (SSA). This study aims to test three hypotheses among medical students in four selected countries - Ghana, Nigeria, Sierra Leone and Uganda in sub-Saharan Africa (SSA).

Method: This research utilized a cross-sectional design and employed an online self-administered questionnaire. The measurement of burnout was conducted utilizing the Maslach Burnout Inventory General Survey for Students (MBI-GS (S) on Google Form. The survey was distributed via WhatsApp to medical students enrolled in six medical schools across four countries. The statistical analysis was conducted using SPSS AMOS version 24 for Confirmatory Factor Analysis (CFA) with Structural Equation Modelling (SEM).

Result: The prevalence of burnout varied among the medical students in the four countries with Ghana (72.1%) and Nigeria (61.2%) higher than Sierra Leone (59.2%) and Uganda (47.7%). Confirmatory factor analysis showed that the 3-factor structure of the MBI-GS(S) fits both the overall sample and the samples from each of the four individual countries albeit after correlating error terms in the analysis. However, hypothesis 2, which posited structural invariance across the samples from the four countries, was only partially met as the model demonstrated configural invariance across the samples but not metric invariance.

Conclusion: The results of our study provide empirical evidence supporting the presence of burnout among medical students, revealing significant disparities across the participating countries. While the MBI-GS (S) proved to be a useful tool for this assessment, our findings also highlight the challenges of achieving measurement invariance in cross-cultural research, underscoring the need for culturally adaptable methodologies.

ORIGINAL: Limitations to the Implementation of a Robotic Rehabilitation Programme for Stroke Survivors in Nigeria

Mon, 30 Jun 2025 00:00:00 +0000

Background: Stroke remains one of the leading causes of disability worldwide. Arm function recovery is essential for stroke survivors' ability to perform activities associated with daily living. Consequently, impairment in arm function is a significant target for stroke survivors' physical or robotic rehabilitation. This study aims to explore the barriers and facilitators to the implementation of a robotic rehabilitation programme for stroke survivors in a resource-poor setting.

Methods: A cross-sectional design with a qualitative approach was chosen. A semi-structured, interview-based questionnaire was administered and data were collected from stroke survivors presenting at the adult neurology clinic of two tertiary institutions in Nigeria. Data from the interview-based questionnaire were analyzed using descriptive statistics.

Results: A total of 52 stroke survivors participated and were interviewed. More than half (55.8%) of the respondents were elderly, with a male-to-female ratio of 1.6:1. Majority of respondents (58%) had no idea about the use of robotics for stroke rehabilitation. About 44% of the respondents believe that the major determinant of interest in robotics will be favourable outcome after trials on other participants. Lack of financial support and transportation aid constitute barriers, while creation of awareness and the availability of transportation aid from home to hospital were the major facilitators to participation.

Conclusion: These findings highlight the fact that most stroke survivors in the resource-poor setting were not aware of the usefulness of robotics in stroke rehabilitation. Hence, increasing knowledge and creating awareness about robotic rehabilitation will make it more readily acceptable for stroke survivors. KEYWORDS: Barrier, Facilitator, Robotic rehabilitation, Stroke survivors, Implementation.

ORIGINAL: Payment Methods and Coping Strategies for Health Care Costs by Patients with Chronic Diseases in a Low-Middle Income Country

U. I. Mariere, D. S. Ogaji, O. O. Obikeze, A. D. Adesina, S. Babatunde — Mon, 30 Jun 2025 00:00:00 +0000

Background: Chronic diseases contribute the highest to disease burden and deaths worldwide and require long-term access to health care. This study identified the payment methods and coping strategies for healthcare costs by patients with chronic diseases using public health facilities in Yenagoa, Bayelsa State, Nigeria.

Methods: Three hundred and thirty-nine (339) adult patients, being managed for chronic conditions (Hypertension, Diabetes mellitus, Tuberculosis & HIV), were randomly selected from three specialist hospitals that are the major providers of specialized care for patients with chronic diseases in the State. Data on sociodemographic characteristics, morbidity patterns, household financing and coping with health expenditure were collected. Chi-squared test was used to identify significant associations. A p-value 0.05 was considered significant.

Results: Majority were females 211(62%) and about a third were not working 113(33.3%). To pay for their chronic disease healthcare expenses, 268 (79.1%) paid out-of-pocket while 71 (20.9%) used social health insurance. Among the 120 (35.4%) patients who subscribed to a health insurance program, about 2 in 5 still paid out-of-pocket. Missing a clinic visit 145(42.8%) was the common coping strategy followed by patients having to forfeit necessities 113(33.3%) to cope with their healthcare costs. The type of chronic disease was statistically associated with payment methods adopted by patients (p<0.01).

Conclusions: Most patients with chronic diseases rely on out-of-pocket payments for healthcare expenditures including patients with health insurance coverage. This has necessitated households to adopt coping strategies, found to be economically distressing, to source funds for healthcare needs. Targeted programmes are needed for patients with chronic diseases to enhance financial risk protection.

ORIGINAL: Serum Glial Fibrillary Acidic Protein (GFAP) as an Index of Severity and Predictor of Functional Outcome in Acute Stroke

Mon, 30 Jun 2025 00:00:00 +0000

Background: Serum biomarkers, such as glial fibrillary acidic protein (GFAP), have been proposed to accurately assess stroke severity and prognosis. However, there is limited published data on their potential role in resource-limited settings where the stroke burden is highest.

Objective: The study aims to determine the predictive value of the serum level of GFAP in assessing the severity and functional outcome of acute stroke.

Method: This prospective cohort study recruited forty consecutively presenting stroke subjects each for both ischaemic stroke and intracerebral haemorrhage at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife with forty apparently healthy controls. Serum concentrations of GFAP were measured using Enzyme-Linked Immunoassays, and the data were analyzed using Statistical Package for the Social Sciences software with significance at p<0.05.

Result: The median serum GFAP levels among apparently healthy controls, ischaemic stroke group and the ICH group at admission were 18.04 pg/ml, 24.10 pg/ml, and 33.33 pg/ml respectively. At admission, there was a significant difference in the median serum GFAP level in the ICH and apparently healthy control group as well as in the ischaemic stroke group and apparently healthy control group (p = 0.001). The study found no significant correlation between admission NIHSS and serum GFAP levels in both the ischaemic stroke group and the ICH group. In the ICH group, there was an inverse correlation between median serum GFAP level at day 7 and Barthel index at day 7 (p = 0.021) and day 30 (p = 0.001), but a positive correlation with modified Rankin score at day 30 (p = 0.001).

Conclusion: The study found that routine screening for serum GFAP level at admission in ischaemic stroke and ICH does not predict acute stroke severity and does not correlate with functional outcomes. However, Serum GFAP level at day 7 correlated with 30-day functional outcomes for ICH and its usefulness may be explored further in larger studies.

ORIGINAL: Management Challenges of Chronic Suppurative Otitis Media in Sub-Saharan Africa: A Call for Urgent Action

T. O. Adedeji, J. E. Tobih, B. A. Adegbosin — Mon, 30 Jun 2025 00:00:00 +0000

Background: Chronic suppurative otitis media is a serious health care concern in sub-Saharan Africa. Poverty, ignorance, and non-availability of surgical treatment techniques militate against its effective management.

Methods: A retrospective descriptive study conducted at UNIOSUN Teaching Hospital, Osogbo on patients with CSOM over five years.

Results: A total of 428 patients consisting of 232 males and 196 females with age ranged from 1 - 83 years. Children 1-15 years constituted the largest (54.2%) proportion. RCSOM (37.4%), LCSOM (29.9%) and bilateral CSOM (32.7%). Majority (51.4%) had discharge for more than 2 years. Most patients 208 (48.6%) had moderate size perforations and majority (93.5%) were central perforations. Culture results showed pseudomonas 24.3% and staphylococcus aureus 24.3% as the most common organisms isolated. PTA of 152 patients (reviewed) showed that 36.8% had moderate degree of HL and severe degree HL in 26.3%. Ninety four (61.8%) had conductive hearing loss. Hearing loss was significantly associated with the size of perforation (p = 0.001) and duration of ear discharge (p = 0.022). About 99% of patients were managed conservatively with topical ear drops/ dressing with wick gauze impregnated with ciprofloxacin ear drops. Five patients (1.17 %) had tympanoplasty, six (1.40%) had cortical mastoidectomy and 2 (0.47%) patients died secondary to intracranial complications.

Conclusion: Challenges militating against effective management of CSOM in Nigeria include poverty, delayed presentation, few tympanomastoid surgical experts and poor attitude toward surgical procedures. Public enlightenment including early presentation of patients, provision of adequate equipment and focused attention on appropriate surgical techniques should be embarked upon urgently.

REVIEW ARTICLE: Artificial Intelligence in Medical Practice: Time to Join the Global Participants' Train

Mon, 30 Jun 2025 00:00:00 +0000

Background: The application of artificial intelligence (AI) in medical practice is attracting attention in various aspects of disease management. Currently, many doctors lack a basic understanding of this data-driven innovation and are unaware of its potential applications in the field of medicine. This review thus aims to provide an introductory insight into AI, the basic concepts of AI and how it is applicable to medical practice.

Methods: We reviewed the concept of AI by elucidating its fundamental principles and applications in medical practice. Literature searches were conducted on AI using PubMed, Scopus, Google Scholar, and MEDLINE. The search keywords included artificial intelligence, machine learning, AI algorithm, medical application of AI, and the future of AI in medical practice.

Results: Ninety-four articles were initially reviewed, but only 71 met the inclusion criteria. The application of AI in medicine is growing across various aspects of disease management for cancerous and non-cancerous conditions. It has been used for complex procedures, such as robot-assisted surgery, in managing medical information and data, in predictive and precision medicine, and in clinical research.

Conclusion: AI is rapidly transforming the future of human endeavours, and the healthcare community is no exception, with its potential to revolutionise medicine. Incorporating AI into healthcare should be considered a necessity, not just an option. We cannot afford to be passive observers, waiting for others to take the lead.

REVIEW ARTICLE: The Relationship Between Nonalcoholic Fatty Liver Disease and Hepatitis B: Ameliorating or Aggravating? A Systematic Review

S. Abere, B. Oyan, U. F. Okeke — Mon, 30 Jun 2025 00:00:00 +0000

Background/purpose: Chronic Hepatitis B is a global health challenge which has persisted despite universal vaccination against Hepatitis B. The relationship between hepatitis B virus infection and Non-alcoholic Fatty disease (NAFLD) remains unclear thus, a review was carried out to elucidate the nature of the relationship existing between them and the risk factors for this interrelation.

Data source and selection: The accepted guideline for a systematic review was followed. English language-based studies on hepatitis B and NAFLD in adult populations between 2010 -2021 were sourced from CINHAL, PubMed, Medline, Scopus, google scholar and ScienceDirect database.

Data extraction: Following the PICO format, studies which met the inclusion criteria were identified and selected on a Prisma chart. They were further assessed using the modified Newcastle-Ottawa score for the assessment of non-randomized studies.

Result: 11 out of 12,380 studies obtained from multiple databases were included in the review comprising of 128,566 controls and 5177 cases. The relationship between exposure to hepatitis B infection and NAFLD outcome was aggravating, ameliorating and non-existent in six, four and one study respectively. Risk factors for NAFLD identified include metabolic factors such as increased body mass index, hyperglycaemia, raised triglycerides, metabolic syndrome, hyperuricemia and the presence of hepatitis B HBx protein.

Conclusion: NAFLD is most likely to occur in HBV patients in the presence of host metabolic factors.

REVIEW ARTICLE: Prevalence, Mortality Rate and Risk Factors of Obstetrics-Related Venous Thromboembolism in Africa: A Systematic Review

T. U. Nwagha, C. P. Ojukwu, M. Nweke, U. I. Nwagha — Mon, 30 Jun 2025 00:00:00 +0000

Background: Obstetric-related venous thromboembolism (VTE) is common in Africa. However, management has remained suboptimal. Evaluating its epidemiology will aid policy decisions.

Aim: To evaluate the prevalence, mortality rate and risk factors of obstetrics-related venous thromboembolism in Africa.

Search strategy: We searched four databases namely MEDLINE, PubMed, CINAHL, and Academic Search Complete.

Data collection and selection: We undertook independent screening to identify relevant articles. Only peer-reviewed articles written and published in English were included.

Data analysis: We fitted a random-effect model to estimate the pooled prevalence and mortality rates, with I2 computed to estimate the degree of heterogeneity.

Result: Prevalence of obstetrics-related VTE varied between 2 (per 100,000 deliveries) in 2000 and 248 (per 100,000 births) in 2020. The pooled prevalence was 17 per 100,000 births (95% CI 6-480/100,000 births). Two most important risk factors were immobilization/prolonged travel (OR=2.5 [95% CI 1.4 - 4.5] to 18 (95% CI 2.3-137) and oral contraceptive (OR=15.9, [95% CI 1.9-133.1]). VTE-related maternal mortality ranged from 33 to 286 per 100,000 live births.

Conclusion: Moving from 2000 to 2020, there is an increasing trend in the prevalence of obstetrics-related VTE and associated maternal mortality in Africa. The strength of risk factors of obstetrics-related VTE in Africa may not follow a global risk stratification pattern.